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HomeMy WebLinkAbout0020 OUTPOST LANE © "TO S) a � ' - o n a r< , f 3�ZZ1,1 ilk- Town of Barnstable *Permit' tFiE�, ��� �� Exp' months from issue 14117regulatory Services MASS. & Thomas F.Geiler,Director 16gq- Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town barnstable ma us Office: 508-862-4038. Fax:.508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address o 0 \wA Residential Value of Work (.z,j;®0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address . �-tA '� Contractor's Name \� Telephone Number �� ',— F'`1 ki Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) O_,'!>gC) Vorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name tj4A-4p Workman's Comp.Policy# U �SA C„ C( 1� oq Copy of Insurance Compliance CertiNcate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) &Re-side #of doors Replacement Windows/doors/sliders.U-Value %� o (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. . Separate Electrical&Fire Permits.required. *where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner piust sign Property Owner Letter of Permission. copy of Ve � ovement Contractors License&Construction Supervisors.License is equ ed. SIGNATURE: ..:nmi-rrnrnrnn�.GeV...:7A:......A....itfn..:.c\FYPRFS. nc The Commonwealth Q,f massachuseft Department o,f Indushiad-4cdde Ofi$ce o investiga io= 600 Washbipon Street Boston,Md #211.1 . wrc'wJn grrvldia Workers' Compensafion Insurance Affidavit BmId�ers/Conti actorslE•��ectric.ans(Pl�mbers Applicant Information Please Print,I: . b.lv Name{Bu O tion/lndividnal)= V—� Address: Ct, city/state/zip- -etit e �. Phone#: Are you an employer?Cherk the appropriate bon Type of project(required): 1.M'I am a employer with�— 4. ❑ I am a general contractor and 1 6- ❑Newt cam*ucfion employees{fall andl+or pair#-time}.* have hired the sub-contactim ❑ I am a sole prognietoi or partner- listed on the attached sheet 7- PjRemodel ng sbip.and have no employees These sub-contractors have S. ❑Demoliticia wc&ng for me in any capacity. employees and have wo Beers g. ❑Building addition [NO wodars'comp-insurance comp.insurance., required] 5. ❑ We we a corporation and its 10.❑Electrical repairs or additions I❑ I am a homeowner doing all work officers have exercised heir 1 l-❑Plumbing repairs or additaons of art per IYIGL myself.[No workrss'comp- �we have no 12.❑Roof repairs incrurRrace required.]T c.152, yl(4), 1I.0 Other employees_[No wwken' comp.insurance required.}. 'Any app�md thatcliecim box#1 mast also fill am the section belowshoaring theirwaiers'cflmpensationpolicy inf�stio� Y Homeowners who submit this LTI&wd md1ccaaag they ne-doing sfi wod ed then hire outside corers mast submit a new affidavit indicating such. Icantraclars d ar check this box mast attached an additional shen daosfng the name of the mb-cn atmcwn and state whether or notfose entities have emr loyem. Iftbe suh-co is have emplapees,they amst praaide their W-06 a ramp.policy number- I sin arc erinplrr��sr iftrrt isprovidirig wonkFrs'cttnrpsr�sr>7iotr iirsarrurc-a�or rriy'arrtFFa3 Barr is ties polir.��aril jab site informr den . Insurance Compaay Name: Policy#or.Set€ins.Lc,# y �l t� ©� ` �o� E*Mfiou Date: a Job Site Addrew:_a-0 ©J P0"L"k V.A to�P City�state/Zip: Q-QpkVQVI v.\l e A.tiach a copy of the workers'ca mpn-sation policy declaration p2ge(showing the policy amber 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 andlor one-year imprisonment,as well as civil penalties in ffie form of a STOP WORD 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 Im— st gatiow of the DIA for insurance cm-erage ved&adan- I do hereby rtr;y ndsr tlra xri 's rrf urp A&the irrforaidia n prrmded above is true and correct hate' _ ^ � Phone# O OjyWal uses only. Do not snits in this areY4 to be cmpletetd by city or temajoYciaL . City or Toucan• PerzribUcense# Issuing Authority(circle one): _ L.Board.of Health y.Budding Deparhamt 3. I)'ostisn Clerk 4.Electrioral Inspector �.Ph btug Inspector 6.der.. :... 9� 1639: ,�� Town of Barnstable .. . prEp Mp`l A Regulatory Services Thomas F.Geiler,Director. Building Division Thomas Perry,CBO Building Commissioner 200 Main.Street,' Hyannis,MA 02601 www.town.barrtstable.ma'.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize -Qi to act on my behalf, in all matters relative to work authorized by this bui,4 permit application for. G C�.J (Address of Job) e Signature of Owner Date 1 Print Name If Property p rty Owner is applying for permit,please complete the Homeowners License Exemption Form on,the reverse side. Q:\WPFILESTORMS\building permit forms\EXPRESS.doC 1 oFtHME> Town of Barnstable ' Regulatory Services BARN TAB Thomas F.Geiler,Director 1639- Building Division Tom Perry,Building Co missioner 200 Main Street, Hyanni MA 02601 www.town.barnsta le.ma.us Office:. 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENS EXEMPTION Please Prin DATE: JOB LOCATION: number street village "HOMEOWNER": : name home`phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to includ owner-occu ied ellin s of six units or less and to allow homeowners to engage an individual for hire who does not posses a license, providedNhat the owner acts as supervisor. DEFINITION F HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or i tends to reside,on which family dwelling,attached or detached structures accessory to suc use and/or farm structure A person who constructs more than one . there is, or is intended to be, a one or two- , home in a two-year period shall not be considered a homeowner. Such"homeowner"shall su it to the Building Official on a form acceptable to the Building Official,that he/she shall be res onsi le for all such work perff ormed `der the building permit. (Section 109.1.1) The undersigned "homeowner"assumes responsibility for corn iance with the State Building Code d'other applicable codes, bylaws, rules and regulations. The undersigned"homeowner"certifies that he/she understand the Town of Barnstable Building Departm i minimum inspection procedures and.requirements and that he/she will comply with iid 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 Stat Building Code Section 127.0 Construction Control. HOMEOWT ER'S EXEMPTION t The Code states that: "Any homeowner performing work for which la building permit is required shall be exempt from the provisions of th' section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeown r engages a person(s)for hire to do such work,that such Horrieo shall act as supervisor." Many homeowners who use this exemption are unaware that they a assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness o n results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it wo d 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. . CERTIFICATE OF LIABILITY INSURANCE DATE11/07/ D/YYYYI 2012 FICATE 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: 27JDD PHONE FAX NORTHWOOD ESHBAUGH INS A (A/C,No,Ext): (AIC,No): 540 IVLAIN STREET E-MAIL HYANMS,MA 02601 ADDRESS: 73K60 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AME ICA DEAN F STANLEY BUILDING CONTRACTOR INC INSURER B: INSURER C: INSURER D: 359 CAPT LIJAHS ROAD INSURER E: CENTERVILLE,MA 02632 INSURER F: 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 CONDmON 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 CLANGS. INSR ADD SUB'i POLICY EFF DATE POLICY EXP DATE LTR - TYPE OF INSURANCE L R POLICY NUMBER (MIwD%YYYY) (MMIDDIYYYY) LIMQTS GENERAL LIABILITY ;ACH OCCURRENCE g COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR. REMISES.(Ea occurrence) MED EXP(Any one person) $ ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: EIUERAL AGGREGATE $ POLICY []PROJECT❑LOC RODUCTS-COMP/0P AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETEIITION S $ A WORKER'S COMPENSATION AND WC STATUTORY 3 OTHER EMPLOYER'S LIABILITY YIN UB-4569PO81-12 10/05/2012 101OR-Im13 x LIMITS ANY PROPERITORPi1RTIIER!P-I ECUTIVE NIA E.LEACH ACCIDENT $ 100;000 OFFICEPJMEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 100,000 If yes,desaDESCRIPTION under EL DISEASE-POLICY LIMIT $. 500,000 DESCRIPTIOIU Or OPERATIONS below DESCRIPTION OF OPERA'(ONS/LOCATIONSIVEHICLESIRESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDEP AFFECTING WORKERS COMP COVERAGE CERTIFICATE HOLDER CANCELLATION ' TOINrN OF BAMSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED BUILDING DEPT IN ACCORDANCE WITH THE POLICY PROVISIONS. 230 IviAIN ST AUTHORIZED REPRESENT WE t d HYANNIS,MA 02601 � r. � ..� ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. Doc 0 1 :221 v 1S1 '05-14-2013 3=27 t f�a-00336 BARNSTABLE LAND COURT REGISTRY QUITCLAIMM DEED VANESSA LENCEWICZ, being unmarried, of Su nmerfield, FL In consideration paid of$165,000.00 grant to DEAN STANLEY of 359 Cap'n Lijah's Way, Centerville, MA 02632 With QUITCLAIM COVENANTS A certain parcel of land with the buildings thereon. situated on Outpost Land, Barnstable (Centerville), Barnstable County Massachusetts being shown.as follows: LOT 34 on Land Court Plan 32851-B (Sheet 1) Subject to all rights, restrictions, easements and reservations insofar as the same are in force and applicable. Being the same premises conveyed in Certificate No. 156451. See also the Estate of.Janice Helene Lencewicz Barnstable Probate No. BA101`1866EA. See also Certificate No. PROPERTY ADDRESS: 20 Outpost Lane, Centerville,MA f !t . Executed as a sealed instrument.this /� day of May, 2013. Vanessa Lencewicz STATE OF FLORIDA County of On this day of May, 20.13, before me, the undersigned notary public,personally appeared Vanessa Lencewicz proved to me through-satisfactory evidence of identification, which was D L K X—'�Q 9--I y to be the person whose name is signed on the preceding or attached document; and acknowledge to me that she signed it voluntarily and for its stated purpose. ('141 Y.a+^a�s.�'Ycet'Y.:cczYaGSar.?._ �y . FiDIAf�'FTANCfflt.ifNC -- .c� kce�U Irk�-, Notary Public,State of Florida , Notary Public: y mM.')SiOnh�Ezoa413 My Commission Expires:(jW a y f r 1�y comet.E3x�ires Aug.24,2014 ' t Office of ConsumerAffairs&B�idess Regulation ^��ME IMPROVEMENT CONT License or registration valid for individul use only I a egistration 132149 RACTOR before the expiration date.I ® xpiration 8/2019 TYPe: If found return to: Office of Consumer Affairs and Business Regulation Individual 10 Park Plaza DEAN F.STANLEY _ Suite 5170 Boston,MA 02116 DEAN STANLEY �,011- '121 _ I ` 359 CAPT. LIJAH RD c'G': CENTERVILLE,MA 02632``t_' "`'3y 4�- Undersecretary ZNot valid without signature +� Massachusetts-Department of Public Safety ulations and Standards �l Board of Building Reg f Construction Super)isur License: CS-035037 . CYO Is r� DEAN F STAN1✓ Y 1,y�AIiRD ._ TAILS , 4 359 CAP - �k_ ;-, E MA02632 . CENTERYIL Expiration . C J 01/19 I20U Commissioner 9 J BujIdM9iJeParuu=L Complaint/rnquirp Report _ Assessor's No: a G Date: G Rec'd by: 'Complaint Name:- Location Address: -� M/P Originator Name; Street: Vim: State: gyp: Telephone:D/E Complaint Description: Inquiry Description: For Offibe Use 0AIr Inspector's Z -� Specor.t Action/Comments Dace: r Follow-up Action Additional Info. Attached Cop}•Disa7buaon: WIuOe-DepanmentFdc fellow-Inspector Fink-Inspector(Return to Office Manager) a. 1-7 Assessor's map and lot number .................................:.......: (; � MUST BE INSTALLED IN COMPLIANCE Sewage Permit number .....:.....7 ..................................... WITH ARTnUE PI STATE SAP411TARY CODE AND TOWN �QypiTHErO�o TOW N OF BAR:N IBLE • BARNSTABLE. i 0 UPI�`' BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........... ........................................Al. ...... .........................�........ ............... TYPE OF CONSTRUCTION ................. . U..... ..............91..L/ 020 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a p mit according to the following information: Location ..I . ............3..L 1,....;......... .'.... �..........:.... . . .... .. .... ... . .............................. 1 ' Proposed Use ...... ........ ...... IN.Q .A. ............................ . .................................................................... ZoningDistrict ......... ...........................................................Fire District �. .�.......... ................................... Name of Owner . - ........ ... ...,. ......w.... .. ..... ..............Address ..-.. Name of Builder .. . ........ .. .4! rn�t....Address ...`4 ....... ......... .... ... _ yr' Nameof Architect Address.. . . . . . . ..........................................,.......1.................................... Number of Rooms .........(.....................................................Foundation .... N��� .:...W .... . ...................... Exterior ....W.,�. .. . .....I`�4�"':`4A...................................Roofing ......... ...... ....... ........................................................... Floors ..............................................Interior ............... Heating — Plumbing .. - .....( ? ,?........................................... ................... . '`Y`............... Fireplace ........................I.........................................................Approximate. Cost ......4..D,.2—,,.Q...0-0............................. Definitive Plan Approved by Planning Board -----------_-------------------19________. Area ....r.... .... ....... Diagram of Lot and Building with Dimensions Fee ��...................... ........... .......... .. SUBJECT TO APPROVAL OF BOARD OF HEALTH Z ' 4 (J ,V a J F-- I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name PP ..4. ..`V�: ..� ............ .......... .... .. ..... Robert 'West D, No .:6g15........ Permit for .......Doaell.ng........... Residential Home .......................................... ..................... Out ost Location ........ ........ .......... t....,3k................ Centerville- E ............................................................................... Owner Robert D...... Jest,.................................. j Type of Construction ........Wood..Vrme............ ................................................................................ Plot ....17Z.......12Q. . Lot .. ...34....................... ' February Permit Granted ...............................2 ..... 74 Date of Inspection Date Completed ..1.:�/..��// L............19 I PERMIT REFUSED ................................................................ 19 ............................................................................... ............................................................................... ............................................................................... ............................................................................... Approved ................................................. 19 ............................................................................... ..................... ......................................................... I I ( FEE F TOWN- = BARNSTABLE, MASS. d� p d 19 O UA•k THIS IS TO CERTIFY THAT A PERMIT IS HEREBY GRANTED TO o O (PROPERTY OWNER) (ADDRESS) oti 3 TO ................................................................................_........._........................—_-._... E'( „� •O (BUILD) (A LT ) (REPAIR) d,ca� � .........................................................................................................................................._...z .............................. ........................................................................._...._---_._......._ O C (TYPE OF BUILDING) (APPROXIMATE SIZE) v M o b°p LOCATION .............................................................................._......................._...« ..._...................................................................... _.. ...._._._......._._...._ (STREET AND NUMBER) (VILLAGE) NAMEOF BUILDER OR CONTRACTOR __..____. _ ..__......_._......_...__._.............._......_. . ..._......__...._._.__........._...__._............ ., (� A U O d Q APPROXIMATE COST w eom I HEREBY AGREE TO CONFORM TO ALL THE RULES AND REGULATIONS OF THE TOWN OF BARNSTABJ`E, REGARDING THE ABOVE CONSTRUCTION. / ..._....._................._...__................................................................ .......__............._............................................._............................................................................... h d (OWNER) (CONTRACTOR) 0 O O ..' O _....._._.............._................__................................._._.................................................................................... � a BUILDING INSPECTOR Subject to Approval of Board of Health. r i� r a .... .a a .. �- , III ..,....-._ ��. .. _ 4�e �p � {• \1 a. n ` �• •,!°d +a fie• _ ::. - .,