HomeMy WebLinkAbout0115 PINE AVENUE �I�q
.� Town of Barnstable Building
e IPostT,his>Card So That�t.is;Vis�blerFrom he Street A roved:Plans Must be.Retained on Job andthis Cartl Must be.Ke�"1 R.
eAll.'i3'rw8t.� v• �: ' , �.� ."s p p � 7;��,�: �, �� �, '�,8 �` 4�„e� 'a e � �" ..
m Posted Until'Final Inspection Has Been IVlade X^
a Permit
�R Where aCertificate�of Qccupancy��s Requ�red;�swch,B.uildmg shall�Notbe Occupied until�a;Final Inspection�has.been made ,�,,
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Permit NO. B-19-2874 Applicant Name: HOMEOWNER IS APPLICANT Approvals
Date Issued: 09/10/2019 Current Use: Structure
Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 03/10/2020 Foundation:
Residential Map/Lot 308 211 Zoning District: RB Sheathing:
Location: 115 PINE AVENUE, HYANNIS z 5 Contractor Name..;. HOMEOWNER IS APPLICANT Framing: 1
Owner on Record: NAYLOR,KEVIN M Contractor License' EXEMPT 2
Address: 115 PINE AVENUE UNIT A
Est Project Cost: $4,000.00 Chimney:
Jf
HYANNIS, MA 02601 Permit Fee:
$85.00
Description: reinsulate&sheetrock Insulation:
4 Rep Paid S 85.00
441
Reviewer's Note: �Date� " 9/10/2019 Final:
Work is beingperformed in the cottage. RMCK
P g r w Plumbing/Gas
Project Review Req: Rough Plumbing:
F__. Building Official
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work autho-rized bythis permit istommenced within s��x�months after issuance.
All work authorized by this permit shall conform to the approved applicabo land the approved construction documents forAwhIch this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures,shalhbe in compliance with the local zoning by la'', 0, codes.
This permit shall be displayed in a location clearly visible from access street o#�oadiand shall be maintained open for public nspion for the entire duration of the Final Gas:
work until the completion of the same.
�y a� Electrical
01,
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fine Officials are provided on this",permit.
Minimum of Five Call Inspections Required for All Construction Work: x r Service:
1.Foundation or Footing F
2.Sheathing Inspection .� � Rough:
3.All Fireplaces must be inspected at the throat level before firest flue liningis installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final:
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy
Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Per tracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Fire Department
�r Building plans are to be available on site
�� All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
Application Number... ....../6....... .... .........
...... ....... ......... ....
WAS& Permit Fee..*............ ..............Other Fee,.......................
16.3
• Total Fee Paid............. ................................................. ......
TOWN OF BARNSTABLE' Permit Approval b)........ '.On...
BUILDING PERMIT 7
Map.............3.6.7.. .....Paicel.......... ...........
APPLICATION
Section 1 Owner's Information and Project Location
11A Village
Project Address
Owners Name m pis &S
Owners Legal Address //,!5-,* An.-0/ 24vejo tze
City. 14 le a n Y1 M State LT Zip
Owners Cell#
16 6078 E-mail 1& /-7& e�A -1 C
Section 2 —Use of Structure
Use Group_ E]. Commercial Structure over 35,QQ, cubic feet'
7-
7z$zt�
F-1, Commercial Stni&re under 3 0 cubic Xeei..:*
ze
Single/Two Family Dwelling-'
Section-3—Ty-pe of Permit
❑ New Construction %
El Move Relocate Accessory Structure ❑ 9e o se.a.
El Demo/(entire structure) ❑ Finish Basement El Family/Amnesty ❑ 'Fire Alahn,
Rebuild 0 Deck Apartment El sprinkler System
❑ Addition
E] Retaining wall' Solar
a-Renovation 0 Pool
El hisulation
0t1 Specify
Section 4 --Work Description
Zk e,_,VZ4 Af-lo In rl
T+A.+.A- 1 1/1,zmni Q
Application Number...........
Section 5—Detail
Cost of Proposed Construction GC 006 c Square Footage of Project q 00
Age of Structure -4 0 Dig Safe Number
# Of Bedrooms Existing Total#Of Bedrooms (proposed)
110 MPH WindZone Compliance Method FMA Checklist ❑ WFCM Checklist ❑ Design
Section 6—Project Specifics
Wiring ❑ Oil Tank Storage -�' � Smoke Detectors
Plumbing ❑ Gas ❑ Fire Suppression
t• r
Heating System ❑ Masonry Chimney i' } ❑ Add relocate bedroom
� r
Water Supply,. ;. Public _ E] Private
Sewage Disposal Municipal ❑ On Site
Historic District_ ❑ Hyannis Historic District ❑ Old Kings Highway
3.
Debris Disposal Facility: S'SC%xG'D :L21)y Ps-n;4 I am using a crane ❑ Yes No
Section 7—Flood Zone
Flood Zone Designation
Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑
Section 8 Zoning Information
Zoning District Proposed Use Lot Area Sq. Ft.
Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site)
Setbacks Front Yard Required Proposed
Rear Yard Required Proposed
Side Yard Required Proposed
Has this property had relief from the Zoning Board in the past? ❑ Yes EL No
Last undated: 11/15/2018
The Commonwealth of Massachusetts
_ o
Department of IndustridAccidents
Office of Invesdgations
600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly,
Naive (Business/Organization/Individual): CG S U -
Address: 4 ie41 U,ce—
City/State/Zip: r) 1 S Phone#: .�U j kU-
Are you an employer?C eck the appropriate box: Type of project(required):
1.❑ I am a employer with- 4. ❑ I am a general contractor and I
6. El New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet 7, Remodeling
ship and have no-employees These subcontractors have g, Demolition
workingfor me in an capacity. employees and have workers'
Y aP tY• t 9. El Building addition
(No workers' comp.insurance comp.insurance.
� . eA]. 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3. `b� am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees. [No workers' 13.❑Other
comp.insurance required.]
*Any applicant that checks box#1 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.
;Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the sub-contractor;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:
Policy#or Self-ins.Lic.#: Expiration Date: .
Job Site Address: 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 insurance coverage verification.
I do hereby certi n e anrs and penalties of perjury that the information provided above' true correct:
Si store:�\ '--I Date: l
Phone#: 7
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
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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)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 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. 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 couplets 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(if necessary)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 bum 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:
The Commonwealth of Massachusetts
Department of IndustrW Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111 -
Tel.#617-727-4900 ext 406 or 1-877-MASSAFE
Revised 4-24-07 Fax#617-727-7749
www:maw.gov/dia
ABL MORTGAGE INSPECTION PLAN y
REGISTERED LAND SURVEYORS NAME JAMES CURTISS
P.O. Box 70702
Quinsigamond Village Station LENDER CAPE COD COOPERATIVE BANK
WORCESTER, MA 01607 0
508-752-8050 (PHONE) LOCATION 115 PINE AVENUE
508-752-8004 (FAX) HYANNIS. MA co
A Division of H. S. & T. Group, Inc. gp
REGISTRY BARNSTABLE SCALE 1 " = 20 ' DATE 6 3 19 I
BASED UPON DOCUMENTATION PROVIDED, REQUIRED MEASURE- DEED BOOK/PACE 14996/1 86
YEWS WERE MADE OF THE FRONTAL£AND 01"NG(S) SHOWN
ON THIS MORTGAGE INSPECTION PUN. IN OUR JUDGEMENT ALL � SN OF �f s�� PLAIN BOOK/PUN DEED/ASSESSORS
VISIBLE EASEMENTS ARE SHOWN AND THERE ARE NO VIOUT10N5 P�'
OF ZONINO REQURIEMENTS REGARDING STRUCTURES TO PROPERTY
U14ES(UNLESS ODHERWISE NOTED IN DRAWING BELOW). � DANIEL .�+ WE CERTIFY THAT THE BUILDING(S)ARE NOT WITHIN THE
NOTE: NOT DEnNED ARE Asmi;ROUND POOLS DRIVEWAYS, T"
OR SHEDS WITH NO FOUNDATIONS.THIS IS A MOI(RCZE J. - SPECIAL FLOOD HAZARD AREA SEE FEMA MAP:
INSPECTION PLAN; NOT AN INSTRUMENT SURVEY.00 NOT USE TO v TIVNAN ✓1
ERECT FENCES.OTHER BOUNDARY STRUCTURES, OR TD PLANT N 40047 568J DTD 07-16-1 4
SHRUBS, LOCATION OF THE SMUCTURE(S) SHOWN HEREON IS EITHER .p
IN COAAPLt6NCE WITH LOCAL ZONING FOR PROPERTY LINE OrFSU P
REQUIREMENTS. OR IS EXEMPT FROM VIOLATION ENFORCEMENT CI �O FLOOD HAZARD ZONE HAS BEEN OETERMINED BY SCALE AND
ACTION UNDER MASS. G.L. TITLE VIL CHAP. 40A SEC.7. UNLESS IS NOT NECESSARILY ACCURATE. UNTIL OEFINRNE PINKS ARE
THE ABOVE CER11Flf:AlIONs ARREE MADE WITH THE PROVISION THAT OTHERWISE NOTED,THIS CERTIFICATION IS NON-TRANSFERABLE ISSUED BY FEMA AND/OR A VERTICAL CONTROL SURVEY IS
THE INFORMATION PROVIDED IS ACCURATE AND THAT THE MEASURE- PERFORMED,PRECISE ELEVATIONS CANNOT BE DETERMINED,
MENTS USED ARE ACCURATELY LOCATED IN RELATION TO THE
PROPERTY UNES.
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R"UES1' O OFFICE:PIZZUTI & MAZZED. LLC DRAM BY9A
REQUE= BY: CHEC® BY:
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Application Number...........................................
Section 9- Construction Supervisor
Name Telephone Number
Address City . State Zip
License Number License Type Expiration Date
Contractors Email Cell`#
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Mas"sachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license.
Signature Date
Section 10—Home Improvement Contractor
Name Telephone Number
Address City State Zip
Registration Number Expiration Date
I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C...
Signature Date
Section 11 —Home Owners License Exemption
Home Owners Name: _�av►ti,ec ��A.lTt S S
Telephone Number 50—(0$S—&07 T Cell or Work Number
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massachusetts S to 11nilding Code. I understand the construction inspection procedures,specific inspections and
documentation req " ed by 0 and the Town of Barnstable.
Signalu e Date
APPLICANT SIGNATURE
Signature Dated ZS_
/j
4
Print NameIam Telephone Number 5UY )7k
E-mail permit to: ! ILI z1f,✓ - q,l s !�'l
Last undated: 11/15/2018
Section 12 —Department Sign-Offs
Health Department ❑ Zoning Board(if required) ❑
Historic District ❑ Site Plan Review(if required) ❑
Fire Department ❑
Conservation ❑
For commercial work,please take your plans directly to the fire department for approval
Section 13— Owner's Authorization
i
I, , as Owner of the subject property hereby
authorize to act on my behalf, in all
matters relative to work authorized by this building permit application for:
(Address of job)
Signature of Owner date
Print Name
i
Last updated: l 1/15/2018
' Town of n Barstable _
M _ __- Building
s $YA Post This Card So That it is Visible From theStreet-Approved Plans Must be Retained on Job and this Card,Must be Kept
1 `, Posted Until Final`Inspection Has Been Made. t erg4�lilit
Where a Certificate of Occupancy is Required,such Building shall Not;be Occupied until a Final Inspection has been made.
Permit No. B-20-1011 Applicant Name: JIM Curtiss Approvals
Date Issued: 04/15/2020 Current Use: Structure
Permit Type: Building-Addition/Alteration- Residential Expiration Date: 10/15/2020 Foundation:
Location: 115 PINE AVENUE, HYANNIS Map/Lot: 308-211 Zoning District: RB Sheathing:
I-...._ �.......-
Owner on Record: CURTISS,JAMES S Contractor Name: j.HOMEOWNER IS APPLICANT Framing: 1 TC- Jn"�i Zd
Address: 115 PINE AVENUE cottage Contractor License: EXEMPT 2 1 •Z ?,Z.O
Hyannis, MA 02601 Est. Project Cost: $ 1,000.00 Chimney:
Description: Replace rotted sill plates with pressure treated,and replace rotted 1 Permit fee: $85.00
sheeting found upon inspection after removing drywall for. Insulation: Fe-COIL -SG sI IZZ
Fee Paid: $85.00
insulation project, replace cedar siding in conjunction with permit Final:
B-19-2874 Date: 4/15/2020
work in cottage
Plumbing/Gas
Rough Plumbing:
Project Review Req: framing,insulation and final inspection required _ _ b4Building Official
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.
All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public inspection for the entire duration of the Final Gas:
work until the completion of the same.
Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
Minimum of Five Call Inspections Required for All Construction Work:' Service:
1.Foundation or Footing $ Rough:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Fire Department
Building plans are to be available on site
Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
yo�TNETo�y TOWN OF BARNSTABLE
•
H9HHMULE, i
"6 9
a w a' BUILDING INSPECTOR
� aY
APPLICATIONFOR PERMIT TO ............................ .......... .. .......................................................................
TYPEOF CONSTRUCTION ..........` ...................................................................................................
..............a;w—a—. 19-2 0
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
.... .... ....... ......... ..........................................................................................
ProposedUse .... .....................................................................................................................................
ZoningDistrict .............. .............................. ...... ..................Fire District ..............................................................................
Name of Owner ..& " ................Address .........V
Name of Builder ...
......................Address .................. . ............................ .................
Nameof Architect ..................................................................Address ....................................�................................................
Numberof Rooms ` ° " I...................................................Foundation ........... .................................................................
Exterior .... 1....
...Roofing ...... ....... / � .
(f
Floors �;P�L?zP!y..........................................................Interior .......... ..!................................................
Heating .............I. . ..............................................................Plumbing .......................... ........�� ....................................
Fireplace ............. .....................................................:........Approximate Cost ......... ........................................
Difinitive Plan Approved by Planning Board --------------------------------19--------. 30
Diagram of Lot and Building with Dimensions
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I hereby agree to conform to all the Rules and Regulations of the Town of Barns4reg the above
construction.
Name ... ... ...
Savino, Louis A.
C 311910
No ......�3271 Permit for .......add garage to
shed
� Location J�..................115..Pne Streeti� .....................
k .................... J
Owner ......Louis A' SavinoSa -
�l;
Type of Construction frame
................................................................................
Plot ............ Lot ................................
i L q LLy � V
Permit Granted ........Auust..12......:.....19 70 �m�
Date of Inspection ....................................19 AkleS'
Date Completed .... �..".. .�.r............19�a
x
PERMIT REFUSED
................................................................ 19 !
............................................................................... ++
1
...............................................................................
...............................................................................
Approved .................................................. 19
...............................................................................
..................... ......................................................... t
100110
Aown of Barnstable *Permit# T — 8 -3aa 7
• res 6 months from issue date
y Building Department ee
snFwsTnst E «. ���� Brian Florence,CBO �
1' , t 39. Building Commissioner
iOrEp Mpg° � 0 0 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Officer 508-862-4038��� Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number '6;�O'b 1
Property Address B5 T�., A �wA W a z,4.0(-
residential Value of Work$1,12i 1110 A3 Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address K,O) t� Lkf,- sce rKAI
Contractor's Name�t l �SC Telephone Number
Home Improvement Contractor License#(if applicable) 0 3 7 Email: �avJ^NW yew (Dj Cbv,-gCA1,Ti ,&X-f—
Construction Supervisor's License#(if applicable) �'/�— �-(I.t
Z�Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
RrI have Worker's Compensation Insurance
Insurance Company Name IN Syr\"e-`f✓
Workman's Comp.Policy# 4-Rub 1,KKP-Tb70 - 1 %5
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
[r Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows
#of doors:
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
required.
SIGNATURE:
C:\Users\decollik\AppData\Local\Microsoft\Windows\NetCache\Content.Outlook\9NNOKXYW\RESIDENTILONLYEXPRESS.doc
09/26/17
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Town.of Barnstable
Ruildine Department
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COMPIM and Sign This:Section
if Using A Bui1Acr
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W Office of Consumer Affairs&Business Regulation Registration valid for individual use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
o' c Ty. -I f arporabon Office of Consumer Affairs and Business Regulation
Ex
C oi�r—at ion 1000 Washington Street-Suite 710
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09/09/2020 Boston,MA 02118
R l:F DESIGN,INC.
.r �- BILL SWANSO Ul 01�16'N„
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Q >. to o o' N SWANSON .� .,,e/ ithout sign
._ ,; suSA {_r,} Not valid w
cul-� = 'E a IX a { _y 50 CAMELOT LANE `— o r'
3 m U M F. BREWSTER,MA 62631 ` Undersecreta
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The Commonwealds of Massadiusetts
FDepartnieiit of Industrial Accidents
Office of Investigadons
600 Washington Street
Boston,MA 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information L 1 \Please Print LeidMy
Name(Busmesdorganizafi=&dieia ):��IT c 9 ( ]c�-r,�,iS �( ,�'b��►
Adat:ess: 1�0 cvt 'V- 1,ke",-kyj, Uk,,- 026`31
City/Stat&Zip: Phone*
Are you an employer?Check the appropriate box: T of project r
4_ I am a general contractor and I Type P ] (required):
1.❑ I am a employer with g 6. ❑New construction
employees(full and/or part-time).: have hired the sub-contractors
2.[rI 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' 9- ❑Building addition
[No workers'comp.insurance comp-insurance-_
required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3-❑ I am a homeowner doing all wodc officers have exercised their 1 L❑Plumbing repairs or additions
myself[No workers'Comp right of exemption per MGL 12.❑Roof repairs
ur insance required.]i c.152,§1(4),and we have no �{
employees-[No workers' 13.E Other___/__p�,(,��
comp.insurance required-] I C
*Any applicant that checks boa#1 also fill out the section below showing their workers'compensation policy information.
Z Homeowners who submit this affulam indicating they are doing all wad and then hire outside contractors mast submit a new affidavit indicating such
rComtractors tbat check this bar mast attached tm addititmal sheet showing the name of the sub-com actors and stare whether or not those entities have
employees. If the sub-contractors have etmployee%they must provide their workers'comp.policy number.
I am an employer that is providing workers'conipensation insurance for try employees. Belosp is the policy and job site
information.
Insurance Company Name: i— .ti [A9 SU P 4"t-"'
Policy#or Self-ins.Lic.4. 6,ki V-6 t�5F1'37Q^ t ' L 9i Expiration Date:
Job Site Address: 1 1 S' ki i�� ALL City/State/Zip: HYA40 1S t At A 621(P t
Attach a copy of the workers'compensation policy declaration page(showing the policy nu m er 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 S 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 insurance coverage verification.
I do hereby certify under,the 'rs and penalties of perjury that the information provided above is true and correct
Si tore: y Date: 2 V,
Phone#: "77zl
Official use only. Do not sprite in this area,to be completed by city or town official.
City or Town: PermitUcense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
6
Town of BarnstaWV x
tHEt o Regulatory Services.,v- = Oq
P
r
Thomas F. Geiler,Director
B" ASS. '
MASS. 4 Building Division y M � on �.
0
�Dr p Mpg p� Tom Perry Building Conur issioner
} ;..
200 Main Street, Hyannis,MA 02601
Office. 508-862-4038 Fax: 508-790-6230
COMPLAINVINQUIRY REPORT
Date: Rec'd by: VLF
Complaint Name 5 Map/Parcel —30S
Location
Address: i �'1 e 'Y—tv� ►�►'��
Originator Name:
Street:
Village: State: Zip:
Telephone: I
pDescription: ., C6
Complaint ,✓
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vv�K d. C7\-60 s o-'OK,
t ( FOR FFICE USE'ALY `�( � 40 f
Ins ector tion/Comments Date: e t
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Additional Info.Attached
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I
°F� r Town of Barnstable
Regulatory Services
RAMSTAB ' Thomas F.Geiler,Director
1639. .`�� Building Division
Peter F.DiMatteo Building Commissioner
367 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
PLEASE FORWARD THE ATTACHED PAGE(S) TO:
TO:
ATTN:
FAX NO: O
� 9
FROM:
. DATE: � �� ✓ �
PAGE(S): 1 (INCLUDING COVER SHEET)
Town of BarnstablePermit: 7 3R 1,3
®F114ETp Regulatory Services ate:/�a yl3
P o Thomas F.Geiler,Director
*
BABNSTABLE, = Building Division
9 1639 ,0 Tom Perry, Building Commissioner
p 200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
TOWN OF BARNSTABLE
SOLID FUEL STOVE PERMIT
� �
Owner:
�I/'^ 0/- Phone:
Install at: qU,11� Village:
Map/Parcel:
Date:
StoveCD
k �
A. New / se
B. Type: . Radiant/Circulating/ } cv
Lab.No. "�'` `-''
C. Manufacturer: v Vr°G✓c ti s� �' - '
D. Model No.:
Chimney
/
A. New/Existing (If existing,please note date of last cleaning)
B. Flue Size
C. Are other appliances attached to Flue? IJ0
D. Pre-fab Type and M facturer
E. Masonry: ine mined
Hearth
A. Materials:
B. Sub Floor Construction:
Installer
Name: �r/ A ���' Address: �.
Phone: _��U 7 —3 9'
Location of Installation:
APPROVED BY:
please make checks payable to the Town of Barnstable
=*Thzistitutes an official stove permit after inspection,photographed, and approved by the
Building Inspector
Q:forms:stove
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Mr
nn is
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Building Department
Complainvinquiry Report/ Assessor's No.
—/a� — G! Rec d by:
Date:.
�
Com Name:
Location Address: L/�
M/P
Originator Natne:
Street:
Ste, L zip:
v,IL�ge:
Telephone:D/C
ZZ
Complaint ❑
Description: ✓ G�%-C�/
C_ G2 /1W
Inquiry
Description:
For 09ce Use Only
Inspector's Inspector
Action/Conunents Date:
Follow up
Action
Additional Info. Attached
Cop),Distribution: White-Department File
Yellow-Inspector
Pink-Inspector(Ret=to Office Manager)
The Town of Barnstable
Department of Health, Safety and Environmental Services
Building Division
s59-��� 367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Home Occupation Registration 7 jr 7/ 7
Date: 3` 1 9
Name: /;�- le C_ tl<,-y�
Address: 7 ' "I . Village:
Type of Business: �� T l Map/Lot:?O2— Z/Z
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home
occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,
provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or
odor, no visual alteration to the premises which would suggest anything other than a residential use;no increase in
traffic above normal residential volumes;and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject
to the following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,
located within that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,
and there is no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular
matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials, in
excess of normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary
Home Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There is no commercial vehicles related to the Customary Home Occupation,other than one van or
one pick-up truck not to exceed one ton rapacity,and one trailer not to exceed 20 feet in length and
not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of
the dwelling unit.
I, the undersigned,have read and agree with the above restrictions for my home occupation I am registering.
Applicant: 44- Date: '� 2-1—�to