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0115 BUCKWOOD DRIVE
Kw oo a �N � i f J. 204854140 REGISTRATION AND CERTIFICATION FORM FOR FORECLOSING/FORECLOSED PROPERTY Thank you for registering in accordance with Town of Barnstable Code chapter 224 sections 224-3 and 224-4. Please complete one form for each property in foreclosure (section 224-3)or already foreclosed for which possession has been taken(section 224- 4). Please file the original with the Building Commissioner and a copy with the Chief of the Fire District in which the property is located. If you claim you are exempt from registering under Massachusetts law,please state the reason(s) and complete section 1 (property information) and the first paragraph of section 2 (foreclosing party, court, etc. and foreclosing party representative,but not other representatives and attorney) so that the Town can review the exemption and update its records: Section 1 -Propeqy Information Property Address: 115 BUCKWOOD DR, HYANNIS, MA 02601 Assessors•Map#: M272LO90 Parcel#: M272LO90 Land area and description N/A *.o Building(s)description and contents N/A eu 0 d Freedom Mortgage. Occ ied: xx Occupant(s)(if borrowers so state and include name(s)) °.,.. 1 00 Kincaid Dr., FISHERS, IN 46037-9764 co � Q (317)537-3748 Propertypreservation@freedommoq�warge.com cc Phon ;-� email: Propertypreservation@freedommoq�wlrge.com ND Date: N/A Anticipated Length of Vacancy: N/A 'Last occupant(s))(if borrowers so state and include name(s)) Phone: email: other: Has possession been taken NO If so,please explain and complete and file the maintenance and security plan form(unless exempt as stated above) mclo-spin _ Information Foreclosing Party(full name/title) Freedom Mortgage Foreclosure Case Court: Docket# 204854140 Date filed: 12/12/2018 Current Status: NOD Fit Fn Foreclosing Party's representative(s)for property(entry,management,repair, etc.)(name,title,): Freedom Mortgage Company(if different from foreclosing party): Freedom Mortgage Address: 10500 Kincaid Dr., FISHERS IN 46037-9764 Phone: (317)537-3748 email: Propertypreservation other: If an exemption is claimed,please do not complete the remainder. Other representative(s)(if foregoing representative is primarily responsible for property and/or foreclosure and is most likely to be able to address town matters concerning the property and/or foreclosure,please so state and do not complete contact information(i. e. "none" or"see above")). Name,title, other: CODE COMPLIANCE Company(if different from foreclosing party): SAFEGUARD PROPERTIES Address: 7887 SAFEGUARD CIRCLE,VALLEY VIEW,OH 44125 Phone(s): 800-852-8306 email(s): CODECOMPLIANCE other: @SAFEGUARDPROPERTIES.COM Name,title,other: N/A Company(if different from foreclosing party): N/A Address: N/A Phone: N/A email: N/A other: N/A Attorney representing foreclosing party N/A Firm name (if different from attorney's name): N/A Address: N/A Phone(s): N/A email(s)N/A other: N/A I acknowledge that the information provided is accurate and correct. I also understand that any inaccurate information will result in non-compliance with section 224-3 of chapter 224 of the Code of the Town of Barnstable. Date: 1/25/2019 Name:Safeguard Properties Title: Property Preservation Company to Receive Violation Notiqes `N 204854140 r I hereby certify that the above-named foreclosing party is in compliance with the provisions of section 224-3 of chapter 224 of the Code of the Town of Barnstable. Date: Building Commissioner, Town of Barnstable t � : v � :: Town• - � - , of Barnstable= ' (�� , B �Lt s. a _ .t. .. b tdTh�s._�r �SbT at , s,,�'istbl FI• S -.t ,A r�.bved�Plans Must.tre Reta�netl4ony�ob,.and�this. - st.be.K , .,f =•.< .•;;: �:• ."..,�.. Mg,.. t sted Until:Fm - F �. z, 1 x a:.Y ,.: k:, e... '-. .. - ' ...- -.....,: • ..'.,, n T 'ate i a✓-:i i,�. rr - �r _. . .. ,he, ,a� a ., � .c,.�, a. c » s:R .", � ,�, h. n .steal!Not beC�ecu ied:untilaF�nal�Ihs ectrdn,ha�•been'made ,.,,. , , . dill. . . , ., Permit No ' B-17-3210 Applicant-Name:. ANTHONY S QUINN Approvals Date Issued ; 69/25/2017 -..Current Use ,, . z Structure Permit Type Buildin Alteration INTERIOR Work Only Expiration Date' '. 03 25 2018 Foundation: .: Yp g" Y / / - Residential Map/Lot 272 090 Zoning District.._ RC 1 Sheathing: Location: 115 BUCKWOOD DRIVE, HYANNIS Contractor Name ANTHONY S QUINN Framing: 1 Owner on Record: MARTOWSKI, NICHOLAS J '�Q ;Contractor'License GCS-068599 2 Address: 16 FREDERICK STREET = - , i Est Protect Cost: $3,500.00 Chimney: .NEWTONVILLE,MA 02460-2211 Permit Fee: $85.00 Insulation: Description: INSTALL BATHTUB IN 1ST FLOOR BATHROOM ��a � Fee Paid $85.00 Project Review Req: INSTALL BATHTUB IN 1ST FLOOR BATHROOM' Date 9/25/2017 Final: F, Plumbing/Gas a Rough Plumbing: �� . . 19 _= Building Official Final Plumbing: This permit-shall be deemed abandoned and invalid unless the work authoriied'by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents#or whichxhi's permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in with the local zonirig by laws and codes. % Final Gas: This permit shall be displayed in a location clearly visible from access street or&'&&'and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. � iu Electrical The Certificate of Occupancy will not be.issued until all:applicable sign tares by t e'guilding and1Fire Off ialsgare',proviid d o'n this'Permit. Service: Minimum of Five Call Inspections Required for All Construction Work x 1.Foundation or Footing Rough; 2.Sheathing Inspection 3.All fireplaces must be inspected at the throat level before firest flue lining is installed Final 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final Where applicable,separate permits are required for Electrical,Plumbing,and.Mechanical Installations. Health Work shall not proceed until the Inspector..has approved the various stages.of:construction Fin. 1 ''Rerso i—contractin .with;unre isteredcontractors.do;:Dot;have:;access_to he: uaran .f. g, g .. g ty .arid (asset,,fo_rth In:_MGL c_142A) F D men -. _ ire° epart. t.. Bu... .-.: Ilding plans are to be available on site • Final. All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION etjg Map Parcel r Application # . Health Division SEP j g 201 Date Issued Conservation Division r©���Q�&AP/VS�� Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address I Villages S Owner Address 1 j 5 Ibjcy_w,�00 T Telephone 3 3® 2� Permit Request Lam- ��� TUG � Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 6-00 Construction Type Lot Size Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family Or' Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes dNo On Old King's Highway: ❑Yes B"No Basement Type: Cull ❑ 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 Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes 21"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 ���N� �ZTr�lM Telephone Number G_P9 2q9 2D/�t Address i' �S jJ�O.sr �� License # S Cog 5c1C, ►/Yl P► 0 2G 3C1 Home Improvement Contractor# Email r V3 IrOM I-R./M ?macs Q4C W19N Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO s AYI-t n SIGNATURE DATE o FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 0123 1114& DATE CLOSED OUT ASSOCIATION PLAN NO. AWC Guide to Wood Construction in High Wind Areas:110 rnph Wind Zone Massachusetts Checklist for Compliance(780 cMR 5301.2.1.1)1 Check Compliance 1.1 SCOPE WindSpeed (3-sec.gust)..................................................................................................................110 mph WindExposure Category...............................................................................................................................B 1.2.APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) stories 5 2 stgries RoofPitch ..........................................................................(Fig 2)........................................... 512:12 ` MeanRoof Height ..............................................................(Fig 2).............................................. _ft 6 33' Building Width,W. ......... .............(Fig 3). ...... .................................. _ft 580, Building Length,L ..............................................................(Fig 3).................................................—ft _4-80' ..... Building Aspect Ratio(LMV) ...............................................(Fig 4)................................................. 5 3:1 Nominal Height of Tallest OpeningZ ...................................(Fig 4)................................................ <_618° 1.3 FRAMING CONNECTIONS General compliance with framing connections..............:.....(fable 2)..............................:.......:......................... 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.............................................................................................................................. ConcreteMasonry................................................................................................................................... 2.2 ANCHORAGE TO FOUNDATION''3 5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an altemative in concrete only Bolt Spacing—general .................................. ...(Table 4). ....... . ................................. in. Bolt Spacing from endfloint of plate.............................(Fig 5). ........................ .... in.5 6"—12" Bolt Embedment—concrete............................... . ....(Fig 5). ............................................. in.z 7" Bolt Embedment—masonry.........................................(Fig 5):........................................... in.115.. PlateWasher................................................................(Fig 5)................................................a3"x 3"x'/." 3.1, FLOORS Floor framing member spans checked ...............................(per 780 CMR Chapter 55)............................ . .... Maximum Floor Opening Dimension..............................a.....(Fig 6)...................................................._ft 12 Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)....................................... Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall.:..............(Fig 7).....,............................................... ft 5 d Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig 8).............................I......................—ft 5 d FloorBracing at Endwalls.....................................................(Fig 9)..................................................... ........... Floor Sheathing Type ........................................................(per 780 CMR Chapter 55)................................... . Floor Sheathing Thickness ..............:.................................(per 780 CMR Chapter 55)....................... in. , Floor Sheathing Fastening..................................................(Table.2)...... d nails at in edge/—in field 4.1 .WALLS Wall Height Loadbearing walls.....:................ ..............(Fig 10 and Table 5)......................... ft 510' Non-Loadbearng walls................................................(Fig 10 and Table 5)..........................._ft 5 20' Wall Stud Spacing ........................................................(Fig 10 and Table 5)..................._in.5 24"o.c. Wall Story Offsets ............................... ....................(Figs 7&8)........................................... _ _ft _<d 4.2 :EXTERIOR WALLS' Wood Studs Loadbearing walls........................................................(Table 5)..............................2x -_ft—in. . Non-Loadbearing walls................................................(Table 5)..............................2x -_ft_in. Gable End Wall Bracing 1 FullHeight Endwall Studs............................................(Fig 10)......................................I............................. WSP Attic Floor Length...............................................(Fig 11).............................................. ft 2:W/3 Gypsum Ceiling Length(if WSP not used)..................(Fig 11)............................................—ft>_0.9W and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c... (Fig 11).............................. .......:........................ or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays Double Top Plate Splice Length ........................................................(Fig 13.and Table 6)........:............................_ft Splice Connection(no.of 16d common nails).....:.......(Table 6).......................................................... AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone. Massachusetts Checklist for Compliance(780 Civet 5301.2.1.1)t Loadbearing Wall Connections Lateral(no. of 16d common nails)...............................(Tables 7)...................................................... Non-Loadbearing Wall Connections Lateral(no. of 16d common nails)...............................(Table 8)........................................................ Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans ..............................................(Table 9)..................... ' Sill Plate Spans ........................................................(Table 9)............................. . _ft_in.511' . .... . ... .. Full Height Studs (no.of studs)...................................(Table 9)........................................................ Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans.............................................................(Table 9).................................._ft_in.<_12' Sill Plate Spans.. ........................................................(Table 9).................................._ft_,in.<_12° Full Height Studs(no.of studs). ..................................(Table 9).......................................................... . . Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously, Minimum Building Dimension,W Nominal Height of Tallest OpeningZ ............................................................................. _5 6'8° SheathingType.............................................(note 4).................................................... Edge Nail Spacing........................................(Table 10 or note 4 if less) .................... in. Field Nail Spacing.........................................(Table 10)..:.............................................. in. Shear Connection(no.of 16d common nails)(Table 10)......................................................... _ Percent Full-Height Sheathing......................(Table 10). ...... .......................................... 5%Additional Sheathing for Wall with Opening>6'8°(Design Concepts)..................... Maximum Building Dimension,L t gZ :. Nominal Height of Talles Openin .............................................. 5 6'8° Sheathing Type ............(note 4)........................................ ................................. .............. Edge Nail Spacing..........................................(Table 11 or note 4 if less)....................... in. Field Nail Spacing ........................................(Table 11).............................................. in. Shear Connection(no.of 16d common nails)(Table 11)........................................................ Percent Full-Height Sheathing. ................... (Table 11)........... ................:..................... _% 5%Additional Sheathing for Wall with Opening>6'8°(Design Concepts)..................... Wall Cladding Ratedfor Wind Speed?................................................................................................................... ..... 5.1 ROOFS Roof framing member spans checked?.......................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ...................................................(Figure 19)............._ft 5 smaller of 2'or L/3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12).......................I....................U= plf Lateral.............................................(Table 12).............................................L= plf Shear..............................................(Table 12)..............................................S= plf Ridge Strap Connections,if collar ties not used per page 21... (Table 13)...............................T= plf Gable Rake Outlooker.........................................(Figure 20).............._ft 5 smaller of 2'or U2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14)............................................U= lb. ' Lateral(no.of 16d common nails). .(Table 14). .... .................I...........L= lb. Roof Sheathing Type........................................... . ...(per 780 CMR Chapters 58 and 59) ........... Roof Sheathing Thickness....................................................................................... _in.z 7/.16°WSP, Roof Sheathing Fastening ..........................................(Table 2)....................................................... _ . Notes: 1. This checklist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e: Comer Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11, 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade. j AWC Guide to Wood Construction in High WindAreas:110 inph Wind-Zone Massachusetts Checklist for Compliance(7so CnIRs3o1.11.1)1 4 • a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16'and be installed as follows: i. Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates,band joists,and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment -WHEN THIS EDGE RESTS ON FRWAING U ESd NAU A'r6b.c , 11 11 Y 14 - 11 tl 11 11 It 11 11 11 ' t 1 11 1 1 11 I 11 F li I{ 0 1 TI O 11'11 fl X 1 Q • I 1 {� 11 {1 I{ O¢ tl Il � 1 • 11 u ! F„ 11 1{ 11 IJIf II 11 k 1 . 1 1 11 11 !4 1 II .3 11 Ir rr 1 11 v ii II.' +i 31 i DOUBLE EDGE � ,� WAILSPACM PANtL_ 1 4 See Detail on Next Page Vertical and Horizontal Nailing for Panel Attachment AWC Guide to Wood Construction in High Wind Areas:110 mph Wnd Zone Massachusetts Checklist for ComP fiance(7so CMx 5301.2.1.1)1 0 1 w O,.1 i • � i 8Q i I I r 1 i i FRAMING MEMBERS 1 1 I EDGEWFEPMEDIAM 1 1 � STAGGERED 7'MIN. NAIL PATFERN PANEL PA}CEL EDGE DOUBLE NAIL EDGE SPACING DML Detail Vertical and Horizontal.Nailing for Panel Attachment r AWC Guide to Wood Construction in High WindAreass 110 mph Wind Zone Massachusetts Checklist for Compliance(780 cnut 5301Z.1.1)1 FAQ*: WFCM Checklist Question: I understand if a new home is built in a town in a no mph wind zone then the American Forest and Paper Association (AF&PA) Wood Frame Construction Manual can be used to prescriptively design it. I also understand that in some cases the home can be framed per the WFCM 1 oo mph Guide, if it meets certain requirements including but not limited to aspect ratio, roof height, number of stories, and exposure category(B). Ihave heard that Massachusetts has a "modified" checklist that can be used instead of the checklist at the end of the Guide. Is this true and what can you tell me about this "modified" checklist? Answer: You are correct on the items that you have noted. MA has modified the checklist in several important ways. The MA version allows a roof with a pitch up to and including 8 in 12 to not be "counted" as a story. Further it does not require steel hold downs and straps in many locations if full height sheathing is used as defined in the MA checklist. Further, if the building will have furring strips installed in the ceiling abutting the gable wall then 2 x 4S installed on top of the ceiling joists are not required. There are other changes as well that were not noted here. The MA version of the checklist was formulated in recognition of the highly regarded framing methods used in MA for many years and wood framing that has. been used in North Carolina over the past 10 to 15 years which has performed well in severe hurricane weather in that state. *Answers to FAQs are opinions of the BBRS Staff and do not reflect official positions or code interpretations of the BBRS. �'WE Town of Barnstable Building Department Services • RIRNIM433 MAC Brian Florence,CBO . 9. `� Building Commissioner Epi63 NIA 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section - If Using A Builder as Owner of the subject property hereby authorize to act on my behalf in all matters relative to work authorized by this building permit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOIS Rer.09/16/17 Town of Barnstable ' Building Department Services Brian Florence,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 sAMIsTwaM KAM www.town.barnstable.ma.us 1639. Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEEA=ON Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work 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 engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildingpermit. (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 procedures and requirements and that he/she will comply with said 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." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page 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 fonm\EXPRESS.doc 08/16/17 + 1 - �fe�cYrrirnoreuseczv/C�o��/laaoacLc��el� i Office of Consumer Affairs&Business Regulation License or registration valid for individul use only j 1 HOME IMPR9.YEMENT CONTRACTOR before the expiration date. If found return to: (1 Registration: 125537 Type: Office of Consumer Affairs and Business Regulation Expiration 1/15120'18 Individual 10 Park Plaza-Suite 5170 �� �. Boston,MAL0216AN ANTHONY SEAMUSQUI,N ANTHONY QUINN tr155 DEPOT ST DENNISPORT,MA 02639' Undersecretary ! Not valid without signature j v Massachusetts Department of Public Safety I Board of Building Regulations and Standards ;� License: CS-068599 Construction Supervisor ANTHONY S QUINN 155 DEPOT STREET DENNIS PORT MA 02639 �r r Expiration: r 'Commissioner 04/06/2018. s - iu ►,, Town of Barnstable Building Department Services Brian Florence,C$o 3 6 Building Commissioner m 200 Main Street,Hyannis,MA 02601 to www.town barastable ma.us ` a Office: 509-962-4038 Tax: 508-790-6230 c m Property.Owner Must N Complete and Sign.This Section If Using A Builder I,M QV.6f) 1"1Q{•r-{o�WS j /� ,as Otanes of the subject property hereby authorize 7 7Y1t , �i ovw Qu i i n to act on my behalf; in all matters relative to work authorized by this building permit application for. �l BYE Q ZY�N*�� %s,n4 r (Address of b) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections ate perfogned and accepted. Signatu .of owaa Signature of Applicant Print 1*Iatat print Name Date Q.a0M&owNWMtwssi0l•IP0ots aa:o8lmw the Comi-ianivealth of-Vassachusetts Departnreaxt aflndrrshzalAcciderrts Offike o,f�£nm igations 600 Washington Street Boston,CIA 02.111 _ wivik:717asmg.vyldlli Workers' Compensation Insurance Affidavit:Builders/CantractursJEIectHcians/Plumbers ApplicantInfannatian ( Please Print Legibly Name(Bus-...I0rganizationM.R�*i�na1)_ Address `�s ���� �T ` I 6-4^ L5 Ps-,- ft% 6?-c 3 ci Cifyltate( Phone .c3 r?cJ ' 0 t Are you an employer?Check the appropriate box: ' _ Type of project(required)•- I.❑Flat a employer with 4. ❑I am a general contractor and I 6. ❑New construction gees(full and/or partime * have hired.the sub-conactors _ 2- sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees. These sub-contractors have g- ❑Demolition w g for me in an capacity. employees and have workers' .> °� �'c�t3` 9. ❑Building addition [No U-orkerg comp.insurance coop-it]S UMI:e red] 5. ❑ We are a corporation and its 10-�Electrical repairs or additions requi 3.❑ 1 am.a homeoumer doing all work T officers have-exercised their 11-❑Plumbingrepairs or additions ' my el€[No vc&kers•gip- ;right of exemption Per MGL 1 12-0 Roof repairs inn=ancerequired,]s c.152, §1(4X and we have no " employees.[No workers' 13.❑Other camp.insurance required_] *Aziy applicant 1hatchecks box i9lnmstalsofilloutthesectionbelowsbowingtheirvmdcenecompensationpolicyinformation. I Homeowners who submit this affidm A mdai ling they are doing an wal sad then lure antside contractors mast sobnrit anew affidavit indicating such. fC•oatrsctors tbat rhea T-Ws box must attacbett in additional sift shoring the name of the sub-caattac m sad state whet"at not those en itin have employees.If the sub-conttactomhave employee%they mustpnnidetheir umtkers'comp.policynutaber. I urrr an eritpio}Yrr tltrit is pro�zdirrg ivarkers'conrperrsrrtidrt ittsnra>tce for ni}*errtpTo,}�es Setoev is flee pr��icy��i jab sits - inforaratiotu. Insurance.Company lame: Policy R'or Self-ins.Lic.I&: Expiration Date: Job Site Address: City/StatelZip: AU26 a copy of the:workers'compensationpolicy.decbration page(showing the policy number and respiration date). Failure to secure coverage as required.under Section 25A o€MGL;,c- 157 am lead to the imposition of criminal penalties of a fine up to$1,50a.00 andfor one-year imprism=eut,as well as civil penalties.in the form of a STOP WORK ORDER and s fine of up to$250-00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage uerffication I rfa Hereby c underthapairrs acid penahYes ofpet wy,that the informationprotrirW boiv' tare and correct Sitmature. Date_ V L l} Phone 0 Of dal use on[F. Do not write in this area,to be campletad by city ortotim afciat City or Town: PermitUcense# Issuing Authority(tdrde one): 1.Board of$ealth Budding Department 3.City/rown Clerk 4 Electrical Inspector S.Plumbing Fnspector 6.Other Contact Person: Phone#: Information and Instructions Massachuuseffs Gelueral Laws chap ! 152 reqaires all employers to provide workers'compensation for their employees. pursamattD this sty,an ernp&yr---is defined as.",.evmy person in the service of another under any.coitract ofhire, express or implied,oral or wriflrn..", An Moyer is defined as"an individual,partnership,association,corporation or other Iegal entify,or any two or more of the fore en going gaged in a Joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an mdivic�al,partnership,association or other legal entity,employing employees. However the . owner of a dwelling house havmg not more than three apartments and who resides therein,or the occ¢pant of the - dwdIi g 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 I.52,§25C(6)also states that"everystate or local fice=b:,g 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 regnired." Additionally,MCTL chapter, 152,§25C(7)states`Neither the commonwealth nor any ofits political subdivisions shall enter into any contract for the performance ofpubho work until acceptable evidence of compliance with the h mnance.. requ>immerts of this chapter have been presented to the contracting avdhozityf Applicants Please fill out the wo&ers'compensation affidavit completely,by checIozig the boxes that apply to your situation and,if ec nessary,supply sub-contractors)nam(--(s), addresses)and phone numbers) along with their cmtifacate(s)of amnance. Limited Liability Companies(LLC)or Limited Liabf7ity-Partaerships(LLP)vrith no employees other than the members or partners,are not r6quired to carry wormers' compensafion insurance. If an LLC or LLP does have employees,a policy is regni<ed. Be advised that this a.ffidayk 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 retuned to the city or town that the application for the permit or license is being requested,not the Department of ho-du trisl Accidents. Should you have any questions regarding the law or ifyon are required to obtain a workers' compensation policy,please call the Department at the number listed below Self-fim red companies should enter their self-insurance license number on the appropriate lime. City or Town Officials t 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 fM out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permitllicense number which will be used as a reference number. In addition, an applicant that must submit multipIe pemitllicense applications in any given year,need only submit one affidavit indicating current policy b2f6=atiol L(if necessary)and under"Job Site Ad 1dress"the applicant should write"all locations II (city or town)_"A copy of the-affidavit that has been officially stamped or marked by t6 city or town may be provided to the ' applicant as proof that a valid affidavit is on file for fu =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 veniire (Le. a dog license or permit to bum leaves etc.)said person is NOT retpcdrcd to complete this affidavit The Office of Investigafioons would lake to thank you is advance for your cooperation and should you have any questions, please do not hesitate to give us a caIL The Department's address,telephone and fax m�er. Dega�aent of 1'nd ia1 AOCI ent Ufficfa.Of j.VeAk-atiO.= any MA 0�111 T(,-L:#617 727-4900 Cx, 406 or 1-9 MA&RAM Fax 4 617-727 7749 Revised 4-24-07 vmw m w s t�C�L p C LOSE-f s j i�Cr 1 SA rc a A � f Tj CLO s 1 Polo �C- u iV i-tVI.-foFr U plitv I TUPPER TOWN QF `i - CONSTRUCTION CO_LLG 79B MID-TECH DRIVE,WEST YARMOUTH,MA 02673 17 ?- €?,; ; C7 PHONE: 508-778-0111 FAX: 508-778-5010 L WWW-TUPPERCO.COM 0H Date: Town of Barnstable Thomas Perry CBO 200 Main Street Hyannis, Ma 02601 (508) 790-6230 fax Re: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for permit application Issued on has been inspected by a certified c Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, Permit #: --.r Address: Richard Tupper License # CS-69058 1 _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma ".— Parcel V � icati 19 �� p pp Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Villageh�s Owner r_�7 0 leu m a&� ,J&, Address Telephone Permit Request /P'1Cl4 �� �`G C ry. id er� acJ'r /1 0 e/� 6 Square feet:'1 st floor: existing IP�proposed 2nd floor: existing proposed Total new Zoning District Q Flood Plain Groundwater Overlay Project.Valuation & o/�Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: WFull ❑ Crawl ❑Walkout ❑Other Basemdnt Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Nurn,bergf Baths: Full: existin new Half: existing new NdSMber Ed Bedrooms:. existing —new ram:. cl• r;a Total;Room.Count (rota including baths): existing L9 new First Floor Room Count Heat->Typeand Fuel: Cas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes [_f 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 G` APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ��'1CLe�i� C.1�O�°�� Telephone Number J Ud 77 Address �f ��4 1' License# �e1 2h70LC 4 d w V(O/ Home Improvement Contractor# Worker's Compensation #1 " �5� r 0 07 ALL CONSTRUCTION DEBRIS RES TING FROM THIS PROJECT WILL BE TAKEN TO �� 00?, 6 73 SIGNATU DATE J �� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. t ADDRESS VILLAGE OWNER DATE OF INSPECTION: G FRAME fi s1NSULATION -I L °LA-A FIREPLACE I ELECTRICAL: ROUGH FINAL — A, PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT r ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' d i Congress Street,Suite I00 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nagle (Business/Organization/Individual): Tupper Construction Address:79B Mid Tech Dr City/State/Zip:West Yarmouth,MA 02673 Phone#:508-778-0111 Are you an employer?Check the appropriate box: Type.of project(required): 1.X 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. 0 New.construction. 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and haveno employees These sub-contractors have 8: Q Demolition_ . - working for me in any capacity. employees.and have workers'. [No workers' comp.insurance insurance.# 9. El.Building addition . _ com P� 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 , HE Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL l2.❑ Roof repairs insurance required.) t c. 152, §1(4),and we have no employees. o workers' 13.El Other pomp. insurance required.] q ] :*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.: S Contractors that check this box must attached an additiona l sheet showingthe name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:AEIC Policyor Self-ins. #:.WCC500559301200Z 10L3114 Expiration Date: Job Site Address: 115 Buekwood Dr. - City/State/Zip: Hyannis MA 02601 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 p. p sofa fine up to$1,500.0.0 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D1A 'nr s c ,coverage verification. I do hereby.certify w er tl p 'ns a d penalties of perjury that the information provided above is true and correct. Si afore: 1 24 14 Date: / / Phone#: 50877801 1- Official use only. Do not write in this area,to be completed by city or town official: City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACORPN CERTIFICATE OF LIABILITY INSURANCE DATEpOMDA-f" THIS CERTIFICATE lS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTiPICATE HOLDER,THIS 013 CERTIFICATE GOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND;EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW:THIS:CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A_ CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPtermORTANT: If the cc iMcele holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If$UBROOATION IS WAIVED,subject to: the!Efcat and holder In lieu at the policy,certain policies may require an endorsement A statement on this certificate does not conler rights to the ceRificate holder in lieu of such endorsemen s). PRODUCER e tors Lowe Southeastern Insurance.Agency, Inc. E 439 State Rd. AIC No Exl: (508)997-fi061. Ac ;(SOS)990�2731 P.O. Box 79398 R N. Dartmouth, MA 02747 INSURED INSDRERiI;J AFFORDING COVERAGE NABS .. Tupper Construction Co LLC rNsuRERA: - Arbella Protection.Insurance INSURER e: AEIC 27 Roberta Drive INSURERC. CNA Surety West Yarmouth, :MA 02673 w INSURER 1); INSURER E: - COVERAGES CERTIFICATE NUMBERc 2013/14/11NsuR6RF: R. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME AIBOVlw FOR TON E E POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT W1Tk RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . I .. TYPE OP INSURANOE D UER . . . - R YJVD POLICY NUMBER Limits GENERAL LIAdIUTY. M DD Mn71DD EXP 950000874 11/01i2013 11101/2014 EACH OCOURRENCE s 1 000 000 .COMMERCIAL GENERAL LIABILITY - - CIAIMS-MA OCCUR trrti i1MRT $ 100r 00 A MEDEXP(Anyonn wn) ¢ S 00 . PERSONAL&APV INJURY B -=1 000 00 . . . GEN'L AGGREGATE LIMIT APPLIES PER:- GENERAL AGGREGATE $ 2 0tT0 00 POLICY PRODUCTS 000 I rj 9 2 OOQ 00 J LOG - - . . . . . . ._ AUrDMol31LE+•JARILnY 5666240000 12/01/2013 12J0112014 1 M�ED$IN 1, LIMIT s ANYAUTO 9 I Ee B aen0 . 1�000 00 ALLOWNBOAUTOS @ODILY INJURY(PwrPnrlow 11 A $0HL'DUI.t;DAUT09 BODILY INJURY(permnigw* S X HII SO AUTOS: PROPERTY DPJM3E X. NON OWNEO AUTOS. : - (Per accidprn). .. `� INC 5 UMBRE"LIAII X OCCUR S. excMIJAN 46000SS36 11101/2013 11/01/2014 EACHOCCQRRENCE y 1 000 A CLAIdIS.AAAOE [»DUCTIBLC AGGREGATE S IL 000 00 RETENTION .6 t ORKERtg COMPENSATION S ANABMPIDYERIeTp@�'.61APILITY YIN WCC500559301200 lo/o312013 10/0.W2014 X I X. 6 o Yic IMQM�I6R�x�>�R0?EOUTIV6f•""1 NIA RICHARD TUPPER I (Mnnmofy In NR) 1 1 I I UOf+O FOR WG COVERAG E 4,6AO N ACCIDENT. 8 j QQQ QQ aedni="wder ONE F.L.as eA wMaL�ve:$: 1 000 00 POtdr,Y LIMIT 6 1 000 00 AESCIOPTIQN 0P Off I LOCATIONS IVBNIQL66 IAIIA ACORO 10t,Ad4i#onAl RemAm Schedule ifmo/A 5A9C0 b(Rg10rIN!) C�RTIFIOAT�/dQLR3ER CANCELI,4TIgN CRIB SHOULD ANY 10 THE ABOVE DEB ED POUCI"BE CANCELLED BEFORE THE EXPIRATION: OATE.THEREOF,.NOTiCf WILL BE DELIVERH� IN ACCQRpAmCE;WITH THE POLICY PROVNIONS, "Far InformatiRn:Purposes Only., Tupper Construction Co LI.C- AUWRIZED REPRESwiTAtivE ,27 Roberta:Drive W Yarmouth, MA 02673 Lora Lowe AGORA 26 2009/09 ®leas a0P9 ACQRR CORPORATION: Al) 9 iasenred, 1 The ACgRI?name and logo are registered mlirlte of ACORO is V�0611if/�,k Common m=���^� eaanarAnec ass save PERMIT AUTHORIZATION FORM 1, i t✓UtA��.1 li��aWS� , owner of the property located at: (Owner's Name,printed) I (Property Street Address) T(Citytfo n) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Own is Signatu e Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Rev.12132011 y !itlitllgyf3 ot"ll'u"ARNIVIA 11 U I t,tNi. AAassarhusetts.- 1a7l Nord,Strp a T p PMmant of Public Sa". MGM,w 12= Board Of-Sudding Regulat{on3.and Standards SM27s-i2?a. wrvw tp.Ccx{{ £rcanse;GS-068068 .w ' RICHARD S TUPP£R 79 8 MID-TECH DR WEST YARiMOU7N Rkhord Tupp . . �. EAp+ration tSH r+EIM M Foa'DINUTOS AM UMATiou nvE;, Comr{oss,onor 12/31/2014. . #TOME o1rN`IPRBVE�fls{rs 4c 13{(siatw RsR .People Fielp3trg:People Build a Safer Wand"' IMPROVEMENT CONTRACTOR . � . RsylstriNon: 1 5 YYpe:, lxplratlon:: 14, . IngWidual- RtCMRD TUPPER 11 Richard°Tupper TU RICHARD UPPER pper Construction 19 noborta Nve Building Safety Proressioriat VU' . . :VARhAQU,TW,MA b26JS t adrrxcrrt�ry Member#:6158119 Exp:4/30/2014 .w J • TOWN OF BARNSTABLE BUILDING PERMIT:APPLICATION_ A! ' Map a?a Parcel. CrO _ Applicaticin# Health Divi -r C I;-bfA-AA el Date Issued ' •ter -2/��1 X NOR" Conservation Division :Application Fee Planning Dept: ;'Permit Fee Date Definitive,Plan Approved by Planning Board Historic _ OKH Preservation/ Hyannis Project Street Address ig Village H ANti I S Owner W g,---r A +h M vRRhy Address ' b� R dt#�ooa �i2 Telephone S'o� 68t 2y8`y: Permit Request R(EPLA c E e T7 y-j In 0611) 511 t iR J A-OD 5 0 C EN TP_te t RtPL 120 TTrri S l N(.L C-S Square feet: 1 st floor: existing " proposed 2nd floor: existing proposed Total new Zoning District- Flood Plain Groundwater.Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ,:> Two Family ❑ Multi-Family (# units) Age of Existing Structure y Historic House: ❑Yes .2rNo On Old King's Highway: ❑Yes J2<o Basement Type: Dull ❑ 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: y existing —new Total Room Count (not including baths): existing 71, new First Floor Room Count Heat Type and Fuel: . Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes 21Go 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: i N CD Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ { �, Via. � Commercial ❑Yes ,21rNo If yes, site plan review# ' �a c� Current Use Proposed Use a APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) cap M Name h�'��i , 1��IZ�Ry Telephone Number 8'y Address //5- 300CwWfl P4 License# �I/� l�-?A-N 1V15 Plt+ 02C-y/ Home Improvement Contractor# Worker's Compensation # N// 1-)- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE /Z' • FOR OFFICIAL USE ONLY s APPLICATION# DATEISSUEQ MAP/PARCEL NO. I ADDRESS VILLAGE OWNER ; I' DATE OF INSPECTION: k FOUNDATION FRAME INSULATION FIREPLACE s ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING y DATE CLOSED OUT ASSOCIATION PLAN NO. y 7 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): vR Kft c�. Address: //S 130ep,- Waco 12 City/State/Zip: /I'ygNytj IT1 A OLs d I Phone.#: S68" 2'1 d"4f Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with . 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or parUier- listed on the attached sheet. 7.. ZRemodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY $ 9. ❑Building addition [No workers' comp. insurance comp. insurance. requi red.]d. 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.� q ] officers have exercised their 11. Plumbin repairs or additions I am a homeowner doing all work ❑ g P 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 infomation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the wor rs'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 tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature Date Phone#• 695- z yPV 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#: A f 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-contractors)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 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 Industrial Accidents Office of Investigations, 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-'7749 Revised 11-22-06 www.mass.gov/dia �tKE k, Town of Barnstable Regulatory Services Thomas F.Geiler,Director - swntvsrwste. - � MASS 16.19. o.19. ' Building Division Tom Perry,Building Commissioner 200 Main.Street, Hyannis,MA 02601._ www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION ff Please Print DATE: / 2 — t7- e) a JOB LOCATION: //�- I C,K Wwb 1]l2 y J ! S number street village "HOMEOWNER": (N1"/f1M /HV1212A-%4 name home phone# work phone# CURRENT MAILING ADDRESS: J/5� &4kyj0dh . DAL �An�N/S /'1 A- D 2G6 1 crtyhown state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that.he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirem ts. Si 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 bomeowner 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 persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they arc assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the bomcowncr certify that hdshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a fomm/certification for use in your mnununity. Q:forrrms:homeexempt Tara Town of Barnstable Regulatory Services •= uxxsrAMF � MASS. Thomas F.Geiler,Director i639- � ate" Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OwNERPERMISSION T3�crt 12► ✓c PO 03 --C- — - �y s� F►nf D i N L Z J a s �--- y y Pos-rs sy '' o rF Gil d n� ►� ►,�,� IZ�ti`i,%j S (coo " AWcif r� s n% ► 5 l2 PCTP TAO*D �te-�ti G y,-y PO1 ,-s Z 3— 'f� DFF Co 2��trD l n,o Ta TWL) w 14P-O UPJ ,2 s£ -'I2t74 D L k � N l' i vow p Ila A► I � . ti --- a in; n is, Roma, Paul From: Roma, Paul Sent: Tuesday, December 16, 2008 8:56 AM To: 'wmurray@gsrv.com' Subject: RE: Card under door Dear Mr. Murray, I left my card so that you would contact this office. The new side entry and proposed new front entry need a building permit. Please apply for one ( Building Dept. 200 Main St. ) before 12-22-08 in order to avoid a written Stop Work order and the resulting fines. If you have any questions, please contact this office. Sincerely, Paul Roma -----Original Message----- From: wmurray@gsrv.com [mailto:wmurray@gsrv-.com] Sent: Monday, December 15, 2008 9:26 PM To: Roma, Paul Subject: Card under door Mr Roma, I found your card under my door at 115 Buckwood Drive in Hyannis this evening. Please let me know what this is in regard to. Thanks, William Murray 1 of o Expires 6 months from issue dare Regulatory Services ` Fee2 aU 9 ems Thomas F.Geiler,Director 1�QrW1�T 502 bp� '�FOMat► Building Divisionc — Elbert C Ulshoeffer,Jr. Building Commissioner EyS etc y 367 Main Street, Hyannis,MA 02601w : X-PRESS PERMIT Office: 508-862-4038 Fax: 508-790-6230 MAR' 14 2001 EXPRESS PERAUT APPLICATION 122-p'A- Not Valid without Red X-Press Imprint TOWN OF BARNSTABLE j-j l( Map/parcel Number� 2 2, L G� Property Address edVw_11V10 Residential OR ❑Commercial Value of WorkSOya Owner's Name&Address �Tflf-f'j il/c Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) r7Workman's Compensation Insurance Check one: I am a sole proprietor am the Homeowner (] I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Permit Request(check box) Re-roof(stripping old shingles) M Re-roof(not stripping. Going over existing layers of roof) Re-side Replacement Windows. U-Value (maximum•44) Other(specify) •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation.etc. Signature expmtrg