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HomeMy WebLinkAbout0181 SEA STREET IN M-)0 i r 1�11 r'1 �ate r L 4•�_ ter' r•�^ .. Ste? t-e, .i _ r - - 5 Ts , i sly y 77 1 .k �mY TING Ass 40 . x - • t a C 7 VIA Vol Mom VIA N : w s • _ ... - .,,. . . ... ._. .. `ate.._ ...�•... ._�� "� r .. � � �� _ _ _....._..... . ..- PROJECT ll NAME: ADDRESS: 1,7/ T"' PERMIT# ('70 23 PERMIT DATE: .o?, MAP' �� D LARGE. ROLLED L 9 NS ARE LNT• -w SLOT Data entered in MAPS program on: e o. it By: � > Town of Barnstable *Permit# ctD (,cT? Expires 6 months rom issue date rs Regulatory Services Fee () enwvsTeet.e. Thomas F.Geiler,Director 9`b MASS, 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 J6-7 I Property Address S CA VAQ Q1 S f 1'1 6 a(4a I r VfResidential Value of Work Minimum fee of$25.00 for work under$6000.00.' Owner's Name&Address -4e 6,eca_14,0V O ! S1-\ 51V 4YAnj,0S, _MR C9ac�dl Contractor's Name Vwxa" &e=e"U Telephone Number Q r(p Home Improvement Contractor License#(if applicable) W tR S,) Construction Supervisor's License#(if applicable) Workman's Compensation,Insurance .. PRESS PERMIT Check one: ❑ I am a sole proprietor DEC 3 2007 ' ❑ I am the Homeowner I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name A5soCitm�5p tzmnW tt)b Tus ,oc& oanOW. 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 -U'�✓C> (,l+J �h.K�►(� 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. -•�;�?t��;'r7 A copy of the Home Improxe ment Contractors License is required. 7 SIGNATURE ' C? G a J3 Q:Forms:buildingpermits/express j '� , .�i Revise091307 JOB PROPOSAL' R13`%`t7 )i'!'i.�`;1 GG.i,75IT-. T�� I''�:GT>�` G!_L LD F 1ri_�) +._?�vT) G J. !T'1 Jr\ SLUE., tvi.IA 02632 i_:�l°`i? •"'ice �� a,`�:� l.:� � :.�1��� .'Jr . �;"! Job Location and Proposal for. Annette Geraitery 181 Sea Street Hyannis, MA 02601 K.P.Remodelina&Construction propose to strip and replace roof with: *14 sq.of Pewter wood AR-30 Shingles **Ice&Water barrier **15 lb.felt tar paper **Milled Aluminum drip edge **Galvinized roofing nails **Dumpster **Permit fee to the Town of Barnstable We propose herby to furnish materials and labor-complete in accordance with the above applications for the sum of: Two Thousand,Nine hundred and Eighty,Five and 00/100 Dollars Estimated job proposal: $2,985.00 Payments to be made as follows:$1,500.00 Due with signed proposal. $1,485.00 Due upon completion and any extra's. **All materials are guranteed for one full year.All work is to be completed in a professional manner according to standard practices.Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements contigent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado,and other necessary insurance.Our workers are fully covered by Worker's Compensation Insurance. '*ACCEPTANCE OF PROPOSAL-The above price,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payments will be made as outlined above DATE OF Ql ACCEPTANCE �' Signature G Authorized Signature Note:This prposal maybe withdrawn by us if not accepted Within 30 days. Client#:9580 2KPRE DATE(MMIDD(YYYY) ACOR& CERTIFICATE OF LIABILITY INSURANCE 09/10/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS_UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyanough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Associated Employers Insurance Compa Kenneth Perry DBIA INSURER B: K.P.Remodeling&Construction INSURER G 19 Guildford Road INSURER a.. Centerville,MA 02632 INSURER 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 AFFORDED 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. INSR ADWA POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR S TYPE OF INSURANCE POLICY NUMBER q MM/ Y / YY - GENERAL LIABILITY - EACH OCCURRENCE $ DAMAGE COMMERCIAL GENERAL LIABILITY S(Ea a $ - CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ ElPOLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS. HR AUTOS BODILY INJURY $ (Per accident) - NON•{)WNEO�IUtlT05 - - C:1 ce PROPERTY DAMAGE $ AParaaadent)- _ GARAGE LIABILITY` AUTO ONLY-EA ACCIDENT $ EA ACC $ ANY-AUTO ,-y '- OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY!..7 EACH OCCURRENCE $ OCOUR CLAIMS MADE AGGREGATE _ $ $ DEDUCTIBLE-+ - $ RETENTION $ $ A WORKERS COMPENSATION AND WCC5005450012007 06/13/07 06/13/08 X we STATU- oTH- EMPLOYERS'LIABILITY ., E.L.EACH ACCIDENT $1 OO O00 - ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100 000 Ilyas,desama under PECIAL PROVISIONS below E.L.DISEASE-POLICY LIMB $5OO OOO OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS - *"Workers Comp Information Voluntary Compensation Massachusetts Limits of Liability Endorsement Form#WC200301 Edt Date:04/01/84 (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION- Town of Barnstable Bldg_DIY. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL I0_ DAYS WRITTEN Attn:Tom Perry-Commissioner NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 200 Main Street - IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Hyannis,MA 02601 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108)1 of 3 #49038 JMH ®ACORD CORPORATION 1988 ti tNE Town of Barnstable • BABNBPABLL Regulatory Services MAM 039.A� Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 568-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize K_•�, P-P 1Wai k xl t W-S l kQC., l O IQo act on my behalf, in all matters relative to work authorized by this building permit application for: 1 I c56\ 51%y r MW Ob,mA Oro (Address of Job) az't�11 Signature of/Owner Da e Print Name Q:Forms:buildingpermits/express Revise091307 Board of Building'Regulations and Standards License or registration valid for individul use only . HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration 132.282 One Ashburton Place Rm 1301, 40 Expiration '_12/21/2008` Tr# 124628 11 Boston,Ma.02108 Type rf K.P.REMODELIN�Gr�. KENNETH PERRY 19,GUILDFORD RD. CenteNille,MA 02632 Administrator Not valid withot e The Commonwealth of Massachusetts Department of Industrial Accidents OfTce of Investigations _ a 600 Washington Street Boston,MA 02111' r www.mass.gov/dia ' Workers}Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A.Pplicant Information Please Print Le gib Name(Business/Organization/ladividual): Address: �1 City/State/Zip:C' Vao� -Ji14,. 1M& oP63) Phone.#: �6' 2,1 Are you an employer?Check the appropriate bog: :Type of project(required):, 4, I am a general contractor and I 1, I am a employer with�_ � 6. New construction . employees(full and/ov-p -time).* • have hiredthe sub-contractors listed❑ I am a'sole proprietor or partner- listed on the sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• Demolition �vorkin for me in an capacity. employees and have workers' g y p tY• 9, ❑Building addition [No workers' comp,insurance. < comp.insuranca.t' required.] 5. We are a corporation and its 10.❑Electrical repairs or additions q ] 3.❑ I am a homeowner doing ill-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_ employees, [Na workers comp•insurance required,] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating'such. tcontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state'whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I ' 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,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 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' Investigations of the DIA for insurance coverage verification I do here ce under the pain • [ties of perjury that the information provided above is true and correct. Si afore. 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 1 City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6:Other ` Contact Person: Phone#: 1 OWN OF BARNSTABLE BUILDING PERMIT APPLICATION L�zf MJi0 Parcel 1A 7`Z Permit# e -� Health Qivision Date Issued `51.R /- 613 Conservation Division y v� Application Fee 0 Tax Collector Permit Fee Treasurer 3 Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OK14 Preservation/Hyannis Project Street Address i' �00 S' ' Village hJF S' Owneral 12 p r'' Address J Telephone Permit Request2 U e S uare feet: 1st floor: existing [ (e3 q g proposed 5 qO 2nd floor: existing ' proposed �� Total new Zoning District �� Flood Plain Groundwater Overlay Project Valuation < S a Construction Type o .� Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Y Two Family ❑ Multi-Family(#units) Age of Existing Structure go Historic House: ❑Yes 90 On Old King's Highway: ❑Yes J-No Basement Type: ❑Full W-C"rawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 1 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: [was ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 2TRo Fireplaces: Existing �_ New Existing wood/coal stove: ❑Yes CWo 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 ❑Yes UY o If yes,site plan review# J Current Use v✓�r v7�,� l4®k t P Proposed Use BUILDER INFORMATION �- �A)C0p . �� /. Name � � �Q �c� 1 y C Telephone Number _[�61R � Address _ �� ���,� T 1 /�j �t� License# �— �' �' Home Improvement Contractor# l� 1v b � C Worker's Compensation# / ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOU SIGNATURE ��i _ DATE 11,V76 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER E DATE OF INSPECTION: FOUNDATION 711f `03 U FRAME •� �� !/�S�a 3 �(��'�� lJ//� INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING l r r DATE CLOSED OUT , ASSOCIATION PLAN NO. RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 -S d' 63 d Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE s / square feet x$96/sq.foot= l x.0031= plus from below(if applicable) ALTERATI/ONS/RENOVATIONS OF EXISTING SPACE 0 o square feet x$64/sq.foot= g C © x:0031= 6 plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq. ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf 135.00 35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= r STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x'$30.00= o, d (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee prof cost RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations, $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE y� square feet x$96/sq foot= _ x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= d ( �' x-0031= plus from below,(if applicable) ACCESSORY STRUCTURE>120 sq.f� >120 sf-500 sf $35.00 `S >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS , Open Porch x$30.00= (number) Deck x$30.00= Fireplace/Chimney _x$25.00= (number) Inground Swimming Pool $60.00 y Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcosc °F THE I Town of Barnstable Regulatory Services 1 yIL4t ABIX MAASSS. Thomas F.Geiler,Director 1619. o►e °'10 Building Division Tom Perry;Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 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 adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. / Type of Work: R4 wO�-�' Estimated Cost 'S COO Address of Work: l ��'� S 1 f�4 4x 17Y1• ,S / (� Owner's Name: nPI e Date of Application: f 6, I hereby certify that: Registration is not required for the following reason(s): E]Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner 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 hereb applyfor a permit as the agent ofthe owner: ® �!i@� Date Contractor.Name Registration No. OR Date Owner's Name The Commonwealth of Massachusetts Department of Industrial Accidents Office of/nsestigations . 600 Washington Street " s s Boston,Mass. 02111 Workers' Co m ensation Insurance Affidavit name: location: city phone# - ❑ I am a homeowner performing all work myself. ❑ ,I am a sole r *etor and have no one worlds in ca acity VNI ^�am an employer.providin work s' compensation for my mpI gees•working on this job..: ::::::::::•...:..:................ .......;;:.;:.; . .. aom an' :.: .: . . ..r•.. .. ..- ............ ... ..... ......:...:.:::......::....... -K •.::.:..::: X: : ......:::.:.. ......... r may. -ista':'�'`•':-:?:>.:'+'+i!tv;<�i:+� '.'�::�:4:5•isv::,visit:•itivi:;::j::�`v:J:•i::::::?:::�'::is`;:::)i:!C??i::•i'''4:;: :�::w:: .. ar•1� �:i�>%'''.."°`>`:i;i`� :ii�i:; �> .. ;.-�' ii;: �•:;i;i�iiii;i`?i`ii'`S �-�'�I:fll�le'� :::•:�"'::,',??:'>:;r;...: ;.�"'ipiiiEc�''.:i'��.•.:'?'••..........i•::::..,.::.....�::::::;:: yi!!'!'F'�;F.::` t::`�.: ;:{:; :;;sr :? :: : ..... ::'::%? :.:=>r:::?::';;;?';: d: :: :a: :a?:::' '•;:y`::':: .' ::%% :: 5;:::''?'?'.'•���',•'2': :`: : .................... .......... .......... ............ ❑ I.am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: ................... ............................................................ :?.,>:.::.:-::•::•:>'.::,..•::::::::•-:::::::: ,..:.......................:....... .:............-:........................................,•:.:::.;:..;,. _ ...... ,...,:,-::`:;;:;:<4..,•:.a?f:try....;:+::•:,:+..:. :::::_w:.:::.... ..::::.�.�._::v:•::::•.:::::v:::::::::::.::::.::: :::::.:::::::...:..:......................... ................................................................ i+�>:•'isi:?isi:::�ii:tiv:::.;�}istiLi::^iswn::..:::::::::::::::::.:::.:.::::::•::.:v::•:.�::•..:.: : :::.�::::::•::n�::w::::-�::.::':::::n:�::: ++•'l::•�i:+;:•'•:K;•:;^iiiiiiiii:3:t•i:;:;-?iiii:i:•i:�?i;-ii:;;;-ii:-i?i'+%•...:�::::::::+n�:::::::•:;L:•:f:is�:4ii:4?i,iii:{;;�iii::.:.:if4i:i•i>�ii'ti4iii'•••;.••:is i::ii: .•..::�w::::.........•. ...................................................................:...v:.:::+i:::-.:.... ;.•i:^:vh:;i::•iiiiii:ti;Ci}?:is:.:v ........._ r.:................ :r............................. ...................................Y v:::::::::•. j{...............,...........v::.�::.::,....r.::.�:.:::.:.:::::::::::::.v!.•1:•ri...U..)wM.+:?i:•::•i:-::: ., �. .:•.�:::::::.:::v:.�::.:�:::::::.::::...........................:::::::::::v:.�:::::::::::...................................... Q�'..:M'ii:6:;�iiiiiii}iii::ti•i:;•ii}:;;•?ii}iiiiiii:4:•i:%:•i:;•isv;;<.:•ii:•ii:v.......,............................ ..................... ::•:::::::v:::::::::................ ................... ..... ............... ....... . t iii:isij:..:?{::'i:::::v:::>::::}{: ���:?::;(�:';';rj;?r:<::;:i;;:: :;:�:?i:: �i:�i:::i?i:':;•:�ii::::is'isi:;:i':;:•�i:�i::vj::;•:::<j::::4:i::+:::%: ::`�i s�::is�i'I.��'..'i?:'r:::i:::is:•`iii:[;r.j�: ?.....': !i�::;::.:iii:�::vi:T'::ii s•'i::::::::::.:::.�:: t'� •.'•r'I:f ''>`i � ''"�2i:'i:%'i%'%?•'• •:`• aii;i?, ` 3?���E#`=-Sic%';+•,. , �n�UTof f `:i ;'::;; :::;:::::.::.�:::::::moo.•::::::•:::::.::;;: Fafiure to secure covers;e as required ender Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification . --—7 do hereby certifyunder thepains and- enalties of perjury that-the-information pr-a ded_abnv issr_ue andcor.ecG__._._.._____ Signature Date ` !�3 Print name r o Phone official use only do not write in this area to be completed by city or town official city or town: permit/license# OBufiding DepartmentJ ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office _❑HealthDepartment contact person: phone#; ❑Other (raised 9/95 NA) „' Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits 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 y_ou are require06 obtain a workers compensation policy,please cO the Department at'the'number listed below:. City.or Towns ' Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom`of`tfie 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 permitlhcense number which willbe used as a reference aw6er..'Ili�aff davits may�6'retiunedyt the Department by.mail or FAX unless other arrangements have been made: The Office of Investigations would like to thank you in advance for you 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 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 �2�z�rac�a?uae� i B:OsARU OFB_UILDINREGULATIO:NS i icense:'CONSTRUCTION SUPERVISOR. Number. St 0751161 �rthrfa 960 rX5- �81Q( t Tr.no: 4760 e 4V �p BRIAN'P MCFADEI t ' _ 95 AGAWAfM LAKE�FO`'I ! WApREHAM, MA 02 l Administrator 3CiVl :9 Jt3� Q -{ANT Q40 Ac 'egisEatract °>35679 Eztrac. f?74 P'* Bite Corporatica STRA`3HTLINE CRe s- TF�uc--T40 1 95 AGAWAM-LAKE=3F{ME Ds; 2� .; t aLs g.�� d�'k i�-kk'ik 'P " � •*x. i ��� .�e; ��5��.`� t#'��.'v�L� ` � �� DdY ` !'ae�, ti -� D D ^bt (��lw rJ1 uFV UL cci z a,t s`r x �,� •f t P. . a�� , a ^4W, v k 4 Da � JOY ro�"R° � yC � .4 •4ta r _� °F �a��.� ter, - � >^;�r, ',; x.t3 ,�»y;�yF�;.3�+ w S ��y,�vy i`"�'y s.�e f•'u x"+����+" ..,r�§�,�t��e•t fr� MPH w, IOMI o � r dl.T iv �•*,+M`�.1«�-: a D iKDDDD l' s ?VOQ ,. J ] J,�V�����2 D011 G� D l p G L� D GI t I D C C r t ° vv C �� C C �� C .._. _ r mo EPE Q.kk 1� ' ^� ,.OW:Koo T J�V��4�`�l/"\lam � c € Iff �,' •.,4,'>�� .��rw�i+ '''_.. r'. ,.x"tra. 1 D lu U U l 0 DOy U.51_4)w'w�`'LO�� ��'' •fie' ' -A C;:8 7 Barnstable Assessing Search Results Page 1 of 2 q O NRNST,W Home: Departments:Assessors Division: Property Assessment Search Results <<back to search 181 SEA STREET Owner: GERAIGERY,ANNETTE M TR Property Sketch Legend Map/Parcel/Parcel Extension 307 /044/ Mailing Address . GERAIGERY,ANNETTE M TR 13 FOLEY DRIVE N READING, MA.01864 ' r33ih1 Assessed Values: Appraised Value Assessed Value is Building Value: $72,300 $72,300 Extra Features: $2,300 $2,300 Outbuildings: $0 $0 Land Value: $38,000 $38,000 Interactive Property Map: ap requires Plug in: Totals:$ 112,600 $ 112,600 I have visited the maps before Show Me The April 2001 photos available .,. Sales History: Owner: Sale Date Book/Page: Sale Price: GERAIGERY,ANNETTE M TR 4/15/1996 10173001 $ 1 GERAIGERY,ANNETTE M 10/15/1985 4754/113 $ 1 GERAIGERY,ANNETTE M 7/15/1985 4646/164 $ 1 GERAIGERY,ANNETTE M 7/15/1985 4646/164 $ 1 KEATING, LORRAINE TRS 1/15/1985 4381/242 $ 1 GERAIGERY,ANNETTE 2776/ 107 $0 Tax lnFormation: - Tax Rates: (per$1,000 of valuation) Town Tax $ 1,058.44 Town Fire District Rates Other Rates 9.40 Barnstable 2.88 Land Bank 3%of Town Tax Hyannis FD Tax $325.41 C.O.M.M. 1.54 Cotuit 1.88 http://www.town.barnstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 5/2/2003 Barnstable Assessing Search Results Page 2 of 2 Land Bank Tax $31.75 Hyannis 2.89 West Barnstable 1.96 Total: $ 1,415.60 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.69 Year Built 1870 Appraised Value $38,000 Living Area 1357 Assessed Value $38,000 Replacement Cost$96,364 Depreciation 25 Building Value 72,300 Construction Details Style Conventional Interior Floors CarpetPine/Soft Wood Model Residential Interior Walls PlasteredPlywood Panel Grade Average Grade Heat Fuel Gas Stories 1 Story F A Heat Type Hot Air Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 4 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 1 Bathroom Total Rooms 6 Rooms Extra Building Features Code Description Units/SO ft Appraised Value Assessed Value FPL1 Fireplace 1 $2,300 $2,300 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.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A.... 5/2/2003 °FtKKE r Town of Barnstable Regulatory Services • BARNSTABLE, • MASS. Thomas F.Geiler,Director .i63939 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must.Complete and Sign This Section If Using A Builder I, as Owner of the subject property ro e _ P rty hereby ° ' authorize �c. � .� to act on my behalf, in all matters relative to work authorized bythis b ding permit application for(address of job) Mgnature o Owner ate A", Tint Name t tZ"4+'"`` ` t '�. ,1 okay,�•� � '� 1 ..-. ri R ..W 4 Z. oo vwwr _ �- 'Lo ire f f I i yy room AL ) _ Ndel 40 u jr vo -- y J: ..- colt! -•wJ�� w ,. Y F�._. �r_ •• :_ .,� _..,.. _ .:_ - - n y l , y _ -- — — +r J M d j f -LO - ! �. C .� a 1 N 1 ' M -t rYP to c ''� (49