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0398 WEST MAIN STREET (3)
��� ���T-����� Sr � - -� �� � � � ° �M �; j e. Town of Barnstable Building Department Brian Florence, CBO y Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.nra.us Pre-application for Business Certificate Date C 1 , Map Parcel Applicant Information Applicants Name , e ,r k. ()1 G C i _ Applicants Address 3 9's, y,./_ M e� y, 5+ j2 y _ Email Address C,�'in-c-yr M...;l.,`a .� t-Iya„��s,r►a o26�1 � - Telephone Number (7 7'-/) $yri-- g y z 1 Listed 0 Unlisted 2' Business Information New Business? es No c Business is a registered corporation? ____ ________________ Yes If yes Name of Corporation Does business operate under the registered corporate name? Yes L) Is the business a sole proprietorship or home occupation? _____ __ es No If yes then a Home Occupation Registration is required—See Building Division Staff Name of Business C C v u r+ Business Address 3 q T V/_ h et i n s f Uri 1'4- 4A P y c,n 4. C.71601. Type of Business: (' R; m 7%e- S w'e_e.P s1 a e, d/"1a r'n 4 e 7%a n Cr_ Building Commissioner,Office Use Onl C9,nditions / i GL Building Commissioner Date Clerk Office Use Only a�� Town of Barnstable Building Department OF THE Tp� _ o Brian Florence,CBO Building Commissioner sAxrvsrnB , ' 200 Main Street,Hyannis,MA 02601 y MASS. 1639. ♦e www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: -Tq HOME OCCUPATION REGISTRATI N Date: G 2/ //9 Name: /lecri- P 1oc k Phone#: 177y1 ff4rL-9"/ I -1 Address: 3 9'8 W. A4c t',j s i- u„ ;t YA Village; Pl yg„-,t t.s �sr- Name of Business:__ Type of Business: C A j-,m n e u Sw r e a,' na Map/Lot: _ 06A 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.f a ° • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant:' / i,�%� Date:_a2_/ / i ct Homeoc.doc Rev. 10/17 =; O REGISTRATION AND CERTIFICATION FORM ZE FOR FORECLOSING/FORECLOSED PROPERTY -n Thank you for registering in accordance with Town of Barnstable Code chapter 24 sections 224-3 and 224-4. Please complete one form for each property in foreclosure can (section 224-3) or already foreclosed for which possession has been taken (secdn 224- 4). Please file the original with the Building Commissioner and a copy with theChief of the Fire District in which the property is located. -0 rn If you claim you are exempt from registering under Massachusetts law, please state the reason(s) and complete section 1 (property information) and the first paragraph of section 2 (foreclosing party, court, etc. and foreclosing party representative, but not other representatives and attorney) so that the Town can review the exemption and update its records: Section 1 —Property Information Property Address: 398 W-Main St Apt 3D,HYANNIS,MA 02601 Assessors Map#: Parcel #: 269-051-OOL Land area and description Sqft: 1,264, Type: Condo, Year Built:1982 Building(s) description and contents Occupied: YES Occupant(s)(if borrowers so state and include name(s)) Phone: email: other: Vacant: NO Date: Anticipated Length of Vacancy: Last occupant(s),)(if borrowers so state and include name(s)) Francis S Fowler c/o Ocwen Loan Servicing, LLC Phone:-(800)-746-2936 email: PropertyRegistration@ocwen.com Other: Has possession been taken If so, please explain and complete and file the maintenance and security plan form(unless exempt as stated above) Section 2—Foreclosing Party Information U.S. Bank National Association,as Trustee under Pooling and Servicing Agreement dated as of August 1,2006 MASTR Asset-Backer!Securities Trust 2006-HE3 Mortgage Pass-Through Foreclosing Party (full name/title) certificates,Series 2006-HE3 c/o Ocwen Loan Servicing,LLC Foreclosure Case Court: Docket# l 1' Y Date filed: 07/20/2018 Current Status: Foreclosing Party's representative(s)for property (entry, management, repair, etc.)(name, title,): Altisource Solutions Inc-Darren Wisniewski Company (if different from foreclosing party): Address: 1000 Abernathy Road Northpark Town Center,-Building 400 Suite 200 Atlanta, GA 30328 Phone: 8669526514 email: VPR@altisource.com other: If an exemption is claimed, please do not complete the remainder. I Other representative(s) (if foregoing representative is primarily responsible for property and/or foreclosure and is most likely to be able to address town matters concerning the property and/or foreclosure,please so state and do not complete contact information (i. e. "none" or"see above")). "Note: Please mail correspondence to Atlanta office. Darren is local to address property conditions and emergency matters." Name, title, other: Darren D Wisniewski-Regional Field Service Manager Company (if different from foreclosing party): Altisource Solutions, Inc. Address: 1000 Abernathy Road Northpark Town Center,Building 400 Suite 200 Atlanta,GA 30328 (866)952-6514 Phone(s): (407)739-3930 email(s): VPR@altisource.com Other: Darren.Wisniewski@Altisource.com Name, title, other: Company (if different from foreclosing party): Address: Phone: email: other: Attorney representing foreclosing party Firm name (if different from attorney's name): Address: Phone(s): email(s): other: I acknowledge that the information provided is accurate and correct. I also understand that any inaccurate information will result in non-compliance with section 224-3'of chapter 224 of t . Code of the Town of Barnstable. v t Date: ame: Alma Emery Title: Asst Manager. i I hereby certify that the above-named foreclosing party is in compliance with the provisions of section 224-3 of chapter 224 of the Code of the Town of Barnstable. Date: Building Commissioner, Town of Barnstable L 4 I Town of Barnstable Building � '� .��� ":` k�°'-d� ,�r�"� ' � ;�.'k ni y;: rt ,Y� Ra-..�'"�. �` � ,' �; a .�` sn�•gi s., e,..,t n"L;,. PostaThis Card So That t is;Ursible From the,Street Approved.Plans,Must,beRetamed�on,Job;;and€this Card Must be Keptw, lAR3 A'rABi.L*„ Posted Unt�f Final lns ectc►n Has°Been Made . < Permit s ,Where a,Cert ficate o#�Oceu ancy�s„Re u�red;suchgBu�ldmg shall Not be Occupied until a Final,lnspect�on:has been made Permit NO. B-18-472 Applicant Name: CARLOS H FIGUEIROA Approvals Date Issued: 02/16/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Commercial Expiration Date: 08/16/2018 Foundation: Location: 398 UNIT 4A WEST MAIN STREET, HYANNIS Map/Lot 269-051 OOM Zoning District: SPLIT Sheathing: �M, Owner on Record: FREEMAN,KENNETH C&JEANNE MARIE Cont�actorFName CARLOS H FIGUEIROA Framing: 1 Address: 59 WALNUT STREET Contrad o cense CS 104107 2 HYANNIS 'MA 02601 . Est Project Cost: $ 15,000.00 Chimney: Description: REMOVE ROTTED TRIM SIDING ON EXTERIOR'WALL REPLACE Permit Fee: $236.50 SHEETROCK INSULATION INSIDE UNITS B&D DUE TO WATER Insulation: Fee Paid`, $236.50 DAMAGE Date 2/16/2018 Final: Project Review Req: WATER DAMAGE REPAIR ONLY. s - - V � r Plumbing/Gas Rough Plumbing: 4 f :Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonffi this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved appl catiorma'0 the approved construction document for whi h this permit has been granted. All construction,alterations and changes of use of any building and str ctures,shall�be in compliance with the local zo in, lawsand codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road"and shall be maintained open for, ublic insp coon for the entire duration of the work until the completion of the same. s Electrical a 1 ° # " The Certificate of Occupancy will not be issued until all applicable signatures byhe Build ng andtlFireOff�cials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:;. 21 F w Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Application Number................. s�arTsresr.�. ' Permit Fee.........l .r:. ... ..Other Fee................... f � TotalFee Paid................................................................ ...... 1�6� TOWN OF BARNSTABLE Permit Approval by..... . .....................or;.... .. ................... BUILDING PERMIT mj .Vt .... .....................Parc&.... a... .... APPLICATION Section I — Owner's Information and Project Location Project Address 3 P t/)&Sr X/t /Z Sf' Village 14,YRI N f S' Owners Name JoAk ce Go,u D® As S ac . Owners Legal Address C State Zip Dal Cell# .64-3 l�- 15,57 E-mail R v��'°n u6 m�h"G o Co Section 2—Use of Structure I Use Group ❑ Commercial Structure over 35,000 cubic feet BUILDBN c �- l� Commercial Structure uner000 cubic feet ❑ Single / Fam>F Two 1� Section 3 —Type of PermhOWN OF BARl STABLE ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System Addition Retaining wall ❑ Solar . "novation ❑ Pool ❑ Insulation Other—Specify Section 4 -Work Description 'gEMuc- Romeo Tp-tK AJ a. S 10P 6 P• L . REAACar an T Aar imdated•2192018 . . Application Number.................................................... Section 5—Detail Cost of Proposed Construction �K,400. Square Footage of Project Age of Structure ..59 + ,, Dig Safe Number # Of Bedrooms Existing ' r Total# Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics W Oil Tank Storage Smoke Detectors 'nng � ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add%relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ municipal El on Site P Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7-Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No .I Section 8—Zoning Information Zoning Distri ��LProposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No i T...rt.....i..ae.7. 1/A Mn l 0 i A6O Le CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/25/2017 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(les) 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 NAME: Ashley Clark LEONARD INSURANCE AGENCY PHONE (508)428-6921 FAx A/C No): EMAIL ADDRESS: Ashley@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 INSURER F: COVERAGES CERTIFICATE NUMBER: 158506 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. ILTR TYPE OF INSURANCE INSD WVD SUER POLICY NUMBER POLICY MM/DD/YYri LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JE a LOC PRODUCTS-COMP/OP AGG $ 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 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _4EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICERIMEMBEREXCLUDED? NIA N/A N/A AWC40070324242017A 04/30/2017 04/30/2018 (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/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 Of Dennis ACCORDANCE WITH THE POLICY PROVISIONS. 685 Route 134 AUTHORIZED REPRESENTATIVE South Dennis MA 02660 Daniel M Crowey,CPCU,Vice President—Residual Market-WCRIBMA 01988-2014 ACORD CORPORATION. All rights reserved. ACORD.25(2014/01) The ACORD name and logo are registered marks of ACORD Document View via Plugin Page 1 of 2 Barnstable County Registry of Deeds Documents in Cart(0) Important! You must use the Close button to exit this age Zoom In Zoom Outl Rotate Left Rotate Right Close �'' Zooml?ode•`�," e 266117 F'y224 4$1-F)5 ` ►'o._? „ ilk r� 1 37 a. DUILDING DEP1 Pait place C rid®lfliri mol Tfust appoint $ ®f Successor Trustee FEB 15 2o10 TOWN OF BARMSTAS- 11Utl E =1 Pursuant to ARTICLE III, Section 1 of Declaration of Trust dated February 12, 1962 and recorded with the Barnstable County Registry of Deeds at Book 3436, Page 177, we, 4 Jeanne-Marie Freeman and Joan B. DeRosa, l the two (2)remaining Trustees of the above-captioned Trust, do hereby appoint Lynn Carver as Trustee to fill a vacancy caused by the resignation z of Dean M. Letsch. Executed as a sealed instrument this da of v u� ,.�., 2012, y .. anne•Marie Freeman Joan DeRosa https://search.bamstabledeeds.org/ALIS/WW400R.HTM?WSIQTP=LRO I I&W9RCCY=2... 2/15/2018 I Document View via Plugin Page 1 of 2 Barnstable County Registry of Deeds Documents in Cart(1) Important! You must use the Close button to exit this age Zoom In Zoom Out Rotate Left Rotate Right Close anne•Marie Freeman Joan DeRosa BUILDING DEP7 . COMMONWEALTH OF MASSACHUSETTS FEB 15 201 BARNSTABLE, SS, TOWN OF Bl RNSTAZL On this 1 day of 2012,before me,the undersigned notary public,personally appeared Jeanne-Marie Freeman and Joan B.DeRosa,as Trustees 1-4 aforesaid, proved to me through satisfactory evidences of identification which were drivers'licenses,to be the persons whose names are signed on the above document, and acknowledged to me that they signed it voluntarily for its stated purpose. { N 14 iY !O1 a�l� f Notary Public A J. My Commission expires: ''"" RICHA0 J:HbLM ST.Jn. ` �l�ary Public' CG�yC61ViR11�Or'I�ASSA(�IS�T1E l 1 kly Comm ss!on Ex;ices E 4ugt>st 3?,3018 "A t https://search.bamstabledeeds.org/ALI S/W W400R.HTM?WSIQTP=LR01 I&W9RCCY=2... 2/15/2018 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/OrgaAzation/Individual): �,l d. i C•�1��'`-� L Address: d ,awn i •� �� �-( �- City/State/Zip: Phone#: 7 Are you an employer?Check he appropriate bog: Type of project(required): 1 Z-.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.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition employees and have workers' . or me in an capacity. working f any ty $, 9. ❑Building addition [No workers'comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t a 152, §1(4);and we have no employees:[No workers' 13.❑Other comp.insurance required.]' BUILDING O P *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a nx' di ati'$such. #Contractors that check this box must attached an additional sheet showing the name of the sub contactors and state yhether drot� enes� ave employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is&e'policy and job safe information. ff _ Insurance Company Name: �a Policy#or Self-ins.Lie.#: Expiration Dater r � ` Job Site Address: : - City/State/Zip: / 4 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 D1A for insurance coverage verification. I do hereby certify under th ains and penalties of perjury that the information provided above is,true and correct Signature: C� Date: Phone# G7 1'5L Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#: Information aAd 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." I - 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." state or local licensing agency MGL chapter 152, §25C(6)also states that every g Y shall withhold the issuance or ap renewal of a license or pe rmit toop er ate 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 f compliance with the insurance enter into an contract for the performance of public work until acceptable evidence o p Y " resented'to the contracting requirements of this chapter have been p g authority. Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cauy 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 Pe P must submit multiple l ermit/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 OT required to complete ete this affidavit. a do license or permit to bum leaves etc.)said person is N p (i.e. g 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 Npartment of Industrial Accidents Office of Investigations 600 Washington Sheet BOStan,MA 0211.1 Tel,#617-727-4400 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www-m= gov/dia Rn-gi,tration valid,for in.�jvidurl use onh/ b:=ore the expiraiion.:date. if fi�and return to: . rice of Consurnef Aff2'srs and tusine§s Regulztion 1�J park tplaza;;�Suite_5170 aoston,MA 02115, f . (9t V�9i,�Wit' etil signat re r . 7 rpanayreaneuercl�l o�C�/ ijezc/atis' of'C%surner Ait2i,s&Business Reg;^14�ti HC IN7E MIPPI.C+/EPRENT CONTRACTOR.. TYPE:Corporation --istration Expiration 01/07/2019 C&F REMC�DEL.4�+ Carlos F igdeiroa 20 Captain Noyes�ld _ S..Ya;mout.5,MA Undersecre'?r,:,.'- COrnrnonw Div s on o f ea lth of(Hass Board of Build. Professional[chusetts - - `��� constr e9ulations an Sture CS-10 aS. andar a� d V 41 s 0 � �r,rvisor 1 CAR S f I�r. �1��re 8/ SOCAP Fi UEI � l _ 0 25/2019 10 .V6-' Commissioner Construction Supervisor Unrestricted-Buildings of any use group which contain less than 36,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl r{ r P _e fft TKI i loLIDINLO Fig 1� Z TOWN of: i PARK PLACE CONDOMINIUM ASSOCIATION 398 WEST MAIN STREET HYANNIS,MA 02601 February 15, 2018 Town of Barnstable Regulatory Services Building Division Brian Florence, Building Commissioner 200 Main Street, Hyannis, MA 02601 Dear Mr. Florence,, RE: Building 4—Exterior trim and siding repairs and interior remodeling On behalf of the Board of Trustees, please be advised that permission has been granted to C& F Remodeling to perform the necessary repair work to Building 4. Should you have any questions, please feel free to contact our management company at 508-385-9499. Sincerely, c p 13UILDING OEPT Lynn Carver,Trustee Park Place Condo Assoc. FEB 15 2018 TOWN OF BARNBTAa�a. Application Number.............................................. Section 9—.Construction Supervisor Name (-C-t�lft Telephone Number CO Address t ity A4/� Zip License Number ld Co License Type 6 c Expiration Date 09 " Contractors Email Flrl ci .. Oe�,2 , I�Ikx Cell# I understand my responsibilities imder the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. t Signature _ Date > �� Section.10—Home Improvement Contractor Name :` lr (/�i%�C/.j Telephone Number • y � '� �. 3 AddressD ''�- y J Q�City State_ ^� Zip Registration Number 4xpiration Date co I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... ��7 I Signature Date 0 Section 11 —Home Owners License Exemption Home Owners Name: f� %�' ,ut �kS o L Telephone Number Cell or Work Number lit,T CO I understand my responsibilities under the rules and regulations for Licensed Constraction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature Date w Print Name L ®S /, �c,��G- Telephone Number � �� "7 � y E-mail permit to: C'C� '�=e��,� � Z. .�k�� Section 12—Department Sign-Offs Health Department © Zoning Board(if required) El Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13—Owner's Authorization L 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: (Address of j ob) i Signature of Owner date Print Name 4 Last undated:2/9/2018 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, 1st FI.,_367 Main St., Hyannis, MA 026.01 (Town Hall) and get the Business Certificate that is required by law. DATE. Fill in please: APPLICANT'S YOUR NAME/S: BUSINESS YOUR HOME ADDRE TELEPHONE # Home Telephone Number EIN #: E-MAIL: NAME OF CORPORATION: 12e -' NAME OF NEW BUSINESS �r Gin Ca i TYPE OF BUSINESS��, �ja el IS THIS A HOME OCCUPATION? _ ADDRESS OF BUSINESS —r " 11e MAP/PARCEL NUMBER [Assessing] When starting a n.ew business there bra 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 CO Iqor .ER'S OFFI E MUST COMPLY WITH HOME OCCUPATION This individ al hBe info d an er t r quire nts that ertain to this type of business. RULES AND REGULATIONS. FAILURE TO ' igaature** COMPLY MAY RESULT IN FINES. OMMENTS t 2. BOARD OF EALTH This individual has n informed uMe Perm equirements that pertain to this type of business. A' uthorized Signature** HAZARDOUS MATERIALS REG110710NS . COMMENTS:--�o O 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: I Town of Barnstable Building Department Services pTNE tp Brian Florence,CBO Building Commissioner * sAzuvsTAsze, * 200 Main Street,Hyannis,MA 02601 MASS. 9 1639• ��� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date f— -Z�— *- Name: Phone#• b A dres C &A9( Village: Name of Business: Type of Business:,, Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to.the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home. Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There 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 bg employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read agree with the above restrictions for my home occupation I am registering. Applicant: Date: Homeoc.doc Rev.06/20/16 � 1 EEa Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 5/8/17 Thomas Perry CBO Town of Barnstable BUILDING DEPT. Building Division 200 Main St. Hyannis,MA 02601 MAY 2 6 2017 TOWN OF BARNSTABLE RE: Insulation Permit B-17-979 Dear Mr. Perry This affidavit is to certify that all work completed for` 398 West Main`St,"Unit 1B,Hyannii;has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey i Cape Save Inca 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 5/8/17 Thomas Perry CBO Town of Barnstable Building Division BUILDING OEPT 200 Main St. Hyannis,MA 02601 MAY 2 6. 2017 7 TOWN OFBAP,N 4AB .r RE: Insulation Permit B-17-978 Dear Mr. Perry This affidavit is to certify that all work completed foe,398 West Main St,Unif 5C;Hyannis;Jhas been inspected by a third party.Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey ► 13 q-to-I " 0-Yn A ....... ..... Town of Barnstable 200 Main Street, Hyannis MA 02601 508-8624038 Application for Building Permit Application No; TB-17-978 Date Recieved: 4/10/2017 Job Location: 398 UNIT 5C WEST MAIN STREET,HYANNIS Permit For: Building-Insulation-Residential Contractor's Name: WILLIAM J MCCLUSKEY State Lic.No: CSSL-102776 Address West Yarmouth, MA 02673 Applicant Phone: (508) 398-0398 (Home)Owner's Name: GLOVER,WILLIAM R III Phone: (508)326-7314 (Home)Owner's Address: 55 YOUNGS ROAD, CHATHAM,MA 02633 Work Description: Add R-33 cellulose and 2" rigid insulation to the attic.Add R-19 fiberglass to the basement. Air sal the attic plane and basement with expanding foam. Total Value Of Work To Be Performed: $3,200.00 • � M Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor;or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage: I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. t Signed: William McCluskey 4/10/2017 (508)398-0398 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $3,200,00 " Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 4/10/2017 µ $85.00 XXXX-)OM X70tY- ^ Credit Card ............. .... ....: ........_. 0299 Total Permit Fee Paid: $85.00 A le � Town of Barnstable raw 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17-979 Date Recieved: 4/10/2017 Job Location: 398 UNIT 1B WEST MAIN STREET,HYANNIS Permit For: Building-Insulation-Residential Contractor's Name: WILLIAM J MCCLUSKEY State Lic. No: CSSL-102776 Address: West Yarmouth, MA 02673 Applicant Phone: (508) 398-0398 (Home)Owner's Name: SORCENELLI,SHAWN D Phone: (508)367-1185 (Home)Owner's Address: 1823 SW MARKET STREET,APT. 7, PORTLAND,OR 97201 Work Description: Add R-33 cellulose and 2" rigid insulation to the attic.Add R-19 fiberglass to the basement. Air seal the. attic plane and basement with expanding foam.- ; - ,e Total Value Of Work To Be Performed: $3,200.00 r-- r-n Structure Size: 0.00 0.00 0.001 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568) I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: William McCluskey 4/10/2017 (508)398-0398 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost ; $3,200,00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 4/16/2017 $85.00 }000{-X7GYX-X3 p{- Credit Card" ......... .,...... ...... 0299 Total.Permit Fee Paid: $85.00 c PROJECT NANIE: . ADDRESS: I �,�✓%( PERMIT# PERMIT DATE: D l'(.eLq Ct LARGE ROLLED PLANS ARE IN: �0x : ,SLOT : ' A' Data entered in MAPS program on: 14 l.? BY: q/wpfifes/formshdcfiive-. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION n _ Map , �� - Parcel 0510 Application # b , Health Division Date Issued /m—/6 Rz Conservation Division Application IS lc Planning Dept. Permit Fee Alk-, Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address '3 Village A Owner , o G�,2®'J�- Address �c1�G , �, /1�-4-��� . Y�✓r-e J Telephone Soli 3 � 1 1t Permit Request t� �C i1✓ (J�'fi1" Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation q C ` • (b Construction.Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family a Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes F 1 No On Old King's Highway: ❑Yes )LLNo 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 ❑ na size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size — Other. Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ + �a Commercial ❑Yes ❑ No If yes, site plan review# - - N Current Use G�� ...�^ Proposed Use M >er =---APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address t - Q� License # /0 �l a G; _ 4!!�_ CZ Home Improvement Contractor# 193 ?l Worker's Compensation # AlC_Ja 200007®qZ,0�- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �� /1 'c FOR OFFICIAL USE ONLY APPLICATION# k DATE ISSUED a MAP/PARCEL NO. ADDRESS VILLAGE OWNER r >' DATE OF INSPECTION: FOU�I DATI.ONt i . jNSULATION it I; FIREPLACE !I!� ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL is t FINAL BUILDING` DATE CLOSED OUT ASSOCIATION PLAN NO. the w.ommonweaart gmassacauseus Deparbnad of lnduYhW Accidents Office of Investigations ' 600 Washington Street r - Bostollb AM 02111 www.mass govAga Workers' Compensation Insurance Affidavit:Binders/Contractors/EIectricians/Plmnbers Applicant Information Please Print Legibly Name(BusinesY0mnizatio F f Address: 2.0 City/State/Zip: Phone Are you an employer?Che&the appropriate box: Type of project(required): 1.El 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.RT I am a sole proprietor or partner- listed on the attached sheet 7. ❑Romodelmg ship and have no employees Tie 'tors have 8. Demolition 3 working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp,msurdnce. required.] 5. We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work ' 1 LE]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' 134Other ag— comp.insurance required.] *Any-applicant that checks box#1 must also fill out the section below showing their workers'compensation policy intnmzation. }t,�Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. #Conhactnrs that check this box must attached an additional sheet showing the name of the sub-contractors andstatr whether or not those entities have employees. If the sub-contractors have employees,they mnstprovidc their workers'comp.policy number. I am an employer that is proving workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: /_4- l (J�iq•�Ge.-- Policy#or Self-ins.Lic.#: ttl Zc�_pc�o�o-9� G 7�' Expiraliou Date: (� 9 � S Job Site Address: 4City/state/zip: �., 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the fog of a STOP WORK-ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ida hereby certify77=ape,�a,.njp.,7h es ojwy that the information provided above is true and correct S Date: 101-011141 Phone# Official use only. Do not write in this area;to be completed by city or town official o City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3.City/Town Clerk 4.Electrical Inspector S.Plmnbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide woikeas'compensation for their emplo�ees. 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 Iegal entity,or any two or more of the foregoing engaged in*a jomt 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 empIoys 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 d=uied 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 bindings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter l52, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contrad for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants PIease fill oiA the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The"affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fll 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 submif multiple permit/license applications m 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 stomped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for Riture 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 mqu fired 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 member. The Commoniatth of Massachusetts Department of Industrial AoUdents o faun of lavesggwons f Q0 Washington fit. BoAon,MA 02111 Tel,#617-727-4900 ext 406 or Revised 424-07 Fax#617-727-7749. vwW.m.M.go-ddia Town of Barnstable Geographic Information System October 8,2014 269147 tea, #68 Yf mt 269146 Z� x o #62 \ vv Avx t1 v vvy " 269145 #58 269052 269051 CN D #380 #398 269044 #55 269144 �*\a\,s #52 � vmow v C1 77 P V\\\ , R1 v = a4121y' S P a1JK .� .3=,; 269046 #46 2QDw 19 Feet DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:269 Parcel:05100Q - boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel 7.1 1"=100'may not meet established map accuracy standards. The parcel lines on this map Owner:CHIPMAN,JOAN B Total Assessed Value:$112100 are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner:C/O DEROSA,JOAN B Acreage:0 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:398 WEST MAIN STREET such as building locations. - Buffer EVE Town of Barnstable Regulatory Services &UMSTABI E Richard V.Scali,Director . '°rE0 Mai� � 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 _ e - Complefe`�and Sign This Section_�_ If Using A Builder C-� ,as Owner of the subject property hereby au orizeLq6�n® to act on my behalf, in all matters relative to work authorized by this building permit application for. �✓�� (Address of Job) "."Pool fences and'Aums are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are perfonned and acce Signature of Owner - S, ature of Ppplicant CLIAV C-L-I P t Name. t Name Date Q:FORM&O WNERPERMISSIONPOOLS y Town of Barnstable Regulatory Services P�oF roiyy Richard V.Scali,Director i Building Division r � ' * Tom Perry,Building Commissioner 1639. 200 Main Street, Hyannis,MA 02601 'OrEa µaI" www.town.barnstable.ma us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: ber street ' _ mAge �HOMEOwI�rER°: /� fib« name , home phone# work phone# M Q CURRENT AILING ADDRESS: ! ® g Dw keg &-P6.7-P1,_7VN MR- ORbYl cityltown state rip 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. Signafure 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 formlcertification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 i e k 26607 Ps�24' . :48205 15 37ci Park Place C ndominium 'trust Appointment of Successor Trustee Pursuant to ARTICLE III, Section 1 of Declaration of Trust dated February 12, 1982 and recorded with the Barnstable County Registry of Deeds at Book 3436, Page 177, we, Jeanne-Marie Freeman and Joan B. DeRosa, the two (2) remaining Trustees of the above-captioned Trust, do hereby appoint Lynn Carver as Trustee to fill a vacancy caused by the resignation of Dean M. Letsch. Executed as a sealed instrument this / 7 day of v ., 2012• nne-Marie Freeman Joan DeRosa COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, SS, On this _it -day of 2012, before me, the undersigned notary public,-personally appeared Jeanne-Marie.Freeman and Joan B. DeRosa, as Trustees aforesaid, proved to rre through satisfactory evidences of identification which were drivers' licenses, to be.the persons whose names are signed on the above document, and soknowledged to me that.they signed it voluntarily for its stated purpose. `"11,1011,,,,� `mob •o.T, ,pip t. ••n' r, �� ♦t Jr f y r Notary Public My Commission expires: cc 131CHIA J,MdL JR. Notary Public COMMWWEALTH OF MASSACHUSETTS My.COMMI!3sion Fvplrea AuSUM 31,2016 t BARNSTABLE REGISTRY OF DEEDS . ; , - �4ti -�_•cam:. c e -P ubi c.Safe ty nt of ttsp sand Standards MassahuseRe9ulation idin9 Board of Bui , , erNisur ,instruction Sap CS 104107 License CA] oy. Ss MA 1` 664 r Sp IEi YP` OU .� tion Sw ra _` � Comrnissionef TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map . Parcel ` ��✓ Wlin� ` ISO ;? Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis e Project Street Address �r�.Mf awl. Village, l Owner Address Telephone Permit Request ( � 4b -1.i S Square feet: 1 st floor: existing proposed 2nd floor: existing proposed TotaIfnew Zoning District Flood Plain Groundwater Overlay 'Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family. d/ 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: ❑ existirg ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ZNo If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION C (BUILDER OR HOMEOWNER) • Y I�1 NameOlku I�/�� .�� Telephone Number Address d ' a /dA.CAV i License# 06 VW4_266 "IDe�j C�i ✓� Contractor# Email Worker's Compensation # ('�' �''2���C ALL CONSTRUCTION DEBRIS RESULTING FROM THIS P, �OJ CT WILL BE TAKEN TO DATE SIGNATURE �� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ' ADDRESS VILLAGE OWNER a DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL .r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL rs FINAL BUILDING ti DATE-CLOSED OUT A-SS00IkTION PLAN NO. j C®mmonweap of Massachusetts Class A Large Capauty ' License to Carry Firearms(M G t c.140;,.§131; oe L( nse Number^ Date of•Issue piratton Date 1249,.6874A 01/15/2014 1L4(29 y, Issuinq;pi,VT n: YHRMO`TH Restncdons None CASSIDY,HENRY - 8SHED WEST YARM'OUTH,, `A O2 .. .., _.....,,._-.,...,.-...-,�.., v _.,.�..__.....,...«..�_—..tee;,,.,..._...._.,::..:.,.:.,,., _',...._.._........-: - , ylGC�'1lII�PCr'/6 F Cz OL l-tee of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 f Type: Private Corporation Expiration: 12/15/:?b14 Trtt 23;1631 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE ....... SO. YARMOUTH, MA 02664 ° Update•Address and rcturu card. Mark reason for change, Address L_I Renewal I;m��loymcut I. I Lust Card rr f r ir6i�cr�t//errL(l/C of C:,ll eJdrr:f!(llc:lt tlliice(it 1 bnsuiiier Affairs k Business Regulation License or registration valid for individul use.only �r �I OME IMNROVEMFNT CONTRACTOR• before the expiration date, if found return to: a Registration: . 153567 Type: Office of Consumer Affairs and Business Re6ulatiou : 10 Park Plaza-Suite 5170',1=xprratlon: 12/15/2014 Private Corporatiau v, Bostoa,NIA 02116 d'f`COD IN';(AA-riot , INC Id NTAi2IK)N CIRCLE 1'(RMi)U7tI,MA 02664- ( Uiidersetrewry V of Val witho t oat re - _ 1 Die Corninonwealth of Alassachuserts Depar-tatent of Industrial Accidents Off rice of Investigations 600 Washington Street Boston, i M 02111 a wWVV.IY9ass.goV1d is I �Voirkcrs' Cocapernsutiotn Insurance A.ffitllxvit: I3ulilders/Cot tr:�ctors/1 ��lu Y�x t>t sly Yuttrzb�ers v ,'Llaa::.xayl Yttifort�u ttYuytt Pleirlse Print Le ibl P � i hone 4: I�� �� �/��� G'-i.'ity:Sian;/-:.i- . -1 r you :AN etxuployt ir? Check the appropriate box: Type of project (requlred): l I`. 1 t ;�j _ 4., [] 1 am a general contractor and I �� U a a 4111p11)yGf W7tl]"_ ,.- : 6, 1`1c:W C0f13t1'L1C:t1ClA , I :tiipluyCr.t (h111 anchor" pelt-ti.me).* have hired the sub-contractors listed on the attached shcek 7. ❑ Rernodeling ET ;tut a sole proprietor or partrl�:r- , shlp aid tiavc ao an-lployees These sub-contractors have g. (� Demolition employees and have workers' ' working .for inc i.>x.any capacity. 9. [] Building addition . [Nu,warkcrs' comp. insurance comp. insurance.t t l:ctuircd:] �. We arc a corporation and its 1 O•❑ Electrical repairs or add.itiuus l am a home owner do'x7; MI work oflicers.have exercised their , 1;:1.[] Plwnbing re sus or additions Iny'sclf. [No workers' can-►p. right of exemption per MG L 12.'❑ Roof repairs _ I[isurarlcc: rcqu.u-cd.] 't c. 152, §1(4), and we have 110 3A [J I uln it hat7lc0wnCr actillg 113 a employees. [No workers' rijcntl c:oattxactor(refer to #4) comp.insurance required_] ''r�.uy applic:wl tllnr checks twx hN LULLS[also fill out the section below Showing heir wodcen'cotupcnsatiod jwlicy 4dortnariou. Hu,II owuccx wlw subrtut Ltlislid di alavit indicating chcy arc doing 41 wont-,old thctl hilt uuuidc coutracton must submit a ucw uffi(bvii indicutirtg such. �'ulius..wca[lest check this.box rnwit attached au additional sheet showing the unnw of the sub coutnutac�and stato wt1Gt11CY UC[lot C1703C CrIUCIG3 hAvG '.:i:,I,luycc.r. if aic sine-coam&cwrs have cinploy"a, they must provide their wurkcn'comp,policy uumbcr. 1 um an employer that it providing worker compensation irtsurunce for my employees. Velow is ate policy and job site r�r f ultrrullufr, , 111,ul4110c CUulpurly NXIII(t: 'u ,' �� �, f / Expiration Date: 1lu:}' (f Lrr'�C11-lAI�. LLC- :��G `� ! `/ � 1�. ,ZtT Ci /State/zI �C�,e✓(l�lGj 4`I��Of luit tine;�ddlGss: _ _ t rY P= — :XIP i k,cupy of the workers' cotnrpensation policy declaration pale(yho)vlmg,the policy at imub r agid expiratlou date). t allucc to sce.LUC'cover cage as requued under Section 25A of MGL c. 152 can lead to tbo imposition of cl-4ninal pellaltiey of a Tina ui; to D l,jOO.00 and/or one-year irrlprisonment, as well as civil penalties iu kl1G form of a STOP �V012IC �RD1uR anti a tine . i up 1u ;'>>O.OU a day against the violator; Bc advised that a copy of this statement relay be forwarded to the Office of I.nvcsagaaotlx ofthc DIA far ul�lurance coverage verification. l da hereby certify�,tnd4?r the tru knot penalties of perjury that the information provided above i true and correct. QdIciu1 rare only. Do not write in--his area,'to be completed by city or town afciaL w GE'v or i'utvtx Permit(l.icense# 6wiva Auitior-Ity (circle one): I. tiumrd of Health 2, Building ;ucplartmeai 3.40ty/`I'owa Clerk •4. Electrical Inspector 5. 1?lttrrllalrt Irtxpecior 6,Other • CAPECOD-27 M1'OUNC CERTIFICATE OF LIABILITY INSURANCE AILInlhilnplYYYY1 A'I E IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UP`0N I-I-IE CE-RTII ICATE IIOLDER.TIUS i 'tar.11llc:\fl. DOES N(?1' AFFIRMATIVELY OR NEGATIVELY ANIEND, EXTEND OR ALTER THE COVh•RAGF AFFORDED BYTI-IkPOLICIES uLl 1VV. .1111S, GEI-tTWIC•A I E Ol= INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AU'I'tIORIZ�0 rt I Ixt:tiL N I A l IVt: QR F'IRODUCER, AND THE CERTIFICATE HOLDER. rdl'Vr;I AN L: It fhu uartlfic: tw huldur 15 .w ADDITIONAL INSURED,tho polig(les)Must be enllorsud. It SUOROGATION IS VVAIVI=.D,aubjucuu Lit, lurnic. ,+uj concllUurla of LLIu Polley, Certain Policies may require an ondorsunrent. A otatenlont un thta cartitic.ate does nut contar III, 5 wUm R:.,tu uIIH,.:r ill lieu (_)Isuch endor,c nl unl 3 . t.l ll.iu It PG Ei`14OG2 CONIACY -..._ rIAM,Ii Mar aret YOunq 1,1,I.1 IIISUfJIICU Agoiicy, Inc. PIIONI: 1111). C o Ex All, u u Il;vuu::,IVIA U2li6U 1_AI H .Jl . _----....._._ 1... .._L'. r•mAIL N .__ AQLR( S5:rllyounci L�rq(fcrs�Tray.r orl� INSUFL'R S AFF(]FLOINIi COVI5I21LlaL ......AIC.�..._.: INsuNliF(A:PEFRI_ESS INSURANCE COIVIP:ANY INsurerfo;COMIUIERCE INSURAIVCk COMPANY l%:01l,u GUILT IIi:i Ul2ttlOn,•III t: - - uV4URlHRP EVanstc)n InSLII'c'111VQ L.:.O111121 r1y 1u 1-4;,11don (;irr.:lu - - IN5UHl_R0,ATLANTIC CHARTER INSUI:.ANCL_.GROUP '10LIL11 1`arnlol.tth, IVIA. 026641 INSURER------ _._.. .. k: ` CE:h-h(1::ICATE NUMBER, _ _ _ _ RIEVIS(ON NUIVIOEF� : ;Lif I if Y' I-I lA l I I IL" POLIC;ILS OF INSURANCE LISTED HELOVV HAVE QEEN ISSUED I.O THI:INSURED NAMEA)AL)OVII FOR I HF POCI Y l EI(IUD- „h:,,,•It:) NOIVAIII�3T'ANDING, ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHERDOCUMENI WI'fl'II'Lril'L:C1 10 VVIII(A IIIEi I:::\It. MAY GL I:'P'.LJ_0 OR MAY PERTAIN, THE INSURANCE AFFORDED OY THE POLICIES QC-SCRIBEO HEREIN IS SUR)ECT TOAL.L 11'IET[IMS, AIVCI,CC.111DITI0NS OF, SUCH POLICIL_S.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AbCIC SUIdR'----- I 't C Uh ITV lJ rRrx Nl:I: - POLICY NUMUeIi IDO/Y A MInT Y 1' -_- LIMI EAC-1 QCCUItI(.NCC $_._. I,ODU,U00 A `I,utgvu14-ALUNNERAI_LIA13101Y CbPB2330E53 411/20T3 41'112U'14 nAMA(11-TC1'hGNTID IOOU00 I TL-MI:E5 a auallinlu� Y S,UUU ..X. I OCCUti ^M L._O kxN(Al1Y unu(IT wul,_ IlE QNAL a Ar1V IN,UHv y 1000 OUO • GLNL.hPJ..AGC,REuAIu p 'ODU,000 .. 2 000,000 ' µ I 'nxn:hr.l.-rl f C:LIMIT Ah'PL.ICti Nl:h. .. lafiQOU<`I$-GOMPIOI'H06 Y - S.-___— PRO- -.---.�_._:._.....__ _�_— CON 4l)IINL LI 511g1,,1 t lIMl7 l 000 00 I,Ivnlx,t+,l LIX l'd a(:Qllull L '13MNIBCKVMK 41112013 41112014 13C)DiI-YINJUI2Y'(POI-Pulonn) 1 AUTO ILUULED IIQDIL.Y HNJLIhY(PaI uccJd4l%Q b . N(lN<IWNL;Q f1U0PE�RT1!hAMAGI-------- t 6uAUll1}' x ALI'1'OS - - NI Al CIDPN- - unr, l-LAINIsN1r,uL XON.I453512, 41,02013 411/.2014 I(IUUUUU AGGI'iC.IiAIL A Ul li I X� I l n-Iv llt)NT 'IO 000 I-/+(I a LN NIIQIV _� �11 IQ1Q�L L ' III,.Ui LYti -5,1�. ... ..... n coral lutyll'NIcINLwr:xL c;u r{vEy1NI WCAQU :S]U< ti13U12U13 613QP�U'I( E.L.eACHACCIt)l_NI .... t IUUU UUU c r r.ItM1IUtIT Cx{�LIJ DL;I:,"� L__.._,1 N f A _ - ...- �, ,t.I,dalwy In NFU. - ELL,OISEASL FA 1-MPI,0YFI 4 I,000,UUU , •.• � � l:1. L)I�I�ASIi-I'(JLICI'LIAIIP 4 •�_-_,_ ', i lICp(A IYUIV-.I I_OCA 1IONS I Vk FMC:LIHS I,Atwch ACORI)'1111,Agdum wl R.n-kh Schcdulu,If mo,a alaa�c Is rcyullmn ; v.,, I '„ny, lr,uOri inClucl�s Ofticurs Qr Proprietors• ,Ud;lu Wll In:,rli ULI ato tuS fs 1.11 Qviclud.under the Ganerrll Liability when required by written contract or agreeinurrt with the C011iticate I.10100r.,. .R i N'It:r�l t I1Ul_Dk-tom WCLLATION _-.. SHOULD ANY OF THE ABOVE OESC:RIDEn,PCILICILS GG CANCELLED DEFORE (,)dlnsulaUion, II1G THE EXPIRATION DATE Th11=RFQr, NOTICE .VVILI ILL IJELIVEItEO IN I ACCORDANCE WITH THE POLICY PROQ18tONS. p AUTHOHIZEDRkPRESkNTATIYG �. 4 6'1988-2010 ACORN CORPORATION. All rights 1USUNdd- ,f (z01 U/05) Tha`ACORD ndnle and logo arQTQ�i5turecl marks of ACORD o , 460 West Main Street DuSi 1 '. r Hyannis, MA 02601-3698 Assistance r Tel: (508) 771-5400 Fax(508)775-7434) co TTY on all lines Corporation "f Cape Cod f Free hriatin . Your tenant has requested and is eligible for weatherization of your rental home through government funding. This will be provided at no cost to you. Program regulations permit us to spend around $2,500- $7,500 in materials and labor per dwelling unit. Program regulations require us to weather-strip and caulk doors and windows; insulate attics, sidewalls and floors. All work is professionally done by established private contractors. We will conduct a final inspection to make sure that all work is completed to specifications. If you request, you will be informed of the estimated measures before they are done and provided with a list of the actual measures and costs following the completion of the work. We also need proof that you own the property. A copy of.a CURRENT TAX RILL OR DEED listing you as the owner will satisfy this requirement. Please fill in all blank areas of the enclosed agreement and return with the, proof of ownership as soon as possible. if we do not receive the enclosed form within two weeks, we will do a basic energy audit of the home, but no weatherization work can be recommended or done.- If you have any questions please call Suzanne Smith at 508-771-5400, eut. 123 or email her @ ssmith@haconca cod.org LANDLORD: TENANTC.,(,t� ' C 12 email: w(dam 4P, i email: Ca.f t Lbf (�(,(6vvs phone: (home) 52 -- ?25- 5 phone:(home) Z �1 (Coll) (cell) TENANT/PROPERTY OWNER/AGENCY WEATHERIZATION AGREEMENT 1. The Parties to this Agreement are the following: (hereafter known as Tenant), (print your tenant's name) L. I (hereafter known as Property Owner) (print your name) and Housing Assistance Corporation (hereafter known as Agency). In consideration of the mutual promises hereafter stated,the Parties agree as follows: 2. The date of Agency's signature will be the effective date of this Agreement. 3. Property Owner and Tenant consent and agree that the Agency may do the following with respect to the property located at(street,town) unit# and currently leased or rented to the Tenant: a) Enter the premises for the purpose of performing a Weatherization inspection. b) Enter the premises to perform Weatherization work which the Agency determines in its discretion is necessary and appropriate as a result of the Agency's inspection-of the property and in accordance with the appropriate priority list for the type of dwelling. The Agency and the Agency's contractors may also enter the appropriate common areas of the building for the purpose of accomplishing the Weatherization work. The Agency and representatives of the Commonwealth of Massachusetts, Department of Housing & Community Development (DHCD) may further enter the property to inspect any and ,all work hereunder. The Agency will provide reasonable notice of the timing of the Weatherization work and inspections. The Weatherization work will be performed in accordance with the Property Owner's consent as further specified below: ***INITIAL ONLY ONE OF THE FOLLOWING *** I consent to performance by the Agency and its contractors of any Weatherization work determined necessary and appropriate by the Agency as a result of its inspection of the property. I understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of work: I will provide a separate consent to performance by the Agency and its contractors of Weatherization work following my receipt of the Agency's inspection report and a statement of the estimated work and associated value. This additional consent will be sent under separate cover as Attachment A. 1. understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of the work. 4. The Property Owner understands and agrees that any and all work, including related repairs for which the Property may also be eligible, will be performed at the Agency's discretion. The Agency estimated completion of the Weatherization work by the end of 5. If the Property Owner is required to make.repairs to the property prior to the commencement of Weatherization work by the Agency, the Property Owner will be notified by the Agency and will be required to make the repairs as soon as possible. Except where the Property Owner receives a written extension from the Agency, time is of the essence in the performance of repairs by the Property Owner. 6. The Property Owner and Tenant authorize the Agency to receive a statement from the fuel supplier/utility supplier as to the quantity of fuel/utilities used at the above address in each of the past three years and the future three years. The information is to be used only to determine the cost effectiveness of the Weatherization improvements. 7. The Property Owner agrees that the rent for the dwelling unit will not be raised because of any increase in the value thereof due solely to the Weatherization work performed. 8 In consideration of the Weatherization work hereunder, the Property Owner further agrees that upon the effective date of this Agreement and during a period extending through , approximately one year from the time the work is completed, a) The present rent $ jJ15 per month will n2jlae raised for any reason: (The rent amount must be filled in). Heat included in rent?Yes_. No However,this Paragraph (8a)will be waived by the Agency in writing if, and only if,the premises are leased under a state or federal rent subsidy program, in which case the actual rent charged by the Owner shall conform to the standards of the rent subsidy program. Please state which Housing Subsidy program your tenant is on and through which Agency: b) The Property Owner will not institute any summary process action for possession except in the case of non-payment of.rent or other good cause related to the Tenant(or any successor Tenant). c). In the event the Property Owner decides to sell the premises; Property Owner shall comply with one of the two requirements below: -The Property Owner shall not sell the premises unless the buyer agrees (with a copy forwarded to the Agency) in writing prior to sale to assume all obligations of the Property Owner set out in this Agreement; or --The Property Owner shall pay the Agency an amount equal to the cost,as certified by the Agency, of the Weatherization materials installed and labor performed in the premises as of the date of sale. Said amount shall be paid to the Agency immediately upon sale. 9. (Applicable only if Tenant's heat is included in rental payment and blanks are filled in) At the end of the period set forth in Paragraph 8 above, the rent shall not be raised more than % per _ for an additional period of one year, and the provisions of 8b and 8c above shall continue in effect for such period. However, the rent provisions of this Paragraph 9 may be waived by the Agency in writing if, and only if, the premises are leased under a state or federal rent subsidy program, in which case the actual rent charged by the Owner shall conform to the standards of the rent subsidy program. 10. The-Parties agree that the terms of this Agreement are incorporated into any other lease or agreement between the Property Owner and the Tenant, and between the Property Owner and any,successor Tenant, and if there is any conflict between the provisions of this Agreement and the provisions of such other lease or agreement, the provisions of this Agreement shall govern. However, if such other lease or agreement, including without limitation a lease or agreement under state or federal rent subsidy.program, contains stronger protections for the Tenant, such stronger protections shall apply. 11. For breach of this Agreement b the Property Owner, the Property Owner shall reimburse the Agency in an 9 Y p Y � P Y . 9 amount equal to the cost, as certified by the Agency, of the Weatherization materials installed and labor performed on the premises, as well as attorneys fee and court costs. The Property Owner may also be liable for damages to the Tenant in accordance with applicable law; in such instance, the Property Owner shall reimburse the Tenant for attorney's fees and court costs. Without limiting the foregoing, the Agency may at its option terminate this Agreement, by providing written notice to the Property Owner and Tenant, in the event of breach,by the Property Owner or Tenant. 12. Performance of the Weatherization work hereunder by the Agency is contingent upon the availability of funds to the Agency from the commonwealth of Massachusetts and the federal,government, as well as the eligibility of the Tenant under WAP program requirements. The Agency may terminate this Agreement, by providing written notice to the Property Owner and Tenant, if the Agency determines that the unavailability of funds or ineligibility of the Tenant warrants termination. V 13. The Parties acknowledge that this Agreement is under seal. It is intended by the Parties that the Tenant or any successor Tenant is the intended beneficiary of the Agreement and shall have a right of enforcement. Property Owners Signature: a' - Date-. / Phone: Address: �'�' � Pi Tenant Signaerr ~� Date G LA Agency Approved Weatherization Company. r A AII,Cap nergy am T. Incorporated ! Alternative Weatherization / Building Performance Contracting Cape Cod Insu Cape Save / Conservision / Frontier Energy Solutions / Lohr& Sons Inc. Resolution Energy Agency Signature Date 3"oZ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION OF PA Map. Parcel Application VVVd66 SEA , r Z -r 3F 1 . Health Division ;; j; � Date Issued Conservation Division Application Fee62 Planning Dept. Q $ �� Permit Fee =la Date Definitive Plan Approved by Planning Board :. Historic - OKH _ Preservation / Hyannis Project Street Address 398 416S>^9117 Sl—. . &UiAW 46 Village 14VAIVNiS Owner YoWk P/Aee- CoAipo ASSoc . Address /9A 16 eP'4F1 DEN/.s.lye Dad 4I Telephone SD 385-9499 din BFIP .Permit Request A" Square feet:' 1 st floor: existing proposed 2nd floor: existing - proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 a 00 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 ^49 Ic-, IV� UL L / A) Telephone Number Address '7 r� cr t i License q(,)7 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 61, SIGNATURE //? �� /'% G��� DATE FOR OFFICIAL USE ONLY r APPLICATION# DATE ISSUED MAP PARCEL NO. ADDRESS VILLAGE t: OWNER c' f t r s DATE OF INSPECTION: r ._FOUNDATION= FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL E I PLUMBING: ROUGH FINAL s GAS: ROUGH FINAL FINAL BUILDING b DATE CLOSED OUT ASSOCIATION PLAN NO. ' 600 Washington Street. - Bostan,MA 02111 - `' _ www.Mass guv1diu Workers' Compensation Insurance A.ffidavit: Builders/Contractors/Electricians/Plumbers fiemt Information • - 'Please Print LeLffily, Name(Bnsincss(Org�iion/Fndividna]); •Address: -' .' • . . City/Sie/7ip: �/. .av„ We--a- 9'.2R I q5 Are you an employer? Check the apprapffzte bay Type of ro ect'r 1.5g 0 am a en�Ioyer with 4.. I mn a general contractor and I 6. p J employees(fall and/or patt_:E=).* 'haw hired fe [ .New consfi r,�-t;rm , 21. I am&'sole pmprictor or partner- • listed an$ie'aiiarhed sheet': 7. ]R=odeling ship and have no employees 'These i6-co iracfazs have I ❑Demolition wog fprme in•any cipacify: employees and have worlmrs' 9. ❑Sur7dmg addition [No worl=p' camp.ins_nce•. �.me n�P•#' 5, ].'Fe area corporatian'and its 10.❑Firrtrirai repay or adtl>fions 1 a officers have�� ed their `3.❑ I am ahnnieowncr doing aI1•work •_ s 11.❑Pl�rmbingrepain;or ddijions•.• . myself [No workers' camp. ? of egtm�sfian per MCrL 12.❑Roof repam ;ng==P ram•]t c. 152, §1(4),and we have no • eempIoyees �o . 13.E] Other • conT•tagorRmce required.] kAny appIieaaY that chccla box#I must also fcII out the sectitm below showing their wodza'cpmpmsafion polity information Homcovm=who submit this affidavit indicating they src doing aD wm:k and thin biro ontsido cnnhactoa must submit a new afiffdavitmchmting such. - Conhacton that check this box must aftacbod m sddif i mal sI=t showing$e name of the sub-conhacbnis and stain whcthcr cr not fhosc c&ifi=have mployas. If far sub-Conf=wn have=3pbyees,fhey mast prm idt thew workers'camp.poky n=bQ am an employer that is pr&i id g workers'compensation insurancce for my employees BeLow is tke policy and jab site rrformafion.• ?�/ � � z- Q 7 U�3 O 3 y,1 •: '• - - - a.m -mace Company Name: Z (J 1� 7 / olicy#or Self-ins.Lin.#k Expin onDate: 3 2 F U/, M A.r AlS� �/sta�/zz p: H- ��11l -S . �b Site Address: ' itar_h a.copy of the workers' compensation policy declaration page'(sho�Fing the policy number and ezpirafion date), ailtn e to secu>a coverage as required Wider Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a oe'up to $1,500.00 and/or one-year imprisonment as•weII as civil penances in the fog of a STOP WORK ORDER and a fine .'up to$250.00 a day aO met tip Yiolahm. Be advised fat a copy of this stat=am6f may be faiwa d.to the Office of yes�ons of the nLA-for insurance cwy=yeufication. io-hereby certify under the pains•and penalties of perjury that the informadan provided above is true and correct (ivatirre: �' s/2� Date a 4- g 5115 Offirral use only. Do not write in this.area,to be completed by city or town cola . 'City or Town: PermitUcense# - Lssuing�uflioZ4(circle one): : L Board of Health 2,BmldingDepartanmt 3. Cfft gown Clerk 4.RlectriraUnspector 5.PlumhingInspector G. Other CazztartPerson: - • Phoned: • ; DA ACC CERTIFICATE OF LIABILITY INSURANCE TE(MMIDdYYYY) 1/4/13 I 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 endorsemengs). PRODUCER CONTACT NAME: Margaret J Grassi Ins Agency PHONE FAX (508) 291-1707 (508) 295-2007 / No: 1188 Main Street ADD"'RESS: debmjgins@comcast.net West .Wareham, MA 02576 INSURE S AFFORDING COVERAGE NAIC# _ I NSU RER A:Allied INSURED INSURER B:ColonV Insurance AgencV Mark M Mullin INSURER 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 POLICY EXP LTR TYPE OF INSURANCE T IN SR WVD POLICY NUMBER MM/DD/Y MM/DdYYYY LIMITS B GENERALLIABILITY GL3818794 1/5/13 1/5/14 EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(E.DAMAGE TO RENTED ace) $ 100,000 CLAIMS-MADE F—IOCCUR ME EXP(Arryone person) $ 5 000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIESPER PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY PRD El LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acciderd $ ANY AUTO BODILY INJURY(Per person) $ ALL 0 WNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS _AUTOS (per.. Per accident UMBRELLA LIAR F OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 6ZZUB-4O83P83-4-11 12/8/12 12/8/13 X WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ .1,000,000 OFFICERIMEMBER EXCLUDED? 7 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,desuibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Renarks 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. AUTHO REPRd ENTATIVE 1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: ' . A V 1t AA VA JJLLA "aLaUIL; . Regulatory Services Muss Thomas F.Geiler,Director r Building Division Tam Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 . www:towmbarnstable.ma.us Office: 508-862-4038 Fax 508-790-6230 Property Owner Must Complete and Sign This Section 'If Using A Builder TikSTa RIQk Pl as -of the subject' r l PoPy . hereby authorize M( �IN iC6-bewc, i-,G10IpJa to act on mp behalf, in all matters relative to work authorized by this building permit fib' w MRin► s , ffylfivv�s �/d (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. Signatare of 71ZOS'E Signor pplicant J � �e Print Name Print Name Date Q:F0RMS:0WNMERMISSI0NP00LS 62012 f „ ?k 26607 Ps224 OIL482E71-3 08--22-2012 & 11 37c. Park Place C ndominium Trust Appointment of Successor Trustee Pursuant to ARTICLE III, Section 1 of Declaration of Trust dated February 12, 1982 and recorded with the Barnstable County Registry of Deeds at Book 3436, Page 177, we, Jeanne-Marie Freeman and Joan B. DeRosa, the two (2) remaining Trustees of the above-captioned Trust, do hereby appoint Lynn Carver as Trustee to fill a vacancy caused by the resignation of Dean M. Letsch. Executed as a sealed instrument this 1 day of Au s)- _, 2012. anne-Marie Freeman Joan DeRosa COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, SS. On this day of 0L v&4_- 2012, before me, the undersigned notary public, personally appeared Jeanne-Marie Freeman and Joan B. DeRosa, as Trustees aforesaid, proved to me'through satisfactory evidences of identification which were drivers' licenses, to be the persons whose names are signed on the above document, and acknowledged to me that they signed it voluntarily for its stated purpose. `1-%" AST ',T N' . Notary Public My Commission expires: "��.r`��4r CO ID A =Public . AICHAFtDJT JR.� iJoCOMMONyNEALSETTSMy,,comsAug BARNSTABLE COUNTY REGISTRY OF DEEDS A TRUE COPY,ATTEST BARNSTABLE REGISTRY OF DEMOS JOHN F.MEADE,REGISTER 'I iM t..sattev ettl lllpartnieni �)� r-vf1.w� lvv, B(�ar'(l.�►t Bvjt(Iin,T Ri«ul[tuns and +t rnct<tt d� Construction Su ruis4r Ctcer se Ai 3: '' ' Licerts CS',104076` }"-:Restricted o:..,00 N• • P- MARK -MUL-LIN a 10 PERRY:AVE. E U1(AREHAM, MA 02538 F c�G_.�yf� Expiration: 9/7/2013 .. ,y--.------------ �* :T rnntn..i`•nce• _+. Trr: .104076; Rice of�ansnmei Aff, s&8nsmess Regulation tlV�F1tO i License or.registration valid for individul use only •,- I..COrlI'-,, o . . - before the ex iration date: If found refuin use egistr�ton 167281 • .: - TYt�e P xpiratton , 8130%2014 Office of Consumer Affairs and Business Regulation i DBA 10 Park Plaza,Suite 5170:. MULLIN RbOFING AND SIDING Boston,MA 02116 - 1 MARK MULLIN`= , 7 CONNEWRr.WAY W.YARMOUTH,MA 02 - Undersecretary Not valid without signature f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1,7 Map Parcel Application #a6 2 Q `�- Health.Division Date Issued 6 Z Conservation Division Application F'e/e _ n Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/Hyannis Project Street Address 2 UJ Az T_ *Village H Y A N 'V-7-S Al -4,Owner P6 9 K PI. &AC ee)A) j)0 AS f�v Address _T Telephoned Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ) Cl�C� 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 _newL co 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: ,O,Yes; 0 No i L. r-5 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 of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER)_ L Name �� �� ��1 Telephone Number Address 7 6±2�drr - (.�n�-� file I%t� License # Home Improvement Contractor# Worker's Compensation # z/®L33 y4( ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO YApp, 00-rd C)M? SIGNATURE /� C.2i`� DATE FOR OFFICIAL USE ONLY - r '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 DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations _ d 600 Washington Street Boston,M4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): . Address: ? _ O A,,/ ' City p /State/Zi : Phone.#: Are you n employer? Check the appropriate bog: Type of project(required):, 1. am a employer with 3 4. ❑ I am a general contractor and I 6. ❑New construction . employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'.comp.-insurance comp.insurance.T required.]- 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs ' insurance required.]t c. 152, §1(4),and we have no , employees. [No workers' 13.❑ Other comp.insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy.information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: '� �--U Q y �- S'"y'//Expiration Date: Job Site Address: 3Q 8 W, MAT:W SI City/State/Zip: P yAAh i ,s' M,4 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of _ Investigations of the DIA for insurance coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature• i' �i Date: l0� ^.aCSI Phone 4: S5, 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): A.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,�Nith 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/icense 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 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: he Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. ##617-7274,904 ext 406 or 1-977-MASSAFE Revised 11-22-06 Fax##617-727-7749 www.mass.gov/dia PARK PLACE CONDOMINIUM ASSOCIATION 398 WEST MAIN STREET HYANNIS,MA 02601 October 4, 2012 Town of Barnstable Regulatory Services Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 ` Dear Mr. Perry, RE: Building 5—Roof repairs On behalf of the Board of Trustees, please be advised that permission has been granted to Mullin Roofing and Siding to perform the necessary repair work to Building 5. Should you have any questions, please feel free to contact our management company at 508-385-9499. Sincer ly, t eamie Freeman,Trustee Park Place Condo Assoc. r------BARON PROPERTY MANAGEMENT, LLC PO Box 1.682, East Dennis, MA 02641 Tel/Fax 508-385-9499 Email: baronpm@comcast.net October 4, 2012" Town of Barnstable , Regulatory Services Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 Dear Mr. Perry, RE: Park Place Condo Assoc. Building 5 —Roof repairs On behalf of the Park Place Condo Association,please be advised that permission has been granted to Mullin Roofing and Siding to perform the necessary repair work to Building 5. Should you have any questions, please feel free to contact our office at 508-385-9499. n e y, P 1 Bia n Propert Manager—Park Place Condo Assoc. t6aeh use tts Depiir tn.cnt itf Public S ifct- v®AC 0rd.of Building- Regulation, and Standa d. Construction Supervisor License " 'License: CS 104076 WORKERS COMPENSATION Restricted to:_.00 AND IL EMPLOYERS LIABILITY POLICY MARK MULLIN 01 A) 10 FERRY AVE. 0 €, E. 1I,I�AREHAM, MA 02538 TYPE AR INFORMATION PAGE WC,00 0 r 6ZZUB-4083P83-4-11 ): Expiration: 9/7/20f3 r, POLICY NUMBER: (_`onunnsi;nu' . Tr#: .104076 ' OF (6ZZUB-4083P83-4 10) RENEWAL INSURER: AMERICAN ZURICH INSURANCE. COMPANY _ NCCI CO CODE: soo12 1. PRODUCER: INSURED: MARGARET J GRASSI INS MULLIN, MARK•M DBA 1'1.88 MAIN $T . MULLIN ROOFING & .SIDING WEST WAREHAM MA 02576 7 CONNEMARA WAY W. YARMOUTH MA 02673 Insured is AN INDIVIDUAL Other work plac es and identification numbers are shown In the scheduie(s) attached. In address., • 2. The policy period is from 12-08-11 tO 12-08-12 12.01 A.M. at the in s mal g 3 A. woRKERs connpENsnrtoN INSURANCE: Part One of the policy applies to the Workers Compensation Law of the State(S) listed hefe: MA INSU RANCE: NCE: Part Two of the policy applies to work in each state listed in S LlA B 1LITY . B. EMPLOYER , Item 3.A.. The limits of our liability under'Part Two are: Bodily Injury by Accident: $ 1000000 Each Accident Bodily Injury by Disease: $ 1000000 Policy Limit Bodily Injury by Disease: $ 1000000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, 4 any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A D. This policy includes these endorsements and schedules: • SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals.of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY DATE OF ISSUE: 12-06-11 DIS ST ASSIGN: MA OFFICE: ZURICH-ORLAN 809 PRODUCER: MARGARET J GRASSI INS 7282M 1901bi" - _ f Town of Barnstable � t Regulatory Services P ~� Thomas F.Geiler,Director • Building Division F, MASS. * Tom Perry,Building Commissioner '°lEo Mpr a 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved, Fee: 49-3 Permit#: c7 l a O HOME OCCUPATION REGISTRATION Date: t 'Z , Name:_ C� S Phone#: K. Address-7��� � �_ � "S,�`Q �C - L Z - ,,,��S C _a9l'^ i,—Village: Name of Business: d V\.cs,\ ✓1 , o'l -LA G L t a Type of Buswess:r—a, ✓L k ✓t Map/Lot: Z E'q 0 S © D & INTENT: It is the intent of thus section to allow die residents of the Toin2h of Barnstable to operate a home occnYahon �'�4� 5 �iZthiu single f-unily dwellings,subject to the provisions of Section 4-1.4 of die Zoning ordinance,provided that the activity shall not be discenhible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to tie premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or gromidwater pollution. � r After registration write the Building Inspector,a customary home occupation:sli tll be pemutted as of rigl t sbject to dry following conditions: L t� •. The activity is carried on by the permanent resident of a.single family residential dwelling wild located«atI•iai that dwelling unit. �-w • Such use occupies no more than 400 square feet of space. • There are no external alterations to tie dwelling which are not customary w residential buildi s,and there is no outside evidence of such use. o n • No traffic will be generated in excess of normal residential volumes. • The use does not involve tie production of offensive noise,vibration,smoke,dust or other pLiculzu rn;'Mer, n 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,m 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 tie required fi-ont 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 wun 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 die same lot containing the Customary Home Occupation. • No sign shall be displayed indicating die Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,die street address shall not be included. • No person shall be employed un tie Customary Home Occupation who is not a permanent resident of the -dwelling-unit. I,die wide hed e read and agree with die above restrictions for my home occupation I am registering. LHoApplicant; �( v Date: C' T 1 CF. F--CD 1 meoc.doc Rec.01/3/08 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 you give permission too erate. 9 y p 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.Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: 6 P 14-or t'Z ill in please: . � . . APPLICANT'S YOUR NAME/S: J ✓�• e ` BUSINESS YOUR HOMEADDRESS: Z 9 j 9 ,f5UfE3 TELEPHONE # Home ephone Number. NAME OF;CORPORATI,ON. ''ter;' NAME OF NEW BUSINESS. `' " ,n `'cS t: ?r G 55 c� 'l air TY OF:BUSINESS . i IS THIS A:HOME.00CUPATION? .''^ YES NO =< r: ADDRESS OF BUSINES Zw r .t-� .s 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 usiness in this town. 1; BUILDING COMMISSIONERS F E 0, This individual has bee or d of any mit requirements that pertain to this type of business. Authori ignature** T COMPLY WITH HOME OCCUPATION,( . ,` ^, S v COMMENTS RULES AND REGULATIONS,'. Y 2. BOARD OF HEALTH 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: Town of Barnstable �TNE�y, Regulatory Services P Thomas F.Geiler,Director Building DivisiORkII ! Or B MS i A {. MASS. �" Tom Perry,Building Commissioner °ram " 200 Main Street, Hyannis,MAr02601 www.town.barnstable.ma.us Office: 508-862-4038 � ._ _ Fax: '508-790-6230 `Approved• Fee: O35's 00 Permit#: HOME OCCUPATION REGISTRATION Date: Name: `40 Z 1 fJ P� R v S`� � i �J�@,1�e7 Phone ' 16 Address:,�9 ? 'Y\3-eSi• �`t al n 5i-2 00 1C NJ )Ul Village: Name of Business: V Q M Type of Business: INTENT: It is the 'intent of this section to allow the residents of the Town of Barnstable to operate a home occupation «Ztlin 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 dwellinF. there shall be no increase ui noise or odor;no usual 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 ground`i ter pollution. After registration iiith the Building Inspector,a customary home occupation shall be Permitted as of right subject to dne follovirng conditions: ~w • The activity is carried on by die permanent resident of a single family residential dwelling unit,located iizthin that dwellung unit. • Such use occupies no more than 400 square feet of space. • Tlnere 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 iin 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: • Tlnere 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 iridiin 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 aid not to exceed 4 tires,parked on tine same lot containing die 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 ui the Customary Home Occupation ivho is not apermanent resident of the dwelling unit. I,the undersigned, have r d and agr e ith the ab restrictions.-for my home occupation I an registering. ` I Applicant v Date: : Honieoc.doc Rev.01/3/08 YOU WISH TO OPEN A BUSINESS? ► For Your Information: Business certificates (cost$10.00 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: Z�Nei Ch T- Vj . BUSINESS YOUR HOME ADDRESS: 1\J - NA TELEPHONE # Home Telephone Number ` 0 - 96c)-' 6 6 NAME:OF CORPORATION: NAME OF NEW BUSINESS' Q-n 1T 7q-n r) TYPE OF BUSINESS C_ �- i5 THIS•A HOME OCCUPATI N? ES NO ADDRESS OF BUSINESS . C. N A/IS .MAP PARCEL NUMBER o�lv 01J` /_ OC Assessin i � ( gJ 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 CO MISSI NER'S FFICE This indivi al a en-i o f a y permit requirements that pertain to this type of business. ryl MUST COMPLY WITH HOME OCCUPATION or e Si ure** RULES AND REGULATIONS. FAILURE TO COMMENT . 2. BOARD:OF HEALTH -This individual has bee f rrd of the permit requirements that pertain to this type of business. MUST >OMPLY WITH ALL. L ' �V' ' HAZARDOUS MATERIALS REGULATIONS, Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has On infe�e,�q�the licensing requirements that pertain to this type of business. �.a�IL.JJCC..�_ Authorized Signature** COMMENTS: t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION A Map q Parcel Application # Health Division Date Issued Conservation Division Application Fee lU Planning Dept. . Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis A , Project Street Address Q I✓V ✓U/I/:, 0 Village Owner 11iAI-e FPS e-f1r7A I/ Address Telephone E Q 8- O--9 10 Permit Request tAll C A lf,, 9- � �s Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Q Flood Plain Groundwater Overlay Project Valuation Q/ Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. i 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 0 new size Pool: ❑ existing ❑ new size _ Barn: Cq'existing =1l new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other::_*' - c Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER)�.w..� -- - _ Name T/ A crr'elvwom �Sq 1� Tele honeNumberpAddress 3�� C,4, - License# -- 20-077 tl� 9/ J erCl , , Ae, 7 Home Improvement Contractor# 1323 V V Worker's Compensation # rw& 2 3 ALL CONSTRU TIO DEB=:3ESULT,ING/FROM IHIS PROJECT WIL E TAKEN TO e . SIGNATURE ge P `C FOR OFFICIAL USE ONLY APPLICATION# • ti I DATE ISSUED r MAP/PARCEL NO. a �E t ADDRESS VILLAGE t. OWNER } DATE OF INSPECTION: FOUNDATION FRAME r INSULATION .f FIREPLACE a r ELECTRICAL: ROUGH FINAL F ` PLUMBING: ROUGH FINAL r; GAS: ROUGH FINAL FINAL BUILDING C ' S k f} r DATE CLOSED OUT ASSOCIATION PLAN NO. t y r .� The Commonwealth of Massachusetts t - Department of Industrial Accidents .4 Office of Investigations 600 Washington Street Boston, MA 02111 � t www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A . licant Wormation Please Print Le ibl Name.(Business/Organization/Individual): � U �, Address: q5 ect,eiP City/State/Zip: (<.L� fti's 51 Phone #: Are you an employer? Check the appropriat b Type of project(required): 1 D I am a with employer 4. I am a general contractor and I �— have hired the sub-contractors 6. ❑ construction employees (full and/or part-time).* r. 2.El I am a sole proprietor or:partner.- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. ❑Demolition - working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp. insurance r comp. insurance. required.] 5. ❑ We are a corporation and its 10.[] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ 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: 5 t P Y J Policy#or Self-ins. Lic. #: Q � t / 3 mom- Expiration Date: P J 1 rs Job Site Address: / �S &1,V V/1/+�'l ��f City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and e6iration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pd sand penalties ury that the information provided above is true and correct Signature: Date: Phone#: 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#: The Com tit onwealth of Massachusetts Department of Industrial Accidents W Office of Investigations d 600 fFashington Street Boston;MA 02111 W H;41.M ass.go l/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _ Pease Print Le ibl Nallle (Business/Organization/Individual): 19 Address --- --� 1 S ll^ �/ 9 9 City/State/Zip: W 5/� �F}, Phone #: Jcb Are yo an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. �Vdeling. construction mployees (full and/or part time). have hued the sub-contractors 2.,� I arrr a sole proprietor or partner listed on the attached sheet. 7. ship and have no employees These sub-contractors have construction ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp: insurance comp. insurances 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] 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 NIGL 12.❑Roof repairs insurance required.] t C. 152, §1(4),and,we have no employees.'[No workers' 13.❑ Other comp. insurance required.] Homeowners wEo suTirrut tTiis a�fidavrt mid-ng�it ey aree doing all work an8 then h"ire outside contiacfors mu3t�� rb�r iia new affitiaviCindirzting suoh TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employee's,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. M y� —I-+ �^ Insurance Company Name:_ fcz /, ' / �� .d-�S ` a — Policy#or Self-ins. Lic. #: ! Expiration Date:: Job Site Address:.3 / N S UN �/J City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy n er and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500..00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investi ations of the DIA for insurance covers e verification. I do hereby certify r the pains m penalties of ty that th rovided above is true and correct. Date: Si nature: , Phone#: Official use ortl}. 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.Bu'ilding 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 lure, express or implied, oral or w;rinen." + 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 ortother 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 appurtenanttirereto shall not because of such employment be deemed to be an employer." MGL chaw�� 152,.§25C(6)also states that"every state or local'licensing agency shall withhold the issuance or re.n al 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 ofcompliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority.`' Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial --_Accidents-for confirmation.of_insuxance_cover-age.-.--Also-be-sure--to-sign--a-nd-date--the--aff davit:--The-affidavit-should-- ---- e-retnr-ned to the city *o 4en-fGr-the-permit-or-l-icense .s being requested--not-theDepar-tment 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/lcense 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 cityor town may be provided to the Y applicant as proof that a vaiid affidavit is on file for future pernllts of licenses. A new of fidavrt nausi be flied Grit 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. - t The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations - 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax # 617-727-7749 www.mass.gov/dia Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Nome Improvement C��tor Registration Registration: 132349 -= Type: Partnership ;E.. •... `; Expiration: 1/11/2013 Tr# 207392 J & J Remodeling Joseph Duarte = - - 15 Fall St. - Wareham, ma 02571 Update Address and return card.Mark reason for change. Address Renewal 0 Employment 7 Lost Card VS-CAI 0 60M-04/04-0101216 uarralA sines egu a an License or registration valid for individul use only OMee%bonsumm HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Raglatration: _..132349 Type:. Office of Consumer Affairs and Business Regulation qodeling� Expiration: .1111/2013 Partnership 10 park Plaza-Suite 5170 Boston,MA 02116 Joseph Duarte 15 Fall St. 4�.•»�•+ry Wareham,ma 02571'.., Undersecretary of vajld without signature �)a .a�hu•ett•- Dcpa1-tmcnt of PuhliC�afc�. Board of Stiildial-vRrhulatiuos and S(.jndards Construction Supervisor License License: CS 70077 JOSEPH C DUARTE 15 FALL ST WAREHAM.MA 02571 r Expiration: 12W/2012 (,.nm,l.eioncY Tr#: 7G48 r 10 30Vd Z9L.696Z 65:TZ TTOZ/ZO/TO r.� _ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ._: OME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Office of Consumer Affairs and Business Regulation Registration: t26893 Type: 10 Park Plaza-Suite 5170 I Expiration,: 8/3/2012 Supplement Card Boston,MA 02116 i The Home Depot.At-Horne Services ' I DARREN DEMERS 2690 CUMBERLAND PARKWAYS GA 30339 Undersecretary Not valid without signature i f w • r Bedard, Mike � rJ Subject: FW:398 west main st unit 4a y 5 J.0 � �a- From:jamken00@aol.com [mailto:,jamken00@aol.com] Sent: Sun 3/13/2011 11:07 AM To: Campbell, Janice Subject: 398 west main st unit 4a To Whom It May Concern, Installation of AC12 all white vinyl with no grids is approved for 39 We ain.St. Unit 4A by Park Place Condo Assoc. If you have any questions feel free to contact me directly at 508-280-1429. Thank You Jeanne-Marie Freeman President Park Place Condo Assoc. r N ►� S, 5 ' 1 ROME IMPROVEMENT CONiTRACT PLEASE READ THIS ' ' l Sold;Furnished and Installed Branch Name: Boston Date: 3 j��.1 L THD At-Home Services.Inc. d/Wa 'l'hc Homc l)cpot At-Home Sc:avices. 345A Greenwood Street,Unit 2,Worcester,MA 01607 Toll Free(800)657-5182;Fax(_508)756-8823 Branch Number:31 Federal ID#75-26984ti0:Mfi Lie#C 02439.RI(:ont.Lie#16427 CT i,ic A HIC.0S6S522;MA Home Tmpruvemant.Coniractor Reg.#12W.3 Installation Address: �� �� Can �{iy4i�1!?G� � b©1 City State Zip aser(s): Warp Pbune: Hume Ploune: Cell Phone: Homc.Address: (If different from Installation Address) City State Zip E-mail Address(to receive project communications and Homc.Depot updates): _ ❑I DO NOT wish to receive any marketing cmails fivm The Home Depot �/-- Project information Undersigned("Customer 1,the owners of the property located at the above installation address,agrees to buy, and THD At-Home Services,Inc.('The Home Depot")agrees to furnish,deliver and arrange for the installation("Installation")of ali materials described on the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this reference;along with any applicable State Supplermmt and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): Job#: O.t—A x.G` ) S s)tt:" Project Amount-� - Rcx,fing OSiolingZSWWolows ❑insulation' flutters/c ❑over, rntor ry Dos ❑ ` 44 3 y 6 _ Roofing ElSiding ©Windows ❑Insulation $ ❑Gutters/Covers ❑Ecury Doors 1-1 ❑Roofing ❑Siding ❑Windows ❑insulation $ ❑(hitters I(rovers (]Entry Duum❑ QRoofmg QSiding ❑Windows Tnsulation $" QGutters/Covers ❑Entry Doors ❑ Minimum 25%Deposit of Contract Amount due uporr a cwtiun of this c whvii. Total Contract Amount Maine Purchasers may not deposit more than one-third or the Contract Amount, 0 -- Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Custom-.r under this Contract agrees to be jointly and severally obligated and liable hereunder_ The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Producl(s)included herein,at its.discretion,if The Horne Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing errors or hecause work required to complete the job was not included.in the Contract. Payment Summary: The Payment Summary#__c am ,included as part of this Contrdc:t, sets forth the total Contract amount and payments required for the depths and final payments by Product(as applicable)_ NOTICE TO CUSTOMER You are entitled to a completely fulled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there hi one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete.. In the event of termination of this,Contract,Customer agrees to pay The Ifome.Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service)Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WI"I`UROLD AMOUNTS OWED TO THE HOME, DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceotance and Authorization: Customer agrees and understands that this Agreement is the entire agreement betwom Customer and The Home Depot with regard to the Products and Installation services and supersedes all prior discussions and dagrccin6ts,either oral or written,relating-to said Products and insis'rllation.This Agreement cannot be assigned or amended except by a writing signed, by Customer and The Home 13epot.Customer acknowledges and sgmes that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement Ac p.d.b _ s itted by: _ X �LaLf Custo sSignxt Date Sales omcultarw;s ore to X Telephone No. C 601) CIA r aer's Sigmuure. Date Sales Consultant license No. CANCELLATION: CUSTOMER MAY CANCEL THIS (as applipb1z) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING 'PHIS AGREEMENT, THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICF.:ADDITIONAL TERMS AND CONDITIONS ARS STATED ON THE REVER.9F:SIDE AND ARE PART OF THIS CONTRACT 12-27-10 GSC White-Branch File Yellow-Customer Td WdZT:T L00Z 8Z ''daS 1LZZZ9£60S: "ON Xdd Pe6wef: WObd TOWN OF BARNSTABLE BUILDING PERMIT,APPLICATION,,;. Map :- Parcel: ;,•: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 W e5• rV t�wls►rJ i i Village t4GM h 1 Owner A. 0. QS�I[QLA, Address S GV�rK-L� t Telephone L W Permit Request Q �_ lh o tv y Square feet: 1 st floor: existing proposed 2nd floor: existing proposedn Total neb iJ Zoning District Flood Plain Groundwater:Overlay Project Valuation Construction Type , Lot.Size Grandfathered: ❑Yes ❑ No If yes, attach su porting Tocurr�entation. 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 j APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name e CUu, Al, Ca 5 S6-N Telephone Number - 2- C� Z. 2-- A _1 dress _ ( / 1 r l&;n S��0 License# 1) ly Home Improvement Contractor# � Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO L-.QkAd SIGNATURE DATE Z Z FOR OFFICIAL USE ONLY j t APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER Sr DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL- _ FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r , t I t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information A r Please Print Legibly Name(Business/Organization/Individual): PA UL /`J . .S S Address: ('l Q..1 Y\ S�• City/State/Zip: ACA-r Ui1jo, AAC,O Phone Z:l — Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer* m to er with . . 4. ❑ I am a general contractor and I p y 6. ❑New.construction ,Pfflployees(full and/or part-tim.e).* have hired the sub-contractors .2.[ I am a sole proprietor or partner listed on the attached sheet. T. ❑Remodeling { ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'-comp.-insurance comp.insurance.t f required.] 5. ❑ We are a corporation and its '10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I l.❑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 cornp.insurance required.] `Any applicant,that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site. information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify unde a pains and penalties of perjury that the information provided above is true and correct Si afore: Date: 2,2. ' U. Phone# � ZZ O Z�'2-- Official use only. Do not write in this area,to be completed by city or town official .City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health -2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a:business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`-Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contiactor(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 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 Cornmonwealth 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.gQvldia �� SS 0(- � T Town of Barnstable Regulatory Services BAR� '.. Thomas F_Geiler,I) rector i6S9 ��' fa Building,bivision i Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02661 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 L( �6 N pNA66`, of IE ►l p tlaLA6H�ti , , as Qwn r ott'f1 the subject property hereby authorize to act on F U h i Kas in all matters relative to work authorized by this building permit application for. (Address of Job) a � be � ; i M . ignature o Date - Print Name I If Property Owner is applying for pern t please complete.the Homeowners License. Exemption Form on the reverse side. FO RMS:O.WNERPF-RM ISS ION z� 'own of Barnstable Hof r _ Regulatory Services BARNS.,ELF- ; Thomas F. Geiler;Director MA.9.4 16yg ..0�* Building ivision Pr fo�y A Tom Perry,Buildin Commissioner 200 Main Suet H annis,MA.02601 . _ .. vt-wv.town.b ristable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER L CEASE EXEMPTION': Pie a Print DATE: JOB LOCATION: number str t village —'HOMEOWNER': name ho phone# work,.pbone# 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 w i.o 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 re ides or,intends to reside, on which there is, or is intended to- be;a one or two-family dwelling, attached or detached ctures accessory to such use and/or farm structures. A person who constructs more than one home in a two-ye 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 buildfng permit. (Section 109.1.1) The.undersigned"homeowner"assumes responsibility or compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies tl at.he/sbe un erstands the Town of Barnstable Building Department minimum inspection,procedures and requirements and at he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35, 00 cubic feet or larger will be required to comply with the ` Stat Building Code Section 127.0 Construction Con 1 HOMEO R'S EXEMPTION The Code states that "Any homeowner performing wo ' for which a building permit is required shall be exempt from the provisions of this section_(Section 109.1.1-Licensing of construction Su sors);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 una that they are assuming the responsibilities of a supervisor(sce Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Sec 'on 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our oar cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately r sponsible. To ensure that the homeowner is fully aware of hi responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the resp ilitics of a Supervisor. On the last page of this issue is a_form currently used by several towns. You may caret amend and adopt such a forrrrlcertification for use in your community.. Q:forms:homeexempt Boar o trui mg egu a io s an an ar s License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the'Pxpiration date. If found return to: Registration: 128528 Board of Building Regulations and Standards One Ashburton Place Rm 1301 Expiration 4/;15/2011 Tr# 284326 Boston ' y = Type Intltvidual r ,Ma:02108 PAUL N.CROSSEN � PAUL CROSSEN�-,� t` 317 MAIN ST q,Notvali HARWICH,MA 02645 without si natureAdministrator isignature. Massachusetts - Department of Public SafetN Board of Buil'din- Re�-ulations and Standards Construction Supervisor License License: CS 74174 Restricted to; 00 PAUL N CROSSEN k=: 317 MAIN ST ' HARWICH, MA 02645 Expiration: 12/14/2010 f ('ununissiunrr Tr#: 9006 G 07/14/09 Bob McKechnie, Local Inspector Robin Anderson, ZEO 398 West Main Street, Hyannis Responded to complaint received this morning regarding people living in basement of Building II. Site has 4 buildings with 4 units each and basement area contained 4. The basement is bisected the long way, one side remaining open and common and the other side divided into 4 separate storage areas assigned to each unit. We were able to access the basement areas in buildings 2 & 3. Building 2 had a bulkhead opening. The other buildings had doghouse entries. Windows have recently been replaced without permits. Building I had a new slider and windows. It appeared some renovation maybe in progress. A stop work order was posted. No evidence of zoning violations. Caller did not leave contact information. Case closed. 1 r y °pTHE� Town of Barnstable ti Regulatory Services vMAW. ' Thomas F.Geller,Director fL639.,a`` Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 .Office:'508-862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF WITHDRAWAL OF LICENSED CONSTRUCTION SUPERVISOR FROM PROJECT I, D.44 R (e-eyo R G Construction.Supervisor License # aZo ,hereby certify that I am no longer the Construction Supervisor listed . on the application for the project under construction as authorized by building permit #2D 0 02 O ,issued to (property address) /Y14(�' -5( - on �Y , 2001. I also certify that on ��/'/�L, S—,2001 I notified the property owner,that the project under construction must cease until a successor licensed Construction Supervisor, is submitted on the records of the Building Division. 5 211)xe -HOLDER DATE q/forms/newcontr reference R-5 780 CMR File EdltfTools `Help 1y a, � re= t"° � t; 6� a"" 'au 'r «a _ e xi ti c t � �- AGtlan o- u x i a" � ' ONTRAd`C D ppliction 2007020 '. � L Eolleck Status A Ovaner CTIVE x 2854291 ,s"E^``r'," ,<s Department 6300 :BUILDING DEPARTMENT ' a n sex ` �r � '-" ClaselDeny' - MONAFE i Project/Activity 908 RDOFISIDINGIVJINDOW COMMERCIAL "AM, � � ��`��"tr��A j ,Contractors HAKI S CONSTRUCTION; T 3 P i m KI,', rf�NA++� °Workflow : Description 1 RE'SIC9E�BUILDING#5 ` ` "' a Description 2 CONTRACTOFiWITHDRAWNON,415107 . PropertylUse"' Non Conforming DateslMisc Permits � ' ` r � ` wf fi "h. �*A �R bylaw 'ne Rw x s k � ` t A sx � � +i far �� � 4 -VFW*'"t y err a#, Pro a a. PHfi x" £ uE. s # ' Property Use ReaCtlVate w Location 398 '566, a� Existin use ' Ad t F j S eet WEST MAIN STREET - " _�,, ��� 9rzoninle g „^ SPLT `SP.L4TZ01 r ' 269057 OOC• xs err € � � rf f E$CroW j Pafcel x �y-' " k �' w y " a memo � 4 Municl alit =r HYAN �HYANNIS � � ;at� t C law r � �t " vis1$C ionllot Sbdi ,n - _ _tea #" Between _r � £ ., t Proposed use -Paymt HIStofy, s. ° �- '`� a�w.. r w�1. �#at(F-�. t $� `" N ¢'i "L and i°'',.�.r.�' ,r 'e7 �` ° s"i�' p`..q e t. �a :� 4 "' �c#, m�w�'" �� °zorn ng. S PLT S l-T-Z0..1 -..+..,m -a++r.�.3�....444—4 AUdlt Hlstof �: + `UNIT 7C �. � � • v ,memg. a ' Location de"sc f - # °?' 'c`rp m`- y, aumm Permit _ = ass . `PrerequisRes * ` ( HazrdlRestr'i p m Names , (( Bonds ( ^Sub Adz, Plan.ReVlew 4:._ ,• . s :zc -. �.-;. r ,._ .i -Prior History^ ° Inspections 11048latians.` WReview Open Itemsz 1Varriings Find FCelated ^ o A. + '"a :. . v vs-: 4_°,s t °rt x -y'-.Tt Mi _ �� ` `x - a '.E Maintain project f acE'rvity detail For the current'applicaton ;°` #t =3` . . F w .a3 xrn.4 az.3 i,µaz , w 3 ^� r r ��i w> Records)updated.`': .. _., w ,. u fr Imo , TOWN OF BARNSTABLE Building �► Application Ref: 200702001 BARNSTABLE, Issue Date: 04/05/07 Permit MASS. p 039• ��� Applicant: HAKI'S CONSTRUCTION rF�MAC A Permit Number: B 20070673 Proposed Use: CONDOMINIUM Expiration Date: Location 398 WEST MAIN STREET Zoning District. SPLTPermit Type: ROOF/SIDING/WINDOW COMMERCIAL Map Parcel 26905100C Permit Fee$ 150.00 Contractor HAKI'S CONSTRUCTION Village HYANNIS App Fee$ License Num 153203 Est Construction Cost$ 1,300 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND RE-SIDE BUILDING#5 THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: MONAGHAN, BRENDAN 181 LIAM P BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 598 PITCHERS WAY INSPECTION HAS BEEN MADE. HYANNIS,MA 02601 _ b Application Entered by: PR Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY`STREET;"ALLY'OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY ORTERMANENI ENCROACHEMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY"PERMITTED UNDER TH"OLDING CODE;MUST BE-APPROVED BY THE JURISDICTION. STREET OR=ALLY.rGRADES AS WELL.AS DEPTH AND''LOCATION OF`PUBLIC'SEWERS MAYBE OBTAINED FROM,THE DEPARTMENT OF PUBLIC WORKS THE ISSUANC&OF THIS PERMIT DOESNOT RELEASE<THE-APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE.SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTTTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). U1, .,a BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health YOU WISH TO OPEN A BUSINESS? ,, For Your Information: Business certificates (cost$30.00 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.) Business Certificates are available at the Town Clerk's Office, V'FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: /Y 0-7 a i i Fill in please: y €wo Im� APPLICANT'S YOUR NAME: yocDr7 g, q �r a` BUSINESS YOUR HOME ADDRESS: TELEPHONE # Home Telephone Number X/57tit / NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES". NO- Have you.b om the ; ADDRESS OF BUSINESS P W, IMKu^ NO fi l a MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be in compliance with the,ru es 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 ci�—r a e your mess in this town. 1. BUILDING COM ER'S OFFICE t This individu I ha4. b ep inftac of akyeirmit requirements'tha pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO Authprized n t *� COMPLY MAY RESULT IN FINES. COMMENTS: 2. BOARD OF HEALTH This individual has been:Zrmed of theWffmit requirements that pertain to this type of business. __thorized Signature* COMMENTS:. . 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual h;urthorized forme f the licensing requirements that pertain to this type of business. - ignature* COMMENTS: Town of Barnstable VA Regulatory Services yo Thomas F.Geiler,Director Building Division 721 KAM $ Tom Perry,Building Commissioner s63q. ♦0 iOlEo i,,u,�' 200 Main.Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: Z Ga.a 5'�L'. HOME OCCUPATION REGISTRATION Date: S- Jy- d7 Name: 0 V/ --�A l R V& Phone d1 A%3 Address: '2 xIf✓.%d �''19�,�7" e illage: Name of Business: Al 4Z4_ F`f� //1� Type of Business: ��itJLTi11L� Map/Lot,_20 151-do 4 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 Zoningordinance, dur provided that the activity or �P shall not be discernible from outside the dwelling there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • -Such-use occupies-no more-than 400-square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration, smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by,such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: 0 a Homeoc.doc Rev.5/30/03. r Town of Barnstable *Permit# � Expires 6 monthhs from issue ate RegulatorytServices Fee rl" Thomas F.Geiler,,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main StreeVHyannis,MA 02601 www.to, nmbarnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 ' EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number �6 Property Address j 9? y" A091yll ft' Wit / D la�1MN [residential Value of Work i PO Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 1-ill 0Ills t 1N/7lliNsl r�lir/i7r" ! �� 1 Contractor's Name 744/1` 1_ A Telephone Number �,/ 3G0 Home Improvement Contractor License#(if applicable) Construction Supervisors License#(if applicable) ❑Workman's Compensation Insurance Che ne: IaI 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 be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over . existing layers of roof) ❑ Re-side Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home rovement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 " . °FINE>w,. Town of Barnstable ti Regulatory Services Thomas F.Geiler,Director Building Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 62601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize _ - Ol( (1_rr_ LOY-n o_., to act on my behalf, in all matters relative to work authorized by this building permit application for' 396 w - A a o 5t. (,( a+ a:�> `I-Pc c -n Ys (Address of Job) o )a O(O Signatu a of Owner Da e Print Name C QTORM&OWNERPERMISSION n I' 6 r ' � ✓lee -oPar.�no�z�..eu� o���ac�u�avt7a .. Board of Building-' and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR: before the eapiratio.t date. If found return to: Board of Building Regulations and Standards Registration:tg7262 One Ashburton Place Rm 1301 Expirq,19 6/23/2007 Boston,A1a.02108 Type. Irdividual P.ZACHARY ROMA PAUL ROMA 90 CHERRY TREE RD. COTUIT,MA 02635 Admiu�:<trator No` alid 'iti1jiigna Ctianc�eGQ n�cv�,� f��oi3��S I 20 Years Experience U Senior Discounts BUDGET HANDYMAN SERVICES Landscaping•Cleanups Household Repairs•Painting Call 508-292-7507 r - F ti Town of Barnstable THE Regulatory Services F tn. 'Y Thomas F.Geiler,Director �+ BuildingDivision Y BAMSTABLE, i s 1MAS& `eg Tom Perry,Building Commissioner �'•�Fp p�pl A 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: e7�. o Permit#: HOME OCCUPATION REGISTRATION pY Ze: { Phone#: 7 l ` ~Yy s ,S ' Address:— :0 s jj�� /- �yl j� Village: Name of Business: ��/J ��T �e/�.t B IJ �� 1 Type of Business: Map/Lot: /_5 ��9 Q INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. / Applicant: Date: �J Homeoc.doc ev.5/30/03 TO ALL NEW BUSINESS OWNERS DATE: 2 _a 44 ftMR W.41 ' Fill in please: APPLICANT'S � M, YOUR NAME: TA rn es b c 40S,4 BUSINESS YOUR HOME ADDRESS: Ind? • �` . s >/X49- o , TELEPHONE Telephone Number Home - — Q/ NAME OF NEW BUSINESS we e ,� TYPE OF BUSINESS Irk vn<Drj P(f� IS THIS.A HOME OCCUPATION? YES �NO Have you been given approval from the building division? YYEE NO F i-�/ ADDRESS OF BUSINESS-3 &I e&0 r1%&e S¢ klir 41t n MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below,you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall). You MUST go to the following office to make sure you have all the required permits and.licenses.. GO TO 200 Main St. (cor f Yarmouth Rd. & ain Street) and you will find the following offices: 1. BUILDING CO MIS. ION 'S OFF This individual h be nfinfor d of any.p r uire ents that pertain to this type of business. 14 orizk Signa ** A" /, -- COMMENTS: 2. BOARD OF HE This individual has Peep inform d th ermit s that pertain to this type of business. A rized Signature* COMMENTS: 3. CONSUMER AFFAIRS,(LICENSING THORITY) This individual h en inf ed f th li n g uirements that pertain to this type of business. /� Authorized Signature** I ` COMMENTS: G"e- Ir C.� ©)F Wl- Qt tJ( S r I I CQ, w, Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. -it does not give you permission to operate-you must get that through completion of the processes from the various departments involved. **SIGNIFIES APPROVAL FORA BUS/MESS CERRF/CATE 01VL Y. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 0ap. Parcel 051 —00U Permit# ���,, "rf)Yy9� OF '�AI�F1S Tr�9LE Health Division 0gZ9 y 71,o 3 ( � ) Date Issued y V O-3 Conservation Division �11(73 >t 2903 APR -7 Pik 2: 27 Application Fee _. Tax Collector Permit Feed �0 Treasurer�` D �+ISiOf Planning Dept. ICANTMt7ST OBTAIN ASEM CONNECTION PERMIT FROM TI3L Date Definitive Plan Approved by Planning Board ENGWERING NOONpXOS'M Historic-OKH Preservation/Hyannis Project Street Address :39& W&'a ?AA9 �19ECI , aLAC:F, R Abbb AA C Village ,y Owner s t_ �� PLt�1��, Address `39 . \&T AAW 47—L Telephone �;09 - 3(4 AZNZ 1 A Permit Request RL.R"u t _ E SIVEW A1_L 5, A jnZL I Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay oject Valuation Z 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 0 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 2 Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other 12 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: t �rJy yz r fPiR Zoning Board of Appeals Authorization ❑ Appeal# Recorded Cl Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name J 5 Telephone Number (�� Address `3 L License# N C►:'(l 6\11ADI AA Home Improvement Contracto;pl& 4 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO o r mg SIGNATURE w-- DATE k l 03 1 FOR OFFICIAL USE ONLY PERMJT NO. DATE ISSUED 'MAP/PARCEL NO. + ! r ADDRESS `► "VILLAGE -» ' OWNER DATE OF INSPECTION: FOUNDATION a FRAME • 7 I INSULATION FIREPLACE ELECTRICAL: ROUGH i- FINAL- " PLUMBING: ROUGH FINAL GAS: ROUGH — FINAL FINAL BUILDING A fi w 6 h DATE CLOSED OUT — 'ASSOCIATION PLAN NO. ti= The Commonwealth of Massachusetts Department of Industrial Accidents Office offoresmoo offs _ 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit i name: U Jay 1) location 1 lt Iw L�1 wzd, CitV Dhone# -O� ❑ I am a homeowner performing all work myself. ❑ I am a soleroprietor and have no one workin m* capacity %/%%��%/%% /O%%%/O/G%%%%%%%%%%%���%%%%/%////% %%%%%//%/%%%%%%%%/G/...... %/%�%% I am an employer providing workers' compensation for my employees.working.on this job. :: ::: :::::::::: :: : : : : . ::.:::.;:::;:;::.;:;:.::::.:..:::..;:.;.:...;:.;:.;:...:::.::.:. ::.;:.::.::.::.::.::..<:::::.....::.r:.::.r:.:.:::......::.::.:::.:;:.::.: comaanv ::>::: .....::.... . ai .. "..,_ `rtt��TeSs :.:.. . .... >;::::<:;>;;::.;� r::::: of rv, 11,W11117111117111insuranceco.. >` %/ ❑ I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the followingworkers' compensation polices; ::.::::..:::::::::::.::::::.:::,.:::::.....:::: ..:::::::::.::::::::::.:::::::::::::::::::.,:.:::::::::.,,..::.::::,,.:.: X. tomnany name :..........:...:.:..:::::.....:.............:..::ar#t#kess . ..:............................... .::•.:�::::............................... ..... f, �` : i:::ii::;::::�.ii�`•':::�:'.`•:;:p:;.;�'•::.: ,... .rr;:.::. �'`�CCCai>`y `S?` `<`??2 `>�':>':<�ii?% 'i�i 'iz' i">'?`'f:'•.'�%<`'>:. ;:isi?i.`:`%':i ?i;2i ;>:<;;:;:;::»;;;-<;;;:::>;::': oli ctr hattrart sa:n ;::,;::::.;;::;:.r: ::;;:;.;:::: .:::.:::;:;.,:;;.;r..::.::::.::..... :.;:..:;:::::.::.; :: .:::.:::::......:::::::.:::.:::.:::..:..;;.;:.::.;::.r:;:.:.::::::.: :}: e r::;•::.:»:::>::;:::<:»<::::::::>:>;::::`:>::::»»'::::::......:<:>:;>::<'::>::>:>'>:::>«:>:>::>»:::::;::»<: :: :<:>:<:::>:.»:::::>:;«.::>:::::::::>::>::::<::::>;<:::>: <:<:' bon ::.p :•::•::•�:.::::;;:•.:�::•::•rr.•:;•;:•.�:•::..�:::::;::>:;:•::r;::::::�:•r:�r:�r;:�::•:::r:•:.;;;�•`•�:::'::•::'::"•::`•� >`"`av::.;:;.�.:::;:;:;::•:;•>;:;::;:;;'': ':�:>::.:•.;:.;;�.;::.::�::rr.r••;rr:• 4 r imm Fafim a to secor..coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to SUM.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 a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify t e pains and enalties of perjury that the information provided above is ow.,and correct Signature ' Date p Print name 1 oo blj Phone# official use only do not write in this area to be completed by city or town official city or town. permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other Niglio Ormed 9195 PJA) f 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 xeceiver 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 � or on the grounds or another who employs persons to do maintenance , construction or repair work on such dwelling house 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 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 address and phone numbers along with a certificate of insurance as all affidavits may be supplying company names, Accidents for confirmation of insurance coverage. Also be sure to sign and submitted to the Department of Industrial date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is Accidents. Should you have any questions regarding the `law or you being requested, not the Department of Industrial are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned 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. The Department's address,telephone.and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents 0ltice of Investigations 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 °pTHE Tom, Town of Barnstable ' Regulatory Services * * RARNWASLE, $, Thomas F.Geiler,Director 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 I6T yu:bJ6LJ v r ti��FiK as Owner of the subject property J P P riY hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for(address of job) Lig e of Owner mate Print Name I Q:FORMS:O W NERPERMIS SION ACORDM CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YY) 04/03/2003 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Robert E. Bouchie Jr. Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1352 Rt 28A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX 400 - INSURERS AFFORDING COVERAGE Cataumet, MA 02534-0400 INSURED John W.Konyn dba K Konstruction INSURER A: Zurich Maryland Casually Company 35 Millstone Street INSURER B: North Falmouth, MA 02556-3010 INSURER C: INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER DAD E(MWDD DAATE MWDD LIMITS A GENERAL LIABILITY SCP 34482332 01/27/2003 01/27/2004 EACH OCCURRENCE $ 300,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 300,000 CLAIMS MADE OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 300,000 GENERAL AGGREGATE $ 600,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 600,000 POLICY JE PRO-CT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) s HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Peracddent) $ PROPERTY DAMAGE $ (Per acddent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ kE AUTO ONLY: qGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS A EMPLOYERS'LIABILITY COMPENSATION AND WC 3967996501 12/17/2002 12/17/2003 TORY LIMITS ER E.L.EACH ACCIDENT $ 100,000 E.L.DISEASE-EA EMPLOYEE $ 100,000 E.L.DISEASE-POLICY LIMIT $ 500.000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPEGAL PROVISIONS w - . CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: ' CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Town Of Barnstable NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IyonOugh Way; IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR, Hyannis,.MA REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 1 I OJ�'ot Y ACORD 25-S(7/97) p ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED the olic ies must be endorsed. A statement P Y( ) on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. y ACORD 25-S(7/97) G. r BOARD OF BUILDING REGULATIONS Vim: CONSTRUcnoN SUPERVISOR Number.CS O40003 p pars;ZOlOZl2004 Tr. o: "3235 Restricted: 00 JOHN W KO �- 35 MILLSTONE ST, ^� N FALMOUTH. MA 0206 Administrator . w Board of Building Regulations and Standards HOME IMPROVEMENT cONTRAG-TOR I EXsitatlon 12m2103 K-Konstroction Jatm Konrn l 35 Millstone St N.F91MOuth.MA 02556 Administrator • r TOWN OF BARNSTABLE BUILDING PERMIT -PARCEL ID�"'69 �y051' 00C GEOBAS ID 17361. ADDRESS 398 WEST MAID STREET 1 PHONE HYANN IS' l ZIP LUT ��. BLDG 2 BLOCK x LOT SIZE . DBA A : DEVELOPMENT DISTRICT HY PERMIT 67985 DESCRIPTION REMOVE RESIDE SAME PERMIT TYPE 'BMISC TITLE PERMIT CONTRACTORSf: fit. KONSTRUCTION Department of ;. ARCHITECTS: Regulatory Services TOTAL FEES $25.00 BOND $.00 0� . GONSTRUCT` ON COSTS $3,825.00 ' 753 "` ... MISC_ NOT CODED ELSEWHERE 1 PRIVATE ABNIAM LE, s> BUILDI G, D ISION BY IN DATE'-ISSUED 04/08/2003 EXPIRATION DATA y THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,.ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN: CROACHMENTS ON PUBLIC PROPERTY;NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROMTHE.DEPARTMENT OF PUBLIC WORKS..THE.ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM+THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO.COVERING STRUCTURAL MEMBERS . HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. C 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN,MADE. i' 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 4017 2 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS.. TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. B UILDING PERMIT . '�� ( vC t iI 6, co (9 0-1 00 - a � N N CV 6- 00 r-_ i N N N , ay r t -r ' ,z • : tea '„ 4 r -'�" ,� d , f i µ ju 47, , s rr sIA „ r 3 . grc r, z = a: ;O z f r r � • .. ,, a^F r,.f"n �3 �,yry .tzaL.�N �.:u�§ �a' ',-�,a .a ��9E� .',•an�'.,,.'- ,- q•Ea F ;-,v !�. ' ram'" .- , .. ......._. 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