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HomeMy WebLinkAbout0024 OTIS ROAD au G+�s 2� - - -� _ _ — ,1Yo), -7 Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 p o � 1/17/17 Town of Barnstable In J � c Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permit#B-16-3454 TO: Building Inspector(s), This affidavit is to certify that all work completed for 24 Otis Road,Hyannis has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION — rA AIJt'd Map Parcel Q Application #444 l Health Division �o ' Date Issued O Conservation Division �� �� 5P Application Fee Planning Dept. �J ��`�' Permit Fee Date Definitive Plan Approved by Planning Board �Q Historic - OKH _ Preservation/Hyannis AS? Project Street Address Village v kA ri Owner �r arkpj Q c�` G �� Address Telephone Permit Request � �I re��a��e. an� klbmI ss, Cog R"3� ah 103e, kJ �,6, s +n n: 4411 j, -f fir, See,( At 0-41'c 01 t, ' d �a f &,*00 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 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 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 ;K'No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 1 Q Namemartlil30-69�c• Telephone Number 56 0 Address ff,411 AV& License #T L [o& 5 . L N664 Home Improvement Contractor# T �� Email Worker's Compensation # IrJC uD s SH 0,� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO I armaa-I'h SIGNATURE DATE l a FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE 4 OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION j FIREPLACE e ELECTRICAL: ROUGH FINAL I, 4 PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1 PROPERTY OWNERITENANT WEATHERIZATION AGREEMENT 1. The Parties to this Agreement are the following,I 2. (hereafter known as Tenant), (print o tenant's name) (hereafter known as Property Owner) (print your name) and Housing Assistance Corporation (hereafter known.as Agency). In consideration of the mutual promises hereafter stated,the Parties agree as follows: 3. The date of Agency's signature will be the effective date of this Agreement. 4. Property Owner and Tenant consent and agree that the Agency may do the following with respect to theproperty . 9._ �°�9 Y Y- 9 Pe located at:(street,'town unit# and currently leased or rented to the Tenant a) Enter the premises for the purpose of performing a Weatherization inspection. b) Enter the premises to perform Weatherization work which the Agency determines in its discretion is necessary and appropriate as a result of the Agency's inspection of the property and.in accordance with the appropriate priority list for the type of dwelling. The Agency and the Agency's contractors may also enter the appropriate common areas of the building for the purpose of accomplishing the Weatherization work. The Agency and representatives'of the Commonwealth of Massachusetts, Department of Housing & Community Development (DHCD) may further enter the property to inspect any and all work hereunder. The Agency will provide reasonable notice of the timing of the Weatherization work and inspections. The Weatherization, work:.will be performed in acctordance with the Property Owner's consent as further specified below: '-INITIrAL ONt_Y.ON :OPTHE;t=.OLUDWING:*", I consent to performance by the Agency.and its contractors of,any.Weathedzation work determined necessary and appropriate by the Agency as a result of its inspection of the property. I understand that the Agency will provide a statement of the actual work proposed and the associated value. •i will provide a separate consent to performance by the Agency and i� contractors of Weatherization work.fotlowing my receipt of the Agency's.inspection•report and.a statement of the estimated work and associated value. The 'Agency will request your consent, after the..initial audit is completed. I :: .: odertdths .tt' .: : I�11;�ptpX.tde: ;dd.stam1 :;tkre.p�ojecked. ►ojtS perf rrt9�d.and the 0 asstscidted�aUA at"t4 dump otidii.of�t 640rk 5: The Property Owner understands and agrees that any and all work, including related repairs for which the Property..may also be eligible,will be perform t the Agency's discretion. The Agency,estimates completion of the Weatherization work by the end of 6. If the Property Owner..Is required to make repairs to.the.property prior to.the commencement of Weatherization work by the Agency,the Property.Owner will be notified by the Agency and will be required to make the repairs as before the weatherization work can proceed. .. 7. The Property Owner and Tenant authorize the Agency to receive a statement from the fuel supplier/utility supplier as to the quantity of fuelfutilities used at the above address in each of the past three years and the future three years. • The information.is to.. be used :only to. determine the cost effectiveness of the- Weatherization improvements. . 8. The Property Owner agrees that the rent for the dwelling unit will not be raisedbecause of any increase in,the value thereof due solely to the Weatherization work performed. i 14. The Parties acknowledge that this Agreement is under seal. It is intended by the Parties that the Tenant or any successor Tenant is the intended beneficiary of the Agreement and shall have a right of enforcement. Property Owner's Signature:4 =0 k Date Phone: Address: i :..• f` fie._ �" r r . �. , .t r Tenant Signature Date i Agency Approved Weatherization Company Adam T. Incorporated / All Cape Energy / Alternative Weatherization Cape Cod Insulation / Cape Save I Cazeault Frontier Energy Solutions / Lohr Home Improvement / Tupper Construction Agency Signature Date 4i.t , 14. The Parties acknowledge that this Agreement is under seal. It is intended by the Parties that the Tenant or any successor Tenant is the intended beneficiary of the Agreement and shall have a right of enforcement, Property Owner's Signature: Date Phone: Address: Tenant Signatur a Date ! Agency Approved Weatherization Company Adam T. Incorporated / All Cape Energy / Alternative Weatherization Cape Cod Insulation / Cape Save / Cazeault Frontier Energy Solutions . / Lohr Home Improvement / Tupper Construction i Agency Signature Date 9 Y 9 1. V 111 , o The Corrimoriwealth.of Massdchusetts D artntep nt•f I A e o ndustrial Accidents 1 Congress Street,Suite 1.00 Boston,MA 02114-2617 www trtass govldia R'orkers'Compensation Insurance Affidavit:Builders%Contractors/Electricians/Plumbers. TO.BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Letibiv ; Name (Business/organization/individual):Cape Save Inc Address:7-D Huntington Avenue 4 l City/State/Zip:South Yarmouth,,MA 02664 phone#:508-398-0398 Are you an employer?Check the appropriate box: Type of roJe.ct r :, i 1.�✓ I am a employerwith, employees;(full and/or.part-time).• a 7 ' 'Q New.construction.__ 2. Lam a sole proprietor or partnership and have no.era'ployees.working-for me in ` ❑ & 0 Remodeling - x any capacity.[No workers'comp.insurance.required:] 3.E.1 am a homeowner doing all work myself.[No workers'comp.insurance required`]t' . 9. DemOlitiOn ' J 40 Q Building addition ' s 4.MI am a`homeowner'and will be hiring contractors to-conduct all work on my property.I will" '" .._ ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. r I2.❑Plumbing repairs or additions 5,❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance. t 6.❑We are a corporation and.its officers have exercised their right of exemption per MGT,c. 14•E✓ Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required:] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. j t Homeowners who submitthis affidavit indicating:they are doing all work and then hire outside contractors must submit a new affidavit indicating such. -Contractors that.check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those:entities.have ' employees. If the sub-contractors have employees,they must provide their workers'comp.policy number:` I am an employer thatis providing workers'compensation insurance for my'employee& Below is the policy and job.site information. _. s Insurance Company Name: Star Insurance Co. Policy#or Self-ins.Lic.#: WC085540700 "Expiration Date: 4/9/2017 Job Site Address: 24 Otis Road e City/State/Zip:Hyannis ' Attach a copy of-the workers compensation policy declaration page(showing the policy number and expiration date). _ Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A:copy of this statement may forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th pains andpenalties of perjury that the information provided above. true and correct Si attire: Date: 11/22/16 Phone#:508-398-0398 , Official use:only."Do not write-in this area,to'be-completed by city or town offici4l, ' City or Town;' • PermitlLicenSe# z �. a . . , Issuing Authority'(circle one). . "�' ak ' I.Board of Health_2.Building.Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing:Inspector shy.• { -6.Other . �•.... f. M �.`, "F� ,° �via•,, Contact Person.:," Phone:#: .........w,.. a ... ._,. _.__. .. ,. ACORU� DATE(MMIDDIYYYY) C> CERTIFICATE OF LIABILITY INSURANCE F1o/24/zo16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS 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 endorsements. PRODUCER NAME:ONTACT Colleen Crowley Risk Strategies Company ` PH(AIONE Erb: (781)986-4400 FAIX C No:(781)963-4420 15 Pacella Park Drive X40MSS:ccrowley@risk-strategies.com Suite 240 INSURER(S)AFFORDING COVERAGE NAICs Randolph MA 02368 INSURER A:LibertyMutual Insurance Co INSURED INSURER B Allmerica Financial Alliance Ins Co 10212 Cape Save, Inc INSURERC:Ohio Casualty/Peerless Insurance 24074 7 D Huntington Ave INSURERD:Star Insurance Co INSURER E: South Yarmouth MA - 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL16101422377 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. INSZ TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MMIOD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CL' MS-MADE �OCCUR PREMISES EeoccurrSTO-RENTEence $ 100,000 BLS1757246490 10/16/2016 10/16/2017 MEDE(P(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PRJECTO 2,000 000 LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILELUtBILrrY COMBINE SINGLE UP= EaeccideDnt $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED ANNA46796600 11/6/2016 il/6/2017 BODILY INJURY(Per eccident) $ AUTOS AUTOS X HIRED AUTOS X NON-OMED PR PER Y DAMAGE $ AUTOS Per acddeM $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2 000 000 C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000 000 DED I X I RETENTION$ 10,000 US057246490 10/16/2016 10/16�/2017 $ WORKERS COMPENSATION , , .J, ' Officers included for '` X PER OTH-, AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERfEXECUTIVE Coverage E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? N D NIA (Mandatory In NH) • NCO855407 4/9/2016 4/9/2017 ,E.L:DISFASE-'EA EMPLOYEE $ 500,000 Me describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance./ Insulation Specialists CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Housing Assistance Corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Barnstable County ACCORDANCE WITH THE POLICY PROVISIONS. Cape Light Compact. 460 Main Street AtmiORIZEDREPRESENTATIVE Hyannis, MA 02061 Michael Christian/CLC '� O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) ! Office of Consumer;Affaks and Business Regulation _ 10 Fark Plaza- Suite 51'70 Boston,Massaehusetts 02,1 16 Horne Improve ment:Contractor Registration k Registration: 171380 Type: Corporation -' Expiration: 3/14/2018 Tr# 419291 q« - CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE; SOUTH YARMO'UTH, MA 02664, ¢ Update Address and return card.Mark reason for change. . r" Address Renewal Em to ment 17 Lost.Card. oC�/l`ur�acu,e License or registration valid for individul use only Office of Consumer Affairs&Business Regulation g Y ,:V _ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return tw, - Office of Consumer Affairi and Business.Re ulation Registration 171380 Type. g Expiration 3/14/2018 Corporation 10 Park Plaza-Suite 5170` " Boston;MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY 7-O HUNTINGTON AVENUEI SOUTH YARMOUTH,MA t)2664 Undersecretary Not valid i signature ' Massachusetts -!Department of Public Safety Construction Supervisor Specialty Restricted to: Board of Buiidin.g Regulations and Standards CSSL-IC-Insulation Contractor 411/1111 tT1tt1/16 au11C1:Y 11111 JI/Cl'1211 t_V ,N- License: CSSL 102'T76 01 Arl WILLIAM J MC CtU 371NAUSET ROAD j tp West Yarmouth I%A �f 17 s n,� Expiration Failure to possess a current edition of the Massachusetts .>r1a State Building Code is cause for revocation of this license. Commis sio ne r 06/28/2017 DPS Licensing information visit: WWW.MASS.GOV/DPS TOWN OF BARNSTABLE CHECK REQUEST DATE: 6/3/2013 REASON FOR CHECK: REFUND PERMIT FEE NOT INSTALLING SHED DEPARTMENT: Regulatory Services/Building Department MAIL CHECK: X > Pa To Vendor No. Account No. Amount Charles M. Derrick 49892 016301-433150 $35.00 TOTAL CHECK AMOUNT: $35.00 APPROVED BY: Thomas Perry APPROVED BY: J Town of Barnstable Regulatory Services MAE& Thomas F. Geiler,Director 1639. ,� � Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.as Office: 508-862-4038 Fax: 508-790-6230 May 28, 2013 Mr. Charles M Derrick 24 Otis Road Hyannis, MA 02601 Dear Mr. Derrick, Your request for a refund for a shed permit has been approved. In order for me to process your request please complete the attached form and mail back. Thank you in advance for your attention to the above matter. Sincerely, Debi Barrows Administrative Assistant Charles M. Derrick 24 Otis Road Hvannk.MA (12601 May 21,2013 Tnwn of RarnctnhIa Building Division 200 Main Street 0` o 0 Hvannis, MA 02601 ;C �v C) Att: Debbie w Dear Permit Administrator, ? ;z w mOn May 21s`.we spoke on the phone about building permit#201302793 which was issu d to me im May 6" for building a shed. This letter is to inform you in writing that the shed will not be built. The building materials that were for this proiect have been removed from my property. If it is possible, I would appreciate the return of the$35.00 permit fee. Thank you for your consideration in this matter. Sincerely, Charles M. Derrick Town of Barnstable Regulatory Services M IIAMSTM IX ` Thomas F. Geiler,Director 'ArFDMA'��` 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 May 28, 2013 Mr. Charles M Derrick 24 Otis Road Hyannis, MA 02601 Dear Mr. Derrick, Your request for a refund for a shed permit has been approved. In order for me to process your request please complete the attached form and mail back. Thank you in advance for your attention to the above matter. Sincerely, Debi Barrows Administrative Assistant �___ ___. � � �r �� , � � . � � — r i Ctl M.Derrick :R 'AI h b u� ia1( 'd^R �� ��" 4�•„ �v, ` ,�.11YmyY. �`nuM T�'gf�C ptiS.SC.. Tws 24„ Road p ,w `Hyannis;:MQ 02601 • ` - - {5S, USA I EOrever ..fj Town of Barnstable Building Division 200 Main;Street `. Hyannis, MA 02601 No ;— fit ll lihjttj.IjtilIIJ1111ilifi,t�iiis ai r iko E ej K z ol � IL kI i\ IZ� >• 1 OIN A :ems-. Charles M. Derrick 24 Otis Road Hvannic. MA n?nnl May 21,2013 Tnwn of RnrnCtahlP Building Division 200 Main Street ` O Hvannis, MA 02601 LAJ V) Att: Debbie ry —n w eso X) Dear Permit Administrator, ZZ Ori May 21".we spoke on the phone about building permit#201302793 which was issu d to me May 6`h for building a shed. This letter is to inform you in writing that the shed will not be built. T-hte `n building materials that were for this proiect have been removed from my property. If it is possible, I would appreciate the return of the$35.00 permit fee. Thank you for your consideration in this matter. Sincerely, �YA- Charles M. Derrick tHE � 1 TOWN OF BARNSTABLE sARNBTABLE, • ''"1 "1 t 9 MAC. s639. 1 ��o�a .. rcrm� Sumner Application Ref: 201302793 20130998 Issue Date: 05/06/13 Applicant: DERRICK,CHARLES M& FRANCES W Proposed Use. Accessory Structure Permit Type: SHEDS 200 SQ FT &UNDER Permit Fee $ 35.00 Location 24 OTIS ROAD Map Parcel .311058 Town HYANNIS Zoning District (fig Contractor PROPERTY OWNER Remarks 1Ox12 SHED Owner: DERRICK, CHARLES M & FRANCES W Address: 24 OTIS RD HYANNIS, MA 02601 Issued By: PF � POST THIS CARD SO THAT IS $IBLE FROM THE STREET` `� ] , �_ �� --_.r� ��_ f Ott- Townof Barnstab1A,,,,,,7N1,RL E Regulatory Sven ces n 4 3. .L" Thomas F.Geiler;pir�c�gn? ?'_± F'�� . MASS. '��, Building Division 6 ►`� Tom Perry,Building Commissioner 200 Main Street, Hyannis,9A,026Q'1'J — www.town.barnstabl@11a Ws=" Office: 508-862-4038 Fax: 508-790-6230 PERAUT� I V FEE: $ SHED REGISTRATION 200 square feet or less Location of shed(address) V' ge Property owner's name Telephone number � s Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) k (� Sign off hours for Conservation 8:00-9:30&3:304:30' PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. j THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:05201 i o� s- -3 _ 13 Town of BarnstaW , 1 1"E' r,, Regulatory S��riices Thomas F.Geiler,D#9ct 1, 3' '"MAS& ' Building Division i 6,39. Tom Perry,Building Commissioner i i 200 Main Street, Hyannis,lxi0260,1, www.town.barnstablvow sl"s' Office: 508-862-4038 Fax: 508-790-6230 PERMIT 13 V FEE: $ SHED REGISTRATION 200 square feet or less Location of shed(address) V' ge Property owner's name Telephone number Size of Shed Map/Parcel# » ti.�:� Dhy Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway _f'Conservation Commission(signature is required) C Sign off-hours-for-Conservation 8:00--9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. i f THIS FORM-MUST— ACCOMIPANIED BY�A CIMOT-PLANS i i Q-forms-shedreg REV:05201 - i % 1a J k IV IV in Lo7 - ti I n► ze- LOT 9J oT7� .�UA1� On the basis of my ltno:rl.edge, information and Fob:Al/G7"o ct e EL L.vo.E� DES,eI(fA� belief, I certify tO,LjlnQU S 'ELIlTc?s rn"� that as a result, of. a strvey made on ►,he ground W M- M.- W�f I,'IC x: y �!✓C ��/�- on / 3,o z , I find that: The structures) are located on the site as ��� �! ,�/o. F��.�oc�'T�;-M ��� shown Tecvi? Zo�.rn y A The ceu�s teas s of occupation of the �R,TH OF site are shown hereon �.. .. WILLIAM r� �y �he site is situated in ]Flood .:one �o�!-Ila, � G %o. M. m� . Community Panel Vo.Z.Soa&/ ,00w)Q Date: /3 � WARWICK No. 19771 j Date: L Z_ r or,THE) Ewirct 6�nonr is Nam/ �0„1 Fee '15. Regulatory Services �`BARNSTABt�.P/I 9� t `eel Thomas F.Geller,Dhwwr 57 3 3�P plFa ice.+•v Building Division PEW :,• Peter F.DIMatteo, Building Co Be 367 plain Sues. HY=ds,MA 02601w N 0 V 1 5.2001 Office: 508-862—�038 F TOWN OF BARNSTABLE Fax: 508-"90-62:0 gE�DEN'I'IAL ONLY EXPRESS PERMIT APPLICATION - Not Yalid without Ad X--Press lotprutt .lap:parcel`lumber 2 Property Address vaiw of Work L� lei Residential TT 13 �j Owner's Name&.address _Telephone?dumber Contractor's Name Home Improvement Contractor License (if applicable) ' Construction Supmvisoi s License=(if applicable) t • t s , Qworkman's Compensation Insurance Check one: - Q I am a sole propzietor 01 am the HomeoRaer Q I have worker's Compensation Insurance Insurance Company Name NV Mrktmn's Comp.Policy Permit Request(check box) Q Re-roof(stripping old shingles) 17 Re-roof(not stripping. Going over a x'ssdag layers of roof) Re-side Q Replacement Windov.s. U Value �� '44) Q Other(specify) .��rtquired: lssuaace of this pesmic don not exempt compliance with other town d��ent regulations.i.e.Historic.Consen•ition.::=• Sitature ,,�E Q:Forms:eapmtrs:re� �110601 Engineering Dept: (3rd floor) Map Parcel 00 Permit# House# Date Issued Board of Health(3r oor)(8:15 -9:30/1:00- G7v Conservation Office (4th floor)(8:30- 9:30/1:00-2:00) ��g Planning Dept. (1st floor/School Admin.Bldg.) ��� �1He►o �� CSY Definitive PI Ap r ed by Planning Board - 19 � °t�p�l1�®m Q"' RIPEN77 !o�q e� TOWN OF BARNS TA 91�C e 4"FAAL Aj Building Permit Application Project Street Address © l -r ✓Z� F ► ' Village /Y /?N1,V i f Owner /A2L[.l d`fii? nlC ,(� RIZ to Address _Telephone Permit Request. ,J'' ?� L✓n(.L „/ t' f G c L�7L�� 4 �-✓ie�✓t�a l !� 8.2 0 r� First Floor / ( �f �a 2(� square feet Second Floor / square feet Construction Type C D t_o,.!I ILs-r��L,/✓ � Estimated Project Cost $ � d-7_.A Zoning District W T Flood Plain Water Protection Lot Size 0, 19 Grandfathered ❑Yes ❑No Dwelling Type: Single Family Uk/ Two Family ❑ Multi-Family(#units) r 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) 9 IC Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing �4 New Total Room Count(not including baths): Existing_ New First Floor Room Count Heat Type and Fuel: ❑Gas Ly bil ❑Electric ❑Other Central Air ❑Yes 21�o Fireplaces: Existing New Existing wood/coal stove ❑Yes No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) [None Ll Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name fit. elephone Number 2 2 / 6 Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS-WELL AS PROPOSED STRUCTURES ON THE LOT, ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE _ � t J BUILDI�gNG PERMIT DE�tN,yIyED F R THE F LLOWING REASON(S) 40 a � Jf .-,,,- .-.w .-..- ,a,., . „-,-• - I mow•""' ,. ._,.,.. . :.... .. ... _ ... ' «-..- C� _ ... _. _ � f th FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS 1 . . , VILLAGE OWNER { DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE F� ELECTRICAL: ROUGH FINAL i ! PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL'BUILDING - y DATE'CLOSED OUT `- ASSOCIATION PLAN NO.` T 0 , The Town of Barnstable 9 AMAM Department of Health Safety and Environmental Services ram° 9.•`° Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commission: For office use only i 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. ype of Work -Est.Cost t/ Address of Work: wner's Name �A�atef Permit Application: I hereby certify that: ' Registration is not required for the following reason(s): Work excluded by law Job under#1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR - 2 9 �, � D� a Owner's Name The Commonwealth o{'Massachusetts --- i�n ' '=� ��:_� -_ •� Department of Industrial Accidents Office offnlvestigations -- �� 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit t/ location• 2 21 city H phone I am a homeowner performing all work myself. ❑ I am a sole ro rietor and have no one work in in any ca acity ❑ I am an employer providing workers' compensation for my employees working on this job. companv name:. _. address. city phone#. insurance co. policv# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name address:' phone#. _: insurance co oUcv# .:. . company name address: city- phone#. insurance co. - olicd XUR ��. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Oftice of Investigations of the DIA for coverage verification. 1 do hereby certify u r the pains'and j •penalties ojperjury that the information provided above is truognd correct ' C. Signature— Date ^� Print name Z':!:r /7 , DLA1Z(Cd Phone# ���sy ofticial use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Bullding Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised 9/95 PIA) v � r r Information and Instructions I Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",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 section 25 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,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 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 Department 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 permit/license number which will be used as a reference number. The affidavits may be returnid to the Department by mail or FAX unless other arrangements have been 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 Office of Imlesduallont 600 Washington Street Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION P ase pri t. DA JOB. OCATION Number Street address Section of town 'HOMEOWNER"9Y K 4V / (r DC��Z i2 i �•' 1� ���•'�a ��� Name Home phone Work phone . PRESENT 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 such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form accerptable 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 Stat Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" ertifies that he/she understands ...the Town of Barnstable Building Depart nt minimum inspection procedures and requirements and that he/she will comp with said procedures and requirements. HOMEOWNER'S SIGNATURE • APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION ' The code state that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when the Home., Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home "dwner- actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/Ker responsibilities, man communities require, as part of the permit application, that, the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. e e oFIMEl The Town of Barnstable Department of Health Safety and Environmental Services 9'"R s14 Building Division Q)A 059. pie 367 Main Street,Hyannis MA 02601 rF0 MA'S Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Building Permit Procedures for Sidewalling 1. Building permit application form must be completed. 2. Application sign-off required from th ---=alth Department(3rd floor To aYl- 8:30 a.m. - 9:30 �rq �p.m. - 2:00 p.m.) --tax Collector(1st floor Town Hall eastirer - 3" " - 5ckooI PkAm 3. Homeowner License Exemption Form must be submitted if homeowner is acting as general contractor or builder for the project. 4. Workers Compensation Insurance Affidavit must be submitted. 5. Home Improvement Contractor Affidavit must be submitted. 6 Copy of Home Improvement Contractor's License must be submitted (residential only) 7. Fee to be paid before permit is issued. PERMIT Rev 5/11/98 .; `� �. �j� {, SIDEWALLING wk If le gated in OKH or Hyannis Historic District-Certificate of Appropriateness required unless same color/same materials specified on application. Sign-offs from: [� Health Tax Collectors' Office Treasurer Owner's name & address Estimated Cost []Complete dwelling Information for the Assessor's dept. Correct square footage OR number of squares of shingles (times 100 sq.ft.) pplicant's telephone number Signature Workman's Comp. form E�/ Home Improvement Contractor Affidavit Home Improvement Specialist's License O Homeowner's License Exemption Fee OU q-forms-PERMITS 1 Rev 6/2/98