Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0671 OLD POST ROAD
a � � _ _ ._ ... . i OF1HE tp� Town of Barnstable �E�oPA,f Np do Planning & Development Department Barnstable Historical Commission * BARNSTABLE, * 200 Main Street, Hyannis, Massachusetts 02601 MASS. 9cb 1639. (508)862-4787 Fax(508)862-4784 ro ���� 'OrED Mp'i% erin.loran@town.barnstable.ma.us ``"os.BAMc'`P BUILDING DEPT. Commission Members Nancy Clark,Chair Nancy Shoemaker,Vice Chair Marilyn Fifield,Clerk NOV 0 5 2020 George Jessop,AIA Cheryl Powell Frances Parks Jack Kay,Alternate TOWN OF BARNSTABLE DECISION B—ARNCTA °���N d— E�fe 9]k yy'.i e E'L TOWN�3 =LIER35 " Summary: Demolition Delay Not Imposed Pursuant to Chapter 112 Historic Properties, Section 112-3 F Applicant/Property Owner: Reilly,Jennifer Subject Property: 671 Old Post Road,Cotuit Assessor's Map/Parcel: 054/001/000 Hearing Date: October 20,2020 Pursuant to the Barnstable Historical Commission receiving your notice of intent on September 24, 2020, a duly advertised and noticed public hearing was held on October 20,2020 to determine whether the significant structure identified as a single family home on this property is a preferably preserved significant building and whether demolition delay would be imposed for the partial demolition of the structure on the parcel addressed as 671 Old Post Road,Cotuit. After review and consideration of public testimony, application and record file, the Commission by a vote of six in favor (Clark, Shoemaker, Fifield, Jessop, Parks, Kay) and one abstention (.Powell), found that in accordance with Chapter 112F the partial demolition of the single family structure is not a preferably preserved significant building. In accordance with Chapter 112-3 F, the Commission determined, by a vote of six in favor (Clark, Shoemaker, Fifield, Jessop, Powell, Kay) and one opposed (Parks), that the partial demolition of the single family structure would not be detrimental to the historical,cultural or architectural heritage or resources of the Town. This decision applies only to the demolition described in the notice of intent submitted on September 24, 2020. No future demolition shall be permitted without application and approval from the Barnstable Historical Commission. Members present and voting on this application were: Chair, Nancy Clark; Vice Chair, Nancy Shoemaker; Clerk, Marilyn Fifield;George Jessop, Fran Parks,Cheryl Powell,Jack Kay Nancy Shoemaker, e C air Date cc: Brian Florence,Building Commissioner Ann Quirk,Town Clerk r - ZM Town of Barnstable W� ��E�pDJgf O Nr0 Planning& Development Department M" Barnstable Historical Commission z� 3 * 11AJMsrn>BM 200 Main Street,Hyannis,Massachusetts 02601 s639. ,� (508)862-4787 Fax(508)862-4784 a t Fp .IA erin.logan@town.barnstable.ma.us OF BA Commission Members Nancy Clark,Chair Nancy Shoemaker,Vice Chair Marilyn Fifield,Clerk George Jessop,AIA Cheryl Powell Frances Parks Jack Kay,Alternate October 2, 2020 BUILDING DEPT. Re: Notice of Intent to Demolish Structure & Relocate 671 Old Post Road, Cotuit, Map 054, Parcel 001/000 OCT 0 9 2020 Grover Custom Building TOWN OF BARNSTABLE c/o Carey Grover PO Box 1080 Cotuit, MA 02635 Ann Quirk,Town Clerk 367 Main Street, Hyannis, MA 02601 Brian Florence, Building Commissioner 200 Main Street, Hyannis, MA 02601 Pursuant to the attached decision, please be advised that the Barnstable Historical Commission will hold a public hearing on the partial demolition of the single family structure on October 20, 2020 at 4:00pm. This meeting will be held remote via Zoom Meeting and can be accessed at https://zoom.us/i/93511132267 or by calling the toll-free number 888-475- 4499, meeting I.D. 93511132267. This public hearing will be advertised, notices sent to abutters and a notice form will be posted on the building or other visible site on the property. Please contact Erin Logan at 508.862.4787 or erin.logan@town.barnstabie.ma.us for processing information. Sincerely, Nancy Shoemaker, Vice Chair Planning&Development Department-Elizabeth Jenkins,Director zcn LO O�'THE t Town of Barnstable X)0 ��F�oPMFHl �1• Planning & Development Departmentrn Barnstable Historical Commission * _ �BARNSTABLE,g 200 Main Street, Hyannis, Massachusetts 02601 3 y 1639. (508)862-4787 Fax(508)862-4784 Z CJ� 'o Ae�` '°rEp Mp'l A erin.logan@town.barnstable.ma.us "OF Wlk""P IR1 Commission Members Nancy Clark,Chair Nancy Shoemaker,Vice Chair Marilyn Fifield,Clerk George Jessop,AIA Cheryl Powell Frances Parks Jack Kay,Alternate Chapter 112 Historic Properties, Section 112-3 D. DETERMINATION of SIGNIFICANT BUILDING 671 Old Post Road, Cotuit, Map 054, Parcel 001/000 Pursuant to Intent to Demolish Structure The property located at 671 Old Post Road, Cotuit, is associated with the broad architectural and cultural history of this area. In accordance with Chapters 112-2 and 112-3 (D), the Barnstable Historical Commission Chair has determined that this structure is a significant building. This determination applies only to the demolition described in the notice of intent submitted on September 24, 2020. Any future demolition shall require a new determination from the Barnstable Historical Commission. Assessor's office(1st Floor): NN Assessor's map and lot number d ,J x, o i. : ®o 1 A Conservation(4th Floor): Board of Health(3rd floor): " • Sewage Permit number = DA;Iinie Engineering Department(3rd floor): House number ) Definitive Plan Approved by Planning Board ! 19 APPLICATIONS PROCESSED,8:30-9:30 A.M.and 1:00-2:00 P.M.only , TOWN OF 'BARNSTABLE ~: BUILDING INSFECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION z 7 19 13 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a p rmit according to the followi information: Location 77 Proposed Use Zoning District Fire District I ��V g Name of Owner ��U �� ; i�tn11 C r�l t�lAddress mot/r 1 eL(I f® ri ,/��, l i��/�, Name of Builder riC I/ i� � 0 Address u e �i 84 x �g � f. ^/7l, �� Q���L Name of Architect Address Number of Rooms #2 Foundation Exterior Roofing ` rG e -R00f CPGI a U 5!1y/ ? / TL�. Floors k Interior Heating Plumbing Fireplace Approximate Cost ,5-0 Area / V o Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REOUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name a Construction Siipervisor's License 0602 / • tiJ KAUFMAN, SUMNER & CAROL No 36197 Permit'For Re-SHINGLE Single Family dwelling Location 671 Old Post Road Cotuit Owner Sumner & Carol Kaufman _ 9 . Type of Construction Frame Plot Lot Permit Granted Sept. 27 , 19 93 Date of Inspection: _ Frame Insulation 19 Fireplace 19 Date Completed `�� 19 i v 'r F .j ' 1 f i a COMMONWEALTH OF MASSACHUSETTS —E� =AIUMFNT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET BOSTON, MASSACHUSETTS 02111 fames Car=ei. �e-m ss»ne WORKERS' COMPENSATION INSURANCE AFFIDAVIT I,. (c (licensee/permirtcc) _ with a principal place of business/residence at: 0 'J"ter e.CA7 (City/State/Zip) do hereby certify, under the pains and penalties of perjury, that: [ ) I am an employer providing the following workers' compensation coverage for my employees working on this job. Insurance Company Policy Number am a sole and have'no one working for me. proprietor . ( J I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors 11stc6'bcI6w who have the following workers' compensation insurance policies: �U Ic f Contractor Insurance Com any/Polie)r Number Name o Co ct P Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number 0 l am a homeowner performing all the work myself NOTE: Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more tbam three units in whieb the homeowner also resides or on the grounds appurtenant tbereto are not gcnerally-•. W m cnsation Act GL C. 152,sect. 1(5)), application by a borucowocr for a license considered to be employers under ibc Workers'Co p ( PP or Workers' Com nsation Act. omit may evidence the legal gurus of w employer under the rk Pe P g I understand that a copy of this statement wiU be forwardcd to the Department of Industrial Accidents'OfFiee of lnsurancc for"trvcratc verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of_rriminal penalties consisting of a fine of up to S1500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of S100.00Zd2ainst m Signed this day of 27 Licen see/Perm ittec Licensor/Pcrmittor w t ;/die loan+�no�u�reaui o�../ «lt HOME IMPROVEMENT CONTRACTOR Registration 114047 Type - DBA Ex nation 07/29/95 P I ERIC V LUBRANO CONTR ERIC V. LUBRANO 3 LODENGREE OR ADMINISTRATOR E FALMOUTH MA 02536 M ' . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map lJ S--_-q_ Parcel I Application 0 Health Division Date Issued Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 6 7/ ol+`.0 po_9f Village Coo "iU l f Owner Sc1,0444 C �(�-v (\a-u 4-1--0- V1 Address Telephone !�C 7 - `t 4t M l \ Permit Request e 0-c.-e Pd#ed sillogi# Eoa- ,w e�ti E��) `fK6 60�� 1 q .. A / roS�® Su�SI fizn� �'1 a /'1ei� lacei44,) Gvi�.y �pYFr�suve "fUcu tc'r�f � 6 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. , Dwelling Type: Single Family lQ- wo Family ❑ Multi-Family (# units) Age of Existing Structure `�aZ �' Historic House: ❑Yes Ckt�On Old King's Highway: ❑Yes 044e-- Basement Type: 2PF65' 11crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new a �' Total Room Count (not including baths): existing new First Floor Room Count ` Heat Type and Fuel: ❑ Gas / �• .yp �-�I ❑ Electric ❑ Other Central Air: ❑Yes W416_' Fireplaces: Existing New Existing wood/co'l stove: -.0 YegO No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new side_ F - Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use p -APPLICANT INFORMATION- (BUILDER OR HOMEOWNER) Name Erry e y 1 K&( VT0 Telephone Number ��� �r 5 S Address $S iglu-e &5 / (e Or License# C5 r0L, / 1 0 Z H `l `1 Home Improvement Contractor# 1 1 �0 '4-/7 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i SIGNATURE ` - DATE o?j Za lI d /ri y FOR OFFICIAL USE ONLY = 's t APPLICATION# DATEISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER _ t DATE OF INSPECTION: FOUNDATION r FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t = ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations r 600 Washington Street >r Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): k�Pyc V Lg,bq 1 Address: Rs". (��u.e. C4L..5 Or City/State/Zip: M� °ee A& 02 6 q Phone Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer.with 4. ❑ I am a general contractor and I em oyees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.L44f am a sole proprietor or partner- Misted on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No.workers' comp. insurance comp. insurance.t 9. [] Building addition required.] 5. ❑ We are a corporation and its 1.0.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §.1(4), and we have no employees. [No workers 13.0110ther_k/'e `I/� comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy.of the workers' compensation policy declaration page.(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the,violator.. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage yerif cation. I aln hereby certify under the pains a, d penalties of perjury that'llze information provided above i. tr Signature: Date: ue and correct. 3 Z/ Z�f ' Phone#: g6 Official use only. Do not write in this area, to be completed by'city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter. 152 requires all employers to provide_workers' compensation for their employees, Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, constriction 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 perfonnance 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 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 pen-nit/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,ete.)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 in.ot hesitate to give us a call. The Department's address, telephone and fax number: s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel-,4,617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia i a* • BARNSTA6LE, i MASS. s639• Town of Barnstable �0 Aj fp�,t A Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us i Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder Imp e(r l\aL1,�-1� as Owner of the subject property i hereby authorize Eyj.C- LU ram. Q to act on my behalf, in all matters relative to work authorized by this building permit application for: 671 014 (Po5fi R tu;fi (Address of Job) Signature of 46wner at i 54 m/red hQu-CAfPf-,VL1 Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 t - t Town of Barnstable Regulatory Services sARNSTABLE Thomas F. Geiler,Director v ntnsQ � .o,q. A,� 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 Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name. home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow hoineowners.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 lie/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 witlr 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. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt f �\ Office of Corsumet Affairs 3c Business Re�iu:iteuu_ .F t ie�nSe o r� tstrat►On.vah]foIhg nldwldul uSE only. :. 5 c ' HOME IMPROVEMENT CONTRACTOR'" 'hcfore the expr'ktion.date;;•If found return to: I" t Office of Consumer.Affairs and Business Regulation 6gistratiofi e114047 i' ` j 1O,Park Plaza Suite 5170 Expiration 7/29/2011 Tr# 2869a6 <;Boston-:MA 0,2116 ERIC V.LUBRANO BLDG &REMOD ERIC LUBRANO � J i J 85 BLUE ���� �� Not valid i` MASHPEE, MA 02649�, ;j Undersecrefar} � without signature INi.issachttsetts - Dcpar•trntnt of Public Safch Board of Builtlin!r Re--ulations ;Ind.Standards Construction Supervisor License `License: CS 60214 , ERIC V LUBRANO 85 BLUECASTLE DR MASPHEE, MA 02649 5 COMM Expiration: 4/29/2013 isioniw• Tr#: 12631 C�)(D 00 z69 r 0V1FtFTpk Town of Barnstable *pe ;t# E6 tissuedae Regulatory Services _ + BARNSTABLE, ' 9� MASS, Thomas F. Geiler,Director plEb MAv a Building Division A Bes� � �s PERNT Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 jQ, ! www.town.barnstab le.ma.us _ Office: 508-862-4038 TOWN (j,ax8`�48���s ', �E EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Yalid without Red X-Press Imprint Map/parcel Number c>JL( — 1 :� Property Address / �6 TU F7L. esidential Value of Work Minimum fee of S35.00 for work under$6000.00 Owner's Name &Address J(1 y►! G �E'Gji /_' �G�GI TG'�1��G`� Contractor's Name 4'r,C. J s C, K G�G�Gc�� Gt Telephone Number Home Improvement Contractor License#(ifapplicable) J.I q0c/ 7 Construction Supervisor's License#(if applicable) 6 69— ❑Workman's Compensation Insurance Che one: [rll am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's.Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request (check box) ❑ Re-roof(stripping old shingles)'All construction debris will be taken to ' ❑ Re-roof(not stripping. Going over existing layers of roof) r Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc." ***Note.' Property Owner must sign Property Owner Letter,of Permission. A:copy of the Home.Improvement Contractors License & Construction Supervisors License is r ulred. SIGNATURE " Z_ Z_��—_ ;. Massachusetts-.Department of Public Safety. 'Board it Building Regmiations and^Standards Construction SupervisorL:icense License: CS 60214 ' Restricted to: 00 ERIC V LUBRANO PO B.QX 185 E FALMOUTH, MA 02536" Expiration: 4/29/2011 ('ummissioner' Tr# 14112 GT/ze �dm�u�ue a��2aaaa� �yr� r Office of CO r-sumer Affairs&$nsiness Re,u;atfui HOME IMPROVEMENT CONT 1 L -se o ,rcgt�iration vaL�for�►tfo"dtitdul usE only �t RACTOR #�efore theexp ,ktion date,:. IF. . I?egistraUo.- �114047 I Ofi;ce of tivn .Affairsand Bus_return r ss Reo: ! Expiratio_n .-7/29/2011 i lQ;ParkPlaza- Tr# 286946. h Suite 5170 g .. rob TYPe 767A, If: 1 k Bosten,'MA 0,2116 ERIC V. LUB ) 1— ' RAN©-BLD.G�&REMOD. �` ERIC LUBRANO ,FYi:} {� .85 BLUE CASTLE DR /.:' MASHPEE,'MA 0 ( 2649. �✓ ,/ _C ? ~ -- Undersecretary Not valid without signatur a 7. ry The Commonwealth of Massachusetts , Department of Industrial Accidents -Office of Investigations 1�t� / 600 Washington Street tl;r� ; Boston, M4 02111 t , www.mass.gov/daa Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers- Applicant Information Please Print LejZibly Name (Business/Organization/Individual): �1f i(C (�/ L1hrat4 C1 '1 Address: g5 &U e ( _ 5 'he 0t/ City/State/Zip:&,�, -e. i �" (216 el Phone C16162— 5_96 Are you an employer?Check the appropriate box: Type"of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I . 6.. ❑New construction ,pfnployces(full and/or part-time).* have hued the sub-contractors 2.VI am a sole proprietor or partner- ' -listed on the attached sheet. $ ?. ❑Remodeling . ship and have no employees 'These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp, insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10 ❑E"lectrical repairs or additions 3.❑.I am a homeowner doing all work right of exemption per MGL I LEJ Plumbing repairs or additions myself[No workers' comp. c.152, §](4), and we have no 12.❑.Roof repairs insurance required.] t employees. [No workers' comp. insurance required.) 13. her �' - 5/fit' *Any applicant that checks box#I 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 their workers'comp."policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is th.e policy and job site information.. Insurance Company Name: Policy#or Self-ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page (showing the policy number and expiration date). Failure to 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 certif under the pains and penalties ofperjury that the"information provided above is true and correct. Signatur . _.- _ Dater' v , Phone#: Official use only.* Do not write in this area, to be conipleted 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 t;.Other r • I Information and. Instructions Massach use tts'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 line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition., an applicant that must submit multiple permit/license applications in any given year,.need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the, applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts . Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 RavicPrt S_7Fi_nS THPrpti Town of Barnstable Regulatory Services six &q. a A Thomas F. Geiler,Director 'Pcb 16 9. Building Division Tom Perry,'Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstabIC.Ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section" If Using .A Builder j� J a,rn 0 r-r as Owner of the subject pro e P rty, hereby authorize 1ya—+ to act on my behalf, m all matters relative to work autliot zed;by this building permit application for (Address of Job) Signature a Owner Date Print Name If Propea Owner is applying for pen-Tiit please complete. the Homeowners.License Exemption Form on'the reverse side. Town of Barnstable �Of ray Regulatory Services Thomas F. Geiler,Director ems_ 163p. ,�� Building Division PrfD '�a Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 II-Wv.to-A•n.b arnstab le.rna.us Offi6e: 508-862-4039 Fax: 508-790-6230 HOAR OWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: _ number street village "HOMEOWNER": name home phone# work phone# CURRENT 1,rMAJLING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HONIEOWNTR 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.constrycts 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 Budding Official, that hdshe 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 be/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.homcowner 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 wofk, that such Homeowner shall act as supervisor." Many homeowners who use this exemption arc unaware that they arc assuming the responsibilities of a supervisor(see Appendix Q Rules&Regblations for Licensing Construction Supervisors,Section 2.15) This lack of awareness bftcn results in serious problems,particularly when the homeowner hires unlicensed persons. In this case;our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The horncowncr acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her fesponnbilitics,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 fonn/certification for use in your community, MAR.18.2003 11:55AM KAUFMAN & CO NO.769 P.QQ2 , -03 Town of Barnstable *Penmit# F.ipire:6 mOnrhr fMw issae ante BARMARIUM _ Regulatory Services Pee 00 MAU y f 163 + Thomas F.C eviler,Director Building Division Tom Perry, Building CommWorter &qR 200 Main Street, Hyannit,MA 02601 70LI1 , � 8200 Fax: 508 790-623038 ,V®FegR EVPRES,S PERMIT APPLICATIQN - RESIDENTIAL ONLY �B Not Valid wMeut Red X-Pies-Imprint Map/parcel Number C.J� l 0 r Property Address b 0 fd P� `F Rl�, �r �— �esideatial Value of Work Owner's Name&Address 5cf#( err 4A d C ry / �21 Pr lei c c 57- Contractor's Name +--J'i�. V t,�( Cp D Telephone Namber _"539—(:3 3 y Hoet►e Improvement Contractor License#(if applicable)_ I Q q 7 Construction Sap"or's License#(if applicable} C5 t�60 l y 1 Oworkman's Compensation Insurance Check one: [] I am a sole proprietor ` W'I`hmz%va�WI0I,=Tmpensation Insurance Insurance Company Nam ur B'Q.vl 4 _M4C,00IIA/Gt ZV 5, C0 Worlman's Comp.Policy f V w coo A a 7 3 a! oo Pannit Regueat(check box) �7 �of(stripptng old shingles) All construction debris will betaken to In rn e- 0q of [)Re400f(not stripping amg over existing layers of roof) ❑ Re-side © Replacement Windows. V Values,_,(maximum.") ❑ Other(specify) rWhera required: Inumcc of Ws permit does not exempt compliance with otber town deputmeat m Watieos,i.e,Waludc,Coneecva&d.eon. ***Note: Property Owner must sign PropeM Owner IAtter of Pormission., Signature Q:Fons>s:espmtrg 1Ze�i8ed121901 MAR.1842003 +11:55AM KAUFMAN & CO N0.769 P.3 i Town of Barnstable Regulatory Services YAM Thomas F.Geiler,Director ►�g Building Division Tom Perry, HuildingCommissioner 200 Main Street, Hyannis,MA 02601 Office: 509-8624038 - Fax: 508-790-6230 Property Owner Must Complete and Sign This-Section If Using A Builder I, SO�IN�� .�UF�NN ,as Owner of the subject property hereby authorize Lye I/ g�aAed(0-0 to act on my behalf, in all matters relative to wtis authorized bytWs bug&*permit app' anon for(address of job) � Q tore of Owne Date Print NV �/���� . ............ BOARD OF BUILDING REOULATIQNS . License CONSTRUCTIM, ERV•IS.6R Number,C`5, 06U214 i e ? I Tr.no: 9251 R E�cpirad 04129I003 `r r Resttiieted 70 'z00 •/ ERIC V LUBRAN© PO BOX 185 Administrdtor I E FALMOUTH, MA 02536 lards wilding Regulations and Stan Uoard of B CONTRACTOR Me IM1R EMEN7, Rego ort:1� ,. MIT 912003 r f�+VS - r RANI ERIC V.LBRAN 85 BLUE CASTLE DR Administrator MA 02649 Iv1ASHPEE, ,. . i { TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION rar / Wisp �A—Parcel � UU/ Permit# S,V Health Division 5710 Date Issued 3— IS —O3 Conservation Division , A D No C.II N�� ����� Application Fee pp .� Tax�Collector. " Permit Fee U_A3 - G Treasurer /®) Planning Dept. F Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village Owner go eU a6! A0A0W Address � c�e S0.2 41415- Telephone C17 =2 s Permit Re uest c e m ' _ e % 1� � G�J r a* ha-s teitLed a-4 6,(11&5 &Ce P-e ji),t Square feet:1 st floor: existing proposed 2nd floor: existing proposed= Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0 D 0, '9 0 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family • Two Family ❑ Multi-Family(#units) Age of Existing Structure 639 E�Vf-_5 Historic House: ❑Yes 2illo =.On 0ld King's Highway: ❑Yes 3N5__ Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: . Zo it ❑Electric ❑Other Central Air: ❑Yes Fireplaces: Existing 2 New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑exis' ❑new size Pool: ❑existing El new size Barn:❑existing ❑new size Attached garage: existing ❑new size Shed:0 existing ❑new size . Other: t. Zoning Board of Appeals Arhion '❑ Appeal# Recorded❑'Commercial ❑Yes yes,site plan review# Current Use Proposed Use BUILDER INFORMATION f Name ErJc l! �����d10 Telephone Number . �- q �l 3 7 ` -��- Address �Q e t� 1-2d' License# C_S t O"G'O 2 ! .. 2 Home Improvement Contractor# .� 7 . = Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 3 4 �� FOR OFFICIAL USE ONLY " PERMIT NO. s . DATE ISSUED R MAP/PARCEL`NO. `• r ADDRESS VILLAGE- OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION . 1 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING f DATE CLOSED OUT ASSOCIATION PLAN NO. k _— Commonwealth of Massachusetts Department of Industrial Accidents Office 0//nyesil92tioos 600,Washington Street Boston,Mass. 02111 Workers' Compensation.Insurance Affidavit a ...� ea !� I` — --- name Fri location �s V 1 t'� e ��� ram' ci s hone# y [) I am a homeowner p rforming all work myself. I am a ole proprietor and have no one working in any capacity rrram an employer providing workers' compensation for my employees working on this job ef_✓isy. r s- 3"i.�xw;>t,• "' r r Y r41 4 s'yt'�.. y ��SO VY- 'r� S9rz=ut.C. $r3- �rY•.S �.. rN Cr... t 7 Comn name k� 5a r t. r y +x nvv T sY w 'r"�P`a`Q at-w,t.,t_.5. Fr-r r{( tie +^✓.3,"t•,,, r r {I i °'t '4.,y,p x'v r rl r.� M t r, iix, ,,,hhh -6 L+'tr—`J. .. 4' c - t t �'.rl�y,� i4••,.q K r 4>y.yid ..a'i { ice,t`yS�F'� �' M�ii -^n. .�`S'x.a„.a"i•'�'-.�-g-na�� iddress tr ti a � 7e�b�af ,v j'ra�'� ^9t, t `t•.,r. t fxrt a 5r,74 .7 t'.e`�' t' v& r x r' ,1 xSr O s .R C1 rr � r o' + •�i .-w.+ � 'z3d,+Uv .};+'• x ,� x+ s £. �r 4� �K� v s r i 4'S� J � 3�'°;'�,r ..- Y � -+.� E.rrcti :.L,`-ra `✓ �i'r!+ '- r .� a � " ry7 i � �r s5m .y t +�" 4 •InSUranCe�CO. i-;,r � _..a* ..., . ..._ ,. .>. --. .... _... .:. . ..> ..�.. � ._,... [] I am a sole proprietor, eneral contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices y ' r"i c -•-"�'t ..c'c+t tt i < I`�'",a+-ram�' `".�„„- �^� ''•r..Q-s•�°y 'L t 3''tty f- >-'x- 1.V3 x:�� ,r r Fgy �,� terra r ,� tt1 F K r ri �s com aft d&me x z y b 4 f 1 i y3°+'S+- v r r' i.Sl r f.'� t� ,l�'•.Td Ea' 47r �-�-'��a1'� i�?}.s'` +�t}' • M n, i .'.'�..'11 it$•'l:•'„}. `�''r� � ..Yr� �' v- 'l' •7'd t _F 'J' r -t r X 4 f.x -. k I d"1.'�'�zw.}+�'4"''`gs*+Y+'fw .n i,: . . c y °fyy'�t:•r✓a,{(iR j5r'"w r< _try. -si4�,u� , Z F{ tF }y. 1 f aft}FCSS�C a.au 1k Yrs4 7k l J c x >x ;fy; tiii t ?;J'a v s .yf; �§ r4 n"�C, i.. {ir. c� uP�l r ♦ r �^' z 1 t r}TrA �Id1p'rgl,r• y r r R+ a - ,ti r r t=� r 'S:;,;�,i..� r "� �+v2�t.>, `3}dF r x� j 7 - s.� -r,. 'c. t t"� rn� 7 v(, ! g 1 7• 1- y S 3$ �k ''�' t�.� r 5;' s'�, '?5 n '+i'•�� � Y a c m- e'Z si +. y -:•s r' ~rslo .c x�,r+x,t x+y SL-.t.1:�"T @��� w,.,1�r F- r ��„•p�.�rf s`�����-�1c''rsS��C.����ScF dti�3��dr�S'_.- .r�v�.^ �E. .Y <'``"'�`: }t0�'le•'Yt�>'-I'"�¢ . ,r `�>r.K"��:e•� �`"at� _ '>�-�7.- - CI is st "�1,T-`�, .s,FzTe 1'`�tf{7?a4"` -i F c- r'i t t ,r 'i aras2'_.'Z s...x.e,�'•, r.F .7� It f'r�� uh,�t�-Y�*'s7w"� 'S'pC t'�t��`�-•w. by W s �yt� ,� .,.,�� y � ca :C-ti s•.".r� �ShV` uj+.i YY. ^y+K i; �W y "i��� � IJ F � ,A `.Y ,1 f j� �rl. l�^.Y'S T.ri.�3 t:d�..Si��i�>�,+<��•���L �...i'C r��n�;b�Y - r .} -,.,- � v 1 t . r ,d -g+^r p �•:.rr 9� ,'�! t,pna $ i \"��tr'v f"4 41,'aYy�}'1�"•�F�p�� �tL, ..'°.`' ' v i7�y�`�.r�. �'�GSaTfx 3 �✓,s�'J" .{.ql i'�f s P+:'�,i'+,x. t- a s '�„ t�. '5�:.. +�y :.4 S �d�'"'-.+"ty u6i��u M� r'� i"r��i'., com an name � .��Fr�� �� � r,c, b :rt R'k•.:. %: '� "RJ ,.� `r."'- '§ S,x. s .c„4�{j y7� -"s^ r 4 �'y;:.G� ,��•� �j + S t?�;y'4"i',y��a`n.:P.r4'^t ni`ry4 rR$iz��r:' e-rL a }�f^ ': 'rr' '•" dr 'a'4 4 - . 'yat r.-t.:t ('�kv E 5'Y f Sr' .n - r F"^` i 7 r..L c-r.,.n, i .•y t Y . tyg•u`F. `�T s �,�t a: n�+,�vh' *,�( > .$_'"' bs-''-•EN. >a 'r'C^ .`'t F�, ry c 'r. Y+. :,t .r r r address n' w` (.'4,.'N a M „� t rk -'Y....t-L r t:+;('t>S r< x t, 4 r 7 yj"_}J-'•,�`�'Sstyi W.�Gnr �` '"t-�''i +,l,�g,+•du 5t,'�X'c `i+"',>Li,w ( ISy-Y"' � i^"vt'�'. d,3 p s,*t�� 7c§ �F3�7"�".'d i�xsr'T ; t � IlOne � 'r7" "�i-•'.un, zr ���siti t y:;. CI _.''eX'+• `�.y _ ik...wrxs 7 7 `fksS.Gt 1 rY Y1 tr .7 �' ,F. Y '^ - L 'i ,r£ ✓u a ,Y. } y t 24-. ,uis � rss � + ys rS'v St t �s v3 f 4 ; k rr s:S #x4 SIf1k i4i'Ce.CO:'a�'�A.R83, Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DiA for coverage verification. I do hereby certify ur er the pains and per sties of perjury that the information provided above is true and garrec1. Signatu Date 0 j Print name C �Q Phone# s�8 ( !l gig official use only do not write in this area to be completed by city or town official city or town: permit/license# FIBuilding Department ❑Licensing Board check if immediate response is required []Selectmen's Office ❑Health Department contact person: phone#; F—Other (revised 9/95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 section 25 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, 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. gill 101 Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 I P��ptHE 1p�� Town of Barnstable Regulatory Services snarls ABLA Thomas F.Geller,Director ns�ss. 161[g.�A � Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type.of Work: fi-/Nde4, r 46 Estimated Cost Address of Work: i Owner's Name: �C{Ul�l4 d Gero y 1 C44a cf Date of Application: 19A _�7 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law []lob er$1,000 wilding not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MROVEMENT WORK D O NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 3 ,1�/0 3 aac Date Contractor Name Registration No. OR Date Owner's Name i HAR.18:12003 11:55AM KAUFMAN & CO N0.769 P.3 c Town of Barnstable Regulatory Services i► noms F.Geller,Director Building Division Tom Perry, Building Comminioner 200 Main Street, Hyannis,MA o2601 Office: 508-8624638 Fax: 308-790-6230 Property Owner Must Complete and Sign Tbi&Section If Using A Builder I, �SargN �e ,Sly�rllH�/ ,as Owner of the subject psopeny hereby authorize ��r'�c 4 to act on my behalf, in all matters relative to work authorized bythu bull*permit app' ation for(addmss of job) . tcuie of Owne Date .l r+K.�rXiC. a1�A Phut Nv B:OA ASS B{11,00 F��C�i�iT4:- a. Lk:ense ®�ISTRUCT� RiSOR `{ Tr:coo' 925*I ;• � ��3 1 R, }t' '_ t4EC-twd Res- T� ERIC V LUIBRAN P©B®X 1,85 A�I'inenastrator .., �� E F.,A OUTH, MA 025' II rds and Standa.. ;:.. uildingReBnlations , B ard,ot VEMENT CONTRACTOR 12003 :RLC V.LUBRAN MC LUBRAND 85 BLUE CASTLE DR administrator MA 02649 ..,.....- MASHPEE, . s. _.__._.TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION -_ Ma Parcel SEPTI Permit# 4 �C O �P' 0 C SYSTEM MUST`BE INSTALLED IN COMPLIANT He�1th_Division- T� -.....� WITH a Issued -'"- V �i TITLE 5 � • c� Conservation Division e �z2 ZQ�� EN�/TIR®NME�TAL CODE AND Tax Collector REC-Iuj_p- Treasurer o Planning Dept. Date Definitive Plan Approved by Planning Board /� ►� � Historic-OKH Preservation/Hyannis Project Street Address . 7 , �OS Village CO � a Owner S rev ��a(/f) CIO Address Telephone Permit Request 0400' 5 P e cu l %0 e Q C _ dc� 11 IV Square feet: 1 st floor:e isting proposed 2nd floor:existing proposed Total new Estimated Project Colt Zoning District Flood Plain Groundwater Overlay 1 9 Y Construction Type StCf'� uuor'���� Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family O' Two Family ❑ Multi-Family(#units) Age of Existing Structure ea-U Historic House: ❑Yes 9SN6-" On Old King's Highway: ❑Yes ZL4T-- Basement Type: &ull ❑Crawl ❑Walkout ❑Other Basement Finished Area.(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing t new 4 Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas . ❑Oil -❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing .❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No. If yes,site plan review# Current Use Proposed Use � BUILDER INFORMATION Name 1.-.f i,C_ �J G-�(�'I,G�2&I Cp Telephone Number St�' � .5 3� 3 Address A License# C 61 6)2 (�t' Le"�,L),t 11- �yG� O�2 S 3 6' Home Improvement Contractor# • q6?q 7 Worker's Compensation# ALL-CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 6 F -T SIGNATURK ' c- _ -' /. DATE - (0 ' 'FOR OFFICIAL USE-ONLY PERMIT NO. DATE ISSUED - MAP/PARCEL NO. - ADDRESS VILLAGE OWNER . �� � .... f . _ • . , DATE OF INSPECTIO FOUNIT,01ON FRAME r 'INSULATII,,���,, FIREPLArCI k , m rN ELECTRCA TROUGH FINAL ' PLUMBING-S ROUGH FINAL GAS: rs� � ROUGH FINAL -, • - t 1 • FINAL BUILDING' Ilaer10 Q__., il � c � _ t DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents ' office oflotrestigauoos `* ~ _ •y , _ -�" 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit ���I c V/ a bv a o name K9, location, crtv �� T/2 i vhone ❑ I homeowner performing all work myself. ' a sole oprietor and have no one worlan in anvacity /%////%%///iy//////// /''//////,G �///,0%%%7y//////%///%%/'////%///%%///%/%///////%//%/%/////////%//// ///%/%//O�'////////%%%//////%//%//%////////////%////%%/////%%/%%% rovitiin workers' camp—" for my employees worlQng on tius job.:;: ;: ;::::;};>:;:-::}:.... I am an employerp.......:::.::::g:.::::.::.:.:::.:::::.:.;:::m..........;.: ..:,:;<>;:'»:::<:..:..:.::::;;:.; - .::.:::.:} :. . :..::. cam any name:. ..................... .:.......... . address.. h true insurance co. :.: ❑ I am a sole proprietor,general contractor,or homeowner(circle one and have hired the contractors listed below who have UIA=Zl' co ensation olices: - the following mPP.:::.: com anv nam are 1 ad .L. on . ..........::........:::..:......:..:... ............................................................................. insurance ca.. c anv dress:. .....>;::;;;::> ::....... . ad dress: - i .................. one .. ........................................................... .......... dtV ................ Failure to secure coverage as required under Section 25A of MGL 152 can lead to We imposition of criminal penalties of a Sue to 51�00.00 and/or one yam,,imprisonment as wen as civil penalties in the form of a sror WORK ORDER and a fine of$100.00 a day against me. I nnderata<nd that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cerdA under the pairs mid penalties of perjury that the inform adon provided above is tru. correct Date — Signature e Phone# 5 3%' /� 3 official we only do not write in this area to be completed by city or town official pernitAiceme# ❑Bdlding Department city or town: ❑Licensing Board use is aired ❑selectmen's Office ❑check if immediate response required ❑Hesith Department contact person- phone#; other__. (mewed 9/95 P1A) i BOARD OF BUILDING REGULATIONS E IS S U P „. License: CONSTRUCTION RV Number:pCS 060214 . i. 04/29/2001 Tr.no: 9115 esttncbed To: 00 r. ERIC V LUBRANQ x PO BOX 185 :�� E FALMOUTH, MA 02536 ~' Administrator ONE IMPROVEMENT CONTRACTOR .,, Reow& ioo 114047 „f irat a =1/29/01 * 4 ERIC V. EUBRANO Bt86. i RE. .:. ERIC EBBRANO NCO'''SOBS Bl_UE CASTLE OR sgpMINISTRA�R * 'NA 02649 $:MRSNPEE °F IME The Town of Barnstable rnstable snMS McLE. Department of Health Safety and Environmental Services rEo 39. 61 Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Sl4ilf Estimated Cost Address of Work: Owner's Name: ww if il 4, `. v v w Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law. ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply,for a permit as the agent of the owner: . Da ntractor Name Registration No. _.._ OR l Date Owner's Name q:forms:Affidav, Engineering Dept. (3rd floor) Map 0s4 Parcel oi3 f0/ 'oTPermit# House# ��" - Date Issued 5 _Z5 9� Board of Health 3rd floor - 8:15 -9:30/1:00-4:30).ALL Lo &7z V 6� Conservation Office(4th floor)(8:30-9:30/1:00-2:00) INSTALLED �ST `ED I I:�'v MUST BE Planning Dept. (1st floor/School Admin. Bldg.) W PU"CE Definitive P Ilanning Board 19 EN IROMW �N© OWN rf0 MAC NS 'TOWN OF BARNSTABLE BuildingPe rmit Application Pr ' 71 0 l d t90 S f 1f , Village �GC C i Owner LycP CQ Address Telephone Permit Request _ Rep 14C e- &ejJ OS / OR,,; Porch e Q. d O Gti � First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ ��/?�_ oG o = 4 3_� %G Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No - Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name J&01 C 061"d 0 Q Telephone Number �✓�`� _ �z 3 7 Address 1 [ S License# Cs © (p 0 2 1 ! k OqC I (f /*0 0-2 5 3� C Home Improvement Contractor# / / `f 0 7 Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO —IOWIQCf�9 SIGNATURE DATE 7 /7 Z�7 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS - ` VILLAGE OWNER _ j DATE OF INSPECTION: FOUNDATION ; FRAME ` -INSUL'ATION FIREPLACE - t ELECTRICAL: ROUGH FINAL _ t ... In PLUMBING. ,o R;5JGH FINAL, - W GAS: , _~ R (-5-A FINAL FINAL BUILd1lA In l�tS _Z,/ _ DATE CLOSEDjP p n <6D ASSOCIATIONNm in ; v ' The Town of Barnstable mum �' Department of Health Safety and Environmental Services �°r�,�, � Building Division 367 Main Street,Hyannis MA 02601 + Ralph Crossen Office: 508-790-6227 ; Building Comr. Fax: 568-790-6230 For office use only, + Permit no.__ Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. I j o0 Type of Wark• � 45Tf�� 1 Gv 4 G 0 Est.Cost"6-0�' • lO 7f� Address of Work: Owner's Name (aJO I 164 V4 � Date of Permit Application: S 9 7 17 I hereby certify that: Registration is not required for the following mason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the a t of the owner. 4 71 2 Date Cont me Registration No. CllllllltUttiv afth iTAfassachusclf-v • i '' ' Dc' arlllient of Industrial Accidents �' iii _��••�+' 6011 «(Lt//!ll/;tUlt Street f '�v :�•' Workcrs' Compensation Insurance ARd:tv it i li rtn inf rm itin• -•'.�.�...-.��.�----•-_..._.�_------- name [1' by-a o Inc'liton 6 / ( 0 �J 69 S iron• S 3 f— ( Z 3 ctt� l ,tg C.P I am a homeowner performing all work myself a sole proprietor and have no one working_ in any capacity I am an employer providing workers' compensation for my employees working on this job. out tnm• norne! 9dtlrrcc- , tl.. hnnc 1!� no Iicv it incnrcnce CO. _ ..._...—.—....�... - .__._.—• _. [! I am a sole proprietor. vencral contractor, or homeowner(circle arc) and have hired the contractors listed beio�� � the following workers' compensation polices: com any nntnc• ltlrlrrtc• • hnnc a- itn incur-incr rn. com inv nitnr- addresc• � itnnc Itr tilt•- nil •t! insurtnc r .., _... -- .. •. -_......o. •r......s..,�..,.�..u1.1w.. yam.._.. .. Attach additional sheet if necaiarv� ;,%� :�:::5. =-•-"r'; Failure to secure cm erase as required under 5ectton'�A of AIGL Is.can lead to the 3mposttion of enmmal penalties of a tine up to S1Sfl0.0U unc�cars' imprisonment ax-cil:ts civil penalties in the form of a STOP WORK ORDER and a fine of S1oe.00 a day against me. I uadetstanc cope ttf thin ata,cmcttt may be forn•nrded to the 011lce of Investigations of the DIA for coverage Verir=6011. I do herchr cerri nder the pail s an Penalties of perjurr Ilia,the information provided above is true ruL . Dace / Signature Print name ��`� Phone 3 3 ofrtciai use univ do not write i0 this area to be completed by city or town of iiciai n rermidliccnse i# ouiiding Department t city or town: C2Liccnsing iluard gSeiectmen's OlTcc . 41-..ith IlenartmcTTT lassachusetts General Laws chapter 152 section 25 requires all emptovers to provide workers' c0111pensaiidn fbr the. nplovecs. ,As gL10ted from the "ta�ti". an ctnphnrcc is defined as every person in the service of another under any mtract of hire. express or implied. oral or Written. - n c'ntp/nt•cr is defined as an individual. partnership. association. corporation or other legal entity. or any two or more = foreaoin�_ en__a�_ed in a joint enterprise. and including the le-gal representatives of a deceased emplover. or the newer or trustee of an individual . partnership. association or other legal entity. employing employees. However the .•ner of a dwellinu house having not more than three apartments and who resides therein. or the occupant of the .-cllin�_ house of another who employs persons to do maintenance , construction or repair work-,on such dwelIin;_ hou on th::Tounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. ]L chuptcr 152 section 25 also states that m-cry state or local licensing nacncy sliall withhold the issuance or icival of a license or permit to operate a business or to construct buildings in the commonwealth for any Aicant who lies not produced acceptable evidence of compliance with the insurance coverabe required ditionali. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the forntanec of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha n presented to the contracting authority. )hcnnts sc fill in the workers' compensation affidavit completely, by checking the box that applies to your situz;,,on and )lyin_g company names. address and phone numbers as all affidavits may be submitted to the Department of strial Accidents for confirmation of insurance coverage. Also be sure to sign and date the aMdaviL The ovit should be returned to the'%ity or town that the application for the permit or license is being requested. .he Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required ,::in: a %\,orkers' compensation policy. please call the Department at the number listed below. or Towns o be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of Ttdavit for you to J-111 out in the event the Office of Investigations has to contact you regarding the applicant. Pleas -e to fill in the permit/license number which will be used as a.reference number. The affidavits may be returned to !partment by mail or FAX unless other arrangements have been made. >ffice of Investi=ations would like to thank you in advance for you cooperation and should you have any questions. do not hesitate to _ive us a call. . apartment's address. telephone and fax number. The Commonwealth Of Massachusetts rr. gat= •-- •- Department of Industrial Accidents �, r Office of investigations `A 600 «'ashinbton Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (6I7) 7274900 ext. 406, 409 or 375 ` I j I � LJOAN TO be Done l �eIOw+his f ir,G f--a-1 fr X h f)®0 \ NgDO e 1 '0 I IYI , GradF -------�_- - - - ---- --1 ---- _.. .. rmvo- MQ.0 -71. U/04J7/I)Z(YIY DEPARTMENT OF PUBLIC SAFETY _ CONSTRUif IbN_SUPERVISOR LICENSE Nu®ber --Expires: RestrLete -t j 00 LUBRANO s.: BOI 185 ' E FALMOUTH, MA 02536 44 *bCHONE IMPROVEMENT CONTRACTOR Registration 114041 "Type DBA min � f ,Expiration > 07/29/ 7 tit aY°ERIG 11Z.FUBRANOtONTRACTOR 'r ��s`,�s ��}���' �� ERIG Y� UBRANO ����~-�r�'�• I-NOR: y�Kihi--lq..j NA t(3 S 1 w ADMiNISTRa1oR ryFALNOUTH 02540 Y