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'' , ��,;�i .""��,,t�",!"",����.��,,--,,�.'t*���,,�.,,,,�,,,�,�L�,iL,�4,��t��;,,���:,,�i"��',Ilwol"otzow '--;,,j%i!P i, ., ,�� , . � "�.� 7 ,i4�', J, ,� `,,.�kit,�.,, , A , 'er�_ ,�i , I, __ �11:� - ",',,�L -,i:, " ;i""�,,�: m ,�,:t�,i 11 1:E I �q) --i `� ,�; � 1 , � ���f` 0,"ISMAIJ,Q�:1, ,. . , , - , , , , , � , i �".�,,�,,, - , ­W M 1 W, ,.�i' ,�,,, ,�A � - I ",MICRON.=1� 0 Y:v�,,,,� ,!t,t�Lt.""',�, IAAIIYD:1 Town of Barnstable- *Permit#9 Q " Expires 6 months from issue date X-PRESS PERMIT Regulatory Services Fee 4as.n 0 Thomas F.Geiler,Director •, FEB 2 4 2006 Building Division TOWN OF BARNSTABLE Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.townbamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X Press Imprint aPP/ arcelNumber VI j�,�� 71leside Address � � O-'� - y—dntial Value of Work =�19 — ' Vuminimum fee of$25.00 for work under$6000.00 s Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) 2 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑�I am a sole proprietor [� I am the Homeowner , ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) a [�(Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) EiRe-side (Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Ho rove Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 The Commonwealth'of Massachusetts Department oflndustiial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 .•� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AVVHcant Information Please Print Legibly Name (Business/organizationdndividual): "'`x g Address: City/State/Zip: CQf t ( k Phone#: .. Are you an employer? Check the�appropriate box:. Type of project(required):- 1.❑ jam a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. workers' comp. insurance. 9 y p ty. ❑ 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. I am a homeowner doing all work right of exemption per MGL 11.0 P umbing repairs or..additions.. myself.-[No workers' comp. a 152,§1(4),and we have no .12. R of repairs insurance required.] t employees. [No workers'- 13.[/Other 1 I comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affi&Mt indicating such. Contractors that check this box must attached.an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. ram an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site reformation. ' murance Company Name: ?olicy-#or Self-ins.Lie.#: Expiration Date:, lob Site Address: City/State/Zip: r kttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ?aihire to.secure coverage as required under Section.25A of MGL c. 152 can lead to the imposition of criminal penalties of a he 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 if up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of . nvestigations of the DIA for insurance coverage verification. do hereby certify unde pains an penalties ofperjury that the information provided above is tr[eandcorrect, 3i afore:. Date:' ?hone#: Official use only. Do not write in this area,to be completed by city or town offtciaL City or Town: Permit/License# Issuing Authority(circle one) : 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information an. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an egtployee 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-contractors)name(s), address(es) and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Parhierships(LLP)with no employees other than the members or partners; are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of 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 lime. 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/licensenumber 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 thata valid affidavit is on file for future permits or licenses..A new affidavit must be filled out.each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office'of Investigations would like to thank you in advance for your cooperation and should you have any questions, please.do not hesitate to give us a call. The Department's address,telephone and.fax number: The Commonwealth of Massachusetts . Department of Industrial.Accidents Office of Itnvestiga#ons ~ r 600 Washington S�treet� Boston,MA 0211 L. Tel. #617-727-4900 ext 406 or-1-877-MASSAFE Fax#617-727-7749 Revised 5-2&05 www.mass.gov/dia �FIKE loy, ' Town of Barnstable Regulatory Services BAMSTASM ` Thomas F.Geiler,Director jOkF039. � Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name Q:FORMS:0%MRPERMISSION 4 ✓�ie�omsnuouuea�C gt°✓�aaaaclucaek� r } Board of Building Regulations and Standards License or registration.valid for individul use only HOME I!AOVEMENT CONTRACTOR before the expiration date. If found return to: Rea..tw<<it�n.< 24310 Board of Building Regulations and Standards / �007 One Ashburton Place Rm 1301 -- �`i4idual Boston,Ma.02108 James Curley ar P James Curley 287 Fuller Rd. Centerville,MA 02632 Administrator Not valid without signa re i� y , rV y�FTHETO�YTOWN, OF BARNSTABLE BARNSTABLE. ,639- a OR BUILDING IP�PECTOR e APPLICATION FOR PERMIT TO . ��.( .C_ ..................................................... _. �. z� ....&: ....... TYPE OF CONSTRUCTION ...... ......... .......................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The-undersigned-hereby--appl ies-for-a permit according to -the-following information: ........................ Location ..... .........e.. .......... . ..... .(.2..1.......................... ProposedUse ..................................................................................................... ....... ... ............. ................................Fire District ...Zoning District ..... . .... ....... Name of Owner ..... SdrCe)ss .................. Name of Builder ..Address Name of Architect Address .................................................................................... Number of Rooms ..........S-'-�­f K ......... inlpl.Y'. Exterior .... .W. ...... ...........Roofin F............ Floors ....... ........ ............................Interior ........ (z Heating ... ...Plumbing ........ ........................ ...................... Cost ....... ......................................................... Fireplace ................ ............*...........................................Approximate Difinitive Plan Approved by Planning Board --------------------------------19--------- -.*,xf47 Diagram of Lot and Building with Dimensions LU t Ld o _j 0 < co rL 1-- f_ < V) U) - I �_ 0 z —< co X Ls1 0 < U_ LL ,0 ZD LL1 CPOAG-C 0 > 2: X 1_31y� j�: < Ld x LLJ 0 Li_ ry 17— M < < a Ld V) (10 z ­70 Uj Ld < < r) < LU U Crt _J < . LLJ U I < co < I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .............. ..... . ... ..................... Trisorio, Edward S. DEC 3 1 1970 12588 one story, 0 �,CNd . Permit for ... ................ i `'N• single family dwelling-garage ........................................................... / Bumps River Road Location ........... ...................................::e Centerville Owner .........—Edward S. Trisorio .......................... ......................... Type of Construction frame ........................................................................... Plot ............................ Lot ................................ Permit Granted .........September .2 19 69 _ a • 9 r "� _ Date of Inspection .........19 7z9 Date Completed ......................................19 N PERMIT REFUSED - l\ ......... ......................................:............ 19 .................................................. ............ ...... - L N .............................................................. .............. ............................................................................... w Approved .,,..,.......................................... 19 ............................................................................... . ............................................................................... L 1 6?( �V j / v SUMMONS (DUCES TECUM) 424 �i �l� �J G'G4/1�Y/✓ ��� ' D Middlesex ........................................................Me 1& Building..Inspector of Town .. ... ................................... of Centerville c/o Hyannis Building Inspector ' s Office, Town ....•.....•....•uu•uu•......•u......•.a•..+u•:.••n.•.:•:.:..::u.:•::.,..u..,..:.:.•:..•u..:•:.........::.:.:.:..::....:::•::••::a•a:aa•:::aa::a::aaaa.aa Hall , Hyannis , Massachusetts ....................................................................................................................................................4............... ......................................................................................................................................................greeting. Unit art 4rrrbg rrgit1rrb, in the name of The Commonwealth of Massachusetts, to appear before the...D,istrict......................................Court.......�41 Hurd Street).................................. holden at...Lowell ....within and for the county o f........Mid d l e sex ........ ... ........................ th April on the................... . .........da o .............9.:.3 0..............o$clock in the... forenoon, and from day to day thereafter;until the action hereinafter named is heard by said Court, to give evidence of what you know relating to an action contract of........................................then and there to be heard and tried between...............................e.......... . ...Richard C. DeSantis and Claude E. Gilbert .Plaintiff , and .................................................................................................................................. Edward S . Trisorio .O. ............................................................................................................................Defendant , and you are further required to bring with you..all• books , flans .. records , building ........ ........................... permits and other written material dealing with the construction . .........................................................................:.........,.........................................,.............:........................ of 882 Bumps River Road, Centerville being constructed during the •............................................................................... .......... •.....................0.............................................. year 1969-1970 , builders Richard C. DeSantis and Claude E. Gilberto . ...................................................................................................................................................................... Owner Edward S . Trisorio ...................:.................................................................................................................................................. ...................................................................................................................................................................... . •..........00......0.0.......0..........0..0...0...00..00.0.0.0.....00.0.0........0......0......0.0...0..0.0...0.00.......000..00..0.................0................. 14trznt fate nit, as you will answer your default under the pains and penalties in the law " in that behalf made and provided. , „ Chelmsford..o..........................the.......30th...................da ® March.............. 3�rte� ....... f... A. D. 19 73 , " e�f.f .. .............. ... .... .. ................................... T RICHARD L. FOX No Public--� My; commission expir o MaySv 1978 FORM 494 H01355 a WARRB ,,INC.. PUBLISHERB BOSTOH c