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HomeMy WebLinkAbout0068 HADRADA LANE . �� � n , v � o ,, � ° �, N ., m . � .. � - � � ... d _ f Town of Barnstable 367 Main Street, Hyannis, MA 02601. REGISTRATION AND CERTIFICATION FORM FOR FORECLOSING/FORECLOSED PROPERTY Thank you for registering in accordance with Town of Barnstable Code chapter 224 sections 224-3 and 224-4. Please complete one form for each property in foreclosure (section 224-3) or already foreclosed for which possession has been taken(section 224- . 4). Please file the original with the Building Commissioner and a copy with the Chief of the Fire District in which the property is located. If you claim you are exempt from registering under Massachusetts law,please state the reason(s) and complete section 1 (property information) and the first paragraph.of section 2 (foreclosing party, court, etc. and foreclosing party representative,but not other representatives and attorney) so that the Town can review the exemption and update its records: na Section 1 —Property Information Property Address:68 HAD RADA LANE CENTERVILLE MA 02632 Assessors Map #: 68 Parcel#: 148-101 Land area and description residential Building(s) description and contents single family detached Occupied: yes Occupant(s)(if borrowers so state and include name(s)) Cheryl Brennan and Ruth Benevento Phone: (877) 617-5274 email: codeviolations@wellsfargo.com other: Fax:(866)512-0757 Vacant: no Date`. na Anticipated Length of Vacancy: na Last occupant(s) )(if borrowers so•state and include name(s)) Cheryl Brennan and Ruth Benevento Phone: (877) 617-5274 email: codeviolations@wellsfargo.com Other: Fax: (866)512-0757 Has possession been taken If so, please explain and complete and file the maintenance and security plan form(unless exempt as stated above) See attached Vacant Building Plan Section 2—Foreclosing Pally Information NOISIAN Foreclosing Party name/title Harmon Law Offices, F.C. Foreclosure Case Court: _20 SM 0T40 NVI ;^ fi7 Docket# na .. Date filed: 01/03/2020 Current Status: foreclosure Foreclosing Party's representative(s) for property (entry, management, repair, etc.)(name, title,): Wells Fargo Bank, N.A. Company (if different from foreclosing party): Wells Fargo Bank, N.A. Address: 1 Home Campus, MAC F0012-01 G, Des Moines, IA 50328 Phone: (877) 617-5274 email: codeviolations@wellsfargo.com other: Fax:(866)512-0757 If an exemption is claimed, please do not complete the remainder. Other representative(s) (if foregoing representative is primarily responsible for property and/or foreclosure and is most likely to be able to address town matters concerning the property and/or foreclosure,please so state and do not complete contact information(i. e. "none" or"see above")). Name, title, other: See above Company (if different from foreclosing party): N/A Address: N/A - Phone(s): N/A email(s): N/A other: N/A Name, title, other: N/A Company (if different from foreclosing party): N/A Address: N/A Phone: N/A email: N/A other: N/A Attorney representing foreclosing party N/A Firm name (if different from attorney's name): NA Address: NA ` Phone(s): NA email(s): NA other: NA I acknowledge that the information provided is accurate and correct. I also'understand that any inaccurate information will result in non-compliance with section 224-3 of chapter 224 of the Code of the.Town of Barnstable. Christy Yang VP of Loan Digitally signed by Christy Yang VP of Loan - - Documentation,Wells Far Bank N.A.=Documentation,Wells Fargo Bank N.A. 01/1 3/2020 Fargo Date 2020.01.13 16:13:52-06'00' Date: Name:Christy Yang Title: Research/Remediation Analyst I hereby certify that the above-named foreclosing party is in compliance with the provisions of section 224-3 of chapter 224 of the Code of the Town of Barnstable. Date: Building Commissioner, Town of Barnstable A ® DATE /YYYY) CERTIFICATE OF LIABILITY INSURANCE 3/25/2025/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).. PRODUCER CONTANAME:CT Wells Fargo Certificate Service Center Wells Fargo Insurance Services USA, Inc. PHONE FAX A/C No Ext: 404-923-3719 A/c No: 1-877-362-9069 3475 Piedmont Rd AIL ADDRESS: wfis.certificaterequest@wellsfargo.com Suite 800 INSURER(S)AFFORDING COVERAGE NAIC# Atlanta,GA 30305 INSURER A: Old Republic Insurance Company 24147 INSURED INSURER B: Wells Fargo Home Mortgage INSURER C: a division of Wells Fargo Bank,N.A. INSURER D 90 South 7th Street, 14th Floor • INSURERE: Minneapolis, MN 55402 INSURER F COVERAGES CERTIFICATE NUMBER: 8901677 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY A MWZY 304056 04/01/2015 04/01/2020 EACH OCCURRENCE $ 10,000,000 CLAIMS-MADE a OCCUR DAMAGE RENTED 10,000,000 PREMISESS(Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $' 10,000,000 X POLICY PRO- PRO LOC PRODUCTS-COMP/OP AGG $ 10,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident AUTOS AUTOS ( ) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER A AND EMPLOYERS'LIABILITY Y/N MWC 302638 04/01/2015 04/01/2020 X STATUTE I EERH ANY PROPRIETOR/PARTNER/EXECUTIVE 1,000,000 OFFICER/MEMBER EXCLUDED? ❑N N/A E.L.EACH ACCIDENT $ (Mandatory in NH), E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is.required) Proof of Insurance CERTIFICATE HOLDER - CANCELLATION Wells Fargo Home Mortgage, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE a division of Wells Fargo Bank,N.A. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 90 South 7th Street,14th Floor Minneapolis,MN 55402 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) f 4 - a.i. 9 %M i Barnstable, MA Vacant Building Plan Current status of the Building: - The building is secured; all doors and windows are locked. If the property utilities are on when we find the property abandoned, we will transfer the utilities into our name and leave active. If we find the property to not have any utilities we winterize the property according to investor/insurer guidelines. Plan of action for exterior building maintenance: We inspect and maintain our properties. We work to keep the property secure and free of any health hazards and/or debris. Wells Fargo also schedules our grass cuts twice a month. What improvements are planned? z If the property is in need of repair to avoid a code`violation, we will review and take any appropriate action. If there are insurable damages, we will file an insurance claim and review for repairs. What is the scheduled date of re-occupancy? Approximately 90 days after the foreclosure sale is confirmed. Building to be sold or rented?, The building is to be sold. • « M Certificate of Occupancy: The buyer will be responsible for re-certification and occupancy inspection with the city. Is property to be demolished? There are no current plans for demolishing the property. The city will be notified if there is a change of action. ♦ d . WELLS FARGO BANK, N.A. CONTACT INFORMATION For questions or concerns regarding a property registration issue please contact the Property Registration Department.` Property Registration Department Registrations@wellsfargo.com For other inquiries please route applicable requests to: Building and Code Compliance Department. -CodeViolations@wellsfargo.com Utility Bills ConvUtilityPmt@wellsfargo.com HOA or Condominium Dues or Fees HOAPmtRequestFH@wellsfargo.com Tax Related Requests: TaxGatekeeper@wellsfargo.com.,. REO property inquiries PASAPinguiries@wellsfsargo.com Insurance Claims HazardClaims@wellsfargo.com. General Property Preservation Property.Preservation@wellsfargo.com For questions regarding purchasing a Wells Fargo property please contact 1-877-617- 5274. You may also contact our dedicated property preservation call center at 1-877-617-5274 Monday— Friday from 8:00 AM —9:00 PM EST. Please note all legal documents should be sent to our legal mailing•address below: Wells Fargo Bank,N.A. 1 Home Campus MAC F0012-01G Des Moines, IA 50328 n Wells Fargo Bank NA MAC Foo12-01G One Home Campus 0 0 vs Des Moines,IA 50328 TOWN � � � Ph:877-617-5274 Date: 01/13/2020 20 JAB 21 AM 10: 51 Town of Barnstable Attn: Robert McKechnie Building Department DT.VISI.ON 200 Main St. Hyannis,MA 02601 Completed Property Registration for: _ - -7 _.� 68 HADIUDA LANE,CENTE.RVILLE M_A o u2632_ w_ a ,� TAX ID. Dear Sir/Madam: Please see the attached property registration form and use the below contacts to expedite any future requests. Code Violations: CodeViolations@WellsFargo.com - Property Registrations: Registrations@WellsFargo.com General Property Preservation: Property.Preservation@WellsFargo.com Call Toll Free: 1-877-617-5274 For questions regarding purchasing a Wells Fargo property please contact 1-877-617-5274• Sincerely, wy - Christy Wells Fargo Home Mortgage MAC Fo612-oiG One Home Campus Des Moines,IA 50328 Christy.yang@wellsfargo.com � w `' - , The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia f CY� Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly —4— ame-(Business✓Organization/Individual): ( �l2UJ 1yYeltx",, /L� �Ad�----, City/State/Zip:"--.2 P o e#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers'-comp. insurance comp. insurance.$ 9. ❑ Building addition uired:] "'� 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3 _I,am_a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions �m self" o'workers_com right of exemption per MGL y P 12.❑ Roof repairs --insurance-required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp, insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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.M 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 certi under the pains and penalties of perjury that the information provided above is true and correct. �� Si nature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia C' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map arcek - Application # - :' Health Divisio Issu d CD 7. t5 Clp at Conservation Division `Application Feed r Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation Hyannis Project Street Address kaz d Village Owner &A AJ K) a Address � Telephone Permit Request -0 de-1 0 eN Square feet: 1 st floor: existing I 1.0proposed //.<d '2nd floor: existing—proposed Total new' -G— Zoning District- Flood Plain Groundwater Overlay Project Valuation 00 Construction Type Lot Size S" A C le Grandfathered: LJ Yes LJ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family LJ Multi-Family(# units) Age of Existing Structure '?0 11S Historic House: Ll Yes IMo On Old King's Highway: L3 Yes kNo Basement Type: Pull Ll Crawl LJ Walkout LJ Other Basement Finished Area(sq.ft.) -e— — Basement Unfinished Area (sq.ft) Number of Baths: Full: existing' new Half: existing new Number of Bedrooms: 5 existing new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: U Gas 'Oil Ll Electric Ll Other Central Air: LJ Yes VN'o Fireplaces: Existing J—New Existing ood/C e-.-, LJ I stove Yes 9"No Detached garage: Q existing Unew size—Pool: Ll existing Onew size Barn: Ll e isting nevi;:`size— Attached garage: 9"existing L3. new size —Shed: LJ existing LJ new size Other: > Zoning Board of Appeals Aut rization L] Appeal # Recorded LJ Z ut C Commercial Q Yes f) No If yes, site plan review # > �No co r- Current Use �e_ls'GLeJ* Proposed Use 'K CG_1A q co M APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 6 'Name Telephone Number fu Address 4d(C � ` License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO n� LA C-cc SIGNAT DATE 3 ^ 2=j FOR OFFICIAL USE ONLY 'APPLICATION# DATE ISSUED MAP/PARCEL N0. -` -- ADDRESS _ VILLAGE 1 OWNER - DATE OF INSPECTION: FOUNDATION , FRAME jFb r INSULATION 4Aloy FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH _ FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' ' 600 Washington Street Boston, MA 02111 wx www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): C._��qq kA rt gS, 6"fli tl3 p Address: [' /�rid G d a, City/State/Zip: CeA+<t 0 f f e- M/0 Phone.#: 2-1 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 employees(full and/or part-tim.e).* have hired the sub-contractors .2.❑ I am a soleproprietor or'partner-' listed on the'attached sheet. T. Remodeling ship and have no employees These sub-contractors have g•'❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. ❑Building addition [No workers'.comp.-insurance comp. insurance.$ quired.] 5. ❑ We are a corporation and its •10.0 Electrical repairs or additions �.3.elam a homeowner doing all work officers have exercised their I I.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.El Other comp.insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ZContractors 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. 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 tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day.against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of or insurance coverage verification. I do hereb e ify un er the i San, nal ' of perjury that the information provided above is true and correct Si Date: a C� � CJ v Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health '2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees'. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons,to do maintenance,construction oi-repair work on such dwelling house of 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.acceptible 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, it necessary,supply sub-conti actor(s)name(s),addresses)andphone number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the Y 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'infoation(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or mi town).".A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le.a dog license of permit to bum 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 MassachuseM _ Department of ladustzi l Accidents, Office of Investigations, 600 Washington Street Boston,ISM.02111 Tel. #617-727-4900 ext 4.06 or 1-877-MASSAFE Fax# 617=727'77749 Revised 11-22-06 www.mass.gov/dia THE rq Town of Barnstable � i Regulatory Services Thomas F.Geiler,Director �bss Building Division PrfD Tom Perry,Building Commissioner 200 Mairi•Streel;--Hyannis,MA 02601.. www.town.bamtable.ma.us Office: 508-962-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMMON Please Print DATE. JOB LOCATION: TTl✓'i GY !`G}[�C4 number t street village "HOMEOWNER!': �1,� �l•Q (� ^,z name home phone# work phone# CURRENT MAILING ADDRESS: q C - "L city/town state rip code The ctu-rent 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. DEFWMON OF HOMEOWNER Persons)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 shvctares 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 Budding 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 unders1 ed"homeowner"certifies that.he/sbe understands the Town of Barnstable Building Department echo ro ures an ments and that he/she will comply with said procedures and r eme Signati=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 borneowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 1 D9.1.1 -Liomsing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such W^that such Homeowner shall ad 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 ease,our Board cannot proceed against the rmlicensed person as it would with a licensed Supervisor. Tic homeowner acting as Supervisor is ultimately responsible. To cnsuro that the homeowner is fully aware of his/her responsibilities,many communities requite,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 formfcemification for use in your cmnmunity. Q:forrra:homecxempt rati Town of Barn-stable -} Regulatory Services . BwxlvsrA�*�.p t . nuns $, Thomas F.Geiler,Director 6.1 i°TED►J4a�16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnsta-ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 " r Property Owner Mdst'� -Complete and Sign This Section . ... _ I' 0�l 1 \ If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date - Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION i 1 l o r . FAMILY MOVERS LLC Moving & Storage 178 THORNTON DR. . HYANNIS MA 02601 Phone Number: 608-420-0611 Fax Number: 508-778-0035 Email : info@familymoversllc.com FAX TRANSMITTAL FORM ' TO: �....' From; . 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O i die6W1sIneL=tens .rr=ile��e Fia�reaB�Y ef�Tv iaans'9eRdm0l�rea�p S.P lsareKJ�-�ffi Uaae�alFofL nsFaeif=Cvycr8on $�'IEET essor' map and lot'number ....... 1. 1.. SEPTIC SYSTEM 'PhOST BE INSTALLED IN 0010 'pn It5NCE Sewage Permit number ..........................:... ....................... WITH ART" � J Y, 9 T.��r}�wii. 11 �'•i d''j 1� t SANITAV Y Wag r vu ( , TNErO�I TOWN OF BA9ffW • B9BH9TADLE, i "6 q .�� BUILDING INSPECTOR ado M a' APPLICATION FOR PERMIT TO D.- V�, G .... ..----7............................... TYPEOF CONSTRUCTION. ..........................`. .......................................................................................... .................... ........ ..........191 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ,,y q [� / ( '. G�h .............................. Location i ..oP/......1/..42)12,./�::J�.,f�:............1�,/ 'l�! .................. .7 ProposedUse ......D. ............................................................ ...................................................................... /� Fire District l�£'21//LLB— C,/ST£l2✓I LL�. ZoningDistrict ........K��............................. ................ ........ ............ L > Name of Owner Vf ,t�'....? lJ........':�11-1.5...............Address ............................................... Name of Builder.Cvit...W.4.E..... 4F.V....2 64V 9.Address ..3.0(ea....., Name of Architect ..................................................................Address ........................... .................... Number of Rooms ............... ..................................:...........Foundation .....C1�.�..:4,15;5 g. Exierior .............Roofing ...... .:........................................................ Floors .. .f�.. f.. .....`.;°!..:Interior .................................................................................... : Heating ...... ��........ Plumbing . , � !I � Fireplace ....w ..........................................................Approximate Cost ............ . ... Definitive Plan Approved by Planning Board ________________________________19________ . Area 1....................... .............. Diagram of Lot and Building with Dimensions Fee / SUBJECT TO APPROVAL OF B ARD OF HEALTH r s cou / � L � r It _9 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regar in bove construction. Name .. ................ S !i2 ................. Craig, James & Ruth 17847 1 1/2 story No ................. Permit for .................................... single family dwelling Location Hadrada Lane .... ..... ..... Centerville ............................................................................... Owner .....James & Ruth Craig ............................................................ Type of Construction frame ................................................................................ s #2 1 Plot ............................ Lot .......... .................... ei y Y( 4tr} 1 s Permit Granted J�u1v. 25 19 75 Date of Inspection .W�? .....5^..��a 0.... t Date Completed w�7/7,�...................19 f - PERMIT REFUSED S ................................................................ 19 ............................................................................... T ...................... } ............................................................................... Approved ................................................ 19 ............................................................a.................. ............................................................................... 5 ,F. Assessor's map and lot number ........... ..w./ ,Sewage Permit number ......................... ..................... ,........... ` yo*THE To�sTOWN OF BARNSTABLE �. fo�Q� ow Z EAUSTAMLE, i "6 9 BUILDING INSPECTOR CEO MAY a , APPLICATION FOR PERMIT TO ...............� —....�.ri..;;�.. •� �.............................. i ...... ...... ... ...... .... .... TYPE OF CONSTRUCTION -�lr .... ......' .......... ..............19 ! r TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..................:....................................:..... .. ......E.........,.....::..'.............................. ProposedUse .......................l...f./!s ................................................ ........................................................I......................... ZoningDistrict .........................................................................Fire District ...........................................'................. Name of Owner t .. ... /_//t Jll�.......t :/� /.g..............Address .................................................................................... r Name of Builder `rrf - r, �� ��#,i*".1/.... ' .*'!`?Address ...3. A.�r......�:..:..!' �,.tx���.�'........ _ ...�J4l � Nameof Architect ..................................................................Address ..............................:.....;............................................. �abRfd Number of Rooms ..............................................Foundation .........�� Gif' � �................... ,......,........................................................ G° Exterior .. r✓� '��11 Kt tit.,r r/,2"l.............Roofing ......., C .. �,(f ......................................................... } � y Floors ........ . .... ...... .:_........ �Interior .................................................................................... r .� Heating 1V rl 4 . ' g �'�G ��i� ���.r, , --V .................x .... •�G1t...........................................Plumbin ....... Fireplace ..... � Approximate Cost ............. .. .�� ...fs ........ ..............' ....... Definitive Plan Approved by Planning Board ________________________________19--------. Area .... ���....S. .:.......... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH L) I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Namer�,.............................................................��j� Craig, James & Ruth A=148-101 No :'.17847.... Permit for .,,1 1/2 story, ................. ,single family dwelling ................................................................................ Location b� Hadrada Lane ................................................................ Centerville ............................................................................... Owner ............James.. ... ... & Ruth Craig. . .............. ........... .. ........ ...... . .. Type of Construction ........frame .................................. ................................:............................................... Plot ............................ Lot .........��21................ Perm/Gra .........July..25...............1975 Datetion ....................................19 Dated .............:........................19 PERMIT REFUSED ................................................................ 19 ................................................................................ ................................................................................ ............................................................................... ............................................................................... Approved 19 ............................................................................... ............................................................................... ` #,fit^ +�.. 0 F n•o M ice.. .. i -`�,� F /{ r aJ ° r �4.L Y '�/�Ir w/ ! �U ... i l�.,N 4 � rli.(� Yd � •"^A �. (' AWL �.''%• sue" Z.���� LI , �� a 14, ' � \'\. ,''// '� 1, k♦ { e 1�.f.'� �'�•� J ti ,._ =y+-•y •v r'/ , 52 1 F Y f Y �.� } t tv 9 rr i 1J LOC�7"/O/LJ. c�'/./TE/a✓mac.L �-' � r - -C— ell 1 ,�j/O r✓v aJ L7�./ /c G./?/�J- .d�'`...'f_'.t,�Lam?i:.J .L-? - r `Via ''""�,as A x• e �N ���ti ?�o.,�c ��` . j'-�'�-� �z- • �.�ui4�� ' 'SYST��N . ,a�Sl�^J p f•; .:"��' .�. • t�A�N ,Oil" �iti/E��'es�/��k4�� �:�, �: f•✓EL�E�Y CEGT/FY THAT TLIE 6CJ/LIJ/.VG•� w,vsN�B> S7'm../E. �„ � 'art � ; SA40M/N ON 7'I✓l►S IS L O C o TE D 0" TINE 4F"OUA-1 1 A45 -23YIOWA./ N6'CBOti/ APA.10 TF-/FaT /T OF t ro rNE- �o v/.vim- ��jH MgSs9 t A&>--I—oQ WS of 7X-16E 7 A/ of I'VLI@ti/ CONST�[�GTED. O� ARNE xi o OJALA #26348 `s h &� Zs� - �� qNO. Hv jeOCJTE Page 2 of 2 a M 34 lull �nih" canker o(Vdrdow and 8lr$ ?� T 3 15 $-`LO . ; DW; 0 e,HIRh Hal K L\R ' 55 �APPI13,rz CIrOJI - ' two ..y ' • j .. £. 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