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0342 SEA STREET
I 4 i^ 11 CO •. • IN Iru r%-- 0 —_ `!L 1 Ln Wtified Mail Fee j r- Extra Services&Fees(check bar,add fee as appropriate)!? \ ElReturn Receipt(hardcopy) $ 0 ❑Return Receipt(electronic) $ Postma)',I,Certified Mail Restricted Delivery $ . Here � ❑Adult Signature Required $ ❑Adult Signature Restricted Delivery$C3PostageTotal Postage and Feesrq O Stheet and Apt.No.,or POB y/ ----------------- -O/---o---N---�a-- City,State,Z4 -s--- -- _ --a--�---------------------=--- :rr r rr rrr• Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mallplece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(Including the recipient's retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent. Important Reminders. Adult signature service,which requires ttie ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years Qf age International mail. y and provides delivery to the addressee specified ■Insurance coverage Is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retaiq. of Certified Mail service does not:change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. " USPS postmark.If you would like a postmark on ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail Rem at a Post Office'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece., electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records. Ps For,3800,April 2015(Reverse)PSN 7530-02-000.9047 3y,� S'e�sf V�yQnn�s I USPS TRACKING# EPe lassMail e&Fees PaidUSP No.G=10 I E9590 9402 3630 7305 4658 59 United States •Sender:Please print'your name,address,and ZIP+4®in this box- Postal Service TOWN OF BARNS'TABLE BUILDING DIVISION ' 200-MAIN S'T. HYANNIS, A 02601 COMPLETESIENDMI •N COMPLETE THIS SECriONON DELIVERY, ■ Complete items 1,2,and 3. A Signat6rre/` � p Agent j ■ Print your name and address on the reverse X O Addressee so that we can return the card to you. ■ Attach this card to the back of the mailpiece, B. Re.c v d by(Printed Name) C.Date of Delivery or on the front if space permits. ` � 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,'enter delivery address below: p No lia lie ►�tC�l�u� f �� �3�D I II 3. Service Type ❑RegiteredMJITIA ® 0 Adult Signature 0 Registered MaiITM ❑Adult Signature Restricted Delivery 0 Registered Mail Restricted ❑Certified Mail® Delivery 9590 9402 3630 7305 4658 59' Certified Mail Restricted Delivery `p Return Re eptfor Collect on.Delivery 2. Article Number.((ransfer from service labs fl Collect on Delivery Restricted Delivery O Signature ConfirmatlonTM r- --- ;;.• . tilail ❑Signature Confirmation 7 D 1'7 1`0 D 0 0 0 0 0 6 7 5 7 2 5`8 4 f i,i Oil Restricted Delivery Restricted Delivery j PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt i p2o pF sow 4 of tNe ro * � ' Printed On 12/5/2019 CQrnplairt Ca�lt Report a , �44* 4 Pam^ aAA RNiSTAB LP\- - k 1 M ,.60 YA� NS342,SEA STRE ET § M CaSBC. 199- , 2vv A,N Case#: C-19-442 Address: 342 SEA STREET, HYANNIS Date: 5/22/2019 Owner Info: Property Info: VENTURA 5 REALTY LLC MBL 314 MAIN STREET UNIT 103 306-203-003 WILMINGTON MA 01887 Owner Notified?: Complaint Details: Type of Complaint Classification of Complaint Method of Complaint Building Code, Medium Priority' Dept-Referral Complaint Summary: Property transfer identified finished area (no permits) furnished as a bedrooms (possible 2 bedrooms) Egress is deficient. Ordered on 3/14/18 to removed all un-permitted work or obtain permits. Notice of violation sent to Gary Strysko &Thomas Linhares (record owners at the time). No action to rectify the matter occurred. On this date (5/22119) new,owner came in and stated FD said to just remove beds and they problem solved so now new owner believes matter is rectified. Action History: Action Taken Date Description Fee Inspector Close Case 12/5/2019 Violation resolved and $0.00 lauzonj case closed. Inspector Assigned to Complaint: lauzonj Filed by. andersor Comments: Comment Date Commenter Comment 5/22/2019 andersor Assigned to Jeff L as he issued original Notice of Violaiton., � 14 x 12/5/2019 P, x ,, � Townof Barnstable,, Date �oFt"El°, Town of Barnstable Inspectional Services RARNMB`teMAS& a Brian Florence,CBO i639•,,& Building Commissioner ifMA'S 200 Main.Street,Hyannis,MA 02601 www.town.barnstable.ma.us INSPECTION REPORT Address : 342 SEA STREET, HYANNIS Case # C-19-442 Inspection Type : Violation Inspector : lauzonj Description Date W___.. Unit � Status Comment Violation 12/05/2019 PASS 11/5/19 Sent notice of violation to new owners Susan and Michael Carman. 11/14/19 Michael Carman applied for and received a building permit for a sitting room and and a television room in the basement. 11/15/19 Local Inspector Robert McKechnie did a final inspection and the inspection passed. 12/5/19 The violation has been resolved and this case will be closed. Town of Barnstable �nx mwwao� Post This"Card`So That it is Visible From'the Street=Approded Plans'`Must lie Retained on Job and this Card Must be Kept sted UntilTinaltlnspection�Has Been MadeJP6Permit g .� Wherea Certificate of Occu anc is Re wired,such Buildm shall Not be Occupied until a Final Inspection has been made ` un r _�. p Y q Permit No. B-19-3841 Applicant Name: VENTURA 5 REALTY.LLC Approvals Date Issued: 11/14/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 05/14/2020 Foundation: Residential Map/Lot 306-203-003 Zoning District: RB Sheathing: Location: 342 SEA STREET, HYANNIS t ' Contractor Name: Framing: 1 Owner on Record: VENTURA 5 REALTY LLC Contractor License: 2 Address: 9 FERNWOOD LANE Est. Project Cost: $0.00 Chimney: BINGHAMTON, NY 13901 :" Permit Fee: $85.00 Description: No work is require. Prior owner used the basement room as a � Insulation: p q � � ,.Fee Paid:,' S 85.00 bedroom.As trhe current owner my use of the space is as a sitting Date.°a 11/14/2019 Final: room.The application is to permit the space only , Project Review Req: j �*�l��=—� Plumbing/Gas n Rough Plumbing:Rh Plumb•n : Building Official This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within.six months afterrissuance. Final Plumbing: All work authorized by this permit shall conform to the approved application and the°approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. i t Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work ;• Service: 1.Foundation or Footing 2.Sheathing Inspection - Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining'is-installed .,..;` 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: �� Building plans are to be available on site Fire Department �CZ, c All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: > Application Number..................`.. �sT . : 3o 13 0 . � oa MA88. g Permrt Fee. .::.......................Other Fee:......................16396. `3' TotalFee Paid................................................................ ...... TOWN OF BARNSTABLE e,,..amW by... .......... ` .....On...�!,l:.YA t..BUILDING PERMIT Map...............V/...................Parcel.................................. .......... APPLICATION f Section 1 — Owner's Information and Project Location Prqj ect Address-' Village ' Owners Name h I c 46i e S�c e, Ci ram, 4 P1 Owners Legal Address F r d dJ L P , � ✓v �" ;1 ' City ti =o State �/ Zip S Owners Cell# / 7 -Ay 0— 0 COT-j E-mail vL, is 4 Section 2 —Use of Structure I Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3 — Type of Permit` ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation Other Specify Section 4 - Work Description z �a a . r d e 3 heQlm4 , "Ub/no r V. ,�,. ,;4 V e Last updated: 11/15/2018 Application Number.................................................... Section 5 Detail -$0Cost of Proposed Constructions _ rSquare Footage of Project Age of Structure =, Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑"MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring " ` ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private ti i Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No F Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 Application Number........................................... Section 9- Construction Supervisor Name Telephone Number Address City State Zip License Number License Type Expiration Date Contractors Email Cell # , • ®° I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date, . Section 10—Home Improvement Contractor Name Telephone Number r Address _City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C:.. Signature Date Section 11 —Home Owners License Exemption Home Owners Name: !' ���Q S� s�,� rn., 'C7 A7 Telephone Number Cell or Work Number 617—avp —cbo5_ I understand my.responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required b 78 and the Town of Barnstable. Signature Date l/ `I` d/q APPLICANT SIGNATURE ISignature - Date // iz-i act 9 'Print Name �/� �� -P�,R:Z„� Telephone Number G/ bE-mail permit to: Last updated: 11/15/2018 Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13 —Owner's Authorization a as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: ' (Address of job) `j Signature of Owner date Print Name Last updated: 11/15/2018 342 Sea Street, Hyannis, MA - T4.WW Of,PARS,TA �.. ; first Floor 2J19 NOV !4 PM 3- 55 MBR a ;. II Bath MBR Closet 61VISION Laundry f • Deck Master Bedroom g O Dining Room Kitchen Library PaCil! ii f r fX _J Living Room Bedroom 3 1 Bedroom 2 �' x -342 Sea Street, Hyannis, NIA Basement C Unfinished Basement Area Storage Bulkhead Closet Up HVAC • V r' 6 ICI M, H 20 ,, I Tank Sitting Room Television Room v'--- (Finished Area) (Finished Area) D ,. 4 The Commonwealth of Massachusetts'_ Department of IndustrWAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians&lumbers Applicant Information Please Print Legibly "� Name(Business/Organization/Individual): ft� Lo a rryi c+rt _ Address: 5 a City/State/Zip: 1V_ g h ti :'r one#: �l7- aZ Gt - CrO d.5 Are you an employer?Cifeck the appropriate bog: Type of project(required): 1.❑ I am a employer with. 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. []New construction 2.❑ I am a sole proprietor or partner- - listed on the attached sheet 7. ❑Remodeling ship and have no employees These subcontractors have g• Demolition workingfor me in an aci employees and have workers' Y capacity. t 9. El Building addition [No workers'comp.insurance comp.insurance. r9qu1 . 5. We are a corporation and its 10.0 Electrical repairs or additions ir 3.Ell am a homeowner doing all work officers have exercised their 11.Q Plumbing repairs or additions m right of exemption per MGL myself[No workers'comp. 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 hue outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: ' Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce, "ep ' and penalties of perjury that the information provided above is true and correct Sianstore: Date: // e/ Phone# �/ 7 — q 0 COOS— 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 joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into an contract for the performance of public work until table evidence of compliance with the insurance Y P P acceptable P 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-contactor(s)name(s),address(es)and phone numbers)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 requu ed to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for firhrre 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 lilce to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents'. Office of Investigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 4.06 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mm.gov/dia Town of Barnstable tHE T Building Department Services Brian Florence CBO BARNSTABLE, BAMSTABLE N1Ass. Building Commissioner ��S�n^E W TOU �O 1639- 1639_2014 �Fp MA'S A 200 Main Street, Hyannis, MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 MEMO Susan M & Michael J Carman, Please find enclosed a copy of the original Notice of Violation to the prior property owners at 342 Sea Street. I have also enclosed a current Notice of Violation and look forward to working with you to bring the matter to a successful resolution. Thank you for your anticipated cooperation: Jre_eLlauzon Chief Local Inspector (508) 862-4034 Jeffrey.lauzon@town.barnstab le.ma.-us Town of Barnstable Building Department Services Brian Florence, CBO ,�a ru . Building Commissioner BARNSTABLE 200 Main Street Hyannis, MA 02601 �J MCA510"S.MILLS•OSiERV111F•Wi51 NANSRBtE � J � -1639.2014 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Notice of Building Code Violation(s) and Order to Cease, Desist and Abate: Susan M and Michael J Carman and all persons having notice of this order: As property owner or tenant of the property located at 342 Sea Street, Assessors Map 306 Parcel 203-003 and known as residential structure,you are hereby notified that you are in violation of 780 CMR,the Massachusetts State Building Code Chapter 1 Section R105.1, and are ORDERED this date 11/5/2019 to: CEASE AND DESIST all functions associated with the following violation(s) on or at the above mentioned premises: Summary of Violation: On 3/6/2018the Building Department was made aware of a violation of 780 CMR of the Massachusetts State Building Code Chapter 1 Section R105.1 and Chapter 1 Section R310.2.1 Specifically, bedroom(s)created in the basement without the benefit of a building permit and with inadequate emergency escape. Summary of Action to Abate Violation: In order to abate this violation and to avoid further enforcement action by this office, commence immediately upon receipt of this notice the following action: cease use associated with the violation and commence with obtaining the proper approvals and permits to either: 1)remove all unpermitted work or; 2)finish the space in the basement to that of an approved use. And, if aggrieved by this notice and order;to show cause as to why you should not be required abate the violation in this notice,you may file a Notice of Appeal(specifying the grounds thereof) with the State Building Code Appeals Board within(45)days of the receipt of this order and in accordance with MGL c. 143 § 100. If, at the expiration of the time allowed,action to abate this violation has not commenced, further action as the law requires may be taken. By Order, ) r L. Lauzon • Chief Local Inspector (508) 862-4034 Jeffrey.lauzon@town.barnstable.ma.us 0 Ln -o o- OFFICIAL U Ln Certified Mail Fee $ Extra Services&Fees(check box,add fee as appropriate) �k s a [I Return Receipt(hardcopy) $ 0 ❑Return Receipt(electronic) $ ,�� Postmark O � O ❑Certified Mail Restricted Delivery $ Hera 1 O ❑Adult Signature Required $_ ❑Adult Signature Restricted Delivery$ a p Postage O $ 0 Total Postage and Fees f,g $ v h Sent To rq O Street and t.No.yor Pb ox IVo. ---- ------ // C`- Ciry;"Stall ® "> 4_,ST �j- Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for nd additioaal fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate.,__ signature)that is retained by the Postal Service' Restricted delivery service,w` th provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders: Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mall. and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a. certain Priority Mail items. USPS postmark.If you would like a postmark on ■For an additional fee,and with a proper this Certified Mail receipt,please present your —• endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion. of delivery(including the recipient's signature). of this label,affix it to the mailplece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.for a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTAN7:Save this receipt for your records. PS Form 3800,April 2015(Reverse)PSN 7530-02-000-9047 Town of Barnstable �.: Building Department Services Brian Florence, CBO Building Commissioner BARNSTABLE. 200 Main Street H annis MA 02661 �°"""�° ' -2024 w "" �J nt4":OxS M]Lti•W�IRTIl•GiSTDfP.'C:AAIL � J � 1634-]OIq 57 www.town.barnstable.ma.us � Office: 508-862-4038 Fax: 508-790-6230 Notice of Building Code Violation(s) and Order to Cease, Desist and Abate: Gary M. Strysko,Thomas J Linhares and all persons having notice of this order: As property owner or tenant of the property located at 342 Sea Street,Assessors Map 306 Parcel 203-003 and known as residential structure,you are hereby notified that you are in violation of 780 CMR,the Massachusetts State Building Code Chapter 1 Section R105.1, and are ORDERED this date 3/14/2018 to: CEASE AND DESIST all functions associated with the following violation(s) on or at the above mentioned premises: Summary of Violation: On 3/6/2018the Building Department was made aware of a violation of 780 CMR of the Massachusetts State Building Code Chapter 1 Section R105.1 and Chapter 1 Section R310.2.1 Specifically, bedrooms)created in the basement without the benefit of a building permit and with inadequate emergency escape. Summary of Action to Abate Violation: In order to abate this violation and to avoid further enforcement action by this office,commence immediately upon receipt of this notice the following action: cease use associated with the violation and commence with obtaining the proper approvals and permits to either: 1)remove all unpermitted work or; 2)finish the space in the basement to that of an approved use. And, if aggrieved by this notice and order;to show cause as to why you should not be required abate the violation in this notice,you may file a Notice of Appeal(specifying the grounds thereof) with the State Building Code Appeals Board within(45)days of the receipt of this order and in accordance with MGL c. 143 § 100. If, at the expiration of the time allowed, action to abate this violation has not commenced,further action as the law requires may be taken. By Order, r " L.Lauzon Chief Local Inspector (508) 862-4034 Jeffrey.lauzon@town.barnstable.ma.us Date: March 20, 2018 To: Building File RE: Un-permitted/Unsafe Bedrooms/No Permit Address: 342 Sea St, Hyannis Originator: Unknown Complaint: Created unsafe bedroom/work without permits Enforcement Process Steps 1. Initiate local investigation: Jeff 13 2. Document/enter,into system Yes 13 3. Contact 13 4. Property Owner Gary Strysko,Thomas Linehares 5. Seek access to subject property 6. Seek administrative warrant (if necessary) NA 7. Notify state authorities of findings NA 13 8. Document conclusion Open 9. Referred Building 10. Stop Work/Cease & Desist Order Yes-3/14/2018 - Property Property is developed with a SF ranch containing 3 bedrooms and 2 baths (1984)on 0.33 acre located in the RF-1 zone. 3/14/2018 Chief Local Lauzon issued a notice of violation and a cease&desist order after determining work was done without permits and approvals for bedroom(s) in the basement. Bedrooms(s)found to be lacking required emergency escape provisions. Ordered on 3/14/18 to remove all unpermitted work or obtain approvals necessary to finish space in accordance with what is allowed. x k 2G, 190 0 Fe � r :,r^+s� i, •i 7- Posero 34-9 7 fr' i$p 7 Lq. a. .71 71 _ Alf y } r ' , , r•t. '{. '4 + Z s 1 e 'h !� CERTIFIED PLOT PLAN 4 ` Gila-T`"�:q S��'# S'T, NEW CONSTRUCTION ONLY 4 ' ` BRuc� /q $� i::rlP #`T r , T` b �. ' TOP OF FOU N O ATI O'N I N,�S._,..,.;,.,�'EE � ` _ `- •- ABOVE LOW .POINT OF' ADJACENT � �a6i ._� � �� � � 2.0 R 0 AD.. $`CALE�::�,/_3 D� _ DATE 3 L D D E ENG EE JNG C .IN C1LI6MTk° ...�, I `,C ERTIFY THAT THE �,unvA7 i o E41STE RE419 ED y k° M0.WN `ON ; THIS ` PLAN.. IS :'LOCATEp # 5 :THEE BROUND As INDICATED ANO CIVIL . LAND a r �, '�rONRdRM3= T0. THE ZONING LAWB ENGINEER ' $URVEYdRf , Y ��s � QR 4ARNSTABLE, Mas 712 MAIN STREET H AN I'S MASS . �t �lM�' tp a ` ATE RE.3. 'LAQ�D s:t�RVI:Y. R ; 4 s, s -y \ Q - 6 �I A a P&,uo�o i L 0 T Z �1 FQv-7 E D �Uf/NO/d T[n/✓ � O Q sEwee 0 EL-. o DRcaascRV UNE i.tiE@r Ar N PQoFa�ED 3 BCfQM. a, / !' fouND (lON c'l.'2'1.5! IyvJ.L'LLNIJ I . 3 �wca, eL. 19 v, T_ - 64't w Z PDoa��eD i wee u.lE M our IInn Y' 6y U.: ZJ ri L 0 t � - I"xD, F1 LEGEND CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION 00. S0 Of EXISTING CONTOUR --- 0 - = - � y v C ,� .�+ ._ _. FINISHED SPOT ELEVATION FINISHED CONTOUR - 0 _ --- ---_---._--.- -........... FLUB y I N APPROVED = BOARD OF HEALTH4�0 ����,, .� � DATE ---.._-._ AGENT SCALE' / = 3 v DATE : G lELOREOGE ENGINEERING CO. IN CLIENT S^"''` " I CERTIFY THAT THE PROPOSED E E diS-fE-O-E-ld REGISTERED JOB NO. 93 y` BUILDING SHOWN ON THIS PLAN CIVIL LAND r ,, CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR.BYt f? ' � ' OF ;BARNSTABLE , MASS.. 712 MAIN STREET. CH. BY= J .Tz. C . _ HYANNIS, MASS. SHEET-/ OF / DATE ' RAG. LAND SURVEYOR :.FROM - - - -. - 7OWN OF BARNSTABL E Mr'L Francis Me ne BUILEIING DEPARTMENT Town Clerk 367 MAIN STREET H YANN S, MA. 028M Phone..776-1120 SUBJECT: FOLD HERE DATE July•3, 1984 MESSAGE j Work.has -been eampleted uunder' ending Permit 25$14 (Capricorn Realty Trust)-' Please release Bond. .. .. SIGNED .-DATE: - �(/'�.... \ REPLY • ` t. t r ' S,%. - .. F.P - • :. ,. . - t • fie+ - • - r. .. ` 4# TOWN OF BARNSTABLE Permit No. _._-25814 - 17Mn= Building Inspector : . Cash Ma - - — — 1639. gal OCCUPANCY PERMIT Bond _-_-_-_. _- Issued to r1C�= Raajjjy Tt-1g i-. - Address 1A)t 2A, 342`$ea Street, -Hy,arw.is _ Wiring Inspector a.�/ �„� Inspection date _7/ +1 L/ Plumbing Inspecto f � '"? ..;- Inspection date . Gas Inspector Inspection date 1 Engineering Department ,. Inspection date7. Board_of-Health Inspection date 713A? - a p THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUIqILDING CODE.17 / .......w_, _ ... d Building Inspector f Hyannis Fire Department (MA) 95 High School Road Hyannis, MA 02601 ° Fire Dept Violation Notice March 6, 2018 RESIDENCE 342 SEA STREET Hyannis, MA 02601 An inspection of your facility on Mar 6, 2018 revealed the violations listed below. ORDER TO COMPLY: Since these conditions are contrary to law, you must correct them upon receipt of this notice. An inspection to determine compliance with this Notice will be conducted on Mar 6, 2018. If you fail to comply with this notice before the reinspection,date listed, you may be liable for the penalties provided for by law for such violations. Violations 148-SECT 26F Failure to meet code for smokes and CO Note Basement detector had no power to it. 780 CMR 1025.1 Failure to provide cellar sleeping emerg. egress Note Basement has a bedroom with no egress. 31.01 Failure to comply Note Same as above, no power to the combo unit. -1.03(2) Report of violations to other code jurisdictions } Note Second finished room in basement has what appears to be a day bed in it. Inspection Note Town of Barnstable Building Department made aware of situation. 199002 Thomas Lanman X Inspector BLDG DEPT. ' '::' 200 MAIN ST. U.S.POSTAGE)PITNEv® HYANNIS,MA.02601 w f 6: . 1 �• ZIP 02601 $ 00&670 7017 1000 0000 6759 6504 0240 ` `.._0000336455MAR. 16. 2018 Gary M.Strysko Thomas J.Linhares 342 Sea Street Hyannis,Ma. X T i RETURN TO SENDER 4 L.NCILAIMFD t UNABLE TO PORWARD B UNC SC' 02601-400200 = 0 22 - 0Z�3Z-� >3-36 —50* i Town of Barnstable 200 Main Street U.S.POSTAGE'>PiTNEv 80WES Hyannis,MA 02601 ! ®® ®�®p r., 00 0336455A�®®s�C18. STRYSKO, GARY M &LINHARES,THOMAS J 9 FERNWOOD LANE BINGHAMTON, NY 13901 i YY � A 8k- 31138 P:9163 BARNSTABLE COUNTY EXCISE TAX L-"13--16-2018 1O m 33c. BARNSTABLE COUNTY REGISTRY OF DEEDS Rate: 03-16-2013 r) 10:33an CtIA: 274 Doct; 19.941. Fee: $17499.40 Cans: $4901000.00 NOT NOT NOT NOT jl AN AN AN SAGHUSETTS STATE EXCISE TAX -SIABIE COUNTY REGISTRY OF REEKS OFFICIAL OFFICIAL OFFICIAL OFF 3-16-2018 a 10:33am COPY COPY COPY CQRM: 274 Day r: 11941 Fee: $1,675.80 Cons: 4490,000.00 NOT NOT NOT NOT AN AN AN AN OFFICIAL OFFICIQ1TdETkWbtEDOFFICIAL COPY COPY COPY COPY NOX KNOW ALL AM BY THERkRESENTS,&t We,GarryA*.Strysko and Thomas J.Linhares, a married cq6plla,I pf 4: egCSf)&arix*V usebE;I' gjderation of Four Hundred Ninety Thousadftllars AN 100 ($49( 0)grant VNighael J.Carman and Susan M " NCarman,husband and wife as Tenants by the Entirety, of 9 Fernwood Lane,Binghamton,NY 13901 o NOT NOT NOT NOT AN AN �. OFFICIAL OFFICIAL OFFMLQUIO' O COVENANTS ai COPY COPY COPY COPY (0 The land together OT th any buildings thereonOT �Osituated in Barnstable (Hyannis), Barnstable c County,M saen as boundedN��n��d described qe�,'�llow L KN `�N' s AN m I I O IAA I L OFFICIAL , WES Sea L ub� sho lan ereinafter referred to P sixty-nine and 59/100(69.59)feet, NOT NOT L . a.+ M NORTHPCY, NORTHIKKSTERLY, 1,WTHERLYN & NORTHEASTERLY; By Lot 1 16UAi,on WSplddfy fb0FdbD0bA ,tot9M0Uh£one hundred sixty-four . and 8 1 A WI 4.81)feetCOPY COPY COPY EASTERLY by.Lot 3A, as shown on said plan, eighty-seven and 69/100 (87.69) feet; and Q SOUTHERLY AND SOUTHWESTERLY again by Lot 3A, as shown on said plan, by two courses a total distance of one hundred fifty-six and 47/100(156.47)feet. a o Being shown as Lot 2A and containing 14,325 square feet of land on a "Plan of Land in CL Hyannis, Barnstable, Mass. For Franco Real Estate drawn by A.A.M. checked by R.B.E. Date: May 3, 1983 Scale: 1 in. = 30 ft., Eldredge Engineering Co., Inc. Reg. Civil Engineers & Surveyors, 712 Main Street, Hyannis, Mass.", which said plan is duly recorded with the Barnstable County Registry of Deeds,Plan Book 375,Page 12. Bk 31138 Pg164 #11941 NOT NOT NOT NOT AN AN AN AN OFFICIAL OFFICIAL OFFICIAL OFFICIAL COPY COPY COPY COPY NOT NOT NOT NOT For Grantor's titFaltee the deed Mm Russell RAUporte and K&Meen P. Laporte, recorded in the BarnstabQMJaf egisT1FyFb1Dj&js in 99MM4$4,at W DIAL COPY COPY COPY COPY We, Gary M. S4 and ThomaV . inhares; he release an c mate any and all estates of homestead ' pVeeagn e JK eth�x utomatically pursuant to Massachuse %� y e re�iy statjC r Me pains and penalties of perjury that there are no other persons entitled to an estate of homestead pursuant to M.G.L.c. 188. NOT NOT NOT NOT AN AN AN AN OFFICIAL OFFICIAL OFFICIAL OFFICIAL COPY COPY COPY COPY NOT NOT NOT NOT AN AN AN AN OFFICIAL OFFICIAL OFFICIAL OFFICIAL (SIGk RE(S)/A bWLEGE I*T(S)ON FRIOWING PAGE] NOT NOT NOT NOT AN AN AN AN OFFICIAL OFFICIAL OFFICIAL OFFICIAL COPY COPY COPY COPY M o �- i Bk 31138 Pg165 #11941 VO'� T T /I � NOT Witness my handseal this + day of c�A fig, OFFICIAL OFFICIAL OFFF�AKEN OFFICI COPY COPY PY COPY NOT NOT AN AN G Strysk N OFFICIAL OFFICIAL OFF AL OF COPY COPY Thomas J.Li res NOT NOT NOT NOT AN AN AN AN OFF I C I K9MN@ LTRV]F(DIA$SA�YACS Barnstable, ss COPY COPY COPY COPY NOT NOT NOT NOT On theda o$tN N1 A,�►,c 1-IAN me,the undersigned notary public, rys maV pe°OF�FI y ppeared and proved to me through satis c evidence o i entification,w ich was a driver's license to be the person(s)whose laf&jes are signeo@�the precedW document a}?*gcknowledged to me that they signed it voluntarilXpr its stated pMose. AN AN OFFICIAL OFFICIAL OFFICIAL OFFIC COPY COPY COPY Y Nnm�ny, I� O( NOT NO Notary Pu 4��•• N �Fy AN ANMM��Co1HL Tres: s f�� .i ICIAL OFFICIAL p 2^'a�- :a �¢ PY COPY COPY ����nuttuu►►a►► BARNSTABL.E REGISTRY OFDEEDS John F. Meade, Register RE City; Address, S h 51 A, htv'�f -' 342 Sea St 49%906 .3 j Barnstable,MA 02601 Listed at Pride, Fled, Status:Contm,g eit. Ri dfin'. sti iate: Overview Frvprtyetaii `our,lraiht5 Fed fin tirr� t& r+opry Histry: m . �• . fA vw �9 f ; R F { t Z � rn 844-759-77,32, p �6q..F y �Oth§ + 6 /Sq Ft Y P blic facts Schc Lisa Keller 4+ Redf h I 17 OWL,: n i .a b q - 1 a ,r � I 77 ic a PW i . It b pp � � � _ _ JG _ �'—. -.�,, _. ..�� .. o ��. _ _ . . L` Wt t I d v , ` r i y { a k 1 4 Y r s n- '�* � ram• �} �f. i %' '6 ^ s i� { 11�e!t _. w� ou the FRIDAY 000, MAC Ranch Hyannis it"S free,wil Z1715904 ).33 acres including exceptional interior and exterior living spaces. This home Will provide y dntine reading v Stories 1 StyIe Property Type dingle Farrlily : Community Residence ou!I ty Barnstable MLS# s Built 184 Lot Size ! , ,� , Majp Satel[it Ass a and lot number Y °7171 p .... TN E Tp� MUS CONNECT 0 TOWN'S Sewage Permit number ...................................................... d R House number ................... ." ..... ............" -,r 90 eeTi L E° i p s639 �0 TOWN E BARNSTABLE BUILDING I SPECTOR APPLICATION FOR PERMIT TO ...construct Single Family Dwelling TYPE OF CONSTRUCTION Wood... rame.:......... ......... .............................................................................. .................. une 2.3.1..........19...$. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Lot # 2A Sea Street H,�rannis.,..NIA. ................... ................................................................:................................ ProposedUse ........................................................................................................................... ...... Zoning District ..R B• ......................................Fire District HyanrilS ........................ ................................................................. Name of Owner Capricorn Realty Address 2 5..Falmouth Road, H,yanni................. Name of BuilderFraneo Real Estate Dev.. Co Address .765...Falmouth Road,,,,H�rannis ; ..ric.• ..... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms .;aiw........................................................Foundation ..R..Q.r..............................................:................... Exterior Cla bgarA„4DOAx.,shingles....................Roofing As halt Shin les Floors ...9arpet ........Interior Sheetrock ................................................................. ......................................................................... Gas - F.K.A. Two_ - Copper Heating - ....: .......Plumbin _ None40 000 00 Fireplace ..............................................:.......................Approximate Cost ............ ......�.........'............ ....................... . Definitive Plan Approved by Planning Board ________________________________19 . Area .. 1 ..5�•....ft......... Diagram of Lot and Building with Dimensions Fee �C`............................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH /A) 4 OCCUPANCY PERMITS ,REQUIRED FOR NEW DWELLINGS hereby agree to conform to all the Rules and Regulations o e Town of Barnstable regarding the above construction. Name k.2.642.... !'� e.... 000989. CAPRICORN REALTY TRUST 1 14 s4r-e-LV 111. - 25814 One Story ................. Permit for .................................... .. , Sinqle Family Dwell * Single ................. ig.............. Location Lo.t...2A.........3.4.2....Sela...Street. . . . ....... .. .. .. .... .. .. ...............Hyannis................................................................ Owner ..Ca.p.ri.co.r.n...Realty...Trust...... ..... .. .... .... .. .. .. .... .. .... ..... .. . .. Frame Tyki�lof Construction F..?�..................................... C-3 ............................................... Plop.......... Lot ................................ o Perms Granted......No.v.....22.*...............19 83 Datilf Inspection ............................ .......19 t Do Completed .......................10 �� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map % o Parcel '� Permit# �yg �ealth Division Date Issued ions' ervation Division 2 �� Fee Tax Collector e }�� ©v Treasurer C) Planning Dept. a4t Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address 5 SRA S Village ( VA 0u u i 5 Owner el1YY� HE n/.S L��' Address 3 Telephone C3 fit. Permit Request /3 v L d /b x!Z De<P",- l Z6 Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuatio44—A -0, Zoning District Flood Plain Groundwater Overlay 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: O Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths),existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil O Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove DyYes : ❑ No Detached garage:❑existing ❑new size Pool: 0 existing ❑new size Barn: ❑existing ❑dew seize Attached garage:❑existing ❑new size 'Shed:0 existing ❑new size Other: Z�; Z 4 Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name ri Y/Y1D x) Telephone Number j ��`- �` �-7 f • II Address,rQp 13L Ci c!3 c,IRR�j f/ License# O / 7357 �(U.g� ry►ti { /Y1d9 3 S, GZ G� Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO rA L e- LAN n SIGNATURE DATES �'S FOR OFFICIAL USE ONLY E PERMIT NO. DATE ISSUED P MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL FINALBUILDING �k�c>!-> DATE CLOSED OUT ASSOCIATION PLAN NO. {0 Ja s90 ' -p y vo aBo�, L- . r Lv TJp g a.� s 6 „ IPA, { s+M # Yy ' M Z-or34 A { t.f ti w Zr a f4 tj �y\fir r 4 Zo+ PRA v os� 2rsz`. A -� x CERTIFIED PLOT PLAN b F Z LOT A -5 q s r NEW CONSTRUCTION ONLY o IN TOP OF FOUNDATION iS REE ABOV E LOW POINT OF ADJACENT�� � .� ���u� �����•��������`�•g ROAD. r, �F .x ` p' SCALEI ++= 30' DATE k'. '! CERTIFY THAT THE Fv�+vvA 'o" D D E ENG * P P6lOM LOCATE EOfgTEREO REGISTER ROUND AS INDICATED AN CIVIL ,. LAND '� J _ CONFORMS TO THE ZONING LAWS ENGINEER . SURVEYOR A > bR �' ^ 1 . �Ql mARNSAeLE , MA8 712 M A I N &T.R E ET H YA N Pl 1 ... M AS_$ RH ,, .►r ,;A E K REG.. LAND 8.URVEY i s '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 r Please Print Legibly Name (Businessiorpnization/Individual): A �G�AQ 410 Address:_g - &� every Rp City/State/Zip: Izr Phone#: .:�;e � 7 Are you an employer? Check the appropriate box: Type of project.(r-equired):_ 1.❑ I am a employer with 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. New construction employees(full and/or part time). 7. Remodeling 2.54 I am a sole proprietor or partner- listed on the attached sheet. t ❑ g ship and have no employees These sub-contractors have 8.- ❑ Demolition workingfor me in an capacity. workers' comp.insurance. g y p ty. ❑ Building addition [No workers' comp. insurance 5. ❑ We area corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11. Plumbing repairs or additions -_ - - c.-152, 1(4),and we have n myself:[No workers comp. � § 12.❑ Roof repairs insurance required.]u t employees. [No workers' ]_ 13.0 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policyinforniation. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy grid job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 15.2 can lead to the imposition of criminal penalties of a fine up to$1,500;00 and/or one-year imprisonment, as well as.civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. . I.do hereby certify under the pains and penalties of perjury that the information provided above is true and correct: sign Date:* ZJ(0-5 Phone#: 4 Official use only. Do not write in this area,to be completed by city.or town official. I or Town: Permit/License# City . 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 the service of another and oany contract n for their toof hire Pursuant to this statute, an employee is defined as ...every person n in express or implied,oral or written." Or any two or An employer is defined as`.`an individual,P ersh'P,association, e corporation representatives of a deceaseder legal �employer,or the e of the foregoing engaged in a joint enterprise, and including g employees. However the receiver or trustee of an individual,partnership, association or other legal entity,employing 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 vvork'on such dwelling house appurtenant thereto shall not because of such employment be d e e or on the grounds or building 6 also states that"every state or local licensing agency shall withhold the issuance or MGL chapter 152;§25C( ) 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 ter 152, 25C 7 states"Neither the commonwealth nor any of its political subdivisions shall Additionally,MGL chap §.:. (,), enter into any contract for the performance of public,work until acceptable evidence of compliance with the insurance regairements of this chapter have been presented to the contracting authority. Applicants sation affidavit completely,by checking the boxes that apply to your situation and,if Please fill out the workers' compen necessary,supply sub-contractor(s)name(s), addresses)and phone number(s)along wi with no employees,th their certificate(s) of insurance. Limited Liability Companies(LLC)_or Limited Liability Partnerships fLan)I:LC or LLP does hayeer than the rtners are not required to carry workers comp ensation insurance. I members or pa f Industrial employees;a policy is required. Be advised that this affidavit maybe submitted to the Department o Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit: The affidavit shoal 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 ishould enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which Will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or has been officially stamped or marked by the city or town may be provided to the trwn)."A copy of the affidavit that applicant as proof that a valid affidavit is on file for future pemuts or licenses. A new affidavit must be filled out each er or citizen is obtaining a license or permit not related to any business or commercial venture year.Where a home own (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 Massachuset6 , Department of Industrial.Accidents Office of Investigations 600.Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia °FTMeTti Town of Barnstable Regulatory Services `+ a►?u , ' Thomas F.Geiler,Director KAM 9�'°rfD Nw't a � Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION q MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion, demolition,or construction of an addition to any pre-existing owner-occupied improvement,removal,dem n, . building containing at least one but not more than four dwelling units or to structures which are adi acent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: S(Pj QQ c 'K f 2 X l y Estimated Costr 10 v Address of Work: 3 qZ Sgn, S I h`AAA-'�J ' � /✓��S� Owner's Name: RAJ ffi, new S C cY Date of Application: -2 `► — 5 I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law ❑Job Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: PAYA140_ JO S S Y 2 - Date Copoactor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav °FSFIE r Town of Barnstalble Regulatory Services r � vMAM ` Thomas F:Geiler,Director �prEDMp`lp,� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete an g m ld Si gn n This Section If Using ABuilder L Lt.3 Yin N 5 L�`7. ,as Owner of the subject property hereby authorize _ )?,q �� to act on my behalf, in all matters relative to work authorized by this building permit application for. I A- j S /M A-"-"5 (Address of-rob) Signature of Owner Date Print Name QTORMS:O WNERPERMISSION ommauuea�!/ � vccu/u�aella Board of B.D ding Regulations and Standards License or registration valid for individul use only HOME INPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration; 105552 One Ashburton Place Rm 1301 Eltpiratlon 7/i17/2006 Boston,Ma.02108 Type irdlvidual RAYAAOND A PAYNE JR Raymond Payne Jr j 100 Blueberry Hill Rd C l.•-�•��i►�•✓! 1 C -- Not valid without signature Hyannis,AAA 02601 Administrator BOARD OF BUILDING REGULATIONS License iCONS TIT RUCTIQNj"SUPERVIS,6R Number C$ 011357 44 t ` 7 Tr.no 1434'5 Rs RAYMOND A PAY I ? f I 100�13LUEBERRY HI „rr G HYANNIS, NIA 02601 Coinmissloner r t \ 8 N s 0 IV 1 ^a ! t t V"E'° Town of Barnstable *Permit# O� Expires onths fr ssue date x Regulatory Services Fee BARNSTABLE +' 9 MASS. r . 1639• :10� Thomas F.Geiler,Director Building Division "t Tom Perry,CBO, Building Commissioner . 200 Main Street,Hyannis,MA 02601 www.town.barustable.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 . / L 0 3 / 603 Property Address Y4eP re ! 6m t �T /�?st u 2 o C�Residential Value of Work Yl U U • �' Minimum fee of$35.00 for work under$6000.00 t /' d7tt'l, 9 Owner's Name&Address /vlovle �lZZI dew e_ L,ytj. f Contractor's Name Telephone Number fUlr4 y1 j �5_/dol Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) CSC = E ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ' I have Worker's Compensation Insurance Insurance Company Name _ �fLa/�-P/Zi 11 Gl/)f l '7 ff//��/;�y < ��. Workman's Comp.Policy# NO C V.(/,V 3 Z 0,A- Copy of Insurance Compliance Certificate must accompany each permit.. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over 'existing layers of roof) Re-side k #of doors [wa, JY-Replacement_Windows/doors/sliders:U-Value ' - (maximum.35)#of windows 46t�P�✓� *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.` ***Note: Property Owner must si P perty Owner Letter of Permission. A copy of t ome p vement Contractors License&Construction Supervisors License is required SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Wind s\ mporaryInternetFiles\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. is V ,� SPECIFICATIONS AND ESTIMATES STATE OF MASSACI USETTS LETTER OF AUTHORIZATION TO:APPLY FOR A BUILDING PERMIT I, KATHLEEN LAPORTE, OWN THE PROPERTY LOCATED,AT 342 SEA STREET IN HYANNIS, MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO.APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: L OWNER'S ADDRESS: 342 SEA STREET, HYANNIS; MA 02601 OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645.Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: The Commonwealth ofMassachusetts- b r = Department of IndustrialAccidents Office of Investigations fail _ 600 Washington Street }` Boston MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectrlcians/Plumbers Applicant Information Please Print Le�zibIy Name (Business/Organization/Individual):_ C ci 121 •"2 z l•, ZL,ly'd Address: N e aJ 1-,,u17 R Ci !State/Zi Co-Av ' tY . p d / �4 1J.2 � Phone#: - �/2 xd F e you an employer?Check the appropriate box:. - Type of project(required): am a employer with r4• �.I am a general contractor and Iemployees(full and/or part-time).* have hired the sub-contractors 6. 0 New construction I am a sole proprietor or partner- listed on the attached sheet. : T 0 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. 0 Building addition required] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3:❑ I am a homeowner doing all work officers have exercised their. I I.0 Plumbing repairs or additions myself. [No workers,. comp. right of exemption per MGL insurance required.]f c. 152, §1(4),and we have no 12. Roof repairs employees.[No workers' 13.[1�Other IV/All)a a., -- - comp.insurance required:] *Any applicant that checks box#l must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they me doing all work and then hire outside contractors must submit anew affidavit indicating such Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy:number: Tam an employer that isproviding-workers'compensation insurance for my employees. Below is thepolicy andjob site - '. information. Insurance 'Company Name: �f t" Pit 4 pe nI t y� C a -5�o44. �' P Y ?N,f. C i3 e'Yl 9 N V Policy#or Self ins.Lic.#: /1/ LS , V3 Zc? /.L.. _ Expiration_Date. �-Z S/Z a Job Site Addiess li�A!�.1, City/State/Zip.:. 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 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 DI/forinsurance coverage verification. . Ido hereby ce der a pains and penalties.of perjury that the information provided above is true and correct Si afore:` Date: f13�28�2a// y � ' . .� da !F Official use ony 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:. , `Col tactPeison: - Phone.#: Client#:47298 CAPIHOM ,ACORD,. . CERTIFICATE OF LIABILITY INSURANCE Do;/04/20„"' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the. certificate holder in lieu of such endorsement(s). PRODUCER" CONTACT Karen Walther - Rogers&Gray Ins.-So. Dennis NAME:. PHONE 508 398-7980 FAX A/C No Ext: A/C,No: 434 Route 134 nl DRESS: waltherka@rogersgray.com P.O.BOX 1601 PRODUCER South Dennis, MA 02660-1601 CUSTOMER ID M - INSURER(S)AFFORDING COVERAGE NAIC# INSURED - - - INSURER A:National Grange Insurance Co. Capizzi Home Improvement, Inc: INSURER B,ACE Property&Casualty Ins.Co Capizzi Enterprises,Inc. INSURER C: 1645 Newtown Road Cotult, MA 02635 INSURER D: INSURER E: - - INSURERF: - - - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUEDOR 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. INSR - DDL UBR POLICY EFF POLICY EXP - LTR TYPE OF INSURANCE NSR D. POLICY NUMBER - MM/DD MM/DD LIMITS A GENERAL LIABILITY MPB1075H 06/08/2010 06/08/2011 EACHOCCURRENCE $1,000000 X COMMERCIAL DAMAGE TO RENTED GENERAL LIABILITY PREMISES Ea occurrence $500,000_ CLAIMS-MADE a OCCUR MED EXP(Any one person) $10,000 .� PERSONAL&ADV INJURY, $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - - - PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- LOC $ "A AUTOMOBILE LIABILITY BPO10786 06/08/2010 06/08/2011 COMBINED SINGLE LIMIT A ANY AUTO M1M28044 06/08/2010 06/08/2011 (Ea accident) $500 000 BODILY INJURY(Per person) $ ALL OWNED AUTOS " X SCHEDULED AUTOS BODILY INJURY(Per accident) $ � � - PROPERTY DAMAGE _X HIREDAUTOS (Per accident) $ X NON-OWNED AUTOS U1 $250/500,000 X Drive Other Car U2 $250/500,000 A UMBRELLA LIAB X occuR CUB1076H - 06/08/2010 06/08/2011 EACH OCCURRENCE $5,000,000. EXCESS LIAB CLAIMS-MADE AGGREGATE s5,000,000 DEDUCTIBLE .- - X RETENTION $ 10000 - $ B WORKERS COMPENSATION NWCC45843208 12/25/2010 12/25/2011 X I WC STATU- OTH- AND EMPLOYERS'LIABILITY Y,N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1 OOO 0 00 OFFICER/MEMBER EXCLUDED? � N/A OOO OOO . (Mandatory in NH) E.L.DISEASE-EAEMPLOYEE $1, , If yes,describe under DESCRIPTION OF OPERATIONS below I - E.L.DISEASE POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/.VEHICLES(Attach ACORD101;Additional Remarks Schedule,if more space is required) - Workers Comp Information Included Officers or Proprietors _ CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED.REPRESENTATIVE Ilk 198 •2009 ACORD CORPORATION.All rights'reserved. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S61971/M61970 MEE •' ' '✓!24 TGf6� t3�'a,/I!ldXdzSt"Ll.�S41i.42�arfi - _ .. .. Office of Consumer Affairs&Business Regulation license or,registration'valid for indiNidul use only CAME IMPROVEMENT CONTRACTOR before,the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registrations Op740 Type. 10:bark Plaza-Suite 5170 Exp raC n' 3f 1�2, supplement Card 13oston,MA.02116 CAPIZZI GARY GUS1'AFSO 1645 fete Aon Rd. Cotuit,MA 02635 `. Undersecretary ir1 tvithouf signature :_ ll.i+•=tcltci ctt - Dclizu'111.ent srf Public csal'4ts s3a�"d psi'i3ui tln�� tRcd„ulatillot and slafldards � Construction SuPervisasr License license- CS 746, GARY GUSTAFSON s 8 SHORT WAY s SANOi1WICH, MA 02563 l �•,.` ExpiraR cr 11r`29d2012 - Tr= 7058 OpTHE T Town of Barnstable *' rmtt ) Expires 6 months from e e * Regulatory Services Fee' tvl— BARNSTABLE, v MASS. �+ Thomas F. Geiter, Director plfD MA'S A T Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.to wn.b arnstab le.ma.us 01'fice: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY f _ Not Valid without Red X-Press Imnt pri Map/parcel Number .�+�cf/ Property Address �(40 _ °Residential Value of Work f��l Minimum fee of$25.00 for work under$6000.00 Owner's Name & Address Contractor's Name 0���� ``� �[)� �l—vb'1 1 Telephone Number I tome Improvement Contractor License#(if applicable) f Construction Supervisor's License# (ifapplicable) /0/0 ❑Workman's Compensation Insurance a � M Check one: ❑ I am a sole proprietor IL�N }QOJ ❑ I am the Homeowner have Worker's Compensation Insurance TOWN OF BARNSTA5LE Insurance Company Name _ Workman's Comp. Policy Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side i f- — k g4Z_[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. a e L ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. S I G IN'AT U 11 E: ^ i?.`\11'I II.I:SiPc)RMS1 ding ermit forms\EXPRESS.doc Revised 100608 The Commonwealth of Massachusetts ` Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: C W) KbULA5 b City/State/Zip: 4 _S�'J Phone#: L — g-. Qco Are you an employer? Check the appropriate box: Type of project(required): L❑ I am a employer with 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance. $ 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical 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. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerIW4, nder the pains andpenalties of perjury that the information provided above is true and correctSi ature: Date: &Z I d-77 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,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings•in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. 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: J` The Commonwealth'of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia of Manechakft - I3Wrtzent of Indusdr d Accideas `. �.' - D.�ce of IXvsstigrs7t�aec 600 Masfaiaagfon strat Bastax,MA 02111 >v-avw.srt�g6vldia �''. or€ters= Camgensation Inattrnnce davtt_. 8aijdeWC0ntraMr&%jectrici" 1u8zl�ers lica��Wit} atioa lex " t Le ' �-- i3=e;� �izatianf[r,�rr�iw" ' Cit Phone P., Are;0=1 e;rp;Dyer•? iaeck m.sppropriate box: ---i '— ="M a i� general 'Type of psaject(required): 1 hYit i am a cwr aad 1 1 mpic7y-zCS i5au,a Uo-.part-4wc�),s !lave haed dw mib-Gp S (L Q New crost ct= I am a =�'i or parr UsW on the a 'j priegQi �sheet, �- -���� # and 1WT} f�MIDI any capacity emPgoyees sncg lmve:�roa7tcs' � � u De�olitioa t ING woeker`- ,.sncrr ��e cotes insu aumt ' 9. 0 BwXiag additkm ` e 5-j We;are a corporation and it '10.®E3eciris al repairs ar addifiow _ s eow doing R11 work hm 111=94 a= - >c ;M >cen>�. 8f exec iQn ll.[.;PEtt g repaus ad3it7 s �u per&ICsL 2(4),end we bave no 12,0 Roof tWa= evloyeea.No VO&W' 13-Q Oiber 1 swmp inSBrv=aequircnd4 rc ••s tkifaW -Ati • y WC a�sd�beioeai ti a��,s°ear �nDoSnYiaforannnaa "eFC"ttt ft bvX glyU �� tlnen hose�RS9de epgtl nan!soZeala svca&fAdsv$cZ=tkS vxL eye as Addidaast fie€ate t#rr nay of theaubeanaacrvts and stagst ra aa;tbo6c ewes have Scan &ave yeY rna�ptavidt Jac . Tam an 6MPa er ,Fi gpar f�cg l�rktts'co s,� a ? +ss�a�i.7sser�raca �r a�sY eerrptoYtr's i r&W as tie p0&7 and job site . �.zapre Ccr=aua Nerae 1 x z Se:r-i4-A.S.`b r_# A--! h a Apr 14€�be wor srp �����•c ��� =Peas don policy deelamt#on page(s the pact'r ar and rspiradora date}• . Ccves•age as reTahmd was Sectim 25A ofMGL t. 152=lead lb the imfiosifiaa of pnaot es of a =S-yw ,as well as cif is p$c$arm of a-SMF C r iap i�3259 �t 2.days CORK UIYDSR a a fme gamest 6x violator. Be advised t a mpy-of dais s�we 'maybe forvx*d to the'DfBee ofa %�•ms� � -��'���tirr ra tip ? ' Mader tFaQrrs p �, Fe + 3' ivrii prom above i�rimce androtret rcrat ress �II cant avrrte YJtts AOPeaF,tb a Cv B rjy or wwn 4jrad ' --�� `' ?•a=;'.':�'��u: Perauitlfaeense� � i� pZty ( :Bid of 9 L gaile'faiDepart6aeut s>CglTo Clerk 4.'Xhctrica1br9wtcr5,Plumbing llaspecg r �soEac T or: lPbone#a IJun 01 09 09:28a GBDANCE 17818375373 PA ,ATM CERTIFICATE OF LIABILITY tNSU o PRODUCER (781)848-8300 RANCE DATE(MIA/DDNyyy) Granite InSurance Agency, Inc (781)$¢3-4591 THIS CERTIFICATE IS ISSUED ASAMATTER OF INFORMATION 9 25 Garden Park ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXT'E14D.OR Braintree, MA 02184 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Stephen Monaco INSURED M Mana INSURERS AFFORDING COVERAGE Bement Grvup,Inc,Dg,4 Nai on The Head wsuRERA: NAIC� 239 CHURCH STREET Sovereign Excess, Inc. MARSHFIELD, MA 02050 MlSURERB; associated Industries of MA WSURERC: Safety Ins. CO_ INSURER D: C VE GES INSURER E; 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 MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH NSR DO' POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAII 1 TYPE OF INSURANCE POLICYNUMBER POLJCYEFFECTIVE G POLICY EXPIRATION ENERAL LIABILITY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE g 300,O00 CLAIMS MADE X OCCUR MAGET� (,SFSQ Ran�ED $ 100 OOO A GL3594887 03/30/2009 03/30/2010 MED EN P(Anyone person) $ ' 5,000 PERSONAL&ADV INJURY S 300,000 GEN L AGGREGATE LIMIT APPLIES P.ER: GcNERAL AGGREGATE 5. 6001100 PRO X POLICY JE6 Lt)C PRODUCTS-COMPICP AGG S 600,000 'AUTOMOIXE LIASIUTy 3000176 05/21/ZOD9 05/21/2010 ANY AUTO COMBINED SINGLE LWIT ALL OWNED AUTOS (Ea accident) S 3 OO,OOO C X SCHEDULED AUTOS. BODILY INJURY (Per person) $ X HIRED AUTOS X NON-OWNEOAUTOS BODILY INJURY (Per accident) S PROPERTY DAMAGE GARAGE LIABILITY (Peraocldent) S ANYAUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUM13RELLA LIABILRy OCCUR CLAIMS MADE EACH OCCURRENCE g AGGREGATE $ DEDUCTIBLE S RETENTK]N $ $ WORKERS COMPENSATION AND VWC 6008652012009 05/06/Z009 05 06 2010 X , S EMPLOYERS'LIABILITY f / WC STATU- OTH- B ANYPROPRfETOWPARTNERIEXECl1TIVE RY ITS $ 100,0 OFFICERIMEMBER EXCLUDED? E.L.EACH 0.0 DO If Yes.C AL PRfa unceq E.L.DISEASE-EA EMPLOYEE $ 100 000 SPECIAL PROVISIONS delo}v , OTHER E.L DISEASE•POLICY Lf,%VT I $ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 'arpentry .owe's Companies Inc, and any and all su'bsi,Aiarries are named as additional insured's as respect to. he general liability and auto liability '_ERTIFIQATE qni nro NCELLA71ON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL LOWES' COMPANIES,INC. 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ATT' I.S.INSURANCE BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY PO BOX 1111 OF ANY KIND UPON THE INSURER,ITS AGENTS OR R RESENTATIVES. NORTH WILDESB0R0, NC 29656 AUTHORIZED REPRESENTATIVE GRANITE INS.AGENCY, INC G- LCORD 25(20D7J08) FAX: (781)837 5373 ACOIZD CORPORATION 1908 2008'-04-11 11 51 -_ - INSTALLS !1! Board B�ulding egula ons an tan ar One Ashburton Place - Room 1301 Boston; Massachusetts 02.10$ Home Improvement Contractor.Re�istration - :Registration,. :141531 , Type: ,DOA. Expiration: :4/2712010 Tr# 268046 NAIL ON THE HEAD - MI.CHALL'`PURPURA. 239 CHURCH.STREET MARSHFIELD, MA 02060 Update Addre 'and retain card Mark reasoa fur chine. DPS,CA1 8 50M Q7107.PC849U I .I Address _� Rent�+al_,O.Tmpluyment; r—I'Lort Clad �7if�-�na ✓�laee�a&raales '. Bord df Bulldln a Regainttona and StuodardB i.lcense or reaistrattoo.valid for litdividul use only HOME IMPROVEMENT CONTRACTOR 6efore'the esplratlon date If fond return to. Re9istrattor`t i41531 Board of Bulidit Repulatious and Standards ExpirHian. 4/712010 Try 266046+ One Ash4urtaa Place Rm 1301 Typo: DBA`; Boston,Ma..U2108. WAIL 4N THE"HEAD MICHAEL.PURPURA 239 CHUEtCN STREET M1RAR$hIFfELD MA 02050 AdmEnlatralar; 4 of Yelid.tivithoat signature G f\ 2008-09-.26 06:41 �_ - -- INSTALLS P '1/1 ilarsachusetis,- Department of Public ti;tFet% \C Boars!Of Building Regulations anil�t:uut.0 dx tv onstructipn Supervisor Specialty.License License: CS SL 101046 Restricted to: RrAS \ \ MICHAEL PURPURA 239,CHURCH STREET MARSHFIELD, MA mm Expiration!-412J2M2 (tt�inLLw.iuut r . Tres: 101046" rt 0. v a ; P - r'. } :. ". ' r - f _ r . 1�09-05-27 13:54 P 1/1 fr. 0 7d a I i 9�9 i 9 I f +6� i 3 sro,�ti Town of Barnstable Regulatory Services vHASS. $ Thomas F.Geiler,Director Foa�� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.towmbarnstable.ma.us " Office: 508-862-403 8 Fax: 508-790-6230 .Property Owner Must• Complete and Sign This Section If Using A Builder I, !` ,as Owner of the subject property hereby authorize ` to act on m behalf in all matters relative to work authorized by this building permit application for. • r 14- (Address Ujob) Signature of Owner _ Date. Print Name w If Property Owner is applying for permit please complete the HomeoRmers License Exemption Form on the reverse side. Q:F0 RMS:O WNERPERMISSION Y \1 q • fie �onzina�zcurcrltli o��/�aoaac`c�uaeCC Board of Building Regulations and Standards . HOME IMPROVEMENT CONTRACTOR Registration: 148688 Expira-flo.n `f0/18/2009 - _ j, Type Supplement Card Y c LOWE'S HOMESiCENTERS 4 �`` 4 p.JAYMI RODRIGUEZ.E-,�` 1000 LOWES BLVD e MOORESVILLE, NC 281'17 Administrator - r, - r a valid for individul use only 4. x istration return to. License or reg If found .� iration date. Standards before the exP Regulations and .t Board of Building Place 1301 Rm ti One Ashburton � Boston, Nla 02108 a t _ natur _ Not lid without s'g b Town of Barnstable Regulatory Services Thomas F.Geiler,Director RAMSTABM 9 MASS.i639. Building Division �� 'O�Fv nw't°i Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 �� Fax: 508-790-6230 PERMIT# �6 I FEE: $ �-I'S-Zooms SHED REGISTRATION 120 square feet or less UJ .J cv 3-4 Z �"t 4 Sf t,�Location of sh6C- address) Viflage r.... Property owne�'s name Telephone number all S•,-.t ; e Y V 10 -19420300 Lo-34 Size of Shed Map/Parcel# !S 10,5 Signature Date Hyannis Main Street Waterfront Historic District? 'A A 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 Q-forms-shedreg REV:121901 1 F P OPERTY TINES MAY NOT BE ACC T- , ............_...._.__.._ < / j NOTE:not all symbSTANDARDols will appear on a map GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES EDGE OF BRUSH (- —j ORCHARD OR NURSERY / \ }( �,�-y VEDGE OF CONIFEROUS TREES � MARSH AREA 3 - 0 / l EDGE OF WATER I 4# 3 \ / ___= DIRT ROAD —— _ -- 23 . /. \ J!7 ❑ — / \ DRIVEWAY E— ARKING LOT PAVED ROAD .................... fr . ,- . / I .---"" --- — -- — DRAINAGE DITCH 1 PATH/TRAIL PARCEL LINE** - n" � �_....__.-.—..—._...".."......_.:._...,_..._.._...... . MAP 326 �— MAP# MAP 306 o2,E PARCEL NUMBER E�� #367 HOUSE NUMBER j — ---- --------- AP ........... ...... ............... 2 FOOT CONTOUR LINE O i - / —E0— 10 FOOT CONTOUR LINE I ❑ J 0 Elevation based on NGVD29 X # 342 i JJ \ 4.9 SPOT ELEVATION STONEWALL t /. ❑ ,' -X---X- FENCE i RETAINING WALL RAIL ROAD TRACK / kz �.— STONE JETTY / \ Pau SWIMMING POOL ` PORCH/DECK —� AP 306 ► 0 BUILDING/STRUCTURE D 9 - 0 O 1---'-'-� OCK/PIER \ / HYDRANT / \ 6 . 4 e VALVE O MANHOLE 358 11 i o POST O FLAG POLE ' T O W N O F B A R N S T A B L E G E O G R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N 1 T ,p SIGN ® 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 ❑ TOWER 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 UTILITY POLE w e 0 20 40 National Map 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 O ELECTRIC BOX 1 INCH=40 FEET* enlarged scale. on the map. at a scale of I-100'. Parcel lines were digitized from FY2004 Town of Barnstable Assessors tax maps. LIGHT POLE Assessor's map and lot number j �f .:,s-?,°„�,. : 1 (% '���idf,� �2 << THE l� F T Sewage Permit number ........................................................ Z 33AR33TADLE, i House number .......................:.... � .��..L?..::.................. 9 rasa z639• \0�� '1 a mxf TOWN 'OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..Construc.t Single Family Dwelling TYPE OF CONSTRUCTIONnn ...T�'.7e'a �i ................June...2 �............19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......L. ..# Sea Street ................................................Hva�? -s MA ................................................................ ................................................ ProposedUse ............................................................................................................................................................................. Zoning District .R'... .............................................................Fire District .Hya1111i:3.......................................................... Name of Owner Capricorn Realty Trust Address 765 Falmouth Road, Hyannis ........... ....................................... .............................. Name of Builder,rancO...Rea� . Estate De,V. CO Address 7�.ar...Falmouth Road, H.v„annis 7nC. .................. Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms 5�.!:y..........................................................Foundation ..FnAl .................................................................. ExieriorC...c'...�1� ...t �l aX1 �c.'..,shi.n.,,-I S....................Roofing &g-nhalt Shingles.......................................... Floors ..q;Kpe t ..............................................Interior Sheetrock ......................... .......................................................................... . N i 1'YT i�i � HeatingCaS....................................................................Plumbing ........ .... . ... ...i�..p r............................................ Fireplace "ono ............................Approximate Cost Ao,000.00 ...................................................... .................................................................... Definitive Plan Approved by Planning Board ________________________________19_______ . Area ....i Q. 6....pn—t.... t e:....... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 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. o-Name ` '� ...'� f y �v `.........ties.. ' 000989 CAPRICORN REALTY TRUST A=306-203 /1=3o(o- 203-003 No ..2.5814 Permit for .,One...Story.......... Single Family..Dwelling,,,,,,,,,,.„ Location ,Lot 2A, 342 Se Street„ ........................a... ................H 'ann i s............................................. Owner .....Capricorn Realty... Type of Construction ... )MMe.,,,,,,,,,,,,,,,,,,,,,,,,,, ................................................................................ y Plot ............................ Lot ................................ Permit Granted ,,.,Nov. 22................19 83 Date of Inspection ....................................19 Date Completed ......................................19 ®f/a/fao t , Town of Barnstable *Permit# 71/ 99 �O•� Expires 6 months from issue date BARNSUBt e, : Regulatory Services Fee s' 00 9c� ,' ,0�' Thomas F.Geiler,Director ArED1'APyA Building Division YV Tom Perry, Building Commissioner A�PRE�� PERMIT 200 Main Street, Hyannis,MA 02601 OCT 1 0 2003 . Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �20 Z 3 Not Valid without Red X-Press Imprint Map/parcel Number v Property Address ��� / A/lsll' t Residential Value of Work t� d Owner's Name&Address Ws���14�•. 4- Ke.-& PeAJIN lfa K�t Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name-CO kAKt,�� "n S L)v- .,iC Co Workman's Comp.Policy# Permit Request(check box) ❑ Re-roof(stripping old shingles)'All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows. U-Value - .' (maximum.44) t S *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. f f Home Improvement Contr tors License is required. Signature He� Le `Forms:expmtrg :Vlse053003 *Permit °F THE I°,f, Town of Barnstable iitt 6 irtandis froln iss„e dale Fee " : ! Regulatory Services EARNSIABISI• t7 MASS. Thomas F.Geller,Director m Fo►'u�y'" Building Division PERMIT Peter F.Dilzatteo,. Building comudssionOk-PRESS 36;Main street, Hyannis,MA 02601w. OCT 17 2001 Office: 508-862=038 Fax: 508 90-6230 EXPRESS PERIIIIT APPLICATION - RESID1 'Q� STABLE Not Valid withmrt I=X-Press latpn+tt D(P vlapiparcel Number o Property Address OZ �. Value of ZVork� poi v . 0 O Residential jj Owner's Name& Address e& 5 T Telephone Number Contractor s Dame 7 Home Improvement Contractor License 4(if applicable) r-7 Construction Supervisors License-(if applicable) i Z Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ,®_I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workrnari's Comp.Policy Permit Request(check box) �j Re-roof(stripping old shingles) TT`� in_. Goin ❑Re-roof(not stripping. g over existing layers of"00 ❑ Re-side ❑ Replacement Windows. U-Value ( ❑ Other(specify) '• compliance with other foam department regulations.i.e.Historic.Conservation., *Where required: Issua.Ice of this permit does not exempt comp Signature mtm:rcv4)i0601 Q:fornts:esp _