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Home My WebLink About0417 CRAIGVILLE BEACH ROAD 17`3 C l a , 3 � � �� ' i � �� r �� t F �"E Town of Barnstable *Permit# � i F lres 6 months from issue date Regulatory Services Fee « 13ARNSTMIX • MASS. Richard V.Scali,Director 1659. X-PRESS Building Division Paul Roma,Building Commissioner OCT 1 3 2016 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us TOWN OF BABNSTABLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNIIT APPLICATION - RESIDENTIAL ONLY ��/ /. Not Valid without Red X-Press Imprint Map/parcel Number i (yam n (,, � f , I Property Address ;H 1 T CJ� A�G\h LL C e b-C V l d' - 1t'Y l�-Y N i , MA — Residential ❑ 'Value of Work$ QQ0 0 0 Minimum fee of$35.00 for work under$6000.00 i Owner's Name&Address 1�'� E N C PN Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance s Check one: ❑.I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. (Permit Request(check box) ;y ` 1 A Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. copy of the Home Improvement Contractors License&Construction Supervisors License is equired'. SIGNATURE: LA Q:\WPFILES\FORM \building ermit forms\EXPRESS.doc 06/20/16 c ?Tie Commomvealth�z,f Massadinsetts Department cr,f rttrlratrial Actidads Office o•f rnwes*adv=. 600 Washington,6f wt -- Boston,AL4 02111 HIMI.Ma-MgM dia Workers' Cmnpensa Uan InsE�ce Affidavit SmIderslCantractGIVUeCtMians(Phm2bers ApTAkant Infarmatian Please prim E,e lly �j$jnF+ ncin� granir irmlEnrirc+r_ : 1 L �. 9 l� 1 (A P Address: Pc \J I L LC _ N t � bay Axe 6 L� oc T �-- Are YOU an employer?Check the appropriate box: T of project r 4 I am a general contractor and I Y per] ( = I.❑ I am a employer vcitb ❑ ❑Ni eu crosfruc ik;a employees(full arrcjforpart-time)* Ira�e 7ziredfFxe sub-contractors 6_ I El I am a sole proprietor orgartaee- listed vutlze attached sheet I ElRe uodelgag slip and have no employees Mese sub-contractors have g- ❑Demolitioa wading forme in arty capaci4g emprloyees agtdhave xvorlcess' 9_.❑Building addition [Ido walkers'comp.insurance comp.rne....,...p j 5- ❑ We are a•corpomfi m and its M❑Electrical repairs or additions required-] officers have exercisedh their 1L Flumbin r us or additions 3_�I am.a Eiomsau�er doing all wwork ❑ � esP myseL €[No workers' _ C.right o§l and *ef exemption r 13_❑Roofrepaizs insurance rid`] .1 (No wor 1 _❑otheremployees- kers' comp-msors m required-) #Any appficamttEatcbedUb=RffiastaLsaf�ouEthesectiartbeiaa ningtheawo�ces�'c�pen�t;,,.po&eyi oems a¢L ER meDwne surho submit ails zfdarir ingfirxing they mn daing sitwe*sad then lice auuideceatracmrsra saclL fCaat<ac' Yhat checktldz bax must attached sa additi®al street drawing the arms of the sub-�a ffid state whether ar not tbnse eaitiesbsee employees.I€thesnb-camtractashweemployw%dieYamstprmidetbak warlrea'c=p.golicgn=her I am an erlipr fliatisprmridircg�varkers'campertsrnhiare ittsurarrcanr xr}�etrrplo}ees $eIoev is ilce pgticy�tr>rsi job site Insurance Company Name: Policy 4L or Self-ir&Ile_#: ExpindibnDate Job Sit Address: citylStatelzip: Attach a-capy of-lie workers'compensationpolicy der Iaration page(showing the policy number and expiration.date). Failure to secure coverage as required.under Section 25A of MGL a 152 can lead to the imposition of criminal penalties of a fine up to$L 540 Oo andfor one-yearimprisonmenf,as well as civil penalties.in See farm of a STOP WORK ORDER and a Kne of up to Moo a day against the violator. $e adsdsed'that a copy of this staten=t snag be forwarded to the office of Isrvestxgations offhe DIA,for insurance coverage verification. li do IreA* tke ' and psnaMes a.�Ferj }'that ifie in,�orsrta�imrptmided abmw is bus and carrect c Siva ire: , 1C l Date- 10 - 3'— 20 02Wrd am an1jr Dot 1.wt write in fbis area,to be arrupleted by city artorr n oij'rcial . Cry or Tam= PermitUcense AE Lwaing Andmrity(cacle one): L Board of Health I l€3uiliFing Dqm meat 3.iitpTawn Clerk 4.Electrical hmpmtor 5.Plumbing Inspecter 6.Other Conftct Person: Phone#- 6 ormation and lastructions Mr&mica nseft Cletcral Lzws dUp IU MCI==all=pjU=m FUPICIe W06X&=np=-AfoII f:r f Er-Ir eCapl0yeM ` Pm=,-Mt-to this sue,an anplayM is defined as.`�—evmypersanin$ne service of another under any caniract ofhire, CZpr=or ffipliecL oral or Wlift=." AIL Moyer is defined as"an individual,part=nh3p,association;arrPorahon or mrthea Iegal en ,or any two or more of the foregoing=gaged is a Joint erase,and inch uTmg the legal re j r tives of a deceased employer,or fac receiYer or trustee of an individual,Par�easTsip,association or ofhe�Iegal entity,employing employees. However the owner of a.dweIIing bone havmgnot mom than three apartments andwho resides therein,or the octet oftbe- dwPM a bone of ann'&er who=:EpIops persons to do make,c•,, *uct;on or repair worlr on such dwelling boose or on.the grounds or bm7dung appminna�ffierefD shallnotbecause of such emplaymentbe d=nedto be an employer:" MC3L chapter 152,§25g6)also states or local-licensing alencY shall wi-fhhoId ffie issaance ar too erate a bu-siness or to construct b�dh gs in the commorrwealth for atcy renewal of a Iicexsse or permit p r P applicantwho h s notprodnced acceptable evidence of compliance with the nisurance m oveXage req¢ired," Additionally,MC2 cbaptrr 152,§25C(7)s drs INeiiher the cunrmnawcal&nor ay of its political subdivisions shall ealter in1D any contract far the perfon an m ofpnbho work ucE acceptable evidence of compliance with the insmmace rcgon-ements of this cbapinr have been presetd.to the rDIILLac g andhozity." Applicants Please 51 oirf the Wo&=' m:ompensafron affidavit completely,bychegee boxes ffia±apply to you Snfil>atran necessary,supply s)name(s), address(es)and phone r¢mmber(s) along with their=tEcate(s) of msrnance. Limited Liability Comparnes(LLC)or lmnted Liabffitp Paxt=ships(I I P)ono employees otb er than-tho members or p are not rbqaimd.to cony warkee compensation Tnstrra ce- If an LLC or LLP does have =xpIoyees,apolicyisrequired. Be advised that this affda�rtmaybembrattedto the Depa-tmentofIndustrial Accidents for confirmation of ice coverage Also be sm-e to stu and date the affidavit The affidavit should be retx7med to ffie city or town that the application for the permit or license is being requested,not the D epmImenf of hadastrial A r- ' ents Shouldyou bane any gne stions regarding the later or ifyou are required to obtain a work=' comp P eat sation olicY,please call the Department at the number listed below. Self- comparues shauId ear their s elf-fT+sm7ance liccnse number on the approgriai--line. City or Town Officials f Please be sole fhat the affidavit is complete and prh ed legibly. The Department has provided a space at the bottom of the affidavit for you to till out in the event the Office ofInvestigations has to contact you regarding the applicant_ Please:be sure to fill in tine peE i.LWlicen.se xn nber which will be used as a reference number. In addition,an applicant tjaat must submit multiple pemnibIicense apphba ions in any given year,need.only submit one affidavit indim:aimg cent policy hj:Eb nation.Cif necessary)and nudes` ob Site Ate"the:applica3ft-should write"all locations in (may or_ town)"A copy of tine-affidavit that has been,officially stamped or m do--d-by fine city or town maybe provided b file " applicant as-PMofthat a valid affidavit is on fmle for fire pernits or licenses A nett/affidavit must be tilled out each dear.Whew a home owner or citizen is obtaining a license or pennit not related to any bnsincas or mmmmm ial ve e lie.a dog lic use or peuoit to burn leaves mfc.)said person is NOT reqc±:md to complete this affidavit The Office of Investg tons would hlce to ffL=k you m advmc;a for your cooperation and shoull d you have any questions, please do not liesi tE to to give ns a c3Z The.Depsri cots address,Telephone and fax mnummber_ T tir Of M ssachnsi--� Dnmt of 1adcialAnts ice of Xxv�'e�ig�fita� - Boffin,MA Oil 11 TeL 4 617- -4 406 or 1-977 1t&A GAF Fax 9 617 727 7M Kevised424-"07 �g� �INE Town of Barnstable Regulatory Services r XAM t Richard V. Scab,Director. Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maus Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, .y1 `'v 111; ." , as Owner of the subject property hereby authorize to act on my behA r. in all matters relative to work authorized by this building permit application for:- (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are perfomaed and accepted. Signature-of Owner Signature of Applicant Print Name Print Name Date QTORMS:OWNERPERMISSIONPOOIS Town of Barnstable Regulatory Services pk Richard V.Scali,Director Building Division Paul Roma,Building Commissioner 039. ��O 200 Main Street, Hyannis,MA 02601 Ep www.town.barnstable.ma.ns Office: 508-862-4038 - Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: Please Print . I V � � � — � ` JOB LOCATION: ' C ( A I V r L C lt'/\ O� y GI number street village ."HOMEOWNEi.: C, R L E N c fV�A-f;� c-) N 0 So 7 3 EL4 e 4 3 name �( home phone# ,Jwork phone# CURRENT MAILING ADDRESS: I ( � C(?A .� U I o2 6 O,. city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildingpermit. (Section 109.1.1) The undersigned homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection proceor s and require ents and that he/she will comply with said procedures and requirements. ,SignkWeof Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall-act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing.Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities, many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 Q �' OF � ��ISTA L�, INSULATION 7013 SdN -h AM, 1 4 Z -CA 04ASS 3LAM1133 SPNA�fOAM 3431IN0E4 CARS 04R3RS INS4lASION C;ILINO; 1-800-696-6611 x., - D I VIS 1 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Mr Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod.Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village 6 Ci /ems � � v V 1 v1 Cara o Ile, ��- Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( ( 31) ( ) Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls ( ) ( ) ( ) ( ) ( ) Sincerely hCodl Jr, President on, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 1� y Application # Q 36 Health Division Date Issued oZ Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ce- ! -w ' 3 Pp Historic - OKH _ Preservation/Hyannis Project Street Address �E/,7 4�U may;/e Z� ,t .2V Village xys1��i�4 Novi Owner Address Telephone t�W 3 L 5c- ®43;z Permit Request �,��/,941 / �,�f/,�/a s� ��,� A ;G' ; A� Square feet: 1 st floor: existing ro osed 2nd floor: existing ro osed Total new q g—proposed 9—proposed Zoning District Flood Plain Groundwater Overlay Project Valuation49,212:V —Construction Type �w 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'Cs, . ighwayO Ye o cry R,C O .."h _n Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.f ll Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new M Total Room Count (not including bath,3): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Ceiral Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number c5��77�'/z 1`4- Address iflA Z az,)rz� License # Home Improvement Contractor# Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATEo// r FOR OFFICIAL USE ONLY APPLICATION# F, DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER lo f4 S, y. N DATE OF INSPECTION: .r FOUNDATION FRAME INSULATION i FIREPLACE f ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ,y ASSOCIATION PLAN NO. S i� 1 OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at Properfy Address) 2 : 7Z- (Property Address) hereby authorize �{x (Subcont ctor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building, permit and to perform work on my property: -Owes SiSignature Date . D MAY 3 2013- f 1 �lrtssuctlusetts - Depru'rincnt of Public �A'C1\ Board of Building Re,ulatious and Standards ® Gonstrurvtion Supervisor License •�' Licen .'-CS 100988 HENRY CASSIDY 8 SHED ROW ;�a. .r - WEStT `JARMOUTH., MA 02673 Expiration: 11/11/2013 , ; uuuisvinicr Tr#: 7620 F �`lE� (��Cz�ylI�yGCZyGII.�P-�llf�l CZ' �/ 'L/CY;11G11Cxl(1/jC'/'1AJ Office of Consumer Affairs and Business Regulation '- 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Horne Improvement Contractor Registration Registration: '153567 Type: Private Corporation Expiration: 12/15/2"bl4 Trk 233831 CAPE COD INSULATION, INC ..........- HENRY CASSIDY 18 REARDON CIRCLE —_-.--._._..__..._..__.---.-_-._..__.... .. . .._ _.... SO. YARMOUTH, MA 02664 Update Address and return card. Marts reason for change. Address L.I Renewal I.._� N mploynlent ( ( host Card ctJJrrC CU, > \ Office ul t:ousumer Affairs& Business Regulation or registration valid for individu) use only rOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 153567 Type: office of Consumer Affairs and Business Regulation xpiration: 12/15/2014 Private Corporation 10 Park Plaza-Suite 5170 4, Bostou,MA 02116 i::APE W'D INSULATION,;I Hr NkY CASSIDY Ia REARIDO) CIRCLE' ._— S0 MONTH, MA 02664 --- AOtvai' UndersecretaryWIthO t nat 1'e f THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) m A- �-C&-,L DATA C E R IFICATE OF LABILITY IN$ppp R AG``'ryICE _- tnu I ,, Il t_) IV VI A IIVEI-V ll QF INPORAIAII�Iv(l,vl_Y AlvlJ CQNFER:I NU kllitt'I'J W°QN 1 t'i[ Cfal':1'11=It:A'fl:HUL.i)I rt. niis t cl,.11t•li.,y I h�tJlll^•1 NOT!\6'FIIVh,'IAl IVL-.I-I' OF MURANClS UQES NQ7Cul\'SIIlu1c A(;UNIR1CTCikI'WI,EN'IIIL L;i;iIIIN a IN5UL' hX1FNl)IJRAL'fLlt'fhlE CU4LRACl !\Fh4?I@.GGD I;)y i'lll I'iJL.IC;IF.z; crl'I;l•r,INlAllvr•. 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I I WQAQl152:i9u 1li1JU12U'1'? 11Gl�UldU13 k w(::;1A'IN I Il)ru I ,u -)t 11�f�l UII❑IIY 1 I'!5 Hl.l'I IVI. ..._.. nu lulll,L:u.:..jJLit ') N 1A Ck—I�1^ilk tilu?Irll . �_(,AUUIIIUUU 'wy'.I , i , III IN /l l)(',A I'I(IN?!11.111f I.L" (A pawl,A1,n11U 1u1 AJJI I. - Inl'urll{ullt.lu .,, .,4yllN.luIV111 IIIVIV VNN\Y lu IVII IIIIVUI • I,..•I,�LIv,I t.ffll�,vr(! �11 PI't.'hfluCUl.ti - - r, ,;.., I Iulll ;l i:rhlalilll4t.l r:l4 an "illlllli"W UQLllgl,Ullllul tILIIIUI,II LIJUllity WIIUII rU(1LIIru(t by wrItl'4ml ;n111,1,.14'I ,.t J.Il r:unlGlll, •. In)I lIt Il. CANCk1.LA'1I0IV tlll! l,l.)ll IIIGLIIdIi(,)11,11it: tJIMlLUANYCIF1lItA0QVl l]t:541V11'tPpl'(1L,I1,:I�;il:{kl A(VI:hI,kI:IIIIL;I\Ilil 11-IL' UNInATION UATG THEI46 IF, NOTICE IAIILI, kll: 1.11-UVH4 0 IN ' ACLORUANCI• WI'I'li TIIf. f l'it CY Ff UVI:aII:)Na. ------------- Ulld•,MUACQRU L,0140f RAI KIM All il�)lllj Il•',Illllv(i. 1IM110 and 10U0:1111 foiJhlurvd lurki;OtACORO • �... � � 119(z li` -`� The Commonwealth of Massachusetts Pont Forrn Department of Industrial Accidents Office of Investigations t_ I Congress Street, Suite 100 Boston MA 021I4-2017 r •; , www.niass.gov/dia Workers' Conipensation :insurance Affidavit: Builders/Contractors/Electh•iciaris/Plurubers Applicant Inforniation. Please Print Legibly N Iillt (l usinc s/Qrgztnizatiun/Individual):_— el a (ta,VM A' Phone #: (Zl .-ere you at► employer? Check tile appropriate box: Type of project (required): I ttni a crrtployer with 2-0 _ `l• ❑ I am a general contractor and L . l have hired the sub-contractors 6. New construction entpio)•c:cs (Cull and/or part-time). _] I ant a sole proprie >i' or partner- I inn the attached sheet. 7. [] Remodeling ship and have no employees These sub-contractors have 8. n Demolition- ; Working for ire in any capacity. employees and have workers' 9. ❑ Building addition No workers' com :p insurance comp. insurance.$ 5. We are a corporation and its 10.❑ Electrical repairs or additions rcyuired.� ❑ p �] I am a hinneowner doing all work officers have exercised their 1 LE] Plumbing repairs or additions ntyscll. No workers' con-i right of exemption per MGL P� 12.❑ .Roof re�'aiJ Irs nsurance required_) t c. 152, §1(4), and we have no / employees. [No workers' 13. Othe. GVIzaIIp comp. insurance required] 'All) applicmtl that chcckS box M I must also Fill out ttte section below showiub their workers'compensation policy inrormation. l lonlcumncrs who submit this MI-Idavit indicating they zue doing all work aril then hire outside contractors must submit it new allidnvit hidic,iting such. 'COHuucWrs that clieck this box must attached an additional sheet showing lho ozone of the sub-conu'uctors raid state whether or not those entities have implu):Uo. rl the suh-contractors have,employees,they nwst provide their workers'comp.policy number. I ant an eatploYer Mat is providing workers'cornpensation insurance for my employees. Below is the policy and job site iufirrnruturrt• . '' IItns Z � I'�,licv /f itr Sell=ins. I_.ic. #: WGA r�Q� � �0� Expiration Date: Job file address: City/State/Zip: Attach a copy of the workers' corrrpensation 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 linr 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 tine ol'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 ofthe DIA for insurance coverage veritication. do hereby cent& 4naer the pains attid penalties o` erjurh that the in1brnration provided above is true and correct. �i�itttur'�: t i V -7 ID ate: G (>flicial use only. Do not write in this area, to be completed by city or town official. (if-Town: Permit/License# lssuiug Authority (circle one): 1, Board ol"H.ealth 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map $'. Parcel / A licatiop _ pp Health Division 'Date Issued Z0 D Conservation Division Application Feqe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street ress C�A I f Lax Village INV Owner (Z t- /y e ( (� Address c6z Telephone 60 d 36 O �- Permit Request RE S7-0(Z kGb2Md-I 40 vS E B y F L4 It L4.4 716V LL-cF6-A s L_EcEi a "6:45 trA -13AsEo4s1-(7 o S ' AS r.... op6"fly64 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed : Total.,rgew - ca o Z\Size t. Flood Plain Groundwater Overlay Pi Construction Type LJ L Grandfathered: ❑Yes ❑ No If yes, attach supporting db§umMtation. Dwelling Type: ' gle Family Two Family ❑ Multi-Family (# units) Age of Existing Stru re Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq. Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: sting _new Total Room Count (not including baths): existin new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing ew Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ ne size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recor d ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) r � ) Name �. 1 G L FC—�e3 I 14 N 0 Telephone Number c3 6 CC. C) Address CV A G-V t Q& License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 10 SIGNATURE �2�` DATE Q a FOR OFFICIAL USE ONLY t' APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: ' FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I' 600 Washington Street c i= Boston; MA 02111 ywww.mass.gov/dia y Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly_ Name (Busines s/Organizati on/Indivi dual): �� i I\ L l% y �J p Address: O �f f!�' C�� q�u•-� �� I�- City/State/Zip: i'� I t 0�b 01 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 6 ❑New construction employees(full and/or part-time).* have hired the sub-contractors _ .. __ ,7 - __.. .___ ._ 2.❑ I am a sole proprietor-or partner- listed on the attached sheet. . ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition comp.insurance.1 [No workers comp, insurance 10.❑ Electrical repairs or additions q ❑ required.] 5• We are a corporation and its 3`�I a homeowner doing all work officers have exercised their 11.❑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.❑ 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 cntities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MOL 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 certi c der thepains ndpenalties ofperjury that the information provided above is true and correct. Si nature: Date: C O 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#: A"A , Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant Io this statute, an employee is defined as "...every person`M the service of another under any contract of hire, "express or implied, ora'1 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 cupant of the owner of a dwelling house having not more than three apartments and who resides there-in,.or the oc dwelling house of another who employs persons to do maintenance, constniction.or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employmentbe, 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 1.52, §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), addresses)and phone number(s)along with their certificates) of insurance, Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the tion insurance. if an LLC or LLP does members or partners, are not required to carry workers' compensa 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 pennit 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 muked by the city or town may be provided to the applicant as proof than a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each it not related to any business or commercial venture year. Where a homeowner or citizen is obtaining a license or perm (i,e. a dog license or permit to burn leave$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 1-87.7-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia Town of Barnstable r oFtrte rq,�, o Regulatory Services 4 BARNSTABLE. ; Thomas F.Geiler,Director . tKAss. 9� 1639. �� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: D 4Vr+NNt. S JOB LOCATION; C O A 1 Q number street village, "HOMEOWNER": e l YZ L C—N Cr rA 641 fV t] 5'02 S& 4 0(4 3 name home phone# work phone# C�A � �� CURRENT MAILING ADDRESS: � L � � (�v )3 C_-0 , p-I A ry N S A- ()--,2 6 0 1 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an.individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that.he/she understands the Town of Barnstable Building Department mini rm spection procedures and requirements and that he/she will comply with said procedures and re ire e ts. . Slignature f Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to complywith 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/cenification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC �pIHE rqk, Town of Barnstable Regulatory Services BAMSPABL& Thomas F. Geiler,Director 0. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8 -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 autho d by this building permit application for: (Address of b) , Signature of Owner Date Print Name If Property Owner is applying for permit please c replete the Homeowners License Exemption Form on the rev e side. QTORMS:OWNERPERMISSION _ S CL --fn 4 C- -1/D r4 I rq G s ZL DOOR tiax3 ^zxzfx8� A c- ca N � (6D �� `Yv1 sM P ik , � f L00 Idi�S MA DTC Oy_ [Oth OF R�-"TABLE AR ,5 Pik 4: 05 P f .,. --- y 2 -x/ 3LP 3 y z yZ' -K 3Lq L4I Chi' PA VIL.Lr- Ee6?c VAntTft� � � _ 09 05 10 417 Craigville Beach Rd Reported to site approximately7:30 PM , Property owner greeted us outside. Would not admit us for inspection. , Discussed commercial painting vans parking at site. % - Questioned how many people reside here. Questioned if she restored apartment. She claims there is no apartment but would not allow us in until the following Weds. She claimed her ex parks his painting van here because he can't park it where he lives I asked about a financial arrangement in exchange for parking, she grinned and denied it. Officer Kelsey reiterated that the trucks must go immediately and not return. Plate on one van came back to William Campbell of 238 Old Town Rd, Hyannis. p Y 7:45 AM 6/20/2011 Significant reduction in parking at this site noted this morning. 6/22/2011 Attorney Anthony Alva came in on behalf of owner Cirlene Fabiano (508-364-0437). He inquired about the nature of the inspection and reported that the work originally ordered has been completed (see permit 201001806). Attorney Alva stated that the property owner may interested in renting the dwelling.,, < We discussed that this is a single family home and must be rented as such. Cirlene left a vm message for James concerning the inspection. Our inspection is scheduled for this date att 4 PM. Attorney Alva indicated that he may be present as well. Jeff Lauzon will attend, too.A ` If the work has been completed per the original expired permit, Jeff will close it out. 21 Dartmouth St,HY ; • Reported to site about 8:00 PM 1t • Found property to be a duplex. • Property not well maintained. • Noted rotting window sills, concerned rear window(left side facing`property) • Window in danger of falling out due to rot. • Both sides of duplex occupied. • Rear patio divided in half by former bulkhead, • 'Metal bulkhead door open—noted locked door at bottom ofbulkhead'stairs Tenants upstairs were not forthcoming with information. Admitted to basement area by lower level tenant. • ._:Found coin op washer and dryer. • Found storage area straight ahead. • One bedroom—no egress directly to the right of the staircase. One bedroom on right just before the storage room (this door was locked). • .. ,,On the-left side past the washer and dryer was a primitive kitchen with two bedrooms BIRST INSPECTIONS JUNE 16, 2011 Inspectors: James Parziale (BOH), Jeff Lauzon(Bldg). LT. John Cosmo (Hy FD), Robin Anderson(ZEO) BPD: Chief Paul MacDonald, Officer Chris Kelsey 56 Tower Hill Road • Reported to site approximately 6:15 PM • Property file.contains notation on jacket from former BC R Crossen recognizing this to be a NC two family dwelling. • Appears that property is being painted and or power washed. • Property neat, no signs of overcrowding • One unit may be vacant at this time but no resident responded. • No violations found 71 Tower Hill Road • Reported to site 6 PM. • Joseph Sullivan, Jr. was outside in driveway. • Discussed unregistered vehicles. • Two unregistered vehicles have been removed. • Mr. Sullivan is helping tenant. • Two adults and two children reside her. • The camper is likely to be towed to Mr. Sullivan's grandmothers' house off-Cape. • The boat will be towed to Mr. Sullivan's grandmothers' house off-Cape. • It is their intention to also transport the camper there as well but are waiting to get a vehicle with a trailer hitch. • This should occur within a couple of weeks. • Discussed keeping a low profile and maintaining a neat yard. • No violation found 76 Tower Hill Road • File indicates this is a NC property with two units. • Reported to site at 5:45 PM. • Property consists of two units. • Property very well maintained outside. • Found.one vehicle on site MA plate 54K L68 • No screen on front door. • Owner is Adam Hostetter. • Admitted to lower unit by tenant. • Found clean one bedroom apartment occupied by two adults. • Missing one CO detector—later found, unit removed due to chirping. • Advised to replace batteries and reinstall. • Smoke detector needed new battery. • Female tenant advised that one male tenant resides upstairs. • 1 ITown of Barnstable �oFtHe, ti Regulatory Services of t-ble Thomas F. Geiler, Dector ir Public Health Division * BARNSTABLE, 9 MASS. mq Thomas McKean, Director " 1639' �0 200 Main Street 2007 $AlFO MAC A Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 8, 2010 Cirlene Fabiano PO Box 786 Barnstable, MA 02630 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. According to our records,'you own the rental property at 417 Craigville Beach Road, Hyannis. Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at NAww.to«n.i.bariistable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2010 fees included. This must be completed within (14) fourteen days of your receipt of this letter. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4644. Thank you in advance for your cooperation. Ld Timothy . O'Connell, R.S. Health Inspector Health Division Direct#508-862-4646 �l V 'n rLzu roofer q'7 LO i,vQe y2 x3,4 y2x3y ax 3W DQ �kcAs rs 2/?- Y CIRL.CNe ��Q�, No 09 - 0 5 to C, TOWN OF, BARidS"T LE _ -- 1 -- - - -- - . -- - `.i 1 91--rn A ` �'R q-- : ' • . $ x3z\ zXzE�x;Bh N� 0 � a �c- y - o s — s IAJ9 yoFr�Er Town of Barnstable a Regulatory Services s^arsTAr^ate Thomas F.Geiler,Director �u $`TEo 59. 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 ABuilder Town of Barnstable °FINE ram, Regulatory Services o Thomas F. Geiler, Director * BARNSTABLE. A . �0g Building Division iOrFvwa+" Thomas Perry, CBO,.Buildirig Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 .Fax: 508-790-6230 EXIT ORDER DATE: l v LOCATION: �� Cyr l4�6 dI�Gcch< G . � ,k�ri3OlS UNDER THE PROVISIONS OF 780 CMR, THE STATE BUILDING CODE, SECTION 3400.5.1;YOU ARE HEREBY ORDERED TO IMMEDIATELY DISCONTINUE THE USE OF THE CELLAR/BASEMENT AREA FOR SLEEPING PURPOSES. 14 LL 3 /3 k aerWs- L CAL INSPECTOR G J" SIGNATURE OF RECIPIENT ODEM DE-SAIDA DATA: LOCALIDADE: DE ACORDO COM 0 PROVISORIO 780 CMR, CODIGO DE CONSTRUCAO DO ESTADO, PARAGRAFO 3400.5.1, VOCE ESTA ORDENADO DE DEIXAR DE USAR, IMEDIATAMENTE, A AREA DO PORAOBASEMENT PARA 0 PROPOSITO DE DORMIR. INSPETOR LOCAL ASSINATURA DO RECIPIENTE C- .¢ g. Engineering Dept.(3rd floor) _Map tl Parcel /Z 3 Permit# . a1 ,I House# �/ ��g Date Issued c Board of Health 11rd flood N-1 ; -0.10/1.00-4-3 Fee, 0 �6 <cPI-344 office(4th floorJ(8.30-9.30/ :00-2:00) c oo dmin.Bldg.) 1HE plafffliRt d 19 ti ' h, BARNSTABLE, MASS. .: 039. i , rEOMA�> 3 TOWN OF BARNSTABLE. ° Building Permit ADDlication Project Street Address - I� L. f: B E R 6 f R-09 ! Village ,�'T H A 1,4 1\1 15 j>O 9,T Owner lF j 1 t 0 iZ P-,1 S6 FY Address C Telephone 0 19 8 3 d� - Permit Request �! ` -+ �,t" First Floor n square feet Second Floor ' square feet Construction Type a C�ID �.' fL A fm F_ Estimated Project Cost $ �'��1 Zoning District Flood Plain Water Protection Lot Size I t-� is 1:3 �j Grandfathered ❑Yes I$I No Dwelling Type: Single Family C& Two Family ❑ Multi-Family(#units) Age of Existing Structure R3 Historic House ❑Yes ®No On Old King's Highway ❑Yes ®No Basement Type: ❑Full ❑Crawl 0 Walkout ❑Other Basement Finished Area(sq.ft.) 3 Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New 0 Half: Existing New No.of Bedrooms: Existing 3 , New Total Room Count(not including baths): Existing P7 New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ®Electric ❑Other Central Air ❑Yes ®No Fireplaces: Existing 0 New Existing wood/coal stove ❑Yes ®No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) l� • ❑Attached(size) ❑Barn(size) El None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name U// ro d b krIlzO (/ n• Telephone Number Address FOR /ff�N 6 z�''j /� (<E. _ License# S'1kt t w S Q Home Improvement Contractor# Worker's Compensation# u/C' / 31d a 41,-� 72- Q NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO l3 y L) SIGNATURE f/t/ DATE J/ oZl r ' BUILDING PERMIT DE IED FOR TI F LLO G REASON(S) FOR OFFICIAL USE ONLY _F _ PERMIT NO. DATE ISSUED ., = •, ~a � -, --. =, .l :. .• � _ � � • MAP/PARCEL NO: ADDRESS _ r VILLAGEi - ". '7: ,'A,1 '• � -4'' � f S f { - � n- ryf { - � 1 � r 1 r �rt-e. l OWNER DATE OF INSPECTION: FOUNDATION 1 )+ FRAME INSULATION 1 " FIREPLACE ELECTRICAL: ROUGH ' FINAL PLUMBING: ROUGH FINAL.— GAS: , ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT ' ASSOCIATION PLAN NO. WE The Town of Barnstable • e�►axsr� • '1 Department of Health Safety.and Environmental Services fo " Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. i • Date ' AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work:, Est.Cost Address of Work: Owner's Name 1' A J—�� ® 12I? I S Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Na a Registration No. Vl z0 T� Del°/Rd �1?, OR .�_. nwner'c Name f. The Commonivealth of:1lassachusetts ;,;ii �_-��._�. Dc�.^/rrrtnrcnt of Industrial.4ccirletrts ., 1. office of19MV9211ons 600 11'mhittgton Street ''. Boston. Ma-TY. 02111 Workers' Compensation Insurance Affidavit Al�nlic•tnt information: Please PRINT lei .............- _'�- '� -- name: Incation. city —hone>� 1 am a homeowner performing all work myself. 1 am a sole proprietor and have no one workin_ in any capacity • -.... ..��-.�-• ......_w-�._.��e.w+...s.�trKs�.w.w.+r.Y�yw.�....r.ru..��n+��.....�..n.w.........�......r+......�.�.�... �.►....,...._,...__......-. an empiover providing workers' compensation for my employees working on this job. comnam' name: atlriresc• phone#• insurance co. •• policy# a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation offices: _ P P cmmp:rn,• n•rrnc• � 51 D /l7f�iv'6 ahone#• incur-incc rn. Z-1 d 0 Iy/0 ra7f� # W. e 13 7 )-A YA-7, comnarn' name: ndd rest: rite: phone#• insurance co. nniicy# Attach additional sheet if necesiary :•. + ��' "" "�' a-^��r• 'r"••r°Y'�""• ""y".' "'" F:riiure to secure cuycr:tce:-is required under Section Z5A of NIGL 152 can lead to the imposition of criminal penalties of a line up to S1.500.00 andiur unc�cars* imprisonment as Well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that a cope of this statement mac be furN•arded to the Office of Investigations of the DIA for coverage verification. i do herebr cerrifj-tinder the punts and penaitics of perjure'that the information provided above is true and correct. � J i�nature f/ Date " Print name l�/�l ]'i /�� . Phone#�-s� urcrr - official use only do nut write in this area to be completed by city or town ofTiciaf city or town: permit/license# rnlluifding Department fCLicensing,hoard 0 check if immediate response is required OSeleetmen's Offrcc 1' C311calth Department contact person: phone#: rnOther �. i. . I information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' ecullpensation for employees. As quoted from the "ta++' an entple,ree is defined as every person in the service of anot ier under anv contract of hire, express or implied. ornl or written. -An emplurer is defined as an individual, partnership, association. corporation or other legal entity, or any two or me the foregoing emga�_ed in a,joint enterprise, and including the le-al representatives of a deceased cmpioyer, or the cr receiver or tntstee of an individual , partnership. association or other legal entity, employing employees. Howe\ owner of a dwelling house ha+•in` 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 ii or oil the grounds or building appurtenant thereto shall not because of such employment be deemed to be an empioy MGL chapter 15� section 25 also states that even or local licensing abeac.• sh:a i +r-itltliuld ttzc issuance or renewal of a license or*permit to operate a business or to construct buildings in the commonwealth for any applicant ++•ho has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the evidence of compliance with the insurance requirements of this chapter performance of public work until acceptable been presented to the contracting authority. .......�-.��.._.._.... ...._.� • -�� .-. ..... i•: _ .. ... _,ram.. ,' Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation anc supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirm of insurance coverage. Also be sure to sign and date the affidavit• Tite 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 reauir: to obtain a workers' compensation policy. please call the Department at the number listed below. --------------- City or •rolwns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P' be sure to fill in the permit/license number which will be used as a reference number. The afldavits may be returner unless other arrangements have been made. rile Department by mail or FAX The Office of Investigations would like to thank you in advance for you cooperation and should you have any questi please do not hesitate to _give us a call. The Department's address. teleplione and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of investigations ^- 600 Washington Street Boston,Ma. 02111 fax 1: (617) 727-7749 HOME INPROVERENT'CONTRACTOR•:>''>r Registration''1D06A . Type - INDIVIDUAL.,,,, Expiration 06/22/98; k VITO J.,DEPIRO,.JR Kyi' ;r 84 Northingtod'AvBnue` ti=' G�ce�•?�-o,� �°�'�ewsbury NA:•01545 r �' "'ADMINISTRATOR \ u �� _....�.:.:.:.:..:..:�.�.�.�.�............�...•::::..i.i:..::.:.::...:.::.:.::.:..;.::.:.:.?:..P..:.P.:.y.:..i.>.:.;.;.;.4.;.:.;.;.;.:.i..S..:.:.`..:.i.i.r.:.:...F.:.:.:S..:.:2.:.:.:.t.:.?..5.:.:>.:.:.;:.:.;..;.:.::.;.::.;.:..[:.T.:.:.:.:..:::;;2:;.;:::;;�.�:�>�::�:�;:.;:»:;�:�l:i:;:;:;:<:>;:;:;y:•:i%•::::a:��.�� :�:•:.,:r:.;:::•:::::r::y:o-::r:>::::�r:;:;:;:•::::�. ; :::::.::..:.......:.:.: :::.:: :::: ........... DATE(MMID IYY) :ElTA CORD Will 07 10 971S : : N:. PaooucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION i Paul F. Cantiani ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 318 Plantation Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Worcester MA 01604 COMPANIES AFFORDING COVERAGE Paul F. Cantiani COMPANY Phone No. 508-791-2088 Fox No.508-799-0663 A Maryland Casualty INSURED COMPANY B Liberty Mutual Vito J. Depiro COMPANY Vito Depiro C 84 Worthington Ave. COMPANY Shrewsbury MA 01545 D v.... . E................................................................................................................................. ............:::.:::::::::::.:::.::::::::::::.::::::::::::::::::::::::::::::::.::::::.:::::::::::::::::::::::.:.�:...................... .... RAGBS'iiit''i ? cit<> iS#i<'3?Ei� si'>">? iii>is�i[`i?i%'' 'ii>isiii#i<[i'�' siL` `3i?i'i'3isisiri''�$#isiisia�a �iGiSE#i<ii[ ii'i'S �Y;%`?;>%'isa 'isi `?�i�' i?:<>i ?i?isiis'3i?iiii? i?i? i% 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 CER i IFICA71E MAY BE ISSUED OR MAY PERT AIN,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. CO TYPE OF INSURANCE POUCY'NUMBER POLICY�� POLICY EXPIRATION LIMITS YY)LTR DATE(MMIDD/ DATE(MMIDDIYY) GENERAL LIABILITY GENERAL AGGREGATE $ 1000000 A B COMMERCIAL GENERAL LIABILITY SCP3133028 05/06/97 05/06/98 PRODUCTS-COMP/OPAGG $ 1000000 CLAIMS MADE ®OCCUR PERSONAL&ADV INJURY S 500000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $500000 FIRE DAMAGE(Any one fire) $50000 MED EXP Wry one person) $5000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS (Per Person) HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Per occident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT S AGGREGATE S EXCE38 LIABILITY EACH OCCURRENCE S UMBRELLA FORM AGGREGATE S OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND a OC STATUUMI- OTH-:<::;:;: ;::::'::::::: z::::3::: ................................... EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 100000 B THEPROPRIETORI INCL Liberty Mutual 05/09/97 05/09/98 EL DISEASE-POLICY LIMIT $500000 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL WC1312242732 EL DISEASE-EA EMPLOYEE $ 100000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHCLES/SPECIAL ITEMS �oFTNETo�� TOWN OF BARNSTABLE ii • i BAHBSTODLE. i NABL ae�� BUILDING INSPECTOR tam• n l APPcz— LICATION FOR PERMIT TO ... .L?.1.1.. ........1....... 10. ... .1- .1�y�.............................. V TYPE OF CONSTRUCTION ........ ...I..YV�.in. ...... fA. Yr1.L-M..................... .� ..2.....°.L ..�.3j........... �9.°1. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location . ..I..7.... ..�'s��..��.V.14r t.,.g.......f !-O-i3.4. 1�.......1-:M.kr>..........................:........:....::.................................... Proposed Use ......S.LnG*.k.-.6;.....Ck"..A.l... ....00.A0.V.Z.Lrri. .................................................................................... y Zoning District Y.��' ...................Fire District ..� .�q., t !`l..l�l.l�.................................................. .......... I Name of OwnerVll.FLT.b'R, ...pit..N.ATh4-!A...MPJ.4R15.�i.yAddress 1 ...BOA. . ...Nw .... r f I M- § �N. (� �In Name of Builder .c.L ..C-,1��L-.�n4..kf0 .a.. �......Address B �fC5.!71>.!l. ....J .!.[Da a.I.E.................................... Nameof Architect ...!�t�N.g................................................Address .................................................................................... Numberof Rooms ..... ..........................................................Foundation ...is..... P-R.T.6......................................... Exterior ......� .....................................Roofing ... ..... D.1,l.I.n.1. ............................ Floors ...C.41P—P.V.\..............................................................Interior .. .t?-Lj.. 1Z-L ................................................. Heating ..... .i,. g4....\.P...1.� ..............................................Plumbing ............................... Firepp ..Approximate Cost .. .. lace ..........�.5�............................................................ .t...................................................... Definitive Plan Approved by Planning Board ---------------_____--________19 Diagram of Lot and Building with Dimensions p f� SUBJECT TO APPROVAL OF BOARD OF HEALTH Lij 0 Oo m Za I" twn � pLd � < 0 0 0 m = H Dom.. ►� O 1 `(� N U- O - ---0 � � Z <..._ _�. _ . -- - - - - zC 00 wow o � z � � Z >- U) d X � Z w F- LLJ U � = 21 °"! ff ~ Q � Qa I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . .............. . .... ........... � N6rrissey, Wa Natalie A. ��m�y � ~ �� _/ - _ � , single family. dwelling. -4 .Walter J. "atalie A. Mb � . � � - / > � ! / ' ^ ^ -^ PERMIT REFUSED f | - ............................................ 19 .----..—......--.—^..----..—.—...—...~ � � \ ^~~--'-^—'-~'^^^~—'—^'---'--^'—^--^'- \ � ~'''`--'~^'—^~~'---^^'`^'--'—^^^^^—'—'~^'- � � .-------'----..--_---------.—... � Approved ... 19 ` ~ ` . _________ , | ' )' '-----^----^'—^^'--^ | / -----'-----^'—~'----'^—^^^^~--^^' \ � � CRAIGVILLE 13EACH R®A® E PUBLIC 40' W.IDE SRB(FND) S QSi° ' r 15•0 i O O 9.F�3 ---�-.._ — - LCB(FND) .. � . . 2-3.02 T=5.63 wzf R= 6.00 i.- YO� cil A- 9.04 trm �mU >° L®� Q , I1.356 SQ.FT, O . O In W 1� N89 2i' 50°E 4 0.8 O 20.90 19.90 - w m O �' r 0 = � o r+ r 1 4�S Q_ T __. _ _ _ x Iaa.r_.4� _ saa.a& . 4�OOCS ET UX DO�'�+:)'? HY V ASHER El EANOR M. e � D!AN FIN N VOR .. . '� E-T A L.. ;. 0�,, ;-03 2•c�/.� r.�� S. R- SWE.ETSER . ` BEING A RESUBDIVISION OF LOTS 198, 2OO ENGINEER 2Ii 2! � BLOCK' -, r �• - DE!�NIS1='C7r�",Pv9AcaS• �✓ , BLOCK E ON A PLAN OF SEASIDE qp 8�g S�y F I �� r MASS - d3a dm 2 O� -` BA�CZ - PARK AT r1YA�a?`a;,,t-°ORT, MASS• DATED AUG.1893 F BY Fr�ED. 0. ;biTF1,C-E. �� mod ' . APPROVAL UNDER THE SUBDIVISION COI'.3�'rROL L4-VV NOT REQUIRED.. DA �, 1 Y��___ BARN cS T"AE�LE PLANNING BOARD