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0116 SAINT CATHERINE AVE
&x'nL dL4ttviruf rLf � � ��EG� °$� w ®u.��� '�F GENERAL AFFIDAVIT- The within 'named person .(Affiant) Armando`Barreto who is'.'a resident .of . Middlesex' County; State of Massachusetts- personalty; came' and appeared before me,:the undersigned,Notary••Public and makes this his/herf statement :testimony and General A&id.avit under oath or affirmation m good`faith and under penalty of perjury; of sincere belief and personal knowledge thatythe follo�nnng matters^facts .:and things set;forth are true-antl correct to the best : of his/her.knowledge As the Owner of'Green Choice Insulation LLC Lam°providing this statement as requested by The Town Of Barnstable Building Inspector ` The:msulation`matenal used in.the garage,to family room conversion__at 11.6 St'Cath`Brine,Ave Hyannis;'Ma. 02601 ai GACO One Pass Low GWP-F1880 Closed'Cell Insulation The.detailed:Product Data Sheet,Js Titled GACOrWESI. 4 GJacoOneRass Low gwp`F 1`880 and is da/te1d_January 2018 superseded October 2017 i7IL 4 w Date is }� day of E Oil 6e� 20'' 1 T Signs u of Affiant --------------------------------- State of Massachusetts, County o MidrilPspk tk Subscribed_andsworn to or.affirmed, before me=on`this" '' day of 20 _'6yNAffiant A.Y . p _. StfAO _41 S ign a re of otaiy hli� =4, t 11CIA Aj - .. Com. Notary Public ley Commission E` pries:. M monweaithofMassachusens Commission Expires June u 2025 Town ®f Barnstable Building ` �MAE Wsstt:eoP 03P• ohe r Tdh.iUs nCtairl rdF inSao l Ti nhsa ptasrt i L isio Vni sHibasle BFe re onm°.IaVlhaetl5e treet Ap`p`rTzr oved Plan�fs>MustO be.Retained;o n Jaob an d:this�C ard Must be Kepa t Permit ,..p a'r.., -:. .,««< <.. .,z. ..__: »,.y... ,«�.�:m .,., e ._......�: IIa..,-, �. ..;3'�s,,,.,<,.....air �: Fv-.- ... ad,.,+. ..�s+.:ra`�:,..aa•'r Permit No. B-18-3084 Applicant Name: Approvals Date Issued: 10/02/2018 Current Use: Structure Permit Type: Building-'Alteration INTERIOR Work Only- Expiration Date: 04/02/2019 Foundation: Residential Map/Lot 291-079 Zoning District: RB Sheathing:. Location: 116 SAINT CATHERINE AVE, HYANNIS ContractoName; Framing: 1 �` Owner on Record: MORECRAFT,BRENDA G 'P, actor License Address: 116 SAINT CATHERINE AVE ',Est Project Cost: $3,500.00 Chimney: HYANNIS, MA 02601 ;k PermitFe`e: $85.00 Insulation: Description: To Create Living Space, a.Family Room in the Existing Garage by Fee Paida $85.00 ®l��`f 691'r'1HKK adding a Wall and Flooring and Sheet Rock to�the Existing,Structure Date 10/2/2018 Final: Wall and Installing a Ceiling. Project Review Req: maintain fire separation between garage and"living space, a k -. wl/� - Plumbing/Gas smoke detector required in new family room Rough Plumbing: a Building Official r Final Plumbing: =' Rough Gas: Final Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this„permit„is commenced within siz�moriths after issuance. Electrical All work authorized by this permit shall conform to the approved application and thJg pp roved construction�documents for=whichthis permit has been granted. All construction,alterations and changes of use of any building and structures shall be,in com,piiance with thhdAM"al�zornng by l s a and codes. Service: •,�:, This permit shall be displayed in a location clearly visible from access s&'ek,or°road and shall be�mamtained open for public inspection for the entire duration of the work until the completion of the same. ��;w,? ,�:_�- Rough: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Final: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Low Voltage Rough: 2.Sheathing Inspection Low Voltage Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Health 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Final: 7.Final Inspection before Occupancy Fire Department Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracti with u egistered contractors do not have access to the guaranty fund" (asset forth in MGL c.142A). OF ��✓r p get- Application Number. �... .. � ........ Permit Fee... .... .0).....od=Fee. .. ... NABS. MIS A,� �Owy ......00 ...Total Fe Paid ....... .......On... f.. � ..C. TOWN OF BARNSTABLE Permit Approval by................... ...... . . BUILDING PERNIIT Pa,ce1...V......_... ._. - map..C �v................... ....................... APPLICATION Section I— Owner's Information and Project Location ProPra Address //125/- �'h�er��� -� e - � �s Owners Name City _ 1 �l State"'7_ �Owners-Cell#�--=�� 15 !'� �� r --- -- Section 2—Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet. Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling �._Section�3—'Type of Permil�_�� ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑. Finish Basement. ❑ Family/Amnesty ❑ Fire Ahmn Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall' ❑ Solar Renovation ❑ Pool ❑ Insulation Other—Specify �---Section 4=work Description_ re a r,°!v c / T A.d nndstad:2/9/201 S _ Application Number...................................................... f tion 5—Detail? Cost of Prop so............ Construction �� Square Footage of Project 'J Age of Structure, Safe Number��5 � Dig # Of Bedrooms Existing 3 Total#Of Bedrooms(proposed) 110 MPH Wmd Zone Compliance Method ❑f MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors d ❑ Plumbing ❑ Gas [] Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last imdated:2/9/2019 -- -------- I ' r 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): -rs Address: 'Z r i Yl V City/State/Zip: Qb D Phone#: ��0 Zj Are you an employer. Cbeck 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 workingfor me in an capacity. employees and have workers' Y aP tY• 9. ❑Building addition [No workers'comp.insurance comp.insurance t q e uired.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp•insuranCe required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ' Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signafore: 14' Date: -2-01 D Phone Official use only. Do not write in this area,to be completed by city or town offuial 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 ermittlicense number which will be used as a:reference number. In addition,an applicant � p � PP that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,. please do not hesitate to give us a call. The Department's address,telephone and'fax number: The Commonwealth of Massachusetts I� Department of Industrial Accidents Office ofInvestigations _._... 606 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or'1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 ww«►,mass.gov/dia II Application Number............................................ Section 9—_Construction Supervisor Name Telephone Number Address City State Tip ' License Number License Type Expiration Date i Contractors Email Cell# I understand my responsu'bffities under the rates and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Budding Code. I understand the contraction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section-10—Home Improvement Contractor Name Telephone Number Address ' City State TUP Registration Number - Expiration Date I understand my responsibilities under the tales and regulation for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and . F documentation required.by 780 CMR and the Town of Barnstable.Attach a copy of your H.LC... Signature Date �Section_11=Home Owners License-Ezem-ption ll cHome Owners,Name: d��y'1.0� � 0 r-e 4A� Telhone-Number. eP ��y A7'0D�� Cell or Work Number— 7.7 y-W Z-608a -- — I understand my responsibilities under the rales and regulations for Licensed Contraction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspection and documentation required by 780,CMR and the Town of Barnstable. APPLICANT SIGNATURE Signature S C:Da Date--�� - o NCXa �T hoaNumber �� (' 9_ T e..F nInnnlo Section 12—Department Sign-Offs Health Department © Zoning Board(if required) ❑ i Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercid work,please take your plans directly to the fire department for approval J - i Section 13—Owner's Authorization as Owner of the-subject property hereby authorize to act on my behalf in all matters relative to work authorized by this building permit application for: (Address of job) i Signature of Owner date i Print Name r • 1 .. 1 i I j Last undated:2J92o18 Barnstable Bldg. Dept. / / Approved by. Permit #: s. 22 x ' � �;� �:��r.l:•py,�."•�*f+.c+..�. _ -3-,:. ':kT4:':r'�w'"'yh:awe.•+w...+.� `� .d �...:`�l 1 �Y SMOKE DETECTORS R IE O � �- BARNSTABLE BUILDING DEPT. WWEL �: j cr v' FIRE DEPARTMENT DATE TT BOTH SIGNATURES An REQUIRED FOR PERMITTING 00 00 1 5 T u u 0 3 o 1 1 � � { I G cr a- o � o - � o a 4 � I f" C Q J 1 � F lP i I i i � I - I t a Town of BarnstAile • o�That it�s�Visibfe From the Streets q .roved=Pla s. � -'"' '` "`""° '"• '!vim. '�:>�- -�»�, �s � �� �-���x��� � .�, � ..��„ pp � n Must be Retained�on Job and th�s_CardMist be Ke �.,*$ Building • m e : . . .:: ,.;: ._..� ^cy! Required,such Building shall Not be pied until a Final Inspection has been made 3 ermit r:.a., !.4.. ..' r,..,.Tes�rac:sxi.�aeex..<r�«�..,..�... .. ,,,,..... .. .... .. .rk:�`t, e �=• . Permit No. B-18-3084 Applicant Name: Approvals Date Issued: 10/02/2018 Current Use: Structure Permit Type:. Building-Alteration INTERIOR Work Only- Expiration Date: 04/02/2019 Foundation: Residential Map/Lot 291 079 Zoning District: RB Sheathing: Location: 116 SAINT CATHERINE AVE, HYANNIS n Contractor Name Framing: 1 Owner on Record: MORECRAFT, BRENDA G Contractor License 2 Address: 116 SAINT CATHERINE AVE Est Project Cost: $3 500.00 HYANNIS, MA 02601 = Chimney: r`Permit Fee: $85:00 Description: . To Create Living Space;a Family Room in the Existing Garage by Fee Paid $85.00 Insulation: adding a Wall and Flooring and Sheet Rock to the ExlstmgyStructure Wall and Installing a Ceiling. Date ` 10/2/2018 Final: Project Review Req: maintain fire separation between garage and living space, � .UC`� Plumbing/Gas smoke detector required in new family room Rough Plumbing: Building Official Final Plumbing: Rough Gas: r " Final Gas: This permit shall be deemed abandoned and invalid unless the work authorzed by this permst,is commenced within six months after issuance. f Electrical All work authorized by this permit shall conform to the approved application and the approved construction documents for whicCathis permit has been granted. All construction,alterations and changes of use of any building and structures shall be m compliance with thEe oral zoning by laws and codes. Service: This permit shall be displayed in a location clearly visible from access street or road and shalt Lie maintained"op nfor pyblichnspection for the entire duration of the work until the completion of the same. N Rough: v1. 1 The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Final' Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Low Voltage Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Health 6.Insulation 7:Final Inspection before Occupancy Final: Fire Department 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. Final: "Persons contracting with unregistered contractors do not.have access to the guaranty fund" (as set forth in MGL c.142A). 1' � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION T Map e7 Parcel (�7ej Application Health Division Date Issued -�� Qt,<— Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project.Street Address �• (f"Z-. "-k C,r n e_ -- Village qq j, 41 .5 1"o Owner Yen . Me Ile Address ��� �� �r��L>nr�h � i�-� /T�6io 5 Tele one Pe ni Hequest Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay a� Project Valuation O D O, Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Z Two Family ❑ Multi-Family(# units) Age of Existing St:FLII t re O Historic House: ❑Yes a, o On Old King's Highway: ❑Yes Zo Basement Type: ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing �2_ new Half: existing new Number of Bedrooms: -3 existing —new Total Room Count (not including baths): existing _ new First Floor Room Count Heat Type and Fuel: ❑ Gas U,61 ❑ Electric ❑ Other 47> Central Air: ❑Yes U<O Fireplaces: Existing �'O p g New � Existing wood%coal stove: Yes= �o -'M Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑te i,'sting ❑;clew sze_ Attached garage: existing ❑ new size _Shed: ❑existing ❑ new size _ Other: I ' Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ rn �f Commercial U.Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name n a 9/ 10 hPcr4 Telephone Number s y ��7-17C7ga Address Ur'� �� ems` -11frin,, License# io no,_ w Da(oal _ Home Improvement Contractor# Email j'�j' r��ra�1- ® 1Tv C� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 66TYN S�b/ e SIGNATURE / DATE / G - , FOR OFFICIAL'USE ONLY APPLICATION # E _ DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: " FOUNDATION FRAME INSULATION - FIREPLACE i t ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ?lie Conzinortivealth ojfMassachusetts Deparaneig afrnk.-rrhial AccideFtds u .. 600 Waslrbigion Street Boston,M4.0Z.Ul ivitnnniass govldir= . Mrarkers' Campensaf an Insurance davit:$mldei-s(CuntractGrs/EIectricianslPlumbers Applicant Infati ation Please Print LegibIv Name(BUsiaem'OIg3mIZadonffil&+idml) b0 t Address: ���� 5� ��L`E �e �► n�_ CityfStatefZig: J�-1 Gt.V)h 1 5 0.)�6 D( Phone,,','- . Are you an employ*er?Cb :rk.the appropriate bow: Type af project (regvii ed)c I.❑ I am a employer with. 4. ❑I am a general contractor and I * have hired the su6-contractors 6_ [-]New consfzuctiun employees(full andlorpork-time). , 2.❑ I am a sole proprietor orpartner- Iisted onthe attached sheet. 7. ❑Remodeling 4 silt and have no employees. I'llese sob-corifracto'rs hay a. a• P8_ �Ilemolifion for me in any capacity employees andlmre wodcers' . jNo 'comp.in�ranre comp.insurance.f �'. ❑Building additioned I 5. ❑ We are a corporation and its 10:❑Electrical repairs Ar additions 3. I.am.a homeowm-er doing all work Officm have-exercised their 11.❑Flumbingrepairs ar additions self o workers' right of exemption per MGL �' � canzF- 12.0 1Zflafrepairs . mn ce required,]i c.152,§1(4k and we have no employees-[No workers' 13.0 other comp.insurance required.) i #Any applicant ebat checkshox#1 must also fill out the section below shor ing their workers'compensatwu policg informsdoIL � 1 Homeo viers who submit this af5dz%,R imdic=-4 they are doing all vat sari dim like autsi de contractors nmst submit a new affidavit indicating such! ZContractorsthzt cheat this Irmo must attached asadditional sheet showing thenameof the sub-contrxctm sad state whether arnotthose entitieshave± employees.If thesuh-coat®ctnrshave employees,theymorstpmuids their nvrkers'romp.policy n=ber. I am an ellipl ayer that is prm�dnrg tt�trrkers'canrpertsrrtiorr iirs2lratrt e f or rrry*enrploy�ees BeIaav is the policy rmd jab site is�ormrriiort =y ' Insurance Com.panyName: Policy or Self-ins-Lie. Expiration Date: Job Site Addresr. City/State/Ew: eLffach a copy of the workers'compensationpolicy decIaaration page((showing the pofiey number and respiration date., Failmr,to secure Icovera>,,.a as.required under Section.25A of MiCL c 15'7 can lead to the imposition of crimi l penalties of a fine up to$1500.00 and'ar one-yeari gm"sonmeat,as well as chil penalties.in t3le.farm of a STOP WORK ORDERand a Erne _ i of up to$250-00 a day against the violator. Be ad,6sed that a copy of this statement maybe forwarded to the Office of lavest gatiom ofthe DIA for insurance coverage verrf-rcation_ I rIa Hereby fj�an der tMeprurrs ar naWes ofperjur}a fhatflrs infarmrrtLoirprmzried a6mw ig true a1:d ctrrrectq Phone i�- 00 " Off dal use anly.;Dor stet avrlte in this.area,to be,t frinpleted by cite artopm o,ffrciaL ' City or Tomm.: Pernzitffikense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City1rown.Clerk d.Electrical Inspector S.Plumbmgg Inspector 6.Oither Contact Person: Phone#: - i nformation and lastructions {. ... Massachusetts General Laws chapter 152 regIDres all employers to provide worker'compensation for heir empIoyees- Tar this sty,an mp[zyee is defined as."-.every person]n.the service,of another under any contract of hire, express or implied,oral or writinn" An esrTloyer is deined as"an individnal,paztnership,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 mdivid al,partnership,association or other legal entity,employing employees- However the owner of a dwelling house having not more than three apartmeuts and who resides therein,or tine occupant of the - dwelling house of another who employs persons tD do maintenance,contract ion or repair work on such dweIlmg house or on the grounds or building appurtenant thereto shall notbecanse of such employment be deemed to be.an employer." MGL chapter 152,§25C(6)also states that"every state or local Rcensi g agency shall withhold the issuance nr remewaI f o a license or permit tooP elate a bines uss or to construct.buildings to the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage regni_red." Addidonally,MGL chapter 152, §25C(7)states Neither the commonwealth nor any of its political subdivisions shall enter intro any contract for the performance ofpublic work untti acceptable evidence of compliance with the i„ u-ance.. recf=menis of this chapter have bean presented to the contracting anthozity_" Applicants Please fill out the,workers'compensation sfFdavit completely,by checking to boxes$mat apply to your situation and,if necessary,supply sub-contcaeto*)name(s), address(es)and phone numbers) along with their certificates)of ms rrance. Limited Liability Comparries(LLC)or Limited Liability-Partnerships(LIT)with no employees other than th-e members or partners,are not required to carry workers' compensation insurance. If a-a LLC or LLP does hate employees, apolicyisrequired. $eadvis,edthatthisaffidaYitmaybesubmittedtotheDeparfmentof Industrial Accidents for conf arnation of fi mran ce coverage. Also he sure to sign and date:1ne'affidavit. The affidavit should be retnmed to$e city or town that the application for the permit or license is being requested,not the Department of Industzial`Accidmfs. Should you have aqy questions regarding the law or ifyou are recjaied to obtain a workers' compensation policy,please call tame Department at the number listed beIow. Self-insured companies should enter their self-Tr saran ce license number on the appropriate Ire. City or Town Ofdd2ls t Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of time affidavit for you to fill out m fac event the Office of Investigations has to coufact you regarding the applicant Please be sure to$]l.in the permit/license number which will be used as a reference number. In addition,an applicant that must submit=11141a permit/license applications in aay given year,need only submit one affidavit mdic ti g current Policy info�ation(if necessary)and under"Job Site A d�1m&'the aTppIicant should write"aII Iocatians in (city or town)."A copy of the-affidavit that has been officiaIly stamped or marked by$ie city or town may be;provided to the " applicant as proof that a valid affidavit is on file for fame permits or licenses A new affidavit must be filed out each year.Where a home owner or citizen is,obtaining a license or penmitnot related to any business or commercial venture e ibis affidavit d person is NOT to cam Iet d -tense or ermit�boon Iea�es etc. said regrned p (Le_ a og h p , ) P The Office of Investigations would at to thank you in advance for your cooperation and should you have any questions, please do not hesitate tb give w a call. The Department's address,telephone and fax number: - Department cif ladustial Accidents f�$ce 4f�t�e�iig�tio� ��4nanst=t Bastou,MA E12111 Tel.4 CZ t7-727-4900 CEt 406 or 1-,977- SAFF Fax ff 617` 27 7749 ww Revised424-07 ,mas,-gavldra ^u _ '' , AWC Crdde to Woad Corrstruc dory in fKVz W-nd Areas:IIO Frzph T-Yind Zone Massachusetts Checklist for*Com�Iiaa�e(�so chTR53o1 I_l)i �7 Ch=k . Camplianca 1.1 SCOPE- Wind Speed-p ssm gust}_,�__ _�_.�-------==--- --_. - _ -._ _.'11 D mph Wir d Exposure Category--- _.- Wind Exposure Category..:..........._Engineering Re uQed For Entire Project__.__..__.._..._.....-----_-- ...._C 1.2 APPLICABILITY ' -Number of Smries(a roaf wfic h exceeds B in 12 slape shal be considered a sfnry) stories 5 2 stories - Roof Pith -.___' _-___. ___ -•-(Fg 2) _-__ _ - -- -__ _<1212 Mean Roof Height -- ---__ -___. --__-- ___(Fig 2}__.-- -----• ----•-'----_ft s 33' Bulding W idth,W (Fig Buldim91-and.L - ---_-_--- _.----_ -(F►9 Building Aspect Rafio(11tN) _:__:_•_---•-------__(Fig 4)__-- `' ---- s 3.1 Nominal Height of Tallest Dpeningz•_ ---------(Fig 4)------=---- - - `6'B' 1:3 FRAMING CoNKECTIONS General camplrance with framin { g mnnecbrjns --- �—. Table 2)__-- _---- _ __--- -- --- 2-1 FOUNDATION Foundafian Walls meefing requirements of 78D CMR 5404.1 Concrete.....-.................._ .......................... •-•------------•- - ---•-----•-----••-•--- --------•------- Concr-eba Masonry----------------- ._�_� -- ----=--------- 22 ANCHORAGETD FDUWATIDN1�3 ` 5/8'Anchor Bolts=imbedded or 5/8'Prapdetaiy Mechanical Anchors as an alternative in concrete only Bolt Spacing-general....:-----------•--•-- -- R ) able 4 __-_._____Y rn_ . Batt Spacing from endTomt of plate Bolt Embedment-concrete_-_.- -(Fig 5) N ____ - in.>r Bolt Ernbadment-1Masonry_______.____:___._-__--(Fig 5)Plate Washer—.'----' 3.1 FLOORS Floor-fi-aming member spares checked ____ --.-(per 7BD CMR Chapter 55)_ Maximum Floor Opening almension__---------_(Fi9 6)------- -___-__- ----• ft-12' Full Height Wall Studs at Floor Openings less than 2`from Exfariar Wall(Fig 6)_____________-_____:__--- -•- M"aximrim Floor Joist Setbacks Suppai-ing Laadbearing Wails or ShearxaIl - -__( ig 5 d. Maximum Cantilevered Hoar Joists Supporfing L'aadbearing Wafts or Shearwall:_—(Fig 8)- ----_----------------_: ft <d `F1oorBi sing atEndxralfs-.__ -. _.------__CRg 9)_-� Floor Sheathing Type :_ er 7BD CMR Chapter 55)' (P P - Floor Sheathing Thickness - -(per 7BD CMR Gnapt r 55)---------- rn Floor Sheaffing FastP4bg -- --.._...-..-_-_ -4=_(fable 2)_ ci trails at in edge/ in field ; p Wall He- ight Loadbeating walls.---- (Fig 10 and Table 5)_._. __ ft <1D' Nan4_c)adbearing walls_ -----.- ---- (Fig 10 and Table 5) -_-Y.___$'s 21r �_- Wall Staid Spacing _ __. __ -._.-(Fg 10 and Table 5)___-.__-_irL_<24 a.r- Wan Story 56ats - _ ---___ __- -:_(Figs 7&8)-. - -- - =ft `d ` 4:2"E) I OR WALLS' . Woad Scuds - Laadbe.aring' s . --_- _- - .(Table? - - = .__.2x_- $_in. __ _ Non4_Dadbearingvraffs.__--- --- ----.-__.. (Table5)---. _-_... ._----2x_-_fit_h. Gable End Wall Bracing t - '. Full Height Endwall (Fig i WSP-Aldic Floor Length ____��:-.-___ (Fig 11)---- __ ft;'W/3 'Gypsum Calling Length(if WSP not used) ------:I(Fg 11) -_-_---.-__-�_ft?--D_m and 2 x4 Continuous Lateral Brace @ 5 ft o-c-_Fig 11�______________________-.__ or 1 x 3 ceTl ing furring strips @ 16`spacing grim-vfft 2 x 4 blot_king @ 4 f L spacing in end joist or truss bays Dorible Top Plats . Splice Length (Fig 13.and Table 6)...-- ___._- -- _ft Sisk-CAnned3on(no-of 16d common nails)._ (Table 6)_ A FYC Guide fo FYood Canstrucdou irk Aigh Frirzd Areus: 110,Fnph ff'rrrd Zofie :r' Allrassachusetfs Check for Compliance(7so cmRs30l_z r_r)i Loadbearing Wall Connections - Lateral(no.of 16d common (Tables 7)- Non-Lnadbearing Wall Connac ions Lafefal(no.of 16d common (Table 8) Load Bearing Wan Openings(record largest opening but cheek all openings for corripliance to Table 9) Header Spans -._-__ --_ -- -_--_(Table 9)._-�__�--__ —ft_in-511' - _ Sill Plate Spans ___. (Table 9)_.------___-- -•—ft in.c 11 _ FU Height Studs (no. ofsMds)____-- __(Table Non-Load.Bearing Wall Openings(record largest opening biA check all openings for compfrance to Table 9) Headef Spans--------___-_.___.__---_.-.--_--__(Table 9)-------—_-__-.._ft_in_51Z Sin Plate Spans._ 9):_ _ - _ft—in_512` FuA Height Studs(no_of studs) _(Table exterior Wall Sheathing to Resist Uprdt and Sheaf Simultani�Dusfy4 - Nfmimum Builaing Dimension,W Nominal Height of Tallest Dpeningz ----------------- ---------._._--------•_--_5 6`i3' Sheathing Type -- --- ---;- -{note 4)--- ------ -_ _--_--- - Edge Nail Spacirg _-:(fable 10 or note 4 if.less) _ IrL Field Nail Spacng-_=----._�..- _ -.(Table 10)_ IrL Shear Connection(no_of 16d common nails)(Table 10).__.___-,---------•----_--------_--- Percent FuA-HeightSheafhing__-_:-____-- (Table 10)_---------_---..----------- °� 5%Additional Sheathing for Wall with Opening>.6'a."{Design Concepts} Maximum Building Dimension,L Nominal Height of TallestDpening�_--------------------------------------------------------- :__. ` Sheathing Type-----------_-_---.___(note 4)__-__.�-----------------_--- Edge hail spacing --_ able 11 or note 4 if less _--------_______ Field Nail Spacing__.__- _.__.____.-:_(fable :______ in. Shear Connection(no. of 16d common nails)(Table 11)__..._�,-._______—.—.._. -Percent Full-Height Sheathing______-._____ Fabie 11)__ 5%Additional Sheathing for Wall with'Opening>6'8'(Design Concepts) •- Wall Cladding _ Rid for Wrnd Speed?-__-_-_ __- __- -- - _--- _--__-__---_---- 5-1 ROOFS Roof framing member-spans checked?----__ .(For Rafters use AWC Span Toot,see BBRS Website) Roof Overhang __-_______-___-_______-----------------(Figure 19)____:_-_-- ft 5 smaller of 2`or U3 Truss or Rafter Connections at Laadbearing Walls Proprietary Connectors —•(Table 12)___ ----- ---U= Pl pif Shear_ --- —_--(Table 12).--------------_-- S= pff, Ridge Strap Connections,if collar yes not used per page 21___ (Table 13)_-___�___.___.-.T= plf Gable Rake Dullooker_____-_____---- ure 20 ft 5 smaller of 2'or LIZ ' Truss or Rafter Connections of Non-lnadbearing Walls Proprietary Connecors Upfdt 14) --- __--_ - _U= lb. Lateral no_of i6d common nails able 14 ______L= . lb. Roof Sheathing Type—____:_ __-- (per 730 CMR Chapters 58 and 59)............. Roof`Sheathing Thickness -_-.- - --------- -_ _irL?T11S*WSP Roof Sheathing Fastening.___.-- -----•_--•(fable 2) — Notes: •1. • This checklst shall be met in its entirety,excluding the specific exception noted in 2,to comply%dh the mquireme.nts of M CMR530121.1 item 1. If the checklist is met in its entirety then the fallowing metal straps and hold downs ara not required per the WFCM 110 mph Guide: a. Steel Straps per Figure b. 2b Gage Straps per Figure 11 r_ Uprrft Straps per Figure 14 d_ All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 1 as and Figure 18'b 2 'Exceptiorr Opening heights ofup.to 8 fL shall be perm ted when 5%is added to the percent fu"eight sheathing - requir ernents shdwn in Tables 10 and 11• 3- The bottom sA[plate in exiErior walls&W be a minimum 2 in_nominal thickness pressure treated#Z-grade. r` AfFC Gtcide to fYood Corrrtractiorr irr Ili h W-adAr-cas. IID mph Bird Zone Massachusetts .Checklist far Compliance(7so ChIRS3.01 21_>)r 4. a. From Tables ID and 11 and location of wall sheathing and Building Aspect Ratio,determine Perc6nt Full-Height Sheathing and Nail Spacing requirements b. Wood Struchiral Panels shall be minimum thickness of 7116'and be installed as follows L Panels shall be Installed Wfi strength eras parallel to studs. I All horizontal joints shall occur over and be nailed to framing. uL On single sfofy cons•1TllcBDR,panels shall be attached to bottom plates'and top inember of the double top plate_ iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of paneL Upper attachment of lodrer panel shall be made to band joist and lower attachment made to lowest plate at first floor flaming. V. Horizontal nail spacing at double top plates, band joists,and girders shall-be a double row of 3d staggered at 3 inches on center per figures below:Vertical.and Horizontal Nar-f►ng for Panel Attachment 5. Glazing pratacton a)'new house or hDrhmnfal addition—required if project'is 1 mile or doserta shore(generally,south of Rfe-28 or north of Rta.6).,. .. b)vertical addidDn—not requtred unless there is extensive rend-afion to the first floor-, c)replacenientwiridows-needs energy conservation compliavice only{chap 93) 6.Wood Frarn e Construction Manual (WFCM)for 110 MPH, Exposum S may be obtained from the Ame iM n Wood Council • � YlriBiTHSIDC3E>�ESrSOH • Q n 1�F i1�[LS�Sd iJRiLS u tl'• r rs o t Al - •� �i it 1 _1 r - . .- [7 dt j..- _ • • � a tr t t c � -�I li air `—' U a{ [ 1�6ETaCrT� ll LE qq a •� u a"r S - I � � Z STH' � ii r «r 17 11 i t l t a T i + STAM;ER1 f rAK—�kC,kJCt T j 1'ATrH3bT PANEL Ft H]C� GQUIDFSIAR EDC.:ESPACM DE ML • L Sea 13afa1 pn Nexf Page VerUcal and HDT!mrital Hailing Detall for Panel Attachment , Vertical and Natizantal Nailing faF Ninal Attaclunent F 6 t � 1 ei� lxa[caEAxne'x,'�«.kLffiu'x�l::-a:.ier::�:i 9 ! P � To„yy Town of BarnisUble Regulatory Services - b Si/HITS-MEMM .g zeas $► Rich d P.ScaA Director Building Division Tom Perry,EmTdmg Co *aner 200 Main Street Hyannis,MA 02601 wwW.townbarnstab7e=1 as Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section . if UsingA j -skier a L ,as Owner of the subject property hena�yaz�baiize e to act on mybah� in all matters mlative to work airthorized bythis budding permit application for. . _ we' 6ce-- ((Address of Job) R - ' '~Pool fences and alarms are the responsibr7ityof the applicant•Pools are not to be f&d or iil Zzed befofe fence is installed and all final ' inspections.are performed and accepted. ` S4== of Owner : Signatm-e of Applim W Pant Name P Name lute . QFoxu�s:owr�r�ssmr�oors - . Tow. of Barnstable . Regdatory Services s r � Richard V.Scar,Dh-wfor t F g�gTMTaurx Tom Perry,Bufffidmg Commissioner 200 Mafia&=4 Hymis,MA 02601 Office: 508-962-4-038 Fay 508-790-6Z30 • - HOMEOWI�:R T rf"R�7RR EIO�EQI`I G�,,�� �' o2D//- •piersePriat JOB LOCATION / r/'n °. s v) mmr,bcr' s �oowx: ►�e�1 o y7 7`� '`z`P 1 -c�o�'a - b— phone# wozicphonc# . T . CURRENT.MAMING ADDRES S: ebp/tnFen aP CDde The current exemption for`homeowners"was extended fo mclIIde owner-occgpied dweIImes of sic imits or less and to allow homeowners to e engag an individual for hirewho does notpossess a license,Ptoyided that the owner acts as supervisor_ DRF2U;rL0N OFEIMEOWNM P erson(s)who ov ms a parcel of Iand onwhich helshe resides or intends to reside,anwhich there is,or is intended to be,a one or two- fiimily dwelling;attaeht:d or detached structures accessory to such use and/or farm shractums. A person.who constructs mare than one home im a two-year period shaTl notbe consid -ed ahomeowner. Such`lomcownce'.shall=bmitto the Bm'Iding Official da a form ac=ptable to the Bm1dmg officK thathelsha shall be rr RonsinIe for an mchworkperR=ed underlhcbm7dmZ Permit (Section 109.L 1) The undcnEgacd`horaeown -ass=zs respon-;IMiy far courpliance wWithe State Burldmg Code and oilier applicable codes, bylaws,rules and reg latious- _ The undersigned`homeowne a cmt5=thatbelshe understands the Town ofBarnstable BuIIdmg Deparim=t—in-=inspection procedures and repq��ui rcmenfs andfbat helsho wU.comply whit said procedmu andreqo:ir=ezEts. signahaa ofHomco W= Appmydl ofBmIr mgO&cial • Note. Three fay dwcEngs contiini g 35,000 cubic frd or larger wMbe reqah-cdto wmpp y witirtTie State BmZding Code Section 1227.0 Cans•Cro-e11.oa Canhnl. . • Ho ' E�IIox n�owrzL�S The Code stairs that: `Any homeowner performing work for which a bulZdiag permit is reed shall be exempt from the provisions of this section(Section 109-U-Lire of construcfion Supervisors);provided that if the homeowner engages a person.(;)for hire to do such work,that such Homeowner shaIl act as roper dmr." Many homeowners who use this exemption.are nnaware.that they are asslmg the respow1bMdes of a supervisor (sec Appenabc Q,R-ules Bs Regulations for LicenA g Constradinn Sipervisors6 Section 2_I5) This Lack of awarnne;s often results in serious problems,pa&a larly when fhe homeowner hires unlicensed persons. In this case,our Board cannot proceed ag2h=t the u nUcensed person as it would whir a Iiceased Supervisor_ The homeowners acing as Supervisor is ultimately responsible. To ensure that the homeowner is MY aware of his/her responsibSifies,many communities requae,as part of the permit applicafion,tbat the homeowner certify that hehh.e understands the responss-bsMes of a Supervisor. On$ie Last gage rare t amend and'ado t such a formIcerfifle�nn for use in ea$ used b ,severer towns. You may P ' a form enrr of this issuers y y your commmzity. Q-IATPF�FaB2�d5�f""�rr=a P e®itfr�s«R�Ce-moo Revised 0613I3 . , o � O r � R t: • � r o^ � 1� 91 Do•-_- 1s185s900 03-02-2012 1 :04 BARNSTABLE LAND COURT REGISTRY (SEAL) THE COMMONWEALTH OF MASSACHUSETTS LAND COURT DEPARTMENT OF THE TRIAL COURT 2012 MIS( 12 MIsc 459674 ORDER OF NOTICE IIINIII��IIIIll><1NIIII�UIIIII�I�I II�1l�Illi�ll�llllldlf��ll To: Brian E.Morecraft;Brenda G.Morecraft and to all persons entitled to the benefit of the Servicemembers Civil Relief Act,50 U.S.C.App. §.501 et seq.: Bank of America,N.A. claiming to have an interest in a Mortgage covering real property in 116 SAINT CATHERINE AVENUE, HYANNIS(BARNSTABLE)given by Brian E.Morecraft and Brenda G.Morecraft to Mortgage Electronic Registration Systems,Inc.,dated May 5,2006,and registered with the Barnstable County Registry District of the Land Court as Document No.1034675 and noted on Certificate of Title No. 154611 and now held by the plaintiff by assignmen �O -n Ro UEhas/have filed his o a com t for det i of ndanYs e e d s' members status. . If you now are,or recently have been,in the active military service of the UnitedStates of America,then you may be entitled to the benefits of the Servicemembers Civil ReliefAct. If you object to a foreclosure of the above-mentioned property on that basis,then you or your attorney must file a written appearance and answer in this court at Three Pemberton Square, Boston, MA 02108 on or before APR 0 9 2012 20, or you will be forever barred from claiming that you are entitled to the benefits of said Act. Witness,KARYN F.SCHEIER Chief Justice of this Court on FEB 2 4 2012 U Attest:ATRUE COPY F IC t.. s v ATTEST: f1w - C Deborah J.Patterson ;4 r < Recorder G �= RECORDER 3 z (PLEASE SEE REVERSE FOR RETURN ON ORDER OF NOTICE) . b ; r� BARNSTABLE REGISTRY OF DEEDS 201112-0168-BLU �easu fie/S Q�2�e pid 1242068 .vid 89910 REGISTRATION AND CERTIFICATION FORM FOR FORECLOSING/FORECLOSED PROPERTY Thank you for registering in accordance with Town of Barnstable Code chapter 224 sections 224-3 and 224-4. Please complete one form for each property in foreclosure, (section 224-3) or already foreclosed for which possession has been taken(section 224- 4). Please file the original with the Building Commissioner and a copy with the Chief of the Fire District in which the property is located. If you claim you are exempt from registering under Massachusetts law,please state the reason(s) and complete section 1 (property information) and the first paragraph of section 2 (foreclosing party, court, etc. and foreclosing party representative, but not other representatives and attorney) so that the Town can review the exemption and update its records: Section 1 -Pro pea Information Property Address:. 116 Saint Catherine Ave, Hyannis, MA 02601 . Assessors Map#: 000291000000000079 Parcel #: n/a Land area and description n/a Building(s) description and contents Single Family Residential Occupied: yes Occupant(s)(if borrowers so state and include name(s)) MORECRAFT, BRIAN (Legally Occupied) Phone: 800-468-1743 email:vpr@fieldassets . comother: { Vacant: Date: Anticipated Length of Vacancy: Last occupant(s) )(if borrowers so state and include name(s)). n/a Phone: . email: other: Has possession been taken If so,please explain and complete and file the maintenance and security plan form(unless exempt as stated above) e9 STA10 Section 2-Foreclosing Party Information Foreclosing Party (full name/title) Nationstar Mortgage � �` :`� ��� v E �a i�►iil Foreclosure Case Court: n/a Dw t# n/a Nationstar Mortgage :1 1GVE AIM :iO NIMOI 350 Highland Drive, Lewisville, TX 75067 800-468-1743 or vpr@fieldassets . com „ „x,, r Date filed: 0 2/2 2/2 013 Current Status: Default Foreclosing Parry's representative(s) for property (entry, management, repair, etc.)(name,title,): Miguel Lopez Company (if different from foreclosing party): All State Services Address: 4980 N Main Street, #824, Fall River MA Phone:800-468-1743 email:vpr@fieldassets . comother: 508-536-8209 If an exemption is claimed, please do not complete the remainder. Other representative(s) (if foregoing representative is primarily responsible for property and/or foreclosure and is most likely to be able to address town matters concerning the property and/or foreclosure,please so state and do not complete contact information(i. e. "none" or"see above")). Name,title, other: Company (if different from foreclosing party): -field asset Services Address: 101 W Louis Henna Blvd, ste 400, austin TX 18728 Phone(s):800-468-174--fomail(s)vpr@fieldassets . co other: Name,title, other: n/a Company (if different from foreclosing party): Address: Phone: email: other: Attorney representing foreclosing party Firm name (if different from attorney's name): n/a Address: Phone(s): email(s): other: I acknowledge that the information provided is accurate and correct. I also understand that any inaccurate information will result in non-compliance with section 224-3 of chapter 224 of the Code of the Town of Barnstable. Date: 04/14/2014 Name: Melodie Bill n s ` Title: FAS Agent I hereby certify that the above-named foreclosing party is in compliance with the provisions of section 224-3 of chapter 224 of the Code of the Town of Barnstable. Date: Building Commissioner, Town of Barnstable } r[UIU Mtit CM JCrvIUCJ,�t_v ru i vy. �uuw r rcrirra uivu,vw.-vuu , Ny Vendor: 89910 Town of Barnstable 4/17/2014 Account# Address Invc Date Work Order# Invoice Nbr' Amount Paid Total Chk Amt 116 ST CATHERINE AVE 04/16/14 20665633 wo-20665633 10,000.00 10,000.00 Check Number: 00131347,17 ...................... ------------------------ _ Y k OF AMERICA � :: fIElDASSET r. 1�5ERYICES y � 3r��-�a 4.1•0}1 �1/��,;��.y,,�'- ,�' p � a q-> 0t",ti�1;r1u� 7 00,13134 o DA Wn f::r' +f,r Austin pTX 78728 e. X 'F R�va� ` p -" i' atiz `�s-'�' + ` fi ..,0R s (51:2) a 1537 ' � ******* '� f 10,0005 0 .� �."r �k^ .re•,"S.'�s- ,€,tS�5" va f L� u- � �l a.�. rz,- `'akPAY'`Te1T110:11'SanCl0 -4r v .,r .;, ,s-rrr 14.E-- - CM` Y,;, r Ru ° a k " . 4'av + a .;c q i.�v"rp, '�` . y x +w ar '14rN _5� iJ�• x v�^^� �3t'a� f .. r� *'dr'Ba c^SP 4"rua° t} xt"s:.tt`a � ,asAf" cZA e � " F T THE �rGTOWIlr Of Bar istable x rt t [K, i rz a 53 -Tdt L a `fir 3 r Q. { ORDE1t.OF,zy r wpu1�11C Health»-�D1v1S10I1 +. t gk _rt7r.f'" �' w4 4- S r en :ty u+- E4 ;t 9 Hyanns2MAd Ft,".*# '' �rF,rz..�+Ft^S•G+"��xv�:'� r��,�?4'i �,�� 'tu3e'��**��'x � ?;a'r r�.,�,� +r'� tia .,�Z4'� -eJir:..� :%��i,.'��'�y"�t}„5�`z '� 1 �°,�5�^ � *, 1�%;:r wtd �` �F x;;:'�, .�,."°er.� E ��• v- .• q: �+r�"'x- �aM' � t x. --. 't•„dau�� _1� � ...- `. w.�:rT4trL�, yC r3F.-,. .1�,.„c.k,.x '!� '� .�� :„,,r;y� r,?-"a..._. .,...ram,.�N.,,. .. z.=�7-�-�,",--...4.L,.. ... •., .. .-� .. �'Rr.:.as.,c,e _,. n„h. r. .� 11100 L 3 L 3 4 4 L 711' 1: L L 10000 2 SI: 00 S•78 LO 2 7 2 7 Le Last occupant(s) )(if borrowers so state and include name(s)) n/a Phone: email: other: Has possession been taken If so, please explain and complete And file the maintenance and security plan form(unless exempt as stated above). Section 2-ForeclosinngPgjy Information Foreclosing Party (full name/title) Nationstar Mortgage Foreclosure Case Court: n/a Docket# n/a Nationstar Mortgage 350 Highland Drive, Lewisville, TX 75067 8.00-468-1743 or vpr@fieldassets . com r'y '1d o1 CAPE N S U L A fi ?IQ1W fir/ g. 241 /IY(Y 0IMS S[q M[[SS Sppi fOq[I SYSp(NO(p \q(T5 GY(Tik$ IHSY[Pl(OP`R.i(1}IHp 1-800-696-48 14'0 6 OX -4-Z9-13 p� I'owri of Barnstable Regulatory Services Building Division 200 Main St Hyannis, A 02601 oil Date: j�p�/3 Dear Building Inspector_ Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector, All work preformed meets or exceeds Federal & State Requirements, Property Owner Property Address Village �cAly� � Insulation Installed: Fiberglass Cellulose RNalue Restricted Unrestricted Ceilings ) (X 06 Slopes ( ) ( ) ( ) ( ) ( ) Floors Walls ( ) ( ) ( ) ( ) ( ) Sincerely He y E C, sid j , President , Cape Cod nsulation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # 'Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee35 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner Address (% � Telephone �� 06 968 Permit Request o � �� 0??✓� (/LAG(// J �Z GPI � °�� �r�v �� cc • �n �► Square feet: 1 st floor: existing proposed 2nd floor: existing proposed TotaLnew C:� « `"' _ Zoning District Flood Plain Groundwater Overlay "� - (gem tah-� `�: Project Valuation Construction Type � : Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sup orting documeration. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) na Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's H ghway: UYes No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size — Other: Zoning Board of Appeals Au horization ❑ Appeal # Recorded ❑ Commercial ❑Yes Nc If �es site plan review # Y Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 1W CO Telephone Number 4 �2 57 Address �� �� �ense # /9/� Home Improvement Contractor# Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 7i� d r FOR OFFICIAL USE ONLY 3 ti APPLICATION# t DATE ISSUED z l MAP/PARCEL NO. ADDRESS VILLAGE f OWNER f i DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL `t 1 ' PLUMBING: ROUGH FINAL Fj GAS: ROUGH FINAL 4 FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. N11assachusetts - Department itf Public Safety Board of Buill(ling Regulations and Standards' 0 construction Supervisor License Licen CSC 100988 HENRY CASSIDY . 8 SHED ROW WEatT.'*ARMOUTH, MA 02673 Expiration: 11/11/2013 ('iuuwisiuer Tr#: 7620 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2b14 Tr# 233831 CAPE COD INSULATION, INC • HENRY CASSIDY 18 R E A R D O N CIRCLE -----____-- SO. YARMOUTH, MA 02664 ---------------_ ._____._ _._ Update Address and return card. Mark reason for change. Address Renewal Employment Lost Card SCA 1 20M-0511 i - C'T11 l *""9/l.3l""I.elK'CGlriC-O�C?i 1&"Iiac lLl4GffJ - P"\ Office of Consumer Affairs& Business Regulation License or registration valid for individul use only ;T-- IMPROVEMENT CONTRACTOR p before the expiration date. If found return to: -• ___ OME _registration: 1 3567 Type: Office of Consumer Affairs and Business Regulation xpiration 12/1"5/2014 Private Corporation 10 Park Plaza-.Suite 5170 io Boston MA 02116 CAPE COD INSULATION INC HENRY CASSIDY 1. 18:REARDON CIRCLE' � y �L SO.YARMOUTH, MA 02664 tlndcrsecreGa�ry of val' witho t nat re _ Cllent#:4597 CCINSUL CERTIFICATE OF LABILITY II`Il UR/�ANCE =(NINlft)l)jy)yj5SUEO ASA MATTER OF INFORMA'Hc.)NONLYANDCONFERS NO RIGHTS UPON TIiG CERTIFICATE HOLD —-- CERTIFICATE DOES NOl'AFFIRMATIVELY OR NEGATIVIELY ANIL ND,EXTEND OR ALTER THE COVL'-RAGk AFFORDED UY THE,POLICIES t"EL,OVV,1 HIS CERTIFICATE OF INSURANCE DOES NOT CONS II'i ul F.A CONTRACT BETWEEN THE I;IgUING INSURER(S),AU'l WRIL,LII REPRESENTATIVE OR FPr10OUCER, ANO THE CERTIFICATE IIOLOCK IMPORTANT:It tho cerllflcate holder ib all) bOITIONAL tNSUIa p.'jj�r pulicy(les)must be endured.II`SUf3RQGATION IQ WAIVGD,sub(u j to tn�(C11118 UfIL1 CU14LHtloII?A critic pollcy,cartylrl pullcles tlII CIGIJ "lay A n(LoINIICJv IMldur irl C ph15 t81tIIICUp(D(;1 IIOt CUntCr r(I1lS lU IIIC45U4h 6nICnl(S). 'IuruuCUl NAME: Mal aret YOUIIU.' -'_----•--- ------....._--_--Rutiera &Gr;-1y Irrs. -5d. Oarl�acs _ '�J�{I'(0lltd I34' PHONE T Al( c Nu Ean 508-760,4G02 91f 6 -- E-MAIL 16.2ISU Su41H1Uunnlr, MA 02G60-"1G0'I UH J`111 '79it0 -- - wrfuRl;Hla)Arrar+tANu cavErinal: Ir+awa_c :_ ,103J9 CapO Cod Insulation Inc wsuRERd:Evanston Insw'anc©Company ---- -- _... '''�`a aLln()uth huaU INsureltc; Atlantic Charter Insul'bnce IN9URERD:GOrn111C'fC@In6urahceC�L1111 In - ' Ilytuutis, IUTA 02u01 p� y 34754 IWURER E -------- 4LRFIFICA1(w NUMBER: RLVISION NUIviuL R Tlu ft) ('t:R1lF1 IHA'I' 'I HE IJUI IL Ir Ur wtiURANGE u,'IED nu, tv HAVE BEEN.,.,------UED TO-INE INSURED NAMED ABOVE I-OR I Hk POLICY I)ERioo NUI yt L,U. 1'10)Wll r-I,yI ANDING ANY Rt_ l-IIREMImNT I ERNI OR CON'ITIOPI OF ANY CONTRACT OR OTHER DOCUMENT WITH FzespEC1 TO W111011 Il Is -;CR1IFIGATL. MAY LSE: ISSUED OR MAY PERTAIN, THE INSURANCE ArrOROEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL. THE 'I'EaiMS, icXCLUSIONS AND CONDI I IONS OF SUCH POLICIES. LIMITS SHpwN Iv,,;1` rby4�6EEN RGQUCED BY PAID CLAIMS. ITR I V;OF1N8URANGE ADDLSU4R POLICYEFF 244 LIGYekp �A 4ENLNAL LIAk11L1Tt' -_._._ IMMIDDIYYYYI 0p/YWYI LIMITk'CBR82630&i410112012 0'11201` EACH OCCURRENCE — $1,000 DOU _X i OMMttKGIAL GL-NFR(r--A----L--LIABILITY eNrea . ..I C:LAIMti-MAUL l ^I OCCUR ... t✓lEp E.XP(Ally and Uaroanl 1 h�001)---...----- __._....--.--.. P9114QNAh s AOV IN.IaKY r'I 000 00(1 _ --- GEgf-R I..AQIIRQGA11� a�,UUII,000 i,'N'L A4QIAC,(1AI k L1MN'APh'LIGtI VR(} PRUOLIGTS-GOMI(OI AGG y Q, uUyUl1N I) AUTOrdnNlLk LIALIILI'rY — --.- 12MMBGKUmIr 41D912012 Ga1011201; CUNIDIwLDSINGLGi:iIilT, ... vaY ntJ rU Ea atwa�rn-lJ-- ..It 000 uou..--— - .-.. ALL()VVNffD 'X-- - 0401LYINJUR'h'(P<rF�,.o„) ;p _ scHruuleD ___ __ _.. AUIUS AU'I'U$ BODILY INJURY(Pu,:IocidroLL) & --_ X f(IRED AU ToS NUNOWNEU _ AUTp3 PROPEfiT1'LIANIAC-k'----- s H X UMk1Rkl LA LIAtl -._.. OCCUR ;, 410,112012 XONJ45351 04)01I201' CACIOCCURRENCIE I.1 000 000 __ GLAIMSNIAQE , XI nl:ItNnarl ;IU00U 41luUuLUUU C wunntRp l umrtNdHnoN- � —_- ----- +' ANU EMPLOYER$ LIAMI.IrY WCADU5259o',> 613U12U12 UGI90I20'I' X YV(;Sirilu 1bill, ..._ . .... AN" PRQI)HIL'}L1 pgH1rIL I KhCU rIVA YIN {,Ylhlll h.-...l,k)—Ov (111I L17JNtE•MBEtt L((1.U0 �h Al 1 NIA C,L,GCr1 ACCIOkN'l' 1 UUU UUU (hlwululor L;_,.l y�,I NH) (WSCNi Ut) dnatl e.L.l)ISCAszc..IsA eM�l.ovct 'I 4UU 0UU _. _.l'71-SP TtON OF '-- .- --_--- C L OISCAEiF-POLICY Lli il' U[tlt:RII'IIUN Oh'ONL-k4:f10Ny 1 LOCATIONS)VEHICLE$(Adaab ACORU 1111,Addhlu—J kwnwMc tishtlaultl,It IAPN BpgFa IB(tl(I IIIItlU) Wor{iers COrnp Infurrnation 1. 11 10010 Cftic@rs ar I'roprll�tt�r5 CortlrlCate t-IOldcr is IfICIuded tis an aciditional insurad undue Gunnral Liaoiljty Wholl rOqulro(1 by wrlttoll. contract Or agreement. ('ERTIhII,AI t_14OL DER .......... -- ------ CANCELLATION Ca))b Gory Itwulatioral lnc SHOULD ANY OF THE ADOVE❑k$CRIaEO POLICIF.,S DIE GANI:kLLI;n HIcI-GRE THE EXPIRATION DATE THEREOF, NOTICE WILL bE DFLIVEkeu IN ACCORDANCE WITH THE POLICY FROVIWON3. AUfhQRIZLO REPR@SENIATIVE (D�190 -2U10 ACORD CORPORA'FION,All 091-10 tvaiviYutl. "c(11t1)za(solo/os) 1 of'I The ACORV Rama and 10gl)and rgktarod marks of ACORD. - tFs U40/Ma3840 MEY t The Commonwealth of Massachusetts Pint Form_ Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A )licant Information Please Print Legibly Name (Business/Organization/Individual): a Address: City/State/Zip: MA' Phone #: -r2DO- jl " - (Z Are you an employer? Check t e appropriate box: Type of project(required): I. I am a employer with Z10 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 1 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. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof re a rs insurance required.] .t c. 152, §1(4), and we have no �j a f V /D employees. [No workers' 13.� Other W rK h comp. insurance required.] *Aiiv appliciuit that checks box#1 must also till out the section below showing their workers'compensation policy information. r llomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. 'C'onuractors 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 um an employer that is providing workers'compp�e�nssation insurance for my employees. Below is the policy and job site irtf rtrmatian. Insurance Company Name: �vt�L -wl(�lit,� �i�/ Policy #or Self ins. Lic. #: WG��Dj 2�? �D� Expiration Date: C�' Job Site Address: �, "A, Cit /State/Zi : �►'U'l ) Y p / Attach a copy of the workers' compensation policy declaration page(showing the policy num er and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 cer f nler the ainstLnd penalties o er'ury that the in ormation provided above is true and correct. Si matur Date. I 22 Phone#: Dfficial 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#: OWNER AUTHORIZATION FORM I, ( s Name) owner of the property located at /Asrio ny� (Property Address) NVO n - (Property Address) hereby authorize CCX C aj (0. (Su actor) an authorized subcontractor for RISE Engineering,to act on mybehalf to obtain a building permit and to perform work on my property. „ Owner' Signature `\ Date t 12/4/2012 HOMEOWNER Brenda Morecraft called inquiring about a Certified Plot Plan. No permits have been pulled so there is no folder. She stated she is going through the Amnesty Program (Growth Management). Told Brenda if she had a mortgage or has a mortgage to check her paperwork or she could check with the Barnstable Registry of Deeds. Spoke with Robin Anderson regarding this property she would also like to have this property flagged. Parcel Detail. Page 1 of 2 e B tRNSTA CO eo } Logged In As Parcel, De tail Tuesday,December 4 2012 Parcel Lookup Parcel Info Parcel ID I291-079 Developer Loot 17(BLOCK 3) Location 116 SAINT CATHERINE AVE I Pri Frontage. Sec Road("M�ARYALICE LANE Sec 9r� I —L) Frontage( Village FHYANNIS _�I Fire District I HYANNIS Town sewer exists at this address INO ( Road Index 11405 I C Asbuilt Septic Scan: ` 291079 1 Interactive 291079 2 Map Owner Info owner jMORECRAFT,BRIAN E& BRENDA G Co-Owner Streets16 ST CATHERINE AVE : I Street2 city iHYANNIS � �I State!MA Zip 102601 Country ,w Land Info Acres 0.31 -Use Single Fam MDL-01 IZoning RB Nghbd�0104 _ Topographylevel - I Road FPaved Utilities,Septic,Gas,Public Water I Location Construction Info Building of 1 Year€ Roof _ Ext Built 11967 struct rGable/Hip I Wall iWood Shingle Living" ..._ _ Roof _ _ AC�"". _ Area1616 I Cover Asph/F GIs/Cmp._ Type None rt� Style�Colonial _ Int(�D all_ A Bed 3 Bedroomsnzr .Wall i I Rooms '4r f Model'Residential Int Car et Bath 12 Full+ 1 H Floor p Rooms a Grade. Average �I Type Hot Water RoomsTotal 1 7 Rooms ) _ Stories�2 Stories Heat Fuel Oil Found- ation Iroured GOnC. Gross�3132_ I r Area • Permit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=22634 12/4/2012 Parcel Detail Page 2 of 2 Issue Date Purpose Permit# Amount Insp Date Comments 3/1/1990 �1333574 $30,000 11/15/1991 12:00:00 AM HY GARAGE Visit History Date Who Purpose 3/9/2001 12:00:00 AM SM Meas/Listed-Interior Access 10/15/1987 12:00:00 AM ML Sales History Line Sale Date Owner Book/Page Sale Price 1 9/1/1999 MORECRAFT, BRIAN E& BRENDA G C154611 $164,900 2 6/3/1997 BRODD, DAVID M&ELIZABETH M C144662 $1 3 6/15/1990 BRODD, DAVID'M C120804 $50,000 4 BRODD, HERSCHEL J C64518 $0 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2012 $134,300 $32,700 $2,300 $67,600 $236,900 2 2011 $161,400 .$3,400 $0 $67,600 $232,400 3 2010 ' $161,900 $3,400 -10 ;,. $104,100 $269,400 4 2009 $169,700 $2,500 $0 $140,700 $312,900 5 2008 $176,700 $2,500 $0 $146,600 $325,800 7 2007 $176,200 $2,500 $0 $146,600 $325,300 8 2006 $161,500 $2,500 $0 $147,100 $311,100 9 2005 $148,200 ~ $2,500 $0 $133,200 $283,900 10 2004 $120,500 $2,500 $0 $99,900 $222,900 11 2003 $106,160 $2,500 ' $0 $30,300 $138,900 12, 2002 $106,100 $2,500 $0 $30,300 $138,900 13 2001 $110,000 $9,500 $0 $30,300 $149,800 14 2000 $87,400 $2,800 $0 $19,800 $110,000 15 ,1999 $87,400 o- $2,800 $0 $19,800 $11.0,000 16 1998 $87,400 $2,800 $0 $19,800 $110,000 17 1997 $85,100 $0 $0 $16,500 $101,600 18 ' 1996 $85,100 $0 $0 $16,500 $101,600 19 1995 $85,100 $0 $0 $16,500 $101,600 20 1994 $87,100 $0 $0 $23,800 - $110,900 21 1993 $87,100 3 $0 $0 $23,80.0 $110,900 22 1992 $89,200 $0 $0 $26,400 $115,600 23 1991 $96,300 $0 $0 $42,900 $139,200 .24. 1990 $96,300 $0 $0 $42,900 $139,200 25 1989 $96,300 $0 $0 $42,900 '$139,200 26 1988 $69,200 $0 .e ; $0 $19,600 $88,800 27 1987 $69,200 $0 $0 $19,600 $88,80.0 . 28 1986 $69,200 $0 $0 $19,6001 $88,800 Photos http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=22634 12/4/2012 �O*IKErC1t V Town ®f Ba r nstabl' Pei mtt# �3 s'7LI Q Expires 6 months from issue dole II, A6 Regulatory Services r v MAR& � Thomas F. Geiler, Director c� t634, ,gym °lro �a ]Building ]Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number C � ( CY-) Property Address 1, 1 t�—d 1/l ey ' Residential Value of Wor Q Minimum fee C$2 00 fdr work under S6000.00 Owner's Name&Address y � Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) .P t U U ❑Workman's Compensation Insurance 2009 Check one: ❑ I am a sole proprietor BA�NSTABLE ( I am the.Homeowner r OWN OF I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) .All construction debris will be taken to a ❑ Re-roof(not stripping. Doing over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum>44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations, i.e.Historic,Conservation,etc. ***Note: -Property Owner must sign Property Owner Letter of Permission. [-Tome Improvement Contractors License& Construct Supervisors License is"required. SIGNATURE: Q:\WPFILES\FORMS\Express\EXPRESSPERMIT.DOC The Commonwealth ofMassachusetts Department oflndustrial Accidents Office of Investigations' + d 600 Washington Street Boston, MA 02111 °� ��•y`� wwtv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ,Applicant Information Please Print JLel4ibly Name(Business/Organization/Individual): Address:,f, ay e� City/State/Zip: C)_ )0 t Phone.#: 7 < ' Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. 0 I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner listed on the attached sheet. T. Q Remodeling ship and have no employees These sub-contractors have g Q Demolition working for me in any capacity. employees and have workers' Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions 3.1<I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. )Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob 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 crimirial 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 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: G_'q�_ — Phone#: Official use only. Do not write in this area, to be completed by city or town official .City or Town: PerrrtitlLicense # . Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other a 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 tiustee 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,constriction 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 Nvith 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-contiactor(s)narne(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 necessarv) and under"Job Site Address" (.he 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. o„ld like to thank you in advance for your cooperation and should you have any questions, ue Office of Investigations w 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-.7749 Revised 11-22-06 www.mass.gov/dia Town of Barnstable Regulatory Services Thomas F. Geiler,Director " Building Division �PrED Tom Perry,Building Commissioner 200 Main:Street—Hyannis,MA 02601 n wwmtown.b arnstable.ma.us Office: 509-862-4038 Fax: 509-790-6230 HOMEOWNER LICENSE EXE.MYTION Plaase Print DATE;_ ,I c? ti . JOB LOCATION: 1 �O l & IC, , le fww•l number strect / lags/ 2 ..HOMEW ONER": -7 N "�S �r�`� 7 7 X name home phone# work phone# CURRENT MAILING ADDRESS: / city/Yawn 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 au individual for hire who does not possesses license,provided that the owner acts as z supervisor. DEFINITION OIL HOMEOWNER Persons)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.L 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 re ements. `" - S �o om a m Approval of Building Official Note: Thrce-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 EXEMYnON 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 persons)for hire to do.uch work, that such Homeowner shall ad as supervisor••' Many homeowners who use this exemption arc unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rulcs&Regulations for Licensing Construction Supavism,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 unliccnscd person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsblc. To cruvrc that the homeowner is fully aware.of his/her responsbilitics,many communities require,as part of the permit application, that the homeowner certify that hdshe understands the mEponsbilitics 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 fom>Vicertifi cation.for use in your rc)mmunity. VEr� Town of Barn-stable Regulatory Services r r Thomas F. Geiler,Director E1) Building Division 0 Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-62 Property Owner st Complete and Sign T s Section If Using ABu' der as Owner of the subject property hereby authorize • to act on my behalf, in all matters relative to work autho ' d by this building permit application for. dress of job) Signature of Owner Date /PrintNe rty Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. =r:4-r'' w .wew r � ,.r�-+.. � �„Y+a':. ��,a„ ,...s�„�-,�t'^sg.M�`r=.w l+o,Kt��r_<,..+wf , ..�..,,,,.,�,�+-r•sn{ly�sir:.» .�� :;!'�fi`: .�Fi�+,va .r.�z��.yp,.,:hr - .o. t Assessor's office(1st Floor): Assessor's map and lot number -ANE>o Board of Health(3rd floor): C. �Qy o Sewage Permit number �— �� ` .S-D Engineeri fig,Department(3rd floor): ;ssae,9rsntL /l riva House number �l (� °0,. +639• 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 BARNSTABLE BUILDING INSPECTOR ' APPLICATION FOR PERMIT TO 4L° TYPE OF CONSTRUCTION l'UD�r] �"►°Z �i� d• �i�.t�i C� 19 7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ,f Location //4 SST 11%i9 Proposed Use ji Zoning District / 13 Fire Districty ��� S " Name of Owner ./ U C� ��UQ Address sT rr.r,),�/,l,- �r� lY��rv,v ~r Name of Builder r l l D /}/k/JDL) Address fT r4;Ti`r1°1i'>4,,y5 4;y 1Y1>,4,,4,a r. k,. Name of Architect Address ;'� Number of Rooms Foundation I5/ Exterior �l Roofing i"Y h f Floors <'r JUfL�11� T Interior 1 Heating AJUA,)e Plumbing Fireplace. '" d d e— Approximate CostV t �co)<� Area Diagram of Lot and Building with Dimensions Fee 04 CL OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License --f BRODD, DAVAD A=291-079 3 No 33574 Permit For Detraol ish & Lebuild Garage Single Fare iv Dwe11inc, Location Lot It7, 116 St. Catherine Ave. Fiyanri:, Owner. David Brodd _ Type of Construction Frame Plot Lot Permit Granted March 16, 19 90 Date of Inspection 19 Date Completed 19 O PERMIT COMA' cap^.717C BASTE t!,VST BE Assessor's office(1st Floor): �� �IN COMPLIANCE Assessor's map and lot number 2 ` _ 7 / c�tMe to Board of Health(3rd.floor): /�` .��Y������q����p�q�l�{� /� g!� Sewage Permit number r�� ^/ •� ��...` alG'uEiS���l��€4� trJ�LJ��G� 3t6/ Engineering Department(3rd floor): L+ l �r riva REGULATIONS Z asaMASL L p S �o House number / � ° d.0 1639• b .Plannin y�Y 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 BARNSTABLE BUILDING: INSPECTOR APPLICATION FOR PERMIT TOi,�i/7 TYPE OF CONSTRUCTION A�qj)p Fk 4Ale 19 7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ST Proposed Use C�&YOP Zoning District R/3 Fire District �1����S �L A I,L "D S L� Address /� T Ca rbiW I►,W ,� n4de-12 C Name of Owner� cS � �--- Name of Builder L>> /�17Z� Address /l.� fT �7-1YP1t&,4 41W r�I &L'vJ r Name of Architect Address Number of Rooms Foundation R1DG 4 ' Exterior l Roofing ASo k-, Floors C/ 7 Interior Heating 0A)e Plumbing A-)0 V Fireplace A)0 A) Approximate Co /o,D0-6 Area O/O Diagram of Lot and Building with Dimensions Fee C7C� 16 r�C, ~ i I OCCUPANCY PERMITS REOUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding th6,:above construction. t Name J G Construction Supervisor's License _ I BRODD, DAVID _ Y 'a No 33574 Permit For Demolish & Rebuild _Garage Single Family Dwelling Location Lot #7 , 116 St. Catherine Ave.. f y Hyannis �Y -✓ i � r Owner`David Brodd �' f Type" of Construction Frame t~' `r^ � f Plot + Lot - ' Permit Granted March 16, '119 '9 0 MOVDate of Inspection 19 y -Date Completed /.2 19 0 _ cr Y r v f. In. « r ' ,rJ t ��yp�THE Tom~a . TOWN OF BAR.NSTABEE 31"IMUM _ r\ t6.39. ,� MASSACHUSETTS I U I �Ert.Y�� I Solid Fuel Stove Permit ` l TO 6 9 (A$ d PT DATE OF APPLICATION .....2/...�Z/...�............................................. FOP. ISSUING PERMIT ............................................................ NAME (owner) NAME (Installer) 0W11e1 ADDRESS .v./.. `i... /rl/..1/� �/ .. ADDRESS S � ............. STOVE TYPE 5 hU2�m CO*R�Gr � �� CHIMNEY: NEW EXISTING .... ....... Manufacturer ............. ................................................................................................... CHIMNEY: Masonry ............................�..................................................... Mass. Approval ...1......./97cc77.................................................... ...............l.y Z...... CHIMNEY: Metal ............... .................................................................................. ... This is to certify that the above installer has permission to install a solid fuel burning appliance at the listed address in accordance with an application on file with the ................................................................................................... Fire Department, and subject to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made under the authority thereof. Issued By: y� /"s e Title ..... Date ... ...��/JT ........ .............................................. ..... /�.............. Permit to install expires 60 days after issue date Stove ,�srmy/ ...........�.'..J.4. rh ./ �V /� 61/ , Li.......... .................................. .v.....i..'.... I�D9' ...........................................:....... .............................. </ ,#sddr�yocr /rvc�r Stove Clearance ...�?.................. ............................ .........................................................................................................................K.............. ................... .............. ..................... 4: CFloor ............:.......................... .....:..................................................................:........ Li e- s %xac ............................................................................................................... ............................Smoke Pipe �S�tiS L� waLL ......................................................................................................................................................................................................................................................... SmokePipe Clearance ..............................................................................................:................................................................................................................................................................. Chimney ........................................................................ :5. .:....Y..y.................................:......................................................................................................................................................... Smoke Detector .............................................1 �`........................... ......................................................................................................................................................................................... The undersigned hereby certi�fiep t ........... at the installation of solid fuel burning stove and equipment made under au- thority of permit dated 9 ` 1 .. has.been made in accordance with provisions of the Commonwealth 91V1 .................................. of Massachusetts State Building Code now currently in effect and pertaining thereto 0 w�q� ........................................................ Installer INSTALLATION APPROVED �...................... B,y:. .... ,; ....................... Title': .............. .... ......... ....... date WHITE: FIRE DEPARTMENT — CANARY: BUILDING INSPECTOR — PINK: APPLICANT a� l ® e-1 °FT"Er TOWN OF BAR.NSTABLE 33ASHSTADLE, i 039. e°° BUILDING INSPECTOR APPLICATION FOR PERMIT TO .CGS . �1�Lt ................................ TYPEOF CONSTRUCTION .........�®��. V �M.............. .......................................................................................................... ........ ......................1922. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following info mation: Location .. �� 1/1 , � ... ..i ................... `.'.. .. ... .. ProposedUse ............................................................................................................................................................................. .Zoning District ..........................................(/..............................Fire District .....................................A......................................... Name of Owner ... ........'. 1141e06j geNA04' OtJ� ;G .I"`a.. .../................... ;� .. ..................................? Address .... .. ............................ c Name of Builder .@ ... .'... 6?k�................Address .p..w. .'4..VVt41.T .? ... ?.�Q.+.......�"�'. ..��L Name of Architect ........Address :7` Number of Rooms �'Q, .��G Foundation .................................................... ....................... Exterior ... :k*..." t�. ,.a ..................................Roofing ...Q Floors ..........................................................................Interioro ?. ........... ................................... Heating ......................................Plumbing Fireplace ...............e^°.' ..........................................................Approximate Cost .....?.. �. ................................ Difinitive Plan Approved by Planning Board --------------------------------19--------. 7,9 S>1� ®a Diagram of Lot and Building with Dimensions B3 paa I% -a cn ® a � Q UJ 4i G' ►11 < f V'4 P m `� < H •,� > ®_� a- a C N � � �- �� w U) - Q d HKfr ® W F-- ZZ UVE hereby agree to conform to .all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name,- . .. .!�"'.:.......... ,,.... Bernstein, Mr. & Mrs. Harold / , ! � ( - DEC pEC 3 1 r . No —.. Pa,mkfor --add..to.. . ^ ' | � -----. —` .. ---/t e Location —._~~~ --------.. '~ / _ .......................HyAnr)ia........................................ < � \ �_Mrs B Berootein_ / < Owner ---��—.�__ _..�_____�roI�______ Type of Construction ...............frame................ , . ^ i| ` ' -----^--------------------.. � | Plot / �� �7 � , |-- ------- ---------- � -- Permit Granted —..]M|J.oh.2.------lP 70 \ , . Date of Inspection ------------l9 .� ~n Dote Completed —.��������—�..��—]A ~��^�� ~ ' ~^ � � \ PERMIT REFUSED` � U ' .........................................-------- lA / -----.--~---~-------------.. � ^--~---'—^'---------~------~—' | | ^ \ - ' .-,--_-------------~---.---- ^ ' .---.------.-----..--.--.---.—. > 1 � Approved _`_------------- lg ^' ^ -------.-------------..---__ ( ' . � \ ` | ................ � ' | ' ] . / . / I ::•ORA`"'�� _ I i I I' �, 1• ; I �t — IX� ;`',-,�{.,�F .s►�i GASCIA I I � }I f !} c 1 �j II ? --. I 'f0 ' 1 : : I f ,I i I ! � J,- i k -t!t flE• Z`�E 3a,�,Rv>1 �� ' II -6c X , YO :I ,I 1 I , I r ; i �, I J - ------ .—._j 3�I ,i _ _- -. .. - --------- ----- J`; j i �L��-i`•t3C'�E� G-KA1� I - -_.____ _ -' } _ _ _ _ _ - - ------_ ------ ------------ y _ _ - ___ _ __ -_ _- - -- ----- ------- ------------- ---- i I r { ! I'r"o c. b 1 yam/ r Ii / i 1 . - i'/ �IM'r1JSlPh;£ !AGfy?'1G Gr- �x lsT?N4. G'ao�..� ti W:�,t�~.c*� � ; ;J � �' ! -,----•----- I AR£ NcrT i7RRAVJ1A IV { V/ {{ it • �" it I _ I i .A-• I I � �� .. — ,�•�\} _ �r _- f t'=L.----._tt�l�?i + I �X1.5'r;hCi. F+ts£:E.'ts . p 1 ;, I NCa`'•-rd � - L I -------------- ------- 31�1SNatl8 N� SCALE 1,4j APPROVED BY. DRAWN BY DATE REVISED S30N`dH0 310N 0 �� �f'u ; �; r�l t�l , Hd d d �3Ao DRAWING NUMBER 0