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HomeMy WebLinkAbout0213 FAWCETT LANE ra-tvice44 LO.Y) e- r �\ i o� ® Town of Barnstable *Permit v ues 6 mo om' dQdC� ilding Department Services RV frr Brian Florence CBO anuvsr.+sr.�. �4 . � NE as o�'�' 'ding Commissioner s639• �l/ , n w 11? 260 treet,Hyannis,MA 02601 �/J www.town.barnstable.ma.us Office: 508-862-4038 �`/��. Fax: 508-790-6230 148, EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ,-7 `J f Not Valid without Red X-Press Imprint Map/parcel Number y G Property Address —A0 (fPt/ Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �'t y►�e✓V`, 6 11 ti p) 3 2 Contractor's Name ' � _ r' Telephone Number Home Improvement Contractor License#(if applicable) A Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance " ` - :. P e cone: a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name x Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Re est(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to �U m ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: 4 Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. ASIGNATURE: QAWPFII.ES\FORMSIbuilding permit formslEXPRESS.doc 08/16/17 t Doi_: 17331 r 397 10-04-2017 3:0 Ct f 4 s 214272 BARNSTABLE LAND COURT REGISTRY QUITCLAIM DEED LEWIS BAY REALTY INVESTMENTS, INC., a Massachusetts Corporation with a mailing address of P.O. Box 427, Hyannis Port, Massachusetts,02547 For Consideration paid in the amount. of ONE HUNDRED EIGHTY SIX THOUSAND AND N01100(S186,000.00)DOLLARS grant to CAIN MARKO INVESTMENTS, LLC, a foreign Limited Liability Company, of 96 Seans Circle,Centerville,Massachusetts,02632 with QUITCLAIM COVENANTS, LOT 60 Subdivision Plan No. 22825-P(Sheet 1) . The Grantor represents and warrants to this Grantee that the conveyance of this property does not constitute a sale or transfer of all or substantially all of Grantor's assets in the Commonwealth of Massachusetts, and is in the ordinary course of its business. Meaning and intending to convey the same premises as described in Deed recorded with the Barnstable County Land Court Registry as Document No, l 3 3 13 with Certificate of Title No.Al a PROPERTY ADDRESS: 213 Fawcett Lane,Hyannis,MA 02601 I Executed as a seale d ed instrument under the pains and penalties of perjury this day of October, 2017. Lewis Ba Realty Investments, Inc. , John Shea, re ident Treasurer COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. October 3 , 2017 Then personally appeared the above-named John Shea, President& Treasurer proved to me through satisfactory evidence of identification, which was a MA Driver's License,to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he signed it voluntarily for its stated purpose and as the free act and deed of Lewis Bay Realty Investments, LLC. Notary Public- Stanley P. Nowak My Commission expires: June 20, 2019 STANLEY P. NOWAK Notary Public Commonwealth of Massachusetts My Commission Expires June 20,2019 2 77M Coanmomwakh of Alassadiuseffs Deprartmait ofrudustziolAcciderats - Ojfwe of1Fmestigadons 600 Washington Street Boston,MA O211I mviumaxLgovfdia Workers' Compensation Insurance Affidavit::Baildem/CarntracWrsMe ians/Ph ethers AppUcant Information'. Please Brent SI Y �ansiIIeesslDrgamxahoa/Inal)_�W/� ��/�-ri/"`" r - i / Y111 Z PhvneJf-- � Are you an employer?Checkthe appropriate box: Type of project(re quired): I.❑ I am a employer.Urth 4. ❑I am a general contractor and I 6. ❑New construction employees(full andlof part-time).s lxave hired the sub-contractors 2.❑ I am a sale pmprietor orpartner- listed on the attached sheet 7. ❑Remodeling ship and have no.employees . These sub-contractors have 8.,❑Demolition woA ing for mein any capacity_ employ and hay*e worms— [No workm'comp.insurance Camp-insurance I required] 5. ❑ We area corporation and its 10.E]Electrical repairs or additions officers have exercised dmir I am a homeowner doing all warlc 11-0 Plrnabfngrepairs or additions o workers' _ right of emw gfiou per MGL 1�❑ ieF n insurance required,.]F c.152, §1(1(4)6andwe have no, Itoaf employees.[No wodcers' 13.❑Other comp_msarauce required-] •Aziy,a Hcsntdmtcbedmboxfi—telmsna thesectionbrrows�uiugihrs kes'ca�peasariaaporcyirdvem � l Ramwwnen who sabaut this d5da«1 they axe daic6-BU WC*aad dies hie aatside Cantnctotsamst submit a nem afda¢it indicating stub TCantiact, ffiat e'+xtr this boat must attad ud sir addili— sheet shorting the name of the and state whether or xM those entities have —Pioyees.lfthesnh-zaatasctfleshaveemplcyees&e}'=tstpnnddethev workem'tamg policy numbm lam an errrplgw tleatrsprotR&kg tvarkers'co rsdfiarr fimrance for Utzy earph;yem 30101y is filepu cy and1ab site Enforaradam Durance Company Name: olicy;g or Self--ins.Lic. DxpiratibnDate: Job Site Address: CitylStatdz2 p: Attach a copy t:f the workers'compensation.policy declaration page(shovring the policy number and expiration date). Failure to secum coverage as required.under Section 25A of MGL a 1572 can lead to the imposition of criminal penalties of a fine up to$1,50a 00 aadlor one-year imprisonment,as well as civ2 penalties Ju the form of a STOP WORK ORDER and a f me of up to$250-DO 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 verification.. I do Hereby ceri fi��r:ander//thepinns andsperrallies afgarjur}r fhattfie informativrtproud ahmpe fs true and carrect Sismahirer A �1 $-A- w ®q 31 ' O,�icial uss anTy. I7a oat tyrete in this area,fa be arrnpletcad by ciiy arton�n a,(j`tciat City or Town: Per€mtlLicense# Issuing Authority(circle one): 1.Board of Health I Building Department 3.City1rowu Clerk 4.Electrical Fnspector 5.Plumbing Inspector 6.Other contact Person Phone#: laformation, and. Mstructions e .: Mari&�etts C,&acnl Laws chaptrr 152 mpnr s all empIoyers'M provide wo3ieas'compensation for their employees_ Parsaantto this sfaimie,an e2"PIayee is defined as.6_cvmy person in$ie service of another under any coift act ofhfir, " express or implied,oral or wriiiea." An e"P&Uy r is defined as"an incfiyidnA part aersbp,association,corporation or other legal entity, or nay two or more of the kregoing engaged iQ a joint eotmTrise,and iIlcTn�the legal representatives of a deceased employer,or the recei4Er or trustee of as mdividIIal,partnership,association or other legal entity,employing employees- However the owner of a dwelling house having not more than three spartmeuts and who resides therein,or the occupant of the - dwelling house of another who employs pemons to do mace,comsfxucfion or repay worm on such dwelling house or ou the grounds or building apprntenaT>f$into shall not bmanse of sash employment be deemed to be an employer." MOL chapter 152,§25C(6)also states that:'every state or local licensing agency shalI 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 cdmpH=m with the insurance.covexage re quked." Additionally,MC=L chapter 152,§25C( )states'Neither the commonwealth nor any of its political subdivisions shall an into any contract for the performance ofpnblio work uat it acceptable evidence of compIiaace vrith tha fim -a ce,. regtm-euients of this daptcr.have been presented to the cant acting aufhozity." A.gpHcarrts Please El out the workers'compensation affidavit completely,by checI®g the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone Tn Tn r(s)along with their certEcate(s)of insurance. Limited Liability Compames CLLC)or LimitedLiabilityParf ==I ips CLEF)withno employees other.thm the members or partners,are not rbquired to carry workers'compensation insm-Fn c, If an LLC or LLP does have employees,a policy is regnized. Be advised that this affidayit may be submitted to the Department of Industrial Accidents for conformation of insurance coverage. Also be sure to sign and data-he affidavit. The affidavit should be-rsitmmed to the city or town that the application for the permit or license is being requeste(L not the Department of I�ustrial Aceide+ts Should you have any questions regarding the law or ifyou are rcquaed to obtain a workers' compensation policy,please call the Department at the nimmber listed below. Self-fi med companies should enter.their self hisar-arrce lic®se number on the appropmiaie line City or Town Officials f _ Please be scar.that the of avit is complete and primed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in.the event the Office of Invesdgati oas has to conduct you regarding the applicant Please be sure to f Il in the permiillicrose= bes which will be used as a reference number. In addition,an applicant that must submit multipk permitlli cense applications in any giver year,need only submit one affidavit indicating can en. policy inlfirrnatiou.(if necessary)and un der`Job Site Address"the applicant should wn "all locations in (criy or town)-"A copy of Ihe•affidavit that has bey officially stamped or marked by the city or tmwm may be provided to the applicant as proof that a valid affidavit is on file for futore*permzfs or licenses A new affidavit must be filled oi±each year.Whew a home owner or citizen is obt'ammg a license or permit not related to any business or commercial.ventro (Le. a dog license or permit to bum leaves etc-)said person is NOT required to complete Ibis affidavit The Office of Investigations would lflm to thank you is advaace for your cooperafion and should you have any questions, please do not hesitate to give us a call The Departments address,telephone and fax number. Thft COMMMwalth of arh . I�egaifi�.t�cif lad�ial Aacident� Ragton.,MA 0�11F `red.:#617'2i-4900 eat 4€ 6 Q.r I-,977-MA&&AM Fax#617`27 7M Revised 4-24-07 Town of Barnstable Building Department Services ♦ A�AN?IyAT4 • NAM Brian Florence,CBO Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns 1 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 to act on my behalf in all matters relative to work authorized by this building permit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant tom K410 Print Name Print Name Date QTORMS:OWNERPERMISSIONPOOLS Rer.08/16/17 Town of Barnstable r� Building Department Services . Brian Florence,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 KAM www.town.barnstable.maus s6"5 p MOd V., Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: Please Print O U / •r. JOB LOCATION: 2 I` U / Ii/�/ `" y�I;M?f MCA © (0 j "HOMEOWNER": mane hommephone# work phone# CURRENT MAILING ADDRESS: q6 fvoq,�fS 6 r city/Umn state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellin¢s 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. DEF NMON 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 pr 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 buildiU RgMj& (Section 109.1.1) :: . The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. r: The undersigned"homeowner"certifies that he/she understands'the Town of Barnstable Building Department minimum inspection proced s an/d' quiirrements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official 44 I. Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code s. Section 127.0 Construction Control. r: - 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 homeowner4 engages a person(s)for hire to do such work,-that<such Homeowner shall act as supervisor." i Many homeowners who use this exemption are unaware that they are assuming the.responsibilities ofsa supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.1 ` This`lack of aarenessyoften 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in' your community. Q:\WPFMES\FORMS\building permit fomu\EXPRESS.doc 08/16/17 -:n, T