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Home My WebLink About7A STEVENS STREET S4even Town of Barnstable *Permit# Expires 6 months from issue date uT '^ Regulatory Services Fee . • lARNSfABLE, � MAW s6g9. Thomas F.Geiler,Director ♦0 �ArFD MA't� Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number 30 `1 � CA Not Valid without Red X--Press Imprint --1 0"� � (� Property Address l �j`tE yc—iV 0 a 6c, 0 Residential Value of Work$_ CC) Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address - 4 le)yn 0. Contractor's Name A (QS /BOG` Telephone Number ,gdSa3 7q5q--- Home Improvement Contractor License#(if applicable) �j L�`�-d7- Email: Construction Supervisor's License#(if applicable) 0 l l0 7 X--PRESSBT [Z]Workman's Compensation Insurance Check one: O C T 2 4 2013 ❑ I am a sole proprietor ❑ I am the Homeowner �2] I.have Worker's Compensation Insurance TOWN 0F BARNSTASLE Insurance Company Name 41 Workman's Comp.Policy# C - `—Do .-0000 9:,7 �06— Co of Insurance Compliance Certificate must accompany py p co pany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to le W*Z�l ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. `Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner.must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\ lding permit fo \EXPRESS.doc Revised 060513 E-mail: The Commonweah*of Massachusetts Deparanent o,f Indkstria114ct idenls OKWe of mvestigations s .. 600 Washington Street Boston,MA0211I ",m masmgotvldia Workers' Compensation Insurance Affidavit:Builders/Cantractors/ElectriciansMumbers Applicant Information Please Print Legibly Name(Buse ld�ion&dividwl): (9 le 4_11 Address: 2_0 Citylstate/Zip: 0� Phone#: d "7 Are you an employer?Check the appropriate box: T of project r 4_ I atn a contractor and I � � � [ �= I_�I am a employer with�_ ❑ l 6- ❑Nt w construction employees(full andlor part-time)_* have hire .the sub contractois 2_❑ I am a sole proprietor or partner- listed on the attached sheet 7- ❑Rtmrodelmg ship.and have no employees These sub-oontractors have g- ❑Demolition working far me in any capacity_ employees and have workers' g_ ❑Building addition [No wormers' comp_insurance Comp_insurance 1 5 We area corporation and its 10_.❑Electrical repairs or additions 3_❑ I am a homeowner doing all work officers Im-e exercised their 11_❑Plumbing repairs or additions myself [No workers'comp- right of exemption per MGL 152 12. repairs c. , ❑Roof insurance required-]F �1(�'and we IMM no 13.0'other employees_[No works' comp-insurance required.-]', *Any appba mt that checks boor 91 rmast also till out the section below showing their woxkes'compensation policy informatim t 7 Homeowners who submit this sffdavit indicating they are doing all mak and Bien hoe outside contractors— submit a new afl5idavit mrT�SnICIL (Contractors that check this boot most attached an additional sheet shooting the name of the sub-cmthsctors and state whether ornot those emlities hmm earployees. If the sub-contractors have employees,they mu provide their warkers'comp.policy number I am arc employer that is prm Wng ttrorkets'conipe7mation insurance for rtry employees Below is Ste policy rend job site informa6viL Insurance Company Name: Q (f Policy;9 or Self-ins-Lie-4: [I/G cC4 " 0001)�°� Expiration Date: -5 -/ O I Job Site Address: CitylState/Zip: Attach a copy of the workers'compe$sation policy declaration page(showing the policy numb4 and expiration date)- Failure to secure coverage as required under Section 25A of MGL c 152 can Lead to the imposition ofcriminal penalties of a. fine up to$1,500.00 andlor 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 c,t?rli nder tha ptuns andpenalfies ofpe ury that the information prm�ided aboue rs/bus and correct Signature: 01 Date- Phone�- C> 2 3 ? O f rZir1 axe only. Do not write in this area,to be completed by city or town gficiaL City or Town: PeradtUcense# Lssuing Authority(circle one): 1.Board.of Health 2.Building Department 3.City1rown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone;* 6 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 shaII 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 15.2, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone 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 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. 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 lime. 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 applitations 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 e provided rovided 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: The Commonwealth of Massachusdts Depaitment of Industrial Accidents office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4}4(1 at406 or 1-9 MASSAFE Revised 4-24-07 Fax#617-727-7749 www.massgov/dia llMDaWM Ac:o CERTIFICATE OF LIABILITY INSURANCE aATE 23rZ k - 10/23/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DO ES N OT AF FIRMATIVELY 0 R N EGATIVELY AM END, E XTEND O R ALTER THE COVERAGE AFFORDED B Y THE P OLICIES BELOW.THIS CERTIFICATE O F INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1 NSURER(S),A UTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlflcate holder Is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. if SUBROGATION IS WAIVED,suWect 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 endorsements . PRODUCER CONIAUI NAME: Berkley Assigned Risk Services Leonard Insurance Agency Inc 683 Main St B AAC.Na- 800 034 4589 Ne.: 866 215-8�18 ADokiss: Poll erAces berkle dsk.com OsterVille,MA 02655 INSURE AFFORDING COVERAGE NAIC0 INSURER A: Amflia Inj�ijmnnp Co INSURED Carlos .FIqualfoa INSURER B: dba,C N F Remodellna INSURER C: 20 Captain Noyes Rd INSURER D: INSURER South Yarmouth MA 020N INSURER F: COVERAGES CERTIFICATE NUMBER' REVISION NUMBER: THIS IS YO 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 ISSUED OR MAY PERYAW,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN,IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS Or SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EXP LTR TYPE OF INSURANCE INSR WVO POLICY NuuSER MM/DD MM/OorYYYY UNITS OENERAL LIABILITY EACN OCCURRENCE $ -DAMAGE COMMERCULL GENERAL LIABIOTY 1 RENTED - $ - P EYISES Ea occurrence) ❑CLAMS-woe Flo.COUR ❑ ❑ MED EXP oneperson) $ PERSONALS ADV INJURY 3 GENERAL AGGREGATE $ OEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS—COMPIOP AGO $ [�]1 PRO- $ POLICY 1 I JECT ❑ LOC AUTOMOBILE LIABILIYY ❑ ❑ Ea aCddonl $ ANY AUTO BODILY INJURY For rson) $ AUY OWNED ❑BCMEDULED AUTOS BODILY INJURY er accid"11 a HIKED AUTOS ❑NON-OWNED Per oenldo PERYY P $ AUTOS UMBRELLA LIAB ❑OCCUR (--I EACH OCCURRENCE $ EkCEaa LIAB ❑cLAWS-MADE AGGREGATE $ OEO RETENTION S $ WORKERS COMPENSATION WC STATU, OTN• AND EMPLOYERS'LIABILIYY Y/N TORY LIMITS,❑ ER ANY PROPRIETOR/PARTNERIMCUTWE ® El EACH ACCIDENT $ 500000.00 A OFFICOMEMBER EXCLUDED? NIA p WC-20-20-000092-06 5w2013 5/1/2014 (Llandalery In NH) E.L.DISS'ASE-EA EMPLOYEE $_ 500000.00 I/yes,describe under DESCRIPTION OF OPERATIONS WOW E.L.DISEASE-POLICY LIMIT $ 500000.00 ❑ ❑ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORO IDI.AddlPanal Remarks Schedule.1(more space Is required) Election Category Election Status Name All EnUlieshnsureds: Sole Proprietor Include Carlos Figueiroa Carlos Figueiroa CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE'THE Tara BrooK EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 301 Pine St. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Centerville MA 02632 f6'G19 Ze:. 00�i��aao7coea`!/r,o, __ 99 a�a /zcceelli.F. �UU Q �.: office of Consumer Affairs Business Kegufatwn,. License or.registration valid for individul.use u w : ME IMPROVEMENT CONTRACTOR before the.expiration date If.found return to egistra on 153792 ' Type Office ok:Consum xpiratEgn 1/8/2015 er'Affaars aid Business Regulation DBA 10 Park Plaza-Suite 51.70. s Boston,MA I' ,C.&F:REMO 02116 DELING a CARLOS FIGUEIROA j 20 CAPTAIN NOYES RQ V E S.YARMOUTH* MA 02604 Undersecretary. Not valid without signature'::" Massachusetts -Departm7anda Safety y of Building Regulat Construction Super is License: CS-104107 `CARLOSHFIGU)EYRO20 CAPTAIN NO�'EsgWSOUTH YARMOUT40% 02lit Commissionern5 a j i �'ME roy� Town of Barnstable ° Regulatory Services RAIMST• hUssss..I'E Thomas F.Geiler,Director 1639• Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder -,as Owner of the subject property hereby authorize C,61 �ds . T' u ti rna to act on my behalf, in all matters relative to work authorized by this building permit. IA L- �- c.s (Address of Job) r Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. I Signature of Owner ' Signature of Applicant Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 62012 Town of Barnstable Regulatory Services " Thomas F.Geiler,Director '16�Eo.19. 1. 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 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNIER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner 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 t amend and adopt such a form/certification for use in your community. C:\Users\decollflc\AppData\Local\Microsoft\Windows\Temporary Internet Files\ContentOutlook\QRE6ZUBN\EXPRESS.doc Revised 053012 I Parcel Detail Page 1 of 3 ro4i 1 yt Logged In As: Parcel Detail Thursday, October 242013 Parcel Lookup Parcel Info ParC@1'309-211-OOA _ _I Condo U�1 ID Unit' Condo, ......... ......... ........ Complex!WINTER SET WEST Building .............- .. .......... .._..---_ rl .......-- Location 17 STEVENS STREET 145 Frontage Sec __ -- ---- . Sec Road Frontage Fire Villa g e HYAN N IS - -------------•—----____ HYANNIS District Town sewer exists at this Road 11535 address Yes Index' 7 Asbuilt Septic Scan: Interactive 30921100A_1 Map Iv- Owner Info CO- Owner P 0 O X DI 2 E A TR owner 1ST V INTER TRUST Owner Streetl(P o Box 1142 � � Street2 y __ - --� State!M ,. ._ city IOSTERVILLE Zip 02655 Country Land Info Acres 10 j Use l ondominiu M6L-05 Zoning oM Nghbd(0001 J Topography F ______.__._ - ' Road ............ Utilities Location Construction Info Building 1 of 1 _. _ Year j�982 � Roo � I Ext�-- Built' Struct Wall' Living,i940 I Roof � AC;None,..... Area Cover Type Int Bed Styleond cominium Wall Drywall I Rooms I2 Bedrooms Int Bath http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=25393 10/24/2013 � r �4 Y v l e- Vq 9--_k,46 dv mo 6 w 0, b -Af ` T E J I _. _ + . 1 t f ii. + ` • S i ., ✓^ \. I I i The Town of Barnstable Department of Health, Safety and Environmental Services . = Building Division NAM r ,0�' 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Regis=tion 33 Date: Name: Phone ks-d8 I I — I 5 Address• ✓ ` village: i lea► ) C6Map7lot• Type of Business:,. — INTENT. It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dweIIings,.subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in ttA is above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of tight subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling trait,located within that dwelling um L • Such use occupies no more than 400 squarc.feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residenual volumes. • The use does not involve the production of offensive noise.vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,hare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous matcrials,or flammable or explosive mate:iats,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up=&not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to e=eed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • ffthe Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the I.the tmdersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: �+ Date• ! 90 Homeoc.doc