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0064 MURPHY ROAD
��� 't �' I� i I; I III ,� ,t ,, i �� i i Town of Barnstable Buildin •.` ;,Hk.' ' ..« ;,»x.•. ., fie, «u :' ,., a „ ,�` : g r v Po'st'This Card So,Thatit is<Visible From the=Street,.A ' roved Plans Must be Retained on Joband this Card Mustbe Kept a • BARNfTCAHLE. .. a 'Al � .srr.,. xgR pp. g w`� . 7". M" Posted Until FAl "JAI Has Been Made x ttrt +° Wfiere a C�ertificateofOccupanME- cy is Regwred;such Bwldmgshall Not be�Occupied.until a Final�lnspect�on hasbeen made Permit Permit No. B-20-690 Applicant Name: COSTA, MIRIAN Approvals Date Issued: 03/17/2020 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 09/17/2020 Foundation: Location: 64 MURPHY ROAD,HYANNIS Map/Lot: 309 174 Zoning District: RB Sheathing: Owner on Record: COSTA, MIRIAN ) r ,&a ryuContractor Name = Framing: 1 s Address: 64 MURPHY ROAD , z Contra for Ucense 2 HYANNIS, MA 02601 Est< Project-Cost: $5,000.00 Chimney: Description BATHROOM 15T FLOOR-KITCHEN AREA#1 n Permit Fee: . $85.00 BATHROOM-BEDROOM-CLOSET HALLWAY `STORAGE £LIVING insulation: Fee Paid u 5 85.00 AREA#2 BASEMENT-FINISHED AREA BATHROOM-S RAGE#3 Date 3/17/2020 Final: — ? BULKHEAD#4 CAM 7 R ='� z , ° Plumbing/Gas DECK#5-SIDE OF HOUSE ` � d�� Rough Plumbing: PUT PROJECT VAUE IN'!!! .x..„. Building Official .r ' Final Plumbing: Rough Gas: Project Review Req: Thermal envolope in basement must be,closed s : tt Final Gas: This permit shall be deemed abandoned and invalid unless the work authorized bythis permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application nd the approved construction documents for whichthis permit has been granted. All construction,alterations and changes of use of any building and st uRres shall be in compliance with the local zornng by Iy a�w Arid codes. Electrical This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspedbon for the entire duration of the Service: work until the completion of the same. R .. Rough: The Certificate of Occupancy will not be issued until all applicable signatures�by'the Bu lding•andAlre Officials are•provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Final: 1.Foundation or Footing 2.Sheathing Inspection Low Voltage Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Health 7.Final Inspection before Occupancy Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department Final: "Perscsrs contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). 1HE Application Number.. C).......................................... • BARNMBLE, • MASS. Permit Fee......... ...................Other Fee:....................... 03 TotalFee Paid............................................................... ...... TOWN OF BARNSTABLE Permit Approval by...u......b...................on:. .................. BUILDING PERMIT Map.......... ........................Parcel.............. APPLICATION Section 1 .— Owner's Information and Project Location Project Address (0 y MVRPt+VL Village Owners Name. S T-,+ SCANNED Owners Legal Address 11n veiv*x �0 MAR 17 1070 C A/ State-... zi,3 02 Owners Cell# 6® E-mail MSNdDk47 Section 2 —Use of Structure Use Group F-1 Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,060 cubic feet Single/Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate E] Accessory Structure E] Change of use EJ Demo/(entire structure) Finish Basement El Family/Amnesty ❑ Fire Alarm Rebuild PO'Deck Apartment ❑ Sprinkler System F-1 Addition ❑ Retaining wall EJ Solar❑ BUILDING DEPT. Renovation Pool El Insulation Other—Specify MAR 0 5 2020 Section 4 - Work Description TOWN OF BARNSTABLE 3 is A,-ey, yo r,d251ee Lwqt iindAti-d- 11 ninni R i 1 t r qj 1 Application Number............:.................................. �:... 'Section 5—Detail Cost of Proposed Construction ��. Square Footage of Project Age of Structure J Sro Dig Safe Number # Of Bedrooms Existing J Total# Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ] Plumbing ` �° ' �0._ ❑ Gas ❑ Fire Suppression Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom i Water Supply Public ❑ Private Sewage Disposal Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone I ' Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ 'No Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard y Required Proposed- Has this property had relief from the Zoning Board in the past? 0 -Yes ❑ - No ILast updated: 11/15/2018 4 Application Number........................................... Section 9 Construction Supervisor Name Telephone Number Address City State Zip License Number License Type Expiration Date Contractors Email Cell # I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. r Signature Date t Section 10 Home Improvement Contractor Name Telephone Number k Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Ezemption�, t :^ Home Owners Name: 1 (Z% _f"-ro z (20 S Tom• Telephone Number,�T 3 O- Cell or Work Number > ' I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date}` o 0 C APPLICANT SIGNATURE Signature Date Ato 0),0 Print Name 4�� Telephone Number 6"OY- 36 o-77_517 E-mail permit tort JP9 A-2.j* `O�i'i2 i P 1)9,Y ). e re,7. Last updated: 11/15/2018 A Section 12 —Department Sign-Offs 1 Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation For commercial work,please take yourplans directly to theTre departmentfor approvaL Section 13— Owner's Authorization as Owner of the subject property hereby authorize to act on my behalf, in all ; matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name Last updated: 11/15/2018 ® (.70 � BUILD ING QEpY SCANNED- MAR 0 5 2020 MAR 17 2020 TOWN OF BARNS° 44 r _.J Roo< p7Cl� gc - I Wy k,6LiUi rZ o c7l . 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V4f7.t�=l .r�r,.t_.;.r/��Y._�..-a�;� .«r c� r!"c, �-+G .d .,ri, " � �' '�°e�«�' i The Commonwealth ofMassachusefts Department of IndusiddAccidents Office of Investigations -. 600 Washington Street Boston,MA 02111 www.mass.gov/din Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): / ' /J 2 i a' S Address' 6 y I /V rz CD P✓, City/State/Zip: l� ��► S 0'I�1- ®;40 Phone#: - S?g 2 6®" 77 Are you an employer?Check the appropriate bog: Type of project(required): 1.El am a employer with-. 4. ❑ I am a general contractor and I employees(full and/or part-dine).* have hired the sub-contractors 6. []New construction 2.❑ I am a sole proprietor or partner- listed on the ached shy 7• ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance•t 9. ❑Building addition required.]. 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.01 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. tContractors that check this box must attached an additional sheet showing the name of the sub-ontractors 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 up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this,statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the lam ' and penalties of perjury that the information provided above is true and correct. Si Date: [, Q Phone#: SOP 3 a'® � 9 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-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 the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth ofMassachusetts Department of Industrial Accidents Office of lavestigatim 600 Washington Street - Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www:ram.gov/dia �-/ - �Li� � , m �- �. ;� � 6.® 7� � ! � � is ric Hyannis 5,000 10 4 Village NOTES: ' See additional height regulations in Subse Z Maximum lot coverage pertains to buildin 3 Applies to mixed use development only. 4 See also setbacks in Subsection (1) below. (1) Setbacks. (a) Maximum building setback. [1] The maximum building setbac and street side facade so that line of the street. (See Diagrarr t http://ecode360.com/printBA2043?guid=6558570 _�,�-� ���-k,�-ems Town of Barnstable Regulatory Services Richard V. Scali,Interim Director � s�tzartuaa�. X"L Building Division ►�� Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 0 Office: 508-962-4038 Fax: 508-790-6230 October 22,2013 ° Mirian Costa 64 Murphy Road Hyannis,Ma 02601 Re: Illegal Apartment Complaint Locus: 64 Murphy Rd Parcel: R309-174 Zoning: RB-Single Family Zone Dear Ms Costa, As a result of the inspection of your property last week and at your request,please find the following issues that were identified to be addressed: • Smoke/CO detectors- missing/inoperible • Internal staircase to lower level—missing1and rail/guard system • Basement bedroom—lacking proper egress(see exit order issued immediately on site) Oil tank/heating system—permit status&inspections • Bulkhead replacement structure--no permits • Lower level habitable space No permits to create habitable space(bldg/electrical and plumbing) • Lower level bathroom—no permits to create bathroom(building/electrjcal and plumbing) • No code compliance inspections for habitable space&bathroom in lower level • House divided/operating as segregated independent living spaces • Property is not registered as rental property per Health requirements • Inadequate cooking/food preparation area&storage provisions • Deficient means of egress for 20°story units Questionable access to heating It is fully anticipated that you will obtain the necessary permits as discussed during our most recent inspection. Permit applications are available in this office located at 200 Main Street,Hyannis. Staff is eek,you available to assist you with the necessary paperwork. If circumstances have changed since 1 to the re tal must inform.us in writing in order that we may arrange to close out the complaint pertaining matter. The courtesy of a reply is requested by Nov. 1,2013. ly, (; �o Rob . Ande 4 ZUnldg];,rtfo=ment Office 4 irk' `»� ., �.3�t "v Yk•Y'vz' K," }r ift �.. O r9 OFFICIAL CO Postage $ ft.l O Certified Fee �`�N N N IS A_ O Postmark i Return Receipt Fee ! /jam Here O (Endorsement Required) A 'G� O 0 N O Restricted Delivery Fee ?�! O (Endorsement Required) � Total Postage&Fees �p r,u Sent To O Street Apt E No.; orPOBoxNo.____6. —a------------------ W-2 ZI City SYafe, P+4 Certified Mail Provides: o A mailing receipt n A unique identifier for your mailpiece e A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Return Receipt maybe requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 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 return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". n 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. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 SINE ram, Town of Barnstable c Regulatory Services Richard V. Scali,Interim Director • BAMSPABLE. y MAss �* Building Division 0 Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 October 22,2013 Mirian Costa 64 Murphy Road Hyannis,Ma 02601 Re: Illegal Apartment Complaint Locus: 64 Murphy Rd Parcel: R309-174 Zoning: RB - Single Family Zone Dear Ms Costa, As a result of the inspection of your property last week and at your request,please find the following issues that were identified to be addressed: • Smoke/CO detectors- missing/inoperable • Internal staircase to lower level—missing hand rail/guard system Basement bedroom—lacking proper egress(see exit order,issued immediately on site) • Oil tank/heating system—permit status&inspections • Bulkhead replacement structure—no permits • Lower level habitable space-No permits to create habitable space(bldg/electrical and.plumbing) • Lower level bathroom—no permits to create bathroom(building/electrical and plumbing) • No code compliance inspections for habitable space&bathroom in lower level • House divided/operating as segregated independent living spaces • Property is not registered as rental property per Health requirements • Inadequate cooking/food preparation area&storage provisions • Deficient means of egress for 2°d`story units ' • Questionable access to heating It is fully anticipated that you will obtain the necessary permits as discussed during our most recent inspection. Permit applications are available in this office located at 200 Main Street,Hyannis. Staff is available to assist you with the necessary paperwork. If circumstances have changed since last week,you must inform us in writing in order that we may arrange to close out the complaint pertaining to the rental matter. The courtesy of a reply is requested by Nov. 1, 2013. v ely, Rob' C. Anders n Zoning Enforcement Office .'d'4�rs '�✓"J+i'yLdw!St'}q'. 4.Qd.�-F�in:tr„ds�;k`4eh�..rj.1'h a�-.'��+.�-s"i.Zk1:a'� ..•�`„+.r :.:+p-x�_x..'�v1V3A.w�'lia a�+'F�$:�....r.-..i,: '..mr•r.=. ;.5=. .:..,,....,.Y•...titi!' * . Y w . Town•of Barnstable oFINeRegulatory Services ti c Thomas F. Geiler,'Difector . enaxsrAB E. . - MAss; Building Division Thomas Perry, CBOT Building Commissioner 200 Main-Street, Hyannis';IVIA 02601 www.fown.barnstable.ma.us - : Office:, 508-862-4038 Fax; 5Q8-790-6230 EXITORpER DATE; LOCATION:'. M c!✓��it / ' r• UNDER THE PROVISIONS OF 780;CMR;`THE'STATE BUILDING CODE; SECTION 3400.5.1, YOU,ARE HEREBY:ORDERED TO IMMEDIATELY DISCONTINUE THE USE OF.THE.CELLAR/BASEMENT-AREA-FOR SLEEPING PURPOSES; zz LOCAL INSPECTOR'r nATURE OF�RECIPIENT` ODEM DE SAIDA DATA: . LOCALIDADE:- DE ACORDO COM O PROVISORIO 780 CMR; CODIGO,DE CONSTRUCAO DO. ESTADO,'PARAGRAFO..340015.1., VOCE ESTA ORDENADO'DE DEIXAR DE USAR;IMEDI'ATAMENTE, A AREA DOPORAO/BASEMENT PARA O .. PROPOSITO DE DORMIR INSPETOR LOCAL ASSINA•TURA DO RECIPIENTE aoosOaY�D -- Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee 1-3S o — BARNMABI s. f tom. Richard V.Scali,Interim Director 634• It10� Building Division 31OVISNUVO JO NMOi Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 SIR j 0 AM www.town.bamstabI6.mA.us Office: 508-862-4038 A&SIAL 9 � 0-6230 EXPRE S PERMIT APPLICATION - RESID O Y Not Valid without Red X-Press Imprint Map/parcel Numb 7 AI Property Address Residential Value of Work$ 7t7 Q, Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address tf- !I'f A Contractor's Name tdIW�g�4 %-/ U)!CZ Telephone Number ��®-75,�-�•3 p/ Home Improvement Contractor License#(if applicable) ®off /�.� Email: Construction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name beg) 3��5 //Av S • co ' Workman's Comp.Policy# 0 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑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: lswance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.' ***Note: Property er sign Property Ownee Letter of Permission. A copy of H Improvement Contractors License&Construction Supervisors License is required. Y--- SIGNATURE: TAKEVIN D\Building Changes\EXPOKS affleMPMS.doc Revised 061313 HOME 134'PROVEMENT CONTRACT P£.B.ASE READ THIS �1� Sold,Furnished and Tnstalled by: Branch•Natne:Borneo Dlorlh&South Date:qIa�_ THD At-Home Servicca -1 _ d/h/a ThcHome Depot At-HomeS�r��' (fir Branch Number:31 and 33 VM Boom Turnpike,Unit 1,Shrt:wsbury,MA QI `° lr. Toll Fro:977-903-3768 �� Federal iD#75-2698W,,ME LIc#C 92419;Ri Cait.Llc#16427'. / CT Lic CHiC.0565522,MA Home Tmpnwement Contractor Reg,#1.2&kh CqIns4diationAddress. !"Lt)fi - Matz; 3Zip . Ciy ll Pie s): work Phones Home P_hone: Cell Phon Hone A ((f different from lna nitation Address) City State %p E-resit Address(to receive project communications and Home:Depot updates): ❑1 DO NOT wish to receive any marketing cmails front The Home Depot Protect 1Dfortmdon Undersigned("Customer"),the-owners of the property located M the above installation address,agrees to hny; and THD At-Home•Services,Tnc.("The Rome Depot")agrees to Furnish,deliver and arrange for the installation("instaUatioa"•).of all materials described on.the below and on the referenced Spa;Shcet(s),all of which are incorporated into this Contract by.this.. referent,along with any.rlppliCahte Slate Supplement and Payment Summary attachodhereto and any Change Dtdei5(collectively; "Contract")c ,lob#: uftmaiadumo Prodnew flivoc Shp"# Project Amount Rooting 06iding Ll Windows U Insulation ❑Gutters/Covers ❑ray t ❑__.. Roa5ng LJSiding 11 Windows 11 Tmsuladon ❑Guttari/Cove.❑Entry Dom El $ R_m__Tng Siding LJ Windows L1 Insulation g.....�, ❑Gutters/Coved ❑Entry Dom-❑ ❑Roofing+[).Siding LJ Windowx Ll I n lotion OGutters/Covers ❑Entry Dntus ❑ '$ Minimum 2g%Depuait of CoWM Amvaot due W=e:readim c &b conbut Total Contract Amami $ MWnepur :s may not depudtttmretbamane�do€the Cantrac4:Aatat� Caetompr agrees that, immediately upon completion of the work for each Product,Cmiamer will cza:utr:a Completion CeTti.f1 e (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer undo this Contract agrees to be•jointly and severally obiigated and liable hereunder_ -The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at Its discretion,if The Home Depot or its authuritai service pnwitlar dote rinine s that it anno perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing,errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary# L B j 7 ` ,included as part of.this Contract, sets lirfth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). N077CF TO CUSTOMER You are entitled to a completely fitted-in copy or the Contract at the time you sign. Do not sign a Cam oet£on Certaficate.(nole: ftrc is-9wCommpletiou:Certlficltte for each listed Product:as denied by Individual Spec Sheets)before work on that'Product is complete, hn the event of termination of this Contract;Customer agrees In pay The Home Depot the costs of materials,labor,•ealteam anti services provided by The Home Depot nr AuthorizedServiet Provider through thR date of terDtilta&M-phm any other amounts that forth in this Agreement or allowed trader applicable jaw.:THE HOME DEPOT MAY WrrKHOLD AMOUNTS OWED TO THF-HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMiTING THE HOME DFPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. ��sad Autlig.rWation: Cartamer agrees and undentands that ails Ag=mmt is the ewire.agreem met betweeal Customer an borne Depot with regard to the Products and Tni,mllation services and supersedes all prior discussions and agreements,either: oral cs written,relating to said Products and Installation.This Agmeme nt.canno t tie amigiied•or amended except by a writinged by Custumet and The Home Depot.Customer acimowledges and agrees that C hstomer has read,understands,voluntarily the terms cf and has r •ived a of this Agreement. y x y d I� �V Cust Sy Date Sales ' xultant's ra a Date . l5 Telephone Nn 9 i i Cast errs Signature Date Sales Consultant License No. _ CC NCELLAT[ON.- CUSTOMER MAY CANCEL THIS (es applicuble) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DFUVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFrhR SIGNING THUS AGREEMENT. THE . STATE SUP#q EMIwr ATTACH IUMM CONTAINS ' A FORM TO I= IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTI(_'rt AD1)1770NAL TF.RMB AND CONDITIONS ARE STATED ON TSE REVERM SmE AND ARE PART OF THIS CONTRA(-r 10-23.14 While;'Branch File YelloW—Customer Tel 41cP-T:ZT TTOZ 02 1LZZZ9£80S: 'ON XtUA pie6wef: Wo7 u The Coatenoa>weam of Marsaehusew Dot afIndusrisalAe deny Offs=of Invions 600 Washingtat,Street Bost6s4 MA 02111 wrvw.trsassgov/dia Workers'Compensation insaraitee Affidavit: Sanders/Contractors/EEectriiciaaslP[nmbers . tscant Infortoa: P( 'Print Ia�e(Bc�atesslOrgaooa/Enciividuat): L��S Address: Z CrtydStatWMP: Phone#: rJ 0-T-- (0oZ-" 69j 2- Are you aa.emploW.Checktbe appir"riste 4. I am a Type of N'ofect(�P '� . 1.❑ I am a einpbycr with ❑ t� add I eavlayces(full�oTpw-time).* have hired the: p New coon 2.� I am a sole or partner, bsted an the attached sheet. 7. R nwdelmg slip and have no=aploy+ees . These sub-canuzc=have L p Demolition woAdug for me in any c gxcity. cmpm3rees Noid have wad wal [No workers'may.insMM c comp.ft sm-db'c.t 9. 0 Budding add ]- 5. We a=e a: 1013,Eketricd 3.❑ I am a houmwm doing an work offi have emmcind d3eir I I.p Phtmi i repass or mySCK[No wad='COW. rWtof exemption pw MCIL Durance raqvire&]t a 152,§1(4), and we have no employers.[No wanness' 13.[D Other camp.kannanoce rcqnht&) �l +sgpfr t !(�miac—u�ao�iiaa s n�'—$dow�Oa+agrhrir.aaimsCMXPCW=WPQWi ......... --.. T Iw�tSrs main.submit tf�s.afft8mriting-lheYaudmeg-a9.svaricaosd Seca�e waaae�sa�t md�sea ww vue�di�sx� ZContrarsots aoatd&t a box mzt wiclod m ad"waL dea A wving floe--aftesubcomromm and am w hed=or�tdmse ensitiea Env: employees. If tls: bsveeugtloyees,dtey muaspmwide floes w+oaioess'comp,poiiryaatm6s. , . mat as"Wioyer that isP VW*nz worirets'aompenw on Msursum for xv MPtoyees. Mdow is the padicy wad jab the informatiost. bn=m ce C ampaW Nm= Pommy 4 os,Self->a� - Job Sit-Addraw. Attach a we of the workers'compensation poCtry declaration.page(showing the poky number and expiredfon dat4 Farbae fa sedan coverage as required and Section 25A of MGL c. 152 can kad to the itnposition of Mimintl penalties of a fray up to S 1,SOO.00 and/or one-year imprisammcot,as well as Civil penaltes in a form of a MW WORK ORDER and a fore Of nP to SM-00 a day against fbc vioiator. Be advised that a copy of this staftmwt.may 6c,fort/ xo 9os.Dffrsx.of busimtkys of the a covtM vetificeton I do amrthe Pdfia*fPzVm7t1m Me=jbrna6m-lroWded above istrue and correct m# use urn no write in fiwr mum,to by co or town-opkial C1ty or Town: Fermiumeemse Issuing Authority(circle one): 1.Board of Heap 2.Building Departmeat 3.City/Town Clerk 4.Metrical.Inspector &Plumbing Inspector C Other Contact Person: Phone#: The Commonwealth of Massachuselts Department of Industrial Accidents O_rice of Investigations "0)Washington Street Boston,MA 02111 www mass.govldia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AQalicant Information Please Print Legibly Name(Business/OrganizWon/Individual): Nome, bepol W",e_ e__s Address:— City/State/Zip:. s v o/Sy5- Phone#: Ar you an employer?Check the appropriate box: Type of project(required): I.UJ 1 am a employer with 4• m a.general contractor and I 6. ❑New construction employees(full and/orpart-ttme).s` have hired the sub-contractors .El am a sole proprietor or partner- listed on the.attached sheet t ? ❑:Remodeling- ship and have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity: workers'comp.insurance: g. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11 ❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance.required.]t employees.[No workers' 13. Other�E-Spec comp.insurance required.] 'Any applicant that checks box#1 must also fill out The section below.showing their workeas'compensation policy:mfonnation. t Homeowners who submit this dRdwit indicact®g they ale doing all work and then hire outside contractors nu t submit a new a>i&WM indicating such: ;Contraam that check this box num attached an additional shedshowing the mate of the sub-contras and dm workers'comp.policy information. I am an employer that ds providing workers'rompensadon insurance for my employees. Below is the policy and Job site information. � /n� 5 . �o , Insurance Company Name: �/Policy#or Self-ins.Lic.#: C.- 0 / 3 3 Expiration Date: 3 Zo Dl/ Job Site Address: P A4.1City/State/Zip: /`t S Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal.penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in.the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a.copy of this statement may be forwarded to the Office of Investigations of the D f�nsurance coverage verification. I do hereby certify et pa and ofperivy that the information provided. Is pare and correct. Signature: // Date: � / Phone#: (O ��- Ufflcdai use only. Do not write in this area,to be compleW by d&or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building I)epartment 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other . Contact Person: Phone M C V _ Office of Consurne d f- J. 1 _r s end usluess Regulation .: 10 Pair Plaza- Suite 5170 P 0s ton, �assachusetts OZ 116 me Improve-Tnent Contractor Registration Registration: 126893 I HD AT HOME SERVICES INC. - Type: $eAplement Card FINDREW SWEET - Expiration: 8WO16 2690 CUMeERLAND PARKWAY ATL ANTA, GA 30339 (} . SC.I Update Address and return card-itlarlt reason for Address r-hnnga i` i R i Employment f� Lost Card Oflice of Consumer Affairs&Business Regulation � 4 License or registration valid for individut use onl 'riOME IMPROVEMENT CONTRACTOR y =�r before the expiration date. If found return to: ` Registration; 12689.3 Office of Consumer Affairs and Business Regulation Expiratiow.:8l3/201.6 . eat 10 Park Plaza-Suite 5190 THD AT HOME SERVICES,INC. Supplement Gard Boston,MA 02116 THE HOME DEPOT AT'HOME SERVICES ANDREW SWEET 2690 CUMBERLAND PARKWAY S Q„ A2 ABM,GA 30339 ---- Undersecretary N I wit t signature ` ,r A6� 241201 02 5 4PL01 V CERTIFICATE OF LIABILITY INSURANCE °0' °°'Y'"Y' `� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MARSH USA,INC. NAME: TWO ALLIANCE CENTER PHONE FAX No): 3560 LENOX ROAD,SUITE 2400 EMAIL ATLANTA.GA 30326 ADDRESS' INSURERS AFFORDING COVERAGE NAIC# 100492-HomeD-GAW-15-16 INSURER A-Steadfast Insurance Company 26387 INSURED IN :Zurich American Insurance Co 16535 THD AT-HOME SERVICES,INC.DBA THE HOME DEPOT AT-HOME SERVICES INSURER C New Hampshire Ins Co 23841 2690 CUMBERLAND PARKWAY,SUITE 300 INSURER D:Illinois National Insurance Company 23817 ATLANTA,GA 30339 INSURER E' �l INSURER F- COVERAGES CERTIFICATE NUMBER: ATL-003242685-09 REVISION NUMBER:7 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSION_S AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLIDY EFF POLICY MtWOD EXP LIMITS A GENERAL LIABILITY GLO4887714-05 _ 03/01/2015 03/01/2016 EACH OCCURRENCE $ 9.000.000 X COMMERCIAL GENERAL LIABILITY —UA—MAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 CLAIMS-MADE a OCCUR LIMITS OF POLICY XS MED EXP(Any one person) $ EXCLUDED OF SIR:$1 M PER OCC PERSONAL&ADV INJURY $ 9,000.000 GENERAL AGGREGATE $ 9,000.000 G XEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 9,000,0070 JECT POLICY PRO- LOC $ B AUTOMOBILE LIABILITY BAP 2938863-12 03/0112015 03/01/2016 COMBINED SINGLE LIMIT 1000 000 Ea accident _ $ X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) $ AUTOS. AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per acadent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ C WORKERS COMPENSATION WC017731493 (AOS) 03/01/2015 03101/20— X WC STATU- oTH- AND EMPLOYERS'LIABILITY TORY LI TS R O ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WC017731495(AK,KY,NH,NJ,VT) 03101/2015 03/01/2016 1,000,000 D OFFICE MBER NH)EXCLUDED? E N/A WC017731494{FL} 03/01/2015 03/01/2016 E.L EACH ACCIDENT $ 1000 000 (Mandato E.L.DISEASE-EA EMPLOYE $ If yes,describe under a Conifnued on Additional Pa 1,000,000 DESCRIPTION OF OPERATIONS below 9 E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc Manashi Mukhedee 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD OD a 0 IV O P O • J � O tt) a A. 6'a,,, ense or registration valid for X Otte a of ConsumcrAgial sines Begs a z before the ex iration __, urn to: at Homaim cmarsAn - - _ Ice of Ctinsu fairs and Business Regulation r __ _ _ do 10 Registra 3 Type' • Par. Expiration: .5 DBA n,MA 02116 cc do WA vs SiDWG'GO. WALDEMAR PAKA6FIROW,.10 11 MAIN ST. " �`•;:. _ AUBURN,MA 01501 {c;:m:`--- undirsecrefory a �. O N Massachusetts •Department of Public Safety Board of Building Regulations and Standards Cunstructij>u Suporvisor Specialty h O License:CSSL-101315 CO WALDEMAR PAR". CZ'% o 246 iypLLVtMV$T 1151 S yi , m Auburn MA 0150t, =::t� a' o CO Expiration a O. 1012912016 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ;T Map t V Parcel --f Permit# O 5 Health Division Date Issued 95 �7�02 Conservation Division A� 0 --_ Application Fee Tax Collector ��_ Permit Fee Treasurer -® AtTLICAIvi1 NIUS7`Ut l'AiA Planning Dept. CONNECTION PERMIT FROM THE ENGINEERING DIVISION MOR TO Date Definitive Plan Approved by Planning Board CONSTRUCTION. Historic-OKH Preservation/Hyannis Project Street Address Mora Village Ownerk eta n Address Telephone J 5— --7 Permit Request �i r1 S , Gr k>•e- - !q f'O(-A Y\ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 17. (x�c� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting dodumentati'. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) CD -n Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highw y: ❑Ye C�No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other c� �'- 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 �{� BUILDER INFORMATION Name �nor_— IV�t60� k Xt0i Telephone Number s ��l d�C C 64 Address 6� 6 .0 6 r*] R() - License# 02-Co 01 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 7 - / 5` a FOR OFFICIAL USE ONLY j . a i r � - PERMIT NO. DATE ISSUED - MAP/PARCEL'N6:.1' l ADDRESS < VILLAGE OWNER DATE OF INSPECTION FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH `' FINAL 7 FINAL BUILDING DATE LOS�D OUT- �= ASSOCIATION PLAN NO. fv i r . 1 -- . The Commonwealth of Massachusetts nx :-- _ . Department of Industrial Accidents . . . - Office of/naestig►at/ons . - - , _ 600 Washington Street ---c, . Boston,Mass. 02111 ' Workers' Com ensation Insurance davit . —�- name: ► 0: 'O C. !�__ . . location: I -, M v I /-J . . . .. ci �0 hone# • �G•''-���c-. ' I am a homeowner performing all work myself . � - ❑ I am a sole r rietor and have no one worlds in ca ac�ty %/%%%////%%%%%%//G/%%%%%%/G�%%%%%/%%%%%/%%%/%%%%%%%% %O%%%/%/%%%%O�%��/////O%%%%%%%%%%%/%%%�%%%�%��%%%%�%%%/�%��%%%%%%/ ❑ I am an employer providing workers' compensation for my employees working on this job.:: :::: :,:•,.:•..,..,,,,,,•:::.,•:: .:.::::::::.:..:.....:::::::::::::::I.::::::.::::::::::.: .. :coa�aanv:name-:»...:<:::>;:<::- >:......::: :. :.:::::.,_::xw::___: :' :: ::.;;:.:>:-;>{;.;'.:;:<:;.;:.;'::>: r SS ': ':.' ? <`2`' '`''j`` ?...... ` 'y <` <' ? ` ` 2>?'°?'<`%5 ?Y> <f ?`�' �<`: s >'}<` >5 ``<t>` °<� `{fi '� {``` >s<'`" ;:. 1. ad 1-1111111-1 <, <: <,/:� �Et'surance. ........ %/ ❑ I.am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have . 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'.. 5::::."I" ;.!:;:::�'::' �� Fafiure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or . one years'imprisonment as well as civil penalties in the form of a STOP.WORK ORDER'and a fine of$100.00 a day against me. I understand that s copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification - I do hereby certi nder the sins-andPenalties-of-perjury that-the-information-proWded-abnveaslr_ue-and-cotrecG___. __.—_... Date ,�° Cc� r1 Signature o - r Print nameI. �i'1 � I �' Phone# .. � °1��(17-$� - i' ...- official use only do not write in this area to be comple:by or town official . city or town: •1 permit/license# OBuilding Department .. OLicensing Board ❑check if immediate response is required ❑Selectmen's Office . , _011ealth Deparhnentcontact person: hone#; ❑Other (�Cti 9/95 PJA) I Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is.defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the-legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner.of a - w 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 groiiuds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the' commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation ands supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law of if you are required,to obtam.a workers compensation policy,please cO the Department at'the number listed below:. City or Towns - Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottomVof the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please, . ,... . .. ,.._._ _ _ ._ .�; be sure to fill in the.permit/hcense number which willbe used as a reference numtier..The affidavits may lie'returned to the Departnieirt b <`itiaiT of FAX unless other arrangements have been made: - The Office of Investigations would like to thank you in advance for you cooperation and should you have any_questions. . please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigauans 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 t ' °FIMEr Town of Barnstable Regulatory Services 1ARNSrABM ' Thomas F.Geiler,Director 9 MASS. g `bArEoyg.�a`` Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date + AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: n S=Bn Estimated Cost 17 vpc>, O� J rAddress of Work: to ni v P, r S /9— ©az(p CC Owner's Name: ! J e. -e r Date of Application: 5 ' I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑B ilding not owner-occupied wner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. J— Date Owner's Name Q:forms:homeaffidav The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION ^� Please Print DATE: ��• of JOB LOCATION: number street p village "HOMEOWNER': ,?— -7 0 (' name home phone# work phone# CURRENT MAILING ADDRESS: city/town I 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 acceptab•a 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 proc ores and re uirements. Signature 010me6wner 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 fonn/certifrcation for use in your community. Q:FORMS:EXEMPTN Jul 15 02 10: 47p RMBRSSRDOR 7814400426 p. 2 Regal D uchess SPECIFICATfONS AND FEATURES _ = 367"x 21' Overall 15'.x 30'SwimArea 17'6" Q-D. Aluminum Patio Deck Color coordinated in azure blue and white Ail aluminum construction Virtually maintenance free Aluminum walk-around deck surrounds entire pool Aluminum safety fence with privacy panels Heavy extruded:aluminum vertical pool supports aluminum sidewalls that never need painting Vtnyf acrylic finish In-wall automatic skimmer Self-locking aluminum exterior ladder _ - 20 au e-vin. I liner-Terrazzo 9 g .Y e azzo Design bottom Space Age water purification system 30=year transferrable limited factory warranty The Space Age Swimming Pool Filter A TOTALLY NON -CORROSIVE FILTRATION SYSTEM The new Regal Duchess filter system is the key to a clean sparkling pool, day after day. It sets a new standard of per- formance in home filtration, offering features previously found only in commercial systems. • Permanent media sand filter • 2,100 gallons per hour filter capacity • National Sanitation Foundation 20 •' `_ Testing Laboratory approved ; ,;,. • Fiberglass reinforced tank-completely corrosion resistant • Easy to clean strainer pot for maximum - pump protection r • Fingertip control, 6 position multi-port valve " `-` • Filter and 1 h.p, motor and pump assembled on non-corrosive base rFa=-• •- The Regal Duchess Water Purification System cleans pools fast; removes even the most minute particles the first time through. Filter and pump work together in perfect balance. NOTE:not all symbols will appear on a map GOLF COURSE FAIRWAY ••. •• 309 YY;vv ` EDGE Of DECIDUOUS TREES MA - EDGE OF BRUSH ORCHARD OR NURSERY ,._L C° F EDGE OF CONIFEROUS TREES 15 _ MARSH AREA f ��bsyLCS EDGE OF WATER � CD MAP 3O9 ��t�_..� DIRT ROAD.:. •, ___= DRIVEWAY �—PARKING LOT 17 E�PAVED ROAD — = DRAINAGE DITCH AP 309 MAP�]309 v •. •• C� � � ; PARCEL INEI** / J 5 4 MAP,I0 �MAP# A 21 E PARCEL NUMBER 4 r,�---"`"��� #1e60 E HOUSE NUMBER — ----- 2 FOOT CONTOUR LINE 1 —FB— 10 FOOT CONTOUR LINE r Elevation based on NGVD29 /4.9 SPOT ELEVATION STONE WALL FENCE ® AlRETAINING WALL RAIL ROAD TRACK STONE JETTY SWIMMING POOL PORCH/DECK 0 BUILDING/STRUCTURE L DOCK/PIER P 309 Q HYDRANT /� e VALVE O MANHOLE /1 17 C o POST p" FLAG POLE T O. W N O F B A R N S T A B L E G E O G R A P H I C I N F O R M A T I O N S Y S T E M S U N I T .a SIGN ® STORMORAIN N PRINTED SCALE:IN FEET *NOTE:This mop is an enlargement of a [d-7fo The parcel lines are only graphic representations DATA SOURCES: Planimehics(man-made features)were interpreted from 1995 aerial photographs by The James 1"=100'swle map and may NOT meet ty boundaries.They are not hue locations,and W.Sewall Company.Topography and vegetation were interpreted hom 1989 aeriol photographs by GEOD UTILITY POLE n TOWER " ` Q 20 40 National Ma Accuracy Standards at this resent actual relationships to physical objects Cor oration. Planimetria,topography,and vegetation were mapped to meet National Ma Accuracy Standards W f:\dgn\conservation.dgn 07/16/02 11:18:57 AM J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel W Application # -/ Health Division Date Issued Z -Z7- Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street ddress ILP Villa 9 OwnerSJ ' � Address Telephone ��� -36�� ���� Permit Re uest I �/(� / ✓r�u ✓ i��l I�60 G�iCiZC '�� `7' ' 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 O/ 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�_4 Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count! � l Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other (XI Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove❑Yo ❑ No n� Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing YTew Ike_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes id No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ! Telephone Number Address �/ � �(�� YL�� License Home Improvement Contractor# 5 6 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1~ �4 kvAkn SIGNATURE DATE i • ,j r FOR'OFFICIAL USE ONLY APPLICATION# g DATE-ISSUED MAP/PARCEL NO. t ADDRESS VILLAGE OWNER J 1 DATE OF INSPECTION: 0AFO.UNDATIONIN?f r{WA-U_ uPefQc FRAME - - - - - - - -;;INSULATION: { FIREPLACE ELECTRICAL:. ,_ROUGH FINAL ,r PLUMBING: ROUGH FINAL x. GAS: ROUGH FINAL FINAL BUILDING.- a-"= .} DATE CLOSED.OUT ASSOCIATION PLAN NO. s ' Massachusetts -Department of Public Safety Board of Building Regulations and Standards i 'Construction Supervisor License: CS-100988 r, HENRY C CASS110 ! 8 SHE4 D ROW -+° r `:l,l� WEST YARMOLFFH '}Q?6Z _ Expiration Commissioner 11/11/2015 m I "r- - I , I I � I 0. L I.�.� U I. COrltiLl Ile I, AfLIll'S C11.ld 13LISIII eSS Rt.t,U Lltt•Q[l Bostoll, Massadhusctts 02116 L-I Improvemem Contractor 11\,eglstrahorl h@(ilSlf�lllUl1: 153:i(i 7 l vl)e: I vivatk- Cc.iI p o I z(tiull k.xplralian: 12/'la/;"'DI<t TI 21au�1 I"OF) INSULATION, INC i I�I..tAI )1 ON C.IR .:1._.t ! 'r,mothNI0U'l-H, MA 02664 Uptlatc Address and i c(lorn crlrtl. Mall. I cusull (III . 1.1 ,-lrlclress L I R��ucw,ll � .I 1!;nitlloynlanl I I I.uv(:ilrll ..I"..uu',�r�.1t1111-S 1, 1;uSinl lS lie(�ulUll/lu t..IiCIISI'ul relisinitioll villltl )or iildilvillul loc (inl)' i.;Y,II:Pnr tvlh'h(UVl:.l91: N'f CON f KACTOh hrlurc the c.epira[iun tl;nc, if found rowl'll to; 1 , IF'rft�i•,I:�n;tn,n "�:1'7Ci7 ' Type: l)IliceofCunsun+crAffairsunclLiusiucsskc ulul.iou . t, b FII IVdle l:orpurallol lU Par{ I'laziL-Suite 517U ' liuswn,CIA U?I lti is 1tN. INC, t i Ilnticl sl^rrcWrp of V;ll 1Yi1110 t u;rl 'rc The Commonwealth of lVassachusetts P _ Departtrrent of Industrial Accidents r Ojfice of Investigations 600 Washington Street Boston, MA 02111 www.mrass.gov/dia l Workers' Compensation Insurance Affidavit: builder•s/CoutractorsMeetricians/ lunibers ;ti „9at::atrr Itaforr�uatit�ra / �'�ealse P'ri.rrt �.,e ibi N'amc (busmess./Org"i:cabo(/lndividua!): f ��' c� G( /�/�y /' ./ I Phone 0 6 7,7_� J 2 % Z71— Vic you met eulployer, Check the appropriate box: p y [� I am a general coatractar and I Type a t pra�e�t (reiyulred): 4, l. . _.l aru a Stu to er with. _ cmP Y lu ccs (hill ancJ,tot part_iime)•* have hired the sub-contractors Fj New construction U I mil a sole proprietor or partner- listed on the attached sheet 7. � Rcmodt:ling ' ,hip and have no employees These sub-contractors have $. E] Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp, insurance.t 9. [' Building addition tryuired:] 5. [] We area corporation and its 10.❑ Electrical repairs or a:Mtious I ani a homeowner doing all work officers have exercised their 4.1..❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL _ 12,[] Roof repairs insurance rcquircd,] .t c. 152, §1(4), and we have no _ 3a. I urn u homeowner acting as lr employees. [No workers' 131,9'Uther Sandal contractor(re:fcr to #-+) comp,insurance required j 'A,ty applicant taut chccJcs box*1 must also fill out the 3actioa below showing their workers'co t Humcowucrs who subruit this affidavit indicating they arc doing all woiic and then hire outside eo�ntrac ors must a new affidavit indicating such. Cuuuuitura that chuck this box must attached an additional sheet showing the name of the sub-coua-awtots and state whether or not those entities have cut plu c t Y cy. It the rub-<onuxu:tors hove employees,they must provide their workers'comp,policy num6cr. 1 ttm rw employer that is providing workers'eomtpensation insurance for my employees. below is the policy and job site infurmttpurt, _ lusuraalcc Cotuptnay Name: Policy rf or Self=ins. Lic. #: vG. i / Expiration Date: 1 �/�,�✓ Job Site.ladrt ss: _ CityiStatelz p: Att:,ehr copyrvur of the k erst cotn�pensattiou polIcy-declaration page(showing the policy ntruutber and expiration elate). Failure to soourc,covcragc as required under Section 25A of IvIGL c. 152 can lead to the imposition of criminal penalties of a rinc up to b 1,500.00 and/or one-year,innprisonment, as well as civil peaaltic's in 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 OfFictr of tnvestisatiow of Elie DIA for irl.nuance coverage verification. 1 ttv hereby eartify, nder the 0' knd penalties'of perjury that the information provraled ab ve is trcrc and cornett Fl u,Tc only, Do not write inn this area, to be completed by city or town official l'uwty: Permit/Licens'e Authority (circle one): d of Health 2, Build.Ing Depturttnent 3. City/Towu Clerk 4.Electrical Inspector .5. Plumbing Inspector ruutucE E'eno,z:� phone#: _ _ 1 1 CI.1PF-COD-27 M1'OUNG 1z r>- CERTIFICATE ���yy-�^tl -y- LIABILITY �g y -y-v INSURANCE unlr(mmrnurrYrvl l 7I812013 IHI5 OLIO IFICA'I E IS ISSUL=0 AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS Uii-3ON THE CERTIFICATE I-IOLDER.TFIIS CLRTIFICAI'1= DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES IJLLOVV. TIIIS CERTIFICATI OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INS6RER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE:CERTIFICATE HOLDER, INWORTAN l: If holder is an ADDITIONAL INSURED,the policy(ies)must ba endorsad. If SUliROGAl'ION IS VVAIVLD,seuiuctlo w forms anu c,ondifions of thU policy, Certain policies may require an ondoreaolent. A statement on thia certificate does not contur rights to the rt;I(ihcatu 1101der in lieu of such iandorsarnan[(s�. ... . - _ - ------ -. ...-- Ll.:r n,c M PC-614062 N°n,Tncr Margaret Yowtg GI.Iy Imiurancu Agwicy,-Inc. FHONk —�- --._._ IhAT, ----- k:W Rio 1'J4 AIC i5ouul Dennlo,IVIA 021660 E•MaIL ADDREss: IN5URER S AFFORDING GOVISrtAGt_ NnICU ...—__.__—.-..__L�_._._....._...._....-.__...................._.__.-..._..... ..._. _..__............._.._.__...._,.______T ___ wsuaERa;PEERLESS INSURANCE COMPANY. Nsuma;COMMERCI INSURANCE COIVIIaANY L:,tpu GC)d II'ISLIIati6ll, InC. INSURERC:Evans tort Insural1CC CoI'np lly .. 'IU Rcardon Circle uvsuReRD.:ATLANTIC CHARTER.INSURANCE GROUP :iouth Yarn101,4(11, IVIA 0'=664 NSURERe: INSURER IF .CER-fll'ICATE NUMBER: REVISION NUIVIBE1 : (;fj-�IIFY THAT T IAE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO TO THE.:INSURED NAMED A13OVE FOR THE POLIO I'LR100 ImIIWAIL:I) NOI'VVITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHERDOCUMENI-VVI1lIRLSPF.CI'IOWHICIITIilS �.::rrtlr n;Att MAY GE.ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEq.BY THE POLICIES DESCRIBED HEREIN IS-SUBJE CT TO ALL IHE TER0, I nkAA.I,,I0N;1 AND C(DNQlTIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _..__.__..T...- I'r^ AbITCBUOfi Pd�C1�E6 POLICY Y-iNt I-1 O-INSUFAN4E - POLICY NUhtfi ER LIMI1�A MIO 1Y 1Y LACI-1 OC.CURRLINICE 1 1,ODU,U00 hAMAGF T0'RGN fED A X CUnlnaNu laL U6NERALLIAUILII'Y` CkiPS263063 41112U13' 41112014 NREMISESIISr�ocitt�n�1. b 100,00 c t nlNt�MAot I X:I OCCUR MLU kxN(AnY_enu Ilorw�nl. § ... 5 UOU { I PERSONAL�k AL)V INJURY- b - l DDD DDD GENERAL AGC3RCGAIk q 'ODO,000 _.._ 2,000,000 r.I'il n��tdU l,A It UMI r APPLIESPLhl -. - 'RODUC75-COMP1Ot°Alil. b - _ --_� I 1 PRO- I I rin,t 1'I . . )ILII-�L__ COMBINE(TSI GIC^L1MIY ....b_. )I AN AI.I It411Aau.i1Y` 13MMBCKVMK -41'1/20'13 41'1120'14 DQDILYINJURYPaI ulaon I,OUQ000 l P ) AU OWNLI-) QODILY INJURYleer ecclJQnt) b wru _X,.•, Autos FrftOPE.TYI7�MAGE_.___ NON-OWNlc0 X i A hINI-1.1 All iC)S I \ R OCC uh uwu. A 1_IHti I ACti URL NCC X C)C:CUt� _._..__ crc Csn uAU XONJ453512 4/112013 4/1/20'I4 AGOrtGGATE b i,00U,0U X raltNnctN ' 10000 -� vs0A11j_ L b i tt I _ x Oil )i tit �.QMI'kNSITYrUN - � � AND thlr'1UYERti'L.IA01"1'Y - -; �'L' �' 1) I.,ro rr«n`rtlt;lut<wAlRINt wExtCullvE -YI .. WCA00525904 6/3012013 .6I30120'14 E.L EACHACCIDt_N1 b __ cnrmIEA1F1Eli E\CLuuGCr� N r A IManda(ury In NH) E.L..OISEASE-EA.kNIPI.OYLI- I v:dv:�uw unUgr .L.I�ISEA9l- ROLII,YLIMIT Ih MI'l ON OF ON�I<Fl I IC11VC�diuw _ .—.._ ur:,.mI•rn:n ili uncNA�110NS f 1_gl.A I TUNS/VEh11CL.GS (Attach ACORD iQt,Agdiuon>I Run:prht SchcC lo,If mora>Pa'o Ls rayulr��Il� �.�---'_•, -�-~- -- _ Comp-nsation Includoh Officurs or Proprietors. _ l IAutnR:h,tl INauiULI status l5 providud under the General Liability when squired by written contract or agreemant with the Certificate HOW01. .__........_. _.__—.___ i:cR I IFICA I E. HOLUEI; CANCELLATION ........... ....._.._ .__.. SHOULD ANY OF THE ABOVE DESCRIGlEO POLICIES WE CANCGLLLD OEFORE L,a Ju Cod illsillzltion, I THE EXPIRATION DATI: THI:RCOF .-NOTICE: WILT. t'iL= DELIVERED IN l ACCORDANCE WITH THE POLICY PRQV15(ONS. - � - � AUTIIORIZEQ_RkPRGSkNI'A1'IVLT�-__,..._ I ._..........__..._....................... __:.__._.____--.__—.- (D'1988-20'10 ACORD CORPORATION: All rights reserved: AC L)NO 25("01 L/05) The ACORD name and logo aro registered marks of ACORD- Housing Assistance Corporation Cape Cod HOME OWNER WEATHERIZATION WORK PERMIT &,FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM 1F YOU ARE ,THE APPLICANT HOME OWNER. F`A'i'> �� -O S'r q hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation (herein after referred as"Agency') on the property located at: /79 d+J$ f✓.r'P i � ,�- /""� ,,fit. �7�,��,C� � — The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping &caulking of windows and doors, insulation of attics, sidewalls& basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the"Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed.. I have read the provisions of this agreem as listed ly give my consent. Home Owner: (Signature) Date: Agent: (signature) — — Date: HAC approved W eatherization Company : CIN�, All Cape E rgy Cape Cod Insulatio Cape Save Efficient Buildings,LLC Frontier Energy. So u: o r& Sons Resolution Energy - To Robin C t nderson: ` Ref: Inspect on at 64 Murphy Road for the complaint of: questionable access to heating NOT for Illegal A• ►artment Complaint Addressing i :em: Item- 1, 2- resolved :batteries changed.There is a hand rail on the right side of the stairs and a guard/rail o i left side. t Item 3-The -e IS NOT bedroom in basement-was a bed set up BUT IS already removed', as asked by inspector s Item 4-Arr ngement/Plans and proposal are working with National Grid to convert to Natural Gas -Oil tank/hi ating working properly Item 5-Bull:head-in process of getting the properly inspection by the building department-got application Ind paper work and specifications to be filled and,submit _ Item-6, 7, , 11-We declared that is NOT any intent to the-lower lever be a living space. Furniture that is there belongs to my daughter that divorced and moved back with us in k'nuary- Furniture WILL be out to her new home in MARCH/2014 when she will move out. Bathroom (I_.)wer level)WAS build BEFORE we bought the property and probably inspected by ` then. Item9, 10, :11-We don't have ANY intentions to continuing have roommates. -The person/roommate Bessi, will leave/move out,for sure,on November 30th -John,the other roommate,was got in surprise, he no have any place to go now -will be(oohing for place and ask'us for time until at least middle of December. He also WILL moving out as soon as .he can get i''l place. -at the day of inspections they already paid the.current month and last month Item 13- Mts Robin C Anderson-attested to us, at the end of inspection,that Mr O'Connor told her that-this,matter DO NOT proceed Old he observed that there WAS NOT.question about access to heating.The person/rooiinmate Bessi has a Thermostat in her roam and can access it,anytime she wants Rental mattar:We would ask to have the ai time given to the roommates,as they requested appropriafi,,Itime to move out,when the property can be re-inspected and this case/matter close. Town of Barnstable s, Regulatory Services Richard V.Scali,Interim Director MAM cc.!, `• Building Division Tom Perry,Building Commissioner - 200 Main Street,Hyannis,MA 02601 Office: 508-8i'2-4038 Fax: 508-790-6230 October 22,2,Ci 13 Mirian Costa 64 Murphy W_Jad Hyannis,Ma::02601 Re: Illegal Apartment Complaint Locus: 64 Murphy Rd Parcel: R309-174 Zoning: RB-Single Family Zone k Dear Ms Costa, _ As a result of the inspection of your property last week and at your request,please find the following issues that we-re identified to be addressed: k d o Smoke/CO detectors- missing/inoperable i �cZ, • Internal staircase to lower level—missing hand rail/guard system Z e Baseanent bedroom—lacking proper egress(see exit order issued immediately on site) 4 o Oil tsink/heating system-permit status&inspections Bulkliead replacement structure—no permits l (� a Lowi:r level habitable.space No permits to create habitable space(bldg/electrical and plumbing) o - Low(z level bathroom—no permits to create bathroom(buildinglelectrical and plumbing) a ?� o No crAe compliance inspections for habitable space&bathroom in lower level of o Hour.ls divided/operating as segregated independent living spaces 1 o o Proprxty is not registered as rental property per Health requirements. I t l e Inadr:),quate cooking/food preparation area&storage provisions r. i t _ o Defir•ient means of egress for Vd story units e I o Ques:tionable access to heating g1 3 It is fully antiicipated that you will obtain the necessary permits as discussed during our most recent inspection. 1=ermit applications are available in this office located at 200 Main Street,Hyannis. Staff is available to ii.lssist you with the necessary paperwork. If circumstances have changed since last week,you must informas in writing in order that we may arrange to closeout the complaint pertaining to the rental matter. The ,ourtesy of a reply is requested by Nov. 1,2013. Rob C. L 9n Zoning Enfeecement Office lop, 7 000, 9 i y , Town of Barnstable. P q - Regulatory Services �ee 6montl4firomissuedate • ARWRRy� MAM 19. Thomas F.Geiler,Director Building Division , Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstabld.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTL 1 ONLY Not Valid without Red X-Press Imprint Map/parcel Number ' Property Address � �� Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number r19 � Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) DWorkman's Compensation Insurance s A Check one: r�"v� PRESS PERMIT I am a sole proprietor N.I am the Homeowner ElI have Worker's Compensation Insurance TOWN OF BARNS T ABLE isurance Company Name lorkman's Comp. Policy# opy of Insurance Compliance Certificate must accompany each permit. :rmit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to )<Re-roof(not stripping. Going over 101 existing layers of r000 ❑ Re-side ElReplacement of doors Replacement Windows/doors/sliders. U=Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. "*Note: Property Ownef must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. a NATURE: PFILESIFORMSIbuJ ding permit forms0TRESS.doc sed 070110 v The Commonwealth of Massachusetts 1' Department oflndustrTalAccidents JOffice of Investigations 600 Washington Street Boston, MA 021.71 www.massgov/did Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly CName(Bus ss/Organization/Iudividual): 1� 1.� 1 �' ' 5wf o q C®S%f Addres� City/State/Zip:- yU - Phone #: � Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am'a general contractor and I 6 El New construction employees(full and/or part-time).* have hired the sub-eontraciors 2.❑ I_am a sole proprietor or partner- listed on the attached sheet t ?•. ❑Remodeling . ship and have no employees These sub-contractors have 8. ❑ Demolition . working for me in any capacity. workers' comp. insurance. g, ❑ Building addition [No workers' comp. insurance 5• ❑ We are a corporation and its IO D.Electrical repairs or additions required.] officers have exercised their (�3 I am a homeowner doing all,work right of exemption per MGL 1 I.0 Plumbing repairs.or additions myself.[No workers' comp. C. 152, §](4), and we have no 12,0 Roof repairs . insurance required.] t employees.[No workers' 13.0 Other comp. insurance required.] *Any applicant that cheeks 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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.polity information. I am an employer that is providing workers'compensation insurance for Piny employees Below is thepolicy and job site information. Insurance Company Name: .Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to V,500.00 ad/oi one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine n of up to S250.00 a day against the violator. Be advised that a copy of this statement maybe-forwarded to the Office of Investigations of the DIA for.insurance coverage verification. I do hereby certify under the p and penabies of perjury that the information provided above is true and correct Siature: �✓ yqPhon#:" _ �cP0 ?� Official use only. Do not write in this area;to be completed by city or tmvn official City or Town: - Permit/License Issuing Authority(circle one): 1.Board of, f Health 2.Building Department-3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ' J Information and Instructions Massachusetts General Laws chapter.152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the Iegal 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 an such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." f' - 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 onto 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()states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority," Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the' f 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 affMdavit 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 iii the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as roof that a valid affidavit is on file for future permits or licenses e pp p p . A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for g y your cooperation and should you have an questions . Y9 .� please do not hesitate to give us a call. Irk The D-zpartment's address,telephone and fax number. < The Commonwealth of Massachusetts . , • , Department of Industrial Accidents Office of Investigations' 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext406 or 1-877-MA.SSAFE Fax# 617-727-7749 r Ty Town of Barnstable 8 Regulatory Services Thomas F. Geller,Director ` Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02501 www.town.barnstable.ma.us Office: 508-862403 8 Fax: 508-790-6230 Propexty O:wrier t ,COMP fete and Si T s SeetYon If Us in A B ' der asOnr of te nbjct,property hereby authorize to act on ray behalf, in all matters idative to work autho by this buE ag permit,a-PPEC-tiori for. ' ss. of Jab = s4nat= of Owner ate f '1 �' Print Name If Prod e • Owner is applying for permit pleas e c oinplete.the Homeowners License Exeraption .porn on-the reverse side: Town of Barnstable H Reg-alatory Services txrrsrAsrE Thomas F. Geiler, Director sab3 *� ,Building Division CEO {k Tom Perry,Building Commissioner 200 Mazri-Strct t; Ayanais, MA 02601 RWr.towmb armttabl e.ma-us 01]Ece: 508-862-4038 Fax. 508-790-6230 HOMEOV&ER LICEA'SE=MMON Plisse Print DATE Boa Lor-,anox: number s cct village NolrrEowN>=x� T�- r=�1� SA AJTO S ©S /� name bm=phone# work phone At CURRENT MAII�JC3.ilDDRES3'""'��-y-1-1��' eityhown state / up code The emTent exemption for"homeowners"was extended to include owmcr-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire vrho does not possess a license,provided that the owner acts as mpermo DEFINITION OF BOMBOWINMIR Pc-son(s)who owns a parcel of land on which he/she resides or intends to reside, an which•tbcr'e is, or is intended to• be, a one or two-family dwelling, attached or detached structarrs accessory to such use and/or farm structt=* . A person who constrgcts more than one home is a two-year period shall not be considered a bomaowncr. Such "homeowner"shall submit to the Budding Official on a form acceptable to flit Building Official, that he/she shall be resporistble for all such work performed-under the building permit (Section 109.1.1) The imdersigned`ho=owncr"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,roles and regulations. The imdcrsigoed`homeownct"ccrdBm that he/she.understands the Town of Barnstable Building Department rrdr;rrrr,rr,inspection procedures aril requirements and that he/she will comply with said procedures and reg iremcnts. 5i atisr=of Horneutig Approval of Buildiag,Official y Note: Threc-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control_ iimaowNER'S EJCEmmbx T15c Code stales that: "Amy bomcawncr pmfmming worrc for which a building permit is required shall be exempt from the provisions of this srzdon•(Secticn I D9.1.1-Licrosing aCcanstrvctior Supervisors);provided that if the homcowncr cagages a pcsori(s)for hire to do such . work,that s�ufch Homeowner shall act as supervisor•" hriay homernmas who use this.=zmpticn arc unawar=that they are zssuming the msponstbrlities of a supervisor(see Appendix Q It irks&R.egula tions for Licezirimg Construed-Supervisors,Section 2.15) This lack of awarmcss Men resulu in serious pmblerns,particularly vh=the homeowner hires unlicensed pawns. In this case,our Board cannot pmcced against the unlicctsed person as it would with A licensed ,upervisor. The homeowo cr acting u Supcviso-is ultirrmt0y responsible. To crisum that the homeowner is filly away=of hiArrimsponsibilitia,many communities require ns part of the permit application, iat the homao"=terrify that bdshe undcstands the r=sponsnbtliticr of a Supervisor. On the last page of this issue is a,form cur=Vy used by were/towns. You May care t amend and adopt such a form><certif ration for use in Your community.