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HomeMy WebLinkAbout0084 LILLIAN DRIVE 'r�- .oev /e7- TOV^OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel . I Dlo T(Y�VN OF PARNI TA, L Application # Health Division ;':'! •� t �4 „ ? Date Issued z'7-14p P� 14, Conservation Division Application Fee Planning Dept. e .,e. ,� Permit Fee �• b 7 1/Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address/ L /1;C Village Owner LCn)"Nt. Address Telephone ';e-k kc r- C`l 2�- Permit Request -- 6.A-,+L,,r,Lco hCC-i0,-,c Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Ytr Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U,-' Two Family ❑ 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 Telephone Number MikeMcCarthy Address Po Box 52 License # West Dennis, Cell (508) 280-6964 Home Improvement Contractor# CSL-58633 Hic-169393 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 5)04 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ' t ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Office of Consumer Affairs and Business Regulation .; 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 ,. Home Improvement Contractor:Registration' Registration: 169393 Type: Individual Expiration: 6/1 612 01 7 Tr# 264961 MICHAEL MCCARTHY MICHAEL MCCARTHY 1C P.O. BOX 52 --- WEST DENNIS, MA 02670 Update Address and return card.Mark reason for change. Address Renewal j= Employment ^1 Lost Card SCA 1 0 20M-05/11 �— G '>��e�arrenz�<cuea/(l c/?��uf5ticltu5eC73 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: l Registration: 169393 Type: Office of Consumer Affairs and Business Regulation Expiration 6/1612017 Individual 10 Park Plaza-Suite 5170 ..,_.. Boston,MA 02116 MICHAEL MCCARTHY- +. MICHAEL MCCARTHY 6 RANGLEY LN. / SOUTH DENNIS,MA 02660 .`� � , Undersecretary Not id with t signature ItMassachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 MICHAEL J MC )AR PO BOX 52 W DENNIS MA .7 Expiration Commissioner 04/10/2016 n 6 ~ e , ,, The Commonwealth ofMassachttsetts ' .� Department of ln(lustrialAccidents 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 PERIVIITTIf1G AUTAOMTY. Applicant Information Please Print Le ibly Name (Business/Organization/Individual): Mike McCarthy Construction PO Ox 52. Address: west Dennis, MA 02670 City/State/Zip: Ce11 08)#280-6964 _ jjj C_169393 Are you an employer?Check the appropriate box: rEl ect(required): l.�am a employer with employees(full and/or part-time).* onstruction 2.01 am a sole•proprietor or partnership and have no employees working forme in eling any capacity.(No workers'comp,insurance required.]3.Ej I am a homeowner doing all work myself.[No workers comp.insurance required.]t • emoition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are solo I LE]Electrical repairs or additions proprietors with no employees. S.a I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 12.E]Plumbing repairs or additions These sub-conlactors have employees and have workers'comp.insurance.l 13.❑-Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14•L"J/Other .M fl,«,,«h, 152.§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box t1I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tConlractors that check[his box must attached an additional sheet showing the name of the sub-contractors•and state whether or not those entities have employees. If the sub-contractors have employees,they must provide[heir workers'comp-policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �T�'/ t ��„� � > 0 Policy#or Self-ins.Lic.#: ( G I )c S(, -a_i sA Expiration Date: l2 4- '/ 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 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 t a' s enalties ofperjury that the information provided above is true and correct: Signature: Date: Phone#: (SUk Dbk-6 S C t 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#: r1 DATE(MNUDDIYYYY) ,�COPp` CERTIFICATE OF LIABILITY INSURANCE 12/07/2015 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 WANED,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 01962-001 NAHoMNEE-CT Bryden&Sullivan Ins Agcy of Dennis Inc A/C.No,Ext: (508)398-6060 .N,.: (508)394-2267 PO Box 1497 , So Dennis,MA 02660 INSURER(S)AFFORDING COVERAGE NAIL S INSURER A: A.I.M.Mutual Insurance Company 33758 INSURED INSURER B: Michael McCarthy Construction Inc INSURER P 0 Box 52 INSURER D: West Dennis, MA 02670 INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT; TERM OR 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. ILTR TYPE OF INSURANCE I yp W POLICY NUMBER AMEX) AN&K LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE PREMISES(RENTED $ occurrenrel CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ r N'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $ OLICY I ECT OC . COMBINED SINGLE LIMB $ AUTOMOBILE LIABILITY Ea ccide t ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTO NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccident) UMBRELLA LIAR H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ T $ qNy PR�p��ETpq�ppRTNER�E�ECUTNE YIN E.L.EACH ACCIDENT $ 1,000,000.00 /� OFFICER/MEMBER EXCLUDED? �Y NIA VWC-100-6017656-2015A 12H 5/2015 12N 5/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 (Mandatory In NH) �9W'CRIPTION OE OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,i/more space Is required) CERTIFICATE HOLDER CANCELLATION Cape Light Compact PO BOX 427 SHOULD ANY OF THE ABOVE DESCRIED POLICIES BE CANCELLED BEFORE Barnstable,MA 02630 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROyISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD . . 4 Town of Barnstable Regtglatory Serwices • .sutxsreatx ^ Itich�cti�(�'.Scati Director BMli ff kA,D ViSIOn' Tom Perry,Building Commissioner 200 Main Strect,Hyannis,MA 02601 www.town.barnstable.nia:ns Office: 508-862-4038 Fax: 508-794-6230 P ropwy.Oymer Must Ca pleie and Sign This Secdoll if Us, sinz;.A tuilder as Ow er b .tl�e s Ject pr�openy hexcbs authorize. 0 �, .. to.act oil a�ybehalf, in L.mamn relatin to.work.authorized.by this:buiIdingpermit application far. - L .`a► r;u¢ � i�' �s, 1 Duo (- dlress.df'oo .) ' ""Pool.ferices and alarms are theiesportib yof th ph ant: I?d l are z�ot to be fi1l+~d car u la ed befgi&fence is'te e and,au final: :inspections are:performe i and- cceptecL • Signature of Owaer Signatuie.of Appk=t BiAt Name -� Print Naim Date Q:FOUIS:ONVNF.XPERhtJSS10NPWLS Town of Barnstable *Permit# Expires ont om issue date Regulatory Services Fee Richard V. Scali,Director�rED 39• 42015 _.._.__—_^�.._____--- -------- --------=�urldiirg-Dlvzsion--===w--=- -- ------ --- — ---- TOWN OF BARNSTABLE Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number C� `'� P Property Address 21 residential Value of Work$�6 tom. o-u Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number 6e5; /-/C;245� Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑�I a sole proprietor � II�'1 arn the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Reque (check box) — Re-roof(hurricane nailed)(stripping of singles) All construction debris will be taken to ❑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: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historiz,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORM uilding permit forms\EXPRESS. oc Revised 040215 fTown of Barnstable Regulatory Services °fsKWE rqy� Richard V.Scali,Director Building Division r • sasxsras Tom Perry,Building Commissioner Mass. 1639. 200 Main Street, Hyannis,MA 02601 ArEO" A www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print 02 DATE: r JOB LOCATION: tuber street village HOMEOWNER": �`-'wtS� (4Z e home phone(# work phone# . CURRENT MAILING ADDRESS: U4 ► "L�-� cifjtown 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"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 Rerformed 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 roc dures and req ' ents and that he/she will comply with said procedures and requirements. ature 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 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are 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 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 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. Q:\WPFILES\FORMS\building permit forms\E3PRESS.doc Revised 040215 1 �THE Tp� w - i + SAENSfABLE, + - 9� MASS. -Town of Barnstable Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.'ma.us Office: 508-862-4038 i i ' ti i Fax: 508-790-6230 Property Owner Must ` Complete and Sig This Section. If Using A B ' der as Owner of the su ject prop hereby authorize to a o my behalf, in all matters relative to work authorized by this building permit applicad f (Address of Job) Signature of Owner Date Print Name - If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 t !1 ` Tlie Commoinvreakh r�,—Vassach=etts Department of ludustizal Acciderds Offrce oflFmwfigadom y 600 Washington Street —Boston,41A 02111 fl'FV11:IffEati'F�,gt>�dta Mrorlmrs' CampensatiGn Insurance Affidavit: builders/Contractxtrs/EIectr cianslPlumbers Applicant Infw-matian Please Print LegibI' Name(Busmess�ganiza6ian al}: C��'�C�O Address: . Cityfsta&z* g. b Phone� �j � k KCo, a� Are you an employer?Checkille appropriate box: Type of project(required}: 1.El am a employer vdtll. 4. El am a general contractor and I employees(full atrdfor part-time)-* leave hired.the sub-contractors 6. E]New construction 2.❑ I am a sole propFietor or partner- listed on the attached sheet I ❑Remodeling ship and have no employees. These sub-contractors have g- ❑Demolition Working forme in any capacity employees andbzLre wodcers' [No w orloers' camp.insurance comp.tt,suran I 9. Building addition ed_] 5_ ❑ We are a corporation and its 14-El Electrical repairs or additions 3. I am.a homeovxmer doing all work officers have•e=cised their 11-Q Plumbing repairs or'additions M)s f [N8 workers'romp- tight'of exemption per MGL 1,2.❑Izoof repairs insurance required]F c.152,§1(4h and we have no employees-[No wodcess' 13_❑Other comp-insurance required.] `Any WHccstlts:that checks box#1 ems#also EU out the section below--hawing their woskeie compensatioupoRcy informadon- Hamemnerswho submit this afS bMt im&ratmg they are daiag a>i vro*aid then lore autside contractors zmast submit anew affidavit indicating such_ �Canttactors Yost chxY this boot mast attached sa additional street shouting the name of the sub-contractors and state whether or not those entities ham employees. Ifthesub-contactorshaveempiayee%theynmstpmuidetheir workers'comp.politynumber_ I ain art eltepdaj er treat isprfnrid&g workers'ca!lrlrensatia!!hmiratica for my¢nrptnjwes Below is ihopa&cy and job site informadom Iwurance-Company Name: Policy#or Self-ins..Lic-# E Tiration Date: Job Site Addiess: � ��C-�— � CitylS#atelmg: Attach a copy of the:workers'compensation policy declaration page(showing the policy number nd expiration date). Failure to secure coverage as required.udder Section 25A of MGL c- 1572 can lead to the imposition of criminal penalties of a fine up to$1,500 00 and,t or one-year imprisournent,as welt as ci-;it penalties.ia the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe Rwwarded to the Office of lslvestgations ofthe DIA for insurance coverage vetifcation_ Ida drsroby fyr nledRr the pad s r!d perla s vfpeduty that the irl,f orwxativa prolRried abmv is trsre and correct Siucaat,m�- Date- Phone g. Official use Qrety. Do not write in this area,to be campletesrd by diy or totwn officbL City or'Town.: PermitUcense 4 Issuing Authority(circle one): 1.Board of HwIth 3.Bui[Xmg Department 3.CitytTo n Clerk d.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 rDgan-es all employers to provide workers'compensation for their employees. pmsaant-to this sftrt-,an.empIayee is defined as."_.cveay person in the service of another under any contract of hire, express or implied,oral or written." An f77TIvyM-is defined as"an individnal,paatacrsh�p,association,corporation or other legal erdity,or any two or more of the foregoing engaged in a Joint enterprise,and including the legal representatives of a deceased employer,or the receiver or tzustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than tbree apartments and who resides therein,or the occupant of the - dweIIing house of another who employs persons tD do maintenance,construction or repair work on such dwelling house or on the grommds or building appurtenant$iemtD shall not because of such employment be deemed to be an employer" MGL chapter 152, §25C(6)also sus that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to consft Act buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the inset-an_ce,coverage requited-" Additionally,MGL chapter 152, §25C(7)states"Neither the commanwealth nor army of its political subdivisions shall enter into any contract for theperformance ofpublic work-until acceptable evidence of compliance with the insuranCO.- requiremen s'of this chapter have been presented to the contracting azdhodty" Applicants Please fill out the workers'compensation affidavit completely,by checIang the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)andphonenumber(s)aIongwiththeir cm1ificate(s) of inn acre. LimitEd Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no eamployees.other than the members or pamtaers,are not requimd to cant'workers' compensation insurance. If an LLC or LLP does have employees,a policy is requited- Be advised that this affidavit may be sybm_rtte;d to the Department of Industrial Accidents for confirmation of imaraace coverage. Also be sure to sign and date the affidavit_ The affidavit should be retrred to me city or town that the application for the permit or license is being requested,not the Department of Exh,ctr;a1 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 li_stnd below. Self-ias companies should enter their s elf-i *ran ce license number on the appropriate line. City,or Town Officials . f ' Please be sure that the affidavit is complete and pmmted legibly. The Department has provided a space at the bottom of the affidavit for you to fill out m the event the Office of Investigations has to contact you regarding the applicant- Please be sure to fill in the permit/licrose ni=ber which will be used as a reference number- In addition, an applicant that must submit multiple permwlicense applications in any given year,need.only submit one affidavit indicating current policy it l rr ation Cif necessary)and under"Job Site Address"the applicant should write"all locations a (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 home owner or citizen is obtaining a license or pmmmnitnot related to any business or commercial venture (i.e- a dog license or permit to burn leaves etc-)said person is NOT required to complete this affidavit The Office of Investigations would bke to thank you in advance for your cooperation and should you have any questions, -lease do not hesitate to give us a call The Department's address,telephone and fax number_ Thee Commmwealth of Massachus-f--tts , F Dapartmmt of Jiiduskial Accidents , �it�e r�,f ktv�g�tioaa� ��4asbingtan t Bastes MA G1 l I I T(,-1.4 617 727-4900�xt 4-06 or 1-977- SAFF, Fax#617-727 7M Revised 4-24--07 w mago�fdia Date: 11/9/2016 To Building File From R. Anderson Re Fence Complaint Locus: 73 Lillian Drive, Hyannis (subject of complaint) Received a complaint from retired female resident at 84 Lillian Dr concerning a fence located at 73 Lillian (across the street from her). She cited concern about a traffic hazard and stated the property is a corner lot and the fence blocks sight distance for approaching vehicles. Originally, Bob McK got the complaint and spoke to the resident. I asked Bob to check the site and obtain photos for review. The photos revealed a new section of fence joining an existing fence line. The property appeared to be on a bend in the road not corner but I have not confirmed this myself. The woman called and reached me on 11/7/16. She was irate when I told her the fence did not appear to be a hazard. She stated Bob had given her contrary information. She began to shout that she moved here from Worcester and"...Every time (caller) asks the town for something it's No!" She stated she was tired of looking at graffiti on the fence and that it was finally painted over last year. She yelled that the town will be liable when a kid on bike is hit and her grandchildren ride their bikes there often. The she hung up on me. I re-visited the photos. Still didn't note a problem but I called Roger Parsons, Town Eng for his advise. He sent out Bob Golden, Town Surveyor to check the fence. Bob called me on 11/9 and said he had been out there last year to check this fence. Lillian is a private road and we have no jurisdiction over it, aside from that he informed me that the fence does not impose a visual hardship or hazard. He added that he advised this caller about the private road status and our limitations during a previous inspection last year. C: 84 Lillian Dr,Hyannis 'I 1\73 Lillian Dr Complaint 11092016.doc I Legend Elme , Parcels -.Town Boundary `' Railroad Tracks 248'l$87 1 i , 24EQ85 iE ##112 —. 248186 248184 ,, 248183 Buildings #48t #93 , #t 61 _ _ -w Painted Lines A Parking Lots � Paved _ s ---- � s unpaved 19Q Driveways 2 a ` �$' .€ i133 59 Paved ° t Unpaved 2:481859 1. €t #125 Roads 248187 t 248188. �Paved Road Unpaved Road 21484880102 #143 #:611 0 Bridge 10 Paved Median 2.48105 Streams € . T y - It 83 Marsh € tf ai 28278 �'t. Water Bodies #11$ 1. r � 248277 248163 - #€ 248275 i - _ - 94 v 248104, 1 #8'`# t � 481Q3 .. v :24 F 24,ii Q6 3 f X r: IV66 't 4 2482 _ \ l{ r �48107 N r • 248496. #415 1 : 248115 / ! r f' 0C rr ✓ 24819 ��: r'F 248099, �� 24821346 , l\ 31 248114 _ - :`f �/q Ag! wry �� g �g #.€Qt dwr M1 .❑■ 248198 r` 24$.1Q9 Al 2482Q0. 248113- P' # t.3 #21 ../ #,3 6 z "� /,:' ,eta�� ■ Map printed on: 10/31/2017 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 02601 O 83 167 0 an on-the ground survey.It may be generalized,may not accurate relationships to physical objects on the map 5o8-862-4624 reflect current conditions,and may contain such as building locations. Approx.Scale: i inch= 83 feet cartographic errors or omissions. gis@town.barnstable.ma.us o�TME Town of Barnstable *Permit# Regulato Services " �on ry Fe 1639. �e� Thomas F.Geller,Director TOW Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601. www.town.barnstable.ma.us Office: 508-862-4038 EX MI PRESS PERT APPLICATION - RESIDENTIAL ONLY508-790-6230 eG Not Valid without Red X-Press imprint Map/parcel Number / Property Address c 401 ' Residential Value of Work �gdl P. pd Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address J4/-,7`ee5- Contractor's Name���,f-� r - Telephone Number,:E�E ,�'�j C6�p_ Home Improvement Contractor License#(if applicable) bs�/o Construction Supervisor's License#(if applicable) ,�r] / ❑Workman's Compensation Insurance Check one: ® I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance nsurance Company Name ✓orkman's Comp.-Policy# l0 'opy of Insurance Compliance Certificate must accompany each permit omit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of r000 Re-side ❑ Replacement Windows/doors/sliders. U-Value #of doors (maximum.44)#of windows *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&Construction Supervisors License is uired. NATURE: ' rPFILESTORMSIbuilding permit nnsTYPRESS.doc ised 010110 i -'� Massachusetts -Department of Public SafetN Board of Building RegFulations and Standards Construction Supervisor License License: CS 57710 Restricted to: 00 BRIAN D CLIFFORD 10 GOFF TERR + !. CENTERVILLE, MA 02632 . Expiration: 3/5/2012 ('ummissi,mKr Tr#: 19742 license or.,registration.walid a before the expiration for inilivid Office ul use ~� Of Consumer date. If found.return to:.only ; it IO.Park Plaza Affairs and Business Regulation Boston. a`Suite 5170 MA 02116 r :t -A ,sr �! i3. Not Valid out signature 6' _ fie Ur arrUhaan�.ae� a�./j/laaoaclucaett ��? Office of Consumer Affairs&Budsmess Rcgula,ion HOME IMPROVEMENT,CONTRACTOR . Rpgistration 1:06566 type Expiration: 7124/2012 1ndrotdu.af BR. N`CLIFF,ORD ,4 r Brian Clifford r 4 Aw 10.Goff Ter _ Centerville,MA 02632' Undersecretary. s- I" i i `+ The Commonwealth of Massach usetts Department of Industrial Accidents I 1. Office of Investigations tl�"r,� 600 Washington Street ill; , ` 4 j Boston, MA 021.71 tr �- www.mass gov dia Workers Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information / Please Print Legibly Name (Business/Or ganization/Individual): Address: ' ld � � � City/State/Zip: Phone #: .� Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.KI.am a sole proprietor or partner- listed on the attached sheet.t ?•. ❑modeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. g, ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3,0 I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §](4), and we have no 12.❑ Roof repairs . insurance required]t employees.[No workers' 13.0 Other �� comp. insurance required.] *Any applicant that checks box#] must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit 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-contracton and their workers'comp.policy information. I am an employer that isproviding workers compensation insurance for my employees: Below is the policy and job site information. 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 do hereby certify r the p an enables of perjury that the information provided above is true and correct Signafore: Date: Phone#: S-zy Official use only. Do not write in this area;to be completed by city or town bffuiaL City or Town: - Perm it/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other J 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." Additionally,MGL chapter 152, §25C(1)states"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 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 number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partrierships(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 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 the Department of Industrial Accidents. Should you have any questions regarding the law or if you are.required to'obtain a wormers' 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 iii the event the.Office of Investigations has to contact yod regarding the applicant Please be sure to fill in the permit/license 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 one 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 home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn 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 call. . The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations* 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MA-SSAFE Fax# 617-727-7749 A • r r , Ty Town of Barnstable a : LM Regulatory Services WaL Thomas F. Geiler,Director A'FD Building Division Tom Perry,Building Commissioner 200 Main Street,Hya=is,MA 02601 www.town.barnstable_ma.us Office: 508-862-403 8 Fax. 508-790-6230 Property O:waierMust Complete and Sign This Section If Using A Builder as Owner of the subject•property hereby authoxize v� /�����b�� to act on my behalf in all matte relative to work authorized by this binding permit application for. (Andress of Jo10 , W=1M of Owner Date Print Name If Pro�e�Owneris applying forpermit pleas complete. the Homeowners License Exemption Form on :the reverse side. '1 - f Town of Barnstable Regl3latoiy Services Thomas F. Geiler,Director � 1 *g Building Division �Eo { Tom Perry,Building Commissioner 200 Maui-Street, Ayannis, MA 02601 Wwsr.to wmb ar•astabl e.ma..us Office: 508-862-403 8 Fax. 508-790-5230 HOMEOWNER LlCENsE ExEmMON FIcise Print DATE JOB LACA non number street village '730MEOWNER": name home phone rK work phone# CURRENT MATLINQ ADDRESS: eitY/tawn state up code " The current exexaption for"homeowners"was extendcd 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,providcd that the owner acts as supervisor. DEFIN GN OF HOhiFOWNT.R Pcrson(s) who owns a parcel of land on which helslie resides or intends to reside, on which.there is, or is intended to be, a one or two-fmily dwmUing, attached or dctrphed structures accessory to such use and/or farm structures. A person who constrgcts more than one home in a two-year period shaIl not be considered a homeowner, Such "homeowner"shall submit to the Building OfEcial on a form acceptable to the Building Official, that he/she shall be r=mi.sible for all such work performcd•umder the buuldine permit (Section 109.1.1) The nnderaigncd`homeowner"as=r-s responsibility for compliance with the State$wilding Coda and other applicable codes, bylaws,rules and rc '�lat ons. The undersigned'homcownce'certifies that,he/she understands the Town of Barnstable BuildingDcpUt'M=t r n;rm-Yrn inspection procedures and requirements and that hclsbe will comply with said procedures and rez,;rCmcnts. Signature of Hnrncawna ` App mvalpf$uflding,0$cial Note: Threc-family dwellings contaiamg 35,000 cubic feet or larger will be required to comply with the•' State Building Code Section 127.0 Construction Control. 90]IE0WMM,8 EXElr M6H The Code states that: "Any bomeowncrpc fhrning work for which a building perrmit is required span be exempt from the provisions of this section•(Sccdch 1 D9.1.1-Uccnsiirg of construction Supervisors);provided that if the homeogrner mgagrs a p=ari(s)for hire to do such work,that s�uCch Homcown a shall act as supevisor>• Many homeownErs wbo use this cxisoption ass tmaware that they arc assuming the responsibilities of a strpevisor(sec Appendix Q Rulers&Regina lions for Licensing Construction Supevisms,Section 2.15) This lack of awareness bAM results in serious problems,particularly when the homeowner hires unlicsasod papons. In this rase,our Board cannot proceed ao kd the unlicrnsed person as it would with z licensed ;upervisor. The homeowo er acting as Supayssor is ultimately responsible To ensure that the homeowner is fully aw of hislhicsponrbtlitics,many communities mgt&S as part of the pamit application, tat the homeowmet eati5'tbat belshe under arz er stands the rrsponsrbtlities of a Supervisor. On the last page of this issue is a,fcrm eurrautly used by :veral towns. You iaaY care t armed and adopt such'a form/eatification for use in Your eorrununity.