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Box 52 DATE OF INSTALLATION COMPLETION: PART 11—AREAS INSULATED WALLS( 3 O SQ. FT.) CIELINGS( SQ. FT.) FLOORS( SQ. FT.) TYPE OF INSULATION: CS �'rc9'W'yti TYPE OF INSULATION: Cs TYPE OF INSULATION: MANUFACTURER: MANUFACTURER: MANUFACTURER: R-VALUE AMOUNT R-VALUE AMOUNT R-VALUE AMOUNT INSTALLED INSTALLED INSTALLED INSTALLED INSTALLED INSTALLED PART III—CERTIFICATION 1, CERTIFY THAT THE RESIDENCE IDENTIFIED IN PART I WAS INSULATED AS SPECIFIED IN PARTy1I AND THE INSTALLATIONWAS CONDUCTED IN CONFORMANCE TO APPLICABLE CODES,'STANDARDS,AND REGULATIONS. _ gU1LDIN� . UTHORIZED SIGNATURE) �UN 16 202� This certificate must be completed and prominently AR�STABLE p p y posted adjacent to aJl areas which are insulated with pro� 'c1��ls� Town of Barnstable Building t Post,.w.� , 1 This Card So,,That it.is Visible From the Street-.Approved Plans Must,be Retained on Job and this.Card Must be Kept, ranRiaslt'n�t•�. - � > M*� Posted Until',Final Inspection Has Been!Made - .bs ermit �a Where a Certificate of Occupancy is Required;. Building,shall Not'be Occupied until aAFinal Inspection has been made. Permit No. B-20-1064 Applicant Name: Helinton silva Approvals Date Issued: 04/28/2020 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 10/28/2020 Foundation: Location: 16 SYLVIA LANE,CENTERVILLE Map/Lot: 189-079 Zoning District: RD-1 Sheathing: Owner on Record: DASILVIA, HELINTON MAURO Contractor Name ` , Framing: 1 Contractor- License Address: 16 SYLVIA LANE 2 CENTERVILLE, MA 02632 Est. Project Cost: $ 20,000.00 i Chimney: Description: sunroom-adding sun room with half bathroom to existent Permit Fee: $ 152.00 . `i Insulation: foundation I i Fee Paid`; $ 152.00 r � Project Review Req: Date. `fF 4/28/2020 Final: . �} Plumbing/Gas Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Final Plumbing: All work authorized by this permit shall conform to the approved application and the`approved construction documents for.which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and.Fire-Officials are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: �7 1.Foundation or Footing Service: 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final:Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site �<1L Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT D�� Final: 3�0 , ��f � y yi rip Y 1, a 7r,': �-m ty, +` .,c,.w pr r�{^�.. �h,�.--,"sue,-C��y�y�'��•+���+'�.M'� 2i"L�n*v'.�F��--v+��h.{p..,.c ti.��r�"-•ti¢�'1.�`- � z..+n^•"r,.� �,}^Cr,ao.r �"�r Assessor's map and.lot number ... .. ....... :..... .��....:...... o�YNerc � Sewage .:Permit number f•':.:.. �. `09 �� 1'...... d ,��� �P<<1...�•c. ., ..... , i• AHH9TeDLE,B � Ho se u number' ... 9ooM63 ........................................ �0 a l 9• 0 MAt '4 _ TOWN 'OF BARNSTABLE r BUILDING INSPECTOR • APPLICATION, FOR PERMIT TO ........................... .......,.................................. TYPE OF CONSTRUCTION ....—'.....le.a.67 u j!w . '. d iE2....�....YEN. ....:...................................... ................... ...........19. 7! TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...� .....S......................V/ �!.lt........ . ......�i.Y . .................................................... ................................... Proposed Use 1C�' 5l7j�iU11,V L. ............. ...... ................ ZoningDistrict . .......... ..........................................Fire District .............................................................. ��BE2T �,4 �.......aA.�?/.. Address .........�s�i�E' Name of Owner .......................................... ...... .................................................................. Name of Builder cam? ....� .......... i .............................Address�....!U!v.C.....W!`1.........:....................................... Nameof Architect ..................................................................Address ..........................:........................................ Number of Rooms ..IJJA..........................................Foundation. �ev/�:....................::................................... Exterior ....................................................................................Roofing ...............................:................................................ Floors ......................................................................................Interior ..................................................... ........................... Heating ........Plumbing. .............. o Fireplace ..................................................................................Approximate. Cost , otr��0...............,............................... Definitive Plan Approved by Planning Board --------------------------------19-------- . Area ......,..................:................ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town 'of:Barnstable regarding the above construction. Nam ' ./ ............................. Construction (Supervisor's License ............... ,. p CABRAL, ROBERT & P TRICIA A�3$9=;T� 9-07�1 265 SwinnYu ng Pool No g. Pe mit, or ...... ................ c Accessor ..�o Dwelling... . ........... ... ..... .. .... Location 16 Sylvia Lane.............................' ......... ' � •-� Centerville �.. ,• �,_ i �. . �' Owner's.....Robert & Patricia Cabral - >Y; ...... ...... .......... q , . na1y Type of Construction. ................. .. ... ........ .......... t - . plot ........` ...:.............. Lot_ Perm t`Granted "-June 12; ,19 84. n Y e r .. .................. .. .i i r Dote of Inspection. .....................................1.9 �,. Date Completed ...............1:9, ,, x Assessor's. map, and lot number .. ...% Q. ..........�. ..: F THE Sew a- a ;Permit number. '•u:. . liUl d I IN LL MHouse number .....:.. ......... .......` ... ...:... 11TH , 1 2e t A �€ +1 3. = � 9� o Mat a` j TORN OF BARNST`ABLE UUIt!) ING ' IHS{PECTOR APPLICATION FOR PERMIT TO ........................................................�.,..................................................:......... TYPEOF CONSTRUCTION ...... .......................:.. ...... ... ...... ...:....................................... ; ................... ?...:` ...........19.�..7. tO THE INSPECTOPP OF BUILDINGS: The undersigned::hereby applies for a permit according to the following information: , } iLocation .../C J�/`�Vi. ...�` !1/ ....... /2Yil�cC'........................... ......................................................... �-sl�j�,v„ L a ProposedUse ....... ........................................................................... .... ................................. .................................... Zoning District .. ,.1........:........................ ... .....:... .........Fire District ..GT.......................................................................... Name of Owner JR®Bt-A-E.. Cyr v�.....Address ..........-7. pol ............:..................................................... Name of Builder ( c ��s ct 7rcc4 /!VC..........Address ................................................................ Nameof Architect .............................. ...................................Address .................... ........................................ P , 'Number of Rooms . /t .............................................. ........... . ...��.................... ..............Foundation �' �::... ........ 4 e Exterior ....................................................................................Roofing .................................................................................... Floors Interior ........................ . .. ...................................................... Heating ....................................................................Plumbing ................................................................................... Fireplace .....:...............................................:............................Approximate Cost . ............................................................... s , ak Definitive Plan Approved by Planning Board --------__________________-__:__19________. Area ..:....................................... Diagram of Lot and Building with Dimensions Fee --S SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS \ I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam .. .................................................. Construction Supervisor's License .Q ......................... *CABRAL, ROBERT. & PATRICIA iVo 26. 9....'Permit for ...SWinmAng..P.00j.... , ......AcceAaarr...to..Dwelling...................... Location ,.16..Bylyia..Lane............................... .............. .Centervi.l le................................... Owner .Jbbext..&...P.atsioia..Cabral........ ... Z��. Type of Construction ....Vy. nal........................... , .f. ... .................................................. Plot ..... ................ Lot, ................................ L Y Permit Granted .......June 12i................19 84 r Date of Inspection.......... Date Completed Gsr!lkC.......:.....19 5 , F .. • `' FILE' # ig 4435 . , ;CENSUS' TRACT- # CLIENT: Merchants Bank & trusi Co. f C e Cod DEED BOOK 3331 PAGE 326 OWNER: PAN K L APPLICANT: ASSESSORS PLAN PLOT M .QRTGA .GE I N S P E C 10X T' LAN OF ` L -AND , I N yy t BARNST, ABL 'E SCALE: 1 _:30' h° MAY 24. 1984 105.00' y i dS - s b . SHED LOT 3 r5 µ `12,u60 -s.«F + ' LOT 2 - s I PATIO cn s:'�� LOT 4 I STORY -i fo 105.03.1 } - k ccY.'J LV I A_ �L` A .N E I " CERTIFY. 'T0 MERCHANTS.'BANK `& "TRUST' CO. OF-(CAPE` COD, R I`CHARD` P-. MORSE., .JR; ESQ. ` AND �I TS T_I:TLE INSURANCE COMPANY.,' 'THAT..THERE ARE NO V I SI BLE 'ENCROACH- "-... MENTS'. OR.: EASEMENTS .'EXCEPT `AS SHOWN AND :THAT , THIS PLAN WAS PREPARED UNDER MY Ii IMMEDIATE SUPERVISION.; THE '':LOCATION.' OF =,THE" DWELLING , AS ;SHOWN 4 ; HEREON 4::I'S , -IN -COMPLIANCE WLTH THE -`LOCAL w APPLICABLE ZONING" LAWS WITH*WITH RESPECT TO " ;'oFMgs HORIZONTAL DIMENSIONAL REQUIREMENTS . t `��y +• _ IL THE, •YDWELLING".`, SHOWN THERE DOE-S ' NOT -FALL . i~* n _' ' BUILDING DEPT. Application number................................................ c� �► Fee ...... ...................................... .................. . • MAR 042020 C. KAss. Building Inspectors Initials.......... ... . ................... TOWN OF BARNSTABLEL� Q Date Issued...... ........ ...... ........................ q-7c Map/Parcel..... . . ...... TOWN OF BARNSTABLE SCANNED EXPEDITED.PERMIT APPLICATION: TAR U 4 2020 ROOF/SIDING/WINDOW S/DOORS/TENTS/STOV ES/WEATHERIZATION PROPERTY INFORMATION Address of Project: ER STREET VILLAGE Owner's Name: 1 ,., 5%,IV— Phone Number Email Address: Cell Phone Number Project cost$. Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 6M0 j Owner Signature: �- ��,�r� Date: TYPE OF WORK EI/Siding El Windows (no header change)# ❑ Doors (no header change)# Insulation/Weatherization M Roof not applying more than 1 layer of shingles) ( Y g Commercial Doors require an inspector's review Construction Debris will be going to _'�4r5 L�ro 0 Certificate of occupancy with no construction(complete below) Occupant/family relationship or-business name or Existing amnesty apartment(attach a copy of recorded comprehensive permit) CONTRACTOR'S INFORMATION f Mike McCarthy Construction Contractor's name Box 52 Home Improvement Contractors Registration(if applicable)# Wect ll�e,xa.c_ 1@�e( oppY) Cell(508) 280-6964 Construction Supervisor's License# C'CT.-5 94,c(MYft—__169393 Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN 141STORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER l *For'Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event F�1(Clie'&IMe: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or> Yes No , if yes, a gas permit is required. Natural Gas Yes No , if yes, a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing.Lab r Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date b,A. PLIC 'S SIGNATURE Signature Date '� 6 All permit applications are subject to a building official's approval prior to issuance. I,t The Commonwealth of Massachusetts Department of Industrial Accidents Off ce of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am`a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working, for me in an capacity. employees and have workers' g Y P h'• 9. ❑Building addition [No workers' comp.insurance comp. insurance i required.] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑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 3 comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether 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. Signature: 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 Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-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 Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a-call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.,Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia 5�`z, 221 56(107 Permit Authorization mass sakfe Form Site ID: 3982446 Customer: Helinton Silva owner of the property located at: (Owners Name,printed) 16 Sylvia Lane Centerville, MA 02632 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf andkbtaih building,permit to perform insulation and/or weatherization work on my property. Owner's Signature: Date: • O o ac ao 0 oa o �ro�aaaao�aaoetoo�s�or�s+�o�oa�sot+eoaano�aes+���+��o�+o,�o�er��ior►�t�naa�sr�o FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the' above referenced project: LR(V-r Participating Contractor Date Name: RISE Engineering Phone: 401-784-3700 Email: Page 1 of 1 For Office Use Only we.r Rev.�, _10_ ..-a..�..�+,...,rw.*-.� s- �a.:_+.r... �».....w-_a.._ .�..,,c,w- .,sue ..m.. •- - _.,_ .. � q:.,r 201S. Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement gtractor Registration Type: individual MICHAEL MCCARTHY: f Registration: 169393 P.O.BOX 52 Expiration: 06/15/2021 WEST DENNIS,MA 02670 , .j. - Update Address and Return Card, SCA 1 C3 2OM-05117 i a Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE;Individual before the expiration date. If found return to: gggistkittliki Expiration Office of Consumer Affairs and Business Regulation M169S ^06/15/2021 1000 Washington Street -.Suite 710 MICHAEL MC G F Boston,MA,021lf MICHAEL F.MCCA f J i SOUTH DENNIS MA-02660 ' �. Not val out signature Undersecretary 911wea�tf#of Massachuse#� Comm Ls � Q�tsion'af Proft�ssigttat L��nstrte �s[m Board of t3ulldi ali and StSTtffards n9� � o. Conss�. , . motion = or f tI<as Ihtl #*-PWQMI[Rl Wir 23Fd aiiil ��� nn PO QF X62 VJUT 11lrihq,NiMemllMtr, '�.,--- OSHA '00J5587-12 � U.S.DapwWant of Lebo► -sarecr�►�aan admen ::�,. Michael McCarthy etesa�o�to�r .s�!ecy tHeaiei !Q.Ql .fti:' aareiY '. r 8�9 ' iwntrr�w / r:. ' The Commonwealth of Massachusetts Department oflndustrialAccidenis 1 Congress Street,Suite 100 Boston,.MA 02114-2017 www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E,lectricians/Plumbers. TO BE FILED WrM THE PERMITTING AUTHORITY. Applicant Information ��_ CE" Please Print Legibly Name{Business/Organizadon/lndividual): C�fl@� 81' `l Address: PO Box 52 - -- City/State/Zip: --- - ---____ lei ennil _.._ one Are you an employer?Check the appropriate box: Type of project('required): 1.[i3 I am a employer with Y. employees(full and/or part-time).* 7• 0 New construction 2. I am d sole proprietor of partnership and have no employees working for me in ❑ 8. ❑Remodeling any capacity.[No workers'comp,insurance required.]. , 3.E]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 44:1 1 am a homeowner and will be hiringcontractors to conduct all work on m 10 Building addition Y Property. Twill ensure that all contractors either have workers'compensation insurance or are sole I I.❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.O I am.a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp,insurance.1 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other Sr).�1•I+.., 152,11(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box g 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 end then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached in 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. lam an employer that Is providing workers'compensation insurance for my employees Below is the poUcy and job site Information: Insurance Company Name: + Policy#or Self-ins.Lie. V wC v 3� _dZ� 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 MGL c.152,§25A is a criminal violation punishable bya 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify and t e its Wallies of perjury that the Information provided above is true and correct Sienatu Data: i z- If Phone#: .4y-G T6 b Official use only. Do not write in this area,to be completed by chy or town offlclaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: _ r TOWN OF BARNSTABLE BUILDING PERMIT_APPLICATION, M _a Parcel,.--.I �a ce � _ 7A li ti n # P - Pp ca o Health Division Date Issued ` Conservation Division Application.Fee Planning�Dept.; ``Permit Fee Date Definitive Plan Approved by Planning Board `61 Historic OKH _ Preservation/ Hyannis Project Street A s ,� Village Owner Address Telephone Perm' Request A-A 7 Square feet: 1 st floor: existingSaL roposed��nd floor: existing proposed Total new Zoning District; Flood Plain Groundwater.Overlay Project Valuation i 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's Highway: ❑Yes ❑ No Basement Type: UKu-1I ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: 7D existing _new Total Room Count (not, including baths): existing �new First Floor Room Count Heat Type and Fuel: L Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes 0'No Fireplaces: Existing Z New Existing wood/coal-slove: L3, s Flo Detached garage: Vexisting ❑ new size—Pool: dexisting ❑ new size _ Barn: ❑ existing ❑ new sib Attached ara e: g g existing ❑-.new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number, L�_ Address License # enl4), )b Home Improvement Contractor# Worker's Compensation # ALL CO TRUCTION , EBRI))S RESU TING FROM> THIS PROJECT WILL BE TAKEN TO (SL_ SIGNATURE DATE � f a FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE i a OWNER z DATE OF INSPECTION: FOUNDATION G FRAME t INSULATION s FIREPLACE ELECTRICAL: ROUGH FINAL , PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING © ?/k7 Aq DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts ,Department of Industrial Accidents Office of Investigations' 600 Washington Street Boston, MA 02111 �. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information p Please Print LeLribly Name (Business/Organization/Individual): t� Address: City/State/Zip: Phone.#: Are you an employer? ck.the appropriate box: Type of project(required): 4. I am a general contractor and I 1.❑ I am a employer with 6. ❑New employees (full and/or part.tim.e). * have hired the sub-contractors construction 2.0 I am a sole proprietor or'partrler-' listed on the'attached sheet. T. 0 Remodeling ship and have no employees These sub-contractors have g. '[Lolition working for me in any capacity. employees and have workers' 9 0 Building addition ZIam orkers'.comp.-insurance comp. insurance.$ 5. 0 We are a corporation and its 10.0Electrical repairs or additions ed.] I 3. homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other cbmp.insurance required l *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 providb 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 tip 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. Ida hereby certi fy under the pains-and penalties of perjury that the information provided above is true and correct. Si ature: Date: Phone# �no? Offcclal use only. Do not write in this area, to be completed by city or town of lclaL 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 Phone#: Contact Person: 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 Iicensing 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,%ith 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-conkactor(s)name(s),.address(es)and.phone number(s) along with their certificates)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 Departrent 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 permitllicense 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 vear.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 btim leaves etc.)said person is NOT required to complete this affidavit . he 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: Tile Commonwealth of Massachusetts Department,of Industrial Accidents Y , Office of Investigations. 600 Washington Street Boston, MA 02111 Tel. #617-727-490.0 ext 406 or 1-877-MASSAFE Fax# 617-72777749 Revised i 1-22-06 www.mass.gov/dia Town of Barnstable �srt�ram, o Regulatory Services ' Thomas F.Geiler,Director . 1AItTr67A13T.E. MAS& 059. ,m� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4.038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCAT N: number street vill ge "HOMEOWNER": Stiff Q� name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and does not possess a license provided that the owner acts as hire who d , homeowners to engage an individual for P to allow supervisor. DEFINITION OFHOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signa omeowner 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/certifrcation for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC Town of Barnstable Regulatory Services an MAM Mass. Thomas F. Geiler,Director 039. h 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 Sec on If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work autho d ythis building pemiit application for: (A dress of b) Signature of Owner Date Print Name If Pro Owner is applying for permit please complete the . Hom owners License Exemption Form on the reverse side. Q;FORMS:OWNERPERMIS SION - N �' a n i Gosh 1 k � l e O IN tA Z I , vi p 1p ry f jo 0 00 Li i 0 9 o �. c tA i i 0 k 790 ON I _ I �1T , W a r� t j70 �LIN �+ o 70 00 9 , __ . Ala `l Town of Barnstable Health Inspector oFVE r Office Hours o Regulatory Services 8:00-9:30 Thomas F. Geiler,Director 3:30—4:30 rt BARNRrABLE• Only ^� Public Health Division i639• �� _ Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT QUESTIONNAIRE 1. General Information: Address: I(0 l Map Parcel 0179 Name: Phone: 6C ) D--,�-q I 2. How many bedrooms exist on your property now? 1'L 2a. Please include a copy of your floor plans for the entire property. 3. Is the dwelling connected to public sewer? YES or NO If the dwelling is connected to public sewer, skip questions 4-9 below. 4. Location of dwelling is INSIDE o OU`TSID a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 6. Is a disposal works construction permit on file? YES or NO 6a.If yes, how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan„on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO -------------------------------------------------------------------------------- ------------- t FOR OFFICE USE ONLY /•- TO BE SIGNED BY A HEALTH INSPECTOR/AGENT ONLY The Public Health Divisions as no objection to bedrooms at this property. e 1C S Ste► olrS�cJnelQ -tor 3ct�[ev�•s i� �947, S�S�,+� lS I► I�CI� in2c Signed: L Date: 2-9/03 IA s,2e Inspector(Print): - Q;/health/wpf 1es/ainnestyapp ! -2-17 No. Fee$5 0.0 0 - THE COMMONWEALTH OF MASSACHUSETTS__� Entered in computer. Yes PUBLIC HEALTH DIVISIONz-3 'v�N OF BARNSTABLE,MASSACHUSETTS Z(pplication for Migogal �&pgtem Congtruction. 3permit ! Application for a Permit to Construct( 1//epair(x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1 Owner's Name,Address and Tel.No. Ral h Goldin 6 Sylvia Lane P g r Assessor's Map/Parcel Centerville MA 0263 771-6577 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Septic Service ` PO Box 1089, Centerville, Ma 0263 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(n9 Oiher Type of Building No:of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. . Plan Date Number of sheets Revision Date Title' Size of Septic Tank Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic repair consisting of 1500 gal Tank,- D-Box and 80' Teaching ( (2- 40' x 4' �x 2' leaching trench) . Date last inspected: Agreement: . i The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo d of Heal Signed _ Date Application Approved by Date 1 Application Disapproved for the following reasons i Permit No. 7 Date Issued -Z l 3 - --- ----r-i--.----- THE COMMONWEALTH OF MASSACHUSETTS Golding BARNSTABLE, MASSACHUSETTS, Certificate of Compliance � THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( ,)Repaired(x )Upgraded Abandoned( )by Will E Robinson Sr Septic Service t at 1 6 S*lvia Lane, Centerville, MA has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7'G 7 dated .J Installer Wm E Robinson Sr Septic Sry.Designer 1 The issuance of this permit shall not construed as a guarantee that the syste it function as designed. Date ` _ / - _� Inspector . j ———————————————— No. 7 Fee $.5.0•.00 THE COMMONWEALTH OF MASSACHUSETTS Golding', PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Xigpogal �bpgtem tongtruction 'ermit Permission is hereby granted to-Construct( )Repair(x)Upgrade( )Abandon( ) System located at 16 Sylvia Lane. Centerville. MA bV Wm • Robinson Sr Septic Srv. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this %per lit. Date: Z - /�, >'7 APProvedby i f Bk 23168 Ps 2i06 :4-9331 09--22---2008 a 03:0813 MASSACHUSETTS QUITCLAIM DEED We,Matsvei Bal and Aliaksandr Kadolka,of 16 Sylvia Lane, Centerville,Massachusetts 02632, for consideration paid,and in full consideration of ONE AND 00/100 Dollars(U.S. $1.00)grant to Matsvei Bal,Individually,of 16 Sylvia Lane,Centerville,Massachusetts 02632 with quitclaim covenants the following property in Barnstable County,Massachusetts. Property Address: ZZ� � 16 Sylvia Lane Centerville MA 02632 - � ,3 �' .2,0 0 EXHIBIT"All The land with the buildings thereon in Barnstable(Centerville),Barnstable County,Massachusetts: SOUTHWESTERLY by Sylvia Lane,one hundred five and 03/100(105.03)feet; NORTHWESTERLY by Lot 2, Block "B", as shown on a plan hereinafter mentioned, one hundred seventeen and 21/100(117.21)feet; NORTHEASTERLY by land now or formerly of Joseph Daggett, et als, as shown on said plan, one hundred five(105)feet; and SOUTHEASTERLY by Lot 4, Block "B", as shown on said plan, one hundred nineteen and 79/100 (119.79)feet. Containing 12,460 square feet of land, more or less, according to said plan, and being shown as LOT 3, B10CK"B';on a plan entitled,"Subdivision of Land known as `Holly Heights', in Centerville,Barnsatble, Mass.. property of Holly-Heights, Incorporated", drawn by Ed Kellogg, Engineer, and recorded in Barnstable County Registry of Deeds as Plan Book 139,Page 153. The above described premises are conveyed subject to a grant of an easement to Cape&Vineyard Electric Co., et al as set forth in an instrument recorded with said Deeds in Book 1047, Page 334; also conveyed to a taking by the Town of Barnstable as set forth in Book 1295,Page 1145. Subject to all rights,rights of way, easements,restrictions and reservations as the same may be in force and applicable. PREPARER OF DEED HAS NOT EXAMINED TITLE y Bk 23168 : Pg 207 #49331 Witness my/our hand(s)and seal(s)this Pday of September,2008- Matsvei Bal Aliaksandr K"ol Commonwealth of Massachusetts Barnstable,ss: September�$,2008 Then personally appeared the above-named ICY JS 6 �`c' \a\(-SCU-6'r 0d'and probed to me through satisfactory evidence of identification, which were AA Q,D be the person whose name is signed on the document,and acknowledged the foregoing instrument to be his/her/their free act and deed before me. Notary Public: My Commission Expires: :ta PROPERTY ADDRESS: 16 Sylvia Lane, Centerville MA 02632 •`••��� •,. NV�CO�iilfigipR� $�irp BARNSTABLE REGISTRY OF DEEDS Certified Mail#7006 2150 0002 1042 0514 Town of Barnstable 0 '�, Regulatory Services t nAItN FABLE. *+ \\9 MASS. �� Thomas F. Geiler, Director ap tb3q. 1� �arfi° a Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: '508-790-6304 August 20, 2008 Aliaksa Kadolka 606 Old Stage.Road Centerville. MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II —MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION, THE STATE ENVIRONMENTAL CODE, TITLE 5. The property owned by you located at 16 Sylvia Lane Centerville MBA was inspected on August 14, 2008 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.300 and 310 CMR 15.00: There were a total of six (6) bedrooms observed in this dwelling; one (1) was observed in rear apartment, three(3) were observed on first floor of main house, and (2) two were observed within the basement. However, the existing septic system (permit # 96-67) was not designed for (6) six bedrooms. It was designed for three (3) bedrooms. You are ordered to correct the violations listed above within fourteen (14) days of your receipt of this notice by pulling any required building permits (if applicable); You are ordered to remove any (3) three bedrooms from this home by removing entrance doors and by opening all door-way entrances to each room in the basement.to minimum of five feet wide openings. This will bring the total bedroom count down from (6) six to the appropriate (4) four as designated by your septic permit. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance ill result in a fine of $100.00 per violation. Each day's failure to comply with an ord shall constitute a separate violation. Thomas A. McKean, R.S., CHO QAOrder letters\Housing violations\Rental ordinance\24 alberti way cent. 08/14/08 Zoning Inspections Thursday Evening Jeff Lauzon, Building Inspector Lt. Don Chase, Hyannis Fire Dept Martin McNeely, COM Fire Dept. Tim O'Connnell, BOH Robin Giangregorio, ZE Officer Sgt. Steve Maguire 4 Lynxholm, Hyannis Three bedroom ranch with full basement. Found three tenants at home. Most of basement area was unfinished. Found one bedroom lacking proper egress window. Male tenant has RO against former occupant of this room. Tenants are unable to touch personal belongings of former tenant due to RO. Advised tenants that owner will be notified to open wall (5' cased opening). Found three beds in one bedroom on primary floor. Tenant argued that 2 of occupants are 19 yrs old and therefore don't count. BOH determined that area is insufficient to support three occupants. Tenants advised accordingly—owner will be notified by BOH. 11 Owen Street, Hyannis Unable to access—no one home 36 Owen Street, Hyannis Owner admitted team. Basement unfinished—storage only. 46 Sylvia Lane;Center-ville Admitted by tenant in rear unit. Smoke detector disconnected. FPO McNeely inserted new battery and reinstalled unit. No CO detector in unit. Tenant advised by owner to relocate. I advised tenant that he must be out by 9/15/08 or otherwise I would ticket owner. Section of basement under accessory unit is storage only. Main dwelling has 3 bedrooms on primary floor and two on lower level. All bedrooms are occupied. Two girls live here year round and.one girl (student) is leaving in 2 months.- -House has a total of 6 bedrooms on a 3 bedroom septic system. Owner has obtained a building permit to restore to sf home but unit is still occupied. Advised tenants to be considerate of neighbors when celebrating. ,k 1 V 407 Great Marsh Road, Centerville No signs of over crowding. Five people reside here in three bedrooms Found home daycare in lower level of split level home. License identifies 5 children. Basement bedroom set up with 6 cribs and two bassinets. Shelving above cribs bowed with too much weight. Found play yardibassinet in front of used plug (TV above) No bathroom on lower level for children. Appears children play in garage. No segregated yard area for play. Occupants routinely drive and park in rear yard—including over septic. Required owner to install louver door on mechanical room. No smoke detectors or CO on either level. Required owner to obtain necessary smoke & CO detectors. Notify Early Educational & Care office of concerns. Called Lenore Chase, EEC Investigator for SE Region & Cape 508-828-5025 Left message to call me. t 2 3040 Falmouth Road, Unit D1, MM Unable to access unit. 525 Ocean Street, Hyannis Unable to gain access to units. Anticipating 4 units but found 6. Martin Traywick is owner. 511 Ocean,Hyannis—Sandra Walker Auto registered to Sander Decker at this address found out front. Also, her husband's vehicle was there, too. 120 W Main Street, Hyannis—Salon Found tenant home. Language barrier.-her friend translated. Found evidence of at least two hair cuts in waste basket. Tenants.claims to clean houses for a living. She is cutting hair of friend—no charge. Advised her to go to her friend's house to do her hair. 195 Ridgewood Ave, Hyannis-behind former Donut Works Brazilian Ji Jitsu& Luxury Auto Sign code violations. Both businesses closed. Left card Luxury Auto called—advised re: sign code. Will research strip mall as no original file was found. 3 t. TOWN OF BARNSTABLE,BUILDING PERMIT.APPLICATION Map AParcel' Application # 495� Health Division ` Date Issued �� beb Conservation;Division Application Fee Planning Dept. y t - Permit Fee Date Definitive Plan Approved by Planning Board 71VIO8' Historic - OKH Preservation/Hyannis Project Street Address t� �i �Z6Z Village Owner 'l rt�U�[ 1_, Address �� �yLVI4 .�h tvv��1� 0��2 Telephone �1r(r�-c� i'I�w✓1 - S fDff C Permit Request rPMnO y i fir OV% w�a+ cis(,J 6(, `�- %ql� ory qx" �ut �1P Pn�v�V4 �'� 6P.'�wttiP �'� Mtn e- ftW 94AV k&A� V'WQra Pprop l-y to GKL -43 -F ,�►�� Qs� Square feet: 1 st floor: existing proposed floor: existing ?-9,3 proposed — Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4 ODO,wl Construction Type8�"� a" Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family. �W Two Family ❑ Multi-Family(# units) Age of Existing Structure 3�\f. d• Historic House: ❑Yes Edo On Old King's Highway: ❑Yes ❑ No Basement Type: 61(Yull ❑ Crawl ❑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: 6p6as ❑Oil k4ectric ❑Other Central Air: ❑Yes �A/ o Fireplaces: Existing "2- New Existing wood/coal stove: ❑Yes �'No Detached garage: ❑ existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: xisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: n Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ CA Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use C r t.� rn APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Nance _R: ft �� Telephone Number Address A L_1A License# C,Nmy Sri. ��2, ©2-6��-- Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Z��-07'O/ ' y FOR OFFICIAL USE ONLY a ' APPLICATION# DATE ISSUED MAP/PARCEL NO. -ADDRESS VILLAGE OWNER DATE OF INSPECTION: i FOUNDATION ` FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH 'FINAL 'GAS: ROUGH FINAL t FINAL BUILDING I DATE CLOSED OUT` f � ASSOCIATION PLAN,NO. R f r 1j - ,per The Commonwealth of Massachusetts \ Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, AM 0z 111 www.mass.gov/dia Workers' Compensation insurance Affid.avi.t: Builders/Contractors/EIectricians/Plumbers A licant Information Please print Le 1 Name (Business/Organizaiion/Individual): Address: t(o, [>rl City/Statdzip: C&Ae.,J l ae, OZ6-5- Phone.#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6 ❑Kew construction employees(full and/or part-tsme)-* have hired the sub contractors listed on the attached shaet 7. ❑Remodeling 2❑ lam a•sole proprietor or partner- These snb-contractors have . ship and have no employees S. ❑Demolition , employees and have workers' working for mn in any capacity. 9. ❑Building addition o workers' inc,..�nee comp-,�tn�nce.t CUMP•'— 10_ Electrica ir- airs or additions ed_] 5. ❑ We are a corporation and its ❑ p 3. I am a homt�wncz doing all work officers bave exercised their I L❑Plumbing repairs or additions myscl�[No workers' comp. right of exemption per MGL 12❑Roof repairs inrnrance required,.] 152, §1(4), and we have no 13.❑Other . et�ployees. [No workers' comp.insurance required..] *Any applicant that checks box#1 must also fM out the section below showing their workers'eorapmsat;on policy information_ t Homeowocrs who submit this affidavit indicating they arL doing zM wmrk and then hire outside contractors must submit a new aj5davit indica�9 such_ I--=b7actars that cbcck this box umst attacbtd an additional sbect sbowing the name of the sub-contract—and stab!wbetha or not thost entities have employers. If the sub contraetDrs have cmploycea,they must providb their workers'comp.policy nranber. I am an employer that is providing workers'compensatinn insurance for my employees. Below is the policy and jab site inform atiotL lns-tuancc Company Name: Policy#or Self--ins. Lie. #: 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 scarce coverage as required vndcr Section 25A of MGL c. 152 can Ica$to t:hc imposition of Criminal penalties of a fine tip to $1,500.00 and/or one-year imprisonmLnt, 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 statLmerit may be forwarded to the Off ee of Jnvcstigations of the DIA for inrtTrancc coverer o verification: I do hereby certcf under the pains-and penalties of perjury that the information provided above i_s true and correrl. Si atiue: Date: ' 0� Olt Phone k 6fT_ 19f�K Ofj4 chd use only. Do not virile in this area, to be campleteri by city or town officiaL City or Town: Permit/License# Issuing'Authority(circle one): 1.Board of Health 2.Building Department 3. CityfTowu Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: _ 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 writtcn_" An employer is defined as"an individual,Partnership, association, corporation or other legal entity, or any two or more of the forcgoing.engaged in a joint enterprise, and including the Iegal 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 thcrcin, 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 ohapter 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 comph -with.-with. m...-uramc e the 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 ❑ecessary,supply vib-contractors)name(s), address(cs) and phone numbers) along with their eertificatc(s) of insurance. Limited Liability Companies'(LLC) or Limited Liability Partnerships (LLP)with no-employees other than the numbers or partncts, arc not required to carry workers' compensation insurance. If an LLC or L L.P does have :mployccs, a policy is required Be advised that this affidavit may be submitted to the DcpaAmcnt of Industrial kmidrnts for confirmation of insurance coverage. Also be sure to sign'and date the affidavit The affidavit should )e returned to the city or tnwn that the application for the permit or license is being rcqucstrd, not the Department of ndustrial Accidents. Should you have any questions regarding tlhc law or if you are required to obtain a workers' :ompensation policy,please call the Department at the nurnber listed below. Self insured companies should enter their ;cam ine,n-a r,c license number on the appropriata line. ;ity or TOwA Officials 'lease be sure that the affidavit is complete and printed Icgibly. The D cpartment has provided a space at the bottom ,f the affidavit for you to, fill out in the event the Office of Investigations has to contact you regarding the applicant '].case be sure to 5U in the permitgicense number which will be used as a reference number. In addition, an applicant hat must submit multiple permitlliccnse applications in any given year,nccd only submit oap affidavit indicating euacnt olicy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or )wn)."A ctrpy of the affidavit that has been officially stamped or marked by the city or town may be provided to the pplirant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each ear.Where a home owner or citizen is obtnin;ng a license or permit not related to any business or commercial venturc _c. a dog license or permit to born leaves etc.) said person is NOT required to complete this affidavit. he Office of Investigations would likc to than you in advance for your cooperation and should you have any questions, [case do not hesitate to give us a calL ie Department's address, telephone-and fax number. .The Cammonwvc, th of Massarhusc�M Dcparhnent of Industrial Accidents Office of IuVestigatians 6.00 Washinglan Street Boston, MA. 02111 Tei. # 617-727-4900 ext 4-06 or 1-V7-MASSAFF ;d 11-22-06 Fax# 617-727-7749' VFWW.mass.gov/dia Town of Barnstable y�op SHE Regulatory-5er-vices y ruxxsrwsiE Thomas F.Geiler,Director M"F Building Division Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 gt .town.barnstable_ma.us face: S08-862-4038 Fax: 508-790-6230. SOKEOWNER LICENSE EXEMPTION Please Print DATE: Flo t-t OQ JOB LOCATION: n[�u/mbeber 3ireet . village "HOMEOWNER": name 0 home phone# l work phone# CURRENT MAILING ADDRESS: 7 - "N P,, 'L!•Z6 city/town state rip code The current exemption for"homeowners"was extended to include owner-occupied dwellinKs 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 HOMEONY ER Persons) who owns a parcel of land onwhich 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 more than one home in a izva-year, period shall not be considered a homeowner. Such person who constructs "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 be/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 H cowncr Approval of Building Official 41 . Note: •Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the hate Building Code Section 127.0 Construction Control; HOMEOWNER'S EXEMPTION The Code states that "Any homeownQ performing work for which a building permit is required shall be exempt from the provisions + ,f this section(Section I og.1.I-Licensing of construction Supervisors);provided that if the homcowncr engages a person(s)for hire to do such Bork,that such Homeowner shall act as supervisor." • I Many homeowners who use this exemption aic unaware that they are assuming the tcspons�b ilitics of a supervisor(see Appendix Q. .u1cs&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly ,hcn the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed upervisor. 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, at 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 wcral towns. you may care t amend and adopt such a form/ccrtification for use in your eorrunUmty. T"ErO �4 Town of Barnstable Regulatory Services . • sAal•:srAsr.E, uess �+ Thomas F. Geiler, Director. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable-rna.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Musa Compl to and Sign This`"Section Z sing ABu�i`der Z// f I , as Owner of the subject property ' hereby authorize to act on ray behalf, in all matters relative to work authorized by this b �ding permit application for: (Address of Job) Signatute of Owner Date Print Name I£Property Owner is applying for permit please complete the Homeowners License .Exemption Form on the reverse side. „ N t- o N G, 71 C>d_ i I n I _ CIOSLT :N (Ti t 7.V - - + � -47) 7 7'v N o w z 1 � 1 VTJ r � c s ls� _._.... i qz> � , 0 o S � o� 4 —— --- — S� Mac— G D _. m T -- LP �10 r— �7 0 ! _ .p od_ ?.. - - i m � b j `D �ff v ------------- 042 R D m Z T1 �- i Certified Mail#7006 2150 0002 1041 9013 Town of Barnstable Regulatory Services t" HAAN.;rnst_F_ { FQ MAC �Q Thomas F. Geiler, Director O i639 , ter°M a' Public Health'Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 16, 2008 Matsvei Bal Aliaksandr Kadolka 16 Sylvia Lane Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE 11—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property;owned by you located at 16 Sylvia Lane, Centerville, was recently denied eligibility to the Town of Barnstable Accessory Affordable Apartment Program on May 30, 2008. Linda Edson from the Building Department has made the Health Department aware of fact that there is (4) four bedrooms in said dwelling. 105 CMR 410.300 and 310 CMR 15.00: There were a total of four (4) bedrooms observed in this dwelling. However, the existing septic system (#97-67) was not designed for four(4) bedrooms. It was designed for three (3)bedrooms. You are ordered to remove (by pulling any permits if applicable); any bedroom from this home by removing entrance doors and by opening all door-way entrances to each room to minimum of five feet wide openings. This will bring the total bedroom count down from (4) four to the appropriate (3) three as designated by our -records. You must either complete the.above alterations to the bedrooms or up grade the current septic system to represent the current number of bedrooms. Due. to the fact you are not within the Zone of Contribution to public water supply wells you are eligible for this second option. This will entitle you to be able to keep the current number of bedrooms. This must be done with proper permits and engineered plans and be completed within sixty (60) days of your receipt of this letter if you choose this option. Q:\Order letterMousing violations\Rental ordinance\16 sylvia In.doc You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. E OF TH B ARD OF HEALTH T A. cKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Timothy O'Connell, Health Inspector Cc: Linda Edson QAOrder letters\Housing violations\Rental ordinance\16 sylvia ln.doc I � I oFt Town of Barnstable Regulatory Services a r g Y " snxx� ` Thomas F. Geiler,Director s639. � 'DIED N9 69 Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 June 5, 2008 Mr. Aliaksandr Kadolka Mr. Matsvei Bal 16 Sylvia Lane Centerville Ma 02632 Re: Illegal Apartment: 16 Sylvia Lane Centerville Map: 189 Parcel: 079 Enclosed please fins a copy of the letter sent to you by the Assistant Town Manager on behalf of the Town of Barnstable. Based on the letter, you have 30 days to apply for a building permit to remove the illegal apartment and restore the property to a single family home. Failure to do this by July 7, 2008 will result in fines of up to $300.00 per day and court action. Thank you f our attention t is matter. Lin son Amnesty Apartment Investigator Building Department bie OFINETQk� The Town of Barnstable far"St d O•n Office of Town Manager ;Ametcac y �s"RNNSTABLK 367 Main Street, Hyannis MA 02601 i639' www.town.barnstable.ma.us ED MAC Office: 508-862-4610 2007 Fax: 508-790-6226 Email: iohn.klimm@town.bamstable.ma.us John C. Klimm, Town Manager May 30, 2008 Aliaksandr Kadolka Matsvei Bal 16 Sylvia Lane Centerville, MA 02632 Reference—A request for site eligibility for accessory unit at a single-family dwelling at 16 Sylvia Lane, Centerville Dear Mr. Bal and Mr. Kadolka: Your application for site eligibility to the Town of Barnstable's Accessory Affordable Apartment Program has been reviewed and was found not to meet the threshold criteria established for the program. The property does not meet the Town Manager's Criteria for the Local Chapter 40B Program eligibility requirement that the property be "consistent with the character of the neighborhood with such issues as landscaping and parking" due to the number of lodgers residing in the principal dwelling. The property has been the subject of complaints due to adverse neighborhood impacts. The Building Division will be notified of this denial and will be contacting you regarding enforcement of the zoning ordinance. Sincerely, Thomas Lynch Assistant Town Manager Parcel Detail Page 1 of 3 too •, MIL at m.• �;.�fi..t�.:..�..r,...d &ej4 Logged In As: Parcel Detail Wednesday, Octob. Parcel Lookup Parcel Info er Parcel ID 189-079 Develop LotjLOT 3 Location 16 SYLVIA LANE , Pri Frontage 1105 Sec Road I Sec Frontage i village CENTERVILLE 1 Fire District fC-O-MM Sewer Acct Road Index;1680 Interactive Map Owner Info Owner HOUSEHOLD FINANCE CORP II Co-owner'%BAL, MATSVEI & Streets KADOLKA, ALIAKSANDR i Street2 606 OLD STAGE RD City CENTERVILLE State MA zip 02632 Country Land Info Acres 0.28 � use iSingle Fam MDL-01 , zoning RC Nghbd F0107 Topography Road ' Utilities' ' Location Construction Info Building 1 of 1 Year Roof Ext Built Struc Wall 1965 Gable/Hip jWood Shingle_ -- - t - - Effect Roof _ AC Area 1715 Cover Asph/F GIs/Cmp Type,None Int e _ Bed style Raised Ranch I Wall Typical Rooms 4 Bedrooms Model Residential int Bath J 1 Full + 1 H Floor Rooms _.--- ---- - — - Grade Average Heat;Typical j Total 17 Rooms { Type Yp 8 Rooms 1 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=13000 10/10/2007 Parcel Detail Page 2 of 3 as..-11 ;t MT? - i1.4 Heat Found-T. , y 27 i n!Typical stories 1 Story Fuel Gas atio r w Permit History Visit History Date Who Purpose Sales History Line Sale Date Owner Book/Page Sale P 1 12/11/2006 HOUSEHOLD FINANCE CORP II 21594/277 2 12/15/1988 GOLDING, RALPH J & SUSAN L 6539/310 3 CABRAL, PATRICIA SHANK 3331/326 4 1/31/2007 BAL, MATSVEI & 21741/252 - Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parce 1 2007 $150,400 $8,200 $15,700 $183,300 2 2006 $130,200 $8,200 $16,200 $145,000 3 2005 $121,000 $8,100 $16,500 $164,000 4 2004 $98,200 $8,100 $16,800 $111,500 5 2003 $100,500 $8,100 $17,100 $43,000 6 2002 $100,500 $8,100 $17,100 $43,000 7 2001 $100,500 $8,100 $17,100 $43,000 8 2000 $76,900 $7,600 $6,700 $32,100 9 1999 $76,900 $7,600 $6,700 $32,100 10 1998 $76,900 $8,400 $6,700 $32,100 11 1997 $90,500 $0 $0 $25,600 12 1996 $90,500 $0 $0 $25,600 13 1995 $90,500 $0 $0 $25,600 14 1994 $83,900 $0 $0 $34,600 15 1993 $83,900 $0 $0 $34,600 16 1992 $95,300 $0 $0 $38,500 17 1991 $98,700 $0 $0 $51,300 ; http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=13000 10/10/2007 Parcel Detail Page 3 of 3 18 1990 $98,700 $0 $0 $51,300 19 1989 $98,700 $0 $0 $51,300 20 1988 $69,800 $0 $0 $23,000 21 1987 $69,800 $0 $0 $23,000 22 1986 $69,800 $0 $0 $23,000 Photos http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=13000 10/10/2007 AFFIDAVIT les I-1ALo+�-hpon oath state as follows: I have been residing at )? SyG ✓%/ A 4. 4 "Z 'O, Ile for ten years. My house is located right across the street from 16, Sylvia Ln. Centerville MA 02632 and I personally knew the owners of 16 Sylvia Ln residence. I can say that the addition in the back of the above mentioned house with apartment in it existed when I moved into the neighborhood in 1997 and has been there since. The owners',parents lived in the apartment until they moved out. Signed under the pains and penalties of perjury this day of C9c144 )Oea ry --- ----- -- -- --- ---- --- -/7 �AOpucAr WITNESS e o7g OptHE Tp� The Town .of Barnstable 9� MASS. Growth Management Department i63q. �0 AT�DN1A�a 367 Main Street, 3rd Floor Hyannis, MA 02601 Tel:508-862-4678 Fax:508-862-4782 March 11,2008. John C. Klirnm,Town Manager Janet Joakim, Town Council President Barnstable Town Hall 367 Main Street Hyannis,MA 02601 Re: Aliaksandr Kadolka and Matsvei Bal,46=Sy1vi=a-ha-ne-,Cente-rville;one-bedroom accessory unit This letter is to inform you that the Accessory Affordable Apartment (Amnesty) Program has received a request for a project eligibility letter under the Community Development Block Grant (CDBG) Fund and under Article II of Chapter Nine of the Code of the Town of Barnstable and the criteria for the Local Chapter 40B Program. 3� This office is reviewing the request. If the Town has any comments on the project, please forward them to me so that they can be addressed in the site approval letter. This letter gives you official notice of our receipt of the above application(s). We will issue a decision as to the acceptability of the sites and the consistency of this development within the guidelines of CDBG. Sincerely, Elizabeth Dillen Special Projects Coordinator Growth Management Department cc: Building Division(/ Health Division 0I A Bq 9 , 11 will °FTHE ray, Town of Barnstable P� ti Regulatory Services BARNSrABLE, s 9 MASS. �° Thomas R.Geiler,Director 039. Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 AMNESTY APARTMENT ELIGIBILITY VERIFICATION Re: Date After reviewing the street file of the above named property, I verify, to the best of my A4 knowledge, that the apartment was in existence before January 1;2000. This property is now eligible to apply for the Amnesty Program. Tom Perry Building Commissioner r oFt r Town of Barnstable Regulatory snxxsrna�, g Y Services 9`b039. �•� � Thomas F. Geiler,Director Building Division Thomas Perry, Building_Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 September 17, 2007 Mr. Mastsvei Bal &Aliaksandr Kadolka 606 Old Stage Road Centerville MA 02632 Illegal Apartment: 16 Sylvia Lane Centerville, MA 02632 Map: 189 Parcel: 079 Our records indicate that your house at the above-referenced location is currently being used as a multi-family home, which is contrary to Barnstable Zoning Ordinances. Violation of zoning ordinances is a misdemeanor, conviction for which results in a criminal record. You must contact this office within 14 days to either: • Apply for a building permit to restore the property to a one-family home. • Apply to the Amnesty Program • Prove that this is a legal multi-family home. Please contact this office immediately to tell us what direction you wish to take. Sincerely, G --Linda Edson Amnesty Apartment Investigator Building Department gforms:zoning3 Parcel Detail Page 1 of 3 `, r,.- / y B.iRNSTT�,.EILE j �S� t � 17 .. r ✓ - Y Logged In As: Parcel Detail Monday, Septemb. Parcel Lookup Parcellnfo Parcel ID 189-079 I Developot LOT 3 Location j16 SYLVIA LANE I Pri Frontage 105 Sec Road F—�__ I Sec Frontage village ENTERVILLE I Fire District C-O-MM - Sewer Acct I Road Index 1680 Interactive Map 4 AZI, Owner Info_ Owner JHOUSEHOLD FINANCE CORP II I Co-owner %BAL, MATSVEI & Streetl KADOLKA, ALIAKSANDR I Streetz 606 OLD STAGE RD City ICENTERVILLE I State MA Zip 102632 Country - Land Info Acres 10.28 Use Single Fam MDL-01 I Zoning RC Nghbd F107 Topography I Roadl Utilities ,I Location - Construction Info Building 1 of 1 Year F1965 Roof Gable/Hip Ext Wood Shingle I Built Struct Wall Effect 1701 I Roof Asph/F GIs/Cmp I AC None I Area Cover Type Style Raised Ranch I wall Typical I Roome 4 Bedrooms I Model(�Residential R Int _"_ Bath 1 Full + 1 H I� I Floor��n----..--� Rooms Grade Average Type Typical Rooms - Rooms i http://issgl2/intranet/propdata/PareelDetail.aspx?ID=13000 9/17/2007 Parcel Detail Page 2 of 3 As ]� MT '. 249 Stories i1 Story +� Heat Gas Found-MTypical o _7 Fuel ation '4 aa_ Permit History Issue Date Purpose Permit# Amount Insp Date Comments Visit History -- -- ----�____ Date Who Purpose Sales History Line Sale Date Owner Book/Page Sale P 1 12/11/2006 HOUSEHOLD FINANCE CORP II 21594/277 2 12/15/1988 GOLDING, RALPH J &SUSAN L 6539/310 3 CABRAL, PATRICIA SHANK 3331/326 4 1/31/2007 BAL, MATSVEI & 21741/252 - Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcf 1 2007 $150,400 $8,200 $15,700 $183,300 2 2006 $130,200 $8,200 $16,200 $145,000 3 2005 $121,000 $8,100 $16,500 $164,000 4 2004 $98,200 $8,100 $16,800 $111,500 5 2003 $100,500 $8,100 $17,100 $43,000 6 2002 $100,500 $8,100 $17,100 $43,000 7 2001 $100,500 $8,100 $17,100 $43,000 8 2000 $76,900 $7,600 $6,700 $32,100 9 1999 $76,900 $7,600 $6,700 $32,100 10 1998 $76,900 $8,400 $6,700 $32,100 11 1997 $90,500 $0 $0 $25,600 12 1996 $90,500 $0 $0 $25,600 13 1995 $90,500 $0 $0 $25,600 14 1994 $83,900 $0 $0 $34,600 15 1993 $83,900 $0 $0 $34,600 16 1992 $95,300 $0 $0 $38,500 http://issgl2/intranet/propdata/PareelDetail.aspx?ID=13000 9/17/2007 Parcel Detail Page 3 of 3 17 1991 $98,700 $0 $0 $51,300 18 1990 $98,700 $0 $0 $51,300 19 1989 $98,700 $0 $0 $51,300 20 1988 $69,800 $0 $0 $23,000 21 1987 $69,800 $0 $0 $23,000 22 1986 $69,800 $0 $0 $23,000 Photos http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=13000 9/17/2007 Mr. Mastsvei Bal & Aliaksandr Kadolka 606 Old Stage Road Centerville MA 02632 do Town of Barnstable t BAMSTABLE.% Regulatory Services 9`b 03 . ��� Thomas F. Geiler�Director RFD MA'S A Building Division Thomas Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 September 17, 2007 Mr. Mastsvei Bal &Aliaksandr Kadolka 606 Old Stage Road Centerville MA 02632 Illegal Apartment: 16 Sylvia Lane Centerville, MA 02632 Map: 189 Parcel: 079 Our records indicate that your house at the above-referenced location is currently being used as a multi-family home, which is contrary to Barnstable Zoning Ordinances. Violation of zoning ordinances is a misdemeanor, conviction for which results in a criminal record. You must contact this office within 14 days to either: • Apply for a building permit to restore the property to a one-family home • Apply to the Amnesty'Program • Prove that this is a legal multi-family home. Please contact this office immediately to tell us what direction you wish to take. S'ncerelf' �1✓mda Edson Amnesty Apartment Investigator Building Department gforms:zoning3 e k 21741 P:925 2 AWL 16346 ' 01---31-2007 a o9 = 4 7a MASSACHUSETTS QUITCLAIM DEED Household Finance Corporation 11,an entity organized and exiting under the laws of the State of Delaware,and having its usual place of business at 961 Weigel Drive P.O.Box 8632,Elmhurst,IL 60126, For consideration paid,and in full consideration of Two Hundred Seventy-five Thousand and 00/100 Dollars($275,000.00) Grants to Matsvei Bal and Aliaksandr Kadolka,Joint Tenants with Rights of Survivorship, of 606 Old Stage Road, Centerville,MA 02632 WITH QUITCLAIM COVENANTS The land with the buildings thereon in Barnstable (Centerville), Barnstable County, Massachusetts: SOUTHWESTERLY By Sylvia Lane,one hundred five and 03/100(105.03)feet; cv M NORTHWESTERLY B Lot 2 Block "B", as shown on a plan hereinafter mentioned, one � Y � hundred seventeen and 21/100(117.21)feet; NORTHEASTERLY By land now or formerly of Joseph Daggett, et als., as shown on said plan,one hundred five(105)feet; � i SOUTHEASTERLY By Lot 4, Block "B", as shown on said plan, one hundred nineteen and 79/100(119.79)feet. Containing 12,460 square feet of land according to said plan, and being shown as Lot 3, Block V "B", on a plan entitled, "Subdivision of Land known as `Holly-Heights', in Centerville, Barnstable, Mass. Property of Holly-Heights, Incorporated" drawn by Ed., Kellogg, Engineer, recorded in Barnstable County Registry of Deeds as Plan Book 139,Page 153. a 5 The above-described premises are conveyed subject to a grant of an easement to Cape & Vineyard Electric Co., et al., as set forth in an instrument recorded with said Deeds in Book 1047, Page 334; also conveyed to a taking by the Town of Barnstable as set forth in Book 1295, Page 1145. This conveyance does not constitute all or substantially all of the corporation's assets in the Commonwealth of Massachusetts. For Grantor's Title see Deed in Lieu of Foreclosure from Ralph J. Golding and Susan L. Golding dated November 13, 2006 and recorded with the Barnstable County Registry of Deeds at Book 21594,Page 277. Bk 21741 Pg 253 #6346 IN WITNESS WHEREOF,the Grantor has signed,acknowledged and delivered these presents this-ZA day of January,2007. HOUSEHOLD FINANCE COPORATION II By: Its: Dana M.hlo s Name: Asst,Vice Pr sidesn By: Its: Name: fanet Ramirez STATE OF Asst.Secretary COUNTY OF In iglsgid; iity,on the �-� day of January 2007,before me personally appeared Presiden{e fHousehold Finance Corporation II,to me known, and known by me to be t e party executing the foregoing instrument,and he/she acknowledged said instrument by him/her executed to be his/her free act and deed in said capacity, the free act and deed of said corporation. E.V.ROMAN o :OMM #1447374 = :6 '® Notary Public-California A Z Los Angeles County 2 Notary Public f omm Expires oa.z6,zoos My commission expires: STATE OF. COUNTY OF In 6flo\, in said County,on the_Aday of January 2007,before me personally appeared Yanet Flamire of Household Finance Corporation II,to me known, and known by me to be theAXW3SezeVtWg the foregoing instrument,and he/she acknowledged said instrument by him/her executed to be his/her free act and deed in said capacity,a d the free act and deed of said corporation. ROMAN Notary Public p C0MM. 47447374 Z _ i # Notary Public California o My commission expires: Los Angeles County Comm.Expires Oel.26,200, MASSACHUSETTS STATE EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 01-31-2007 a 09:47am Ctl:: 2E9 Doc;: 6346 Fee: $940.50 Cons: $2751000.00 BARNSTABLE COUNTY EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 01-31-2007 0 09:47am Cti4: 289 Doc:: 6346 Fee: $627.00 Cons: $275,000.00 Bk 21741 Pg 254 #6346 RESOLUTION OF THE BOARD OF DIRECTORS OF HOUSEHOLD FINANCE CORPORATION H Dana M.EiUPP " IT IS HEREBY RESOLVED that Asst.Vice President and_ is/are fully authorized in the name and on behalf of this corporation,as and Yanet aamirez of HOUSEHOLD FINANCE CORPORATION II, to execu%MjSe=&a* documents required to convey certain real estate located at 16 Sylvia Lane, Centerville(Barnstable), Massachusetts owned by HFC pursuant to a Deed in Lieu of Foreclosure dated November 13, 2006; and FURTHER RESOLVED that the sale of said real estate by Household Finance Corporation II is authorized and approved. Dana M.Hopp us Asst.Vice President CERTIFICATE I certify that I am Yanet Ramirez of Household Finance Corporation II and that the above resolution is a WAMIN&copy of a resolution unanimously adopted a� meeting of the Board of Directors of said corporation held at its office on Q(V� 2007,a quorum of the members of the Board being present anA voting; that this resolution has not been revoked and/or suspended and that it remains in 1 force. Secretary Yanet R rez Asst.Secretary BARNSTABLE REGISTRY OF DEEDS $ST. CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT DEPARTMENT OF FIRE-RESCUE&EMERGENCY SERVICES 1875 Route 28•Centerville, MA 02632-3117 1926 508-790-2375 x1 FAX: 508-790-2385 John M.Farrington,Chief Martin 01.MacNeely;Fire Prevention Officer Craig E.Whiteley,Deputy Chief Francis M. Pulsifer, Fire Prevention Officer January 23, 2007 Mr. Thomas Perry Town of Barnstable- Building Commissioner 200 Main Street Hyannis, MA 02601 Dear Commissioner Perry: Pursuant to MGL Chapter 148, Section 28A, I am making you aware of and request your interpretation of a suspected un-permitted apartment and addition of living 4 spaces without permits at: .16 Sylvia Lane Centerville,-MA°02632 . During a recent inspection at this address, I observed separate living quarters in the rear of this structure with a kitchen,baffUnd•bedroom. The entire residence including both floors has a total of three bathrooms, the*Town of Barnstable has the ` property listed as 1 full and 1 half bath."It appears there may be several code issues at the address that need attention Please feel free to call me with any questions relative to this situation at 508-790- 2375. I am holding the.26F smoke detector certificate.until a conclusion can be determined from your office. Thank you for your prompt attention to this issue. Sincerely, Francis M. Pulsifer Fire Prevention Officer Cc: Health Department "Commitment to Our Community" � e VI �e 16 Sylvia Lane, Cent. 8/14/2008 71 � M x a s r� w A 16 Sylvia Lane, Cent. 8/14/2008 7 c ° 4 i stlae"`�T'v�'A M, �, t 3 "q_ _ ��' T } L° .d, "�,•�, '°� ge�. �?�s `+'` , w"I Ai x �{ fi`Y, '0. � .d � '�� y �x,3'e � �2st�F y���1 }�'. .� ( 1�,�.R. �eq •. 16 Sylvia Lane, Cent. 8/14/2008 kk }� 6 1 ,vg„ a Wk n d a r z• �.✓�^ a k`g Est § `�,�� � � ��� t 14, tr 16 Sylvia Lane, Cent. 8/14/2008 SST CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT DEPARTMENT OF FIRE-RESCUE&EMERGENCY SERVICES 1875 Route 28•Centerville, MA 02632-3117 1926 508-790-2375 x1 • FAX: 508-790-2385 John M.Farrington,Chief Martin OT. MacNeely, Fire Prevention Officer Craig E.Whiteley,Deputy Chief Francis M. Pulsifer, Fire Prevention Officer July 2, 2009 Mr. Thomas Perry-Building Commissioner Town of Barnstable 200 Main Street Hyannis,MA 02601 Dear Commissioner Perry: Pursuant to MGL Chapter 148 Section 28A, I am making you aware and request your interpretation of an l-pennitted apartment without secondary means of egress at: 16�Sylvia Lang Centerville, MA While on a sale and d transfer inspection at this address, I observed an apartment without secondary means of egress located at the rear-of the structure. The property is a single story raised ranch with a three bedroom septic. There were a total of five rooms that were designated as bedrooms. There are no permits pending relative to addition of bedrooms, apartment, or upgrading of the fire alarm system. We are holding the certificate pending investigation from your department. Please contact me with any questions you have relative to this situation at 508- 790-2375 Ext.l. Thank you for your attention to this issue. Sincerely, Francis M. Pulsifer Fire Prevention Officer 'W k Cc: Robin Anderson CO �. "Commitment to Our Community" v�� �a Dy` MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Towna MA.` Date:r'���`f'c'1�permit# Building Locations,�, f/ls9 Z� Owners Name: 141_ /,P/ ..��. .. Type of Occupancy: Commercial Educational Industrial 0 Institutional F-1 Residential New:Ll Alteration: Renovation:0 Replacement:E] Plans Submitted: Yes No FIXTURES ' z z co O Y h L) w Z rn >- J x I- w � a z ~ Y� v, rn a a m Z Z N = W U) W N I— w Z_ r j Y v� 0 a F_ 0 cow w o � a Y = r z LU a aY a rxQOOOz m=a Fwa- aw-- x> zWaaywO JoJ a o x J u_ 0 he w C0 co I_ :3 >S O SUB EMMT. In I IV BASE NT o 'I FLUOR 2 F400R it 3 FL;POR 4 F OR 5 FLOOR =' 6 FOaOR `rt 7 1 m F!00R c 8 FEOOR Check One Only Certificate# Installing Company Name: �r,1 ' t Corporation Address: 5J�iA ( — City/Town ,E'Zrc.,i State:LmA u— Partnership Business Tel: ', - " / Fax: Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: ` I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Yes'��No If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy j Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner Agent.0 Si nature of Owner or Owner's Agent 1 hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By r ..,,�.�. �-..�€ TYPe of License: Tit►ejl 1 ✓ Plumber Signature of Licensed PI r ...a,,.e.....,,,.m..,..,,.,. �,,,,,.,,� _� Cityll-own License Number: _^-^=4 Master ,_I I APPROVED OFFICE USE ONLY Journeyman {�; I/'G�_ `. -7 OMEr� Town of Barnstable *Permit Regulatory SeMees Fee 6 months from issue date 44 HARNSTABLE, • � ,]� . v rsnss. �" [1 Richard V.Scali,Director 20,11 Building Division A�R 2 Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office, 62-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address /7 1�r a,I n r F g[Residential Value of Work$_ O.000 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address r?'yO/( r Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance r Check one: ❑ I am a sole proprietor I am the Homeowner 1 ❑ I have Worker's Compensation Insurance- Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) l ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to s g _.) CYC d. ❑Re-roof(hurricane nailed)(not stripping. Going over , existing layers of roof). ,Re-side // d Replacement Windows/doors/sliders.U-Value�h�F��Jk.W,(maximum.32)#of windows D #of doors: _ *Where required: Issuance of this permit does not exempt compliance with other.town department regulations,Le,Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy o the Home Improvement Contractors License&Construction Supervisors License is e uir d. SIGNATURE: ' Q:\WPFMES\FORMS\building permit fonms\EXPRESS.doC 01/25/17 4 Use and Occupancy Agreement AGREEMENT made this /Y day of April 2017 by and between Vadim Privalov ("Seller") of Massachusetts, and Helinton DaSilva ("Buyer") of Massachusetts with respect to the property known as and numbered 16 Sylvia Lane, Centerville, Massachusetts (the "Premises") . In consideration of One Dollar ($1.00) and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties hereto hereby agree as follows: 1. Seller shall be permitted to use and occupy the Premises for residential purposes for a period following the sale of the Premises on April 14, 2017 and terminating no later than 5:OOPM on April 30, 2017. 2. Seller agrees to indemnify and hold Buyer harmless from any and all claims, action, causes of action, or any liability whatsoever arising out of Seller's use and occupancy of the Premises during the term hereof, including the payment of reasonable legal fees and expenses. 3. Seller acknowledges and agrees that Seller's personal property located or placed in the Premises after the sale of the Premises shall be at. Seller's sole risk and hazard, and, if any loss or damage occurs, no part thereof whatsoever is to be charged or borne by Buyer. 5 . Buyer and Seller agree that the relationship between the parties hereto shall not be the relationship of landlord and tenant and it is agreed that the relationship shall be that of licensor and licensee. 6. Seller agrees that at the end of her use and occupancy period she shall deliver the Premises to Buyer in the same condition as of the time of Buyer's final walk through on April 14, 2017, except that the Premises shall be free of all Seller's personal property not included in the sale and in broom clean condition. If the seller remains and Summary Process Action is needed, Seller shall be responsible for the Buyer's legal fees and costs to force Seller to vacate. 1 it 7. This Agreement shall be governed by and construed in accordance with the laws of Commonwealth of Massachusetts. This constitutes the entirety of the Agreement, and any modifications or adjustments thereto shall be null and void unless agreed to in writing by the parties and their signatures affixed thereto. IN WITNESS WHEREOF, the parties hereto have hereunder set their hands and seals on the date first written above. Seller: Vadim ivalov f3u§eZ. ifelinton DaSilva 2 _ t Town of Barnstable Regulatory Services D1E Richard V.Scali,Director Building Division Paul Roma,Building Commissioner e39. � 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.ns 0 Office: 508-8624038 - Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print t DATE: JOB LOCATION:�� S� (L/>► �� ���//J'��� number 11 street �( vwage "HOMEOWNER.: name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 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 un s' ed"ho owner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection pro req ' ments and that he/she will comply with said procedures and requirements. 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 itwould with a licensed Supervisor. The homeowneracting as Supervisor is ultimately responsible. F 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:\WPFUES\FORMS\building permit forms\EXPRESS.doc 0620/16 0 Town of Barnstable Regulatory Services Richard V.Scali,Director - f�� 1� 3 Building Division. Panl Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 kA Property Owner Must Complete and Sign This Section _ ' t 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) **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:FORMS:OWNERPERMISSIONPOOI S Yhe Coanrno2"veaM-qf MaYsadj- e&s , Deparkment ajf'lii huftid Act de.?sft l7}Jace afIkvCSqatWM. ' .600 Waslhurgtm Ss reet -- Bastin,MA 02111 - fpFsn-n nza=gav/dzfl Warke& CampeniaffianIIIsmrance Affidbrvib 13,ugdeFs CmtrdcWrsMecftic aII5 h]3nbe 's AppHIan#InfdTII1atign Please Fxint Y 'Na= . Address: Cstglstatd t Phone ik , Are you an employer?:(Meckthe appropriate box Type of project(required)- t.❑ I nut a employer uitb. 4 ❑I am a general coatractar and I emp-loyees(fall andfor part time).* have hired the mb-conhmctoas .6- [-]New eonzfrucEiog 2.❑ I am a sale pmprietar orpartner- listed anthe attached sheet ?- ❑Remodeling ship and have no employees These sub-ccniractors have g_ ❑Demolition Ia andhace wmloers' worsting forme is any capacity- � I� 1 9..❑Building agog INo�wodor&comp-fin ante comp-im a. required-] 5. ❑ We are a corporati=and its 10-❑Electrical repairs or additions 3. 1 am homeommer doing all vmk officers have exx=ed their 1L❑Plumbiagrepa-or additions xayseU[No worlaers'tromp- zigbt of esempfion per 14(M n❑Iioofrgmics +nimnax+'ceretlaired.I7 c:152, §l(4),aadweHaveno employees.[NoWoAne& 13-❑0tlier cone-kmrm ae required] ',4ap apgH=atffst&edzbas#1 mast ilia Monr*e sw icab9awsbn�dudiwadeW cnmpensati=J1GHcgizC5MMS uoa. # ecmTers Who SIIbnrit dIL i�d3MF] they sxe damp a1f v�o�Sud Iltea]�aatide coat<acmrs�ct submit a neW affit'IDdlC rocs. IC48=CtoaIff=CrbecYLidsbmcmastsit f-h tm.xMitinmisheetshowing the aame•ofthesob-c�sc6 and stare Whetheraraatf=eemitieshzve employees.It:thesnlrton�have empIcfers,t57mastpmsid dAr trod am,camp.galicg a=bm I am an srripioysr flint is prauitiirrg�vorkets'eoerrperesrdirrrt iresctrarrca for my empl?gees: $eTbiv is the po cy and joh site inforraalian: Insurance CompaayName: P�ficy or Self-ins Lio lxpiratianDate: Job Sit�Addresx CitylStatetr"- Aftach a-copy of the warkters'compensationp.oIicy declaration page,(showing the policy number and expiration date}. Fairue to secate covemge as required under Section 25A of MCL m 157—can lead to the impositiioa Qf criminal penalties of a fine ap#a$L,54a t)U tivdfor one-year of as well asrigrl penalties is Ste farm of STOP�,r(}} OIZDEL�and a fine of up to$25Q-Ga a clay against the violaian Be ahnsed brat a copy of this,statement=ay be fzv riled to the Of of Iuvestegations ofthe DFA.fat-" e coverage verifrcati m I do teemby s widpenaWes ofyzrj ury thatthe ire,farmz i=protiiW abm e!s ftm and carred Si Date — !X S�69 OfflIcd use aril. ,Da slat write in fills area,to be-casrip&tesd by city artown o,jj`iera£ City or To%= Pierm9tfTaense tg Lwemg Anf harity(merle one): L Board of Health I Bwffirmg Depart 3.row.auk 4.Elecrical Inspector 5.PhumUfiig Inspector 6.Other Confect Person: Phone#: ormation and Instructions . . ..�. MMsszac,nseft Geticr-al Laws amPtw M re IM=all=gloyers'JD lsovide Wits'MMp=aflon far•Hieir employees. Pursuar fn Phis sf e,an eag�Ioy�'is dafiaed as .every person in�e savicc of another MA=a¢p Contact of hire, MTrC s or impHed,oral or w tra." Au.�&YEr is deed as"an mil,per,assocua9nn,corporation or o$ier leg-a'ertthy,or any two or more of the foregoing aged m a Joint mferP�,anlj inchufmg tfie legal removes of a deceased employer,or fie receiver or traStee of an andxvidnELL PM:ftl sblP,associaf'nn or otbeslegal enft enTloying CUPIDyeM HoweQez fhe owner of a,dwelling house having not more tbm,three aparlmeults and-who resides fhercill,ur the occupant oft he - dwrlling house of Many Who=:[P ays pess=to do mamienan cc,r-. nshuct on or repair work on such dwelling house or oa the grounds or b ilcImg appu t=m:Et►fi=tn shallnotbecanse of south emplopmea±be deemedto be an employer-" MQ,chapter 152,§25C(6)also s dns that"every siafe or local Ficens�g agency shall witTihold f e TSSQaIICe or renewal of a license or permit to operate a business or to contract buildings is the uornmam alth for any applicant Who has notproduced acceptable evidence of comp&anm Wn the insurance.covearage required, Additionally.M(H,chapter IS2,§25C(7)states-Teitberthe nor nay of its PoETHcal subfxvisims shaIL enter mto any contract ft 1he pe-Em3nance ofpublk workuaia acceptable evidence of compliance VMh&a fimu"ce•- req==erds of this chapterhave bee ipresentedto the cnntcactivg M3 iorxty.7 A-PPlicanfs � Please fa oiot the-vorlsrrs'compmsaation affidavit completr ,by d=cj:jzg$e bones 1hat apply to pour situation and,if necessary,suPPIy s)name(s), addresses)andphonermmber(s) alongwifhtheir ceaiitica(s)of insurance- L=atr-dLiability Comparries(LLC)or Limited LiabilityParfn=s s(LLP)wifhno employees other fhanthe members or partners,Ee not requited to carry Worice&comPensafim filCmm e- If an LLC or LLP does have employees,apoIicyisrequBed. BeadvisedthatthisaffdayitmaybesnbmitfedtotheDepa�nentof Ind�xial Accidents for confmmaiim of finu ice coverage Also be sure to sign and date the affidavit. The a avit should be retonac d to m e city or town that the appficaiion for the peunit or license is being requesttA not file D ep arbnent of LnAnstag A=dens- Shouldyou have any questions regarding fire law or ifyou ate regmred is obta>a a workxrs' compensation policy,please call the Depar�ent at the namber listed below. Self-insm-ed companies should ear the ir self-insurance Reuse mnmber on the appropriate line. City or Town Officials r Please be sore that the affidavit is comple#e and prmtedlegibly. The Depa2tnenthss provided a space at tine bottOM of the affidav=tfor you to fM out mthe event the Office ofInvesigatiDns has to comae-'tyourrega�mgthe applicant Please:be sure to fMinthepcn h/ censemrvberwhichvMbcused as are5==cenxxmbcr_ Th.-addition,an applicant that must submit multipIo pennMicrose appHtaiions in any given year,need.only submit one affidavit' ;atm a cat policy infonmatiom(if n mzssarY)and under`Job Site Ad&s"the appliamt should write"all locations in (c4Y Or town)"A copy of the affidavit that has been officially stamped ar marked by the city cr town maybe provided to the applicant as proo-fthat a valid affidavit is oa file for fore permits or licenses A nevi a$davit must be fiIled out earl year."Wheae ahome owner or citizen is obtaining alicense or permitnotrelatedin anybnS�or comFne vial (ie-a dog license orpe¢oit to bran leaves a _)saidpmrson is NOT=Tihredfn complete ibis affidavit The Of ofInvesfigkims Wovldlrketo tTmnkyoumadvance for your cocpeaafionand shouldyouhave any,questions, please do not hem to gtve us a caTL. The Depsrtmeinfs aridness,t 4ephone and fax Cr_rn*mb Tha CDD=0nqMM of Massach . • , DqaLtnMt of likestdalAcciden rs F • $os�MA F�11F Ta 4 617' -4 Qzxt 406 err 1477-MA SAS Fax 617` 27 7749 Revisad424 07 - ��ARM Town of Barnstable r of Regulatory Services Richard V. Scali,Director Building Division 1MAE& 1�B Paul Roma,Building Commissioner Fn ° 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 ..Fax: 508-790-6230 Approved: Fee: Permit#: l(0 o f HOME OCCUPATION REGISTRATION Name: A-60.SUU V /-2a, Phone#: Address: -5-q I V I A lh Village: C,6:A/TCR VI L L E Name of Business: 66tJ M7 y e 1 igro m mer 4- Type of Business:_ /J Q Map/Lot: 0 9 _ L INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residentiallvolumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other.particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. . • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. ' . • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one. pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included: • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. 1,the undersigned,have read and agree ith the above restrictions for my home occupation I am registering. Applicant: Date:_ Homeoc.doc Rev.06/20/16 YOU WISH TO OPEN A BUSINESS? y r For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this forrn at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, '1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: 08-/0-0M Fill in pl se: � t APPLICANT'S YOUR NAME/S: _ /t'JGy -/.S 1Z _�2/� BUSINESS YOUR HOME ADDRESS: 16 / L ` .ate 5- 9-rl ('_.,---Al- FRV/L.LA' /Y d 0263Z r TELEPHONE # Home Telephone Number . . 'NAME-OF CORPORATION: NAME.OF NEW BUSINESS ' L-* -TYPE OF BUSINESS . n..Tnprcgve. m4- ISTHIS A HOME,OCCUPATION? YES. NO ADDRESS OF BUSINESS S' / 'n L-il G Vv .RV `e' A-44MAP P ARCEL NUMBER CJ . Assassin star ting rtin anew business there are several thins yo u must do in order to be in compliance with the rules and regulations o t 9 9 Y p g f he Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate erate your business in this town. 1. BUILDING COMMISSIONER'S O FICE MUST COMPLY WITH HOME OCCUPATION This individual has been info e n e it nts that a'n art i to this a of business. P typ RULES AND REGULATIONS. FAILURE TO Aut orize Sig ature COMPLY MAY RESULT j,N FII'�t=S: CO ENTS: /ryt 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: