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Ppstal Service
TOWN O� BARNS'TABLE
BUILDING DIVISION
200 MAIN S'T.
1 HYANNIS,NIA 02601
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Date: Nov. 20, 2018
To: Building File
RE:. Illegal basement bedrooms/Unpermitted work
Address: 431 Pitcher Way, Hyannis
Originator: HFD
Enforcement Process Steps.
1. Initiate local investigation: YES
2. Document/enter into system Yes
13 3. Contact
4. Property Owner Bimal Khadka
Seek access to subject property
5. Seek administrative warrant (if necessary) NA
6. Notify state authorities of findings NA
7. Document conclusion OPEN
8. Referred Building-Bob/Electrical- Bill
Property—270-146
Property is developed (1968) with a 13/story dwelling consisting of 4 bedrooms and 2 full baths on 0.44
acre located in the RB zone.
11/19/2018
As a result of a domestic call, HFD was called when a gas odor was noted. The Gas Company responded
and found nothing but FD found 2 lower level bedrooms without emergency escape provisions. HFD also
installed 2 smoke detectors before they departed.
One basement bedroom was occupied by an adult male and one young child. A space above a desk was
carved out.into a sleeping loft. It is unclear how the child accesses or exits this space. The occupant of
the 2"d basement bedroom was not present.
The electrical and building inspectors were requested to respond by HFD. Bob McK and Bill Amara
reported to the site.
ACTION:
Building advised the Mrs. Khadka that no one can sleep in the lower level.
Written notices of violation will be sent from both inspectors.
Town of Barnstable
Building Department Services
Brian Florence, CBO pD�
Building Commissioner BAMSTABLE
200 Main Street Hyannis, MA 02601 H""�" mW-1'=
K. H:JS•LiTI'FVIIl1'•Y%LTNY.STI.IIl
'/ Y 1639-3014
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Notice of Building Code Violation(s) and Order to Cease, Desist and
Abate:
Bimal Khadka,431 Pitcher's Way,Hyannis,MA 02601 and all persons having notice of this order:
As property owner or tenant of the property located at 431 Pitchers Way, Hyannis, MA, 02601,
Assessors Map 270 Parcel 14.6 and known as a residential structure,you are hereby notified that
you are in violation of 780 CMR,the Massachusetts State Building Code Chapter 1 Section R105.1,
Chapter 1 Section R115,Chapter.3 Section R310,and are ORDERED this date 11/20/2018 to:
CEASE AND DESIST all functions associated with the following violation(s)on or at the above
mentioned premises:
Summary of Violation:
On 11/19/2018 I observed a violation of 780 CMR the Massachusetts State Building Code Chapter
1 Section R105.1 Specifically, Work performed without a permit. Chapter 1 Section R115
specifically Stop Work,and Chapter 3 Section 310 specifically Emergency Egress.
Summary of Action to Abate Violation:
In order to abate this violation and to avoid further enforcement action by this office, commence
immediately upon receipt of this notice the following action: Chapter 1 Section R105.1: Commence
the process to obtain a building permit for all unpermitted work,Chapter 1 Section R115: Stop
work on the property until permitting is in place, Chapter 3 Section R310: Immediately Cease the
use of the basement for sleeping.
And, if aggrieved by this notice and order;to show cause as to why you should not be required
abate the violation in this notice,you may file a Notice of Appeal specifying the grounds thereof
with the State Building Code Appeals Board within forty-five(45)days of this notice in accordance
with MGL 143 c. 100 and 780 CMR. If, at the expiration of the time allowed,action to abate this
violation has not commenced,further action as the law requires may be taken.
By Order,
Robert McKechnie
Local Inspector
or�� copy �ne� Ali
Date: Nov. 20, 2018
To: Building File
RE: Illegal basement bedrooms/Unpermitted work
Address: 431 Pitcher Way, Hyannis
Originator: HFD
Enforcement Process Steps
1. Initiate local investigation: YES
13 2. Document/enter into system Yes
3. Contact
4. Property Owner Bimal Khadka
run Seek access to subject property
5. Seek administrative warrant (if necessary) NA
6. Notify state authorities of findings NA
13 7. Document conclusion OPEN
13 8. Referred Building-Bob/Electrical- Bill
Property—270-146
Property is developed (1968) with a I story dwelling consisting of 4 bedrooms and 2 full baths on 0.44
acre located in the RB zone.
11/19/2018
As a result of a domestic call, HFD was called when a gas odor was noted. The Gas Company responded
and found nothing but FD found 2 lower level bedrooms without emergency escape provisions. HFD also
installed 2 smoke detectors before they departed.
One basement bedroom was occupied by an adult male and one young child. A space above a desk was
carved out into a sleeping loft. It is unclear how the child accesses or exits this space. The occupant of
the 2"d basement bedroom was not present.
The electrical and building inspectors were requested to respond by HFD. Bob McK and Bill Amara
reported to the site.
ACTION:
Building advised the Mrs. Khadka that no one can sleep in the lower level.
Written notices of violation will be sent from both inspectors.
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Parcel Detail Page 1 of 4
IME �s
Logged In As: Parcel Detail fuesday,November 20 2018
Parcel Lookup
Parcel Info
Parcel ID 270 146 ( Developer Lot LOT 84
Location`431 PITCHER'S WAY Pri Frontage 115
Sec Road :, Sec Frontage ,.
Village fHyannis Fire District HYANNIS
Town sewer exists at this address No .� I Road Index
Asbuilt Septic Scan: '
270146_1 Interactive Map '9s .
,I
270146_2
Owner Info
ownerEKHADKA BIMAL.;,.�"",�" co-
Owner
Streets 431 PITCHER S WAY Street2
cityHYANNIS State MA zip 02601 country r
Land Info
............... ....................... ......... ......... .._.._. ......... ......... .........
Acres 0.44 use#Single Fam MDL 01 zoning jRB Nghbd 0104
Topography Levelyu:. .... Road IPaved .:..>I
Utilities Public Water Gas Septic Location
Construction Info
__ _._.._........... ..,.
Building 1 of 1
Year 1968 �� « Roof Gable/Hip ] ext 1Wood Shin le
Built Struct. Wall g
Living 1346 Roof EAs h/F GIs/Cm nc;None
Area Covert p p Type-
Style Cape Cod wall Drywall Rooms ;4 Bedrooms
Model Residential �� Floor nt Hardwood Rooms r2 Full-0 Half ,
Grade jAverage .: � e Hot Alr „ Rooms ...........
Type R 6 Rooms
Heat' Found
Stories 1 3/4 StorleS Fuel!Gas ationPOUred COnC.
Gross2621
Area
Permit History
Issue Date Purpose Permit# Amount Insp Date Comments
6/24/2016 Solar.Panel-Res 16-1392 $17,000 3/13/2017 Install solar panels on roof
12:00:00 of existing house, with any
AM upgrades, if applicable, as
specified by PE in Design;
http://issgl2/intranet/propdata/PareelDetail.aspx?ID=20151 11/20/2018
Parcel Detail Page 2 of 4
To be interconnected with
home electrical system.
6.76 kW 26 Panels JB-
0262486
ADD R-19 CELLULOSE
AND R13 FIBER GLASS
6/30/2015 TO THE ATTIC. ADD R-1 3
5/12/2015 Insulation 201502602 $4,000 12:00:00 CELLULOSE TO THE
AM WALLS AIR SEAL THE
ATTIC PLANE WITH
FORAM
7 Visit History..._
Date Who Purpose
4/11/2017 12:00:00 AM Jeff Rudziak Bldg Permit Completed
2/13/2014 12:00:00 AM Jeff Rudziak In Office Review
5/27/2010 12:00:00 AM Denise Radley Change of Address
2/1/2006 12:00:00 AM Gary Brennan Meas/Est
2/15/2001 12:00:00 AM Paul Talbot Meas/Listed-Interior Access
.......: _.,.. m.. _ ... .... _..,. .... .. ,: _.......
Sales History
Line Sale Date Owner Book/Page Sale Price
1 4/13/2010 KHADKA, BIMAL C191129 $199,900
2 1/11/2010 DEUTSCHE BANK NATIONAL TRUST CO TR C190486 $175,000
3 10/31/2005 BALTAR, SAMUEL G C178400 $328,000
4 12/22/1997 GEMME, JOSEPH M & MARY A C146907 $34,000
5 12/22/1997 CORBETT, MARY A TR' #D712609 $0
6 2/15/1990 CORBETT, JOHN F & MARY A TRS C119751 $1
7 1/15/1990 CORBETT, JOHN F &ALICE C C42842 $0
Assessment History
Save Year Building XF Value OB Value Land Value Total Parcel
# Value Value
1 2018 $112,800 $24,800 $2,700 $93,500 $233,800
2 2017 $105,500 $22,000 $0 $71,500 $199,000
3 2016 $105,500 $22,000 $0 $72,100 $199,600
4 2015 $109,400 $20,900 $0 $70,400 $200,700
5 2014 $101,300 $20,900 $0 $70,400 $192,600
6 2013 $101,300 $20,900 $0 $70,400 $192,600
7 2012 $103,600 $20,700 $0 $70,400 $194,700
8 2011 $123,100 $3,500 $1,100 $70,400 $198,100
9 2010 $122,700 $3,500 $1,200 $108,300 $235,700
10 2009 $122,800 $2,500 $600 $159,800 $285,700
11 2008 $127,600 $2,500 $600 $171,100 $301,800
13 2007 $149,800 $2,500 $600 $171,100 $324,000
14 2006 $130,000 $2,500 $600 $177,100 $310,200
15 2005 $121,300 $2,500 $600 $141,500 $265,900
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=20151 11/20/2018
Parcel Detail Page 3 of 4
16 2004 $96,700 $2,500 $600 $120,300 $220,100
17 2003 $86,100 $2,500 $600 $32,700 $121,900
18 2002 $86,100 $2,500 $600 $32,700 $121,900
19 2001 $86,100 $2,700 $0 $32,700 $121,500
20 2000 $64,800 $2,500 $0 $21,600 $88,900
21 1999 $64,800 $2,500 $0 $21,600 $88,900
22 1998 $64,800 $2,500 $0 $21,600 $88,900
23 1997 $56,500 $0 $0 $21,600 $78,100
24 1996 $56,500 _ $0 $0 $21,600 $78,100
25 1995 $56,500 $0 $0 $21,600 $78,100
26 1994 $58,600 $0 $0 $26,000 $84,600
27 1993 $58,600 $0 $0 $26,000 $84,600
28 1992 $66,800 $0 $0 $28,900 $95,700
29 1991 $75,400 $0 $0 $46,900 $122,300
30 1990 $75,400 $0 $0 $46,900 $122,300
31 1989 $75,400 $0 $0 $46,900 $122,300
32 1988 $54,300 $0 $0 $23,100 $77,400
33 1987 $54,300 $0 $0 $23,100 $77,400
34 1986 $54,300 $0 $0 $23,100 $77,400
Photos
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http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=20151 11/20/2018
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Parcel Detail Page 4 of 4
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http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=20151 11/20/2018
Town of Barnstable
Regulatory Services
OF SHE Tp�
o Richard V. Scali,Director
�xxsr.+sm
Building Division
M'M Paul Roma,Building Commissioner .
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax:. 508-790-6230
Approved:
Fee:
Permit#:
HOME OCCUPATION REGISTRATION
Date: 1 —
Name: _Toe 1 Phone#: S C>g. Z Z0 Z71 1?
Address: 4 3 1 P c.1., Una Village: 41,a,n r i c
Name of Business: —Tc,% C'
Type of Business: ,A, Map/Lot: 0 f L{ �
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the
activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual
alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal
residential volumes;and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located
within that dwelling unit.•
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there
is no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular
matter, odors,electrical disturbance,heat,.glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials, or flammable or explosive materials,in excess
of normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There are no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
I,the undersigned,have read and agree with a restrictions for my home occupation I am registering.
Applicant: / Date: —Z 1 — 1-7
Homroc,doc Rev. 116
YOU WISH TO OPEN A BUSINESS? �a
For Your Information: Business certificates [cost$40.00 for 4 e=rs . A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give,you permission to perate:TYeu must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed.form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and get the.Business Certificate that is
required by law.
DATE: 21ZI7_ Fill in please:
a;:• +r,, ;;; �;01P. APPLICANT'S YOUR NAME/S: \
""" YOUR HOME ADDRESS: 1 3 P a 'Sa L
,�>.:�•a;.•.' i�., ., BUSINESS
,• •� e)�. ;;,+roc; '
r,_'!%�,•',cy(8=i�,i`p YZi' -r•',+�.;r� �d -Z.�0.2'1 1 a , ,
TELEPHONE # Home Telephone Number .S`�t. 2 fed. -2-21 S / Sob Zgo.MA 0
S'P
NAME OF CORPORATION:
NAME OF'NEW BUSINESS TYPE OF BUSINESS Ljg,66
IS THIS A HOME OCCUPATION? YES NO
ADDRESS OF BUSINESS- 3 Gut MAP/PARCEL NUMBER �74 / (Assessing)
When starting a new business there are several things you m.ust do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth '
Rd. &.Main Street) to make sure you have the appropriate permits and licenses required to legally operate your usiness in this town.
1. BUILDING COMMISSIONER'S FFIC MUST COMPLY WITH HOB OCCUPATiii':
C This individual has bee inf rn any peArmieqirements that pertain to this,type of businessRULES AND REGULATIONS. FAILURE TO
MPLY MAY FIE$ULT IN PlNcaq,
uthorize Signa
COMMENTS:
2. BOARD OF HEALTH
This individual has been informed of the permit requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
, i
Town of BarnstableBuilding
s �Post.�1'his<Card�So'-That`�rt>=.�s''U`�isible` From the Street::-FAq�froved�PlansyMust be,Retained on Job,and�this Gard;Must,be Ke t��;%.
♦ MIYAR3CABI.La -;,j .C.,rY rlyi,, .. '�` .,�",X• 4�sat ` !'p 3 ; ,Ya .'' ' " ; ea- :e ,n y<..p
W"S& Pgsted Until FinalInspectionaHas;Been Made, � � � � � :� �'£ � � �� � ���� � � •
p Where a Certificate of`_Occu aric .is Re umed'�s'wch Bui dm .shall,.Not-be.Occu ied°untrlWa:F�nal lns ectidnha�s been made Permit
Permit No. B-16-1392 Applicant Name: Cheryl Gruenstern Map/Lot: 270-146
Date Issued: 06/24/2016
Current Use: Zoning District: RB
'Permit Type: Solar Panel-Residential Expiration Date: 12/24/2016 Contractor Name: SOLAR CITY CORPORATION
Location: 431PITCHER'S WAY, HYANNIS Est Project Cost: $ 17,000.00 Contractor License: 168572
Owner on Record: KHADKA, BIMAL Permit $ 136.70
Address: 431 PITCHER'S WAY q `'
Fee Paid�� $ 136.70
V.
HYANNIS, MA 02601 �r
�Date:�� . � 6/24/2016
Description: Install solar panels on roof of existing house,with any upgrades,if applicable,as specifiedyby PE in Design;To be
interconnected with home electrical system. 6 76 kW 26 Panels JB-0262486 �� � � �� � AAA --
Project Review Req : Install solar panels on roof of existing house with any upgrades if appl cable,a�s�spe cified by PE in
Design;To be interconnected with home electrical system 6 76 kW 26 Panels 1B-0262486
ft
Building Official
This permit shall be deemed abandoned and invalid unless the work authorized by this permit-lis'cornmenced within six mom'onths after issuance.
All work authorized by this permit.shall conform to the approved application;and the approved construction documents for�whi h' permit has been granted.
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All construction,alterations and changes of use of any building and structuresY,shall*in compliance with the local zoning by taws and codes.
This permit shall be displayed in a location clearly visible from access streeorroad and shall be maintained open for public inspection for the entire duration of the work until the completion of the same.
The Certificate of Occupancy will not be issued until all applicable signatures by the.Building and Fire Officials are provided on thi p mit.
Minimum of Five Call Inspections Required for All Construction Work: nff
1.Foundation or Footing �W
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before West flue limng s nstalled�
r a '
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection F
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation
7.Final Inspection before Occupancy l
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.
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Building plans are to be available on site
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
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Cape Save Inc. y`:P41 OF BARNSTARE
7-D Huntington Avenue
South Yarmouth, MA 026641 ?`3 9 2 Ali I I J 6
Tel: 508-398-0398 Fag: 508-398-0399
5/27/15
Thomas Perry CBO
Town of Barnstable
Building Division
200 Main St.
Hyannis,MA 02601
i
RE: Insulation Permit 201502602
Dear Mr. Perry
This affidavit is to certify that all work completed forL431 Pitchers Way,.Hyannis-havbeen
inspected by a third party Certified Building Performance Institute(BPI) Inspector.
All work performed meets or exceeds Federal and State Requirements.
Sincerely,
William McCloskey
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATIONi
Map a70 Parcel I LI r.�ET " ''a?�r Application #�y �fJ
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Health Division 5 :: Date Issued Z ( �
Conservation Division Application Fee �1
Planning Dept. Permit Fee �& V
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
Project Street Address 31 ` Al
Village t4-y oannis
� I (-
Owner jM 4 �� �1 A� kp., Address _ c a�m 6
Telephone 508 a. 9 a MOO,
Permit Request f'1c�� R' 1 cP�(�V1�oSC nn �- 3 GSS +p A
pk� ff PY 1� ceI(ato L fa 'F'�e Wc% 11s, Rig sC I '4-�►I' 1_� A1 nP
h C' i h �Vft,m,
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 4 4 0 0 Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths): existingnew First Floor Room Count i
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 Brd of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial Yes J`/No If yes, site plan review #
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name W1111116A M Ir.A.
Ace Telephone Number 508 9$ 0 3 9$
Address 4tAIr'�� Tn 14ve, License # _LC tog 7-7
l IL m ooJ 164 Home Improvement Contractor#
Email Worker's Compensation # 313 b a 4q
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Y�-� o��'�►
SIGNATURE DATE 5 6 I S
FOR OFFICIAL USE ONLY
APPLICATION#
4�
DATE ISSUED
r MAP/PARCEL NO.
ti.
r ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-20 7
wwwmass gov/dia
NN'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print. Lezibty
Name (Business/organization/Individual):Cape Save Inc
Address:7-D Huntington Avenue
City/State/Zip:South Yarmouth, MA 02664 Phone#:50.8-398-0398
Are you an employer?Check the.appropriate box: Type of project(requlred)<
].ED I am a employer with. employees(full and/orpart-time).*
7. 0 New construction
2. 1 am a sole proprietor or partnership and have no employees working for :in.
0 8: (]Remodeling
any capacity.(No workers'comp,insurance required.]
:
3.01 am a homeowner doing all work.myself:[No workers'comp.insurance requrred.]t 9. E]Demolition
4:nI am:a homeowner and will be hiring contractors to conduct all work on my property. t will 10[]Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees:
12.n Plumbing:repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13 ❑Roof repairs
These sub-contractors have employees.and.have workers'comp.insurance.*-
6.❑We are a corporation and its officers have exercised their right of exemption per MGL,c;
14. Other Insulation
152,§1(4),and we have no employees:[No workers'comp.insurance required.]
"Any applicant that checks box#1 must also fill:out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing.all work and then hire outside contractors:must submit a new;affidavitindicating 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.
Tnsurance Company Name:Wesco Insurance Company
Policy#or Self-ins.Lic.#:WWC3136274 Expiration.Date:04/09/201`6
Job Site Address: 431 Pitchers Way City/State/Zip; Hyannis
Attach a copy of the workers'compensation policy declaration page(sbowing the policy number and expiration date).
Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250:00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations.of.the DIA for insurance
coverage verification.
I do.hereby certify under th pains and penalties ofperjury that the information provided above is true and correct
Si attire: Date: 5/6/2015
Phone#:508-398-0398
Offrcial use only. Do not write in this area,to be completed by city or town official.
City or Town: Permifticense
Issuing Authority(circle one):
1.Board of Health 2 Building Department 3..City/Town.Clerk 4.ElmtricatInspector 5.:Plumbing;Inspector'
6.Other
Contact Person:. Phone#:
Y � DATE(MMIDDIYVYY)
CE1 TIFICATE �F L1AB1UTY 1NSURANCE: 3/24/2015
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
t3ELflYJ THIS CERTIFICATE OF INSURANCE DOES,NOT CONSTIYiJTE A CONTRACT BETWEEN THE ISSUING-INSURER(S), AUTHORIZED'
REPRESENTATIVE O,R PRODUCER,AND THE.CERTIFICATE HOLDERr" '
IMPORTANT: If the certificate haides Is an A.DDI710NAL INSURED,the poitcy(Ws)must be endorsed.. If SUBROGATION US WAIVED,suigect 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 endorsements.
PRODUCER J NAME: Colleen Crowley
Risk StrategleS Ctlmpaay PHONE (7$1)9$6-4400 I,
E FAC, o;a7ti1)963-9920
15 Pacella Park Drive
Suite 2 40 ccrowley@risk-stateges.com
. .
INSURER 3 AFFORDING.Pa COVERAGE NAM
aclolpn +fA Q23f 8 INSURER A:Se�l.ective ins. csF. ,merlca
INSURED _.
INWRERs All�oerica giaauaial All'idnCe 0212
Cape Save, Inc INsuRc7esco' Insurance. Any
7 D Huntington Ave _ ,
INSURER D:
t�
At� TSURERE:
SButh Yzymauth i IJ2��4
INSURERF
COVERAGES CERTIFICATE NUMBER:CL1532491501 REVISION NUMBER:
MS IS TO CERTIFY n4AT THS POLICffSOF�iNSURANCE LISTED SEtOW HAVE BEEN ISSUED TO THE:INSURED'WNA7fA'EL?A`BdVYE TOT'lffE POLICY PE "
INDICATED. NOTWITIWANDINd ANY REiQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTAER DOCUMENT WITH:RESPECTTO ALL TO WHICH THIS
CERTIFICATE MAY BE:ISSUED=OR MAY;PERTAIN;THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN S SUBJECT THE TERMS,:EXCLUSIONS AND CONDITIONS:OF.
SUCH,POLICIES.LIMfTS SHOWN:MAY HAVE BEEN REDUCED BY PAID CLAIMS,;
INSRDMSUBR
TYPE OF INSURANCE SMPO�.EFF PO� EXP LIMITS
POLICY NUMBER
GENERAL11ABILITY
FACH 000URRENCE $ 1,000,000
X. COMMERCWL'GENERALLIABILITY dA tTto PREMISE_ E occuRe e $ 100400
A CLAIMS� a OCCUR Si994486 `t)/16/2014 O/16/2015 MED FXP(Any one person) $ 10,000
PERSONALaADVINu ,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPUES:PER: PRODUCTS-COMPlOP AGO $ 2,060,000
POLICY X PRO X LOC _
AUTOMOBILE LIABILITY
Ea accident 1 000 000
ANY AUTO BODILY INJURY(Per,Person) $
AULOVVNED SCHEDULIA 46796600 1/6/2014 1/6/2015
AUTOS AUTOS> BODILY INJURY(Per accident) $ r
X HIRED AUTOS AUTOS
PR• TYDA>ntAt,E':
P nE $r
$
X UMBRELLALIAB. X OCCUR - EACH OCCURRENCE $ 140.00,000
A EXCESS'LIAB CLAIMs-mADE' -
AGGREGATE $ 1,000,000'
m REtENTION 51994480 9/iS/2014 0/16/2015
Q WORxM;9MP-ENSATI9N $
AND EMPLOYERS'LIApuTY. fflegra niclu ea for X tihC STATU- TH-
ANY PROPRIEfOR1PA,RTNER/EXECUTIVE�vrN OV6r3ge T
OPFICEPtMEMBEd EX>vLL�EErt i=_1 NIA El.FACH ACCIDENT $' S.00 000
{Mandatory in NH) -C313r;G?4 /9/2015 j9/2M 6 `
If yyees.desaibe under El,D3a^EASE-EA EMPLOYE $'
DESCRIPTION OF OPERATIONS belovy ' E:L.DISEASE-POLICY LIMIT $ 50O 000
DESCRIPTION OF OPCRATION51 LOCATIONS 1 VEHICLES(AthcfiACORD 101,AddRienai Remarfcs:Schodule,if more space is requlrerA
Issued as evidenge of insurance.
Thielseh Engineering, Zne. is listed as additional it sured:,..as respects General
_ 'Libilyasreuire .written contract. :required,.
CERTIFICATE HOLDER
CANCELLATION
3118�IIi� Ca�33e]j Ali ts. a+ tee. QSCJ SF(t ULD iANY OF THE A6OVE DESCRieW POLICIES BECANt:ELLED BEFORE
THE EXPIRATION DATE THEREOF, NoTiCE WILL SE DELIVERED IN
Cape Light Conpact ACCORDANCE WWTH THE POLICY'PROVISIONS.
Attn: Mar garet Song:..._ _
pO AUTHORIZED'REPRESENTAnvE
3195 Main Street
Barnstable;:h3�i D2E3i)
chael Christian/CLC .....
CORD 25(Z(it0Jt 5� O 19811401Q ACORreserved-
ON.
,E3 Ct�R611RATdJ�##fiagt>tsINS025(zoloosaot, Tire ACORD name and.logo are registered marks ofACORD.
Building Permit Authorization
I, Bimal Khadka , as owner -
hereby give my permission to
Cape Save, Inc.
7-D Huntington Avenue
South Yarmouth, MA 02664
Office: 508-398-0398
to take all necessary steps to obtain a building permit to
perform work at my property located at
431 Pitchers Way
Hyannis, MA 02601
Signed
Dated /S"
i
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
'� •�,�,,..„, �»�- Registration: 171380
Type: Corporation
3= Expiration: 3/14/2016 Tr# 249649
CAPE SAVE INC. _
WILLIAM McCLUSKEY
7-D HUNTINGTON AVENUE `
SOUTH YARMOUTH, MA 02664 ------- —
44 6 °" Update Address and return card.Mark reason for change.
SCA 1 0 20M-05n 1 Address Renewal E] Employment Lost Card
rTNr•sivau ruveulf�a �l�h�t�rc>rra e%/'
qL
`• Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egistration: a179380 Type: Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
j, xpiration3/114/201.6. Corporation
Boston,MA 02116
CAPE SAVE INC. E `
WILLIAM McCLUSKEY- -
7-D HUNTINGTON AVENUE-'-
SOUTH YARMOUTH,MA 02664 Undersecretary Not vali tthout signature
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Constr-uction Supervisor Specialty
License: CSSL-102776
W ILLIAM J MC C-LUS
37 NAUSET ROAD .-
West Yarmouth?RA
Jam, Jy '� j4` Expiration
Commissioner U6/28/2015
s
t Town of Barnstable *Permit# �
�p Fxpire 6 months frame date
Regulatory Services Fe
&UMSTesi,e, Thomas F.Geiler,Director
nsass.
G 9.
r.•� -PRESS PEA THIding Division
Tom Perry,CBO, Building Commissioner
FEB 2 ® 2Nfo0 Main Street,Hyannis,MA 02601
�F
fown.bamstable.ma.us
Office: 508-862-4�$�VV�I BAR�ISTA Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number 2701 , (o LoT eel
Property Address 3 \0►"o VS, -(A) k si A�n vn i 5
residential Value of.Work ZSoo Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address Saymv"'l
Contractor's Name Telephone Number _S3'7_)e!S: cj �.
Home Improvement Contractor 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
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
Re-roof(stripping old shingles) All construction debris will betaken to ThZ 610 4tey S DI S 02 sa
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)
*Where required: Issuance,of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License is required.
SIGNATURE:
QAW.PFILES\FORMS\building permit forms\EXPRESS.doc
Revise020108
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): sa"" A c�• aa\�ar
Address:
City/State/Zip: 01 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
. 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 ty• $ 9. ❑Building addition
[No workers'-comp.insurance comp.insurance. 10. Electrical repairs or additions
required.] 5. ❑ We are a corporation and its ❑ P
3iE Iam a homeowerdong--all_work,. , officers have exercised their
11.El Plumbing repairs or additions
myself. [No workers'comp. right of exemption.per MGL 12.0 Roof repairs
152 t c. 4 and we have no
insurance required:]' . ,§1( }�
employees. [No workers' 13.0 Other
comp.insurance required.] .
"Any applicant,that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit 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:
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
Investi,gations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
gnture• _
'Si a�.. .�����2- Date:��- ��- o�
Phone#:
Official use only. Do not write in this area,tb 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-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 permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"Lhe 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 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
Fax#617-727-774 9
Revised 11-22-06
www.mass.gov/dia
f -
-f
FtrQ,,, Town of Barnstable
ti
Regulatory Services
sA BM
NAM Thomas F.Geiler,Director
039. 0. Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-8624038 Fax: 508-790-6230
Property Owner Must
>---�
Complete and Sign Thi /Section
l �
If Using A B ' der
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to /orkutlorized by ' building permit application for.
Address ofjob)
Signature of Owner Date
Print Name
If Property Owner is applying for pen-nit please complete the
Homeowners License Exemption Form on the re eve se..side�
Q:FORMS:O WNERPERMISSION
!y
Town of Barnstable
PROF THE 1p��
o� Regulatory Services
Thomas F.Geiler,Director
BARNSPABM
9 MASS*
�A 1639 Building Division
TED �e Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:- b Z O Z
FJQB;LOCATION:_ 4-31 Pi d*,S wa.w AIyrA rza j S /Y!
f number, i street T �y �] village
y.��� 1 eA ►t pq 18 J o 0 I �`S 3 6169 9U
l.�"HOMEOWNER": �i. .slr
`" name home phone# work phone#
' _`,
CURRENT MAILING ADDRESS:�� 0lr4-Z:lnl.✓S (A)AA./ by A,✓vvvt C yyuA oZ-toC->i
^T
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to
be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
S4gnature of HomeownF
� Approval o g rov f Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certiftcation for use in your community.
Q:foT ns:homeexempt
r