HomeMy WebLinkAbout0260 STRAWBERRY HILL ROAD r •
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The Commonwealth of Massachusetts
Department of lutlustrial.4ccitlurts
office of/flyest/921/010
'I\_,i"'' :rr;�'1 600 111a.vhittf;tutt Street
` • '� Bnstutr. Ma.u. 02111
` Workers' Compensation Insurance Affidavit
A � licant information:• Please PRI1VTle�' """'"""""-'—•"�"—»r -'�- V•
name:
location: C5�G /o�l/z✓r/Pr
tv ohnne 0
[� I am a h caner performing all work myself.
®'�I a sole proprietor and have no one working in amp capacity
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Cj I am an employer providing workers' compensation for my employees working on this job.
contoanv name:
aticiress:
gin•: „ ohnne�•
insurance en. policy#
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[I I am a sole proprietor. general contractor, or homeowner(circle otte) and have hired the contractors listed below who have
the following workers' compensation polices:
comnanv name:
address:
gin•: phone#• \\
insurance rn. nolicv 0
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comnanv name:
address:
phone f#-
insurance co. nolicy
Attach additional sheet if necessary; %_ r _ !! :a.. _•• _ _��"_r:'� �+w.." {��.�w '•�i.:� i
_ -- -----.. - '. 'S::—==— e:— tee.=.�=— :�ir..i`_.M-
FAilurc to secure coverage as required under Section:SA of NIGL 152 can lead to the imposition of criminal penalties ol'a line up to S1.500.00 andior
one rears' imprisonment:ts well as civil pcnaitics in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that a
cope of this statement mat- be forwarded to the Office of Investigations of the DIA for coverage verification.
I do herch.r certify under the pains and penafties of perjury that the information provided above is true and correct.
/`,icnaturc Date
Print name Phone#
official use unit- do not write in this area to be completed by city or town official z+
gin or tm-n: permit/license>f r•tlluilding Department
CLiccnsing Huard
I]check if immediate response is required 0sclectmen's Ofrtce 1
C311calth Department
phone##• rJOthcr :
contact person:
b
information and Instructions
Massachusetts General Laws chapter 152 section 25 requires ail employers to provide workers" compensation for the
employees. As quoted loom the "ta��'a. an emploree is defined as every person in the service of anotlier under any
contract of hire• express or implied. oral or written.
An cmpinrer is defined as an individual. partnership,, association. corporation or other legal entit\,, or an) two or moo:
the foregoing cnuaged in a joint enterprise. and including; the legal representatives of a deceased emplover. or the
receiver or trustee of an individual a partnership. association or other legal entitj);empl�yin�► employees. However t!
owner of a dwelling house haying 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_ Inc
or on the ;;rounds or building appurtenant thereto shall not because of such employment be deemed to be an empioye
MGL chapter 152 section 25 also states that even- state or local licensing agency shall witlihold the issuance or
renewal of a license or permit to operate a business or to construct buiidings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter
been presented to the contracting authority.
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to ;your situation and
supplying company names. address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested.
not tine Department of Industrial Accidents. Should you have any questions regarding the "law a or if you are require,.-
to obtain a workers* compensation policy. please call the Department at the number listed below.
Citv or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom c
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pie
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questio
please do not hesitate to give us a call. .
The Department's address. telephone and fax number.
az rr
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 R'ashington Street
Boston,Ma. 02111
fax #: (617) 727-7749
.,t,., � u• rat^� 777-4900 (%t_ a06. 409 or 375
DEPARTMENT OF. PUBLIC SAFET 1 7
ONE ASHBURTON PLACE, RM 1
BOSTON;- MA 02108-1618 JANA Z mAs
CONSTRUCTION SUPERVISOR LICENSE;
Number: Expires:
woo
Restricted To: 00
JOSEPH DALUZ .0 Detach bottom, fold sign on
90 MITCHELL WAY back, and laminate license card.
HYANNIS, MA 02601 Keep top for receipt and change
of address notification.
o
✓�ie �om��,aru�real� a��/G�.r�uaeCta
Restricted To: 00
DEPARTMENT OF PUBLIC SAFETY
CONSTRUCTION SUPERVISOR LICENSE 00 - None
" Nusber: Expires:
16 - 1 E 2 Fatily Hooes
Restricted To: 00 Failure to possess a current edition of the
Massachusetts State Buiilding Code
JOSEPH OALUZ is cause for revocation of this license:
� -r @'uo 90 MITCHELL NAY
HYANNIS, MA 02601
Page 1 of 1
Anderson, Robin P�
From: Santos, Theresa
Sent: Thursday, April 22, 2010 1:00 PM "
To: Anderson, Robin
Subject: FW: Vages property -sorry sent it to Dave instead of you - my oops! -
-----Original Message-----
From: Santos, Theresa ,
Sent: Thursday, April 22, 2010 12:39 PM
To: Anderson, Dave ,
Subject: Vages property -
Hi—M/P 247-104-001 -
.4 ,
Mr. Steven Fernandes—508-967-8033
Looking for guidance on the property„he has a trailor(equipment) on the property while'he is
cleaning it up -and is looking for guidance
Thank you for taking care of this
4/22/2010
.� Town of BarnstableBuilding
o Pst This Card�So That�t is Visible':From the Street Approved Plans Must be` Retained on Job and this Card Must be Kept
M" PBAMSTA
osted Until Final Inspection Has BeenalMade x �F 1639.
p
ermi
¢ Where aCert�ficateoofOccupancy�s Required; uch Bwldmg shall Not be Occupied until aFnal Inspe ion has been made
Permit NO. B-17-3487 Applicant Name: donald lacoy Approvals
Date Issued: 11/03/2017 Current Use: Structure
Permit Type: Building-Shed-Residential-200 sf and under Expiration Date: 05/03/2018 Foundation:
Location: 260 STRAWBERRY HILL ROAD,CENTERVILLE Map/Lot: 247-104-001 Zoning District: RB Sheathing:
Owner on Record: LACOY,DONALD R �� Contractor Name:, Framing: 1
Address: 260 STRAWBERRY HILL ROAD Contractor License 2
.i a .< �'
Est Project Cost: $1,500.00
CENTERVILLE,MA 02632 f..,. Chimney: j
Description: Build small 8'X 14'garden shed `
" Permit Fee: . $35.00
IS
Fee Paid: $35.00 Insulation:
Project Review Req:
Date 11/3/2017 Final:
` Plumbing/Gas ,
- , Rough Plumbing:
Building
i f z i Off
icial cial
Final Plumbing:
t..
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas:
All work authorized by this permit shall conform to the approved applieatiorrand the%approved construction documents°for,which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas:
This permit shall be displayed in a location clearly_visible from access street'o road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same.
Electrical
411,
The Certificate of Occupancywill not be issued until all applicable signatures by theiBuiiding and Fie Offi gals are provided on this permit._ Service:
Minimum of Five Call Inspections Required for All Construction Work:
1.Foundation or Footing Rough:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Ins
pections ections to becompleted priorto Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.insulation
7.Final Inspection before Occupancy Low Voltage Final'
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction. Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department
Building plans are to be available on site Final
ISSUED RECIPIENT
All Permit Cards are the property of the APPLICANT
Town of Barnstable'1# BAWMABLE .11
RECEIiPT
200 Main Street, Hyannis MA 02601 508-862-4038 '
Application for Building Permit
Application No: TB-17-3487 Date Recieved: 10/8/2017
Job Location: 260 STRAWBERRY HILL ROAD,CENTERVILLE
Permit For: Building-Shed-Residential-200 sf and under
Contractor's Name: State Lic. No:
Address: Applicant Phone: (508)450-2803
(Home)Qwner's Name: LACOY,DONALD R Phone: (508)450-2803
(Home)Owner's Address: 260 STRAWBERRY HILL ROAD, CENTERVILLE,MA 02632 --i
Work Description: Build small 8' X,14' garden shed q
�€
co
M
Total Value Of Work To Be Performed: $1,500.00
Structure Size: 0.00 0.00 0.00
Width Depth Total Area
I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before
he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568).
I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by
filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to
accept coverage.
I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have
been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the
Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and
specifications. All information contained within is true and accurate to the best of my knowledge and belief.
All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24
hours in advance.
Signed: donald lacoy 10/8/2017 (508)450-2803
Applicant Date . Telephone No.
Estimated Construction Costs/Permit Fees
Total Project Cost : $1,500.00 Date Paid Amount Paid Check#or CC# Pay Type
_...µ. ..__ , _..... ..: ..._. .... _._.
Total Permit Fee: $35.00 10/8/2017 $35.00 1 XXXX-XXXX-XXXX-= Credit Card
_...._ 0529 !
......... .. ........... ......... ............. ... ..................:.............
Total Permit Fee Paid: $35.00
THE
The Town of Barnstable
MAJM $ Department of Health Safety and Environmental Services
"9. Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commission:
For office use only `
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization,
conversion, improvement, removal, demolition, or construction of an addition to any pre-existing
owner occupied building containing at least one but not more than four dwelling units or to
structures which are adjacent to such residence or building be done by registered contractors, with
certain exceptions,along with other requirements.
Type of Work: �A "�"JI Est. Cost
Address of Work: If `P
Owner's Namedc—LA6e
Date of Permit Application: C1 9
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under S1,000.
���OBuilding not owner-occupied
wner 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 w
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner.
q / r 1—) l 5
Datd Contractor Name Registration No.
OR
4
! Engineering Dept. (3rd floor) Map Parcel '. Permit#
House# - oZ(� S Date Issued
Board of Health(3rd floor)(8:15 -9:30/.1:00-4:30) SYSTEM- „Z�rdo
Conservation Office (4th floor)(8:30- 9:30/1:00` 2:00)' - 1ST IED IN COMPLIANCE
WITH T
NVIRONME AND
,DefinitiVP Plan Annmc�ad._},..n, D���,7 19 �. TOWN R 1
r a -l-U=e
MASS.
TOWN OF BARNSTABLE
Building Permit Application ( bev (d— l oki),
Project Street Address 02�0 SMI&J6Es72.(LY 91LL /&
Village
Owner [� 1� l�L Address ' y '®
Telephone
Permit Request f� U. :ai v.di %f O .� �' /6�
T
First Floor - square feet Second Floor ' '� square feet
Construction Type -�--
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ZKes ❑No
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes On Old King's Highway ❑Yes .Wo
Basement Type: p1ru-11 ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing New
No.of Bedrooms: Existing New
Total Room Count(not including baths): Existing New First Floor Room Count
Heat Type and Fuel: Z05as ❑Oil ❑Electric ❑Other
Central Air ❑Yes OkNb Fireplaces:Existing New Existing wood/coal stove ❑Yes 4 No
1 Garage: ❑Detached(size) r' Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes .❑No If yes, site plan review#
Current Use Proposed Use
PP Builder Information
Name 7J-Ae
I�U�L Telephone Number
Address License# 61
04 Home Improvement Contractor#
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
CSIGNATURE DATE
BC 4F4_ -"1 OLLOWING REASON(S)
/ /"w
FOR OFFICIAL USE ONLY74
t - = r • = F
-PERMIT NO. '•
DATE ISSUED
MAP/PARCEL NO:
ADDRESS 'c : VILLAGE ? yr
OWNER `- `'.
DATE OF:INSPECTION:,
FOUNDATION
FRAMEr
INSULATION -
FIREPLACE +t r
ELECTRICAL: = ROUGH c ,f R FINAL 3 r
PLUMBING: ROiJH N FINAL' V F
h
GAS: 0 ROU10H FINALtr
mat
FINAL BUM
DIN& nN
+
M C) - 1
DATE CL SFB OUw Q.
I- �
ASSOCIA%tM PL NO. t '
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Official Website of The Town of Barnstable -Property Lookup Page 1 of 4
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Assessing Division Property Lookup Results - 2015 J�
367 Main Street,Hyannis,MA.02601
<<BACK TO SEARCH<< Q! Pflnt FfleOdlV
Owner Information- Map/Block/Lot: 247 / 104/ 001 - Use Code: 1010
Owner nj') l
Owner Name as of 1/1/15 VAGES,THOMAS L&DONA MARIA Map/Block/Lot G/S MAPS ( -
8 FOREST GLEN RD 247/104/
001
HYANNIS,MA.02601
Co-Owner Name Property Address vX, I
260 STRAWBERRY HILL ROAD
Village:Centerville
Town Sewer At Address:No `,b
GIS Zoning Value:RB
Assessed Values 2015 -Map/Block/Lot: 247 / 104/ 001 - Use Code: 1010 1 „ )��
Iv
2015 Appraised Value 2015 Assessed Value Past Comparisons
Building Value: $11,500 $11,500 Year Total Assessed Value
d�9 Extra Features: $0 $0 2014-$119,700
YY 11 ` i
2013-$119,700 '
Outbuildings: $0 $0
2012-$80,700 /I a
Land Value: $109,000 $109,000 2011 -$106,800
Y 2010-S 114,700
2015 Totals $120,500 $120,500 2008-$206,700
2007-$n/a
4 Tax Information 2015 - Map/Block/Lot: 247 / 104/001 - Use Code: 1010
Taxes O�V� sFzw
C.O.M.M.FD Tax(Residential) $186.78 /,;f
Community Preservation Act $33.62 Fiscal Year 2015 TAX RATES HERE V W "—
(!✓ 1 Tax
IU f, Town Tax(Residential) $1,120.65
lM � $ J,
'uW 1,341.05
w
Sales History- Map/Block/Lot: 247 / 104/ 001 - Use Code: 1010 � �� ,(-ITY
History:
Owner: Sale Date Book/Page: Sale Price:
VAGES,THOMAS L&DONA MARIA2002-09-10 15573/9 $1
VAGES,THOMAS L 2001-12-06 O1 P1448EP1 SO
VAGES,THOMAS L&MARY V 1959-01-19 1028/197 $0
Photos 247 / 104/ 001 - Use Code: 1010
� S
Sketches - Map/Block/Lot: 247 / 104/001 - Use Code: 1010
eta,
http://www.townofbamstable.us/Assessing/propertydisplayscreen 15.asp?ap=0&searchparce... 6/8/2015
Official Website of The Town of Barnstable -Property Lookup Page 2 of 4
'TQ
AS Built Card$:Click card#to view:Card #1 1 Card #2 l
Constructions Details- Map/Block/Lot: 247 / 104/ 001 - Use Code: 1010
Building Details Land
Building value $11,500 Bedrooms 1 Bedroom USE CODE 1010
Replacement Cost $38,295 Bathrooms 1 Full Lot Size(Acres) 0.46
Model Residential Total Rooms 3 Appraised Value $109,000
Style Cottage Heat Fuel Gas Assessed Value $ 109,000
Grade Economy Minus Heat Type Hot Air
Year Built 1925 AC Type None
Effective depreciation 70 Interior Floors Carpet
Stories 1 Story Interior Walls Plastered
Living Area sq/ft 400 Exterior Walls Aluminum Siting
Gross Area sq/ft 650 Roof Structure Gable/Hip
Roof Cover Asph/F GIs/Cmp
Outbuildings& Extra Features- Map/Block/Lot: 247/ 104/ 001 - Use Code: 1010
Code Description Units/SQ ftAppraised Value Assessed Value
PATI Patio-Average 250 $0 $0
Sketch Legend
Property Sketch Legend
E12N 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)
CLIP Loading Platform GRN 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
http://www.townofbamstable.us/Assessing/propertydisplayscreenl 5.asp?ap=0&searchparce... 6/8/2015