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0078 FLEETWOOD PATH
7e ;,. . _ t� �� �� . .; ;: �. �. �} .�; .. ; � �I ��, '� y � �� i `. 0 r a ? �.—._ _ Town of Barnstable Building Department °FZHer ,o Brian Florence,CBO MUST COMPLY WITH HOME OCCUPATION Building Commissioner RULES AND REGULATIONS. FAILURE TO snaxsresIE, ► 200 Main Street,Hyannis,MA 02601 COMPLY MAY RESULT IN FINES. y Mass. g 039• www.town.barnstable.ma.us prFO MA'S A Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: Z 2-0 1 Name: A'1`� (Ld"1 LS 7—� Phone#: c 7 ���7-6/d0� 1 /'►�7 Village: �rN Address: I c Name of Business: G��,�. L l J T LA—N o 5 CAp( a c Type of Business: l 5G�-t� (�� Map/Lot: �O INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors;electrical disturbance,heat,glare,humidity or other objectionable effects. . • There is no storage or use of toxic or hazardous materials, or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage,or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,hav read and agree • e above restrictions for my home occupation I am registering. Applicant: Date: S Romeoc.doc Rev. 10/17 own of barnstaote Building Department Brian Florence, CBO MUST COMPLY WITH HOME OCCUPATION Building Commissioner. RULES AND REGULATIONS. FAILURE TO 200 Main Street,Hyannis,MA 02601 COMPLY MAY RESULT IN FINES. www.town.barnstable.ma ns Pre-application for Business Certificate Date Mapo Parcel Applicant Information lic amt Name , rn� �cy-� /� ll h . ...__... _..--- ..... inn APPhcants Address 79 FL&ij-WQ� P qT(4 - f �/l� S rONS, v�'1,c �S Emaiil Address �'T� OI`' 7e w[� ''`�-�4���� /y e--7— Telephone Number 77Y°W 02 7p Listed❑ Unlisted ❑ Business Information New Business? --------------------------------------- Yes Cam`J Business is a registered corporation? ________________________. Yes >� If yes Name of Corporation Does business operate under the registered corporate name? Yes No Is the business a sole proprietorship or home occupation? _________ No If yes then a Home Occupation Registration is required—See Building Division Staff. Name of Business LAST Business Address 7q � � MOD PA-TV M —S ON' s N Lo y4 o— ot,3(61�6? Type of Business wilding Commissioner )ffice Us Only Co ditio l� ` U �. t mac. Building Commissio r ate Clerk Office Use Only J I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 15 Alo15 2 . Map Parcel `t' A ica ion # �S. Health Division - Date Issued Conservation Division Application Fee Planning Dept. Permit Fee , Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village /V l R/_5 kn Owner��� Les; Address S� ✓Lr-c_ Telephone J��' R — S-8 7-7 -.Permit Request e.� ,�. , — Q-rrs��.•.( / ��►'� `�s. .� . 9.a " �e 1��, /�,sz, L ! 7 I/ (GtL�v�c�'� (,�.✓l�� fr tG•� U� O(JK Vlc.—►g Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new :Zoning District Flood Plain Groundwater Overlay Project Valuation G Construction Type e Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family a-' Two Family ❑ Multi-Family (# units) Age of Existing Structure 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) _-A Number of Baths: Full: existing new Half: existing new, Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Ro m Count ' Heat Type and Fuel: ❑ Gas, ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood coal stove: ❑r4s ❑ No rM Detached garage: ❑ existing ❑ new size_Pool: Elexisting Elnew size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use n _ APPLICANT INFORMATION ICE�N ins"(�,�1,r (BUILDER OR HOMEOWNER) Name Telephone Number Address J' o �v /b S License # f�d d 1 S e e office,,k d L-lrl I Home Improvement Contractor# V U Email a e rt 7 Co C'l''"`'' CtJ"- Worker's Compensation # U A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1=kI SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAPJ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: , FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r" FINAL•BUILD:ING, DATE-CLOSED OUT ', ASSOCIATION PLAN NO. ., _ :. Department of Industrial Accidents Office of Investigations ' T 1 Congress Street,Suite IOf y i-- Boston, MA 02114-2017 t,... www.mass gov/dia Workers' Compensation Insurance Affidavit: lit$alders/Col<ntractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ��4 4-,� /c. �''� Address: /dam os City/State/Zip: sR e�� Ct, 'J Jd?7/ Phone#: ��( 7 Are you4n employer? Check the appropriate box: Type of project(required): 1. I am a employer with d 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. ❑Building addition [No workers' comp.inswance comp.insurance.1 required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4), and we have no. 13. Oth ,J employees. [No workers' er eWt a comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. e 1 am an employer that isproviding workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: ACC/U i Policy#or Self-ins.Lic.#: 06 L(?41 S' 1P(P(S� Expiration Date: Job Site Address: �4 / /�Q kUcld 1_�r City/State/Zip: Azs 44 " ./ iJA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 6�� Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify and t e ns and enalties o er'ury that the in ormadon provided above is true and correct Si ahire: I'Datel/. Phone# Official use.only. Do not write in this area,to be completed by city or town-offrciaL.. _. . ... .... City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 1 Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: 4i.ghtfax C3-2 8/4/2014 8:44 :21 AM PAGE 8/022 Fax Server Ado D® CERTIFICATE OF LIABILITY INSURANCE, a-042014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SI.AUTHORED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. if SUBROGATION IS WANED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: VIVEIROS INS AGCY INC PHONE FAx 140 PLYMOUTH AVE AiC No.Ext). rA/C.Ncl: FALL RIVER MA 02723 e-nn!� INSURER(S)AFFORDING COVERAGE NAJC f: INSURER A-ACE AMERICAN INSURANCE COMPANY INSURED INSURER B: RETROFIT INSULATION CORP INSURER C PO BOX 105 SEEKONK,MA 02771 INSURER C: INSURER E: MLIRE<F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED'BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AD SUB POLICY NUMBER POLICY EFF I POLICY EXP LIMITS LTR INSR YW6 (MNVDDlYYYY) MWDDNYYY GENERAL LIABILITY j EACH OCCURRENCE S i COMMERCIAL CENERAL LIABILITY i DAMAGE TO RENTED S CLAIMS-MADE OCCUR PREMISES F occurrences MED EXP(Any one person) S PERSONAL&AJY!NJURY S GENERAL AGGREGATE S i GEN'L AGGREGATE LIMIT.APPLIES PER PRODUCTS•COMP.OP AGG S PRO- LOC i I S POLICY JECT AUTOMOBILE LIABILITY SINGLE LIMIT S ANY AUTO xa iEa denll ALL OWNED SCHEDULED - BODILY INJURY(Per person) S AUTOS AUTOS BODILY INJURY(Peracddent) S HIRED AUTOS NON-0WNED AUTOS i Ors�AMAGE S i S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS UAB CLA,M&4AA0E j AGGREGATE S DIED I RETEN T ION S g WORKERS COMPENSATION WC STaTU- OTH- AND EMPLOYERS LIABILITY Y:N i X TO LIMITS I I ER ANY PROPRIETORPARTNERJEXECUT IV= OFFICER,MEMBER EXCLUCED? N NIA E.L.EACH ACCIDENT $1.000.000 ;Mandatory in NH1 6S62UB 08-02-2014 08-02-2015 It vas.describe wMor 4705P615 E.L.DISEASE-EA EMPLOYEE $1,000:000 DESCRIPT$0,%OF OPERAT IONS betow E.L.DISEASE-POLICY LIMIT $1:000:000 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.AdMonaE Remarks Schedule,If more space Is required) THE INSUREDS MA WORKERS COMPENSATION POLICY AND ITS LIMITED OTHER STATES ENDORSEMENT AUTHORIZES THE PAYMENT OF BENEFITS FOR CLAIMS MADE BY THE INSUREDS MA EMPLOYEES IN STATES OTHER THAN MA. NO AUTHORIZATION IS GIVEN TO PAY CLAIMS FOR BENEFITS IN STATES OTHER THAN MA IF THE INSURED HIRES,OR HAS HIRED EMPLOYEES OUTSIDE OF MA. THIS POLICY DOES NOT PROVIDE COVERAGE FOR ANY STATE OTHER THAN MA. CERTIFICATE O DER CANCELLATION BPI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES B 107 HERMES RD SUITE 110 CANCELLED BEFORE THE EXPIRATION DATE THEREOF, MALTA,NY 12020 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUrHORIMD REPRESENTATNE .r ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD • i Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachysetts 02116 Home Improvement C"Or Registration Registration: 160461 - Type: Private Corporation Uzi R. ""v Expiration: 7/292016 Tr# 252915 l RETROFIT INSULATION, INC. 4= JOSEPH REILLY P.O. BOX 105 `'5. ;Z51f SEEKONK, MA 02771 �F `I ftic�,: `lF K 5 Update Address and return card.Mark reason for change Address Renewal Employment Lost Card SCA 1 0 20M-05M1 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only E IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ;sbati«,_ 1 Type. Office of Consumer Affairs and Business Regulation ration:r Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 ' 11-� RETROFIT INSULAT[ Cd= :-;IOSEPFi REILLY 644 RODMAN ST FALLRIVER,MA 02721 — Undersecretary o alid without signature NlPi ,,_,; •�. _ -;" ,':--ate;-:--,•,, .,�;ti... Vie- cf.TT JOSEMJ ai r � r M'fi i R I S E ENGINEERING 5 Dupont Avenue Yarmouth, MA 02664 OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at (Property Address) (ZZGZ (Property Addre s) hereby authorize , (Subconf actor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. Owner's Signature Date TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 4(7 Parcel 07 ce Permit# 75(003 s ARNS*fABLE Health Division ?T-9 /Ai Date Issued 3)20)6V Conservation Division j Z-q D * . .AR 24 APB 9: 08 Application Fee ,-2 s � Tax Collector -3 Z S/ O ���� o0 1 Permit Fees rA Treasurer Al _- DIVISION -'0I 5 0 A A SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE Date Definitive Plan Approved by Planning Board WPM TITLE 5 ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address Z( f"lnf wo ac r10K Village / )411�54 0&5 Owner m J-- 6I.�Q^� Address J111P\P Telephone Permit Request C kAi J 0I� �1.'-✓���✓� g19,012 w i`rZc. "I 5ef To l Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation r{Goo Construction Type Lot Size . 419 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes Ao On Old King's Highway: ❑Yes /E No Basement Type:AFull ❑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 `o new First Floor Room Count Heat Type and Fuel: ❑Gas AOil ❑ Electric ❑Other Central Air: ❑Yes ;lo Fireplaces: Existing % New Existing wood/coal stove: ❑Yes allo Detached garage:❑existing ❑new size Pool:UK isting ❑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 ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION r; Name r Telephone Number Address Z,3 QLA, License# Ai//5 M C\ Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TQ SIGNATUR ..'t DATE dy 0 FOR OFFICIAL USE ONLY PERMIT NO. ' DATi"ISSUED " t MAP/PARCEL NO. , ADDRESS - VILLAGE • 1- OWNER: DATE OF INSPECTION: ' FOUNDATION t 'FRAME INSULATION ' FIREPLACE � f 1 • . -ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ► V M GAS: ROUGIItU FINALIm < FINAL BUILDING m • DATE CLOSED OUT- _O -7 f OWN ASSOCIATION PLAN+;N0. co ., "�ti m S The Com iin vea>ith-of Maslsachusetts Department of Industri Accidents` - - QI o If�i'll.Apffo ' 6 WaWshington Street _ Boston;Mass.. 02111' rl�ers'..C zn �ensatfon. risnranceAffidavlf-General Businesses ' wo / i %� YSx�. •.�,w y;l:?rijt:wzl'a",':;�arrt',1$,r`s'•,. .. � ...: •. _' '''.L>'- dress: - yak v V a ds o 1 state _ _. . . . _ MA site location fult address :' e. []Retail[]Restaurant/Bai/Eat►nSEstnblishment El I a�•a sole Proprietor and have no ono $psiness ' El Office Saps(includin REa1 Fstae,Antos etc.) ca t3'• tivorldn8 in any pace er /%%%%%i I am an 1'Dl to nth "em to ee5 full&' art tzm)e,, ' /�///////%/y%�//%/%//%///� ct►m�e>3sation for my en'pl ,oyees wor]nn�on this r I pzoviding vlprkers , , !t f't .� a ,•,1,,;' 1 aD1 an t��lOyer, . �. .{f.• :D� rr1;S}' , ':t h• •4d�\P r:•i,.�{j��'.i•';:;'3'.A'•, sr •+•' .�. rr`�'Jyi:•l f�'�.•;• �h• t.:. Si S; ,��71• I, t,ZZh.. :i• •'�•;1S":.�',1,•{ti.�+2� �7 . .:.. � t. i•.fir.•1.5•'.l;i'�.f.'•t'ti i:; 'i�y:p••`5.�. :: ,f•', r.(,. .� r '.t '1^,r 2r la:{'' ..,:ry••{. ,. •:rt .'.l ,•. f .7 r.l r. •S,•�•'...'r• COIt1�9II r'a�r(:X;•' I:'i r,. •"} �:;.,:.. :{ i'. , 1. .{% t �: i! c:r .'2: �+•r T•';� .. 1 \' . .i r y t•.•.; :ir,. rvtr+'i,t}. :� t =4.:1 c• .s, .C�:i:.. ti: :P� S• ' •' !S':if 1 r '► i...r,''q�;�'.1�` �•. aa..r. 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Y.�i•rL'.J.q" D'll •:ft' ' X gv:" insursncdsb++ • ' 00,00 an or cure coverage as required tinder Section?.5A of MGL 152 can lead to the imposition of erimina111enaea of a fine up to$1,5 Failure to se der ses lo the foYm of a 152 WORK ORDER and a fino of 5100.D0 a'day against me, I uaderatand that}I one years'imprisonment as well as ctlrllp copy oT statement maybe forwarded to the Office of Investigation+of the DlAfor coverage verification der a ains and penalties bf pedu that the inform atiox provided above is fro and 0 Yew I do hereby ee �Sigaa r"' ,• L�d� �.,j.c.r p a��, _p�� C7 hone# print name oflicLti]use only do not write in this area to be completed by city or ioTm oMcW permit/licente# ❑Building Department []Licensing Board etty or town: ❑selectmen's Office [�checkif immediate response is required []HealthDepartmenf . []Other phone#; contact person: (seeped Sept.2003) _ ' Ynformiation and lAstructions. ' ral L'aws chapter 152 section 25 requires all employers to provide workers' eompensatidia fir their. h2assachus c��{ ' 9 c loy ; ,As quoted'frornthe 1Ww"., an employee is.def=d as every person in the service oi'another under any c011tract of hire;express or for dd; oral or written. I er is defined as individual,partnership, association,corporation or other legal e�ity, or amy iwo or rngre of An emp the foregos gaged in a'0vint enterprise, and including the legal representatives of a deeeased,employer, or the receives or trustee of an individual,parjnrxshiP,association or other legal entity, employing employees. 'Howevei.the owner of a dwelling h°use hang,not'more than three apartments and who resides therein, or fhe occupant o the:dwelling douse bf another who.emPlb3'spersbns to do mainkenance, constriction or repair work on such dwelling fiou5e.csr on the grounds or bg aP� enant thereto shall not because of such:employmerzt.be deemed tb be ail employer. .: r ° shalt withhold the Issuance or renewal MGL chapter'.152 sectibn 25 also'states fhat'every. state or Iocal liicensing b a�ene y sh of a license or per t to operate a business or to construct buildings in thexommonwealth for any applicant who has not produced acceptable evidence of compliance hallfi insurance coverage the performance of paditionallyublic work unto coixunonwbalthnor'.any.of its political subdivisions s . . Y acceptable evidence of eompliari with t�e insurance rbquirements of this chapter have been presented to the contracting authority: OEM Applicants Please f the workers'•Colpemafm a€ddavit 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 maybe subrlitted to the Department-of Industrial A.ccidents•for confirmation of insurance coverage. Also'be sure to sign and date the affidavit, The davit should be returned to the city or town that the application for the permit or license is being requested, not the Department o�Tndustrial Aceideuts. Should you have any questions regardni�the'"Iaw"or if you are required to,obtain a workers'•compensationpQ1icy,please call theDepa�nent at the number liste,cl elovsr. City or Towns Please be sure that the affidavit is cbmplete andpriated legibly. The Department has provided a space at the bottom of the affidavit for you to fill opt in-the event the Office of Investigations has to contact you regarding the applicant. Please fill inthe permit/Jicense number which wM be used as a reference number. The.affidayits m� y.be returned tQ• be;sureto , =mtshavebeenmade, '' the Department bye. or FAX unless other:arrang . The Office of Investigations world like to thanks y'Qu in advance for you cooperation and should you have airy questions, esitate to give us a please do noth The Deparbnent,s address,telephone and:fax number: . ' The Commonwealth Of Massachusetts- Deparbnent.of Industrial Accidents eifice of ta>feslipfens 600 Washington Street Boston,IYda. 02111 fax#: (617)727-7749 To of Barnstable ' op ttte rosy ,� o� Regulatoxy Services • 3 Thomas F.Geiler,Director a srSS. Buxldln.g 11.DiViS7A 9�,, s6�9• ��� lFD�'y Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 • 'Fax: 508-790-6230 Office., 508-862-4038 ' permit no• Data AFMAVIT 1Mp mINT TO PERMIT AYP CATION c 142A requires that tha"reconstruction,alterations,renovation,rep eireTxisting eo a'cc pied ion, MG ay�ent,removal)demolition,or construction of an addition to any p .� . at least one but not than four dwelling units or to structures which are ao nt to binding containing alongwi th such residence her or building be done by registered contractors,with certain exceptions, requirements. ,A,JJ U 6 Q� �;�r�o✓S Md WLJ0 Sn47' Estimated Cost r Type of Work• ,I/` . _ Ades of work- ' Owner s Name• llcation:___-__3°� d Date of App 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 [ Qwner pulling own permit Notice is hereby given that: GLSTERED OVVNB RS PULLING TEMIR OWN PERMIT EaROVEMENT W G WITH OR DO NOT H.A.YE CON p, CTORS FOR APPLICABLE HOME OR GUARANTY FUND LTI�TDER MGL c.142A, ACCESS TO THE AI�YTRATION PRO GRAM SIGNED UNDERPENALTIES OF PERJURY Thereby applyfor apermit as the agept of the owner: Contractor Name RegistrationNo. Date OR C i,,,e Owner's Name oFTME T Town of Barnstable Regulatory Services s 33ARNSTASLc. Thomas F,Gefler,Director .��� Building Division TED Mp` Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 office: 508-8624038 Fax: 508 790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as.O�vnet.ofthe.subjectproperty- L,-- --- - ..._...__ .. hereby authorize - : . .to`act on iny..behalf,. in all inattets relative to work authorizetl•by.this building,pe=it-apphcation�for: 79 PKfwooJ, 0 -_ (Address of Job) , 3 aY 0Y e Owner Date . Moy J Print Name PA- �o�,bbie ax Ll Do�bble a�� �JCAPW`e -�Acx --tea X Ll AcK ----� f-4 `''� ; . alp PAWr5 ` Co go For w;riDo a - od}C(o G(?(e Ad wO04 P rn i a�S w a 3 8 /6 PLY e4c f T PL y �C Ce D�rR SIM v � P „78 .,FIet�vjoa fors "h57//f x Cb aXb Cb 31,1 pT 1 ” R D Fo i o4J DI 8 axe a LOT 101 :s LOT 90 o .IIII III IIII III o/I/I I IIII II p .III, , ._. O IIII ;IIIII , • IIIII Ir III o .. .� :;:..:: _ 44 cv IIIIII "lee,,I IIIIII 26 4 ��sr ,M LOT 309 ti �O ! LOT 316 1 yt . 00, i LOT 315 LOT 310 RES. ZONE.- "RF" This MORTGAGE INSPECTION Plan is For FLOOD ZONE.- "C" Bank Use Onl TOWN: _ TQA5_� A LE---____ REGISTRY OWNER: 1fE4EF.REY_AfF1LXW_________ DEED REF: _.'TF.. f,Z3__—_---BUYER: JM&,EZ ._CQHF1L�._S&0BA_ O-CHLLL--- -- DATE: —121�/,9}------------ PLAN REF: _?0�'5j SL2 _---SCALE:I"- I HEREBY CERTIFY TOI�S111t1TlL QF TE' OF _ITS SUCCESSORS AND�OR ASSIGNS THAT THE BUILDING ����N ' YANKEE SURVEY SHOWN ON THIS PLAN IS IACATED ON THE GROUND AS � PAUL y� CONSULTANTS SHOWN AND THAT ITS POSITION DOES CONFORM o ME�ITFIEVY ti TO THE ZONING LAW SETBACK REQUIREMENTS OF THE 40B INDUSTRY ROAD TOWN OF R-LZ __ _AND THAT No.3208a c � MARSTONS MILIS, MA U2648 IT DOES NOT LIE WITHIN THE SPECIAL FLOOD HAZARD fCISTERE� TEL- 428-0055 AREA AS SHOWN ON THE H.U.D. MAP DATED_$ �. ��NAI tApoSJ FAX 420-5553 Co . it -Panel # 250001-0015-C THIS PLAN NOT MADE FROM AN INSTRUMENT 16033 GGM B A c QTTT?VFY NnT Tn nV. TTar.n FnA' rrmrr.R F.Tr �FTME ram, Town of Barnstable Regulatory Services ivszAs . ; Thomas F.Geiler,Director 9 MAss. 1639• Building Division A�FO MA't a 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: a 0 JOB LOCATION: 78 �eefi✓Od� number c /` /street t/ village "HOMEOWNER': J l/T&Ay J, L'J�nl Ild" 6J7� a�I oZ —vR-FO name �7 lJ p / A home phone# work phone# /CURRENT MAILING ADDRESS: �ZeeT,00j, C 9540/-5 /" it/5 ^k 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 procedures and requirements and that he/she will comply with said procedures and require nts ature o 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:fonns:homeexempt Engineering Dept. (3rd floor) Map - 04 Parcel U -0 X—Permit# 4W31p2 / 7 ng, House# Date Iss d �-• Board of Health(3rd oor)(8:15 - 9:30/1:00-4:30). �^G�/�+�� Fee % 1� 0 Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Planning Dept. (1st floor/School Admin. Bldg.) "vj��' �►�,p Definitive Plan Approved by Planning Board 19 yG/ TOWN OF BARNSTABLE 309. Building Permit Application Project Street Address T Z- p 4 Village_ 0 Owner \Address Telephone Permit Request :RpK' O,\Z0UP-- First Floor , 3 tp square feet Second Floor /�� square feet Construction Type j` CC����e-q � �&� Estimated Project Cost ,$ !!K11,0d �- Zoning District &<r\-,N(2Q\nJ p Flood Plain N e1 Water Protection Lot Size - 48 Grandfathered ❑Yes ❑No Dwelling Type: Single Family 0"' Two Family ❑ Multi-Family(#units) Age of Existing Structure r 3 Historic House ❑Yes ®-N'o' On Old King's Highway ❑Yes C1tftr---' Basement Type: ®TF'ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing —�— New Half: Existing - New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing_? New First Floor Room Count Heat Type and Fuel: ❑Gas EJ'64il ❑Electric ❑Other Central Air ❑Yes Zfl�o Fireplaces: Existing New Existing wood/coal stove ❑Yes al Ne Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) one ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name R l CA--- V.(-\ Telephone Number &o?a - 6 e)A 6 Address T McA License# (( 'S73 ' 9q VP 'M0. Q•(o(a: Home Improvement Contractor# 1 O:1 17r(D' Worker's Compensation#-P-013-&)n 1<p\,j-X0 -.q 1 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE 1 n�k.kPATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASONS) =` L 4 - = r • FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED e ; MAP/PARCEL NO. ADDRESS VILLAGE OWNER r DATE OF INSPECTION: t FOUNDATION r .FRAME INSULATION "FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: jgUGH FINAL N `- GAS: ROI,i FINAL FINAL�BUILDING,' [ga, DATE CLOSED OUT ASSOCIATION PLAN NO. d ' "l • f , ! f, f ` .\, \ iUTi✓�'i:).>iy_1.i:tt`:..:� 'I.i:ti`L C.. 1.:E..IJw'G•., ..:A::....v.... .. ..l...r..... .u,.. .......... ... .... ..... ;:�:.�., `.,`•:. 'i,- ", ,:e:1i.��.;.41�11i.,a:(' -/%ti�ac.?•it�.i':�.�fw�tni.. ,�_.: .. _ �_ { LOT 101 ' LOT 90 elb �O •// /. // 1eb 44f 1 A� • ////// ////// cv �.., �l .4 IZI CI _ ►� �� ,N LOT 309 LOT 316 1¢ .40/ LOT 315 LOT 310 RES.. ZONE- "RF" This MORTGAGE INSPECTION Plan is For FLOOD ZONE.- "C" Bank Use Only TOWN: _ ARST _______ REGISTRY OWNER: 1&M-RE'Y-A(MMAN_ DEED REF: _CM-A 223--------BUYER: �ABBY�I��QHFIIC.d��4NDBA �HII.L----- DATE: -J2,1P,/,9}------------ PLAN REF: _?0�'5 5 �2 _---SCALE:1"- I HEREBY CERTIFY TO A1YK_umzm Eas, IFSBOF _ITS SUCCESSORS AND OR ASSIGNS THAT THE BUILDING ����N SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS o� PAULy�' YANKEE SURVEY' SHOWN AND THAT ITS POSITION DOES CONFORM i A. CONSULTANTS TO THE ZONING LAW SETBACK REQUIREMENTS OF THE 3 MERMEW H 40B INDUSTRY ROAD No.a209s � TOWN OF , U,6ffSL-4&Z _-_ _AND THAT MARSTONS MILLS, MA. 02648 IT DOES NOT LIE WITHIN THE SPECIAL FLOOD HAZARD ��ECISTEa�SJ� TEL: 428-0055 AREA AS SHOWN ON THE H.U.D. MAP DATED V-10 B5 oN,�i �ANo FAX 420-5553 Co it -Panel # 250001-0015-C A THIS PLAN NOT MADE FROM AN INSTRUMENT 16033 GGM 4. f rl`tf1!W, P SURVEY NOT TO BE USED FOR FENCES ETC. Steel Core . Copper-Bearing Alloy tr Stainless Steel Alkaline-Cleaned S Top Cover Hardware G115-Armored Bond ,y ; 7-in.Ribbed Top Full Contoured Hot-Dipped Galvanized t Strucural Foam Covers Ledge with Alkaline-Cleaned NC Crystex Cote Bonderized Coating / ra� �A�I ES a_a Chromic Seal / d �n j� / Alloy � � Coer-Bearing th• aAlkaline Cleane A to of stren9 1-in.Unwersat Crystex Coteon Steel Top& G 115-Armored Bond t p ed ootve f1n15In Bottom Sub �� r Hot-Di ed Galvanized b °tbox gOlid °neplace Frame Assembry Unive ITop&Bottom Plates Alkaline-Cleaned l universol topBonderized Coatingon- stee Printed wan withcton9u1ar 1° 1•in.Ext uded Crystex Core Chromic Seal Vinyl Edging'At roilsandbpttom plates. Primer Coat ;A>'!rsal toP n-structural / Outd o�EnarmeGPamtOnive toured des. steel Massive 6-in.stainless Box•Vertical COV Full con strength Steel Side Support Printed Coat with renter ._ � Crystex foam 101 9 ordWore. structure top Coler rsoI sub es and e e {\$ MBea W11hv °dolor l Oc from 1-in.USubFFrrameAssemb�ttom 0� Universal To BBottomPlates ARMORED x $E m o ppsi. ck y p BOND b%ne provides cam ossemblY vertico tion for eOSY Bond G115 constru ON Armored rotection- G 1 15 pLPR0ISCT1 nized steel p stex Cote ed 9°Ivo given by Cry of metal M°r 6PP ection 9 diagram HOT DIPPED rl Added Plot illustrated HOT GALVANIZED finish. (See I edging• DIPPED STEE protection) vinYALVANIZEDw ruded UNERPROTE OR out-loot ou cloand STEEL- 48" POOL SIZES 52" POOL SIZES WALL Patented tope, ssernblY er ggg).l (approximate) (approximate) t system In stfe�ghr C�PoovrdegVe3trco ROUND POOL OVAL POOL ROUND POOL OVAL POOL '• of walls P SIZE SIZE SIZE SIZE may, , installation of Cprrugotton for DECOR 11 k mrnef ar\d return f1H1n9• 15 ff.x 48 in. 24 ff.x 15-ff.x 48 in 15 ff.x 52 in. 24-ff.x 15 ff.x 52 in , red streOgAln Woodgrain wall with contrasting 18-ff.x 48-in. 30-ft.x 15-ff.x 48-in 18-ff.x 52-in. 30-ft._x 1.53ff_x.52-in thru w° .1100 d grain p1ank P°fern ,A 21-ff.x 48-in. 33-ft.x 18-ft.x 48-in 21-ff.x 52-in. 33t1 F z 18-6 x 52-in DECORwhite frame and top ledge covers. WALL stex Cote flnish• 24-ff.x 48-in. 24-ff.x 52-in. With CN 27-ff.x 48-in. 27-ff.x 52-in. SPEaRCARM AND FEATURES FOR OVAL POOLS STRUCTURALS Patented hold down'pressure sheets. Heavy gouge steel buttress and braces.High Yg 9 g SLNSHINE . strength tension bolts interlocking buttress post and rail assembly.Universal strap assembly. 11171119 WARNING: M EAR ®® NO DIVING POOLS ARE NOT I ( of I SHALLOW WATER DESIGNED FOR LLLJJJ �f - DIMG MAY CAUSE CAUSE DIVING OR - DEATH OR Egg PERMANENTI JUMPING NATIONAL �s ��� DuuRv SPA&POOL INSTITUTE Manufacturer reserves the right to alter specifications without notice.All pool sizes are approximate. -r .,. a k 1. i 0 1 ,�„ { �t� �,•`'{ _ � fit, , + it r• - - - O �,..; �, 1:lzzz v ` r {^~ •� �' �+w fir- '+I -i~ !IUK Nil? !r. o i ' The Town of Barnstable ,g Department of Health Safety and EnvironinentaI Services BuiIding Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 BuiIding Commissi; For office use only Permit no. I , i 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. 7 � � Type of Work: '!o X J E&L Cost B V" Address of Work: Pa7d V Owner's42 Name ate of Permit Application: :2 — /,Z I hereby certify that: , Registration is not required for the following reason(s): Work excluded by law Job under S1,000. 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 Contracto�rN ame Registration No. OR the C!//llllJll/l11"e"'t-II ey 31asuicjlusCrlti i_. 1Z. Dr`parllltCW Of blduuticl Accidants "�f OflfcEallayes1l9a1loas ��•: 6ari tf ashill1rutr 6. , :. „ Slrrrr Bosnia.Maw 92111 __ Workers' Compensation Insurance Affidavit — ..._ Plcnse i'RINT Te tom,, !_.......,_..�__._. ii an nfermatitin= --. v . anms* �,�-ry Cohex� �5c�-co. c 1r.►�� Inciting. Gir M► S M0. Qa(D it yIE 2V 7 ['I I am a homeowner performing ail%v rk myself l am a sole proprietor and have no one working in any capacity I am an empiover providing workers' compensation for my employees working on this job. corntianv n•tmc• adrirccc• ' Cttt•� nhnnc ft• inc n ri ncc cn. nnlict•tt L I am a soie proprietor. seneral contractor, or homeowner(cdrede v.-te) and have hired the contractors listed beiow who ca,. the following workers compensation polices: cmmnhnv Warne• adrlrrcc- �Q / 1 C`�G C1 -• `C XQ` (AJ ��f1��l1Cl city (!.1 e) nhnne#? -• �1� -(0 incrrr-inrr rn L,,o-QQ cS C1 )cc,,n c, •�.:•-. ��-..' - Truer-. r� .������y����_.�...�.�...��. ..�.. �;ne�.�_. �r •.�.•...s.�.�..'- emmnan� n�tnr• adrlrrcc- -irt•• nlrnnc ff• ncur�, Holier lttachadditicnalsheetifnreeiiarv.• •• �.�•-►_ •. --+%' :.•••• .,-:.;:.::";;. ••�• ••••• -.j. •---•• +••---�•� •�-.�._ �__�'�"._:�•— "allure ttr secure cut•erace as required under:iectton SA of AIGL 152 can lead to the imposition of criminal penalties of a line up to S1.500.111)andiur nc.cars'inrprrsnnment as well as cit•ii penalties in the form of a STOP WORK ORDER and a line ofS100.00 a day apainst me. I understand that a ON 'if Misstatement Mai- be furn•ardcd to the omcc of lu estieations of the DIA for cot.. ge verification. do herchr cerrij• uulcr the parrs and pe,ial,ics of perjurr Ilia,the injorma,fon prm ded above is true and corm►= ^atvrc C I Dace / e ( ( 'rint name �C�. _X �C \ Phone# `��►�- r�`1 •0(icial use unit, do nut write in this area to be completed by dtr or town amciai cit) ar town: petttnit/license if Rlluiidine Department QLiccnsin0 Guard . 0 check irimmcdiatc response is required QSeleetmen's Once ►tt- Otleallh Department contact perzan: phone ff: r'101her__�� Information and Instructions Massaclhuxetts General Laws chapter 152 section 's requires all employers to provide workers' compensation enrplrn•ee is defined as every person in the scrVicc 01 :j-pother under employees. As quoted tcom the "tag+".an contract of hire, express or implied. oral or written. An cmpltn•er is defined as an individual. partnership, association. corporation or other icgal entit%• or any two the Cort:�goin�_ en�ga_gt:d in a joint enterprise.and includinL the legal representatives of a deceased employer. or , rccciver or trustee of an individual . partnership. association or otlier,ld* I emit)'. employing employees. Howe owner of a dwelling lhotlse having not more than three apartments and who resides therein. or the occupant of ti dwcllin_ house of another who employs persons to do maintenance, construction or repair work on such dwell or on tlhc mounds or buitding appurtenant thereto shall not because of such employment be deemed to be an err MGL chapter 152 section :5 also states that every state or local Iicensing agency shall withhold the issuanct rerheW:hl of a license or permit to operate a business or to construct buildings in the commonwealth for ar applicant who fins not produced acceptable evidence of compliance with the insurance coverage required Additionaliy. neither the commomvealtlh 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 tlhis ch: been presented to the contractinc authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the boa that applies to your situation supplying compan}• names. address and phone numbers 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 affidati•it. 'i'Ihc affdavit should be returned to the city or town that the application for the permit or Iicense is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law"or if you are re: to obtain a workers' compensation policl•. please call the Department at the number listed below. Ciro• or •rowns Ple--ze be sure that the affidavit is complete and printed legibly. The Department has provided a space at the boa the affidavit for you to fill out in the event the Office of Investigations has to contact you re-garding the applicant. be sure to fill in the permittlicense number which will be used as a reference number. The affidavits may be retu: 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 qu:. please do not hesitate to :give us a c:11. Tlhe Departments address. telephone and fax number. •, y •TItc Commonwealth Of Massachusetts Department of Industrial Accidents -• Office of invesdgadons 600 Washington Street Boston,Ma. 02111 fax #: (617) 77.7-7749 TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. . DATE JOB LOCATION Number Street a dress Section of town "HOMEOWNER" hL°� Na#b Home phone Work phone PRESENT MAILING ADDRESS City town State Zip code The current exemption for "homeowners" was extended to include owner-occur: dwellincs of six units or less and to allow such homeowners to engage an is dividual for hire who does not possess a license, provided that the owner acts as suuervisor. DEFINITION OF HOMEOWNER: Person (s)' who owns a parcel of land on which he/she resides or intends to side, on which there is, or is intended to be, a one or two family dwellinc attached or detached structures accessory to such use and/or farm structurE A person who constructs more than one home in a two-year period shall not t considered a homeowner. Such "homeowner" shall submit to the Building Off= on a form acceptable to the Building Official, that he/she shall be resDonE for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the 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 requiremien-. and that he/she will comply '-th said procedures and .requirements. HOMEOWNER'S SIGNATURE � 1 nn Q,(AA (t A A APPROVAL OF BUILDING OFFICIAL Note: .Three family dwellings 35 , 000 cubic feet, or larger, will be requires to comply with State Building Code Section 127. 0, Construction Control. _ Ali%/A s Office(1st floor Map (,'1•/ ? Parcel 7 Permit# 0 ' /Conservation Office 4th flo. r)(8:30- 9:30/1:00-2:00)' �3 to Issued �D o�.�' 9� Board of Health(3r�r)(8:15 -9:30/1:00-4:45) ,7 4 ��`J� )' tl�e��� /Engineering Dept. (3r_d floor) House# Planning Dept. (1st floor/School Admin:Bldg.) SEP� , ��f���c`q � INSTAL aL Definitif;nvd by Planning Board 19e,d TOWN OF BARNSTABLE Building Permit Application -- •� Project e PT"�•/oo� �/� 't�G ( �c�l �llage zbwner j/}/lQy J Gke/i Z IC A I, ddress b5�4n1 P /elephone 11 7y 73 XermitRequest t First Floor EXkf ,J N eW 1 square feet S and Floor square feet 7 Estimated Project Cost $ TL10 Q Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family 1// 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 Builder Informmation Name / CO / -J Telephone Number y,�g /—7 Y 7� ddress Xcens o-rfe' 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 i' i SIGNATURE DATE 1 d J GI5 � y 1 �; BUILDING PERMIT D D FOR THE FOLLOWING REASON(S) t FOR OFFICIALUSE ONLY r _ PERMIT NO; - - DATE ISSUED - MAP/PARCEL NO. r i ADDRESS + d VILLAGE OWNER DATE OF INSP ION: s _ ,� FOU DATI N FRAME' INSULATION r - FIREPLACE ELECTRICAL: ROUGH FINAL Y PLUMBING: ROUGH 'FINAL GAS: _ ROUGH FINAL - t '. FINAL BUILDING DATE CLOSED OUT t ASSOCIATION PLAN-NO. . w The Commonwealth of Afassac%usetn it,'' Dtp artlyzent of lndristrial Accidents ` ;� -���y 01IJceo/ocesLlgat/oas • 600 ►t uslthigton Street 'r; �; + Boston.A1uss. 02111 ' Workers' Compensation Insurance ARclavit " Pleace PRINT`ley `Aapllca—e iormaiion \_ name ray J CP LJ Incation 7 1S' FIC e o00k N lS 441Y 7y73 �r5 iv), I am a homeowner performing all work myself. I 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. ntldret�• Rhone ff• . nolidh•� _ incdtr,�nse co _ I am a sole proprietor,general contractor or owne (circle one)and have hued the contractors listed below who have the following workers' compensation polices: address• city phone f►- �__--- nolicv p eY�rncsy ► ate * .e..,r--+— r*gar m vn cadre city phone#: poliev# ins rant- r.0 __ �Atiaeh nidditional'shiR if'aeeessa Y• w_ -� ...,;�..-... Ao+,4n.L.,N�•-tiw1Y'r..N!�M�_�.n:.:f R . •.. ..n i..Mws...: Failure to secure coverage as required!under Section 2SA of h1GL 152 can lead to the impasitioa oterimiaal penalties of a fine up to 513110.00 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 may be forwarded to the Office of investigations of the DIA for coverage vet•ifieation. I do hereby ceni •under the ins and penalties ojpedurq•that the injonnation provided above is tn,e and correct. Sig u natu Da �./ / one 7Y73 �nt name U� J �' oMcial.use only do not write in this area to be completed by city or town official city or town permithlicense f� nfiuilding Department (3Ucensing Board (7 check if immediate response is required Selectmen's Office Dliealth Department 4 contact person: phone 11; nOther lievned 3195 P3A1 - . _ The Town of Barnstable NAMDepartment of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Ralph Cros= Officer 508-790-6n7 Building Commis F= 508 775-3344 For office use Duly Permit no.__ Date AFFIDAVIT HOME MROVEMENT CONTRACTOR LAW SUPPLEMENT.TO PERMIT APPLICATION MGL c. I42A requires that the"ton=ct on,alterations,'renovation,tip on,co con zo improvement,. zpied mma%ml, demolition. or eonsa=on of an addition to nay p owner oo buildicent ng containing at least one but not more than four dwelling units or tQ with which are h other other to such residence or building be.done by registered eoatraaors,with certain C=Ptions.along Type of Work: 5 kArj Est Cost ji 0 0 0 Address of Work: Owner.Name: Date of Permit Application: /0 I hesdn certify that: Registration is not required for the following reason(s): Work emduded by law Job under SI,000 Building not owner-oocapied Ow=palling own permit Notice is hereby gh-en that: CONTRACTORS OWNERS PULLING THEM OWN PERNQT OR DEALXNG NO'T U14 HA ACCESS '1 FOR APPLICABLE HOME WROVEMENr DO ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hcrcby apply for a permit as the agent of the owner. Date Contractor name Registration No.- 94,0y OR l J �Q� r LOT 101 LOT 90 \'f cv � .4 ,// LOT 309 LOT 316 579�8'�5,L' 1¢ . 00, LOT 315 LOT 310 RES. ZONE.- "RF" This MORTGAGE INSPECTION Plan is For FLOOD ZONE.• "C" Bank Use Only TOWN: _9dfUTQ&,FLhfJS------- REGISTRY OWNER: -ZEFE'Y-40L AN DEED REF: _fTF,,9W2,?.,3--------BUYER: _R14B&Y1T��QH NDl�d D�HILL--- DATE: - /,9_4------------ PLAN REF: _30751E S1Y_.2 ____SCALE:1"= 30 F—— I HEREBY CERTIFY TO I��l1l�1TFIZ_O� e�, �'�S� `�H of M ITS SUCCESSORS AND OR ASSIGNS THAT THE BUILDING ,�'� '� YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS o'r -PAUL sue. CONSULTANTS SHOWN AND THAT ITS POSITION DOES ___— CONFORM A. , TO THE ZONING LAW SETBACK REQUIREMENTS OF THE MERTNEW H 40B INDUSTRY ROAD TOWN OF BARNSTABLE --------AND THAT No.32098 o MARS TONS MILLS, MA 02648 IT DOES_NOT_ LIE WITHIN THE SPECIAL FLOOD HAZARD 'g �'�E-iSTEaE�o� TEL: 428-0055 AREA AS SHOWN 'ON THE H.U.D. MAP DATED d/_, _f_. �Nql L�µos FAX 420-5553 Co it -Panel 250001-0015-C __ THIS PLAN NOT MADE FROM.AN INSTRUMENT 16033 GGM 'PA L A RIT PLS �' SURVEY NOT TO BE USED FOR FENCES ETC. TOWN OF BARNSTABLE BUILDING DEPARTMENT ' HOMEOWNER LICENSE EXEMPTION P ase print. •+�:�: . DATE JOB LOCATION •78 'Number Street address Section of 1:5wn "HOMEOWNER" (�91-,��✓ �r 7y7J Name Home phone work phone PRESENT MAILING ADDRESS OAG�? ty .town State Zip code The current exemption for "homeowners" was extended to include owner-occupi.I dwellings of six units or less and to allow such homeowners to engage an ini. 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 r 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 structure A person who constructs more than one home in a two-year period shall not b considered a homeowner. Such "homeowner". shall submit to the Building Offi on a form acceptable to the Building Official, that he/she shall be respons. for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes ,responsibility for compliance with the Building. Code -aad 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 requiremen- and that he/she will comply 'd procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be requires to comply with State Building Code Section 127.0, Construction Control. y HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which--=.a:.build: permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; .provided tha- Home Owner engages a person(s) for hire to do such work, -that such' Home shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assume the responsibilities of a supervisor (see Appendix Q, Rules and Regulat+ for .licensing Construction' Supervisors, Section 2.15) . This lack. of iwz often results in serious problems, particularly when' the Home Owner hire ,unlicensed persons. In this case our Board cannot proceed against the inlicensed person 'as' it would with licensed Supervisor: The Home"bwaer: as supervisor is ultimately 'responsible. To ensure that the Home Owner is fully aware. of his/her responsibilities communities require, as part of the permit application, that the Home *Ow certify that he/she understands the responsibilities of a supervisor. O. last page 'of this issue is a form currently used by several towns. You 1 care to amend and adopt such a form/certification for use in your commun. i r i I I 511 per' n _ t Rf Toe ukvj TOWN OF BARNSTABLE BUILDING DEPARTMENT COMPLAINT/INQUIRY REPORT Date Rec'd By Assessor's No. Q + Last Name Le:��P, `v First Name ORIGINATOR Street o 0) I ` Village State zip Telephone: Home 1 - f� Work �j zs 0 2 Description: C, V COMPLAINT ` cv c v INQUIRY Requestor's Signature —P. COMPLAINT Street Address �o LOCATION —7 OFFICE USE ONLY G / INSPECTOR'S Date Z3 -1 , Inspector ✓� ACTION/ COMMENTS e FOLLOW-UP ACTION ADDITIONAL INFO. ATTACHED COPY DISTRIBUTION: WHITE - DEPARTMENT FILE YELLOW - INSPECTOR PINK - INSPECTOR (RETURN TO OFFICE MGR.) MISC1 �w [ ] [R047 076 . ] LOC]0078 FLEET WOOD PATH CTY]03 TDS] 300 CO KEY] 29249 ----MAILING ADDRESS------- PCA] 1011 PCS]00 YR]00 PARENT] 0 COHEN, BARRY J & MAP] AREA] 12CC JV1361487 MTG]2012 MEDCHILL, SANDRA A SP1] SP2] SP3] 71 MANATOBA ROAD UT1] UT2] .48 SQ FT] 1124 MASHPEE MA 02649 AYB] 1978 EYB] 1978 OBS] CONST] 0000 LAND 22200 IMP 61800 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 84000 REA CLASSIFIED #LAND 1 22,200 ASD LND 22200 ASD IMP 61800 ASD OTH #BLDG(S)-CARD-1 1 61,800 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 78 FLEETWOOD RD TAX EXEMPT #DL LOT 316 LC30751-E RESIDENT'L 84000 84000 84000 #RR 0548 0145 OPEN SPACE #UP FY96 COMMERCIAL INDUSTRIAL EXEMPTIONS SALE] 12/94 PRICE] 85000 ORB]C135802 AFD] I TE LAST ACTIVITY107/17/95 PCR]Y R`47 076. P E R M I T [PMT] ACTION[R] CARD[000] KEY 29249 00000000] PERMIT-NO MO YR TYPE VALUE CK-BY MO YR %CMP NEW/DEMO COMMENT [B20591] [09] [78] [ ] ] [ ] [01] [80] [ 100] [NEW ] [ 1 ST ] ?J J� R047 076. A P P R A I S A L D A T A KEY 29249 COHEN, BARRY J & LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RF 22,200 61,800 1 A-COST 84,000 B-MKT 64, 100 BY 00/ BY /00 C-INCOME PCA=1011 PCS=00 SIZE= 1124 JUST-VAL 84,000 LEV=300 CONST-C 0 ----COMPARISON TO CONTROL AREA 12CC ----------------------------- NEIGHBORHOOD 12CC MARSTONS MILLS PARCEL CONTROL AREA TREND STANDARD 10] 10 LAND-TYPE 22200] LAND-MEAN +0% 84000] 74734 IMPROVED-MEAN -17% 25% ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 100%] LOCATION-ADJ APPLY-VAL-STAT 1 LNR]LAND LFT/IMP]ADJS/SB/FEAT STR]STRUCTURE ARR]AREA-MEASUREMENTS NOR]NOTES COM]MARKET INC]INCOME PMR]PERMITS GRR]GRAPHIC FUNCTION-[PMR] STRUCTURE-CARD NO-[000] DATA-[ ] XMT[?] f r TOWN OF BARNSTABLE Permit No. _-_.20591 1 „UMU 6 Building Inspector Cash -- — �� 9 � OCCUPANCY PERMIT Bond d -�u? "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Holly Enterprise Corp. Address Box 957, Hyannis lot #316 78 Fleetwood Path. Marstons Mills I Wiring Inspector X � - Inspection date Plumbing Ease ctor a� Inspection date Gas Inspector Inspection date Engineering Department~ ,j�� , / _ f Inspection date j ' 7� THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. »....,.. _.._.... ... ...... r Building Inspector Assessor's map and lot number .......... .. �� EP IC SYSTEM MUST BE �D�THETo� NSTALLED IN COMPLIANCE WQ o Sewage Permit number ...... .... w .... '7 ................ ` `�/'Tli ARTICLE If STATE SANITARX�CODE AND TOVNN I BARNSTABLE, House number 7� REGULAT.IONS, '� rb o ....................................................................... O G& � �'OYPYa, TOWN, OF BATNST ' BLE BUILDING INSPECT-01 APPLICATION FOR PERMIT TO ............................................................................................... G FI�...-..... ..�''A 4402 TYPE OF CONSTRUCTION .................. . .................................:............................................ ...........J'... ....:3..............19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......�o.T...'�3/�.... LL'2% L-o o D Proposed Use ..._...... .2 S! h 1�iC/1...................................................................................................................................... ................ ZoningDistrict ........................................................................Fire Districtp.............................................................................. -Name of Owner 4. .Gy......r�. 1'... �? P................:....Address ... `,.. 1.�S.......................................................... Nameof Builder ................. A �`? ...................................Address .................................................................................... Name of Architect ...R......1pp.../,C,K;.?1L.5 1. !��R u-aT/2 . . .... .......................Address .... .�Z............................�......................................... Number of Rooms .............Foundation .... ...... "h'�r............................... �............�.......��........ ...................... � � Exterior ........I r n.l.o....'L... ...����.�................................Roofing .........�3.5..... ................................ 1 Al Floors ..v.......... ...... ... ......................................Interior .......... .L!d ST�..�............................................... Heating 1 /7!. //—? Plumbing j �..� T J:.............................. ........... ..... .... ....... .o.... ....................................... Fireplace ..:........ .................................................................Approximate Cost ........1 a..0......o........................... ........... I Definitive Plan Approved by Planning Board ____�------_______-----------19_ . Area ..... .. . ..S. ........... Diagram of Lot and Building with Dimensions Fee �....A-,-��........... SUBJECT TO APPROVAL OF BOARD OF HEALTH 736AK/ I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. / Nameg,A.. oz,4��t..I ' ��....��..... �1 G ✓ Holly Enterprise Corp. No ..20591..... Permit for .......one...story.............. ...... . .... single family dwelling ............................................................................... Location ..........78...Flee.t.woo.d...Path. ..................... ........ . ...... . ...... . Marstons Mills ............................................................................... Owner .... ......... Holly ..Enterprise Corp,. ....... Typ6 of Construction ............frame........ ................................................................................ Plot ............................. Lot .........#31.6.............. Permit Granted ..............September ...18...19 78 September Date of Inspection .... 19 ............................... Date Completed ......... d. PERMIT REFUSED ............................ ......... ...I.................. 19 ... ....... .................... . ................ ............ .... ....... . . . ..... ............................................. .. ........ ...... .. ..... . ..... .................................... ............................................................................... 19 Approved ........................................ ............................................................................... ............................................................................... P Assessor's ma a „ -1 r�� nd lot, number ........: ��...... f% Sewage Permit number ......, ...6 ................`.:+r....................... Z 9AH33TADLE, i House number ' 9 JOA66 ................................................................. ppo,1639. DNA a. TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ................ . :..........:..................................... TYPE OF CONSTRUCTION °..:........ ........... — — ...,....... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... ... . .. :............. Proposed Use ._ ZoningDistrict ........................................................................Fire District .............................................................................. Nameof Owner ..:.....'...: °d...........................::%......................Address ...........:........................................................................ Nameof Builder ................. .......:..::....................................Address .................................................................................... Name of Architect ..,.. ,..,.-. . .......................Address ......................... ....................... Numberof Rooms `...................:..............................................Foundation ..............:...`.....:.......................................................... Exierior ................. .........::................................Roofing ......... ......:.. y................................... Floors Interior .........................°... ........:............... Heating g ............................................................... :. ...........................................................Plumbing Fireplace ............................................................Approximate Cost .......:........................ .............::.......................................... Definitive Plan Approved by Planning Board -----------_------_-----------19_______. Area ..... .h..::...:................... Diagram of Lot and Building with Dimensions Fee ` \ ........ ... :::?ti............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH a I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..:. .......................................... ............................. HC'Lly E I hterprise Corp., '-A=47-76 ` V20591 V, on, story No ................. Permit for ........................... single family dwelling ............................................................................... 78 Fleetwood Path Location ................................................................. Marstons Mills ............................................................ .................. Holly Enterpriee Corp. Owner .................................................................. frame Type of Constructi,n .......................................... ................................................................................. #316 Plot .... ...................... Lot ................................ September 18 78 Permit Granti, ....................................19 Date oyf4pection ....................................19 Date ompleted ......................19 PERMIT REFUSED ......................... ...................................... 19 ................... ...... .... . ......... . .... ..... ..... ..... Zd, .. . ..... .... . ........... .. ........... ........... .. ... ... ..... ................. ....................... .............................. A3 .... .. ................. ........... Approve ..... ................. ................................................................................ I.......... .................................................................... - 301L . LOA -- , 2"PEA S'ON E 1 4"C.{. olsr i' • •• 1 of 1 ( J Box t.•.• ° '. �-�•-� ra MIN. IQOQ � '. ••• 1000-- GAL. v o; GAL., + o 4••i PRECAST OR �°} - 97 SEPTIC 6 1a a� ••. BLOCK ° Q, T!!Y•Y , TANK . • . SEEPAGE PIT over 4464orfUL, ——�-�----�- 2 0� MINIMUM ` FOUNDATION t• R!� • ' I %: WASHED STONE I ELEVATION SKETCH �` 10' �'—�`"--"�-�! rERC. RATE �flyV ,9 -4*v / SCALE: I"% 4' TEST BY : ^�� _ TOWN INSPECTOR SACKHOE OPERATOR • ^-oP of J7*tr[ L� 30p. 'rEST MADE ON' Btu MOO /� _ 14 5•0 0 W -�r- � � No IF i AACXS yy dfgg 77F y 7W*r No 7/ /F7 o4avt3 + JY RtII S ` F �'V A!tV •Q�'Q•.. fb 7� AW Z4*,v-'�Y4r .t i +R�t puke N ke�M s 7�,x' � •. � , � � - � Ito" Ono No IV No 41C No ye *4 L C7`T` 31 tc► No Yam___ So'f � __ _._ _ , .. �• /az N., ... ......,,. .. . �. f ` ,. 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