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0020 CAPTAIN ELLIS LANE
ACTI VE .� . } ��' r ', 'I Town of Barnstable Pe it Cod Q„ Expires 6 months rom issu -date Regulatory Services Fee = ANsr.4331,E, ; �� Thomas F.Geiler,Director Building Division Tom Perry,.CBO, Building Commissioner'.,: . 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Otf ce: 508-8U-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red)(-Press Imprint Map/parcel Number (054r-o Property dress - - - 14 A t esidential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name 4 Telephone Number Home Improvement Contractor License#(if ap icable) � j Construction Supervisor's License#(if applicable) ' o,®„ Workman's Compensation Insurance Check one: ❑ I am a sole proprietor O C T 12 2012 ❑ LorSe Homeowner have Worker's Compensation Insurance Insurance Company Name_ ��/E1r� }� "-�� TOWN OF BARNSTABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate,must accompany eachpermit. Permit Request(check box) ❑ Re-roof hurricane nailed (stripping old shin 1( es All construction( PP g $ ) debris will be taken to ' ❑Re-roof(hurricane nailed)(not stripping: Going over existing layers of roof) /Replacement e-side #of doors Windows/doors/sliders.U-Value (maximum.35)#of windows El Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Sepa'rate,Electrical&Fire Permits:required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. i. ***Note: Property Owner must sign Property Owner Letter of Permission. co of the me.Improvement Contractors License&Construction Supervisors License is equi'a SIGNATURE: Q:IWPFILESTORM%building pe it formsEXPRESS.doC Revised 053.012 r HOME IMPROVEMENT CONTRACT f PLEASE READ THIS l t Sold,Furnished and Installed by- Branch Branch Name: Boston Date: �/�/�-, THD Al-Home Services,Inc. I` d/b/a The Home Depot At-Home Services 345A C rmnwood Street,Unit 2,Worcester,MA 61007 Branch Number:31 Toll Free(800)657.5-182; Fax(508)756-8823 r /+ Federal ID#75-269M60;ME Uc#C 02439;RI Cont.Licit 16427 / ) CT Lic#565522;MA Home Improvement Cont=u)T/Reg.#126893 Installation Address: 01 l� - `j A�,�� CZ C) �E, 6 City State Gip Purchaser(s)' Work Phone: Home Phone: Cell Phone:.1 et:u rH42r a �f Home Address: (If different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): W ❑I DO NOT wish to receive any marketing emails from The Home Depot Project Information: Undersigned("Customer"),the owners of the.property located at the.above installation address,agrees to buy, and THD At-Home Services,Inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation("Installation")of all materials described on the below and on the referenced Spec Sheet(s), all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Urdzrs(collectively, "Contract"): Job#: a w_a Rd.-1 Product Spec Sheets #:' Pro ect Amount' Roofing USiding J&Wmdows ❑Insulation e 6 6-0 6 753 �mn/Covers ❑Entry Doors ❑_ G�o �'6 9 $ 6 5'0b Roofing ElSiding ❑Windows UInsailation $ ❑Gutters/Covers ❑Entry Doors ❑ Roofing Miding, Wndows ❑insulation $ []Gutters/Covers []Entry Doors n Roofing USiding 'Windows ❑Insulation $ ❑Gutters/Covers ❑Entry Doors ❑ Mmimum25%Deposit of Contract Amount due po.exc+auSonor this contract Total Contract Amount $ / MainePurchasers may not dep0.dt more than onedhud ofthe ContractAmount. Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Compl lion.Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a siruciural problem with the home,environmental hazards such as mold,asbestos or iead paint,other safety concerns,pricing errors or because work required to complete the job was not included in the Cpntract. Payment Summary: The Payment Summary # __Z included as part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at tire,time you sign. Do not sign a Completion Certificate(cote: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY W1TIIUOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and Thd Home Depot with regard to the Products and Installation Services and supersedes all prior discussions in()agt'eements,either oral or written,relating to said Products and lastallanon_This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot.Customer acknowledges and agrees that Customer has read,undenlands, voluntarily accepts the terms of and has received a copy of this Agreement Ac• pted y: Sub by: x �3•/ Customer's Si Date Sales Co ultant's Signature Telephone No. ustomer's S Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS (aq spplicublc) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACKED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE SrATED ON THE RF VERSE SIDE AND ARE PART OF'rHIs CONTRACT 3309 GSC White-Branch File Yellow-Customer Pink-S ales Consultant Td Wd6Z:S 600Z OT 'add T2-EFF928OS: 'ON XUJ pe6wpt: WOa_j fzce of consumer Affair and Buslr,ess Regulation 10 Park Plaza - Suite 5.170. Post ssachusetts.02116 a . r " - �-Zore JGu7.prove • ' ontractor 1�.e 15t1 r�t1011 g t Registration: 12fi893. �� �--- Type: Supplement CaN w �piratlon: j The Home Depot At-Home . ervi w RIGHARD' -rALLONE- 2690 CUMBERLAND PARKWAY = ATLANITA; GA 303.39 hr Sys v Update Address end return card.Mirk renson.for chnngc. Address (� Renewal .�mpioymcnt f� Last Cnrd ' - I bP5•GA'i ?g 50Pd•04/01-GG'17j0jj1218p - .. •1Ud97fAfL64tY1JC?-U�� ,' �otlice of Consumer Affnirs&Business Regulation, , License or registration valid.for individul use only before the expiration dnie. If found return-,to:' I OME`iMPROVEMENT CONTRACTOR; office of Consumer Affairs and Business Regulntion r,;:y Recglstratlon: ,126893 ,�YPo 10 ParkPlazn-Suite 5170 Supplement Card. Boston,MA 02116 ' tiv ExPlref(tin',.8!3' '4 PP The Home Depot�A7 140tne j'iy,4es RICHARD FALL(9NiT ��a� J _ 2090 CUMBERLA�ID.p k ti V1�AY S -ARt�`l�,`GA 30339` Undersecretary- - lot valid tivith ut si nature -4. . t' Board 'of B.--uillding R. gulations and Stairid�nrds CSSL-100478 �> BRIAN K LARObIE 17 COLLEEIaT I)RE i SEEKONK MA ®2771 r x ommissioner 02/08/2014 CERTIFICATE OF LIABILITY' IBIS NNE DATr(r12511,rn', 0912bJ12 ! THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND.CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES . BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING.INSURER(S), AUTHOt'IZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ., IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policyOes)must-be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certaln.pelicies may require an endorsement. A statement on this certificate does:not confer rights to tha certificate holder in IieU of such endorsement(s). CONTACT. - - PRODUCER 401-769-9500 NAME Hunter Insurance,Inc. -769- PHONE 401 9502 FAx 389 Old River Road,P.O.Box 9 AIc No Ext: AIc Ne: Manville,RI 02838-0001 E-MAIL ADDRESS: . - 0 UCER B�LCO-1 - CUSTOMER ID It: INSURERS AFFORDING COVERAGE NAIC B INSURED B&L Construction INSURER A:Merchants Insurance GrOUp 23329 Brian LaRoche INSURERB:Beacon Mutual Insurance Co. 145 Phenix Ave,2nd FI INSURER6: Cranston,RI 02920 INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE'INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED..CERTIFY THATNDINGO IC 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE POLICY NUMBER MMIOD E MMIDDIYYYY. LIMITS GENERAL LIABILITY EACH OCCURRENCE $ SOO,OO A X COMMERCIAL GENERAL LIABILITY X BOP9093646 04I23/11 04I23/12 PREMISES Ea occurrence $ 500,00 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 15,00 A BOP9093646 04I23H 1' 04/23/12 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 1,000,00 PRODUCTS-COMPIOP AGG $ 1,000,00 rGEWLGGREGATE LIMIT APPLIES PER:LICY PR0. LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY IN IURY(Per person) $ ALL OWNEDAUTOS BODILY INJURY(Per accident) $ " SCHEDULED AUTOS PROPERTY DAMAGE $ (Per accident) HIRED AUTOS $ NON-OWNED AUTOS $ " UMBRELLA LIABRCLAIMS-MADE OCCUR EACH OCCURRENCE $ EXCESS LIAR AGGREGATE $ $ DEDUCTIBLE _ $ RETENTION $ WCSTATU- OTH- WORKERS COMPENSATION TORY LIMITS ER AND EMPLOYERS'LIABILITY 01I19/12 01/19/13 E.L.EACH ACCIDENT $ 100,00 B ANY PROPRIETORIPARTNERIEXECUTIVE YIN NIA A 63653. 100 00 OFFICERIMEMBER EXCLUDED? E.L."DISEASE•EA EMPLOYEE $ r (Mandatory in NH) 500,00 Ryes,descnbe under EL.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Carpentry. THD At Home Services, Inc. and The Home Depot are included as tiditional Insureds as respects the General Liability policyy as per written contract/agreement in effect. Completed Operations is included in the Additional Insured endorsement., CERTIFICATE'HOLDER CANCELLATION THDATHO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 4 THD At Home Services,lnc. ACCORDANCE WITH THE POLICY PROVISIONS. DBA The Home Depot At Home Services AUTHORIZED REPRESENTATIVE 3200 Cobb Galleria ParkwayS200 Atlanta,GA 30339 0 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD .n i August 17, 2012 Barnstable Building Dept. The following is a list of our approved sub-contractors for The Home Depot:-. Ericsson Torres—CSSL# 100546 HIC# 163528 Michael Viola CSSL#099403 HIC# 140993 Robert Reposa CS # 60526. HIC# 147080 Timothy Thomas-CS# 51899 HIC # 152121 Joseph Duarte - CS# 70077 . HIC# 132349 Douglas Szynal CSSL# 103950 HIC# 146142 Brian Laroche - CSSL# 100478 HIC# 152612 Joseph Mckeon - CSSL# 98863 HIC# 132614 If you have any questions please contact Mike Bedard our permit coordinator at 508-962-6942 or myself at 617-438-9017. S' cer y, ussel Jo t e Branc stallation Manager - THD At-Home Services, Inc. 908 Boston Turnpike• Unit 1 •Shrewsbury, MA 0.1545 Phone:774-275-2139 a Fax: 508-845-6076•Toll Free:800-657-5182 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant hdforMation Please Print Legibly Name(Business/Organization/Individual): UN . - - ---- - --- — Address: City/State/Zip: hone.#: _ 675f Are you an employer? Check.the appropriate bo :Type of project(required):. 1.El am a employer with 4. I am a general contractor and I 6. ❑New construction . employees (full and/or part-time).* . have hired the stab-contractors 2.❑ I am a•sole proprietor or partner- listed on the-attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingforme in an capacity, employees and have workers' Y P tY• t. 9. ❑Building addition [No workers' comp.insurance comp.insurance. re ed 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions ' q� . ] 3.❑ I am a homeowner doing all work-• officers have exercised their 11.[1 Plumbing repairs or additions myself, [No workers' comp. right of exemption per MGL 12.E]Ro airs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13. Other comp.insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensatim.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 isproyiding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: ;:WEN Policy#or Self-ins,Lic.#: Expiration Date: 1 Job Site Address: � City/State/Zip:_ � _ Attach a copy of the workers' compensation liblicy 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$1'1500.00 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 ag ' e violator. Be advised that a copy-of this statement may be forwarded to the Office of Investigations of the DLYfor iiAurance c vera e verification. I do hereby certi er p es of perjury that the information provided above is true and correct Simafore: Date: iVIe Phone olo �/ 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): I..Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: ' Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. contract of hire e person in the service of another under an , . Pursuant to,this statute,an employee LS defined as"...every p. Y . 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 en iloyer,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()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 msLancc requirements of this chapter have been presente '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-cont�actor(s)name(s),address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials. , Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill_in the permit/license number which will be used as,a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,'need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all.locaiions in__(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit :The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call., ; The Department's address,telephone-and fax number: rho C-mmouvm4 i of MmsaoL.useUS ' DQparlmeint of ladustual Acold(M s Office,of Invatigations 600 Washinatcai S.U=t Boston, IAA 02111 Tel.# 617-727-4900 ext 406 of 1-977 MASSAFE Fax##617-727-7749 Revised I1-22-06 www.inassgov/dia TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map L °— ���Parcel `,} ,,,; ; r Permit# `; ,1�'/� Health Division f Date Issued l Conservation Division �2�Z�) Nk, t� Application Felid e Tax Collector -t Permit Fee 7 Treasurers ,; { S Uf c ' I. � /o� PT° SYSTEM FAUST BE Planning Dept. LLED IN COMPLIANC VATH TITLE 5 G �J Date Definitive Plan Approved by Planning Board �ITAi.CODE A Historic-OKH Preservation/Hyannis Project Street Address cg's 44W-� Village Owner %J yleS 9� O Q& /s ,a// Address ZO l �Gfis�q. axis Telephone-Permit Request Request r 20 26 A_a- v- t,0 © -o-e j/— 1Square feet: 1st floor: existing oO proposed 2nd floor: existing GO D proposed Total new ^ r Zoning District Flood Plain Groundwater Overlay .�.Project Valuation Construction Type Lot Size 2�15'�d Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family` Two Family ❑ Multi-Family(#units) Age of Existing Structure Zsyrs• :Historic House: ❑Yes • �No On Old King's Highway: ❑Yes �No Basement Type: ❑Full ❑Crawl ❑Walkout ❑OtheriV6A45 Basement Finished Area(sq.ft.) NN Basement Unfinished Area(sq.ft) 1?0 Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing new First Floor Room Count -Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other AJONE7 :'Central-Air: O Yes XNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes )0 No Detached Agarage:❑existing ❑new size Pool: ❑existing ❑new size • Barn (existing ❑new size Attached.garage: ❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# .Current Use Proposed Use BUILDER INFORMATION Name <` G � L� Telephone Number " Address License# L��✓C�S P`;, �lCe Z- Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 3 4 3 i - ' FOR OFFICIAL USE ONLY PERMIT NO. 'f f DATE ISSUED- I MAP/PARCEL NO: i ADDRESS VILLAGE I OWNER f: DATE OF INSPECTION: FOUNDATION f0 D �/ a 7/0 el FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL- - GAS: ROUGH . FINAL.' ;F r � FINAL BUILDING '0-`f ? � : Cl .% �• - ry cry � r • } DATE/CLOSED OUT ASSOCIATION PLAN'NO. .s ,oFTHE Tp The Town of Barnstable r BARNSTABLE. Department of Health Safety and Environmental Services MASS. w 9 t679 ,00 MA Building Division 367 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: C S /wAle Map/Parcel: S Q ~ 0 3 ° Project Address: �2o C i°rI Al fzCCiS Builder: ® I'V'V 7,or The following items were noted on reviewing: % S T/ k1 h11,-A1 le',F A e / l S o /9 N /Co 6,ry eA 7"io 7/ l✓G /T Reviewed by: Date: q:building:forms:review _ The Commonwealth ofMassachusetts L Department of Industrial Accidents -' — OfffCC Of/DYeSt%981%OQS 600 Washington Street Boston,Mass. 02111. 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I do hereby certify under the pains andpenalties ofpedury that the information provided above is true and correct Signature Date Priat name �t✓rJAaj��l Phone# official use only do not write in this area to be completed by city or town official city or town. permit/license# ❑Building Department ❑Licensing Board checkif immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other��_ 0cmad 9195 Ply` Information-and: Instructions ' Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire,express or lied, oral or written. �P employer is defined as an individual,partnership, association, corporationor other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased�einployer, or the receiver or, trustee of an individual,Partnership, association or other legal entity, employing employees. However the owner_of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or'renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neitherthe commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until ce of compliance with the insurance requirements of this chapter have been presented to the contracting ble evidence p accepts authority. M . }: Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and su 1 ' co any names,address and phone numbers along with a certificate of insurance as all affidavits maybe fg Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and submitted to the Department of affidavit. The affidavit should be returned date the d 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. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference nin6ei r. The affidavits may be retumod to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. Please do not hesitate to give us a call. *, The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Imlestlgatlons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 . f JHEr Town of Barnstable Regulatory Services anxxsrasi.E. Thomas F.Geller,Director 9�A 1659. a`�$ Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOM£RYIPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other w, requirements. Type of Work. .r� t4 M Vet,tA.1QX IS'�'t~ r N Estimated Cost Address of Work: Z o C4a I ot Owner's Name P 3 1'r tdl Date of Application: I hereby certify that: , Registration is not required for the following reason(s): QWork excluded by law ❑job Under$1,000 []Building not owner-occupied 'SrOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MIPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby.apply for a permit as the agent'of the owner: Date Contractor Name Registration No. e��j,CS Res Date Owner's Name Qlo=homeaffidav , RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alteratio enovations $25.00 45 Building Permit Amendment $25.00 FEE VALUE WORKSAEET NEW LIVING SPACE square feet x$96/sq.foot x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0031= v ACCESSORY STRUCTURE>120 sq.ft. v e s+1A bar.► r `'>1isf 00 s �$ �00 0f 0 0S O ® ® >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031 STAND ALONE PERMITS '} z Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) , Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00. ` Relocation/Moving " $150.00 (plus above if applicable) Q ' Permit Fee projcost ` Ft►,E T� Town of Barnstable Regulatory Services • snnrts�+atE, Thomas F.Geiler,Director 9q, �. _ Building Division p�En � Tom Perry,Building Commissioner ' 200 Main Street,`Hyannis,MA 02601 )ffice: 508-8624038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION:. number street village '1i01v1EOWNEW: e 5 / �b-7s3•S�/ 3�$�79/ /�`16/ 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 alll 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 1eqe Si of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger.will be required to comply with the State Building Code Section 127.0 Construction Control. _ HOMEOWNER'S EXEMPTION The Code states that: "Any 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 laek 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. SEP-01-99 04 :58 PM EDGE 19783734190 , P. 01 N/►= E—LIS 100.00' 0 20,000 S,F,t 0 O O N .EA Q z RN 2g T � Q J z C" `¢ --- ---- --------- THIS IS A .MORTGAGE LOAN INSPECTION FOR FINANCIAL PURPOSES ONLY, THE CERTIfi„>1 Cr; ;;N PtAN :S NOT TO eE VSEO TO ESTABL SH THE SOVNOARIES, FENCES, PLANTINGS. ADOI IONS. SPECIAL PERMITS. OR .YARIANCE5. RevIsEo BY: Yt'1;vNc, A� Loc,lnoN: :ITY/TCyM oArC 3 LIM AND MAN RE(Erri�CE. AcZr151FlQI.EutGI;U Uf IILEU, 1.. i, - TOWN'OF BARNSTABLE BUILDING PERMIT APPLICATION Y Map Parcel _® 3 C Permit# 2- Health Division Q Date Issued Conservation Division 3 34 Zog 1 ' " °'--AR------ 20�� `'j Fee Tax Collector 33oOi Lth Treasurer SEPTI STEM MIST BE Planning Dept. INSTALLED IN COMPLIANCE WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND , Historic-OKH Preservation/Hyannis TOLMN RE:GULATi0NS Project Street Addres d /S Village Owner Address ' �/gjs( l�s Telephone �n- ��—��� 7Cos-7S`3-9Yt?,T� (,22 c,,�l , lC i'c Yet /� � Permit Request 911V L 540 M i Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation C'� Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size 001660 Sri Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes XNo On Old King's Highway: ❑Yes XNo Basement Type: XFull ❑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 .3 new Total Room Count(not including baths): existing new First Floor Room Count 7 Heat Type and Fuel: )4Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes VNo Fireplaces: Existing I New Existing wood/coal stove: ❑Yes *lo Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes No If yes, site plan review# Current Use SIV L~e Proposed Use -� BUILDER INFORMATION Name / Telephone Number .Vi'8 7 5� - 753-9�Fy Address Z© 4/� /4S /a ALicense# Home Improvement Contractor# . Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE - FOR OFFICIAL USE ONLY - - PERMIT NO. - DATE ISSUED 114, f T I MAP PARCEL NO. . t - ADDRESS VILLAGE .i OWNER' . DATE OF INSPECTION: FOUNDATION „ FRAME INSULATION FIREPLACE ELECTRICAL: - ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH • 0 FINAL ' - E - FINAL BUILDING Ka DATE CLOSED OUT - i ASSOCIATION PLAN NO. t The Commonwealth of Massachuserts Department of lndustrial Accidents • k � �e —�=-; , '�_ 01�cea1lap�stlgaffoas -- 600 Washington Street Boston,Mass. 02111 Workers' Cam ensation Insurance davit �/i!"�ii.//��ii,,'�i �/" �///.'---�//��////�% name: ar-s location dtv g ti K ;s I�VI ►�- phone# I am a homeowner pofmming all work ngsel£ ❑ I am a sole tarvrnietor and have no one working in aav caaacitr ❑ 1 on I am as ,Dyer providing workers c�mpeasation for my employees worlQng this job. ...................w:::::r.::.....::..:•:::::.�::::x:::::vv.:::::::v:::::{?.}:i}}i}X.wvy.}:{ ............ .......:.:v............... ...... ....... ...... MMN.•.i••::.::.:::{{:•:::v.v:.�:::::.... ..........x.:..:.. .................v::;•;:;...::•::::x:•::w:::.... 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I mderstmd that- capy of this st w==may be forwarded to tha Order of Imesdpd=of tha DIAfor coresa;e•aiticadum. 1 do herby certify Dade the p ' and pataltia of pvjury that the utfomsadon provided above is o w•am correct Signanat: Date //� - print ��5 �uf , Phone# Of 7 COchnkifimmediate use only do not writs in this area to be completed by city or town ofildai own• peesrdtlllcense ❑Building Deparanmt ❑Ilcensing Board response is required ❑HeslthDeps��person. phone#: ❑Other Dessau 05 F1.0 � � �• it 1 � �. � � :1••11 • • • �• • •IIt e 1 / / / •.III•_• M •�1 •/ I 1 • I• I II• I • - • • • /• • ./• •r. • • le • el �1/1 .1 r / • 1 • 1• • • •Y. • .�SIN•: • • • • :NII• • • • ' • • • /•• •1 • •/-1 e U •w .•• •Iv • • •� r :.1.1.1 :IIN• • II • =•••1• • • • �1 1 •• •:A • 1 • 1• • I• 111 • •• •• • 1 koI • .ev •••«el•. ./1 • • 1 • r`I •.� •�e �•• •) II • •. /1 • / • • •• I• I• •d I • M••I• • •�1 •1• • v • e• II/ICI• • Y •11 ■ I M• •le •I • I • /, •Iv • • • • • I• • •1• • 'J • • • • N • • r • t�l•Y. vl I•A �11• 1 I 1 • •_••:11 • 1 / w•111 • 11 �•11 • •►«•/_• • • .1/ �•NI• • �1 • "'ll I I 1 1 1 1 1 1 1 �1 1 1111 1 1 1 .11 • IAY 11 —+.: 1 •1 11 • 1 r • 1 • 1 J. 1 •1 rI Ielll e • e 1 1 • ! • I 1 1 1 JI r 1 1 ll)e 1 111 1 11 11 1 r a • 1 / •• 1• •II I •NI••-ne *levels •1e ••�•: 1/v 1 •1 •11 • •) Iw • • 1• Y+ V/ • •1 ' Y •le YI I .II11.I 101•**!:I I • Y•III■ 111 /I •.•/ •••• .1•M • ■ 1 • • • •. • Y«• Y, • •1 -011119 ,11 Y • I■$ 001 11 111:11 Y _• 111 «I/�111•. •1 Nei MI./• I« • 1 •_�11 • w ti•1 _• • I• Y•1.1• 1 1 I•let ' �t I /e // ••1/.��••� •'•INI•w♦ w.t• •11 .■•• • ' 1 Y•1111• .s/ v MI_ .�11 • I/ ••► •t .1 .I• • w. 1• •• 11 ll•1 .•■ •1• .•e 1 N•v • 11 •Illl• .II IY.III� • •1 �v, ,11 • • 1 •111 IIIIII •wl. •11{• III Yti ••• W.II •1 le le•:1•M I .1•/ • Iw /•. r • HIII/N_I ■• /• •./ •11.•II •1 1111Ub1••K « • w.11. 1.1 ♦•IN11.11r.0 •11 •1 UA 11•:II Y Y• ' II 1 1 11 / J/ / • 11 11 • •/ •• • ' I VI • 1 • Ii w•/1.1 �• le II— «1 •1 /• •' 1 Iv .I /I .1• • W,11 •1• t•1 I• /�/r 1111 •1 Yw• • 11 • —• / I_• 1 I // • J••11�11 •1 1 •le ••Y. « •—•IIA le • 1 • • • / 1 .11 • • 1 � • •11 �.V:I III• • II •1 _• le• �• I• • • Ylle •11.•�••. Y•11111 w1A`•:I• •11 I • • ✓. I II � w•Y. •II—.11 .I 11 •11111 •-1 I_• V / e/ Iv .1 •y1 •• • • 1 Y•INI• w1 .11 • 11.1111_• �.•J • r1 ' • .• ••/w•1 • • • • •�• • . .e re r•• •III • ••• • 1 1.-1y • • I 1• III • 11 1• •e 1 wfl /I /• Y •1 1 •-.VI �I:11 •/IA / •• Y•lel•^. N •• 1 Y •III • I• .•• 1 N:IN 1 �I o so to l of 7"114.777. 7 ti•�• �•• IIII./ •.• I ••• Iw //Y. • •N•• • •• , •./ ■el N • r1 •1 IU • I•—1 -••rU •aa111�Ilw 1✓. /Lr• It✓. • iI Y • • • • •J:•■ •11 •• 1 • NOR/e .•1 • / II I • .I• r 1.1 • • 1 W..w•••H .•• •1• .1•I 1• • • • .ev • w••• ����j/Vi%//////j/����j/�����///�������jjjjjj�����jj/�����jj�GiLGGGj� j����iG(/�i:!/����'H/j 1 1 11 11 1 1 1 � 1 ' I •11 1 1 1 1 11 • I I 1 1 1 1 1 III I 1 11 I I --1 i t 1 1 I I . 1 111 - • ' II 41 11 • 1 ' I The Town of Barnstable ' ' � a�xrvsresrt•; • Regulatory Services Thomas F. Geiler,Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied , . building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost Address of Work: ! elks 1-4 Owner's Name:`*"e5 Date of Application: 3 3® O I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law []Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. Date ame g1orms:Affidav .. rP EST/MA TED PROJECT COST WORKSHEET LIVING SPACE Value (high end construction) square feet.X$115/sq. foot= (above average construction) square feet X$96/sq. foot= (average construction) square feet X$57/sq. foot= GARAGE (UNFINISHED) square feet X.$25/sq. foot= PORCH square feet X$20/sq. foot= DECK square feet X$15/sq. foot= ` SSA OTHER square feet X$??/sq. foot= Estimated Project Value 5 5-o Total Esh ] � "an8xsrw8t.t: The Town of Barnstable 94, i659. �e� Regulatory Services _ Thomas F. Geiler, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-;90-6?=0 HOMEOWNER LICENSE EXEMPTION Please Print DATE: � c.7� � / JOB LOCATION: number street village .HOMEOWNER": `��e� s J�bt� n e home phone# work phone# \ CURRENT MAILING ADDRESS: o�oZ I' C�/�( Cp�p-q,�� e = 5VS--7Y3-Eel f J city/town state rip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to eng age an individual for hire who does not possess a license rovided that the owner acts as supervisor. p 'p 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 r ireme is Si of Homeowner Approval of Building Official Note: Three-family dwellings containing.35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S SON 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 pact of the permit application.that the homeowner certify that helshe 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:FORMS:EXEMPTN i SEP-01-99 e4:58 PM EDGE 19783734190 N/F E_LIS 100.00' 0 20000 S,r,t 0 Z. a C� sa r \ _ >�Lry Z Cover r- Q r wo I 100.00' N/ _LLIS' THIS IS A MORTGAGE LOAN INSPECTION FOR FINANCIAL PURPOSES ONLY. THE CERRf-CAI0;;ry ' PLAN:S NOT TO BE USED TO ESTABL SHI THE BOUNDARIES,FENCES,PLANTINGS. ADOHONS. SPECIAL PERMITS,OR VARIANCES. " REVISED: BY: LOCATION: `� U1Vlrj /nASS c :IrY/TCwn :IAIr Gnr • 23-AvG 7y ii1Ll+ Q fEE I. OEM AND huh REF EN ECE. J3 ( N.57A131°. ..__.. OF ULED..POW . Ofl'OOJ<TN _PA brPL 1 0 CERr $E IFICAIE Ur TI hUMBER' , 'P a. CERTIFICATION IS HEREBY MADE 10•` _ t ,. (*�1 Iva YL�� MORTCAOOR. JAM0,.S -{ R05£Mn12Y •MAILSM/ uoarcAcEE: QA V STATE A V r/Mtn S a4A r TITLE INSURER: Q_�TCT 4MEmICAH 'nTl.r, P•L. AiE '- �/// THAT THE EXIST.YO STRUCTURES AS SHOWN ARE SIIUArED ON ThE LJi UESIGNATED,IN COMPLIANCE WITH _S. : THE APPLICABLE ZONING BY-LAWS,FOR SETBACK, AREA AND FNONTAGE REOUIREMENTS OF THE MUNICIPALITY WHEN CONSTRUCTED,EXCEPT Wr'ERE OH IERmS[NOTED.OR ARE EXEMPT FROM T VIOLATION ENFCRCEMENT ACTION UNCEA".Cl. Ch 40A Sac 7, PfOfessl0n0( LQI'Q Services RE^ CERTIFICATION IS HEY MADE 14AT THC STRJCTURE(S)SHOWN ON THIS IS NOT LOCATED WITHIN A ENGIN��RItvG dE SURVEY SPECIAL F1000 dAInRC AREA(100 YEAR)AS DELINEATED ON THE FLOOD INSURANCC RATE MAP FOR: COMMUNITY Nc, 2 5 0001 PANEL No () GSC t4 6 S P.O. 90X 863 DnTEO:-�• , P Q GEORGETOWN, MA 01833 THIS PLAN WAS PREPARED USING(MTING RECORDED NFORMA10N,EXISTING MONUMENTARON,AND A DATA, AND D $TEL: 1979; 373-9950 MIXESSNO DETE MINATIONaAS TOl T iEPNT EXISLTENCEN OF$SSURFACF. S1RU TRINSTRUMENT SURVEY OFE .H;UREM�ES,OR PRESENCE , OF HAZARDOUS MATERIALS,NOR DO 'K REPRESENT ThAT EXPANjION tN' DIL'CURNENT USE POSSIBLE. FAX: (.978' 373-4190 CCU RUNT"t P0 211 11/26/2003 15:53 508-7535630 JJM INSUE'ANCE PAaE 01 "v l /A/l JAM, Insuarance A enc g Y 623 Chandler Street, Worcester, MA 01602 Phone: 508-791-1141; Fax: 508-753-56.30 Date: 11/26/03 'o: David Matos, Local Inspector .Fax#: 508-790-.62 0 3 Fray: . Jim Marshall I2a�id, I received.tbe following letter near the beginning of this month. We have not touched the barn since you stopped by. t have the permit paperwork completed and ready to present'to your . o.fces. t have-drawings and specifications via my friend who is helping me with.the barn work. I run;an.insurance business yap here in Worcester and this is:achy busy time of the year(January auto insurance renewal time). t simply :have not had a chance to get,away and come to Hyannis. I'm hoping to be able to take a day next week and go to Town Hall to get of the permit issues cleared up. Thanks,very much,'!'re'ally appreciate your patience. r 1/2612003 15:53 508-75356.30 JJM INSURANCE PAGE 02 x. Town of BaTnstable Regu.iatury Services sAnrQ MAM Thomas F..Ge.iler,Director Building Division OPn Perry,Building Commissioner 200 Main Street, Hyannis,MA.0260 Office: 508-862-4038 Fax: 508-790-62.30 Notice of Building.code Violation and Arder to Cease, Desist and Abate: James J.and Rosemary I Marshall'atl persons having notice of this order. As orwrier/occupant of the ' premiseststructure located at,20Captain Ellis Lu.,Hyannis,MA Assessor's Map 326 Parcel 039;you are hereby notified thai you are in violation of the Massachusetts State building code 780 CMR Section 110.0'and aTe.ORDERED this date N6vember 5,2003 to: l.'CEASE AND AiE5IST 1(MI)IATELY,all functions connected with this violation.on o;at the:abovc . mentioned prenmises. SUMMARY OF VIOLATION: 780'CMR Section]10A Application for.permit.. 2. C(IMMENCII!immediately,action to*abate this violation. SUMMARY OF ACTION TO ABATE: Apply.f'or building and/or all relates/permits. And,if aggrieved by this notice and order,to show cause as to yvhy you should not be required to do so,by fling an appeal with the State Building Code Appeals'13oar4(as specified in Articled,Section 1.22.of 780 CMR State Building Code)within forty-five(45)days after the service of this notice. By or David Mattos Local Inspector.. Q/FOR�vi.S/riolate i SECTIONS�NDER: COAqPLETE THIS SECTION COMPLETE THIS ON DELIVERY le Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent e Print your name and address on the reverse X rn ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery a Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item ? ❑Yes If YES,enter delivery address below: ❑ No � a56MAKI i46AQ 3. Service Type. )6 Certified Mail ❑ Express Mail ❑Registered Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7002 ::1000: 0005 : 0781::7952; (Transfer from service label) ' ' :: PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class'Mail' Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • TOWN OF BARNSTABLE BUILDING DIVISION 200 MAIN ST. HYANNIS,MA 02601 1�1III!t1lttlh till till!l:iLl J111 t!!�t!l3Sif�i�lEtlllitll3it� I 1 tiLn Er uurua� •. • �. . a 0FFICIAL USE C3 Postage $ S LO Certified Fee O2 O Postmark O Return Receipt Fee erg__ (Endorsement Required) e7YlrIW'! O Restricted Delivery Fee p (Endorsement Required) O '-q Total Postage&Fees $}. oSent TcJC �-a 5G�"17T� q r+. Street,Apt.No.; { fz4 .L_ or PO Box No. y�------------------- ------------------------ --- Ci ,S te,LP+4! ,` l M n / S t :,' " M �GJ �t(J/l,a^7f�1,•yUGC,l, C/.1N1 i Certified Mail Provides: , to A mailing receipt G A unique identifier for your mailpiece o A signature upon delivery n A record of delivery kept by the Postal Service for two years Important Reminders. e Certified Mail may ONLY be combined with First-Class Mail or Priority Mail.' o Certified Mail is not;available for any class of international mail. o NO INSURANCE',C(5VERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a�Return Receipt may be requested to provide proof of delivery.aTo obtain Qibm Receipt service,please complete and attach a Return Receipt-,PS Form 381'1)ato the article and add applicable postage to cover the fee.Endorse mailpiece.`Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. , o For an additional fee, delivery may be restricted to the addressee-or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a,postmark on the Certified Mail receipt is desired,.Please present the arti- cle aY the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,April 2002(Reverse) i 102595-02-M-1133 i � �- _ � �� ��� j © C � ,��S � . �, ��-� _.... _ .._.. rt. • x 1 .. - 1 4 OFTNE fn Town of Barnstable Regulatory Services • &UNSTASLe, 9 Mass, g, Thomas F.Geiler,Director i639.'OrEDMA'ta Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 . Office: 508-862-4038 Fax: 508-790-6230 Notice of Building code Violation and Order to Cease, Desist and Abate: James J.and Rosemary J.Marshall all persons having notice of this order. As owner/occupant of the premises/structure located at 20Captain Ellis Ln.,Hyannis,MA Assessor's Map 326 Parcel 039,you are .. hereby notified that you are in violation of the Massachusetts State building code 780 CMR Section 110.0 and are ORDERED this date November 5,2003 to: 1. CEASE AND DESIST IMMEDIATELY,all functions connected with this violation on or at the above mentioned premises. SUMMARY OF VIOLATION: 780 CMR Section 110.0 Application for permit. .x 2. COMMENCE immediately,action to abate this violation. SUMMARY OF ACTION TO ABATE: Apply for building and/or all related permits. And, if aggrieved by this notice and order,to show cause as to why you should not be required to do so,by filing an appeal with the State Building Code Appeals Board(as specified in Article 1, Section 122 of 780 CMR State Building Code)within forty-five(45)days after the service of this notice. By ord David Mattos - Local Inspector Q/FORMS/violatel Town of Barnstable f 1KNE '0`'tio Regulatory Services P Thomas F.Geiger,Director BARMABM MAC Building Division s639• '°rEn tom" Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 COMPLAINTANQUIRY REPORT Date: Rec'd by: Complaint Name:J11v7 In/;n s, c Map/Parcel R S 0` - 000 Location. Address:_ a C.9�°T �,.� L c < CAI Originator Name: Street: Village: State:. Zip: Telephone: Complaint Description: /°y ` S To /10 1//a 0 A Pr/r �Jct zzo .7 FOR OFFICE USE ONLY Inspector's Action/Comments Date: Inspector: 1 Additional Info.Attached - Q:forms:complaint l j �j Barnstable Assessing Search Results Page 1 of 2 Home: Departments:Assessors Division: Property Assessment Search Results ......... 20 CAPTAIN ELLIS LANE Owner: MARSHALL,JAMES J&ROSEMARY J Property Sketch Legend Map/Parcel/Parcel Extension 250 /030/ So 6 V 6 Mailing Address MARSHALL,JAMES J&ROSEMARY J 22 HAVILAND ST3 WORCESTER, MA.01602 2004 Assessed Values: ' Appraised Value Assessed Value ' Building Value: $87,400 $87,400 Extra Features: $2,300 $2,300 Outbuildings: $8,800 $8,800 Land Value: $164,200 $ 164,200 Interactive Property Map: ap requires Plug in: Totals:$262,700 $262,700 1 have visited the maps before -, Show Me The Map m„ April 2001 photos available _ Sales History: Owner: Sale Date Book/Page: Sale Price: MARSHALL,JAMES J&ROSEMARY J 9/3/1999 12520/275 $ 118,000 LEPERA, FRANK A&RITA B 10/15/1986 5331/325 $ 105,000 BEAUCHAMP, NICOLE C 1/15/1986 4888/081 $91,300 KLEPSER, NANCY A 1.4131059 $0 2004 Tax Information: Tax Rates: (per$1,000 of valuation) Tax information will be available on.10/15/03 Town Fire District Rates Other Rates 6.61 Barnstable 2.01 Land Bank 3%of Towi C.O.M.M. 1.10 Cotuit 1.52 Hyannis 2.03 West Barnstable 1.36 http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 10/3/2003 1 Barnstable Assessing Search Results Page 2 of 2 Due to rounding differences these values may vary Land and Building Information ` Land Building Lot Size(Acres) 0.46 Year Built 1953 Appraised Value $ 164,200 Living Area 1550 Assessed Value $ 164,200 Replacement Cost$ 111,990 Depreciation 22 Building Value 87,400 Construction Details Style Cape Cod Interior Floors CarpetHardwood Model Residential Interior Walls Drywall Grade Average Minus Heat Fuel Gas Stories 1 1/2 Stories Heat Type Hot Air Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 3 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 1 Bathroom Total Rooms 6 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL2 Fireplace 1 $2,300 $2,300 BRN3 Barn 1 Sty/Lt 400 $8,800 $8,800 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 10/3/2003 113117141 Assessor's map and lot number .......................................... Q /� SE�i'90. SYSTEM MUSTgBE Sewage Permit number ' far,' F I� STXrE 5A4'`I€f„y CODE AUD TOVM Q�ofTHE 10�0 TO WVN OF BARNS` X"w1uh 33ARMADLE. i ° "6 ,•� RUILUNG INSPECTOR am a' a{. r /� j� APPLICATION FOR PERMIT TO .... G3! C... ......[...►.. .!."' .5.. .............................................................. TYPE OF CONSTRUCTION ... 11.../4.iY. '> !'.......................................................................................... j �d 4:-/..444. 3.-�'-�......19- ......... . ..... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .........Cl. �.. ./�7!dGet ¢h 19c �i, � r�.�l ......................................................................... .... ... .... .................. ............... .... ProposedUse ....... .C!F.L .0..01pts..............................................................................................................I......................... Zoning District .............P.C-/.........................................Fire District ...d44f 1a.4�R.............................................. Name of Owner l..YG'kc ...../•%�.A...l��5-+�t ...................Address ....A d#?A! $'S............................. Name of Builder ............................Address ...... H.4;✓.6J1 -{ `� 55.4................. Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms .........s1....................................................Foundation ...........:.................................................................. Exterior ........ /.. ! ./e...T.................................................Roofing ............................................. Floors ....... 4r,WOC ..........................................Interior ...........51.6-c'.t. .e�A\.......................................... Heating �.1'-C-er/...g Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost ............ 1.J...��..`.®..�ga ...... ......................:..... Definitive Plan Approved by Planning Boar -19--------. Area �.�.... '� � O Diagram of Ladand ee .. ....- -.. ............... SUBJECT TO A PROVAL OF BOARD OF HEALTH • i r I lr v � � x � D 4 i I I hereby agree to conform to all the R Ms-and—Regulafions of th'e Town of Barnstable regarding the above. i t construction. + ` Name ...I/../, ....... . ....0,A/-./4�.. ........... Klepser, Nancy A. No ...�66... Permit for ......dormer .... ......... .... .. . ...... .. ............... el 'K 0 1441--L', .. ..LS... Location ................................................................ Hyannis ............................................................................... Owner ........Nancy.. ............................... .. .... ........ ...... Type of Construction ....................frame...................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ........Januax7. .........19 74 ........... .... .. ..3.1.. . 1, f Date of Inspection-4m*..��Ae-a� Date Completed ....................... . PERMIT REFUSED ................................................................ 19 ............................................................................... ............................................................................... ............................................................................... ............................................................................... Approved ................................................. 19 ................................................................. ......... .................. ........................................................... ------------ -Fla- CA tooI rc --------------- IT ...... ---------- CR On;! 14 ------------ .......... ........... ......... ............. .. .......... ............. wo ---- ---------- L .........- ...........- TvAk 10, WA -W I'S A JAI M4 ------------ ---------------- If L ' DI { I , T _ I-AAA -- ------------.----! -�-� ------ --- II �— '- !— I I i I � i } I I j r � ; �. � . , { � � { i I t - -- --- — ---r I I---�---"I----I_. 7q� 5 3, CYwore .6 7-T CAM IOU; rc ............. CP,4; rear eiq 36, !balu .......----------- P�l ................ I � I � ; �� � ! ' I I I � I I � � � � I I r � l I- I I. ............. i i �.., { I ........... ........... ------- ...... ........ f. -------- --- .......... ------- ------------- ... ------- II f -------------- . ....... 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