The URL can be used to link to this page

Home My WebLink About0161 BETH LANE I6 1 Q�'r'H z APSE �- --- ACTIVE �� n�i� -.. i I' 1 "U& ccl� lz> ./US C94-p -Hk5,&n�- e-vLp lob v�--e" Town of Barnstable Building hr' is GTPost b" Ued "'r.,,a,'r..d*z,'°S oTxl 3':,.a,2t,w�^T�t°i.s,,"U.x'�L s.i b�l:e.,".:'Fz��,'r o'?m....:;t•;"h,�,.',.e��S t"�Fb e,•`�R;e�tatnadde;'...d�-�so nn Jo,.,bs�8a§`n��'^d,.t..,.h�f Permit �s Where a Cert�ficateof O,ccupancyis Required,such Bwldmg shall Not be Occupied until a Final lnspectionwhas beenmade `- s'.;. _,i:�i,w :G s :, Ss....,.fim.,e..:: .�.��:,_-ate-« :.-. >.. Er.h-; ..w_„ ;-.X. ., ..�.:.. to :•.fur .�.z �> .,, , . ,_�. . ,.a'.`, ..,: t, .,a- " ,a_., ,a_ T. - Permit No. B-18-2443 Applicant Name: RUTTY,ALTHEA Approvals Date Issued: 08/14/2018 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 02/14/2019 Foundation: Residential Map/Lot: 272-165 Zoning District: RC-1 Sheathing: Location: 161 BETH LANE, HYANNIS %COn`-"' r Name' Framing: 1 ..e Owner on Record: RUTTY,ALTHEA kCorit�actor.bcense 2 �.' ,. Address: 161 BETH LN . EstProlect Cost: $750.00 Chimney: HYANNIS, MA 02601 ' Permit Fee: $85.00 IT Description: frame out large bedroom into 2 rooms bedroom and�family room FeePad 5 85.00 Insulation: �� m Date$ 8/14/2018 Final: Project Review Req: MANDATORY SMOKE UPGRADE REQUIRED DHOW IN NE1N OI ' BEDROOM MUST MEET EGRESS REQUIREMENTS '" .�� `�� —� Plumbing/Gas . r : Rough Plumbing: ��' Building Official Final Plumbing: bL Rough Gas: = r Final Gas: This permit shall be deemed abandoned and invalid unless the work auihonzed�bythis permit is commenced within six mothsafterssuance. All work authorized by this permit shall conform to the approved application and the approved construction documents far which his permit has been granted: Electrical All construction,alterations and changes of use of any building and structures shall beam compliance wiih the local zonmg;by lawsand codes. This permit shall be displayed in a location clearly visible from access street or road arriid shall be ma ntained open for public inspection for the entire duration of the Service: work until the completion of the same. ' a Rough: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Final: 1.Foundation or Footing Low Voltage Rough: 2.Sheathing Inspection g g 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Health 7.Final Inspection before Occupancy Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Fire Department Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contract' g wit egistered contractors do not have access to the guaranty fund" (asset forth in MGL c.142A). F Z /c� Town of Barnstable Building Post ThisxCard So Thatit3is 1/rs�ble:'Fromthe Streeter App�oved;Plans,Must be Retained on;Job antl this Card Mustbe�tCept Posted Until:Final Inspection Has Been Made _ z Permit Where a Certificate Qf�Occupancyis,Requ�retlsuch Bu�idingshall Not be Occupied ant�l a Final Inspection has been made � „ ,. Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT , �w �• s . F. F* ,cam .� �`"iR J� � yy • - r s 3 t , � 3 ' ' � ��....................� ....... , ............ # S Pemit Fee. ..7 ............Other Fee........................ XASIL 1639. TotalFee Paid..................................................................... TOWN OF BARNSTABLE Pew Approval by..... BUILDING PERMIT ? .. .per..........0-6.11 ......... APPLICATION Section 1— Owner's Information and Project.Location Project=Address., � �_ - tOwners Name _ , 4 Owners-Legal:Address-. e r Ci"- t a415 S "G, tate- A -— - � - � �mail3 V` w��t�•G.�� Owners,-Cell-#� 2 Section-2�Use-of_Stracture-� Use Group �' Commercial Structure over 35,000 cubic feet `�o� r� ®�t� " ❑ Commercial Structure under 35,000 cubic feet z: Single Two Family Dwelling Section:3=Type-of-Pe ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alamo. Rebuild ❑ Deck Apartment Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar D Renovation ❑ Pool ❑ Insulation Other-Specify Section 4=Work Description----� _n^ - 4 `. i T Act nndzteit 219MI S 4 i Application Number.................... ..........................:.... Section 5—Detail Cost of Proposed Construction Square Footage of Project Age of Structure Dig Safe Number #Of Bedrooms Existing 3 Total#-Of Bedrooms(proposed)-, 110 MPH Wmd Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist Design Section 6—Project Specifics Wiring ❑ Oil Tank Storage, ❑ Smoke Detectors ❑ Plumbing [] Gas -❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required _ Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last imdated 2J92019 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information f� Please Print Legibly Name(Business/organizatio Address: l . _ / City/State/Zip: Gi'n�l APbpiG UlPhone#: �(�� `1 Are you an employer?C eck the appropriate box: Type of project(required): L❑ I am a employer with. 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition reo workers' com insurance comp.insurance.: ed. p 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3. I required.] as homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL c. ❑Roof repairs insurance required]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors 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 thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerli and r e pains an en of perjury that the information provided abo a is trugland correct Si ature:I Date: Phone#: 25 L?2_ / Official use only. Do not write in this area,to be completed by city, or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate building sin a business or to constrict buildin s in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C( )states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Qce of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877 NIASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.govfdia . SMOKE DETECTORS REVIEWED ca � p 2 BARN BUILDING DEPT. DAT FIRE DEPARTMENT DATE EOrN SIGNATURES ARE REQUIRED FOR PERMITTING 91 �A "� l 1 _ c, Ln Barnstable Bldg. Dept. Approved by: X S Permit #: ` f , _ ....ram_-.' - .,.� •. _._-_�__ ._��-tee i T73 BUILD OWN 0F3� �tiv53 �` e 5 Al Q� y N LA ., Application Number........................................... Section 9—.Construction Supervisor Name Telephone Number Address City State q License Number License Type Expiration Date t. Contractors Email Cell# I umdeistand my responsibff tries under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section-10 —Home Improvement Contractor Name Telephone Number Address City State Tip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and docmnentation required by 780 CMR and the Town ofBamstable.Attach a copy of your H.I.C... Signature Date Sectionn-ll=Home=Owners=License-�emptionn, Home Owners Name: VS* Q-P\ �A,. Telephone Numb Cell or rk Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the To of Barnstable. rSgn"ature - Dates APPLICANT-SIGNATURE Signature — si Dater sprint Name' �j �'�" Telephone Number 1 ,E=mail permit to: G,�. (� �i i Cc) re,F....a a_a.11innnTo Section 12—Department Sign-Offs Health Department ❑ Zoning Board Cif required) Historic District ❑ Site Plan Review(if required ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13—Owner's Authorization L , 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 i Print Name k Last undated:2/92018 f / F'THE Town of Barnstable *Permit "�h�q � e s 6 mRe Mato• Services eireoni sue e ♦ 3iRNCT�Ri F. y uAss. $ Richard V..Sca%Director �A 10 9• TEa �' Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA.02601 www.town bamstable.ma us Office: 508-862-4038 ' Fax: 508-796-6230 EXPRESS PERm. APPLICATION - RESIDENTIAL ONLY n '" Not Valid without Bed X-Press Imprint Map/parcel Number Property Address YL4 f eA titj /S �- 2'neside�iial Value of Work$ , a0 Minimum fee of$35.00 for work under$6000.00 R ,. Owner's Name&Address 46 M,!! l RL4�T I Contractor's Name Telephone Number H me Improvement Contractcr License#(if applicable) Email: Construction Supervisor's License#(if`applicable) ❑Workman's Compensation Insurance " � Check one: JV �. ❑ I am a sole proprietor N 2 s, . - .910'l ® lam the Homeowner To � ❑ 1 have Worker's Compensation Iusurance� !� !��. � Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit ReiTSent(check box) ❑ Re-roof(hurricane nailed)(stripping old s'ninglbs);^Au construction debris will betaken to & [VRe-roof(hurricane nailed)(not stripping. Going over existing layers of roof). ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. ` A copy of the Home Improvement Contractors License&z Construction Supervisors License is required.; SIGNATURE: ' Q:\Wp=SWORMS%uilding.permit forms\MRESS.doc 01/25/17 . ' fIIWC oOM-W99adam- Boston,MA 021H kPiP'lfi.Fi1FJS5��AP��id ' Iufarman Please Pik Ei�v �s Are gau an employer?.IM the appropriate b� h Type of project(regdm I-❑ I am a c�sctm and I• I ama emplapersv2itb. ❑ � 6. El New wog em�yew(fall.wlbr part-Mime * have hired.the sub-contmcEors 2~❑ I atn a sole piqp6etar orp Tilted on the attached sheep ?. ❑RPM daligg ship and have no empl5*ees Wiese cornhactars have .• li_ ❑Denali ba waging forme i a any capacity_ amployew aadbave wa&ers' 9_.❑S,nil&*adEf�oa jNo ivo&:c&ooaip_MSC= a comp_;,,g znc # 5. ❑ We are a carpasatim and its 1OQ❑Elechisai repairs or addiions 3- I ama bo winner doing all vmk-. oi3iceas ham exercised their ' 1L❑Phmzbingrepaus or addiriams mpseM[No wos'f='=mp_ Tigbtof Oemgficu per MCzt. 17'K Roafrepaim immaace requimd j T c.>:52,§I(4�andwe have no coax ��ap,�pg�$�at cber�sboz�l mast aLsa ffio�the se�oabeTacv�sCsda��eirwodced c�ap�atiaaparscgi�u�. • —srffim :neWxffiaxn -czucT,- . ICoatmGn6ffiricfier3c sbcmmast— msadili—A shed sloudngdam—of othiesbxm �glayees.7ftHe have e@p7ayws6 they ztpaysidetea tom'gyp.paRU mxmbm -Tam art eeriplofsr f7ia isprauirlir�n�crkers'camperisr�imt irivnraricsor xiy eutPlayex $eTorp is tTrapvlity torsi jab spa fss�ormaliott Iasacmm CampazylCame: P.Dlicy 41-or Self-izas_I.i Job Site Addre= Cftl1St3tefT=_ ALtach a--spy of&e workers'compensation policy dec m•atiaa gage(showing the parity mrmber and expiation date). FaAme to secmm coverage as sequimd•uades Sez ioa 25.A of MIM s-lP-caa lewd to the imposilioa of criminal penalties of a fine up to$UOD OD andfor o&,:= irimpdsoznexd.,as w&asrivil penalties sa&e fazm of a STOP WDFX€]RDERand a tine of up la a day aa` ind the violator. Be advised gid a copy offiis.xWement maybe f rwmded ta the Ofnre of Inve trgations ofte D-TA fcw msucaum csvemge vegan.. Ida her$iry Gan*corder tha pains audpw!��safyrdW7 th attha iafbrn:atiaaprovi&ff abmv is true grid Garrett s*ontum Date PLmae Z o g - (-.O - t102kid use arsff: Do jwt mite in this at ea,to 5e WROta by cily artnirrr ojolaal. 0ty of Tama: PerrmtUceme;ff Lssamtg Auffiurfty(drek one): L Sward of$eai.& mw Ilaimmg Dept 3. tTown Gk-xk 4.neck ical Inspector S.Pl Mbi ug motor C.Other Contact Person: P1tonE - - - - - ;xY 6 ormatio)a and hasctions M�ec r7 cdfa GeteralLaws dwPter 152 req=m an em9310ye=7n p dewm�ss'compeasafian{urfiicez£�7inyees- =&art ofh�, ,; ��fhis ,as awIoye�'is defined as- �yperson.in the sa•vicc of anothu Underaay or implic4 orfll or wrift=." . asso om4 oarporaf M or adirt legal�3',of�two or made An bY�is &Zfmcd as an.mdimidwL parfnmabip, �c r the of the foti=gvmg m aJ° fie'aadmg l of a dcrxzsed eatpl _ ,assoc�im or of =iegai e�ity,employing eoxployees,. However fhe reccEver or truster of an b&Odha�P�=P ortbc o oftbe- horse notmore 'f3ree apm t=±s mmiwho=udwtiierein, _ own=ofa.dwelrmg having e horse of ano5im who empInys peas®s to do r.neFrrtrFi can Cr repair wo�c on sarlx dWelimg h� g - be doemedto be an employe" • or OIL the�& or boVmg ,herein shaIlnotbecmse of such e¢rpI¢ymr� mm abap §25C(6)also stairs that¢emery sty Or Deal?*—'='b ag $ bola$te issaaace or ter i52, m the ca—Gxrweal$i for a:ay r•encw'aI of a R=nse or permit to open m a 3mssk=or to cons�ir act bufldacgs' applic=j--WIio has aotproduced acceptable eFiffmce of cnmphanm Wn tim insurance.roverage regnir� sues�Tertbcri3u _ nrnr any ofifspal>f�I sob&isiow shah ,�_rn,a_1Ty,MGZ rJ�aptrr I52,§2SC(7} �evidece of campliance�iii�.the m��•_ enf >a►naaycmrtart for tbcpMf`,',r M3J::�ofpvbTiav�=Za�p - -y r*m`r of tb rh h=cve b;; p >t:)+-I ca�-i- - `Z * - i APPl?cmfs ' Please fa oil the VUa=°=npensation affida.Yk completely,by a=Zmg ac bo=$at apply to Yots Omzffm if. n Y,�PIY s)name(s), address(es)andPb n=bez(s)aIongwALffi it s than the bsrance. LkHtDdLrabMLY Com=paaics(LI.C)or L=u:tcdLmbiayP s(�)w&no em ecs opIny members or partners,'are not regcmcd in ca=ry wot�e=3Pc°- l= rv- If an LLC or LLY does bay employees,apolicpisregaaed. Beadvi.sedVjs±ffiisa$da.VitmaybesahmittedtatbeDepadmentof Lubsh:w Aecidmts for eon of fiZMrM=cometeg- Also be sore to sign and dais ice aMdaYit Tha affidavit should nottbcDepar[med of be retrmzed to�e city or town that the apphcafioa fnr$ie pc�t or Itcease is being r • Indms-ixi�1 Ate- SbLmldyoa have any T=slions_ °'tiie law ,irdn:l h=obis a wozl�rs' az tic mzozber 7is�d below. Self-ins�xi compass shcrold enter-thew• ;�-„ �,;ai�apoficJ',P�'rj.:c:ra;lthCDeparfine� • self-ice Iieose roar oa ffie Vie. . O�riak n _ City or Tow r Please ore$i be sat the afhdavifis compictc mdpri�dlegibly. TheDepmimcnthaspmvIffc&& pace atthc bottom . of the affidavit f or you to fi[1 out ia.the event the CdE=of Tjyesti�has to�o�c-tYam g thLe applicant. Plmsebe s=to fininthepen lI crosemrnberwbichv Mbcmedas areB=ac numbcr_Im'addi&n,anapplicant that must mbmii m�plep=n*U=n a applk tions in 2ny aveuY�aced onl3'��one affidavit ind5ra ng comet and vndea`Job S5m Addr*rss*•&e,apphcant should v;fix="an Iomtbw in (�Y or policy in��ation[f nxessary) ed or matted by-&c city ar town maybe provided•m the ' ' town)»A copy oftbc-affidavittbathas b=ofhc ianY staazp applicant as�=6o ftbat a valid affidavit cs m file for Rd= r�.l tQ Iic�ses Anew af5dav>tmnst. i�TL t r Ii yS ij 7Tf7T1Sl a11tz0.Se G1;.pr�m7fIlOfITIB �mybusin=or Comm=cisiYe�� urn;�Ti:C.L•'�%Si 1ti31,iti':i`i�,'LG.VL E33s'affidira ' (ie_m dog license orgemaitto bmn Ieavrs a _)sauipen m is NOTrcgthed The Office ofInv�g�s woBIdl to�kyoainadvan.=foryo=eocperaflamandsbouUigoulzaveanyga �, �. please do north �give US . I} erimeafs TT a and fa�cnnmbcx: , cOZ A - ' - �4 Haan � Oil II Btviscd4-2¢-07 _ g Town of Barnstable A Regulatory Services Richard V.Scali,Director Buildilag Division n• *�� = Paul Roma,Building Commissioner KAM i� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862�038 -Fax: 508-79.0-6230 HOMEOWNER LICENSE EXEMPTION ' Please Print ` DATE: s/ -.JOB LOCATIOF-AA. - 4 � 9 o� /� number vill age "HOMEOWNER": - name home phone# e phone# CURRENT MAILING ADDRESS: ,'�- v�''� 10 c' towwn state f zip code The current exemption for"homeown s"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- f anily 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 hermit (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 proce ure d require an he/she will comply with said procedures and requirements. i + 1gnature of Homeowner 4 - Approval of Building Official i Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control • HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1,-Licensing of construction Supervisors);provided that if the homeowner engages aperson(s)for hire to do such work,that such Homeowner shalFact as supervisor." Many homeowners wbo 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 lid used 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. Q.\WPFILES\FORMS\building permit forms\EXPRESS.doe 06/20/16 r AWE Town of Barnstable ` F Regulatory Services Richard V.Scab,Director Building Division. Paul Roma,Building Commissioner 200 Main Street;Hyannis,MA 02601 www.town.barastable.ma.us Office: 508-862-4038 Fax: 508-790-6230 �iompProperty Owni' er lete and Siam. ction If Us' A B . II as Owner of the subject property hereby authorize to act on my behalf in all matters relate to work autho ed by this adding permit application for. (Address 0 0 ) **Pool fences and alarms are the res o�sibility of the applicant Pools are not to be filled or utilized befirre f�nce is installed and all final inspections are performed and a cepted. Signature-of Owner Signature of plicant Pant Name Print Name Date Q:F0RMS:0WNERPERMISSI0NP00L4 Op1HE Town of Barnstable *Permit "I Jr09 "o Regulatory Services 6moni t�su c sxxivsMLE, Richard V..Scali,Director F �p s639. ♦� c rr+p�' Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PLRM APPLICATION - RESIDENTIAL ONLY n Not Valid without Red X-,Press Imprint Map/parcel Number Property Address 6 t"Le / /74 t^ 1-1 t, C) � V1 Residential Value of Work$ ` Q O Minimum fee of$35.00 for'work under,$6000.00 - Owner's Name&Address RL4 T I Lf A/ 7,(1z Z ti lei i1 `WGa 6 2 E C+ Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) • - Email: Construction Supervisor's License#(if applicable) e ❑WorlQnan's Compensation Inswance . . Check one: ❑ I am a sole proprietor, e 9 .20 7 [� I am the Homeowner W� . ❑ I have Worker's Compensation Insurance �� - Insurance Company Name Workman 7s Comp.Policy# Copy of Insurance Compliance Certificate must accompany each.permit. Permit rte checkbox _Re-roof(hnmcane_nailed)j(stripping old shingles) Ati cuns+suction debris will be taken to Y J WRe-roof(hurricane nailed)(not stripping. Going over existing layers of roof). ❑ Re-side ❑ 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 Omer Letter of Permission. A copy of the Home Improvement Contractors License'&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\F.ORMS\buildmg permit fo=02RESS.doc . 010/17 t z ` NOTICE to BUILDING INSPECTOR / ENFORCEMENT OFFICER June 26, 2017 PLEASE BE ADVISED THAT WE REQUEST THE IMMEDIATE NOTIF- ICATION OF-ANY BUILDING PERMIT OF ANY KIND FOR THE PREMISES AT 95 CHASE STREET, HYANNIS, MA.YOU ARE HEREBY NOTIFIED THAT THIS IS A PENDING LEGAL MATTER AND THIS PROPERTY IS ALSO NOW INVOLVED IN A MATTER BEING BROUGHT THE PLANNING BOARD BY WAY OF A PUBLIC HEARING. PLEASE CONTACT LAURA WENTZEL at: 617 549-5555 OR JOHN JULIUS at: 508 237-2700 or email to cape330verizon.net or: jjulius@todayrealestate.com AS PREVIOUSLY MENTIONED, THIS.MATTER MAY LIKELY INVOLVE A LAWSUIT AND YOU,AS THE ZONING ENFORCEMENT OFFICER ARE MERELY BEING ASKED A SIMPLE REQUEST TO INFORM EITHER OF US IMMEDIATELY UPON ANY ISSUANCE OF A PERMIT OF ANY KIND. THANK YOU FOR YOUR COOPERATION IN THIS MATTER. JOHN JULIUS: 508 237-2700, 140 CHASE STREET, HYANNIS, MA. 02601 LAURA WENTZEL 617 x549-5555, 7 HARVARD STREET, HYANNIS, MA. 02601 bI JUN,26 ?Q17 TO l�i,tr r i 9 /y n " I �4l� f of U>` aIT't .0 CAPE COD zhT INSULATION ;� �� ®2 I M 12:. FIBERGLASS SEAMLESS SPRATFOAM SUSPENDED '�', � • BAITS GUTTERS INSULATION CEILINGS 'cam 1-800-696-6611 D INJA Town of Barnstable , Regulatory Services Building Division i 200 Main St Hyannis; MA 02601 Date:11—' f 1 j Dear Building Inspector i Please accept this Affidavit as documentation that Cape Cod Insulation, Inca performed.& completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute 1 (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village ' Insulation Installed: Fiberglass Cellulose R-Value Restricted 'Unrestricted Ceilings ( ) ( �) (.a0) ) 00 Slopes ' Floors p Walls ( ( 1 ( X Si rely Hk,d1n , t nt ; Cri, . E TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel t� Application # Health Division Date Issued l Co Conservation Division 'Application Fee Planning'Dept. .Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address �� l-Ar�-e- Village yN t W\ S Owner a)N t rA V} `I Address 1 UA7k Lo MA - Telephone So T- 72 T-- 18'�j j Permit Request r s'cr: �o�r-� f(�1c 3-D �jkg\0�re Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new . Zoning District Flood Plain Groundwater Overlay �`I Project Valuation 00 Construction Type Lot Size Grandfathered: U Yes ❑:No If yes, attach supporting documentation. Dwelling Type: Single Family;; ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq ft) Number of Baths: Full: existing new Half: existing new �= Number of Bedrooms: existing _new :X Total Room Count (not including baths): existing new First Floor Room Counte Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other LV �- Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove'❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - Name- CAef. CA&-rjSAft-V`W Telephone Number Address. 4 S S YArMo., License # 1 d09g T B:J"N s ►nn r4. CYc D\ Home Improvement Contractor# S3 S Worker's Compensation # Ut_A QQ SaS9 O 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �� — ` FOR OFFICIAL USE ONLY APPLICATION# r l` DATE ISSUED r i MAP]PARCEL NO; o s ADDRESS VILLAGE OWNER 1 f DATE OF INSPECTION: f FOUNDATION, FRAME INSULATION =t FIREPLACE F ELECTRICAL: ROUGH FINAL 4t , PLUMBING: ROUGH FINAL ."F t GAS: ?; FR ROUGH .i__-` ; FINAL ' FJNAL BUILDING ,r -DATE CLOSED OUT t ASSOCIATION PLAN NO. i � Tile Commonwealth of Massachusetts Department of Industrial Accidents 1= _- Office of Investigations 600 Washington Street t Boston, MA 02111 ' yy www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/It lectl-icians/Plumbers Applicant Information Please Print Lel7ibly Name (Business/Organization/Individual):_ CA fLQ r �/V ,ski ( 12 (Th Address: ✓� City/State/Zip:LLLACL Phone #: 5-0 �r� I Are you an employer? Check th appropriate box: Type of project(required): 1. I am a employer with 7_ 4. ❑ I am a general contractor and l 6. ❑New construction eiriployees(full and/or part-time).* have hired the sub-contractors 2.El I ain a sole proprietor.or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, .0 Demolition working for me.in any capacity. employees and have workers' 9 Building addition No workers' comp. insurance comp. insurance.1 required.] , 5. []. We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a bomeowner.doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4);and we have no employees. [No workers' 13.0Other(,� ._LM� A iT!Oft` 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. tContractors 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' co nip ensation insurance for my employees. Below is the policy acid job site information. Insurance Company Name: CA P CIA .1 Policy# or Self-ins, Lic. rZ,15,9 01 Expiration Date: Job Site Address: CQS,,D1,City/State/Zip: Nv,&- cY"y� 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 MOL c. I52 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. Ldo hereby certify u e pa' and penalties of perjury that the inforrnation provided above is true and correct. Si nature: Date: Phone 4: 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 Phone#: Contact Person: llassachusctts Ucpartntcnt of Public �,xfctN Board of Buildinl- Regulations ind Standard. Construction,Supervisor License License.`'CS 100988 Res ricted to: 00 HENRY CASSIDY 8 SHED ROW WEST YARMOUTH, MA 02673 xw Expiration: 11/11/2011 (u+iiii+isviuncr Tr#: 100988 AMi Vefu Ia`i'oi an 4nalrkf s — One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement'Contractor Registration Registration: 153567 Type: Private Corporation Expiration 12/15/2010 Tr# 278247 CAPE COD INSULATION, INC HENRY CASSIDY ---- -- ------- ------- --- -- ---- -- -__ _ _- ------------ ----- - - 455 YARMOUTH RD. - - - - - HYANNIS, MA 02601 - Update Address and return card.Mark reason for change. (� Address Renewal Employment (� Lost Card `-CA 1 0 5OM-07/07-PC8490 - - - _ [3os��bt�BkY�C(t ^fCLrgiti�1!°ttis af�� 1'�i�3f License'or registration valid for individul use_only -HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 153567 Board of Building Regulations and Standards Z Expiration:' 12/15/2010 Tr#, 278247 One Ashburton Place Rm 1301 Type: Private Corporation Boston,Ms.02108 CAPE COD INSULATION INC HENRY CASSIDY 455,YARMOUTH RD. ff ` HYANNIS,MA 02601 Administrator Opt id wt•itput i�gnature- u L'H 'V ; li,iuk Q9 -J,1.oil'I785735- Rogers a Cray Ins. VaQQ; 002 Client:4: 4597 CCINSUL ACORD,M CERTIFICATE Or LIABILITY INSURANCE DATE(ININIUU/Y'YYY) 07f27f2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS No RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.. " IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)mustbe endorsed.If SUBROGATION IS WAIVED,subject to the lai Ins and condifions of the policy, certain policies may require an endorsement.A Statement Do this certificate does not confer rights to the certificate holster in lieu of such endorsement(s). 3000L:ER _NAMEACT Margaret Young, - .ogers&Gray Ins. -So. Dennis - , , PHONE --- `— - FAX _. - LAIC No Ext:508-760-4602 _--_-- ----. -" ac 34 Route 134 E=mAiL - - - - ADDRESS: 0.Box 1601 IDii: --.._-.__'.___..._...._...__-'._....._._. ;oath Dennis, MA 02660-1601 CUSTOINER ---------- INSURERS)AFFORDING COVERAGE NAIC u JSUtfED _ - - Cape Cod Insulation Inc INSURERA:Peerless Insurance 4.55 Yarmouth Road wsuRERe:Ohio Casualty Insurance Cornpany' — INSURER c.Atlantic Charter Insurance Hyannis, MA 02601 INSURER D:Commerce Insurance Company 34754 INSURER E: - INSURER F: - :OVEf:AGES CERTIFICATE NUMBER: REVISION NUMBER: PHIS 11;TD CERTVY 1 FIAT 1'HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDo::ATE.D 1`401'VV11H,1;IANOING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS rE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE PERMS. EXCLAJSIOIVS AND CONDITION,;OF 5UCI-I POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MIT OLICY EFF POLICY EXP - - rR TYPE OF INSURANCE NSRAIVO POLICY NUMBER IWNrODIYYYY IVIMIDOlYYYY LIMITS A '6ENERAL.LIABILIIY CBP8263063 - D410112010 04101/2011 EACH OCCURRENCE $1 000000. - DAMAGE O R—N ED _ X t'r1NVdt hl IAI UI NI HAL LIAI:SIL.ITY PREMI,L $100 000 l.l.na(s MAUF L OCCUR Mr-D EXP(Any olio parson) $5,000 PERSONAL&ADV INJURY $1,000,000 - _...._....._..._.._...._..._._ GENERAL.AGGREGA'IL' $2 UOO,OOO ..l'NIA6C;Nri_;ru i-1iMi1 APPIJI::S 1°P"R PRODUCTS-COMP/Oi�ACG $2,000,000 - . vo Icy Jilt $ p AUTOM08ILELIAUILrrY 10MMBCKVMK 0410112010 04101/2011 COMBINeDSINGLEUIvIn- (Fa act:0011l) $1,000000 AN,Au10 BODILY INJURE(Per person) $ AI I :IriN1 11,w I O:; BODILY INJURY(Per acr"uienl) S :il'.1 II IJIJI I'U All I 115 - PROPERTY DAMAGE - X ilinl U.lU 1l!;i (PL'r accoam) X PION;1:'SIVLaJ AIIIUS $ . B UmURELLALIAU X ciccuR MEYAPP397725. 611712010 0410112011 EACH OCCURRENCE $1,000,000 "- I_XCES4 LIAu CLAIMS-MADTr AGGREGA-rE- $1 OQO OOO $ - X w-I 111 1U•I 10000 $ - C WORKERS COMPENSATION WCA00525901rop 613012010 0613012011 X WC YTATU- AND EMPLOYERS LIA0ILn-Y YIN 1H i'ttUrl LI(Ihrl'ARINI-Ivh"XtCUTIVE�� "- FL.L-ACFIACCIDIN'I - $SOO,000 Ill I-t;140.11 k111LK I`XCI UDFD'1 l •-i N/A - (@laudwwy In Ni I) - E L.DIS-ASE -FA L-MPLOYC-I.. $500,000 I nfIr.ao rumubr,In,lul —. --- -- ---- ,iCHil'Nl 4V U1 011t'RA( L IONS bolow E .DISEASF-POOCY HkIll $500,000 ' GESCItiP'rION OF UPE RATIONS I LOCATIONS I VEHICLES(AIIUCU ACORD 101,Additional R0111allt 85 cnatlula,d more spa cu is roquu ad) . Workers Coplp Inforn'tation Included Officers or Proprietors {Sea Attached Descriptions) CERTIFICATE HOLDER CANCELLATION 10 Da Vs for Non-Payment !: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Housing Assistance Corp. ACCORDANCE WITH THE POLICY PROVISIONS. 484 West Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE 01988-2009 ACORD CORPORATION,All rights reserved. ACORD 25(2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD 4S,4814IM53353 MEY c -; SUS T � 460 West Main Street H-vanniis, MA CO2601-3698 ErTEFG`t = ..: & HOME REPAIR ASSISTANCE ^i2y `GR. 'C�R 'I'1��1J T (Jcs; F �5a ��-��o , >3) ?90- E N ii`J n HOME OWNER WEATHERIZATION WORK PERMIT& FUEL RELEASE: ------ --. F1tL-0tT-AVD--S - THEAPPI_ICANT HOMEOWNER. i, t --s�— —hereby consent to and agreethat weatherization work may be done by the Weatherizati n Prb ograrn of Housing Assistance Corporation (herein after referred as "Agency") on the property located at: l�y �� r `�lt� • Theweatherization work donewill be based on programmatic priorities and availability of funding and it may includeall or someof thefollowing Measures: Weather-stripping& caulking of windows and doors, insulation of attics, sidewalls& basements, attic and other ventilation measuresand possibly replacement of badly deteriorated windows In consideration of theweatherization work to bedoneat my home I agreeto thefollowing: 1. i give permission to the"Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work.on said property. 2. The Housing AssstanceCorporation reserves the right to inspect thefuel or utility bill for the weatherized unit on an ongoing basisfor no morethan five(5) yearsafter theweatherization work is completed. have read the provisions of this agreement as listed and'fredy give my consent. Home Owner: (Signature) �..j�� Datet(signature) Agent Date HAC approved Weatherization Company : Caliber Building&Remodelin Cape Cod Insulation Cape Save Creswell Construction. Frontier Energy Solutions Lohr& Sons Peter Smith Resolution Energy Rock Solid Construction Sprinkle Horne Improvement 2;.,, ;.,..1,7�.. .r-,rf: cnrit rccr_._cr..•_.•i,c_ Town of Barnstable P�OEVE rp Regulatory Services Thomas F.Geiler,Director " > MASS, , ' Building Division �p�Eo dye Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 . Office: 508-862-4038 Fax: 508-790-6230 COMPLAINVINQUIRY REPORT Date: Rec'd by: Complaint Name: o Map/Parcel Location Address: Originator Name: Street• Village: AA fV State: Zip: Telephone: 60 2 �VI� kew`�" Complaint Description: a ir-�l YV -P k&10,h-J -1-4 I Li 1�`' + t 5 dL CA s o f O c FOR OFFICE USE ONLY Inspector's Action/Comments' Date: Inspector: Margaret L.Earhart,CSA Long Term Care Insurance ►�� Representative Genworth Financial 152 Beth Lane Hyannis,MA 02601 866 5 y3fi E 62 Send correspondence to: 508 246.2332 Office 15 New England Executive Park Burlington,MA 01803 Additional Info.Attached ax peg@capecod.net 888 GENWORTH Licensed insurance agent of Genworth Life Insurance Company n:forms:comulaint Lf V dA L °Ft►E,� Town of Barnstable Regulatory Services 9 BAM `'MAM �' Thomas F. Geiler,Director 039. 3r per. Building Division Tom.Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-403 8 Fax: 508-790-6230 November 7, 2006 Melanie Edwards 161 Beth Lane Hyannis,Ma 02601 Re: Operating a Business in RC-1 Zone Map 272 Parcel 165 Dear Ms.Edwards: This office has received a complaint regarding the operation of a trucking business from your property located at 161 Beth Lane. It has been reported that multiple trucks arrive and depart at all of hours of the night and day and on occasion impede the traffic flow by parking in the street. You should be aware that this area is zoned for single-family use only and any other use is contrary to our Zoning Code as outlined in Chapter 240 Sectionl4. Consequently,this office is obliged to notify you that you are required to relocate your business activities to an appropriately zoned.location by Nov 30,2006. Please know that we are available to assist you in identifying and confirming proper zones for your enterprise.Because non-compliance is subject to fines of up to$300.06 per day per violation,we remain confident that you will take immediate action to remedy this situation. Please contact me directly at 508-862-4027 in order to discuss this matter and all legitimate options available to you. Your response must be received by November 13th in order to avoid additional action. rely, Robin C. Giangregorio Zoning Enforcement Officer J:\Cornplaint Inv Reports%l61 Beth Lane Melaine Edwards.doe Certified Mail 7004 2510 0002 6227 9801 C- r QUITCLAIM DEED We, Bryant J. Edwards of No. 4, Route 6A, East Sandwich, MA 02537 and Melaine J. Edwards of 161 Beth Lane, Hyannis (Barnstable),Massachusetts�02601, being unmarried, in consideration paid of Ten Dollars($10.00) grant to Melaine J. Edwards of 161 Beth Lane, Hyannis, (Barnstable)MA 02601, with Quitclaim,covenants,the land in Hyannis, Barnstable County, Massachusetts, bounded-and described as follows: Being Lot 38 as shown on a plan of land entitled"Plan of Land in Hyannis, Barnstable, for Cape Investment Trust"which said plan is duly recorded in Barnstable County Registry of Deeds in Plan Book 271 Page 83 to which plan reference is hereby made for a more particular description. Subject to the right to use the roads and way as shown on said plan for all purposes for which roads and ways are used in the Town of Barnstable. Also subject to an easement to the New Bedford Gas and Edison Light Company and New England Telephone and Telegraph Co., duly.recorded in Barnstable-County Registry of Deeds in Book 2502, Page 117, and Book 2503, Page 202. For our title see deed from Edward C. Bogle and Janet Goodrich Bogle to us dated March 27, 1998 and recorded with the Barnstable Registry of Deeds in Book 11316 Page 299. WITNESS our hands and seals this 110 October 2002. $Bnt J. E ards _ Me�aineEd ds COMMONWEALTH OF MASSACHUSETTS Barnstable, ss October lr'o , 2002 Then personally appeared the above named Bryant J. Edwards and 1Vlelaine J. Edwards.and acknowledged the foregoing instrument to be their free act and deed. t. Al"Ad WCLS s� � Before me, •s My commission expires: k+2 rng- 10-/6•UZ Rrlvil tr► to/A- �/q 3"• L�.Dw�.ds S/G-r�Y7) /Ictf�d�9� �� p�0�IIy�� A. �1� ,• I .tl • ,yr �5. :is h':'�(:'.a 4 ' C ®l��' saildx3 uoIssIunit> Y �'�,•�`� r �tiec a BARNSTABLE REGISTRY OF DEED onend A23b�.LfJ1��n�uu��+`✓ W.,e P. Mycoffimi$63"Expir+ss' ry A'�_ r._ ..' SENDER: COMFiLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. � Qi/� ❑Agent e Print your name and address on the reverse X O Addressee so that we Can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, `nele IFL e cF olcva I a t� 0 or on the front if space permits. 10 D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: 136 Ida Sr � 3. Service Type /04-Gertified Mail ❑ Express Mail ❑ Registered ,'Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7004 2510 0002 6227 9801 (Transfer from service label) PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540 UNITED STATE -P, ` A S-. AW IS. DEC 2mse,� Pm^,-> ri • Sender: Please print your name, address, and ZIP+ I`n ffiis box • ""-""''``:... TOWN OF BARNSTABLE BUILDING DIVISION 200 MAIN ST. I HYANNIS,MA 02601 I M Ir 11 ! �11 i U.S. Postal,�ServiceTM C-ERi'IFIED M I M9. RECEIPT (Domestic Mail,Only;No l�nsuranceryoverage,Provided) �F,a�,delivery,information,visit our�web`site aat OFFICIAL I �/ or PO Box No. s it r i PS FForm 3800,June 2002 See.Reverseforinstructions Certified Mail Provides: (es -odSd o A mailing receipt a A unique identifier for your mailpiece o-A record of delivery kept by the Postal Service for two years Important Reminders: e Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. e For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811�to the article and add applicable postage to cover the fee.Endorse mailpiece'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. °FVKWE r Town ofyBarnstable °^ Regulatory Services 9'"R'SrAB g Thomas F. Geiler,Director �AlE1 390. p`0 Building Division ' Tom.Perry,Building Commissioner 200 Main Street,Hyannis,MA'02601 Office: 508-862-4038 Fax: 508-790-6230 November 7, 2006 Melanie Edwards 161 Beth Lane Hyannis,Ma 02601 Re: Operating a Business in RC-1 Zone Map 272 Parcel 165 Dear Ms.Edwards: This office has received a complaint regarding the operation of a trucking business from your property located at 161 Beth Lane. It has been reported that multiple trucks arrive and depart at all of hours of the night and day and on occasion impede the traffic flow by parking in the street. You should be aware that this area is zoned for single-family use only and any other use is contrary to our Zoning Code as outlined in Chapter 240 Sectionl4. Consequently,this office is obliged to notify you that you are required to relocate your business activities to an appropriately zoned.location by Nov 30,2006. Please know that we are available to assist you in identifying and confirming proper zones for your enterprise.Because non-compliance is subject to fines of up to $300.00 per day per violation,we remain confident that you will take immediate action to remedy this situation. Please contact me directly at 508-862-4027 in order to discuss this matter and all legitimate options available to you. Your response must be received by November 13th in order to avoid additional action. rely, Robin C. Giangregorio Zoning Enforcement Officer JAComplaint Inv Reports\161 Beth Lane Melaine Edwards.doc Certified Mail 7004 2510 0002 6227 9801 P,�,— � v �d�a C ��f,��,e. d . V November 3, 2006 To Whom It May Concern, I am writing this letter in reguards to the property at 235 Bumps River Road, Osterville, MA. It has always had two driveways and the reasorrwas that it had a garage under the house.'which has since been remodeled to extend the basement. I sQjd the property in 2003 to Robert R Pina with two driveways and nothing has changed. r Yo�urstrul'J7 Old,,Mil1 Road Osterville, MA 02655 R.4-A,�o'► �•�,rr �pi��'f�'iG ��tal�."lll` T, �'1 1 vZ ids' z �` h "• ,aiu:xr - v. r r •�?.a .3 �'�� liri a �_ I ��+�,,.� ''3`�.,.,,�► *,► ,�+"'. ;^z.•4� �4: � •F•Ufa:. �_,�. � ^_ n � I--" ��•F � ~,. �!'!�!' l t:. Jam---' "-, 2 16 � n a MJ6 et ..�.�t •�', a '�> .wy y x; ..1>tis ,K &� 1 1 Id s IIS:'� s •mot •' :tiC '�.,a%" M 1 u �O w A47- i.... .'' �PZ �� I W- R- r-. r _ • JOA �� TIN, oIf,21 :.....:.. o� . ....... KO)0r� •_t•` .riL� ,�,�1 ,+�^JR r ,tir,7' Y. ..r!:�/rY'�i••'1 w'�K~. � .+r �v�.,$�;'_-�' r - �'�.R�'�..� ,� '�?►Y*�.r:/��R, �.~ti '�•L�R{�j,'!.I�. ',• sip �9�'a�F..,y_`�f�� rJ: � ;�� ,+j.�,. lk ♦ �� 1� y�?' .fir^`. •C ,; :♦ ��}lY'./��:• �:� � •i. WWI •s �, .- .. �:•�" __err•+ P.- �� I"w t '} s � � � k c - t 6. RA :;.,..�.✓- -,e.. 4:. �;.,�..,rl.-:r .:t�... tea.�,..+. r� .::.T;c,. �...._ i..�.. ...,c_ ....L. l t�.> e4 °w'.:: .O.-J,l`§ i. ._.- __.. 3.�... _. �,....�.... ,._. . . yr. :.. . "IMP�_�.,,,. ��.._.�..� ._. _,.s.. ,.�,,.• sY .t_. . 3! iq S e- o�: Bk 19174 PO 219 'W83372 10-26-2004 & 01239P QUITCLAIM DEED We, Bryant J. Edwards of No. 4, Route 6A, East Sandwich, MA 02537 and Melaine J• Edwards of 161 Beth Lane, Hyannis(Barnstable),Massachusetts 02601, being unmarried, in consideration paid of Ten Dollars($10.00) grant to Melaine J. Edwards of 161 Beth Lane, <� y' Hyannis, (Barnstable)MA 02601, with Quitclaim covenants,the land in Hyannis, Barnstable County, Massachusetts, bounded•and described as follows: Being Lot 38 as shown on a plan of land entitled"Plan of Land in Hyannis, Barnstable, for Cape Investment Trust" which said plan is duly recorded in Barnstable County Registry of Deeds in Plan Book 271 Page 83 to which plan reference is hereby made for a more particular description. Subject to the right to use the roads and way as shown on said plan for all purposes for which roads and ways are used in the Town of Barnstable. Also subject to an easement to the New Bedford Gas and Edison Light Company and New England Telephone and Telegraph Co., duly recorded in Barnstable'County Registry of Deeds in Book 2502, Page 117, and Book 2503, Page 202. For our title see deed from Edward C. Bogle and Janet Goodrich Bogle to us dated March 27, 1998 and recorded with the Barnstable Registry of Deeds in Book 11316 Page 299. WITNESS our hands and seals this E'b October 2002. 442 B nt J. E ands Me�aineEd ds COMMONWEALTH OF MASSACHUSETTS Barnstable, ss October llrp , 2002 Then personally appeared the above named Bryant J. Edwards and Melaine J. Edwards.and acknowledged the foregoing instrument to be their free act and deed. ` Before me, ,r?,taine �rCuavcu s� � My commission expires: l rnA. !G"!b•UZ C�q�3{S� /O//6�� »� �1:�,�►bar •� �,•...•.•. o•��a�l... 'r as i�/G� '• '`:i;l i`k� .-l.rr:.'.a �Y SgtjZ le 1aqQ " •'.S'�w; .s:. P�6 ,G saJldxa uolsslunit�mcw BARNSTABLE REGISTRY OF DEED anand A2 Vlbf�i��,,,,,,<<�:' ti �{lfllPlti8s3®nEAirisYgtj' �o a}b9JL'�f llLl�s ;a,,#' rta �s 7vVrv� s`� p CLU # 0 044ss A Job OV . l ny y l� c� S 1 rl'1 t in. ko a-do NtQ cYwv ry it iv CCU d , o�oc1� a `JAU614 h. 6AIK- fGY/✓1 5 � 2-4 !o - -- 2 `3 z- Map Page 2 of 2 y t J 1 r-- http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=267148&mapparback=address 10/30/2006 Map Page 2 of 2 R� 1' http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=267148&mapparback=address 10/30/2006 Gessworth Fismsstirtl is a proud sponsor of ` . ..._. (r'A� _. i,/�a550C1ai:1OTi i alzheimefs iV the compassion to are,the leadership to conquer r Margaret L.Earhart,CSA Long Term Care Insurance r)� Representative Genworth Financial 152 Beth Lane Hyannis,MA 02601 866=2462332 Send correspondence to: 508 :0;ffff. 15 New England Executive Park x Burlington,MA 01803 peg@capecod.net 888 GENWORTH Licensed insurance agent of Genworth Life Insurance Company Town of Barnstable Regulatory Services Thomas F.Geiler,Director * M "' ''ASS'MASS. ' Building Division i6 9 0a _ 39. �� ACE p 39.E a Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 CONIPLAINVINQUIRY REPORT Date: Reeld by:- Complaint Name: o Map/Parcel Location ,� - ..t S!t lV Address• � � - _G{/ylQ.�...._ =y�-YU!ti _5 '_-..._._� Originator Name: Street• =t Villager 6A f V State: Zip: 0 �—/o d Telephone: 5po 0' Complaint Description: BE?61de-nflat 6 V\/ U 0 P r-2�jI yu ®f k o-jN�° dnn i yv cf s 0 f f� d Jv-6,6Daa olj,,O� � o-k N a r s� � FOR OFFICE USE ONLY Inspector's Action/Comments' Date: Inspector: J Additional Info.Attached n forms:comnlaint � z SO c��L 7p � a _ Ice vv �1 4 1 � � b � t a maw Town of Barnstable of "E'Ow Regulatory Services Y 3 �• �� J �Pv do V? Thomas F.Geiler,Director i V11 ' BARNSfABLE, ' Building Division r rsass. � Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 . Fax: 508-790-6230 Office: 508-862-4038 COMPLAINT/INQUIRY REPORT y 1 Date: Rec'd by: s , w rt� s Complaint Name: o Map/Parcel Location f Gf/1�1 Address: Originator Name: Street. w Village: 6A 0 V State: 1 Zip: 0 �? Telephone: Complaint Description 'N i f Q -,S NN YV IS1� z� U GV� J s -6cm�tQ L' a�s �� w acre. �1 ! FOR OFFICE USE ONLY 4 4" Inspector: Inspector's Action/Comments Date: -- g P TOWN.OF BARNSTABLE BUILDING PERMIT'APPLICATION NSA �7 & Parcel ,_C�) . . . . � Permit# Health Division !! '. �'.�� .J Y Date Issued l �� >� Conservation Division Fee Tax Collector- I t ' � p I 1 SEPTIC SYSTEM MUST BE TreasurLl ®o INSTALLED IN COMPLIANCE Planning Dept, WITH TITLES ENVIRONMENTAL CODE AND, Date Definitive Plan Approved by Planning Board TOWN RIQULATIONS Historic-OKH Preservation/Hyannis 'Project Street Address 1 � �Z!h Village 19 S Owner lul_1 s7f y:: Zen"�� ,�.�r�ra✓s ` Address / Telephone Permit Request / CL ,. �r Square feet::1st floor: existing proposed 2nd floor: existing proposed Total new 1 � ��% wvf/N F/vat /airy Valuation Zoning District Flood Plain Groundwater Overlay Construction Type . tJ Lot Size o S Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure yrS Historic House: ❑Yes ❑4d'o— On Old King's Highway: ❑Yes BrITo Basement Type: W- ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) /. 1"o Sly , 1--7— Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 02 new Half: existing _,,g59- new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: O Gas i'Oil ❑ Electric ❑Other Central Air: ❑Yes Mlo Fireplaces: Existing _� New Existing wood/coal stove: ❑Yes ZkrGo— 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 U1 o If yes, site plan review# Current Use G Proposed Use ; r'o0 R4 . 0 BUILDER INFORMATION Name " Telephone Number Address - License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO DATE SIGNATUR /ems �%rG � x FOR OFFICIAL USE ONLY P MIT NO. i DATE ISSUED- - • 6' _ j � -` - �. - .. t' '.•. MAP/PARCEL NO. ADDRESS ��- . VILLAGE - r . OWNER DATE OF INSPECTION:' _ FOUNDATION FRAME ! - W4f 3 _ INSULATION>` y j FIREPLACE ELECTRICAL: ROUGT ! IT- - FINAL k . PLUMBING: ROUG ' «_ ,,,. FINAL a GAS: ROUG)Hj ,. _ ,.�»�, FINAL FINAL BUILDING _ ` sr � 4 DATE CLOSED OUTS} x� - ASSOCIATION PLAN NO. f s � •' ' „�'""' TOWN OF BARNSTABLE Permit No. _19548 8/26/77 Building Inspector Cash _-_-- °""Y� OCCUPANCY` PERMIT Bond _- —_____ "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to C. & F. Builders Address Falmouth lot ##38.4 Beth Lane, Hyannis Wiring Inspector L - � Inspection date ;211 2 Plumbing Easpecto1 ,� Inspection date o ` Gas Inspector !� Inspection date Engineering Department Inspection date 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. c �.. _._... , 1927 Building Inspector TOWN OF BARNSTABLE Permit No. It8- 8/26i77 I n23T..z Building Inspector Cash -__---- 'Oo OCCUPANCY`, PERMIT Bond "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to C. & F. Builders Address Falmouth lot 038 Beth Lame, liyamiis r Wiring Inspectors--` Inspection date Plumbing Inspector ,�G'-� �Tl�� Inspection date ✓� Gas:Inspector _ Inspection date rz Engineering Department Inspection date 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. s t �j . �_ ...............................�.....__.........., 19....'.� ..................... ..Building..Inspector. ...__....._............ 1 41 Xeo ` 40 al 7--Co w 4 i ..Y O G(11 IG• h 30 ± Cr Fr fir. y 4;. •. ° i 4:; 41=4 c�+,l�4#�y _!t%r°-� o .� �� -�: .,auGVS� r 7777 t I4. I'�i.�FG..G-'f\/ifi 71 C lAwl. Tom/r P4 s4A./ ./S -11�qle � 'GLI.r�AtS .qu :VsWG WA.1 .4.vZ; 7-AVo9T . iT ` tJ�$. 4`4.VFC�@A.J' TO. Tf,/�- O.C//� .• , IME5 i �Y=•L.A{+1f.�'3 C� J',yE 7'2�Jf✓ilJ C?F ��ie/UST-�+�3G'� '��` L, cr * 4 yC'-fV/L- E',c/G/ASEE A'�}. �t f �►y�/1��:�'.'y�.�+n,r--• ��rf2e4t-L2.._ad[�.6�1/.ES/CE?� z�--�.; - 3 �l�$ f+� �_' � �,�� yt�,� .,�,e."c�, ,�� e�J s. ' ;� vrsr, .s4i4 5s. � �Ar� ,��.. LR ,fiy;, r,v.�✓�'+'''oC'"` -•' Assessor's map and lot.number E TE - W,T{yA� �� IIV C®MpST �� a 9'ewage Permit number RrIGc Llq "G :.. .... i' - r ANIrARY GGD If S-r - THE rov TOW O1 BAR \ S 1.REGLIXUI �� r� i23ARES L • D pYae�� <° �U.1LD NG' INSPECTOR . . ... ' .. ... r.... . • X GG ' APPLICATION I'di PERMIT TO4��...... t TYPE OF CONSTRUCTION ..........:........................ .... .7 7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit a cording to the following information: Location ....... .D... ..................... .. .............................. .. ............................................... Proposed Use ......... ..........:..................................................................................................................................................... :.. ZoningDistrict ..�D...� Fire District.......... ... ...................... ................................................................ ............. O ... ...../ Name of Owner rSv..... .... Address .....` .... ............. ... ............... ......... e� Nameof Builder .....:....................:.........................................Address ............. Name of Architect ..... ...................................Address ......... .� rcf,e 6 Numberof oms ................. ..........................................Foundation ............................................................................. Exterior ............ ............................. ....C/ .� oofing .................... .............................................................. Floors Interior ........................ . ..... .................:............. ............... . HeatingPlumbing ..................... . . ..................................................... Fireplace Approximate Cost `%7 !�!J C) ....................... ................................................ .........................../........................................ Definitive Plan Approved by Planning Board -----------_------_-----------19________. Area `... �...... ..................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH �yp /moo I hereby agree'to conform to all the Rules and Regulations of the Town of Barnstable r arding t e above construction. ..• Nam ...................... ......... ....... ....................... ,,,,,Frost Cape Cod t f 1 91348 ne story , No ............. Permit fo .................................... t 'single family dwelling .... .............................. ...................................... Beth Lane LocatiorO............................................................ , Hyannis _ = .......................................................................... - Frost Cape Cod - - Owner ..... ......................................................... r frame' t' Type of Construction ............................................................................... Plot ............................ Lot ...........06.............. i Permit Granted ......August 36 ... .......1977 - - Date of Inspection ..........19 Date Completed ./:(`1...� .19 k 11S7 - • PERMIT REFUSED _ - r . 19 r f' ............................................................................... " ............................................................................... - .........................................................................:.... I s Approved ................................................ 19 ............................................................................... ................:.............................................................. f- / ^ ~ ^ | | / ~ - ^ � Frost Cape Cod 165 ~ � �� ~~�,u- 19548 ne story mo —. -- re,m/ .................................... single family dwelling ...................................... . ` h^ \ Be t hLmne J iocohoniU/—.---'--------------- Hyannis '....... Owner Ax�$4 t 16 77 ` r=,mn G,on,=o Dote of Inspection . ` . ' Date Completed/ PERMIT REFUSED- � � -----------' ----' —' — ----- .— � � ~.—.—.—.—. —~~—. xw..................................... --------^--'^' --^---^------'' � Approved ---------------- lg ' --------------------------' � ---------------------.~.—~.. � anruvsrna[S The Town of Barnstable Regulatory Services �''°TEo►�j' Thomas F. Geiler, Director Building Division Ralph Crossen, Building Commissioner 367 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 notmore than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost_ ' Address of Work: Owner's Name: Date of Application: I hereby certify that: ` i Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 ❑Bu'lding not owner-occupied wwner 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. Date Owner's Name q:forms:A ffidav i "'� The Commonwealth of Massachusetts a = -= Department of Industrial Accidents - - -= Office otlosesdgat/eos 600 Washington Street . -...- Boston,Mass. 02111 on Insurance davit i name: 11 r U/2n-&- -,L- N,04-1 ,P7 0 , 2Jz rd-5 . . / J� / /� location I 1 /� 7/1 J-- P /—�N, - ti .it, hone# I am a omeowner performing all work myself. I am a sole rietor and have no one workiu in anv acity %%%�%%%//%%////%%%%%%%%%%%%/G�%%%%%%%%%%.... I am an employer providing workers'compensation for my employees working_on this job. :: :::..:::::::::::::::>:;::>: :: >i^Ellie'isi< isi�ii;�i;ii?=?i?i?i i is ;`i !isi <` i '<2< r::... isi > i;': ?;3 ;.-? ' : : ;::.;.;_::__.:i<`:i�:'::ti �i� :<::asi:'is�:°:<i:i;:; :`:;::;<..............si..... si i..... i..'..i i is is;i::::?i:it'ii:i;i: _ ontaanv n ...:.........:::;.:.:;.;:. :.:::::...::.....::.:...'.:: ;:;';.;::.;:.:::.:::.::.::.;:.;:.:::::::.i. .: >:>:> _ phone#::.. .......::. g :..::::::::::::::.::::.::.:..::::....:::..:. . .:...::..::. .:.::. :<;:::.:.;: : .:::..::. allcv#: 9nsurance to::, ..: .. .. . MOVIIIII74F��IIIIIIIIIIIIIIIIIIIII-IIIZIIIIIIIIIIIIIIIIIll�ll�11111�Ill1111111111�11111,�l�ll�lllll,lffl�ll�llllll,::Il�,�1111111,-, ------- /i, ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have . the following workers'compensation policesr aomnanv>namu•:' :,.:..;; :........... 'a ss: : ::i%:?isi? ?' y : :y: :' :% as Y! 'y>i s ?> :':r i i ? y% t?"....:: :(-1 .. :><%i i� i` ` :i si si'..... :j:'is y i:: is ?ic`i:: a'±: % %[%i yi y'j i`=i'i i .......... :.:::. ::::::::.; adie s $ r ::Mv.....n v.�v: 1{i:>-..i::i::::,IIII......??::};:;::<}''j':i:'i':i'}':::':J:4:i'iiiil;'::tisiiY4::::::}i'>...:':n}iiiii}'';:' :w:::v:t.;.;•:......................................... ...... ... ......................................... tMe. ::w::>:'r•v:• i:�'Ki.}}}iiii;is ii:is�ii'i>:L:•:'ii4r:•:4 iii:.....ii::^.ii;i;ii:.:ii::vix::•::...•••.•....:.v::•.:nv .............. .... i;:J:4>:v:i:•::::::::::.vi::::::.v:::::::::v::i::::::::w.:�::::::::•.^::::::::::.:::::: :: ...i:•:........... ;i:i:::: ::::.v::::........;::i}?;:::.�::::::vi i^:::.:i{::.;i:Y iY"iiii:h:4:•:ii:{ii�ii:?4:•;Ti:•i:4i:i:Liii;ii?i>}}> 4:::•isi•i:•i};ry:Jiii:i::;?i};i:......:.....:J iiii}:>iiiiii:;i::vi:•:T?;:;X:•i:hii:?:'F.:K:..i};iiiii:•iv SYii':::.: % >. ................................................... ::Via`.— ::::::::.:.:::::::::..:.:.:....:..:: ::::WN.. ............:•:::.. ............................................ .... ............... ..................................... .......:.:,..........,.......... ltY ` � /✓/%///%% ;:.;::.....:.:.. nddresss1. .::;.;::.;:.;..::.:::.;:.:.. :::::.:: :.;:.;::;.;:.;:.::..::.:'.:.:.;.::........ ::.:...:..::.;::..'::.::.;:.;;::.. .:...:.::...:;:.;::' tltw �..... ......._ v:::::.v::::::::::::::::.:::::::::............................ .........:v::::::: :::....:::':::::::: '::::::.........ii::.......;;?i:;v:?:4i:;4;};}ii::Li:v};:vi::.�:::::.v:.; 'r?;;i:}'::;>S:•:•i si;.isLiii:.:; ::{isii?:»i"'ii:X.""`.'.""::!:�i""'::::"':J""'i+!i•::i:i:>:'i::j}:'i::i:iiii::::j::i J::i:++ii <::}'l.+!v:.y::::. ' i > :•..:;:::;;:•i:;br'•'•::4>isbi:i......:^i:•;:!!;i:!'i"':::!':<::.:'"::::';i:':'.`':i':;::ry>::.:jj::........:': 1. <i Q : .. .: 11646% Faflme to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crinmimsl penalties of a Sue to S1,500.00 and/or one years,hnprisomnent as weft as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is trr.mid correct signatara " Date Print name A �I Phone# official use only do notwrite in this area to be completed by city or town offidal city or town. permit/license# ❑Building Department ❑Licensing Board ❑checkif immediate response b required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other *wind 9/95 PW 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 implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the 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 the 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 and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits 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 Mf being requested, not the Department of Industrial Accidents. Should you have any questions regarding the`Uw"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 and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peinutllicense number which will be used as a reference number. The affidavits may be retumed in- the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of lavesduatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 CF[HE t °'�. Department of Health Safety and Environmental Services N•�'' �► Building Division '' t sesrtsrwer.E. t 367 Main Street,Hyannis MA 02601 9 MASS 1639. HBO MP'I�` Ralph Crossen Office: 508-862-4038 Building Commissioner Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: I1 1,46/06) 00 JOB LOCATION: ;1� /3E street village number 8� "HOMEOWNER': / name home phone# CURRENT MAILING ADDRESS: 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 engagded e an individual for hire who does not possess a license, that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land oa which he/she resides orintends to reside, whory ich such useere ,Or is and/or intended to be,a one or two-family dwelling,attached or detached structures period not be considered faun structures. A person who constructs more than one.home>� two-yearo a form acceptable to the a homeowner. Such !homeowner"shall submit to the Building 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 resp onsrbility forcompliance 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 and that he/she will comply with said Department minimum inspection procedures and requirements procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors):provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." the responsibilities of a supervisor(see Many homeowners who use this exemption are unaware that they are assumingoften 2.15 This lack of awareness Appendix Q,Rules&Regulations for Li the hometowner hirescunlicensed pens. Inoth s case.our Board cannot proceed against tsthe serious problems.particularly unlicensed person as it would with a licee. nsed Supervisor. The homeowner many communities require,as part of the permit To ensure that the homeowner is fully aware understands his/her responsibilities, application,that the homeowner certify thats cae to amend and adopts ch a formicertifica onr for use ein your community. is a forth currently used by several towns. You Y Q:FORMS:EXEMPTN , 161 defy 'PI+ XO `r I aR- - 3X,3 3,13