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HomeMy WebLinkAbout0114 SPRING STREET (2) V I - THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) M A , �C(�J / "- L DATA C* 1 � o N ] v i u � O y TU .0 O cn O t N 7M. o- O�Op N �aNO zi } l� W W N PostalTM CERTIREO Service 7 o . .�� O O to u7 LP) LL j LLn Certified Mail Fee Extra Services&Fees(check box,add fee as appropriate) ❑Return Receipt(hardcopy) $ O I3 ❑Return Receipt(electronic) $ Postmark 0 O []Certified Mail Restricted Delivery $ Here ❑Adult Signature Required $ C3 C3 ❑Adult Signature Restricted Delivery$ p [> Postage O O $ C-3 C3 Total PostpAb and F $ • Sent ��/� � Q-- C3 C3 No. @ity, t ZIP+ C y � Q) :6 ; O V N cc C W O 3 CO O m � N Z I r li A I O W , (0till co r. N;Cr) a 0�0 O d O O N ti•f1�• p Certified Mail service provides the following benefits: c� ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail C13 ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate fs. ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. li,USPS®-postmarked Certified Mail receipt to the 1 N ■A record of delivery(including the recipients retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides 0 T � for a specified period. delivery to the addressee specified by name,or a 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 Mai!®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which f ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age i international mail. and provides delivery to the addressee specified ■Insurance coverage Is notavallable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). t 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 itero'at.a Post Office'for the following services: postmarking.If you doo't need a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion 1 of delivery(including the recipient's signature). of this label,affix R 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, 1 complete PS Form 3811,Domestic Refum l Receipt,•attach PS Form 3811 to your mailpiece; IMPOHTANr Save this ieceipt for your records. 1 PS Form 3ii00,4ril 2015(Reverse)PSN7530-02-000.9047. @. 0) A c a O O >% asE_ Nx z I �. l�f � t ___ n+c Printed On:.7/9/2020 ~' Complaint Call Report 817 BLDG 1 UNIT 1 SOLD STRAWBERRY Case# C-20-191' HILL ROAD, HYANNIS Case#: C-20-191 Address: 817 BLDG 1 UNIT I OLD Date: 6l4/2020 STRAWBERRY HILL ROAD, HYANNIS Owner Info: Property Info: MBL: Owner Notified?.- Complaint Details: Type of Complaint Classification of Complaint Method of Complaint Building Code, Medium Priority Phone Complaint Summary: Edwin Bowers received phone call From Carol Curtis (lives in unit below) has concerns of poor workmanship and no permit. Stated beam being replaced. Please contact Carol with results of complaint. 508.577.4031 Action History: Action Taken Date Description - Fee - Inspector Close Case 7/9/2020 No violation present $0.00 bowerse Inspector Assigned to Complaint: bowerse Filed by: bowerse Comments: Comment Date Commenter Comment 6/4/2020 bowerse Suspected working without permit Have scheduled inspection LDate, 7/9/2020 Town of Barnstable F .. v _ J r .I�� , ' , _ . . a - � . - i r u , . " -,,,..mow. .. � ,,.Al ....... y File Edit Tools Help It iz µ r f j a i lcation" P.ro ect./A.ctiv Location I+Unct alit C!vpmer Status;", User Status'�'WPi J .,, P- r P 2r�64519 RESIDENTIAL ADDITION='ALTE.R`TIO 11A SPRING STREET HYANNIS BORING, ROBERT L CO10PLETE _CLOSED APPLICATION t` 20N4659 RESIDENTIAL ADDITION.!PtLTERATIO 114 SPRING STREET HYANNIS BORINO, ROBERT L COMPLETE CLOSED APPLICATION r ,rr r r r 33305' PLUMBING RESIDENTIAL SPRING STREET HYANNIS BORINO, ROBERT L. COI9PLETE CLOSED APPLICATION i .a.2D84 PLUMBING RESIDENTIAL 114 SPRING STREET HYANNIS BORING. ROBERT L. COMPLETE CLOSED APPLICATION 43A57 GAS RESIDENTIAL - 114 SPRING STREET 'HYANNIS BORINO;ROBERT L COMPLETE -� CLOSED APPLICATION 43539 RESIDENTIAL ADD 114 SPRING STREET HY.nhJNIS BORING,ROBERT L ACTIVE ACTIVE APPLICATION 413755 ELECTRIC RES.ADD,''ALTE.R 3 . 114 SPRING STREET HYANNIS BORINO,ROBERT L - COMPLETE CLOSED APPLICATION £. 53387 ELECTRIC RES.ADDfLTER 11Y SPRING STREET HYANNIS BORING, ROBERT L COMPLETE CLOSED APPLICATION i - 4 I '��r Search 1'After Record v. E. , r 0 r f 1 : : z : r CAI, r de� . r r r � ` P���?�- ��2 2��5— '��-�c i r�=�= e I ----- �------_. I _______� - � j ----- f `�_. _ t ,\ ..\ � � /� �� / _ _ r - � .. .. .. H � l l r S , c' ti .:. -f'- � C_X,a_ Rd 0t�6 94 Psi �i ,, �-...� E _ . �� _ .. - � � �.� �._ .�.� �� _ - _ � � � . , �_ _ s � . t .� �.. _,..�..� _ . W. F Ap --------------- i Di �� s __ f �. -� / -w ✓° . _ . . i _ o, � e t! i �t` � i —� n J i aka I 1 • ' I / 1 / / � r r •• mti I ow, IM Mz 20 M MINA e� _RFMI a mmm-: ►L 1 i � FA i �J / �, _lo / rJ v ► z =� 1i'`syee �z ,uo4 -e, yE � - ��„�,��4 L4 )Pl' 'I� z0 W mac. -'o-- i r,v! i�1.� �s l� ril 1g l4. � � h°L-HgJLYm�- I1A � � �rc�iS�M I U. �.t,, ��,i 11JvnM't93rakUL 95... re YP174 /6 C'rT Z� 4. �i�v�J� iy�.�y cfute���-g `6viva�( /..-r-�. /��✓T �, ,�. /f •_ g�-O vd�_. ecrurile� /�.e� -JIo-C�O•ee� . Avo 57-1 AW L'•r�9 �C�v�i�-�-of 7 7 <2ti• - �r_ri•-��_ _ JS�1.�-v_ Ov°J 9/15/95 TRIAL COURT OF THE COMMONWEALTH DISTRICT COURT DEPARTMENT FIRST BARNSTABLE. DIVISION BARNSTABLE, MASS. TO: ROBERT FALANGA c/o Robert G. Brown P.O. Box 2187 11yannis, "t A 02601 RE:. Citation # 41041 By-1,aw Received from the BARNSTABLE Police Department You are .hereby notified that the Non- Criminal Hearing you requested on the above referenced citation will be held on THURSDAY, OCTOBE'? 19, 1995, at 200 p.m. in the Clerk's Office 17 FD302 Clerk-Magistrate k r ji Al , P ti (/ E UPD ] ORDI*E VIOLATION UPDATE SCREE* Help [ ] Action: , C] Citation Nbr: 41193] Offender: [FALANGA, ROBERT ] Date of Violation: [082195] Contact: [ ] Time of Violation: [ 1030] Address: [114 SPRING STREET ) Alarm Number: ] City: [HYANNIS ] Call Number: ] State: [MA] Zip: [02601] Issuing Person: [URENAS ] DOB: [00000000] Mailing date: [082195] (MMDDYY) LOCATION OF VIOLATION: House Nbr [ ] House Ltr [ ] Road [ 114 SPRING ST. ] Vill HYA MV Operator Fine Due: [0100 ] Business ID: [ ] License Numb: [ ] Date Paid: [ ] Notice Date: [ ] Violation Type: [ZON] Court date: [ ] Complaint Date: [ ) Issued By: [BBU] Disposition: [ ) Status: [HR] Cancel [ Next Screen [UPD ] Next Action [ ] Next Citation Nbr [ ] Next Alarm Nbr [ ] Next Call Number [ ] [ ) UPD ] ORDI E VIOLATION UPDATE SCREE p [ ] ��] Help Action: C] Citation Nbr: 41191] Offender: [FALANGA, ROBERT ] Date of Violation: [081495] Contact: [ ] Time of Violation: [1100] Address: [ 114 SPRING ST. J Alarm Number: ] City: [HYANNIS ] Call Number: ] State: [MA] Zip: [02601] Issuing Person: [URENAS ] DOB: (00000000] Mailing date: [081495] (MMDDYY) LOCATION OF VIOLATION: House Nbr [ ) House Ltr [ ] Road [ 114 SPRING ST. ] Vill HYA MV Operator Fine Due: [0100 ] Business ID: [ ] License Numb: [ ] Date Paid: [ ] Notice Date: [ ] Violation Type: [ZON] Court date: [ ] Complaint Date: [ ] Issued By: [BBU] Disposition: [ ] Status: [HR] Cancel [ ) Next Screen [UPD ) Next Action [ ] Next Citation Nbr [ ] Next Alarm Nbr [ ] Next Call Number [ ] [ J UPD ] ORDI*E VIOLATION UPDATE SCREE I ] Help [ ] Action: C] Citation Nbr: 41035] Offender: [FALANGA, ROBERT ] Date of Violation: (072095] Contact: [ ] Time of Violation: [ 1000] Address: [ 114 SPRING ST. ] Alarm Number: ] City: [HYANNIS ] Call Number: ] State: [MA] Zip: [02601] Issuing Person: [URENAS ] DOB: [00000000] Mailing date: [072095] (MMDDYY) LOCATION OF VIOLATION: House Nbr [ ] House Ltr [ J Road [ 114 SPRING ST. ] Vill [HYA] MV Operator Fine Due: [0100 ] Business ID: [ ] License Numb: [ ] Date Paid: [ ] Notice Date: [ ] Violation Type: [ZON] -. Court date: [ 113095] Complaint Date: [ ] Issued By: I-BBUJ� Disposition: [ ] Status: [HR] Can 1 [ ] Next Screen [UPD ] Next Action [ ] Next Citation Nbr [ ] Next Alarm Nbr [ J Next Call Number [ ] [ J o r � Town of Barnstable Department of Health, Safety, and Environmental Services Consumer Affairs Division 230 South Street, P.O. Box 2430 oFti Hyannis, MA 02601 Tel: 508-790-6250 Fax: 508-778-2412 a « « �ARNgI'ABIE. MA8& Jack Gillis Gloria Urenas, Zoning Enforcement Officer Supervisor FROM: Carole Morris, Consumer Affairs SUBJECT: Ordinance Citations DATE: September 21, 1995 The following are scheduled for hearing: Robert Falanga #41035 10-lq- 15 Robert Falanga #41191 Robert Falanga #41193 �5 Lee Eiler #41030 Lee Eiler #41031 Lee Eiler #41029 Kindly send a written report of the incident, together with any pictures. Thank you. /ctbuild TOWN OF BARNSTABLE REPORT PPLEMENTARY/CONTINUATI N REPORT NAME (.LAST, FIRST, MIDDLE) DIVISION /DEPT NOTE DETAILS 6 OBSERVATIONS-ITEMIZE EVIDENCE, SERIAL $S ETC. Nrl //w 11 4/&:I�c f9 o f - �� pyJ a - 3 � lie f s SUBMITTED BY PAGE $ ` P 015 493 810 Receipt for- Certified Mail *. No Insurance Coverage Provided Do not use for International Mail (See Reverse) - Sent to Robert Falan a ate. Street and No. .' 114 Spring Street P.O.,State and ZIP Code Hyannis MA 026011 Postage Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing r to Whom&Date Delivered m Return Receipt Showing to Whom, c Date,and Addressee's Address 7 TOTAL Postage C &Fees Postmark or Date M E 0 U. STICK POSTAGE STAMPS TO ARTIM TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONA4 4RVICES(tee front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attachbd and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach and retain the receipt,and mail the article. rn 3. If you want a return receipt,write the certified mail number and your name and address on a 22 return receipt card,Form 3811,and attach it to the front of the article by means of the gummed. y ands if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. O O 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. E 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If LL- return receipt is requested,check the applicable blocks in item 1 of Form 3811. a 8. Save this receipt and present it if you make inquiry. 102595.93-Z-0478 SENDER: ro I also wish to receive the y • Complete items 1 and/or 2 for additional services. !� • Complete items 3,and 4a&b. following services (for an extra ` • Print your name and address on the reverse of this form so that we can fee): m return this card to you. • Attach this form to the front of the mailpiece,or on the back if space 1. ❑ Addressee's Address does not permit. •r t • Write"Return Receipt Requested"on the mailpiece below the article number. 2. ❑ Restricted Delivery • The Return Receipt will show to whom the article was delivered and the date V G delivered. Consult postmaster for fee. 3. Article Addressed to: 4a. Article Number Robert Falanga P 015 493 810 4b. Service Type E 114 Spring Street ❑ Registered ❑ Insured V t7f I y ertified El COD Hyannis MA 02601C I 5 W ❑ Express Mail ❑ Return.Receipt"for 3 p� MerchAndiseo C 7. Date DIV J w C 0 I Q T cc 5. Signa ure ddr ee) 8. Addressee's Address(Only if requested x I and fee is paid) 6. Signature (Agent) ~ I � I HPS Form 3811, December 1991 *U.S.GPO:1993-352-714 DOMESTIC RETURN RECEIPT UNITED STATES POSTAL SERVICE I Official Business PENALTY FOR PRIVATE USE TO AVOID PAYMENT OF POSTAGE,$300 4� I Print your name, address and ZIP Code here I � • Town of Barnstable • j Building Division I r 367 Main Street I Hyannis, MA 02601 I . I I I . . �: The Town of Barnstable • annxernsM • - NAM � Department of Health, Safety and Environmental Services e bgq.A` Ma+ Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner January 19, 1995 Robert Falanga 114 Spring Street Hyannis, MA 020601 Mr. Falanga: You are hereby ordered to come in and take out a building permit to revert your property at 114 Spring Street, Hyannis, to a single family dwelling- as that is the only permitted use for that area. You have thirty(30) days to comply. Sincerely, Ralph M. Crossen !�4t Building Commissioner RMC/de Certified mail A g950119b 8 19 98 E � ��E 328 081 erg 11,14 SPRING.STREET `1 nett€ s ANTONETTE HAMMETT Mll v MONDAY SHE CALLED TO SAY PEOPLE WERE MOVING INTO 114 SPRING STREET. ON TUESDAY THE E• PEOPLE MOVED THEIR STUFF OUT AGAIN. BUT HE STILL HAS TWO OTHER APARTMENTS RENTED IN THERE. 3 L � •. flh s! �E - 6 y. J <' <>Iiii'l Ilia €«x a « <'« Ifalann two . { ><. ME >: Y ` > 114 PRI NG STREET ]�yyNIS LiiG:tiii:ivvvLv� WM •:::::•••••vxvw.v.:„•::•:nvvvvv:::v:•::•{.:iiiLi:•:;•i:;;•i:•i:•isv«it::tv<tiii:ii:'v::iii:';�i::ii::ii:!iii:•':::;;i:�i: > '•. ii.:ti:'L'ri.j>:';{.}y.}:. :j:?' '<`t:Y'<: '. v•O'r::}};'•is:;:vy:::j`y::}<y}'`Llti`.:iiti>::�y�y:«::<?::::•ij?:i ii•?iyY:;:t},>•t::iy::iii jj`{;T: M1::?::<ti>.{>.+ti::C?::::: :':::{:'`v`v~:i*.tiiii:::::}:4 is Will :::::::w:::::v:w:::::::nw:n:�:::::::::::::•.w::::nvv,•.�:: v:...:•:::::••..::•.:::`::.t:::::::v•: ''•Yriii`i. Bill N EI HB R > »`'' `>`'?'M1'.ti` `' <tz 'zz<z# ? # %# ' `l'>':< > ## ?`t'.>': <{ S #> ' > 8 .......... M O ONE FAMILY,,._= V::. E ERA:.t• s i•• .....:..:..::.:::.::.............. ill CARS—ALSO RS POLICE LSO MADE AR REST RRES AT 11-.101 L ATI N. OC O low r f ::::•:::::•.. :.:;•;:•::':Sr::is y::::.; ti .. :.REFER T loop , ; �<` ':<.••: � . .::: O R .TO VERIFY : .. \ 2-� -r C G `P- -e -3- . v e } 1 t "b zr low ion TOWN OF BARNSTASLZ gEpORT E RPORT L33MENTAAY/QONTINQA . DIVISION � i ✓1 NAME (LASS. FIRST. RIDDLE) 5 Ul NOSE DETAILS i OBSERVATIONS—)SENILE EVIDENCE. SERIAL IS ETC. 10 C) �9 ol a a t a PAGE i' TOWN OF BARNSTABLE BUILDING DEPARTMENT COMPLAINT/INQUIRY REPORT Date Rec'd B Assessor's No. Last Name First Name ORIGINATOR Street 42 9 �� Village State zip— Telephone: . Home `77e �'���``f Work Description: zZy COMPLAINT _.C� INQUIRY Requestor's Signature COMPLAINT Street Address //y 211 LOCATION A= OFFICE USE ONLY INSPECTOR'S Date ,-., Inspector ACTION/ COMMENTS FOLLOW-UP ACTION ADDITIONAL INFO. ATTACHED COPY DISTRIBUTION: WHITE - DEPARTMENT FILE YELLOW - INSPECTOR PINK - INSPECTOR' (RETURN TO OFFICE MGR.) J Parcel �/ --Agwermit# Ila 3 House# ate Issued '7 apm a Board of Healtli(3rd floor)(8:15 -9:30/1:00-4�A) a.lh�S �=-- e �5 • Cea&oPA4ien-Office(4th floor)(8:30: 9:30/1:00-2:00) COWR EAiNd DI1►�Ip� � f Admin.(1st floor/School Adm . Bldg.) U�TtOA d THE �1_/� DP4w-F4an Approved by Planning Board 19 BARNSTABLE, MARR s 1 39. TOWN OYBARNSTABLE F Building Permit Application Project Street Address Village Owner GbP Address 5 a/i� Telephone 36� -923/ - Permit Request 1 - , a First Floor square feet Second Floor l U square feet Construction Type Estimated Project Cost $ 060 Zoning District Q 1 ' Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 70 Historic House ❑Yes )ffNo On Old King's Highway ❑Yes ANo Basement Type: ❑Full ❑Crawl ❑Walkout Jj Other _-�5 Basement Finished Area(sq.ft.) ff—Xr I Basement Unfinished Area(sq.ft) �U� Number of Baths: Full: Existin L g � New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: XGas ❑Oil ❑Electric ❑Other Central Air ❑Yes XNo Fireplaces: Existing New Existing wood/coal stove ❑Yes, �(No Garage: ❑Detached(size) A4 Other Detached Structures: ❑Pool(size) /V/� ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) 0 0 ❑Other(size) IV n-� Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 1 (No If yes, site plan review# Current Use Proposed Use ;V/4 Builder Information Name l/ f, Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# /6'Pfa® 6326S �s� NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C/.�"``� SIGNATURE DATE BUILDING PER DENIED FOR THE FOLLOW G REASON(S) /� s FOR OFFICIAL USE ONLY PERMIT NO. ! , DATE ISSUED if ' MAP/PARCEL NO. - ANDR ESS — VILLAGE + _. OWNER DATE OF INSPECTION: FOUNDATION - FRAME a y INSULATION FIREPLACE � -,RICA_ L: ROUGH FINAL PLUMBINS� If ROUGH FINAL ` x GAS: ¢ ROUGH =.FINAL , FINAL`BU tJG • r �a Y f , � j 1 � i 2 DATE CLO OUT ASSOCIATION PLAN NO. 4 } TFIE nn._ + BA ffABLE. tFDNIC'�A The Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner June 17, 1998 Mr. Robert Falanga PO Box 303 Cummaquid, MA 02630 Re: 114 Spring Street, Hyannis - Dear Mr. Falanga: Based on a site visit today with you, we will agree to issue you a permit to convert the structure at 114 Spring Street back into a single-family home under the following conditions: FIRST FLOOR 1. Build corridor from original cottage to new addition in the back with a cased opening in the old cottage connection. 2. Stairs to be installed in new addition in front room (second room on right)to second floor. This will be an open stair shaft. 3. Illegal kitchen in new addition will be turned into a laundry. Dishwasher and refrigerator to be removed. Cabinets over old stove and next to old stove to be removed. Reinspection necessary. 4. Shelves to be built where dishwasher was. SECOND FLOOR 1. Open foyer where stairs enter. 2. "Wet bar"to be only that and no cabinets will be allowed. �y •g980617a THIRD FLOOR To remain as is. All electrical permits and plumbing permits will be taken out within 30 days and nothing will be insulated until all proper electrical and plumbing inspections are completed. A signed affidavit acknowledging that this is a single-family home and will be used as same from now on will be submitted prior to Certificate of Occupancy. Sincerely, Ralph M. Crossen Building Commissioner RMC/lbn Agreed to by: dated: obert Fa anga The Town of Barnstable • m►atasreet8 • �' De artment of Health Safety and EnvlronmentaI Services �;•`° Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commission: For office use only 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. �` co U �P Type of Work: ---Est.Cost r ZAddress of Work: AIL( jr' Owner's Name C Date of Permit Application: - I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. 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 PROGZAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owne ' i ame The Commonwealth of Mascusetts ' .�� --=• Department of Industrial Accidents 600 Washington Street ' - Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: �r location k f i► �ii city phone# ❑ I alp a homeowner performing all work myself. ❑ lamas ole pro rietor and have no one workin in any ca acity I am an employer providing workers' compensation for my employees working on this job. company name i A - address. � �� cfty �� d'll phone insurance co. ❑ 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: comaanv name address: city . phone#: insurance cm DO cv#: ebmnanv name ... address: city' phone# insurance co olicv# M. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one years'imprisomment as well as civil penalties in the form of a STOP WORK ORDER and a tine of S 100.00 a day against me. I understand that a copy of this statement may be forwarded to the Of ee of Investigations of the DIA for coverage verification. 1 do hereby certify under, he.pains and penalties of perjury that the information provided above is truo and correct Signature a� """ Date ® 7 _ Print name � � 7 Phone# J�v official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department (]Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised 9/95 P1A) I 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 hasa 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 you are required to obtain a workers' compensation policy, please call 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 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. The affidavits may be returned io 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 Invesugations 600 Washington Street Boston; Ma. 02111 fax#: (617) 727-7749 -' phone#: (617) 727-4900 ext. 406, 409 or 375 • TOWN OF BARNSTAB.16 BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. : •- e/DATE �— — ..... , JOB. LOCATION Number Str et address S tion of town /"HOMEOWNER" � ,/O Name Home phone Work phone . PRESENT MAILING ADDRESS City town State Zip code The current exemption for "homeowners" was extended to include owner-occupies dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEVINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Officiz on a form acceptable to the Building Official, that he/she shall be responsib: for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes responsibility for compliance with the StE Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Departame 't minimum inspection procedures and requirements and that he/she will comp with sai procedures and requirements. HOMEOWNER'S SIGNATURE C APPROVAL OF BUILDING OFF IAL Note: Three family dwellings 35, 000 cubic feet or la to comply with State Building Code Section 127. 0, Construction lControlquired HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which aibuilding permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person (s) for hire to do such work, that such Home Owne shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix 0, Rules and Regulations for . licensing Construction Supervisors, Section 2. 15) . This lack of awarene often results in serious problems, particularly when the Home Owner hires unlicensed persons: In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home ''Owner acti: as supervisor is ultimately responsible. , To ensure that the Home Owner is fully aware of his/tier responsibilities, ma: communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. r, t f f y � � �'', � g �. ' � l�.- �� ,t ,:� � � � ,�,. �� i ! �.~---°-- ; , ; � j � , � ' , �..,� lr i . - ----�-� ,, i Q {� ' i � � //, q ,. j / f,/ /_i'� 1� .� ,� \� \`•\ � �� i `� { I �l I � i \\� I ._, ! ._\,\` �`� f i ; i` ; ' _ � ' �,�, n i �� - i. � � j . i _ .Y.-__�___,. f t I � Jj i f� 1 � { � _ _ t'r i' I1 f d �`fir � f � � i . � __—� I J F n.... ... .Y �. �..'� ; i __ _ .- ....v� ' � t(11]11] iI '. �' � ::�.rey... 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