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HomeMy WebLinkAbout18/20 HIRAMAR ROAD ��Pl�x ��� - / �� OFI E l 'Town of Barnstable Regulatory Services + BARNSTABLE. Mass, g Thomas F. Geiler,Director 1639. rfnnnpt° Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 March 8, 2011 Dear Property Owner, This letter is to inform you that Regulatory Services canvassed the general area of Hiramar and Fresh Hole Roads on Friday afternoon, March 4,201 Fin an attempt to assess the current . conditions of the properties located in this area. This department recommends"that all landlords personally inspect their property in order to obtain an accurate assessment of their individual rentals. For your convenience I am identifying the findings in a generic list below: • Broken window panes and storm doors. • Failed glass • Missing storm doors. • . Torn or missing screens t • Broken glass strewn along.the perimeter of dwellings • Broken glass surrounding'dumpsters and in parking areas • Peeling paint • Uncontained outside storage of household trash .• Abandoned appliances.outside • Missing or clogged gutters • Failure to post contrasting.house numbers. • Rotting window sills and support posts • Missing or broken outside lighting fixtures • Blocked egress including a rear exit nailed shut. In addition, landlords should confirm that all units have the adequate number of operable smoke . detectors properly placed as required and units relying on fossil fuels are also required to have.. carbon monoxide detectors. . Please feel free to contact me directly at 508-862-4027 in the event that you require additional information concerning this letter-. > erely, R ry(— Robin C.Anderson Zoning Enforcement Officer CC:Chief Paul MacDonald,BPD,Debra Dagwan,Town Council LAW OFFICE OF SCOTT B. BRILLIANT Telephone Attorney at Law Facsimile (508)759-4347 449 RT. 130, SUITE 7, BOX 12 (508)562-4524 Sandwich,Massachusetts 02563 www.lawofficeofscottbbrilliant.com SBBRILLIANT@COMCAST.NET November 15, 2008 Building Division Town of Barnstable 200 Main Street Hyannis,MA 02601 Re: Public Records Request 18-20 Hiramar Road, Hyannis, MA Dear Sir/Madam: I am writingto o request,pursuant to M.G.L. c. 66, §10, copies of all records and bills within your office's possession, custody or control which relate to 18-20 Hiramar Road, Hyannis, Massachusetts from 1970 to present. All the records requested are public records as defined by M.G.L. c. 4, §7. Pursuant to M.G.L. c. 66, §10, they are therefore open to inspection by members of the public and copies of the requested records must be made available within ten days. These records are also requested under the Freedom of Information Act. 5 U.S.C. Section 552. I understand that'pursuant to M.G.L. c. 66, §10, you may assess reasonable charges for the expense of copying these records. Please remit.a bill to this office indicating the fees for these copies. - I look forward to hearing from you within ten working, days of this request. . Thank you for your cooperation in this matter. Sincerely, f Scott B. Brilliant, Esq. SB/bw s C� 77 N) �- rn 8 - f t ESS wn of Barnstable *Permit# OF Expires 6 months from issue date FEB 1 2Q� Regulatory Services Fee Thomas F.Geiler,Director swxMsrasr.E 9�AlFn►3�►a+MAW OF BARNSTABL Building Division Q Tom Perry,CBO, Building.Commissioner I 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Numberf Property Address ,A) ltiR y/!1/ii.0 11Y,4/2,7/5 ff Residential Value of Work 4?) Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address /may i3 rz 4� OOAI /AzF to Contractor's Name M f,1/.715 Telephone Number Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name 'rt,git���9 S Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ® Re-side ;Pal t (j�Replacement Winos/doors/sliders.U-Value > ,�y (maximum.35) *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 of the Home Improvement Contractors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC Revise020108 • � o fix. ' The Comrionwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street, Boston.,MA 02111' wttiw.mass.gov/dia ' Workers -Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A_pplicant Information Please Print Leeibly Name(Business/organization/Individual):. •Address: City/State/Zip: 44W6 _12& Phone.#: v d ' ZY6 qWTZ Are you an employer?Check the appropriate bog: Type of project(required):, 1•❑ I am a e to .er with 4. I am a general contractor and I mp y 6. ❑New construction . loyees(full and/or part-time)-*• have hired the sub-contractors listed on the-attached sheet. 7. ❑Remodeling 2•Z 1�a'sole proprietor or partner- These sub-contractors have ship and have no employees .. . 8.;;Q Demolition employees and have workers' - avorlsing for me in any capacity. 9. ❑Building addition comp,insurance. [No workers comp.insurance 10.❑Electrical repairs or additions required.] 5. [] We are a corporation and its 3.❑ I am a homeowner doing all-work officers have exercised their 11.[]Plumbing repairs or additions ' myself[No workers' comp. right bf exemption per MGL 12.❑Roof repairs insurance.required.]t c. 152, §1(4),and we have no 13.❑Other-4 sri 190& D 1 employees.[Nb workers comp•insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating inch. tcontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I4m an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site' information. Insurance Company Name: `77Z r9-W 44 — Policy#or Self-ins.Lic.#: 6160% `744ZI (Z-G —3-6'77 Expiration Date: 449 ' Job Site Address b ��%���� `�' City/State/Zip: k&G1Ah�� (04 oe_6&1 Attach a copy of the workers'compensation policy declaration page'(showing the policy number and expiration date). Failure•to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine V tb$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORKARDER and a fine of up to$250.00 a day against thq violator. Be advised that a copy of this statement maybe forwarded to the-Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains•ahilpenalties of perjury that the information provided above is true and correct Si afore �` Date- afllll%rlj� Phone Official use only. Do not wrtte in this dreg to be completed by city or town,official. City or Town- ' Termit/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#: is - °F1HET Town of Barnstable Regulatory Services eaxxszABLFE Thomas F.Geiler,Director Mnas. ' 1639. iOrFnnw�a Building Division, Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 , www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, axle W14� r , as Owner of the subject property hereby authorize S7-Z-9W,--1y 1,4`41I,6 to act on my behalf, in all matters relative to work authorized by this building pernut application for 1�4 6 Z01 (Address of Job) .. gignatdre of Owner &- Date 1 • Print Name If Property Owner is 'applying for permit please complete the m Y Homeowners License Exemption Form on the reverse side.. Q:FO RM S:O W N E RP E RM I S S I ON Town of Barnstable OF1HE Tp� " Regulatory Services BARNSPABLE, Thomas F.Geiler,Director y MASB. 1639• p.� Building Division TED � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as c� 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 all such workperformed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature 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 persons)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 fomi/certification for use in your community. Q:forrms:homeexempt DATE(MM\DD\YY) � .�4�4�h1®® RT Fi CAfiE OF N S U RAN E,' 1 1-27-07 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIOM PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 0 BRIENS CENTERVILLE INS HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX 610 COMPANIES AFFORDING COVERAGE CENTERVILLE MA 02632 OOMPANY 28SBK A THE TRAVELERS INDEMNITY COMPANY INSURED COMPANY HOLMES, STEPHEN M B P.O. BOX 2537 COMPANY HYANNIS MA 02GOI C COMPANY ' D .VERAta1£5 . . THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, _EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM\DDWY) DATE(MM\DD\YY) GENERAL LIABILITY GENERAL AGGREGATE S COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR. PERSONAL&ADV.INJURY $ OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE S ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY (Per Person) S SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per Accident) PROPERTY DAMAGE. $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ' OTHER THAN AUTO ONLY: ANY AUTO I EACH ACCIDENT ..$....... AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE S OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND _ STATUTORY LIMITS A EMPLOYER'S LIABILITY (6KU6-743X 126-3-07) 04-24-07 04-24-08 EACH ACCIDENT $ 1 qOO i THE PROPRIETOR/ INCL DISEASE-POLICY LIMIT $ mn PARTNERS/EXECUTIVE OFFICERS ARE: RX EXCL DISEASE-EACH EMPLOYEE $ 500 000 OFFICERS ARE: OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS : .THI.S. REP.LACES._ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. C£RTIFIOATE M£3L�EtT CANCELLATIONIN ... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LI`BILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. . AUTHORIZED REPRESENTATIVE .�. :... ::.;::.:;.;;:.::.::.::. i<:;;' :;;;;::; .. �. ACORD STE� CERTIFICATE OF LIABILITY INSURANCE o xo DATE(MM/DD/YYY7) PH-1 11 27 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE O'Brien's Centerville Ins Agy HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 259 Pine Street, P.O. Box 610 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Centerville MA 02632 Phone: 508-775-0005 Fax:508-775-6772 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Arbella Protection Ins. Co. INSURER B: Stephen M. Holmes INSURERC: P.O. BOX 2537 INSURERD: Hyannis MA 02601 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE DATE MM/DD/YY DATE MM/DD/YY GENERAL LIABILITY EACH OCCURRENCE $500,000. A X COMMERCIAL GENERAL LIABILITY- TO BE ASSIGNED 11/27/07 11/27/08 PREMISES(Eaoccurence) $ 100,000. CLAIMS MADE X�OCCUR r MED EXP(Any one person) $5,000. 7S70 6-3 L(T1 � PERSONAL&ADV INJURY s 500,OOO. GENERAL AGGREGATE $ 1,000,000. GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000. }( POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ EA ANY AUTO OTHER THAN ANY $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ UTH_ $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $, If yes,describe under E.L.DISEASE-POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpentry, Remodeling; **Subject to Policy Terms & Conditions** CERTIFICATE HOLDER CANCELLATION FRASE-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTAT �O Ste hen B. O -ACORD 25(2001108) ©ACORD C' PORATION 1988 v }? p Board of Building RegulaEio au` t►ndards . `HOME IMPROVEME T C� aR ' s ., s r �:'-��Reg(strdtton .1Q3d79� � � � ¢ tatlon� ft/2008 7 _ l�... ,i S�'}�'r q�.rT. ."" � a�'1 "71fA1dUd•1��-'� Y�4 y;F ' »C't; + 'STEPHEN M.HOLiVIE' Stephen Hol�mesr 38 PRISCILLA S.F. ' t ryannis MA 02601 D LP • ,t*w,.,.�,^^,�F��,� .�',�r, :, ,�r, �tit r w. � r 1.� �aui;�i;i 07/ -P�� � i Board o Building Regi sand tan and F Construction Supervisor License f License: CS 27 �j Exprration 1130/2010 Tr# 15125 �-,Rest ctran 0Q�' STEPHEN M HOLM PO BOX HYANNIS MA Commiss ioner i ioner Townr of Barnstable *Permit# r. Expires 6 months from issue date Regulatory Services Fe t RAMSrABLE, t Thomas F.Geiler,IDirector / Building Division`,` RA Tom Perry,CBO, Building Commissioner t ? � 200 Main Street,Hyannis,MA 02601 www.townbarnstable.ma.us t Office: SFB Fax:508-790-6230 PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ��'i 2 4 So PropertyAddress i p &L ►4 Y' Residential Value of Work 0 Minimum fee of$25.00 for work under$6000.00 3 Owners Name&Address to i �✓I N�` x - °R TContractor's Name Telephone Number 7 7 F Home Improvement Contractor License#(if applicable)_ i Z I. S/ r' WOlkman's mpensation Insurance CMeoe: a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation insurance' ., Insurance Company Named r7. Workman's Comp.Policy# C P w ,q 2 "7 *` Copy of Insurance Compliance Certificate must be on file. ,;- Permit Request(check box) 1I Re-roof(stripping old shingles) All construction debris will be taken to �A,4 a/o A-A(,.e . ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ,I ❑ Replacement Windows/doors/sliders.U-Value (maximum.35) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc Y, 41 e ' ***Note: Property Owner must sign Property Owner Letter of Permission. ` ' A copy of the Home Improvement Contractors License is -required. a SIGNATURE: UX__ / QAWPHLESTORMS\building permit forms\EXPRESS.doc Revise020108 j - . ndards Sta Boa. �.'u�ld►n� >QdENT SON;.� of$ TRACTOR .HOME��MpROV�, 4 A.. Re9'strat�on g159t� . < tlon 5C s Expira�� 'Ic�drndu�r �' mmistr taFa MICN ON�RTN %=s� C�nutv.:Ad - g4 CIRCl11T MOUTH,MA 02673 i I t �' dul use only I Aurn`to befc" x Bo:;rcr'ndards Qni A Bos 01 {� •� t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA'02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): r� .�- Address: Ctef Gv f / City/State/Zip: Phone.#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction .24011,_am a sole proprietor or partner- listed on the attached sheet. 7...❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor mein,an capacity. employees and have workers' Y P ty $ 9. ❑Building addition [No workers'comp.insurance comp. insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.❑ I am a homeowner doing all work - officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. r 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 entities have. employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:, A �� Policy#or Self-ins.Lic. #: f t{�-7 3 Expiration Date: I ?�£-0 9 Job Site Address: -20 City/State/Zip: J /a Attach a copy of the workers'compensation policy declaration page(showing the policy numb r and expiration date). Failure to secure coverage,as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a, fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and,correct Signature: Date: Phone#: Official use only. Do not write in this area,to-be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.1City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their,employees. Pursuant to this statute,an employee is defined as"...every person in.the service of another under any contract of hire, . express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides.therein,or the occupant of the dwelling house.of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in -_(city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to_thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia it tHE rpm Town of Barnstable snaxsT" e. • Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO 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 �ew as Owner of the subject property hereby authorize `'� ,v�f to act on my behalf, in all matters relative to work authorized by this building permit application for. 2-0 (Address of Job) f SignatAre of Owner Date Print Name Qi\WPHLESTORMS\building permit fonns EXPRESS.doc Revise020108 IME Town of Barnstable Y Regulatory Services RAJWS,OIX : Thomas F.Geiler,Director KAM 16 9. 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: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building2gimit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC YORK CLAIMS SERVICE, INC. 100 Grandview Road, Suite 108 Braintree, MA 02184 Date 1/14/2008 (781)356-7344 Building Commissioner/Inspector of Buildings 200 Main Street Hyannis, MA 02601 c0oard of ealth/Board.of Selectmen co 50 Main treet Wyannis, A 02601 N NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B Claim has been made involving loss,damage or destruction of the property captioned below, which may either exceed$1,000.00 or cause Massachusetts General Laws,Chapter 143,Section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the cap- tioned insured, location, policy number,date of loss,and YORK file number. Insured: Eric J.Winer Property Address: 18-20 Hiramar Road Hyannis, MA 02601 Policy No. CPP 0065955 00 Loss of 01/14/2008 YORK File No. PRV-0491 (Signature) Timothy R.Linscott Title: Adjuster On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Signature and date o���� [ ] [R292 146 . ] LOC10018 HIRAMAR RO:-.p CTY107 TDS] 400 HY KEY] 203416 ----MAILING ADDRESS------- PCA] 1041 PCS] 00 YR] 00 PARENT] 0 WINER, ERIC J MAP] AREA163AD JV1373189 MTG11002 P 0 BOX 741 SPl] SP21 SP31 UT11 UT21 . 16 SQ FT] 1440 SOUTH YARMOUTH MA 02664 AYB] 1945 EYB] 1980 OBS] CONST] 0000 LAND 17400 IMP 36600 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 54000 REA CLASSIFIED #LAND 1 17, 400 ASD LND 17400 ASD IMP 36600 ASD OTH #BLDG (S) -CARD-1 1 36, 600 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 18 HIRAMAR RD HYANNIS TAX EXEMPT #DL LOT 74 LC17786-E RESIDENT'L 54000 54000 54000 #RR 0723 0031 OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE] 05/94 PRICE] 53000 ORB] C133684 AFD] I LAST ACTIVITY] 08/29/96 PCR] Y R292 146 . 1-19 P R A I S A L D A T A • KEY 203416 WINER, ERIC J LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 17, 400 36, 600 1 A-COST 54, 000 B-MKT BY 00/ BY ME 9/87 C-INCOME PCA=1041 PCS=00 SIZE= 1440 JUST-VAL 54 , 000 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 63AD -- TREND EXCEEDS STANDARD NEIGHBORHOOD 63AD HYANNIS PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 174001 LAND-MEAN +00 540001 54197 IMPROVED-MEAN -320 250 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 10001 LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP]ADDS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] R292 146 . VP E R M I T [PMT] ACTIO01 CARD [000] KEY 203416 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR OiCMP NEW/DEMO COMMENT RESIDENTIAL PROPERTY MAP NO. LOT NO. FIRE DISTRICT STREET Hiramar Rd. Hyannis SUMMARY ee H 73 LAND a o o 272 BLDGS. 9yu c..r 146 OWNER dl• O1 TOTAL ; \ RECORD OF TRANSFER DATE DK PG I.R.S. REMARKS: J G7 LANDBLDGS. - 01 + B TOTAL • • • LL__ •,.C7� LAND BLDGS. ' r TOTAL WS LAND 7Jones ,Ej.Jzabeth C. ; ,Tr. (LGL. Trust) 12-19-73 Ctf. 50213 BLDGS. U �a:Vi LL�-G•C. /'7 SS D C r- TOTAL LAND C oD.oLf c, A A/ BLDGS. C �, a TOTAL LAND 2 —sb BLDGS. TOTAL LAND BLDGS. TOTAL LAND INTERIOR INSPECTED: rn BLDGS. /� TOTAL DATE: -7 _ �� Z r1X r LAND ACREAGE COMPUTATIONS BLDGS. LAND TYPE .# OF ACRES PRICE TOTAL DEPR. VALUE TOTAL HOUSE /6 20 b Moo() 0 o U y 00 0 LAND CLEAREDW NT BLDGS. REAR TOTAL WOODS&SPROUT FRONT LAND REAR BLDGS. WASTE FRONT TOTAL REAR LAND BLDGS. TOTAL LAND l o � BLDGS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND 3 TOWN WATER/ ROUGH � BLDGS. HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND BLDGS, FOUNDAI'IV . LAND COST .Walls Fin.Bsmt.Area Bath Room -Base .� BLDG. COST Bsmt Blk.Walls Bsmt.Rec. Room St. Shower Bath . Slab Bsmt.Garage St. Shower Ext. PURCH. DATE �y Walls PURCH. PRICE. Walls Attic FI.&Stairs Toilet Room Roof RENT y_ a Wells Fin.Attic Two Fixt. Bath , Floors . INTERIOR FINISH Lavatory Extra i F 1 2 3 Sink v Y' Plaster Water Clo. Extra Attic TERIOR WALLS Knotty Pine Water Only le Siding Plywoodup No Plumbing Bsmt.Fin. e Siding Plasterboard In I. Fin. lhingles TILING UYG r 1 t7 Blk. BathBath FI. Heat.Brk.On Int.LayoutBath F &Wains. polo Ht.UnitVeneer Int.Cond. Bath FI.&Walls Fireplace ' Brk.On HEATING Toilet Rm. Fl. Plumbing �— Com.Brk. Hot Air Toilet Rm.Fl.&Wains. Tiling O a Steam Toilet Rm. FI.&Wells ket Ins. Hot Water ✓ 7F St.Shower O� Ins. Air Cond. Tub Area Total2`1• 4 Floor Furn. ROOFING a. �?—onC 5 COMPUTATIONS Shingle Pipeless Furn. D S.F. Al5 6 d r r Go Shingle No Heat S.F. I.Shingle Oil Burner S.F. ' Coal Stoker S.F. I Gas S F OUTBUILDINGS s ROOF TYPE Electric S.F. 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 MEASURED Is Flat Mansard FIREPLACES S.F. Pier Found. Floor O brel Fireplace Stack Wall Found. 0. H.Door LISTED FLOORS Fireplace Sgle.Sdg. Roll Roofing �J 0 LIGHTING Dble.Sdg. Shingle Roof No Elect. DATE Shingle Walls Plumbing wood ROOMS Cement Blk. Electric � h.Tile Bsmt. 1st f2 TOTAL `� Brick Int. Finish PR! D i- gle 2nd 3rd FACTOR Z S > REPLACEMENT _ 1 3 3 O - OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL. j ✓LG. 1 I r i 1 D TOTAL 1;� TOWN OF 3BBNSTg8LZ �'- 88PO8T RWO8T.- L33MENT88Y/CORTINIIB . � p=pi5I0N /D1T! ' NAME (LASTt TIRSTo MIDDLE) No= DETAILS i owzRVIITIDxs-ITZMIZE iEVIDENCE. SERIAL IS ETC. A"4U L417 { i r