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0025 SOUTHWINDS CIRCLE
'R , lC rd tA� LOn ....._.�. ��_ .y.,. ,, . I I A CL - � ): I � � I . � I IL I I I I� . I . � ��� , —NVLI J, ,,—-- `' �. '" Qr`'C(?{ vie �l NE , .y. ..� - ,-.i ., - .,:, :: ... " _. .. .:;: �. P Y. v ._ r. r ,� .....- ... - . = ,: ,'..,. , _ .< l . tl �'„ .- ———� 1\ .. m .:a.' :. ' Parcel Detail Page 1 of 2 �f M E b=7 - ✓CASK u O 3 � _ - •; � Logged In As: Tuesday,September 4 2018 Parcel Detail . Parcel Lookup �.,."Parcel Info,..__.. Parcel 226-160-OOA I condo IUNIT 25., ID h Unit Cond 25 7 SOUTHWINDS CII Uilding Coml I Location`25 SOUTHWINDS GIRC Frontaci Pr, M4 Sec Road se ._._.._ , Fronta villageCenterville Disc Fir ,C O-MM A, Road Town sewer exists at this address ENO Inde 1923 - t nteractry 3 Owner Info .... ..,,& ., Owner BURNS, MOY T&JOHNI'owner Streetl t563 CHESTNUT STREE�street2 I - utyNEEDHAM I state MA I zip�02492 country l ..... ............. ......... ............ __ ..... ......... Land Info .. ... Acres 0 l Use Condominium MDL-05 l Zoning CBDCB I Nghbd D001 Topography Road Utilities ........ . Location ..~., I Construction Info .. ......... ....... ......... ........ .......... .. ...................................... Building 1 of 1 Beat»1950 Struct Gable/Hi�p » wa l rWood Shingle a l LivingArea 650.w. Kw�� cover Asph/F GIs/Cmp Type None Style gCondominium Int D all— � Bed�2 Be rd ooms f Wall Rooms Model y es Condo m FI o� Carpet R o th 11V Half�w Full-0 ^ Grade Average TYPe gHot Water Rooms 4 stones r1�Story feel i ai_ Found-, `Blk/POur FtgS Gross Area > Permit History _... ._, _„. ,. ......_: Issue Date Purpose Permit# Amount Insp Date Comments 9/12/2016 Insulation 16-2455 $4,665 Weatherization • Visit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=107269 9/4/2018 Parcel Detail Page 2 of 2 Date Who Purpose 6/15/2015 12:00:00 AM Tony Podlesney. In Office Review 12/10/2014 12:00:00 AM Tony Podlesney In Office Review 11/21/2014 12:00:0O AM Susan Ricci Cyclical Inspection 12/5/2013 12:00:00 AM Tony Podlesney. In Office Review ..............................._......_........___..........._---_......_._..............................__.....__._............___.............__..__............_:._........._._...._...._._.._........_..---.........._.......__.__._......_.... _...:_:.............___-.......:_ _......_.............__..._......_..........---.......-__......__..__ -- Sales History Line Sale Date Owner Book/Page Sale Price 1 4/28/2015 BURNS, MOY T&JOHN J 28830/81 $220,000 2 4/27/2015 BERTRAND, ERIN 28827/101- $1 3 5/1/2013 O'CONNOR, ROBERT M &CONNIE P ET AL 27342/75 $420,000 Assessment History Save Year Building XF Value OB Value Land Value Total Parcel # Value Value 1 2018 $197,300 $3,500 $0 $0 $200,800 2 2017 $197,300 $3,400 $0 $0 $200,700 3 2016 $197,300 $3,400 $0 $0 $200,700 4 2015 $92,700 $7,500 $0 $257,700 $357,900 Photos . y _ r Y http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=107269 9/4/2018 Official Website of The Town of Barnstable - Property Lookup Page 1 of 3 Assessinq Division Property Lookup Results - 2014 367 Main Street,Hyannis,MA.02601 «BACK To SEARCH"Print Friendly ... .............................. ...... .......-. ............ .... .............................-........................................ ................. Owner Information-Map/Block/Lot 226/1601 OOA-Use Code:1020 Owner Owner Name as of MANN,DANIEL O Map/Block/Lot GIS MAPS 1/1/13 C/O ERIN BERTRAND 226/160/OOA WAKEFIELD,MA.01880 property Address Co-Owner Name %O'CONNOR,ROBERT M&CONNIE P ET AL 25 SOUTHWINDS CIRCLE Village:Centerville j Town Sewer At Address:No GIS Zoning Value:CBDCB Assessed Values 2014-Map/Block/Lot:226/1601 OOA-Use Code:1020 2014 Appraised Value 2014 Assessed Value Past Comparisons Building Value: $166,900 $166,900 Year Total Assessed Value Extra Features: $3,200 $3,200 2013-$170,100 Outbuildings: $0 $0 2012-$169,900 2011-$n/a Land Value: $0 $0 2010-$n/a 2009-$n/a 2014 Totals $170,100 $170,100 2007-$n/a Tax Information 2014-Map/Block/Lot:226/160/OOA-Use Code:1020 i Taxes C.O.M.M.FD Tax(Residential) $256.85 Community Preservation Act Tax $46.54 Fiscal Year 2014 TAX RATES HERE Town Tax(Residential) $1,551.31 $1,854.70 C Sales History-Map/Block/Lot:226/160/OOA-Use Code.1020 History: Owner: Sale Date Book/Page: Sale Price: O'CONNOR,ROBERT M&CONNIE P ET AL2013-05-01 27342/75 $420,000 MANN,DANIEL 0 2005-10-04 20330/44 $0 --------- ----- ---e- --- ----------- — — — - -- Photos 226/160/OOA-Use Code:1020 .. ..-. ........ ........................ _........ .......---......- There are not any photos for this parcel Sketches-Map/Block/Lot:226/160/OOA-Use e 1 20 7-1 �s 1 iU e Oob 01, Cf Y /w ilt Card N/A `� Constructions Details Map/Block/Lot:226 160/OOA-Use Code 1020 p Ma / l Building Details Land 0 x p � i Building value $166,900 Bedrooms 2 Bedrooms USE CODE 1020 \✓ /} � S t '` 1 Replacement Cost $211,296 Bathrooms Lot Size(Acres) 0r V C I� http://www.townofbamstable.us/Assessing/pr-opertydisplayscreen l4.asp?ap=0&searchparce�/. 6/5/2014 Official Website of The Town of Barnstable - Property Lookup Page 2 of 3 Model Res Condo Total Rooms 4 Appraised Value $0 Style Condominium Heat Fuel Gas Assessed Value $0 Grade Average Heat Type Hot Water Year Built 1950 AC Type None Effective depreciation 21 Interior Floors Carpet 4 Stories 1 Story Interior Walls Drywall Living Area sq/ft 617 Exterior Walls Wood Shingle Gross Area sq/ft 617 Roof Structure Gable/Hip Roof Cover Asph/F GIs/Cmp --------------------- ------ --- .... __......-..-.. Outbuildings&Extra Features-Map/Block/Lot:226/160/OOA-Use Code:1020 ........... ......... ............ ......... ........... .............. Code Description Units/SQ ft Appraised Value Assessed Value FPLt Fireplace 1 story 1 $3,200 $3,200 .................--------- -..-._-....----..................... -- ........................- _--- --_.._....._...--.....--....-.-..-....-------- Sketch Legend ............. Property Sketch Legend 62N Bam-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor,Living Area FTS Third Story Living Area(Finished) SOL Solarium BMT Basement Area(Unfinished)FUS Second Story Living Area SPE Pool Enclosure (Finished) BRN Barn GAR Garage TQS Three Quarters Story(Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRIN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine,Unfinished UUA Unfinished Utility Attic FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story (Unfinished) FOP Open or Screened in Porch PRT• Portico WDK Wood Deck PTO Patio I 1 Print Friendly Contact IDirector of Assessing Jeffrey Rudziak 1, P 508-8624022 F 508-862-4722 8:30a.m.to 4:30p.m. !Helpful Links to Downloads , Abatements i ( SALES LISTINGS Barnstable FD Residential C.O.M.M FD Residential i Commercial-Industrial-Mixed Use Cotuit FD Residential Hyannis FD Residential Townwide Condominium W.Barnstable FD Residential Department of Revenue Exemptions Parcel Consolidation Questions about values http://www.townofbamstable.us/Assessing/propertydisplayscreenl4.asp?ap=0&searchparce... 6/5/2014 Official Website of The Town of Barnstable - Property Lookup Page 3 of 3 Town Tax Rates Town Land Use Codes Helpful Maps All Town Maps Flood Insurance Maps Property Maps _. Contact Director of Assessing Jeffrey Rudziak P 508-862-4022 F 508-862-4722 8:30a.m.to 4:30p.m. (Related Boards .. Board of Assessors TOWK PROPERTY' DATAUSE t _... Owned and Operated by The Town of Bamstable-Information Technology Home Departments&Services I Boards&Committees I Residents&Visitors I Doing Business I Town Calendar I Phone Directory Employment I Email Town Hail http://www.townofbarnstable.us/Assessing/propertydisplayscreenl4.asp?ap=0&searchparce... _ 6/5/2014 [ ] [R226 160 . ] LOC] 0025 SOUTHWIND ' IRCLE CTY] 12 TDS] 300 106 KEY] 136739 ----MAILING ADDRESS------- PCA] 1041 PCS] 00 YR] 00 PARENT] 0 BANKERS TRUST CO MAP] AREA146AD JV1290982 MTG12001 LIZOTTE, EDGAR JR & LINDA SP11 SP21 ISP31 32 RYDEBERG TERR UT11 UT21 . 14 SQ FT] 1350 WORCESTER MA 01601 AYB11950 EYB11975 OBS] CONST] 0000 LAND 53000 IMP 76000 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 129000 REA CLASSIFIED #LAND 1 53, 000 ASD LND 53000 ASD IMP 76000 ASD OTH #BLDG(S) -CARD-1 1 76, 000 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 25 & 27 SOUTHWIND CIR TAX EXEMPT #DL LOT 4 RESIDENT'L 129000 129000 129000 #RR 1923 0099 OPEN SPACE #UP FY99 COMMERCIAL INDUSTRIAL EXEMPTIONS SALE104/97 PRICE] 105300 ORB110688169 AFD] I L LAST ACTIVITY] 06/26/97 PCR] Y R226 160 . P P R A I S A L D A T • KEY 136739 BANKERS TRUST CO LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RC 53 , 000 76, 000 1 A-COST 129, 000 B-MKT 86,400 BY 00/ BY /00 C-INCOME PCA=1041 PCS=00 SIZE= 1350 JUST-VAL 129, 000 LEV=300 CONST-C 0 ----COMPARISON TO CONTROL AREA 46AD ----------------------------- NEIGHBORHOOD 46AD CENTERVILLE PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 530001 LAND-MEAN +00_. 1290001 91427 IMPROVED-MEAN -170 200 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 1000] LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP]ADJS/SB/FEAT STR] STRUCTURE ARR] AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] TpwN OF 888N8?88LZ ON B�POBT gapOBT_ PL333ES=ABT/QORTINQ oMszos iman UM (usr. Mme N==) pTz mm= i mst3tn=oxs_rnmzzz DzxCz. szRzu. IS D EIC. Gonc. Blk.Wells Usmt.Rec. RoomShowerSatit O O O pURCH. DATE - Conc. Slab Bsmt.Garage St. Shower Ext. Walls PORCH. PRICE Brick Walls. Attic Fl. &Stairs Toilet Room Roof RENT Stone Walls Fin.Attic rV U Two Fixt. Bath Floors ' Piers. INTERIOR FINISH Lavatory Extra Bsmt. F 'f 2 3 1 Sink ' '/i '/z r/� Plaster Water Clo. Extra Attic EXTERIOR WALLS Knotty Pine 13 Water Only Double Siding Plywood No Plumbing Bsmt. Fin. Single Siding Plasterboard Int. Fin. 1_.,>^� Shingles TILING Conc_Blk. G F P Bath Fl. Heat D Face Brk.On Int.Layout Bath .&Wains. G Auto Ht.Unit Veneer Int.Cond. Bath Fl. &Walls Fireplace Com. Brk.On HEATING Toilet Rm.Fl. Plumbing (� Solid Com. Brk. Hot Air Toilet Rm.Fl.&Wains. ------ -- Tiling Steam Toilet Rm.Fl. &Walls Blanket Ins. Hot Water St. Shower El y� Roof Ins. Air Cond. Tub Area Total Floor Furn. ,;I S ( / ROOFING COMPUTATIONS Asph. Shingle Pipeless Furn. bS.F. .'>d Wood Shingle _ No Heat S.F. Asbs. Shingle . Oil Burner S.F. " Slate Coal Stoker S.F. Tile Gas S.F. OUTBUILDINGS ROOF' TYPE Electric S.F. 1 2 3 4 5 6 7 8 9 110 1 2 3 4 5 li 7 8 19 10 MEASURED Gable Flat Hip Mansard FIREPLACES S.F. Pier Found. Floor Gambrel Fireplace Stack Wall Found. 0.H.Door LISTED FLOORS Fireplace Sgle.Sdg. Roll Roofing Conc. LIGHTING Dble.Sdg. Shingle Roof Earth No Elect. DATE Shingle Walls Plumbing q Pine 1.ti! W / "7 '� Hardwood ROOMS Cement Blk. Electric PRICED Asph.Tile Z Bsmt. list o + TOTAL Brick Int.Finish Single 2nd I 3rd FACTOR — 0 „? G' REPLACEME 1J 1_ O OCCUPANCY CONSTRUCTION SIZE AREA CLASS 1 AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE unct.Dep. ACTUALrV�AL. DWLG. L t S Si / J v1I t� 17e 3 2 3 4 t .. 5 6 7 8 9 10 TOTAL � I RESIDENTIAL PROPERTY*" MAP NU.•.• LOT NO. FIRE DISTRICT SUMMARY ""-""—• STREET LAND �S - C-0 /3 BLDGS. Ilo 51 J 226 � OWNER � 160 TOTAL LAND RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: _lCT,l a) BLDGS. 5 ,,, ; TOTAL ._ Dennisa02rt fdMi.till" CO.'.- _...,...- __._M - 1` 18 2 802 240 ___ B . �S 0o, �� ;,>IS aC LAND Thor-Witty Corporation ___ "" `5 27 71�" 1'1"2 —2 "- BLDGS. Spellman;:-,Jobir-LR. ---,,, M,. % 2/4/72 1598 189 s TOTAL . LAND 76-- 231� 178- 3 , 6;�0 BLDGS. '- TOTAL Al der, Robert C. & Margaret J. 5-1-78 . 2698 147 ($42, LAND ATO A Ap T BLDGS. O) TOTAL -S(-,o7-j,4 N. LAND 0) BLDGS. TOTAL LAND BLDGS. OI TOTAL LAND INTERIOR INSPECTED: rn BLDGS. TOTAL DATE: LAND ACREAGE COMPUTATIONS BLDGS. LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL HOUSE LOT , , LAND CLEM FRONT BLDGS. REAR TOTAL WOODS&SPROUT FRONT LAND REAR BLDGS. WASTE FRONT TOTAL REAR LAND BLDGS. TOTAL LAN D BLDGS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH rya FRONT FT. PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ROUGH TOWN WATER BLDGS. HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND SWAMPY NO RD. BLDGS. TOTAL jROPERTY ADDRESS J STATE ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED S I I PCs I NBHD CLASS KEY NO. 0025 50UTHWIND CIRCLE 12 RC 30C 12CO 07/09/95 1041 iIJ A ) R2216 16C. z Z- LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T � 1.'.�6 7�9 Lana By/Dale Sae D�ryen.�on Ty UNIT ADJ'D.UNIT ACRES/UNITS VALUE Description 1 6 R I F F E N, D A N I E L P III T R F1 A P- cD. FF.De Acres LOCJYR.SPEC,CLASS ADJ. COND. E PRICE PRICE ;7 L R.4 D 1 .5 3,O 0 O CARDS IN ACCOUNT — 10 18LJG..S.IT 1 X .1w =10 A=155 407 59999.9�; .378539.96 .14 53Ju0 4JL0G(S)-LARD-1 1 76,000 01 pF 01 11PL CRAIGVILLE BCH RD CENT COST 9000 J BATHS 2 .0 U x ! C= 100 70GO.0 7000.00 1.00 7J+JO 3 4 L LOT 4 MARKET 86400 - NO BSMT S x I C= 100 15.1 6.1 C 1350 8- Ju-3 �.� 1;`2� CU9Y INCOME REPLACE O X C= 1O0 3100.0 ' 3100.0E 1 .00 31JO ._J lJF FYKi6 US£ DD FIREPL J X I C= 100 1300.O 1300.00 1.00 13Ju y APPRAISED VALUE , 1 J � A 129,000 h UI I PARCEL SUMMARY S I A;VD 53000 T SLDGS 76000 M 0-IMPS El I TOTAL 129000 _ I _ N CNST T I DEED REFERENCE Tvpa DATE gxora.a P R I O R YEAR VALUE MEE Page Incl. MO. .Yr� Soles Price 5 2 S D LAND 000 9SS21141, 11r10/94 A 100 PLDGS 76000 1/CJc6: IJ4192 H 39901 (TOTAL 129000 4 1,1 J1105: 1:02/85 8990C BUILDING PERMIT / I Number Oete ro LAND LAND-ADJ INC ME I QiSE SP-OLDS FEATURES OLD-ADJSI U'JITS pe Amount 5300 J II 3200 Class COnsl. Total Year Built Norm. OnSV. Un:ls Unrls Base Rale Atll Rale A I Age Depr Con O. CND Loc ^A R G Reps Cost New Atll Repl Value Slorigs Heigbl Rooms qms Bolbe •Fi. Pert 11 Fac. 02C 000 110 110 50.810 66.88 50 75 19 80 100 80 95053 7b0J'J 1_J G k 2.0 3.0 10n plion Rare Square Feel Repl.Cosr MKT.INDEX: 1 U O IMP.BY/DATE. / SCALE: . 1/0 LI.9 E ELEMENTS CODE CONSTRUCTION DETAIL , 65 66.7 1:3 6 91565 i� S 1 W FA LY DWELLIING C;�ST 'i:;P:iJLi 65 43.47 I 36 1565 *---------------------5E--------------------* STYLE 170UPL`x --------- --- 0 0 ! ! DLaI iV DJ i'T !), ESIGN ADJUST 10.0 ! - --- -- --------O 0 cXT�2.-drILLi i1J00D FRAME .L. i - 0- ------------- ♦EAT7AC - - J'GAS --U_] ! ! INTcrt.r.PczSH 0�, ------------------ 7. 1 IN_r R L:tiYJiiT 12 A'v' 1 7I Gqm—AL---- .0 ! ! IIN-1'v_T:-]UALTY- -J2;i_.4itiTE_ 45 _eXf_ '�-_-t�J 27 BASE 27 rLJJ C rJL +t ISFUT .r� D W! .' IFL_�)J2 -CJVE - -J0 ------- --------Q_C: E rolalAreas IAua . :S5 Ba:e= 1350 ! r:2il-O-r TY'-sr---- -Ju -------------------J.l? B UILOING DIMENSIONS ! I _L L'L 1 R 1 r L 31 ------�r_'Z T OAS W29 FEP SO4 E09 ;N04 '404 1 --------__ L A •. FaJCIDATI-CN: - )V ---r�- .-.� BAS W21 N27 E.50 S27 . . i ---------_--_-- - ----___--- --- ------------ L *-^------21----^--*--- V_�Uhf3JRHaSD LbAD CENTERVILLt 9---*----29-----------x LAND TOTAL MARKET 4 FEP 4 PARCEL 53000 129000 *^--9---* A IR EA 14614 VARIANCE +0 +78.3 3TA114DAR0 20 TOWN-OF BARNSTABLE BUILDING.PERMIT APPLICATION TO' N Or BARN°STABLE ' -1 lb-2 NHS Map Parcel � Application # Date Issued ,Cye, & P/C' Health Division (' Conservation Division Application F e Planning Dept. ". • ',t Permit Fee I Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address ga5 QA r- C'-a:�yt d i��Iffi0- C) (c 3 Villager: I l� Owner fy) i Address 06- SXX4r-) s (is 0a('(j e- Telephone Permit Request I"S4a t l (v l o Ver R-2.1 G-110 10 sz.- �;y ",S4,'nZ truSv i'a ion �y M jlo S 0 QAnc 9 ®per o,4F,'` �'tQ.}'. Tx�toje- ci ;c-ko--k.h f. c�dc�C� �/1 Rnef vents o `yert el," �.�,�`a� . T���{�r��,�cls '�„•,1.4, �,'b2�toss �C,ic�z� ` T►?�i� C��st�ac�a Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1Y ,j.tr.uQ Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family j Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name C,!�.a C-A Lnoe-y1 t Telephone Number S-5& 7 -tp-764 Address �41u C"r-c"fe <s-r License # C62,�s 1a� f�c�lt r- .MG,_ o277Z.0 Home Improvement Contractor# Ro 7V Email � � ( S��(c� 5cv ;.��1 Worker's Compensation # R L0 5' ✓q I Sa?Ll ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO A f lied 1AJ0_S+C -�Jcnaniecb )UP A_(rr_)cct- 94 Fa,�k �%vpf SIGNATURE k- / � DATE ��r r FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED s MAP/ PARCEL NO. ADDRESS VILLAGE OWNER , DATE OF INSPECTION: FOUNDATION FRAME INSULATION T ` FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL — GAS: ROUGH FINAL FINAL BUILDING _f r DATE CLOSED OUT ASSOCIATION PLAN NO. " ;Fedetat,ED#tlrQ4t}5529 MSE Engineer-rig Rl contraeouRegistration Nd 81es . AX-Contractor RegtstratlorrtJo.120fI79 x y A division iif:TfueLScli Euginei ring CT t.oniractor Registratron No fi2U120 a)7upont Avenue,South Yarmouth,MA 02664 ENGINEERENG" -ON ACT' 508-5ti I%26 x-G2o5 FAX 50$.56&1.933 Page. PROGRAM, :..TIOS CODrI'RACT tS Et:ITEREO•INTO SETtlt£EN-RISE`. NGCC4=HES EMGiR:"i;ANDTMVJSTO$"FORWORKAS DESCRIber4ELow .CUSTOUER PHONE. ;,DATE tx.tENT.O .WORK ORDER: MOY.B'URNS (617)398-8811 :M/07/2Q16. 222408 45402 SERVICE STREET BILUNG STREET - - 25 Southwinds Circle 563 Chestnut Sirei t` t h SERVtC£CITV STATE:ZIP MLUNG citY,:5TAT£,.ZIA Craipille MA 02636 Needham.MA 02492 .. JOB I3E�ON `Aik SEAUNG:Provide labor.and.materials toseaI are�x i�f Your hutiie ag imst wastctu(.eYces5 air leal.agc Thi performed in concert:u ith the:use of special toots and diagne5suc tetits to assure that your h w1116 left with a ht althfvl level.,f air eccttangc aril indoor air quality.:Materials to,be used(o:seal your,home can include.caulks tuams:weatherstripping arid other` products: Prnmarv;areas for sealing inc)ude:Tir leakage to'atties,bmsements,attached garages and,other unh s(w eated,areaindows.:are ni9t geperall}addressed) (7);wtirking"ltouts:-A-reduction.invubic feetper tn➢itutc(ei'in)of air inf ltsanon will-occur but.the•actual, l numbLh of:ctm ts-tw(;guarantecif., 5539:oU <1TT[C FLAT:'-Provide labor nd:materials to install a 6"layerof IR ('labs i:Cellulose added to 41=1)square feet of open attic` space:: xy ST96aTt) :. FIX EXfSTtNG'LS'SCILATtON`.:Mnvz ezistirtg cellulose that had been'.moved-from slope anti upper;attic ilk track. ". ACC:hSS Prtivlde labor and rtiatciTals toriisulate"ilic btLk of(I:j atuc.Itat'h wltli'2"rigidl'hcrntax board.We,`rstnpthe S42 50 V:ENTTLATION Provide labor and m Install(i)S":diameter roof veil,(s)to increase ventilation in;ainc areas;T'-e vent can bc,suppli "in(circle cola blac rown;gray or mill.Gnish: f S'61,$5 �'> `IT1L�i t',tC».F'ruuidc labiir'Sntt ITiatcrial,w Intiiall(I}`insulated exhaust hnsc'w,th rant inou pper vent to celt.yzt existing,battir<)om fan(s): Sl tb;,l;0 1`E v"ITL 1'l'IC)` ;Provide labor and materials tCtinstall,veniilauon cftiiies m(CtU`):ratter h tysfn ni3int tin atr flii ow: $2.69AU.- COMivtON:WALL S Provide labor and'materials to install'i'"FSR 6ced semi-rigi i i7beteisss board:iiisulation to i25)•sguare•f&toF common wall area. H tmeDwner.has rcctitied,a cttpv of th .f!'4's.Renovate l2igh L e id Sdfe tnfnrm pon tilde explaining the:' p6tenttal"ri'sk of-the.lead hazard exposure front the weatheriration ork:to be-perlormed.Your signatures is your acknowe igernent 61'Tecciprand agrei rnenrto Proceed, • �82;Z5 C[2 AWLSP aCF Provide Tabor"and materials a insta)I(GSUj s lucre feet of R-19 unlaced fiberglass'insulatiitri.it'thc criwhync ccilrng tahe,In contacrwith,the subfltwcaitd.ci7nipletLly tilling the jgist eavity,lo beIN h'with the joist bottoms. Thcninstall2" pUl4tsocvanurate.fnam.boaTd insulation. S al.A scams widi FSK:tape. $2 795i(}U': tt 1� Federal iD#OSO4tlS629 RISE Engineering: RI contractor Registration NO 9186: MA'CorNiactor Registration'No 1 0979 }, A division of Thielsch tingmeeritrg CT Conlactar Registration-No 520120 S Dupont r�senve,Smith Yarmouth,pia 02664:: ENG,iKEERIN CONTRACT 508-5694926X-620 FAX5011-568-1933 Page. 2 F'ROGRA'vi Ta9S,CONTRACT,15 ENTERED tNTO:6PiVtEEN RISE: NGGC4 HES.'> +wNEEr +cANDTNE:cusTost:FaawaRKas �- o£scraBED aELow- CUSTOIJER PHONE DATE. CUENT.0 WORK ORDER tMOY BURNS (617:)38$-8811 08/07/20M 2224€9 15402 SERVICE.STREET SlltdNG-STREET- 25 Southwinds`Circie 563 Chestnut Street. SERVICE dTY STATE:ZIB WLUNG CITY.STATE,71P Craipille.MA 02636 Needham, MA 02492 JOB ORSCRIPTION i.\CAN Its') RISE:Enetneenng will•appiv:all apl{iicablc,c]'i'sible:incentives to th.is cpntraci. Ynu will t?e Uilled,Gnly the.,Net: amount. Cunentiv,far eligible measures.National Grid.oflers 73%,.incentive.not toexceed b4.000per calendar year;and an incentive of I005i f6i'thc:Air Scaling.measures: For the safety And health of your home's indoor air,(uabty wemill be conducnne.a bloNkr'door diagnostic of the availabic'uir,flow, in your h'onic both before r the.work iS`,begun,and after the:weathcrization•work-is,comglete.We will.also coniiyct a dia_ntistic:. assessment°orthe comtiu9tuin;tuines id the exhausl'fluc of vour heating systcmant4 water heater..l'iiis.has a value of$y()and is PO Cost to you. 'ncc Permh u;1'1 he secured by the insulation contractor,at.ht)< ddltiunalcotii:`.(t is;the hanicaµnL"s'responsibility o cinseout'':this permit Uy contacting thcir.municipality at the complcnon of=ibis work. $90.00 , Total; K665 50 Program Incentive: $,3,61 00 Customer Totai : $1,03350 WE AGREE HEREBY TO;FURNISH-SERVICES:-:COtdPIETE IN ACCORDANCE.WRH ABOVE SPECIFICATIONS.F�6014:SUIkQf ***One ThOusand Thirty Thr."ee:&501100'a6l1airs $l,0313650 UPONANAL INSPECTION AND APPROYAt 6Y:R15E'ENGiNE£RING.CUSTDMER AGREES:TO REMIT:AMOUNT DUE(N FULL-INTEREST OF It;YRLL BE CHARGED MONTMY,ON ANY uNPAIO BALANCE AFrE-A-30 DAYS.SEE REVERSE,FOR IMPORTANT INFORMATI61iON GUARANTEES,RIGHTS OF'RECISION,SCHEDUtJNG;-AND CONTRACTOR REGI.STAATON:- DO NOT SIGN THIS CONTRACT IF THERE" Y`BLANK.SFA £S Alp AUTHORIZED.SIGNATURE RISE E+�ginoedm .. C TOMER ACCEPTANCE .. _.. _ _,.... HGTEi_THIS CONTRACT MAY:BE•wIrHORAW1a BY:US,FHOT:E%ECUTEDWRHIN; DATE OF ACCEPTANCE - .. r , , . ACCEPTANCE OF CONTRACT•THE ABOVE PRICES SOECtFICAT10N5'AtOD CONDRIONS ARE 30 DAYS.- SATISFACTORY TO US AND ARE .i. T.HE•WORK;. AS SPECIFIEO.PAYMENT YJILLBE MADE:A5f 0UTUHED ABWE .. _. _. _ r ' 'o w 6f^3a' stable' Reg lat® e � 'r�a�fc*r • fLtC},�;art�V.Sraly;.Ifsr�iur i'arta.i'ei' 13i!$iutuaurussis � 200 Mazxk:Sffcc"t, w�ti�vtv�vc�.barYUE.a�I�m,i;r�s Ua3 c: 5 7$. 862 `i 38 ay: 5 90=6230 Proper w-ne X us t co x :plete n 5��n "�.h' Sectxc a fUsF� t: Moy _..,u... .. s Xcr 0,11J`p bl!'i f 33.?. TCJ" rir � 3 i1GI 7ia 25 &.2� °oufiF vu�nt s r le Grai.gvtlle, MA 02-36 Po! l.fene" alarz s are the 17e-sp ns'p l cif'thy: ap.ph, o"As are not to bi� f llc:d or u' d be-fore f iic :is =taRed and, all inspections are.,performe .un .acuptett. S 'nzis'Narm The Commonwealth of Massachusetts Department of Industrial Accidents y, ra 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please,Print Le)ibly Name(Business/Organization/Individual):Insulate2Save/Roland Langevin Address:410 Grove Street City/State/Zip:Fall River MA 02720 Phone#:508=567-6706 Are you an employer?Check the appropriate box: Type Of project(reQu<reO'.. 1.�3 am a employer with 20 employees(full and/or part-time).* 7. New COriStrllCtion 2.a I am sole proprietor:or partnership and have no employees working for me in 8, D Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.a Lam a-homeowner doing all work myself.[No workers'comp.insurance required.]t 10 0 Building addition 4.M I,am a homeowner and-will be hiring contractors to conduct all-work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical,repairs;or additions proprietors with no employees. 12.QPluinliing repairs or additions 5.. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.* 6.a We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Otherinsalation 152,§1(4),and we have no employees.[No workers'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 sub mit.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.tlie'sub-contractors have employees,they must provide their workers'comp.policy number. Tam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Liberty Mutual Insurance Policy#or Self-ins.Lic:#:XWS 56418741 Expiration Date:12/10/16. Job Site Address 5£ Z� _� W A)d.S d rC_ City/State/Zip: �2 Attach-a copy of the workers'compensation policy declaration page(showing the policy number aJd expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification.: I do hereby certify under the pains and nalti s of erjury that the information provideA is true and correct Signature: - /'r�� Date: J/ Phone.#.5087567-6706 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): ' 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: OF -Officeof Consumer Affairs and Business RWIat of 10,Park.Plaza Suite 5170 y Boston, Massac tts,02 i 16 Home_hWrovement C tor:Reps=ion Registr on:.' 18Q747 .' Type; Cosporatwri. zi _ :' 12129f2tt l6 Tr# 150Z INSULATE.2.SAVE., INC. ;..$ROLVDILAN IN b,, FAUR3—, :IM.11 7 IZI 6 -Upa#all*tlddrrss;and., boa secAtan sea ❑ Address .7.Renewal ..Ofce Of-CII=ir s A,sue Regale OD L'icease or regis os valid for ipilividei ase oa{y MPRGVEIIIENT CONTRWTOR befere.the expirstien date, 4f d retard to• gm atim, 747 Type' -Office.of-Consnmer Affairs and BuM Coryoratrr+fl 10 Park Plaza-$gw,500 - 'Bostoa;MA 02116 IA1SlHA1'E2SAi1E-� �3E� ROLAND i.MGf1/li - 41fl/��p[� FALlRfiHEl3,MA 0272t} Not valid witbaeusMeatm Massabhuseft Department of Public Safety Board of guitcfixg Regulations and Standards License: CS-10=1 Construction Supervisor RPLAM LANCEM 56' .[PHF?.. AtLf11fLiROHORES MA . . � JZ77 Expiration: , Commissioner M24=17 r CERTIFICATE OF LIABILITY INSURANCE DATE(MMi2//)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 Anthony F. Cordeiro Insurance PHONE FAR 171 Pleasant Street IA/C. ' (508) 677-0407 No: (508) 677-0409 L ADDRESS: hsouza@cordeiroinsurance.com Fall River, MA 02721. INSURERS)AFFORDING COVERAGE NAIC# INSURER A:LibertV Mutual Insurance INSURED I NSU RER B: Insulate 2 Save, Inc. INSURERC: 410 Grove St. INSURERD: Fall River, MA 02720 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES 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 ADDL SUBR POLICY EFF POUCY EXP LTR TYPEOFINSURANCE IN SR WVD POLICY NUMBER M/DD/Y MM/DD/YYYY LIMITS A GENERALLJABILITY Y Y BKS 56418741 12/10/15 12/10/16 EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 CLAIMS-MADE 7 OCCUR ME EXP(Anyone person) $ 51000 PERSON4L&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELONITAPPLIESPER PRODUCTS-COMP/OPAGG $ 2,000,000 }(I POLICY PRO LOC $ A AUTOMOBILE LIABILITY COMBY Y BAA 56418741 .12/lo/ls 12/10/16 (Eaac dent) GLELIM R $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALLOWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE $ _AUTOS eraccident $ A X UMBRELLA LIAR X OCCUR Y Y USO 56418741 12/10/15 12/10/16 EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000 DED RETENTION$ $ A WORKERS COMPENSATION XyIT$ 56418741 12/10/15 12/10/16 X WC STATU- DTI- tti AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICERMIEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yyes describe under DESG�RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Renerks Schedule,'d more space is regtired) Proof of Insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Town of Barnstable *Permit ffor�o cxr2 ce t 1''-xpir atq�drs fry issue date Regulatory Services F • IMAMS • MASS Thomas F.Geiler Director _�¢ v 1�Zrofo9 Building Division JAN Tom Perry,CBO, Building Commissioner 3 2009 200 Main Street,Hyannis,MA 02601 TO www.town.batnstable.ma.us eIZ5 R� � Fax: 508-790-6230 &PRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not 6 and without Red X Press Imprint . Map/parcel Number J a 6/ lei 6 CT01 Property Address g3 Residential Value of Work ) 00. 06 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address !j l 5 1-;CA I"I a n n S SC.VT4 V- d3 J L)<GIE t�t / Contractor's Name , (►o `'y 6 S Telephone Number Home Improvement Contractor License#(if applicable) /bl / Construction Supervisor's License#(if applicable) J �� ❑Workman's Compensation Insurance Che�one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Work-man's Comp.Policy# CoPy of Insurance Compliance Certificate must be on file. Permit.Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ R -side [Replacement Windows/doors/sliders.U-Value a maximum.44 ( ) "Where required: Issuance of this permit does not exempt compliance with other town department regulations,Le.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: ✓g' C:IL'snrsldecollik1AppData cal\Microso$\Windows\Temporary Internet Files\ContentAutlook\LvY'7NB R:EXPRESS.duc Revised 100608 �: � `� d ✓�ze T�p7ryyreoiyureq.�Uy o���acfucJe(t`` `i i i oard of Building Regulations and Standards • ? construction Supervisor License s' Li c ense: S �.: 80579 i if%jt4h a 6/5/1965 \ I fE ration 6 5/2009 Tr# 15236 f JOSEPH W POWERS }1 i- 130 FULLER RDA '`' CENTERVILLE,MA 02632 �j— � ' l Commissioner f Board oPB Building Regulations and Standards HOME IMPROV EMEN7 CON7RgcTOR I.icense or registration valid for indivitlul use only j Registrafio,' before the ex 1390"19 . it Y Exp r_af on Board o fB expiration date. If found return E T/28/200g uildin Ype pgq Trig 131937 One Ashburton plaRce ulations and to:. T g Standards JOc POWERS Bostoe AI;i Rm 1301 HOMER�NOV� �`� 02108 6 J�OSEPH POWERSa CATIONS 13.0 FULLER RD � 1 CENTERVILLE,MA 02632 -_ -. Administrator- � '`• -- Not valid without signature C Town of Barnstable Regulatory Services Thomas F.Geller,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstabkma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I '9 �� ,as Owner of the subject property hereby authorize � ) (Z�� ��`�j 1-PA� to act on my behalf in all matters relative to work authorized by this building permit application for: (Address of Job) azure of Owner to Print Name , UProperty Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. , C:1LlsmWecollikAAppDataU o-AMicrosoffvWindows\Temporary Internet Files\ContentOutlook\W7NB4ILTEXPRESS.doc Revised 1009A i The Conunonweadth o�f'Massac setts Departtnent o,f'Jrnduciel Accadmts Duce of Investigations ' 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/orgmizatioWlndividual): es 5 �s e �e�0P a Address: Ci /State z ¢�Tc c 0 .3 Phone Are you an employer?Check the appropriate box: Type of project(required) L❑ I am a employer with 4. ❑ I am a general contractor and I have hired the subcontractors 6. ❑New construction al (frill and/or part-time). - 2. am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' o workers'comp, con insuranee.t 9. ❑Building addition required.] �� 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.❑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-®Other coMp.MMrance required.] *Any aWieantthat checks box#1 must also fill out the section below showing#heir workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and that lure outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and:t6te whether or not those entities have em0ovocs. If the sub- tractors have employees,they must provide their worlms'comp.policy number. I am an employer that is providing workers compensation insurance for my eoWloyem Below is the policy and job site mfa'»ra"L 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 dri Hereby certi l the . and� of perjury that the information provided above is true and eonvd� s ' 'Date: Si °�''" �D e: Phone#: Offidal use only. Do not write in this area,to be completed by'city or town oJ,j`urd d City or Town: , PermitlLicense# Issuing Authoi (circle one): 1.Board of Heal 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: _ Phone#: t Town of Barnstable *Permit# . t9d6?b:300y Expires 6 months from issr date Regulatory Services Fee swxivsresc Thomas F.Geiler,Director �. 1639. A.,•� $wilding Division Tom Perry,CBO, Building Commissitmer 200 Main Street,Hyannis,MA 02601 www.town.bamstable.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 �Lo 1 Ce 0 Property Address J S6u'r �J5 6 je'd C Gen;;tld residential Value of Work SI�-G dD Minimum fee of$25.00 for work under$6000:00 _ Owner's Name&Address Da" i k l� Contractor's Name , 0 S ep k P6 w e4 5 Telephone Number V v�) w✓J�/1 Home Improvement Contractor License#(if applicable) 13 + r ❑Workman's Compensation Insurance Ch k one: [ I am a sole proprietor q IT ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance JUN _ 4 2008 Insurance Company Name MAIN nF BARNSTABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. f Permit Request(check box) �or1 2/Re-roof(stripping old shingles) All construction debris will be taken to ��v�S`e' �l-4 ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum,A *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 is required. ^, SIGNATURE: ' Q:\WPFILES\FORMS\building pemrit forms\EXPRESS.doC Revise020108 f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: BuiIders/Contractors/Electricians/Plumbers A licant Information [ Please Print Le 'bl Name(Business/Organization/Individual):, d S�/p�1 W — Address: 1U u e< City/State/Zip: G e 11,rc t y l �4,O�M-Phone Are you an employer? Check the appropriate box: Type of project(required): L❑ I am a employer with 4. 0.1 am a general contractor and 1 6. ❑New construction ployees(full and/or part-time).* have lured the stab-contractors 2.Rj 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' 9 Building addition [No workers' comp.-insurance comp.insurance.t required.] 5. F1 We are a corporation and its ME]-Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their HE Plumbing repairs or additions myself,[No workers' comp. right of exemption per MGL 12.[' Roof repairs incr=re required.]t P. 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 workcis'eorrrpensation policy information. t Homcownms 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-contractms and state whether or not those entitirs have employees. If the subcontractors have employes,they must providt 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 crimifial 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 the DIA for insurance coverage verification. -- I do hereby ce u the p s•and penalties of perjury that the information provided bo a is true and correct ✓V Date: Si ature: ) — Phone# f 0Q /7I J/UI l 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 S.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." chapter 152 25 7 states`Neither the commonwealth nor an of its political subdivisions shall GL Y Additionally,M . p ., § C( ) t enter into any contract for.the performance of public work until acceptable evidenceof compliance vtzh the insurance. requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers) 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 equir confirmation of insurance coverage.e. Also be sure to sign and date the affidavit The affidavit should Accidents for nfirma gn g 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 permittlicense 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 onv 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 homeowner or citizen is obtaining a license or permit not related io any business or commercial venture (i.e. a dog license or permit to brim 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 salt The Department's address,telephone-and fax number. The Commonwealth of Massachusetts. Dgwtaaent of Industrial Accidmts Office of Investigations 600 Washington Street Boston, MA 02111 TO. #617-727-4900 ext 4-0b or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia �oF1HEro Town of Barnstable Regulatory Services HAIMSTABM Thomas F. Geiler,Director lFo,r,A�A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02661 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder. as Owner of the subject property y4; %/ � ,�SY y behalf, hereby authorize to act on m behalf in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner bate Print Name If Property,Owner is applying for permit please complete the Homeowners License Exemption.Form on the reverse side. Town of Barnstable �oF THE Tp�� Regulatory Services ti - Thomas F.Geiler,Director BARNSTABES, MASS. 16j;9. uilding Division T f0t A B Tom Perry, g Buildin Commissioner . 200 Main Street, Hyannis,MA 02601 wmv.town.barnstable.ma.us ,Office: 508-862-4038 Fax: 508-190-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow 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 to the Building Official that he/she shall be shall submit to the Building Official on a form acceptableg , }1�mc�wncr 1; 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 1o9.1,.1-Licensing of construction Supervisors),provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." . Many homeowners who use this exemption ai-e 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 to serious problems,particularly a it would with a licensed against unlicensed person s er hires unlicensed persons. In this case,our Board cannot proceed p when the homeowner 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. • ✓fie _arn mareufe2 o�✓l�ladaac�iu6e%�d Board of Building Regulations and Standards License or registration valid-for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: y Board of Building Regulations and Standards Reglstratioli'-;139619 One Ashburton Place Rm 1301 ;Expiration 7%28/2009 Tr# 131937 Bostoe,Ma.02108 _ t DBA HOME-RENOVATIfONS I ,IOE POWERS f 1 / w JOSEPH POWERSL�, •,130 FULLER RD Not valid without signature \. CENTERVILLE,MA 02632 Administrator —_ —.-----