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1067 PITCHER'S WAY
0�� . p 1 t �y f �� � 17L �CC��Py V�� S � w^^a C� LA�, lo /vTMC4/v Dfz- a2Ya1-3 Barnstable iE�cE�{PST s NIA 02601. 508-862-4038 r Building Permit Date Recieved: 3/11/2018 r State Lic. No: CSSL-106102 Applicant Phone: : (508) 776-2900 Phone: (774)521-5362 C LLE,MA 02655 oofing shingles from the rear two story shed dormer of the r � d � :v `HE TOWN OF BARNSTABLE Permit No. � Building Inspector""'*"� Cash OCCUPANCY PERMIT Bond ----_________—__-_—_-__ "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to C & F Builders Address Box EE Falmouth, 14A 02541 1067 Pitcher's Way, Hyannis Wiring Inspector iV" P Inspection date Plumbing Inspector� ` \^ `0` Inspection date Gas Inspector` Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. _ ._........._, 1977 ................ ......... _...._ Building Inspector ,.t""� TOWN OF BARNSTABLE .7 ". Permit No. -" 1 »n.� Building Inspector cash riva --------------- uo'�ta rar►>� OCCUPANCY PERMIT Bond ----__—___-____—__-_ No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to C is r 13uild':.3� Address �== %:� 1'1�"•pl'L11: i i� 0�_j�}_. 1037 i i tclicrT a :eriy; Hyannia Wiring Inspector "` r!—., Inspection date Plumbing Inspector �_; ' Inspection date Gas Inspector _ Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ........................... �/................ 19.'.... ....:�....................... ............��... .:......`..............._. ..... ._ Building Inspector T t tt t.14� { it� 27"t } x Fi ya�tcat kr rt fix, .-.) r 7 ` '-y k " '} %� 4 1, tia 'r£ �-y•w✓ s ) T t { °r _ r zu - "3 yr e.x`f �`�,*1-1 :� ii 4 rv,"A9 Y'` .E } 41} `� I P5 ,+!I ./1 hz E t e"h` v + *�, xt. r '�} Z % x 'i'17 t -r # P �t:.art AI`'�k `' >rIJi �f r 0 { -xl y y a k1'7(1 Ly11 �x 3�,x '1�'7 a X{ 9' e'3i r " ��t ; - ( .'qtt t .: /1 sF �, °fi ': Y-" C fi," 'Fa1"•iR:t, .�iki' r W a -Ja z �Ys�cit� � , d {,.-v .✓jr;i r' t �', r P.- .•Y } :r W '•v il+r L r , ";:",:` `S 'r�„tlh' - ,}� {fv "• rri sr 1 a. } S r ��� r ,� a� -S j' `-`',t I', f � '\altf 'r w.r -_� - x f .° ;t r a Jf p y€' r Yr� s{ {-r '&� �r t s i e 2' a i'' w 4 r u v k x � � #1.{ a vx 7'n / 'a s `. 5 4,3<` w '�� ,fir . 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L r x a « r, '� t9 x - +, < •La ;� s i r ; t .. - R O s ��i��a�f y a 'r-,,yy� r� R • S�J' �p'rT IRr ��y�I�ICri��� �I O�l it j t kt �a r •. t �5, �111.A 4 rr,.''!, { t,N s �Y.. •� a F Gf w, f a'ht #-r •�y� _ r.' r 7 f '"� �"a a °.+. .ak•.+ i�` f$ i3'" �t�� '3^.�'��w`'r�r etr,` � R7 C/ti✓/•rL.a'�.t7CI°/.:�./E�Ar"m t i'y,,?•'v..of r:r x4 k d". e t xY't 4'tt'� , ,� � 'i ;h x W § h s 'm �' '° v'tY}LA.cl i$44i/a3Y0ldS s1. ash' 1' a t,` �� 'it { ` ^pY�.E'/1 10(. TIt"' M!-�SS 1 atii� � ' :' i R DfiTE Pr ff��* rr-,t ar.i a. ya t r - - - y SEPTIC SYSTEM MUST BE L 070 �,9 ,� INSTALLED IN .COMPLIANGPd,"ro 2A.' AsS&AO's map. and lot mumber ... .... ........ ... ..... WITH�'ARTIC[�E II''STATE '`� rr �d �PD TOWN USewageUPermit number ....................... o FT"E n TOWN OF BARNS�TAI&LE �16 9 - BU>ILDING,+ INSPECTOR APPLICATION FOR'PERMIT TO /'./1.D. .l.::.C/�1 ra ! .a .�Y�rr.. ..... .+I]���j'...............................' ...... J� TYPE OF CONSTRUCTION '..: /./Y L.e.. 4�l.l.�. ®!�"4..�- ....... ,�.......... .................. F .s ..................Aa...!,;a..19.!7 # I® � 7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit�a/ccording to the following information: LocationR/7' .c.AS.....P'.Ay.......:........ . .A H. Z ................................ ................................... ProposedUse ...MO.�f .................................................................:........................................................................................ y.AMM S.....AAr.V.. Zoning District ... ..........�.....................:.................................Fire. District ....t� ..:................... / Name of Owner ., ...... . .L.�..... ....... .. !au. . .......Address .... . . t 9 Name of Builder % j���. .�P�. �A. ►.�l�l�, �• �dress ... �...�I.Y/. ..70ly... O . ..... > .1� , n � e Name of Architect .tI ©Q4�..... ....................Address .... ............... Number of Rooms ... PtA 'Qy.....,G....................................Foundation ...R0.Ugw...... JI/ �'......... Exterior J f ARoofing .,as,4/b4Ar..... .............................. 6 Floors .. Interior DR,,i �.�.� i C ' �a: . ................................................ .. ..... ................................ HeatingA077.1v.,41-C&...........................................Plumbing .................................................................................. Z. 60a' Fireplace ......13R.1•C•�•�.• Approximate Cost ...:....... . . ..............................................:... ................................;.O.d.......... Definitive Plan Approved by Planning Board ______________________________19________. Area Diagram of Lot and Building with Dimensions Fee �.. ................. ........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH y . oho � � _ � - � � • 20 C Y. I hereby .agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name 6 .�e Frost Cape Cod, Inc. i 19190 one story No ............... Permit i for ...... . ... � � .. r single family dwelling , Location'.....Pitchers Way ' Hyannis ........................... ........... ...................................... Owner ........Frost. . Cape Cod, Inc. Y ' ...... . .. Type# Construction frame y , �... _ .... .............................................. w Plot ....'a........... _ Lot .. 23.............. Permit Granted"..... May. 6 :............ ..19 77 i Date of Inspection .�.yr ... ...19 Date Completed' ..� .. G c............ .19 1 , r PERMIT REFUSED ..................... ..'. 19 } "" 4. ....... j` U[ ( /L/! T/ ......... ., Approved .-............................................. 19 Z. v ............... ...,...:- ..................................................... .............. , ............................... ....... ...... Assessor's"map and lot' number ............................................ �'4 F r Sewage Permit number h °`7HE.r°�° TOWN- OF BA_ RNSTABLE -7 � Z MAiNST"LE, i NABILBUILDING INSPECTOR °May APPLICATION.FOR PERMIT TO s!11..,.;; ' TYPE OF CONSTRUCTION �...t�� /N i/ ':.... �•iL ! ... �0 4.c:........................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 1Tc"e r .t Z .:*.-1 �t ht `J 1"A/NJ :� ................................................ ..:............................................................................................................ ProposedUse ..? .. .y.. ........................................................... ;..... Zoning District �•' f ""� ��Iv�; � AA C V Fire Distract ..............:...............................................:............... Nameof Owner ......:................ .................Address .................................................. Name of Builder �4� f.tte. r1r7� %!r. Address . ....AIG !.. './.. A .......t. ... r• i............. �#b Name of Architect t"7�'Ql ri.. ........ U.-....: ....................Address �4� /A/ A/S .1 .. .............................................................. ...........Foundations *v �•��-- '°" Number of Rooms .... , tS. ......4? .......Pei t..�C ;�................................................... � F Exterior (i� a n ter f't e . �fia r` ,#'jrI�Roofing . r A�Gt't` ;,` �Al 1.. ............................. :+. .......... ...... 1 ;. . ................. .. ...a ..... rj « DR'-1 WALL Floors .,a:�. . ..........:........A. L �t' �fd.l. :................ .:........:........................................................Interior ...........................`................I................ Heating ........................ ........................................ :.......Plumbing .................................................................................. . ......... . av Fireplace .....: ?.! .tL.........................................................Approximate Cost ....... ..................................:.�.......... Definitive Plan Approved by Planning Board ________________________________19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee .......�0 ...................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH �- lip 4�'6 Sop A-0 f/ 0 s t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name4_! .. ...i!." _... ... ....rµ�r.:i...........:.....?...?..:°�..'it Frost Cape Cod, Inc. A=273-1984 19190 one story J Ala ................. Permit for .................................... single family dwelling ................................................. IPitchers WayLocation i.(,U ............................................................... Hynis ...........................rost Cape Cod, Inc. Owner ......................................................... � _ •� . Type of Construction frame ............................. ........................................................ ...................... Plot ............................ Lot ... 4�23..... Permit Granted ".. Agy.....................19 77 Date of Inspon ....................................19 Date Completed ......................................19 �U PERMIT REFUSED ........................ ..................................... ..... .... .. .. ..r..?.. • • .. .................................................. .' ........................ • + + • 4. • - I0 Approved ................................................ 19 S4 ............................................................................... ............................................................................... - I Date: June 14, 2018 To: Building File RE: Overcrowding/Apt? Address: 1067 Pitchers Way, Hyannis Originator: Unknown Complaint: New garage unit on 2nd floor driveway&staircase to 2nd floor indicates new apt to caller Enforcement Process Steps ® 1. Initiate local investigation: RA ® 2. Document/enter into system Yes ® 3. Contact ® 4. Property Owner Keila Barreto Costa 5. Seek access to subject property 6. Seek administrative warrant(if necessary) NA 7. Notify state authorities of findings NA ® 8. Document conclusion OPEN ® 9. Referred Jeff Property—273-198 Property is developed with a 1 story single family dwelling (1977)containing 2 bedrooms and 2 full baths on 0.35 acre located in the RC-1 district. 06/15/2018 Caller identified that that an additional driveway and clearing has been made to accommodate all of the cars. Also a new staircase in the rear to the 2"d story leads caller to the conclusion that there is an apartment. Town of Barnstable f kBuilding wixsrw�s� ? Post This Card So T4hat it is V�sibl6 ""6 the Street Approved Plans Must be Retained on Job and this Card Must be Kept 1619. m$ Posted Until Final Inspection Has.Been Made Where a'Certificate of Occupancy. s Required,such Building shall Not be Occup!ed until a:Final inspection,hasbeen made Permit ,> , . ... ..�. .,...m Permit No. B-18-3463 Applicant Name: COSTA, KEILA BARRETO Approvals Date Issued: 11/14/2018 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 05/14/2019 Foundation: Residential Map/Lot: 273-198 Zoning District: RC-1 Sheathing: Location: 1067 PITCHER'S WAY, HYANNIS Contractor:Name: Framing: 1 Owner on Record: COSTA, KEILA BARRETO Contractor License: 2 Address: 10 HEMEON DRIVE - - Est. Project Cost: $4,000.00 Chimney: . WEST YARMOUTH, MA 02675 Permit Fee: $ 170.00 Description: convert existing garage to dining rm &living rm/remove one non Fee Paid: $ 170.00 Insulation: bearing wall in living rm. Houas has pre fab trussess.frame in closet Date: 11/14/2018 Final: convert garage : remove overhead door frame in using existing heater. install onenew window. insulate walls'&drywall. patch in Plumbing/Gas missing side wall shingles.framed&insulated floor and.installed /t 3/4" plywood Rough Plumbing: Building Official Project Review Req: CONVERT GARAGE TO FAMILY ROOM. INSULATION TO Final Plumbing: COMPLY WITH 2O15 IECC. Rough Gas: Final Gas: Electrical . � Service: Rough: . . �.. r Final: Low Voltage Rough: Low Voltage Final: Health Final: Fire Department Final: . t Town of Barnstable Building. . This Card So That it is�Visible From the Street Approved Plans Must be•Retamed onJob and, diisCard Mt'be Kept ' iAHN`.3Y'ABLE, • ; - - k �i. i • v 6 Posted UntilFinal Inspection Has:Been Made _ �� � a Where a Certificate of Occu anc ';is Re cared,such Buildin "shall Not be Occu ied until a Final Ins rectionhas been made �� e p Y q !; .. tea. . R p P This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed. 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations.-" Work shall not proceed until the Inspector has approved the various stages of construction. . "Persons contracting with unregistered contractors do not have"access to the guaranty fund" (asset forth in MGL c.142A). Building plans are-to be available on"site All Permit Cards are the property of'the APPLICANT-ISSUED RECIPIENT �r . AWH�= ........�"��....�.`.. ..... �4 • _ ' • BUILDING DEp� Pert Fee... ...`..a..Y..............Other Fa........................ PJQV p 1018 Total Fee Paid:..................»............................................. . OWN OFeq / TOWN OF BA INSTABLE�,�eLE P by... . ......... .»............On. l�:!Y, .,. ..... BUILDING PERMIT a. ...... ...../. ..�............... . . ..»... .................. APPLICATION Section I—Owner's Inforniation,and Project Location Project Address /o�� �o/�'� G��4 y Village �,>'4Ivll 1.I" Owners Name .,�JZ A G o-�i9� � G�� T� 4AKZ_1_112f'/6 Owners Legal Address a c staxe —zip o� 67,r- rty w. y� �,� owners Cell# s"o J 7 s 9/I email el 1/N 11 :w1i �y�f/�/.4/l.cow`► _ Sectiony2 ITse,of Structure Use Crro ❑ Commercial'St t ture over 35,000`cubic feet up ❑ Commercial Structirt under'35,000"cubic feet. S'We/-Two.Faauly Dwelling -Section 3 Type of Perini, ❑ New Constriction e Move❑ M /Relocate ❑ Accessory Structure ❑ Chang"e of use ElDemo/(entire stract=) El Finish Basement ❑ Family/Amnesty El Fire Alain Rebuild ❑ Deck". Apamnent © Sprinkler System ❑ Addition a - Retaining wall ❑ Solar ' w:rli ry G ❑ Renovation Pool Insulation Other Specify lZ Section 4-Work D_ ascription �✓ c/!'E%H E:X nT/�tr F'�f�E`�'v J'TAle oI" /di�l.� Gri/�'�oY�✓. - vGJl�'JGiJ ��ooX A ~I� 1LE�b 'Lease 47e-_ �01107-a J' r5.gr, M4 019 ` The rCommonwealth'ofltlassachrisetts a; .G.. Depw*nent of Industrial Accidents r :4ff. e o, vesttgat Ir: Boston,MA 02111 _ Workers'iCompensation Insurance%Wftyat. Bwlders/Contractors/Electr�cians/PIumbers Appli&iWIMormation �z `"' _:_. :_ .�YQ ,Fzy „rPle°ase Print I •b u.Stn Name:(B_ ess/Organizatiot>/Individtull Address: � t g. City/State/Zip., 1/Li/Je� w : , r.Phone#tF S"o � �r S91 j ` Are you an`employers Check the appropriate�bog a _ ' w A r 1.Qrr a Type of pro,ect(required) I am a employervvitt ` ' 4sT�Q-I am a general contractor and I Y t t * „have;h ❑ employees{(hill and/o pait=tune). ""r fired the sub-contractors r �.6y New constraction 2 ❑ I am a sole proprietor or partner- the attached sliee z�- Y.7 �Remco mg " `slu and have no em"lo"ees:"' ^ m Theseasub-conlractors have.. P p Y 8 Q-Demolition < _ w working for me in any.capacity. employees and have workers' 3ti p ,ncnran # 9. ❑Building addition '+ [No workers'comp,insurance; oom ce eq d] �' J. Q We are a corporaizon and its' 1'0 Q Electncal repairs ar a'd'ditions required.], k � 7 t„n t Off1Cers have eXerClSed;�leff `�� r am a homeowner doing all works ad , e ` , k 11 Q,PIumbmg repars or,additions myself. [No workers',coin nght of°exemption per MGL } p 12 QRoof repairs. insuranceand we have no ees }o w _" _ s ,'�1 3 r . I � a-s� fi P oy orkers' r 13�❑} w - k ,�f ,vt i� ag x t^ e"�, '�,rye < comp2 insurance requaed=]. : .. * tst. - Any appUcaat ti�at checks box#1 must also re., out the section below showing then workers compensaton policy information t Homeowners who submit this affidavit tadtcatmg they;are doing aU work and then hue outside conhacfors must°submit anew affidavit mdicatrn such i`boxd esu a 1.11a nt)oose$Contractors that check th t a tes employees If the sub-contractorrs have employees they must pmvtde the workers'comp pole 1, u work cynr w umber I ant an employer that u providing workers'compensation insurance for my employees. .Below is the po6uyiand job s#e.! information. Insurance Company Policy#or Self°ins Iic# ` ' - `f Exp fit" on'Date ` F rs��a rvra s Job Site Address �� ` City/State/Zip v�� t r t 'z° .."X.> '.. " Attach a copyofthe workers'compensation pohcy declaration page(showmgtheipo�hcy number and egpzrration date) Failure to secure coverage aswrequired under,Section,25A of MOL'c. 152 can lead two the m posrtaon of cnmmM p-enaltze rof a y fine up to$1,500.00 and/or,oneFyear,irYmpnsonment,as-.well-as,civil penalties mytheifoim of a STOP WORKtORDER and a fine of up to$250.00 a day against the violator: Be advised{that a copy of this statement may befonvadedo theme Office of Investigations3of the:DIA forsinsurance coverage verificatt�n r K. 3: I do.hereb c w aloes o<.Pur!' and correct x,y ss .au eP,_ k,, P.en f that the informaizon proW above u true .e u..r z ti Phone.#: Offuial use only. Do not write in this area,to be:conrpleted by city or town official. p.. City or Town: Al Pe smit/Lieense# Issuing Authority(circle one) 1.Board of Health 2.Building Department 3.City/Tovvn Clerk 4 EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: ° Phone#: Y 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 ia.the commonwealth for any. applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,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 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 Partnerships(LLP)with no employees other than the members or partners,are not 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 licenseis 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-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 e affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. of the y Please be sure to fill in the permitllicense 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-townmay 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 ladustiial Accidents Office of Investigations 600 Washington Street Balton,MA 02111. Tel..#617-727-4900 ext 446 or 1-877 MA.SSAFE Fax#617-727-7749 Revised 4-24-07 www.maw.gov/dia I Application Number.................................................... Section 5—Detail Cost of Proposed Constructiond�14_0oo. Square Footage of Project Age of Strt�etine �� ��-T' �/L. 7 Dig Safe Number 41,4. # Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance-Method. ❑ MAC}ecklist.❑WFCM.Cheddist -Design Section 6=P iect Specifics ❑ Wiring Oil Tank-,Storage _ Smoke Detectors ❑ PlumbingGras File S ssion❑ ❑.� - uppre ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply Public ❑ Private Sewage Disposal ❑ Municipal On Site Historic District [] .. Hyannis Historic District ❑ Old Kings Highway Debris Disposal F �rd_ G,d ,b _4 Disp Facility- I am using a crane ❑ Yes No Section 7 Flood Zone Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑ . No Section 8-Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks.. . Front Yard Required Proposed Rear.Yard Required :: Proposed Proposed Side Yard Has this property had relief from the Zoning Board in the past?N ❑ Yes No Last Mda2eth 2/92018 - Application Number...............:........................... Section 9—.Construction Supe ' or Name Telephone Number Address 'ty State Tip, License Number License -Expiration Daze Contractors Email Cell# I understand my responsibilities under the roles and regulations for Licens "on Supervisor in accordance with 780 CMR the Massarlmsetts State Building.Code. I understand the construction_insp procedm es,specific inspections and documentation repaired by 780 CMR and the Town of Barnstable.Am&a.copy of I ccnse. _ Signature D Section-1 one imoovementCon tractor Name_ hone Number eP Address �`® City State 'Tip' Registration Number -Egpiration.Date _ ?A I understand my responsibilities under the rule4nd regulations for Home, ,guilatl Improv Cofactors in accordance wrth 7 CMR the Massachusetts State Building Code. the construction inspection ced�m es,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.L C.... : Date Section 11=Home Owners License Exemption Home Owners Name: /L A G a y7X 46�?(12RJ 17—p Telephone Number s" �a cP 2 S-7 ep �-� � 7 r9// Cell or Work Number - I understand my responsibilities under-the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the.Massachusetts State Budding Code. I understand the construction inspection procedures,specific inspections and documentation y 7 and the Town of Barnstable. Sigiiare � /Q APPLICANT SIGNATURE print Name /� � c a f' '4 .� �4j�/ Telephone Number J1'cP a 7 �91/ E-mai1-permit to: .,k�e/Z/.J4/# i u•.a.....i..a�.i.nmhmo 401 �..'�' _ .. - ` �r. tom;ter..+ �• - _" � - _ - . Or it 1 t'. 'fit ly t _ _ •.h Town of Barnstable Building Department Services Brian Florence, CBO Building Commissioner STABLE. 200 Main Street, Hyannis, MA 02601 B ib39-2014 www.town.barnstabie.ma.us Office: 508-862-4038 Fax: 508-790-6230 Notice of Building Code Violation(s) and Order to Cease, Desist and Abate: Keila Costa and all persons having notice of this order: As property owner or tenant of the property located at 1067 Pitcher's Way,Assessors Map 273 Parcel 198 and known as residential structure,you are hereby notified that you are in violation of 780 CMR, the Massachusetts State Building Code Chapter 1 Section(s)R105.1and are ORDERED this date 7/13/2018 ts: CEASE AND`DES ST afl functions`ass'ocia`ted withnhe following violation(s)on or at the above mentioned premises: Summary of Violation: On 6/21/2018 the Building Department observed violation(s)of 780 CMR of the Massachusetts State Building Code Chapter 1 Section(s)R105.1, work without the benefit of proper permit(s). Summary of Action to Abate Violation: In order to abate this violation and to avoid further enforcement action by this office, commence immediately upon receipt of this notice the following action: cease activity and commence with obtaining the proper approvals and permits to either: 1) remove all unpermitted work or;2) obtain all required permits and subsequent required inspections. And, if aggrieved by this notice and order;to show cause as to why you should not be required . abate the violation in this notice,you may file a Notice of Appeal(specifying the grounds thereof) with the State Building Code Appeals Board within(45)days of the receipt of this order and in accordance with MGL c. 143 § 100. If;at the expiration of the time allowed,action to abate this violation has not commenced, further action as the law requires may be taken. By Order, J e L. Lauzon Chief Local Inspector (508) 8624034. Jeffrey.lauzon@town.barnstable.ma.us r r' = 10/18118,12:22 PM Oi keila nascimento Qui 18/10/2018, 16:21 Para: kc-cleaning@hotmail.com <kc-cleaning@hotmail.com> • `f m :.��,e '.• a ,�. :,. t • � ," fix, �� s T � � ` � � ¢ � '$ks •M r �r _ h i r i r �w a..• -' t .a• w ,ram,'^5... �� - Sent from my Phone about:blank Page 1 of 1 r ly • a ryaF _ ni , , t' I ti y a; a_- ..� .: �;�" -�. a ,7 a a � Ol „ € e ; r �orA Q X 9,�� 6-�� 4- jag d D, =r (A v � Dso A00411P VIC O�NOF 7 50OV80owl IL - ! � 3 Barnstable Bld Dept. � Appwved / F'-3yO Permit#: y D -P ba,19 Lei nj 4m Er Ln Cert)fed Mail Fee E re Services&Fees(check box,add tee as appropriate) O ❑Return Receipt(hardcopy) $ 11) ' '�. 0 ❑Return Receipt(electronic) $ y apostma* 0 ❑Certified Mail Restricted Delivery $ p HefB O ❑Adult Signature Required $ C'nC. ❑Adult Signature Restricted Delivery$ O Postage r C3 y� C7 $ ' 'Pi �" rq Total Postage and Fees ! $ •,��{ r-q Sent To I r3 ------------------- ,t Ir�--ten------ XNo.�[hv - ►1U f i'l-----(-------------- i---- ---------------- :,r t Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. . associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service' Restricted delivery service,which provides for a specified period. delivery to the addressee specifiedrlty name,or to the addressee's authorized agent.. I . Important Reminders: Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(hot First-Class Maile,First-Class Package Services, available at retail). or Priority Maile service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mail. and provides delivery to the addressee specified ■Insurance coverage Is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). r of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. - electronic version.For a hardcopy return receipt,i complete PS Form 3811,Domestic Return Receipt,'attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records PS Form 3800,April 2015(Reverse)PSN 7500-02-000-9047• , Town of Barnstable Building Department Services Brian Florence, CBO Building Commissioner #�nw,, BLE. 200 Main Street Hyannis,MA 02601 `""""��j 6TVAG'•AnE7J7 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Notice of Building Code Violation(s) and Order to Cease, Desist and Abate: Keila Costa and all persons having notice of this order: As property owner or tenant of the property located at 1067 Pitcher's Way,Assessors Map 273 Parcel 198 and known as residential structure,you are hereby notified that you are in violation of 780 CMR,the Massachusetts State Building Code Chapter 1 Section(s)R105.1and are ORDERED this date 7/13/2018 to: CEASE AND DESIST all functions associated with the following violation(s) on or at the above mentioned premises: Summary of Violation: On 6/21/2018 the Building Department observed violation(s) of 780 CMR of the Massachusetts State Building Code Chapter 1 Section(s)R105.1, work without the benefit of proper permit(s). Summary of Action to Abate Violation: In order to abate this violation and to avoid further enforcement action by this office,commence immediately upon receipt of this notice the following action: cease activity and commence with obtaining the proper approvals and permits to either: 1) remove all unpermitted work or; 2) obtain all required permits and subsequent required inspections. And, if aggrieved by this notice and order;to show cause as to why you should not be required abate the violation in this notice,you may file a Notice of Appeal(specifying the grounds thereof) with the State Building Code Appeals Board within(45)days of the receipt of this order and in accordance with MGL c. 143 § 100. If;at the expiration of the time allowed,action to abate this violation has not commenced,further action as the law requires may be taken. By Order, J e L.Lauzo- n Chief Local Inspector (508) 862-4034 Jeffrey.lauzon@town.barnstable.ma.us � Town of Barnstable Building Department Services Brian Florence, CBO Building Commissioner BARNSTABLE 200 Main Street, Hyannis, MA 02601 b N5RlE,�NTYIlf.Q UR-""" riM5fit0 M:05•ISM1'0.Y01L'•PGi NA'6".iel[ 1639-2014 www.town.barnstable.ma.us5 Office: 508-862-4038 Fax: 508-790-6230 Notice of Building Code Violation(s) and Order to Cease, Desist and Abate: Keila Costa and all persons having notice of this order: As property owner or tenant of the property located at 1067 Pitcher's Way,Assessors Map 273 Parcel 198 and known as residential structure,you are hereby notified that you are in violation of 780 CMR,the Massachusetts State Building Code Chapter 1 Section(s)RI05.land are ORDERED this date 7/13/2018 to: CEASE AND DESIST all functions associated with the following violation(s)on or at the above mentioned premises: Summary of Violation: On 6/21/2018 the Building Department observed violation(s)of 780 CMR of the Massachusetts State Building Code Chapter 1 Section(s)R105.1, work without the benefit of proper permit(s). Summary of Action to Abate Violation: In order to abate this violation and to avoid further enforcement action by this office, commence immediately upon receipt of this notice the following action: cease activity and commence with obtaining the proper approvals and permits to either: 1) remove all unpermitted work or; 2) obtain all required permits and subsequent required inspections. And, if aggrieved by this notice and order;to show cause as to why you should not be required abate the violation in this notice,you may file a Notice of Appeal(specifying the grounds thereof) with the State Building Code Appeals Board within(45)days of the receipt of this order and in accordance with MGL c. 143 § 100. If;at the expiration of the time allowed, action to abate this violation has not commenced, further action as the law requires may be taken. By Order,• J e L. Lauzo- n Chief Local Inspector (508) 862-4034 Jeffrey.lauzon@town.barns?able.ma.us Y BLDGDEPT. U.S.POSTAGE®TNEYsowEs J011- 200 MAIN ST. HYANNIS MA.02601 ZIP 02601 006.67' _: % x r 02 4YV Y .3. 2018. 3 6455 JUL. 1.3. i 0000 7.017 1000 0000 6753 9327 9 Keila Costa 1067 Pitcher's Way Hyannis,Ma.02 —� E T U''I,'GN T w7 S E N,.D E'R r v !.INC.?AXME:D 3'Cd *3022.- 641-B9-1.3 '38 Jill JIL111111@11 "lilt' r -N COMPLETE • COMPLETE • ON DELIVERY I I i ■ Complete items 1,.2,and 3. A. signature j ■ Print your name,and address on the reverse X ❑,Agent so that we can return the card to you. ❑Addressee I ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery i or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1.? 1:1 Yes � Q i I If YES;enter delivery address.below: ❑No 0 vi -(��e�s i 3. IIIII�III IIII IIIIIII I IIII III II I III I IIIIII III ❑AdulltSign tice uree 13❑.RegisPr Mail iority eT- I I l Adult Signature Restricted Delivery O Registered Mail Restricted. i 9590 9402 3615 7305 6410 87 Certified Mail® Delivery Certified Mail Restricted Delivery ❑.Retum Receipt for J ❑`Collect on Delivery Merchandise' I 2. Article Number(Transfer from service label) ❑'Collect on Delivery Restricted Delivery ❑Signature ConrirmationTM r ------ Insured Mail ❑Signature Confirmation 1 7 017 10 0 0 0000 6 7 5 3 9 3 2 7 pf Insured Mail Restricted Delivery Restricted Delivery ^I(over'$500) - I PS Form ,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt i, /000 Anderson,Robin From: Lauzon, Jeffrey Sent: Wednesday, August 29, 2018 8:19 AM To: Anderson, Robin; Florence, Brian Cc: Lauzon, Jeffrey Subject: 1067 PITCHER'S WAY Robin, ` To date the above address has not made any effort to correct the violations noted in the notice of violation dated 7/13/2018. How do you wish to proceed? Jeffrey Lauzon Chief Local Inspector (508) 862-4034 jeffrey.lauzonP_town.barn stable.ma.us 1 - -t Town of Barnstable Regulatory.Services 0t 1HE Tp� �. ti Thomas F. Geiler,Director Building Division * BARNSTABLE, v MASS. g Tom Perry,Building Commissioner prE 639. a 200 Main Street, Hyannis, MA 02601 www.town.b a rns tabl e.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: U l0 OLI 7OO. HOME OCCUPATION REGISTRATION Date: / / 00 1 Naiiic:_Y-)e_1 �0, cin Nab6 Pliolle 9: t�08 23-7, Address: IO 1e e� Village: 14 vi ►�'J Name of Business:--- � ---- ----------------------------------------- Type of Business: Map/Lot: 07 3 t6romV INTENT: It is[lie intent of this section to v the residents of the To�wu of Barnstable to opeate a house occupation within single funuil dwellings,subject to the provisions of Section 4-1A of the Zoning ordinance, pro6cled that the activity b Y g � J I sliall not be discernible from outside the dwelling: there shall be no increase in noise or odor; uo VISual altertion to the premises wlrich Fvould suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or gro,undwi . f pollution. After registration with the Building Inspector,;i customary home occupation shall be permitted:as of right subject to the follotwing Conditions: • `Fite activity is carried on,,by the pertnauenf.resident of a single.family residential cltwelling unit, loc'atecl within that dwelling unit.. • Such use.occupies no more than 400 squu-e feet of-space, - • There.are no externA Aterations to the dwelling which are not customary iiu residential buildings,and there is uo outside e'indence of such use. • No traffic ccnll be generated in excess of nornial residential volumes. • The use does not.invohe the production of offensive noise,vibration,smoke,clustoi-other particular matier, odors,electrical disturbance,heat,ghire, humidity or other objectionable effects. There is no storage or use of toxic or hazlydous materials,or flammable or explosive materials, in excess of nornial household quantities. • Any need forparlcinggenerated by such use shall be niet on the sarue lot containing the Customary Home Occupation,uul not within flue required front yard. • "['here is no exterior storage oi•display of materials or equipment. • "There are no commercial vehicles related to the Customary Home Occupation,other than one van or one {pickup truck not io exceed one ton capacity,and one trailer not to exceed 20 feet in length and.not to exceed 4 fires,parked oil the same lot containing the Customary Home Occupation. • No sign sltall be displayed indicating the Customary Home Occupation. • If the Custontu-y Home Occupation is listed or advertise.ci as a business,the street address shall not be included. • No person shall be employed in the Customary Horne Occupation w-lio is'not a penitanent resident of tlic dwelling unit. - I, the and Sig fed, h•ve re: r fl afire with the Above restrictions ['or my home occupation I am registering. Applicant . Date: YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30_00 for 4�ears). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L:-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: r ^/ Fill in please: APPLICANT'S YOUR NAM E/S: R C�.S+ r e,Z�C� YL 40 BUSINESS YOUR HOME ADDRESS: 7 _1 TELEPHONE # Home Telephone Number �j Oj RkLrfi:�lLQajrAc;Ji_:A" NAME OF CORPORATION: .: NAME OF NEW BUSINESS 11 TYPE OF BUSINESS 42,V\ , IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS tO - MAP/PARCEL NUMBER 2)1 ' I (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 20M`ain St. - (corner of Yarmouth Rd. & Main Street) to make sure you have-the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFI This individual has been i forme ny permit requirements that,pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION orized Signature** U ES AND REGULATIONS. FAIIW E�(� I • 5 COMMENTS: P4121Y MAY I C K� . IT IN PIN 2. BOARD OF HEALTH This individual has b en i- off he permit requirements that pertain to this type of business. MUST COMPLY VMALL M'" � HAZARDOUS MATERIALS REGULATIONS COMMENTS: Authorized Signature** 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has for of the lice ing requirements that pertain to this type of business. u ri e�ig ature**COMMENTS: - �'� Town of Barnstable ( �1� THE Regulatory Services /r F T P�otio Thomas F.Geiler,Director ll • Building Division 1AMSTABLE. KASSg Tom Perry,Building Commissioner1639. 4'Aten 39�s 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: �s Permit#: HOME OCCUPATION REGISTRATION Date: lit.//0U/ 06 Name: 6 n rY?C V Phone#: Address: �o�o� l �"'C �Is CA�'Hs-1 illage: Name of Business: "1 �5�w SOA-- Type of Business: MLS=- Map/Lot: Z7�r1 q INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the l dwelling unit. I,the unders' ,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: Homeoc.doc Rev.5/30/03 Jam ' C,, 1 YOU WISH TO OPEN A BUSINESS? 0 � For Your Information: Business Certificates cost$30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 15t FL., 367 Main Street, Hyannis, MA 02601 (Town Hall). �- DATE: 0,5 0.8 " Fill in please: APPLICANT'S YOUR NAME: n 60meS �2 U � BUSINESS YOUR HOME ADDRESS: 10C��"L �, c GIs vJ�,� 3+ x � 1i$TStA5{4 €, r�fl147���J `11� rsN�1 \ 111 A- TELEPHONE # Home Telephone Number: _15©8 12a(c,,9, '1 �3i6 NAME OF NEYII BUSINESS TIRE :F BUST ESQ... :.. . . .. M., l TI-IIS...A S. .:::..:.:::.. o e 1-1. _.0 . . �v s roI fr= t . .,. y . n YIDS DD 5S: :. A. �kE. ............... :� When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING C SIGNER'S OFFICE This indi idua h been ' or of any permit requi?L!,ments that pertain to this type of business. Authorized ature** COMMENTS: I— d 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AU ORATY) This individual been, ,IQW,rmed t re ' n requirements.that pertain to this type of business. Authorized Signature** COMMENTS: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 73. Parcel Permit# 4/913-3 Health Division Date Issued Conservation Division / Fee Tax Collector F Treasure Planning Dept. Date Definitive Plan Approved by Planning Board ; Historic-OKH Preservation/Hyannis Project Street Address f0(1?1 LA/,47 Village N is Owner 6ND 9 a LAND Address Ale 1�l Z/�lr Q�S Gy�� ,4L,wvls- Telephone 7-70" 71 cl o nad ,er grtA4 kwe-A. Permit Request �F /Z0�.n!& D VfIZ e r A/4 L€s A4eg S44t V64-Ps W441 7 6tlfi�_4 rZf� fvj� 9hF-1@?S A44�_ 4 K8 IS 16 Square feet: 1 st floor- existing proposed 2nd floor: existing proposed Total new Valuation Q o 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 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 BUILDER INFORMATION Name J1 ., Telephone Number S4!�2 -. Address 532- X, Al / License# 0006 r/ ►�%rrlocl i ADS' Dula" Home Improvement Contractor# O Worker's Compensation ALL CONSTR CTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE i DATE S8-P 5. -2,OoB FOR OFFICIAL USE ONLY, PERMIT NO. _ DATE ISSUED , MAP/.PARCEL NO. ADDRESS .� _. VILLAGE OWNER DATE OF INSPECTION: FOUNDATION ,t t FRAME , INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial.Accidents .'M;t-_ --3 Off�CZ Of/lIYBSll9fll0/IS 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance davit %%NI. rriiiii WE n���� 1'4 Z. location: # city hone . I am a homeowner performing all work nn5eif. I am a sole.pro rietor and have no one working in amp capacity , �/%%%��------//%O//%% %%...... �%% I am an employer providing workers' compensation for my employees working on this job. cocnoanv name address: :.. �: . 15 7_ hone# city ins u ra n ce co: I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the follo«•ing workers' compensation polices: omnanv n amp: . address: .:...: :::.:.... .. ::...;. hone =...:: ctty: . .:..:.::. :........... :.:.::.....:. ..::...... r . insurance rn. / ////./.�.//�� • address: -_ .. .; .. one citv- ..- - >;:;:6::;»a: :;;::i is :>.::: > ::::>a:;:<;:::>•:�:;.;:<;:;«::: - ::. insurance co. / ////.: .. of a tine up to 51,500.00 and/or Failure to secure coverage as required under Section 25A of MGL 152 can lead to the fmpostlio P one years'imprisonment%�well a'dvil penalties in the form of a STOP WORK ORDER and a tine of 5100.00 a day against ma I understand that a copy of this statement may be fon►arded to the OfIIce oClnvestigatlons ottheflIA for eoversge verifleation I do herehv certi der t e pains Ziperiury that the infortnotion provided above is true and correct Date Si�tature Print name ��.!/ LA /i� Phone i1 96 Z7V J •: .... ..:: otIlcial use only do not write in this area to be completed by city or town offidal s 3. permit/ilcense# ❑Building Department city or town: ❑Licensing Board ❑Selectmen's Office " ❑ check if immediate response is required ❑health Deparunent phone#; contact person: ❑Other :r2 ::;;x .,:� Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for�� M person m the service of an Y employees. As quoted from the"law",an employee is defined as every of hire, express or implied, oral or written. An employer is defined as an individual,pa rtnership, 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 receive: 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 Irepair work on such dwelling house or on the grounds c building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or reneN of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who h: not produced.acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract forte pbeor ance of een presentedto the��public work undl acceptable evidence of compliance with the insurance requirements of this chapter authority. Applicants K . ' the box that applies to your situation and Please fill in the workers'--compensation affidavit completely,by checlang hone numbers along with a certificate of insurance as all affidavits may be r supplying company�' address p Also be sure to sign and k submitted to the Department of Industrial Accidents for confirmation of insurance coverage. -4 or town that the application for the permit or license is date the affidavit. The affidavit should be returned to �9 ors `9aw"or if yc not the Department of Industrial_Accidents. Should you have any questions regarding berg request compensation policy,please call the Department at the mmiber listed below. are required to obtain a workers � xm Mpg! � . City or Towns is complete and printed legibly. The Department has provided a space at the bottom of t sure that the affidavit omp Please Please be the hcaat. affidavit for you to fill out in the event the Office of has to contact you regarding aPP be sure to fill in the peimitllicense number which will be used as a reference member. The affidavits may be returned t^ the Department by mail or FAX unless other arrangements have been made r._. .. . - The Office of Investigations would IOce to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. WA rmmmm The Department's address,telephone and fax member: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Invesdoadons 600 Washington Street - Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 o,TMe r The Town of Barnstable �, - �e� . .Department of Health Safety and Environmental Services 9. Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 Building Commissioner Fax: 508-790-6230 T ' Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERNIIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovadon,repair'modernization,conversion, improvement,removal,demolition,or consmmdon of an addition to anY pig owner-occupied building containing at least one but not more than four dwelling�or to structum which are adJaceat to such residence or building be done by registered contactors,with certain W=Ptions,along with other .requirements. /J J Estimated Work: / Cost 29�� Type of -/ Address of Work. Owner's Name: Date of Application• I hereby certify that: Registration is not required for the following reason(s): Work excluded by law OJob Under S1,000 C]Building not owner-occupied ❑Owner pulling own permit . Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT ORDEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND MGL a 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the ag t f the owner. ��� �eoa Contractor N Registration No. Date OR Date Owner's Name �y - � f �' N d a '. d ►H r l .v ®� ems.co . m - ) eD ►�. ; PO V e ..