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Home My WebLink About0140 PINE STREET itia � nF s� - _ f - � :PEMCO LIMITED :4108.5 DATE INVOICE NO. COMMENT:. . AMOUNT.~ DISCOUNT. NET AMOUNT. 8/14/2019 1698770791 140 Pine Street: 75.0.0 0..00 . 75:00 . - (� r. Check 041085 8/14/2019 Town of Barnstable 75,00 3 Town of Barnstable Certificate of Zoning Compliance Certificate 2019-27 Map 248 Owner Name as of 1/1/19: Parcel 024 Address 140 Pine Street FEDERAL NATIONAL MORTGAGE ASSOCIATION Village Hyannis PO BOX 650043 Zone RB DALLAS, TEXAS 75265-0043 Single Family Residential Zone Overlay Water Protection Overlay Year Constructed— 1950 Lot Size 0.16 acres Property Use: Single Family Dwelling RC Setbacks: Front Yard 20 Cert of Occupancy NO Side Yard 10 Rear Yard 10 Date Permit# Open Permits: No Zoning Relief: None found in Building file. Refer to Planning- 508-862-4678. Permits: Building Permit# B-16-2064 07/27/2016 R-30 cellulose/air seal attic Building Permit# B85426 07/14/2005 Re-roof Building Permit# Building Permit# Code Violations: Zoning Code No open violations on file Building Code: None on file. Zoning Violations: None open. Accessory structure appears to be situated over boundary (not verified). Zoning Relief: None on file. Refer to Planning for definitive check. 508-862-4678. Site Plan Review: Not applicable. Zoning History: The subject property was constructed in 1950 as a 1,632 (gross) sq ft, 1 story single family home containing 2 bedrooms and 1 full baths on 0.16 acre in the RB zone. Reviewed by Title Date: Robin C. Anderson Code Compliance Manager 08/23/2019 .", gend + 13 Zoning Districts GP-Groundwater Protection q r ©WP Well Protection2 9 a -36 136 Road Names 7r( d 1 k r — r 4 1151 w . r. .. z , s. ?1 AI' * t r .. Al 24t1U2xf �4 e 4 h s All a rt_ ' g '' '. „ Y' r .sue �. + • r ^'r '. ' y C a. 424; Map printed on: 8/23/2019 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 o26cn 0 42 83 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 508-862-4624 reflect current conditions,and may contain such as building locations. Approx.scale: 1 inch._ 4:2 feet cartographic errors or omissions. gis@town.barnstable.ma.us Legend 13 Zoning Districts .1 it ' , G -Groundwater Protection a ,. ° WP Well Protection 2 9 3 �. � EJ Parcels ' (( Town Boundary �t8'22 Railroad Tracks #11"37 Buildings t s� . k x -: - 2W FO Approx.Building - x 1J Buildings Y.r �� Painted Lines z F Parking Lots 0 Paved Unpaved Driveways Paved Unpaved Roads ` `�` 13 Paved Road ;" Unpaved Road �,.,...-^ .q. Bridge -2Wl �t�02t - � s � Paved Median IF d9f&25 Marsh i Water Bodies - - - r" - � 5 3 S � q26 .. #5� } fir— E: a JK r ' �� n , Tl g { 1 ig- 71 Jvb`i SP'.� X G- � lr.u�{ yy02 a � 1rL� DA11I A sx x 5 �• Map printed on: 8/23/2019 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town 4 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 026oi 0 42 83 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: 1 inch= 42 feet cartographic errors or omissions. gis@town.barnstable.ma.us r Y 1 pia V. DEM O L I M I T E D PEMCO-Limited 1850 Parkway Place,Suite 500 Marietta, GA 30067 Town,of Barnstable Attn Robin Antlerson 200 Main Hyannis, MA 02601 Date: 8/14f19 RE: Code Violations Search Dear Code Enforcement Please see attached check for the $75'00 search fee required by your city. PEMCO-Limited represents Fannie Mae,the owner of record of the property located at: 140 PINE STREET,CEN ,MA 02632 We would like to request copies of the following: 1) Copies of open code violations and summons(if applicable) attached to the property. 2) If there are open invoices pertaining to the code violation or past due liens, please send copies along with the fee breakdown. Thank you for your time! �Q 0 Nicholaus Rice Property Specialist Direct: (770)609-6832 t nick.rice@pemco-Iimited.com C! I I o�IQ PEMCO-Limited,4600 S.ULSTER ST,STE 530,DENVER,CO 80237 I 71 i fqr\II,1RN 4 f 10& f144 . Logged In As: Parcel Friday, August 23 2019 Parcel Lookup Parcel Info Parcel ID'248-024 _ I Developer Lot r y. Location i1 0 PINE STREET_( Pri Frontage 50 I Sec Road 1 Sec Frontage I Village Hya�4 Hyannis H � I . Fire District'HY�ANNIS��VI Town sewer exists at this address'No � Road Index 1258 Asbuilt Septic Scan: " ., %� .. 248024 1 Interactive Md D x »x k 248024 2 p Owner Info -: Co-z .. Owner ERAL N FEDATIONAL MOR1 Owner` Street1 PO BOX 650043 I Street2 City;:DALLAS State TX I Zip i75265-0043 Country Land Info Acres 0.16 I Use'Single Fam MEL-T I Zoning FRB Nghbd!0105 Topography'Level I Road'Paved Utilities,Public Water,Gas,Septic Location Construction Info Building 1 of 1 Y 19 ear, 50 I Roof;Gable/Hip Ext Wood Shingle Built" Struct Wall' Living . ...-...._ Roof•. .,_ __�. AC Area 768 Cover Asph/F Gls/Cmp I Type'None WA Int Bed, .. ., . Style Conventional - Wall Drywall Rooms 2 Bedrooms _ _ _ _ Model Residential I Int ,Hardwood Bath Full 0 Half 'eit Floor Rooms` Heat " Total,..�_._ Grade Average Plus 'Hot Air I Rooms 6 Rooms I " Type Stories i1 Story I Heat oil • I Found-tTypical Fuel ation Gross 1632 ...._ .aI Area Permit History Issue purpose Permit# Amount Insp Date Comments ®ate 7/27/2016 Insulation 16-2064 $4,400 6/30/2017 Weatherization 12:00:00 AM 7/13/2005 New Roof 85426 $4,000 6/30/2006 12:00:00 AM Visit History Date Who Purpose 4/23/2010 12:00:00 AM Paul Talbot Cyclical Inspection 1/12/2006 12:00:00 AM Paul Talbot Meas/Est 10/26/2004 12:00:00 AM Gary Brennan Cycl Insp Comp 9/2/2004 12:00:00 AM Paul Talbot Meas/Est 11/30/2001 12:00:00 AM Paul Talbot Meas/Listed-Interior Access Sales History Line Sale Date Owner Book/Page Sale Price 1 12/24/2018 FEDERAL NATIONAL MORTGAGE 31747/254 $268,200 ASSOCIATION 2 5/20/2005 ALLMAN, DAVID A & MICHELLE M 19844/224 $315,500 3 5/25/2004 MAKIEJ, JOHN & LYNN 18635/232 $252,500 4 1/5/2001 MURPHY, MICHAEL W & KIMBERLY 13471/208 $151,000 5 12/19/1986 WHITE, ROBERT V & PAMELA 5466/173 $90,000 6 12/19/1986 WHYNOTT, VERNON D & 5466/172 $1 CALLACHAN, ROBERT 7 9/12/1986 WHYNOTT, VERNON D & 5296/92 $72,000 CALLACHAN, ROBERT 8 9/12/1986 SNOWDON, RUSSELL M ' 5296/90 $0 9 8/17/1939 SNOWDON, RUS SELL M & IRENE 556/116 j $0 Assessment History Save l°Building Total Marcel Year Value X Value O Value Land Value Vale 1 2019 $92,500 $24,400 $3,600 $93,200 $213,700 2 2018 $71,300 $24,700 $3,700 $98,100 $197,800 3 2017 $70,200 $25,300 $3,600 $98,100 $197,200 4 2016 $70,200 $25,300 $3,600 $67,600 $166,700 5 2015 $78,000 $26,900 $3,600 $62,800 $171 X0 6 2014 $78,000 $26,900 $3,700 $62,800 $171,400 7 2013 $78,000 $26,900 $3,800 $62,800 $171,500 8 2012 $77,100 $26,000 $3,600 $62,800 $169,500 9 2011 $115,100 $3,100 $3,300 $62,800 $184,300 10 2010 $115,100 $3,100 $3,400 $67,600 $189,200 11 2009 $129,300 $2,600 $2,800 $146,700 $281,400 12 2008 $116,200 $2,600 $2,800 $156,900 $278,500 14 2007 $115,600 $2,600 $2,800 $156,900 $277,900 15 2006 $75,700 $2,400 $2,900 $160,200 $241,200 16 2005 $71,000 $2,300 $3,000 $142,300 $218,600 17 2004 $57,500 $2,300 $3,100 $105,200 $168,100 18 2003 $53,100 $2,300 $3,200 $40,500 $99,100 19 2002 $57,500 $2,500 $3,200 $40,500 $103,700 20 2001 $57,500 $2,500 $3,200 $40,500 $103,700 21 2000 $38,200 $2,000 $3,400 $29,000 $72,600 22 1999 $38,200 $2,000 $2,700 $29,000 $71,900 23 1998 $38,200 $2,000 $2,700 $29,000 $71,900 24 1997 $36,000 $0 $0 $23,200 $60,700 25 1996 $36,000 $0 $0 $23,200 $60,700 26 1995 $36,000 $0 $0 $23,200 $60,700 27 1994 $38,000 $0 $0 $26,100 $65,800 28 1993 $38,000 $0 $0 $26,100 $65,800 29 1992 $43,300 $0 $0 $29,000 $74,200 30 1991 $47,000 $0 $0 $46,500 $97,300 31 1990 $47,000 $0 $0 $46,500 $97,300 32 1989 $47,000 $0 $0 $46,500 $97,300 33 1988 $31,800 $0 $0 $17,200 $52,300 34 1987 $31,800 $0 $0 $17,200 $52,300 35 1 1986 1 $31,800 $0 $0 $17,200 $52,309 Photos I Legend 0 Zoning Districts a� ©GP-Groundwater Protection _ �� 13 WP-Well Protection �. a Road Names -36 tj DPW #[5 ",� 4 x 4 t �p k is a s 4 4, 34 : ft x. X -1, 41 Al r•P �° F '� y�` A r ;. 311 t007 - y . Af 1 y Q 61" i .m• Map printed on: 8/23/2019 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 026oi 0 42 83 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: 1 inch= 42 feet cartographic errors or omissions. giS@town.barnstable.ma.us Print this page, Owner Information Map/Block/Lot: 248 / 024/ Property Address 140 PINE STREET (HY,CENT) Village: Hyannis Town Sewer At Address: No GIS Zoning Value: RB Owner Name as of 1/1/18: FEDERAL NATIONAL MORTGAGE ASSOCIATION PO BOX 650043 DALLAS, TX. 75265-0043 Co-Owner Name Assessed Values Appraised Value Assessed Value Building Value $ 92,5,00 $ 92,500 Extra Features $ 24,400 $ 24,400 Outbuildings $ 300 $ 3,600 Land Value $ 93,200 $ 935200 Totals $ 2139700 $ 2139700 Past Comparisons 2018 - $ 19700 2017 - $ 1975200 _. x 2016 - $ 166,700 2015 - $ 1715300 2014 - $ 171,400 2013 - $ 1715500 2012 - $ 1691500 2011 - 1 R4.100 I Tax Information Hyannis FD Tax (Commercial) $ 0 Hyannis FD Tax (Residential) $ 658.20 Community Preservation Act Tax $ 32.90 Town Tax (Commercial) $ 0 4 Town Tax (Residential) $ 1,096.59 $ 19787.69 Residential Exemption Received= $98,270 Sales History Owner: Sale Date Book/Page: Sale Price: FEDERAL NATIONAL MORTGAGE ASSOCIATION 2018-12-24 31747/ 254 $268200 ALLMAN, DAVID A & MICHELLE M 2005-05-20 19844/ 224 $315500 MAKIEJ, JOHN & LYNN 2004-05-25 18635/ 232 $252500 MURPHY, MICHAEL W & KIMBERLY J 2001-01-05 13471/ 208 $151000 WHITE, ROBERT V & PAMELA 1986-12-19 5466/ 173 $90000 WHYNOTT, VERNON D & CALLACHAN, ROBERT 1986-12-19 5466/ 172 $1 WHYNOTT, VERNON D & CALLACHAN, ROBERT 1986-09-12 5296/ 92 $72000 SNOWDON, RUSSELL M 1986-09-12 5296/ 90 $0 SNOWDON, RUSSELL M & IRENE 1939-08-17 556/ 116 $0 Photos Sketches � 2F1'P As Built Cards:Click card # to view: Card #1 Card #2 62N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor, Living Area FTS Third Story Living Area(Finished) SOL Solarium BMT Basement Area(Unfinished) FUS Second Story Living Area(Finished) SPE Pool Enclosure BRN Barn GAR Garage TQS Three Quarters Story(Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story(Unfinished) FEP Enclosed Porch MZ1 Mezzanine, Unfinished UUA Unfinished Utility Attic FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story(Unfinished) FOP Open or Screened in Porch PRT Portico WDK Wood Deck PTO Patio Construction Details Building Details Land Building value $92,500 Bedrooms 2 Bedrooms USE CODE 1010 Replacement Cost $134,070 Bathrooms 1 Full-0 Half Lot Size(Acres) 0.16 Model Residential Total Rooms 6 Rooms Appraised Value $93,200 Style Conventional Heat Fuel Oil Assessed Value $93,200 Grade Average Plus Heat Type Hot Air Year Built 1950 AC Type None Effective depreciation 31 Interior Floors Hardwood Stories 1 Story Interior Walls Drywall Living Area sq/ft 768 Exterior Walls Wood Shingle Gross Area sq/ft 1,632 Roof Structure Gable/Hip Roof Cover Asph/F GIs/Cmp Outbuildings and Extra Features Code Description Units/SQ ft Appraised Value Assessed Value BMT Basement-Unfinished 768 $ 15,300 $ 15,300 FGR2 Garage-Avg-Wd Shingle 256 $3,600 $3,600 FEP Enclosed porch- 96 $5,900 $5,900 roof,ceiling FPL1 Fireplace 1 story 1 $3,200 $3,200 Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 a 8/8/16 4 Town of BarnstableLO-� Thomas Perry CBO 03 Building Commissioner J 200 Main St. Hyannis,MA 02601 RE: Building Permit#B-16-2064 TO: Building Inspector(s), �Y This affidavit is to certify that all work completed for 140 Pine St, as been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey p TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Hg Parcel ria BUILDING DEPT. Application.# O Health Division Date Issued r 20 116kl- JUL 20 2016 Conservation Division Application Fee ((� Planning Dept. TOWN OF BARNSTABLE Permit Fee l/,-,--VV Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis Project Street Address (I e eG� Village };%"js Owner l l e, it'I pg a,n Address 5-a m Telephone Permit Request l�"3 CL' `,[�, SG �o '��► c,-{�-i� � 101 e t'f e Square feet: 1 st floor: existing - proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ��o 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 ❑ 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 1XIIIIjAim M4,1146i 5&, Telephone Number Address ,,Zi - d A+ri IV Riez License# �C l oa T7 6 SS• �aclhDu 4� (�o�b b Home Improvement Contractor# Email ' Worker's Compensation #VC OB S 5 g om ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Z DATE l D FOR OFFICIAL USE ONLY APPLICATION # t DATE ISSUED MAP/ PARCEL NO. r' I r ADDRESS VILLAGE •S i • OWNER DATE OF INSPECTION: FOUNDATION FRAME c INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ;i ASSOCIATION PLAN NO. ACORUe DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY LNSURANCE 4/12/2016 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 pollcy(les)must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certiticate.does not.conferrights to the certificate holder In.lieu of such endorsements. PRODUCER CONCT NAME Risk Strategies Company Risk Strategies Company PHC No E .(781)986-4400 , EAC N,:(761)963-4420 15 Pacella Park Drive Ennall randol P g hcldprisk-strate ies.com' ADDRESS: Suite 240 INSURER(S)AFFORDING COVERAGE NAIL Randolph MA 02368 P INsuRERA:Selective "Ins. of America INSURED INSURER B Allmerica.Financial Alliance Ins Co 10212 Cape Save, Inc INSURERC:Star Insurance Cc 7 D Huntington Ave -- INSURERD: INSURER E: South Yarmouth MA 0266.4 1 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1641211275 . 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. INSR TYPE OF INSURANCE POLICY NUtA89t- MMLICY EFF MlD EXP LIMITS... . LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000;000 DA'AGE A CLAIMS-MADE Fx_1 OCCUR PREMISES Eaocwrrence $ 100,000 X S1994480 10/16%201S 10/16/2016 MEDEXP Anyone:person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L.AGGREGATE LIMIT'APPLIES PER`. GENERAL AGGREGATE $ 2 p000.y 000 POLICY_a.JECT LOC PRODUCTS-COMP/OP AGG $ 2.,0,00,000." OTHER: $ .AUTOMOBILE LIABILITY - - -Ee BINEDitSIN_ LIMI $ 1,.000,_000 ANY AUTO BODILY IN AIRY(Per person) $ B ALL OWNED SCHEDULED AUTOS X AUTOS _ .AUHA46796600 11/6/2015 11/6./2016 BODILY INJURY-(Per accident) $ NON-OX HIRED AUTOS X AUTOS�� PeraEident)DAMAGE $ $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,060,000 A CLAIIviS�vIADE r. �. „ AGGREGATE $ 1,000,000 . EXCESS DED X RETENTION.$ SIL" 81994480 "" 10/16/2015"10/16/2016" $ . WORKERSCOMPENSATION -- Officers Included for ,. x PER _. OTH- " AND EMPLOYERS'(ABILITY, .•. YIN R' , - STATUTE "ER. . ANY PROPRIETOR/PARTNER01ECUTIVE NIA Covers e OFRCER/MEMBER'EXCLUDED? N❑ Q E.L.EACH ACCIDENT $ 500 000 C (Mandatory In NH) I I 9C085540700 4/9/2016 4/9/2017 E.L.DISEASE-EA EMPLOYE $ 500,000 Wdescribe.under - - IPTIONOFOPERATIONSbsim E.L.DISEASE-POLICY LIMIT "$ 500,060 DESCRIPTION OF OPERA-nONS I.LOCATIONS I VEHICLES(ACORI)101,Additionai Remarks Schedule,may be attaehed if more space Is required) - - National Grid Corporate Services LLC d/b/a National Grid, Action Inc, Colonial Gas Company and NStar Electric are all included as Additional Insureds with respects. to the General Liability coverage of named insured as required by written contract. rl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED:BEFORE. Housing Assistance Corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE.POLICYPROVISIONS. -Barnstable County 460 (Rest Main Street AUTHORIZED REPRESENrATIVE Hyannis, MA 02601 Michael Christian/CLC ID 1909-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(701401) - The Commonwealth.ofMassachusetts:- b Department of IndushialAccidents I Congress Street,Suite 100 . Boston,MA 02114-2017 www massgovldia R'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TIRE PERMITTING AUTHORITY. Applicant Information Please Print Legibly )\1ar11e(Business/Organization/Individual) Cape Save Inc Address:7-0 Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone#:508-398-0398 Are you;an employer?Check the.appropriate box: Type Of project(required): 1:rV_1 I am a employer with 15 employees(full and/or,part-time).= 7. Q.New construction 2. I am a sole proprietor or partnership and have.no.employees working for me in ❑ 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.r_1 I am a homeowner doing all work myself.[No workers'comp.,insurance required.]f 9. Q Demolition Q . 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. T will 10 Building addition ensure that all contractors either.have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.0 I am a general contractor and I.have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.t 13:E]Roof repairs 6.FJ We are a corporation and its officers have exercised their right of exemption per MGL.c. 14.[.D Other Insulation 152,§1(4),and We have no.employees:.[No workers'comp.insurance required:] *Any applicant that checks:box#1 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-contractors and state whether or not those entities.have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. d am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Star Insurance Co. Policy#or Self:ins.Lic.#; WC085540700 Expiration Date: 4/9/2017 Job Site Address: 140 Pine Street City/State/Zip:Centerville 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$1,5.00.00 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. 1 do hereby certify under th pains and pendhies of perjury that the information provided above is true and correct Si Mature: Date: /16 Phone#:508-398-0398 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#: F, Office of Consumer Affairs and Business Regulation - _:,;y 10 Park Plaza- Suite 5170 Boston;Massachusetts 02116; Home Improvement C©ntractor Registration Registration. 4>71380 . Type Corporation `=ft`r Exp reton 3114120 :8 Tr# 41.9291 CAPE SAVE INC:: t� WILLIAM WdCLUSKEI' ,mot 7-D HUNTI,NGTON AVENUE SOUTH YARMOUTH;'MA 02664> f,' rs * a` � Update Address and return card.Mark reason for change. d_ C] Address OrRenewai: (�,Employment J7 Lost Card SCA 1 0 20M-05111 eanrrrca>tcaetc�l�•aQ/�lataacr<cce Office of'Consumer Affairs&Business Regulattoa License orregistraf�on valid for mdividul use only a HOME IMPROVEMENT CONTRACTOR before the expiration date If found'return to: h V)Registration r 17.1380 Type: Office of Consumer Affairs:and Business Regulation 2 Expiration 3/1412018` Corporation 10 Park.Piaza Suite Si70 Boston,MA 02116 CAPE SAVE INC. W t-- WILLIAM McCL•USKEY 7=0 HUNTINGTORAVENt7Ew SOUTH'YARMOUTH,MA 02664 Undersecretary Not valid i signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards 4riu,u uc` -- P/Ti ner- - • r.____v.ii u ouiii License: CSSL 102776 r}` n WILLIAM J MC aU = 37 NAUSET'ROAD I • it West Yarmouth MA `%, ,,; �11 • '„a,�` Expiration Commissioner 06128f2017 HOME OWNER WEATHERIZATION WORK PERMIT: PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property located at: nv The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather stripping; air sealing; attic&basement insulation; exterior wall insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to Housing Assistance Corporation the property with such equipment and materials as may be necessary to perform weatherization. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five(5)years after the weatherization work is completed. I have read the provisions of this agreement and give my consent. r, Home Owner(signat,re Home Owner email: V4'�V "�V Date: �' W Agent:(signature) Date: Weatherization Contractors: Adam T Inc �. ��erne�rgySolutions All Cape Energy Alternative Weatherization Lohr Home Improvement Building Science Construction Tupper Construction Cape Cod Insulation MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108-1904 (6171723-3800 Ma Only(800)392-6108,FAX(800)851-8424 2/7/2012 Form of Notice of Casualty Loss to Building Under Mass. Gen.Laws,Ch.139,Sec,313 BARNSTABLE BUILDING COMMISSIONER 367 MAIN STREET 367 MAIN STREET HYANNIS MA 02601 Re: Insured: MICHELLE AND DAVID ALLMAN Property Address: 140 PINE STREET,C€147}7OfCtE, MA 02632 Policy Number: 0841165 d-I`^{C-Al'-S Type Loss: Fire(including Fire caused by Lightning Date of Loss: 02/02/2012 Claim Number: 299761 Claim has been made involving loss,damage or destruction of the above captioned propert,which may either exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139,Section M is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location,policy number,date of loss and claim or file number. MPIUA Claims Division CMA00021 Ij )