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0740 OLD STAGE ROAD
µ.. M .r /� y e + 11 r 5 4 _ a r u o ` Y TOWN OF BARNSTABLEINE Building201506089 pBARNSTABLE, Issue Date: 09/24/15 Permit 9 MASS. �pr16 339. a Applicant: KURKER,WAYNE TR Permit Number: B 20152667 Proposed Use: SINGLE FAMILY HOME Expiration Date: 03/23/16 Location 740 OLD STAGE ROAD Zoning District RC Permit Type: RESTORE TO SINGLE FAMILY Map Parcel 191114 Permit Fee$ 35.00 Contractor PROPERTY OWNER Village CENTERVILLE App Fee$ 50.00 License Num Est Construction Cost$ 500 v Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND RESTORE TO SINGLE FAMILY BY-REMOVING THE APARTMENT IN BAW FCARD MUST BE KEPT POSTED UNTIL FINAL CABINETS, SINK, STOVE INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: KURKER,WAYNE TR BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 1 WILLOW STREET INSPECTION HAS BEEN MADE. HYANNIS,MA 02601 Application Entered by: JL Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,'ALLEY1OR SIDEWALK OR ANY PART THEREOF,EITHER PORARILY'rA�S ENCROACHMENTS ONPUBLIC PROPERTY,NO SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,:MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES ND LOCATIONOF PUBLIC SEWERS MAYBEOBTAINED FROM THE DEPARTMENT OF PUB LIC WORKS. THE ISSUANCE OF THIS PERMITDOES NOT:RELEA$E THE APPLICANT ROFANY APPLICABLE SUBDIVISION'S -RESTRICTIONS.. MINIMUM OF FIVE CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.SHEATHING INSPECTION. 3.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEF IRST LUE L ING IS INSTALLED. 4.WIRING&PLUMBING INSPECTIONS TO BE CO PLETED PRIOR TO F SP CTION. 5.PRIOR TO COVERING STRUCTURAL MEMB (FRAME INSPECTION) 6.INSULATION. 7.FINAL INSPECTION BEFORE OCCUPA WHERE APPLICABLE,SEPARATE PE TS ARE REQU OR EL TRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL T INSPECTOR HAS ROV THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL OID IF CO TR ON WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS OTED ABO PERSONS CONTRACTING WITH UNREGIS ERED CO ORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ( —. _ Telephone Number SO&190' X 80 o z�ar Address I W S: o— .�� N1� License# T Home Improvement Contractor# Email UJ c- �SligyV1S M41k10A C Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map `c%l -, l A . Parcel Application # Health Division Date Issued I �/ Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address k4 y d Village Owner a i- ,, c qt g,%� k�/�o,C- Address Telephone 967 -7-4 G-2 yboy Permit Request o('a �� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 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 Historic House: ❑Yes Al No On Old King's Highway: ❑Yes ❑ No Basement Type: �4 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 Y new First Floor Room Count Heat Type and Fuel: ❑ Gas ; Oil ❑ Electric ❑ Other Central Air: ❑Yes 1�', 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:A existing ❑ new size _Shed: ❑ existing ❑ new size — Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 33 Commercial ❑Yes No If yes, site plan review # Current Used 0,;. ®.�, , _ ��, � \ � Proposed Use APPLICANT INFORMATION E m (BUILDER OR HOMEOWNER) Name e phone Number 3-oEr- 3 b` -Li b Z , ,i Address 0 7-7 Li ense # qn ' 1P lrr H e Improv/TAAKEN actor# Email n o_ ca o 29- 14 vwi ,t"4 W ker's Com ALL CONSTRUCTI DEBRIS RES LTING /OM THIS PRO CT WILLTO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED i MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION hIN FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT* ASSOCIATION PLAN NO. Bk 2336=c Paa;U4S a 15 e 4-6 QUITCLAIM DEED JOHN C. SHEA and WAYNE KURKER of P.O. Box 427, Hyannisport, MA For consideration paid and in full consideration of One Dollar(S1.00) Grant to WAYNE KURKER,Trustee of 740 OLD STAGE ROAD REALTY TRUST, e under Declaration of Trust dated March 19,2009 and recorded at Bamstab 1r,County } Registry of Deeds herewith t9G P.o,,i�,oX q2-7 yAyjr_j L S,O�_T 1_1 With QUITCLAIM COVENANTS The land with the buildings therein situated at 740 Old Stage Road, Centerville,MA 02632, in the Town of Barnstable(Centerville), County of Barnstable;and ; Commonwealth of Massachusetts,bounded and described as follows: Northeasterly by Lot 66 as shown on the hereinafter mentioned plan, 161.0V feet; Southeasterly by land now or formerly of Eben Smith,219.38 feet;and Southwesterly by Centerville, West Barnstable Road,272:16 feet Said land is shown as Lot 67 on a plan of land entitled"Plan of Land in_Ce'aterville, Barnstable, Mass. Being a subdivision of Land Court Plan 33723-A sca.le:1"= 80', January 19, 1970, Charles N. Savery,Inc,Registered Engineers&Survcyars, Hyannis, South Yarmouth, Mass.",which plan is recorded at the Barnstable County Registry of Deeds in Plan Book 236 Page 127. For our title, see deed recorded in Bf.im'stable Registry of Deeds in Boo&23105 page 348. EXECUTED this 04 .day of March,2009 , 1 r JO SHE WAYNE KURKER 1 '�:- �� � - � � `.� I � I . . � �. 'i � % � .jf _. F' � a 1 l -= � - � � � 3 c h . . . ,. ,... �. � � . �� �� P .. � �. �, - - . � t� �, }� -^ �- ,�� U - r �+� � � } Q � L . !, r � ... _._ _ .��.-. t . •� 2.G-'�. .. � . � l � T . Ij CNO y �v p Y rt ° 16) AL - b P y _ i 1 E. a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY P MA DATE PERMIT# �j S 0657 JOBSITE ADDRESS OWNER'S NAME u�f POWNER ADDRESS 1 TEL 1FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL RESIDENTIAL[ � PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES N0[] FIXTURES I FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM - DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM I — DISHWASHER I A' DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN t INTERCEPTOR(INTERIOR) KITCHEN SINK Led LAVATORY �� _ _ _ (:_ I ROOF DRAIN a SHOWER STALL SERVICE I MOP SINK TOILET _ I URINAL �' WASHING MACHINE CONNECTION — ' I WATER HEATER ALL TYPES WATER PIPING _ I ja `OTHER T'k a INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements,of MGL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ® AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accu to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with won of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 5 6 6 c PLUMBER'S NAME Cie LICENSE# 31 t P SIGNATURE ' MP JP CORPORATIONS#PARTNERSHIP®# LLC0# COMPANY NAME ADDRESS CITY STATE !I ZIP O TEL FAX CELL �-36o-1 EMAIL j„E r Town of Barnstable . . *Perini � � '�% Expires 6 nths fr*nrisst e °� Regulatory Services Fee - BARNSTASLE + MASS. Richard V.Scali,Director 16 Building Division Tom Perry,CBO,Building Commissioner r 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us = " w Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION } RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 1 Q 1`" 1►%4. Property Address `1�� 6 IC4 � a Residential Value of Work$ Minimum fee of$35.00 for work'under$6000.00 Owner's Name&Address S" bU� 4Z1 y~t9 Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) , ❑Workman's'Compensation Insurance PE PE� Check one: Ej km a sole proprietor [Nr I am the Homeowner 'SEP 16 ZOiS- ❑ I have Worker's Compensation Insurance TOWN OF'BARNSTABLE Insurance Company Name T Workman's Comp.Policy# . 1 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request`(check box) ' - VRe-roof(hurricane nailed)(stripping old shingle's).All construction debris will be taken to_ �s( �S' t.•,p S ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ; ❑; Re-side 7 ❑ Replacement Windows/doors/sliders.U-Value i° (maximum.32)#of windows } #of doors: Smoke/Carbon Monoxide detectors 4 floor plans`marked with red S and inspections required Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc' ***Note:.., Property Owner must sign Property Owner Letter of Permission'?, A copy of the Home Improvement Contractors License&Construction Supervisors License is required. ' SIGNATURE: Q:\WPFILES\FORMS\building perrn5 forms\EXPRESS.doc Revised 040215 Ile Cominorrivealtls of Massachusetfs De parhrment of lrrrdwft ial Accidews - - Of -ce of.£mwaigations 600 Waskington Street - _ _ Boston,M4-012111 ` wrvrtx mass_gvv1d n ""Torkets' Campensatian Insurance Affidavit:Bu ildenICantractGrs!'EIectricians(Plvmbers Applicant Inform atian Please Print Legibly Name(Busffiessrotgan zationa&d nai Address: JPG Cityfstatctzip.: one Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with , �1 am a general contractor and I 6. ❑New construction employees(full andl`or part-timed* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- Tisted on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have 8..❑Demolition waning far me in any capacity. employees and have workers' [No wmrlmm'comp.insurance, comp_Msuranml 9. ❑Building addition required-] 15. ❑ We are a corporation and its 10_❑Electrical repairs or additions 3.❑ ) am.a homeowner doing all work officers have exercised their 11_❑Plumbing repairs of additions myw1f_[No workers'comp_ right of exemption per MGL 12-F Rnofrepair$ insurance require&]1 c.152, §1(4�and we have no ' employees.[No workers' 13.❑'other comp_insurance required-] •Any appBcsnt&at cbecksbos Pl mist also M out the swfionbeiow showing then wolkere compensation paHU infMnatiaa Homeowners who submit tihis aiidavt indicating they are doing all waak and then hire outside contactors mast submit i new affidavit indicating sudLi ZCcnUwWrs tbat check"this boat must attached m additianal sleet showing the name of the sub-coact=and,state whether ar not those entities has e' employees.Ifthesub-mtotmishave employees,theymorstpmvidethek workers'comp.palicl number. I ant aft efffploper tlfat isprmr ding ivorkers'compemadvii ittsftrance for my enrpla,ces Below is tha policy and job swig irformaffon. Insurance Company Name: Policy,or Self--ins.Lic-t DxpirationDate: Job Site Address: ' CitylState)Zip: Attach a ropy of the corkers'compensation policy declaration page(shaving the policy number andexpiration 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$1,50a.OD andror one-year imprisonment,as well as civil penalties in the farm of a STOP WORK ORDER and s fuse of up to$250.00 a day against:the violator. Be advised that a copy of this statement maybe forwarded to the office of, Investigations of the DIA.for insurance coverage u,erifeation- I do Ifereby he�r nnder ifs andpenances ofpedfuty that the ufformadon pimi&d abmw is bars and correct Sitmature: ' - `' Datfy: I . Phone j;� Ste ' `3 t 2 -'Z G '7 O,oacial=e only. ,Do not write in this area,to be completed by city ortown official. City or'I'omm: PermitUcense# Issuing Authority(tdrde one): 1.Board of Health 2.Building Department 3.( tyfrown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.tither Contact Person: Phone it: Information and Instructions Massachusetts Gdaeral Laws chapter 152 reties all empIoyers'to provide workers'compensation for their employees. msar Pantto this sire,an.emplayPe is defined as."_.every P erson m the s ce of another under any cDntaa of biie express or implied,oral or written-" An anployer is defined as"an individual,partnership,association,coipo on or other legal entity,or any two or more of the foregoing engaged in a Joint enterprise,and including the legal esentafives of a deceased employer,or the receiver or t mA=of an individual,partnership,association or other 1 entity,employing employees. However the owner of a dwellipgg house having not more than three apartments and o resides therein,or the occupant of the - dsveIIing house:of another who employs persons to do mahtEman cc, on or repair work on such dwelling house or on the grounds or building appurtena�themtn shall not because o such employmembe deemedto bean employer." MGL ter 152,§25C(6)also states that"every state or local Ii easing agency shall withhold the issuance or renew a license or permit to operate a business or to co ct buildings in the commonwealth for any applicant who has�not produced acceptable evidence of comp anr� �vitIi the insurance.coverage required_" Additionally,MCrL chapter 152, §25C(7)states"Neither the co onwe-alth nor nay of its political subdivisions shall enter in� any contract,for the performance ofpublio work acceptable evidence of compliance with the irc�rrarC@: raq=rmerds of this chapter have been presented.to the arziho ts!" = t • Applicants ! � Please fll out the woikers'ca)Tpensafioa affidavit coin etely,by checking the boxes that apply to your sitoatiou and,if necessary,supply mob-contracto(s)name(s), addresses and phonenumber(s)along with their certificates)of 7rcrTrarce. Limited Liability antes(LLC) or L Liability-Partnerships(LLP)withno employees other than the members or partners,are not r m carry work. 'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be ed that affidaYit maybe submitted to the Department of Industrial Accidents for confirmation of' verage. Also be sure to sign and date the affidavit The affidavit should be retauned to the city or town that the app patio for the permit or license is being requested,not the Department of lr L.,Sftia_i Accidents. Should you have any ons regarding the law or if you are required to obtain a workers' compensation policy,please call the Departn. at the number listed below. Self-insured companies should enter their self-m�ce license number an the appro line. City or Town Officials Please be sari e that the affidavit is complete rind p ' Iy. The Department has provided a space st the bottom of the affidavit for you to fill out is the eveht the Office o vestigations has to contact you regarding the applicant Please be sure to fill in the pC=it/license;umber which e used as a reference number. In addition,an applicant that must submit multiple perm¢llicense applications in any year,need only submit one affidavit indicafmg current policy infornhation(if necessary)and u der"Job Site Address" applies should v.ute"all locations in (may or town)_"A copy of the affidavit that has been.officially stamped or ed by the city or town may be provided to the applicant as proof that a valid affida is oa file for f�nre permits or es- A new affidavit must be filled out each year.Where a home owner or citizen/is obtaining a license or pemmit not lated to any business or commercial vent re (i e. a dog license orpeffiit to beaves etc.)said person is NOT complete this affidavit The Office of Investigations w'7:a: at to thank you in advance for your cooperafign and should you have any questions, please do not hesitate to give vsl The Department's address,tel hone and fax number. Tht CG_=jMWeatth-of Ma.�achuseM . Department of 11idusfdel Agent% �Q4-�ashin�tQn Sf�t . . - BQSton.,MA E12111 Tf,-1.4 617-727-4900 cxt 4-06 or 1-9 I CE Fax#617-727 7749 Revised 4-24-07 .mas5-gov/dia Aco® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `--�� 9/16/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME, JIM HINDMAN Schlegel & Schlegel Ins Broker PHONE FAx 34 Main Street IA1C.N • (508) 771-8381 IAI N2): (508) 771-0663 ADDRESS: schlegelinsurance@qmail.com West Yarmouth, MA 02673 INSURE S AFFORDING COVERAGE NAIC# INSURERA:NGM INSURANCE CO 14788 INSURED INSURER B:HARTFORD UNDERWRITERS WE S TON P RADWAY I NSU RER C: DBA ARC CONSTRUCTION INsuRERD: 20 LONGVIEW ROAD INSURER E: YARMOUTHPORT, MA 02675 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD/Y MM/DDIYYYY LIMITS A GENERAL LIABILITY MPT2037Q 10/17/14 10/17/15 EACH OCCURRENCE $ 1,000,000 }{ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMI E Ea occurrence $ 500,000 CLAIMS-MADE OCCUR MED EXP(Arryone person) $ 10 000 PERSONAL&ADV INJURY $ 1 000�000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APP LIES PE R PRODUCTS-COMP/OPAGG $ 2 000,000 POLICY JE LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccident $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS accident BODILY INJURY( )Per $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WC-0210973 10/18/14 10/18/15 WC STATU- OTH- ANDEMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUIIVE E.L.EACH ACCIDENT $ 100,000 OFFICE RIMEMBER EXCLUDED? NI N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If Iyyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is regui red) WESTON RADWAY HAS ELECTED TO BE COVERED UNDER HIS CURRENT WORKERS COMP POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF BARNSTABLE ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: BUILDING INSPECTOR HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE IN HAND, ©1988-2010 fCPRD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACO Phone: Fax: E-Mail: Town of Barnstable +.jigs 4 Regulatory Services , oFtr rqy,` Richard V. Scali;Director Building Division 11MMSPA131.4 " Tom Perry;Building Commissioner 16yg. `0� 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: %I it LL1 r JOB LOCATION:___ ')_y 0 61 A- number street village "°HON EOwNER": Vr ..S-a, ,SOfi, 6 Z name home phone# work phone# . CURRENT MAILING ADDRESS: ` +4b 7 '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 individ"*for hire who does not possess a license,provided that the owner acts as supervisor. DEtINITION OF HOMEOWNER Person(s)who owns a parcel,of land on which he/she resides or intends to reside,on which there is,or is intended-to,be,a one or two- family dwelling,attached or detached structures accessory to.such use and/or farm structures.`A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building.Qfficial 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 procedur and equirements and tl at he/she will comply with said procedures and requirements. Signature of Ho a er r - r • � Approval'of Building Official Note: Three-family dwellings containing 35,000 ubic feet or larger will be required t'comply with the State Building Code Section 127.0 Construction Control. t • ,, "'HOMEOWNER'S EXEMPTION s.. .. r 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:\WPFILES\FORMS\building permit forms�RESS.doc- rb a Revised 040215P A r c r ' ro 0* iV • • �nABM 9� ,� Town of Bar stable ArED MA'1 A Regulatory ervices Richard V. Sca ,Director Building ivision Thomas Pr ry,CBO Building mmissioner 200 Main Street, Hyannis,MA 02601 www.to .barnstable.ma:us Office: 508-862-40 8 Fax: 508-790=6230 Pro rty Owner Must omple and Sign This Section. f Using A Builder I , as Owner of the subject property hereby authorize. to act on my behalf, in all matters relative to work au orized by this boil permit application for: (Address of Job) C-7�\1� t I Signature of c5Vner ate M" Print Name If Property Ov/ner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. i Q:\WPHLESTORMS\building permit forms\E3TRESS.doc Revised 040215 { oFt►+F To,,, Town of Barnstable " Regulatory Services } BARNSTABLE. " 9 MASS. Thomas F. Geiler,Director Building Division 1 „ Tom Perry,Building Commissioner, - 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 July 13, 2010 Wayne Kurker PO BOX 427 Hyannisport, MA 02647 RE: 740 Old Stage Rd;, Centerville Map: 191 Parcel: 114 Dear Mr. Kurker : - This letter shall serve as notification that a recent site inspection has revealed the ' following violations: 1) Work has been done at the above referenced property without the benefit of,a building permit (construction of front step). 2) A pool was observed on the property without the proper barrier(i.e. fence) as required by the Town'of Barnstable. ` 3) Permit application number 200804816 has not been finalized and further the plumbing permit necessary has not been issued. Your immediate attention is required to bring the property into compliance. Failure.to comply will result in further action by this office. Please call (508)862-4034 with any, questions regarding this matter. By Order, y Lauzon Local Inspector Q zoning5 1ST CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT DEPARTMENT OF FIRE-RESCUE&EMERGENCY SERVICES 1875 Route 28•Centerville, MA 02632-3117 19261 508-790-2375 x1 - FAX: 508-790-2385 John M.Farrington,Chief Martin O'L.MacNeely, Fire Prevention Officer Craig E.Whiteley,Deputy Chief Francis M. Pulsifer, Fire Prevention Officer August 29, 2008 Mr. Thomas Perry- Building Commissioner. Town of Barnstable 200 Main Street Hyannis, MA 02601 Dear Commissioner Perry: Pursuant to MGL Chapter 148-Section 28A, I am making you aware and request your interpretation of construction of a suspected apartment without secondary egress at: �740aO1�d�Stage��R�oad Cente jille N1 Tkl While on a rental inspection at this address, I observed a finished basement with two large rooms, 3/ bath, and two rooms that the owner referred to as "bedrooms"..The " bedrooms have no secondary egress. The house is vacant and the owner is aware that the basement rooms cannot be used.as bedrooms. I advised him to contact your 6ffice to review the property and suggested he speak with Health Dept. as well. �(` l Please contact me with any questions you have relative to this situation at 508- 790-2375 Ext.l. Thank you for your attention to this issue. Sincerely; Francis . Pulsifer Fire Prevention Officer Cc: Robin Giagregorio "Commitment to Our Community" i i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Mai �� Parcel //Z Permit# Health Division Date Issued zin Conservation Division Application Fee Tax Collector Permit Fee S Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address -iL4 © aid f a �C Village n o(�' Owner ( c�T�tC p� !' , Address �Y)ll �i sl/�(�n �obt Telephone -ain D���0 31 Permit Request (-5/hol�° 0 1P Square feet: 1st floor: existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay t rojdct Valuation �O Construction Type m Lot Size 01 Grandfathered: ❑Yes ZN If yes, attach supporting ocumeQion. , r Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) 40al y, � Age of Existing Structure ICj�1 Historic House: ❑Yes Z1,No On Old King's Hig ay: ❑ i�ol Basement Type: 3 Full ❑Crawl ❑Walkout ❑Other Basement Finished s ed 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: ❑Gas eOiI ❑Electric ❑Other Central Air: ❑Yes (B o Fireplaces: Existing New Existing wood/coal stove: ❑Yes CI-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 0 Telephone Number Address I . /1� 111 CAA) C License#Iffi4 I. ✓lam' Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESU TING FROM THIS PROJECT WILL BE TAKEN TO l <71Wn A&4 XQJSIGNATURE DATE U 1 FOR OFFICIAL USE ONLY ol PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE " OWNER - DATE OF INSPECTION: FOUNDATION FRAME rgc�l 9) INSULATION 1 FIREPLACE ELECTRICAL: ROUGH FINAL-- PLUMBING: ROUGH FINAL GAS: ROUGH FINAL - FINAL BUILDING r DATE CLOSED OUT ` t ASSOCIATION PLAN NO. • r i The Commonwealth of Massachusetts Department of Ircdustrial Accidents Office of Invesfigations 600 Washington Street Boston, MA 02111 • www.mass.gov/did Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectri�ciarin umbers A licantlnformation / ,, Please PrzntLe 'bl Name (Bus�incss/organizatidn/lndividuaI): �(.(,r Le City/StateJZp ,.. r'lYl�� .✓�0� tp� Phone.#: LJ�b "�G1E�'t-�UU6 X �� 1 Are you an employer? Check the appropriate box: Type of project(required): 1"❑ 1 am a employer with 4. ❑ I am a general contractor and I 6_ ❑Ncw construction employees(hill and/or part-time).* have hired the nib-contractors 2_❑ X am a sole proprietor or partner- listed on the attached sheet . 7. ❑R=odeling ship and bave no employees These sub-contractors havc g" ❑Dcmolitioa employees and havc workers' working for me in any capacity. 9. ❑Building addition [No workers' comp.•?rLnrTancc comp.insurance.t S. ❑ We arc a corporation and its I0_❑Electrical repairs ar additions rbquircd_] offi exercised cers havc their 11.0 Plumbing repairs or additions /3.jg 1 am a homeowner doing all work myself [No workers' comp. right of exemption per MGL 12 ❑Roof repairs incrTrance required.]t c. 152, §1(4), and we havt no 13.❑ Other employees. [No workers' corup.insurance required.] ;Any applicant that ehm)a box#1 must also;Fill out the section bdowshowing their workerx'eoropcnsaAon policy infam-mtion , t Hamcowoers who rubmit this affidavit indicating they arc doing all work and than hirr outside contractors must rubmit a new affidavit indicating such. TCantractors that cbcck this box must atiachcd an additional shcct rbowing the name of the sub-contractors and stain wbcthcr ur not those rntitits havc employees. if the sub-coniraefnrs havc ar�loyers,thry must prwidC ffieir works s'comp.pobey nurnba. lam wt employer that is providing workers' compensation Ensurance for my employees. Below is the policy and job site information lmsurancc Company Name: Policy#or Sclf--ins. Lie.#: Expiration Date: Job Site Address: City/Statelzip: 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 fi=tip to $1,500M 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,statemerit may be forwarded to the Office of InVCStI ations of the MA for ins mace covers c verification. I do hereby cent[ under the pains-and,penaldes of perjury that the information provided above is true and corrnct Si afro. (� Datc: 30 d _ Phone# - Offuial use only. Do not write in this area, to be completed by city or town offtciaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Towu C1er1c 4.Electrical Inspector 5.Plumbing Inspector 6. Other 1, Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their cruployeCs. Pursuant to this statute, an employee is defined as "._.every person in the service of another under any contract of hire, , cr_press 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 ajoint enterprise, and including the legal represr, ". tivcs of a dercascd employer, or the receiver or trustee of an individual,partnership, association or other Iegal c ty, employing employees. However the owner of a dwelling 4DUSe having not more than thrcc apartments and who sidcs therein, or the occupant of the swelling house of another who employs persons to do maintenance,cons ctron or repair work on such dwelling house cr on the grounds or building appt`frt�cnant thereto shall not becausc of suc employment be dccmed to be an employer." vI GL chapter 152, §25C(6) also states`iha.t"every state or Iocal licensia agency shall withhold the issuance or -enewal of a license or permit to operate a business or to construct b ` dings in the commonwealth for any ippIIcant who has not produced-acceptabir evidence of compliance the insurance coverage required." additionally,MGL obapter 152, §25C(7) states'Neither the commonw th nor any of its political subdivisions shall Inter into any contract for the performance of 1l01ic work until acccptabl cvidcacc of compliance with the in,- c: cquiremenfs of this chapter have been presented\the contracting autho ty. applicants ' lease fill oust the workers' compensation affidavit completely,by chcc ' the boxes that apply to your situation and, if ccessary,supply svb-coniractor(s)name(s), address(cs)�and phone n s) along with their certifieate(sj of m r'ance. Limited Liability Companies(LLC) or Limitch iab, P erships(LLP)with no employees other than the ambers or partacts, are not required to carry workers' compcnsabon' Dr. If an LLC or LLP does have mployecs, a policy is required. De advised that this aMdavitNmay be mitted to the Department of Industrial ccidcnts for confirmation of insurance coverage. Also be cure to si and date the affidavit The affidavit should ;returned to the city or town t�the application for the permit by lice e is being requested, not fhc Department of idustrisl Accidents. Should you have any questions regarding the\law or if you are required to obtain a wDAcrs' ,mpefio nsan policy,please call the Department at the nurgber Est ed-b low. Self-insured companies should cntcr their lf-i:uw.ra=-o liecnse number on the appropriate line. ity or Towii Officials case be sure that the affidavit is complete and printed Icgibly. Th Department has provided a space at the bottom 'the affidavit for you to fill out in the event the Office of Invcstigons hast,o contactyou regarding the applicant ease be sure tv fill in the permiVlicensc number which will be us as a reference number. In•addition, an applicant it must submit multiple permittlicense applications in any given car,need onNsubmit onp affidavit indicating current 4cy information(ifnecemary) and under"Job Sitc Address" the applicant shouts.write"all locations in (city or Frn)."A cbpyof the affidavit that has been officially stamped or kcd by the citpor town may be provided to the plicant as proof that a valid affidavit is on file for future permits r licenses. A new kfffidavit must be filled out each rr.Where a home owner or citizen is obtaiIrlllg a license or p t not related to any business or cornmcrcial venture a dog license or permit to burn Ica etc.) said person is NOT equircd to complcte this�affidavit c Office of Investigations would 15m to thank you in advance for our cooperation and should u have any ques$om, ase do not hesitate to give us a call Depaaztment's address, tcicphonc•and fax number. The C6mmonwWth of M chusetts D eat of Industrial Accidrrnts - Office of Investigaduns 600 WashingtGn Street Boston, MA 02111 Tel. # 617-727-4910.0 ext 4.06 or 1-M-MAS.SAFB Fax# 617-727-7749 : 11-22-06 www.mass.gov/di a Town of Barnstable SHE Ty yw o Regulatory Services r Thomas F. Geiler, Director HARNSIABLE, " .y MASS. g, i659. Building Division PjFD '�a Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnsiable.ma.us Office: 508-.862-4038 Fax: 508-790-6230 H, .�« 011IEOWnER_LICENSE-EXET+IPTM 22 ��f!S- Please Print DATE: 10B LOCATION: LLQ ( J Cl 'j S10 26 j\`Q -, number 0 strcct r `(` village "HOMEOWNER": �I�JC4��1�Q � _�V C 1���' ���r�1Vt�O name -- t� homnc phone# work phone# CURRENT MAILING ADDRESS: n( 1(1nL� AkrA 01 (anC i.ty/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 individuahfor hire who does not possess a license,provided that the owner acts as - supervisor, DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/sha shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and re uirements. / `Signature bf 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 perfomung 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 parson(s)for hire to do such �^ work, that such Homeowner shall act as supervisor." Many homeowners who use this exemption ase 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 homeownu 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 forrn/certification for use in your community. 1 °F�HEr Town of Barnstable Regulatory Services! B.ARNSTABLE� Y - Thomas F. Geiler, Director -ljA i634. �4, .. TFb,r,N�a $uilding.Divisio Tom Perry, Building Com ssioner 200 Main Street, Hyannis, A 02601 www.town.barnst le.ma.us Office: 508-862- 038 Fax: 508-790-6230 r plroper�t Owner Must Complete and Sign. This Section Zf Using .A BuEdet r , as Owner of the subject property V hereby authorize to act on my behalf, in all.matters relative to wok au orized by this building permit application for: (Address�of Job) Signature of O aer Date print Name If Property Owner is applying for permit please complete the Homeoamers License Exemption Form on th'e reverse side. OFIME r Town of Barnstable Regulatory Services " '` Thomas F.Geiler,Director v buss. $ �p 039. �0 rEp�,,orA Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 December 6, 2006 Januario Viana 740 Old Stage Road Centerville, MA 02632 Re: Illegal Apartment: 740 Old Stage Road Centerville, MA 02601 Map: 191 Parcel: 114 Our records indicate that your house at the above-referenced location is currently being used as a multi-family home, which is contrary to Barnstable Zoning Ordinances. Violation of zoning ordinances is a misdemeanor, conviction for which results in a criminal record. You must contact this office within 14 days to either: • Apply for a building permit to restore the property to a one-family home • Apply to the Amnesty Program • Prove that this is a legal multi-family home. Please contact this office immediately to tell us what direction you wish to take. Si cere , L' a Edson Amnesty Zoning Enforcement Officer Building Department gforms:zoning3 h pFfNE T Town of Barnstable Regulatory Services r + MASS, ` Thomas F.Geiler,Director .e�ep MA'S a � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 December 13,2006 Januario Viana 740 Old Stage Rd. Centerville, MA 02632 RE: EXIT ORDER 740 Old Stage Rd. Map : 191 Parcel : 114 Dear Property Owner/Occupant Recently, an inspection of the above premise revealed that the basement was being used as a sleeping area. In accordance with 780 CMR 3400.5 you.are notified that the basement is declared dangerous and unsafe and its use for sleeping must cease immediately. Additionally, the basement has had work done without the benefit of permits. You must either remove the unpermitted work or obtain the proper permits and subsequent inspections..You may call(508) 862-4034 with any questions regarding this matter. Thank you for your anticipated cooperation in this matter. By Order, Mey'L. Lauzon Local Inspector Q:zoning5 Parcel Detail Page 1 of 3 f -- , 4 ..................... ... Logged In As: DetailParcel Wednesday, Decem Parcel lookup Parcellnfo .. ........ ......... .... ................................ Parcel ID 191-114 DevelopeoY!LOT 67 Location :740 OLD STAGE ROAD Pri Frontage 272 Sec Road Sec Frontage ......... ......... ............. ......... .... _.. ............ village CENTERVILLE _ Fire District C-O-MM ......... ......... ....... ..._..... ......... Sewer Acct Road Index 1174 X,ff Interactive ; Owner Info ...... Owner;VIANA, JANUARIO JOSE Co-owner'%DOMINGOS, GENUINA A .... ......... ....... ........... .. ......... ................... .... Streetl i740 OLD STAGE RD Street2 City=CENTERVILLE State MA zip 02632 Country Land Info __._....... ...... ......... Acres,0.40 use'Single Fam MDL-01 Zoning RC Nghbd 0105 Topography,Level Roadl Paved Utilities;Public Water,Gas,Septic Location Construction Info Building 1 of Year" RooR0°f-Gable/Hip weu!Wood Shingle Built= Struct Effect--' ................................. Roof ' F ''s/,"' ,.. p AC None, Area #1675 Cover Asph/ G ICm Type Style Ranch wan Drywall Rooms 2 Bedrooms _ .. Model Residential Floor= Rooms,2 Full Grade;Average Type Hot Water Total Rooms 5 RoomsLl http://issql/intranet/propdata/ParcelDetail.aspx?ID=13438 12/6/2006 Parcel Detail Page 2 of 3 word£ _......... Heat Found- _ Stories 1 Story OII ETyplcal _ Fuel ation u Permit History Issue Date Purpose Permit# Amount Insp Date Comments Visit History Date Who Purpose 1/6/2006 12:00:00 AM Paul Talbot Meas/Est 1/20/2000 12:00:00 AM Paul Talbot Meas/Listed Sales History . .._.__ Line Sale Date Owner Book/Page Sale P 1 6/7/2005 VIANA, JANUARIO JOSE 19907/169 2 7/29/2004 PRIORITY ONE PROPERTIES, LLC 18877/054 3 4/28/1998 BOUDREAU, ROBERT F JR 11388/054 4 8/14/1997 YEU, YOUN OK 10899/027 5 3/15/1987 DAEKI, CHOI &YEU, S W&YO 5603/067 6 10/15/1986 KERVIN, RICHARD C & 5373/079 7 SERETTO, MICHAEL &AGNES 2672/153 8 2/23/2006 DOMINGOS, GENUINA A 20763/222 Assessment History _ ._ ........ _..._.. ......... ....... ......... ......... ......... Save# Year Building Value XF Value OB Value Land Value Total Parc€ 1 2006 $139,500 $2,600 $700 $153,200 2 2005 $131,300 $2,600 $700 $118,100 3 2004 $106,700 $2,600 $700 $118,100 4 2003 $96,800 $2,600 $700 $46,200 5 2002 $96,800 $2,600 $700 $46,200 6 2001 $96,800 $2,600 $700 $46,200 7 2000 $73,300 $2,400 $0 $31,500 8 1999 $73,300 $2,400 $0 $31,500 9 1998 $73,300 $2,400 $0 $31,500 10 1997 $79,600 $0 $0 $28,000 http://issql/Intranet/propdata/ParcelDetail.aspx?ID=13438 12/6/2006 Parcel Detail Page 3 of 3 s 11 1996 $79,600 $0 $0 $28,000 12 1995 $79,600 $0 $0 $28,000 13 1994 $75,000 $0 $0 $34,700 14 1993 $75,000 $0 $0 $34,700 15 1992 $85,400 $0 $0 $38,500 16 1991 $87,900 $0 $0 $56,000 17 1990 $87,900 $0 $0 $56,000 18 1989 $87,900 $0 $0 $56,000 19 1988 $62,400 $0 $0 $20,500 20 1987 $62,400 $0 $0 $20,500 21 1986 $62,400 $0 $0 $20,500 Photos http://issgl/intranct/propdata/ParcelDetail.aspx?ID=13438 12/6/2006 ®rc_ � N�` AM W - r� � � •7 '+'t H• +fit_ �o,R r • pE�.•,.. I�{z� { - _ Rb�� �?' h'.� ` v y �, �qr;�ti � Y e � .q�;`'�•-`19�',Y 1 �'•�'�� , �� •`�" A1�.�� / �rt. ,a t�}« ; rw ,. :�t,► �t �'. � s �.�...9,vc +t{�l d� tR � a �C, � � ` eN ' ..yr .-a .�s� „ •Y�� '• ! _ti ' g•Y�YY.a.a.,., � ` tv-. �j •a���•�r>'�'■ ..yr�•'}�'Ys.\,!� Z'�d7t'�. 11 •I`�r� 1.. �7.�1.� T`S(lI7i _.-.Pr• . s-•'t ya ''' aK.r ► a ' � r r sir rA P � �; Yr �. .ia Ali Y yy.j� M Sa , k , ,y a ' f , r� ram. . . f y a r ' _ � 4 k �i '"t.�r..�.c•i x.X ,.r x I J _ 740 Old Stage Rd., Centerville 12/6/06 �. �1� — r Y L { J� 14 �__ /_� �� .ti._ .��� _ �'�� �/� s d �, -�� �� �,ry, V J ', ,,, w '4 �r . � "v�.w. �i.1 �. .. .... mm P lV � i.i "� ,. l ��� a ��� '���� ��s •�`,.,.., �..d � ��. momm* y. , �r , �a r K �� i::�• �. Y, � r ey, r Y k 4,1 � : s�- :. � �`�, r �� Ti 1s�a'. � �i .ry:, ;� f f, �� I J � _ y .. �.;. e..'. r+ F ; � � fj �`a f� :, '� � �� ,,� �, � . . ----.. --,��__.__._.,. ,_, —,-__ j � i ° � N O u r , ` r w t - �: t F � �� ... 740 Old Stage Rd., Centerville 12/6/06 i � 1 1 . V t ,;tee , - 740 Old Stage Rd., Centerville 12/6/06 f i t` / 4 � 1� 4 r 1 ' 740 Old Stage Rd., Centerville 12/6/06 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map pp lolI Parcel Application# C�6 04 6W�1 Health Division Conservation Division Permit# BZaCi,;i_ayo Tax Collector " - Date Issued 112,12,2lU1 Treasurer Application Fee Planning Dept. - Permit Fee �Z3. Date Definitive Plan Approved by Planning Board ��-�3� o Historic-OKH Preservation/Hyannis 3 AAAM Project Street Address OLdSTcl a Village C c, Owner 1 Addresses Telephone 0 8 — ALA q 3 Permit Request 4 iI 151%.%t_ cc n � a � �d 10 2. �ilX �C V Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District CID Flood Plain Groundwater Overlay Project Valuation 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 Historic House: ❑Yes XNo On Old King's Highway: ❑Yes �<No Basement Type:XFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) C)00 4P Basement Unfinished Area(sq.ft) Number of Baths: Full:existing 6Z new Half:existing new Number of Bedrooms: existing 02 new Total Room Count(not including baths):existing new First Floor Room Count k.. Heat Type and Fuel: ❑Gas Oil ❑Electric ❑Other Central Air: ❑Yes )No Fireplaces: Existing New Existing wood/coal stove: ❑Yes XINO t« Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new-;size:,'. Attached garageX. existing ❑new size Shed existing ❑new size Other. ' r...T _ �r i-2` cam, ED Zoning Board of Appeals Authorization Cl Appeal# Recorded❑ --` Commercial ❑Yes ❑No If yes,site plan review# xy Current Use Proposed Use r BUILDER INFORMATION Name �NGL`0 Ar- �+`�5 � Telephone Number S �� Address -7 q License# Home Improvement Contractor# I Worker's Compensation# ` ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �`/1�d 1A 11— 1 i�IG'o S DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE--ISSUED ?4AP/PARCEL NO. ADDRESS VILLAGE f - r y OWNER } J DATE OF INSPECTION: FOUNDATION 2 107 FRAME INSULATION : FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' FINAL BUILDING DATE CLOSED OUT 1 ASSOCIATION PLAN NO. ` s :{ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): . 143 MA 6 Address: '1 `® ®Z,Ck., a� _ G.aN 61" (. T" 0_q%� �W- Phone.#: �O� — �� 1 O� City/State/Zip: C N 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-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. %Remodeling ship and have no employees These sub-contractors have g•.&Demolition ' workingfor me in an capacity. employees and have workers' Y. P tY 9. ❑Building addition [No workers' comp.insurance comp. insurance. (equiredo . 5We are a corporation and its l0lectrical repairs or additions ] officers have exercised their 11. lumbin re airs or additions amahmeowner doing all`work g P yself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.[-] Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance"for my employees. Below is.the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/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 herebycoertify under the pains-andpenalltti'ess ofperjury that the information provided above is true and correct. Si 1 gnature: X //� C�1�1�1 '�i�m i of 6-o5 Date: Phone# S O0 c.180 1 O3-0 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5..Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for eir employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any c ntract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased mployer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing emp ees. However the owner f a dwellin house having not more than three apartments and who resides therein,or occupant of the own o g g P dwelling house of another who employs persons to do maintenance,construction or repair w k on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be eemed to be an employer." MGL chapter 152, 6§2 G(6)also states that"every state or local licensing agency shall ithhold the issuance or renewal of a license or p mit to operate a business.or to construct buildings in th commonwealth for any applicant who has not pro \§25C(7) ptable evidence of compliance with the insu nee coverage required." Additionally,MGL chapter 1 states"Neither the commonwealth nor an of its political subdivisions shall enter into any contract for.thnce of public work until acceptable eviden of compliance with the insurance •requirements of this chapter presented to the contracting authority." Applicants Please fill out the workers' compensation affi vit completely,by checkin the boxes that apply to your situation and, if necessary,supply sub-contiactor(s)name(s),ad dr s(es)and phone n er(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or L ted Liability rtnerships(LLP)with no employees other than the members or partners, are not required to carry workers' ompe on insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affida ' ay be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also s e to sign and date the affidavit. 'The affidavit should be returned to the city or town that the application for t permit. license is being requested,not the Department of Industrial Accidents. Should Y you have an questions egarding the 1 or if you are required to obtain a workers' Y compensation policy,please call the Department a e number listed be w. Self-insured companies should enter their self-insurance license number on the appropriate me. City or Town Officials Please be sure that the affidavit is complete zandprinted legibly. The Department ha rovided a_space at the bottom of the affidavit for you to fill out in the evnt the Office of Investigations has to contact regarding the applicant. Please be sure to fill in the permit/licens number which will be used as a reference number. addition, an applicant that must submit multiple permit/licens applications in any given year,need only submit one a idavit indicating current policy information(if necessary)and.under"Job Site Address"the applicant should write"all loc 'ons in . (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may b rovided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be lied out each year.Where a home owner or cittaen is obtaining a license or permit not related to any business or commer ' 1 venture (i.e. a dog license or permits urn 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 tgtive 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, ILIA 02111 Tel. ##617-727-4900 ext 406 or 1-877-NIASSAFE Fax##617-727-7749 Revised 11-22-06 www-.mass.gov/dia r -1VVTJ.l V1 J.PaAAA04LlAJl%;i f o� Regulatory Services Geller Director y,;eysrae�,$+ Thomas T. , Cuss. 9�'°lED 19, �,� Building Division Tom.Perry,Building Commissioner 200 Main Street, Hyamiis,MA 02601 www.town.,barnstable.ma.us Face: 508-8624038 Fax. 508-190-6230 Permit no. '�pO(0 S �' Date . . AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requites 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 adj acent to \ such residence or building be done by registered contractors,with certain exceptions,along vsdth other requirements. 0 � ;'w X S�� /� � Estimated Cost /7� Type of Work: t Address of Wonk:. -7qO Owner's Name: V).nl A. Date of Application: Z'18 I hereby-certify that: Registration is not required for the following reasons): j []Work excluded by law FIJob Under$1,000 4 []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: Date Contractor Signature Registration No. 42--1Lo(, ll4 NLI I�v6.0 Owner's Signature Date Q;wpfnes.forms:homezffi day Rev: 060606 1. t o��► ,�, Town'of Barnstable Regulatory Services $nxNsrasLe Thomas F. Geller,Director RAS& �p�fn►%6.39. wilding Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-79076230 Property Owner Must Complete and Sign This Section If Using A Builder I, �E 0 U-1 n1 Pr �`(�1 NY&O ,as Owner of the subject property hereby authorize per,�� `�U to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) LL7-" A62V U J —Lxyr t Signature of Owner Date s Print Name Q:F0RMS:0VINERPERMISSI0N i Ott) snprC CrC(4 (�. _DC C, W AWN . o �C- IN3E� C V6 fi r ti SIP, z rJ vouJ � rs� si� At) move m� At �`� b it ?o-Al- © '100 (40 t xT�R�o�• w� — rNs�l�T'���I �Z-13 '' �Eino��' �S��i N fr° '��'. �, m�rtCe� �� W i�.. pj.�IV�n►(i°-� -eou� our cp6i'pzTs N!� I W O�N�N6-- 5,.-� Remove iDe E��S�N(ram - � `1 , ®. 6 uu1 mow F,x%S"t j N�RA-mc..�. t- B,Lt� oN his'; �►ct Nap, ;ern► ( -. .� F��� '7qo out, , esn - e.�jT [.� - asot®`0 Town of Barnstable �oFT�'°wti Regulatory Services BARNSTABLM Thomas F.Geiler,Director MASS, %639n. ,• Building Division rED MA't A 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: I "® J ABC N 1 C ►� number street village W be "HOMEO NER": U bN U 1 N A- (m'N GNS Sbe —2$10 l_0_+0 name home phone# work phone# CURRENT MAILING ADDRESS: �1'YtC city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt Town of Barnstable yP °� Regulatory Services MASS' MASS. Thomas F. Geiler,Director 9 Building Division Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: born i VX45 Map/Parcel: 19 ) )l q Project Address `7 0 04 S-�MGe. Fd Builder: ner- The following items were noted on reviewing: 3 � �0 6�' o-�\ rZQwS e FZnj-,i�SHED (-oRY0'-kS 1. o Cc 'ej 0 X4N\(V Ur- �-Q r J 1f8 ,-s opy, TO co-4 o4e4- C Reviewed by: UU Date: I Z - zl Q:Forms:Plnrvw r Crossen Ralph From: Lomba Lois To: Crossen Ralph Subject: 740 Old Stage Road=Complaint Date: Thursday, May 11, 2000 4:08PM Priority: High Hello Ralph -today on my voice mail I received a complaint from Carol Hagerty, telephone number 771-6718. She complained of part-time mechanical work being done on vehicles at 740 Old Stage Road. Tom asks that you please investigate the matter. Thank you. Page 1 Assessor's map and lot._number ..,L... /.:......'.!. ..... . V a- c ' Sewagey-�' ermJit number „"„.......:...... :..... . 1 SEPTIC SYSTEM MUS T ICE THE 11 E- I �. a � T TOWN O F �B A R N TATB"L� yjP>sIANC . OTATE y . .:, t SANIT'4-: Y CODE P.iND TOWN SS LE, - SAAN TAD i ^ BUJLMNG INSPECTOR APPLICATION FOR. PERMIT TO ...... X.... . E .....< �. ........................ TYPE OF,CONSTRUCTION ... ....... :d.. .. ...................... ..............19 7.? TO THE INSPECTOR OF BUILDINGS: The undersi ne hereby armies for a permit according to the following infor ation: / / �-Tj /' 4 .. Location ....................1............V.".��:................ Proposed Use ..... J .. ................. ........................................................................................................................................ l.N..: Zoning District .:. ./. .' ' ..........Fire District Name of Owner ..... i:...............Address �K/L.................................. Nameof Builder .....................................................................Address .................................................................................... Nameof Architect ............................................................:.....Address ...........................:......................................................:. Numberof Rooms ............... ...................:............................Foundation .............Jr d. .. .................................................. �:. /. .........................................Roofin �� i .. Exterior ................. g ............................. Floorsv, �.. :. Interior .............�� '.ZGt�....'e:..�................................ ........... ,1............................... ..., ' Heating / = UU...fl.,!�...'. �/.........................:Plumbing j ... Fireplace .......................................................................:..........Approximate Cost ...... 00 O ...................................^................ Definitive Plan Approved by Planning Board ________________________________19________. Area ..................`...... ............ Diagram of Lot and Building with Dimensions ��— Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH • I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardp*ng the abov construction. Name ........................ ..... 1r�,,� . ....... Capevide Development one story N10fi 19122 Permit for ..... ........................... ingle family dwelling . ............ ... ..Location ........I ix Old' StageRo �.. . .................................. .......... ......... Centerville .................................................................... ........... Owner ...............C.a.pew.i.de..D.e.velo.pment .. . ...... . .... .. . ........ ................. Type of Construction .........frane, . ................................. T .............................................................. "Plot ............................ Lot ..........#67 ...................... April 19,1 19 77 Permit Granted ........................................ Date of Inspection .4 V.. L A........19--; Completed ... r Date Corn .........................*A 9 PERMIT REFUSED ...................................I.........:..................... 19 .................................................................................. ............................................................................... ............................................ .................................. ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... e� C ' 1 1 e,A 44 P 1T tapy!i� • - _ [s{'1��ej[[ � _ � �oli�iM'tbrl -il!" `Nk�. a= .,_ • !Mny,§4;4& N. F • ' � t. i �h?LJ'4 , �� �d is . � - I - � � t ' ' � '{ ' �l.Y as � • +'^ • { .. `• _ • /{,vim + � �. + ' N v Y+ k ,V��' Y LGCATIC}t-4 -77 Csi Tt. w�{ r- ri bow ri :� a e�t5c o,;v PtT �► R t� �.tc AWC> Seitz ACV- VC-4UUl4.Sv E"TS'aF ;rNC- P 40 BAA Et2. . .__r__ _ G?S-TF��/k -LG o kCASri italSMUAASt,IT ' ZVr-4' 1t-'Nr--- OtrC'SE--T-� SE-ioww APPL4 C�►.h.�T' �^ p _ r : .- ____ t_ tit t �fe n .. N Y • , T _ z i F n 1 - - .. i , t .. .,: .. ,. _ .:., .- .. _. �d•- - .��'�.="�-a:.-'tG..�..._�=`,�`^_.—�C.—..�' ��'_—cam._..—.`=_::�___..__ _ ....:�_d�a"`,�Su: t r � o. A_wv.,_ KTA e .__... �_.*-_. 1 2 PT : - — a r a. . TOP AM _ 3 W - ��,'�•i �4 1 } :S ' X n AnQ Av A .. x- a� 4 7 . p �I