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HomeMy WebLinkAbout0010 EVSUN DRIVE F 'a P .0 o o � . � � ., o � x � o a � . g C � � .a � 9 a. v 7 O � � .. 'i - A. �� � � p .. a � oF1 r Town of Barnstable *Permit# 09- , 614 11 Expires 6 months from issue date Regulatory Services Fee ems, twxMA Thomas F. Geiler, Director �4 Jos/off' q�p 16�9 akE.SS PERPAITBuilding .Division SEP — 2008 Tom Perry, CBO,.Building Commissioner Building Main Street, Hyannis, MA 02601 TO www.town.barnstable.ma.us �/N OF BARNSTABLE Fax: 5087790-6230 Office: 508-862-4038 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY // Not Valid without Red X-Press Imprint Map/parcel Number Property Address �[� LE y SV 1V Q Residential. Value of Work _13 6_0 Minimum fee of$2S.00-for work under$6000.00 Owner's Name & Address a3 I\j 14 ,,i- \E CL it s Cat% CA\j,c ttr Contractor's Name Telephone Number Home Improvement Contractor License# (if applicable) ❑Workman's.Compensation Insurance Check one: ❑ I am a sole proprietor [�am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must The on file. Permit Request(check box) ❑ Re-roof(stripping old shingles.) All,construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) S -side e- Lac ❑ Replacement Windows/doors/sliders. 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. A copy of the Home Improvement Contractors License is.required. SIGNATURE: Q:\WPFILES\FORMS\building permit fonms\EXPR_ESS.doc Revise'920108 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.m-a-ss.govldia Workers' Compensation Tnsnra.nce Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leubly_ Namf, (Businessiorkaniza6on/Individual): t �''`0 1 4 y A c- l b w City/Statdzip: Cc�•, cf 14,V Phone.#: S-� 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 6. ❑Ne construction ti employers(full and/or part-time).* have hired the shb contractors 2❑ I am a sole proprietor or partner- listed on the attached sheet 7. Remodeling ship and have no employees These sub-contractors have g• ❑Demolition employees and have workers' working for me in any capacity. 9. ❑ $vilding addition [No workers' Conte.m nr_c comp-in uran�'$ ec1] 5. ❑ We are a corporation and its 10.0-Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised thrir 11.[]Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12 ❑goof repairs c. 152, §1(4), and we have no inmu-m=required.]t craployees. [No workers' 13.[] Other comp.msurancc required.] «/wy applicant that checks box#1 roust also fill out the section below showing their workers'cornp*nsaSian poficy information. . t Homeowners who'submit this of davit indicating trey an:doing all work and tliai hire outsider contractors must submit anew affidavit indicating such. tContractors that check this box nrna-t zttm'he;d an additional sheet showing the name of the sub-contraztEn and slate whether or not thosd rntitics have cmpioycrs. If the sub-cantractms have employees,they must pravi&their workers,armP•po&cy number. lain an employer that is prcviding workers'compensation insurance for my employees. Below is the policy acid job site information. Insurance Company/darne_ Policy#or Self-ins.Lic.#: Expiration Datc. fob Site Address: City/StatclZip: Attach a copy of the workers' compensation policy.declaration page(showing the policy number and expiration date). Failure to sccurc coverage as Irequired und.cr Section 25A of MGL c. 152 can lean to the imposition of erimiig peml-tics of a line tip to$1,500.OD and/or one-year irprisonrncnt, as well as civil penalties in the form of a STOP WORK ORDER and a f nt of rip to$250.00 a day against the violator. Be advised that a copy of this statcmcrit rcay be forwarded to the Office of Inycstigatims of the DIA for tncirr•anc e cover& e verification. I do hereby c T the -and penalties of perjury that the_information provided above rs true and correct Si c: Data: Phone-1 O Reid use only. Do not write in this area, tb be completed by city or town offcciaL City or Town.: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Toym Clerk 4.Electric-al Inspector S.Plumbing Znspectar 6. Other Phone#: Town of Barnstable O F THE r " Re ul for Services a r saxrtsiesr t Thomas F.Geiler,Director MASS. q, 0.19. Ib Building Division PIED���a Tom Perry,-Building Commissioner 200 Main Street, Hyannis, MA 02601 w vv.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 9 G " JOB LOCATION: U VS V ¢v JI�LV L Cc r number �- street village "HOMEOWNER": name / home phone# work phone# CURRENT MAILING ADDRESS: 3 ��ai�LiZvtt Cyr 11-L U)- C 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 re u' t,- -that he/she will comply with said procedures and eme 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 12T0 Construction Control FIOMEOWNER'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 lo9.I.I-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(sec 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 Hith a IiCensCd Supervisor. The homeowner acting as Supervisor is ultirnately responsib)c. 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 fomVcertification for use in your community. 'THE t, Town of Barnstable Regulatory Services MASS..3 Thomas F. Geiler,Director �p 16.9. �m r�o a Building Division Torn Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 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: t (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeoamers License Exemption Form on the reverse side. Town of Barnstable *Permit#'a(901 �r tip Expires 6 months from issue date Regulatory Services Fee aaiuvsrAsie, �� Thomas F.Geiler,Director 9`b,�lEo A�►•w .ZO p� Building Division ) 43 bkv T� Tom Perry,CBO, Building Commissioner BA�'1IVSTABLE 200 Main Street,Hyannis,MA 02601 www.townbamstable.ma.us Office: 508-8624038 Fax: 508-790-6230 - EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint D (�Z Map/parcel Number Property Address / 0 1✓.i 5 v Z��C �. c�:�i�'cZ\j c L I"I y4 0 4 '3 Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address W b X i<S ; j,�,, 5 — I K, .,, 4 C_1 v / o L vS�P N ��� �� ��:�vZ•(Z. v� c,t� i��. off- G3�? . Contractor's Name EC Li Telephone Number Sb -S�4 4-._a-G'•t°'` Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor 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) - �e-roof(stripping old shingles) All construction debris will be taken.to 134R S i3 t v.,t., ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,-etc. . ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of.the Home Improvement Contractors License is required. SIGNATURE:" Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 I r ,J 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): t I 4 �� C_ 1 6 w Address: 3 X N,c t o a• t< T"i� City/State/Zip: Cram•,t p vt t�L C Phone.#: 5-9 -S G 4 -ri G �( 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. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7...❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor mein an capacity., . employees and have workers' Y $ 9. ❑Building addition [No workers' comp.insurance comp. insurance. 10. Electrical repairs or additions �,�quired.] 5. ❑' We are a corporation and its ❑ P 3.p/I I am a homeowner doing all work officers have exercised their I L EI Pl bing 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' 13.0 Other a comp.insurance required.] ° *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: • 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 c ui er the Pains and pen [ties'6f perjury that the information provided above is true and correct Sijznature: ' Date: Phone#: S v 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,constriction 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 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 sore to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to 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 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 ifI Town of Barnstable � }p t u �STAB ~ Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA.02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 Town of Barnstable Regulatory Services a"'tttvsr,►six Thomas F.Geiler,Director 1639. ,�� 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 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 3 — 3 —C4 JOB LOCATION: I U L— v S v 7 1Z v LS CL+v is R"i l C C number street village .HOMEOWNER": " o �, q `M `���� S--hP -sC G-f C�( name home phone# work phone# CURRENT MAILING ADDRESS: 4 K T iZr+ t 0114 c,ac3D 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. , 1. 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 buildingpernut. (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 r em Signature of Hom er 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 ��m:t .err r C'• �t ,i11 R � �� / `A '�,��'�7r�M!.'7�f= �J•,i - .. .•1, r .r ��,{1t, l k �� ' ,,_ �' y•`l\ 1, !,f1 '.7• , 1 � '. 1 r f- � •r : < /.l` Yea •` ." .'� _ - .- '. � - a. i - r,• .r •.4•�.• -mil_ '• ,��.J•.-�y�1,.T .. .... � - 5 a Town of Barnstable *Permit# 02&?o Expires 6 months from Issim date X-P PERMIT Regulatory Services Fee 5 Thomas F.Geller,Director MAY - 2 2007 Building Division Tom Perry,CBO, Building Commissioner -�® BARNSTABLE 200 Main Street,Hyannis,MA 02601 warw.tovm.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERTM APPLICATION - RESIDENTIAL, ONLY c, Not Valid without Red X-Press Imprint tp/parcel Number )perty Address i Q e y5 U F1 b C t°/1�P�►'�1�1 i° / O a(0 3� y Residential Value of Work 41, 01001 a` Minimum fee of$25.00 for work under$6000.00 *pf vaer's Name&Address (i :;Zia (Je 0Q/<Tarl� mtractor's Name Se 14 Telephone Number )me Improvement Contractor License#(if applicable) - ]Workman's Compensation Insurance_ Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance surance Company Name _orkman's Cornp.Policy# spy of Insurance Compliance Certificate must be on file. ,rmit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ( �� ❑ Re-side Replacement Windows/doors/sliders. U-Value- co (maximum.44) "Where required: lsstisnce of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission, A copy of e Ho Improvement Contractors License is required. "GNATURE: Fornts:expmtrg :vise061306 The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111' UV w)*.mass.gov/dia ' Workers'Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers Applicant Information .Please Print Legibly Name(Business/OrganizatiovUdividual): 44-1l /• Address: �f aag �ra1J City/State/Zip: ( '_P.(1�e�vi`�1 W ()&3L Phone.#: Are you an employer?Checkthe appropriate bog: :Type of project(required):, 1;❑ I am 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.El am a'sole proprietor or partner- listed on the•attacbJed sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition . iyorkin for me in an capacity. employees and have workers' g Y P ty. $. 9. ❑Building addition [No workers' comp,insurance comp,insurance. 5. [] We are a corporation and its 10.[]Electrical repairs or additions required.] officers have exercised their 11. Plumbingairs or additions ' '3. I am a homeowner doing all-work . right bf exemption per 12.❑Roof MGL ❑ repairs myself.[No workers comp. repairs insurance.required.]t p. 152, §1(4),and we have no employees, [No workers' 13.[ f Other 3 _ 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 ornot 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 isihe policy and job site• information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: �.v /1 k v l 1 fl� (0 3 lob Site Address: / 0 5 uc ��. �F' G �' P l�fJ- 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 forrn of a STOP WORK.ORDER and a fine of up to$250.00 a day against thq violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under the arils and penalties of perjury that the information provided above is true and correct Si fora: Date: a 0 Phone#: FOther Officialonly. Do not write in this area, tb.be completed by city ar town official. n: � Yermit(License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector rson: 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 hize, 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 s 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 bean 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 ehapter_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 caunpl ariue vrithtlie insurance requirements of this chapter have been presented'to the contracting authority.'• Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability'Companies•(LLC)or Limited Liability Partnerships(LLP)with no employees other than the . members'or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit 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-iummnce license number on the appropriate'line. City or Towp 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 ono affidavit indicating current policy information(if necessary)and under"lob Site Address"the applicant should write"all-locations in (city'or . town). PA co y of the aff.davit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future perruits 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 Depaximent's address,telephone-and fax number:. The CommonwWfh ofMamoh=tts Departomt of I.dustdal Acdd is ' Pake of fumagations 600 a hin Stmet Boston-,.MA 02111 • . Fax#617-727-77-49 Revised 11-22:06 WWW.M .&0VM0 NAME OF OFFENDER,• ; t !•` D„(�DAD 6 9-110 TOWN OF ADDRESS OFOFFENDE 3, Oak, Ti .- 1 BARNSTABLE CITY,STATE,ZIP COQECe, crv,"\1c ��• 0MO INE�Ok� MV/MB REGISTRATION NUMBER OFFENSE ,'y/,.�[! 1 p xax -Sxi.e. J — P`��) A 'll C ,6rt_� h Gw. e� h 3 �, ��� s e s� � s � c, prEDMP�►' q w V� z TIME AND DATE10F VIOLATIONi L"AyION OF VIOLATION Z NOTICE OF (A.M.i P.M.)ONSC T,,,,6rg ,205y !�! 'rVSu(� ,r J a SIGNATU OF E F -CING PE ON,� ENFORCING DEPT. BADGE NO. tW VIOLATION �f/w/'. o 1— OF TOWN I HEREBY ACKNOWLEDGE RECEIPT OF CITATION X a ® Unable to obtain Sig lure of offender. J ORDINANCE 9 THE NONCRIMINAL FINE FOR THIS OFFENSE IS $ QQ•�� ~ Date mailed��A w w OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a. . DISPOSITION WITH NO RESULTING CRIMINAL RECORD. w N REGULATION (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, w before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, a Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature NAME OF OFFEN"riIm 0 A CA 0 if f ]BAR 910 7 TOWN OF ADDRESS OF OFFE ER / Oak, orra`, BARNSTABLE CITY,STATE,ZIP ODE ,,,. ME ip� MV/MB REGISTRATION NUMBER P�p OFFENSE" MASS PC CL. V �(+1,}1 S - �!! I/jf' .i ��133i `1 tin II' \�/ w�r✓ :j TIME AND DATE OF VIOLATION LOCATION OF VIOLATION ��� Z NOTICE OF (A.M./ P.M.)oNAVLyas ` '30 ,20011 to Evptn Dr' 0e� r-rV a SIG TUR OF NFORCINGWON.,o ENFORCING DEPT. - BADGE NO. Uj N VIOLATION TOWN o OF I HEREBY,ACKNOWLEDGE RECEIPT OF CITATION X a ORDINANCE unable to obtain�igqure,of offender. THE NONCRIMINAL FINE FOR THIS OFFENSE IS $ E� 0,e� Date mailed �s/!3 S+I/J �+ w OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. w REGULATION (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, w before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, a Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ HEREBY ELECT the first option above;confess to the offense charged,and enclose payment in the amount of$ Sinnahva . 'p�'oFTHE 1py, Town of Barnstable u7 �O,e Regulatory Services • BAMSTABLE, v MASS. g Thomas F.Geiler,Director �p i639• �0 rf039 A Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 July 26, 2004 Timothy Acton 10 Evsun Drive Centerville, MA 02648 RE: 10 Evsun Drive, Centerville, Map : 168031 Parcel : 082 Dear Mr. Acton: It has recently come to the attention of this office that the above address is being used for a landscaping business. The property is in a RC zone which is residential and does permit home occupation of certain businesses. However; there is no record of an application by you for a home occupation at the above address. Additionally, if a home occupation is granted; there are strict conditions that must be adhered. You may contact this office with any questions you may have. You have until August 8,2004 to bring the above address into compliance. After that date legal action may be taken. By Order, Jeffrey Lauzon Local Inspector Q:zoning5 Assessor's'map and lot number R4.... . r �pF?M F 1p�y gs- g3 a 6.K � C Sewage Permit number ............................ ..,............. House number .......l/d t BABa9TABLE, ...... �/i'' t... 4l, MAB6 ........................................... y �O 1639. 9� 4 TOWN 'OF BARNSTABLE �fk BU ING INSPECTORK,,-D r ...... ........... ,Y........ ` .e............................................................ APPLICATION FOR PERMIT )TYPE Of CONSTRUCTION ......W.O.O................................................................... ............................. .19........ TO THE INSPECTOR OF BUILDINGS The undersigned hereby applies t a permit according to the following information: Location .......4 /.. ...........C�.......... ...1(... ........../✓.. .!..1�..1t.............Iv:..CJ ll ec.I1.l..! .. '' ......................... Proposed Use .......... .P.. ....................................................................................................................................................... ZoningDistrict ....... � ...................Fire District.. ... /:..�. ../............/......... /.............. ......................... ...................................... Name of Owner .... ...1...C"'.g .(... . .(...le...............Address ..,1�7�......1/v.... ..�.�.f�?....51....................... Name of Builder ... ./.. .... ��1��. rl.P1-1.........................Address ........t� X....... ... ..1............................................. Nameof'-, rchitect ..................................................................Address ....................................... ........................................... Number of Rooms �// ............ .....................................................Foundation .... ....4.U.r...�..........�Ovl�i�'P C ................................... Exterior ...........rl`'l. ..� rC�.. . ..��f/��✓t�-„t l ..............Roofing ......Ay� .. ... ,1....... ....... ......................... a� r Floors � � ��.� e Interior � ........................................�� 9 �p W.q/f'V— g Fieatin . ................................................................Plumbin / ..... Fireplace ........... . ../ /.C........................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board = - ---------19 Area zpyo Diagram of Lot and Building with Dimensions Fee .,.. SUBJECT TO APPROVAL OF BOARD OF HEALTH '� 72-.,i-? 5 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all'the Rules and Regulations of the Town of Barnstable regarding the above construction. Name / r 1,........ tc,............... Construction Supervisor's License ........ WHITE, MICHAEL A=168-082 No ...285.12... Permit for ,, One Story .... ...... Single Tamily Dwelling ............................................................................... C Vsvh Location Lot 4, 10 Evenepn Drive .......................................................... Centerville ............................................................................... Owner Michael White .................................................................. Type of Construction ., Frame ............................... .....................................:.......................................... Plot ............................ Lot ................................ Permit Granted .....October .9,,,,,,,,,,,,,,,19 85 Date of Inspection ....................................19 Date Completed ......................................19 � 3/—. 9 �s'— 1Assessor'srtnap and lot number. o. '.l�.cS ......�:k. pFTNE ro Sewage Permit number .......:..:.............�3 a .....................:.... SEPTIC SYSTEM MUST INSTALLED IN COMPLIA STABLE. House number ........1..�J...�'��'!:1.................... ..........:......... rasa WITH TITLE 5 °° 0 MAY 01* - A TOWN OF B ARl , °,& CODE TIONS BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....: ......ga.r)........ . l U. . .,............................................................. TYPE OF CONSTRUCTION .......:.1/!/.f�Q.........................:............................................ ....................................... ...........................,9.77 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Jam ` '/ ,p '/ , Location .......4 .. ..........q..........�r...U..:..1. .......... L.V....1r............calle izi.. / ......................... ProposedUse ..........ge.-....................................................................................................................................................... Zoning District .......k....... ...........................................Fire District .............4 .li.Name of Owner ....L...f.(./".q!°r...(... ✓..41..�.e...............Address ..� J�.......�.... . .G}.(.�1....s, ...................... Name of Builder ... �.�!•..... GL.�/. (d•e.�l.........................Address ........444�... .......(—./,!1............. ................................ Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ......... .................................................Foundation ....�QV.� Q �/�ee ..... .... ........................... Exterior ......... ..22t; . . ... �l��f Ge..............Roofing ...... �...vl.��.4...�............................................. .... ( :. Floors ........re �...el.......�C. .�:.........................Interior ..........f.. . .L�.........1... �G Heating ....... .....................................Plumbing Fireplace ...........lyt) 1.C..Y`................................................Approximate Cost ................... ................................................. Definitive Plan Approved by Planning Board94 ', `` -- —�--------19!__�_ . Area ...10`?`.o•.. ..................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ' S. . .............. �- Construction Supervisor's License ��� , ........ WHITE, MICHAEL 28512 One Story 01.................. Permit�-for .................................... ;� Single Family Dwelling ... . .... . . .... . . .... �V**'5-0**'W--'**—*-*** Lot 4 10 Z*eT--tor Drive j Location ................,................................................ J. Centerville . ............................................................................... Michael White Owner ....:............................................................. Type of Construction .............Frame............................. ............................................................................. Plot ....:....................... Lot ................................ Permit Granted .... ...............19 85 Date of Inspection ...... ..................19 .......... 1 Date Completed ....... > F6 77; Y , i ; _ I � i VA' /(P, �� Afo a ,c uA i i/4C�� .c > V �- ,�J 77 ,[�. 1 � �04 WIWAM LL SURVEYM F '1'fCISiEa�J�•'�: / , PINK- DEPT. FILE COPY/WHITE- FIELD COPY/ItLIOW- APPLICANT COPS D_ ' Qa i TOWN OF BARNSTABLE, MASSACHUSE17S °PERMIT ' � ! VALIDATION • t?�l a8--0c?_ �y NO x • DATE _ 19 PERMIT NO. _ `%L APPLICANT B �i C��- )e' ADDRESS Beth Lane, Cent. Own -r (NO.)' (STREET) (CONT R'S LICENSE) ' - NUMBER OF BuildR`4i (_i) STORY SizgIe Family Dwe!1 nf, DWELLING UNITS PERMIT TO Ir N� 121: (TYPE OF IMPROVEMENT) NO. (PROPOSED.USE) ZONING AT (LOCATION) n� a I Q Vira Tts IPT,tPrr' -Y a DISTRICT t.{' (NO.) •(STREET) r BETWEEN AND • - (CROSS STREET) (CROSS .ST REET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY F.T. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: ( ton:.! AREA OR �(-)`tv SGo PERi.}.. _ 50,000.00 FEEMITE� -„-, �c VOLUME - ESTIMATED COST ' (CUBIC/SOUARE FEET) L LL.JCha 'li ci�ZE /� OWNER t .ia V2 y I _.. __;.• . BUILDING DEPT —11 ►-i , ,ADDRESS BY / THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCT-ION WORK: ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT B-E OCCUPIED UNTIL MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS r 1 ' 1 S ' I S ` 2 2 2 vf— fvs�� ,, D I 3 1 HEAT:NG 'NSPECTING APPROVALS REF,-RIGERA7.ION -INSPECTION APPROVALS, V7j, DIWSION Z6 dun � - `�86 ,ov f,4 0 'HER 12 2 e —� BOARD—OF,.- HE LTN o Cam © W`RK _,AL NCT -ROCEED UNT':C' THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION iNSPECTIONS INDICATED ON THIS CAR: NSPECTCF SAS APPROVED 7HE V,!�!CUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE STAGES 3F CONSTRUCTION. .PERMIT 15 ISSUED AS NOTED ABOVE. - OR WRITTEN NOTIFICATION. TOWN OF BARNSTABLE BUILDING DEPARTMENT ! ssa rAu�61 : TOWN OFFICE BUILDING � i6J9' ' � HYANNIS MASS. 02601 ti MEMO TO: Town Clerk FROM: Building ,Department DATE: �04 An Occupancy' Permit has been issued for the building authorized by = A Building Permit $k.......................................�..:........:..._f..._.............................................................................. ........._.................._..._..._.._ issued to ...................1../... .......................» ............................................ ...................... » _ _ ... . .. .... Please release the performance bond. • �� .. TOWN OF BARNSTABLE Permit No. -----28512-------------- !r,..x i Building Inspector cash ------------------- • +mow OCCUPANCY PERMIT Bond ____X____—__________ Issued to Michael White Address _ Lot #4, 10 Evson Drive. Centerville Wiring Inspector---___ Inspection date Plumbing Inspector �.� Inspection date Gas Inspector Inspection date r Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ............................................. .. •!; - Building Inspector �0�i/sw•: 1��i�, pTME . �° Town of Barnstable Office of Town Clerk � 'OrEDMp�p 367 Main Street,Hyannis MA 02601 Office: 508-862-4044 Linda E. Hutchenrider, CMMC/MMC Fax: 508-790-6326 Town Clerk Website: www..town.barnstable.ma.us July 27, 2004 TO WHOM IT MAY CONCERN: Please be advised, that according to the records of the Town of Barnstable, Evsun Drive, which runs southeasterly off Falmouth Road/Route 28 is a private road. This statement is true as of this date. Linda chenrider, MMC/CM C Town Clerk/Town of Barnstable ,232 LJW,�,c 0ck T'c;ll Ccr ,rv►��t� 02�3L