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J�t � 9 , . .., , , . , - � , �, , &U� i," -�-,, " ,,� ��",��,,�,,,,,,,,,,,,,"""",""I'l"""""""��,,�,,� ... J". . , , fit 2", " .- f 6 /6 Town of Barnstable *Permit# �- 5;0 y F�ues 6 months from issue date ry Regulato Services Fee Mass. g, Richard V.Scali,Director Z44 s6gq. ♦0 Building Division Paul Roma,Building Comm issioner& a �_ 200 Main Street,Hyannis,M�i02601'YoV.3 302016 www.town.bams tab le.ma.tt`slfrj Office: 508-862-4038 .R ,3rA Fax- 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL 04W Not Valid without Red X-Press Imprint Map/parcel Number n / -Property Address , 5'7 5 A ► ✓7✓I I e 5 �-rt V1 10 �.Q✓1�(w12_lI i 1 I e A, 6 ,4" 3 Z Residential Value of Work$k0 4. o () . 0­0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ,j�1 S �'l 1(4 G1 (tS [ t"e,44-1 2 A (Q MA Qo26 YZ. Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance aa sole proprietorhe Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ (check box) Re- of(hurricane nailed)(stripping old shingles) All construction debris will be taken to- dVN w - gt❑ oof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side' ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and 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,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:IWHILESTORMS\building a it forms\EXP SS.doc 06/20/16 1 x r . 0 Department of f ladush ial Accidazt`s 600 WashZlWon S`!wd _ Basion,M4 62111 • e kPFVk'13i11AS��QY�lllfl . ✓' Nf Torlors' Cumpenimfian Insurance Affidavit BmtderslCantractarsMectrwmurJPhunbers Applicant Information ( Please Print E,e1Ty SffiE'4 ludw lQ rani EirtinFFn_ r3na1 ��1 �- #�jg r Address Sc1 �1 I e Q e ✓Cut 4-- Oc9 City/stat�l Are you an employer?:Qteckthe appropriate born: T of ect r 1.❑ I am a to with 4 ❑I am a general contractor and I � ew c ( erti in }: b ❑ employees(full angor Part-time)-* have hired the sab-coadractors 6. I�ietiF oohs icxt 2.❑ I am a sole pmpFietar or partner- listed onthe attached sheet: 7. ❑Remodeiiug ship and have no employees Mese sob-contractors have 8_ ❑Demolitioa working for rEre is any r�tg_ employees oadh#ave wodmrs' ..9..❑B.niltimg atidifioa I 5. ❑ We are a cozpomfica and its lO_❑Electrical repairs or additions IL❑Fbznbingrepairs or additions3_ Im officers have exercised their rio emempfion per mysd€[Nb workers'caarg_ c.1 t of I andw.*e have :`' 13.❑Roof repairs incvrra�r.P raTiked.]i § (4), employees.(No woriexs' 13_El other comp_ias�required.] 'ArEyapg&csatdhatchefs box#lmast also fiIloutthesadoabelawshmdugfiekwa&ers'compensa6=pmRcpinf=cwff L # HI4IS WhC sabmit ibis�daeir i g they sxgdm'a 811 WU�C sadfheaNice outsider,,,n*sre�,.zmms#sub=anemaffidaeFt sari_ rCautzactDm ifta rl ewMhis box nEast wftrh =addilimsl sheEt shomi=ff&a-of the�sad stsfe Whether ar nottbose emiidesb.m employees.Ifthesuk-co�haseemigioyee-%they nmstpmuidetheh vmdEm'tomp.pa1i yn=bez -Taman Be&w is rihepaHcy and f ab site iffformadon Iasm ce Company hfame: F PCliicy-4,or Self-ice Lic: FkpirationDafe- Job S;fe Address: CitylStawzpr Attach a�wpy of the workers'compensationpolicp declaration page(showing the policy mrmber and expiration date). Failum to secmd coverage as required-under Section 25A of MGL m 1572 can lead to the imposition of criminal penaHges of a fine up to$UDD.OU andlor one-y&ir impdsm==3,as well as rim penalties in ihe faun of a STOP WORK ORDER and a Erne of up-to Q_OO a day against the violator. Be adsdsed that a copy of this statement maybe fnrvwiled to the Office of lavesdgafims oft a DIA fat insurance coverage vetdfrcation. I do IfefreZy cerlr fp rtndar tJfs prrats and ah ¢s a ga rxy f7rat the iraf a�tativaprsar�rf€d abor�s ig true :d correct ; inure: - C.Date:-- Officialumanly. Do not write in this area,to be ivimpTeted by city artorrn of U&I Coy or Town: PermiVUeense f Issuing Ailharity(drde one): L Board of Ht2 h 1 Bwlifimg Departmwd 3.CAyffuwn Clerk 4.£lectrieal Iuspeetor S.Plumbing Inspector ti.Ofller Contact Person Phone 9: 6 ormatian and 11astruc-ions mass r etts Get='al Laws chi 152 recces all e=ploye=to provide worxe&campeasation far their eanplay=. p this she,an errployez is defined as.,_cvesyp=ssonin$ire seaviee of another under airy contract ofhimy r express or implied,oral cr wrote . An=qp&yEr is defined as aan.mdiiyidaal,p m b p,association;cmporaf=or ofber legal erit ,or any two or more of the fbregning engaged is a Joint use, inchidiog tha legal repseseatjfives of a deceased employer.or$ie receiver or trast=09Rindividual,p ,association or otherlegal entity,=910YIng c=plDyees- However the owner of a.dwelling haviug not mom tbree aparhnents andwho residestheren,or the occogaat ofthe - dwelling house of aoo•6zer MOPIoys p to do maw m,c onctr ac t;on or repair wok.on such dwelling house or oa the grounds or building atit Onn not because of such emplopmeaat be dsemed to be an emploYcr" MQ,cbaptea 152,§25C 6)also every sisiE or local licensing agency Shall WRhhoId ffie issuance or renewal of a ficense or permit to op bussiams or fn construct bwIdin gs in the commonwealth for any applicantwho has notprodnced accep I evidence of cdmp]ianeewNk the insttrance.covaJrageraquir: Addmona.Uy,MCEL chapter 152,§25C('7} �leitherthe con�aaweahhnor any ofifspolitical subdivisions shall enipr ink any contract for the peas. o c wazic un acceptable evidence of campIi�ce with the �- rcqun-eme r s of this chapter have Been ApPlic-aat� _ , aiA if Please f�out the workers'compeusatio affidavit comp, �YMg the boxes that apply Yoe sl Lan necessalL Ply soh�onfxactar(s)nam s), add mss(es) a er(s) along with then ce fieate(s) of insurance. Limited Liability Companies C}or Limited s(LLP)withno moployees other than the members or partaeas,are not Mquired to W I-e& comp C.C. If an I LC or LLP does have employees,apolicy is mquired. Be ad ' that this affrda. may tor the Depadineat of Industrial Accidents for conffimaiim of insurance ver ge. Also be sure to an date the of ckvit The affidavit should be retained to ffie city or to, 1�the licaHan for the permit or li is b ' requested,not the Department of ILdust dg Acdd�. Should you have gnesdons regarding the law or n required to obtain a wozho rs' compe nsation policy;please can the DeP tment at the number listed below. - companies should ear their _ s clf-in saran ce license rmmbw a a f ae line City or Town Officials f Please bes=that the affidavitis compI and pi rdlegIly. TheDeparfinenthaspro ' aspwz attliebottam of the affidavit for you to fm out inthe e the Of oflnvestigations has to coutzty the applicant Please be sure tD fill in the pennitllicrose er which wDl be used as a refe3rnee number- dition,an applicant $oat must submit m_ultple pennitiUcense ap "r ations in arty giver year,neei only mbmtt one vit indicating Curre` policy fi formation(if necessary)and TMA ob Site.A ddre"the applicant should wate"all to in _(city or town)_"A copy of the affidavit that has b officially stamped or marked by the city ar tnwn maybe vided to the Iica ut as proof:that a valid affidavit is on a for 5:±m peim.#s or licenses A new affidavit must be ed Dirt each aPP - year.Whew a home owner or ddzra is o a license or pew not related to any bn Cio=or Comm venture (i.e-_a dog license orpemnit to bum leaves etr, said person is NOT regajsAto complete this affidavit The Office of Invesdgs&m would like tD. you ia.advance for your coopeaada a and should you.have:any ons, please do not hesjtE t to.give us a call. The Departmenfs address,telephone and fax ear- Thu ter of ach - c}f lridn�a�A��nts . �R4 �n S�� • Bosom VA 02111 Tt,-L 4 617-' -49940=t 4€16 or 14&77-MA SSAFE Fax 617`27 7M Revised 424--07 ��.mg�gf pia . y4. G1 Town of Barnstable Regulatory Services MAB& p Richard V.Scab,Director. Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 r Fax: .508-790-6230 Property Owner Must Complete and Sign This Secti If Using A Builder I �avner of the subject property hereby authorize to act on-my beh4 in all matters relative to work authorize by uilding permit application for. G (Addres of Job y *Pool fences and alarm at the responsib 'ty of the applicant Pools are not to be filled or u" ed before fence ' in and all final inspections are perfo ed and accepted. Signature-of Owner Signature of App t Print Name' Punt Name Date QYORMS:OWNERPERMISSIONPOMS Town of Barnstable Regulatory Services Richard V.Scali,Director . Building Division L►sNsra33.e. II Paul Roma,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: , 13 0 / n / JOB LOCATION: �S �� (�)VI / f '-4'h Ve � v!� t U-Q number street village "HOMEOWNER": I�D_o i9"�� '�'�'—/Upd 5+4VKe - name '. h0 home phone# work phone# , CURRENT MAILING ADDRESS: R 5 P .f✓I✓I l.es Le,- W Q "r C'm+6E V• I I� �'I'1 a4 o a6 3 a- 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 reMonsible 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. S' a of Ho eo 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 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. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 I Official Website of The Town of Barnstable -Property Lookup Page 1 of 4 1.._.. Select Language{'t Assessing Division Property Lookup Results - 2016 367 Main Street,Hyannis,MA.02601 <<BACK TO SEARCH<< E Print Friendly Owner Information-Map/Block/Lot:250/048/ Use Code:1010 Owner Owner Name as of MCCANN,SHAUN A& Map/Block/Lot GIS MAPS 111/15 NOELLE 250/048/ 595 PHINNEY'S LANE property Address 595 PHINNEY'S LANE CENTERVILLE,MA.02632 Co-Owner Name %FAY,JOHN F Village:Centerville Town Sewer At Address:No GIS Zoning Value:RD-1 Assessed Values 2016-Map/Block/Lot:250/048/-Use Code:1010 2016 Appraised Value2016 Assessed Value Past Comparisons Building $74,400 $74,40011, Year Total Assessed Value: Value Extra $35,900 $35,900, 2015-$223,000 Features: 2014-$223,000 2013-$223,000 Outbuildings:$0 $0 2012-$222,300. 2011-$220,100 _ Land Value: $112,500 $112,500 5 2010-$220,000 2009-.$216,500. 2008-$235,100 2016 Totals $222,800 $222,800- 2007-$234,500 Tax Information 2016-Map/Block/Lot:250 1 0481-Use Code:1010 Taxes C.O.M.M.FD Tax $354.25 (Residential) fiscal Year 2016 TAX RATES HERE Community Preservation $62.23 Act Tax; Town Tax(Residential) $ 2,074.27 2,490.75 Sales History-Map/Block/Lot:250 1 0481-Use Code:1010 , http://www.townofbamstable.us/Assessing/propertydisplayscreenl 6.asp?ap=0&searchpar... 11/30/2016 b ; Assessor's map and lot number ... .:J..aSc .. � � , - s2 THE n; Sgwage Permit number ........&4 .-c SEPTIC SYSTEM MUST BE d� } ® INSTALLED IN COMPLIANCE, = BasasTanLE, i ` House number MAM :, .........................................................q............. WITH ARTICLE 11 STATE Doo,�039 hK�`' SANITARY CODE AND TOWN cwara� ' f' TOWN OF BARN.` XBL-E BUILDINn G PEe T R .� S C 0 1 ARPLICATIOM FOR:.PERMIT TO wt'i u ......................... .................................................................................................. TYPEOF C6-kSTRUCTION .................I. ...... ..........:............................................:.......................................... u .,7.' .2 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...............................4-�..T.... P�?.../A1' 1 j-1V S'... . . . JV . .....� eAor7,t;�R 1'.r .L.L.................... ProposedUse N .Nl�-.................... ...................................... .............................................................................. Zoning District .........................................................................Fire District ...G�rN.7..................j ............................... Name of Owner J"� ..Address ........ ../..............................................................®A//V � 9A4 Nameof Builder ... .................................................Address ..........................................................�� ......................... Nameof Architect ..........` r ...Address..................................................... .................................................................................... Number of Rooms .........................:........................................Foundation .............................................................................. Exterior �.' � �.......................................,............................................Roofing .................................................................................... O Floors �Y Interior .................................................................................................................................................................... Heating ...................�.L:.....�.�......................................Plumbing .................... Fireplace ..:...............................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board ________________________________19________. Area ......... ..................... Diagram of Lot and Building with Dimensions Fee .... '... .... .. . .................... SUBJECT TO APPROVAL OF BOARD OF HEALTH h ;terse I \v 301 TO L. 4 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 4.Name ....... ................................... Centerville Owner Frederick 0. Sarkinen Date Completed .,...19 PERMIT REFUSED — .—'------------.. lV ` . ^ ---.';--.....--------~—.—~..—.-- - ~ ' --....—...-----..------.--.--.--.— � , Assessor's map and lot number , �. .y ./..:. ...; ' l(✓ SEPTIC SYSTEM MUST BE ,, INSTALLED IN COMPLIANCE 't Sewage,'Permit number ........ ! /.. �✓..�..... WITH TiCLE Ii t 7 A' STATE SANITARY CODE AND TOWN .v TNEro�o r TOWN OF }BAR: � r��TA"BLE 33 ARNST cABIL PYa�•� .; DU1 1-D11G INSPECTOR -� APPLICATION FOR;PERMIT .TO .... ..... v ( .L..!!.►. .......................................................................... �, TYP,E OF CONSTRUCTION .................................. .......f . -�t i •� `" '•'•f ...:........:.................... a ......... ... /..(�...........19..<.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a pefmit according to the following information: Location ........................... L.S....... .... .... . ... .... '. .s -.................................................................. ........ ProposedUse ....................... .......... .................................................................................................................................... Zoning District .............. . ''' ...........................................Fire District ........ ........:........................................................... Name of Own . '` .!.�.�?. ......Address ............ Y�'f ....:....................:...........:........ . .... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ........................ ...Foundation ............... �..... .................. . � ExteriorW ...................................................Roofing ............ ?J.T....................................... Floorsf.../..../C ..a.........:..................................Interior .......................... .: ..ef.'vaVe ...................... Heating . ..............Plumbing fl...................................................... Fireplace ..................................................................................Approximate Cost ............ DV0l. . .......... . Definitive Plan Approved by Planning Board ----_----------------------------19--------. Area ........��..'.��....:.:................... Diagram of Lot and Building with Dimensions Fee °� / SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. , Naml................................................................................ Sarklnen* Frederick ( ` a�d �w �o ..1 - permk��r .._-------------_ - / / dwelli�m.� � ` -----^^''/�' -^r--^`-'-^'-~-----' - � - � 595' o ' Locationne `""°. . --.-----........................................... ~ Centerville ............. ___,,,.~_____,__.._______- � ' Frederick Sar��m��n ~ Owner . � ---- . ---~-----,-..------.---. Type of Construction ........frame ~ -..'--.�^.---.---.-...---.. ................... �� , ~ ' nr ~ Pkzx ''' : '' ' Lot ' ' '� '' .' � , . "=""'|""==" ", InspectionDate of ^/ 19 uo,e Completed : � ^z°x '��--�. /° �_ ^ ' '' '' . - -,� -- PERMIT REFUSED ' ~l9~^'`--~`-'—'-r-^~^~----''—^''-- /~ ...--._..--..........-........-..�-L--.. , � �� - �°~ / : � . ' ' ^^ . ' ''..'~'--^--'~'-----..,----'-^-^-'---� . , ~~-^~^~^^-^'��'.^-^~~^ '^-'``^^^'-^~'`-~�c���*- ........................................................... ............. lgApproved ''--------------''' ^ ' � ../:-------------.~...--.~. ..--. � � ' . - . . . . ................ ---------^^^'-~'-^-'r`��� , - � T"Er°�. TOWN OF BARNSTABLE BABBSTABLL i ° "6 q BUILDING INSPECTOR �E�NPY a' �f / /� n/ JToI2�f /L/A. , APPLICATIONFOR PERMIT TO .............................................../............................................................................. TYPE OF CONSTRUCTION ............... All ........................................................................................................... ........... ....../.....192. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a' permit according to the following information: Loton .... �.//1//y"-f'.� '4 J/........ ....:... ................................................................................................... ProposedUse ..............................C............................................................................................................................................. 71 Zoning District ........../ ..�....... .............................Fire District ....���'1 ....... ' e.................................. 11 Name of Owner ...........................................Address Name of Builder .......... 67..........................................................Address .....................................N► r ............................................... Name of Architect S'*M I ..................................................................Address .................................................................................... Number of Rooms .............................Foundation .. O v� � .'. Exterior .....w.��.C/...............................................................Roofing ..... .5. .. ..r............................................. Floors ........ ..............................................................Interior ...... ... ......................................................... Heating ..................................................................................Plumbing ..............� .PA Fireplace ..................................................................................Approximate Cost ...........:........................................................ may' Difinitive Plan Approved by Planning Board ________________________________19--------. Diagram of Lot and Building with Dimensions 9 010_ 11001, �`. 00 CO g Uj Qj 1� tj ce I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .v.� .... Sarkinen, Frederick 0. �fi C 31 1971 No ...13314... Permit for one s.tory. ...... , . ........ . single family dwelling # .................................................................. r . Phinney°s Lane Locatio ,.t>......................................................... Centerville .......................................................................... } Owner ............Frederick. . ..0.....Sar. kinen ....... ............. . .... .. . .... ............. Type of Construction frame ........... # ................................................................................ Plot ............................ Lot ................................ F Permit Granted .....September 1.................................19 70 Date of Inspection ... . ............19 70 Date Completed .......V7._8................197( g PERMIT REFUSED ............................................................... 19 ............................................................................... ............................................................................... I Approved .,e..,........ .. .....7a....:........ 19 CA ............................................................................... .................. ......................................................... I , t