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HomeMy WebLinkAbout0356 SCUDDER AVENUE Assessor's office(1st Floor): l Assessor's map and lot number f�_ THE>O�` _y e Conservation SEPTIC tYsTrul Board of Health(3rd floor): INSTALLED IN C®M ` �1oLL Sewage Permit number ��'" 2 Engineering Department�L3rd floor): Y ` WITH TIT'LE °ooas House number 2.5 Zp ELT—' ENVIRONMENTAL C Definitive Plan Approved by Planning Board 19 TOWN Bel-(-%nULAT1 W9S APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN , OF BARNSTABLE BUILDING INSPECTOR 4 APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION 19 _ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ax-k� 1 Proposed Use Zoning Fire District Name of Owner Address 0 V�\1 4U Name of Builder Address —✓�� Name of Architect_� Address Number of Rooms Foundation Exterior Roofing Floors o 47 Ul3'�'�--�- Interior C Heating Plumbing Fireplace_M Approximate ost �� .iN" Area Bo Diagram of Lot and Building with Dimensions Fee 0' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. NamW4 Construction Supervisor's Licensee PAPPAS, FREDA B. No 351'71 Permit For REMODEL INTERIOR r Single Family Dwelling Location 356 Scudder Avenue Hyannis w ti Owner 'Freda B. Pappas Type of Construction Frame Plot Lot . t Permit Granted June 30 i 19 92 ~ Date of Inspection 19 ' Date Completed 19 } . r • t f i . J , ! TOWN OF BARNSTABLE .. + f BUILDING DEPARTMENT _= HOMEOWNER LICENSE EXEMPTION. ` Please print. C O 4 A 5 95- 5 o a - --- --- -- lea�� .o DATE JOB , CATION � � Number Street Address Section Of .Town O H014EOWNER A17 / . .0'" Name Home Phone Work Phone r. PRESENT 'MAILING °ADDRESS #,1Q_k,E?V- City/Town State Zip Code , t Thecurrent exemption for "homeowners" was extended to include owner-- occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. t DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six 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, by-laws, rules and regulations. The 'undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements 3 HOMEOWNER.'S SIGNATURE , �i } APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127 .0, . Cons'truction Control. MZSC5 a 1 HOME OWNER'S EXEMPTION The code states that. "Any Home Owner performing work for which a building permit is requi"red shall be exempt from the provisions of this section (Section 109. 1. 1 -Licensing of Construction Supervisors) ,: provided that if Home Owner engages a person(s) for hire, to do. such work,, that such Home Owner shall act as supervisor." Many Home Owners who use this exemption are unaware that they are assuming the ;�responsibilities of a supervisor (see Appendix Q, Rules and Regulations for 'Licensing Construction Supervisors, Section 2. 15) . This lack of awareness often results in. ,serious problems, particularly when the Home Owner hires unlicensed persons. . In this case our Board cannot proceed against the unlicensed person as it would with -licensed supervisor. The Home Owner acting as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, many communities .requ'ire, .. as part of the permit., application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. ` t * C �01 r OFIHE T Town of Barnstable Permit# 0 `1 Expires 6 nths from issue date Regulatory Services Fee Vr BARNSTABLE 639; ,�� r N Thomas F. Geiler, Director plFD Ml+l A T' �) 7,0o Budding Division gq/ �, Tom Perry,CBO, Building Commissioner. 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint !v1ap,parcel Number -1 Property Address 3_5 C 11 C-)C) y — l� I l� Yfj'�s ✓��/ Pll esidential Value of Wort. Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address &C2b e_ R r S�� H y� yL,yLI.S ;�//7► Contractor's Name 1)19 L.C'.A/ G` S TOn 0 T I o A" .S Telephone Number 7�� � �J � I tome Improvement Contractor License# (if applicable) �a c/� Lf Construction Supervisor's License# (if applicable) ❑Workman's Compensation Insurance Check one: am a sole proprietor ❑ l am the Homeowner [ I have Worker's Compensation Insurance Insurance Company Name Q&D 'T 9GT1 G 1I- Workman's Comp. Policy# 502 f:32 0 Y 0 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) E�Re-roof(stripping old shingles) All construction debris will be taken to 7jmmou�h l LC�L�'��/✓liry CG�7�� ❑ Re-roof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders. 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. A copy of the Home Improvement Contractors License is required. t. SIGNATURE: Q.`\A PFII.LSU 01RMS\building permit forms\EXPRESS.doc Revised 100608 T\ Board of Building Regu ati©ii5 and Standards - 40ME IMPROVEMENT CONTRACTOR' Registration: 129244 Expiration: 7130/2009 Tr# 132276 y* Private Corporation Wh26en Pestoratlon Services Inc. Wiliam iNhaien 22 Arnokaq Warr South Dennis;MA 02666, Adrasirais8rat®e j it '�>:e�'y� si �'i;ifs�g.-• ;•SC'�i3 aSr-:3 et i ��.➢3r �. ijti . Lki e^se: CS 74928 Restricted=e: 00 -y� WILLIAM WHALEN 122 POND STREET BREWSTER, MA 02631 _xpitMion: 8/10/2010 Date: 4/29/2009 Time: 9:44 AM 'To: Kathleen H 1,15087609995 Rogers & Gray Ins. Page: 002 Clent#:32193 WHALRES ACORD;,, CERTIFICATE OF LIABILITY INSURANCE 4/29/09'Do1YYYYI PRODUCER S:LT- T'.FICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.-So.Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. P.O.Box 1601 South Dennis,MA 0266L"-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED NSURER A: Arbella Protection Co WKalen Restoration Services Inc NSURER B: 22 American Way NSURER C: South Dennis,MA 02660 NSURER D: _ NSURER E COVERAGES 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 AF=ORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO.ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSR DATE(KWDD,M DATE MMiDD1YY LIMITS A GENERAL LIABILITY 8500040398 - 0,4/01109 04101If 0 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABIL TY DPp IEMAC M SES�z occu ENTEv ce g1 OO OOO CLAIMS MADE a CCCUR MED EXP(Ary one person) $5 000 PERSONAL'&ADV INJURY $1 000 000 _ 1 GENERAL AGGREGATE s2,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP!OP AGG s2,000,000 PRC- PCUC"F1 JECT LOC EC A AUTOMOBILELIABII.ITf 74917400001 09/25/08 09/25109 COMBINED SIIJGLELIMIT ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (For person) X HIREDAUTOS BODILY INJURY $ X NCN-ON/TIED AUfrs, (Fer accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESSIUMBRELLA LIABILH-r 4600021586 _ 04/01109 04101110 EACH OCCURRENCE $1 OOO 000 X OCCUR CJ CLilk;1S MADE AGGREGATE $1 OOO O00 $ OFEUCTIBLE $ X RETENTION $10000 - $ T H- A WORKERS COMPENSATION AND 9091320408. 04/01/09 04/01110 X I TWIRCY71"ITITA CIE, EMPLOYERS'LIABI ITY E.L.EACH ACCIDENT $500 000 .ANY PROPRIETORIPARTNEREXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.D SEASE-EA EMPLOYEE $500,000 If yes,cescdbe under SPECIAL PROVISIONS below __ - - E.L.D SEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS!LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BYENDORSEMENT/SPECIAL PROVISIONS Project address:356 Scudder Avenue,Hyannis,MA 02601 CERTIFICATE HOLDER y CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Robert Bearisto I DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAR JA_ DAYS WRITTEN 356 Scudder Avon Lie NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA 02601 y i IMPOSE NO OBDGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR I REPRESENT_AT!VES_. AUTHORL?I:O4 PRESENTATIVE ACORD 25(200110B)1 of 2 ;* ,43262042529. CBR ©ACORD CORPORATION 1988 I . s"Er° �. Town of Barnstable ` Regulatory Services . uxNs-rABLe. K&M $ Thomas F.Geiler,Director- Eo;96. 16 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 Using A Builder I, ECA-3e ll as Owner of the subject property hereby authorize W�, -,,, 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.. Q`.FORMS:OWNERPERMISSION _- - THE Town of Barnstable Tp " Regulatory Services 1I AS Thomas F.Geiler,Director 11- MASM . �* 1639. Building Division PrED A Tom Perry,Building Commissioner 200.Mairi-Street,_Hyannis,MA 02601_. www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNTER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: eityhown state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six traits 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"asm es 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 minimtun inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signatine 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•surer that "Any borneowner perfomring work for which a building permit is rapimd shall be exempt from the provisions of this section(Section 1 -9 -1 -"Licensing of construction Supervisors);provided that if the homeowner engages a pason(s)for hire to do such work,that such Homeowner shall ad`as supervisor." Many homeowners who use this exemption am unaware that they am 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 thate:homcowncr is fully aware of his/her responsibilities,many communities require,as part of the permit application. that the homeowner ccrtify-thai hdshe 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 amrnd and adopt such a fomn/certification for use in your community. Q:forms:homccxempt The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations• ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatiomindividual): fV f'_a Ti C,NS Address: 22� 2, 19 Al E 6L.1 C.19 N W A'y City/State/Zip: S, 06rvtvJf 144 0;k466 Phone.#: -5-6 a 76a I A-re you an employer? Check the appropriate box: Type of project(required): 1.LvI 1 am a employer with 2C7 4. I am a general contractor and I employees(full and/or pa time).* have hired the sub-contractors 6. ❑New construction rt 2.0 I am a sole proprietor or'partner-' listed on the'attached sheet. T. E] Remodeling ship and have no employees These sub-contractors have 8.' Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers'-comp.•insurance- comp.insurance.$ required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑PIumbing 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 employees. [No workers' l- R(� /Z P I Q 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. 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 subcontractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A O J£ L bq •P1 Z&T f G`r t e of fie' Policy#or Self-ins.Lic.#: 5. C� O O ® ,� Expiration Date: Job Site Address: 3 V_U ck)E_fL /9L V L City/State/Zip&yf) q/A/)S /V/; Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crimirial penalties of a fine 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 maybe forwarded to the Office of Investizations 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: LU Date: Phone#: D Z M O 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#: i 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 ffi stee 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, §2SC(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-contiractor(s)name(s),-addresses)andphone 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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating 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 Department of 1ndustliol Accidents Mee of InVestigatiaW 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727=7749 Revised 11-22-06 www.mass.gov/dia Assessor's map and lot number ............................................ A 6f ' 4l� ��! z THE Sewage Permit number .. 9:��•.,,,,• ! � ✓ d�' �� Z DA"STADLE, i House number rasa L O 0 Ypv.�`e0 TOWN -OF BAR.NSTABLE �E BUILDING INSPECTOR APPLICATION FOR PERMIT TO .......f A l, °"': . .... TYPE OF CONSTRUCTION ........... 1.. . . .. t`: .................:............................ .. .......................... ...........:.. ................................}9 ?. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies �for a, permit according to the following information: Location ........3).r ......` ................................ ........... > ........ ProposedUse . a ' .. ............ ..... ......... .. ............................... ............................. Zoning District ................. .............................Fire District ...... ........................................... Name of Owner `t.,1/, .A.!1.I:M......t. ,. ..5..........Address �' .............................................. Name of Builder- °`'...... .,�� .C. `---................... Address.... .................................................................................... Nameof Architect ..................................................................Address ............................,....................................................... ,j Number of Rooms ..................................................................Foundation .......,.. W�2.,o .... ............................................................ Exterior ..... ..................:..........................................Roofing ....................................:............................................... j • Floors t,�..C.. f�....1 ....Interior .. .........................:. .. . s } -.n s Heating g;': :.................:....... ---'...,............. g .................................................... .............. ! ?, Fireplace .......... m .... .. . !................... . ...............1....... Definitive Plan Approved by Planning Board ______________ _________.1.9 __ - Area .... .... Diagram of Lot and Building with Dimensions Fee ............:................................ .,SUBJECT TO APPROVAL OF BOARD OF HEALTH l i ti OCCUPANCY PERMITS REQU1RED FOR NEW DWELLINGS ' : I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardir the above" construction. t Name ... �i? �1 .... .... .......... ................... SINTIRIS, WILLIAM 23960 ADD USUN DECK No ................. Permit for .................................... Single Family Dwelling ............................................................................... Location 356 Scudder Avenue Hyannis ............................................................................... Owner ......William Sinti:ris Type of Construction Frame ................................................................................ Plot ............................ Lot ................................ a Permit Granted ...Ap.r.7..1....14.,..............19 82 Date of Inspection ....................................19 Date Completed [ oa"�� r 4> 1 f;M t i • `••sue`-- ,' - Assessor's ma and lot number �.... �� STE'� MU 4 Aq 7r MPS Q�of ro�� f/ �'r`dE$ g� �N ® �F THE Sewage Permit number ............... ........... }f TAB ra` II 1) Y� 'g r �fC� e+� o,► k f y.,� flflZ rqr� , A',tl BARNSTABLE, i House number, ...::. y _� .. r NAM. Dos,1639: �Fp Ma-1 A,- TOWN OF BAR.NSTABLE BUILDING--- UILDIN INSPECTOR APPLICATION FOR PERMIT TO .............................?mwzle.................................. .......................................... TYPE OF CONSTRUCTION ........................................ ... ' .......... ..................1 1%d TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......................... .... ".......... . . ............ rU ..r................................................:.....:.................................... ProposedUse ..................................................................................................... ...............:..:...........................................:..... Zoning District s .............................Fire District ........,. ....... .....................:.................................... , Nameof Ownerxl.da-r?1..� .............Address ..................................................:................................. e� .z Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address ..................................................................................:. Number-of Rooms ..................................................................Foundation ......................................................................... Exierior ....................................................................................Roofing .............................................::..................................... ..................................................Interior . Floors '! !.N. ......................................... Heating .......... 5.. ......................................................Plumbing .............s ............................ Fireplace ....................Approximate Cost.............................................................. ............ ... .. . ........................................... Definitive Plan Approved by Planning Board ---------------_---------------19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee / vv SUBJECT TO APPROVAL OF BOARD OF HEALTH r n / A" C/ U f A �^ I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regar g the above construction. Name .Vd. .... . ........ ... ................................... Sintiris, William G. No .2079.9...... Permit for ......remodel...dwelling ...... . ...... ...... . . ............................................................................... Location ..........3.5.6..S.c.udde.r...Avenue................. ...... ...... .......... ... .........Hyannis......................................... Owner ...........W.1-11i.a.m. G.. -Sinttiris ........... . .. .. . .............................. Type of Construction ................ Aw............... . ................................................................................ Plot ............................ Lot ................................ November 10 78 Permit Granted ........................................19 Date of Inspection ........................... .......*...19 7 t. Date Completed .......11!�............... .......19 PERMIT REFUSED 4 .................................... 19 ................................................................................ .......... ..................................................................... ............................................................................... ................................................................................... Approved ................................................ 19* ................ .................................................... ............................... ............................................... ' Assessor's map and.lot number ....,.!.l,l.�...�.'"rt. .:.: ..... -J P�Of THE tp�1 Sewage Permit number • -. ;_ Isar BSB ASTIIDLE, i House number. .......................:..........I...Y :.................. ........:..... INSTALLED ALLED IN COMPLIANC '90 PASIL C 16 9. \e�9 N - 4 WITH TITLE 5 'EO vxf hXE L T a'D DE AND TOW OF BAIN IONS BUILDING HNSPECTOR APPLICATION FOR PERMIT TO ..:..... V..1A I...... .............................................. TYPE OF CONSTRUCTION ........... L) m...::................... ............................... ........................................ .............................19X TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit acqQrding to the foil wing information:�AI r 1, / s Location ........w( •.........5..:V ...:�� ........ ... .. ............. ........ .....s............................. Proposed UseY.(. �V 1.,. �o. ............................................. ................................................................. r. Zoning District ............ .................................................Fire District s j ............Address &rlL Name of Owner. 'L�l.,..1.F1.1 .... .. ..rl.............. .................................................................. Name of Builder' .................:... . ..............Address Nameof Architect ...................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation ............G.....C/ 5......................................... Exterior W.O.� ,o Roofing ........... . ............................................................... .: ....... FloorsWI � .Interior ....................................................................................Heating ^^—_—........................ :......:........................Plumbing .................................................................................. Fireplacepp p�.........:......,,,.... ...........................................:.....Approximate Cost ....... ... /..A... . ..................................... . .: Definitive Plan Approved by Planning Board ________________________________19________. Area ............. ::. ....: . .. .. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD, OF HEALTH OCCUPANCY PERMITS FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of B stable regardin the above construction. Name ....... `!�-.................... SINTIRIS ' WILLIMI ` / �0 (> - 7 23960 --- ---No -----.. Pern � for � Single Family lIi -----..=—. = -- ^ ' / 3�6 S�����z Location ---.—.--.---.���=^^ ----.. . . Hyannis / .--.----_,,—~_—_____.L�._____.. | ' [��' | . �iIIiam Siotirio Owner ----.--.--------------- - I,�� Type of Construction --— _------. .................................................................. \ . Plot --.-------. Lot. ----------.. ^ - April I4 , 82 ^ � Permit Granted -------�r.�----lg _ ^ Date of Inspection .-----------.lq ' ^� ^� .C`� Dote Completed ..��..^..°—.--_---.]u��� ' ' . ' ` 1 ' l � . . . " ' .. . ^ ' . . . | ' | � BIKE , Shed TOWN OF BARNSTABLE Permit " * B NSTASLE, ' MASS +_r 9�Ar�0A Permit Number. Application Ref: 200801535 20080550 Issue Date: 03/24/08 Applicant: BEARISTO, ROBERT W Proposed Use: SINGLE FAMILY HOME Permit Type: SHEDS 120 SQ FT &UNDER _ Permit Fee $ 25-.00 Location 356 SCUDDER AVENUE Map Parcel 288045002 Town HYANNIS Zoning District RB Contractor PROPERTY OWNER Remarks' 8'X8' SHED Owner: BEARISTO, ROBERT W Address: MAC#X2301-034 1 HOME CAMPOS DES MOINES, IA 50328-0001, Issued By: ' PR POST THIS CARD SO THAT IS VISIBLE FROM THE STREET -w� k Town of Barnstable "o Regulatory Services Thomas F. Geiler,Director + BAMSTABLE, + 9� MASS. Building Division Tom Perry,Building Commissioner 6L E 200 Main Street, Hyannis,MA 02601 '� ? www,town.barnstable.ma.us `(J Office: 508-862-4038 ```Fam 5,Q8-790-623( PERMIT# n �� FEE: SHED REGISTRATION 120 square feet or less 3M Locati n of shed(address) V 1 ge 9_rT. UD , Eeort5T6 5 08 - 7`Z 9- O 13 Pro Arty owner's name Telephone number ; 0 —JAR OY5—6 U oa !Aze_ofWedMap/Parcel# . o"T Sign re Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature is required) ( Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM. MUST BE ACCOMPANIED BY A PLOT PLAN Q-forins-shedreg REV:042506 Town of Barnstable Geographic Information System March 24,2008 2eeoas 288205 -rt #340 #348 288081 #341 288204 9350 W045002 �042 ` ft 356 #16 � t � � 4 .a 268115 #353 ,c 288045001 " .. #362 t , 200044 . #6 r 288093 0 16 Feet #365 l r r. t� DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:288 Parcel:045002 Q N boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel 1-=100'may not meet established map accuracy standards. The parcel lines on this map Owner:BEARISTO,ROBERT W Total Assessed Value:$256200 are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner:C/O WELLS FARGO HOME MTG Acreage:0.18 acres Abutters i! W E boundaries and do not represent accurate relationships to physical features on the map Location:356 SCUDDER AVENUE rf y+ such as building locations. Buffer r fi� � F TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION._ Map O`„ Parc Y SV Application Health Division Date Issued d Conservation Division Application Fee71 ' Planning Dept. MPermit Fee " Date Definitive,Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address "� G 0\,o ✓t Village Owner �" �I '�`6 S Address --' ZTelephone Permit Request -X �t W n d dUotluw o t e,urn._ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 490 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:,4 Yes ❑ No j Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other i - Basement Finished Area(sq.ft.): Basement Unfinished Area(sq.ft)? Number of Baths: Full: existing new Half: existing ;'.l 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 t Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ 2 Attached garage: ❑ existing q new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) r Name � 'e- ® � '�U s'� � Telephone Number Address ) L CC( e�� UUQ . License# C J [5 �Cu" 0�q� � � Home Improvement Contractor# ' Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO -7 SIGNATURE DATE � a FOR OFFICIAL USE ONLY. �. APPLICATION# DATE ISSUED MAP/PARCEL NO. i ADDRESS VILLAGE OWNER DATE OF INSPECTION: g FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ` FINAL BUILDING DATE CLOSED OUT ASSOCIATION-PLAN NO. r q 1 The Commonwealth of Massachusetts. Department of Industrial Accidents Office of Investigations- ' 600 Washington Street Boston, MA 02111 a4 �� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name(Business/Organization/Individual): Address: . City/State/Zip: Phone.#: Are m an employer? Check the appropriate box: Type of project(required): 1. I a a employer with 4. 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New..construction .2.[] I am a sole proprietor or'partner-' listed on the*attached sheet. 7.. deling , ship and have no employees These sub-contractors have g•' - Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. ❑Building addition [No workers' comp.-insurance comp.insurance.$ required.) 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself.(No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 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. lContractors 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 employecs,they must provide their workers'comp.policy number. lam an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. _ Insurance Company Name: V i d �' )�:A S 1) Oo' � (Q a' Policy#or Self-ins.Lic.#: h wCD/t'1 ,�eq Expiration Date: i S- KQP cc Job Site Address:_ `� C J pil�Y r y City/State/Zip: l•7 _y��G� c' Od--(.0 D w�-- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under,Section 25A of MGL c. 152 can lead to the*imposition of crimirial penalties of a fine tip to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day.against.the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1-do hereby certify under the pains andpenalties ofperjury that the information provided above is tru and correct Si ature: G Date: , _ Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,parinership,association or other legal entity,employing employees: However the owner of a dwelling house having not more than three apartments and who resides therein,or.the occupant of,the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states`Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for•the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),addresses)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 Offisiais 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 permitflicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy'information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le. a dog license of 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 Dceparlment of ladustriol Accidents office of IQvestigatlons, 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-3749 Revised 11-22-06 www.mass.gov/dia r ;t OFTHEA Town of Barnstable Regulatory Services . Ki.usa� Thomas F.Geiler,Director 16, Building Division Tom Perry,Building Commissioner 200 Main Street,'Hyannis,MA 02601 www.town.barnstabl e.maxs Office: 508-862-4038 Fax: 508-790-6230 Properly Owner Must Complete and Sign This Section If Using A Builder L 51-0, as Owner of the roect subject e P P rtY hereby authorize &-a ll �< CO CST���L(� to act on mybehalf, in all matters relative to work authorized by this building permit application for. �� ter- �,v� � s e tom-► (Address of Job) 17 Apr aco S, tore of Owner Date r T Bsck i fib Print Name If Property Owner is applying for permit please,complete.the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERM IS S ION Town of Barnstable Regulatory Services N '� • Thomas F.Geiler,Director awxNsrwst e. '� ,�� Building Division prED Tom Perry,Building Commissioner 200 Mairi-Street;_Hyannis,MA 02601_. www.town.barnstable-ma.us Office: 508-962-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMFAWNEW': name home phone# work phone# CURRENT MAILING ADDRESS: I eity/tovrn 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 Persons)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to- be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit..(Section 109.1.1) 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 Departnnent 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 bomeowner performing work for which a building pemrit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeooyner rngages a person(s)for hire to do such work,that such Homeowner shall ad as supervisor." , Many homeowners who use this exemption are unaware that they are assunring 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 A Duld 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 mquim as part of the permit application, that the homeowner•certify that hdshe 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 eomimnity. Q:forms:homw cmpt RightFax C3-1 4/9/2009 4 : 47 : 52 AM PAGE 2/002 Fax Server ACORD. CERTIFICATE OF INSURANCE DATE(MM\DD\YY) 04-09-09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DOWLING&ONEIL INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 973 IYANNOUGH RD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE HYANNIS,MA 02601 � C:a COMPANYn 76RNJ A AMERICAN ZURICH INSURANCE CO ANY p„ INSURED COMPANY B COUTINHO SEA DBASEAN'S W MASONRY COMPANY 21 PICKERAL WAY C ` us FORESTDALE,MA 02644 COMPANY tp D COVERAGE THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDIC TED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY E 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. CO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM\DD\YY) DATE LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL PRODUCTS-COMP/OP AGO. $ CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY $ OWNER'S&&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Anyone fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY- ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS BODILY INJURY(Per Accident) $ HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UB-0236M209-08 09-08-08 09-08-09 STATUTORY LIMITS X THE PROPRIETOR/ EACH ACCIDENT $ 100,000 PARTNERS/EXECUTIVE INCL DISEASE-POLICY LIMIT $ 500,000 OFFICERS ARE: X EXCL DISEASE-EACH EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/RESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGr_ THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR COUTINHO SEAN. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF BARNSTABLE;BUILDING DEPT. EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT 200 MAIN STREET FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. HYANNIS,MA 02601 AUTHORIZED REPRESENTATIVE ACORD 25-5(3/93) w A Bolinder Bo�d o ,.w mg egu a ions an an ar,s t Construction Supervisor License nwi License. CS 79315 I g Birth�dOOf, 6/6/1967 EX 6 6/2009 TO 15448 Restriction --�1A;h q SEAN.M COUTINi�0 IIf 21 PICKEREL WAYi «i FORESTDALE,MA,O\2644 ' n Comm'is`sionerx. '� ,p ✓�ie �ayivnzoncuP,tr.�i a��/�aooac�it�vel�b \ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR �f Registraon:� 149014 Expiration =1%18%2009 Tr# 260196 . - ,t err T e b SEAN COUTINHO� 3 SEAN COUTINHO; 21 PICKEREL WAY Y A"i FORESTDALE,MA 0264"~ Administrator f MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108-1904 (617)723-3800 Ma Only(800)392-6108,FAX(800)851-8424 12/16/2008 Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws,Ch.139,Sec.313 BARNSTABLE BUILDING COMMISSIONER 367 MAIN STREET 367 MAIN STREET HYANNIS MA 02601 Re: Insured: ROBERT W.BEARISTO Property Address: 356 SCUDDER AVE.,HYANNISPORT,MA 02647 - Policy Number: 0897883 Type Loss: Fire(including.Fire caused by Lightning Date of Loss: 12/14/2008 ) ` .,I Claim Number: 258119 r Claim has been made involving loss,damage or destruction of the above captioned propert,which may either �- exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139,Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location,policy number,date of loss and claim or file number. MPIUA Claims Division CMA00021