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HomeMy WebLinkAbout0082 TIMBER LANE I ?live M9 a . , 4 Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 i 9/20/19 Brian Florence CBO Town of Barnstable Building Division ?' o� 200 Main St. Hyannis,MA 02601 RE: Insulation Permit B-19-2855 r, Dear Mr. Florence: This affidavit is to certify that all work completed for 82 Timber Lane,Marstons Milles has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey Town of Barnstable Building • eeaivsrABM L Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept ° Posted Until Final Inspection Has Been Made. Permit ct Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-2855 Applicant Name: William McCluskey Approvals Date Issued: 09/10/2019 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 03/10/2020 Foundation: Location: 82 TIMBER LANE,MARSTONS MILLS Map/Lot: 149-058 _ Zoning District: RF Sheathing: Owner on Record: AGUILAR,JOSE Contractor Name: William J McCluskley Framing: 1 Address: 82 TIMBER LN Contractor License: 102776 2 MARSTONS MILLS, MA 02648 E Est. Project Cost: $3,900.00 Chimne Y: Description: Add R-30 cellulose to the attic.Add R-10 rigid insulation to the Permit Fee: $85.00 basement.Air seal the attic plane and basement with expanding 1 Insulation: foam. General weatherization. � Fee Paid:. $85.00 Date: 1 9/10/2019 Final: Project Review Req: ��� Plumbing/Gas Rough Plumbing: \Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced withinRsix months after issuance. All work authorized by this permit shall conform to the approved application and thetapproved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. I . I J� A/ Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this,perm it. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: £�n'►/4y L_ S Ea'1' Town of Barnstable Building Department Services Brian Florence, CBO Building Commissioner BARNSTABLE 200 Main Street Hyannis, MA 02601 °"°""�"��'� ""`'`°""'""'MANE � Y � 1639-301a www.town.barnstable.ma.us �� Office: 508-862-4038 Fax: 508-790-6230 Notice of Zoning Ordinance Violation(s) and Order to Cease, Desist and Abate: Jose Aguilar,82 Timber Lane,Marstons Mills,MA 02648 and all persons having notice of this order: As property owner or tenant of the property located at 82 Timber Lane,Assessors Map 149 Parcel 058,you are hereby notified that you are in violation of Part 1 of the Town of Barnstable General Ordinances, Chapter 240—Zoning, and are ORDERED this date 9/10/2019,to: CEASE AND DESIST all functions associated with the following violation(s)on or at the above mentioned premises: Summary of Violation: On 8/26/2019,I observed a violation of the Barnstable Zoning Ordinance Chapter 240 Section 240- 14(C)(1) Specifically, operating a commercial landscaping business in a residential neighborhood without a special permit. Summary of Action to Abate Violation: In order to abate this violation and to avoid further enforcement action by this office, commence within 30 days upon receipt of this notice the following action: Cease operation of the commercial business from above address which includes storage of commercial equipment on property or obtain a special permit through the Zoning Board of Appeals for a home occupation. And, if aggrieved by this notice and order, you may file an appeal with the Town Clerk of Barnstable, specifying the ground thereof within thirty (30) days of the receipt of this order (in accordance with Chapter 40A Section 15 of the Massachusetts General Laws). If, at the expiration of the time allowed, action to abate this violation has not commenced, further action as the law requires will be taken. By Order,, Jeff Carter Local Inspector MORTGAGE INSPECTION PLAN YOUR FILE NUMSM IVIL ENGINEERING ' NEWTONVILLE,MA 02160 TELEPHONE(617)965-0789 I hereby certify to: LOT 5 LOT 7 LOT 6. ou I v 0 AND Ai KE W_ LEE )962' i3r5A .24.19' That the permanent structures are approx- imately located on the ground as shown and they HAVE conformed to the setback requirements of the local zoning ordinances in effect at the time of construction,and that there are no encroachments of major LOT 35 improvements either way across property 20,093 S.F. lines except as shown. Zia DECK Comments: LOT 34 /SPUT LEV L LOT 36 pi d = 40'i I further state that according to Federal ,w ——— Emergency Management Agency maps,the I major improvements on this property fall in 33' an area designated as Zone C Community Panel No: I f Effective Date: 20.00 A = 148.77' (Note:Zone C is areas of minimal flooding) NOTE: This plan was prepared in accordance TIMBER with the procedural and technical standards for /� Mortgage Loan inspections as adopted by the LANE Massachusetts Association of Land Surveyors and Civil Engineers Inc.and use for any other purpose is prohibited.This plan was not made for recording,preparing deed descriptions or con- struction. tp .(.7 VARTAN T. c✓' c MOORADI dv 4 No r TE yob APPLICANT: Rif I v 0 AND At tr;= w L DATE OF EE INSPECTION: MAR 12, 1992 HD SURv� SCALE: ►~ = 40' t LOCATION: 89 TIMgER LANE . ARSTON MILLS. MA DEED: 4204/98 PLAN:'247/82 i 0 MORTGAGE INSPECTION PLAN Yo'-"LE NuMeim AM=WEE T= AM ",V CIVIL ENGINEERING r NEWTONVIL.L:E,MA 02160 TELEPHONE(617)965-0789 I I hereby certify to: LOT 5 LOT 6. LOT 7 RII I Y 0 AND'ALIC'F W_ LEE 1962' . i35:6f)' .24.19' That the permanent structures are approx- irnately located on the ground as shown and they HAVE conformed to the setback requirements of the local zoning ordinances i in effect at the time of construction,and that there are no encroachments of major LOT 35 I improvements either way across property 20,093 S.F. I lines except as shown. DECK Comments: 4 1 LOT 34 = /SPUT LEV L re) LOT 36 40't I further state that according to Federal ———— Emergency Management Agency maps,the major improvements on this property fall in I 11 an area designated as Zone C 133' I Community Panel No: I I t Effective Date: = 1 (Note:Zone is areas of minimal flooding) 20.00'�J A i48.7T t 1, NOTE: This plan was prepared in accordance T I M B E R with the procedural and technipal standards for LANE n I E Mortgage Loan inspections as adopted by the L H i V Massachusetts Association of Land Surveyors and Civil Engineers Inc.and use for any other Purpose is prohibited.This plan was not made for recording,preparing deed descriptions or con- struction. O'F &I t� VARTAN T. c MpORA01 No. TE yob APPLICANT: Rtt I Y 0 AND Al ICE w LEg DATE OF �yD SURF. INSPECTION: MAR 12, 1992 — SCALE: r = 40' 'h LOCATION: AP TIMRFR 1_ANF MARSTON MILLS MA DEED: 4204/98 ~ PLAN: 247%82 r. Assessor's office(1 st Floor): I q 0 s�y Assessors map and lot nu r d i THE SEPTIC SYSTiEM Conservation — / - INSTALLEQ IN '• Board,of Health(3rd floor): w , ■r11 H ct ✓�� Sewage Permit number a ENVI TITLE ' RONMENTAL MASK Engineering Department(3rd floor): � .: (,'�,! � i0 9• House numbei Towiv REr� Definitive Plan Approved by'Planning Board 1g• APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1*00-2:00 P.M.only, ` TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned her permit applies for a permt according to the following information: re Location /� ca 72,o z-� � AeA�A-11 AW/-Zz Proposed Use ,z,7[)/V Zoning District- Fire District �� y Name of Owner f��/ (� �� Address Name of Builder � ,2Z� Address__ Name of Architect Address t--� Number of Rooms FoundationX/S Exterior S n r S Roofing Floors Interior Heating Plumbing Fireplace Approximate Cost ���� Area Diagram of Lot and Building with Dimensions Fee �� i 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. _ I Name Construction Supervisor's License i LEE, BILLY 0. _0, hl- No `� Permit For ENCLOSE DECK. Single Family Dwelling Location 82 Timber Lane Marstons Mills Owner Billy 0. ' Lee r Type of Construction Frame Plot Lot is 4 , Permit Granted July 1 , 19 93 . Date of Inspection 19 Date Completed Q 19 • td± a "�„o•"' . TOWN OF BARNSTABLE 25182 ` Permit No. ----------—------------------ V Building Inspector cash • ------ � OCCUPANCY PERMIT Bond ______Y' ------� Issued to Scott K. Kurtzer Aadress North Reading, M lot #35 82 Timber Lane, Marstans Mills Wiring Inspector //G' rT Inspection date /Pz w r Plumbing Inspectorx, - Inspection date 1 Gas Inspector 12 Inspection date I-Engineering Departmentt��t � ��__ Inspection date— Board of Health � h ,YJ S�G �t� Inspection date 15 _-5_ Vy I: 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 SECTION41'9.0 OF ,THE MASSACHUSETTS STATE BUILDING CODDE. 19......_._ .........................IZAI� .................c.................._........-........_........._._...... [ U Building/ Inspector FROM TOWN OF BARNSTABLE 6 �.� .�. BUILDING DEPARTMENT anci L;thteine '367 MAIN STREET - HYANNIS, MA 02WI Taan Clerk Phone: 775-1120 SUBJECT: j FOLD HERE - T DATE MESSAGE "cc letr�ci tmr der Permit w#25182 (Scott R: Kurtzer) i Work has been •. `Please release Bo€>d. R wars:r-....,r.� _�s/•{*dF9aK,K i+,+n®e.r+►•ss�..r. iSIGNED DATE I _ REPLY 7. • .. ` - SIGNED .1- Ne74"MI RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY - + _ • PRINTED IN U.S.A.. SENDER: SNAP OUT YELLOW COPY,ONLY.•SEND WHITE AND PINK COPIES WITH CARBON INTACT. / Assessors map and lot number ...L..7.. ... P........... L' Q�aF THE t�`y 0—"f y wage Permit number ....... ...-! �............................ ffJf \A Z EARNSTSDLE, F�lHouse number ...........�... Z ..................... .. s rasa b o a M a' TOWN. OV BAD ��t BUILDING INS? TOR APPLICATION FOR PERMIT TO ........ rviC�.�c.....T.. C?�.� �1........... Si�</.� ......... ... 2 ................ TYPE OF CONSTRUCTION .......V!�.�?. ..0 l�".............. .1 Q.. ?'..�.e........................... ............................... .....S.....................19 ..1. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location L..l.... .� ....:.....J:�Tyl.. �r......:.4-.`t!?.. ' ................................./ e� .//f.................... .... ......).�kqzx ...... Proposed Use ............1..o .. !^t.�.. r.................X /.^,C� / !l/.0 .................................... .... .. . ZoningDistrict ......... ... .... .............................................Fire District ......... ........................................................... Name of Owner SGq //," ��......kVie-z_� ,..Address ......��.......U�l..�1.. e......................................... Name of Builder .. o.. ...:A....1CV.r. �7.A.C.C..Address ..............................a �........................:..... .............. ............ Name of Architect .,5 f'? �ct..� .............(..Y. e:"711 /)��cY.... .-. ... ................... .........Address .............................. .. l....... /..... Q, Number of Rooms ...sr..x...�.4,) �-..Y � Foundation ........... .. ................. .................................... Exterior ....ArO.U.Q.R.T ............................................Roofing ..... ............. /6 Floors .�2r0. cvcz�' Lt�j......L.-.�!!P !�! nterior ....&4 ,!...... ......'7 � .............. Heating.. ..0.1.1�1. ....... 8.. .....:.`[. Plumbing ......�..�........... .... ........................�.1.1......... Fireplace .........f............ ...........................................................Approximate Cost ......... ....... . G / _ ,........ � ..........,..._ Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area .../.. ... ........................... Diagram of Lot and Building with Dimensions 7 r Fee ....... .. ....®�.............. SUBJECT TO APPROVAL OF BOARD OF HEALTH /9DIl L 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. Name .......................... Construction Supervisor's License .. ................... ......... KURTZER, SCOTT K. 25182 1�2- StO�// No ...... .......... Permit for .................................... Lngle Family Dwelling F.' . ........... ................................................................ Location .Lot.. 35,r......82....Timber...L.ane.. .... ....... .. .. .... .. Marstons Mills • ............................................................................... Owner ....Scott K. Kurtzer .............................................................. Type of Construction ........Frame....................... .......... ..................................................................... Plot ............................ Lot ................................ June 14, 83 Permit Granted ......//.I...............................1119 Date of lnspectiorZ)�4-1!1. ................. 19 Date Completed ..........19 /5 -Assessor's map and lot number ..�7..,7...f... ...Q.......... o THE o w Q q emit number TeA a; .Pg. -Re ........'a.............................................. Jhkp 1... BAHBSTADLE, House number ............................ .8` 1639. 00� TOWN OF BARNSTABLE i BUILDING INSPECT--OR APPLICATION FOR PERMIT TO .............S�r�q/„ .....!. '/? .f. ...........-s�f r .........1....... ................... TYPE OF CONSTRUCTION .......Y!!.aQ..GG.f".............. rr�.�??.. >.............................................................. ......................I ..............19 S TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to, the following information: Location LO ........ .ar?.. ........ ..........�.:4':l...a f STons.... �.1/5..................... ProposedUse ............................ .... Z..� ........................................ ... g,� ......................................................... Zoning District ........./... .............................................Fire District ....... .....1 6...................... Name of Owner J G©. ...k...... .v� /�-Q .Address ..... � / .!..Y!.. e. ............... .................... ......... ... ...................................... Name of Builder .. G� (t ��TLp. ...Address Q" '� F'• Name of Architect .(5 S�' . 4.1.........Address ................................................►' a l�� ��'Q di'�9/v/Q, / / Number of Rooms ...:,: .5 ...(..Ya. ...................................Foundation ..............y.X................. ....................... ....... / �/ inExterior .....v / / .� ....................... ...O .... ... ........................... .............................Roofng .... ..:..,..;.......... ... ... 5... �4/ e/ /14�� wOO Q ii7o�/��nterior .... k".� Floors . ..:...�?..........)...............................1...... ............... .........................................::.......... Heating ��, T-or e. l�.�7� ! al. .!". Plumbing ................. �5......................... .. ..... ..✓9. .... Fireplace ........ .......................................................................Approximate Cost ............. o ..0.00............................., Definitive Plan Approved'by Planning Board -------------------_-----------19_______ . Area ... /� ........................ Diagram of Lot and Building with Dimensions Fee ...... ✓...t............ 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. r . - Name ..................... �4v ......................... Construction Supervisor's License ..C....:r�.......�r.L..?Jt/..... KURTZER, SCOTT K. A=149�'58 25182 12 Story- No Permit for P'. ........ ..................................... �. a S . ,gle Family Dwelling 1 h............:.................................................. Location Lot 35., 82 Timber Lane Mars,tons Mills ............. ................,............................................ Owner .....Scott K.. Kurtz�r ............. ... ..... .......................... Type of Construction .....Frame Plot ............................ Lot i 1 June 14 83 Permit Granted ..........................!. ...........19 Date of Inspection ....................................19 Date Completed i45 �� 8 ' A\0 .� d ,f-,q �vV O o,, L"i Ea of -ALcA 43. 5(o L F _ �o � �s9�z 4�•asl�,��♦ 1 '3E 1��s�,enEG F�c�iC-z'ru-vJ Uw A2T. �C, su �aIAFT. sib, G- E , ..G12As-4bFA-n- aa ��a„�E �_;4 �Tin��E �,� , •• CERTIFIED PLOT PLAN JovEM L:C 2 t 9-ig. ;Akio/oR• c.wi*r LD7 35 7'/.M GER Lfi r✓- 4o A , . 5e7,-r c- IV)A )? s 7?0N.5 M/ L Z-S IN ,. SCALE, '/ ' -,Jo DATE= 4 3 (��TDRVQGE ENGINEERING CAIA01 CLIENT I CERTIFY THAT THE EGISTEREO REGISTERED SHOWN ON THIS PLAN IS LOCATED JOB N0. 2-13 ON THE GROUND AS INDICATED AND CIVIL LAND CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR pR.OY+ A. .. OF BARNSTA LE , ASS. • 712 MAIN ST. CM.4Y� _. HYANNIS, MASS. . 3 8 SI�EET..�..d2F DA E E6. LAND SURVEYOR TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Q�YJ Parcel of „T Permit# 7 79W ILA l'doa Health Division `� '- 0 _ Date Issued 7� I� Conservation Division 2M JUL —7 AM 8: 53 ' Application Fee Tax Collector e�zO�a Permit Fee ©' �� Treasurer DIVISION SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED !i_! COMPLIANCE Date Definitive Plan Approved by Planning Board ENVIRONN?EN.-I a ;ODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address 'T 2 T I M .6( s9 AJ L Village M Pt fL5 TZ)V 111N'1 Lk_S Owner C H fl-1.S U�J Al AA/ Address A-/IN C Telephone �; Li 10 Permit Request 1 IQ STALL a �5 0 N 0 TQ GE FQ 0 T l U G LA w 0 C�Z_ I o i If ADO O r'TI0 AJ ;Au?--t i C fd r`i ''r S C O N"T.S �'1 C T i✓J J_U C� pDD pCCK -dALLi4S'rC­k A V4 yAnro& ACi✓ r o /"tcFr C-0go Square feet: 1 st floor: existing 1`/ proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure j Y kS Historic House: ❑Yes 0446o On Old King's Highway: ❑Yes �O Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other IV D N 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: Cl 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 'T4V/✓200 Proposed Use BUILDER INFORMATION Name LT_ A M Telephone Number S O /S 2 7 /()S o Address & ()EL C TT A DA License# ' IM L 11,10 ,4 T- I"t Home Improvement Contractor# Worker's Compensation# W G S .3 / S 33.5 a?4 7" 843 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 3 061,NE r! 4- DATE SIGNATURE i FOR OFFICIAL USE ONLY r PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER r " DATE OF INSPECTION: FOUNDATION QAV FRAME .9f,94.0,e. INSULATION I FIREPLACE ELECTRICAL: ROUGH FINAL m PLUMBING: ROUGH',, ,',, FINAL GAS: ROUGH FINAL 3 f FINAL BUILDING AoA . cr ce DATE CLOSED OUT ~ 'ASSOCIATION PLAN NO. L d I oF'THE ro Town of Barnstable Regulatory Services ' BAMSTABLE, Thomas F.Geiler,Director 9`bA,F 3;tA Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 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. IS A L C U �C_ Estimated Cost • �� Type of Work: F00Ti �� �' A Address of Work: 'fi(eV\,2(5yZ t✓%9 N Owner's Name: C 14 k( S M Date of Application: , d I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. C ��i_ Q OR Date Owner's Name Q:forms:homeaffidav _ The Commonwealth of Massachusetts = Department of Industrial Accidents' WOO of AMMVP#M - 600 Washington Street t Boston,Mass. 02111 . . 'Workers' Compensation.Insurance Affidavit-General Businesses address / G y G o5 - / / C/ " city ry ' state" zi,,: l��SI ,,hone work site location Out address): [] I a sole proprietor and have no one Business Type: [I Retail❑RestaurantBai/Eating Establishment r ' gin any capacity. ❑Office[] Sales(mcluding.Real Estate,Autos etc.) an ism to er with employees full 11j, art time): ❑Other I am an�,ployer providing vtprkers' compensation for my employees working on this job.: - . . comp v �_{ '. . ?., •s • . . ::.. ed"dre'as•' .70 f?W1amF//!gs=o1e .��proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: co'm"en•'nam'e= s:.W . := • city �",�' � :;1,•,: in'sttrsnce'co. :•S'.' :.[' 1. �•' i : address:. •• `�j ,.` cif'' iiisuraticecb-���`'. h •#': ,.tom::.;. •.' .: :•.. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that R copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify r the pains and enatties of erjury that the information provided.above is true and correct. Signature Date O y (J Print name /Z C— Phone# official use only do not write in this area to be completed by city or town official L-check n: permitllicense# []Building Department . ❑Licensing Board immediate response is required ❑Selectmen's Office❑HealthDepartmentrson" phone#; ❑Other 2003) Information and Instructions Massachusetts General Laws chapter�152 section 25.requires all employers to provide workers' compensation for their. employees.. As quoted from the 'law", an employee is.defined as every person in the service of another under any contract of hire; express or mViied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or mare of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased,employer, or the receiver or ,partnership, association or other legal entity, employing employees. However the owner of a trustee of an individual 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 budding appurtenant thereto shall not because of such.employment.be deemed to bean employer. .. MGL chapter 152 section 25 also'staies that•every state*or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the.commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance coverage required. Additionally,neither the- commonwealth nor.any .of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with t�e insurance requirements of this chapter have been presented to the contracting . authority. Applicants Please fill in .the workers'*compensation affidavit completely,by checking the box that applies to your situation:.-Please supply company name, address and phone numbers along with a certificate of insurance as all athdavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding'the"law"or if you are required to obtain a-workers.'-compensation policy,please call the Department at the number listed.below. . City or Towns . Please be sure that the affidavit is complete andprinted 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 pernntllicense number.which will b�e used as a has number. The.affidavits maybe.returned to the Department bynzail or FAX,unless otherarrangements have been made. The Office of Investigations would like t6 thank you in advance for you cooperation and should you have any questions, please do not hesitate to giye us a call.• FRI The Department's address,telephone and fax number: The Commonwealth Of Massachusetts- Department of Industrial Accidents efftce of Nesngafions 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ext:406 Town of Barnstable o�•SHE Tpk� Regulatory Services S Thomas F.Geiler,Director v� 119. p,� Building Division ATFD � Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 . W",town,b arnstable.ma,us Fax: 508-790-6230 Office: 508-862-4038 Property Owner Must Complete and Sign This Section If Using ABuilder C. R u S0 /vX. ik.-AJ as Owner of the subject property .'to act on my behalf,'. hereby authorize in all matters relative to work authorized by this building permit application for: (Address of Job) Date Signature of Owner CH y i Print Name r..cna tvtC cnVTNERPBRMISSION 1 j Board of Building RdOo� d Standards . i HOME IMPROVEMENT CONTRgC R I Reg(str�tlo 1 20592 i 2006 a � — MOORE CARPET JAMES MOORE a 15 GO9L�A DR EAST FALMOUTfi MA" 's �jjjr�� A NO } License. CdA'tTRUCTION S,l")Pf=FDVI;Sr06? . Nunilier-CS 045-959 Bir-1*104_4 t0e4/1957 .j' 1 resr 14� 04 Tr.no: .7329 . w- z9" r�. _µ�} =r� RestWefm �_ 3 JAMES S MOOFtF.U�W,15: PO BOO X 3008 BOURNE, MA 02532 7.4/ Adininistrafor i , r IHE�°w�� The Town of Barnstable MRSSWILL Department of Health Safety and Environmental Services 1659•��e° 'f0 M>� Building Division 367 Main Street,Hyannis,MA 02601 508-8624038 508-790-6230 PILAN2EVIEw Owner: Map/Parcel: - ,o Project Address: 0 1 L Builder: �l ff/° Al. /fpjRe rCO�iiQ.r�TvL�) The following items were noted on reviewing: ��Gl1 A S S/down/ d Sri PLit� 2�/?�5�� 77 rc 19 S0 A10 uR� /l R ��D S l P12e T fey y U l-D v��/J S NeW-5 S,' Al-r Of Move-tit,ewT �GD C'OivT,�.�c 7�,� .�d ��l'Gy •%f� ��fzrLi�'T' �Oj2 /ZDa� rr Reviewed by: 'ew Date: la — `7 J-