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0051 EMERSON WAY
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'.� � - v Parcel Detail Page 1 of 5 CLANS Logged In As: Parcel Detail Thursday,August 3 2017 Debi Barrows Parcel Lookup Parcel Info Parcel ID 188-025 I _ Developer Lot LOT 54 ~I Location[5 17 7EMERSON WAY 71 PH Frontage I100 Sec Road Sec Frontage Village Centerville I Fire District IC-O-MM I Town sewer exists at this address No i Road index 0502 r � Interactive Map Owner Info owner UNDERS,JON A&S co- O wner Owner streets 37 ROCKY LANE Street2r777777777777l city ICOHASSET � I state MA �I zip 02025-1350 country .. .I Land Info .............................................................._.........................................................................................................-................................................................................................................................................._......._........................._..................................................................... . Acres 0.26 ----]use Single Fam MDL-01 Zoning RD-1 (Nghbd 0106 Topography Level I Road Paved Utilities Public Water,Gas,Septic� Location Construction Info Building 1 of 1 s�ili 1967 struci Gable/Hip wii Wood Shingle RwaW. Living �296 cover Asph/F GIs/Cmp Type Central Style Raised Ranch wall Drywall Rooms 3 Bedrooms Model Residential Floor Hardwood - R om Full-0 Half Grade Total verage Plus Type Hot Water Rooms 7 � Stories 1 Story fuel GaS F ati n Poured COnC.� ea Gross 2952 Area • Permit History Issue Date Purpose Permit# _ Amount Insp Date Comments 6/18/2015 Restore to SF 201503781 $100 2/9/2016 RESTORE TO A SINGLE 12:00:00 FAMILY HOME BY AM REMOVING 1 BEDRM IN LOWR LEVEL REMOVING http://issgl2/intranet/propdata/PareelDetail.aspx?ID=12740 8/3/2017 Parcel Detail Page 2 of 5 ACCORDIAN DOORS ON 5' CSD OPENING TO BE STOR RW-FRNT STEP,DOOR SILL,RESHINGLE BACK 6/30/2010 DW, CLOSET FOR 4/28/2009 Repair Work 200901576 $5,000 12:00:00 WASHER/DRYER, AM REMODEL KIT, 26TH, REPL PRIVACY FENCE ON DECK Visit History Date Who Purpose 7/20/2017 12:00:00 AM Keith Markowski Cyclical Inspection 6/2/2016 12:00:00 AM Jeff Rudziak Sale Review 2/9/2016 12:00:00 AM Robin Benjamin In Office Review 7/20/2015 12:00:00 AM Tony Podlesney In Office Review 3/28/2012 12:00:00 AM Denise Radley In Office Review 12/15/2009 12:00:00 AM Jeff Rudziak In Office Review 1/16/2009 12:00:00 AM Denise Radley In Office Review 12/12/2008 12:00:00 AM Paul Talbot Cyclical Inspection 5/10/2007 12:00:00 AM Karen Perry In Office Review 1/6/2006 12:00:00 AM Paul Talbot Meas/Est 7/9/2001 12:00:00 AM Paul Talbot Meas/Listed-Interior Access Sales History Line Sale Date Owner Book/Page Sale Price 1 6/25/2015 SAUNDERS, JON A&STEPHANIE S C206627 $355,000 2 7/20/2009 CARRIERI REALE, LOREDANA&SILVIO C189058 $326,500 3 3/20/2009 NOWAK, STANLEY P & HIGHAM, THOMAS B C188164 $242,000 4 12/16/2008 FEDERAL HOME LOAN MORTGAGE CORPORATION C187543 $179,148 5 4/8/2005 DELAZARI, ODORICO 0 C176368 $337,500 6 11/26/2004 LEVIN, BELLE #D998468 $1 7 12/21/1993 LEVIN, PAUL S & BELLE C132389 $1 8 1/17/1977 LEVIN, PAUL S C69606 $45,000 - Assessment History .. .................. ........... ................. Save Building Total Parcel # Year Value XF Value OB Value Land Value Value 1 2017 $125,800 $64,800 $2,400 $132,300 $325,300 2 2016 $113,500 $38,500 $2,400 $133,100 $287,500 3 2015 $91,500 $40,600 $2,900 $128,000 $263,000 4 2014 $91,500 $40,600 $3,000 $128,000 $263,100 5 2013 $91,500 $40,600 $3,100 $133,200 $268,400 6 2012 $94,800 $39,800 $2,400 $158,800 $295,800 7 2011 $127,600 $17,500 $0 $158,800 $303,900 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=12740 8/3/2017 i Parcel Detail Page 3 of 5 x , 8 2010 $127,500 $17,500 $0 $153,600 $298,600 9 2009 $155,900 $24,300 $0 $183,400 $363,600 10 2008 $140,300 $24,300 $0 . $200,600 $365,200 12 2007 $139,500 $24,300 $0 $200,600 $364,400 13 2006 $121,700 $24,300 $0 $158,000 $304,000 14 2005 $113,700 $24,100 $0 $178,700 $316,500 15 2004 $92,300 $24,100 $0 $178,700 $295,100 16 2003 $88,700 $24,100 $0 $49,000 $161,800 17 2002 $88,700 $24,100 $0 $49,000 $161,800 18 2001 $88,700 $31,200 $0 $49,000 $168,900 19 2000 $67,000 $29,200 $0 $36,500 $132,700 20 1999 $67,000 $29,200 $0 $36,500 $132,700 21 1998 $67,000 $30,000 $0 $36,500 $133,500 22 1997 $114,800 $0 $0 $28,900 $143,700 23 1996 $114,800 $0 $0 $28,900 $143,700 24 1995 $114,800 $0 $0 $28,900 $143,700 25 1994 $103,600 $0 $0 $39,100 $142,700 26 1993 $103,600 $0 $0 $39,100 $142,700 27 1992 $118,000 $,0 $0 $43,400 $161,400 28 1991 $122,500 $0 $0 $57,900 $180,400 29 1990 $122,500 $0 $0 $57,900 $180,400 30 1989 $122,500 $0 $0 $57,900 $180,400 31 1988 $80,900 $0 $0 $22,100 $103,000 32 1987 $80,900 $0 $0 $22,100 $103,000 33 1 1986 1 $80,900 $0 $0 $22,100 $103,000 Photos ......................................................._......................................................................................................................................................................................................................................................................................................................................................................................................... ...... http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=12740 8/3/2017 r i% low NO. 1 '.` tt001 CRAIGVILLE REALTY,INC. MARTIN C. TRAYWICK P.O.BOX TWO WEST HYANNISPORT,MA 02672 TEL: (508)775 3174 FAX: (508)7715336 E-MAIL: martinclay@comcast.net www.craigvillebeach.com JUKE 2015 ` TO: COMM { r , RE: Certificate of Compliance ADDRESS: 51 Emerson Way Centerville,MA Dear COMM: In•hopes of coordinating a re-inspection for this address,I submit the following: 1. Copy of the last page of the purchase and sale agreement which required sellers remover the accordion doors leading into the suspect room. 2. Photograph of same room after sellers removed doors and furniture on Saturday, 13 June 2015. For what it's worth,there were no changes to these premises since current owners took title in 2009. Because the doors were vented and collapsible,they were not aware that constituted a bedroom. Buyers wanted them removed as they did not work properly. That said,we have moving vans scheduled to arrive today, and buyers taking occupancy tomorrow. I am highly motivated to accommodate buyers, sellers, lawyers, bankers and more importantly, the COMM, and am standing by to perform whatever duties required. Hopeful] , . T, r gville Realty,Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ,� Application Health #�� Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Y1 Village Ownerl—erlm Address��� Telephone G . Q e_Y Permit Request r� �? � � o1e'/-PI O® 4 D !r�PAY" Y le_. / cb G c 0 0" ��l� ( G6 O /i v Oc n�� +mil Square feet: 1 st floor: existing proposed 2nd floor: existing 4�eproposed � � Total new Zoning District Flood Plain Groundwater Overlay eject Va ul ationA. D Construction Type Lot Size 2= 4:�, Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family , Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ Nc On Old King's Highway: ❑Yes ❑ No Basement Type: ,Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) 4�' dO Basement Unfinished Area (sq.ft) ti 0 Number of Baths: Full: existing ' off- new.. Half: existing l new Number of Bedrooms: _ existing 6 new - Total Room Count (not including baths): existing 7-- new�_First Floor Room Count Heat Type and Fuel: U'das ❑ Oil ❑ Electric ❑ Other Central Air: des ❑ No Fireplaces: Existing Z New Existing wood/coal stove: ❑Yes SNo Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:,4existing ❑ 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 X7 Al�lephone Number �. �Ad' d- r—e C_ License # A �'-zHome Improvement Contractor# Email 6t-v hG a- Co M C,G 12 Worker's Compensation # ALL CONSTRUCTION DEB IS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNAT FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. t -S y ADDRESS VILLAGE OWNER t DATE OF INSPECTION: ' FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL _i FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f a E ne C61nmmn.3waI&of Mlissachissetts DqwAwmt of Indu hid Accide7as - Offwe of lumfigations•' 690 Washington,street Boston,MA#2111 . >w rmasxg�ov/&U Workers'Compeasation Insurance Affidavit: Buffiers/C ntractazs/Electddaus/Plumbers Applicant Information Flease Print b f Name - Ph�on�e CItyP'StabelTrrp: i Are you an employer?clieAtle appropriate box: Type of 1.El am a 4. ❑ I am a general contractor and I project(mod}: �'l (f and/or part-time) have hired the sub-coottachon 6. E]Neew' 2.❑ I am a sole prop rietor or-paainer listed on the attached sheet. 7- [ tRemodeling ship and have no employees These sub-contractors have 3. ❑Demolition. employees andhave workers' vuau�ing �me in arty i�- -9. ❑Budding addition [No woriceas'comp.insurance comp-mix 5. ❑ We are a corporation and its 10_❑Electrical repairs or additions 3. am ,eoveaer a hom doing all work officers ha'M exercised their l L❑Plumbing repairs or additions myself [No workers' right of exemption per MGL insurance ]T c.152,§1(4);and we have no 12.❑other repairs employees.[No workers' 13.0 Offe comp.insurance required-1 •Aay applicav�Out cbecU bau#1 mast also fill out the archon belorw sbowing�woakere cem on policy infn�im �1$a®eo=M who submit this atH z=hulkatmg they are doimg W vat and then hue oats a cGnUK1 s mast ch submit a stew affidavit iadicsom sack. aas that lconuacteck dtis boat must attacbed mm additional sheet showiG`Sg the name of the sa�b-ca=sam and state whethw ornat those enfifies ham' employees. Nthe su-mut=ors bm employees,tey mnscpmv de dWu wmkm''comp.pdIicY MMdW. I am an emplL,O,er fliat is proizding x orkers'comport s aton inmranre for my employees. Bdow is the poticy as job site informadom Insurance Company Name: Policy#or Self=-ins.Lit #: ExpiratsflnDate: Job Site Address: City/State/2ip: 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 -year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 vtim hereby fI' Pm pe Pg+7 P .z correct I doh cerfi s+td a 'ns nahres to that a rov�tded above is true and Deate. L Official use only. Do not write in f lis area,M be completed by city,or town ofciaL Y City or Town: Permit/License# Lssning Authority(circle one): 1.Board of Health 2.Bnffifing Department 3.C ity/Tawn Clerk 4.Electrical Inspector S.P lambing Inspector 6.Other Contact Person: Phone#: --- 6 Town ot,liarnstawe Regulatory Services ' Richard V.Sc dl Director BniIaiing I) sioxt _ Tom Perry,Building Commissioner KAM 200 Main Strom Hyannis,MA 02601 wwW towabarnsfablemans . Office: 568-862-4038 _ Fax 508-790-6230 _ HOM MAM UCEM EXEMTION �6--= leasePtint DATE /� ✓. _- JOB IDCAT ON: �' h-► e v� o y� �. �Y�/�� number shRd viIlage name homephone wow phone CURRENTMAMdNG ADDRESS : rip code The current exemption for"h-- —ers"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. DEFII MON W HOMEMM Person(s)who awns 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 tut the Building Official on a form acceptable to the Building Official,float he/she shall be responsible for all such work yerformed under the bidding pit (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"ceztifi he/she the Town ofBainstable Building Department minimum inspection Pro eats y with said pr�ceduuEs and requirements. gnat<ue of eownc leeL Approval of BuDding Official y, Note: Three-family dwellings containing 35,000 cubic feet or larger wM be required to comply with the Stare Building Code Section 127.0 Constmdion ConlroL HOMTsOWMIS MCEAMnON The Code states that: "Any homeowner performing work for which a building permit is required sbaII be exempt from the provisions of this section(Section 109.Ll-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that suclt 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 unTrcensed 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 My 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 fnrm/cerfir=tion for use in your community: :IWPFILFs'1FORM51bm7dm eimitfo�slII�RESS.doc � Revised 061313 , o� Town of Barnstable Regnlatory Services Rlduwd V.Scab,Director Building Division Tom Perry,Bwlding Commissioner 200 Maas Street,Hyamris,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 as Owner of the subject property hembyauthorize to act on mybehA in all mattexs relative to work authorized bythis buUding permit application for. (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are perfomed and accepted Signature of Owner Signatu re of Applicant Print Name Print Name Date Q:FORMS:owNWM MISSMIeOOIS 24 f bee i O i 54' BATH , DINING KITCHEN BEDROOM IIIQ d' - tV _ - - BEDROOM LIVING ROOM / BEDROOM 54' c /Vc f I � Deck l o f f 54' BATH DINING KITCHEN BEDROOM NJ LIVING ROOM BEDROOM BEDROOM 54' e / UTILITY LAUNDRY LH N 2 Gar Garage N FAMILY ROOM d 'f �r ¢ O t to 54, ? N UTILITY LAUNDRY BATH Car Garage - - N iV FAMILY ROOM STORAGE 54' 9 POWER OF ATTORNEY FOR REPRESENTING SELLER I, SILVIO CARRIERI, AN INDIVIDUAL of 18 POPLAR STREET, SUDBURY,MA 01776, THE PRESENT OWNER OF 51 EMERSON WAY, CENTERVILLE,MA 02632, do hereby constitute and appoint MARTIN C. TRAYWICK of 648 CRAIGVILLE BEACH ROAD, WEST HYANNISPORT, MASSACHUSETTS, 02672, as my true and lawful attorney to represent me in all things necessary to file for and obtain a building permit with the Town of Barnstable for the purpose of converting the premises located at 51 Emerson Way, Centerville MA into a single family, three bedroom residence. This power of attorney shall not be affected by the subsequent disability or incapacity of the principal(s). i i i Executed as a sealed instrument this day of June,2015. SILVIO CARRIERI I STATE OF MASSACHUSETTS County of Barnstable On this day of June 2015,before me,the undersigned Notary Public,personally appeared SILVIO CARRIERI,and proved to me through satisfactory evidence of identification, which were MA Drivers License,to be the person whose name is signed on the preceding document,and acknowledged to me,that he signed it voluntarily for its stated purpose. i My commission expires: f- . Doc-: iv11.9,321 07=24-2009 11 _26 I Ctf :: 189053 BARNSTABLE LAND COURT REGISTRY i QUITCLAIM DEED WE, STANLEY P. NOWAK and THOMAS B. HIGHAM, c/o P.O. Box 550, Barnstable, MA 02630 For Consideration paid in the amount of THREE HUNDRED AND .TWENTY-SIX THOUSAND AND FIVE HUNDRED AND NO/100($326,500.00)DOLLARS grant to LOREDANA CARRIERI!REALE 56/100 ownership. and SILVIO CARRIERI, 44/100 ownership,as Tenants in Common,of 18 Poplar Street,Sudbury,MA 01776 i with QUITCLAIM COVENANTS the following described premises: The land with the buildings thereon situated in Barnstable (Centerville), Barnstable County, Massachusetts more particularly described as follows LOT 54 AS SHOWN ON LAND COURT PLAN 24614-E(Sheet 2) Subject to and with the benefit:of all rights,rights of way,reservations,easements, appurtenances and restrictions of record insofar as the same may be in force and'applicable. For my title,see Certificate of Title No.. 188164. PROPERTY ADDRESS: 51 Emerson Way,Centerville,MA 02632 I MA-SACHULETTS STATE-EXCISE TAX t BARNSTABLE LAND COURT. REGISTRY I Date: 07-20-2009 ? 11:26am Ct1It 742 Doc`.: 1119321 Fee: 4P 116.63 Cans: b326r500.00 } ' B,,ircN.STfLBLE COUNTY EXCISE TFV {' .;RW,1' A2,LE LAh,D COURT REGISTRY mate: i17-20-200 3- 11:26a,-;-! C i 1.2 GocY: I119�21 Fee.' 1331.55 Cons: $326,5011.011 , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r -1 Map Parcel dµ Application # �� I Health Division Date Issued 3 Conservation Division Y,Application Fee 1 Planning Dept: 'Permit Fee Date Definitive Plan Approved by Planning Board 9 09 Historic - OKH _ Preservation / Hyannis ; Project Street Address Elm ig rs9�-, e Village /✓lc�hl�i I�� Owner'Fe N di/✓l2 Loctn Address PX7 o n e5 r ph y i V16 Telex ve Act I- tc>tb - t Permit Request Rem d t/e �a( I � �cl2 �t;h��S r �i��f i S I Cf YI G� "` 11 o r er to er be, r 'Vo Square feet: 1 st floor: existing[I Hproposed I 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio _ 10�C Construction Typew��, Lot Size ® ClUeS Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family . Two Family ❑ Multi-Family (# units) Age of Existing Structure lj6 7 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl R' Valkout ❑ Other Basement Finished Area (sq.ft.) 890 Basement Unfinished Area(sq.ft) 3 5-y Number of Baths: Full: existing new Half: existing new Number of Bedrooms: _S existing _new Total Room Count (not including baths): existing new First Floor Roo;rim Count Heat Type and Fuel: eGas ❑Oil ❑ Electric ❑ Other �—, �2 h Central Air: ❑Yes LOr No Fireplaces: Existing New Existing wood coal stove: U.-Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑existing ;.)❑ new size_ Attached garage: Wbxisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: c�a Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes o If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) .Name Telephone Number � ��� Address �.� License # ^C a Home improvement Contractor# " so= Worker's Compensation # 1 A CONSTRU TION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Ya+�'hS1�� �i ns ��'e42d . SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED 'c MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r 3 4`09 DATE CLOSED OUT ASSOCIATION PLAN NO. l 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/Orgmization/Individual): \ `,�11•� Address: City/State/Zip: 0'e. �� 1 Phone.#: ® -(�D e you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 1 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction ..2.0 I am a'sole proprietor or partner- listed on the-attached sheet T. E]Remodeling ship and have no employees These sub-contractors have 8. 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 '10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other cbmp.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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: 1 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 finq tip 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 maybe forwarded to the Office of Investi ations of t1mD1A for insurance coverage verification. Ida hereby ertify nder the pains a es o that the information provided above is_ a and correct -� . Si store: Date: Phone#: 6 Official use only. Do not write in this area,tb be completed by city or lawn officiaL .City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#:• Information and Instructions ; Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the aintenance, construction or repair work on such dwelling house dwelling house of another who employs persons to do m 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 aZth 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, it necessary,supply sub-contractor(s)name(s),addresses)andphone number(s)along with their certificates)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to 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 permittlicense 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 oit#en is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax number: The Commonwealth of MassaGhusQM Department of Industzill Accidents Office of IakestigadQns• 600 Washington Street Boston,MA 02111 TO. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727=7744 Revised 11-22-06 www.nmass.goy/dia ILe: 6/24/2008 Time: 11:00 AM To: R 9,15087906230 Page: 002 Client#: 9580 2KPRE ACORM CERTIFICATE OF LIABILITY INSURANCE o6z4/2008 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR g y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyanough Rd., PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Associated Employers Insurance Compa - Kenneth Perry D/B/A INSURER B: K.P. Remodeling&Construction INSURER G: _ 19 Guildford Road INSURER D: Centerville, MA 02632 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH. POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSR - TYPE OF INSURANCE POLICY NUMBER DATEY D MMF /YYE POLICY) D DATE MM/ /YY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED REMISES Ea occurrence $ _ CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS 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 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND WCC5005450012008 06/13/08 06/13/09 X. WC STATU- O FIR EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT $1 OO,000 OFFICER/MEMBER EXCLUDED? YES E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS r Job: 213 Ocean Street,Hyannis, MA ( - C_ Kenneth Perry is excluded from coverage under the workers compensation policy. Operations performed by the named insured subject to policy conditions N cc and exclusions. cn, z� 7-L CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED EFORE THE�EXPIRATI9TJ Town of Barnstable Bldg DIV. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS-*RITTEN Attn: Tom Perry-Commissioner NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAI RETO DO SO SHALL 200 Main Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Hyannis, MA 02601 REPRESENTATIVES. AUTHORIZED R€PRESENTATIVyE^ 4CORD 25(2001108)1 of 2 #S52501/M52484 LS1 © ACORD CORPORATION 1988 �`. HOME IMPROVEMENT CONTRACTOR Registration: 132282 Expirat�on _.12/21/2010 Tr# 278840 — pe BiA t , K.P.REMODELING KENNETH PER 19 GUILDFORD RD Centerville,MA 02632`=* Administrator 0 f _ Board of Building Regulations and Standards Construction Supervisor License License: CS 76820 @#thdate 8t28/1965 Exp ri atiort g%2$12009 Tr# 2373. ; r Restriction 00`r KENNETH O PERRY`,, 19 GUILDFORD ROAD_. •-w �'"�— �� : CENTERVILLE,MA 02$32 Commissioner } n , i ...... .only - valid for►nd►vidul°to. or re$istratjp° i{found return tice►►se irafion date. gtapdards pefore the e . Regnlat►ons a°d uild►ng ! and of 1.B Rn'1301 � $0 urton'Place ; One pshb 02108 Boston,Ma' ' °utsignature i � valid with .�.---- 1 , Town of Barnstable Regulatory Services . ABS. Thomas F.Geiler,Director i639• �� �Eo . Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstible.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I,W6V Q 1 40-vw r 6 a_v� M6A* 1,i er of the subject property hereby authorized to act on my behalf, in all matters relative~to work authorized by this building pe rmit application fo : (Address of Job) ture of er 'Fe 2 Date Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse•side. Q:FORMS:O WNERPERMISSION sett: Town of Barnstable Regulatory Services sAsxsrwsM : Thomas F.Geiler,Director 16.19. .�� Building Division AIED Tom Perry,Building Commissioner 200 Maiti.Street,_Hyannis,MA 02601.. 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: cityhown state rep 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. DEFON OF HOMEOWNER INITI 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 "horneowner"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 build 9 Rermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Cods 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 exerrnpt from the provisions of this section(Section 109.1.1-Ucensing of construction Supervisors);provided that if the homeowner engages a pa sons)foe hire to do such worlc,that such Homeowner shall act as supervisor." Many homeowners who use this exemption an unaware that they art assurning the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness oftern 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 erasure that the homeowner is fully aware of his/her responsibilities,ties,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 can t arnrnd and adopt such a form/certification for use in your community. Q:fomns:homcexempt cti VJ C enfe. r Vl1le dS e rooAi rc caf i o n5 Orr e Co uA p( i o nc e NO C,Q l ,L +Zvi dov- a OLI I Boo (P' fo- �o ( io a. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION,, Map 0 Parcel : Application #�� 5 Health Division Date Issued , Z� Conservation Division .;Application Fee O` Planning Dept. Permit Fee: Date Definitive Plan Approved by Planning Board Historic _ OKH ,_ Preservation/Hyannis Project Street Address1'►�1 Village `�- Owner 2N.1m,le.y Q'. l�->'t1 cV�'FYK (`Y�G4vtc�s f�, '1 i�i � � Address f','�', /I- dx LS371i 4,,t" 4 d Z( & Telephone �'7�����\��' LO6"71�z _ `7F/yS Permit Request P F S 'Aid -,b&e4 9MW,U,, do�J- Ao 4(JEA G-_'l oe A&AtecAd ff(*e_kA4,� '1, Square feet: 1 st floor: existing 11716 proposed 2nd floor: existing proposed Total new ( Zoning District Flood Plain Groundwater Overlay Project Valuation f O Construction Type Lot Size f Grandfathered: U Yes ' ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ,�1, Two Family ❑ Multi-Family (# units) Age of Existing Structure / ( 7 Historic House: ❑Yes AA.Ng On Old King's Highway: ❑Yes Alo Basement Type: ❑ Full ❑ Crawl NtWalkout ❑ Other [A"AA-, Basement Finished Area (sq.ft.) —� Basement Unfinished Area (sq.ft) S� Number of Baths: Full: existing-. new Half: existing ® —new—0 Number of Bedrooms: 3 existing ©new Total Room Count (not including baths): existing 77 new 0 First Floor Room Count Heat Type and Fuel: >Gas CIF Oil ❑ Electric ❑Other Central Air: ❑Yeslo Fireplaces: Existing OL, New ® Existing wood/coal stover YesANo Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑e ingew size_ Attached garage:)kexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ w ca rn Commercial ❑Yes Flo If yes, site plan review# Current Use F� i emus Proposed Use alp -C APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number 5-0 7-` 77 5- 9287 Z Address 149 OAK A ZK r-O License # 0 k>K4 e_ T 1 S O/ Home Improvement Contractor# 27 -1�(_/SZ_ Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO FA_0 i'V e L__�f'v(5 P::-( L�__ SIGNATURE r DATE ! 2� `t FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE �C • OWNER DATE OF INSPECTION: FOUNDATION I FRAME INSULATION I N � r FIREPLACE F+ x ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 3 FINAL BUILDING A b og ,W DATE CLOSED OUT ASSOCIATION PLAN NO. R �t Town of Barnstable o Regulatory Services BAMSTABM ; Thomas F.Geiler,Director 9q, '� Building Division RFD MAr A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 0 JOB LOCATION: number stre t g village "HOMEOWNER": 6L 5 name �{ home phone# work phone# 4CURRENT MAILING ADDRESS: V 00L y Aj'e- u 6- wV" JS . 6ZGo1 ci /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,byl».vs,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. SigrAture 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 form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC THE Town of Barnstable Regulatory Services B"M 'KAM ` Thomas F.Geiler,Director 163;9. � 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 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 If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FO RM S:0 W N ERP ERM IS S ION The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 i� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ( Please Print Legibly Name(Business/Organization/Individual): m MA ram¢ Q, . Pa Ii] .✓� Address: City/State/Zip: - Phone.#: �- Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a er w employer 4. ❑ I am a general contractor and I p y 6. ❑New construction ployees(full and/or part-titn.e).* have hired the sub-contractors .2 I am a sole proprietor or partner-' listed on the attached sheet. 7.. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑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.)Z I am a homeowner doing all work officers have exercised their I I.El 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.[—_1Other comp.insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. [Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M 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 tip 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the pains and penalties ofperjury that"'he information provided above is true and correct Sizaature: - 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#: 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-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of X 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 perm-tVlicense 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 pemut 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia No, r �)Il U �. fir,vn cc fGron ' (1 —''t Entered in Fee coin uteri .THE COMMONWEALTH OF MASS CHUSETTS p PUBLIGHEALT.H DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplicotion for Miopooa[ *potem Con!6tructi6n Permit Application for a Permit to Construct( )Repair 06 Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. I e),5 Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Den ner's N ree A��ddress and Tel.N . �, 7 �`� © � ty\wC. CSc11 'v"' Cam \ Type of Budding: Dwelling No.of Bedrooms_ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design:Flow gallons per day. Calculated daily flow gallons. Plan Date -Number of sheets Revision Date Title Size of Septic Tank ,Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) -F�,l.I el YI A 1 C I� '"� Date last inspected: Agreement: The undersigned agrees to ensure-the construction and maintenance of the afore described on-site sewage disposal system in accordance'with the provisions-of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been' ue y t ' Bo ealth. Signed �� Date Application Approved by Date 2 Application Disapproved Ur the following reasons Permit No. a U US-- 6 1,P Date Issued 46 2. G THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE MASSACHUSETTS Certificate of Compliance THIS IS TO CEEB FY, that the O -site Sewage Pisposal System Constructed( )Repaired A ) Upgraded Abandoned( )byAff at t P i I. _ has been constructedin accordance with the provisions o Ti 5 and the for Disposal System Construction Permit No.. 3 O&S 014 dated 3 Installer \'Cc t il.Ga�A.,l� I 'Designee The issuance' this a shal hot nstrued as a guarantee that the sys�-_ 11` u c ion as desi ned. Date � � Insped t-Qr___tl_ "'�^~ No. D Fee THE COMMONWEALTH OF MASSACHUSETTS -PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Iopoo f *potent ColYotruction Permit . a= Permission is herebyranted to Construct lke air U 'ade ) g ( ) P � ) Pg Abandon( , � �y System located at and as described in the above Application for Disposal System Construction Permit. The applicant recogniies his/her duty to comply with'Title 5 and the following local provisions or special conditions. ` Provided: Construction must be completed within three years of the date of thi ermit. Dats: l .a a — Approved by h '- Barnstable Assessing Search Results Page 1 of 3 a Home: Departments:Assessors Division: Property Assessment Search Results New Search F New Interactive Maps >> Owner: 2009 Assessed Values: FEDERAL HOME LOAN MTG CORP 51 EMERSON WAY Appraised Value Assessed Value Map/Parcel/Parcel Extension Building Value: $ 155,900 $ 155,900 188 /025/ Extra Features: $24,300 $24,300 Outbuildings: $0 $0 Mailing Address Land Value: $ 183,400 $ 183,400 FEDERAL HOME LOAN MTG CORP Totals $363,600 $363,600 8250 JONES BRANCH DRIVE Residential Exemption Received=$100,964 MAILSTOP A62 - MCLEAN,VA.22102 2009 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Community Preservation Act Tax $54.37 Fire District Rates Town R4 Barnstable FD-All Classes $2.37 $6.90 C.O.M.M.-All Classes $1.08 Town Ci C.O.M.M. FD Tax(Residential) $392.69 Cotuit FD-All Classes $1.43 $6.12 Hyannis-Residential $1.78 Town Tax(Residential) $ 1,812.19 Hyannis-Commercial $2.77 p � W Barnstable-All Classes $2.11 h" Total: $2,259.25 Construction Details BuildingProperty Sketch & ASBUILT Property Sketch Legend Building value $ 155,900 Interior Floors Hardwood Style Raised Ranch Interior Walls Drywall Model Residential Heat Fuel Gas Grade Average Heat Type Hot Water http://www.town.bamstable.ma.us/assessing,,/2009/displayparcelO9map.asp?mappar=188025 2/25/2009 i =-' -Barnstable Assessing Search Results Page 2 of 3 Stories 1 Story AC Type None Exterior Walls Wood Shingle Bedrooms 2 Bedrooms Roof Structure Gable/Hip Bathrooms 1 Full+ 1 H # Roof Cover Asph/F GIs/Cmp living area 1296 Replacement Cost $185621 Year Built 1967 3h , Depreciation 16 Total Rooms 5 Rooms Land f � f CODE 1010 -% Lot Size(Acres) 0.26 Appraised Value $ 183,400 AsBuilt Card N/A Assessed Value $ 183,400 ' View Interactive Maps > Sales History: Owner: Sale Date Book/Page: Sale Price: DELAZARI, ODORICO 0 Apr 8 2005 12:OOAM C176368 $337,500 LEVIN, BELLE Nov 23 2004 12:OOAM DD/N $ 1 LEVIN, PAUL S&BELLE Dec 15 1993 12:OOAM C132389 $ 1 LEVIN, PAUL S C69606 $0 Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL1 Fireplace 1 $2,500 $2,500 FPO Ext FP Opening 1 $700 $700 BGAR Bsmt Garage 2 , $6,700 $6,700 BLA Bsmt Liv-Aver 688 $ 14,400 $ 14,400 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 GRIN Greenhouse UUA Unfinished Utility Attic , FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story (Unfinished) http://www.town.bamstable.ma.us/assessing/2009/displayparcelO9map.asp?mappar=188025 2/25/2009 Town of Barnstable OFTHB, '4• Regulatory Services c Thomas F.Geller,Director i Building Division IIAItNSTA13IX — MAS& 163'9. �$ Tom Perry,Building Commissioner � �fD MA'I a 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us ffice: 508-862-4038 F • 508-790-6230 Approved: Fee: ed Permit#: HOME OCCUPATION REGISTRATION Date: C` 10-4/0 5 _ Name: ODO IV G0 VC 4A2-A!Z4 Phone#• Address: 5/ Ps C)N WA`/ Village:_ Name of Business: 1 Z (� /" PA ( NC, �•A� Type of Business: )Uw,41-L CO�rttZA C-rD ?- Map/Lot: g 0 oZ 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�isual 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 a Occupation is listed or advertised as a business,the street address shall not be included. • No perso a employe a stommy Home Occupation who is not a permanent resident of the dwellin the undersign ead and a e above restrictions for my home occupation I am reeg;istertu applicant^ G Date• O ell Iomeoc.doc Rev.5/30/03 l II 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, 1s` FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: 105 Vk Fill in please: APPLICANT'S YOUR NAME: 0)VAIC0 15 4.42.4FL! BUSINESS YOUR HOME ADDRESS: 5 t-1rtC,2-SOAL-WAY G S. TELEPHONE # Home Telephone Number �59JR NAME OF NEW BUSINESS LA2AZi ALI 9 3412W40 . TYPE OF BUSINESS IS THIS A HOME OCCUPATION? ?C YES NO Have you been given approval from the building division? YES NO V ADDRESS OF BUSINESS fV - MAP/PARCEL NUMBER I O o V ` When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S O I E This individual has Peen infor of any permit requirements that pertain to this type of business. Aut orized Signa u COMMENTS: c/ 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: I ,. ' I i I, � I I I ' I i_ I ' � � � �- Y� � ' ' �, �v G 5� � T �� � � I � I � � � I i i I � j : i i p �. � � � ._— � ' i 4,. 'I - 'I - i I I ' . '.. � - ... .._... .. _._._ ..._�..,..... a ' �-. �. �. ., I • . _. � I ..- ,. �. 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