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0025 WATERFIELD ROAD
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D o �.. � .. � �o ., � a � - I�, a �(i° �� � n ,�,�C ��� r ,I P a a ago I � .. � ,.rl � .. o �a �. p� mow' � ,.+� � � �1..,„.5 5 c+ � � n"� .A'y'^,� A,�;:-..�_ K..•,...,.;-r;�:.+�' >T"^'�,rt ,.�{�", �.:"„�.s,n. .sue-_lk^t"�±ti"w.�`-.���.-_-�T.^.�'"►'f^-?�'...t�;.�.,,,,.,r�w,,.x.-, .dM.�- o Example Blank Form Duct Leakage Test-Form Customer Information: Test Conditions: Name: l Date: Address: 'f Time: �, City' CY.t ---- Indoor Temperature(F):. -1 S" State/Zip: Outdoor Temperature(F): Phone: J5 2$O- Floor Area(ft''): b S(o Email: System Airflow(cfm): Cooling Size(tons): Building Address: (if different from above) Heating Size(btu): I '16 Street: Primary Location of Supply Ductwork: .G City/State: Primary Location of Return Ductwork:. a;Qi-c, Comments: kw ci- - D (.N . tA Yqpc Total Leakage�T�es/t Depress Press Outside Leakage Test Depress Press Test Pressure: (Pa) Test Pressure: (Pa) Baseline Duct Pressure(optional): *(Pa) Duct Flow Ring Fan Press Flow Duct low Ring Fan Pr s Flow Press. Pa Installed Pa cfm Press. a In ailed (cfm) vZ- Fan ModeUSN: Results: i Outside Leaka/fm):Fan ModeUSN: Outside Leaka Results: System Airflow: Outside Leakage as% Total Leakage(cfm): Floor Area: Total Leakage as% System Airflow: Total Leakage as% Floor Area: 89 r- S 1 U�� �5 . � ,,, _ � 1 / TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map v Parcel /0 "Application # ze7/ Health Division Date Issued 8 Conservation Division Application Fee Q Planning Dept. =Permit Fee Date Definitive Plan Approved by Planning Board ok hs l Historic - OKH Preservation/ Hyannis Project Street Address Village Owner F A f-C .rA G�D/1 /I Address��� 564 v41-i-xrr e S� Telephone f ? 21 —3 � 7 —6 7 5 �3 f Permit Request /1 e.i''r a d t✓116 Gt- I &3 k ro 611 ' -J 7 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay �0 C, `-? Project Valuation 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 wo d/coal stove: ❑-Yes ❑ No 'Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: O'existing newD size_ t- — e Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:'_ - - I - Ln Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# v�i M Current Use Proposed Use APPLICANT INFORMATION ` (BUILDER OR HOMEOWNER) Name FALio-r-A C1611IN/1 Telephone Number Address Ll 2 S �L1M i License # ct o n. /M o V 7 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE rd DATE Fe-�Waj-'Y O . �l , i 7. g 5 FOR OFFICIAL USE ONLY APPLICATION# ` DATE ISSUE_D r - MAP-/PARCEL NO. 1 ADDRESS VILLAGE r OWNER S ' 3 L s DATE OF INSPECTION: - FOUNDATION 7 FRAME 4111ill On Y/2Z/lj s INSULATION.;. FIREPLACE t ELECTRICAL: ROUGH FINAL m PLUMBING: ROUGH FINAL i' GAS::-; a ROUGH FINAL t _FJNAL_BUILDING<.., - I;7hj . ; f - a DATE CLOSED OUT �. ASSOCIATIONS PLAN NO. . z . P I The Commonwealth of Massachusetts Department of Indtfstrial Accidents t s�' Office of lnvestiga6017s 600 Washington Street " Boston, MA 02111 ri www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A1plicant Information f- Please Print LetribIy �Ckrc c ro 148T1e (Business/Organization/Individual): � I LJ �r J 3 5�Ll tyl ryl P C it]/State/Zip: Lf-o>7 /�1 4 ' 0 12)z Phone #: 8 ( —3 7�7_6 Are iou an employer?Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction Imployees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7. ❑ Remodeling hip and have.no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity, workers' comp. insurance. 9. ❑ Building addition No workers' comp.insurance 5. '❑ We are a corporation and its �quired.] officers have exercised their ]0.❑Electrical repairs or additions 3. Iam a homeowner doing all work right of exemption per MGL 1 LEI Plumbing repairs or additions myself [No workers' comp. c. 152, §](4), and we have no 12,❑Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑Other 'Any appIiant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowiers who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContracton that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 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: 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 VOL 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. 1 do hereby certi c der the pains ,d' nalties of perjury that the information provided above is true and correct Si nature: Date: �J U�� Phone #: F at use only. Do not write in this area, to be completed by city or town official.r Town: Permit/License# Authority(circle one): d of Health 2. Building Department 3. City/Town Clerk 4, Electrical Inspector 5. Plumbing Inspector r Pierson: Phone#: Information and Instructions ) Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. lursuant to this statute, an employee is defined as "...every person-in the service of another under any contract of hire, txpress or implied, oral or written." i 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 nceiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the awner 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-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 required 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 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 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 Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MAS.SAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia Town of Barnstable ' Epp THE Tp�y - ���� o Regulatory Services BARNSTABLE, Thomas F. Geiler, Director Y MASS. �b 1639• Building Division P�rD rya Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 v,wiv.to A,n.b2rnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: �e (/�Cl..� JOB LOCATION: o� J a f L° r �/,e l(/1 X © � / j��/I' number I /1 street 2 village Z „HOMEOWNER": �;-f/�W ftil"Ol_-I�CO��fI ll -/O 5 name t home phone# work phone# CURRENT MAILING ADDRESS: 1 Y kJ�l Y'LA e-r fib ILI Di ?Za 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 i spection pr ced s a .requirements and that he/she will comply with said procedures and require ts. Signature of Homeowner 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. of Jr-HE r � Town of Barnstable Regulatory Services + M.WSTABLE, ,ASS, Thomas Thomas F.Geiler,Director cbp 1639• 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 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 the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION i a� 60(o d �oFrttrtow Town of Barnstable 'P.ermit# ti �' � 1:.rp/ mm�l/ nr issue r/nle tt t Regulatory Services re •a r. ��sr ate, Thomas F. Geiler, Director �ATFI/AA't a e�N tl Zpl; qg Building Division 11I nI�c I`OWN OF Tom Perry, CBO, Building COmmissioner ABLE200 Plain Street, Hyannis, MA 02601 www.town,barnstable.ma.us 0 M c e: 508-862-403 8 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Fax: 508-790-6230 /V01 Vniid wilkorrl Red X-Prer,r Imprint Map/parcel Number ���r _1,2 06 3 Property Address ❑ Residential Value of-Work l(b Minitnum fee ofS35.00 for work under$6000.00 Owner's Nam e & Address &rL___2_ C r 0 y�— Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable)_ ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp, Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request (check box) ❑ Re-roof(hurricane nailed) (stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side 3 #of doors Replacement Windows/doors/sliders. U-Value (maximum .35) #of windows s *Where required: Issuance orthis permit does not exempt compliance wilt other town department regulations,i.e. Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improve; ent Contractors License & Construction Supervisors License is j "required. L / 3IGNATURE: ):IWPT-n rcirnj?MR1h11i1dinP ne..rmii rnnnclry Drcc a-- The Covi-inivirwea.11h ofMassachusells f Z Department of Industrial-Accidents Office of In vestigalions 600 WashinglonSIreel k Boslon r L4 0211-1 I VIVI JP.RMSS.go w'dia Ccimpensation Insurance_Affidat•it: Buildel-.s/Conti--,icto]-S/E(IL-c-tiic-l..iusMiunbei-s Applicant Informa d on Please hint Legibly Name (B-Lisine&V)DrgaiizEiboijlln&vidtial). C r- ci Address:— 5 2 (3 city/State/Zip: Phone-4-:_ Z8 - Are you Tin emplqyer?Check the zrppropriate box: Type orproject(required): L.El I am a arnployer with 4. 1 am a general contractor and I employees(full and/orpart-4ime).* Yha-ve hu',ed.the s-rib-contractors 6- [:].New construction I❑ I am a sole proprietor orpartnef- listed on.the attached sheet. 7. E].Remodeling Ship and have no employees These nib-contractors have S. E]Demolition working :forme in any capacity. employees and have warkers' !(No i�orkers' cckmp.insurance comp-insurance.1 9.. E].Buildrag addition I,je,uirod construction air required.] 5. We are-a corporation.and.1ts 1O.EjElectrical repairs oraddibions Jon, 3.❑ 1 am a.homeowner doing-all work afficexs have exercised their ILEI-Plumbing repairs or additions myself. [No workers'comp, right of exemption per tiTGL 12.0 Roof repairs insurmicerequffed.] l c. 152,§1(4)., and we have no employees. [No workers' 110Other *Any applicant that check'box#].must also fill out the sK(ion below,0oving their workers'Coropeuse.tionpoli.cyinfon=tiorL T Homeowners who submit this.a-midavit indicating they are doing all-work and then hire outside contractors trust submit a 7jew affidavit indicating stick. 'Contraciors that check this box must attached an addidonils:hvei showing the olMe Of the SUb-CMtMC1nT5 3DA state whether at-not those eatities-have employees. Ifthe sub-contr.actors.'bsve einployLes,lhey.must provide their workers'comp.policy number. I wit an employer that is pro vidbelff 1VOYkerS CO 7)'1PV1Tah`G1i ins-n-ran.ce for tqy e utplayeas. ffelo tr is di e po'lic dj b an 0 site it!forffiatioit. Insurance Company Name: Policy#of Self-Ills-Lic.-9: Expirntion.Date.- Job Site Address: city/Statla/zip, Attach a copy offhe workers' compensation policy deciaratioa page(showing the policy number and expiration Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead-to the imposition of criminal pemil.ties of fine up to S1,500.00 and/or one-year imprisann ent,as well as cittil penalties in the form of STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a cop),of this state-mentruay be-forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerdfv 1.4rder the jo�j'its an, ,%- ialfies ofpoijury Mat the it.rfortttaho-.jipri7iidad.abol,f?is traq and correct Sig mat ure _1_1 Dale.- 7" Phone M ?L F60t1Official ffic-l" - 11"'To fficial use only. Do not tirite M this area,to be coniplWed by city or toli'll ofj-lciaL Cat}-or To)).,n: Permit/License# To")IssuingAntilwity(ch-cle,one): T'-"j'g 'fj 1.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector S.Plumbing Inspector I otilel, i Other Contact act PI, Contact Person: Pli one M The Commonwealth of Massachusetts i Department of Industrial Accidents 'i Office of Investigations 1 t 600 Washington Street S Boston, MA 02111 `c www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information J Please Print Legibl �(/C y Name (Business/Organization/Individual): / �j,i2 E, Ll er Address: o � Aea5gn4- MVP City/State/Zip: t11V M?:�j. Phone #: 52)0 D97 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 6. ❑New construction pployees(full and/or part-time).* have hired the sub-contractors 2.LVII am a sole proprietor or partner- listed on the attached sheet, x 7• [] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity, workers' comp, insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑.We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §](4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers'. 13. Other , ct:s comp, insurance required.] *Any applicant that checks box#I 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. tContradtors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 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: 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 certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: w ) 1 Phone#: �"OJ—(111BORe)0D2 rt Official use only. Do not write in this area,to be completed by city or town ofjciaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: 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-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 required 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 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 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 Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 0211.1 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia of THE Tp� Y 1 i ' + BARNSTA6LE, + "`"SS. Town of Barnstable prFD MAC a Regulatory Services Thomas F. Geiler, Director Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property ®wner.Mu t Complete and Sign This Section If Using A Build r i as Owner subject property hereby authorize to act my behalf, in all matters relative to work authorized by this btulding per it application for: (Address of Job) .` I . Signature of Owner Date Print Name Tf Property Owner is applying for permit, please complete the Homeowners.License Exemption Forme on the reverse'side. QAWPFILESIFORMSIboilding permit formslEXPRESS.doc e . ��ol► rq�y Town of Barnstable Regulatory Services » M » $,q�sTABLX, .V_ IASS. » Thomas F. Geiler, Director $ ` 6-'9. A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 5l8-862-4038 Fax: 508-790-6230 -----------------------_---_ 140MEOWNER LICENSE EXEMPTION Please Print DATE: `"I U y e/A,�e - d o l l JOB LOCH"rION: a5-tj6 pi- T ,c I� K V / .� ✓y number street village ,,I-IoMEOWNER" Lj6, �rdnl�n )8 /3 67_�758 97� �73 /0 i 7 name l ? s home phone N work phone N CURRENT MAILNG ADDRESS: / `/J / ✓11 /t'l t I` 5-1— c-/b/-? ;m .4 .?,2 o 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 awns 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-yearperiod 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 tinder 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 undersi ned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedure nd requirement and tha he/ will comply with said procedures and requirements. Sig at i e o Homeowner 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. HOMEOWNERS EXEMPTION 1-he 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.) -Licensing ofconsrruction 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,thal 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 I amend and adopt such a form/certification for use in your community. �• Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc t ; °FJHE r�� Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee er ;3 BARNSrABLE, ' v MAss. Thomas F. Geiler,Director 039• TfD MA'1 a < Building Division _I Tom Perry, CBO, Building Commissioner g��N10� . 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address �Y� //t/�r��7s! �J x b o re—K v)�i � i7 606 57S Residential Value of Work ^� ' Minimum fee of S25.00 for work under 36000.00 Owner's Name&Address b 1 20 Arl U Contractor's Name 4�e_k /0-F k ZCL_ Telephone Number k 7 7 9 /! r Home Improvement Contractor License#(if applicable) / U 2 y S Construction Supervisor's License# (if applicable) D 9 a ❑Workman's Compensation Insurance -PRESS PERMIT Check one: ❑ I am a sole proprietor AUG s, 2 2010 ❑ I am the Homeowner �I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# ( P�T V 4 1) 3 V a `,5 Z8- Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to S 7 e I S T� Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum .44)# of windows *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 required. SIGNATURE: The Commonwealth of Massachusetts Department of Industrial-Accidents d Office of Investigations a 600 Washington Street Boston, MA 02111 wivmmass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Y,e� Name (Business/OrganizatiorAndividual): /J�-E/✓ZIEF_L.► Address: �5 "��4-# w" City/State/Zip: �N7�C—✓L V I Ll A4 6 #: �G k 77 k- i/"I Ar you an employer? Check the appropriate box: Type of project(required): 4. I am a general contractor and I 1. I am a employer with � 6. ❑New constntction employees(full and/or part-time).* have hued the sub-contractors 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. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions _... . ..---.__m self,..[No workers.,-eo?(np,.....-_.._.._.........:._.. right of exemption per MGL p . y 12. Roof.re airs........... __. .... _.,._ insurance required.] t C. 152, §1(4), and we have no employees. [No workers' 13.0 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. tContractors 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. — t Insurance Company Name: Q S �p r/ 7 Policy# or Self-ins. Lic.M —3 )0 -1-0 ` , 0 d Expiration Date6-- Job Site Address: ✓ �� �� f City/State/Gip: J— Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration a e). 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.OQ 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 certify/u�n/der thepainsla,�ndfpen'alties ofperjury that the information provided abo a is t lie.and correct. signature: r ` [�_' W Date: �� �� Phone#: 5—G ?? /, 1/ Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other � 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 in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,NIGL 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 of_partners are not re hired to c workers com ensation insurance If an I i C of I:T;P 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 maybe 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 Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 wwtiv.mass.gov/dia 0FTNE Tp�y Town of Barnstable Regulatory Services &kRNSTAaLE, ' - Thomas F. Geiler,Director 9� 1639. A g Buildin Division QED µAI Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I p t , as Gamer of the subject property hereby authorize //!d- to act on my behalf, in all matters relative to work authorized by this building permit application f or: 5 uJ��.� ��� if 4�6 (Address of Job) 4S1jnaturZeo-1:3Cvwne D to Tint Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the.reverse side. Q:FOR1vIS:0 WN ERPERM IS S ION Town of Barnstable oFIKE T � o Regulatory Services 4 BARNSfABLE Thomas F. Creiler,Director ,' : ,�� Building Division AlED MAt p Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 wtiww.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street .village "HOMEOWNER": name home phone#! work phone fJ CURRENT MAILING ADDRESS: 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 requirements and that he/she will comply with said procedures and requirements. ' Signature of Homeowner 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 ofte 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:\WPFLLES\FORM S\homeexempt.DOC Massachusetts- Department of Public Safety p Board of BuildinI Re nilatiuns and Standards Construction Supervisor License License: CS 9055 Restricted to: 00 j MARK A WENZEL Valli, 94 45 WHIDAH WAY CENTERVILLE, MA 02632 �--G—�' ir` Expiration: 6/17/2012 Con till i<siollor Tr#: 26980 ' registration ✓l/liaeccc/aeaehb .License or valid for individul use only Ot7icc of Consumer Affairs&B sincss Regulationy l _F�)Z��L HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:Registration: ,. 100285 Type: Office of Consumer Affairs and Business Regulation //Expiration: 6/15/2012 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 FRAMING, INC.; Mark Wenzel �^ \�� 45 Whid \` ah Way / I Centerville,MA 02632 Undersecretary Not valid without signature -6A161u4% Ali-1 1/016ulu b:J4 :34 AM PAGE: 2/002 Fax Server ACORD. CERTIFICATE OF INSURANCE DATE(MMIDDIYY) 07-06-10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GOLDMAN&ASSOCIATES HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 4527 FALMOUTH ROAD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COTUIT,MA 02635 COMPANIES AFFORDING COVERAGE COMPANY 28HPP A TRAVELERS DIRECT ASSIGNMENT INSURED COMPANY WENZEL FRAMING INC B COMPANY 45 WHIDAH WAY C CENTERVIL LE,MA 02632 COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD WBIcATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TRtS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED By THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- CID POLICY EFF ' POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE O M MYY) DATE(MM1DD%yy) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGO. $ CLAIMS MADE OCCUR. PERSONAL 88 ADV.INJURY $ OWNER'S 88 CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Anyone fire) $ AUTOMOBILE LIABILITY MED.EXPENSE(Any one person) $ ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS BODILY INJURY(Per Accident) $ HIRED AUTOS NON-OWNED AUTO PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM _ AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UB-0731N449-10 07-11-10 07-11-11 STATUTORY LIMITS X THE PROPRIETOR/ EACH ACCIDENT $ 100,000 PARTNERS(EXECUTIVE X INCL DISEASE-POUCY LIMIT $ 500,000 OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $ 1001000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESJRESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTMCATE HOLDER AFFECTING WORKERS COMP COV ERAGS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION GORDON L IBBEY DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE 158 FOX HILL ROAD SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. CENTERVELLE•MA 02632 AUTHORIZED REPRESENTATIVE ACORD 25-5(3/93) Charles J Clark � T The Town of Barnstable Department of Health, Safety and Environmental Services Building Division t1��e� 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Regisaation Name: Ay w Phone!#• Address: �S wA 'f wf 1 t-L)) �b village: n V/LC_E Sc� )2Ez�'n D cAjG �vD 2 c K ►� (, v N Type of Business: IMI& OFF 1 C C (�1 U .�� I.ot: I I g " / 2 S - 0 0 5 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 dwelling,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 tight subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling tacit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • Tltere are no exrn teal alterations to the divellinTwhich are not customary in residential building,and there is no outside evidence of such use. • No traffic ivill be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular der.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. Home • Any need for parking generated by such use shall be met on the same lot containing the Custotaaty Occupation.and not within the required front Yard. • There n 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 pickup truck not to exceed one ton capacity,and one tr 1w 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 Oocupation who is not a permanent resident of the dwelling unic- I,the undersigned, and a with the o res ions for my home occupation I am registeriutg. Date. 7A'�/� 7 Appii� � r The Town of Barnstable Department of Health, Safety and Environmental Services 's „MMIC,UL& : Building Division 1 1%, 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: �� c9 . 11q 7 Name: _ 1 �/ (J Phone#• Address as e: C v s•ro Ay c offer rx'g 6E5 . lf,CT PIL")Avi�, IV,,0Fc onyx p Z 0D3 Type of Business: 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 tight 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 building,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 quanddes. • 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 from yard. • There is no exterior storage or display of materials or equipment. • There is no cornmerdal vehida 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 m 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. in the Customary Home Occupation who is not a permanent resident of the No person shall be employed dwelling unit. I,the undersigned, read and a with the above restrictions for my home occupation I am registering. Applicant • � F. L 1 P" tl. 15�I•I S WArSc -SSoA VJAT ep, rE LTD �cni C tt- �' c.r�z�t(=Y ���-1AT' Tr-1r✓ . ��ue�D��oa 5u��� ��.�1 R�>`�r�c`.tc.�. • t��Q E°ril..,� CcaNMt?L�lS Vl/1 T{-1 Tla� S1 D>< t_.t►-�� AWt> SeYLACK K'GaUtrZEMaWTy OP 'j0 4cl tJ G "BQEki"T A I... �l.A+� F-oe. l Mtn m As {A,&j aiw BAYT[ V- �;� t-IYr 1�•iG RCG(�; 1CI:i T> IJa1JG SU��ii=YotZS TµIS IPLAW IjS QC)T 1-5ASE:D CA-4 /\&J U ST[.f7-V1L_LC-• o 1•�;\" Eft: U��( tJ lu De i ti_�ltl►Jt_- /�. 1._L�T qV two GArzsn�.� GPI z 2aat�� Low t to x 3 = 33o G.pv. S rIc TAtilK = 330.. 150 % = 4-S 6.PD. USA- t 00C� 6A L.. r �1SPO�AL PIT - USE IOOp GAL.. .,UZWAL-L AZF-A = (SO S.P. IC�o SF ,c Z.S + :!^;77S G.P.D. O �� $aT-MAA .ZED,c E;o Sr--. SD Ts=. ,c t .o - 5o G.R D. O��b C tuoo GAL TOTAL �t6,16IJ = 425 G•p D• TOT&t_ �A t L.-( FLOW E,,PD. StTA►N N PMfZCDL&TIOQ QI&TE CIU 2-MIu, OfL Lam. Of 61,ck� WILLIAM R(]- No IS3,34 ' f TE ST Tar F'wo L d M Ov IaJv � e I oao Iuv Sut36uti. t AP& Iw. GAL. I / T-AWIC GAIN. .A _ 17 P+T Gi W1rLA I't WAS►ILM STOwl� • S �0� �.p• � p _ ►J CEQTtFIED PI.dT- P�zoi='�L_� �j S ill l.L�t�: I�d• C 40' b 'T cl T$4 A T TOG- PUP. D KIgW y S&AO J 1.) kV % /-1tr:QL°t5W WIT" T► i1: 5lVr=-U►•1E-- `...G� A�D�4CTL��CIC l~GgVI�EM�u�-y OF T► e R -Tow u or- 4A�e,►�S B t5. -cS -��` gh.XTCIZ �. 4.11E t►.1G_ 1 � RGGIS�tttLED LA1.lG 5U2V`Y�+2S l '[.4 .5 t7LA►4 IS UOT Z-Ae>GV Ot-4 AN OSTE�V1�.tL c� t�CASS. if r,C,bklc- i ��Ut,•/�-�( � TiaG (�F�i�t"�� SIIGWL� r ANPt_l <_A.ti.1T C�R'TNI.�lI,3C �.— I•k�r 1?�1= U%�11 r�:, t�r•TCCMi�1l-= 1�-'C' l_IN��..; -- °`;'•. TOWN OF BARNSTABLE Permit No. ----------_--------- Building Inspector � rua Cash --------------------- OO�OIIPY►� OCCUPANCY PERMIT Bond ----___-------—A1 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 Address Wiring Inspector 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 Assessor's map and lot number ....��.�..'...�.i�.!'.9:. K O� E`TO Q `'Sewage Permit number .6p.'.aclV..:..d�Ki..l SEPTIC SY46TIM W1 u ` House number ............................. INSTALLED IN �AS"BASSTa� LAv A D. _ 16}9. ♦� WITH TITLE 5 0'` r. TOWN OF BAR1� ,� C10NISj, BUILDING - INSPECTOR �i,}'+� APPLICATION FOR PERMIT TO ......45 (d4t.... TYPE OF CONSTRUCTION ...... G. Q.G........ ...............................................................................:..:.......... r'} ................i. ... ..............� TO THE INSPECTOR OF BUILDINGS: y t The undersigned hereby applies for a permit according to the following information: Location .......�Ci.�.�....#. ..... .. • X....... .../ ...(/.. ...................................... ProposedUse ....��! � i!ti.... ...... .......... .... ... .........................................................,.......... Zoning District .................................... .................................Fire District ... ... Name of Owner Nameof Builder ..... . ..... . ..S/....... ......Address .................................................................................:.. .Name of Architect ..................................................................Address .................................................................................... Numberof Rooms .............4................................................Foundation ..... . .................�......................... Exterior .....(iCD�'� .... .. ......Roofing .......% ................. .. . .................... Floors ....... ..... ;..Interior .....� !. ............................................ } O ye . Heating ........ Plumbing, ..:....:. . Fireplace .........,121." .-......................................................Approximate Cost .......4J. . . ......:..................................... Definitive Plan Approved by Planning Board __ �1!_b_1 L_____19 V�. ;Area ........ Diagram of Lot and Building with..Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTHQ , t 1k I hereby agree to conform to all the Rules and Regulations of the To o4BB.,arn ble regarding above construction. Name �.. ....................... I� _ f4ILKIE, CATHERINE B. °No ,.2.240.9.. Permit for ..Orne...1,/2.... toxy S inq le...Family..Dwe.l ling............... Location .Lot...#.3...25...WaterfieLd...Road \ ................Ostexv.i1.le.................................... Owner ...Catherine...B......Wilkie............. Type of Construction ...Fsame.......................... a ........ ............................. .................................. Plot ............................ Lot ................................ Permit Granted ...........August 5i 19 80 Date of Inspection ....... ?......19 Date Completed .... ...,?�O.... .-. .......19 1 ' P%MIT REFUSED } .......... .T. . .... ........................... 19 f . .................. ' ..... ..... ..... .................. A Jl- r .................. . ' Approved `............. ..... .......... 19 .. . .... .... ... ... .... y Assessor's map and lot ,nur*6e .d,,.. ...,1.`.`h.�..�.�!�. :.X: OFT E T0� N O. Sewage- Permit number Z 339HHSTADLE, i House number ......................: �:S", s MAS& �Oo 1639. \e00 1 'Ep MAY.a TOWN OF BARN•STABLE BUILDING INSPECTOR APPLICATION,FOR PERMIT TO ... �(.r h/ �.•fC!)GLr�/ 4w;-7. (......................tt1 C+� = ................... <� TYPE OF CONSTRUCTION ..... .• ... /.: ..... ,....... ................0................................................ ............�.......zr... ................19 TO THE INSPECTOR OF BUILDINGS: The undersigned /hereby applies for a permit according //to the following information: Location ...... ,/.� ....# �.....��.� �.'�kP �'.1.;' C. � .Proposed Use . .����%. �.. .J,/./;�;f.�+..�� ��(i�.�/4f'�.14;(iZ'r a ........................................................ ... p ............................. / .............. ZoningDistrict 4 "� �;7/J1t�ij l C.?`/J ?/,/o•t.0 Fire District ...... ......................: :......................::. Name of Owner ` /1/�� ,....� .:.... :' ! , lL�Address .... .... ! 'K....� '7.•„�/,CG�'7�%/G'Jl<Name of Builder .....�,���,•d ..,.f.../...<._..D.......�/>f...L (. .Ad dress ..........`.......................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ............ ..••..(..�C!i' +.................................................Foundation . . ..................................................................... Exierior .....(m-r. L1J�Z7q'C L( %�il/Y» :......Roofing .......1 ...................................� C .': ..................: S. ...........G. ... Floors ........: �... ....................................................Interior ...../�„�'t �.(mil/).�:�•:.�............................................ G . Heating ^ ��'.: /1,� f :..............................:.....Plumbing ......... ........... �.................... Fireplace .....................................................Approximate Cost q5 ...C.2-0 ............ ............ . ..... ..................... Definitive Plan Approved by Planning Board __J6� _ -----19 8L). .Area //U.q Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH ' r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. l ! Name . illVSK.' % � /!�.'�!...................... t ~ , VVILKZIC/ CA]�{IZ ]�.. J\=llO—l25 . . . . . . . ' l No ..� � 2,� 9.. Permit-for —--I/2 Permit-for .`--�tz r y .. . Family D�elIi —'����f����—..���—'^-----.��g----- � ----''on .� ��t_ 3_� ��5_VV�t����i�I'� Road --' '' ' ' --'� 'r-----'' _____.Oote�vilIe____________ . Ovvne, ....Catbezi��—B�—VVi.l}xi/�---- ` 'Type /Constructi Plot ' |� . '`"""' ` '=�" uora or Inspection Date Completed .l. A PERMIT REFUSED ----. ER ----. ' = � ---- ------------'—' — ------------.----. ^- . _ ` � . ' ' ..Approved --,------------- 19 --------------------------. ' -------`----------------~—' ' - I • i i ow J-7 9 p.,� 31 I r tJa���' SMOKE d t TORv. T REVIEWED L BUILDING DEPT. DATE FIRE DEPARTMENT DATE i BOTH SIGNATURES ARE REQUIRED FOR PERMITTING . . nI k 4r- _ 14K T4" ' too ilk _ �) elf ou YN f Ca���. IVY jo. 1 c-d{-eyi ��rQO7 ' A _ L n H L 5 �q 0,51(yi l�P x Pr jyS�C " /�/ti'� a-��i rlSUv►1 S � /�� �c • La C)V+ l o �� Th