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0674 WAKEBY ROAD
. � �� �� � � �. S - Date: Nov. 8, 2018 To: Building File RE: Unsafe/Unsanitary Living Conditions Address: 674 Wakeby Rd, MM Originator: COMM FD Complaint: Hoarding/Unsafe living conditions/Unsanitary Conditions Enforcement Process Steps ® 1. Initiate local investigation: YES 132. Document/enter into system Yes ® 3. Contact ® 4. Property Owner Karen Massoni (deceased) 5. Tamlyn Mansfield 508-428-7025/774-368-8114 ® 6. Seek access to subject property 7. Seek administrative warrant (if necessary) NA ® 8. Notify state authorities of findings NA ® 9. Document conclusion --QPE* Cko-s . - ® 10. Referred Jeff(Building)/Mike Grossman (COMMFD)/Tim (Health) Elder Services/Lynne Poyant Property—028-001 - Property is developed with a 2 story dwelling (1930) containing 4 bedrooms and 2 Y2 baths on 1 acre in the RF zoning district. Oct 24, 2018 R Anderon met FPO Mike Grossman on site with Chief Local Inspector Jeff Lauzon,Tim O'Connell, Health Inspector as a result of a call to investigate a hoarding situation and unsanitary conditions. Property owner,Tamlyn Mansfield admitted us to the property. She explained her partner now deceased was a hoarder for 40 years. She is currently trying to clean the property and dispose of the debris but she is a disable vet and is unable to stand for any duration and cannot lift heavy items. A large dumpster was noted to be outside. MS Mansfield indicated that multiple dumpsters have already been filled and taken away. The conditions of the house were found to be unsanitary and cluttered. Although there was clear access to the kitchen, the kitchen itself does not function as intended.There is no clean food preparation area* i. Pagel i (all kitchen surfaces to be cleared and cleaned), a window over the sink is missing and closed with plywood* (Replaced window or finish area appropriately). All household trash and debris shall be removed the living quarters. The wood floor is not sealed and therefore does not meet the sanitary code requirements of a water restraint finish.* (Painted and sealed with water restraint paint or replaced with an appropriate surface). An empty room on the first floor was devoid of sheetrock**. This room has been suggested to be finished for use as the owner's bedroom rather than the second floor area where the owner currently stays. It is anticipated that in case of emergency the disability of the owner will prevent or delay a timely exit and thus her ability to self-preserve. The stairs leading to the 2nd floor are old and filthy. The rug has been ordered to be removed.* Advised owner that staff present will file with elder Services in order to seek assistance from them for clean-up and allow the owner to remain in the home. Her goal is to clean out house, sell property and relocate to Las Vegas. She indicated someone would be heaping her. She was granted a 30 day order with a progression inspection scheduled around Dec. 1" Oct 25, 2018 R Anderson and Tim O'Connell both filed with Elder Services. Mike Grossman filed as a mandated reporter as well. Nov. 7, 2018 Owner called RA to advise that the person intended to assist her had a fatal heart attack on 11/6/18. Therefore she would not be able to meet the 30 deadline. Nov.8, 2018 Discussions with Lynne Poyant on 11/7/18 resulted in a reference to the Hoarding Task Force. The Building Commissioner suggested on 11/8/2018 there may be options with the Sheriff's Dept. under an Elder at Risk program. *See Order letter from Health Department **Suggested finishing Vt floor room with sheetrock and relocate bedroom furniture and necessary amenities to first floor room. L Page 2 pp�� /�� `I . ��� r , , � � , , �:: � ' ;� ,; �; .. �6 _ ' ... ' ��� 1 � � _ , � ` � .�.�._._...._� .�... ..�...... III �.r.w. .�.i �. _ .. j .I �� T 1 1 a. 1 _ 5 �. 7 �5 � � .� ., i ' �. �. ., , } � ; 1 "lder services of Cape-Cod and the Iflendf �, 1 access/service/edvoca CY �I t Eileen Schoener t M 68 Route.I 34 South Dennis,MA 02660. Phone:508-394-4630 Fax:508-394-0998 :' Email:lileen.schoener@escti.org NOT FOR PUBLIC VIEW °FTFIE Tq�,_ . .�'{ The Town of Barnstable • BAMSTnsr e, - '"�; � Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner PLEASE FORWARD THE FOLLOWING TO: TO: � - ATTN: 1 ����/� — A04 FAX #: 790 FROM: �. DATE: - o Pages (excluding cover) 1.0 t; I q:forms:facsimile f Crossen Ralph From: Klimm, John To: Crossen Ralph Date: Tuesday, March 14, 2000 9:51 AM Hi Ralph- I received a complaint today about (allegedly) a yard with too many unregistered vehicles. The address is either 665 or 674 Wakeby Road, Marstons Mills. Could you have someone check it out when time permits? Thanks, John 7-7 Gz� s" Page 1 Two arrested in Marstons Mills pot and gun bust / •� I �) t (/l Page 1 of 2 (Q L4 .. capecodtoday cape cod: 24/7 Home I Blogs I Links I Weather I Calendar I Movies I LotterX I Horoscope) Police and Fire News The latest local police and fire news. Become a business sponsor of CaWCodToday's Police/Fire News&Court Reports! -FREE Initial Consultation THE LAW OFFICES OF -No Obligation fnJOHN S. MOFFA -Focus areas Include: Auto Accidents, Call :11 4. or online Worker's . . • • use our •nal Injury Questionnaire Construction Two arrested in Marstons Mills pot and gun bust 11/15/12.2:56 pni::posted b) editor $5,000 in marijuana confiscated "Grow room"allegedly found in bathroom of home • .ram Left to right:Tamlyn Mansfield and Karen Massoni.BPD booking photos. MARSTONS MILLS-Two Marstons Mills women were arrested Wednesday when Barnstable narcotics detectives raided their home at 674 Wakeby Road. According to a Barnstable police release,detectives and Street Crime Unit (SCU)members had been conducting an investigation into marijuana at the home when they learned there were several illegal firearms in the home.During the course of the investigation,police had purchased marijuana at the home on more than one occasion. http://www.capecodtoday.com/news/CWN/2012/11/15/two-arrested-in-marstons-mills-po... 11/16/2012 Two arrested in Marstons Mills pot and gun bust Page 2 of 2 A 3 p.m.Wednesday afternoon,police executed the search warrant at the Wakeby Road home.Two residents,59-year -old Tamlyn Mansfield and 62-year-old Karen Masson were placed under arrest. During the raid,officers seized approximately 1.5 pounds �'9`r�J ► r�. of marijuana.Police estimate the street value of the drugs •. at$ ,000.Marijuana was reportedly being grown both inside and outside the home. Officer discovered a"grow room"in the downstairs bathroom of the home,outfitted with specialized equipment used to cultivate marijuana. Four firearms--a.22 caliber rifle,a.357 revolver,a .22 Guns,pot and equipment seized by police.BPD photo. caliber pistol and a .38o caliber pistol and assorted ammunition were also confiscated during the raid. Mansfield and Massoni were transported to the Barnstable Police Station where they were booked and charged with possession of marijuana with intent to distribute,cultivation of marijuana,and four counts of unlawful possession of a firearm/rifle. Both were arraigned in Barnstable District Court Thursday. Content blocked by your organization Want to take issue with the above post? Email us a Letter to the Editor by clicking here or Tweet us your comments here.Be sure to include your name and the town in which you live.If you are a"Whistleblower",or must remain anonymous because of social or business reasons,explain the reasons in your message,and it will be honored at the Editor's discretion.If we decide the reasons are not sufficient we will not print your letter.Click here for information on sending a Letter to the Editor. I I Please see the archives menu on the right for access to older articles in this column. Previous Post: « Harwich brothers charged with home invasions,assaults in two Cape towns Next Post:'Three teens arrested in connection with Marshall J.Lopes Jr.Field booth fire» http://www.capecodtoday.com/news/CWN/2012/11/15/two-arrested-in-marstons-mills-po... 11/16/2012 r Certified Mail#7015 1730 0001 4990 0263 ,,ofTa�ti Town of Barnstable Inspectional Services • ■ARNSI'ABLE. y_ MASS. 1639. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October 24, 2018 Tamlyn Massoni 674 Wakeby Road Marstons Mills, MA 02648 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE H — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 674 Wakeby Road, Marstons Mills, MA was inspected on October 24, 2018 by.Timothy O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received at The Barnstable The following violation(s) of the State Sanitary Code were observed: 410. 602: Maintenance of Areas Free from Garbage and Rubbish: Observed trash and garbage and debris throughout the dwelling unit. Ground in filth was observed in the rugs; the kitchen floor and the second floor bathroom floors/walls. 105 CMR 410.504—Non-absorbent Surfaces Observed wooden kitchen floor with ground in filth and lacking water resistant finish as stated within code. 105 CMR 410.500— Owner's Responsibility to Maintain Structural Elements: Observed window missing in the kitchen and in need of replacement. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by pulling any required building permits (if applicable); by cleaning kitchen floor and walls; by making kitchen floor nonabsorbent; by returning kitchen into a functioning sanitary kitchen; by cleaning ground in filth from dwelling units floors and walls including second floor bathroom; by replacing window in the kitchen; by clearing all secondary egress from all the areas of the dwelling unit. QAOrder letterMousing violations\Rental ordinance\674 wakeby.hyannis.doc r You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, S., CHO Director of Public Health Town of Barnstable Cc: Mike Grossman, Fire Prevention Officer COMM Fire QAOrder letters\Housing violations\Rental ordinance\674 wakeby.hyannis.doc HOMESMulti-disciplinary Hoarding Risk Assessment Instructions for Use ■ HOMES Multi-disciplinary Hoarding Risk Assessment provides a structural measure through which the level of risk in a hoarded environment can be conceptualized. ■ It is intended as an initial and brief assessment to aid in determining the nature and parameters of the hoarding problem and organizing a plan from which further action may be taken-- including immediate intervention, additional assessment or referral. ■ HOMES can be used in a variety of ways, depending on needs and resources. It is recommended that a visual scan of the environment in combination with a.conversation with the person(s) in the home be used to determine the effect of clutter/hoarding on Health, Obstacles, Mental Health, Endangerment and Structure in the setting. i ■ The Family Composition, Imminent Risk, Capacity, Notes and Post-Assessment sections are intended for additional information about the hoarded environment, the occupants and their capacity/strength to address the problem. ©Bratiotis,2009.[The HOMES Assessment was developed in conjunction with the Massachusetts Statewide Steering Committee on Hoarding.Information about the assessment can be found in Bratiotis,Sorrentino Schmalisch,&Steketee,2011.The Hoarding Handbook:A Guide for Human Service Professionals.Oxford University Press:Newyork.] HOMESMulti-disciplinary Hoarding Risk Assessment ❑ Health ❑Cannot use bathtub/shower ❑Cannot prepare food ❑Presence of spoiled food ❑Presence of insects/rodents ❑Cannot access toilet ❑Cannot sleep in bed ❑Presence of feces/Urine(human or animal) ❑Presence of mold or ❑Garbage/Trash Overflow ❑Cannot use stove/fridge/sink ❑Cannot locate medications or equipment chronic dampness Notes: ❑ Obstacles ❑Cannot move freely/safely in home ❑Unstable piles/avalanche risk [Inability for EMT to enter/gain access ❑Egresses,exits or vents blocked or unusable Notes: ❑ 1 Y 1 enta I health (Note that this is not a clinical diagnosis; use only to identify risk factors) ❑Does not seem to understand seriousness of problem El Defensive or angry ❑Unaware,not alert,or confused ❑Does not seem to accept likely consequence of problem ❑Anxious or apprehensive Notes: ❑ Endangerment (evaluate threat based on other sections with attention to specific populations listed below) ❑Threat to health or safety of child/minor ❑Threat to health or safety of person with disability ❑Threat to neighbor with common wall ❑Threat to health or safety of older adult ❑Threat to health or safety of animal Notes: ❑ Structure & Safety ❑Unstable floorboards/stairs/porch ❑Leaking roof ❑Electrical wires/cords exposed ❑No running water/plumbing problems ❑Flammable items beside heat source ❑Caving walls ❑No heat/electricity ❑Blocked/unsafe electric heater or vents ❑Storage of hazardous materials/weapons Notes: © Bratiotis, 2009 HOMES® Multi-disciplinary Hoarding Risk Assessment (page 2) Household Composition #of Adults #of Children #and kinds of Pets Ages of adults: Ages of children: Person who smokes in home ❑ Yes ❑ No Person(s) with physical disability Language(s) spoken in home Assessment Notes: Risk Measurements ❑ Imminent Harm to self, family, animals, public: ❑Threat of Eviction: ❑ Threat of Condemnation: Capacity Measurements Instructions: Place a check mark by the items that represent the strengths and capacity to address the hoarding problem ❑ Awareness of clutter ❑ Willingness to acknowledge clutter and risks to health, safety and ability to remain in home/impact on daily life ❑ Physical ability to clear clutter ❑ Psychological ability to tolerate intervention ❑ Willingness to accept intervention assistance Capacity Notes: Post-Assessment Plan/Referral I I I Date: Client Name: Assessor: © Bratiotis,2009 Clutter Image Rating Scale: Kitchen Please select the photo below that most accurately reflects the amount of clutter in your room. tat• sjr M 99"' �wa 6 r L . r w 7 8 g Clutter • • : Bedroo Please select the • . . that most - • room. AV ffl� ilia z r c I xtez�' ••►� a. rjj 'may t" • • • ImageClutter Rating: • • • Please select the photo below that most accurately reflects the amount of clutter in your room. 1 Tr V. • Inmate Work Program Barnstable County Sheriff s Office Page 2 of 2 Indemnification Work Crew Request Form Please call or email the BCSO Community Service Director with any questions: Phone: 508-S63-4305(tel:S08-563-4305) Email: Community5ervice@Bsheriff.net (mailto:CommunitySer✓ice@bsheriff.net) Home Office of the Sheriff About BCSO Inmate/Visitor Information Community Programs Employment Public Info Contact Forms ttps://www.facebook.com/Barnstable- Sh - O 3r w.i stagram.com/�bbarn ram.com/barnstablesheriff/? 76h test�Y BB!r7OWXkee7 v Copyright©2017 Barnstable County Sheriffs Office.All Rights Reserved. Privacy(http://www.bsheriff.net/privacy-12olicy/)I Terms(http://www.bsheriff.net/terms/)I Sitemap (http://www.bsheriff.net/sitemap/) Site Produced by:Coastal Mountain Creative(http://coastalmountaincreative.com/) English http://www.bsheriff.net/community-programs/work/ 11/8/2018 Inmate Work Program I Barnstable County Sheriffs Office Page 1 of 2 CONTACT(http://www.bsheriff.net/contact/) I DIRECTIONS (http://www.bsheriff.net/directions/) 91(https://www.facebook.com/Barnstable-County-Sheriffs-Office- 767270049958217/) 0(https://www.instagram.com/barnstablesheriff/?ref=badge) G+ (https://plus.google.com/112760150580589633778) r' (https://www.youtube.com/channel/UCCLrsnxb27Xkee7W7BHflkQ) O (https://twitter.com/SheriffCummings) � � Aflp+► A �M ' (http://www.bsheriff.net/) NA, Work .rew Program Barnstable County Sheriff's Office 4 � The BCSO Community Service Work Crews provide I inmate labor to perform a wide variety of services including painting, landscaping, carpentry, roofing, siding, simple construction, demolition, moving services and maintenance for municipalities, county, state or federal agencies as well as non-profit organizations,with preference and priority given to .dF 501(c)(3) non-profits. All work performed by BCSO work crews must be on project sites owned by a non-profit organization, a r municipality, county, state or federal agency in order to qualify for the program. Work Crew Request Requirements Procedures for Requesting a BCSO Community Service Work Crew Work Crew Policies Paid BCSO Officer Details for Community Service Work Crews !!a English http://www.bsheriff.net/community-programs/work/ 11/8/2018 Inmate Work Program I Barnstable County Sheriff s Office Page 1 of 4 CONTACT(http://www.bsheriff.net/contact/) I DIRECTIONS(http://www.bsheriff.net/directions/) 91 (https://vi=—w.facebook.com/Barnstable-County-SlQriffs-Office- 767270049958217/) 00' (https://www.instagram.com/barnstablesheriff/?ref=badge) G+ (https://plus.google.com/112760150580589633778) r0 (https://www.youtube.com/channel/UCCLrsnxb27Xkee7W7BHflkQ) O (https://twitter.com/SheriffCummings) Y•J (http://www.bsheriff.net/) - c - MAF r Workluew ProgramZA = a 4arnstable County Sheriff's Office The BCSO Community Service Work Crews provide inmate labor to perform a wide variety of services u,ar including painting, landscaping, carpentry, roofing, LITI siding, simple construction, demolition, moving services and maintenance for municipalities, county, state or federal agencies as well as non-profit organizations,with preference and priority given to 501(c)(3)non-profits. All work performed by BCSO work crews must be on project sites owned by a non-profit organization,a 11 l municipality, county, state or federal agency in order y _ to qualify for the program. Work Crew Request Requirements Procedures for Requesting a BCSO Community Service Work Crew Work Crew Policies 1. Hours: Inmate work crews leave the Barnstable County Correctional Facility in Bourne for E2 English http://www.bsheriff.net/community-programs/work/ 11/8/2018 Inmate Work Program Barnstable County Sheriff s Office Page 2 of 4 project sites at 7:30 a.m. Monday through Friday and must return to the BCCF by 4:30 p.m. each day. CZ 2. Site environment: Inmate work crews will leave anyjob site deemed unsafe or if inclement weather develops. 3. Rescheduling: The BCSO work crews consist of inmates and Deputy Sheriffs who work with and oversee the inmates on projects.At any time,with or without notice, a work crew may need to leave a work site,the project may be cancelled, or the project may be rescheduled due to BCSO security operations.The BCSO will do its best to adhere to project schedules but makes no guarantee that a project will be completed on time. 4. On site agency support: All agencies and organizations are required to provide a representative to be on the project site for the duration of the project to coordinate with our Deputy Sheriffs. 5. Supervision: Inmates are supervised by a trained BCSO Deputy Sheriff.At all times, BCSO Deputy Sheriffs keep inmates on a project site within sight and sound. 6. Expenses: All expenses including materials, building permits, meals provided, etc. related to a project must be borne by agency/organization requesting the BCSO inmate work crew. 7. Materials: All materials needed to complete the project must be on site before the start of project. 8. Permits: It is the requesting agency's responsibility to obtain and pay for all state,town and federal permits and licenses that may be required for a project.The BCSO will not RA English http://www.bsheriff.net/community-programs/work/ 11/8/2018 Inmate Work Program Barnstable County Sheriff s Office Page 3 of 4 be responsible for compliance with local building codes. 9. Meals: Q Inmate work crews that are on project sites at 11:30 a.m. must be provided lunch by the requesting agency.The requesting agency/organization must pay for and deliver lunch(including drinks)for consumption by the work crew at the project site. Most agencies provide a takeout menu from a local sandwich shop to the Deputy Sheriff overseeing the inmates for them to make a lunch selection. In the event a work crew is on site beyond 4:00 p.m., dinner must be provided for the work crew. 10. Bathroom facilities: A bathroom must be available on site for use by the inmate work crew. Inmates are not allowed to enter private homes. 11. No children present: Inmates are prohibited from job sites where children are present. Projects may be done at a school during off hours or school vacation periods when children are not present. 12. Other than BCSO staff, no person is allowed to: A.Take pictures of inmates. B.Talk with an inmate about anything other than project specifics. C. Give anything to an inmate. D. Oversee or supervise an inmate. 13. The BCSO reserves the right to place a sign at the work site acknowledging the BCSO Community Service program.Any sign placed by the BCSO will be removed at the end of each day. Paid BCSO Officer Details for Community Service Work Crews indemnification English http://www.bsheriff.net/community-programs/work/ 11/8/2018 Inmate Work Program Barnstable County Sheriff s Office Page 4 of 4 l Work Crew Request Form + lease call or email the BCSO Community Service Q Director with any questions: Phone:508-563-4305(tel:508-563-4305) Email: CommunityService@BSheriff.net (mailto:CommunityService@bsheriff.net) Home Office of the.Sheriff About BCSO Inmate/Visitor Information Community Programs Employment Public Info Contact Forms Ittps://www.facebook.com/Barnstable- (OUDtly- S40iff, - I I .i stagram.com�barn tablesherif P 76h test Y� 3s7rW027Xkee7V Copyright©2017 Barnstable County Sheriffs Office.All Rights Reserved. Privacy(http://www.bsheriff.net/privacy-policy/)I Terms(http://www.bsheriff.net/terms/)I Site�ap (http://www.bsheriff.net/sitemap/) Site Produced by:Coastal Mountain Creative(httl2://coastalmountaincreative.com/) M English http://www.bsheriff.net/community-programs/work/ 11/8/2018 i Inmate Work Program Barnstable County Sheriff s Office Page 2 of 3 If an agency/organization desires to schedule an _nmate work crew sooner than the availability Q of our usual community service work crew, they may opt to utilize a BCSO Community Service Paid Detail. This option provides a Deputy Sheriff and inmate work crew to perform a job at a project site under the same parameters as set forth above, however,the agency/organization agrees to pay for the Deputy Sheriff's services at the hourly detail rate for the current town police department(if your project is in Bourne, you would be billed the detail rate of a Bourne police officer for the hours worked by the Deputy Sheriff.) No inmate labor will be charged.The requesting agency/organization must pay time and a half for the Deputy Sheriff's services for any detail shift worked beyond 8 hours. A bill for the detail will be sent directly to the agency/organization and must be paid within 30 days of receipt. Indemnification Work Crew Request Form Please call or email the BCSO Community Service Director with any questions: Phone:508-563-4305(tel:508-563-4305) Email: CommunityService@BSheriff.net (mailto:CommunitySer✓ice@bsheriff.net) M9 English http://www.bsheriff.net/community-programs/work/ 11/8/2018 Inmate Work Program I Barnstable County Sheriffs Office Page 1 of 3 CONTACT(http://www.bsheriff.net/contact/) I DIRECTIONS (http://www.bsheriff.net/directions/) 11 (https://vi=—w.facebook.com/Barnstable-County-Sl%riffs-Office- 767270049958217/) ® (https://www.instagram.com/barnstablesheriff/?ref=badge) G+(https://plus.google.com/112760150580589633778) Y0 (https://www.youtube.com/channel/UCCLrsnxb27Xkee7W7BHflkQ) O (https://twitter.com/SheriffCummings) o: arRw 'Stiff.- A .iia�r (http://www.bsheriff.net/) Workii�.rew Program Rarnstable County Sheriff's OfficeXY The BCSO Community Service Work Crews provide inmate labor to perform a wide variety of services including painting, landscaping, carpentry, roofing, 911III siding, simple construction, demolition, moving services and maintenance for municipalities,county, state or federal agencies as well as non-profit organizations,with preference and priority given to .. ;, r,. `. 501(c)(3) non-profits. All work performed by BCSO work crews must be on ;, Y I project sites owned by a non-profit organization,a " `- Ijmunicipality, county, state or federal agency in order .� M to qualify for the program. Work Crew Request Requirements Procedures for Requesting a BCSO Community Service Work Crew Work Crew Policies Paid BCSO Officer Details for Community Service Work Crews lA English http://www.bsheriff.net/community-programs/work/ 11/8/2018 Inmate Work Program Barnstable County Sheriff s Office Page 2 of 3 Indemnification The requesting agency/organization assumes all responsibility for any liability that may arise relative to the work performed by the Barnstable County Sheriff's Office including the erection of any event tents provided by the BCSO. Further, the requesting agency/organization agrees to indemnify and hold harmless the Commonwealth of Massachusetts,the Barnstable County Sheriff's Office, its employees, inmates, agents, successors,and/or assigns,from any claims, actions, rights of action and causes of action, damages, costs, expenses and compensation from liability for any physical injuries or damages sustained to property which may occur as a result of any work performed or event tents erected by the Barnstable County Sheriff's Office, its i employees or inmates. Work Crew Request Form Please call or email the BCSO Community Service .Director with any questions: Phone: 508-563-4305(tel:508-563-4305) Email: CommunityService@BSheriff.net (mailto:CommunityService@bsheriff.net) Home Office of the Sheriff About BCSO Inmate/Visitor Information Community Programs Employment Public Info Contact Forms !9 English http://www.bsheriff.net/community-programs/work/ 11/8/2018 Inmate Work Program I Barnstable County Sheriff s Office Pagel of 3 CONTACT(http://www.bsheriff.net/contact/) I DIRECTIONS(http://www.bsheriff.net/directions/) M(https://www.facebook.com/Barnstable-County-Sheriffs-Office- 767270049958217/) O(https://www.instagram.com/barnstablesheriff/?ref=badge) G+ (https://plus.google.com/112760150580589633778) Y0 (https://www.youtube.com/channel/UCCLrsnxb27Xkee7W7BHflkQ) O (https://twitter.com/SheriffCummings) 'f tiY1'` ," (http://www.bsheriff.net/) �c MW 16 Work .rew Program F 4arnstable County Sheriff's Office 4 - :_'" f � The BCSO Community Service Work Crews provide -. + inmate labor to perform a wide variety of services including painting, landscaping, carpentry, roofing, y Illl! siding,simple construction, demolition, moving services and maintenance for municipalities, county, state or federal agencies as well as non-profit y� organizations,with preference and priority given to 501(c)(3) non-profits. All work performed by BCSO work crews must be on I project sites owned by a non-profit organization,a i 11 - municipality, county, state or federal agency in order to qualify for the program. ` Work Crew Request Requirements Procedures for Requesting a BCSO Community Service Work Crew I Work Crew Policies Paid BCSO Officer Details for Community Service Work Crews !9 English hnp://www.bsheriff.net/community-programs/work/ 11/8/2018 r A. Barnstable County Sheriff's Office Community Service WORK CREW Request Form Please complete the requested information,save the PDF and email it to communityservice(cDbsheriff.net or print the PDF and mail to: Community Service Program Barnstable County Sheriffs Office 6000 Sheriffs Place Bourne, MA 02532 All work performed by BCSO work crews MUST be on project sites owned by a municipality,county,state or federal agency,or owned by an organization designated by the IRS as a non-profit organization Today's Date: Organization Name: Requesting Organization is a: Municipality County,State or Federal Agency 501(c)(3)non-profit organization as designated by the IRS* Other non-profit Organization Fax Number: Street Address: Mailing Address: Primary Contact Person: Primary Contact Email: Primary Work/Cell Phone: Secondary Contact Person: Secondary Email Address: Secondary Work/Cell Phone: Organization Description: Tax ID Number: Address where work to be performed: Name of current Property Owner**: Description of work to be done: (attach separate page if needed) Tools Needed: Requested Schedule Dates: Have we worked together before: Comments: *Attach a copy of IRS 501(c)(3)Designation form **as recorded at the Registry of Deeds The requesting agency/organization assumes all responsibility for any liability that may arise relative to the work performed by the Barnstable County Sheriffs Office including the erection of any event tents provided by the BCSO. Further,the requesting agencylorganization agrees to hold the Commonwealth of Massachusetts,the Barnstable County Sheriffs Office,its employees,inmates,agents,successors,and/or assigns harmless from any claims,actions,rights of action and causes of action,damages,costs,expenses and compensation from liability for any physical injuries or damages sustained to property which may occur as a result of any work performed or event tents erected by the Barnstable County Sheriffs Office,its employees or inmates. By providing an electronic signature below,I certify and acknowledge,under the pains and penalties of perjury,that I have read and agree to the terms of the BCSO Work Crew Request Requirements,that I am an authorized signatory on behalf of the requesting agency/organization,and that all information provided on this application is true and accurate to the best of my knowledge and belief. Type name of person authorized to sign on behalf of the requesting agency/organization: Approved by BCSO Superintendent: Date: Senior Programs Barnstable County Sheriff s Office Page 2 of 2 between the Barnstable County Sheriffs Office, Elder Services of Cape Cod,all 15 Councils on Aging in Barnstable County,the Barnstable County District Attorney's Office, Independence House of Cape Cod, and numerous health care service providers throughout the cape. For more information contact: Phone:508-563-4319(tel:508-563-4319) Email: bcso@bsheriff.net(mailto:bcso@bsheriff.net) , Home Office of the Sheriff About BCSO Inmate/Visitor Information Community Programs Employment Public Info Contact Forms �ttups://www.facebook.com/Barnstable- Shff -, 76fh 4 i sr t� agraeco�m am tablesherif/? g��c §'nW&�27Xkee7\j Copyright©2017 Barnstable County Sheriffs Office.All Rights Reserved. Privacy(http://www.bsheriff.net/privacy-policy/)I Terms(http://www.bsheriff.net/terms/)I Sitemap (http://www.bsheriff.net/sitemap/) Site Produced by:Coastal Mountain Creative(http://coastalmountaincreative.com/) !9 English http://www.bsheriff.net/about-bcso-2/departments/seniorprograms/ 11/8/2018 Senior Programs Barnstable County Sheriffs Office Page 1 of 2 CONTACT(http://www.bsheriff.net/contact/) I DIRECTIONS (http://www.bsheriff.net/directions/) 91(https://www.facebook.com/Barnstable-County-Sheriffs-Office- 767270049958217/) ® (https://www.instagram.com/barnstablesheriff/?ref=badge) G+ (https://plus.google.com/112760150580589633778) Y0 (https://www.youtube.com/channel/UCCLrsnxb27Xkee7W7BHflkQ) O (https://twitter.com/SheriffCummings) sao• Ae :i:i.i-- �f . (http://www.bsheriff.net/) i MAC' Senior Programs eke Barnstable County Sheriff's ® O fice 4 - The Barnstable County Sheriffs Office is proactive in promoting Senior Citizen initiatives through educational and awareness programs. Our quarterly presentation series is popular among seniors throughout the Cape and focuses on topics such as identifying and avoiding elder scams, how to identify and report elder abuse,and disaster preparedness tips. In addition to our regular programs the BCSO is collaborating with the Cape and Islands Consumer Assistance Council,an entity of the Massachusetts Attorney General's Office,to conduct extensive outreach and education to seniors on consumer rights. The Sheriffs Office is also engaged in regional initiatives to safeguard seniors. One regional initiative is the Cape Cod Elder Abuse Coalition(CCEAC)which was created through an idea of local Councils on Aging to promote awareness and to educate those who have daily interactions with seniors to identify senior abuse, senior neglect, senior fraud, and how to report these crimes.The CCEAC is a partnership !M English http://www.bsheriff.net/about-bcso-2/departments/seniorprograms/ 11/8/2018 t7 Town of Barnstable Building Department Services SMA' Br'g Brian Florence,CBO :46S9 g Buildin Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.m a.us Office: 508-862-4038 Fax: 508-790-6230 PLEASE FORWARD THE ATTACHED PAGE(S) TO: ATTN: p� FAX NO: -3q G l i RE: FROM: DATE: PAGE(S): I Q:forms/faxcover Rev 08/15/17 Anderson, Robin To: Stanton, David; Florence, Brian; McKean, Thomas Cc: mmacneely@commfi red istrict:com; Mike Grossman (mgrossman@commfiredistrict.com); Gallant, Therese Subject: 674 Wakeby Rd, MM David, I talked to Martin and Mike. I.think a smaller approach is best but I want Therese to advise us regarding the weapons that were noted to be in the house on prior occasions. I am also concerned about the mental health issues so maybe Therese or another officer could stand by during the attempted inspection..Mike said Elder Services is opening a case but of course the occupant must be cooperative. No one, however is anticipating voluntary cooperation.That being said, I am suggesting that Health, FD and PD attend. I was not hearing any concern about the condition of the structure itself so I am not dispatching a local at this time. FYI: Mike will reach out and attempt to secure an appointment.We will figure out an alternative plan if necessary once PD weighs in about the history&weapons. Thank you all. p�qbtn Robin C.Anderson Zoning Enforcement Officer 200 Main Street Hyannis,MA 026oi 508-862-4027. I 1 Town of Barnstable *Permit# - 7 /15/ Regulatory Services EFeees 6 months from iss a date BAMSTAIRE � Richard V.Scali,Director 139. Building Division 3 _--- 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us A O� Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY G Not Valid without Red X--Press Imprint Map/parcel Number QO�� '��� . Property Address D-R-esidential Value of Work$ Q 6 b Minimum fee of$35.00 for work under$6000.00 Owner's Name&-Address 1�Ll r e n ✓ ''b� S,3 a/17 �QlAke sAh A-- Q 2./ I S" Contractor's Name Telephone Number S`6 g 'jf 2 8— 746 Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑., II a sole proprietor L I omeeowne ❑ I have Worker's Comp�ensatiorn Insurance / Insurance Company Name�! 1`' V Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. PermitRequest(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side 2"Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: 'where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner,Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is req 'red. Q:\wPFaM\FORMS\building permit forms\EXPRESS.doc 01/25/17 The Cammm weaWr ajfA&wadH=etfs Offlw' �az7�Feat ur�'��1�ecir�e�s ofI afw= $90'Wadagt=,rea -- MVM MMMgrrv/W7a W6rkere CumV ensAimn Iusu-mce Af avf'B�-tiers/CIItractcamMecbdcian s f ghm3,bers A] Ucam#Iufmm=6nn r levee PrIn Y e � , /M*a 47-yv jl' / s IJ 2-6 :' S' a ` -1 2A 7 6 2. S� Aiigyra aan emplapr?fhecktbe appropriate box: ' Type of project(re+grived): L❑ I am a employ vfTi 4. ❑I am a general coafactzsr sad I 6. ❑New cramhudion employees(fidafldforpart-dime).* bavehiredfha MALCOStract= 2.❑�I am a sole orpartaw- Trsfed onthe'atbched sheet.. 7. Rr�►odedmg ship and ham no employees. These sub-coaftwias ha:va . g.,Q Demolifroa wodldag for is arty capacity. exapk7em andbwre wagoe=s7 9. ❑Budding aMifion [No tvo� coin.fiance °�- j 5. ❑ We are a porafiflaanrt ifs 10:0Mechical repairs or adcEtiaas F a.a homeavmw doing all work o� ��tR"�`�ed 11-0 Phunbingrepaiss ar moms. NO vir&RM& of per Mct �� srgsel€[N �_ 1�7❑Boat iM�reguiE.e&]z c.M§l(4k andwehaveno Faye-[No l3.❑oilier co=.P-imun ) •8.ay npg��dhat che�sbo:�l taa�eLsa ffio�tJ�t seetaabe7,awsi�da3 t3ieitsvo$ce�ca�peasafiaapo�yia�6a� . fit �snlMIRtinsai592T3 ateyzmdam.-RUwa&mdffimbileau=decoatmcbssmc#sahn&aUMSMdamtmdi SWIi d�ecY&isbox . r.ftrh dr —VWmal shad s7aud=gtLenmreoflme=VcaabKtaxmdstde-heth amotilase br%,e ®plopees.Ifthem)-C—ad have em27ayee%BLe}*amstF=ide&ek aarls& •FolkF avmber lain ars eUrpbj�w Scat;is prauirling nrorkets'coogertsafian izx=razwefbr mg eearrpk eeA $dnty is ire pa�cy arrd jQti sofa iRf bt7lla'r70iL . e 'PoRry;q or Self--ism llr-&- Dats- i -Aaaress lil� A ffaclt a copy of the workers'rompeas OnpoHW&cbrat=page(shriving the policy number and expiration date). Fa2ure to secnm coverage as requiredunder Section 25A o€MQ,C.152 can lead to tfie iffipo360I1.of criramA penalties of a fine up to$L50D OU adfor one-yearimprisonmeuk es well as civil penalties a fe fu=of a STOP WORK ORDEgand arme, of up to$250-00 a tray against the violaim He advised that a copy of this statement.maybe forwarded fa the Office of hrvwliga s ofttte DIA Ex iasnsancso canape v I rfa ber-sity tlrs andpsual sa�fFerjsuF atiits asfbr=iaapr -hW abMI9 is bus and correct Dat, 2- 3 — 7 Phow 9 t)fji�taf me and Ua oat r�rite firs tlsis area,do be carupfete�6p trip arinnzt t City or"fawn: Permifflceuse;g Lsstring AuHSurity(circle one): L Board of Health 2.BuMb IDepartineat 9 fity1rusm Clerk 4.Electrical I'asgectar S.PlmmMmg]star CLOOHV Coniact Person: Phone#. 6. Information and instructions Mxr�ear rase fs Ge=mlLaws Ise recjm=an emgloy=,1:o>�&wa&& fort it=PpIoyees. 'Cbis sty,as�Topee is dcfmcd ss.¢—e�erYPason m.$ie scaVi a of anatiirr ffider aay oo�xart oflmc� • esp2 ar iniplied,oral or quiffm:� An=Tk yml is ddmcd as� partn�. 0m.�P or otbs legal may. �5'two or mo¢E o �mffi �of a dectased e�ploYe�ar S� reoriYs or t, s of as iadividnaL pazW ship,assoccafmn or offie£Iega]eafity,c�lt►yzng=Pm - However fho owner of a dweffmghonsa havingnot more i3m three aPB:1tm="s and Who resides f=h3,or ffie omupant off=- dweIImg house of muffim who employs persons to do maw cCnskuC rsn or IrPair work oa s mh dwzITmg house or an th.e grotmds or bnrldmg t=:,D innnotbex==of sack maplaym the&t=e dto be arm Culploym MM c haptrr I52.§25C(6)also SAPS tl3 St-eV Cry St d D ar local rPTTtM agLacy$Ban W f hho Cl ffhe ZSS¢aIIte or reneveaI of a Tcease or perm to operate a basiness or to consh ar±bm flings is tTie commoner for e _ L: applicantwao has notproduced acmpfa.ble evidencs of CdMpTzance•wi&tbM k=-An=rDVCX- ere ake(-" 0. Adab=,Ily,MCiL chaptrr I52.§2.5dM gW=-=ffi=tbz _qw=M nor inY Of its pDHt1=l s ubdivisions shall"=:�% an into airy wa(rad fur�p ofpubFM work m�I arceptable evidracc of coOMPH P=wn the insoraaee.• - Mr3kc CEPS oftlzis rhqfthMl;e=p¢eseoti-,din$m conirac6mg.a3tbo1*." Please fM oiot &c wed s'oomm&m.pea affidavit campy ialy,by cog�.eoxes b fhat apply to Your sffinafion and,¢ nzceY.SAY sub- s)n .e(s), addresses)and ,T.m .bm(s)along wit Lffi==XtB (s)of fi�an�e ice. Lj a �j lability Companies(LLQ orLimitrdUsbfty' S(LU)'w�m �PbY= mambeas or pis,arc not rimed to catty wadomce campmsa1bm ice- If as LT,C cr LLP does hate empIoyces,a.policy isr=iOftod. Bea3vimd-ffiatfisafbrdaykmaybesntmftedtotbeDgmmentofIndustrial AueirT for comB=as1in of iosarsnre c°veaagz Also be sm-e to Sig¢and data 9ffie affidavit '1ba of dAvit should- bez e3 to$e city or fownthat the aPplic�i=foT the peu�or use is being tulneste d,not fhe Deparfinenf`of dal Acaidmts- Sbanldyon havn any qucsttons g the law or iFyon ate rc�¢cd in ob�in awo�ras' compensation pgfiey.pleas°mn the Deparcirzit at the numb¢listed be1nw. Self-turned ccro�anics should ear their self-msorance license mmnhm on I ie lime. City or Town Of udaIs - c Plcaso be sni a fhb the affrdavitis complc 8mdpri�dleg�Iy_ �e Dep �thas proQidcd a space at the botfmn of&r-affida�itfor YDUtn fn out infiie eve the Office Df1VVCS6gafi=has to codmctyomngardmgffim BPPHM Lt_ Plmse:boura to fMinthcpeXLiyrlcensenambetwh'r'Lwfbe used asarcarexCemm2bac Inaddifion,aaaFPliCMt fhaf must submit MUMPle P=IWH= a appllt�ons a MY givr�ayca4 need only salnart aoc aif<davit;nd;�g cant policy mf [d y)and ands"Tob Om A b.-:! '�applaeas't r should wrif�-all lams in =( Y; town)"A copy of tbeaif[davit$zthas been officially ahmped clrmamiCedbythe city cErtownmay be,provided to fhe applicant as proof that a valid affidw&is an Elm for fafta -p=n s or Iieevsw, AnOw ofbdavit=st be fMed of f t arsi year.-Whcro a home owns nr cif-M is obtai�g a1icanse ar pe�itnotrelatzdiD auy busmrss or commlial - �ie.a dug license orpermitto bumleaves etc-)ssidp=son is ldOgni Tret�to rmnPlctD lhis affidavit The Office ofInvcsd onswadUlilmto thankponmadv-�a f�ryota'mopmat manl sbonId You bave say4II ons, please do not hcsitatn to give vs a call jbe Dc j ffitr s�rt's addres%izlephonc and Paz numb=- T f1,,F-727-4,Qw cgt4-06 or 1•-977 mASSAYE Fax#617-727-7M Kevise�424-a7 Ff� Town of Barnstable Regulatory Services dF Richard V.ScaI4 Director Building Division t 11MRIMAIRA t Paul Roma,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEbWnON ��� `n r � .- 1 � Please Print I PATE: . k / q,� r "-71 ,/,� / I�OBTACA N �O�� 1 1/U,,, 1z A I!S number - ge villa oMEowFIER 1�&fCA2 Massa, / name home phone# work phone# CsI lW_hMMA LING:AD b,RESS1V7erIJ-f61,7J AA city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 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 dwelling,attached or detached structures accessory to such use and/or form 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 um ersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection pro and ents and that he/she will comply with said procedures and requirements. Sim f.Homeowncr�- 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 EXEAIMON 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 3.15) 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. QWHII.ESIFORMS\buildmg peanit fomns\EXPRESS.doc 0620/16 Town of Barnstable ` Regulatory Services s 11WIMIM 0 Richard V. Scab,D wlor Building Division. Paul Roma,Building Commissioner 200 Main Sftvat Hymn*MA 02601 www.town.bamstable.maus Ofce: 50&862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder L ,as Owner of the subject property hereby authorize to act on.ray behalf in all matters relative to work authorized by this building permit application for: (Address of Job) **P' ool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all'final inspections are perfomaed and accepted. Signature of Owner - Signature'of Applicant Print Name Print Name Date QYORIAS:owrE"ERMIsstorPoois Town of Barnstable *Permit#. Expires 6 months from issue date Regulatory Services Fee 1I 5 > C— 'BMRNSI' `e$ Thomas F. Geiler,Director X Building Division 'PRESS PERMIT Tom Perry,CBO, Building Commissioner p E — 5 2012 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma us Office: 508-862-4038 TQ% gF� f�LE EXPRESS PERMIT APPLICATION - RESIDENTIAL u �� Not Valid without Red X-Press Imprint Map/parcel Number 21e /I Property.Address 67,q ❑Residential Value of Work / 1) Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address kkrz, Ra rs-6A) Mi I ' Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor WI am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. I Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ' ZRe-side #of doors 9/Replacement Windows/doors/sliders.U-Value//n44-z5or (maximum.35)#of windows. ❑ 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 copy of the Home Improvement Contractors License&Construction Supervisors License is re red. n, I SIGNATURE: � � i QAWPELESTORMS\building permit forms\02RESS.doC I. RP.%A a nsini The Commomsealth of Massachuseft -Deparbnent-of-Indx�stal Office of Investigations 600 Wash*gtoyx Street Boston,A4 02111 www.mas%govldia Workers'Compensatitan Insurance Affidavit: Bunters/Contractors/ElectncianslPLumbers Applicant Information Please Print Legibly Name tion/Individoai): k\are,, /r lljJ S�rlt Address: Ie 7 4 l/l/Q./'g," k,( City/Stat&Zip: AA-G�1 ����J /1'1/9' Phone 4-6? 2 702—.5� Are you an employer?Check the appropriate boa.: Type of project(required): 1.El 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 ling 2..❑ I am a sole � proprietor or _ listed on the attached sheet ❑�odL These sob-contractors have ship and have no employeess $_ ❑IJemolitiosi'•• w for race in a employees and have wodcers' orlriztg any capacity. I 9. ❑Building addition insu [No worlaers' comp.insurance comp. rance ed] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions I am w 3_ am a homeowner doing all wank Officers have exercised their 11_❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.El Roof repairs insurance required.]T c. 152,.§l(4),and we have no employees.(No workms' 13. 0-6ther d comp.insurance required.) r *Any,applicant that chedm box#h must"fill our the section below showing their workers'compensation policy udormsuan 1 Homeowners who submit this affidavit indicating they are doing all wat and then hue outside contractors nnt9'submit a new affidavit indicating such- tCaunctors that check this boa must suadhed an additional sheet showing the name of the sub-caaftaclors and state whether or not those entities have employees. If the sub-cuntmaors have employees,they must provide their workers'comp.policy number. lain an employer that is pn"iding worirers'congmui dion inmrance for arty errepinsW& Bdiow is the palicy end job site itformadan 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 eSpiration 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-yeas imprisonment,as well as civil penalties in die 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.D1A for insurance coverage verification- I do hereby certe y un#rfhepainss andperrabies ofpedury that the information provided above is bus and correct Date: l Phone#: oftkiai ease only. Do not write in this area,tv be couiptetetd by city or town official City or Town: PermitlUcense it lssning Authority(circle one): 1..Board.of Health 2.Building Department 3.Cityfrown Clerts k flectrical inspector 5.Plumbing Infector 6.Other . Contact Person: Phone#: °Eta rqk� Town of Barnstable Regulatory Services ` s" MASS. Thomas F.Geiler, Director 1639. a 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: °� 5 9, rr ee''f���', J ) JOB LOCATION: 471 yVIV�"'^9 d�Q ' '�'�s� me 1),f num�beerr, street village ..HOMEOWNER": l�[M>f►'1 /�6�ISD�I -42y"'-7d2s � name ,home phone# work phone# CURRENT MAILING ADDRESS: .7/1 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "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 proced re and.requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner 1 Approval of Building Official Note: Three-family dwellings containing 15,000 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.I.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. 0:\WPFILES\FORMS\building permit forms\EXPRESS.doc i iARNSTABLE. � ' 9� ,�� Town of Barnstable pr fD�r A Regulatory Services Thomas F.Geiler,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 to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit;please complete the Homeowners License Exemption Form on;the reverse side. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 00.1-1i n-rni in Assessor's offioe Ost floor): of THE>oV"= Assessor's map and lot number ..... �� eW Board of Health Ord floor): Sewage Permit number ........ 1S!�r...... ..............�1..r ...... �r Z 33AUSTODLE, j Engineering Department (3rd floor): rasa r } ��O t639. \0� Housenumber ...................................................................:..... o MAI a APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 •P.M. only G TOWN OF BARNSTABLE BUILDING INSPECTOR v APPLICATION FOR PERMIT TO Co1JS�Q C� .lam.......,• �'gI,cv�J.�ci..,r„ae ��R �;,,.,,,, , TYPE OF CONSTRUCTION ......�a..2(Lri.S. .... Zl'_....��. !.�1..°.a? i/ ,39 .}�. sec/r�„'�? •..c1i i�,P-S� -----------------:.....� ................. ...19-- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following.information: (07� LcJr��le �O. Gr.S r�.S----/�i �S Location f.........:........... ....... ...... ........................................................................... Proposed Use .....�..`J/9.r �°.......9.' 4.0ii�-CD................................................................................................................. . Q` Zoning District ....IAP:. ...........................................................Fire District ....... .........//...`...?!l '1..........:::............................... Name of Owner .t...........................Address Name of Builder ....... .... Y.........:........:.>.....................Address ........... �`'1.E'..............................................:........... Nameof Architect ......:.!111A7..................................................Address .........4_)- 1.........................•.......................................... Number of Rooms ........7........................................................Foundation ....��?R..?.0 .....:................................................. r L 7�i Cf'Gl�l Y Sli�' �PS- �aJ�' !/��� - S /� S4'.v /P�� Exlerio. ...�.:....:...........................��.4.?.'.::.......,. .....................�..Roofing ......./.1.��?�n;...............i.�.................................... Floors C{?JUC. .`cam...:..... ., c) .... .... .. ..........................Interior ..... .(�.r Ol �'�................................................. Heating Fu c"�.)f?!..�'. l:S .../ ///�......::.................Plumbing �s //, �1Y:. Fireplace ..........�tQO?Q.......................................:................Approximate Cost .......: U:GSC1T7......................... Definitive Plan Approved by Planning Board ______________________________19________ - Area .......................................... Diagram of Lot and Building with Dimensions Fee ......... .......... i SUBJECT TO APPROVAL OF BOARD OF HEALTH , o 1 f 1 . o 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 .................................. ........................ ....... jConstruction Super'visor's license .................................... MASSONNI, MARK A=028-001 No ..2.9.7.15.... Permit for .....Bu.i.ld..A.d.di t.i.oA/Garage .................. Location .......67.4..W a k.P-b.Y..F,.Q.ad......................... ........................ ........................ Owner ............ .......................... Type of Construction .....Framp........................... ............................................................................... Plot ......................... .. Lot ................................ Permit Granted ......... .................19 86 66te of-Inspection ....................................19 Dat e Completed .......................................19 1/4,7 Assessor's offioe (1st floor): �y _ FTNET Assessor's map.and lot number .........J................ ,� Xr + '� �o o`` Board.of Health (3rd floor): 110L •• INSTALLED IA9 ®f� i •Sewage Permit number ..... .... ..............�.... (t• '" 41 LE. Engineering Department (3rd, floor): 14JITH TITLE 'oo NAAM House number ................................................................ .. i ENVIRONMENTAL C� rvax a� APPLICATIONS PROCESSED 8:30 '9:30 A.M. and 1:00-2:00-P.M. only r T'1017N REGULATIOXR3 c TOWN OF . BARNSTABLE , BUILDING . -INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION .....W.1 . r. ,y7a e,�J �,' i� �} �r�. , . ................... ...... a .y.............I9.A TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... 721....1—�! fle. .�!..' ............. CtI�SGI.?�5.... 111s'...................................................................... ProposedUse ......4 ..°........`..... U! ? P.....................................................................:........................................... DD ....................Fire District ....... .'..v! h/�'j Zoning District ....1�•'j..............:...................:.. .............. ........................................... Name of Owner . .........................Address ... ? r`�.GCC1! �!. �.. �/t/'SS'.. '7, Nomeof Builder .......:04�,&X.r..........................................Address ...........!�.g.......................................................... , Nameof Architect ......./.1"?..................................................Address ........10A.................................................................. Number of Rooms .......7.......................................:...............Foundation .... ........................ Exterior ..Roofin ...... 49.2.77.S! s 10�d Floors C£ .. ............ .Q...........................................Interior .....5'�r �°- '©Gl' ................................................. Heating /..........................Plumbing Fireplace ..........?�QOV.0.......................................................Approximate Cost .......�Jd�.C?...................... . Definitive Plan Approved by Planning Board ________________________________19-------- . Area �..................... Diagram of Lot and Building with Dimensions Fee ,.. ,s-'..... . SUBJECT TO APPROVAL OF BOARD OF HEALTH ------------------------- r l` asp r 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 ... /�...........�� c .... O�Jalf"�— Construction Supervisor's License .................................... MASSONNI, MARK No .... ... Permit for .... Add j.tjo.n/G,-trage Single Famijy..1)W.P,.l I j Bg ................................ ................ Location ....Q4.Y4.k9by..RQa.d........................... .................. .............................. Owner Mark MaqspjjAj............... ........................ .................... Type of;�Construcfion ......Frame.............. .......... .................................... .......................................... Plot ............................. Lot ................................ Permit Granted .............Ju Y.. ......19 86 Date of Inspection' 9-,Z�?/...... Date Cojrnpleted .............. f Town of Barnstable *Permit# C' Expires 6 months from issue date Regulatory Services Fee • ■nsxsresM 0� Thomas F. Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number V ' Property Address y 7 y CJC, Residential Value of Work 7 1� G0 r c-j Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ►`ci'►'1 I VA /✓1 n S �� I Contractor's Name R ` ,�� („��r• Sv �t��f�n Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) C j . ry VT dworkman's Compensation Insurance Check one: . 1 2012 ❑ I am a sole proprietor MAY ❑ the Homeowner I have Worker's Compensation Insurance BAVINSTABLE Insurance Company Name TOWN OF I Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ 9t(check box) 1Re-roof hurricane nailed (stripping( )( . pping old shingles) All construction debris will be taken to A��.J r^ ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows *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. r copy of the Home Improv pt Contractors License&Construction Supervisors License is required. h SIGNATURE: /J(.L ` j—a611.11'�-i��' Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 051811 The Commonwealth of Massachusetts Divartment o f Indrsshial Accidence Ojo ce of Investigations 600 Washington Street Boston,MA 02111 www.massgovldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lewbly Name(13usuesslOrgag�ttionlindividnal): i ( ¢} �' �''� Address: a X -7 7 C1,A 6 r-01- M 6 (p City/State/Zip: Phone Am an employer?Check the appropriate boa: Type of project(required): 1.LJ I am a employer with �-- 4- ❑ I am a general contractor and I employees(full and/or pnct-time). * have hired the sub-contractors 6. ❑New construction. 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ?- ❑Remodeling ship and have no employees. These sub-contractors have 8. ❑Demolition wcAdng for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance-19. ❑Building addition required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work 1L❑Pgrepairs on additions myself.[No workers'camp- right of exemption per MGL 12. Roof repairs insurance required.]i c.152, §1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] •Any appficanE that checks boa C mast also fill out the section below showing then workers'compensation policy informstiob l3otreoovoers trho submit this affidavit i&catmg they are doing all?roam and then hue outside contractors mmst submit a new affidavit indicating such ZContracmn that cberk this boa most attached an additional sheet showing the name of the sd►coortractors and state whmW or not those entities Dave emphryees. Ifthe sib-contractors bave employees,they ra=provide their workers'comp.policy number. I am an employer that is providing workers'compensation.insurance for my empla y'em Below is the policy and job site inforrnaiiom Insurance Company Name: Policy#or Self ins.Le.#: Expiration Date: Job Site Address: City/StatelZip: Attach a copy of the workers'compensation policy declaration page(showing the policy member.and expiration date). Failure to secure coverage as required unbar 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 ca�rtif}'a/cedar tlk sand nalfies o perjury that the infor4taatiortprovided above is true and correct Si tore: `/�Z�u v I 2lz'"�� Date:Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permitffkense# Issuing Authority(circle one):. 1.Board of Health 2.Building Department 3.City/rorsn Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone it: 6 i 1 WORI f. tS'= O IIPE ISATI N �►t�[DlMPL-by- t,,]L B�LI INS x �n 1 1 ' ' x � rmat�o gager L `` ,r ►C oo flo k _ ..�._. Atlantic Charter Insurance Company VDAC NCCI Co. No.:29211 `Policy Number. WCV00984700 1. INSURED: Prior Policy Numbe . New Richard Sullivan Producer: PO Box 775 Schlegel &Schlegel Insurance Sagamore, MA 02562 Federal ID Number:033605144 Brokers, Inc. ' Risk ID'Number. 34 Main Street-Rte 28 West Yarmouth, MA Business Type: Individual SIC:9999 NONCLAS IFIABLE ESTABLISHMENTS Other Named Insured:See WCE106 Other Work Places: See WCE 107 2. POLICY PERIOD: The Policy Period Is From: 12/31/2011 To 12/31/201 12:01 A.M. Standard Time at The Insured Mailing Address" 3. COVERAGES: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed' here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed iri,item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit. Bodily Injury by Diseases $ 100,000 each employee C. Other States Insured: Part Three of the policy applies to the states, if any, listed he e: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A D. This policy includes these endorsements and schedules: See WCE105 4. COVERAGES: The premium for this policy will be determined by our Manual f Rules, Classifications, Rates& Rating Plans. All infonnation required below is subject to ver abon and change by audit. Premium Basis Total Rat Per Estimated Classifications Node Estimated Annual $1 0 of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: $500 $500 Interim Adjustment Annually Servicing Office: Estimated Premium (Minimurr Premium) $500 25 New Chardon Street Boston, MA 02114-4721 Issue Date 01/11/2012 Countersigned By: Date '.opyright 1987 National Council on Compensation Insurance Form:100mv p� dyl/e`i(varwnwouueaCC/o199111eccc/c(IM0 License or registration valid for individul use only Office of Consumer Affairs&Business Regulation g y _ pME IMPROVEMENT CONTRACTOR before the,expiration date. If found return to: oegistration: 1,64857 Type: Office of Consumer Affairs and Business Regulation xpiration: =-1.1/;19/2013 DBA 10 Park Plaza-Suite 5170 �.'' ==;:a Boston,MA 02116 ALL CAPE PRO ROOFING&REMO,DELING RICHARD SULLIVANY� 4 ,lr 3 CRESCENT AVE. `:_-_ ;:j PLYMOUTH, MA 02360 Undersecretary Not valid without signature il1assachusctts- Del):u-tmcnt of Public S;irch-. J Board of Building Re;!ul rtiuns and Standards Construction Supervisor License " License: CS 103266 Restricted to: 00 RICHARD SULLIVAN: PO BOX 775 SAGAMORE, MA 02561 Expiration: 8/31/2013 . ('ummisioncr Tr#: 103265 All Cape Pro Roofing And Remodeling services 781-217-8123 Name- Tamlyn Mansfield Job address- 674 wakeby rd Date- 04/10/12 marstins mills MA 02648 Phone- 508-428-7025 Home address- Cell- Email- P.O. box- Office Karen Massoni We hereby propose to supply the materials and perform the labor necessary for the completion of installation of complete new roof Job details to follow: strip off existing roofing install new tryflex premium waterproof underlay-ment install certainteed winterguard (ice&water shield)first 3 feet from soffit and around any penatrations install new architectural style asphalt shingles from Certainteed (landmark Pro) install Certainteed starter shingles and Shadow ridge cap vented drip edge will stay in place ridge vent completion of this job will take 3-4 days from start date. Integrity roof system dumpster on site for removal of all debris customer must provide power for all power tools and access.to breaker panel 130 MPH wind warranty $3,450.00 labor $3,910.00 materials $450.00 disposal 23 square certainteed landmark pro HD 4 rolls of ice and water 2 rolls tryflex waterproof underlayment 2 boxes 1 %roof coils 4 bundles of starters certainteed 3 20' rolls of ridge vent there is your material list if you need to get the materials your self www.allcapeproroofing.com Home Improvement Contractor registration#164857 Construction Supervisor License#103265 All Cape Pro i All Cape Pro Roofing And Remodeling services 781-217-8123 Name- tamlyn Mansfield Job address- 674 wakeby rd Date- 04/10/12 marstins mills MA 02648 Phone- 508-428-7025 Home address- Cell- karen Massoni Email- P.O. box- Office II material and work is guaranteed to be as specified and all work will be completed in a substantial workmanlike manner for a total sum of $7,810.00 with payments made as outlined. Deposit $3,905.00 Remainder due immediately upon completion! Please make check payable to All Cape Pro If paying by credit card please note that there will be an additional cost of 3% in addition to any APR that you may already be incurring. If you would like different payment options please ask. II workmanship will be guaranteed for five years. Factory warranties apply to all materials used and we Standby the products we use and also our customers. In the event of a problem with any product used we Pledge to stand behind our customers to resolve the issue. Any alteration or deviation from the above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above the estimate. This proposal may be withdrawn by us if not accepted within 14 days. Any issue of mold in the building will not be our responsibility during or after the project. Please sign the All Cape Pro Copy and submit it for completion. i Signature Date of acceptance r� I I The above prices,specifications and conditions are satisfactory and are hereby accepted. I as the owner of the property hereby authorize you to do the work as specified. Pavments will be made as outlined above. WCards Home Improvement Contractor registration#164857 www.alicapeproroofing.com Construction Supervisor License#103265 All Cape Pro