HomeMy WebLinkAbout0007 VAN GOGH DRIVE �..J
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Town of Barnstable
Building Department
Brian Florence, CBO
•` Building Commissioner.
200 Main Street,Hyannis, MA 02601
www.town.barnstable.ma us
Pre-application for Business Certificate
Date �) Map Parcel "70
Applicant Information
Applicants Name
Applicants Address. y C(✓\ —'VDC'kn
Email Address J J�Qrt-z_CD hNcw l or 1ne i Co M
Telephone Number 50 L�kc(-t S 01 a Listed❑ Unlisted ❑ O C iE
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Business Information D a M
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New Business? ----------------------------------------• No C =
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Business is a registered corporation? --------------------------- Yes No Z Z C
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If yes Name of Corporation 2 . m
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Does business operate under the registered corporate name? Yes No C
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Is the business a sole proprietorship or home occupation? --------- Yes No m D
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If yes then a Home Occupation Registration is required—See Building Division Staff Z
Name of Businessf J•�(�O� I�/`�� l.� V��'� '
Business Address ( V Q
Type of Business Q
Buil ' g Commissioner Office Use Only
ditions Oft4 t '
1p �t -CAW,
Building Commissio
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Clerk Office Use Only
Town of Barnstable
Building Department
.t �OpSHE Tp�o Brian Florence,CBO
Building Commissioner
BARNSTABLE, 200 Main Street,Hyannis,MA 02601
y MASS.
$
039• www.town.barnstable.ma.us
ATE0 �A
Office: 508-862-403 8 Fax: 508-790-623 0
Approved:
Fee:
Permit#: 3
HOME OCCUPATION REGISTRATION
Date: O 1
Name: 3U� �--Q (� Phone#:
Address: V Q� ����%,� �,1Y1�� Village: eM
Name of Business: aACIU—
Type of Business: 1 UIVv���' ��r�`^ Map/Lot:
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 C7 M K
following conditions: O C C
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located m
within that dwelling unit. D n
• Such use occupies no more than 400 square feet of space. Z O
• There are no external alterations to the dwelling which are not customary in residential buildings, and there D -0
is no outside evidence of such use. < m r—
• No traffic will be generated in excess of normal residential volumes. M C
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular C:
matter,odors;electrical distw-bance,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 Z Z O
of normal household quantities. -n Cn K
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home Z ' M
Occupation,and not within the required front yard. CCn D
• There is no exterior storage:or display of materials or equipment. C (-)
• There are no commercial vehicles related to the Customary Home Occupation,other than one van or one M C
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to __J D
exceed 4 tires,parked on the same lot containing the Customary Home Occupation. O
• No sign shall be displayed indicating the Customary Home Occupation. Z
• 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 above restrictions for my home occupation I am registering.
Applicant Date: a3 6_�69
Homeoc.doc Rev. 10/17
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ti oFINE, Town of Barnstable *Permit
Gp�' 0 Expires 6 months from issue date
y7 ^ Regulatory Services Fee
snxrasTesi e `
9� 16J9 � Richard V.Scali, Director (�
Building Division
Tom Perry,CBO,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Map/parcel Number
1�� Not Valid without Red X-Press Imprint
/ ��-roperyAddres � �� OS��
❑Residential Val ue_of,Work-$ f "6..®C� Minimum fee of$35.00 for work under$6000.00
r Owner s=Name-&=Address ... {'Vl t CI4 iQ ej
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable)
❑WorkChec Compensation Insurance X-MM1z 'T
Check one:
❑ I am a sole proprietor
ff)I am the Homeowner APR 15 2014
I have Worker's Compensation Insurance
Insurance Company Name TOWN OF ES NSTABLE
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box) �+
KI�Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to tiJ `�� £ X C a
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
WRe-side
Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*,Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License& Construction Supervisors License is
r ed
SIIONATURE
QAWPFILESTORMS\building permit fo s RESS.doc
Revised 061313
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
AvOlicant Information Please Print Legibly
t s �
`Marne(Business/Organization/Individual): �, /�c
�Addre� �� ft N (; o Q�l
,—City/State/Zip: °---c)-7,;�,Ay t We IkA- Phone#: S'O t�- 3 6 - o�
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New 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 8. ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp.insurance comp.insurance.:
re ui d.re 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
q , officers have exercised their 11. Plumbing repairs or additions
,�� I am a homeowner doing all work ❑ g P
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.[1 Other
comp:insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby Gerd u ains and penalties of perjury that the information provided above is true and correct.
-w-
Si ature: Date:
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
i
r
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold-the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(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-contractor(s)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 required to cant'workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a 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
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 to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit._
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel, #617-727-4900 ext 406 or 1-877-MASSAFE
Revised 4-24-07 Fax#617-727-7749
www.mass.gov/dia
Town of Barnstable -
Regulatory Services
dF Richard V.Scali, Director
Building Division
grAB Tom Perry,Building Commissioner
MASS,
039. 200 Main Street, Hyannis,MA 02601
Ado Nub www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
A) 7 Please Print
DATE:—r" /► J /
JOB-�ATION:-- U)qA3 U OA
number streetQ r' village
,HOMEOWNER":_—_rV l'1 f'v!A r AW e
name home phone# work phone#
CURRENT-MAIL-ING ADDRESS:— � 1 b ox 7
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 ' on procedures and requirements and that he/she will comply with said procedures and
req ' m
GSignature of Hom r_'�
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.
1.
+ BARNSTABM •
MASS. , Town of Barnstable
Regulatory Services
Richard Scali,Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,-MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit,please complete theHomeowners License Exemption Form on the
reverse side.
QAWPFILESTORMSIbuilding permit formAsmokecarbondetectors.doc.
Revised 050412
is
Zra 1 1
,: Safeguard
-. Prop o p e r l 1 e S 7887 Safeguard Circle
T Valley View,OH 44125
800 852.8306 p
WO#160966860 216 739.2900 p
Town of Barnstable z16 739.2700 f
Building Commisioner
200 Main Street
Hyannis, MA 02601
Date: 4/10/2015To Whom It May Concern: <a
--n
' UD
We are writing to inform you that we are the registered agent for our client: �NC �
MORTGAGE who is the previous registrant of record for the property located at:
Address: 7 VAN GOGH DR OSTERVILLE, MA 02655
t•q�F
Please be advised that this mortgage has: been sold.
Please know that during our research, we have found no process in which to formally de-
register this property with your jurisdiction. Please contact us directly at 877-340-0060
or vpr.orders@safeguardproperties.com if in fact you have a process in which we are not
yet aware of. Otherwise, please consider this notice as a formal de-registration of the
property on behalf of the client mentioned above.
If you have any questions or concerns, please feel free to contact us, directly.
Sincerely,
Safeguard Properties, LLC.
Phone: 877-340-0060
www.safeguardproperties.com
"Customer Service =Resolution"
Safeguarding our clients' interests.
Safeguard Pro sorving today.
Properties Protecting tomorrow. '
f
www.safeguardproperties.com
Barnstable Ordinance 224 Page 1 of 2
Mckechnie, Robert
From: Rochella Overbey [Rochella.Overbey@safeguardproperties.com]
Sent: Wednesday, November 05, 2014 10:30 AM
To: Mckechnie, Robert
Subject: RE: Barnstable Ordinance 224
Good Morning,
Thank you for responding to my call yesterday. I would like to confirm a few things with your bond program to
ensure our compliance and allow our clients to better understand what to expect.
Bond Filing:
Bond Amount: $10,000
Administrative Fee:
Registration Requirements for bond: properties in foreclosure; properties upon notice that are vacant
Property Types required: Condo, Townhome, Mobile Home, Single and Multi family Homes—
residential (Are vacant lots required to have bonds?)
Bond Release:
Required information for bond release: New owner Contact information
How to file for bond release:
Contact for Bond release check#/date/amount from City:
Expected return of Bond from filing of Bond release letter/form/email:
Could you please attach or direct us to the forms required for both filing the initial bond registration and
the bond release?
We currently have on file only one property which has had a bond filled with the city of Barnstable: 7
Van Gogh Drive, Osterville, MA 02655.
Bond chk#: 5928550
Date: 12/19/2013
Amount: $10,000
We no longer however have the form this bond had been filed with and could not locate it again on the
city's website.
Currently on file our records do not show what criteria must be met for the bond, only the two types of
registration, those based on foreclosure, and those based on city notice for vacancy.
Thank you very much for all your help and clarification,
Rochella Overbey
VPR Coordinator
Safeguard Properties
Office: 800.852.8306 Ext: 3600
8100 Tyler Blvd. Suite 100
Mentor, OH 44060
Seat Location: Men-Q 9
rochella.overbey@safeguardproperties.com
11/5/2014
Barnstable Ordinance 224 Page 2 of 2
www.safeguardproperties.com
Customer Service = Resolution°
Safeguarding our clients' interests.
From: Mckechnie, Robert [mailto:Robert.McKechnie@town.barnstable.ma.us]
Sent: Wednesday, November 05, 2014 8:54 AM
To: Rochella Overbey
Subject: Barnstable Ordinance 224
Hi Rochella,
This is the email address that you can use for correspondence regarding this Ordinance. It is also available on
the Town of Barnstable website for viewing and download. When corresponding please reference the property
address.
Thank you,
Robert McKechnie
Local Inspector
Building Department
Town of Barnstable
200 Main Street
Hyannis, MA 02601
508-862-4033
PRIVILEGE & CONFIDENTIALITY NOTICE: This e-mail and any attachments or links contained
herein may contain information that is privileged, confidential, or proprietary. Any review, disclosure,
copying, distribution, or use of the contents of this e-mail or any attachments is strictly prohibited. If you
are not the intended recipient, or received this in error, please delete it immediately and contact the
sender. Thank you.
i
11/5/2014
I
Me �?ARNr-T,�;�+E
� � Town of Barnstab��'7�. N OF
C', Regulatory Service$013 DEC 26 PM 12: 57
anal AS& e t Richard V.Scali,Interim Director
39. Building Division
Tom Perry,Building Commissio
200 Main Street,Hyannis,MA 02 6 ',
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Section 1—Vacant/Foreclosed Proyerty Information Rezistration
Single Family l Two family ❑ Multi-family ❑ Condo ❑
Year Built Occupied: ❑Yes /'KNo Foreclosure: ❑ Yes ❑ No
Date of last Inspection:/�A113
Section 2 — Bank/Ownership Information
Company: C
Contact:
First Last
'tre t Ulty State 1p
'f 13- - /3 -2 ' .a's _ )-Doc. C'Dm
12 Telephone Email
Section 3 —Management Information
Agent:
First 2 y Last
Telephone Email
❑ Cash/surety bond of not less than$10,000 has been posted.
�/ ❑ By checking here I acknowledge that the information provided is
i� accurate and correct. I also understand that any inaccurate
f/ \ =fo
tion will result in noncompliancewith Barnstabl or finances.
�
Signature &TitleJ Wre
i 06
c
Q:FORM&OWNERPERMISSPOOLS 10/13
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LL� RPS811 PR ULTRASEALO by Relyco www.relyco.com -I
ir --- ----- ------ ------ ------ -- - -- ---- -- - --- ---- -- ---------- ---------d-----
TOWN OF BARNSTABLE December 19, 2013 5928550
I �J 'Document No: Date Description Net Amount ; d�
1139369455-01 12/19/13 Vacant Property Registration 10,000.00 !
Total 10,000.00
I .
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b Safeguard Properties Management LLC JPMorgan Chase Bank, N.A. 5928550
Columbus, ; m
s `OW, 56-1544/441
7887 $3feg6adsCtrcle < M
' Valley Vlew, Q'H 44125 c t £ I •
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I 216 739 2900 0v D_ecember 19, 2013 $10,000.00 c
Safeguard Y � E X I r
i PROPFRTI ;S a nks,` { ' D
TEN\THQUSAND DOLLARS AND 0/100 _ { I m
I D
To TheMT_,.,.,.
OWN;OF BARNSTABLE .r, ; c
�4�.Order,pf l q�' 200;MAIN STREET r
I p
I , HYANNIS, Mi42601
CUTCHK c a3 , r � ;f, i °`,
' x Authorized Signature
._C�e4k$mUsf be cashed within 130 days of check date MR�
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11' S9 285S01111' 1:044 L L54431: 9866 L94 2Tin 3
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'See Reverse Side For Easy Opening Instructions'
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5928550 I
CUTCHK
7887 Safeguard Circle !
%- Valley View, OH 44125
216 739 2900
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Return Service Requested
TOWN OF BARNSTABLE
200 MAIN STREET
HYANNIS, MA 2601
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map S Parcel ' :Application#
Health Division Date Issued' a-
Conservation Division Application Fee
Tax Collector Permit Fee �s
Treasurer
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address I(� V kL" lwuSk
c�
Village _Q 4& &(\�c
Owner fi°L< 'Cti �0d;%Press-
Telephone
Permit Request V eS(-&<r_ S�;c 'mow,,(,t e - f.,kV%,4e-Vn �'J-a��,o�,,•• -s
i
Can LO&L Vl 't k ok w-„t b <
Square feet: 1st floor:existing proposed 2nd floor:existing V\V� proposed Total new 4
Zoning District Flood Plain Groundwater Overlay
Project Valuation �>`-;'O 0 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 C"No On Old King's Highway: ❑Yes ❑No
Basement Type: dFull ❑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: 6/Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes t/No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size Pool:0 existing ❑new size Barn:❑existi g ❑new size
Attached garage:❑existing ❑new size Shed:g(existing ❑new size Other: =
w �
Zoning Board of AppealZAth ization ❑ Appeal# Recorded❑ NCommercial ❑YesIf yes, site plan review#
Current Use 1'h wr l Nf Proposed Use
BUILDER INFORMATION
Name aliy`�S \'� Vy l \�P l� Telephone Number ?` -l
Address License# n�1y�T
Home Improvement Contractor#
Worker's Com ensation# tip\'bl�r��
ALL,CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO UtM�
LSIGNATURE= DATE / 6
z�
\ r t•
r
FOR OFFICIAL USE ONLY
APPLICATION-#
DATE ISSUED
MAP/PARCEL NO. _
ADDRESS VILLAGE
OWNER __
DATE OF INSPECTION:
FOUNDATION
4 FRAME
r; INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
'
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
no
r FINAL BUILDING
DATE CLOSED'OUT
ASSOCIATION PLAN NO.
y,
,per The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
rt d 600 Washington Street
Boston,MA 02111'
www.mass,gov/dia '
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information .Please Print Legibly
Name(Business/Organization/lndividual): g� �i�!? �7 491
Address
city/state/zip-0 Phone.#:� ? 230ZC
Are you an employer?Check the appropriate bog: :Type of project(required):.
1.❑ I am a employer with 4. 0 I am a general contractor and I 6. ❑New construction .
employees (full and/or part-time).*• have hired the s'ub-contractors
listed on the'attached sheeC 7. [1 Remodeling
2. I ama'sole proprietor or partner- These sub-contractors have
ship and have no employees These ❑Demolition'
employees and have workers
working forme in any capacity. 9. 0 Building addition
comp,insurance.
[No workeze comp.insurance 10.❑Electrical repairs or additions
5. [] We are a corporation and its
q ]
3.❑ I am homeowner doing all work . officers have exercised their 11.❑Plumbing repairs or additions
myself.[No workers'comp. right bf exemption per MGL 12.❑Roof repairs
insurance.requited.]t c. 15i, §1(4),and_we have no 13 Other '
employees.[No workers'
comp,insurance required]
*My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating'such.
Contractors that check this box mutt attached an additional sheet showing the name of the Bub-contractors and state whether ornot those entities have
employees. If the sub-contractors have employees,they must providb their workers'comp.policy number.
I am an employer that is provlding workers'compensation Insurance far my employees. Below is.the policy and job site'
information.
Insurance Company•Na!me:
Policy#or Self-ins.Lic.#: Expiration Date: -
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date).
Failure•to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine 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 CIA for insuran a covers a verification.
I'do hereby cer fy under the pains•alid penalties of perjury that the information provided above,Is true a;dcorrecl
Date: �.
Si ma e •
#:Phon
Official use only. Do not write in.this area, tb be completed by.city or town offcciaG
City or Town: ' Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector
JAM-10-2008 THU 04:55 PM PREMIERE ASSET SERVICES FAX NO. 3018468487 P. 01/01
Town of Barutable
L !
MAW ltegaLa ry Services
is T'mum jr Gala,Dlreatnr
Building Division
Tbmsts pent',CW
euudiog Camm�ipner I
2W M*Sftd, Ryaet ik MA 0=1
- wwoableuosas
Offices 108-9624028 Fax: 508-79"230 i
Property,Owner Must
Complete and Sigh This Section
If TJsing A Builder
as_Ow,ner-of-dw subject property
hereby authorize ._�(jLYytsL.S i\ to act on w behalf,
in all matters reladve to Wcdc authozivcd by this bu&ft per apPHadc=foot
-:17 -\JdAL C)7C)Q 1-) .� ()5
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ReWS0091307
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BOARD OF BUILDING REGULATIONS
i License:'CONSTRUCTION.SUPE 06R C
Number CS 009494 `4
;
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` 'Blrthdate�-06/��' r�
ExpFI-es 1 0A6/Y1!8/2008 Tr no._3592 0 '
,�?`
Re'fricted -00 0
• JAMESrJ
`F MILLER — = }
i 26 BUZZARDS BAY�QR•.
i PLYMOUTH, .MA 02360 // 1
1 Commissioner
4.
7 �ommzar^�eue a�.
Board of Building Regulations and Standards
License or registration valid for individul i
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found returt
Re istrat o' Board of Building Regulations and Standa
9 .-_..���158531 g g
Ezpiratiori2%4/2010 Trt1 263994 One Ashburton Place Rm 1301
e BA/r Boston,Ma.02108
J f YpeO
_
COMPLETE HOME REPAIRS
JAMES MILLER _ / /
26 BUZZARDS BAYNDRI % '
PLYMOUTH,MA 02360 `- Administrator Not valid)Y t1foWsignature
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Page i of 2
Perry, Tom
From: Ann Quinlin [annquinlin@yahoo.com]
Sent: Monday, February 11, 2008 9:55 PM
To: Perry, Tom
Subject: wd: #112r706903'0 T Van Gogh Dr Ostervlle/ 'asement,MQd'ificati,on o
Hi Tom:
This is my last bank owned property with a basement issue.'
The contractor, Jim Miller will be in on Tuesday to apply for a permit. Can you help with this so there is
not a long delay. Also, will this email (see below) from the asset manager suffice? - along with a faxed
copy of the signed form you require (which Jim will be bringing with him). This was delayed because
Jim needed the HIC certification - he now has it!
We are trying to close this at the end oif the month, so anything you can do to help expedite the permit
would be greatly appreciated.
Thanks,
Ann
Ann Quinlin <annquinlin@yahoo.com>wrote:
Date: Mon, 11 Feb 2008 18:33:35 -0800 (PST)
From: Ann Quinlin<annquinlin@yahoo.com>
Subject: Fwd: #1127069030 7 Van Gogh Dr
To: annquinlin@yahoo.com
Craig.E.Knighl@wellsfargo.com wrote:
Subject: #1127069030 7 Van Gogh Dr
Date: Thu, 10 Jan 2008 15:39:41 -0600
From: <Craig.E.Knight@wellsfargo.com>
To: <annquinlin@remax.net>
CC: <Kellie.A.Bridges@wellsfargo.com>
Hi Ann Q. -
I have review the bids and city/state requirement and I will go ahead
and approve basement modifications. I'm approving the bid of
$3,485.00 from Jim Miller./ Duncan Lowe. Please proceed immediately.
I am faxing you back the signed form right now that you needed me to
okay.
Thanks,
Craig K.
PAS Asset Mgr.
Craig Knight
REO Asset Recovery Manager
2/12/2008
}A ti Page 2 of 2
Premiere Asset Services
8400 Stagecoach Circle
Frederick,MD 217014747
MAC X3800-03C
Phone:1-240-586-7083
Efax: 1-866-859-0455
Email: craig.e.knight®wellsfargo.com
Website:http: www. asreo.com
Website: https://portal.12asreo.com
This message may contain confidential and/or restricted information.If you are not the addressee or authorized to receive this
for the addressee,you must not use,copy,disclose,or take any action based on this message or any information herein.This
information should only be forwarded or distributed on a"need to know basis".If you have received this message in error,
please advise the sender immediately by reply e-mail and delete this message.Thank you for your cooperation.
E-mail is not a secure transmission medium and should not be used to communicate confidential information.If you elect to
send or receive information via e-mail,Wells Fargo cannot assure its security and will not be liable if it is intercepted or viewed
by another party.
Ann Quinlin
RE/MAX Classic
167 Lovell's Lane
Marstons Mills, MA 02648
508-776-4486 Cell
866-770-8361Fax
www.realestatecape.com
Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.
Ann Quinlin
ZE/MAX Classic
167 Lovell's Lane
Urstons Mills, MA 02648
508-776-4486 Cell
366-770-8361 Fax
mw.realestatecape.com
'.00king for last minute shopping deals? Find them fast with Yahoo! Search.
2/12/2008
n
r 25732
•��}}..��,,,, TOWN OF BARNSTABLE permit No. _.. _____
1 .fit s Building'Inspector '
�.a.n Cash% ___--
%•• :
OCCUPANCY PERMIT Bond
Issued to Greenbrier Corp.
Address
1 i.t- 40,4 k /,.7 7, VnnCnok rh--Rio flat crss� (n
Wiring Inspector �� Inspection date
Plumbing Inspector�� �� _ Inspection date
Gas Inspector ,1 I�n / * i ce Inspection dateZ 4-4 A4
,Engineering Department � �� Inspection date
,Board of Health y ?. 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
19 _... _..:_ v � ..
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CERTIFIED PLOT PLAN
�t>��� of R4Assq�y /-U.r- 4- /,� I/AJ 's-o ;y T�2•/
a R.OBERT GJ D S-IkkNEW CONSTRUCTION ONLY $ BR ---- -
TOP OF FOUNDATION IS- FEE l�" ELDREo - IN
3.
ABOVE LOW POINT OF ADJACENT
ROAD.
' •,... ,c, SCALES mo o ' DATE t /0112 fAF-3
�PRFC�✓BR E�
(ELDf� DGE ENGINEER/NQ CO.IIV I CERTIFY THAT THE �`''E�� "✓�
SHOWN ON THIS PLAN IS LOCATED
tEGISTE.RED REGISTERED g220 6 ON THE GROUND AS INDICATED AND
S
CIVIL I . LAND CONFORMS TO THE ZONING LAWS
JOB N0. ,,..�..:.._
l ENGINEER URVEYOR �R OP:,
OF' BARNSTABLE , MAS
CH.
BY!
712 MAIN STREET - --- &A ;
HYANRIS, MASS. SHEET::;L01' REG. LAND .SURVEYOR
V ,,�� � / 0 e SAL 91 193
A sessor's map and lot numberlG�C .....�...... ;/..6..-b ///��
'6
S�F 1d'6STI5iiAiV ST BE �Q,,oFTNE',o�o
Sewage Permit number 9.3n....19.5"........................ INSTALLED IN COMIQLIANC d
WITH TITLE 5
n `'
BJSd9TODLS, i
House number ... .. ... ... ..7.... t�........, F1lfa/IR®A4�tiEt�TAI CO '" _- "6 a
....... 'OD + 39. \0�
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ..................................: ....Q. ........ ..............................................
TYPE OF CONSTRUCTION ................................................h. .Q, ..G.......FloT.. '................................
....................r/.�................,9 p
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit[aaccording to the following iinformation:: / �\
Location ................................ ..0 ...... 1 ... .7 1/ � �? . .l!� �� f.`....�.............
ProposedUse (.: �.................................................... .... .........f7 ......
Zoning District .......................��... .............................Fire District ................................
....�...............
O
.............................
�u
Name of Owner ............... - .. l.`.�: 1........ eddress ......................... ......6
Nameof Builder ....................................................................Address ....................................................................................
Nameof Architect ...................................................................Address ....................... ................. ....................................
�� r
Number of Rooms ...................4...........................................Foundation ................................... ........ -. d.lil/r
.. ..................
Exterior � .(.......... ? ......L.2...............Roofing ......................
Floors .................... �..�..?.........t..... 1. ........Interior ........................ .....
Heating ............................... ..................................Plumbing ................................................... ..�.5 ...............
Fireplace ..................................................................................Ap oximate Cost .................... i... .., ..U...0........
Definitive Plan Approved by Planning Board --------- Area ........ .....� .................
Diagram of Lot and Building with Dimensions `� '� �{ Fee 61
SUBJECT TO APPROVAL OF BOA D OF HEALTH /l /o CA f
C
l
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnst I ardin Vabove
construction.
Name .......... ... .................
Construction Supervisor's License .......C).f .
REENBRIER CORP.
160 0 r7?-
25732
w"O. ............. Permit for A32 §:t.Q.-.. rY.............
'N
.......Single...Fa.mily...p3ge.11.ing..............
.. .... .. . .. ..... .... ..
Location ...GQgh Dr.
Os,terville
...............................................................................
Owner ..GreenbrierC.Qrp........................
.............................
Type of Construction .......F-r C-Ullp............1..........
................................................................................
Plot ..... ...................... Lot ................................
Permit Granted ..,.....November .4......19 83
....................... ..
Date of Inspection ....................................19
Date Cornpletecll;*:A;:�--,S� .........9
f i
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53.6
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/ ; 321 S P No.10951
0
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LEGEND CERTIFIED PLOT PLAN
EXISTING SPOT ELEVATION 0„0
EXISTING CONTOUR --- O --- ��tH uF M�ss� L v;z HV y7. A1r ,:aN raoc,�/ �2��t
FINISHED SPOT ELEVATION ® .��' ROBE °yam ss0 ���E lam'
FINISHED CONTOUR 0 a� e UCE OS TG/ZV/G�
o ELDRED ^ IN
APPROVED BOARD OF HEALTH i �TE 9Ai3hS fA J bLA`�:�•
Np �
DATE AGENT sub SCALEF DATE , 8-z9-63 .
LOREDGE ENGINEERING CQ No CLIE�NT i CERTIFY THAT THE PROPOSED
EGISTERE REGISTERED JOB NO..Z.Z (� � BUILDING SHOWN ON THIS PLAN
CIVIL LAND CONFORMS TO THE ZONING --LAWS
EN_OINEER OR.BY� 'rho OF BARNSTA8L E i MASS.
71.2 MAIN STREET CH-BYE � 2
1-I YA N N 1 S� M A-S S':- SHEET_ OF DATE
GREv,--LA' 'p--S-uRVEYOR
O
��•T
Assessors map and lot number�.&.......,......... ...............
.�"
Sewage Permit number ....... .... .... .........................
•
House number Q��. BARNSTABLE, J
rt! ............................�.......... v rasa
Op 039.
q.
•, � �EYPYp"
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ...................................� �. ..1�...........
/.� /J
TYPE OF CONSTRUCTION ...........................................................U......:�!. c.....................................
................... J..,!..................19 ..
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies forma permit according to the following information:
Location .............................. . .. ..r......................Clf...y2...................
� /:�. .... / .............................................
' ../ (J�.............
ProposedUse ...........................................................�..�.T....... !�........ �........ .......,......................... J' .. ..
Zoning District ........................ �............................Fire District ......................�....... o
Name of Owner ...............5,,!�/l�=. .�'�... .�` ?... U�'ddress ......................... 61...................... .... `/ ..... {.
r--
Nameof Builder ....................................................................Address ....................................................................................
Nameof Architect ..................................................................Address .......................... .........................................................
o -� .� r
Numberof Rooms .....................!............................................Foundation ..........................................................................�-
I 5 /!
Exterior . " 1.................Roofing �7l
lit/,�„ "T,��/ !, � ,/�.
Floors ..................... .: ... .. ! lam. l Interior .. S`� �/.r� C
r^
Heating ...............................�tl /.............Plumbing ).................
_ ................... .................................................................
Fireplace ..................................................................................Ap roximate. Cost ................... ..S �..��..(1........
�.......
Definitive Plan Approved by Planning Board ____________ K,________19_a� Area .......... ......................
Diagram of Lot and Building with Dimensions Z y Fee
SUBJECT TO APPROVAL OF BOA D OF HEALTH (( G C
` 4
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform -to all the Rules and Regulations of fhe-Town of Barnstable regarding the above
construction. ) � �
Name ........ . �. ...................................// ..........
vr f/
Construction Supervisor's License ......!%. )...�. ...�C
GREENBRIER CORP.
25732 lh Story
No ................. Permit for ....................................
Single Family Dwelling
...............................................................................
Location ..Lots 44, & 47, 7 Van Gogh Dr.
............................................................
Osterville
..................................................................... ..........
Owner ....Gr.ee.n.bri.er....Corp. ............................ .... .. .... .. .... .... .....
Type of Construction .,,,Frame............................ .. .......
................................................................................
Plot ............................ Lot..................................
Permit Granted ..:..November...4, 19 83
.. ............ .. ..
Date of Inspection ....................................119
Date Completed .......................................19