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HomeMy WebLinkAbout0039 PINE GROVE AVENUE - - - --- i I C�� C pE e op ALE INSULATION. 11R14 Ol AS! ![AMLI Sf 5/RAY IOAM SUSV[Nplp R Ail3 OUPQ S INSULATIOnH gSII�INOj 1 800��696�6611 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Ins ulation,sulation, 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 PA CA, �eeK� 39 �� �itvN c f/Y.a44s Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes ( ) ( ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls ( ) (JC ) ( 13 ) (k) ( ) Diver y (VO r k leer Jro r��ol A�� Otis Sincerely rry ssi r, President Ins ation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATI:+ON .l hh Map U Parcel'. Application # y S� 0 1 pp � 3U� Health Division Date Issued Conservation Division P 1� Application Fee Planning Dept. Permit Fee IK5. 00 Date Definitive Plan Approved by Planning Board Historic _ OKH _Preservation/ Hyannis Project Street ddress Village a6 , Owner_ '( Address Telephone Permit Request ( (V Wga I c ova 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 U/ 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 goal stove:-ILI 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 a/No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name CV,5 Telephone Number 0 6 �1 4z, Address V v V' License # �U aVIAA 94 Home Improvement Contractor# �7 Email Worker's Compensation # Uf I �b ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Z� t t FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED s' t MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: - FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ,.FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r k Massachusetts _ Dbpartment.of Public Safety Board of Building Regulations and Standards Construction srrlmwizcir License; CS-1009,88.. HENRY E CASSIIJV ���ti'.•. 8 SHED ROW W EST Y ARM 0 VrH ��.0 b ✓,.�.-� JJ� �. " �'� Expiration Commissioner 11/1 1/2015 a t Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration, 153567 Type: Private Corporation Expiration• 12/15/2016 TrW 259138 CAPE COD INSULATION, INC HENRY CASSIDY - - --- 18 REARDON CIRCLE ---- SO, YARMOUTH, MA 02664 ----- '•Update Address and return card Marl( reason for GA 1 Address Renewal l mployment Los! C:�rii +.5 20M•05/11 CJ/ie cpai�r�na�atuea�C/n�C���rWJac�u4eCl<l - a \ 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; = ecdlstratlon; 1.53567 Type; office of Consumer Affairs and Business Regulation xpIratIon;;:,;:.1,.21:15/20.1,6 Prlvale Corporatlon 10 Park Plazn -Suite 5170 Boston, MA 02116 .;APE COD INS ULAT.I,'0),INC":'',` -iENRY CASSIDY 18 REARDON CIRCLE' 30,YARMOUTH, MA 02664 Undersecretar -- Y N valid wiy, gut sign e i The Commonwealth of Massachusetts Department of I ndustrtal Accidents W Office of Investigations s 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information q� / Please Print Legibly f� Name (Business/Org 'zation/Individual): gut;L ;4� y Address: V y (� G11� � Phone 4: City/State/Zip: �� � ' Are you an employer? Check 4.e appropriate box: general contractor and I Type of project(required): 1.[;'I am a employer with '?,t ❑ I am a g employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling ship and have no employees These sub-contractors have 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 work officers have exercised their I I.[] 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�l' h p 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 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 joh site information. n Insurance Company Name: k2vez Policy#orSelf-ins Lic. Wxpiration DaterJob Site Address:3� ]�� City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy numb r and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition if 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 certify n r pains and penalties of perjury that the information provided«5o e is tru (andl rrect. Signature: Date: C Phone#: 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#: I From:Rogers&Gray Insurafax: To:+15087786735 Fax: +15087785735 Page 2 of 2 03/3012015 10:04 AM CAPECOD-27 BDELAWREh1C:I DATE(h,1 hAl0DiY'r 7'r; CERTIFICATE OF LIABILITY INSURANCE 3/30/201 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER T1 HS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE'-; BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIIE_I) REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 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 Ileu of such endorsement(s). PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE o Fa/c No: 877 816-2.156 434 Rte 134 Ext: ( ) South Dennis, MA 02660 EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE MAIL INSURER A:Peerless Insurance Company-see LIBERTY MUTUAL INSURED INSURER B:SAFETY INSURANCE COMPANY INSURER American Specialty Cape Cod Insulation, Inc. p tY Ins. Co. 18 Reardon Circle INSURER 0:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth, NIA 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 F'EI?IOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO VVHICfI T'ril<: CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE-1 FM"Ils EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I SR POL C EFF POLIC EXP LTR TYPE OF INSURANCE INSO WVOI POLICY NUMBER MMIDO/YYYY MMIDWYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY _ EACH OCCURRENCE I. 1,000,OOU CLAIMS-MADE M OCCUR CBP8263063 04/01/2015 04/01/2016 PREMISES EaocCLi1Te_Dnce 100,000 - MED EXP(Any one person) $ 5.000, PERSONAL&ADV INJURY 2 1,000,OUQ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000, X POLICY a JECT LOG —— -0 I PRODUCTS-COMP/OP AGG t ?_.000,OOU OTHER:AUTOMOBILE LIABILITY EOMBINIEeDISINGLE LIMIT $ 1,000,000 TBDB -- _..._ _• - ANY AUTO 04/02015 04/01/2016 BODILY INJURY person) s n 1/ -----..---—ALL OS X SCHEDULED BODILY INJURY Per accident AUTOS AUTOS ( )X - hION-OWNED PROPERTY DAMAGE X HIRED AUTOS --- AUTOS (Per accident) 2 --- . X UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 2,000 0001 C EXCESS LAB CLAIMS-MADE EXC10006635000 04/01/2015 04/01/2016 AGGREGATE ___ DED X RETENTION2 ������ Aggregate S `2,000,000 WORKERS COMPENSATION PER OTH- ANDEMPLOYERTLIABILITY Y/N STATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE WCE00431900 06/30/2014 06/30/2015 E.L.EACH ACCIDENT 1,000,000 OFFICER/MEMBER EXCLUDED9 N/A _ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 2 1,000,000 If yes,describe un(Ier --- _- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,00() DESCRIPTION OF OPERATIONS(LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under thl 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 B EEO RG I 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 Town of Barnstab.le Regulatory Services 1 WSMADIZ Ricbard V.Scali,Director 6}y.�0�Eo►;u,+L Building Division Tom Perry,Building Commissioner 200 Main Sheet,llyanws,INIA 02601 www.town.barnstable.ma.us Office: 508-862-40 38 Fax: 508-7190-6230 Property Ow-11er Mus t C;omplcte and Sign This Section if Utiinc,A Builder as Owner of:he suhjec,- prop.n:y ]tcrchyautho=i:Z _C 01 IN lC. Cod 1.lot- to act on my behalf, in a!1 r-n-'TC rs rr_!ati'cc to W-ork authorized by this b>ldzm, poem-Litt agFlic.wuion for: (��idztrss.cal ), Pool forces and Liriis at-e the rts.ponsibility of tht applicam. fool; are not to be f illi:ti oiU.dL- e:d before ore fCni:e is iasLiRetl and all i-,Kd inspc6io is aiv p lzftmatd apd :kcepted_; �K1,gnatw-e of Owner Si a"Im,of.Ap lic;Ult Print Name ' Print NaM. I latC Q;FORM S'QVr-.%FiRP;-R.!1SS10XT(X)US V 1 i Town -of Barnstable. *Perms# —D®, 0 Y ? 3� Expires 6 months from issue date i Regulatory Services Fee MAS# .S 165 � ,e�' � Thomas F. Geiler,Director ® SS , Building Division 1 2p12 Tom Perry,CBO, Building Commissioner SEP 200 Main Street,Hyannis,MA 02601 www.town barnstable.ma.us R�S"rAg�-E Office: 508-862-4038 BA 'T®% Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid.withoutRedX-Press Imprint Map/parcel Number ' Property Address i �. (i- �)V. 4A 4 )q Residential Value of Worj 1 <r®0 Minimum fee of$35.00 for work ender$6000.00 Owner's Name&Address (7144-F,( Lf r Contractor's Name S Fj Telephone Number -�- Home Impiovement Contractor License#(if applicable) f �, Construction Supervisor's License#(if applicable) (/-qS OWorkman's Compensation Insurance. Tk one; ' am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name ' Workman's Comp. Policy# .Copy of Insurance Compliance Certificate must accompany each-permit. ' Permit Regy;est(check box) 1 [� Re-roof(hurricane nailed) (stripping old shingles) All construction debris will be taken to ,O#\A �S ea ❑Re-roof(hurricane nailed)(not stripping. Going over existing-lagers of roof) [�Re-side #of doors ❑ Replacement Wmdows/doors/sliders.U-Value (maximum 35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.l Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town deparbuent regulations,i.e.Historic,Conservation,etc. ***Note: Acopyo ust sign Property Owner Letter of Permission. me Improvement Contractors License&Construction Supervisors License isSIGNATURE: Q:RPFM\FORMS\bur7dingdoq The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name(Business/Organization/Individual): C 70 )r if Q^fS-fF_uc�_1 o 0, J Address:C9l 1921 AVC^ City/State/Zip: /W N 1 fyvG' Phone.#: Are you an employer?Check the appropriate bp,(. Type of project(required):. 1.❑ I am a employer.with 4. I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. New construction . . . I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• $. 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 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 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. Tam 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 Investi ations of the DIA ance coverage verification. I do hereby certify un er a ns and penalties of perjury that the information provided above is true and correct qN Sip-mature: Date: Phone#: Z, Official ust 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 CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ;_ Contact Person: Phone#: tructions Information and In s 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." y 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 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(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 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . 600 Washington Street Boston, IOTA 02111 Tel.##617-727-4900 ext.406 or 1-877-MASSAFE i Revised 11-22-06 Fax##617-727-7749 www.mas,-,.gov/dia . The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers,- Applicant Information Please Print Lezibly / Name(Business/Organization/Individual): �{� ( )041,rg1 �LyCx l'Q aj Address: w-W-r� f, w l City/State/Zip: ��G�jv (�� Phone.#: V-`l Are you an employer?Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I _ 6. New construction . ployees Oulland/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 sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' Y P. t3' 9. ❑ Building addition [No workers' comp.insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I an,a homeowner doing all work officers have exercised their 11.0 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 1 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. 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. 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$256.00 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 pains and enalties ofperjury that the information provided above is true and correct. signafore:;' Date: �' _Z o l IS Phone#: 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-contractor(s)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 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(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'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 its a.call. The Department's address,telephone-and fax number: The Cormnonwmhh of Massachusetts Departmimt of.1ndustrial Accidents Office of Investigations 600 Washington Street Boston,h!iA 02111 TO. # 617-727-4900 ext 406 or 1-$77-MASSA,FE Revised 11-22-06 Fax# 617-727-7749 www.mass.gov/dia I I I . f- Lie tPorivrreaazcueczlC�z a��/laa�ac�ic�e�� _ - _.._ _,.._- Office of Consumer Affairs&Busi ess Re ulahon : License or re �sfration valid for'indwidul use only g g y� OME IMPROVEMENti CONTRACTOR before the ex i,aMn date ound return to: a istration � f P ��.. , 9. . 172405.: Type Of ce'of Consumer Affa►rs and.Business u1 tio_,n xpiration 6/21/2014> DBA ti 10 Park Plaza "Suite 5170 CTS CONSTRUCTION " 9 d Boston MA 02116 ALUISIO SANTOS '� { 21 7TH AVE. ' -EOMINSTER, MA 01463 Undersecretary t Not v id without signature 1 ...------ Massachusetts -Department of blic Safety Board of,.Building Reg3fations arl:,;Standartis; Construction Super isor License: CS-098684 :'a� ALUiSiO SAN.Tas _ 21 7M AVEXIUE LEOMWST R MA 0 453i :-� J.�w.. , any Expiration . Commissioner 10/10/2013 I d , j �/ae�poorvrraaruuealC/d�C�/la�aac%led j " Office of Consumer Affairs&Business Regulation License or regvs€ration vand.;for mdividul use only P OME IMPROVE;M-64i CONTRACTOR before the expf a6 n date found return to: r u egistration: 172405 Type Office of Consumer Affairs and Business Rlation xpiration ,,6/21/2014; DBA 4' l0 Park-Plaza-Suite 5170 M f ' Boston,MA 02116 CTS CONSTRUCTION'tg; s} 1 ALUISIO SANTOS 21 7TH AVE. LEO.MINSTER; MA Undersecretary t Not v id.without signatu% r Massachttsetts Department of Safety. sr Board'o!>z.Building Regafi'ons a ' Standards, Construction Supers isor 7k License: CS-098684 r 4Cl;S ALUISIO SANbS 21 7TH AVENJJE LEOMM'ST R ! . MA 0` 453, ,flea Commissioner Expiration . 10/10/2013 aU,�� �� s-� � �� ��� �� CONTRACT FOR SIMPLE HOME REPAIRS Patricia Keenan ,Homeowner,desires to contract with, Aluisio Santos ;Contractor,to perform. certain work on property located at: 39 Pine Grove Ave,Hyannis,Ma 02601 1. Job Description The work to be performed under this agreement consists of the following: Remove existent roof shingles and dispose off site.Re-roof entire area with landmark series certanteed shingles.Remove existent cedar shin es&caprap board &dispose off site(corner board and soffits) Supply+dispose of 16 windows,3 doors+slider door re-frame and install 16 windows(owner supplyed windows) Install 2 gable vents siding area. 2. Payment Terms In exchange for the specified work,Homeowner agrees to pay Contractor as follows(choose one and check the appropriate boxes): ❑ a. $ ,payable upon completion of the specified work by❑cash ❑check ❑ b. $ ,payable one half at the beginning of the specified work and one half at the completion of the. specified work by❑cash ❑check. ® C. $ -------",per hour for each hour of work performed,up to a maximum of$ ;payable at the following times and in the following manner: Total amount:$ 15,309 divided as:$5,100at signing,$5,100 when roof and windows completed, $2,554 when insulation in complete installed,and$2,556 when project is completed and reviewed by customer,based on the agreeded. S 0 3. Time of Performance R�U 0 F _.a-iC The work specified in this contract shall(check the boxes and provide dates): ®begin on_ 09/06/2012 _ [�be completed on 10/06/2012 Time is of the essence 4. Independent Contract Status It is agreed that Contractor shall perform the specified work as an independent contract. Contractor(check the appropriate boxes and provide description,if necessary): ®maintains his or her own independent business. ® shall use his or her-own tools and equipment except: ®shall perform the work specified in Clause 1 independent of Homeowner's supervision,being responsible only for satisfactory completion of the work. 5. License Status Number Contractor shall comply with all state and local licensing and registration requirements for type of activity involved in the specified work, (Check one box and provide description) ® Contractor's state license or registration is for the following type of work and carries the following number: HIC-172405 MA:CSL-098684 ❑Contractor's local license or registration is for the following type of work and.carries the following number: ❑ Contractor is not required to have a license or registration for the specified work,for the following reasons: 6. Liability Waiver If contractor is injured in the course of performing the specific work,Homeowner shall be exempt from liability for those injuries to the fullest extent allowed by law. 7. Permits and Approvals (Check the appropriate boxes) ®Contractor ❑Homeowner shall be responsible for determining which permits are necessary and for obtaining the permits. ®Contractor ❑Homeowner shall pay for all state and local permits.necessary for performing the specific work. ®Contractor ❑Homeowner shall be responsible for obtaining approval from the local homeowner's association,if required. Additional Agreements and Amendments Homeowner and Contractor additionally agree that: Contractor will provide all material,except for windows and doors,customer got them already. a. All agreements between Homeowner and Contractor related to the specified work are incorporated in this contract. Any modification to the contract shall be in writing. Homeowner: { Dated: C�,t - CY`'l_ i Contractor: -- Dated: DISCLAIMER: IS FORM IS INTENDED TO PROVIDE EXAMPLES OF THE HINDS OF TERMS THAT, AT A MINIMUM, SHOULD BE INCLUDED IN SUCH A CONTRACT.IT IS NOT INTENDED TO SERVE AS A SUBSTITUTE FOR THE ADVICE OF AN ATTORNEY-AT-LAW. BEFORE ENTERING INTO A CONTRACT INVOLVING GIVING SOMETHING OF VALUE TO ANOTHER FOR GOODS,SERVICES OR MATERIALS,BE CERTAIN THAT YOU HAVE A CLEAR UNDERSTANDING OF ALL OF THE TERMS IN THE CONTRACT AND WHAT REMEDIES ARE AVAILABLE UPON DEFAULT OF ONE OF THE PARTIES.AN ATTORNEY-AT-LAW CAN HELP YOU WITH ANY QUESTIONS YOU MAY HAVE ABOUT THE PROPOSED CONTRACT. w z*. Town of Barnstable * erit# a�OFTHE�� m ` Expires 6 months from issue date ~� Regulatory Services Fee s ► t s * BAMSTABLE, • - - r� 1639. ,0� Thomas F.Geiler,Director iOTfD MA't A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ® 2 2 Not Valid without Red X-Press Imprint Map/parcel Number (,G JJ Property Address 1 1N �' �` ��' � `��n C AResidential Value of Work ")t'I40, 0 y Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �"1'►/�-7� ✓ 7� l�f�' C� / =�� g Alt-A✓P1466 s: Al d o Contractor's Name Telephone Number Home Improvement Contractor.License#(if applicable) Construction Supervisor's License#(if applicable) �J ❑Workman's Compensation Insurance ��� SS ERMIT Check one: ❑ I am a sole proprietor I am the Homeowner MAY ' 3 2012 ❑ I have Worker's Compensation Insurance Insurance Company Name NSTABLE TOWN OtF= Workman's Comp.Policy# 46 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) ❑ Re-side 2 #of doors Replacement Windows/doors/sliders.U Value 0 J � (maximum.35)#of window 'Where required: Issuance of a 't does not exempt compliance with other town department regulations,.i.e.Historic,Conservation;etc. ***Note: Pro Owner must sign Property Owner Letter of Permission. A y of the Home Improvement Contractors License&Construction Supervisors License is uired. ' SIGNATURE: C:\Users\decollikWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\DDV87AAZ\EXPRESS.doc Revised 072110 r s The Camnionstwahli ofMassachusetts Deparhuent gf'Indushial Accidents Office of Investigations 600 Washington Street y. Boston,.JL4 02111 mo v mass.govldiaz Workers'Compensation Ins nce Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LezibIy Name(Btrsimssio gau zatiowhdmdual): &m Address: D 1Z19-1v 4-"- s J City/State/Zip: /L'0 �49�� 07A a�3 Phone#: S &g 7—Y3— Are you an employer;'Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑I am a general contractor and I employees(full.andlor part.time).: ha,.T hired the sub-contractors 6. ❑New construction 2.❑ I am a sole propnetor or partner- listed on the attached sheet 7. ❑:Remodeling ship and have,no employees These sub-contractors have S. ❑volition world for me many ci employees and have workers' � �capacity. I 9_ ❑Building:addition [No workers'comp_insurance comp.insurance: required-1 5. ❑ We are a corporation and its 10_❑Electrical repairs or additions 3.V1 am a homeowner doing all work officers ha--e exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑Roof repairs e. 152,§1(4}and we have no Q insurance required.]a , employees.[ o workers' 13.2Other Pod S comp_insurance required.] •Any apphia=that checks box#1 must also fat out the:sectiou below showing their workeTV compensation policy information. Homeowners who submit this affidsvit indicating they are doing all stork and then hire outside contractors mnu submit a new afEdarit indicating such_ kontrwrars that:check this twat must attached an additional sheet showing the nmme of the sub commtractazs and state whether w not those entities have employees. If the sub-€ounctors have employees,they mug provide their workms'comp.policy number.. I am an employer that is providing trrrrkers'cattrpertssafztrn insurance for rrry a trpinyees. Below is tite policy,and job silo nformatian lftssurance Company Name: Policy 4 or Self-ins-Lic_4: Expiration Bate: Job Site Address: CityiStatetZip. Attach a copy of the rsorkers'c sation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as 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 e= r imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine. of up to$254:00 a day as t e violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D insurance coverage verification_ I do hereby certifjF the pains rand penal/es of perllary that the ire,formaffon prm ided above is true and correct Si, attire: 2 (� Date: Z O r Phone s: , " g -Y>- 7 Z 3 Official use only: Do not write in this area,to be completed by city or torero official. City or Towm: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/I`ow:n Clerk d.Electrical Inspector 5.Plumbing Inspector +6.Other Contact Person: Phone 0< r- v FIKEr� Town of Barnstable Regulatory Services x x x 98A MtA�$ Thomas F.Geiler,Director 1639. �'Arfoga`� 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: q 2q —C 2— JOB LOCATION: ✓--c(� / �N� (� �/�� /�/ /�'�y�Jy^'o"cs ynuumber ,,,,-_/ p �p street �� ,,�/ / village [/ ..HOMEOWNER": /�►I�'J�I%`J"� �/ /�"Y Ap" d��l� �C✓ 5a9­2-/3—( 2,3 L/ name home phone# work phone# CURRENT MAILING ADDRESS: &,L;. J�l '57- lVp I za�_63-ljp,_/ 14-7/9 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned" owner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylawIgn "homeowner" ations. The u certifies that he/she understands the Town of Barnstable Building Department minimum inspection procements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work 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 homeowner 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. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 172111 r MLS Page 1 of 3 10 propertv History Listing Summary Attached Docs Q Interactive Map Report Violation Listing#21101985 39 Pine Grove Ave, Hyannis, MA 02601 Active (03/11/11) DOM/CDOM: 14/14 $79,900 (LP) Beds: 2* Baths: 1 (1 0) (FH) Sq Ft: 824* Lot Sz: 11325sgft* Town: Barn Yr: 1955* Remarks Fannie Mae 2 bedroom 1 bath ranch with convienent Hyannis location. Fireplace and some Hardwood floors. ;_ Interior rehab needed and may not qualify for all lending programs. This property may qualify for Fannie Mae '�� renovation financing. Some restrictions apply. Pictures 16) 1"= s " Y n. } R u— 7 _ 77. Agent Jack P Creaven Jr (ID:UODQ)Primary:508-737-3728 Secondary:508-428-2300 x28 Other:508-737-3728 Office RE/MAX Classic(ID:CLAS2)Phone:508-428-2300,FAX:508-420-0469 Property Type Single Family Property Subtype(s) Single Family Status Active(03/11/11) Town Barnstable Facilitator Comm 0% Listing Type Excl.Right to.Sell Owner Name FANNIE MAE County Barnstable Tax ID 290-33-0-0-BARN Beds 2" Baths (FH) 1 (1 0) Approx Square Feet 824* Sq!Ft Source Assessors Records Lot Sq Ft(approx) 11325* Lot Acres(approx) 0.260 Lot Size Source (Assessors Records) Year Built 1955" Listing Date 03/11/11 All Office Remarks prepare your buyers for unchangeble addendums. Directions to Property West main street to pine grove ave. Listing Page Commission-Other 0% Commission Sub Agent Comm. Buyer Agent Comm. Dual Var Comm 0% 3.0% No Special List Cond. Foreclosure Showing Instructions Call Listing Agent General Page Zoning residential Year Built Desc. Actual Total Rooms 5 Total Levels 1.0 Basement Baths 0.0 I Level 1 Baths 0.0 Level 2 Baths 0.0 http://ccimis.rapmis.com/scripts/mgrgispi.dll?APPNANM=Capecod&PRGNAME=MLSPropertyDetail&... 3/25/2011 MLS Page 2 of 3 Leve4:-3"Baths 0.0 Basement Yes Basement Description Full,Walk Out Foundation Block,Concrete Fndation Wing Width 0 Fndation Wing Depth 0 Irregular No Lot Depth 0 Lot Width 0 Topography/Lot Desc. Level Association No Annual Assoc.Fee $0 Assoc.Fee Year 0 Garage No #of Cars #0 Parking Description Unpaved Driveway Year Round Yes Separate Living Qtrs No I Waterfront No Water View No Convenient To In Town Location,Marina,Medical Facility,School,Shopping Miles to Beach .5-1 Water Access Ocean, Public Beach Description Ocean Beach Ownership Public Street Description Paved,Public Interior Page Fireplace Yes Number of Fireplaces #0 Floors Hardwood,Partial Carpet,Vinyl Exterior 1 Style Ranch Pool No Dock No Energy Saving Feat None Exterior Features Yard,Outbuilding Roof Description Asphalt Siding Description Clapboard,Shingle Mechanical Heating/Cooling Natural Gas Water/Sewer/Utility Town Sewer,Town Water Hot Water/Water Heat Tank Legal/Tax Annual Tax $1200 Tax Year 2011 Land Assessments $102400 Improvement Asmt $79500 Other Assessments $0 Total Assessments $181900 ,Annual Betterment $0.00 Unpaid Betterment, $0.00 To Be Assessed Unknown Mass Use Code 101-Single Family Title Reference-Book 22271 Title Reference-Page 247 Land Court Cert# 0 Underground Fuel Tnk Unknown ,. Lead Paint Unknown Asbestos Unknown Flood Zone Unknown Publish to RPR Yes *Denotes information autofilled from tax records. http://ccimis.rapmis.com/scripts/mgrqispi.dll?APPNAME=Capecod&PRGNAME=MLSPropertyDetail&... 3/25/2011 i MLS Page 3 of 3 -=t Information has not been verified,is not guaranteed,and is subject to change.Copyright 2011 Cape Cod&Islands Multiple Listing Service,Inc.All rights reserved Copyright©2011 Rapattoni Corporation.All rights reserved. U.S.Patent 6,910,045 Generated:3/25/11 11:13am D http://ccimis.rapmis.com/scripts/mgrqispi.dll?APPNAME=Capecod&PRGNAME=MLSPropertyDetail&... 3/25/2011 Assessor's offioe (1st floor): _ v�'o ' Assessor's map and lot number ...o(:./.�."..�. 3 �� oFTNE>o Board of Health Ord floor): ego Sewa o=,Permit number ... m2-lOp �/�G�.................. . � a Z 21MUSTODLE, Engineering Department y(3rd floor): t6 9• : House number ..........................................1............................. APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only t ti TOWN OF BARNSTABLE �-BUILDING INSPECTOR , APPLICATION FOR PERMIT TO ........... .......... .. 12 ......... .......�.l.. 1.� E l.. ................................................. f TYPE OF CONSTRUCTION D V�...................................................................................... .............................. .............19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit acc�o ding to the followiing( informatiio/nn- Location ........... i `"'° :.. .... ...... ........•1••••(/L�G` ............. .l�l�,...� .4�•C... Yr�. .i.,�' 2 "i Proposed Use ...................... ........................................ .... ......... ..... .. ............ r •,,.... // .....Fire District"......... ... .. Yl r J 4 ZoningDistrict ... ......... ...�:.........................:,.................... ........ .............. Name of Owner ......... r........................:... .. . ........................Address ..�..... ........................... ...... / Name of Builder .......... �-........+......Address . tName of Architect ""' .....�.�............ ............`........................Address ................... 5 Number of Rooms ....... .....................................................Foundation ...1 .. .................':;. t . Exierfor �.. ..... . . ................................Roofing.................. .......................................................... Floors ...... ..............�.. ...���..............!" .......Interior ...............�.. !..t—�L ... . ... ..... ��, ....... !....... o l h / .J �•.�� • Heating - `.r�....-.: .^... ...'.:..:�_�/.._!, ;). Plumhi,ng .. 1...:.. .-...............1 _ E a- es ` Fireplace ...................11 —1 1..................Approximate Cost .. ..(�...�............... ... ......... . ............ ........... . k�k'N,Definitve Plari"App-roved by Planning Board _--------------------.----------19________ . AreaD. :�.....1;!:7-!...... Diagram o ot,�and Building with Dimensions r Fee- ................... SUBJECT TO APPROVAL Of BOARD OF HEALTH W w� ( f OCCUPANCY PERMITS REQUIRED FOR NEW-,DWELLINGS J I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable 'regarding the above construction. r .. Name4'. �,v. ............................................ Construction -4upervisor's License ..... ,P BEARSE, ALLEN H. A=290- .2 5;10 -_-?,3 033 No 58... Permit for ....M.Q.V.Q..X).Welling e.... .aluily..pW.e I I_i rjg........ Location .......3.9...Fine...G r.o.v.e...Averlu je..... Hyannis ..............................................................I......... Allen H. Bearse Owner .................................................................. Type of Construction .....Yrame........................ ...................:........................................................... Plot ............................. Lot ................................ Permit Granted .......October....2.!.......19 87 Date of Inspection ....................................19 Date Completed ......................................19 ' ti s'."4 ��=y.:.. ��rr.. •M' •.- .,,,•g *'.rr � 4M r -..�:�}, ..�.,.ta;s IY`"JrA!MY.'.F�,'t+N*r`.h:'ti.ar "`r!k'.Si..„f.,.`,,,p-. ...fie' - ,- ,�.. .- - r _vr-x ., TOWN OF BARNSTABLE 31258 � Permit No. ................ BUILDING DEPARTMENT a�a TOWN OFFICE BUILDING Cash 7 .Y� H'YANNIS.MASS.02601 Bond N/A CERTIFICATE OF USE AND OCCUPANCY Issued to Allen H. Bearse Address 39 Pine Grove Avenue Hyannis, Mass. USE GROUP FIRE CRADING OCCUPANCY LOAD li 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. March 22, 88 19................. ..........,.. .4.......:.�.................... Building In pe�ijor r . fssor's offioe (1st floor): nn rC o*TWEro sseso,ss ' map and lot number .. .. (. ........., '..... J Q.. �♦ Board of Health (3rd floor): Sewage"' Permit number ...?K��� eAM ngineering Department (3rd floor): -3� FPS o "b o `ems House number APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00•P.M. only, TOWN OF BARNSTABLE BUILDING I-H `PECTOR APPLICATION FOR PERMIT TO ........... ........ ...........e...... �...'�V ..�<.l.n. ................................................. o a� --� TYPEOF CONSTRUCTION ....................... ....................................... ..................................................................... ................................................19......-- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit ac ding to the following info tion: Location ......��.. ............ ......... .... ......... ..:�.: ... Vie, . -.................... ProposedUse ............ .. ......... .... . ........ .... ..................... ...................................... Zoning District ... .... .... ... ........................ . ..........................Fire District ..... . . ��.� ...... .... . .. . . Name of Owner ...... .......................L''!..:... .. ..s_44� ��Address ...T��... ... .. ......... � .. . . . Q��YjPs• Nameof Builder .............. .. C✓...!.!!.... ................Address .................................................................................... Nameof Architect ............/.(..................................................Address .................................................................................... cc--�� L-- � Numberof Rooms ......./......................................................Foundation ... . ................. ...... .................................. Exterior .................... ' . ...Roofing Floors .......... . . .............. ..............................Interior ............... �^ 1 Heating . ............. ^.... ...'.....(„�4�...+. ............Plumbing. ............... ._....,........................................................... vFireplace .....................J....'-:�1..��J....................................Approximate Cost ../. .../........................................................ Definitive Plan Approved by [[[Planning Board _______________________________19________ . Area �,.Q....... .C. .. Diagram of Lot and Building with Dimensions Fee ... ��.. ..................... . SUBJECT TO APPROVAL OF BOARD OF HEALTH 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. X.Nam .'.d.......... .................................... Construction Supervisor's License .....OZ4.)17..1' ` . ' ` ^ No ...� 5ti. Permit for ..��!��.��D��.�����!� ` �~ lIi� - J� ' .�DY��--.. �.---JWBL�� ' 39 Pine Grove Avenue Location ---------------------. . ~ Hyannis io ...................... ............................................. ......... ' .. '. ��IIeo B Bearee Ovvne, -------'�-------------- / ^ ~ ) Frame Type of Construction -------------- . ' + -------------------------- Plot ---'���----� �t ----------' . ' . - � ~ Permit G,onts6 -.Ug.-'-qb.er.'2�---]9 87 ' . . Dote of |n ' lg ` Date 19 ` ' | � ' - . . ' . . ' ' - . ' . ' [ � `