The URL can be used to link to this page

Home My WebLink About0365 SCUDDER AVENUE 4 4` E r: �` i I f I 1 i i i a 0. Pew 9 ri R, CAPE C dril N eR TAOkE INSULATIQRNSEP 2 9 REIN" 'A115 "M16 lt"I Af10N Ci111t/05yAy,�, .:� 1-g00-696-66TA"'Q 'I'uwn of Barnstable Regulatory Services - Building Division 200 Main tit Hyannis, NIA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. perfortile'd.�.. com le ted the insulatio n and weatherization wor k k at the property listed below. Cape Cod _ Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (,BPI1) inspector. All wort:preformed meets or exceeds Federal & State Requirements. a 5' - property Owner Property Address , Village w vc AtrOef-(A 36 S 5--i Ave ty44,4dt Mil Insulation Installed: Fiberglass' Cellulose R-Value Restricted Unrestricied Ceilings slopes hlubrs ) ) ) Sincerely HI ry L C:as y`Jr; President i' e Cod I ulation, Inc. e 'j TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel l l p7�plication # Health Division Date Issued Conservation Division Application Fee w Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 3 �ei°du ,� ✓ Village ,(//� Owner�,�/�J't`/�/.9 .1,4J'7.�io�/.� Address Telephones�� 7 .JJ'7,1 Permit Request 2'/®iy Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Go dd1 J Construction Type / //lao-i 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 9.No On Old King's Highway: ❑Yes JUi(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 Q Total Room Count (not including baths): existing new First Floor Roo Count " Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other d cD Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stoves Yes;❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing Oew `~size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: �. g 9 9 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION_ --- (BUILDER OR HOMEOWNER) Name �/ �� CfJd /eo0_4 ' Telephone Number :50�8 Address f ff r License# ae9 f jl� 7i1,,g2/1�0� Home Improvement Contractor# Worker's Compensation # ' �,D ,y ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ��/ FOR OFFICIAL USE ONLY APPLICATION# r _DATE ISSUED MAP/PARCEL NO. Y ADDRESS VILLAGE OWNER DATE OF INSPECTION: �tFQIJNDATION b, uit+ur•.3iYU C:uwv FRAME INSULATION34 .t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: _ ROUGH FINAL FINAL BUILDING DATE CLOSED OUT- ASSOCIATION PLAN NO. • The Commonwealth of Massachusetts 01 Department of lndus&i'al Accidents Office of Investigations 600 Washington Street ° Boston, MA 02111 www,mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Legibly Name (Business/Organizaaon/Individual): �,�2��e Address:lot% City/State/Zi 2 f� o �Ahone # ��- Are you an employer? Check the appropriate box: r - 1. I am a employer with - 4. 0 I am a Type general contractor and I � of project ject(required): employees (full and/or part-time),* have hired the sub-contractors . 6, ❑ New construction 2.❑ I am a sole or rietor ro partner- listed on the attached sheet, .7, P P P ❑ 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 I0,7 Electrical repairs or additions 3,❑ I am a homeowner doing all work officers have exercised their . 11.❑ Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12.7 Roof repairs insurance required.] t c, 152, §1(4), and we have no 3a.❑ I am a homeowner acting as a employees. [No workers' 13,[?� Other/,-/'�,� igeneral contractor(refer to #4) comp,insurance required,]• "Any applicant that checks box 11 must also fill out the section below showing their workers'compensatiod'policy information, t Homeowners who submit this affidavit indicating they are doing-all work and then hire outside contactors must submit a new affidavit indicating such, tContracton 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-contactors have employees,they must provide their workers'comp,policy number. 1 am an employer that is providing workers compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name /L� llzq 47 Policy#or Self-ins, Lie. #: Expiration Dater �' ,y"'• a Job Site Address: T�,�L,�l -City/State/Zip:zAe e9z 4-e'i Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date), Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, 1 do hereby certify un the pains and penalties ofperjury that the information provided above Is true and correct: _~^ r Si a Dat 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): I. Board of Health 2. Building Department 3, City/Town Clerk 4, Electrical Inspector 5. Plumbing Inspector 6, Other Contact Person: Phone#: I 1 �J G APECOD 27 KLI ' -' CERTIFICATE OF LIABILITY INSURANCE cETT DATE(MMIDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.1 HIS 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 m INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,sub ect the terms and conditions of the policy, certain policies may require an endorsement, A ent on this certlflcats does not confer rights)to the certificate holder in Ileu of such endorseent s), statem 'RODUCER ogers&Gray Insurance Agency, Inc, NAME: Barbara DeLawrence 34 Rte 134 PHONE outh Dennis, MA 02660 ra/c No ExcJ� I ` A DRESS'bdelawrence rc ers ra ,com AA No: 877) 816-2156 INSVRER(SI AFFORDING COVERAGE !S RkfD---__ —_--_�,-•-- --"- INSURERA;P@@ri@SInsurance _ NAICk s Insura _nce Com an Y _ II INSURERB;COMMERCE INSURANCE COMPANY Cape Cod Insulation Inc INSURER c:Evanston Insurance Company 18 Reardon Circle SURERo;ATLANTIC CHARTER INSURANCE GROUP South Yarmouth, MA 02664 IN - - � _ - INSURER E; - - OVERAGES INSURER F., '- -- CERTIFICATE NUMBER: I THIS IS TO POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED CERTIFY THAT THE D ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS C R;TIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E CLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY-HAVE BEEN REDUCED BY PAID CLAIMS. R ...t-._ TYPE OF INSURANCE POLICY EFF POLICY EXP X COMMERCIAL GENERAL LIABILITY POLICY NUMBER M IDD YYY MMI I - LIMITS l CLAIMS-MADE II x11 OCCUR CBP6263063 EACH OCCURRENCE LE 04101/2014 O4I0112015 Tom rtrET--- $ —... 1,000,000 1 PREMISES(Ea occurrence) _ $_' 100,000 _.... MED EXP(Any one person) $ --^6 000 G N'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ 1,000,000 POLICYI 11 PRO. ( � GENERAL AGGREGATE h;,.l JECT I _J LOC OTHER PRODUCTS•COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY ------ ANY " $ COMBINED SING E LIMIT auTO 14MMBCKVMK Ea accident $ 1_,000,000 . ALL O NED X 04/01/2014 04/01/2016 BODILY INJURY(Par person) $ SCHEDULED AUTOS _ HIRED AUTOS X NON-OWNED. BODILY INJURY(Par accidenp $ AUTOS PROrERTY DAMAGE - _ Per accident $ X UMBRELLA LIAR X OCCUR $ EXCESS LIA9 _ LA EACH XONJ453514 EACH OCCURRENCE $ 11000,000 DED X RETENTION$ 10,000 04/01/2014 04/01/2016 AGGREGATE WORKERS COMPENSATION Aggregate $ 1 p AND EMPLOYERS'LIABILITY Y!N OR 625904 H ANY PROPRIETORIPARTNERIEXECUTIVE WCA00 STATUTE OFFICERIMBER NH)EXCLUDED? p NIA 06/30/2614 06/30/2015 -- E.L.EACH ACCIDENT $ 1,000,000 DtSCR PTION OF OPERATIONS below Y E.L.DISEASE•EA EMPLOYEE $ 1,000,00 E.L.DISEASE•POLICY LIMIT $ 1,000,000 RtP7lON OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarka schedule,may be attac erg Compensation Includes Officers or Proprietors, hed It more apace Is required) :10 al Insured status Is provided under the General.Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, 4 TIFICATE HOLDER _ CANCFI I ATIr)M M;ass4lchusetts -pepattni�'nt of P7Iblii'c Safety , :0 )'trd of Building Regula;•fans end Standards C unstrllcrian 5upcn isor gip. �llyrn License: CS-100988 J„. I-II—KRY .R CASSII V 8 S11ED.Row WE,ST YARIVIO'(�` -1 i 5 � Expiration Commissioner 11/11/2015 M1T yyLt2yliGl�2GrC�� t� � GGY�I!'GrC%!'7i�11 (I r Office of Affairs and Business ��.e�;ulatiol�. JJJ� 10 Palk P1aUa Suite 5170 Boston, Massachusetts 02116 Home Zm r•ovelnerlt,C p Q.� acstor Registration . . , . Registration: 153507 Type, Private Corporation Expiration: '12/15/2014 1PIl 233831 CAPE COD INSULATION, INC: HENRYCASSIDY _.� _...._ .._. ............. ............. . . .. . ...__.... 18 R E A R D O N CIRCLE ;;.;. ` _x' ---- _..._......._........._....................... ._.__.. SO. YARMOUTH, MA 02664 :,;.1 ,,� .•;'.. ,, ''Updnte Addt'uss mid roturn cnrd, Mnt'I( rG26)lln rnr chilllg'C. Address Itenuwnl �) lrnployment' O LWCnrd ��r•,`(( r,t•ricnrotacr((.11 I C),r' t u %tc,dcac r l)rriee ut'lbilsumcr Atrnlrx St Rusnlass Rcgulnliuu;: License Or registrntion valid for'Individul LINO only t' 'WOME IMPROVEMENT CONTRACTOR beforu the Oxpirotlon date. It'found !'churn to: [Registration: 153.�67 Type: Office of ConsumerAFfairs nod Business Itegultitioll 3Lxpiration: 1211'5/2014 Private CQrporalion 10 Pari(Plnzn-Suite 5170 Boston,KA 02116 'E(UD INSULA'I'IQN,t;I�J i ,• IRY CASSIDY ' UPOON CIRCI.L YA NIOUD-I, MA 02664 Ilildl l'Jl'(1'l`l'tlt'y of Val' wit hu t . [lilt i'e ' I • +�totznrs� ITT M mass save ppp �I sav;n�tlro�r orsergy dficfer�ty �. PERMIT AUTHORIZATION FORM 1, R. Laftsidis ,owner of the property located at: (Owner's Name,printed) 365 Scudder Ave Hyannis (Property Street Address) (city) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed " below to act on m behalf and obtain a building permit to perform insulation and/or weatherization Y g Pe P / work on my property. asnere' e Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Ct Participating Contractor Date For Office Use Only Rev.12132011 f L l [R288° 093 . ] LOC] 0365 SCUDDER 'AVE E CTY] 07 TDS] 400 HY KEY] 191919 ----MAILING ADDRESS------- PCA11041 PCS100 YR100 PARENT] 0 WILLIAMSON, JOHN P MAP] AREA] 55CC JV] 420217 MTG] 0000 WILLIAMSON, EUNICE R SP1] SP21 SP31 566 COMMONWEALTH AVE UT11 UT21 .22 SQ FT] 1350 APT 606 AYB] 1950 EYB] 1975 OBS] CONST] BOSTON MA 02215 LAND 30500 IMP 62400 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 92900 REA CLASSIFIED #LAND 1 30, 500 ASD LND 30500 ASD IMP 62400 ASD OTH #BLDG(S) -CARD-1 1 62, 400 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 365 SCUDDER AVE TAX EXEMPT #DL LOT 2 RESIDENT' L 92900 92900 92900 #RR 1440 0088 OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE100/00 PRICE] ORB12600/211 AFD] LAST ACTIVITY] 05/23/96 PCR] Y f R288 093 . �P P R A I S A L D A T A• KEY 191919 WILLIAMSON, JOHN P LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 30, 500 62 , 400 1 A-COST 92, 900 B-MKT 74, 100 BY 00/ BY ML 12/88 C-INCOME PCA=1041 PCS=00 SIZE= 1350 JUST-VAL 92, 900 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 55CC ----------------------------- NEIGHBORHOOD 55CC HYANNIS PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 305001 LAND-MEAN +0% 929001 78256 IMPROVED-MEAN -2001 250 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 1000] 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 [?] 1 R288 093 . 0 P E R M I T [PMT] ACTIS[R] CARD [000] KEY 191919 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR .CMP NEW/DEMO COMMENT OF tME tp� i a • BARNSMIX, June 16, 1997 ATFD MA'S A The Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Re: 365 Scudder Avenue Map/parcel 288 093 June 16, 1997 TO WHOM IT MAY CONCERN: 365 Scudder Avenue is a legal two family dwelling. Sincerely, Gloria Urenas Zoning Enforcement Officer GU/km Q Marianna E.Pappas REACTOR® Cobb-Nowak ; 1550 Route 28 Center Place Centerville,Massachusetts 02632 Business(508)775-2121 Fax(508)771-8089 Home(508)778-9369 Each Office Is IndependenW Owned And Operated �p THE : �. . The Town of Barnstable • BARMY _ 6 ,,$ Department of Health Safety and Environmental Services fo ' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissic PLEASE FORWARD THE ATTACHED PAGE(S) TO: TO: ATTN: FAX NO: 7 7/ f� FROM: DATE: PAGE(S): _ (EXCLUDING COVER SHEET) TGVM OF 88888?88Lz gnpOBT M�7NT8BY/QO�iTIT�A �g�pQRT Z)VZSZDX mxrr (LAST, F=W, N=D=) y pTE Omxu i aummA=oNS-r%zmzZE MVENCE- SERA- IS ETC. ......... Imo: THE t Town of Barnsta e i lmsTen Department of Health, Safety and Environmental Services o 9�,� Public Health Division 367 Main Street,Hyannis,MA 02601 Office 508-790-6265 Thomas A.McKean FAX 508-775-3344 Director of Public Health July 23, 1996 John and'Unis Williamson 566 Commonwealth Ave. Room 606 ` - Boston,,-MA-02215°' NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE H MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE, ARTICLE 51 The property owned by you located at 165 Scudder Avenue, Hyannis was inspected on 15 1996 b Edward Bar Health Inspector for the Town of Barnstable, because of Jul Barry, P Y Y a complaint. The following violations of the Town of Barnstable Rental Ordinance Article 51 and the Sanitary Code H were observed: 410.351 A : Toilet does not flush when using handle. Bathtub drain shut-off valve inoperative. 410.500: Windows in bathroom and living room inoperative to open or close; Rear door: distance between door frame and door greater than 1/16 inch; Storm door: handle missing, door close mechanism missing. 410.351: Excessive amounts of smoke observed when electric stove is turned on. Refrigerator water continually collects in bottom trays of unit. 410.481: No sign provided on building displaying name, address, and telephone number of the owner. You are directed to correct the violation of within'twenty-four (24) hours of receipt of this notice. You are also directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. I You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH t Thomas A. McKean Director of Public Health cc: Marsha Fisher, tenant JOSEPH D. DALUZ , - 790-6227 Building Commistiontr TELEPHONEt XX%XNM ]Exx=x TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING HYANNIS, MASS. 02601 January 4, 1991 Mr. John P. Williamson 870 Gay Street Westwood, MA 02090 Re: A=288-093 65Sc:ud'der�A_v_enue;tFiyan:nis , Dear Mr. Williamson: At the request of your tenant, Mr. William Stearns, I inspected an apartment in a building owned by you and located at 365 Scudder Avenue, Hyannis. The following violations of the Massachusetts State Building Code were noted: 2101.10.4.2 Means of egress 2101.14.1.1 Smoke detector type 2101.14.4 Maintenance and testing of 'smoke detectors Please make corrections and notify this office for'an inspection. Very truly yours, v �l Alfred E. Martin Building Inspector AEM/gr cc: -- Mr. William Stearns . Town Manager Certified mail: P 119 480 518 R.R.R. Town of Barnstable *Permit#(/' Expires 6 mondes rom issue date CRESS P Regulatory Services ERMI7' Fee Thomas F.Geller,Director 01 JUL ! 4 2006 Building Division Tom Perry,CBO, Building Commissioner I OVEN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 www,town.barns table.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 `7 .-• C R o l JResidential Value of Work � , Qoo Minimum fee of SM-00 for work under$6000.00 P Owner's Name&Address ox � J Contractor's Name ` Telephone Number 1 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman'Compensation Insurance k one: etor I am the Homeowner a or er s Compensation Insurance Insurance Company Name Workman's Corap.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 �( ❑ -roof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows. U-Value (maxinum.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 Improvement Contractors License is required. SIGNATURE; Q:Forms:expmtrg Revise071405 t he t ommonwearrn uJ ivlussucnu�eci� Department of Industrial Accidents 92 Office of Investigations ' 0 600 Washington Street Boston, MA 02111 / VVy y www.mass.gov/dta Workers' Compensation Insurance Affidavit: Bluilders/Contractors/Electricians/Pluffibers Applicant Information Please Print Legibly Name (Business/organizatiowhdividual).. , .`` , Q�, L(A -�S Address:�61_s City/State/Zip: Phone#: Are you an employer? Chec the•appropriate box: 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.[__1 I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for mein any capacity. workers' comp.insurance. 9. ❑ Building addition o workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 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 sub-contractors and their workers'comp,policy inforrnation. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy aned ja p site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500;00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and'a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office; of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and penalties of perjury that the information provided above is true and correct Si ature: Date: o Phone#: i - 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 S.Plumbing Inspector 6. Other Contact Person: Phone : Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal.entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds orbuilding 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 Liabi7ity 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 mast 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 e,t 406 or 1-877-MA SSAFE saw 1 617-727-7749 Revised 5-26-05 ww-w.mass.4ov/ciia ° „4 St Town of Barnstable 30 Regulatory Services-, BARN Thomas F:Geiler,Dkeetor Building Division �rED � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 •PERNftT# FEE: $ SHED REGISTRATION 120 square feet or less 5 Cvc( er . Location of shed(address) Village • P II '�" Z- s J Property owner's name Telephone number !� Size f Shed Map/Parcel# ignature ^ 73 O^ d Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN L-C]l1it4-T UPF-4 C3F PPC3P1=_"y /*_1NES MAY NOT BEACCUR—ACFE- STANDARD LEGEND .. ................. NOTE:not all symbols will appear on a map MA,P'28 GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES EDGE OF BRUSH • # 3 ORCHARD OR NURSERY MAP2 V 7, EDGE OF CONIFEROUS TREES MARSH AREA EDGE OF WATER MAP 353 DIRT ROAD no ff DRIVEWAY it. PARKING LOT 4 — i ��PAVED ROAD —--—--— DITCH .62 DRAINAGE MAP 288 ----- PATH/TRAIL PARCEL LINE mAP I io -<—MAP# M P 288 21 _—PARCEL NUMBER # #1860 —HOUSE NUMBER 2 FOOT CONTOUR LINE 365 10 FOOT CONTOUR LINE 1 Elevation based on NGVD29 SPOT ELEVATION STONE WALL .......... -X—X- FENCE RETAINING WALL RAIL ROAD TRACK M 288 STONE JETTY SWIMMING POOL MAP288 PORCH/DECK AP 28 0 BUILDING/STRUCTURE DOCK/PIER # 14 HYDRANT # 24 e VALVE @ MANHOLE 988 0 POST 0" FLAG POLE T 0 W N 0 F B A R N S T A B L E G E 0 G R A P H I C I N F 0 R M A T 1 0 N S Y S T E M S U N I T a SIGN S STORM DRAIN N PRINTED SCALE:IN FEET NOTE:This map is an enlargement of a NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimetrics(man-made features)were interpreted from 1995 aerial photographs by The James 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD 0 UTILITY POLE n TOWER E 0 0 40 National Ma Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards I INCH=40 FEET enlarged scale. on the map. at a scale of 1"=100'. Parcel lines were digitized from FY2002 Town of Barnstable Assessors tax maps. LIGHT POLE ELECITIC BOX Property Location: 365 SCUDDER AVE.., MAP ID: 288/ 093/ Other ID: Bldg#: I Card 1 of 1 Print Date:02/12/1999 T7 Ill I LYUN,JEk'11HLY A&JrINFNIVEM a Descriptio Code Appraised Value Assessed Value LYON,JEFFREYRES-L-AND IU4w— 30,50C --3U,5U PO BOX 64 RESIDNTL 1040 45,40C 45,40C 801 HYANNISPORT,MA 02647 BARNSTABLE,MA UIVIA A ccoun Plan Kei t;; MMY Tax Dist. 400 Land Ct# Per.Prop. UP FY99 #SR Life Estate ffDL I LOT 2 Notes: VISION 9DL 2 Mal -75,9U AIL Z a, 'Am,0 ERPPTK�"" F NEKWLF AAL&%V Wit.W4 biql Yr, I SHP I�LW UJI 06/247199z U I I 1A Yr. Code Assessed value— rr. Code Assessed Value Yr. Code Assessed Value LYON,JEFFREY A TR 11436/086 05/18/199 U I I 1A LYON,JEFFREY A&JENNIFER S 10877/208 07/31/199-, Q I 80,00C 00 WILLIAMSON,JOHN P&EUNICE R 2600/211 Q0 7`oFaT, 92,90c, -I-OTaT., 9 2,9 O-C 75-15-1 92,90C A " v="' N is signature acknowledges a visit by Data Co)fect—or—or-Assessor f"AW g Year lypelDescription Amount Code Description Number mount C omm.Int. W",T Appraised Bldg.Value(Card) 45,400 Appraised XF(B)Value(Bldg) 0 Appraised OB(L)Value(Bldg) 0 a: A" Appraised Land Value(Bldg) 30,500 Special Land Value Total Appraised Card Value Total Appraised Parcel Value 75,900 Valuation Method: 75,900 Cost/Market Valuation Net Total Appraised Parcel-Val—ue 75,90U Permit ID Issue Date lype Description Amount Insp.Date Yo Comp. Date Comp. Comments Date ID Cd. PurposelResult E, A A ism, "T""IWr "5*11"', B# Use Code Descrtj—iion one D Erontage Depth units nit rice L Eactor S.I. G.Pactor Nbhd. Aaj. fVOteS-Aajl,)peciat Pricing Adj. unit Price Lan -T---TO4U--rw--o-F-amliFy- —RH—--T- U.22 AL 0.5C 10 IBLUG.S1 I JU'5ut Total an unt otal an Va 3", Property Location: 365 SCUDDER AVE MAP ID: 288/ 093/ Other ID: Bldg#: 1 Card 1 of 1 Print Date:02/12/1999 Element Ca. Ch. Description Commercial Do-Pteinents Style/ ype H RanchElement Ud. CA Description Model 1 Residential Heat Grade C C Frame Type Baths/Plumbing BM Stories 1 1 Story Occupancy 0Ceiling/Wall ooms/Prtns Exterior Wall 1 14 Wood Shingle /o Common Wall 2 Wall Height Roof Structure 3 able/Hip Roof Cover 3 sph/F GIs/Cmp Interior Wall 1 3 Plastered ffl ' l - y�,--'' '° '' 2 ement ode Description Vactor 27 Interior Floor 1 14 Carpet Comp—ex 2 Floor Adj Unit Location eating Fuel 2 ii eating Type 5 Hot Water Number of Units C Type 1 None Number of Levels /o Ownership Bedrooms 3 3 Bedrooms Bathrooms 1 2 Bathrooms 0 2 Full na j.Base Rate 48.00 Total Rooms 7 Rooms Size Adj.Factor 1.08951 Grade(Q)Index 1.01 ath Type Adj.Base Rate 52.82 Kitchen Style Bldg.Value New 85,568 Year Built 1950 ff.Year Built 1975 not Physcl Dep 22 uncnl Obslnc con Obslnc 5 ., ,.. t: :.. Spec].Condo Code peci Cond /o Code Description ercenta a Overall%Cond. 53 wo 1,amry eprec.Bldg Value 45,400 ,` AVA TA! - A � - 11 o e Description nits nit rice r. p t o n x pr. Value REA SUM, Code escrrption LivingArea UrossArea Ey.Area Unit Cost Undeprec. Value JJAh Mrsttloor , UBM Basement,Unfinished , 1,35C 27C 10.5f 14,26 YL Ur-o—ss L iy11 ease Area g a Town of Barnstable Approved Regulatory Services Fee 6- ' C/" Thomas F.Geiler,Director Building Division Peter F.DiMatteo,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Home Occupation Registration Date: Name 1,Ck 10�1�S_Ixk s Phone#5 1 I`5 a 1 t Address: ASCO 5 SCy�(�p c ay I Village: g Name of Business: \N) Type of Business: Q Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located. within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of-normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the unders' ,have read and agree with the above restrictions for my home occupation I am registering., Applicant Date; \ O Homeoc.doc f� 'ZiS'r. lztS=. J�St 7z ,rrsrrc icmi Z7MMM= ZCU= IC 35 s J 'ROPERTY ADDRESS I I ZONING I DISTRICT CODE SP-DISTS. DATE PRINTED I CSTATE LASS I PCS I NBHD KEY No. 0365 SCUDDER AVENUE 07 RB 400 ... 07HY 07/09/95 1041 00 55CC R238 093. LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T 191919 Lana By/Daie 5�ze o�mens�on Y UNIT ADJ'D.UNIT ACRES/UNITS VALUE oescn lion WILLIAMSONo *JOHN=P pggP- 777:/ cD. FF-De m/Acres LOC./YR.sPEc.cLASS ADJ. COND. PE PRICE PRICE fjLXND 1 30.500 CARDS IN ACCOUNT 10 18LDG.SIT. 1 X .22 =10 277 49999.9 . 138499.9 — .22 30500. #BLDG(S)-CARD-1-_1 : 62.400 Ol OF 01 #?L 365 SCUDDER AVE q— g�$ - A BATHS Z.0 U X C 100 7000.0 7000.00 1.00 I 7000 3 #DL LOT 2 MARKET 74100 V - D #RR 1440 OU88 INCOME SE A PPRAISED VALUE D D I 92.900 4 ARCEL SUMMARY T u AND 30500 T I LDGS 6240E -IMPS M OTAL 92900 E . CNST TN DEED REFERENCE TVpe DATE Recmcea R I O R YEAR VALUE '1 1 Book Page Inal' MO. Yr.D s i—Pry I AND 30500 r S 2600/211, 0/00 BLDGS 6240E TOTAL , 92900 BUILDING PERMIT LAND LAND—ADJ INCOME SE SP-6LDS FEATURES BLD—ADDS UNITS Number Dare Type Amount 30500 I 7000 Const. Total B -I1 Norm. Obsv. (;'-s Unils L'nils Base Rale Atll.Rate All Age Depr. Con O. CND loc 4p R.G Repl Cosl New Atll Repl Value Stories Height Rooms Rms Balna a Fix. Puly..it Fp 0 000 100 100 60.80 60.80 50 -75 19 80 90 70 89080 62400 1.0 7: 3 2-0 8.0 R I S 1 R C st 7 1 FX: 1.00 1DA7 ML 12188 CA E 1/00.90 ELEMENTS CODE CONSTRUCTION DETAIL 60. uu i'_ *--------------- 50-------------------- STYLE 03 ANCH 0.0 Z + ! € G - SI- N-A-aJMT- -00 ----- -------------0- 0 -XTf-R-W-AtrS-- -tt 017D-SWI-NGLE-S----K-0 EArtAC-TYPE- -09 It--HOT.-NATER---n-.-O + + NTf-R:FI#ISH- -05 t-KSTER-----------V.O r ! ! NTE-R:LA'tJUT- -T2 VfR./iVURMAt-----ff�;-0 NTf-R:0U-A-I:TY -02 A7fiE-A�-EXT-E-W--D-�O 27 BASE 27 L`0O-R-STRUCT -02 V_J01S-r/8E-ATt---Zo() w + E L00-R COiVER- J4 -ARP€T------------- 0 TOIalAreas, qoa= I ease= 1,350 ! ! OOf--TYP-E---- -0t A-SLE=ASPH-S'H --V:O E L€t-PRIC-At- Ut VERAGE----------- 0-_0 BUILDING DIMENSIONS ! ! T ! ! 0U"ATiID-N- - -01 1WRED--CONC-----94.K7 A + + -------------- - - ---------------------- + + -----NCI IMORH D 3-5CC-RYA NNIS------- L *---------------------50--------------------X LAND TOTAL MARKET PARCEL 30500 92900 AREA 4027 VARIANCE +0 +2206 STANDARD 25 RESIDENTIAL PROPERTY ri MAP, NO. LOT NO. FIRE DISTRICT STREET SUMMARY r: 365 Scudder Ave Hyannis Port LAND so l H �3 Blocs. 01 93 OWNER / 3 Ci TOTAL Q Q d y� LAND * RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: L/.L. 2 BLDGS. rn TOTAL _ -oo• v� LAND IL Ol BLDGS. TOTAL .Williamson- John P. & Eunice R. 10-18-77 2600 211 31 0 LAND 9 Of BLDGS. : TOTAL t. LAND BLDGS. TOTAL LAND A BLDGS. TOTAL LAND 01 BLDGS. TOTAL 'LAND INTERIOR INSPECTED: '-��f e !r l / /° BLDGS. TOTAL DATE: G _Z 7 / LAND ACREAGE COMPUTATIONS 01 BLDGS. LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL HOUSE 41Z ° zOo p C 0 LAND CLEARED ONT O BLDGS. REAR TOTAL WOODS&SPROUT FRONT LAND REAR O BLDGS. WASTE FRONT TOTAL REAR LAND BLDGS. TOTAL LAND j BLDGS. — LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND 8 ROUGH TOWN WATER 01 BLDGS. HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND SWAMPY NO M BLDGS. LAND COST Done.Walla Fin.Bsmt.Area Bath Room Base Cone.Blk.Walls Bsmt.Rec.Room St. Shower Bath / Bsmt. BLDG.COST a O O 27 PURCH. DATE Conc.Slab Bsmt.Garage St. Shower Ext. Walls PORCH. PRICF. Brick Walls Attic FI.&Stairs Toilet Room Roof RENT Stone Wails Fin.Attic Two Fixt. Bath 3 Floors Pier INTERIOR FINISH Lavatory Extra Bsmt. ' F 1 2 3 Sink Z / DZ:) . y: r/ 0 Plaster Water Clo- Extra Attie EXTERIOR WALLS Knotty Pine Water Only Double Siding Plywood No Plumbing Bsmt.Fin. Single Siding Plasterboard Int.Fin. sV ,)p*,�Shingles TILING ,�Z d-yt�J� D Cone.Blk. G F P Bath FI. Heat f' Face Brk.On Int.Layout L.,j Bath &Wains. Auto Ht.Unit Veneer. Int.Cond. Bath FI-&Walls Fireplace Com.lIrk.On .HEATING Toilet Rm.FI• Plumbing D Solid Com.Brk. Hot Air Toilet Rm.Fl.&Wains. Tiling �� Steam Toilet Rm.FI.8 Walls Blanket Ins. Hot Water ^ St. Shower Roo(Ins. Air Cond. Tub Area Total ( (Q-J Floor Furn. •Z X/.� ROOFING COMPUTATIONS Asph.Shingle Pipeless Furn. .F. 3 p Wood Shingle No Heat S.F. Q 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 30 1 21314 516 7 819110 MEASURED Hip Mansard FIREPLACES S.F. Pier Found. Floor -z Gambrel Fireplace Stack Wall Found. 0.H.Door LISTED FLOORS Fireplace Sgle.Sdg. Roll Roofing Cone. LIGHTING .,:.:... Dble.Sdg. Shingle Roof Earth No Elect. DATE Pine Shingle as Plumbing Hardwood ROOMS Cement Blk. Electric Asph.Tile Bsmt. 1st TOTAL 3 of Brick Int.Finish CED Single 2nd 3rd FACTOR Ile •j REPLACEMENT OCCUPA CY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL. DWLG. S !2 oir 73sv 2 --- 3 - 4 -• 5 . 6 - 7 8 g 'f0 - TOTAL,.