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HomeMy WebLinkAbout0079 CAPTAIN ELLIS LANE r a' .:";}'0•�..,..,. ..wf3kYf' 'r:yq•,Rrv`>,t.+Yt+•.N.w. .+.Ir">r:a..:N` ;.,.p4i y. .r;.% gy. -.:.r, ,sy...e..ti rti -.'";+ -h,y v..v..4J,sc_:2- _r t'• .-a .. ::x:-...•..,.y;a,.,•...v.•,<...»,r..:.. Town of Barnstable °Ft"E'°'+; Regulatory Services' Thomas F. G61e'r; Director •;BARNSPABLE. " MASS. Building-Division Thomas Perry..CBO, Buildin • g Commissioner I 200.Main Street, Hyannis,;IVIA 02601 wwwaown:barnstable.ma:us Offtce-: 508-862-4038 Fax: 508-790-6230 EXIT.ORDER' f DATE: f r�' �' L S A-PT� LOCATION: � /!' ►�"I C 1 UNDERTHE PROVISIONS OF 780,CMR, THE STATE BUILDING.CODE,. SECTION 3400.5.1, YOU ARE�HEREBYbR'DERED Tb IMMEDIATELY DISCONTINUE THE USE OF THE CELLAR/BASEMENT AREA FOR SLEEPING PURPOSES. LOCAL INSPECTOR IGNATURE OF RECIPIENT ODEM DE.SAIDA., DATA: - LOCALIDADE: DE ACORDO COM O PROVISORIO 780 CMR, CODIGO DE-CONSTRUCAO DO ESTADO, PARAGRAFO 3400.5..1, VOLE ESTA ORDENADO DE DEIXAR DE USAR, IMEDIATAMENTE, A AREA DO PORAOBASEMENT PARA O PROPOSITO DE DORMIR: INSPETOR LOCAL ASSINATURA DO RECIPIENTS_ d 1 I f DATE: March 12, 2012 4 TO: Building File .; FROM: R Anderson w RE: Complaint=Basement.Bedroom Lacking Egress LOCUS: 79 Capt Ellis Lane, Hy'` Reported to site today with 2 officers (Geno & Chris) Tim O'Connell'& Paul Roma.-. Admitted to dwelling by older female-resident'(Lin a BOnia). As;the result of arrescue call over the week-end, EMTs found an unresponsive young male downstairs,in.the makeshift bedroom. He was transported-tO CCH and remains-thereon this date. The response team was concerned that the room had no egress;and'subsequently Lt. Cosmo made me aware. I immediately coordinated an inspection,effort and contacted'the PD to have a cruiser meet us as recommended; not-only due to the nature of.the�call.but that the residents were reportedly less than cooperative. . ' z Found property to be assessed as a 3 bedroom':ranch. Once admitied,•I observed an,. elderly woman seated at the kitchen table.'.Four small dogs were inthe.home,,two behind':, a gate in the living room; one outside and a pug running around our feet:-N's Bonia`Y indicated that the stairway to the lower level was just on the other side of the-interior kitchen door. (The initial entry is a"mudroom/porch area)ry We did n66nspecfthe`rest of', the house. Ms Bonia was upset that we were there ;'She ranted on about being inspected by Health and HAC already and admonished the police officers that they yalready were here and searched the house. She was assured{that,the PD"was here now only to keep the peace.- She was argumentative and`combative•swearing conversationally'and venting at .. all of us but not directing iti to anyone person and yet she proceeded to"let all of us in anyway.- We found the basement to be',a typical unfinished;:primitive`.area-containing a washer and dryer. The front portion of the basement area contained a twin sized bed with laundry ; and clothing stacked on top and a.walk4n closet behind a proper door. A small ` refrigerator was beside the washer and-dryer'-ah&large freezer was on the opposite side. with a sign posted reminding everyone to make sure the unit was closed An area was walled off but had a 5' opening: The tenant,:Linda insisted this:was opened up at the direction of a health inspector in order that this area would not lie counted as.a a bedroom. Because there are three bedrooms,upstairs on a three bedroom system, an, additional bedroom would be in excess w.of, is allowed,as a=matter of right.:This segregated area backed u .to;a walk-in closet.on the end'.x ~ P _ =far A The unfinished 5' opening-was covered by a heavyhanging blanket This room was set UP with a full-sized made up bed; a°sitting area with'a sofa and table and a closet. Personal belongings were scattered throughout the roornIncluding posters,'photos and"" toiletries. (see photos). HY PD confiscated a marijuana pipe left in-'the open" The tenant` is unhappy,;claimed . ownership of the pipe;stated she'smoked to;tak6 the;edge off of tier nerves but clarified that she doesn't smoke in front of her grandson(even though the drug paraphernalia was in the basement in the vicinity of the sleeping area). A debate on the merits of decriminalized v illegal and what one is legally allowed to possess ensued. This continued as we exited the dwelling and seemingly ramped up as we approached our vehicles.,Linda was still swearing"and arguing as we drove leaving, ` the police to deal with her. She was not arrested as the cruiser was expected to accompany us at another location. . j 79 CAPTAIN ELLIS, HYANNIS 3/12/12 - o i 1 � 79 Captain Ellis Lane, Hyannis 3/12/12 a s eRIWARD ma Ik3 - 80�_ �� - •8�-�(��.'�� Y _ � ,, ,� "/,off 6-9 r x +� �;,, va-spix" s ,1 rt _ 1 t y �tiYY �s rr • ,t „S A ` 8k t jy s' t ._: �4 Ilk r r 1 i ��� ..� ry,�•A.s � � � �) Fit +a� rye i k k t A � si.4� F{kl.• if 41 A y ! 'f 9 s rn r v CD 77 d _,. ,._ } ,� ...� .�� .,. _ � E �;+�. �'-. �,_ - �„ ��,� -- �; >� - � _ ��.. f� ;.�: ., �+' �— �r '�'r, �� � *f•: �= e ,,;:;,. - '' �a t ��� •� - ----- � � = .. e.� <, {� � "ems. t 1y� ,�� � Y �. �. 1� ; � - -s • I � I ` _ 1 _ i r � td ��-.. r� •N.�©b`j, -0 1' , OVA y`. yy s. f'lh� � - �'cn ��y 4 i�: • • i tia � F � ,Y 9THAE ow • t: .� IDES `��. a r C. k t ♦r � t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r �< Map A Parcel` pP A lication # _ Health Division Date Issued 4 Z C1 ,Application Fee Conservation Divis' n r; 'Planning Dept ;Permit Fee Date Definitive Plan Approved by Planning BoardPIZ „ Historic - OKH _ Preservation/ Hyannis IC roject Street Address ✓� �AAi.r1e \ illage kiwner o J Address C L � ® Telephone Permit Request J1-b Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation _300 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 Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove '0 Yes) ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn ❑ existing O new ze_ „ems Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other - _ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ k ' Commercial ❑Yes ❑ No If yes, site plan review# carn Current Use Proposed Use APPLICANT INFORMATION ­(BUIL==DER-OR-HOMEOWNER) Name �' Telephone Number Address aq 1 G`G'r4_,, License # A-46'ViA Home Improvement Contractor# t Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE � J�'VP�'� � '` DATE / LI FOR OFFICIAL USE ONLY " APPLICATION# lit r DATE ISSUED t= MAP/PARCEL NO. R ADDRESS VILLAGE OWNER DATE OF INSPECTION: a FOUNDATION Sr FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL R FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street + Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City_/State/Zip: Phone #: a Are you an employer?Check the approprife; _ox:� Type of project(required): 1.❑ I am a employer with 4 m a general contractor and I employees(full and/or part-time),* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition workingfor me in an capacity. employees and have workers' f Y P Y• 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ quired.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.EJI,am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4);and we have no employees: [No workers' 11D 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. xContractors 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.M Expiration Date: .. Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised.that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do-hereby certW under the pains and penalties of perjury that the information provided above is rue and correct. Si nature: �'" f Date: Y U Phone#: 6 d (s Official use only. Do not write in this area, to be completed by city or town offciaL I , 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#: ' r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwellinghouse having not more than three apartments and g p 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 P g or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." emp oyer. MGL chapter 152, §25C(6)also states that"ever state or local licensing agency shall withhold h Y g g y d the.issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, °°MGL chapter 152, §25C(7)states Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-,insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A n.ew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number:. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 ww,w.mass.gov/dia The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers r plicant Information Please Print Legibly me (Business/Organization/Individual): ress: /_State/Zip: Phone #: .! 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 e ployees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction Col .�I am a sole proprietor or partner- listed on the attached sheet. 7. [] Remodeling , These sub-contractors have ship and have no employees 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp, insurance. _ uired.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3- I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 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.M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. ' I do hereby certify it, er the pains and penalties of perjury that the information provided above is true and correct. Si nature: Date: 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#: '2i r _ ° TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date 11 /�l Uhl Time: In %®•.0 0 Out . 16 Owner jlL�( cav2R Tenant Li 04 ,' w Address 2 L t5 k A'Z c? i✓L.LLIL Address 71 fA Ing ' LA Oa . yr'lA t s` �1.� A4 1-4 � _Compliance Remarks`or • Regulation # Yes ° NO Recommendations 2. Kitchen Facilities ° 3. Bathroom Facilities Y y 4.Water Supply 5. Hot Water Facilities 6. Heating Facilities S 7. Lighting and Electrical Facilities 1v f6DS 8. Ventilation - 9. Installation and Maintenance of Facilities ?; 10. Curtailment of Service pt �. 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements „ (�.�ea 3 . : 1�✓v�i'Z 1' - "� i:��ti'( 14.Insects and Rodents 15. Garbage and Rubbish Storage and Disposal -V- !� �( 16. Sewage Disposal t�. 17..Temporary Housing " � w r 18. Driveway.Width 19. Number of Tenants Observed 4 Y e f "• 4 PART-.II ti • , 37. Placarding of Condemned Dwelling, Removal of Occupants; Demolition .Number of Bedrooms �Ri> Number of Vehicles+Allowed (max) Number of,Persons Allowed (m x) Persons) Interviewed .' y` Inspector 22S If Public Building such as Store or Hotel/Motel specify here Town of Barnstable o Regulatory Services Thomas F..Geiler,Director BARNSTABLE, • - HAS& Building Division 03.pTED �a 9. 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 DATE. JOB LOCATION: number 2 street village "HOMEOWNER": b ` `5SU (�; 57 bv� me / h�E1ome phone#��> work phone tl - CURRENT MAILING ADDRESS: ofI cityltown 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 Persons)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 requireL nts. Signaturemeowner ilding Official Note; Thme-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\ORMS\homeexempt.DOC THE ri, Town. of Barnstable Regulatory Services " anaxanADLE. Thomas V. Geiler,Dfrector Huss. 039. � Building Division Tom Perry,building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the . Homeowners License Exemption Form on the reverse side. Q:PORMS:OWNERPERMISSION � VVV �`a f 7 _1 Town of Barnstable *Permit# 3r`F7 P �•w Expires 6 n onas from issue dare a Regulatory Services 'cb , ���� Thomas F.Geilery Director Building Division JUL Tom Perry, Building Commissioner I .5 2005 Office: 508-862-4038 200 Main Street,.Hyannis,MA 02601 TOwN OF SARNST ASLE� ' Fax; 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X Press Imprint ap/parcel Number operty Address �� c�1 Z` i ,S esrdential Value of Work 1L J J Mfnimum fee of$25.00 for work under$6000.00,;C � wner's Name&Address U s!?i) ontractor_s_Na:oae . Telephone Number ome Improvement Contractor License#(if applicable) onstruction Supervisor's License#(if applicable) ]Workmen's Compensation Insurance Check one. ,I a.sole proprietor am the Homeowner ❑ I have Worker's Compensation Insurance l� tsurance Company Name Torkman's Comp.Policy# 'opy of Insurance Compliance Certificate must be on file. ermit Request k box) roof(stripping old shingles) All construction debris will be taken to El -roof -roof not stripping. Going over existing layers of roof) e-side . Replacement Windows. U Value (maximum.44)- *Where required: Issuance of this pm=it does not exempt compliance with other tows department regulations,i.e;Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. H%na Improvement Contractors License is required. ligaature 2Forms:cxpmtrg • Levise063004 • The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 .•�° www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/Individual): Address: City/State/Zip u- Y S 1 D2_,kz�? " .Phone#: � .��� 7j,6,� Are you an employer? Check the appropriate bog: `.' - Type of project(required); 1.❑ I am a employer-with 4. ❑ I am a general contractor and I 6. �;emode e ustruction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ 7• ling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition ' comp. insurance 5• El We are a corporation and its �o workers officers have exercised their 10.❑ Electrical repairs or additions r ] g ri t of exemption per MGL 11.❑ Plumbing repairs or additions 3. am a homeowner doin all work mP P -c.152, 1 4 ;and we have no myself. [No workers' comp. § O " 12.❑ Roof repairs insurance required.]t employees. [No workers' 131-1 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 their workers'comp—policy-information. - I am an employer that is providing workers'compensation insurance for my employees. Below is the policy dnd 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 coverage verification. I do hereby certify under 1he pains and penalties of perjury that the information provided above is true and correct Dater Si ature: V 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 Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employes. 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 or the of the foregoing engaged in a joint enterprise, and including the legal representatives of a deemployees, easlo eeed ls lHow�ever, the receiver or trustee of an individual,partnership, association or other legal entity, employing mp Y 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 deer he w-employer." MGL chaptei 152, §25C(6)_also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or commnwealth for any permit to operate a business or to construct buildings in theo applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter_152, §25C(7)states `Neither the commonwealth not any of its political subdivisions shall the erformance of public work until acceptable evidence of compliance with the insurance enter into any contract for P 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), addresses)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(I:LP)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 - - this affidavit may be submitted to the Department of Industrial c y is re u q ire d. Be advised that _ `Also be sure to sign and date the affidavit. The affidavit Accidents for confirmation of insurance coverage. 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/hcense number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in . (city or town)."A copy of the affidavit that has been officially stamped or markedby ena new city r town may s affidavit be filled out to each applicant as proof that a valid affidavit is on file for future permits year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia Assessor's map,and lot number ... SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Sewage Permit.number :. WITH ARTICLE 11 STATE tr SANITARY CODE AN :'TOWN r' QyOF'THE TOWN O F BA.RNSTALB(INE ' t.i rod' _ �•n � Z BAHB9TADt i j 1639. r ° om���� : w BVILDIHG IH.SPECTOR APPLICATION FOIE` PERMIT TO 4� .............. - !�7!!P.. ....�r�j�........4-1 TYPE OF CONSTRUCTION .... ......Q..4 ...................�e� ...L�. ................. .......... k TO,THE-INSPECTOR OF BUILDINGS: The undersigned hereby applies for a ,,peermit according tothe following information: Location ..........7.,�...........�/siT��.,�i ..ri4,r....... �ll.`.e�.......... ... ........ ........... //"" S Proposed Use ......... .... . ..� /�ta ........... iG ' : ... ..} .......................................... ZoningDistrict ........................................................................Fire District ....................... Name of Owner � .....!�. ..F. ../.�,:e.4r-, ..........Address .............. its./5�/'.'r�....................... . Name of Builder RSr� ...�r�l -,' v4�'/Q Address .SW.7 0 �'li`....�................. Name of Architect ............................:.......:.............................Address ... �.C.t. �yrQ.C;..................... Number of Rooms .................................:..........................:.....Foundation ...... �.. ........... ................................ .......................... Exterior ........C....../..'' ...................................................Roofing ..........�Q........ ......! ., `........ Floors .........!'v...�N 'L' +�..f........................................Interior ........ .................................. . ..... ..................... Heating ......... e.!?..Ae�!..................................................Plumbing ................. ..... .. ....y K - . Fireplace ........... .......'......................................Approximate Cost .............%-::�-,Oo"'Oe......................... . ............. Definitive Plan Approved by Planning Board ----------------_---------------19________. Area ..................... .................. l Diagram of Lot and Building with Dimensions Fee L ...._' I SUBJECT, TO APPROVAL OF BOARD OF HEALTH _V Al ,Gr►ow V c Y0 hereby agree to conform to all the Rules and Regulations of the Town of.Bernstable regarding the above construction. Name .. ......................... ......................................'........... i Childs, Ethel 0720164 add to dwelling - ,j No ................ Permit for .................................... s 79 Captain Ellis Lane Location ................................................................ Hyannis =. ......................... ........................... Ethel Childs Owner .................................................................. frame } Type of Construction .......................................... ...................... ...................................... ..................... -- !, Plot ........... Lot ................................ .: I May 3 78 Permit Granted :.19 Date of Inspection ........ ...... ....... 19 Date Completed ................. . e� .19 a 4 PERMIT REFUSED i .............................................................T 19 ................................................... : ... ........ x .. ............. - .............. .................:......._.............. ...................... .. ...... Approved ................................................. 19 r. ............... .......................................................... ................................................... . .... 1 , I 5_ r A Ssesso6 map and lot number ...}.. .....z-j:..................... •«y j! Sewage Permit number °`T"Er°�y TOWN OF BARNSTABLE I BasasTdnLE, S 0 9 ,e�� BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....C c..�:.'":I '.:�r::.�.��.........�-`? r���..P g9 ... ...`.....j�..`.... .. TYPE OF CONSTRUCTION ...............�,�C,...... ....................... ... .e®, ......................................... .`:: ......-.`�.........................19. G TO THE INSPECTOR OF BUILDINGS. The undersigned hereby applies for a permit according to the following information: Location ................!............ ....—..'� �s °s.�::.... :....... l' `.'..........�.�/`...:........:. ^;; ��..�''.......... r Proposed Use ...............t.�.`. . ... •-..!......................................... r, ZoningDistrict ........................................................................Fire District ........................... .............................. Name of Owner ......................... !' Address *�,� '-�ter-"s Name of Builders'... .... /: fi7'` G?� ✓Address .�`�'I .-'!' V..y4�., �,G...1'................. Y Name of Architect ..................................................................Address ?',! ! ra/ '..:."`.�1 Numberof Rooms Foundation . ..��:::� ~.................................................................. ........................... ..................................... Exierior � +��� �' .....Roofing c 'd x .tr-� !�` ............".............................................�_. .. ........................................ .................................... Floors .:�.'.`:="�'" ....................Interior Heating f g ......................................................................Plumbin .......................... .......:............................................. Fireplace ...........::' f..... ..............................................Approximate Cost ............�...L-...........................:.............. Definitive Plan Approved by Planning Board -------------------______ ------19-------- . Area ...`':^':'................................... Diagram of Lot and Building with Dimensions - Fee ' .............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH i \r. i t\ I I hereby agree to conform to all the Rules and Regulations of the Town of.Ba rnstable regarding the above construction. Name .................... �� .. �..`?........... Childs, Ethel A+250-101 t a l � 1 i 20164 add to dwelling No Permit for s ............................................................................... Location 79 Captain Ellis Lane s .......................................................... Hyannis ............................................................................... Ethel ChjjAs Owner ........................ ..... ................................ ' frame Type of Construction ..... .................................... .............................................. ............................ Plot .............. .. Lot .......................... T i• r Permit Granted ................................. May 3 78 ..... ........................19 Date of Inspection .. ..................................19 Date Completed ......................................19 PERMIT RE USED ..... ....... !........ 19 ' .... ......4. 2. .. . ...................... .......................... ............................................... . ............................ ........................... i Approved ................................................ 19 ............................................................................... ............................................................................... Zlo....47.;... g-7lvAs'sesso�s ..map and lot-�n ber ..... ... - ti 7' SYSTEM MUST r� �� 2 STA(LE IN COM Sewage; Permit number C ............... .............................r,.-......:.� D PLIAN fo - WITH. ARTICLE'Il STATE a SABtN1T'Afa r QyofTHEro�� ,. TOWN �OF BARN 9�TAI `L �D T , itd i BARNSTABLE, i jI9- ` RUhLDI'�NG INSPECTOR O 3 �Fp MPY a � �. • APPLICATION FOR PERMIT TO .E...... .. .. ....... c. ............. :«..... ...............a.... TYPE OF CONSTRUCTION ....... ................t�...l l}-O.Q ........................ :. . � .................. TO THE INSPECTOR OF BUILDINGS: The undersigned h eby a�plies for p rmit. according to the fol information: °-�- ,, Location. ................. ................................... . . ..............�C-�'� ............ ........................................................... ProposedUse ....... . " ........................................................................................... ............................ Zoning District .......... .....................Fire District ................. ....o............. ... ...........:.... .................. Name'of Owner . ............... ....... .. ...................Address ..Z .. .... !K�................................!T!�' .,.�. Nameof Builder ....:..... .........................................................Address .................................................................................... Nameof Architect ..................................................................Address ................................... ............................................... - Numberof Rooms ........................`..........................................Foundation ............ .. :. .. ::..:. ....... .... .... ............................ 1 �� ,/ ,.....................................Roofin Exterior ......... . . . . .. .... g ............ .. . .. . .................................... Floors ,. . I ............................................Interior ...................................:.......... .................................... M1 / <r at Heating / . ......................................................Plumbing ............ .. ............................................. Fireplace .............................. ....:.............................................Approximate Cost .....................:...........�J./......�............... ......... • Definitive Plan Approved by Planning Board _______________________________19________. Area /C .�!.... Diagram of Lot and Building with Dimensions Fee 5 ........C9L/........................ SUBJECT TO APPROVAL, OF BOARD OF HEALTH � S I hereby agree to conform.to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name: .:......:..........................:... Breen, Joseph t 8. 91 7 one s tory, ` �......... ..... Permit.-+for..;................................... _ Ingle family -dwelling .. ............................................ ............ Nl\ ` Ca t. Ellis Drive. Location p _ Hyannis - ........Joseph Breen Owner _ r Type'of Construction .............frame..............:... -� _ ...... -..`.... ................................................. Plot ...:.r..........: .......... Lot ..............46............. _ a .Permit Granted•.......November 2 ? 1 q 76 .................... Date of Inspection * 4 y Date Completed . . ���t ...........<..........19 PERMIT REFUSED. A ....................... .................................... 19 ` .................. ........................................................ ` .................. ............. .................. ........ `! .................. ......................................................... > �. /.......................... • .......................................... • �' . , - Approved ................................................ 19 .............................................. ... ... .................. t ........................................................................... Assessor's map and lot: number ......... 4.7.......... o-7 -. Sewage Permit number 2 T"E.T°�� M: TOWN OF BARNSTABLE i 'BARNSTABLE, 1 7, AfiL 6 9 �•`� BUILDING INSPECTOR e Mav a• ` L APPLICATION FOR PERMIT TO n TYPE OF CONSTRUCTION . � .. 1 ....... ..:....�'..?..................i wK TO THE INSPECTOR OF BUILDINGS: I The undersigned hereby applies fora permit af_ccording to/�he followiing.:information: 1 Location ........../C?.............' .........(. r'..�1' ,.......................................l'- 1 e �a1................................................................ ,Il,,/ •,,;..;�i...�.... Y"� .. Proposed Use .............. ZoningDistrict ..........A..............�.j...........{..................................Fire District ....................... ............. .................................. Name of Owner .. Jt,........` ':1:e >...,-........Address .. ..1....�w??...... ��..........'........... r Name of Builder .....................Address r: Name•of Architect ..................................................................Address .................................................................................... _ Numberof Rooms .......................T......................................Foundation ..............::„ ;.-'......,.................................. -..... / ..- P...................................... Exterior ................. .....-"", :._..:......;.........f�........................Roofing ........................................... .... T Floors .....................................Interior L. a7let Heating ........... ...........................................................Plumbing ............ :....,..... ..` ........................... ................... Fireplace ............................. .......................................Approximate Cost ....................................................... .:...... Definitive Plan Approved by Planning Board ________________________________19________. Area ' g1 F r . Diagram of Lot and Building with Dimensions Fee 1­2l ' SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. - -- Name ......... ..................................................... mraeu^ Jmmeo6 A=I50~101 , . . 18791 - one atmry, ' No.---'�—. Permit for -------.�---.. tingle family dwelling .-----. - ^ ----_.~-------- ' ' .Cap� 8ll1a Drive ` Loco�on --�.--.—..�--.----._------'' ' . Byaoo1a ' ' ----..--------.-----..--_--- Owner ...............Jpoeph...Braeo_.�______. � . Typo of Construction ----fra Construction --me-------- ' ' --------.—.---------^------.. ' ' Plot ............................ ^Litt ........ _ #6............... . ' - ' November2 76 ' Permit Granted ....................................... .lg Date of Inspection ....... ------_--l9 Dote Comp�fe6'-------------lq � . . ^ . . . . PERMIT REFUSED ' � '----'---.'--..--------,. lV � .----.----^---.�.-----.'--..�---' . ' � ~ . ^ —__'_-'--.— - . . . . . . . ' v -------.-- ��.--------.. -------- ........... ' _ O D / s�o a9 T7 '7 �Q Ti / Ce c� u✓ Zt•t4 f V1U.3 TA_� 0Cr•.-r/C3A/ oa6 s 15 ,L3edr00Y77 /yof�l v0 ' iC Q/S�►v3 r B 7¢ g-z. Z o � r� 7 - sY.s —, /AO'4 ss. c'o de , T i le S k -7 a * O 4 o I CERTIFY THAT THIS PLAN SHOWS 4 THE ACTUAL LOCATION OF THE STRUCTURE ON THE LAND AND THAT IT CONFORMS WITH THE ,00 BY-LAWS OF THE TOWN ` /1,74 �I t LAN OFLAND /V MASS. Ceti Nrr o BY FRANK n FRANX FMNK CONERY S, TRENTON ST. t� CU(V ER�! y �' CJNERY y 5573 HYANNIS. MASS. 02MI aXMgr'vAX0 dN0jt 9N. a LAAo ►*St 4yo'st yp� �� -�v,�1;�i " SE 1 1N s�'0i ', t�c- 5 f97 ;{ ,,. 11R f'"� ors.,,,: SCALE