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0208 GREAT MARSH ROAD
�'. .. f � ��'. ?a y �.nM .. ' 4 r � _ �. _ t,.. A u s f _ .. ' r .. '� w � � �. ,. .. �� �. - ,. - �. .. _ - �.. ' �... _ �� -. ` .. � - � � � r _ r � � .. ... .i _ j e �. � .w � i .. '.'+ .. �a � F p G c.. - .� � �:. � �' + .. �. :�. �. � .. .' � .. h, ., , - .. .+. ;. i � .. r y _ _ Y � .. � i �.. � ,' .' ... � ��.. .. ._ � �� �.. . - a .�, �, -. � _.. y 4 F - � ... r , c Olb a �`1 Town of Barnstable SINE Regulatory Services Richard V. Scali,Director Building Division BARNSTABII v� $ Paul Roma, oafne 1639.2014 c 'OrFo Me+s Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us March 13, 2017 Mary Callahan RE: Massachusetts Public.Records Request 208 Great Marsh Road, Centerville Dear Ms. Callahan: For copies of documents pertaining to 208 Great Marsh Centerville, MA please pay the following: 37 copies at .05 a page 1.85 Postage 2.24 Total 4.09 Please make check payable to the Town of Barnstable, once the payment is received the copies will be completed and mailed. Sincerely, Debi Barrows .Office Manager it Barrows, Debi From: Roma, Paul .Sent. Monday, March 13, 2017 11:36 AM To: Barrows, Debi Subject: FW: RAO Hi Deb, Asa p thanks -----Original Message---- From: Quirk,Ann Sent: Friday, March 10,2017 9:36 AM To: Roma, Paul Subject: FW: RAO This is a public records request, please respond tommcalla444@gmail.com and a copy to me. Thank you,Ann -----Original Message----- From: Mary Callahan [mailto:mcalla444@gmail.com] Sent:Thursday, March 09,2017 10:07 PM To:Quirk,Ann Cc: Peter Biagiotti Subject: RAO Hi, I am considering purchasing the property at 208 Great MarsN Rd. Centerville 02632. This is to request any,and all public records for permits (including any that are open)that have been issued for construction and or renovation at that address. Thank you - Mary Callahan 1 - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map / d Parcel U Application 4Z 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 )-.08, Village P'`� �' P Owner Address Telephone S� 3 1 of Permit Request G wio ld_�d k�c Vve.'v` t'`e,& 4% � 001 Y- -,r- 5 l , >1. � ice - �GU,T,L� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ? o Construction Type Lot Size Grandfathered: ❑Yes ElNo If yes, attach supporting documentation. Dwelling Type: Single Family U / Two Family ❑ Multi-Family(# units) Age of Existing St7FLII re Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Type:Basement T e: ❑Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing a new Half: existing new Number of Bedrooms: 3 existing _new BUILDING DEPT. Total Room Count (not including baths): existing 00 new First Floor N ma - Heat Type and Fuel: ❑ Gas ®'Oil ❑ Electric ❑ Other TOWN OF BARNSTABLF Central Air: ❑Yes U No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Est aw1 \�CIVN Telephone Number ��—3i�`� " `I Address _ \ License # (� OIL- !; NNps G10_26 Home Improvement Contractor# Email (Jo A Cam-\C,\!A 0 , a &o Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # -DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION I. FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1� CQ73Zmaldmp akh Off{ Sad r=et& Department efrudmizidAccidatft 600 Wasbingi=meet Baston,MA 02111 _ Wurlm& CunVeniafm Insurance Affidavit:Bugders/ ers Please Print Lemffilv Address t lvb v-r Are you an employer?Check the appropriate b Tyke of project(requirea)_ I_❑ I ant a employer vvith 4. I am a ge�eral=1trsctac and I 6 New oanshac6on emFloSew(fiall andfor parwime * lave 7m-edlhe sutra 2.ElI am a sale pmpsietor orparfaer- listed c mthe attached sheet �- `[ deling ship and have no employees These sal-coatractam have g ❑Demolition Waddag forme.in any capacity_ employees and have; odm.rs' 9- ❑Ba ma addition INo Wadonw gyp-sa� comp_ks uranc l -I 5. ❑ We we a emiporation and its 16-❑Ele�repairs ar ad0ions 3_❑ Iamafiomeownr doing all w&k officers lmve exercised their 1L❑Plumbsngrepairsoradditions• €[N � o workers' y of esemprfiou per M(M �❑ � � ��d-]f � c.M,gl{4h andwe lave no L.emp'loyem[Now�•s' 1�_0`of?&e�ec camx mmranm required.j ',4ayspp��t�atr1he box'lma msmt; paTuginffiMMxd - # eoamecsWlmsubs sadL fGa�s tt�ecYtlds boot s8adsed m-Adi+md sheet showing then—of the amd stafewLetbs arnatthnse .mve employees.Ifthesvb-tantimch,Rhave emp2opees,1herxaastprm ade-tbw wakas'—P.Falicy mmilrM I am gut euiplayw diet Below is tfiepalicy Md job site i$,�or-rrr�ntL Iasut2nce Company Name: Paficy Cr Self-sus.Tic_ onDat Job Eta AddresszCrtplS - Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and expiration date). , Failnre to secur15 coverage as required under Section 25A of MQ.c_M can lewd to The imposition of ctim.ffiai penaHies of a , fine up to$L50D 0D andfor sae-gewimpEiso as Weil as civil penalties izr ifie fonts of a STOP WORK ORDER-and a fme of up to MOO a dayagafiutffieviolatar. Be adsdsed drat a copy of this zbdement maybe forwarded to the Office of Iuvestsgaiions of the DIA fbr hism neff coverage vserfficatifla Frfa her* Lire 3 taltres a pa u y that die in orma6mprmided abm is true mid correct (a 'TC6 Offl;W nw a nlj. Do nat wrkr in ffd3 area,tax be cnupfeted by city artotpa a at City or Town: Perndfficense# Enring Aaflarity(code.one): . L Board of zrcd& tl Emiaing Dgmtment 3.fityaosm Clwk 4.Electrical Inspector S.Plumbing Inspecitor 6.oflrer F Corot Person: PhD #: 6 ! ! , ! 1 1 i OTIRM l/: `.r: _■I■w�,■•_ - ■ : .t.t.i� :•tat«. 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Water Bodies 210075 222gg t 3` ¢ h . � x R �X yap: 2100&0 201 -- :11s4u 210131 F � Map printed On: •10/26/2o16 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA o26or 0 42 83 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map $o8-862-4624 reflect current conditions,and may contain such as building locations. Approx.Scale: 1 inch= 42 feet 0` cartographic errors or omissions. gis@town.barnstable.ma.us " e A uv-� 5 =dz 3 • y S ,aco CERTIFICATE OF LIABILITY INSURANCE /DDVYYYY, �" DATE(MM 12/6/16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER TACT NAME: Bill Nolan Nolan Insurance Agency, Inc. PHONE FAX PO Box 938 E-MAIL (508) 224-3600 1 (AIQ No: (sos) 224-3618 728 State Rd ADDRESS. billnolanjr@nolan-insurance.com INSURERS AFFORDING COVERAGE NAIC# Manomet, MA 02345 INSURER A:SAFETY INSURANCE " INSURED INSURER B:NORFOLK & DEDHAM McKay Plumbing And Heating Cc INSURERC: 669 State Rd INSURER D Plymouth, MA 02360 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN.IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER M/DD/YYYY MM/DD/YYYY LIMITS A GENERALLIABILITY BMA0006862 5/16/16 5/16/17 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED crrn $ i CLAIMS-MADE a OCCUR MED EXP(Anyone person) $ 10,000 PERSONAL&ADV INJURY___ $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 LOCX POLICY PRO AAUTOMOBILE LIABILITY 1710542 5/14/1 COBcINEDSINGLELIMIT65/14/17 Eaaiden $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALLOWNED X AUTOS SCHEDULED AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _AUTOS , Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WE095686A 5/1/16 5/1/17 WCSTATU- OTH- AND EMPLOYERS'LIABILITY y/N e ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCI DE NT. $ 500,000 OFFICE RIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is regui red) �O PLUMBING AND HEATING CONTRACTOR . OwNOpe ?O16 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Nate Cavacco ACCORDANCE WITH THE POLICY PROVISIONS. 7 Jacobs Ladder Plymouth, MA 02360 AUTHORIZED REPRESENTATIVE CHERYL STAZINSKI © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: ncavacco@msn.com , t n t �- Barrows, Debi f From: Paul Callanan <paulcal94@gmail.com>_ Sent: Tuesday, November 29, 2016 9:23 AM To: Barrows, Debi; Nathan Subject: Re:208 great marsh Thank you for following ups We are-still}reviewing-estimates from o p tmg sub contractors: .wWe hope to finalize by early next week. _ s . e- On Nov 29, 2016 9:17 AM, 'Barrows',Debi" <Debi.Barrowsktown:barnstable.ma.us>wrote: Good Morning, I ain still waiting for the list of sub contractors for the 208 Great Marsh Rd., Cent. Building permit. Thanks Debi y t - Town of Barnstable Regulatory Services M 'AJM ` Richard V.Scali,Director ice* Building Division Paul Roma,Building Commissioner y 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:,508-790-6230. Property Owner Must 'o Complete and Sign This Section If Using A Builder I as Owner of the subject property hereby authorize to act on my behalf in all matters relative to work authorized by this building permit application for. . nY C (Address of Job) "Pool fences and alarms are thelresponsibilitp'of the applicant Pools are not to be'filled or utilized before fence is installed and all final inspections are performed and accepted. ; ///xv Signature of CAmer S e of Applicant •Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOIS - Town of Barnstable Regulatory Services dF Richard V.Scab, Director Building Division t Paid Roma,Building Commissioner pan .200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 /Fax: 790-6230 HOMEOWNER LICENSE EXEMPTION f r DATE: Please Print `� f C�I 1 rQ JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityhown state zip code The current exemption for"homeowners"was ext/hd inc a owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for d snot possess a license,provided that the owner acts as supervisor. DEFINIHOMEOWNER Persons)who owns a parcel of land on which he/ es or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detactures accessory to such use and/or farm structures. A person who constructs more than one home in a teriod shall not be considered a homeowner. Such "homeowner"shall submit to the Building Officim acceptable to the Building Official,that he/she shall be re onsible for all such work erformed under ermit (Section 109.1.1) The undersigned"homeowner"assumes re risibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regal ' us. The undersigned"homeowner"certifie that he/she understands the Town of Barnstable Building Department minimum inspection procedures and ements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three- y dwellings containing 35,000,cubic feet or larger will be required to comply with the State Building Code 'on 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code tes that: "Any homeowner performing work for which a building permit is required shall be exempt fr m 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 to amend and adopt such a form/certification for use in your community. I Massachusetts -Department of Public Safety Board of Building Regulations and Standards JU c____lICI__YI�V!_-_ . - l.Vll�ll UlL1V 11 . ' License: CS-068642 rf.N RICHARD P CALON 9 SEPTEMBER OR I IF FRANKLIN MA;020A Y `L Jay-1" .�r��`` Expiration. commissioner 01/03/2017 J Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR ii� before,the expiration date. If found return to: gistration: ,,156976 Type: f Office of Consumer Affairs and Business Regulation e Wxpiration:�_512.1_%2q i7: Individual 10 Park Plaza-Suite 5170 -" Boston,MA 02116 RICHARD P CALLANAN' +:" RICHARD CALLANAN', 'c%CC` 9 SEPTEMBER DRIVE „ FRANKLIN,MA 02038 i Undersecretary No valid without signa re Unrestricted-Buildings of any use group which ,. contain less than 35,000 cubic feet(991m3)of enclosed space. , Failure to possess a current edition.of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS r r-- --__- -�- � � � � fFI �} 1 f� • Bose cascade Double 1-3/4" x 9 4/4" VERSA-LAM® 2.0 3100':SP Floor Beam1171301 Dry 11 span I No cantilevers 1 0/12 slope December 14, 2016 11:07:28 Ot CALCO,Design Report Build 5684 File Name: N Cavacco_208,Great Marsh Job Name: Wright Description: Designs\FB01 Address: 208 Great Marsh Road Specifier` jlm City, State, Zip: Cente'rVille, MA Designer: Customer: Nathan Cavacco Company. Shepley Wood Products._ Code reports: ESR-1040 Misc: BUILDING DEPT ` n u � 0,06� � , 11-00-00 BO „ 131 Total Horizontal_Product Length= 1,1-00-00 • , Reaction Summary(Down/Uplift) t Ibs) _Bearing Live Dead Snow Wind Roof Live BO, 3" 2,137/0 764/0 B 1, 3-1/2" 2,153/0 769/0 Live Dead Snow•.Wind Roof Live Trib. Ta Desc�i tion- y Load T e- Ref. Start .. Erid_ 100%° 90%° 115% 1"60% 125° Load SuMM �_ p Yp /° 1 Standard Load Unf. Area(Ib/ft^2) L. 00-00-00 11-00-00 30 10 - 13-00-00 COntrols.Surrtmary_ value %°Allowable Duration: Case Location ` Pos. Moment 7,412 ft-Ibs '55:8% 100%° 1 05-05-12t` End Shear 2,360 Ibs 38.4% 100% 1 ` 01-00-04` Total Load Defl. U392 (0;324") 61.2% n/a 1'~ 6 05-05-12 s �: Live Load Defl. U533 (0.238") 67.6%° n/a 2 • 05105 12.` Max Defl. 0.324`' 32:4% n/a 1 05-05-12 } Span/Depth 13.7- n/a n/a 0 < 00=00=00 %=Allow %Allow Bearing Supports Dirn.,(Ux w) . '_Value .'Support Member .,. Material"'.. • ' ' BO . Post 3"x 3-1/2" 2,901,lbs n/a - 36.8% Unspecified B1 Post „. 3=1/2"x 3=1/2" 2;923,lbs n/a 31.8% Unspecified 4x Notes . - r Design meetsCode minimum-(U240)Total load deflection criteria. Design meets Code minimum(L/360) Live ioad,deflection criteria. Design meets arbitrary(J')L Maximum total load deflection criteria. ' Calculations assume memberis fully braced. ` Design based on Dry Service"Condition. Fastener Manufacturer,TrussLok'(tm) t - ,t Page 1 of.2 x5. Boise-6a§cade Double 1-3/4" x 9-1/4" VERSA-LAM®2.0 3100 SP Floor Beam\F1301 Dry 11 span I No cantilevers 0/12 slope ;December 14, 2016 11:07:28 BC CALCO Design Report Build 5684 File Name: N Cavacco_208 Great Marsh Job Name: Wright Description: Designs\FB01 " Address: 208 Great Marsh Road Specifier: jlm City, State, Zip: Centerville, MA Designer: Customer: Nathan Cavacco Company: Shepley Wood Products J Code reports: ESR-1040 Misc: Connection Diagram . _ Disclosure b d Completeness and accuracy of input must L be verified by anyone who would rely on a - output as evidence of suitability for • • • particular application.Output here based on building code-accepted design properties and analysis methods. i Installation of Boise Cascade engineered wood products must be in accordance with e 'current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions,please call a minimum=2" c= 5-1/4 •(800)232-0788 before installation. b minimum =4" d =24" e minimum - 1" BC CALCO,BC FRAMER@,AJS-, 'ALLJOISTO,BC RIM BOARDTM,BCIO, All TrussLok screws may be installed from one side of multi le ply Y'VERSXLAM beams. B018E GLULAMTM'SIMPLE FRAMING P All TrussLok screws may be installed from one side of multiply Versa-Lam beams. SYSTEMO,VERSA-LAM@,VERSA-RIM PLUSO,VERSA-RIM@, Member has no side loads. STRAND@,VERSA-STUDS are Connectors are: FMTSL338 trademarks of Boise Cascade wood Products L.L.C. BUILDING DEFT DEC 1.4 2016 TOWN 0F BARN TA B ABLE Town of Barnstable Permit: Ak' Regulatory Services Date:9/2�/°� nFIKE Tp� Thomas F. Geiler, Director Building Division Fe * BARNSTABLE, Tom Perry, Building Commissioner 9 MASS. g 1639.� �m 200 Main Street, Hyannis, MA 02601 ATEo Mai a www.town.barnstable.ma.us Office' 508-862-4038 Fax: 508-790-.6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT � J �� y/3 2s-0 £� Owner: (,l//`� Phone: Gt/i2�(o� ( install at: 2 0 '1( G2E)4T WI A2S t t Village: Map/Parcel: O 0/6 Date: Stove A. XS;/Used B. Type: Radiant Circulatin C. Manufacturer: t1hZ-oIts Lab. No. D. Model No.: fZ A-//V le P Chimney A. New Existin (If existing, please note date of last cleaning) S5E B. Flue Size $ � C. Are other appliances attached to Flue? 75 D. Pre-fab Type and Manufacturer E. Masonry: the Unlined Hearth A. Materials: B. Sub Floor Construction: Installer ,• Name: Address: Phone: Location of Installation: H.I.0 Registration # Construction Supervisor# OR.check `Homeowner Installing, no tic nse ren fired APPLICANTS SIGNATURE APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection, photographed,'and approved by the Building Inspector Q:F0rms:stove Rcv 103107 l2t.4.Jo4 THE Town of Barnstable *Permit# 31 i M Expires 6 months from issue date > ttrsr�Bi.E, : Regulatory Services Fee � u" •� Thomas F.Geiler,Director ArFD MPS p, Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 PRESS o.. Fax: 508-790-6230 p ,a 2004 PERMIT PERT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint TOWN OF BARNE. .. .:_ . .. Zap/parcel Number ®O�� 'rope Addressate Residential Valueof%&4/500 Minimum fee of$25.00 for work under$6000.00 )wner's Name&Address /J � ✓ s�'l ® � /f� / / ,ontractor's Nam /C5/z� �Oel x�OfIr 0 7S 'lA telephone Number7- come.Improvement Contractor License#(if applicable) :onstruction Supervisor's License#(if applicable) orkman's Compensation Insurance ` Check one: ❑ I am a sole proprietor j ❑ I the Homeowner F311"have Worker's Compensation Insurance t s„rce Company Name //i?Z�G5'�� r, 9Vorkman's Comp.Policy# Copy of insurance Compliance Certificate must be 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) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property O er must sign Property Owner Letter of Permission. „ Ho a rovement Contractors License is required. Signature Q:Fonns: trg Revise063004 a• Tom of Barnstable HE'°��°,� Regrdatory Services Thomas F.Geller,Director B guRdin.g DivisIOn \ TomPerrY, Building Commissioner 200 Main Street, Sya=js:MA 02601 . - •- TMv,town..barastable•ma.us - Pax; 508-790-6230 Offioe; 508=862-4038 property C w erMust .Complete and Sign This Section -•• If'USing A.Builder . u Owner of the subject property to:act on m7behaTf; hereby authorize . nets relative to work authorized b7this building.Pit applicati°n for. in ma - (Address of Job) gate. - Signat=of Owner Print N=e Lit~or re'ratlw.kalif hr fadiwb l ase oaly briers the espinliw die. B fwmd.vM W. Beard of McgubdWes MO SUmdards One Aswwriw now Rw 1361 Basiw,Ai1a.021K . lWt raid wltbwt si�aatare _.----- -•- . a Y �, , ,/,� fow..w�.u�olu yl:•�aeooa�rrowA�a B"fd of idmft Raw- k a"Srwinrm MM WVROVEMENT CONTRACTOR 12sm Tra &Vvwmd Cab MARK AUDETTE 3200 COBB GALLERtA"Y M a ALTANTA.GA 30339 �sT. CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT DEPARTMENT OF FIRE-RESCUE&EMERGENCY SERVICES 1875 Route 28•Centerville, MA 02632-3117 1926 508-790-2375 x1 • FAX: 508-790-2385 John M.Farrington,Chief Martin O'L.MacNeely, Fire Prevention Officer Philip H.Field,Jr.,Deputy Chief Michael G.Grossman,Fire Prevention Officer March 15, 2012 TO: Tom Perry, Building Commissioner Building Department Town ofBarnstable 200 Main Street Hyannis, MA. 02601 In accordance with MGL 148, Section 28A, the.Centerville-Osterville- Marstons Mills Fire/Rescue Department brings to your attention the following potential violation(s) of 780 CMR: Massachusetts State Building Code for your review and/or interpretation of same. NAME/BUSINESS: Residence ADDRESS:- 208•Great Marsh.Road, Centerville.- OBSERVANCE: Received notice from Town of Barnstable Health Division that this house had no working smoke detectors or carbon monoxide detectors. I went to this house on March 14, 2012 to check for smoke detectors and observed a sleeping area set up the basement with no emergency egress. Michael G sman Fire Prevention Officer .O.M.M. Fire District a ZE ACC:Jeff La o Building Inspector --A co en "Commitment to Our Community" I y'ST. CENTERVILLE-OSTERVILLE-MARS AL1 SA DISTRICT DEPARTMENT OF FIRE-RESCUE&EMERGENCY SERVICES 1875 Route 28•Centerville,f_ 026 2 3 17 1926 508-790-2375 x1 • FAX: 508-790-2385 John M.Farrington,Chief .,.martin O'L.MacNeely, Fire Prevention Officer Philip H.Field,Jr.,Deputy Chief a Michael G.Grossman,Fire Prevention Officer March 15, 2012 TO: Tom Perry, Building Commissioner Building Department Town of Barnstable 20U M_diK_Street Hyannis, MA. 02601 In accordance with MGL 148, Section 28A, the Centerville-Osterville- Marstons Mills Fire/Rescue Department brings to your attention the following potential violation(s) of.780 CMR: Massachusetts State Building Code for your review and/or interpretation of same. NAME/BUSINESS: Residence ADDRESS: 208 Great Marsh-Roads Centerville OBSERVANCE: Received notice from Town of Barnstable Health Division that this house had no working smoke detectors or carbon monoxide detectors. I went to this house on March 14, 2012 to check for smoke detectors and observed a sleeping area set up the basement with no emergency egress. nnirh�eI r ssman Fire Prevention Officer C.O.M.M. ire District CC: Jeff Lauzon, Building Inspector "Commitment to Our Community" �� � ��� s as gs�g ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris ❑Re-roof(not stripping. Going over existing layers ❑ Re-side ❑ Replacement Windows. U-Value (maxim *Where required: Issuance of this permit does not exempt compliance Mtl ***Note: Property Owner must sign Property Owni Home Improvement Contractors License is Signature r' Q:Forms:expmtrg Revise053003 10/07/2005 208 GREAT MARSH RD . C Town of Barnstable errnit: Regulatory Services �3 oFtMe 1p� ate: Thomas F.Geiler,Director ✓® -`�-u S� ' B^�'' "B B1111d1I1g D1viS1oII ee:a�dU y Mass �At 16g9. s`�� Tom Perry, Building Commissioner Eon 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: r%���ie� Li'/l/ie���7 Phone: 5D K ��3 2�bg, Install at:' liE7114�11 Village: ' Ll"6_IVTMIIIG�E. Map/Parcel: Date: _ O Stove A. New/ sed B. Type: Radiant/Circu:1a:tiln ) C. Manufacturer: Lab. No. D. Model No.: Chimney g .(Yf g,P A. ew Existing existing, lease note date of last cleaning) B. Flue Size v C. Are other appliances attached-to Flue? - -D. Pre-fab Type and Manufacturer E. Mason ry: Lined/Unlined Hearth A. Materials: /J 91 G itf-„ B. Sub Floor Construction: Installer Name: Address: Phone: Location of Installation: APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed,'and approved by the Building Inspector Q:forms:stove Rev 122801 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) � I m /\C LI DATA Town of Barnstable ermit: °fSME T°y Regulatory Services 73 ate: Thomas F.Geiler,Director ✓� �-o �� aMuvs►^Bi.E Building Division Fee:0&- 4�,,�Fny p�0� Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL.STOVE PERMIT Owner: ��� 2 �ie� ��ie���,/� Phone: �� yr3 fig' Install at:'-2 0,8/ 61e -/ y1j�;6 f Village: Map/Parcel: 0/0 0 K62 .Date: E_F> D S� Stove A. New/ sed B. Type: Radiant/ irculatin C. Manufacturer: ' Lab.No. D. Model No. ' i he Chimne ; x j A. ew Existing (If existing,please note date of last cleanings ; B. Flue Size z a C. Are other appliances attached to Flue? lvo D. Pre-fab Type and Manufacturer , K Y � 3 .► E. Masonry: Lined/Unlined , :.. s i ITW- Hearth A. Materials: /j /G , N i B. Sub Floor Construction: -or PCQ/1k/oo D 2 Installer x Name . Address: Phone: i0.7 .R Location of Installation: ip Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q forms:stove ar �Q-V I- l• 1 0,I ' qiv S. 3 -Y\ Nr e �t CU r�r-Q Cam°lv� 0 1„ _ N S'CV 2w S YYI� ✓1 Town of Barnstable Permit: Regulatory Services Date:01/0-F �OFZHE fps Thomas F. Geiler, Director Fee: 6 Building Division BARNSTABLE, - .Tom Perry, Building Commissioner 3, MASS. � 1639. �m 200 Main Street, Hyannis, MA 02601 prFDMAta www.town.barnstable.mams Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT 4 Owner: 441AX.0 10/G1-17- Phone' y/'3 Z S0 Install at: 20 F� 6 -e mil` Lq�5W Fb Village: C�iN le-1VO Ile . Map/Parcel: S0 Date: V 7 SeP Oa Stowe A. New/ se B. "Type: Radiant/ Circulatin C. Manufacturer: C.4L1-/0/1/ Lab. No. D. Model No.: Chimney A. QLew/F_,xisting (ff exi,sting, please note date of last cleaning) B. blue Size (o C. Are other appliances attached to Flue? N 0 D. Pre-fab Type and Manufacturer w REwtoC K- 14F-FUF I/ F. Masonry: Lined./Unlined Hearth A. Materials: 5 Y-i c.k- B. Sub Floor Construction: CiF&7 x/'r $,okCICE-r 4;0R-ie-jo Installer Name: Address: Phone: . Location of Installation: H.I.0 Registration # Constructio:�'Homeowner pervisor# 011 ,che.ck Installing, no li se re ed APPLICANTS SIGNATURE APPROVED BY: Please make checks payable to the Town of Barnstable *This cohslitutes an of stove permit after inspection, photographed, and approved by the Building Inspector:., Q:forms:stove Rcv 103107 A y e •+ M�rNanrrwNIL r • � Alkw I Ilk05 ,.. el v r• 1 ..,. N� y 4_ 4� � i �� �.. �:�. _.__. r � -�d - d i'�.}.'E'rt�T�' '�. � t y � ,. -{ i �.v-_ _ .e 3_ �, l i!?•:: � .f �� s ,i� � a _ _ .. ._, � ,A. J 1,1 � �' � - �!ti.. . -. �� .. . r � , \� _ .� '� � � - • x ` r ¢ too. •� .LS'Yi7l.. k.o r I. 4 :wry 4 alY t - T I Marsh Rd ........... E n M1�•k '1Cd�a�. .y Engineering Dept.(3rd floor) Map a�I Parcel0,9(, Permit 74 House# Date Issued Board of Health(3rd floor)(8:15 =9:30/1:00-4:30 Fee `��P �. 0?➢ and 19 r® NM 14�� TOWN OYBARN5TABLE Building Permit Application Project Street Address art-W rs14 1\6f Village am'�`, j6lle Owner oc e-ty, Sf ILI'SO� Address 209 G 11444s4 Telephone 7��'• d = Permit Request ua� o Sell1ig�� First Floor /goo- square feet Second Floor 960 square feet Construction Type Gl r Estimated Project Cost $ (7Ra Zoning District Flood Plain Water Protection Lot Size a6,16 Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: f J Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) t Basement Unfinished Area(sq.ft) 34114 i Number of Baths: Full: Existing New — Half: Existing New No. of Bedrooms: Existing 3 New Total Room Count(not including baths): Existing_ New First Floor Room Count Heat Type and Fuel: ❑Gas 2116,i1 ❑Electric ❑Other Central Air ❑Yes Z No Fireplaces: Existing New Existing wood/coal stove ZKes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) None hed(size) jp x 1Z ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information -Name cul Telephone Number Address Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE C I DATE BUILS,41ft THE FOL 0 G REASON(S) FOR OFFICIAL USE ONLY « PERMIT NO: DATE ISSUED; MAP/PARCEL NO f ADDRESS VILLAGE` ? OWNER DATE OF INSPECTION: y FOUNDATIONS E FRAME INSULATION r FIREPLACE ELECTRICAL: ` ROUGH FINAL , PLUMBIN�: fit.► ROUGH i FINAL GAS: r 4OaUGH FINAL • • � sue., � s } FINAL BU .® ; 9 _ DATE CLOSED to ASSOCIATION PLANVO. c Assessor's Office(1st floor) Map Lot Permit# Conservation Office(4th floor) Date Issued t i Board of Health(3rd floor)(8:30-9:30/1:00-2:00) Fee �--� Engineering Dept.(31d floor) Hous A'--00 8- PJJ rk `- 1p • BARNSfABLE. TOWN OF'BARNSTABL � "�° Building Permit Application Project Street Address�Cjc� Village (��ti f CNi1�� a2 6 3 Z y ► f Owner I-�o�e Gcx�iUVI Address dU-e Telephone .Permit Request 10 t X 12 ` $1eoQ 2�XTet�tce l�i'a�r%r� Ih:TZJ �•f"lS�ncr 6O�Gr�2 1 u� eyio k emr//• actna In7b ZZ Total 1 Story Area(include 1 story garages&decks) 156V square feet Total 2 Story Area(total of 1st&2nd stories) Q A6'0 square feet Estimated Project Cost $ %d,000— Zoning District Flood Plain Water Protection Lot Size .26 g c re Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use S cnv1a 4c l;61 1 11211-e- Proposed Use Construction Type wvQ Commercial Residential +� Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure 2 g cigar,rS Basement Type: Finished ' Historic House A10 Unfinished Z Old King's Highway 0 Number of Baths 12 No.of Bedrooms Total Room Count(not incluud,,i-n baths) (� First Floor y Heat Type and Fuel 0"1 — t7 V tom"_ Central Air ]() Fireplaces dh ve Garage: Detached. Other Detached Structures: Pool 12a Attached �� Barn Mp None Sheds no Other ;1d - Builder Information l Name ��7me-e cLonze r Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO2rvcs � a SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. #84 4 DATE ISSUED _ Ju;� 1995 MAP/PARCEL NO. 2. :0.086 ' ADDRESS 208 G feat Marsh Road - - VILLAGE Centerville, MA P:Rik ±x 92732 s r OWNER Rohert & riscilla _Swanson A � r DATE OF INSPECTION: - }' i _1 FOUNDATION �• C� r FRAME INSULATION \•�� �� ��J FIREPLACE ELECTRICAL: ROUGH FINAL ti PLUMBING' ROUGH .•FINAL GAS: ROUGH FINAL _ FINAL BUILDING -c7 '•�7 DATE CLOSED OUT ASSOCIATION PLAN NO. 11%02/94 17:02 IC61TT277122 DEPT IA'D ACCID k• T . _ —� Conunoluuealdt o f 11iJa6.jac1zu4e& 24pcar ine-iga I 600 Wa�lungioa Si .James J-Campbell &ton, ///aaeac" 02111 Commissioner Workers' Compensation Iftsurance Affidavit ' caor1 r with a principal place ofbusiness at: . ccm►isr�wzty� do hereby certify under the pains and penalties of perjury, that: Q I am an employer provid'mg workers' compensation coverage for my employees working orl this job. a Insurance Company Policy Number O I am a sole proprietor and have no one working for me in any capacity. O I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor Insurance Company/Policy Number insurance Com alsylPolicy Number Contractor p Contractor insurance Company/Policy Number I am a homeowner performing ail the work myself. I understand that::cot: of c is statement will be fo:v:arded to the Office of imestiptions of the 01A for cc%,mge verification and that failure to see ce.erage:s recuired under Section 25A of MGL 152 can lead to the imposition of criminal penahies contsisdne of a fine of up to S 1,500.00 andtc years' imptiorr..ent as we as civil enaltie<' ,,,forrr cf a STOP WORK.ORDER and a tine ofS100.00a against mc.Signed thisday of � Licensee/Permittee Building Department Licensing Board Selectmen Office rr Health Department ^rr).vr-p i ry r r ivrl?AGF. IN FO PMATIOAI CALL: 617-727-4900 X403, 404, 405, 409, 375 The - ,own of Barnstable a Department of Health Safety and Environmental Services 1659. P Building Division 367 Main Street,Hyannis MA 02601 , Office. 508-790-6227 Ralph Cmssen Fax: 508?75-3344 Building Commission For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION - MGL c. 142A requires that the"mcortstruction,alterations,renovation;repair,modernization,conversion, improvement, remcn-4 demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements- Type of Work: qle4olla v� , s�ir� Est Cost A,6(071e i Address of Work: 6 7 6 eel,_k rvt Ile 1 O%%mer.Name: i�bs �4��GiSU'I Date of Permit Application: I hereby certify that: „ Registration is not required for the following reason(s): `< Work e:ccluded by law Job under S1,000 Building not owner-oc=pied =Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY hereb y apply fora permit as the agent of the owner. t by Date Contractor name Registration No. OR ------------ Date Owner's name Ce,vx kr-vi'/(C s o • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE a JOB. LOCATION do R (�¢T�' �a r��e .��� � /7i ` Number Id/ OQa- 2 Street address Section of town "HOMEOWNER" Name Home phone Work phone .- PRESENT MAILING ADDRESS ( p,,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 such homeowners to engage an in- dividual for,hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF .HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six 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 acgeptable 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 Stat Building Code -and other applicable codes by-laws, 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. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 a Home Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for .licensing Construction' Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home"Owner-"actin as " supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities,, man communities require, as part of the permit application, that the Home 'Owner ' 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 to amend and adopt such a form/certification for use in your community. 9 µ3 , i; 0�u, t I OQ e4l . � 1 1 �f L 11,5no �tl ---=I- Q CaI�E'laCiE IN —cJ r s � Y I Y� 1 ,2e /3Z4,74 Bum, `-�J��.�t�l, Ie�er � � P�IL� ,MORTGAGE INSPECTION PLAN m me(C14FE{Mo ITS la ,,,p�NDS 9r1�fzTGA�<a�. ` LOQAIFD IN I oemBv;a I NA4E exAwNty>Ne PR6BSEa ANp nu s�YnlNm 1Nol�N Do 1 MASSACHUSE M ONLY W iFie 20NW0 lAW5 ANO AyE74DYENiB.Lw SIDe;,,•RLAR YARD Sall arar or �at a�z��7-,ap,� i.riatRucim, INA�wm A nur nas PRaPeary a Ala? wDArtD w 1He DTAIIUM FLOW DE COMMUNITY PANEL N0.1250001-00o S CDAIE- 8•I'j_gc_, eoac 7 1`��o LAMTEX"N naN ar TIK Re0oRoa Is wADe DNLr sa qulT4r m 14E IIIOMO DAre Of u LATE9r D1ID AND ODES NDT alCWDC yip AOCI3RAOY na:ow Dl, WVON PA,PREExatt m.ra oAn a Rfi00RD. n«B DDw�xr 1s Nor RFA ON®91(rDR ANY awtxrunax woe a 9 ro na RfgOROFq Mr.N0.—__ DAW aP rNe urear ocaD a RrmRe Py 1HAr A YOIIL P aLR4lY IIe N1Da 10 WOYY�r 1RON Md PRO 1mrf WX It la ADMW nm m 191 ►W 111�WfAWRpWN1A PIA f - DAM ROT 'r10NA rl'R°oP�Dry m°H�R'�ic1"'W W RAWY MAU-0r onm/.r�AM D= LCa cxT 7 TNIS CERnnCATI0N TD BE MORTOACE PURPOSES ONLY, I�1 — aDAtt,i•o?o� TO BE USED IF THE S PROPERTY LINES g oxnwea,ill ' p�B RA D FC R D��11 p 309BB a . ENOIKEERING CO. e _ P.O.Box 1244 mo W. C J IIIR.4 Sr 11670� kvim MA chal The Town �"Of Barnstable • usrreruut; • .�0� . Department of Health Safety and Environmental Services °rEo tom'' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissior. For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: (�2 Est. Cost 6 `f�z Address of Work: n?nZ Owner's Name '�,4'4� Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law 'Job under S1,000. Building not owner-occupied ✓" Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MOROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL G 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. L/ Registration No. Date OR - The Connm,n lrealth of:l tassac h usetts Department of luditstrial.4ccidents ` - Olticea/lnvestigatlons 600 if a.0ibi ton Street Boston.Alas. 02111 Workers' Compensation Insurance Affidavit .. -- .--•—� .---- - . .._.. Please PRINT•lei. .....,�......_...-._._....-_...-..•.,.r.._._-- ------ —•- - Annitc:tnt informati�o/n: name _ _.._ r location- g o a Wf- ��n wa[SG � Anhrmc# .K I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity [� Tan-1 an entplover providin_ workers' compensation for my employees working on this job. enrntrrnv name: address• CM.- phnnc#- . insurance cp. nolicv tt M I am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: cmmp:lrn• nainc: atlrlresc• Shone#: insurance ro. noiiev# 1 •1.. V••- �. - �.�1..._ ... _-- -- lr-���::�^tt iT"l^.wws�.-.., �Tr..-- ...w.ti..,..��...-... - COmOanV nnmC: adtlrCSt: rttt" hone#- insurance co. policy# Attach additionaa sheet if necessary: •— :�_ _ + - + •^ _ __ %� :' �' "'-••• y-+�"' '••'-- ^��'-^ Failure to secure covcniec as required under Section 23A of 111GL lit a lead to the imposition of criminal penalties of a fine up 1 S1S0 UO ndrur one years' imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement mac be forwarded to the OMce of Investigations of the D1A for coverage verification. /do herebt•71Z (tilts and pena/tics of perjun•that the information provided above is true and correct. SitnatureDate Print name I , 4@i'� (.' 1�! Phone# 7 �� rlo),f�rj al use unIy do not write in this area to be completed by cin•or town oRcial yor town: permittlicense# rntluilding Department Licensing sward C]check if immediate response is required C2Seiectmen's Office ► (:]ttealth Department contact person: phone#: Mother s: Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for employees. As quoted from the "law'% an einpluree is defined as every person in the service of antrt�l4r under sn� T fl'. ' contract of hire, express or implied, oral or written. An emplt rer is defined as an individual. partnership. association. corporation or other legal entity. or any two or :nc- the foregoing enuaged in a,joint enterprise, and including the legal representatives of a deceased emplover. or the receiver or tnrstee of an individual , partnership. association or other legal entity, employing employees. Ho«reyer owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the d\vcllin; house of another who employs persons to do maintenance , construction or repair work on such dwelling lie or on the ,rounds or building appurtenant thereto shall not because of such employment be deemed to be an empioye: MGL chapter 152 section 25 also states that ever• state or local licensing agency shall withhold the issuance or reneival of a license or permit to operate a business or to construct buildings in the commonwealth for ati applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the pt:-fornnance of public work until acceptable evidence of compliance with the insurance requirements of this chapte- been presented to the contracting authority. 77�- Applicants Please fill in the %vorkers' compensation affidavit completely, by checking the box that applies to your situation and Supplying, company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial ,accidents for- confirmation of insurance coyera`e. 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 requirec to obtain a workers- compernsation policy. please call the Department at the number listed below. . City sir Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottorr., o: the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Ple: be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned -he Department by mail or FAX unless other arran`ements have been made. Tile Office of irnvesti`atiorns would like to thank you in advance for you cooperation and should you have any question. please do not hesitate to :Live us a =11. . Tile Department's address. telephone and fax number- The Commonwealth Of Massachusetts .n. Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Ma. 02111 fax #: (617) 72747749 phone T: (617) 727-4900 ext. 406. 409 or 375 { • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE - JOB. LOCATION Number Street address Section of town "HOMEOWNER" ew,049" gco Name Home phone Work phone PRESENT MAILING ADDRESS �D� G�g,� �. �• ' ►a 3 City town State Zip code The current exemption for "homeowners" was extended to include owner- dwellings of six units or less and to allow such homeowners to engage an in- dividual -for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, 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 Offic4 on a form acceptable to the Building Official, that he/she shall be responsih- for all such work performed under the buildinq permit. (Section 109.1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the St Building Code c and other applicable odes, by-laws, 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. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35 , 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person(s) for hire to do such work, that such Home Owne: shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for .licensing Construction Supervisors, Section 2. 15) . This lack of awarene: often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home " wner-' actir. as supervisor is ultimately responsible. ,. To ensure that the Home Owner is fully aware of his/her responsibilities, man communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. FTo � eC 5 a Cerl� �t Cot cow euve she �lcnr Fioor-