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0118 SCUDDER AVENUE
i Scu�D P� A,)e, rUtat'r� ozo if I+� r �i I I i B�S � co � I`--�c ss� j i � � �) f t �g -�, � s �� . 134,000 7 Vol-r I a 1�. yr F m Lot 1.04 Built 1917 Anorox WatrAcc Zoning 118 W Scudder Ave. TR 1 - A Land Pays Water Map/Par 289- 045 MI Beath 1 to 2 Mlles BchOwner Public Com Feat NolFtr Ext Foot I Heat OII,HotWat Pool Watr/Sewer PriSew,TwnWtr Park Unpvd pock . B mt Full Ger CShed Asmt 116,700 Tx 1 J76 1996 Load Unk Rem Large, spacious saltbox colonial on 1 acre converted to two large apartments. Carriage house converted more abandoned apartments. Owner Sossos Delis, Tr Shw NGas LetOH Paul Drouln, REALTOR, DRO Ph 508-790.79M I DROPPh 508-999-9999 Dir Main Street to west end rotary to Scudder Ave. House on right, D e 7 4 1 Town of Barnstable Buildin o:._ ,. ` 'k;��.",•F,.k a.,& '.' .,�r`e r,,�:,re; .. .9< aE- -,t .ten .,; 3, f, ',, ','�« fi.'., ..� r. ;«£:r S_�, sa .,.m s r b �ua,` g st Thrs�Card�SoTha rt=�sVisrble=Fromahe Street3 �A _ raue'd�PlansMust beRetarned;onJob,and thrs�.Cartl�Mustbe:Ke t� ,'r� * BwRNtTfAl32.� • �r. .' - ?�;-c"Y". s' .'s..; :"', s &tom.^'sue; 4 ;3f pp „° '':,. ;6 `$ �'' �'. a.. < n' p' 'v .;':. 0 b"� el \ „�' w.ai' < +.-'d"7"* ,;` ."a ? �. '`. - Z., ..re£.. '.' "..a i�=, vi:'�; ii::'a'F.• 4.c;$r *,J� ",=, .A,. �R .:Wher=e a Cert�ficateof Oceu "anc >rsrRe airedsuch=Buldm shall Not�;be�Occu red:until�a,F�na!"Ins`"ectror has"!%enama�e' rllll t Permit No. B-18-2886 Applicant Name: Approvals Date Issued: 09/05/2018 Current Use: Structure Permit Type: Building-Shed-Residential-200 sf and under Expiration Date: 03/05/2019 Foundation: Location: 118 SCUDDER AVENUE, HYANNIS Map/Lot 289 045 Zoning District: RB Sheathing: Owner on Record: WEBER,DONNA&JEFFREY �' = _ a �G nta torName Framing: 1 � Address: 118 SCUDDER AVE Contractor Ucense 2 HYANNIS, MA 02601 v Est Protect Cost: $0.00 Chimney: Description: 10x 12 shed � � .` 41 Permit Fee: $35.00 Fee Paid $35.00 Insulation:' ' Project Review Req: ��� MFinal: 3,Date 9/5/2018 Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorizedoby this permit is commenced within six months=after Issuance. Rough Gas: � a g All work authorized by this permit shall conform to the approved applcationand the approved construction documents for whicttthis permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by IawA codes. Final Gas: This permit shall be displayed in a location clearly visible from access streetxor road and shall be maintained open for public;inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable sign ures by the�Buddrn andmre Officials are provided on this permit. g P P Service: Minimum of Five Call Inspections Required for All Construction 1.Foundation or Footing ' � M Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:. 4.Wiring&Plumbing Inspections to be completed priorto Frame Inspection S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final' Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health 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). Fire Department Building plans are to be available on site Final: �' All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT gr Town of Barnstable �zHE r� Building Department Services g`J��� ti Brian Florence,CBO t R[AN9Ry : Building Commissioner MAS 1639. `�� 200 Main Street, Hyannis,MA 02601 prEO MF•'� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT#:6 - 1 g� fp m• $35.00 SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less /J n 1* Location of shed(address) Villaje Property owner's name Telephone member / D Size of Shed Map/Parcel# ZE OLD1 C) Signature Date Hyannis Main Street Waterfront Historic District? 0 � ao Old King's Highway Historic District Commission Jurisdiction? r ki O a rn You must Me with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4_30 PLEASE NOTE: IF YOU ARE WY=THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAMS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN . Q-forms-sbedreg REV:08/6/17 SEP-29-2011 TNO 11:28 AM O' KEEFFE LARGAY LAW FAX No, 508 731 3388 P• 005 'pi 1 PAVED ACCESS DRIVE 42/$ ��7b ypq Ovw DRIVEWAY , � �45 ('Y � Fry I f N1 .y �d IN 9p� \ 2 ryNry I U ' �� •,\' v U I mrn II � m , d I d I C7 GRAVEI ORIVF,WAY '�� K^�� �BrA i" ' 7 u e d �--fy �AS `^A4 � I —�•t33, 4' n 90 \� ( ' A I z I �,�, I C I I fT1 I °p� yi,sc °rs I Aqc tisti. *E I t M h 1` f 1 - liv Is. o a y 3S+ � I ?p J � I I ti�y p4. •� �I 7r�re . I I cu a a I N O 50 0 50 100 Sturgis Charter School. SCALE IN FEET 125 West MAin St& B 9 XIEE.NYE ENGINMIN'G&SURVE1Z TG 1",50' Scudder Avenue Nyannls,MA d RanisremlProf�siopalEnocwandLandSwveycts Easement�J(ittblE 0 78 Notch Smxi-3rd Plaor,Hyannis,Mcs aechusetts 02601 ' Phone-(508)771.7502 Fat-(506 771-7622 OATS: Jonuory 21, 2011 o rev, 11oy 11, 2011 o:2D�o 7p�0-oN Cml Pt0 20i0-o.H- -Ezra ,a CAPECOD TO',,,411N OF IBARNI STAB L�' INSULATION 10� -15 II-IRGIA113 5IAMLF$5 SPAY 01`FOAM $ 414DIED 9ATIf ourT I $ IN UI ITI ON '111.1101 1-800-696-6611TM ' IVI S 1,01 N fcf, To 'O-'f Barnstable wrl( ', Re 1-atory Services Bui'ldig Division 200 Main St Hyannis, MA 02601 Date: 16-/--;4 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 PerformanceInstitLite '(BPI) inspector, All work preformed meets or exceeds Federal & S.tate Requirements. Property Owner Property Address Village Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes Floors Walls (X) ( 13 ) 6V0r /per)CO r 41 e0l Sincerely 2CHry E ssi r, President ; Te C Ins ation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map -I Parcel Application # a�)1 S Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village ��� Owner V W Address Telephone 47 0 0 - t 0 31 Permit Request rUlW040AU-)o 226 o 0Yev D �� "atA1 (4 Square feet:_ 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type_ Lot Size / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 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): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other entral 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: --i Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ H _ Commercial ❑Yes o If yes, site plan review # Current Use Proposed Use _ 'v - - APPLICANT INFORMATION ' (BUILDER OR HOMEOWNER) JA Name C44ilkTelephone Number Address 01 4�61A License # LO M tIALIAM9 Home Improvement Contractor# //Jb Email Worker's Compensation # Wo ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PFAOJECT WILL BE TAKEN TO Aukd SIGNATURE DATE I / FOR OFFICIAL USE ONLY ' APPLICATION# DATEISSUED MAP/PARCEL NO. ti ` ADDRESS VILLAGE OWNER c DATE OF INSPECTION: FOUNDATION. FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f s k ' Massachusetts - Department,of Public Safety :Board of Building Regulations and Standards Construction superrris6l, License: CS-100988., -` HENRY E CASSPI ' 8 SHED ROW WEST YARMOU'rH p. p ✓,�..� .t " ��� Expiration Commissioner 11/11/2015 a b Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Co`n,tractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 1'rtt 259188 CAPE COD INSULATION, INC HENRY CASSIDY ------ - 18 REARDON CIRCLE SO, YARMOUTH, MA 02664 Update Address and return card, Mark reason for change. :CA 1 :a 20M•05111 Address Renewal Employment Lost Carcl ......--- ......_...._. ............. .. �ie i0 o;t w4eoeaNt c1191P/KMdccc/ eCGi .... �\ 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; egistratlon: '1.53567 Type: Office of Consumer Affairs and Business Regulation xplratlon:,;;;:1-21:.15120,1:6 Private corporation 10 Park Plaza .Suite 5170 B6s'ton,MA 02116 RAPE COD INSULATI;b:N;;;INC°: .:" 1ENRY CASSIDY ,r• 18 REARDON 30,YARMOUTH,MA 0266*4 " Undersecretary N valid wi ut sign e ' r I y The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations d 1 Congress Street, Suite 100 c� Boston, MA 02114-2017 www,mass,gov/dia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers A plicant Information Please Print Legibly Name (Business/Or 'zation/Individual). (:� �(, Y V Address; 6, 40V� V �I ' City/State/Zip; A aka { Y 1� Phone #; 1�7G� �1`1 e� ( l Are you an employer? Check he appropriate box; �— 1,5;'I am a employer with 4• ❑ I am a general contractor and I Type of project (required); employees (full and/or part-time),* have hired the sub-contractors 6. ❑ New construction j 2.❑ I am a sole proprietor or partner- listed on the attached sheet, 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity, employees and have workers' [No workers' comp, insurance comp, insurance,= 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10,❑ Electrical repau-s 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 insurance required.] t c. 152, §1(4), and we have no 12,[l Roof repairs l employees. [No workers' 13, Other. ``( V comp, insurance required,] *Any applicant that checks box#1must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit thisIffidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors 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, i, Expiration Date; Job Site Address; ( City/State/Zip; ,Lj(/[. �/ 1,V1 Attach a copy of the workers' compensation policy declaration page(showing the policy num `e and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the impositio f cri.mbial penalties of a rune up to$1,500,00 and/or one-year imprisorunent, as well as civil penalties un 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 cerllfy n r pains and penalties of perjury that the Information provided r bov is tru and correct. Si nature. '' Date; Phone#; OF Offlclal 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); i 1• Board of Health 2. Building Department 3, City/Town Clerk 4, Electrical Inspector 5• Plumbing Inspector 6, Other Contact Person; Phone#; � I CAPECOD-27 KLIGETT CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 6113/2014 NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Rogers&Gray Insurance Agency,Inc. NAME: Barbara DeLawrence 434 Rte 134 PHONE ------.__ 81C, /C No Ext) (877) 816-2156_ South Dennis,MA 02660 ao�REss: bdelawrence@rogersgray.com I INSURERS AFFORDING COVERAGE NAIC n _ +--- — INSURER A:Peerless Insurance Company INSURED INSURERB:COMMERCE INSURANCE COMPANY _ Cape Cod Insulation Inc INSURER C:Evanston Insurance Company 18 Reardon Circle INSURER 0:ATLANTIC CHARTER INSURANCE GROUP _ South Yarmouth, MA 02664 — INSURER E INSURER F CO ERAGES CERTIFICATE NUMBER: REVISION NUMBER: T IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD C ICATE D. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERAiS• EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SR ADDL UBR _ LTR TYPE OF INSURANCEINqn POLICY NUMBER MI A X COMMERCIAL GENERAL LIABILITY MDD/YYYY MM/DDY E YY LIMITS EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR CBP8263063 64/01/2014 04/01/2015 -- D MA E R ED PREMISES(Ea occurrence) $ 100,000 ME EXP(Any one person) $ 5,000 GEN'LAGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ 1,000,000 X POLICY❑JE ❑ LOC GENERAL AGGREGATE $ _2,000,000 PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: ---------.. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B Ea accideno $ _ 1,000,000 ANY AUTO 14MMBCKVMK 04/01/2014 04/01/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED _ I _ AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE $ - Per accident X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1 000,000 C EXCESSLIAB CLAIMS-MADE XONJ453514 04/01/2014 04/01/2015 — -- AGGREGATE $ DED X RETENTION 10,000 Aggregate $ 1,000,000 ORKERS COMPENSATION ND EMPLOYERS'LIABILITY PER OTH- YIN STATUTE ER D NY PROPRIETOR/PARTNERIEXECUTIVE WCA00525904 06/3012014 06130/2015 FFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT 000,ODU$ 1, Mandatory In NH) f yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 ESCRIPTION OF OPERATIONS below — ---- E.L.DISEASE-POLICY LIMIT $ 1,000,000 �l DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation Includes Officers or Proprietors, Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certlficato Holder. CER CANCELLATION LIFICATE HOLDER CANCELLATION HOLDER CANCELLATION - —__J Town of Barnstable - ti 'Regulatory r g Y Services - HAWNSTAMM, Richard V.Scali,llIrectur ,r \tea\ 63A Building Division Tom Perry,Building Cuininissiuncr 200 MaLu siseet,Hyalnis,AA 02661 •'Vi'IVW.toivn.barnstable.ma.us Office: 4087862-40 8 * Fax -SGs- 90-6230 1 xc�pe-Ii} C7w ust CIO m, lete-and Sign:This Section IfaJsing A.Rui�dc i as(Ti'l1Cr OI dle suhjc;T_ p]C)()i Itv .y her�.by Hud;ome _ '' 1 _ ,' r. �� a i,7(_ to act nu rni-nealalF; . in'Jl tnaIxers r^latrve,to�=ol.-k audiotized b;;,this btildiri p.ernlit zPPllc:�,_ion far: � jib,5 i[Glc_(c� TIA UZ G61 r ! (Address cif job) Toc.)1 fences .;nd.al� are the rrTc'tnslhihty of.th- a -pli.ciri Po(As ilre ]lot to be fjllyd.or mil.i:ied'hefcire fence is ia�tall. d arad aJl a,ux 1 Illspr.. roils arc. peifclrrued and accepted.` r Star�tyue f h�n �a�.r Sl; ttlrc of�Appli{wit JljJ it N8I712 PAWL Natrrm' ` - Q:F;JRial$��1�1FRP£31.i1SSIpUPCX):S "�` ° XPRESS � Co-�anonwe lth of M ssacbusetts Map. 2����� Parcel: 5s Sheet Metal Permit MAY -812014 yOF Date:.. Permit 77 Estmated;Job Cost $ J� PerFnt Fee 09 Plans Submitted; PIES;: NO Plans>RevleWed YES NO Business License#. / JSAR(Yft �Lte Business. riformation: Pioperty owner/Job Locatton Infonnatdor: Name::ICJ A)A r?ce J. 111A C. .�C S.treetc 7R�tA y�e�as �,..-� y— street::.. k 6c, jdd er ?�cf City I'owri �r0 ncJ a Yl\� 6 Cdty/Town: n is Telephone:;_, � , � �/.7 Telephone: 7 � " �e 20 —96_31 y Photo LD:;requdred/Copy of PhotoI.D. attached: YES._N®, Staff Ioi[iaf 3-1: M 1=unrestricted license J 2%41..restricted to:dwellings 3=stflnes;ar less;and commercial up to:10,0.0;0 sq ft;/2 stones or less Residential 1-2 family Multi family Condo/Townhouses Othex Commerc as C)ffce` Retait Industrdal Educational; I Fire Dept.Approval Institutional: Other, . Square Footages under X 0,000 sq ft; over 1% ft;� Number of Storr<es E Sheet meta-work to be:.comp ad& New Work: Renovation FIYAC NMetal Watershed Roofing Kitchen Exhaust.S stem; t Metal..Chimney%Vents: Air Balaucudg Provide detadleddescnption of workto be:done::: } /U b,-,g! (;A s F%ram a e, .��s 13`�a j'Z- . (FAIT I P 0 z: C A 1 %/ a r t-2- leA V"L f 4" #NSURANCE COVET.AGE: have:a current insurance policy or its equivalent whoch meets the requirements of M GL.Ch.112 Y. If you have dheckeid Xjt-Aridicate'ftlypeof coverage by cteckirtigthe appropriate box below:. � f a liability insurance;pollcy Other typeof indemnity. Bond 0. OWNER°S IIVS.i RANCE WAIVER:1 anz aware.that ttte,llcensee:does not have the insurance coverage req,uiped;by=Chapter 112 of the , Massachusetts General Laws„ara�tha4 m si. nature:on this:: nn�t:a lication' this re remert. Y 5 . Pe pP aw Ives. �.... Check;One Orfy Owner:; Agent. [� . . '1 Signature of QTW.or Q mees Agent. By checking this bo)tb i.hereby cerbfy that aii of the details and information t haves b -itted(or entered)regarding:this appiication;are true and. accurate to the best of my knowledge and that aii'sheet metal work and mristaiiabons`perform6d under the permit issued for this application wiil be in compliance,with ail pertinent:provisiowof the;Massachuse#ts EI4if diAg Gods and.c hapter 1.12 of the;General Laws. Duct ins . tion.re aired, rior to;insulation ns ltation YE$; . N0 P q P. Prfl�ress Insnectuns.: t Date Comments;; �nallns;�ecti n Date Comments ;Type:of':Lice se 3y Master" 0 Master Restricted': ; ]Joumeyperson Signature of Litnsee. . [jJoumeyperson Restrict l.lcense Number Check at www.mass gcvJdnl aspector Signature of pennrt Approval: i ;` s ; I `,.:... lOMMONWEALTH OF MA$ AGHUSET'F.S:. SHEET::PIETAl WORKEg.. ISSUES T:HE FOLLOW I Nfl CENSE ASt FASTER UNR�STRI CTED L INItfl'IN T STUBBS BALANCED HVAC I NC ; $ �. 15 JAN SABASTION bR S,ItN.bWfcH MA 025E3 2354 16 .>. ..:0772&/t:5 48437 a . C.0 M H U r' ASS, C !J €rg�' SHEET METAL WORKERS. AS A BUSINESS ISSUES'THE ABOVE LICENSE T'O: r.>t LINCOLN T STUBBS m,< BALANCE') HVAC INC _ 15 JAN, SEBASTIAN DR ` SANDWICH MA 02563 0000 .. :143. 12/07/14 307263 .,... '. . y T � AS'SAXCH,USET 'S `- ' LICENSE 4P I" On EWD 4d NUMM 09 t7e201S NONE 5565627 ll tt Q7015 07=24-197;1 y' pu�s �zar3 �s s M: Is Hcr 6.00 ONE z NCOLNT d?24I9,, ,_•, u 78 JOHN EWER ROAD I SANDWICH,MA 02%&2605 t$,$, a DD 09•f0201�Hev 071S2009 �.,w.�, �y ' DATE(MMIDWJYYYY) AC�® CERTIFICATE OF LIABILITY INSURANCE O3/27/2014 THIS CERTIFICATE IS ISSUED AS A MATT OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S).AUTHORIZED REPRESENTATIVE OR.PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the pci(cy(les)must be endorsed.If SUBROGATION is WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(a). ��3624�785 � PRODUCER PAYCHEX INSURANCE AGENCY INC Arc s77-0aa7 150 SAWGRASS DR chex®trsystero com ROCHESTER,NY 14620 PRODUCER NT"RAVELERS (877)362-6785 NAIL dSV996 70A AFFORDING AVERAGEINSUREDINSURER ADEMNITY COMPANY OF CONNECTICUTBALANCED HVAC INC INSURER B15 JAN SEBASTIAN DR STE E1 INSURER CSANDWICH,MA 02563 INSURER DINSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 778911735580680 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR POLICY EFF POLICY EXP TR TYPE OF INSURANCE NS SUBR POLICY NUMBER MID MMO LIMITS GENERAL LIABIITY EA H OCCURR CE COMMERCIAL GENERAL LIABILITY P $ CLAIMS-MADE OCCUR MED EXP one n $ DVINJURY $ G $ GEN'L AGGREGATE LIMIT APPLIES PER: P $A PRO- $ POLICY LOC COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accident) ANY AUTO BODILY INJURY(Per pemn) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPEfY�AMAGE $ (Per ace ent HIRED AUTOS $ NON-OWNED AUTOS $ UMBRELLA LIAR _ OCCUR EACH OCCURRENCE $ EXCESS llAB CLAIMS-MADE AGGREGATE $ DWUCTIBLE RETENTION A WORKERS COMPENSATION NIA UB-7348P140-14. 03/01/2014 03/01/2015 X T� O AND EMPLOYERS'LIABILITY YM E.L.EACH ACCIDENT $100.000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100 000 (Mandatory In NK) It Yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 SPECIAL PROVISIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is requlred) CERTIFICATE HOLDER CANCE LATION THE TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 200 MAIN STREET EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE HYANNIS,MA 02601 WITH THE POLICY PROVISIONS. V AUTHORIZED REPRESENTATIVE �0 . ©1988-2009 ACORD CORPORATION.All rights reserved. ACORD 26(2009/09) The ACORD name and logo are registered marks of ACORD i BALAN-1 OP ID:AH CERTIFICATE OF LIABILITY INSURANCE °"01�°"14' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy0es)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A Statement on this certllicate does not confer rights to the certificate holder In lieu of such e s. PRODUCER Phone:508-44"841 CONTACT Reid-Hofmann Insurance Agency 12B Rt BA PO Box 1839 Fax:508-588-5148 PHONE PAIL Sandwich MA 02583 Adam Not'rTlann OR INSURE AFFORDING COVERAGE INSURER A:Citation Insurance Co. 40274 INSURED Balanced HVAC,Inc. INSURER a:Nautilus Insurance CO 15 Jan Sebastian Way Sendwich,MA 02583 INSURER c: INSURER D: r MSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L R TYPE OF UISIIITANCE POLICY Po EXP LAM GENERAL LIABILITY EACH OCCURRENCE S_ 11011101000 B X COMMERCIAL GENERAL LIABILITY NN283324 11/02/2013 11/02/2014 IRAMAG E SE�w Ety 5 100,0001 CLAIMS-MADEa OCCUR MED EXP tAny am 9 Aclo PERSONAL 9ADV INJURY S GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S POLICY i PRO- LOC S AUTOMOBILE LIABILITY NEDSINGLE Mrr A ANY AUTO BBBD01 11/02/2013 11/02I2014 BOaLY INJURY(per pmw) 5 ALL AUTOS X AUTO SCHEDULED BODILY INJURY(Per wadot) S HIRED AUTOS NON-OWNEDPR AUTOS OE 5 S UMBRELLA UAe OCCUR EACH OCCURRENCE 5 EXCESS UAe CLAIMS-MADE AGGREGATE S DED I I RETENTION $ WORKERS COMPENSATION WCSTATU- H- ANDEtlPLOYP-RS'LUURLITY YINUMT ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT S OFFICEMMEMBER EXCLUDED? N/A (MWIdAMY M NN) E.L.DISEASE-EA EMPLOYE S It yyeess desalbe raider - ' DEBL1IIPT ON OF OPE TIONS belly E.L.DISEASE-POLICY LIMIT S 11 T DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(AN8Ch ACORD 101,AddWwW ReI.w Schedule,N a me apace is realdred) HVAC CERTIFICATE HOLDER CANCELLATION TOWNBAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 367 Main St ACCORDANCE WITH THE POLICY PROVISIONS. " Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD - 4 i Town of,Barnstable . :; Regulatory Seces, MAM Thomas F.Geiler,Director s RadIng Dlvis&on Tom>Perry,Banding COMMISSIolier , 200'914m Street,fiyanvs,MA 02601 www.town.barnstableina.us Office; 508-86203.8` Fax 508=.790-623Q' �rO.perty �wt�ex Must Complete and Sign This Section;. If Using ASuildez : . ,as(Owner of the Bubb c!property' hereb :autho ze _ z rGoP:. ?—� 1 Y 6 to act on my beha . in all"matters relattae.:to work;a�xthonzed by thts tuldtng'.pesnut ti (Address o€J *pool fences and alarm are the res ponsibility, of the,apphcant Pools are not;to be filled before fence is installed and pools are not utilized until aUfmal inspections are performed and accepted f Ovanez: Signature of Applicant Print Naive Priat Name. _ I Da e. Q:FQRMS;QWNERPER1rIISSot�ooLS I The Comrnori�uealth nfll�assachuse#s . 7. e artmeoit of 1� b�cr114eca�dem O,Bice pf I madgadorrs 600 Washiokiorc S'lmef Bos oit m 62111 ' wwwma4rsgov/did ', Workers'Comp en.sad lnsnraalce A ida t:: niiders/Contractors/Electricians. u nbers A.nnlicant Inforlmiation: Piease Print-Le�iby Name ustaess/org ah ra Y1 Le 1 Af C Address _ .� � .. City/st3*e/ ,.5.A a c� w. c�s�. yv n P.hone.# Are yo employer?Check the appropriate bog- a of; ro ect: r 1.; I am a e l.oyer with 4. I am a erat c°ntractar and I T`yP P j { s have'hired tine`a�ub-contractors 5: ❑N constrnchon . employees(f l and/or 2: I am'a'sole proprietnr orpartner listed on the attached sheet. 7,: deling These snb-coactois shs and have no employees have `.8. ❑Demolition for me m an employees and have,workers' work. . : . y am ity' 9. Bufidmg addittoa [No workers'comp,insurance c°mp::>xnsuCance$ required.] We area coiparation;and its 10.0 1 ::. .Ib l:repaas or addid'ns 10 I atri a homeowner doing all:work officers have.tixercise theme'.:. 11 ❑Plumbirtg repans'ar additions. of en on er'MOL niysel [No workers'comp: ` p. 12[]Roofrep aus. . and we:have no< insurance;.regaued 13 [ of WA L . to s o workers,'< comp insurance required J: •Any applicant tea'checks box#i must also fin oat tttt section below sluiwmg Stec worlo�s'•:cotupeoaetian policy nsformation t homeowners who submit this affidarnt indicating 'ate doing all work add tberr lure outside eonttactots trust submmt anew affidavit mdtcatiag sucdi . xContraccs:that checktbis boz mctsYattttched an additioaal'shaet showing tiicsiatie of the sub conttactprs imd she whs8ier or,noYthose entities have ea>ployees. if Ohs sub conttacte¢s have employees,they mustptovidE their wotkrs'comp.poticyn®her I pm an a cpioye�that rs:provu ng workers'concpensadon insurance for,rnY employees: Below:is the poluy and job site information. Instm uce,CompanyNanx:. .. .. rg ..►L�-� .5 Policy#or.Self--ins Lie # u ?J`�.�' y P t o -- 1q. Expnatton Date:: �✓� ®/)� Jgla.Site Address: fl d C.Yty/Stabef?.rp `f Aitach a copy of the workers'compensation policy declaraiionipage(showing:the policy mtmbration date): Failure.tb:'secvme coverage as required ardor Section 25A of MGL:.c 152 can lead.:to the m posihoa of cnrmaal penalties of a fine p to$1,500.00 and/or one-year M ' onment,,as.well'as civil penalties in the'foim of 9T0iVoPtbAbER and aline of up to$250.00 a day against toe:violatoz;..Be advised that a campy of this statement naay.be forwarded to Off ce of InvesttEations of the DIA for insurance coverme<verificatiom Ido hereby certtify:'under'thepainampenalt�os:'ofper�ury the informat�onprovided:above.s.true andcorrec Phone fl use only Do ytol wrctem ihrs;area,,tb be completed by:ctty or.town,;o, cral Caty or,Towns F. Permit/Iicense: Issuing Authority(cu cis oixe) B Bbard of Health Z.$nilduig Department:3.City/Town Clerk 4 Electrical Inspector S,:Plnmbng Inspector ai Other Contact;Person: Phone# ; M r J Page 1 Residential Heat Loss and Heat Gain Calculation 5/8/2014 In accordance with ACCA Manual J Report Prepared By: Balanced HVAC Inc For: Webber Residence 118 Scudder Rd Hyannis, Ma Design Conditions: Hyannis Indoor: Outdoor: Summer temperature: 70 Summer temperature: 90 Winter temperature: 75 Winter temperature: 0 Relative humidity: 50 Summer grains of moisture: 88 Daily temperature range:Medium Building Component Sensible Latent Total Total Gain Gain Heat Gain Heat Loss (BTUH) (BTUH) (BTUH) (BTUH) Duct 475 0 475 2,576 Floors 487 0 487 2,348 Walls 1,464 0 1,464 4,653 Ceilings 873 0 873 1,490 People 0 0 0 0 Fireplaces 0 0 0 0 Misc 1,200 0 1,200 0 Windows 3,668 0 3,668 2,789 Doors 390 0 390 1,242 Glassdoors 0 0 0 0 Skylights 0 0 0 0 Infiltration 1,412 1,440 2,852 13,235 Whole House 9,969 1,440 11,409 28,333 ( 1 tons ) HVAC-Calc Residential 4.0 b HVAC Computer S - . Y stems Ltd.p Y 888 736 1101 Load calculations are estimates only,actual loads may vary due to weather and construction differences. riellOul-163 tiisO',6sHl4r#j3 e>-W h,31i hllnsbi,?95i s'! L I AO"I'A rlikv ;mnoiocyls 0 b n ;I00bluo A,)Obfl, aiuJi-.,l-,3qmaJ ieiprnu3�1 0 r, lu;'l 0 'mofGicuqmel iafinivv d7 11 qaiorij to emai_p,*rrrp!j8 E,5 ci L yjibv:jr, :,r lmlaA OT inaic'-f eldieric;8 "f )JESH (liso mAiD (IJ,UTO �HUTti) (Huln) (HUTS) a V4 0 �3E t 0 0 0 0 C137, sz 0 fl, W- 0 ?not t 01-17-2012 4r 01213P q - v... Town of Barnstable Zoning Board of Appeals _ Decision and Notice m Appeal No. 2011-056 —Weber c' Section 240-94(A) —Change of a Nonconforming Use to another Nonconforming Use To change a two-family dwelling to two detached dwelling units Summary. . , Granted with Conditions J Petitioner. Donna and Jeff, Weber Property Address: 118 Scudder Avenue, Hyannis Assessor's Map/Parcel: Map 289 Parcel 045 Zoning: Residence B District, WP Overlay District Hearing Date: December 14,2011 Recording Information: Deed: Book 18984 Page 142 Background In appeal 2011-052, Donna and Jeff Weber proposed to change the non-conforming two-family use on the property into two separate dwelling units on the property. The Weber's proposed to convert the principal building to a single-family residential dwelling by removing one kitchen and a second private entrance into the dweliing. The.Petitioner proposed to establish a second dwelling unit on the second floor of the carriage house. The existing carriage house would be refurbished to accommodate the new unit. The ground floor of the carriage house is used for storage. No physical expansion of either structure was proposed. The subject rope J property is 118 Scudder Avenue in Hyannis. The property is 1.04 acres and is located south of the West End Rotary in Hyannis. The parcel is developed with a residence currently used as a two-family dwelling and a second freestanding building on the rear of the property. The .principal residence was built in 1925. According to the Assessor's record, it is a two-story, 2,095 sq.ft house with a total of four bedrooms. The second structure on the property is a two-story "carriage house". The applicant indicates the structure.is approximately 800 square feet in area. Prior to the Petitioner's ownership, there was-a-dwelling unit it the carriage house. The Petitioner's concede,that the use of the structure for residential purposes has been abandoned. i Procedural & Hearing Summary Appeal No. 2011-056 for a Special Permit to change a nonconforming two-family use to two.single- family dwellings on one lot was filed at the Town Clerk's Office and at the Office of the Zoning Board of Appeals on November 7, 2011. A public hearing before the Zoning Board of Appeals was duly advertised and notice sent to all abutters in accordance with MGL Chapter 40A. The hearing was opened December 14, 2011 at which time the Board found to grant the Special Permit'subject to conditions. Board.Members deciding this appeal were Board Chair Laura F. Shufelt, Craig G: Larson, Alex M. Rodolaxis, George T. Zevitas and Brian Florence. r The Petitioners, Jeff and Donna Weber, represented themselves before the Board. The Petitioners stated that they wanted to convert the two family dwelling into a single-family owner occupied residence and reestablish an apartment unit on the second story of"a carriage house on i ii of Barnstable Zoning Board of Appeals-Decision and Notice ,i&ber-Appeal No.2011-056 the property. They confirmed that the property would be connected to Town sewer and that two sewer hook-ups were available. The Board questioned if the carriage house had been used as residence. The Petitioners indicated there were furnishings inside that indicate it had clearly been lived in at some point. The Board confirmed that the first floor of the carriage house would continue to be used for storage and would not be habitable as part of the apartment. The Board questioned if there had been previous code enforcement actions on the property. The Board reviewed the 2000 Certificate of Inspection ,submitted by the Petitioner and indicated that, at one point, three units were recognized on the property. -The Board expressed the importance of the fact the principal dwelling would be owner- occupied. Public comment was requested and no one•spoke in favor of or in opposition to the request.' Findings of Fact At the hearing of December 14,, 2011, the Board unanimously made the following findings of fact for Appeal 2011-056: 1. Donna and Jeff Weber have applied for a Special Permit pursuant to Section 240-94(A) — Change of a nonconforming use to another nonconforming use. The Petitioner is proposing to convert a pre-existing nonconforming two-family dwelling to a single-family dwelling and restore a detached single-family apartment on the rear of the lot. The resulting nonconformity would. be two single-family dwellings on one lot. 2. The subject property is located at 118 Scudder Avenue, Hyannis, MA as shown on Assessor's Map 289 as Parcel 045. It is in the Residence B Zoning District. 3. The application falls within a category specifically excepted in the ordinance for a grant of a t special permit. Section 240-94(A) allows for a preexisting nonconforming use to be changed to another nonconforming use by special permit. 4. Site Plan Review is not required for alteration or expansion of a single- or two-family residential structure. 5. After an evaluation of all the evidence presented, the proposal fulfills the spirit and intent of the Zoning Ordinance and would not represent a substantial detriment to the public good or the neighborhood affected. 6. The proposed nonconforming use is no more detrimental to the.neighborhood than the'existing nonconforming use. 7. The Department of Public works confirmed that two units could be individually connected to Town sewer if the required connection infrastructure, such as the grinder pump, is appropriately sized. DPW also requires a sewer connection, and associated betterment, for each dwelling unit: 8. The following requirements have been met or are not applicable to the subject request. The proposed nonconforming use: . a. Requires no more parking than the previous use; b. Does not generate more traffic than the previous-use, as measured by the Institute of Transportation Engineers Trip Generation Handbook or other sources acceptable to the Zoning Board of:Appeals, nor does it cause Town expenditures to address traffic mitigation measures, c. Does not result in an increase of on-site and off-site noise, dust, and odors; d. Does not result in an increase in the hours of operation or in the number of tenants or employees; 2 of 4 ,vn of Barnstable Zoning Board of Appeals-Decision and Notice VVeber-Appeal No.2011-056 , e. Does not expand the gross floor area of the nonconforming use, except as may be provided in § 240-93B, nor does it increase the number of nonconforming uses on a site; f. Is on the same lot as occupied by the nonconforming use on the date it became nonconforming; and g. Is not expanded beyond the zoning district in existence on the date it became nonconforming. The vote to accept the finding was: AYE: Laura F. Shufelt, Craig G. Larson, Alex M. Rodolaxis, George T. Zevitas and Brian Florence NAY: None Decision Based on the findings of fact, a motion was'duly made and seconded to grant Special Permit No. 2011-056 subject to the following conditions: 1. Special Permit 2011-056 is granted to Donna and Jeff Weber pursuant to Section 240-94(A) to allow a change in a preexisting nonconforming two-family use into two single-family units on one lot at 118 Scudder Ave, Hyannis. 2. There shall be one dwelling unit in the principal structure and one dwelling unit on the second story of the carriage house on the property only. 3. An occupancy permit.for the establishment of a second unit in the carriage house shall not be issued until the kitchen facilities and second private entrance in the main dwelling have been removed. 4. Expansion of the uses or structures is prohibited without further relief from this Board 5. The total number of bedrooms on the property shall not exceed five. 6. When available, both units on the property shall be connected to sanitary sewer. Each unit shall have its own sewer connection and,,a betterment shall be paid for each unit. 7. All parking for the dwelling units shall be provided on-site. 8. The decision shall be recorded at the Barnstable County Registry of Deeds and copies of the recorded decision shall be,submitted to the Zoning Board of Appeals Office and the Building . Division prior to `issuance of a Certificate of Occupancy for the family apartment. The rights authorized by this special permit must be exercised within two years, unless extended. The vote was: AYE: Laura F. Shufelt, Craig G. Larson, Alex M. Rodolaxis, George T. Zevitas and Brian Florence NAY: None Ordered Special Permit No. 2011-056 to change a nonconforming use to another nonconforming use has been granted subject to conditions. This decision must be recorded at the Barnstable Registry of Deeds for it to be in effect and notice of that recording submitted to the Zoning Board of Appeals Office. The relief authorized by this decision must.be exercised within two years unless extended. Appeals of.this decision, if any, shall be made pursuant to MGL Chapter 40A, Section 17, within twenty(20) days after the date of the filing of this decision, a copy of which must be filed in the office of the Barnstable Town Clerk. ' r t t rz 7.. S� Laura F. Shufelt, Ch it Date Signed 3of4 s:rn Of Bamstable Zoning Board of Appeals-Decision and Notice ✓eber-.Appeal No.201 1-056 I, Linda Hutchenrider, Clerk of the Town of Barnstable, Barnstable C nt certify that twenty (20) days have elapsed since the Zoning Board of Ae' Massachusetts, hereby ppals filed this decision and that no appeal of the decision has been filed in the office of the Town Clerk. Signed and sealed this day of perjury, under the pains and penalties of ` Linda H utche nr id e r, Town Clerk 4of4 wort Page 1 of 3 ,oning Board of Appeals (ZBA) Abutter' List for Ma Parcel(s). 289045 p Parties of interest are those directly opposite subject lot on any public or private street or way and abutters to abutters. Notification of all properties within 300 feet ring of the subject lot. Total Count: 30 , Close Map &Parcel Ownerl Owner2 Addressi Address 2 Mailing CityStateZip Country Deed 289040 HOPKINS,JANE E 40 ARBOR WAY HYANNIS, MA 289D41 MURPHY,RICHARD a 02601 C178839 J&JOAN E 30 ARBOR WAY HYANNIS, MA HANSON HERBERT 02601 C61894 289042 C 184 COCHITUATE ROAD WAYLAND, MA 289043 HOAGLAND, 01778 C129631 ` WILLIAM M 10 ARBOR WAY HYANNIS, MA KEHOE, 02601 C155682 289044 CHRISTOPHER J& STACY M .78 SYLVAN DRIVE HYANNIS, MA 02601 C136393 289045 WEBER, DONNA& JEFFREY 118 SCUDDER AVE HYANNIS, MA 289046 MASON, FRANCIS J WIINIKAINEN 02601 18984/142, III& MICHELE M 100 SCUDDER AVE HYANNIS, MA 289047 SEAMAN, FRANK A .02601 4598/203 &MARILYN E P 0 BOX 1251 HYANNIS, MA 02601 C541820 289048 AMES,CLAIRE P 0 BOX 1272 HYANNIS, MA 289049 QUINN, FLORENCE ` 02601 C72354 M 53 ARBOR WAY HYANNIS, MA 02601 C150334 BROWN, LAWRENCE 289056 _ W&BETTINA S 44 SYLVAN DR HYANNIS, MA 289057 ANDERSON, BRETT 02601 C145318 C&PAULA E 7 WELLS ST WORCESTER, MA 289060003 SHORE,JOSEPH& 01604 C167124 CARYLYN PO BOX 121 HYANNIS, MA 289073 FEDERICO,ANGELO 02601 13105/290 A&PATRICIA 278 BEECH STREET ROSLINDALE, MA i 289074 SILVA, CLAYTON 02131 8326/016 73 SYLVAN DRIVE HYANNIS, MA 289075 COTELLESSA, 02601 C168362 JOSEPH A 65 SYLVAN DR HYANNIS, MA CLARK, LOUIS J JR 02601 C118315. i 289076 - &PSOMOS,ANNE 165 SCUDDER AVE HYANNIS, MA 289Q91 SPATARO,STEVEN 02601 4246/157 j P 24 SCHOOL ST MIDDLEBORO, MA 02346 2522/230 i 289092 - DICECCA, LOUISE 39 GREENWOOD . AVE HYANNIS, MA KUPRIS, HELEN M 026D1 10678/042 28909300.1 %KUPRIS, HELEN M 10 ATWOOD ROAD TR HYANNIS, MA' i 02601 .: 12753/131 289093002 BANK OF AMERICA C/O JP MORGAN 7255 BAYMEADOWS CHASE BANK NA WAY JACKSONVILLE, ROBINSON; . FL 32256 24833/114 289093003 MICHAEL T& SAUNDERS, %BOOTH,CRAIG A' 11 GREENWOOD HYANNIS, MA DEBORAH AVENUE 02601 20783/095 289093004 DACOSTA, MANUEL + R&CECILIA P 0 BOX 905 HYANNISPORT, MA OZ647 9634/217 j http://66.203.95.2-16/arcims/appgeoapp/AbutterRe ort.as x? p A �pe=ZRA 11/14/201 1 I LEGAIL'Noticit TOWN OF BARNSTABLE TOWN OF BARNSTABLE ZONING,BOARD.OF APPEALS tONING 130ARD OF APPEALS NOTICE OF PUBLIC HEARINGS NOTICE.OF PUBLICHEARINGS UNDER THE ZONING ORDINANCE ;,,UNDER THE ZONING'ORDINANCE DECEMBER 14 2011 DECEMBER 14,2011 To all persons fnterested'in or affected by-the actions of the To all persons interested m or-affected.by the actions of the _ 3 -Zoning Board of Appeals you are hereby notified, pursuant.;. Zonin Board.of to.Section 11 of;:Chapter 40A:of the General.Laws:of the,.,, g Appeals you are,.herebyr,nohfied '.pursuant Commonwealth of Massachusetis,:and all amendments thereto to Section 11 of Chapter 40A of'the General Laws.:of the 1 that a_public hearing on the following appeals wit(beheld on ; Commonwealth of Massachusetts and all amendments thereto December:f4,2011 at,the-time.tndipted ' that.a public'he' on;the following appeals,.wfll be held on. P 9 7.05 PM.` December 14,2Q11.at the hme;indicated I AppeafNo 2011-054 7 05 PM` Appeal No:2011-054 OCW Retail Hyann!s;:LLC OCW Retail-Hyannis,LLC OCW Retail Hyannis;LC has petitioned for.Special Permits for _1 the construction of an approximately 8,050 square,foot bwiding '. OCW Retail-Hyannis,LLC.has petitioned for Special Permits for i for:restaurant and retail use,"together with a new,'entrance onl the construction.of an approximately 8,050'squar I -,building y for.restauranf_and retail use,together with anew entrance_.only 'i curb`cut.on Route 13F and related parlung and infrastructure; curb.cut on Route-132 and related parking-and infrastructure. improvements in the Southwind:Plaza shopping center. Special improvements'in'tha.Southwind Plaza shopping'centet'.:Special Permit relief is requested in accordance with Section 240 25 C(1) Permit relief Is requested.in accordance with Section 240-25:C(1) c.ondflonal Uses to allow for upto four tenant spacesforrestaurant t and retail purposes in the HB Disfict .Spzcial Pertnd relief!s CpndihonalUsastoallowforupto.fdur,tenant spaces forrestaurant -also requested.16 accordance with Section 240 93 B Nterahon/ and retail purposes in,the HB Distdct :Special.Permit relief is t also requested.in accordance wftti Section 240 93 B Alterahonl Expansion of a Noncgrtforining,Buildmg7Structure to expand thepansion of a Nonconforming Bull in Structure toe and the. preexisting`nonconforming lof,coverage from.the existing,56 4% preexisting nonconforming,lot coverage from the exrsh g'56.4% . to the proposed 61:2%°.lot coverage And e,Petitioner requests i r to the proposed(31:2%lot coverage.:And,the Petitioner.requests_ Jo modify Special F'ermd No 1997-23 to allow a proposetl right -to:modify Special Permit No:1997-23 to allow a proposed.nght :turn:only entrance ciMo the site off Route 132 The subject ,; tum only entrance into the site off Route 132' The subject i ` properties are located at 990ayannough Road(Route:132)and a 65 Independence Drive;Hyannis MA as shown on Assessor s Ma `: Properties:are located at 990 lyannough Road(Route i132)and P 65 Independence Drive;Hyannis MAas shown on Assessor's Map 295 as Parcel 015 X02.and Map 294 as Parcel 004 They,are in: 2g5 as:Parcel 015 X07and Map 294 as Parcel 004 They.are in . the HB Highway Business,B Business and IND Industrial Zoning the:HB Highway Business;B Business and IND Industrial Zoning Districts and the Groundwater Protection Overay DlstrcC 7;05 PM Districts and the'Groundwater Protection Overlay District Appeal No 2011-055 7 05 PM Appeal No-2011-055 OCW Retail Hyannis,LLC ; OCW Retail-Hyannis,LLC = QCW Retail Hyannis LLC.has applied for a variance to I "`OCW Retail-Hyannis, LLC..has.;appl!ed for a„variance to Section:'240 35 F(3).=Groundwater Protection OvedayDistrict Sechon.240-35.F(3)-Groundwater Protection Oveday,Dfstrict Lot:Coverage lhe:.appl!cant:,is proposing to construct an •:; Lot.CoJerage _7he applicant Is proposing;to construct an approxjriately 8 O50 square-foot_timldmg for:retail and restaurant_ approximately 8,050 square foot building for retail and.restaurar i J use,together with anew entrance only Curti cutonRoute 132 and use,togetherwith a new entrance-only curb cut on Route 132 and.- related parking and infrastructure improvements in the Southwind related parking and infrastructure improvements in the Southwind .Plaza shopping' center-This project'will,inciease the.'imPervious .i: 1 Plaza shopping center:This project will increase the impervious.. ,I coverage on the site from 56.4%to 6129/6,'where a maximum 50% `overage on,the site from b6.4'/o to 612%,where a max!mum..50% impervious coverage is required in the GP.Oveday District The impervious;coveregels requ6d inane GP.Oveday District''The properties are located at 990 lyannough Road(Route 132)and 65;:: :Independence Drive,Hyannis MA as shown.on Assessors Ma Properties are located at9901yannough Road:(Route 132)and 65 p:, Independence Drve Hyannis MA`as shown onhsessors Map 295 as Parcel 015-X02.and Map 294 as Parcel'004.,They are in 2fl 5.as Parcel 015 X02'and Map 294 as'Parcel 004. They are m the'HB Highway Business;B.Business and IND-Industrial Zonin 9 the.HB Hi hive Busme .,Districts and the Groundwater Protection Overay District.'-• ;_; g- � y- �,B Business and IND Industrial Zoning _ Dfsthcts and the Groundwater Protectlofi Overay Distinct 7:10 PM Appeaf No.2011-053. Hoithouse •710 PM ;Appeal No:2011 053 r. Hothouse Rachel-Holthouse has petitioned for a Variance to`Section: Rachel Holthouse,has petitioned fora Variance to Section 24011E-:Bulk Regulations,Minimum Side.Ya- Setback The 24011E .Bulk Regulations'Minimum Side:Yard Sethackl'The i. petitioner;is proposing to construct an;aoditian to the-ewshng". pehhoner.!s proposing to construct"an addrtipn to the existing single-family dwelling,-consisting of an attached garage and living sin le famil dwell!n g g g g ..• I l g y_ g consistin of an attached are a and°ivm area proposed foruse as a family apartment The addition-will be area proposed far 9pe;as a famfiy.apartment .The addrhonwill be located 4.tifeet tiom the side property I!ne,where a minimum..10 located 42 feet from the side roe line,where a minimum 10 foot side yard setback is required..The property is.located at 13 P'p Laura Road;Centerville;MA as showo-on Assessor"s Ma 251 as foot side yard setback{s`regwred.,?he,property is located'af 13 P Laura Road;Centerville;MA as shown on Assessor s Map 251 rj Parcel:113.It rs in the Residence D-1 Zoning District parcel 113 It Is rn.the Resrdence.D..1 Zoning D!stmct ?15 PM :Appeal:No;2011 0.56.• Weber =715 PM':Appeal No:2011-056. Weber Donne and Jeff-Weber have:applied for a Special"Permit Donna and Jeff Weber have;applied for'a Special eermd pursuant to Section 240-94(A)-Change of a nonconfor ing use to pursuant to Section 240-94(A) Change of a nonconforming use to another nonconforming use The_Peihoner is proposing to convert another nonconforming use The Petitioner Is proposing to convert 1 a pre-e;isting.nonconform!ng two-family dwelling to a single-family a pre�wsting"nonconforming two family dwefl!ngao a single=family dwelling and restore a`detached'single family apartment on the• dwell!rig,and restore.a detached single fartiily a�artmenl;on the rear of the.lot The resulting nonconfortn!ty would be two single rear of the lot The-iesulting nonconformity would be two single family dwellings on one lot The property Is located at 118 Scudder. family dwellings on onelot The properly is located at 11 B Scudder �. Avenue Hyannis MA as shown on Assessor's Ma 289 as Parcel P Avenue Hyanns MA as_shown.on Assessor s Map 289 as Parcel 045 It is in the Residence B Zoning District 045 Itis in the Residence B Zomng D!stricL TheseAubici Hearings will be field at the Bamstable',Town' These Public Hearings will be lieid at the Barnstable_Town Hall 367 Main Street,Hyannis,MA Hearing Room 2nd Floor, Ha11367 Main 5treet;Hyann!s MA Hearing Room 2nd:'Floor 1 Wednesday, Decemher.14 2011. -Plans and applications may Wednesday pecember:l4 2011 plans and;:applicatlons may be reviewed at the Zdnng Board-of Appeals Office Growth; be reviewed:at the Zoning Boaro of Appeals Office Growth Management Department Town Offices 200 Mam Street; Management' Department Town Offices 200 Mam Street -! Hyannis MA Hyannis MA _ I Laura E 8hufelt,;Chair:: _ � Laura F ShufeB,Qhair Zornng'Board ofAppeals- Zomng Board of Appe9f� Th Bamstatile Patriot,. J. The Barnstable Petnot # ti ° November'25 antl December 2 2011 November 2 and 4ecember 2 2Q11 �° � - j I � .s �� ; f-�-�.� cam►�. �s -1-h f,4 ao n in 9 �l a.n a( h P—•ifi w� o �i U ��el i s ` ►ten iss o f boJ . lvt w erm�� 1 P IR 4 pROJ-EC _ NAlY1E:/�T9 ADDRESS: PERMIT# ��/�-=�/3/ 3� PERMIT DATE: �02-� Z LARGE ROLLED PLANS -A R-E BOA_ lo � SLOT Data entered rn MAPS program on: BY. 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION s Map �l Parcel^ 0 Application # a1,0 6`3` 33 HealtWDivision Date Issued Conservation Division Tr Application Fee Planning Dept. Permit Fee l � Date Definitive Plan Approved by Planning Boardp Historic - OKH _ Preservation/Hyannis Project Street Address J C«�AJL l� t Village -/ G n in 1�5 Owner L f •t tAJL,6 t_ Address _Sa-m t Telephone y -7-7 p u (L� g 7 Permit Request all o u a_:k &vi 1 G.u-trr v Lt.,S e- b.��r�v rn t.cU�7 ru-c.,! - /n 3 U,� �✓1 � � �1�.�rVt ,� t `R c,J ► n a�,.�5 p� D v t( � P it s h 6 �c 5 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed b-0 O Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 0, 0 0 O Construction Type Lot Size 0 a eu'LK -_5 Grandfathered: ` Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ . Multi-Family(# units) Age of Existing Structure r![ D Historic'House: ❑Yes �No On Old King's Highway: ❑Yes ;�No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other /1 a A Q� Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) c� Number of Baths: Full: existing new Half: existing new Number of Bedrooms: cZ existing —new `Y y Total Room Count (not including baths): existing new First Floor Room Count•, Heat Type and Fuel: �d Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes rd No Fireplaces: Existing New Existing wood/cTal stove-**0 Yes- 4/No -10 Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ F Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size Other: Zoning Board of Appeals Authorization (� Appeal # Recorded Commercial ❑Yes No If yes, site plan review # Current Use no n Q. _ . -- Proposed Use APPLICANT INFORMATION { _. BUILDER OR HOMEOWNER = Name n rL& W(iL¢/_ Telephone Number 7 7 a a Address I bd/pJ-A License # ; � G�l1✓l!-5 M IA Home Improvement Contractor# _ Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Lt- DATE i FOR OFFICIAL USE ONLY i APPLICATION# DATE ISSUED , ,. • r° t MAP/PARCEL NO.:. r ' ADDRESS VILLAGE r OWNER r' F n• DATE OF INSPECTION: FOUNDATION, FRAME INSULATION,_ : 1a { FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ,ROUGH FINAL P GAS: . ,, ROUGH :.- FINAL DATE,CLOS_ED,OU_T , ASSOCIATION PLAN NO. 1 ' The commonwealth of Afassachuselfr :Deparbnm7t of IndzrstriajAccider r OfjTce oflityeskgaiians 600 Washington Street Boston, MA 02111 WW .mass gw/din -s ''Porkers' Compensation.Insurance Affidavit;Builders/Contractors/Electricians/Plmabers Hcant.Iiiformafion Please Print Leeibly Name (Bnsmrss/0 m3&dividml): p n ►'i Q AS / Address: CitylRaWZi o Phone# J�UP FE e you an employer? Check the appropriate ba= I am a employer wish 4. [�I am a general coniractnr and I T'yPe-af project(regrdred): . empIoyees(M and/or part-time),* have hued the sub--ecmT,a ,,,s 6. E]New conslrucfion .I am a sole proprietor or partner- Hsted on the attached sheet. 7. [�Remodeling ship and have no employees These sub-contractom have worlang for mein any capacity employees and have workers' 8. ❑Demolition [NO.workers'comp,vlc,,=c cow,msnmmce,# 9 ❑Budding addition . d] 5• [� We are a corporation and its I O.2 Electrical repairs or additions 3.[ ] I am a homeowner doing ail work officers have exercised their e 11.®Plumbing repairs or additions mYs [No worker' camp. right of exemptionpar mm, .insuuance required.]t c. 152; §I(4),and we have no 12.[]Roofrepaim employees•[No workers' I3.[]Other cOp•msmEDIce requ>zed.] A13Y applicant abut checks box#I mast also M oat the section below showing.theff wmsrs'coazpeasalion o' Homeown=who submit this affidavit indicating they arc doing an worr and Hine hire ouhidc con p hCy iofnrmatioa #Coulrac[ars that check this box mast attached an additional sheet hectors mast submit a new of-dwvit indicating such, anpinyers. If the sub•-conhartum have=PIoyees,t}uy must j& the name of the sub-cnahacmrs and�whether or not those entities have provide their workers comp.policy amber, I am an errrp Loy el-that is providing workers v coIVensafion insurance for rrzy employees. Belot'is the policy and job site, Insruanoa Company Name: Policy#or Self-ins.Lic.#� Expirafion Date: Job Site Address: • City/StateJZip: Attach a copy of the workers' compensation policy decFaration 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' osition of ) fine up to$1,500.00 and/or one- ear �mal penalties of a Of rip to$Z50.00 a day Y �' o��as well as civfl penalties in the�ml of a STOP WORT{ORDER and a fine y against the violator. Be advised that a copy of I this statement may.be forwttrded to the Office of . m'e fLP ons of the DIA for iner,�.,ne coverage veafication I do hereby ce A57 under&e pains and penalties afPerjwy drat the information n Provided above p is hzte and correct Date. 7 / Phone# 7 P' O (o Q al use.onl3.-Do not n7rite in this arnav to be completed by city or town official City,or Town. Penmit/hicense# Issuing Authority(circle one): L Berard ofnea.tth 2.BWIdingDepariment 3. Gity/Tuwn Clerk 4.Elec ical Inspector 5.Plumbing ectnr . fi.Other Contact Person: Phone#: VE Town of Barnstable Regulatory Services Thomas F.Geiler,Director KAMM 16.79. Building Division ti 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:__ .l�jr �{ JOB LOCATION: A /1 S number j / , 'street village «HOMEOWNER" VtJ: Do f) f16L_ Q . T. LS 7 7,P 'y 6 name home phone,# work phone# CURRENT MAILING ADDRESS: 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,pr superviso ovided that the owner acts as r. 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 pernut. (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 minimarn inspection procedures and requirements and that he/she V;M comply with said procedures and requirements. Signature of Homeowner — i I Approval of Building Official Note:`Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the e 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 krplicensed 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 uP page of this issue is a form currently used by several towns. You may care t amend and adopt such a fom>/certification for use in your community. s Q:forms:homeexempt . �IKETown of Barnstable Regulatory Services BARNSUBM MASS Thomas F.Geiler,Director s6;q. 1�g n M►x k Building Division Tbm Perry,Building Commissioner 200 Main Street;HYannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 508-790-,6230_: .. . : Property Owner Must Complete and Sign This Section If Using A.Builder as Owner of the subject property hereby authorize to act on my behalf, in ail,m.attets relative to work authorized by this bumngP= it (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all fmal inspections are performed and accepted: Signature of Owner Signature of Applicant Print Name Print Name Date Q:FM&:O WNERPEP h0SI0NP0oLS . BEc 2,5���� F' 1��2 �2590 i 01-17-2012 a 01 = 1.3P sKAMMKX.F u a Town of Barnstable Zoning Board of Appeals Decision and Notice Appeal No. 2011-056-Weber• C-' Section 240-94(A) -Change of a Nonconforming Use to another Nonconforming Use To change a two-family dwelling to two detached dwelling units Summary: Granted with Conditions Petitioner. Donna and Jeff Weber Property Address: 118 Scudder Avenue, Hyannis Assessor's Map/Parcel: Map 289 Parcel 045 Zoning: Residence B District, WP Overlay District Hearing Date: December 14, 2011 Recording Information: Deed: Book 18984 Page 142 f Background -° In appeal 2011-052, Donna and Jeff Weber proposed to change the non-conforming two-family use on the property into two separate dwelling units on the property. The Weber's proposed to convert the principal building to a single-family residential dwelling by removing one kitchen and a second private entrance into the dwelling. The Petitioner proposed to establish a second dwelling unit on the second floor of the carriage house. The existing carriage house would be refurbished to accommodate the new unit. The ground floor of the carriage house is used for storage. No physical expansion of either structure was proposed. ; The subject property is 118 Scudder Avenue in Hyannis. The property is 1.04 acres and is located south of the West End Rotary in Hyannis. The parcel is developed with a residence currently used as a two-family dwelling and a second freestanding building on the rear of the property. The principal residence was built in 1925. According to the Assessor's record, it is a two-story, 2,095 sq.ft house with a total of four bedrooms. The second structure on the property is a two-story "carriage house". The applicant indicates the structure is approximately 800 square feet in area. Prior to the Petitioner's ownership, there was a dwelling unit it the carriage house. The Petitioner's concede that the use of the structure for residential purposes has been abandoned. Procedural & Hearing Summary Appeal No. 2011-056 for a Special Permit to change a nonconforming two-family use to two single- family dwellings on one lot was filed at the Town Clerk's Office and at the Office of the Zoning Board of Appeals on November 7, 2011. A public hearing before the Zoning Board of Appeals was duly advertised and notice sent to all abutters in accordance with MGL Chapter 40A. The hearing was opened December 14, 2011 at which time the Board found to grant the Special Permit subject to conditions. Board Members deciding this appeal were Board Chair Laura F. Shufelt, Craig G. Larson, Alex M. Rodolaxis, George T. Zevitas and Brian Florence. The Petitioners, Jeff and Donna Weber, represented themselves before the Board. The ; Petitioners stated that they wanted to convert the two family dwelling into a single-family owner- occupied residence and reestablish an apartment unit on the second story of a carriage house on i of Barnstable Zoning Board of Appeals-Decision and Notice ,ieber-Appeal No.201 1-056 the property. They confirmed that the 'property would be connected to Town sewer and that two sewer hook-ups were available. The Board questioned if the carriage house had been used as residence. The Petitioners indicated there were furnishings inside that indicate it had clearly been lived in at"some point. The Board confirmed that the first floor of the carriage house would continue to be used for storage and would not be habitable as part of the apartment. The Board questioned if there had been previous code enforcement actions on the property. The Board reviewed the 2000 Certificate of Inspection submitted by the Petitioner and indicated that, at one point, three units were recognized on the property. The Board expressed the importance of the fact the principal dwelling would be owner- occupied. Public comment was requested and no one spoke in favor of or in opposition to the request. Findings of Fact At the hearing of December 14, 2011, the Board unanimously made the following findings of fact for Appeal 2011-056: 1. Donna and Jeff Weber have applied for a Special Permit pursuant to Section 240-94(A) — Change of a nonconforming use to another nonconforming use. The Petitioner is proposing to convert a pre-existing nonconforming two-family dwelling to asingle-family dwelling and restore a detached single-family apartment on the rear of the lot. The resulting nonconformity would be two single-family dwellings on one lot. 2. The subject property is located at 118 Scudder Avenue, Hyannis, MA as shown on Assessor's Map 289 as Parcel 045. It is in the Residence B Zoning District. 3. The application falls within a category specifically excepted in the ordinance fora grant of a special permit. Section 240-94(A) allows for a preexisting nonconforming use to be changed to another nonconforming use by special permit. 4. Site Plan Review is not required for alteration or expansion of a single- or two-family residential structure. 5. After an evaluation of all the evidence presented, the proposal fulfills the spirit and intent of the Zoning Ordinance and would not represent a substantial detriment to the public good or the neighborhood affected. 6. The proposed nonconforming use is no more detrimental to the neighborhood than the existing nonconforming use. 7. The Department of Public works confirmed that two units could be individually connected to + Town sewer if the required connection infrastructure, such as the grinder pump, is appropriately sized. DPW'also requires a sewer connection, and associated betterment, for each dwelling unit. 8. The following requirements have been,met or are not applicable to the subject request. The proposed nonconforming use: a Requires no more parking than the previous use; b. Does not generate more traffic than the previous use, as measured by the Institute of Transportation Engineers Trip Generation Handbook or other sources acceptable to the Zoning Board of Appeals, nor does it cause Town expenditures to address traffic mitigation measures; c. Does not result in an increase of on-site and off-site noise, dust, and odors;. d. Does not result in an increase in the hours of operation or in the number of tenants or employees; 2of4 , wn of Barnstable Zoning Board of Appeals-Decision and Notice vVeber-Appeal No.2011-056 e. Does not expand the gross floor area of the nonconforming use, except as may be provided in § 240-93B, nor does it increase the number of nonconforming uses on a site; f. Is on the same lot as occupied by the nonconforming use,on the,date it became nonconforming; and g. Is not expanded beyond the zoning district in existence on the date it became nonconforming. The vote to accept the finding was: AYE: Laura F. Shufelt, Craig G. Larson, Alex M. Rodolaxis, George T. Zevitas and Brian Florence NAY: None Decision " Based on the findings of fact, a motion was duly made and seconded to grant Special Permit No. 2011-056 subject to the following conditions: 1. Special Permit 2011-056 is granted to Donna and Jeff Weber pursuant to Section 240-94(A) to allow a change in a preexisting nonconforming two-family use into two single-family units on one lot at 118 Scudder Ave, Hyannis. 2. There shall be one dwelling unit in the principal structure and one dwelling unit on the second story of the carriage house on the property only. 3. An occupancy permit for the establishment of a second unit in the carriage house shall not be issued until the kitchen facilities and second private entrance in the main dwelling have been removed. 4. Expansion of the uses or structures is.prohibited without further relief from this Board. 5. The total number of bedrooms on the property shall not exceed five. 6. When available, both units on the property shall be connected to sanitary sewer. Each unit shall have its own sewer connection and a betterment shall be paid for each unit. 7. All parking for the dwelling units shall be provided*on-site. 8. The decision shall be recorded at the Barnstable County Registry of Deeds and copies of the recorded decision shall be submitted to the Zoning Board of Appeals Office and the Building Division prior to issuance of a Certificate of Occupancy for the family apartment. The rights authorized by this special permit must be exercised within two years,:unless extended. The vote was: AYE: Laura F. Shufelt, Craig G. Larson, Alex M. Rodolaxis, George T. Zevitas and Brian Florence NAY: None Ordered Special Permit No. 2011-056 to change a nonconforming use to another nonconforming use has been granted subject to conditions. This decision must be recorded at the Barnstable Registry of Deeds for it to be in effect and notice of that recording submitted to the Zoning Board of Appeals Office. The relief authorized by this'decision must be exercised within two years unless extended. Appeals of this decision, if any, shall be made pursuant to MGL Chapter 40A, Section 17, within twenty (20) days after the'date of the filing of this decision, a copy of which must be filed in the office of the Barnstable Town Clerk. Laura F. Shufelt, Chair ` Date Signed 3of4 -In of Barnstable Zoning Board of Appeals-Decision and Notice /✓ober-Appeat No.201 1-056 I, Linda Hutchenrider, Clerk of the Town of Barnstable, Barnstable certify that twenty (20) days have elapsed since the Zoning Board of Appeals filed this sdets hereby that no appeal of the decision has been filed in the office of the Town Clerk. decision and Signed and sealed this perjury. -------day of under the pains and penalties of Linda Hutchenrider, Town Clerk 9 4of4 a r • � se srq�P,sr��.�� , ° `•� 4 ti rp'� rr I V I I HOUSE 178 _ g / PAVED ACCESS DRIVE R•�? `•\0 y tip p DRIVEWAY . 4 I TEMPORARY GRADING EASEMENT Ve ti• �� �I Rz m cc: GRAVEL DRIVEWAY mo ,Z 133.24- '40 . A, ?'p° ., e� �' 'rs p 2'0 A cI A y r c a q p m I - in F o 4 Ff T �°cb - IK Ix y t h m_o o c q s ISas12 E H r / "� szr v is- JS s a4'' ?,� m I 50 0. 50 100 Sturgis Charter School z SCALE IN FEET 125 West MAin St& BAXTER NYE ENGINEERING&SURVEYING 1"=50' Scudder Avenue 9 Registered PtafessionalEnrineersand Land Suveyms Hyannis, MA "a 78A'orth Street-3rdFloor,A),annis,MunchascasL260, Easement Exhibit Phone-(509)771-7502 Fax-(509)771-7 v 0.z010 2a1 DATE January 21, 2011 TOWN OF BARNSTABLE Building201200580 * BARNSTABLE, Issue Date: 02/02/12 Permit MASS. �1 N39. A � Applicant: WEBER,DONNA&JEFFREY Permit Number: 'B. 20120223 Proposed Use: TWO FAMILY Expiration Date: 08/01/12 Location 118 SCUDDER AVENUE Zoning District RB Permit Type: RESTORE TO SINGLE FAMILY Map Parcel 289045 Permit Fee$ 35.00 Contractor PROPERTY OWNER Village HYANNIS App Fee$ 50.00 License Num Est Construction Cost$ 0 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND RESTORE STRUCTURE 1 TO ONE FAMILY BY REMOVING KITCHEN 2N1Pffit CARD MUST BE KEPT POSTED UNTIL FINAL REMOVE W ALL ON IST FLOOR.FUTURE PERMIT FOR 2ND DU-201 056INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: WEBER,DONNA&JEFFREY BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 118 SCUDDER AVE INSPECTION HAS BEEN MAD HYANNIS,MA 02601 Application Entered by: PC Budding Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARLLY OR PERMA NTLY. ENCROACHMENTS ON PUBLIC PROPERTY,NO SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND.LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. 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. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept. 2 Board of Health _ fl rS1 n ® a ®j mpl t Project Tltle. Weber residence Energy Code: 2004{Lit C r -t Locatidn: Barnstable iNass +� ~� ;s Constriction Type Stngle Faintly : tj Project Type: Addttton/Alteration 'Heating Degree Days. 6137 r .. w, fit Climate Zone: Construction Site: Owner/Agent:.;... DesignedContractor 118.Scudder Ave. �onna''8 Jeff Weber David Olson Hyannis MA 02601 1.18 Scudder Ave.;; Olsondesign Associates Hyannis,MA 02601 Dennis Port,MAf02639 S08 77&0687 508=7Z5=4300 dweber3435@comcast.net olsondesrgn@venzon.net ` aximum UA:163 Your UA 162 o a o Ceiling,1:Flat Ceiling or Scissor Truss 650 38.0 38 0 i' 9 Wall 1:.Wood Frame,16"opc. 804 30:0 30 0 13 Window.1.Wood Frame:Tr and With.Low 62 Door 1:Glass Floor 1:AlkWood Joist/Truss Over Unconditioned Space!u 7 2 0 0 38.0 r, 19 .Basement Wall 1':Wood Frame Wall height:7l0' Depth bebw grade:4.0' Insulation depth 7.0' Project Notes: Old existing garage.Existing second floor apaHment renovated. �rAir .o I Project Trtle Weber residence Report date 06/25I12 Data filename Untrtled.rcki Page 1 of 4 m.. 1... ... _:..: h RES he S6 �r ersio 4:4 Energy;Code: 2iJ09 MCC Location: Barnstable,iNassachusetts Construction:Type "Single Fariiily Project,T pe: Addition/Alteration I Y Heating Degree.-Days: 6137 Climate Zone: g .. Ceilings: ❑ Ceiling 1:Flat Ceiling or Scissor Truss,R-38 0 cavity+:R-38.0 continuous insulation Comments: w . Above-Grade Walls: ❑Wall 1:Wood'Frame,16 o c R30.Qcavity,+R-30A continuous msulation Continuous insulation specifiedw vluratingac ::rofull area of.!the wall is Comments: Basement-►balls: ` ❑Basement Wall 1:Wood Frame 7i0'ht/4.W bg/7 0'insul,R-30'0 continuous insulation Windows: ❑Wintlow 1:Wood Frame Tnple Pane with Low E,U-factor 1 000= For windows without labeled U-factors,describe features #Panes_Frame Type Thermal Break?_Yes,_No'; Comments: ;Doors: ❑ Door 1.Glass;U-factor:;1 000 ::'_ Comments: Floors: C]Lrr Floor 1:Ail-Wood JoisUTruss:Over Unconditioned Space,R-38.0 continuous msulation Comments: Floor insulation is installed m permanent contactmith the underside of the suMoor decking. Air'Leakage: ❑ Joints(induding rimjoist junctions) attic:access openings,penetrations and all other such openings n the building envelope that are Sources of air leakage are sealetl with caulk,gasketed,weatherstripped or otherwise sealed':with an air bamer rtiatenai,suitable film:or Isolid materiak. - ® Air barriLLFer and seating exists on common walls between dwelling units,on-exterior walls behind tubs/showers and m openings between win dow/door iambs;and framing ❑ Recessed;ligMs in the buddmgahermal envelopeare 1)type;C rated and ASTM E283 labeled and 2)'sealed with a gasketor caulk between the housing andthe interior wall or ceiling;covering ❑ Access door§separating.condRimed from unconditioned space are weather-stripped and it sulated,(withoutinsulation compression or damage)to at least'the level of insulation on the surrounding surfaces.:;Where loose 11,insulation exists.z a baffle,orretainer isInstalled to maintain insulation application " ® Wood-burning fireplaces havegasketed doors,and outdoor combustiorr,air Automatic or raw m da rs,are installed on A outdocir airintakes and exhausts: AtrSealingand Insulation: .' ❑ Building envelope air tightnessland msulation installation complies by'either 1)a:post roughsm blower door test result of less than 7 s ACH at 50'.pascals QR 2):the.foilowmg items have';been satisfied., Protect,Tdle.Weber residence Report date Q6/25/12 Data filename:UntitIed:nck Page 2 of Oil N _... ... .. f (a)Air barriers and thermal barrier:Installed on outside of air=permeable insulation and breaks or joints in the airbarcier are filled or p re aired. (b)Ceilinglattic:Air bamer in any dropped ceiling/soffit is substantially akgned with insulation and anygaps.are seated. (c)Above-grade walls:Insulation is installed in substantial contact and continuousalignmenf with the building envelope air.barrier. ::- "(d)Floors:Air barrier is installed at any exposed edge of insulation. (e)Plumbing and wiring:Insulation•is placed between outside and pipes.Batt insulation is cut to,fd arountl wrong and plumbing,or - sprayed/blown insulation extends behind piping and wring. (� Corners,headers"narrow framing cavities andrim joists are insulated. (g)ShoweYftub on eutenor wall:Insulation exists between showers/tubsand extenorwalC: Sunrooms:' ;. ; ® :Sunrmoms'that are thennaily isolated from the building envelope have a maximum fene'sVat i on U factor of 0.50 and the maximum i skylight U=factor of 0.75.New windows and doors separating hesunropm from conditioned space meet the building thermal envelope Fequirements. � Materials Identification and Instal Materials and equipment are installed in accordance with the:manufactureYs insfallahon insfructions ;:: ® Materials and equipment are identified so that compliance can be determined ® Manufacturer manuals for all installed heating.and cooling equipment and service water heating equipment have been provided (] Insulation R-values and glazing U-factors are clearly marked on the building plans or specifications Duct Insulation: ® Supply;ducts in attics are insulated to.a'minimum of R 8.All.other ducts m unconiiitioned spaces or outside the building envelope"are insulated to at least R-6. Duct n Constructio and Testing, Bwiding framing cavities are not used as'supply ducts ® All joints and seams of air ducts,air handlers,•fitter boxes,and budding cavities used as return ducts are substantaly airtight by means of tapes mastics,liquid sealants,gasketing or other approved closure systems.Tapes,mastics,and fasteners are rated UL 181A or UL 181B and are labeled according to the duct,constructiom Metal duct connections with equipment and/or fittings are mechanically fastened.Crimp joints for round metal ducts Kaye a`contact lap of at least 1 1/2 inches and are fastened with a minimum of three equally spaced sheet metal screws Exceptions: Joint and seams,covered with spraypolyuretti'ane foam: Where;a partially'inaccessible duct connection exists,mechanical fasteners cambe equa ehe,eposed"porion of the:xn joint so as to prevent a hinge effect I Continuously welded and locking type longitudinal joints and seamson ducts operating at less than 2 in r ® Duct tightness test has been performed and meetsone of the:followingaest criteria: f 1)Postconstmction leakage to outdoors'test:Less than or equal to 8'cfm per.100 ft2 of bonddioned floor area. (2)Postconstruction'total leakage test(including air handler enclosure);Less than or equal,to 12 cfm per 100 ft2 3 equal to 6 cfm per 10(J ft2•of'condiboned floor area.O Rou h-in total leaka a test'vnth air handler installed Less than or 9 : 9 (4)Rough4n total leakage test without air handler installed Less than of equafto'4'cfm per 100 fY1 of conditioned floor area Temperature Controls. Where the,j primary heating system is a forced air furnace,atieast one programmable thermostat is ristalled to control the primary heating system and has set pojnts initialized at 70;degree F far the heating cycle and 78 degree F for the coaling cycle ® Heat pumps having.supplementary electric resistance heat have controls that prevent supplemental heat operation when the compressor can meet the'heating load bleating and Cooling Equipment Sizing ® Additional requirements for equipment siting are included by Ian inspection for compliance with the Intemational':Residential Code For systems sernng,muIt dwelling units documentation has been submitted demonstrating compliance,with 2009 1ECC Cornrriercial Building,Mechanicaland/orService Water Heating,(Sections 503 and 504) Circulating Service Ho4 UUater Systems ® Circulating service hot water pipes are insulated to'R 2 ® Cimulating service hot water systems include,an automatic or accessible manual'switch to 4'urn off the;circulating pump when the system is not m use; r bleating and Cooling piping lnsulati®n : Protect Title .Weber residence Report date 06/25/12 Data filename:Untitled.rck Page 3 of 4' i i 'HVAC piping conveying fluids above 105:degrees F,or chilled'fiuids below 55 degrees F are linsulated to R-3., Swimming,Pools: Heated swimming pools have an onloff heater switch ' Pool heaters operat hg,on natural gas.or LPG have'an electronic pilotlig..t ® Timer switches on pool heaters:and pumps are present. Exceptions: Where putslic heaftti-standards require continuoys pump.operatiio Where pumps operate within solar-and/or waste-heat-recovery systems:. ® mming pools have a cover on brat the watersurfece.For pools heated'over 90 degrees.F(32.degrees C)the.cover has a Heated swi minimum insulation value of R-12 I , Exceptions.: Covers are not required.when 60°k of:the heating energy is from site recovered energy or solar energy source Lighting Req u irements: A minimum of 50 peril ent,of the lamps ih permanently installed lighTtng fi�ctures earl be categorrced as one of the followmg�: i (a)Compact fluorescent (b)T-8 or smaller diameter linear fluorescent (440 lumens per watt for lamp wattage:-15 (d)'50 lumens per watt.for lamp wattage>15 and<=40 (8)60 lumens per.watt for lamp wattage>40 Other Requirements; Snow-and'ice melting systems'wfth energy supplied from the!service to'a budding shall include automatic controls capable of shutting off the system when a)the pavement temperature is above 50 degreesl'F,b)no precipitation<is falling,and c)the'nuttloor temperature is above 40 degrees F(a manual'shutoff control is also permitted-to satisfy raquirernovc'). Ceetif sate: ® A,permanent certificate is provided on grin the electrical distribution panel listing the predominant insulation.values window U-factors;,type and efficiency of space-ronditioningand waterheating equipment.!The certificate does;not"coyeror obstruct the visibility of the circuit directory label,service disconnect label or other tmouired labels. NOTES'TO-FIELD:(Building Department Use:b I ) A I ,. .. :. .: I: is .. ... ..,e ... ...... Protect Title Weer residence Reportdate 06/25/12 Data filename: Untitled.rck; Page 4,'of 4 .. is �: is �:i: �:i ..,�:.': wyy , _I : i her f Ceiling i Roof 76'i00, Wall fi0.00 ai Floor/Foundation 3800 Ductwork(unconditioned spaces). ' Window D1.00 Door 1.00 NA Ma Hea4ng,System. Cooling System: 77777 Water Heater. Name: Date: 1'. 4 ..: .;.. :: .. 61 r i v R a i v .. v I i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 9 Parcel 0 y ' Application # Health.Division Date Issued Z. Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village )(.�c "'II S Owner 4 4-J Q_ wtktk, Address 10-1Yl L Telephone Y 77�- o & Y-7 Permit Request --fa k &A,14 r A� ro c, 1 n-_nod o n �i'��s �I o r h u is lv aci 44ham � �.p nza rnrj �v�! Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size / b a CL.Lka- 5 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes W No On Old King's Highway: ❑Yes ❑ No Basement Type: I Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) J, ,A e Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 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: '0 Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes V No Fireplaces: Existing I New Existing wood/coal stove: ❑Yes V No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization-❑ Appeal # J0i1 0 5_6 Recorded% Commercial ❑Yes Cp No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) .� Name /n) n n a l.vj Telephone Number Address l -1-(j �� A � License # aq an LS /) Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1 Lj-2 / )-o/a, i r I a FOR OFFICIAL USE ONLY ,r t; APPLICATION# DATE ISSUED L MAP/PARCEL NO. ADDRESS VILLAGE OWNER F f DATE OF INSPECTION: i A � i FOUNDATION FRAME INSULATION r r .s, FIREPLACE i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ti FINAL BUILDING r• DATE CLOSED'OUT �f - r ASSOCIATION ,PLAN NO. T t� - The Commonwealth ofMassachuseas Department of industrial Accidents Office of Investigations 600 Washington Street Boston,MA 0211.1 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors ficant Information /Electricians/Plumbers Please Print Le 'bl Name (Business/organization/tn&vidaal): ®0/1 n G 4— SS: 1 City/State/Zip: i ��e ✓�' Phone Fno you an employer? Checkthe appropriate box:1.❑ I am a employer with . 4. I am a general contractType of project(required): employees(frill and/or part-time).* have hired the sub-con6• .❑New construction 2..0 I am a sole proprietor or partner- listed on the attached s7Remodeling ship and have no employees These sub-contractors working for me in any capacity. employees and have ws' El Demolition �o�workers' comp.insurance comp.insurance.# 9• []Building addition �gture5. [] We are a corporationan0.❑Electrical repairs or additions �3' 'I am a homeowner doing all work officers have exercised myself [No workers'-comp, right of exemption per 1,❑Plumbing repairs oradditions insurance required.] t c. 152,§1(4),and we ha2•❑Roof repairs employees. [No workers' 13.❑ Other comp.insurance required] *�Y 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 and then hire outside contractors must submit a new affidavit indicating Stich. doing all work :Contractors that check this box must attached sa 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 information rrry employees. Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lic.#; Expiration Date: Job Site Address: Attach a copy of the workers' compensation policy declaration page(shooting the�policy Z�nu Failure to secure coverage as required under Section 25A fine up to$1,500.�0 and/ of MGL c. 152 can lead to the imposition bof criminalPenalties d of a or one-year imprisonment, as well as civil penalties in the form of s 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 andpenaltiej ofperjury that the in Provided above is true and come I/ rovidd ct Sinature: r r Date: �. Phone#: 7 7 �a E=B only,. Do not write in this area to be completed c o by city r town offzciaL n: Perri tUcense# hority(circle one): Health 2.Building Department'3. City/Town Clerk 4.electrical Inspector 5.Plumbing Ins actor pson: Phone#: r ToW'U of Barnstable yam. o Regutatbty Services c r ReA* � s Thomas F, GezZer,Director MAIM Building Division Tom Perry, Building Commissioner _ . 20D Main-S�r_r _HYaq=,MA 02601 _ www.town.barnstable:tna..us )f = 508-962-4038 Fax:: 509-790-(5230 ErOMMORhNE:R LIMISE=l mON • glean Print • DATE JOB LIDCATION: number village "HOMEOWrrr: bannw a ..-Q...H ti� �5ei �DF- -7 oL �7 name bomo phone# work phone# CUkRm'T)JAn.24G ADDRESS: a/ rtate zip emc The current exrtiption for"homeawa= was ended to inclndr owner-occupied dwellmes of six traits or Iess and tb allow home:ownCrs to migage an individual for hire who does not possess a license,provided that She owner acts as SLLFelYISQI. DEFINMON OF HQTi$0VIrNIER Pmrson(s)who owns a parcel of land on which he/she residoS or intends to'mside, on which thz=re'is, or is intended to- be, a one or two-family dwelling, attanhcd or detached siractracs accossory to such use and/or farm structures. A person whD canstrgcts mare than t1ne'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 tic Building official, that hmishc shall be rc_spansIle:for al]such work verfb med under the building hermit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance vrith the State.Building Coda and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"ecrtifit;s thathelshc understands the Town of Barnstable Building Department rrrin'=r`n inspection procedures and rl--C +T*T'Tnr-nts and that hclshc will comply with said'procmdurm and rcquu'cmcnts '' '' '' U 'ignatiirc of Homeowner , .gproval of Building Ofezal , I Note: Thrae-&za2y dvetm2gs containing 3 5,00D cubic feet or larger will be required to comply with thc tots Building Code Section 127.0 Constrvdion Control.. HQMEOw2�El�'S F.70;h2YIIOh' -The Code sIXtrs that Any homm—cr pabandmg work—for which a bmIdmg perrdt is required shaD be czracpt from The prDYW mu thir section_(Seotion 1D9.1.1 -Li=msing of mmshvrtion Supmrisors),provided that if the homeo-yna engages a parson(s)for hies to do such 6,, that such Homeowner 4mZ act as supervisor."' luny hotncownas who use this rxaaption are unaware that they arc essuming ncc responsibilities of a supmzsor(see Appendix Q. )es&4&h tiow for Lie-sing Construction Supervisors,Section 2.15) This lack of awarrn=bfl=rosulm in serious problems,particularly en the homeowner hires unlicensed porous. hi•this ease,our Board cannot proceed against the unlicensed person as it mould with p lireaised rervisor. Tbehomeowncractingas Supmzsoris uTtimatc}ytuponnbla To assure that the homeowner is fully¢wars of his/hQ responsibilities,many communities require,as part of the permit appica6m, the homeowner certify that he/she understands fire respoasrhtlities of a 5upervisor. On the last page of this issue is a form eutrmoy used by aal towns You may care t amend and adopt sueb a formlcprtifieation for use in your community, rrrs:homco:cnrpt i i_ e IKE Town of Barnstable Regulatory Ser ices Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyinnis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If U.sWg A Builder as Owner of the subject property hereby authorize to act on my behal� in all matters relative to work authorized by this building permit. (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date QTORMS:OWNERPERMISSIONPOOLS Town of Barnstable . Regulatory Services snatvsrasi.e.sL►ss. Thomas F.Geiler,Director g 16 9. 6�0 Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 MEMORANDUM DATE: TO: File REGARDING: COI Multi-Family Use Re: Certificate of Inspection is not required for this property--does not consist of 3 or more units within a single structure. Notes: > �o-rs-e 2 © �� Town of.Barnstable Regulatory Services r • ' 3AR MBLE. ' Thomas F.Geiler,Director K►ss. 059. � Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508490-6230 CERTIFICATE OF INSPECTION CAPACITY INSPECTION DBA LOCATION / OWNER USE CAPACITY&FEE DATE OF INSPECTION INSPECTOR COMMENTS c. � P (0 J990125a oFt r -Town' of Barnstable *Permit# pExpires 6 months om issue ate Regulatory Services , Fee BARMSTABt E Thomas F. Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601. www.t6wn.barnstabl6.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 Property Address 11,Residential Value of Woi i Ud Minimum fee of$35.00 for work under$6000 00 f Owner's Name&Address �/ } A-4 Contractor's Name Y( Telephone NumberT7&t,;0 • U 7 �DC ,� Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable)::.=;. a ❑Workman's Compensation Insurance X-PRESS PERMIT Check one: 4. .❑ I am a sole proprietor >` ❑ I am the Homeowner JAN - 5 2012 EJ I have Worker's Compensation.Insurance Insurance Company Name TOWN OF BAR STABLE Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit: Permit Request(check box) ❑ Re-roof(stripping old'shingles) All construction debris will be taken to ❑ Re-roof(not stripping'. Going over .existing layers of roof) , T side y" #of doors ❑ Replacement Windows/doors/sliders. U-Value, (maximum .44)#ofwindows *Where required:,Issuance of this permit does not exempt compliance withother 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& Construction Supervisors License is wired SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC Revised 070110 The Commonwealth of Massachusetts Department of Industfial Accidents Office of Investigations ' r 600 Washington Street Boston,,MA 02111 °'.. www.mass.gov1dia Workers' Compensation Insurance Affidavit:;Builders/Contractors/Electricians/Plumbers Applicant Information A APlease Print Le ibl. Name(Business/Organization/Individual):. ° �. /'V t Address: City/State/Zip: ;j/� ' ` d� � Ph ne.#: Are you an employer?Check the appropriate bo Type of project(required);.; 1.❑ I am a employer with .4• E r 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. T ❑Remodeling s and have no employees These sub-contractors have,` g mP []Demolition working for me in any capacity.' ` '. employees and have workers' 9. ❑.Building addition [No workers' comp.insurance comp.insurance.t required.] 5. ❑ We are a corporation and its. 10.❑-Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing officers have exercised their umbing repairs or additions myself. [No workers' comp. p 12.❑Roof repairs,.' . } , § insurance required.]t 152, 1� )4 ,and we have no* " -. c. .13.❑ Other . - e to ees. o workers,' , mP Y [N Sr 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 subcontractors have employees,they must provide their workers'comp.policy number. lam an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site k information Insurance Company Name: Policy#or Self-ins.Lip.#: Expiration Dater Job Site Address. City/State/Zip: ,� a 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 j. Investigations of the DIA for insurance coverage verification I do hereby certify.u der t e pal�pajtpenalties of perjury that the information provided abo is tr a and corr`ect Si `atuie: Date: M, Phone#: t. F ,Official use only. Do not write,in thiy�area,`to be completed by city.or town affcciaL City or Town- i PermitlLicense# - .Issuing Authority(circle one): 1.Board of Health 2:Building:Department 3.City/Town.Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6: Other x. Contact Person: Phone - #: F 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." R An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of&Ibregoing 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-contracior(s)name(s), address(es)and phone number(s)along with their certificaie(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 permittlicense number which will be used as a reference number. In addition, an applicant that must submit multiple permittlicense 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"all4ocations in (city.-or . town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be°piovided 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 fo 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 M=adhusetts Department of Industrial Acoidents Office of Investigations 600 Washington St eet Boston,MA 02111 TO.#61 7-727-4900 ext 406 0r 1-9 77-MASSAFE Revised 11-22-06 Fax#�617-727-7749 WWW.Mas&gov/dia 01/03/2012 16:03 50S771✓G63 SCHLEGEL_1NSURANCE PAGE 0i/01 CERTIFMAYE OF LIABILIfY INSURANCE -DAM(I1vWVVrYYYY) _ _ D1/0�/2012 THIS CERTPf rCATE IS PS9UEt) A5—A MATTER-- INFORMATION ONLY AND CONFERS- NO RIGHTS UPON TIE CERTIFICATE HOLDER. THi:R CERTIFICATE, DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE$ BELOW. THIS CERTIFICATE OF INSURaNCF, DOES NOT CONSTITUTE A CONTRACT OFT VEEN THE ISS ANG IN$VRER(S), AUTHORIZED ftsPRESE'NTA'TIVE OR PRODUCER,AND THE CERTIFIC,kTF.HOLDER. IMPORTANT7I4 th® CertlficRfe heldar fa all ATIONAL INSURED,the polloy(le9) must be endomied. If SUBRc GAYII N i5 WAIVED, Subject to the terms ;trot condltlona of the policy. cerf,Itln p®lieies may requirr) an Orldomement. A statement on this certlflca;P. does not Confer rights to the Certificate 1101VOr In lieu of such endorsement(s) -- SC$lAq l & SChlegcal Insuranc9 BrokerEl Inc �oa'. �--_ FAX (nrc'No,Ext1: _M.� 34 :MAIN SwzE'1 -f�ATC " _ (Arc,No): ---__ .— ADORCaP.; PRODITCER . CUSTOMER ID @i NeOt Yarmouth, bv� 02673 ...--- — •�, ---• ._�__.—.__ hISURER(SI 9�FPDRI7IMG MOVER!it NAtC Y lRRI,IREO - INSURER A NGM SNST DANCE'CO Jams MCMr"!r(:er Db1 0'Em Construction --- -- - -----._ -- — - INSURER a ZJRICH tiT Cir^ e Ll1`l VEI JNSURFACPROGUSSIVE ' tiyaTinis, bill 02601 dunr:Rt i _._. .... COVERAGES CERTIFICATE NbjMSER: _ REVISION,DUMBER: - . Try$ S TO L:rRTIFY THATTEAT THE hOLiCICS :)F 111SUS:ANCE LISTED I3PI.QVV HAVE BEEN ISSUED TO TH.r INSURED NAMED ABOVE fOR TlaE POLICY PERIOD NDICA.Ttb. NCTVn'!THSTANIDINC ANY RRQUIRENIENT, '+`ERM or. CONI')ITION OF ANY CONTRACT OR OTHER DOCUMENT' W171.1 RESPECT TO WHICH THIS CERTF,Caie >,In RE ISSJED OF MAY P€R7AIN, .Hrz !NSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN li Su19.IrCT TO ALL THE TERMS, EXCIMSIONS AND COA'DI'PON'S OF SUCH POLICIF.3.JW.1T$SHOWN MAY HAVE BEEN REDUCED sY PAIID CLAIMS.POLW f 9I� k'fF f Or WM INUR LTR I Trn .IRANCE 'TI70 1 POLICY NUMBER I (MMIDDNYYY) (AgmlDDlYYYY) Lf LJIAITS r r- oEnERALl.1.1n1 I , �05/Ol/11 05/01I12 AChocPVl RENCt 8 1,000,000 A ><TYJ9751M OAMAQ1 TO !�'� V) . . .. jt 1 C^_"de.7 R:Lil'+QNIRf.L:.bY91iiT'/ i I , f I !i 3 s DD i � 000 , PRFMBF,$(F.t JC^(Iff9nC9} :liAa;,^.:n,12E I OCv11R { r on paJ¢on. 5 0 0 FxP Ar. w r. , 0 PEaeorrAl,A ADS IN,aiMY J-a ,000,000 OFNFRAI.AC REGATC 9 OOD OOD 4c40. e.ATE_I MI Arpt,J6^.PER: I r�`R^� ..DUCT^' :OMR;OP:AG:; s2,000,000 LOC �1_E_ EE C AV,OMOBILELIAFII.IIYj !134565605 02/1e/11 102/19/12r,0)viIllNEha JOLEI.iMIT q, 5oo,o0D — i i 1 (Sa aceldant) i ANY j0.jTl, __._........... I I 80DtLY INJVI Y(Pal pnlpoJ7)" f• 1 : ALL i)WN!i1�AUTGS I 90OII,Y IN.111 Y(P9t ACNMPII) I T n AUTOS --1 F'ROFGR Y C HIRR;All OS _ I (Poi noCltlnM) 1$ — I OCCUR � F.ACH 000UI _ OCCUR--._ MESSLIAn /60AFOATt &� DrC:)C.,,,LE e wuRxERscatglnNsnttoN ; I ?9F328�8-1.-OJF y 6612911 06/29/121X I �I --- — AVM?IMPI.CYEr,9 IAUILITY' rj.. _ , V. TOF'Y L Al7q,1, ER_.-1_ ANY VR'JP.UETt,d ARTNER ?iL•CUTIvkF r---� 6,• 1 i F CER/aeraA R CXGLJP.CO� I N t E L EAOH A0:IDeN1 (�XDD,DOO - ' rndr ory to MI ! % .. I'yna;I]narfiA§u„da i j E.L vIaEA3E EA EMP.OVE6 j$ 100,000 I CEacR PTIOrI CvI OPCR..T!ONS 90-MY --I—' .. ..... .__ —.- 1 I .1.013EASE POQCY 500 000 I I )G'ICRJPTION OF OPEkATIONS:'LOOATTONa 1 VEHJCLP'' iArtacA ACORG'7dr,M1ddltl9nAl RomarNa aohaduln.Il mom npAr.A(n rogWradl - TKE WORKERS 'COM)ProkATION YOLICY DOES agox PROVIDE COVERAGE FOR JAMS MC=RROta ZERTIFICATE HOLDER L• CANGffLLA Y'ION - I SHOULD .ANY OP THE ABOVE DESCRIBED POLICIES 13R CANCELLED 9rrORE THE EXPIRATION DATE. THEREOF, NO'ICE MLj. BE DELIVERED IN J ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPREaENTATIVC h""OR-Z00SS 9 ACOF D CORPORATION, All rights rpverned. 1CO30 2S(2009M,+9) 47'he ACORD nRni9 and logo are registors marks of ACORD - ivrtssacuuscus- vclraruncnt rn r;uunc �:ur��: - Board of Building 1104ulations and Stand ti•dti Construction Supervisor Lrtense License: CS 98120 JAMES MCMORROW 17 CIRCLE DRIVEN . HYANNIS, MA:02601 ... wa •,Expiration:_9/10/2013 i ('unuiu�siintct Tr# 3573 . `__.....:� ..— .-.— •off-,-----;_----- " Office f Consumer ffai&Bu�sines g ga a o j License or registration HOME IMPROVEMENT CONTRACTOR valid for individul:use only Registration before the expiration date. If found return to: 170630 Expiration 11/22/2093 • Type: : .Office of Consumer Affairs and Business Re ulation ' Individual 10 Park Plaza-Suite 5170 g MI AEL C.ROD,RIGUES�Y '• Boston,MA 02116 '. lr � ��p 'y • _ MICHAEL RODRIGUEST, ; 191 STONEY CLIFF.RD CENTERVILLE, MA 02632 Undersecretary Not va id without ta4t e } apiHE Tp� Town of Barnstable Regulatory Services snxtvsre.ss.MA Thomas F.Geiler,Director y �' �p i639• lFonw'�a Building Division, Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230, Property Owner Must Complete and Sign This Section If Us ing A Builder I, 0V%VN4' as Owner of the subject property hereby authorize �k i to act on my behalf, in all matters relative to work authorized by building permit application for. (Address of Job Signature of Owner / D ate Al Do f) Q 4- 14i'LA, Print Name . If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. QTORM&O WNERPERMISSION �r ' 1 Town of Barnstable �oFT�T°�ti P o Regulatory Services SrABLE BMWThomas F.Geiler,Director MASS, 9q,,, 16�9• ,�� Building Division rfD MA'I A 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: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: 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. Signature of Homeowner j Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control.. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall b_e 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,particulp: , when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed personas it would with a lice_" 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 a'ppli that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue-"a a form currently u.�.o ,A several towns. You may care t amend and adopt such a form/certification for use in your community. t _-UA, 1 Q:forms:homeexempt �. �r �t r Town of Barnstable ermit# 4p Expires 6 months from issue date K Regulatory Services Fee * BARNSTABLE, ' 9 Mass. i6�� Thomas F.Geiler,Director 4> 'OlfO MA'I s , Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA-02601 www.town.bamstable.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 �, o LI -� `, /0 y 5/ u `/ U Property Address Residential Value of Work .3 Q 0.0 0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address `Jf(�f �i.y� 6 t7 n n Gam--• � C�✓Yl Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: k g� E��*ro S- PERMIT ❑ I am a sole proprietor lam the Homeowner ❑ I have Worker's Compensation Insurance O C T 2 5 2011 Insurance Company Name e OWN OP BARNSTABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors �,�, .Replacement Windows/doors/sliders.U-Value 30 (maximum.35)#of windows_Z *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&Construction Supervisors License is required.'' SIGNATURE: N C:\Users\decollik\AopData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\DDV87AAZ\EXPRESS.doc Revised 072110 7je Conti)latr.ttaealtir.:of assacltrisetts Department of Irrd itstrial Accieti►tarfrts Office of Investigalions v 600 Washington Street. s Boston,JM4 02111 mvir.massgov4dia Workers' lCompensation Insurance Mfitlavit: BliiilderslContracto:rs/EIectiicians/Plumirers ,'applicant information C Please Print Legibl Name(Batsines&OrgauizadoniMvidual): City/State/Zip: Phone 4: Are you an employer?Check the appropriate boa. Type,of project(required): 1_❑ I ant a employer with 4• ❑ I am a general contractor and I a * have hired the sub-contractoors 6 ❑Near constructs`an. employees(full and or part time). 2.❑ I.am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have:no employees Thesesub-contractors hat*e g- ❑Demolition. working g for mein any capacity emplc},ees and have wm—kers" 1 p acity t 9. ❑Building addition. (No workers'comp-insurance: comp.imurance.- required-] 5- ❑ We are a corporation.and its 1a.❑Electrical repairs air additions l officers have exercised their 11. Plumbing repairs or additions 3.' I am a Iromeov�uer doing all tv�k ❑ g ep - m myself o workers'co right of exemption per 2MGL 5 � mp- 12.❑Roof repairs insurance required.]1 c. 152,§1(4),and we have no employees.[No workers' HE Other comp.insurance required.] *Any app€icaut that checks box#1 must also fill out the section below,showing their workers`cDmpewation policy infoamatlon. 9 HGmetmrnees who submit this affidmat indicating they are doing all arms and then]sire outside contractors must submit a new affidavit indicating such. 4Contractors that check this box must attacked an additional sheet showiar the pause of the;sub-ccurmcmis aad state whether or not those entities have employees. If the subcontractors.have employees,,they must provide their workers'cotup.policy ntmber- I art art einplol'er tdtat ispros iditig workers'coniperisatiort iiisiiraitce for itt eatiployees. Belot is file policy an d,job site inforttiatioti. Insurance Company Name: Policy-or Self-ins-Lic.4 Expiration Date_ Job Site.Address: City,atate,'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 IV,ORK ORDER and a fine. of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarrded to the Office of Investigations of the DU for.insurance coverage verification.. I do hereby certify anrdegr Ilepains anid penalties of`petjitty Matthe inforttiatiott proi icded abosre is trite and correct Signature: tCi/A/ll`e,6•e�— Date: ► �'a�s �'7 Phone#-.'_ ����d� (?jjiriad use ontt. Do not write,in this area,to be caittpdeted by citi'or town affilcial. Cite or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City!Town Clerk 4,:Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone##: 6 OpIKE to Town of Barnstable * Regulatory Services * BARNSTABLE, * Thomas F.Geiler,Director y MASS. 039. ph Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: d l lii✓1 V1 13 number street village „HOMEOWNER": �J��✓LGl �� / d 0 L �� name home phone# work phone# CURRENT MAILING ADDRESS: 0-ry,_4 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 OFHOMEOWNER 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. 1. Q) � �IJ Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S.EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may caret amend and adopt such a form/certification for use in your community. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 I� FtHE The Town of Barnstable BAMSTABLE 9�pM�. ��� Department of Health, Safety and Environmental Services rEo Mo't°' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner September 12, 2000 SOSSOS DELIS 93 GREENWOOD AVENUE HYANNIS, MA 02601 SECOND REQUEST Re: Certificate of Inspection Multi-family Dwelling (5-year Certificate) 118 SCUDDER AVENUE, HYANNIS 289 045 3 Units - $81.00 Dear Property Owner: We have not received a response to our letter of May 15, 2000 requesting you to return the Certificate of Inspection application with the required fee.to this office. The Certificate of Inspection is required by Section 106.5 of the Massachusetts State Building Code, Sixth Edition. The fee must be paid before the Certificate of Inspection can be issued. Your failure to respond indicates that you are not interested in maintaining your multi- family status with this office. Please submit the application and fee immediately or contact Lois Barry of this office(862-4039)to clarify your situation. Sincerely, Ralph M. Crossen Building Commissioner RMC/lbn j000906a �� � � , � �� . i ,: oFtME r Town of Barnstable BARNSTABLE, + Regulatory Services 9 MA3S. g i63q. 10 ArfDMA'�A Thomas F. Geiler,Director Building Division Tom Perry Building Commissioner 200 Main Street, Hyannis, MA 02601 } Office: 508-862-4038 Fax: 508-790-6230 MEMORANDUM TO: File FROM: L. Barry DATE: 6/21/04 RE: 118 Scudder Avenue,Hyannis Prospective buyer of this property called. She wants to rehab the carriage house and have 3 units on the property. T. Perry reviewed file. She will have to prove when it was last occupied. If more than 2 years ago, use is abandoned, and she would have to go to ZBA to reestablish use, apply to Amnesty, or apply for family apartment. i .s DEdP�ARTMW vNT ®F oALa 5; �; y4AN � y T�I��I�S STRi7CTr� AP�� ryl.WV,,J, �©N��® ESE PRE1I�I�IS �. �, OI2���E�PRE�SyES �® 'C � QED UN�I�L.T ®�E`•a o ® E�°V"�OI.:�T�I® S °.yY PE�IZS®11 lVi®V,ING T IS Nol ;.INNIS PIZ®I'EIZA ® ®RI7.�T 01�1 Sj m; BE I�I� B LSE` � E t t, e f�U1ll�lna:sst _ " mn - e s 3s rY a,r-vi�.r�rt wv I IMCJ `,./—O.I LL.V LJ V I of L 9 BOURNE: Large 1-2 BR apts BARNSTABLE VILLAGE: Of- 17'GLASTRON:SX-175 2000 92' BAYLINER: Full cabin 9'HOLDEF near.Bourne Rotary. $950- fice Space. 1, 2, 1 Offices. NEW Meruruiser 4.31-motor sleeps 4, repowered, 4.3L Sloop, bi $1,100mo +. 1st, last, se- Waterview. $695-1450/mo.. in 2004. Top & trailer incl Merc,new trailer,runs great, used. $6 curity+ iyr lease required.. Owner,508-776-0001 $10,900/BO.508-833-6405 - ,- fish.or family boat,steal for (508 Payment plan avail for last CENTERVILLE: .17' KEYWEST: 1720CC Pro: $8,000 508-3.64-2572 Cell(5 mo.No Pets.508-743-9100 RETAIL/ OFFICE: 619_Main 2007 (15 hrs total use), 22' LARSON: Cabrio 2005, 14'CAPE I. CENTERVILLE: 2BR, 1BA St, next to Four Seas Ice 75HP Merc, gpps, bimini, beautiful.sport cruiser boat; tom oar; Brand new.W/D,deck,gas. Cream,500 sq.ft.x Call trailer,16K 540-257-3412 mint,less than 50hrs.Mari-. Ri%ggi $1,275+. 1st, last, security. ' Silva&Silvia Assoc. 17'MAKO:1979,CC,VHF,FF na maintained, sleeps 2, (50£ , (917)656-5679 508-420-0226 must sell due to health,slip & Depth Sounder galva avail. Call for. details. 18' MARS CENTERVILLE/HYANNIS: CHATHAM: RETAIL /OFFICE nized. trailer, good .cond, bat; SO $34,900. 508-89838 or qq 1&2 bedroom,$850-$1100 SPACE Available 90HP Evmrude needs minor w/6 HP ! 508-274 9838 No pets.Ca11508-775-93T6 LIGHTHOUSE REALTY work,WO.508-398-9558 or Rite traile 508-945-5350 508-776-2495 23' BLUEFIN: 2006,. Center Call; C2 Br. No pets.CH:1.Br.& console: ONLY 20 hrs on 2 Br:.No. etc. Startin at MASHPEE:WAREHOUSE iT MAXUM:.'96 Bowrider. 18'. MAR; g 175 Suzuki 4 stroke engine!$800/mo: OS-945-5350. 1000-25,000 sq. ft., brand Force 120HP. Trailer, full g LING:Cal new, bigg doors, high ceil- canvas bimini. Fast;& fun Garmin GPS colored fish sprit,trail FALMOUTH, EAST: 1-2 BR, ings,$10-$12 per ft. boat!Pictures online.$4995 finder&chart pplotter,trailer, mamt r 1BA. Open living space. CALL 508 775-9316 $34,goo.Call 508 509 4176 Chades River views.No pets ( ) Firm.Carl 774-836-2905 wish,$12 $975 incl. 781-935-3242 23'MAKO:1982.Good condi- y 1T SEA HUNT: Triton 172 lion 2 Johnson t15 0.6. 19' RHOOI HYANNIS: 1 & 2BR luxu 2005, CC, 90HP Yamaha, very good ry roller trailer, low hours. GPS Loran, Fish /'depth, board,no units avail yr VHF, marine toilet; T-top, round;55+508-771-2202 BUSINESS & WAREHOUSE $20K New,Asking$12,500 p ass,wor $7500 or B0. . pp SPACE:In BOURNE..5Q0 to (774)353-6969 trailer,extras. $1800/BO HYANNIS 1BR downtown. 18,000 SgFt,loading docks, (508)•454-5062 Centerville studio cottage. 3 phase electricity w/office. 1T2 SCOUT: 1999 Center- Or(508)428-6459 21' MAGRI 1` Dennisport 2BR. Hyannis, Call 508 563 2740 Console, *trailer, 90 HP Sailboat v u 2BR townhouse condo. Yamaha,Low Hours;$9,500 23'POLAR:2005 Walkaround 508-255-I HARVARD REALTY BUSINESS BAYS. Hyannis - (774)368-0418 Cuddy Twin Yamaha 115 HP / 508 775 1803 Independence Park,2000 to 0/Bs 2011 warranty,75 hrs. 22'CATALI 5000+s.f 508-771-6633 1B. BOSTON WHALER: 1987. Hardtopp, tandem 'trailer: Swing k HYANNIS:2BR,:1 BA,Walkout, outrage 150 johnson alumi- $49,000 B/O 508-563-5162 trailer, Ni ' l near beach $1000 pays all CONTRACTOR BAY; S. Chat- num trailer,lots more!! extras, 4 raigville RE 508 775 3174 ham, 1000 Sqft $685/mo water ready$9500 23' SEA OX: 2003 Mercury $2750 B/I (508)945 2615 617 510 7209 200hp Optimax 2 stroke S YANNIS Great location 2Br ~ a 2001 Quikload Trailer.1988 22'CATALI Ls $1200/heat"included-RefC%_ CONTRACTOR BAYS/:.WARE- 18'GEORGE WILLIAMS: hull. Electronics; many ex Swing k —ences.(508)-778=0687 HOUSE: 1200 4000'; Office Skiff 2000, 25hp Johnson, tra's. Great. fishing boat., trailei, Ni. CY .— uits 550 2000', fenced. tiller steering, i int condi- $9900.00(508)631-7703 extras, 4 ANNIS: Large stud o Outside Storage-S.Dennis ton,w/manyy extras,$3200. $3000.B/! $950/mo incl utils.Gre t - L.Seminara 508-385-2605 508-945-1584 23'WELLCRAFT:2002,W/A, cation!508-790-11 175 Johnson OB,'dual axle 22' SOUT CONTRACTOR BAYS&COM- 18, KEY LARGO:.2002 wJ roller trailer, full enclosure CRAFT:1' HYANNIS: Nice clean 4br, MERCIAL OUTSIDE STOR- 2003 90HP Merc. Great electronics, well maintained new rigg! ne ` walk to Main St. $1400+ AGE:Thomas Landers Road Cond. Has Trailer, Bimmin!, $22,900(508)737-0608 ` $1800/B i J HURRY!! (61.7)827-4592 E.Falmouth 50.8-548-4397 depth,water sep filter,more. 608.896.1 HYANNIS:Studio&1 CONTRACTOR BAYS: $10,500 774-392-4238 24' FORMULA:. V-8 Merc ,bedroom a artments. Mash pee,1000 sq.ft.,$900 cruiser, 1979. Rebuilt out 23' O'DAY; p p 18,5' EDGEWATER: 1999 drive,.tandem trailer. Needs O/B. Less Call 508-776-4137 508-362-5838 185CC,Yamaha 130HP OB, carburetor$4,000/BO sails usggeq MASHPEE:1 BR,includes all, LAW OFFICE SPACE: Center- 2.stroke, Loadrite Trailer, 508-240-1590 moorl508 excellent location. $300/wk; ville law firm has furnished Electronics, Cover, ready to 24'GRADY WHITE:1999 Ad ` $1200/mo 508-740-5373 offices for sublet. Confer fish! Low Hours, $14,900 varioe CC, 250 Yamaha, T- 26' PEARS ence rm, and hone. First Hyannis Cell 781-962-3345 P top, radar, FF,.color chart barrier co MID CAPE class space.Respond to Of- 18.7' OMC: '94, CC; 120 plotter trailer,excellent cond son sails £ fice,Space, P.0 Box 578, Johnson(96),S0000 Relia- $37,900/BO 508-237-0216 lots of eqi '\ Barnstable 02630 SS bakerl V ft►d ble. as, stainless TTop, 1- FlIB;IDt"1#87 t?t8 Trailer, Dingy and more. 24'.LIMESTONE:1987. LAW OFFICE SPACE: CEN y 2000 Merc,300 hours 27'board, ne TERVILLE law firm has fur- $5400/BO 508-487-6886 *** 1 board, ne Let us het 19' CAPE CODDER: '84, 88 $ 6,500 *** p you find the niched offices for sublet. new Ix right yearly rental for you! Conference rm, and phone. HP Evinrude'89,5 star trail (508)221-6837 $4500/BO Choose from a large selec- First class spacq.Please call er 'J8, 10" stainless steel 24'STARCRAFF:250HP Merc 2T O'DAY: lion of clean,.well main (508)775 5010 electradyne lobster pot haul- Cruiser Inboard Outboard, condition, twined studios, apartments LAW OFFICES:list Class,as er$6800,401-625-1011 Rebuilt engine, less than read to &homes.. sorted sizes from 400,800, 50hrs. In water. $10,300 westerbea 19' CAPRICE: 1986, Cuddy 1200,2600&8000 ft.6 to Cabin, w/GPS, FF, bed, CB -. (508)563-173 galley w/2 508-778-0073 choose, Hyannis/Centerville, Radio, De th Finder, Bimini icebox, turn key!.....(508)Z75-9316 To p 24'WELLCRAFT:2002,walk sloop rig, 5 E.Main St.,Hyannis p, good .cond, witrailer, around with 200 HP Evin, 548-5439 Al OFFICE ,CONDO: Buzzards motor needs work. Asking Garmin GPS/Fish Finder,',ex- 1`t Nos Falamos Bay 720ft 4 Rms.New Car- $2200/80.774.836-7975. : cellent condition, $18,500. 28' CAPE I v Portugues Pet&Paint.508-428-3852 19'MAYCRAFT:CC 2007 115. (413)636-5556 tom Dodg OFFICE SPACE: Hayes Bldg; HP E-TEC warranty thru 24'WELLCRAFT:199$240SE furler., w H annis/Yarmouth line. 2014, T-Top, Leanin Post 5.7 merc. aft cabin, micro, 394- , $ CapeCodApartment yy g 394 3195 Finders.com 3 Rm professional suite EF, GPS, VHF,. Clean fridge; bathroom, sleeps 4, $650/mo+util 508-775-0080 $14,675.508-362-8492 excellent cond. with trailer 30' PEARS NEW BEDFORD: Luxury 2/3 OFFICE: The Best Hyannis 19' SEASWIRL STRIPER: 05 $15,900(508)398-6240 Wheel str bedrooms. Excellent area. locationt Just $265y& upp! Yamaha,115HP 4 stroke w/ 25' BLUE FIN: '04 CC. Twin. !rig, jib, 1 From$750.(508)99872227 FOSTER RE 508-771-7810 trailer$27k b/o 2003 Nissan- 140hp Suzuki 4-strokes, t- plus spina 4x4,pkg.deal$34k b/o top; GPS, fish finder, VHF, 501 SAGAMORE BEACH: Large 2 508-292-2431 radio,trailer,mint condition, 1994 CATF BR Townhouse apts. near OFFICE. W,0001BO 508-292-2284. 6.0. Mint Scusset Beach. $1,200- Large, open. In Mash pee' 19'SILVER LINE:1982 sa!Ibox'. I $1,400/month +. 1st, last, Commons with small . bow rider, Lake George tom hulls security+_1year lease. kitchenette.975 sqq ft, Boat, clean metal,complete 25 HYDRASPORT ers&jibs No Pets. 508-833-0101 second floor.$1500/mo+ new fuel system,runs ggreat, CC, Kevlar Hull, 2nd owner; 501 508 477-5400 turn keyy and go! $2,500 Twin140,Furano GPS.Trailer SAGAMORE:Yr. round, 2 Br. ( ) firm 774.836.3723 *$11,250*508-771-4321* WANT TO R opts. Immediate openings. OFFICE/RETAIL• FREE RENT 19'SKI BOAT:200 HP Merc. 25' LYMAN: 1966 CLASSIC or small $806 $900/mo.heat&hot 1month Prime Location (1999).seats 6; surround wood'la stroke, restored in Bay side c water included.Call for UNION STATION PLAZA s pp Trailer or: details, Mon-Fri. 8:30-4:30. system,all papers,mechan- 2000. :Teak decks, Mafiog fleet helpfl 508 888 3608. EHO. S Yarmouth. Call now 508- is owned,in water,w/trailer. interior. 327 inboard, on, sary.Ex e 394-6424 or'508-274-1916 $5,900/BO 508-237-1331 trailer, needs minor-work local refen YARMOUTH„S.:1 Br Apt utils $3500.508'255 4647: 413 included, list & Secur�'y OFFICE/RETAIL: Over 40 dif 19'6" AQUASPORT: 1978, . $1025/mo(508)394-084b ferent locations.200-10,000 center console,new canvas,. 25' PROLINE: Walk around ronbanksC s.f. Handicap Hyannis to GPS/fishfinder,, 150 Merc cabin, new in 2007,all op YARMOUTH, S: Old.Main St, Cotuft 508-775-9316 ' 1 br apt,utilities,cable incl. www.hol mana ement.com Easy Loader trailer $3,900 lions,radar,GPS, to Merc N 9 508.759.7475 Optimax, warranty 1st&last.508-760-2784 iy to 2010 RETAIIJOFFICE/GALLERY:. 19.10'JONE$BROTHERS:LT Paid $63,000. GO over YARMOUTH, W:.1-2 br turn. Route 28,Dennispport,Bgrest $46,000.508-776-0815 8' CANOE: apt,1 ba quiet area,deck wJ locations.508-398-7867 Cape Fisherman,new trailer, glass: $3 yard.Also 2-3br,2ba House, Yamaha S150TXRX, polling 25'SPORTCRAFT:V8,10 Re Dinghy. WAREHOUSE: 1500 S platform,with man extras!i. $175. garage. Washer & Dryer qFt in. powered 2004,.custom T .. .. Q99QQp/Rfl FnR_ 91-1Fd9 �,,,, ,,,,,,, ,,,,,,,,,,,, ,,,;_ ,,. RESIDENTIAL PROPERTY MAP NO. LOT NO. FIRE DISTRICT SUMMARY STREET Scudder Ave. Hyannis LAND 73 ,Z89 45 OWNER H BLDGS. le, TOTAL LAND RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: OI BLDGS. "AIVes �CeCile Gi �1" �Vl �FCJO B TOTAL LAND BLDGS. TOTAL LAND rAwn. Sossos & Agatha & Santis Emanuel 8 15 72 1704 182. BLDGS. A79 . oa TOTAL LAND O1 BLDGS. TOTAL LAND BLDGS. TOTAL LAND BLDGS. m _ TOTAL LAND INTERIOR INSPECTED: BLDGS. DATE: v'"1�— TOTAL LAND ACREAGE COMPUTATIONS rn BLDGS. LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL HO Jf LAND CLEARED FRONT 01 BLDGS. REAR TOTAL WOODS&SPROUT FRONT LAND REAR BLDGS. WASTE FRONT TOTAL REAR LAND 0) BLDGS. TOTAL LAN D BLDGS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT. PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ROUGH TOWN WATER rn BLDGS. HIGH GRAVEL RD. TOTAL LOW DIRT RD. --_[ LAND SWAMPY NO BLDGS. tone.Walb Fin. Bsmt.Area Bath Room �:,idu Cub fi {I Base 6 .Z BLDG. COST 1 Cone.BIk-Walk.N Bsmt. Rec.Room St.Shower Bath Bsmt — ' � PURCH. DATE Conc.Slab Bsmt.Garage St. Shower Ext. Walls PURCH. PRICE. Brick Walls Attic FI. &Stairs Toilet Room Roof RENT Stone Walls Fin.Attic Two Fixt. Bath , Floors ' Piers INTERIOR FINISH Lavatory Extra Bsmt.' F I' 2 3 Sink Z Attic a/ • 1/2 'A Plaster Water Clo. Extra _ EXTERIOR WALLS Knotty Pine Water Only z 8 Double Siding Plywood No Plumbing Bsmt.Fin. Single Siding Plasterboard Int.Fin. 1 g, Shingles 601, TILING o 1430. 2 ' Cone. Blk. G F P Bath FI. Heat Face Brk.On Int.Layout Bath FI.&Wains. Auto Ht.Unit Veneer Int.Cond. Bath FI. &Walls. Fireplace ' Com. 64.On HEATING Toilet Rm. FI. Plumbing Solid Com.Brk. Hot Air Toilet Rm.FI.&Wains. Tiling t ` Steam Toilet Rm.FI.&Walls Blanket Ins. Hot Water St. Shower Roof Ins. Air Cond. Tub Area Total Floor Furn. ROOFING COMPUTATIONS U.•+�GlrJflGi�, Asph.Shingle Pipeless Furn. G S.F. I Lf 9 D Wood Shingle No Heat S. F. Asbs.Shingle Oil Burner S.F. ' Slate Coal Stoker S.F. Tile Gas S. F. OUTBUILDINGS ROOF TYPE Electric Gable Flat S.F. 1 2 3 4 5 6 7 8 9 10 1 2131415 6 7 8 9 10 MEASURED Hip Mansard FIREPLACES S.F. Pier Found. Floor Gambrel Fireplace Stack Wall Found. 0.H.Door LISTED FLO RS Fireplace Sgle.Sdg. Roll Roofing Conc. LIGHTING Dble.Sdg. Shingle Roof Earth No Elect. DATE Shingle Walls Plumbing Pine Hardwood ROOMS Cement Wk. Electric Asph.Tile // Bsmt. list TOTAL 17,f 10 Brick Int.Finish PIOD Single 2nd 3rd FACTOR A REPLACEMENT OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep• ACTUAL VAL. DWLG. J $ j I!— /�JS 4 5 6 7 8 9 10 TOTAL RESIDENTIAL PROPERTY FIRE DISTRICT MAF' Nn. LOT NO. SUMMARY — STREET Scudder Ave. Hyannis 28yt c.R' .. --� 73 LAND -2 I OWNER H rn BLDGS. It" TOTAL Gf LAND RECORD OF TRANSFER DATE eK PG I.R.S. REMARKS: BLDGS. TOTAL ._ LAND Delis--Sossos'&--A�atfia- & Saritis- Efa r el- - 6 29 17- ---00lv i BLDGS. TOTAL IJ _ LAND Delist Sossos & Agatha & Santis &muel 8 1 2 1704 182 o _ o- BLDGS. TOTAL - � LAND BLDGS. TOTAL LAND O1 BLDGS. TOTAL - LAND BLDGS. TOTAL LAND INTERIOR INSPECTED: rn BLDGS. TOTAL DATE:/_ FBLDGS. A REAGE COMPUTATIONS 01 LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE HOUSE LOT /'o S0 8 S 8 S CLEARED FRONT v s .S /Zoou `/3. 3 = O Z5 vpn/ / AllkkkREAR TOTAL W03M SPROUT FRONT LAND REAR BLDGS. WASTE FRONT TOTAL REAR LAND Ol BLDGS. TOTAL LAND a /�-p .. BLocs. rn LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND S ROUGH TOWN WATER BLDGS. 77 HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND SWAMPY NO RD. BLDGS. TOTAL rac. Walls ✓ Fin. Bsmt.Area Bath Room / ✓ Base — __. 0 d y G� p a '� Blk.Walls, Bsmt.Rec. Room ' St. Shower BathMBLDG. COST JfjSIeO Bsmt.Garage St. Shower Est. Bsmt. PORCH. DATEWalls PURCH. PRICE. Walls Attic Fl.&Stairs Toilet Room RoofRENTWa11s Fin.Attic Two Fixt.Bath Floors rs INTERIOR FINISH Lavatory Extra a /✓f so mt. F f 2 3 Sink L / 1h y4 Plaster Water Clo. Extra v Attic 6r2. XTERIOR WALLS Knotty Pine Water Only uble Siding Plywood No Plumbing Bsmt.Fin. We Siding Plasterboard Int. Fin. e Z "&Shingles TILING c. Blk. G F Bath FI. Heat e Brk.On Int.Layout Bath Fl.&Wains. Auto Ht.Unit f- Veneer Int.Cond. Bath Fl. &Walls , Fireplace /� (e O ZZ• Brk:On HEATING Toilet Rm. Fl. Plumbing /9(,p id Com.Brk. Hot Air Toilet Rm.Fl.&Wains. Tiling Steam Toilet Rm.Fl.&Wells nket Ins. Hot Water St. Shower • f Ins. Air Cond. Tub Area Total Floor Furn. ROOFING COMPUTATIONS h.Shingle Poll Pipaless Furn. O 0 f) S.F. (o 5 U od Shingle No Heat S.F. a 3 3 0 s. Shingle Oil Burner 6A.,l/ S.F. //.(e O J U to Coal Stoker S.F. Gas S.F. OUTBUILDINGS ROOF TYPE Electric le Flat S.F. 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 1 8 9 10 MEASURED Mansard FIREPLACES S.F. Pier Found. Floor G - d:J brel Fireplace Stack Wall Found. 0.H.Door LISTED FLO R Fireplace Sgle.Sdg. Roll Roofing �- �� L. c• LIGHTING Dble.Sdg. Shingle Roof h No Elect. DATE e / Shingle Walls Plumbing dwood ROOMS Cement Blk. Electric h.Tils Bsmt. 1st ?� TOTAL 3 9 3/ Brick Int.Finish PRI 61e Ind 3rd FACTOR REPLACEMENT `3 7 3 S—/ OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL. LG. ,.; s�%3 S/�_ ✓ / Z — 373 .S/ 5v1 lee 710 ' s,• s u3 y 2 3 5 6 9 O C 61- TOTAL z FIE ] [R2$9, 045 . ] LOC40118- SCUDDER AVE1v E CTY] 07 TDS] 400 HY KEY] 193873 ----MAILING ADDRESS------- PCA] 1041 PCS] 00 YR] 00 PARENT] 0 DELIS, SOSSOS TRS MAP] AREA] 55CC JV] MTG] 0000 DELIS FAMILY TRUST SP1] SP21 SP31 93 GREENWOOD AVE UT11 UT21 1 . 04 SQ FT] 2084 HYANNIS MA 02601 AYB11925 EYB11965 OBS] 90 CONST] 0000 LAND 51900 IMP 64800 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 116700 REA CLASSIFIED #LAND 1 51, 900 ASD LND 51900 ASD IMP 64800 ASD OTH #BLDG (S) -CARD-1 1 60, 800 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #BLDG(S) -CARD-2 1 4, 000 TAX EXEMPT #PL 118 SCUDDER AVE HYANNIS RESIDENT'L 116700 116700 116700 #RR 1440 0325 OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE104/90 PRICE] 1 ORB17134/277 AFD] I A LAST ACTIVITY111/29/90 PCR] Y R289 045 op P R A I S A L D A T A• KEY 193873 DELIS, SOSSOS TRS LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 51, 900 64, 800 2 A-COST 116, 700 B-MKT 157, 500 BY 00/ BY ME 6/88 C-INCOME PCA=1041 PCS=00 SIZE= 2084 JUST-VAL 116, 700 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 55CC -- --MAY NOT BE COMPARABLE-- NEIGHBORHOOD 55CC HYANNIS PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 519001 LAND-MEAN +Oo 1167001 78256 IMPROVED-MEAN -1706 250 ] FRONT-FT 1] 100 DEPTH/ACRES TABLE 02 10001 LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP]ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] f R289 045 P E R M I T [PMT] ACTIC ] CARD [000] KEY 193873 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR oCMP NEW/DEMO COMMENT as Rakrnstable Assessing Search Results Page 1 of 2 171 y,1 L,AFL*�S P�.ITI-�. .�� .e:� i'"i"";�""�' ,/r „aM»ri�'•w^" �n a , Home: Departments:Assessors Division: Property Assessment Search Results 118 SC1JILN"YEldlik AVENUE. i Owner: DELIS,ALEXANDER E& MICHAEL S Property Sketch Legend This property contains multiple Please use the navigation below the sketch to brc Map/Parcel/Parcel Extension 289 /045/ Mailing Address DELIS,ALEXANDER E &MICHAEL S . v 93 GREENWOOD AVE HYANNIS, MA. 02601 0 r 2004 Assessed Values: Appraised Value Assessed Value Building Value: $ 167,000 $ 167,000 Additional Sketches 1 12. Extra Features: $6,100 $6,100 Click Here for print version that displays all sk( Outbuildings: $0 $0 Land Value: $ 172,300 $ 172,300 Interactive Property Map: ap requires Plug in: l�cl� For Totals:$345,400 $345,400 1 have visited the maps before � t Show Me T.h_.e Map ._X April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: DELIS, SOSSOS TRS 4/15/1990 7134/277 $ 1 DELIS, SOSSOS&AGATHA& 11/15/1987 P1168A1 $ 1 DELIS, SOSSOS &AGATHA 6220/165 $ 1 DELIS, SOSSOS &AGATHA 1704/ 182 $0 DELIS, SOSSOS 4/15/1990 7134/265 $ 177,867 DELIS,ALEXANDER E& MICHAEL S 4/12/1999 12192/094 $0 2004 Tax Information: Tax Rates: (per$1,000 of valuation) http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing... 6/21/2004 f Barnstable Assessing Search Results Page 2 of 2 Town Tax $2,283.09 Town Fire District Rates Other Rates 6.61 Barnstable 2.01 Land Bank 3%of Town Tax Hyannis FD Tax $701.16 C.0.M.M. 1.10 Cotuit 1.52 Land Bank Tax $68.49 Hyannis 2.03 West Barnstable 1.36 Total: $3,052.74 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 1.04 Year Built 1925 Appraised Value $ 172,300 Living Area 2904 Assessed Value $ 172,300 Replacement Cost$ 195,771 Depreciation 25 Building Value 167,000 Construction Details Style Conventional Interior Floors Pine/Soft Wood Model Residential Interior Walls Drywall Grade Average Heat Fuel Oil Stories 2 Sty w/UAT Heat Type Hot Water Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 5 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 2 Bathrooms Total Rooms 7 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL2 Fireplace 1 $2,300 $2,300 APTX Extra Apartmt 1 $3,800 $3,800 Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area (Unfinished) BMT Basement Area (Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area (Unfinished) FAT Attic Area (Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story (Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story (Finished) http://www.town.barnstable.ma.us/tob02/Depts/AdministrativeS ervices/Finance/Assessing... 6/21/2004 Mrnstable Assessing Search Results Page 1 of 2 ti r Jr T Home: Departments:Assessors Division: Property Assessment Search Results 118 SCUDD'yu_'jR AVFEJNU Ej Owner: DELIS,ALEXANDER E&MICHAEL S Property Sketch Legend This property contains multiple Please use the navigation below the sketch to brc Map/Parcel/Parcel Extension 289 /045/ Mailing Address DELIS,ALEXANDER E&MICHAEL S R$ P _ y A: 6 g 93 GREENWOOD AVE T HYANNIS, MA. 02601 �'"� r r 2004 Assessed Values: Appraised Value Assessed Value Building Value: $ 167,000 $ 167,000 Additional Sketches 1 2 Extra Features: $6,100 $6,100 Click Here for print version that displays all skE Outbuildings: $0 $0 Land Value: $ 172,300 $ 172,300 Interactive Property Map: ap requires Plug in: Totals:$345,400 $345,400 1 have visited the maps before Show Me The Map. April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: DELIS, SOSSOS TRS 4/15/1990 7134/277 $ 1 DELIS, SOSSOS &AGATHA& 11/15/1987 P1168A1 $ 1 DELIS, SOSSOS&AGATHA 6220/165 $ 1 DELIS, SOSSOS &AGATHA 1704/182 $0 DELIS, SOSSOS 4/15/1990 7134/265 $ 177,867 DELIS,ALEXANDER E& MICHAEL S 4/12/1999 12192/094 $0 2004 Tax Information: Tax Rates: (per$1,000 of valuation) http://www.town.bamstable.ma.us/tob02/Depts/Administrative Services/Finance/Assessing... 6/21/2004 Barnstable Assessing Search Results Page 2 of 2 Town Tax $2,283.09 Town Fire District Rates Other Rates 6.61 Barnstable 2.01 Land Bank 3% of Town Tax Hyannis FD Tax $701.16 C.0.M.M. 1.10 Cotuit 1.52 Land Bank Tax $68.49 Hyannis 2.03 West Barnstable 1.36 Total: $3,052.74 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 1.04 Year Built 1925 Appraised Value $ 172,300 Living Area 2904 Assessed Value $ 172,300 Replacement Cost$ 195,771 Depreciation 25 Building Value 167,000 Construction Details Style Conventional Interior Floors Pine/Soft Wood Model Residential Interior Walls Drywall Grade Average Heat Fuel Oil Stories 2 Sty w/UAT Heat Type Hot Water Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 5 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 2 Bathrooms Total Rooms 7 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL2 Fireplace 1 $2,300 $2,300 APTX Extra Apartmt 1 $3,800 $3,800 Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area (Unfinished) BMT Basement Area (Unfinished) FTS Third Story Living Area (Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area (Unfinished) FAT Attic Area (Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story (Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.barnstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing... 6/21/2004 Tgwn of Barnstable WebMap Page 1 of 1 Q 2�9211 '_'ay�94002 .� zeu 3i tR 'a`� .— I �:..1 2aj73 Full Screen Map. "� Magnifiers Zo m In $' Zoom`Out Print Map L http://www.town.bamstable.ma.us/Webmap/assessorsK/TOB WebMapmedresK.asp?action... 6/21/2004 "t• y. 'R OPERTY ADDRESS I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I CSTATE LASS I PCS I NBHD KEY N0. 0118 SCUDDER AVENUE 07 RB 4 I LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS TV UNIT 'A�-IED,_CUN'T Lano By/Date Sze D�men�;on 1LOC./Y R.sPEC.CLASS ADJ. COND. PE PRICE E ACRES/UNITS VALUE oescrlv,�on DELIS. SOSSOS' TRS MAP- CD. FF-De n/Acres CARD IN S ACCOUNT — IBAiHS 0.0 U .x D= 100 1.0 . 1.00 1.00 3 02 OF 02 q - NO BS�iT S x D= 100 7.8 6,12 672 4100-3 COST 116700 �- NO HEAT S X o= 100 2.3 1.83 672 1200-3 MARKET 15750C - UNFINISH S x D= 100 22.5 17.5 672 11800-e INCOME A USE D I (APPRAISED VQE J I IA 116.70C U PARCEL SUMMARY S { AND 5190C T ; LDGS 6480G M 10-IMPS _ INI NO T AL CNST 116700 ' ( DEED REFERENCE Type DATE Recorded R I O R YEAR VALUE A T i I Bool, Page Ins,. MO- Y,_D s.lea Pilo. A N D 51900 Sj i I �LDGS 6480C TOTAL 11670C BUILDING PERMIT —POOR CONDITION. D -------------•..i i Number Date Type Amount i LAND LAND-ADJ INCOME SE SP-BEDS FEATURES 8LD-ADJS U�JI7S 17100— Const. Total Vear Built Norm. Ott- Class Units Units Base Rate Atll Rate A I Age Dep, Cond- CND Loc %R G Rapt Cost New Atll Repl Value $,ones Height Rooms Rms 9e,ns a Fia. Pertyw.11 F,c. 01D+ 000 100 100 53-45 53.45 30 30 64 20 90 10 40369 4000 2.9 6 1.0 D--p—o Rate Sq,are Feet Reps.Cost MKT.INDEX: 1.DO IMP.BY/DATE. ME 6/88 SCALE. 1/01.DD ELEMENTS CODE CONSTRUCTION DETAIL SAS 100 53.45 672 8IGROSS AREA 44 SINGLE FAMILY' DWELLING CNST GP:00 820 60 32.07 672 21551 *------------- 28------------* STYLE 1ODLD STYLE 0.0 -- ------------- ------------ � - 8 ! DESIGN ADJMT 00 0.0 1 � � E-XTER.-W-ALL-S-- --- ------------ --- -------O.D EAT/AC TYPE 01 ONE_ _ 0.0 i � ! NTER.FINISH 11 NFINISHED 0.0 --- ---------- 1 N TER.LAYOUT 12 VER._/NORMAL 0.0 ! NTER.QUALTY 02 S AME AS EXTER. O.D 24 BASE 24 L00R STRULT 07 OOD JOIST D.0 Q W ! ! E LOOR LOVER-- -06 ------- - --------- 0.0 E Total Areas Au. Base 672 ! ! OOf TYPE - 0U ------------------0-�6 BUILDING DIMENSIONS T -L! ! ECTAICAL 0A 01 YERAGE SAS W28 N24 E28 S24 ._ B20 N24 ! __ _ ---------------------- A - OUNDATION W28 S 24 E28 -------------- - --- --------------- --- --- *-------------28------------X LAND TOTAL 'MARKET PARCEL AREA VARIANCE +0 +0 STANDARD IROPERTY ADDRESS I I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED CSTATE LASS I PCS I NBHD KEY NO. 0118 SCUDDER AVENUE 07 RB 400 07HY 07/09/95 1041 00 551 R289. 045. 193873 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS TY UNIT ADJD.UNIT Lana ay/Dace size o�mens�on �LOCJYR.SPEC.CLASS ADJ. COND. P PRICE PRICE ACRES/UNITS -" VALUE Descdpuon DELIS. SOSSOS TRS MAP- / CD. FF.De th/Acres E i#L A N D -.1 51,900 CARDS IN ACCOUNT - 10 1aLDG.SIT 1 X 1 =10c 49999.9 49999.991.00... 50000 #8LDG(S)-CARD-1. 1 60.800 01 OF 02 A 11 iRESIDUAL 1 . X _04 =10 475 10000.0 47500.0 .0-4 1900 #BLDG(S)-LARD-.2 1 4.000 -_TTb7 U- J 4PL 118 SCUDDER AVE HYANNIS 157500 BA7HS 2.0 U xC= 100 7000.0 7000.00 1.00 7000 3 #RR 1440 0325 NCOME AFIREPLACE U x C= 100 3100.A 31C0.00 1.00 3100 a �ARKET SE D I PPRAISED VOE 116.70C T U ARCEL SUMMARY S ! AND 51900 A Ti LOGS 6480C m ! O-IMPS TOTAL 11670C E CNST N ! DEED REFERENCE]Type DATE R�wow R I OR YEAR 'VALUE T i Boon vage I_ Mo. Yr.p S.I-P.io. -AND 5190c, S � 7134/277 104/90 A 1 LDGS 6480C 7134/265 Ib4/90 N 177867 rOTAL 116700 ? P1168A1. 871111/87 A 1 BUILDING PERMIT 7 X 8 SHED N/V NO J Number Date I Type Amount AL............. LAND LAND-ADJ INCOME SE SP-BLDS FEATURES BLD-ADJS UiYITS NEEDS MAINTENAN II 51900 10100 E.............. Class Con sr. Total gase Hale Adj.R.I. ar Buil, Age Norm. Obsv CNp Loc %R.G Re Cosl New AO Rep, Value Stone He,hl Rooms Rms B.tha a Fig. P-,.fl Fac. Units Un�rs A Depr. Contl. p1 9 06C 000 100 100 59.40 59.40 25 65 29 66 90 90 50.4pQ 120626 60800 2.3 7 5 2.0 7.0 Descnpnon Rale Square Feel Rep,.Cost MKT.INDEX: 1.DD IMP.BY/DATE: ME 6/88 SCALE- 1/00.66 ELEMENTS CODE CONSTRUCTION DETAIL aAS 100 59.40 1000 59400 GROSS AREAROOMING HOUSE CAST GP:00 FSF 90 53.46 84 4491STYLE 10 L_D_ STYLE_ 0.0 I� FEP o5 38.61 54 2085 6 FEP 6 ESIGN AUJMT 00 0.0 -------- - 1 ---------------------- � 823 75 44.55 1000 44550 *--*--9--* -_XTER.W_ALLS _ _11 OOD SHINGLES _ 0.0 6 FSf 6 EAT/AC TYPE 09 IC-HOT _W_A_T_ER 0.0 i *-------26--14---* - ---- ---- -- NTER.FINISH 04 RYWALL 0.0 8 NTER.L'AY OUT 12 VEk_-?-w ____RMAL ___ 0.0 1 ! NTER.RUALTY 03 EC_04 EXTERN D.0 LOOK STRUCT_ _02 0 JOIST%BEAM 0 A W ! E1OUN_[$AT_1_�6N LOO:R COVEr� D8 INE FCOORIN& 0.0 Total Areas Au._ 54 Base_ 1084 ! ! 0OF TYPE Gl ABLE-ASP N___S_H____ 0.0 E BUILDING DIMENSIONS ! ' BASE 30 LECTRICAL Dl VERA6E _ 0-0 T aAS. W36 N22 E10 N08 E26 FSF N06 22 ! G2 ONCREYE BLOCK 99.9 A FEP N06 W09" S06 E09 .. FSF W14 ! " ---------- -- --- --------------------- S06 E14 .. BAS S30 .. ! -----NEIbNSORH 06 SCC HYANNIS L ! ! LAND TOTAL MARKET ! PARCEL 51900 116700 ----------36----------X AREA 4027 VARIANCE +0 +2797 STANDARD 25 Barnstable Assessing Search Results Page 1 of 3 ypv _2.�,R «.'..Il - 118 SCUDDER AVENUE Owner: Assessed Values: DELIS,ALEXANDER E&MICHAEL S Appraised Value Assessed Value Map/Parcel/Parcel Extension 289 /045/ Building Value: $ 138,700 $ 138,700 Mailing Address Extra Features: $6,100 $6,100 DELIS,ALEXANDER E&MICHAEL S Outbuilding: $0 $0 Land Value: $65,700 $65,700 93 GREENWOOD AVE HYANNIS,MA.02601 Totals: $210,500 $210,500 Sales History: Owner: Sale Date Book/Page: Sale Price: DELIS,SOSSOS TRS 4/15/1990 7134/277 $ 1 DELIS,SOSSOS 4/15/1990 7134/265 $ 177,867 DELIS,SOSSOS&AGATHA& 11/15/1987 P1168A1 $ 1 DELIS,SOSSOS&AGATHA 6220/165 $ 1 DELIS,SOSSOS&AGATHA 1704/182 $0 DELIS,ALEXANDER E&MICHAEL S 4/12/1999 12192/094 $0 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $ 1,978.70 Town Fire District Rates 9.40 Barnstable 2.88 Hyannis FD Tax $608.35 C.0.M.M. 1.54 Cotuit 1.88 Land Bank Tax $59.36 Hyannis 2.89 West Barnstable 1.96 Total: $2,646.41 Other Rates Land Bank 3% of Town Tax Due to rounding differences these values may vary Land and Building Information Construction Details Land Style Conventional Lot Size (Acres) 1.04 Model Residential Appraised Value $65,700 Grade Average Grade Assessed Value $65,700 Stories 2 Sty w/UAT Exterior Walls Wood Shingle Building Roof Structure Gable/Hip Roof Cover Asph/F GIs/Cmp Year Built 1925 Interior Floors Pine/Soft Wood Living Area 12654 Interior Walls Drywall Replacement Cost 1$ 161,422 Heat Fuel Oil http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing... 6/21/2004 Barnstable Assessing Search Results Page 2 of 3 Depreciation 25 Heat Type Hot Water Building Value $ 138,700 AC Type None Bedrooms 5 Bedrooms Bathrooms 2 Bathrooms Total Rooms 7 Rooms Extra Building Features Code Code Units/SQ ft Appraised Value Assessed Value FPL2 Fireplace 1 $2,300 $2,300 APTX Extra Apart 1 1$3,800 1$3,800 Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area (Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story (Unfinished) CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area (Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story (Unfinished) FCP Carport GRN j Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story (Unfinished) FHS Half Story (Finished) SFB Semi Finished Living Area WDK Wood Deck FOP j Open or Screened in Porch TQS Three Quarters Story(Finished) " ',7f ay a a l http;//www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing... 6/21/2004 I Barnstable Assessing Search Results Page 3 of 3 v , IA Y P. i http://www.town.barnstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing... 6/21/2004 ► �� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION., 45, Ma 00 17 Parcel 616 7�Lfq p � Application# Health Division Date Issued 6D Conservation Division Application Fee Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address I f —SrklA A.cA dc+-C.. ` Village N_q Q A 4 .5 Owner O n n u �12, Address Telephone P' 7 7 P- 6 U Fl Permit quest z) 0 r o uJ3 E cLo -7n 7yv-� ` kk— . Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay 4 Project Valuation Q Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family Ud� Multi-Family(#units) Age of Existing Structure p ` Historic House: ❑Yes 16 No On Old King's Highway: ❑Yes ❑ No Basement Type: �d Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing I new Number of Bedrooms: existing new o Total Room Count(not including baths):existing new First Floor Room ount L=, ry Oil Heat Type and Fuel: was ❑Oil ❑ Electric ❑Other co ram; Central Air: ❑Yes Z(No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial 0 Yes. 0 No If-yes,site plan review#— ---_-� -- Current Use Proposed Use `tV U BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ujuj/-Ut DATE FOR OFFICIAL USE ONLY ,APPLICATION# DATE•ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION FRAME 'J INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ��C- -f 7 f n DATE CLOSED OUT ASSOCIATION PLAN NO. 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 LeEribly Name(Busmess/OrganizatiomUdividual):. a n r�,4 Ll%.p A__AA Address: �1 d t c.A d, _ City/State/Zip: ILW a li.e?/,3 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. El 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' �- 9. ❑Building addition [No rkers' comp.insurance coir�.insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3. I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t e. 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 contractor;must submit a new affidavit indicating such. ZC6ntractors that check this box must attached an additional sheet sbowing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must providb their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the!)IA for insurance coverage verification, I do hereby certc;fy under the pains--and penalties of perjury that the information provided above is true and correct Sienature: ,�.�. U* h_L1qA Date: 7 7 Z-2 _ Phone#: i= p 7 1 d Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: e,-•} 9 4 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)stares`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of conplimice with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required.'Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 'The affidavit should be retained 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 member. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all-locations in (city-or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo 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 Dcpsrrtment of Industrial Accidents Office of Investigations 600 Washingtofi Street Boston,MA 02111 Tel. #617-727-490.0 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 wlww.mass.gov/dia .°F�"EIOti Town-of Barnstable Regulatory Services Thomas F.Geiler,Director 161 Building bivision Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax: 508-790-6230 Permit no. Date . AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW ' SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, 'improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adj scent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work y y r, . o O r Estimated Cost 4ddress of Work rh A Q [�.. LL Q n✓i't 5 owner's Name: d n A b �A Date of Application: Z 1 1 I hereby certify that: Registration is not required for the following yeas on(s): E]Worlc excluded by law ZJob Under$1,000 Building not owner-occupied POwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES.OF PERJURY I hereby apply for a permit as the agent of the owner: Da Contractor Name Registration No. OR Date Owner's Name Q:f0=:hame^aMd'av �OF1HETp� Town of Barnstable Regulatory Services BARNSTABLE, : Thomas F. Geiler,Director KAM 039. A.�� Building Division eo MAC 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: )L2 /--7 JOB LOCATION: /I -P —5 aj-d Liq 4.4 9 t S mun ber f street / village "HOMEOWNER": �8Y1 n Gr ���1-7 LUi ,�-tJt J- -)-) F" c) name /1 ^ 0 home phone# �"wwork phone# CURRENT MAILING ADDRESS: V— �l s`� -a f-t, a �� 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. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the.permit application, that the homeowner certify that he/she understands the responsibilities ofa.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/certification for use in your community. Q:forms:homeexempt f r • x i r J 6 M t" m , A � dfa t 1 x} r x w + y , t , y 2 � d . �:•. � � ,- e � ,._ .a a su., 118 Scudder Ave, Hyannis 5/2/07 a dim t � ��}a � a � � �f, r��..z_ -e:.a.�.•2����#`��4 ,,,,` �� ... 7'�i'"". 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Permit Fee Date Defini iV,�Ian App y Planning Board ' Historic- � Preservation/Hyannis y Project Street Address det� 6.4 ZL Village Qn h I c Owner z n /l Ll £ Tc�F T f�� 1 Address Telephone PermitkequestX arnotlod 6 W i h d,)LdJt e Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay s � Project Valuation �",fl'� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentai<a. W ;a : _ Dwelling Type: Single Family ❑ Two Family Multi-Family(#units) Age of Existing Structure 1 9 Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes Di No Basement Type: 01 Full ❑Crawl ❑Walkout ❑Other M Basement Finished Area(sq.ft.) / 0-00 Basement Unfinished Area(sq.ft) Number of Baths: Full:existing o� I L 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 O Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑'No Fireplaces: Existing I New Existing wood/coal stove: ❑Yes Flo Detached garage:0 existing ❑new size Pool:0 existing ❑new size Barn:❑existing ❑new size r Attached garage:0 existing ❑new size Shed:❑existing ❑new size Other: NY Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ �itr►��tL4 Commercial—❑Yes ❑No If yes, site plan_review.#_ Current Use Proposed Use BUILDER INFORMATION Name Sal [)O-Y)M ,ti. ( �LQ✓ Telephone Number Address 112 A I A 4A, License# v �u ( Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE AL, FOR OFFICIAL USE ONLY X JERMIT NO. DATE ISSUED MAP/PARCEL ADDRESS - VILLAGE OWNER f r DATE OF INSPECTION: FOUNDATION X v ' FRAME INSULATIONr ` 0 0 FIREPLACE fa m ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING O JL f DATE CLOSED OUT ASSOCIATION PLAN NO. ,per The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, ALA 02111 � . www.mas&gov1dia Workers' Compensation Insurance'Afridavit: Builders/Contractors/Electricians/Plumbers Applicant Infofmation Please Print Legibl Name (Business/Organization/Individual): b z)l)" W e,jam,/ Address:' d,", 0" City/State/Zip: (x n ki t-5 /V? 0)u0 Phone#: 7-) 9 0b, Are you an employer? Check the'appropriate boa: 'Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6 ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or par�er- listed on the attached sheet. $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.( I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required,] t employees. (No workers' 13.❑ Other 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 subcontractors and their workers'comPp y olio information. - I-am an employer that is providing workers'compensation insurance for my employees. Below is the policy and,pob site information. Insurance Company Name: Policy#or Self-ins.Lie. #: 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 maybe 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; Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. a City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk a.Electrical Inspector 5.Plumbing Inspector �. 6. Other j Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their emloyees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hue, 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 permi0icense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. - 617-727-4900 ext 406 or 1-1077-MASSAF E Fay 617-727-774 Revised 5-26-05 w-w-w.mass.2ov/oia °Frti Town of Barnstable Regulatory Services 9BAMSrnBt.B,g Thomas F.Geiler,Director Mass. E&6,39. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 . Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence.or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: i�x j 1/� vl G 4I{y1!� J 1 P G(�:r� Estimated Cost Address of Work: Owner's Name:_ U✓1 y7 u Date of Application:__/ ! I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 Building not owner-occupied dwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply four a permit as the agent of the owner: Date Contractor Name Registration No. 3) }t, OP � � Date Owner's Name Q:forms:homeaffidav SHE Town of Barnstable Regulatory Services BABNSTABLE, : Thomas F.Geiler,Director 9 MASS. 039• Building Division �ATFD N1A'1 A 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: �/ �d.! �? • JOB LOCATION: J G C�(J1_ &A_� 04 J A f 1,6 number 1 street villagb `' .HOMEOWNER": t�2J%I Q Jre/`� (/LJ( 2 S�� 7 l S> OC/ a 7 5-T Y name home phone# work phone# /3 CURRENT MAILING ADDRESS: /q&f�—�- 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. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt �. �� � � -� � � � � � � � , N � � �, �. � � � ;�. � G �'� W cR �^ �° � � �' • � I � � � ,� .�-- s � � � � g P P � P � � � � � � Ci � �� � r n ¢.. * o� Town of Barnstable *Permit# 2 Expires 6 months from issue date Regulatory Services Fee C) Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 MAR 7 %fir. www.town.bamstable.ma.us )'Q�/�E 1aQ Office: 508-862-4038 BOpl� 0-62W EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY R/VSTge` Not Valid without Red X-Press Imprint._ Map/parcel Number 6t Q -- Property Address �� ��- ' f C 4 A /7 V1 I D 1P Residential Value of Work y �� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address .J e T t W t.._ Contractor's Name blP, Telephone Number 7 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 4� ❑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 be taken to ❑Re-roof(not stripping. Going 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. Home Impr�o"vement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise07. 1405 The Commonwealth of Massachusetts Department oflndustrial Accidents . Office of Investigations ' d 600 Washington Street Boston,MA 02111 `'~ S www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 0. Address: City/State/Zip: 4 ri tS Phone#: 7 g d ly 9 r] ire you an employer? Check the-appropriate box:. Type of project(required): ElI am a employer with 4. El am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction ❑ 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 workin for mein an ca aci . workers' comp. insurance. [No workers' comp. insurance 5. We are a corporation and its ing addition j Aequired.] officers have exercised their 10.0 Electrical repairs or.additions ® I am a homeowner doing all work right of exemption per MGL': 11.❑ plumbing.repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' comp. insurance required.] 13:❑ Other_.t,J7 ny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information' omeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such>ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. man employer that is providing workers'compensation insurance for my employees. Below is-the policy and job site ormation. urance Company Name: Gcy#or Self-ins..Lic.#: Expiration Date: i Site Address: City/State/Zip: .ach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). lure to.secure coverage as required under Section 25A of MGL c. 152 cari lead to the imposition of criminal penalties of a up to$1,500,.06 and/or one-year imprisonment, as well as civil penalties in.tlie form of a STOP WORK ORDER,and a fine 1p to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of estigations of the DIA for insurance coverage verification. r hereby certify under the pains and penalties of perjury that the information provided above is true and correct. nature: Date ,ne#: )fcial use only. Do not write in this area,to be completed by city or town official "ity or Town: Permit/License# Issuing Authority(circle one): ..Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical In i.Other spector 5.Plumbing Inspector ;ontact Person: Phone#• Information and Instructions [assachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. arsuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, cpress or implied,oral or written." ,n employer is defined as-"an individual,partnership, association,corporation or other legal entity,or any two or more f the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the -ceiver or trustee of an individual,partnership, association or other legal entity, employing employees. Howev..er:the wner of a dwelling house having not more than three apartments and who resides therein, or.the occupant of the welling house of another who employs persons to do maintenance,construction or repair work`on such dwelling house r on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." AGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or -enewal of a license or permit to operate a business or to construct buildings in the commonwealth for any ►pplicant who has not produced acceptable_evidence of compliance with the insurance coverage required." kdditionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall ;rater into any contract for the performance of public work until acceptable evidence of compliance with the insurance -equirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary.,supply sub contractor(s)name(s), address(es) and phone number(s) along with,their certificate(s) o insurance. Limited Liability Companies(LLC) f. 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 riiay be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below.. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant: Please be sure'to fill in the permit(license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need_only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the:affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for.future permits or licenses..Anew affidavit must be filled out each e or permit not related to any business or commercial venture year.Where a home owner or citizen is obtaining a licens (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 9, Investigations 600 Washington Street , Boston,MA 02111 Tel. #617-727-4900 ext 406 or-1-877-MASSAFE Fax#617-727-7749 revised 5-26-05 www.mass.gov/dia Town of Barnstable *Permit# -70L i Expires 6 months rom issue date F; T Regulatory Services Fee S E P 1 7 2007 Thomas F.Geiler,Director Building Division �(J STAB �om Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number2m, Property Address a,L-p, c) "[ ]Residential Value of Work '�i 0 Uy Minimum fee of$25.00 for work under$6000.00 Owners Name&Address ,Contractor's Name ) 't Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor -®'I am the Homeowner 'a ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over' existing layers of roof) LRe-side Replacement Windows/doors/sliders. U-Value A 1- (maximum.44) //Lj � a *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. " I i ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: rCh- Q:Forms:expmtrg Revise061306 s The Commonwealth of Massachusetts Department ofIndustrial Adcidents Office of Investigations 600 Washington Street Boston,MA 02111 , www.mass.gov/dia Workers"Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name (Business/Organizatio di clu Address: Qla�-Q- City/State/Zip: fI P148Phone.#: ,� Are you an employer? Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I . employees (full and/or part-.:time). have hired the sub-contractors 6. ❑New construction . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ' ship and have no employees These sub-contractors have S. ❑Demolition . . working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp. insurance comp.insurance.$ required.] 5• ❑ We are a corporation and its I0.❑Electrical repairs or additions '30 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 13.❑ Other_ `Ct GI- employees. [No workers' comp. insurance required.] . "Any applicant that checks box#1 must also fli 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 sbowing 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 proylding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-inns.Lic.M 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 maybe forwarded to the Office of Investiggations of the DIA for insurance coverage verification, I do hereby certify:ender the pains•and penalties of perjury that the information provided abo is tru and correct: Sienature; Date: _ 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 ts 6.Other Contact Person: Phone#: f oFTHE, Town of Barnstable Regulatory Services B.MSTABLE, Thomas F. Geiler,Director truss. �'prF039. " � Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION n Please Print DATE: JOB LOCATION: ! 1 d 5&1/a " _I.LA_� /lViU(} !!1 l�7/ d'ILJ, U / number street ! ' z village "HOMEOWNER": b b t _A_A_ TLft- name home phone# work phone# CURRENT MAILING ADDRESS: C%t ✓ r`� 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. Signature of Homeowner Approval of Building Official .Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the . State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of 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/certification for use in your community. �t Town of Barnstable *Permit#� bl ��- ,y� Expires 6 months from iss d Regulatory Services Fee �6o * anxxsrnsie Thomas F.Geiler,Director n Huss (� 1e39. ,m$ Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.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 Property Address j J ��( ( � _ /Q ✓� ��5 [Residential Value of Work 3 bD Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address i)Y) 11.t, Tufl W L -� Contractor's Name Telephone Number j, 7 7 Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ 1 am a sole proprietor -PRESS PERMIT I am the Homeowner ❑ I have Worker's Compensation Insurance APR 14 2008 - r Insurance Company Name TOWN ()C R 4RNiSTABLE 0 Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) WrRe-roof(stripping old shingles) All construction debris will bet en to ��%�'Ll I DL,0 ❑Re-roof(not stripping. Going over existing layers of roo ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum,? *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permissio . - A copy of the Home Improvement Contractors License is required. od SIGNATURE: QAWPFILESTORMS\building.permit forms\EXPRESS.doc Revise020108 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Nance(Business/Organization/Individual): y)A.&, 14_/J _t�,(� Address: l ) �' S (�.1 City/State/Zip: z4 A Phone-#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. El New construction . . employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed an the attached sheet 7. ❑Remodeling • ship and have no employees 'These sub-contractors have S. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp..msuianee comp.insurance$ ,..,� . fA 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3 1 I am a homeowner doing all work officers have exercised their 1 L❑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.] k must also fill out the section below showin their workers'compensation policy information. Any applicant that checks box#1 g t indicating art:doing all work and then hire outside contractors must submit a new affidavit indicating such. Homeowners who submit this affidavit g they g tContmctors 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 ernployms,they must providb their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: 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 crirnirial penalties of a fine tip to$1,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the WA for insurance coverage verification. I do hereby certtfy under the pains•and penalties of perjury that the information provided above" true and correct Si ature: Date: _ Phone k Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees: Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representative's 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),addresses)and phone number(s)along with their certificates)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for f ituire permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture . (Le.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number. The Commonwealth of Massachusetts Dgmttnent of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-490..0 ext 4-06 or 1-977 MASSAFE Fax# 617-727-774 Revised 11-22-06 www.mass.gov/dia Town of Barnstable yOfSHE Tp�� Regulatory Services " Thomas F.Geiler Director . MASS. Building Division lfD � Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 R VnV.town.barnst2b1e.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: O 5 uti `- -t� at"� Pq K 1 number s et y� p /village HOMEOWNER": (Z 1�I/t V J�Q V name I n 1 tLyQh home phone# work phone# CURRENT MAILING ADDRESS: 3 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. Signature of H meowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form./certification for use in your community. THE r Town of Barnstable Regulatory Services =nxx S. Thomas F. Geiler,Director v$ iG39. A `fig' . lF6.19 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section I£Using A Builder I , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name ' If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. 1 1 (�� E e w d t , a r f a • , I y r l ' . - V 61 6-411 r - J _ i r . ti. r ° - r - • 1 C , { r t F 1 f , 1 , f , i a r . - 1 rt . 1 f � t F r- ,. a: f r _ ! 1 r �, -- - - f _ _ T I._