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0020 EASTWOOD LANE
� ���-�� i i Town of Barnstable Building t Post'This Card So,That-it is.Visible From the StreetApproved_Ptans'Mustbe Retained oriJob and this�Card Must be Kept DAMil�1'�IBi.E. ,. ,� Po ed'Until Final Inspection Has Been'-Made Permit ea Wher&a Ce�rtlficate of Occupancy is=Required,such Building shall Not be Occupied until a Final Inspection has been made 1'll Permit NO. B-19-3630 Applicant Name: Domenic Venturelli Approvals Date Issued: 11/19/2019 Current Use: Structure Permit Type: Building-Addition/Alteration- Residential Expiration Date: 05/19/2020 Foundation: Location: 20 EASTWOOD'LANE,COTUIT Map/Lot: 025-036 Zoning District: RF Sheathing: Owner on Record: DENNIS,CAMERON W ContractorNameDML BUILDERS INC Framing: 1 Address: 361 COTUIT BAY DRIVE Contractor=License: :197025 2 COTUIT, MA 02635 Est Project Cost: $69,073.00 Chimney: s Description: Construction of a new Garage and master bedroom addition. New `` Permit Fee: $402.27 concrete foundation,wood frame construction,Asphalt Insulation: _ Fee Paid:: S 402.27 shingles,Cedar shingle siding,Anderson 400 Series windows. r' Interior finishes,including blue board plaster g _ Date• 11/19/2019 Final: Project Review Req: S/CO AT BASE OF BASEMENT STAIRS(UNFINISHED BASEMENT) Plumbing/Gas CHANGE CO TO HEAT DETECTOR IN THE;GARAGE. � Rough Plumbing:. 7Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized,by.this permit is commenced within six months;after issuance. All work authorized by this permit shall conform to.the approved application and the�approved construction documents forwhich this permit has been granted. Rough 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. Final Gas: This permit shall be displayed in a location clearly visible from access streetorroad and shall be maintained open for.public inspection for the entire duration of the work until the completion of the same. .. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials,are provided on this,permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 4 1.Foundation or Footing , Rough: 2.Sheathing Inspection g 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final- Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT ��° �" Mckechnie, Robert From: Mckechnie, Robert Sent: Wednesday, March 28, 2018 3:02 PM To: 'yarmolovichandr@yahoo.com' Subject: 20 Eastwood lane, Cotuit Andrei, I just sent you a copy of the permit for this property. This was taken in and paid for at our front counter on February 16, 2018, with a copy of your Construction Supervisor license and your HIC and the form appears to be signed by you. Do you recall roofing this property? It is possible that one of your subs contracted with the homeowners for the siding work and couldn't apply for the permit. I will be issuing a letter of violation to the homeowner as they will be ultimately responsible for permitting the sidewall. Please let me know if you have come up with anything before tomorrow morning. Thanks, Robert McKechnie Local Inspector Building Department Town of Barnstable 200 Main Street Hyannis, MA 02601 508-862-4033 - 0 l� AAA 3�Z --1 Ale Ut,O eAG o ® 1 Building Department " ' _ U.S.POSTAGE>>PirNeveowes Town of Barnstable 200 Main Street Hyannis,MA 02601 : 02 02601 $ 006.670 7017 1000 0000 6759 6580 I 0000336455MAR. 29. 2018�Pu ------- Thomas J Ribaga - Donald P Mone 20 Eastwoo(-'-r--a-n,- RPa.itv_Trust PO Box 1021 rrx=: z u:E � j: . 319V1SM r 1t71 Cotuit, MA a RETURN TO SENDER UNCLAIMED UNABLE TO FORWARD UN C 3C' 02601400200 *DZ69 02694-29- 41 ��- :•;r����.��,���;�� t_ I ,I ' SEN• -: COMPLETE THIS SECTION' . ON I ■ Complete items 1,2,and 3. A. Signature \ I ■ Print your name and address on the reverse ❑Agent I _ so that we can return the card to you. X ❑Addressee ' ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 17 ❑Yes I j /77,vIM4 5 /(?i G If YES,enter delivery address below: p No I I I I - I I I II IIII�I I'll 111 I lI II ll i l l illli III'i I 3. Service Type ❑Priority Mail Express® ❑ 1 I l l II l Ill ❑Adult Signature Registered MaiITM I I ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted I ' I I 9590 9402 1933 6123 1780 71 "o certified Mail Restricted Delivery Delivery ry v9etum Receipt for '4. I ❑Collect on Delivery Merchandise 12. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature ConfinnationTM I -'i 'nsured Mail ❑Signature Confirmation 7 017 1000 0000 6759 6580 nsured Mail Restricted Delivery Restricted Deliveover$500) ry Form 1,July 2015 PSN 7530-02-000-9053 Domestic Re turn PS o I 381 i Town of Barnstable Building Department Services Brian Florence, CBO Building Commissioner BARNS'TABLE: 200 Main Street Hyannis, MA 02601 - 1639-2014 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Notice of Building Code Violation(s) and Order to Cease, Desist and Abater Thomas J Ribaga,and Donald P Mone,and all persons having notice of this order: As property owner or tenant of the property located at 20 Eastwood Lane,Cotuit,MA 026539 Assessors Map 025 Parcel 036 and known as residential structure,you are hereby notified that you are in violation of 780 CMR,the Massachusetts State Building Code Chapter 1 Section R105.1,and are ORDERED this date 3/28/2018 to:CEASE AND DESIST all functions associated with the. following violation(s)on or at the above mentioned premises: Summary of Violation: On 3/26/2018 I observed a violation of 780 CMR of the Massachusetts State Building Code Chapter 1 Section R105.1 Specifically,The'house was being sided without a permit'. Summary of Action to Abate Violation: In order to abate this violation and to avoid further enforcement action by this office, commence immediately upon receipt of this notice the following action:apply for and obtain a building permit to side the house. This can be done online by the licensed contractor or by you,the property owners And, if aggrieved by this notice and order;to show cause as to why you should not be required abate the violation in this notice,you may file a Notice of Appeal(specifying the grounds thereof) with the State Building Code Appeals Board within(45)days of the receipt of this order and in accordance with MGL c. 143,§ 100. If, at the expiration of the time allowed,action.to abate this violation has not commenced,further action as the law requires may be taken. By Order, Robert McKechnie Local Inspector Town of Barnstable Building Department Services Brian Florence, CBO DST Building Commissioner BARNSTABLE 200 Main Street Hyannis, MA 02601 �°""� ° 'sue"`M' rt J 1639-2014 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Notice of Building Code Violation(s) and Order to Cease, Desist and Abate: Thomas J Ribaga, and Donald P Mone,and all persons having notice of this order: As property owner or tenant of the property located at 20 Eastwood Lane, Cotuit,MA 02653, Assessors Map 025 Parcel 0.:)6 and known as residential structure,you are hereby notified that you are in violation of 780.CMR,the Massachusetts State Building Code Chapter 1 Section R105.1,and are ORDERED this date 3/28/2018 to: CEASE AND DESIST all functions associated with the following violation(s)on or at the above mentioned premises: Summary of Violation: On 3/26/20181 observed a violation of 780 CMR of the Massachusetts State Building Code Chapter 1 Section R105.1 Specifically,The house was being sided without a permit. Summary of Action to Abate Violation: In order to abate this violation and to avoid further enforcement action by this office, commence immediately upon receipt of this notice the following action: apply for and obtain a building permit to side the house. This can be done online by the licensed contractor or by you,the property owners And,if aggrieved by this notice and order;to show cause as to why you should not be required abate the violation in this notice,you may file a Notice of Appeal(specifying the grounds thereof) with the State Building Code Appeals Board within(45)days of the receipt of this order and in accordance with MGL c. 143 § 100. If, at the expiration of the time allowed,action to abate this violation has not commenced,further action as the law requires may be taken. By Order, Robert McKechnie Local Inspector I PostalTM CERTIFIED o RECEIPT a .. Only ,n Er n-� Ln Certified Mail Fee Ss r •! /�� '•�. Extra Services&Fees(check box,add fee es appmpdate):�. W'4 - ❑Return Recelpt(hard copy)'.- $ 'r - �•�s' t ��v 4 I 0 _❑Return Receipt(electronic) $ - J Postmar ° Certified Mail Restricted Delivery .:$ ' � Here's• i C3 92 1 0 ❑Adult Signature Required 3'`^ -$ ' �� ,r O �Adutt Signature Restricted Delivery Q' Postage• O t a9 C3 Total Postage and Feel. I`- sent To.-- , O street and Apt.No:,or Pd Box No. +. i :rr r rr rrr•r _ b S ., Parcel Detail Page 1 of 4 �✓r' 'kss, 5 b Logged In As Pa rce I Detail Wednesday,March 28 2018 Parcel Lookup Parcel Info ............. ......... . .. . .__.- ..... „_„ ,,,.,.,.... .,.,.....,,. .„ „.......„.,.. g..�.. .,.... ._ Parcel ID 02 6 I Developer Lot LOT 14 Location,20 EASTWOOD LANE « Prl Frontage 135 «n' .,........» Sec Road �. Sec Frontage Village#COtUIt i Fire District COTUITy~ � Town sewer exists at this address NO.m,. ..,�,=. ten.«» Road Index 0471 Asbuilt Septic Scan: Interactive Map 1 x€ 025036_1. ai Owner Info ownerRIBAGA,THOMAS J&A� owner20MEASTWOODLANE Rl streets PO BOX 1020pfi (streetz « « city COTUIT state AMA I zip02635 (Country Land Info ........ ..... .... .................................... .... ...... . ...... ......... Acres 1.0.50 use Single Fam MDL-01 zoning RF (Nghbd'0107 Topography Above Street Road ,Paved utilities Public Water,Gas,Septic] Location[77 �. w Construction Info Building 1 of 1 Year 1977 �'S rucr Salt Box well Wood Shingle �� Living Roof .:..,,»._.,,.�»».» AC Area 1152 cover Asph/F GIs/Cmp TypeBed None style Saltbox wall Drywall _� Roams r2 Bedrooms Model�Residentiah Floor Pine/Soft Wood Rooms 1 FUII-1 Half Grade Avera a "eat Hot Water Total 5 Rooms g Type r Rooms Heat j Stories 2 Stories Fuel oil Found-ation POUred COnC Gross 21r12 Area Permit History Issue Date Purpose Permit# Amount Insp Date Comments 2/20/2018 SidNVind/Roof/Door 18490 $2,500 reroof(stripping old shingles) /15%197 9/1/1977 Dwelling B19637 $0 1 1/15/197 9 AM CO 1 1/2S 1 :00http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=1487 3/28/2018 Parcel Detail Page 2 of 4 . Visit History Date Who Purpose 9/3/2013 12:00:00 AM Robin Benjamin Cycl Insp Comp 10/28/2009 12:00:00 AM Michele Arigo Change of Address 4/7/2005 12:00:00 AM Paul Talbot Meas/Est 7/21/1999 12:00:00 AM Frederick Stepanis Meas/Listed-Interior Access Sales History Line Sale Date Owner Book/Page Sale Price 1 8/5/1998 RI AGA, THOMAS J & MONE, DONALD P, ET 11617/234 $1 2 6/17/1992 RIBAGA, JOSEPH T& MARY TRS 8072/119 $1 3 6/17/1992 RIBAGA, JOSEPH T& MARY L 8072/110 $1 4 5/30/1990 RIBAGA, JOSEPH T& MARY L 7176/288 $1 15 . 2/10/1978 RIBAGA, JOSEPH T& MARY L 2660/168 $0 Assessment History Save Year Building XF Value OB Value Land Value Total Parcel # Value Value 1 2018 $103,100 $21,300 $5,000 $172,700 $302,100 2 2017 $85,600 $22,100 $5000 $172,700 $285,500 3 2016 $85,600 $22,100 $5,100 $174,400 $287,200 4 2015 $83,500 $19,900 $3,200 $137,900 $244,500 5 2014 $83,500 $19,900 $3,300 $137,900 $244,600 6 2013 $83,500 $19,900 $3,800 $143,400 $250,600 7 2012 $84,500 $19,700 $3,000 $137,900 $245,100 8 2011 $104,700 $4,000 $500 $137,900 $247,100 9 2010 $104,000 $4,000 $700 $140,100 $248,800 10 2009 $119,800 $2,600 $300 $147,400 $270,100 11 2008 $135,000 $2,600 $300 $153,600 $291,500 13 2007 $134,500 $2,600 $300 $163,600 $291,000 14 2006 $112,800 $2,600 $300 $159,900 $275,606 15 2005 $116,800 $2,700 $300 $145,400 $265,200 16 2004 $97,000 $2,700 $300 $109,000- $209,000 17 2003 $84,100 $2,700 $300 $48,800 $135,900 18 2002 $84,100 $2,700 $300 $48,800 $135,900 19 2001 $84,100 $3,200 $300 $48,800 $136,400 20 2000 $65,100 $3,100 $200 $30,000 $98,400 21 1999 $57,400 $2,600 $0 $30,000 $90,000 22 1998 $57,400 $2,600 $0 $30,000 $90,000 23 1997 $61,600 $0 $0 $22,500 $84,100 24 1996 $61,600 $0 $0 $22,500 $84,100 25 1995 $61,600 $0 $0 $22,500 $84,100 26 1994 $66,800 $0 $0 $30,400 $97,200 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=1487 3/28/2018 Parcel Detail Page 3 of 4 27 1993 $66,800 $0 $0 $30,400 $97,200 28 1992 $76,000 $0 $0 $33,800 $109,800 29 1991 $71,700 $0 $0 $48,800 $120,500 30 1990 $71,700 $0 $0 $48,800 $120,500 31 1989 $71,700 $0 $0 $48,800 $120,500 32 1988 $60,200 $0 $0 $19,500 $79,700 33 1987 $60,200 $0 $0 $19,500 $79,700 34 1986 $60,200 $0 $0 $19,500 $79,700 Photos 99 u3, r fJ3 +t it I R �ti;I EwI, Iit�W �I r zw».. .��, ,,••, F°� `d'y���Jl��1�79,i.131j iwl I�, �1� t _3 s N y x �e x, 'http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=1487 3/28/2018 Parcel Detail Page 4of4 ht:%Iss l2immn tp opd ta/Pa c lD&6[a px?ID=1487 3%U2018 T .w l 'a y �_ . ., : •:• . ate. r. al-6 00 3 :LO'T" . , 73 - LOT • o. ��r1S�' • . 43 �+ 7.8 F'OON.D ° F, 0 MS'T1NEr WELL O 135.00 EPSTWOOD QRZ.VE 4o` W I D E /Cl L T . L-4 A4 f A//yj U M F-C7TZ � � r TELLEGEN FERRONE " �R a/v' r' L_CO CA 710AJ G f}ry ZD-4 2- C E,e 7' F)' 7-1-IA 7" T�/E FOOAJZ)-4 I/O N /S L o CAA 76 D A�5 75. �40 Gce,tiJJ 0/t 1 7/4 y0,j�+-'r >- f v.^'�'+rc.:,.L1.+e. /w�..% 4»a..:L.sr ..J �'" of 4fv 5F /N C7' L d.7". l-,IAJ //'J GEORGE LOW, ii ,,,, �✓ /o c 9 z s Assessor's map and loth r .... d u; If �3 : _ S SEPTIC SYSTEM MUST BE ` 02 INSTALLED Sewoge,.Permit number ..............................:..........:............... COMPLIANCE N s3. WITH ARTICLE } II .STATE uFTHE?� F, '` S V A"? ,® WN Qy � . TOWN: O F BARE I�STt'll - t_r w; -} 0 99S3STd311B • C Y 9° 46 9e� BUILDING INSPECTOR G '7 APPLICATION FOI�.PERMIT TO a.`.15�(/�/� .... •. .............. .1...}C. ............. ............................... ... .... TYPE OF CC NSTRUCTION ............ t .... ...........:................. .:.......:.....:..........:...................:... t 0 .19. 7 t^3 TO THE INSPECTOR OR-BUILDINGS: The undersigned hereby`?applies for a permit according to the following in'fo_r/mation: Location ....../f�. .....�Z1..........:.. ��:ST�c�l c�......!�.��...... :.............1...C?Tui .....:................................................ ProposedUse ............C.44;1.P.:G/l..�l�...S..................................................................................... .................. Zoning District .............................................�— Fire District .................rig :..1.......................................... > ... Name of Owner P..l�r f;....��'r:%4i':f'...G 55.0.r..L.7:w1.C..Address .... ? ..........3.,23....C Name of Builder .1,1?9.•P.a..................... ......Address � Name of Architect ...... T .....: ........................Address .......... .............4, .X�........................................ Number of* Rooms ............:.Foundation ..J..........., nu! cif Co;'.�!'C. P.........:........ Exterior ..... .r . .../?���..:Srrf<wc+l�P.r...�..Roofing .... . ......... Z ............................... Floors ./?� .........(�....... .. ,p/�.7.P.. ................Interior ... ... Sf.4�'.eJ .� .�Q�:!�. �" ........................................ PuCHeating !-. L'�� . f: .Plumbing � _ CN Pr *.............. :,- ,��................. _.. Fireplace .....GP_............ !L.........C>..?... .........................Approximate Cost .... 2-y ............................. .. ..... Definitive Plan Approved by Planning Board -----------_----- -----------19_---_-__. Area �lr. ....s .:...-•.... Diagram of, Lot and Building with Dimensions Fee �Q .................................. SUBJECT .TO APPROVAL OF BOARD OF HEALTH l . - 9- --F- \ /y)1405,e, wCJ /I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ........... Tellegeu-Ferroae Associates, Iac. � t T19637 M; 1 1/2 story 'No . ...............Permit for.,.................................... ................siugle"family dweliiag..................... ` Eastwood 8o8d............................ Location. ......, " y Cotui ti u� ......................................................... ................... o 0. Tellegea-Ferroue`sAssociate................................... s, Inc'. ......... M12 Owner Type of Construction ............ ..f= e. ........................ .......................................... ......... n i.Plot ....................... Lot . .................... Permit #`� September 23 77 Granted .19 Date of Inspection .........•z. ...............' ......19 ' Date Completed ..:./d7( .:.......19 -PERMIT-REFUSED ............................................................... 19 , . ..... .................................. _ N '................ ... ...... ........................................... ........................--•�.................................................. i Approved . .... 19 •� m d .............. ........................................................ . ..................... ...................................................... f } • Assessor's map and lot number ................................ .......{./ Sewage Permit number .......................................................... OFTNEt� TOWN OF BARNSTABLE BA$$9TABLE, i BUILDING INSPECTOR ' APPLICATION FOR PERMIT TO ` ..? ��"t'j.1........................................................................................... TYPE OF CONSTRUCTION /,� , c r�................................................................................. A� ................................................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby lapplies for a permit according tothe following/in`f�or/mation: Location .....�13,�.....�L!.............. 0 S Tu h e)nr,�......!�, .......................!_ ,, -/e.d� ................ ProposedUse J........ !,//, 6? /� r!ar. ................................................................................................................................ Zoning Districts.....................................................Fire District ? Tt,.: ........................................ Name of Owner ... A" rrn�r A... .. .Vic ' Address .....:. x «fir P Nameof Builder .....�..5..//o.A,or,:� .........................................Address ........................ e........................................... Name of Architect Tt euAn..................................Address ......................................... ............ v Number of Rooms .Foundation f� �' nil r ���'�................................................................ /./;.............................../............................... Exierior S/G TI/�........ �1;, �;rslr�pan/�`� /.Roofing .. r A,.........�5��!!F, /� ................. ......... Floors .......... �...... ... .. .........w ... : !�?......................Interior ........:......... Heating FA/1A) n ,"/ ) lC�,, C Pr .......................................... Plumbing ............... ............ .y. ...................................... Fireplace .... ...... '? rcri6I�:...........................Approximate Cost ! .�� ...................................... Definitive Plan Approved by Planning Board ---------------____-----------19________. Area ......!�.,�. ....... .......... Diagram of Lot and Building with Dimensions Fee � �............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH foI405ecr wP �J I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ...... . .....).......................... .......... Tellegeu-Forrone Associates, Inc. A=25-36 ,5-J 19637 1 1/2 story No ................. Permit for .................................... single family dwelling ..........Ab..................... Eastwootiftwd Location ........................... Cduit ............................................................................... Tellegen-Ferrone Associates, Inc. Owner .................................................................. frame Type of Construction .......................................... ............................................................................... #14 ✓ Plot ............................ Lot ................................ Permit Granted ........................................19 eptember 23 77 Date of Inspection ....................................19 C=7 Date Completed ......................................19 o PERMIT REFUSED ................................................................ 19 ....................... .................. ............. ... .... ...................... 0' ........................... ........ . ............ Approved ................................................ 19 ............................................................................... ............... . ...................................... .................... -� - q 'THE Town of Barnst le *Permit Building Departments Departmentsi® I Expires6monnejr e snxxsrnaL% : Brian Florence,CBO r` Ar 1 �� Building Commissioner �� fc 200 Main Street,Hyannis,Al, ' �t www.town.bamstable.ma.us pp Office: 508-862-4038 ax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY n Not Valid without Red X-Press Imprint Map/parcel Number Q AL(3 Property Address 2 S x, moo( Residential Value of Work$ 2 S Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address P'wlPrtt`$ s Contractor's Name �yG� `' 6� t�y�Gyi Telephone Number Home Improvement Contractor License#(if applicable) 1r_7_2Y 7C, Email: i'Y/tY—D'k-B�deO-VI��i ��►�uet? Construction Supervisor's License#(if applicable)r'g —1 /3 �St� Worr an's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [-I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy Copy of Insurance Compliance Certificate must accompany each permit. Permit R st(check box) Du ` Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: 'Where required: Issuance of is permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pro Owner must sign Property Owner Letter of Permission. A y of the Home I ovement Contractors License&Construction Supervisors License is re ired. SIGNATURE: Q:\WPFILES\FO \b Y'ding rmit forms\EXPRESS.doc 08/16/17 V ; J j �V Town of Barnstable Building Department Services ` Brian Florence, CBO „39. Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. - If Using A Builder 6C•� as Owner of the subject property hereby authonze �� �g��+'"� w 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 i ' s ed and all final inspections are performed and accepted Signs o er VignatureApplic Print Name Print Name Date Q:FORMS:OWNERPERMISSIONMOLS Rev:09/16/17 Town of Barnstable W Building Department Services Brian Florence,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 �,�, KASL www.town.barnstable.ma.us 639 Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityAown state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fmms\EXPRESS.doc 08/16/17 The Commornrea*ofMassadmu!t& .��nsf��e�xt afl�'r.�dr�striat�cc�c��at� Office-,f Im. gvdom 600 Washingtoxi.street -- Bastnn,CIA 02 Ul *guru masmgttvliiia Winrke& CGffipens3fimtIusur2nce avit:BuflderslCunfracfgr Mectd 'ens hmibers AppUzant Iufmmaf nn Please Brest NZffiega 'L ��gf�tatel �a�-� �� ���L� Phca��• � � ��� / t `�C� Are . u an employer?Checkthe appropriate ban ' Type of project(required): _ lamaemploy I am a general confractor andI ❑ i employees(full dfor part-time).* ❑hate lwred.fhe suer-costractozs 6. New constructia4 2.0 I am a sole propiietar orpartaw- T.isted Bathe.attached sheet;. 7 ❑Remodeling These sob-confiaclars have strip and have no employees • 9-,❑Demolition wa dr a forme in any capacity eEnployeass andhace woAmrs' 9. ❑Rvitding addifim jNO steers.' comp fnmuce comp.msurm I • . . 0 file are a cmpomfim and its 10:❑FIeorica repairs or ad&ions rewired� • 3.❑ Imnahomeorvmer doing allwoda offcersStave exercised duir 1L❑rhmNagrepaiEsoradditions. of ou er M(M mysel€[No route c=g- f p 1-❑Roof repairs insurance reqMie&]i c.152,§1(4k andwe have no employees_[1Va wo&e& 13_0 other comp.insurance required_] &AnygyBamtdiatc7mclabus#lmustalsoffirnittheswdoab9owssmdugflLakv &eieam3p=mdauperkyinivmsaaa Hbm1wwnerswhosubmgttd9sdHdzvi iadiCsfigg&a_yile3m'alfvra&MCI&IlhimcamidecontmctM—stsnbtmitanewsffidadtmdirgdansack. fCa os S�zt ehec3c13 z b=must�bea sn additiamal shed sbowlhglhen—of lme sub-c •rssnd s6Revrhe m arnat$ease emntiuhwe emp9oyee�.7fthesnb caatractaeshave emPiaSers,tfie}'mustpmr�de rhos urodo�'romp•Pali a>mabrs I uirt era s1r�p r fltat isprauiriri 8�ar&ors'catrgsertsra�'vrt ' irartca j'er m}*cmpia3�e ZeNv is fiiepv rye and jah site inforrna6m ,r•3 It�ce Company NL MMLe: a� `('S� c Poficy 41 or Self-izrs.I.ic_ f •`61 G 6 Q EspiratioaD. l� Job Rte-Address` City/Stawz�p: Affach a.ropy of the workers°compensationpoRcydeclaration page(showing the poficy,number aid expiration date). Fai nre to secure coverage as requiredunde:r Section 25A of MGL m 152 can lead fo the imposition of criminal penalties of a fine up to$1,5010D anNor one-year'1M.pmonmeigg as well as civil penalties in the farm of a STOP WORK ORDERznd s free of up to$2f0 G0 a dap against the vio . 13e adcdsed drat a copy of this statement.nsay be f xwarded to the Office of Investigations ofIhe DFA for Be yrerifrcation.. Ftfo kerRby csr u er$rs arrd�pattaItirs a. grr�ircr�? att7as ificfar+s�cr#imtpe atuFed abotrs is[rus acid rect Sienatare Date- t7,fc[id use . Dv not tvrrtg in fft ax€�eft be campfetad by city artntr�li n ut City or Town: Permif Icense� issuingAuth-ar€ty(dn:k one).: L Sward of He2ftfi r.Building Ilepaar(ment 3.City1 o n Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: -- - 6 Information and last cols jass��Gebeaal Laws ffiVb=M requires.all employ='tD PEE ,"pensation for idieir employees_ Parsaantto this ,an MMF&Y a is defined as".�ypeasonin the service of anoih�ceder any contract oflilre, empr=or implfec ,oral or wry." Air ers�Ioyer is d fined as"an.mdiyidnal,PMtnerslP,association,corparation or of =IegaI�iiY,Ora two or m= of ii=f rgoiag a Joint=tMTd a,andincbrdmg ilia 1egal=esenfa&W of a deceased emPIoyer,or file receiver or twteer of an inchvid�pa tamsbip,associaionn or otherle girl entity,employing employees. However the awnear of a dvMUigg h=o having not mar e;taM tiztee a=finents and o resides fi�rnm,ar file oc of f3�e- dwzHing house of anothea who employs persrms to do ,canshmcd=or repair work on such dw(--IIing house or on.the grounds or building qp L tfaereto shag notbecanse of snch employmed be deemed to be an employee'° MGL cd3apter 152,§25g6)also sister that¢every stf or local Rceasnag agency shall witFihold ffie isshaancg ar r mawral of a ficerzsa or permit to operate a baseness or to constract binZdings is the co—DtEwealth for any aPPjrcantw•Tio has notprodnced acceptable evidence of compu=M•tun t1M man=coverage regairedf AdrlitionaEy, MCA cb�piPa ISZ,§25C,(7)states-NDitbcr the commcnw'�i nor any of its political subdivisions shza emter ink any corstrad forthe perfmmanoe ofpnbho woikuaff acceptable evidence of eampli2_n=v1hh the:mscn�ce. requ enfs of riots chaps have Been preserott-d to file mnir�anfb oulyf Please flu 1.oil the workeas'compeasaiifln affidavit completely,by dieing e boxes t�aPPl9 fo your situation and,if n=msary,apply snb-oantr� s)nEme(s). addzess(es)andphonemm�bea(s)aIongwrth s)of iLLC)oLmitndLiablmsa ace. LanfedLrBbOy Companies y s(LIP)'withno exapinyees ofhea than the members or partaeas,ale not rbqui and to cagy wozio&cQarpensaiion iBsmance. If an LT.0 or LLP does have employees,apolicy isrequ>Led. Be adyisedtbAthis a$daykmaybe snhmir�d to the Department of rndns dd Accidents for confrm�ou of ins ce covey age Also be sure to sigh and dafe ire afdavit. The affidavit should boTeet zai-,d to_fie city or town that the appfica m fur the permit or license is being m taested,not the D.pparfineaf of Tn±pefi-ia1_A=d=:fs, gwuIdyOn have any quest ans regazag fhe law or ifyou air regnsed to obtain awo11cers' compensation porrey,please call the Department at the number listed.below= pelf-rosin ed cninpantes sh ovld=t1-r their self-i surz ce liceose n=nber on fhe appropriaio Ime. City ar Town offErsals . r Please be sarm that the afadavif is complete andpzio�IegIly. The Deparimeethas provided a space at the bottom. of thr,affidavit for you to fill out in the event the Office oflnvmf19ations has to comtctyonregardmg the applicant. Please be sure to fill in the pe xn4WHc;=se mnaber which wr3M be used as a reface rammber. In addition,an applicant chat must submit multiple pemrWHcense appHta ons m any gi=yca ,need only submit one affidavit m&catmg==t p olicy inf0=,-day.Cif necessary)and under"lob SiL-Qd&ess"the applicant should write"aU locations in (may or town).-A copy of tho affidavittizaf has beCa officially stamped or marked by the chy or town may be provided to me " applicant as groofthat a valid affidavit is on file for 5 fe pe�ifs or licenses. A noPT afdavitmust be filled oil each year. W here a home owner or ci i=is obtaffi3mg a license or pezmit not iaate&:D any business or commercial 4ent3E - Cie.adogji=maorDmmitt3b nIcaTm efo said person isX0Tregcimdlo eomple#et3risaffidavit The Office ofavcSdgeficM wouUhlmtothankyouin.advance for your cooperafimaad slouldyoubane any quesfiam. . please do nothes>fatr to give=a c�M The Depar =f9 address,inlephone and faxnrrmber. . Tha CaMMMWMM of Massac h , R. 0411 Ta 4 61 I- -4 =t4-06 ar 1477 MA&iAFF, Fax#617 727 7M xmvised4-24-07 ,tea Z�d�d Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards j: Construct izrt S ypervisor CS-111305 x 'm E' ires:: 06/0112021 ANDRE YARl1AALOVICNf Aff 204.CINDER ER ELLO TRACE.: MARSTONS MILLS MA V,!."8, Commissioner t ------__._._ • r`/�c:�Kf1itJ�7•fYla/C �(y/�'�!LllxliQt�flu`F�.CS � Office_of Consumer Affairs&Busrdess ltegalahon:. HOME IMPROVEME T CONTRACTOR Registrations 172476 TXPe. Expraf�on 7[3120a8, DBA BEL I NDS HOMEti�A4PtEAENT ANDRE:I YARMALOtilt{ . 204 CINDERELLA TER MARSTONS MILLS MA U2648` Uadersecre't$ry .. . WORKERS COMPENSAc11ON AND EMKOYEM UABI ITY ItVSUR `lIG' t t uc L rty Mutual. 10 . INSURAN'.CE 'AR INFfRIUTAlTION PAIL . issued by LK INSURANCE CORPORA TION.. 27243 Pok-i Number WC.5-31S-615667-018 Issuing Office 01.6C: RENKWAL Ot: WC5-318-615667--017 Issue Dalo 01.-11-18 Account.Nur r 1-615667 Sub Account 0000' 1. InswW and Wiling A€fd es BELISL.4NDs 1110ME" I PRGVE(41ENT.LLC" RISK ID 000024627 (4 C(NDEJULL,A TERRACF Stratus. 46 lMI TED LIABILITY CO Other vrnrk*60 natshiown alov+e. SEE ITEM.4, PMtull UM,'EXTENS[ON OF INFOANWI*10 4 PAGE 2. Poliq Period-The Wicy period is.from 02-11-2018 to 02-11-2019 12;01 A,K standard time a-t the In.swe 1'S m iliho a41dress.: I Coverage A. Workfws Compensation 4nsurarrcc:Pert ©rie of fFae�lie'��o�rlies to the Mrkers Ce ri r�;a9 pn leer of the states lied bore: 0. Employers LiaNifty Ins toance: Fit Two,-of the policy appl'JOS to work in each,state fisleif in Item O.A. The firsts 0+our liebi! y_under Part Two We..,. Godly In.-Jury by Ace dent $ 500,000 each accident 8odify Injury by Disease $ 500,000 pubcy Ifrnit Bodily Irsjrary by Disease $ 500 r 000 each employee C.. tither Stag lrsumoe:Part Threes of the pl y applies to tl:e states.if any, listed here: 0, This policy, indudes these end-orsernents and schedoWs_ SEE EXTENSION OF INPORN 4TION PAGE 4. Premium, The prernium for this policy will be determined by our 1&nua;ls of Rulin,Classifications,fetes and Feting Plans. All Informaton requ-ired.belrji4tis-subjea to verification and Mange by audit, Code Premium Bw15 Totat tote per 100 i�stHr reed Annual Classifications Number . €stianated Annual P,-nuneration of€emullefation Premium. Sae Ex".enslo,n of Info rmation Pam MnimumP'romiurn $ 500 i;1.. Total Estimated Artrual Prerruurrr$ Premium will be billed ANNUAL Producer 0004-190013 SRYDEN & SULLIVAN. INS' 8 8 rA LM0lJTR .RD HYANNIS M 02601 WPC 00 00..01 A 01S87 Natiarwt COurdi on c mperrsatb0 w M 00 06 01, 8 tCAt Ed-13 liDl M1 t AR,Rights t ervtd , r` Page.1 of 1 Town of Barnstable Bulldln 9 PostTh�stCard So°Thatit;is Uisibae,From:the Street A' 'roved'Plans Must be;Retained on Job andthis Cad Must be"Ke•t !i'1AHMtjC`A&#:E.:• p � p M'° Posted UntilFinal Inspection Has°;Been Made; „ �� � �' �, as. ` �_ �� � '' Where a Cert�ficate•of.Occu ant �s Reiredsuch:-Build�n shalhNot be Oceu �ed.untila;Finallns ect�on has beenmade Permit ..moo� . .. �_a�:�;� :� �.�p.�. y* �.q . . '�-: . ...... .g._a� .. H�, a ..? �: p� ..,.:-��• a: �... p�_ , -...�.�._ . „<>.. Permit No. B-18-1263 Applicant Name: RIBAGA,THOMAS J& MONE, DONALD P, ET TR Approvals Date Issued: 04/25/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 10/25/2018 Foundation: Location: 20 EASTWOOD LANE,COTUIT r Ma Lot: 025 036 Zoning District: RF Sheathing: Owner on Record: RIBAGA,THOMAS J&MONE, DONALD POET Contractor Name Framing: 1 Address: PO BOX 1020 �`� 3' ContractorL�cense 2 ! , COTUIT, MA 02635 �." Es# Protect Cost: $5,600.00 Chimney : Description: reside �PerJt Fee: $35.00 Insulation: Fee Paid $35.00 Project Review Req: zs 5 Date 4/25/2018 Final: Plumbing/Gas SF Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work aut15, ed by this permit is commenced within sixmonths afterassuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documeriMor which this permit has been granted. All construction,alterations and changes of use of an building and structur kshall be in with the local zo h&y.lauGs and codes. Final Gas: g Y g M This permit hall be displayedin location clearly visible from access street oraroad a d shall be maintained open for- ublic inspection for the entire duration of the s pe i s a Y P P._., p,; . work until the completion of the same. j Electrical SM • The Certificate of Occupancy will not be issued until all applicable signatures b mg y the Build and Fire Officals are pr6vid�ed3d`this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:; ° 1.Foundation or Footing �. `, Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Merhanical Installations, Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 1 1 � � i Town of Barnstable *Permit# (3 Building Department 0 e 6monthsjromissu�s . EV &AINST,mLE, « Brian Florence,CBO ' AM Building Commissioner '0ttro p�p`l�' 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us T tr 2�j 01RQ Office: 508-862-4038 O �n� ?Fdx: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONtE O D / Not Valid without Red X.Press Imprint Map/parcel Number (Q Property Address [§Residential Value of Work$ �b 5`�0®� • " Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �.-�-m.�� `��a.\���"��.•��- � T�d�.�>`��1�G��•,. ,\,•�,s�-� "v,q— . dam av ��� , r-\A o-ae35" Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ 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) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of ioof) e-st e ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: /�. �►.,�.,J ' 'R�9c�c.. \�r., -� Q:\WPFILES\FORIvIS\EXPRESS2017 Town of Barnstable pFTHE rok- Building Department ti ' Brian Florence CBO Building Commissioner MASS. 200 Main Street, Hyannis,MA 02601 AtFD 59. A www.towu.barnstable.ma.us Office: 508-862-4038 t`y Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: Please Print ' `J - . JOB LOCATION: number street village S. al�� "HOMEOWNER": �� �-a`a w�•c► q ��� �.� �V��.��Pv �. to 16� }— name home phone# work phone# CURRENT MAILING ADDRESS: �� 0 • �C�y 1��, p��, Q �o � �J ti.J city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied.dwellinas of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner"acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such , "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner ------------------------- Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. 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. Yon may care to amend and adopt such a form/certification for use in your community. r °FIHE rqy Town of.Barnstable ' Building Department BARNSTAB Brian Florence,CBO MAE& . � i639• a��� Building Commissioner AlED MA'1 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This,Section If Using A Builder 1 , 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 r Print Name Print Name Date Q:FORMS:O W NERPERMIS S IONPOOLS Rev: 10/17 fi, • Z6 Coasmomvealth ofMaswadrrrseffs Deparbwevit erf industrial Accidmar Off"of rMwNtigations 600 Washuigtoze Street Boston,AA 02H nwvnt maxLgovfdia Wmimrs' Campensaf an Insurance davit:Btdldex-dCunftucturaMec&kLan&Tlumbers A lkaut Infor aafiOII Please Print NamenCFnP rBII�Q1 �+V V''h'1d•� 1�1 Cfi�y- n , y r y��•�� fit fStatef Phone-41--, .5 0 r_,;z cz� 3 LA 25 `a-- Am you an employer?Che kthe appropriate box: T of project(r J� e4uired)= L❑ I am a employs with. 4. ❑I am a gm-eral contractor and I 6. ❑New eonstrucizoa e y-loyees(full aadfor part-time).* have hired the sub-cont:acton 2.❑ I am a sole propcietor orpartner- listed on.the attached sheetti 7. ❑Remodeling ship and have no.employees These sub-cantactam have $..❑Demolition woddag for me is any capaEity: enT l oyees and havewodoms' 9. ❑Buildingaaddition . [No fig'comp.i1•ncnxance camp.irmura re $ Q�= 5. ❑ We am a corporation and its 100Electrical repairs or a cEtioas meowner doing all work Officers have exercised their 1 L❑Plumbing repairs or additions myself[No workers'camp. right ght of I exemption have L 12.❑Roofrepairs ions ante rued.]3 § (� 13.El other employes [No wodoers' cam-insurarce required-] ;Amy apg&C=daccbedMb=rFll�nstalso5no�rtthesecuonbetaar ug ao�ctRs'c�mp�n�++�•poreyi> avL eoaraets Who sabot[Tuts af5damr inelxaling tLzy axe doing slE Wc¢�sad dui hue amsidg r.x�hvren.�mLSt submit a new affidaest indi a m sacb_ fCaatacmis Mbar checlt this bout mast attadxed as addiiiaBal sleet sboirmg the name of t�^'-�^^��'•^��d state Whether ar xwt those enRtiesha� employees.Ifthesub-can ctaeshmmnptoyees,&eymL;rpmuidetLiu wwkme camp.p6licy mmibm I um au eiliplayer drat is pranzdfng ivarkers'compensation insraranca for my emprgwm Below is the paHcy arad jab site inforezation. Insurance Company Nam: Poficy 4 or Self-ins-Iic.;� ExpirafionDate: Job Eta Addressc Citylstatdrlp: Attach a copy of the workers°compensationpolicg-declaration page(shawing the policy number and expiration date). Failure to secure eavwage as required.under Section 25A of MGL t: 1572 can lead to the imposition of criminal penalties of a fine up to$1,50D 00 andfor one-year imprism=ent as well as civil penaalties in the farm of a STUP WORK ORDER and a fine of up to$250-00 a days against the violator. Be advised that a copy of this statemm i may be forwarded to the Office of lmrestsgations of the DIAL for finance coverage verification- Ida heraby car*under t#epains and penalties gfpar,ury thatflie&fatwxa#imrprioi hW rabmv!S trua oral correct Date: Phone# Oar d arse anfj. Do trot write in d s area,to be evinpieted by city artown officirat City or Town.: PermitUcense# Issuing Authardy(m—de one): L Board of Health 2.ceding Departrumt 3.CUp Town Clerk 4.Dectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions � A M zs2cj,nce#ts G qu eucral Laws chapter 152 reires all=players to provrde workers'coulpeusatton far their employees. � i Prasto this statnfa,an employ=is defined as 6_.eveay person in the service of another under any contract off, express or implied,oral or An e npkyer is defined as"an indivi ual,pmtacrsbip,association.corporation or other legal enttfp,or any two or more of the foregoing=gaged in a joint eofeap¢ise,andincbzdmg file legal.-P1 eatatives of a daceased employer,or the receiver or trustee of an individual,paitamship,association or other legal entity,employing employees However the owner of a dwelling house having not more than.-fla ee apartments and who resides therein,or the octet ofihe - dweIImg house of anodzer who employs persons to do maintce,construction or repair work on such dwc ing house or on the gronnds or building app tT:L=tD d aIl not because of such employment be deemed to be an employer." MGL chapter 152,§25CC6)also stars that"every state or local U.=nsing agency shall withhold the issuance or renew-al of a license or permit to operate a business or to construct buildings in the commonwealth for any, applicant who has notprodnced acceptable evidence of compliance with the ksnrance.coverage required." Addition jb,MGL chapter 152,§25C(7)states-Neither the conaramweatth nor;�ny of its political subdivisions shall an into any contract for the perfvnmaace ofpnbho woik mriil acceptable evidence of compligace with the insurance._ regtm ewer of this chaptea.have been presented tot-�¢the con authozify." - Appficatcfs Please fill out the workers'compensation arTda:&completely,by cbeclang to boxes that apply to your situation and,if necessary,supply sob-contradur(s)name(s), addte$s(es)and phone numbers)along with their certificate(s)of hisuianw. Lmmited Liability Companies(LLC)or Limited Liabxfity Partnerships CLEF)wish no employees other.than the members or partaea-s,are not rcgithed to carry workers' compensation iusuran . If an LLC or LLP does have employees,"policy is rmlui red. Be advised that this affidayrtmaybe submi�d to the Department of Industrial Accidents for confirmation of insurance coverage Also be sure to sign and date-the affidavit The affidavit should be retained to the city or town that the application for the permit or license is being reque:stiA not the Depar ineut of . n ,st al Accidents.ants. Shovldyo'a have any questions regarding the law or ifyou are regrr red to obtain a workers' compensation policy,please call the Department at the number listed below. Self-iced companies should enters their self-in s**ai:w license number on the appropriate line. City or Town Officials t Please be sure that the of davit is complete and printed legibly- The Department has provided a space at the bottom of the affidavit for you tD fEa out in.the event$ce Of of Investigations has to contact you regarding the applicant- Please be sure to fill in the permii'llicrose number which will be used as a reference n=ber. In addition,an applicant lira±must submit mulfipIe peoaWHcense applications in.any givea year,need only submit one affidavit indicating cogent policy information Cifnecessary)and nndar`Job Site Address"the applicant shor write "ail locations in (city or town).'"A copy of the affidavit thiat has been.officially stamped or maimed by the city or town may be provided m the " applicant as proof that a valid affidavit is on file for fbdme'perni s or licenses A new affidavit must be filled out each year.'Whe m a home owner or citizeu is obtaining a license or permit not related to any bnsiness or commercial venture Cie. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Of of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesh to to give us a call- The Department's addre 4 telephone and fax number. - Degac mmt c6f1a Accide�i =Ce of lnvestkialio= ' �R4 �nlet ; os an,MA 0�111 Tf,-L 4 617-727-4900 CXt 406 or 1-977 MA29AFF, Fax#617 727 7749 Revised 4-24-07 .Maz-gavidia- -' Town of Barnstable- Post ThiCa::;rrdFx Soa Tx"hs;az,t rt :s< Visib Building eReta J bptle Fro st m andss MASIL Posted Until Final Inspection Ha"s Beeri Nlatle "' � p s t en ° Where a Certificate of0ccupancyX�s Repuired,"such Building shall,Not be Occupied,'until a Final Inspection has been made 1 er L _ Permit No. B-18-3595 Applicant Name: William McCluskey Approvals Date Issued: 10/31/2018 Current Use: Structure Permit Type: Building- Insulation- Residential Expiration Date: 04/30/2019 Foundation: Location: 20 EASTWOOD LANE,COTUIT- Map/Lot: 025-036 Zoning District: RF Sheathing: Owner on Record: Cameron Dennis Contractor'Name`. WILLIAM J MCCLUSKEY Framing: 1 Address: 20 Eastwood Lane Contractor License: 'CSSL-102776 2 COTUIT, MA 02635 Est. Project Cost: $3,500.00 Chimney: Description: Add 450 sq ft of R-38 fiberglass to the attic.Add 90 sq ft of'R-10 Permit:Fee: $85.00 rigid insulation,and 590 sq ft of R-30 fiberglass to the crawlspace. Insulation: Air seal the attic plane and basement with exparnding•foari. General Fee Paid:' $85.00 weatherization. :Date: 10/31/2018 Final: Project Review Req: , Plumbing/Gas „L %L Rough Plumbing: g Building Official Final Plumbing: Rough Gas: Final Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and th6'apprcved construction documents for which-this permit has been granted. Electrical All construction,alterations and changes of use of any building and structures shall be in"compliance with the'local zoning by-lav✓s;and codes. This permit shall be displayed in a location clearly visible from access street o_r road and shall be maintained open for public inspection for the entire duration of the Service: work until the completion of the same. Rough: 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: Final: 1.Foundation or Footing 2.Sheathing Inspection Low Voltage Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Health 6.Insulation 7.Final Inspection before Occupancy Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Fire Department Work shall not proceed until the Inspector has approved the various stages of construction. pN--TkJ Final- "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). I Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 11/9/18 0 Brian Florence CBO Town of Barnstable c v Building Division a 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 18-3595 _ Dear Mr. Florence: This affidavit is to certify that all work completed for 20 Eastwood Lane,3Cotuit has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. . Sincerely, William McCluskey _ `