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1125 SERVICE ROAD
/la S Serevrc� r�o�� �' 1a0rfl, Town of Barnstable 0 Regulatory Services • BAMSTABLE, v Muss. g Thomas F. Geiler, Director �A s639. 10 'E039 6. Building Division Thomas Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 October 23, 2007 Stephen P. & Carol J. Cobb 1125 Service Road W. Barnstable, MA 02668 Dear Mr. & Mrs. Cobb: Enclosed is the Certificate of Occupancy for your family apartment. Sincerely, Lois Barry Division Assistant Enclosure faco �`"E' � Town of Barnstable ' Building Department - 200 Main Street ELAMST"LE, # Hyannis, MA 02601 MASS. �' (508) 862-4038 1639- A Certificate of Occupancy Application Number: 200701512 CO Number: 20070235 Parcel ID: 153038 CO Issue Date: 10115107 Location: 1125 SERVICE ROAD Zoning Classification: RESIDENCE F DISTRICT Village: WEST BARNSTABLE Gen Contractor: NICKULAS BUILDING CO. Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: FAMILY APT TO S. P. & C. J. COBB FOR ARCHIE & IMGARD HEATH, PARENTS 0-7 Building Department Signature Date Signed I f♦ N .i TOWN OF BARNSTABLE .: t CERTIFICATE OPF OCCUPANCY PARCEL I'D 000 .000 097 GEOBASE ID ADDRES-Sr 1125 SERVICE ROAD r PHONE WEST BARNSTABLE, MA ZIP .02668- •LOT 4 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT PERMIT -r 27354 DESCRIPTION CERTIFICATE OF OCCUPANCY PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: N I CKULAS BUILDING CO. Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES:. THE BOND $.00 CONSTRUCTION COSTS $.00 756 CERT.IFICATE OF OCCUPANCY 1 PRIVATE PIs�'' ?EBARNsi'ABLE, ; a t MASS. 1639. A� ED Mld BUILD SI BY DATE ISSUED 11/25/1997 EXPIRATION DATE BUILDING PERMIT RCEL ID 000 000 097 GEOBASE ID DRESS 1.125 SERVICE ROAD PHONE WEST BARNSTABLE, MA ZIP 02668- T 4 BLOCK LOT SIZE { DEVELOPMENT DISTRICT RMIT 25403 DESCRIPTION 2STORY FULL CAPE//ATT.GARAGE/W. BSMT(SEW97311 AIT- TYPE BUILD TITLF NEW RESIDENTIAL BLDG PMT NTRACTORS: N I CKULAS BUILDING CO- Department.ofHealth, Safety cHBc'rs: and Environmental Services 'CAL FEES: $413.97 VD ' $.00 Oki ISTRUCTION COSTS $133,54:0. 00 � 11 SINGLE FAM HOME DETACHED 1 PRIVATE P I • ■ARNSPABL& :dBR NICKULA S BUILDING, INC. , i6 ' DRSS$-.. A p.0- BOX 507 BUIL V N M' $ARNSTABLE, MA n B DACE ISSUED 09/03/1997 EXPIRATION DATE HIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN- �OACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR !; EY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS 'ERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. ►VINiIU . OF FOUR CALL INSPECTIONS REQUIRED ALLYCONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE INUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- -(READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. j USULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. `'•:9t41NAL INSPECTION BEFORE OCCUPANCY. - • BUILDING INSPECTI N A PROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS At 2 2 2 l s �- 3 ,�7 (f 1 HIEATI G 114SPECTift APPROVALS ENGINEERING DEPARTMENT hl 2 BOARD OF HEALTH OTHER: it SITE LA REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIe PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA I TIOP. NOTED ABOVE. TION. . 1 _ 1 i I i 1 N - I O O O O ICJ 1 O O O O Y I IS! In LC] M1 U co to O W CD H H U W Z Lu 4J J W O 1 co K cmE CD 1 m i • H- � K W O O I � W •- F 2� W H ¢ N O 1 ¢ W } ¢ O C/) F. 1 d W O uj W ¢ CO M Qf 1 W H H E Ot U Z Z W W d H m I d ¢ ¢ U ¢ d. d - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION • t . Map Parcel ' ''ALE Application#aOO-7y Health Division NA R 1 kt C Conservation Division �, _ Permit# / `�o Date Issued Tax Collector -/. /S/ /.f`----..� Treasurer Application Feed• o 0 Planning Dept. Permit Fees` a o Date Definitive Plan Approved b Planning Board Historic-OKH Preservation/Hyannis Project Street Address �//Z `�� j//�P� dGt c� Village . 1 rig. Owner, Address ZZ Z Telephone S"—�) ",� �, /7 tIn 7 ,9, Permit Request ��r�i Square feet: 1st floor:existin proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type !-J O co Ae a4 2 =h_,,,oL2D Aecc k Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting docur�ntation. Cobb's Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure CJ Historic House: ❑Yes *0 On Old King's Highway: ❑Yes to Basement Type: Oull ?,Crawl Walkout ❑Other Basement Finished Area(sq.ft.) r IZ7 — Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Z Half:existing U new Number of Bedrooms: existing _ new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other Central Air: Yes ❑ No Fireplaces: Existing _ New Existing wood/coal stove: ❑Yes �o Detached garage:❑existing ❑new size` IC1" Pool:❑existing ❑new size `� Barn:❑existing ❑new size .— Attached garageexistingew size L Shed:❑existing ❑new size`/ , Other: �/5/x2I/'J Kr Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes to If yes, site plan review# / Current Use d0l 19 19/.(- /!�i'� . Proposed Use ffw. BUIL/DER INFORMATION f—0 CY Z 8 U yQU Name Gam' C f �/l Telephone Number SG 3 6 7— Address �1 License# Z Home Improvement Contractor# 1001�CC e� Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 13r, s SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER - DATE OF INSPECTION: _FOUNDATION l r/ FRAME INSULATIONj0k —o ff if P. FIREPLACE ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH FINAL ; GAS: ROUGH FINAL FINAL BUILDING © (e— to_) DATE CLOSED OUT ' o ASSOCIATION PLAN NO. � ¢ r Bk 219493 Ps 257 -22 25 s -13-20 7 & 12 a 49� ToWn' of Barnstable Regulatory Services ' Thomas F. Geiler,Director • r'i1'r7 c r•,r. a MASS. $ y f - ' `Building Division 9� z6gq ♦0 ABED MA'1 a Tom Perry,Building Commissioner ;- 2-00•Iviaara Sxreet, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 AGREEMENT FOR FAMILY APARTMENT I(We), the undersigned, being the owner(s) of property situated at 1125 SERVICE ROAD in WEST BARNSTABLE, MA, holding title under a deed recorded with the Barnstable County Registry of Deeds or Barnstable County District Registry of the Land Court in Book /D�9 , Page a , or as Document No. being shown on Assessors' Map 153 as Parcel 038, hereby agree, certify, warrant and represent to the Town of Barnstable that the accessory attached apartment,which contains living quarters, is intended for use as a family apartment, for year-round occupancy. The intended and authorized use is for ARCHIE & IMGARD HEATH, PARENTS OF OWNERS 'STEPHEN P. & CAROL'J. COBB associated with the residential use on the same premises. This unit shall be used for a"Family Apartment" (as defined in Zoning Ordinances) which would require compliance with the Family Apartment Rules and Regulations. This unit shall not be rented as.an apartment or as a single room, or in any fashion, which rental would be a violation of the Town of Barnstable's rules, regulations, and zoning ordinances. Prior to occupancy of this unit, affidavits reciting the names of occupants are to be recorded with the building department. This agreement shall be updated whenever a change occurs or every calendar year. This Agreement shall be duly recorded or filed at the Barnstable County Registry;of-Deeds/Land Court for the purpose of alerting future owners of the property of this binding Agreement concerning the use of the property as'.herein stated. The consideration for this Agreement is the issuance of a building permit and/or certificate of occupancy by the Town of Barnstable Building Department. n WITNESS our hands and seals this 12 /4 day of :L 200_7. TOWN OF BARNSTABLE OWNER(S) By: ilding Commissioner THE COMMONWEALTH OF MASSACHUSETT BARNSTABLE COUNTY, SS .. Date Then personally appeared the above-named. (owner), - �. and made oath as to the truth of the foregoing instrument,befor : e. L4 I �A - Notary Pu is My Comm sion Expires: Nancy S.Colgan Notary Public .'Ay Commission Expires September 24,2010 ServiceRd1125 S SMOKE DET S REVIE E I -- d7 NSTABLE BUILDING DEP. D TE FIRE DEPARTMENT DATE L BOTH SIGNATURES ARE REQUIRED FOR PERMITTING -- ® L-L 1 IMPORTANT—UPGRADE REQUIRED T- STATE BUILDING CODE REQUIRES THE UPGRADING OF A4'"L SMOKE DETECTORS FOR THE ENTIRE DWELLING WHEN r ONE OR MORE SLEEPING AREAS ARE ADDED OR CREATED. NOTE: A SEPARATE PERMIT IS REQUIRED FOR THE ® INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL PERMIT DOES NOT SATISFY THIS REQUIREMENT. 4-- �L CARBON MONOADE ALARMS �r MUST BE INSTALLED PER MASSACHUSETTS BUILDING CODE I I FRONT Er.E VA•7r ri- scats /v':/-o• I I \ n f` T i Fm IT li I — & Ex s LFFT ELE'VtvnW- 9eA'LEYY'=,�0 . Appmom ] P�A-N4 • r�/.fin �w�vmni _ sNkRON 14ALONE-JDIFN1nN 778-667y LS CDR. LA_rRRY N1G�[�;Tl/LC �p/QFy r I k 4F. I F l� m r r 11 F I - I JF. I R P m 0 7� n x I . G _3 ax l> GlarS W 3' GO/„ F/LG ONT. FTG Ea nusT CAP — _DM4P P:o VF�a to 6RA•aE cryr) ` 2 Fx/snu(...G�•cs.G E . zcno 4°ccwc..5/..1-s..yWPEv Y`cONc. •' E5 *GRs�W L IA y .SEW L L PAGE' -- 7a DD02. ,— -- -- � �oZ,-- - -- -�"R.O 2-1°1 -ate• ucw Ll -- - Q 7 001446-] I I SIO YE •�O:Y Da J� n ,i ulrred m �2 NA GA2� GI`il.bGE 7-7 .I n 1 C+/L 61.R+GE p • STEE OR M GaO.LAM. 6EAMj � REA R[OM / Flee aociK-._--- ' M1N.WALL v 9>L7 OH•. r�..aooR m-e 4x7 o.N.Cam.Lioolt 19 Li _ L- � =iocT LinnR'�P.sy_ SGAY,E�S'Y=/Y9" I) PA/,E oF4 1 ,x L 0 1 , N UFg J e v a c' - ; o v 6-P°7D J_d_ G' DynF � //�gp60f DER I 1 W K wa ` qx � I uy �� W �� �.� ; ;^�°0•� Mf cy1 I C q'Z f o. L mL I v ,P C mS X Ax.r Ap7e A � I � L rCPI`o Z2�4 oak o I y and f� cr o �7c_y •�nbn�H TI I' � � •��.,v e � 't6Lµ 3.A 4 �� A A 4�• I a L4V. f i L.D. NICKULAS CO.' P.O.BOX 507•WEST BARNSTABLE,MA 02668 OFFICE:508-362-6295•FAX:508-362-5578 �Gz C `C ' t� •e � Gt/' �� � •' // Z J'" J t�✓t/r C'e � G a Z✓.e s 5P4 IYA r,2 ie fix. 'sue n S r �cc s 2 •� r17 o_r e cr 1 -e c •�v v c, Zess � `max 2 �/ — S�� �-�-�� �, S x �• s- 2 / z'r- �G Z, y c, . � O cp y / L.D. NICKULAS CO. P.O.BOX 507•WEST BARNSTABLE,MA 02668 OFFICE:508-362-6295•.FAX:508-362-5578 G l f-e- I-ra.ft re �� d' ua Ia a � a I a 9 '4 4 a � 3 ly 4 I �1 y i3 4 6 9 ea w• I I I §; 4 I a l I 4 rF Ld �a SECOND FLOOR PLAN FIRST FLOOR PLAN 1� DATE S WA I N E R COBB RESIDENCE AS-BVILTS 02i12i07 --� 1125 SERVICE RD ge3/�11 SCALE W.BARNSTABLE, MA ve°=i -o• 508-771-0491 i �4J BEAM B @ VAAVryerhaeuserBusmess 1 CAR GARAGE TJ-Beam®6.25 Serial Nuinber:7005122634 User:1 3/15/2007 11:29:29 AM 3 Pcs of 1 3/4" x 11 7/8" 1.9E Microllam@ LVL Page 1 Engine Version:6.25.71 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED 0 Product Diagram is Conceptual. LOADS: Analysis is for a Drop Beam Member. Tributary Load Width: 12' I Primary Load Group-Residential-Living Areas(psf):40.0 Live at 100%duration, 12.0 Dead Vertical Loads: Type Class Live Dead Location Application Comment Uniform(plf) Floor(1.00) 480.0 120.0 0 To 14'6" Replaces SECOND FLOOR LOAD 40/10 12'0 SUPPORTS: Input Bearing Vertical Reactions(Ibs) Detail Other Width Length Live/Dead/Uplift/Total 1 Wood column 3.50" 1.50" 3480/995/0/4475 L5 None 2 Wood column 3.50" 1.50" 3480/995/0/4475 L5 None -See TJ SPECIFIER'S/BUILDERS GUIDE for detail(s):L5 DESIGN CONTROLS: Maximum Design Control Control Location Shear(Ibs) 4372 -3684 11845 Passed(31%) Rt.end Span 1 under Floor loading Moment(Ft-Lbs) 15484 15484 26772 Passed(58%) MID Span 1 under Floor loading Live Load Defl(in) 0.336 0.472 Passed(U506) MID Span 1 under Floor loading Total Load Defl(in) 0.432 0.708 Passed(U394) MID Span 1 under Floor loading -Deflection Criteria:STANDARD(LL:U360,TL:U240). -Bracing(Lu):All compression edges(top and bottom)must be braced at 14'6"o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by Trus Joist(TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, input design loads,and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code BOCA analyzing the TJ Distribution product listed above. -Note:See TJ SPECIFIER'S/BUILDER'S GUIDES for multiple ply connection. PROJECT INFORMATION: OPERATOR INFORMATION: LARRY NICKULAS J Andrew Shakliks 1125 SERVICE RD MID-CAPE HOME CENTER W BARNSTABLE MA 465 ROUTE 134 SOUTH DENNIS PO BOX 1418 South Dennis,MA 02660 Phone:508-760-4973 Fax :508-760-4559 ashakliks@midcape.net Copyright 0 2006 by Trus Joist, a Weyerhaeuser Business Microllam® is a registered trademark of Trus Joist. C:\Program Files\Trus Joist\TJ-Beam\ORL BEAMS\BEAM JOBS\NICKULAS SERVICE RD B.sms ®� 15�4Z� BEAM B @ -AWeyerhaeuserBusire. 1 CAR GARAGE . TJ-Beam®6.25 serial Nurhber:7005122634 User:1 3/15/2007 11:29:29 AM 3 Pcs of 1 3/4" x 11 7/8" 1.9E Microllam@ LVL Page 2 Engine Version:6.25.71 THIS PRODUCT,MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Load Group: Primary Load Group 14' 2.00" ^ Max. Vertical Reaction Total (lbs) 4475 4475 Max. Vertical Reaction Live (lbs) 3480 3480 Required Bearing Length in 1.50(S) 1.50(S) Max. Unbraced Length (in) 174 i Loading on all spans, LDF = 0.90 , 1.0 Dead Shear at Support (lbs) 819 -819 Max Shear at Support (lbs) 972 -972 Member Reaction (lbs) 972 972 Support Reaction (lbs) 995 995 Moment (Ft-Lbs) 3442 Loading on all spans, LDF = 1.00 1.0 Dead + 1.0 Floor Shear at Support (lbs) 3684 -3684 Max Shear at Support (lbs) 4372 -4372 Member Reaction (lbs) 4372 4372 Support Reaction (lbs) 4475 4475 Moment (Ft-Lbs) 15484 Live Deflection (in) 0.336 Total Deflection (in) 0.432 PROJECT INFORMATION: OPERATOR INFORMATION: LARRY NICKULAS J Andrew Shakliks 1125 SERVICE RD MID-CAPE HOME CENTER W BARNSTABLE MA 465 ROUTE 134 SOUTH DENNIS PO BOX 1418 South Dennis, MA 02660 Phone:508-760-4973 Fax :508-760-4559 ashakliks@midcape.net Copyright O 2006 by Trus Joist, a Weyerhaeuser Business Microllam® is a registered trademark of Trus Joist. C:\Program Files\Trus Joist\TJ-Beam\ORL BEAMS\BEAM JOBS\NICKULAS SERVICE RD B.sms i ®� �j►��� BEAM A @ ,AV:kyerhaeuserBusiness 2 CAR GARAGE TJ-BUsere;m®5�O r1121m8AM005122634 2 Pcs of 1 3/4" x 11 7/8" 1.9E Microllam@ LVL Page 1 Engine Version:6.25.71 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Overall Dimension:28'2" F_ Ell a, o b 14'1' Product Diagram is Conceptual. LOADS: Analysis is for a Drop Beam Member. Tributary Load Width: 12' Primary Load Group-Residential-Living Areas(psf):40.0 Live at 100%duration, 12.0 Dead Vertical Loads: s Type Class Live Dead Location Application Comment Uniform(plf) Floor(1.00) 480.0 120.0 0 To 28'2" Replaces SECOND FLOOR LOAD 40/10 12' SUPPORTS: Input Bearing Vertical Reactions(Ibs) Detail Other Width Length Live/Dead/Uplift/Total 1 Wood column 3.50" 1.50 3003/708/0/3711 L5 None 2 Steel column 3.50" 4.05" 8350/2287/0/10637 L5 None 3 Wood column 3.50" 1.50" 3003/708/0/3711 L5 None -See TJ SPECIFIER'S/BUILDERS GUIDE for detail(s):L5 -Bearing length requirement exceeds input at support(s)2.Supplemental hardware is required to satisfy bearing requirements. DESIGN CONTROLS: Maximum Design Control Control Location Shear(Ibs) 5319 4624 7897 Passed(59%) Lt.end Span 2 under Floor loading Moment(Ft-Lbs) -14803 -14803 17848 Passed(83%) Bearing 2 under Floor loading Live Load Defl(in) 0.333 0.464 Passed(U502) MID Span 1 under Floor ALTERNATE span loading Total Load Defl(in) 0.387 0.696 Passed(U432) MID Span 1 under Floor ALTERNATE span loading -Deflection Criteria:STANDARD(LL:U360,TL:U240). -Bracing(Lu):All compression edges(top and bottom)must be braced at 8'2"o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -The load conditions considered in this design analysis include alternate member pattern loading. PROJECT INFORMATION: OPERATOR INFORMATION: LARRY NICKULAS J Andrew Shakliks 1125 SERVICE RD MID-CAPE HOME CENTER W BARNSTABLE MA 465 ROUTE 134 SOUTH DENNIS PO BOX 1418 South Dennis,MA 02660 Phone:508-760-4973 Fax :508-760-4559 ashakliks@midcape.net Copyright 0 2006 by Trus Joist, a Weyerhaeuser Business Microllam® is a registered trademark of Trus Joist. C:\Program Files\Trus Joist\TJ-Beam\ORL BEAMS\BEAM JOBS\NICKULAS SERVICE RD A.sms I �-h-' BEAM A @ -AV✓tyerhaeuserBusiness 2 CAR GARAGE TJ-Beam®6.25 Serial Nbmber:7005122634 User:1 3/15/2007 11:21:19 AM 2 Pcs of 1 3/4" x 11 7/8" 1.9E Microllam@ LVL Page 2 Engine Version:6.25.71 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by Trus Joist(TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, input design loads,and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code BOCA analyzing the TJ Distribution product listed above. -Note:See TJ SPECIFIER'S/BUILDER'S GUIDES for multiple ply connection. I i PROJECT INFORMATION: OPERATOR INFORMATION: LARRY NICKULAS J Andrew Shakliks 1125 SERVICE RD MID-CAPE HOME CENTER W BARNSTABLE MA 465 ROUTE 134 SOUTH DENNIS PO BOX 1418 South Dennis,MA 02660 Phone:508-760-4973 Fax :508-760-4559 ashakliks@midcape.net Copyright O 2006 by Trus Joist, a Weyerhaeuser Business Microllam® is a registered trademark of Trus Joist. C:\Program Files\Trus Joist\TJ-Beam\ORL BEAMS\BEAM JOBS\NICKULAS SERVICE RD A.sms r Town of Barnstable Regulatory Services BARNSrABM Thomas F.Geiler,Director 9�A 1 MASS. ,0�' rE1 ,9.rA Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no: Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: z/ / Ile-7. Estimated Cost ' fv Address of Work:-/ 2 •e�'(�//C Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY/ I hereby_ap ly for a permit as the agent of the owner: /� �, 6 y� to Contracto ame Registratio�No. / � ✓OR G Date Owner's Name Q:forms1omeaf day ' Town of Barnstable ' . P�nptKE�cy�c • Regulatory Services Thomas F.Geiler,DirectorILONSTABIA . Building Division Eo TomPerry, 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 as Ownet of the sub'ect property T ��'� v to act on my behalf, her, authorize in matters relative to work authorized by this building p ertnit application for: so, (Address of job) � — �z o7 Signature of Owner Date print Name Q:FORMS;O�ERPERMISSIOI�i i RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET 1�410/ NEW LIVING SPACE � J y twp 43 square feet x$96/sq.foot= U x..0041= plus from below(if applicable) ALTE/RATIONS/RENOVATIONS OF EXISTING SPACE (.O 2 square feet x$64/sq.foot= ��� D d D x.0041= . plus from below(if applicable) GARAGES(atta`ed(&detached) �� 1-3 Z _ Z S O O 6 square feet x$32/sq.ft. x.0041= ' ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $ 35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf=Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00 (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Per mit Fee Projcost Rev:063004 et C�t �:@r•::A�er��� 780 CM.A, .I Trade- } Wor kshy • Permit� G •.. Gate iuilder Name tY 111 Zone 0 d ,, 111 3uilder Address ' .t 9 / Z �1�— pate 3uiid►ng Address .t Phone Submitted BY BONN- 00— Dora over outside Air Required x Area � UA Ceilings, Skylights, grid U.value InsuiaCOn x Area n UA 7Z p fra „a Cescriptlan R.Value U•Valuo 7 2 Ceiling V Floor Over Outside Air f12 g{ryiight � Oaitsngs:TotalA�ea Required x " VA Walls, Windows, and Doors UA U.Vaiue Area g i nstilaton Area fn F1•Value '-3•Valu® x � 7 Description �D 4 � +� Wail 3 3 / ftx 2 r --• Windcw y ftn Oaor 'j ftz sliding Glass Door fn M tot �talis:Tatai Area m Required Area or U.Value ar UA Floors and Foundations Ateaor F431ue x Per!m®ice Insulation U•Value or „ UA s '7Zo RZ 3 C' insui3Udn P.Value x Perimeter Dept R.Value O ft, Descrption 0 iR Moor Over lSncondit}oned ttz ^�I Casement Wall It it i 1, l g Unheated 51ab l In. fl2 --•�""' in. Nested�Iab • Total SeqWred UA Total?reposed UA t1i719�1 22 • �' be less Char+or eR+�a+to L`te Tots!Re cations, UA. ' Total Proposes UA moat 13ns,speeifaranons, a ,ds.n design represented in these documents is consistan�tt}�tna build P pence: •rise Proposed must ppcation. Statement of Comp and other Calculations submitted with the P�� V$1 P7 ` Date GtyL Company Blame 4'l /ze+ 2,9 2 i'c"W o� . aaaacfiuoet�a t xk� BOARD OF BUILDING.REGULATIONS ryt'° -I License: CONSTRUCTION•SUPERVISOR Number CS'E. 002265J. '! 5'�,Birthdate�01/18/1955 1 Expifes 01/18/2008 Tr. no: 14065 :1 ' �. Restricted:`00_ LARRY D NICKULAS` A, PO BOX570 . = / W BARNSTABLE; MA 02668 �^`^" Commissioner. ' � lie TOanvnw�•e�aeci� a�./�aaoaclxecael�2? j'•' Board of Building Regulations and Standards HOME IMF,ZOVEMENT CONTRACTOR'r', Regist atibr', 100496 Ex—pi�ation:=6/18/2008. �Y — Type.:=l dI idual LARRY NICKULgvS - -Larry Nickulas ' 20 CEDAR ST. W. BARNSTABLE,MA 02668 Deputy Administrator-:� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual) n/'/ le. ✓ / Address: c 0 G✓tt°S f �Ol r cS CC, O e City/State/Zip: Z- 6 Phone.#: �U .Z & 1 Are you an employer?Check the appropri e b Type of project(required):, 1.❑ I am a employer with 4. I am a general contractor and I employees(full and/oi.part-time).* have hired the sub-contractors 6. ( New construction.. 2.❑ I am a'sole proprietor or partner- listed on the attached sheet. 7. [21IRemodeling 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.#, required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.El officers have exercised their I am a homeowner doing all work 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. tcontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors bave employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#.or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date): Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK.ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the bIA for insurance coverage verification. I do hereby certify un he pains and-fien Ities of erjtiiy th the information provided above is true and con ect: Sinafore: 6 Z,� Date: Phone#: 5 v 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): A.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions r 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 TPce leRal 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 produce&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-contiactor(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-a . 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 tfiatmust 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 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 of 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 eommonwWth of Massachusetts Dgpartmemt of Industrial.Accidents Office of InvestigatiQlas 600 Washington Street Boston,MA 42111 Tel. #617-727-4900 ext 406 or 1-977-MASSAFB Revised 11-22-06 Fax##617-727-7749 www.mass.gov/dia ... .... .... .. ... .. ........ . . J�%._. ... - ...._.__ / c .................. _. ....._..._ . .. y� ... . ........ . .... .. C- .__.� c-... ....._......... ... ._.__....___. ..---- .....-._...----_...__... .c.- . % . Vic...... .._ _..,.._._._._._.................--------_.__ _..._......_.___.... - .._..._....__.. ._......._... - -- - �-r , ,_� _._....._`y� ...... -._... .._......._j7CIf p Ycs_ ......... 01" ................. ............ ........... ------------- -s00000:. .................. ............. ............. ................. ................ .......... .............. .......... .... ............ . . .... .. ............................ ........--------- ............ ..........--------- ............ ............... ............... ....................... 000 000 C)q7 Assessor's Office'(I 1st flood) Map Lot L Permit# 25-403 Conservation Office(4th floor) i 1_ � '�g a of .,\I 1 0fry Date Issued � q 05- Board of Health(3rd floor)(8:30-9:30/1:00- 2:00) � ?Fee -, Engineering Dept.(3rd floor) House#1 3 n� ;Planning Dept.(1st floor/School Admin. Bldg.) 4�1� C $T BE Definitive Pla pr by PlanningBoard 19 (� $ S ANCE 0 o� PSv,"Re W VYWN OF BARNSTA NARONMENUL CAD E AND �� Building Permit Ap lication TOWN REGULA11ONS. Project r e Address A,- Village e2 -� Owner /r !� v,' Address �/ Telephone Permit Request /�� �?f� �ryl• �.;'K)�•�``�' 1, ZS�3 Total 1 Story Area(include 1 story garages&decks) U� square feet 2 y�Z?� Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ /33 Sy Zoning District Flood Plain Water Protection Lot Size--~L ���� Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use - n Proposed Use Construction Type //0'cl Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) V First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached. Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name _f/' t , C J Telephone Number 2z Address �(J �c Sr � Q — License# C! 2 2 (s d Home Improvement Contractor# Worker's Compensation# r , NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE C� /Z C �— BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) `, .1 <!q FOR OFFICIAL USE ONLY PERMIT NO. - • DATE ISSUED MAP/PARCEL NO. `^a r ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION'-," / �✓ J "7 FRAME r•i INSULATION 'rqf �s FIREPLACE ELECTRICAL: ROUGH 1 FINAL PLUMBING: RI& FINAL GAS: RJ ::; <Rs FINAL _ CP FINAL BUILDING o t �. M•t liz FA' 7:A... DATE CLOSED OUT`2a !°at` ,•: , r ASSOCIATION PLAN-Nth. mirl ` I ' I a r Ic odd i.I 'r6 N , y� • 'e� ,.. -. I I" it � _.� ; i I a, I• i "' n61 ee—� li . I I a�� °3 r -I�g� a J xN�li I,I ;•I ii)'I i'SII '� � �gp: �� 3 �_ .'o • I I 1 I ! O.JI Mon WN ice' I-C_:IiC.11 I. HBO! I I � WW1 I I -- II I�II�W .��. � � NIIIIHNiIIIiHIIINIHI� � h N . I I i w,,;_ INA I IU��IIIIIIIIIIIIII � I f7 IIIIII IIIII I'�i�i IIIIIIIIIIIIIIIIII �; IIIIIIIIII�IIIIIIIII I��f` IM..�_IIIII �11�:.:I.III Il�lil�l�llll®II �I I 1 , ' � I�IIIIII�IIh�� , ►( ', V l ' v - ,tsV TS pZ CD s oa > m 03 2s o� 1 Zo o P 1 Ira JD , Z w -Ac a� i I I i �ti! Lielturtate»t t!f Industrial Accidents : . ; '�_ ` l�& Office oflnvestlgallons 600 11 u.chin,,tt►n Street Ba.ctun, Alus,v. 02111 Workers' Compensation Insurance Affidavit ARtilicz��t�,ft�t•t^'�^^• �, j ZI2= PRINT Ie;'b11__v_•�,� ,-, ' namc citY , 1 am a homeowner performing all Nyork myself. Q 1 am a sole proprietor and have no one working in any capacity L�,v� �•.'-w. ?�'• +rnr;•!.q .. ,...-vw.fi.•,•--et.n +r '.nr-• .+...+eP► .+•••. _ZZ.11--:; �y � .�^.'^""'.!•..+r+.'."�.. 0-1 am an employer providing workers' compensation for my employees working on this job. cntn� �, v n•tmc• x OR - ac c rc%s• - s� tit.•• �( �S��G �/'� f G. nhonc M• insurance �u cJ � � / ,� Policy N Kthll_�arn a sole propri or, general contractor omeowner(circle one) and have hired the contractors listed below who have e following workers compensation polices: Simrany namc• address: d Insurnnce CO. ,/_ ... n:•f•.. _�.r„b�.-_n^r'•:'�..fY r.i. •1=_-•�_.••`+t� .r- .a-7T,fK�/'T7:Qi••Y•'ry�'..u, 7c`�rr^it.•.v�.�.p� "Q"""�'�: �...ri...._...ca.. �..... ...w.. .�i.Jtiw /�J cnm tiro. n•tmc OfC_ 7. iddr ` T. (/ 12 ' i°jN.. phonc# nM�r�r tncc co F..Atiachedditional'sheetifrieeessa_ryr; �i ____, —_ `.iY• :ay;..�t-•�r;;+a =�,„�- �=�" '_+',:. -�•'"►.^""'' rl;;! Poilure to secure coverage as required under Section 25A of hIGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/ur .1�ftije ..uric years'imprisonment as well as civil penalties in the form of a STOP\PORK ORDER and a fine of 5100.00 a day against me. 1 understand that a . cope of this statement may be forwarded to the Olficc of Inycstigations of the D1A for coverage verification. f� I do hereby certify under lite pains a vtnitics of perjun•Ile the in ormation provided above is true and correct. Sienature Date Print name e5fc, / C "eJ /O'J Phone f: 7('/ 7 s official use only do not write in this area to be completed by city or town official city or town: permidlicense tt r'lltuilding Department FC)Licensing hoard (]check if immediate response is required �Scleetmen's Officc C31le21th Department contact person: phone N; r —Other F>19�T�'��'i. rw .� u la O'�hidwi.-'va•,�+,J.,yw ,,..+'.J�:.._x•.a:.:ae4. d �P ;4� / .-... •.Par•:: 1tat1+.�,.-, �^' A^�', i r Jh 7 ti s y_ 2 _.yeyry } 1 O, ry r,. P ',� icy=••: '. .. �:�1 +r emu. . p v 't M' � • +� ',.� � � - v. .. � .. . _ ._ � �' .. � .: .� � . - .. q # ¢ F _ y �. iY' �� is r i y _ J J � .. --. _� k: d:.�\ .. . � �. � h - � } j � � .. � T �. 7 4 f. n � '•, C __ 4 ill � r i a" � i � } �. rf � �' ` v _ o .;' ,7 f 1 '� �. 1 � � �i �� �� ,,,� ��._ i �a � � �` > I � 1 J � �• r ' V ? 'r ..' ` -. ti 3 _ _ ' } t •� - OFIMETgy, Town of Barnstable Building Department Services • Brian Florence, CBO &UMSznais• MASS, Building Commissioner i639•ArEo rug+° 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us �, y Office: 508-862-4038 Fax:,,.508-790-62a3Q, Town of Barnstable Family Apartment Affidavit'��y� I, being on oath, depose and.state as follows: My name is Lro I am the owner/resident of the property located at: 11 a S Sexy" -PA. . The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: Arr.ni,c. �te&A)n -F�A a<- Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notes the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit 1 andlor the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to under the pains and penalties of perjury this a a day of 2019. Signature Phone Number Print Name CQrb 6� q:forms/famaffid.do c rev 11/08/13 Town of Barnstable Building Department . Brian Florence, CBO + ' BuildingCommissioner TOWN OF , �bs�. �,m� BARNSTABL�E en + 200 Main Street, Hyannis, MA 02601 T018 �� r www.town.barnstable.ma.us -6 AM 9. 38 Office: 508-862-4038 Fax: 508-790-6230 �VISIT'® Town of Bamstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is __ Ca.ry ,1_ Co�b I am the owner/resident of the property located at: /0 S Ser✓i'�� j�d. The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: /-fir"t e- kle,&,k Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit andlor the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notes the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this day of J{4v,,,l 2018. 24Y(o Signature Phone Number Print Name Co 6 6 q:forms/famaffid.doc rev 11/22/2017 Town of Barnstable Regulatory Services BUILDING DEPT' of Richard V. Scali,Director Building Division FEB 14 2017 AM Paul Roma Building Commissioner 059. 200 Main Street, Hyannis, MA 02601 TOWN OF BA�NST�BL� www.town.ba rnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is -��b�. 3 . �-b I am the owner/resident of the property located at: 1 ;t S-e-f-"J -C_P Q� .\PJ gsk i3�r►�S kc�lol,e , M/� b 2_L to�/ The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: A c-,--e 4e_ �", c -ut Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to under the pains and e lties of perjury this day of r-eb . 2017. 569- 3-75—o q8V Signature Phone Number Print Name q:forms/famaffid.doc rev 11/08/12 Town of Barnstable Regulatory Services of Richard V. Scali, Director Building Division BMWSTAB. s NAM' Thomas Perry, CBO,Building Commissioner iOrEn s`e� 200 Main Street, Hyannis, MA 02601 www.town.ba rnstable.m a.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, dep e �Lstateas follows: Q My name is I am the owner/resident the S' /c - property located at: ��ZV C 12-0.A,-3 The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: 49 0-141 E D . ��ta,1 j)� ��-1�e T� •�/1� Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notes the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notes the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to under the pains and penalties of perjury this /Z, day of AVe!,,Acq 2016. Signs a Phone Number Print Name a ccy�& q:forms/famaffid.doc rev 11/08/12 Town of Barnstable of r Regulatory Services ti o„ Richard V. Scali,Director TOM OF BARNSTABLE STABLE, 1 Building Division 'SAT 163 ah Thomas Perry, CBO,Building Commissioners 5 i r'111 -5 Psi 4: 2 j ED MA'S 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 D1VI'WJxN 508-790-6230. Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is I am the owner/resident of the property located at: ���5 T 7ZV Lem-" 012 a The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: Name & relationship to owner: 1 The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sw der thin an pena ies of perjury this day of�J A�✓�" 2015. � Signature � � Phone Number Print Name -1 L C�IJZ, COS q:forms/famaffid.do c rev 11/08/11 Town of Barnstable Regulatory Services`. rgyti Richard V. Scali,Interim D' r Building Division OF BARNSTABLE B"R'''s'^B Thomas Per CBO Building CON-VOLsio MM& � �, u g Pf 2 58 `bAr fo ,�p 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 DI FWK. 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is 60,!5 6 I am the owner/resident of the i property located at: Hz,,5- %*e-Vl;cq � ,evA.0 The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address:Name &relationship to owner: )/�RO-aI6 141'"17Y J� � )A/ 4a9pi1 Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notes the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,-please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to under the pains and penalties of perjury this day of � 11191 14. Sign6fure Phone Number Print Name S-rie)'rol �' ('D 61? q:forms/famaffid.doc rev 11/08/11 Town of Barnstable Regulatory Services rq Thomas F. Geiler,Director T0��1 0l' A1��tT Building Division ABLE R&MSCABLE Thomas Perry, CBO,Building Commissio ?M FEB 19 PM 3' 19 �p i639 s`0� 200 Main Street, Hyannis, MA 02601 www.town.barnstable.maxs Office: 508-862-4038 ©1V1 j(F -/ -6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name isCQ1I y ` "`„mil i dam the owner/ sident of the property located at: 5C(Z,V1 Cr X7 OA o The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address:Name &relationship to owner: Add 141 Cj kd e 64rd e& t(CAS Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately note the Building Commissioner in writing. 1 understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to under the pains and penaltie of perjury this /"1 " day of ` �1JiQ12113. �2M f /.Signafure Phone Number � Print Name Tip � � � q:forms/famafd.doc rev 11/08/11 i Town of Barnstable Regulatory Services °F Thomas F. Geiler, Director Building Divisiop �?R': _', � L r a ■^xr' Thomas Perry, CBO,Building CommissionerMAS& �. �8 �' 200 Main Street, Hyannis, Mr,�?02601� '° www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is C1 �.! �o '�� I am the owner/resident of the property located at: %q�t Gc- RoA o The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: ,Xge,�tE V. 14L':�rt-�4 ciThtt-yr Iti/ /-,gw Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. 1 also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. i The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this /S day of )5515Q2�Aq012. Signatu e Phone Number Print Name IL �I� �,.� q:forms/famaffid.doc rev 11/08/11 Town of Barnstable Regulatory Services FINE ro Thomas F. Geiler, Director Building Division BAMWABLE. ' Thomas Perry, CBO BuildingCommissionerMesa �AT 039. A�0 200 Main Street, Hyannis, MA 02601 fv nwr www.town.ba rnsta ble.ma.us Office: 508-862-4038 T';, Fax: 508-100-6230 Town of Barnstable- Family Apartment Affidavit I, being on oath, depose and state as follows: My name is k 025el#61Z CDd,1V I am the owner/resident of the property located at: The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: I Name & relationship to owner: 114 L'�l zC ���All Name & relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, 1 will immediately notify the Building Commissioner in writing. I.understand that no subletting or subleasing of said Family Apartment is permitted. I understand that 1 am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. 1 also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other �r Sworn to under the pains and penalties of perjury this J day of6i2U 2011. Signature Phone Number Print NameI� J (it738 Town of Barnstable Regulatory Services pFit+e ro�ti Thomas F. Geiler,Director TOXIN OF BARNSTABLE Building Division BARNSTABM Tom Perry, Building Commissioner Z�r� FEB 10 p + MASS. 039. 200 Main Street,Hyannis,MA 02601 CEO s www.town.barnstable.ma.us D�slON Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is Coro O b b I am the owner/resident of the property located at: 11 a 5 S e.rYi c.e 1 'A 1k). BOX S-Vabl,e. , MA 0 The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: AV. ACGhi e_ Wco_4-h - �a��ie Y, Name & relationship to owner:, WS-Trma&M Wea441 — rno a- le v' The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, 1 will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants.in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn under the pains and penalties of perjury this day of 2010. Sop- 375-- 6 Y 9"Y Signature Phone Number Print Name 'J-r 6,0 !� Q/bld g/fonns/fa maffid Rev:l2/08 Town of Barnstable Regulatory Services pFIME Tn , Thomas F.Geiler,Director ti Building Division ■&INSTABLE, ' Tom Perry, Building Commissioner a o 1�9 �0� .200 Main Street, Hyannis, MA 02601 "4�ii�� ter BARtjST ABLE lEn►�ts www.town.barnstable.ma.us 2009 FEB 13 P11 4: 20 Office: 508-862-4038 -�� Fax: 508-790-6230 DjvjsjoN Town of Barnstable Family Apartment Affidavit ° I, being on oath, depose and state as follows: My name is v' ^� C lzhLS • I am the owner/resident of the property located at: Gt• >ZO,-1-0 ty° O The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: A�L�I �• �H �f� E2 C,4Re L� Name & relationship to owner: � �� The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, 1 will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. 0 1 understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.]*Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this 31'f'r day of J;" 2009. ignature ,` ( Phone Number Print Name le"444Z'T. ( � Q/bl d g/forms/famaffid Rev:l2/08 Town of Barnstable Regulatory Services pUZME rON, Thomas F.Geiler,Director - y"� Building Division j B` R� ,,S rABLE �BMWSTABLE,g Tom Perry, Building Commissioner Z�109 JAN 31 PMMasi. 1639• ♦0 200 Main Street,.Hyannis,MA 02601 18 �prEn MAC a www.town.barnstable.ma.us Office: 508=862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is �� ' I am the owner/resident of the property located at: v- <G�Ft--Z' Vt.L� /',tom The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: �Qclirt t /46;Q-11-4 r-*rftc- /" L-,iw Name & relationship to owner: C-zo(Lf) 14619-'J4 g4o-rtE2 1 ty The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, 1 will immediately notify the Building Commissioner in writing. 1 understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that 1 am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. I If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this 1 -7 day of JZ/ t, ,e 2008. ?7S Qg Pg Signature Phone Number Print Name 5rr:m-c'. P Q/b I d g/fo rm s/fa m a ffi d Rev:1/03 Bk 21940 Ps257 a2202.5 04-13-2007 a 12 e 49v� oFt►�,� Town of Barnstable Regulatory Services snxivsrnai.r. Thomas F. Geiler,Director � ?�,�, 3�('�MAM � � r,�, 1, ,�� �� �� Building Division rED MAC a Tom Perry,Building Commissioner 200-Main-Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 AGREEMENT FOR FAMILY APARTMENT I(We), the undersigned, being the owner(s) of property situated at 1125 SERVICE ROAD in WEST BARNSTABLE, MA, holding title under a deed recorded with the Barnstable County Registry of Deeds or Barnstable County District Registry of the Land Court in Book /101?9 , Page _?c7_l , or as Document No. , being shown on Assessors' Map 153 as Parcel 038, hereby agree, certify, warrant and represent to the Town of Barnstable that the accessory attached apartment,which contains living quarters, is intended for use as a family apartment,for year-round occupancy. The intended and authorized use is for ARCHIE & IMGARD HEATH, PARENTS OF OWNERS STEPHEN P. & CAROL'J. COBB associated with the residential use on the same premises. This unit shall be used for a"Family Apartment" (as defined in Zoning Ordinances) which would require compliance with the Family Apartment Rules and Regulations. This unit shall not be rented as an apartment or as a single room, or in any fashion, which rental would be a violation of the Town of Barnstable's rules, regulations, and zoning ordinances. Prior to occupancy of this unit, affidavits reciting the names of occupants are to be recorded with the building department. This agreement shall be updated whenever a change occurs or every calendar year. This Agreement shall be duly recorded or filed at the Barnstable County Registry,.of.Deeds/Land Court for the purpose of alerting future owners of the property of this binding Agreement concerning the use of the property as'herein stated. The consideration for this Agreement is the issuance of a building permit and/or certificate of occupancy by the Town of Barnstable Building Department. n WITNESS-our hands and seals this 12 rh day of 200_7. TOWN OF BARNSTABLE OWNER(S) By: iIding Commissioner THE COMMONWEALTH OF MASSACHUSETT BARNSTABLE COUNTY, SS . -Date Then personally appeared the above-named (owner), . and made oath as to the truth of the foregoing instrument,befor e. Notary Pu is My Comm Sion Expires: Nancy S. Colgan Notary Public My Commission Expires September 24,2010 ServiceRd 1125 S -WA 6,E G., ?-P_/ o" 7-P- Z E< ,77,'f TP- 3 T,o- 5� II F/iV/ s'/Y GR/9D E SANDY G oAM A Sf)NDY L.Of1 M A SANDY L 0�9M q SAND y L oAM p M//V, SL.oP� DF LO CDVE2 To „�_�- q"MJ�• OF FIAI. GRADC 3G"MAX- COVC9 To W/T,y/N ., sY,4 z /Z 7,SYR � 8 7SYR f G'DVEJg /Q/SER + Lo�9My Si9ND SfINDy LOAM G ' O/= F/A/. 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