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--- - ' '� '� l Application number.... ... ........�:..j�...�...... ��Lp1NG DEPT. . oC, �► i�V Fee.........................KAM .....'......q.. Building Inspectors Initials... Ow 0 Date Issued.:. ....... . ........................ . ii Map/Parcel..............QM.......1.6. .l........::...:....... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 10 l-& NUMBER STREET VILLAGE Owner's Name: Phone Number �5(58" Email Address: Cell Phone NumberJd9'7?V 32 V Project cost$ 12-J00,. 111-0 Check one Residential V Commercial OWNER'S"AUTHORIZATI N As owner of the above property I hereby authorize .pe:�42/-14 to make application fo a uilding pe 't in accordance with 780 CMR Owner Signature: 'Date: / G TYPE OF WORK Siding ❑ Windows(no header change)# ❑ Insulation/Weatherization ❑ Doors(no header change)# 'Commercial Doors require an inspector's review ❑ Roof(not applying more than I layer of shingles) Construction Debris will be going to i�k 0-0r5 CONTRACTOR'S INFORMATION # ', Contractor's name &P u Home Improvement Contractors Registration(if applicable)# /,��/ y 7C� (attach copy) Construction Supervisor's License# 0 c,0 15 (attach copy) Email of Contractor Phone number c5pb4226185-W ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTYIS IN • •§//-T/An1/-nOrrn1A--r Ifni► •w1ICrPIDrAIAI UICTADlr ADDD/11/AI DCCADC A DCDAAITPAAt DCI«IICn APPLICATION NUMBER............................................ *For Tents Only* Date Tent(s)will be erected' Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached.`Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or>Yes No ,if yes,a gas permit is required. Natural Gas Yes . No , if yes,a gas.permit.is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# . Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work 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 Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date `Cv � All permit app Wcations are su ' ct to building official's approval prior to issuance. IL 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 Name(Business/Organization/Individual): �/J QJu i k)6" $Tr Address: '68 A74K ;5TZIFE-1 City/State/Zip: &J, P,4r4A)5 '¢J6 Phone#: 7 76 ` 8 S Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6.•❑New construction nployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner= listed on the attached sheet. 7. D.Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. employees and have workers' Y P h'• = 9. ❑Building addition [No workers'comp.insurance comp.`insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑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 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. /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. y 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 certify under th ains an penalties oApedury that the information provided above is true and correct. Signafore: cTs'rt-�--'' Date: / -e,:, � Phone#: ` l G Official use only. Do not write in this area,to be completed by city or town oJficiai 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 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,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. 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 Office of Investigations 600 Washington.Street -Boston,MA 02111 Tel.#617-727-490.0 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.maw.gov/dia Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constructi�00't pr Specialty Ip CSSL-099695 h �cpires: 12/03/2021 a {� /. RONALD R B)JRLI GA f 58 OAK STREfT ,� WEST BARN �IBLE668 O OISS l�10 Commissioner xb,,� Office of Consumer Affairs 8 Business Regulation HOME IMPRO EMENT CONTRACTOR T4 Individual 07/16/2021 RON BURLINdta 1' ` I. RONALD R.BU � a `58 OAK ST Y 02668 Undersecretary W BARNSTABLE,MA ' T AUG 5 b Barnstable *Permit# o CAS Yo / 2 Expires 6 mon 6 from issue date ��NN OF regulatory Services Fee iA ENABLE, � BigR�o as F.Geiler, Director MASS. ,Y� 039. ur>•�' Tifi6Ving Division Tom Perry,CBO, Building Commissionerj��2(ow��J'� 200 Main Street,Hyannis,MA 02601 v v 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 ' Property Address_ Residential Value of Work \7 CO , Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �I,�, CP �tiPnnis Contractor's Name �` n ��A6M R \��-�\gym Telephone Numbet�& Home Improvement Contractor License#(if applicable) �y ❑Workman's Compensation Insurance Check one: ❑ 1 am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value ,'S� (maximum.44) *Where required: Issuance ofthis 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 is required. SIGNATURE: - Q:Fonns:buildingpermits/express Revised 123107 �7 -� �ards��- One . Board o ui in e ula-�iOns an tan g g Ashburton Place - Room 1301 Boston, Massachusetts 02108 Construction ervisor License fz.V ��N License CS: 57032 t _ b — _ j Restriction: 00 Expiration: 9/26/2009 Tr# 3801 THOMAS X CAPIZZI JR `' ------ 1645 NEWTOWN RD COTUIT, MA 02635 - ,� -� �� r Update Address and return card.Mark reason for change ' � L7 Address Renewal Lost Card DPS-CAI Co-50M-05/06-PC8490 . - - - � ✓�-ID0971.972l�1ZU/C2GU2 P�/GLUQP.�6 �_ . y Board.ofl3uildln{ Regulatio6s and Standards F ;Construction Supervisor License t; License CS 57032 o J : y p mod.. '. F tr .r own 9/26/200 3- 19 Tr# 3801 ` 0j0 t. THOMAS X CAPI /_1 t 1645 NEW:TOWN,R,, w COTUIT,MA 02635 _ Commissioner ' F ✓Xe 611011Wo-1ea/,C/ o� aaaaclucaelly Board of Building Regulations and Standards License or registration valid for individul use only - _ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registrat ion: `Do Board of Building Regulations and Standards , 100740 - One Ashburton Place Rm 1301 Expiration 6/23/2010 Tr# 267955 Boston,Ma.02108 ,Type .'Private Corporation CAPIZZI HOME IMP:RO.VEMENT`INC. Thomas Capizzi tr ` 1645 Newton Rd. Cotuit,MA 02635 "`yam Administrator Not valid without signatu e The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street r' Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affit X}ty�$, i�Oen q s/Electricians/Plumbers Applicant Information 688E Please Print Leeibly Name(Business/Organization/lndividual): f'i` L !1, [VA 02635 Address: City/State/Zip: Phone Are you an employer?Check the appropriate box: Type of project(required): 119 I am a employer with ''3 4• ❑ 1 am a general contractor and I employees(full and/or part-time).' have hired the sub-contractors 6• ❑New construction i 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' [No workers' comp.insurance comp. insurance.: 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doingall work officers have exercised their 1 I.❑ Plumbing repairs or additions myself [No workers'comp. right of exemption.per MGL t c. 152, 1 4 12•❑ Roof repairs insurance required.] § O, and we have no employees. [No workers' 13•7 Other comp,insurance required.] •Any applicant that checks box#i 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 the policy ami information. Insurance Company Name: c Policy#or Self-ins. Lic. #: `7 � J- ------ - _ Expiration Date:_ Job Site Address: �` �,t _ City/State/Zip:�alS 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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance covers a verification. I do hereby certify under the pains an t ry that the information provided above is true and correct St_g_natu e: -- Date: 1�s Phone #: 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#: Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, OWN THE PROPERTY LOCATED AT IN , MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: Client#:47298 CAPIHOM ACORDTM CERTIFICATE OF LIABILITY INSURANCE 06/12/zoos Y' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.-So. Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 434 Route 134 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.0. Box 1601 South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: NGM Insurance Company Capizzi Home Improvement, Inc. INSURER B: American Home Assurance Capizzi Enterprises, Inc. INSURER C: 1645 Newtown Road INSURER D: Cotuit, MA 02635 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY DATE MM/DD/YY LIMITS A GENERAL LIABILITY MPB1075H 06/08/08 06/08/09 EACH OCCURRENCE $1 OOO 000 X COMMERCIAL GENERAL LIABILITY PREM SE S( aTO cTED $500 000 CLAIMS MADE 17X OCCUR _ MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1 OOO 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY CUB1076H 06/08/08 06/08/09 _ EACH OCCURRENCE s5,000,000 X OCCUR CLAIMS MADE AGGREGATE $5 000 000 $ DEDUCTIBLE $ X RETENTION $10000 $ B WORKERS COMPENSATION AND WC6716562 12/25/07 12/25/08 X T WC STATUI - OTH- A EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE s500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE'-POLICY LIMIT s500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis, MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S36540/M36539 KW 0 ACORD CORPORATION 1988 s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 4 R Map �-7a Parcel Application# 6 Health Division _ Conservation Division ei 3 .d Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ®ran Historic-OKH Preservation/Hyannis V o` Project Street Address Village �VG011( ( Owner Address IL43 h�yo Pd QA ri/1 I Ll Telephone ,S o b d qs( Permit Request p e G �c Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ,500.00 Construction Type Lot Size a 3 1 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentatign. Dwelling Type: Single Family J Two Family ❑ Multi-Family(#units) j ,� o Age of Existing Structure 1980 Historic House: ❑Yes C No On Old King's Highway: ❑ r�Yes RNo Basement Type: O°Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) =' Number of Baths: Full:existing new 6 Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing ticnew 0 First Floor Room Count Heat Type and Fuel: ❑Gas C10iI ❑Electric ❑Other Central Air: ❑Yes CINo Fireplaces: Existing New U Existing wood/coal stove: ❑Yes B<O 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 ��f 4it Proposed Use BUILDER INFORMATION Name Telephone Number J-0 -A0 Address � q,e5 deal License# 9 9d 9,5'8 Home Improvement Contractor# 7 �� Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE </ 0 6 pp- 1 FOR OFFICIAL USE ONLY •z. PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS' VILLAGE t OWNER a DATE OF INSPECTION: FOUNDATION x FRAME s' 1 INSULATION _ 3 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING F ' DATE CLOSED OUT ASSOCIATION PLAN NO. Department oflridustrial Accidents Office.of Investigations: ' 600 Washington Street Boston,MA 02111-. www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers kpIplicant Information Please Print Legibly V31Ile (Business/orpnizationandividual):. cG Address: City/State/Zip: �V��Q;VVI16 �4 6��� Phone#: Lre you an employer?Check the-appropriate box:. Type of project(required):- ❑ I am a employer with 4. ❑ I am a general contractor and I g6. Imployees(full-and/or part-time).* have hired the sub-contractors 6 El New construction am a sole proprietor or partner- listed on the attached sheet 1 ?• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity, workers' comp.insurance: 9. ❑ Binding addition [No workers' comp. insurance 5. ❑ We area corporation and its 10.❑ Electrical repairs or.additions required.] officers have'exercised their ep .❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp.' c. 152,§1(4), and we have no. 12.❑ Roof repairs insurance required.]t employees. [No workers' comp.msurance required.] 13.❑ Other ny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: iomeowners who submit finis affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. mtractors that check this box mint attached an additional sheet showing the name of the sub-contrabtors and their workers'comp.policy information. . !m an employer that is providing workers'compensation insurance for my employees'Below is the policy and job site Formation. ,urance Company Name: licy#or Self-ins.Lic.#. Expiration Date: b Site Address: City/State/Zip- tack a copy of the workers' compensation policy declaration page(showing the policy number and Expiration date). flure to.secure coverage as required under Section 25A of MGL c. 152 can:lead to the imposition of criminal penalties of a .e up to$1,500,.00 and/or one-year imprisonment; as well as civil penalties in life form of aSTOP-WORK ORDER and a fine up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of restigations of the DIA for insurance coverage verification. 'o hereby certify under the pains an penaltiesof perjury that the informationprovided abov is and correcx attire:. fi G Date:*. one Official use only. Do not write in this area,to be completed by city.or town of xiaL 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 , Iassachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. ursuant to this statute, a' employee is defined as"...every person in the service Df another under any contract of hire, Kpress or implied,oral or written." ,n employer is defined as.:"an individual,.parmerslup,:associOgn,corporation or other legal entity,or any two or more f the foregoing.engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the eceiver or trustee of an individual,partnership,association or other legal entity,employing employees. Howev..er-the ,weer of a dwelling house having not more than three apartments and who resides therein, or.the occupant of the welling house of another whti employs persons to do maintenance, construction or repair woik•on such dwelling house ,r on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." v1GL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or enewal of a license or.permit to operate a business or to construct buildings in the commonwealth for any ipplicant who has not produced acceptable evidence-of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its-political subdivisions shall ;rater into any contract for the performance of public work until acceptable evidence.of compliance with the insurance -equirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if. necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificates) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members orpartners; 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 n't out in the event the Office of Investigitions has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that mast 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 tbat-a valid affidavit is-on file for.future permits.or-libenses..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 burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would]five to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and,fax number: The Commonwealth of Massachusetts . . : Department of Industrial.Accidents ..Office of Investigations j . 600 Washington Sheet, Boston,MA 02111. ' r Tel.#617-727-4900 ext 406 or-1-877-MASSAFE Fax#617-727-7749 nised 5-26.05 www.mass.gov/dia i oF;HEro Town of Barnstable Regulatory Services satuvsrnet E ' Thomas F.Geiler,Director 7 'MASS. �A!1639• a,• Building Division EO MA'S Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along vnth other requirements. Type of Work: �� Estimated Cost If SC)o Address of Work:. Owner's Name: G6 Date of Application: « ULO I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 riding not owner-occupied &Towner 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 p y for a permit as the agent of the own : 9 166 l4eL1 Date Contractor Signature Registration No. OR to Date weer s Signature i Q:wpfiles.forms:homeaffi day Rev: 060606 THE� Town of Barnstable Regulatory Services 9 BAMSTABM KASS. g` Thomas F.Geiler,Director 1639. oi Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder lu, , as Owner of the subject property 4- L hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) L516k LCI 4 1r Signature of Owner Da e Print Name QTORM&OWNERPERMISSION SHANE PACHECO, Realtor nits 1330 Phinney's Lane PCEALLTY Hyannis, MA 02601 E�ECi1TlYES (800)244-1592 ext.717 SPacheco@realtyexecutives.com t } ./' F 1 LI I r � f 1 � i i .- ._.-sm�.i-ie...vw=�-tea• - -. _. ..l.:..i ,ti::4..+re_s _._ _... _..� ..- _ - ...".Y�.':n:Y.+i3����`hx.i'...__..—_a.�a dx 5 P.T 10 Sono ' 0 � ,� +04A FILE.-- 2006—M1P-1966 REGISTRY OF DEEDS - BARNSTABLE COUNTY 1 CLIENT- LAW OFFICE OF BENJAMIN J. LOSOR©O UNREGISTERED LAND LENDER GIV ►4tORTGAGE, LLC DEED BOOK 11078 PAGE 29 , PARCEL 5 OWNER KARL & CHRIS77NE BOSWORTH PLAN BOOK 271 , PAGE 83 , LUT S 34 i APPLICANT SHANE M. PACHECO REGISTERED LANs DATE: DULY 24 2(D06 L.C. PLAN SHEET . LOT(S) ASSESSORS MAP 272 BLOCK LOT 161 CERTIFICATE OF 777LE . J178 M LM& HYANN 4 NA. i i Lot 11 ... ... ... .... 125:A®' Lot #34 0 15,000 s.f.± 0 0 Lot 33 No Lot 10 i, 1178 ; F stry . 'i Ci m 42'f o 1 227't To L,,.,25io0l. Vieth. Lane BETH LANE I THIS PLAN IS FOR Ma?TGAIGE PURPOSES ONLY SHEET 1 OF 2 CE R7TflC,4Ttt I CERWY 7HAT 7NIS PLAN WAS PREPARED0 ACCORDANCE NTH WE i HERERY CB?77F'Y TO THE EEST OF- MY KNOKEEDGE AWCE"AL ANp.TECIWWM STANPAROS FOR INE PRACTICE OF LAND SURWYINC IN THE CCA4fAl0Ni ALTH OF MASSACHUSE77S 250 AND BELIEF, TO 7HE ABOVE AT79RN" BANK AND CUR SECTION 6.05 AND WITH ME REMARKS.SHEET ATTACHED HERETO. AND THEIR 7777.E INSURANCE C0j4PANY, THAT 7HE7iE ARE NO VISIBLE ENCROACHMENTS OR EASEMENTS j EXCEPT AS -%fO;W, AND THAT 1NIS PLAN WAS PREPARED UNDER MY IMMEDIATE SUPERW90N tt1 i JORN L LMBY CONSUL n CONSUL TTNG LAND* SURVEYORS w 97 COVE STREET, NEW.BEDFOR©, MA 02744 ML(506) 999-0I06 FAX-(508) 999-2860 Vanlibby�.fibbyconsulting.com ' T www.,Wbb)consvIting.com i I 1 8 January. 1579 1 have personally checked the location of :this four�datIon and certify it :is in the.. sfiow.n`on-.-his print. . . . OF Mq SgA yG , ti Charles- D.. Spohr., P.E. _ C h a rl MOM o: - No 7468 v. S.5 BE H ANE 113 3 2 5 58 �E 1 2 5:0 0" w O N O (0 es M a 15,000 S, o � . O 3 Z' O a (9'D N � ° SEPTIC Y NK ~ Z PRECAST B%T. cIl LEAP�SNGr 125,00 5 . 3° 25 5 8" W PLOT P LA N " OF LA ND I N HYAN.NISS MA5S OF kq3 t�• �----�.�•_.°fin Joxx S h o wj nq proposed house and a Pti c PATRICK D01CF.S. y s t e m. CA ` CC'ISTt.'�, a Q r !4 y0 jt*4E+p C F B U I LDERS 5CALE: I "= 40 ' OCT. I978 r Assessor's map and lot number ... 27'2 ^ / �� ©�� �Ci� QyO%TH E T��y Sewage Permit number :.... ...... 1�.- .���/.....: .............: ' SL�TIG� �^Y�; INSTALLS STEIN t' Iy► � BE _ p BABH9TABLE, i House number ......F........!... .............................................. , WITH ARTICLE Ili Gt'•".?f'COMPLIANCE 'oo mum �TILE II ST/�,TE nwara�0 SANITAR�' �� TOWN OF B A R NCI,� ���� ��'�Iv BUILDING ' IMPECTOR APPLICATIOWFOR PERMIT TO ........ rQ.}1 .1.1 !{< ...:..... .(teeJh ................................................:.. TYPE OF CONSTRUCTION ...........W.0.6..da........:.. ........................:. ............................................ .................:. . ..... 19... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for )a pe�er,-mit according to the following information: Location ........� ........ .1 : ��•y�� . .....1.:�C'. .hi]..x..... ......................... ProposedUse .......�. � . . ............................................................ ...................................................................... Zoning District ...........(................................................................Fire District t............................................................................... Name of Owner, ... t�lo l...... .�&..-:...Address ...1J ... .......uft.,P q✓ .....VA.....easvj Name of Builder .. �Yl ....T". 1?.YL..........x.........Address Bay..u./....... — Name of Architect — .....Address ......... J Number of Rooms .......�5...............:....................................../'�Ocfing ndation ..... �jr� ............................................ Exterior ....wv.�:.G ! .. I-!91—A"/. .G'lof.�. ..... �a.c�- ......... ......... .................. Floors / �........ nterior Heating �'.`...� ...Plumbing � i1.. .. l V a G Fireplace ....... -0...................................................................Approximate Cost ....... .........�.3.........../. ............ Definitive Plan Approved by Planning Board ---------------_---------------19________- Area ...... ..!....°��•T d® . ................ Diagram of Lot and Building with Dimensions Fee .................................... �p�1� cam?!......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH4 0 sUC� s1 ti 1y I hereby agree to conform to all the'Rules and Regulations of the Town of Barnstable regarding the above construction. Name Q. emx7.... ..... .. C1V?.......................... Clark & Flynn Builders 272 _ 161 6,No 209.58..... Permit for :....DwL1.}i Location ..1A.t.134...17.8.. _ ...........................Hyannis.................................... Owner ....Clan.k.:&..Fl.ynn...gui1-ders.............. -- R- Type of Construction ....Fume........................... ,r ...................................................... ..... Plot ..27.2............:..... Lot ........#.3.4..... . ` Permit Granted i _ r Date of Inspection = ......19 Date Completed ... 19 1. ... t ` ` r 1—��- j { PERMIT REFUSED . ............................................................`..... 19 - ............................................................................... ............................................................................. ............................................................................... ........................................................................... Approved ................................................ 19 } ......................................................................... y ...................: .................................................... .. i s " :t'LJ! k,�{ .- .,., •*.�r,:,;.i�,-.,Y='."•V.�"U'.' -..--.+-^..rf:._ 4.:-�r•.. vry -.i .,,.^.•;srt. a:.+"t TOWN OF BARNSTABLE permit No _ 095$ i a.�n.� Building Inspector Cash 0110. --- 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 Clark & Flynn Builders address Box EE Falmouth, MA lot #�4 118 Beth lane, Hyannis Wiring Inspector l-� � a. f Inspection date Plumbing Ihspector�L,R Inspection date Gras Inspector � f / _ Inspection date i Engineering Department. ` , Inspection date ill r/i/,• /s/.f,./ 1^�� 43 - - 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. wilding Inspector THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA Assessor's map and lot number ... "�'` P�. �. � ✓%f/fr s jf ��. Y� .,:7 ..... " PLO*THE t0a4 �.......................................................... SewaS Lt Permit number E.....•- g 33ARNSTADLE, e° House number ....... r ro nnea 4 ............t................................ p 1639: 00�r �0 tlPY a\ T10yWN OF A 111DI NS T A 11DO LE U LD N 9NVP CT® OR APPLICATION FOR PERMIT TO fP�(rJY�n,�Xl;���.►�`��....t (� �.`j4so................................ ............... - 1 u TYPEOF CONSTRUCTION ..............................................................................r...................................................... TO THE-INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the followinng/� information: ^� Location ....... ice, :..3'°" ,[ ...... ��h` ........ k r,/v :'i a .14 `• ...7 (.r�!�....�d �.'vo� ,/....: 41........................... .......... ...... ..... ... .. ......... .... ..... ........ x�::111; Er K 4 11 r� iI' Proposed Use .. ...... ..........................:...................... Zoning District ...............................Fire District ...................... . ..... .. ............ 14 Name of Owner ...ff � '1.......... ' �1�c.��ae. .:....... ,....?Address ......., kk' }'¢ fad �Cir t ,........................... ` A , AA I Name of Builder .. .......::. Address ....... ... ... Name of Architect ....... " ...........................:................:...:...........Address ................................................................ , Number of Rooms ......:...'..............:........................................Foundation fin, a ? :............. .......................... Exterior .:..:`!f�Fr: .j.F ,•f... �!Y'�rZ4,,., /1!X—I.n,/lua:�Roofing h±c+ ^� rkt.............................................................E ; U / Z j +� /, ..... r :. .Interior I .�iit � 1 oaf Floorsi, , :rrt? �• 1{ ` f✓tni.�J * 11/� ` r �l...... ?r ................ p / P Heating lt_, f f }�-.1 f? ' ... ��..:...................................Plumbing .. ,9jI 42N x/ /�/. .. .. . ... ...... rr F Fireplace ..:.... ... Jr1 ;: r'ts ij f� - .............................................Approximate Cost .............. Definitive Plan Approved by Planning Board __________________________ ------1 9-------- . Area .......................................... Diagram of Lot and 'Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 44 I hereby agree to conform to all .the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .aft ....` ......................................... �... - � .. ,.xe.._.....,.1...-,• av�1. ....Y.i....n........... ..t.:1_."•u M1r .�l..nr.<...+ .ukFla[..., .�..-.L..i G.02• Clark & Flynn 8ufld8pS 272 161 . ^ � No ..2095R-' Permit for ...DweIl ' ----- - � . --'--'--~---------------'—'—''' � Location .................... . Hyannis —~'--^'---'--'--''—^~---------- Cwner ...[lark..&..F]y.D[L.J3.ui.1d.ers............... Frame Type ofConstruction N -------------- rux 2./.2............ L OL4 ......161 � Permit Granted A PERM REFUSED ^. ' ' __.. lg PERM ......... ... . � --.--. `—^— x / / .v. _____.. ............................................... —'' '' —''' ........'......,...(-,�.................................................. --.---...—..~..—.--~..---,..--.—.. . ' Approved ................................................ lQ ----^---'----^'--''—'~^--^—^'—'—`' --------'--^'--~---^--^'^^--~^^ � Assessor's offioe (1st floor): `),I�^7�-Y j l �---' . y`q / F TN E t Assessor'-� map and lot numj er ............ 0 0 Board of Health (3rd floor): 7Eir- 5 3f� Sewage Permit number ........................................................ 2 DasasTODLL, Engineering Department (3rd floor): i 'o 039 House number MAM .�.�,�� 4 i63q r. ........../ ............Y.r..... �F0DAY fr• APPLICATIONS. PROCESSED 8:30-9:30 A.M. and 1:00-2:60 P.M. only F BAR T B TOWN O NS E A L BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... .......... ............. ... . V TYPE OF CONSTRUCTION ......................................... .... ............................................... ....... . b TO THE INSPECTOR OF BUILDINGS: .5 The undersigned hereb applies for a permit according,to the following information: Location :...:..:.....:............®l..:..............:.. . ..........................:;.r........................................ �o Proposed Use j ' ZoningDistrict .........................................................................Fire District .....�...r..................................................................... Name of Owner i (f ("<( a/i`.�z...... a ......Address ..... !...":`.................................................................... Name of Builder �� ...........Address `¢ ' �. . �;..!.. �*:�`......... .................. .............. � ......': .............. Nameof Architect ...... , ..A.r. .............................................Address. .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ...Roofing Floors.....................................................................................Interior .................................................................................... Heating .'., - P.umbing .-.:..:............:.. ...'................ ................................. Fireplace ..................................................................................Approximate Cost ..... ..!:.... ....... .......................... Definitive Plan Approved by Planning Board --------------------------------19-------- • Area //.! �-. .......... .......... Diagram of Lot and Building with Dimensions Fee ....�a, .................... J SUBJECTO APPROVAL OF BOARD OF HEALTH ' a M., J •PC''. _ 'yam, � t OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........................... ........................ Construction Supervisor's License ... ...`....... ............... HANSON, RICHARD & SANDRA A=272-161 31368 permit for ..•_Add SkXlite to No ............... ..... Single FamilX Dwelling Location 178 B.eth. ...La. ne...........(Lo. t•••#34) .. .... .. .. ....... .. .. H X annis ..................................................... Owner -Richard & Sandra Hanson .............................................................. Type of Construction, .....Fr.ame .......... ..................... ' r ............................................................................... 0;4 Plot ............................ Lot ................................ Permit Granted -.• November 2, 87 ` ...........................19 Date of Inspection ....................................19 i Date Completed ......................................19 f� Assessor's offioe Ost floor): ��pp�� A ssessofr9 map and lot numberV".4���" ! b/ OF TNe to ............ ..... .. .......� �► Board of Health (3rd floor): Ky-PTIC SYSTEM MUST BE 7fS �36 :: :� LLED Its COMPI.WiC,'� Sewage Permit number ....... ... 7 Engineering Department (3rd floor): // IV1 BATH TITLE � toBeaVAAL a snt House number ............................... ...../..7.f ..."�° Li�_, �` ; "TfOYAY.a o� s 6 APPLICATIONS PROCESSED 8:30-9:30 A.M, and 1:00-2:00 P.M. only TOWN OF BARNSTABLE E BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... VA .. .. .. .... ... ... . TYPEOF CONSTRUCTION ..................................................................................................................................... .............. ------...9. .� TO THE INSPECTOR OF BUILDINGS: / The undersigned hereby op lies f r a permit according to the following information: 7 , ,�W�. L Location ..............................................Q......................... . �. Proposed Use L�' 1..`P c "J.` ZoningDistrict ........................�...............p............ .........................Fire District .... .......................................................................... Name of Owner�l.IG�t;Qlct.jl - C.f^4.....1.1z .� ......Address ..... !.....'�...�.................................................................. Name of Builder tcl4a ...........Address30 � A . 5°, ........... . .......... ......... ............................ a Nameof Architect ..... .. �............I..............................Address .................................................................................... Numberof Rooms ......I...........................................................Foundation .............................................................................. Exterior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior ........................................................................ Heating ..................................................................................Plumbing ..............................,.................................................... Fireplace ..................................................................................Approximate Cost ..... � ..�.... ....... .......................... Definitive Plan Approved by Planning Board --------------------------------19-------- • Area . .VA�!�!�!�� Diagram of Lot and Building with Dimensions Fee �DJ....�.� SUBJECT TO APPROVAL OF BOARD OF HEALTH aid 3o�x. 4 g OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardi g t above construction. 1 Name ........ . ......................................... .......................... Construction Supervisor's License ...�..?//............... HANSON, R1CHARD & SAND No; 31368 Add ' ylight to ................. Permit for .............. ....... Single Family Dwelling ............... .......................................................... Location ........17.&..Beth Lane Lot #,34) ......................... .............. .................................... ......... Owner .......Richard & Sandra Hanson ...............................................I........... Type.of Construction ....Frame......................... .. ................... ...................................F..................... Plot ... ........................ Lot ................................ Permit Granted ......�,.o.vem.b.e.r....2 ,.....19 87 .. .... .. .. . .. Date of Inspection ....................................19 Date Completed ..............i/..f.................. 19 `F ,sa �' F ::.G '" 'kT a•> �`'- „r i;�r7 H ,�s r'• LOT��--# 34 BETH ' S •t LARIE Y �� z 15, OOo F�E ry 9 401.- H S LANE N 13° 25 5 8" E - -- 125,00' '�--TOWN MA LOTi LOT 10 o FRDU LOT . 34 �, , 68, Q � 00 : ..MCCA$�F Ct MC QEM,SEPT I G O ' SEE. FIZOfm l t,.E _ 36 ° N �� ►o' � 3 O �° ;' T', CONCRETE I..'I~ACMING PIT 41 RE O Z .� 14, p f� :)FIL.E" CETA I'L5 125.00 3° 2 5' 5 S„ f F.Rc, , RI I I ICE -' ti Town of Barnstable *Permit#,";t? b / Expires 6 months from issue date X-PRESS PERMIT Regulatory Services Fee o35 • Thomas F. Geiler,Director � � SEP 11 2006 Building Division EoinPerry,CBO, Building Commissioner TOWN OF BARNSTABL 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNIIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint f Map/parcel Number ,:2 7d Property Address / 7 19<esidential Value of Work �4�r 000 M' imum fee of$25.00 for'work under$6000.00 Owner's Name&Address Contractor's Name i 4�- Telephone Number �Cl�/ �7 HomejImprovement Contractor License#(if applicable) l`,9b)&-3 Construction Supervisor's License#(if applicable) G 9a 9S� ❑Workman's Compensation Insurance Cheslf one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) E R-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) "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 Pro erty Owner Letter of Permission. A copy of e 'me Impro en Contractors License is required. . - /�ti SIGNATURE.. � � Q:Forms:expmtrg Rewise061306 s Department ofbidustiial Accidents Office.of Investigations: . y a 600 Washington Street Boston,MA 02111' y' www.mas&gov/dia - Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers kpplicant Information Please Print Legibly damp (Business/Organization/havidual): � Q� address: City/State/Zip:— &I r"✓I Phone#: d .re you an employer? Check the appropriate box:: Type of project(required):- El i am a employer with . 4. ❑ I am a general contractor and I loyees (full'and/or part-time).* have hired the sub-contractors 6 ❑New construction � U I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑ Remodeling ship and have m employees These sub-contractors have ' 8. ❑ Demolition worldng for me in any capacity. workers' comp, insurance: 9. ❑ Building addition [No workers' comp.insurance 5. El We are.a corporation and its , required..] officers have exercised their 10.❑ Electrical repairs or.additions. .❑ I am a.homeowner doing all work right of exemption per MGL 1I-❑ Plumbing repairs or additions 'myself-[Noworkers' comp.' c. 152,§1(4), and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13 [� Other 1 C,II.1 On insurance required.] ny applicant that checks box#1 must else fill out the sectioa.below showing their workers'compensation policy information: iomeowneis who snbmit1his affidavit indicating they are doing all•work and then hire outside contmetm must submit anew affidavit indicating such mtractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. . im an employer that is providing workers'compensation insurance for my employees'Below is the policy and job site formation. mrande.Company Name: licy#or Self-ins.Lie.#: Expiration Date: b Site Address: City/State/Zip: tach a copy of the workers' compensation policy declaration page(showing the policy number and Expiration date). ilure to.secure coverage as required under Section 25A of MGL C. 152 cam:lead to the imposition otcriminal penalties of a e up to$1,500,0.d an one-yearimpnsonment; as well as civil penalties in jiie form of a STOFVWORK ORDER and a fine up to$250.00 a day against the violator. $e'advised that a copy of this statemed maybe forwarded to the Office of restigations of the DIA for insurance coverage verification. `o hereby certify and the pains a Z naldes of perjury that the information provided above and correct afore:. e Date:• one#: Official use only. Do not write in this area,to be completed by city,or town official~ ' City or Town: Permit/License# . Issuing Authority(circle one): L Board of Health !..Building Department 3.City/Town Clerk 4.Electrical In 6. Other spector 5.Plumbing Inspector Contract Person: Phone#• A _ v. Information and. Instructions Iassachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. nrsuant to this statute;an employee is defined as"...every person in the service-of another under any contract of hire, xpress or implied,oral or written." ,n employer is defined a$•:,?n individnal,.pagiiersbip,association,corporation or other 1ega1 entity,•or any two or more f the foregoing-engaged in a joint enterprise, and including the legal representatives of ad eceased employer,or the eceiver or trustee of an individual,partnership,association or other legal entity,employing employees. Howc�er:111e .wner of a dwellinghouse having not more than three apartments and who resides therein, or The occupant of the welling house of another who employs persons to do maintenance, construction or repair wofk-oii such dwelling house ,r on the grounds or building appurtenant thereto shall not because of such employment b e deemed to be an employer." v1GL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or enewal 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." kdditionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its'political subdivisions shall ;rater into any contract for the performance of public work until acceptable.'evidence.of compliance with the insurance .equirements ofthis chapter have been presented to the contracting authority. kpplicants 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 numbers)along with their certifieate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(L•LP)with no employees other than the members orpartaers; are not required to carry workers' compensation insurance. If an LLC or LLP does have B e advised that this affidavit may be submitted to the Department of Industrial employees,a policy is required 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 Departiiment of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below, Self-insured companies should enter their. self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.Please be sure'to fill in the permit/license number which will be used as a reference number. In addition, an applicant y given year,need only submit one affidavit indicating current that must submit multiple permit/license applications in an policy information(if necessary)and under"Job Site Address"'the applicant should write"all locations in L(city or town)."A copy-of 1he: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-li6enses..A new affidavit must be filled out.each year.Where a home owner or citizen is obtaining a license or permitnot related to any business or commercial venture (ie. a dog license or permit to burn leaves etc.).said person is NOT required to complete this affidavit. : The Office of Investigations would like to thank you in advance for your cooperation and should you.have any questions, please-do not hesitate to give us a call. The Department's address,telephone and fax number: ' The Commonwealth of Massachusetts . Department of Ind4strial.Accidents . . .. . . .. .. Office gf Investigations . a' ..600 Washington Street f 4 Boston,MA 02111, Tel.#617-727-4900 ext 406 or-1•,877-MASSAFE Fax#617-727,.7749 . evised 5-26-05 www,lrna s.gov/ilia °Ft►�,�ti Town of Barnstable Regulatory Services * Thomas F.Geiler,Director" 9 MASS. 4 i639' 4 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder � �/ ' ex of the subject I ,as Own b'lect hereby authorize PuiLc to act on my behalf, in all matters relative to work authorized by this building permit application for: &4 ► kku (Address of Job) Signature of Owner Date , Print Name UORM&OWNERPERMISSION ✓lie iaam�noruvealC� a�✓Zr'aa�aclivaelta ' Board of Building Regulations and Standards Liceo.ae or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Boa►:l of Building Regulations and Standards Registration: 149863 One Ashburton Place Rm 1301 Expiration: 2/16/2008 Bostcn,Ma.02108 Type: Individual SHANE PACHECO SHANE PACHECO 74 GREAT HILL ROAD _e,- ✓ — i �Gf.� �Ct d� SANDWICH,MA 02563 Administrator Not valid without signature r. �, ��ze �a-nrinyanurea� ,.p✓�r''a��z __ BOARD OP BUILD-ING REGULATIONS � f �;j,x w � r License: CONSTRUCTION SUPERVISOR �+ at' Number�CS 092958 i n �" `Expires f0/17/2009 '' # Tr, no: 92958 �Restncted r 00 SHANE PACHECO r 74 GREAT HILL ROAD SANDWICH, MA 02563 G" j Y. 'Commissions I TOWN OF BARNSTABLE BAR-W 3309 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager g',oA4t 4 ;r Yl-Y Address of Offender ) 7 6 rl-" MV/MB Reg.# Village/State/Zip A1V. A,-.1A,r - Business Name ooV-A h# Iot: of S 50 P P r �17 1e:4Cam1RPV,- on 20� / Business Address Signature of 'Enforcing Officer Village/State/Zip_ "/1Z Location of Offense Enforcing Dept/Division Offense A" "t*0, 4"t-1 el C. 70 f,e Facts C1, A IvI, .,j 11.1t, < 7' e, z) h I t k 7 A& re" /4 t1A Af This will serve only as a warning. At this t 'Ee,&o legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. 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' � c+ .:�, '` ` r ?r_t �wr S•ttiei/,..-�•Ay +£3.'t's Y"as!'iid 1a ,i ` ,. fi33R - y �„m.......-.------' _ } +1.t 7 1�"(a� {7"'#�nT-. � +4+ �.. , t1 :�� y ,1rl �r' irt,� �p r�• '-,w'+� s � .# '� f r.,. °- �.�r?,-�,h+rr���"r�,f h' f..#r .1�h ��, p I 1}�.�i.. - ii �• _ .__1-.- ' r tj fj PA } t 411 ✓r'+ I:iz yy r . t aXi t L►� ���""_ly+'• '�kP-1 �' �~ cam"a~.•. ; ')3arnstable Assessing Search Results Page 1 of 2 j R 4 } Home: Departments:Assessors Division: Property Assessment Search Results 178 B-Ivr,,TH LANE Owner: Property Sketch Legend BOSWORTH, KARL A&CHRISTINE Map/Parcel/Parcel Extension 272 /161/ Mailing Address BOSWORTH, KARL A&CHRISTINE y 178 BETH LN HYANNIS, MA.02601 2004 Assessed Values: rf; i Appraised Value Assessed Value Building Value: $95,400 $95,400 Extra Features: $0 $0 Outbuildings: $0 $0 Land Value: $ 135,100 $ 135,100 Interactive Property Map: ap re uires Plug in: Totals:$230,500 $230,500 I have visited the maps before Show Me The Map April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: BOSWORTH, KARL A&CHRISTINE 11/24/1997 11078/029 $98,000 HANSEN, RICHARD A&SANDRA K 3062/346 $0 2004 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $ 1,523.61 Town Fire District Rates Other Rates 6.61 Barnstable 2.01 Land Bank 3%of Town Tax Hyannis FD Tax $467.92 C.O.M.M. 1.10 Cotuit 1.52 Land Bank Tax $45.71 Hyannis 2.03 West Barnstable 1.36 Total: $2,037.24 Due to rounding differences these values may vary http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 3/16/2004 i Barnstable Assessing Search Results Page 2 of 2 Land and Building Information Land Building Lot Size(Acres) 0.34 Year Built 1979 Appraised Value $ 135,100 Living Area 1344 Assessed Value $ 135,100 Replacement Cost$ 109,665 Depreciation 13 Building Value 95,400 Construction Details Style Cape Cod Interior Floors Carpet Model Residential Interior Walls Drywall Grade Average Heat Fuel Oil Stories 1 Story F A Heat Type Hot Water Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 3 Bedrooms Roof Cover . Asph/F GIs/Cmp Bathrooms 1 Bathroom Total Rooms 5 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage 'UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 3/16/2004 \`-'�, •."'�A>.. ,_ 4 v •'t It C+1 � • 'a� •�ti C '��g?yy'r,,-�,���•��.�jrr ..r,�. ^^{`,�,� vtr r �,� „f�ia"+ '�l (��j.;�A�` 4 `,�+ �'1"ji.�� ��'�(:.,s�c�,.`� r��~����'�'��t��►„`r"'`^,` �'`r" '•�° i 'a„ #(�i±h���,• '� „ t ''�.; �j ''3'`�«Y1�t�{�y'� +f'%1'*'� � �` ,a,C,L `1`�i,A"�\� .,',� ' �}.�.j.•� ,�.'•..'��x�,��-�`� :"r"'k�'���n �.�Y "' *r��, T ,�.c� "`fir-�r;",;*��^.'\�� C'7p� t�j " � �k ,�+.Q����3'Lr�1_`�4+�Z'•;��'`�•S�•`r• .ik._". ;i�✓:.�6?7,aL/•r "{=,r„P+ ° .:�w�..��\ ,y -' .�S � �a si,., ,'�'`�"rji�, �I�`�� 4',`'p'.'j°k', f.;'�l••^� )1'y,a,.:Jf�'� =}+.�"•"pN .f`' 1 3 * 'da .°' `. xY< �. r N - �*-�;ts. ...vas r� ��."..+$t ,,+��"- rq :Fr�,��s• . �tk �s~'::S r�t TaT v�y�.�_ ct `` � �� ;f'.�'\����o,��•• `*� .r ,'J4t ,���+!`.""�'� �!"t�. ° F�+�:� � � rw �.�'t' � r �:... � 9''/ .� tom. �:+1 ��.�"*'�^ �`•",�4., r_ 1t:9 •��'V �`t�y�y � ~ ���"a�` .T' ''` t:v`:*-_sr p» a ;. x� �'. 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TR?'` .•.. r The Town of Barnstable Department of Health, Safety and Environmental Services Building Division &61 10�' 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: l'"111 1 L Name:_ 4 '\D"' 1`I a fln 1 e+n Phone#: � � I Address: �, �•ti'� �� Type of Business•.n-�C-1C�6 Cff:6-Ik)- Sa1a5 Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwellingwhich are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. - • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Ocxupadon. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. with the above restrictions for my home occupation I am re I the undersigned,have read and agree ��P gis Applicant �• lY -E'✓ti'� Date• { -f (� I Hnmeoc_A=