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Home My WebLink About0036 SUN HILL ROAD led r a _ i �I i ` f `r Oxford® —NO. 1521/3 ORA MAN w use►. ESSEM z r c u Y • 1 l:ZyIF7 C ,q � , / � ' ��► C,�, ��Saaa � ��i��9 7�.�-g.��0 7 , , . . . � � . Town of Barnstable ermit. oF"'E' ti Building Department Services ate: Brian Florence,CBO WAN STABLE, Building CommissionerFee:KAM �,eT fo 3g6 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: l�1��i ot�l/tQS"�W�C3n. Phone: -]-1 - 2-0 S — t'18 Install at: 3 6 5 U'(\ w1 k QG . Village: t olr"' - Map/Parcel: Date:24'l )Z Za 1c Stove A. New/ se B. Type: Radiant/Circuleting C. Manufacturer: r(&nc Lab.No. Z5j - S . - 1). Model No.: C3 , (3 Chimney A. New xistul (If existing,please note date of last cleaning) PoU . ZO 16 B. Flue ize Lil C. Are other appliances attached to Flue? D. Pre-fab Type and Manufacturer E. Masonry: Lined/Unlined Hearth A. Materials: . er2i2a S e— B. Sub Floor Construc ' n: Installer 13JI Name: Address: �Df��iG Phone: Location of Installation: FEB 1.2 ®19 H.I.0 Registration# TOwIVOp&ARCS j h Construction Supervisor# /4@Lc OR check_0(Homeowner Installing,no license required LICENSED INSTALLERS SIGNATURE: APPLICANTS SIGNATURE: ( M, APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev:08/16/17 t ?lie Comrnomveahi of?t2`acssarJruse& ' D,eparanext o,fbuhrs&id Accidents Qfue of ImwaLgadom 600 WasJzazzgton Street Boston,4 02 U1 %,Fvtv.mwmgovfdza Workers' Campensatian Insurance Affidavit BBm-lders/Contractars Uectdcians/Phumbers APPEcant lufm-matiQn. Ple25e Frint Y A;d&ess~ 3 (o Svc uh l t met. 1r2Lt- -Z0S— 14,834:1 Are you an employer?Checkthe appropriate box: -Type of I_[II am a 1 wrth 4. ❑I am a general coaixactor and I New project tr egnired}: employees(full or part-time)-* lie hiredthe sub contractors 6. ❑Newconstruction 2.❑I am a sole proiYAetor orpartuer= listed on the attached sheet 2- ❑Remodeling ship and have no employees . These sub-cm ractars have 9. ❑Demolition woddng fog;me in any capacity_ employees andhave wagers' 9. ❑Building additi. INC wpdmm, comp-iu©r;nre Comp.insurart 1 El are a corporatifla and its 10.❑Electrical repairs or additions required] 5. 3.66 I am,a homeowner doing all work officers have exercised their 1L❑Phrmbsngrepaim or addiftions. myself[No wo=kmrs'c=p right §It exemption we 5 per MGL L-❑Roof repaim iumnance required_ 1 13.❑Other I&Y� employees-[No wo&=' comp-insurance row-) ;Any WBc;mtfstcbedcsboaftl—stalsoffioatthesectioabalcwshmdagdh wmkes'camp—sat; pmrxykffi�aaob �I�CID2D0l3475 w17D snb�t�S�5daeu im�catmg tLey are dn�ne SIE Wow Sud then bae aut9de caatrscm6�st Snhmlt a aeW afadaeg indicating 5a<Ti iCm=cft.6 Yhzt check this bax must attached as adffifi— sheet dowk g thename of @se sub-ca�cto-m ffid state wbethm ar vat fhnse eaedes� empicyees.Ifthe A--tin.a—hareempIoy-%dLermnsrIam•3dett—trorxe'tmp.pGhcymm3ber.. lam an inmiranze far my ampLo1wes Below is the pvEcy arrd job site inforraatiom Insurance Company Name: "Policy-4 or Self-ins.Uc- Expiratian Date: Job Site Address: Ci3y/Statel�.tp: Aftach a copy of the workers'compensatioupolicydeciaration page(showing the policy number and expiration date). Failure to secam coverage as requiredvnder Section 25A o€MGL c 1572 can lead to the impos itioa of criminal penalties-of a fine up to$1,50QOa aadror one-yearimprisonmeid,as-meg as civil penalties is the form of a STOP WORK ORDEBand a time of up to$250-00 a day against the violator. Be advised that a copy of this sbdemed maybe forwarded to the Office of Investigations.of the DIA for iasuraace coverage verifrcafton_ I do Hereby cerh)Fy ajt&r(the pains and pajalYes ofparjfus that trio informidimt prof-tded aba1ps is bus and carrect Si�atitre (/1Ail�l ,7X/� Date- Z 1121 Z o I Phone ik Q07cird um only. Do not write is ttds area,€rr be eainpFetead by city ortown oj)rerat City orr' aww PerruitlLicense ig Issuing Autherity(Circle one): L Board of Health M Building Department 3.Cityf£own Clerk 4.Electrical Inspector S.Plmmbh g inspector 6.Other Contact Person: Phone#: laformation. and Instructions Massachusetts General Laws chapter 152 requires an employers to provide works'a:oarpensaflon far their eo ipIoyees- +' PuL this sf�te,an errr47Iayee is definel as-,�-=aypeason in the service of another under any confract afhire, express or implied,oral or writtrn." An Moyer is &fined as-an indreidmal,parinershup,associaffan,corpor-ion or other legal ettity,or any two or more of the foregoing engaged in aJoint enterprise,and i acbrUmg the legal repre m a&=of a.deceased employer,or the receiver or trustee of an iadividmal,per,association or other legal entity,enploymg employees- However the owner of a dwelling house having not ma¢r,tban.tbrw apartments and who resides therm,or the oc CUP ant of the - dweME g house of another who employs pessans to do mice,construction or repair wodc on such dweIbmg house or on the gr ommds or bmldmg appnt�thereto shall not because of sack euiplopmead:be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shaII withhold ffie issuance or renewal of a license or permit to operate a business or to construct bu ¢dings in the commonwealth for any applicant who has not produced acceptable evidence of c6mpfiance with the hisnrance.coverage required-" Additionally,MGL chapter 152, §25dM stairs-Neither thecoinmaxwealth nor ay ofits political snbdxvimons shall ems into any contract for the pesfm=Lance ofpublic wmk uaff acceptable evidence of compliance with the,fi „-a„ce. requirements of this chapter have been presented to the ctmft- anfhozity-" Applicants Please ER out the worl ms'compensation affidavit completely,by checking the boxes that apply to your sitaaiion and,if necessary,supply sub-cont=ctor(s)name(s), ad&=s(es)and Phone numbers) along with their cestifieate(s) of nst-¢mce. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)withno employees other than the members or partners,are not requmed to cast'workers' compensation ns2iraum If an LLC or IS F does have employees,a policy is required. 13 e advised that this affida-vit may be submYnd to the Department of Industrial Accidents for confirmation of insmaice coverage: Also he sure to sign and dafe;.he affidavit The affidavit should bezutmmed to the city or town that the application for the permit or license is being requested,not the Department of hTbasfr;al 2isc; its Mmuldyou have any questions regatdmg the law or ifyou are regcm-ed to obtain a workers' compensation policy,please call tin;Department at the number listed below. Self-ms�meanies should err their Self-insurance license number on the appmF¢iate line. City or Town Officials. t - Please be Mare that the affidavit is complete and primed.legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Inver-gabn�figs to��you regarding the.applicant_ Pleas a be s1n a to fill in the penmit-/licrose minber which will be used as a refe=ce n amber In addition,sin applicant that must submit multiple permit/license applit atans m.any givear year-,need only submit one affidavit ndic-ating c eut policy information Cif nwzmary)and under-job Sits Address"$e applicaot-should wnte,-all locati:,ns iu (may or town)"A copy of the affidavit that has been.officially stamped or m m:kDd by the city or isrwtr maybe provided to the applicant as proofthat a valid affidavit is on Mc for frain 'permits or licenses_ Anew of iidavhmust be f Mcd Olt each year."Where a home owner ormibarn.is obtaining ahoense or permitnotrelatedto any bin�,�or commercial vend= (Le_ a dog license or pert to bum Iezvm etc-)said person is NOT rcquimd to complete this affidavit The Office of Investigalinns would film to thank you in advamce for your cocpeaafiou and should.you have any questions, please do not hesitate to give us a call- Me Departrueof.'s address,telephone and fax xannber: - Depadm mt cif 1ndlxsfial AWid.Cnts ��a$Xuv'e�g�tiaA� 6w-Wain Sfteel: Bwtou=MA O�111 Tfl 4 617't -4900 c-4- 406 or 1-977 M AFE Rai#617 727 M Revised 4-24-07 �gdrd Q. ho is rem nsible for making r application foth - -- --.--� Application for a permit is required to be made by•the owner or lessee or their agent of the building (e.g.; the HIC registrant). if application is made- other than by.the owner, written authorization of the owner must accompany the application. Such written authorization shall be signed by 'the-owner and shall include a statement of ownership and shall identify the owner's authorized agent, or shall'grant permission to-the lessee to apply for the permit. The full names and addresses of the owner, lessee, applicant and the responsible officers, if the owner or-lessee is a corporate body, shall be stated in the application. Please note: It is the res onsibili' of the registered HIC tb obtain all . ermits necessary for work covered by the Home Improvement . Contractor Registration Law, M G L c 'f42A.• An owner who secures his or her own permits for such shall be excluded from the guaranty fund provisions as defined in M.G.L. c. 142A. Back to Top Q. My contractor told me 1 need to obtain the permits fo construction. Ma 1 obtain the relevant permits from irny local building department, or is the contracto Ireq uired to do that? While you may certainly obtain your own permits, be aware that if you do, you will fall into a homeowner exemption that'will disqualify q rty you from being eligible to receive recourse through M.G._Lc. 142A the HIC Law, -or the statutorily authorized Guaranty Fund, should a'problem arise; It is the responsibility of the registered HIC to obtain all permits necessary for work covered b ( the Home Improvement Contractor Registratiori Law M.G•L c. 142A. If the HIC you are contracting with refuses, you may wish to reconsider using that contractor's services. Town of Barnstable Building Department Services Brian Florence,CBO ' Building Commissioner 200 Main Street, Hyannis,MA 02601 BAWWLAMX MAW www.town.barnstable.ma.us 039. Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION 'j--DATE: .7i `q Please Print I Z' � JOB LOCATION: -7�//I P f 11 number) /��/�/� �at, street U village name 11home phone(# work phone# CURRENT MAILING ADDRESS: QCS 0Z4065 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dweW s 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 strictures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildingpermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and eats and that he/she will comply with said procedures and requirements. Signkfire of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page 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. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 08/16/17 fi �IRE Town of Barnstable F, Building Department Services 33AI Brian Florence, CBO `� Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, ,as Owner of the subject property hereby authorize to act on my bebA in all matters relative to work authorized by this building permit application for. r (Address of Job) **Pool fences and alarms are the responsibility 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.F0RMS:0VR4UFERM1SSI0NP00IS Rcr.09/16/17 Regulatory ServicesDate:1 Z (9 oFTME Richard V. Scali,Interim Director Fee: Building Division _3 ' a"u"A'^B Tom Perry, Building Commissioner I E1639. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: 3 EQ5Tr1A0A Phone: 7 11� g(O Install at: 3� SV n �\1 Village: W4S� �arnS 1C. Map/Parcel: Date: Stove A. New/ se 8(J/�D B. Type: adi /Circ ting '/VG DEPT C. Manufacturer: LX(-(yWN'T Cc�Iqj Lab.No. D. Model No.: Z�'1� T - 071016 Chimney lease note date o last cleaning) Z d 1(o OwN OFggRNST A. New l�stln (If existing,p f g) AeCE B. Flue Size (10 C. Are other appliances attached to Flue? r1 0 D. �Pre-fab Type and Manufacturer Aer c� e5 a$ E. Masonry: Lined/Unlined Hearth A. Materials: co"Ac- B. Sub Floor Construction: Installer Name: Address: Phone: Location of Installation: H.I.0 Registration# Construction Servisor# OR check V Homeowner Installing,no license required LICENSED INSTALLERS SIGNATURE: APPLICANTS SIGNATURE: APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev 11/4/13 Town of Barnstable r s 1 Regulatory Services of Richard V.Scali,Director Building Division tBAWMAREA = .Paul Roma,Building Commissioner i639. �� 200 Main Street, Hyannis,MA 02601 p www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: (� JOB LOCATION`. number street U I- village "HOMEOWNER": c\ll 4 8(D2(O S CUy— ->2 b 4 aZ name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedureh and require that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness 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 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. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 Town of Barnstable Regulatory Services MAM Richard V. Scali,Director Building Division. Paul Roma,Building Commissioner /. 200 Main Street,Hyannis,MA 02601. / www.town.barnstable.ma.us , Office: 508-862-403 8 Fax: 508-790-6230 P erty Owner Must Complete nd Sign This S ction If U ' A Builder I, --- Owner of the subject property hereby authorize to act on my behalf; in all matters relative to work authorized by this ding p t application for. (Address of ob) **Pool fences and alarms are the esponsibility of the app 'cant Pools are not to be filled or utilized efore fence is installed an all final inspections are performed d accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS r .. 27se Commoyrivealtih of-Vassachusetts Deparknent of Industrial Acciderds - Of,f ce of Imwstigadons 600 Washington Street Boston,ALA 02111 fvivi nia=gov/dire Workers' Compensation Insurance Affidavit:Bu ilders/Contracturs/EIectricians/Plumbers APPEcant Information / Please Print LtubI Name t$asm2SS�Org3IISZ3flan�I"� �inal} (�� ` h '��\ Address: `J(V S V l(1 [1 . I' City/Statelzsp: P t f r (T k- Phone-',�- _(-1 1-A Are you an employer?Check the appropriate box: ' Type of project(required): 1.❑ I am a employer with 4. ❑I am a general contractor and I 6. ❑New construction employees(full andfor part-fiime).* have lured the sub-contractors 2.E I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remode-ag ship and have no employees. . These sub-contractors have 8.•❑Demolition warding for me in any capacity. employees and have worms' 9. ❑Building addition [No workers, comp.insurance comp.insuran�t required-] 5. ❑ We area corporation and its 14.❑Electrical repairs or additians �e ] 3.P1 am.a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additioms myself-[No workers'comp- right of exemption per MGL 12.❑Roofrepairs insurance required.]F c.152,§1(4h andwe have no employees.[No workers' 13.❑Other comlp.insurance required-] •AnyappHca that checks box 91 also fill out the section below showing th&vio)2eW campensation policy infbr=dm Iinmeowners who submit this affidavit;dkxtmg they axe domg all we*and then lure outside contractors amst submit a new affidavk indicating snrfi fcoatractors that ebArlr thus bars must attached sa additional sheet showing the name of the sub-cautwaDrs and state whether ar not those en ities have employees.7fthesub-antrsctarshaveemplayw%theymustpmvidethreir worken'camp.policy number. I am an ereepLgvr tleat is prom ding workers'conepemagaii irmzrance for nzy a Tloy ees. Betoav is the po8cy and job site information. Insurance Company Name: Policy#or Self-in.S.Lic.# ExpirationDate: Job Site Address: City/Stawzip: Attach a copy of the corkers'compensation policy-declaration page(shoving the policy number and expiration date). Failure to secure coverage as required.uuder Section 25A of MGL c. 1572 can lead to the imposition of criminal penalties of a fine up to$1,50U ors andlor one-Dear imprisonment,as we11 as civil penalties.in the form of a STOP WORK ORDER and a fine of up to$250-00 a day against the-violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby eatfify und�le prates aredperealties ofgerjuey[drat the inforertatiare pr-atriried a is tru8 and correct Sitmature: Date: (� Phone if- Ull Of jzezal use anly. Do not nrite in this area,to be Completed by city ar taim officiaL City or Tanu: PermitUcense# Issuing Authority(circle one): 1.Board of$ealth 3.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbmg Inspector 6.Other Contact Person: Phone#: Mformation and lnstxuctions Massachursetts General Laws chapter 152 requires an employers to provide wou3�eas'compensation for their employees. Pursuautto this statute-,an'employee is defined as."_.e:vmy Person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,pntnership,association,corporation or other legal entity,or may two or mom of the foregoing engagrd in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,pa-biership,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 budding appu>�thereto shall not because of such employment be d=med 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 cimpliance with the insurance.covearage required.." Additionally,MGL chapter 152, §25CM states'Neither the commonwealth nor any of ifs political subdivisions shall enter into any contract for the performance ofpubho work u dil acceptable evidence'of compliance with the incunanc6.. requirements of this chapter have been presented iD the contracting mithoaty-" Applicants Please fill of± the wolkm'compensation affidavit completely,by checidng the boxes that apply to your sitnation and,if necessary,supply sob-contractor(s)name(s), addresses)and phone number(s)along with their certcFaca-e(s)of insurance. Limited Liability Companies(LLC)or Limited Liabi[ityPartaerships(LLP)withno employees other than the members or partners,are not regdaed to cant'workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this of ida-Tit may be submitted to the Department of Industrial Accidents for confirmation ofinmTrance coverage. Also be sure to sign and date the affidavit:. .The affidavit should be retumed 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 ifyou are required to obtain a workers' compensation policy,please caIl the Department at the number listed below. Self-io a companies should enter their self-insurance license number an the appropriate line. City or Town Officials i Please be sore that the affidavit is complete and primed legibly. The Department has provided a space at the bottom of the affidavit for you to Ell out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peumit/license number which will be used as a reference number. In addition, an applicant that must submit multiple pennit/license appliu;ations in any given year,need only submit one affidavit indicating current p olicy information(if necessary)and under".Tob Site Address-the applicant should write"all locations in (cif'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 fnt='pmMits or licenses- A new affidavitmust be filled out each year.Where a home owner or citizen is obtaining a license or permit not related tQ any business or commercial Ventre (i-a. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like tQ 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 nu mber. The Walth of Massachusf--tis , Depait cnmt of lradustial Accidents ��e rlf�t•�es�g�fi,o� , ��a$hingtQn Str�� Bagtou�MA E1i111 TtrL 4 617 727-4900 Q�' 406 or 14M MA..SSA� Fax#617-727-774-9 1Zevised 4-24-07 V.mas,-7�gavldia o Town of Barnstable Regulatory Services $ Thomas F'.Geller Director soy Building Division Tom Perry,Building Commissioner 200 Main Street, Hyamnis,Nip,02601 Office: 508-862-4038 Fax: 508-790-6230 PERNIIT# S/ FEE: $ SHED REGISTRATION 120 square feet or less / a Location of shed(address) D ViIlage 50$ J(i 3 Property o er's name Telephone number $ i0 GCr -oorl c)a-I- y Size off Shed '- Map/Parcel# cod d r raj - rn sfpiA= Date Hyannis Mafia Street Waterfront Historic District? Old Kings Highway Historic District Commission jurisdiction? 'Conservation Commission(sigaatmv required) T. PLEASE NOTE: IF YOU ARE WITHIIN TBE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE CObff4 SION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN I Mplifl ouu1I to ®Yb ittg'� *iffblvap Regional Wotorit lai0trict Committee In the Town of Barnstable CERTIFICATE OF APPROPRIATENESS kppiication Is hereby made, with four complete sets, for the Issuance of a Certificate of Appropriateness under Secdon 3 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, irawings, or photographs accompanying this application for. CHECK CATEGORIES THAT APPLY: 1. Exterior building construction: ❑ New ❑ Addition ❑ Alteration indicate type of build�g: ❑ House ❑ Garage ❑ Commercial ❑ other 5�1 2. Exterior Painting: 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole 116ther TYPE OR PRINT LEGIBLY: DATE ADDRESS OF PROPOSED WORK au Oar-m+al,¢ASSESSOR'S MAP NO. OWNER& �✓'�r�l�'� ASSESSOR'S LOT NO. V HOME ADDRESS JSIA0 t� I1 12.�- '�►��fr�S ' "'j MAr TELEPHONE N05UK.3G�s�3$ FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way: (Attach additional sheet if necessary.) Day ,. land 50 SLkQ W I I AGENT OR CONTRACTOR � 'n�--rTa,��O� N��- rGo��GfiS TELEPHONENO.,IM ADDRESS �Im�'tn1S lh�0.r(jQ DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. Signed (Mner-Contractor-Agent For Committee Use Only This Certificate is hereby ill— \ Date Approved/ enied Committee Members'Signatures: .. I ,r Town of Barnstable ` Old King's Highway Historic District Committee SPEC ,SHEET FOUNDATION SIDING TYPE CHIMNEY TYPE COLOR ROOF MATERIALk(� ' 1 COLOR We-ZtAn H PITCH L cm I C, WINDOWS " U COLORd SIZE o TRIM COLOR ` 'V r DOORS tl ' '^' ` �' C�y COLORSI' ,N SHUTTERS COLORS GUTTERS "' 1 ' COLORS DECKS MATERIALS GARAGE DOORS COLORS ►V'� / SKYLIGHTS ' " SIZE X COLORS —VK SIGNS �r� / COLORS FENCE 1'1 COLOR NOTES: Fill out completely, including measurements and materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape plan and elevation plans, wbea applicable. SPECSHT Revised 11/98 �l B �► W S8119 5O,:p � Op cl� - �6 . 0O p4.p• ovE)uravc N88°26'48"W 178. 77" ----�21 LOT 4 • C CT S74 2345"W LOT 5 SIO 33'20"E RIF 82' cr_ • l yV 124 03, . .. _ 579,1��00 ES. ZONE.• "Rr This MORTGAGE INSPECTION. Plan is For FLOOD ZOMM "C" Bank Use Only OWN: _ Z BLE REGISTRY OWNER: SIICXar Ac TRUsrr o� A a purr a� EED REF: —BUYER: —GA&v— �KI�fBER.��OS.TBOtt� )ATE: AL2"5 PLAN REF: SCALE:Irr= 50 FT. HEREBY CERTIFY o P TC1 THAT'THE BUILDING tN of A4. YANKEE SURVEY 30WN ON THIS PLAN IS LOCATED ON THE GROUND AS CONSULTANTS •TOWN AND THAT ITS POSITION DOES —___ CONFORM PA�u� THE ZONING LAW SETBACK REQUIREMENTS OF THE 3 i�lmlymEW VI (SUITE 1) )WN OF Bd Y,F�9,81 __� -.._AND THAT Oft 32o9e. _ INDUSTRY ROAD DOES__ff— LIE WITHIN THE SPECIAL FLOOD HAZARD �f� ER�o MARSTONS MILLS, MA. 02648 I AS SHOWN ON THE H.U.D. . MAP DATED_zf�fg2 _ ate �a�.y3� TEL: 428-0055 ,250001 0011 .D FAX 420-5553 THIS PLAN NOT MADE FROM Ar TRUMENT 1(ig4.9 RJS . —pt�F" --� e.++r+rfcv wtnm Tn o� rtonn snn rn►rnr.n' .n,.... S - F. _ t - I ` CONC. _-- 176.77' __ FOUND. u - LOT 4 LOT 5 ;. I e 5.242ACRES N N . CP 124.03' INDIAN SPIRITUAL AND CULTURAL JOB # 89-091B I CER TIFIED PL 0 T PLAN i LOCATION : SOPWA-S � - 7T--T'.v PARNSTABLE, MA SCALE : 1" = 60' DATE : 3-15-95 PREPARED FOR: REFERENCE LOT 4 PB 420 PG 92 MI CHAEL MA CHERA S I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE 1N OF GROUND AS SHOWN HEREON. ARNE at 5M-362-4541 N. t� soe ssz-vase OJALA N down cape engineezlng, Inc. CIVII. ENGINEERS _ � ------ � -------- LAND SURVEYORS Aso main et. yarmouth, ma DATE REG. SURVEYOR Q07,00 6" T Application to 1 9 9 5 �'�,1 Ng4�PNy`E Pw`O"5 ePP Qf Eq{b gyp.`f,PN Old Kings Highway Regional Historic District Committee 9 in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and.on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: Q New Building ❑ Addition ❑ Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY I ( � DATE ADDRESS OF PROPOSED WORK �' yJ ►O l ` R`-G� ASSESSORS MAP NO. � r OWNER A J=- " ASSESSORS LOT NO. ��• 40Z. HOME ADDRESS > au `i t TEL. NO. ---- FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). C. /i zAirfh X. NA I��- 4,15 h/t �iCAA11r Mhr-hea.A6 S✓i0 91 r[J 16,04eA J F Iw v✓z)tu fT AGENT OR CONTRACTOR fl"JA ' ei 7 C��YIU l� TEL. NO. ADDRESS 3 N i 4 I tf�` l� DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). :� i( c S ec` g'(a'' r1��It o2Xi( Coi-w�TKt.,C a �� L �1. �,00c� CdJe(' e o rt II c � � o c v�� -f'r� � A z��u.c.c.. /,✓e�ctc�d i,uoo� i L Q It 10A1,L[✓ AG,(w-aS IS vC-iM1 7/2cy "�a � 1 � ea . J6 j y A., $,�i I o.,/e s vu e �!s .�tr°N�u'" mac( 12- 5,. 5v[�t w &A i�.t l(s fi c�ef<<.� ASrt Z/X /�✓C SNee7S U ® �0 Signed Owner-Contractor-Agent Space below line for Committee u Received-by,H:D.C.- ; j Date The Certificate is hereby Date 1 nT 1 ,,TirtSe�``3 a 1995 ► �� ' By Approved ❑ IMPORT T: If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act. ,� M_ - --- 4 Town of Barnstable h 's Old King's Highway Historic District Committee SPEC SHEET FOUNDATION �, c M L i'l— 1 SIDING TYPE BA YL 1✓ bOA 9-dS COLOR (flee CHIMNEY TYPE COLOR �o ye.A,� Texfc.i� ed ShjjLj S en.QC( ROOF MATERIAL SA rxe AS ASS 429-0.✓ -�a' x& e-COLOR 6—o0 PITCH WINDOW SIZE TRIM COLOR tipT J2,d. , D e w + fb SvSC 2c 1,u DOORS 1 ��X �y COLOR GL SHUTTERS GUTTERS DECK GARAGE DOORS —f COLOR ' NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the plot plan, landscape . plan and elevation plans, . when applicable. Plot plan need not be "Certified", ® but . should show all structures on the lot to scale. SPECSHT w W 5811950':p 00.p Q) _ 268 00, Ma 233E � !g0 b_55. / OVERXANC -_--__ k O N882648"W 178. 77, 21� --:�? __ LOT 4 a� o � o W+ S74 2345"W 11.52 LOT 5 ' SIO 33'20"E T 22.82 w "W 124,03' � \ — 579•10 00 RES. ZONE.- 'RF" This MORTGAGE INSPECTION Plan is For FLOOD ZONE.- "C" Bank Use Only TOWN: WE= T�XS-�ELE _ REGISTRY OWNER: -rrCHAALS MACtHERAs, TRUSTEE OF YA.S.A.C. REALTY TRUST DEED REF: _,521QA0_ — — —BUYER: �'AR.L&_,ffA ?4L_O=OM DATE: �26�95_ _ - - PLAN REF: 420 — — —SCALE:1"= 50___FT. I HEREBY CERTIFY TO fL1901j_H_A0_RTGAGE ___THAT THE BUILDING «� OF Mqs YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS ��. sq`y CONSULTANTS SHOWN AND THAT ITS POSITION DOES _ _ CONFORM PA. �� TO THE ZONING LAW SETBACK REQUIREMENTS OF THE � �IGzfiOTHEW U 40B (SUITE 1) TOWN OF BARNST.4BLE_____________AND THAT q No. 32098 z. INDUSTRY ROAD IT DOES_NOL _ LIE WITHIN THE SPECIAL FLOOD HAZARD r) ,�"lSTE O <'v MARSTONS MILLS, MA. 02648 � 'As��ofR`�SJ�� AREA AS SHOWN ON THE H.U.D. . MAP DATED_7 2��__ TEL: 428-0055 Co i —Pa el # 250001 0011 D ryas iA FAX: 420-5553 _ THIS PLAN NOT MADE FROM AN STRUMENT 16949 BJS ' PA L A. MERI EW.PLS SURVEY. NOT TO BE USED FOR FENCES ETC. LOCATION OF PROPERTY LINES MAY NOT BE ACCURATE STANDARD LEGEND NfOOTE:not all symbols will appear on a map, GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES EDGE OF BRUSH r i ORCHARD OR NURSERY V-V-V-V EDGE OF CONIFEROUS TREES l MARSH AREA — — EDGE OF WATER = _ _ = DIRT ROAD E DRIVEWAY — - I PARKING LOT JE-- I��PAVED ROAD — — DRAINAGE DITCH AP ` - - - - - PATH/TRAIL PARCEL LINE # 36 mAP11a F-MAP# 21 E-PARCEL NUMBER #1860 —HOUSE NUMBER i 2 FOOT CONTOUR LINE 0 10 FOOT CONTOUR LINE Elevation based on NGVD29 4.9 SPOT ELEVATION 00o STONE WALL -X—X- FENCE RETAINING WALL RAIL ROAD TRACK MAP 196 © STONE JETTY 7 - 4 SWIMMING POOL # 50 L PORCH/DECK D BUILDING/STRUCTURE - DOCK/PIER HYDRANT E) VALVE OO MANHOLE o POST 0" FLAG POLE T O W N O F B A R N S T A B L E G E O G R A P H I C 1 N F O R M A T 1 O N S Y S T E M S U N 1 T a SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET *NOTE:This map is on enlargement of o **NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimetria(man-made features)were interpreted from 1995 aerial photographs by The James �, - 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aedol photographs by GEOD Rt UTILITY POLE o TOWER w E � m National Actura Standards Q 3Q 6Q p ry do not represent actual relationships to physical objects Corporation. Planimetria,topography,and vegetation were mopped to meet National Mop Accuracy Standards 4 LIGHT POLE O ELECTRIC BOX x �I INCH=60 FEET* enlarged scale. an the mop. at a scale of 1"=100'. Parcel lines were digitized from 2001 Town of Barnstable Assessors tax maps. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ni-ap j 1 b Parcel 6V2- Permit# Health Division- Date Issued - Conservation Division FeeS�e Tax Collector 0 L Treasurer lb oa Planning Dept. Date Definitive Plan ved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 3 b �v t� �► flu Village b-)•. G A K LJ 94AW _ Owner GA ILA/ 0 s'1 ko Address 6 .�„�� C'�E` �/ �Zc/ lzz, 124 g tv Telephone 5-0 Permit Request M szQ Cy n e A-rvL �6 e l-fe i o.dT tb /,'Z A 1vS M I 5 1 o y` C,u1ACC'M c.A, Square feet: 1 st floor: existing 3S.S 01� proposed 2nd floor: existing proposed Total new Valuation Zoning District Flood Plain Groundwater Overlay Construction Type h` Lot Size C K 1— Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family W Two Family ❑ Multi-Family(#units) ,4ge of Existing Structure 1 e-Af25 Historic House: ❑Yes M No On Old King's Highway: ❑Yes ®No Basement Type: ® Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new i 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 ❑ No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Cl No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name 5714 0 YV\ Telephone Number Address ll License# M f dw h/ �,VL. Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY ; ' PERMIT NO. DATE ISSUED e MAP/PARCEL NO. ' ADDRESS VILLAGE Jf . OWNER' DATE OF INSPECTION: r FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING , r DATE CLOSED OUT ASSOCIATION PLAN NO. RESIDENTIAL: SHEDS - POOLS-DECKS-OPEN PORCHES- GAZEBOS DETACHED GARAGES FEE VALUE WORKSHEET ACCESSORY STRUCTURES >120 sq.ft.(Sheds,detached garages,gazebos,etc.) >120 sf-500 sf $35.00 $ >500 sf-750 sf 50.00 $ b.60 >150 sf- 1000 sf 75.00 $ >1000 sf- 1500 sf 100.00 $ >1500 sf—USE NEW BUILDING PERMIT APPLICATION DECKS x$30.00= $ (Number) PORCHES x$30.00= $ (Number) IN GROUND SWIMMING POOL $60.00 $ ABOVE GROUND SWIMMING POOL $25.00 $ RELOCATION/MOVING $150.00 $ (Plus above fee if applicable) PERMIT FEE $ Q:forms:dkcost eff:082301 6.4 ge it no • F�•v'?`•r }.},4,.Yvf �:n: fr::}: '''i.11t{: f�r.��,Si O S :�tS! 9,. '•i:<fii .. •7 E03 101 Rill if.: t3 ti N Mi Aliljl: U."11� Eq u Vyxg.: gg" x;o P4 x X:x I Q • ik . .......... VI >.ajs. :w I'll O _2 iiiiii'll ,Jill (19❑ 0 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all-employers to provide workers* compensatzoa forthr:r employees. As quoted from the."law", an employee is dewed as every person in the service of another under any cP r- of hire, --cpress or implied. oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or taore of the-foregoing engaged in a joint enterprise. and including the legal represeataaives of a deceased etnplover, orthe reccwe: tnistee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartrn+ and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance grrnmric � cansuuctica or repair waric on such dwelling house or on the_ building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 sectiaa 25 also states that every state or local.licensing agency.shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,nczthrrthe commonwealth nor any of its political subdivisions shall eater iato any cm==forte performative of public work until acceptable evidence of compliance with the ksurance requires cf this chapter have bees presented to the ca=acting authority. - -Applicants Please fill is the work=' compensation affidavit completely,by checking the.box that applies to.your and supplvmg ceaatpaay names,address and phone numbers along with a certificate-of insurance as all affidavits maybe submitsed to the Department of Industrial Accidents for &=tee age Also be sure to sign and date the affidavit 'The affidavit should be.retnmed to the cry ort�own that the application for the permit or license is being requested,not the Depart scat of Industoal Accidents. Sbauld yam have.=9 questions regarding the law„.or if S ou are required to obtain a workr:rs' ca®peasatioa policy,please col the Departmrrtt at the number listed below . / City or Towns - _... _. . .. . Please be sure that the affidavit is complete and printed legibly. The Dqm m=has provided a space at the bottom of the affidavit for yeti to fill out in the event the Office of has to caartact you regarding the applies. Plms e r*�+*trti a number which wiII be rued as a rtfereace nttmher. The affidavits may be r io be sure to fill in the p . the Department by mail or FAX unless other have been,made. The Offica of Investigations would lice to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. T'he Departtaeni's address,telephone and faxnmaber. The Commonwealth Of Massachusetts Department of Industrial Accidents Me of lavesduadoas y 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 I'� °F SME l� • The Town of Barnstable :.. &ARNsMai.e. _ 9 � g Regulatory Services i639. .0� Geiger, Director plED MP'1� Thomas F. Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street.Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date d 1 o�9O L 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: 1'vL 1LA►'L �QAC►2 timated Cost SOa' Address of Work: b �� 1" �Sia0w� Owner's Name• ►'L�r / Date of Application:—()ITOgI O L 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 apply for a permit as the agent of the owner. Date Contractor Name Registration No. l ` V p6_M O Q0z- Date Owner's Name q:forms:A ffidav:rev-070601 IKE rpW The Town of Barnstable arnstable 9q� 6`s; � Regulatory Services iOrFo ra+°' Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 0 e dL JOB LOCATION: [� S� lJ N/ ��Cl i C [>,d t✓L�f r� (�j�� // number street village "HOMEOWNER":(�dg_u (��—IILUh.. �O6?-,36d-- 55'38 Soli S66 i7/8 name/ 2 / home phone# work phone# CURRENT MAILING ADDRESS: J b S, A lL, /l/ �2C� city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied-dwelling of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she.will comply with said procedure d requirements Signature q Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may caret amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN TOWN OF -BARNSTABLE ._ 'BUILDING PERMIT PARCEL ID 196 .007 002 ',GEOBASE ID 32691' ADDRESS 36 SUN HILL ROAD PHONE W BARNSTABLE ZIP - LOT 4 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT WB PERMIT 40341 DESCRIPTION SINGLE) FAMILY DWELLING PERMIT #840 PERMIT TYPE BCOO TITLE CERTIY?CATE OF OCCUPANCY 1 j CONTRACTORS: 4. Department of Health, Safety ARCHITECTS: and Environmental Services 'TOTAL FEES: BOND $.00 Ox THE ,CONSTRUCTION, COSTS $.00 Qi► 7 53 MISC. NOT CODED ELSEWHERE * BARNSI,ABLE, MASS. �► 1639. A�0 ED MA'S j BUILDIN V . BY DATE ISSUED 08/11/1999 EXPIRATION DATE �` °F ZFIE T� The Town of Barnstable MM 116 9 Department of Health Safety and Environmental Services ArEOMA'�A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner August 11, 1999 Mr.Gary Ostrom 36 Sun Hill Road Barnstable MA 02668 RE: 36 Sun Hill Road.Barnstable.Mass, Dear Mr.Ostrom: A recent review of our records revealed that a Temporary Occupancy Permit was originally issued for the above referenced home pending approval from the Old King's Highway Historic District Commission for the shed which was erected on the property. Although the shed has since been approved by Old King's Highway,application for the final Occupancy Permit was never made;and it remained inadvertently unissued. In order to bring our files up to date and since the project has been completed and approved,I am forwarding the Certificate of Occupancy to you as property owner and apologize for any inconvenience this may have caused. If you have any questions concerning this letter,please feel free to contact me at#862-4033. Sincerely, �Alked in BUILDING INSPECTOR Enclosures AM/kl q:martin:letters:99081 la In essor's Office(1st floor) Map Parcelservtion Office(4th floor)(8:30-9:30/1:00-2:00) �Xa,,9G + Date Issued S� .� �1903 ' Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) 9 � Ne ,,.,e �. s P in De t. is (L— c how- Engineering Dept. (3rd floor) House# INSTALL � PLIA CE Ton O®E AN®, udr 11(Vino '. ' TOWN OF BARNSTABLE ` ' Building Permit Application Ttreess Y✓96 �✓ z `//l A/`• , Village '.Owner �,�yc �c`fihC Address 441 Telephone Permit Request 017 .J S ea/ I v First Floor ��. square feet Second Floor �' square feet Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded ' Current Use I Proposed Use Construction Type '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) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other X,.� 4S'6Ko t'N Builder Information Name Cl�Ge�t!J 4: � G 104 Telephone Number Address 2d s"i k,, lY1 // ,494/ License# 4JG5f It A a.Et&5, 'A 614 Home Improvement Contractor# Worker's Compensation# 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 r\_SIGNATURE,z:-� DATE 1 a i1 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) . .. . j' OFFI E O r ;FOR CIAL USE NLY e PERMIT NO. !i DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILD-I&G f` fL- DATE CLOSEbb'til ASSOCIATION pPLAN NO. IJ uV � , ` o g TOWN OF BARNSTAB.LE TEMPORARY CERTIFICATE OF OCCUPANCY'. PARCEL ID 196 007 002 GEOBASE ID 32691 ADDRESS 36 SUN HILL ROAD #: PHONE . W. Barnstable ` + ZIP ILOT 4 BLOCK LOT SIZE DBA , DEVELOPMENT DISTRICT WB PERMIT 11051 DESCRIPTION SINGLE FAMILY DWELLING PERMIT TYPE B000 TITLE CERTIFICATE OF OCMPAT11hent of Health, Safety CONTRACTORS: and Environmental Services ARCHITECTS: . y ` , TOTAL FEES: BOND � $ 00 CONSTRUCTION COSTS . $.00 ' 753 MISC. : NOT CODED ELSEWHERE ; snRNSTABLE, # k 059. OWNER MACHERAS, MICHALIS TR ADDRESS YA-S A C REALTY' TRUST ` PO BOX 702 s. � Y W BARNSTABLE MA :BUILD G D VISIO/ DATE ISSUED 10/20/1995 EXPIRATION DATE BY 1 DIVISION APPROVALS FOR CERTIFICATE OF OCCUPANCY TO BE SIGNED BY EACH DIVISION HEAD UPON COMPLETION •BUILDING: ',' DATE: COMMENTS: PLUMBING: DATE: COMMENTS: _ 1 ELECTRICAL: DATE: COMMENTS: GAS: DATE: COMMENTS: CONSERVATION: DATE: COMMENTS: OKH: DATE: COMMENTS: HISTORIC: DATE: COMMENTS: FIRE DEPT.: DATE: COMMENTS: OTHER: DATE: COMMENTS: TURN THIS IN TO THE BUILDING COMMISSIONER AFTER ALL SIGN-OFFS ARE COMPLETED.A CERTIFICATE OF OCCUPANCY WILL BE ISSUED AT THAT TIME. .a 14 TOWN OF BARNSTABLE TEMPORARY CERTIFICATE OF OCCUPANCY .. _ ��. rr.F•L .J PARCEL ID 196 007 002 GEOBASE ID� - 32691 ADDRESS 36 SUN HILL ROAD PHONE W. Barnstable - - - ZIP - : LOT 4 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT WB • PERMIT 11051 DESCRIPTION SINGLE FAMILY DWELLING PERMIT TYPE BC00 TITLE _ CERTIFICATE OF OCHVPent of Health, Safety CONTRACTORS: and Environmental Services ARCHITECTS: TOTAL FEES: BOND $.00 CONSTRUCTION COSTS $-00 - — - 753 MISC. NOT CODED ELSEWHERE OWNER MACHERAS, MI CHALI S TR 039. A� ADDRESS YA S .A C REALTY TRUST M1� PO BOX 702 ----------- W BARNSTABLE MA BUIL D SIO DATE ISSUED 10/20/1995 EXPIRATION DATE BY OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. s MINIMUM OF THREE CALL -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: UNTIL FINAL INSPECTION HAS BEEN I ELECTRCAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANCAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO BEFORE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS CIS 2 2 .hwZ`Pb - 2 3 I HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT /' � •` �/ 2 ^S S OAR H t�4� OTHER r SITE PLAN REVIEW APPROVAL /a // cfC) WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. TOWN OF BARNSTABLE TEMPORARY CERTIFICATE OF OCCUPANCY PARCEL ID 196 007 002 GEOBASE ID 32691 ADDRESS 36 SUN HILL ROAD PHONE . W. Barnstable ZIP - LOT 4 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT WB PERMIT 11051 DESCRIPTION SINGLE FAMILY DWELLING PERMIT TYPE BCOO TITLE CERTIFICATE OF OCDdpa 'f` ent of Health, Safety CONTRACTORS: and Environmental Services ARCHITECTS: TOTAL FEES: �tME BOND $.00 CONSTRUCTION COSTS $.00 753 MISC- NOT CODED ELSEWHERE + spitrlgTABLE, •' • MASK. 1639. OWNER MACHERAS, MICHALIS. TREp I ADDRESS YA S A C REALTY TRUST I PO BOX '702 III W BARNSTABLE MA I • BUILD_ DIVISIO I DATE ISSUED 10/20/1995 EXPIRATION DATE BY I THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. OEN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET R ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. I MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION WHERE APPLICABLE, SEPARATE 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- PERMITS ARE REQUIRED FOR (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 I I 1 I . I I I 2 2 2 1 ' I I I • I 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT I I I 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVEDTHE 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- TION. NOTED ABOVE. TION. 508-790-6227 i i i i � ., i i i � C rn � r � . v � _ Z � ,--� ; _ � _ -_ r Town of Barnstable Building Department ComplainVInquiry Report Date: Rec'd by: 2�=-- Assessor's No.: Complaint Name: — (�/a4�� 0.4- Location Address: M/P Originator Name: Street Village: State: Zip: Telephone: D/E Complaint a Description: Inquiry Description: I For Office Use Only Inspector's Action/Comments Date: a Inspector. fz Follow-up Action Additional Info.Attached Copy Distribution: KW&--Depament Me Yellow-Inspector Pink Inspector(Return to Office Manager) �tME ipy_ The Town of Barnstable RARARA MASS Department of Health Safety and Environmental Services 039P 'QED Mn+> Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection � ..� l t�C�� UU Location 3 6 SV\ �l LL Permit Number Owner Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: MCI R�z A"1111,4-7f ,4;�' �� 7GU I�0� Please call: 508-790-6227 for reei/n�specti6n. Inspected by , Date l '�� The Town of Barnstable o� BA MMZSA LE. MASS Department of Health Safety and Environmental Services g Building Division 367 Main Street,Hyannis, MA 02601 ' Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice t Type of Inspection '�'' L-01 Location 310 Sowk 4*kCLP-D Permit Number Owner Ili NC V$.=I Builder Y ,�, , Vim— _ One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: V`1 M-- n�l >>l_1 t ale - i-'c5V 4'4�-r- r)Q- NHVc�$ Ak n V (A 1P cl;\ � 0 � Please call: 508-790-6227 for reeinspection. Inspected by Date ® 2-0 The Town of Barnstable BARNSTABLE.$ Department of Health Safety and Environmental Services MASS. i679 �0 gEc,,o+" Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection 2 V7 . Location ;'Yo &' A•3 qku' Ov�t-v�) Permit Number Owner( 't-- t\AaC V\- J\M Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: Please call: 508-790-6-227 for reeinspection. Inspected by �� Date Assessor's Office(1 st floor) Map /fb 4,& O��^ oo� Permit# Q Conservation Office Oth floor Date Issued Board of Health Ord floor -'- �N Engineering Dept. Ord floor House# Planning De t.- lst floor/School Admin.'Bld :'' Definitive Plan Approved by Planning Board M R '-z CA " �y 19777�- (Applications processed 8:30-9:30 a.m.& LOO-2:OOp.m.) J TOWN OF BARNSTABLE SUr)Bull ling Permit Application Proiect'Strcet Address '� d T '� ��. f � tr' ry Village j �� Z/Y S'T �L t7` Fire District Owner.- M " Hie ffE/Z-d S Address Telcphoiic r Permit Rcauest: /Y f--w a O/-9 6 Zoning District Flood Plain Water Protection Lot Size - Grandfathered Zoning Board of Appeals Authorization fL,!!5? Recorded Current Use Proposed Use ` Construction TyNe 1/,,y0ox SPA, H 5- EaistinQ Information Dwelling°Type: Single Family Two family Multi-family Age of structure G\Ar Basement type Historic House Finished Old King s.Highway- Unfinished Number of Baths No. of Bedrooms 3 Total Room Count(not including baths) ^ , — First Floor Heat Type and Fuel GAS Emtsp n(—Central Air NO - Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Namc E Telephone number D Address t Q k License# Home Improvement Contractor# Worker's Compgnsation 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 Pro ec Cost14 SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T gya FOR OFFICE USE ONLY l gol 00 0 0 cZ ADDRESS �C� C5L11!I �Ll VILLAGE OWNER DATE OF INSPECTION: FOUNDATION r FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL l•, FINAL'BUILDING -�'Jo �� l �✓ �-o'/-.E DATE CLOSED OUT: ASSOCIATE PLAN NO. o , z� n 0 N I N/F ANGEA J. KING TR. 9B, INDIAN SPIRITUAL 268.00' AND CULTURAL i lc;l ' C0NC. 178 77' __ FOUND. o it LOT 4 LOT 5 53 827 SF �s 1.�4 ACRES N 124.03'. i INDIAN SPIRITUAL I AND CULTURAL I JOB # 89-0918 CER TIFIED PL 0 T PLAN i LOCATION : SOPHIA'S WAY WEST BARNSTABLE, MA PREPARED FOR: SCALE : 1" = 60' DATE : 3-15-95 REFERENCE LOT 4 PB 420 PC 92 MI CHAEL MA CHERA S I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE � GROUND AS SHOWN HEREON. V�Jto Of Of • off! sob.-382-464+ M, F t� sob sbz-vase O►AI A -_ N down cape engineering, inn CIVII. ENGINEERS -------- LAND SURVEYORS �" ------ � DATE �. REG. SURVEYOR css main et. Yarmouth, ma -- k Ale 1 '?(a 0 O 7 LOCO(:) 6 ROUTE_ 6-A CTY05 TDS 500 WB KEY 326917 ----MAILING ADDRESS------- PCA1:=01 PCSOO YR85 PARENT 12181/. MACHERAS, M I CHAL I S TRS MAP AREAS SAC JV MTG2001 YA S A C REALTY TRUST SP1 SP2 SF_; PO BOX 702 UT1 UT:=' 1 . 24 SO FT W BARNSTABLE MA 02668 AYB EYB OBS CONST 0000 LAND 39300 IMF' OTHER "_�='�---- DESCRIPTION---- TRUE MKT _.. _,-�i REA CLASSIFIED �- #LAND 1 39, 300 ASD LND 39:=00 ASD IMP ASD OTH #PL 36 SUN HILL RD WB DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #DL LOT 4 TAX EXEMPT #RR 2122 RES I DENT'L 39300 _9_:cho 39:I:00 OPEN SPACE COMMERCIAL INDUSTRIAL SPL I Tc 605 ,7 EXEMPTIONS SALE07/8/.::. PRICE 250000 ORB5210/298 AFD V V hl LAST ACTIVITY02/13/9 PCRN RCV F Window PCR/1 at BARNSTABLE (28) ip ] ] [R196 007 . 002 ] TAX ACCOUNTING [ ] 23202- [ 3269171 RECEIPT NO. PAYMENT TAX YEAR/B.G. AMOUNT DATE TYPE PID 121816 [ ] ] 1ST DUE �9501] 439 . 741 A1020951 [1] ] [ ] A ] FULL DUE A9501] A G07 . 21] A1020951 [F] ] [ ] A ] ^ ] ^ ] ^ ] [ ] ] ------CERTIFIED OWNER------ TAX DUE 526 . 62 ] OUTSTANDING 526 . 62 MACHERAS, MICHALIS TRS ] TAX CODE 500 ] CITY 051 DISTRICTS WB ------JANUARY 1 OWNER------ ACTION ] MORTGAGE CODE A2001] MACHERAS, MICHALIS TRS ] ----CERTIFIED VALUES---- -------CURRENTOWNER------- TAX EXEMPT . 00 ] MACHERAS, MICHALIS TRS ] TAXABLE . 00 ] YA S A C REALTY TRUST ] RESIDENT'L 39, 300 . 00 ] PO BOX 702 ] TAXABLE 39, 300 . 00 ] W BARNSTABLE MA 026681 OPEN SPACE . 00 ] 00001 TAXABLE . 00 ] -----LEGAL DESCRIPTION----- COMMERCIAL . 00 ] #LAND 1 39, 3001 TAXABLE . 00 ] #PL 36 SUN HILL RD WB ] INDUSTRIAL . 00 ] #DL LOT 4 ] TAXABLE . 00 ] #RR 2122 ] ] ACTION CANCELLED I '?O�i)✓ Oi:=? ' S ?':r>•.PTION The code orming work for which a permit is recuired sha' _ • � r section _ -' lie �..cr�i'.� _r.c::-; t. e provisions of this section (Section 109 . 1 . 1 - Licensing of Construction Supervisors) ; provided that,_if Home Owner engages a person (s) for hire to do such work, that -such Home Ownez shall act as supervisor. ". Many Home Owners who use this exemption are unaware that they are, assuming- the responsibilities of a. supervisor (see Appendix Q, Rules and Regulations for licensing Construction- Supervisors, Section 2. 15) . This .lack of awarenes -. often results in serious problems, particularly when the Rome.Owner hires- unlicensed persons. '- In this case our Board cannot proceed against..the- inlicensed „ _..person as it would with. licensed Supervisor. The. Home &]ii actin as supervisor is ultimately responsible. - .l To ensure that the Home Owner is fully aware of his/her. res ponsib�ilities,_ man communities require, as part of the permit application, that the 116me -0w;her 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. i TOWN OF BARNSTABLE BUILDING DEi ^;•; '?, Please print. . DATE -- .• .- _j JOB. LOCATION Number Street address Section of tiown: 7,5 5. ..2 . . "HOMEOWNER" Set- 79 7 951 . Name Home phone .• - Work phone PRESENT MAILING' ADDRESS /C-10, s 0 - , City town State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"- shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the Stat Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said p ocedures and requirements. HOMEOWNER'S SIGNATURE APPROVA.T_ OF BUILDING OFFICIAL Cot Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127 . 0, Construction Control. 41 - 1® {iw� 0 f 6 . w 10 (!) o.' ' W IILli .. Ar ra LP fl •. ,[.+1 hi!-Il.11m n�•1}lY^• . .:nY n:.vKM1:af.�l.. .. � ♦ u . 1 I I • ' t=..�•�!.il. i it '� _ i_. .' i% • ,ice ...,. •� .I��t _ I r i __ .I � \." 1 ' I I I • � � Ii a y ARGHI'—TECH A550CIATE5 . : .. : J ',�,a,r,c•h,i..teetura•I de5fgn_•:-`. u e..e�-ass :cr urtur plan,uxK'1,1950 route 2E,......:.. 508 771•5900; . • ��tsxta:vllla nu.„;.�_,�•� ' 02892 o. .5 I J_^ - 1 tl y �.;'i Xn i.iY I t.'•.J'S. •.f: '?� � 4., -�S• t r-- n j i rL z aLi u 1' ' rr ' _ ' Application to. . 1994 0.21.1 Old King,.s Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application Is hereby made, id triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973. for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ® New Building ❑ Addition Q Alteration Indicate type of building: Q House Garage ❑ Commercial 0 Other 2 Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑.Other (Please read other side for explanation and requirements). 9 TYPE OR PRINT LEGIBLY DATE- ` ADDRESS OF PROPOSED WORK pJISSESSORS MAP NO. OWNER �1 C: 4 4 E R 14S ASSESSORS LOT NO. y HOME ADDRESS _P f��O�C POfq. 4"S TEL NO. O G CA 1*7 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent street or way. (Attach additional sheet if necessary). property owners across any public ,BOsToM '/Y/f ,p.?/pS . B�9R s ,ems •D�6G �' AGENT OR CONTRACTOR `�L - �Z"cam c 22 O TEL NO. ADDRESS o ON 2Gl,rf DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No.8,other side),including materials to be used, if specifications do not accompany plans. In the case of signs,give locations of existing signs and proposed locations of new signs. (Attach additional sheet,if necessary). Signed AVM Space bMow line for CommiaN use. R e Ce ' i e is hereby Date Ai T �1�1tfiN6iAfiLE Q pproved ❑ IMPORTANT: If Certlflcate Is approved,approval Is subject to the 10 day appeal period provided In the Act. Disapproved 0 OLD KING'S HIGHWAY HISTORIC DISTRICT SPEC SHEET FOUNDATION Y E t SIDING TYPE__ 0 COLOR CHIMNEY TYPE_ COLOR ROOF MATERIAL Sf N 4l1' COLOR PITCH I � WINDOW ' 1 h��S© ") SIZE TRIM COLOR _ I DOORS COLOR SHUTTERS GUTTERS . DECK �S { GARAGE DOORS_ . 1 I � COLOR NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the plot plan, landscape plan and - elevation plans, when applicable. Plot plan need not be "Certified", but should show all structures on the lot to scale. 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III jm 9 1I i 9 I ! ! 5cILn --+----rm i — i� -----+----+----'---+—`--- ---+--- ------+--� +—+—+—+— —+—+----+ ---- A To Date / Time WHILE YO WERE OUT M of Phone 7, f S!,5-6 Area Code Number Exte sion TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTSTO SEEYOU URGENT RETURNED YOW CALL Mess e_ � f perator AMPAD 23-021-200 SETS �j EFFICIENCY® 23-421 -400SETS CARBONLESS 1 C L o .. c •�-i� '`_ --_=i:_: Department of Industrial Accidents Officeol/atvesl/gat/ons 600 11'ashington Street Boston.Mass. 02111 Workers' Compensation Insurance Affidavit Attnllcant Information• '• Please PR11YTlerib_1�,�� 11J I t ahnne0 361 138 1 am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this job. company n•tmc' ^•tdre�s• ' may nhonc#: insurance co polite•# 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company n•tme: •tddress• cit.,: nhonc#• insurnncc co policy# K'l[•✓:•r.T..•:•m•e��Tr,Y?';'1'!Rt;a 'T7V► :'Zc�'�+.' -��!'�![+!^'!Y.:. :eR!o^�"""^�S c6minam•name: -- address: city phone#• insurance co policy# .Attach additional'sh'it if neeessa .��: ._w s ,. t,y.:,�rr. ., ;_ �:.a. :•t£��s�=y ---- __�. ,►...>•-y�;•: .= Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1500.00 and/or unc years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Once of investigations of the DIA for coverage verification. 1 do hereby certify wider the ns and pens tics f perjure•that the information prodded above is true and corre . Signature Date �' 7 Print name .e !9 v o YV" Phone# -3 " 5 38 �d official use only do not write in this area to be completed by city or town official city or town: permit/license# rIBuilding Department OLicensing Iluard check if immediate response is required Selectmen's Office [311calth Department contact person: phone#; nOther +: Ire%vcd 3M3 PJA) a .2a ( Ire 1 of � � - . , • i 19 3Atr Ovi ; } 1 fi i Application to 4„ A EPP OEHe,'�'lE P� 9 A V! Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTI FICATE OF APPROPRIATENESS Application is hereby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and.on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: tZ New Building ❑ Addition ❑ Alteration !r-- Indicate type of building: ❑ House ❑ Garage ❑ Commercial ) Other a1t��r_ �t P._C� 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign Q Repainting existing sign 4. Structure: ❑ Fence ©•Wall ❑ Flagpole ❑ Other (Please read othe-,side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK :1 '✓ '` ASSESSORS MAP NO. � ! OWNER (7 A 2.U Jr . ?/r b Win- ASSESSORS LOT NO. ��• OZ I ., f� 2 HOME ADDRESS - 6 ►y �V i ` •`C TEL. NO. .s�6 �'l`/ �) FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). / / y� / C. ZA ,P th/i L�Oi� l CC ��i9J� /C T b/� �O lull I(f S I �i iL� Jf'7 ,�T �i�. /('AAIfs filhi'ItCitA6 �CJ J1/2t; �`I[ le 1/0:zeA J LIw r7oCr nlu-IL'•t•) .� 1. C' C'v r..s r , . �� _Od rag ,vi .ti✓ ✓ -r e- AGENT OR CONTRACTOR i�vJl iLd t-<A t-r �f nQ fx TEL. NO. 3� L5 5 3 ADDRESS 3� I.. N� GA[LP , T-YA e ,r DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new (Attach additional signs. sheet, if necessary). :, g y P 1%. wood CDC e 1v"`cf !f ��• �o rt.�c�e. ��e.e\ B (d 6�r�k a �►�.�wec.. a /r 10A tz l✓ bc,11�- Cr (v F�.. �Pz.c.y -{"a �r�,c -f'i1 � Arab , l�✓2d'�� iNOL� w /louses/ a ,iC SHee"t`s ti✓i(/�� tc�i��! A fz �Sr. s.,lAf[ow- &Ar1d w•c ((s �} cKc/tag /8 �/'t�' Signed I rpm' Owner-Contractor-Agent Space below �line for Committee use. Received Y�L) H-D:I Dte� _ The Ce�r icate is her by Date OCT .30 1995 Time By LX Approved ❑ IMPORT T If Certificate is approved,approval is subject to the 10 day appeal period• provided in the Act. z M - - - - - 41 � Town of Barnstable Old Fing's Highway Historic District Committee SPEC SHEET FOUNDATION Q A4 e-w SIDING TYPE (jA a IJ bod It COLOR C CHIMNEY TYPE COLOR e.Ai� Texfc.i�cd Sh�l� �es / ROOF MATERIAL S,s n4e RS A & sLCOLOR GyDoc+ PITCH WINDOW SIZE TRIM COLOR /V oT OA i i,,Ted e,v f6 IL14r4 4-15 f,3 '-5 DOORS 1 a X �y COLOR SHUTTERS f GUTTERS DECK GARAGE, DOORS —� COLOR � NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the plot plan, l� landscape . plan and elevation plans, . when ® �1� applicable. Plot plan need not be "Certified", \ but . should show all structures on the lot to scale. oz,,,e/e-) SPECSHT � � � �� - � � � _ , _ � . � . . ,' �' � '` J J �. . � , � r � � �� .� � . � � � 1 ..__T _ .___. ._._�--_4 �.__ -.�-�----� . � . . .- � ss` '� ► <5 o W S81195p,�, O O ,268 00,. "1 ~� r 24.z• � '� 233-1 -l.01 b,-5s \• 1 �P o VERHANC =_ _ b--- -- s �,- 15 N88 26'48"W 178. 77' cAI t �. LOT 4 Ts O W S74 2345"W 11.52' LOT 5 22.82 is „W 124,03 \ 579.10 00 go p RES. ZONE "RF" This MORTGAGE INSPECTION Plan is For FLOOD ZONE.- "C" Bank Use Only TOWN: WEB B-ARNST-ABLEL — REGISTRY OWNER: tcHAvs yAcHERAs, TRUSTEE of YA.S.A.C. REALTY TRUST DEED REF: 5210 2Q$ _ _ _BUYER: CAR& O=Om DATE: �26�95_ _ _ PLAN REF: 4201_919 — — —SCALE:I"= 50____FT. I..HEREBY CERTIFY TO RLY9Q_UTH ffD1?TGL4_G_F,'_CQ____ ____ _______THAT THE BUILDING ��t� of MQ YANKEE SURVEY a SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS �? ss�`ti CONSULTANTS t SHOWN AND THAT .ITS POSITION DOES ____ CONFORM PAUL TO THE ZONING LAW SETBACK REQUIREMENTS OF THE � MER THEW c 40B (SUITE 1) 11 TOWN OF _ BARNSTABLE_____________AND THAT q No. 32496 x. INDUSTRY ROAD ' IT DOES_ NOT _ LIE WITHIN THE SPECIAL FLOOD HAZARD �� E�ISTER�� a MARSTONS MILLS, MA. 02648 AREA AS SHOWN ON THE H.U.D. . MAP DATED_�2��_.- ssipry�I `AN\ yap` TEL: 428-0055 Co i -Pa e] � 250001 0011 D FAX: 420-5553 THIS PLAN NOT MADE FROM AN INSTRUMENT 16949 BIZ SPA L A. ME EW. PLS SURVEY. NOT TO. BE USED FOR FENCES, ETC. • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION `Please°l.:pr.int. a:. ^DATE lO JOB. LOCATIONRA j Number Street address Section of town "HOMEOWNER" ' CA N � atizo 61 Name ( Home phone Work phone - - PRESENT MAILING ADDRESS led -BA r-*P 5+)k City town . State o2�6 Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sy who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six 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"• sha•ll submit to the Building Official on a form acgaptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes responsibility for compliance with the Stat Building Code -and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that- he/she will comply wit said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIA Note: Three family dwellings 35, 000 cubic feet; or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION - The code state that: "Any Home Owner performing work for which aRbuilding permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that,.if Home Owner engages a person (s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor, (see Appendix Q, Rules and Regulations for .licensing Construction Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person-as, it would with licensed. Supervisor. The Home "Owner'`actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her. responsibilities,. man communities require, as part of the permit application, , that the Home Owner 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. a I q•. i e i I • I I �,�,�::� ._ ..ram- _ r .tom"' � ��- �.: r , . _ � >:•. t( � �--- � �.a f � ^I ♦•�I l Ifs w� ,I R %!' : r _ IF rAjP w'C/C� �. /, I 7_ Ml U N}G►PGI. W e.T�-2 !`-' o.va.�t,liP.St,,,E ;nvr, { �' � } '•; ,�,, � ; • i , �+, D�iC-�t�! 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