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HomeMy WebLinkAbout0069 WAYLAND ROAD Cod � lamed. �� .,� �. - - -- - 3 � :����� �� �� � � � �� } r a e�� - __ Town of Barnstable *Permit#ZOIS66&q V ExpFee 6 ma». .from issue date Regulatory Services » SARNSTABLr, " "'"i6g9•- Richard V.Scali,Director . Building Divl � ,q Tom Perry,CBO,Building Commissioner REI #� 200 Main street,Hyannis,MA 0g 16 2015 www.town bus Office: 508-862-4038 """"�� ®F Bp Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESJ DENT'1��nn����SS��--` 6, LY ,Z�I^ Not Valid without Red X-Press Imprutt Map/parcel Number 1 0 Pro rty Address e `0�LAAJ D A\J� , T 1�qI j/L1 s m(q} �© f Residential Value of Work$ `65D_ 1Vfinimum fee of$35.00 for work under$6000.00 Owner's Name&Address SAMi K)1\_S©,1J Vq WlaT—WD W K kFCls(ISS:4 QYl_ ©26cD Contractor's Name Lr,,j DF�j Telephone Number Home Improvement Contractor License#(if applicable) "1 Email: Construction Supervisor's License#(if applicable) CS 10&_aD6 ❑Workman' mpe Insationn Insurance k one: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to �JA R-P46 U 7 f I ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property must sign Property Owner Letter of Permission. copy of a me Improvement Contractors License&Construction Supervisors License is uired. SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 DREAM HOME IMPROVEMENT 60 Franklin Ave, Hyannis, MA 02601 PHONE 1-(508) 332-8119 CERTAINTEED LANDMARK LIFETIME-ALGAE RESISTANT ARCHITECTURAL STYLE RE-ROOFING PROPOSAL October 5, 2015 SARAH NELSON 69 WAYLAND AVE HYANNIS, MA DREAM HOME IMPROVEMENT herby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturer's specifications and local building codes. Remove and haul Away All of the Old Asphalt Roofing Shingles. j Supply and Install CERTAINTEED LANDMARK AR: COLOR: COBBLESTONE G. Supply and Install 8" WHITE ALUMINUM DRIP EDGE on All of the Eaves. Supply and Install #15 BLACK SATURATED FELT ROOFING PAPER. Supply and Install CERTAINTEED WINTER-GUARD (Ice & Water) WATERPROOF UNDERLAYMENT SYSTEM on Roof the Eaves & under the Step Flashing on the Chimney. Supply and Install AIR VENT SHINGLE VENT II RIDGE VENT on the Entire Main Ridge. Aluminum and Neoprene Soil Pipe Flashing. Supply and Install TYPAR SYNTHETIC UNDERLAYMENT PAPER Supply and Install ALUMINUM WINDOW & DOOR FLASHING. Clean and Remove Debris from work area after job is completed. TOTAL INVESTMENT ------$ 8650.00 PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Normally Scheduled for Completion Within 45 Days of Acceptance and Receipt of Deposit Providing the Materials are Available. Please make Checks Payable to: ALEXEY LEBEDEV DREAM HOME IMPROVEMENT Warranties the Shingles and Labor for 10 Years. CERTAINTEED Warranties the shingles and labor 100% for the first 10 years and the shingles your LIFETIME if the shingles becomes defective. CERTAINTEED Warrants the shingles up to CATEGORY III HURRICANR-130 MPH WIND WARRANT. CERTAINTEED Warrants the Shingles to be Algae resistant for a Full 10 Years. DREAM HOME IMPROVEMENT Carries Workman's Compensation and Public Liability Insurance on the above work. DATE OF ACCEPTANCE: 11/25/15 ACCEPTED BY: SARAH NEL, ON ALEXEY LEB V HOMEO ER DR AM HOM PROVEMENT 1 Massachusetts'-,Department of Public Safety Board of Building Regulations and Standards C'omtruction Super--kor License:CS-108208 ALEXEY LEBEDEV - 60 FRANKLIN AVENUE Hyannis MA 02601,' l Expiration Commissioner 11/27/2018 Office of Consumer Affairs and Business Regulation. 10 Park Plaza - Suite.5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 176777 Type: LLC Expiration: 9/25/2017 Tr# 270447 DREAM HOME IMPROVEMENT LLC' ALEXEY LEBEDEV 60 FRANKLIN AVE. HYANNIS, MA 02601 j � � --------- Update Address and return card.Mark reason for change. SCA 1 0 20M-05/11 �( Address F7 Renewal G Employment Lost Card V/re car�a-r�us+rc�m�C���:rl i.uac�rc�r,(1' Office of Consumer Affairs&Business Regulation License or registration valid.for individul use only ;�j'iHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration �176777 Type: Office of Consumer Affairs and Business Regulation Expiration ,9125/2017 LLC 10 Park Plaza-Suite 5170 z. Boston.MA 02116 DREAM HOME IMPROUEMENT_LLC:" ALEXEY LEBEDEV 60 FRANKLIN AVE. c _w• ..,,- HYANNIS,MA 02601 Undersecretary Not valid without signature L ,AcoRo® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) k. � 12/15/2015 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 NNAAMI-cT Ashley Paiva Southeastern Insurance Agency, Inc. PHONE A/C No Ext: (508)997-6061 AIC No FAX (508)990-2731 439 State Rd. E-MAIL ADDRESS: P a aiva@southeasternins.com - P.O. Box-79398 INSURE S AFFORDING COVERAGE NAIC 9 North Dartmouth MA 02747 INSURER AArbella Protection Insurance 41360 INSURED INSURER B.AEIC Armen Safaryan, DBA: Corey and Corey INSURERC: 67 Sea Street INSURER0: INSURER E: Byannis MA 02601 INSURERF: COVERAGES CERTIFICATE NUMBER:2015 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 S BR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD[YYYY) IMMIDDAfM LIMITS R COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A CLAIMS-0AADE ❑% OCCUR PREMISES Ea occurrence $ '100,000 9520046441 9/18/2015 9/18/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 R POLICY ElPRO- n JECT F+LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED 1 PRO PERT accident) $ AUTOS $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE NIA' E.L.EACH ACCIDENT $ 1,000,000 OF IXCLUDED? B. (Mandatory in NH) WCC-500-5015091-2015A 9/18/2015 9/18/2016 E.L.DISEASE-EA EMPLOYEEI$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL:DISEASE-POLICY LIMIT $ 1,0001000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Display Purposes Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORrLED REPRESENTATIVE Ashley Paiva/AMP ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(2o1401) The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations d 1 Congress Street,Suite 100 4 W= Boston,MA 02114-2017 5� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print Legibly Alexey Lebedev Name (Business/Organization/Individual): Address:60 Franklin ave City/State/Zip: Hyannis, MA, 02601 Phone #:7742083589 Are you an employer`! Check the appropriate box: Type of project(required): 1.® I am a employer with 4. 0 1 am a general contractor and I X * have hired the sub-contractors 6. New construction ployees (full and/or part-time). I am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling sub-contractors have ship and have no employees These 8. ® Demolition N orking for me in any capacity. employees and have workers' 9. ® Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ® We are a corporation and its 10.® Electrical repairs or additions 3.® 1 am a homeowner doing all work officers have exercised their I I.® Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.® Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.® Other employees. [No workers' comp. insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-ye i Phone#: as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against th vi lator. Be advised that a copy of this statement may be forwarded to the Office of of Investigations the DIA for ins ra ce coverage verification. 1 do hereby certify u der the pa sand penalties of perjury that the information provided above is true and correct. 12/15/2015 Si ature: Date: 774 89 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i Town of Barnstable Regulatory Services o Richard V.Scali,Director Building Division B"MABM r M'� $ Tom Perry,Building Commissioner 1639• �0 QED MA'1 a 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: 3u" Permit#• HOME OCCUPATION REGISTRATION Date: @►,��/�/�l �J , �D); Name: SU/m�-% a)o Yl Phone#: s Uy 3 C Address: (M.G4 Village: 41"0� Name of Business: Type of Business: Cc,-,SJ7}� kS) ap/Lot INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4"1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • 'There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned e ead and agree with the above restrictions for my home occupation I am registering. _ Applicant Date: 3 t Homeoc.doc Rev.10 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years]. A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. � DATE: Fill in please: APPLICANT'S YOUR NAME/S: Svt/'z� YOUR HOME ADDRESS: ti/14 d 7 C o 1 YN xr Ny TELEPHONE # Home Telephone Number. rp 1�p 2-- NAME OF CORPORATION. J IS THIS A HOME EW BUSINESS •Y M�!J i H- TYPE.OF BUSINESS Ill G1 a L�lc. MU.A,.S) abL�S NAME OF N OCCUPATION ES �a NO p • ,� t s / C� ADDRESS O B US NESS ? x Y ? MAP' PARCEL NUMBER (Assessing] When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIO ER'S OFI� fan ` This individu:bl hkehobnin p rmit re ui ements that pertain to this type of business. �17 :�Au` on Si nat . C MMENTJ-Y-\I 0-\ t,_K1 A Lim - s 0 2. BOARD OF H TH This individual has been informed.of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: x: , TOWN OF BARNSTABLE BUILDING PERMIT,APPLICATION,,,, Map Parcel 'Application# � � l Health Division µ Date Issued 1 Conservation Division Application Fee Planning Dept Permit Fee Date Definitive.Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address Village S �j OG fP (Address 33141;.y e Telepho e �.%D�l'-y!/�/ z -1J?40 Permit Request T© -.4�C��� F%P��, .r, e..�- /�Al C06 J2wsry r, T-0 i Square feet: 1 st floor: existing 1.6� proposed -2nd floor: existing proposed --' Total new O Zoning District Flood Plain Groundwater Overlay Project Valuation '�i S 0 0 Construction Type Lot Size 3 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family . Two Family ❑ Multi-Family(# units) Age of Existing Structure YOB- Historic House: ❑Yes 02.No On Old King's Highway: ❑Yes tNo Basement Type: mull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) 10 Y C Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing -knew Total Room Count (not including baths): existing new `— First Floor Room Count Heat Type and Fuel: %was ❑Oil ❑ Electric ❑ Other , -: Central Air: ❑Yes 62FNo Fireplaces: Existing f New Existing woo" oal st : 4,Yes No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: i F xisting� near v size_ Attached garage:�eXisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: ' { Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes c®.Wo If yes, site plan review # Current Use S 1 N t- -A!u-_, JY Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 6&ThtYL, Vic, co Telephone Number Address 1. 3 jj:5 6q be `> d iL License # NO L/i L L C , Pk rH1 S - Home Improvement Contractor# Worker's Compensation # 0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO To-- •--h SIGNATURE �� DATE i `i C z FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER I DATE OF INSPECTION: t T FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 4f-- �- r- DATE CLOSED OUT ASSOCIATION PLAN NO. ,xri v . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' ' d 600 Washington Street Boston, MA 02111 Q s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: f t ay City/State/Zip: C x 2 vl L-LL�7 Ad a Phone.#: �_6 S L Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with . 4. ❑ I am a general contractor and I employees(full and/or part-.time).* have hired the sub-contractors 6. ❑New construction .2.Fa I<am a sole proprietor or partner-' listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Q Demolition workingfor me in an capacity. employees and have workers' Y P h'• # 9. ❑Building addition [No workers'-comp. insurance comp. insurance. 10.❑Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contrectors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers.'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance cow4rage verification. I do hereby ce under the pains a d penalties perjury that the information provided above is true and correct Signafore: Date: L Phone#: Official use only. Do not write in this area,tb be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: } Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in.the service of another under any contract of hire, express or implied,oral or written." . An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees''. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house.of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitllicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in _(city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid.affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations- 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia part Massachusetts- De R`�um t ons and Standards ` Board of Buildin la ervisor License Construction Sup r License: CS 31802 c r. � t RestrictedF 00 { k 4," ART HUR M'PACHECO " ,133 ASHLEYoDR CENTERVILLE MA 02632 Expiration: 6/1512010 Tr#: 29134 Commissioner" 'J°"'mLO"�`e License or registration valid for individul use only Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration 105488 One Ashburton Place Rm 1301 Ex0-iratio1_7L 97/2010 Tr# 269518 Boston,Ma.02108 �i q p v dual Yp y. ARTHUR M.PACHECO-_ Arthur Pacheco �Y 133 ASHLEY DR. 4a �`�"' Not valid with signature Administrator CENTERVILLE,MA 02632�' ;. . ~ '-"- f IMrti Town of Barnstable Regulatory Services uxxsxesM Thomas F. Geiler,Director. 16jq. .�� 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, T n Wa V) /"redc , , as Owner of the subject property hereby authorize !$u /�: ��i�JC to act on my behalf, in all matters relative to work authorized by this building permit application.for. (Address of Job) fS giature_of er ate r"-po7'�V f �Pri.n Name If Property_Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:F0FMS:0 WNERPERMISSION Town of Barnstable SHE tp�� „�. Regulatory Services BARNSr"M : Thomas F. Geiler,Director P > Building Division rfD � Tom Perry,Building Commissioner 200 MainSireet, Hyannis,MA_02601 R'wsv.town.barnstable.ma.us Office: 508-862-403 8 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 extende to inclu owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire o doe of possess a license,provided that the owner acts as supervisor. t DEFINITION O OMEO«'NER Person(s)who;owns a parcel of land on which he/she resid or intends to reside,on which there is, or is intended to be,a one or two-family dwelling, attached or detached s c s accessory to such use and/or farm structures. A person who constructs more than one home in a two-ye perio shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on, form acc table to the Building Official,that he/she shall be responsible for all such work�erformed under the b ' din ermit. (Section 109.1.1) The undersigned"homeowner"assumes responsib' ity for compliant with the State,Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that_h she understands the To of Barnstable Building Department minimum inspection procedures and require nts and that he/she will co ly with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will b required to comply with the State Building Code Section 127.0 Co truction Control. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is required s it be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engage 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 s crvisor(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 hire's 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 s.form currently used by several towns. You may caret amend and adopt such a fomt/certification for use in your community. Q:forrns:homeexempt Assessor' m st Floor): n 2 — 9 Assessor's map ap and. /d. t num O( Conservation fo — ��,����L S Board of Health 3rd floor): �® Sewage Permit number Jr�2� / w'ril�� • Engineering Department(3rd floor): / � DiviW� �AL e79'`�� House number y tG� 1Pk Definitive Plan Approved by Planning Board 19 � APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION YCPEE 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location __C q wr9 y L.A�f/ /(aL 111,1,e xi r1/ S Proposed Use Zoning District Fire District Name of Owner��ryJUllllfc-� a�2 /- Address Name of Builder Address Name of Architect Address Number of Rooms Foundation Exterior Roofing Floors Interior Heating Plumbing Fireplace Approximate Cost ,1 Area -2 U Diagram of Lot and Building with Dimensions Fee � (� �24 -�nl9 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. C. Name, `i?.t.( Construction Supervisor's License r FORTI, DOMINICK ' J�7" SCREEN & ENCLOSE No �351 Permit For DECK i 6.2 Sing1 Family n�11_IIg F, Location 69 Wayland Road ' Hyannis ; Owner ' DaTni ni rk J- FnrH Type of,,Construction Wood Frame Plot Lot - Permit Granted June 16 19 92 Date of Inspection 19 J y` L . Date Completed �� 191 f e a I " Z. r t } + F _ gran r + � } ' ' X � _ L• �: i h+. Assessor's map and lot number -h.. .��--..'7`.`7.......... QyoF ropy a , Sewage Permit number ..........�:...�1,�............................. r Z BARNSTADLE, i House number ..1...1...... .................................................... ro Hasa / F e �63Y' � MA a' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO Conq:kM9t... ing e,,,Fazzai];u„I�we n ,,..................................... \ TYPE OF CONSTRUCTION ....Wood. Frame .................................................................. ...................................... ............... � ........................19 .�, TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .� .!. ...... ,1/ 1/ I �? I ......SSA . .. ..�._`�...... .............................................. ........ ................................... ProposedUse ............................. .. .......... 4 c...................................................................................... ............................ Zoning District ...R.B.............................................................Fire District ...HYanriiS........................................................ e Name of Owner aprieorn Realty Trust Address ..77 5...ralmouth Road, Hyannis s Name of Builder Franco Real Estate Dev. C..Address .76�...Falmouth Road. Hyannis Inc. ............................I.. Nameof Architect ..............................I.........I..........................Address .................................................................................... Number of Rooms ..SIX.......................................................Foundation .... C•.................................................................. Exterior .clapboard and/or shingles Roofing Asphalt shi n 1es.................................... ........................................ Floors ...carpet..................................................................Interior sheet rock .................................................................................... Heating ...................................... Plumbing .. u�it�........,C,0:P-c7................................................. Fireplace ..NQD1 ....... ... ............ ........................................Approximate Cost ...................................... Definitive Plan Approved by Planning Board --------------------------------19--------. Area 1.0.Kh-30.......rt.............. Diagram of Lot and Building with Dimensions Fee �� SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 1 - r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name J 271 22` CAPRICORN REALTY TRU T Q-eA=271-47 a lea y 23781 O Story No ................. Permit for .................................... r,tp .......Single,,Fami ly,,,Dwel line,,,,,,,,,,,,,, Location Lot...#..a...6.q„Way,land...Rd......... ..............Hyannis.............................................. Capricorn Realty Trust Owner .................................................................. Frame Type of Construction. .......................................... ................................................................................ Plot ........................:... Lot ................................ Permit Granted ...January 2 8, 19 82 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED .............. .� C/00......."1- 1......... 19 ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... i ............................................................................... r Assessor's map and lot number .��-.. rf.......... !2• THE �'��� Bpi pp ry Sewage Permit number .... ............................ SEPTIC SYSTEM �i U411 INSTALLEDI+ Z BAR39TADLE, i k c•`ad N 6 House number .�?�.�. .....................................................:... V4/I�°¢�� CopA� �_��,; 900,0�1 39 ����� fiBTI®E 5 'Fp MPY tr' `N T CODS ANO TOWN ' OF BARNS � � �, BUILDING INSPECTOR APPLICATION FOR PERMIT TO Construct Single„Family„Dwelling,...... TYPE OF CONSTRUCTION ....Wood. Frme a ............................................................... ............................... ....... ........................19�.�. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..� .....�!v..... ..��h� . .......?I,WCJ ..4�1......(�.C455.. .............................................. IProposed Use ........................................t•...•.t..�............................................................................................I......................... Zoning District ...R.B.............................................................Fire District ...Hyannls........................................................ Name of Owner Capricorn Realty Trust Address . 76s Falmouth Roady Hyannis.............. Name of Builder Franco Real Estate Dev. CoAddress .765 Falmouth Roads Hyannis ..... ..... ..... Inc. Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms SIX ....................Foundation 1.�.c.�............................................... .................................................................... Exterior .clapboard andlor shingles..............„Roofing .Asphalt shingles........................................ Floors ...........9arR t...................................................................Interior ..... heet...rock..................................................... Heating .......F... W.eA.r................................................. .t..Plumbing .. .W.O...-...C.O�??�.�x................................................ Gas . . Fireplace .............None.....................................................................Approximate Cost .... ...................................... Definitive Plan Approved by Planning Board ________________________________19________ . Area 1.0.56...S.q......ft............ Diagram of Lot and Building with Dimensions Fee .... .... .........r................. SUBJECT TO APPROVAL OF BOARD OF HEALTH v I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. . Name ... ... . ... ........ . ...................... ^ . . ~ ' ' . ^ CAPRICORN REALTY TRUST IST lvo ---.--. PermitOn�or --.-��.....�---. . . Single Famill'' Dwelling ' � ----.------.-----------. ......... Location L 0t�*% -69--W�—v—l—and--Dd—.^—'--.—. �. — � .- — ` . . ) / ^ j ` ' ----.---.-----.------.---'-- ' - � . - ' - Capricorn Realty `����o�t Owner ����--- � _ -----~--------�r--' � Frame Type of Construction .......................................... ' ~ � ------'--'-------�----------'' . ` Plot ---------. �t ----. .................. ' Permit Gnunoa6 — }^........ P 32 ' Dote of | ------]V ' uo/e Completed r ^o ^ ' - � , PERMIT REFUSED ' —�---'r—,''. ..----------_ lA �� ' —.-----...�—..—.-----.�--------`.. , ' . ...................°._-----.—.—.---.—.^—,�. . ^ '~ `. . ,—.-.--.--.--------_--.—..—...—.—.. .---.—.—..—.......~,....—.--..--.—.' � ^ ---`------------.. l� . . . ^ ` . , �------. . . —.—.-------..— ' ' ' - - ' . Z �>= 22> ; I F^ ul ,+ IN 2 3 00 1 d , Q 0 39'f I 48+ + �PoD"� '� O R OF �� Py aN N CERTIFIED PLOT PLAN BE H L.csT' 14 viRYI.A�+D Qo�O 4 NEW CONSTRUCTION ONLY = N I S TOP ,OF FOUNDATION IS G,I FEET SURD ABOVE LOW POINT OF ADJACENT. ROAD. SCALE' I 30 DATE; CEc.9,194� (A-DREDGE ENGINEERING CO.IN I CERTIFY THAT THE �a�o� CLIENT SHOWN ON THIS PLAN IS LOCATED EGISTERED REGISTERED JOB NO. %1205 ON THE GROUND AS INDICATED AND CIVIL I LAND , . � CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR.BY� OF HARNSTAB E , SS. CH.BYE 712 MAIN STREET III-Ai4� H YA N R I S, MASS. SHEET. OF L DATE . LAND SURVEYOR -` f y,,.rrT o TOWN OF BARNSTA.BLE hermit.No. _=L 3 7 8 ''` Building•,4nspector -- o�a Cash - '�°""•� "•`"` f 0CCU'R'AN tY' -PERMIT' Bond --- _`___� "No buildingo nor structure^,,shail�Be.;erected, and no,land,ib iilding,,or structure shall be .used for a new, different, changed, or, enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until:a certificate of occupancy has been'issued by the Building'Inspector,•" ' YIGVIIl Realt Tr St Capricorn Y •, Address ~• - Lot #1$ b9 Wavl:and Road Hyanna s _ _ Wiring Inspector. � � �� �, Inspection•date- ° Plumbing Easpector;,f� '� , "t�,� t � °`rinspection'da Y'{ ..E.c - Gas Inspector Inspection date�3�, 9 i_ )(.Engineering Department Inspection'date_ r THIS PERMIT WILL NOT BE VALID, AND THE BUILDING, SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE' WITH TOWN REQUIREMENTS. 1. .. . ......1................... 19 ._ ................... ng Buildi ...Inspector .... C*NF�R.n� `Ta 2 0 ,��,�6 - m a c r12,/�c, ,2-, . 2 r. �G tc CO , I VE ? 6 6 � I I � ; i I I R PoX.�-y .�. , J)a� I Op v , G,Z cc CptR 1 Y i r 0 P6 vP��,�6 5 5f ' �t0 � 5 , i i t ' -" - i ?- I i 1 i I — — — a.- —3 — _ . To Ov 16 --1 a ' ; r i II 8 G' , _ _ .