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T{, •., �i,S, ` Town of Barnstable *Permit# ,�;?06 d L1d,-7 Expires 6 months from issue date Regulatory Services Fee 4 S Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner LP 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ` Not Valid without Red X-Press Imprint Map/parcel Number iT M Property Address `7�J� ��1!4 � D f2 Residential Value of Work 16 0, On Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address J—P-M)AA06 6P_A-nU rZ!!5 f,Q A) `7 V 711�[t721961(c'=TA 6C2 is 3�Z Contractor's Name Telephone Number ���©�J Y 7 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance PERMIT A Check one: X-PRESS ® MI SS 5�E1 T ❑ I am a sole proprietor [R I am the Homeowner J U L 12 2007 ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping, Going over existing layers of roof) ❑ Re-side Replacement Vb ats/doors/slams. U-Value (maximum.44) *Where required: 1 ance of this permit does not exempt compliance with other town'department regulations,i.e.Historic,Conservation,etc. ***Note: Prope wner must sign Property Owner Letter of Permission. L :`i [ J z ' jrir A co o e Home Improvement Contractors License is required. (? SIGNATURE: Q:Forms:expmtrg Revise061306 t. L The Commonwealth of Massachusetts Department of Industrial Accidents r Office of Investigations d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name(Business/Organization/Individual): . L�LQN IA ko p Wre6C o A/ Address: T 5 A/�Y_e t nQ City/State/Zip: Phone.#: Are you an employer? Check the appropriate box: Type of project(required):. 1.❑ I am mp a employer with 4. I am a general contractor and I 6. ❑New construction eloyees(full and/or part-time).* have hired the sub-contractors . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' �• 9. []Building addition [No workers'comp.insurance comp.insurance. 10.❑Electrical repairs or additions required.] 5. [� We are a corporation and its P '3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[]Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.[ Other_ comp.insurance required.] . ''Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;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 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 ay against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations o or insurance coveraize verification. I do hereby c ander pains-and penalties of perjury that the information provided above is true and correct ' Signature: ll �` . Date: _ Phone#: S��J `� - 0. 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." is defined as"an individual,partnership,association,corporation or other legal entity,or any two.or more . An employer 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()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-contiactor(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 Department at the number listed below. Self-insured companies should enter their self-insuran.Ge 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"al'Mocations 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 Depadment of 1nftsttial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia I *l . c� Op1HE r Town of Barnstable Regulatory Services BARNSTABLE, : Thomas F. Geiler,Director y MAss $ �pr 1 39. 1% Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 -------------------- HOMEOWNER LICENSE EXEMPTION �7 Please Print DATE: JOB LOCATION: �/% /l�`j V = VeVI- number street village "HOMEOWNER,,: to q ,e-5coAJC (� 36o—o�'� I name n�^ home phone# work phone CURRENT MAILING ADDRESS: ��/�►v 1 f C�M�Q vIL1 e- 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 &appliccodes, laws,rules and regulations. meowner"certifies that he/she understands the Town of Barnstable Building Department procedures and requirements and that he/she will comply with said procedures and K Signature of Homeo ner , Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt THE r°�. TOWN OF BARNSTABLE • B98dSTAHL i t 0pY6. BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......... dll.J.�l......t!.�!e.:. '�n,,1. ......,(.!.w .l��.l`!. ................................ TYPEOF CONSTRUCTION ..... .................. C........,:............................................................. %..�` x TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....Gov...... .....22.......1.fd..s. C 2 ........... e........... y 2 ��.. .................................................................... ProposedUse .......A��<,/.ewtl.,.gi .................................................................::...:.........................................:....................... Zoning District ............ .,,T ..........................................Fire District v�1kG ...0S.�t'.i--V'1,l C.......��.14.irl � I 1 Name of Owner ... dr me�..j ....1 tQ1?1eS.. N...�............Address ....... :5.1.11.5°�1.... Name of Builder ... 6. ?: 5.... N.C_.,....Address .................//....... ... i. Nameof Architect ..............N.Q.?U, !�'................................Address .................................................................................... Number of Rooms ............ ..................................................Foundation .........P0. r.c-Ot......... .P.M�<1- ................ Exterior ............... /..Il.!. 7 Roofing ............. ..5.. ?.�j.s?..I.r......................................... Floors ..........(,fa.ry..e'......V..............................................Interior ............: •• .J!'.f?I�........................................... 7V Heating ............ .Qf....,04 1..............................................Plumbing ............../.yl ..p.Rt�iS.......................................... Fireplace ............. ......'5............................................................Approximate Cost�AC...4 �.:. ` y ............................... _ Difinitive Plan Approved by Planning Board -----------__________------- Di agram of Lot and Building with Dimensions Ld 0 �. ;jQM Vo < 10 � \AU, m w ;' ® >- = :. O IM:4 �.L LJ tJ) 7 1:u r n c� ri / . � JS L rI 1°i l �r hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �i II Name .. `.. ....t � ......... ...... Dormest Homes, .Inc. , - 14981 one story ^ No .................... Permit for ------------ - ~ . single family c-�Te111rg ---------,..-----.—.—.—~--._—. / Thistle-Drive Location ------_-----^--------. ' Cerd�»zvi]LIe ^--'—'-----'--^----''r^------- ' Nmrnaest H»nows^ Inc. � Owner ---------^--'--------^—' ` � frame Typo of Construction .......................................... \ ( ' -----^-------^-------'^—^`--'' / 0.7 Plot . � . --------- Lot' ---- -----.. Jpo~^�^� �l 27 | Permit Granted ------------- �� 'lg ) Dote of Inspection ............... .....................19 | } uo/a Completed. _- . � > PERMIT REFUSED \ � ----.---^------------. lQ | . | � ..------------.--~---------. ^ / ~--..--....--..-----.--------. � --------~-----'-----^—^---'^^' ' | ( . . ----.—.--.—..—.~—.—..—..—..---~—' | � Approved ... 19 --------'--------------^'^~—' --------'--^^---------'^^^^^^^^ � | ' •1 M A ..� z . r�• �� '- r� ems' _� .... S1, If low , '� x� V •an _�.�.1;� l-. I/ _ I� Q" 9 1 1 1 , � tV r w, a I a 1 air AA 16 1'' mot el ,_% .e (Nff�lfiiiiS�tt.aka`" :d• _�� 1 __..._ AC. Thio+lc Cnial 7qf'- x: -s i _.lam" ```C��1••1 lb',.I::. .. d.r, Thictip nrivP rPntPn/IIIP 7/17/777 1 2 .. wr1 k' 3 r 1 r^ , ov°, TT ti G i July 9,2007 To Whom It May Concern, Please find photos offW#4 Thistle Drive,which is a neighbor mine. The view is from our backyard. There are 3 unregistered vehicles parked in the backyard. All the wood you see was imported from another area and dumped.in his backyard over the course of-a week. The wood has been there for about 8-9 months. There is a partially constructed"shed"as well. There was a cease and desist order issued by your office and the only thing he has added is a door. The word is that since the"shed"could not be completed,he is now doing work.in his.basement to accommodate more people.As far as I know,there is 2 himself,his wife and 2 children living there. However,there may be more. Hi�name . listed as the owner in the.Town of Barnstable property database. His name is IJeonardCr- r Francescon. The wood is slowly making its way onto my property line. His backyard is-a disgrace to.the neighborhood. It looks like.a huge.dumping.ground for wood old -broken down-vehicles. Z kP If there is anything that can be done I would appreciate it. I would put up a fenc ,but I .:- , .doubt.he would.ever.be-able.to-move-all that wood. He has knocked down his b kyard' neighbor's fence due to trees he was cutting did not fall as he had planned. He h 2 women holding the ropes that held the trees,while he was up in them and cutting them with-a.chain-saw. It sure was a sight to behold. If you need any further information;you may contact me. However,I would appreciate it if our names were not mentioned during any process that may take place. David&Donna Silva 508-420-2-175 5.0.8.737-4325.ce11_(daytime)