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Town of Barnstable Building
� g
,WWIs Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept
�t63 Posted Until Final Inspection Has Been Made. Permit
9� ��
Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made.
Permit No. B-18-4087 Applicant Name: Carl Rebello Approvals
Date Issued: 12/14/2018 Current Use: Structure
Permit Type: Building- Insulation-Residential Expiration Date: 06/14/2019 Foundation:
Location: 27 TROTTERS LANE, MARSTONS MILLS Map/Lot: 047-133 Zoning District: RF Sheathing:
Owner on Record: CARVEIRO, ROBERT R III Contractor Name `,,Carl J Rebello Framing: 1
Address: 27 TROTTERS LANE Contractor License: CS-084358 2
MARSTONS MILLS, MA 02648 � Est. Project Cost: $3,560.00 Chimney:
Description: Insulation&Air Sealing. i Permit Fee: $85.00
Insulation:
t Fee Paid:' $85.00
Project Review Req: ' Final:
Dater 12/14/2018
Plumbing/Gas
Rough Plumbing:
��•:Building Official Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas:
All work authorized by this permit shall conform to the approved application and the approved construction docume`ts 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. Final Gas:
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open forepublic inspectiofns for the entire duration of the
work until the completion of the same. _.--. -„'"/ !
Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service:
Minimum of Five Call Inspections Required for All Construction Work:
1.Foundation or Footing Rough:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction. Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT pllvl�p/1�
0(40u .S f..rT
i
Town of Barnstable *Permit# ao67D19 7
;. y
Expires 6 months from issue date
Regulatory Services Fee c?S 00
X-PRESSPERMIT Thomas F.Geiler,Director
MAR 2 9 2007 Building Division .
Tom Perry,CBO, Building Commissioner
TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601
www.townbamstable.ma.us
Office: 508-862-403 8
Fax: 508-790-6230
EXPRESS PERMIT APPLICATION .- RESIDENTIAL, ONLY
Not Valid witho'ul Red X Press Imprint
[ap/parcel Number -y 7 /3,3 }
�i
roperty Address 'L-? _�Y 6. ,Q )—Vn , r S o k
Residential Value of Work '-AGO g . O 0 Minimum fee of$25.00 for work under$6000.00
iwner's Name&Address
e_r Z.-L)
.ontractor's Name Telephone Number
[ome Improvement Contractor License#(if applicable)
cer�se-#��appiieablej .
]Work{nan's Compensation Insurance
Check one:
❑ I am a sole proprietor
YI am the Homeowner
❑ I have Worker's Compensation-Insurance
asurance CompanyName
Vorkman's Comp.Policy#
:opy of Insurance Compliance Certificate must be on file.
-emait Request(check box)
dRe-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
�Re-side
❑ Replacement Windows/doors/sliders. U-Value (maximum,44)
•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 rent Contractors License is required.
IGNATURE: -
t:Forms:expmtrg
.evise061306
I ne L-ommonweaith-oj massacizusens
Department of IndustrialAccidents
Office of Investigations •
a' 600 Washington Street
Boston,MA 02111
,v www.mass.gov/dia '
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):___(
• O
Address: `i,-1 r o rt
GZ6yF
City/State/Zip:_ o.ns MA 5 �I'V's Phone:#:_
Are you an employer? Check the'appropriate box: -Type of pioject(required):. .
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part;time).
have hired the stab-contractors 6. ❑ ew construction .
2.❑ I am a'sole proprietor or partner- listed on the'attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have g, ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
o workers' comp.insurance comp, msurance.t'
re cued 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
q ]
3. I amahomeowndr doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. o workers' co right of exemption per MGL
Y � comp. - 12dRoofrepairs
§1,152 4 , and we have no
insurance required.]t c. O •
employees. [No workers' 13:❑Other
comp,insurance required.]
,,Any applicant that checks box 01 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 cheek this box must attached an additional sheet sbowing the name of the'sub-contractors and state whether ornot those entities have
employees:If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site
information.
Insurance Company Name:
Policy#or Self ins.Lic.#: Expiration Date:
lob Site Address: City/State/Zip:
Attach a:copy of the workers' compensation policy declaration page'(showing the policy number and expiration date).
Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA-for insurance coverage verification.
I do hereby certify under the pains•and penalties of perjury that the information provided above is true and,correct,
Signature,: Date: mot 6
Phone#:
Official use only,. Do not write in this area, to be completed by city or town offrciaL
City or Town: PermitlLicense#
Issuing Authority(circle one):
:L.Board of Health 2,Building Department 3. City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector
6.Other
Contact Person: Phone#:
Inf®r ' at! and In�tructi®ns `
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 ernployer 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
=eceivPr nr trustee of an individual partnership, association or other legal entity, employing employees. However the
owner of a dwelling-house having not more than three apartments and who resides therein;or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or.local licensing agency shall withhold the issuance or
renewal,of a license or permit to'operate a business or to construct buildings in the commonwealth for any
applicant-who.has not produced-aeceptable 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-.aceeptable evidence.of complizrice 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-contractor(s)name(s), addresses)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 required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. D.e advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or.license is being requested,not the Department of
Industrial Accidents,' Should you have any questions regarding the law.or-if you are require$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 primed legibly. The Department has provided a space at the bottom
Of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy*information(if necessary)and under"Job Site Address"the applicant should write"all•locations'in (city-or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related fo 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 hike to thank you in advance for your cooperation and should you have any questio, R&_,—
please do not hesitate to give us a call.
The Department's address,telephone'.and fax number;
Tho Commonwealth of Massaobusotts
Depar�mmt of lidustdQ Aocidernts
Offacc Q.f InYestigations
600 Washington St ea
Boston,MA 0.2111
TO, #617-727-00.4 ext 406 ar 1-M-M_ASSAFfs
Fax 4 617-727-7?-49
Revised 11-22-06
www.mass.gov/dla
r
Wit, T Town of Barnstable
Regulatory Services
BAMSTABLE, : Thomas F.Geiler,Director
MASS.
94, =639• ,•� Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: Z CN\ 0
JOBLOCATION: Z.—)
number street village
"HOMEOWNER": \ i 1^ L jz: `�A —)-1"A— `6 3 S 'c1 6 3
name ` home phony work phone# ✓
CURRENT MAILING ADDRESS:
t��-ro �cS L h M°\V- �a��
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building'Official,that he/she shall be
responsible for all such work performed under the building permit (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance-with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he she understands the Town of Barnstable Building Department
minimum inspection procedures and requireme is and that he/she will comply with said procedures and
eq ' ements.
Signature of Homeown
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control..
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner.shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:forms:homeexempt
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. CERTIFIED PLOT PLAN
OT
TRUCTION ONLY = ��,'�� '`'.��:._:�..`'�.".^ .�4�_t._[_s• .. �.
FOUNDATION IS .1 FEET IN Y `'
..
_ .1tQ LOW POINT OF ADJACENT o
''` ;' :a. ., •.._ L -- n-G. GATE=lzvG. �,=197?k
w EI�CI RI 4=INO
CLrENT_ �/ 0 N I CERTIFY' THAj THE n u^��<+ •.
-- SHOWN ON .THIS PLAN 13 LOCATO
EA B®ISTERitJoe no. ON THE GROUND AS INQICATED AJWPq
a Vtil; LAND CONFORMS TO THE 2bNIN4 LAW'*
`S YmYO0 OR-By OF 8A4lVS SLED ASS.'
Yt404 §T 7,12 MA14, ST
5�, '�,hl �� ��+ t�T AL AD
Assessor's map and lot.number .., .:................. .
1�5
SEPTIC SYSTEM MUST BE
INSTALLED IN coMPl_IAIvc
Sewage' Permit number ............................ V' ! H A;TIC E 11 q-T
>!!TE
IF
yo�T�Ero� TOWN' OF BARNsTABLE
(} i, 12B STABLE. i t7
F"6 9
M ,,� ` BU .ILDIHG INSPECTOR
o ar°
APPLICATION FOR PERMIT TO ........ .0 1�..........N..C.Vj.Cw�t U ,° ^................................................
TYPE OF CONSTRUCTION ..... 1' .�lYl.�...............
a
........ .........................19.7.7
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies
for a permit according to the followiin�,g� information:
Location ..... .ct%... Q......./..�Q fr S... .r.l .......1.:1. .r.. �e'7....!.:l.l. /..5.................................................................
Proposed Use ... . .G-.sZ.l.o4.Crle..l.l..0, .�....54.�..�.rr...T'G 1ert.�.1 1.......................................................... ...........................
ZoningDistrict ........................................................................Fire/District ..............................................................................
e � r
Name of Owner !1�V.a�..1.1.V.(...> V.J.f.�l.•....�'•1..............Address .....J�
Nameof Builder ... .............................................Address ...........,7xL.M. 7.:.......................................................
Name of Architect .. v.�ti.T rr.�.V.................................Address .......
Number of Rooms ..�J�............................................................Foundation ....Po.V..,r`:o.:.I-CAK. l.:.........................
. r
Exterior �........... 1
............................Roofing .....�.S.R..�!1a,v. . ....��.�.!:�.�.G..C...............................
s 1
<-('.� ......./ Uhc�cr�ay �.y �U�{..5.............Intenor S�..FcTJ'ecc.�:.,. !`ylva / ..
Floors .......... g ....... v ............. .. 1 .........1.................
.Heating ' . .a.......................Plumbing ....�:.4 G.Y•.................................
DD 1
Fireplace ....4 f.:c..S .. ............................................................Approximate Cost ...7Z � Q .........................................
/. ee
Definitive Plan Approved by Planning Board ------------____—-----------19________. Area .......0.6.q..
QU..............
Diagram of Lot and Building with Dimensions Fee / / ��
. .................. ..........................
SUBJECT TO APPROVAL OF. BOARD OF HEALTH �( �?
1.2 •
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ...T,;7
Inovative Builders
119513 one story
N ............... Permit for. :...................................
ngle family dwelling
.............................b....................................... ...... ...
Trdtters Lane
Locat0 ...................................................... ........
Marston Mills
...............................................................................
Owner
Inovative Builders
..................................................................
Type of Construction. .....................frame.....................
................................................................................
420
Plot ............................ Lot ................................
Permit Granted .........A,144u.st 17 ........19 77
Date of Inspection ...........19
Date Completed ......................................19
PERMIT REFUSED
................................................................ 19
...........................................I....................................
...............................................................................
................................................................................
...............................................................................
71D
Approved ................................................ 19
...............................................................................
...............................................................................
d ,
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y� •� „ 'jb � *�I�i S`2.t)+OLD
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' P.
�'�j 4: r"' :.•,'.+, •• ------_ _ .____ _._ . ._. _.. .___�_. to ._ BUNIKie « ,a
CERTIFIED PLOT PIL
+ 'tr `'S:s'•'w`I 1 L �T 'i "
N TRUCTION .ON
FOUNDATION IS—
FEET IN ;l.•.
}: / V$• Lty1tY POINT OF ADJACENT SAJ1A31ASL� 'Ai�� +
SCALE DATE _ uGt .. 9?
. + 7,_
s E QI RI CLI'FNT -^� i CEItTIFY' THAT ,THE
_ .,, _ Y..` ____�__ _ --_- SHOWN ON THIS PLAN' IS., LOQ4TED
��:. $f•_ ENE REGISTER RH6ISTFR D /jo•�-�,
d0®, FtO. ____;__ ON --SHE GROUND-AS INDICATE% 111 f--
SUR�fEYpA. DR.�Y= A,,`' �''' CONFORMS TO THE 20WIM8 1.
n .p— OF BARN5 BLE , A$$:`
71 i tl1• S i OK 0Y' _t' - ' '
IAs I ,, ,; LA.Ia ID
Assessor' a and lot number, ..... ��' � r ✓'���
p .. . �.... ' s ...
Ill ��•
d -
Sewage;Permit number .............N..........................................
°`'TT"Er°� -TOWN OF BARNSTABLE
BAHB,9TAMLE,
oaY BUILDING INSPECTOR
9��•F 2 63 q
a•
. s III
APPLICATION FOR PERMIT,TO .... i al......w. !t.1 C�f. S•t•�`•U !
TYPE OF CONSTRUCTION
-,�r� �„��- ,
.........................19.7 7
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the followinginformation:
Location .....:4e?'T...�:().......Te S Ss.. ►�. .ii..................................................,. t --9 1 ...................
Proposed Use ... 1�.r..`.l�•I r �;�! �IaAC � r����i l v............. .........................................................................
ZoningDistrict ................................................................!.........Fire District .................................,............................................
Name of Owner .- l�nii ..Tu ..: u�(•�!..bcr.f.. . ........Address .....` •, •rc.• ..:.Cl...�n)•�•• /C� /c�i•SS
Nameof Builder ......S I .. ....................................il.........Address ............. .C.:.....................................................
Name of Architect n � I
............. ..� !...............�r+ CT S
GT G,a k rzr,C<.;�s✓12y..:.....
.. .. ..................................................I! �'�U r F �c �t r�T� .
Number of Rooms .........Foundation ..............................................................................
Exterior ...............................(!.........Roofing .....
Floors '.a,,.:!....... /S UNc�C,/Ayh,I:vT jf. ,a .S � SA C=C=TP�6� � �:l�rywe—I��
1
......................................... Interior ........................
................ .... .i...............................
Heating .......................... .....`..................c '........ ........Plumbing
� �C� t
Fireplace .... rr•�<k (.........Approximate Cost ...........:........................................................
r c
Definitive Plan Approved by Planning Board -----------____---------------19--------. Area ......... _
Diagram of Lot and Building with Dimensions Fee . `•��
SUBJECT TO APPROVAL OF BOARD OF HEALTH ��
wy,
i
. I -
I hereby agree to conform to all the Rules and,Regulations of the Town of Barnstable regarding the above
construction.
Name . :..v./ /l/!1`Lc .................��+;-;C. .....
e
Inovative Builders/A=47-133
19513 one story
No,�-,,.............. Permit for ....................................
single family dwelling
........................................................................
,4
I I Trotters Lane
LocationAI.............................................................
Marstons Mills
................................................................................
Inovative Builders
Owner .. i-
................................................................
fr �e
Type of Construction. ........... ........................
...............................................................................
4�20
Plot .........................-.---Lot .... ............
Augus t 17 77
Permit Granted ..............I.......J...................19 %1
Date of Inspection ............. .......................19
Date Completed ...........................::..........19
/107
7,.
PERMIT REFUSED
......... ................................. ................... 19
. ... ......... . . . .......... ...........
................ ..... ........... .. ...... ..... . ..................... ZJ...... . ..
.................... .........................................................
. ................................... ...........................................
Approved ................................................ 19
...............................................................................
...............................................................................
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in
town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town
Clerk's Office, 1 FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and 200 Main Street Offices at the Licensing counter.
DATE: 10 ( t o -1
Fill in please:
APPLICANT'S YOUR NAME: C
BUSINESS YOUR HOME ADDRESS: CA�S �r
TELEPHONE # Home Telephone Number: 5 o S�
NAME OF NEW BUSINESS L- TYPE OF BUSINESS SI-o vN zA-c- v g-±'x e
IS THIS A HOME OCCUPATION? YES NO—V
Have you been given approval from th buildin divisio.r,)? YE� NO
ADDRESS OF BUSINESS m-i 1 ro is v, /"\0r-3 'w\s r'l , �\ c MAP/PARCEL NUMBER OL
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of
the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200
Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally
operate your business in this town.
1 . BUILDING C SIONER'S OFFICE
This ind idu I h bee for of any permit requMments that pertain to this type of business.
n MUST COMPLY WITH HOME OCCUPATION
Authoriz ature** RULES AND REGULATIONS. FAILURE TO
COMMENTS: r - COMPLY MAY RESULT IN FINES.
2. BOARD OF HEALTH
This individual has en inf�rme of the permit requirements that pertain to this type of business.
A ized Signatu ** MUST COMPLY WITH ALL
COMMENTS: nl O b HAZARDOUS MAT€RIAz8 REGU64T.I^I"^
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual een in rme�d�of t pce si equirements that pertain to this type of business.
I
Authorized Signature*
COMMENTS:
�i
Town of Barnstable
SHE
Regulatory Services
OF Tp�
P� o Thomas F.Geiler,Director
Building Division
► BARNSTABLE.
v� 63S. `0$ Tom Perry,Building Commissioner
AlEO MA'S A 200 Main Street, Hyannis,MA 02601
, ww.town.barnstable.ma.us
Office: 508-862-4038 Fa 508-790-6230
Approve
Fee:
Permit#:
HOME OCCUPATION REGISTRATION
Date: l a I 1 1 I O--1
Name: �Ly r N S�o ) st r L.9- 1�.�n Phone#: l '1 '-� — 3 (�—S"► "3
Address: Z- o *A Cs L-.h . Village: o\. -S o ns > >' S
Name of Business: C_ J L_ V\ A Q r S
Type of Business: C10 q'N v C� 1 O n Map/Lot: 'l ✓�
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 Hcme 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
dwelling unit.
I,the undersigned, have read and agree with the a strictio is for my home occupation I am registering.
Applicant: Date: \-O I I1 O
Homeoc.doc Rev.5/30/03
The Commonwealth oj!Ilussuc%usctts
• ;��1 '�..�`_._::_�;_� Department of Industrial Accidents
Office 01111yes&9=89s
600 11<ashitt;;tun Street
Boston, A1us.v. 0 111
Workers' Compensation Insurance Affidavit
tlsnitc•tnt tntormahon: Please PRINT le il1""`�`"��
name ���6�-rJ �✓l r1t/1
location / %/9/2CA—W
nhonc i♦
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working_ in any capacity
_ ..�.,,....._._-...-•,---�-�...sue---•----.•--••��--_-.—_�•..
am an employer providing workers' compensation for my employees working on this job.
cnmpany name•
address:
city: phone i!•
intur•tnce co �-a solid•to Ux (3/a uSa :26
I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who ha%
the following workers' compensation polices:
comp•tnv nimc•
address:
cirv: nhonc>Y•
I
insurancc co onliev#
con now name:
•tddre s:
citw• Phone 9-
insurance co nolid•0
:Attach additionalsheetiftiecess r�.W _+.. .'..."��.•"►/ C sy`i. .. .. :•c:.a`.�3 .,•.. �..•i+; x�ti� .• �.ry.A�: .. `.. .�. sy.`r— �
Failure to secure co.vcrage as required under Section 25A of INIGL 152 can lead to the imposition of crimin2i penalties of a fine up to S1S00.00 and/or
unc'-'cars'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and it fine of 5100.00 a day against me. 1 understand that a
cope of this statement may be forwarded to the Otrice of Investigations of the DIA for coverage verification. _
I do herehr eery, under t• i and pens!ies of perjui tr that the information provided above is true and correct.
Si_nature Dace /96
Print name Phone#
�official t►sc only do not write in this area to be.completed by city or town official
city or town: permitAicense# r llluilding Department
C3Liccnsi1g hoard
check if immediate response is required Selectmen's Office
Qllcalth Department
contact person: phone f;; nOther :
ire%isra 3,115 PJA)'
C�
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' c0illPensatiott for their
employees. As quoted irom the -law". an empinree is defined as every person in the service of another under an\'
contract of hire, express or implied, oral or written.
An ernplt tr r is defined as an individual• partnership, association, corporation or other legal entity, or any two or more
the foregoing enuaged in a joint enterprise, and including the le-al representatives of a deccascd 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
d\\:cllin�,, house of another who employs persons to do maintenance , construction or repair work on such dwcllin�z 1101.
or on tite arounds or 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 ��ithhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the Commonni calth for an.
:applicant who lass not produced acceptable evidence of compliance with ;lie insurance coverage required.
Additionally. 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 h
been presented to rite contracting authority.
777..,
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to ;your situation and
supplying company names. address and phone numbers as all affidavits 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 tlae permit or license is being requested.
not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are requires
to obtain a workers compensation policy. please call the Department at the number listed below.
City or 'towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at tite bottom o
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Ple
which will be used as a reference number. The affidavits may be returned
be sure to fill in the permit/license number
tlae 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 question
Please do noti hesitate to give us a call.
Tile Department's address. telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Waslaington Street _
Boston, Ma. 02111
fax #: (617) 727-7749
nhone 9: (617) 7 •'"100 1 ext. 406. 409 or 375
1
Engineering Dept. (3rd floor) Map Parcel X, Permit#
House# �� Date Issued i l 13 to
0/1 00-4.30) Fee 'Y o2
:30-9:30/1:00=2:00)
P1 s os/. .hc,olAdmin. Bldg.) INE.p
ppzoued_b 19
BARNSTABU.
TOWN OF BARNSTABLE 'F°"`'��
Building Permit Application r ..
r I
Pro treet Address �o
Village 1!57A S:Jwrt
Owner Address
Telephone
= Permit Request
67
First Floor square feet Second Floor square feet
Construction Type
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
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
No. 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
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal#_ Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use _ Proposed Use
Builder Information
Name QC4AA (,�,Q�1 , Telephone Number
Address `7/ License#
t2AA=,t Home Improvement Contractor ^3 6
Worker's Compensation# 4! .X 63 6/ y
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
AeSIGNATURE DATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
PERMIT No. � � �21
i t F
1
DATE ISSUED'
y ; ,
y -
MAP/;PARCEL NO.' r
i
ADDRESS• VILLAGE
OWNER ' , -
i
• i •
DATE OF INSPECTION:
FOUNDATION
FRAME t �!
f 1
I -
INSULATION
FIREPLACE
r
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH. FINAL
GAS:' ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT '
'ASSOCIATION PLAN NO.
1 1
1
°fry
The Town of Barnstable
� = Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
For office use only
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL,c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization,
conversion, improvement, removal, demolition, or construction of an addition to any pre-existing
owner occupied building containing at least one but not more than four dwelling units or to
structures which are adjacent to such residence or building be done by registered contractors, with
certain exceptions,along with other requirements. p
Type of Work: Est.Cost
r
Address of Work:
Owner's Name
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under$1,000.
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the o r:
Da4 Contractor Name Registration No.
OR
Date Owner's Name