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i} r� �<' ', i Pi� �M�� j - - - - - __ _-�_ . - f , :1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map t♦ Parcel Z I Application # 2 w 1 V Health Division 'S fS`Oja � .Date Issued Conservation Division Application Fee 570' W Planning Dept. Permit Fee �_?S•Do Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner Address 5" Telephone_ szF` &.�.y-sn-Itio Permit Request :7i� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U?"' 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 Number 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 Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Mike McCarthy Construction Telephone Number P® Box 52 Address west pennig, MA 02670 License # Cell (508) 250-6964 CS1 58633 HIC-169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY r _ APPLICATION# DATEISSUED MAP/PARCELNO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. �6MCIIdEfiR11NC OWNER AUTHORIZATION FORM I3y) av) TK6IN1 SUYl (Owner's Name) ' owner of the property located at: (Property Address) a vwt (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. A:4,17-1 All' Owners Signature Date j i RISE Engineering 5 Dupont Avenue South Yarmouth, MA 02664 J } Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 MICHAEL J MCC�kR . PO BOX 52 W DENNIS MA 8267 Expiration Commissioner 04/10/2016 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement C&tractor Registration Registration: 169393 Type: Individual Expiration. 6/16/2017 Tr# 264961 MICHAEL MCCARTHY , MICHAEL MCCARTHY I Y P.O. BOX 52 5. WEST DENNIS, MA 02670 r Update Address and return card.Mark reason for change. s — . Address Renewal _j Employment ID Lost Card 20M-05/11 The Commonweallit ofMnssachtisetts Department of In(InstrialAccNents I Congress Street,Snite 100 Boston,A1A.02114-2017 www.mass.govItlia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Pliirribers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Name (Business/Organization/Individual): Mike McCarthy Construction Address: West Dennis, MA 02670 Cell (508) 280- city/state/zip: 6964 5 3#: 141 -169393 Are yor an employer?Check the a propriale box: Type of project(required): I.7m a employer with �employees(full and/or part-time).* 7. ❑New.construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in $, ❑Remodeling any capacity.[No workers'comp.insurance required.] ❑ In i am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. Demolition 4. i am a homeowner and will be hiring contractors to conduct all work on m ]0❑Building addition ❑ g y property. 1 will ensure that all contractors either have workers'compensation insurance or are sole I l.(]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These subcontractors have employees and have workers'comp.insurance,? 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.90ther 152,§1(4),and we have no employees.[No workers'comp.-insurance required.) •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached An additional sheet showing the name of the sub-contractors and state whether or not those entities have employees..If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. helot,is the policy and job site Information. insurance Company Name: Policy#or Self-ins.Lie.#: y�L���-6�i �Cs6 p�al�( jj Expiration Date:_ )� 1l� )►i Job Site Address: )-7 �t1,�le _ 5}, 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER•and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DiA for insurance coverage verification. I do hereby certify un t/ al sand alUes rjnry that the_information provided a ove is true and correct. Signature: Date: 11 Phone#: Official use only. Do not write in this area,to be completer/by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing inspector 6.Other Contact Person: Phone#: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMA7R7W'PA.GE A.I.M. Mutual Insurance Company . 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800)876-2765 NCCI NO 26158 POLICY NO. VWC-100-6017656-2014B PRIOR NO. I VWC-100-6017656-2014A ITEM 1. The Insured: Michael McCarthy Construction Inc DBA: Mailing address: P 0 Box 52 FEIN:**-***3862 West Dennis, MA 02670 Legal Entity Type: Corporation Other workplaces not shown above: See Location. 2. The policy period is from 12/15/2014 to 12/15/2015 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in`item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000.each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease. $ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans: All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 0712979. INTER SEE CLASS CODE SCHEDU E Minimum Premium $550 Total Estimated Annual Premium $29,332 GOV GOV Deposit Premium $7,748 STATE CLASS MA 5479 State Assessments/Surcharges $28,601.00 x 5.8000% $1,659 This policy, including all endorsements,is hereby countersigned by 12/15/2014 Authorized Signature Date Service Office: Bryden&Sullivan Ins Agcy of Dennis Inc 54 Third Avenue PO Box 1497 J Burlington MA 01803 So Dennis, MA 02660 / WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, \ v� used with its nermissinn. V Town of Barnstable *Permit Expires 6 mont Regulatory Services sro sae e • ,nnr srABM • 71 1 Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office'. 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address _,1"1 esidential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Y 77"1 fa-- E" 45 ' -F�S I-VO A bra Contractor's Name p o Telephone Number .<9 '4' 3;q5<z31 Home Improvement Contractor License#(if applicable) Email: pp�� Construction Supervisor's License#(if applicable) XPR ❑Workman's Compensation Insurance Check one: JUL ®5 2013 I am a sole proprietor ❑ I am the Homeowner ,',O ❑ I have Worker's Compensation Insurance wN Insurance Company Name 'Wag Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Reque check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 30V24M IVALF1 LIL ❑Re-roof(hurricane nailed)(not.stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the a Improv went Contractors License&Construction Supervisors License is uir SIGNATURE: Q:\WPFILES\FORMS\buil ' g permit forms\EXPRESS.do Revised 061313 %i 27se Commonwahb ofhlassadrusetts Dqmrftent o,flrr&mvial Accidmis f),, we of Imwstagalions 600 Wasirington stmet Boston}M54 02111 wwmmamLgov1dia WOAWS' Compensation Insurance AM&,witr Builders/Co i s/Plumbers Applicant Inform;atian Please Print Lembly Name Address: -P t3 -513 City/StH&zip:;'1R Cr- Phone# B Are you an employer?Cherie the appropriate boa: Type of project(req iredD: 1.❑ I am a employer with 4�. ❑ I am.a general contractor and I 1 fall and/or 6. New canstcuctian. employees( pall}-time).* have .the snub-romtractass . 2.�,am a sole proprietor or partner listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition worming for me in any capacity. employees and have workers' [No workers'comp.insurance comp-insu.g.,..o I 9 ❑Budding addition required] 5. ❑ 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 12.540of repairs insurance &]T c. 152, §1(4),and we have no 13.0 Other employ.[No workers' comp.insurance required-] ''Any apptt:ant cat checks box#1 mast also fill trot the section beltrw showing their workers'caution policy information. Homeovmers who sal anit this affidasdr i&cating they are doing all w ak and rhea hue ou=&connectors mast submit a new affidavit indicating sncli lContractors dmat cbeck tidy box Est attached sit additional sheet showing the mmne of the sob-cantrsctm and sun whethe or not those entity have employees. Ifthe sub-contr=ors baw employees,aey must pmvide t6 w works'comp.policy n>tmber. I am an employer thatisprnnrditrg workers'conTensadon inmrance for try emplayea. Below is the policy a,rd job site informadv& Insurance Company Name.- Policy#or Self-ins.Uc.#: Expiration Date: Job Site Address: j , :Srr City/State/Zip S � Attach a copy of the Workers'compensation polio*declaration page(showing the policy uninter 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$1,500.00 and/or one-year imprisonment,as well as civil penalties m the form of a STOP WORK ORDER and a fine of up to$s250-00 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 insurange coverage verification. I do herebj,certi a and pen .f perjury that the informatim provided above is true and correct Si Date: Phone#: 00cial use only. Do not write in this area,to be completed by city or town official City or Town: PermitUcense# Liming Authority(circle one): I.Board of Health 2.Budding Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: .. 6 OFTME Town of Barnstable '/ Regulatory Services �� Thomas F.Geiler,Director 0.19. �m ►�xi' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, I % n/J , as Owner of the subject property hereby authorize d `, �(U IA r A / f p �_to act on my behalf, in all matters relative to work authorized by this building pexmit n (Address of Job) **Pool *Pool fences and alarms are the responsibility of the applicant: Pools are not to be.filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner VLute of Applican L it., �vN Print Name Print Name Date Q:F0RMS:0WNMPERIv1ISSI0NP00LS 6,r2012 Town of Barnstable Regulatory Services `* B"INST111= ' Thomas F.Geiler,Director 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: t M LOCATION: number street village "HOMEOWNER": e home phone# work phone# CURRENT MAILING ADDRESS: cityRown state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building hermit. (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 regt ements and that he/she will comply with said procedures and requirements. Sign ofH a whet Approval of Building Official A 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. C:\Users\decoUik\AppData\Local\MicrosoMWmdows\Temporary Internet Files\ContentOutlook\QRE6ZUBN\EXPRESS.doc . Revised 053012 ' 1 ;.I Massachusetts- Department of Public Safet1 'Board of Building; Regulations and Stiiiiilurd;e �C}onstructipn.Supervisor License :'License: CS 89664 ` �rF mot• . .t"�- +� ROY S FOORNIERTx� ` ..P.O. BOX SAGAMORE,B CH MA`02562' . Expiration: 12/25/2013 C bmm issiuner` Tr#: 8066 Office onsume'l'iriai �c•rB inessM egu at. , Licensj�or registrationvand for" drvtdul use a'y before!Ehe,ex iration date. If found return HOMEIMPROVEMENT:CONTRACTOR p __ Registration: <.157173 Type Office f Consumer Affairs and Business Pwa lation Expiration 9/1012013 DBA 10 Parp Plaza-Suite 5170 +:q Boston,:MA 02116 Z IZE CONST_ t0Y FOURNER i C GOVERNORS WAY::::; /A ; _ AILFORD,MA 01757; ;``Y_'..t > Undersecretary N t valid without Signature i. t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION • " Map y d Parcel Application # Health Division Date Issued ta, 2 Conservation Division Application Fee k AD Planning Dept. Permit Fee ' Date Definitive Plan Approved by Planning Board �---� Historic - OKH _ Preservation / Hyannis Project Street'Address 17 L oze-i Sk Village 1va,Jiv S Owner b )10 a m ifol . 4 r2ms1-rz.6.rC,T, Address S'Am f . Telephone ' 77 y� ,S/ _ 6(9-3 Permit Request 1",..I k � 1h Z Y Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation � � Construction Type r�E rn O b IL Lot Size V ?'9�2 S Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 'Two Family ❑ Multi-Family (# units) Age of Existing Structure ;3:� 8"5'�iAS Historic House: ❑Yes No On Old King's Highway: ❑Yes 4No Basement Type: VFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) �a� Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: _-3 existing L new Total Room Count (not including baths): existing new First Floor Room Count 13 Heat Type and Fuel: ❑ Gas XOil ❑ Electric ❑ Other Central Air: ❑Yes ANo Fireplaces: Existing New Existing woodjeoal stove.-L1 YeseeNo Detached garage: existing ❑ new size—Pool: ❑ existing U new size _ Barn ❑._existing ❑^,hew—gize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ea r Commercial ❑Yes XNo If yes, site plan review # co Current Usen,,o�E: %zva.r. Proposed Use APPLICANT INF (BUILDER HOMEOWNER) Name %2 mS LLu, ,ram Telephone Number 7 7`�—eZV — 06 9 L Address 17 ZlivA P..e4 S/_ License #�i¢ j a 2[e CL/ Home Improvement Contractor# • kx Worker's Compensation # ev ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE -�� /� ' PATE V1 ,5/ /a A FOR OFFICIAL USE ONLY APPLICATION# 'DATE ISSUED �; r MAP/PARCEL NO. - i ADDRESS VILLAGE OWNER ti DATE OF INSPECTION: ;,- FOUNDATION y FRAME INSULATION: FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL- GAS" ROUGH -,-,-,, FINAL FINAL BUILDING:x DATE CLOSED_OUT z w. ASSOCIATION PLAN NO. r The Commonwealth of Massachusetts Department oflndustrial 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/IndMdual): ,IU 2;,K L<.oi1i City/State/Z p` �11 .f s G a:��)Phone. 4(Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. EJ I am a general contractor and I . employees(full and/or part-time). *. have hired the stab-contractors 6 ❑New construction 2.0 I am a sole proprietor or'partner- listed on the-attached sheet 7..XRemodeling ship and have no employees These sub-contractors have 8. 'El Demolition working for me in any capacity. employees and-have workers' [No workers' comp.-insurance comp.insurance. $ 9. ❑Building addition required.] 5. We.are a corporation and its 10.❑Electrical repairs or additions n officers have exercised their L3 r�am a homeowner doing all work 11.Q Plumbing repairs or additions - myself. [No workers' cow. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 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 anew 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: 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 tip 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 maybe forwarded to the Office of Investieations of the DIA for insurance coverate verification. I do hereby certify under the pains and penalties of perjury that tite'information provided above is true and correct <Zl=Sieniiture• i ��� �.. ,. _�•'"�2 — � Date:• JZa,:` 2 F ial useonly. Do not write in this area, to be completed by city or town offtciaL or Town: Perrnit/License# g Authority(circle one): ard of Health '2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector er ct Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compeisation 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 of 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 certificates)of w 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 F 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 ermit/license number which will be used as a reference number. In addition applicant P ,an . 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 applicarit 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 maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavitmust 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 bum 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: 's. w , `The Commonwealth of Massachusetts Lleparlmont of Fndustdal Accidents 4frice of Invesiigatians 600.Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 ar 1-877-MASSAFE Fax#617-727-774 t 'evised 11-22-06 s+. wvvw.mass.gov/dia �aFY�ray Town of Barnstable Regulatory Services kxxsa�srE Thomas F. Geiler,Director Building Division prED � Toro Perry,Building Commissioner 200 Mai -Street,_Hyannis.MA_02601 WWv.town-b arnstable.rna._us Office: 508-862-4039 Fax: 508-790-6230 HOh'IEOWNER LICENSE EXEMPTION p Please Print DATE _2G1 JOB LOCATION: / L/Cr// number 1l street village "HOMEOWNER lud'I ,✓n 72 —Qy 2J name home phone# work phone# CUR.R-MT MAILING ADDRESS:/17 �i✓/J�rf� /fawn start 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. DEFIJArITON OF EOMEOwh'ER Persons)who owns a parcel of land on which he/she resides or intends to reside, on which fhcre is, or is intended Lo- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constricts 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 perfarmed under the building permit (Section I09.1.1) 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 rranirr,nm inspection procedures and rc4uirements and that he/she will comply with said procedures and rcq ircments. Signature of Homeowner Approval of Building Of<iciial Note: Three-family dwellings containing 3 5,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Const action Control. HommowNER'S EXEMPTION .The Code states that: "Any bomeowner performing work for which a building permit is required shad be exempt from the provisions of this section.(Sectian 109.1.1-Uccnsing of construction Supenzsors);provided that if the homeowner cngages a pa-son(s)for hilt to do such work, that such Homeowner shaIl act as supervisor," Mzny homeowners who use this exemption arc unaware that they art assuming the responsiblitics of a supervisor(see Appendirc Q, Rules&Rcgulations.for Liecnring Ccrostruction Supervisors,Section 2.1� This lack of awareness often rtsults in serious problems,particularly ; when the homeownq hires unlicensed parsons. In this case,our Board cannot proceed against the unliecnsed person as it would with a licensed r 5upmN isor. The homtownrr acting as Supervisor is ultimately responsible To ensgre that the homeowner is fully a we ofhis/hrr respon ibilitirs,many communities require,as part of the permit application,- that the homeowner certify that btlshe understands the responsibilities of a Supervisor. On the last page of this issue is a farm currently used by several towns. You may care t amcnd and adopt such a fotrnlccrtification for use in your community. Q:forms:homw:cmpt T TO ti Town of Barnstable Regulatory Services s,ixxsust,� F ' suss g Thomas F:Geiler,Director �Eo► '` Building-Division Tom Perry, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstab l e.ma.us Office: 509 962-4038 Fax: 509-790-6230 Property Cfwner Must Complete and Sign This Section If Using A Builder I, as Owner of the subject_property herby authorize to act on my belLalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Print Name. - If Prouty Qwtler.is applying for permitplease complete the Homeowners License ExernptionFOn. n on the reverse side. Q:FORMS.D WNERPERMISSI011 L ' i , I z 2QJ W�Id mw /I PAT . i r t - b 17:I FAA a 4 SIR I P (I L2S � , ��TWO, all - MAT I r i = — - s lot ' I I I ='I �I. I 1 F•:',+l6': 1.�;. I� ;,�I , ' I J i �+ 1 r I - i_,_ ± j I ,� I, '.� ." ...I I �' I ` I i •�' -. I, .-1 I I ,�� r�' II i t •i: I' .I I'.. I:/ 7�t--I ,II Y I r WON r` ± ' -'I Gt -17 —I ---- ; I: ,_,_ j [, �:�-.�: � f:. ! ..-`_I _ + t _ __ ' m ' - 1 1 _� ' - ' - - �r: I' _•_—� -- - > cc } - I - its .L. r A / o ; ,mil ;,;� —.>� uia�o��f1• O 2 l —a I _ I I l a I,I q 4,01 IV t. d : v : 1 i j � I : i , i n�eQ,�ir,�,•a (n PPry!rn i �.,. - i woP� I ; : : 14 __7 _ I � : I I ` I� �G Aji a .S � _ . i I i t� i TZ vl 2 : ' I I. iv o Rfh Q I i II 1. L jL1 ,.--' i i I j. ' I 1 I , I I Yl I i a cl , r 4---11', mob. Ar NI) N I C' let - _ - .•_ � it �'� - 3 - - - - -- -------- -- --- - Q Town of Barnstable �1NE � Regulatory Services Thomas F.Geiler,Director MUNSTABM MAB& g Building Division s6;p. iOrE �ri�' Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 COMPLAINVINQUIRY REPORT Date• Reel by: (CA �IV V v Complaint Name: Map/Parcel �� JAJ Location Address: AA ;wW i Originator Name: Street: 1.4 Village: State: Zip: --- Telephone: Complaint Description: L)t- v,L(��i lt)y a A—Ufw- �,k L4 AJFA-� FOR OFFICE USE ONLY Fe� Inspector's Action/Comments Date: Inspector: Additional Info.Attached Q:forms:complaint I Perry, Tom From: Blanchette, Debra Sent: Monday, May 21, 2012 10:16 AM To: Perry, Tom Cc: Niemi, Maureen Subject: Parcel 310-269 Good Morning Tom, I sent a letter, dated May 18th to: William Armstrong, Sr. and Ellen A. Armstrong 17 Linden Street Hyannis, MA 02601 Advising them of the status of their Tax Title account. This property has been liened for fiscal years 2005 through 2010 and owes for 2011 and 2012 as well.. William's daughter, Jane Armstrong, called this morning to ask that the foreclosure process be delayed as they were attempting to refinance. In addition, she informed me that they were denied a building permit that is needed to bring the property into compliance that had been ordered by the Town. As discussed, I believe this is one of those catch 22 situations and I am in agreement with allowing the permit. !Debra M. Blanchette, Treasurer Town.of Barnstable 230 South Street Ifyannis, Y,4 02601 508.862.4661 1 F e E'C TdA.1,He 11,11141e FrE tit a � " t �. : _ w .- `_ _. NOW,_a - x as sin;. xti #,� nr :.a. „:+r ,saw+ak s'w s...`t .* ;a uw. .a.,aiy,kY::r+ms'.vm'n�Fa ,�. a a, NMI i , .. })Yarning Type Descrption �. ReFerence° to Date, Hold,1 • $°3204908j .. Unpaid Bill UTILITY BILLING 2012 60 00004918 m$224 I1/28/2011g w TRONG;N+ILLIAM M SR& ?' Unpaid Bill UTILITYBILLING 2012 60 00009107 $157, 02J21 j2012 I" Unpaid Bill UTILITY BILLING 2012 60 00012803 P $106 05123 2012 ?ERTR,Y.„WNE w . Unpaid Bill REAL"ESTATE - 2011 20 00000750 -_"` , N R � "ar p $2�645 03/07 201B Unpaid Bill REAL ESTATE 2010 23 00000011 2 " - ��' � Unpaid Bill-., �,._ �REAL ES TAT E " - _ 20092300000010' ,-$1,525 09/13f2011 I .,bpRPR,O,V,E-D1©�INSP,ECTREQUIRED�;" "n5;, Unpaid Bill REAL ESTATE 2008 23 00000009 $1,824 03/24/2011 Unpaid bill' - ,REALESTATE, ' 2007 23 00000010 $3,611 ;,,_ 10[I5/2iJ10 a1 Unpaid Bill REAL ESTATE 2006 23 00000016 $3,479 0612612009 - Unpaid Bill.. REAL ESTATE 2005 23 00000096 7$4,217 12/05�2008 r sr a t � � a" s .. x z Location �` 117 LINDEN STREET 9 i 1, � w- �y� t �.�4,�" a IPIGLE FAMILY HOME, dJUS" . 4 t HVANNIS MAC 9 RB-RESIIT I Es dl` Municipality Fi1AN HYANNI �, ,� m ;�t i `� WORM w +*' 02 ,- ftrcCe k . : p r as x i.' O nTM a d{`':-a�,.•by�,'fj1�^°";SZmai*;wit x„ �Y*'„h a` y A Fi00d�.zone �E - n Pro osed'use rMO SINGLE FAMILY HOME*'fk .PPa Lot/5ection/Phase ;� Betvd . r tdlkiisV, -zone, ' tea@3 a; 1 m Rim 1 tn rIya.t ( Ih CU u ipp �I � t ' t E la .4 r i w' �_$ : o f F 1 *Atkacfiments li c,eP* ati a �� $� ��>�a� ��a �� .a.�� �.„ �ym��:' s����� � . �✓�.�rz�� �z"�� a -a�2 .w.a *' Maintain project/activity detail For the current application , � k "" �; * �'' ' j , .. Start Inbox MaosoFt .; Par`cel Lookup,V i" � Perrp;,Tom Galen, Amara;Udilliam;.� Ij Main System Menu.",4 Appli lion Entry _ k9 57 AM � � = . �. • ru .I M Postage $ D ocertified Fee p Return Receipt Fee "8 p (Endorsement Required) p Restricted Delivery Fee r-q (Endorsement Required) sPs' CE) C3 Total Postage&Fees p Sen p �+ r" Sfreet�;; / ---- f ' or PO Box No. /7_ G�/vLC Q )a_............__..-•1... Cry;sia P+a ' MOr iz Ce laA rt mailing receipt ified Mail Provides: es�anaZoo)Zoo eunp'ooss w,u.4 sd D A unique identifier for your mail piece " C A record of delivery kept by the Postal toeniice fo?two years In.o.ortant Reminders: o Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. • Certified Mail is not available for any class of international mail. n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. D For an additional fee,ia Return Receipt may be requested to provide proof of delivery.To obtalwRetum Receipt seance,please complete and attach a Return Receitot(PS%Forrn 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece Return Receipt Requested".To receive a fee waiver for a duplicate rettum.recelpt,a USPSe postmark on your Certified Mail receipt is required. •For an additional:fee,delivery may be restricted to the addressee or addressee's authorized a ent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". • If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. 3 �`= � rt � � � � A ,, � Town of Barnstable Regulatory Services MASS. Thomas F. Geiler,Director z639� 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 r May 2, 2012 Mr. William Armstrong 17 Linden Street Hyannis, MA 02601 Re: 17 Linden Street Dear Mr.Armstrong, On April 10, 2012, in response to a complaint, this office made a site visit to the above referenced property.An illegal apartment was found, an exit order was issued, and explanation was given for the procedure to obtain a building permit for the removal of the apartment. As of today's date,a building application has not been applied for, and the property has not been registered with the Health Department as a rental property. On April 27, 2012 an ad ran on Craig's List for the rental of rooms at this address. Please be advised that a building permit must be applied for by May 15,-2012 and work must be completed by May 31, 2012 and that registration with the Health Department must happen before any rentals take place. Failure to do so may result in fines of up to $100.00 per day with each day constituting a different offence. If you have any questions or feel aggrieved by this decision, please do not hesitate to contact this office. Sincerely, Paul Roma Local Inspector ' i Y Simmer J1 Students Welcome (4) Page 1 of 1 email this posting to a friend cape cod crai sg list > housin >`rooms & shares please flag with care: L?j miscate orized prohibited spam/overpost best of crai sg list Statinp- a discriminatory preference in a housing post is illegal - please flag discriminatory posts as prohibited Avoid scams and fraud by dealing locally! Beware any arrangement involving Western Union, Moneygram, wire transfer, or a landlord/owner who is out of the country or cannot meet you in person. More info $100 Summer J1 Students Welcome (4) (Hyannis) Date: 2012-04-27, 3:18PM EDT Reply to: b47nm-2982847729nhous.cral sly ist.org [Errors when replyin tom] Great accommodations for up to four students for the entire summer!!! Available May,1.2 ,Sept 30. Private entrance to two fully furnished rooms, plus private bath, and full kitchen and laundry privileges. Private entrances. Central location near Main Street, Transportation Center, and Shopping. Quiet park across the street. $400/week for up to 4 people (avg $100/person). $400 security refundable your last week if you stay for the summer and no damages. When you get to the Cape, come by and see if it is to your liking; and the current availability 1"17 Linden Street,,Hyannis. Thanks! http://capecod.craigslist.org/roo/2982847729.html 5/1/2012 t'r*'�"�Ai''4•+s"s:4Ls J: '1§0�+'�'k:%2,�s..'!•Yr�w:*';.w.ttrrwS•...:!E.�L"f"T4 "s`.D'-`:£ ,_s.rAyji w•rtr:.,s--' --•s#{.•kJ ;`..4:�1"^.^--$'»s•x'r ,,y ..-v.i^.`. .-,r _ rs.,,--, y - T...,y x`._q.-.-- • Town of Barnstable F THE 1p� alldo Regulatory Services Thomas.F. G61 r Director BARNSTABLE. *, a MASS. �' B.ul�di DI .kioll Thomas Perry, CBO; Building Commissioner 200 Main Street;.`Hyannis,MA.02601 . www.town.bar•nsbble..ma:us Office:; 508-8627-4038 Fax: 508-790-6230 EXIT,ORDER DATE: LOCATION: '7 L. 1-1 D � ; 1 . UNDER THE PROVISIONS OF 780 CMR,THE STATE BUILDING CODE, SECTION 34M5.I, YOU ARE HEREBY ORDERED TO,IMMEDIATELY DISCONTINUE THE USE.OF THE CELLAWBASEMENT AREA.FOR SLEEPING PURPOSES. .' LOCAL INS OR. SIGNATURIE R-`EC'IPIENT ODEM.DE SAIDA DATA: LOCALIDADE:. .DE ACORDO COM O PROVISORIO 780 CMR, CODIGO DE.CONSTRUCAO DO ESTADO, PARAGRAFO 3400.5.1, VOCE ESTA,ORDENADO DE;DEIXAR DE USAR, IMEDIATAMENTE;A AREA-DO PORAOBASEMENT PARA O PROPOSITO DE DORMIR. INSPETOR LOCAL ASSINATURA DO'RECIPIENTE WON$ .5=�XKV- tj SENIDER- COMPLETE THIS SECTION COMPLETETHIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si gnat re item 4 if Restricted Delivery is desired. X ❑Agent ■ Print'your name and address on the reverse ❑Addressee so tl;,3t we can return the card to you. B. Received b (Printed Name) C. of ivery ■ Attach this card to the back of the mailpiece, _r or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1? Yes If YES,enter delivery address below: I.No -2" 3. Service Type Q 4? a Ag.Certified Mail ❑Express Mail ❑Registered Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. ( 4. Restricted Delivery?(Extra Fee) ❑Yes Article 12 (Transfer from eservice labeq i 11! 7 6 0 6(I0 8 7 010,000 3 5 2 4= 6'14 7. PS Form 3811,February 2004 — Domestic Return Receipt 102595-02-M-1e40 i UNITED STATES POSTAL SERVICE First-Class Mail i Postage&FeF>Paid LISPS Permit No.G-10 I • Sender: Please print your name, address, and ZIP+4 in this box • I TOWN OF BARNSTABLE i:;i. BUILDING DIVISION 200 MAIN ST. PYANNI5,MA 02601 I I E i i i D I M li.tat��ii!�1,.Ii�����sti�i����a����r�F��sir:'i�}���if���i��►���tl � e - i )" �y '� �y t,. �i i �' • • It 1,f tAt. f'-:i✓ fy�fi'4 't•r'1.�4T.3 �- � a "*. �S, �� yr,� 3a s• r. � 4F -,.,„.,�„,�, f, # � 'r � "�•'r,�j ,� �Rf x "'�i.,„f�'",: Ili" �,,,^ `M,•J � x 1 �1 7' r f `fi r a 4} d�� a if •10£ ;,vim.• r s ,9 % NA .. �1� .�, ( I f ♦t ..-7 � � �.i��`rFyf• r'^,i�, ► ,t -� `�,Y'�l p�v :.::-, 17, L i n d e n Sfire�el �, H ya n 1 12 h I I a t � rr: n t A a 4 4.1 s: i e-I r e n T «. x xn W*t1��1 .ti1.'4�i�'r� sa .l. '4',+.'•. 1 :- ;�_=F �1° f fA I w.. d Rak n i i xw, i, � I f , i.. � E : jA K , l 41 { P, 1.7 Linden Street Hyannis ��: ' }` 4/10/1#2 f ' Ad oil Ma 10 mowRM NOW 4 . 3 V► �- - :._ _ a € r Alt r i! r 17 Linden Street, H - annis 2 y _ _ � .---- LID- 1 - ..� Ma" --mm t. 4�. t i u II� I I 61 ujt'�" ° 1 � 1 1� 4/10/12 ................. u k r ' w i t 17 Lindens 4/1-0/=12 itkzlll - q ,. X 4:aa s Y. � „� *'4�p �F� 'six m*.c:;,,.±;-. 5 �,• .r � _ e n4t n d e n Stre r t� f t a � f O f f 4 n.. e � f w ry� i fF Y rA� s .$ e• 40 A Linden :Street, anIn H w �.. is 4 u � � 2 ,. ; t . y� ,mac rv+' W11 a c _ca .'.a 3 tlN Y-x� rc 'p .1 r - i 7--Linden Street, Hyannis 4/10/12 r .r 4 i- - y S i 6 16 1 � y 4 v. f P E ' Yy 1 ¢ t r e A , #� 2 x b s Wannis 4/10/12 kr� 'A # S � N r k 44 P � r c3 V 3 ` S ; V '2 Y r , �. ro. �k 17 Linden Street, Hyannis 7 Linden Street, Hyannis 4/10/12 { a. �Ky.q k; �• � �;_ r� � 3�r n 7Y n'u F h�,11 li - 4 I Al •". Ix rt r .i ya n n i s 0/12 17 Linden /..met H. ann s 4/10/1:2 �r All y x .0 f a � �if ,1 .� :gyp. T �� "✓, w 4/1v 17 Linden Streeter - - # �� .. .; . .�� ; � 0/1All p+# � rt ji .. ;�� 4. F t i NOW ""now 0 o V r e�--.'.•'sue �,#�w ``.'F�a„.�ss. 4 17 Linden Street, Hyannis 4/10 A_. E � SSS n r_ i1gg �d 3 ' 1 4 n w. y f ��Y+.i7:,.••_'"�(� ,a+ .$,�''r 4 ���\M,`l'�, � t� v yt"s a ''xY t. S�. t ` A � �t-•lam ��_ � y, ��� { `1 � ' ^�� .•fir '�.. � ���''!' _ �' � � .�* "�� '� , �,:. a •` a wq C+,�,,.44n o�a'�nMt a f, f�f f�fn h f�lifs' ,"ak � a � � • s� ffP+'f ff f�af af'f frf f� / z: � � '. �. "� -mob.-, - y, r i a ✓ 4f s \ 1 4 i•'`� * fir." i,� �� ��v►� �''. 1� ' 1 a 1 1+7 Linden treet H an x 1' ,str n is 4/10 Ty f 4 ed a � f s gg 11 s i i WW *4%Lk��r" �111 s .Y p e �N�" � � \:,•via •A i i,++e,j� �' ..aw,,.ems. � ....mw.. � v. J.� `� i Ira „H jar r a x 17 Linden Street, Hyannis 4/10/12..... ..... x� pp44k k. c• As ry o.e a � t 4/1'0/1,2, Ar r � wr G' �<e 1F k� , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map .3/0 ' Parcel 26 _ Permit# �O Health Division ,I 6 wt k tMe✓� Date IssuedJ U 6 6 Conservation Division - Application Fef S0. 00 Tax Collector 11 C Permit Fee 02 S. .O o Treasurer v Planning Dept. CONNECTED SEWER ACCOUNT Date Definitive Plan Approved by Planning Board # 3Ix Historic-OKH Preservation/Hyannis Project Street Address / '7 �-I�✓.��N -sr Village ��ttiw S Owner &/e7,V &f� Address /7 L lnib C,7,1 J—,7` — �`G ✓y,t Telephone fit/ Permit Request ��" RaOF Square feet: 1 st floor: existing proposed 2nd floor: existing 76 proposed Total new: Zoning District Flood Plain Groundwater Overlay mf roject Valuationrd D 6 Construction Type oA, 74 Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. - - Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) �M Age of Existing Structure Historic House: ❑Yes d'No On Old King's Highway: ❑Yes Flo Basement Type: UFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing Z new Half:existing new Number 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 Cl No Detached garage: existing []new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name 1?1i IIIA" 10Q f>` IV Telephone Number Address/ ���`�Cow S-7 License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE v DATE �� FOR OFFICIAL USE ONLY t PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: " FOUNDATION' FRAME 2 !3 -Q,,5' , yam INSULATION 3' FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH 0 ,, FINAL GAS: ROUGH FINAL FINAL BUILDING 0 , m uz DATCLOSED OUT k ASSOCIATION PLAN NO. I `l I 1- roe Town of Barnstable V1 Regulatory Services l saxNSTaBr s, Thomas F.Geller,Director Mass. 039. a Building Division rFD MA'S Tom Perry,Building Commissioner 200 Main.Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 Permitno. 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 � are adjacent to building containing at least one but not more than four dwelling units or to structures which such residence or building be done by registered contractors,with certain exceptions,along with other requirements. "5 (' 4.-�f ,/JEstimated Cost Type of Work: !l CD Address of Work: . � may/ jf� ([, A^ C �-�n Owner's Name: W ��" �- � y Date of Application: I I hereby certify that: Registration is not required for the following reason(s): QWork excluded by law ❑Job Under$1,000 []Building not owner-occupied RrOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED ROVEMENT WORK DO NOT ACCESSCONTRACTORSTH ARBITRATION APPLICABLE PROGRAM OR GUARANTY FUND UNDER MGL c 142A. ACCESS T _ SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR D Owner's Name Q:fomis:homeaffidav f �a `�',� ,��3 ��� ` RESIDENTIAL BUILDING PERNIIT FEES APPLICATION FEE ; New Buildings $100.00 Residential Addition $50.00 6 Alterations/Renovations $50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE �yf/Al square feet x$96/sq.foot= x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120.sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf-1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= . (number) ' Deck x$30.00= (number) Fireplace/Chimney. x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee .® V Projcost Rev:063004 The Commonwealth of Massachusetts Department of Industrial Accidents F. 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavi v�G�er Bs!lnesstM in kwv address: Gam`zt/ state• hone ci %13—alm te location full address a sole proprietor and have no one Business Ty [�Retail[]Restaurant/Bar/Eating Establishment working in any capacity. ❑0$tce ElSales(including Real Estate,Antos etc,) I'am an en Toyer with on to es(full& art time). ❑Other / / //////!//�//O.: am an ployet providing vwQrkers' compensation for-my.empl0yees workflng on this job: em c'o'm aav name: ' ,,, •;'' .. ':'"•' ,;^� '; . 1 r "•�"�1: '1• • ''e':.;z. .t••• f: :i.' •t'. •,•,1.: ..at•r,•�• �_� f.••,1.r. address:' '� r„ �. :,: 7 ' `••• F:. "'{ '; r •Gifu' r,1 S instii ance.cod'r :,•.: / /// ////1/ /%////1,�0/// // / /i/ , I am a sole proprietor and have hired the independent contractois listed below who have the following workers' com msation polices: ; $ • COalan name: ti.^•' :•�r '..a;i :'.r'. •. `� ''• .t ... r' :1:', :?.s: 'q•, ^fit,•.{• •;~,}i•'r;••J••5:.� ...+rr;.: ..>`•.f.'a;t:;:�.• t•: . 'T.:'i•"•l ;i: 'a:t. 1.1 in: _ - address ;~ y:.,,% : .7' :.r.. `.. 't, `, r +• :7'r{ .r' .is'I:+�r.aA, hone#'', 77 •,'4:�,r ` !: �, ., • . '.1.:• .',t. i',.%• .: '1,,+„fat• •• `'`'' •' _ /. r�,,•t,?. % .'' .';.3v,.rtri a�'7.' `'r�' .,.••+..'Ol]CV:# '.}S,• -r. '� ��/J//���� insurance co ` ,/ ` P. ,i• •f.• rr :P.;.r'!. •y7''' .L: ••aaa ''t - com'ari�asvde�•d•- :5i�-l.:g'„1 .. .. .•!• . Vr, •a'•• - "1'••.:•. • address: ,;' r .• •:�.; ..�, ' .7 oi. h. ,;; •Lr.�is!`7. ,y 'y. ,( 'Y,.r.a• .'ya. ( .\ y+.•' ;j'. .•Y• a•J^ •'Tv;.:' +b" :S 'i' lr.,: -.. �� �// Fallure to secure coverage s9 required ender Section 25A of MGL 152 csa lead to the imposition of criminalpenaltics of a fine uP to 51,500:00•andlof one years'imPrlsenment as well as civilpenaltln in the form of a STOP'wORK.ORDER and a fine of s100.00 a day agaia+t me. I understand.that copy of this statement may be forwarded to the Office of Investigations of the DlAforcoverageveriRcation. tify under the pains and penalties o�rjury that the tnforin anon provided above.is true a at corre De /G t I do hereby cer f� .. 5i�nature � � - � Print name Phone# official we only do not write in this area to be completed by city or town official ermittliceme# ❑Building Department city or town: P. Dliceasing Board ❑Selectmen's Mee ❑check if immediate response is required ❑$ealthDepartment , conperson hone taet p n; Other a irevaad ScyL MM) Information and Instructions Massachusetts General Laws Chapter�152 section 25 requires an 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"anytwo 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. Howevci the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the°dwelling ho4e.7: another who employs persons to do maintenance,construction or repair work on such dwelling house or.on the-grounds or budding appurtenant thereto shall not because of such;employment be deemed to be an employer. ter 152 section 25 also states that every state or local licensing agency shall withhold the- or renewal+. MGL chap d - .. a license or permit to operate a business or to construct buildings in the commonwealth,for'any applicant who hat,,.- of not produced acceptable evidence of compliance with the insurance coverage required. Addttionally,,�leither 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 presentad:to the contracting P authority. PIPE Applicants � "' i ia',�� 'i r•; ,�,r - , - Please fill in the workers' compensation affidavit completely,by checking the box that applies p yo&situation. Please" supply company name, add-,ess and phone numbers along with a certificate of insurance as all affidavits maybe s4mitted to the Department of Industrial Accidents for confirmation of insurance coverage. .Also be sure to sign and date the ; affidavit. The affidavit shouldbe 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"lave'or if you are required to obtain a workers' compmsationpolicy,please call the D.epai trrment at the number listedlielow. 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 pemzrrit/license number which will be used as a referencemuai . The iffidavits may be,returned to r- -i&nents havebeenmade. theDepartmentbynUilorFAXunless other a=ra The Office of Investigations would lilce 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 ON 011e"stgatl0ns 600 Washington Street Boston,Ma. 02111 fag#; (617)727-7749 phone#: (617)727-4900 ext:406 oFt r Town of Barnstable Regulatory Services BARMSTABLE, : Thomas F.Geiler,Director MASS. i639• .0� Building Division ArED MA'I A 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: G/ !/O/ JOB LOCATION: 1 �i�B /� �/ 75� �I/ /T numbbeer �( r / street � ` village "HOMEOWNER": ��((/fry I— ' �'Q�,574,' g-lb--` name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) 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 ell Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt 6,47hRQO A/4.1/5- 1,171?4-5U. C Ul u 00C19 fV7 T.� oe 6A m e ° L; d , VAN, 1 ` _ 8 0 I RST i G� 1k — o j<t Tchvi AS 4 F r E I rvAtroN a l f 01A/V A fihRo�m GD,v D f-loo R N�W Q l G C { . . c y�- 0 , ,� v Tr. A 0 0 Fli I R`o SpAG r :... PRnwptE_p a Oi Ro 0 r� T 1 o D- 1,A Sour �+ si<' ��/1D U✓ ./ a 7'o /fit fily/< °VA.NI�Y ,jr.r) ov�R pRo P oS t Y H r L..ui. 171 SCR�P .q�d gS161AC L")cr-1v r6 -EASTT Co-oR of llou5, y.A,, _ G ' 0 V --dp �r • 3�aoZ/Q oFISErots, Town of Barnstable *Permit# Expires 6 months from issue date • Regulatory Services Fee Sri, - �, a�►ss �' Thomas F. Geller,Director i6 Building Division � I�4ay F`E(-^dry Prz� Tom Perry, Building Commissioner R ; , 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 MA 2004 Fax: 508 790-6230 EXPRESS PERAUT APPLICATION RE SIDEN'1TRfgf)PARNSTABLE Not Valid without Red&Press Imprint Map/parcel Number ��� Property Address [residential Value of Work Owner's Name&Address Contractor's Name Telephone Numbe�— a�� Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor [-j am the Homeowner ❑ I have Worker's Compensation Insurance — — Insurance Company Name Workman's Comp.Policy# 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) 9-je-side' ❑ Replacement Windows. U-Value (maximum.44) *Where requued.. 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. Home Improvement Contractors License is required. Signature Q:Forms:expmtrg Barnstable Assessing Search Results Page 1 of 2 5 P i Home: Departments:Assessors Division: Property Assessment Search Results 17 LINDEN STRZEIET ®caner: g,19 s F /�" rA17 Property Sketch Legend ARMSTRONG,WILLIAM M SR& Map/Parcel/Parcel Extension 310 /269/ Sp Mailing Address ARMSTRONG,WILLIAM M SR& Y � ARMSTRONG, ELLEN A 17 LINDEN ST A' HYANNIS, MA.02601 ;, 2004 Assessed Values: Appraised Value Assessed Value Building Value: $95,000 $95,000 Extra Features: $2,300 $2,300 Outbuildings: $6,100 $6,100 Land Value: $90,500 $90,500 Interactive Property Map: ap requires Plug in: Totals:$ 193,900 $ 193,900 1 have visited the maps before Show Me The Map April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: GALONEK,GARY E&PALMERINO, MICHAEL 3/15/1988 6189/060 $ 107,900 ROBINSON, PATRICIA A 3031/192 $0 ARMSTRONG,JANE 9/17/1998 11705/058 $0 ARMSTRONG,WILLIAM M SR&ELLEN A 4/23/1998 11376/279 $75,001 ARMSTRONG,JANE 3/3/2000 12862/263 $0 ARMSTRONG,WILLIAM M SR& 3/3/2000 12862/265 $ 100 2004 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $ 1,281.68 Town Fire District Rates Other Rates 6.61 Barnstable 2.01 Land Bank 3%of Town Tax Hyannis FD Tax $393.62 C.O.M.M. 1.10 Cotuit 1.52 http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 2/9/2004 Barnstable Assessing Search Results Page 2 of 2 Land Bank Tax $38.45 Hyannis 2.03 West Barnstable 1.36 Total: $ 1,713.75 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.11 Year Built 1935 Appraised Value $90,500 Living Area 1576 Assessed Value $90,500 Replacement Cost$ 126,720 Depreciation 25 Building Value 95,000 Construction Details Style Cape Cod Interior Floors CarpetHardwood Model Residential Interior Walls Plastered Grade Average Heat Fuel Oil Stories 2 Stories Heat Type Hot Water Exterior Walls Wood ShingleClapboard AC Type None Roof Structure Gable/Hip Bedrooms 3 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 1 Bathroom Total Rooms 6 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL2 Fireplace 1 $2,300 $2,300 FGR2 Garage-Avg 360 $6,100 $6,100 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/tob02/Depts/A`dministrativeServices/Finance/Assessing/A... 2/9/2004 Complaint Number: " 1708 - Taken hv: BUILDING SLRVICLS j Date 3 /00 x Map/parcel G — oZ Referred to: BUILDING 9 _ SUBJECT OFaCOMPLAINT Y Business/Occupant Name: - 6 Number- 17 Street: LINDEN-STREET a - . Aw ,Ir COMPLAINT INFORMATION Complainant's Name: 4. NEIGHBOR Address: Telephone Number: Complaint Description:' RUNNING BUSINESS----ALSO MANY UN- - REG. CARS Actions Taken/Results:- R J. WILL CHECK. r v 44 �. a . Date Closed: 3/30/00 rVoO