HomeMy WebLinkAbout0049 BUCKINGHAM WAY Wl�lj
I
i
THENORFOLK DEDHAMGROUP®
October 6, 2015
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B
Building Commissioner, or Inspector of Buildings
c/o City or Town Hall
367 Main Street
Cotuit, MA 02601
Board of Health or Board of Selectmen
c/o City or Town Hall
367 Main Street
Cotuit, MA 02601
Fire Department or Arson Squad
c/o City or Town Hall
367 Main Street
Cotuit, MA 02601
RE: Our File No.: P1501447
Insured: CHRISTIE ZENOPOULOS
JACQUELINE ZENOPOULOS
Address: 49 BUCKINGHAM WAY, COTUIT, MA
Policy No.: H1036157A
Loss Date: 09/28/2015
Loss Type: Building or Other Structure Damage
A claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause Mass. Gen. Laws, Ch. 143, Sec. 6 to be
applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct
it to my attention and include a reference to the captioned insured, location, policy number, loss
date and claim or file number-.-
If no reply is received from your office within ten days, we will assume you have no liens of any
-type against this property, and the claim will be paid in our customary manner.
Sincerely,
Marie J. Landers' 3.4
03
Property Claim Examiner LJ r
1-800-688-1825 x1136
NORFOLK&DEDHAM MUTUAL FIRE INSURANCE CO. 222 Ames Street,P.O.Box 9109,Dedham,MA 02027-9109
DORCHESTER MUTUAL INSURANCE CO. Telephone:(800)688-1825
FITCHBURG MUTUAL INSURANCE CO. 0 Fax:(781)329-1818
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel \� D Application# D16 Z 9
Health Divisio —2.� 91 3D-4.10
Conservation Division Permit#
Tax Collector Date Issued
Treasurer Application Fee 4,9 O
Planning Dept. Permit Fee
- D
Date Definitive Plan Approved by Planning Board 3� (�
Historic-OKH Preservation/Hyannis U
Pro ecct"Street d s s
Village �--.
downer Address 12-12v►i-e.
,,Telephone .V;Lk- /K&a &I , ?a — 6 2e? 5 84
Pe�rrriit=Request.�.
Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
>�rojectiValuation r ,�( P�t --Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family V Two Family ❑ Multi-Family(#units)
�y
Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No
Basement Type: ❑ Full Ulcrawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) 74, 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: VN
s ❑Oil ❑Electric ❑Other
I
Central Air: El Yes o Fireplaces: Existing New Existing wood/coal stove: Yes O No
c-_.
Detached garage:❑ xisting ❑new size Pool:❑existing ❑new size Barn:❑existinlg ❑new-. size~:
co
Attached garage: existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ I x
w rn
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
1*1
� OUX)9f BUILDER INFORMATION �v� �/z�:� e Q
ZName--i rQo19( �R. rs , Telephone Number
VAddrress �;� t� �`lrl4L,_., ,&, A6Zgo&, License#
774, Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
(SIGN URE,,, f�� �, 4' j�iE, i DATES L�
FOR OFFICIAL USE ONLY
PERMIT NO.
.r t
DATE ISSUED '
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER • . �� ,
DATE OF INSPECTION:
FOUNDATION Al f2
c 4
FRAME q
INSULATION
t
r FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT s
i
ASSOCIATION PLAN NO.
r
°FIME, Town of Barnstable
ti
Regulatory Services
9'"MA�eg" Thomas F.Geiler,Director
4'A 039 Building Division
RFD MA'S a
Tom.Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601 1
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: �508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more.than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements. •
Type of Work: OVI -D �' I IR 1 /01-AC 1— Estimated Cost
Address of Work: +9 13VGx ; NGHAM WA ey, COrV1 T
Owner's Name: ERE DIR J C P. C l-A u S s E N
Date of Application:
i
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded by law
❑Job Under$1,000
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Signature Registration No.
J `2 G C 2 OR
r
Date t Owner's Sign&&e
Q:wpfiles.forms:homeaffidav
Rev: 060606
e Gommonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' a 600 Washington Street
Boston, NIA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: builders/Contractors/Electrzcians/Plu>�abers
Applicant Information Please Print Legjbly
Name (Business/Organizationllndividual):
Address:
City/State/Zip: �/f Phone #:
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
employees(full and/or part-time).
have hired the sub-contractors El New construction
2.❑ I am a sole proprietor or parser- listed on the attached sheet t 7. ❑ Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
working for mein any capacity. workers' comp.insurance. 9. ❑ Building addition
o workers' comp. insurance 5. ❑ We are a corporation and its
officers have exercised their 10.❑ Electrical repairs or additions
required.]
3. 1 am a homeowner domg all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.] t employees. (No workers' 13.[:1 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
ZContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information.
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.Lie. ##: 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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the p and penalties ofperjury that the information provided above is true and correct.
JSign Date: 9
Phone#: �� 7��� to �A rr /
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License# 4
Issuing Authority(circle one): 1
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other '
Contact Person: Phone#:
1
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 cornmo.nwealtb 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 R—LC)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. Anew 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, MA 02111
Tel. L 617-727-4900 ext 406 or 1-877-NIASSAFE
Fax #; 617-727-7749
Revised 5-26-05
wwtiv.mass.gov/dia
Town of Barnstable
ZNE 1p�_
Regulatory Services
S � ?BARNSTABLE, Thomas F.Geiler,Director
MASS
i639. Building Division
Tom Perry,Building.Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: /� �,�•
JOB LOCAnON: 9 !✓ VC K/ N G I4 '1 A l C O T U I T
!a number street village
"HOMEOWNER': FR E Q IR I C P C iLAV 55�5N, 5VX- *98- 40 SLY-4375-009
name p� ` home
/phone# work phone#
P.
CURRENT MAU.NG ADDRESS: I�. 6 tip k 9d
o TU I.T MA , o a.V 3s""
city/town state zip code
.The current exemptionfor"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 .
suvervisor.
DEFINMON 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'dwelting,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"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
eme
C&,,�
V
ignature 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:
.Q:forms:bomeexempt
I
I
vy �u�K,�G�M �Ay
Town of Barnstable
Regulatory Services
B MOUBIE. Z Thomas F.Geiler,Director
39, Building Division
Thomas Perry,CBO,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-8624038 Fax: 508-790-6230
PLAN REVIEW Mrr-- ;
7O7
Owner: C L�u ss Map/Parcel: a ( Q 7 D
Project Address � 49acArl cdWK-k UAyBuilder: �--
C
The following items were noted on reviewing:
Alv � N a R reOPJ Q Je ��+-}1 P.,-N I R lc✓Jc-!�'��
1149-r=-� D N /V G 4- /Lt u Jc y 4 C"0Ns rga cry
per� 3 Colo _
Aso Qu,r 62� Ali
Reviewed by: 12
Date: oZ D
Q:Forms:Plnrvw
o•;`t TOWN OF BARNSTABLE -
�., , Permit No.
1 »n Building Inspector
7 �Yl
Cash
" 9
OCCUPANCY PERMIT Bona _
"No building nor structure shall be erected, and no land, building or structure shall be
used for a new, different, changed, or enlarged use without a Building Permit therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector."
Issued to 0 Address
i.n* �A �, ^nr_ Ru,�ki.nrrhrr, � (�-�'rx+rl l;r� r C�i•_i�i �.
Inspection date
Wiring Inspector r� � `
1
Plumbing Inspector ,, �_t+ t � Inspection date
Gas Inspector Inspection date
Engineering Department .�-Inspection date J r ' (%
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.
.1�.1 .._........._. 19 � ...................................................
tBuilding Inspector
LoT I Cj4
r. .:;.
frl
S� 14
to . .... __... .7,- 'y CX(ST)t4h
r09
Tov►]P�iaT,o o
34'
y I-4 �j$°- - 4 "v\/
vc- Is (,i c-,
ELEVATION OF TOP OF FOUNDATION
I CERTIFY THAT THE FOUNDATION
SHOWN DOES NOT VIOLATE ANY
EXISTING ZONING RFGULA'fION OF
THE TOWN OF �� 5 � A` �OW N o €
rL ..
O WALTER 4G
OLDHAM
*23207
9.
i4 t
Assessor's map and lot number .... %.. o.� ..�.. 0c laC)�;i-
THE Tyr
'
softP
4 .....� '............................. M
M
Sewage Permit Permit number .0
J-y � ` O STABLE, *
House number ..."�...�t..�...... ............... M Aea
4 Er VIRONMENt IT1.E 6 0,�0 gar Ar
TOWN OF BARNSoEAN
N$
BUILDING INSPECTOR
APPLICATION- FOR PERMIT TO ....Gy.�.-;o... ` �Z 1.,�L..5 ..
\\�
TYPE OF CONSTRUCTION .tiG - ...................:...................................
.`1........................>!9�. ..
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .......................................................................... .......
.............. - .......................... �.
ProposedUse ... ........................................................................................................................................................
Zoning District ...�@5t. �'k 't!� �.. ...............................Fire District (�0.JA,...4.! ...................................................
Nameof Owner ... . ..............Address ....................................................................................
Nameof Builder .......SZ�k.. V'g...................Address ....................................................................................
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ......Foundation . " �....�
aI..........................
Exterior ...` �...C� z�-..............................................Roofing ...... 5� 2.1. .....................................................
FloorsCZVPeu. ........... ............................Interior .............................................................
Heating ...... .1. `
..�..�.. .................................Plumbing d .. . 3,.V:S..........................................
4 O
Fireplace��4�. ..............................................................:Approximate Cost ........'t'.�ro�...G.......................... . .......
Definitive Plan Approved by Planning Board -----------______-----------19 . Area /�� 'S'�.. ... ..... . .
Diagram of Lot and Building with Dimensions Fee ....... ............................
SUBJECT TO APPROVAL OF BOARD OF HEALTH �allo
D1
I hereby agree to conform to all the Rules and Regulations of th n of BC%er g the above
construction. Name �....... ........
Blakely, ;eorge W. A=L1-40
ZNo 24343...... Permit for .1a..s.tory..dwe1•l:ing
side family..dwell.i.ng........................
Location lot119A....49..Bucking
7ai..D�•�... '
...................QQ.W .Z...............................................
Owner ......�oxge..W....Blakely.......................
Type of Construction try...............
....................•...........................................................
-Plot ....................... Lot ................................
Permit Granted ........................Ani6.4`19 79
Date of Inspection ........ ..........................19
Date Completed ..:,/ ... ..............19
PERMIT REFUSED
.... 14W.................................. 19
fx
.Qs.,.2. ............ .....`_..,....................
a. . ......................;...................... �.
a. ..................
..........I.� ®.o.............................................
fn
:. .....................:...::::...... 19 r
Appr o0 O
............................................................ . .................
.................. .........................................................
y/
........ .., ` �/1 /)C/),;7- 5 -9- y. ' THE
As'sessor's map and lot number . / .�./ '� 1 7
-'sewage Permit number Af
........ .z............................
v Z BABB�98TADLE, i
House number ........... ....C- ...........:.........................
: a
ep�,a�.i639. 00�
�F4 MPY a�
TOWN OF BARNSTABLE
BUILDING INSPECTOR
A - \we � . �.� S DIe�
APPLICATION FOR PERMIT TO(�..............\....... .................................... ........................ .................
44.:
TYPE OF CONSTRUCTION ... `� .! .`.`" .................... ......... .....................................................
..-....................... �.�..
J
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location 1 cc,,,,- c� %t�C��� �����. 1 Cx�or �� ..�.Q CG f
(rr.
��z�Stza�e
................. v ........................ .............. ....... ......................
ProposedUse .............................................................................................................................................................................
.. ............. .....Zoning District ...............................Fire. District Cn �. . ...:...............................................
a tt
Name of Owner QUvC���, , � K ..............Address
.................. .....................P...
Name of Builder ...........S 'n- ...2 ... �aVKi....................Address ....................................................................................
Nameof Architect ....................................................................Address ......................................................................................
.....f �L�w�....;S�C�o ......Foundation s"1r� ....\.aV^Cv P..........................
Number of Rooms ........... .... � ..........
Exterior l�J`1.t C C�? Roofing ....... ..���
``...............`... \.........................................................
Floors .... z�.P4.................................Interior .��rJz. ..•Z..1......................................................
Heating •�� -� • �!.. ................Plumbing 'G.p, +..>.
.......... ........ .....................
Fireplace v Approximate Cost q f�� Gv.>............................. ................r..................................... ..
Definitive Plan Approved by Planning Board -------------------_-----------19--------. Area s'` ..: ...............................
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH ���
7 �7
r
hereby agree to conform to all the Rules and Regulations of the`Town of Barnstable regarding the above
construction.
4 � 4
Nam ...+ ..........`.................... s ................
Y
Blakely, George W. ;,A=/2{1-40 .
2I34 Permit for .... e..&Wry..dwel•ling
....... ; 1ingle...famil y...dwelling
Location ...1Qt..#19A....49••Backi
Qatuit......................../............................
Owner ....CeQr9e..W.....B akkeLy........................
Type of Construction .......fra'm........................
............................... ., ......................
Plot ............................ Lot ' ......................
Permit Granted ....19
...... """"June"4 79
Date of Inspection ....................................19
Date Complete ......................................19
PERMIT REFUSED
....... .. ................... 19
.. ..... .� .. ........... ...............
................... ........... .. . ... .................
...............................................................................
Approved .......1 ................................. 19
..`.......... -.. 0............................. _ .................
...............................................................................