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2400 MEETINGHOUSE WAY/RTE 149
1 ypd b A 'I �l i i 44 1 NO. 152 1/3 ORA ESSELTE 10% � T Town of Barnstable Building `Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept UARNMASS�$ IPosted Until Final Inspection Has Been Made. . � .a Permit s9. .0 `Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection.has been made. Permit No. B-20-1967 Applicant Name: Ekaterina morozova Approvals Date Issued: 07/31/2020 Current Use: Structure Permit Type: Building-Detached Accessory Structure- Expiration Date: 01/31/2021 Foundation: Residential Map/Lot: 155-045 Zoning District: RF Sheathing: Location: 2400 MEETINGHOUSE WAY/RTE 149,WEST Contractor Name: Framing: 8 �o Zo Owner on Record: MOROZOVA, EKATERINA Contractor License: 2 I Address: 2400 MEETINGHOUSE WAY Est. Project Cost: $29,000.00 Chimney: WEST BARNSTABLE, MA 02668 �� Permit Fee: $545.80 Description: Restore the exhisting brick garage that is on the property and is ' Fee Paid: $545.80 Insulation: detached from the main house.The roof was in a very bad t ,' Date:. � /31/2020 Final: condition due to previous owners neglijence by not maintaining it It was unsafe and it did collapse 3 years ago:,the building was r inspected by a structural engenier and I was sugested to 2 Plumbing/Gas Plumbing: h additional 25 feet steel beams and 6 columns to support the weight � Rough g= j Building Official of the roof plus the snow load during the winter.Also the concrete slab was determined not to hold the weight of any modern car,so Final Plumbing: a new concrete slab was neded to meet the curent standards.This Rough Gas: was approved twice by the Historical committee of Old Kings Highway. First time the approval expired,the second timewas � Final Gas: prior the Covid19.Theres no excuse that the'permits bothAimes where not finalized. I - -~ -~ - ~- � Electrical Service: Project Review Req: I Rough: Final: Low Voltage Rough: Low Voltage Final: Health Final: � s Fire Department Final: Town n_of Barnstable Building o� �. _.__. . Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept, Posted Until Final Inspection Has Been Made. 1639 ♦0 Permit FOMn't° Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire-Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work:' ` 1.Foundation or Footing 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed ` 4.Wiring&Plumbing Inspections to be completed prior to Frame Insp",ection 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy r Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical-Installations. Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund (as set.forth in MGL c.142A). Building plans are to be available"on-site - All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT i Town of Bamstablc,Planning dt Development Dapartrl�f Old Kings Highway Historic District COMItoe 0 v E i NAM 200 Main stmet,Hyannis,Massachusetts 02601J Phone 50&862A787 Etmd erfiL og a} .t wn. m le:t txs DEC 19 2019 CERTYk'1tCATE OF EXFXMON PLANNING&DEVELOPMENT Application is hmby made►with four(4)compWo acre,fbr the iasuaoce of a Ce dd=of lbneqtioa wider Sodlon 6 and 7 ofChapter 47Q,Ada W Resoivcs ofMautchusetM 1973,as amended fbr propond wort as dos abed blow and=pbms,dra vWA or photopgb e000mpaoying thin application: Date Z 'r g 63 Adddiva otpmoposed work Assessor's Map and lot S' S O q 5r Hoene# �019 stt�t ./f e e ���e Gto w se w'6yvllkp:_ (,tJ�S� . 75a 714 This appileadon is tor an eaemptfoik of the propgsed•twngnidim on tho grottgds that Worw ❑ WW not be visible ftnmi mW way or.pabUc Plm ❑ Is within a oategary►declared amply the Old Kings Highway ROgi W Historic Di&Wct Cootmission ❑ odw ) Jj�t�:of'1Pr-p.-O" ifoil�: �.�. g to P.(� Gt 1l D X Y o s w r+. o o rr f k t, O4 a-k of 4-0t c M et ee 24:k o �o �Y'S'fVw. . Ca .t%a Q. 6.9kst a ov n t%N C, 5 W V1tit✓ 67l V �Y� �G va.W1.v(w bt.N� Cr1,LG 0.�� 6' ° �4t. (J'.•. (AJ(��O(V�.+ •'1.t�A' C O mz 0.'=2v Q g �ou S !'a' t 2 fp�t vC? �'e✓e rdWW p v Apd4wcord. W t 7- Tel.no. ?Address Owner(pieasep w: > 4-e tit' t4 oL Ai�.o.�o,✓.A Telno. Ownw-mailb eddmm. N 0 n A4 t C %0-1 C W¢ ICU• �jaz�*S� /i[t O�•iT 9lgtuil.+OlOa�xerod�t 4`heeldls! 0 Four eomtplete sots of the uppljcWm aad spp m*S doamtvnUdon U S Fft Fee.(smaftpchvd sdpdule) For Committee Use 0* Thin CoWficate is be •y APPR•OYE DBMED Dates_ Com�be l+�em'b�s 9igaa . APPROVED Q _ JAK e a c 'iown of Bamstable Condittoms qf approval: itt Old King's Highway Commee t7Sllfuw1gp11onFa+x,�017 jbY �a w;.�. na�• •s v �,� It f7 �•!�r4Lw" -i� lr t�t �y so. 14 spew ,r- •~'• y Town of Barnstable Building aAMST� Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept Posted Until Final Inspection Has Been Made.t Permit 39. Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-20-1823 Applicant Name: Ekaterina morozova Approvals Date Issued: 07/29/2020 Current Use: Structure Permit Type: -Building-Pool-Inground Expiration Date: 01/29/2021 Foundation:60 aktL 0 Location: 2400 MEETINGHOUSE WAY/RTE 149,WEST Map/Lot: 155-045 Zoning District: RF Sheathing: U Owner on Record: MOROZOVA, EKATERINA Contractor Name: Framing: 1 Address: 2400 MEETINGHOUSE WAY Contractor License: 2 WEST BARNSTABLE, MA 02668 Est. Project Cost: $45,000.00 Chimney: Description: Install a 20X40 unground swimming pool in the back of the Permit Fee: $ 175.00 Insulation: property. Fee Paid: $175.00 Project Review Req: Date: 7/29/2020 Final: 111f_,11_r;;rt�� Plumbing/Gas Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is coinm—enced-within six months after issuance. Final Plumbing: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and st pctures shall be in compliance with the local zoning by-laws an#d codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Final Gas: i rmi . The Certificate of Occupancy will not be issued until all applicable signatures by the Building-and-Fire-Officials-are provided on this pe t Electrical Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Service: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue6 1i,n_ing is installed Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Perso s contrac with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Town of Barnstable Building Department Services Brian Florence, CBO Building Commissioner BABSTABLE 200 Main Street, J H annisf MA 02601 � .�"." 1679-201a www.town.barnstable.ma.us I Office: 508-862-4038 Fax: 508-790-6230 July 29, 2020 Notice of Building Code Violation(s) and Order to Cease, Desist and Abate: Ekaterina Morozova and all persons having notice of this order: As property owner of the property located at 2400 Meetinghouse Way/Rte. 149,West Barnstable, Assessors Map 155 Parcel 045 and known as residential structure, you are hereby notified that you are in violation of 780 CMR,the Massachusetts State Building c. 1 § R105.1,and are ORDERED this date 3/9/2020 to: CEASE AND DESIST all functions associated with the following violation(s) on or at the above mentioned premises: Summary of Violation: On 7/25/2020the Building Department observed violation(s) of 780 CMR,the Massachusetts State Building Code c. 1 § R105.1, specifically, remodeling an accessory structure without the benefit of a building permit. Summary of Action to Abate Violation: In order to abate this violation and to avoid further enforcement action by this office, commence immediately the following action: apply for and obtain a building permit for work along with successful completion of all required subsequent inspections. And, if aggrieved by this notice and order; to show cause as to why you should not be required abate the Building Code violation(s) in this notice,you may file a Notice of Appeal (specifying the grounds thereof)with the Building Code Appeals Board within (45)days in accordance with M.G.L. c. 143 § 100. If, at the expiration of the time allowed, action to abate this violation has not commenced, further action as the law allows may be taken. By Order, he fr L. Lauzon Chief Local Inspector (508) 862-4034 Jeffrey.lauzon@town.barnstable.ma.us Iva -BUILDING DEPT. Application Number.�...t.......... �...1.......`..f............... MAY 0�7 2020 Permit Fee. Other Fee. TOWN OF BARNSTABLE � Total Fee Paid.. �:..'.... TOWN OF BARNSTABLE Permit royal b on........................... tiPP y....................... BUILDING PERNUT IF S A (�y ry ..... ...................... arcel............................................. APPLICATIONl�l Section 1 — Owner's Information and Project Location Project Address O o Aee4u-u-.p 4&%4 5 Q War Village W. Owners Name VA e a Owners Legal Address a K o 0 e 4v-:°l b o Lc S e W a..j city C/V . a 2,.� S�� B e2 State AIR zip 0-2 6 6 f Owners Cell # 1 S ' S nob E-mail -io ti13 V L M-- G A C9� A F • cc Section 2 —Use of Structure Use Grroup ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structur hange of use ` t^n ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty Fire Alarm Reliuild. ❑ Deck Apartment ❑ Sprinkler System ❑ Addition - ❑ Retaining wall ❑ Solar IS Renovation ❑ Pool ❑ Insulation Other—Specify // Section 4 - Work Description -- F� f 2 R?Q Q T �•"�`� " 0�f le Zo D 7`Gc e y exc S CQ`r 2�2 e etouSC �tia e �K 'fec'� �.c.2C'f� eo02 `S . e :���oL�tvS d L to, O �J p o ez S- p��- s eo o�k uLe, d y %4- w Q. (°oe- o'z- e- 1� Ar '" T:act nn�iatPri• 1 1/1 S/�(11 R "�`� i CFO. Application Number........... .........`.:.. Section 5—Detail Cost of Proposed Construction 3 0000-u00 Square Footage of Project Age of Structure 0 2 Dig Safe Number # Of Bedrooms Existing -,T., . #Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist 0 WFCM Checklist ❑ Design Section 6—Project Specifics Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply ❑ Public Private _ Sewage Disposal ❑ Municipal On Site Historic District ❑ Hyannis Historic District Old Kings Highway Debris Disposal Facility: I am usingg�a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required ' ' Proposed c. Side�Yard rK Required Proposed,,! Has this'property had relief from the Zoning Board in the past? ❑,Yes ti • .I1 1" - Last updated: 11/15/2018 :~ Application Number.............. Section 9- Construction Supervisor Name Telephone Number Address City State Zip License Number License Type Expiration Date Contractors Email Cell # I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section 10—Home Improvement Contractor Name Telephone Number ' Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: _VV p,+e z C wo f(/l oZo-Z oy a Telephone Number -` 5 S -��°� Cell or Work Number 1 - I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and t documentation required by 780 CMR and the Town of Barnstable. j Signature Date t 2- ' 4 •l9 ;APPLICANT SIGNATURE Signature Date 1L• i 1 Print Name �k a �2'iJ%,.k l�G 7-o-aoi_a Telephone Number 6 / S s S-0 0.6 E-mail permit to: -49 -To V K u L A A-6A-C RC . CLuAl Last updated: 11/15/2018 Section 12 —Department Sign-Offs Health Department ® Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ ` Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval i Section 13 — Owner's Authorization i I, FK a z c;v-,q Ako�,o Z-o v Q , as Owner of the subject property hereby I authorize to act on my behalf, in all matters relative to work au orized by this building permit application for: atfop Aee, ri% Ke6Lov WeYsk Bee Ao, 02 66 (Address of job) 12 - 14 �q lgnature of Owner date F x a e vvi.Q 0 207-0V Q Print Name i Last updated: 11/15/2018 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass govh a Workers' Compensation Insurance Affidavit: Bu7ders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): t q Z"Q N`O;Zo ill" lQ Address: ) 4 0t7 tv City/State/ZipW•F.°`U4 0 46 144o i rP 6 F Phone#: 6/ SS-S o co 6 Are you an employer?Check the appropriate box: Type of project(required): LEI❑ I am a employer with- 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3 M I am a homeowner doing all work officers have exercised their I I.El Plumbing repairs or additions myself.[No workers'comp. rat of exemption per MGL 12.❑Roof repairs insur-ance ram]t c. 152,§1(4),and we have no employees.[No workers' 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 are doing all work and then hue outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the subcontractors 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 the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: 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 u d e pains and penalties of perjury that the information provided above is true and correct Signstore: Date: 12' /� • �� Phone#: g S • S Co O 6 Official use only. Do not write in this area,to be completed by city or town gfJWal City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical 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,m internan ,, * io,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 liceusing awgeenncy haII�'thhold 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 confamation 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 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 firhure 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 - t- Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www;maw.gov/dia �tHE� BUILDING DEPT. ! O� Application Number......B..—S ....—........ .� .........`. % • e '~ BARNSTABLF, MAY 0 7 2020 MASS. .Permit FZ6...... .........................../ Other Fee:............:. ..: a639, . , TOWN OF BARNSTABLE '� Total Fee Paid TOWNOF BARNSTABLE Permit Approval by.................................on........................... BUILDING PERMIT SCANNE Map......... .......... Parcel........v...l. ....................... t" ' APPLICATION > Section 1 — Owner's Information and Project Location - Project Address a cf O o e e &o kSe- Way Village Q 2•u, g Fee, \ Owners Name Owners Legal Address a 4 o o A e et:v&o &-g e W�0., City W. apt u g-I it State At Zip p 2 C 6 8 Owners Cell # I 4 5-5- • Soo 6 E-mail to N 8 u z A N G a 0 61 �. Go w �l Section 2 -Use of Structure j Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3 -Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar ❑ Renovation Pool ❑ Insulation Other-Specify Section 4 - Work Description VILA, 207 / O �5Wc --- Z, 6L ®oe fame- 13ac o e,, RU t-2 +664„K,o .Aa- -exams-' cgz2.: e_ &o!�se_Aphre T.aM nnrlopvi• i l/1 inni R i j Application Number..................................................... Section 5—Detail 1 Cost of Proposed Construction 6 O4oO� 0 O Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing Total##Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑'WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom i Water Supply ❑ Public Private Sewage Disposal ❑ Municipal On Site Historic District ❑ Hyannis Historic District Old Kings Highway Debris Disposal Facility: F X co D e--v-Z f __ I am using a crane ❑ Yes 12 No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No c Last updated: 11/15/2018 Application Number........................................... Section 9- Construction Supervisor Name Telephone Number Address City State Zip License Number License Type Expiration Date Contractors Email Cell # I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and . documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date ` Section 10—'Home Improvement Contractor Name Telephone Number Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: FtA !"`,0 qV 00 y Q Telephone Number 6 17�g 5-Sr ��O.o Cell or Work Number 6� 1 S S S_o p f6 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation require d by VIR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature Date /2 —13 9 Print Name Q /4 Telephone Number 617 E-mail permit to: ?o N T> to i, M A 6.4 P C C.o w► Last updated: 11/15/2018 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approvak Section 13 — Owner's Authorization I, Ail a Zo evv4 as Owner of the subject property hereby authorize 73 to act on my behalf, in all matters relative to work authorized by this building permit application for: a �( 049 L 2 ' L_ K o u S`e (i(9 e �. R a `tom S Pee lt4Q to Z G G,? ~. (Address of job) Signature of Owner date ' Print Name r . t • 1 � t t r Last updated: 11/15/201.8 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations IF 600 Washington Street Boston,MA 02111 www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers APPUcant Information Please Print Legibly Name(Business/Orgenizatimvbdividual): G �4 e2 K e 144 �0 2'0V �" Q Address: a 4.o 0 /ke e 7�k P �louSLo VAQY City/State/Zip:w-%4.Z K-5gl /�(� 0 266 2 Phone#• / 7'- �� �o'�' Are you an employer?Check the appropriate box: Type of project(required): 1.ElI am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hued the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers'[No workers'comp.insurance comp.insurance._ 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3`� I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions /—myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t C. 152,§1(4),and we have no employees.[No workers' 13.❑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 hue outside contractors mast submit a new affidavit indicating such. =Contractor 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 worker'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: i 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 un da4he pairs and penalties of perjury that the information provided above is true and correct: Signstore: Date: /Z • / 4 Phone#• / S 5-0 0 Offrcial use only. Do not write in this area,to be completed by city or town ofj"iciaL 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 sire 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 MASSAFE Revised 4-24-07 Fax#617-727-7749 www mass.gov/dia l Town of Barnstable,Planning&Development Department C E . Old Kings Highway Historic District Comir e { MADL ' 200 Main Street,Hyannis,Massachusetts 0260 0 1 '�� Phone 508.862.4787 Email erin.loari a.own barnstable. a_us DEC 19. 2019 CERTMCA,TE OF EXEMPTION PLANNING&DEVELOPMENT Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Exemption under Section 6 and 7 of Chapter 470.Acts and Resolves of Massadwsetts,1973,as amended,for proposed work as described below and.on plans,drawiags,or photographs accompanying this application: Date (l - r 5 • fl 9 Address of Proposed work, Assessor's Map and lot# S O 'l� House# 2 4 0 t7 Street taw t"S �Village: W LS� 75Q This application Is for an exemption of the proposed cdnstructfon on the grounds that work: ❑ Will not be visible from any way or.public place ❑ 1s within a category declared exempt by the Old Kings Highway Regional Historic District Commission ❑ other �scrgtian.of Proposed W_or�k: �r•.g f'0.� Q �l 0 X �/o s'w v wr.�K-' �0 0 k e, IBat ak O� P%0, e2 if e-2„ k Of ILA e �%cjs�w a .va 2 floisse a, _•s4aee a 4 ro4- kv. a 5 wvw& vtA 0 e rru 4.Q"Wt ww. e"4e- 'VL d t"A� Qr c o w v'Clo w s tz u d Cod's Q� �Q Pons t �� e L%ve r Tel.no. Agentar ant ctor(please pfuitt): Address Owner(please print): CKaje'L' wQ ago o.t/ Tel no. Ownersmailftadd= 4 o d eG or~g e W G!• 1;cL"9& 0"6T Slped,.OwnerfCont m,*r/Ag=t Checklist ❑ Four complete sets of the application and supporting_documentation U $ Filing Fee(sce.attached schodule) For Committee Use Only This Certificate is hereby PRO /DE ED Date: VEE) Committee Membeas Si JAM 0 9 Town of Barnstable Old King's Highway Conditions of approval: Committee I 0121Ezo pltonForm7017 yr mtc ML CURADOSSI a� o..�m..�a.,....�1 . s ®cm.3— JOB 360 Sm —0 BULUGA �•, -� •�• � � RESIDENCE Q }� 00000000 R « Q O O O O uuo ui. 1 e�aw 1 GO. OO., Mid—]OmnLdo5si �' - . -• - Y SCBIG 1��� I��i �� V .Immlmi, Tit 4�� ti L1.0 v 0 0 —.... r; C,Zs_ LANDSCAPE 3�o, o PLAN ID cm Applicati0Wu ber.. 1.1., q Fee ............ . ...................... .................. KAM Building Inspectors Initials........ .. ........................ !�� ,,•� AUG 0 12019 Date Issued................��..!.. .�.��..... .... TOWN O� bARNS f-. L Map/Parcel................. ..D......................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 00 M e d 11t e40 t,«C2 W aV W01 A,.0`z NUMBER VTREET VILLAGE Owner's Name:P__ICQ&z0 v,-a /4 0 7.o zf V'a Phone Number—,0"' 'y s 5 ' 00 6 Email Address: -lo A A G M e- - Co `u Cell Phone Number Project cost$ �, O • U ,0 Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a buildinO nermit in accordance with 80 CMR Owner Signature: Date: TYPE OF WORK Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to S ( )C X c 0 CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR/F THE SUBJECT PROPERTYIS IN A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER....................................................... . *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or> Yes No , if yes, a gas permit is required. Natural Gas Yes No ,if yes,a gas permit is required. If food is being served at.your event please obtain a Health Department approval between the hours of 8:00am-9.30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: KA i F k aNH Xf D /Z 0_e�o vs}- Telephone Number - 5 �� O 1 Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town rnstable. Signature Date 5 •l 5 APPLICANT'S SIGNATURE Signature ate All permit applications are subject to a building official's approval prior o issuance. 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 j� Please Print Legibly Name(Business/Organization/Individual): k A T F X ,, A/!) /"��,Aq Address: 4 O 0 /t4 eetc P 4 o L Ls e (�Q L�lozo 6 8 City/State/Zip: W. o, -IAA f-�Q Seee Phone#: 7':5 S 0 0,6 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' Y P h'• t 9. ❑Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.1p,I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: 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 un r e pains and penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: / .5 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 Contact Person: Phone#: r' Information and Instructions l Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to 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-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia I I Town of Barnstable Building Post This'Card So That it is Visible From-the Street'--Approved Plans Must be Retained onlob and this 64Must be Kept t' Posted Until Final InspectionjHas Been Made. Permit rao. Where' Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-18-2467 Applicant Name: MOROZOVA, EKATERINA Approvals Date Issued: 08/01/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 02/01/2019 Foundation: Location: 2400 MEETINGHOUSE WAY/RTE 149,WEST Map/Lot: 155-045 Zoning District: RF Sheathing: Owner on Record: MOROZOVA,EKATERINA Contractor Name Framing: 1 `y Address: 2400 MEETINGHOUSE WAY Contractor License:T � l 2 WEST BARNSTABLE, MA 02668 {' Est. Project Cost: $2,000.00 Chimney: i Description: re-roof Barnstable solid waste Permit Fe e: $ 35.00 i Insulation: Project Review Req: Fee Paid: $35.00 i Date: 8/1/2018 Final: Plumbing/Gas Building Official Rough Plumbing: Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after"issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained openfordpublic inspecti on for the entire duration of the work until the completion of the same. i Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: v 1.Foundation or Footing '"` Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 7 r Application number.B.-. .... T.Sa...(.. r4 JUL 312018 Date Issued................. n�.ss. -: cc i s��`, 1 (n� ��- � C Building Inspectors Initials.. ............................... Map/Parcel...... ./..5.. ........ ....` ...................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SID1NG/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: Lf o Q 2 �� i•. Qit o t,.s e i v [A), NUMBER ST ET VILLAGE Owner's Name: " � o�t i7d�� Phone Number C / SS S S 0 0.6 Email Address:2aN7S u L M# 6�� IMe - Low- Cell Phone Number 614 95 S.•�;-v 0,C Project cost $ a 0 0 o Check one Residential V Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize /In,4 Gff to make application for a bu4& y4errnit in accordance with 780 CMR Owner Signature: Date: 7 - TYPE OF WORK E-1 Siding 0 Windows (no header change)# 0 Insulation/Weatherization 1:1 Doors (no header change)# Commercial Doors require an inspector's review 51 Roof(not applying more than 1 layer of shingles) f Construction Debris will be going to %�cQ? 5/a ooee o C'J A' tv Q S Ae eK e rd4-4&41 CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. i i f APPLICATION NUMBER............................................................ *For Tents Only* Date Tent (s) will be erected Removed on number of tents total } Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each'tent If food is being served at your event please obtain a Health Department approval between the hours . of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: 1 A- 0 O Telephone Number / `3 S S" 6 Cell or Work number I.understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town o a st e. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. s t� 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 Legibly Name(Business/Organization/Individual): '� -T F_ 7z k' N,# AAO Iz J 8 o L4 Address: 'A H O O .e e C? iU Q City/State/Zip: W. 1� On"I 51 a f ee Me 0 2 'hone#: d t I Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' Y P ty� t 9. ❑Building addition [No workers' comp.insurance comp.insurance. 10. Electrical repairs required.] 5. ❑ We are a corporation and its ❑ p s or additions 3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions LIN myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 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 un r t pains and penalties of perjury that the information provided above is true and correct. Si ature: Date: ' 3 Phone#: (o t 4 5 ' 'S O 'D G 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 Contact Person: Phone#: i F. Information and Instructions s 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 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-72747749 Revised 4-24-07 www.mass.gov/dia USPS?TRACFaNG# First-Class Mail f Postage&Fees Paid USPS e Permit No.G-10 9590 9402 r3615 7305 6412 30 United States: 0 Sender:Please print your name,address,and ZIP+4®in this box*- Postal Service 'TOWN OF BARNST'ABLE BUILDING DIVISION r 200 MAIN S'T. HYANNIS, MA 02601 /ely? _ �i SENDER: COMPLETE.THIS SECTION COMPLETE THIS SECTION DEAERY ■ Complete items 1,2,and.3. A. SignatureI" 90Z i ■ Print your name and address on the reverse X ❑Agent so that we can return the card to you. 1 ❑Addressee ■ Attach this card'.to the back of the mailpiece, B. ei _by(Printed Name) , C.Date of Delivery or on the front if space permits. ' 1: Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑No Gt�, SQa i'nSf��d/eT /rI� II I IIIIII I'll Mail ExpressO Service e teSga Registered I IN III IIII IIIIIII III I III 11dul Signature Delivery 17 Registered r ed Mail Restricted Certified Mail® e9590 9402 3615 7305 6412 30 ❑Certified Mali RestrictedDelivery ppethuvmeryReceipt for ❑Collect on Delivery- Merchandise ❑Collect on Delivery Restricted-Delivery ❑Signature Con irmationT" �._?mncfar_from_sen/1CQlabel) ❑Signature Confirmation __' .. 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Q&A ,�D Building Commissioner BAMS.. 1 200 Main Street Hyannis, MA 02601 ' � Y � iwe-xa�a24 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Notice of Building Code Violation(s) and Order to Cease, Desist and Abate: Ekaterina Morozova and all persons having notice of this order: As property owner or tenant of the property located at 2400 Meetinghouse Way,West Barnstable, Assessors Map 155 Parcel 045 and known as residential structure,you are hereby notified that you are in violation of 780 CMR,the Massachusetts State Building Code Chapter 1 Section 105.1, and are ORDERED this date 5/1/2018 to: CEASE AND DESIST all functions associated with the following violation(s)on or at the above mentioned premises: Summary of Violation: On 4/18/2018 I observed a violation of 780 CMR of the Massachusetts State Building Code Chapter 1 Section 105.1 Specifically,The roof and facade has been removed from a historic barn on the property without a proper permit or historic approvals. Summary of Action to Abate Violation: In order to abate this violation and to avoid further enforcement action by this office,commence immediately upon receipt of this notice the following action: 1.) Stop all work on the accessory barn/garage.2.)Submit an application to the appropriate historic board to perform the intended work. Complete plans are required. 3.)If the approval is granted then proceed to apply for the full building permit describing the proposed work after the appeal period has passed. And, if aggrieved by this notice and order;to show cause as to why you should not be required abate the violation in this notice,you may file a Notice of Appeal(specifying the grounds thereof) with the State Building Code Appeals Board within(45)days of the receipt of this order and in accordance with MGL c. 143 § 100. If, at the expiration of the time allowed,action to abate this violation has not commenced,further action as the law requires may be taken. By Order, Robert McKechnie Local Inspector Town of BarnstableBuilding {: Post This Card So That it is Visible From the 127 �Muetained on Job and this'Card ust be&Keptosted U",1111 final Inspec on Has Been Mapr.iiuc+° Where a Certificate of QeeupancyisRequiredKKsuhBdingshall Noupieduntil a Finlnspectionkhasbeen made. h mit. Permit No. B.-18-827. Applicant Name: MOROZOVA,EKATERINA Approvals. .Datelssued: 03/23/2018 Current Use: Structure Permit Type: Building Siding/Windows/Roof/Doors Expiration Date: 09/23%2018 Foundation: Location: 2400 MEETINGHOUSE WAY/RTE 149;WEST Map/Lot 155 045 Zoning District: RF Sheathing: z Owner on Record: MOROZOVA,EKATERINA Contractor Name Framing: 1 Address: .2400 MEETINGHOUSE WAY, " ContractorLKcene 2 WEST BARNSTABLE, MA.02668 x EstProject Cost: $3,000.00 € � �r Chimney: �� P e Description: 'reroof(stripping _ e . old shingles)` ^��,� a � � rmrt F e: $35.00 replacement windows(5) y} Insulation: Fee Paid. $35.00 g, % F �door(3) 3/23/2018 Final: Project Review Re' q' tt ` ,ter"'4 mb u ing/Gas OR PI k gf` a h . Rough Plumbing: Building Official � ,.. Final Plumbing: , .� ,. This permit shall be deemed abandoned and invalid unless the work authonzedby this permit is commenced within six months afterissuance. Rough Gas: All work authorized by this permit shall conform to:the approved applicabon-!and the approved construction documentsfor which,this permit has-been granted. i bs � �� All construction,alterations'and changes of use of any building and struct111ures shMkbe in compliance with the local zoningtby laws,and codes. Final Gas: r �� � This permit shall be displayed in a location clearly Visible from access street or roadand shall be maintained open forlpublic inspection for the entire duration of the work until the coinp letion of the same Electrical The Certificate of Occupancy will not be issued until all applicable signatures y tFie Building and Fire Officials§are?prowl d onxth permit. Service: Minimum of Five Call Inspections Required for All Construction Work: � � 1:Foundation or Footing� � � b"a� R;��' ;`, � >��,�� .;� �'��: Rough: 2.Sheathing Inspection 3:All Fireplaces must be inspected at the throat level before firest flue lining is installed final: 4.Wiring&Plumbing Inspections to be completed,prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage.Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage final Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department c� Building plans are to be available on site Final: -All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT oF� Town of Barnstable *Permit# U Building Departnt Ve 6monthsfromissuedate Brian Florence CZ 1639• ,0$ Building Commissioner e� '0 200 Main Street,Hyannis,MA 02601 �- www.town.barnst 'Aa'.us Office: 508-862-4038 l�� ?0, Ax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDE ' ' ONLY Not Valid without Red X-Press Imprint �C Map/parcel Number Property Address —A Ll 0 @ � ��t Q o ro` 5 4 �/�• l J o'�`?�/� S' ��� !I Residential Value of Work$ 100 0• 0 Q /� ,Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address�1F7 u it t�ZJ� /v` 0 2-0 V/,J� �,� vc q Jt7 / tee vL4 Ou S2 watt( 1'Vc?` st7 Vl5�� si D26' Contractor's Name Telephone Number l�'ASS' ©off Home Improvement Contractor License#(if applicable) Email: 2ON 3 M it(5 4. Co &--i 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 /V 0,2�.�Q,5 C'V YVLP L-`� wce,- 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 S Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: '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 -re it - SIGNATURE: - Q MPFILESTORMSE)PRESS2017 °FZHE t Town of.Barnstable Building Department Brian Florence,CBO � 1659. `0�iOrEv a 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 I , 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) **Pool fences and alarms are the responsibilify of the applicant Pools are not to be filled or utilized before fence is installed and all final• inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORM&OWNERPERMLSSIONPOOLS Rev: 10/17 Town of Barnstable FIRE rqh, Building Department ~o� Brian Florence CBO L SST Building Commissioner v MAES. $ 200 Main Street, Hyannis,MA 02601 ' s639. �0 'OIFD Ma'1° www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: d JOB LOCATION: O / number street V village "HOMEOWNER": EU4 7- Z I N 141- I+D t O "V q C 5 J S 0 0 6 name home phone# work phone# CURRENT MAILING ADDRESS: C�C. 'I Q - % "" �S e cityhown ' 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 Qerformed under the building yermit. (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 inspe n.procedures and requirements and that he/she will comply with said procedures and requirements Sign of o caner 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 to amend and adopt such a form/certification for use in your community. V The Commomveaith orfMassadiusetts Departwent of ladastrial Accidents Of we ofinvem,91dom 600 Washington,S`tr9eet Boston,CIA 02111 ivmv mas&gov1dia Workers' Cumpensafian Insurance Affiffiavit Bailders/Centr°a,ctarsiEIecfticians/Phimhers Applic mt Information Please Frint F.et�hly Name - k /L`l o v Q Addre= '1 C © vvA.e,��-,;14 9 s _ . i/U e lam, 73 St 214 City/Stately_ (,{1, �� �`L�tS�t 6& l�� OL64h,=4--• 6! 1 s s ;-. ;o 0-C Are you an employer?Checkthe appropriate box: ' 'r of ' {r J� project egged}: I.❑ I am a employer with 4. ❑I am a general conbmetor and I 6- ❑New caasttuction employees(full an&or part-time).* have hired the sub-com twtors 2.❑ I am a sole psnpiietor orpar4aer- listed on the attached sheet I- ❑Remodeling ship and have no-employees . These sub-ccatractars have g_.❑Demolition woddng �for me is employees and have wodcers' ❑ [No wp� 1 9. Building addition reqaire& g'camp_irozance camp.sn¢tvartrn 1 5. ❑ We am a corporation and its 10❑EkChicat repairs or additions 3. I am homeoumer doing all work offiieen have exercised their 1L❑Flumbsngrepairs or addi iens. o work=' right of per MGL 1 repairs insurance gyp-ce eked.]j c.152,§I(4X andwe have no � Roof employees_[No worms' 13 Other cam-==a=required-] 'Aay appHc=z9wtchedsbos ff1—st also ffiloatihe sectionbelowshoviing theirwa&ere cumpensatiaapo&-yinformaaon. Mmemners Who submit this affidasdt imlr— ag they are doing aU wa&anti then hire outside cantxctum ast submit anew affidavit iedirsda sack. ICaut<sct' Scat ebeclt t1¢s baz rnvst attadted n additional sheet sbnnmg the name of fe and state whether ar not those eutides haee employees.If thesnh-ca shmmmnpIoyea;dLe}—sipmvidedLeir w —P.polky"i er- I am art elttployer tlratis providing workers'congmnsagon is ntratzee for mY earpFnywm Bellow is the paficy and job site informadom Insurance CompanyName: Podficy:ff or Self-in&Iic.;k FxpsaatronDate: Job Site Address: City/StawZip: Affach a copy of the workers'compensationpolicydecEaration page(shoving the policy number and expiration date). Failure to secure coverage as required under Section 25A of MQ.c� 1572 can lead to the imposition of ccimffial penald of a fine up to$1,50a 00 andlor one-year imprisonment as weft as civil penalties in the form of a STOP WORK ORDER and a Fhe of up to$250-00 a day against the violator. Be advised that a copyg of this stateme may be forwarded to tlxe Office of ItrvesEigatinns ofthe DIA fakr insurance,coverage veriffeahon. 1rfo Iieraby ceritfy 17 s andpenaItiess gfvarjury that the informaifltx prov&W abatis is true and correct slim tmr: Date: Phone 02tciai use Qttly. Do not write in ores area,to be cmnpWad by city artown oftciat City or Town- PermMEAcense; Issuing Authority(cirde one): 1.Board of Health I Building Department 3.CityYrown Clerk 4.Electrical Fnspector S.Plumbing Inspector 6.Other Contact Person: Phone#• 6 formation and Instructions � 1Ma.s:&=bnsettS Geheaal Laws chapir M req=m all employees to provide workers'compensation far their employes. Pmsaaufto this sib,au=V&yee is defined as.'_-every prdson m the service of another ffid a¢y contract off, eqmmss or implied,oral or writhe." Air Toyer is defined as ran in EVid ual,parfnersbip,associaliamt,corporation or other legal entity,or airy two or more of the foregoing=gaged is aJon Vie,and inchuding the legal representatives of a deceased employer,or the rec Ver or tinstm of an iadividoaI,pa:tnersbip,association or other legal entity,employing CM:Ployexs. However the owner of a dwEIling house having not more than three apartments and who resides therein,or the occupant of the - dweIIiag house of another who employs persons tD do maims m,cons traction or repair work on such dwelling house or on the grounds or bmiCTmg aPpnrfenaiitthereto shOnotbecanse of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every stale 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 cdmpyance with the hLTr ran ce"cov=ge required." Additionally,mar-chapter 152,§25C(7)states-Neither the camn%(rccweallh nor Zay ofits political subdivisions shall enter into any contract for the p erfornaaace of1mblic work unbI acceptable evidence of compligace with the it n-a c6. requmtents of this chapt .have been presented tD the Contracting anfhozify." Applicant Please fill out the workers' compensation affidavit completely,by chug the boxes that apply to you-sitnafion and,if necessary,supply sub-coir[ractor(s)na rp(s), address(es)and phone-m- e(s)along with their ctrtlacate(s) of insraance. Limited Liabiity Compaines(LLC)or LimitedLiabr7ity Partrimmbips(LLP)with no employees other than the members or partne as,are not regtmrd to carry workers' compensation insu r am If an LLC or LLP does have employees,apolicy is reqrrired. Be advised that this affidavit may be snl�itied to the Department of Industrial Accidents for confirmation of iosurm.=coveragm Also be sure to sign and date the affidavit The affidavit should boratorned to the city or town that the application fur the permit or license is being requested,not the Deparme at:of . In±astrial Asa mts Shouldyou have nay gnestions regarding the law or ifyou.are required to obtain a wor3�ers' compensation policy,please call the Deparimeut at the number listed below. Self-insured companies should enter their self—insurance license number an the appropriate lme City or Town Ofd als t _ Please be sure that the affidavit is complete and pried.legibly. The Department has provided a space at the bottom of the affida. for you fn fill out in the event the Office oflavestigations has to contactyou.regarding the applicant Please be sure tD fill in the peunit/licemse number which will be used as a refer mce number. In addition,an applicant that must submit multiple pezmifMcense applit zfi=in any given year,need only submit one affidavit indicating current policy information(if necessazy)and umder'Job S`>te Addre-ss"the applicant should write"all locations in (�Y or town)-"A copy of the affidavit that has bees 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 fnt m *pe nits or licenses- A new affidavit must be filed oil each year.Where a home owner or citizen is obtaining a license or pemit not related.to any buisincss or commercial venture (Le. a dog license orpei nit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to Ihamk 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,11:1ePhone and fax nzonber Tho tie of Masmch Depailmmt ofTndis dal Accidents ice of Investikatjo= 654-Wn Sulu . Tf,-L#617 -4900 I=t 406 ar 1-97 MA&WE Fax#617 727 7M Revised 4-24-07 F�C� YOU WISH TO OPEN A BUSINESS? ti For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Maid St., Hyannis. Take the completed form to the Town Clerk`s Office, 1 st FI., 367 Main.St., Hyannis, MA 02601 (Town Ha[[)and get the Business Certificatethat is o required by law. a DATE:�'°�6` 6 Fill in please: a APPUCAIrT'S YOUR NAME/S. o ti Lk 4-1l.( G USINESS YOUR HOME AD RESS: t-P 0000 TELEPHONE # Home Telephone Number (i f :7- • o SS NAME OF CORPORATION: L_ )kA, Iltl NAME.�F.N hLBLISINESS C� S �,e.,e.. v�rMGwL TYPE OF BUSINESS 1STH1S A HOME OCCUPATTON.__ ____ R you w4� ���� .YES 11I0 1 /� �/ ADDRESS OF 13USINESS�NO o 'vK2 a-zc t *AAP/PARCEL NUMBER (Assessing] When starting anew business there are several things you must do in order to be in compliance with the rules and regulations of the Town of - Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (comer of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO ISSIO ER'S OF nj This individ at h n i tee i re ui ments hat pertain to this type of busines UST COMPLY WITH HOME OCCUPATION u or d igria e** RULES AND REGULATIONS. FAILURE TO MFu9EN QQMPLY MAY ! I IT� ✓ o� 2. BOARD F LTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature*" COMMENTS: • z I 0 I 3. CONSUMER AFFAIRS (LICENSING AUTHORITY] This individual has been informed of the licensing requirements that pertain to this.type of business. Authorized Signature COMMENTS. i own of barnstabie oFt„E rq� Regulatory Services �y` o Richard V. Scali;Director Building Division 4Axtasr LE,KAM vcb 1639. � Tom Perry,Building Commissioner prEn�nnt" 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: . '(„ HOME OCCUPATION REGISTRATIONT�f Date Name: /U 3 tk ,✓( i/ G Phone#: 6 �^'� d( . Address o Lf 0 O L�� `u �/l u 3 P i�J c� Village: Name of Business: l-Q S eo,vt o�S �( O\n.LC LE -yAE 70 V e-W e—L' Type of Business: COUL S�2:t G r`°u Map/Lot: IIN'I'F1V - It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor,no visual.alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such'use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment • There are no commercial vehicles related to the Customary Home Occupation,other than one van dr one pick-up truck not to exceed one ton opacity,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 I,the undersigned,have and agree with the above restrictions for my home occupation I am registering. Applicant; Date: > 1,6 Homeoc.�Rev 13 �( O,o w� � �o c,L \N QZ. S e2 0- vio( 4beq �A- ► �" � �2 mow(, �� p 4- C/lq 6-e, ck jo o,v e- V,/o CpA- Peoej.i� �1 CO AAA- Q V 0 u W LL 1 je �o� CONSTRUCTION SUP-:E1'd-MI-S-Olt-- Ir1C!~NlS� @VfG�}CAM�MA-TIO:N :. Sample The following sari ple.questions may..be useful to:review for the style and type of L/dlE'S�101tS question formatting that may be used m your exam The:coerect answers to these questions are provided at.the end of the`set of sample questions. I. Day-care centers shall be classified.as which:of 4 In an.;approved fire'window, 1/4-inch wired the following Use Groups? glass'is limited to a maximum area of (A) 1-1 (A) 100 sq: in. (B) I-2 (B) :144 so. in. (C) I-3 (Q.720 sci—in. 2. What is the minimum allowable prescriptive 5 All of the following statements are true about envelope wall R-Value for a two-family dwelling? the`testmg of.concre,te except (A) 38 {A} Laboratories that perform,concrete testing (B) 20 - must be:licensed. (C) 13 - (B)• Personnel who perform field concrete testing (D) 9 must be licensed.,: (C) Field concrete testing must be witnessed by a 3. What is the Basic Wind Speed for a single-family registered architect or,engineer. home in the town of Mashpee? " (D) Concrete.cylinders are used to test compressive strength of'concrete. (A) <90 mph . (B) 90 mph (C) 100 mph Answer Key 1 D; 2. B;., 3. D; 4. D; 5. C (D) 110 mph Page 1 of 3 Client Detail with Addl Pics Report Listings as of0l/14/16 at 10:29am Active 01113/16 Listing#21600304 2400 Meetinghouse Way,West Barnstable,MA 02630 Map Listing Price:$529,000 County: Barnstable Property Type Single Family Property Subtype Single Family r � Town Barnstable Beds 4 Approx Square Feet 3147 Assessors Records Baths FH 3 2 1 Year Built 1807 Lot Sq Ft(approx) 70567((Field Card)) Tax ID BARN-155-045 Lot Acres(approx) 1.6200 AIL } 4 Ott•, t E ; I W1J a 'tiQ rr y., :sAZI L3ji" Yi http://ccimis.rapmis.com/scripts/mgrgispi.dll 1/14/2016 Page 2 of 3 L /1 L 14 IL 011 r' Q Directions Rte 6A to Rte 149 Or Rte 6 to exit 5,Rte 149 to Meetinghouse Rd#2400 on right side going north. Public/Internet Remarks West Barnstable just off Rte 149 Exit 5,Short Sale opportunity to secure a grand c 1807 Federal Colonial on 1.62 acre lot,4 bedroom,2 1/2 bath,4 fireplaces, needs new owner's finishing touches,3 car garage,large rooms with high ceilings awaits your impending arrival.Sale subject to third party lender short sale approval. Location Description South of 6A Street Description Paved Special List Cond. Short Sale Zoning residential Year Built Desc. Cer.Historic, Renovated Total Rooms 8 Total Levels 2 Level 1 Baths 1.0 Level 2 Baths 2.0 Basement Yes Basement Description Full, Interior Access Foundation Stone Irregular No Topography/Lot Desc. Interior,Level Association No Garage Yes #of Cars #3 Garage Description Detached Year Round Yes Separate Living Qtrs No Waterfront No Water View No Convenient To Conservation Area, Horse Trail,House of Miles to Beach 1 to 2 Worship,Major Highway,Shopping Beach/Lake/Pond Sandy Neck Beach Water Access Bay,Beach,Harbor Beach Description Bay Beach Ownership Public Fireplace Yes Number of Fireplaces #4 Floors Wood Interior Features Dry/HU-E,HU Washer Style Colonial Style Description Antique Pool No Dock No Energy Saving Feat None Exterior Features Yard Roof Description Asphalt,Pitched Siding Description Brick,Shingle Heating/Cooling 3+Zone Heat,Hot Water Water/Sewer/Utility Cable,Septic,Electricity,High Speed Internet, Town Water Hot Water/Water Heat Natural Gas Warranty Available No Publish to Internet Yes Annual Tax $5026 Tax Year 2016 Land Assessments $173600 Improvement Asmt $279300 Other Assessments $87000 Total Assessments $539900 To Be Assessed No Special Asmt Pending No Mass Use Code 101-Single Family Title Reference-Book 22521 Title Reference-Page 243 Underground Fuel Tnk Unknown Lead Paint Unknown Asbestos Unknown Flood Zone Unknown Presented By: John C Weld Jr Joly, McAbee &Weinert Lic: 120306 Broker Lic.:9059427 Office:508-394-2880 909 Route 28 South Yarmouth,MA 02664 508-394-2880 Fax: 508-394-6511 E-mail:Johnweld@capecodjmw.com See our listings online: January 2016 Web Page:http://www.capecodjmw.com http://www.capecodjmw.com http://ceimis.rapmis.com/scripts/mgrqispi.dll 1/14/2016 1 Official Website of The Town of Barnstable - Property Lookup Page 1 of 3 i Select Language Assessing Division Property Lookup Results - 2016 367 Main Street,Hyannis,MA.02601 <<BACK TO SEARCH<< QiPrint Friendly Owner Information - Map/Block/Lot: 155 / 045/ - Use Code: 1010 Owner Owner Name as of 1/1/1 5 WOLFSTON,ELIZABETH Map/Block/Lot G/S MAPS 47 FIRE STATION AVENUE 155/045/ i I � Property Address OSTERVILLE,MA.02655 2400 MEETINGHOUSE WAY/RTE 149 Co-Owner Name Village:West Barnstable Town Sewer At Address:No ' GIS Zoning Value:RF Assessed Values 2016 - Map/Block/Lot: 155 / 045/ - Use Code: 1010 2016 Appraised Value 2016 Assessed Value Past Comparisons Building Value: $279,300 $279,300 Year Total Assessed Value Extra Features: $41,000 $41,000 2015-$599,200 2014-$599,700 Outbuildings: $46,000 $46,000 2013-$606.800 2012-$610,100 Land Value: $ 173,600 $ 173,600 2011 -S 593,500 2010-S 597,900 2009-$612,000 2016 Totals $539,900 S 539,900 2008-$619.900 2007-$618,000 Tax Information 2016 - Map/Block/Lot: 155 / 045/ - Use Code: 1010 Taxes W.Barnstable FD Tax $ 1,446.93 (Residential) Fiscal Year 2016 TAX RATES HERE Community Preservation Act $150.79 Tax Town Tax(Residential) S 5,026.47 E 6,624.19 Sales History- Map/Block/Lot: 155 / 045/ - Use Code: 1010 History: Owner: Sale Date Book/Page: Sale Price: WOLFSTON,ELIZABETH 2O07-12-07 22521/243 $675000 SKLAREW,PAUL R&BARBARA B 1993-09-1 5 8807/159 $267500 DAVIS,JOHN A&SANDRA P 1976-09-15 2392/1-41 $0 Photos 155 / 045/ - Use Code: 1010 http://www.townofbamstable.us/Assessing/propertydisplayscreen 16.asp?ap=0&searchparce... 2/1/2016 Official Website of The Town of Barnstable - Property Lookup Page 2 of 3 + Sketches - Map/Block/Lot: 155 / 045/ - Use Code: 1010 t o 4BAS 5 PTO �• ; i 93 t17 19}l eSFUS 7 t BAS BMT 31 i 42 ,pq AS Built Cards:Click card#to view:Card #1 1 Constructions Details - Map/Block/Lot: 155 / 045/ - Use Code: 1010 I i Building Details Land I Building value $279,300 Bedrooms 4 Bedrooms USE CODE 1010 Replacement Cost $398,945 Bathrooms 2 Full-1 Half Lot Size(Acres) 1.62 Model Residential Total Rooms 8 Rooms Appraised Value $173,600 Style Colonial Heat Fuel Oil Assessed Value $ 173,600 Grade Custom Plus Heat Type Hot Water Year Built 1807 AC Type None Effective depreciation 30 Interior Floors Pine/Soft Wood Stories 2 Stories Interior Walls Plastered Living Area sq/ft 3,147 Exterior Walls Brick Veneer Gross Area sq/ft 5,549 Roof Structure Gable/Hip Roof Cover Asph/F GIs/Cmp Outbuildings&Extra Features- Map/Block/Lot: 155 / 045/ - Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed Value FPL3 Fireplace 2 story 2 $9,300 $9,300 FPO Ext FP Opening 2 $2,500 $2,500 FGRB Gar Ave w/BMT 1050 $35,800 $35,800 PAT2 Patio-Good 801 $6,400 $6,400 FOPC Open Prch-roof, 50 $2,400 $2,400 ceiling BMT Basement-Unfinished 1551 $26,800 $26,800 FPIT Fire Pit l $3,800 $3,800 Sketch Legend Property Sketch Legend B2N Bam-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor,Living Area FTS Third Story Living Area(Finished) SOL Solarium BMT Basement Area(Unfinished)FUS Second Story Living Area SIDE Pool Endosure (Finished) BRN Barn GAR Garage TOS Three Quarters Story(Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLIP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) http://www.townofbamstable.us/Assessing/propertydisplayscreenl 6.asp?ap=0&searchparce... 2/1/2016 No -iWA . t is y- arAl F! • .: J F t fe Yt. S y ����� my� • .jly7 _ ¢1,4 Alt � m - s� t 6 14 1 r �� "�• J w:; .y '.^?.•}•.,i� .y;� mot, �•� "7' �'yj�,i�..•5. n�� w �. I ,� .....�e..r,,.y,`! .. ;✓ i - L,. r .N—� �( ;M. Y�,a;- _ f i n ��� � �'� �-� �� � ��� ++ ���`►� ��, WA a�_ N {MO MET (,R.P��`' 3 o a,ArldM° �► 'e� lk' All AN rw RA +,'4jT� '.f�f� gyp' • �p ' rA�A At ` pair •� �rdP �` �,y ,' 6i WIN as. t. tp lrYO Sp3" ALI I 4. A r, { M 1 �� ,ty�•: { ice` a"m' r *� ATE f F y w�i. r/X.Y .� r•C'" ..s. :+ r�> a-mil` 6r.� C ea . `st+i +*_ • fy_, }• -��� LIM 0l 5 ' :.,,1� ` :y, �1+'� fy r�p�J♦S"f it � `/ _!k •11 •y{ ' - it � 1 •. - �_ / .4,j ff.'ns � � � u•+�yy��d-0.a.. � i �_�a j,OFl .�"C1yy i � l� I :-•`�',,.,. �.;� ��'�'r' �� °��w -•'lam - - -. - 1� �VV * � ���� IV. -Anew At: Nk N, w_ e•NAi, , k OOR P"A 4 w ap 46 IF ova wkl: wn SP W-n 'Ail I tk ref T. I jp or, AIN WOW- !;imp RV Imp ISO �-c PAP. e)qolc-� -A-.0 -VA 'o, A AN X!, oft --MWACi� p've ral At < 1 N a — a; I r ` ..�. � _...�.a-.,+air � -n•,.:�' - �. _-...,y t - ...ate—• y F T } m-' ���� - ��v � IL Town of Barnstable *Permit# t t V Expires 6 months from issue date Regulatory Services Fee �18t�IVM _�O Thomas F.Geiler,Director "building Division 9001 6 I )�m Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 �� � d .town.barnstable.ma.us >ffice: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X Press Imprint 'parcel Number crty Address o?qoo /t-1, xv / Aus'e 4td-Y .esidential Value of Work Minimum fee of 25.00 for work under$6000.00 er's Name&Address Pau �Q r'Q 2100 ractor's Name &e e �'�s ��"``��'��� Telephone Number S O�T 3t5°®a a 7 Y 9 to Improvement Contractor License#(if applicable) l 41 E Z 816 ppiiea�l„) - - - Jorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ',P❑�am the Homeowner i have Worker's Compensation Insurance rance Company Name L/'/ e,-, y i9l kman's Comp.Policy# ke/C-e-2,3 Z-5? -3 3 9 9 e 7 623 J y of Insurance Compliance Certificate must be on file. nit Request(check box) 62/Re-roof(stripping old shingles) All construction debris will be taken to-7 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Owner must sign Property Owner Letter of Permission. A co f the Home Improvement Contractors License is required. NATURE. `� -- rms:expmtrg se061306 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111' ww'Mmass.gov/dia Workers"Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Iudividual): . &e- Address: l3 O Te'cA� _3 V4 City/State/Zip: !�//l a k"4S' 026Grphone.#: Are ou an employer?Check the appropriate box: 4. I am a general contractor and I :Type of project(required):, 1,l�1 I am a employer with � ❑ 'employees(full and/or part-time).* • have hued the sub-contractors 6. ❑New construction . 2.[ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp. insurance. 10. •Electrical re airs or additions required.] 5• ❑ We are a corporation and its ❑ P officers have exercised their '3.❑ I am a homeowner doing all-work . 11.❑Plumbing repairs or additions . m self o workers' co right of exemption per MGL Y � n?P• 12.Rf Roof repairs insurance.required.]t c. 152, §1(4),and we have no employees. [No workers' 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 are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant 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.#: �6.C2 31S'33 9 96 703J_ Expiration Date: 10 028 Job Site Address. a yd O'• �/��/ /�cLep City/State/Zip:_ 9,,a 1--r A ZIP, AjOt-. Attach a copy of the workers' compensatio olicy 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby certify er pains and penalties of perjury that the information provided above is true and correct. Signafore: Date; Aa /�P g Phone#: SD9 360 ' o� Official use only. Do not write in this area, to be completed by,city or town officiaL City or Town: ' Permit/License# j Issuing Authority(circle one): A.Board of Health 2:Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: l 1.�lU�gll�.i;lU11 A.11(,l illJ�.l il�:�iVil<� . 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 ehapter.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 ofcompl aaee withilie 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-conti•actor(s)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members*or partners,are not required to 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 Tow[i 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 permivUcense number which will be used as a reference number. In addition,an applicant 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 (cityror 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 io any business or commercial venture (i.e.a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have-any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. The Cor=oi twealth of lvlassarrhusetts Department of Industfal Accidents ' Office of fnvew-ptionEs 600 Washinpri Street Boston,.MA 02111 T0. #617-727 4900 ext 406 or 1-877-MASSAFE Fax#617-727-77-49 Revised 1I-22-06 www.mass.86V'fdia Town of Barnstable Regulatory Services rrSTABIA ` Thomas F. Geller,Director MASUS 9� a6g9' Building Division Tom Perry, Building Commissioner 200 Main Street,.Hyannis,MA 02601 Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder l,C as Owner of the subject P ro erty l p hereby authorize C fts+-R cq CIH V to act on my behalf, in,all matters relative to work authorized by this building per nit application for: a� (Address of jot) �a /9 Signature of Owner Date Print Name Q:FORMS:OWNERPERMIS SION Of ' 9BiSf�afRpv,Megv/a�ion� �. qa ��a . n 7 �T C a4as. �� �. 9,g ON IN � �81 86 TcT, as~ds yYq Fq ST q2y a NINE KIL �R • r Town of Barnstable oF�Tor._ Regulatory Services %I•o Thomas F.Geiler,Director Building Division sMwsrnsr. , Mara �* Tom Perry,Building Commissioner s639. �0 'OTFp t,�pl s 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 08-790-6230 Approved: 5 Fee: Permit#: HOME OCCUPATION REGISTRATION Date: 12 Name: P1(1,Vb 0,VGL SK i Ol Y)ek%) Phone#:n 36 Q-:7�9 �D Address: 4W Mab uL(2�.MAZ.e Village: W. Name of Business: �1-C OU&LW / LUW Sty 16v1 del l�S LeftS Type of Business. CV— h U/fat16) S Map/Lot: 15 S 4EFF8i n Zoning District Zoning Disd RC-1 require Special Permit from Zoning Board of Appeals. 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 8,Y following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • - Such use occupies no more than 400 square feet of space. • 'There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. 6kt)aa Applicant:� ) Date: Homeoc.doc Rev.5/30/03 DATE: -- -- Fill in please: APPLICANT'S P, ��� • YOUR NAME: �3c�V(� BUSINESS YOUR HOME ADDR SS: aw- ' TELEPHONE - Telephone -__._. _... ...._ ......_......:__. h e Number Home � � Nr,461-J LnN'L,vnF: } cm:ry ud...,i F;u:'!u 4a:•rJ;;:?;,,,v,;;,,,�;'r.,:t:, ...:.................:... ... ,. ,o �: ... .. ..... ..,. h,4. il': J .h .,. i ,�„I. 'h', ,+ .x i !1 !G.a_. .p.:^� 4:xr!L a:m:!wn�:�:.r;-nanx:Pm•d:xlw...,. .,:x:' � - v I _ , .. vl:. .:. . E, .._:. ,...: _ .. .:. r :.•�.. ,,;I,;t,., .. �,:�ds!'dr 8:,..�'L''..r :'h.,!'L!!4LIV E�_. ��i '.':'=,�"� :!•��...._..:, .:(I:L� �.1�_��: ..�. ....c.:l.�'..�.! M :_L,... ..• .. u—• :... .. ......:.ih,: _ �._:ln�_v.:-'v5]:v�. 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Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. — (co er of Yarmouth . & Main Street) and you will find the following offices: 1. BUILDING MMI S1O ER'S This individuakfias begn in med Zimit r quirements that pertain to this type of business. o ed Sig ture"* , COMMENTS: — 2. BOARK OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature" COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature" COMMENTS: Business certificates (cost$20.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. "SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# Health Division e1d' Zp,,V--4V Date Issued Jt5'-u —� � n Conservation Division .�� s' �� ®� • Fee Tax Collector $/f$ . Treasurer. -, � � -.'flC SEPTIC SYSTEM Gt UST BE Planning Dept. INSTALLED IN COMPLIANCE WITH TITLE 5 ' Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS i Project Street Address 2400 Meetinghouse Way Village West Barnstable I Owner Paul and Barbara Sklarew Address same Telephone 5nR-362-77gF + Permit Request Bathroom Remodel nF Square feet: 1st floor:existing 1200+ proposed 0 2nd floor:existing 1 nnn+ proposed o _ Total new n Estimated Project Cost 20K Zoning District Flood Plain Groundwater Overlay Construction Type Residential Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 11 Two Family ❑ Multi-Family(#units) Age of Existing Structure 100+ Historic House: ❑Yes %l No On Old King's Highway: )7 Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout EN Other Partial full and crawl Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft) -�nn+ Number of Baths: Full: existing 2 new 0 Half:existing 2 new Number of Bedrooms: existing 3 new 0 Total Room Count(not including baths):existing 7 new 0 First Floor Room Count 4 , Heat Type and Fuel: O Gas 0 Oil ❑ Electric ❑Other Central Air: ❑Yes )]No Fireplaces: Existing 1 New 0 Existing wood/coal stove: ❑Yes ❑No Detached garage:10 existing ❑new size 500 Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:O existing ❑new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes a No If yes, site plan review# Current Use Residence Proposed Use Residence BUILDER INFORMATION Name OHC Inc dba The House Company Telephone Number 508-771-0303 Address PO Box 1166 License# CSO42406 Barnstable, MA 02630 Home Improvement Contractor# 100932. Worker's Compensation# WC 7 9 3 5 9 2 6 ALL CONSTRUCTION DEBRI ESULTING FROM THIS PROJECT WILL BE TAKEN TO Rnu rn e La n d f i I I SIGNATUR DATE It 00 ' FOR OFFICIAL USE ONLY '. PERMIT NO. DATE ISSUED, MAP/PARCEL NO. ADDRESS i VILLAGE ` OWNER• .z ear • DATE OF INSPECTION FOUNDATION Al FRAME INSULATION r FIREPLACE _ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH ' ' FINAL GAS: 'ROUGH •X ', FINAL FINAL BUILDING DATE CLOSED OUT _ ASSOCIATION PLAN NO. ' nO CAR Apprndi=J �E Table JS.Z1b(continued) �i prescriptive packages for One and Two-Family Residential Buildings Seated witb Fond Fuels MAXIMUM MIMMUM 8 well Floor Satemmt Slab Heating/Cooling Glazin Glazing EffiaencY Ana'(%) U.valueJ R-value' R-value' R value' wall paioa� �Fmm ftkaa_e R-value' R value 5701 to.6500 Heating Degree Days' Q 12% 0.40 3E 13 19 10 6 Nonce[ R .12% 0.52 30 19 19 10 6 Noma! S 12% 0.50 38 13 19 10 6 85 AFUE T iS% 036 78 13 23 N/A N/A Noma! U 1SY• 0.46 38 19 19 10 6 Norval V IS•iG 0.44 3E 13 25 N/A N/A 85 AF[JE w 15% 032 30 19 19 10 6 ES AFUE X 19% 032 38 13 25 N/A WA. Nomad Y 18% 0.42 3E 19 25 N/A N/A Norval Z .18% 0.42 f 38 13 19 10 6 90 AFUE AA I S% 0-50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: 2400' Meetinghouse wLa_I West Barnstable, MA 02668 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q-AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. N/A-Interior renovations only . 64 feet squared of exterior wall will be insulated w/ R-13 Fiberglass batt insulation BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-080303a e � . tom' v l i \ Ori m � c N „y, m J IN 3'-11" SKLAREW BATHROOM REMODEL THE HOUSE COMPANY SCALE 1/4" = 1' - . 6/7/00 aF IME The Town o f Barnstable . • sUwsTABL& • 9� "M �0 Department of Health Safety and Environmental Services i0rE0Ma'tA Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-403°8 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. TypeofWork: Bath oom RPmnr3a1 _Estimated Cost ?nu Address of Work: 2400 Meetinghouse Way W. Barnstable Owner's Name: Barbara and Paul Sklarew Date of Application: 8 18—0 0 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$11000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. IGNED UNDER PENALTIES OF PERJURY I hereby appl r penyit. a agent of the owner: K�4 /i I lq�l ��k c 1.00932 Date Contractor Name Registration No. J re Goldstein, OHC Inc OR Date Owner's Name q:fomis:Affidav The Commonwealth of Massachusetts 5.. =- =v Department of Industrial Accidents CA 01Bce ol/aaestl�atloos 600 Washington Street Boston,Mass. 02111 Workers Com ien� ��davit name: Barbara and Paul Skl arPw - location: city YWest,,, Barnstable MA 02668 phone# 362-7796 ❑ I am a homeowner peri®�u n all work myself ❑ I am a sole roprietor and have no one workin cavacitv %2. ////%/G%/%////%%%%%%%/%%/G%%���% %%%% /%%%/%%%/D//%%%%%%%%%/%%%%%%%/%/%/%%%%%%/0���/%%%%//���/G%///%%�%%/%%%%�%%%. I am an em 1 rovidin workers' compensation ® P�P...............g......................:::::::::.:.::.:.:.::::..................::::::::::::::::::::::......:..::::.::::::.........................................:::..:::.:::::::::::::::::::.::::::::::::::.........::: COmQ anv name H ... rilalre orrr �-- ....... 8 :::: :<:::::>:«:<::>:::>.. one#?;<::::>::: a 1 �r-rtt....... ..........::::.MA...:El � ah -- :.; oli e.az.�'i�::::::::..::::,::::....... ............ ...... %/ ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have compensation on olices: the following workers P ::.::::::::::.::...:;::.:;;:;<.;:.:.;:::.:.;:.;:.;;:.;:.;:.;:.:.;;:.;:.;;:.;::.:;:.;:..;;;:;:::.;;:.;;:::<:«<:> ......>;:<...«<:::::>::»: g........................ .............::::::.::::::::::::.:....:..:::::::........................ cam anv n XX- addres ...............::.:.:::::::.......... •:.F:; ::a::::.: -�e totr:•iiii:::;::}::i•:ii:{i•:i:ii:•i.vi:i?.v::iii:•i.�:v::vi•ii}::v:v.^iiiiii:::. iii:i:i•:�ii:•i:�i: :::.:..... ................................... ....::::;:•:::::::•:::::•::::::.ter::w:.v:::isSii:•::::::isviiiiO:Jiiii}}iii:•:i4iii:�ii::Ji'r:::Jiiiiiii:..iii:• 'ri�i:�iiiiTtJiiii:�iiiiiiii$isiv:�iiiiiii:;{v�::::::::::...................:......w::>::+.^:y:.:::•::::::•}:.... ... .............. .............f....... v::.:.�::•::.:n•.i'.i}?:^i:?i%:3iiiii?i:i::::�::::::iiiiii:^iiiii::::n:i.::r::::.�::::::::::.�::.�:::: +'iii:i•ii::::::::•:.iii:.::.i}?:4:.�:::::::::::m:.iii:•%•iii}ii;;?i_ i:::1:iiiii::J%}:iiiXii•isi•i::•ii::biiiii::::S::t:::is�iii;ji:�:�i::iii:::i::»<::v:i:<::::t:: #'::�:..v.:.:::::.:•.r..:.:.:.:..^..:...:.�::::::+�::::.:::::::::::.�::.:...........�::.::::::::::::.:: c sav :::»: '::::::<:> ...... X. a tes <'"`'`b� of?' `<.` ' '>< ` < >'< ` >'.>:`>< > :::::::::•:::: ::.:...:.;;::•;;;;;:;:•;;: ;;::;•;;: .....::; ::..:::::::•:::::::::::::::::::::............... ........ ................................................:::::...:............... ................................... .... M. j Fafiore W accost coverage as required ender Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,00.00 and/or one years'imprisorrmmt as weII as civfi 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 fo to the Office of Iavestlgatioa�of the DIA for coverage verification, 1 do hereby certify under the and penalties ojperjury that the information provided above is trrw and correct Signature Date Priest a GoldsteinPhone# 508-771 —0303 MINX official use only do not write in this area to be completed by city or town official city or town: permit/liceme# ❑Building Department ❑Licensing Boenl ❑check if immediate response is required ❑Se alth Dn's Office '(]Health Departneat contact person: phone#; ❑Other Ormed 9195 PIA) ,� Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 .Home improvement Contractor Registration Registration: 100932 Type` Privat orpor ion Expiration: 06 4/200? OHC INC. DBA/THE HOUSE COMPANY„ Jeffrey Goldstein 30 PERSEVERANCE WAY UNIT 213 Hyannis, MA 02601 Update Address and return card.;Mark reason for change 7 Address ❑ Renewal Employment Lost Card Board of Building" Regulations One Ashburton Place, Rm 1301. Boston, Ma* 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 03/18/1947 Number: CS '042406 Expires:03/18/2002 Restricted To: 00 JEFFREY GOLDSTEIN PO BOX 1166 BARNSTABLE, MA 02630 Tr.no: 18627 Keep top for receipt and change of address notification. 1p ie V�o�irrra�uuea� a�✓��aasac�tet6e� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS O42406 Birthdate:.03/18/19 Expires: 0 /18/2002 Tr. no: 18627 Restricted To: 00 - . JEFFREY GOLDSTEIN _ PO BOX 1166 (. •«�►�i / BARNSTABLE, MA 02630 Administrator 4 mtc MLCURADOSSI! MA 02M _ � Iv �.yl. I• • +. �f�ij L � � OW�ImI® IDCmM00 Q �JPI/ �D�/ `/ ROK�,� � W • Q' BULUGA I ;:`�/;f/%" -1 RESIDENCE Batbk MA C' �S '� OOOOOODO. i1 OGG G. 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