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0191 WINTER STREET
Ci��� �� �� ��� f�� t I 111 I i I iI it �� i I 'F i V ����C7 � - O � �� �� �. _ . _� ,, v �t- i ,_ __ � Y f ���� , r..I� 1��h .. •�4 . .. .!".y- ,j \\ ��1 . \�� �, `7 r� \ \ 1 � �� .t v 1 r r � J. (I r J ___M � „- -•'.� ��M��-..,.. -��..-fix;=...'`-h+�►`�,��a J � A, n- I$ t' t y N r ,. r rs —�"�• "1 or r �i ., �,a �� �� .r,.� `► � y�q`� G ..� -'� �^ �� ,� rn � °�r .G G� G ����� '����� J� �� 'Sr© r / 1 .�� , °= ��`�'� is TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION OF BARNSTABLE Map Parcel v Applicati Health Division " w.' (: Date Issued ZO 6 �� Conservation Division Application Fee PlanningDept. � ha= - :, p � �(,� �m��,• � Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner �`�Le-� (� -eY��.��� CC.e,,� , Address Y%N Telephone Permit Request Wt ALk, A, 04, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family GY/ 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 rqijcg McCarthy thy Constr uctioRl Telephone Number I'O Sox 52 Address , Dennis., MA 02670 License # Cell (508) 280-6 964 ,.SL 58633 HI '-169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ' ADDRESS VILLAGE { OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. l(7 `'CoN 38(+Q Ic( Cell iaZ R /v C.'r.. / T&�vn of Barnstable do RegiflAtory Services swx,rsri,et� Richard'V.Scat,Director , 9. Tom Perry,Ouilding Cur missioner 200 Main gbtet;Hyx s,-MA 02601 wvmtown.bamstable ma.vs F Off cc 508-862-4038 fax ,508 794-6230 Property Owner Must C6mpkte and Sign T.Ms Section �f T.Jstn �:•1�,�uilde�' Choler of the !Jc.t+pjnp-'7 }icxeby.a tliorize to aCt on:nybehalf,. m Am=mrelativve to,work.authorized by this buildingpernnit application.for. < {Address of"job}.7 "Foal feces and ajar s are i lie respox ib-Iti r ciI she applic ui Idols are not to-be filed carer ti ed before-(f nce u; t-Led aricl 4 i a3': r a>7s.pe tons are per[orrned and ccepted� M _� ._.... .. r ez � ' — "Signat�reof•A;pplicant �... �_v_.__..� Priiat;lame Print Name - ZAe Q:F0MS:O�VT2b EI,QvMS1.ONPWLS w Office of Consumer-Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 r` Type: Individual Expiration: 6/16/2017 Tr# 264961 MICHAEL MCCARTHY MICHAEL MCCARTHY -- P.O. BOX 52 --- WEST DENNIS, MA 02670 °' — --- Update Address and return card.Mark reason_ for change. Address Renewal , ; Employment ^� Lost Card SCA 1 •n 20M-05/11 �__: _. / e (lnnz7nzb�uucaf/[- JS[�GILCcfiCtfJ 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: l registration: . 169393 Type: - Office of Consumer Affairs and Business Regulation ' Expiration 6/16/201.7 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 MICHAEL MCCARTHY MICHAEL MCCARTHY 6 RANGLEY LN. SOUTH DENNIS MA 026 1...` Undersecretary Not id with oft signature. , Massachusetts -Department of•Public Safety Board of Building Regulations and Standards Construction Supervisor License: C"58633 MICHAEL J MCCAR - PO BOX 52 _ W DENNIS MA 8267 - � a Expiration Commissioner- 04/10/2016 A � . The Commonwealth of Massachusetts V _ Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers,, TO BE FILED WITH THE PERMITTING AUTHOMTY.. ' Applicant Information Please Print Legibly Name (Business/Organizationilndividual): Mike McCarthy ConstruFt on ox Address: west Dennis, MA 02670 City/State/Zip: Cell 08)#280-6964 _ 14TC-169-393 Are you an employer?Check the appropriate box: , P7. of project(required): 1.�am a employcrwith � employees(full and/orpart-lime)•+ New construction 2.❑I am a sole proprietor or partnership and have no employees working for me inany capacity.[No workers'comp.insurance required.] Remodeling 3.O I am a homeowner doing all work myself.[No workers'comp.'insurance required.)t Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property.'I will 10❑Building addition -ensure that all contractors either have workers'compensation insurance or are sole. I LEI Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.n I am a general contractor and i have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.t 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.['Other b✓C.f 152,§1(4),and we have no 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. tConiractors that check Ibis box must attached an additional sheel showing the name of the sub-contractors•and slate whether or not those entities have employees. If the sub-contractors have employees,[hey must provide[heir workers'comp.policy number. I ant an employer that isproviduig workers'compensation insurance for my emtployees. Below is the policy and job site it formation. Insurance Company Name: A '/ 1 .A_J �j, o Policy#or Self-ins.Lie,M V 1,✓L- 7�-( G Q7 ,SJC -D'IsA Expiration Date )2 )If- J I 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 MGL c:152,§25A is a cfiminal violation punishable by 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.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 t a• s enalties ofperjury that the information provided above is true and correct Signature: - Date: Phone#: Ls'4< L . 6 f C r r L[Ot e only. Do not write in this area,to be completed by city or town official. wn: Permit/License# thority(circle one): f Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector rson: Phone#: r AcoRo` 12107/20 CERTIFICATE OF LIABILITY INSURANCE S DATE 07120YYYY) 15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED;the policy(ies)must be endorsed: If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 01962-001Ww CT Bryden&Sullivan Ins Agcy of Dennis Inc ! o, ; (508)398-6060_ No,; (508)394-2267 PO Box 149758. So Dennis,MA 02660 INSURER AFFORDING COVERAGE NAIC# INSURER A: A.I.M.Mutual Insurance Company 33758 INSURED INSURER B- Michael McCarthy Construction Inc 1 RER C: P 0 Box 52 INSURER D: West Dennis, MA 02670 INSURER E• 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. ILTR TYPE OF INSURANCE 1 & POLICY NUMBER M NI IDD % (WASM LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ P EM E a e CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ __)POLICY ECT OC BINED AUTOMOBILE LIABILITY C a acciden SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED P OPERTY DAMAGE $ AUTOSacci ar $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION$ $ �'I����I��� RtPCIR4f4 X A MIpROPRIETQR/PA�T{y9WECUTIVE YIN N/A VWC-100-6017666-2015A 12/15/2015 12/15/2016 E.L.EACH ACCIDENT $ 1,000,000.00 (Mandatory in NH) EX LuDtu E.L.DISEASE-EA EMPLOYEE $. 1,000,000.00 6MRiPTION OF 9PERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,B more space is required) CERTIFICATE HOLDER CANCELLATION Cape Light Compact PO Box 427 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Barnstable,MA 02630 THE EXPIRATION DATE THEREOF; NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD I . - " Massachusetts Department of Public Safety f Board of Building Regulations and Standards License: CS-058633 Construction Supervisor i MICHAEL J MCCARTHY P.O.BOX 52 TJ WEST DENNIS MA Q2671),', �` = Expiration: Commissioner 0411012018 Construction Supervisor, Restricted to: Unrestricted-Buildings of any use group which contain less than 35,0OO cubic feet(991 cubic meters)of enclosed space. f Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit:WWW.MASS.GOV/DPS I ' qr i i i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. Map Parcel Application #0��� Health Division Date Issued Conservation Division, Application Fee G, i Planning Dept. Permit Fee ✓ li0,11 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address 19 l Village 04;- /U I S Q"C Owner , I G t Ceti lk5 Address Telephone �— Permit Request Al QE C C16 1JUi Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay roject Valuation vc ' 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 ^a Basement Finished Area (sq.ft.) Basement Unfinished Area (s o "3 Number of Baths: Full: existing `� e new � Half: existing �, new Number of Bedrooms: 3 existing 1 new Total Room Count (not including baths): existing new 1 First Floor Ro m Counter ~ Heat Type and Fuel: ® as ❑ Oil Ind Electric ❑ Other ' a Central Air: ❑Yes �No Fireplaces: ep aces. Existing New 0 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 C"Z& Or- Telephone Number 5 0b Address ,3)_ J ilk. License # Home Improvement Contractor#' /6o7 t Email G�r1�c 6mm-L Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i k (P� SIGNATURE DATE "'' FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ' , ADDRESS VILLAGE { OWNER DATE OF INSPECTION: ` FOUNDATION ti FRAME INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL k PLUMBING: ROUGH FINAL GAS: ROUGH. FINAL r. FINAL BUILDING DATE7CLOSED OUT ASS5@P7 VATION PLAN NO. ,� a Arai�t��rrroa�s��It3i off'�usscre�rrs Departtnmt of1adks f4ccidents ie orrvestigaaras 600 Was*i agfaan Street Boston,,MA 02 , - wnwanass gar rlua Wormers' Camps-nsati€anInsuranceA fidav&.E Idea-s/ContractaisMectricians/Mum'hers Apggk-ant Information Please Print Legibly Name(B s Orga�a�n cfnrlivirl>z?>7_ JJ I,. 5 i uA I CityfStatzlZip: ® U 1 t Phone� 5 O� �0 __._.. _. . ---Are.yffn an.employet•?�G7xecktl�_spgrgpri3�bow -___-- ---_._-,_ _. T of o"ect. r � � --...-.---.- - 1_❑ I am a employer with 4_ 0,1 sirs a geaeral contractor and 1 6_ * have hired the sub-coma iom _ employees{full audlorgatt-iime)_ rLjf 2_ I am a sole proprit tar or partner listed on the attached sheet; 7- Remo ship and have no ettrployees .These sub-oontractors have 8- Demaliti-Da wowing for me in any capacit3� employees and have workers' y- ❑Building addition - [NoA�QrkCiS'C(7IIlp_invxanr�. � ���raru 0 We are a corporation and its 10-0 Electrical repairs-or additions r-pliredj 3.❑ I am a homeawner doing all w0fk officers 1zav exercised their 1 Lo Plt?mhing repairs or additions myseright.of f- ea ption per MGL f.[No�varl�' _ I2-0 IZnafregaug „ ;�,, „tee regaiied_] c-15Z§1(4} and we hin--no euiplayees-[No worb> - 13-0 other p comp_ima anc a rlgntrL *Axysixg tyardcbeaksboaW-1ninst also fM out the sectionb9awshawingfheirrvodxm'rnmpensariaarpalsyirsfnr t Humeawnas who submit this affidavit M&Ext m•g try ace doing zR vrc*an3 then hire Dutside coatiactars nu snbcnit a new affidsyst IafCAtin mach- =Cautmctors that cheek this box wart attached sa adeitionxi sheet showh3g the name o>L tfe finis and state whether M):Mt Suss entities.b� OMglayees If the svk-contnctars hs-ce empko-ee%they mist pwwae their trackers'comp.policy number- -Tam an Ring r thrrtis prrr►adirtg tear era'ea;zrp tsalia:n arrrttrrutc$far rtz}:Rtrrg£ayc�eu �elntF is fhega.Fie}*cued}o5 sites ift�`atmatian_ Insurance GompanyName: Policy#Cr Self-ins-Lim a` FxpiiatianDate: Job Sge Address: F �i�A �� City/Stat>?IT.tp= IUf ©f Attach a•cogy of the workers'compensation policy declaration page(showing the polio nu her and espnation date): Far-lure to secure coverage as retluired under Section 25A o€MUl-c. 152 can head to the imposition ofciiminal Penalties of a fine up to S 1,50D OD and/or one year±mlxis�as wen as cizji peualfies in the.fom2 of a STOP WORK ORDER and a fine ofup to$250_00 a day against the violator_ Be advised that a c4Ty of this statemem maybe f7arwarded to the Office of Im--estigations of the DIA far insamm coverage v�catic� f under thgus adenaFsrau} pIif #eret a P c3r rrj�d ahrn a rs kua and G4lxsct - S.itmature: � .Dates �/ Phony g Offtciir£use anly..Do not tpriie in tfds:urea, bd compietad by cis y or town officiaL City or Town:- P>rraftUcense# Iss-uin Authority(arde one).: L Board of Health 2.Buif ing Department CitFlFawn Clem 4.Electrical faspector 5.Plumhimg Inspector 6.Othcr Contact Person: Phone#: 6 Yt�l information and Tu-struetions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"_..every person in the service of another under any contract of hire, express or implied, oral or written_" An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the . receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or IocaI licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in-the commonwealth for Pnay 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 vYith 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)narae(s),address(es)and phone numbers)along with their cei i_ficaie(s)of insttrance. Limited Liability Companies(I LC) or Limited Liability Partnerships(LLP)withno employees other than the members or partners, are not required to carry workers' compensation insurance_ If an LLC or LLP does have employees,a policy is required_ Be advised that this affidavit may be submitted to the Departinent of Indu.:-7;t-i.al 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 Ell 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 perm-itthm se 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 fuh permits ermits 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 aifida>,dt The Office of Investigations would lake 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. nt Comma we atth of Massachum,,tis Depaitcnent of Industrial Accidents O-f iQe of luwstiptio-ns 600 Wasj�gtan Street Boston,MA G21II TeL A 6I 7 7-49 ext 4Q6 or I4 MASS.AFE Revi sod 4-24-07 Fax 4617-727-7-749 THE rqf� Town of Barnstable x Regulatory Services g Y yea:ssBtE Richard V.Scali,Director i639' �� 1DrF1639- " Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, as Owner of the subject property hereby authorize to act on my behalf, in all,matters relative to work authorized bythis building permit application for. - - � C1 I Ilk A Kn e , (Address of Jo ` 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. Signatur er Signature of Applicant CA Print Name Print.Name Pate Q:FORMS:O WNERPERMISSIONPOOLS Regulatory Services _ P�oFTHE Toty,� Richard V.ScaIi,Director w Building Division E Asa < sa� « Tom Perry,Building Commissioner v� 1639• ��� 200 Main Street, Hyannis,MA 02601 CEO a www.town.barnstable.ma.us Office: 50 8-862-403 8 Fax: 508-79076230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATIDN: number street village "HOMEOWATER name home phone# work phone CURRENT MAILING ADDRESS: cit3 town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides.or intends to reside, on which there is, or is intended to be, a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature ofHomoowner 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 &ReguIations for Licensing Construction Supervisors,Section 2-15). This Iack 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 fuIIy aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. QAV,TFII.ES\FORMS\building pm-nit foims=RESS.doc Revised 061313 Office of Consumer Affairs& Business Regulation -_ - - ME IMPROVEMENT CONTRACTOR egistration: 166919 Type: xpiration: _-7/19/20161 Individual CEZAR LANCA CEZAR LANCA - ' 37 SCALLON DR. DENNISPORT, MA 02639 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston,MA O2116 il�J f Not valid without signature f °� License or.registration valid for individul use only Office of Consumer Affairs&B siness Regulation HOME IMPROVEMENT CONTRACTOR 1 before the expiration date. If found return to: : Registration: .1.66919 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 )Expiration: 7/19/2014 individual i . Boston,MA 02116 C R-LANCA 1i z CEZAR LANCA 37 SCALLON DR. w , DENNISPORT, MA 02639 = f _ _� Undersecretary ." Not valid withoutsignature I i "*, Massachusetts -Department of Public Safety Board.of Building Regulations and Standards . Construction Supen7isor License: CS-102905 CEZAR A LANZA:` 37 Scallop Drive Dennis Port MA 02639 j Expiration, i Commissioner 05111/2015: !. lv -3 o Town.of Barnstable *Permit# Expires 6 mnnihs from issue date Regulatory Services Fee sARNSTASLE 9� NAss, Richard V.Scali,Director 1639 �TEG MP'1 A Building Division . Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERAHT APPLICATION - RESIDENTIAL ONLY �j,jn Not Valid without Red X-Press Imprint Map/parcel Number Jk/ �y Pro•erty Address q� .��/ N Residential Value of Work$ ,500-Io Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address JI I CO/J M ECCJ/A�> 191 cUc-G1 _ Contractor's Name—LOAa L ,&) Telephone Number bob Home Improvement Contractor License#(if applicable)�OI(/ Email:LOW f uu(A 967naiL,C 4, Co truction Supervisor's License#(if applicable) '/00O5 X-PREE PONT Workman's Compensation Insurance Check one: J U; 3 Q c W i4 ❑ am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name l Ht . gftcl Af 01 Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to pja,A !0 h �❑ e-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forns\EXPRESS.doc Revised 061313 Hie CarmiralmWakh of Massachrise , DlDeparhnent q f 1-,uhrst 1#ccidents ri - Owe of.rmlm ga iorxs 600 ffirrshingtom Street Boston,,MA 02111 wnmmasygurldica Workers' CompensatiouInsuranceAffidavit:Budders/ContractorsMectricians/M mhers F phrant Infarmation J Please Print I�iM Name Oisine� OTani�on,h&,idmo: -[, dtiressj As�n1Py,i 'iJc Gitylstatdz* U IT M 3, S Phos e 47 d5 36© .2'1 Are you an employer?_Check the appropriate boz: T :a#gro ect r _ I am a e9a la er wiffi 4_ ❑ I arr�s ctmfractar and I ❑ {fullartdforpart-time}_* • llavehiredthesub- . 6_ New�aansitisc�u�x a�Iwoyees asolepropreororparfner- listed on the attached sheet T_ ❑Remodeling t L These sub-oontractors havesnd have nct employees 8- ❑Demolition o�^,, forme.in any c emplra_y'ees and have worricers' cir _ _•El Building addition f.s [No worms' comp:insurance COml3_tttil�ran{�� 5.. We are a corporationand its R. 1U_Q Electrical repairs or additions ofEmrs haves exercised their II_. Plumbing airs or additions 3_❑ I am a homeowner doing all work ❑ g , myself, [No workers'awip- right of eimmption per MGL 12_. of repairs insurance required_]I c_154§1(4).and we lnmn-no employees_[No Workers' I3_ Other comp_insurance required.], 'Tay ap hamt that checks boa W 1 amst also fM out the section below showing ih&waateis7 compensatioai pviiU inf,srnatinrx Homeowners wb.submit this afhdsvit isxE e.g they ece dying as wc*L d them hire outside coat actors mast submit a new affldxit inffirg#n mrh_ tCoutcactors thud check this box must attached au additional sheet sboxingthe tine trythe Mk-caaft3cbcs andstste 4rhether oeugt thesis ism Drs 5a Iuytses_ If the svb coatmctats have empls,the}nnrst lnuvide their wark�s'camp.palicY number am ari emplgyer that isprm idirrg it�orke-r-s'compensrrhan irmirartce for my ampLayeaL 11elvir is thepaticy and job life inj`ormahan< Insurance t,ompatryliame: f �`'"' -= a' Policy 4 or Self-ins Lic- t` Expiration Date. Job Site Address l'L� � (!✓1 �IL � Gifyr"5tatelZig: /�/�� flttach at copy`of the workers'compensatitm polio-declaration page(showing the policy nidber.and expiration date): Failure to secure coverage as required under Se-etiogi 25A of MGL c. 152 can Lead to the imposition oferiminal penalties of a fine up tQ$L50�_0�anti7or one�eaz im isotuneut,as well as civil penalties in the fonn of n STOP WORK ORDDEit.and a fine. of-up to".250-DO a.day against the violator_ Be advised that a copy of this stat mwut:maybe forwarded to the Office of Im estagations of the DIA for insurance coverage ve1:rfic26011- I do hereby fy tinder thepairts andpenaYies of pedury that the inforraation prinidedabam is trite and correct. a� at use on[y. Da not nrritg in this urea}to ba cafrtpleted by�}'ar town officiaL City or Town: - Permitucense# Issuing Authar4(drele ane): 1.Board of Health 2.Building Department I City1roms Clerk 4.Electrical Inspector S.Plumbing Inspector 6.ether Contact Persian: Phone 9-- a 6. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written-" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also stories that"every state or local licensing agency shalt withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for arty applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone nimnber(s)along with their cert,-Ecate(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 in¢ttrance coverage. Also be sure to sign and date the affidavit. 111e affidavit shoLd 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 obtaiz 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 Torn 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 permitllicense 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 milled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would lice 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 Commnnwmalth of Massachusetts Department of Inclustual A.ccOeen . Qf ke Of Javestigattiam 600 Washing-aa St=t Bastou�Imo.02111 TeI.W 617 727 49 0 W 406 or 1-a MASSAFE Revised 4-24-07 Fax#617-727-7-149 www.mass—gavlcha + BARNSTABLK � . MASS& Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 Property Owner Must Complete and Sign This Section t. If Using A Builder I, C�R i C c:)`n M,PC C?� C ,as Owner of the subject property hereby authorize 0 7.EJ�fz il_`n r to act on my,behalf, in all matters relative to work authorized by this building permit application for: - V 4 (Address of Job) 1n c�mn�-moo !mil l�20 Z.a G-1, Signature of Owner Date Print Name If Property Owner is applying for permit;please complete the Homeowners License Exemption Form on the reverse side. QAAWILESTORMS\building permit forms\EXPRESS.doc Revised 061313 Town of Barnstable Regulatory Services P�oFtxE rotyy Richard V. Scali,Director Building Division * snnNSTnBr E Tom Perry,Building Commissioner KA-S& v� i639. � 200 Main Street, Hyannis,MA 02601 plfO I'u�p www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. - The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed"against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities, many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a formlcertification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 ''. , Ql1CLrJ ) iirii���,.6 Q H� I®d�b5�oa�a�� 6/30 l/a �S'CERTIFICATE' IS 18SUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS'UPON THE CERTIFICATE HOLDER THIS '_RTIFICATE DOES NOT AFFIRMATIVELY OR NE(?iAATNELY AAAEAID, EXTEND OR ALTER THE COVERAGE AFFORDED gl( THE-POLICIES OW. tIHS_�ERTIFlCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING {NSURER(S), AUTHORIZED 'PRESENTA'iiVE OR PRODUCER,AND TfIE CERTIFICATE HOLDER. I{IAPORTANT: If the certfipte holder is an ADDITIONAL INSURED,the policy(ies) rrulst be endorsed. If SUBROGATION IS WAIVED,Subject W. the terms and conditions of the policy,oe n policies may require an endorsement A stebemerlt on this certificate does not confer rights to the, certificate holder in liey of such end orsement(s). CONT Aul PRODUCER PINSURERA;The ME: Circle 'Business Ins. Agcy, Inc 978 777-5619 (978) 777-4898 247.Newbury Sheet S- Danv2ra, MFl 01923 INSUF B AFFORDIND GOYERAOE NAIC a Hartford INSURED INSURER B: ML Custom Wood Work Inc. INWRERO; Cezar Lanca INSURERD: 24 Bramblebush Road INSURERE: Cotuit, NA 02635 1 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS I$TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY Pr l0' INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS'. CERTFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE 1 VAM POUCYNUI,®r MM/DD MMIDDIYYYY LIMITS A RE GENWALLIABILITY Y OBSBAIL5616 3/26/14 3/26/15 EACH OCCURRENCE $ 1 000 000 DAMA E RENTED S 1• 000 0O Ol O . x COMMERCIAL CXAIMs�1ADE C.DccuR MED ExP one Person $ 10 000 1 ' PERSONAL&ADVINJURY $ 1' 000 00 GENERA),AGGREGATE S 2 000 000 t_ PRODUCTS=CONPIOPAGG T, 2 000 000 GEN�L AGGREGATE L IMIT APP LIES PER $ POLICY P 4 LOG AUTOMOe1L.E UABIUTY s ahciderR $ BODILY INJURY(Per person) S ANYAUTO gLLOw1�D SCHEDULED I BODILY.INJURY(Peraccldent) $ AUTOS AUTOS I PROPERTY DPMAGE g NON-OWNED ! eracadenf .HIREDAUTOS_ _AUTOS UMBREU A UQB OCCUR EACH OCCURRENCE $ AGG RE GATE $ EXCESS LIAB OLAIIAS-MADE „ g DED RETENTION'$ 1 WC STATU- OTH- NJORKEfZ4 COMPENSATION OBDQECC¢2396. 3/2S/19 3/26/15 K /INO FMPL�RS'LIAOILIT( E N CIDENT $ 100,000 ANY PROPRIE rORIPARTNER)EXECUTT Y/N N!A OFFIC£WMEMBEREXCLUDED? J El.DISEASE-EA:ENPL I- 1.00 OOO pilaroaWry In NH) r IF ee d�ctlbeundor E,L.DISEASE,POLICYLIMXr $ 50 OOfJ f DSbRlPTION OF OPERATIONS below L d 5' W 0pSMpT10N OF OP62ATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Adbldonal R®„arlp Schedule,If more sFqm 4s requred) I� e ,. .. CERTIFICATE'HOLDER CAN CELLATION SHOULD ANY OF THE,ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,, NOTICE WILL BE DELIVERED: IN ACCORDANCE WITH THE POLICY PROVISIONS. ToFm of Barnstable 200 Main Street AunlORazEo ResLNTAT Hyannis, MA 02601 Paula Halal ®1988-2010 ACORD CORPORATION. Alt rights reserved--:•' ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Rrone: Fax: (508) 790-6230 E-Mail: i �o,,,,,,o,,,�,Pca/� o�✓�aaaac�ivaetla License or registration valid for individul use only Office of Consumer Affairs&Business.Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation . Registration ,166919 Type. 10 Park Plaza-Suite 5170 Expiration 7!1.9/2014 Individual Boston,MA 02116 C., .R`LANCA .� � • ii {tt{ IS CEZAR LANCA zpo 37 SCALLON DR. DENNISPRT, MA 02639 Undersecretary Not valid without signature O Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supers isor x: License: CS 102905 GEZAR A LANZA`\`` ' .37 Scallop Drive Dennis Port MA b2639 NX Expiration Corn' issioner_ 05/11/2015 .t r IT Town of Barnstable *Permit ) o �wti Expires 6 mg /ts ronj iseeee date {{�� �}5q Regulatory Services Fee * BARNSCABIJ��rr",s LI Z I`t 9 MASS. $ Richard V. Scali,Director s6;q. AjEp ,tA T OF BAFINSTABLE Building Division . Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY /Q& rj Not Valid without Red X--Press Imprint Map/parcel NumbetE - Property Address / o� Residential Value of Work$ r Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name tav- 05, a f' . "Ce Telephone Number 3 f`IK69 Home Improvement Contractor License#(if applicable) k�'t?2. �] Email: 7 Construction Supervisor's License#(if applicable) C�^��� �! 5-3 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name �1i P-�l�i42 04.P1 �l/�� v►c Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value e9l (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A c y of the Ho ov a Contractors License&Construction Supervisors License is ed. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 cc of Consumer Affairs&$osieess Regulation� License or registration valid for individul use only ME IMPROVEMENT COW rRACTOR before the expiration date. If found return to: Registration: 14868g Office of Consumer Affairs and Business Regulation Type 10 Park Plaza-Suite 5170 Expiration: 10/18/2015 Supplement"lard Boston MA 02116 LOWE'S HOMES CENTERS INC ROBERT ABBOTT 136 TURNPIKE RD.SUITE 100 SOUTHBOROUGH,MA 01772 Undersecretary Not vali w out signature I ' The Commonwealth of Massachuseus Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information // Please Print Legibly Naive(Business/Organization/Individual): L a! Address: i City/State/Zip: '' f''t� ? hone#: �� 3 � O Are you an employer?Check the appropria-box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp•insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LF1 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 41 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: 'tr✓ c`IG�1 �: �' `v ���> !>� Policy#or Self-ins.Lic.#:_ �� �/ 6 97 je 13 Z 47 Expiration Date: 11111LI7` Job Site Address:T !/� �� �j� City/State/Zip: GIGJ Attach a copy of the workers'compensation policy declaration page(showing the policy nu 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 py of this statement may be forwarded to the Office of Investigations of the DIA for' ce cove a veri I do hereby certify unde p pen a in ormation provided above true an correct Si ature: 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/di'a r Workers' Compensation Insurance Affidavit:Builders/Contractors A Iicant Informa 'on Builders/Contractors/Electric ' Please Print Le 'bI Name(Business/OrganizatioMndividual): L•l � Address: I City/State/Zip:` Phone#: Are y�am n employer?Check the appropriate box: 1•❑ I a employer with Type of project(required): eloyees(full and/or * 4. ❑ I am a general contractor Ipart-time). have hired the sub-contrac6. ❑New construction 2• I am a sole proprietor or partner_ listed on the attached sheet7• ship and have no employees ❑Remodeling working 'These sub-contractors have 8. [)Demolition for me in any capacity. workers'comp.insurance. 9. ❑Building addition p Insurance 5. ❑ We are a corporation Iporation and its ❑ officers have exercised their 10.❑Electrical repairs or additions 3 I myself a homeowner doing p work right Of exemption per MGL I l.❑Plumb' myself(No workers' mg repairs or additions insurance required.]t P c. 152,employees. [No d or have no 12.Q Roof repairs employees.[No workers' `Any applican�that cks box#1 must comp.insurance required.] 13-❑Other t Heownerswosubmit this affidavit ll ou the section below showing their work•eom tContrac tors that check this box must attached an additional sheet showing the name �e ation policy information indicating Y are doing all work and then hu+e outside contractors must submit a new affidavit indicating such. 'Miltra ram an employer that is providing workers'compensation insurance or aors and their pdicy mfotrnation formasion. f °0'eQonnrP 0 ees Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lie.#: xpiration Job Site Address: E Date: City/State/Zip:. Attach a copy of the workers'compensation policy declaration page(showing the policy n her and ez it ' Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the impositionp atlon date). fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK pRDfiR Ues of a Of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office o Investigations of the DIA for' and a fine Insurance coverage verification. f I do hereby certi under the pains and penalties of perjury that the information provided ab Si ature: �� ove u true and correct #: / Date: Phone official use only. Do not write in tl:is area,to be completed by city or town official City or Town: Issuing Authority Permit/License# ty(circle one): I. Board of Health Z.Building Department 3. t 6. Other Ci Yr1 own Clerk 4.Electrical Inspector 5.Plumbing Inspector . Contact Person: - k i jy' ��iis c 6iJ:rJxt.•�:u��/J&o�n>'�''Zll�iaCJSlu,;e/�S r \ Offce of COnsamer Affairs&Business Pnolatioa License or valid for iadividul K iSB only lkxjm,5�- 165027M�.E-HA R:VEMENT CONTRACTOR before the exp' a� Iffoand retura to: Type: Office of Cons sad Snsiaess iration:. 12?7%2014 Dgq 14 Park Plaza- 170 Boston,MA 021 KENNETti KENDAlL" ;.�"-��•�.�`.. . ".•: �. KENNETH !KENDALL , FA{RHAVEN,MA 02719 Undersecretary Not �v6oat signature j a_..-,ms and Standards ' Construction S::Femisor L;cense: CS-0751ICENNET53 5W INP L' LA 'jam. • � t[ FAIRHAVEN bMk. - I - Expiraflon Cec suss er 01I12MIS r..t 6 1 CONTRACT# s MASSACHUSETTS SERVICES SOLUTIONS INSTALLED SALES CONTRACT � 'w' LOWE'S AUTHORIZED REPRESENTATIVE NUMBER CUSTOMER _ STREET ADDRESS (/Y+ STORE NO STREET ADDRESS I , e As CITY STATE AP --'CITY V STATE ZIP If j TELEPHONE -� - TELEPHONE _ !/� (/ I E DATE LOWE'S HOME CENTERS,LLC'S MA HI NO.:148688 CASH DANk LCC REG �V CARD FEIN:56-0748358 ' This is only a quote for the merchandise and services printed below.This becomes.an agreement upon payment:`Upon payment,the enbre agreernent-ihduding the spedbcally completed pages of this document,the Tenons and Conditions included with this document and a,oU.,add:d:and.attachmenT'h7-t-,sha be refemed.to herein as this Contract." PLEASE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. INSTALLATION STREET ADDRESS CITY STATE ZIP •f l{�P�l `i / L. NOTICE TO CUSTOMER—PRICE CALCULATIONS:In order to properly perform the installation of certain Goods,the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area.As a result,the parties agree that the lump-sum Price stated in this Contract is calculated upon both the value of estimated Goods required to fulfill.the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which may be estimated based on the amount of Goods required to fulfill the Contract(including waste). By signing this Contract below,Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed. /�.��`" � Contract Total i — ��q Are permits required for this installation?::[ ]Yes [ ]No *applicable tax included ✓ NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right.By signing this Contract,Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. NOTE:If rotted wood is discovered during installation additional charges will apply.You will be given a quote and a change order must be completed and signed by the customer for any additional charges. IL I r' Customer must initial. *Any work or material not specified is not included in this contract.Any changes or additions will be at an additional charge for the material and labor. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity.Customer authorizes Lowe's to copyright,use and publish the photographs in print and/or electronically,and agrees that Lowe's may use such photographs for any lawful purpose,including,but not limited to,marketing, advertising,publicity,illustration,training and Web content.By initialing here,Customer agrees to the foregoing. _ '3 [Customer to initial to the left]. Work is to commenceupon reasonable availability of Contractor and/or any special order or customer made Good(s)which is anticipated to be r `7 [fill in date].Estimated completion date is - %`/ [fill in date]. Said estimated substantial completion date is,not ofA he essence.A statement of any contingencies that would materially change said estimated substantial completion date is as follows: (if applicable,insert a statement of such contingencies). IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: ACustomer to Pay in Full; OR [ i Customer to use the following payment schedule: (1)Deposit $ to be paid upon signing contract.Deposit should be 1/3 the total contract price;and (2)Payment of$ to be paid anytime after this Contract is signed and before commencement of installation,I/We authorize Lowe's to do one of the following(check appropriate box below): [ ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or ( j Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c 142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION ASPROVOE IIN,M.GL:c.19� f •-..; By. .. Date: l Lovd's me Centers,LLC By: ! i Date: Owner Sirgbature / THE SIGNATUkES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G.L.c.142A.THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPARATELY SIGNED BY THE PARTIES. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. f BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S)AND SEAL(S)BELOW THIS_` tJ .DAY OF Lowe's Home Centers LLC Lowe's uthorized Representative_ O net 1 r Co-owner or Witness m Custoer acknowledges receipt of a true copy of this contras t4high,was completely filled in prior to Customer's execution hereof.You,the buyer,m, cancel this transaction at any time prior to midnight of the thir2l"busjness day after the date of this transaction.See the attached notice of cancellation form for an explanation of this right. V 11_ ®2ar04bawtrdLmaesdFeNCabole desi.gn FF1M AF\/ 11/1'2 FILE COPY rpragon Hull://ShLslV.IUWUS.L:011l/I1LO U/rrwanuntluow.jspzprojecua=124J%.SJ4U Back to Quote LOWE'S HOME CENTERS,LLC#2376 2421 CRANBERRY HWY,STE.100 WAREHAM,MA 02571-0000 4 USA (774)678-6000 Date:05/13/2014 Project#: 404016312 Description: 1 st install Customer Name: MICHAEL MECENAS Customer Phone: (508)292-0033 Customer Address: 191 WINTER ST HYANNIS,MA 02601 USA Line Item Product Code Frame Size Description Unit Price Quantity Total Price 0001 Manufacturer:Reliabilt by Atrium O Size=27 3/4"W x 44 3/4" rgy Star Requirements for Northern/North-Central/South-Central H Southern Regions***U-Value:0.30,SHGC:0.21 FS Size=27 1/2"W x 44 1/2"H DP35:Size Tested 36"x 74" a Division:Millwork ' Product:Windows l Type:Double Hungs Manufacturer:Reliabilt by Atrium Product Type:Double Hungs Product Line:Replacement Series:3500 Better i Number of Units Wide:One i ( Unit Configuration:Single Unit DP50 Wind Zone Rating:No Sash Configuration:Equal Configuration:Integrated Lift Handle Color:White ***See in-store displays for exact color samples for both interior 1 and exterior color.*** Glass Energy Efficiency:Ultra Low-E w/Argon Glass Color:Clear ***The graphics present an estimation of the color and are not a ' completely accurate representation.*** Glass Strength/Safety:Double Strength i Grid Type:No Grids Grid Style:No Grids Hardware Color:Color Matched Double Sash Locks:Yes r i Screen:Half Screen Foam Wrap:Not Applied Head Expander:Yes Extended Coverage:Lifetime Glass Breakage and Labor- 1 Discounted Package ***Project Lead Time: 14 Days*** $23536 5 $1,176.80 002 Manufacturer:Reliabilt by Atrium O Size=21 3/4"W x 36 3/4" gy Star Requirements for Northern/North-CentraUSouth-Central /Southern Regions*** U-Value:0.30,SHGC:0.21 S Size=21 1/2"W x 36 1/2"H DP35:Size Tested 36"x 74" Division:Millwork Product:Windows Type:Double Hungs Manufacturer:Reliabilt by Atrium Product Type:Double Hungs $225.05 2 $450.10, 1 of3 5/13/2014 5:52 AM �uvw u��.ii��wl v.luw cacvuui�.0 Ui1uGU11u11�(LLULG JJ�:�rUJ e(:LL(1-1L4J/JJ4U Product Line:Replacement 1 E Series:3500 Better Number of Units Wide:One 1 ' nit Configuration:Single Unit { ! DP50 Wind Zone Rating:No ------ Sash Configuration:Equal Configuration:Integrated Lift Handle Color:White ***See in-store displays for exact color samples for both interior I i and exterior color.*** Glass Energy Efficiency:Ultra Low-E w/Argon Glass Color:Clear ***The graphics present an estimation of the color and are not a completely accurate representation.*** Glass Strength/Safety:Double Strength Grid Type:No Grids g Grid Style:No Grids Hardware Color:Color Matched 1 � Double Sash Locks:No Screen:Half Screeni Foam Wrap:Not Applied f Head Expander:Yes ; Extended Coverage:Lifetime Glass Breakage and Labor- Discounted Package ***Project Lead Time: 14 Days* 0003 Manufacturer:Reliabilt by Atrium RO Size=35 3/4"W x 44 3/4" rgy Star Requirements for Northern/North-Central/South-Central Southern Regions***U-Value:0.30,SHGC:0.21 S Size=35 1/2"W x 44 1/2"H DP35:Size Tested 36"x 74" j Division:Millwork Product:Windows f Type:Double Hungs �II Manufacturer:Reliabilt by Atrium I ; I Product Type:Double Hungs Product Line:Replacement Series:3500 Better 1 Number of Units Wide:One 1 Unit Configuration:Single Unit DP50 Wind Zone Rating:No Sash Configuration:Equal Configuration:integrated Lift Handle Color:White ***See in-store displays for exact color samples for both interior and exterior color.*** Glass Energy Efficiency:Ultra Low E w/Argon i Glass Color:Clear " 1 ***The graphics present an estimation of the color and are not a completely accurate representation.*** Glass Strength/Safety:Double Strength Grid Type:No Grids ! Grid Style:No Grids Hardware Color:Color Matched Double Sash Locks:Yes Screen:Half Screen Foam Wrap:Not Applied Head Expander:Yes Extended Coverage:Lifetime Glass Breakage and Labor- Discounted Package ***Project Lead Time: 14 Days*** $243.09 2 $486.18 Project Total: $2,113.08 Salesperson: CRAIG STOUT(52376CS1) Accepted by: Date:05/13/2014 2 of 5/13/2014 5:52 AM c;� w � 2arf1t` OF 8A ' "I ABLE u I ��M svev MITT ROMNEY �t61l1 07775 lJt � f STEPHEN D.COAN GOVERNOR, CJ ' v� STATE FIRE MARSHAL KERRY HEALEY (978)567-3-100 (978)567-31,2,1 THOMAS P.LEONARD LT.GOVERNOR DEPUTY STATE FIRE MARSHAL ROBERT C.HAAS SECRETARY October 23, 2006 Building Department 200 Main Street HYANNIS, MA 02601 Re: Informal Public Records Request 0-1 WINTER ST;Ff ANNIS f Dear Sir or Madam: Please be advised that the Office of the State Fire Marshal is conducting an informal public records request and is hereby requesting your assistance. Please review and fill out the following form to the best of your knowledge, and return fax this letter to(978) 567-3121. Thank you for your assistance in this matter. If you have any questions, please feel free to contact me at(978) 567-3301. �. Very truly yours, Tim Rodrique, Director Office of the State Fire Marshal 1. For the address above,can you please indicate if the home was constructed before or after 1975 or after 1975? Before 1975 After 1975 2. If after 1975, please indicate what year the home was constructed? Year: . c_xY�inziir�,catia�iue P� ,a • C��ac�aua CJ�i`a,�niiia/ �w�nae CJi i�zaaacLu�aettb G'�i oz %� �caa • � o� ie 'late �'i�e CJ/f/ iaC Z-,/6TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map _Parcel 67 Permit# Health Division tw2✓ 1 2 v? SrJ Date Issued ///12 6 G 3 r I �Sol - ` ; _ p ee 0Conservation Division . Tax Collector � -3 Iy �. 11 �s/�� Permit Fee �(�i _ Treasurers — j Ir �� ?1_�... AMC�M!'1 'POBIAWA Planning Dept. W"Cu RM To f Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 11 tv IN%4/e Village YA/VA115 Owner kogar `r,14-c1 S Address 22-7— LUC:5*Ac 'PIZ 1yLA-1_'5T;MV 11 a$ Telephone 6,vq Ll L® �'T `5D S 9 !1 g Permit Request Cow y-Ek ' E)(t Sal yc- V z- 0'Cl-i)' (Alr® f:�:u`-L ett CA-; Ex15TiWe, `Th-iP-S riom -3d -rc) �� ' 11Y5ULAIrC AiU'b 1F(05f( P_0L K 1 PUVA2L� fl IVIS E.0 7—wt' -F:-"L_009 Square feet: 1st floor: existing /I 3 proposed 2nd floor: existing Z0 proposed Total new Zoning District Flood Plain Groundwater Overlay r Project Valuation �/S,oyo Construction Type Lot Size . 1 h Grandfathered: ❑Yes Cl 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 Z, Half: existing_ new C Number of Bedrooms: existing new Total Room Count(not including baths): existing 6 new 7 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 ® No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO C APC UJ SIGNATURE DATE /1/f/03 ' FOR OFFICIAL USE ONLY -V • PERMIT NO. DATE ISSUED y _ MAP/PARCEL NO. } ADDRESS - - VILLAGE OWNER DATE OF INSPECTION: ^' FOUNDATION 4 , FRAME �%r�✓! d /t �Z3Ty INSULATIONG.S >+/s d ©,IF 3/r4l, - i ,r FIREPLACE _ ELECTRICAL: ROUGH FINAL. PLUMBING: ROUGH FINAL ` GAS: ROUG 8 FINAL FINAL BUILDING ' DATE CLOSED OUT ;. ASSOCIATION PLAN NO. J J RESIDENTIAL BUILDING PEMT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations 25.00S Building Permit Amendment $2 . 0 FEE VALUE woRKSHEET NEW LIVING SPACE r . square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE C/ 4 s = d® � x.0031= J 6 square feet x$6 / q.foot plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft._ x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) ' Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost f 1 ..�� 'Er0`�' Town of Barnstable Regulatory Services Thomas F. Geiler,Director sb39. ��+ Building Division lfD►hP't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 • Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, •improvement,removal,demolition, or construction of an addition to any pre-existing owaar-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. �(pg�►%b l &A'T# Estimated Cost 9, 000 Type of Work: Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): MWork excluded by law []Job Under$1,000 []Building not owner-occupied ROwner pulling own permit Notice is hereby given that: OVMRS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Date Owner's Name T'he Commonwealth of Massachusetts -{ Department of Industrial Accidents =_ = OfBco of/nyostlg�2005 _ 600 Washington Street Boston,Mass. 02111 Workers' Com ensatiatt Insurance Affidavit name ovation: L`'1�ll. i` � � � � YT �� u hose# � � ,�y /�!S ai rl A ❑ I am a homeowner performing all work myself. ❑ I am a soley netor and have no one worku in ca ac1 iii111", 'din workers compensation for ff eln�lo�ees warldng on this job. 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Y. x ».n... ,:.;::.,:•:: fiy,..•{t{':'. z:. :.,,+ ;•s:?}r:::!•x•::.vr:•n. }..t. ,. r}y, .}•,./.,.;r•: •;T:•}r:.3:•fir: , + •fi:to.� t•{y.<,;.}.3 rr;{.n�L,'�}..tn 7= �] .v::{k'rr.?}r.`»::•.•`.+a:;}:.:,a:•nr;t{ .. a;ti'Y �':7}fR}tirfiTk.3..ni,r.{{!•!:•:•x•:•:•xhv.:'•:•\•:+}?}: Faitiue to secure coverage as required under section 25A of MGL 152 can lead to the imposition of criminal penalties of a One IIP to S1,500.00 and/or one years'hnprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me: )<miderstand that a copy of this statement may be forRarded to the OtHce of Investigations of the DIA for coverage verification I do hereby cero under th aurs and penalties of perjury that the information provided above is true and correct Dad Signature nn Phone# Print name 'ti°� L7 -r .,II iJti ofncW use only do not write in this area to be completed by city or town ofac al city or town: perudt/Ucense# ❑Building Department ❑Licensing Board ❑Selectmen's OMce ❑checkif immediate response is required []$eslth Department contactperson: - phone#; _ ❑Other • �9ros rla) Town of Barnstable yP�pP Z}tE Regulatory Services 11AANsrASIX : Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 ice: 508-8624038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: d 70B LOCATION:. number street village cMEowr�Ex». �0��2 Tl.Ll S Sig y2o y V!�3� name , home phone# work phone# CURRENT MAILING ADDRESS: 22,Z s `L�71—G hb,1Z6' b R- city/town state -zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and. to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as su-pervisor. DEFINITION OF HOMEOWNER Person(s)who owns-a'parcel of land oil 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 andlor fame,structuie's: 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...•:• rnin;rrn,m inspec Uon procedures and requirements and that he/she will comply with said procedures and requiremen . Signature of omeowner Approval of Building Official - RNote: Three-famUy dwellings containing 35,000 cubic feet or iarger.will be required to comply with the State Building•Cod$Section 127.0 Construction Control _ HOMEowN,ER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed' Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. ! ! I i ; - --�-- --_.1_.�____--'----'- ---'- -_A -----�--�'._� x- �-_�-___�_--- '------�- - -- -fir____•---1-___: i f I I _ � � i � �� ,� -i +�- {J , � � � � F � . +� � � t - Irt I� - � ---a_ � 1 r� � � � - � � � � i , � � � -� �� � fi � t �-�- �- 1� -� } � � � � II -_1 t All SCAM _Vj FA I ISTACK 11 � os � 1 i 1L i !---,----!-�-15�'r`1/Vtrf t cr i i a S U - N I i —P, BL 1it t _F I --� SG�Lie I 4— -- - - -- --— - t-- --- l - —�- - KM i L fit � , r ! ► � � I I � i Irt I � e � A , i I i r I � ? IJ i ' I -�� �� ��, � � , �� _- J' IL L �, �fi �-� J �� � J r, � , J t ��I - � �r- , � i �-� �, � �� fi J� �i ��� I � �1 t , � L � ���'� ' I� '_ � rti --j ....... OEETECT -R& uNEW O F I /k --E--IqOIW'-�AVV."- =V-E-NTH�EADDiTiON--O -A— _N lJo -I-LLA RIGGER---A_N___ .L_ R A -0 TECTOR$ E�, -S. K81D 17--T t ..........H .-S HpUSE. YOU MUST -FOR AWE;W HOU�_ P 14 (COPDOWY AN . AV YOU _ _AQ- IANOKEIOUTTHE_All . E !yPR LECTRIC , 1 j i 0013 -THE Rod EFA. RTM�NT. FIR p RIM p3,�231 IT;AT ------ I---------- - JJ J 17- UID�L t)f I icl (I'AT ti + ENTRY I je k-L I I . .......... K\y 1 _�115+1 A) rLtok, LA IRS O'i� -- --------- Pik -ISIS • BVIL D Ep T. B�.RNSTABL HUOY 3VAH G r f • 1 I I I 2v01\ I ri . 1 1 1 t i I I �x7 � ( ! i • - I I I I I ! ! ! i , sri Af -- r I f_ -- - -- - - ---- - -- .- - - -- - -- - , - I , I I 1 i I 1 ' � i j rl ..i ' E ' , , • I FA I 1 i t M onvv� I I 1 , I 1 , ! i i i i i r 1 � I I 1 I I JND SINK I r I , : TAcI I 1 I HALLI I i i j i I � I ! + � I j I 1 1 i j i i� � �' ! j 1 1 I •� , I : I e '-i'---'t I ' S , I ' ''-• I - i �! - - - '-- I --'-i---I -- -- I I j----I-- - I � i-"- ._. ..I s I ' I ' I j ! i I i j I ' i • , 4 I - , +-U LL J , I ! 1 � I ! y ( 1 ! ! I 1 i` , � 1 i , �� i I I i I • { • ; i ! f ! � i I � I I i i ! ; � i I i -----r--- 7 _ I , I . I 1 i ! - -... ---- -- - - - - -- --'---- ----------- --' _ -'-------- 1-- ---- - - -- -- - - - , , . i 1 i `�- i- i , : I I c i I ! : , : ! I I ! 1 I : , I , I ' I I Z I - , I I --- i - : ' I I i I = •.ti _ - _ i - ; `� �!� t �� � � � � - . � � � J \ ,� � � � a d �, � � RUN DATE 12/11/02 TIME 07:46:41 �FtHE t Town of Barnstable Regulatory Services Thomas F. Geiler,Director * BARNSTABLE, MASS. g Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 March 6,2003 John J. and Susan Mahoney 191 Winter St. Hyannis,MA 02601 RE: 191 Winter St.,Hyannis Map 309 Parcel 309/067 Dear Mr. and Ms.Mahoney: The Barnstable Police and Hyannis Fire Departments have notified this department of several rescue and police calls at 191 Winter St.,Hyannis for the homeless people living there. This department posted the building"Uninhabitable"on October 9, 2002 after an inspection by the police, fire inspectors and the Board of Health. There was no water, electricity, or heat and homeless people are there every night. In referring you to Massachusetts State Building Code 780 CMR 121.3 you are hereby ordered to secure this building. This must be accomplished by March 18,2003. Failure to do so will result in fines and a possible lien on the property. Your anticipated cooperation is appreciated. Sincerely, Thomas Perry Building Commissioner cc:Household Finance Corp. 961 Weigel Dr. Elmhurst,IL 60126 o/ �l 0 a Permit number 4 ad y �d� Y TOWN OF BARNSTABLE DEPARTMENT OF HEALTH,,SAFETY AND ENVIRONMENTAL SERVICES o D, BUILDING DIVISION KEEP OUT h © _.UNSAFE STRUCTURE UNINHABITABLE CONTACT BUILDING DEPARTMENT 4 BEFORE ENTRY OR REPAIR i Address a u a- Bldg. Official — 1 Barnstable Assessing Search Results Page 1 of 2 HEJTV x r a 3 J / _. .. Home: Departments:Assessors Division: Property Assessment Search Results <<back to search 191 WINTER STREET Owner: MAHONEY,JOHN J III&SUSAN Property Sk t .......................__.... Map/Parcel/Parcel Extension 309 /067/ Mailing Address ..w MAHONEY,JOHN J III &SUSAN 191 WINTER STa 3339I I9 ; li' c HYANNIS, MA.02601 Assessed Values: Appraised Value Assessed Value Building Value: $88,600 $88,600 Extra Features: $2,300 $2,300 Outbuildings: $0 $0 Land Value: $34,400 $34,400 Interactive Property Map: ap,"relcluires Plug in: Totals:$ 125,300 $ 125,300 I have visited the maps before Show Me The Map April 2001 photos available jj6ijw.. Sales History: - Owner: Sale Date Book/Page: Sale Price: PERKINS, LUTHER B&CONSTANCE M 12/15/1988 6568/289 $ 120,000 ZWICKER,JOYCE L 572/524 $0 MAHONEY,JOHN J III &SUSAN 6/5/2000 13053/012 $ 141,455 BUTLER,JOSEPH A 11/19/1999 12676/099 $ 128,000 BUTLER,JOSEPH A TR 12/1/1999 12697/317 $ 100 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $ 1,177.82 Town Fire District Rates Other Rates 9.40 Barnstable 2.88 Land Bank 3%of Town Tax Hyannis FD Tax $362.12 C.O.M.M. 1.54 Cotuit 1.88 http:Hwww.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 3/5/2003 Barnstable Assessing Search Results Page 2 of 2 Land Bank Tax $35.33 Hyannis 2.89 West Barnstable 1.96 Total: $ 1,575.27 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.17 Year Built 1940 Appraised Value $34,400 Living Area 1722 Assessed Value $34,400 Replacement Cost$ 118,120 Depreciation 25 Building Value 88,600 Construction Details Style Cape Cod Interior Floors CarpetHardwood Model Residential Interior Walls Drywall Grade Average Grade Heat Fuel Gas Stories 1 Story F A Heat Type Hot Water Exterior Walls Vinyl Siding AC Type None Roof Structure Gable/Hip Bedrooms 2 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 1 1/2 Bathrms Total Rooms 5 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL1 Fireplace 1 $2,300 $2,300 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area (Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.barnstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 3/5/2003 i II / i 1 Property Location: 191 WINTER STREET MAP ID: 309/067/ Vision ID: 25226 Other ID: Bldg#: I Card I of I Print Date:0111412003 13:28 A ;0020 IW'T k:F-40, MAHONEY,JOHN J III&SUSAN Description Code Appraised Value Assessed Value _RES LAND 1010 34,400 34,400 801 191 WINTER ST RESIDNTL 1010 90,900 90,900 HYANNIS,MA 02601 V: Barnstable 2003,MA R 3t`:S PPG"MEN 7" Additional Owners: Account# 223341 Plan Ref. 014/041 rax Dist. 400 Land Ct# Per.Prop. #SR Life Estate 9DL I LOTS 1&SOU]Notes: VISION 9DL 2 GISID: 25226 Totali 125,300i 125,300� U11A VWC5FC�W 0 Z Lt"PAT"U ik�01 WA 4 HONEY JOHN J Ill&SUSAN 13053/012 06/05/2000 Q 1 141,455 00 Yr. Code Assessed Value Yr. Code Assessed Value Yr. Code Assessed Value UTLER,JOSEPH A TR 12697/317 12/01/1999 U 1 100 IA 2002 1010 34,400 2001 1010 34,4002000 1010 20,600 TLER,JOSEPH A 12676/099 11/19/1999 Q 1 128,000 00 2002 1010 90,900 2001 1010 90,9002000 1010 81,500 ERKINS,•LUTHER B&CONSTANCE M 6568/289 12/15/1988 U 1 120,000 N qI WICKER,JOYCE L 572/524 Q 0 Total. 125 3001 Total. 125,300 Total: 102'100 4 OW ,& ap i M This signature acknowledges a visit by a Data Collector or Assessor Year TypelDescription Amount Code Description Number Amount Comm.Int. APPRAISE])l�AL UEE'!SUMMARY 2" M Appraised Bldg.Value(Card) 88,600 Appraised XF(B)Value(Bldg) 2,300 Appraised OB(L)Value(Bldg) 0 Total t ft Appraised Land Value(Bldg) 34,400 RL�ME 21"C' AM Special Land Value l *JOYCE'S BEAUTY *60-40....... SALON.20X13 FOP ADJ FOR CHEAP QUALITY ECONOMICS....... Total Appraised Card Value 125,300 Total Appraised Parcel Value 125,300 FRAME&C'ORRUGATE Valuation Method: Cost/Market Valuation D FIBERGLASS.... FIRE ON PREMISES 4/2/02 . . ............... el Total Appraised Parcel Value 125,300 Z NO` ,11-1111 ,11a 11112,15r. Permit ID Issue Date Tvpe Description Amount Insp.Date %Comp. Date Comp. Comments Date ID Cd. I Pu 11/15/1987 ME B# Use Code Description Zone ID[Frontage Depth Units Unit Price I.Factor S.I. C.Factor Nbhd Adf. I Notes-AdLISpecial Pricing Adj. Unit Price Land Value 1 1010 Single Farn RB 4 0.17 AC 347,000.00 1.00 5 1.00 63BC 0.55 SPCL(.17,U10)Notes:10 IBLD 34,400 Total Card Land Unitsi 0.17 AC Parcel Total Land Area: 0.17 AC Total Land Val, 34,400 Property Location: 191 WINTER STREET MAP ID: 309/067/// Vision ID:25226 Other ID: Bldg#: 1 Card 1 of 1 Print Date: 01/14/2003 13 _,... a. ., 31 1 = . Element Cd. Ch. Description Commercial Data Elements Style/Type 04 ape Cod Element Cd. Ch. Description Model 01 Residential Heat&AC BMT[390] Grade C Average Grade Frame Type Baths/Plumbing Stories 1.4 1 Story F A ccupancy 00Ceiling/Wall 20 ooms/Prtns Exterior Wall 1 25 Vinyl Siding /o Common Wall 2 all Height 13 FOP 13 Roof Structure 3 able/Hip Roof Cover 03 sph/F GIs/Cmp 20 CO1D0/MOBIZ XOM �1 ....,, BAS 22 Interior Wall 1 05 Drywall Element Code Description Factor 2 2 Interior Floor 1 14 Carpet Complex 2 12 Hardwood Floor Adj 14 1 Unit Location Heating Fuel 03 as Heating Type 05 Hot Water Number of Units 30 12 C Type 01 None umber of Levels /o Ownership Bedrooms 02 2 Bedrooms 18 18 GAR 18 Bathrooms 1.5 1 1/2 Bathrms �., Q +T/MARKET VAL(IATID a r,•; 11 1 Full+1H FAT Total Rooms 5 5 Rooms nadj.Base Rate 60.00 26 BAS 2 Size Adj.Factor 1.03278 [F—E—F 12 12 Bath Type Grade(Q)Index 0.98 Kitchen Style dj.Base Rate 60.73 Bldg.Value New 118,120 30 Year Built 1940 ff.Year Built (A)1975 rml Physcl Dep 25 uncnlObslnc 0 �• ��, � MIXED3CISE con Obslnc 0 Specl.Cond.Code 1010 Single Fam 100 Specl Cond% Overall%Cond. 75 eprec.Bldg Value QQ ran 'OB ®IITB ILIlING'&'Yf1RDI7EMS' ` / �BULCDIYGEXTRA �EA7C> ( „�, Code Description LIB I Units Unit Price Yr. Dp Rt %Cnd Apr. Value FPLl Fireplace B 1 3,000.00 1975 1 100 2,300 f1REA,SUMMAR}FSCT„I„ONE 0' Code Description I Living Area Gross Area E .Area Unit Cost Unde rec. Value N BAS First Floor 1,332 1,332 1,332 60.73 80,892 BMT Basement Area 0 390 78 12.15 4,737 FAT Attic,Finished 390 780 390 30.37 23,685 FEP Enclosed Porch 0 24 17 43.02 1,032 FOP Open Porch 0 260 52 12.15 3,158 GAR Attached Garage 0 216 76 21.37 4,615 Td. Gross Liv/Lease Area 1,722 3,002 1,945 Blde Val: 118,120 s 4 R309 067 . P R A I S A L D A T A KEY 223341 PERKINS, LUTHER B & LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 21, 300 86, 300 1 A-COST - 107, 600 B-MKT 83 , 400 BY 00/ BY ME 11/87 C-INCOME PCA=0131 PCS=00 SIZE= 2112 JUST-VAL 107, 600 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 63BC -- --MAY NOT BE COMPARABLE-- NEIGHBORHOOD 63BC HYANNIS PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 213001 LAND-MEAN +0% 1076001 61720 IMPROVED-MEAN +40% 20% ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 10001 LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP] ADJS/SB/FEAT STR] STRUCTURE ARR] AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] 1 R309 067 . P R A I S A L D A T A• KEY 223341 PERKINS, LUTHER B & LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 21, 300 86, 300 1 A-COST 107, 600 B-MKT 83 , 400 BY 00/ BY ME 11/87 C-INCOME PCA=0131 PCS=00 SIZE= 2112 JUST-VAL 107, 600 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 63BC -- --MAY NOT BE COMPARABLE-- NEIGHBORHOOD 63BC HYANNIS PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 213001 LAND-MEAN +0% 1076001 61720 IMPROVED-MEAN +400 200 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 100°61 LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP]ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] h . A, R309 067 . P E R M I T [PMT] ACTI*l CARD [000] KEY 223341 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR .CMP NEW/DEMO COMMENT s FNT ® '.N 2 Conc. Blk.Walls Bsmt. Rec. Room St. Shower Bath _ ' Bsmt. ��G�r v pURCH. DATE F Coric. Slab Bsmt.Garage St. Shower Ext. Walls PURCH. PRICE �0 Brick Walls Attic FI. &Stairs Toilet Room Roof RENT .l I Stone Walls Fin.Attic/'/ /_— Two Fixt. Bath I 60 Floors - Piers INTERIOR FINISH Lavatory Extra Bsmt. CC F' /n 1 2 3 Sink✓` a�/ '/ r/i r/� Plaster Water Clo. Extra Attic EXTER;OR WALLS Knotty Pine Water Only Double Siding ,.'_I L I,jp; / Plywood No Plumbing Bsmt. Fin. Single Siding, Plasterboard - Int. Fin. ~—JV/'1 Shingles TILING C Conc. Blk. G F P Bath FI. Heat _ Face Brk.On Int Layout �, Bathfr.&Wains. / Auto Ht. Unit f— �n b Veneer Int.Cond. Bath FI. &Walls Fireplace Com. Brk.On HEATING Toilet Rm. Fl. �1 � Plumbing Solid Com. Brk. Hot Air Toilet Rm.FI. &Wains. Tiling Steam Toilet Rm.FI. &Walls Blanket Hot Water St. Shower Roof Ins. Air Cond. Tub Area Total , Floor Furn. ROOFING COMPUTATIONS Asph. Shingle Pipeless Furn. S.F. Wood Shingle No Heat % S. F. —3 10 (% 7 Asbs. Shingle Oil Burner L /1 / S. F. i� �r7 laJ Slate Coal Stoker �- / .M S. F. 3 G Ft' C4"[ I/,,,y o-r Tile Gas ROOF TYPE Electric r%c S. F. s�` '!� �� OUTBUILDINGS Gable Flat S. F. 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 MEASURED Hip Mansard FIREPLACES S. F. Pier Found. Floor �J Gambrel Fireplace Stack I Wall Found. 0. H.Door LISTED FLOORS Fireplace I Sgle.Sdg. Roll Roofing � Conc. LIGHTING Dble.Sdg. Shingle Roof Earth No Elect. Shingle Walls DATE Plumbing Pine r,� /✓ /�11 !. Cement Blk. Electric Hardwood i / ROOMS PRICED Asph.Tile 3 Bsmt. list 6 +'C' TOTAL '/ j Brick Int.Finish Single 2nd 3rd FACTOR j r ��3 REPLACEMENT OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL. OWLG. ' _...�1�` �''r "' > >�1� I! /�r� �' 30/ 9 D /S�l A L/ 1 --- 2 3 4 5 . 6 7 8 9 10 TOT,aL 1 ' 7 RESIDENTIAL PROPERTY MAP NO. LOT NO. -. STREET 191 Winter St. HyannisFIRE DISTRICT SUMMARY 309 67 _ H 7,3 LAND G 3 0 0 OWNER %,•- /::. to•z.e .f:._r. m BLDGS. aL//S O TOTAL RECORD OF TRANSFER DATE eK PG I.R.S. REMARKS: v r s + a LAND l 'l a 0) BLDGS. Z i.cker. Joyce L. o 11.11:/%0 572 524 $ TOTAL .17a LAND s BLDGS. L ✓y/.,i''" �:'.. / TOTAL of - LV LAND BLDGS. TOTAL LAND Ot BLDGS. TOTAL LAND 0) BLDGS. TOTAL LAND BLDGS. TOTAL - -INTERIOR INSPECTED: 'LAND BLDGS. DATE: ri "ACR TOTAL LAND E OMPUTATIONS I J BLDGS. LAND TYPE PRICE TOTAL 1'/DEPR. VALUE TOTAL HOUSE LOT LAND CLEARED RONT AR 01 BLDGS. WOODS SPROUT FRONT TOTAL REAR LAND WASTE FRONT BLDGS. TOTAL REAR LAND BLDGS. TOTAL r ; LAND BLDGS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH % FRONT FT. PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ROUGH TOWN WATER BLDGS. HIGH GRAVEL D. TOTAL LOW DIRT RD. HLANDSWAMPY NO RD. O1 i ?ROPERTY ADDRESS s ZONING I DISTRICT CODE SP-DISTS. DATE PRINTED STATE pCS NBHD. CLASS I " I KEY NO. 0006 CHESTNUT STREET 07 RB 40C 07HY 07/09/95 01.31 : UU 63BC R309 067_ LAND/OTHER FEATURES DESCRIPTION ADJ7FNFACTORS - c oRs T 223 41 3 Land ey/Dale sae D�men��on v UNIT ADJ'D.UNIT PE RKI NSi LUTHER 8 & MAP- / cD FF De IroAcres LOC./YR.S ADJ. COND. PE PRICE PRICE ACRES/UNITS VALUE Daarnpuon #LAND 1 10,P400 CAR9SINACCOUNT - III L t�'N18LDG.SIT 1 x .1 , =10347 29999.9 104099.9 .1 0 10400 #LAND 3 10,900 01 OF Cl A =SITE 1 x .1�.=100347. 150 29999_9 156149.9 .07 10900 4:3LDG(S)-CARD-1 1 51,P800 I #3LDG(S)-CARD-1 3 34,500 . ARKET 83400 N HS 1 .1 U X 100 6000.0 6000.0 1.00 60JU S #PL' 191 WINTER STREET HY` INCOME 2 SSMT S x I -C 100 A 3.6 3.6 780 2800-3 #DL LOT 1 ;b 1/2 0 USE REPLACE U X I C= 100 3100_0 _ 3100_0 1.00 3100 3 #RR 0295 0097 1866 0071 APPRAISED VALUE . G t Ji - #SR MINTER STREET 107,600 TUi ARCEI, SUMMARY A S AND 2130C TI LDGS - 86300 M 0-IMPS El TOTAL : 10760F C CNST T DEED REFERENCE Tyr DATE Recoroea R I O R YEAR VALUE 4 ..Book ea Pago s- MO. Yr.D S*l Prig .AND 21 30C T S 6563/289yE1L12/88 N 120000 LDGS 8630C 5721524 ;00/00 OTAL 10760C BUtLDINGPERMIT. JOYCE*.S BEAUTY I� Dale Type SALON. 20X13 FOP LAND LAND-ADJ INC f�lE g7SE SP-BLOB FEATURES BLD-ADJS N-, A-uol CHEAP QUALITY 21300 6300 _ I _ FRAME& CORRUGATE . - ci Cons, To'' ease Rale na Rale e '; n e Norn,. oos� T - q..;-.-.LA FIBERGLASS.. I" Unils U, s I' Ac u g Depr. C ntl. CND Loc 4b Fl G Fepl CAs1 New I Ad, Repi value Slone_ He�gnt I Roo- IR.rn Rms Be1na a Fl 0 ' Ou0 105 105 57.50 60.38 40 75 10, 80 100 80 107866 363JJ 1.4 S 2 1.1 6 .. - 4C k_.. Win) Rale sq�a.e Feel Re Cosl 1.00 ME 1 1/8 7 1/0 0.5 3DJ fOR r, 100bU.38 780 �7096 KT.I DEX: M .B /GATE: SCALE ELEMENTS CODE CONSTR/CTIFEPI 65 39.25 24 942CONOMICS._ .... N *-----2U---* STYLti 04 APE COD FSF 9U 54.34 552 29996 13 FOP 13 DEJTGN-A-6JMT J1 FSIGN--II-DJUST5 0 FOP 35 21.13 260 5494. 1 1 1 XTcR:;J-A-LCS- -06 luMIVrNYL------_U.0 FFG 30 18.11 216 3912 *-----20---* EA-F/AC TYPE- -07GA-S=ROT-WATYR---U.-O 814 30 18.11 780 14126 1 FSF ! INTcR.F-1-41SH- -04 RYWALt------------9 0 14 14 INT-LR:LA"YOUT- -t2 VER.lWO`RMA ------KID INT-tR.3JALTY- -02 A_KE-A-S--EXTFR.---U 0 W a:-------30------ *--12. ._ FL-OJR STRUCT- -02 -D-10I-8T/BEA-M--- -U 0 - 0 500 1332 ! ! � * L tJJ"R LJ1tf.R JS Al7PET- b_9D�IiD---U-:C E Tola'A,— Auw= Base= , 81 4 1 8 1 8 18 031. T YF1= -01 A�TL E=ASPS-YH--- O.0 T BUILDING DIMENSIONS U.0 Eta rRlrat - -Jt VFRAGF- ----- A `W ! N' FEP W04 N b E S 22 1 1 1 A BA5 N22 E3U FSF N14 £02 FOP F0VN)ATY-0N - -J2 �NCRET-E-3LOCK-9-4.9 26 BASE 26 ! FFG! -- N13 EZU S13 W20 .. FSF E22 S14 *-* ---- - *--12-*--12* ----N€ib`Kz10H L FFG S18 W12 N18 E12 .. FSF W12 6 6 ! LAND TOTAL, . MARKET S18 W12 N18 .. BAS S26 .. 814 FEP ! PARCEL 21300 107600 N26 W30 S26 E30 .. *-------30------X- AREA 2325 VARIANCE +0 +4528 STANDARD 20 1 � : t .�� __ _ _ _ `�. �.� ® r'y � �r � y�V N �_-, � �� .. :, i I i NAME (LAST, FIRST, J / / DIVISION / 'o'11 _ Fat i i � l � I � NOTE DETAILS A OBSERVATIONS-ITEMIZE EVIDENCE, SERIAL #S ETC- 17:pil.f.l -woo i 1.0 ilram Won 111,101 i ARIA oml SUBMITTED BY i • YC�7 i Jr i. - ! .; g;! y: " yj"LE �i \fix Et ! �l•E �:.:.E• .......�.. 309 0 7 z< � i - - �K E. tEE � '� 4 E".: {N�pEY� I�E•E .,'�� ,ru.1 r.« i��.. �r.� �,.E€ ,e. :•.:'.•�l� �� E«�� s Et E��,fE€ 'CY AS rzf4j 191 WINTER STREET CNR WINTER&HYANNIS CHESTNU.-W Y: 1 VS { EE, " EAN MITCHELL 20 LOCUST ST.775-4658 -!x .......... BUSINESS BEING RUN FROM HOME. NAME ON DUMP TRUCK IS GOMES. F HEAVY EQUIPMENT&BUILDING E E E MATERIALS STORED IN YARD z _ V € n `•" �FE �ru"t�t t`u`;ix � 1�� 1 A , �Q ""- _yam•§ _ -. -T —r ,��� •�,'�-4 4�� "YA � , '`,{.� 1. . AE slop �.to .{�•J' Ak• 1r .q. ��� it t •r .1 _. �. a r L v+ `• L f y� • ? G a � � y r d � �-• '^r�!;� 3,�,'rf. 0 �f•1�F 74�1+�iJ�':a4.ff;+^,+�r�'!'' I .yam_ '�t 1�. �.:! '.i •�✓ JG �-i- - 7 `9/ C CL Y ^rl y fl' i G � � � ..+vs-r � v �,. ✓ R f ti-.1: �Y,•j'�a �.• , '•fro ems' t,Y. 1 ��'� .. �,� ti�—�. , : r _„>sa. _A , �i r v � i Icy �- �" C _ ..�,. d .E � 0-1 � �� .. �a `��•5v �. �, � ° �o.� r �� t_ y\ � Y �� Q i .r C 5ry„ � L. Y t_ e �� r- i� � d r 1 IY t 1 1.S�,a < O r � O ..y � ( i`° i 1!: •,�" ® *.N $ � �; � � N = `N �$ �i 6 fD ``a a 3• i TOVM OF 3 All STABL33 SEPOBT S ��ENTBIIY/QOSTINIIBTIO�g�pOHT , 91 'ME (L.AST, fPBT, K=DlZ Dn►ISZOx /issm :OTE DETAI6ICS i ossERVATZONs-ITmlzz EVIDEBGE. SERIAL is ETC. LU. ] [R309 067 . , ] TAX ACCOUNTING* ] 8867- [ 2233411 RECEIPT NO. PAYMENT TAX YEAR/B.G. AMOUNT DATE TYPE PID " 0 [ ] A ] ^ J ^ ] ^ J [ J ] [ J ^ ] ^ ] ^ ] ^ ] [ ] ] ------CERTIFIED OWNER------ TAX DUE 1, 869 . 37 ] OUTSTANDING . 00 PERKINS, LUTHER B & ] TAX CODE 400 ] CITY 071 DISTRICTS HY ------JANUARY 1 OWNER------ ACTION ] MORTGAGE CODE A0000] PERKINS, LUTHER B & ] - --CERTIFIED VALUES---- -------CURRENTOWNER------- TAX EXEMPT . 00 ] PERKINS, LUTHER B & ] TAXABLE . 00 ] PERKINS, CONSTANCE M ] RESIDENT' L 62 , 200 . 00 ] 38 GREENWOOD AVE ] TAXABLE 62 , 200 . 00 ] HYANNIS MA 026011 OPEN SPACE . 00 ] 00001 TAXABLE . 00 ] -----LEGAL DESCRIPTION----- COMMERCIAL 45, 400 . 00 ] #LAND 1 10, 4001 TAXABLE 45, 400 . 00 ] #LAND 3 10, 9001 INDUSTRIAL . 00 ] #BLDG (S) -CARD-1 1 51, 8001 TAXABLE . 00 ] #BLDG�DEC C 34, 5001 ] g:, INTER STREETLL CONT'D XMT [?] 1 , ClAk A-VL�l QUERY PERMITS : T QUERY ENDY ` QUERY PERMITS PENTAMATION----------------------------------------------------------- 01/14/03 PERMIT NUMBER 60078 PARCEL ID 309 067 191 WINTER STREET PERMIT TYPE BEADALTR WIRING-RES . ADD/ALTER DESCRIPTION RESTORE POWER AFTER FIRE CK 1059 CONTRACTOR PERMIT FEE 25 . 00 VARIANCE, STATUS C COMPLETED CONSTRUCTION TYPE 753 GROUP TYPE APPLICATION 04/03/2002 EXPIRATION VALUATION 0 . 00 DATE ISSUED 04/03/2002 COMPLETED 04/05/2002 DEPARTMENT-----STATUS---DATE-----DEPARTMENT-----STATUS---DATE---- (N) EXT/ (P)REVIOUS/ (C) ONTRACTORS/ PR(0) PERTY/ (I)NSPECTIONS/ (H) ISTORY/ (F) EES/ (A)RCHITECTS/ (V) IOLATION/ (E)XIT QUERY PERMITS : QUERY END QUERY PERMITS PENTAMATION----------------------------------------------------------- 01/14/03 PERMIT NUMBER 47702 PARCEL ID 309 067 191 WINTER STREET PERMIT TYPE BGASA GAS PERMIT ALT/ADDITION DESCRIPTION WH. CK*1268 CONTRACTOR PERMIT FEE 20 . 00 VARIANCE STATUS C COMPLETED CONSTRUCTION TYPE 753 GROUP TYPE APPLICATION 07/27/2000 EXPIRATION VALUATION 0 . 00 DATE ISSUED 07/27/2000 COMPLETED 08/07/2000 DEPARTMENT-----STATUS---DATE-----DEPARTMENT-----STATUS---DATE---- (N) EXT/ (P) REVIOUS/ (C) ONTRACTORS/ PR(0) PERTY/ (I)NSPECTIONS/ (H) ISTORY/ (F) EES/ (A) RCHITECTS/ (V) IOLATION/ (E)XIT QUERY PERMITS: QUERY END QUERY PERMITS PENTAMATION----------------------------------------------------------- 01/14/03 PERMIT NUMBER 47701 PARCEL ID 309 067 191 WINTER STREET PERMIT TYPE BPLUM PLUMBING PERMIT DESCRIPTION WH. CK*1268 CONTRACTOR PERMIT FEE 20 . 00 VARIANCE STATUS C COMPLETED CONSTRUCTION TYPE 753 GROUP TYPE APPLICATION 07/27/2000 EXPIRATION VALUATION 0 . 00 DATE ISSUED 07/27/2000 COMPLETED 08/07/2000 DEPARTMENT-----STATUS---DATE-----DEPARTMENT-----STATUS---DATE---- (N) EXT/ (P) REVIOUS/ (C) ONTRACTORS/ PR(0) PERTY/ (I)NSPECTIONS/ (H) ISTORY/ (F) EES/ (A) RCHITECTS/ (V) IOLATION/ (E)XIT Office Use Only at.public *deg OcclAPS"s Fee cased APPLICATION FOR PERMIT TO PERFORM ' LECTRICCAL WORK Ali work to be perfumed in a+c=datr4e v4th the Massachusetts setts Electrical Coda, 527 OMR 12� (PLEASE PRINT IN INK Of$ ALL O TION) J date City at Town of P - Ta the tnspector of Wires: The udersigned applies for a perml t pergcsrrn the electrical work ascrlbed below. Location (Street S t4urnber) 7"'�/� S 0w her or Tenant Ownes's Address T Is this permit in conju Lion with q bulfding permit: Yes ❑ No 0- (Check Appgopriate Sox) Purpose of Building -- _ , 4 1 Utility Authorization iVq�,��/0? 0 Existing Service Atoms 1r,9 PJ6 Wis Overbead Undgrnd ❑ �Afo_ a Meters ` New Service — Amps 7 'Jolts Overhead ❑ Undgmd ❑ No. of Meters Nurntssr of Feeders and Arnpacky Location and Nature of Pr sad Electrical Work -- �C S �et'e �C.L/O C a e-y e r�(-E k.Er t--c2. No. of Lighting outlets No. of Hot Tubs No.of Transformers Total KVA No. of Lighting Fixtures DMMInitag pool Above in- grnd. ❑ grnd. ❑ Generators KYA No. at Emergoncy Ua mn% No. of Receptacle Outlets No_of Oil Burners Battery Units No. of Swach Outiets No.of Gas Burners FIRE ALARMS No.of tomes "f No. of Ranges No.of Air Corr!- Total tQo,of Detection and tons initialing Devices C:t No.of Gisposals No of Real Total Total Pumps Tons KW No. of Sounding Davl_ W co No. of Salt Can No.09 Dishwashers SpacetArea Heating KSPd Deug4iontSounding. s A No. of Dryers Heatfng Devices ICW Local {—� municipalOthetOO "1 ❑ Connection ❑ 3> No. of No.of Low Voltage r- No. of Water Healers KW Signs Ballasts Wiring � M No. Hydro Massage Tubs NO-of Motors Total HP OTHER:. INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws i have a current Liability Insurance Policy includingilad G Op Coverage Operations or its substantial equivalent. YES 0- NO 0 1 have submitted valid pram of sarne to the Ott".YES NO 0 It you have decked YES. please Indicate the type of coverage by checking the w9ropriate box. INSURANCE BONA -O OTHER 0 (Please Specily) (Expiration Date) fcsT"mated Vakre erl teciritat Work$ _ Work to Start Inspection Bate Requested: Flougtt final Signed under the Penalties of perjury: FIRM NAME LiC. NO. Licensee I eC.Ae Artfle Signature LtC. tVO. .?i 6 Q �/ Bus. Tel. No. S'7JY.22ji-� 7 6 Address "0 / d{�_�¢!'7 ��4/rGy /yl�. m+o3 Alt. Thu_No. !0 Sr- 6 3 S-zslc:` OWNER'S INSURANCE tA3AiVEA.I am aware that the Licensee close not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent tptease check one) Telephone No. PERMIT FEE lSkMlsse of Owner ca Mani) Town of Barnstable. CF THE Tp� Regulatory Services sAxxsznatie. : Thomas F.Geiler,Director 9 MASS. 1639. ,• Building Division rEDy a Pete F.DiMatteo Building Commissioner 200 Main Street,Hyannis,MA 0.2601 Office: 508-862-4038 Fax: 508-790-6230 REQUEST FOR ELECTRICAL INSPECTION ELECTRICAL PERMIT NUMEBER ? (Permit required in order to process inspection) Today's Date 7 Z-- Requested Date of Inspection I, i 6tP �(,2 hereby request an inspection under Massachusetts General (Electrician) Law chapter 143,section 3L and.237 CMR 4.02(3). The installation is complete and ready for inspection at 7n� C�c/ h, r (Property Location) Type of inspection requested: p ❑ Temporary Service ❑ Service Re-inspectio xb �I a c ❑ Excavation ❑ Rough Re-inspecti(;R t ❑ Service Inspection ❑ Final Re-inspectio4 X- OD ❑ .Rough Inspection for z�v .NO r cn rn ❑ Final Inspection for Other �_- S I�f:4 V d uJ-2 r Ct �� .e r Owner or tenant Licensee's name, address,and phone /� 5���S SfJN/WI License number 3, 7�E Licensee's Signature This section to be completed by Barnstable Inspector of Wires Inspection date -5;/—10,::� oZ ❑Approved Not Approved This work was not approved for violation of the following Articles and Sections.of the MA Electrical Code: m , Q:wPFiles:Bldg:Elecrequest 4 � � - = z m m O Q n C.Z7 0 I c1>c� m I I I � I cn m O z j I I I I D cn Cn I Z �NO--j m0n1 T cn Dm p m m .� w m D f r '° Go O 2 Co � m m p�—�n p f9^ M c � z`� `^ �z S a z on T M T r a T m cn i o c Om Z m c, r m T m 0 > rn G � � m� m..= A : O cn = mom Cp s .. m O 7op� mZm 70 m � p Sol C CC�I�m Vim = rn � T� D ^' Gv mOCn rS v �m m T m m my CD GJ ?-n z nm0 GZiv O 0 A n rZn n Q 64 =3 V� V) c TJ O O L(I W D O m S D I� < � � O O O wmz m * 0 0 0 o. a. m >kr-s•�z—�kr-s'� 18' f SHEET TITLE PROPOSED CONDITIONS PLANS PROJECT REF: PROJECT NO: 0032 DATE:08 19 14 r;` T FILE: WINTER ST "°" SHEET NO _ DCALE: 1 4 MA 191 WINTER STREET HYANNIS, MA f DRAWN BY: RMA � � OI CHK D BY: : ;t F,{, 'r` c 6 (01 f 3 OO\ ' N s,+y' mu .' r ;_ no J rlsl o ";.� t rrr7 :, � �, ,• -:.: ;I.' b4�?�` Hp� m '�I��^re.����i r r '�'N� `710 �lw y'.�a' �.;�. v 292 310 328 ' 710 ! l0; ` ,,_a �„q�y �q , ". rd9 -S' 1-:1 r•n e..— '�c. .. W E in .1 ; 3 I -... ,,. a9 :v. �� G" � 11 a y a-.m :gym ,tt , .a , \ N � 291 309 32/ to 7� 5 _:� to •5ss..\',. !-`B'.: /t 1 � � r _ ����' ,sl, t•� VV" 7n / m 4r SCALE: V=250i Li 29013081326 ':: 4'_ t �_ �♦ 8 �5"SSSeee��� m*\ �/ +�e I� 3m 7os � r n t :.,N�i rl9o! _" --- _" P �`t�k�"( �'�v" � �� r ''�� Q1 ��A�I _ / ,:. � �,.i� :, rA, .•., :;..-' 'i 3 ga � W Ntol� �3n_ e +�¢ ,-�,� "k. .r.tes 'N p\ is, �. ., is ", � r '' .o• % �� � .19•. I71; � p*=';� 34 4TO N _ .�09; EE NJ Vo3 nl � a5o - ':yelo � r191 r.lte'� - ! P1 3 r :1�•�7ia, C ', `` [�!,,, ' �: Ell- VO e ` :,14 � � m.'' - •34;,- / HERRY tw :x{ «30 N t 3 1 �3 1 `.,'3°°.r N + t°t➢`' * t-.;+p `' j37 � 3n t7 , rm3w rlor � �m34, n o ' LAY _ o a o" n \ .j� mp °ri.106 I � \ rin 'e..• �� _ � ...max,, - .N ',�x1 Na _ � f*� 2 Nes �y.; �eAl \ --_ 158 . $yi� � -"- A2 \ \ - , rm O 7 ' 9-1 V t� 1•ru 10 73 - \ �\ \\\ � �7r.�k _ �-: 7� IV o 683 Io . - �1 bY/ — Z73 t ,� +- � `a:�.i't'��'�;t4 ',m,'ivz•t - `# 1L ��` �" r'„�'. t \ � 'E.i.,� 1 � y 0 a^: -j - � ,�`�' -��ak*� '(1j ` `m !�#my r" _ 's"•�•fix, i� r �' may% �"` ::'�:sr ei�o��4 - - .F 20 "':'y� x"� '.,�a � � rl t•" �i%%��/���� rlw �4 °Y c �^� fin'° pus \ ® \ : .. :Ole „ I, �. n 44 i Iu5 -�z s .f �+:- Q 73n r o o \ � eplg Y IMP op . � 2 �-' t . '3�`r"+ �° u -:,.\,� + O \ .�-�•, 2933 �{ -�_a.J O i o' Z.;k� :. ® > i r- :,xis ' - �`` • 293n icie9 \�, 7n 7 } r'" -` .w� / �� rat , r� a 159 ro �3pg B®7n �Jl r _ // ♦1 ': S + 4 : N'Mf y ' yf � j u� I `t