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0286 SUDBURY LANE
i; �, { �'! _� i ,� 1 / 17119 o►/!EO eca n,Jz7- i f - t.p '9 Application number. A a9 4� Fee............... .................................. ................. 4 � zp, , �7jf., ,. _ Building Inspectors Initials...... ... .................... 46 Date Issued.*... .l,................. 0 Map/Parcel............::................................................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ` ROOF/SIDDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION: -= Address of Proj ect:= Au: sj k,v o2te&l NUMBER S ET LAGE ' Owner's Name: bsk____ S 1 l vOL; CPhone Number- `77 Lj 3 63 Email Address: Cell Phone Number` p - • v Project Bost V a;3 f7 0 ` Check one,�ResidentiaL, Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF:WORK, Siding 0 Windows (no header change)# Insulation/Weatherization Doors(no header,change)# , Commercial Doors require an inspector's review Q Roof(not applying more than 1 layer of shingles) Construction Debris will be going to ` J_QW ) O0 dl&2Q_�-b 6ko�L.; Ank P� CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License.# '° (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or>Yes ' No___,if yes, a gas permit is required. Natural Gas Yes No ,if yes, a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9.30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number �-� �� Cell or Work number 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 ins ction procedures,specific inspections and documentation required by 780 CMR and the Tow f Barns able. Signature Date APPLICANT'S SIGNATURE Signature L .Date CK 0 q'. All permit applications are subject to a building official's approval prior to issuance. r The Commonwealth-of Massachusetts Department of Industrial Accidents Office of Investigations- 600 Washington Street Boston,AM 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): O S S t Address: G -S y CCity/State/Zip: A ti x Phone#: Are you an employer?-Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 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 workingfor me-in an capacity. employees and have workers' Y P n'• 9. ❑Building addition o [No workers'comp.insurance comp,insurance.: 10.❑Electrical repairs or additions required.] - 5. ❑ We are a corporation and its P 3 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL -12.❑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: F- 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 - insurance coverage verification. I do hereby certify and t e pains an penal es of perjury that the information provided above is true and correct. Si ature: -j 2 Date: < - Phone#:�-7 53 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-contractors)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: 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/dila y `!.. ..�.......T. ....... W5 Application number.........l +3 ► ``' ` Date Issued... �..�. ....4. ....................... B............... Building Inspectors Initials. N (n Map/Parcel............ ".......................................... TOWN OF BARNSTABLE � �. EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES[WEATHERIZATION PROPERTY INFORMATION Address of Project: LP NUMBER STREET VILLAGE Owner's Name: 7]> l/0, Phone Number Email Address: Cell Phone Number Same- ao a� Project cost$ 3.a CO Check one Residential__ _ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR T Owner Signature: Date: TYPE OF WORK ...*:. 4 r change)# Insulation/Weatherization . �idin Windows (no header �_ . g Doors (no header change)# Commercial Doors require an inspector's review 0 Roof(not applying more than 1 layer of shingles).. Construction Debris will be going to��1 ivi l m is je O� CONTRACTOR'S INFORMATION on it Ctractor's name ` ^.r � Home Improvement Contractors Registration(if applicable) # (attach copy) Construction Supervisor's License# (attach copy) �. I . Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN. .Ilrrno►i- AoounveI ► PIMRF d PERMIT CAN BE ISSUED. j t a APPLICATION NUMBER............................................................ . *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions ofeach Tent X X X Additional tent"dimensions can be attached on a separate piece of paper., Check one: this event is a: for profit non-profit,event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site'plan with the location(s)of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel T e YP Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Home owner's s Name:: p S, �l/y--- Telephone Number . Cell or Work number 7?14-3s3 73 99 I understand my responsibilities under the rules and regulations for or Licensed Construction Supervisor in acco ce with 780 CAM the Massachusetts State Building Code. I understand the construction ' sp tion procedures,specific inspections and documentation required by 780 CMR and the To f Barnst ble. Signature Date p t PLICANT'S SIGNATURE Signature Date 0 f- l S . 19 All permit applica 'ons are subject to a building official's approval prior to issuance. r The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations "600 Washington-Street Boston,MA 02111 wyvwxws.gov/dia 'Workers, Compensation Insurance Affidavit:Builders/Contractors/El Pctri�cians {umb bs Applicant Information Name(Business/Orgmizatiodndividual)' Address: Phone City/State/Zip: #: Type ofproject(required): Are.you an employer?Check the appropu4bor. a general aoniractor and I 6 New construction 1.111 am.a employer with have hired the sub-contractors employees(full and/or part-time).* listed on the attachd sheet. 7. ❑Remodeling er- arUmm 'on proprietor or a Demolition ro P have 2.❑ I am a sole p p These sub-contractors 8. ❑D ship and have no employees employees and have workers' 9 Building addition working for me in any capacity. # o workers'comp.insurance insurance. 10.❑Electrical repairs or additions [N 5. ❑ We area corporation and its required.] officers have exercised their 11.0 Plumbing repairs or additions 3. I am a homeowner doing all work right of exemption per MGL 12.0 Roof repairs LP myself[No workers'comp. c.152,§1(4),and we have no 13.0 Other insurance required.]t employees.[No workers' comp.insurance required.] ensationPolicyinformation *Arty applicant that checks box#1 must also fill out the d below and then hire o twing their side CDahactors must submit a new affidavit indicating such. t homeowners who submit this affidavit indicating they g the name of the sub-contractors and state whether or not those entities have $Contractors that check this box must attached an additional sheet showing policy number. l ees,they must provide their workers'comp.p �9 employees. If the sub-contr�rs have emp.oy and' I am an employer that is providing workers'compensation insurance for my employees• Below is the p oU4job site information. ` Insurance Company Name' Expiration Date' Policy#or Self-ins.Lic.#: City/State/Zip: Job Site Address: the policy number and expiration date). Attach'a copy of the workers'compensation policy declaration page(showing P imposition of criminal penalties of a under Failure to secure coverage as required der Section 25A of MGL c.152 can lead to the fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form be forward d to the of a STOP WORK OfficeORDER a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may Investigations of the DIA for insurance coverage verification. the and p aloes ofPerJur1'that the information provided above is true and correct I do hereby certify P Si e: a Date: ` t Phone#: Official use only. Do not write in this area to be#co niPleted by city or town offici al Permit/License# City or Town: Issuing Authority(circle one): p Inspector 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing 6.Other Phone#: Contact Person: 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 iii 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 constrict buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage*required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited 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 pmmit/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 (Le.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 ep ep fax number: The 6mm=We4th of Massachusetts' 4 Department of Indust W Aeddents Me of Iuvesta • ' . gam 600 Washington St=t Bow,MA 02111 Tel. 617-727-49 0 ext 406 or 1- -I ASSA Revised 4-24-07 Fax#617-727-7749 WWW.mass.90VIdia Date: 09/21/2017 To: Building File ' From: Robin C. Anderson,ZEO Re: Complaint-Unreg vehicles Location: 286 Sudbury Lane,Hyannis t Zone: RB Also Present: Bob McKechnie Conditions: Cloudy, light rain, occasional wind gusts (remnants of Hurricane. Jose) Property: The dwelling is 3 bedroom, 2 bath ranch constructed in 1984 on J9 acre and situated on the end of a cul-de-sac. It has 2 driveways: Complaint: A concerned citizen registered a complaint about the growing number of unregistered vehicles at this site. First there were two now there are 5 or 6. Not sure if anyone is residing in the house. No sign of children since school started. lnspection: Reported to the site on 9/20/17 at 3:45 PM. Observed 2 cars and a trailer in driveway on right,.side of house. Observed"a classic car=red impala(no plate), van(with plate)jeep ` and 3 other vehicles (unable to see plates if any) for a total of 6 vehicle in driveway on left'side. Zoning:Chapter 240 Section 11 This.property is located in the RB single family district. The renting of rooms to three unrelated lodgers is allowed. Achori )✓misted aid of COA Gallant to have PD check status of vehicles. She notified the DC. Action pending. Date 09/22/2017 Received email from CAO T Gallant advising patrol responded and founded 4 uhreg vehicles BPD will follow up. Complaint closed. Anderson, Robin From: Gallant, Therese Sent: Friday, September 22, 2017 11:13 AM To: Anderson, 13ob.in Subject:,. 286 Sudbury _ r FYI, patrol went out there. 4 Unregistered MV's and they will follow up with them. I've not forgotten 23 Olander either. I'm taking half a day today but will follow up on that one on Monday.. Have a great weekend!!! TG ,+ P.n - f `i 4 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2f0q Parcel. ZCDO Application # Health-Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 2&P Si udbun j_ L Lhe. Villageu aYlY1tS r Owne ' J C��� l l Address 2,g(���lC bukt L �CS Telephone Jr0$- Q " 07 U Permit Request 11h st-ruca vvn . /As77f 0 -.Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new ..Zoning District Flood Plain Groundwater Overlay Project Valuation 1 Construction Type JKing' CoLot Size Grandfathered: ❑Yes ❑ No If yes, portingdpcurmntation. Dwelling Type: Single Family It Two Family ❑ Multi-Family (# units)Age of Existing Structure Historic House: ❑Yes ❑ No On ighway." ❑ ❑ No j 1-- Basement Type: ❑ Full 0 Crawl ❑Walkout ❑ Other rn 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 ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑7Yes ❑ No If yes, site plan review # - Current Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 6ay.-P11) sw'"i Telephone Number �l -�114 -(VAq Address q,QY 605 h ` O K, S lLIM A��License # 10 a 3 Home Improvement Contractor# Email ( SLLL �55�(,�noru I. (�DY�1 Worker's Compensation # WC, 0q9 10 882- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 0 SIGNATURE DATE 106'f/'/V i FOR OFFICIAL USE ONLY APPLICATION# '. DATE ISSUED MAP=/PARCEL NO. i ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION 5 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 'I DAT-Et�CLOSED OUT - ASSOCT' 1ON PLAN NO. � f The Commonwealth of Massachusetts Department of Industrial Accidents , Office of Investigations 1 Congress Street,Suite 100 Boston,MA 02114 2017 wM 5° www.mass.govldia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): HOME DEPOT AT HOME SERVICES Address:2455 PACES FERRY ROAD City/State/Zip:ATLANTA, GA 30339 Phone#:774-275-2139 Are you an employer?Check the appropriate box: Type of project(required): 1.R I am a employer with 20 4. .❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed.on the attached sheet. . 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition ' working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.t ❑ 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 11.❑Plumbing repairs or additions - myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no 1 - employees. [No workers' 13.�Other _n5u l fi On _ 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. lContractors 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:NEW HAMPSHIRE INS. CO. Policy#or Self-ins. Lic. #:WC049101882 Expiration Date:3/1/2015 Job Site Address: City/State/Zip: n rot' i t vA Attach a copy of the workers' compensation po icy declaration page(showing the policy num er 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 insuranc yrage verification.ZI I do hereby certify under the pains nalties of perjury that the information provided above is true and correct. Si ature: Date: Phone#. 401-714-6399 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#: c - Office of Consumer mer Affairs and Business Regulation 10 Park Plaza - Suite 5170 w Boston, Massachusetts 02116 - Home Improvenient:_Contractor Registration t _ Registration: 126893 Type: Supplement Card THD AT HOME SERVICES, INC. - Expiration: 813I2016 ANDREW SWEET 2690 CUM13ERLAND PARKWAY"SUITE�300. — ATLANTA, GA 30339 • � Update Address and r _ ---� -� P return card.iVlark reason for change SC AI ;: zora osn i Address I Renewal ?:- Employment f Lost Card ..a n��r 1(ri/r in(itlrr•fI�/�C�t'"l�Ylllir�itir//� Office of Consumer Affjirs&Business Regulation License or registration valid for individul use only . before the expiration date. If found return to: •�,.. :, HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: '9 i2t3893, Type: 10 Park Plaza-Suite 5170 ,���`'�•� '""P 8i3l2016 Su lemeni Card ira.on pp Boston,MA 02 116 run nr unnnc ccbinC_cc n - THE HOME DEPOT AT HOME SERVICES / ANDREW SWEET 2690 CUMBERIAND PARKWAYS __— u=c aen _ - U• .. .The Commonwealth of Massachusetts Department of IndustrialAccidents d Office of Investigations I Congress Street, Suite 100 e Boston,MA 02114-2017 n".mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): IQ bur-r)& Address: 31 1"l n6on City/State/Zip: l9� rx AA Ol q4, hone#: q7e- ?7 7 Are you an employer?Check the appropriate bog: Type of project(required): 1.ElI am a employer with 4. I am a general contractor and I 6. ❑New construction employees (full and/or part-time).*_ have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling hip and have no employees These sub-contractors have g. Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. Building addition [No workers' comp.insurance comp.insurance. 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 11.[]Plumbing repairs or additions myself. [No workers' comp. . right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no 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 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 certify un r the ' sand penalties of perjury that the information provided above is true and correct Si afore: Date: 4 4✓ Phone#: a7g' 777 " O&aq 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#: CSSL-102535 F DONALD L BURNETT 31 MARION ROAD MARBLEHEAD MA 01945 t;r+G_. 12106/2014 f 1 - Oct 19 14.12:49a Chris Read 1-508-681-8800, p.1 • , 'OAMLI,1'Ut I lt.)1 t�.0 a,ttu •.�u.u,.w ..J. IBran�h Na e: Boston Date: �,% ,r,% �'?� TFID Al-Home Services,Inc. �C� d/b/a The I-lome Depot At-Home Services � �� 908 Boston Turnpike,Unit I_Shrewsbury,MA 01545 Toll Fi cc(�',OO1 hS7-a 18=; Fax(508) 845-6017 Branch NumRyer•31 v Federal ID##75-2698460:1 JE Lic 1f C 02439: RL Cont.Lie# I&27 CT Uc#HIC-0565522.MA Home lhiprcn•cnreatt Contractor Re,.#.12GS9 i .Installation Aiddress: ;y�.�'�' � `-' City - Stle 7_ipc- Purchaser(s): Work Phone: Horne Phone: Cell Phone: 4 —,-17 — [ j [ i Home Address: (If different frc)m Installation Address) City St,uc Zip E- ail Address(to receive project communications and Home Depot updates): DO NOT wish to receive any marketing emails from The Home Depot Project Infor3tnation: Undersigned("Custorster"), the owners of the property located at the above.installation address. agrees to buy: trod THD At-Home Services. Inc. ("The dome Depot") agrees to furnish,dciiver and an�ut�,e for the installation ("Installation") of all materials.ticscribed on the below and on.:the referenced Spec Shect(s). ;ill of which are illcorporatcd into this Conrad by this reference, 1110112 With any applicable State Supj?iement and Payment Summary attached hereto and any Change Orders (collectively, "Contract"): job#• IIDICMLI RLre-11C9 Products: Spec Sheet(s)#: Project Amount ❑Roofing ❑Siding ❑Windows Insulation 3 "7 Goners!Covers Entr Dnors —- ❑Roofing ❑Siding ❑Wiuduws ❑ Insulation ❑Gutters 1 Covers ❑Entry Doors ❑Rooting ❑Siding ❑Windows ❑Insulation []Gutter/Covers []Entry Doors❑ ❑Roiifing ❑Siding ❑Windows ❑Insulation $ - ❑GURCTS/Covers ❑Entry Door.❑ - - I immunt?g%DePasst o!Contract amount due upon execution of this contract Total Conti-act Amount `� 14laine purchasers may not deposit more than one-third ortbe Contract 4mount Customer agrees that, immediately upon completion of the work for each Product, Custonu:rwill exeCule'a Complekon.Certilicate (one for each Product as defined by an individual Spec.Sheet) and pay any balance due. As.applicable. each Cuslomer under this Contract agrees to be jointly and severally obligated and liable.hereunder. . 1 The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Horne Depot or its authorized service provider determines that it cannot porlbrni its obligations due to a structural problem with the home, environmental hazards such as mold; asbestos or lead paint, other saft:ty UonCcrns, pricing errors or because work required to contpiete the job was not included in the Contract. _ E� , ` Pa meat Suatlmar : 'Tlie Payment Surmmry # / included as parl;e�f this Contract; sets I'orth,tile total Contract amount and payments required for the deposits and final payments by Product(as applicable): NOTICE TO CUSTOMER You are entitled to a comple6a)y filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Shorts)before work on that Product is complete. In the event orAermination of this Contract,Customer agrees to pay The Dome Depot the costs or materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date ar termination, plus any other amounts set forth in this Agreement or:allowed under applicable law. THE HOME D�J10,r rvIAY VVYI'1 HOLD APA6UNTS OWED TO- THE.HOME DEPOT FROM THE DEPOSIT PAYMENT OR O'f HEIR .PAYMENTS MADF, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. S. , Acceptance gird Authorization: Customer agrees and understands that this Agreement is the entire agrecncnt hetween Customer ` and The Home Depot with regard to the Products and Installation services and supersedes all prior discussions aril•t«rccnt�nts,either oral or written.relating to said Products and Installation. This Agreement cannot be assigned ur.unrndcd cxc�ht by a writiti- signed by Cnstrnn 'itnd The Home Depot. Customer acknowledges and agrees that Customer has rttad, understands, voluntarily accepts the terms 01 aT has rccc'vcd a.copy of this Agreement. F Submiitted . 1 _ Accepted`by �; ff t s gnats rc tie Sales Consultant's Signauuc D:ue i October 30,2014 TO:Town Of Barnstable RE: 286 Sudbury Lane, Hyannis fl)�j-35' p TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application# e5;10b-7 0C0Lf(orD Health Division � 572 Date Issued 1� Conservation Division Application Fe t-6 Tax Collector Permit Fee O ���•� Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 6 �S J Q U in Village 6 k6b( Owner Address Telephone S�© `l o� 6 6 1 Permit Request % !�7 77- Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay W Project Valuation :6 200 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 1 1 Two Family ❑ Multi-Family(#units) Age of Existing Structured Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No Basement Type: Id Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ��� Basement Unfinished Area(sq.ft) Number of Baths: Full:existing )!�a new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count c Heat Type and Fuel: I1 Gas ❑Oil ❑Electric ❑Other « -i Central Air: ®Yes ❑No Fireplaces: Existing New Existing wood/coalfstove: ❑Yes Q No c�,l Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑ex41ing ❑new size ` s Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION �7 Name L��(, � �iM i'L f �elephone Number s�o Address _ OSE&I41AA �.o License# N tc k U 1 W <i ^) Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE TE /A R� ! . . . . . . .. FOR OFFICIAL USE ONLY k APPLICATION¥ \ ^ DATE ISSUED { , UAP/P RCELNO ' " - ƒ \ ADDRESS ' ® VILLAGE ` OWNER ! . / ATE OF INSPECTION: f FOUNDATION { \ FRAME \ INSULATION \ \ FIREPLACE \ ELECTRICAL: ROUGH FINAL \ \ PLUMBING: ROUGH FINAL fGAS: ROUGH FINAL- FINAL BUILDING z2 /Aop xxc 6 ��o� ��e �■�� . { DATE CLOSED OUƒ, } } ASSOCIATION PLAN NO. ,per The Commonwealth of1{Iassaehusetts Departinefit of Industrial accidents Office oflnvestigations 600 Washington Street Boston,MA 021II , www.m ass.gov/dia Workers"Compensation lusurance.A€fidavit. Builders/Contractors/,Iectricians/Plumbers Applicant Information -Please Print Legibly Name ()3usiness/OrganizatiomUdividual):. �b S�� S AN,f A •A.ddress: v� � C� `71�Vd�� � 'N ` ity/State/Zip: ttYAWN`5 Pf 49 o 6of Phone.#: \- a o o l yy Are you an employer? Check the appropriate box: -Type of project(required): 1.❑ I am a employer with 4• ❑ I am a general contractor and I employees(&I. and/or part_time).* have hired the shb-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 - g• Demolition workingfor mein an capacity. employees and have workers' Y P tY• 9. E]Building addition [No workers' comp.insurance comp.insurance.#" required.] 5. F] We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3 I am a homeowner doing all work ❑ g P myself [No workers' camp. right of exemption per MGL 12 []Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] , ''Any applicant that checks box#T must also fill out the section below showing their waikcrs'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. IContractors mat check this box must attached an additional sheet sbowing the name of the sub-contractors and state whether or not those entities have employees. Tf the sub-contractors•have employees,they must providb their workers'comp.policy numbm lam an employer.that is providing workers'compensation insurance for my employees Below islhepolicy and job site information. Insurance Company Name: t • 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 tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Xdo hereby certi a der the ai s•and enaltfes ofperjury that the information provided above is true and carrect: Sienature: ( � Date: ®- ` O _ Phone.#: `t)® ' Offzcial use only. Do not write in this area,Yo be completed by city or town ofj7c1aL City or Town- Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/ToWu CIerk 4.Electrical Inspector• S.Plumbing Inspector 6, Other Contact Person: Phone#: �pFIHEJp� Town"of Barnstable Regulatory Services �anA IE s $` Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: r ✓L Estimated Cost. 100 Address.of Wo=rk Owner-s-Name Da e_of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law F]Job Under$1,000 Building not owner-occupied UOwner 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: Date Contractor Name Registration No. L ® I OR `), Date �Owner�s Name y Q:fomms1omeaffidav Town of Barnstable �F IME Tp� Regulatory Services + BARNS'rABLE, Thomas F.Geiler,Director MASS. g q,A =a39• ,0 Building Division CEO IdA'10 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 p 1- Please Print DATE: t o. 1 ) .�p 6 JOB LOCATION: 1) j� AA numberl�, ` street village "HOMEOWNER": J Qn J O O C� name home phone# work phone# CURRENT MAILING ADDRESS: �/�NNt� "1 ►ASS Dd bbl 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 minim spectio procedures and requirements.and that he/she will comply with said procedures and requ' eme ts. Sign ture of Homeo r 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 109A.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/cenification for use in your community. Q:forrns:homeexempt r f N i 1+ i I I ±1 �a � '� �� .._.. / ..._ � i � ._ r �� 7 1 ��� � 1 � � p rb �cE . n G 4 - Parcel Detail Pagel. of 3 a � y rth 1IN , �w Logged In As: Pa rCe I C�eta i Thursday, Septemb Parcel Lookup Parcel Info I J Parcel ID`269-260 _ Developer LOT 13 Location 286 SUDBURY LANE -...._ I Pri Frontage 84 �--Wu Sec Road Sec Frontage Village 1HYANNIS �— '� Fire District jHYANNIS� � v_ Sewer ct 2572 �V4 � Road Index 1552 Interactive i �ffil" I oO Owner Info Owner!SILVA, DOSE SELMIR & GENERCY C Co-owner; Streets 1286 SUDBURY LN Street2 city IHYANNIS , State jMA _ zip(0 62 01 Country F Land Info Acres 10.29 use!Single Fam MDL-01� I Zoning Nghbd 10106 Topographyi Road Utilities�— I Location j Construction Info. Building 1 of 1 � YearBuilt 11984 �Str e, ; __._. _ .,.._._.__ Roof f— _'____.._.___.,._W.._.._ _ Ext __._..._______ _.. _._._ e uct lGable/Hip wall Wood Shingle Effect! _____ Roof AC,..._ __.__ ....__.._... Area i 1262 cover Asph/F GIs/Cmp Type None Style Ranch_� Wall Int Dry Rooms wall �, Bed 13 Bedroomsv � - In Bath ModelResidential Floor I Rooms(2 Full _ _.... Grade Average �� Heat i Hot Water Total 6 ROOms —� I Type Roomsl http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=19968 9/27/2007 Parcel Detail Page 2 of 3 Jf " , 1 Story Gas Poured Conc. Heat i._._.._.�._.._.._._.�.__�._ Found- stories( I ry I eaFuel ation ._._.,,,___.___.. £ 40 . Permit History. Issue Date Purpose Permit# Amount Insp Date Comments Visit History Date Who Purpose 7/21/1998 12:00:00 AM Lloyd Kurtz 9/15/1990 12:00:00 AM MIL Sales History_^ �r Line Sale Date Owner Book/Page Sale P 1 12/11/2001 SILVA, JOSE SELMIR &GENERCY C C163647 2 6/27/1997 SILVA, JOSE SELMIR C144942 3 4/15/1984 LEVINE, ALLAN R & SARAJANE C95895 4 11/15/1982 FRANCO, NICHOLAS D TR C90060 ; Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parc( 1 2007 $128,100 $0 $0 $183,800 2 2006 $116,800 $0 $0 $165,600 3 2005 $112,100 $0 $0 $131,900 4 2004 $91,000 $0 $0 $79,100 5 2003 $82,500 $0 $0 $40,000 6 2002 $82,500 $0 $0 $40,000 7 2001 $82,500 $0 $0 $40,000 ; 8 2000 $63,800 $0 $0 $26,000 9 1999 $63,800 $0 $0 $26,000 10 '1998 $63,800 $0 $0 $26,000 11 1997 $57,600 $0 $0 $26,000 12 1996 $57,600 $0 $0 $26,000 13 1995 $57,600 $0 $0 $26,000 14 1994 $56,600 $0 $0 $29,200 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=19968 9/27/2007 i Parcel Detail Page 3 of 3 r �r of 15 1993 $56,600 $0 $0 $29,200 16 1992 $64,400 $0 $0 $32,500 17 1991 $69,500 $0 $0 $45,500 18 1990 $69,500 $0 $0 $45,500 19 1989 $76,500 $0 $0 $45,500 20 1988 $54,500 $0 $0 $19,300 21 1987 $54,500 $0 $0 $19,300 22 1986 $54,500 $0 $0 $19,300 Photos http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=19968 9/27/2007 Town of Barnstable Regulatory Services do * Thomas F. Geiler, Director * BARNSPABLE, Y MASS. Building Division i679' ♦0 A'f039.t6. Thomas Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barn stable.ma.us Office: 508-862-4038 Fax: 5Q8-790-6230 EXIT ORDER DATE: q / Z�- /0-) LOCATION: S t,,-Z 13 c,,-x G, UNDER THE PROVISIONS OF 780 CMR, THE STATE BUILDING CODE, SECTION 3400.5.1, YOU ARE HEREBY ORDERED TO IMMEDIATELY DISCONTINUE THE USE OF THE CELLAR/BASEMENT AREA FOR SLEEPING -- -� PURPOSES. LOCAL INSPECTOR : . SIGNATURE OF RECIPIENT ODEM DE SAIDA DATA: LOCALIDADE: DE ACORDO COM O PROVISORIO 780 CMR, CODIGO DE CONSTRUCAO DO ESTADO, PARAGRAFO 3400.5.1, VOCE ESTA ORDENADO DE DEIXAR DE USAR, IMEDIATAMENTE, A AREA DO PORAO/BASEMENT PARA O PROPOSITO DE DORMIR. INSPETOR LOCAL ASSINATURA DO RECIPIENTE - •✓� pFTHE Tp� J�4 j.„i ik: M U 5 ..i,� y�Pv 0� }vy s,i y £4r t - •13.ei 9 a,' sASBL� 9 nA '4 ) Director 3b39. p�M PIED MA/, a' 61,.Ifflnu flivislon P�srry, CBO Build'Ana k ammissioner 200 Main Street, Hyannis, MA 02601 w w.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Building Department Checklist Date: Location: Lod Cl- Year built: Zoning district: ceiling height (T basement; TP house) after 1973 only sleeping room (70 sq. ft.) smokes egress carbon monoxide detectors # sleeping rooms -.S /Vd £r re ss' Zdh/3lS- s # sleeping rooms allowed septic or town sewer t #kitchens iyr uri ham. Zee Jn t'rv-'-k r. ? apartment ASAAW'0t z exit order yes - a � s , �R�ay►+s r car count and license plate# fire separation if needed mechanicals: make up air NO?' rE/'Xf- 197E proper work clearances other building permit needed electrical permit needed plumbing permit neede �l Town of Barnstable Geographic Information System September 27,2007 z70101 D02 270281 270282 A70�10�94 ram, f_,^ #29 #93 #237 270311 270198 t`J #288 270163 270165 !11 #238V ! 270210 ^ + #5 #�+ 2701761 �r #109 $ f#108 #155 270095 270162 C;zk 270276 n IN 270115 2 r T #300 270166 #1 270280 270312 9571 O 270211 270106 #47 #50 2701 5 #253 } Q #Z50 2701 (? #118 Q 9193 ( [ r r w. #147 r U W 270096 O !#306 #4 1 `1trF 27 7Z 0" 2 212 91835 c.a #h2 _, 2701 4 270275 2 3 9 �! #130 p - ( , y #1391 #1441 2031327 t 0187 #312 270160 f ► rea #262� 270375 jj #33 270168270314 #146� 270104 T #154.' � 270173 � t_270218 #1360 #173 270278 '#139 270 097 270159 #131 270274 #273 r . 9320 270169 #1327 <270316 #26' #444 270103 2701723 270098 270158 #123 J 270277 27031 + #163 328 #17, #283 #167 270170 270318 -ryr #122' �.� 0099 270157 #115 1J ^-g, 336] #9 r; 2�263 269062 2701 r1t fV 2�660 269262 #132 #122 #153+J ` 26 79 #269257 29� ' #135 269178 key 269180 269256 v #4 #110 2690�82 2139259 26926ME #143r1 177 269258_ #290 9123 #2931 �y 269255 r, a. 176 — 269172 i #98 269196 #116 269081 38 7 #7`` 269061003 #133 «- 269150 a. #109 Fj } #� 194OM - O 269063003 Zs #108 O #98 ti90 ° q 269061002 V. 2 2#690380 #8,041 269149 269052 #101 0 n #102 Q 269039 IT CND #380 #27 269148 #398 q �.x < 269063002 269174 in 269042 0 #72 #41 / #73 .s° En #97 t; tri 269- �=269079 -i #94 �3 #1133 j Q C 269147 269061001 Y tff___J U 269030 m #68 -,�#46o z x #e5 27 G 269063001 2C gg1g1 8 � } G �269043 269146 �' M 269078 Y4YY d9 #89`3 #86 4 #21 P1 #63 1y #82 269060 #103 t 1.,.".,#77 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:269 Parcel:260 boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map Owner:SILVA,JOSE SELMIR&GENERCY Total Assessed Value:$311900 are only graphic representations of Assessors tax parcels. They are not true property Co-Owner: Acreage:0.29 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:286 SUDBURY LANE such as building locations. Buffer CC f � R� fit) oc 1 f s 3 f i 6286 Sudbury Ln, Hyannis 9/26/07 s y�glr l C)CD _ n3 [ t + x �z VI/1 '^' • \iJ co 286 Sudbury Ln, Hyannis 9/26/07 f 4� .v� �•� @ � �� 3 �1. 7 It } E g 17 1 l�+ ti r 286 Sudbury Ln, Hyannis 9/26/07 r f ` Town of Barnstable " of HE,, Regulatory Services Thomas F.Geiler,Director Building Division EARNSTABM MASS. $ Tom Perry,Building Commissioner ArE1 µ. a 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 50 790-6230 Approved: Fee: dU Permit#: HOME OCCUPATION REGISTRATION Date: p Name: / i Phone Address:_ /I Village: i Name of Business: Type of Business: /ice Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular . matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. ' • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to - exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant:. � 1/V A` IJ2 ' - 11/01 f Date: Homeoc.doc Rev.5/30/03 TO ALL NEW BUSINESS OWNERS w y DATE: Fill in please: " ' APPLICANT'S YOUR NAME:�l;76d- S�L� " BUSINESS ° YQJJR HOME ADDRESS: O ,6 TELEPHONE Telephone Number Home NA O 1=w IN15. S , TYPE Q1= eu r ii S � IiS"i1HIS A klp r 00CU�AYl01�1 YES N Here you been g�ver� appreval t,ta the b�u4tdar d�vis�a7 YS N4 f MISS Cal 11N55 ' : When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the,business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St.— (corner of Yarmouth Rd. & Main Street) and you will find the following officer:: K 1. BUILDING COMMISSIO R'S OFFICE This individual has en info ed of any permit_requirements that pertain to this type of business. uthorized Si natur ' COMMENTS: 2. BOARD dF HEALTH This individual has been informed of the permit requirements that pertain,to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS' ru(LICENSING AUTHORITY) This individual�q been ed of t I ns' g requirements that pertain to this type of busines -. r. Author *�ized Signature*'` COMMENTS: Business certificates (cost $30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. "SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. I f F� Town of Barnstable flm Regulatory Services � Thomas F.Geiler,Director r r Building Division BAMSTABM MAss g Tom Perry,Building Commissioner RFD MA't► 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fa 508-790-6230 Approved: Fee: �6-Oa Permit#: rMC0190 HOME OCCUPATION REGISTRATION Date: Name: eM n-6 Phone Address: C o(R �� JJ l��'�/ �Y1 Village:_ Name of Business: a-e,�nj V1 a-n — /�, _ _ Type of Business: n r2 /t x�Q.ill^t`( � Map/Lot: � �) / 27(r':zJ INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within o that dwelling unit. • Such use occupies no more than 400 square feet of space. 1� • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,' odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no.commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: Homeoc.doc Rev.5/30/03 TO ALL NEW BUSINESS OWNERS DATE: ... .. Fill in please: APPLICANT'S 7. YOUR NAME:' `f1 BUSINESS ; YOUR HOME ADZRE : 4 TELEPHONE Tele hone Numbme NAME OF NEW BUSINESS t TYPE OF BUSINESS _ C� �-� IS THIS A HOME OCCUPATION? YE NO Have you been given approval from the building division? YES NO ] b2 MAP PARCEL NUMBER ADDRESS OF BUSINESS uAbv When starting anew business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below,you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make s you have all the required permits and licenses.. GO TO 200 Main St. - (c ner . f Yarmouth Rd. Main Street) and you will find the following offices: 1. BUILDING MMI SIO R'S O This individual as ee info ed o re uirements that pertain to this type of business. ed Si nat e COMMENTS: 2. BOARD OF ALTH This individual has been informe of the permit requirements that pertain to this type of business. Authorized Signature* 'COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. -it does not give you permission to operate-you must get that through completion of the processes from the various departments involved. **SIGNIFIES APPROVAL FORA BUSINESS CERT/F/CATEONL Y. r The Town of Barnstable Regulatory.Services - Thomas F..Geiler, Director ��7\ Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Fax: 508-790-6230 Home Occupation Registration Date: Name: 2� Phone#: -��TO Address: �� ����GI�2�/ Y-1 Ay �/�/��LVillage: Name of Business: f--1 )!Q )i ( QY\i�C f C k Q \ \S �F Type of Business:m.� G F)o Pp 6� Map/Lot: prod INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings, subject to the provisions of Section 4-1.4 of the Zoning ordinance, provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector, a customary home occupation shall be permitted as of right subject to the following conditions: The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors, electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials, or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation, and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity, and one trailer not to exceed 20 feet . in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. No person shall be employed in the Customary Home Occupation who is not a permanent f the dwelling resident o g unit. I,the undersigne ave read and gree with he abo"nse occupation I am registering. Applicant: ate: / �✓�` Homeoc.doc 7v� �o� �ra ��z ��/�1 i A.M. FOR �' DATE V TIME. P.M. PHONED RETURNED, PHONE �✓��-� YOUR CALL OUE UMBER N PLEASE CALL- MESS A DO �yzXT CALL �D V �I's WAGAIN. 0 r �'r ILL CAME TO / �� I r kj SEE YOU f _ _ _ WANTS TO `f i�u PA �� SEE YOU SIGNED I1/V2 Sale 48003 NOTES , Building Department Complaint/Inquiry Report Date; / — �� Rec'd by: Assessor's No.: Complaint Name• �t Location Address:• Originator Name:- Street: Vim: State: Zip: Telephone:D/C Complaint 71J Description: Inquiry Description: For OlBcc Use Only Inspector's Action/Comments Date:' Inspector. L2 Follow-up Action 7 .2 so , Additional Info.Attaclied Copy M=i&don: White-Depamnent File Yellow-Inspector Pink-Inspector(Return to Office:lf=2;rr) y�tYr • TOWN OF BARNSTABLE 2�8� Permit No. - ----------- Building Inspector cash -------------------- rua 1639. OCCUPANCY PERMIT Bond _----__X_ y s Issued to, CapAicou ReO-ty TAu t Address .Cot #13 286 SudbuAy :Lame, Hyanni Wiring Inspector �/°' ~�� -"Inspection date Plumbing Inspector Inspection date Gas InspectorQ Inspection date �k \ rrEngineering Department Inspection date /Cl --V-ej vB,�OaoxfRoeoalth Inspection date 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 BUILDING CODE. I ::.....:...:......................................... 19.......�._ ::..,.......................................................,. ...,......................... _............. Building Inspector �) • FROM - TOWN OF BARNSTABLE J. BUILDING DEPARTMENT Mr. Francis Lahte rye kt'4 x a,If FY 1W, C- ,_!.*M7 i FAIN STREET HYANNIS, RA 026M Town Clerk e . Phone: 775-1120 SUBJECT: ' FOLD MERE - - _ S DATE - :p- 1 4-- u M E S S,A G E' Work has- been completed r tier .P rmi „ 2 � Ca r�qar .Rq.Aj Trust).. P�].f'.ase release AQ44 SIGNED tI `�.'•"...,. DATE - r REPLY - SIGNED - N87•RMt RECIPIENT:•RETAIN WHITE COPY,RETURN PINK COPY - PRINTED INU.S.A. SENDER: SNAP OUT YELLOW COPY-ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT.- y Rz 3 <S ' 2 u u v IV S�•f is �, u 2` • \a N ill (h� ..�"'� Z4 7°' �°C,Ja aseac,, 2 7'5 ell o� As CERTIFIED PLOT PLAN S a'o r3 vr°Y L9 t HGC�kR1 `� "� i 3 ` />/s ;Tt/ NEW CONSTRUCTION ONLY ;!;' RUCT d`�`IORE �T0P" OF FOUNDATION 19 ^°�� FEET , f.,_ IN ABOVE L01fi► POINT OF -ADJACENT �4 AAghS f A2,L SSA ROAD. SCALE.- 40 DATE , /2.IIpq GE ENGINEERING CO.IN "�rvc 1 CERTIFY- THAT THE CLIENT SHOWN ON THIS PLAN IS LOCATED EfCIVIL ED ROISTERED -g2I S' ON THE GROUND AS INDICATED AND CIVIL I LAND J.O� NO. ENt#INEER - SURVEYOR DR.®Y+ CONFORMS TO THE ZONING LAWS OF BARNSTABLE , MASS 12 MAIN rSTREETCH.BYE H1 YA N R I S,- MASS. SHEM.L OP DA E RE.G. LAND SURVEYOR THE em TOWN , 'OF BARNSTABLE BUILDING INSPECTOR � � APPLICATION FOR PERMIT TO -..-CV��t���t 3i I ��� �� �����!- � . --.. .. �. .- �419.-.--.-_----. TYPE OF-CONSTRUCTION. ---WnVd--- ...��.-�m�................................................................................................. , ,U ...3l .,.,,,,,,,l9.,.B3 ' | TO THE INSPECTOR OF BUILDINGS: ' The undersigned hora6v applies' for o permit according to the following information: Zm� �� I3 - Sndbury L��e, ' �� Location --------------------'-------.-----------.-..�����e»��x-.---.-------. � ProposedUse ............................................................................................................................................................................. � Zoning District _ B........................................... --r--..Fire District .. ...M.--------------- | Name of Owner .Ca__i�co.rn_Re�Ity_�����.t___..A66re« .7h5..F ..Roadx,. ��x...I��_. � ' Name of Builder Franco Real-Estate..Dev.�. CoA66�so .7.55-F��l����th..Il�}�dx- ��x..�&- � ] � � � � ' -� �. ".(:MWRICORN REALTY TRUST No 25145 One Story .................... Permit for .................................... Sing�,e..Famil.y... ............... .............. ... ........... 3t 1 Location Lot c......286 S:gdj?.qr_v...Lane H y.c-jn Tj i s ................ ................................................. Owra ...Ca,pA:A--.qorn Real:�y. Trust ..... . ........ ........... Typ T Construction' ......K:rame ' ............................... ....... ......;............................................................ PlotU.......................... Lot.................................. Per Granted .......... ..DeR....... ..emb ..r....6..........19 83 Dat Inspection ....................................19 Date Comp t . ................19 3,Z, .... -Engineering Dept.(3rd floor) Map Parcel L4 446ermit# �2_6 J �S House# p� � Date Issued V I Board of Health(3rd floor)(8:15.-9:36/1:00-4:30 F / Fee 0?s 0-?) Conservation Office(4th floor)(8:30-9:30/1:00-2:00) P 00 _ iNE Arillar 19 OL Hag"i ^btu tt3M�8 V ��y TOWN OF BARNSTABLE Building Permit Application ct Street Address Village / �/� /tl/✓!S , Owner Address Z Y6 S41.1�ue4, 111,0iynlLs Telephone -5 'O 7 9- Permit Request 1�Q?1,4GF E xt ST/A)9 deck W f JeG,t -IA4 S,9sytB dt.,77eNS ion First Floor square feet Second Floor square feet Construction Type ,L UM/3 E/Z Estimated Project Cost $ /77.5: Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes XNo On Old King's Highway ❑Yes ,�j 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 No.of Bedrooms: Existing New Total Room Coun t(not including baths): Existing New First Floor Room Count 'Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No i Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name _J 'i Inc�'/q 122/ Telephone Number S-U 9- 76 0 _-0 5-0 Address _S 7 ,4 SP/n/e T Ro Vd License# 0 6 b a 9 e/ S, Y/Ae hV,# D2.66 0 Home Improvement Contractor# //4 Worker's Compensation# 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 ,'Dymi0 SIGNATURE DATE 19 9 7 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY ' Q L PeRMIT NO. ,, _ �`� y J DATE ISSUED`" t t MAP/PARCEL NO- ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION . FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL i s PLUMBING: ROUGH` FINAL GAS: GH FINAL t FINAL BUILDIN �r ! DATE CLOSED *- U ASSOCIATION P� v -t 0tUA/ 2 AZ Li/✓ LEVIq / N� lam 8E/Z 7-0 r'c PIzr=556102ETR T CREZ c2T&.sq trugy /,qN/V I S, lrvl 14 �j-�-' /'GAG S�l:'i�•J 4 I 1 $' pLNcc.s c � m LEDGE.-� //R vGEl2 rye ?x9L ti- p 4X4 ry? j 7rP �f-D �. -4 i 41//I,/J v/ ;,,l:: t2 pt f4/rl T i — " ~ /e avzi�xarecuecc�ll. a`� iI GCLdJCGC/e e,jetlr Restricted To: 1G 81231 s! DEPARTHENT OF PUBLIC SAFETY � . !J CONSTRUCTION SUPERVISOR LICENSE 00 - None Number: E-lpires: Birthdate: !A - Hasonry only CS 060294 101281i998 10128/1929 !G - 1 & 2 Family Homes Restricted To: 1G Failure to possess a current edition of the Massachusetts State Buiilding Code JOHN H HCGARRY is cause for revocation of this license, VB 31 ASPINET RD S YARHOUTH, HA 02664 �`� ✓ HOME IMPROVEMENT ,CONTRACTOR Registration 116174 I Type _::.;,INDIVIDUAL i • Ezpit tioh 05/25/98` "CONST CO MC6ARRY G6ARRY .M? • ADMINISTRATOR-37.ASPINET.:RD F SO YARMOUTH MA 02664 °F THE �M y The Townt of Barnstable • BARNSPABM * C 9� 116jq. Department of Health Safety and Environmental Services ArEDnn►•t°i Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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. Type of Work: i�EPGACE EXIST/rv9 Joe Est. Cost /776- Address of Work: o? 7,61 Owner's Name 41146 / Date of Permit Application: — .6= 97 1 hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT , OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: a?- =9 llv-IdUO Date Contractor Name Registration No. OR Date Owner's Name The Commonwealth of Alassachusetty usi. Department of Industrial Accidents t ` ' Office 8110yes#9211nns 600 1Vashin;;ton Street 4 Boston, Ma.v.v. 02111 Workers' Compensation Insurance Affidavit Applicant,in... formation: _:... ...-_.,__._Please PRIN'i'leb't�l,j,�,,�^ .__..•..--.._ :.- - name: .J D 4 ill mC location: 7 /N= T �and city s, oe�2 /mou�li, phone# S a'�i—760-5 2 Sb I am a homeowner performing all work myself. �,°I am a sole proprietor and have no one�vorktni* many capactiv M. .,; •...fix � :_.� •'•P ,. .s*ter-.��mura:.z't�T-s+^4+q'+rs.:s%2'*3�„err'+r�r.^!.^�.,a..y "�stg^-�+*s*+a..•-.a,.•j,�....y.-a� ^.or.� e..+a�•t+._.,,...... .r....; I am an employer providing workers' compensation for my employees working on this job. company name: address: ----3 7 ASAlNF_% jE"6r4d/ cit: 4Mi'YIdO4, I'Yll9 ahnnc insurance co. policy# ,_ v♦ ...,..�-r,f1......v nlTw• .,;.+A�.�'B� !'n.c• +W 'isk�' T?c sr'1+�. MI••„rs°'.�wywa aaMrr 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: company name: address: city: phone# insurance co. policy# ....: ..... :n:Fi'«:.;�....?yw.: _:.:"'S, 'S'. ..c--•.. •;.c ^-e"^t^:.�-s"'_^,�_y"s r a.r. - x r •.rv,....�i 7 � ...as¢:.ra.►�:a.�..r:...: _._._.,:,+.r:.twir�:..;.t�3_• --.�a'i.�6:s.+.,-...�.�-4 :...�.._.-a'i.__:��.t.av :r..: i`i.�?.•. company name: address: rite phone#: insurance co. policy# :Attach additional sheet if necessary.�. �t-•- r%�ti + ...�x%; �.��„ _r •�•�•'"�r '^^�•�-w-�'�.' ` era " ., �.. _. -- ----..... _...__._._.—__ ...4....... Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a cope of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify to er the pains and penalties of perjuq'that the information provided above is true an correct. Sienature ' Date '5� Print name j d h IV �C�j qgu Phone# 5�g-760-5 Z S O official use only do not Ni-rite in this area to be completed by city or town official Y city or town: permit/license# MBuilding Department C]Licensin-,Board 1]check if immediate response is required QSelectmen's Office 0I1calth Department contact person: phone#; r 1Othcr w _�_..� .i'y sp e:-^''fsrrn••.,r^�»...,N�^'S+,.',,.. T- ,...o .-a .... ...... ..�I.M.Rs.�•4q"�e' (revised Jix)`)1JA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for their employees. As quoted from the "law", an enlpinree is defined as every person in the service of another udder anv contract of hire, express or implied, oral or written. An empl(►rer is defined as an individual, partnership, association. corporation or other legal entity. or anv two or more of the forcgoin`,enga-cd in a joint enterprise, and including the legal representatives of a deccasc>3 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 ,rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter- 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionaliv. neither the commonwealth nor anv of its political subdivisions shall enter into anv 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 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. Tile Department has provided a space at the bottorn 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. Tile affidavits maybe returned to the Department by mail or FAX unless other arrangements have been made. The Office of investications 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. 777 Tile Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations _- 600 Mlashington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 Assessor's map and lot number .... .?Q...:..a. .` ................... / / I Eros Sewage Permitnumber I 6�Q ♦� Z BARISTAILE. i House number .......................... .G.......10- y MAO& ....................... Apo,i6}q. �FQ MPY a� TOWN OF BARNSTABLE BUILDING -INSPECTOR APPLICATION FOR PERMIT TO .........Construct. Sinop Farri.ilv,,Dw Nino TYPE OF CONSTRUCTION .........Idood..Frame................................................................................................. ..Octa�er 31., 19...83 ...3 ................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 1L,ot...#.... :3.........'........ :udbury..Laner..............................................Hyanni .n: ........................... ProposedUse ............................................................................................................................................................................ s� t R.B. Zoning Distract Fire District ..uy.?:an i.S.1...n.............................................. Name of,Owner C.ap.r.icorn Realty Trust: Address .765„Falmouth Roads k•, jAnis4...11r... Name of Builder Franco Real Estate Dev. COAddress .7�5 Falmouth Road, HSrannis, PIA ....... Tnc. ................................................................. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .. 1x........................................................Foundation .....P.C.o............................................................... Exterior Clapboard and/or shingles Roofing ,....•As�ha.lt shingles ............................................................. ............................................................ Floors Carpet................................................................Interior Sheetroc}c Heating F.Ud.A. Plumbing . �Xp........!:g1: ..lp ................................................ Fireplace None Approximate Cost ... ` n.e 000.0O . .. ................... Definitive Plan Approved by Planning Board ---------------____-----------19________. Area 1056 . . 1.0.56... .....ft...................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH r � CFI to t ` W x OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the al:ove construction. �..� Name ....'` �" es :.:: ?...... � .•/?�' " r. ,� 1 "r . Construction Supervisor's License ()00989 ............................ CAPRICORN REALTY RUST A=270-229 ..PL f/.?G a No 25845 permit f One Story Single..Fami lY....Dwe l lin.�............... Location Lot. 13,,,,,.. 28.6...Sudbury,,Lane ..............HY.ann ;s................................................ Owner .Capricorn Realty,,,,Trust,,,,,,, Type of Construction ......Frame,,,,,,,,,,,,,,,,,,,,,,, ................................................................................ Plot ............................ Lot ................................ Permit Granted .,....December 6, 19 83 Date of Inspection ....................................19 Date Completed ......................................19 4 Sri. L o ,c� 1- :..L—* `,. 3 R I oe� a .. t • { 5 e ' .. a v. a •