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HomeMy WebLinkAbout1085 PHINNEY'S LANE Do's' ��j��� s ��, � � � - -- --� � e== �. ., 1 y F I ® 1 Oxford NO. 7521/3 ESSELTE t o% O OZ-15--2006 a 02 =05rx QUITCLAIM DEED We,Vidal J. Camacho, Sr. and Virginia M.Camacho of Barnstable, Barnstable County, Massachusetts, in consideration of THREE HUNDRED TEN THOUSAND ($310,000.00) DOLLARS, GRANT WITH QUITCLAIM COVENANTS to Robert M. Lehman, an individual, of 4/12 Boulevard Nantucket Massachusetts, 02554, the real estate and improvements thereon located at 1085 Phinneys Lane, Barnstable(Centerville), Barnstable County, MA 02632, as more particularly described in the attached Exhibit «A„ �1 Subject to and with the benefit of any easements,restrictions,takings,rules,regulations, V terms,by-laws,conditions and reservations of record, insofar as the same may now be in force and applicable. For my title see deed recorded with the Barnstable County Registry of Deeds in Book 12825,Page 236. N Executed as a sealed instrument this 151h day of March, 2006. HASSACNUSETTS STATE EXCISE TAX I BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 03-15-2006 d 02:05vn Ctl`.: 1197 Doc:: 15791 Via J. Cama o, Sr. Fee: tlro6o.2o cons: $310►000.00 BARNSTABLE COUNTY EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 03-15-2006 0 02:05am a Ctia: 1197 Doc4: 15791 (Virginia M. Camacho Fee: $706.E0 Cons: $31or000.00 COMMONWEALTH OF MASSACHUSETTS Barnstable,ss. March 15,2006 On this 6 h day of January, 2006 before me, the undersigned notary public, personally 0 appeared Vidal J. Comacho, Sr. and Virginia M. Camacho, proved to me through satisfactory evidence of identification, which was a Massachusetts Driver License, to be the person(s) whose name is/are signed on the preceding or attached document, and acknowledged to me that they signed it voluntarily for its stated nuumose. n�','W ,0w ..... ohn P`f3enson,�7Not o °k �i'••,.v ., �c Commission Expire :aQ6,''`S17t' cc:i Property: 1085 Phinneys Lane %,S ';;� ;4. Barnstable(Centerville), MA 02632 '= r'h�^ •.r�rro�w��� �C` � ' s1� Bk 20824 Pg 232 #15791 j EXHIBIT"A" The land together with the buildings thereon,situated in Barnstable(Centerville), Barnstable County Massachusetts,described as follows: Being Lot 1 as shown on a plan of land entitled: "Subdivision Plan of Land in Centerville,Barnstable County,Massachusetts,as Surveyed by John F.Rafferty, Scale 60 ft.to 1 in.,August 1955,as Prepared by Charles N. Savery Co.,Engineers& Surveyors #85537",which plan is duly filed in the Barnstable County Registry of Deeds in Plan Book 124,Page 83. Being the same premises conveyed by a deed recorded with the Barnstable County Registry of Deeds in Book 12825, Page 236. BARNSTABLE REGISTRY OF DEEDS I Town of Barnstable *Permit# Expires 6 onths from issue date 190TRegulatory Services Fee snxxsrnste.,: v amass. $z639. 1 C1 QQ 20}!`� Richard V.Scali,Director �A �� 4 rfD MA't a Building Division , Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY o� l` Not Valid without Red X-Press Imprint Map/parcel Number U 1 Property Address I ca ✓ Rl"ne�44 XResidential Value of Work$_ 0 5V 1 00 Minimum fee of$35.00 for wor der$6000.00 Owner's Name&Address 1 t-�--CLb [)Ono V l0 `^ ykiinne,�j� Contractor's Name V u(5t& Telephone Number c � Home Improvement Contractor License#(if applicable) Email: .✓l O lv6050-M I 9 a,/► Construction Supervisor's License#(if applicable) r?6L 10��(�� (4 6~, ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner 'XI have Worker's Compensation Insurance Insurance Company Name L__.I Workman's Comp.Policy#� ���� 3to Copy of Insurance Compliance Certificate must accompany each permit. Permit Rqquest(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to VV ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#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.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 re ire SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.d 7 Revised 061313 The Official1Website of the Office of Consumer Affairs&Business Regulation(OCABR) C onsuer Affairs and Business Regulation Home Consumer Home Improvement Contracting I' .HIC Registration Complaints S Registration# 154549 Home Improvement Contractor Registrant Registration Home Page Name PAULGUSTAFSON Address 14 JONATHAN CIR City,State Zip. PLYMOUTH, MA 02360 .Expiration Date 03/19/2015 Complaints Details :.No complaints found for this registrant: -You can also view arbitration and Guaranty Fund history. Back To Search ap .O'fj u�J��� `if''4'�It.�S WI (' at use Dep 7;f Board 6f B��ildi►g-Reguiattvr�s Arad Star�iards , Ei' ConStruotion Supeti 0or_SPeal� License CSSL 105967 FF PAUL GUSTAYS0 V. 1�1 14 JONATHA_N C R Plymouth 5IA 02360 11/21120 E 6 r Gomrru er wt.11AP://services.oca.state ma.us/hic/licdetails.aspx?txtSearchLN=55927 11/27/2013 ;. Page 1 of 1 Paul Gustafson Exterior Restoration Specialist 14 Jonathan Circle Plymouth, MA 02360 Cell 508-269-1263 License # 154549 email at: gustafson:roofing@gmail.com June 15, 2014 Attn: Elizabeth Moore 1085 Phinneys Lane Centerville Ma 02632 508-778-0620 Regarding Reroof of Home. Properly protect home and grounds during construction. Remove and properly dispose of existing shingle roofing.. Inspect roof deck and make ready for new sheathing.. Install new 3/8" CDX exterior grade plywood over entire roof deck fastened with 8 penny ring shank nails. Fabricate and install new plywood chimney cricket. Remove gutters' where.necessary to replace facia boards. Remove and dispose of rotted facia boards and replace with new preprimed pine facia boards approximately 32' . Replace existing rake board along chimney cheek location. Remove existing lead chimney flashing. Grind out proper mortar joints-to accept new lead flashing. Pin and tuck point in new lead flashing to make ready for new roofing. Install new white Flintastic at porch transition. Adhere ice and water shield along eaves,wall and chimney crickets Apply 15# felt on remaining roof deck. Replace aluminum step flashing. -Replace all soil pipe flanges. Install new 8" white aluminum drip edge on all perimeters. Reshingle with new Certainteed Lifetime Landmark shingles. Install new Cobra ridge vent with Certainteed Lifetime hip and ridge cap shingles. Cut new opening along all soffets. Install new J channels and Harveys white triple 4" 'vinyl panel vented soffets panels. Clean gutters and magnetic broom grounds upon completion. Provide all necessary pe i hits. Total:, $10, 950 ' Customer Signature: � �I 11 Authorized Signature: OU C , h 77te Commorrywakh of Massaehusef€s Deparment of huhwsfi Lal Accidents - Office of'Ii stigations 600 WffYhuzgiet Street Boston,,AM 02111 ",m mass goVdia Workers' Compensatiuu Insurance Affidavit Builders/Contractorsf0ectricianslPtumbers APPEcant Infarmation Please Print Legibly Name(tJ�6fganizaiio da&vidaaQ GU 0 AA& e-ss-- I H l a,n Cityfstatejzip= o Phone 9- YOF a,(Oq 1.2,6 Are you an employer?Check the appropriate bo= Type of Project r 4. I anu a contractor and I 3'� pT' l ����= 1.❑ I am a employer with 6- ❑New oDnstnretiort t m a pioyees(full and/orpart lime * have hiredthe sub-contractors. 2._ I a sore proprietor or partner- listed on the attached sheet; 7- ❑Ran deltng These sub-contractors have .ship � S. Demolition and have no employees ❑ �P oY w for mein an capacity_ employees and have wormers' arkang Y c instrrance_I 9- ❑Building addition [No workers' comp:insurance nce comp- required_] 5-❑ We area corporation and its 10_.E]Electrical repairs or additions _❑ I am a home vrner doing all worm officers have exercised their 1I_.Q Plumbing repairs or additions myself. [No workers'comp right of,exeniption per MGL I Roof ;nsur- ce rewired_]1 e_1.52, §1(4},and we have no repairs l3_❑Other employees-[No workers' comp_insurance required_]! *llny sggfccaae that checks box-91 temst also fill out the section below showing rhea�a oders'compensation policy a� �rma Ho-meowners who submit Ibis affidavit in&cstmg they are dome zR wacc mzd dLem hire outide contractors— submit s aewf afidnit m�rntm sucli ZContacturs that check flits b=nvast attached an additional sheet showing the nmme of the sub-cauftalors and state whether ornot those dries have Employees. Ifthesnb~contmctots hors employees,they must provide their workers'come.policy number. -Taman ernplo ywr that ispmi&hWg workers'cotrgwmalio.n irmirauce for my ampinyem Halow is Stegoucy and job site information- � Insurance Company Name: �l `✓)� I V l V Policy ff or Self ins_Lie 9: Expiration Date: Job Site Addrew: 10TY VK� e City�'StateJZip: UU, V\1A G(, Attach a ropy of the workers'compensation policy dedaration page(showing the policy number and expiration date). Failure to secure caverage as required under Section 25A of MGI_c. 152 can lead to the imposition of-criminal penalties of a fine up to$1,500_©D and/or one-pear imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up.to S250.00 a day against the violator_ Be advised that a copy of this statement maybe forwarded to the Office of Irn estigations of tfte DIA far insurance;coverage verification- I do hereby aerti t the ns at penalties feet jury that the information pratvidsd a/ ,e is and correct Si tore: Bate: 6 Phone#: ©f Ecial u w only. Do,not write in Mis area,to be completed by city or town oficiaL City or Town: Peradt/License# Ensuing Authority(tarde one): 1.Board of Health 2.Building Department 3,City/Town Cleric 4.Electrical Inspector +.Plumbing Inspector .6.Other Contact Person: Phone#_ 6 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 Iocal licensing agency shall withhold the issuance or renewal of 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." AdditioaaU,MGL chapter 152, §25C(7)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 witli 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 cerriificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required_'Re 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. T1e affidaNit 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 workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-ins,ranc0 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 Ell out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/licease number which will be used as a reference number. In addition,an applicant that must submit multiple permitllicense 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 bum 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 oz InvestigatiGns 600 Washingtau Street B oston=MA G21 I I Tel.A 617-727-4900 W 406 or I-977 MASWE Revised 4-24-07 Fax# 617 727-7-149 www.inassgov/dia W .F LOT LOT 28't c LOT 1 (PLAN 350144) 24, - - - - - - - - - - - - - - - - - - -1085 --_---o - 1 ti6 33 , ?00. 00 T', BAN y) J 50"w y s I _ P� NN NOTE.' PRE-EXISTING iVONCOiVIORIIING. Plan is r RES. ZONE.- 'RC-1" This MORTGAGE INSPECTION' Bank Use Only FLOOD ZONE. "C" THE DISTANCES AND MEASUREMENTS ON THIS PLAN SHOULD BE VERIFIED BY AN INSTRUMENT SURVEY. 'GOWN: -MVI 6 --------- REGISTRY OWNER: DAVID_GEDER_TRUSTEE DEED REF. _L133=I!.281-------- BUYER: DATE: Z25%2000---------- PLAN REF: _1241'83-----------SCALE: I"= 30' FT. I HEREBY CERTIFY TO LVORTH_aA/ERIC_4N dIORTG_-1GE CQ /T'S `NOf YANKEE SURVEY S_U_C_C_ES_SO_RAN_D_IO_R ,AS_S_I_GN_S._AT_1,41ATHAT THE BUILDING SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS � CONSULTANTS SHOWN AND THAT ITS POSITION DOES _ CONFORM � PI/A. CONSLiLT 1 � 40B (SUITE I) TO THE ZONING LAW SETBACK REQUIREMENTS OF THE Ew TOWN OF _ B_[P..A157' 19LE_____________AND THAT NO. II ,V INDUSTRY ROAD IT DOES_ VZ LIE WITHIN '['HE SPECIAL FLOOD HAZARD MARSTONS MIL[.. MA. o26-tH AREA AS SHOWN ON THE H.U.D. MAP DATED f- 1.9f1_ 5 Pfe�a � I'EL: -!'28--0055 C'�mmllnit�-P In� l :: �'.�0001 OOOG C _ UMD FAX.- 420-55-5: THIS PLAN NOT MADE FROM AN 1NS' . 7NT S11161"i' , , 1,wi, :v NOT TO HF FOR' FFNUF.f. RI'11.DIV; rFr.�trr rT� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map G Parcel 0 Permit# Health Division 9�;- CM ZS 0' Date Issue —L Conservation Division So �� Fee WJ 46 Tax Collector'' Treasurer �� `i SEPTIC SYSTEM MUST E Planning Dept. INSTALLED IN CCMPLsMF` `ItTH TITLE, 5 Date Definitive Pla A roved by tanning Board "�� Historic-OKIH Preservation/Hyannis Project Street Addre /D bT wL Village C FW 1_GRVr LLC Owner O bA L£ V 1 F_Gi rii tq 0A-W Aell� io Address JO 6.0 PNiwrvl�S A4AtAi�-. (Ce�7_ ,000111_�1�� Telephone S-0 b 1717 4/c)& .7 M Permit Request c914 a, Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation boo Zoning District Flood Plain Groundwater Overlay 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 * ti f5 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: I 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 J new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas )l 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:Nb 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 BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ` DATEQ— a , FOR OFFICIAL USE ONLY ° PERMIT'NO. v DATE ISSUED A , MAP/PARCEL NO. " ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATIONS/��" FRAME �'��`.� t.� �- 1s INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL Y PLUMBING: ROUGH FINAL r - x GAS: ROUGH -- FINAL FINAL BUILDING t L' , DATE CLOSED OUT ASSOCIATION PLAN NO. Message Page 1 of 1 Giangregorio, Robin From: Evans, Brenda Sent: Thursday, June 15, 2006 11:00 AM To: Giangregorio, Robin Subject: RE: 1085 Phinney's Lane Engineering has determined the sign is on town property. A work order has been given to the Grounds crew to remove by the end of the day tomorrow. -----Original Message----- From: Giangregorio, Robin Sent: Wednesday, June 14, 2006 9:11 AM To: Evans, Brenda Subject: 1085 Phinney's Lane The Yard Guy is Robert Bastille of Dumont Street, Hyannis. It's important that the sign make it way over to 200 Main St. The Commissioner says to have it taken down at 4:15 Friday! 6/20/2006 Bk 20824 Ps 231 15791 03-15-2006 & 02 2 05P QUITCLAIM DEED We,Vidal J. Camacho, Sr. and Virginia M. Camacho of Barnstable, Barnstable County, Massachusetts, in consideration of THREE HUNDRED TEN THOUSAND ($310,000.00) DOLLARS, GRANT WITH QUITCLAIM COVENANTS to Robert M. Lehman, an individual, of 4/12 Boulevard Nantucket Massachusetts, 02554, the real estate and improvements thereon located at 1085 Phinneys Lane, Barnstable(Centerville), Barnstable County, MA 02632, as more particularly described in the attached Exhibit "A" ivy �1 Subject to and with the benefit of any easements,restrictions,takings,rules,regulations, V terms,by-laws,conditions and reservations of record, insofar as the same may now be in a force and applicable. `J For my title see deed recorded with the Barnstable County Registry of Deeds in Book 12825,Page 236. N Executed as a sealed instrument this 15`h day of March, 2006. MASSACHUSETTS STATE EXCISE TAX j BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 03-15-2006 A 02:05vn Ctl:: 1197 Dot:: 15791 Vi a J. Cama o, Sr. Fee: t1►060.20 Cons: t310000.00 V\ BARNSTABLE COUNTY EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 03-.15-2006 a 02:05pm Ctl&: 1197 Doct, 15791 irginia M. Camacho fev_s $706.80 Cons: $310►000.00 (� COMMONWEALTH OF MASSACHUSETTS Barnstable,ss. March 15,2006 On this 6`h day of January, 2006 before me, the undersigned notary public, personally 0 appeared Vidal J. Comacho, Sr. and Virginia M. Camacho, proved to me through satisfactory evidence of identification, which was a Massachusetts Driver License, to be the person(s) whose name is/are signed on the preceding or attached document, and acknowledged to me that they signed it voluntarily for its stated p ose. ohn Pf3enson,Notary; . 4i'••,•v ., Commission Expires:'Q6� 17 i S? Property: 1085 Phinneys Lane , 0.W y� ,`,�•;,�4; Barnstable(Centerville), MA 02632 4,^ ••rr.....�.•' Q: :ate_ a Bk 20824 Pg 232 #15791 EXHIBIT"A" The land together with the buildings thereon,situated in Barnstable(Centerville), Barnstable County Massachusetts,described as follows: Being Lot I as shown on a plan of land entitled: "Subdivision Plan of Land in Centerville,Barnstable County,Massachusetts,as Surveyed by John F.Rafferty, Scale 60 ft.to 1 in.,August 1955, as Prepared by Charles N. Savery Co.,Engineers& Surveyors #85537",which plan is duly filed in the Barnstable County Registry of Deeds in Plan Book 124,Page 83. Being the same premises conveyed by a deed recorded with the Barnstable County Registry of Deeds in Book 12825, Page 236. BARNSTABLE REGISTRY OF DEEDS I Bk 20824 Pg 248 #15792 Exhibit A - Property Description Closing date: 03/15/2006 Borrowers) : Robert M. Lehman Property Address: 1085 Phinneys Lane, Barnstable, Massachusetts 02630 The land together with the buildings thereon,situated in Barnstable(Centerville), Barnstable County Massachusetts,described as follows: Being Lot 1 as shown on a plan of land entitled: "Subdivision Plan of Land in Centerville,Barnstable County,Massachusetts,as Surveyed by John F.Rafferty,Scale 60 ft.to 1 in.,August 1955, as Prepared by Charles N. Savery Co.,Engineers&Surveyors #85537",which plan is duly filed in the Barnstable County Registry of Deeds in Plan Book 124,Page 83. Being the same premises conveyed by a deed recorded with the Barnstable County Registry of Deeds in Book 12825,Page 236. r BARNSTABLE REGISTRY OF DEEDS The Commonwealth of Massachusetts 2 =�.z Department of Industrial Accidents :y. ,� -_•-: , :=� . OlfJcr a/lasesUgat/nos 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance davit name �V Ibi9�- In�lh AC�-y d location Ne �5 44M5- citytIa : (o a hone# 77�'ieil O t'o homeowner performing all work myself. in any ca�acity n /%/%/%%%Il/// i 'T/ , //////////%D//%//%%//////%�%%%/%////Ol// /1/%/%O//� a sole proprietor and have no one myself. 7 workers compensation for my employees working on this job.: ::::..:. :.: ::::.......:::.:....... Iam an employer pravidmg.............::....::.: ' ::;:> :: : <.: cam anv namt:. s ... ::.... Hone ta :..........................:::::;;;: ::. .. :. »;>::>;::::ifisurance ::::. .. _.. ❑ I am a sole proprietor,general contractor, or homeowner(circle one and have hired the contractors listed below who have ' compensation polices: llowm workers mp P .................,.,..:.:.:::.::::::..::.:::::.: ::.:.:,::::.: : . ::::::::.:.:::.:::.:::.::::::::::::::::.::::::::::::::.::::.:::.:::: the fo g : ::...:.:::::..:.: ......:::::::::......... ..:::: . :.:..::::........::::.::::::: :::::........ .......,:::.::::::::::;.::,:::,:.::::::::.::.::::;,:.:::.>... XX X. :cons an :..:....... fr dress ,•:..:. :,::::::.:•. :���:::;�ij%%:y:!�i:;%:�{:;:?!{:;:•,%:3:�;:!;:;ii:;:'.%:::�:�:;iS%:}Li'::tiv:::i?i i:;%i:iyii:t!::`'Vy;v:!i:'i::J: ...... ........ ......... ..........................•:•n...................,.....• � ...........}::4:7;•:M%Jy?::{•::r:{+.J:{{4ii:::i<^::::::.�:::::}::i:!J:{S:4?:•:ii:v:.Q.,:•ii^:.:..: snv:name: :,>:<:; address: ,.. :•._: .......................... //.. one ye to secure coverage as required order Section 25A of MGL 152 can lead to the impo>itl°n of eriminsl penalties of a fine up to S1�oo.00 and/or one yam,imprisonment as weft as civil penalties in the foam of a STOP WORK ORDER and a fine of 5100.00 a day against me. I man"t"d that a copy of this statement maybe forwarded to the OMCC of Investigations of the DIA for coverage veriitcatiom I do hereby certify under the pains and penalties of perjury that the information provided above is tru'and eorred Date -- Signature Phone# �� � F/`� t` print name — otfldal use only do not write in this area to be completed by city or town 0Mdal perndt/license H ❑Barg Depart i. city or town: ❑Licensing Board ? Selectmen's 0mce ❑check if immediate response is required ❑Health Department contact person: -- phone#; - other_----, lierued 9195 FJ7U M'4 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensatim for heir employees. As quoted from the "law", an employee is defined as every person in the service of another of hire, express or implied, oral or written. r v two or more of An ernP lover is defined as an individual, partnership, association, corporation or other legal entity, lover or the receiver the foregoing engaged in a joint enterprise, and including the legal representatives of to deceased However the owner of a trustee of an individual, partnership, association or other legal entit3, employing employees. 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 o of such thereto shall not because employment be deemed to be an employer. building appu rtenant the MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew mmonwealth for any applicant who hr of a license or permit to operate a business or to construct buildings in the co not produced acceptable evidence of compliance with the insurance coverage reggeireerdfo��Cenall ,of n caw z tm commonwealth nor any of its political subdivisions shall enter mto,any the contract for p have been presented to the contracting acceptable evidence of compliance with the inst rance requirement�of this chapter authority. / / .,, j Applicants ' ensation affidavit completely,by checking the box that applies to your situation and Please fill in ,he workers comp along with a certificate of insurance as all affidavits may be supplying company names, address and phone numbers submitted to the Department of Industrial Accidents for confirmation of imsm=coverage. Also be sure to sign and or town that is date the affidavit. The affidavit should be returned to the city hat the application for the permit or license any questions regarding the'law"or if yo being requested, not the Depar meat of Industrial Accidents. Should you are required to obtain a workers' compensation policy,please call the Department at the number listed below. �j City or Towns as provided a space at the bottom of tl Please be.sure that the affidavit is complete and.priated legibly. The Department has the licant. Please affidavit for you to fill out in the event the Office of Investigations has to contact you regarding d e app be sure to fill in the permit/license member which will be used as a reference number. The affidavits may be returiiR t^ the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions' pleasedo not hesitate to give us a call. FIN The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Imlesduadons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 40 9 or 375 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft.� >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf_Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS f Open Porch ! x$30.00= 30,60 (number) I Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee proj cost r °F THE T �.�r/j•°� The Town of Barnstable • BARNSTABLZ- MASS, - g Regulatory Services �A i679' �`° Thomas F. Geiler, Director TEo rvtP'1 Building Division , Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Fax: 508-790-6230 Office: 508-862-4038 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 10B LOCATION: I'WIC street village number v1D�}1— �pma��r;tU Sd8 j77J�lOCo �1�8_ �7g0� "HOMEOWNER": home phone# work phone# Dame CURRENT MAILING ADDRESS: f city/town stye rip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units d that less and to allow homeowners to engage an individual for hire who does not possess a license, the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on Nvhich 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 performed under the building permit. (Section 109.1.1) ility for compliance with the State Building The undersigned"homeowner"assumes responsib Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature f Homeowner A pproval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comp iv 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 nstruction Supervisors);provided that if the homeowner engages a provisions of this section(Section 109.1.1-Licensing of co 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 aainst the g e. unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor unities require.tely s part llf the permit To ensure that the homeowner is fully aware of his/her responsibilities,many application.that the homeowner certify thathes cunderstands e d�dds the adopts s responuch asibilities for of ertuper supervisor. r. On a ourcomm nitvace of this'ssue is a form currently used by several towns Y Q:FORMS:EXEMPTN 9-_ iWAr'N NousE LEI i r A. io 8,5- P/-// CF/V7--FRV//1 A4.4SS L . !^ 4n Rr <" - IcC'i�.�7 --P COX 3 X� Nc-AD i I.- 2X6 C-n///45 T/PS 77-1 ol 13.Ll G�aGe 00-AC r F'e-mi� Nomt ✓ �, i2 ----- - — - ^S PHA TZr I - i r r r r i ti+tire,rr 040usr I , �- + 10-0 1-11 li I' 1� I', I,, lil i 11, T I I . _./08S PNi�/.vEYS L,v. __CZ IV V I 1 t44.4 SS i �cC W rr--R DBL. AXE P.T. ci i 2x� fizz Or I �5 nW-I:r-Aro - - — - 41 7-1 _ _ _ 2 Belo-, G�acle � A/XS' _f�T. Town of Barnstable Ft�Er � g y yN I, STABLE � o Regulatory Services oJ OF BAR Thomas F.Geiler,Director 1' 0 RmtNs�rnsm + r AR IMAW. Building Division ! 2! s6gq. ♦� ACED MA'�A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA �! v f s l Office: 508-862-4038 Fax: 508-790-6230 //�^, PERMIT# CX 74 2 0 FEE: $ SHED REGISTRATION 120 square feet or less Location of shed(address) Village_ 0 Property owner's name Telephone number X '27 -_IZ, a Size of Shed Map/Parcel# Si g'h-al rue Date Hyannis Main Street Waterfront Historic District? "A/A Old King's Highway Historic District Commission jurisdiction? A)IA- Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 �d t S- v 1 W F LOT 2 LOT 28�t LOT I (PLAN 350144) XX - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - =-1085 --_--_o- - ,+ 33 , 41 0v ow LA� 555 49 50P14 1 INS NO TF PRE-EIYISTING iVONCOM-ORATINGPlan RES.. ZONE.- 'RC-1" This MORTGAGE INSPECTION Bank 1UseoOnly FLOOD ZONE.- "C" THE DISTANCES AND MEASUREMENTS ON THIS PLAN SHOULD BE VERIFIED BY AN INSTRUMENT SURVEY. TOWN: _MVTFRI/ILLE--------- REGISTRY OWNER: -DPI V1D_GEDER_TRUSTEE ___________ DEED REF: -U1IZ42281_______- BUYER: -19D L-J_J� _�BCIL-vL4-1_� �. &---________ DATE: 1JZ25i2000---------- PLAN REF: _1 4/83_-__- SCALE:I"= lq=__FT. I HEREBY CERTIFY TO NORTH_1AIERIC_Ar hIORTCAGE CO.-IT'S _S_U_C_C_ES_SO_R_S_A_N_D_�0_R_AS_S_IGN_S._.4T_IAT HAT THE BUILDING �,�K YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS PAUL CONSULTANTS SHOWN AND THAT ITS POSITION DOES __ _ CONFORM A. 40B (SUITE 1) TO THE ZONING LAW SETBACK REQUIREMENTS OF THE w � MERITHHEIIY a INDUSTRY ROAD TOWN OF BAR;-VS_T.-1 BLE __________AND THAT No. 3206Y IT DOES_L,`( T LIE WITHIN THE SPECIAL FLOOD HAZARD MARSTONS NIA. 026-18 AREA AS SHOWN ON THE H.U.D. MAP DATED_6-_1_9_ 8?__ b� TEL 428-0055 Community-Panel _'50001 0006 C uMu FAX: 420-5-5-5: TIIIS PLAN NOT MADE FROM AN INS' � 7 -NT SUIRVGI'