HomeMy WebLinkAbout0510 WILLOW STREET ^J// ��/11 /_ //J�' ..
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CERTIPIED MAIL. RECEIPT
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PS Form 3800,August 2006 See Reverse for instructions
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Certified Mail Provides:
■ A mailing receipt �-
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Important Reminders:
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Receipt(PS Form 3811)to the article and add applicable postage to cover the
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a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is
required.
■ For an additional fee, delivery may be restricted to the addressee or
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endorsement"Restricted-Delivery".
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cle at the post office for postmarking. If a postmark on the Certified Mail
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IMPORTANT.Save this receipt and present it when making an inquiry.
PS Forth 3800,August 2006(Reverse)PSN 7530-02-000-9047
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3.Also complete A.' 14 ure
item 4 if Restricted Delivery is desired. ❑Agent
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te Name) C. Date of Delivery
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1. Article Addressed to: If YES,enter delivery address be
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4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Numbert j ,; j i t 7 0`12I 10 A{'0 0 06►2+8 4 3112 3 2 4 i f I
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PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540
UNITED STATES POSTAL SERVICE First- ggs it
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TOWN OF BARNSTABLE
BUILDING DIVISION
200 MAIN ST. I.
BYANNIS,.MA0260
'lilt a 111111 111$111%1111111111 till 11111 lilt
NAME OF nn
OFFENDER, t h ( rn S?le
f 1 n� D DAD 0 9
TOWNPF ADDRESS OF OFFENDER ' jl•tl
_"5 10
BARNSTr FILE aTy,siarE,ZIP CODE�` ^ to
Of tt�► r MV/MB REGISTRATION NUMBER
.OFFENSE L
' HAX\.TAeIE raf/ 1M 1} 14 MASS.
1 { �(y�/'�'��1 \(//i
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TIME AND DATE OF VIOLATION', LOCATI-O�;OF VIOLATION, _ J W
NOTICE OF (A.M /P.MJ ON I I ' CI ,20/�"` . ') 1 f. l+I lOI,CJ—s 11�IL
SIGNATURE O ENFORCING PERSON t ENFORCING�DEPT. BADGE W. _ W
VIOLATION (,� It s7 / _�� IC4 6
OF TOWN I HEREBY ACKNOWLEDGE RECEIPT OF CITATION X } a
ORDINANCE ® Unable to obtain signature of offe. der. 1 F—
THE NONCRIMINAL FINE FOR THIS OFFENSE IS i (Date mailed W I` �y —( W
OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL CL
DISPOSITION WITH NO RESULTING CRIMINAL RECORD. LU
REGULATION a
(1)You may elect to pay the above fine,either by appearing in peison between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, Ly
before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,R Box 430, a Hyannis.MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE.
2 If you desire to contest this matter In a noncriminal proceedingg,yyoou maayy do so by making written request to DISTRICT COURT DEPARTMENT,FIRST
F RNSTABLE DIVISION,COURT COMPOUND,MAIN STREET.BARNSTABLE,MA 02630,Attu:21D Noncriminal Hearings and enclose a copy of this
1 citation for a hearing.
(3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the
hearing to be due,criminal complaint may be issued against you.
❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of E
Signature
!I NAME OF OFFEND R ` \ � � BAR 74209
�llll TOWN OF t
ADDRESS Of OFF D R
\ s
BARNSTABLE CITY,STATE.ZIP Co
MV/MB REGISTRATION UMBER
NE
1679• �� ^ W
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F VIOLATIDN LOCATION OF VIOLATION Z
NOTICE OF (A,M. P.M ON z0 ( W
VIOLATION R P S E N DEFT 1 BADGE w
N
OF TOWN CKNO EDGE RECEIPT OF CITATION X WORDINANCE o obtai ign ture of offender. a
THE NONCRIMINAL FINE FOR THIS OFFENSE IS i f—
OR Date mailed �--- W
YOU HAVE THE FOLLOWING ALTERNATIVES WITH-REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL UJI
a
REGULATION DISPOSITION WITH NO RESULTING CRIMINAL RECORD. W
(1)You may elect to pay the above fine,either by appearing In person between 8:30 A.M.and 4:00 P.M. Monday through Friday,legal holidays excepted, N
before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430,
(Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THEggDyyATE OFyyTHIS NOTICE.
CL
UNou desire to contest this matter in a noncriminal
STABLE DIVISION,COURT COMPOUND,MAINrSTREIET BARNou NEILE,MA 0263o so by 0 Attwrittrc 21D Noncriminal Hearuest to DISTRICT ings d encloURT se a copy FIRST
of this
citation for a hearing.
I
(3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to a for the hearing a
hearing to be due,criminal complaint may be issued against ear you. pp 9 or to pay any fine determined at the
❑ I HEREBY ELECT the first option above,confess to the offense.charged,and enclose payment in the amount of$
Signature
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`N
r Town of Barnstable
• �p THE�p� '
Regulatory Services
Thomas F. Geiler,Director
1AMGTABLL4 i
Building Division
p�fD►�� Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www,town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-623(
PERMIT#�-009 0 a
FEE:
SHED REGISTRATION
120 square feet or less
—Location of shed(address) Village
Property owner's name Telephone number
(30 - oz C&
Size of Shed Map/Parcel# .
`"(1 2C1 � <r,
Signature Date
Hyannis Main Street Waterfront Historic District?
Ct7 j
Old King's Highway Historic District Commission jurisdiction? c s
Conservation Commission(signature is required)
Sign off hours for Conservation 8:00-9:30&3:30-4:30 w r
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE
COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE.
PLEASE SEE,THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM. MUST BE ACCOMPANIED BY A
PLOT PLAN
Q-forms-shedreg
REV:042506
002 ..
1P c� �415
$' J y 7zB.a�
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I certify that this property is
located in Flood Hazard `Lone C (out-
side the 500 year 'flood) as identified
by the Department of Housing and Urban
Development (HUD) .
Date .)�;>ve x-7 Zoo j CERTIFIED PLOT PLAN
`;.. LOCATION
SOLE .✓'s'�iov'.... DATE J1�✓e L-7 Z603
1,4 :;Serve `o=/ PLAN REFERENCE .t����v�- 49�" bZ.
THE LOCATION OF THE ORIGINAL DWELLING
I certify to its title insurance company SHOWN HEREON OTHER WAS IN COMPLIANCE
that there are no visible encroachments WITH THE LOCAL APPLICABLE ZONING 9yLAWS
or easements 'except as shown and that this IN EFFECT WHEN CONSTRUCTED (WITH
plan was prepared under my immediate RESPECT TO HORIZONTAL DIMENSIONAL
supervision. RE®UIREMENTS ONLY),OR EXEMPT FROM
VIOLATION ENFORCEMENT ACTION UNDER M.D.L.
TITLE VII,CHAPTER 40A;SECTION 7,UNLESS
�� OTHERWISE NOT �� sHOI HEREON,
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510 Willow Street, W B 12/1/06
Town of Barnstable ermit: Gj �?
ZME Tp� Regulatory Services ate:
Thomas F.Geiler,Director
+ pAsrrsTABLE,A+ Building Divisionee:�)Y 00
9 MASS. 0
�AIFc 3.16 Tom Perry, Building Commissioner l
200 Main Street, Hyannis,MA 02601 I e/"J
www.town.barnstable.ma.us I
Office: 508-862-4038 Fax: 508-700-6230
TOWN OF BARNSTABLE
SOLID FUEL STOVE PERMIT
Owner: ` Phone:
Install at: �� ����lp7Zs� Ste, Village: 21 �S' p�z��v,
Map/Parcel: (N Date: t ?d C�
Stove
N
A. New,/�Use
B. Type: adia Circulating CD
C. Manufacturer: 1Z tT��,A,, Lab. No.
D. Model No.: v`, o °3
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c„
Chimney N X
A. New/ xistin xisting,please note date of last cleaning) o co
B. Flue Size >< ka— CA) M
C. Are other appliances attached to Flue?
D. Pre-fab Type and Manufacturer
E. Masonry: Lined/Unlined
Hearth
A. Materials:
B. Sub Floor Construction: C
Installer
Name: �' Q S l Address:
Phone:
Location of Installation:
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 122801 v r fe •,::,, �*.^' -�
Town of BarnstablePen-nit:
�FTHE Tg� Regulatory Services ate:
Thomas F.Geiler,Director Ix
13AANSrAHL6. Building Division eea 'QQ
y MASS.
1639.
1 3r a�� Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 )O Fax: 508-790-6230
TOWN OF BARNSTABLE
SOLID FUEL STOVE PERMIT
/ S�5 z S Cn c
Owner:(0 )_ ( � Phone:
r Install at: '! o Village: b-J . (�P gL,J
Map/Parcel: D Date:
Stove
A. 0/Used o
B. Type: ( Ra:d:i;- �/Circulating �^
C. Manufacturer: � � S +a �� Lab. No. n
D. Model No.:
1`tJ
Chimney -
A. New/ �xistingisting,please note date of last cleaning
B. Flue Size x cZ
C. Are other appliances attached to Flue? eV o
D. Pre-fab Type and Manufacturer o ca
E. Masonry: Lined/Unlined
w M
Hearth
A. Materials: Ctcc--(
B. Sub Floor Construction: f— r ��, ,
Installer n
Name: �� �J�ik-� Address:
Phone:
Location of Installation:
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:fonns:stove
Rev 122801
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 13 6 Parcel 0 Z Permit# �� `� S
Health Division ^'a-� '7 D $I�F�EEC ,Date Issued ` $r-b S _
Conservation Division
W�i5� ,'9*ey—C4 INSTALLED IN CMUP�BE Fee ' -7
WkIbs-dp p/e6eR�TITLES Application Feef/®®, 0®
Tax Collector ENVIRONMENTAL CODE AND
Treasurer
TOWN REGULATIONS 4�
Planning Dept. Checked in By
Date Definitive Plan Approved by Planning Board Approved By
Historic-OKH Preservation/Hyannis
Project Street Address SI U to- LLUUu 5-t
Village GU(c'S► ( (Zr K L2LE
Owner(d,_)"l f K��Nt -7� i��--�' t��IZ Address
Telephone
Permit Request v 6 x `1�s e4-1
Square feet: 1st floor: existing proposed 1 725 2nd floor: existing proposed Total new
Valuation 11�6 A Zoning District Flood Plain Groundwater Overlay
Construction Type e?,i\ ytn t%
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: 6'Yres ❑ No
Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing 13 new �' Half: existing new
Number of Bedrooms: existing new
Total Room Count(not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing 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 ElCommercial ❑Yes EIut No If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION L ��
Name �..
��� �,✓ z/L— Telephione Number �C �G Z cl ,'//
Address !�-i y License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO
SIGNATURE DATE �.
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
MAP/PA
.RCENO.
ADDRESS,.- - " VILLAGE
j OWNER
1
DATE OF INSPECTION.
FOUNDATION >
Q � a
FRAME _5
A �
INSULATIO
FIREPLACE M 0
00
ELECTRICAL S R(zo FINAL
to 6
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION,PLAN NO.
•
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--- _ the Commonwealth of Massachusetts
Department of Industrial Accidents
Office of lnvestigations
600 Washington Street, 7`4�Floor
Boston,Mass. 02111
Workers'Com ensation Insurance.Aftldavit:BuildinLY/Plumbin /Electrical Contractors
MR
name:
address: �� L1J4[C}w
city�� `Y� l ShlA(.de state: 2( ..phone# 3&2—e)W
w r e location full address):
I am a homeowner performing all work myself. Project Type: ew Construction[]Remodel
ay Ida;,&mt a sole proprietor and have no one workingm an capa�cityy..p •. �p .BuilsdVilti Addition
.`7. 9'.N.r'`•°'i�'.'�n,-!•.. -•m .z�;",,-'. '•'.q i� ;�y ,4�F-, !,�fb'•P'�'. ti^"!%'•i`� 'm'. :i'�X t;'•n:' i•4•' } , .t iti'�T'''! ,''•'r�uP.,'�H,•.`•.'9;y'?.'•z.;�•.UC.�r.,pfi�.�'SYb•c�`.bM'
M] I am an employer providing workers' compensation for my employees working on this job.
company name-
—
address:'
city phone##•
insurance co. Dolicy
Ee+&�ri4a,v4t�Ci:6Y..t¢'s�Iwtdresvn$rrrb?•#I�tbwY�.Cerm!'�r.�irieS4�'' .^ i'�,�C:>b:�:�.'1's`,3.L•r.w1`l••c�aJS�^(!�.�+4&�a'}�ir'w!'.uDft°vrY:'s�:�.u4:'�'��•.•a'.r.w�`:3'."�'•.�w'.`'�{+�. ' ..»
[� I 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 name:
address
city phone#:
insurance co.�,{{(,� yq yqq MM q� oyli�c�p# 77 y
��',.'�:•fi ..4y{YiC.`1 :SAC. .t SYY'•..Vi�i�rt� '.. "9'IiR.T!!f:'i:liLt:b• ..r:3Tia�i1:�YN.l1:T�1`i'y�S119. itnL!`:1A.i:•.:y�•..'�k.'��'!! �••7 y! >• 5! �,•r Y:! (.t�<6j�ri.••i`SN'Y i•'�
'company name:
address:
city: phone M
insurance co. oli # y4�1g
' VI b+sliyt" ,
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$1¢00.00 and/or
one 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. I understand that a•
copy of this statement maybe forwarded,to the Office of investigations of the DIA for coverage verification, '
r do here y certify under the pain penalties of perjury that the information provided above is true an correct.
Signa Date v�
Print namelJ`•' '`1�:..� \"IN-+mil' Phone#�
official use only do not write In this area to be completed by city or town official
city or town: permit/license#
❑Building Department
❑check if Immediate response is required ❑Licensing Board
❑Selectmen's Office
❑Health Department
contact person: phone#; ❑Other.
(revised Sept 2007)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all•employers to'provide•workers' compensation for their '.
employees. As quoted from the"law"-, an employee is defined as every person in the service of another under.any
contract of hire,express or implied,oral or written;. .
An employer is defined as an-individual,.partnership,association,corporation or other legal'entity,or'any two or more of
-'the foregoing engaged in a joint'enterpnse,and including the legal representatives of a deceased employer,or the receiver
or trustee of an individual,partnership,association or other-legal entity,employing employees. How6verthe owner of a - -.
dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of
another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds.
or building appurtenant thereto shall not because of such employment be deemed to be an employer..
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any .
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have
been presented to the contracting authority.
> s '• .s,. ,��• }, .:e+• . ,la.Y,-:!y�iY 'Q LYir�, s7iYiuii U�Y..
Applicants
Please fill in 'the workers' compensation affidavit completely,by checking the box that applies to your situation. Please
supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is
being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law" or if
you are required to obtain a workers' compensation policy,please call the Department at the number listed.below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference.number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made. '
The Office of Investigations would like to thank you in advance for.you cooperation and should you have any questions,
please do not hesitate to give us a call.
f
�. ��,.a r�b"�+'"' ��' - 'A�' ' .�:� ` �,• � .�: �'ca.�'f','�'H`;�'�"i-':r*�}:� '`tir."�••��..,�wr� k ,'•' ..r The Department's address,telephone and fax number: r
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street,7`s Floor
Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617)727-4900 ext.406 .
1
°FtHE T°� Town of Barnstable
Regulatory Services
BAMSTABL' MASS. ' Thomas F.Geiler,Director
AlEDW►A'�p Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work Per?_ -1 Estimated Cost
Address of Work: (,uJ�c3?_ J •l 3 Ptf ZT( ,
Owner's Na me:_(A `� V Q
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
geFwner 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.
OR
Date Owner's Name
Q:forms:homeaffidav
1•
RESIDENTIAL BUILDING PERNIIT FEES
APPLICATION FEE
New Buildings $100.00
Residential Addition $50.00
Alterations/Renovations $50.00
Building Permit Amendment $25.00
FEE VALUE WORKSHEET
NEW LIVING SPACE
square feet x$96/sq.foot= x.0041=
plus from below(if applicable)
ALTERATIONSMENOVATIONS OF EXISTING SPACE
square feet x$64/sq.foot- x.0041=
plus from below(if applicable) -
GARAGES(attached&detached)
�7 square feet x$3Vsq.ft.= 5 (o x.0041= �' I
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)
Permit Fee
Projcost
Rev:063004
® ECC � MC
AUG - 4 2005
BARNSTABLE CONSERVATION
'o- �v
2� ti15 NI (1Z
t` 7z8,87
N
f`
AIQ
� � 3� De'+-+r fl � �� •
M f '
(b X` c ..
c9/X a0/
-733
I certify that this property is�
located in Flood Hazard Zone C (out-
side the 500 year flood) as identified
by the Department of Housing and Urban
Development (HUD) . X
Date .%,vc Z 7 zoo j
CERTIFIED 'LOT FLAN
LOCATION .W�3TRrz*vs`T�B«�- . .
SCALE .��r1oo' ... DATE `.. v�..
Red., ,°Zarid :Surveyor FLAN REFERENCE .� !"!G , /�?-/aZ . .
I certify to its title insurance company THE LOCATION OF THE ORIGINAL DWELLINGSHOWN HEREON,'EITHER WAS IN COMPLIANCE
- that there are no visible encroachments WITH THE LOCAL APPLICABLE ZONING BYLAWS
or easements except as shown and that this IN EFFECT WHEN CONSTRUCTED (WITH
plan was prepared under my immediate RESPECT TO HORIZONTAL DIMENSIONAL
supervision. REQUIREMENTS ONLY),OR EXEMPT FROM
VIOLATION ENFORCEMENT ACTION UNDER M.G.L.
TITLE VII,CHAPTER 40A;SECTION T,UNLESS
Xf 114-77
1/ ��./ /� pC�TT'icr�7 -- r7— OTHERWISE NOTED OR SHOWN HEREON,
o�tHE 1r, Town of Barnstable
Regulatory Services
txsznsLe.
MASS, : Thomas F.Geiler,Director
�b ,�� Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: /rr
JOB LOCATION: 5;�(0� C�—
number ^ street village
"HOMEOWNER"Z �?Alvt2 V— .SQi`J 3G Zq _2 t 1 ,�,�10� Zl d l�
'%-fiame (� home phone# work phone#
CURRENT MAILING ADDRESS: �� C�,�kn KCT3"1
� (�P,&a , \'(-t A— CYZ.&r s
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
Cum inspection procedures and requirements and that he/she will comply with said procedures and
equir men omeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board.cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:fomu:homeexempt
f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION td
Map Parcel 07—S Permit#
Health Division .2&�)�— 3 �i�r`{ Date Issued o
Conservation Division4 Application Fee
by rZ e)� _
Tax Collector 7 Permit Fee
Treasurer
Planning Dept. MPTIC SYSTEss9 WiMT C`i;
VISTALLED IN CONIPLd %Ct:;
Date Definitive Plan Approved by Planning Board VIM TITLE 5
Historic-OKH Preservation/Hyannis ENVIRONMENTAL CODE AM1'OWfV REGULATIONS
R
Project Street Address sl® d .,kidw sr.
Village
Owner Le]`'`'' 4 Y--*,y-rtiL-mot P[,L--rt N E f]�s Address Sl v tAvr klaw -St—,
Telephone g 6 Z I
Permit Request 2' W z ec
Z / _
Square feet: 1st floor: existing proposed 2nd floor: existing proposed ,Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation �� Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family C� Two Family ❑ Multi-Family(#units)
Age of Existing Structure YU Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing new
Total Room Count(not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes ❑'No Fireplaces: Existing New Existing 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 O Yes ❑No If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION
NameLo�,C(��� `' �( �� �. tl Telephone Number O; 36 29 714
Address 54_ W ,z License# C7'7— 3 L-1 5 7
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO` ,c1.�.�—' Lu�rypJ•�(
SIGNATUR DATE
a
V ° '
' FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
•
=' MAP/PARCEL'NO. y
a
ADDRESS', VILLAGE
OWNER
DATE OF INSPECTION:
M
FOUNDATION'
f a
FRAME r'r
INSULATION
FIREPLACE "
ELECTRICAL:j' ROUGH FINAL
PLUMBING: ROUGH FINAL' -
s� GAS: ROUGH FINAL
FINAL BUILDING / N �C I �! �/�� �➢ t.
- DATC LOOSED OUT
j ASSOCIATION PLAN NO.
y
i
'The Commonwealth of Massachusetts
ci= =!e
� -- ('' Department of Industrial Accidents
600 Washington Street
Boston,Mass. 02111
Workers' Com�ensation Insurance Affidavit-General Businesses
male:
address: = 0 [_o I, IS I 11 `
city t, \`�tf-1r(L+tiJS�/ �Q state:' C111_ ant7Z&(. phone# -?Go Gl7(I )
wor 'e location full address):
I am a sole proprietor and have no one Business Type: ❑Retail❑Restaurant/Bar/Eating Establishment
working in any capacity. ❑Office❑ Sales(including Real Estate;Autos etc.)
❑I am an em1 Toyer with em loyees(full&part time). ❑Other
I am an emiployer providing workers' compensation for my employees worldng on this job.
company name:
address:' ..:.
city: phone#:
insurance.eo;•:
I am a-soleproprietor and have hired the independent contractors listed below who have the following workers'
compensation polices:
comvenv name: •.' .. :• ... ,::.. : � . .
a'iidress: '
- I
city:.
ineiiraace c0. eilie`:#
:.:.
company, nerve:'
address:
city,.: phone#"c
insurance t o. :: .:.. .:...... ;...
olicv#`
Fallure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a flneup to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a
copy of this tatement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do her by ce ify the pai d penalties o the information provided above is a and f orreci
Signa Date Z7
Print name t? Phone# <(475—Z62_���y,
official use only do not write in this area to be completed by city or town official
• I
city or town: permittlicense# ❑Building Department
❑check if immediate response is required ❑Licensing Board
p q ❑Selectmen s Office e
❑Health Department .
contact person: phone#; ❑Other
(mvised SepL 2003)
r
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract
of hire, express or implied, oral or written.
An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or.the receiver or
trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a
dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of
another who employs persons to do maintenance,,construction or repair work on such dwelling house or on the grounds or
building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has
not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the
commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until
acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting
authority.
Applicants
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please
supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted
to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the
affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being
requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are
required to obtain a workers' compensation policy,please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the
affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits•may be returned to
the Department by mail or FAX unless other arrangements have been made.
r
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number: ► , ' t
The Commonwealth Of Massachusetts
Department of Industrial Accidents
BMW of Imsugatlens
600 Washington Street
Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617) 727-4900 ext.406
i
oETME, . Town of Barnstable
Regulatory Services
13 i s, Thomas F.Geiler,Director
059. �,�� 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 owiaer-occupied
building containing at least one but not more than four dwelling units or to structures which are adj acent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: Estimated Cost
Address of Work--
Owner's Name: �,C )vl
Date of Application: I Zl(d
I hereby certify that:
Registration is not requited for the following reason(s):
0Work excluded by law
❑Job Under$1,000
[58uilding not owner-occupied
gOwner pulling own permit
Notice is hereby given that:OWNERS PULLING THEIRTHEIROWN
_OR DEALING WITH IlYIPROVEMENT WO KDO NOT HA.YE
GISTERED
CONTRACTORS FOR APPLICABLE HOME
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.
OR
Date Owner's Name
Town of Barnstable
Regulatory Services
S sAatWABM : Thomas F.Geiler,Director
MASS
Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 'S08-862-4038 - Fax:.508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION: ��/ C� (ti U 011-i _r, U�j
number street
village -
"HOMEOWNER': -
name ,hot»e phone# work phone#
_. CURRENT MAZING ADDRESS: ( C� CJzv S l'1
city/town state zip code
The current exemption for"-homeowners"was extended to include owner=ocwied 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 procedures and
requirements.
G--sikierofHomeowner
Approval of Building Official
Mote: Three-family dwellings containing 35,000 cubic feet or larger will be.required-to-comply-with the. ". . 7
:.
_State Building Code Section 127:0 Construction Control
HOMEOWNER'S EXEMPTION -
_.
The Code states-that:."Any homeowner performing work for which a..building pemrit is required shall be dxempz-fronilhe provisions
:of this section(Section 109.1'.1-Licensing of construction Supervisors);provided that if the homeowner engages a perstiri(sJ 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 personas 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
-iveral towns. You may care t amend and adopt such a fornikertification for use in your community.
i
rP v r (i rj N 1 ^N!1
f Z
7Z8•B7 ' t
Aft
l3D
a . •t
tole
00
Ga7--W/
I certify that this property is
located in Flood Hazard Zone C (out-
side the 500 year flood) as identified
by the Department of Housing and Urban
Development (HUD) .
Date J�vve 47 zoo-T CERTIFIED PLOT PLAN
Y LOCATION
SCALE . ....../ r ... DATE T�. ..LX. ...
Red. �, t# .Surveyor PLAN REFERENCE �'
. . . . . . . . : . . . . . .. . . .. . . . . . . . .. . . . . . . . .
I certify to its title insurance company THE LOCATION OF THE ORIGINAL DWELLING
that there are no visible encroachments SHOWN HEREON,EITHER WAS IN COMPLIANCE
WITH THE LOCAL APPLICABLE ZONING BYLAWS
or easements except as shown and that this IN EFFECT WHEN CONSTRUCTED (WITH
plan was prepared under my immediate RESPECT TO HORIZONTAL DIMENSIONAL
supervision. REQUIREMENTS ONLY),OR EXEMPT FROM
VIOLATION ENFORCEMENT ACTION UNDER N.G.L.
�, ,� TITLE VI I,CHAPTER 40A SECTION 7,UNLESS
f
APPtication to �s Q
®tI Ring'o 3[qtgbb3ap Regional �EqfOtortt �Diotrftt Committee
• APR 1 5 Zp�4
In the Town of Barnstablero
T�ROpRERNStAE�
CERTIFICATE OF APPROPRIATENESS SEAV.710
,lication is hereby made, with four complete sets, for the issuance of a Certificate of Appropriateness under Section
Chapter 47D, Acts and-Resolves of Massachusetts, 1973, for proposed work as described below and on plans,
mings, or photographs accompanying this application for.
•ECK CATEGORIES THAT APPLY:
C:)
❑
r
Exterior building construction: ❑ ❑ Addition ElAlteration
New �• c
Indicate type of building: ❑ House ❑ Garage Commercial • Other Rl�0-A f S rc�n 5 _,O
Exterior Painting: ❑ �= '
Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign
Structure: - [fence ❑ Wall ❑ Flagpole ❑Other / 7-, �
FPE Oft PRINT LEGIBLY: DATE J ! /'/ �O K W
w
N
)DRESS OF PROPOSED WORK ,-l✓® W �� !1 ST' W, &kJ40 ASSESSOR'S MAP NO. 130,
�
NNER Q����� .. k 'I1�►'L l�l PL-ETn'4tr 0, ASSESSOR'S LOT NO.
)ME ADDRESS TELEPHONE NO. Sid?, 161E 74 N
JLL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any-4
iblic street or way. (Attach additional sheet if necessary.) C)
i
SENT OR CONTRACTOR L P Mgr TELEPHONE NO. 1�_01?)_?6zG 7 q/
DDRESS 00
ESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please
ciude locations of proposed signs. (d. 3&' Y 4 S' ((�
S 14ct+) 122 Y 3 G'
Se en �' x 1 2"
Signed
Owner-Contractor-Agent
�or Commlttes Use Only
This Ce 'f to is hereby Date Z
pprove enied
i
Old Kings Highway Committee
200 Main St.
Hyannis, Ma. 02601
Re: Application of William&Kathleen Plettner to build barn, sheds& fencing, 510
Willow St. West Barnstable. D
Abutters list APR 1 5 2004
Beatrice Harnois TOWN OF BARNSTAB!E
P.O. Box 141 HISTORIC PRESERVATION
W. Barnstable, Ma. 02668
Kevin& Betty Anne Merrigan
75 Cedar St.
W. Barnstable, Ma. 02668
Thomas & Cheryl Trahan
Richard& Dorothea Johnson
8 Mattheson Ave.
Rocky Hill, CT 06067
Donald&Edith Johnson
P.O. Box 501
W. Barnstable, Ma. 02668
John&Marie Small
519 Willow St.
W. Barnstable, Ma. 02668
George & Shirley Palmer
526 Willow St.
W. Barnstable, Ma. 02668
U 3Aa-P4 3L 'x
G-) S464)
Town of Barnstable D E C E U U E
' Old King's Highway Historic District Committee
APR 1 � 2004
SPEC SHEET .
TOWN OF BARNSTABLE
)ATION C n N CZ I?OS"� HISTORIC PRESERVAI:ON
vG TYPE '-OUG►* Sp.wN pl o,1e COLOR N"CkrTL12pr L
REY TYPE COLOR
�• u
MATERIAL 0�5ON'^ct-T S H- -1 6LC COLOR G O-(aX I I_o T(2-4&rd)iT(0.04AL-
H
OWS /(1 N c Ai Z. COLOR IC QLUL= SIZE
i COLOR )ptdt-K ]3 LUI.
:S Sd�GE: < f u"rGH COLORS k -13 LUE-
.'TERS — COLORS
.'ERS COLORS "-
;S MATERIALS
G i �
AGE DOORS 1 x 7 G COLORS -13 L.UL �J�/A-rLY2.41__T1
TIGHTS SIZE COLORS
dS• COLORS
3 0pta-o w/Z�Xy'' wiPZG - j;1b-y.,'w4LTe-FL_ FC-_1-4c C
:E y 30AILO �a-OQ'�-� J� COLOR
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
Im ^
DATA
i
E C E[
7 PR 1 2004
�hr
' }U-c�Qn�� 2i01RCA�F1€t,ES�PF:riAv��
��' 7z8•s7 •'£ x NIST RiCPRESERVA IuN
LJ •
CN
o - 344. �i
Z67--ol ► j
t
I certify that this property is�
located in Flood Hazard Zone C (out-
side the 500 year flood) as identified
by the Department of Housing and Urban
Development (HUD) .
Date Z7 zoo3 CERTIFIED PLOT PLAN
_;,• •,' z.. LOCATION .W�3T BATa!vsr796G�....
SCALE DATE•Tcvdr L7;e Z603
RegP' ric>,Surveyor PLAN REFERENCE Z
I certify to its title insurance company THE LOCATION OF THE ORIGINAL DWELLING
that there are no visible encroachments SHOWN HEREON,EITHER WAS IN COMPLIANCE
WITH THE LOCAL APPLICABLE ZONING BYLAWS
or easements except as shown and that this IN EFFECT WHEN CONSTRUCTED (WITH
plan was prepared under my immediate RESPECT TO HORIZONTAL DIMENSIONAL .
supervision. REQUIREMENTS ONLY),OR EXEMPT FROM
VIOLATION ENFORCEMENT ACTION UNDER M.G.L.
TITLE VI I,CHAPTER 40A;SECTION T,UNLESS
A, L4CZ�/ /�- pLv�TTNL172 - ��T OTHERWISE NOTED OR SHOWN HEREON.
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T Town of Barnstable
Regulatory Services
&AMSTMU& ` Thomas F.Geiler,Director
�' 1639.
39. 0. Building Division
Thomas Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
November 6, 2012
William and Kathleen Plettner
510 Willow Street
W. Barnstable, MA 02668
Re: 510 Willow Street
Map: 130 Parcel:028
Dear Property Owners:
Our records indicate that your house at the above-referenced location is currently being
used as a two-family home, which is contrary to Barnstable Zoning Ordinances.
Violation of zoning ordinances is a misdemeanor, conviction for which results in a
criminal record.
You must contact this office as soon as possible to either:
• Apply for a building permit to restore the property to a one-family home.
• Apply to the Zoning Board of Appeals for a variance, or
• Prove that this is a legal two-family home.
Please contact this office immediately to tell,us what direction you wish to take.
Sincerely,
1
Thomas Perry
Building Commissioner
gforrns:z6ning3 -
Town of Barnstable
- �OFTHE TQ�
do Regulatory Services
Thomas F.Geiler,Director
• MUMSTABM
MAss Building Division
AT fp M►►'�° Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
PERMIT# 7 �� FEE: $ p
SHED REGISTRATION
120 square feet or less
Location of shed(address) Village
Cb4perty owner's name Telephone num er
( `3 y
Size of Shed Map/Parcel#
i ature Date
Hyannis Main Street Waterfront Historic District?
Old King's Highway Historic District Commission jurisdiction?
Conservation Commission(signature required)
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE
COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE.
PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
I
THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN
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