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0017 WOLLEY ROAD
=-- - - �`70 - I " � �x 7/3i/v,� �6�-s�-� �� � �� t .��' ,_-- ��,� �� �� r; 6 Olt � -- Commonwealth of Massachusetts., Sheet Metal Permit �1 Map Parcel N OF, V Dater ; , . s Permit# � Cam' (� Estimated Job Cost: $ Permit Fee: Plans Submitted: YES O `1 � �Y - -Plans Reviewed:'YES NO Business License# ,SM silo,� ��, Applicant License,# 5 b Business Information: - Property Owner/Job Location Information: Name: I Name: 0 _ Street: T I)A O !� PC J' Street: , I City/Town: Gfy e w l\\� ,. /"`� City/Town: PJ o U"1n Telephone: y � 3 .`� Telephone: Orb �_q 1 '3 3 Photo I.D.'required/Copy of<Photo I.D. attached: - YES NO' Staff Initial J4/M-1-unrestricted license J-2/M-2-restricted to dwellings 3-stones or<less arid'commercial up to 10,000 sq. ft. /2-stories or less " Residential: 1-2 family 2 V Multi-family Condo/Townhouses Other i I Commercial: Office . Retail" Industrial YEducational z. Fire Dept. Approval m Institutional_ Other Square Footage: •under,10,000 sq. ft. over 10,000 sq ft. ' Number of Stories: Sheet metal work to be completed: New.Work: Renovation: HVAC •Metal Watershed Roofing_ Kitchen Exhaust System Metal Chimney/Vents Air Balancing ` Provide detailed description of work to be done: T>ns d u�ac a; l ai ((&j i-A.i ow" Ca 1 INSURANCE COVERAGE:. I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes[/No ❑ If you have checked la, indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee sloes not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only, Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box[],I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required_prior to insulation installation: YES "NO Progress Inspections` Date x Comments Final Inspection Date Comments 7 7- Type of License: 3y ❑ Master Title ❑ Master-Restricted 'ity/Town ❑Journeyperson k Signature of Licensee 'ermit# . ❑J o u rneyperson-Restricted License Number =ee$ Check at www.mass.govIdol nspector Signature of Permit Approval The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyiblv Name (Business/Organization/Individual): Address: City/State/Zip: Ce1,/�-r i\�� Oc� Phone#: � `J a Are you an employer?Check the appropriate box: Type of project(required): 1.[ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ ew construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. LVRemodeling ship and have no employees These sub-contractors have 8. ❑Demolition . working for me in any capacity. employees and have workers' insurance.$ 9. ❑Building addition [No workers' comp. insurance ' comp. 10.❑ Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp. : right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t`Homeowners who submit this affidavit indicating they are doing all work and then hire outside'contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �1 _ Insurance Company Name: 1 n�' QK( I®jAD'I IrwLt / AQ!A _L%A"5 Policy#or Self-ins.Lic.#: c, �4 Expiration Date: ff,,,, , Job Site Address: I W O §,l R�_ City/State/Zip: a11M�1A1vr.:l' 1Ca �-1Q�.1� Attach a copy of the workers'_compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal.penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to.$250.00 a day against the violator. Be advised that a'copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under enalties of perjury that the information provided above is true nd correc Signature: Date: o� O p�®`' Phone#: �i s Official use only. Do not write in this area,to.be completed'by city or town official City or Town: Permit/License# Issuing Authority(circle one): ```,Y 1.Board of Health 2.Building Department 3. City/Town Clerk"4.Electrical Inspector_5.Plumbing Inspector 6..Other Contact Person: Phon eft:' �3. xti r __ ..71�, f SHEET METAL;AORKERS ' i} A JOURNEYPER:O�q UNRESTRICTED I$SUES THE ABOY E LICENBE JOAO MCHUMBINAO- 1815 PAL RSA.: r: APT CENTER.`VILLE =.-MA .02632=3167 5283 03/28/12 961947 ' `fFrF.r � 1ca ,j i 012,24 sat xEsr�xcr, sex� 1' t 15�FALMOII'�H�ROA :• '�� �.: 1 rHEr, Town of.Barnstable a Regulatory Services F MAE& g Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barngtable-rna.us Office: 508-862-403 8 Fax: 508-790-6230 Property 0wrier Must Complete and Sign This Section If Us ina A B uilder It C4 Z ,:as Owner of the subject property hereby authorize 4 " �/Y to act on my behalf, in all=tters'rela&e to Work authorized by this building permit application for:. d a LLB �`J i✓sf//, (Ad ss of jog), (=atu °fVWMr T.: vIY;: Date Print Name < if Property Owner is applying for permit please complete the ; Homeowners.License Exemption Form on 'the reverse side. Q:FO RM3:O W ISEKP EP MISSION Town of Barnstable Prof Yttr ray o Regalatoty Services Thomas F. Geiler,Director 16 .�� Building Division Tom Perry,Building Commissioner 200 Main-Street;_l3yannis,MA_02601 www.t o wn.b arnstab l e.ma.us Office: 508-962-403 8 Fax: 5DS-790-6230 HOMEOWNER LICFNEE EXEIv MOM Please Print DATE JOB LOCATION: number street village "HOMEOWNER': name home phone# work phone CURRENT MAMING ADDRESS: eity/town state dp code The current exemption for"h0MDDWner9"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 ants as supervisor. - - DEFIhT GN OF HOh!EOW\ER P ers'oa(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 Of-racial, 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"homeo-wner"cmti5cs thathe/she understands the Town of Barnstable Building Department mum inspection proccdures and rc.tT, ctits and that he/she will comply with said procedures and re,q T7rements. Signature of Homeowner Approval of Building Of ci2l Note: Three-family dwellings containing 35,DD0 cubic feet or larger will be required to comely with the State Building Code Section 127.0 Construction Control. HOAMOWlQER'S EXEMPTION .The Code states that: "Any homeowner pafonrring work far which a building permit is tequitzd shaD be exempt from the provisions of this section.(Section 1D9.1.1-Licensing of ecrostuctioa Supcnzsors);provided that if the homeowner engagrs a persons)for hiro to do such work,that such Homeowner shall act as supervisor." }many homeowners who use this exemption are unaware that they are assunvng the responmtbilities of a supervisor(see Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lark of awartn=s bft=results in serious problems,particularly when the homeowner hires unlicensed persons. In.this ease,our Board eannot proceed against the unlicensed person as it A Duld with n licensed Supervisor. The homcown cr acting as Supervisor is ultimately responsible. To ensure that the hamoowner is fuDy aware of hislher responmtbiIitia,.many communities require,as part of the permit application, that the homeowner certify that hr�she understands the resp=bilitics of a Supervisor. On the last page of this issue is it form curtly used by several towns. You may care t amend and adopt such a fomiccrtifir-t an for use in your community. Q:forrns:homw cmpt Client#:21832 2CHUMBIMHOJO DATE(MM/DDNYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 01/31/2012 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 A4CONTRACT 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). ACT PRODUCER NAME: Joanne Sullivan Dowling&O'Neil n/co"t o Ext:508 775-1620 NC,No): 508 778-1218 Insurance Agency AD E-MDREAIL SS: jsuilivan@doins.com 973 lyannough Rd., PO BOX 1990 INSURER(S)AFFORDINGCOVERAGE NAIC# Hyannis,MA 02601 INSURER A:National Grange Mutual Ins INSURED INSURER B: Joao M.Chumbinho dba Air Rite INSURER C 1815 Falmouth Road,Apt A5 INSURER D Centerville,MA 02632 INSURER E: � INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. LTR TYPE OF INSURANCE NSRL SUBR WVD POLICY NUMBER MMIDDY/YEYrr MM/DDY EXP LIMBS A GENERAL LIABILITY MPT8454A 4/13/2011 04/13/201 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES ERENTED o�ante $500 OOO CLAIMS-MADE 5XI OCCUR MED EXP(Any one person) $10 OOO PERSONAL&ADV INJURY $1,000,000 -GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY j cT LOC I I COIN $ AUTOMOBILE LIABILITY Eaac den SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS - NO OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WCT8454A 4/13/2011 04/13/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $5OO OOO OFFICERIMEMBER EXCLUDED? a N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500 OO.O If yes,describe under E.L.DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ` Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ,y� kflit ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S91097/M91096 JRS r Town of Barnstable *Pe #a ���� �T � � Ezpir `� io�ttt frustltssne date PE Regulatory Services Fee . ice, # _ &b 2012 Thomas F. Geiler,Director pT�D MA'1 Building DMsion TOWN OF EjAFIN Tom Perry, CBO, Building Commissioner STABLE 200 Main Street, Hyannis, MA 0260.1 www.town.b amstab l e,ma.us Office: 508-862-403 8 Fax: 508-790-623 0 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Vafid without Red X-Press Imprint Map/parcel Number Property Address6E Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 1i PO . E%x 33 14 r9i�-4(SPoP_i fil 19+ Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ` ❑Workman's Compensation Insurance Check one: I am a sole proprietor ; the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Camp. Policy# Copy of Insurance Compliance Certificate must accompany each,permit., Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going-over. existing layers of roof) ❑ Re-side A,-jrj R-5oA oo #of doors Replacement Windows/doors/sliders. U-Value 0/,31 (maximum.44)#of wind ws � *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic T on,etc. . �{1a4c"1e I co/V Cezr�riS71�H tit' ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors:License& Construction Supervisors License is required. [GNATURE 1WPFILESIF0RMS1buflding permit fnrmslE)2 5.ddc ,wised 0701.10. r 1 IN The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' :600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): C�/1 f�aq /V A/11 Af Address: , o UGG!J �il dV4&&1 City/State/Zip: IAgign17yi Phone.#: �D. 7 32 Are you an employer? Check the appropriate box:' . Type of project(required):,' 1.❑ I am a Y emp to er with 4. ElI am a general contractor and I 6..El New construction . employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the-attached sheet. 7. �temodeling f ship and have no employees These sub-contractors have g•.E]Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. ❑Building addition [No workers' comp.insurance comp.insurance.t ,_ ruined.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions 3.EY I am a homeowner doing all work officers have exercised their 11:E]Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs S. insurance required.]t c. 152; §1(4),.and we have no employees.[No workers' 13.❑ Other comp.insurance required:] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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 isproviding workers'compensation insurance for my employees.. Below is the policy and job site information. Insurance Company Name: g f y Policy#or Self-ins.Lic.#: Expiration Date: Job Site,Address: City/State/Zip: Attach a copy of the workers'.compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.:Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains an)d peenalties of erf that the information provided above is true and correct. Signature- f° P Date: d� P.2e Phone 4: c�D�) dZ z - 37 3 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department'3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6. Other Contact Person: Phone#: i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide,workers'compensation for their employees. Pursuant.to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing'engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced,acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. ` Please be sure to fill in the permit/license number which will be used as a reference number.: In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. The Cminwwc4th of Massachusetts Department of Industrial Aco donts Office of Investigations 600 Washington Street Boston,MA 02.111 Tel. #617-727-4904 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax##617-727-774 www.rr>ass..gov/dia OFIKE Town of Barnstable Regulatory Services s MSTMM MASS Thomas F.Geiler,Director � i639. ���� 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' " 1iD�✓� ��' ,as Owner of the subject property hereby authorize to act on my behalf, in.all matters relative to work au ed by this building permit (Address of Job) ,j- -41 - *Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled-before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. . Signature of Owner Signature of Applicant Print Name :. Y `Print Name Date Q:FORM&OWNERPERMISSIONPOOLS ` 'THE Town of Barnstable Regulatory Services BABPSPABLE, « Thomas F.Geiler,Director 16yg. �.�� Building Division ED MA'1 Tom Perry,Building Commissioner 200 Main Street, Hyannis,Na 02601 www.town.barnstable.ma.us Office: 508-862-4038 ' Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE ev /Z-G JOB LOCATION: // Wa /A�y/�^/ �/✓/ number eet village W "HOMEONER C_�P_EL—s 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 requir nts. gnature of H eo r Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 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, I 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 caret amend and adopt such a form/certification for use in your community. jJ i Q:forms:homeexempt 1 1 i r YOU WISH TO.OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which you must do by M.G.L.-*it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, V FL,367 Main Street,Hyannis, MA 02601 (Town Hall) DATE:Q5 bo 10 lowFill in please: APPLICANT'S YOUR NAME: `)j LLE 1 j-IJL I A PA ��I BUSINESS YOUR HONE ADDRESS:-I is lVffZ e,4 `P TELEPHONE # Home Telephone Nui NAM9.OF NEW BUSINpSS G . TYPE OF:B�I.SINE5S LEA �NI A I$THIS.A HOME OCCUPATIOW... 1-lave ycfu bean gWien approval fro the uildinlg diiiisibn . YES NO I ADDRESS OF•13USINE$$ W� �1 MAP,IPAf3clrl.NUMBER l When starting anew business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need.- You MUST GO TO 200 Main St. - (corner of Yarmouth Rd.&Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM NER'S OFFICE MUST COMPLY WITH HOME OCCUPATION This individu h b naraf � f any permit requirements that pertafrrittfL8$44 C({g gfOMONS. FAILURE TO COMPLY MAY RESULT IN FINES. Au horize nature* *LE(k P, COMMENTS 2. BOARD OF HEALTH. This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS- . 3. CONSUMER-AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this,type of business. Authorized Signature* COMMENTS: Town of Barnstable THE Regulatory Services P� do Thomas F. Geiler,Director r r Building Division * BARN STABLE. Tom Perry,Building Commissioner 039. ♦0 'O1fp Mp.�A 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: 05 t 8olo-�- Name: 0 j ktE 1 J ULI� A M pr bG/_L l Phone#: Address: 3 --)- WaLE`( U 1:U 9AWJ XA.(d illage: Name of Business: U �ER Type of Business: C«� N COKAV y Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings, subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit, located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials, in excess of normal household quantities. % • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation, and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: nl ' /� ��:J Date:OS/30A,? Homeoc.doc Rev.5/30/03 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION M PLC �S UdC dgl0 Map �� Parcel � ;, Application# Health Division Conservation Division1 `(�� ( Permit# �. f., Tax Collector Date Issued Treasurer Application Fee `:6-y Planning Dept. Permit Fee '0 Date Definitive Plan Approved by Planning Board Q Historic-OKH Preservation/Hyannis Project Street Addressi— Village Owner Ai 3-/- 65r 60 OJ Z Address Telephone Permit Request 4? 40 Square feet: 1 st floor:existing proposed 2nd floor:existing proposed i Totar* Zoning District Flood Plain Groundwater Overlay Project Valuation a fl o 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: *�ull ❑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:AGas ❑Oil ❑Electric ❑Other Central Air: ❑Yes o 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 Shed5o existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current: se Proposed Use C BUILDER INFORMATION /O Name _P al le 6 S4 JZa Telephone Number Address h/a S` r C�_ License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIG NATURIe/�,.; DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED i c ' MAP/PARCEL NO. , ADDRESS VILLAGE -OWNER x DATE OF INSPECTION: i FOUNDATION FRAME INSULATION 1 FIREPLACE 7 ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING tG4W DATE CLOSED OUT i ASSOCIATION PLAN NO. i 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, AM 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Y Name (Business/Ora nization/Individual): Address: Ullttcq City/State/Zip: - nz) 4A- ®WCoo Phone #: Are you an employer? Check the appropriatepox: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I b, ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or pa per- listed on the attached sheet`# Remodeling ship and have no employees These sub=contractors have 8. Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ 'Building addition [No workers' comp. insurance 5. El We are a corporation and its � 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or, additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correcr. Si afore: 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 a.Electrical inspector 5.Plumbing Inspector 6. Other I� Contact Person: Phone#: 3 r �F'THE;gy, _ Town of Barnstable do Regulatory Services BARNST"sM ' Thomas F.Geiler,Director 9 MASS. Fn i�a'�a`0 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 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: �Estimated Cost Address of Work: � t M 2 ' Owner's Name: Date of Application: ©� I�- — 06 I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 E113uilding not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Signature Registration No. OR -- 1-4-—06 SiM I Date 0 er's Sionatuie Q:wpfiles.forms:homeaffi d av Rev: 060606 r ,r'THE Town of Barnstable OF Regulatory Services y Thomas F.Geiler,Director BARNSTABLE, MASS. g 1619• ,• Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstible.ma.us ;e: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 09 t —CX JOB LOCATION: �� l ` number stree village `,jj0MEOWNER name X home phone# ��-- work phone# CURRENT MAn_NG ADDRESS: I A Y\aAC &rL city wn 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 Persons)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 of 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 wotk 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. K . �---- 'rSi ature of Ho owner 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 persons)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 bis/her responsibilities,many communities require,as part of the pemut application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns, You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexernpt AC0RD� CERTIFICATE OF LIABILITY INSURANCE 08 17/DD//206006 / PRODUCER (508) '790-1919 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Sandpiper Ins. Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 12 Enterprise Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Scottsdale Insurance Co. Frederick Bione INSURER B:Continental Casualty d/b/a FB Construction INSURERC: 153 Tanbark Road INSURERD: Marstons Mills MA 02648— INSURERE: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS A GENERAL LIABILITY CLS1188856 10/31/2005 10/31/2006 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 CLAIMS MADE DOCCUR / / / / MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY JECT LOC / / / / NOWND AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS / / / / BODILY INJURY SCHEDULED AUTOS (Per person) $ HIREDAUTOS / / / / BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR El CLAIMS MADE AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION $ $ B WORKERS COMPENSATION AND 1017C181-05 10/19/2005 10/19/2006 TORYLIMITS X �R EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE$ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ( ) ( ) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 'ERATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL XPJ 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Marcelo Souza FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 17 Wolle Road INSURER,ITS AGEOS OR REPRESENTATIVES. AUTHORIZE R �IV Hyannis MA 02601- ACORD 25(2001/08) ©ACORD CORPORATION 1988 �7M INS025(0108).05 ELECTRONIC LASER FORMS,INC.-(800)327-0545 Page 1 of 2 4 46,0' n ��� b c n Fto n 46.0 Smm w Commerds: .AREA CP1l�UL4710NS SUMPAARaf -_. `ARFA`EtftE:ATfDON1AJ -_ Code _ D�serpHoh �- _ �__ -She _ Ne_l,Tolals -- _ .-Breakdo�Vo- .*:3uhdutal_s.- 84� Besmeat 1196.00 i196_00 Form S(T.BIdSM—'TOTAL for Wb dm:C appaisd s ftwe by a b modk arc—t-BDO�ODE- Ft► ,�, Town of Barnstable Regulatory Services 9B'�ASS ��" Thomas F. Geiler,Director s63q. �0 16,39 " Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 J August 2,2006 Marcelo P. Souza 17 Wolley Road Hyannis,MA 02601 Re: 17 Wolley Road EXIT ORDER Dear Mr. Souza: Under the provisions or 780 CMR,the State Building Code,section 3400.5.1,you are hereby ordered to.immediately discontinue the use of the cellar/basement area for sleeping purposes. Your cooperation in this matter is appreciated. Sincerely, Paul Roma Local Inspector A- UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • TOVvrN OF BARNSTABLE BUILDING DIVISION 200 AWN ST. HYANNIS,MA 02601 M • COMPLETE • ,..�i s Complete items 1,2,.and 3.Also complete A. Si atu item 4 if Restricted Delivery is desired. tr gent ■ Print your name and address on the reverse X ❑Addressee I so that we can return the card to you. p B. Receiv y`Pnn I ,v, ) C. D to of eli�yery ■ Attach this card to the back of the mail iece, 0;DC /b or on the front if space permits. D. Is delivery address different from item 1? ❑ es 1. Article Addressed to: If YES,enter delivery address below: �Ple- na4":-ea//fJd 0 .XJ Gam_ 7 3 i . S.2f0ertifled Mail ❑Express Mail ❑Registered AEA tum Receipt for Merchandise ❑Insured Mail ❑C.O.D. i 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 9 i s 1' i" (Transfer from service label) 7 D`0 4 2'S 10 D 0 D 2 6 2 2 8 2 6 6 5 j PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 U.S. Postal Service7M C-ERTIFIED MAIL7M RECEIPT (Domesti�Mai�Only;No Insurance1Coverage Provided) [Fo�,deliveiTinformation vvisit our websitii aat www.usps.cor ro • t• � P,S Fes'orm;800,June 2002 See Reverse for,lnstructions Certified Mail Provides: anay)ZooZeunp'ooBE�od Sd a A mailing receipt es� o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders. e Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail& o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. e For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"RestrictedDelivery". e If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. 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Y _ I w h Y M ye. r #F r Y I : fly.•►'•:+ �.� � 'h" 1 Ftw.�`,4 •l' ] x 3* , f a.''' ���is .. _.. .. .���, .ate`,.. rMF " w-`f"'�.'�..- - 1•� '"s -`. t •'y_�,� _�ram_--� - « _,- =.: K - - x k AL— tv 1ri s T ' � x T a `tkA T°�- .:: _ ,. f ''`';'a►,�,R''i...� a "�°">,,, ^.. .k �'w..�(I•` "i'a�a' �''"'tiy"°Wv"�+��2.'�...._� ..ry :- a 17 Wolley Rd., Hyannis _ 8/3/06 Barnstable Assessing Search Results Page 1 of 2 .fi 121 t,>: Home: Departments:Assessors Division: Property Assessment Search Results New Search ;New Interactive Maps >> Owner: 2006 Assessed Values: SOUZA, MARCELO P 17 WOLLEY ROAD Appraised Value Assessed Value Map/Parcel/Parcel Extension Building Value: $99,300 $99,300 270 /158/ Extra Features: $ 15,400 $ 15,400 Outbuildings: $0 $0 Mailing Address Land Value: $ 16000 $ 160,500 SOUZA, MARCELO P Totals $275,200 $275,200 17 WOLLEY RD HYANNIS, MA.02601 2006 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Community Preservation Act Tax $33.15 Fire District Rates Town Barnstable-Residential $1.90 $6.31 Barnstable-Commercial $2.51 Commei Hyannis FD Tax(Residential) $443.07 C.O.M.M.-All Classes $1.06 $6.54 Cotuit FD-All Classes $1.33 Persona Town Tax(Residential) $ 1,104.88 Hyannis-Residential $1.61 $6.49 Hyannis-Commercial $2.50 Other R; W Barnstable-Residential $1.60 Commur W Barnstable-Commercial $2.46 Total: $ 1,581.10 Construction Details Building Property Sketch Legend Building value $99,300 Interior Floors Carpet Style Ranch Interior Walls Drywall Model Residential Heat Fuel Gas Grade Average Minus Heat Type Hot Water Stories 1 Story AC Type None Exterior Walls Wood Shingle Bedrooms 3 Bedrooms Roof Structure Gable/Hip Bathrooms 1 Full http://www.town.bamstable.ma.us/assessing/assess06/displayparcelO6map.asp?mapparbac... 7/31/2006 Barnstable Assessing Search Results Page 2 of 2 Roof Cover Asph/F GIs/Cmp living area 1080 Replacement Cost $116830 Year Built 1971 Depreciation 15 Total Rooms 6 Rooms ` Land ' CODE 1010 Lot Size(Acres) 0.17 9 Appraised Value $ 160,500 � f 5 Y � . Assessed Value $ 160,500 { 4 View Interactive Maps > Sales History: Owner: Sale Date Book/Page: Sale Price: SOUZA, MARCELO P Jun 3 2004 12:OOAM 18674/059 $281,000 FERRANTE, EDMAR R Mar 15 2002 12:OOAM 14931/151 $ 176,000 DIGIOVANNI, SILVIO Jun 30 2000 12:OOAM 13104/223 $ 135,000 PACHECO, SHANE M Mar 30 2000 12:OOAM 12914/094 $98,000 CAHOON, CAROL V Jul 15 1987 12:OOAM 5845/297 $ 1 CAHOON,WILLIAM A 1653/327 $0 Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL1 Fireplace 1 $2,600 $2,600 BFA Bsmt Fin-Aver 1000 $ 12,800 $ 12,800 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 UST Utility Area(Unfinished) (Finished) 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.bamstable.ma.us/assessing/assess06/displayparcelO6map.asp?mapparbac... 7/31/2006 i Town of Barnstable of T"E ram, Regulatory Services Thomas F.Geiler,Director BARNSTABLE, Y Building Division y MASS. g 0,59. �m Tom Perry, Building Commissioner ATFD^'�r s 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 July 31, 2006 Marcelo P Souza 17 Wolley Road Hyannis,Ma 02601 Re: Illegal Apartment Property ID: Map 270—Parcel 158 Locus: 17 Wolley Road,Hyannis Dear Mr. Souza: A recent review of our records,including the permitting history and the Zoning Board of Appeals records, indicates that the present use of your property located at 17 Wolley Street, Hyannis is limited to that of a single-family home; any other use is illegal. A copy of a July 22,2006 incident report was forwarded to this office by the Hyannis Fire Department along with photographs taken by the Barnstable County Sheriff's Department. Research indicates that the subject apartment was created without the benefit of permits and proper inspections. As you did not obtain the necessary zoning relief you must now take immediate action to restore the property to a single-family home. A building permit is required in order to reconfigure the subject space to its original use and all work,including the removal of the downstairs kitchen and bedrooms shall be completed by August 17,2006. You should be aware that you have the right to apply for zoning relief. If you choose to explore this option we will be happy to discuss this matter with you but be assured that your failure to comply with this notice will result in a $200.00 fine and possibly criminal action. Please contact me by August 7, 2006 to confirm your intention. You may reach me directly at 508-862-4027. Sincerely, Robin C. Giangregorio Zoning Enforcement Officer JAIllegal ApartmentAl7 Wolley Rd Souza.DOC Certified mail 7004 2510 0002 6228 2665 C� A � T�� � ❑ Delete NFIRS - 1 . L01922 7/22/2006 001 I A260735 �0 J 11change State * Incident Date Station Incident Number Exposure ❑ No Activity BBSIC Location Check this box to indicate that the address for this incident is provided on the wildland Fire [ [ Module in Section B"Alternative Location Specification".Use only for wildland fires. Census Tract 30 ® Street Address 17 �� WOLLEY ROAD L RD u El Intersection ❑ In front of Number/Milepost Prefix Street or Highway Street Type Suffix ❑ Rear of J [Hyannis [ MA [ 02601 [ ❑ Adjacent to Apt./Suite/Room City State Zip Code ❑ Directions I ❑ Cross street or directions,as applicable C Incident Type E1 Dates &Times Midnight is 0000 E2 Shifts&Alarms 440 Electrical Local option Incident Type wirin:7/equipment problem, Check boxes if Month Day Year Hour Min_" dates are the � u Still D Aid GIVen_ReC21Ved � same as Alarm ALARM always required I `�' I Date. Alarm 07 22 2006 10:57 platoonr No OfAlarm�istrict 1 ❑ Mutual aid received I I I I ARRIVAL required,unless canceled or did not arrive 2 ❑ Automatic aid recv. u u E3 Special Studies 1 i 3 ❑ Mutual aid iven TheirFDID Their ® Arrival 07 22 2006 11:03 p �;. g State CONTROLLED optional,except for wildland fires Local Option �b ❑ Automatic aid given U I .5 ❑ Diner al given [ [ ❑ Controlled N ® None Their Incident Number ® Last Unit LAST UNIT CLEARED,required except wildland fire Special Special i. Cleared 07 22 2006 12:54 Study ID# Study Value F Actions Taken G1 Resources G2 Estimated Dollar Losses&Values r ❑ Check this box and skip this section if an 8 6 11 investigate LOSSES: Required for all fires if known. Optional for non fires. I Apparatus or Personnel form is used. Primary Action Taken(1) Apparatus Personnel None ` Property I [ El ' 82 [Notify other agencies. I Suppression �444� 15 Contents I ❑ Additional Action Taken(2)_ EMS Iu,, II 444�II PRE-INCIDENT VALUE: optional Other U u Property [ [ ❑ Additional Action Taken(3) Check box if resource counts include aid [ [ ❑ received resources. Contents ❑ Completed Modules H1 Casualties ® None H3 Hazardous Materials Release Mixed Use Property Deaths Injuries N® None EFire-2 Fire NN® Not mixed � Structure=3 -- Service 1 Natural gas:slow leak;no evacuation orHazMatactions �� R �� J ❑ ❑ Assembly Use D Civilian Fire Cas.-4 Y 2 ❑ Propane gas:<21 lb.tank(as in home BBQ grill) 20 ❑ Education use ❑.Fire Serv. Casualty Civilian $ Gasoline:vehicle fuel tank or portable container 33 ❑ Medical use. , J �0� ❑Q EMS-6 4 ❑ Kerosene:fuel burning equipment or portable storage 40 ❑ Residential use51 ❑ Row of stores ❑HazMat-7 Detector 5 Diesel fuel/fuel oil:vehicle fuel tank or portable storag r: ❑ ❑ Enclosed mall ❑,Wildland Fire-8 H2 6 ❑ Household solvents:Home/office spill,cleanup only 58 ❑ Business&residential Required for confirmed fires. from engine r portable t 59 e container ❑ Office use El Apparatus-9 7 Motor oil:f nin o ❑❑Personnel-10 1 ❑'Detector alerted occupants 8 ❑ Paint:from paint cans totaling<55 gallons 60 ❑ Industrial use 63 ❑ Military use 2❑:Detector did not alert them 0 ❑ Other:Special HazMat actions required or spill>55 gal., 65 ❑ Farm use U❑I Unknown Please complete the HazMat form 00 ❑ Other mixed use J Property Use Structures 341 ❑ Clinic,Clinic Type infirmary 539 ❑ Household goods,sales,repairs 131 ❑ Church,place of worship 342 ❑ Doctor/dentist office 579 ❑ Motor vehicle/boat sales/repairs 161 Restaurant or cafeteria 361 ❑ Prison or jail,not juvenile. 571 ❑ Gas or service station ❑162 Bar/tavern or nightclub 419 ❑ 1-or 2-family dwelling 599 ❑ Business office 213 ❑ Elementary school or kindergart. 429 ❑ Multi-family dwelling 615 ❑ Electric generating plant 215 EJ High school or junior high 439 ❑ Rooming/boarding house 629 ❑ Laboratory/science lab 241 College,adult ed. 449 ❑ Commercial hotel or motel 700 ❑ Manufacturing plant 311 Care facility for the aged 4459 ❑ Residential,board and care 819 ❑ Livestock/poultry storage(barn) 331 ❑ Hospital ❑ Dormitory/barracks 882 ❑ Non-residential parking garage 519 ❑ Food and beverage sales 891 ❑ Warehouse Outside 936 ❑ Vacant lot 981 124 ❑ Playground or park ❑ Construction site -; 655 ❑ Crops or orchard 938 ❑ Graded/cared for plot of land 984 ❑ Industrial plant yard ' 669 Forest(timberland) 946 ❑ Lake,river,stream 807 ❑ Outdoor storage area 951 ❑ Railroad right of way 960 ❑ Other street Look up and enter a 919 ❑ Dump or Sanitary landfill Property Use code only if Property Use 419 931 ❑ Open land or field 961 [:1Highway/divided highway you have NOT checked a 962 ❑ Residential street/driveway Property Use box: 1 or 2 family dwelling [ t NFIRS1 ReYsgn07N1199 A260735 -:EXP 0, 712212006 PAGE 1 OF 2 J K, Person/Entity Involved 1 17744870954 Local Option I Business name(if applicable) Phone Number `l ® Check this box if I I Magaly I I—I I Morais I J same address if incident location. Mr.,Ms.,Mrs. First Name MI Last Name Suffer 7 Then skip the three � �� I duplicate address 17 I�I WOLLEY I RD I RD lines.. Number/Milepost Prefix Street or Highway Street Type Suffix I (Hyannis I Post Office Box Apt./Suite/Room City 3 I MA I 02601 State Zip Code j ❑More people Involved? Check this box and attach Supplemental Forms(NFIRS-IS)as necessary. 1 r:.,. Owner ®Same as person involved? I';. Then check this box and skip I Marcelo I 15 083 672464 3 Local Option the rest of this section. Business name(if applicable) Phone Number Check this box if I I Marcelo I u I Souza I �� same address as incident location. Mr.,Ms.,Mrs. First Name MI Last Name Suffix Then skip the three duplicate address lA I Marc Drive I �RD� �RR)� lines. Number/Milepost Prefix Street or Highway Street Type Suffix 111 IPlymouth I Post Office Box Apt./Suite/Roam City Ma II State Zip Code LRemarks: Local Option x i :ITEMS WITH A MUST ALWAYS BE COMPLETED! ® More remarks?Check this box and attach Supplemental Forms (NFIRS-IS)as necessary. M Authorization 8501 (Dean L Melanson I I- Deputy /EMT I I Suppression 07 22 112006 Officer in charge ID Signature Position or rank Assignment Month Day Year Check box if same as Officer in charge.4 ❑ 8201 JIThomas F Kenney I I Lieutenant / P I I Suppression 07 1 2211 2006 Member making report ID Signature Position or rank Assignment Month Day Year a260735 - Exp 0, 712212006 page 2 of 2 A 01922 u I 7/22/2006 1 001 I a260735 I 1 0 Delete NFIRS - 1S FDID State* Incident Date Station Incident Number Exposure Change Supplemental K1 Person/Entity Involved I I 17744870954 Local Opton Business name(if applicable) Phone Number C)cc Lip zmt sCheck amea dress s IMagaly I u IMorais I �� same address as incident Iocafion. Mr.,Ms.,Mrs. First Name MI Last Name Suffix Then skip the three � �., I duplicate address 17 �� I WOLLEY I D �RRDD lines. Number/Milepost Prefix Street or Highway Street Type Suffix � I (Hyannis Post Office Box Apt./Suite/Room City A I 02601 State Zip Code K2 Person/Entity Involved I I I5083672464 Local Option Owner Business name(If applicable) Phone Number - Check this box ff l� I Marcelo I U I Souza I J same address if incident location. Mr.,Ms.,Mrs. First Name MI . Last Name Suffix Then skip the three I I � n�., I duplicate address lA I I (Marc Drive I L`�'J I RD lines. Number/Milepost Prefix Street or Highway Street Type Suffix � -1 (Plymouth Post Office Box Apt./Suite/Room City xM i Ma i I State Zip Code NFIRS71 Revmm&M a260735 ' 01 2 1 L AI I 7/22/2006 I j 001 � A260735 I 0 ❑ Delete NFIRS - 1S • 1h State * Incident Date �n7 Station Incident Number �7 ExPUfe �n7 ❑ Change Supplemental K2 Remarks 17 WOLLEY ROAD WE RESPONDED A FIRST ALARM ASSIGNMENT TO THE ABOVE LOCATION FOR A REPORTED BUILDING FIRE. UPON ARRIVAL AT SIDE I NOTHING WAS SHOWING. THE BUILDING IS A 25 BY. 40, 1 AND 1/2 STORY WOOD FRAME DWELLING. THE OCCUPANT WAS OUTSIDE AND REPORTED THE PROBLEM IS IN THE BASEMENT. WE ENTERED THE BUILDING AND PROCEEDED TO THE =3 BASEMENT. ONCE INSIDE WE COULD SMELL THE ODOR OF SOMETHING BURNING. I DOWN GRADED THE RESPONSE TO CODE C. CAR 802 ARRIVED AND ASSUMED COMMAND. THE OCCUPANT OF THE BASEMENT APARTMENT STATES SHE WAS WATCHING TELEVISION AND SUDDENLY SMOKE AND SPARKS STARTED SHOOTING OUT OF THE SIDE OF THE TV. SHE QUICKLY PULLED THE PLUG AND NOTICED THE LIGHTS WERE GOING OFF AND ON AND FROM j ':..DIM TO VERY BRIGHT AS WELL. THAT IS WHEN SHE EXITED THE BUILDING AND CALLED THE FIRE DEPARTMENT. WE PROCEEDED TO INVESTIGATE THE BASEMENT WHERE THE ODOR WAS STRONGEST. WE UTILIZED A PHYSICAL SEARCH AS WELL AS THERMAL IMAGING, BUT DID NOT LOCATE A FIRE. THE MAIN ELECTRICAL PANEL WAS CHECKED AND ALL BREAKERS WERE IN THE OPERATIONAL POSITION. NO TRIPPED BREAKERS WERE EVIDENT. THE TELEVISION IN QUESTION IS A TOSHIBA MODEL MW20FP1 SERIAL # 86785838A. WHILE SEARCHING WE OBSERVED THE LIGHTS TO SUDDENLY BECOME VERY BRIGHT AND THEN THE BULB FAILED. FURTHER INVESTIGATION LED US TO FIND THE METER WAS LOOSE ON THE BUILDING AND OTHER WIRING ISSUES. ? COMMAND REQUESTED ENGINE 822 CAPTAIN E. FARRENKOPF TO CHECK NEIGHBORING HOUSES TO SEE IF THE PROBLEM WAS COMMON. IT WAS NOT. COMMAND REQUESTED THE WIRING INSPECTOR AND NSTAR TO THE LOCATION. THE ELECTRICAL INSPECTOR, BILL AMARA, ARRIVED AT 11:25 AND HIS INVESTIGATION REVEALS THAT THE NEUTRAL SERVICE 71 TO THE HOUSE HAS BEEN LOST AS WELL AS OTHER ELECTRICAL ISSUES. THE PLAN IS TO TERMINATE THE ELECTRICAL SERVICE AND HAVE THE PROPERTY OWNER HIRE AN ELECTRICIAN TO MAKE REPAIRS. COMMAND HAS ALSO REQUESTED B.C.S.O. FOR PHOTO ;DOCUMENTATION. DEPUTY MATT SMITH ARRIVED AND PHOTOGRAPHED THE SCENE AS WELL AS ALL DAMAGED/POTENTIALLY DAMAGED ELECTRICAL ITEMS. AT 12:20 NSTAR ARRIVED. LINEMAN TONY PATZ PULLED THE METER AND CHECKED THE SERVICE. HE REPORTS THE >NUTRAL IS LOST OUTSIDE OF THE HOUSE AND HE WILL CHECK AT THE POLE PRIOR TO a DISCONNECTING. AFTER TESTING AT THE POLE, HE STATED THAT THE BREAK MAY BE IN THE PIPE, THE CONNECTIONS AT THE WEATHER HEAD, OR THE SERVICE DROP. DURING THE INVESTIGATION IT WAS NOTED THAT THE BASEMENT OF THIS`DWELLING IS AN' ILLEGAL APARTMENT. DEPUTY MELANSON WILL FOLLOW UP ON SAME. THE HOMEOWNER WAS ON SCENE AND THE SITUATION WAS EXPLAINED.TO HIM AS'PERTAINS TO THE APARTMENT; THE'INCIDENT TODAY, AS WELL AS THE NEED FOR AN ELECTRICIAN. THE PROPERTY WAS TURNED BACK OVER TO THE OWNER AT 12:52. ENGINE 823 THEN CLEARED THE SCENE. THOMAS F. KENNEY, LIEUTENANT 072206 ,sr A.Z60735 Barnstable County Sheriffs Department { r� Bureau of Criminal Investigation Public Safety Building, P.O. Box 315 Barnstable, MA 02630 Phone (508)375-6125 Fax (508)375-6286 Incident Detail Report Printed On: Tuesday, July 25, 2006 Case Number: 20061358 NCIC: BCI Status: Awaiting Approval Status By. S-58-Smith,Matt Juvenile: No Protected: No Case Hold. No Additional Reports: No Status Date Time: 07/22/2006 14:43 Call For Service Date Reported., 7/22/2006 Saturday 11:36 . Date Committed Start: 7/22/2006 11:36 Date Committed End: Received By: 113 -Napolitano,Jennifer Department: BARPD Description: BCI PHOTOGRAPHY.(713) CAD Seq Nbr: BCI:2006:1358 Event Type: CAD Agency: BCI Scene Location: Low House Nbr: 17 High House Nbr. Community Code: Street: Wolley Road Unit Nbr/Type: Intersection Street: City/State/Zip: Hyannis,MA Address: LGN: GEO Code: , Weather Conditions: Officer Information Officer Dt/Tm Dispatched Dt/Tm Assigned DUTm Arrived Dt/Tm Cleared Role S-58 Smith,Matt . 7/22/2006 11:38 7/22/2006 11:38 7/22/2006 11:57 7/22/2006 12:13 . Criminal ID Officer Offense Detail ISM 01 Offense Code: 609 literal. Arson and Bombing Statute: Status: Pending Status Date 07/22/2006 Criminal Activity.- CAD Offense Code: CAD Literal., BCI PHOTOGRAPHY(713) CAD Disposition: Clear Remark: Disposition: Related Records P62ff Record Module Record Number Dept Contact Officer Yes Incident A260735 000 Deputy Chief Melanson Officers92006 D NCIC: BCI Case Nbr.• 20061358 Licensed to Barnstable County Sheriffs Office Page 1 of 2 CC Barnstable County Sheriffs Department Case Number 20061358 (BCI) Incident Detail Report Printed On: Tuesday, July 25, 2006 Narrative On Saturday, July 22nd, services were requested by Hyannis Fire. On arrival, I spoke with Lt Kenney. I was advised that the residence had sustained a power surge, causing a small electrical fire and damaging several electrical appliances inside. At the direction of Lt. Kenney, photographs were taken with attention to the external electric meter, the fuse box in the basement, the furnace, a washer and dryer and several other various electrical appliance in the basement and main floor. One (1) set of photographs to be delivered to Deputy Chief Melanson-H.F.D. Licensed to Barnstable County Sheriffs Office Page 2 of 2 - - r `i i it � J FOR OFFICIAL USE ONLY Barnstable County Sheriff's Office Bureau of Criminal Investigation Date Reported 7/22/2006 Case Number 20061358 Description BCI PHOTOGRAPHY (713) " Scene Address 17 Wolley Road Hyannis, MA Contact Officer Deputy.Chief Melanson PD Case# A260735 Department 000 Officer S-58 - Smith, Matt 'I r� I A dV QUALITY PARK 9x12 I FOR OFFICIAL USE ONLY Barnstable County Sheriffs Office Bureau of Criminal Investigation Date Reported 7/22/2006 Case Number 20061358 Description BCI PHOTOGRAPHY (713) Scene Address 17 Wolley Road Hyannis, MA Contact Officer Deputy Chief Melanson PD Case# A260735 Department 000 Officer S-58 - Smith, Matt l j) I F v I �I yr IK I o ' ♦ Ix It 4.1 J< ' FOR OFFICIAL USE ONLY Barnstable County Sheriff's Office Bureau of Criminal Investigation ,•r Date Reported 7/22/2006 Case Number 20061358 Description BCI PHOTOGRAPHY (713) Scene Address 17 Wolley Road Q..- :308 133 Hyannis, MA d Contact Officer Deputy De ut Chief Melanson �Q* <^. PD Case# A260735 Department 000 Officer S-58 - Smith, Matt `� 0 s;r ;;: ---� ��' 0� i,!. l' � ® � � � a ,� �' ���-� I �' - _ �, �" _ . \ �� Ti � � �r -�`� -. '� Y� �r✓�� � .' a� � � � • ;m 1 FOR OFFICIAL USE ONLY Barnstable County Sheriff's Office Bureau of Criminal Investigation Date Reported 7/22/2006 -� Case Number 20061358 p ' Description BCI PHOTOGRAPHY (713) * ! 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FOR OFFICIAL USE ONLY 300 Barnstable County Sheriff's Office Bureau of Criminal Investigation ' Date Reported 7/22/2006 Case Number 20061358 Description BCI PHOTOGRAPHY (713) Scene Address 17 Wolley Road Hyannis, MA Contact Officer Deputy Chief Melanson PD Case# A260735 Department 000 Officer S-58 - Smith, Matt -c10 0 .r+ fir_. �f FOR OFFICIAL USE ONLY Barnstable County Sheriff's Office Bureau of Criminal Investigation Date Reported 7/22/2006 Case Number 20061358 Description BCI PHOTOGRAPHY (713) Scene Address 17 Wolley Road ' sSfO 133 i Hyannis, MA Contact Officer Deputy Chief Melanson PD Case# A260735 Department 000 a Officer S-58 - Smith, Matt 0 ,teas irk 41 Vt FOR OFFICIAL USE ONLY Barnstable County Sheriff's Office Bureau of Criminal Investigation s ; Date Reported 7/22/2006 Case Number 20061358 Description BCI PHOTOGRAPHY (713) Scene Address 17 Wolley Road K TS iJSOi3 130 Hyannis, MA WOW Contact Officer Deputy Chief Melanson PD Case# A260735 Department 000 Officer S-58 - Smith, Matt .a � i = � .�- r`-°'� � -®� �f �$. �■ '1 � c ' � i �w�� .� � �� � 'ti _� � !,� � �. 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