Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0006 LINDEN AVENUE
AYe,��� V e , v, k 4 x c , r n 7 w 'p .. - .:. } .,;;. .y,...a�,, ::;, k,,,. r ,. ^:�P4 ,},N,' 4 d a•1:�djy a'i' yF{ t, y �?.(, ,.Q:: 4 Iv,,i,.[' `-2 8s. } i 4. ^-:z� +, �' x, M ay3✓Me Y't:f,. bC p,. a ... ,r .. ., - :;.-. ,,. �_:. .-,:, .. „•.a: , ..e#"o i -.. t ,�, ,. .,.;; -rt i ..,,e -.x.., - 'a: :S p�� r' �zrs , 6. ,,.. � �x ...,_ !..,. 5 -, '.. » ,�: '. .,1 \:..:y, ,,,,. ..,,1,.+t,0 ...r .t3 „ ,'vS ?, N >} 'k,+ <,b• q`!, - < �' JJ ., 5 , fi. ,:.,t,. • ., .. , .- a. .-: . . ,. ,,^ .§ , 'p�, ::"= � .,tr:i a :.; ."Yy::� ,. ',: ,, ,<..., 2Y.r,: ,5„ ., S m•w. ..; ,r rr..,'°,r ,...�'a. , k ,,. ?« k, ..fv J r yp r_ F4- e'4 `,�� , ,p �,,.,:.: 4 *,.:... ,-_ :Y;..., .,r,....r. .-.>.wY ,...:-... , ,.a::.. Y ,- .:. , '-. d .,,4, �:✓aL .A,.:, S':X } 1 ,.. � i ',s, ..3:-: r. ,,, ....., .. , ,i,,,,.-:t.,i r-, rf' - ., .,, •, y ,N„ u^' aril } « r .- .._. ,+ . ...,. .._. r ...,. u..., 'u.... .tr. _ .: ,< s •.-, ,... ,. a ,'.':i.r ,••:,,r. v, .,' #t`, a ',�. .,1 +d tr. >:: .....' , ..... ,..:-.,... -r .t :._.�: S".., v... fe. y.,.,. �::r.. ♦ -: -,.. 4"� .:. ,,e. 6�'M.-,,:. ,.}",c. 7'- 6. .>r „ ,.a ,�• z..:.. ,. ,'., tv. ,.:,., ..[ :.,. e �.. ., .3' .._�..._ ,_„ _,:- ... ,... a...,. ? w.. sd.,rw..,:,. , ',' „>•a` f. 4s :,r✓ ><`<^ xr �...., v r.. .. .. --,... a ..:. rs ... t :,, .,r i_. ,-, , ,�^.—l�.. : �:. ,«,.., .,. .:•,.,. .:,,' r,, .s» '� it: � �e'�i .-::- rr. l -.. : ,x. ,.-._ i. .., • P...-. 9.> ,.,...�A'. :. a "1!. .f .'i„ .�r. o, .9'�',,;.� .#aye -3,. ,..-,-..u- .. :,,., . -, lti< .. ,.�rr r5 YYs ,,{{,,,, .,,...,,. ,. n ::.. Y.✓. r, .: '..- p ,<:, � ;:.� =t F e „.., .. r. ...: , .,.J .. :!Y' -. Y. ..� '�5 .:.x..,. .., . .., ..: .. f F k o-. ... a. Frv,:.; Rr {,'✓t d. �M_ .. .. t .. ..'rx_., .'- t s... r 8 ,.:,r i" `�,. y,....,..,- ....,.,, _ .__ ,, ,,a.-.:L ,. ,. ,,, �.._ .t,,. +'� r a,t✓ ff4' •:.a ;.�+aA• .. C `<., .. r,. i ... .. ..4._.. ,., s,. .. ..z 3;..;"' ,.. ,..., ...,.. 's,..-:. _ ,, 3•",. K,r. '%...a,.%i ...F. r:. a �:.. ..�.:,, �fl' ., ,_. ..o. ,s.:.f• .... ..... ..�tr..+ ti. r ita :,.. :._.,. .,. ,...e.. -.. ,, .,.::a „ x u„::,d, .f ..r +-.+Sa.aYi aA .aV' �:. ?'R^�+Q.nla e ... ... :. ,... _:'�r .. .., .. • _ .... r ..ry { ..a., ..,, .., .f.ff5 Yb.,s4 �. -^+ .,.-.,iy,F,x ...Ft ,.. o- .. .. tit* ,,..- i 1S __ .:,.' 9t, ., .,:,. >. ,.F,. `F:., •�} ... ,. .. ..� _. .. ::. , -,. ....... 5 •,: �✓'r ..,-- ...,....,-t ..- -p o..;x. F „at>. `8 t ? 4•A t ,:r; s:a'T", ,+„ .:;� sk.• ,r:.-.: ,/ .. ?s . a.x. .... , -, .r•; _-. .. _ ._. �,.,'.,, .: ,. '+...,. :.,. ,.:,. : r':,ra ,�:: ,, '. ;?.: a-:'. 9 y,.4,�,c r n r„" + -::}.:. �r�^" i. , ,-r,. :. .... .... .. '� :a..,,}hi ::.,. .. r. :,: .,<rr �,. _,•.,, •� ;:, rL�= ,.:,, a "n.;:: s k,a r "�: ; w-:... - �.,,-.. :..- ;,. .f. ..,.. r.. ,. '�,,,.. h:,:: ,., .. ,n.,-... ,'a,. ,,: r .. ,- .> .;.x-.x � •ac r„Y a:� 5"� GIs:'.-c.. S" .�-.• .0. a a, - :V.. > .. t ,6...�.:,^"♦,.,$ � �� �i '� ,1"." : .;d�... .',5 ': .. ,:, t ,.. .,.,..., .,- g ,...:: ,..,. r„q`✓,-0�. Wy .5 t� �':.., .0::� .. .r.,- ,a<e. ,'tv. .. ,�.- `-S Y W "xr „ .... ,... ».. ,:.,:,- ,.., i,,y rk„t,, a rr ., :.,. .,..-,r .,. ,.' g... •�,.. 'df ,t r ';'#? Y y .. ,.... ....r.e, ,.. ... ,_. ., .. .. _:. .a ,7 t.>., _.. , :.:1.. ,„ t J:; :t• 4 '� . , -:r r ... .r... s �, a, ., a.,. :,. , r'-.... ..3. ..,.r.. ,.<.r..., ..-, .�... k t f �N•, 1 F,V.a b -.r5 -:�$' ✓«tr.. rii,,, ,t. i,...k';. ._,«,-..,... »._ u n :.:': , x,. r,, 4 • -:.-.p.. -�r.• >t5' dx 3 , .,,r., . ,r>.„';� � -., .: ,,. ,.•. s r....s°E' o, .�-. -... _ v# -an .t, 'rs.F` ? : r A 1 +wY :rxi d .•rY+� w S R, � �•5 r�.+s k F ( M1 q F' k � A q , M1 �s s , oFTHE TOk- �. Town of Barnstable *Permit# p� Expires 6 mont is from issue date PIRRUdrory Services Fee + BARNSTABLE,y+�` 9Q MASS' 0' JAN.Z 1 2"�omas F. Geiler, Director �j J o i639. Ajfp�.�A TOWN Building Divisionllq 23r t �V OlrSA , i CBO, Building Commissioner / 2 'M�k�ree ,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION — RESIDENTIAL ONLY Not Valid without Red X=Press Imprint Map/parcel Number V-� Property Address _ ['Residential Value of Worl. Minimum fee of$25.00 for work under$6000.00 te—L Owner's Name & Address t:LL 4 c.�.� AA CJ2 Contractor's NameC W Telephone Number L re-6 18 I tome Improvement Contractor License# (if applicable) L 7 t'^02l� J Construction Supervisor's License# (if applicable) d �O ems ❑Workman's Compensation Insurance Check one: /(I am a sole proprietor 1 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) VRe-roof(stripping old shingles) All construction debris will be taken to lFe✓ \ `T\1 ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ 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: Pro Owner must sign Pro rty Owner Letter of Permission. cop ,of the me lmprov ent Contractors License is required. SIGNATURE: Q.'Will-I[.IS\PURMS\building permit forms\EXPRESS.doc Revised 100608 • 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/Individu ): Address: (� City/State/Zi Phone.#: Are you an employer? Check the appropriate box: Type of project(required): L❑ I am a employer with 4. I am a general contractor and I employees(full and/or part-tim.e). * have hired the sub-contractors 6. ❑New construction 2.( I am a We proprietor or partner listed on the attached sheet. 7.. ❑Remodeling ship and have no employees These sub-contractors have 8.'❑Demolition workingfor me in an capacity. employees and have workers' y p �'• # 9. ❑Building addition [No workers'-comp.insurance comp.insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ p 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.M Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] "Any applicant-that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors 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.M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page'(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine 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 certi n r Wia enalties of perjury that the information provided a ove is rue and correct Signafore: Date: l !. �L 1 Phone#: Official use only. Do not write in this area,to be completed by city or town officiat City or Town: Permit/License# r Issuing Authority(circle one): 1.Board of Health -2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: . Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.,, MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and.phone number(s) along with their certificate(s)of insurance. Limited Liability Companies.(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under."Job Site Address"the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant - as proof a valid f that 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 Investigatlm. 600 Washington street Boston, MA 02111 TO. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.g4v/dia tTti Town of Barnstable Regulatory Services � MABS. $ Thomas F.Geiler,Director 1619L16�� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town_b arnstable.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 autho C to act on my behalf, in all matters relative to work authorized by this building permit application for. L(U3!D'_"A_ Ave G5�'7a'WWX WO t)) Z. .(Address of Job) Signatge of Owner 9Date �7r,`Zq6� � KfI6eA Print Name If Property Owner is-applyrng for pens t please complete the r Homeovmers"Licen'se Exeimption Form on the reverse .side. Q:FO R IvI S:O WN E RP EW IS S I ON Town of Barnstable 4 Regulatory Services t Thomas F.Geiler,Director r RI RAfCP�Rrc ! AdA3.4 . Building Division Tom Perry,Building Commissioner - 200 Mairi=Street�--Hyannis,MA 026-01 _.._. _.__....._.. www.town.barnstable-ma.us Office: 508-962-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityftown 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 sinictures accessory to such use and/or faun 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 Stage Building Code and other applicable codes,bylaws,rules and regulations. The undersigned."homeowner"certifies that-he/she understands the.Town of Barnstable,Building Department minimum,inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to Comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any bomeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 1 D9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall ad as supervisor." Many homeowners who use this exertion ale unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Rcgulations'for Licensing Construction Supervisors,Section 2.15) This lack of awareness often resul;v in serious problems,particularly when the homeowner hires unlicensed persons. In this ease,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 cars t amend and adopt such a fomu/certification for use in your community. Q:forms:homccxcmpt ' v " % ' 9 4 Massachusetts -Oe0artrnen=of Public Safety Board of Building Regulations.and Standards' { construeti4m Super3 tbcr� License. CS-066582 THOMAS C WHITE 'y ` 415A MAID ST + Centerville MA 03b32z Expiration �ta�amissscsr�e� 0311412015' } .- F, C-��e�r�nenza�iCuetclC�za�C/l��csuic�cc�et _ ffice of Consumer Affairs&'Business:Regi lation ` t 0ME IMPROVEMENT CONTRACTOR _. gistration 177283 Type s —t xpiration: 0.1,51 LLC x THOMAS:C:WHITE WOODWORKER"LLC. THOMAS WHITE _ 415A NflAiN ST. :.CENTERVILLE,MA'02632 Undersecretary ajmviti2is;nogj!m Pl eA 10 91TZ0'VWaoI.so.g OLiS 01mS ezeld 3.11 a,01 . um W. ssapisng ptiu site}IV�awnsao3;o a Ujo o urn;a�_punol;I .'a;sp aot;sltdxa_ay;atoaq ,Ciao asn.lnp!nlpui lo;p!IvA uollsJ;si ao M=i7 ,r a Town of Barnstable.� Permit; Regulatory.Services ate: Orr .l THE A . (, y homas F. Geiler, Director Building DivisionBARNSUELF, MAM ' Tom Perry, Building Commissioner 1639' � 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta ble.ma.us Office: 508-862-4038 TOWN OF BARNSTABLE Fax: 508-790-6230 SOLID FUEL STOVE PERMIT Owner: Phone:_. 7�s 9IN Install at: � Village: •P✓1 Y�till p Map/Parcel:-- �' 0 1 Date: 3-a _ Stove A 2ype:/ Used B• aRaZ /Circulating i C. Manufacturer: 1s-}'L� Lab. No. D. Model No.: Chimney -� A. New/ xisting (If existing, lease note date of last cleaning) B. Flue Size C. Are other appliances attached to Flue? No . D. P - Type and Manufacturer �,Q ,. aso me relined Hearth _ � • A. Materials: B. Sub Floor Construction. /U✓Y�G�'� Installer i7V► f Name: Address: �p Phone: Location of Installation: H.I.0 Registration# / 5 �x� .�/a�,�l Construction Supervisor# '/�o�OR check-Homeowner Installing, no license required. APPLICANTS SIG A RE APPROVED BY: Please make phecks payable to the Town o Barnstable is constitutes an official stove permit after inspection,photographed, and approved by the Building inspector. • I I y r The Comhionpeahh ofM=sachusetts . Department aflndustriaZ,tccidents Office 9flnve4-aeons . - 600 Washington,Stred Boston,lYlA 02111' '' w .v.mass.gov/dia Workers- Compensafion Builders/Contractors/Eledtriciarts/Plumbers Applicant Information PIease Print Leml Name(Business/Qrganizati®/Iudividual): . f/ EE ®arm •Address: +30 - 9D City/State/Zip-6 t� MA. 426/ip 3 Phone.#: Arne y an employer? Cbeck the appropriate.box: :Type of project(r]additiom 1.[ 1 am a employex with 3 4. [] I am a general contractor and I 6 New c employees (full and/or part time).* • have hired t'he stab-contractors ❑ w construction2.❑ I am a'sole pioprietor or partner- listed on the'attached sheet 7. ❑Remodeling ship andhaveno.employees These sub-cofactors have 8. 0 Demolition '�orldng for me in any capacity employees and have workers9. Bumldm add[No workers' comp.insurancecow. insurance.$' ❑ g required.] 5. [] We are a corporation and its 10.❑•Electrical rep'3.❑ I am a homeowner doing a'I.work , officers haveexexcised their• 11.❑Phmmbing rep myselL [No workers'comp. right of exemption per MGL 12.❑Roofrepais insurance required.]t c. 152, §1(4), and we have no employees. [Na workers' 13.�.Othex cow,insurance required] *Any applicant that checks box#1 must also fM Qut the section below showing the"workers'compensation poficy mformatioo. t EIcT=owuers,lvbo submit this affidavit indicating they are doing-an work and they hire outside contractors must subrrut anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-conh=tors and state whether ornotthosc entities have employees. If the sub-contractors have employers,theymust provide their warkera'comp.Poli' number. cY I am an employer that is praviding workers'compensation insurance for my employees. Belaw ixAe policy and job site' infbrmi4on. Ins=ance Company Name: Y ' . Policy#or.Self-ins. Lic.m Ol� Expiation Date: --�Q1 Job Site Gity/Statemp: �Py��t✓IUi��� '�/' SS �o Attach a copy of the workers'compensation policy deciarafwn page'(showing the policy number and expiration date). Fafl me,to secure coverage m iegnited under Section 25A of MC3L c, 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisaoment, as well as civil penalties in the form,of.a-STOP WORK;ORDER and a fine of up to$260.00 a day against thq violator. Be advised that a copy of this statement may be forwarded to the.Office of- Iuvesti lions of the DIA for fiou nee coverage verification,. I do hereby ce. fy irn a pains and penalties o 'perjury that the information prgvided above is true wsd correct Si tire: Date: _ . Phase Official-use only. Do not write in this area, tb be completed by cdj,or taws official City or Town.: Yermt/Llcense#' issuing Anthorifp(circle one): E Town of Barnstable Regulatory Services BMWSTABLY y MASS. 'g, Thomas F.Geiler,Director >Ec .ra Building.Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA'02601 www.town.barnsta b le.m a.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 rr - ✓� to act on my behalf, in all matters relative to work,authorized by this building permit. A/{ awi4w,—Villto hi s (Address of Job): . **Pool fences and alarms are the `responsibility of the-applicant. .Pools• are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signa of Applicant lot Print Name . Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 y oF1HEr�,. Town of Barnstable .' Regulatory Services m . BARNST,BLE, . Thomas F.Geiler,_Director, 16 9. ,•� Building Division' Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION y Please Print DATE: JOB LOCATION: , number t street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of sixunits or less and to allow homeowners to engage an individual for hire who does,not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be,a one or two-family dwelling, attached or-detached structures accessory to such use and/or farm structures: A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner",assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be 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 sucli } 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 ho meowner certifythat he/she understa the ere responsibilities sp s 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 fomn✓certification for use in Y p your community. ty Q:fom-is:homeexempt ✓/ e lt/ ✓`���,��./,,� t�s Massach Depa,-tmenT cT Public Safety ze �arsvrrco�rcuiecz �r - Office of Consumer Affairs&Business Regulation Board of Regulations and Standards HOME IMPROVEMENT CONTRACTOR Construction uper%isur 1 &2 Family Registration -120859 Type: '. Lice ,_. :. CSFA-058557 Expiration: xpiration 3/1212014 Private.Corporatior SA N WICH CHIMNEY SWEEP INC'. KEITH A CLIFF -. PO BOX 90 F SANDWICH MA 02563 s KEITH CLIFF 28 EMERALD WAY,: FORESTDALE, MA 02644 Undersecretary Ccr:, ;:::yloner 02/27/2015 COIU MON-WEALTH OF MASSACHUSETTS, Chimney Safety institute i -47 , . CertifiedSHEET METAL WORKERS AS A MASTER<UNRESTRICTED 42 J ISSUES THEID •ABOVE LICENSE TO CHIMNE - q. SWEEP Valld Thru K I T H A :.0 L IF F f June c 28 EMERALD WA.Y,,, N. } 2013 f FQRESTDALE MA . 02644 1530 11'D88 02/28/15 330094 Sandwich Chimney Swoc)p 1 Massachusetts -Department of Public Safety Sandwich, MA Board of BuildingRegulations g ons and Standards Construction Super isor 1 &2 Fami1 License: CSFA-058557 ' License or registration valid for individul use only KEITH A CLIFF Regulation PO BOX 90 before the expiration date. If found return to: - _ F1� ' Office of Consumer Affairs and Business Reg SANDWICH MA-Ob63 F= 10 Park Plaza-Suite 5170 w . Boston,MA 02116 Expiration C01nmissioner 02/27/2015 i . Not vat' thout signature, mom, CONTROL# H575047 - IMPORTANT N ONL-i3y 1=-ice WO ?�nOWOw�3O�< a n If this"license is.lost or destroyed, notify your Board at the: =.-u01,o m----lam a� -Q.w" . -=�;.,�,n�_ -i; f/1 Division of Professional Licensure 1000 Washington St. n a "'o33`;ra,� zayaev.��a_v, > Suite 710,Boston,MA 02118-6100. alloan_ %.dsy� 0 If your name or address shown is changed, notify your board _Lm,�-dam° L� =„a N a 3 a;a a of correct name or address to insure proper mailing of next _ - �z a d m u s a v °a' "v" a 0 Renewal Application. Always refer to your license number. `' This license is subject to the provisions of the General Laws ag N R ITI as amended. It is a personal privilege,and must not be loaned or assigned to any other person. Keep this license on your. person or posted as required by law. 2 _ MAR, 22. 2013 9. 32AM HART INSURANCE NO. 306 P. 1 cc ®° CERTIFICATE OF LIABILITY INSURANCE �A�I�I ► =22l2013 THIS CS ERTIf 1CATE IS ISSUED AS A MATTER OF INFORIIMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVEI-Y OR NEGATIVELY AMEND,EKTEND OR ALTEtt THE COVERAGE AFFORDED 8Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUINGINSURER(S), AU THORItED REPRESENTATIVE OR PRODUCER,A14D THE CERTIFICATE HOLDER. to IMPORTANT: ff the certificate holder is an ADDITIONAL INSURED,the poliCy(il �must be endorsed. if SUBROGATION!S WAIVED,subject the terms and conditiods of the policy,certain policies may require�Tn endorsement. A statement on this certificate does not colder rights to the certificate holder in lieu of such endorsement(s). N La ura J Murphy eb[suC " FAx 5Q8 759-7366 HART INSURANCE AGENCY,INC. PHONE (508)759-7328 a Ne 243 MAIN STREET LEs: Imurphylahertinsuranceagerley.ccm PO BOX 700 wuc e BUZZARDS BAY,MA 025320700 INSURER 5 AFFORDING covERAGE MAX SPECIALTY 20C?79 INSURER a: CIALTY INSURANCE 44326 REo Sandwich Chimney Sweep ddsURER S_ ATLANTIC CHARTER INSURANCE COMPANY PO Box 90 INSURERC Sandwich,MA 02563 1»suaER u INSURER B: INSURER F :OVERAGES CERTIFICATE NUMBER: REVISION NUMBER_ THIS IS TO CERTIFY THAT THE POLICIES OF;INSURANCE LISTED SELOW 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 I'HIS 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- POLICY L SUe PO oGYEPF MPOLICY LUPITS E OF INSURANCE PODGY NUMBER 1,QQQ,444 rrr MAX0131Q0005253 10/09/2412 10t0912013 EACHcfCCURTtENCE $ PAM oRo� S 100,000 AL GENERAL WMLITY $ 004 �OCCUR MED ExP orro :soN PERSONAL&ADV INJURY S 1,(IOD,QQ4 GENERAL AGGREGATE S 2.000,000 PRODUCTS-COMPIOPAW E 1,00Q000 GEN'L AGGREGATE UNIT aFPL1ES PER: $ POLICY PRO- LOC WMBINEO b-fNGLE L[MrT AUTOMOBILE LIABILITY jkqas WM 80DILY INJURY(Per pemn) S ANY AUTO BODILY INJURY(Per nddenQ S ALL AUldS D A"T03ULED NON-0WNED P OPERTYOAk;gGE HIREDAUT08 AUTOS 5 trMORELLALIAR O(.4`UR EACH OCCURRENCE $ ' EXOMLAR Q{AIMEWMA E AGGREGATE $ 7- H- DED RETENTIONS YyC$TgTU• OTH- B WORKMS C0MPENSA7MN WCV01032500 OW812012 4812B12013 AND EMPLOWRT LIASILn y. Y I N - E.L.FACH ACCIDENT s 500,004 ANY PROPRIEYORIPARTI4'ER'E>EG-ITNE ® N t A OFFIGERmJEMBEREXGWOE6? EL DISEA56-EAEht9LOYEE S 540,QQ0 (Mandatory In NHI SQQ,QQQ It�ss dasmbe beef E.L.DISEASE.POLICY LIMIT S 0 RIPTION OF OPERATIONS 10— DE$CRIP ION OF OPERAAONS I LOCATIONS I VEHICLES(AWzhACORD 10#,AddMonal Ramwk&St1lodUk4 If niaffi sUce Is re4uIred) Operations as performed by Terms&Conditions in the policy. CEERIlFtCATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVP DESCRISbb POLICIES BE:CANCELLED BEFORE Town of(3r#rnstable ++ THE EXPIRAYION DATE THEREOF, NOTICE WILL BE DELlVER1 D IN ACCORDANCE WITH THE POLICY PROVFSIOAIS, Building Department b ' AUTHORRED F"RESENTATIVE 01988-2010 ACORD CORPORATION. All rights reserved, ACORD 25(2010/05) The AOORD name and logo are registered marks of ACORD t` a Town of Barnstable . *Perml.1 a Q, Expires 6 months] date Regulatory Services Fee ' BARNSTAHLE. + Thomas F.Geiler,Director �prFD MA't� 7`/uliz '_Building Division C . Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number r Not[valid without Red X-Press Imprint Property Address RResidential Value of Work OGCX:,6 a Z> Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �&L,k-z Contractor's Name ,o ,/> � ` Telephone Number Home.Improvement Contractor License#(if applicable)_. Cot.70o Construction Supervisor's License#(if applicable) X-P��SS PERMIT ' ❑Workman's Compensation Insurance JUL 23 2012 Check one: . I am a sole proprietor ❑ I am the Homeowner ElT�WN �F B I have Worker's Compensation Insurance ARNSTABLE Insurance Company Name l�/ Workman's Comp.Policy#AS' Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken toQy�S� ,, '( , ❑Re-roof(hurricane nailed)(not stripping.. Going over existing layers of roof) ❑ Re-side #'of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ 'Smoke/Carbon Monoxide detectors 4 floor plans marked with red Sand inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,eta. ***Note: Property,Owner must sign.Pr perry Owner Letter of Permission. p oft rHo Imp ement Contractors License&Construction Supervisors License is re re SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC Revised 053012 ?die C'rrmrrronwed&of Manuchusetts a &wnt©f rn&strit d Accidemf O,ice ofInvu4atioizv j bt?i1 Washington Street _ Boston,CIA 02111 Workers Compensafaon Insurance Affi&vif Bid/den/Contmctar&Tlecfticians/Plumbers ippbcant Inform2atian !, Please Print Lezlbly oa/Indiviana . ® C.�l :address: to o✓ _ ityltateLip � .awct� MCA phone.# Are you an employer?Check the appropriate baz: Type of project(required):1.❑ I am a employer with 4. E] .I am a gen�eral.csontractor and I have hired the sub-contractors 6employees(full and/or'part-time)- El New construction 2_ I am:a sale proprietor or parttfr- Isted on the attached sheet. 7. Remodeling and have no employees These:sub-contractors have � � 8_ D Demolition working for me m any capacity. employees and have worms' ' B 9- .Q Building addition[No workers'camp_inana„ce comp_;,,a„+anm X g require ] d5. We area corporatiau:and its 110.El Electrical repairs or additions I F] 'I am homeowner doing allwanrk offfixffs have exercised their 11.0 Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL. 12.0 Roof repairs insurance required..]T C.152,§1(4X and we have no employees-[No workers'. 13..❑Other comp-insurance required-] *Any apphc=th2t chedu tw,a#1 mast also fill out the section below showing their waiet policy — I HomWWDM who sub=this af5 In it m&catmg they are doing all wwk and then hire outside contractors—st a hmit a new affidavit indicating such. f Con= n lhn check tLas ba x must attached an add al ition sheet showing then of the sub-caatsctors aod:srate whe8mw ornot those entities have employees. If the.sub-cm=ctors have employees,they n=pmvide t wir wo(ren'romp.policy number. lam an emplj*wr thatispr+suiditrg workers'componsation.iamrance for my irmpplay,ees Below is the policy and job site. information. Insurance Company Name: Policy#or Self ins.etc.#: Expiration Date: Job Site Address: Cityl'Statelzip: Attach a copy of the.workers'compensation policy declaration page(showing the policy number.and respiration 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-yeas 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 f xwnded to.the Office of Investigations of the DIA insurance coverage I t3v heraby cRrh y a rrfpeajury thatthe izf;rmafim-pnMAr�dabvP9fs.qe and correct Si Date: Phone oJokial use only. Do not write in this area,to be completed by city or town offwiat City or Town: PermitUcense# L%suing Authority(circle one): L Board of Health 2.ling Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other. Contact Person: Phone 9: 6 T aMASS. 1659. Town of Barnstable r 9�A 10� Regulatory Services Thomas F.Geiler,Director Buildings Division Thomas Perry,CBO ' Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.nia.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 ` �� IXU� � to act on my behalf, in all matters relative to work authorized by this building permit application for: c -� w (Address of Job) Signature o Owner. ate Print Name . If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. i QAWPMESTORWbuilding permit formsU�PRESS.doC Revised 051811 Town of Barnstable Regulatory Services > nsz>;.MAM ' Thomas F.Geiler,Director i639' hpr► 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: , JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFEN11TION 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 wto constructs more than one dome 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, 7ylaws,rules and regulations. 1"ne undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection )rocedures and requirements and that he/she will comply with said procedures and requirements. signature of Homeowner 1pproval 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 rom the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner :ngages 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 esults in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot 1roceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ltimately responsible. To ensure that the homeowner is fullyy aware of his/her responsibilities,many communities require,as part of the ermit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page f this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in our community. :\WPFILES\FORMS\building permit founs\EXPRESS.doC .evised 051811 ? Office of Consumer Affairs,&+B mess+Regulation (lAILEIMP_BOYFMF;yT�ONIRfACIOR _ R®glstration123702 TY,Pe Explrati'on; 3�8OY3 DBA i T o as C.'Wh'ite' Qfir I R�LC° 3 — 1 Thona4s W, hits 415A Main St. IviIle Mid 0263 c? of n ersegrel x Vlassacliusetts Depa'rtnient of Public Safety trd of Building Re-ulatibns and Standardti 1 Construction Supervisor License License: CS 66582 �, z THOMAS C WHITE i 415A MAIN ST ' CENTERVILLE, MA 02632 I' Expiration: 3/14/2013 ('unmiissiuner Trt#: 536 J }- t : Licenseror registration valid for indrv�duEuseaonl ;' before the::ex�r#J. date: =If found returnY�t`o OOice of�ConsamW air9 and Bvs�nes R"�' 'one PI'aza Suite 5170 S. 0211E on,MA 77 Niit valri9without rgnatue d, $ k+,. -— Massachusetts` Department of Public Safety a Board of Building Re-uh tkms and Standai dti Construction Supervisor License License: CS 66582 rt THOMAS C .WHITE 415A MAIN ST CENTERVILLE. MA 02632 . 'j • i Expiration: 3/14/2013 Commissioner Tr#: 536 .rt 'u r Fil a � a r x4 6 L in den , Cent . 5/7/13 r n To Whom It May Concern FROM TOWN OF BARNSTABLE BUILDING DEPARTMENT 387 MAIN STREET HYANNIS,MA 02601 L . J t:Cp L^Yi(J.&>n ^veY^u.e, SUBJECT:Linden Avenue,Corner Main Street,Centerville f DATE ^^ May 'i,19R3 MESSAGE The buildings shown on plan dated April 14,1980 by Baxter St Nye Inc.Plan Ref.PI.Bk.20,Pg.>39,shown as Lot C,were built prior to the enactment of the Town of Barnstable Zoning By-Laws and are a legal non-conforming use. SIGNED <J^Mhrf DATE REPLY a'K\ RECIPIENT:RETAIN WHITE COPY.RETURN PINK COPY PRINTED IN U.S.A SENDER:SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT.