HomeMy WebLinkAbout0399 OAKLAND ROAD OWN
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508-398-0398
December 14,2011
Town of Barnstable
Thomas Perry CBO
Building Commissioner /
200 Main St. Hyannis,MA 02601
RE: Building Permits
Dear Mr. Perry,
This affidavit is to certify that all work completed for permit application #201102571, Status A,
Parcel 271012 at 399 Oakland Road,Hyannis, Permit type: RADD, and issued on 5/23/2011 has
been inspected by a certified Building Performance Institute (BPI) Inspector. R-30 Cellulose
insulation was added to the attic. The walls were dense packed with R-13 cellulose insulation.All
work performed meets or exceeds Federal and State Requirements.
Sincerely,
William McCluskey
Cape Save 7 Huntington Avenue Suite C, South Yarmouth, MA 02664
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 0 1 Application # Zo U,
Health Division Date Issued I
Conservation Division Application Fee v
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Street Address 9 �aG.lan �Iok
ti
Village `/ ool n�S
Owner L kLN A i ce11 o QiAe s Address Swrna
Telephone �0 5 - a 4 '
Permit Request h 1"el 6e�)i Q�-+�`���•n��.na 6 , /9c k R-3� �1��`���5 r- �i-a eZ e r � I
Lle))
[, r- V'o t
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 5 0W ,U0 Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family N Two Family ❑ Multi-Family (# units)
Age of Existing Structure 12 6 8 Historic House: 0 Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: W Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing_ new Half: existing new
Number of Bedrooms: 3 existing —new c?
Total Room Count (not including baths): existing $ new First Floor Room Count-'=. `7
r
Heat Type and Fuel: M Gas ❑ Oil ❑ Electric ❑ Other _
Central Air: ❑Yes ® No Fireplaces: Existing /. New Existing wood/coal stove-- Yes:;❑ No
� 1
Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑'.new Vie_
Attached garage: 0 existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
i
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use V1, ',:A
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name I�I101m i"4cvs�"� �a� Telephone Number 502 - ���- 03 �0
r p
Address :3-C U i n Vt License# __:�_C 1 6
S�Q+h Ta -rnoy+h jm n6 6q Home Improvement Contractor# , 3 r
Worker's Compensation # 9 9 Jr
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Y m,6U4
SIGNATURE DATE 5 ` 6 `
`s
FOR'OFFICIAL USE ONLY
t APPLICATION#
DATE ISSUED P
I
r MAP/PARCEL NO.
ADDRESS VILLAGE
z
OWNER t
DATE OF INSPECTION: _
t
5 FOUNDATION
FRAME
INSULATION
t I
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
F
GAS: ROUGH FINAL '
FINAL BUILDING
a
r DATE CLOSED OUT
ASSOCIATION PLAN NO.
� ej
Vi 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
NaMe(Business/Organization/Individual): M t C'_a A rzi A&C 14151C 64 ID1131k ( _&A
Address: _ -C.. &N� IN(aVQt�
City/State/Zip: S • 1AMOS&Tt�ii- #4A 6LUgone#:
t k-
Are you an employer?Chec the appropriate box: Type of project(required):
1.[K I am a employer with� 4. ❑ 1 am a general contractor and I
employees(full and/or part-time).
* have hired the sub-contractors 6. New construction
2.❑ I attt a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have b. n Demolition
working for me in any capacity. employees and have workers'
9. (] Building addition
[No workers' cotiip.insurance comp.insurance.=
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.[]Plumbing repairs or additions
myself o workers' comp. right of exemption per MGL
1211 Roof repairs t
insurance required.]t c. 152,§1(4),and we have no 13 Other--�ns cti
employees. [No workers'
comp. insurance required.]
*Any applicant that checks box#i 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.
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: r 4A(2T 4 5 C yy S lri 1V!��E
Policy#or Self-ins.2Lic..#: C- '� g3_(�1 Expiration Date: (6 2_1 17 6(�
Job Site Address: J 1 O IA.o k(I J 'Z 6MJ City/State/Zip:4 y_ a� A A'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 DIA for insurance coverage verification.
I do hereby cert<fy under the pains d Penalties erjury that the information provided above is true and correct.
Sijznafore: f Date:
Phone# ,&
Official use onitl. Do not write in this area,to be completed by clop or town official
City or Town: Permit/License#
Issuing Authorih'(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
CERTIFICATE OF LIABILITY INSURANCEF11/1/2010
DAT)3(MhUOD(YYYY;
�---�
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: It 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 'NAME: Shannon Sperrazza
Risk Strategies Company PHONE (781)986-4400 FAX (781)963-4e20
15 Pacella Park Drive ass;ssperrazza@riek-strategies.com TT_
Suits 240 I PRODUCER10g,0 0018476 —"
Randolph MA 02368 _ INSURER�S)AFFORDING COVERAGE NAIL#
INSURED INSURERA:Seneca Specialty insurance Co _ _^
1 INSURER B.Keating Grog Ins Services _
Michael McCluskey, DBA: Cape Save lNsuRERc:Chartis Insurance _
7 C Huntington Ave INSURER D
INSURER E:
South Yarmouth MA 02644 INsuRERF:
COVERAGES CERTIFICATE NUMBER:CL1011132675 REVISION NUMBER:
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, I
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TAR' i POLICY EFF i POLICY EXP ! —�
R; TYPE OF INSURANCE POLICY NUMBER MMf MMIDD/YYYY LIMITS
GENERAL LIABILITY
r— EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY 0
—� ; ,PREMISES'Es ooasrancei $ 5b,000
A i ;CLAIMS-MADE JL. OCCUR MG1002608 -10/16/2010,10/16/2011 MEDEXP(Any one person) $ 10,000
i
PERSONAL&ADV INJURY $ 1,000,000
I-- I GENERAL AGGREGATE $ 1,000,000
GEN L AGGREGATE LIMIT APPLIES PER:
PRO PRODUCTS-COMPIOP AGG :S 1,000,000
X POLICY' - ; 'LOC �-
$
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I
$ 1208200 1000,000
ANY AUTO
- ALL OV,RdED AUTOS I I BODILY INJURY(Per person) '$
80DiLY INJURY(Per acddem)'$
:X :SCHEDULED AUTOS i PROPERTY DAMAGE
X'HIRED AUTOS I (Per socident) $
NON-OVMED AUTOS S
I
I X 'UMBRELLA UAS j
_{OCCUR V 's EACH OCCURRENCE
$ 11000,000
EXCES8LiA9 CLAIMS-MADE I ! I AGGREGATE v $ 11000,000
DEDUCTIBLE
B RETENTION $ 023578601 10/16/2010'10/16/2011
Q j WORI(ERSCOMPENSATM Ij Michael Mccluskey YdCSTATL 7OTH-I$
AND EMPLOYERS LIABILITY i ! X TORY LIMITS' i ER
YIN ' I
ANY PROPRIETOR/PARTViER/EXECUTJVE I ! ;is excluded from, coverage;
s OFFICERIMEMBER EXCLUDED? y j N I A i i 'E.L.EACH ACCIDENT $ 500,000
{Ma in i9930951 10/21/2010;10/21/2411;E.L.DISEASE-EA EMPLOYEES 50Q�000
DESGtRtPT(ON OF OPERATIONS below i E.L DISEASE-POLICY LIMIT i$ 500,000
i ' I
i I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Mach ACORD 101,Adchdonai Remarks Schedule,if more apace is required)
Issued as evidence of insurance. Contractors-Executive Supervisors or
Executive Superintendents.
CERTIFICATE HOLDER CANCELLATION
(508tt)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Housing Assistance Corp ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Ruth
460 test Main Street AUTHORIZED REPRESENTATIVE
Hyannis, NA 02601-3698
chael Christian/SMS
ACORD 25(2009t08) ®1988-2009 ACORD CORPORATION. All rights reserved.
INS025(2oa a) The ACORD name and logo are registered marks of ACORD
460 V'tst "'laiji Srrec;.-
HOUSINk-Y
HvL
A SST;TAM'---,-'E FNFiGY H E 1Z F P-A I r,,
T ("508) 771-i400 F (50",')790-2-4-251
CORPORATION TT Y on all mies� wit -g
HOME OWNER WEATHERIZATION WORK PERMIT&FUEL RELEASE:
PLEASE FILL OUT AND SIGN THIS FOR24 IF YOU ARE
THE APPLICANT HONE OWNER.
I LAO)hU Licn, Goe)ke!5 hereby consent to and agree that weatherization work maybe
done by the Weatherization Program of Housing Assistance Corporation ( herein after referred as
"Agency") on the property located at:
3T")- C>A�---C-A 6 P,L%
Ny�'3
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&caulkLug 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:
I- 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(S)years after the weatherization
work is completed_
I have read the provisions of this agreement as listed and freely give my consent.
Home Owner.(Signature)
Date: f
Agent: (signature)
r
HAC approved Weatherization Company: a00- Vle
Caliber Building&Remodeling Cape Cod Insulation Cape Save Creswell Construction
Frontier Energy Solutions Lohr& Sons Peter Smith Resolution Energy
Rock Solid Construction All Cape Insulation
X.H,A
4-
T Office of Consumer Affairs and Business Regulation
= _^}. 10 Park Plaza.- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 164432
Type: Supplement Card
CAPE SAVE Expiration: 10/K011
WILLIAM MUCCLUSLEY _...._.._._.____. .. ... ..
8201 S. HOURD CT — . . ...... .. _.._...-.
CHAPEL HILL, NC 27516 _•___.-__. ___ .
Update Address and return card.Mark reason for change.
: Address _ ' Renewal Employment : Lost Card
./�u �r��r.•a:t,•,:r:.esa1:� -�r"•.•Ftru:sr:crirtt�!'��
office of Consumer Affairs&Business Regulation License or registration valid for individul use only
M-s
' '`HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
r =f',
Office of Consumer Affairs and Business Regulation
*,. Registration: 164432 Type: 10 Park Plaza-Suite S170
Expiration: 10/812011 Supplement Card Boston,MA 02116
CAPE Sava_
WIWAM MUCCLUSLEY
7C HUNTING AVE, � ---
S.YARMOUTH,MA 02664 Undersecretary Not valid wi ou signature
-Ana... N1.1"% iaHi,,i'ff De'li.:f'merit oil'P111-di" %'14-11
� titI„arel „1-lluilrlilr� i2rts)cit,,,iia .tali �f.ir,t}:►1-11�
i.icense: CS SL 102776
Restricted tom. IC
YY,LLtAM MC CLUSKY -tl
37 NAUSET ROAD
WEST YARMOUTH, MA 02673 -
r= 102776
08-12512010 09.23 9193212955 PAGE 01i01
COE* SAVE
Weatherization
508-398- 0398
August 22, 2010
To Whom It May Concern:
William J. McCluskey is an employee of Cape Sage. He is authorized to negotiate
contracts and building permits for our.company.
Michael IMcCluskey
Cape Save—Owner
919-593-5939 cell
X Huntington Avenu, ,South Yarmouth, NIA 02664
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS
NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the`necessary
signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FL., 367. Main Street,
Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. fi
Fill in please: Date:
APPLICANT'S NAME:
YOUR HOME ADDRESS:
1 sF r;
BUSINESS TELEPHONE # HO ME:TELELPHONE #:
NAME OF CORPORATION 1=1D #
NAME OF NEW BUSINESS '` J \N
TYP E OF BUSINESS P, i J
IS THIS A HOME OCCUPATION. E -, NO
ADDRESS OF BUSINESS J' MAP/PARCEL NUMBER 21 I' (Assessing)
_-_
When starting a new business there are several things you must do to be;in compliance with the rules and regulations of the Town of
Barnstak�le. This form is to assist you in obtaining the information you may need. You MUST GO T0�8- +a +. (corner of Yarmouth Rd.
8� IVlain Street) to make sure you have the appropriate permits and licenses required to legally operate yyour business in town.
c<.
1. r'BUILDING CO' ISS NER'S OFFICE ,
�- This ual indivi gasPPeD.infer ed f a y permit requirements that pertain to this type o R iF6810MOLy WITH HOME OCCUPA
RULES AN T`ION
�. Aut e�ffr/
re** !LURE
COMPLY RESULT IN FINE&
COMMENT
D
2. BOARD OF HEALTH 0/ �..�
This individual as en inf rimed of the permit requirements that pertain to this type of business.
41ArV
Authorized Signature** MUST COMPLY WITH ALL
COMMENTS: HAZARDOUS MATERIALS REGULATIONS
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual;has been informed of the licensing requirements that pertain to this type of.business.
Authorized Signature**
COMMENTS:
Town of Barnstable
aF�HErow y Regulatory.Selrvices
Thomas F.-Geller, Director
o�
{ Building Division
BARNSTABLE,
y iIASS �$ Tom ferry, Building Commissioner
1639.
�°rEaMAta� 200 Main Street, Hyannis,MA 0260.1
Fvwt .focvn;barnstable.ma.us g.
Office: 508-862-4038 >t`-, ax: 08-790-6230
DPP owed .r— C_4
Fee: � - 5.
Perm t#: d Zj
...HOME OCCUPATION REGISTRATION
Date:��.
Name: �, IK N: 1`'7'J
c
Address; 3 9 O R r l� ( ) .�, �ynr C�� A0
Name of BusillesS:___ — ---
--� _
�T
[� , _r C�
Type of liusl(tess: .1/� +'Mat)/Lot:_c��`� -- / �• "
INTENT: It is the intent of this section to allow(lie residents of the`Cows of B unstable to.oper 1U,a hor ie occupation
mdull single family diyellings, subject to the provisunis'of Sectibii 4-1.4 of tlie-Zoning ordinaricc,provided that the activity
sluill not be disceiilible£rolii qutside the dlwellinf:•allele shall be i)o;incre-ase in noise or odor; Ilci,visual,ilteratioii to the
preiilises it'I1icI1 Would suggest anytllilig otller than a residential use; no lllcrease in traffic above tlormal residential volumes;
and no.increase in air or gTounchvater pollution.
After registration mth (lie Building Inspector,a.custonlaryllomi occupatioil"shall be permitted is of.right subject"to(lie
following contlitioiis:
a
•s The activity is carried oil°by the:petniat;Cid resideia ofa single fir llily resiticnti:iltliiclluif;Y unit located«'ithiii
that dictelling unit.
• ,Such use occupies no more than.400 stfum-e feet of spilm, •
"Tliere are no external alterations to the dwelling whic it am,not customary in 1:61deutial lii ildir�gs,-61 there is
no outside.evideiu:e of such use: _
• '.,,,No traffic iidll be-genes rated ill excess,of iloi nail residential vohulies
• Clie use does not.iiivolve the production of Off, I live noise, i�blation su oh( dust"t>r other particulsu iTl,ifter, ,
odors, electiicAt disturbance,heat,ghire,}hunudity or oflier obtectioliable effects,
There is no storifre or use of toxic of h;izlydous ni<i(en.ds; or fla3iinaable or explosii e.niateri;ils,.in e:icess aF
noml�d household quantities.
• Any need for parking generitecl by such use shall lie nlet o`ii the same lot collt uluiig the CustonMiy Home
Occupation,mq1 not cl7'tliin file required f-ont y ird. ZI
• Cllere is no c e(enor storage oi•display of materials"or equilanicnt
" 'Chere'arc no coniiiier`cial vehicles related to tiie:Custo_nialy Ilonie Occupatiou,other than oiie Irafi oroiie
flick-up truck not lcrexceed one toil capacity, gild bile ti,uler not to exceed-20 feet,i lenglli.and not to
e.cCeed %I tires,pm-ked on the same lot Containing the Custonialyy,Hon)e'Occuliatmil.
a • No sigh sliall,be displayed indicating the'Customary Home Oc•cuhation.
'.
ff the Custom,uy Honle Occupatioll'is listed,01.aldverlised as a business,the street address sliall not be x
included.
(N0 persoll shall be employed in the Custorilaiy Floine Occ'iip,ilioii rain)rs no i lic11 uicnt•re'suleut iif till` 4
dwelling unit.
I, the uncle sigriech,;h,n`e Bead alul.atnee,nitli the above lestiiclibns`for uiy Iicirlie occufmtioii.I atil registuiiig.
ftpplu uif:= tw j
TOWN OF BARNSTABLE BUILDING PERMIT,APPLICATION
Map Parcel ` Application #
Health Division ' Date Issued
Conservation'Division Application Fee •00
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
P�ro-ject Street.Address s Q CEO.
c_Villag-e�
�Owner\— M, Address
::::Tye Lepho-n ems' JV t� • oN
Permit Reques
Cfin
A Al
Square feet: 1 st floor: existing p oposed 2n or: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
,ZProject=Valuations tF'Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family - Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: Xull ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing_ new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count
eat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes '�No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
1,�etached garage: xisting ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑e fisting Q7 new; size_
o r
Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Other: c
71
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ a% �
Commercial ❑Yes ❑ No If yes, site plan review # v
Current Use Proposed Use �""•'
co rn
APPLICANT INFORMATION
(BUILDER OR HOVIEOW ENEN R)-3
Name - Telephone Number �7
Address License #
Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
cSIGNATURE 1�a' DATE 02 — 07
4
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL N0.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION: '
FOUNDATION
FRAME i
INSULATION
a FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH ;FINAL .
FINAL BUILDING
i
DATE CLOSED OUT '
ASSOCIATION PLAN NO.
5
J
The"Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le 'bl
�Nanle--Ou w s/or�on/lndividual): �-
City/State/Zip:` /0� 4 'a O�hone.#: . 36
--e—r
Are you an employer? C ck the appropriate box: Type of project(required):
1.❑ 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 g, ❑.Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers'comp.•insinance comp.inclrrance.t-
rtgwrrA] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
31 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.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑Other
comp.insurance required.] J.
*Any applicant that eb'cks box#1 must also fill out the section below showing their workers'coropmsation policy information.
t Homeowners who submit this of davit indicating they are doing all work and then hire outside contractors must subrmt a new affidavit indicating such.
=Contiactars that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
cariployees. If the subcontractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: — -City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL C. 152 can lead to the imposition of criminal penalties of a
fine tip to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the Office of
_ Investicatians of the MA for insurance coverage verification.
I do he certify under the pains-and penalties of perjury that the information provided above is true and correct
Date: —
Phone#
Official use only. Do not write in this area,to be completed by city or town officlaL
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 ohaptcr 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s) along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees, a policy is required Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the munber listed below. Self-insured companies should enter their
self-inanranr,o 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 permittlicense 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 c=cnt
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 ofi file for future permits or licenses. A new affidavit must be filled out each
year.Whore 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 brim leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would film 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 C6mmonweal1h of Massachusetts
Department of Industrial Accidents
Office of Investigattans
6.00 Washington Street
Boston,MA 02111
TO. #617-727-49-00 ext 406 or 1-977-MASSAFE
Fax# 617-727-7749
Revised 11-22-06 www.mas,.gov/dia
� tes
Town of Barnstable
o10HE ra
Regulatory Services
Thomas F.Geiler,Director
BAMSTABLK
MAS&
16 9. ,� Building Division
pTFD t"�� Tom Perry,Building Commissioner .
200.Main Street, Hyannis,MA'02601
vsww.town.b arnsta bl e:ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: 06—C)V'�,—
JOB-WC-A770N;�
number street village
"H 3MB0WNER"_:_.
4 '77.
name home phone work phone#
CURREW MAILWG ADDRESS: 11.
city/town state p c e
The current exemption fo#`"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER '
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to`
be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such _
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be
responsible for all such work performed under the building?permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies feat Iitar,:he understands the Town of BarnstabIP 9ulding Department '
minimum inspection procedures and requirements and that he/she will comply with said procedures and
quirements.
LSignatu, ,o Homeowrier�3 -�
r
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 iom.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
scveral towns. You may care t amend and adopt such a form/certification for use in your community.
°FT"EJr, Town of Barnstable
Regulatory Services
swxxASS. . Thomas F. Geiler,Director _
i639� ��� -
,or�o . Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601 .
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner st
Complete and Sign . 's Section
If Using A " der
I , as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work au orized by this wilding permit application for:
(Address of Job)
Signature of Owner Datea �`
� a
r
Print Name : ' „ ,"'7,:�.�
u y
If Property Owner is apply' -for permit please complete the Homeowners License
Exemption Form on the reverse side.
UAL
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Assessor's office(Ist Floor):
Assessor's map and lot number r ! V � S THE
Conservation Board of Health(3rd floor): •
Sewage Permit number j sesMUL
r. y rua
Engineering Department(3rd floor): i639.
House number Rio rrr
Definitive Plan Approved by Planning Board 19
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
TOWN OF . BAtRNSTABLE
BUILDING ,INSPECTOR
APPLICATION FOR PERMIT TO ) �{
��ryr�✓e �.�I4ce �«�t-
TYPE OF CONSTRUCTION _ "-5 y L�
19
M1
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location L mil`/ 6/r d uP N,,,n O'er
Proposed Use S ��
Zoning District Fire District
4�7�-
O dName of Owner i"S �r/�f 2Address Abe-
Name of Builder l� er Cc Address /fie knee ��„ p S �n„ mA ,,4A odze
Name of Architect / Address
Number of Rooms / Foundation
Exterior Roofingff
Floors / Interior &14
Heating 24 Plumbing
Fireplace Approximate Cost 4,2 9,00,en
Area
Diagram of Lot and Building with Dimensions Fee (�
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I
a I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
1
D
Name k W�/A 4--
Construction Supervisor's License 19 � �
CAHOON, SHERRIE MRS.
L
No 3 5 4 8.7 Permit For REPLACE ROOF
Single Family Dwelling
Location 399 Oakland Avenue
Hyannis
f
Owner Mrs. Sherrie Cahoon y
Type of Construction Frame
Plot Lot
Permit.Granted November 2 , 19 92
Date of Inspection 19
Date Completed 19 r
• =E r
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To Whom It May Concern,
Please check on the following houses on Oakland Road in Hyannis_ 399 and
4 io. These houses are three bedroom single family houses and are being
used as rooming houses. The septic systems are not made for the number of
people that are staying in the houses. On any given night there are between
six to ten cars at these houses. The areas on the yard can attest to that fact. It
seems to be different people, every couple of months.
Please look into this for the safety of the neighborhood. Thank you.
CD.
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oFt roy,
do Town of Barnstable .
iAMSTABLE.A* Regulatory Services
MAC.
i67q.
Thomas F. Geiler,a ,Director
r
EO MA
Building Division
Thomas Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4024 . Fax: 508-790-6230
April 22, 2008
Mr. Laudicelio Guedes
399 Oakland Road
Hyannis, MA 02601
Illegal Apartments: 399 Oakland Road Hyannis, MA 02601
Map: 271 Parcel: 012
Our records indicate that your house at the above-referenced location is currently being
used for more multi-family units than allowed, which is contrary to Barnstable Zoning
Ordinances. Violation of zoning ordinances is a misdemeanor, conviction for which
results in a criminal record.
You must contact this office within 14 days to either: '
• Apply fora building permit to restore the property to a single-family home
• Apply to the Amnesty Program
• Prove that this is a legal multi-family home.
Please contact this office immediately to tell us what direction you wish to take.
nda Edson
Amnesty Apartment Investigator
Building Department '
gforms:zoning3 :�'
Parcel Detail Page 1 of 3
THE o73
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lax
Logged In As: Parcel Detail Tuesday, Ap
Parcel Lookup
Parcel Info
Parcel ID 271-012 I Developer LOT 4
Lot
Location 1399 OAKLAND ROAD ( Pri Frontage 135
Sec Road I Sec
Frontage
village HYANNIS I Fire District I HYANNIS
'Sewer Acct I Road Index 1 1 15
Interactive �� � , w
Map , _
X „
Owner Info
Owner IGUEDES, LAUDICELIO C I Co-Owner
Streets 399 OAKLAND RD I Street2
City JHYANNIS I State MA zip 102601 1 Country
Land Info
Acres 10.37 Use zoning RC-1 a ughbdS 0105
Topography I Level I Road Paved
Utilities 1 Public Water,Gas,Septic I Location
Construction Info
Building 1 of 1
Year 1968 I Roof Gable/Hip �I Ext Wood Shingle
Built Struct Wall
Effect 1407 I Roof Asph/F GIs/Cmp I AC None
Area Cover Type
Int Bed
Style Ranch I Wall Drywall I Rooms 3 Bedrooms
Int Bath
Model Residential I Floor I R oms 1 Full
I Total rade Average Minus . I Type Hot Air I'Rooms 5 Rooms
f
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hitp://issgl2/intranet/propdata/ParcelDetail.aspx?ID-20341 4/22/2008
PPV Parcel Detail Page 2 of 3
V
40 r .
Heat
stories 1 Story I Fuel Gas I Found-ation Poured Conc.
u r2'q.
Permit History
Issue Date Purpose Permit# Amount Insp Date COMM
111/1/1992 B35487 $2,400 1/15/1993 12:00:00 AM HY RE-
Visit History
Date Who Purpose
2/3/2003 12:00:00 AM Paul-Talbot Meas/Est
6/3/2002 12:00:00 AM Paul Talbot Meas/Listed
3/15/1988 12:00:00 AM IML
Sales History
Line Sale Date Owner Book/Page Sale P
1 1/15/2002 GUEDES, LAUDICELIO C 14703/214 ;
2 3/15/1992 CAHOON, SHERRIE D 7910/288
3 10/15/1983 CAHOON, ARTHUR H 3896/242
Assessment History
Save# Year Building Value XF Value OB Value Land Value Total Parc(
1 2008 $119,500 $2,500 $0 $148,800 ;
3 2007 $118,900 $2,500 $0 $148,800 ;
4 2006 $104,700 $2,500 $0 $151,100
5 2005 $98,000 - $2,500 $0 $137,000
6 2004 $79,300 $2,500 $0 $102,800
7 2003 $74,300 $2,600 ' $0 $41,900
8 2002 $74,300 $2,600 $0 $41,900
9 2001 $74,300 $2,600 $0. $41,900
10 2000 $58,800 $2,300 $0 $27,500
11 1999 $58,800 $2,30.0 $0 $27,500
f 12 1998 $58,800 $2 300 $0 $27,500
13 1997 $54,600 $0 $0 $27,500 '
14 1996 $54,600 $0 $0 $27,500
l ttp:Hissgl2/intranet/propdata/ParcelDetail.aspx?ID=20341 R 4/22/2008
Parcel Detail Page 3 of 3
15 1995 $54,600 $0 $0 $27,500
16 1994 $54,700 $0 $0 $31,000
17 1993 $54,700 $0 $0 $31,000
18 1992 $62,300 $0 $0 $34,400
19 1991 $73,200 $0 $0 $48,200
20 1990 $73,200 $0 $0 $48,200
21 1989 $70,600 $0 $0 $48,200
22 1988 $48,400 $0 $0 $21,400
23 1987 $48,400 $0 $0 ; $21,400
24 1986 1 $48,400 $0 $0 $21,400
Photos
a -
hitp:Hissgl2/intranet/propdata/Parcelbetail.aspx?ID=20341- 4/22/2008
oFIMEr Town of Barnstable
Regulatory Services
Y Y
BARNSTABLE, Y .
MASS. Th om as F. Ge it er, D it ect or
i639• ♦�
1639. Building Division
Thomas Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
May 14,2008
Mr.Laudicelio Guedes
399 Oakland Road
Hyannis,MA 02601
Re: 399 Oakland Road EXIT ORDER
Dear Mr. Guedes,.
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.
Your cooperation in this matter is appreciated.
Sincerely
Paul Roma
Local Inspector
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