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Home My WebLink About0571 SOUTH MAIN STREET ah �.. ti ''� �, �a t�� •*; _ :tire, ,! �� s, N°F�'�� r ,' �! 1'1'l !i' r x.r. 5 r y� look t, s L5 .i ' a ; " -� .. „ F '. " ,i��a .tl ,yw" ��e5� `'tee .{[- c� «:'' It y;y �a;p lb�• •riI A.,i t�1i� ''s�° ry, n r 5 : t, 6 � s • e h �• E 0 } ry 0 i- y c f o � V e _ t _.:.., TOWN OF BARNSTABLE BUILDING PERMIT APPL•ICATION � fl7 " fMap Parcel ® T ' P�RNTABLE Application # Health Division .d Date Issued 4-ZI5 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board'.' Historic - OKH _ Preservation/ Hyannis Project Street Address Village G '�yTE4VJ__1 Ll�� Owner � '��L�''i ��'�!� G/�i Address Y, Telephone 305�q�q SS� 3 Permit Request �eig I f✓- ,�%�Z,[� %�rTi&0! 21Q Square feet: 1 st floor: existingN- roposed l f2 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay (&'XXS7PiV 3 64A46F) Project Valuation (900 Construction Type � go A M rL Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure 0R s Historic House: ❑Yes WNo On Old King's Highway: ❑Yes ft o Basement Type: ❑ Full Drawl Ll Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing&new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: WGas ❑ Oil ❑ Electric ❑Other Central Air: f3Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 6 0 Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: sting ❑ new size _Shed: ❑ existing ❑ new size _ Other: 1&//►, . Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 9No ^ If yes, site plan review# ®�/V Current Use tk" 4 9— Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) r- I O o(a- - Name t1 I C / '� Telephone Number _ Address License # C S F- 0,4 9 9 I Home Improvement Contractor# 1 c) S,4 LPo p Email J f10�r.S � Worker's Compensation # � ff 6f 0� j r O ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO GA V 0 5 S.Af SIGNATURE DATE a' FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING P , DATE CLOSED OUT ASSOCIATION PLAN NO. ' ' .?'lre Co mra'oi*pealth af-Vaassadinseas 7. Depcaramuit cr,f rndus-rial Accidcra s .1 Offi-ce o,f fni�tigad nrs { 600 Washington Street :.._ . Boston,�02 I f4'Fina mass govIdia 'Warkers' CQmpens.atimt Insurance Affidavit:Bm1dermICantractursMectricians!Plumbers Applicant Infcwmat nit Please Print LeQibIy Mamie�Bvs�uerganQatiaaffndi�*rinal I� !`w Addr : la Gs e& city/statelzip Phone Are you an employer?Check the appropriate box: ' Type of project r I am a general contractor and I _ YPe P J t �1��'= I_V. employees am a employer with 0 6. [:]New dion (full au for part-time).* Iiavehir'ed.the sub.-contractors 2. am a sole grop=ietot orparfner- Fisted on the attached sheet: ?_ odeling These sob-contrac#ors ba e slop and have no employees. _ $. Demolition f wo tunab employees audhmie wodcers' .for e-in any capacity.� 9. ❑Building addition [NO S 063EW Comp_irrSUrmre comp-i muranc--i retinked] 5. ❑ file are a corporation and its 10❑Electrcal repairs cr additiaas . 3.❑ I am a homea wner doing all work officers Have exercised their 1L0 Plumbingrepairs or additions. myf-[No w&kets'comp- t of exemption per Lr4 GL I-[:1 Roof repairs immance retied,]i c.152,§1{4),aadwe have no employees:[No workers' 13.❑Other comp.insurance required-] �Aay W itmtdatcbedesbax PI mmst dm Ma2tthe sedionbeIowsi mki rhie workere compensationpaRcpinformauaa fi Somem erswho submit fins zMdac'u indicating they are doiag RUwoA and dumbire outside:contractors— mbmit anew affidavit indicating.smrl rCan=ctors Est ched This bcx must attached=additianal skeet shou-ing the n=e of the sub-caatrsuors and stda whether ornot•rl�nse amddes h me employees.If the sub-coatractorsh=e employees,they mustpmti'idetheir worken'romp.polky.number. I air[art erltplo�r flirt is pro�zdin, markers'conrireresatiart irisriraiica f or nr}T enrplay�e¢s: Helbev is the poIiry and job site tnformat&m Insurance Company Name: Policy or self-ifls.Iic_ ExpirationDate: Job Site Address: City/Statdzip: AC#ach a copy of the workers°compensationpolicy-decIairaiion page(showing the policy number and erphattion mate). Failure to secure coverage as.requiredunder Section 25A of MGL c 1572 can lead to the imposition of criminal penalties of a fine up to$1,50U Oa andl'or one year imprisonment,as we:11 as civil penalties in the form of a STOP WORK ORDER and a fine ` of up to 0_00 a day against ffiq4lator. Be adi'ised•tlrata copy of this statement.may,be forwarded to the:Office of Investigations of the DTA,far' c coverage y2rifcation 'Id'o hereby MIMI,turd rife lahis and rat94 uifarmationprm dcd abma.i, .e and carrrect simatuie: Date- fit Phone ik - q 01 / 60 te �. OjoZmaL use aril}: Do not write in this ar€a,to be campteted by cffp artown otj`iciat City or Toww. Permi fLieense I€ Issuing.A.ulhor€ty(circle one): 1.Board of EleaIth 2.Building Department 3.01S ,]Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Uther Contact Person: Phone#: urination andlastr etions , Massa ch=ct s Geheaal Laws chapter 152 regres all empIopers Yn provide woes'cotapensaiian far their employees. Pnrsuantto ibis sty,an=rplayee is defmca as.¢..eveaypeLsonm.the SCMCe of another unde ct r any co�ra cfhire, express or implied,oral or " " ' • co oration or other legalefdy,or any two or more An errrplvyer is defined as an mdi�idnaI,parfnersb�,association, rp of the foregoing engaged m a Joint entu rpz ,and including the legal representatives of a deceased employer,or the receiver or tin stee of an individual,pmtamsEp,association or other legal entity,employing employees. However the owner of a dwcUnog house having not more than three apartments and who resides therein,or the occupant of the- dwellmg house of another who employs persons to do maht an ce,conskuc(ion or repay work on such dwelling house or on the grounds or buzZdmg appurtenant thereto shall not becanse of sash einplaymmt be deemed to be an employer." MGL chapter 152,§25C(6)also sues tloat`°everysfata or local licensing agency shall withhold the issuance or . renewal of a license or permit to opate a Business or to contract buildings is the counmonwealth for any er applica ntwho has not produced acceptable evidence of compliance with tTie h surance_coverage required_" AdditionaIly,M(TL chapter 152,§25C(7)sums aldeither the commgnwealth nor imy of its political subdivisions shall enter into any con- ct for the perfmmanm ofpublicworlcuntil acceptable evidence of coinpliance�rith the r ems of this chapter have been presented to the contracting aofb oity:' AgpIi�aafs , Please flI oil the workers'compensation affidavit completely,by checlong tie boxes mat apply to your situation and,if l sub-contracto s nam s), address(es)and phone number(s) along with their certfficate(s)of . . necessary,supply �) .e{ . than the „cr„-ance. LimitedLiabdity Companies(LLC)or UnitedLiabRityPartnerships(LLr)wrthno employees other members or pmtacrs,are not required to cagy workers'compensation insurance. If an LLC or LLP does have To ees a olicy is required. De advised that this affidayitmaybe snbmi�d to the Department of Industrial emPY P- Accidents for confirmation of ins=ce coverage Also Be sure to sign and date the affidavit The affidavit shoal be-retlmmed to the city or town thaat the application for the pemmit or license is being requested,not the Department of Dial Accidents. Shoulciyou have any questions regarding the Iaw or ifyou are required to obtain a workers' compsationpoliey,plmsecalltb.eDepartmm±attiennmbralistedbelow. Self-fi uredcompaniesshouId�tertli en eh self-i saran ce license number on the appropriate line City or Town Officials t Please be sore that the affidavit is complete and pr%ated.legibly- The Department has provided a space at the bottom of the affidavit for you in fill out in the event the Office of Investigation has to contact you regm g the applicant Pleas e be sure to fll.m the p e�.idIi.crose number which will be used.as a reference number. In addition,an applicant float must sabnhit EiII14IepennWHcense applications in any givenyear,need only submit one affidavit indicating cent p olicy inb=mation of messa y)and under'�-ob Sita Add Imse the applica:at should write"all locations in (ciY or town):'A copy of the-affidavit that has been officially sipped or marked by the city or town maybe provided to the applicant as proofthat a valid affidavit is on fle for fofare'pemj s or.limmes. A new affidavitmust be tilled out each year.Where a home owner or citizen is obtaiming a license or pe=it not related in any business or commercial veninra (Le.a dog license or permit to bum leaves etc.)said person is NOT required to Mete this affidavit The Of of Invesbgataus would EM to thank you in a&mca for your cooperation and should you have any qua oars, please do not hesitate to give is a c L The Dep artmenfs address,telephone and fax mmnber „- -Thc Cmmimweal*of Massa.chn& tL , Depar(mmt of l idustdal AccZeut; B n�YA f 111 Tf,-1<4 617' -4904 cmt 406 or 1--a77 MA3 AAFE Fax#617` 27-7M Kevised4-24-07 €.mac-gavI a. AWC Guide to Wood Construction in High Wind Areas:110 mph,Wind Zone Massachusetts Checklist for Compliance(780 C,Irx 5301.2.I.1.)' C�1 Cheek Complieace 1.1 SCOPE WindSpeed(3-sec,gust)................................................._......._.._..__.. .................__.........:_.....110 mph _ WindExposure Category.............................................._......................_._. 1.2 APPLICABILITY Number of Stories ._................_. ........._.._..........._.._. (Fig 2)._......:....._........... stories 2 stories _ Roof Pitch .(Fig 2) ...... 512:12 Mean Roof Height......_..........._.._._.._................•......[Fig 5 33' Building Width,W.__. ..._._.._.._.__....._.___.....__. _.. ..(Fig 3).._.._.__:_..._...._..__.._...._ _ft 5 till' Building Length,L �� _ _ F 3 ft 5 BO' ' Building Aspect Ratio(UW)._.................._.....' ......... _.(Fig 4). _..._._..._ .. _<3:1 _ ..... _... ..... ... Nominal Height of Tallest Opening2 .........................__...(Fig 4)....:.........._..:.._....._...._.....,._ s 6 B' 1.3 FRAMING CONNECTIONS General compliance with framing connections.........._........(Table 2)........................ ...................._.._....... 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete..... .............................._.................I..............................I..............---.................. .... ConcreteMasonry............._......................................_............ 2.2 ANCHORAGE TO FOUNDATION''s 5/8'Anchor Bolts imbedded or 5/8'Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing-general.........................................(Table 4)._..... ..... ...._.._....... in. Bolt Spacing from end(oint of plate ....... (Fig 5)............_._... .. in.5 6"-12" Bolt Embedment-concrete.:_...._............ (Fig 5)..._......... :........_ .._..._._..... in. 7" _ Bolt Embedment-masonry..._.:.................................(Fig 5).......__........................:...._.. in PlatePlate Washer.........................................................._(Fig 5).:_.._............:..:............:........2 3'x 3'x t/4" 3.1 FLOORS Floor.framing member spans checked ..................:. .......(per 780 CMR Chapter 55).....- _............................. Maximum Floor Opening dimension_......_........................(Fig 6)..................._....._ft s 12'or U2 or W/2 Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)....................................... Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall...............(Fig 7)._._._:_... .._._.............................. ft 5 d Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwail................(Fig 8)..................................................._it 5 d Floor Bracing at Endwalls.................... _...... ...._._..(Fig 9).........._......._...... .........:........ :_.. _...� ....... ..... . Floor Sheathing Type ...................._...............................(per 780 CMR Chapter 55)........_..........._....___ Floor Sheathing Thickness........_.........._...................._.....(per 780 CMR Chapter 55)..__.................. in. _,. Z- Floor Sheathing Fastening.................._........_......:.......: Cr able ).._d nails at in edge/ in field 4.1 WALLS Wall Height Loadbearing walls.......... .................._............:..._..(Fig 10 and Table 5)......_:..._.._.._..__ft s 1.0' Non-Loadbearing walls::.... .._........_........ .._......._..(Fig 10 and Table.5)........................._ft 5 20' f Wag Stud Spacing ...................................... ....(Fig 10 and Table 5)...____..........._in.5 24"o.c. Wall Story Offsets . ......:........_._.............._........... .(Figs 7&8)................................. . ft S d 42 EXTERIOR WALLS w ,Wood Studs Loadbearing walls........ . ........I..........._ .(Table 5). .............. 2X-_ft_in. Non-Loadbearing walls ., .. (Table 5)........_........._........2x - ft in. Gable End Wall Bracing — — — Full Height Endwall Studs........._.. _... _ .. .(Fig 10)...................................... . ._.._............. WSP Attic Floor Length_..........._.... _ ........... (Fig 11):............_. ...... ft>W/3 _ _ ._... ..... .._ Gypsum Ceiling Length CO WSP not used)...____:.._ _(Fig 11)......................_......__,........ ft k 0.9W, 2 x 4 Continuous Lateral Brace @ 6 ft.o.c...(Fig 11).............................._..__.. Double Top Plate _.._...__. ' Splice Length ...._...- (Fig 13 and Table 6 Splice Connection(no.of 16d common Waifs):....._..__.(Table 6}.__.,,.._....._............_...........__._..... AWC Guide to Wood Construction in High end Areas:I10 rrspk Kind Zone MassachaseM Checklistlor Compliance(7so cm s3tn.m.1)l Loadbearing Wall Connedons Lateral(na of endnaled 16d common nails)..__:._-__-(Table 7).............................................. Non-Loadbearing Wall Connections Lateral(no.of endnaged 16d common nails)..__._..._(Table 8)._...........__.........__.............. _... Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans _.. ......._ _........................(Table 9):. ._._................... _ft_in.s 11' Sill Plate Spans _..._.......___.__........:. .....__._.(Table 9).____...____... _ft_in.511' Full Height Studs (no.of studs)__......___ __._..(Table 9).....__......_......._............ .._ _.. Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans.._......... __.......... . ._........__...(Table _ft_in.s 12' Sill Plate Spans...:..........._.........................�_..._. .(Table 9)_............. ..._...._.... _ft...... in.s 12' Full Height Studs(no.of studs)._......._.__.._.:__....__ .(Table 9)......_:............:_......._.. Exterior Wall Sheathing to Resist Uplift and Shear SimultaneousV Minimum Building Dimension,W Nominal Height of Tallest OpeningZ ._...... ..... . ..............�.._... 5 6'8' .... .._. ...».. _ SheathingType........._....._..........................(note 4)..........._......................... ....._._...._ Edge Nall Spacing._..................__.._..__.__..(Table 10 or note 4 if less)_..__..____._.. in. Field Nall Spacing.........-__..___•• (Table 10).............._...____... in. Shear Connection(no.-of 16d common nails)(Table 10}_.______._ ...._...._..... _...._.:..:.._ Percent Full-Height Sheathing.._..... __._..(Table l0)__._:......... _............................_% 5%Additional Sheathing for Wall with Opening>6'8'(Design Concepts)_.._...____..._. Maximum Building Dimension,L Nominal Height of Tallest Openine_._._.-._.................................................................._.........._5 61B" SheathingType_...............»............__......—(note 4)............................................._.. Edge Nag Spacing....... . :.....____._.. . -. (Table 11 or note 4 if less)............. . in. Feld Nag Spacing.. _..».....»...._.(Table 11)................................... in. Shear Connection(no.*of 16d common nails)(Table 11).__..._..................... .._._............_ Percent FuiHieight Sheathing...._......._-.......(fable l l)...__...__..._......__-__...__.-__. 1...... 5%Additional Sheathing for Wag with Opening>5'8'(Design Concepts).-.......- ._._.. Wag Cladding Rated for Wind Speed?...:._.._.:____..................._... __ ........_..:_..._.. _.._:. _._.._.. ...... _... 5.1 ROOFS Roof framing member spans checked?L..................(For Rafters use AWC Span Tool,sea BBRS Website) Roof Overhang ......._.......... .. (Figure 19)............._ft 5 smaller of 2'or W Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................_.._ ...(Table12).............................._. U= pif Lateral..._._..................................(fable 12).......... _........................._.....L= Plf Shear...._..............-.._.._.._...._._._.(Table 12)._ S:�__ Ridge Strap Connections,if collar ties not used per page 21..._(Table 13)........._...................T= pif Gable Rake Outfooker.........................................(Figure 20).............._ft s smaller of 2'or Lit Truss or Ratter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift........ __. ...._..»... _(fable 14)......._..._..........._..............._U= lb. Lateral(no,of 16d common nails)...(Table 14)...............................+. ...:L= lb. Roof Sheathing Type._._ ......... ......._............._.....(per 780 CMR Chapters 58 and 59)................-. Roof Sheathing Thickhess_....................._._ ...»__.. ._....._.._......_.__... _in.a 7116'WSP Roof Sheathing Fastening_......................__..........(fable Z)..._..._ Notes: 1. This checklist must be met in Its entirety,excluding the specific exception noted in 2,to comply.with the requirements of 780 CMR 5301 ZI A Kam 1.if the checklist is met in its entirety then the following metal straps and hold downs are not required per fhe WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 a Uplift Straps per Figure 14 d.• All Straps per Figure 1T e. Comer Stud Hold Downs per Figure 18a 2. Exception:Opening heights of up to.8 f.shall be permitted when 5%is added to.the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate In exterior walls shag be a minimum 2•in,nominal thickness.pressure treated#2-grade. AWC Guide to Wood Construction in Sigh Wind Arens: II�mph Wind Zone Massa.chusefts Checklist for Compliance(780CV[R5301.2.1.1)t 4. _ a. From Table 10 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing requirements b. Wood Structural Panels shall be minimum thickness of 7/16*and be`installed as follows: 1. Panels shall be installed with strength axis parallel to studs. I All horizontal joints shall occur over and be nailed to framing. 51. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. V. Horizontal nail spacing at double top plates,band joists,and girders shall be a double row of Bd staggered at 3 inches on center per the Figure, VertIcaf and HoAz6nfal Narrng for Panel Attachment • f • 1 y 1 AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zane M"Sachusetts CheckUst for Compliance(7m CMR53o1.2.].1)' -UVfiM THE EDGE RESTS ON FiFi4 AW EISESd NALS AT Waim • Ir rI • t _u • Y u so do • U t► ' i i1 ii � • 8 lY F'E I ie t: 1 r 6 d ii I CL • � a r. r f u . IL i to it ILIt u 1[f t • 1 � 4 It i; 1 1 it • 'll � 146JLSFACM EAN% eL LJ See Datatl on Text Pago Vertical and.Horizontal Nailing for Panel attachment 1 • II • �tME Town'of Barnstable Regulatory Services B"N esLE' Richard V.Scali,Director Eo;9. Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601. www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property.Owner Must Complete and Sign This Section r If Using A Builder C, 6 / ' as Owner of the l?eroect subject l p riY hereby authorize to act on ray behalf, in all matters relative to work authorized by this building permit application for: I_ (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 caner Signature of Applicant ot'], i MA4 /C4* ct0�r Print Name Print Name Date Q:FORMS:OWNMERMISSIONPOOLS Town of Barnstable Regulatory Services dr'THE Richard V.Scali, Director Building Division BAMSTABM # Paul Roma,Building Commissioner MAM 03g6 �� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508 790-62 30 HOMEOWNER LICENSE EXEMPTION / / Please Print DATE: 1177 . JOB LOCATION: I number street ( village "HOMEOWNER": Ail G I Ct/'1 �� U"1 name home �phone# work pho eQ# CURRENT MAILING ADDRESS: i7 t 6�'I'1 �' ��Y� 1✓'/ o ' cityhown 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,Rovided that the owner acts as sppervisor. Jai ~, 1 J ! ` DEFINITION OF HOMEOWNER I ` ti ' 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 l'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 r sponsibility for compliancewith t e Stag 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 pro edures and requirements and that he/she will comply with said procedures and requireme Signature of omeown 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 pr oceed roceed against the unlicensed-person as it would with a licensed persons. In this case,our Board g . Supervisor.. The homeowner acting as'Supervisor is ultimately respons ible. 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 g Supervisor. On the.last page e of this issue is a form currently used by several towns. You may care to am end and adopt such a form/certification for use in your community. I Massachusetts-Department of?Public Safety _ rds Board of Bui'tding Reg ulatio�ss and-Stands /.---I---- s�j�IC1 V11111 2 1 11L rnulin- . LII liltl Ulll�l 11 � - License- CSFA*49915 gUpB EN J GIATO 106 Cape Drive. . Mashpee MA 02lA9 t LA Expiration J.� 07/21/2016.; Commissioner - - _ G7� F 12 Office of ConsWner Affairs' ''and Business Regulation 10 Park I lation. Plaza Suite 5170 Boston, MassaQhUsetts 02116 Home Improvement Coatractor Registration J ,. y Registration: 125460 STEPHEN GIATREL i' Type: Individual ISM - w i +G�r""' Expiration: 1/21/2018 STEPHEN 'GIATRELIS 5� � Tr# 2345 106 CAPE DR. . j' MASHPEE, MA 02649 05n1 w Update Addressdress and return card'Mark reason for change, [ Renewal Employment CJ Lost Card Licen c or registration valid for individul use onl befor I-he expiration date. If found return to: y Offc of Consumer Affairs and Business Regulation - Office of Consumer Affairs&Business Regulation//r 10➢'fk 11laza-Suite 5170 .,Registration 0 strantionOVEMENT CONTRACTOR BOStoi i� A 02116 9 `125460 J19 Expiration 1/21/2018Type:STEPHEN Individuali GIATREL i i; STEPHEN GIATRE68"'N 1 f i Not valid without Sig 106 CAPE DR. ,.; MASHP EE,MA 02649 Undersecretary } 1 Parccl Detail Page 1 of 5 P {l; *% 3 ,WtASB r x.. Logged In As: Parcel Detail Monday,August"z's 2016 Parcel Lookup Parcellnfo _...._ _.. --.------- ..........._ ._..........__------ _� _ w_ �.._..,..._._. Parcel ID186-078 Develop er Lot Location 571 SOUTH MAIN STR Pri Frontage258I Sec Road Sec Frontage Village Centerville . I Fire District C-O MM AI Town sewer exists at this address NO Road Index i1507 Asbuilt Septic Scan: " 186078_1_ Interactive Map �I 186078 2 Owner Info Owner HOGAN, DAVID E� I owne�.%KANARICK,WILLIAM I streetl!8 ROSE AVENUE" .�_]street2 �� city MARBLEHEAD ) state�MA ._I Zip a01945 Country Land Info ........ ......... ....... ......... ......... ....._ Acres 1 58 I use j'Single F zoning 0 am MDL-01 N- 1 I ` Nghbd11 „3 .rl Topography revel Road Utilities Public Water,Gas,Septicl Location Water View, .,.wI Construction Info Building 1 of 1 �ti ....;� .P........,..' " Year 1968 Root Gable/Hi exc Wood Shingle Built r �� I Struct wall g Living i1472 a Root SAS h/F GIs/Cm Type C al „w.:... . Area€ Cover p p Style Ranch wall Drywall Rooms Bedrooms J Model Residential Floor Hardwood Rooms A2 Full-1 if Heat,•.".`< ,. `�` Total�."=; GradeCustom PIUS Type Hot Water Rooms 6 Rooms Stories 1 Story Fuel GaS F u d- Poured Conc Gross 67 Area R Permit History Issue Date. Purpose Permit# Amount Insp Date Comments 8/23/2013 Wood Deck 201305689 $9,000 9/11/2013 DECK 20X24 12:00:00 AM 5/7/2012 New Roof 20102205 $3,000 6/30/2012 REROOF STRIPPING 12:00:00 AM OLD . http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=12602 8/29/2016 I Parcel Detail Page 2 of 5 9/29/2011 Remodel 201105200 $113,000 2/16/2012 JINTERIOR RENO-KIT, 12:00:00 AM BTHS,LIV RM-REPLC WINDS Visit Histo.rY_.. Date Who Purpose 6/2/2016 12:00:00 AM Jeff Rudziak Sale Review 2/4/2013 12:00:00 AM Mike White Bldg Permit Completed 8/23/2012 12:00:00 AM Jeff Rudziak Sale Review 4/25/2012 12:00:00 AM Nancy Finch Sale Review 3/13/2012 12:00:00 AM Robin Benjamin In Office Review 11/21/2008 12:00:00 AM Paul Talbot Cyclical Inspection 9/27/2001 12:00:00 AM Paul Talbot Meas/Listed-Interior Access 7 Sales History ------------- __v__. .. „ .._._.r Line Sale Date Owner Book/Page Sale Price 1 7/1/2011 HOGAN, DAVID E 25543/242 $454,000 2 7/1/2011 JAMES W& CHARLES G PADULA 25543/239 $0 3 8/22/2002 PADULA, LILYAN M 15501/171 $100 4 3/30/1998 PADULA, LILYAN M . 11319/124 $1 5 8/17/1967 PADULA, CHARLES G & LILYAN M 1375/249 $0 6 3/29/2016 KANARICK, WILLIAM B 29541/38 $859,000 Assessment History ......_. . .. ._. _........... _. _ _...,,... ._._.____ .. Save Year Building XF Value OB Value Land Value Total Parcel # Value Value 1 2016 $128,600 $14,800 $5,200 $414,800 $563,400 2 2015 $118,900 $15,000 $6,300 $411,500 ' =$551,700 3 2014 $118,900 $15,000 $6,200 $411,500 $551,600 4 2013 $118,900 $15,000 $6,300 $411,500 $551,700 5 2012 $115,600 $13,900 $1,900 $341,000 $472,400 6 2011 $137,900 $3,100 $0 $341,000 $482,000 t 7 2010 $137,800 $3,100 $0 $347,300 _ $488,200 8 2009 $142,600 $2,500 $0 $420,000 $565,100 9 2008 $170,900 $2,500 $0 $429,100 $602,500 11 2007 $170,900 $2,500 $0 $429,100 $602,500 12 2006 $175;700 $2,500 $0 $432,500 $610,700 13 2005 $163,500 $2,560 $0 $389,300 $555,300 14 2004 $123,000 -$2,500 $0 $692,000 $817,500 15 2003 $123,800 $2,500 $0 $255,800 $382,100 16 2002 $153,400 $2,500 $0 $255,800 $411,700 17 2001 $153,400 $2,500 $0 $255,800 $411,700 18 2000 $116,100 $2,300 $0 $135,800 $254,200 19 1999 $116,100 $2,300 $0 $135,800 $254,200 20 1998 $116,100 $2,300 $0 $135,800 $254,200 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=12602 8/29/2016 Parcel Detail Page 3.of 5 21 1997 $124,100 $0 $0 $135,800 $259,900 22 1996 $124,100 $0 $0 $135,800 $259,900 23 1995 $124,100 $0 10 $135,800 $259,900 24 1994 $109,600 $0 $0 $135,800 $245,400 25 1993 $109,600 $0 $0 $135,800 $245,400 26 1992 $124,900 $0 $0 $150,800 $275,700 27 1991 $137,700 $0 $0 $180,800 $318,500 28 1990 $137,700 $0 $0 $180,800' $318,500 29 1989 $137,700 $0 $0 $180,800 $318,500 30 1988 $106,800 $0 $0 $120,500 $227,300 31 1987 $106,800 $0 $0 $120,500 $227,300 32 1986 $106,800 $0 $0 $69,100 $175,900 Photos ....... .......... . y a , A l . i qy< r 4 S " x NII NII [}} http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=12602 8/29/2016 Parcel Detail Page 4 of 5 x:,� � � dr t-. e'"^ d '�'/�"KKK`�.✓ f' a , K { 1 ' 3 S as . �a s w I 1 � I http://issgl2/intranet/propdata/Par.celDetail.aspx?ID=12602 8/29/2016 Parcel Detail Page 5 of 5 J j yt �j. t_ x Q y i45 Ta + & 4 y http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=12602 8/29/2016 Town of Barnstable Geographic Information System August 29, 2016 q s y, � = k f F 7s a $5¢z § k p 99 C , .ate La's koTd�� V x'� 9 a a v s $ x 44 iZa. g { k s §per d f S .�.:,rsxa �� .;._ 'oxs " .. 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"s 'a.. � & £v sp4s ^�°. �r p�-�.3-8.55'�are•:o'd' x�.� =u.L<.rEkba�d � rod. ,4§h# :..4• .d $Frog. $ wE' £ 'S wA.a$ _: oad."� �P 1-�1. 3A dF ter, E` wA `R,a ':,a.eGt,F $k5k.-^ i U .a k3,er. ,§ +58>;- $'c:: d..�& $M•` 8j' *a 4§'; la <.- =Y-m <�„.::..@a,�S � �• 3 k-Qs s a,y-4.a.�N '3 Fw.g .oF x.... "r � { p R, ' s� �0 p a �s.'^e(:("[._.c"0'"a:�n+.nc,`.�x.-,-7.._.'Lg7..v>'a'.uGa'c,S,..s F£4as*dma'n•,n....,g, ,.._�s3.._,.d...:;.;.:.,.3T s33§d.'.&t.-.�..ibP c.:abs^.$,,_.=. _dermaF„> F,a-�.P k'✓3a av-p$1,.$-S pt•Sx S,$�':,4a'ia_s'a.q.--dro4f� .. .a $"iN M �6F k n. DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map: :186 Parcel:078 Selected Parcel boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:HOGAN,DAVID E Total Assessed Value:$563400 1"=100'may not meet established map accuracy standards. The parcel lines on this map %' W .- are only graphic representations of Assessors tax parcels. They are not true property Co-Owner:%KANARICK,WILLIAM B Acreage:1.58 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:571 SOUTH MAIN STREET such as building locations. Buffer ��!,. s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' Map Parcel :;,'Application #4:::�& 2 Health Division Date Issued L �- Conservation Division Application Fee ' Planning Dept. Permit Fee . Date Definitive Plan Approved by Planning Board p c Cjl Z4�� Historic - OKH _ Preservation / Hyannis Project Street Address J�7 S 04774 M41IJ Village C'd-N TV-0 U6- Owner U/D -go G R/U Address Telephone 2p,3 _253 - 2I 7Z ; Permit Request /ZonU A` -C /fly rMO L OP /YQMe- Square feet: 1 st floor: existing tMproposed IY3 8 2nd floor: existing proposed Total new. Zoning District Flood Plain _Groundwater Overlay Project Valuation &//�� 000 Construction Type lVWD Y»(I- f Lot Size Grandfathered: ❑Yes ❑ No If yes, attach°supporting-6ril tation. mom; Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) ; C:) Age of Existing Structure /� 30 Historic House: ❑Yes 0 No On Old King s;Highway� b Yes'Jg,No Basement Type: ❑ Full ;d Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) 0 Basement Unfinished Area (sq.ft) Qk• Number of Baths: Full: existing new Half: existing nee Number of Bedrooms: _ _ existing — new Total Room Count (not including baths): existing A 5 new First Floor Room Count Heat Type and Fuel: 4 Gas ❑ Oil ❑ Electric ❑ Other Central Air: A Yes ❑ No Fireplaces: Existing New 4_ Existing wood/coal stove: ❑Yes kf No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:;o existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes %I No If yes, site plan review# Current Use 3'Lt IyOM41k 'aQ&6 Proposed Use shod m Ivoedv- APPLICANT INFORMATION "+ (BUILDER OR HOMEOWNER) Name C�64I�J2 1 UI�t,L� Telephone Number 23a "2 /(F Address License# CS 7ROL 025 4p Home Improvement Contractor# 0 l q Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO NAw M- D 1/1 SIGNATURE DATE EL13 0 /n S FOR OFFICIAL USE ONLY :,'APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE I� OWNER DATE OF INSPECTION: _FOUNDATIONd` _ # FRAME t4 M _^INSULATIONZo��► FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: - ROUGH .SR FINAL '- • J = z.JNAL BUILDING; DATE CLOSED OUT f ASSOCIATION PLAN NO. ` s The Commonwealth of Massachusetts Department of Industrial Accidents f_a i Office of Investigations ` k °I`� 1Y 600 Washington Street Boston,MA 0.2111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):- (tT e,� YOa 4 Address: g O t !Q 123`t City/State/Zip: �mmigp l, nn� ��07� Phane #: 7 �� . q 239 _291 F-;4 you an employer? Check the appropriate bons Type of project(required): I am a employer with 4. ❑ I am a general contractor and Iemployees(foil and/or part-time).* have hired the sub-contractors 6• ❑New constructionI am a sole proprietor or partner- listed on the attached sheet. $ �. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp, insurance. 9. ❑ Building addition [No workers' comp, insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work 'right of exemption per MGL 1 L[:1 Plumbing repairs or additions myself. [No workers' comp, c.152, §1(4), and we have no 12•❑ Roof repairs insurance required.] t. employees.[No workers' comp. insurance required] 13•0 Other ;Any applicant that checks box€l1 must also fill out the suction 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. lContractors that check this box must attached an additional short showing the name of the sub-contractors and their workers'.comp,policy information. I am an employer that is providing workers'compensation Insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Dater 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. f do hereby cert�under the pains and pena of perjury that the information provided above is true and correct Si nafore: Date: 1 r Phone 7 q Z 3 Official use only, Do not write in this area,to be completed by city or town official City or Town: 'Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4: Electrical Inspector 5. Plumbing Insp ctor, 6. Other Contact Person: Phone#: - 1 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, y 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-contractor(s) 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 r' Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number, In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-490.0 ext 406 or 1-8,77,MASSAFB Revised 5-26-05 Fax # 617-727-7749 r www.mass..gov/dia i o : �Q �ji4mv �I�`�u"5ine��'�eAg'ufa ion Office of'consumera�rs ,HOME IMPROVEMENT CONTRACTOR Type. Registration: .,170141 Individual Expiration: 91.1g6L2013 GARRETT S.YOU LDEN GARRETT YOULDEN 110 SANDCASTLE OR E.FALMOUTH,MA 02536. Undersecretary - ... t`lassachusctts-Department of Public Safcis Board of Building Re„ulations and Standards Construction Supervisor License License: CS 78261 GARRETT:S YOULDEN a PO BOX 1234 i MASHPEE, MA 02649 3 • � _ ii Expiration; 6/29/2012jI y (ommis4ion�,r Tr#:. 1415 . TME To* wn of'Barnstable r � Regulatory'Services • HAAN6TABL.� MAB& Thomas F. Geiler,Director 619- Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property owner Must 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 bythis budding permit application for. (Address of Job) k t� a Signature o Owner Da Print Name If Pro e ,..., , p rt� Owner is applying for penmi t'please complete the Homeowners License,Exemption Form on -the reverse side. Q:FO RMS:WA NERPERMISSION } Town of Barnstable of�►�rots Regulatory Services ti� O suzrrsrAsts Thomas F. Geiler,Director HA& Building Division orEoi Tom Perry,Building Commissioner 200 Maiti.StreetAyannis,MA_02601 VrWW.to Wn.b arastabl e.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOI IEOWNER LICENSE EXEMPTION Pleare Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state pp 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. DE14IHIT1ON OF EOMEOWI\'ER Persons)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 twctryear 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 yi rfbrmed under the buildig 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. HONXOWNER'S EXEIv mbx 'The Code states that "Any homeowner performing work for which a building pernrit is required shall be exmmpt from the provisions of this sectign.(Section 1 D9.1.1-Licensing of construction Supervsors);provided that if the homeowner engages a parson(s)for hire to do such work,that such Homeowner shall act as supervisor. )Jany homeowners who use this exemptian 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 bftcn 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 homcowncr certify that he/she understands the mspons�bilitics 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 fomi<certification for use in your community. Q:forrris:h omcea cmp t � F atet 9/19/2011 Time: 12:49 PM Tot GARY 02 YOULDEN 9,17742551325 Rogers >� Gray Ins. Page: 0 Clierd#:23864 PECKDAN1 DATE(NWI/DplYYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 911912011 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. 1 PORTA T: the certificate holder is an ADDITIONAL 1 SUR D,the policy(les)must be endorsed.ff SUBROGATIO WAIVED,su 'act to the terms and conditions of the policy,certain policies may requ ire an endorsement.A statement on this car ire does not confer rights to the certificate holder in lieu of such endomement(s). NTA T Mina Vaughan t PRODUCER _ NAME: Rogers&Gray Ins.-So.Dennis PHONE 508 3Q8-7980. FAX No:__ CONE EM: — — 434 Route 134 EDR L ADDRESS: P.0.Box 1601 CUSTOMER 07#: - South Dennis,MA OZ660'1 BQ1 INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Nat9 Grange Mutual Insurance.C INSURED Daniel J.Peckham ,NsuRER B.Associated Employers Insurance dba D J Electric INSURER c 87 Audrey's Lane INSURER D Marston Mills,MA 02648 INSURERS INSURER F COVERAGES CERTIFICATE NUMBER: INSURED REVISION NUMBER: ED OvE F511 THE POLICY ITHIS IS TO CERTFF��—THAT THE ND CATED.NOTWITHSTANDING ANY REQUIREMELICIES OF NT,,CTERM OR ONDITION OF ANY ONTBEEN ERACOOR OTHER D BELOW HAVOCUMEN WITH RESi'ECT O WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY TrIE POLCIES D��4 EXCLUSIONS AND CONDITIONS OF SUCH POLICIE REIN Is.SUBJECT TO ALL THE TERMS, S.LIMITS SHOWN MAY HAVE BEEN I Ptd13CY M DDL BR .POLICY NUMBER .. . .. .R TR TYPE OF INSURANCE RRENCE (?A71 04120I2Dt "EACH OCCU 5t`fie lltiQ A GENERAL LAABR.tTY MPT56M1 U. DAMAGE T RENTED 000 PREMISES(Ea amurrence X COMMERCIAL GENERAL LIABILITY -. MED EXP(Any one person) $10 000 CLAIMS-MADE n OCCUR -I PERSONAL$ADV INJURY $1 000 0 0 . I _I GENERAL AGGREGATE $6,000,01w i (. PRODUCTS-CCUPtOP A G $71MONO GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accident) BODILY INJURY(Per person) $ ANY AUTO BODILY INJURY(Per acddeM) $ ALL OWNED AUTOS — _ .I 1'NOPtIt1Y UAMPtGt $ SCHFDIII Fr)AUTOS I (E'er acadenQ HIRED AUTOS - $ NON-OWNEU AU I OS - 3 EACH OCCURRENCE $ UMBRELLA LIAR OCCUR AGGREGATE_ $ - EXCESS LIAB CLAIMS-MADE - $ - DEDUCTIBLE RETENTION W C STATU-r I OTH- �tq�0812011 04108r201 X YL)ly(T B f WORKERS COMPENSATION UyGG50Q8115012011 i"" E.L.EACH ACCIDENT $100 000 I AND EMPLOYERS'LIABILITY _ (ANY PROPRIETORIPARTNERIEXECUTIVEY/N E.L.DISEASE-EA EMPLOYEE $100000 /M500000 _ . OFFICEREMSER EXCLUDED? Y NIA E.L.DISEASE-POZIGY LIMIT 500 000 (mandatory In NH) I(yes.describeunder - - pESCRIP ION OF OP RATIO S b low DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required) *'Workers Comp Information-Proprietors/Partners/Executive Officers/Members Excluded:Daniel J Peckham, sole proprietor'* CANCEL T[ON CERTIFICATE OLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Gary Youlden THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS' 110 Sandcastle Ave. Falmouth,MA 02540-MA AUTHOPJZEOREPRESENTATIVE i e m ig8j.2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009109) 1 of 1 The ACORD name and logo are registered marks of ACORD MLV _ _WS715051M66730 U� � S T7 i M�� Town of Barnstable Regulatory Services SINE Thomas F.Geiler,Director Building Division 13AMSTA13M • Tom Perry,Building Commissioner � M 3s 19. �� 200 Main Street,Hyannis,MA 02601 �ED MA'S A Office: 508-862-4038 Fax: 508-790-6230 January 16, 2013 David Hogan 361 Janes Lane Stamford, CT. 06903 RE: 571 South Main St., Centerville, Map: 186 Parcel: 078 Dear Mr. Hogan: This letter is to follow up on the status of permit application number 201105200 and to inform you that this department has become aware of violations of 780 CMR at the above referenced address. The following must be addressed: 1) A final building inspection is required. 2) The deck constructed on the back side of the house does not have the benefit of a building permit(not included the scope of the permit issued). Please contact this office immediately to resolve these items. Respectfully; L J au on Local Inspector Jeffrey.lauzongtown.barnstable.ma.us (508) 862-4034 y i a67� °Ft r ti Town. of Barnstable *Permit# P Expires 6 months frorn issue date. Regulatory Fee �5. BARNMBLE, z+ orris. Thomas F.Geiler,Director ,p 1639. X-PRESS PERMIT tfD�`{t► . Building Division: .. Tom Perry; CBO, Building Commissioner MAY 7 2010 200 Main Street,Hyannis,MA 02601 . TOWN OF.BAR (STABLE www.town.barnstable.ma.us Office: 508-862-4038 Fax:.508-790-6230 EXPRESS PERMIT APPLICATION. - RESIDENTIAL ONLY l Not Valid wilhont.Red X-Press Imprint Map/parcel Number 1$lo 6,78 Property Address 2Z n f t L i7 ❑Residential Value of Work Q 0 0 Minimum fee of$25.00 for work under$6600.00 Owner's Name&Address c �`t a- Ices t,, A- .L.�{� wrt cc- d CL [c:Lr"A Contractor's Name _. Telephone Number Home Improvement Contractor License,#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance aPRES S Check one: PERMIT ❑ I am a sole proprietor 2-1 am the Homeowner MAY - 7 2010 : ❑ I have Worker's Compensation Insurance - 70WN OF BAMSTABLE'. Insurance Company Name Workman's Comp.Policy#` Copy of Insurance Compliance,Certificate must accompany each permit. Permit_Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to`7 -n S`FCs`l�l u �r ❑Re-roof(not stripping. Going over existing layers of roof) ❑'Re-side' #of doors . ❑ Replacement Windows/doors/sliders..,-Value (maximum .44)4.of windows *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: ✓ n l jL<`"� .-'j < I ;\ The Cotnrrionwealth oflVlassachttsetts Department of Indttstrial-Aceidents Office of Investigations 600 YYashington Street Boston, MA 02111 wwminass.gov/dirt r+, Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name (Business/Organization/Individual): alckd r- E, . � / 1 >�ZQ n! � — Address: City/State/Zip: t J r V t Phone #: 5 0 e ' �5'y 7 7 S J 7 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 6. E]New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g• Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp.insurance.$ � ��/required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.L VI 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions _-__anyself,..[No work >s_'_coznp,. _ right of exemption per MGLa_ _.,.A2.[1 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains dpenalties ofperjury that the information provided above is true and correct. Sign c�oe f Date: Phone#• Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other r �. u Phone# e 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-contractor(s)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 bembers or partners are not re urred tocarryworkers com ensation insurance. If an`I I;C or LLP doe`s have employees, a policy is required. Be advised that this affidavit maybe 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 slue 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 maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia Town of Barnstable regulatory Services &nxxsrnsr E Thomas F. Geiler,Director Tg,A 1b 9 ,m� Building Division QED IN, Building Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us n Office: 508-862_4038 _ _ Fax: 508-790-6230 Jf HOMEOWNER LICENSE EXEMPTION Please Print DATE: 7 - A01 D 1 / �__ JOB LOCATION: .5-) l�V r number street village j "HOMEOWNER": CL_ G'7"//t c Gl D 7 7' S name homy phone# J� ( work phone# CURRENT MAILING ADDRESS: y 0/UL city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner, Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other '1 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 requ'r-epnents. j Si nature of Homeowner t Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S.EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC II oFIKE r Town of Barnstable Regulatory Services B,ARNSrABLF- Thomas F. Geiler,Director 9 MASQ- �' D a.,a`� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 wwrv.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must 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: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the. reverse side. Q:FORMS:OWNERPERMISSION I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map , Parcel 01 V Application #WO Health DivisionDate IssuedConservation Division 3 fE. 5� Application F Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board o4c ��Z3I13 Historic - OKH Preservation / Hyannis Project Street Address 51 I _ S OU`� r� ki N 5-T . Village l W/e F Owner_ &*W Address W V OFS LA10E M&FOP-- CT Telephone 011 s2 Permit Request Zd 2y Square feet: 1 st floor: existing proposed 2nd floor: existing -proposed Total new. Zoning.District Flood Plain Groundwater Overlay Project``Val on 00 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King'ss Highway:rp�7 Ye8❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq Number of Baths: Full: existing new Half: existing new, 2' Number of Bedrooms: existing _new � 4 Total Room Count (not including baths): existing new First Floor RoodCount Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ 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) Nf anrrie 1b Telephone Number 203- 253- qj SZ AAddress 3 N t License# � a M l) F- G I QGgQ3 Home Improvement Contractor# Worker's Compensation # AL L�CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 SIGNATURE DATE I ZO 3 V �_ FOR OFFICIAL USE ONLY 'APPLICiATION# DATE ISSUED L MAP[PARCEL NO. ADDRESS VILLAGE OWNER Y` DATE OF INSPECTION: +otFOUNDATI.ON:�th�'��}u1�5�.��ua'�d� 4 FRAME iINSULATION FIREPLACE ELECTRICAL: :.. ROUGH FINAL L k PLUMBING: ROUGH FINAL s Y GAS: ROUGH FINAL FINAL BUILDING _ DATE CLOSED OUT ASSOCIATION PLAN NO. jM Town of Barnstable Regulatory Services anaNST-433 . ' Thomas F.Geiler,Director MAM 39. 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 qi I q 3 Please Print DA TE: O I y� �o,, . JOB LOCATION: 5-7 l c j 0A thtq 1 cS-L GeM�y1)'1P, number street village ..HOMEOWNER": Fl qiV 1`G� Z S 3- R j $2 name home phone# work phone# CURRENT MAILING ADDRESS: ��I �I aN e� P. city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures an equ' is and that he/she will comply with said procedures and requirements. eme 0�_� V9 R�_— Siggiiatum of Homeowner 1 Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor.." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible: To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\decollik\AppData\Local\MicrosoR\Windows\Temporary Intemet Files\ContentOutlook\QRE6ZUBN\EXPRESS.doc 'Revised 053012 °FTME Town of Barnstable Regulatory Services • snittvsrwstie, • . Mass g Thomas F.Geiler,Director i639• 1� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit (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 Signature of Applicant Print Name Print Name Date Q:FORM&OWNERPEPMISSIONPOOLS 6/2012 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-contractor(s)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 cant'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 that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 0211.1 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations W3Ert 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicantt;Information Please Print Legibly Name(Business/Organization/Individual): Address: lue. /4/State/Zip: UN- 06W, Phone#: Zo 3- 253-q,l s 2 'Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.El am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship�and have no employees These sub-contractors have g, ❑ Demolition workin for me in an capacity. employees and have workers' g Y P tY• 9. ❑ Building addition [No workers' comp. insurance comp. insurance. ,required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3� I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ 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. 'TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state.whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si+ ature: Q�4 lk Date: g -s Phone#: r Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r r Towne of.Barnstable:' - Regulatory Services SINE Thomas F.Geiler,Director Building Division BMWSTABLE. * Tom Perry,Building Commissioner , - � 6 q 1 �� 200 Main Street,Hyannis,MA 02601 •MA'S A Office: 508-862-4038 Fax: 508-790-6230 December 4, 2012 Garrett Youlden 110 Sandcastle Dr. E. Falmouth, Ma. 02536 RE: 571 South Main St., Centerville, Map: 186 Parcel: 078 Dear Mr. Youlden: b This letter is to follow up on the status of permit application number 201105200. To date, this office has no record of a.,final building inspection.Final electric.and plumbing inspections were done in March of 2012 and it appears the project is complete. Please contact this office immediately to arrange a final building inspection or explain the lack of progress. Thank you for your attention in this matter. - Respectfully, MAF4166-n— Local Inspector jeffrey.lauzon cgtown.bamstable.ma.us (508) 862-4034 _� . ;. � 4 F 'r4'•Y �. a �J qq V �0 3ah�s Lci.r►L CT 069°3 G ,P Z� // oSZ° Town of B Regulator * w * BARNSTABLE, 9 MAgg, Thomas F. Ge 1639• �� '°rso59rp Building Tom Perry, Buildi 200 Main Street, H Office: 508-862-4038 January 5, 2011 Patricia Gisleson PO BOX 172 Centerville, Ma. 02632 rf wn.F RE: 590,Lumbert Mill Rd., Centerville, MA, Dear Ms.Gisleson: Richie's,Insulation Inc. 111=0ld Bedford.Rd Vi/estport, ll/Ia 02700 TOWN: I'll � A►y_, AREA �E.��P11JL� CEILING , t� WALLS kr STAIRWELL BASE. CEIL GARAGE CEIL G.H. WALL CRAWL OATH. WALL, Ra► F3�415 ' � FOUND. WALL B `LOCK/RUNN. SLOPES ` �1;a t P/V i ;— IANUARY 12 S M T W T F S 1 2 3 4 5 6 7I- 8 9 10 11 12 13 14 15 16 17 18 19 2021 22 23 24 25 26 v 2829 30 30 31 �_ e��r -- FEBRUARY 12 I j • • I j t, architecture e ngineeiring management { I ' I S M T W T F S 1-- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 �¢� � �. I ' I ( � i I �r.-�_ 19 20 21 22 23 262728299 ♦ —�- � ' I �� I —i MARCH 12 S M T W T F S 1 2 31 - 4 5 6 7 8 9 10 �—� 11 12 13 14 15 16 17 18 19 20 21 22 23 24 - 25 26 27 28 29 30 31 - L—! 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SEPTEMBER 12 S M T W T F S 2 3 4 5 6 7 8i- - 9 10 11 12 13 14 15 1 1 I 16 17 18 19 20 21 22 23 24 25 26 27 28 2930 OCTOSER 12 i - I S M T W T F S 1 2 3 4 d w - j --; --I --- --- I - — - � t6/& 5 6 7 8 9 10 11 i 2 13 14 15 16 17 18 19 20if 21 22 23 24 25 26 27 ' - 28 29 30 31 + '_ NOVEMBER 12 j - -- -- - - S M T W T F S -� 1 2 3 4 5 6 7 8 9 10 ILA r1 i if 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 j DECEMBER12 —�- S M T W T F S WA 2 3 4 5 6 7 8 9 10 11 12 13 14 15 � 16 17 18 19 20 21 22 ` 23 24 25 26 27 28 29 - - � 30 31 Produced for EDM 1 j vvwuv.edm ae.com i un onville, ct I• Pittsfield, ma 888.336.6500 by Excelsior Printing Co ! ITT T _ Recycl!ed S OFIME Toy, Town of Barnstable Regulatory Services *" BARNSTABLE, MASS* $ Thomas F. Geiler,Director i6;q. ♦0 `i'�rfo.39,�A Conservation Division Robert W. Gatewood,Administrator 200 Main Street, Hyannis, MA 02601 E-mail:conservation@,,town.banstable.ma.us Office: 508-862-4093 Fax: 508-778-2412 - 1 Date: January 17, 2013 71 � - Name: David E. HoganGA Add.: 361 Janes Lane Stamford, CT. 06903 RE: Enforcement Order#VIO2013005 Dear Mr.David Hogan: The enclosed enforcement order, issued to you, will be discussed and voted upon by the Barnstable Conservation Commission at a hearing to be held on Tuesday,Jan.29, 2013 at 8:30 a.m. at the Barnstable Town Hall, 2°a floor® Hearing Room ❑ Selectmen's Conference Room, 367 Main Street,Hyannis,MA. You and/or your representative are strongly urged to attend this hearing. ' If you have any questions,please call me at 508-862-4041. Thank you. Darcy Karle ; Conservation Agent/Enforcement Officer DK/ Cc: Building Department ' Enclosure(s) Wpfiles\forms\enforceltr R Massachusetts Department of Environmental Protection DEP File Number: �TNE► Bureau of Resource Protection -Wetlands . WPA Form 9 Enforcement Order > STABIX. ` Massachusetts Wetlands Protection Act M.G.L. c. 131; §40 �039.�.0� §237-1 TO § 237-14 TOWN OF BARNSTABLE CODE fD MA'S A. Violation Information Important: When filling out This Enforcement Order is issued by: forms on the Barnstable January 17, 2013 computer, use Conservation Commission(Issuing Authority) Date only the tab �. key to move To: your cursor- do not use the David E. Hogan return key. Name of Violator 361 Janes Lane, Stamford CT. 06903 rab Address i 1. Location of,Violation: as above Property Owner(if different) 571 South Main Street Street Address Centerville City/Town Zip Code �. 186 , 078 Assessors Map/Plat Number Parcel/Lot Number 2. Extent and Type of Activity(if more space is required, please attach a separate sheet): r Alteration of a flood zone and the Barnstable Conservation Commission 50'undisturbed buffer zone and 100' buffer zone, by construction of a new'deck over an existing patio, landscaping improvements including driveway reconfiguration and removal of vegetation on northside of house and around deck. 1 4 B. Findings The Issuing Authority has determined that the activity described above is in a resource area and/or buffer zone and is in violation of the Wetlands Protection Act (M.G.L. c. 131, §40)and its Regulations (310 . CMR 10.00), because: .the activity has been/is being conducted in an area subject to protection under c. 131, §40 or the buffer zone without approval from the issuing authority(i.e., a valid Order of Conditions or Negative Determination). wpaform9a.doc rev.7/14/04 Page 1 of 4 J i n y Massachusetts-Department of Environmental Protection DEP File Number �INEIoN Bureau of Resource Protection - Wetlands WPA Form 9 - Enforcement_Order 9Bnxx 39'LE- Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 §237-1 TO § 237-14 TOWN OF BARNSTABLE CODE B. Findings (cont.) 0 the activity has been/is being conducted in an area subject to protection under c: 131, §40 or the buffer zone in violation of an issuing authority approval (i.e.,.valid Order of Conditions or Negative Determination of 1.Applicability) issued to: Name Dated File e Number Condition number(s) EJ The Order of,Conditions expired on(date): Date The activity vio.lates,provisions of the Certificate of Compliance: The activity is outside the areas subject to protection under MGL c.131 s.40 and the buffer zone, but has altered an.area subject to MGL c.131 s.40. ❑ Other(specify): C. Order The issuing authority hereby orders the following(check all that apply): .. The property+owner,his agents,permittees, and all others shall immediately cease and desist from any activity affecting the Buffer.Zone and/or.resource areas. ❑ Resource area alterations resulting from said activity,,shall be corrected and the resource areas returned to their original condition. ❑ A restoration plan shall be filed with the issuing authority on or before Date for the following: rT she restoration shall be completed in accordance with the conditions and timetable established by the suing authority. wpaform9a.doc•rev.7/14/04 Page 2 of 4 Massachusetts Department of Environmental Protection °pIKE,° Bureau of Resource Protection-Wetlands DEP File Number. WPA Form 9 — Enforcement Order 9 BARNSTABLE, Massachusetts Wetlands Protection Act M.G.L. c. 1.31,, §40 -MASS. �Ar i639 ►� §237-1 TO § 237-14 TOWN OF BARNSTABLE CODE FO MA'f C. Order (cont.) ®, Complete t Notice of Intent(NOI). The NO[ shall be.filed with the Issuing Authority on or before: February 26, 2013, After the fact filing fees will apply. The deadline date for the NOI can be, extended with agent once a consultant is retained. The consultant/engineer may contact staff at for the following: rTo try and seek approval for the deck and address all landscaping changes (driveway reconfiguration and removal of plantings) or remove deck and address driveway and plantings in consultation with staff by same date. No further work shall be performed until a public hearing has been held and an Order of Conditions has been issued to regulate said work. ®`.The property owner shall take the following action (e.g., erosion/sedimentation controls)to prevent further violations of the Act: -Refrain from removing vegetation (mowing, cutting or trimming) in the 100' buffer zone or wetland/salt marsh in the future without consultation with conservation staff. **'`Note Phragmites removal requires a filing with the Conservation Commission. Failure to comply with this Order may constitute grounds for additional legal action. Massachusetts General Laws Chapter 131, Section 40 provides: "Whoever violates any provision of this section (a) shall be punished by a fine of not more than twenty-five thousand dollars or by imprisonment for not more than two years, or both, such fine and imprisonment; or(b) shall be subject to a civil penalty not to exceed twenty-five thousand dollars for each violation". Each day or portion thereof of continuing violation shall constitute a separate offense. D. Appeals/Signatures t An Enforcement Order issued by Conservation Commission cannot be appealed to the Department of Environmental Protection,but may.be filed in Superior Court. Questions regarding this Enforcement Order should be directed to: Darcy Karle Name 508-862-4041 Phone Number ' M-F 8:00 am 4:30 pm Hours/Days Available Issued by: Barnstable Conservation Commission Conservation Commission signatures required on following page. wpaform9a.doc-rev.7/14/04 Page 3 of 4 Massachusetts Department of Environmental Protection CEP File Number. oF'THE b Bureau of Resource Protection-Wetlands WPA Form 9 — Enforcement Order 9$" STAB LE, -MASS. Massachusetts Wetlands Protection Act M.G.L. c. 131,�§40�as. s6,9 §237-1 TO § 237-14 TOWN OF�BARNSTABLE CODE ED MPS D. Appeals/Signatures (cont.) . In a situation regarding immediate action, an Enforcement Order may be signed by a single member or agent of the Commission and ratified by majority of the members at the next scheduled meeting of the Commission. Signatures: Signature of delivery person or certified.mail number wpaform9a.doc•rev.7/14/04 Page 4 of 4 t j II I, I • I i � I j I I� I__i III -� � II • 1 I III I�l�i Ili I _ - CA I ,I II III lii'li I III - 1 ' T - j:. �� 1-LWij Tl III II l L I I <. 9 NI- i li I �-�-__ • —-- rl - II I I I I i I C �I GI (1 ol I N m i• iI iS 6 I II t 4 IFS 1 L I I � 71 0 i o / III �• '� }r I ---- � S- IIj cc C N I. o �• C� o I I, " ud I iI _ yyy31 r, �rf Ir'W I IFm I��I I r P m m• _n '6; � � —m III _ �. — I _ I • I I' I . o Y P - N j�� m I I i III � i 1 i ' li�� r J HUE 1 a_I i ? �zo�T _�YeyA?I.oN I j I II j I I FLE] LL' i •• ..." DELIL_.._ ca =-PAL O___. Ll `s f - - 1- _Hd1=1C_1k1:CLOSET "�-� OO i ,. -.KITGOffi.: . g:4. O�D nc7R_ TI A t 1 „ I I. BUILDING DEPT.. oa Andrejs R. Strikis APR 2 5 2017 r, _._eoecu_ I� I u1.S. 85 Rivzr Vew Architect u Centerville,M—chus—02632 -Telephone(508)7%.0420 Renovations TOWN OF BARNSTABLE i 571 South Main Street,Centerville,MA A 1 Rood t cudder y Locus orse oe Ln + �� a o Bo Lod 7 Rood \ \ f O M St on Beoch Nantucket 3r6, Sound � LOCUS MAP / i I ,' \ . / ' • \ \ \ .111• , i , 1! . 1. 15. .� �, .1� ••. .•Y f n • 1 li '.! !J • � . } •! 3 �1. Y �.- ♦ ! r Y SCALE 1"J2000't ASSESSORS MAP 186 PARCEL 78 / I LD DRIVEWAY EDGE OF LAWN ( 2008 AERIAL PHOTO 950\ v\\ � LOCUS IS WITHIN FEMA FLOOD ZONES A10 EL. 11, & B AS SHOWN ON COMMUNITY / PER ASSESSOR'S _ \ \P PANEL #250001 0016 D WEB PAGE (3,990f SF) 0� �� ° P * 45`9 \\A OWNER OF RECORD DAVID E. HOGAN �, r\ 361 JANES LANE / EXISTING DRIVEWAY 0m, a• ° 2 �. \\\ STAMFORD, CT,06903 . dt WALK (3,059t SF) �C'B d = 9 5� �� e LAWN WITHIN A W LAWN , EG COASTAL BANK REFERENCES TO BE R,ATURALIZED (400± ` DB 25543 PG 242 PROPOSED PB 94 PG 59 _ PHRAGMITES REMOVAL DATUM IS APPROXIMATE NGVD 29 I ,9 -:;�• , S 3 1 ,STIN c a 1,AVl m' 3$3 r PARCEL TS _, _ BASED ON tiTOWN -GIS y : 9571 60,6 OR PA 0 3 C T •i` 5 0 Di 1 6 . 5 PLAN OF LAND AN IN f', ' . ,:`?,.:: ::' ' . .. :., • :' . :.•':: "'° 22 / _ / / C' REMOVE ASIAN BITTERSWEET, MULTIFLORA ROSE. P �.:' :; :','•• �g / / / �' HONEYSUCKLE, do PHRAGMITES ON COASTAL BANK (937t SF) ° CENTERVILLE, MA •' . ::: ;.�`+a• t$y� ° EXISTING DECK WAS BUILT ED LA OVER PREVIOUSLY EXISTING 'i•a. ';:. ::,' .' gob a2 GE / ///� PATIO. I / �� PREPARED FOR I / —7— \ \ \ 59 TOP OF C`b1A�T -.7 — / DAVID E. HOGAN DATE: MAY 6, 2013 99� 305't �Z 324 Scale:1"= 20'6. 0 10 20 30 40 50 FEET 4.h: i ! ; , #q1 •v.. Y , .. ,. , .; '!.:,! / 'i ;?r .:'t '1° A' S f!• w . ♦ ^fo:' ! ) i! Y !. . off. 508-362-4541 <<Q168L� Z .m,a. ,. :...-r fox �08-362-9B80 aA OF�rr�y�F3 syc y y downcope.com %o DANIEL `� W "� m down cope tjet apring' Inc. oJALA o No:403R N o Q > civil engineers of o� m w °� 6 land surveyors 939 Main Street ( Rte 6A) O YARMOUTHPORT MA 02675 DATE DANIEL A. OJALA, P.L.S. Z #13-026 13-026 HOGAN.DWG - Rood rudder y Locus 1 n� JfSe oe Ln SS CX e0ch Rid Nantucket 3,6• Sound LOCUS MAP / I "9 fo \ � \\�� SCALE 1 =2000 f / I \cb\\ \ \ . S 63 - q ASSESSORS MAP 186 PARCEL 78 / f DRIVEWAY \ TqC LOCUS IS WITHIN FEMA FLOOD ZONES A10 / EDGE OF LAWN 2008 AERIAL PHOTO e5o\ � 6q�\ �p \ \ PER ASSESSOR'S/ EL. 11, & B AS SHOWN ON COMMUNITY WEB PAGE (3,990f SF) \� PANEL #250001 0016 D a may, � \\� ` / � 5X\ \� �\l►,G / ° \ OWNER OF RECORD 9 0 �°? �P� a DAVID E. HOGAN / 5 J0. ° v�R H `\� 361 JANES LANE EXISTING DRIVEWAY a �* 2 \\\\ STAMFORD, CT•06903 �- r9' do WALK (3.059t SF) "� 2 9?� A� � � L J LAWN a ( \\ LAWN VIATHIN A Qom` E� ° ao \ ` COASTAL BANK REFERENCES tER * \ TO BE NATURALIZED c� 9 i� `g a3 \ (mot DB 25543 PG 242 a PROPOSED PB 94 PG 59 � - - PHRAGMITES _--_ - ExIST1NG o / REMOVAL "DATUM IS IS"'APPROXIMATE NGVD 29 a3 PARCEL T$ - -_. BASED ON TOWN -GIS ^ 3 DWELLING �/ / 3• tSR ° V ER OR 605t 60, SF ' (— I .s.:.fjtit..�' JJ� 6 (�t� o �$ 9_ � n 11r' 13 a rJp OFF \ a6 PLAN OF LAND DIVTi I ~+ i• ° S IN f .". ?`'�- .;,, L / //% •' REMOVE ASIAN BITTERSWEET, MULTFLORA 08N2 HONEYSUCKLE, d PHRAGMITES ON COASTALK (937t SF) CENTERVILLE, MA EXISTING DECK WAS BUILT 6f �' ; •- $°a '//%/ OVER PREVIOUSLY EXISTING f0 GE 1-4 ///� PATIO. PREPARED FOR —7� o 6^�--� -- TSE OF - -: DAVID E. HOGAN fp 11-02 r DATE: MAY 6, 2013 6 g9 305't 23242g� Scale:1"= 20' 9��► � 0 10 20 30 40 50 FEET ` '. 1. r ' 1 ' ? • f ' Fn,'..-.• ? 1. 1 ' ;i 't '.T . 1: i ;. R •t :0:� f d 1 tv , 1 off 508-362-4541 I <<0�68 L�9p Z fax 508-362-9880 DANIEL downcope.com A. m down cape eft elfring1 Inc.. OJA� C) © Nd. . 8 z o Civil engineers FfS land surveyors Vy .' / 1 " '9.;9' Main :'S&:eet `(r 'R'te &A) . . l ' p YARMOUTHPORT MA 02675 DATE DANIEL A. OJALA, P.L.S. z DCE #13-026 13-026 HOGAN.DWG