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HomeMy WebLinkAbout0018 HOLIDAY LANE oLa-1)e__ 0 r� Town of BarnstableBuilding ._ ... .. } Post,Thls Card SoPermit 14A That it is VisibleFrom the Street Approved=Plans Must be'Retained on Job and this Card Must;JbeyKept • tA1LN•3CA$LF s. v 6 `®$ Posted Until Final"pection Has Been Made x y Fvrm�t° Where a 30- Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made Permit NO. B-19-3489 Applicant Name: KARPOVSKY,ALEKSANDR& ISKHAKOVA, DINA Approvals Date Issued: 12/02/2019 Current Use: Structure Permit Type: Building-Fence Over 6'-Residential Expiration Date: 06/02/2020 foundation: Location: 18 HOLIDAY LANE, HYANNIS Map/Lot: 267-184 Zoning District: RB Sheathing: Owner on Record: KARPOVSKY,ALEKSANDR&ISKHAKOVA,± ` Contractor Name;: Framing: 1 Address: 41 OLD FARM ROAD _ Contractor License: 2 NEWTON, MA 02459 Est .Project Cost: $0.00 Chimney: Description: 11 Ft screen with slats extending from 5' uo to th etop approx 34in Permit Fee: $ 120.00 Insulation: length Fee Paid. $ 120.00 Project Review Req: PRIVACY FENCE ONLY PER ENGINEERED DRAWINGS. Date 12/2/2019 Final Z.o Plumbing/Gas Y: 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 aftei issuance. All work authorized by this permit shall conform to the approved application and.the`,approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be incompliance with the local zoningby laws°and codes. 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, Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Build ng and Fire Officials areprovided on thispermit. vw Minimum of Five Call Inspections Required for All Construction Work Service: 1.Foundation or Footing 2.Sheathing Inspection ° Rough: 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 Final: 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. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Application Number.... ...... .................. RARMABIX MASS. Permit Fee...... ............................ .....Other Fee:....................... ��,�• moo,lVa L Fee Paid................................................................ ..... I zJ TOWN OF BARNSTAU%�E"0,0, by..... ........... QFe BUILDING PERMIT 4,91VsL,, q .................... ....................Parcel............................................. APPLICATION 6M*=-t- S Section 1 — Owner's information and Project Location 9 Project Address /AV 'a Village-,..A0 \�Aez k-S AV Owners Name- 4 Y67 V Owners Legal Address City .111eewQ�I-L, State Z11) Owne rs Cell# E-mail Section 2 -Use of Structure Use Group_ ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structu're under 35,000 cubic feet Single Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate 1:1 Accessory Structure ❑ Change of use 0 Demo/(entire structure) ❑ Finish Basement El Family/Amnesty El Fire Alarm' Rebuild Deck Apartment Sprinkler System ❑ Addition E] Retaining wall F] Solar 1:1 Renovation El Pool El insulation Other-Specify, D !1,9 Section 4 - Work Description sueeW L4­9 4. T..qqt linrInted- 11/1 s/?,nl R Application Number.................................................... Section 5—Detail Cost of Proposed Construction Square Footage of Project : J Age of Structure Dig Safe Number # Of Bedrooms Existing , Total# Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ 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) Setbacks Front Yard Required 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: 11/15/2018 s Aft 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/Plunibers Applicant Information Please Print Legibly ' Name (Business/Orgmization/Individuai): Address: -2�fS City/State/Zip: SK0.5 Y Phone#: +SOO "c299"!S75 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with- 4. I am a geneisl contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me m any capacity. employees and have workers' _ insurance.: 9. ❑Building addition . [No workers comp.insurance comp. required.] S. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am 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 informffiion t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether_or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: ` Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c..152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerd=t pains d pen�allaperjury that the information provided above is true and correct Signstore• Date: i� f Phone Qijcial use only. Do not write in this area,to be completed by city.or town pfjrrial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their 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-MASSAM Revised 4-24-07 Fax#617-727-7749 «rww.mass.gov/dia ,-o'ftV � . . ..1. . 1 " LIs L �... lII - �� -�--1 _ �, _ ,`z v1I . 1 . .A ,­.1_."". . ,w� 4,I f —• � - � "I., I I �:� .I I � .t �'.,,, ," t�, , :: _ , � I,.:;., �'� ," I 1:.-, .. �,, . , � 1'.��,� .-'�:k%".,, ,-��. :." , " , -� , �,�,�,,,X�-z �-.,; , . --�.:,� -� -,'�1, ��.. � .11 I . � I I 11 , ., , -,,�� , Z�ll..., .­V; A,. - -I,. I � I�l�I.1".': "",'�.... " ,4�:vv-�!,��-, ,,�t." .'� - .. :..- 't,.,-;:,!.'.� I� ,�.. ,., ,_ . � , 1 • 4�­.-it *,!�k-A ,�,;,, �.��, 4 1 ,. . �.1�.l . � .���;, - , , - � - - , . ,:1 .. -- , - .:, , , - , �� '�m- —I ,.,,.,.�.-. __ - I . — . *1 1 1. 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F "2 W1i . cri o y,F-1 u CES TI T ATi - T i E .2 .�4" b 4 /V . :­ I SH WN;5,0N,� T HI-S � PLAN Ak:"% BEEN .. . ­ ,%L .CATE ON`,TH3ROUN AsNINDI INDICATED M , , : _ ... bVa uA - B N0 ��� cLE T � 4�­.. .. , , I � I I -, - From: Michele Cudilo,P.E.mcudilo@comcast.net Gil Subject: STAMPED SK:18 HOLIDAY LN.,BARNSTABLE:FENCE Date: October 16,2019 at 1:38 PM To: raciii raciii@comcast.net,Michele Cudilo,P.E.mcudilo@comcast.net Attached, Thanks, Barnstable Bldg.Dept. Michele Cudilo, P.E. roved by: Consulting Structural Engineer APp Centerville, MA 02632 Permit#: �Q 3 41 508-737-8521 rt . � r - off ._ $ C o �., 3. . MICHELE CUDILO, P.E. fP-I A C-( f�W CA-- R Coneu!tin Structs,roi !:n inset 1 CatMrt�npQ torro.Cur'.fevlk.Y�}�OFrJG3i I Mpp{jjlcATlotiS - - w� - Cate; LallDrawincri' 0 al;rl N Ft- S K ° a • ' r Application Number........................................... Section 9- Construction Supervisor Name Telephone Number E Address City State 'Zip I 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 CM�and the Town of Barnstable.Attach a copy of your license: Signature Date Section 10 —Home Improvement Contractor . { 3 Name - Telephone Number Address City State Zip `N. 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: Telephone Number Cell or Wo Number I understand my responsibilities under the rules and regulations for Licensed'Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation re q ' d y 780 CMR and the Town of B le. Signature / Date y Zoiel APPLICANT SIGNATURE 'Signature 6bDate Print Name �a�'' D�!S�� Telephone Number �� 6 V Y ' j E-mail permit to: X:: a - OK A_- �!6r� Last uvdated:11/15/2018 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review required)uired) ( q Fire Department ❑ E, i Conservation F For commercial work,please take your plans directly to the fire department for approval Section 13— Owner's Authorization a k POV , as Owner of the subject property hereby authorizeVZ�i:� )q ®r= mmku:ssV_ to act on my behalf, in all matters relative to work authorized b this building permit application for: / l S CW o (Address of j ob)L�� /0 ZI Signature of Owner date .44 r Print Name Last updated: 11/15/2018 Town of BarnstableBuilding., W, e (Pos�ThisCard So.Thatitas Visible Fromkthe,5treet SA roved,PlansrMust,be Retained on Job andahis Card Mustzbe Kept M" Posted UntilFinal Inspection Has.BeenMade � f$ k r { MWhere a 163 Certificate of Occupancy is Required,such,Buildmg shall Not,be Occupied until aFinal Inspection hasbeen made Permit Permit No. B-19-3761 Applicant Name: KARPOVSKY,ALEKSANDR& ISKHAKOVA, DINA Approvals Date Issued: 03/06/2020 Current Use: Structure Permit Type: Building-Deck Expiration Date: 09/06/2020 Foundation: Location: 18 HOLIDAY LANE,HYANNIS Map/Lot 267-184 Zoning District: RB Sheathing: Owner on Record: KARPOVSKY,ALE_KSANDR& ISKHAKOVA, f Contractor Name Framing: 1 C ontractor.L ce in e 2 Address: 41 OLD FARM ROAD z • ', " Est Proj,Ct Cost: $3,000.00 NEWTON, MA 02459 4 Chimney: Description: replace existing 18'x18'deck with 18''by 14'decks Permit Fee: $ 110.00 a� Insulation: Fee Paidr $ 110.00 Project Review Req: 18'x 14'deck d Date 3/6/2020 Final: o f Plumbing/Gas Rough Plumbing: „t Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzedby this permit is commenced within six monthsafter issuance. All work authorized by this permit shall conform to the approved applicatio and the approved construction documents for which this permit has been granted.• Rough Gas: All construction,alterations and changes of use of any building and structures'"shall be in compliance with the local zoningby laws and codes. 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 Final Gas: work until the completion of the same. Electrical The Certificate.of Occupancy will not be issued until all applicable signatures by the Building amend F ri a Offic als are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: , Service: 1.Foundation or Footing 2.Sheathing Inspection 4 " Rough: 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 Final: 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 MG c.142A). Building plans are to be available on site Fire Department. All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: tHL ' - Application Number.... .....t....9......—...7�.........7... Co.I. AIRY, ............ f 0 BARNST MASS. Permit Fee........................................Other Fee:............. .......:.. s6-9. 16 0 Total Fee Paid............. .......................................... ...... Tov- 46L 0 Q TOWN OF BARNSf"L Permit Approval by..... On. LIF..... BUILDING PERMIT ..........ParelMap......... .............................. APPLICATION ' . Section 1 — Owner's Information and Project Location Project Address- //67z/��� Z/2- Village Owners SCANNED Name/ IV Owners Legal AddressLf�— MAR 0 6 2020 C State zip 02 ,Jj�f Owners Cell# E-mail Section 2 —Use of Structure Use Group_ ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Single!Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate E] Accessory Structure E] Change of use El Demo/(entire structure) El Finish Basement .El Family/Amnesty El Fire Alarm Rebuild El Deck Apartment Sprinkler System ❑ Addition ❑ Retaining wall _F1 'Solar Renovation ❑ Pool El Insulation Other—Specify Section 4 = Work Description T.Aqt iindnteA- 11/15/701 R Application Number.................................................... Section 5—Detail Cost of Proposed Construction=- 3WO ocJ 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 Section 6—Project Specifics ❑Wuin;gt ❑ Oil Tank Storage ❑ Smoke Detectors ❑,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 a Debris Disposal Facility: I am using a crane ❑ Yes ❑ No t 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) Setbacks Front Yard Required 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: 11/15/2018 t 1211 4' (ZSZA Z Barnstable Bldg.Dept. SCANNED Approved by,. MAR-0 6 2A�� permit#: . t ,y sF _:."b ✓ :~.' t ti �f� :-x Tyr u hr z, r `� ti. ? + `` :-: --: - r. . - .;.st.j Fz si _ � t f `+ }. } - y u :. £ - � ,ice t .r :�- i 3<s # 'r.. h i a t +. a. y fi ,zi a + >' 7 x. . r _ s f a. 4 ,11 i il Y r r _ f ,l . t - 1 - .- 4 T r ` e. 4 . -/ 83 , f. I d r { 1 4 t I t ++ 5 d f k: s. k F.._ 1 f+i t A C S d y:-�\ Y ..V h k A t - {'}. sr- a✓ty c: Q '3 J-w' k s ' n. 1. ¢ ,� �-.,.. 6 L y A:.. k: 1 .-;"1 :t)°➢6' �>< u L y..t heel V t"'V Aw 2 ;t`', CPt '.s4 ell rzd y s,`.��Sr.,� �,.T .i ry 4Y' i 3 ; k :U A J Sj X£ f �. 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SCANNED ': u + , rf r�h u�,, ; � ` ` r CERT1F1E: . s � 'L , , 1P � P } �� MA:R 0 6 Z020 •�'N ,c . ,j, NlkS Yk Y ; ` :y = t r r`:' s't } f `,t t t T 4` i .n j y.. v 7°" Q _ x t ' ^' y' Sl i�"� - '�t .j } 4' ' '. - .r5 .} 7 7< I C'E1:tFTi '�� r TMAtT THE �vunrd ,,::3 v R J 'G�� fE 11�, /NC., 1� .S, R5 _ f BROWN ©N 'MtB= ?LAN HAS BEEN ^ fi 1;f'.V&, RQUTE ` �134� ' LOCATED ONsTME Gt40UND A:S INDICATED y ErEt�NtSf fiAA�S `" r ate _ .. x_i., The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Invqdgadons 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/OrganiradmAndividual): Address: / 4 F ° City/State/Zip:Y_ `U tW L{!Z Phone#: Are you an employer?Check the appropriate boz: Type of project(required): . L❑ 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 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in anycapacity. employees and have workers' _ 9. ❑Building addition [No workers'comp.irorrance comp.insurance. r e L 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions ] officers have exercised their 11. Plumb' repairs or additions 3.❑ I am a homeowner doing all work ❑ � P • mysel£[No workers'comp. right of exemption per MGL 121-1 Roof repairs ]t c. 152,§1(4),and we have no insurance required employees.(No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box 41 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 woricers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy 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 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 certi a pains and penalties of p that the information provided above is true and correct Si afore: 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.Cityfrown 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 mmiber listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Offiicials 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 lie 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 oflnvestigatiom 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 ar 1-877-MA.SSAFE Revised 4-24-07 Fax#617-727-7749 r:mass.gov/dia Lauzon, Jeffrey From: Lauzon,Jeffrey Sent: Tuesday, December 31, 2019 8:08 AM To: 'karpovsky@gmail.com' Cc: Lauzon,Jeffrey Subject: ViewPermit, Permit No:TB-19-3761 Applicant, Please be advised that the above application has been reviewed and the following is noted: 1) No framing plans submitted. (11105.3) The application is denied pending the submission of the required documents demonstrating compliance.And, if aggrieved by this notice;you may appeal to the Building Appeals Board within 45 days in accordance with M.G.L. c. 143 § 100. Jeffrey Lauzon Chief Local Inspector (508) 862-4034 Jeffrey.lauzon(�town.barnstable.ma.us 1 Application Number........................................... Section 9-.Construction Supervisor Name Telephone Number Address City State Zip 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 Name Telephone Number ` 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: j�iC Telephone Number Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentatioV�re7by 780 CMR and the Town of Barnstable. Signature Date 2l ' l� APPLICANT SIGNATURE Signature Date2� Print Name X1Z K/�, OJISIC Telephone Number E-mail permit to: n902 .r Last undated: 11/15/2018 Section 12 —Department Sign-Offs '" r Health Department ❑ Zoning Board(if required) ❑ I Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approvab 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: ++' l �r (Address of job) Signature of Owner date j l Print Name , Last updated: 11/15/2018 ,,oFz"Ero� Town of Barnstable ' o Inspectional Services ■AMSTABLE -MASS. Brian Florence,CBO 9 mp Q� 1639•: Building Commissioner ATfD MAC a 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us INSPECTION REPORT. Address : 18 HOLIDAY LANE, HYANNIS Case# C-19-764 Inspection Type : Violation Inspector lauzoni Description Date. Unit Status Comment Violation 12/05/2019 1PASS .11/7/19 ENGINEERING AND APPLICATION SUBMITTED FOR FENCE ONLY. I12/2/19 BUILDING PERMIT ISSUED FOR .: FENCE AND APPLICATION SUBMITTED FOR DECK. 0,0HEr° , Town of Barnstable do Inspectional Services BABrrSTABLE. Brian Florence,CBO T MASS V,C �A 1639• s�o Building Commissioner Tev MAC 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us INSPECTION REPORT Address : 18 HOLIDAY LANE, HYANNIS Case # C-19-764 Inspection Type : Violation Inspector: lauzonj Description Date Unit Status Comment Violation 11/06/2019 FAIL 10/17/19 APPLICATION STARTED FOR A BUILDING PERMIT TO CONSTRUCT A PRIVACY FENCE. APPLICATION NOT SUBMITTED AND NOT PAID. TAXES !OVERDUE ON PROPERTY. 111/06/19 NOTICE OF VIOLATION MAILED TO. PROPERTY OWNERS IN NEWTON MA. Inspection Type : Violation Inspector: lauzonj --- - ------------— -- _..._. ---_ _ ..__..__. _... Description Date Unit Status Comment Violation �10/03/2019 FAIL Deck and fence installed without permits. Inspection Type : Violation Inspector : lauzonj Description Date Unit Status Comment `:Violation 10/04/2019 FAIL Notice of violation posted. Town of Barnstable Building Department Services Brian Florence, CBO rait '�T Building Commissioner MSTA 200 Main Street Hyannis, MA 02601 '/ Y 1639-2014 www.town.barnstable.ma.us 573 Office: 508-862-4038 Fax: 508-790-6230 Notice of Building Code Violation(s) and Order to Cease, Desist and Abate: Alex Karpovsky and all persons having notice of this order: As property owner or tenant of the property located at 18 Holiday Lane, Assessors Map 267 Parcel 184 and known as residential structure,you are hereby notified that you are in violation of 780 CMR,the Massachusetts State Building Code Chapter 1 Section R105.1, and are ORDERED this date 116/2019 to: CEASE AND DESIST all functions associated with the following violation(s) on or at the above mentioned premises: Summary of Violation: On 10/3/2019the Building Department observed a violation of 780 CMR of the Massachusetts State Building Code Chapter 1 Section R105.1 specifically, a deck and privacy fence constructed without the benefit of a building permit/ Summary of Action to Abate Violation: In order to abate this violation and to avoid further enforcement action by this office, commence immediately upon receipt of this notice the following action: cease use associated with the violation and commence with obtaining the proper approvals and permits to either: 1)remove all unpermitted work or; 2) construct a deck and privacy fence. And, if aggrieved by this notice and order;to show cause as to why you should not be required abate the violation in this notice,you may file a Notice of Appeal(specifying the grounds thereof) with the State Building Code Appeals Board within(45)days of the receipt of this order and in accordance with MGL c. 143 § 100. If, at the expiration of the time allowed, action to abate this violation has not commenced, further action as the law requires may be taken. By Order, J re . Lauzon Chief Local Inspector (508) 862-4034 Jeffrey.lauzon@town.barnstable.ma.us qq Application Number....................... .................. A I 4�4�BAJtNSTAI= • f MASS. Permit Fee....... ........... ....Mer Fee ........................ s63 TotalFee Paid............................I..........................I..........., TOWNOF BARNSTABLE Permit Approval by..:.........................._...On....................::...:. BUILDING PERMIT M ...............Parcel.....................;......:................. 1 Map......................... APPLICATION Section 1 — Owner's Information and Project Location Project Address— 2 Village Owners Name Owners Legal Address City —State Zip eV V-5-�' Owners Cell# E-mail Itn'a-g�11j- Section 2 —Use of Structure Use Group_ E] Commercial Structure over 35,000 cubic feet El Commercial Structure under 35,00*0 cubic feet Single/Two Family Dwelling Section 3 —T`ype of Permit R New Construction r-1 Move/Relocate E] Accessory Structure E:] Change of use El Demo/(entire structure) El Finish Basement El Family/Amnesty El Fire Alarm Rebuild Deck Apartment ❑ Sprinkler System Fj Addition ❑ Retaining wall Solar El Renovation ❑ Pool D Insulation Other—Specify r0 Oeq scic FSection 4 - Work Description 11& 4­6 OP 4 4w+ smew L.0,1 A4k !G JO& e�4 JeLA� 4&,tXa a J - T T.aqt iintisted- 11 115n0l R THE rqy� Towne of Barnstable Regulatory Services * BMMSrenatE, « MASS. Thomas F.Geiler,Director 9.z63 ,� .: . � - en Building'Division ,Tom Perry,Building Commissioner- 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6236 August 21, 2012 Boris, Maria&Aleksandr Karpovsky 199 Coolidge Ave Unit 313 Watertown,MA 02472 Re: Complaint Trucks in Residential District Property ID: Map 267 Parcel 184` Locus: -Cr8'H6hday Lane, Hyannis, MA - Dear Mr& Mrs 2Karpovsky: Please be advised that this office has received more than one complaint concerning large . - P g :. g trucks (tractor trailer) accessing Holiday Lane and parking over night. The complaints not only identified their concern that the road is too small and narrow to accommodate this type of traffic but it also impedes the neighbor's ability to utilize the end area to comfortably turn around. Additionally, you>should be aware that anyimpediment to.the neighbors would also extend to emergency equipment including fire trucks and ambulances.... I am sure that the traffic division of the Barnstable Police Dept. has been riotified of their concerns directly. With this in mind, I,urge you to find an appropriate location to st6re the subject vehicle and possibly-avoid any action by,the local authorities. You may reach me directly at 50.8-862-4027 in order to confirm your'intentions. :1 anticipate your timely response and look forward to working with you to resolve this issue. rely, (� Robin C. Anderson Zoning Enforcement Officer s�I-1 JAIllegal Apartmentoliday Lane 18 Karpov§4 letter 082'12012.DOC Official Website of The Town of Barnstable - Property Lookup Page 1 of 4 Select Language l V Assessing Division Property Lookup Results - 2012 367 Main Street,Hyannis,MA.02601<<BACK TO SEARCH« 1'"p rant Frle Owner Information - Map/Block/Lot: 267 / 184/- Use Code: 1010 Owner Owner Name as of 111/12 KARPOVSKY,BORIS&MARIA Map/Block/Lot GIS MAPS 199 COOLIDGE AVE, UNIT 313 267/184/ WATERTOWN,MA. 02472 Co-Owner Name KARPOVSKY,ALEKSANDR Property Address 18 HOLIDAY LANE Village: Hyannis Town Sewer At Address: No Assessed Values 2012 - Map/Block/Lot: 267/ 184/- Use Code: 1010 2012 Appraised Value 2012 Assessed Value Past Comparisons Building $136,400 $ 136,400 Year . Total Assessed Value Value: Extra $25,700 $25,700 2011 -$290,400 Features: 2010-$292,900 Outbuildings: $3,100 $3,100 2009 $328,300 Land Value: $126,100 $.126,100 2008-$338,900 2007-$349,800 2012 Totals $291,300 $291,300 2006-$295,900 Tax Information 2012 - Map/Block/Lot: 267 / 184/ - Use Code: 1010 Taxes Hyannis FD Tax(Residential) $652.51 Fiscal Year 2012 TAX RATES HERE Community Preservation Act Tax $73.58 Town Tax(Residential) $2,452.75 $3,178.84 Sales History - Map/Block/Lot 267 / 184/- Use Code: 1010 History: Owner: - Sale Date Book/Page: Sale Price: KARPOVSKY,.BORIS&MARIA 1/30/2002 14763/109 $235000 HUGHES,JANE E TR 9/16/1998 11703/062 $1 SPIVAK, IRWIN&JANICE L 5/15/1998 11429/091 $132000 CATALDO, PAUL A TR 5/19/1997 10756/117 $96000 YOUNIS, DOROTHY 7/15/1990 7237/041 $100 YOUNIS, EDWARD G&DOROTHY 3/15/1990 7088/198 $250 LYOUNIS, EDWARD G 3118/278 $0 htt w p://ww.town.bamstable.ma.us/Assessing/propertydisplayscreen 12.asp?searchparcel=2... 8/21/2012 sess&'s ma and lot :number ..... THE Sewage :Permit number' ............................ ..... Y AHaWit . :. House •number :... � ....... t-° ... 9 B q 6.3 Ems. i pow• i9'.'.�00 �EQ tlPY a' APPLICATION.FOR-PERMIT TO ................................................ } . ..(.: ...... TYPE OF CONSTRUCTION . .............G y""�-� ��......•�... ........ `-�....... . ...................................... ................................/ .................19 TO THE INSPECTOR OF BUILDINGS: f The under/signed hereby applies for a/permit according to the following information: Location ..... 17 / //;Lm .e..... ^.� ....."..... :: ..:r�"�..., .......... •//...s...a�� .....:`l5jxtea" Proposed Use /� ��/ �e f����i G� `�......... ......... ..................... Zoning District ....... ! ��..................�'�` !.........�...��.. ,Fire'Dis#rich' ................. , .•, :: l :f ! ..... vL//7/Yt ` a l.3 �.. • '� r�CJj ( r1 } 7 ' P I', ',� �/, •/, d`-+'� y• Name of Owner ............... :Address ..•:.......................................( .............. z.l.. . ...... Name of Builder ...:........................................'...I...................Address ........................ r Name of Architect .................1 '?'�'+...7�....�../. �0.. .......Address .......-.j ,?.� �r :-r....... Number of Rooms ...`.' .:f. �,t `r: /�� � �/J Foundations -��, 4?GI.Cy ...... d Exterior Roofing ...... .. Floors ...............1.1 .................. ......... ........Interior ........ .... �4....!�..�,...�..�....................................... Heating ..�.��,;� C �� c .,• /4 ,•e,�11./�" .Plumbing !% a .. .. .. :. Fireplace ...... .....................................:..................................Approximate Cost it i1�J� ...... Definitive Plan Approved by Planning Board ________________________________19________ . ^',} Area .... Diagram of Lot and Building with Dimensions Fee �............................ .... ; SUBJECT TO APPROVAL OF BOARD OF HEALTH �a I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable.regarding the above construction. Nameh.... .................... .... .........�e:::'. i :.'.' ........ Yx Sc:.t1aW...r.Ec7.M'e'i...,_y-z3 i�f.l...�..:.,,a`�.+.✓Xm1W"a.4..a.i..n:!�rx.,.:.r+ei''�.i.v'e�f..s:ii�.,�u.eu �s-- � .. .. ..»:7 ,- - t.... .. Nelson, Williaor,,�- . A=267-184 ` * No .....2I234.. pernn� for __.I..�/2.. —. ___. i ...fam.iIv .d�eIIiu9_,_____ 18 Holiday. *�g� �yann�)s Owner Wi����9� _ Type of Construction ^ _ Plot .........................../ Lot .....la�........... � Permit. .~....d uoxe of o.vp=`""". PERMIT REFUSE/ � -----' ---------' '----'— --'' ' ----^ ........................ ' ------- / \ � ................... —'---'' ^' � �Y`�'~-- '' v \ / � / �� / ����� '��' ......'........,'.........,......,...' Approved v ................................................ lg � � --------'-------^^^--^--^---' � . � -------------------'—^^'—~'—'^ . Town of Barnstable *Permit# c9QcX0,S36D- XPRESSExpires 6 months from issue date PERMIT EP 2 4 2008 Regulatory Services Fee o25 S Thomas F.Geiler,Director . TOWN OF BARNSTABLE Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Numbero (0 Pro Add e �r 1i / Property Address ®Residential Value of Work ! Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address l-1-17® t`\ ! -% V'S 72 Ctntractor's Name Telephone Number Home Improvement Contractor License#(if applicable) /° �C-'�chime Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: 91-l 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 roust 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 ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *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. SIGNATiJRE: Q:Forms:expmtrg Reviae061306 . Board of Building Re ulations.and Standards HOME IMPROVEMENT CONTRACTOR I Re on 100053 gistra itit Expiration 6/8/2010 Tr# 26- ! �� i t G .r3 Type IridlV idual I VICTOR J.WIINiKAINEN, Victor Wiinikainen 58 CAPE COD LN ���f' t: Administrator BARNSTABLE,MA 02630 i License or registration valid for individul use only before the expiration date. If found.return-to: .Board of Building Regulations and Standards 1 One Ashburton Place Rm.1301 I ' „ Boston,Ma.02108 " i �1 t valid without signature Q 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/Blectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Set City/State/Zip: L Phone.#: ds Are you an employer?Check the appropriate bog: Type of project(required)-. 1.El am a employer with 4, Q Tama general contractor and I employees(full and/or part time). * have hired the stab-contractors 6. ❑New construction . 2.[ am a'sole proprietor or partner- listed on the-attached sheet. .7. ❑Remodeling ' ship and have no employees . .These sub-contractors have g, Q Demolition employees and have workers' '*orldng for me in any capacity. 9. ❑Building addition (NO Workers' comp.insurance comp.inerrranca t, 5. its 10.Q Electrical repairs or additions Q We are a corporation and required.] - 3.❑ I am a homeowner doing all work . officers have exercised their i I.❑Plumbing repairs or additions ' right of exemption per MGL myself[No workers comp. 12.Q Roof repairs insurance.required.]t c. 152, §1(4),and we have no ] employees.[No workers' 13.❑Other comp,insurance required] *Any applicant(hat checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowoer tyko submit this affidavit indicating they are doing all work and tlien hire outside contractors must submit a new affidavit indicating'such. tcontract ors that check this box must attached an additional sheet showing the name of the subcontractors and state whether ornat those entities have employees, if the sub-contractors have employees,theymust providb their worker;'comp.poicy number. compensation insurance for my employees. Below isthe policy and job site;' I am an employer that is providing workers' 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 declarafion page'(showing the policy number-and expiration date). Failure,to secure coverage a&required tmder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tilt 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 thq violator.;Be advised that a copy of this statement maybe forwarded to the-Office of _ Investigations of the WA for insurance coverage verification. — I dohereby ce under th par and penalties of perjury that the information provided above is true and correct Si afore: m Date: — Phone Official use only. Do not wrlte.in this area, to be completed by,city or town:offtciaL f City or Town:' permit/License# Issuing Authority(circle one): J.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector 6. Other ' Contact Person: Phone#: �tHera,� Town of Barnstable Regulatory Services BARNASABM SS MA � Thomas F.Geiler,Director 16.39. Building Division r Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property ProP e Owner Must Complete and Sign This Section If Using A Builder L .�SC �,4f Vows f� 60 R s k406tU G�y ,as Owner of the subject property hereby authorize pmR 37 �(/c'fYfC�5C�1 to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature ofOwner ' Date Print Name / If Property Owner is applyinglor permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM&O WNERPERMISSION t� Town of Barnstable �oF '°�ti „gyp Regulatory Services BARNSPABM Thomas F.Geiler,Director 9 MASS. 1639• ,• Building Division A rFn � 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 s 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 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 fomi/certification for use in your community. Q:forrns:homeexempt C The Commonwealth of Massachusetts Department of Industrial Accidents Office o1/ayes0400ns 600 Washington Street Boston,Mass. 02111 Workers Compensation Insurance Affidavit FZA �ame ,cation ` �7 �•�' city ❑ I am a homeowner performing all work myself. �I am a sole pro net or and have no one working in any capacity ❑ I am an employer providing workers- compensation for my employees working on this job. comi3any name address: city phone#. insurance co. TinficV# 7aiiiiaaiiiaaiiaiiiaiaiiaia��ii��oiiiaiiiiaiiiaiaiiaiiiaaiiiiaaiiiiiaiiiiiiiiaiiiiiiiiaaiiiiaii/iaa/i/aiiaaiii/iaiii ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: ......... com nnv name- address: phone#�. ,:..:...,,.:.: ..., .; cft�r insurnnce co. :.;.:, :�: :.::... 01icv# .: :. :: ... //o/ai//a/a------ cam any name: - address: city- phone :.. insurance CO. aOure to setw a coverage ss required under Section 25A of MGL 152 can lead to the imQositlon of criminal Qenaltla of a Otte up to 51,500.00 andlor F one years'imprisonment as well civil penaltles in the form of a STOP WORK ORDER and a One of 5100.00 s day sgaitut me I amderatnrd that a copy of this statement tttay be forwarded to the Oftice of Investigatiotu of the DIA for coverage veriflcatloa I do hereby certify under the pains and penalties of perjury that the information provided above is tru,and coned Date Sipatur - Print name Phone# o fficialnly do not write in this area to be completed by city or town official, town: permit/llcense# QBuilding Department ❑I,lcensing Board mediate response is required ❑Sdectttten's OtIIce ❑Health Department n• phone#; ❑Other__ (ovum*95 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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`Uw"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns 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 pi number which will be used as a reference number. The affidavits may be returned in the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 Me of Investlgatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 The Town of Barnstable Department of Health Safety and Environmental Services °r�,r, ► Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissions For office use only Permit no. 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: il'e tv Est. Cost �0' 11-`_/ Address of Work: �?/ t/� I_ de, LA'-Y� `14 `I�/1 � l a��i �! A fwner's Name ,��t^�4 h TA9/ yel �C Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. 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 PROGZAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: / Z I qe :"-� fl t,al /ZS7/Z- !/ No. Date Contractor Name Registration OR Date Owners Name r G.�i a�ooaeaxaouceald(r o�,ittaaoac�uaeA' �t HOME IMPROVEMENT CONTRACTOR Registration 125712 EmIr um Type - INDIVIDUAL Expiration 02/19/00 RICHARD W. NEAL 45 PARK AVENUE -;f z6� TERVILLE MA 02632 ADMINISTRATOR �. rC . I DEPAA �ENT DF PDBII�. SRFET� , CONSIR�CIIDN SUPERVISOR iICENSE E . • fr.pi�es; Bi tnd � { Number_ 9,►1.,.: • Restricted Ta: RIGNRRD u ,NE�t t PARK RYE � ItllE H qj4?� _„ .- �00 Vt -_ - � �L FRAMING SECTION a — — — — — — ALL DIMENSION LUMBER SHALL I BE KID SPF NO.2 OR BETTE-R. x COLLAR.TIE +5" O.G. 2 x RAFTER O.G. SHINGLE I� 2 x CEILING TOIST @ "" O.C. W�IS LB. FELT � I i Ix PINE FACIA R-30 KRAFT FACED FG BATrS R- UNFACED FG BATTS Ll SOFFIT VENT W/6-MIL POLY VAPOR BARRIER PINE SOFFIT (1 sT 2., FLOOD) 2 x $ FLOOR TOI ST @ "o.G. (isr 4 2Nn FLOOR) ` If f SILL , o I c > SILL SEAL '� 0 ANCNDR BOLT @ 6 0" O.G. "CONCRETE a FOUNDATION WALL ) Map hn Parcel' '� f 7 Permit# o2-0 House# f - Date Issued s' 1 Board of Health(3rd floor)(8:15 -9:30/.1:0 4 W Fee , ��� <S; o n Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) - W /1V G,O $qu 7- Ey VIP TCE S L1ANoe re P 19 CC,.. 3 ' BA MATS4 o •B�E.?.d�9�; Gqt®� 039 T. TOWN OF`BARNSTABLE 7. Building Permit Application { Project Street Address Ho t ( dam, L ffn_�_ y , Village Owner / V�1 f ddress Telephone Permit Request .1 G o✓liter k at-,C/ J6 i7e24'1 I r "First Floor G p U square feet Second Floor y U square feet -Construction Type 7—X q _` G©h ll( Estimated Project Cost $ ._ Zoning District .Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑, Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 2fio If yes, site plan review# Current Use Proposed Use r� \ / Builder Info ation r/ 7ddress e 1 L�� 1 ! V Tel phone Number, G c tr l��v® 71 f IM! ) o e Improvement Contractor# / 2S 7/ on# 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 SIGNATURE e DATE -! d BUILDING PERMIT DENIED FOR E FO WING REASON(S) �r FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED Il 1 Jt MAP/PARCEL NO. - s _ ADDRESS - VILLAGE t OWNER C+ s— •- r a _ DATE OF.INSPECI'ION: i FOUNDATION FRAME INSULATION, r' > FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: Vn ROUGH FINAL FINAL BUILDING• r iw �� r C3 }• - E F DATE CLO JED'OUT.r I in ASSOCIATION PUANtNO. �^'r t+c,,, .}:,k �t d ° sexy 5.� s`' "€% k3' £.�' nk 5Y�< :M r�4.z r w`k y rg;7`^r g.�rl x'jaa•'� t yt `'� h r i=, a .5' r y y'"^ "i .,1 �� �...,. '� ...._...«=5.....e .t,S,+mn` e.°.-., �....t.....%'* ..''..,..t:. 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"-,111, z'rcy r �t '-'z t,�r k k '� x { a ,: ,� { r..y{ c. �iy 5K^tom q'i £ 1F s ?787� ss3. -ti '�- ° r; {I i +.., ` r ^9.? a„t �, - 3 trs L 4 xe W�I�:� `� W z 4t r t cep j y A t 'tr "a�A'` t -E �' a ,''c = sf } a .�,A t[ s^ :, e „# > ? a i r 'h?,P : '� a^ S e'.g k rr it,-.': ti x., � v"S'V;Y./'� �i,� r + $ - ,s r �" .� s*. r- �� F r, a � P, � I �'suR � ks ,x Y CERTi FIE y PLOTS: i�P L�►N }� � „ . -,s carry cd,_; s s 1 w` _ a Q /-� a ,. A _ i �' r y, " -. ., �, ,s t ,,_ 4 ... J ig . at, J,n1 f_3Al N .... 1.. -. .. . .. ,.., E ..n , ... K,: .,.�. ... GERTIFY THAT THE �N04 ,:: ")'' R 'O f,�EAfr'Nf; INC; '`RI.S, RS 3 ' � _l t ,?; t SHOWN Oo, 'THIS PLAN HAS BEEN 1348 �ROU1E' 134 ' _ I LOCATED �-O ,"- HEY GROUND AS '' IN.DICATED ,Y z'� EAs}T oENNIs, aSS aR= >Y § ` _F I e e 2 ;,a.<a.F ,� 4 :rJ'- i /ry / - /3va. T s r. ^?<<3�J!l�, x'" 7iu� J3UJGI. /�1/G S 7" �6 3 4' ,t � .", s}��, D�� � SCALE 18. 1.�/!�J,., ,4 ,`: UAW.. ��s"/,I .U�S"T.t1 :.. , 1 ' ` x ,3, JOB; N0 '�9L34 CLIENT /!/�—sc IJ e N�i6 x ! I r aq DATE GIST D AN:D ,'SURVEYOR DR , BY - SHEETS_ 01=k .�� t n Asstsssor's map and lot number 3 ' ?�Of 7HE Sewage Permit number .......... .. ... .: SEPTIC...... :.................. TIC SYSTEM MUS INSTALLED IN COMP 2MUSTADLE, i House number ...... ..?........................................................ WITH ARTICLE II STA't.moo HAS& ♦� SANITARY CODE AND a639•ypY a` TOWN OF BARN-S111fiL � BUILDING INSPECTOR APPLICATION FOR PERMIT TO/. .................. ............................ , ....... ..... .... ..._................. :. TYPE OF CONSTRUCTION C,� ............................................. ............................................................................ 44 ...............v .................19. TO THE�LINSPECTOR OF BUILDINGS: 9�D'.•._,�7a;�'"^�. .•�:��:� �""^ ib:: i�yd'F, _ ,yn�?. .h-Uut::.. a:. �wue:%74 "A. The undersigned hereby applies for a permit according to the following information: Location .. ........���....... 1�. .... .............. ....... ....................:. ..... :!!t/�221y/ �1`1�$ ProposedUseI ................................J ........................ .G. ..................................:..................................... ZoningDistrict ........ &.......................................................Fire District ...f.?. ................................. ....................... ....... Name of Owner !e!{.11!.!.� e.�s ` c..........Address 7�9��I � •.. e. l.. ...1..`./� .. ............................. ............ Nameof Builder ........I..........................................................Address .................................. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms 63 -..................................................................Foundation Z.........�l,GI�E.'..�.........�ol�............. Exterior .... G,> ............................y ./QS.......................Roofing .. . �/�. .<. ..`..` ��.�Q ... . .. ..... .... ..... Floors � d 7.2..�..........................................................Interior ........ .................................... Heating .0.4..ee..5. 1.4 14. Lit ...Plumbing ........./.................................................................... Fireplace .....:/........................................................................Approximate Cost ...C, ... .1J..4................................ Definitive Plan Approved by Planning Board -------------------_-----------19--------. Area ......./. '..... ....... �0 y Diagram of Lot and Building with Dimensions Fee Q / SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the To n of Barnstable regarding the above construction. r Name .. .. ??.. .. .....:.'........ Nelson, William � ^ � 21234 l 1/2 story �u ---..--,Pennit for ------------ ~ , ' single family dwelling � | .............................. , . ' 18 Holiday Lane ^ J Location ---..�------1-1..--...................... ~ West ` / ''-------~'----'"—'^—^"--''�'---- � � �F! ~ Williao �kaloon . Owner --.�-------------------.. ` = � � Type of Construction ----.�ra�e------ � . - ^' ----���----------. ^ ^ ---------..... ' #4 'Plot -----~---. Lot ----------'' � . ( April �5 79 Permit Granted Granted '' � `'lV ------------'' ' l � � Dote of Inspection ........................°............lA ' l Dote Completed 6--- ]g ` - � PERMIT REFUSED _________-----------... lg --------.------------------ � � —.----.~..------'---.-------~.. —..---.—.----..--~---.--.~--.—.. - ' -------------.--.~~.,-----.—.. - -----.----------.. l� Approved ° ^ | . \ `--------------...—.----..—.-- -----'..----.---.------.—..—.... ` \ i / A � ( U | | P. 2 x f ♦Pfl®:A• 1f 4 ?M1�kcf�i•r^^K.z•�u..+.•1' � • � A Sk Nk CERTIFIED LOT • i - 1'} , 1.• + "' i • 1 CERTIFY-'. THAT THE � �� .. �{'1r'_ l�', % OW EARN�. C'«) � �' SHOWN CAN THIS -PLAN HAS BEEN t�4S , ROUTf t.S4 L ATE O ON THE GROUND A IN OI AT D, E $DATE � DENNIS , ►�� .' . s,..•.�,