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HomeMy WebLinkAbout0008 JIB WAY V/�J �GW __ __ _ / / RICHIE'S INSULATION INC. ti 111 OLD BEDFORD ROAD WESTPORT, MA 02790 508-678-4474 BUILDING DEPARTMENT TO WHOM IT MAY CONCERN: PLEASE BE ADVISED RICHIE'S INSULATION, INC. INSULATED THE FOLLOWING JOB: ADDRESS: 8 JIB WAY TOWN: HYANNIS, MA 02601 CONTRACTOR'S NAME: RALPH SADOWSKI = CONTRACTOR'S ADDRESS:8 JIB WAY, HYANNIS, MA 02601 CONTRACTOR'S TELEPHONE NUMBER: 413-575-1943 THE FOLLOWING INFORMATION IS WHAT WAS USED ON THIS SPECIFIC 106: MANUFACTURE: ICYNENE w TYPE: PRO SEAL LE THERMAL CONDUCTIVITY PER INCH: 7 PER INCH AREA - THICKNESS R-VALUE ROOFLINE WALLS STAIRWELL BASEMENT CEILING GARAGE CEILING G.H.WALL BEHIND FIRE PLACE 3" R-14 OVERHANG CATHEDRAL WALL CATHEDRAL CEIL FOUNDATION WALL BLOCK/RUNN. SLOPES W/ 7" R-49 SHEATHING P/V THANK YOU VERY MUCH FOR YOUR COOPERATION IN THIS MATTER. IF YOU HAVE ANY FURTHER CONCERNS PLEASE CONTACT MY PHONE NUMBER. INSTALLER: ERIC JOHNSON RICHIE'S INSULATION INC. Wv 1 Assessor's office(1st Floor): �'� Assessor's map and lot number �' SYSTEM `• Board of Health(3rd floor) / STALLED IN Co c Sgwage Permit number l W� Engineering Department(3rd floor):/ FJ� 11MU TABLE House number bTOM REGM(definitive Plan Approved by Planning Board 19 A� Nix APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 3 Proposed Use ��e�%a 5-e Zoning District e Fire District 5- Name of Owner G,eSie-, Address -fiber Name of Builder Tarr � Address 9 Name of Architect ~ Address- Number of Rooms Foundation G Exterior ram Roofing !/ Floors t/ e2,1 C-2-e 7-L Interior , zA,,C Heating A,) Plumbing Fireplace '� Approximate Cost Gd Area 7' o0 Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. I Name Constr /nSupervisor's License WASIERSKI , JOHN H. No 33622 permit For Build Garacr _ s Accessory to Dwelling 'K Location 8 Jib Way ` Hyannis r Owner. John H. Wasierski Type of Construction Frame z t Plot Lot Permit Granted March 26 , 19 r9 0 Date of Inspection C5 19 M Date Completed G���/ r 19 f 4 i F,v I ZXYAOo Ir ro in 1n i Jp'* tw. " '4,.t" .M�,v+r.--+rr�rxy.7yt. -4"r,1t m,ti y':-�:,...+t y'�,ra"h�N�.f�......-:n.,�:sue,•. _ Y ..i a f+ s � � , ..�'Y.., - ':..�.,. Y 'Assessor's office(1 st Floor): n 1 r Assessor's map and lot number it - �QyoF Tw a toy o Board of Health 3rd floor Swage Permit number i t asaasTsnt,� S " Engineering Department(3rd floor): FJ� NAM- House number Jefinitive Plan Approved by Planning Board 19 r�r 0' APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only 1 TOWN OF BAR.NSTABLE BUILDING- INSPECTOR APPLICATION FOR PERMIT TO >�i� ,'�� /r� -.7, 'HG� -4f- ' TYPE OF CONSTRUCTION -7-7 to /tf 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information:: \ Location �/ �' `/ /� �� ✓i f ( I n i o� J Proposed Use ��� r-7 Q � �. Zoning District /,- Fire District �F/��N'� 1 Name of Owner ��� l« f/ Aj!� Addressi Name of Builder �-) ��.� �' < Address Name of Architect Address ` Number of Rooms Foundation f Z Exteriors.,..,._ i /T =� Roofing f i Flobrs y `�' ' ' Interior //•� '��s � v s Heating �a Plumbing f Fireplace Approximate Cost Area t Diagram of Lot and.Building with Dimensions Fee "40CCUPANCY`PERMITS REQUIRED FOR NEW DWELLINGS I�hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. NameC '�"—' �?%� -� Construction Supervisors License WASIFRSKi,. JOHN H. A=24/--188 No 83622 Permit For Build Garac­ Accessory to Dwelling Location-8 Jib Wag Hyannis Owner Johri H. Wasierski Type of Construction Fram6e Plot Lot Permit Granted Mar_ch 2 6, 19 3 0 Date of Inspection 19 Date Completed 19 PERMIT ,,'cv % COMPLETE T014N OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER"LICENSE EXEMPT Please print. ION ,t DATE 'J06 LOCATYON "NOhi UM er reet EOWNER" /oti�; . a Tess ection.o ;town 4 ` ame K e PRESENT " 4 om pone MAILING ADDRESS r { or P one it own dhe cu"r,,rent exemption •fors �� pcoe ellfri'gs of"';six units or home, was extended .t 1Y1 ua SS ,.dn . o include gwner-occupi* ' for hire, who:does not ' ° allow such homeowners: to engage. acts as supervisor. such license (State Building Code Section anr" . -�...,........, , provided that .... t the owner . :DEFINITION OF HOMEOWNER: Person s `side ,Owho owns a . parcel of land on which he/she resides on which there is, or is intended to be, a on attached or. detached structures °r intends to re- A re.r�son who constructs more es.acc-es e t0 s'ix fami 1 ;considered a homeowner. ,� y to such use. and/or y d«eIling, .on a. form acceptable tot home, a two / farm structures. Such homeowner" shall submitatopthe°guihaI not be rf�r all such work he Building Official, Permij he/she shall belies o performed under the bui'idin9.Orficizl, the undersigned "homeow 9 ectlon p nsible Building Code and"homeowner" assumes- responsibilit other aPPlicable Y for com the undersigned"hom codes, by-laws Pliance with the. State rules. and regulations. BarnstableBuildin eowner ee.rtifies that he!a►ld,that he/she willPcomartment. filnimum inspection understands 'the Town of PIY with said procedurespanderdereS and • requirements HOMEOWNER GUirements; � ` 'S STGNATORE: - APPROVAL OF BUILDING OFFICIAL .Note: Three famil to comply well - with State�Buildigs 35,000 cubic feet '' g Code Section 127.E °r larger, will be Construction required r 8 V1, HOME OWNER'S .EXEMPTION The Code state that : Permit "Any Home Owner performing work (sectlon1109required shall be exempt from for which a bufld'Ing Home Licensin . the Provisions of this IUIIdIon Owner engages g °f Construction Supervisors shall' act as SUperwlsoerson(s) for hire to do such work ) � provided that. '.1f::_a. * ._.,. that• such" Horno Owner Many Home Owners who use^ th1. exempt ) • the :r e s ,.._ •t.,. _.. . -. ' ponsiblIItles on are unaware that for. LIcens.in °f a supervisor they are assuming. ' often res g Construction Supervl (See `Appendix 0, Rules Ults In sors, Sectfon 2,y� and Regulat Ions. ' � Unllcensed seri.oUs problems, � • This� lac k 'of awaroness parsons. In. partL.cularly wlion the Homo unlicensed-per this ' 'case Owner son our as lt 'woutd''ivlth licensed Supervisor cannot hires ,as sUpervlsor is ultimat-el procoed;a"gahnst--th6 y, responslble, pervlsor ' • The- Horno Owner acting To ensure. that the Homo communities 're Owner I . fully away® ,ot °his/her .responslb' certify qU ihe, as_ `part 'of the "t.hat he/sh© permit application 1lltio�, many last'pa e of Understands the responslblll 9 this Issue is a, Corm ,.current I ' , .thaty tho:"F1omo '`Owner K care to 'amend ties of a supervisor': . p and ado Y Us n.adopt s Used b th© UCf a ;.f Y sevora ' o j' rm/certlflcatlo towns: You.. ma of or Y �u s e . In.. your - communlfy. -eo 11 Fr a (, /0 A ty cs 63 1- - Poeo oo 00 - 1a 23' 9 f 1 f f' I � , { Z Zx zZ i7 (Is i ,. Town of Barnstable Building PostTh�s Card So Thai it isU�s�ble:From the Street xApp,roved:.PlanS Must be Retained on Job and,th�s Card;Must be Kept MPARNWA Post Unti�Final lis'ecton Has Been Made �.. , ` � C'' �.; � s Where a Cectificateof Occupancy;is Required;such Building shall Not be Occupied until a Final Inspection has been made Permit ,...� ;...; .� :-,,:�-�.. ,. __. ,..✓�.. ,r,.......P<, .,�✓.: ., ,:.f�.., .:�;,.., e�d, �,. ... „ -.rw ..�, _.. .. „.tea. ...... .. ... ...... ,,.. .ems.::. .. zr ,..x :.r.. Permit No. B-18-3453 Applicant Name: SADOWSKI, RALPH& KAREN Approvals Date issued: 10/29/2018 Current Use: Structure . Permit Type: Building-Addition/Alteration-Residential Expiration Date: 04/29/2019 Foundation: Location: 8 JIB WAY,HYANNIS Map/Lot: 247-188 Zoning District: RB Sheathing: •. � »* �. �ate,. Owner on Record: SADOWSKI, RALPH& KAREN Contractor Name Framing: 1 Address: 48 ALEXANDER PLACE ` �01, Gontractor=Ucense 2 WESTFIELD, MA 01085 Est Protect Cost: $25,000.00 Chimney: " .' e: $ 1 Description: 15x21 addition at back of house sunroom P ermit�Fe 77.50 F Insulation: $ 177.50 Project Review Req: � Fee Paid :` Date 10/29/2018 Final: 40, Plumbing/Gas k Rough Plumbing: E ti Building Official ;• Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed: by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application nd�the'approved construction documents for which1his permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shalHbe in compliance with the local zoning by laws'and codes. This permit shall be displayed in a location clearly visible from access street orroad and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. z Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Build nl g and Fire Officialsare;prowded on this,permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection � � _ w Rou h: g 3.All Fireplaces must be inspected at the throat level before firest flue lining s insstalled� 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Town of Barnstable Building PoshTh�s Gar' 'So That is V�s�ble From:the Street A rovetl,Plans Must be Retained on,Job and this Card Must'be�Kept A, en to ,: tr x Pp • Posted'Until`Final InspectionHas Been Matle 3 1634 Permit Where,a Certificate of Occur ancyas`Required such�Buld�ng shall'Not be,Occup�edunt�fa Final Inspectionhas been made , ...,.,w...__._.y__ ;..p'`..ME .._.:�:,.. aa,e "a �,. .;. ,: i::" .nK :•.a ..'a,vas�� a.... .- ., ..✓.__._ .<,�.u, .Yw....,;.z. .a ,�.- Permit No. B-19-381 Applicant Name: Richard Tavano Approvals Date Issued: 02/06/2019 Current Use: Structure Permit Type: Building-Sheet Metal-Residential Expiration Date: 08/06/2019 Foundation: Location: 8JIB WAY, HYANNIS Map/Lot: 247 188 Zoning District: RB Sheathing: y Owner on Record: SADOWSKI, RALPH&KAREN � Contractor Narne RICHARD J TAVANO Framing: 1 Address: 48 ALEXANDER PLACE _WIN Contractor L�ense6653 2 WESTFIELD, MA 01085 EstProJect Cost: $ 14,000.00 Chimney: Description: Installation of HVAC system with one zone f Permit Fee: $85.00 y Insulation: Project Review Req: Required Documentation per 2015 IECC should be on-site R `Fee Pald $85.00 Date 2/6/2019 Final: 20 4 Plumbing/Gas Rough Plumbing: _,Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorizedby this permit is commenced within soc months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents.f�or which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and strictures shall be in compliance with the local zoningbyzlawsand codes. ` Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Bullding and Off Fire icials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work. y: Service: 1.Foundation or Footing z 2.Sheathing Inspection �:', �. .a., ., Rough:lk 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to 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 All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: MICHELE CUDILO, P.E. Consulting Structural Engineer 123 Cottonwood Lane • Centerville, Massachusetts 02632-1979 • (508)737-8521 • mcudilo@comcast.net December 11, 2018 Mr. Brian Florence, Building Commissioner Town of Barnstable 200 Main St. ZZ Hyannis, MA 02601 © 00 fi W RE: Sadowski Addition 8 JIB WAY,HYANNIS, MA - _ 3 N a Dear Mr. Florence, C3 t,n Please be advised that the above captioned project has been inspected on December 6, 2018 to review the Addition framing components,and then follow up construction photos of the completed work. This office has designed the addition,which consists of mostly glass openings, using rigid corners with steel 2-way saddle post caps,SIMPSON ECCL/R. The exterior wall sheathing nailing was reinforced to have 3"on center,o/c,edge nailing. The roof sheathing was reinforced to have 8d at 6"o/c edge and 6"o/c field nailing. Wind blocking,2 bays,4'o/c,was added. The as-built addition framing is adequate for high wind loads. I trust that the above addresses your needs at the present time. Should you have any question on the above, please do not hesitate to call. S'ncerel , Michele Cu ilo, P.E. X; OF MASs4 /2018-123 2�P M\GNE O GO O Sj�Ao ,o 194 Gr.i `P��=� 9�'Fsslotl�� Mckechnie, Robert From: Mckechnie, Robert Sent: Thursday, December 06, 2018 10:14 AM To: 'Ralph Sadowski' Subject: RE:8 Jib Way Good Morning Ralph, The nailing pattern, as well as the construction, is regulated one of three ways: 1.) The Guide for the Wood Frame Construction Manual, 110 mph Exposure B, or 2.) The Building Code, specifically those sections regulating high wind zones, or 3.) The specifications listed by a Massachusetts Licensed Architect or Engineer on a stamped plan. So,this is not a blanket answer for all projects. This information should have been listed somewhere on the plan. However, the plan was not onsite when I did the inspection so I could not refer to it. Perhaps the only way to rectify this is to meet you or your contractor or both onsite and review the requirements. As far as the roof nailing, the minimum requirements are spacing the nails 6" o.c. on the edge and 6" o.c. in the field of each piece of sheathing for this wind zone. I will be going on vacation after Friday, tomorrow, so that if you need to get in touch with the building department you will have to call our main phone line 508-862-4033 to arrange an inspection. Thank you, Bob Robert McKechnie Local Inspector Building Department Town of Barnstable 200 Main Street Hyannis, MA 02601 508-862-4033 From: Ralph Sadowski [mailto:rms1956(cP)gmail.com] Sent: Wednesday, December 05, 2018 5:46 PM To: Mckechnie, Robert Subject: 8 Jib Way Good Morning Bob, I apologize for the numerous emails and phone calls but I'm just trying to keep this moving forward, can you let me know what the nailing requirements for the wall sheathing are, spacing, type of fasteners if applicable, etc,,. Are the requirements for the roof sheathing the same?My contractor is going to be back down there late this week, well hopefully so anyways, and maybe we can get this right this time. Regards, 1 Town of Barnstable oFt"e Regulatory Services 0 Thomas F. Geiler, Director + BAMSTABLE, MASS. �0� Building Division 'OrFonnA�" Thomas Perry, CBOBuilding.Commissioner 200 Main Street, Hyannis,MA 02601 www.town..barnstable.ma.0' Office: 508-862-4038 Fax: 508-790-6230 EXIT ORDER DATE: � ! LOCATION: UNDER THE PROVISIONS OF 780 CMR, THE STATE BUILDING CODE, SECTION 3400.5.1, YOU`ARE HEREBY ORDERED TO•IMMEDIATELY DISCONTINUE THE USE OF THE CELLAR/BASEMENT AREA FOR SLEEPING PURPOSES. - LOCAL INSPECTOR / S115 A IURE�RECIPIENT - " ODEM DE SAIDA DATA: LOCALIDADE: DE ACORDO COM 0 PROVISORIO 780 CMR, CODIGO DE CONSTRUCAO DO , ESTADO, PARAGRAFO 3400.5.1, VOCE ESTA ORDENADO;DE DEIXAR DE USAR, IMEDIATAMENTE, A AREA DO PORAO/BASEMENT PARA .0 PROPOSITO DE DORMIR. INSPETOR LOCAL ASSINATURA DO RECIPIENTE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map -�,q7 Parcel I u Application # Health Division Date Issued Conservation Division Application Feg_�%� Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project=Street'Address J[ J l S Village ppM =Own'er 6AX,ecm Rt 3A%, �`ywS� tla A "ress rG 90 ,_-Telephone� S 0� �-7 G Sl 0?5 `4-- cFermit=Regaest� �1A a ,I 1 Cam! �' 4 � ►04 -�r•E- _�{'�� IIMA 1�1� OVJ6 && ,%i u1 64k 6Vt RA4Atd + D <: 4v 6t -a" �i� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatiiori�J Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full 0 Crawl ❑Walkout ❑ Other BUILDING ®EP 1 Basement Finished Area (sq.ft.) Basement Unfinished Area (s�q Number of Baths: Full: existing new Half: existing 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) r-Nf.'-S � TelephoneYNumber��d� �1� 3� VAddress 1'&°1d,. I x'A-4 License# ctf Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SfGNATUR ,—DATE �.w FOR OFFICIAL USE ONLY +APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE ~ OWNER DATE OF INSPECTION: FOUNDATION .FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL , M GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1, ' T7re Conzrnorriveakh of-Vassochusetts Department of lndurstrialAccidents Of-ce-of 1ni.•sfigations t 600 Washington Street y Boston,MA 0 71`11 " 1 mi niasygovfdia Workers' Campensafian Insurance Affidavit:Builder(Cuntractnrs Electricians/Plumbers � Applicant Inforimation. Please Print Legibly �11�31]1P,- USBf23IIffitlrfnlTnc�cc ir�na9� �'�MA�{M\ •" U� '��" �G ! Phone r;� ��• p ��� Are you an employer?C1 ee the appropriate box. Type of project(required): I.❑ I.am a employer with. 4 ❑I am a general contractor and I 6- ❑New construction: employees(full anNor part-time).* have hiredthe sub-contractors 2.❑ I am a sole proprietor arpartuer- listed on,the attached sheet. 7. ❑Remodeling sh�p and h we no employees. These sob-contractors have g- ❑Demolition working for nee in any capacity employees andhaue workers' o workers' camp.insurance comp.insurance I 9. ❑Building addition (-I equired I 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3: am.a fiomeoumer doing ail work officers have exercised their 11.❑Plumbing repairs or additions C se1£� o workers' right of exemption per MGL '�' � gip- 12.❑Roafrepairs insurance required.]1 c.152,§1(4X and we have no employees.[No workers' 13.❑Other comp.insurance required.] J I ;Amy app5csatdotchecksbox01lmast also filloutthesectionberowshDwingiheirwortleis'campmsdionpolicyinfbratad L Homeowners who submit dsis af5dzve ind rsnn,g they are daiag all wank and china.like autsidecaatractorsnmst submit a new affidavit indicating ssacb ZOantmaors that eheck this box must attached as additional sheet showing the nurse of the sub-contractors—sad stafewhethet arnatthose entitieshave emplayees.Ifthesubtaatractnrshave employees,theynnstpmuide their warken'[omp.policy number- I am aft eatpib;}�€r float is prmzdurg�a�crkers'compertsatt'oar iitsrirant:e fvr ax}*enzpt��ee� $etoav is Ylta poiicy�aa�d ja7a site fr formairom Insurance Company Nance: 'Policy,or Self--ins.Lic.k l kpiration Date: Job Site Address: City/Stafelzap: Attach a copy ofthe corkers'compensationpolicy declaration page(showing the policy number andexpiration date), Failure to secure coverage as required undrr Section 25A of MGL c 1572 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andrar one-year imprisar n-tpuf as well as civil penalties.in the form of a STOP WORK ORDERand.a fine of up to ZO-00 a day against the violator. Be adcdsed that a copy of this statement maybe fonvarded to the Office of Imvestfgations of the DIA for insurance coverage I d zero c. rant pan s ofpetjur}�f7uatflta irajorrrrafiouprmzrTedab .i� urE ad:tf cixrrect Official use only. Do not tsrite in difs-area,tv be cainpleted by city ortown o,�t'ciat City or Tana: PermitUcense 4 rssuing Authority(carde one): 1.Board-of Health 2.BuMing Department 3.City/rown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and listruefions Ma-ssachusetts General Laws chapter 152 regr=s all employers to provide workers'compensation for their employees. p urs�this stAute,a a employee is defined as."_.every person in the service of another under any contract 0f hille, express or died,oral or writinn_" Au wTluyar is defined as"an individual,pmtaersbip,association,corporation or other Iegal entity,or any two or more of the foregoing engaged in.a joint enterprise,and including the Iegal representaiives of a deceased employer,or the receiver or t-ustee of an individual,partnership,association or other Iega. entity,employing employees. However the owner of a dwelling house having not more t3-an three apartments and who resides therein,or the occupant of the - dwel�ing house of another who employs persons to do maintenance,contraction or repay work on such dweang house or on the grounds or building app- rtena�thereto shall notbmanse of such employment be deemed to be an employer. n MGL chapter 152,§25C(6)also states that�'eyery state or local Hcensing agency shall withhold the an ar renewal of a license or permit to operate a business or io construct buildings is the co-umonweaWt for any applica Tit who has not produced acceptable evidence of compliancewith-the,h1snranqe_coveragerequ>z-ed." Additionally,MGL chapter 152.§25C(7)sF.{' G-Nerlherfar-commonweaNhno iny of its politicalsubdivisions shaR enter into any contract for the peifoimance,ofpublic woi:k until acceptable evidence of compliance wi the instsance. requirements of this chapter have been presented to the contracting aii fhoatyf AppHcants Please fill oirt the workers'compensation affidavit completely,by checking&e boxes that apply to your situation and,if necessary,simply sub-contcactor(s)name(s), address(in)and phone number(s) 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 r6qui ed to cairy workers'compensation insurance. li au LLC'or LLP does have employees,a policy is rbgaired Be advised that this affidavit maybe submi red to the Department of Industrial Accidents for confirmation of fi mince coverage. Also he sure to sign and date the affidavit The affidavit should be,retnmed 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 regrading the Iaw or if you.are required to obtain a workers' compensation policy,please call tht-.Department at the number listed below. Self-insured companies should enter their self-ju er=ce license number on the appropriate line. City or Town Offidals t - Please be sore that the affidavit is complete and printed leg--bly_ The Department has provided a space at the bottom of tht affidavit for you to till out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the par iq icrose number which will be used as a reference number. In addition,m applicant that must submit multiple penitllicense applications in any given year,need only submit one affidavit indiczti g current policy mforn-ation(if necessary)and under"Job Site Address"the applicant should write"all locations in (cry or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for fi-tur,permits or licenses. A new affidavit must be filled out Bads year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (Le- a dog license or permit to bum leaves etc_)said person is NOT regniced to complete this affidavit The Office of Investigations would at to thank you in advance for your cooperation and should you have any z,e;sfions, please do not hesitate to give us a caM The Department's address,telephone and fax number: The CG-mMCtwcaltbF of Massachuttts - D ep ial Aoaiients 4 Qface 4f f fvesf igatio �4� as�in tan St=t Bostmn MA E1�111 Tf,-1.:g 617' 7--4909 Qx- 406 ar 1­97 IA4.SaAFE Fax 9 617-727 7749 Revised4-24--07 p w mas.5-go-Wdia. Town.of Ramstahle . f Reg-datorg Services r Richard V.Scz%Director , t morass. Tom Petry,EmZdmg Commissioner 200 Mak Sfrce Hyaniffs,NIA 02601 w w tnmbara`�iIr_m� Office: 508-862-4038 Fay 508-790-5230 - HOMEOWI�rrrFrJCR F.REMP'r�ON JOB Lo=CYK- f, C- a fiwo�[Pbo`nc�� CURRENT IAAff WGADDRFSS: _ ---- � q/VMIA . zip codc The current exemption for°homeowners"was extended to include owner-occupied dweIImes of six units or less and to allow homeowners to engage an individual for hirewho does notpossess a license,provided thatthc awner acts as supervisor_ DxF=ON OFHOM WIRT R p mon(s)who owns a parcel of land on which he/she resides or intends to reside,on wh cb.there is,or is intended to be,a one or two- family dwelling•, attacbed or detached siract a=accessory to such use and/or farm shuc m-es- A person who constmcts more than one home i-a a two-year peri rod shall natbe onsid=s d ahomcowncr: Such`homeowne r'.shall sabmittn the Bm� mg Id Official on a intro acceptable to the Bmiffim Offi"ihatbdAhs shall be 1.sMonsr-ble for all sari workperfoffied underthebm7dmg permit (Section 109.L 1) br The undersfg cd`-homeowner"mmacs responsrb�y for compliance wdiithe State Building Coda and other applicable codes, bylaws,roles and rm9alatiOns- r Tlurmdemgad-`homeeowner'=tfr thathe/she the TowerofBamsfabIcBwZdmgDepartm=t=m=insprf-t - p ' ements thathr/she y whit said pmmedncs and regaaemeafs- Approval ofBm1cr=gOfFdzI Note: Three fa:fIy dwellings containing 35,000 cubic feet or larger wffibe requi mdto comply wdi the Sfata Buildmg Coda Section 127.0 Coristru on ConiroL Hon�owrr»'s E�i'tQPI The Code states that: aAny homeowner performiag work for which a big permit is required shall he exempt T.iceusing of construction Supervisors);provided the homeowner from the provisions of this section(Seetzon 1091-t engages a person(s)for hire to do such Mork,that such Homeowner shall act as supervisor." Bf2ny homeowners who use this exemption are unawam.ffiat they are assuming the responsibilities of a supervisor (sec Appendix Q,RnIes&Regulations for Lictnsi,g Construction Siperdsors,Section 2JS) ']his Lark of awareness oticn results in serious problems,p=tenTarly when the homeowner hires unfrcensed persons. In this rase,our Board cannot. proceid against the unlicensed person as if would with a licensed Supervisor_ The homeowner acing as Supervisor is ujt=trly respo=-Me. To easlse that the homeowner is fully aware of bWher responsibilities,many communities require,as part of the pPr,mdt application,tbat the homeowner cerfrfy tI mthe/she understands$re re;SponsMrTrdes of a Supervisor. On the Lastpage,, of this issue is a form currently used by.scieral towns. You may care t amend and adopt such a fbrmI6erti&a&n for use in' your comsmanity. � pe�itfiamslEXPBFSS.dne ' ltz&ed 06U 13 Town of Barnstable : o� ` Regulatory Services - ' � RlS7NlC1'1T2f4 F • K$ Richard P.SmlI Director IL Building Division TomPerry,Bm7db3g ConMissioner 200 Main Street Hy=�MA 02601 www fown-lamsfable raa_us. Office: 508-8624038 Fes: 508-790-6230 I'raperfy.OwnerMusr Complete and SignTllis Section IE Us ina.A Builder as Owner of the subject ProPeity Iserebyaur]iori7P to act on mybehal� in all matters relative to wank a rized bythis building permit application for: . (Add=es of b) ""Pool fences and alarms are the r onslilityof the applicant Pools are not to be filled or uilized befo - fence is installed and all final ' inspections_are peZonned and accep Sig== of Owner Signature f Applicant Print Name Pzim Name Date . �Fax�rs:owr�r��smrrtPaors . I - Bk 274-32 Ps 135 32-761 QUITCLAIM DEED I, ROSALIND A. PACHECO, of 8 Jib Way,Hyannis, (Barnstable), Barnstable County, Massachusetts, 02601, For CONSIDERATION PAID of ONE DOLLAR($1.00), GRANT to: ROSALIND A. PACHECO, Trustee of TheiPacheco RealtfX-rust,Dated May 29,2013, 8 Jib Way,Hyannis (Barnstable),MA 02630,as evidenced by Trustee's Certificate recorded herewith. With QUITCLAIM COVENANTS, The land together with the buildings thereon located in Hyannis(Barnstable), Barnstable County,Massachusetts bounded and described as follows: NORTHERLY . by the intersection of Jib Way and Rudder Road,by a curved Line having a radius of twenty-five and no/100 (25.00)feet,a distance of thirty-four and 93/100 (34.930)feet; NORTHEASTERLY by Rudder Road,by a curved line having a radius of one hundred twenty and no/100(120.00)feet; a distance of thirty-nine and 629/1000(39.629)feet; EASTERLY by Lot 26,one hundred three and 592/1000(103.592).feet; SOUTHERLY by land now or formerly of Lawrence S. Tobey,one hundred and no/100 (100.00)feet; _ __. . WESTERLY by Jib Way,forty-nine and 426/1000(49.426)feet; and NORTHWESTERLY by two courses, a curved line having a radius of eighty and no/100 (80.00)feet,a distance of fifty—four and 889/1000 (54.889)feet;and a straight line,a distance of twenty and 639/1000(20.639 feet. , r Containing 10,811 square feet of land and being shown as LOT 25 on a plan entitled"Plan of Land in West Hyannisport,Rudder village, Section II,Rudder Realty Trust,J.Paul Tama, Trustee, Scale 1"=40' May 20, 1968,Robert G.McGlone, Surveyor and Engineer,Airport Plaza,Hyannis,Mass."Which said plan is duly recorded with the Barnstable County Registry of Deeds in Plan Book 232,Page 125. Subject to and with benefit of all rights,rights of way,easements,restrictions and reservations Of record,insofar as the same or now in force and applicable. For title see my deed recorded at Barnstable County Registry of Deeds in Book 12754 Page 070. Property address: 8 Jib Way,Hyannis(Barnstable),MA 02601 IN WITNESS WHEREOF, I herein set my hand and seal this 29 day of May, 2013. Rosalind A. Pacheco Commonwealth of MA Barnstable, ss On this 29th day of May,2013,before me,the undersigned Notary Public appeared Rosalind A.Pacheco, who proved to me thro Personally identification,which was �satisfactory evidence of Personal.knowledge, to be the.person whose name is signed'o Preceding document,and acknowledged to ffie that she signed it voluntarily for its v.:;•- v' Purpose. N 0 Pu c BERT J. OWENS ' M ionft i Fsfublic Commonwealth of Massachusetts My Commission Expires April 14; 2017 s-q.p TR T TSTF.F.'S C'.FR TTFTC A TP PR T TQT T A ATT TA C_'.HAPT_R.R 5qR of t1,P A('TQ nf)nr» y,. NAME OFTRTT.$T; PA( T-TPMPPATTVT0TTcr DaT_F.T)MAV IQ 2413 NAME OF TRUSTEE: ROS A?I?D A.PACHECO PROVISION FOR APPOINTMENT OF The original Trustee appoints ROBERT O.NELSON SUCCESSOR TRUSTEE as Successor Trustee. In the event that Robert()_Neimn k unable to serve,the original Trustee appoints SUSAN M` BLANC, -as�his successor. Any person dealing with a successor or additional trustee may rely upon a copy of an instrument appointing said successor or additional trustee,as evidence of said successor or additional trustee's appointment and power to act pursuant to the terms of the Trust. CERTIFICATION. I,Rosalind A.Pacheco,Trustee of the Pacheco Realty Trust Dated May 29,2013,with a mailing address of 8 Jib Way,Hyannis,MA 02601 certify that: A. I am the current trustee of the Trust. B. I have the power to accept additional assets to the Trust and to dispose of the assets of the Trust accordingly. C. The Trust gives the trustees the following powers: - To the extent specifically directed by the beneficiaries hereof,the Trustees shall have fiill power and authority to borrow money and to sell, exchange or otherwise dispose of all or any part of the trust property and to mortgage or lease all or any part of it by one or more mortgages or leases for a term or terms which may extend beyond the date of any possible termination of the trust;to execute and deliver discharges,partial releases,assignments and subordination or mortgages and to make other agreements or arrangements conceming mortgages and mortgage obligations,to grant or acquire rights or easements and enter into agreements or arrangements with respect to the trust property,and to acquire property and leasehold interests in property D. There are no additional facts which constitute a condition precedent to acts by the trustee or which are in any other manner germane to affairs of the Trust in • connection with this conveyance. EXECUTED as a sealed instnunent under the pains and penalties of perjury on May 29, 2013. —XHX&�P Q� RO ALIND A. PAC CO,TRUSTEE PACHECO REALTY TRUST TRUST DATED MAY 29,2013 COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, SS. On May 29,2013,before me,the undersigned Notary Public,then personally appeared Rosalind A.Pacheco,as Trustee of the Pacheco Realty Trust Dated May 29, 2013,who proved her identity through personal-knowledge,signed the foregoing document and acknowledged it to be her free act and deed., &A a�@� NWARY P Public t Common ealth of Massachusetts My mmission Expires April 14, 2017 LAST WILL AND TESTAMENT OF ROSALIND A. PACHECO I, ROSALIND A. PACHECO, of Hyannis, Barnstable County, Massachusetts, make this my will and revoke all wills and codicils previously made by me. ARTICLE I. DISPOSITION OF TANGIBLE PERSONAL PROPERTY. I give and devise all of my tangible personal property,including, but not limited to, household furniture and fur- nishings, cars and clothing, but excluding currency, securities, investment metals, notes, and the like in equal shares to my children; ROBERT O. NELSON and_S_USAAN M. BLAROHE _ If one of the foregoing children should predecease me, I give and devise his or her share to his or her children per stirpes or by right.of representation. If the decedent child has no children,I give and devise his or her share of my personal property to his or her surviving sibling. Any remain- der shall go by way of my Residuary Disposition. I request that my Personal Representative,formerly known as Executor,and any distributee under this Article consult any memorandum I may leave containing my wishes for disposition of spe- cific tangible personal property and honor those wishes. ARTICLE II. RESIDUARY DISPOSITION. I give and devise my residuary estate in equal shares to my aforementioned children. If one or more of the foregoing children predeceases me, I give and devise his or her share to his or her children in equal shares per stirpes or by right of representation. If the decedent child has no children, I give and devise his or her share of my re- siduary estate to his or her surviving sibling. If no beneficiaries survive me, my residuary estate shall be distributed to that person or those persons who would inherit my property under the laws of Massachusetts in effect at the time of my death as if I had died intestate,unmarred and domi- ciled in Massachusetts,and in the proportions provided by such law. ARTICLE III. PAYMENT OF FINAL EXPENSES. My Personal Representative, formerly known as Executor, shall pay, from the residue of my estate, all federal and state estate, inheri- tance taxes and final expenses occasioned by reason of my death. ARTICLE IV. FIDUCIARIES. I nominate ROBERT O. NELSON as my Personal Representa- tive, heretofore known as Executor, of my will., If he is unable to serve, I nominate SUSAN M. BLANCHETTE. Any Personal Representative named in this will shall also serve as temporary Personal Representative upon application to the probate court. ARTICLE V. PERSONAL REPRESENTATIVE'S POWERS. My Personal Representative, heretofore known as an Executor, in addition to and not in limitation of all common law and statutory powers, shall have the following powers,without order or license of any court: (1) to retain, without liability, any assets owned by me at the time of my death, the period of such retention to lie in my Executor's discretion; and to acquire by purchase or otherwise, and retain for whatever period my Executor shall deem proper, any property, real or, per- sonal,at such times and in such amounts as my Executor shall determine; Page 1 SELF-PROVING AFFIDAVIT I,the undersigned Testatrix, do hereby declare that I sign and execute this instrument as my Last Will and Testament,that I sign it willingly in the presence of each of said witnesses,and that I execute it as my free and voluntary act for the purposes herein expressed. A� ROSALIND A. PACHECO We,the undersigned witnesses each do hereby declare in the presence of the aforesaid Testatrix that the Testatrix signed and executed this instrument as her Last Will and Testament in the presence of each of us,that she signed it willingly,and that to the best of our knowledge the Testatrix is eighteen(18)years of age or over,of sound mind,.and under no constraint or undue influence. IF Witness iv Witness COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. Subscribed and sworn to and acknowledged before me by ROSALIND A.PACHECO,the testatrix,and subscribed and sworn to before me by Douglas H. Grainger and Ann M. Grainger, witnesses, this 29th day of May, 2013. �V4�............... BERT J. OWENS No C Notary Public Commonwealth of Massachusetts My Commission Expires April 14, 2017 Page 4 yu o � o � 6 N Y II' f ;,1 Lol� S JG -o