HomeMy WebLinkAbout72-76 NAUTICAL ROAD �� - 1-7 /�J�uic� l Sao.
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Application number... ....�................ .............
d � 0 BaRN
Fee ... ..............................
3 ! �'
1019 NOV Building Inspectors Initials.... ..........................
, 5 Pf #�' 15
Date Issued:.... I:S...9......... .........................
Map/Parcel..... .............../.........� ..............
D VISION
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project:724 � OV141UT/jZ � r1,VUMBs
ER STREET VILLAGE
Owner's Name: GJ f] A.1 1 Phone Number 08"o2aV0— �96)
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Email Address: a -M 5 a Cell Phone Number •S D� - Z�D� y�7
Project cost$ gav' 00 Check one Residential Commercial
A
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize
to make application for a building permit in accordance with 780 CMR y
Owner Signature: Date:
r
TYPE OF WORK
Siding Windows(no header change) rInsulation/Weatherization
❑ Doors(no header change)# Commercial Doors-'require an inspector's review
❑ Roof(not applying more than 1 layer of shingles)
Construction Debris will be going to AIMPSiIM
CONTRACTOR'S INFORMATION.,
Contractor's name -
Home Improvement Contractors Registration(if applicable)# (attach copy)
Construction Supervisor's License# , ' s .(attach copy)
Email of Contractor Phone number s -
ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
r ql•
APPLICATION NUMBER............................................................
*For Tents Only*
Date Tent(s)will be erected Removed on number of tents total
Does the tent have sides?Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X X X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a: for profit non-profit event
Check one: Food served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent
Fuel source being used LP tank 20 lbs. or>Yes No_____, if yes, a gas permit is required.
= Natural Gas Yes No_____,if yes, a gas permit is required.
If food is being served at.your event please obtain a Health Department approval between the hours
of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval.
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front back left side right side
HOMEOWNt S=LICENSE EXEMPTION
Homeowner's Name: G I0 30,S 6-b-1/ /
N'
Telephone Number S 0� Q �� Cell or Work number
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 MR the Massachusetts State Building Code. I understand
the construction inspec ' �r a pecific inspections and documentation required by 780
CMR and the To
e
Signatures Date,
C. � - NATURE Y,
Si Date_/#--- �
� gna
All r t a s are subject to a building official's approval prior to issuance.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
"Na me=(Business/Organization/IndiA dual):
Address:,7Z 12�4t/'74 (;4
---_C--.ity/State/Zip_; 63W�-� Phone#:
6-o8 290 ��9Z/.
Are you an employer?theck the appropriate box: Type of project(required):
L❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8.°-❑.Demolition
workingfor me in an capacity. employees and have workers'
Y P h'• 9. ❑Building addition
[No workers'comp.insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 10.❑ElectricaTrepairs or additions
03 m a homeowner doing all work officers have exercised their I I.❑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' ;7
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:
Policy#or Self-ins.Lic.#: Expiration Date:
,zJob`Site Ad edredr ss: 72, 761 /V,4u '� " [_ZCiiy/State/Zip: - ` VC lwdl
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' prisonment,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 iolator.-Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA r' ce coverage verification.
I do hereby certi d e" allies ofperjury that the information provided above is true and correct
Si at�uree rDate:—_..
Phone#:
Official use only. Do not write in this area,to be completed by city or town officiaL
City or Town: Permit/License# `
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.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 cant'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
(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 Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington,Street
Boston,MA 02111
Tel.#617-727-4900 ext 406 or 1-877-MASSAFE
Revised 4-24-07 Fax#617-727-7749
www.mass.gov/dia
.. 8k 32126 Po 132_ -30588
06-28--2019 a. 01 = 190
MASSACHUSETTS STATE EXCISE TAX
BARNSTABLE- COUNTY REGISTRY OF DEEDS
Dater 06-28-2019 a 01:19ae:
Ctl*: 842 Doct: 30588
- Fee: $1:026,00 Cons: 3300000.00
BARNSTABLE COUNTY EXCISE TAX
BARNSTABLE COUNTY REGISTRY OF DEEDS
Date: 06-28-2019 a 01:19am
Ctl:: 842 Doer: 30588
QUITCLAIM DEED FPP: $918.00 Cons: $300000.00
ALJ REALTY CORPORATION, a Massachusetts Corporation having a usual place of
business at 707 Main Street.'Hyannis,'Massachusetts 02601, -
for.consideration ol'THREE HUNDRED THOUSAND and NO/100.(�300,000.�0)
DOLLARS,
grants to MARCIO JOSE AGOSTINI, Individually, of 825 W. Main Street, Apt. 18,
Hyannis, Massachusetts 02601;
With Quitclaim Covenants,
The and and buildings thereon, situated in the Town and County of'Barnstable
(Hyannis), Commonwealth of Massachusetts being further described as a portion of LOT
7 on a plan entitled: "Plan of Lots in Hyannis,Barnstable, Mass., belonging to_Aldege
Aubin, Scale 1 inch=40 feet, October 24, 1961;Nelson Bearse-Richard Law, Surveyors,
Centerville, Mass.", which said plan is duly filed.in the Barnstable County Registry of
Deeds in Plan Book.1,71. Page`61. more pai•ticulaiy.described as follows:'
Beginning at the northwest corner of the described premises; thence turning S 77 degrees
-
( ) p e
1�' �0" L for a distance of one hundred and 36/100 100.36 feet to a omt• Thenc. _
running S 13 degrees 45' 50"W:by LOT#8 for a distance of eighty-one and 57/100
(81.57).feet to a point on the north side of Nautical Road; Thence running by said
Nautical Road N.76 degrees 26' 50" W for a distance of one hundred and 05/.100 (1'00.05)
feet to a point; Thence running N 13 degrees 33' 10" for a distance of eighty and 23/100
(80.23) feet to the point of beginning.
The Grantor hereby waives any and-all rights of Homestead in and to.the.'premises
conveyed hereby and warrants and represents that there are no persons entitled to any
rights of Homestead under.M..G.L. c. 188 in the premises conveyed by this deed.
Meaning isend, ed � t nvy. the-* c asilecrib inewthe
f3atnsta cunt Registi��u�l 1)cE�is u� Book 5Z 1?�tg�.+-
Property Address: 72 Nautical Way, Hyannis, Massachusetts 62601
Signed under the pains and penalties of perjury this. day of June, 2019.
ALJ Realty Corpora`
Juan Mai'' al, President& Treasurer
COMMONWEALTH OF MASSACHUSETTS
Barnstable, ss: ,
�Tt '.
On this day of June, 2019 before me, the undersigned notary public,
personally appeared Juan Marichal, proved to me through satisfactory evidence of
identification. which was a MA Driver's License to be the person whose name is signed
on the preceding or attached document and in my presence swore or affirmed to me that
the contents of this document are truthful and accurate to the best of his knowledge and
belief. and ac-knowl edged tome that he signed it voluntarily for its stated purpose.
(seal)
Notary•Pub ' Stanley P.Nowak
My commission expires: 06/05/2026
N,
14 : .
3
;Municipal Lien Certificate
• Office of the Collector of.Taxes
�nnrtecssi,e; �
p� Town of Barnstable
The Commonwealth of Massachusetts
State Tax Form 290
Certificate 23079,
Issuance Date: June20,2019. . -Bk 321 -6 P-0131; �31]S87
01219P
Requested by:
LAW OFFICE OF'MICHELLE MACHDO MOREIRA PC
ONE SHIPYARD WAY,SUITE 201
MEDFORD,MA 02155 .
I certify from available information that all taxes,assessments and charges now payable that constitute liens as of the date of this
certificate on the parcel of real estate specified in your application received on 06/03/2019 are listed below.
Description of Rroperly
Parcel ID 307-236 72 NAUTICAL ROAD
Land Area`. 7,841 SF
ELIO,ANTHONY TR Land Value 94,800
871 MAIN STREET Impr Value 149,500
OSTERVILLE MA 02655 Land Use 0
Exemptions 0
Deed Date:0210812012 Book/Page:26066 91. Taxable Value 244,300
Class: 1040
Fiscal Year. 2019 _ r-- 2018` ." 2017.::
CPA 69;63 65,24 68.86
HYANNIS FD COMMERCIAL RE 0:00 0.00 0.00
HYANNIS FD RESIDENTIAL RE 752.44 608.75= 589.47
REAL ESTATE TAX-COMMERCIAL
REAL ESTATE TAX RESIDENTIAL 2320.85 2174.74 2295.32
SEWER EXTENSION APPOR COMMITTE: 499.73 519.72 1099.41
Ljj
SEWER EXTENSION APPORTIONMENT 499.73 =499.73 999.46
Total Billed - -4142.38 3868;18 `" 5052.52,
Charges and Fees 0.00 0.00 0.00
Abatements/Exemptions 0.0 0.0 0.0
Payments/Credits 4142.38 3868,18 .5052.52
Interest to:07/05/2019 0.00 0.00 0.00, .
Total Balance 0.00 0.00 0.00'
FYI Actuals Tax Bills.were issued December 31,20.18 with 3rd quarter bills$0.00 due 02/1/2019 and 4th quarter bills$0.00:due
5/1/2019.
Total Interest Per Diem:0.0000
Other Unpaid Balances
Tax Title . 0.00
There is a Sewer Betterment assessed on this property.Please contact the Assessor's Office for instructions on how to
obtain a Payoff amount 508-8624022
For Unpaid Betterments/Special Assessments not yet added to Tax call Assessors.508-8624022 for a payoff amount
For Unpaid Water call 508428-2687
All the amounts listed above ere to be paid to the Collector. I have no Knowledge of any other outstanding amount that constitutes a
lien. Real estate parcels are subject to supplemental tax assessments under Massachusetts General Laws Chapter 59,Section 2D.
GISLAINE M MORSE
ASSISTANT COLLECTOR
RNSTABhE REGISTRY of er
6A Re ►st •�
John F. Meade, $
s<vachuweffwl
< (� � c>Ut/t//'�,ll/l..11l�'CCIt/l
licr/r' ,%(c�i�a'c', .�./�a•s/air. , //crsa'uc�r<<s'c /s• (.>>/���'
William Francis Galvin
Secretary of the
Commonwealth
Date:May 30, 2019
To Whom It May Concern
I hereby certify that according to the records of this price.
ALJ REALTY CORPORATION
is a domestic corporation organized on September 18, 2013. under the General Laws of the
Commonwealth of Massachusetts. I further certify that there are no proceedings presently pend-
ing under the Massachusetts General Laws Chapter 156D section 14.21 for said corporation's
dissolution: that articles ol'dissolution have not been filed by said corporation; that, said cor-
poration has filed all annual reports, and paid all fees with respect to such reports, and so far as
appears of record said corporation has legal existence and is in good standing with this office.
In testimony of which,
I have hereunto affixed the
el, Seal of the Commonwealth
on the date first above written.
1� Secretary of the Commonwealth
Certificate Number: 19050606710
Verilj this Certificate at: http: 'curr.sec.st;Ue.nui.us.( t�rpl6ch C:'erlitii Iles \'eril�.ospx
I'rocesscd b\: _
BARNSTABLE° REGISTRY OF DEEDS
John F. Meade, Register
' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map
��D`7 Parcel 3 Application # 7
Health Division /7oZ Date Issued 1 .
Conservation Division Application Fee
Planning'Dept Permit Fee
Date Definitive,Plan Approved by Planning Board p '
Historic = OKH Preservation/Hyannis
Project Street Address 7 V&A)
Village �- jL tol a `i
Owner / Address
Telephone
Permit Request /QpS f nPd�y- 7� S a�Ie ' t'/y
Square feet: 1 st floor: existing proposed .2nd floor: existing proposed Total new
Zoning District. Flood Plain Groundwater Overlay
roject Valuation !�LODC), 'oa Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family 0 T o Family Multi-Family(# units)
Age of Existing Structure istoric House: ❑Yes ❑ N On Old King's Highway: ❑Yes ❑ No
Basement Type: �d Full ❑Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing_ new Half: existing i new . .
Number of Bedrooms: existin _new
Total Room Count (not including baths): existing new First Floor Rodffi Count
Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes A No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
g-
Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing O,new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review #
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name w,,e.,f AQVZJ.c - Telephone Number L7)8 77.6 /4`7 1
Address :S71 &f License# q L/
�-�A-hei AV1 l��fr P1 6 Y? Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ✓ ,,, s1�
SIGNATURE DATE off-
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
3
f
Z
1
DATE OF INSPECTION:
FOUNDATION
FRAME
r
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL '.
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
� 4
FINAL BUILDING
e5
4
C
DATE:CL•OSED OUT
4
ASSOCIATION PLAN NO.
d
-'` Massachusetts- Department oT Public Safeh
Boar(I 01'Buildin«
Rcl;ulations and Standards
Construction Supervisor License
License: cs 68941
Restricted to: 00
JAMES E ROONEY
251 LAKESIDE DR
MARSTONS MILLS, MA 02648
Expiration: 1/9/2011
('ununissiuncr
Tr#: 9509
; e
—� THE COMMONWEALTH OF MASSACHUSETTS
Board of Building Regulations and Standards For DPS Use Only.
One Ashburton Place, Room 1301 Registration No:
d Boston, MA 02108
Application for Registration as a Effective Date,-
Home Improvement Contractor
or Sub-Contractor Expiration Date:
(MGL c. 142A; 780 CMR 110R6)
I. LEGAL NAME OF APPLICANT:
(MUST BE EITHER AN INDIVIDUAL,CORPORATION,LLC,LLP,TRUST,(OR OTHER LEGALLY FORMED ENTITY)
2. APPLICANT TYPE: Y INDIVIDUAL CORPORATION _LLC_PARTNERSHIP LLP _TRUST
(CI'IECK ONE-MUST 13F SAME ATS IDENTIFIED IN#1)
3, 1F APPLICANTWft"OvEaEASE IS DOING BUSINESS UNDER ANY NAME OTHER THAN THA
IDENTIFY THE NAME (DBA):
(SEE INSTRUCTIONS REGARDING THE ENCLOSURE OF A CITY OR TOWN R Rj I'IFICAI'EAF DBA IS LISTED)
4. MAILING ADDRESS: v
STREET CITY ucenSMTE ZIP
5. PERMANENT ADDRESS:
(IF DIFFERENT FROM#3) STREET CITY STATE ZIP
(PLEASE NOTE THAT A P.O.BOX IS NOT ACCEPTABLE FOR PERMANENT ADDRESS)
6. APPLICANT PHONE#: .(�b4776 t 7!o APPLICANT EMAIL ADDRESS:
7.
8. NUMBER OF EMPLOYEES:
9. A) HAVE YOU REGISTERED PREVIOUSLY UNDER THIS LAW? _YES NO
B) IF YES, PLEASE PROVIDE THE NAME AND REGISTRATION NUMBER UNDER WHICH YOU WERE PREVIOUSLY
REGISTERED:
5
NAME,: HIC REGISTRATION#:
10. A) ARE. YOU CURRENTLY OR HAVE YOU EVER BEEN AN OFFICER, PARTNER,OR CO-VENTURER OF AN
APPLICANT WHO PREVIO SLY APPLIED FOR OR HELD A REGISTRATION UNDER THIS LAW(G.L. C.
142A)? _YES NO
13) IF YES, PLEASE PROVIDE THE NAME OF THE APPLICANT AND NAME OF THE BUSINESS(IF DIFFERENT).AND
REGISTRATION NUMBER:
NAME: HIC REGISTRATION #:
11. A) ARE YOU CURRENTLY OR HAVE YOU PREVIOUSLY BEEN EMPLOYED BY A REGISTRANT OR APPLICANT
FOR REGISTRA" ON AGAINST WHICH DISCIPLINARY ACTION WAS TAKEN BY THIS DEPARTMENT?
YES NO
B) IF YES, PLEASE PROVIDE THE NAME OF THE INDIVIDUAL AND BUSINESS (IF DIFFERENT)AND REGISTRATION
NUMBER:
NAME: fi HIC REGISTRATION #:
Town of Barnstable
Regulatory Services
s
e nAewcri" o
p Thomas F.Geller,Director
s6S9. .Q7'
n, cc Building Division
Tom Perry,Building Commissioner
200 Main S`lreet,Hyannis,MA 02601
www.town.barastable.ma,us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, (,tlGlSX lny '► Rv VA 117e AIJ4n ,as Owner of the subject property
hereby authorize �}A m-e S z� L n e �/ to act on my behalf,
r
in all matters relative to work authorized by this building permit application for.
(Address of Job)
SBr _..
Sip2p3oaqP06ocigement Solutions,Inc.as
went ashington Mutut2! c
S lcb�g Agent for ier/tat Re=d
�-- �
Print Name
If Propert�er is applying for permit please.complete the
Homeowners License Exemption Form on the reverse side.
Q:i oxras owrr
C
Washinron Mutual ?Z.Box 4409Ci
HOME LO A R!S ia.k5(n v&Ile.rL
Wrr.151-30ft
To Whorl it may concert:
Please be advised that LPS Asset Management Solutions is a designated Asset
Management Company for Washington Mutual Bank and is authorized to list
and sell properties on behalf of Washington Mu W Bank. Furthermore
Washington'Mutual Bank authorizes LPS Asset Management Solutions to
execute Listing Agreements and Purchase/Sales contracts on our behalf. The
properties being sold could be titled to Long Bmh Mortgage as Trustee for
Deutsche Bank,or various otlr-r entities that W NIU would provide 110A for
on an as needed basis. Washington Mutual is the authorized Attorney in Fact
for the title owner of these Bank Owned properties and will be signing ALL
Deeds and HUDS to complete the title transfer of these properties.
The authorized Asset Managers of LPS Asset Management Solutions that are
approved to sign on our behalf are:
Michael Adam_ . Margaret Eagan Susan Pyle
GaH Kneeland Michael Russell � Ryan Pian
Bernadette Sylvester E
F.
Flerning _ Greg Smith ' Farris 3
Benjamin
Graves Jeff Subia x Travis Newton
Jeremy
Alberto Lope; Susan Tucker Carpenter
Marianne Michelle
Metger Julian Pe McGo
Charley M
Nina Freda I Sorensen Jan Schmidt
Sandra . y - ; Maryanne
Camt?ell _ I Zornick Madelyn Felix
Thank you,
Kelly Livingston
Officer i As-sistant Treasurer
Washington Nltrtual Bank.now backed by the strength of JPlviorgan Chase
Washington Mutual Bark, FA
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E'- ��„.:e4roi`"...b...'?3i.+E$c:.�:., .A � fa5'u xu � y. .T;•o- ri:i:e� aa. ��k- ils::caw�€:'4.N=,T
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office,of Investigations
' 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leiribly
Name(Business/Organization/Individual): �S LT1 &e1
Address: QS_/
City/State/Zip: �� �� !'"GI! �'"/u Phone.#: . `� � 776 f 716
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with
Y
emP�o 4. I am a general contractor and I
❑
employees(full and/or part-time).* have hired the sub-contractors 6. New constructi on
.2.)o 1 am a sole proprietor or partner- listed on the attached sheet. 7.. 0 Remodeling
ship and have no employees These sub-contractors have g. KB
Demolition
working for me in an capacity- employees and have workers'.
g Y P ty- $ 9. uilding addition
[No workers'-comp.insurance comp. insurance.
required.] 5. Weare a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself.[No workers'-comp. _ right of exemption per MGL 12.[A 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.
XGontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information
Insurance Company Name:
Policy#or Self-ins. Lic.#: Expiration Date:
lob Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi under the pains and penalties of perjury that the information provided above is tr a and correct
Si aiure: Date:
' Phone
Official use only. Do not write in this area,to be completed by city or town official
.City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.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 o f 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
to do maintenance,construction or repair work on such dwelling house
dwelling house of another who employs persons
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 y•
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary,supply sub-contractors)name(s), address(es)and.phone number(s) along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is!being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant--
that must submit multiple pernut/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 bum leaves etc.)said person is NOT required to complete this affidavit.,
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The.Department's address,telephone and fax number:
The C6mmo11w th of Massachusetts
Department of Industrial Accidents
Office of Investigatioms
600 Washington Street
Boston,MA 02111
Tel. #617-727-4900 ext 406 or 17$77 vIASSAFE
Fax# 61?-727-774
Revised 11-2M6
www.rnass.gov/din
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complaint/Inquiry Report
G?/ Rec'd by: Assessor's No.:
Date:
Complaint Name:
Location
Address
NWP
Origin
ator Name:
vim: f S Tap:
Telephone:D/E Jam_" 3p 5�-'
Complaint
Description:
Inquiry rM 'Y -
Description:
For Office Use Only
Inspector's
Action/Comm ents Date. .F Z 1 —O� Inspector._
rollow up
Action
Additional Info. Attached
Cop},Distribution: White-Depamnent File
]'ellory-Inspector
/Remm to Office Manager')
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HYANNIS FIRE DEPARTMENT
95 HIGH SCHOOL ROAD EXTENSION
HYANNIS, MASS. 02601
HAROLD S.BRUNELLE,CHIEF
FIRE PREVENTION BUREAU
LT. DONALD H. CHASE, JR. LT. ERIC HUBLER
Inspector Inspector
Foley Real Estate
Attn: Kevin
January 15, 2009
RE: 72-76 Nautical, Hyannis, MA
Dear Kevin,
This property was inspected by the Hyannis Fire Department on Friday, 9 January,
2009. The purpose of the inspection was to ascertain compliance with MGL 148 Chapter
26F - namely, the smoke detector/ carbon monoxide law for resale property.
During the inspection, it was noticed that there were sleeping areas in the basement
of the house that did not have proper egress for emergency escape. This is a violation of
the State Building Code, namely "Emergency Egress".
Under Mass Law, MGL 148 Chapter 28A, any violations of any other jurisdiction's
code requires mandated reporting to that agency by the Fire Department. Such is the case
here with both a violation of the Building Code and a violation of the Town's Zoning
Ordinance for non permitted apartments.
The removal of the same requires a building permit and subsequent sign off by the
Building Dept. and Zoning.
Thank you,
Sincerely,
Lt. Donald Chase, Jr., FPO
Fire Prevention Officer
Hyannis Fire Department
Tel. 508-775-1300 Fax 508-778-6448 Emergencies 9-1-1
HYANNIS FIRE DEPARTMENT
95 HIGH SCHOOL ROAD EXTENSION
r HYANNIS, MASS. 02601
1 HAROLD S.BRUNELLE,CHIEF
l\,
FIRE PREVENTION BUREAU
LT. DONALD H. CHASE, JR. LT. ERIC HUBLER
Inspector Inspector
Foley Real Estate
Attn: Kevin
January 15, 2009 c�
RE: 72-76 Nautical, Hyannis, MA
Dear Kevin,
This property was inspected by the Hyannis Fire Department on Friday, 9 January,
2009. The purpose of the inspection was to ascertain compliance with MGL 148 Chapter
26F - namely, the smoke detector / carbon monoxide law for resale property.
During the inspection, it was noticed that there were sleeping areas in the basement
of the house that did not have proper egress for emergency escape. This is a violation of
the State Building Code, namely "Emergency Egress".
Under Mass Law, MGL 148 Chapter 28A, any violations of any other jurisdiction's
code requires mandated reporting to that agency by the Fire Department. Such is the case
here with both a violation of the Building Code and a violation of the Town's Zoning
Ordinance for non permitted apartments.
The removal of the same requires a building permit and subsequent sign off by the
Building Dept. and Zoning.
Thank you,
Sincerely,
Lt. Donald Chase, Jr., FPO
Fire Prevention Officer
Hyannis Fire Department
Tel. 508-775-1300 Fax 508-778-6448 Emergencies 9-1-1
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k TOWN OF'BARNSTABLE609r
Ordinance or Regulation
�> WARNING NOTICE 3.
P. AA,4.1
Name of Offender%Manager � ' '� u'
Address:.of Offender _ /..�' l ) fi 1.`l , ; �i Y.. . N MV/MB. Reg #
Village/Scat"e'/Zip: `"` � Fp �` a � MSS#
1
Business :Name " am/.p P.
Business' Address 'f
P.
Signature of."Enforcing,`Off cer
VilTage/'S"fate%Zip.
..Location"',of OffenseI6,•`�.
{ 30� tG' I ` � r Enforcing Dept/ v i i o Disn ,
Offense. / `�? rit
Facts" !t �
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�, '.�� i � ,� R l,y` � x i � r-r� ,r' t �1 r� •a ,r.^, ,,r
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h is � I' � } o� 3�
This .will serve only as a;warning`. 'A"t this t'=e''no .l'e:gal:act o. i has been taken
It is -the. ggal", of Town".. .agericies., to achieve voluntary compliance ' of Town
Ordinances, .Rules and:"Regulat,ions: Education effoz,ts• and :warni'ng' notices . are
attempts :to gain . voluntary compliance Subsequent violations wihl result ins`
r appropriate legal- action by the Town
,
Building'Department
ComplainVInquiry Report -
Date: (5 1 - J `W 1 d a Rec'd by: ���v S — Assessor's No.:
j
Complaint Name: .Sf-Ghl G Y). PA C-V� e-Co
Location
Address: 46 n u s
rvvP
Originator Name: >>i,7+ IV G 1/1S oar
Street:
Village: State: tip:
Telephoner D/L
Complaint _
Description:
Inquiry
Description:
OA)-,e �D r�
For O/Sce Use Only
Inspector's
Action/Comments Date: Inspector.
Follow-up
Action
Additional Info.A=died
Copy Distribution: White-Depamnent File
Yelloiv-Inspector
Pink-Inspector(Return to OITce.:llanager)
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