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Home My WebLink About0550 MAIN STREET (HYANNIS) �� `�-� G�� . i '�. 3 FjHETp�yO -To of Barnstable Building Department-200 Main Street T s63q EOMp+ Hyannis, MA 02601 , Tel: (508) 862-4038 Certificate Of Occupancy Permit Number: B-16-3183 CO Issue Date: 4/10/2017 Parcel ID: 308-074-OOD Zoning Classification: HVB Location: 550 UNIT 4 MAIN STREET Proposed Use:. (HYANNIS), HYANNIS - Gen Contractor: ERIC STANLEY Permit Type: Commercial - Business Comments: MRS. M'S SUMMER HOUSE GIFT SHOP . . Building Official Date: t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 191A Application # �lJ I NVG Health Division Ae ate Issued Conservation Division T• cT�.�'Ro'l Application Fee Planning Dept. VVN®�BgR,V, r Permit Fee Q Date Definitive Plan Approvedby Planning Board gQLF '`hy�gr S Fia✓`� Historic - OKH _ Preservation/ Hyannis Project Street Address X_cuvti. e-� "A A3 d Village Owner t1i%A,A AddresslCo �Z�k,tVt�s�62,) l�r s�?o,. 02 03 Telephone 6�28 6Lt( q-7A Permit Request W G� :�63 s�n Cit CQ — �.l t�Q QLQ r �r l�� TTII/� C� ,1�15 ►� Vi Square feet: 1 st floor: existing _proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0, D 6 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King'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 0 Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number 508 6(�R - Address B J b I\dl� License # CSC 0 1 ( � 1 Home Improvement Contractor# Email l lu �yr _ (()In. Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO t)LM*S 1eJ-CJn S!' SIGNATURE DATE l f I�n FOR OFFICIAL USE ONLY APPLICATION # r DATE ISSUED 4 MAP/ PARCEL NO. T .r ADDRESS VILLAGE OWNER ;.F DATE OF INSPECTION: FOUNDATION ., FRAME INSULATION s; - FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 'GAS: ROUGH FINAL FINAL BUILDING ` DATE CLOSED OUT ASSOCIATION PLAN NO. s r" .e :?iv, For 3t•�♦taeA Kral 1'4fNa q�t e C.w�l v � � ewrtawb.,�.,_ � t � w..� ...,� �� e � *r �� . � T I �� , � ,� ° i d � + � �� -441 f ' 'lie Commorrtvealth of-Marsadirmetts Deparft terxt of r4 ustdd Accidents f3 rue of imlestigatdow 600 Washington Street G nwit<r ma-v&g4 p1din Workers' Campensatian Insurance AfFidavit:$mlders/ContracturslEIecfricians/Phunbers Applicant Informatian Please Print Le�� Name ' sstDrgan � Er,c S+c n Lou Aaaze : U{b�-- a .kd M-5 /(` w` rn �J citwstr3: �+ v 10IIG rli: . )V l It C7� Are you an employer?dheckthe appropriate bay T f r am a genera confmctor and I Y of project{1ect equired)^: I_El I am a employer u7tb. ❑I l employees(full an&or part-time).* 'have hired the sub-coatractoas G. 0 New cansirucfion - 2.`_;] I am sale propjietof-or partner wed onthe attacked sheet 'I- ❑RemoBel'ng ship and have no employees. These sub-confractars have g_ ❑Demolition, for me in any c.-parity- employees and have woAcers' 9. Building addition [NO svrnkers'camp.in�xa.,ce comp_insurance-1 ❑ g required-] 5. ❑ Mite are a corporation and ifs - 10-❑Electrical repairs or adcrAions 3-❑ I am homeowner doing all work offices have-merdsed their 11_❑Plumbing repairs or additions ' rgue1€[No workers'camp- tight of exempfion per MGL 12.[1 Roofrepairs. awrancerequited]Y c.152, §1(4�and we have no, employees.INOwoders' 13-❑Other comp_insurance required_ ` *Any a HCzatfatchecksiwxF1— a]safiIloutthesecdoabeiowshmdngflmkwmies'ca®pessatieapaTuginformauom- #Mmeo=a s uho submit dais xifiaa%m iuuffratimg they ate doing RU wat sud&m hire outside contmaorsnmst submit a new affidavit imHcRfilgsnrx FCant;actoM*zt cbea This boa must xttad and au addidaeal sheet showing die name of the sub-caatrwtom and state whether.arnot•rinse entities bare empla32es.If the sub-cont ctnishave employee%tfaeymust prni&their nrnrkess'toaap.policy aimmbm I am an empLoyerr that is pnniding workers'congwaadon irmirancafor my employees Eetoly is fflepalicy tmdlah site ir�orrrcatiart L • Insurance Company Name: - Policy 4,or Self-inns-Uc.:9: Fxpi-atiQnDate: Job Site Address: CitylStatel.rp: Aftach a copy of the wor- s'compensationp.olicy declaration page(showing the policy number and expiration date). Failure to secure cove, e as required under Section 25A of MGL c 1572 can lead to-the imposition of criminal penahi s of a fine up to$UOD 00I&Vror one yearimpusonmenty as well as civil penalties,in ilre form of a STOP WORK ORDERand a fne of up to$250-00 a day against fhe violator_ Be advised that a copy of this statement maybe forwarded to the Office of Irrvestigations of the DIA for insurance coverage verification I rfa Iiereiry cecrti ;*jepaws4wtdprnabffkx o,f et txy7 flrattlre irrforRta#iaruprm r d ahof�is tr�r$and correct Si�ature: Date: Phone ik OjOTchd use only. D47 iwt write in this area,to be crrrspletad-by char orton-w.a,,0Tciat _ City or Town: PernutMicense g Issuing Autlwrity(circle ogre): L Board of Health 2.Building Department 3.CRyl Town Glerk 4.Electrical inspector 5.P.lam—bing hmpector G.Other Contact Person: Mone<#- ira I52 aII I ers is de warkeas'compensation for theiF employees. Information and T-ustructio,"S 7.If�eca��**.Set1'S Geh�alLaws chap reQ�� oY P� Pursue this tea,an ezrrployee is defined m"_.eYerp person in t3:.e seaYi ce of another under any cojract of hire, • express or implied,oral or wrfttmn.." ar(n associafion,Go ration or other IegaI e Efy,or ny two or more An vnpky8 is defined as"an.inchvidnal,p ��, Ie sentafives of a dEceased employer,or the Of the,foregoiog engaged ina joint enterprise,and inchiding gaI=1� receiver or trastee of an individual:pa tee b , associaiinn or other legal entity,employing employees- $owever the or th owner of a.dtimlliiig house having-not more ee than thr apartments andwho resides therein, e occupa nt of the- dwelling house of mother who employs persons to do mai„tm:i; cB,conshuctlon or repair wolk.on such dweIIing house or on the grounds or budc1mg appm-fa tht--mto shall notbecanse of sash emplaymentbe deemedt o be an employer." MGL chapter 152,§25C(6)also states tba± everystafa or local licensing.agencyshall withhold the issaance or renewal of a Hcensse or permit to operate a business or,to"constract buildings k the commo :wev alth for any applicant mho has notproduced acceptable evidence of compIianceith fiha ?n�.COYeXagerequrred" Additionally,MGL chapter 1�,§ �� -Teitlierihe'commaWeahh nor any of its political subdivisions shall antes into any confzact for jhe performance of j ubhc;worts rm I acceptable evidence of cornpIiancewith the in c�rrance. r-e-C m enfs of this chapter have be:=presented to the contacting arfiioz ity." •�, Applicants , ' Please fill oizt the workers'compensation affidavit completely,by checking$e boxes that apply to your situation and,if necessary,supply sob-contcactor(s)name(s), addresses)and phone number(s) along with their certifrca -(s)of Disura„ce. Limited Liability Companies(LLC)or Limited Liability Pa dneam ps(LLP)withno employees other than the members or partacxsy are not required to carry workers' compensation hasuraace- If an LLC or LLP does have empToyees,apolicyisregnared. Be advised that this affidayk maybe sabmitfed to the Dea p -tmentofludusirial Accidents for confnmation of insurance coverage Also Be sure to sign and dam_he affidavit- The affidavit should be retried to the city or town tbaf the application for the peonit or license is being requested,not the Department of ens the law or if you are rimed to obtain a workers' L,diistrial Accidmfs. Shouldyou have any quesd reg� er companies should enter their compensationpoliey,'please call the Department at the nnmbes listed below. Self-ins�ed self-insurance Iicense number on the appropriate line- City or Town offfc als t Please be sore that the affidavit is complete andprh:ttd legJbly. The Depadmeathas provided a space at.the bottom of thn affidavit for you to fill out i a the event the Office of Investi gations has to coact you regarding the applicant_ P leas e b e sure to fill in the p e�iYlicense number which will be used as a referpace number_ In-addition,as applicant t3>at must sabmt multiple per ityUcense applications in any giveayear,need only submit one affidavit mdirating com-at policy info=n.atioa(if necessary)and under"Job Ste Addm&*the applicant sho77ld write:"all.locatitins Y or ed or maimed by the city or town may be provided to the " town)-"A copy of-the-affidavit that has been officially stamp . applicant as proofthat a valid affidavit is on file for future permits or licenses Anew affidavit must be filled Dirt each Year.Where a home owner or citizen.is obtaining a license or permit not related fio any bminess a commercial Yee (i e_a dog license or penuit to bum leaves etc.)said person is NOT req�to com eplet this affidavit like to thank you m advance for your cOoperzdca and should you have any,questions, The Office of Tnvestigairnns would please do not hesitate to give us a call The Dq arfinenfs address,telephone and fax number_ Tht eammoaw attbE of Massaahnse t r,ry f ant of xiid�iak A�iden.� . . . . � . .> �c�ref�zv�et�a t:io� •. - 4 Woman t Bost MA 02111 Tf,-1<4 61 I' -4 =t 4-06 Qr 1-977 h3ASSAFE Fax 9 617`27 7M Kevised4-24-07 + Y DIME Town of Barnstable" ' Regulatory Services L►xrtsresu.. MA.S& �►, Richard V.Scali,Director eo► " Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 . www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Y n Property Owner Must. F .r Complete and Sign This Section If Using; A Builder I, , as Owner of the subject property - hereby authorize _ to act on my behalf,' in all matters relative to work authorized by this building permit application for: (Address of Job) **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 Signature of Applicant Print Name Print Name Date QTORMS:OWNERPERMISSIONPOOLS f Mass. Corporations, external master page Page 1 of 2 w c1• sf r Corporations Division Business Entity summary A ID Number: 611567232 Request certificate_ New search . Summary for: 550 MAIN STREET, LLC. The exact name of the Domestic Limited Liability.Company (LLC): 550 MAIN STREET, LLC. The name was changed from: 540 MAIN STREET, LLC on 01-28-2009 , Entity type: Domestic Limited Liability Company (LLC) Identification Number: 611567232 Old ID Number: 000980369 Date of Organization in Massachusetts: 06-19-2008 Last date certain: a The location or address where the records are maintained (A PO box is not a valid location or address): Address: 106 MAYFLOWER TERRACE City or town, State, Zip code, YARMOUTH, MA 02664 USA Country: The name and address of the Resident Agent: Name: MONA K. SOLMONTE Address: 106 MAYFLOWER TERRACE City or town, State, Zip code, YARMOUTH, MA 02664 USA Country: The name and business address of each Manager: Title Individual name Address MANAGER MARK CORLISS 485 NORTH DENNIS RD YARMOUTH PORT, MA 02675 USA In addition to the manager(s), the name and business address of the person(s) authorized to execute documents to be filed with the Corporations Division: Title Individual name Address SOC SIGNATORY MONA K. SOLMONTE 106 MAYFLOWER TERRACE YARMOUTH, MA 02664 USA SOC SIGNATORY MARK CORLISS 485 NORTH DENNIS RD. YARMOUTH, MA 02675 USA http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=611567232... 10/27/2016 f Mass. Corporations, external master page Page 2 of 2 SOC SIGNATORY MONA K. SOLMONTE 106 MAYFLOWER TERRACE YARMOUTH, MA 102664 USA The name and business address of the person(s) authorized to execute, acknowledge, deliver, and record any recordable instrument purporting to affect an interest in real property: Title individual name Address REAL PROPERTY MONA K. SOLMONTE 106 MAYFLOWER TERRACE YARMOUTH, MA 02664 USA ❑ ❑Confidential ❑Merger '❑ Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS Annual Report ; Annual Report - Professional _ Articles of Entity Conversion Certificate of Amendment v (View filings Comments or notes associated with this business entity: New searc r. http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=611567232... 10/27/2016 a - _gyros ; Public iof ! . l to dSUP, -rvisor , e�4 gpg g +�, ■� aa ,,,gyp y„� �iyuit'ST N •",t ,89 GLUES . ry.�G. R A & NNIS - Expiration!! CO MiS i n 6Z l �'..(}{� �� WOA- S Ll • 2 - Fromm t HA c $, a Q Al . I . . ff 1s r y x+� --- ti Fromm'� - i FP4, n � Oft �2 0`� _ 1 t , i c e; V ' its \. } e �`v i R _Tl w "IT if Q )d a-0— z if �201 I Fr011 Sn M Pr--T� s J Upi^-T Pareel Detail Page 1 of 2 3N1 A. / t .. .,.:.4,�" Logged in As: Parcel Detail Thursday,October 27 2016 Parcel Lookup Parcellnfo _ .. ........ Parcel 308-074-60— condo ID Unit b UNIT 4 � Cond 540 MAIN STREET CON wilding BLDG 1 Com le Location 550 MAIN STREET HY Pr Fronts I Sec RoadIBASSETT LANE se Fronts Fir _.....,...„ Villag fWyannis Distri HYANNIS Town sewer exists at this R a0952 In de nteractiv Div Ma i . . Owner Info ..... ................................ ....... .......... ......... .. .......... ....... . . owner 1540 MAIN STREET LLC( C0 %MRS MITCHELL'S CO Owner_a Streeti,283-285 OCEAN B aq streetz city HAMPTON BEACH state NHu i zip 03842 _ Country Land Info ..................... ....................... _ __ Acres 0 %1 Use RETAIL CONDO MDL-0 zoning HVB Nghbd J0003 d Topography Road F'. Utilities Location M Construction Info _.......................................... .......... .............. .. . . ....... Building 1 of 1 Year 1962" "�� Roof I Ex[ Built Struct >uli �J Wall P wI Living 3004 Roof »»""» AC Central Area. Cover Type Style Retail Condo wall yDrywall Rooms In Model Com Condo Floor Vinyl/Asphalt Roeoms0 Full-0eat Total h Type HOt Alr Rooms u3 Grade Heat' `.".�W Found-,, Stories1 Story 1 Fuel rGas � atiori;'Cone. Slab Gross 3004 Area� L�..�n� Permit History Issue Date Purpose Permit# Amount Insp Date Comments 5/13/2014 Commercial 201402510 $1,200 CM ADDED RM FOR TATTOO RMS-2 WALLS . Parcel Detail Page 2 of 2 Date Who Purpose 1/26/2011 12:00:00 AM Denise Radley Change of Address 3/12/2010 12:00:00 AM Tony Podlesney In Office Review 6/10/2009 12:00:00 AM Michele Arigo Change of Address Sales History Line Sale Date Owner Book/Page Sale Price 1 7/23/2008 540 MAIN STREET LLC 23058/295 $495,000 2 7/9/2008 540 MAIN LLC 23032/303 $1 3 9/1/2016 1 MRS MITCHELL'S COUNTRY SHOPPE INC 29906/106 1 $580,000 Assessment History.... . .. ................................. _.... Save Building Total Parcel # Year Value XF Value OB Value Land Value Value 1 2016 $381,200 $0 $0 $0 $381,200 2 2015 $374,100 $0 $0 $0 $374,100 3 2014 $374,100 $0 $0 $0 $374,100 4 2013 $374,100 $0 $0 $0 $374,100 5 2012 $359,400 $0 $0 $0 $359,400 6 1 2011 1 $431,200 $0 $0 $0 $431,200 Photos - APPLICANT INFORMATION e - v (BUILDER OR HOMEOWNER) O4 �' VV"� Name Telephone Number e Add ss �'.�� License # g Home Improvement Contractor# Email V Lof I ft �MWorker's Compensation # ALL CONSTRUCTION DEB IS RESULTING FROM THIS PROJECT WILL BE TAKEN TO f SIGNATURE DATE 0? /A/ w " TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Bu r :A p� Map Parcel Application bM Health Division 2001 APT, ^!( {!A Date Issued 9: 4 Conservation Division Application Fe Planning Dept. Permit Feel ' 1 V7S .4 Date Definitive Plan Approved by Planning Board IV Historic - OKH _ Preservation / Hyannis Project Street-Address Man S4—. ,Village Al f . - Owner Mir Ca f�l ss Address 9 9 oid n` ` A Telephone Permit-Requester ece. � t�:r :^w1 — 2 WnJl S Ub �'Jec (\�,`-cuc b Qn Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ' GCQ Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King',s ighway: l Yew❑ 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 6ount 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 r ` Proposed Use T APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name= Telephone Number rlSC �_ &L.6' r _._. Address 5 !1� r--License-#- 1 * 0 S 1 'C 3D Home Im rovement Co actor# Email Worker' Compensation # AALL�`ONSTRUCTIOK-DEBRISR ULTING'FROM T 'PROJ T WILL BE-TAKEN-TO -----. SMATURE— DATE n a FOR OFFICIAL USE ONLY ni (APPLICATION# ! DATE ISSUED j MAP-/PARCEL NU. ADDRESS VILLAGE OWNER DATE OF INSPECTION: s * FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL j FINAL BUILDING QAT-E-CLOSED OUT AS__,,0"ON PLAN NO. c The.Commonwealth of Massachusetts _ Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le bly Name(Business/Organization/Individual): �L t. Address` //r i City/Stat_e/Z_ip /S 6 r.Phone#: l YAre you-an employe_L eek-the-apprapriate box: Type of roJ ect(required): 1.❑ I'am a employer with 4:[S J a general contractor and I project q employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2T am a sole proprietor or partner- listed on the attached sheet. 7 ❑Remodeling ship and have no employees These sub-contractors have g, E]Demolition working forme in any capacity:° ' employees and have workers' comp.in�rrance.$ 9. ❑Building addition' w[No orkers comp. insurance p• 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.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13. Other " comp.insurance required.] *Any.applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $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: ;.. L F Policy#or Self-ins.Lic.#: + Expiration Dater b Site Add sir"` .'� f\SP . .* y/State/Zip Attach a copy of the workers' compensation policy declaration page(showing the policy num er 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 e coverage.verification I do hereby certify u der the and penalties of perjury that the information provided bone ' " ue and correct "_ CS attire: _. ,. Date: Phone#: Official use only. Do not write , this area,`to be completed by city or town offs 'a. City or Town: Permit/License Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electric hispecr Iumbing 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 amployee 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." r 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 filll out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)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.theDepartment 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 S1 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 (Le.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 CO=Onwealth a£Massachusetts Department of Industrial Accidents Office of Myestiga.tians �. 600 Washimgtou Street. B oston=MA 02111. Tel,#617-727-4900 axt 406 or 1-877-MASS Revised 4-24-07 Fax#617-727-7749. www.mass.gGv/dia r �. Town of Barnstable Regulatory Services Richard Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 b Fax:. 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I,_ 1 �(�_ ��I( , as Owner of the subject' l property hereby authorize E� s—F nV' E-Y to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signa /10 f Owner Date HWK C(—)ii Print Name If Property Owner is applying for permit,please complete the Homeowners License Eiemption Form on the reverse side. QAWPHLESTORWbuilding permit formAsmokecarbondetectors.doc. Revised 050412 Town of Barnstable Regulatory Services �'THE Richard V. Scali, Director Building Division Tom Perry,Building Commissioner Mesa i639. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and . to allow homeowners to engage an individual for hire who.does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the 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 form/certification for use in your community. Massachusetts -Department of public Safety Board of Building Regulations and Standards Construction Supervkor � s` License: CS-091047 ERIC STANLEY 89 BLUEBERRY A1LL} HYANNIS MA 02601 Expiration Commissioner 03/0412015 3 r Unrestricted-Buildings of any use group which. ` contain less than,35,000 cubic feet (991m3)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. + for DAS licensing information visit: www.Mass.Gov/DPS /no_ 5: c5 C-Aok Kra ..- b5 rt G ti L Cr 1 i, QQ I t� . s� YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you per to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office; 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required bylaw. DATE: a ' - �' Fill in please: APPLICANT'S YOUR NAME/S: L ✓� -��=k �� BUSINESS YOUR HOME ADDRESS: - '' S�-- A - ems,, x A 0 TELEPHONE # Home Telephone Number.�-i7")� � NAME OF CORPORATION: ` NAME OF NEW BUSINESS V .(' TYPE OF BUSINES IS THIS A HOME OCCUPATIO ? YES N ADDRESS OF BUSINESS `! MAP/PARCEL NUMBER �� (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER' FFICE This individual has been or f Arirements that pertain to this type of business. Auth ri d i na r COM NTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: