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0017 CANTERBURY CIRCLE
17 J\A - 04 t u(A 1 � + i, r • a I- f /�.Et GtJ�Y� L7o�uf�r�" 617� £ P 112 A)e eo{ l l5t- le .1y, Town of Barnstable�AxNrl,3+TsAeBSR:6, .� '' WPosh? G ltTPo ;r-d So That rt rS U�s�ble'.:.;;';Fr.o m•'°ahe"�S treet'� A.PP"roved=Plans�Mt ust be<-Re€tai'rieds°-on Job andthis,•Car,d\�Must�b�e Ke P t Building Permit Permit No. B-18-1085 Applicant Name: Approvals Date Issued: 05/03/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 11/03/2018 Foundation: Location: 17 CANTERBURY CIRCLE, HYANNIS Map/Lot: 249 111 Zoning District: RB Sheathing: Owner on Record: RIVERA, MIKE&TRIMARCHI,JENNIFER Contractor] Framing: 1 Address: 17 CANTERBURY CIRCLE Contactor li else 2 HYANNIS,MA 02601 73 oJect Cost: $0.00 Chimney: Description: Deck will be removed and Masonary work to be done too �e back Permit Fee: $85.00 yard to create a patio on the ground F e Pa, $85.00 Insulation: Project Review Req: g Date 5/3/2018 Final: �a um PI ias b Rough Plumbing: Building Official Final Plumbing: WMAThis permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application day" e'approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures"shall be in compliance with the local zoning by laws and codes. z ' `E ,I Final Gas: This permit shall be displayed in a location clearly visible from access street o`r`road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Buildin Fire�®ffiu g and als areGprovideii on thispermit. Minimum of Five Call Inspections Required for All Construction Work: Service: z a 1.Foundation or Footing Rough: 2.Sheathing Inspection a am RR 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. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). <I0- Fire Department �1 Building plans are to be available on site c Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT i 'am� c I R 1 1%1 1 1 1 1 1 1 . •.uu . / 1 . 111 . •.1 .1 11 n u.- 111 1 1 • / 1 lot ' 11 ■ .. . ■ -1n u 1 .nn ' - .• .14 •1 '•• . . 1 .11 • 1 1 1 1 • � 1 1 1 � 1 1 ��1.�1, - � ►ill► � � •� / i ,7�v�e��'� q��///���/I�►�� �`��if������I�.RPI, �y�/ i�<<���1d1/��/:�s��i/`I 11.���:� �\_ `vim \� �.� �!/i �� ,,7i'�wi�. VA-A,`�7�//Ih� ���//I� �� •�� /f,� I�1•,<r�� % �I .�I�j`1'i.. 1 Application Number..................................................1.. Section 5—Detail Cost of Proposed Constructions�� v v Square Footage of Project Age of Stn cture Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind Zane Compliance Method MA Checklist ❑ WFCM Checklist Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing D Gas [] Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I an using a crane ❑ YesA(No Section 7—Flood Zone Flood Zone,Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes. , ❑ No Last,mdzbt d_-2/9=18 -- --------- . APPlication Number................................... Section 9—.Construction Supervisor Name Telephone Number Address City State zip t, License Number __ - License Type�. yp Expiration Date Contractors Email Cell# I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor m accordance with 780 CMR the Massachusetts State Budding Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. 9 Signature Date Section-10—Home Improvement Contractor Name Telephone Number Address IRY State Zip Registration Number Expiration Date . I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.LC... Signature Date C --Section 11-Home-Owners License Exemption --__7 Home Owners Name: M KQ 1�VV,4,P -t- c�&-i,�rvtk_y2 i jUM?(jX0-1 Telephone Number 20.5'le6(Q 0 443 Cell or Work Number 203 (QOC9 81y3 I understand my responsibilities under the roles 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. Sigoature Date APPLICANT-SIGNATURE . Signature AaA Date t I� Print Name tqtP.ww�� , P11 � Telephone Number E-mail permit to: c 1 1 , mikrZC4 19S(� G`i MAr-,,A L. Co VV1 r e.4 o l . ... ........... Section 12—Department Sign-Offs Sech p � Health Department © Zoning Board Cif required ❑ Historic District ❑ Site Plan Review(if regmr4 ❑ Fire Department ❑ Conservation i For commercial work,please take your plans directly to the fire department for approval Section 13—Owner's Authorization a I, 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 j ob) Signature of Owner date Print Name e F ' Last uDaWxxk2/92ois • I The Commonwealth of Massachusetts Department .f IndustdalAccidents o Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information M n Q IEPleasye�PrintLegiblY Name(Business/0rn n�on/IndMduaD: MCC,1�kC, K(�,A t O�pk r, �PN R Address: CANTCP,P&UPq N4M city/s - OU001 Phone#: Are you an employer?Check the appropriate box: 'Type of projecf(required): 1.❑ I am a employer with 4. []I am a general contractor and I 6. ❑New construction employees(fall and/or part time).* have hired the sob-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contactors have g. Demolition working for me in any capacity. employees and.have workers' 9. El Building addition comp.insurance.: [No workers comp.insurance 10.❑Electrical re airs or anions equired] 5. [] We are a corporation and its P 3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions right of exemption per MGL " myself:[No workers comp. 12.0 Roofrepairs insurance re ed. t c.152,§1(4),and we have no ] employees.[No workers' 13.❑Other comp,insurance required.] #Any applicant that checks box 91 mast also fill out the section below showing their workers'compensation policy information. 1 t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mast submit anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state Whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. I' f Insurance Company Name: 'lll{�'U1f:�l(�(,jl PST � &&:"34 I r MW &MO&WW Policy#or Self-ins.Lic.#: /,wl'%Vp— IlSo� Expiration Date: Job Site Address:, . City/State/Zip:� �Y1XS , 'V . 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 a 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 ce under e p an of perjury that the information provided above is true and correct Si e: Date: 7 Phone#• official use only. Do not write in this area,to be completed by city or town official City or Town: PeriniMcense# L Authority(circle one): of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. Person• Phone#: pFTFiE� TOWN OF BARNSTABLE RARN BUILDING DEPARTMENT APPLICATION FOR CERTIFICATE OF OCCUPANCY 4'prEn r�° Date Building permit application number map/par A Address of structure Area of structure C.O.will be issued to Name of Tenant Edition of Building Code Use and Occupancy Classification Type of Construction Design Occupant Load Is the facility licensed by a State agency Yes ❑ No ❑ If yes if yes, name of agency Relevant Code of MA Regulations (CMR)that apply Automatic Sprinkler System Sprinklers provided? Yes ❑ No ❑ Sprinklers required? Yes ❑ No L-1 Building Department Use only Special Conditions: 'ALTERNATIVE WEATHERIZA 'ION . OiNco ®�i FAQ Date O .l. tiO ?0 ,c 1 Rr�ST -14 Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 The insulation work at • '�i`tft1� has been completed In actort#i Presi dent CSL 105454 5 8 DICKINSOM STREET I FALL RIVER,MA 02721 (508) 567-4240 ALTERNATIVEWEATMERIZA'IONOGMAIL.COM TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map l I Parcel Application 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 Village S Owner ro,__ Address Telephone 0 b AQ4_,"'f 0 D Permit Request t 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 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing, new Half: existing new Number of Bedrooms: existing _new p Total Room Count (not including baths): existing new First Floor Room'Co 0 Heat Type and Fuel: ❑Gas ❑ Oil ❑ Electric ❑ r,�Other o > 00 Central Air: ❑Yes , ❑ No Fireplaces: Existing New Existing wood/coal s we: ❑Yes ❑ No rn Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ex�i 'b sting_ new size_ m 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 Telephone Number Address License# dV 7 1 A 6o-Lq9- Home Improvement Contractor# 7(JZ Email � Worker's Compensation # VO �f a� v v ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PRDJECT WILL BE TAKEN TO SIGNATUR DATE / 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 DATE CLOSED OUT ASSOCIATION PLAN NO. i HOME OWNER WEATHERIZATiON WORK PERMIT: PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property located at- The weatherization work dune will be based on programmatic priorities and availability of fundingand it may include all or some of the following measures: Y 9 Weather stripping; air sealing; attic& basement insulation; exterior wall insulation;ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1, I give permission to Housing Assistance Corporation to access the properly with such equipment and materials as may be necessary to perform weatherization, 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement and give my consent. Home Owner(Signature) Iyi ke Home Owner email: - t , ! f'" > pate:__ Agent:(signature) _ _._....... __ _ _ Date: Weatherization Contractors: Adam T inc Cape Save Frontier Energy Solutions ternative We eri- Lohr Home Improvement Building Science Construction Tupper Construction Cape Cod insulation The Commonwealth of Massachusetts Department of Industrial Accidents = 1 Congress Street,Suite 100 a Boston,MA 02114-2017 www mass.gov/dia Wbrkers'-Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. AnWlicant Information Please Print Legibly Name (Business/Organization/Individual):ALTERNATIVE WEATHERIZATION, INC. Address:2 LARK STREET City/State/Zip:FALL RIVER, MA 02721 Phone#:508-567-4240 , Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 16 employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees'working for me in 8. D Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.F]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I I.E]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.L]Roof repairs These sub-contractors have employees and have workers'comp.insurance? 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other INSULATION 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors that check this box must attached an additional sheet showing the name of-the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site - information. Insurance Company Name:STAR INSURANCE COMPANY Policy#or Self-ins.Lic.#:0849257 00 Expiration Date:4/4/18 Job Site Address: r -1z?.rhu City/State/Zip: Attach a copy of the workers'compensation po' declaration page(showing the policy nu er and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify unde th ins an a 'es p rjury that the information provided above is true and correct. Si ature: Date: Phone#:508-567-42 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#: .-• ALTEWEA-01 SNERONHA A t >>t CERTIFICATE OF LIABILITY INSURANCE A (MWOONYM 0512612017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUIRER(S),AUT14ORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on j i this certificate does not confer rights to the certificate holder in lieu of such endomemen s. PRODUCER i cT Christine Costa Mason&Mason Insurance Agency,Inc. I,CC%o,E.):(781)523-0067 �AIc, 458 South Ave. Whitman,MA 02382 ccosta@masoninsure.com INSURERS AFFORDING COVERAGE i NAiC# INSURER A:Evanston Insurance Co. 136378 i INSURED i INSURER 8:Safety Insurance Company 139454 Alternative Weatherization,Inc. I INSURERGC Star Insurance Company , i18023 1 2 Lark Street t INSURER D Fall River,MA 02721 1 INSURER E: i INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: i THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE.FOR THE POLICY PERIOD i INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY'CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS I CERTIFICATE MAY BE ISSUED OR-MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES, DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, j EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR' 1ADOL:SUER POLICY EFF POLICY EXP TYPE OF INSURANCE I i POLICY NUMBER LIMITS 1 A 1 X 1 COMMERCIAL GENERAL LIABILITY 1Ofl0,000 EACH OCCURRENCE— - cLA1Ms-NAPE 1 jC 1 occL3R ! ! j3C42088 0610712017 06107f2t118 1 PRf DAMAGE To RENTED 1 5 100,000 i i i i I 6,000 1 ! MED EXP(Any Me rsori S PERSONAL&ADV INJURY i S 1,000,000 I ' I�GEId'L AGGREGATEPR pLIMIT APPLIES PER: j f i GENERAL AGGREGATE I g 2,000,0002,000'000 i POLICY JECT LOC i 1 PRODUCTS CDMPlDPAGG i S OTHER. $ g i AUTOMOBILE LIABILITY1 i COMBINED SINGLE LIMIT I s 11000,000 j ANY AUTO j6237702 j 04108/2011 ?0410812fli8 BODILY INJURY(Per Person) YS i- OWNED SCHEDULED �— ! AUTOS ONLY I X i AUTOS �� � BODILY INJURY(Per accidents $ AUTOS ONLY X }AUUTDS ONLY ? �2OPERTY'DAMAGE ;S —t er atttd$fR)) i I 1 1 s A UMBRELLA LIAR X I OCCUR i EACH OCCURRENCE '$ 11000,000 I I X ,EXCESS LIAR CLAIMS-MADE XOBW6619616 0610712017;06107/2018 i AGGREGATE a 1,000,000 33 ; { I DED !RETENTION S $ I WORITEPLC E SA NSAT)ON I i X i;SR �I CTH- I AND EMPLOYERS'LIABILITY i I YIN ' C 0849257 00 ? 04104120171 0410412018 E T_ . 600,000 I ANY PROPRIETORiPARTNEPUEXECUTIVE i� N 1 A i E.L.EACH ACCIDENT $ EXCLUDED? !. I� i 600,000 I Mandatory M NH) E.L.DISEASE-EA EMPLOYEE S It yes,describe unaer - 500,000 i iDESCRIPTION OF OPERATIONS deoav I [EL04SEASE-POLICY LIMIT i S ' i f I i ! i DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,Addtfiom)Remarks Schedule,may be attichad#more space is requiredl #Action Inc.and National Grid USA,its direct and indirect parents,subsidiaries and affiliates shall be named as additional insureds on Commercial General !Liability policy perterms and conditions of forms CG2010 and CO2037 and Commercial Auto Liability policy per terms and conditions of farm SCA 005(02 116).Forms Available Upon Request: CERTIFICATE HOLDER CANCELLATION 1 1 y SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN i j National Grid ACCORDANCE WITH THE POLICY PROVISIONS. I 40 Sylvan Road j Waltham,MA 02451 i 'AUTHORIZED REPRESENTATNE ACORD 25(2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD -.: 4 F _3 •F Y �.; '6 "X - N}r o�F, xr" `" s, �;- `R w1� } r , �• '% Ws '•� �'�. - ri3 ;'fah+' t�'7. ..a' -' ,n "zi,`s, �,sr' .r` 'y °:x- +_• 45 7 <# '' 1 s 'gyp. 3. x �W "?` S i •-,: ,�:-sue, Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, M us6tts 02116 Horne lmproverh tractor Registration Type: Corporation f Registration; 175M, ALTERNATIVE WEATHER)ZATION,INC �? Expiration: 05J2812019 2 LARK ST �� FALL RIVER,MA 02723 � ty z = update Address ar d'return card: mars reason for change, .c4 '-j1/rs �<.�rcirrz>rarrteri�,l�•��`•^��ra,;:srr,�'�iru.,ell Offlce of Cc+ timer Aftrs&Susineis:Reguiatfon " HOME IMPROVEMENT CONTRACTOR Registration valid for Individual usa.only TYPE:Comorafim. before the e4tration data. If found return to: $ffi X3d E2SDIi E1 Office of Consumer Affairs and Business Regwaffon ,�, 17 3 05128/2019 10 Pait Plaza-Surte 6170 ALTERNATNE V+I� T143N;INC. MA 02116 r TIMOTHY CASRAL,.„ 2 LARK ST FALL RIVER,MA 0272f " Undersecretary of v O`,. s 8fi11@ j , r Town of BarnstableBuild ing - e. r � ARK Post This Card So That it�s\/isible,From theStreet Approved Plans,Must beRetarned onJoband;this Card Must;be Kept u M ``Fines `I"n w,i .yh..Has:Been Matle:" 16�w Posted Until. al sped o, .e Where a Certificate of Occupancyr:�s Required,such Buildmg`s,Fiall Not be Occapied„untdxa F'inal;lnspect�on hays been made ' ' Permit Permit No. B-16-3197 Applicant Name: Nathan Tissot Approvals- Date Issued: 12/06/2016 Current Use: Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 06/66/2017 Foundation: Location: 17 CANTERBURY CIRCLE, HYANNIS Map/Lot 249 111 Zoning District: RB Sheathing: Owner on Record: RIVERA, MIKE&TRIMARCHI,JENNIFER ° Contractor Narne: SOLAR CITY CORPORATION Framing: 1 Address: 17 CANTERBURY CIRCLE k,,Contracctor�License 168572 2 HYANNIS, MA 02601 Est Pro ect Cost: $9,000.00 Chimney: k 1 , y: Description: Install solar electric panels on roof of existing house withany permit Fee: $95:90 -. upgrades;when applicable,specified by Design,To b'e interconnected Insulation: Fee Paid 595.90 with home electrical system. JB-0263085 5.9 23 Panels _ _} Date*"'1 12/6/2016 Final: l Project Review Req: Install solar electric panels on roof of existing houseith anyFs`" . . upgrades,when applicable,specified by®esgn;�Tobe s � W. <L�r -. Plumbing/Gas interconnected with home electrical s "stAm6 0263.085 �L �W - - - - Y Rough Plumbing: 5.98KW 23 Panels �'' Building Official Final Plumbing: ',. - This permit shall be deemed abandoned and invalid unless the work authored by this permit is.commenced within six months after'issuance. 11 � - Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for whicH th's permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or,road`and shall be maintained open for,?public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of occupancy will not be issued until all applicable signatures by''t he,Building and Fire Officials are,prowded on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work 1.Foundation or Footing r .; it 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. Final: ,"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: c, . All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable Arm 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Fr►�u- 5 '''r * _ Application No: TB-16-3197 Date Recieved: 10/31/201600 ; Job Location: 17 CANTERBURY CIRCLE,HYANNIS Permit For: Building-Solar Panel-ResidentialLn Contractor's Name: SOLAR CITY CORPORATION State Lic. No: 168572 �— � Address: 24 ST MARTIN STREET BLD 2UNIT 11, Applicant Phone: (508) 640-5839 MARLBOROUGH, MA 01752 (Home)Owner's Name: RIVERA,MIKE&TRIMARCHI, Phone: (203)606-0143 JENNIFER (Home)Owner's Address: 17 CANTERBURY CIRCLE, 'HYANNIS,MA 02601 Work Description: Install solar electric panels on roof of existing house with any upgrades,when applicable,specified by Design; To be interconnected with home electrical system. JB-0263085 5.98KW 23 Panels Total Value Of Work To Be Performed: $9,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage-unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. 'I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the , I Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within.is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Nathan Tissot 10/31/2016 (508)640-5839 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $9,000.00 Date Paid Amount Paid Check#or CC# i Pay Type Total Permit Fee: $95.90 10/31/2016 $95 90 X30C{X3CC{ Credit card 5477 Total Permit Fee Paid: $95.90 � v' T ISYS�IV�T A�PEI� - M.A.P. INSTALLED BUILDING PROD P.O. BOX 1309 UC S SAGAMORE BEACH, 1tA. 02562 (508) 888-359.9 (508) 888-9609 Fax Date job completed: Address of foam /4-� — -- applicatioz-i: Inches sprayed in: - �'ezlir�g Y Malls 7 Slopes Overhang_— Bsmt veil Blockers & Ru.ziners `' . - fc ---------- -- . U Cath Cell - bath malls �,� -- � Kt-tee Walls A/H Walls Lra`,vl Cell Installers Signature- Lr — HEATLOK810.0 DEMILEC ® � CO- Heatlok'is a two component,closed cell,spray applied,rigid polyurethane foam system.This product uses recycled plastic materials,rapidly renewable soy oils,and the blowing agent has zero ozone depleting potential.Heatlok complies with the intent of the International Code Council's residential and commercial building codes and is commonly used as a thermal insulation,air barrier,vapor retarder and water resistive barrier in above grade,below grade,interior and exterior applications. g:� ,� r ix '�3�--Ksx �. ar,:.:i� �... • yy• 3' -pa i; �'�sP � �'"�.. ir.;� .,�;.� ',� a+. € - . ASTM D 1622 Density 2.1 Ib/ft3 33.6 kg/m' ASTM C 518 Aged Thermal Resistance(R-value @ 1 inch) 7.4 fth°F/BTU 1.3 Kmz/W See ESR 3210,Table 1 for additional R-value information ASTM E 283 Air Leakage @ 75 Pa @ 1" <0.02 L/sm2 ASTM E 2178 Air Permeance @ 75 Pa @ 1" < 0.02 L/sM2 ASTM E 96 Water Vapor Permeance @ 1.2" < 1 perm <57.2 ng/Pa•s•m2 Qualifies as a Class 11 vapor barrier per IBC Section 202 ASTM D 1621 Compressive Strength 28.7 psi 198 kPa ASTM D 1623 Tensile Strength 46.2 psi 319 kPa ASTM D 2126 Dimensional Stability @ 158OF(70°C)97%R.H. (%volume change) (168 hrs,sample without any substrate)L/W/T -1.37/-0.42/+0.27 CA Spec 01350 VOC Emissions Standard Compliant ASTM C 1338 Fungi Resistance No fungal growth ASTM D 2856 Closed Cell Content -90% -- - r 4 3 ps' '.,� 7 Surface Burning Characteristics,4"thick Class I ASTM E 84 Flame Spread Index 20 Smoke Developed 400 Ignition Barrier-Compliant with 2006,2009&2012 IBC and IRC,and ICC-ES AC-377 NFPA 286 Appendix X,for use in attics and crawl spaces without a prescriptive ignition barrier,thermal Pass barrier or intumescent coating. NFPA 286 Thermal Barrier-Compliant with the 2006,2009&2012 IBC and IRC,as an interior finish Pass without a 15 minute thermal barrier with BlazelokT'TBX at 11 mils dry film thickness. ASTM D 1929 Ignition Properties(spontaneous ignition temperature) 932°F(500°C) Polyols Containing Recycled and Renewable Content -40% Renewable Content 13.5% Pre-Consumer Recycled Content In Progress Post-Consumer Recycled Content In Progress Total Recycled Content In Progress Cream Time Gel Time Tack Free Time End of Rise 0-1 seconds 2-4 seconds 3-5 seconds 4-6 seconds 3315 E.Division Street,Arlington,TX 76011 Heatlok Technical Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 5-5-15 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 1 of 2 Z9�/�/ y�FTHET��� TOWN OF BARNSTABLE • BAB.ISTABLE. i 0 9.a` BUILDING INSPECTOR p �yJ/ e �JL. �K�1.... APPLICATION FOR PERMIT TO ................. ... .. -G. .. ..:......:..:................................................... TYPE OF CONSTRUCTION ..............` ....... ................................................ ...............dl...:.:.... 19 �r TO THE INSPECTOR OF BUILDIINGS / 7 The undersigned hereby appliepermit according to the following information: Location ....... . ,F � �x�•.4.��'!d/,�-Et,z.... .................... /."Proposed Use ......... r A ................................................................................................................... ZoningDistrict ........................................................................Fire District .............. .............................................................. Name of Owner .. 3. ... �� 1:..� . .�4.��f@. . . .. i%�l�Address ............... ....�`....t'..-� 4 Name of Builder •••,6! A ..Address Nameof Architect ............. . �.................................Address ........... ....................... ..... ..,.. Number of Rooms .............. .........................Foundation ......:-6 ls :.........,................. 4 Exterior . . ... Roofing .. .......... .. . .................. Floors ......... ......Interior ........ .. ... �L ............................. Heating ...4 ..Plumbing ......ca6.r.... �.................................. Fireplace .. (� .................... ...........................................Approximate Cost ........... ..... .. ....................... Definitive Plan Approved by Planning Board -----------_-------------------19 . 7s.� Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH a m _Z C1' ` E4 N > W LU Lu Y_ Q co W � u_1 j f O �L U o � � r CL a r; w = ZQxz w -cn � I hereby agree to conform to all the Rules and Rejulations of the Town of Barnstable regarding the above construction. Name ....... � :.�. Cedar Acres Realty Trust No ...15 ?... Permit for .....,,,one story........ single family dwelling Location A...4 Canterbury Circle ...... .... ................. H3':annis...................................... Owner ............Cedar Acres Realty Trust Type of Construction .......UAMIA......................... ................................................................................ Plot ............................ Lot ........j .................... I� Permit Granted ............. Augu..stlF. . 19 72 ......... . .. r` Date of Inspection ...................... .............19 22 Date Completed ........19 PERMIT REFUSED ................................................................ 19 ............................................................................... ............................................................................... Approved .,............................................... 19 ................... ......................................................... r• Permitmimber G„x�. ./` o-p TOWN OF BARNSTABLE REGULATORY SERVICES BUILDING DIVISION KEEP OUT UNSAFE STRUCTURE UNINHABITABLE .9,4.sE115M -r— CONTACT BUILDING DEPARTMENT BEFORE ENTRY OR REPAIR w ' Address 1 Bldg.OfficialC 17 Canterbury Circle, Hyannis 2/7/12 r^. " � r""'""d'"r ....� ,g...�_ .w-I�;/I�+Y+'.rrrrlr�+!,•_ �� lit ��,�,.gy� � x 6 r k t t ¢ ow II kalm w' ., s ^ �t.. ,�wa �R• ..I M E'" ��tYl bra ¢ .C' y' '•.IJj'.A �„ '� vC (► � ® V � �. �, � �h, s�^��' k, 1'�P Y—'i u �'Jt ht+t r sari_ <;�:a ��{ .y�'a• .� �!.'.�� '�.�GG?4 �4"a a'°W l y f&a/a�� �+•�y�;: �u . �...,,, �, t t�Y���ti �� �. �'1P J��4•'?a'tS"�l�'Y�j{"� !fir � '"� 4 X Sri �a•.'�''�i.. .la. .-.. .. ,. ..: t�c, ^��� ",`. �r�'�">�•� LY � r"' '7�. Ste. g�? " u ni _ x. � � �. •' / ME l MA a� _y� n '�- \' �� � .� .k a "` ¢. -� . ,�y�, � ��. - i��r t � _r \ �y '+" .. c t� � a L ", t � 1 a. �y'Is i` `��.' -, �� J'-.- +� .. v; � ., e �f � i oy` :,. . /�q�J T r�].".L � � � 1� ;�+ � tom-- �_ (y, � �� +�Y� � 1� - M .. ��' � r' �' � � - �. �:. ,�_. . __ � . `, �. _.. . :�r� _ �. �_ �I _ _ � . . ,� "?Z �p ... t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION . C;) Map �` ql- Parcel Application #r Health Division Date Issued Conservation Division L Application Fee Planning Dept. eymit Fee Date Definitive Plan Approved by Planning Board , 1S p Historic - OKH _ Preservation/ Hyannis � Project Street Address 0fIN i a 6U-!( O 16c.0 Lc Village N M/VA) ,_C LM 4 d-CP 0 I 1!» _T � r�'7 a1 L KW .' Sul iZC/�®O Owner fiRE-bi bic YAAC ✓ iokIC_ Address-CA9"L-L-10iNf TX 7,!;,007 Telephone T7 Q -SR I — 2S(o3 Permit Request kE&o O9 ..LL.=a h L !IpA vziEw VI�fT l 1.l � /' c�M�-.�'rs • /9 A 1'C i�/''S.�,..^�j/'"�T` TLf.�fY-'( w rr R LDS`ram c ib s o ►y 6 C.C Y �fo G /2�f�r� � c'GYCt/ t N�6ACN Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4�c00.0_d 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 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: 0Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 3 3 c2 Number of Baths: Full: existing 3 new Half: existing new Number of Bedrooms: 3 existing —new Total Room Count (not including baths): existing i�, new First Floor Room Count Heat Type and Fuel: 'Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes 0 No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:4Pextutlng ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attache.kl garage: *existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes l No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) -617-low'—(06 r.� C Name G uF04 Telephone Number ro r' 7—(0 26 ,J8 7 7 -o Address _ Q(c e.� j-/i ci C License # 6 f 3 /Cl-V AJ Home Improvement Contractor# 1/ 8 729 Email U 1P,y rG,e,„ z T_)qz&f2 . CeM Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE 3,49AADATE `/lag I f I ' FOR OFFICIAL USE ONLY 'APPLICATION# DATE ISSUED " MAP/PARCEL NO. -, ADDRESS VILLAGE i OWNER T T DATE OF INSPECTION: s r FOUNDATION S FRAME `1 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 4 GAS: ROUGH FINAL FINAL BUILDING 1 r DATE CLOSED OUT ASSOCIATION PLAN NO. Print Page 1 of 1 4» 4 a Subject: Freddie Mac Asset Ready for Reporting Completed Capital Repairs From: DoNotReply@freddiemac.com (DoNotReply@freddiemac.com) + .: To: JGUERRACONST@YAHOO.COM; Date: Sunday,April 26, 201510:20 PM Freddie Mac HomeSteps has approved a repair bid assigned to your company. A new task has been created for you to report when the repairs have been completed for the following asset. Asset Number: 1122732 17 CANTERBURY CIRCLE HYANNIS,MA 02601 BARNSTABLE COUNTY Please go to http://www.homestepsconnect.com to complete the task. If you are unable to complete this bid, notify the HomeSteps assigned listing broker and Sales Specialist. v Thank you, HomeSteps i https://us-mg5.mail.yahoo.com/neo/launch?.rand=3j9gasuhndpov 4/28/2015 HomeSteps Connect Page 1 of 2 Home I Forms I •.,.*,p,�.,.:,> I contact Us I My " °-r �I Froflle I I-mm HomeSteps Con heel•q. # 0t�e FedgteMac.mm I HomeSteos_com Asset iD Loan Number Property Address rr Status/SubStatus DOM DII General Asset Data Notes Contacts Flags ed 1122732 Pre-listing 1 Asset Details 458168591 17 CANTERBURY CIRCLE. Repair Then List 0 397 View Capital Improvement Repair Bid Details *indicates required fields) ; Downfoad Bid Sheet(PDF) (To View or Add GC Photos,Click Here.) Comments: ` *Contractor Company Name: IJOHN GUERRA 7 *Bid Type: I Initial Bid v *Contractor Name: IJOHNGUERRA- 1 Repair Bid Number: 519955 -ry *Contractor Office Phone Number: (617)696.2877 Bid Received Date: 0411 7 2 01 5Jry Contractor Cell Phone Number: (617)645.6695 Estimated Completion Date: 05/08/2015 J Contractor Fax Number. (617)696.2877 *HomeSteps Requested Completion Date: 05/082015 _ *Contractor Email Address: IJGUERRACONST@YA, Approved Date: 04262015 *Contractor Address Linel: 1188 BLUE HILLS PARKV *Pay To: Cont@ctory Contractor Address Line2: 1 7 Bid Status: Approved `Contractor City: IMifton Amount Paid At Approval: *Contractor State: MA v Amount Paid At Completion: 'Contractor Postal Code: 02186 - Home Owners Association Contractor Postal Code Extension: F - Company Name: Phone It. Ext Approved Scope of Repairs-Bid Required Other \ Use this section to bid repairs not captured in the sections above.) '4.<f�.!*:1s Item Recommendation - DetailslExplanation Amount '� t _.:. demo basementincluding Repair 0 Replace remove illegal apartment in basement. Remove partition walls; kitchen ;:_ $2500.00 ' plumbing and electrical Total Other $2500.00 Approved Scope of Repairs Bid Total $25W.00 Supplemental Bids-GC Recommended Lighting&Electrical Address illegal splicing,missing wires,etc.Specify if fixtures are inoperable or missing and give number of fixtures to replace(prices include new bulbs and globes).Bring electrical up to code compliance. Sub-Category Recommendation Details/Explanation Amount Breaker orWirng 0 Upgrade O.Repair 0 Replace City: 100 remove all wiring to outlets and lighting $10o0.00 Total Lighting&Electrical $1000.00 Plumbing Specify type of repair or replacement and give location(kitchen,hall bathroom,garage,etc.).Address all supply or drain line repairs,valve boxes,sewer dean outs,and stopped up/leaking fines.If new shower pan,bid new drain piping.Notify broker of any emergencies.Include type,number of gallons,size,brand and reason for replacement. Sub-Category Recommendation Detaits/Explanation Amount p Pipes-Interior ©Repair 0 Replace Cap off water and.drain lines to kitchen. sink. Take out two permits. $1000.00 Total Plumbing - $1000.00 Supplemental Bid-GC Recommended Bid Total $2000.00 Overall Bid Total $4600.00 Approved Bid Total $4500.00 .... 'oe :. I„ •l_gfhr•,�rn-y,, _n, 0 2W3 Freddie Mac,All Rights Reserved Glossa y I User Agreement https-//www.homestepsconnect.com/homesteps/newVlewRepairBidDetail.do 4/28/2015 r John Guerra PROPOSAL MA LIC 013140 PAINTING-ROOFING•GUTTERS N0. GENERAL REPAIR Datej ���� KITCHEN&BATHROOM REMODELING 188 BLUE HILLS PARKWAY Sheet N0: MILTON,MA 02186 TEL.617-696-2877 PAGER. 617-56"139 Proposal Submitted To: r'?IS` iQ pp i M r. y 1tl Work To Be Performed At: Name F•kc bb i E ItIl9C Street 4100 Street Y (fIle City ('A,PR-QLt-1:O/U City H%9 1,$ State 1-114 State Tt�R5' Date of Plans Phone 7 _ _ Architect We hereby propose to.furnish the materials and perform the labor necessary for the completion at P90rtFP-`)r /VpN Cam ill trft'r p -Ir_LrGA 19P4,k--71 iq&V7- //Y19 4/f1fc / �/Y'tc'u r !�►�'�!./� /►t fUr �1-"Vi) -'oGr.oy-ira f64 l) P4.c,cV44ifV6 Or 4-f.4-• B C—A:PIUS, Lam:L,; A N Aecc-14a a At e-c ©CAB.# .01-71 E"n T— /W 3 649^1�F..-TZ? i.� -� _.ttr' S 66 1,3#gFMeN x- 6472YR0001 7V iir NSu4-- /7 wA-f 1 fv,, "%4 Ilea �4-LL Wi NC, IV 4-M) Ou.)'e'r) r�v�t L t-4,4k I� f a� �,~z ,a6; � sedrr2r' r Ge � 0stA ONT All material is guaranteed to be as specified and the above work to be performed in accordance with the drawings and specifications submitted:for above work and complete in.a substantial workmanlike manner for the sum for the sum of with.payments to be made as follows; N c� F / �¢ j''RP??ttn+'1 svA N Dollars($, e j: I N :Actc£iJ 't''7� C' Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become an Respectfully submitted extra charge over and above the estimate. Al agreements contingent upon strikes,accidents or delays beyond:our control: Owner to_carry fire,tornado and other necessary insurance.upon above work. workmen's Per Compensation and Public Liability on above work to be taken our by Note-This proposal may be withdrawn:by us if not accepted Within -a days. ol ACCEPTANCE OFPROPOSAL' The above prices, specifications and.conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. SIQrIHtUr$ Margaret /� p} "Digitally signed by Margaret McGranahan 1 Y 1 a rg a re l DN:cn=Margaret McGranahan,o=VRM, you=VRM, - r McGranahan Date.Date email=mmcgranahan@vrmco.com,r—US Signlature rF. Date:2015.04.2808i41:34-05'00' REORDER:ZIPRINT CENTERS 781.963.2250 YL-,COn=GMFMMh OPfa5--SarCh 60 Wk&h7poyr Streat Rom MA t2T Wurkerss Cumpeusaf InsmranceA davit Raddersf tractgrsXfectucianslP mmbers fi r;Infurmafian- 7'o t4 ni Ca uEPPA se T t Name U'E stress c_c C �prCW d/ 0 / 7 Amyunan employer?Check the-x-pprDpxiatEtbo= T3 'f'p7°ied(FcIuired)= k[?J�I am a employer vift f 4_ ❑ I am a geu=il c=traciar ad I ,F-I Near employees(fbaandlbrgait�-)* have-biredfhesub conbmckyr& 2_❑ I am a sole propzistor orparfner listed on the attached sb>ref y- ❑R ad.ei;�g ship and have na employees These mb-mnimctou have g- ( Demalitian Wong forme is any capacity- employees and have workrrs' 9_ 0�uilziing addifian [No-caorkes' comp-+ trap e t:omP Fr,cm I j_ We area corpordiicnaad its IO Q Ie cal repairs ar additions I❑ I am a home doing a1I work officers have exr rcised their I LO Plumbing repairs or additiclns u;yxtf INo` orker$'oonfp_ right:oftmemption per MM- I2 IZnafsepairs incrxs n_rg red-]-F c-I52,§l(#},ald we have aD � employees-INo WorIMM, 13_E Other comp_in-smtance retluir j �liny�p�4ibatche�ksbar�Il�stalsofiIloutt�secfioubcIowsbaccmgc'i�.eswo�e�'r�mn�nsstioupopir�-�+*�--- �ff�meuwnes ear,>��this s�Y;. g d�3'�Tccmg`II r.-Y� +�ih�h;,E ate conttactms mast sal�it a a�s�dsrit mn�rat�g sorb TCuutmcmrs lhst rhxk this bex most atiarhed MI%daidaral s-heet Whether DCnatthass M9ffbesfi_—vn _. �F��'- Ifthe sah-cnz�xdus h..'re r�nTs��eQs,the}Est gmuide then t�b�s'camp.pQiicp n�}� ;Firm ffrr arrrpIvper rhrttzs prfn�idurg trarke-rs'rorrgzt?rts�riezt azcszcrrutce for trz��ers�£�yees. �eTvtr is f}fep�F�c}rcrcd jbb sits • �r�armafzc?rz. b- .. Insurance GarapazlyName_ U,'U bO"ZL JP-I(( f VANS C-O PORCY ii or Seff-ins_Tic- job§rf r Z �'A ice c� Ci.r c;ty�stat�zp B^/�k'�;tTM•4 e? of Af#ach a copy of th-vmrkers`compensation poiir.T declaration page(showing the policy number and e3jSation date): Failum to sec-mc coverage as regain under Secfion-25A ofMGL cc 152 can lead to tin:imposition of criminal pmalEes of a fine up to SL500.00 andlor-osie-year impus as wen as civil penalfies in the fans of a STOP WORK ORDER-and a ff= of up to$250.00 a day against the violator_ Be:advised fbat a cnpp of ibis si zmmt maybe:ffi red to the Office of IfrresE[gatitms of 1#�e DIA for*nonce co�e�ge v+��atit� - I do.11 9t elT Mfffp rcrrtlet t1Era prmzs sdpanaIfrss�p&jkry f3fatfhe info nna6anpras6k,Ed dkrztre r`s trrra rt2zd correct Phrme ik- irL ress ari£,�. Dd t[at Imrif�i�fkzs crecr��rx ba cfttrrgi`.ested bg��xx txr�n��r:fn£ � , G`itg or Towa: PermiUUcense# Issue r�zrfhori�tcQcIe atta�: . _ - LSoulof$ealffe 2.RuUdingIlegart t 3.OVFawnO=k 4_EIeetricaibxsgectur S.Pbnediffig Eizptrtor 6,Other Coatact Person: Fb�rne 6 1�!lassarhLts feral Laws chapter 152 requites all employers to provide workers'comp=afion for their MOPIoyees. Pmsnas�to fads statzt-q,an employee is defined as'__every person in the service of another under any contract oflj M- expmss or irnpHed, oral or men." . An anpToyeT is&fmcd as'an individual,partaeashin,association, corporation or other legal entity,or any t o or morn of the,foregoing engaged in a joirt eziterprisa,and including the Iega1 representatives of a deceased employer,-or the receiver or trustee of an individual,partacnEp,assordafioa or other legal entity,employing employees_ However the owner of a dv�elling house having not more thm three apartments and who resides therein,'or fhe occupant of the dwelling house of another who=:iploys persons to do mafi tmance,constr ctioa or repair work on such dwelling house or on the grounds or bm1diag appurtenant thereto shall not because of such employment be deemed to be an employer." MEL chaptrr 152, §25C(6)also sfafes that'every state or local licensing agency shall wifhhold the issuance or renewal of a license or permit to operate a business or to construct bnildings in the commonwealth for airy applicant who has not produced acceptable evidence of compliance with the insura_uce.coverage required." Additionally, MGL chapter 152, §25C(7)staffs"Neither the commonwealth nor any of its.political subdivisions shall enter into any contract for tine pert rmanee of public work until acceptable evidence of compliance with the insurtnce re;cpuiremmts of this chapter have been presmited to the contracting arrihority.' - A-pPTica ats Please fill out the woikers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-(zntract:Dr(s)name(s), addresses)and phone numbers)along with their ccrHEcate(s) of insurance. Limited Liability Companies(LLC) or Limited.Liability Partnerships(LLP)with Do employees other$an the members or partners,are not required to carry workers' compensation ffiS a„ce. If an LLC or LLP does have employees;a policy is required. Re advisedthat this a.ffidaavitmay be submitted to the Departrnent of Indu dial Accidents for confirmation ofin�ce Coverage. A-Iso be sure to sign and date the affidavit The affidavit should be mtvmed 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 obi?in a workers' coInpeDsation policy,please call the Department at the number listed below. Self-iosored companies should enter their self-in.cL=ce license number on the appropriate line. City or Town Officials . Please be sure,that the affidath,is complete and printed legibly. The Department has provided a space at the bot�m of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding ihe applicE!dt Please be sure.to fIl in the pennitllieense number which PtM be used as a reference number. In addition-an applicant that must submit multiple permitliimase appliCaiions in any given year,need only submit one affidavit indicating cim-ent policy information(if necessary) and under"Job Site Address"the applicant should write'all locations In (city or town)."A copy of tine affidavit that has been officially stamped or marked by the city or town may be pro�rided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be i lled out each year.Where a home owner or citizen is obtanaiing a license or permit not related.to any business or commercial venue (i e, a dog license or permit to bum leaves etc.)said person is NOT regtmed to complete this affidavit The Office of Investigations would at to thank you:in advance for your cooperation and should you have any questions, please do not hesitate to give rit a call_ The Department's address,telephone and ffaxnumber. ` Tb��CoI]aM:GIl &of 1�assachu f s Departaeat cf In'ustdal Ac? ,aideats " ofIUVI-, tfaru; 03 WaSI1jMgtM Stet B i),MA G21II TeI_,.4 6.17 72 -4 Qxt4-06 Gr 1-977 hLAO Fa 4 617-727- 414 Revised 4-24-07 -gov/dia- DATE IMMIDDIYYYYI- CERTIFICATE OF LIABILITY INSURANCE . , TWMLERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE 0 D . IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,Ahe policy(ies)must be endorsed.if SUBROGATION IS WAIVED.subject to the terms and conditions of the policy;certain policies may require and endorsement. A statement on this certificate.does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME-., .. RSC INS BROKERAGE[NC PHONE FAx 15 PACELLA PARK DRIVE (A/C,No,Ext): (A/C,No): E-MAIL RANDOLPH,MA 02368 ADDRESS: 762TP INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURER A: 14ARTFORD UNDER\V'RITERS INSURANCE COMPANY GUERRA,JOHN INSURER 8: INSURER C: INSURER D: 188 BLUE HILLS PARKWAY INSURER E: MILTON,MA 02186 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS TO CERTIFY THAT T E 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. LIMITS SHOWN MAY.HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD_ SUB POLICY EFF DATE POLICY EXP-.DATE LTR TYPE OF INSURANCE L R POLICY NUMBER •JMMIODIYYYY). (MMIOOIYYYY) LIMITS GENERAL LIABILITY -ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED $ CLAIMS.MADE OCCUR. DREMISES(Ea occurrence) ED EXP(Any one person) $ PERSONAL&ADV INJURY $. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY13 PROJECT LOC PRODUCTS-COMPIOP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per Person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per ) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND We STATUTORY OTHER EMPLOYER'S LIABILITY YIN U8-9%EA76A-14 09/i8Y2014 09M8/2015 UMITS ANY PROPERITORIPARTNERIEXECUTIVE a NIA E.L.EACH ACCIDENT OFFICEPJMEMBEREXCLUDED? $ 1,000,000 (Mandatory In NH) E.L.DISEASE-EA'EMPLOYEE $ 1,000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1.000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF`OPERATIONSILOCA-nONS1VEHICLESIRESTMCTiONS!SPECIAL ITEMS THIS REPRICES ANY PRIOR CERTIFICATE ISSUED 1'0 THE CER11FICATE HOLDER AFFECTING WORKERS CO\4P COVER.�vGE. THE INSURED'S M:I WORIKERS COMPENSA7110N POIJC:Y A!ID ITS l,I\41TET)oTHF,R STA7T:S.E.'DOCLSE\IEI 1 AUTHORILFS'f W PAYivtE\T OP BENT 1'1'IS LY7R.CL•,uNtS 14ADL'BY THE INSUREDS\4A EMPLOYEES N STATES OTHER TIl_AN MA. NO AUTHORIZATION IS GIVEN TO PAY CL.Af\9SORN S71I )11ESR I7LAN NIA IF NSl1R'ED,IB[2E5.OR IiAS Ii1RLD F'\4PL01'EES UllTS[DE OF�9 I, TE{)S I(7LICT`'pOF5 tiOT PROVIDE COV ERAGE-R AAIS'STATE OT[IER:T[LAN>La THE WORKERS'CONIPFN-s.AT10N POLICY DOES NOT PROVIDE COVERAGE FOR GUERRA,JOWN CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILLBE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONC,t AUTHORIZED REPRESENTATIVE ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORIATIOW,All"'igfits reserved. JauoissILUWo�� 91, z/90190 u01lea1dx9 ., _ =1�2I2I�f1 o �asuaol 0bL£60-S tiuo � aosl�ladnS uuUinal: � paeo96ulpl!nq to esuolleln6ab su sry3eseW Spaep u eda(3- oilqnd 0,luaWp - .., - t y ` r in use only istration valid for to: ' License or reg If found return a ulation .' : . }I.. fore the expiratio Afft date- and Busine ss R g be. •. er ai office of Consum 5170 za 10PaikFla suite h fle�aaaasaa o P fl �. MA02116 �. _ Boston r � s a r 9BLZ0 t/W NOlIIW Y �VI)Id SIIIH 3f118 8 F r- trzla3n� NHor, i Hato � r ,r is re of . u g valid with ;i b2I213f1J NHO Ienpinlpul r, GLOZ uoi3endx - w: I ad�tl r •��•-3»L/i�� I} I i _ a r O1�Va1NO�1NW3A0adWI=3W;; s ,ka oo13eln�a�,ssaorsn.g.�,s�Is13V�awnsno �s �77arr 330.4aJJO - _- •------�—•.�,�-;:--._�:.�. _ --- `�• .. -_:_ -- -, R to Public fe ty P ® Cu- Vip1 v1`XrVr�1r r�j .a n,, .. S_ a Admen s tts - a Stan dardd as saOuse Ok Regulations ln oa w40C., r 3 Lise GUI ; 48 0 A 6051201r 6 one, n +r ,. Y ; PP4� � COS F ' IL goo 9 Lo 'emSrr w e t - k 1 Volk,", po S `i IV C 17 6 Doc: 1 ,2S0,468, 07-22-2014 1 is:07 Ct f Y:203976 BARNSTABLE LAND COURT REGISTRY FORECLOSURE DEED Nationstar Mortgage LLC, having its usual place of business at 350 Highland Drive , Lewisville, TX 75067, holder of a mortgage from Maico Marcondes to Mortgage Electronic Registration Systems, Inc.,as nominee for Lehman Brothers Bank,FSB,A Federal Savings Bank dated April 27, 2007, and and registered at the Barnstable Registry District of the Land Court as Document No. 1063378, as noted on Certificate of Title No. 176321. Said mortgage was then assigned to Aurora Loan Services, LLC by virtue of an assignment dated December 15, 2008, and filed as Document No. 1106540, and further assigned to Mortgage Electronic Registration Systems, Inc by virtue of an assignment dated December 3, 2009, and filed as Document No. r 1130193, and further assigned to Aurora Bank FSB by virtue of an assignment dated December 6, 2011, and filed as Document No. 1188662, and further assigned to Nationstar Mortgage LLC by virtue of an assignment dated June 19, 2012, and filed as Document No. 1200391, by the power conferred by said mortgage and every other power, for One Hundred Ninety-Three Thousand Seven Hundred Two and 16/100 Dollars ($193,702.16) paid, grants to Federal Home Loan Mortgage Corporation, with a mailing address of: 8200 Jones Branch Drive, McLean, VA 22102-3110, the real property with the buildings and improvements thereon, if any, situated in Hyannis, Barnstable County, Massachusetts, which real property is fully described in Schedule "A" attached hereto and made part hereof by reference, being the premises conveyed by said Mortgage. PROPERTY ADDRESS: 17 Canterbury Circle,Hyannis,MA 02601 Executed under seal the day of 2014 as the free act and deed of Nationstar Mortgage LLC,by s��" ,its Assistant Secretary Welk by: by: its, Assistant Secretary, State of Jessica Mitchell County of ss. On this ::2—day of 2014 before me, the undersigned notary public, personally appeared JPssira Mitchal '4 Assistant Secretary , proved to me through satisfactory evidence of identification, which was o be the person whose name is siggpd—o—ntN preceding or attached document,an acknowle ged to me that(he) (she)si ned it v ntarily fo its stated purpose. (Affix Seal)' .•�.t;e�4 CHRIEfINA JOURNET Notary signature �e Won(Public,Stare of Texas My Commission Ex ��'_ ��� ,= 1 I+w Commission Expires October 03,2017 SCHEDULE A �a The land together with the buildings thereon situated in Barnstable (Hyannis), Barnstable County,Massachusetts, and shown as: i Being shown as Lot 6 on Land Court Plan No.25929-B, w There is an appurtenant to said land the right to use Canterbury Circle in common with other ' lawfully entitled thereto. Said land is subject to the rights granted in an easement given to the New England Telephone and Telegraph at at dated April 18, 1970,bting Document No. 138,101. '. P Subject to restrictions, reservations, easements and covenants of record, insofar as the same are {, in force and applicable. For Grantor's title see deed recorded with said Registry of Deeds in Certificate No. 1.76321, Document 997,940 dated 04/01/05. . Subject to and with the benefit of easements, reservation, restrictions, and taking of record, if+ any,insofar as the same are now in force and applicable. r In the event of any typographical error set forth herein in the legal description of the premises, the description as set forth and contained in the mortgage shall control by reference. This property has the address of 17 Canterbury Circle,Hyannis,MA 02601. + a 1 AFFIDAVIT 1, J��,�,�,4wlrchell Assistant Secrt' r being the duly authorized of atY onstar Mortgage LLC, named in the foregoing deed, make oath and say that, the principal, interest, and tax obligations mentioned in the s` mortgage as more particularly described in the Foreclosure Deed recorded herewith were not paid or tendered or performed when due or prior to the sale.In compliance with G.L.c.244§ 14;Nationstar Mortgage LLC,caused a notice of sale to be published in the Barnstable Patriot,a newspaper published,or by its title page purporting to be published in Hyannis,Barnstable County,Massachusetts for three(3)consecutive weeks:February 28,2014,March 7,2014 and March 14,2014,notice of which the following is a true copy: SEE EXTUBIT"A"ATTACHED HERETO AND MADE PART HEREOF Nationstar Mortgage LLC,has also complied with Chapter 244, § 14 of the General Laws of Massachusetts and all amendments thereto,and 26 U.S.C. §7425(c)of the Internal Revenue Code(if applicable)by mailing the required notices via certified mail to the owner of die equity of redemption appearing on our records as of thirty (30) days prior to the sale, to the last known address of said owner of the equity of redemption,and all other persons of record holding an interest in the property junior to the mortgage being foreclosed, return receipt requested,as well as regular mail,thereby complying in all respects with the power of sale. Pursuant to said notice, on March 25, 2014, at 12:00 PM, at which time and place upon the mortgaged premises, Nationstar Mortgage LLC, sold the mortgaged premises at public auction by Sandra Monroe of Monroe Auction Group, a licensed auctioneer, to Federal Home Loan Mortgage Corporation, far'One Hundred Ninety-Three Thousand Seven Hundred Two and 16/100 ($193,702.16) Dollars, being the highest bid trade therefore at said auction. < LIP_0 4 its: Assistant Secretary jesslua Mitchell State of ) County ofjj j ss. On this I�day of l 2014, before me, the undersigned notary public, personally appeared JessZ511itchell proved to me through satisfactory evidence of identification, which was Sony( �.itOWl ,to the person whose name is signed on the preceding or attached document,who swore or affirmed to me t t he contents of the document are truthful and accurate to.the best of his/lX=_ knowledge and belief. (Affix Seal) Nota signature Chrl Ina oUrnt3t ry My Commission Expires — AA, ah,G CHRISTINA JOURNET Notary Public,State of Texas %.... : My Commission Expires October 03,2017 EXHIBIT&Wl NOTICE OF MORTGAGEE'S SALE OF REAL ESTATE By virtue and In execution of the Power of Sale contained in a The premlres h to be sold subject to end with the benefit of an _._. certain mortgage given by Maico Marcondes to Mortgage Electronic easements,restrictions,leases,tenancies,and rights of possession. Registration Systems,Inc.,as nominee for Lehman Brothers Bank, building and zoning laws,encumbrances,condomtnlum fiens,t any FSB,A Federal Savings Bank dated Aprl 27,2007,and registered at and all other claim in the nature of liens,if any there be. the Barnstable Registry District of the Land Court as Document No. In the event that the Successful bidder at the foreclosure We shall 1063378,as noted on Certificate of Title No.176321:said mortgage default in purchasing the within described properly according to the was then assigned to Aurora Loan Services,LLC by virtue of an terms of this Notice of Sale and/or the terms of the Memorandum of assignment dated December 15,2008,and filed as Document No. Sale executed at the time of foreclosure,the Mortgagee reserves 1106540,and further assigned to Mortgage Electronic Registration the right to sell the properly by foreclosure dead to the second bid der,dder, providing that said second Systems,Inc by virtue of an assignment dated December 3,2009, highesthighest bidder shag and filed as Document No.1130193.and further assigned to Aurora deposit with the Meitgagee's attorneys,DOONAN.GRAVES.8 Bank FSB by virtue of an assignment dated December 6,2011,and LONGORIA LLC, 100 Cummings Center, Suite 2250, Beverly, fled as Document No.1188MZ and further assigned to Natanstar MA 01915,the amount of the requited deposit as set forth herein Mortgage LLC by virtue of an assignment dated June 19,2012,and within three(3)business days after written notice of the default of fled as Document No.1063378.dwhich mortgage the undersigned the previous highest bidder and title shall be conveyed to the said Is the present holder for breach of conditions of said mortgage and second highest bidder within thirty(38)days of said written notice. for the purpose of foreclosing the same will be sold at PUBLIC If the second highest bidder declines to purchase the within AUCTION at 12:00 PM on March 25,2014,on the mortgaged described Property,the Mortgagee reserves the right to purchase premises.The entire mortgaged premises,all and singular,the the within described property at the amount bid by the second premises as described in said mortgage: highest bidder, 17 Canterbury Orcle,Hyannis,MA 02601 The land together with The foreclosure dead and the consideration paid by the the buildings thereon situated in Barnstable(Hyannis),Barnstable successful bidder shall be held in escrow by DOONAN,GRAVES, County,Massachusetts,and shown as:Being shown as Lot 6 on B LONGORIA LLC,(hereinafter called the'EscowAgenr)until the Land Court Plan No.25929•B,There is an appurtenant to said land deed shag be released from escrow to the successfid bidder at the the right to use Canterbury Cirde in common with other lawfully same time as the consideration is released to the Mortgagee,thirty entitled thereto.Said land Is subject to the rights greeted In an (30)days after the date of sale,whereupon all obligations of the easement given to the New England Telephone and Telegraph Escrow Agent shag be deemed to have been Properly fulfilled and at al dated April 18,1970,being Document No.138,101.Subject the Escrow Agent shall be discharged. Other terms to be to restrictions,reservations,easements and covenants of record, announced at the sale. Insofar as the same are in kew and applicable.For Grantor's the Dated:February 4,2014,Nationstar Mortgage LLC,By:Reneau see deed recorded with said Registry of Deeds in Certificate No. Longoria. Esq., DOONAN, GRAVES,&LONGORIA LLC, 100 176321,Document 997,940 dated 04101/05. Cummings Center,Suite 2251),Beverly,MA 01915,978.921- Subject to and with the benefit of easements, reservation, 2670,www.dgandl.com restrictions.and taking of record,d any,insofar as the same are now (6215.85(P))(Marco des)(02-28.14, 03-07-14, 03-14-14) . In fa (304747ce and applicable. ) In the event of any typographical error set forth herein In the The Barnstable Patriot legal description of the premises,the description as set forth and February 28.March 7 and March 14,2014• contained in the mortgage shall control by reference. This property has the address of 17 Canterbury Circle,Hyannis, MA 02601. Together with all the Improvements now or hereafter erectedon the property and all easements,rights,appurtenances,rents, royaitles,mineral,oil and gas rights and profits,water rights and stock and all fixtures now or hereafter a part of the property.A8 replacements and additions shall also be covered by this sale. Terms of Sale:Said premises will be sold subject to any and all unpaid taxes and assessments,tax sales,tax titres and other municipal liens and water or sewer liens and State or County transfer fees,if any there are,and TEN THOUSAND DOLLARS ($10,000.0D)in cashier's or certified check will be required to be paid by the purchaser at the time and place of the sale as a deposit , and the balance in cashier's or certified check will be due In thirty (30)days,at the offices of Doonan,Groves 6 Longoria,LLC,100 Cummings Center,Surge 225D,Beverly,MA 01915,time being of the essence. The Mortgagee reserves the right to postpone the sale to a later date by public proclamation at the time and date appointed for the sale and to further postpone at any adjourned sale-date by pubric proclamation at the time and dale appointed for the adjourned sale date. BARNSTABLE REGISTRY Of-DEEDS YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town [which -you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1 ,'FL., 367 Main Street, Hyannis, MA 02601. [Town Hall) DATE: 5�,Z,L�%y Fill in please: RA i 5r� �{�,� �� APPLICANT'S YOUR �NAME/S: 'I�N 1 g-mt.Iq)ll`'��4��ti �! +l. .BJ..1SI ESS YOUR HOMEADDRESS: I �- C-LI-,v✓T��C R�i2 l' G(� N yrm y, 1,3�.� ��Yc 2 �r LLC— y!� ,, � CkXNI�L •� IbP!-n b'Ri Ifs TELEPHONE .# P - rcp ,tlf�pYNp Home Telephone Number HiNi%1llmlA ts� (!�i ' NAME OF CORPORATION: Cl 3 .2 �'I G�. NAME OF IVEtiV BUSINESS C--C L.� C� tyC TYPE OF BUSINESS �-.�w/. Sc/r/�lyC IS THIS A HOME OCCUPATION? YES NO p 2�a1 ADDRESS OF BUSINESS J-4- C�ivTC-2 I;U2 f' G't/� I-t 1'�►r 5t M,cr MAP/PARCEL NUMBER O� 9 r (Assessing] you must do in order to be.in compliance with the rules and regulations of the Town of When starting a new business there are several things " _ Barnstable .This form is intended to.assist you in obtaining the information you-may need. You MUST.GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your bus' ess in this town.. y" 1. BUILDING COMMISSIONER'S OFFICE I Io This individual has been informed of any permit requirements that pertain to this type of bus iness Authorized Signature COMMENTS: 2. BOARD OF HEALTH This individual h b n in r ad of the er it re ents that pertain to this type of business. MUST COMY WITH ALL Authorized ignature** HAMOOUS MATERIALS REGULATIONS COMMENTS: 3. CONSUMER AFFAIR L ENSING HORITY) This individual h s b an inform f the I' ensing requirements that pertain.to this type of business. r Authorized gnature* COMMENTS: * . l rr� F1ME r Town of Barnstable. Permtt �`J Expires 6 t` ro ue e Regulatory Services Fee snxrisrnst ee�� MA & $ Richard V.Scali,Director Esi Rlp '°rFn w►a+° Building Division APR. A Tom Perry,CBO,Building Commissioner 'A,n' PR 302015 200 Main Street,Hyannis,MA 02601 0�/V/U OF BA RI VS n, www.town.barnstable.ma.us S TABLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS kERVIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 4 \ - Property Address cck r- l V J >LN r [residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 y R 5, Owner's Name&Address ( c� U e r n�, r Contractor's Name j P0/-'T(( ✓1 0 d 9 Telephone Number _- Home Improvement Contractor License#(if applicable) P7&,3)Cl Email: M' P i I Construction Supervisor's License#(if applicable) _ orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Ube 4?! V1 wo r �I Workman-'s Comp.Policy#�k _—Qu 0 " 004� .;2 Fr9—C0 Copy of Insurance Compliance Certifica a must accompany each permit. Permit Request(check box) T (hurricane-nailed)(stripping old shingles)—All-construction debris will be-taken to ["'e0 10 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side 3oZ ❑ Replacement Windows/doors/sliders.U-Value (maximum_. #of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License ruction Supervisors License is quired. i' 'QAWPSIGNATURE: —. �,y-�`-�/- �. Viral 1 I� oI FILESTORMbuilding permit forms\EXPRESS.doc - Revised 061313 S i�- � _ -1'rhe C'rrmMWeirrM OfMamachusdft Depctrtotent ofIndustridAccidmts Office of lurest gadom x4 6#0 Washing.Sxtreet: Boston,M4 02111 t wwwmamgmVdia Workers'Compensafim I arauce'A#firiav t:B lersl' nt rackw&Tlmtrician umbe Applicant Information Please Print Leib.r Name cd- J CityfStaa t=lZ x_ �, 1`/�' '} one#- S —3(p PQ�� ' Are you an employer?Check the appropriate box: Type of project - 4. I am a general contractor and I 3� ,lam] (required): - L I am.a employer with ❑ 6. New have lured the sub-conhuctors ❑- construction eutployees{full an�{or pit-fiim��. , • ,, 2_❑ I am a sole proprietor or partner- , listed'on the attached sheet 7. ❑ ; slip and have no employers .ham sub-mritrwAors have 8.,❑Demolition -a fur rme in enrplo}gees and havre wadmrs' capacity-any ' - ❑'�_ Bt�Iding addi�tm [No wodmrs'comp.insurance "� comp.insmace.Z : �d 5. ❑ We area c atpotation:and its 1t}_❑E1t laical or adttitita ts. 3.❑ I am a home mimer doing all work c cen have imercised their '11_❑Plumbing repairs or additions' m sel£ o workers' right of exemption:perIw GL Y � °` l.2_❑R:oafrepaizs inst�re r�]1 c_ 52,§1(41 and we hn a no "& employees [Nowod=s' 13.0 Other comp-insurancerequired_]' *p ay applicsnF flit checks box*I must also fill out the sectiou below thaviing�vodeW cm policy informstiart I He oaunsrs wlm submit this af5dawr iubcating they are doiae all vat t sad then hire outride cont[acanrs rnM submit a nea*affidavit in&ccaticia sa lL ' �C Umcttars that check tbis box mast attached su additinnil sheet sbo ing the name oftlae sr#-conawton acid state whether ornot thm amities hg¢e 4 employees. If the subcontractors base employm,&9 .iapr-ide their worker'comp.policy number_ I,am an e)nplo5,vr that isproilfiffiW nwrkers'compmsatian insurance for my employees. Below is t'herpaUcy and job sfta informaiorr.' t Insurance Company Name_ �llr,"—n` wof l N . Policy t or Self-ins-Lic_# 4 ^t t � 'G ��"' � Fxpintionl3aie fJ' '' 9�5 Q Olin j��l Yi i. _ _ .m. .. ... Attach a copy of the wairkers'€ompensation policy decla ation page(showing the policy number and expiration date): Failure to secure_co-mrage as required unttet Section 25A of MGL c; 152 can lead to the position of esimii al penalties of a fine tip to S 1,500.OD andlo one-year iropma as well as civil penalties in the faun of a STOP WORK OI,tDER.anti a fine. of up to$250.00 a day against the violator. Be adt sed that a copy of this statemeat maybe ceded to the{'Office of Izrvestigeticros of the DIA for insurance caverage Yerificaatitsrl I do herby certi&rr>ir the pain�_s and nets o.TFs�Tur'that the information protde,d abartfe is tar and cc►rrect Si Lure: = Hate: Phone#_ , 0.07c aL uw army.. Do not wrRe in Miss arm to be complst4 by'cio;ortmM o iciat City or Tows: ,. PermitfLicesse# , Issuing Authority(iarck tine): ` i.Board of Health t Biding Department 3.Ciq-ffown Cleric 4.Electrical InsFect€tr 5.Plii€nbing Inspector 6.Other contact Person: Phone#: ' " R 6 Information and Instructions r 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 m the service of another under any contract of hire, express or implied, oral or vs¢ifteu..- An anplayer 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(17 also states that"every state or local ficensing•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 ofpublic 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 regnired. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confmnation of insmance 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 lime. City or Town Officials � f f 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/licemse number which will be used-as a reference number. In addition, an applicant that must submit multiple pr=t/liumse 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 maybe 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 D e ca g ar enfi of lndusfdal Accidents Mce of kvestigatia.AS 600 WashaoGia Street Bastou,MA 02111 RI.#617 727--4900 at 4€16 or 1,977 MA.SSAFB Revised 4-24-07 Fax#617-727-7744 w .ma s_govf dia Aca vP CERTIFICATE OF LIABILITY, INSURANCE DAT10Y2015' THIS CERTIFICATE IS ISSUED AS A"MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DO ES N"OT AF FIRMATIVELY•O R-N EGATIVELY AM END,E XTEND 0 R ALTER T HE COVERAGE AFFORDED B Y T HE"P OLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A;CONTRACT BETWEEN T.HE"I SSUING I NSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE'HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed: If SUBROGATION IS WAIVED,subject to file telITls and conditions of the policy, certain policies may require an endorsement.A_statenerlt on this certificate does not confer rights to the certificate holder in lieu of such endorseriert(s). PRODUCER CONTACT Insurance Store The NfME: BerkleV Assigned Risk Services GallagherAgency No.Ed 800 634A589 F .No. (866 '215-LB118 106 Spring St ADDRESS: Poli ervic berid k.com W Roxbury,MA 02t32 INSURE AFFORDING COVERAGE NAIC0 INSURER A INSURED Micheael,Portanava INSURER S: Westem World Insurance ACADIA dba Veritas General Contractnq• INSURER Ci 183 Columbia Road Unit3GA INSURER a INSURER E: Hanover MA 02339 INSURER F: COVERAGES CERTIFICATE NUMBER REVISION NILMWEIt THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOWHAVE 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 MAYBE ISSUED OR MAY PERTAIN,THE.INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS'SUBJECT TO Ail`THE TERMS; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPEOF INSURANCE POLICY NUMBER LIMITS LTR INSR WVO- WDDIYYY 100fYY GENERAL LIABILITY EACH OCCURRENCE $1000000.00 COMMERCIAL;GENERAL LIABILITY P ESOE.occu�noe. $ ❑ CLAIMS-MADE.®'OCCUR ❑ ❑. MED$EXP - one erson $ KPP129789 05/30/14 05/30//15 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $2000000.00 r.E?fLAOGREGATE LUrr APPLIES:PER: PRODUCTS=COMPIOPAGG $ PRO- POLICY ❑.JECT ❑ LOC: - $ AUTOMOBILE LIABICrrY ❑ ❑ �CUMBINED SINGLE LIMFIF accideff $ ANYAUTO BODILY INJURY Per erson - $ ALL OWN® ❑SCHEDULED AUTOS $: AUTOS BODILY INJURY Peraoddenf HIREDAUCOS ❑NON-OWNED PR OP ERTY DAMAGE $ AUTOS Peraccident ❑ $ UMBRELLA LIAB El OCCUR. -❑ ❑ EACH OCCURRENCE $ EXCESSlUUI ❑CLAIMS-MADE - AGGREGATES $ BED ❑ RETENTION$. $ WORKERS COMPENSATION. WC STATU-' Ei OTH- AND EMPLOYERS'LIABILITY YIN .TORY LIAITS ER -ANY.PROPRIETOR/PARTNERIEX ECUTIIE ❑ E.L EACH ACCIDENT $ 1wabo_oo... A. OFFICEAAEMBER EXCLUDED? - - iLA ❑." WC-20-26-005284-00, 05/30/14 05/30/15 '(Mandatory in NH)_N.yes,describe-der E.L DISEASE-EA EMPLOYEE $ 100000.00 "DESCRIPTION OF OPERATIONS.below E.L.DIS EASE-PO LIC YLIM rT $ 500000.00 ❑ ❑ BE SC RIPT10N OF OPERAT ION SDI LO CATI0 NS f VEHICLES(Attach ACORD 101:Additional:Remarks Sdiedula.if more spa ce.is required) Election Category Election Status Name At Entilies/Insureds: Sole Proprietor Exclude Micheael Pottarrova Micheael PortanoVa I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF."NOTICE WILLBE:DELIVERED I.N. ACCORDANCE WITH THE POLICY'.PROVISIONS: AUTHORED REPRESENTATIVE i �.Ofc llriE TOE * BARNSTABLE. ' � Town of Barnstable .39 RFD MA'I A - Regulatory Services Richard Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder )EVr r1:X. , as Owner of the subject property hereby authorize l� G t ( I Cl � � to act on my behalf, in all matters relative to work authorized by this building permit application for: (�Tul r n!f J, Cry Address of ob �U Sig4ature of Owner Date In Print Name If Property. Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILESTORWbuilding permit forms\smokecarbondetectors.doc Revised 040714 P�Op* Tay, Town of Barnstable Regulatory Services • anxrrMassBtE Richard V.Scali,Director ��AIfD 39. 0. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 HOMEOWNER LICENSE EXEMPTION 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 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 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 of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\smokecarbondetectors.doc Revised 040714 c-�//u,�anvr�2aruu�o�C�aa�uael�' . _ � OtSceofConsnmrr-Affa;�rs?&-Bnsi.obasRegu_lafion : , TOR�A�E;I�VIPRO�/ENf€wT CONTRAC i egistration 7, 9 TYPE; "pirationl F Sfa DBA — r VE ITAS.GENERA RL" �IG IV MIC.�IAEL�PORTANQ 18 C [l OA1kENyBUCzKT F Q d. SCITUAT�,'Mk 02066- Undersecretary ,+' r� / License or regigtratien vand fin�iv1, ul5dse=only before=tle egpiratioa relate Tf<fo`�ndkr>eturnto f Ofe of Consumer Affa�rsxad'�Busuess zRegtlat�on: If 10'FarkY�azauite' 314F0 Bo'sxon,MA 0211E � -�a6d twifhout signature -� { ' I artment.of Public Safety Massachusetts gulations and Standards Board of Building eciiilty . Construction Supe L-0r Sp -095�8�41 License: CSSL tyuCHARL J POR 18 OLD OAKEN BU SCTfUATE)VIA�06 11i1012015 CoinmissiPner .. x �e tpoo��n�zorzcueal�o�G%l�Gccaa�ccaeL�' OtTce-of ConsumeF AtfsrrstBrBnaineesit®gulaTton-..- lE'IMPROENi€NT CONTRsACTOR . r iab I-.ation: 176 1:9 TYPe 19 xpi`dation �-8f8 �_ VERI TAS GENERAL - n MIC4i ZL. RORTAN 18 CjLD OAKEN Bill R SCit, At 3Ma 02Q66':. T f 'Undersecretary. ��' -10 1.L 'SY p K3 • 6 61)t h6lyve �_ �. E .� �� ,�! �, _ �� �- t ' �t _ ' _� t� . . •j • 1 � �^ � � +_ .. ,E f_ �! -_ e r, � � ''1. .'' _, y � :�V'i �� �__.. �� , ,h � �, •_ s ''� ---� ., , ��. � ,E � '� ��V �Z 'Parcel Detail Page 1 of 3 K n :, � �. ...r• •��7 . �•i k . °1n' k' - asA;h� *Y Logged In As: Thursday,August 20 2009 Debi Barrows Parcel Detail Parcel Lookup Parcellnfo f Developer Parcel ID 1249-111 per ..� Lot ILOT 6 Location 17 CANTERBURY CIRCLE .� Pri Frontage ,120 Sec Road Sec I... Frontage ! Village �HYANNIS I Fire District jHYANNIS Sewer Acct I Road Index 10224 1 k Asbuilt Septic Scan: Interactive w` 249111 1 Maps T - Owner Info ownerMARCONDES, MAICO Co-owner Streets 117 CANTERBURY CIR Street2 City jHYANNIS State 1 zip 102601 Country Land Info Acres i0.33 use ISingle Fam MDL-01 Zoning FRB Nghbd0106 Topography Level Road I Paved Utilities iPublic Water,Gas,Septic ) Location - Construction Info Building 1 of 1 Year 1973 Roof Gable/HipExt(Wood Shin le _ g Built Struct Wall Effect �— --- --- - Roof _ _._ AC .. _ Area !1804 Cover Asph/F GIs/Cm Type None Style Ranch Wall wall Rooms Bedrooms Int Bath Model Residential Floor CHardwoodr�� Rooms 2 Full Heat .- .........tt Total �..... __.. --....... Grade Average Plus Type Hot Water I Rooms 16 Rooms http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=18089 8/20/2009 n Parcel Detail Page 2 of 3 >;1 6' +DK Stories!1 Story Heat!Solar Assisted I Found- Poured Conc. ` Fuel ation Permit History Issue Date Purpose Permit# Amount Insp Date Comments Visit History __ Date Who Purpose 01/12/2006 00:00:00 Paul Talbot N/C -Cyclical Insp. 03/11/2004 00:00:00 Paul Talbot Meas/Est 10/08/2003 00:00:00 Gary Brennan Meas/Est 01/12/2001 00:00:00 Paul Talbot Meas/Listed-Interior Access 10/15/1989 00:00:00 ME Sales History Line Sale Date Owner Book/Page Sale Price 1 04/01/2005 MARCONDES, MAICO C176321 '$377,000 2 11/26/2003 FREITAS, MARCOS DE PAULA& C171400 $283,000 3 01/31/2003 LEGEYT, LINDA L C168112 $227,000 4 05/23/2000 CENZALLI,ANGELA C157730 $153,000 5 09/15/1994 SANICK, RICHARD J & NANCY C135000 $114,500 6 05/15/1988 SCANNELL, GERARD J & MARY M C114372 $135,000 L8 __] 03/15/1986 JACOBSON, ETHEL M C80110 $1 06/15/1904 JACOBSON, ARVID L DTH CTF C80110 $0 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2009 $146,500 $2,600 $400 $155,600 $305,100 2 2008 $174,000 $2,600 $400 $166,500 $343,500 4 2007 $173,100 $2,600 $400 $166,500 $342,600 5 2006 $149,100 $2,600 $400 $148,400 $300,500 6 2005 $137,200 $2,600 $400 $134,500 $274,700 7 2004 $110,400 $2,600 $500 $154,600 $268,100 8 2003 $99,700 $2,600 $500 $40,900 $143,700 http://issgl2/intranet/propddta/ParcelDetail.aspx?ID=18089 8/20/2009 Parcel Detail Page 3 of 3 9 2002 $99,700 $2,600 $500 $40,900 $143,700 10 2001 $99,700 $2,600 $500 $40,900 $143,700 11 2000 $73,100 $2,300 $300 $26,800 $102,500 12 1999 $73,100 $2,300 $300 $26,800 $102,500 13 1998 $73,100 $2,300 $300 $26,800 $102,500 14 1997 $70,000 $0 $0 $26,800 $97,400 15 1996 $70,000 $0 $0 $26,800 $97,400 16 1995 $70,000 $0 $0 $26,800 $97,400 17 1994 $65,000 $0 $0 $30,100 $95,700 18 1993 $65,000 $0 $0 $30,100 $95,700 19 1992 $73,900 $0 $0 $33,500 $108,100 20 1991 $88,700 $0 $0 $46,900 $135,600 21 1990 $88,700 $0 $0 $46,900 $135,600 22 1989 $88,700 $0 $0 $46,900 $135,600 23 1988 $65,100 $0 $0 $20,300 $85,400 24 1987 $65,100 $0 $0 $20,300 $85,400 25 1986 $65,100 $0 $0 $20,300 $85,400 Photos http.//issgl2/intranet/propdata/ParcelDetail.aspx?ID=18089 8/20/2009 ,:Parcel Detail Page 1 of 2 t i.RAFiNSTAN.E./a i+..�ti 11ASS ",4c y d �`,s fvv'� //..��, / �",..•�'y ue� .�...-'xI �':y�n P Logged In As: n f/// ) F Pa rc I Detail Monday, March 8 2010 j arcel Lookup a-.;t Y 7- parcel Info - Owner Info owner MARCO ES, MAICO Co-Owner; Streeti 17 CANTERBURY CIR I Street2` I city HYANNIS State MA Zip 02601 Country - Land Info Acres 0.33 Use;Single Fam MDL-01 I Zoning RB Nghbd 0105 Topography Level Road Paved Utilities Public Water,Gas, eptic Location '— Construction Info _._ _ . Building 1 of 1 Year 1973 I Roof Gable/k Ext Wood Shin le Built 1 Struct p I Wall g 1 1 { Effect 1804 I Roof Asph/F GIs/Cmp None Area Cover Type 4& b, Style Ranch Drywall 3 Bedrooms I sAR� i4 e�ns" " ram: Int Bed y I Wall y Rooms' Int _ Bath Model Residential I Floor Hardwood Rooms 2 Full I 14 Grade Average Plus I Type Hot Water I Rooms Total 6 Rooms I Heat:Solar 1 Story Fuel' Assisted I ation Poured Conc. I ;d Permit History Issue Date Purpose Permit# Amount Insp Date Comments Visit History Date Who Purpose 1/12/2006 12:00:00 AM Paul Talbot N/C-Cyclical Insp. 3/11/2004 12:00:00 AM Paul Talbot Meas/Este . u? 10/8/2003 12:00:00 AM Gary Brennan Meas/Est —g'' `" ` 1/12/2001 12:00:00 AM Paul Talbot Meas/Listed-Interior Access 10/15/1989 12:00:00 AM IME tl_ — r `-A UI0 - Sales Historyg, r 4 q1a _ 0 0 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=18089 3/8/2010 ,,,,,,Parcel Detail Page 2 of 2 Line Sale Date Owner Book/Page Sale Price 1 4/1/2005 MARCONDES, MAICO C176321 $377,000 2 11/26/2003 FREITAS, MARCOS DE PAULA& C171400 $283,000 3 1/31/2003 LEGEYT, LINDA L C168112 - $227,000 4 5/23/2000 CENZALLI,ANGELA C157730 $153,000 5 9/15/1994 SANICK, RICHARD J &NANCY C135000 $114,500 6 5/15/1988 SCANNELL, GERARD J &MARY M C114372 $135,000 7 3/15/1986 JACOBSON, ETHEL M C80110 $1 8 6/15/1904 1 JACOBSON, ARVID L DTH CTF C80110 $0 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2010 $152,800 $3,200 $900 $104,700 $261,600 2 2009 $146,500 $2,600 $400 $155,600 $305,100 3 2008 $174,000 $2,600 $400 $166,500 $343,500 5 2007 $173,100 $2,600 $400 $166,500 $342,600 6 2006 $149,100 $2,600 $400 $148,400 $300,500 7 2005 $137,200 $2,600 $400 $134,500 $214,700 8 2004 $110,400 $2,600 $500 $154,600 $268,100 9 2003 $99,700 $2,600 $500 $40,900 $1.43,700 10 2002 $99,700 $2,600 $500 $40,900 $143,700 11 2001 $99,700 $2,600 $500 $40,900 $143,700 12 2000 $73,100 $2,300 $300 $26,800 $102,500 13 1999 $73,100 $2,300 $300 $26,800 $102,500 14 1998 $73,100 $2,300 $300 $26,800 $102,500 15 1997 $70,000 $0 $0 $26,800 $97,400 16 1996 $70,000 ' $0 $0 $26,800 $97,400 17 1995 $70,000 $0 $0 $26,800 . $97,400 18 1994 $65,000 $0 $0 $30,100 $95,700 19 1993 $65,000 $0 $0 $30,100 $95,700 20 1992 $73,900 $0 $0 $33,500 $108,100 21 1991 $88,700 $0 $0 $46,900 $135,600 22 1990 $88,700 $0 $0 $46,900 $135,600 23 1989 $88,700 $0 $0 $46,900 $135,600 24 1988 $65,100 $0 $0 $20,300 $85,400 25 1987 $65,100 $0 $0 $20,300 $85,400 26 1986 $65,100 $0 $0 $20,300 $85,400 Photos http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=18089 3/8/2010 i G Town of Barnstable #fib,,} O rTr FTHE3f #� °w Regulatory Services * Thomas F.Geiler,Director ' r' Z Z ut € B"RNST"B MASS. w Building Division .9 � s639• �� �ptEG MA'S s Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601_ ,p Office: 508-862-4038 Fax: 508-790-6230 COMPLAINVIN UIRY REPORT Date: Rec'd by: Complaint Name: Map/Parcel �� l Location Address:. C6,U-6P r A r-V Cc�-, T�•v►�,5� Hax� Originator Name: Street: Village: State: Zip: r Telephone: ��J c�S) 7 7l p l (o Complaint Description: ie ),`eve � re-' S / s ob r 'FOR OFFICE USE ONLY Inspector's Action/Comments Date: Inspector: Additional Info.Attached - Q:forms:complaint b Town of Barnstable oFz"E t°w Regulatory Services ti yP �� Thomas F.Geller,Director H` MASS. Building Division 9 MASS. �q , 0 �pIE1 Mi►'�a` Tom.Perry Building Commissioner .200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 COMPLAINUIN UIRY REPOR Date: Rec'd by: Complaint Name: Map/Parcel Location Address: aw Originator Name: Street: 4 Village: State: Zip; Telephone: Complaint Description: p FOR OFFICE USE O LY Inspector's Action/Comments Date:' 'Inspector: Additional Info.Attached Q:forms:complaint �"" .• Tx,^ } .k ..,*•'.•�✓-•'.�:f_�:... r u-msJ,,;f (Az-`i'' a`.r.,.,'"r .S'; t.;tia:... V.,inj Via.#� ..c• .^-`� L;':•"`� y� � 4�(,,," _ 9`+ �. �. Town of Barnstable t"e r��o Regulatory Services Thomas F. Geiler, Director • BARNSrABLE. MASS. g Building Division �p 1639. �0 rEo ,�s Thomas Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXIT ORDER DATE: LOCATION: 17 ��NT' 2 / u!�IV a G E "Ale S UNDER THE PROVISIONS OF 780 CMR, THE STATE BUILDING CODE, SECTION 3400.5.1, YOU ARE HEREBY ORDERED TO IMMEDIATELY DISCONTINUE THE USE OF THE CELLAR/BASEMENT AREA FOR SLEEPING PURPOSES. LOCAL INSPECTOR SIGNATURE 0 REd-PiENT I � • ODEM DE SAIDA DATA: LOCALIDADE: DE ACORDO COM 0 PROVISORIO 780 CMR, CODIGO DE CONSTRUCAO DO ESTADO, PARAGRAFO 3400.5.1, VOCE ESTA_ORDENADO DE DEIXAR DE USAR, IMEDIATAMENTE, A AREA DO PORAOBASEMENT PARA 0 PROPOSITO DE DORMIR. INSPETOR LOCAL ASSINATURA DO RECIPIENTE l - y 4 r 1 e ` A �.. r } ri L ya w p� Canterbury Circle, Hyannis 2/6/12 II.N At' -, ry µ,< ref t 1-7Canterbury Circle,' Hyannis 2/6/12 LA 1 E i t f t 1 � + r } o .. anterbury Circle Hyannis 2/6/12 .W r ix « Mye,F File .`Edit °Tools ;Help R .. - , , , r l , Detail +1 -� °A hcat�on: 201200695, j` PP, Owner_% 36771,1 1 L3 .� = � t = - . St :. , .. Status E-D ollect ..E:_ ! MARCONDES MAICO , ••De artment•r •;=.w 6300},BUILDING DEPARTMENT• z� P _ ._ ��� ,,Close Den _ n raeto � . ... Protect/.Actjrnty 9,9 Ex T Business bescri tion l .__ BASEMENT UNSAFE IMPROPER EGRESS "�' „ 'Workflow P - ACTtIV PLI fO- , Status Cade ACTVJ rti� Ps_ r. �. �V, ,SAT . _ . POSTING PLACA0 2 7 12.PAUL•<ROMA `x• \" r' *"Descnptian 2 J J: , ~;, S � N� c i __ -- - s x Parwng jMisc,' i , , ;_ - , Status memo ' A licant PP h t - r Assigned to :. Estimated cost 0 .:..Fees.effective 021�712012 �.' n: • n• .:.... by ra rt se ' }',:. n.F': ri„ a•- ;•' - :. q 4+ {Kk:.rt Non,Conforming, DatesJMisc :,�.. Permits + °+ y •.,. areal=, >%_ :. -_ 24911 t Reactivate. ...+� .. q z , ... 1 u _ r - _.. n use's. 1010 `, SINGLE°FAMILY HOME. ,oca ion,: 1.7 CANTERBURY:CIRCLE. - :. Puseest � �HYANNIS.MA x-, ., . q �• zarnng RB„��RES�,RB} ,> �urnci alit HYAN.. HYANNIS x k P, Y., r r r Escrow Taff a ,. �t on z .., , Misc L-9 fi flood zone _ x; - i,. , j Proposed use 1010:;: �� SINGL'E,FAMILYHOME ,- Paymt History of f Section�Phase 0 �r'A},< ., ( ^`tfi.e9a ,-•—w:—r 4 ;...,. _.,- c ':a# d, .: i,.: , ,., .. .. ;._ .^i d t^,� �� t Y - �` S: { r t"w �.. - "Audit<Hiskor Y t.. .*—'r:•^,.--'-"'-s_---s ( ..w::t . _ _;.,, r, .., .,.- � �.`;a ._ .1:: ,.,e*.^, * i;Y .ac'h' .. .ocation desc- F-7 Flood zone < 'HazrdRestrr� -: .Names> (Fj,,Bonds ;•_._ PlanRe�iew Findby;Parcel LmkInsps ' f Warnin "s Find Related 3 PnarHistor Ins actions `Violatior7s ( Reviews (�-0—��en Items-� Lei g 11.• ��i.,, =PI '. q _ -. - �QAttaChrrients(0),� a� w, , w o 7--7,-4 Maintain ro act activit det for , lication. .ail khe w.... current.a PP Y. �/�ry/yam'' S� m,Sysem�InbaxMcoso Mai' n® ,. 10 34 AM BIRST INSPECTIONS DATE: April 15, 2010 Thursday Evening 5:00 PM PRESENT: Local Inspector Bob McKechnie, David Stanton, Health Inspector, Officer Brian Morrissey, Robin Anderson, Zoning Officer 85 Old Yarmouth Road Responded to property after receiving complaint from a local business in this area and comments from the Hyannis Water Board citing concern that use may involve hazardous materials. Found Tim Ferreira sitting outside on porch as we pulled in. He advised that he was closed. He was irate over the complaint and didn't.want to allow any of us on site. He called Bob a pedophile and revisited the accusation from a few years ago when Bob. was inspecting TF's former wife's duplex located at 3/7 Cook's Circle. He accused Bob of peering into front window of,this house'at a teenage girl just getting out of shower. The configuration of the house does not lend itself to this possibility as the front window , does not allow visual access to the hall where the bathroom is located. Of course Bob denies incident ever happened and there is no reason to doubt Bob.. There were too many changing variables with.Tim's story including the fact that it was his own daughter(the incident took place on the'rental side and Tim does not have a daughter). 1.7_Canterb_ury_ Y ;.Met.owner's wife.at the door. She advised that the lower level was in fact rented: Unable to see unit at this-time but will call to make appointment.' We did get in about a week later: Tenant was moving that day: Found 2 bedrooms without egress.. Advised owner to open common wall with 5' cased opening and open entrance wall same in order to disqualify as a bedroom space and remove kitchen, obtain plumbing permit for same. Owner did obtain building permit application to perform work. Re viewe&application and work with owner on 5/20/10: Licensed plumber scheduled for estimate. 138 Elijah Childs RC/GP/RPOD ,Owner has 4 bedrooms-and rents three to 5`•adults. Advised that he can only have 3 unrelated lodgers. One couple moving out.- Basement is like"a giant closet set-up for're-sale. No apartments. ., 5 d Property unkempt outside—likely source of complaints along with number,of cars. Advised owner to register as a rental. Needed CO detector: ' Something wrong here but can't put my finger on it. 563 Strawberry Hill 3 adults and one child reside here. : Three bedrooms on main side. Annex area has small primitive food pre space but is very questionable as to whether or not it qualifies as anything other than counter space. Occupants just moving in. There is flow between space. Not really set up as'a distinct living area. i. Needed batteries in smoke detector-annex area. Needed to provide CO detector. FPO Mike Grossman returned to check smokes twice without getting in: 70 Acorn Drive, Ost Complaint regarding business operating form this'location. Spoke to tenant; she will have her husband, Marcus call. 508-367-7475. -Advised that my hands are tied and if he doesn't relocate equipment I will be forced to " ticket him for each piece every day. He did call and advised that he was able to relocate equipment. ` No additional complaints have been logged. 123 Asa Meigs Road,MM RURPOD' Linda Edson responded to ad'in paper for apartment on�4/12/20TO. She was advised that the unit'was created. Added property to BIRST list for April,15th. _ Denied access by man.claiming to baby sit dogs: Subsequently spoke to,owner's son"Brewster" by phone w He stated his mother is the owner was-helping his sister in Maryland but she lives; he, Also resides afthe property,with his partner. We discussed available avenues of'relief for apartment. " I noted that I-was concerned that she is not eligible for any relief as his mother(the actual owner) does not reside here on a year,round basis. , Advised that she would have to prove she lives here on a year round basis. When no definitive option was identified as requested within the timeframe agreed upon I issued one*citation and mailed it 5/5/2010 to Ms. Sherwood's.Maryland address. Received correspondence from Mike Stusse indicating.he represented the owner and { would seek relief fora"temporary" family apartment under 240-47.L. ° 2� 39 Micah Hamlin Road, Centerville Found landscape equipment and storage sheds Walked around house. No response . k „ Left card indoors. As of 5/20/2010 no one contacted this office. DC Campbell LS 508-428-00431: y Mass 92Y F06 2 Mount Wood Road, MM Responded to complaint regarding too many cars, overcrowding &basement apartment Previous BIRST inspection found lower level apartment with egress issues. Birthday party in progress. Spoke briefly to owner and advised them to call to make an appointment. Also discussed that large Braga plumbing truck and'pick up in driveway. Owner called the next day and scheduled an inspection by appointment. Subsequently, a lower level apartment was found. In-laws reside in basement. - Egress issues must be corrected. . ' Number of bedrooms must be reduced. They will reduce-one.bedroom upstairs (is office) and lower level bedroom opened up into studio. Large window cut in common interior wall to disqualify space as bedroom for septic count. New egress window will be installed.. Unrestricted flow to lower level (nolocks). Property clean and'well maintained: No signs of overcrowding. Property owned by young couple who reside with one set of parents. Couple cooperative.. 3- " TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION yam,. Map Parcel'` ;Application # o 7 1 Health Division - ` Date Issued Conservation Division " Application Fee Planning Dept. ''Permit Fee Date Definitive Plan Approved by Planning Board i Historic - OKH _ Preservation / Hyannis Project Street Address Zq CAAJ J&a3i U R Y 01,2CL Village llylq"1% Owner j) /'I co � �`�'��� Address Telephone t_Permit Request�___,&au., �! A e_T11 fi/ , ?7t'»'I�i' - I '� .s ,�,11 i,rr H E-4., �641 -sC d OV r Square feet: 1 st floor: existing A3 proposed !' 2nd floor: existing�Rproposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes _gNo If yes, attach supporting documentation. Dwelling Type: Single Family �D Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) 3Zy 5 Basement Unfinished Area (sq.ft) 2 3 y .6 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 -r y e) Central Air: ❑Yes No Fireplaces: Existing 1 New Existing wood/coal sfove: ®=Yes M No Detached garage:P existing ❑ new size—Pool: ❑ existing ❑ new size _ Barr:-U existing ❑ new size_ ii Attached garage: ❑ existing ❑ new size _Shed:,4 existing ❑ new size _ Other: " Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ v Commercial ❑Yes - ,No If yes, site plan review# Current Use t Proposed Use -...APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) Name ,/ �J� c� .%�/ , ✓ �c0.,�(--� Telephone Number Address ` Ai4 15A60Q 4 C Z 6 License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY t APPLICATION# DATE ISSUED �. MAP/PARCEL N0. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ' `t ASSOCIATION'PLAN NO. Me 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 rAlicant Information Please Print Legibly e(Business/Organization/Individual): / �f � 1�1 �� % a�2C�re'ss: Csw„` 6&2—,-,V a/State/Zip: 4/,q ilk / Phone.#: ��- �, ; (1 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. El New construction employees(full and/or part-time).* have hired the sub-contractors 2. listed on the attached sheet. T. Q Remodeling 0 I am a sole proprietor or partner ship and have no employees These sub-contractors have g, Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'comp:insurance comp. insurance.$ required.] 5. ❑ ❑We are a corporation and its 10. Electrical repairs or additions 87. I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions m self. o workers' co right of exemption per MGL 12. Roof repairs A insurance required.] t C. 152, §1(4),and we:have no P employees. [No workers' 13.❑Other comp,insurance required.] *Any applicant,that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have . employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: " Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1;500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a"fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance GOvAize verifrea I do hereby certify under the pains a eu,alties of j ry that the information provided above is true and correct Si ature�— -1. �/ %.��.: "Date: :� :� 1 : 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#: Information and Ins ttuctions , 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 3 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 permitnicense 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 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 02.111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 . Revised 11-22-06 www.mass.gov/dia l Town of Barnstable o Regulatory Services anxxsrnacE Thomas F.Geiler,Director HAss. 1639° ,�� Building Division rFp �a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 -` `` Fax:. 508-790-6230 HOMEOWNER LICENSE EXEMPTION _ Please Print ` h � DATE: 0 ZJ 07•-2 0,'1 2 � JOB LOCATION: 7 4 N� -9 C C AY,,M//V/,5 number street (.� villlaag/e� "HOMEOWNER":/ Q lti� 'Il/ T r ., ( IUZ . ame home phone# work phone# CURRENT MAILING ADDRESS: / q AA L/no ' —�� e ity/town state zip code The current exemption for`.`homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a,parcel of land on which he/she resides or intends to reside,on which there is,-or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersign "hom ' er".certifies that he/she understands the Town of Barnstable Building Department minimum ' ection edures and requirements and that he/she will comply with said procedures and require ts� tl4u 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 hoineowners.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 personas it would with a licensed Supervisor. The homeowner acting as,Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the.homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and.adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC. THE r0�'fi Town of Barnstable ..� Regulatory Services r r 9MAS&' �," Thomas F.Geiler,Director E&6yg. ` 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. QTORMS:OWNERPERMISSION nJ o n� - Q I of { Po 0,/� 3l N NC-,2. f ZC OO/l ®,,� ° `4 -4 ®1 tc [I(f/\j ' O i I�Ro�M ol aoDO J /A 02 CcosE QQ M N- 3 J,'Ool\4 N � 2 u VLF+� K'�c-f+ErJ 9\jooM � bA T I-I aoOM I � sta,as suu ep- oo�A 00 0 r�f�, �1 +1-ti � ;�i�� +P8.L Sys � w n+cat. F�c�c✓1, RAM � �� N e �` � �/ 'U �sH Esc-�►c� �J�pp2 StAi'2S �1 ',+.,w•�,...r},.�'�f<�_:XI' f"'`i7r�""Sl"_ ]i`yf'a!"'..+.o--r•p..} yw„}.+..-...-ry...br')�+"Kfa:". ;rr. r.,..>x-..., ,�: .� 1-�, .wy'a•.v'R ;I?6+ 1.--e},lpt6- :F ;;;w . -y .•c;,. ..-. Town. of,Barnstable . °FtNe,gy, Regulatory. Services " Thomas:F.:Geiler Director � . • BARNSTABLE. * ' .MAss. $ Buildin Division g. 9�iDrFo Nw+°�0 Thomas Perry; CBO,:Building,yCommissioner e200 Main Street, `Hyannis; MA02601 www.town.:barnsfabie.ma.us' Office: 508-862=4038' Fax: 508-79076230 EXIT ORDER DATE: LOCATION: I C .7 A AOzE4E✓ \ UNDER THETROVISIONS OF-780 CMR,THE:STATE BUILDING CODE;: SECTION 3400.5.1, YOU ARE HEREBY ORDERED TO IMMEDIATELY DISCONTINUE THE USE.OF THE CELLAR/BASEMENT AREA FOR SLEEPING PURPOSES. LOCAL IN P, �ECTOR S SIGNATURE OF RECIPIENT ODEM,DE.SAIDA DATA: .LOCALIDADE; DE ACOROO CO.M O PROVISORIO 780 CMR,-CODIGO DE CONSTRUCAO DO ESTADO, PARAGRAFO 3400.5:1, VOCE ESTA ORDENADO DE DEIXAR DE USAR, IMEDIATAMENTE, A AREA DO PORAOBASEMENT PARA O PROPOSITO DE DORMIR. INSPETOR LOCAL'. ASSINATURA DO RECIPIENTS