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3461 MAIN ST./RTE 6A(BARN.)
34�� d�c � l� \ ,, �-. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address 3 7&/ / !&G /1 Village ^� o 4l e- 1�� Owner�J� � �'► 's! e0A Address 3 &/ Maly', - Telephone /►�.� -36?a — YV2 / ' Permit RequestA r ,-' az a um h-wA_ rti &,6 f,:;,_ ;^- 42�b C Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �6sa 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 =a Basement Finished Area (sq.ft.) Basement Unfinished Area ( � '.' CD Number of Baths: Full: existing new \ Half: existing nbw Number of Bedrooms: existing _new can Total Room Count (not including baths): existing new First Floor Rocfn Count- Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION /y (BUILDER OR HOMEOWNER) �,� Name /h l c� l�Gc�I" Telephone Number f - Address _` V O Ay- License# ` C /-Z2.4 lei vim" / V 1) ! Home Improvement Contractor# Email If, Worker's Compensation # 11 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL B `E TAKEN TO �VG�- SIGNATU E DATE ka11-;_11 L/ i FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED M'AP/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 s + ASSOCIATION PLAN NO. ' — ..� Town..,,,oflgam, le Rory Sees z63�... .� But cn. Tam Perry,Borlct3ong Coianisiioner 200-NUiaStrftt,RVnais,MA 02641. wwPvE��va.bar�,SEaWensaus bffice; 598 038' Faac .508-790-523 Pre, Owner' Must Complete arc S g�, Seg# an if Us-g A Builder, wi as owner of tie subject prorty he Zy aur�ifhonze: ve is aA matters relative to raorI-.authorized by-this- Pernut app "''an f or 07 ,. -Pooh:fe:IIces and Akr=,are'rhe rie . . , of the; 1�c a .Tools P°'as Wiz. aPP are-aat to: e 04por�d before feu�e�.�d.ar}d:all final' u�sp�ct3o��are pe�orned�ucl.aeceptecl. S , t rif U�aner S of.Apphcant P Na�ne< Pnnt.Nau I?ate> Q:F?ORMS ONVNERPIEW bN'POOIS IPnnt Form The Commonwealth of Massachusetts Department of IndusbW Accidents Of ke of Investigations 1 Congress Street,Suite 100 =-' Boston,MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):ALTERNATIVE WEATHERIZATION,INC. Address:1440 STAFFORD RD CitY/State/Zip:FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate bog: Type of project(required): 1.0 I am a employer with 8 4. E] I am a general contractor and I 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.El officers have exercised their I am a homeowner doing all work 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof insurance required.]t c. 152, §1(4),and we have no repairs q ] 0✓13. OtherINSULATION 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. 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 job site information. Insurance Company Name:ACE AMERICAN INSURANCE CO. Policy#or Self-ins.Lic.#:6S62UB5B918901 Expiration Date.4/5/15 Job Site Address 7 j0 4 f-f• 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 EM un4e pains a that the in ormadon provided above is true and correct Signature: Datel vL Phone 0:508-567-4240 Official use only. Do not write in this area,to be completed by city or town gffi W 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#: ACCORD'® CERTIFICATE OF LIABILITY INSURANCEDA04414-2014 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 pollcy(les)must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s): PRODUCER CONTACT NAME: VIVEIROS INS AGENCY INC. PHONE FAX 375 AIRPORT RD AIC No EYd: aC No): E-MAIL FALL RIVER,MA 02720 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:ACE AMERICAN INSURANCE COMPANY INSURED INSURER B: ALTERNATIVE WEATHERIZATION INC INSURER C: 1446 STAFFORD RD FALL RIVER,MA 02721 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE 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. LLTRR TYPE OF INSURANCE I SD POLICY EFF POLICY EXP I WVD POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES CLAIMS-MADE a OCCUR a occurrence) MED EXP(Any oneeperson) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ POLICY 7 JE 7 LOC $ AUTOMOBILE LIABILITY a D SINGLE LIMB $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED OaPEE AMAGE $ AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS I ER ANY PROPRIETOR/PARTNEWEXECUT M E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N NIA 6S62UB 04-05-2014 04-0&2015 (Mandatory in NH) 56918901 E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS betow E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACach ACORD 101,Additional Remarks Schedule,if more space is required) ERTIFICATE HOLDER CANCELLATION NATIONAL GRID SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 40 WASHINGTON ST CANCELLED BEFORE THE EXPIRATION DATE THEREOF, WESTBOROUGH,MA 01581 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I JOHN J.LUPICA President ©19M2010 ACO , CORP ghts reserved. ACORD 25(2010/05) The ACORD naive and logo are registered"marks of ACORD 1 _r d P !� Office of Consumer Affairs and Business Regulation t WF, 10 Park Plaza.- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 1756M Type: .Corporation Expiration: 5/29/2015 Tr# 241009 ALTERNATIVE WEATHERIZATION,.INC. TIMOTHY CABRAL 1440 STAFFORD RD. FALL RIVER, MA 02721 Update Address and return card.Mark reason for change. sca tom os,„ — Address �_; Renewal J Employment �11Lost Card ���C llf--/!I'1/If•'N/IY'lllfl C/�."l/(/�.i(/Cl/LiN�Li Office of Consumer Affairs&Business Regulation License or r registration valid for individui use only Wj, j?Expi ROVEMENT CONTRACTOR before the expiration date. If found return to: n: 175683 Type: Office of Consumer Affairs and Business Regulation rat-on- 5l29/2015 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 ALTERNATIVE WEATHERIZATION,INC. TIMOTHY CABRAL 1440 STAFFORD RD. FALL RIVER,MA 02721 Undersecretary N�t vali hoot signature • 9 ai_a'S:.,. ..�9i. - - -_ - ... Ili n�ii IICtliil�URI'1'�'F�ni CB-905454 ,gym - TIM07HY CARR" 58 DICKEMsON ST Ball River MA W721 OW0812015 s 3- i7-1S- ALTERNATIVE N4 :° y. WEATHERIZATION Date Town of Barnstable Building Division 200 Main St. ' Hyannis,MA 02601 The insulation work at,�_,^ l n completed in has been p iZi" ar I •1 u..:•�:�n" .lei"•'r; �'✓�`�:aY�; � J••�' .'t'' .F�r'':,,"., .,lY.r_f ''^tea _ y��r NS?a '`A ;yp,,�� .,Y,•.tt'i' ','�'__: ;�k..7:,,�,..�'.o: ..:�j•,jL''��:n Y". CnA+S y<k�!':J' ::.s!�'i•%Hnr,.:,c:r;,'i": a"r„C'.:: a:{4.e�Ri::';- _ ur..IIM,''�r.: /� ��n.V�� . ���n� •A.-y. -J':�', ".v.--a, Yt.���',�,' ' " a .a thy`a YG�^ h•,�J:r. ;� 4. •- •�: :)..•J�._ ���`y :�,�:':f'�'-. _.:i..7 �F President .— CSL105454 58 DICKINSON STREET I FALL RIVER,N A 02721 I (50&)567-4240 I ALTERNATIVEWEATHERIZATIONOGMAIL.COM Ali - 3 %f Pre X-P ERMIT Town of Barnstable *Permit#2�6 l.4 'I4 Expires 6 months from issue date 14 Regulatory Services Fee -s * BAmgrABm TOW " • �AS'A33. Y f�;63�� , w�IABLE Richard V.Scali, Director rfD MA'I A Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number 2 n�/- Not Valid without Red X-Press Imprint (J� Property Address 0 ` 44,,f" A/ ST S�i�/'c1C/"��/�l'�G� 9 � a�6'36 NZ/Residential, Value of Work$ 46-0 d Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number SAl 5 Home Improvement Contractor License#(if applicable) Email: Const ction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: ❑. I pra sole proprietor dXam the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# /W C�'— Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) t ❑ 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 Replacement Windows/doors/sliders.U-Value - -3 (maximum.35)#of windows 13—. #of doors: s ' ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 A copy of the Home Improvement Contractors License&Construction Supervisors License is required. - SIGNATURE: Q:\WPFILES\FORMS\building permit fo RESS.doc Revised 061313 � b Y betails Page 1 of 1 Licensee Details Demographic Information Full Name: CHRISTOPHER A BEASLEY Gender: Owner Name: License Address Information Address: Address 2: City: Harwich State: MA Zipcode: 02645 Country: United States License Information License No: CS-103589 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 3/21/2013 Issue Date: Expiration Date: 3/14/2015 License Status: Active Today's Date: 10/30/2014 Secondary License: Doing Business As: Status Change: License Renewal Prerequisite Information No Prerequisite Information Discipline No Discipline Information Documentum http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license id=29251... 10/30/2014 Office of Consumer Affairs & Business Regulation- Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation Home Consumer Rights and Resources Home Improvement Contracting HIC Registration Complaints M x. Registration# 180259 Home Improvement Contractor Registrant TECC HIMES LLC. Registration Home Page Name CHRISTOPHER BEASLEY Address P.O. BOX 87 City, State Zip SANDWICH, MA 02657 Expiration Date 10/28/2016 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search http://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=82200 10/30/2014 .ct ?, The Commonwealth of Massachusetts Department of IndustrialAccidents 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 Legibly Name(Business/Organization/Individual): (_ .lial"/ Address: 0 o zGs City/State/Zip: Phone#: AW=arna employer?Check the appropriate box: Type of project(required): 1. employer with 4. ❑ I am a general-contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. �[�] onstruction 2.ElI am a sole proprietor or partner- listed on the attached sheet. 7. eling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance. # 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑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 13.❑ Other 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. 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 job site information. �s Insurance Company Name: 410 6-461_IfIZI /A—Se t� Policy#or Self-ins.Lic.#: C �' ! 0� rC Expiration Date: t1a 19 �l s Job Site Address: �zr 5�4, —City/State/Zip:�� G�.ZC�O 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 ceAft u er the pains and penalties ofperjury that the information provided above is true and correct. Si ature: Date: Phone#: ( D a 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)egal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or ther legal entity,employing employees. However the owner of a dwelling house havinepot more than three apartm nts and who resides therein,or the occupant of the dwelling house of another who em�loys persons to do maint ance,construction or repair work on such dwelling house or on the grounds or building appurtliant thereto shall not ecause of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states�'that"every state local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business o to construct buildings in the commonwealth for any applicant who has not produced accep ble evidenc of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) , tes"Nei er the commonwealth nor any of its political subdivisions shall enter into any contract for the performance public ork until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to ; e contracting authority." Applicants Please fill out the workers'compensation affida vt mpletely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(�e�s)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' c a mpensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affida it may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be ure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the perm' or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding law or if you are required to obtain a workers' compensation policy,please call the Department at the number list 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 Departm t has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to ntact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a referenc number. In addition,an applicant that must submit multiple permit/licen a applications in any given year,need only s mit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should *te"all locations in (city or town)."A copy of the affidavit that hals been officially stamped or marked by the city or own may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new a avit must be filled out each year.Where a home owner or citizenis obtaining a license or permit not related to any bus' \,mmercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this . The Office of Investigations would lice to thank you in advance for your cooperation and shhave any questions, please do not hesitate to give us a ca!. The Department's address,telephone 6d fax number: The Commonwealth of Massachusetts rDepartment of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 0211.1 Tel. #617-727-4900 ext 406 or 1-8.77-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.gov/dia " Town of Barnstable Regulatory Services Richard Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,'MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize G arc i,,� e- SL.e /1011W to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) S' Mare of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILESTORWbuilding permit formAsmokecarbondetectors.doc Revised 050412 Town of Barnstable Regulatory Services ptrT Richard V.Scali, Director Building Division l i►tnsa>�. • Tom Perry,Building Commissioner 1639. 200 Main Street, Hyannis,MA 02/601 www.town.barnstable.ma u/s Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENS XEMPTION 1 Please Pri DATE: a JOB LOCATION: number street village "HOMEOWNER": name home one# work phone# CURRENT MAILING ADDRESS: city/to state zip code The current exemption for"homeowners"\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. DEFIN ION OF HOMEOWNER Person(s)who owns a parcel of land on which he/sh:Irsides or intends to reside, on which there is,or is intended to be,a one or two-family dwelling,attached or detachetructures 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 onla form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building ermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibih for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/sh understands the Town Barnstable Building Department minimum inspection procedures and requirements and that he/she will compl ith 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 persQn(s)for hire to do such work,that such Homeowner,shall act as supervisor." II; I 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 agi(nst 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. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD�YYYYi Fo 17/2014 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(SI. 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 endorsement(s). PRODUCER NAME PAUL SCHLEGEL SCHLEGEL INSURANCE BROKERS INC PHONE - -------- ---------- -----------------._.._-._(AIL.-No.Extl: 508-771-8381 nc No1508=7710663 _...__. 34 MAIN STREET E-MAIL ADDRESS: SCHLEGELINSURANCE@GMAIL.COM WEST YARMOUTH MA 02673 INSURER(S)AFFORDING COVERAGE NAIC r: INSURERA:NGM INSURANCE COMPNAY 14788 INSURED _ INSURER B:AMGUARD INSURANCE COMPANY Tecc Homes LIc - --- -- -- - ---'- ----- -- - . INSURER C: Po Box 87 --- - _...— INSURER D INSURER E. Sandwich, MA 02563 INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SELOV•1 HAVE BEEN ISSUED TO THE INSURED N•ANIED ABOVE FOR THE POLICY PERIOD -INDICATED NOT%AJITHSTANDING ANY REOUIREMENT. TERN OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VATH RESPECT TO Vd'HICH THIS CERTIFICATE IViA)' -BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY "rHE POLICIES DESCRIBED HEREIN IS SUBJECT TO .ALL 'IHE FERMIS. EXCUISIONS AND CONDITIONS OF SUCH POLICIES.1_110ITS SHO\%dN MAY HAVE SEEN REDUCED BY PAID CLANI& - - INSRPOLICY EFF �PO131 Y EXP—._...__— _._—__—__.—.__._............... .... L,R : TYPE OF INSURANCE INSR wVD POLICY NUMBER i (MP.1lDDl(I'YV) IMFAiDD,^rYYYI LIMITS j1 GENERAL LIABILITY i MPT8400P 109/09/2014 09/09/2015� EACHOCC RPPNCE ;S 1,000,000 i I $ COMfAERGAL GENERAL LIABILIT'+ - I f I DAF��GE —- SOO,OOO ?._.. n JEa occu:ren_eIi J1_=7M&1AADC i OCCUR 10,000X cxa lAr reor)- --------- ; PERSONAL SADVINJUP- 1,000,000 2,000,000 epee ✓IT.>P . s PER ` PRODUCTS.couPCP>c 2 000,000 _ I I AUTOMOBILE LIABILITY LIABILITY 1JSINGLE LIMIT BODILY INJURY;Per person) I l D SCHAUTOS BODILY BODILY INJURY fPe1.—de t, i 5 I. ao G v_n Fa=bP RT D ---- 5_._ .__._..__. .-... rU Ca I ccldenP,~M rE I UMBRELLA LIAR Oc_CUR ! EACH OCCURRENCE I S t ' EXCESS LIAR C`AItrSM.OE i CGPE--_ _...._-. '.. .. .... .. .......... B !WORKERS COMPENSATION 'WCT-1068672 10/Ol/2014i10/Ol/20151 ' _ AND EMPLOYERS'LIABILITY L_ —GRY LIMITS R YIN .. ... .o. Pr i P_P TIJE,?'chE CLT!VE - I E E-CH ACCI E4, 5 100,000 000 EXCLUDE_, �;NIA _ _ _..... (mandatory in NH) - = CbEASE E5 MPL �.O I i 100,000 If!es de SCube JGCer I L_'---------..------'----- 'D'. - T;;JPJ O`OPERA.TIONS beta;: ` i _ -sca:P L OD .POUCY LIMIT 500,000 i ! i DESCRIPTION OF OPERATIONS I LOCATIONS-!VEHICLES (Attach ACORD 101.Additional Remarks Schedule,if more space is required) I CERTIFICATE HOLDER' CANCELLATION JOH14 MCKENZI SHOULD' ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 37 CARELTON ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CENTERVILLE MA G2632 ACCORDANCE WITH THE POLICY PROVISIONS. - - AUTHORIZED REPRESENTATIVE DIJON55@HOTMAIL.COM s�198 -Z010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks Of ORD as ne s� { J k IQ ' ;. i 34 R 1 T h{H iF' ' ���r1ce xnex a p u .n t� \ "R z N aSSachusetts - x F �U. �Eri Of PUbli% safest"f # q� Board of 8ui'd'n R29iat or, and Standards CS-103589 CHUSTOPHER A BEAS!::Ed( 4 A 1. 4 Partridge Lane HarwichMA 02645 ye 03/1a/ 1R YOU W 1SH TO OPEN A BUSPESS? ForYour-bfDrm atiDn: Business certificates (cost$40 DO fDr4 years).A business cert:'cate ONLY REGETERS YOUR NAM E iz town Whih)�ou m ustdo byM G L.-sdoes notgie you perm ssbn tD operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that i,s required by law. 5 DATE: iv Jd l FJRn phase: a d APPL>vANT S YOUR NAM E/S: /!oh asJ 1d), ' BUSINESS YOUR HOM EADDRESS: /L14 126.3o 177L/-2S/-663(. /'15, Pa D /oNa7 lam,-.. L •� o �n o�1 L M TELEPHONE # Home Otehphone N um ber NAM E OF CORPORATDN :_ - Ce h4�r ram- ��; y� NAM EOFNEW BUSINESS Cary4;. e�—_� , C, n_ _� _ TYPE OFBUSNESS I - IS THIS A HOM E OCCUPATDN? YES _ /�1 I ADDRESS OF BUSINESS ;� rh O MAP/PARCELNUM BER261"l - D(C5 0ssessiZg) W hen starthg a new busness there are setieralthngs you m ustdoh order to be n com plane wih the rubs and reguht has of the Town of Barastabh. This fain is intended tD assstyou n obtaining the reform atbn you m ayneed. You M UST GO TO 2-0 0 M an St.- (comer of Yarm ouch Rd.& Man Street) to make sure),Du have the approprate perm its and)senses required to hgaIV operate yourbusness n the town. 1 . BUILDING CO IS ERA 0 MUST COMPLY WITH HOME OCCUPATION Ths n ' e izfD of y rm srequirem ents thatpertain to thi;type ofbusness RULES AND REGULATIONS. FAILURE TO MMENT 2 . BOARD OF ILTH This hdirslualhas be an ed of the peen_trequirem ents thatpel ain tD tiffs type ofbushess. ' `` MUST 4MPL'Y WITH ALL i'V(Vl HAZARDOUS MATERIALS REGULATIONS Authoried S.�nature* COM M EN TS 3 . CONSUMER AFFAIRS LICENSING AUTHORIL'Y) This ndirdualhas been hfDnn ed of the kensing requirem ents thatpertah tD the type ofbusness. Author>red Signature* COM M ENTS r 4s i �v TVu Vi LLinliL7bCi."lli Regulatory Services - P`• Thomas F. Geiler,Director Building Division MASS. Tom Perry,Building Commissioner pry a 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: 6b I =Eq 4- HOME OCCUPATION REGISTRATION Date: "0 0 Name: / �' Phone#: °77�'�Y- Z56 3 Address: ��J(o,� �"'( :� L��rh�Azle- ��ViIlage: Oo26 8 Name of Business: at,.�C" Deg�-s I Type of Business: ;t(201, Map/Lot: 9 11 - Q to INTENT: It is the intent of this section to allow die residents of the Twim of Barnstable to operate a home occupation ,vNit in single family dwellings,subject to die provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside die dwelling,. there shall be no increase in noise or odor;no visual alteration to die premises which would suggest anything other di�ui a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with die Building Inspector,a customary home occupation shall be permitted as of right subject to the folloiiang conditions: • The activity is carved on by die permanent resident of a single family residential dwelling unit,located h`'ithin that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to die dwelling which are not customary ui 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 qu<lntities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not widen the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one mailer 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 Custonia y Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in die Customary Home Occupation iviho 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 ccun registering. Applicant Date: /10 /O t Homeoc.doc Rei-.01/3/08 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 06 Application #�� `4 Health Division Date Issued !D Conservation Division Application Fee Planning Dept. Permit Fee k Date Definitive Plan`•Approved by Planning Board Historic - OKH _Preservation /Hyannis Project Street Address 3 f{ o f mWi is S r Village BA04US C AWke , Owner_3Oft" A I u s-re b Address 3'1 I OAAr#,� ""V Telephone Sri `ir y Permit Request i4A&Au--iLocw Ay _Dt1A0 ® ice Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio I ®� 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 � 13 Xs Historic House: ❑ No On Old King's Highway: ®'Yes ❑ No Basement Type: ❑ Full 6/Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) rj 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 b Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing 0 new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ dAttached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: s Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) _ y Name \irk Telephone Number Address _ o�'� �+��`�-1�-►�tJ� �s�'�9 License# C 5 00 7 Y 7 arr- o Home Improvement Contractor# 4 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO YAaw a, l� b S Pk�-%A(.._ ftrR(;y-I V� SIGNATURE (J� DATE e"EC� �� F FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. - ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE v ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. "~ v , 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 Legibly Name (Business/organization/Individual): Whalen Restpration Services Address: 22 American Way City/State/Zip: South Dennis, MA 02660 _ Phone #: 508 760 1911 Are you an employer?Check the appropriate box: Type of project(required): L® 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 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Zolition deling shipand have no employees These sub-contractors have 8. 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.]r c. 152, §1(4),and we have no employees. [No workers' 13-❑ Other comp. insurance required.] *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information.t Homeowners who submit this 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 attachfd 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: Arbella Protection Co. Policy 7 or Self-ins. Lic.n: 9091320408 Expiration Date: q� 1 �� Job Site Address: 3961 N�►Aw 5r (4�1,T City/State/Zip: 13a�N57-t�e3l� 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. 1752 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 S250.00 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 penalties of perjury that the information provided above is true and correct. Signature• � e{ �' _ 10 Date: Phone#: l 'T®'�r> 7G0 Official use only. Do not write in this area,to he completed by city or town officiaL .r t 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#: Dates 4/8/2,010 Timet 11t13 AM Tot 9,15087609995 Rogers & Gray Ins. Paget 002 Client#: 32193 W HALRES ACOR& CERTIFICATE OF LIABILITY INSURANCE Z08 0DDIYYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.-So.Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.0.Box 1601 South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC 0 INSURED INSURER A: Arbella Protection Co 17000 Whalen Restoration Services Inc INSURERB: 22 American Way INSURER C: South Dennis,MA 02660 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'N5K ADD'LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY (MMID IYYE POLICY EXPIRATION LIMITS A GENERAL LIABILITY 8500040398 04/01/10 04/01/11 EACH OCCURRENCE $1 000 000 nCOM MERCIAL GENERAL LIABILITY PREMISES(RENTED crrnce $100 000 CLAIMS MADE a OCCUR ME EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG s2000,000 ri POLICY JPERCOT- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/1JMBRELLA LIABILITY 4600021586 04101/10 04JO1111 EACH OCCURRENCE $ X OCCUR F CLAIMS MADE AGGREGATE $1 00()00O DEDUCTIBLE $ X RETENTION $10000 $ A WORKERS COMPENSATION AND 9091320408 04/01/10 04/01/11 X OR STATUS OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR)PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-FA EMPLOYEE $500,000 if yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500 000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Workers Comp Information-Included Officers or Proprietors Named Insureds are Whalen Restoration Inc dba Clean Air Systems;Whalen Services Inc dba Chem-Dry of Cape Cod Project at 3461 Main Street,Barnstable,MA 02630 CERTIFICATE HOLDER CANCELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Moan Hi mstead DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN 3461 Main Street NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Barnstable,MA 02630 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S50419/M50418 MEE 0 ACORD CORPORATION 1988 SHE r Town of Barnstable Regulatory Services r RA_FWSTABL- " Thomas K Geiler,Director MAIM :Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town_barnstable.ma.us Office: 508-862-4038 Fax: 508-790-62.' Property CNgIer-Must Complete and Sign This Section if Usin-A Builder I, SC 0—IT as Owner of the subject property hereby authorize U ,4,0,LCVv >��C"" ' -�'�`.� S to act on my behalf, in all matters relative to work authorized by this building permit application for. 3 y b b AA41 s c �� c, (Address of rob) signature of Owner Date � d'I`�`1" � t�✓pis -` .ems Print Dame If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. ` 'own of Barn able of IKE r Regulatory Se ices . o atitzNsrwst� Thomas F. Geiler, irector �P 5 A Building Di 'sion Tom Perry, Building Tommissioner c 200 Main Street,.Hy_ ._is, MA 02601 www.town.barn table.rrta.us . t Office: 508-862-4038 Fax: 508-790-6230 HONIF-OWNER LTC 'SE EXEMPTION ePlease tint e DATE: JOB LOCATION: number sit village name h me phone# work.Pborlc# CURRENT MAILING ADDRESS: city/town stato rip code r"hdMEO US"was exte ed to include owner-occupied dwellings of six units or less and The current exemption fo to allow hQmr-owners to engage an individual for h' e who does not possess a license,`provided that the owner acts as supervisor. DEFIN ON OF HOMMOWNER Person(s)who owns a parcel of land on vihich he/s,e tresides,or intends t6xeside, on which there:is, or is intended to- be, a one or two-family dwelling, attached or detac ed structures accessory to such use and/or farm structures. A person who constructs more than one home in a tw•-year period shall not be considered a homeo wner, Such "homeowner"shall submit to the Building Official n a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109,1.1) The undersigned"homeowner"assumes responsibrlr'ity for compliance with the State Building Code and other applicable codes, bylaws,riles and regulations. The undersigned"homeowner"certifies that_he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements an i that 6`clsbe will comply with said procedures and t i requirements. � t Signathrc of Homcowncr t Approval of Building Official Note: Three-family dwellings containing 35, 00 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Contr 1. HOMEOWNER'S EXEMPTION .The Code states that "Any homeowner performing work for which a building perrrrit is required shall be exempt from the provisions of this seetion.(Scction I D9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a pa-son(s)for hire to do such work., that such Homeowner shall act as supervisor." Many homeowners who use this exemption arc unaware that they arc assurning the responsibilities of a supervisor(sec Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awarcnessoften results in serious problems,particularly When the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it mould with a licensed Supervisor. The homcowncr acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of hisAcr responnbilitics,many communities require,as part of the permit application, that the homeowner certify that hdshc 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 foraVccrvfication for use in your corrununity. Ll Nlti�MOO V-, �1 Co � . t EMERGENCY DATA SHEET Owner: Phone: Address: Work: City/State/Zip: FAX: Cell: Mail Address: Phone: City/State/Zip: Tenant: Phone: Manager: Phone: Contact: Work: Type of Loss: Areas Affected: Cause of Loss: Date of Loss: Insurance Company: Claim#: Policy# Deductible: Agent: Phone: Address: Fax City/State/Zip: Adjuster: Phone: Address: Fax`: City/State/Zip: f If other responsible for bill: r Name: Phone: Address: Company: City/State/Zip: P.O. Box#: Called in by: Date called in: Time: Cross street: Map page: Referred by: Info taken by: Notes: Appointment: Key/Access: Childs 398 2556 15-20-30-40 CC Trailer 362 2721 - i , 1 rc ` . e f ..• I` F .. 3 ` J1 i `"lo r J 1MR" 1 7+ 1 pA Zla<aachwseus - DclYartment of Public Safeth Board fit' Buildinu Re.uulailfitis and Standards Construction Supervisor License %.Ecnse' CS 74928 Rest*icted to: 00 WILLIAM WHALEN 122 POND STREET ! BREWSTER, MA 02631 f Expiration: 8/10/2010 ,,,tfna,• .a+cr Tr-;;: 1937 ..a&h �/�`z°�a�Zccaatita License or registration valid for individul use onl; ate\ Office of Consumer Affairs&Business Regulation e g - - -- HOME IMPROVEMENT CONTRACTOR before the expiration date. 1f found return to: Office of Consumer Affairs and Business Regulat Registration: 129244 10 Park Plaza-Suite 5170 Expiration: 7/30/2011 Tr# 287004 Boston,MA 02116 Type: Private Corporation Whalen Restoration Services Inc. William Whalen - 22 American Way South Dennis,MA 02660 undersecretary Not valid without signature °FTME . y The Town of Barnstable • snncvsTnai.E, Department of Health Safety and Environmental Services ,. �TEOMA'�p Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner July 16, 1996 Jeff Lyon Business Digest 72 Winter Street Hyannis,MA 02601 Re: 3461-Route_6-A,_Barnstable,�MA (Main Street&Braggs Lane) Dear Mr.Lyon: We have investigated the zoning status of the apartment owned by Mr.and Mrs.Himstead at 3461 Route 6-A,pursuant to your inquiry. We found no zoning violations at that address. Sincerely, Ralph M. Crossen .Building Commissioner RMC/km cc: Scott Himstead Warren Rutherford,Town Manager June 25, 1996 Jeff Lyon Business Digest 72 Winter Street Hyannis, MA 02601 Dear Jeff, Regarding the material you dispatched to Warren Rutherford, the photograph which you included was of the barn at the rear of my property, and detached from my house. Surely you must have been aware of this, and mistakenly indicated that it was a photo of the outside of an apartment which is attached to my main house. There never have been tenants of this barn. And regarding the apartment, it has been a permanent fixture of my property since the house was built in 1797, thus was grandfathered when single family zoning was adopted for the area. All of the windows are intact. Scott Himstead i cc: Warren Rutherford - - FIRE DISTRICT. aP NO._. LOT NO. .. 3� f SUMMARY STREET M2ITi St. & Braggs :I+STle Barnstable LAND _. ss 7 oa 299 . 9 B G o 0 73 BLDGS. OWNER TOTAL LAND Z OOa 73 BLDGS. RECORD OF TRANSFER DATE BK PG, I.R.S. REMARKS: �9CIOi w TOTAL 17� 1-2130.58 it at'; Z. 1 a 7S" LAND Za 7400ebb, F�-Bhelii;F ^I -8_74 067 212 ( 85,0 �m BLDGS. 'L� o t .mstead, Sclott.& Joan S. 7 , 1.73a TOTAL 9 �O OQ ?. S 1fi/LrG � � /x ia.U�ts�ta Rrr. 7 NO BLDGS:ol =554"-5Z `. TOTAL. 7 LAND , BLDGS. TOTAL LAND BLDGS. i r.- - 0) e TOTAL �a u T•� 7 LAND ! Tic fj d BLDGS. i TOTAL i? LAND' BLQGSI 0I iTERIOR INSPECTED: �;,.. � � TOTAL k - ', LAND � ATE: ��.p 7-7�, ACREAGE COMPUTATIONS BLDGS. TOTAL LAND TYPE # OF ACRES PRICE TOTALFDEPR VALUE . LAND JSE LOT ZO Ce®fJ 000 O o _ � BLDGS. ARED FRONT �® TOTAL REAR Q Sc 5 LAND ,ODS&SPROUT FRONT d� O d �� BLDGS. REAR ,�. �� ✓ -�/g ca ��lt5' t 01 TOTAL STE FRONT LAND REAR - BL DGS.S. :�• TOTAL LAND —t a /1 0) BLDGS. LOT COMPUTATIONS LAND FACTORS TOTAL } FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND s ROUGH TOWN WATER BLDGS. i HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND SWAMPY NO RD. BLDGS. € TOTAL TOWN OF BARNSTABLE. MASS. UNITED APPRAISAL CO., EAST HARTFORD,CONN. f 'FOUNDATION BSMT. & ATTIC PLUMBING PRICING F'OMMAC3. LAND COST - .�dDnrt�/1 y `- ?onc.Walls Fin.Bsmt.Area Bath Room 6r.r� Base 5- aZO BLDG.COST Conc.Blk.Walls Bsmt.Rec. Room St.Shower Bath Bsmt. Conc.-Slab - Bsmt.Garage -St. Shower Ext. ��O y0 PORCH. DATE Walls f6 PURCH. PRICE Brick Walls _ Attic Ff.&Stairs ' Toilet Room Z Roof .�- RENT drJ /'Q�� Stone Walls / Fin.Attic Two Fixt. Bath _ Floors Piers INTERIOR FINISH Lavatory Extra z -7 I _ ;r Bsmt. F f 2 1 3 Sink Z ' % /Z 1/4Plaster A Water Clo. Extra Attic N L d5 EXTERIOR WALLS Knotty Pine Water Only /,/� � 1,J�'5�4���jy% gg /J. ✓ / 4 Bsmt.fin. i9 Double Siding Z Plywood No Plumbing Single Siding Plasterboard Int.Fin. f -t,?r Shingles z TILING tConc. BI k. G F P Bath Fl. Heat a a d: _ _ Z -•sue Face Brk.On Int.Layout �/ Bath FI.&Wains. Auto Ht.knit /3� 30 Sore riG 9 3,� °gyfx' U i' ,. Veneer Int.Cond. Bath Fl.&Walls Fireplace YnoO =174 -Ile- s i Com.Brk.On HEATING Toilet Rm. FI. Plumbing Solid Cam.Brk. Hot Air Toilet Rm.FI.&Wains. I 1 Tiling Steam / Toilet Rm.FI.&Walls Blanket Ins. Hot Wa St.Shower jRoof Ins. Air Cord. Tub Area Total , Floor Furn. ROOFING COMPUTATIONS ' F. Asph.Shingle Pipeless Furn. :a/ 7 / Wood Shingle- No Heat p/ S.F. .a Q�y /hC -Asbs.Shingle.- Oil Burner - S.F. `Slate Coal Stoker •' ! �S.F. F /ile Gas r S.F. (e� OUTBUILDINGS ROOF TYPE Electrc `® ; }� F t�.s � b� 1- 2 3 415 51?1 8 1 9 1^II 1 2131415 6 7 E Gable I Flat _ -- Hip tnansaru' FIREPLACES �a7 S.F. C Pier Found. I , 1 I t Floor. Gambrel Fireplace Stack Wail Found. r 0.H. Door r� �C Q �j lQ Q I I _ic rcr FLOORS Fireplace Sgle.Sdg. I Rol Roofing FConc LIGHTING Dble.Sdg. Shingle Roof E Earth No Elect. — •••� + Shingle Walls (Plumbing .t l n fj P IJ� [ :Hardxood ROOMS Cement Blk. Electric "• Bsmt. 1s z t71- 7/t TOTAL O a'3 Brick Int.Finish AsDh Tile . '.Single 2nd 3rd FACTOR •� 4-,5 3/6 / C/ rs/ L - REPLACEMENT 5.,.,.,. .. . y;OCCUPANCY � '..CONSTRUCTION .SIZE AREA CLASS ''AGE REMOD. COND. .REPL:.VAL. Phy.Oep. PHYS. VALUE Funct.Dep. ACTUAL VAL.' -. ovvLG ` . /Coat/ s; /`) f! S� 1790 r (: g r4 Kgd 10 ,:yw•� - ,TOTAL. As ffioe (1st floor)- 4 ® THE A ess is map and lot number ... . ..- �:-�.. �o�` Toff Board of Health (3rd floor): � .�22---�-77 � Sewage Permit number ...... . L................................... ' "" .. Z BARM39TAIDILE, Engineering Department Ord floor)- oo `b 9• House number ..................................... ......p .( ................... 0 APPLICATIONS PROCESSED 8:30-9:30 A.M, a d 1:00 2:00 P.M. only - 6h TOWN OF BARNSTABLE BUILDING INSPECTOR v V 01dAPPLICATION FOR PERMIT TO '�- .�t.1............................................................................. TYPEOF CONSTRUCTION .............................. .................................................................................. )r-eAD!....YJ.......................19..Q..v TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according tot following information: Location . !�,1..�.... :l.�r�.... ..r!..l...l...;. ... /,!JrL,�� . .......................................................... Proposed Use ... � ... .�.CX ........ C !. 6 ............................................................................... ....... Zoning District .... �. ....................................................Fire District ....:..Czl•• - ................................ Name of Owner--�d 1�.. � C b �� � Iddress - Name of Builder .0.G-+.T..E.A-SyCVCA7,.S 4.Address��J... Name of Architect \CA-A.k ... 5 )..4��. v...................Address Number of Rooms .............1..................................................Foundation ...IS ..(5v.)6....ccX.)..- . --�..... Exlerior �-el.,.................................Roofing ^ Floors .. Q.0.8.................................................................Interior �7..� .1....!4.U.G�I..................................................... Heating ...EAe.. ................................................Plumbing ........��C'c ..r�U�J6? 7 Fireplace .....10...0.....................................................................Approximate Cost ... Z ................................... Definitive Plan Approved by Planning Board ____________________________19_______ , Area ..... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 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. d c c, 17'; Nome,�.... .... . . .... ... .. . .. .................. Construction Supervisor's License 13..�?f.9...... HIMSTEAD, JOAN & SCOTT 30510 REMODEL DWELLING ................. Permit for .................................... A )k S i ng.je..X:AiM.j.],y...J).W.Q 'I ........... Location ....3.4.6.1...Ma.in...S.tr.e.e.t................... Barnstable ............................................................................... Owner ...........Joan & Scott Himstead ....................................................... Type of Construction ........FX?KXQ.Q..................... ........................................................ ...................... Plot ............................ Lot ................................ . Permit Granted ...............................March 12,..........19 87 44 Date of Inspection ....................................19 Date Completed .......... .............19 .