HomeMy WebLinkAbout0173 HINCKLEY ROAD / 73 �✓ _ ,
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Town of Barnstable i111d1
`. PostThis Card SoThat etas`UistbleaFr..om::iheStreetA roved P1ans,Must be;Retamed on Job and this Gard Must be Kept,
MRSWA[SLE. • ;*`...- �,'+.. «� „ ,...�L � ..` s, ;'"'c"mac i r ✓ i' ,.. rw e' a '� •
PP
NAM Posted Until F�nallnspection Has Been Made �,
Where aCertificate of Oacu anc,,is Requ red,-such Building sFall Not be Occupied`:unt�l a Finalanspection'has been rhade Permit
� �C ._sue
Permit No. B-18-2962 Applicant Name: Brien Langill Vivint Solar Developer LLC Approvals
Date Issued: 09/26/2018 Current Use: Structure
Permit Type: Building-Solar Panel-Residential Expiration Date: 03/26/2019 Foundation:
'Location: 173 HINCKLEY ROAD, HYANNIS Map/Lot: 310-088 Zoning District: RB Sheathing:
Owner on Record: TENEZACA, ANGEL L&LANDI,GLADIS M �' Contractor Name=:A : BRIEN LANGILL Framing: 1
Address: 72 WINTER STREET ). � Contractor1icenseCS-106675 2
HYANNIS, MA 02601 Est Project Cost: "$ 10,560.00 Chimney:
Description: Installation of roof mounted photovoltaic solar systems, 16 panels Permit Fee: $ 103.86
�� Insulation:
4.8kW � Fee Paid $ 103.86
Project Review Req: �; zDa�te 9/26/2018 Final:
$;
Plumbing/Gas
q Rough Plumbing:
Building Official
Final Plumbing:
Rough Gas:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six,months afterissuance.
All work authorized by this permit shall conform to the approved application and thesapproved construction document's for which; 5 permit has been granted. Final Gas:
All construction,alterations and changes of use of any building and structuretes shall be in compliance with the local zoning by laws'iand codes.
This permit shall be displayed in a location clearly visible from access sire or r p road and shall be maintained open foublic inspection for the entire duration of•the
work until the completion of the same. R:'.
Electrical
4 'R
. � Service:
ri
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Officials are provided on this permit.
Minimum of Five Call Inspections Required for All Construction Work:, '' , Rough:
1.Foundation or Footing
2.Sheathing Inspection Final:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough:
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation Low Voltage Final:
7.Final Inspection before Occupancy
Health
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final:-
Work shall not proceed until the Inspector has approved the various stages of construction.
"Per§=5 contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department
Final:
Building plans are to be available on site
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
U ,
Town of BarnstableBuil ing
:,
I Il Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept
t ;,.enx�8rn��.ef +f Permit
-v' m ' Posted Until Final Inspection Has Been Made.
lt� 16639.
eMa+°/ Where.a Certificate of Occupancy is Required, such Building shall Not be Occupied until a Final Inspection has been made.
Permit NO. B-17-3853 Applicant Name: CARIBBEAN REALTY INC Approvals
Date*Issued: 11/20/2017 Current Use: Structure
Permit Type: Building- Deck Expiration Date: - 05/20/2018 Foundation:
Location: 173 HINCKLEY ROAD, HYANNIS Map/Lot: 310-088 Zoning District: RB Sheathing:
Owner on Record: CARIBBEAN REALTY INC Contractor Name: Framing: 1
Address: 72 WINTER ST Contractor License: 2
HYANNIS,MA 02610 Est. Project Cost: $500.00
• •. Chimney:
110.00 F it- ee:
Description: deck 10x8 � Perm $ ,
Insulation:
Fee Paid: $ 110.00
Project Review Req:
Date: 11/20/2017 Final:
Plumbing/Gas
Rough Plumbing:
Building Official
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 documents 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 for public inspection for the entire duration of the
work until the completion of the same. Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service:
Minimum of Five Call Inspections Required for All Construction Work:
1.Foundation or Footing Rough:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&"Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction. Final
'Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
Op THE tp� 7 J ��
Application Number .... ............. .......By........................
* BARNSTABLE, F
Permit Fee....................o................Other Fee........................
9 MASS.
1639•
AFC A Total Fee Paid
TOWN OF BARNSTABLE Permit Approval b on....... :t(�!.`."7..
PPy....... ....................
BUILDING PERMIT
APPLICATIONMap....... 1.b.......I..............Parcel...........�.............................
Section I — Owners Information and Project Location
Project Address °� f'� M r\�C' Village_ �V61�t� 1p5
T"
{ 4
Owners Name-
Owners `� f
qt_
Legal Address �' I�► I� Q
City cy►rvi j State Zip 0260
Owners Cell# c�R,� Z2 3 s 7q O S— E-mail aoidelvic c9 ® m'►a • 04
— Structural Use
Section 2AS
Single/Two Family Dwelling ❑ Commercial Structure over 35,000 cubic feet
❑ Commercial Structure under 35,000 cubic feet
Section 3—Type of Permit
❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use
❑ Demo/(entire structure) Finish Basement ❑ Pool ❑ Fire Alarm
Rebuild Deck ❑ Solar ❑ Sprinkler System
❑ Addition ❑ Retaining wall ❑ Insulation
❑ Renovation
Other—Specify
Section 4-Detail
Cost RProposed Construction I fo i Square Footage of Project
Age of Structure Dig Safe Number
#Of Bedrooms Existing Total#Of Bedrooms (proposed)
110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design
Last updated: 11/3/2017.
Section 5 - Work Description
Section 6—Project Specifics
❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors
I
❑ Plumbing ❑ Gas ❑ Fire Suppression
❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom
Water Supply ❑ Public ❑ Private
Sewage Disposal ❑ Municipal ❑ On Site
Historic District ❑ Hyannis Historic District ❑ Old Kings Highway
Debris Disposal Facility: I am using a crane ❑ Yes ❑ No
Section 7—Flood Zone
Flood Zone Designation
Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑
Section 8—Zoning Information
Zoning District Proposed Use Lot Area Sq. Ft.
Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) O r4
Setbacks Front Yard Required 6� Proposed .
Rear Yard Required Proposed
Side Yard Required Proposed
Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No
Last updated: 11/3/2017
Section 9- Construction Supervisor
Name Telephone Number
Address City State Zip
,r
License Number License Type Expiration Date
Contractors Email Cell#
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.Attach a copy of your license.
}
Signature Date
Section 10—Home Improvement Contractor
4� Name Telephone Number
1�
Address City State Zip
Registration Number Expiration Date
I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C...
Signature Date
Section 11 —Home Owners License Exemption
Home Owners Name: cVll' CO,
Telephone Number( �A) Cell or Work Number
-7 �--
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 7 CMR_ d- own o f arnstable.
Signature - Date I 6 2a (
APPLICANT SIGNATURE
Signature Date llaihoff
_ Print Name A1 L Q i7 CA Telephone Number (S09) Z123 - VD S6
E-mail permit to: Q 0 d e lu Jr' Co-
Last a rn'z
updated:11/3/2017
Section 12 —Department Sign-Offs
r ,
Health Department ❑ Zoning Board (if required) ❑
Historic District �1 Site Plan Review(if required) ❑
Fire Department ❑
Conservation
For commercial work,please take your plans directly to the fire department for approval
,I
I
Section 13 — Owner's Authorization
I, , as Owner of the subject property hereby
authorize to act on my behalf, in all
matters relative to work authorized by this building permit application for:
(Address of job)
Signature of Owner date
Print Name
Last updated:11/3/2017
1'he Commarrwea.M of-M swain etas
Deptukneirt of rnd,rstrid Accide?dg
— On ce of mw_stigations
' 600 Washington Strew r
_ Boston,-41A 02111
10mv.masmgovIdia '
1ITc-1cers' Canzpensati=Insur aatce davit:BuilderslContractursMec�slPlnmhers
Aj3plkant InformatigII Please PFmi Le'b
Na=(Bu gan>zatioa vi hal Na - dudlCieD _
Address...
City/Statef •rrtyti Ph�z '03 `2'2 `'_v
Are you an employer?Cheekthe appropriate bom ' Type of project(requiried):
I-❑ I am a employ uith 4. Q I am a general contractor and I
employees(fall an&or park-fiime)-* Piave hired the sub-contactom 6. Ej New oonstracim
2.0 I am a sale proprietor or partner- ' listed on the attached sh;eef, 7. 0 Remodeling
These sub-contractors have
ship and have as employees $.,Q Demolition
wading, fix me ��t3`-is employees asrdhate workers'
� C m��rr�2 9. �Building addition •
ENO w doer3 Camp.insamme oF-
required-j 5. 0 We are a-corporation and its 10❑Elegy lrical repairs or addditions - _--
3_ I am a l� neouner doing all;work officers have exercised their 1L0 Plutimbingrepairs or additions.
myself[No viers'oomp- Tight of em=pt'ibn per MGL 1?❑Roofrepairs
incrr=eieTired][ C.152,§1(4,andwe have no--
employees-[No workers' 113.0 Other
Camp__ksmmnwmgtir j
•gays ffc.- Heat cheftbos ft1 mar#also fi]latttth�sectEoabeIow�tntting diririvaticen:compem afinupaTtcyiatnamaao�
ffameoarngrs who submit this sfbdz6Z irA rztia submit a new affidsmt in irs�sac7i_
fCantmctotsBhzC checYth,G boot must attach=:Idditim sheet s'hoceing the=ne of the sub-camtsctom=d stdewhethec at not fhese entideshwe
eatptoyees.If the employees,9heynnstpmsade their workers'comp.poliU n mbm
I am art etrtp r flecrt is pra�ading tt�ariFers'cotttpertsafiort irtsriratrca for trtl'omplo}�ees Baloty is Me pvUcy and job site
information.
InswanceCompany1fame:
PoIiCy 4*'or Self-ins.lie. FxpimtiouDafe:
Job Site Addresm City/state/4:
Attach 2 copy of the worltierr''comppensation.poHcy-dedaration page(showing the policy number and expiration date).
Fadnre to secure coverage as required under Section 25A of MGL m 1572 can lead to the imposition of criminal penalties of a
fine up to$U 0 0 0D andlor one-year imprisosmipaA,as well as civil penalties.in the fora of'a SWOP WORK ORDER and a$me s
of Bp to$250.OU a day agaiut:the violater. Be advised that a copy"of this statement.may be farwarded to the Office of
Itavestsgatioms ofthe DIA€or fin ff"cffc0v=geveri&afiDEL
;Ici`a Ftet'.aby Ce&f aard ri s d� r s afpajxry f laftfis arft7nna€rm-j rm--&Wabavg is trace and/carrect,.
Phone ik nzsG ,
O&W use wdy Dv ant write in fhb area,ffr be crTjnpktad by city ar ayrn o ffrcirit
City or TGwa: PermitffAcense#
Issuing Authority(cirde one):
L Board of Health I Build"ing llepai t ent 3 fity1Fo n.Clerk, 4.Electrical Fhsspector S.Plumbing Inspect it
6.Other
L'onbet Person: Phone#:
ornaation an' d lastractions
M ssach setts Ge7aeaal Laws ctiapf r M regmzes all employes`tn provide wojl a MOMPMSEti6Il for their emploY=S-
to this s mote,an nnpInyee is defmed as.":cV=:Ypeasonin.$ie service of anoiba under any coift-a Ct ofhires
express or implied,oral or
An erIoye�-is defined as"an indrvidnal,partnersT�,as&Dch on,corporation or other legal�nfify,or any two or more
of the foregoing ezigaged is aJ°int Vie,Badmclndmg fie legal representatives of a deceased employer,or the
rweiver or trastes of an individual,pare,association or othealegal entity,employing empIDYC:M However the
owner of a dymUing house having not more than tbree apartments and who resides therein,or fihe occ¢paat of the-
dwelling house of ano$er who employs pemans to do maintenance,cmdcazf'on or repair wok on such dweMag house
or on the grounds or bml mg app thereto sbannotbmanse of sack employmentbe d=medto be an employer."
MOL chapter 152,§25C(6)also states that-every siaia or local Reensmg agency shall withhold ffie issuance ar
renewal of a license or permit to operate a business or to construct bufldiags in the commonwealth for any
es
applicaantwhLo has notprocinc ed acceptable evidence of cdmptianee wn the insarance_coverage requrz ed_"
Additionally,MOM cbapt�x' 152,§25dM states-Neither the commonweal nor any ofits political subdivisions shall
en er into any contract for the performance ofpubho work U atl acxepiabIo evidence of comp li4acc V&±L fhe mscaanc6.
req=ements of this chapter have been presented to the confrai'.fing anihoraty."
ApPticzn&
da ' completely,b cbe�g the boxes That apply to your situation and,if
Please fiii oil the workers compeusaiion affi vrt co mp Y
. , Y
necessary,supply sob-contra i(s)name(s), address(es)and phone numberCs) along wift their cm tiFac at*)of
„mince. LM1itr-d Liability Companies(LLC)or Limit Liabffiiy.Parinoxsbips(LLP)wino maployees othr-r than the
members or parfne-as,are not rimed to cagy workers'compensation If an LLC or LLP does have
be sobmRted to the D aiitnent of Industrial
affida ' m eF
. employes,a policy is required. B e advised that this Y¢maybe
Accidents mr confamafion of film=ce coverage. Also be sere to sign and data the affidavit The affidavit should
be:retrm,-_d to the cify or town that the application for the permit or license is being requested,not the Department of
Twin frig Accldem-tS. S ouldyou have nay questions regm-dmg tiie law or ifyou are required to obtain a workers'
compensation policy,please call the Department at the number lists dbelow. Self-fiLmxed co>rlganies should CU er their
s elf-fi so-a ce license number on the appr°priafE Ime.
City or Town OMdals
r
Please be sore that tho affidavit is complete mdpriufedlegHy. The Depmtmemthas provided a space at tiie bottom
of the affidavit for you to f M out in the event the Office oflnvestigations has to contact youregarding the applicant
Please be s=to fll in the p=LiJlice e;number which will be used as a reference umnber. In addition,an applicant
that must submit muhiplepeMitllicease appli'caiions in.any giveaYcar,neea only submit one affidavit M&catmg'-uE t
policy infonnation(if necessaiy)and under"Tob Site 1A-d&ese tie:applicant should wrLt---all locations in (citY arr
town)-"A copy of the-affidavit that has been officially simape:d or marked by fhe city or town may be provided to the '
applicant as proofthat a valid affidavit is oa file for fatm 'pmm#s or licenses A new affidavit must be flied out each
year-Where a home owner or citizen is obtaining a license or permit not related in any jb„siness or commercial V&nbire
(io. a dog license or permit to bum Ieaves efe.)said person is NOTd complef>r this affidavit
you in advance far your cooperation and should you have any gvnst<ons,
The Office of Investigations would like to thank
please do not hesitate to give us a call.
The Depart aimfs address,telephone and fax
-Th�CanmtonVealtil of Massachusatt DepartinmtafladustialAwjdeataa
f toe ref;[tLVMv&-QLO.=
R IAA 0�111
Ta 4 617- -490Q cxt 4-06 ar 1-9 MA&�AFR
Fax#617` 27'74
Revised 4-24-07
Legend
Parcels
JL
x. Town Boundary
Railroad Tracks
31i372 e3 = t
Buildings
Paint Lines
311� � 315a" Parking Lots
t #1 Paved
Unpaved
Driveways
Paved
"� i •Unpaved
i^
Roads
Paved Road
01 Unpaved Road
i 311065 Bridge
,fr
� fan
t eams
k Marsh
rfM Water Bodies
r #160
310008
M W # } .;
E 31 7a �.
#323.; rf t,6 to
310086 3100
310433 310085--,, :. 3160
7,#311 #189
_ ........._.._.........
Map printed on: 11/14/2017 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town Of Barnstable GIS Unit
adequate for legal boundary determination or representations of Assessor's tax parcels.They are
Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 026ot
O 42 83 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 5o8-862-4624
reflect current conditions,and may contain such as building locations.
Approx.Scale: 1 inch= 42 feet cartographic errors or omissions. gis@town.barnstable.ma.us
PID: 1511765 89910
REGISTRATION AND CERTIFICATION FORM
FOR FORECLOSING/FORECLOSED PROPERTY
Thank you for registering in accordance with Town of Barnstable Code chapter 224
sections 224-3 and 224-4. Please complete one form for each property in foreclosure
(section 224-3) or already foreclosed for which possession has been taken(section 224-
4). Please file the original with the Building Commissioner and a copy with the Chief of
the Fire District in which the property is located.
If you claim you are exempt from registering under Massachusetts law,please state the
reason(s) and complete section 1 (property information) and the first paragraph of
section 2 (foreclosing party, court, etc. and foreclosing party representative,but not other
representatives and attorney) so that the Town can review the exemption and update its
records:
Section 1 —Property Information
Property Address: 173 Hinckley Rd Hyannis ( MA 02601
Assessors Map#: 310 Parcel#: 088
Land area.and description Use code: 1010; Lot size: 0.2; Appraised value: $64,400
Building(s) description and contents Model: Residential; Style: Ranch; Grade: Below average
Year built: 1972; Effective depreciation: 15; Stories: 1; Gross area: 1,664 sq ft
Occupied: No Occupant(s)(if borrowers so state and include name(s))
Phone: N/A email: N/A other:
Vacant: Yes Date: 09/03/2015 ° Anticipated Length of Vacancy: Unknown r
Last occupant(s) )(if borrowers so state and include name(s)) N/A ;
s
Phone: N/A email: N/A other:
Has possession been taken If so,please explain and complete and fife the
maintenance and security plan form(unless exempt as stated above)
Section 2—Foreclosing Party Information
Foreclosing Party(full name/title) N/A
Foreclosure Case Court: N/A Docket#N/A
Date filed: N/A Current Status: N/A
Foreclosing Party's representative(s) for property(entry, management, repair,
etc.)(name, title,): N/A
Company(if different from foreclosing party): PHH
Address: 2001 Bishop Gate Blvd I Mt. Laurel I NY 144125
Phone: 800-468-1743 email: vpr@fieldassets.com other:
If an exemption is claimed,please do not complete the remainder.
Other representative(s) (if foregoing representative is primarily responsible for
property and/or foreclosure and is most likely to be able to address town matters
concerning the property and/or foreclosure,please so state and do not complete
contact information(i. e. "none"or"see above")).
Name,title, other: Property Registration Department
Company (if different from foreclosing party): Assurant Field Asset Services
Address: 101 W Louis Henna Blvd, Suite 400 1 Austin I TX 178728
Phone(s): 800-468-1743 email(s): vpr@fieldassets.com other:
Name,title, other:
Company(if different from foreclosing party): N/A
Address: N/A
Phone: N/A email: N/A other:
Attorney representing foreclosing party
Firm name(if different from attorney's name): N/A
Address.: N/A
Phone(s): N/A email(s): N/A other:
I acknowledge that the information provided is accurate and correct. I also understand
that any inaccurate information will result in non-compliance with section 224-3 of
chapter 224 of the Code of the Town of Barnstable.
&��, J, Date: 09/18/2015
Name: Deanna R lado, AFAS Authorized Agent
Title: AFAS Authorized Agent
I hereby certify that the above-named foreclosing party is in compliance with the
provisions of section 224-3 of chapter 224 of the Code of the Town of Barnstable.
Date:
Building Commissioner, Town of Barnstable
DECLARATIONS
STANDARD GUARANTY INSURANCE COMPANY
PO BOX 50355, ATLANTA, GA 30302 POLICY NUMBER: MLR21147721127
A Stock Insurance Company
POLICY PERIOD:
EFFECTIVE DATE EFFECTIVE TIME EXPIRATION DATE
03/19/2015 12:01 am 03/19/2016
FIRST NAMED INSURED and Mailing Address: For Company Use:
COLDWELL BANKER MORTGAGE Basis:
ITS SUCCESSORS AND/OR ASSIGNS Territory:OOOt
Closs:
AS THEIR INTEREST MAY APPEAR Other:FIR SFD 021140042
P 0 BOX 5954
SPRINGFIELD, OH 45501-5954
DESCRIBED LOCATION. The property covered by this Policy is at the described location_unless otherwise stated:
173 Hinckley Rd.
Hyannis, MA 02601
COVERAGE AND LIMITS OF LIABILITY-Coverage is provided only where a premium is shown for the coverage, subject
to all conditions of this Policy.
RESIDENTIAL PROPERTY:
LIMIT OF LIABILITY DEDUCTIBLES PREMIUM
Coverage A- $232,600 All Perils: $250 $2,359.00
Coverage B 10%of Coverage A
TOTAL PREMIUM $2,359.00
COMMERCIAL PROPERTY:
LIMIT OF LIABILITY DEDUCTIBLES PREMIUM
Building - All Perils:
TOTAL PREMIUM
Optional Coverages, Assessments, Surcharges, Taxes, Fees (if applicable):
TOTAL AMOUNT $2,359.00
FORMS AND ENDORSEMENTS which are made a part of this Policy at the time of issuance:
MIP 252 SG (03-12),MIP 254 (03-12),MIP 243 IL (06-12),DF00244A(04-13),NOTI1102 (06-12)
NOTI1106 (06-12),MIP 260 (03-12),MIP 263 (03-12)
BORROWER- Name and address:
DICKSON SHAWN
173 Hinckley Rd. 4
Hyannis, MA 02601
Loan No.: 0040523318
CLAIMS: 1-800-326-2845 Issue Date: 06/05/2015
ALL OTHER INQUIRIES:
1-888-882-1855 Countersignature (where required)
MIP 256 SG (03-12) Page 1 of 1 MIP256sGR-0614
ASSURANTS1 '. su
+ Y
As ran't
P r pe; , Fldsst Serves
VACANT BUILDING PLAN FOR:
173 HINCKLEY RD
HYANNIS, MA 02601
AS OF: 09/18/2015
PROPERTY IS BEING SECURED AND MAINTAINED.
PROPERTY WILL BE LISTED FOR SALE.
OWNER CONTACT IS:
PHH
2001 BISHOP GATE BLVD
MT. LAUREL, NY 44125
800-468-1743
l
AGENT CONTACT IS:
ASSURANT FIELD ASSET SERVICES
101 WEST LOUIS HENNA BLVD. STE. 400
AUSTIN, TX 78728
800-468-1743
P:800-468.1743 F:512-833-8101 www.fieldassets.com
LICENSE OR Liberty Mutual surety
PERMIT BOND PymouthMeettiins PA19462a
Bond 016066744
LICENSE OR PERMIT BOND
KNOW ALL BY THESE PRESENTS,That we, Assurant Field Asset Services, LLC
as Principal,and the Liberty Mutual Insurance Company .a' Massachusetts corporation,
as Surety,are held and firmly bound unto Town of Barnstable, MA
as Ob.11geet
in the sum of Ten Thousand and No/100-----—
Dollars($ 10,000.00 )
for which sum,well and truly to be paid,we bind ourselves,our heirs,executors,administrators,successors and assigns,jointly and
severally,firnily by these presents.
Signed and sealed this 10th day of September 2015
THE CONDITION OF THIS OBLIGATION IS SUCH,That WHEREAS, the Principal has been or is about to be granted a license or
permit to do business as 173 HINCKLEY ROAD HYANNIS, MA 02601-0000; PID: 1511765
by the Obligee.
NOW,Therefore,if the Principal well and truly comply with applicable local ordinances,and conduct business in conformity therewith;
then this obligation to be void;otherwise to remain in full force and effect.
PROVIDED,HOWEVER; 1.This bond s
shall continue in force;
❑ Until ,or until the date of expiration of any Continuation Certificate
executed by the Surety
OR
® Until canceled as herein provided.
2 This bond may be canceled by the Surety by'the sending of notice in writing to the Obligee,stating when,not less than thirty days
thereafter,liability hereunder shall terminate as to subsequent acts or omissions of the Principal.
Assurant Field Asset Services, LLC
Principal
By
Liberty M ual Insurance Company
By
D-Ann Kleidosty Attorney-in-Fact
S-0908ILM 10/06
XDP
- - .. ..
THIS'POWER OF ATTORNEr.IS NOT.VALID-UNLESS IT IS PRINT
ED:ON:RED BACKGROUND:. -
: This.Power of Attorney limits the acts of those:named herein,and they-have oo authority to bmd.the Company except;in the:rnanner and fo the extent herein stated
. .
- -
Certificate No 700e94
- American Fire and Casualty Company Liberty Mutual Insurance Company
. -
The Ohio Casualty Insurance Company West American Insurance Company
-; � ;
- .; - POWER OF.ATTORNEY
KNOWN.ALL PERSONS BY THESE PRESENTS ThatAmerican Fire S Casualty Gompanyand The Ohio Casualty.Insurance:Company are corporations duly organized under the laws of -
the State of New Hampsnire,ahatLitierty Mutual Insurance.Company is a corporatiori duly;organlzedunder the laws:of the State
Massachusetts;and WestAmericanInsuranceCompany
is a corporation:dulyorganized under theaaws of.the State ofandiana(herein collectively called the Companies) pursuant to and by authority herein"set forth;.does hereby name:constitute
_-
and appoint, ::Brooke:A:Sharp,D=ann Kleidosty;:Ga ,D.:Eklund;Sharon, Potts'syfl is M.Ogle,Willlarrt G:MoodV .-
all of he city of.Atlanta " state of G- each tntlividually ifahere be morethan one named;ifs trueand lawful attorney In fact to make,execute; eal acknowledge
and deliGer for and on its:behalf as surety and as its act and:deed anyand all undertakings;;bonds r.. 1.zances'and othersurety obligations In:pursuance of these presents and shall
I__.--_--.-4__/_..--:-�._---_-I._--.---.-_-_a----,_-,�
- _q .,
-
=. tie as binding upon the Companies as if they have;4een duly signed bytt.. president and:attested byttie`"secretary of the Compames.in their own prayer persons _
_
c- :
I.
IN WITNESS WHEREOF this:Power of.Attorney figs been subscribed by an authorized officer or official:of the Companies arid the corporate seals of the Companies have been affixed = -
_ -
therato this lath day:of -July 2015-. -
LL
American Fire and Casualty Company a
��a°°Foq�� ��P�� °"��q2 J��Pu,Roy°�F. ���P� �� �� The:Ohio Casualty Insurance Company _ry
z -4 o :. Liberty Mutuallnsurance Company m.
1906 '.o ID 't979 0 1912 3: T991 .: C
d a o �. W - Wesf mencan Insurance Company ,N.
N- ��b•i:Anvs''`w�a -- o'y "Naraes�Q�aD.; �'7�Snc��'�Err? - ' HGIANP < _ -7
�. _ B. _
_= STATE OF PENNSYLVANIA --s. David M Care Assistant Secretary C
-.__. , . as
=`L COUNTY OF MONTGOMERY _:C
t>s _ -
=M On this 28th day-of July:- 2015: before me personally appeared David M Carey who acknowledged himself to be the Assistant Secretary of American Fire and ;v E"
v:d= CasualtyCompany,:Gberty Mutual Insurance Company Ttie:Ohio Casualty Insurance Company and West American Insurance Company and tliaf tie assiich being authorzed'so to do ::j,N
6 , execute the foregoing instrument#or the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer a',-
gip. _ - :. -
_. :. '
a1:>. IN WITNESS WHEREOF tfiave.hereunto subscribed my name and affixed my notarial seal.et Plymouth.Meeting,.Pennsylvania on the day and year first atiove written.". <'O n
c0. P Pq"g COMMONWEALTH OF PENNSYLVANIA /� <O
= J�Q�o Mo"W���l� Notanai Se'ai /y/�/ ,
C:N- - ti o s r Teresa Pastella Notary Public gy � . - O
M_d_: = oir` _Plymouth Twp Montgomery County Stella;NOta.ry"Teresa Pa L
O L- \P My:Commission Expires March 28 2017 _ �
.y- 'SytdP
O- p�Q V Member Pennsylvania Association of Notaries - 'O-
�= -: Rr". d_�.
C-�_ This:Power ofAttomey is made and executed pursuant to an.by authority of the following By laws and Authonzations:of American Fire and C L I-y Company,The Ohio Casualty Insurance ;w_p
d�, Company Liberty Mutual Irsurance Company and West American Insufance Company which:resolutions are now in full force and_.-- -eading asfollows .=
0
ew L ARTICLE IV OFFICERS-Section 12 Power ofAttomey Any officer or-other official of the Corporation authonzed for that purpose m writing by tlieChairman or the President and subject O c
r to such limitation as the Chairman or the President may prescribe shall.appoint such attorneys infact,_as may be necessary to actnn behalf ofI a Corporation tomake execute seal --:5
O_: acknowledge and deliver assurety"any and.all undertakings aionds reeognizances.and othersurety obligations-.Such attorneys in fact subtect tothe limitations set forth in their respective :�_ ,,
> �: powers of attomey,:.shall have full power to bind the Corporation by their signature and"execution of any such-instruments and to attach thereto:the seal:of the Corporation When so-, a>:
_.
, executed such instruments:shall be asbinding as if Sig- -:by the President and attested to tiythe Secretary Any power orauthonty granted to any representative or attorney in fact under >.s
`"=_= the provisions of this article:may be revoked at any time bythe Board the Chairman the President or by the officer:or officers"granting such power pr authority: d 6:
a
_�: ARTICLE XIII ,Execution of Contacts:-SECTION 5 Surety,Bonds arid_Undertakings Any officer of the Company=authorized for that purpose in writing by the chairman or the president .-T
>=am- and:sub ect to"such limitations as the.chairman or_the resident ma rescribe shalfa pint such atiome s in fact:as ma a necessa to actin behalf of the Com ari ao make,execute cV
L__ l P _ y P : PP Y. _ y ry P .y rI
0== seal,_.ackribW6dge and deliver as surety any and all undertakmgs bonds recognizances and other surety obligations `Such attorneys-in factsubtect to the,limitations set forth:in their,C:a?.
Z,U_- respective powers of attorney,shall have full power to bind the Companyby thug signature and execution of any such instruments andto attach thereto the seal of the Company When so C o.
executed such instruments shall be asbnding as if signed by the president and attested by the secretary:
Certificate-of Designation,-The President of the,Company.acting puisuantto the Bylaws ofth_Company authorizes David M Carey,Assrstant Secretaryy i,appoint`such attorneys in =-
fact-as may be necessary to.act on behalf of the Company:to make execute eat;acknowledge-and deliver as surety any and all undertakings-;bonds recognizances and other surety
obligations -
Authoriza ion By unanimous consent offhe Company's Board of Directors the Company consentsttiat facsimlle.or mecha[ncally reproduced signature of any assistantsecretaiy of the = -
._ _
Company-wherever appearing upon a:certified eopy of any power of attorneyissued by thebompany in Connectlgo with surety bonds,shall be valid antl tiinding upon the Company with _
the sarne-force and effect as though manually affixed
- _,
.
Gregory W.Davenport the undersigned Assistant Secretary of Amenean Are and CasualtyCompany,The Ohio.Casualty Insurance Company Liberty Mutual Insurance Company and
..
--
=WesYAmencan Insurance'Company do,hereby certify thatthe original power of attorney of which the foregoing tsa full true.and correct dopy of the Power of Attorney executed:by said
Companies is m:full force and effect and has notbeen revoked _ Q
-=IN TESTIMONY WHEREOF;:I have hereunto set my hand antl affixed the seals ofsaid Companies this'' day of =J�- 20
Pp10 CASG - �-�V INSp ��NStlq N1FSUq _ - _ _
Q� opeortgrF 9t J� syo�r 9y �JP o�oRarq�'r` \�,P ceroagr't'� -.
¢ o �. ,tA Fo 2r , : .
a : 1906 a o 1919 n. 1:912' ° ¢ 1991 By
o E. * _ . 5 ab y i Gregory W Davenport Assistant Secretary .:
d�LG HAhiFS`*C1aD .�� HAb14S'��v�a'_ ��,��FS�CN se Ir 3 �MDIANP _
_ ._
"
_..
230 of 500
,." _.iMS_12873=122013 '
3I0-
Assessor's map and lot number ......................... ........
t
Sewage Permit number .......................................................... /
yFTNET��i TOWN OF BAR.NSTABLE
Z EARISTA33LL
039.o w BUILDING INSPECTOR
� aY a'
- v
APPLICATIONFOR PERMIT TO ........ ... ...... ........................................................................................................
TYPEOF CONSTRUCTION ......................................................................................................................................
..................:":... ?...................19..�..�
f TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies fora permit according to the following information:
Location J ���!,t- ' ►:......................................................................
1.
ProposedUse ... . '�-�? P4,r................................................................................................................................
Zoning District ..............f).,,,-..............................................Fire District ......... .. ............... ..... ....... .
Name of Owner ..� t ►g j`15�.W,D ...... [? .l!!?. Address J.2—B
Name of Builder ....... ....... ....Address ...* . " i...................
Nameof Architect ......................./............................................Address ....................................................................................
Numberof Rooms ...................yC...........................................Foundation ..............................................................................
Exterior .... ..,.1._:
0j. �? ..........................................Roofing ........:. ....,.a:pT-/t +' - -�a........................................
,!
Floors ..................... ....C`.'+% ..........................Interior ...... .. ............. .. .. ........... � .`
Heating :................Plumbing .........'" --'^...................................
Fireplace .................. e' ``. .:.......................................Approximate Cost ........ 4a ......... .......
Definitive Plan Approved by Planning Board ---------------____-----------19_______. Area .......... ......
Diagram of Lot and Building with Dimensions Fee f o
SUBJECT TO APPROVAL OF BOARD OF HEALTH
SEPTIC SYSTEM MUST SE
I;•,STALLED IN COMPLIANCE
E'r`1TI ATICLE 11 STATE
( � ,ANITASrY CODE AND TOWN
REGULATIONS,
o -�zla-Let
V
0 VS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ........... t"'�Q1'"� ...................
Phoenix, Gertrude
16198 storage
. �
' No .................
Permit for ....................................
- shed
' -
-----~---'-----------------'
' , |
Location --'I��--_____.Hinckley I�m��______
Hyannis '
—..--------------------'---.. �
Owner -- ----- ----'---' '
-------------------~-- i
frame �
� Typo of Construction ........................................... ]
^
—'----^-----------------'--'' `
^
\ ' �
U Plot ............................ Lot ----------' /
�x �
k
�
/
Permit Granted --..May..7-------19 73 �
'
r Dote of Inspection lV / ^.
�
\�
PERMIT REFUSED /
'
'|
-----'----..---------.. 19
n
~ �------------.-------------..
^'-----^^—'--'---------~----''
^'----''--'—'-----^^—^--^^-----^'
--------'------^-----^^^~—~'—
Approved .. lA �
�
^
----------------'—^~—^'-----'
'
`
----------------.----..~.—~..' �
�
• - pia - g�
yoFTHETo�° TOWN OF BAR.NSTABLE
•
33AWS ULE, i
"b 9
am BUILDING INSPECTOR
PY A•
�
t
s
APPLICATION FOR PERMIT TO0111e1
...... A !?`-�.. . .... ..... ..... . ... ............
TYPE O /F CONSTRUCTION ...................
�/� .........�......................................................................................................
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby plies for a er it according to the following inform on:
172
... .....6
Proposed Use .
.. ................
Zoning District ...N44441y -- .. ........•.........Fire District ..l..t ............................. .............. . .. .. ..............
Name of Owner ..(� ..rC�. ...`'�... .. . ..................Address �. .. ...i!<r✓?-f/y!�-c .Or ly...s1.:'...
Nameof Builder ....................................................................Address ....................................................................................
9
Nameof Architect ...................................................................Address ....................................................................................
Number of RooLs ... .............Foundation.... .. v l
r
Exterior .....W............... ...........Roofing ... . .. ,[ ..........................
... A .
. ... ..... ... .
Floors ........ ...A.......i.. ..... .. ...... ..................Interior .... ... ....... . ... ........................ ..................................
Heating ....... .......................................
/ � eat, V... -......Plumbing .. ��.��7
�... '..
Fireplace ............. .........................................:.........................Approximate Cost . ...f Gl?. 1...........................
Difinitive Plan Approved by Planning Board ________________________________19________. 3
US
/ 2S
Diagram of Lot and *ilding with Dimensions Fe e. b
'I ?L
w L
0
n. LL a0 w"4
7, � ZAxa ¢ --
a�m
mow = aZ
C1 x z
w � Ld
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a: �
01
W
HZQ
•
CT
I hereby agree to conform to all the Rules and Re"ulations of the Town of Barnstable regarding the above
construction.
NamJ/ .............
Johnson, William k.
No ..1952.... Permit for .......one story.........
single family dwelling
...............................................................................
Location .............Hinckley..Road...................... F � �
Hyannis
..............................................
ed
Owner .................................................William Johnson :................ k
Type of Construction frame
......................... _ ,
...............................................................
1 6A
Plot .... . ................. Lot .............3..................
s
Aril1 . 2
Permit Granted G /3*�
9 :.. 11�9 i
LI
Date of Inspection .. . 19
..................Date Completed Y'
PERMIT REFUSED-%
............................................................... 19 ;r #
......................................................`.......................
................................................. ...... .................
...................................................... . ......... ....._.... I r
................................................... .r. ......................
Approved ............................................... 19 JN`.
...............................................................................
................... ..........................................................
-7
tt a� ���d)Town of Barnstable *Permit
fires 6 onthslsorri sue date
Regulatory Servicesee
6 2Q� Richard V.Scali,Director
� i63q.p�� JPN 2 f
Building Division
Paul Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
3` (�//6 Not Valid without Red X-Press Imprint
Map/parcel Number ( UU
'Property Address 123)
❑Residential Ualue of.Work$ t MinimQ fee of$35.00 for work under$6000.00
Owner's Name&Address
Contractor's Name elephone Number ! -
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
(Check one:
Tm-a so e 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.
Peinu_� f Reque t(check box) \
a- [B Re-roof(h ru ricane nailed)(stripping old shingles) All construction debris will be taken
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
;' side
Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows
#of doors: _
"Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy he Home Improvement Contractors License&Construction SupervisorsLicense is
e i
SIGNATURE:
QAWPFILESTORNIMbuilding permit forms\EXPRESS.doc
01/25/17
AWarfmwt c frnd slrid Acddern!s-
Oe of IM- -WSqVt
600 Wadagim S`lreet `
_ Briton,MA D2111
fv vx�.r�tansgav/din
Wk"kD& U=Mpensatjenn Insua-mce Affidavit Sufldk-slCantrachws/fEI ers
AppUcgot hfMnaiian Please Print
Alt
Are you an employer?. eckthe appropriate bar: Type of project(red).
Y_❑ I am a employes vvi 4 ❑I amp a general ca3fmctor and I 6. ❑ldesv
employees(fell andkr pnt sme * have luredt&e su camdxa ozs
2.❑ I am a sale propieto r orparbmr- listed onthe attached sheet. I`- ❑RPTaodeHag.
ship and Dave no empinyees� These sob-canftwkrs have 8. ❑Demolitioa
Wing for mein any capacity_ employees and have w<aadoer ' 9..❑Budding addition
LNO ems'Comp.i cti comp.ksmmn e '
j 5. ❑ W-e are a corporation and its 10-❑Elechicai repaks or a,dditiCas
3.al am a bomwwner doing all wask Ph=biagrepaus or additions. '
myself[No wrosiaeE 00Mp of e r MGL
c.= §1(4h L.❑Roo-frepais
_ 13_❑f?liier
employees.[Ko- s
cam ms regtnred.j .
*Any appUssnt:fistcbedx bas Al—st also Moutthe secti=bc7owslwsdaz dwirwodkere o mpmsarWnpn&cginformsaua
Ekmwwvmaxvdw mb dtt duo af�ida«im p dtey see daing Muwak aA�him autdecao Mmst evbmit a new affidatt mdirstfna oath
1Caffiacros tcbe lrthiz bmcnmd offadditiaoa2 sheet dww1=gthza of the and styewhefec arnotthose hm
aVb3rem Iftbea2b-cmmWu1shnm emgIoyw_%dLeymzurpsaside&eir warms'vmnP•pafiy am 3b
lam an euiper flint isprQuirling�varkers'sort peresrd�n iruairascsvr m eurP�a3�ees: $efnty is riTispa�icy a jab site
ix�oizaQhba. _ � - •
i� �CotnPaag�ame=
Policy 4x'or SrH-in€]ic- `.\ l i�atiau I?afe=
Job Site Address 1�t Cgl5tafet.tp: St b7 �'
AEtach a-0opy afthe wart--erg'comp ' agolicg declaration page(showing the policy and espization date).
Farlme to sec um coverage as required under Section 25A of MQ.m 157—can lead to the impositioa Qf Criminal penalties of a
fine up to$U0D.00 iadlar oie_:y&irimpdsona a ut,as well asrivil p—alfie=s n the farm of a STOP WORK€RDER.and a fme
of ups$Z5M a dap against the violaiur. Be advised tht a copy of this statement saaybe faswarded to tln f 25M of
Insrestcgati ofthe DIA ix msumnet-coverage vedffication_
ya£a Jtereby COO, t&s pains andpsroalfixs a Fer eF f#atfJi4 ii;,farwrafzonpr�rriifdr*d Lm true and c aired-
h.
Date=�-.1 7—�
�Pivo-ae ik-
tJ at a* Do not wife firs area€ct be cxrrriprfete by Qfp Ira a f etat
My or T'an= Fere>hlLice=e;9
Lssng AuBcarEty(code one):
L Sowd of$ea10 _.Ilwiag Depaxtt neat 3.f dylrowa Clerk d,.Electrical bgmtoc S.Pbunbing InTector
b.vt>hW
Contact Person Pbona#:
6
taformation and Instructions o
MRSMC3111SOft Gcbmal Laws chggE r 152 re lm=en a g)hTeo;to provide VMIX 'campeusafion for their=3play=.q-
pm=antto&is statofn,an arrploym is defined as -avmTpersanin$f a scavicc of mwffi r under a¢y dart ofhae, t
or fiq3Iie4 oral or wnf ellf
An eazpkYer 3 s de<imed as"aa fiuEv dmLL per,assoc sfion;c"Pmen or offi legal enty,c$any t4.o or ffi
mare
of$ia foregoing engaged is a joint terse,mdmchu:Eng'ie pesenfves of a deceased employer,or
receiver or tragtee;of an mdrnidnal,pa�shrp,asso�ion ar off legal entity,emplaytag eazcploye� $owevez�
owner ofa.dwclHngbnusebavmgnotmm-otb fbrw apmtners andwho rmddesHim7min,ortho occap8,It oftbe -
dweMag house of a x&w who enpIays persons to do m cl,- construction or repair voik on.sash dweIIing bawc
or am the gro=a& or building appmt mantfiamrAD shallnotbecanse of such eaiplaymeatbe deemedto be ffi EuTIOYen"
MCA cbaptm-152.§25g6)also states thEt¢every sit or Ioc al picensiag a cF shZ�rEhlioId the aM ce or.
renewal of a license or permit to operate a business or to construct buadiugs is the commonwealth for any
applic mt:who bras notprodaced acceptable evid=ce of cdmtpH=c-m wiffi the insuran=.coverage req'aired."
Addidm3alLy,MCrZ cbaptra L52,§25CM gtatrs�Nefflacr tl a wcab h nor'my ofitspo E,ficaI subdivisions shah
e„ intoanycmrb:ad for tbep ofpubIiow133kuablacceptableevideumofcar3pliancewi1htheinsurance-"
re(Emx ieasfs of dais chapt�bave lie®Ares edto the confraciiag a hozhy.
Alplican-ts
Please f I out the wmkeas'compensation affidavit completely,by g ELe boys tip apply to Your sRnaH Bnc�if
necessBIL S-opPIY em s)name(s), addresses)MdPhaw nmber(s) along WI&f s cm t[f'cate(s) of
- s�ance- L=Mted Liability Companies(LLC)or La dt5dLmbM4,Patt=mbzps(LI P)w&no =3PI°Yees O'ff=fhan fire
members or pm to.=,4 are not rbgakc d to caqywa6=e compensafrm ii=m e_ If m LLC or LLF does have
a o is Be adVised-fhatthis affidayitmaybe snbxn-if�to the Deparfinent of Indusftial
e2npIoye�s, P � req�ed- .
Accidents for cones of msrsmzce cove`aage:. Also be sure to stn and date dire aF=-daYit: The a$davrt should
be i u cd to!he city or town dust fire agpficaiion for the pemdt or license is being regaesbA not the D epzdmed of
Tndn iAl A zd drams_ Shouldyort have may gaeslions rega¢dmg the law or ffyon are rued to obtECM a wozioeta'
ecmxp=;aiion pofiey,please caU f=Deparimeat at the nmnber Iistnd befog! Self-fnsored companies should eotet their
self-h mnm r-P license nnntber en the mmnu date line.
City or Town OMdals
Please be sure that the affidavit is complete sndpria:frdlegibly_ The Departmeuthas provided a space at the bottom
of the affidavit for you in frIl out in the eves the Office oflnyesti yaws has to coafactYam cga cdmg the applicant
Please be sure to fiIl fa the pa iulicense rnnnbm wbich vM be used as a ref xmm amber. Im addition,on,an applicant
-d�mnst submit nzuhiplo p=W cease BPPh=aiicros M aay given Year;need only sabnut one affidavit indicating current
Or
p olicy mfonnatian(if nwmsaly)and Tmei `Job Sit=Address'°$re applicant should wee 6a1I locations ii� (�Y
tow a�n)_"A copy oftbaeffidavftthathas bee officially sbmpcd ormmicedbythe city ortownmay be provided in the
applicant as#ool=tbat a valid affi&-vft is on fate for fnfnre pEm . or licenses Anew affidavit xmrst be f cd.oIxt each
r year.-Where ahome owner or cM=is ob aiaing alicemse or pm=dtnotrelatedto anybasio=or co*nrn=ial ve3az
a dog license or permit tc)burn.Imves _)said peason is RIOT reqficed to co Iete 13vs affidavit
The Office ofInytstigab=wou1dIxlo:toth;mkygnmadvanceforyour cooped and shouldyouhave anygaestions.
please do not hesitate to give vs a caIl_
nm Depsrtr e s address,trlepbone and fax nambea_ -
taf 1s.'sachas5tt. .
• . o �, ��f Accidents
* f�tc�af�titx� • .
F= a 7 72-1-7749
B.evised 4-24-07 c P"¢Ark .
Town of Barnstable
Regulatory Services ` .
aIF Richard V.Scali,Director t
'Building Division '
t HAsnt� •' Paul Roma,Building Commissioner-
s639. ��� 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma:us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
_ .�ti ! Please Print
DATE: v2
JOB LOCATION:`- ` h VQ S ?
number village
Ul
"HOMEOWNER '�3: +
nhme home phone# work phone'#
CURRENT MAILING ADDRESS:` ,�' \
city/town state zip code
The current exemption for"tom ers"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,did he/she shall be responsible for all such work performed under the building permit. (Section
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The and i `homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
pro s requirements and that he/she will comply with said procedures and requirements.
'Sign 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
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. t
QAWPFILES\FORMS\building permit formsV(PRESS.doc .
06/20/16
f
WE To-Wn of Barnstable
Regulatory Services
WAM ` Richard V.Scali,Director
Bailing Division.
Paul Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 , Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject property
hereby authorize to act on my behalf
in all matters relative to work authorized by this building permit application for.
(Address of Job)
**Pool fences and alarms are the responsibility of the applicant Pools
are not to be filled or utilized befort fence is installed and all final
inspections are performed and accepted.
Signature-of Owner Signature of Applicant
Print Name Print Name
Date
QFORM&MMERPERMISSIONPOOIS
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