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0005 CASTLEWOOD CIRCLE
���Si�.�-���� ��f� .� A LT'ER N.AT IV E WEATHERIZATION Date: .04 Town of Barnstable 200 Main St Hyannis,MA 02601 Re:Permit# 'r;? �'• .r,',�'��+• "'���';':i,s.$"' '•' '�9;•'• a;,•Se;4i�:••y,'S^'.''".'.+ �.i�.. :';?:i�;�'•:r%°',1 r .!%5::: •.,�(.�.;...r,1'�' .''1'� � y,...C-4 .!.Y Nti__•l.y.;/;;:: . .: we mark at a insulation a a Al 'a.•'iQ: �>„ . ' <r,.,:�1-;'.`�':n: y., ,.,..•f i .;, •;�+r':"�;;_':'•': i4'�sbeen com let '.. din wt � -�1":an,•=;:r!;','f71 S1 7t• .. ,"%'rir`ii'S�;:�.+L ••?•: %'7:• °"�:•-�:b_:./. _ _ :��? .':7;1>.:•+aa:A..'Q!;.;5: :i "f,'�4u:'( a"n aSta'.Iy•:tn �•j::li<�: '+i�'� '..a� :i_�:^'r.'ei:" :¢� :aQ�,%�;ty.�fr.w•,..:4::.�� V'�'i'="-,•;;�;.�z::;` rw" ...,. � s��,_iic'^h"yrr - ••�4 , s.• ,i,'��„L>-.,f';^'•i-"i-�;;;~' ;:�:;,;�_:,i :�bts?;.� .eiy�'•;.z'?';.'tLEy,::�.i •N',.fr •�.J•;'�•,--5.; ,i:_•`=;:r y;��;;aF:�;.y.: '✓i;i�ti '.ti•�_5:�'�.',,�d;: c•,:<5.} i;•. .:.'•t�'�{ �'}''.'I.t—`ti,�` .:�:•':e�:kd.r:::P:�`=;iY'� G, ..h<'Y':" 'r4',° :,i• t•`��,��5�-• ,C%�;f',"•., ::S,y i:'•;�'"•�"a:.'�: f'i.���i�l• • � �rC.l..a'� ,f �:J.st v [:195�.y_ .l,. :�"Y,'y J:\ia ':W5r4.2�..,,„;.�.� �-I`7'',il.ii`'�.i,;.�c\ NryS:�'.5:,'.J�'-"�:J'l:•.P};T Y:•'J�'11... ,•�f7,�;+.;�';����I,;.,rin • f�K.k..,_ •:r';t"hy',� ter•.. �,. :F4"��Tii;7`�iR�'.,a.7..(.}i.4,��e ni'r� !.� n� �./'i ^`4 `k,'..'�•;;�:� .�,:;�rS_^.'ii:i�'Y�Y;;•:`,c'+:•�';'L,;.�;:;�r{C� • ..(:•c+�%%"2'- i+'��..;'.v;iJ .u-,. •"tea.::'f_�, Timothy Cabral, President ,CSL-105454 58DICrJNSONSTREEr I FALL tiiY R,MA,02721 J' (508) 567-4240 I P;LTERNATIV I.EkTI IZA�T10�J GM;AIL.COM,. / ' Town of Barnstable Building Post':This Card�So�That itx�s Uis�bleFrom the Street=:A \#pproved�PlansgMust be Reta�ned o�n Jobs and this Card Must;:be Kept �.: �ANdiS'C'AtTLCS, • 5 :W 'a �a '.t, - g r2 ' �*%' a a "1 �$ 6"� `� Posted Until,Fm�al Inspection Ha een Made , z� � � � �, :. h , , as Where aCert�ficate§of Occupancy is Required,suchBuildmg shall Not b�Occupied until Final Inspection has been made Permit Permit No. B-18-4109 Applicant Name: ALTERNATIVE WEATHERIZATION INC. Approvals Date Issued: 12/18/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 06/18/2019 Foundation: Location: 5 CASTLEWOOD CIRCLE, HYANNIS Map/Lot 273-061 Zoning District: RC-1 Sheathing: Owner on Record: LEDUC,THOMAS E Contractor Name ALTERNATIVE WEATHERIZATION Framing: 1 Y 2 Address: 5 CASTLEWOOD CIRCLE m.._::a .-Contractor License 175683 HYANNIS, MA 02601 Chimney: Est Pro�e'ct Cost: $2,951.00 Description: Weatherization Insulation: >� Perinrt°F.e'e: $85.00 Project Review Req: signed installeres certificate required to close Fee Pald. $85:00 Final: 12/18/2018 Plumbing/Gas �d's�.,civ� �� roC�TeSZ9— Rough Plumbing: _. .... : Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction clocuments;for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open forppublic inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building ad Fire Offgcials a�eprovided on this'permit. Service: Minimum of Five Call Inspections Required for All Construction Work:' x k Y 1.Foundation or Footing � ^` Rough: 2.Sheathing Inspection ".:.�.: W, . 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: L 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and'Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Application_number . GI (U ®; .. AW Date lssued-• .... .............................. 77, �EC i nspectors Initials .. Bu Idng i .. 01 'I �'bAK'I 8fABL TOWN: OF BARNSTABLE �x . .'= EXPEDITED PERLVITF APPLICATION:: ROOF/SIDING/WINDOWS/DOORS/TENT,S/STOVES/WEATI RIZATION PROPERTY�NFORIVIATION Address,.-of-Project:, pod-; .. . .. °S. .,. .,., STREET x vim, E weer s Name: �T (�Lw� : . Phone NumberLoy . 2 ti Email Address:&&b yl6L �c�,(/u-n@(C�Otacf CeryYl Cell:Phone.Number Project cost$ qJ G'U Check one: Residential !/ Commercial OWNER'S AUTHORIZATION As ownery :of the above property I hereby authorize /1y~ Ca ox• to make apphcatZon for a budding permit in accordance with 786 MR a Owner Signature: Jl e Qk&6 Date: TYPE OF WORK Siding .- Wuiiows(no header Insulatton/Weathenzattonk ❑ Doors(no header change)# Commercial Doors require an znspeetor'sLTevrew '0 Roof(not applying more than t layer of shingles) 3" Construction Debns,wiil be going.to . CONTRACTOR'S INFORMATION: J y Contractor':s name Ot /NB G r Home Improvement Contractors Registration(if applicable)# /,J (attach copy) Construction Supervisor's License# / 7 (attach t6py. ) . Email of Contractor Phone number .h'T>F_ o7"/01�0 ALL PROPERTIESTHAT.HAVESTRUCTURES 0 VER,75 YEARS OLD OR:IF THESUBJECT PROPERTY lS iN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER ' *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours o 8:00am--9.30 am or 3:30 m-4:30 m. Commercial events may require Fire Department approval .f P P . i *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date API IC 'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. I ry d own,.of arnsta le" Z�gY'att�ryervices r s R. kh id"V. :iiy Director Tom"tadin Comn=slarrcr iao,Main. iirre -MA ) 634 Office; 508';024081 'Fax. .5fig=790.-6230` ro6ertv.Owner t.. I Co p �.and 5Ign `bis Section,. w ..r c r. �t ter . , � fi112 � .`F'f' ' ' v t r;a �i�"m sae alf i 1 rs C4 e rl : tai d is ;pemait Applicatio x or: C *g o 1 2 �r I0—o'll- c" d� arCthe �S " r `Zt i e cl s e 00., a p in e a "a tc�, j Signat o '"der . St �f . plae sr rr N� ..,.,,„.,.,.,,.."...-.—.a• k:<;..�.. _« .-..... .." .. .,,"...«...- a ,.... ...,.._.,,,,. � The Commonwealth of Massachusetts Department of Industrial Accidents 0 I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(BusinessiOrganization/Individual): ALTERNATIVE WEATHERIZATION, INC. Address: 2 LARK STREET City/State/Zip: FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 16 employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working forme in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.M I am a homeowner doing all work myself.[No workers'comp.insurance required.] 9. El Demolition' 4.n I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.�Plumbing repairs or additions 5.❑I am a general contractor and I have lured the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have em toY ees and have workers'comP.insurance.'' ❑ P 6.F�We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[E]Other INSULATION 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: LIBERTY MUTUAL INSURANCE Policy#or Self-ins.Lic.#: X�iWO(19)58867158 Expiration Date:6/8/19 Job Site Address: _ ( "�,Sf�� UA6c( °, City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy nu er and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u d ain a p lti s f perjury that the information provided abovey's true and correct S4,mafore: Date: I NJ /7 Phone#:508-567-4240 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#: # t a .1 r tt J r taitsns � �s �ori��€� iarc SLfe #scar -:R .� _ MOW CAS y 'I, f#8,t�l�AtSt'3N w— expiration her _. „ tiy�'l!��tr��2,�,1,�P,C����'Z, W4hyt' Office of Consumer Affairs and Business Regulation sue% 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvemea %C-.fl tractor Registration Type: Corporation Registration: 175683 ALTERNATIVE WEATHERIZATION, INC �Y`5 Expiration: 0512812019 2 LARK ST -. FALL RIVER,MA 02721 w z. Update Address and return card. Mark reason for change. ". .. ?a,,...:,;.. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Indlvidual use only TYPE:Cormation before the expiration date. If found return to: align �io! Em-ration Office of Consumer Affairs and Business Regulation 125683 05/28/2019 10 Park Pima-Suite 5170 ALTERNATIVE WEATHERIZATION,INC. n,MA 02116 TIMOTHYCABRAL 2 LARK ST FALL RIVER,MA 02721 Undersecretary Tt Ou 3i 8ture A ® DATE(MMIDDIYYYY) C)O CERTIFICATE OF LIABILITY INSURANCE Fo6111/18 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),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Anthony F.Cordeiro Insurance Agency (A//PHONE.Ext; 508-677-0407 ac No; 508-677-0409 171 Pleasant Street ADDRE Fall River,MA 02721 SS: HSouza@Cordeirolnsurance.com Fall INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Liberty Mutual INSURED INSURER B: Ohio Security Alternative Weatherization INSURERC: Ohio Casualty 2 Lark St INSURER D: Fall River,MA 02721 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. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MMIDDIYYYY LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RE97= CLAIMS-MADE Fx_]OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 15,000 A Y Y BKS58867158 06/08/18 06/08/19 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY❑PRO- ❑ JECT LOC 2,000,000 PRODUCTS-COMP/OPAGG S OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 ANY AUTO BODILY INJURY(Per person) S B OWNED x SCHEDULED Y BAS58867158 06/08/18 06/08/19 BODILY INJURY(Per accent AUTOS ONLY AUTOS accident) S X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY Per accident S x UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS LIAB CLAIMS-MADE Y Y USO58867158 06/08/18 06/08/19 AGGREGATE $ 1,000,000 DED RETENTIONS g WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDED? n1 NIA XWO58867158 06/08/18 06/08/19 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Action Inc and NGRID,USA its direct and indirect parents,subsidiaries and affiliates is added as an Additional Insured for General Liability on a Primary 8r Noncontributory basis per the terms and conditions of form CG2001 (04/13),for Ongoing Operations per the terms and conditions of form CG2010(04113),for Completed Operations per the terms and conditions of form CG2037(04/13)and Waiver of Subrogation applies per the terms and conditions of form MEGL0241-01 (04-11) Additional Insured for Automobile Liability applies per the terms and conditions of form SCA005(02/16) Excess Liabilitv is a following form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NGRID USA ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Road Waltham,MA 02451 AUTHORIZED REPRESENT / —----------- i 1 ©194-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Parcel Detail Page 1 of 4 �F 1n .:rc� � � Jr— Logged In As: Parcel Detail Tuesday,December 18 2018 Parcel Lookup Parcel Info ,....__ .. I....,.._�..____ _. __..... w Parcel ID 11273-061 Developer Lot LOT 28A Location �� WOO 5 CASTLED CIRC Pri Frontage 69I ��� Sec Road PITCHER'S WAYv I sec Frontage19 Village Hyannis I Fire District HYANNIS Town sewer exists at this address'N0 ) Road Index 0253 Asbuilt Septic Scan: ,; 4 273061_1 ` 273061_2 Interactive Map 273061_3 rT a„ Owner Info .................... .. ......... .._ Owner iiLEDUC,THOMAS E I owner I%FALLON, ERIC J&KAI streeti l5 CASTLEWOOD CIRCLI street2 city FFiYkNNIS state gMA zip j02 001 country M Land Info Acres 10.17 I use ISingle Fam MDL-01 zoning SRC-1 . ,.,. ;n�Nghbd 0105� _ f. Topography�•�...,�«.. I Road Utilities sue, " Location --'— .I Construction Info ......... _ _....:.......................... _...._... ......... ......... ..... Building 1 of 1 Year 19fi '"`� "" Boor Gable/Hi E'� Wood Shin le J Built struct e p Walt= g Living 967.:.;a....,�.., ,,,N�.I Roof Asph/F GIs/Cmp") Ac Central Area Covers Type 7 Style Ranch wall Drywall Rooms2 Bedrooms Model,Residential '"t Carpet Bath 1 Full-0 Half Floor, Rooms Grade Average Type FHot Air I RTotal ff5 Rooms 0o s Stones 1 S Heat Found Heat Fuel Gas I ation.Poured Conc. Gross Area r�2957 -„ - Permit History Issue Date Purpose Permit# Amount Insp Date Comments 4/20/2011 Repair Work 201101885 $1,000 6/30/2011 REPAIR TERMITE12:00:00 AM DAMAGE 4/11/2011 Remodel 201101884 $8,000 6/30/2001 RENO KIT& BTH 12:00:00 AM http://issgl2/intranet/'propdata/ParcelDetail.aspx?ID=20934 12/18/2018 Parcel Detail Page 2 of 4 �... Visit History Date Who Purpose 2/22/2016 12:00:00 AM Susan Ricci Bldg Permit Completed 5/5/2011 12:00:00 AM Robin Benjamin In Office Review 6/6/2002 12:00:00 AM Paul Talbot Meas/Listed-Interior Access 6/15/1991 12:00:00 AM ML Meas/Listed-Interior Access Sales History Line Sale Date Owner Book/Page Sale Price 1 3/29/2011 LEDUC, THOMAS E C193907 $140,000 2 12/17/2004 PERRON, MARILYN M C175375 $0 3 9/10/1980 MURRAY, EILEEN #D270178 $0 4 10/30/1968 MURRAY, JOHN H & EILEEN C44083 $0 5 8/27/2018 FALLON, ERIC J & KATRINA M 31492/208 $273,000 Assessment History Save Building Total Parcel # Year Value XF Value OB Value Land Value Value 1 2018 $84,600 $42,500 $1,400 $98,900 $227,400 2 2017 $78,500 $43,000 $1,400 $98,900 $221,800 3 2016 $70,300 $40,100 $1,500 $104,300 $216,200 4 2015 $70,200 $40,900 $1,400 $97,200 $209,700 5 2014 $70,200 $40,900 $1,500 $97,200 $209,800 6 2013 $70,200 $40,900 $1,500 $97,200 $209,800 7 2012 $70,200 $39,600 $1,300 $97,200 $208,300 8 2011 $105,000 $3,100 $1,100 $97,200 $206,400 9 2010 $104,900 $3,100 $1,100 $97,200 $206,300 10 2009 $96,900 $2,500 $600 $133,900 $233,900 11 2008 $115,600 $2,500 $600 $139,500 $258,200 13 2007 $115,000 $2,500 $600 $139,500 $257,600 14 2006 $101,500 $2,500 , $600 $141,200 $245,800 15 2005 $95,100 $2,500 $600 $124,300 $222,500 16 2004 $77,000 $2,500 $600 $93,300 $173,400 17 2003 $68,900 $2,500 $600 $37,600 $109,600 18 2002 $68,900 $2,500 $600 $37,600 $109,600 19 2001 $68,900 $2,500 $600 $37,600 $109,600 20 2000 $64.500 $2,300 $300 $23,600 $90,700 21 1999 $64,500 $2,300 $300 $23,600 $90,700 22 1998 $64,500 $2,300 $300 .$23,600 $90,700 23 1997 $64,200 $0 $0 $23,600 $88,500 24 1996 $64,200 $0 $0 $23,600 $88,500 25 1995 $64,200 $0 $0 $23,600 $88,500 26 1994 $64,300 $0 $0 $26,500 $91,500 27 1993 $64,300 $0 $0 $26,500 $91,500 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=20934 12/18/2018 Parcel Detail Page 3 of 4 28 1992 $73,100 $0 $0 $29,500 $103,400 29 1991 $83,000 $0 $0 $41,300 $124,300 30 1990 $83,000 $0 $0 $41,300 $124,300 31 1989 $83,000 $0 $0 $41,300 $124,300 32 1988 $55,500 $0 $0 $15,400 $70,900 33 1987 $55,500 $0 $0 $15,400 .$70,900 34 1986 $55,500 $0 $0 $15,400 $70,900 Photos 1 d �•- Mt. B w E.. w J,: a http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=20934 12/18/2018 Parcel Detail Page 4 of 4 E � e http://issgl2/intranet/propdata/PareelDetail.aspx?ID=20934 12/18/2018 ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation /Hyannis Project Street Address �'.rly7�1.Gyd1J Village 964-4w-15 Owner f � Address Telephone Permit Request i lZ�,S?�� T��Jll/T•� Q�//!/�lf Square feet: 1 st floor; existing proposed ® 2nd floor: existing D proposed Total new eO Zoning District Flood Plain Groundwater Overlay � _onstruction P oject Valuation 7_ .- . Type 1ya60• .� Z Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ;d Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes Z No On Old King's Highway: ❑Yes A No Basement Type: id Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing / new D Half: existing O new.' V� Number of Bedrooms: -3 existing 99 new u Total Room Count (not including baths): existing new 4 First Floor Room"Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑Other Central Air: 0 Yes A No Fireplaces: Existing l New ® Existing wood/coal stove: '0'Yes`4 No Detached garage!existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:A existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: . Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes J No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION - - (BUILDER OR HOMEOWNER) Name / lAfX/ Telephone Number n' 934/&S43 Address /.D, Xox Z39 License # //7Z!? 10*&,4ke� 1W14 eelos 1 Home Improvement Contractor# Worker's Compensation # Ut/JG(yDnS/D9B0zZdt�1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO w c SIGNATURE DATE * r FOR OFFICIAL USE ONLY r APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS r VILLAGE } r OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION 4 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i rf a GAS: ROUGH FINAL. FINAL BUILDING «r DATE CLOSED'OUT ASSOCIATION PLAN NO. The Cotmnonwealth of Massachusetts Department of Industrial Accidents Office ofInvestigations }1 600 Washington Street Boston, MA 02111 r � www.mass.go vIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): A q/ 44- Address: P®, d ZB City/State/Zip: . Phone #: 2310 Are you an employer? Check the appropriate box: Type of project(required): 1.V1..I am a employer with 4. ❑ I am a general contractor and I employees-(full and/or part-time).* have hired the sub-contractors 6. [] New construction 2.❑ I am a:sole proprietor or partner- .fisted on the attached sheet 7. V Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp: insurance comp: insurance.$ 9. ❑ Building addition required.] 5. ❑ We area corporation and its 10.0 Electrical repairs or additions q ] 3.❑ I am a homeowner doing all work officers have exercised their lL❑ Phurtbing repairs or additions myself. No workers' com right of exemption per MGL Y [ P• - 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that cheeks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating thcy are doing all work and thin hire outside contractors must submit a new affidavit indicating such. iContractors 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 numbcr. I am an employer that is providing workers'compensation insurance for my employees-. Below is the policy.and job site information Insurance Company Name: 4/if-5� l/�lid Policy#or Self.ins.Ltc. #; �G yaco® z ZOool Expiration Date: /Z- Job Site Address: G � ® A4 City/State/Zip:044�j�/V&10- Ae Attach a copy of the workers' compensatian 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 yezification. I do hereby'cert" u er t c and penalties of perjury that-the information provided above is.true and correct Si ature: Dater Phone#: Official rise only. Do.not write in this area,,to be completed by city or town offcciaG City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspect,§r 5. Plumbing Inspector 6. Other Contact Person:. Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or ustee of an individual,partnership; association or other legal entity, employing employees. However the tr owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of.a•license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been,presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s) along with their certificate(s) of with no employees other than the C or Limited Liability Partnerships (LLP) Liability Companies LL h' P insurance. Limited L y p ( ) 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'pemvt 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 permitAicense applications in any given year, need only submit one affidavit indicating current policy information(if-flbcessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Te4;.#.617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia ass. ov/dia 1 r Op IKE Tp� f A _ t EARNSTASLE. -MASS. Town of Barnstable Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 y 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 */z/ to act on my behalf, in all matters relative to.work authorized by this building permit application for: ` (Address of Job} Signa re of Owner . ate Print Name If Property Owner is applying„for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollikV+ppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.outlook\DDV87AP.Z\EXPRF-SS.doc • Revised 072.1 10 z Town of Barnstable THE Regulatory Services Thomas F. Geiler, Director RARNSTABLY, 9-4-%S- BuildingDivision qQ� s6ys Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.t6wn.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: '�/1I I I JOB LOCATION: number street OF village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings Of'Six units or less and to allow homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit, (Section 109.1.1),_ : Y. 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 compfy•witlr said procedures and requirements. Signature of Homeowner o� 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 I27.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any hbmeowner 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 ofa supervisor(see Appendix Q, Rules&Regulations for Liccgsing 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:forms:homcexempt t i _ DATE(MMMWrM) ACORD- CERTIFICATE OF LIABILITY INSURANCE 04/11/2011 PRODUCER (781) 312-7206 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Don Bunker Insurance Agency HOLDER- THIS CERTIFICATE DOES NOT AMEND. EXTEND OR 51 Mill St Bid F ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Boa 221 Hanover MA 02339- INSURERS AFFORDING COVERAGE NAIL# INSURED tNSURERA:Vermont Mutual Lilly, Michael INSURERB:A.T.M. Mutual Insurance P.O. Box 239 -INSURER C 1717 Main Street, Marshfield INSURERD: North Marshfield MA 02059- INSURERE: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INBR ADD'L POLICY EFFECTNE POLICY EXPIRA LIMITS L am TYPE OF POLICY GATE molwyE 1TE IxLeroarY) A GENERALUABILI7Y SPIS000474 05/10/2010 05/10/2011 EACH mA OCCURRENCE s 300,000 ET 11 X CoAERctAL GENERAL LIAmmy P E AWS Ea oo=mwwa $ CLAUS MADE Q OCCUR / I / / AHED EV one person 3 5,000 PERSONAL&ADV INJURY 5 10,000 GENERAL AGGREGATE 3 300,000 GENL AGGREGATE LIMIT APPUES PER: PRODUCTS-COMP/OP AGG $ POLICY JTECT LOC AUTOMOBILE UA69JIY / ! / / I COMBINED SINGLE LIMIT 3 (Ea am dent) ANY AUTO ALL OWNED AUTOS / / / / BODILY INJURY S (Per person) : SCHEOt1LED AUTOS HIRED AUTOS / / / / BODILY INJURY $ 1 (Per aaident) NON-OWNED AUTOS I PROPERTY DAMAGE S (Per aociderd). GARAGE UAWLITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC 5 AUTO ONLY: AGG $ EXCESSAXIBRELLA LIABILITY / ! / / EAG H OCCURRENCE $ OCCUR U CLAMS MADE AGGREGATE $ S DEDUCTIBLE RETENTION 4S B WORKERS COMPENSATIONAND VWC6004090022009 04/07/2011 04/07/2011 ImUh7si 10k ANY PROPRIETORWARTNERIEXECUTIVE E.L EACH ACCIDENT $ 100,000 OFFICERNEMBEREXCLUDED? ! ! / / EL DISEASE-EA EMPLOYEE$ 500,000 I yes,descr be arxlar SPE :PROVISIONS below E.L DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSR.00AMNSNEHtOLEMCLUSIONS ADDED BY ENDORSENENTWECIALPROVISIONS 1747? ` Ad CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE Town of Barnstable E>atRATION DATE THEREOF, THE ISSUING INSURER WILL'ENDEAVOR TO MAIL 10 DAYS vmTTEN NOTICE TO THE CERTIFICATE HOLDER NAILED TO THE LEFT,BUT 200 Main Street FAILURE TO DO SQ SHALL IMPOSE No OBLIGATM OR LJAiRUTY OF ANY KIND UPON THE IfTHORIZED RER,ITS AGENTS OR REPRESENTATI M Barnstable Mass. R ATSVE :'::>ti .., `.• w" ACORD 25(2001l08) - D CORPORATION 1988 TM INS025(0108).DS ELECTRONIC LASER FORMS,INC.-(800)Wt545 Pap I oft TO/TO 39Vd 63ANnaa . 80ZLZIETOL 89:91 TTOZ/11/b0 I I3�saaE-u+c€ 3tai4ifi�•� }�;°�Fei.fa;t►sat ,asa�i tit:aaa4s.a¢'<I� Ucense: CS 11729 Restn,ctea lo: MICHAEL G LILLY 'y',' PO BOX 239 PG�l. N.MARSHFIELD,MA02059 ��� � YxF,traticn: 11/12 ----— — Tr=: 13108 7110 Office of Coesamer Affairs&Business RegaiaEion "- HOME NPROVEMENT CORTMCTOR 6 Rg9aE►:....;.115087 712011 Ted 291911 . .: Expiration:`.:s. ....... Type: MICHAEL LILLY MICHAEL LILLY PO BOX 239/1717 AMAIN ST N.MARSHFIELD,MA 02M Underseeretsry r MICHAEL LILLY CONTRACTOR D.B.A, LILLY CONSTRUCTION f P.O. BOX 239, N. MARSHFIELD, MA 02059 TELEPHONE (781) 834-2363 it NSA egg jz t Ip -� zx'° ,vk � -ra��o �r �T oG. u OOFING REMODELING e + TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �� Parcel Application #C;L0 , 6 Health Division _ Date Issued Z Conservation Division Application Fee Planning Dept. Permit FeeC Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis Project Street Address �� l�®J� C/o e Village Owner C -?i' IA-z, Address S< -s:a ' lao elie. Telephoned Permit Request -Gib ko—cocP4 Pt- 43 Square feet: 1 st floor: existing proposed 0 2nd floor: existing d proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio Oeu. Construction Type G '!Z 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 Flo On Old King's Highway: ❑Yes ❑ No Basement Type: OFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new 0 Half: existing 0 new Number of Bedrooms: �--- existing Q new -- :; - Total Room Count (not including baths): existing ��new CJ First Floor R .om Count' G" - Heat Type and Fuel: )&Gas ❑Oil ❑ Electric ❑Other Co Central Air: ❑Yes `jd No Fireplaces: Existing / New 0 Existing wood%coal stove:- ❑Yes YNo 6 -rl Z? Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ e�isting U-new.�3size_ 4-: 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 S 7�09. i ;n ft q MtUj61n Proposed Use c� r APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name U WI A zs l,G Telephone Number Address 61aJr1-L--,0CJ� e- License # Vet-(k Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO &90019( SIGNATUR ley- DATE r k FOR OFFICIAL USE ONLY � F APPLICATION# t DATE ISSUED E MAP/PARCEL NO. J ADDRESS VILLAGE i, OWNER F DATE OF INSPECTION: S FOUNDATION °x -s FRAME f I INSULATION `Y i ` FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL } FINAL BUILDING t , DATE CLOSED OUT ASSOCIATION PLAN NO. X The Coinmonwealth of Massachusetts Department of.Industrial Accidents Office of Investigations 60.0 Wash ington.Street Tf Boston MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): W��� (� Address: 0 LA vIL::Ojo.7"o Oti— City/State/zlp. iS Phone #: Are you an employer? Check the appropriate box: T e of ro ect(required):' t . YP P 1 . 1.❑ I am a employer with 4. ❑ 1 am a general contractor and 1 * have hired the sub-contractors 6 '❑ New construction employees(full and/or part-time). , listed on . ❑ Remodeling 2.❑ I am a sole proprietor or partner- li , the attached sheet. 7 ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have'workers' [No workers'comp.`insurance comp.'insurance.$ ' 9. ❑ Building addition 5. We are a co oration and its. 10.❑ Electrical.repairs or additions required.] �. rP 3. I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions, m self.. o workers' com right of exemption per MGL i nsurance require . Y � -d.]t p. ,, c. 152, §1(4), and we have no,. 12.❑ Roof repairs.. , employees. [No workers' 13.0 Other comp. insurance required] . *Any applicant that checks box#1 must also fill out the section below showing their workcrs'compensation policy information. t Hommwncrs who submit this affidavit indicating thcy 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-contractois have employees,they must provide their workers'comp.policy number, 1 am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy andjob 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 pag&(showing the policy nuniber and expiration date). Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to�the imposition of criminal penalties of a fine up to$1,500.00 and/of 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: 1 do�at eby certify under the pains and pen ties of perjury that the information provided above is true and correct Si Date: �' l Phone#: -7). _ � ' SO Official:use only. Do not write in this area, to be completer)ty 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 Inspectt}r 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. 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 and including the legal of the foregoing engaged in a joint enterprise', g representatives of a deceased employer, or the g receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do.maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s),address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships (LLP)with no employees other,than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation.of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the'permit or license is being requested,not the Department of . Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fil1 in the permit/license number which will be used as a reference number. In addition,an applicant permit/license applications in an given year, need only submit one affidavit indicating current that must submit multiplepp Y g Y . P policy information(ifilecessary) and under"Job Site Address"the applicant should write all locations in (city or town)."A.copy of the affidavit that has been officially stamped or marked by the.city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do'n.ot hesitate to give us a call. The Depattment's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents office of Investigations 600 Washington Street. Boston, MA 02111 Teh.#.617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia r } OF THE r O t HARNSTASLE. .r - 'K"3 Town of Barnstable • orED µA't�` .Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 t., 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 I, as Owner` of the subject property 3 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 Naive If Property-Owner is applying for permit,please complete the Homeowners License Exemption Form on the " reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.OutlooklDDV87AAZ1EXPP-ESS.doc Revised 072110 { • - Town of Barnstahie Regulatory Services I Thomas F. Geiler,Director anaxsT,lsLe, _ Building Division Tom Perry, Building Commissioner 2.00 Main Street, -Hyannis, MA 02601 www.t6wn.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: t 14 Lk,-Vocgo Cl e _ ]/t./jo y number ,n5 ` / S.— village ' (, "HOMEOWNER": 7yk%, lA� i '/�Y `' names�C home phone# �+ work phone# CURRENT MAILING ADDRESS: Z CGGiJ I F— nl�5 ity/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor, DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildine 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 procedur s and requirements and that he/she will comply witlrsaid procedures and equirements. �1 Signa re of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t.amend and adopt such a form/certification for use in your community. Q:forms:homeexempt