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HomeMy WebLinkAbout0000 TOWNHOUSE TERRACE �o�unha�se, � �� ��c�os J`�v�a.� old s Y Parcel Lookup U, S+C'Y►'� Same PAY p kr, �u l + �` QG l S QA-e Page 1 of 3 G-,(-- L,(-) � w)oc d 'u. 61 Logged In As: Parcel Lookup Tuesday, November 4 2014 Road Lookup Condo Lookup Multiple Address Lookup Reports Search Options Search By Street -� rt T Street#Seet r_ Name townhouse Village Hyannis _ Search- <Prev Next> Page 1 of 1 Rows/Page: 75 Parcel Location Owner Village Index Map 290-104- 2 TOWNHOUSE COURT VINTZILEOS, LAZAROS S HY 1731 2901040AA OAA 290-104- 4 TOWNHOUSE COURT MATEVOSIAN,ARAXY D ET AL HY 1731 2901040AB OAB 290-104- OAC 6 TOWNHOUSE COURT IRELAND, LYNN A HY 1731 2901040AC 290-104- OAD 8 TOWNHOUSE COURT MATSCHULLAT, ROBERT W&ARIANE M HY 1731 2901040AD 290-104- 10 TOWNHOUSE COURT STANLEY, JOSEPH HY 1731 2901040AE OAE 290-104-OAF 12 TOWNHOUSE COURT HORGAN, STEPHEN P&CAROL A HY 1731 2901040AF 290-104- 14 TOWNHOUSE COURT ENGELMAN, ROBERT&SARAH HY 1731 2901040AG OAG 290-104- OAH 16 TOWNHOUSE COURT RIVERS, CATHERINE HY 1731 2901040AH 290-104-OAI 18 TOWNHOUSE COURT GREEN, PENELOPE T HY 1731 2901040AI 290-104-OAJ 20 TOWNHOUSE COURT DALEY, JEAN M TR HY 1731 2901040AJ 290-104- 22 TOWNHOUSE COURT KYLLONEN, MIRIAM G HY 1731 2901040AK OAK 290-104-OAL 24 TOWNHOUSE COURT CHARLTON, DONALD F HY 1731 2901040AL 290-104- OAM 26 TOWNHOUSE COURT NI,YUANKUN&WEI, HONG HY 1731 2901040AM 290-104- 28 TOWNHOUSE COURT LEACH, GERALD E& KATHLEEN M HY 1731 2901040AN OAN -104- 8 TOWNHOUSE ORPIN, MARILYN L HY 1732 2901040CE OCE TERRACE 290-104- 10 TOWNHOUSE SALDI, DIANE N HY 1732 2901040CD OCD TERRACE 290-104- 12 TOWNHOUSE SPINA, MICHAEL J HY 1732 290104000 OCC TERRACE 290-104- 14 TOWNHOUSE http://issgl2/intranet/propdata/lookup.aspx 11/4/2014 Parcel Lookup Page 2 of 3 Z. OCB TERRACE BAGLEY, JOSEPH L& LINDA S HY 1732 2901040CB 290-104- 16 TOWNHOUSE ZIBART, KITTLER B HY 1732 2901040CA OCA TERRACE 290-104-OBZ 18 TOWNHOUSE SPARROW, MICHELE L&WILLIAM W HY 1732 2901040BZ TERRACE 290-104- 20 TOWNHOUSE ALLEN, MARTIN&DELORES HY 1732 2901040BY OBY TERRACE 290-104- 22 TOWNHOUSE OBX TERRACE BEZANSON, CHARLES G JE HY 1732 2901040BX 290-104- 26 TOWNHOUSE ESTRADA, ILIAD M &GRAY, DORIS KING HY 1732 290104OBW OBW TERRACE 290-104- 28 TOWNHOUSE BUTTERFIELD, KENNETH L& MARILYN V HY 1732 290104OBV OBV TERRACE TRS 290-104- 30 TOWNHOUSE STETSON, LOIS W HY 1732 2901040BU OBU TERRACE 290-104-OBT 32 TOWNHOUSE DESHARNAIS, ROBERT L&VIVIAN V HY 1732 290104OBT TERRACE 290-104- 34 TOWNHOUSE BALEGNO, MARY E HY 1732 290104OBS OBS TERRACE 290-104- 36 TOWNHOUSE MAHAN, KATHLEEN M HY 1732 2901040BR OBR TERRACE 290-104- 38 TOWNHOUSE HOPKINS, JAMES A HY 1732 2901040BQ OBQ TERRACE 290-104- 40 TOWNHOUSE MCGRATH, CHRISTOPHER J & DEBORAH B HY 1732 2901040BP OBP TERRACE TRS 290-104- 42 TOWNHOUSE COHEN, PHYLLIS HY 1732 2901040BO OBO TERRACE 290-104- 44 TOWNHOUSE BIRK-MAC CONDO, LLC HY 1732 290104OBN OBN TERRACE 290-104- 46 TOWNHOUSE MCGOWAN, LAUREN L HY 1732 2901040BM OBM TERRACE 290-104-OBL 48 TOWNHOUSE RESENDES,JOSE F&MARIA HY 1732 2901040BL TERRACE 290-104- 50 TOWNHOUSE HOWARD, CAROLINE MCBURNEY HY 1732 2901040BK OBK TERRACE 290-104-OBJ 52 TOWNHOUSE LOCONTO, DOROTHY A HY 1732 290104OBJ TERRACE 290-104-OBI 54 TOWNHOUSE THAYER,ANDREA C TR HY 1732 2901040BI TERRACE 290-104- 56 TOWNHOUSE LANTOS, ROBERT L&SANDRA L HY 1732 290104OBH OBH TERRACE 290-104- 58 TOWNHOUSE KILROY, PEGGY TR HY 1732 2901040BG OBG TERRACE 290-104-OBF 60 TOWNHOUSE SHANK, KERRY LYNNE HY 1732 290104OBF TERRACE 290-104- 62 TOWNHOUSE MCARDLE, DONALD L&SUZANNE F TRS HY 1732 2901040BE OBE TERRACE 290-104- 64 TOWNHOUSE KOCHAVI, PHYLLIS& DORON TRS HY 1732 290104OBD OBD TERRACE 290-104- 66 TOWNHOUSE LUBOSKY, NATHAN J & DONNA J HY 1732 290104OBC OBC TERRACE 290-104- 68 TOWNHOUSE LUMENTI,ANTHONY C&KAREN HY 1732 290104OBB OBB TERRACE 290-104- 70 TOWNHOUSE HARSFIELD, KAREN S HY 1732 2901040BA OBA TERRACE http://issgl2/intranet/propdata/lookup.aspx 11/4/2014 Parcel Lookup Page 3 of 3 290-104-OAZ 72 TOWNHOUSE JOHNSON, KELTON D& BEVERLY L HY 1732 2901040AZ TERRACE 290-104- 74 TOWNHOUSE HALPERN, ROBERT B HY 1732 2901040AY OAY TERRACE 290-104- 76 TOWNHOUSE OUELLETTE, RUTH A HY 1732 2901040AX OAX TERRACE 290-104- 78 TOWNHOUSE FERNALD, SUSAN L HY 1732 2901040AW OAW TERRACE �fl 290-104- 80 TOWNHOUSE KERSTIEN, PAUL S&JANET C HY 1732 2901040AV OAV TERRACE 290-104- 82 TOWNHOUSE LEWIS,WILLIAM J HY 1732 2901040AU OAU TERRACE 290-104-OAT 84 TOWNHOUSE SKLAR, MICHAEL B TR HY 1732 2901040AT TERRACE 290-104- 86 TOWNHOUSE BAKER, MARLENE B HY 1732 2901040AS OAS TERRACE 290-104- 88 TOWNHOUSE FRY, MICHELLE TR HY 1732 2901040AR OAR TERRACE 290-104- 90 TOWNHOUSE EVANS, GEORGE P&COYLE,ARTHUR M HY 1732 2901040AQ OAQ TERRACE 290-104- 92 TOWNHOUSE KEEFE, JOHN W TR HY 1732 2901040AP OAP TERRACE 290-104- 94 TOWNHOUSE BOTTINO, DENNIS&AMELIA R HY 1732 2901040AO OAO TERRACE http://issgl2/intranet/propdata/lookup.aspx 11/4/2014 L4V9 q�a �� � b e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ® Parcel 4/) Application # 7 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 ��_ � >o�''�''NOu��r 7L A4LM CC Village HYA n'N oS Owner rr►Je; 62ab� Cow 0® (N-S C. aC Address o?6_TOWrJ 8ovS 6 �_V-fz t c5: Telephone S®9- 3�s' q�q g Permit Request Rl:-RdOC%vS 4,. �^ 3 A Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other - s`h Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wo coal stove: ❑rYaos ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn:"0 existing .0 new; size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: - Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ r Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �L6dily � Telephone Number s Address ��_ q-z:,I Sri- �- License # /G O Home Improvement Contractor# /53 7 Email Worker's Compensation # C Au y2,5�i1�,4 . ALL CONSTRUCTION DEBRIS RESULTING OM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE Q X;11116 FOR OFFICIAL USE ONLY - APPLICATION # _DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING f' DATE CLOSED OUT ASSOCIATION PLAN NO. R v j • ?7ie Cornuioinvealth of-Vassachusetts Departrnent of ri dustrial Accrdercts Offi- e oflnvestigaiiorrs r 600 Washington Street Boston,-414 02111 }E'FOR H"l as3:.govIdia 'Warkers' Campensat on Insurance Affidavit-Bmidei-s/C+ontractursJElect icianslPlumbers Applicant Infai at �+ Please,Print Legib 1ly ame�115ffi�SSi' SDIZa�l�nl6n n �}: C 90 Address: lty/sf3tfi- _ Phone 4 r De Are you an employer?Ch_ekthe appropriate box: Type of project(required)_ . I am a general contractor and I T_-Q I am a employer with ❑ 6. New construction employees(full andfor part-time)-* have hired,the sub-contractors ❑ 2.❑ I am a sole proprietor or partner- listed on.the attached sheet. 7. ❑Remodeling These sob-contractors have slug and have no employees. $_,❑Demolition wodring for me in any capacity. employees amdhave workers' [No❑;ork-ers'comp.insurance comp_insurane�# 9. ❑Building addition e required] $. ❑ We are a corporation and its 10,❑Electrical repairs or additions 3. lam.a homeowner officers have exercised their 11: Plumbin re airs or additions ❑ er doing all work ❑ g p o ' right of exemption per.MGL �'set£� workers comp- 12.El Roofrepairs § insurance required.]T c.152, 1(4k and we have na employees.[No workers' 13_❑other comp.insurance required.]! rlava €ican6:�Fiatchecksbox91mustalsofilloutthesection.bclowshowin their c ensatiwa o" - � g �P policy information_ t Homeoamers who submit this d£idavu indicating they are doing all woak and then hoe outside contractors armst submit anew affidavit indicating sucIL fCantractors that rhea This ba x must attached are additional sheet showing the name of the sub-contrzaors and state whether.or not those eruitks have employees. Ifthesub-coatnicturshave employees,they=nT provide.their worken'romp.policy number. I a7rt a77 e7reptvy r tlta is proxziding,�t�arkers'contpe7tsa1ro7t i�isnrarfce for Erik*¢nzplay�ees Beloav is Cite policy and jobs situ it7forarafia7t. Insurance Company Name: t a Policy#or Self-ins-Lie.--A: C � ,���j �� I �JO�iq EXpiratioaDate: y Job Site A,dds ess:T 2 • � � -(�l.Gi t �i�-�1A cl�-(2.. City/StatelMtp: /��.Q/✓it/t - 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$1,540:Qa andlor one-year imprisonment,as well as civil penalties.in the form of a STOP WORK ORDER and.a Eme 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 D for insurance coverage verification. I do hereby cert7f1"r7t tRpai7ts aitdpetiabiaes 46fpe.July'tlrattlte infbrmatio7>prm2rfed ab4m a fs true aiid correct Sitmature: �. Date: / Pho CJ0 3 7 a Z t7,,f vial use alily. Do not mite in this area,tv be Completed by City ortolvil ofciat City or Town: P'ermitUcense# Issuing kuthor€ty(circle one): 1.Board of Health 2.Mudding Department 3.CitylTown Clerk d.Electrical Inspector S.Plumbing Inspector 6.Other Contact Persons Phone#: n� bafarmatian and Instructions , Massachusetts General Laws chapter 152 respires all employers to provide workers'compensation for fir employees. p m this fie,an ezrplayee is defined as.`-.every person in the service of another under any contract of hire, express or implied,oral or Misr " An enprcyer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more ` of the foregoing engaged is a Joint mtL r, e,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partaersbip,association or other legal entity,employing employees. However the than three apartments and who resides therein,or the occupant of the - owner of a dweIIimg horse having not more dwelIi ag house of another who employs persons to do maintenance,construction or repair work on such dweIling house or on.the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25CP also sties 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 ms�ance.coverage required-" Additionally,MCrL chapter 152, §25C 7)states"Neither the commonwealth nor any of its political subdivisions shall Mt(-If into any contract for the performance ofpnblic work until acceptable evidence of compHaucewith the insuranc0. requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the wolicere compensation affidavit completely,by checking tie boxes that apply to your sitnation and,if necessary,supply sub-contractors)name(s), addresses)and phone number(s) along with their cerfficate(s) of in c�ce. Limited Liability Companies(LLC) or Limited Liability-Partnerships(LLP)with no employees other than the- members or partners,are not required to cagy workers' compensation insurance. lE an I LC or LLP does have employees, a policy is required. Be advised that this a$dayit 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 retomed to the city or town that the application for the permit or license is being requested,not the De-partmeaf of Industrial Accidents. Shouldyou have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-fi mm-an ce license number on the appropriate line. City or Town O fd a T.c t . . 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 permitllicense number which will be used as a reference number. Iu addition,an applicant that must submit multiple perruit/limnse applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should:trite"all locations n (ciry 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 Hcenses Anew affidavitmust be,fiIled 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 burn leaves etc.)said person is NOT required to complete this affidavit bke to thank you in.advance for your cooperation and should you have any questions, The Office of Investigations would please do not hesitate to give us a call. The DepFtracafs:address,telephone and fax number: Ca of Massaohusf--tts • Degarbmen�cif�udial A�ci�ent� f�fFit�e�f�"ve�g�tio.� 600 WasbiVoll S=t Bostm.,MA Q� I I I Tf,-1.4 617` 27-49QO Qxt 4`06 or 1,3-77 1vS A SAFE Fax 8 617-727 7749 Revised4-24-07 vj mas.5-gotr/dia W Town of Barnstable. Regulatory Services � Richard V.Scali,Director Nua 1 Building Division_ Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I. PV0110vii- cot/Do Dk S®e- , as'Owner of the subject property hereby authorize 4f C' to act on my behalf, in all matters relative to work authorized by this building permit application for. 4. ' (Address of Job) **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 spections are performed and accepted. 1 SWiutJ of Owner 5' t7ekof Applicant Wo tint Name Print Name 0 6 Date QTORMMOWNERPERIMSIONPOOLS r - �c /YYYY) - ��- CERTIFICATE OF LIABILITY INSURANCE FDATE os(MM/DD(MMIDD1s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ONTAC NAME: Rebecca Powers LEONARD INSURANCE AGENCY PHONE t. (508)428 6921 FAx A/C No: MAIL A Rebecca ADDRESS: @LeOnarda enC .COm 683 MAIN STREET SUITE B INSURERS AFFORDING COVERAGE NAICN OSTERVILLE MA 02655 INSURERA:-AIM MUTUAL INS CO 33758 INSURED INSURER B: C & F REMODELING INC INSURERC: INSURER D: 20 CAPTAIN NOYES ROAD INSURER E: SOUTH YARMOUTH MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER: 84980 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE T RE TE PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG $ PRO- OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION _ /� STER ATUTE OERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? NIA NIA NIA AWC40070324242016A 04/30/2016 04/30/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS l LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more apace Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. .CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Hall Of PrOVInCetOWI'1 ACCORDANCE WITH THE POLICY PROVISIONS. 260 Commercial St. AUTHORIZED REPRESENTATIVE Provincetown MA 02657 Danlel:M Cr y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-21114 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks Of ACORD Town of Barnstable Regulatory Services f - $ Richard V. Scali,Director , Nua Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 . Fax: 508-790-6230 Property Owqrr MU*St Complete and Sign This Section If Usi= A Builder I as Owner of the subject property hereby au orize f )r 96-14d 14�Lf r4 6, to act on my beh4 in all matters relative to work authorized by this building permit application for. 17Y- IY j—oAmjse I-weer NY'fPNo S (Address of Job) i **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 accept S' a of6wner \ S' tore of Applicant i 16�� Prin Name Print Name Date i QYORMS:OWNERPER WSSIONPOOLS Town of Barnstable Regulatory Services dFt Richard V.Scali,Director Building Division sULRNWAEMX Paul Roma,Building Commissioner Musa 039. 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 "HOMEOWNER": 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- this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for'use in your community. Q:\WPFU,ES\FORMS\building permit fomnslEXPRESS.doc 06/20/16 Bl,c 29040 P's 34r5 imor-36120 07-28-2015 0'1 02 = 35P PINEBROOK CONDOMINIUM TRUST 25 TOWNHOUSE TERRACE HYANNIS, MASSACHUSETTS 02601 NOTICE OF ELECTION OF TRUSTEES In accordance with Article II, of the by-laws of Pinebrook Condominium Trust recorded in the Barnstable County Registry of Deeds,dated September 16, 1971, Book 1530,Page 132, Instrument#39989,Notice is hereby given of Election of Trustees. The undersigned hereby certifies that, pursuant to the vote held at the annual meeting of unit owners on July 25,2015 at the Community Building,the following unit owners were elected to be the duly constituted Trustees of the Pinebrook Condominium Trust of Hyannis: Names &Addresses Term Expires 4th Saturday of July of the year: Marti Baker, 86 Townhouse Terrace 2018 Catherine Howard, 50 Townhouse Terrace 2018 Executed as a seal instrument this day of 0" 2015. Linda Bezanson Secret COMMONWEALTH OF MASSACHUSETTS Barnstable, ss S� , 2015 Then personally appeared the above-named Linda Bezanson, and acknowledge the foregoing instrument to be of her free act and deed, before me. - ,..y Public JOSEPH R. PACE WA My Commission expga0Notary Public �. � Commonwealth of Massachusetts a` •'v av 't ��:. My Comm.Expires September 25,2020 S))fflltlti�a�`�` ` BARNSTABLE REGISTRY OF DEEDS' John F. Meade, Register �1a�/�� TOWN OF BARNSTABLE BUILDING P RMIT APPLICATION ., tw S�© l� 'aMap Parcel Application 1 Health Division NgTP��� Date Issued Conservation Division 10WN OF 6 Application Fee Planning Dept. Permit Fee ,'''�6 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 86 9 Tb ;-J Ho -C t T&)i2A CC Village 1YAlJ tJ a S Owner 40ti-0 0 RS S IO C e Address o,�_"Tao g t 400 S tF A--e_,d Telephone 3 ffr g it S g Permit Request ( -2 o a�'� C` u`� n at 3 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation DC. Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full \ ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ 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: tci l _ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use a c APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name � � �� Telephone Number Address °2 _ License # /0" ( C/ 1Z.4A/w' Home Improvement Contractor# 15 7 92 Email Worker's Compensation # 4V6 4yo ?o39 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ✓Y1119 c, A- SIGNATUREOSe��_ DATE 0? Z_/f zlr 1 1 s FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. t r ADDRESS VILLAGE 4 _ t OWNER s DATE OF INSPECTION: FOUNDATION FRAME y INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ; PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT L t ASSOCIATION PLAN NO. Y Town of Barnstable t Regulatory Services Richard V. ScaIi,Director Nua Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnsta6le.ma.us Office: 508-862-4038 Fax:, 508-790-6230 t Property Owner Must Complete and Sign This Section If Using A Builder l I , as Owner of the.subject property, hereby au C R&Wth ooze � to act on may behalf in all matters relative to work authorized by this building petmit application for. qY I-01#1JNoV;U 7z-j1rL4 C6 14yAWri i 3` (Address of Job) **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 pections are performed and accep S' tz r of Owner igmture of Applicant C -tit/65' F-c Print ame Print Name " Dat Q:FORMS:OWNERPERMISSIONPOOI.S Town of Barnstable Regulatory Services p+FtHE Richard V.Scali,Director Building Division ssxtve-r t Paul Roma,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 "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityhown 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. t 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- this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 Bk 29040 Ps 34-5 A:36120 ' 07-28-2015 a O2 = 35w PINEBROOK CONDOMINIUM TRUST 25 TOWNHOUSE TERRACE HYANNIS, MASSACHUSETTS 02601 NOTICE OF ELECTION OF TRUSTEES In accordance with Article II, of the by-laws of Pinebrook Condominium Trust recorded in the Barnstable County Registry of Deeds, dated September 16, 1971, Book 1530, Page 132, Instrument#39989,Notice is hereby given of Election of Trustees. The undersigned hereby certifies that, pursuant to the vote held at the annual meeting of unit owners on July 25, 2015 at the Community Building,the following unit owners were elected to be the duly constituted Trustees of the Pinebrook Condominium Trust of Hyannis: Names&Addresses Term Expires 4th Saturday of July of the year: Marti Baker, 86 Townhouse Terrace 2018 Catherine Howard, 50 Townhouse Terrace 2018 Executed as a seal instrument this—�—day of�� 2015. Linda Bezanson, Secre COMMONWEALTH OF MASSACHUSETTS Barnstable, ss J , 2015 Then personally appeared the above-named Linda Bezanson, and acknowledge the foregoing instrument to be of her free act and deed,before me. f Public JOSEPH R. PACE My Commission exp�pet'� i1/!t S~� Notary Public Commonwealth of Massachusetts ;��0 �55V �j,-Qe��d'®��i� My Comm.Expires September 26,2020 - e L g tt' <� lff!litle4��, BARNSTABLE REGISTRY OF DEEDS , John F. Meade, Register Ile Cornrnorriveakh of Massachusetts Deperrhner.t o,f industrial Accidents - ' r Of ofFniwtrgadorrs 9 600 Washington Street _ Boston,-41A02I1I , " 4 wiviv.masS.govIdia 'Workers' Campensatian Insurance Affidavit-.Budldei-slContractursMect icians/Plumbers Applicant Infatinat one Please Print LegibIy Name(Busitiess,�Organizatia�nFL t, l) 1� A( cK%Ct�iC� Address: City/State(Zip_ VIIA M4& � PI>r3ne C)e a 3 Are u an employer?Check the appro riate box: Type of project(required): 1_ I am a employer uith. 4. ❑I am a general contractor and I 6. New construction employees(full andlor part-time).* have hire8.the sub-contractors 2.❑ I.am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling shop and have no employees. These sub-contractors have g_.❑Demolition working far 7Yie in any capacity. employees and have workers' [No workers'comp.insurance comp-insurance f g ❑building addition regained-] 5. ❑ We.are a corporation and its 10-❑Electrical repairs or additions . 3.❑ I.am.a homeoum-er doing all work officers have exercised their 11:❑Plumbing repairs or additions myself [No workers'comp- right of exemption per MGL 12-❑Roofrepairs insurance required.]i c.152, §1(4),and we have no , employees.[No workers' 131-1Other comp.insurance required-], 'Any W iccaut dhst checks box Al must also fill out the section belaw showing their vmAeie compensation policy iaformaiicaL Hommnniers who submit skis affidmrit indicating they are doing all woal and then hire outside contractors nmst submit a new affidavit indicadiao such. fC'ontractors that rhea This boa must attached an addiiianal sheet shooing the name of the sub-coutczctars and state whether or not those entities have employees.Ifthesub-coatenctnrshave employees,theymnstpruuidetheir warken'tomp.policy mimber .Tani are enipLgvr that is pra* chug tvarkers'congmisalion insurance f or n;y eitiploj,ees. Belosv is the policy and job sate irforrnatioiL A Insurance Company Name: Policy,4 cr Sehf-ins.Lic.44 C ,Z 00 _ D P , Expiration Date: B Job Site Address: 6e__ City1StaWzip:� Attach a copy of the workers'compensation policy declaration page(showing the policy numbef.and respiration 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 for one-years 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 vaffication. I do If erg by c.e&fir lilt tlta putts andpsnhFc�a v feet jury fhattlte in fbririationproi id edabotg is true aridl rrect Simature: Date: Phone alo/ S Official use only:: Do not ivrata in this.area,to be completed by city orton-tt offi at City or Tomm: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.fity1rosrn Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Oth-er Contact Person: Phone#: - .� r Infarniafion and Ins&ucfion.s Massachusetts General Laws chapter 152 r all employers to de workers'compensation far(heir employees. aP �s �P Y Pmvt Ic �is defined as_ erson in the service of another under any contract of hire, Pm suantto this side,an�np y ev�3'P express or implied,oral or written_" An eznpkyer is defined as"an individ na.L paxinershtp,association,corporation or other legal entity,or any two or more of the foregoing engaged is a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other Iegal entity,employing employees. However the owner of a dwelling house havving not more than three apartments and who resides therein,or the occupant of the - dwelIing 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 15Z,§25C(�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 commanwealth for any applicant-who has not produced acceptable evidence of complianmwith the uS`Zrance-coveragerequir-ed." Additionally,MCrL chapter 152, §25C(7)st d s"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the ins rranc-6 re uiiCnicuts of this chapter have Been presentedtr)the contrasting authority." Applicants Please fill out the worker'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), addresses)and phone numbers) along with their cerfficate(s) of insrrrance. Limited Liability Companies(LLC)or Limited liability Partnerships(LLP)with no employees other than the members or partners,are not required to cagy wormers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this afidavit maybe submitted to the Department of Industrial Accidents for confirmation of in.¢rrran_ce coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application,for tale permit or license is being requested,not the Department of Ladmstrial Accidents. Should you have any questions regarding the law or ifyou are required to obtain a worker' compensation policy,please call the Department at the number listed beIow. Self-insured companies should enter their self-h m*raace license nuraber on the appropriate lime. City or Town Officials f . 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 pemiit/license number which.will be used as a reference number. In addition, an applicant that must submit multiple pemlitllicense applications in any given year,need only submit one affidavit indicating current p olicy inforraation Cif necessary)and under"Job Site Address"the applicant "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 fie for future permits or licenses A new affidavitmust be filled OiA each year. here a home ow citizen is or citi is obtaining a license or permit not related to any business or commercial v W enture (i_e. a dog license or permit to bum leaves etc.)said person is NOT ref�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 C==Wealth-of Massachvttts Department cif lad ial Accidents � asY,ingtQn Strut Bastw,MA G2111 Tc,-L 4 617 727-4900 Qxt 406 4r 1-977—MASSAFE Fay#617-727-7749 Revised 4-24-07 -mas.�-ggvjdia i` 'Town of Barnstable Regulatory Services i * ' ' ' ` Richard V.Scali,Director s639• �� Building Division. Paul Roma,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 I, N��2c1®(/L(' Yea ,A-S.3 oc , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for i4o Us (Address of Job) **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. a M Ar►d��i r'�• a tur of Owner tore of Applicant R- ® �� ri< �--- , Print Name Print Name . Date QYORMS:OWNERPERMISSIONPOOLS A`C ® _..�, CERTIFICATE OF LIABILITY INSURANCE DATE(MMDD/YYYY) 09/14/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A'statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Rebecca Powers LEONARD INSURANCE AGENCY PHONE (508)428-6921 _FAX A/C No ADDRESS: Rebecca@Leonardagency.com 683 MAIN STREET SUITE B INSURERS AFFORDING COVERAGE NAIC# OSTERVILLE MA 02655 INSURERA: AIM MUTUAL INS CO . 33758 INSURED • INSURER B: C & F REMODELING INC INSURERC: INSURER D: 20 CAPTAIN NOYES ROAD INSURER E: SOUTH YARMOUTH MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER: 84980 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DDY/YYYY MMLICY EXP DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGERENTED-- PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO LOC JECT PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY - COMBINEDSINGL LIMIT $ - - Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED, PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE EOT RH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y 1 N E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED9 I NIA N/A NIA AWC40070324242016A 04/30/2016 04/30/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass,gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Hall Of PrOVIfICetown ACCORDANCE WITH THE POLICY PROVISIONS. 260 Commercial St. AUTHORIZED REPRESENTATIVE Provincetown MA 02657 Daniel M Crc ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ME Map Parcel &4! D, / 7071N 0 J ' Application # Health Division _ t, •= r =' ??: '.g Date Issued a E — Conservation Division Application Fee Planning Dept. , , Permit Fee V Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address ��- • �. [ Village Owner P i A✓�_ [) ��G2 (G..ECG, S,�GC, Address _ 4du l���Q►1�� , Telephone ,Sd 3ff5. qq,ff Permit Request �aCiF , Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation -OM onstruction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ 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 19 Yes ❑ No If yes, site plan review # Current Use Proposed Use -�--�, APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number 3 7el Address ��Aa- X;b P 9 License # 1©� /o ]� j �dn A/Y(0,4d ��-6'� Home Improvement Contractor# I f_3 Email Worker's Compensation # L,-A-�V 70j,2 ,64, ALL CONSTRUCTION DEBRIS RE ULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED x MAP/PARCEL NO. k S ADDRESS VILLAGE OWNER F x DATE OF INSPECTION: FOUNDATION FRAME INSULATION M FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL F FINAL BUILDING DATE CLOSED OUT x ASSOCIATION PLAN NO. b .:�:.` N}f'}r �_.Qom• - , }. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel (7 / l°` Application # C24/5 d 5 3 ��7 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 Village 14 L/..- i S Owner P v C- ) Ycw 6C (G _�S SCC". Address `t t'`n? 1 Telephone S�6 �S Permit Request I'L Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new - Zoning District Flood Plain ' Groundwater Overlay Project Valuation - OOD Q1Construction Type Lot Size Grandfathered; ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑-No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half:.existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel:= ❑ Gas . ❑Oil ❑ 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 Yes ❑ No If yes, site plan review# Current Use o-J� . Proposed Use ova APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name /0 ct% Telephone Number Address P Q License # O Home Improvement Contractor# I S3 �— Email Worker's Compensation # u--•4/0. 70).2 yJ41-'�is� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO AA nn�� n• SIGNATURE 1A^ DATE i' ( f /I/ S� FOR OFFICIAL USE ONLY APPLICATION# 4 DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. AST • Hie Corawonyveah*qfMassachusefts Depapknent aflinhuftial Accidents Orke of rm�esdga ians 600 Wkshirxgton meet Bastarj,MA 0211I w 11V.MaSN gviAdira w1arkers' Compensation Insurance davit:$uilders0ContracterslEIectriciansMumbers `cant Infarmation Please Print Legibly Na=03+��i Ad&e.ss- Zo Gitylstat&z-v— -5-` Pho= C D 37 � Are you an employer?C4ck t a appropriate box: Type of project. �a< contractor an d nd'I (r���_ 1.El I am a employer with 4 I❑ 6- ❑New construiu o employees(full and/or part-time).* have hired'the sub-conttractors. I am a sole proprietor orpartner- listen on the attached sheet y- ❑Remodeling These sub-contractors have ship and have no employees 8_ ❑17emo1itioa w for me m any capacity employees and h2[Ve workers' �� Y � � - � 9_ ❑Building addition [No workers, comp:insurance comp-ursutmice repaired_] 5..❑ We are a corporation and its 10.❑Electrical repairs cr additions 3.❑ I am a homecu ner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'camp- right.of e2zemptionper MCL 12_0 Roof repairs ins7xmce requi ecl]F c.1.52,§1(4) and we hne no, employees.[No erg' 13-0 other comp-insurance required:] *Any appbx$at fast ched�.,s boa#1 trmsf also fill oin the section below shuteing their wo$cets'rnarg pony firm t Mmeffwners wbn submit this affidsvit in&cst mg they are doing s1I tide anal then hoe outside contracmms nmst subM3t a aem smd3rit mdialtm sort =Gnatmcmrs thst c1reck this bcx must stffiched an addilionsl sheet showing the name of&e sins-ems and ststP arhethem omnot those eiaities fizo. zmplapees_ If the stab-contmctom hwe employees,they must pmvide their warless'comp policy ntmzbe r I am an empiayer Mat isgrmizbkg it orkam'compensation i mrtrarice for my e-mgiayem Belau is thegolicy and fob site information. nn Insurance Company Name: � Gx• n / Policy or Set€ius_Lie ;k ®Q . ��' _ O Expiration.Date: G`1 Job Site.t1-ddress: P 36 Ciblistatelzip= ` Attach a copy of the workers'compe-nsatiron policy deZaration page(shaming the policy number and expiration date). Failure to secure coverage as requireduuder Section 25A of MGL c. 152 can lead to the imposition of criraiiW penalties of a fine up to$1,500.00 and/or one-year rmpnsommeats as well as civil penalties in the famr of a STOP WORK ORDER.and a fine. of up.to S250.00 a.day against the violator- Be advised that a copy of this statement maybe forwarded to the Office of Im estigations of the DIA for invrrance coverage veriticatim I da hcrreby c errlthe pains said panattiss of perjury fhatthe informtdion protided abcan�e is.true and correct Sitnate: ,�— Date: tm Phone : Qf fWal use only. Da not rrritg in this area,to be completed by c i or town of ficiaL Cit-s'or Town: PermitUceuse# Ensuing Authority(drde one): 1.Board of Health 2.Building Department &Cit (fawn 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. Pursuantto this st tute,an employee is defined as"...every person in the service of another under any contact 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 IocaI 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:ray 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 subdiv-isioas shall enter into any contract for the performance of public work until acceptable evidence of compliance ,,ri`h the insurance requirements of this chapter have been presented to the contracting authority_" PP — A licants compensationif fill out theworkers' affidavit corn Ietel b checking the boxes at a to your ituat7o that 1 � r s n an ii completely, Y g apply ) � necessary,supply sub-contractors)name(s),addresses)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)wi'ih 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 Depa u�nent of industrial Accidents for confirmation of insurannce coverage. Also be sure to sign and date the affidavit. '11he a,.Hda�6t 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 obii in a workers' compensation policy,please call the Department at the number listed below. Sell insured companies should enter their self-i-asurance license number oa 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 permitllicease number which will.be used as a reference number. In additicn,an.applicant that must submit multiple perm-itllicense applications in any given year,need only submit one affidavitdicat indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"ail 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 f mire 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 GommonwTealth of Massachusetts Depai ment of Industdal Accidents MQe of kves ipfiaus 600 Washington Street Boston=MA G21I1 Tel,9-617-727--4900 W 406 of 1-9' MASSAFE Revised 4-24-07 F�x i':617-727-7-749 w .rnass-govIdia • anxivsTesM • , ' ,e Town of Barnstable ArED MA't�` Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO 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 I UUI� � as ,Owner of the subject property hereby au. orize — �� to act on my behalf, in all matters relative to work authorized by this building permit application for: c� (Address of Job) : P 1 Sigga e f Owner Date a kle'f— print N e If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit forms\EXPRESS.doc Revised 061313 rY1asachus "s Dena-t,nent of Public Safety Board of Buiii�sr_g Regula::ons and.Standards CfInstnution Sapenisor ti License: CS-104107 CARLOS H FIGU`fIRO .20 CAPTAIN NOYES"RITi, SOUTH YARMOYJTTf ` 4 Expiration Commissioner 08/25/2015 • h _ use group whit Unrestricted;:Buildings of any g P : 3 co ntain less than 35,000 cubic feet (991m )of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS C��e �Pa»c�rea�acuecclC�o��aa�c�ca�eLZ`�.:�i - Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR p' before the expiration date. If found return to: ;egistration: 153792 Type: Office of Consumer Affairs and'Business Regulation _ xpiration: _,:1:L8% Qt7 DBA. 10 Park Plaza-Suite 5170 r; i.. Boston,MA 02116 C&F REMODELING' L- r CARLOS FIGUEIROq=�,`�_�==fit=� 20 CAPTAIN NOYES RD S.YARMOUTH, MA 0260 i Undersecretary C_. Not valid without signature 8/20/2015 15:38 FAX 1001 s Sk 29040 P'9 345 036120 r]7-25—�41 S A 02 to 35e? PINEBROOK CONDOMINIUM TRUST 25 TOWNHOUSE TERRACE HYANNIS, MASSACHUSE7TS 02601 NOTICE OF ELECTION OF TRUSTEES In accordance with Article II, of the by-laws of Pinebrook Condominium Trust recorded in the Barnstable County Registry of Deeds, dated September 16, 1971, Book 1530,Page 132, Instrument#39989,Notice is hereby given of Election of Trustees, The undersigned hereby certifies that, pursuant to the vote held at the annual meeting of unit owners on July 25,2015 at the Community Building,the following unit owners were elected to be the duly constituted Trustees of the Pinebrook Condominium Trust of Hyannis: Names&Addresses Term Expires 4th Saturday of July of the year: Marti Baker, 86 Townhouse Terrace 2018 Catherine Howard, 50 Townhouse Terrace 2018 Executed as a seal instrument this day of� - 2015. J, 'C> Linda Bezanson,'Secrets Y COMMONWEALTH OF MASSACHUSETTS Barnstable, ss S , 2015 Then personally appeared the above-named Linda Bezanson, and acknowledge the foregoing instrument to be of her free act and deed, before me. - afy Pub is JOSEPH P PACE My Commission • Notary Publlo , S) I, Commonwealth of Massachusetts ` d "'��/ U My Comm.texplrss September 2ti,20 00 _ .` .•,3? �! f � 1/l�ll'j%IN BARNSTABLE REGISTRY OF DEEDS John F. Meade, Register Y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map `I Parcel I D I �:, � l�' f Application # -I Health Division �`< f ,Date Issued!_ Conservation Division - Application Fee J &C) Planning Dept. pa,ck_„ Permit Fee — V Date Definitive Plan Approved by Planning Board Historic - OKH — Preservation/ Hyannis Project Street Address ' A �� Village S Owner aonjft AsSoG, Address � J USIJODU9C- lbz Acef 14YA 4-9 Telephone �'� '� Permit Request QQ Pool-- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ 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 -1' Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address 010' C/041'eL­ License # Home Improvement Contractor# Email Worker's Compensation # 0 33a.�J f' -):�15,4- ALL CONSTRUCTION DEBRIS RESULTING FP THIS PROJECT WI BETAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION:. FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE.CLOSED OUT ASSOCIATION PLAN NO. e F r; x�e Co;!ss�rxontti�a��[ZSSUcTfIls�ffS aelwftnent a bdzu iW.Accidents - - Office tr,l b"M igntians 600 Mwhington&reet Boston,MA02111 wn- tna-mga/dia W,arker-s' Compensation Insnrance.ffidavit:Bu€ilders/Contractors/FlectricianMumhers APPEcant Infarmation Please Print h . Name(PosneselOrgon8n&viana9: C_.. Address: 0C/ City/Stat&Zip: Phone Are yav an employer?Check I appropriate box: T ect r 4. I am cont l of ractor and I �i {Nerd)- I.❑ I am a employer with 6- ❑New ansauctioa employees{full andlarpazt-time}* ha�ehiredthe sub-contractors. - 7:M_j am a sole proprietor or partner listed on the attached sheet y- ❑Remodeling V "ship and have no employees employees ees a niracto. have 8- ❑Demolition w for many capacity. eurployees and have workers' . o��g y I I 9_ ❑Building addition [No workers' comp:,'*+ ,Sr**,ce comp-nssuran 5.,❑ We are a corporaticn and its ltl-❑Electrical repairs or additions required-] I❑ I am a homeowner doing all Woe,- officers ha7--:exercised their I I-❑Plumbing repairs or additions Myself- [Na workers'comp- right of exxmptionper MGL 12❑152 RDof c_ , �� inclrrnnre required]T �1(�and we hn-e no 13_❑other - employees-[Na w•orkeM' comp insurance regtured.]; y1,',ppUu,nt that cheds bos W 1 rrmst also Ml out thQ sibaiva below shnwtug ihetr waQl'c�T rnamessstiou po3icF anf3ar m� t HxnBD Wner5 Who submft this afEdawt 9+fcsf mE dzY are doing all Zrak sd then b re outside contra tors mast smbmA a ueaa 2JB&vh it 6irsstnmv such_ tCoutncmrs nst check d&box mast attached an additions)sheet showfag the name of ft sit- xs and st, orhethe[snot thnsa zmiries fin cMnplQyees- If the sub-coutmCt0rs hose—ployees,they must p-vide their workers'camp polacy tam bez Tarn an employer that is prot*UHg workm'corrTens rtion irrsrtrance for my employem Below is the policy anal job sits information- Instuance Company CG vt r policy#our Sett ins Ii ,�-of �! S Expiration Date: Job Site Address: A4 6? L21 City/StatelZip: Attach a copy*of the workers'compensation policy declaration page(showing the policy numb : and expiration dater). Failure to secure cm-rsage as reTireduuder Section 25A o€MGL c. 152 can lead to the imposition ofcriminal penalties of a fine up to$1,5QO.OD andlor one-year imluisorment,as well as civil penalties in the form of a SWOP WORK;ORDER.and a fines ofup.to$250_00 a,day against the violator_ Be advised that a copy of this statement maybe forwarded to tale Office of Im-egfiptions of the DLk far insarance,coverage mrificatlon- I do hereby certrfy rt. s pains andpenaWas afpedwy thatihe info rmthan prcnid8d abave is brim and correct Sitnratore: � Date: Z_jc'(/-,I-- Phtme : OP 3 7 f Of Ed,al use on£}. Da not rants in this area,to bs completed by citl:or town offrciaL City or Town: PerraitUcense# Issuing Ai thority(circle one): 1.Board of Health 2.Building Department I Citylrown Clerk 4.EIectrical Inspector 5.Plumbing inspecto r 6.Other Contact Person: Phone 9- 6 Information and Instructions =V Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 slat-es that"every state or Iocal 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 aray 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,,,AH 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),addresses)and phone numbers)along with their cert ficaie(s)of insurance. Limited Liability Companies("LLC)or Limited Liability Partnerships(L LP)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 conafirmation of insurance coverage. Also be sure to sign and date the affid2vit. 11e a,.idavit 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 obtr_.il a workers' compensation policy,please call the Department at the number listed below. Seli iaSUl ed companies should enter their self-ins rmce 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 a��davit 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 burn leaves etc.)said person is NOT required to complete this affida,, t. 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: r $e Gomnon malt of Massachusetts Department of Industrial Accidents 0mce of Invostigatioas 600 Washington Stet Boston,MA 02111 Tel. 617-727-4 9-00 ext 406 or I-9 MA SSAFE Revised 4-24-07 Fax 9 617-727-7749 www.mass govldia fi MASS. ,� Town of Barnstable 'DlEG MA't A Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO 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 athori ze to act on mp behalf, in all matters relative to work,authorized by this building permit application for: AA (Address of Job) � e Si e of Ow er ate e tN e ` If Property Owner is applying for permit,�please complete the Homeowners License Exemption Form on the reverse side. - Q:\WPFILESTORMS\building permit forms\EXPRESS.doC Revised 061313 X h7assachusex. Oepa�;nant of Public Safety Board of Buii '„,g Regula_lons and Standards 0)b-itructiun Supervisor License: CS-104107 CARLOS H FIGUEiRO 20 CAPTAIN NOYES`- . SOUTH YARMOV17i 'i-' 4 Expiration Commissioner 08/25/2015 Unrestricted--Buildings of any use group which contain less than 35,000 cubic feet (991m)of enclosed`space. Failure to possess a current edition of the Massachusetts b State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS '. c�//ce ipa�n��aancaeezlG�a��cca�cz�c��e�.''��• I .. .. - i Office of Consumer Affairs&Business Regulation �' License or registration valid for individul use only UgME IMPROVEMENT CONTRACTOR �' before the expiration date. If found return to: egistration: A 3792 Type: s Office of Consumer Affairs and'Business Regulationxpiration 1L8/2017 p 10Park Plaza-Suite 5170 r - Boston,MA 02116 C&F REMODELING�', ,- CARLOS FIGUEIROq') 20 CAPTAIN NOYES -------- S.YARMOUTH,MA 02604 == i Undersecretary Not valid without signature ;': . 8/20/2015 15:38 FAX 2001 Bit 29040 P w 345 :036120 _ - r]7-2S-2t715 8 !?2 to 350 PINEBROOK CONDOMINIUM TRUST 25 TOWNHOUSE TERRACE HYANNIS, MASSACHUSETTS 02601 NOTICE OF ELECTION OF TRUSTEES In accordance with Article II, of the by-laws of Pinebrook Condominium Trust recorded in the Barnstable County Registry of Deeds, dated September 16, 1971, Book 1530, Page 132, Instrument#39989,Notice is hereby given of Election of Trustees. The undersigned hereby certifies that, pursuant to the vote held at the annual meeting of unit owners on July 25, 2015 at the Community Building,the following unit owners were elected to be the duly constituted Trustees of the Pinebrook Condominium Trust of Hyannis: Names&Addresses Term Expires 4th Saturday of July of the year: Marti Baker, 86 Townhouse Terrace 201E t Catherine Howard, 50 Townhouse Terrace 2018 Executed as a seal instrument this_ �day of 2015. Linda Bezanson, Secretaiy 1 COMMONWEALTH OF MASSACHUSETTS Barnstable, ss S , 2015 Then personally appeared the above-named Linda Bezanson, and acknowledge the foregoing instrument to be of her free act and deed, before me. - l afy Public . JOt3EPH R. PACE: My Commission exp ei 'I'��: / v V Notary Pubho ) v Commonwealth of Massachusetts ^ /- ri My Comm.Expires September 26,2020 � .y1i�. 4':•�n ..�a BARNSTABLE REGISTRY OF DEEDS John F. Meade, Register TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map •¢ Parcel Perm ' it# 66 7� Health Division �� _ ..�� �� zo744-0-�11t CiF BARNSTABLE Date Issued 3/ Conservation Division l79, �/�3 � ? � � � AIM 11; 38 Application Fee -S 0%Q d ffi Tax Collector Permit Fee $ Treasurer .__ _ �3 alo 3 D4R{lSlOtd Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Tf�a ce Project Street Address 7� �wh P 4aw � 6 f 3 Village 11 aAl fI r S° Owner �("i Iry Address Telephone 7 0 fA- ` Permit Request a �G L �'�i l�1 f/V),, � e f Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 30• Gp a °°t Construction Type Lot Size Grandfathered: Cl Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) _ Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ 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 ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name ( OayY z/vc Poi f'L6 ") ���N�Telephone Number 133 -S_ � Address Y J Gli-n/t J e_-,�a,i6cw 01- License# Home Improvement Contractor# l 3 V (� Worker's Compensation# Y,3 �t 7 Y JU IV ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO L-ad-1111 SIGNATURE Ar4141v -wr DATE / ,�? - 4 3 FOR OFFICIAL USE ONLY PER1 UT NO. DATE ISSUED I MAP/PARCEL NO. ADDRESS VILLAGE OWNER III -rf Ott DATE OF INSPECTION: FOUNDATION FRAME INSULATION r' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ' DATE'CLOSED OUT { ,ASSOCIATION PLAN NO. K ' v ' _Z \ RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 So " � o Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) t f ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq. foot= 3 O O x _ 00 plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq. ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 21 (plus above if applicable) Permit Fee projcost The Commonwealth of Massachusetts Department of Industrial Accidents M office o/%yestigatioos t 600'Washington Street v Boston,Mass. 02111 Workers' Com ens.ation Insurance Affidavit name: L 7- 6,elyl7 location: city y/Nlil A� vhone# ❑ I am a homeowYer performing all work myself. ❑ I am a sole Darietor and have no one workiz in i I ca achy (D'I am an employer providing workers' comlensation for my employees working on this job. r.........:::.:.........:::;. .comt5any name. ....:..:::.. ............: ......................... . ............. .....,...,.::::,,.......:..::...::........................:........................................................... .............................................:. .=�::' ::.';:.�:::�::��:..... ..... .. .... ..... ... ...... . ... .... :..:.... phone#:.:........ •;{:�•:;?:••'''-,.••::;:;:};.....,'.;:';:?•}:�:•:•.....:?iy:;ii:';'i'riiiiijiii y;;}{:;'{.}::?•::::.;:>::i"'::ii::j :'''•'•riii>}?}••",?:{•.•iiii>i'•':>.::.'::i;{}:~'••;::j•'••,;i'y,.•xr v;` t.:.y;}'� ,;}''!'} `:: <.}::::>:<>:>':»: :::� ..:'.: .:•: :.:.:•... ... .: . :•:.::::•:::.:.:::::::.:.:.: ol�cv.#.:::. ....... ........:�{.:::.:;:::: ... . : . ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers'..compensation polices;.:........................:................................::....:................................................. .. uomnany"pain :.......:.:....:............. :{::.:.. ...................................... ;w. :oat'ikess:::<::'<.;>:•;:?.}?:•;:;�>::>r:,:,::?.:::;:::.;;:;;:;:;;:::.>;:;,:;,�.:;:;:::.;:.:;::::;•.:.:;•::;::;:;:i;<::.;:.:.:.;:::?:.:;;:,:;:.:;<.:.:;.;:?.;::,: :}::::::;�:;::::: . .;v:.v:.'4.:v{;, v.�:.r;:}n;{{:i•?:4} •:::•.v:::::i r,:}::::::.:�:.v:::ryp?:;'?::::';•?:;�i}}?isJ'rii:is':is?;;:?i::iiriyi?:•iiiiv}y::$i:•:?:y{;',:i?}}}:•:. ...........:...................n••:r?:::::::.v::::::::w:::.�:::?}}::•i}?::v::::::::::::::::r.v•::::.r::::::::.v::.4:... ...v:•::;•}:.w.v:::. •'•}}:•}•ti:4:•tiiii:;r.}}:•:::vw.,x•.v:?::::{. • ..:::.:.... .....tiff:S::ry•?:;•:i!:}:<•?i?:•}:v•:...,.::.:.�::::?:v:.v:w:v::•............ •.{{v?•v.:;..v..;. :::... .........:::::.�.v:;}::::::is v:::t:v::•.::::::r:::::::.:::::?v:::::::::::::::::::........:::.w::::r.v..{...:.:.v:::::•. ..... .nv........................ ..................-...-................:.v;:n...v:.:•:.:.::•::.:.....;;.:.:::::::::::...::::.v::::::.v::::.�:::•:.:v:::.v.;r.:::k:}::::::.vv..W 5...,;^}?Y.::Y::{v::•.v:: :::::;;?3:?`::}:v:;i:•::::^}:{4:•?}:::{;i•?}:.}C:?•L}?:;{:{•}:h:4:•i:{•}h:•?:4:4:??vi?:;:;:.;}:,•:y???:::::.:-is?4%•}}}i?1??}'.,•{:.}?•{:::x�•{{?;•i:?�:j?:4:{4:;�:^:;{•?>i:* M. ..:....... .b3nf'BrICeCQ :.:. 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'v.�::::::::w:.::�::.v.::.::....::.:::•::•:::..;•:.:::.::::::,:•::::.:�::.:.:::.::.v::.::::n::::::•.v.::.,•::..v:.;.}:::}:;?;;':•: �,� :'#:?•?:i:•}}i??}}:•}?:?•?Y.•}}:4:•}:P:•}}:•�::?^:4}:•$:•:•:•ii:•}?}i}:i+.;??O}::?>.•.::.:..:...:..::..,...:f..:.:....., nsursnce co . Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a line up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day againnt me: I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains andpenaLdes of perjury than the information provided above is true and correct c Sipature liwK,N Date ? -G - - Print name /t? — /�� Phone#Op 1'33 —I/1 / (contact ficial use only do not write in this area to be completed by city or town o�dal ty or town: permit/license# ❑Building Department ❑Licensing Board checkif immediate response is required ❑Selectmen's Omce ❑Health Department person: phone#; _ ❑Other__ Ormad 9195 PJA) J " Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contact. of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally;neither the k until commonwealth nor any of its political subdivisions shall enter into any co er have beenfor the presented to the conce of public wo tracting acceptable evidence of compliance with the insurance requirements of this p P authority. Applicants Please fill in the workers compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the the Office of Investigations has to contact:you regarding the applicant. Please affidavit for you to fill out in the event be sure to fill in the perautllicense number which will be used as a reference number. The affidavits maybe ret arhiA*to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Investlgatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 n l P rt I� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION % Z Map Parcel Permit# 6 7 ,2/ n„ �,�., - <,� . OIYN OF BARNS_ / '0 0s Health Division �'V "' 207 E AI9at Issued Conservation Division / 'Zil JAN 28 I I A �pllication Fee Tax Collector � L Permit Fee Treasurerw•._..� i ��f Planning Dept. 30/0 3 Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 20 Village � "h 1` _ Owner ell? �roa Address /O(J�V�6uj Telephone d7 7 7 tf caS_7 ��o�„ �ir��Sw�►z Permit Request —R lea-,SAinq if �-e C'e 441- Square feet: 1st floor:"existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation " Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure 30 V f Historic House: ❑Yes dNo On Old King's Highway: ❑Yes 0 No Basement Type: ❑Full Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑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 ❑Yes ❑No If yes,site plan review# Current Use Proposed Use Polk BUILDER INFORMATION Name L7" GyNs r. T C 7 S&4lv,�o /0/N Telephone Number, Address 9 44 License# �L L✓i Cc Home Improvement Contractor# Worker's Compensation# �/3 y 7 IV— ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE pr� (/L. DATE FOR OFFICIAL USE ONLY 4' PERMIT NO. ` nDATf ISSUED MAP/PARCEL NO. ADDRESS!! ' ; VILLAGE OWNER _rt DATE OF IN.SP.EC"TION: FOUNDATION FRAME - INSULATION--L ,,FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r . GAS: ROUGH FINAL' w FINAL BUILDING DATE CLOSED OUT ASS9CIATION,PLAN NO. 1 RESIDENTIAL BUILDING PER HT FEES APPLICATION FEE V New Buildings,Additions $50.00 '0, ® d Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE G06 � C v do square feet x$00q.foot= a y o O O • x plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 64 (plus above if applicable) 40 H6 . i/40 Permit Fee7 projcost Z7s, . ` _ The Commonwealth of Massachusetts -� Department of Industrial Accidents ` ��y�'- Ol!/ee of/oyestigatioos ti 600 Washington Street r Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit i name: T 6,oNf—, on: //1i✓�! 14C ✓•� city W*A-C-t 11 r, ` phone# ❑ I am a hoineowder performing all work myself. ❑ I am a sole rietor and have no one worl� in ca achy %% %%%%%/%%%%%%%%��%%/O%%%//%%%//% %%%O//%///%%%%%%%///%%////%///%%%%/G/%%%/%/%%�/%///%�%%%%%%%%%%///%//lam%%/%%%%%/ I am an employer providing workers' compensation for my employees working on this job. •i:i:':`;.� . its::;;:;;..;:;:�:::::.'• .::' :? .< ::>< ::;::�<':<.>:<:::.>::>:.: <>:<::..::::: '��•:.............� ............ .... ........ . : ....:... .:... hone#.::::::.::.:. -:::<:•;:.;:.; .;::?;:{.;:;::.:::::,?:.;,:.:{:{;.;;?;<::,?;;.:.,;.�.>:?..{.k:.>::.{:.>:•.?.;:•>::::: cites � n .......................:...::::::{:.;::..:..:{:::.>:....... . < '< ::...:::...::..:...:::..>:. . .::: . .. .. .::.. :.::: :lristirence•ca.:.:.:...:....:: •.;,:•..........,.. .. .......... ....:........... .... ..... vlrcv:#>:< >.:,;»><:;;'` :> .......: ,.::.... ........:. ::.::,:,::.:... ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers'..compensation polices;.........................:.....................:................:................................. comnany n m :yr�`:�:t�i: 2�':��:•`.•`:�:�':� %;�::%ii:�:�:+si:�it<'t�:� :?�:�i:�:�>:�::�:�>r?�:%$� � :�:�:�:� :�:�i";:':•:':' :~2�:%�:>,�:���:�:>::<�i:'::%:�:�.'•:�:t�`.�?3�i':�:�:2$:i::#�i::;:;:�?:;f:� ::::;:;��::?':;:;:��;} ;:;:;{:y:>:<:::::': ::S::r:::;>;.;{•;;:;,..... :....:... .::�•,•;;..:':4•:•>ii:•:J»:�:{{>:•i:•>i>:•>:4:•::.:4»inviii?$iYiii.......::...... ,.....•..::nv...........,.... ...?d:v»ii:•>�:•:»::{:?:::�? �TiL .>..viSiii{i::;:. ....n..... ...........:..::::•.v::x:•:•:vr.•:v:::::.:f:::::::•.v::::•.v:.v:::::xm:::::::::n.....................4>:•i»i}:S:?•::+:?v::::::.v::::nv::.v:..................................:............ .... ...,... :.:. ......... •>:'•:.?•>:{i•;{•:v:;::.•;•,:;.:v:::::+;::;:::•>v:::.v::{:?{:.:.:{y::::::n:v::.v::::i hv:.v::nv:4'v}:•;:4};::::;:.v::.:::::::::::.vnv:::::::.v:x:.v.»:i:i::.:;;•.?.}•.}i•..n.., �..........v:..::.:{{{:?•}>::%v:•»::•>:{r{.;{•:v::::»:•::'r.K?•i:?>•?>:•i»>:>.?•;>:{,:�i:v:•r:::.:v:>:•».{3:•»>:•i:?{?>:^:.:>:{{{r.:is^:•>:4.???S::inv:•Y .:::::::y>'.hY:.h.:•>:4>:>:•:•>i>:•i:{n}v: .. .......:.......•.,r............. . :•}>:-:•:•:•>:-:?{•>:{?{•>::,::::::::.>'.;•:::{.>•.v:.v::.K.v.v::::•._:::•::•:::::::::.v;.:.:-::•v:.v:.v:•.v.:v:.:•.v:::......•:v:,v:::::.:v v.v:.�•::... •: .:.:::::::.:::r:.v::::::::•:v;....n..........v.......:v:>.:.?>:{•'.•>:vNM;::.:;Y.,::•>::•:•:•}:?:• 0111111111111111 :sampsn�?name;•.:::,::•:,:•::.:.:•::::,,:::...::.:....:•::::::::,•....:................... ..........:.....................................................................::::::>:-:?•>:;•s:.>:.>;::::;:•>:•:<;•>:•;:.;:{<:>.:;;.;:;?•...... iiF i;:;::<>.':>ii:J:'::......;......:! ;;?;:;'..:�.:;.;i:::.:i:`:.:i�i1 ii:;:'.'i :....;:; :'i..;.;:::::.{...:....IBM i'`i}f:i'ry{:{':vCvi:tiv::Cis4?iiii:4?'::;{:y i:L::.?`:i'i">;iii$:;:•i{W:M:�''n?iii+ n: ::•:::.:.:.....:...:..,..;....•:.•. :•:. .......... .. . ..........:,.......,...:. :;:;i4:�:iii:t$::;:;i:•:}$::is�ii}?iii:4:'::•:2:::j<;iryii$":ii i}:;:Yjfiiii> Ilium ceco...................:..............................................................................,.........,:•:::::•.�::•:.�:::. Old :�•::::•:::::::.:::.::::::::::::::::::.;:•>:-:-i:•:?o»:<.>::<,:.:{.:;:>:;.,..,,:•:•'•r:>:•; :.:;:::::::::;::;:i?:i;:;::> Failure to aecare coverage as required under Section 25A of MGL 152 can lead to the imposition of erhntnd penalties of a fine up to SI,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day agahut me.I I understand tbat a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains pen 'es of perjury that the information provided above is true and correct. Signature Date Print name 0 /P /4 Phone#Op f 33 _TJlcl / official use only do not write in this area to be completed by city or town omcial 4 city or town: peiadt/llceive# OBuiiding Depj ❑Licensing Bo ❑checkif immediate response is required ❑Selectmen's❑Health Depar contact person: phone#; _.:.[]Other Uniud 9195 PJA) v Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract. of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a and who resides therein, or the occupant of the dwelling house of dwelling house having not more than three apartments another who employs persons to do maintenance, construction orr be deemed to be h we ll ing house or on the grounds or r. building appurtenant thereto shall not because of such employmrr MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the p r the erformance of public work until commonwealth nor any of its political subdivisions shall enter into any contract for p P acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. " Should you have any questions regarding the law"or if you are required to obtain a workers' compensation policy,Please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the appl}cant. Please be sure to fill in the permitllicense number which will be used as a reference number. The affidavits may be reamed to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Invesugauans 600 Washington Street Boston, Ma. 02111 fax 4: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 11doIMA Y . `� � �xpi�igi► 6 �� }` '�CONST INC � '8;1 ,NSEBASIAN�f� 4 t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ZOG Permit# /�oW1i OF SA,RkiSTABLE Health Division �� _<�,_wcf- Az G 7,071 Date Issued /l3/Za =' Conservation Division Zt' � �� 2 A"i j j' `' Application F e 1�°s �` 0 Tax Collector J? Permit Fee 18,3 t Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street AddressG�lri Village `l"I Owner Pin-e-b A / i 'Uf 74 , Address Telephone -7 ��� 7 ,! e ro Permit Request d12ep fkf ( Jt e Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ?O,ddd °'0 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑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 ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name �LI CONS /�/C .� �('� � �,..0//, Telephone Number �U �� Trk Address J d^� �f e-haj{�1 ��' License# Xdt,4�Gv'!GLi Home Improvement Contractor# Worker's Compensation# e L 3 K 72 /?XK ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �OK,7,17Zc // ( SIGNATURE DATE Z 7 a3 FOR OFFICIAL USE ONLY `t t PERMIT NO. DATE ISSUED 4 MAP/PARCEL NO. f , ADDRESSf VILLAGE OWNER i r DATE OF INSPECTION: ' FOUNDATION FRAME ' INSULATION FIREPLACE 4; ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 0 DATE CLOSED OUT r i 1 ASSOCIATION PLAN,NO. RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 �® Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERA.TIONS/RENOVATIONS OF EXISTING SPACE \ < 006/ Co/71 square feet x$64/sq.foot= 30.4 0 0 41. x, = J plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq. ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) fr/ Permit Fee ! r 'd projcost The Commonwealth of Massachusetts N _ Department of Industrial Accidents _ anceODUVeSH92 iens _ _ t 600 Washington Street _ B Boston 'Mass. 02111 iiiiiii ii ens tion Insuranc%%%/%%%%%%%��%%///////%%%/�%�/////////////%�%�/G%% name vi , location: city hone# ❑ I am a homeowi&r performing all work myself. ❑ I am a sole proprietor and have no one worldn m* capacity %%%/GO ////�/%%%////%/%// 1 er ravidin workers' compensation for mry employees worldrig on this job.: :.:::::.::::....::::::.::::::.:::.: :::::::::::::.::::•rr::?•::r:?;;:.rrr::;•ro-r%:::::.. .. ........:... . :::::. mom::;;:.r:.>;:;<;............ an Ram e m Y r0 D t `9tY�I'b L r h .....:.......:::. .. ... .................. :a tea X. ..::.....:..,...... ❑ I am a sole proprietor, general contractor, or homeowner(circle on and have hired the contractors listed below who have orkers' co ensation olices. the follows p..........................:..........................::.. na m ::......: ::::<:.:..........:.....::..:. 'cam ::..:::::.:. . ;::.::::::..:::. ........................:::.:::....::::..:................................ .................................................. dttie ....................... .:�.:........... ..:..�.�:.:.....:...::..�..................... ::::....::.:............................... ......... •...:gin•.»::•?{•:;{{%a:4:; ..1:. �....:: ......................... ............................:.......................:...:.�.:�:::::::::::.�:::::::::.�:.iii:riri:.rr:+f::•:�:•r.::•:::::::w::::::::::::::::r::.v:.:::.Y?•r:•r:?:??::::{b'::•.........••• ......n..Y:....a•••vv...v:.v:: ...{.....::v-v .n4.,r•.••:sat.. +.:v�a.:::• .:�:::.v:......;..;4:;4r+:4rrr::•.w:::::•::y::::v.�:.v.v:::.v:::::::::::::v::::::•:::::.v:::::r;i:�ii:•'ii:?{4>:{•rY.ii :x:>::i�iiiiri::ii:ii�ii::{:y;%:iiF;i:;:?i sj;}:x;x:}j::,'{%:<;;ii::i:?�iiY�:;i:!;:;i:•i:%�iijiii'�:iiijij:�iij?4r:•r:?•:r::.•r. � .r:4r:•irr'4ri:•:•i.4.:.....•...... rw :::::•.;.v.,y...:...........v.....-..�..:,.......xi•:n�::::::::.:v... •...v.•.:•..yev•. ............ ...:..................::: •...:..........::::::v:n:�.:.......:.-, vw::n:nv:::r:•.rr:4:W:• OR .............................................. .......... ......r... .......... .......... ...... ...... .................................:...... r:r::::::....:>:r.n„a.a,Oar.n•. .. .... n.....yv..... ................. ....i. y ...v.........................r........ ....{.... :.... :•:.v}.a......v:::::::::::::.......v::r.. ........ ........ � %%r:?::%:•%;:•%:•:v:r:•\%%:;%:'%:•, :y;%:y�•%:•%:•r:'::r}�..::::??;;:?{b:•%:i:.:::rii::iti%%•r:::%::::::%%i ;:<:r%:::>::::::;:•r:;.r;r;%;;;:;,:.>:c;:.::,?:: :::::::..::.::,., .,.. :. . .. :adtlres s :X.. .. ...... e ................. .................::..:..........::...::.::::.. :r» v.. :::•{v;•::.:':::.rY•r,:..•.......: ::.:::.�:::.v:iiii+r is?:;j^:}j i:$•:LLi;.:;.��::::.r.:;:-y ::.:i::::: ''llj>{�;}ti}'::^:?:�f'::is�'?�}j•ri::';:isx4i:%>Y:+%:::�:t%Y:;:?�;:`.�r��:?{'�.i:.�:::•:�v:::::..v:}�>f%::; :;. :.. .•••:•:w:::•:::::••::::::::::•irr:{?:;vrr:4i:rir:•r.v::::.r:4ii):+.4ir: .. �:is}i:%+i:$:nisi:%ii'iii1::?%i:`}iiv:%:ii:%ti:rii$iijj}}}iir:•i:.......:v.. ... 02222122 Faflure to secure coverage as required wider Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains pen 'es of perjury that the information provided above is true and correct Signature liwwN Date 7 G Print name Q-- ;P i °P— /��2— Phone# 1��3 official use only do not write in this area to be completed by city or town official city or town* permit/license# ❑Building Department ❑Licensing Board ❑checicif immediate response is required ❑Selechnen'a Office ❑Health Departrnent contact person: phone#; _ ❑Other Umud 9/95 PJIa Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract. of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or employees. However the owner of a partnership, association or other legal entity, employing trustee of an individual,p p, use of eats and who resides therein, or the occupant dwelling house having not more than three apartm of the dwelling house or on the grounds or work on such dwelling gr another who employs persons to do maintenance, construction or repair lung building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until ements of this chapter have been presented to the contracting acceptable evidence of compliance with the insurance requnr 'authority. . Applicants 'on and r; compensation affidavit completely,by checking the box that applies to your situate workers co ;w Please fill in the mP may be ess and hone numbers along with a certificate of insurance as all affidavits y supplying company names, addr p 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 retumed to the city or town that the application for the pemnit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the'law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitllicense number which will be used as a reference number. The affidavits maybe retmmed tn- the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions• please do not hesitate to give us a call. XXX The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents 0mce of favesugations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 .f rr \ J ' I j° TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel _Application # t0 Z LC7 Health Division Date Issued Conservation Division Application Fee MO., Planning Dept. Permit Fe s, /Wo Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address jC! U6 7 S Village _ Owner / %iJ < Ad r Gclfr c yr 4 //'�S Address c_9 �- Telephone J Permit Request A52e,P7-1aC/C S .t e r Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total ne® Zoning District Flood Plain Groundwater Overlay ZE Project Valuation6 S6 Construction Type C) o Lot Size Grandfathered: ❑Yes ❑ No If yes, att:�Pc orting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) 7w co Age of Existing Structure e3 G Historic House: ❑Yes UI No On Old King's ighway:%4 Yes❑I`Tb__ Basement Type: d'Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) t 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 0 new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board?Yes ofpeals Authorization ❑ Appeal # Recorded ❑ r i I ❑ No If es site Ian review# Comme c a y p Current Use C/- t�10V_J T" Proposed Use -.APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name G '�� � JC)� 6.4-, Telephone Number ,�G c� 30 9- Address License # o 4 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE i FOR OFFICIAL USE ONLY i APPLICATION# DATE ISSUED ,MAP/PARCEL NO. ADDRESS VILLAGE OWNER x DATE OF INSPECTION: 1 f FFOUNDATIOW, FRAME ' INSULATION,; FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GASH :' ROUGH ,%�t g, FINAL =f'FI:NAL•BUILDING`._:, j f R :DATE CLOSED OUT 3 ASSOCIATION PLAN NO. 1 - I `, a .h. m n ea th of Ma a usetis' • The'Com o w lss Department of IndustriaC Accidents'"; F 'Office of Investigations ��� •� "600 Washington Street ' Bos on t ,'MA 02111 •_��` "�' "www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nane(Business/Organization/Individu 'TT t" �� p " Address: CO City/State/Zip. , ..C, � Phone M t6T O Are you an employer?,Check the appropriate boz:'. `" Type of project(required):, 1.,❑ [ am a em to er with 4.`Q I am a general contractor and I p y ❑"New co struction e ogees(full,amVor part-time). * have hired the sub-contractors ` 6' Pram, a sole prop"rietor or partner listed on,the`attached sheet.' 7 emodeling These sub-contractors have ship and have no employees 8. []I7emoTitton workin' for me in an ca actt employees and have workers' g" Y p, Y 9. ❑ Building addition . [No workers' corrip`:insurance comp. insurance:' required.] 5. [] We are a'corporation and itsi; : , �10.0'Uectrical repairs or additions officers have exercised their 11. Plumbin re airs or additions, , 3.1 lama homeowner doing all work 0 g ,p myself [No workers-'comp.", rt right of exemption per MGL 12.'Q Roof repairs, insurance required.] c, 152, §1,(4), and we have no employees.[No workers' 13.0"Other, w comp. insurance required.]. *Any applicant that checks box#Emus[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 thosc entities have, employees. If the sub-contractors have employees,they must proyidc their`workers'comp.policy number. I am an employe.that is prbviding`workerv'compensation insurance for my employees. Below is the policy and job site information. Insurance Company.Name Policy#pr Self-ins:°Lie #: :'` Expiration Date; Job Site Address: ' City/State/Zip: �. Attach a copy of the worker's' 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,pen'alties of a fine up tof$1,500.00 and/or one-year'imprisonment,as well as civil penalties in the form of a STOP WORK ORDER"and'a fine of up to$250.00 a day against the violator.-Be advised that a copy of this statement maybe forwarded to'the Office of Investigations of the DIA'for'insu anee coverage verification." I do hereby certify,undeeIrflftp ins a p realties ofperjury that the information provided above is true and correct. OF Date: Signature: Phone#:'. Official use.ono.- Do nofwrite in;thisarea,to be completed by city or town official City orTown." 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 co oration or other legal entity, or an two or more �P R � rP g Y� Y of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s) name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below.,Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia Il4 TO BARNSTABLE BUILDING INSPECTOR THE PINEBROOK CONDOMINIUM TRUST AT SOUTH-WEST CORNER OF WEST MAIN & PITCHERS WAY, HYANNIS HAS A 2&X 40' CLUB HOUSE WHICH HAS FIVE 6 PATIO, DOORS FACING SOUTH. MOST OF THE SEALS ARE BROKEN (37 YEARS OLD) AND WE WOULD LIKE TO REMOVE 4 THEM AND REPLACE THEM WITH A 3'X6'8", OUT SWINGING SELF CLOSING. DOOR ON EACH END AND REPLACE THE THREE MIDDLE PATIO DOORS WITH SIX,1"28 X24 ONE/ONE INSULATED DOUBLE-HUNG WINDOWS BETWEEN, FRAME UNDER W/PLYWOOD&C &INSULATION/ SHEETROCK INSIDE ESTIMATED COST- �G - 6580 j� LLL� vropoml Johnson Door & Window 7 Penelope Lane Cotuit,MA 02635 Office(508)237-3309 Proporsal Submitted Tc d /US`7` Job Name i UU� C Job# Address ���/� US� fE_ Job Locati n Date Date of Plans Phone# f� C�(J���F �' � x# Architect ewe hereby propose to famish the materials and perform the labor necessary for the completion of:• try loe z� c x te-e G��i Ci! G7 ��G? C LtiGti? r O We pro hereby to furnish material and lab I complete in accordance with the above specifications for the sum of. S C. UG Dollars with payments to be made as folio-%All " 3 Any alteration of deviation from above specifications Respectfully 4/ involving extra cost will be executed only upon f written order,and will become an extra charge over Submitted ` and above the estimate.All agreements contingent upon strikes, accident or delays beyond our control. 'Note—This proposal may be withdrawn by us if not accepted within jdays, Acceptance of proposal The above prices, specifications and conditions are Signature i% C satisfactory and are hereby accepted: You are authorized to do the work as specified. Payments will be made as outlined above, '. Date of Acceptance /��114 Signature 4 d. _A hUtictt�_ Re eN;sor `,tense. �of Burl�on.guP ' B�`rr COnSt�uCt� s 62g30 %cen5e L C Restricted tiO a ` E 30NN \ pEpENE�opE02 35 312g120�t C01 MP` EXpirat�0r0 t�3g a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel I y L 6* 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 Village W/hvyis Owner &VFAgea1? 49N®6 ATDG Address $CIF Telephone Permit Request / 41—k !®/fi r o 1 0 d, so (so) Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation coo,-C Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach �6t porting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King ighway:�0 Yes❑ No Basement Type: ❑ Full . ❑ Crawl ❑Walkout ❑ Other :73- 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 ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Nam!d S 1"7&11'I Q a,+ Telephone Number �0R Address 0)0757 A/P VFS A ' License # /4/0 Z a Home Improvement Contractor Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Y/XM 11r# SIGNATURE DATE FOR OFFICIAL USE ONLY 1 APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE i OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION a t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. � I ,y The Cmmmcr�xfsif#afMassachrEsefty DeFw&YeW ofIudvsiil Accidents 600 Wa&hvk x meet .dos MA 02 wa'r JnassgaVdxa Workers' CompensafiunInsarance�4ffidavrL BuiMersfCuntractolt/iectricmnMumbers Applicant Information Please P'rmf Iev�ihIy Name(Iltrsi�ssl0rgani iiQaFfntirnich C ��G ?01��'fi'�vv dress a?o WfAlry AloYe-S 4b C ty/Sta.&_7ip: S, - p v mft v 2bQV Phone 4 0 -.2 9s^7;2- Are you an employer?dheckffie appropriate bo= T 'r a contractor affdI �of�o3ect€r���: LQ I am a employer with ❑ I ❑New you ' etuployees{full agdfat gait tirue}* �ebiredthe - 2 I am a sole pmp�t2r orpartner- Itste3 on ihE attached sheset F_ ❑Remodeling ship and have no employees These sub-contractors have 8- ❑Deraclitiort Io and have workers' woAing forme is any capacity 9_ ❑Building addition �.WQZ�gS' Camp_inmrranre comp.mcttrar�n regniredl 5. ❑ 'We are a corporatica and its 10-0 Electrical repair or addifions '3_❑ I am a hamez7u ner doing all wad officers have exrscised their 11LE]Plumbing repairs or additions myself [No urarksrs'comp- Hght•ofemmption per MGL 12❑Roof rep=, c 152,§1(4},and we lras'e no, employees.[No /f /� in�rxanre required-]F workers- 13_❑Other / -9f b F comp-insarance required_I Y�Ptixicat that cheers box f1 mast also fill out thee section below sh=ing their wo3cecs'coapeasaiiou pa&T infer ffametrwners ttho submit this sld.- infesting d32y will mr5 ttW rhxk this bar mast stbiched an additional sheet Shlo'K.iae the name of the sub- r;and 5t8te whether aC=t Ihase mgitk S haVe - employees. Lfthe suU{autractarshave employees,they-ex provide their waders'comp.policy number- Lam am arz empinyer thdisprtmidixg warke-rs'conwnsedio.n irm4rrrrzcs far niy enpta,yeecs. BelotV is fftepa cy an.d job site irzformQFi4t4 Insurance Company Name: �9C�.,� 1 AISU 4AueE . PoEcy#orSelf ius_Li�;k Le aWo Fxgi=atifluDate: Jolt Sit,-Address . /" �W�Hbv S�' ��t�2A�ny� b ) city�stater2sp: �/al�'. 411 Attach acopy of the trorkers'compensation polies declaration page(showing the policy number and expiration date). . Failure to secarc cav erage as regairedunder Seetiota 25A of MGL c, 152 can Lead to the imposition of criminal penalties of a fine up to SL50D.0D and/or me yearimpiiso=ent,as well as civil penalties in tine£offi of a STOP WORK ORDER-and a fine of,vp to.$250.00 a day against the violator_ Be advised that a copy of this statement maybe farwnded to the Office of . IIIves ptions of the DIA for insurance coverage vacation_ I c€n Facrreb}�7 ri tiis,puirts artripsn� ees a `pedwy diatthe infor ta'ianprmu�d abm�e is true d corr�sct lure; Date �'( , ciul use 47111y. Da not writes in this area,to bs campleted by chi or farm official City or Town; PermitUcense# Fssuing Auf mity(tdrde oice):. t L Board of Health 2.Ruilffing Depailment 3.afyfrown Clerk 4.Electrical h2spector S.Pfmmbing Inspector 6.Other Contact Persan: Phone ih 6 Wormatioia and instructions ti.. Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. pmmnntto this stitrrte,an anployee 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,partaership,association, corporation or other It-,gal entity, or any two or more of the foregoing engaged in a j oint 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 Iocal licensing agency shall withhold the issuance or renewal of a Iicense 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 thin 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), addresses)and phone number(s)along with their ceri�ncaft�s)of insurance. Limited:.lability Companies(.LC)or Limited Liability Partnerships(LLP)with n o empl oyees 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 maybe submitted to the Department of Industrial Accidents for confirmation ofinnu-nce Coverage. Also be sure to sign and date the affidavit. T1ie afhda)2t should be mtumed 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 th e 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 Ime. 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 permitllicense number which will be used as a reference number. In addition-an applicant that must submit multiple pemnit'limnse 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 maybe 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 brrn leaves etc.)said person is NOT regoaed to complete this affidav-it 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. y at Commaav7Wa of M ssachusett-, Depajt=at of hi&&tjaj Aoaidezt &M Wasbm9t m Shy B as,in=MA 02111 . Tel..A 617 727-4905 W±4�06 ar I-977-hEkSSAFE Revised 4-24-D7 Fax# 617-` 27- 49 v dia .mqs.�.go � � ETti Town of Barnstable Regulatory Services �$"IM 'Eg Richard V.Scali,Director 1639.���O 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 I, OAKS r of the subject property hereby authorize C eyIySt-j d A/ to act on my behalf, in all matters relative to work authorized by this building permit application for: 36 jd-WAuf-AoUsC- r&-;�e4a .���i�/� (Address of Job) 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. r ' a e of r-7h u6Ti�E Signature of Applicant 41 . Print e Print Name- 1 � 0 1 q Dat Q TORMS:O WNERPERMISSIONPOOL4 Town of Barnstable Regulatory Services V4 Ta Richard V.Scali,Director ` BuiIding bivision 4 � t Enaxszas Tom Perry,Building Commissioner arnss. 9� 163¢. 200 Main Street, Hyannis,MA 02601 a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": 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 on(,- 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,RuIes &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 formlcertification for use in ;your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 i. axq;eu�rs fnoy;r,u ptien;ON . s.. o Public Safety I, . Massachusetts -Departrhent f Board of Building Regulations and Standards Construction Supervisor � s License: CS-104107 9IIZOxy1I`uo;sog ezzld 31atid 0I ,� I uor;elnDag ssautsng pfre�Yrrn;;d aawnsuo xo 30WO' CAR OS H FIGUEIKO f o;uzn;a r punol`;I a;ep uor;exrdxa ails a►oLaq; 20 CAPTAIN NOYESF'RD _ SOUTH YARMOiJTH `y 02964 < �,"-n asn inprnrpuf o;pr`en uor;ea st�da io��uaarZ r Expiration �ea» �zorzcueall�o,�C/�/l�coJCrurelE�' OSl2512015 Office of consumeeAffairs&.Business Repulatioa commissioner - ME IMPROVEMENT CONTRACTOR _ egistration 15.3792 T� { ype . � x irambrr:Y_1/ P 8/2015 - 'DB ; A i C&F.REMODF_LINC +; I • - , 1 'ARLOS FIGUEIROA .... 20 CAPTAIN NOYE:S'Rf7 S YARC UndersecretaJIOUTH;MA 02604 j k. _ ry.. e. _ ' . . k. PINEBROOK CONDOMINIUM TRUST 23.TOWNHOUSE TERRACE. HYANNIS, MASSACHUSETTS 02601 NOTICE OF ELECTION OF TRUSTEES In accordance with Article II,of the by-laws of Pinebrook Condominium Trust recorded in the Barnstable County Registry of Deeds,dated September 16, 1971,Book.1530,.Page 132, Instrument#39989,Notice is hereby given of Election of Trustees. The undersigned hereby certifies that,pursuant to the vote held at the annual meeting of unit. owners on July 20,2013 at the Community Building,the.following unit owners were elected to:be the duly constituted Trustees of the Pinebrook Condominium Trust of Hyannis: Names&Addresses Term Expires 4th Saturday of July of the year: Ruth Ouellette, 76 Townhouse Terrace 2014 Linda Bezanson, 22 Townhouse Terrace 2014 .Don McArdle, 62 Townhouse Terrace 2014 Marti Baker,.76 Townhouse Terrace 2015 Phil'Kelly, 10 Townhouse Terrace 2015 -Ik Executed as a seal instrument.this _day of 013. A. Linda Bezanson, Secre COMMONWEALTH OF MASSACHUSETTS Barnstable, ss YPd4we* i:S-4, 2013. Then personally appeared the above-named Linda.Bezanson, and acknowledge the foregoing instrument to be of her free act and deed,before me: BUST IN. No ublic 'Pubkexpires:My Commission ex na OF cwllsi:frs P wComiNwim Ex.pires 27,WiO DARNSTA RE DEEDS b DATE(MMIDD ACC CERTIFICATE OF LIABILITY INSURANCE 8/26/2014mm THIS'CLRTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S)i AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Leonard Insurance Agency Inc NAME: Berkley Assigned Risk Services NE 683 Main St B n/cc.No.E,d: (800)634-4589 lac.No.): 866 215-8118 E MAIL -Osterville, MA 0265555 ADDRESS: PolicyServices@berkleyrisk.com ` INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Acadia Insurance Co. 31325 INSURED _ INSURER B: - Carlos Figueiroa INSURER C: - dba: C N F Remodeling INSURER D: 20 Captain Noyes Rd, INSURER E: South Yarmouth, MA 02664 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AN CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR PE OFINSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS - LTR INSR WVD. MM/DD/YYYY MM/DDNYYY GENERAL LIABILITY - EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE PREMISES (RENTED $-' _ Ea occurrence ❑ CLAIMS-MADE ❑ OCCUR ❑ ❑ - MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ - GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $ PRO- POLICY ❑ JECT ❑ LOC $ AUTOMOBILE LIABILITY El ❑ - - COMBINED SINGLE LIMIT $ Ea accident ANY AUTO $ BODILY INJURY Per person) - A OWNED ❑SCHEDULED AUTOS $. AUTOS � BODILY INJURY Per accident HIRED AUTOS ❑NON-OWNED - PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB ❑OCCUR - ❑ ❑ EACH OCCURRENCE - $ EXCESS LIAB ❑CLAIMS-MADE - _ AGGREGATE $ - DED_ ❑-RETENTION$ $ WORKERS COMPENSATION - WC STATU- OTH- ' "AND EMPLOYERS'LIABILITY - Y/N - - TORY LIMITS ❑ ER ANY PROPRIETOR/PARTNER/EXECUTIVE E:L EACH ACCIDENT $ 500,000 A OFFICE/MEMBER EXCLUDED? N/A ❑ WC-20-20-000092-07 05/01/2014- 05/01/2015 - - - (Mandatory in NH) - - E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below - - E.L.DISEASE'-POLICY LIMIT $ 500.000 ❑ ❑ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - - Election Category Election Status' Name All Entities/Insureds: Sole Proprietor Include Carlos Figueiroa Figueiroa CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Andrew Ol'Brien THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 91 Pleasant Pine Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE x / Signature: s ACORD 25 (2010/05) BRAC 3139 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION f I6� b (L(��7 � Map 0 Parcel 1 Application # Health Division Date Issued /b Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 3 Y 7TOXhboSE /6724ftE ARVi 1pdy-6 7 Village 14YA-NtlIS Owner rtA1 E 6PV,01_ dq o o-o mro Address 54m e- Telephone Sa4p"3&rS_9 L1gq `/m4m j deiffow y Permit Request 1grs*,Vae 90/GD1Nq 40 pr S�v 1 �P R` s du S� �S'Q ca X Square feet: 1 st floor: existing proposed 2nd floor: existing-proposed- To ne Zoning District Flood Plain Groundwater Overlay Project Valuation (�yConstruction Type I Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation... Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ 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 ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name SOS 5&d G 1h,4 Telephone Number S Oe d 7 �7 5 Address 0�0 MAW Ax9rS ID• License # lV//07 VIA 0yZ&0�t Home Improvement Contractor# /5 37 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO7�rQ1l SIGNATURE DATE 1041 // y FOR OFFICIAL USE ONLY APPLICATION# E DATE ISSUED MAP/PARCEL NO. L ADDRESS VILLAGE OWNER DATE OF INSPECTION: 4, FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSQ,CIATION PLAN NO. s Tke CdJltfmlJ4ZlS QfMassachmsefts t ~'� Dgmrtr t ref ImkYfrcad Acddent - - [ �-rtifkgrrs 600 Wmhkpa Street Aastarj,MA 02M wnw.mass.gotldia W-arkers' CrrutpensafmnInsadance�kffidavt RmldersfCaLnfractors/Bectric=sOumbers pIkant Irfa rmafian- Please Pant Legibly Nate caasfiess/a ��t�aly: e Q i® f Tdress. �0 6V-1%h-U NOV6~s Cityls : S-YOPW UWq j IVA Il2 GD V Pho=9-- 6DA,?37A q,ga i re yan an employer?Checkthe appropriate ba=' Type of project r L I am a employer with 4. El am a dal contractor and I I tactim �SloyeesUbna4dtorgart4ime-) ea �contra�tors * have-hirtbes 6- ❑Ne lam a sole proprietor arparfner- listed on the attached sheet �- ❑Remadeinxg ship and have no employees These sub-contractors have g- ❑Leronlitio-a working forme in any capacity. employees and have worms' 9_ ❑Build-mg addition WO.WorleLS' camp.Msardnne comp.mcnr Me l reTlired-1 5. ❑ ate are a corporaticaand its 10-0 Electrical repairs cr additions 3-❑ I am a homwwner doing all work officen have exercised their 11-0 Plumbing repairs or additions off [No worriers'comp- right of exemption per MGL 12_❑Roof repairs incrxwnre z uiied.] c-15Z§1(4),andwehgg��ena . F 13-g Od ux emglrue -[Na Workers' comp-insurance required_I 'Any appEcmtthat checks box'l=ist also El out the Section belaxshz ingi�eirwmrRen'compenmd=policp;ni,�*+,', Ram W- W ne rs wb o submit ibis sffl&—v-A i,dlc^*;they a'e doing=II si th=*+hire outside coat maom most submit anew 2d5dsrit in tnrsra Such orsthstcheckthusboxmostattackedsaadd;r;rn,4tsheetsb=iogthenameofdie and.statewhetirertrnatihoseprhfiesfie employees. Ifthe sub<oMmamishire employees,they must provide tieeir warps'comp.policy number. lam arc Bellow is fitepLaYr artd job site iri�ntwrQtiran_ - F , Insurance C-ompaYI•=e: ACAD;I+ >1a]3t RY46E Poficg�ar SeSf.ins_Lick: �(% aDoZ 0 t�D qp7�7 Fxpiration.I?ate: � .� �. Job§ice A- -y�y5�'1 Z��cr'/�c��c�r,�� �7� C 4Stat� *a�� Attach a ropy of the:workers'compeusaf m policy-dedaration page(showing the policy number aadd expiration date). Failure to seL-ore:coverage as requiredunder Section;25A of MGL c. 152 can lead to the imposition of criminal pexmlties of a fine up to S1,500.0D an:dlor one pearimprisonrnen�as well as civil pertahim in the fuffi of a STOP WORK ORDER-and a fine of up to V-50.00 a day against the violator- Be advised that a copy of this statement maybe forwarded to the Office of Inr-ersfigations of the Mk for invmxnce coverage ya:iScation- I do figreby it der s pains acid psnaZ9 of thatthe irrfvrmafaaa pratdded abcr c fs fnw and correct Bate © Id Phone 9 , C#TWiaZ rrm arty. Da not wrifts in fibs area,is be camggeted by city or fawn ajfic&L CIfy or Toww. Pam6tUcense# henna Au-thRrity(drde 4he): .. L Baard of Health 2.Building Department 3.afyfFawn Orrk 4.Electrical Inspector 5.Ptu mbmg Fnsgectoe 6.Othrz Contact Person: Phone ff 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Ptusuaatto this stattrte,an an is defined as"---every person in the service of another under any contract Of ire, 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 reside's therein,or the occupant of the dwelling house of another who employs persons to do maintenaace,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((�also states thAt Revery state or Iocal 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 i,,.crrra„ce requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by cheeld og The boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone numbers)along with their cerdfcatc{s)of insurance. Limited Liability Companies(LLC) or LimitedLiabrlity Partnerships(LLP)withno 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 taus affidavit may be submitted to the Department of Indusbial Accidents for confiim- ation 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 Depar rent 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 companje-s 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 add_rton an applicant that must submit multiple permit/license applications in any given year,need only submif 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 stomped 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 (Lt.a dog license or perms to bum It-ayes etc.)said person is NOT requited 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 a.d.d-ess,telephone and fax number. at COMM MW&of Massachusets D$ nt cif 7ndustrial Aoaidtn s Q �e Of Tsnve�tiga�tF�ns WO Washington Strut BQStGa.,MA G2111 Tel.f4 617-72-7-49QW(=t 406 or 1-977-MAS AFC Revised 4-24-07 F=# 617-727- 49 - aUs gov/dia f 'ME rqy Town of Barnstable Regulatory Services 9MASa $ Richard V.Scah,Director i639. �� �Eo +. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder „ I, H A P I � 6A k6-9- , as Hof the subject property hereby authorize oe- a-w 5 We,V* o.,./ to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) " "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. S TpSTE�,S�jv Si nature of A licant g PP Print ame Print Name 0A 1'5�lr� -1 Dat Q:FORMS:O WNERPERMISSIONPOOIS Town of Barnstable Regulatory Services y, �oFVHWE Tolry,� Richard V.Scali,Director Building Division 4 Y • t Enxxsz'AsL Tom Perry,Building Commissioner MAss. 1639- ��� 200 Main Street, Hyannis,MA 02601 �E° '�a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": 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 reside&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. _ ti 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. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 I` i zc}jeu2!s}notppM M113A 19N G'j1 " t of Public Safety - PJlassachuseYts Departr��en r. I Board of Building Regulations and Standards i Constructi(ili Supervisor License: CS 104107 �S 9IIto-YIAI`uoasog i IN i�� I CIS a1mS-ezeld�1aBd OI' �r r uo�lelnDag ssamsng po stiiiuj;d aamnsuo CARLOS H FIGUEIItO tt I :.: 20 CAPTAIN N01'FS�'RD 01 u rnlaa punol`�I alep uo� Ea�dxa eq;alo;aq ti�nn asn inpiAlput ao;p�ien..uo�;ea;s��„.� io.,asuaa��. .•� SOUTH YARMOYJ TH: i 0264 A. EX p l t at l o n. y� aoz<uezll�o'�C��aJ rt / J.�.� 0$/25/2015 \ Office of'Consumef Affairs&'Business ReUulationJelh Commissioner — ME)MF�ROVEMENT CONTRACTOR egistration 53792 Tr ype . �xpirau pn �:.1/8/2015 I DBA C&F REMODELING I I,ARLOs FIGUEIRO 1 S YA: M.QUTH' MA 02604 Undersecretary:. _ @D�`-b-",�.:,g_ 10 : vim& 1 =- 5 s.P PINERROOK CO"OIMIINIUM TR FIST i.� 25 TOWNHOUSE TERRACE HYANNIS, MMSSACHUSETTS 02601 NOTICE OF ELECTION OF TRUSTEES In accordance with Article II,of the by-laws of Pinebrook Condominium Trust recorded in the Barnstable County Registry of Deeds, dated September 16, 1971,Book 1530,Page 132, Instrument#39989,Notice is hereby given of Election of Trustees. The undersigned hereby certifies that,pursuant to the vote held at the annual meeting of unit owners on July 20,2013 at the Community Building,the following unit owners were elected to be' the duly constituted Trustees of the Pinebrook Condominium Trust of Hyannis: Names&Addresses Term Expires 4th Saturday of July of the year: Ruth Ouellette,76 Townhouse Terrace 2014 Linda Bezanson, 22 Townhouse Terrace 2014 .Don McArdle, 62 Townhouse Terrace 2014 N: Marti Baker, 76 Townhouse Terrace 2015 Phil Kelly, 10 Townhouse Terrace 2015 Executed as a seal instrument this 4 day of 2013: - 0_ lS QA � Linda Bezanson, Secre COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. t e/ 6 , 2013 , Then personally appeared the above-named Linda Bezanson, and acknowledge the foregoing instrument to be of her free act and deed, before me. -=77=1" Not ublic My Commission expires: alo2Ekvm M 5M BARNSTABLE REG Of DEEDS i 7 DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 8/26/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions Of the policy, ce rtain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such end,orsement(s). ' PRODUCER CONTACT - Leonard Insurance,Agency Inc _ NAME: BerkleyAssigned Risk Services 683 Main St B aco.NN.Ext: (800)634-4589 (,C.No.): 866 215-8118 Osterville, MA 02655 n DD AIL PolicyServices@berkleyrisk.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Acadia Insurance Co. 31325 INSURED - INSURER B: - Carlos Figueiroa INSURER C: dba: C N F Remodeling INSURER b: 20 Captain Noyes Rd INSURER E: South Yarmouth, MA 02664 INSURER F: . COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AN CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -INSR PE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR , INSR WVD .MM/DD/YY.YY MM/DD/YYYY GENERAL LIABILITY x EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ - PREMISES Ea occurrence ❑ CLAIMS-MADE ❑ OCCUR ❑ ❑ - MED EXP(Any oneperson) $ - _ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS—COMP/OP.AGG $ POLICY ❑ JECOT ❑ LOC $ AUTOMOBILE LIABILITY ❑ ❑ _ COMBINED SINGLE LIMIT $ _ Ea accident ANY AUTO r $ - BODILY INJURY Pe person) ALL OWNED ❑SCHEDULED AUTOS - .AUTOS BODILY INJURY Per accident $ HIRED AUTOS ❑NON-OWNED PROPERTY DAMAGE $ - AUTOS Per accident UMBRELLA LIAB ❑OCCUR ❑ ❑. - EACH OCCURRENCE $ EXCESS LIAB - ❑CLAIMS-MADE - - AGGREGATE $ DED -❑ RETENTION$ - _ $ WORKERS COMPENSATION - WC STATU- OTH�( - AND EMPLOYERS'LIABILITY Y/N- '`J. TORY LIMITS ❑ER - ANYPROPRIETOR/PARTNER/EXECUTIVE E.LEACHACCIDENT - $ 500,000 c.. A OFFICE/MEMBER EXCLUDED? N/A ❑ WC-20'20-000092-07 05/01/2014 05/01/2015 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500-000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT $ ❑- ❑ - DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required). - - Election Category Election Status Name All Entities/Insureds: Sole Proprietor Include Carlos Figueiroa Figueiroa CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Andrew�OV13rien THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN -91 Pleasant Pine Ave. ACCORDANCE WITH THE POLICY PROVISIONS: Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Signature: ACORD 25 (2010/05) 'BRAC 3139 TOWN OF BARNSTABLE,BUILDING PERMIT APPLICATION Map Parcel ,�. Application # o �`J-✓�'�I Health Division FP -6 P_i ;. Date Issued Conservation Division Application e /71 Planning Dept. Permit Fee VJV�T (`,, Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address 1-owm Alov.46 D,26 Village ®®11)1,9 INtS Owner Urde pog CMG �,SOG • Address A fJI 0#00so 7��L,eAIG-,/°-��yR�✓�,LS Telephone s-a-y-sys7-9 99 Permit Request . `1� �9' 'Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio f Oo Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ 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 ❑Yes ❑ No If yes, site plan review# Current Use- -- -------- _ - _ -- Proposed Use- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ;/ �r.�� Telephone Number Address '7_ o�rrr ,.,� � W t M W License # /O V O 7 6 Home Improvement Contractor# Worker's Compensation # 6Z.2 00_1V ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE /;%� � DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP PARCEL NO. ,t ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION i.` FRAME INSULATION !,r ". FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL Y FINAL BUILDING DATE CLOSED OUT k . S ASSOCIATION PLAN NO. Pp d } 600 Washingtort Street- Bostdx,MA 02111 wwwanass.govldia Workers' Compensation Insurance A ffdavit:Builders/Contractors/Elecfri.cians/Plumbers Applicant Inforliation Please Print Le ' l Name(sash s �/FnriiVidmD: City/ e/Zip: w,��y 'f r�q `j Phone.# S4��d�d�f Are you an employer? Check the appropriate bo= a of iro'ect'r 1.�a employer�h _ •4. •❑ I am general ca�actor and I � P I ( �'�}�• . . . • .. eapioyees(fall and/or part time).* have hoed Hie Sob-corLacirrrs 6. ❑.Nevi const,,,�t;rn, , 2.0 I am a•sole proprietor or partner- • ' listed on ffie'altached sheet' 7. []Remodeling ship and have no employees These sob-cantacton have ' _ I. ❑Demolition work mg forme many capac4-. employees and have wD3i=' [NO worJonp' caD3p.in�� r_ne• cam•IIy�m,ance- t 9.. []Binlduig addition require3] 5. ❑•We are a corporation and its ID.❑$lechicalrepairs or additions officers have cxm-+ged fheo 11. P aim or additions `3.❑ I am ahonaeowner dflmg all-work ❑ Iim�bingreP ` uglst of exemption per MGL myself [N'o workers camp• - 12.❑It.00frepaos . msarance mod-)t c. 152, §1(4),and we have no craployce4 [96 workers' 13.❑Other coup.incmance 1 . 'Any applicaut ffiat checks box#1 must also fill out the swfim below.shD;a i their wmk='compensation policy ixdormatiom. Hrlmeowaers who submit ads affidavit iaficating ffiey an dung aD work and thin bin outside mutza�must submit anew affidavit indicating such. . Conhaclnrs that check this box must attached an additional sheet showing$ue name of the sub-conhactom and share whefficr or not Swsc mtitics have =ployecs. If the sub-conhactma havo employees,flicy most providt rhea w0is'comp.policy number. pw an employer that is pr6viding workers'compensation insurance for my employees Below is tke policy coed job site mfarmafion J/ a.gu ance CompauyName: V �+ olicy#or Self-ins.Lic. L—y()O 3 P :ib Site Address: i 'I�e( 1q-1 fTJ 1 .t s M .ftachL a copy of the workers' compensation policy declarxaonpage'(sho�i thepolicy number and e=pirafion dafe). ailua-e•to secure coverage as required under Section 25A ofMGL c. 152 can lead to ffie imposition of crin�al penalties of a ae up to$1,500.00 and/or one-year k onment; as-well as civiil penalties in ffie form of a STOP WORK ORDER and a fine np to$250.00 a day against the violator. Be advised that a copy of fhis gta�may be forwarded to the Office of YesdKab=of the DIA for insurance coymagc verb.cation. fo•hereby cerl jy under ae pdns•andpenables ofperjury that the informa:don provided above is true and correct m.atrire: «� �� Date /-. lone# Official use only. Dd not write in dds•areq to be completed by city or town co7cW, 'GKy or Town Permit/I�icease# Issuing,kmthartty(mete one): L Board of Healfh 2,Buildbig Department 3. City/Town Clerk 4.RlectricalInspector 5.Plimlbm9Inspector 6. Other 20ntact Person: Phone#: PINEDROOK CONDOMINIUM TRUST COMMUNITY BUILDING 25 TOWNHOUSE TERRACE HYANNIS MA.02601 Phone(508)775-7356 August 13, 2013 To: Town of Barnstable-Building Division Re: Building 8 Siding Repairs Please be advised that the'Board of Trustees give permission to Mullin Roofing and Siding to do some siding repair work on Building 8 located at the Pinebook Condominium Association, 25 Townhouse Terrace, Hyannis, MA 02601. Should you have any questions,please contact our management company at 508-385-9499. Sincerely, Ruth Ouellette Trustee/Treasurer OF'WE rq� Town of Barnstable ti Regulatory Services MA ssl E Thomas F.Geiler,Director ArEo 39. 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 I, R/ i1 61/f/7 ®���h� ` , as 9wftet of the subject property /yI U4,4141 A210F� � S%AiN - hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit. fOGUR/ Ol1S� Elegy 1,ly�/l/�iS, (Address of Job) **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. Signature of der t eJ1 't-C E-- Signature of Applicant Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 r �TME Town of Barnstable Regulatory Services MAM E Thomas F.Geiler,Director 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 "HOMEOWNER": 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\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 lld�Ktlt7iltiCit,� Lpep 1Cml111 u� r-U[aaiv aIvt-- , g' 8oardmf Build►n- R.<<jul ttiS►n� u►il"Star►tlt t1e ConstrucY►on 5 grv►s9 Vcense # «s., A - License CS'.104076 y Restricted to:..:00 �,• :. . tom.- MARK MULLIN a " 10 PERRY AVE. E NtAREHAM, MA 0253f3 h Expiration: 9/7/2073 T. . --. __ _- y -Q�- --- - � °(f�uutns�i�ln�•�• _ Tr#i ,104076'. _ G c(an�na�uue /a CJAlezaac ucrel y.. nGonsnmft Affaus:&$usiness Regulahon �IV(p,EtO 11'CO►dTRACTOP, License or registration valid for individul use only' eg►str�tion 167281 before the expiration date: If found return to. Type' Office of Consumer Affairs and Business Regulation ` xpgation r 8/30/2014 DBA 10 Park Plaza:-Suite 5170:, MULLIN RbpFfNG AND SIDING Boston,MA 02116 MARK MULLIN i 7 CCNNEMARA%&AY ' W.YARMOUTH MA 02673 Undersecretary' Not valid with signature I f _ A CERTIFICATE.OF LIABILITY INSURANCE ��(MMIDDtYYYY) L.� 1/4/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE.A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Margaret J Grassi Ins Agency PHONE FAX 1188 Main Street (A/C.E-MAIL West Wareham, MA 02576 - (508) 295-2007 / N : (508) 291-1707 ADDRESS: debmjgins@comcast.net INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Allied INSURED INSURERB:ColonV Insurance AcTencV Mark M Mullin I NSU RER C 7 Connemara Way INSURER D: West Yarmouth, MA 02673 INsuRERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICYVPERSO�AL&ADVIINUURY LTR TYPE OF INSURANCE IN SR POLICY NUMBER M/DD/Y MM/DDVLIMITS B GENERALLIABILITY GL3818794 1/5/13 1/ NCE $ 1 000 000 X COMMERCIAL GENERALLIABILITY TEDurrence $ ZOO OOO CLAIMS-MADE OCCUR ne person) $ 5 000V INJURY $ 1,000,0 OO GENERAL AGGREGATE $ 2 000 000 GENLAGGREGATELIMITAPPLIESPER PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY PRO--JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS _AUTOS araccident UMBRELLA LIAB F OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ I A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY 6ZZUB-4O83P83-4-11 12/8/12 12/8/13 X WCSTATU- OTH- ANY PROPRIETOR/PARTNERIEXECUTNE YIN E.L.EACH ACCIDENT $ .1,000,000 OFFICERIMEMBER EXCLUDED? 7 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 11000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZ REPRE ENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: PINEBROOK CONDOMINIUM TRUST 25 TOWNHOUSE TERRACE HYANNIS, MASSACHUSETTS 02601 NOTICE OF ELECTION OF TRUSTEES In accordance with Article H,of the by-laws of Pinebrook Condominium Trust recorded in the Barnstable County Registry of Deeds,dated September 16, 1971,Book 1530,Page 132, Instrument#39989,Notice is hereby given of Election of Trustees. The undersigned hereby certifies that,pursuant to the vote held at the annual meeting of unit owners on July 20,2013 at the Community Building,the following unit owners were elected to be the duly constituted Trustees of the Pinebrook Condominium Trust of Hyannis: Names&Addresses Term Expires 4th Saturday of July of the year: Ruth Ouellette, 76 Townhouse Terrace 2014 Linda Bezanson,22 Townhouse Terrace 2014 Don McArdle, 62 Townhouse Terrace 2014 Marti Baker, 76 Townhouse Terrace 2015 Phil Kelly, 10 Townhouse Terrace 2015 4k Executed as a seal instrument this day of 013. o'. Linda Bezanson, Secre COMMONWEALTH OF MASSACHUSETTS Barnstable, ss YeaYevAu 6 , 2013 Then personally appeared-the above-named Linda Bezanson,and acknowledge the foregoing instrument to be of her free act and deed,before me. Sj,tARAH'13U8T1N. No ublic Coraso�u ► sacr+usEns PWk My Commission expires: ala?/� W.Cammission Expires 2T,2020 SARNSTAKE IMMYOF DEEDS BUILDER INFORMATION p Name �— Telephone Number Addr6 s . /' % rr� —/�`T License# ey 5-7 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RES G FROM THIS PROJECT WILL BE TAKEN To SIGNATURE DATE f� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATIONS Map cr Parcel Permit# Health Division p Date Issued g 3 0' Conservation Division Application Fee Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address (/ �ov �r Village vu--vt "/c Owner sI r� �� _ ( ,427 a Tf,4 Address Telephone -7 71 7 Permit Request V? G2 07/e � 2 2 1 �Se Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 570 Construction Type 1_J eecl Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single.Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes Oslo On Old King's Highway: ❑Yes Ur o Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other yp Ot e Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes - ❑No Detached garage:Cl existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use . BUILDER INFORMATION Narr e ��� �/1N)T /1-t C -3-T I fioflN6 Telephone Number U _ �'� -�� Y2 Address d Gti ,, License# <J ►Q ��P.� Home Improvement Contractor# �3 Worker's Compensation# /JY 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /&?7 I tt SIGNATURE DATE a — 6111 . FOR OFFICIAL USE ONLY PERMIT NO. f" DATE ISSUED MAP/PARCEL NO. ' ADDRESS VILLAGE OWNER .mot ) DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ��� � ASSOCIATION PLA`V'NO. r I , I 1 ' } ' f ✓7e COOryivntp�uisea`/f O�i/lCpgQd�itE[Ge6 BOARD OF BUILDING REGULATIONS; iLicense: CONSTRUCTION SUPERVISOR ; d I Number:-LCS`.. 057337 G Birthdate 07/08/1954 t { Expires'07/03/20Q5 Tr.no: 13752 I � Restricted' 1 G MICHAEL L LEBLAtC 40 CRAWFORD RD/PQ B01 1422 ,�, COTUIT, MA 02635 ' Administrator II I ' l t _ _ Commonwealth o Massachusetts ,,•. _ _ , The Commonwe f , t _ - Department of Industrial Accidents* 6oa Washington Street _ Boston,Mass. 02111 Workers'..Comp ensation.•Insurance Affidavit-General Businesses ARF eddre36 4 ��, /d�✓ �� state:` 2i ; have# • - work site location(full addressl: ❑ I am a sole proprietor and have no one Bpsiness Type: []Retail❑Restaurant/Bar/Eating Bstablishmem working in any capacity. 0 Offie El Sales(including Real Estate,Autos etc.) I am an em to er with .' etn to ees(full& art timed ❑Other /% ///O�%////� %M I am an employer providing workers' compensation for my employees working on this job. :. ;• , coin"8I1'•.n 6i:- - +';� '�. +.,�„. �' •'' X. .fnsurance.co +• •-�:•a •� •-+ _ /� I am a sole proprietor and'have hired the independent contractors listed below who have the following workers' .compensation polices: /•.COm an r3ftlu •t .. ' address:. ;.�•.> ...r• • r i.= .•�'•.• ..;,.' , i.;,rv' '0�]e =#, •t"''fit' insurance c a7dresss. , . .. is'' •'�ru c.`: r, h0 -k insurance.:rbi'i' �• Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that i{ copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify u er the a' s enalties of perjury that the inform ation provided above is true a corre Date Signature ' �G Print name Phone#01,111 gi official use only do not write in this area to be completed by city or town official permft(license# ❑Building DepartmenJ city or town: ❑Licensing Board D check if immediate response is required ❑Selectmen's Office ❑Health Department contact person • phone#; Other I, (revived Sept 2003) Information'and Instructions Massachusetts General Laws chapter 152 section 25.requires all employers to provide workers' compensation for their. employees: As quoted from the"law", an employee is.defined as every person in the service of another under any contract of hire, express or implied; oral or written. An employer is defuied as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in ajoint.enterprise, and including the legal representatives of a deceased,employer, or the'receiver or trustee of an individual,partner'ship,.association or other legal entity, employing employees. 'Howevei.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, const mcdon or repair work on such dwelling house 6r on the grounds or building.app urtenant thereto shall not because of such en7ployment.be deemed tb be an employer.. MGL chapter 152 section 25 also'states that every. state'or local fimsing agency shall withhold the issuance or renewal of a license or permit.to operate a business or to construct buildings in the.commonwealth for any applicant who has not produced acceptable evidence.of-compliance with the insurance coverage required: Additionally,neither the commonwealth nor.any.of its political subdivisions shall enter into any contract for the perfomiance of public work unto' acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting . authority. e Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation..Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department-of Industrial Accidents-for confimmation 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 regardirie the�"law"ar if'you are required to obtain a.worke&'compensation policy,please call the Department at the number listed:below. . City or Towns . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fillin the permit/license number which will be used as a reference number. The.affidavits,rrray.be returned to the Department by,marl or FAX unless other'arimgements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents WN of Wes"DaNns 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 nhnnP#- (6171 727-4900 exf.406 °FtNKE�° Town of Barnstable Regulatory Services BARNSrABLE, Thomas F.Geiler,Director y MASS. $ � 1639..,61 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must.Complete and Sign This Section If Using A Builder L (,/ �f , as Owner of the subject property hereby authorize to act on my behalf, in all matters rela#-Vtow � orized b is buildin ermit application for address of job Y g P PP � � , Signature of Owner Date Print Name BUILDER INFORMATION p Name Telephone Number � � Address ;2/) License,# 5 7 7 ~M Home Improvement Contractor# = ' Worker's Compensation# ALL CONSTRUCTION DEBRIS RESU G FROM THIS PROJECT WILL BE TAKEN TO � SIGNATURE DATE 7 a �c�G✓� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel t��N � � ��� Permit# Health Division Date Issued 3 G Conservation Division Application Fee Tax Collector Permit Fee Treasurer 0 IT Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address X&vj4 et Village �f � Owner I Indrodh r Jo //'Vjt- Address Telephone 71 a us- 7 17 L,& . tie Permit Request kl-- Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Sw 0 . Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwellin�Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes RNo On Old King's Highway: ❑Yes @,,o Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) ` Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ 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 ❑Yes ❑No If yes, site plan review# ` Current Use Proposed Use R BUILDER INFORMATION Name kLr— GGw-5—( I /,-f G !Qt4rwy Slof TelephoneNumber i / 1 Address 5 G� ��b�a�16K4 t r- License# SA44 �/i (',�i (� - Home Improvement Contractor#' Z 00 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO s c h_ch&e SIGNATURE DATE / " q 4 y r_, � �.� FOR OFFICIAL USE ONLY -v I V r, fERMIT NO. � DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE. OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION j I • a. FIREPLACE t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ft Air, GTIe Pomvno.zu�ea o� /�craaacju�aelta BOARD OF BUILDING REGULATIONS iLicense CONSTRUCTION SUPERVISOR Number--CS 057337 6 Birthdate 07/03/1954 E I Expires R07/03/2'Q05 Tr,no: 13752 Restricted 1 G MICHAEL L �LEBLAIVC 40 CRAWFORD COTUIT, MA 02635 Administrator I� _ ------- ��FZHETp,�� Town of Barnstable yam? 0� Regulatory Services BMWMASS Thomas F.Geiler,Director E16 9. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder ✓7', OVE U& as Owner of the subject property hereby authorize#iv�eto to act on my behalf, in all matters relawWaurized byt building permit application for(address of job) All Signature of Owner Date Print Name _ The Commonwealth of Massachusetts-`° Department of Industrial Accidents* 6oa Washington Street Boston,Mass. 02111 Workers'..Coin ensation.Insurance Affidavit-General Businesses address: 'Ole'! 0f Zip: hone# work�telocation(full��d�s;l: y ❑ I=.a sole proprietor and have no one Bpsuiess'I�pe. ❑Retail❑Restaurant/Bai/Eating Establishment yvoildng in any capacity. ❑ Office❑ Sallee (including Real Estate,Autos etc.) ❑I am an ere to er with .' employees(full& art time. ❑Oilier �/////%%%/�%%%ii�//lily/% %/%//%�///%%%/%m i l/%///O//G% I aril employer providing eskers compensation for my employees working on this A. �1i. :.i54:•1i,1:j: ,�i: •!•: �P .,t;•�::'.t' •:1.3•'.3•. � i:l••li '.ii .•i{ '.:i`'Y�.•.. ^t com an ne$e: a :i .ti .�tt�.ii.'• +':.:.1'^" h'.:'' i 1:: .::�:.•lr,: .�L': :y' wti :is•. ::ji' :f. t.M' •9 :f`3.l7•', •1•r' •( ...y,s:— .�r"{:,. '1 :4-r•:'_F::.t{.!;�.'`{eye ..�.i:,<.• ..a.•- 't...•::t...:: :1'.• ' ' stl$re'ssE` :�;.' ':• hone:#.:.�"�',• •. 1 '1. - 't t.'.•i`;•• t� •1• 'il:•�.i•' •"i. •� '4' •t..i' •4• '>...•.'.' ':' � .:„`F. :;�.••w: :;E;�.4 .•k:,.. OI1C• .# insura / I am a sole proprietor and'h�ve hired the independent contractors listed below-who have the following workers' COII7 8II name• t. r :�'.. 1 t.v,y°,:t�::•.: �•. e.i• ... r„' ,,�•? ,•1a •:7.pr•••:S'� .�':ai'i'. h:.: r•' ..i ti' 1 •, R . :'i' >.t'i •s¢ '1" :e'iJ:Ti%t�.'..s 1 .f:'. '.0 +!•Y ti•>.•t'• `•{`•t.:�•, 'l1C iIISl12'aIICe •:.ice ;�{.s:):1. :1,: '':,` r t '';Ir,h:4 'tiC.•J•`�4.•'• '�� •'s•. �t� .•i.J• ;+:It .� C�• iwlK<. • ,: ." ' ' •done#: ;: :. .s • CI .. 't �1.!.. •.i. •.r• .+:�.:• +..•r.S.;a; .i.• >;:•k:°�i:'' ^+•'r'' '��`f�.•c: '.1•.;`5;.• :L .:fit ' f•.• till•• _��. ..+:r— .t'".;9. :,t• s- i� ;•• i :s• Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crimfnal penalties of a fine up to$1,50D.00 andJor one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand ibat tF copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification I da hereby certi,fy u er the a' s enalties of perjury that the inform ation provided above is true a corre 1 Date signature .. • sine Phone# �� �� Print n official use only do not write in this area to be completed by city or town official permit/license# ❑Building DDP.rt3 city or town: (]Licensing❑Selectmen'❑'check if immediate response 35 requh ed []Health De phone#; []Other contact person: (revised Sept 200) BUILDER INFORMATION �77 30 Name � �-- Telephone Number" w Address-2l)/*y License# Uy S 7`3;, 7 z tic OZ �� _ Home Improvement Contractor# ® Worker's Compensation# , ALL CONSTRUCTION DEBRIS RESU G FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATEZ� W TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION / Map arcel �Q�L�`/ Permit# Y S// Health Division Date Issued 1 Conservation Division Application Fee `JlJ Tax Collector Permit Fee Treasurer u7 Planning Dept. Date Definitive Plan Approved by Planning Board r' Historic-OKH Preservation/Hyannis Project Street Address Village Gwcc r Owner 7'(AF_ rzr, t- �,iiri `, e-?iP f Address Telephone n Permit Request �G d l�IA_ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuations -� • °" Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)// // Age of Existing Structure Historic House: ❑Yes ❑AO On Old King's Highway: El Yes S N0 Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑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:O existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use _ _ Proposed Use BUILDER INFORMATION Name �G� 6%�J pT Telephone Number. S Adroress IIA4� License# Home Improvement Contractor# Worker's Compensation# �7 3 � 4 W/V 10? ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO JQ1,_ SIGNATURE 1y-&� DATE " ��� FOR OFFICIAL USE ONLY _ PERMIT NO. DATE ISSUED - MAP/PARCEL NO. ADDRESS VILLAGE OWNER T a DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL •Y FINAL BUILDING € DATE CLOSED OU ASSOCIATION PLAN NO. < I ti r ✓fie 1°omvinoouuea/�__-...__._.. BOARD OF BUILDING REGULATIONS License CONSTRUCTION SUPERVISOR b Number CS`'. 057337 f Birthdate 07/03/10,54 �` E�fpiresy=07/03/2Q05 Tr.no: 13752 Re6triote&li§._ , MICHAEL L LEBLA1�hC f: 40 CRAWFORD RD/PO�BOX r COTUIT, MA 02635 r; Administrator I� The Comnwnwealth of Massachusetts '. Department of industrial Accidents' 600'Washington Street Boston,Mass. 02111 Workers'..Com ensation.•Insnrance Affidavit-General Businesses / "Sy,. ;Tra r. .yy. • :� -� .•.'.ty',AsEtr] / na=: address: zi hone# _ ,q74. 3 work sitecation (f loull addressl: !/�- El I alit.a sole proprietor and have no one Business Type: [l Retail❑Restaurant/Bai/Eatiug Establishment working le any capacity. 0 Offi'ice'[J Safes(including Real Estate,Autos etc.) ❑I am an em to es with .' etn to ees full&part time.. ElOther �%/%%////%%%//. / %/%%/%/�% I am an employer providing viork.ers' compensation for my employees workin % % g on this job.. \.• :.1:4'.)t _. 'h• P .G�;;,'�, .;t'i,t,:'S•. !: _ - ':i�'ii ri`t:`' •.li :•a' •:'t`'v.. com`an name• �y r: rtir: _ •.,a.e. t':�:{• _ it`s:- 1 „:id:i� _ •f..t0: :+:�.�s]• 'i:" .i:.:.. d•'.:�i. y?'.yai.'; 'h,'• ... .insur233ce.co5 '" u T am a sole proprietor and'have hired the independent contractors listed below•who have the following workers' ''e'-.' J.•'rrC! tom,.;.,. _r' �: :l•:'r S`��t'v:.;�?"'' -�e.,7t'4„F♦ .tit, .r. IZ address:. _ .+;. '. �°'�' .''' •' r r;t: •? ,•A,' :7.•i•••.t•�•trs',a:a:t/'.. ,�:{:! •�' ''• •'ti:. - .j:�; 1,•'t. :+,.y:. .',:.,:'kti4,t.i t'{.,it:• al 6::• :;,�` ik,::lily;; 'r r ;, •'t;, '+_' in'suratice'co. :x. r`: ; • z:,•„. ir'-::` %////�/////�i / ,y: +:ti.':•1 :1.• -:t;• .. 'r' •st.. �.�r:fi }2:: 21+77i r'•� ;•,irt :•i• 'i•i•t - coin'aii. us. e:.,-er =' _ ;: 1;;� addressi. � •; t. ? DO fiisuancr sb:r=` Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crirdwil penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties fII the foim of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that it copy of statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herebp.certify u er the a' s enaities of perjury that the information provided above is Prue a coogre Date _/ ® ' 5ienaivra Phone# ����� Print name �G official use only do not write in this area to be completed by city or town official or town permit(Reense# ❑Building Department cit y []Licensing Board • ❑Selectmen's Office [}checicif immediate response is required ❑Health Department contact person: • phone#; Other (revised Sept 2009 °FtHE� Town of Barnstable ° Regulatory Services '�$^MAss.. Thomas F.Geiler,Director �'ArEn Mp+a`� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1 17 ,as Owner of the subject property hereby authorize _ to act on my behalf, rued b buildin ermit a lic in all matters relative to wo ation for(address ofy g p pp lob) r Signature of Owner Date Print Name I E.T TOWN OF BAR.NSTABLE Z EA"ST"LE, i "6 9 BUILDING INSPECTOR °•Ea MAI a APPLICATION FOR PERMIT TO ............................. .....07....�,U'.Vx. .... �R.. .�............... TYPE OF CONSTRUCTION ............ ........#AP !!�^.....��:..:.:a...... ......�. ..W10.44.............................. ................... .".�.�.........191.1.. i TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ............ .a"!`.'r►. ..... ..........................1. `'WNW! .................................................................................. ProposedUse ......... ........................ ` ..................................................................................................................................... Zoning District ...: ..................................Fire District Nameof Owner ��.. ...V .....�............Address .2.0. ......................................................................... Name of Builder .... ...........Address Name of Architect J. .. ....�/�� .Address W ,............................... ..A........................................ Number of Rooms ......Z .......................A.............................Foundation ... ................ Exterior .........Roofing .... lo .. ... Floors .....� X4.4"+«l.1st 14 0 �. Z.. ..Interior . W 0.� ... ........ .................. .. . .. .. . .. .. . IL& HeatingPlumbing......................................................................... ....C .......� ..... .. . ............................. 0' Fireplace ..... ...........................................................................Approximate Cost ............�!O. 0 .............................................. ... Difinitive Plan Approved by Planning Board ________________________________19________. Sa40 f y Diagram of Lot and Building with Dimensions v,.&,` VA4 „p �_ A--�C (14 g 7 I 30 � a 0 � a it _ T T I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . 1.L ... i! ............. . - - � Plnabrook Realty Trust 14173 two story No ................. Permit for .................................... --- ��apartment ~�� . � / ����-�` . . ' ~ ^ \ Location --._,.___....___._.________.Hyanrds ' ! .---..—.—~.:.-----.----------- / Pinebrnok Trust Owner .................................................................. Typo of Construction frame Construction ..-------------. —...—.—..----------..--------- �Ph � /� ^f Plot --------_. Lot —_________.. J � �7, Date of Inspection ��� Dote Completed ~ n" PERMIT REFUSED . --.—...---...—.------......—. 19 _ ----------------.....—.---..—. � . . '-------..—.—.—.--........—~...--. . \ ^ .—..~..~—.--.---~.._—.—~...—.----., ~ � � r � .-----.----.---.---.—...—.....^..—' ' � Approved .. lQ ( . -------.—.----.----~.--.--.--. -------`--^^--'—'—'---~^—^~^'~'``