HomeMy WebLinkAbout0578 OAK STREET (CENT./W.BARN) J7
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UPC 12543
No. 53LOR
Friedline & Carter Adjustment, Inc.
rlei�hrie'. 4.36 Main Street,P.O. Box 338
M � Hyannis,Massachusetts 02601
} Tel. (508) 771-3232
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FAX (508) 790-2344
-�-" claims@friedlirrearidcarter.com
DATE: June 4, 2018
Town of Barnstable Building Division
Attn: Records
200 Main Street '
Hyannis, MA 02601
RECORDS REQUEST
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RE: Our File Number: L3509 ,
Insured: ALCOCK,`Arthur&BASKIN, Jeanne "
Date of Loss: 5/22/2018 C
Claimant: Desmond, Thomas v w
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Loss Location: 578 Oak Street 70
West Barnstable Fire, MA
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Please send information requested below in regards to the above referenced t"
caption and proceed accordingly: rh
Please forward complete medical and/or hospital records for the above claimant.
Please forward all hospital/physician bills for the above claimant.
X Please forward Building Dept. records regarding all inspections at the loss
location.
Please forward Housing Assistance.
Please forward Police Report.
Please forward Fire Report.
Attached please find medical authorization forms. Please sign so that we may obtain
necessary medical records.
_ Please forward Dog"Officer's Report.
Thanking you in advance for your anticipated cooperation.
Very truly yours,.
Pauline A. Skiver
Liability Claims Manager
►Jb et(Wj('f-7
Sig� 2011
FjHEfTp :' Town of Barnstable
i3utxsr�at Er• 200 Main Street Tel.(508)862-4038
04
TEDM INSPECTION REPORT
Permit: Addition/Alteration -
Residential
Use:
Date: 7/3/2012 12:00 AM Inspector: Permit Number: B-2011-07393
Name: ALCOCK, ARTHUR JAMES & BASKIN, JEANNE E
Address: 578 OAK STREET (CENT./W.BARN), WEST BARNSTABLE Unit No.
Inspection Type Inspection Item Status Comment
Building Final A- Inspection Results PASS RMCK:
Inspection Overall Comment:
Overall Inspection Status: Re-Inspection Date:
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Inspector Signature Owner Signature Total Score:
FT"E Town of Barnstable
uxxsr�a[:e.
200 Main Street Tel.(508)862-4038
INSPECTION REPORT
I Permit: Stove
Use:
Date: 12/28/2007 12:00 AM Inspector: Permit Number : B-2007-07227
Name: ALCOCK, ARTHUR JAMES
Address: 578 OAK STREET (CENT./W.BARN),WEST BARNSTABLE Unit No.
Inspection Type Inspection Item Status Comment
Building Stove A- Inspection Results. PASS JLEB:
Inspection Overall Comment:
Overall Inspection Status: Re-Inspection Date:
Inspector Signature Owner Signature Total Score:
i
'Town of Barnstable ermit: -70-? ,),a
Regulatory Services ate:
F1He r Thomas F.Geiler,Director
Building Division ee. 06)
BARNSTABLE. t Tom Perry, Building Commissioner
y Mass.
1639• `�� 200 Main Street, Hyannis,MA 02601.
�prEG A1°'�a www.town.barnstable.ma.us
Officer 508-862-4038 Fax: 508-790-6230
TOWN OF BARNSTABLE
SOLID FUEL STOVE PERMIT
(3aJc 5� 5 bg� 7& - 3?- �c11
Owner: f�fL Ph e
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Install at: �Villa e: � 2 sST�3l t—
Map/Parcel: )OL S� a a `'7 Date: -7
Stove
A. ew Used
B. Type: adian Circulating
C. Manufacturer: ��.-r-,, . Lab. No.
D. Model No.: -F -S0-zJ 1
Chimney
I
A. New/Exisiin (If existing,please note date of last cleaning)
B. Flue Size
C. .Are other appliances attached to Flue? ►�
D. Pre_ b Type and Manufacturer
E. aso Line nlined
Hearth
A. Materials:
B. Sub Floor Construction:
'Installer
Name: Address:
Phone:
Location o Installation:
H.I.0 Registration#
Construction Supervisor#
OR check Homeowner Installing, no.license required
APPLICANTS SIG TURE
APPROVED BY: X, E f.
Please`Hake check a able to the Town qf Barnstable
*This constitutes an official stove permit after inspection,photographed, and approved by the
Building Inspector
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Q:forms:stove
Rev 103107
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0 Mid-Cape Hwy, West Barnstable 12/27/07
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map- A 41 S Parcel 6 0r7 nn® Application # e40 bl
Health"-Division v Date Issued I 1
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Conservation Division .' Application Fee
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Planning Dept. ermit Feel.-ID
Date Definitive Plan Approved by Planning Board
Historic - OKH Preservation / Hyannis_ I`
Project Street Address42
Village ARCE
1�1 � �421�TS4 4�AA liid 11 '
Owner AeZ iV Q_ J �f-'r`[e cal Address peC'4L 1�ty 1N ° 1 �
Telephone
Permit Request" TAf--T- L �'a 1�5 \` C��^ N
L.,.
Square feet: 1 st floor: existing b, proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation � r �b-0 Construction Type A iri
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family .m Two Family 0 Multi-Family (# units)
r
Age of Existing Structure .3 5 -42 ' Historic House: ❑Yes A No On Old King's Highway: '` Yes ❑ No
Basement Type: XFull ❑ Crawl ❑ Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing Z- 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: 0 Gas '4 Oil ❑ Electric 0 Other
Central Air: 0 Yes No Fireplaces: Existing I X New Existing wood/coal stove:/dYes ❑ No
Detached garage:J existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_
Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes No If yes, site plan review #
Current Uses-- nrt,�v Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name . ice L� Telephone Number ����''
Address �� � �cl ��1VT� t 11tLicense #
Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
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SIGNATURE DATE 0 _ Z
ti FOR OFFICIAL USE ONLY
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APPLICATION#
r'. MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER.:'
DATE OF INSPECTION:
FOUNDATION
s .
` FRAME.
'INSULATION, ..:
FIREPLACE
ELECTRICAL: ROUGH FINAL
L
PLUMBING: ROUGH FINAL
ROUGH, INAL
;:FINAL.B:UILDING
QAT.E CLO.S.ED OUT „K
ASSOCIATION PLAN NO.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
IPI
Name (Business/Organization/Individtial): `z _��,fL J .
Address: lX6 nsiZ32,1 cLC 1
/State/Zi c&,2�` -ig- rx�3L
Ci _
ty p: � Phone#: —,3ZZ
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.El I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity, employees and have workers'
[No workers' comp. insurance comp. insurance.$ 9. ❑ Building addition
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3 ] 1 am a homeowner doing all work officers have exercised their I I.❑Plumbing repairs or additions,.
/ myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152, §1(4), and we have no 13. ] Other � l
employees. [No workers' �i►t�N�l ll
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature: Date: O 'b� Z o i
Phone#: — 2-Z
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Town of Barnstable
OF'[KE!
P y
ti� o Regulatory Services
Thomas F. Geiler,Director
Building Division
rED µt+t
Tom Perry,Building Commissioner
200 Main-Stmet,_Ayanais,MA_02601
www.to wn.b arastab l e.ma.us
Office: 508-962-4038 Fax: 509-790-6230
HOI EOWKER LICENSE EXEMPTION
Pleare Print
DATE: F iI X '
JOB LOCAnON:
number �� strut p� �7 village
"HOMEO WNER':�A LrJ - '�7 ?C Z� C
name home phone# work phone#
CLIRPEW MARNG ADDRESS: Q �►�'C �j O
city/town states 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.
DEFI7II'ITON OF HOMMOWNER
Persons)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 t)ne home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Budding Of5cial on.a form acceptable to the Budding Official, that be/she shall be
responsible for all such work performed under the building permit (Section 109.1.1)
The undersigned"homeowner"asstmoes responsibility for compliance with the State Building Code and other
applicable codes, bylaws,rules and regulations.
The undersigned"homeowner"certifies that.he/she understands the Town of Barnstable Building Department
minimum,inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signa 're of Ho eo Pr
Approval of Building Official ,
Note: Three-family dwellings contain.ing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Constriction Control.
HO7r17;OFPKER'S EXEMPTION
.The Code states that "Any bomeowner parfomring work for which a building permit is required shall be exempt from the provisions
of this section.(Section I D9.1.1 -Licensing of canstrvction Supenrisors);provided that if the,homoovvner engages a person(s)for biro to do such
worms that such Homcowncr shall act as supervisor."'
MJany homeowners who use this rxcrrrption arc unaware that they are assurrring the responsibilities of a supervisor(see Appendix Q.
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness bf=results in serious problems,particularly
when the homeowner hires unlicensed persons. In.this case,our Board cannot proceed against the unlicensed person as it A ould with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/hQ responnbiliticc,many conumunitics require,as part of the permit application,
that the homeowner certify that helshe understands the responnbilities 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 fonn/ccrtificatian for use in your community.
Q:forms:homccxcmpt
I
Trti Town of.Barnstable
` Regulatory Services
A E& Thomas F. Geiler,Director
-Bculding Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barngtable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Ovv ier Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject.property
bereby authorize to act on mY behalf,
in all matters relative to work authorized by this budding 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:F0RM3:01tkNEPPERMISSION