HomeMy WebLinkAbout0010 CROCKER ROAD OxfordNO. 152 1/3 ORA
a
Town of Barnstable *Permit# SzE-
Expires 6 months rom issue date
Regulatory Services Fee
Thomas F.Geiler,Director
%ff nR spS PERMIT Building Division
Tom Perry,CBO, Building Commissioner
SEP • .200 200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Off �TP`�L-€ Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
ap/parcel Number
operty Address I O
a�
Residential Value of Work t4obo Minimum fee of$25.00 for work under$6000.00
avner's Name&Address G�� C'A=
)ntractor's Name Telephone Number
ome Improvement Contractor.License#(if applicable)
)nstruction Supervisor's License#(if applicable)
]Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
am the Homeowner
I`have Worker's Compensation Insurance
surance Company Name
'orkman's Comp.Policy#
opy of Insurance Compliance Certificate must be on file.
;rn it Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
�Re-side
Replacement Windows. U-Value (maximum.44)
'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
me Improvement Contractors License is required..
[GNATURE:
:Forms:expmtrg
;vise071405
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
Applicant Information Please Print Leidbly
Naine (Business/Organization/Individual):pbn�t\\4—
Address:
_ City/State/Zip: W- Phone
Are you an employer?Check the-appropriate box:. -Type of project(required):
1.❑ l am a•employer with 4. ❑ I am a general contractor and I 6..❑New contraction.
employees (fulland/or part-time).* have hired the sub-contractors
2.❑ I am.a.sole proprietor or partner-
listed�ou the attached sheet x ? Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me,in any capacity. workers' comp.insurance. g• [] Building addition
o workers' comp.insurance 5. ❑ We are a corporation and its
officers have exercised their 10.0 Electrical repairs or.additions
required.] 1'1.❑ Plumbing repairs or additions
3•�I am a homeowner doing all work . right of exemption per MGL _• g ep
myself'[No workers' comp. c. 152,§1(4),and we have no.'. 12.❑ Roof repairs
insurance r aired. t employees.[No workers'
required-3]. 13:❑ 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 an doing all work and then hire outside cofactors must submit a new affidavit indicating such
tContract m that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'eou p:;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 Dater
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 imprisomnent, as well as,civil penalties in the form of a STOP'WORK ORDER and a fm' e
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 certi nd r the pains and penalties of perjury that the information provided alcove is true and correct.
Signature: Date:. �—
Phone#:
Official use only. Do not write in this area,to be completed by city,or town official
City or Town: PermitUcense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6[Contact
Other
Person: Phone#:
formation and Instructions. ;
Massachusetts General Laws chapter 152 requires all employers workers'
ano�under any contractensation for their�of hire .
Pursuant to this statute, an employee is defined as ...every person in the service n
express or implied,dral or written."
An employer is defined aS•.:4 44,P
a-Mers ,association, �rporation or other legal entity,or nay two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the
arts , association or other legal entity, employing employees• HoRteYer.tbe-
receiver or trustee of an individual,PP
erein,or.the occupant of the
owner of a dwelling house having not more than three
o� t maintexianC� R construction O ho resides r rep
wo kvu such dwelling house
dwelling house of another who employs persons
ant thereto.shall not because of such employment be deemed to be an employer."
or on the grounds or building DPP
ce o
Xy
MGL chapter 152,§25 C(6)`also states that"every sas or to construct buildings flicensingagen n the commoall lnwtepith foar any r
Tell of a license or pew to operate a buss
applicant who'has not produced acceptable evidence�of compliance with the insurance coverage required."
ter 152, 25C states"Neither the commoirwealth nor any of its-political subdivisions shall
Additionally,MGL chap . § (�
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
along
lboxes��aPPlYeir �cate(sf situation��� ..
necessary,supply sub-contractors)name(s), addresses)and phone numb ( ) g
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than•the
or LLP does have
members or partners; are not required to carry workers' c amp ns be submitted to the Depoi insurance. If an Cartmen of Industrial
employees, a,policy is required. Be advised that this affidavit y
Accidents for confirmation of insurance coverage..application for the permit or licensenis being reqd date the uested, not the Deparimeat of should.davit. The affidavit
be returned to the city ar town that the
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 thefr
self-insurance license number on the appropriate lime.
City or Town Officials .
Please be sere that the affidavit is complete and printed legibly. The Department has provided a space at the bloom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
licant
Please be sure'to fill in the permittlicense number which will be used as a reference number. In addition, an app
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). PY"A co of the.affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof thax.a valid affidavit is-on.file for;future permitSS orlicenses..Anew affidavitmust be filled out-each
year.Where a home owner or citizen is obtaining a license or permit not r any business affidavit Ve°ture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT requiredcomplete
%ke to thank You in advance for your cooperation and should you have any questions,
The Office of Investigations would 1
please do not hesitate to give us a call.
The Department's address,telephone and.fax number:
The Commonwealth of Massachusetts .
- : Department of IndnstriaLAccidents
Office of Investigations
600-Washingfol •Street .
$oston,MA 02.111.-
' Tel. #617-7.27-4900 ext 406 or-1-877-MASSAFE
Fax#617-727-7749
Revised 5-26-05 www,mass.gov/dia
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Permit# o
Health Division3_6a�� XA CAzato Date ssued
/�- 6 a
Conservation Division
Tax Collector �- F � -7 7
pnS?ING7ke
C SYSTEM
Treasurer BEDROOMS
UMREDTO en BPlanning Dept. y
Date Definitive Plan Approved by Planning Board Approved By
Vistoric-OKH Preservation/Hyannis
Project St eet Address O cxc>U�Y
Village (Z 4&61
Owner P�.-�-r'� JC_ W01P))e6,, Address �y c roc kGr V,h
Telephone �7S3
Permit Request � �4.�ehl�v�' (,�J1a1�Vld�;�'�0 �/'1,L�lP �Ttl121
CA14 Dec k Via► II
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Valuation .. ��d v Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes *No On Old King's Highway; ;kYes_.T ❑ No;
Basement Type: 1ALFull ❑Crawl ❑Walkout ❑Other c
Basement Finished Area(sq.ft.) Y Basement Unfinished Area(sq.ft)
i
Number of Baths: Full: existing new Half: existing new,:, +�
�`Jjy ,
Number of Bedrooms:. existing 7 new
T �
Total Room Count(not including baths): existing S new First Floor Room Count
Heat Type and Fuel: XGas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes XNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes XNo
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing ❑new size Shed:&existing ❑new size Other:
�J
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes,site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name a:�il jc� 06'O pci Telephone Number
Address 10 cr6chgx a License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
d6� SIGNATURE DATE (3- — 6�
w
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
ADDRESS 'VILLAGE `-
- OWNER
r
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION _~
FIREPLACE o
ELECTRICAL: RONGA FINAL
-PLUMBING: RC GH FINAL
'GAS: ft0%GO FINAL
N m
FINAL.BUILDING.
Li i.
DATE CLOSED OUT
ASSOCIATION PLAN NO.
The Commonwealth of Massachusetts
Department of Industrial Accidents '
n. Office of Investigations- ' .
a a 600 Washington Street
Boston,MA 02111'
y`y www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plunabers
Applicant Information Please Print Legibly
Name (Business/Organization/lndividual)'
Address: 1 D GY'o
City/State/Zip: _ Phone
Are you an employer? Check the appropriate box:. Type of project(required):'
1.❑ I am a-employerwith 4. ❑ I am a general contractor and I
` ' 6. El New construction
employees (f a and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or parts er- listed on the attached sheet $ I ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
workingfor me in any'Cap aci workers' comp.insurance. g
p tY• ❑ Building addition
[No workers' comp.insurance 5. ❑ We area corporation and its
officers have exercised their 10.0 Electrical repairs or.additions
• required.] � . .
3.( I am a homeowner doigg all work right of exemption per MGL 11.❑ Plumbing repairs or additions
I elf.,0 worker'-co?irzp employees. [No workers'c. 152,§1(4), and we have no 12.❑ Roof repairs
im u ance ieguired]
- - 1.3. 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 anew affidavit indicating such
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'=mp:;policy information.
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 pen0ties 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 thus statement maybe forwarded to.the Office of .
Investigations of the DIA for insurance coverage verification.
I do hereby certi u 1 der the pains and penalties of perjury that the information provided above is true and correct:
sSi atnre Date:' ` 8
Phone#:
Official use only. Do not write in this area,to be completed by city.or town official,
City or Town: PermitlLicense#
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.
ter 152 r uires all employers to provide workers' compensation for their emp'loy'ees. ,
Massachusetts General Laws chap �l .
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.":.
association,Forporation or other legal entity,or any two or more
An employer is defined as-"�?n�dpaL.:Pa_Merslup,:
of the foregoing-engaged in a joint enterprise, and inchiding the legal representatives of a deceased employer,or the
receiver or trustee of an individual,pa
rtnership,association or other legal entity, employing employees. Howov..er.tbe
owner of a dwelling house having not more than three aparanents and who resides therein,or.the occapant of the
dwelling house of another who employs persons to do maintenance, construction or repair woikvn 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
d.
applicant who not produced acceptable evidence-of compliance with the insurance coverage require "
25C 7 152
ter , states"Neither the commonwealth nor any of its-political subdivisions shall
Additionally,MGL chap .. § ( )
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 numbers) along with their certificates)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(L.LP)with no employees other than the
members orpartners, are notrequired 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
cense number which will be used as a reference number. In addition, an applicant
Please be sure to fill in the Permit/li
that must submit multiple permittlicense 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-&ennses..Anew 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
hke to thank you in advance for your cooperation and should you have any questions,
The office of Investigations would
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 jnvestigations
r. .600 Washington S eet� .
Boston,MA 02.111:
Tel.#617-727-4900 ext 406 or 1877-MASSAFE
Fax#617-727-7749
Revised 5-26-05 www.mass.gov/dia
Town of Barnstable
Regulatory Services
'+ anaNsresra, ' Thomas F.Geffer,Director
.mass.
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
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adj acent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: ��<<e ke( InjloOj dt,5 f&0)(I`l Estimated Cost-
'Address of Work: �O Ly-y ae-�,,
Owner's Name: �,�`r L TV)along,,,_
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
[]Work excluded by law
❑Job Under$1,000
OBuilding not owner-occupied
C:KOwner-pulling-owzperfrd
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
I
Date Contractor Name Registration No.
R ;N1_-
Date t —Owner's-Name
Q:farms:hameaffidav
4
/ �
THE Town of Barnstable
pF T�
o� Regulatory Services
Thomas F.Geiler,Director
SAM
,. Building Division
Tom Perry,Building Commissioner
200 Maier Street, Hyannis,MA 02601
www.town.barnstable.ma.us
ice: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
P Please Print
DAM.— - 0. � Q j
JOB LOCATION; 10 �Y'C�L( Jl� K I yJ W.
number street village
"HOMEowNER':PrAY) C -T�rblorwn/ sn-36,c�- I7S'� . - 1-C>4 3-5
name 11 home phone# work phone#
CURRENT MAILWG ADDRESS:
e
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
s_,-pervisor.
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
re ._emepts.
0
Signature o ome
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 fbimilcertifieation for use in your community.
rl•fnr.nc•lmm�wvrnnt
• ' Application to
®1b Rjng,,!� 3�igbbjap Regional 3�I5toric �Biotrirt Committee
In the Town of Barnstable
,
CERTIFICATE OF APPROPRIATENESS
CD
Ln
Application is hereby made,with four complete sets,for the issuance of a Certifcate of Appropriateness under Section
6 of Chapter 470, Acts and Resolves of Massachvsetts, 1973, for proposed work as described below and on plans, Y
drawings, or photographs accompanying this application for. G —
CHECK CATEGORIES THAT APPLY:
1.-Exterior building construction: ❑ New ❑ Addition Alteration
Indicate type.of puildjrtg:. ❑ House ❑ Garage ❑ commercial E] Other
2. Exterior Painting: UJ
3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign
4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other
TYPE OR PRINT LEGIBLY: DATE
ADDRESS OF PROPOSED WORK �� C.Y-01 ASSESSOR'S MAP NO.
OWNER r� A >rSSQR'S LOT NO. d,.
HOME ADDRESS O C r n�c:hn, -TELEPHONE NO-2'�0 3Gd-
FUI_I, NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across auyw
public street or way. (Attach additional sheet If necessary.)
rn 1v
C ha-VA
C �a. O
a o
AGENT OR CONTRACTOR TELEPHONE NO.
ADDRESS
DESCRIPTION OF PROPOSED WOM Give particulars of WGrk to.be done including materials to be used. Please
Include locations of proposed signs. ��taxe— l��hc S �So '_�21M� ^9►�I�rs�v ) �►-,�y`�
.V_ 4
Signed -e"
E n f::t� Owner-Con ctor-Agent
For�} mitleo tee
u1 7 1115
I his Certificate is hereby Date r �`I\
L
N pF gFPNSl ,BLE roved/ Hied V
1'�IC PRFSFF;V�TION `
mmittee embers' Signatures:
Town of Barnstable
Old Xing's Highway Historic District Committee
SPEC SHEET
FOUNDATION
SIDING TYKE \1L� GDLek
CHIMNEY TYPE COLOR
ROOF MATERIAL COLOR
PITCH 4
dorfor1 W o i.Yo? 11 01 2005
SIZE_, �U —
ra`,v��o� �$oN
O W (3 E'p,CSEF,
TRIM COLOR
DOORS COLORS
I
SHUTTERS - COLORS
GUTTERS COLORS
DECKS MATERIALS
GARAGE DOORS COLORS '
SKYLIGHTS STZF CO>;b27$'
SIGNS__ COLORS
FENCE- __ COLOR
NOTES: Fill out completely, including measurements and materials/colors to be used. your copies of this
form are required for submittal of an application, along with Four copies of the plot plan, landscape
plan and elevation plane, when applicable.
Master TW21046 3'X4'-9" ,
Master TW2042 21-2'°X41-5" ,
Master TW2042 2'-2"X4'-5" ,
Living TW2046 41-61'X4'-9" z � [�
Stairs TW 4 ' ' "2 42 5 2 2
Stairs TW2042 2,--2,"X4X4,-5-5„
Powder. TW2032 2,�-2„X3�-5„
, j�wci of��sERv
Bath TW21032 3 X3 5 , ti�s��3F --
Kitchen
Basement TW21032 3'X3'-5" ,
Bedroom TW2042 21-21'X4'-5" ,
Bedroom TW2042 2'-2"X4'-5" ,
Sitting TW2442 5'-2"X4'-5" z
' =tom'.-'�.."'�;CCr-'1�i�.^'!t-.�--7�•:.Ls.GC'•,�_�n<c-T-', �.c�-:'V. ..
/v 9. 3 ZS,oc�
n ",)r?
d�. 1 ilc'
y.
Lol
1- Aet
P.
,'is .. '•::.:t:.4 . ..
-BUN W
GKE �o NaM2o"' r.
4�F�eze4to�
.• 4: � . •' . ; ' . : .. ., • . "Osumi° �•>°•�::;_
'i + :
CERTIFIED 'PLOT PLAN`"'-
E•W CONSTRUCTION ONLY : T /3AR2Nc_S7'Af�t�:',,;::•,,..:;'''.: .:
TOP• ,'O.f 'FOUNDATION' IS L��`FEET IN
4801tE =`.LO.�H POINT :;OF . ADJACENT J A1' 10 TA SLA MA4,94
4.0AD:..'
SCALE. 0.' DATE !* 9 ;
eAAE QAE E'NGINE£RIIVG C0.lN� I CERTIFY. THAT' NE �4
-.-• CLIENT
EGISTEREO� rRE(iISTERED —' SHOWN -ON THIS PLAN 1S . LOCATED
JOB•NOr �S O_O- 'ON - THE GROUND AS •INDICATED•-AND:..
CIVIL'E .� LAND R ' CONFORMS TO -THE ZONING LAWS
:ENGINE .R$. �SURVEYO DR. BY- A •M'
OF R•AR•N T BL , MASS'.: :•
$3 40~ MAIN 5T 712 MAIN ST. CH':'BY 7z• f•�S 7� y'�'
YARMOUTN,:MASS. HYANNIS, MASS. -'HEFT OF r—
:_ ___ _ S -�- - DATE REG.-LA-NOSURVEYOR '!'
Page 1 of 5
Pat Moloney
From: "Wolf Andersson" <swede88@comcast.net>
To: "Pat Moloney" <hillsidefoods@comcast.net>
Sent: Tuesday, September 06, 2005 8:16 AM
In7 —�� Jack Studs
King (Cripple Studs)
Stud
Header- i
Double US,
Blocking 2X8, etc.
ZMay Be
equired Rough With Plywood
By Local Opening Spacer
Codes)
Trimmer Stud
Sill
Jack
Studs Trimmer Stud Lower Portion
Portion
Stud Pattern, 16" o.c.
Wall Framing - Elevation Section Thru Window Rough 01
(Enlarged)
Framing A Window Rough Opening
Figure 1: Using 2x6's, 2x8's, etc. For Header Framing
Iso note the blocking between the king stud and the next stud. Supposedly, some
local building codes require this, though I haven't seen any carpenters do this extra
9/6/2005
Application to
®Yb Ring'.0 ROligbbialp RPgionat 3�isstDriC Mi5triCt Committee
In the Town of Barnstable
CERTIFICATE OF APPROPRIATENESS
Application is hereby made, with four complete sets, for the issuance of a Certificate of Appropriateness under Section
6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans,
drawings, or photographs accompanying this application for:
CHECK CATEGORIES THAT APPLY: C)
CV)
1. Exterior building construction. ❑ New ❑ Addition 191,Alteration
Indicate type of building: House ❑ Garage ❑ Commercial ❑ Other
2. Exterior Painting: ❑ b w
3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign -�
4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other
TYPE OR PRINT LEGIBLY: DATE -oS rr-,i o
w
ADDRESS OF PROPOSED WORK ASSESSOR'S MAP NO. �)o q
OWNER QA-rsc-�— f olel) ASSESSOR'S LOT NO.
HOME ADDRESS 10 C-,V2 �`� TELEPHONE NO.,,"?
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across�ny
public street or way. (Attach additional sheet if necessary.)
, e
AGENT OR CONTRACTOR TELEPHONE NO.
ADDRESS
DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please
include locations of proposed signs. \ C110�h9R- *V,'ki -ram w, r,^Cio�e
- y
s
P ned ��A
y+•�t �� w �. c�,P Si g
Own ontractor-Agent
For Committee Use Only
DC� (� This Certificate is hereby PP OVEu Date
15 v� ( App ve Hied
AUG 0 1 20 55 1 ittee Members' Signatures:
TOWN OF BARNSTABLE 4 �Ao"� %--- \J
HISTORIC PRESERVATION 61
Town of Barnstable
Old Kings Highway Historic District Committee
SPEC SHEET
FOUNDATION
SIDING TYPE COLOR
CHIMNEY TYPE COLOR
ROOF MATERIAL COLOR
PITCH
WINDOWS COLOR SIZE
TRIM COLOR
DOORS COLORS
SHUTTERS COLORS
GUTTERS COLORS
DECKS `\QQC� Nn1� 11��/l�W�� 1i TERIALS_\ICE,
GARAGE DOORS COLORS
SKYLIGHTS SIZE COLORS
SIGNS COLORS LE C, �-E
AUG () 1 2005
FENCE COLOR I
T(�' �r D'ARNSTABLE
W' ',t-"' 1FSFRV.4Ti0N
NOTES: Fill out completely, including measurements and materials/colors to Ised—Four-66pies—of—f-hi-s
form are required for submittal of an application, along with Four copies of the plot plan, landscape
plan and elevation plans, when applicable.
SPECSHT
Revised 11/98
4-
� � o
-Nm ' i
,I) ,
AUG 0 1 Z005
f
TOWN OF BA`�NSTAB�E
HISTU�lIe P_FRVW',ON
Andersen Windows-Window Schedule Repent
Project Name:MALONEY-WDH 6/6
Quote : 007136 ]Print Date:_09n2f2005 Qum Dahm- 05I09I�AD5 iQ versiorc ew i Of i
Dealer: : ACKERTE??
216 Thornton Dn ifilling
Hyannis.MA Adds
50"62-6200 Fho¢►e_ Fax-
o Sales Rep: YOA'PIERS— —_ Camtact: ----- — - -_-- _
z Unit Siw Rough Opering
Code Unit aorxniption MY Location Width_ He?SU Wldtt — Height
00D1 13448E,AA 1 ----MASTER --I 3'5 5f8' 4'8 TJ8" 42 VW 56 7!8'
- 0002 WDE12842E,AA -- 1 — MASTER2'7 518' 4'4 T!8' -- 32 11W 552 79r
0093 - V&1HZS42E,AA 1 MASTER ---2'7 5W 4'4 7JW _-32 VW _52718'
L4m WDH2046E.AA 2 LMNC -_ 2'1 5/8' - 4'8 718' 26 yir _- —55 7Ar
0005 WDH2442E,AA 2 STAIRS 2'5 5w 4'4 7/8' 30 Ur 52 7Ar
0006 WUH2O42E..AA----- 1 STAIRS 2'1 5f8' 4 4 71W 26 VW .52 71W
0007 1AU42032,AA 1 - PC%ifDER - 2°1 --- 3 4 718' 26118' -----40 T18"
c> 0008 APOH21032.AA -------- 9 - BATH --- 2't 1 5'8" 3 4 79r 3611w 40 T18"
0009 CR135-Cl35-CR135.LSR 9 POTC9 gyp! 4'to 3!8" 3 4 13116' 4'10 71W 3'5 3W
0010 VV()H21 W2,AA 1 t3ASEMENT 2'11 5J8" 74 7!8' 361I8" 4Q 718
Z - --- - -- ---
-0011 %70H2ti42E.AA —--- 1 - - BM ROOM - 2'7 5!8" 4'4718" 321W 52 7J8"
0012 WOH264.2.E.AA 9 BM ROOM 2'7-NW 4 718" 32 V8 52 7J8"
0313 WDH2442E.AA-- ----- 2 _ --- SITTING-- --- 2'S-51g - 4'4718^ 30 Iff' 52 71W
z
PFoject OoCnRt nts: ---- ---------- ---------- ---
p4 WEEKS I DEAD f IME ---�I
TEMS ARE SPECIAL ORDERED&11iflPi-RETURNA13t-E
a •
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AUG. 22. 2005 12: 19N SHEPLEY/ANDEk5EN _14WkOOM N0. 642 °.
Shepley Wood Products, INC
Andersen showroom
177 Thornton Drive,Hyannis Phone(508)862-6228 Fax(508) 862-6029
Name:
Fax: U),- 77�i Ir V Phone;_ L��, �ti� Papa:_
Thy you for the opportunity to quote this job.
We look forward to supplying you With the best
service and quality materials.
Hours of Operation:
Monday through Friday,7:00 a.m.—5:00 pm,
Saturday,8:00 ay..--12 noon
a From Route 6(Mid-Cape Highway),get off at exit 6(Route 132).
• Bear right at the bottom of the ramp and head South on Route 132 towards
Hyannis.
a Approximately two (2)miles from the highway,or at the fotuth traffic light,just
past Sam Diego's Restaurant,make a left into Independence Park.
a Go straight through a set of lights.
a Go straight at stop sign,
a After A mile make a left onto Communications Way.
Follow the signs for Shepley Wood Products, Inc.
a Bright orange building
I
Amlersen Windows-Abbreviated Quote Repon
Project Name:MALONEY-WDR 6/6
Quote#: 007136 Print Datc. 08/2212005 Quote Datc: 05/09/2005 _iQ Versiarr iQ5.1 --Page_— I Of 4
r,• Dealer —_ Customer: ACKERTE??
216 Thom—Da. Billing
gams,MA Address:
Fan:
508-$FZ-6200 P�
G Sales Rep: JON PD3RS ---— _ — --
Item tl Item Size` Vratiom —_ -- —Location _Unit IPrice Ext Prue
0601 1 'WDE3446E(AA) 1►ZASTER S 693.073 693.07
RO Siize—42118"W x 56 719"H 'Unit Size=3'5 5W1 W s 4'8 7/8"H
ELMUnit,Equal Sash,a4 hke/Prer£mished Vk�,HVh Perforaaance Glass,Divided Light with Spier,Colonial,4W2H,3/4",Ch'md'ea,Ext Grille-White,Iut
Griji -Prefiniahed White(Each Sash)
Equal Sash,Insect Scxeex�'%Iute —
ff
I 0M2 —I lE'D'E126421E(AA) iV----- -- ASTER $ 566.25 S 566.25
RO�—32 V8"'W x 52 718"H Unit Size=2'7 5/8"W x 414 718"11
Unit,Equal Sash,M-InteJPro-Finished White, High Peiformauce Glass,Divided Light with Spacer,COronial,3W2H,3/4",Chamfer,Ext Grille-White,lat
r' Grille-Prefinished White(Each Sash)
Cc Equal Sash,Insect Scram,'White
0 00aD3 1 Vl'DH2642)p:(AA) —--- ---- MASTER --- --$ 566.25 3 56615
w _ RO Size=321/8"W.x 52 7/8"H Unit Size=217 5/9"W z 414 7/8"H
w -Unit,Equal Sash,Whitefte-fmisbro White,High R formasoe Glass,Divided Light with Spacer,Colonial,3Rr2H,3/4",Chaanfer,Ext Grille-White,fnt
—._ Grille-Prefnished Whitt(Each Sash)
Q Equal Sash,lased Screen,White
WDDH2046E(AA) LMNG S 557A7 S 1114.94
f Ow RO Size—26118"W x 56 7/8"R Unit Sae=211 518"W x 4'8 7/8"9
Unit,Equal Sash,Whir Pro-faiWted 1A'lrite,High Performance Glass,Divided Light with.Spacer,Colonial,31%V211,314",Chamfer,Ext Grille-R'hits,Jut
Grille-Prefershed 1Vhite(Each Sash)
=: Equal Sash,insect Screen,Whine
0005 2 —�A244? (AA)---- --— STAIRS $ 557.47 S 1114.Y4
`" iIIJI RO Size—3011811Wx527/8"H Unit Size-=2'S518"Ws4'47/8"H
Is, at
iUnit;Equal Sash,WiiiwAte--fsWwd lie,High Perfonnwtce Glass,Divided Light v zth Spate[,Colonial,3W2H,3/4",Chamfer,Ext Grille-\TJhibe,
�+ Grille-Prefiaishad White(Each Sash)
Equal Sash,insect Screen,Whitt
COMMENT_VI"Y NO TEMPERING NEEDED
Andersen Windows-Abbreiriated Quote Report
Prcqea Naine:MALONEY-WDH 6/6
Quoseff: 007136 Print Dam 08n?J2005 Quote Date: 05/0912005 iQ Version. Q5.1 2 Of 4
Dealer: Castomer. ACKERTE??
216 Tkoraton.Dr. niumg
Hyannis,MA A-ddn-..s:
508-867-6200 Phone: Fax:
o Sales Rep: JON PIERS Contact:
iteaot oty Location Ujat Price ExL?rice
STAUlts 539.95S 539.95
0006 1 -,VDH2042K(AA)
RO Size=26 1 M"W x'-V-718"11 Unit SUe-21 1 SM"W x 414 718"H
Unit;Equal Sash,WhiWPze-SikAwd White,High Performance Glais,Divided L.ight vth Sp==,Colonial,3W2H,314",Chaniftr,Ext Grille-'Alhite,Mt
Grille-Prefinished White(Each Sash)
Equal Sash,ftweet Screen,White
CU61MENT VEREn NO TEMPERING NEEDED
0007 I IRM112632(AA) POWDER $ 487.90 437.80
RO Size-26 118"W x 40 718"B Unit Size=211 5XI W 1314 7f81r JR
f r-M
C>
11.1111 Uxdt Equal S-asit,Mrhixa)re,-finkhM Wbite,Uth Pimftmmmce GLuis.Divided Light with Spacer,Colonial,3-%v2jL 3/4",Chamfer,Ext Grille-White,Int
FTT1111 -hod White(Each Sash)
Orille-Piefin is
FAPWI Sant,IRSCCt SC100M,VJ%]W
0008 1 '%&M-H21 W.(AA) BAnt 531.92 $ 531.92
RO Size-36 118"W x 40 7/8" H Unit Size=2 I 5j8"W x 74 718"H
Unit;Equal Sash,%ifite/Pre-Imid W od AV High Perfonwnce 01m.DivAed Light with Spacer,Colonial,3W2H,314",Chamfer,Ext Grille-White,hit
Grille-Prefinished White Mach Sash)
Equal&a*Insect Screen,Whib:
0009 1 CR135-C735-CR-135(L-") NIrCEIEN 963AS 963AS
RO Size=4'1.0 719"W x 315 3/8"H AMU Size=4110 31811 W x 314 13116"K Mull Type:
Composita Unit;whifttwhite-Vinyl Wrapped,High Perforce GiassDi-%ided Light With Spacer, Mulling Location:FairAory(Direct),
Narrow AWt Aftlt Prwilty--VerbCal
Insect SCWCT6 Wlxw
Hardware Pack,PSC,Andersen Cbssic Series-White
CO3a4ENT:VERIFY UNIT SIM
Andeas.en Wmdok's-Abbreviated Quote Report
Project Name: MALONEY-WDH 6/6
Quote#: 007136 Print Date OW22005 Quote Date- 05109/2005 iQ Yersiam: iQ5.1 Page 3 Of 4
Dealer: - ---- -— Customer ACKERTE V
2161hornton Dr. Billing
Hyannis,MA Address:
� 508-852-62{DO
Plhona Tax.
Sales Rep. 3ON PIERS _ Contact: --a — Location Unit Price .Eat.Price
_-- )item _�{' IBem Size(Operatiosi) _._..--. _ - -
00?id l WDID1032(AA) BASEMENT S 53L:82 3 531.82
RO Size=36118"W z 40 718"If Unit Size-2'11 SM"W z 3'4 7/V'0
Unit,Equal Sash,WhiteAlve,-fin slmd N"mite,High Pmfommce Glass,Ditridni Light WA Vac:er,Colonia➢,3 W21,3/4'.Chum ,Ext faille-Vi'laibe,Ini
- Grills-Pret5raished White(Each Sash)
Equal Sash,insect Sclm-x,White ---------Oi111 t 43'®H264B C(AA) l$EI)RO0114 $ 556.Z5 $ 566.25
FRIROSUe=321,18"Wx52718"R UnitSize=2'7SA"Wx4'4719"HI Umt,Equal Sass,bt^lite/Pre`f-ffiimhed White,I ighP�erforB�ce Glass,Divided Lift withSgauer,C01ML 1,33°�HL 314 Chamfor.rxt Gxi11e-White,int
Grille-�PrefinUed While(Each Sash)
Equal Sash,insect Scm=t,vvkw
a -- otD�z a W�l asaa�(AA) ---- — — — > ROOM $ 566.25 S 5k&25
L_ RO Size=321/8"W a 52 718"H Unit Sint-2'7 SW'W z 4'4 718"H
-Unit,Equal Sass,VlWWPre-finshed White,High Performance Glass,Divided Light with Spacer,Colonial,3 W211,3/4",Chamfine Ext Grille-White,int
I— Grills-Pref finished While(Each Sash)
Equal Sash,lnaect Screech,White --- ----------__ --
0®ll3- 2 -�5'1DH7,442E(AA) -_.__- ---- SITIE'ING 8 557A7 S 111.4.9�4
z �� RO She=30118"Wx 52:�v8"JAf Unit Size=2'S 518" 'z 4'4 718"H
`n HE-
Unit,Equal Sash,Vl%te te-finWwd White,High Performsm a Glass,Divided Liglit wi lh Spacer,Colonial,3W2H,3/4",C%amfer,Ext Grille-White,Ent
Grille-Prefinkhed White(P.ach Sash)
Equal Sash,insect Screen,While — --- - --- - - --
c-4
Subtotal U467.88
Total Load Factor Misc.TaxableCttsbonhec SigaaZare 2927 � Tau(5.00m)Misc.Noes Taxable
IAndasm! Andersen Windows-Abbreviated Quote Report
I n-cied Name:MALONEY-WDH 6/6
ffal
j Quote 007136 FrmADaWr Mrl-l'"5 Qtwte Dabr. 05M,1035 Q Version: iQ5-1 — Page 4 Of 4
Customer ACKERTE??
Dealer
216 Thomton Dr. Bang
lfyaanis,MA Address:
508-96M20D Phone: FM
,::5Sales Rep: JON PIERS Contact
Item _V Item Sim(operatIM) Location unit Prim EIXL Prim
Qt
CA,,d Total
Dealer Signattua
All graphics viewed froffn the exterior
WEEKS LEADTIME
ONCE ORDERED NO CILANGES
:_SF rMMS ARE SPECTAL ORDERED&NON'TRETURNABLE____. —-----
<D
Thm*you for the opportunity to quote ffin Job-
reView aTI quwfities&specifwzfions for accaracy.
Special orders cannot be Yourraed for credit
LL Signature indicates acooptauce Ofthc5e,specificatkMa-
Your order will not be entered without ansuamized signature-
o m Leadtics are I-wed onAndusen WWing scedulm,
e�
axs
(CA,
✓ELUFJMEN I INU.ZI r 7 r.c/c
1h of Massachusetts
[T of HouSING &
� DEVELOPMENT
ley,Lt.Governor • Jane Wallis Oumblc,Director
3ept:ember 3, 2004
pment (DHCD)has reviewed Barnstable's request for
usin Plan. DHCD has reviewed the documentation
permits. Having reviewed the permits and supporting
units exceeds the number necessary to comply with
ffordable Housin Plan and 760 CMR 31.07(1)(i).
ing units that are consistent with the production goals
ION
TOWN OF BARNSTABLE BUILDING PERMIT APPLICAT 's
07
Map Parcel ® S Permit# % 7
Health Division,� � o � GZ 13-�� / Date Issued le a� O
Conservation Division —'t J 7/oZ Application Fee �® ` 00
Tax Collector A0 AO 11,92 Permit Fee
Treasurer !! /_19--z _ SEPTIC SYSTEM MIST BE
Planning Dept. INSTALLED IN COMPLIANCE
Uri TITLE 5
Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE ANL
Historic-OKH Preservation/Hyannis TOWN REGIILA,TIOtVS
Project Street Address 1 C ra J<-e r Il
Village
Owner Y1 C Address
Telephone 7 ,S
Permit Request c�ti D-e—ck
Square feet: 1 st floor: existing ,proposed 2nd floor: existing proposed Total new
Zoning District ...,,�� Flood Plain Groundwater Overlay
Project Valuatiora�,�oc�o Construction Type D:Ldc
Lot Size f Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family CEIr' Two Family ❑ Multi-Family(#units)
Age of Existing Structure A Historic House: O Yes tfo On Old King's Highway: 4a-f-Ift ❑No
Basement Type: �I ElCrawl ❑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: b-G"Ns Cl Oil ❑ Electric ❑Other
t G.�
Central Air: ❑Yes 4alqo— Fireplaces: Existing !�O New Existing wood/coal stove: ❑des %5, 113-
l CD
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new sizev
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ .'
_. ca
� r
Commercial ❑Yes o If yes,site plan review# M
Current Use Proposed Use
BUILDER INFORMATION
Name 0bA)e-dam Telephone Number
Address License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE U DATE
FOR OFFICIAL USE ONLY
PERMI' NO.
DA ' ISSUED
MAP/PARCEL-NO. ;
ADDRESS VILLAGE
OWNER {'
x<
J '
DATE OF INSPECTION:
FOUNDATION ,n
FRAME �/Z In (�� ,V �? / Y/d'X
i -
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH' FINAL
GAS: ROUGH w! e _ ti'_-'-' FINAL
FINAL BUILDING :4
DATE-CLOSED OUT
ASSOCIATION PLAN NO. r
..: .`
The Commonwealth of Massachusetts
- -. Department of Industrial Accidents :
0lfice of/eYest/gal/aas
_ - 600 Washington Street
Boston,Mass. 02111
Workers' Coe�at ion�Affidavit
�ffrsi�
name AJ ,°)Ujbr)e�4
location O C rc>�er '•-'"f 11� _
hone
ci
I am a homeowner performing all work myself.
❑ I am a sole r rietor and have no one wor
idng in ca achy
//%%%%%%//%%%%%/G%%/��%/G%%%%/%%%%%%%///��/%%%%/�O%%/%�/�////%///////////////i�///�F
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have
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Fafiare to aeeare coverage a+required under Section ZSA of MGL 152 can lead to the tnpositloa of crhninal penalties+of a fine UP to SI,500.00 and/or
one years'imprisonment as well as dvfi penalties in the form of a STOP wORK ORDER and a fine of S100.00 a day against me. I understand that a
copy of this statement may be forRsrded to the Office of Investigations of the DIA for coverage verification
I do hereby certifyfnderthe pains and a es of perjury that the information provided above is true and correct
Signature Date - _O� -
�` rnplp��,)� Phone#
Print name �q SFr\
Official use only do not write in this area to be completed by city or town official
permit/llcense# ❑Bundhig Department
city or town: ❑Licensing Board
❑Selectmen's Office
❑check if immediate response is required ❑Health Department
contact person: -
phone#; _ ❑Other
. (feviaad 9/93 PJ/a
Information and Instructions -
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law", 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, associition of 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 section 25 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,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 instance requirements of this chapter have been presented to the contracting
authority.
Applicants
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and
supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
date the affidavit. The affidavit should be returned to the city or town that the application for 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.
City or Towns
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. The affidavits may be retamed-tn
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions.
please do not he to give us a call.
The Department's address,telephone and fax number: ! r
The Commonwealth Of Massachusetts
Department of Industrial Accidents
0MC9 of lavestlaguons
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 ext. 406, 409 or 375
I
Town of Barnstable
NAP Regulatory Services
1AMSTABLE, ' Thomas F.Geller,Director
MASS.
039. `�� g Buildin Division
�TED MPS a
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date — _ b
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements. Q_
Type of Work: Estimated Cost dpoo
Address of Work: `� �.�
Owner's Name:
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
[]Work excluded by law
❑Job Under$1,000
❑Building not owner-occupied
XOwner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
R
Date Owne ' Name
Q:forms:homeaffidav
o i
as
AV
6.
Ll
�3 .
D T e9
also s;F. _
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f Q D S -suHixss l`
G K E IK No."20
aTnLIL
- z ��Snit •' �.`
CERTIFIED PLOT PLA�i` -'',;
L o r 89 C v c fc .: R.d OV
EW CONSTRUCTION ONLY : % - /3�4 /Y�_�.4 !34-&:,:::;:,;;.: ::`"
�-
1"OP. O.f -FOUNDATION IS Z�—FEET IN
480VE::`.LOIN POINT
.,OF �' .i,�l�J�� , �•1V �' .;;
SCALE:
_ L-40. DATE, 9/��
'LORE06E ENGINEERING ING
'- `--= CLIENT t:��!! . I CERTIFY THAT THE Z�?. —V'non/ `
EOISTERED REGISTERED -- SHOWN ON THIS PLAN IS . LOCATED
:ENGINES LAND JOB N0. ?�'= pN THE GROUND AS INDICATED. AND .,
IVILR SURVEYOR DR. BY �'I ' CONFORMS TO THE ZEkNIN.G LAWS
.: :. .._� .__ OF B-A R N T.
S-.
0 MAI,N ST 712 MAIN ST. -
�YA.RMOIJTH,: MASS. HYANNIS, MASS. S-"HEET-L OF
- DATE REG. LAND .SURVEYeQ °:
............
............... ...................
..........
-------------
--------------------
sx-
ii
------------
------......
----------
---- ---------- .......-----------
............ ...........
---------------
........... ---------- .................
The Town of Barnstable
Regulatory Services
Thomas F. Geiler, Director
Building Division
Tom Perry, Building Commissioner
200 Main Street,Hyannis MA 02601
Office: 508-8624038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
1 Please Print
DATE:
JOB LOCATION: l_f'�C_!\E's� 9xi i 94k__
number street h p village
"HOMEOWNER": ';]`r V Jbg ZI
name L home phone# work phone#
CURRENT MAILING ADDRESS: VaA 1 ►I wGV �f �.c) C rO t r
c
city/town state zip co e
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
pro c ur d re uirements.
Signature of Homeo
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply
with the State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the
provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a
person(s)for hire to do such work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of'a supervisor(see
Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in
serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the
unlicensed person as it would with a licensed-Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit
application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a
form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:FORMS:EXEMPTN
Application to
(g)jb Jbigbbjap Regional 3�IotDrit �Biotrict ColttnYittee
In the Town of Barnstable
CERTIFICATE OF APPROPRIATENESS
)placation is hereby made, with four complete sets, for the issuance of a Certifcate of Appropriateness urfor Se-Ution
of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described'lelow an-d;on puns,
awings, or photographs accompanying this application for: isr-
HECK CATEGORIES THAT APPLY:
Exterior building construction: ❑ New ❑ Addition ❑ Alteration � D
Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other
Exterior Painting: o z
Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting ExistinbSign —° ':•
Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑.Other iJE'_ w�
YPE OR PRINT LEGIBLY: DATE
,DDRESS OF PROPOSED WORK IO c'Y'bc ;��r IL.tJ ASSESSOR'S MAP NO. 10
)WNER Pp, ,�•� c,1Uh� ASSESSOR'S LOT NO. CAS
iOME ADDRESS CrQCJb,L V—D TELEPHONE NO..Sb?3'39d' 'I7.�8
=ULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any
)ublic street or way: (Attach additional sheet if necessary.)
eN Cr
ch.
c
AGENT OR CONTRACTOR TELEPHONE NO.
ADDRESS
DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please
include locations of proposed signs. � \l� de 3kiw 0 1 �5�aw-*nar�
J vKAI 1C P1 1��ta►��/ ��• l h 1 - shy 6 Sc.r
Signed
Owner-Co actor-Agent
For Committee Use Only
This Certificate is hereby Date 1 a1S-0-L-
i
ed
r
C=ttMembe s' Signatu s:
i
Town of Barnstable
Old King's Highway Historic District Committee
i SPEC SHEET
'OUNDATIO 4
SIDING TYPE COLOR
:HIMNEY TYPE COLOR
ROOF MATERIAL COLOR
PITCH
WINDOWS COLOR SIZE
TRIM COLOR
DOORS COLORS
SHUTTERS COLORS
GUTTERS COLORS
DECKS GJ rL MATERIALS �reSS(J�I� �T�� 1'lg O.7 �(�^
GARAGE DOORS COLORS
SKYLIGHTS SIZE COLORS
SIGNS COLORS
FENCE COLOR
NOTES: Fill out completely, including measurements and materials/colors to be used. Four copies of this
form are required for submittal of an application, along with Four copies of the plot plan, landscape
plan and elevation plans, when applicable.
SPECSHT
Revised 11198
CAL
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59
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CERTIFIED PLOT PLAW:l'T
�-o r8jvcic2.: R.Oh x
E'W- CONSTRUCTION ONLY : w T �3�?2n��T.413
rOP. ',O.F FOUNDATION IS Z
180VE.: � FEET
IN
=.LD.W POINT �:OF .'ADJACENT •` 1
LOAD.. R .:allh ��1 �.a, j :�.�•
SCALE- � �'-40.' DATEt
L DREDGE ENGINEERING Co.
-- /NG�FIE , ,. I CERTIFY THAT THE �non/
--•�=_:.� ..�_... .' ._.. __._.._ ._._.__. C���y, . .
EGISTERED� REGISTERED '- SHOWN ON THIS PLAN IS'. :LOCATED .
C.IVII.' LAND . ?�'_ ON • THE GROUND AS INDICATED. AND -:.
:ENO'INEER SURVEYOR DR. BY: '``� �'? CONFORMS TO -THE ZANIN.G LAWS
---�" ---
OF B•AR'NS;TA'B"LE MASS.`-'
3 'NO MAIN ST 71 CH:•'BY -P• � . !
2 MAIN ST.
-YA.RMOLlTH,:_MASS. HYANNIS, MASS. . :.'; .4AT.�g
SHEETOF :' DATE REG.' LAND .SURVEYOR
-..................- ....--....._.._
i
I
....----...__
_:....._ ......-..._ _..----._.-----------------
:
.........._ :_.:....... ......._..._.----_..--
- --............ .
i '
_........... ----- -- -
• �I
e iI
!. ��. �"-.r�.e-2.jam.. - _ � .�r.'+a� .ram �f �iYe- .:-]r:�= __ rd;y � . 'r '�.{.. .c..rN•-y.t^...�.�'. ... .v'`:. ^.�
TOWN OF BARNSTABLE Permit No. 20586
1 Building Inspector cash $640..00 !ovmer) y�y
OCCUPANCY' PERMIT 'Bond
"No building nor.structure shall be' erected, and no'-land', building or structure shall be
used for a new, different; changed, or'..enlarged use without .a Building Permit therefor
first having been obtained from the Building, Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector."
General Delivery, West Barnstable, t ;
Issued to Paul & Patricia Cali Address -BG
lot #89 10 Crocker Road, Test Barnstable
Wiring Inspector ` ���� �•• __j Inspection date
/! �P
Plumbing Inspe#m j_ +�- Inspection date
Gras Inspector ��f Inspection date2 jy� rY.f�
of /�
Engineering Department
CXrf 'r r 1 �4 �` ``/• - Inspection date./ 1
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.
.................._.. ��. _.. . ...M, 1927� ............. Building Inspector
33
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4 P.
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_ Q18TC Q.
4�o su
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CERTIFIED PLOT PLAN
LOT 8g Cn0cKE2 jZDA
W,5�:-5•T 13A RM3 T-A &t-E-
NEW CONSTRUCTION_ ONLY : 4-
TOP OF FOUNDATION IS . z'S-FEET IN
ABOVE LOW POINT OF ADJACENT 6SA41v AS'J ASJai4NAS54
ROAD.
SCALE: I '�fD DATE , 9' Sr-
�ELDI4EDGE_ENGINEERING CO. INia �fl , , I CERTIFY THAT THEoll_!�!D.priol✓
CLIENT SHOWN ON THIS PLAN IS LOCATED
EGISTERED� �'REGISTERED JOB N0. Iko ON THE GROUND AS INDICATED AND
CIVIL LAND CONFORMS TO THE ZONING LAWS .
ENt31P1EER�: SURVEYORS- DR. BY
_ �-- --- _ _ OF B'ARNSTABLE , MASS...
BY-. /<
. !S
33 NO MAIN 5 T 712 MAIN S T. CH:'
-)0 YARMOUTH, MASS. HYANNIS, MASS. SHEET.J OF -/- DATE REG. LAND SU-
RVEYOR
oA-sem ............................................
,
ia —
'` SEPTIC SYSTEM MUST BE °r,THEr°�`
Sewage Permit number ....... INSTALLED IN COMPLIANC Q
...... ...... ...................................
/ lJ - WITH ARTICLE II STATE t BAMSTABLE,
House number /.. ....7.1.�................................ SANITARY COD 9 S a
E AND TO o 0 39-
REGULATIONS. ----"`-
TOWN OF RARNSTABLE
D.UILDIHG ;IHAS.PECTOR
APPLICATION FOR PERMIT TO Y
TYPEOF CONSTRUCTION .....................................................................................................................................
......�-W....... ..,..................19. ..
'TO THE INSPECTOR OF BUILDINGS: ,
The undersigned hereby applies for a permit according to the following information:
_ I1�e a rv�Q� t- ,M/n
Location ...........to [�Y�. r! ...1hXlrJCY..........v C .......BtT4Q,5.I."L�... ..1.1:Y�i..................................................
ProposedUse .... arl.�U..... LE).................................................................................................................
Zoning District ..... .. . . . . .......................Fire District ..............................................................................
Name of Owner ......RAWL.A.I:n AMCAA.......tA14........Address ..P:.Q..A0X...J037..... AStWE .,. :...........
Name of Builder .......
RU l4 ....S .W.( ZI..................Address ............IC U M.( . ..ryl/ .-...............................
Name of Architect ....41KAV PMB.&LZ..................Address U11116 JVE.5 ,. ID: CE; L-L
Number of Rooms ........7......................................................Foundation ..�11.Q1� ...C..UPS?.CA .............................
Exterior .. ...� �Q ..:F� ...'. 1 fang .......T+' PI-411 t.r.T......................................................
w
?' Floors ...................................................0..................................Interior ..................................0.................................................
i
Heating1 L ..... .....W.!.LAG'r Z...............Plumbing .....................................................................:............
Fireplace ...............Nom.. .......................................................Approximate Cost .........�:4.5).B( {)
S f
Definitive Plan Approved by Planning Board ____�lZ� ------19.7-0_. Area ........ .......................
Diagram of Lot and Building with Dimensions Fee
0...2...................
SUBJECT TO APPROVAL OF BOARD OF HEALTH n, �/Go TL' QQ
G y- C/Dmtk
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
�.. Name ..... P�Wd6z."....►....:...�- ./•...........0...........
Cali, Paul & Patricia '
`
�
-20 — Permit for --.t�o..�t����--' ` �
��
r
.................°--.— ...... ............~.`~"....................
. -
Location ..............lO. .�A�d-----..
~
............................West......... ...........
_____..
Owner --.—..pa«I'&.. .{�li--..--- ' ------.
Typo of Construction ----.t)J�WQ..................
^ .
. -
-----.--------------------
Plot --.------- �t ----�{��----�
' -
September 18 ?8
Permit Granted -------------l�
.
^ -
Date of Inspection ------------lq ,
Date Completed � -
,
`
~ .
PERMIT REFUSED '
- ~
-.
19
------.. . -`
- �
J��°�
----"=`=—..........
=~=",=°`.="�`.="",=``�`=, . . . ~.
� .
. ~ .
. ............... .. ........................................
0-9
~
^
.
' ................................................. 19 ~
Approved
.
---------------....---..~.---. '
----------'--------------^'—
^
| ^ �
Assessor's map and lot number ....... Gr
QUO%TM E T0�
Sewage Permit number ...... .........................................
-.ram Z 13AUSTODLE, i
House number ...."? ". ........ / 7 so rasa
............... po,1639 ♦�
V a`
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATIONFOR PERMIT TO .............................................................................................................................
TYPEOF CONSTRUCTION ........................................................................................:............................................
........i........ ....... ................19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ......... I .........i...........................A.J..........�A��..`........... N,(,..:.?..........?!..!..... ......................................
Proposed Use "i , n i(-,
.................. .................. ..............
ZoningDistrict ..... , .:....................' .......................Fire District ..............................................................................
Name of Owner .......' :.:..:..:! N ,lr i t t ►�..... .i 1�-+ Address .. .?.%... Ck r, � h.A���f ,...`.:........................... ...................... .................................... ... .......
Name of Builder ......r........ +r...............Address ,,( ..': , t�. ......
Name of Architect ....... !_..................Address .RA)/i,.0- 12 i,lr?r or- f i-1�� t` i„ j r
Number of Rooms .......................................................Foundation ....%:.��1 r `. . n•..1, i. •_-?L
........... ..................................................................
Exierior ..'.!`.:'.:,i y:.. i^t �,, ,a�i i1►'1 [-!�, ., - Is�k71`l1 t Roofing F�!t .t....................................................... .
.................... ........................................ g ................... ...
Floors .................................................................. ...................Interior ....................................................................................
___ -
Heating---:.....-..-..`.:.::, :-.:.....`.:=:..I.........................................Plumbing ..................................................................................
Fireplace �l.;Jt ...................................................Approximate Cost 11�l a�)i
Definitive Plan Approved by Planning Board __ -TI)k1F ?9_-----19.2A. Area ............6 i...................r.........
Diagram of Lot and Building with Dimensions ._ Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH j f j ��!%,/% .a
p 7`
C�
'I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction. �}
Name ..... 1......../i i............:......./ .. :....:.............................
1 ,
S Cali Paul & Patricia A=109-85
T
I
I
No ...?95.6L Permit for :....two„storY,,,,,,....
.......... ....................
Location ...........IQ ....................
j
.........................alest..Bar ataulp....................
Owner ........�.aL1j...�C..Pat?< G�a.Cali..............
I U
r
Type of Construction fr.aMe...........................
YP ....
I
i
Plot ............................ Lot ......#.a9....................
Permit Granted ......, September 18 19 78
............
Date of Inspection ....................................19
i Date Completed ......................................19
PERMIT REFUSED
' ...... .... ............... 19
........................ .. ...... .....................................
................. .............................................
4�.74....... ................... . .................
' ...............................................................................
Approved ................................................ 19
............................................................................... _
...............................................................................
pFz1 rpw Town of Barnstable *Permit# 2-
P� ti
Expires 6 months from issue date
saxivsrnete,
Regulatory Services Fee 5 0 0
9� 1639. Thomas F.Geiler,Director
A�Eo�yA P�
Building Division
Peter F.DiMatteo, Building Commissioner �• 2002
200 Main Street, Hyannis,MA 02601 EB $
Office: 508-862-4038 BARS �-E
Fax: 508-790-6230 �IN OF
EXPRESS PERMIT APPLICATION - RESIDENTIAVONLY
Not V without Red X-Press Imprint
Map/parcel Number ,
Property ddress
esidential Value of Work d
Owner's Name&Address 1 c) d
Contractor's Nalne Telephone.Number �Y- J—c".5,v— 11
Home Improv ent Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Co ensation Insurance
Chec e: -
ai a sole proprietor
❑ I am the Homeowner. 1
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Permit Request(check box)
❑ Re-roof(stripping old shingles)
❑Re-roof(not stripping. Going over existing layers of roof)
Q,Re-side
❑ Replacement Windows. U-Value (maximum.44)
❑ Other(specify)
*where required: Issuance of this permit does not exempt compliance with other town department regulations,.i.e.Historic,Conservation,etc.
Signature 4�
Q:Forms:expmtrg
Revised121901
Town of Barnstable
Building Department
ComplainVInquiry Report
Date: 6,2 Rec'd by: OA am,,• Assessor's No.:
Complaint Naine: c:)N e-`f
Location p
Address:
M/P
Originator Natne:
Street:
Village: State: Zip:
Telephone: D/E
Complaint n
Description: IQ n L� , L J) N- QA)S -, t d JT Q
Inquiry
Description:
Fur 0111cc Use Only
Inspector's
Action/Cornments Date: Ork - 0:;j Inspector. �• Jdl�ns-
A4�,,D once
Follow-up _
Action
Additional Info. Attached
Copy Disa7buaon: IMite-Deparunent File
3-elloiv-Inspector
r
it7 ,96
The Town of Barnstable
Department of Health, Safety and Environmental Services
= Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph CMSE
Fax: 508-790-6230 Building Commissio:
Home Occupation Registration
Date:
Name:
Address: 10 c-roCte.-1r' Q Yillage: w- r n s4C'-'b If
Type of Business: K I>,\1 uQ y; Map/Lot:• `Q '? 'O?e
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home
occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,
provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or
odor, no visual alteration to the premises which would suggest anything other than a residential use;no increase in
traffic above normal residential volumes;and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject
to the following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,
located within that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,
and there is no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular
matter, odors,electrical disturbance,heat glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in
excess of normal household quantities.
• Am need for parking generated by such use shall be met on the same lot containing the Customary
Home Occupation,and not within the required front yard
• There is no exterior storage or display of materials or equipment
• There is no commercial vehicles related to the Customary Home Occupation,other than one van or
one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and
not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of
the dwelling unit.
1, the undersigned,have read and agree with the above restrictions for my home occupation I am registering.
Applicant: Date:r_ 6