Loading...
HomeMy WebLinkAbout0019 EASTWOOD LANE �9 ��STL✓a a�> ��1�/d� J INE � ~ Application Number. ' Lo,,......... * BARNWAsr t. PIP asAse. �, �E��,�(a' Permit Fee.......................................other Fee........................ 03 �`� 8p Mfg a MAR 12 2019 Total Fee Paid................................................... fouVl�j TOWN OF BARNSTABLE � v�144,�Q Permit Approval by.... ..:'.. . .................on....... BUILDING PERMIT Map.. .....................Parcel.....6..43..................... APPLICATION Section 1 — Owner's Information and Project Location Project Address AF ��5%�J�� L A Village C o['0 Owners Name- Owners Legal Address 0bTw-o a L.rl City Co-,tt �a State 1-tA zip d a 33 Owners Cell# 31 S Yco L E-mail A Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment. © Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify I Nur� i NTH/�i o 17�?ry F7Section 4r-Work Description j�etioye FL..uu �m tpi5 f�' l� J �� % yGl� [Jx sT %—/Ov.` t� I �.�.- i Last undated: 11/15/2018 Application Number.................................................... Section 5—Detail Cost of Proposed Construction PS706.— Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method 0 MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing. ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: C61zaL`S - D terf PSrP"- I am using a crane ❑ Yes ® No Section 7—Flood Zone f Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated. 11/15/2018 Town of Barnstable Building ", N AB Post This Card So That it is Visible From the Street-Approved Plans Mustbe,Retained on Job and this Card Must be Kept i M 165 Posted Until Final lnspectiorr Has BeenrMade Permit ° Where a Certificate of Occupancy is Required;such Building shall Not be Occupied until a Final Inspection has been made. Permit NO. B-19-776 Applicant Name: MULTISTATE RESTORATION CAPE COD DIVISION INC. Approvals Date Issued: 03/18/2019 Current Use: Structure Permit Type: Building-Addition/Alteration- Residential Expiration Date: 09/18/2019 Foundation: Location: 19 EASTWOOD LANE,COTUIT Map/Lot: 025-043 Zoning District: RF Sheathing: Owner on Record: FADDEN, M PATRICIA ( Contractor Name: MULTISTATE RESTORATION CAPE Framing: 1 COD DIVISION INC. - Address: 237 NORTH MAIN STREET #322 _ 2 SOUTH YARMOUTH, MA 02664Contractor License: 140427 �Ma Chimney: Description: REMOVE FLOORING AND SHEETROCK ON 1ST FLOOR DUE TO . >-Est. Project Cost: $5,700.00 WATER DAMAGE-NO STROCTURE REMOVALIAND NO RE-INSTALL Permit Fee: $85.00 Insulation: Project Review Req: Fee Paid: $85.00 Final: Date: 3/18/2019 Plumbing/Gas Rough Plumbing: Final Plumbing: Building Official This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months,after issuance. Rough as: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Final Gas: . All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. 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 work until the completion of the same. { Electrical Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work _ Rough: - 1.Foundation or Footing x. - 2.Sheathing Inspection Final: 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 Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Per I sons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). fire Department Final: Building.plans are to be available on site L All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT v vt/1 Act 03/05/CERTIFICATE OF LIABILITY INSURANCE °A�`M /2019 ' 019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)- PRODUCER - CONTACT Laura Turchetta NAME: Cross Insurance,Inc.-RI PHONE (401)431-9200 FAX (401)431-9201 A/C No Ext:. '"` FAX No 376 Newport Avenue E-MAIL Iturchetta@crossagency.com ADDRESS: P.0.BOX 4830 INSURER(S)AFFORDING COVERAGE - NAIC If East Providence RI 02916 INSURERA: Nautilus Ins.Co. INSURED INSURER B Multi-State Restoration Cape Cod Division,Inc. INSURERC: 68 Nicoletta'S way INSURER D: INSURER E: Mashpee MA 02649 INSURER F: COVERAGES CERTIFICATE NUMBER: CL191774420 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AUUL1SUI3R1 - POLICY EFF POLICY EXP LTR TYPE OF INSURANCE - INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY .LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR, M O E 100,000 PREMISES XtNI occurrence) $r MED EXP(Any one person) $ 5,000 A r ECP202804710 01/02/2019 01/02/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑PRO- J ECT ❑LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: Pollution Liability $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea $ accident ANYAUTO - BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON=OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE F-1 E.L.EACH ACCIDENT - $ OFFICER/MEMBER EXCLUDED? N/A - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Job:19 Eastwood Ln,Cotuit,MA 02635 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601 �J ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I ACC)" CERTIFICATE OF LIABILITY INSURANCE °ATE`MM/°°"Y"' `..../ 03/06/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Lisa Stone STARKWEATHER&SHEPLEY INSURANCE BROKERAGE INC to/c°No Ext: (401)4353600 ac No: ' E-MAIL ADDRESS: Istone@starshep.com PO BOX 549 INSURER(S)AFFORDING COVERAGE NAIC# PROVIDENCE RI 02901 INSURER A: AMGUARD INSURANCE CO 42390 INSURED INSURER B MULTI STATE RESTORATION CAPE COD DIVISION INC INSURERC: INSURER D: PO BOX 2210 INSURER E: MASHPEE MA 02649 1 INSURER F: COVERAGES CERTIFICATE NUMBER: 375323 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LT R SD D POLICY NUMBER MM/DDIYYYY MMIDDIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE To RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ❑POLICY PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION - �-_. X.I PER STATUTE ORH AND EMPLOYERS'LIABILITY Y I N - _ ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? NIA NIA N/A R2WC942723 `� 07/16/2018 07/16/2019 (Mandatory in NH) -- - �-- - ' - - - - E.LCDISEASE-EA EMPLOYEE $ 500,000 _- If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate.was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. Jobsite: 19 Eastwood Lane,_Cotuit,_MA.02635. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE �.... Hyannis MA 02601 Daniel M.Crawley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety.: Board of Building Regulations and Standards,_;. License: CSFA-051784 f Construction Supervisor 1 & 2 Family RICHARD D LAURIA 1 LEAH DR yT ROCKLAND MA 02370 ti rt� _ itc�`�K� �st�ct— Expiration: Y Commissioner 04/01(2Q9 • 02. �OhivrriwizroealClt a�� �� '�utael�i Office of Consumer "taaa HOME IMPRO airs&Busmess;Re airs CONTRAGTOghon TYPE:S.UoolemenYCard Re istratioms, Ex ' 14042_..T gyration MULTISTATE 1011*2619 �-71fiQ CAPE COD DIVISION,INC. .. RICHARD LAURIA, `21 PEQUOT RD. ! MASPHEE, MA 0264g Unders - — ecretary MULTI-STATE RESTORATION, INC. FIRE* FLOOD*WIND* SMOKE*HURRICANE*VANDALISM Fed ID#050515889 CONTRACTORS REGISTRATION#140427 AUTHORIZATION TO PERFORM SERVICES AND DIRECTION OF PAYMENT e;Z A/A�1 ,herein referred to as "Customer",authorizes MULTI-STATE RESTORATION,INC.,herein referred to as "MULTI-STATE",to perform any and all necessary cleaning and construction services on Customers'property at: L Gi Telephone: and with respect to items that need to be cleaned at a remote location,to remove and clean such items as necessary. V.,feu Customer authorizes Insurance Company,herein referred to as "Insurance Company",to directly and solely pay MULTI-STATE. If for any reason the check should come to be or be made payable to the Customer, Customer then agrees to pay MULTI-STATE immediately upon receipt of the check from the insurance company. In order to expedite payment to MULTI-STATE, Customer hereby appoints MULTI-STATE as attorney-in-fact,authorizing MULTI- STATE,to endorse Customers'name,and to deposit Insurance Company checks or drafts for MULTI-STATE services. Customer agrees to pay Customers' deductible in the amount of$ that applies to this claim. If the loss is not covered by insurance,Customer agrees to pa e t tal amount to MULTI-STATE upon receipt of the invoice. Signature of Owner It is my understanding that the services to be performed by MULTI-STATE will be limited to those,which are authorized by my Insurance Company. Insurance Company Name Policy Number. Customer agrees that MULTI-STATE is working for the Customer and not the Insurance Company or agent/adjuster. Additional remarks:_[/E�- car I have read this document and completely understand and agree to same. Signatur Date Printed Name P.O. BOX 2210•MASHPEE, MA 02649.866-921-9Ill •FAX 774-238-4422 U _ lla / v C-c» u-L i ILI ITM IL s-91 /LF17 L r The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations - 600.Washington Street Boston,MA 02111` www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lepibbr Name(Business/Organizationdndividual): H lJl.L—ri Address: N t L.o L e.TT 415 L;u a t ^ City/State/Zip: rl,06-� ;tee MA- Phone#: 5-2>Y- '77 - 3 3"33 Are you a-n employer?Check the appropriate box: Type of project(required): 1.ELI am a employer with- 3 4. 0 1 am a general contractor and I' * have hired the sub-contractors employees(full and/or part-time). 6. E]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. ElDemolition working for me in any capacity. employees and have workers' 9. Building addition insurance workers'comp.in� nCe pomp,insurance. # required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their H ❑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 cbecks 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 shut 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 thepolicy and job site information. Insurance Company Name: A-A G u A P-- Policy#or Self-ins.Lie.#: a 11J C `1 4 f J 3 Expiration Date: / Job Site Address: N I.W oz) City/State/Zip- J-(A Cd<2 G 3;S 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: Sigg " Date: Phone#: V- Official use only. Do not write in this area to be completed by city or town ojjicial 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate lime. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space it 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 lice 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 Commouv ealth of Massachusetts Deparlment_of Industrial Accidents Qmce ofluvestitgations 600 Washington Street BosGan,MA 02111 Tel.#617-727-4900 oxt 406 or 1-877-MASSAM Revised 4-24-07 Fax#617-727-7749 www.mam.gov/dia {C F I - i Application Number......................................... Section 9- Construction Supervisor i Name `tZt��t-/t►e L R.rA Telephone Number Z9 Address I L CA R _��� City iZnz_KLtwd State MA- Zip 0 Z 3 74 License Number CSrA t551,WV License Type (,4.Z F4M Expiration Date q -4-- Contractors Email L 4Q-2cA a 1 HSIJ God Cell# 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.Attach a copy of your license. Signature Date 3 l Z _/' Section 10—Home Improvement Contractor i Name L e ry a- L:Au2,^ Telephone Number 77Y -7 7 Address i L E-)�-kr aYZ, City. 1ZcxXLAr-�- State JLfA— Zip 6 3 7- Registration Number /L41:2 Expiration Date - {�f 7 I understand my responsibilities under the rules and regulations for Home Improvement Contractors 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.Attach a copy of your H.I.C... Signature Date Section 11 Home Owners License Exemption Home Owners 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 APPLICANT SIGNATURE Signature - Date 3 _/2 -iy Print Name l C"( y L/4--L(?K_-i A Telephone Number 99 s E-mail permit to: L- 4 2 r,� a l Last updated: 11/15/2018 Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) El Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation For commercial work,please take your plans directly to the f re department for approval i Section 13— Owner's Authorization I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name 7 Last updated: 11/15/2018 �"`xrr��.•.wr,-al,.�.e.�wy. �,. tea..� ..a.x -,-v-- .. - - 'e7�4c .1.. .� -.+... .�:.��. +n M .. � a:�i:E lh'.,•1.t., i.y...-KE, *s.'Y i�vv—,•aP. -te^�a..v 'v LET a 4- ari .... Mv is ' `���r, '_1 �� • dl r ' ` a5 H, b < y/ ? A 15 00a 1 vt �0D RIVE 40 ' WIDE T L AA1 . C E r/F 5' -rl-N,A T T/-/E_ FCC,)A >A 7-/0&/ /S .�'0Jt/!!V vV/-/r--ftJ 7`Y9 r-'Z-ASV WA,5 :,4,) 1or w 3ACA f-'5T".4C t— C.-?JUi.i7-/ '/Z 4,= Z:>E: u � LOW,Jk �• 7nL'/� LC��-p I N A )=&z;)4-; A L.. Z5E S' �3AJA 7r 7. T UR 0 1177 7 '7 Assessor's map and lot numberSYSTrV.. .f. ::... ......� _ E Sewage Permit number 77 LLEp Ci B sr c _ TH .A,RTICLE (COMP LIANCE `` �FTNET��� .�. � E' TOWN. OF �BARro�,� �Q o M6 BUILDING INSPECTOR APPLICATION FO_1 PERMIT TO ............... .. NS. .h.U. .f.......... :... C, .. ... ' -TYPE OF CONSTRUCTION { ` ...... 52 ... �................19........ TO THE INSPECTOR OF BUILDINGS: , The undersigned hereby applies for a permit according to the following information: Location ........ .....L? ./ ........ (�IJO,(j .,......., &a .............. .!..v.(. .................................... Proposed Use ..... .dwe.dl/11. .............:....................... ZoningDistrict ............C.I..t ..............................................Fire District .......... v! ........................................ Name of Owner .je 4 /....Address .... .d ..... ../.. ........L.Zc' �v�//!�e - Name of Builder ............ //-e ,r/ -........... ..�..............................Address .......................fir t.. ........................................ Name of Architect ........... 1/e. ..-e!!!......................Address Ali Number of Rooms ......... . �...................................................Foundation .�eq.�..... Q .1�.�1........t�Q Exterior �.r ����. .('Q..�. .r/. f�,P.),o (Roofing .. ...�... ./4.i....... ........ / .,, . Floors �..........v�........................ /..Nli.....Interior .................../M...�f......�j . ..... /..;dG......... Heating ...............................7 .... ........... ........Plumbing - k C7 C.O P ..... Fireplace Q.<(fW , .SUP✓ �� Approximate Cost ........ ....... p / ... <J..... ........ ................. Definitive Plan Approved by Planning Board ________________�___________19_______. Area ..�-...7. .......................... Diagram of Lot and Building with Dimensions Fee P`0 j� SUBJECT TO APPROVAL OF BOARD OF HEALTH I 1 oZ Y a n S 0c . 5J�wry pw I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name 1 ��: �s�l.:�::,� .°.. ?e.... r.....4...t.� . Tel legen & ft r��ne f 19712 Dwellin No Permit for g............ t .......................-..... ./ ..... ........ Location ...bo.. -21 as twood rRd: ............................................................. cotuit f ' j Owner ...........Tellegen,&..Ferrone Type of Construction Wood Frame ....... .... .... ...... Plot ............................ Lot ......... 25....L....43 - 4 Permit Granted _ Date of Inspection ...... , . .. ...' .....19 i Date Completed .....1,71 ... ..'19 5 -PERMIT-REFUSED , .............................................................. 19 ........................................... ................................... ' ..............................................................' r........... ' ..................... ........... ................ . ..: .............................. ........................................... Approved ................................................ 19 ' .......................................................................... .�..y ` ' + ��. i�. 0 . .................... .................................... . ...... ..( *V C Assessor's map and lot number .... !-.. . '-............... .�Sewage Permit number ............. .. ...................................... V yDi TM E tb� TOWN OF BARNSTABLE • B9HBSTOHLE, i Y, a pY. BUILDING INSPECTOR _ = 11'0,AIS 24 APPLICATIONFOR PERMIT TO .............................................................................................................................. TYPE OF CONSTRUCTION ..v .........................�.(�fJ/� •....... ! I .` J ............................................. ............. .�.� ................19...�� /. : TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ,F��S � �E:C� r .............. ./JcJ. .................................... .................................... .............. .` Proposed Use ...... ?.. .t/P�l ...... ................................................................................................................................. ZoningDistrict ...................�................................................Fire District ..........�!>........v.i................................................ Name of Owner l� G� orti� , pl�!� )... ...7 .Address .... .d. .......,a '). ..a................r ....P✓,t/...f....P Name of Builder ...............L.../` �'`'v�' ..Address Nameof Architect ......... ..................Address ........................ ........................................ Number of Rooms ..................................................................Foundation ......... O U,!r"Cf ......�(?/1� a �// !�' �lJ 1 W Exterior ............................ ....... .........irr�� /rl�f�P/r g > //i `i .7 L �/ �... Interior /, Floors .. F / ,� / a!................... ........'. ....... ......................................... Heating ............................................. ......... �?.�./........Plumbing ................................/.�.i C.............. rl�'P ' . . I Sv.�Jr�6k/ Fireplace ' Approximate Cost .......... .r�....:r� ,n Definitive Plan Approved by Planning Board -----------_------_-----------19--------• Area .......................................... Diagram of Lot and Building with Dimensions Feed . ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH x lb �' ; I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ........?....../�_�,�n a�1,y �:, Tellegen & Ferrone 3= Y-� No ..1.97.12... Permit for .....gwe. 1• ng............. Location ..k9t. as.>;raooa. .' ....... s 71 ..........................catui t....................................... Owner ..Tr.11e1gen..&..F.errone...................... c; z Wood Frame => Type of Construction .......................................... .......................................................... .................. Plot ............................ Lot .....M..25.......L..43.. L C� Fv Permit Granted .........................ov..........19 77 G2 Date of Inspection ....................................19 Oj Date Completed ......................................19 .4 J ry E H� PERMIT REFUSED ...................... ......................................... 19 ��� .. ............. ° w 0 . ............... ...... R.... .......................... ro ............................ VV .. .......... ....... ........................ r Y_ Approved a ............................................................................. jtiEr Town of Barnstable Regulatory' Services Depactm.ent BLS. I,6,lR.Sr1131a Public Health Divisil 15 3. FD MAC ! E; 1 200Main Street, Hyannis MA,02601 2-0 Certified IV>al#7009 2820 0003 3168 1633 CAIVISit) Office: 503-362-4644 Thomas F.Geiler,Director FAX: .503-790-6304 Thnmas A.McKean.C'HO `,July 14;2010 Patricia Fadden 19 Eastwood Lane Cotuit, MA EMERGENCY CONDEMNATION AND ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger The property owned by:you located at 19 Eastwood Lane, Cotuit,`was visited on July 13, 2010 by Cotuit Fire and Police Departments after receiving a caWfrom a concerned r neighbor requesting a wellness check. Based on photographic evidence presented to Jim Parziale;Health Inspector for the Town of Barnstable, the Barnstable Health Department.finds that;the dwelling is unfit for human habitation. Pursuant to M.G.L. c:il27B and 105 CMR 410.831`(D), the Health Department further finds that the conditions within the dwelling aie such that the danger to the life or health of the occupant of the subject'dwelling is so immediate that no delay ' may be permitted'in making this finding The following violations of 105 CMR 410.00, State Sanitary Code II: Minimum 2 Standards of Fitness For Human Habitation were observed: 105 CMR 410.750: Conditions Deemed to Endanger or Impair Health or Safety (I) "Failure to comply with any provisions of 105 CMR 410.600, 410.601, or 410.602 which results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. t There was a large accumulation of garbage, rubbish, filth and'other causes of sickness present at the location. 105 CMR 410.451 : Egress Obstructions "No person shall obstruct any exit or passageway. 'The owner is responsible for maintaining free from obstruction every exit used or intended for use by occupants of more than one dwelling unit or rooming unit. The occupant shall be responsible for maintaining free from obstruction all means of exit leading from his unit and not common to the exit of any other unit." There were large amounts of trash and debris obstructing numerous passageways and exits. Based upon these findings any and all occupants are hereby ordered to vacate and the landlord/owner is ordered to secure the subject dwelling within 48 hours of receipt of this order. If any person refuses,to leave a dwelling or portion thereof, which was.ordered vacated, they may be forcibly removed by the local Board of Health (M.G.L. c. 127B),or by local police authorities at request of the Board of Health: ' Furthermore, anyone who'-fails to.comply with any order of the Board of Health may be subject to fines of not more than $500. Each day's failure to comply with an order shall. constitute a separate violation Once vacated this dwelling may not be occupied without the written approval of the Board of Health. Note: This is an,important legal document. It may affect your rights. Sign Thomas McKean Director of Public Health - CC: Cotuit Fire Department Barnstable Police Department ; TOB Building Department z Cape Cod Hospital 4