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2026 MAIN ST./RTE 6A(W.BARN.)
d �UD Ja oy �� 3 No 513 3LOR � HA$TINsS, ION � r Town of Barnstable Buildin ,� �� Post This Card So That it is Visible From the StreetLE� ,Approved Plans Must be Retained on Job and this Card.Must be KeptBAJ a v 6sA `0$ Posted Until Final Inspection Has Been Made. • eor�a+° Where a Certificate of Occupancy.'is Required,such�Building shall Not be Occupied until a'gFinal Inspection has been made. Permit Permit No. B-18-373 Applicant Name:. Whalen Restoration Services Inc. Approvals Date Issued: 02/07/2018 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 08/07/2018 Foundation: Residential Map/Lot: 217-018 Zoning District: RF Sheathing: Location: 2026 MAIN ST./RTE 6A(W.BARN.),WEST Contractor Name: . Whalen Restoration Services Inc. Framing: 1 Owner on Record: DONEHEY, KELLI A TR Contractor Licenser 129244 2 Address: 2026 MAIN STREET Est..Project Cost: $ 10,000.00 Chimney: WEST BARNSTABLE, MA 02668 s Permit Fee: $ 101.00 Description: demo of affected interior finishes,insulation drywall,trim,and vinyl Insulation: Fee Paid:' $ 101.00 flooring. rebuild bathroom-new shower,vanity,wall lights,tile , .$ Final: -VA S /�iP7j7 work insulation,drywall , Date: �� 2/7/2018 t Project Review Req: � — �/� � Plumbing/Gas Rough Plumbing: uilding Official Final Plumbing: a This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for`public i6spectio,n for the entire duration of the work until the completion of the same. _. ° Electrical ^ . �r The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:' Rough: 1.Foundation or Footing i - 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT GF THE r, OApplication Number...... . (. ..........................:.......... * BARNSTABLA « 9 MASS Permit Fee........../,0../....................Mer Fee........................ TotalFee Paid...........................................:.................... ...... TOWN OF BARNSTABLE Permit Approval by...Rig CIk..................On..�?1?7..8....... BUILDING PERMIT Map........................................Parcel............................................. APPLICATION Section 1 — Owner's Information and Project Location Project Address 2oZG /t 4/IV Village BUILDING DEPT. Owners Name kE��i. R y00%�Ey FEB 10,7 2018 Owners Legal Address 2026 OW41,V srxee-r TOWN OF BARNSTABLE City. &v. a.++,z vs T-),w Lc: State M A, Zip 02l t g Owners Cell# 7'7 — 99`f — /S23 E-mail 6 K a onl C-g-Ey P Co c,+s r. Svc r Section 2— Structural Use dSingle/Two Family Dwelling ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System _ ❑Y Addition ❑ Retaining wall _ .__❑ Solar _ Renovation. El Renovation. El Insulation Other-Specify GUA rre D usrGE e v� ra ,�.¢��.¢roc ro / s`-10=Z44*r- A4 T Section 4 - Work Description v�o o� �;—� � /i✓r�,v,a,L �iiviSF{�.s /rysvc,.�-,�c�,� • /J�-1GvA-tom. - i"�w� 26 Bvi1� t3� -QooN�t — /V��y �/fowlSt- (/J4 /r.7 f.✓�4-r�i Lid%t�S i�LE L�o,�.(� �i✓syl.�-,�c�./. ;lUe�9 G�iF-u. P!�/�s3�•v6 � C�T�-/Gv02. Tact nnAatwi• I VIRM)l7 Application Number.......... . ......................................... Section 5—Detail Cost of Proposed Construction /O, 000-oo Square Footage of Project A/�s '` 7 P i Age of Structure t3 v-,,-r— i q 3S �63 yes)Dig Safe Number g /�) Total# Of Bedrooms (proposed) 3 # Of Bedrooms Existing � p � � ) I ' 11-0-MP-H_W._ind_Zone_Compliance Method 0 MA Checklist ❑ WFCM Checklist ❑ Design i Section 6— P Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas [] Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Disposal Facility: uiy�la �rv4*"v ��� ,'� I am using a crane El Yes E/No Debris Dispo ty: Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8— Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side�Yaid Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No r .., a «o i• 11 MR/In 17 Application Number........................................... Section 9— Construction Supervisor Name UnW" WRp,Le4 TelephoneNumber(5DO 7&0-011 Address 2Z Ayvt6,Lic4N WA i City 5• D"Nln State M4. Zip 02`6(o 0 License Number CS-074928 License Type'U.UR_csrrxt&9 Expiration Date -rOli�18 Contractors Email Jcu[.G_Ty Cell-# '7,74'=207=722E I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature (A-%` Date Z/7z/9 Section 10 —Home Improvement Contractor Name alhe t-vc. Telephone Number jsab) 7(00 - t9r Address 22 R-mce cA,j w" City s. oe"JNK State MA, Zip OZGdo Registration Number /2 9 24f' Expiration Date -711z 9 1/i 9' I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date 1-7 Section Section 11 —Home Owners License Exemption Home Owners Name: EGci gcnv fty Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date ii is i APPLICANT SIGNATURE Signature Z-t/L--- Date 2 > /0 Print Name w*o-ic� Telephone Number ) 760-/911 E-mail permit to: %cuu-i rH (m++w5t.►966 rtaA--nor-S•60M Last updated: 12/28/2017 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board (if required) Historic District Site Plan Review(if required) ❑ Fire Department ❑ Conservation For commercial work,please take your plans directly to the fire department for approval. Section 13— Owner's Authorization as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of j ob) Signature of Owner date Print Name I 1 Tact undated: 12/29/2017 f Restoration Services Inc. Fire, Smoke, Soot,Water Damage&Mold Remediation Services Cleaning • Deodorization , Reconstruction Specializing in Fire Restoration - All Work Guaranteed Access, Authorization and Direct Payment Request Form I (we) authorize WHALEN RESTORATION SERVICES to perform work as per estimate at property located at 9026 Main street, west Sarnstabie, MA 02668 to repair damage caused by water on As owner(s) of this property, I (we) understand that I -(we) must authorize this work. I (we) hereby authorize WHALEN RESTORATION SERVICES to perform this work and accept responsibility for payment upon completion. I (we) authorize and direct my Insurance Company Barnstable County Mutual claim #cHK,70QQ Policy No. HM00360416 , to make payments directly to WHALEN RESTORATION SERVICES, Insurance Claim Specialists, for doing this work and to that extent I (we) assign the benefits applicable to this loss to WHALEN RESTORATION SERVICES. I (we) acknowledge receipt of a copy hereof: 3 7 OWNER DATED SIGNED OWNER WHALEN RESTORATION REP. SIGNED 22 American Way, South Dennis,MA 02660 Phone: (508)760-1911 Fax: (508)760-9995 • 1-800-244-2598 •E-Mail:restore@whalenrestorations.com Web Page:http://www.whalenrestorations.com OFFICE COPY=WHITE CUSTOMER COPY=YELLOW Massachusetts Department of Public Safety ; ;;,•.;,;,::,;�;� ,'r lf.;.;;,;.:it!:a • Board of Building Regulations and Standards Office of Consumer Affairs&Business Regulation License; CS-074928 = ,j - HOME IMPROVEMENT CONTRACTOR Construction Supervisor j=' TYPE:Corporation '}�Y"'.�:• Registration Ex i o 129244 07/29/2019 WILLIAM WHALEN POND WI POND STREET r WHALEN RESTORATION SERVICES INC. BREWSTER MA 02631 WIWAM WHALEN J 22 AMERICAN WAY SOUTH DENNIS.MA 02660 Undersecretary .n CA t"-1Z -- Expiration: Commissioner 08/10/2018 Unrestricted=Buildings of angv use group which contain less V&-d 35,000 cubic feet(991M )of License or registration valid for individul Use only before the expiration date. If found return to: enclosed space. Office of Consumer Affairs and Business Regulation n 10 Park Plaza-Suite 5170 Boston,MA 02116 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Not valid without signature For DPS Licensing information•Visit. WWW.Mass.GoV/DPS t L- S_ ' 14 The Cam mniveaUh o Ma swchar 1• arts Department QfAndustrlalAceldents 1 Comma Out,same lop Boston,MA 03114.201 WWWWOSS40VIdla Workers°Compensation Insurance Afdavitt Builders/Contmetora/Elechiciens/Plumbers. BB FILED WM TRE P ING AUTHORITY. A�lieant h&Mltsfilon Was t aent i NaM0 Muffs d0rganizadoc&dlvldual): Whalen Restoration Services AddreSS: 22 American Way CHy/StdOMP: . South Dennis, MA 02660 Phone#; 508 760 1911 Anyou sn emplgyer?Cheek tbegVpmpr12te bom 1.®fam&omployerwM_�employeas(fLltend/orparttlme),m �'pBofpro�ect(requlred); . 2, Iemaeola 7. 0Nowconatruction ❑ 1?mpriatorcr Puff ablp ad have no employees working thr me to say capeofp►.lAtowarkW comp.lnsunanco regwred.] 8. O Romodeling 3.131 eme homeowner daing all work myself lNo workers'comp insaueacerequlred j t 9. ❑Demolition 4.❑I em a hemeowaaraad wM be htrLtg contractors to conduotaU work ou nW property. 1 will 10❑Building addition Men)Well c bactom eldw have woMm,oampensellon instaeace or am sole l l.[3 BlpoWoal repairs or additions proprietors with no eautloyea. S0I am a ganaml eantcactorand I have hired th oto e eub-contmrs listed on the attached shoat: 12. Plurabutg repairs or addIttona 7hma sarbKoatmotore have employees and have workeW comp.instuence a 11C]Rdof tepairs 6.13 We are acorpomtionand its oifia:ershM exercised thairrightofmamptioaperMOL c. 14.[30ther IS2,@t(4),and we have no employees.iNo workers'comp.insurance required] -xv appHcentthetohamks box 91 must also fill out the section below showing theirworkms'compansatiam poUasq Mm adon. HomeowaerswhoacbmkthisWfidavttindlmtngthayamdotngaUwmkimdtheak:outsMewnaaota matmbmitanowafdavitindtoathngstmh. tLbntractar IMcbeektibbexmnstattsohedaneddttioealsbeetshowingthemmeofdmsl&convaetonMdstatewho0wernotthoseentitieshaw employees.Udwsub-contraotarshaveemployee%ftmustprovldoth k wort leconmellcyumnber lOmlWar loya that fspravliangworkers'conrgnsadon s-rsaranacefar nr en(ployee9 Below is thepolicy andjobslte ImsunMc@CompanyNaMW Ace American Insurance Company Policy#or Selfdns.Lis#: 6 S62UB5B89454217 4/1/18 .� 13xpiratlon Dabs: , Job Site Address: 20Z6 kt1A-1n/ s nr- r Cityfi tatetap:_Gv. o2G 68 Attach•a Copy of the workere compensation policy declaration page(showing the policy number and expiration date). Fell=to secure coverage as required under MOL a 1 S2,§25A is a criminal violation punishable by a fine up to SU00.00 and/or one-year imprisonment,as well as civil peneltles In the farm of a STOP WORK ORDER add a,fine of up to MUD a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for kestuanoe coverage Verification. [do hereby cereJy and penalBes gfpe&V that the bdonnaden provided above Is hue andeonat �attua• (tip=._ ��- D�A.r._. .._���jB P 28 716o- /9// Offld l use on&. Do noIWAVein this ores,to be cmnpleled by ei+j{►orlown tp 9M City or Town: PermitiLicense# Issuing Authority(circle one): 1.Board of Health 2.Banding Department 3.City/Town Clerk 4.Electrical Inapeetor S.Plumbing IInspactor 6.Other Contact Person: Phone#: i ,ac R CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 01/17/2018 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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,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 endorsements). PRODUCER CONTACT NAME: Theresa Cahalane-Norkus HUB INTERNATIONAL NEW ENGLAND LLC IAIC No.PHONE , 508945-0446 nAic No): E-DDREss, theresa.cahalanenork@hubinternational.com 600 LONGWATER DRIVE INSURERS AFFORDING COVERAGE NAIC# NORWELL MA 02061 INSURERA: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B WHALEN RESTORATION SERVICES INC INSURERC: INSURER D: 22 AMERICAN WAY INSURER E: SOUTH DENNIS MA 02660 1 INSURERF: COVERAGES CERTIFICATE NUMBER: 230595 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. ITT R ADDL TYPE OF INSURANCE wqn wvn SUER POLICYNUMBER POIDICY EFF POLICY DNYYYI DDI EXP YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE OCCUR AMA O RENTED PREMISES Ea occurrence) S MED EXP Any oneperson) S N/A PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 1 POLICY 0 JECTPRO- ❑LOC PRODUCTS-COMP/OPAGG S I OTHER: S 1 AUTOMOBILE LIABILITY (CEO,eBcldd.n SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Par accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ I UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ I DED RETENTION$ S WORKERSCOMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE Y/N E.L.EACH ACCIDENT S 1,000,000 A OFFICER/MEMBEREXCLUDED9 I N/Al NIA N/A 6S62UB5BB9454217 04/01/2017 04/01/2018 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yyes,describe under DESCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT S 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If moro space Is raqulrod) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mbss.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Keel DOnehey ACCORDANCE WITH THE POLICY PROVISIONS. 2026 Main Street AUTHORIZED REPRESENTATIVE West Barnstable MA 02668 DanielCr ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Main Level 7' 10" 2' 9" 7' 2" rub/Shower(3 1) M Bathroom bN 00 N � N �-1' 10 5' 4" 0-�o - ^' N (V M F1 c 1 Laundry Room (1) 1 00 N - 6' 2„ 1 a 6' 10" Main Level DONEHEY_CON 2/6/2018 Page: 8 y Town of Barnstable • B•uildin9 .. . e - Post;This Card So'That it is Visible From the tceet-Approved Plan's.Nlust be�Retained on Job"and thishCard Muss be Kept R r: auuvsr,�si.¢ , .� � r arias' Posted Until,Final lrispeetion Has Been4Made: �erlrll� �. 2." _ del • s . Where aCertificate�of Occupancy isyRequired,such Buildingshall•N'ot Abe Occupied unt�i;a Fnalilnspection has been mad.'e: Permit No. B-174723 Applicant.Name: Approvals Date Issued: 06/19/2017 Curren t•Use: Structure Permit Type:" Building-Shed 'Residential'-200 sf and under Expiration Date: .12/19/2017 Foundation:. Location:' 2026 MAIN ST./RTi1 6A(W.BARN.),WEST' :,Map/Lot: 217;018 Zoning District: RF Sheathing: ' _Owner on Record: DONEHIY,KELLfATR �t ten. �ont�ractor Name: framing:. 1 Address: 2026:MAI N'STREET ;� ontractor Lic WNM ense- 2 WfST.BARNSTABLE,MA 02668 Est Project Cost $0.00 .' . : Chimney: • Description: _ 10'x12'shed _ Pern�ie: $35.00 F. - Insulation: ��,ee Paid: ' . Project Review Req: 10x12'shed - r S 35.00 Date 6/19/2017 final: F '; Plumbing/Gas" Building'Official 4 � H Rough Plumbing: This permit shall,be deemed abandoned and invalid unless the work a uthonied b"th s a�mrt s omme ced with s nt�hs after issuance. ng; P y P final Plumbi. All work authorized by this permit shall to the approved applic tion'and the approved construction d m ocuents for�whii6h-this permit has been granted, All construction,alterations and changes of use of any.building and stnu�cture" s hal f in compliance with the.local zoni g`by 15'�,•,a d codes. Rough Gas: This permit shall"be displayed in a,location clearly visible from access street orroadiand shall be maintained.open for-publK inspection for the.entire_duration of the work until the completion of thesame. " a final Gas:- �. ��. � � The Certificate of Occupancy will not"be issued until all.applicable signatures by<the sui ing and fire Officials are.provided on his permit Electrical Minimum of Five Call Inspections Required for Construction Work:x ���� N�v � x � 'Service: 1."Foundation or.Footing f x . 2.Sheathing Inspection t �����x. 3:All Fireplaces must be inspected at the throat level before firest flue"lining isan Rough:stalled _ 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final: 6.Insulation 7.Final Inspection before Occupancy low Voltage Rough: • Where applicable,separate'permits,are required for Electrical,Plumbing,and Mechanical Installations: Low'Voltage Final: Work shall not proceed until-the Inspector has approved the various stages of construction. Health ' "Persons contracting With unregistered contractors do not have access.to.the guaranty fund":(as set forth in MGL c.142A). Final: Building plans"are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Town of Barnstable ZE ,�"'E'a►�,o Regulatory Services Richard V. Scali,Interim Director B" MAS&` Building Division "' � 03 Tom Perry,Building Commissioner ED MA Cn 200 Main Street, Hyannis,MA 02601 A www.town.barnstable.ma.us r- rrn Office: 508-862-4038 Fax: 508-790-6230 PERMIT# 647 �3 FEE: SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less do a6 /�cu S7S-,ee�f 66,�,r-f SG/n 57�,� 1z , �/� 41-L 11 T Location of shed(address) Village Property owner's nam Telephone number /O X /a IIIII I Size of Shed Map/Par el# 7 Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) , Sign off hours for Conservation 8:00-9:30&3:30-4:30 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:110413 0 0�-1W Town of Barnstable,Planning&Development Department Old King's Highway Historic District Committee RECEIVED AB1$ 200 Main Street, Hyannis,Massachusetts 02601 moll Phone 508.862.4787 Email JUN 0 5 2017 CERTIFICATE OF EXEMPTION GROWTH MANAGEMENT Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Exemption under Section 6 and 7 of Chapter 470,Acts and Resolves of Massachusetts,1973,as amended,for proposed work as described below and on plans,drawings,or photographs accompanying this application: Date �O S 7 Address of Proposed work, Assessor's Map and lot# House# 004 to Street j Village: 60-ed .43/n S�7.✓' This application is for an exemption of the proposed construction on the grounds that work: Will not be visible from any way or public place ❑ Is within a category declared exempt by the Old Kings Highway Regional Historic District Commission ❑ Other Description of Proposed Work: /n`d�ll i ZQ )(/a Agent or contractor(please print): Tel.no. Address Owner(please print): ge f i1. D Ontht" Tel no. SUT-3(o,� -33 V Owners mailing address: 6��'as/ �U A S t6ldt.. (A) . 8ar/1 s fzv(2fe rM H Signed,.Owner/Contractor/Agent Checklist ❑ Four complete sets of the application and supporting documentation ❑ $ Y6 Filing Fee(see fee schedule) ommittee Use Only This Certificate is hereby APPROVED/DENIED Date: Committee Members Signatures: UN 14 z011 kingsN9hablc mmCO IQ- way Conditions of approval: OKH Exemption Form 2017 i THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA Ujp arm haAJi �l!��( 5-6(e JAS Ct 1I y 001/Z 5 5 y3 � inatw s� . yar,-nMa • - ' ® hv�t 1wy& Installation'h."e - nh weight orptessereB placed ontauside.Westronglyrecammend that(lie Le.a wall,fenceors(deof a building. iTHE.GARDEN�HED'. H GARDENKHE Cedar Sltimg ' is •4'depth meets most HOA "-- ----- Si:e(wrtl — SmartSlding Pine Cedar Vinyl requirements.Great for �:. M 7 condos and townhomes! �- 4''x8'. $1,099 $1,399 $1,549 $1,729 Y r y 4'x10'' : $L44'1 $1,599 $1,779 $1,999 -rl " 4'x12' $1,G99 $1,799 $1,999 $2,249 r Th .. i Scrobnhouse Features- livery &Screenhouse •1116r(jo�gcio.vii wliidow'+ w • (I•lMilulows on 101 x•17.') Here'S 1Nhat 0Ul •!1i,-ay dilly hulkh111AkolIII Wes(,ou(iiing ; 610111 �u�(wrn 1 u Cedar lulu Lxii,l ltfu�.irarlxllii� Have to •'Irh!1klnrlllyriurSerco Irot.ise 1Q'x1z' nnl $4,23G h1Co irl t.;ol9nn roon -with t1111af1i1iil Impact lesl.'Ilk artt — t�s rici°yllc W111d lw Inserts 1o'xt6' 54,466 $5,115 "We worked with tI tridned proles all,the way%J&hn:b Nor..MOInOt 4. —_• ,_•,. answered ev..ery.quescion, Lb dwig'.ProVidence;RI 12'x 16' $5,045 $5,621 . 2026'Main St- Google Maps Page 1 of 2 Go gle Maps 2026 Main St Rqst to install shed behind the pool y; a • • • ry;a Imagery 02017 Google,Map data©2017 Google 50 ft AUL .X P'. RECEIVED JUN 05 2017 As--- �; GROWTH NI LkNAGEMENT 2026 Main St West Barnstable, MA 02668 https://www.google.com/maps/place/2026+Main+St,+West+Barnstable,+MA+02668i @4l.... 6/5/2017 RECEIVED - A-M. 217119 WE FHB PLAN. REF.- 121155 JUN 05 2011 . _. MHB ZONING. ..RF.. ASSESSORS MAP 217 BARN 320 26 GROWTH MANAGEMENT :;: 9 F O 0.D: 2 ACRE IN FLOOD ZONE. v� 80,6 8.0' a �t o SEPTIC IN o ,r .. o _ FRONT36. 0 30" Z. 0' 4.� PER OWNER o ......................,8 1 U1 110.7 ,o �. 35' ....., y �:�;.. E'D 12.0�� cz cp 1 IN S ppRCH i� ►o __ __ �'==o?2.0' A.M_ ,217/IB _ q 9.9- AREA=32,671 f S.F. �- SED� ......"ZN iv. �PROPO N o :::,....,.., a 7 �a ITIO ca ADD Iz 24-3 t 150. 00' _ V03 59 IP w NO3 59'40 o>, w� ;HSE " A.Af. 217154 �} PLO T PLAN OF LAND LAIV E SITUATED AT."- LOCUS MAP MAG GI i, I CERTIFY THAT THIS SURVEY-AND PLAN WERE MADE�� - 1/0026 MAIN- ,STREET WEST BARNSTABLE IN ACCORDANCE WITH THE PROCEDURAL AND TECHNI STANDARDS FOR THE PRACTICE OF LAND SURVEYING WEST PA RNSTA R-LE TH OMMONTYEALTH OF MASSACHUSETTS A MERITHEW P.L.S. DAT PREPARED FOR" ` `=•' PAUL -RR POBEPT & KA THLEEN BA Y COLONY 'o� PAUL �y� t PIERCE - MAY 22, 2001 YANKEE SURVEY CONSULTANTS 0 GRAPH SCALE UNIT 1 40 INDUSTRY ROAD LOCUS , 30 0 15 30 + 60 120 P O. BOX 65 MARSTONS MILLS, MASS. 02648 ( INET TEL: 428-0055 FAX 420-5553 1 inch30 ft. Jf 52726 GM . I r %SA �T'own of Barnstable *Permit# �,, •��„���� Expires 6 months horn issue date Regulatory Services Fee ..MASS. Thomas F.Gefler,Director 163 Building Division f_ Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number L k f)LT Property Address C esidential Value of Work$ 't�()00 _ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address v�y b '� ��l l�z GA R- Contractor's Name 0-cAD ��D'i Telephone Number Home Improvement Contractor License#(if applicable) ( 1�Sb ( Email: `-1� epee 0. e' Construction Supervisor's License#(if applicable) ® -7 i ❑Workman's Compensation Insurance Zm one: a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Be-roof(hurricane nailed)(not stripping. Going over existing layers of roof) [ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximmn.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not eicempt compliance with other town department regulations,i.e.Iistad Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is gwed. QAWPFU-ES\FORMS\building permit forrnsTMESS.doc r u-. ' I ' The Comuroinuealth of Massl chus fts Delvwftnmt of huhstrid Accidents - Office of Imesfigadons ' 690 Washington S&eet Bostani 1A 02M wnnv.ma3&gvv1drn Workers'Compensation InsuranceAffidavat:Rudders/ContractnisMectricians/Plumbers Applicant Information Please Print E&6bly -NaII to Address. oZ 1-7 Qtyrstateizip: v a s c9�t Cis one Are you an employer?Check the appropriate be= Type of project o'ect r 4. I am a contractor and I � Pr' 3 (�m�= 1_❑ I am a employer with ❑ G_ ❑ �New stnsetiosi loyees(full andlorpart4ime)* have hire tithe sub-cofactors ,� �,/ 2. I am a sole proprietor orpartner- listed on the attached sheet 7. L j' deg ship and have no employees Those sub-eontractomhave g- ❑Demolition wohjang forme m any capacity. employees and have woricers' 9. ❑Building addition [No workers' comp.insurance comp.insu ance 3 required] 5-❑ We area corporation and its 10-0 Electrical repairs or additions 3_❑ lam.a homeowner doing all words officers have exercised their 11-0 Plumbing repairs or additions myself[No workers,comp. right of emernption per MGL 1�Roofs insurance d.]1 c_152,§1(4} and we ha1'e uo employees.[No Workers' 13_0 Other comp"insurance required.] 11 *Amy WpW=nt that checks boa 91 mmst also f M oat the section bdw showing heir wodtea'campe=fi on polity infitmfioa T H..trha sabnut this afd:vit isdic 9. they indoing sII wm-k and&ea him outd&contractors nmst submit a new affidWh tat rstim sack. tCoM.ms that rh ark this box mast attached madditional sheet showing the name of&a ah-caaft2ctorz andsute uhadw nrnot those em&ks hme employees. If the sob-contractms have empley-ees,they mmst pmvide their workers'comp.policy number. I am an employer that is prouid ug workers'compensation ina4ravoe for my employm BeZow is die policy and job site information. Insurance Company Name: Policy#or Self-ins"Litz#: Expiration Date: Job Site Address: City/State zip: Attach a copy of the workers'compensatitm policy-declaration page(showing the policy cumber and egxim iaa date). Failure to secure coverage as requiredunder Section 2SA o€MGL c. 152 can lead to the imposition ofcsiminal penalties of a fine up to S1,5DOM and/or one-year imprisonroent as well as civil penalties in the farm of a STOP WORK ORDER and a fine of up<to P-50_00 a day against the violator" Be advised that a copy of this statement maybe forwarded to the Office of Imestigatitms of fire DIA for insurance coverage veciffcation. I do hereby ;fy under UpVxins aadpenahF&s ofpedwy that the information pros ided above is true and correct Si ( Date- 3 -z D—�7 Phone#: IS D Ic— -; ®.(0 ole(� Qjw- &Z rue enly. Do not tvrhtas in this area,to be comnpieted by cdy or thnvn o,Q'iciaL e "" 'mob Authority(circle one): 1.Board of Eealth 2.Binding Department 3.Gtylfown Clt k 4.Electrical Inspector 5.Pitt abing hq?ector a. o Information and-Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant-to this statute,an err3Ployee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more ' of the foregoing engaged in a joint enterprise,and'including the legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(L.LP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pemzit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone and fax number. The Commonwealth of Massachusetts Depai#ment of Indus dd Accidents Mince of lavestiptions 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 at406 or 1-877MASSAFE Fax#617-727-7749 ..a Town of Barnstable ` Regulatory Services � � Richard V. Scan,Director i6s9�- Building Division. Panl Roma,Building Commissioner 200 Main Sheet,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-962-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder L re o-96V"7- -!�s�r��fiE�/ , as Owner of the roect subject l property hereby authorize 7��4✓i G'r� y to act on my behalf, in all matters relative to work authorized by this building permit application for: a of Ca 27• 64 WEST- (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature-of Owner Signature of Appli ' t AIG-16—T7 4y-�"V 60rt)y Print Name Print Name Date QIORMS:OWNERPERMISSIONPOOLS Town of Barnstable :t Regulatory Services ok Richard V.Scali,Director Building Division e tMRNSTANA Paul Roma,Building Commissioner 039• &� 200 Main Street, Hyannis,MA 02601 Ep www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE:�/1� �'. JOB LOCATION: Z o 2 !a',, AT. .•} number street village "HOMEOWNER": J�o��2r o�r��+ 5_68-3 31g9 5oP--)7a-''t86 - name \� home phone# work phone# CURRENT MAILING ADDRESS: Lo cityhown` state zip code The current exemption for"homeowners"was extended to incl a owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not p sess a license,provided that the owner acts as supervisor: DE ON OF HOMEOWNER Person(s)who owns a parcel of land on which he/s e r des or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures acce ory to such use and/or farm structures: A person who constructs more than one home in a two-year period shall not be considere hoeo allwner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she be re v onsible for all such work performed under the buildingermit. (Section 109.1.1) The undersigned"homeowner"assume responsibility for comp ce with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner" res that he/she understands the Town f Barnstable Building Department minimum inspection proce es and requirements w6 that he/she will comply with said procedur and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall-act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing.Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 I a y f Massachusetts Department of Public Safety VI Board of Building Regulations and Standards License: CSFA-057540 Construction Supervisor 1 & 2 Family ` DAVID J GADY ' .y, 217 A TIMBER LN. ' MARSTONS MILLS MA 02648' (�-� l� Expiration: Commissioner 12/28/2017 ��e�c�a»Unza�zraecc�l�a�C�/�ica tcc�ec�etta Officeof Consumer Affairs&Business Regulation License or registration valid for mdrvdtil use only HOME IMPROVEMENT CONTP,ACTOR hero ,-the expiration date. If found return to: 'c i C _ Regi"station:; 114561 Type: Of ice of Consumer Affairs and Business Regulation -4 Expiration:a/4/201;7 DBA 10 Park Plaza.-Suite 5170 Boston,MA 02116 -7, DAVID GADY CARPENTRY I ,= David Gady 217A Timber Ln "�a f r' Marstons Mills, MA 02648 Undersecretary Not valid witho signatureI TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map V-7 Parcel— TOWN OF BARNSTABLE Application #Qh � Health Division 1013 FEB 15 PH 3: y q Date Issued Conservation Division Application Fee Planning Dept. DIVISIONPermit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Stree Address�~ �L�Z-fo ��:�� �: Village Owner -d- (ill �y Address � �`4�i� Sk. e==Telep.hone_ Sf0Y_ 3(9�?__ 3�3 4 5i Perms mit Requester � :i,, (�, utC> c ?G5 �E�1'F nS icQP �� �� )Soo, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project*Valuation Construction Type %�d Lot Size Grandfatheeredd: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑. Two Family lam" Multi-Family (# units) Age of Existing Structure &01 Historic House: ❑Yes @I<o 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 Z new Half: existing new Number of Bedrooms: .3 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 C,1101 Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name? i V=.Telephone-Number, -ZSa �L,0`b Address License # Home Improvement Contractor# _Worker's Compensation # ALL GONSTRUCTION'DEBRIS RESULTING FROM THIS PROJECT-WILL BETAKEN TO -B� "6-. ?�&;l ee,,_ i SIGNATURE -� I h 7 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED 1 MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: s s FOUNDATION •FRAME: %y. INSULrATIONr FIREPLACE _— n ELECTRICAL°.~' ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING - { DATE CLOSED OUT ASSOCIATION PLAN NO �i- 2 The Commonwealth of Massachusetts Department of IndustriaLAccidents Office of Investigations ' 600 Washington Street Bostox, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers A- Isom Information Please Print Le "bi eNa>ne s iness/org�i�lion/fndividuan: _ A ��K 2 IT z6iw� bo City/Stat,dzip: &k-bV" + Phone*: �d 8 &D (/0 Are you an employer? Check the appropriate box: r of pros ect(required): 1.❑ I am a 'toyer with 4. I am a general contractor and I New construction oyecs(fall and/or part-time).* have hired the salrconftactars listed on the attached shoot Rcmodcling 2 1. a'solc proprietor or partner- Thcsc�-eo�ctors eve ship and have no employees 8. ❑Demolition employees and have workers' 9 Bui]din addition woOdng for me in.any capacity ❑ g O wOtkCLS COIDp.tncrnan�r_,t ' �•.innnanrr 10. Electricalrc airs or additions 5. ❑ We are a cisrporation and its ❑ p � � officers have exercised their 11.❑Plumbing repairs or additions 3':0=I am=a 1meownLr"cluing all work Y myself[No workers' comp. right of exemption per MGL 12 ❑Roof repairs c. 152, §1(4), and we have no ' msm-dnce regard.]t employees. [No workers' 13.❑ Other COmp•bLsuranee rcquirCd-j 'Any applicant that ehcrAx box 01 naut also fii1 Out ih0 SCGt7DII br-1DW ahDwing then'worker S'compmr4on policy infam3atiarL t E1==uwners who submit thiszffidxvit iracaimg fey aze doing at1 worlcand ffi=hire outside czmtartam must submit anew affidavit indiratmg rush. tr Dntraehrrs that chccicfhu box moat atlatlred an additional sheet showing flu name of the sub�oniradars and staffs whether Or not those rntitirs have ernplayecs- 1f the sub-antraet on have maploy=r,thry must providt their wmi=-e comp.policy nurnber. I am an employer that is providing workers'compensation insurance for my employees. Below is the polity and job site information Insuramrr Company Man Policy#or Self-ins.Lic.#: Expiration Dale: Job Site Addm=: City/Statelzip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to sea mwr coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to S1,50D.00 and/or ono-year imprisonment, as wcIl as civil pmaltir-s in the form of a STOP WORK ORDER and a fine of up to$250.0D a day against thq Violater. Be advised that a capy-of this stata it may be forwarded to the Office of Inytstigstions of the DIA for in¢rtrmcc coverer a vcrificat Um I do her certify under a pair sand penalties of perjury that the information provided above is true and correct Phone Official use only. Do not write in this area,fo be completed by city or fowls offcciaL City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person Phone#: Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supenisor 1 & 2 Family License: CSFA-057540 tiC':t VS DAVID J GAW y�r 217 A TEVIB&R Ll MARSTON � 648 i Expiration commissioner 12/28/2013 Office`6f�ofiiP3iY�K'i'f�'i���1�i e � License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR ' before the expiration date. If found return to: ' Registration: ._._114561 Type: Office of Consumer Affairs and Business Regulation Expiration: '10/4/2013 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 G. GADY CARP[NTRY= David Gady 217A Timber,1n Marstons Mills,MA 02648t,'`;',,'' Undersecretary' ! Not valid hout sig re r orIHE r, ' SABNSrABM MASS. Town of Barnstable �p a6Jq: �0 rFOMAye Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barn stab lc.mams Office: 503-562-4035 Fax: 505-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, hel/1 .��10elle`'"`7 ,as Owner of the subject property hereby authorize ( .! to act on my behalf, in all matters relati-re to work authorized by this building permit application for: (Address of Job) / j hy Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Lsers\decollik\AppData\Local\klicrosoft\Windowffemporaty Intemet Files\Content.Outlook\DDV37AAZ\EXPRESS.doc Revised 072110 ` THE y Barnstable Old Dings Highway Historic District Committee 3(.)U Main Street: Hyannis, MA 02601,TEL: 508-862-4787 Fax 508-862-4784 EDtAA'�° APPLICATION, CERTIFICATE OF APPROPRIATENES6 Application is hereby made, with -our(=4)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of�pter 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or Rtod aphs �.. accompanying this appiicatior:for Check all categories that gf ply; `n that � c- 1. Buildins construction: ❑ �fi'ew D Addition Alteration ?. Tvpe of'Buddin!j.' ✓/ (q_ � House ❑ Garage/bam �❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting, roof ❑ new roof ❑ color/material change, of trim, siding, window, dotQ 4. Si-n : _J New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence '_ Fall ❑ Flagpole ❑ Retaining wall ❑ Tennis court ❑ Other 6. Pool ❑ Swimrnin2 ❑ Other man-made pool ❑ Solar panels ❑ Other Type or Print Legibly: Dale Lx f/ 3 NOTE All applications must he signed h•:the current owner Owner(print): —_AN/U/1 / & All _T _ Telephone 34 A - 3 Address of Proposed Work:..�O(P /;G4jo, S_/( d Map Lot# Mailing Address(if different) .... Owner's Signature Description of Proposed Work: Give particulars of work to be done: G_!�iu /u ��..�s• �`� _�i�2 �{J/.Ir/at�.! /�;%/ 6'9G[ %C.': // i}l, '2 "LiC P k/••S 7�j.7�' Agent or Contractor(pnr.t): Telephone#: )—p5' ooV y Address:_ � %%.�/1� ` lCi, C /'ICL '�I/Z_'_s_1111 I/J Contractor/Agent si^_nature: For committee use only. This Certificate is hereby APPRO D/PVNIED Plate Members signatures ArrhUVED i�:\fSunrds ruui Cuu:mi.,,:,,,;,J)id!'ur,�N. h„a L,KN ii; iir,r:iu,i.\001 DRAFT 2011 Curt Appropriatenes DRAFT.doe- "AN 2 3 .2013 I Town of Old Kings h'ac!t;•; _,Y committee, CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 5 copies Foundation Type:(Max. 12"exposed)(material-brick/cement,other) Siding Type: Clapboard_ shingle_ other Material: red cedar white cedar other Color: Chimney Material: Color: Roof Material: (make&style) Color: Roof Pitch(s):',(7/12 minimum) t X_ (specifyy on platis for heir buildings, major additions) k Window and door trim material: wood_Zotherniaterial,specify _ Size of cornerboards size of casings(l X 4 min.) (Y-4 color w;.-Ae- Rakes Ist member 2''d member i Y-Z— Depth of overhang 4" x Window: (make/model) material t ka;;W-ts color L—)1ti c'� (Provide ►vindrnv schechde on plan for neiv buildings, major uddtlio . ) 4 Window grills(please check all that apply_: true divided lights, exterior glued grills grills between glass removable interior_ None Door style and make: material Color: Garage Door,Style Size of opening Material Color Shutter Type/Style/Material: Color: Gutter Type/Material: Color: Deck material: wood other material,specify Color: Skylight,type/make/modeU: material Color: Size: Sign size: Type/Materials: ColAPPROVED r: Fence Type(max 6' )Style material: Color: r `P P R OV E Retraining wall: Material: JAN 2 3 2013 Lighting,freestanding on building illuminatin Town of Barnstaalp g m Committee OTHER INFORMATION• THE ATTACHED CHECK LIST MUST BE COMPLETED AND SUBMITTED Please provide samples of paint colors,manufacturers brochure of windows,doors,garage door,fences,lamp posts etc Signed: (plan preparer) ` Print Name Rv at., 6s►P'r Q.\Boards and ConttaiSSiotLAOld Kings Highwa\OKII ApplirationAOKll i)RAFr2011 Cert Apprupriareness URAfTdor — �-- � I• ( i -j i � I I ' � I I ~i ! � _-..I I_ ( ( _ _ I ( I —_ ��o►.rot�+��1� _ vJ �N mom;- � �- I -I ( LI L3 � -- _--� cc —7 -- z z: ------------ AJ - _! ► w a i I I _ .Z U °FIKE r Town of Barnstable *Permit# C�)Od Dd 7 'b Expires 6 mon s rom issue date Regulatory Services Fee s anttMx;� B homas F.Geiler Director 'iC a.�� °�� �RM I Building Division FD MA't FEB — 6 2009 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN OF BARN,$TAf3;� , www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number t 7 d L Property Address 2��CQ. i l� t �✓ ` S"t=� esidential Value of Work .2 00 0 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address + V_,Ak• 2a Gpntractor's Name V)ri)c Telephone Number Home Improvement Contractor License#(if applicable) 114 S P ❑Workman's Compensation Insurance Chec am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value (maximum.44) A>je-.v-1 *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: QAWPFILESTORMMuildmg permit forms\EXPRESS.doc Revise020108 kf Jc\ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name(Business/Organization/Individual): A v 1�1 &A-b"( Address: 1;�2r City/State/Zip: r � s �`L�1�S Phone.#: fig' Are you an employer?Check the appropriate bog: Type of project(required): I.❑ I mployer with 4. ❑ I am a general contractor and I 6. ❑New construction ployees(full and/or part-time).* have hired the sub-contractors 2: I am a sole proprietor or partner-' listed on the attached sheet 7. .❑Remodeling ship and have no employees These sub-contractors have g.'❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition o workers'.-comp.-insurance comp. insurance.$ S. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their 11.[J Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a-STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy.of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification: I do hereby c rtify under the ains-and penalties of perjury that the information provided above is true and correct: Si tore. J Date: e ' Phone#• �� �Z 6 f ( Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in.the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing-engagedin Iomt enterprise; melu�n`g alie legal-representative?; receiver or tiustee of an individual,partnership,association or other legal entity,employing employees.-However the owner of a dwelling house having not.more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract.for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers'compensation affidavit completely,-by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and.phone number(s)along with their certificate(s)of ' insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly..The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in - (city or town)."A.copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that'a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a calL The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents office of Investigations 600 Washington Street Boston,MA 02111 W. #617-727-4900 ext-406 or 1-877-MASSAFE Fax#617-727-7749 Revised 1 i-22-06 www.mass.gov/dia trosti Town of Barnstable Regulatory Services RAJy ' Mq $, Thomas F. Geiler,Director 16 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 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property hereby authorize azz 1 G to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) '4,& Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:F0 RMS:OwNERPERMISSION Town of Barnstable THE Regulatory Services . - ��� ; Thomas F. Geiler,Director 1Kwss . t639.. �.� Building Division TED µA{ Tom Perry,Building Commissioner 200 Mairi=StreetrHyannis;MA--02601. _.".........._.... ....__ ..._.._.. .. .. www.town.barnstable-ma.us Office: 508-862-403 8 Fax: 508-790-6230 H0114EOWNER LICENSE EXEMMON Please Print DATE.- JOB LOCATION: number street village "HOMEOWNER": name home phone q work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to" be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) Tlke undersigned"bomeowner"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 BarnstabIq.Buildiug Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for.which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1,-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall ad as supervisor." Many homeowners who use this exemption are unaware that they am assuming the responsibilities of a supervisor(sex Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) Thu lack of awareness often results in serious problems,particularly when the homeowner hirrs 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 sucb a formicertification.for use in your community. Q:forms:homccxcmpt. 1 Board of Building Regulations and Standards License or registration valid'for,individul.use only HOME IMPROVEMENT CONTRACTOR before the expiration date:.-.If found return"fo: _ _- �-\ Board of Building Regulations and Standards / Registration 1 114561 Ex iration One Ashburton Place Rm 1301 t p T `a -DBA 2009 Tr# 260861 Boston,Ma.02,108 j.q k ,yp j DAVID GADY CARPENTRY David Gady 4� ads J 235 Timber Ln •.��J.� �,,,,,,,,�, _ e�L�s,..�,. —__ Marsto6s Mills,MA 02648 Administrator Not valid out sib '..ture:. j 111�i 0PPYA'iR9t� ti�8 —r Construction.Supervisor License • i. i ` License: CS 57540 Ex iration 1;2/28/2009 Tr# 14108 1 ic DAVID J GADY' 235 TIMBER LN i MARSTONS MILLS MA 026°48 Commissioner 4 e r� , Town of Barnstable *Permit Expires 6 months from issue date 1 Regulatory Services Fee 22 oA D (�Jl Thomas F.Geiler,Director Building Division ryry Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number d l? ,t ZO/ Property Address ap a(, �,i—&,Ef Residential Value of Work �Uy Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address n Contractor's Name Da4l 1 r.1Ll Telephone Number_ Home Improvement Contractor License#(if applic le) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance � �� ���MI� �a� � Check one: I am a sole proprietor lam the Homeowner JUL 19 2007 ❑ I have Worker's Compensation Insurance �� TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Regt 11est(check box) [rte-roof(stripping old shingles) All construction debris will be taken to , 1 Fj' Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ? Replacem Jent Windows/doors/sliders. U-Value 3 (ma)dmum.44) 1 'Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Co6siii 3ation;etc.. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: 7 _1�4} Q:Forms:expmtrg Revise061306 r , �F1HE Town of Barnstable Regulatory Services r S BARNSTABLE, : Thomas F. Geiler, Director 039. ,.�� Building Division rE0 AAA'1 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: //f t JOB LOCATION: a�aZ�D fQ 14JAP0 ,86'/17 , number street village "HOMEOWNER": i & —33 7 9 -------. name home phone# work phone# CURRENT MAILING ADDRESS: �.Q,S7'�—,UCl//)57Ti,1✓�'L. /�/� C�2.(o!� 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 requirements. Signature of Homeowner. 17 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 ofawareness 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:forms:homeexempt The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations _ 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: r r)o a c - - J 3 y 1 City/State/Zip: IA ).0S+ Phone.#: Are you an employer? Check the appropriate bog: Type of project(required):. 1.❑ I am a employer with 4. I am a general contractor and I 6. El New construction . employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a•sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' $. 9. 0 Building addition [No workers'comp.insurance comp.insurance. required.] 5. We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11.❑Plumbing repairs or additions r 3.� I am a homeowner doing all work myself [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no do employees. [No workers' 13 �� �(/) door comp.insurance required.] , ►r 6C•emm t— *Any applicant that checks box#1 must also fin out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating They are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors That check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M ExpirationDate: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains•and penalties of perjury that the information provided above is true and correct Si afore Date: O Phone# - Offuial use only. Da not write in this area,tb be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Informnation and Instructions { Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee-of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C()states `Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies•(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 'The affidavit should be returned to the city or town that the application for the-permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number.listed below. Self-insured companies should enter their Self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is comiplete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure.to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in_(city-or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bairn leaves-etc.)said person is NOT required io complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number.. The Commonwealth of Massachusetts DTar4ment of lndustdal Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-977-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia 'i Application to ®Yb Rittq'o 3E)igDbJdP Regional TOWN CLF:. K In the Town of Barnstable CERTIFICATE OF APPROPRIATENESS JUL 13 A10 :25 Application is hereby made, with four complete sets, for the issuance of a Certificate of Appropriateness.under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings, or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior building construction: ❑ New ❑ Addition R'Alteration Indicate type of building: House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign . ❑ Repainting Existing Sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other TYPE OR PRINT LEGIBLY: DATE Cr L3�O 7 ADDRESS OF PROPOSED WORK oao 3•Co Ft- CP i+ W. i awA s4T b/e ASSESSOR'S MAP NO. a l l OWNER /�K//� fi Re.>&/-L A e c-c ASSESSOR'S LOT NO. 61 y HOME ADDRESS C C)J& kt &ig TELEPHONE NO. $0$'-3&d-3>3% C/ FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way. (Attach additional sheet if necessary.) 72pi ;, . - cw&I o I�4 1A Gb 5- i AGENT OR CONTRACTOR y i' .I TELEPHONE NO. JDQ-a!?6-&O yQ ADDRESS TMfi�r- ��yl�_ /17a , &I's DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please �1:07°1..> ' include locations of proposed signs. �^c1 /fir �O�J j- 6j,11 be- lz�460r d• ` 6-e- lt�/a Ce 4� C�o%r>- -icc s I7kl 1i1 ��rce�, / doo 71W,5 ,,,no-T..v Signed O� S Owner-Contractor- ent Cb/ C/3 For Committee Use Only i This Certificate is hereby Date Approved/Denied �1 ; a —�7 I m ittee Members' Signatures: JUN 4 2007 ' TOWN Oi BARNSTABLE I HISTORIC PRESERVATION ..� BARNSTABLE Town of Barnstable TOWN CLERK Old King's Highway klistoric District Committee '07 JUL 13 A10 :2 S SPEC SHEET FOUNDATION SIDING TYPE COLOR CHIMNEY TYPE COLOR ROOF MATERIAL COLOR _U-i U— PITCH WINDOWS COLOR SIZE TRIM COLOR 06140 Q D G � DOORS l0 / COLORS [,Q:Si�C /�/G( [� Q SHUTTERS �Cj/� G//Qd/-e COLORS fLl�n &S C R/GC k GUTTERS COLORS DECKS MATERIALS GARAGE DOORS COLORS SKYLIGHTS SIZE COLORS SIGNS COLORS FENCE COLOR 'i,, l F 4 ; , L • NOTES: Fill out completely, includin measurements and materials/colors to be used. F r X`of fhis-- ;;;,;`.;,• ,s�:, form are required for submittal of an application, along with Four co� PP 4 pies of the pl plan and elevation plans, when applicable. - . SPECSHT Revised 11/98 ri .�. TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY FAMILY APARTMENT PARCEL ID 217 018 GEOBASE ID 13388 ADDRESS 2026 MAIN STREET/RTE 6A ( PHONE W BARNSTABLE ZIP - LOT 1 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT W$ PERMIT 85054 DESCRIPTION FAMILY APARTMENT PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of ARCHITECTS: Regulatory Services TOTAL FEES: $25.00. BOND $.00 pU CONSTRUCTION COSTS $.00 RAMSTABM * * 63¢ A1� RFD MA'S BUIL NG IV _ ION BY DATE ISSUED 06/27/2005 EXPIRATION DATE ` TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY FAMILY APARTMENT " PARCEL. ID 217 018 GEOBASE ID 13388 ADDRESS' 2026 MAIN STREET/RTE 6A ( PHONE W BARNSTABLE ZIP - LOT,--- 1 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT WB PERMIT 85054 DESCRIPTION FAMILY APARTMENT PERMIT TYPE` BC00 TITLE CERTIFICATE OF OCCUPANCY I ' f CONTRACTORS` Department of ARCHITECTS: Regulatory Services TOTAL FEES: $25.00 j BOND $.00 CONSTRUCTION COSTS $.00 * BARNSTABLE, t639. ,I -BUIL NG IV ION BY DATE ISSUED 06/2-7/2005 EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. ' MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE + 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE gNICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ' - 4.FINAL INSPECTION BEFORE OCCUPANCY. I POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT -,)--7- 2 BOARD OF HEALTH 411 OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. BUILDING PERMIT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map o 1 -7 'Parcel / Permit# -7� Health Dtks.ion Date Issued o- S Conservation Division Feed 6 O 6_71 Tax Collector Application Fee Treasurer t Planning Dept. Checked in By Date Definitive Plan'Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address Village ( ,S Y15-6b le Owner 11__ ky el' One Address 310a,U Ma A., 54- /,J -f- galimk6lr Telephoned - & Permit Request OC E' -_-F&COtd�2 Square feet: 1st floor: existing dodo proposed 2nd floor: existing looa proposed Total new 1,360 Valuation Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size 0. 7(p Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family > Two Family ❑ Multi-Family(#units) Age of Existing Structure 70 Vr Historic House: ❑Yes XNo On Old King's Highway:XYes ❑ No Basement Type: 111rFull ArCrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) A/6 n-L 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 /y new�_ First Floor Room Count Heat Type and Fuel: XGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 25-No Fireplaces: Existing I New Existing wood/coal stove: ❑Yes Q' o Detached garage:❑existing ❑new size Pool:9existing ❑new size I Y 6 Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:U(xisting ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use - - Proposed Use` - BUILDER INFORMATION cy// - o2 t�' !0 0 V 0 Name D6w t a tJ-acl Telephone Number YC- l / Address jd( l[ vl �!.v�.[ License# (�S ��U 1 �� !//ST✓�'� r)a6 VT Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 04 4 SIGNATURE J` DATE 0 , FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION i FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL:BUILDING (g DATE,CLOSED OUT ASSOCIATION PLAN NO. i r «, Bic 19968 ps 265 �42SB7 Town of Barnstable Zoning Board of Appeals - Decision and Notice Appeal 2001-11356 Robert & Kathleen Pierce Special Permit = Section 3-1.1(3)(D) - Family Apartment Summary: Granted with Conditions Petitioner: Robert J.Pierce and Kathleen M. Pierce Property Address! 2026 Main Street West Barnstable,MA Assessor's Map/Parcel: Map 217,Parcel 018 Zoning: Residential F,Aquifer Protection Overlay and Resource Protection Overlay Districts Background&Review:. Appeal 2001-113 is an application for a special permit family apartment in accordance with Section 3- 1.1(3)(D)of the Zoning Ordinance. According to the Assessor's record Kathleen.M.Pierce owns the property. It is a 0.76-acre lot developed with a two-story 2,802 sq.ft. three-bedroom single-family dwelling. The property is served by private well water and on-site septic. According to the records,the dwelling was built in 1935. The lot is a pre-existing non-conforming lot in respect to area,and the structures located on the property meet required setbacks. The applicants are proposing.a 24 by 40-foot, 1.5-story family apartment unit as an addition to the existing dwelling. The total area of the apartment unit is to be 1,298 sq.ft: According to a proposed site plan the addition will conform to the required setbacks for the district. Procedural&Hearing Summary: This appeal was filed at the Town Clerk's Office and at the Office of the Zoning Board of Appeals on July 19, 2001. An extension of time for holding the hearing and for filing of the decision was executed between the applicants and the Board. A public hearing before the Zoning Board of Appeals was duly advertised and notice sent to all abutters in accordance with MGL Chapter 40A. The hearing was opened October 03,2001, at which time the Board granted the special permit for the family apartment with conditions. Board Members deciding this appeal were Daniel M. Creedon, Thomas A.DeRiemer, Jeremy Gilmore, Randolph Childs and Vice Chairman, Gail Nightingale. The applicants Robert and Kathleen Pierce represented themselves before the board. The explained that they intended to sell the property to their daughter and son-in-law who will occupy the single family dwelling. The applicants will move into and occupy the accessory family apartment unit. The situation was precipitated by the special care needed for their grandchild. An interior plan for the layout of the unit was submitted to the file. The applicants noted that they had read and understood all the condition for the issuance of the special permit and would abide by all of those conditions. The public was invited to speak and no one spoke,in favor or in opposition to this appeal. Findings of Fact: At the hearing of October 03, 2001,the Board unanimously found the following findings of fact: 1. The applicants in Appeal 2001-113'are Robert J. Pierce and Kathleen M. Pierce,who reside at 2026 Main Street West Barnstable,MA in a Residential F Zoning District. The parcel is shown on Assessors Map 217 as Parcel 018. 2. They have applied for a Family Apartment Special Permit in accordance with Section 3-1.1(3)(D)of the Zoning Ordinance. The applicants who�presently reside.there own the property. They will be the occupants of the family unit and their daughter and son-in-law will own and reside in the single—family dwelling. i o'. CAAA4C Roa :b 0 LL-%Itm Ki+CkAn 10 -doJ-------1- UiA T—T bd4-L T 40, j ----------- 7 bw roo,�) l(O ...... ......... C-) !- LA -e, K 4 4d 0' ................... _ Barnstable Assessing Search Results Page 1 of 2 Wd 1 ".�!A cay � �.-� JJ ;Y. -��{h"�"�� ��/:� s,�J,y/✓/,�Jy� �1� < .^�a �4"I�s 4 t",� �'"oa �- s „.;�'t�PAD [.�.'�?.� '�" 31�k���k .. �rY C!/,�ef��LF 3\�� -`+C•tti c,bra.. �yv��H��i '�A Mal.-' - ... - ,s�� r- . ,,.�:.s:.t_,....a.:L:3•.s{n.�...,-„.:.:. ....'.,�cs.a..ix�r.,,_..�.3...*'+aa'.;' 'r Home. Departments:Assessors Division: Property Assessment Search Results 2026 MAUX ST./IRTE 6A(W®BARN.) Owner: DONEHEY, ROBERT A&KELLI A Property Sketch Legend Map/Parcel/Parcel Extensionq 217 /018/ - Mailing Address DONEHEY, ROBERT A&KELLI A } 2026 MAIN ST W BARNSTABLE,MA.02668 2006 Assessed Values: Appraised Value Assessed Value Building Value: $307,000 $307,000 Extra Features: $9,600 $9,600 Outbuildings: $16,000 $16,000 Land Value: $161,200 $161,200 Interactive Property Map: ap requires Plug in: Totals:$493,800 $493,800 I have visited the maps before Show Me The Map April 2001 photos available =- Sales History:' Owner: Sale Date Book/Page: Sale Price: DONEHEY, ROBERT A&KELLI A 11/2/2001 14403/.134 $310,000 PIERCE,KATHLEEN M 8/15/1985 4670/260 $137,000 SALIMENO,KENNETH F ETAL 3411/267 $0 2005.REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Land Bank Tax $89.62 Town Fire District Rates Other I $6.05 Barnstable-Residential $2.12 Land B. Barnstable-Commercial $2.80. W.Barnstable FD Tax(Residential) $711.07 C.O.M.M.-All Classes $1.01 Cotuit FD-All Classes $1.28 Town Tax(Residential) $2,987.49 Hyannis-Residential $1.52 Hyannis-Commercial $2.39 W Barnstable-Residential $1.44 W Barnstable-Commercial $2.10 Total: $3,788.18 Due to rounding differences these values may vary -- ---h4://www.town:bamstable.mauus/tob02/Depts/AdministrativeServices/Finance/Assessing...._�6/22/.2005__..___ .,_ 14 V I c� a N C1L' r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION' Map Ya .21a, Parcel 0 1 , Permit# 5500 Health Division �7Cr f A��p Date,Issued Conservation Division Fee Tax Collector ` SEPTIC SYSTEM MAST BE Treasurer INSTALL-ED IN COMPLIANCE , Planning Dept. WITH TITLE 5 ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN IREGULATIONS Historic-OKH Preservation/Hyannis Project Street Address Z®Zvi i A.�,. S•�. = L64- ; Village el4'+- Owner V AAt Ate,-, M. ate rW, ' Address "Zozio Telephone -009'— Permit Request Square feet: 1st floor: existing 1$b0 . proposed 2nd floor: existing qo proposed 31Jr' Total new c Z7X Valuation.fiZ�,? l .3�a � Zoning District 1Z Flood Plain Groundwater Overlay T Construction Type ��� Lot Size T2 7?0 Grandfathered: ❑Yes O No If yes, attach supporting documentation, Dwelling Type: Single Family Two Family O Multi-Family(#units) Age of Existing Structure Historic House: O Yes QA(o On Old King's Highway: Urle's ❑ No Basement Type: C 411 ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 06 Number of Baths: Full: existing new Half: existing O new 0 Number of Bedrooms: existing new ro 3 Total Room Count(not including baths): existing I O new First Floor Room Count —7 Heat Type and Fuel: C3'Gas ❑Oil D Electric ❑Other Central Air: O Yes ©'No Fireplaces: Existing New Existing wood/coal stove: O Yes Detached garage:0 existing ❑new size Pool: O existing C�?'new size '1orcW Barn:0 existing ❑new size Attached garage:O existing 0 new size Shed:misting ❑new size 4 wo Other: Zoning Board of Appeals Authorization O Appeal# Recorded❑ Commercial O.Yes 2No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name�Inu-tt 6fft r Telephone Number --S-Of LOi'1 Address 1'2-1 �, License# 6S_?S WD 1 G-vi 4 Home Improvement Contractor# I I�ISb1 Worker's Compensation# W CV .3 oo�6t1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE '0 I FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSSIED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ,fir • ' �. DATE OF INSPECTION: „- FOUNDATION �QZ FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH` FINAL GAS: ROUGH - FINAL FINAL BUILDING. DATE CLOSED OUT ASSOCIATION PLAN NO. Barnstable Assessing Search Results Page 1 of 2 EKE Tf Home: Departments: Assessors Division: Property Assessment Search Results 2026 MAIN ST./RTE 6A(W.BARN.) Owner: DONEHEY, ROBERT A& KELLI A Property Sketch Legend Map/Parcel/Parcel Extension 4. 217 /018/ UAL Imo'- Mailing AddressW DONEHEY, ROBERT A& KELLI A � DA5. n's�, �s 2026 MAIN ST W BARNSTABLE, MA. 02668 T1' FHS 2005 Assessed Values: 8,t ow Appraised Value Assessed Value 2, Building Value: $307,000 $307,000 Extra Features: $9,600 $9,600 Outbuildings: $ 16,000 $ 16,000 Land Value: $ 161,200 $ 161,200 Interactive Property Map: ap requires Plug in: Totals:$493,800 $493,800 1 have visited the maps beforeLicAF6�rShow Me The Map April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: DONEHEY, ROBERT A& KELLI A 11/2/2001 14403/134 $310,000 PIERCE, KATHLEEN M 8/15/1985 4670/260 $ 137,000 SALIMENO, KENNETH F ETAL 3411/267 $0 2005 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Land Bank Tax $89.62 Town Fire District Rates Other 1 $6.05 Barnstable-Residential $2.12 Land B. Barnstable-Commercial $2.80 W. Barnstable FD Tax(Residential) $711.07 C.O.M.M.-All Classes $1.01 Cotuit FD-All Classes $1.28 Town Tax(Residential) $2,987.49 Hyannis-Residential $1.52 Hyannis-Commercial $2.39 W Barnstable-Residential $1.44 W Barnstable-Commercial $2.10 Total: $3,788.18 Due to rounding differences these values may vary http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing... 6/14/2005 Barnstable Assessing Search Results Page 2 of 2 Land and Building Information Land Building Lot Size (Acres) 0.76 Year Built 1935 Appraised Value $ 161,200 Living Area 4052 Assessed Value $ 161,200 Replacement Cost$352,832 Depreciation 13 Building Value 307,000 Construction Details Style Conventional Interior Floors Pine/Soft Wood Model Residential Interior Walls Plastered Grade Average Heat Fuel Gas Stories 2 Stories Heat Type Hot Water Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 4 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 3 Bathrooms Total Rooms 10 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value APTX Extra Apartmt 1 $4,400 $4,400 SHED Shed 80 $600 $600 SPL2 Pool Vinyl 648 $ 15,400 $ 15,400 FPL2 Fireplace 2 $5,200 $5,200 Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area (Unfinished) BMT Basement Area (Unfinished) FTS Third Story Living Area (Finished) UHS Half Story (Unfinished) CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area (Unfinished) FAT Attic Area (Finished) GAR Garage UTQ Three Quarters Story (Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing... 6/14/2005 19 0 ` c i oFt�t Town of Barnstable 0 Regulatory Services &UWSTABLy MASS. E Thomas F. Geiler,Director 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 June 14, 2005 Robert& Kelli Donehey 2026 Main Street W. Barnstable,MA 02668 Re: 2026 Main Street, W. Barnstable Map 217, Parcel 018 Dear Property Owner: Our records indicate that the former owner of your house at the above-referenced location received approval for a family apartment in 2001. The building permit procedure for the family apartment was not completed and no occupancy permit was issued for the apartment. In addition, our Zoning Ordinance states: "When the family apartment is vacated, or upon non-compliance with any condition or representation made including but not limited to occupancy or ownership, the use as an apartment shall be terminated. A building permit must be applied for to remove all cabinets, countertops, kitchen sinks and appliances from the family apartment and the water and gas service utilities must be capped and placed behind a finished wall surface. We have received information that there is now an apartment at 2026 Main Street. What is the status of this property? Please contact me or Lois Barry, Division Assistant, 508 862 4039, as soon as possible. -, Sincerely', Thomas Perry Building Commissioner istat Town of Barnstable • r Regulatory Services r + BARNSTABLE, v MASS. �, Thomas F.Geiler,Director �p i639. �0 16 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 June 14, 2005 Robert&Kelli Donehey 2026 Main Street W. Barnstable, MA 02668 Re: 2026 Main Street, W. Barnstable Map 217, Parcel 018 Dear Ms. Donehey: Enclosed is the instruction sheet and building permit application for the family apartment. Please call me at 508 862 4039 if you have any questions. Sincerely, Lois Barry Division Assistant jdon CFI E, Town of Barnstable Regulatory Services San MASS.AlE B ' Thomas F. Geiler,Director �ArEo;;. 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 June 14, 2005 Robert& Kelli Donehey 2026 Main Street W. Barnstable, MA 02668 Re: 2026 Main Street, W. Barnstable Map 217, Parcel 018 Dear Property Owner: Our records indicate that the former owner of your house at the above-referenced location received approval for a family apartment in 2001. The building permit procedure for the family apartment was not completed and no occupancy permit was issued for the apartment. In addition, our Zoning Ordinance states: "When the family apartment is vacated, or upon non-compliance with any condition or representation made including but not limited to occupancy or ownership, the use as an apartment shall be terminated. A building permit must be applied for to remove all cabinets, countertops, kitchen sinks and appliances from the family apartment and the water and gas service utilities must be capped and placed behind a finished wall surface. We have received information that there is now an apartment at 2026 Main Street. What is the status of this property? Please contact me or Lois Barry, Division Assistant, 508 862 4039, as soon as possible. Sincerely, Thomas Perry Building Commissioner istat i PLAN REF 121155 A.M. 217119WB _ MHB MHB _ ZONING.- "RF" BARN ASSESSORS MAP 217 320.28 R.P.0.D.: 2 ACRE • NO3°56'06'�W ��\1_1�1_\\ : "� FLOOD ZONE.- � � a c,► g0.6' 36.5 8.0 SEPTIC IN o o ..,. O 00 N FRONT o a �] 36. ___-�� ;15 8: :,HOUSI;;;:;:;::;:a PER OWNER i PROPOSED i O :::::8.1 - V1 ...........35.8 .,,... Cb p00L �O 110.7" d y EENED 12.O,w ... S PORCH o io x ,;;;o, 2.0' 4. A.Ill 217/18 to _r__i. —r-- .... 40 0 ..,...,. AREA=32,671f S.F. �-- ,9.9..:;;:::: i� PROPOSED a I{' ADDITION o ............. w zv :;.....\:::: O40.0 24.3" p� O 'r 150. 00' v NO3 59 40 IP 185 12' ©�s� z" L��. N0359'40 ro ;HSE A.M. 217154 ` E PLOT PLAN OF LAND MAG LOCUS MAP GIE LAN SITUATED AT. / CERTIFY THAT THIS SURVEY AND PLAN WERE MADE 2026 MAIN STREET WEST BARNSTABLE IN ACCORDANCE WITH THE PROCEDURAL AND TECHNICAL ES'T BARNSTABLE STANDARDS FOR THE PRACTICE OF LAND SURVEYING IN T OMMONWEALTH OF ASSACHUSE .�•.3 ate. ' Q J PREPARED FOR.• RR PAUG A. MERITHO W, P.L S. ftAT ROBERT & KA THLEEN BAY COLONY PAUL PIERCE �a G Mew N MAY 22, 2001 �c1 Na��OOA YANKEE SURVEY CONSULTANTS GRAPHIC SCALE UNIT 1, 40 INDUSTRY ROAD g 6 LOCUS 30 0 15 30 60 120 P. 0. BOX 265 MARSTONS MILLS, MASS. 02648 1N FEET ) TEL: 428-0055 FAX 420-5555 1 inch = 30 ft. J# 52728 CM ctL- ��ss�� y QUITCLAIM DEED WE, KENNETH F. SALIMENO and MARTHA R. SALIMENO, husband and wife as tenants by the entirety both of 2026 Main Street, West Barnstable, Massachusetts 02668 for consideration of ONE HUNDRED THIRTY SEVEN THOUSAND and 00/100 DOLLARS grant to KATHLEEN M. PIERCE, of 2026 Main Street, West Barnstable, Massachusetts 02668 with Quitclaim Covenants the land and building thereon situated in Barnstable (West) , Barnstable County, Massachusetts bounded and described as follows: NORTHERLY by land now or formerly of Carl & Ava G. Salo as shown on hereinafter mentioned plan, one hundred and 00/100 (100. 00) feet; EASTERLY by land now or formerly of Santer Jarvi, as shown on said plan, three hundred twenty and 28V100 (320. 28) feet; SOUTHERLY by the State Highway, as shown on said plan, one hundred and 00/100 (100. 00) feet; and WESTERLY by Lot 2 and 3, as shown on said plan, a total distance of three hundred thirty-five and 12/100 (335. 12) feet. Containing 32, 780 square feet, more or less, and being shown as Lot 1 on plan of land entitled "Rebel Acres Land in West Barnstable, Mass. Belonging to Carl & Ava G. Salo, Scale 1 inch=40 feet. , May 26 , 1955, Bearse & Kellogg Civil Engr' s. Centerville, Mass. " which said plan is duly recorded in Barnstable County Registry of Deeds in Plan Book 121, Page 55. Subject to and with the benefit of easements, rights, rights of way restrictions, and reservations of record insofar as the same are in full force and applicable. Said premises are subject to a water easement recorded in Barnstable County Registry of Deeds in Book Page For title see deed from Sheila A. Bearse recorded in Barnstable County Registry of Deeds in Book 3411 , Page 267, and being the same premises described in said deed. This property is now known and numbered 2026 Main Street, West Barnstable, MA. WITNESS our hands and seals this _ �' day o f G-GC.� ;1 ' 1985. J i 9.ti KENNETH F. SALIMENO MOTHA R. SALIMENO w r' 1 COMMONWEALTH OF MASSACHUSETTS I BARNSTABLE, SS. August 8 , 1985 Then personally appeared the above named Martha R. Salimeno and acknowledged the foregoing instrument to be her . free act and deed, before me, Carol A. Skala, Notary Public My commission expires: August 16 , 1985 The Town of Barnstable &6199� Department of Health Safety and Environmental Services �OrEo ` Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 RalDh Crossen Fax: 508-790-6230 Building Commissic: Permit no. Date AFFWAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENTTO PERNIITAPPLICATION 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 orto structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Axj��°KU^ Estimated Coj too.Doz. Address of Work: -LO1 o Owner's Name: Date of Application: �-Z 6 l I hereby cer*.tb= Registration is not required for the following reason(s): Work excluded by law QJob Under S1,000 OBuilding not owner-o=apied QOwner 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 er. Date o Name Registration No. bR Date Owner's Name q:forms:Affidav o.f Massactiuserz� The Commonwealth Department of Ind al Accidents 7 ,° O�ca iuffVst10a11Oas ix`_=_ 600 Washington Street L Boston,mass. OZIll ne e davit Workers' comoeasation Insara •�or��o�i.,.,,,�.aiairrn�,x�t _. 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F.v:)vi•}}:v"::.v:........:•:::n...::::::?iiii:......:::......::.... .... ..ii::•::v.......• yy.�.,}:........ ..... .vr...von:--„••:,':•. ... c] ..-......::•:. .:ravor^ooY:;a:,'��,{••vn� .. ... .•.... :•...........;. �::.:. ^'h n.�`...b...3�3-.S.!} $�3�}:` ::'.`:•+.•:�. ..........................v':::::+:}>.!:{•}xp•.-•:'r-S'r,;nn'v.•.:•'`�M�',7:•xM •:a\ 0. ......:•;3waw..•x•: ............................ �� to 51300.00 aaalor tnsarsnce••eo:•:: ....:: ota�lpmaltiesota>1�IIP �a switantSl►of MGL l4 em h�m�'° Fafict'e to secure caveat°air a uire' B�in tba fO"n of a STOP a0= ��PTednCaLML �of S100A0 a dq ataimst�• I��d one pears'�pnsomasat be fos�da tba OIDea of Ia�atli copy of this statattent>r7 above£s vw.md eorred • ofP�that�ittforntatio�t prot'ided I do hereby certify under thep Date Z Signannz - - Phnat:# .mot Alt: • �awn amdal ofIItial use only do not writs its this area to ba b7�7 , ❑Bua&ng Deparunent penumceme ❑Licensing Board 'city or town: QSdeeunen's Omce resonse is required ❑Health Depsrttaeat p ❑check if imm Other�� pbaam Ih. contact person: Information and Instructions: foyers to provide workers compensation `iassachusetts General Lases chapter 152 section 25 requires C�quoted from,from the "law", an emPloyee is defined as every Person in the service of another uncle: and' c�—- �InPIO•ees. As . of hue, -press or implied, oral or writtea. oration or other legal entity', or and-two or tnor. defined as an individual,parmership, aSSOCIatI°n, core plover. - lover is defm eves of a deceased em �' emp and including the�mP ;he foregoing engaged in a joint enterprise, lovers. Hoverer the o�•ner or a legal=zitY, =PW,=g� the a house sustee of an individual,parmership, associaaen or other ara� and who ��,or the occupant of ..dv; liin_ 1n ening house ha%bg not more than three ap ��work on such dwelling house or on the you:_. c another who employs persons to do maintenance be deaamedto be an employer. buiidin° appurtenant thereto shall not because of such employmeat y that every state or local ltr'rg agcy- shall withhold the issuance a. 1iiGL chanter 152 section 25 also states is commonwealth for any applicant vac of a license or permit to operate a business or to construct bm'I�ags AdditiaS.? :thee the produced acceptable evidence of compliance with the insurance a thafim p�aace of public work u=:- c:o p olitical subdivisions shall.v=hM nay commonwealth nor any of its p -- ofthis-cbapter have been pzrseated to the cottu_-- acceptable evidence of Complianceins - /.!%authority. ;applicants dm=dm and _ �Zdavit y�by gthe box that app es W s all y be please fill in the comp®s�n amdavits may of msurd= "�g company names,address and phone number w> a ��covemor. Also be sure to si=nsuppl submitted to the Deparmteat of Industrial chy ortoovat sba application for the p or ucease - • affidavit should be retuzaetl garg the "law" or L -_ date the affidavit. m - ested,not the Deparm=of kdwt dal Ae©dC�• D have any�ga a nu ber listed below. o_uig to obtain a wod=9 � .p 9,P are ;.��, ,� ":,•. OR NI I//. City or Towns mnt bas p=dded a space at the bottom C. � • jerse please be sure that the affidavit u CC� y bastD cow� the appiic�. P. t fOr you to fill out mthe eveatthe Office will used as asefetzace=umber: The affidavits may be. " be sure to fill in the pezmiticease manber w= bM bemmada the Department by mail ar FAX imlrss other a�S®� Tne Ofitce of Investi_sations would Like to thank You in advance fory_oa cooperattan and should you hay�and•eP:�aons• pi of hesitate to give us a cII. ,.........cas„ don a i�'.�'" / /177/ Tne Department's address,telephone and f=number: The Commonwealth Of Niassad�� Department of Industrial Otttce of lnvesUDaUoos 600 Washington Stred Boston,Ma. 02111 f=#: (617) 727-7749 .,u,;. . at (617) 727-4900 ezt. 406, 409 or 375 no cAR Agpmda J Tabla.iLLIb( ) :A�with FoauY Faeb p pseissV foram and Two4amdY Re ddeadd Baitdbip HO&OCcaiing Gla mcd= Ceiling wall , &vNai�J wan Pled FtEa=cy, Arce(A) U4%iod &vim Rrvaina WvaW Rrvaloar P=rast SJOI t � 19 10 6 Normal 13 Q 12% QAO � 6 Normal R 12% O SZ 30 19 I9 to !S AFUE u 19 10 6 S 129A am 36 25- wA. . MIANormal T 13% 036 A Nosmai 19 19 10 6 0 15% OA6 wA its AFOE V 13% Qr44 31 i3- 1!lip WA gNScmW ALM 6 w 13% 0.32 � � � r 19 v� WA x la'/. am � 19 2S NIA wAy 19% 0.42 1 � 19 10 6 Z IVA GA 38 19 19 10 6 90 AFEM AA 12% 30 1. ADDRESS OF PROPERTY: L— • 2. SQUARE FOOTAGE OF ALL EXTERIOR:WALLS: 3. SQUARE FOOTAGE OF ALL GLA23 `iG= 4. %GLAZING AREA 03 DIVMED BY#2): ° J' 5. SELECT PACKAGE(Q—AA•see ch=ab0we - ; NOTE: OTMM MORE INVOLVED MMODS OF rlEi XMININUBCMGYREQUIREIVIENTS ARE AVAILABLE. ASK US FOR THIS INFORMAZO& BUILDING INSPECTOR APPROVAL: YES: NO: q-i0rms-t980303a 780 CMR Appendix J Footnotes to Table JRLM assemblies (mpg sHding-g1M doors, skylights, and Glazing area is the ratio of the area of � the glazing bin e7CClud3IIg opaqu e doors)t0 the gross wall basemcat windows if located in walls that enclose �maY be extruded 5�the U•value requirement. yea, apressed as a percentage.Up to 1/o of the total glazing um desi with 300 fl of glazing area. For example,3 fl of decorative glass msY be�m��a g � in accordance with =pRer January 1, I999,glazing U-vahres musi be tested and doc:mented by the the National Fenestration Rating CarmeO Q'Mp test P'0 ' or taken fi'0m Table J1S3a. U-values are for whole units:center-of--glass U-vabtes catutot be used- If the insulation achieves the full ' 'Ihe ceiling R-values do not assume want R-30:boa may be � for R 38 insulation thickness over the estertor R�9 it saladon. CeMna R-vahses represent the sum of cavity insulation and R-38 insulation may be subs � g must be placed between insulation plus insulating sheathing(if �,��� the conditioned space and the veablmd portrmz of the zoo£ iasalabmg g (l f�. Do not include 'Wall R values represent the stun of the w� aaviW. eat could be met EITHER ex=ior siding,strnctural sheathing,and into' l an R-19 regautm insulation OR R-13 envity phM R-6 insulating & Wall requirements apply to by R.19 cavity bat do not ZPP1Y m=Ml-ftame construction. wood-frame or mass(concrete,masamY,logy waned crawIspaces,basements, S The floor requirements apply to floors over tmeodditioaed spaces(SnClr asMcanditi°a or garages).floors ova outside airmustmanthe ccilmg � less than SO%below grade must Tre entire opaque portion of any basCmCnL wall Wlth doors of conditioned me=: the same &value requirement as abovelpade walls Windows and sliding glass ba�emeats must be included with the other.glazia& Basement dOOm taust meet the door U-value requirement d_s bed in Note b. Add sdditiorral R-2 for heated slabs. 'The R-value requirements am for unheated Slabs• 3,4,or 5. if you plan to install more ' if the building.utilizes electric resistance heating vse enmp�en ent with the Iowest eat or more thaw one piece of-cooling �'the�� than one piece of heating equipment the selected p� efficiency must meet or exceed the ef�iciencY byc r ww�see Table J521a "For Heating Degree Day requirements of the closest City NOTES: ues are minimum acceptable levels. a) Glazing areas R-value requirements are for insulatio and U-values are amx�um k levels.Iasulatioa Rval- and do not include st anal�ponc- n Onlythan 035.Door U-values must be tested b) Opaque doors in the building envelope must have a U'value no gstst�' the manufactutts is accortiaace W&the NMC test procedrae or taken from the door U-value and documented by and an aggrepte U-value rating for that door is not available, include the in Table J1.r.3b.If a door contains glass door U-due m demmine compliance of the door. glass area of the door with your windows nd use dm��a U-��than 035). One door may be excluded from this requirement or�l spy wall=npone�includes two or more areas with c) If a ceiling,wall,floor,basement wall.slab�d8e►if the ateweighted avcmp R-vahm is greatest than or equal to different insulation levels,the component comps or door compoaeats enmPlY .weighted average U- the R-value requirement for that component Glazing U-��requirzmeat(035 for doors). value of all windows or doors is less thaw or equal ESTIMA TED PROJECT COST WORKSHEET Value LIVING SPACE (high end construction) square feet X$115/sq. foot= (above average construction) square feet X$96/sq. foot= /Z Z you (average construction) square feet X$57/sq. foot GARAGE (UNFINISHED) square feet X$25/sq. foot= PORCH q(.p square feet X$20/sq. foot.= L rl �'" • `� DECK square feet X$15/sq. foot= OTHER : square feet X$??/sq. foot= Total Estimated Project Cost A-17.y,3zo 5 3� RESIDENTIAL ADDITIONS OR ALTERATIONS If located: North of Route 6 - any work visible from outside - needs approval from OKH ❑ In Hyannis - If work visible from outside - Check to see if it's included in the ❑ Hyannis Historic Waterfront District - if so it needs approval from them APP ICATION PACKAGE MUST INCLUDE: w) Map/parcel number t Approval S*Q - ffs from: [�Health Er Conservation (if exterior work) FTax Collector (4�— � Treasurer c P— If ZBA relief(Special Pe.:mit or Variance is required for project: VA 2 ❑Copy of ZBA Decision o`-, I ❑Documentation proving that decision was recorded at the Registry of Deeds w/in one year of ZBA decision date. 4:0 CO.``rV?#01C TDB_ Street address 1 rr ❑�Owner's name & address �� eI7nit'equest - full description of proposed project(U-value of replacement windows if applicable) (Ar— quare footage - proposed project stimated project cost � I EComplete Dwelling information for Assessor's Office [Builder's information Signature 2`9 A of plan Se P� Plans - 4 sets measuring 11" x 17" fully dimensionlized with found a on, floor plan, cross section, framing schedule & smokes, with a Red S (SB or SH) Lq�Home Improvement Contractor's Affidavit Worker's Comp form must include: Insurance company's name &Worker's Comp policy number energy Compliance Form copy of Construction Supervisor's License &Home Improvement Specialist's License OR ❑Homeowner's License Exemption Form. ❑ Fee CHIMNEYS ❑ Need Home Improvement License ❑ No plot plan required PIERS & DOCKS J ❑Need Construction Super license AND Home Improvement License Owner cannot pull own permit 0.orns:permits l rev.08/30M i September 4, 2001 We agree to remove our kitchen if the Zoning Board of Appeals denies our request for a family apartment. 6T �omvmo uuea i �✓uaaa c/u aelld f BOARD OF BUILDING REGULATIONS ,:.,•� Ucense:;CONSTRUCTION SUPERVISOR Number4EiS J .001 Tr.no: 12336 — Resb cted OAVID J GADY =� 121 TIMBER LANE MARSTONS MILLS, MA 02648 Administrator ? t 1 i • f:t .. ''��.---. a x- �, qi,i�� �` �• . • - M � � lS61 �• . 19 0 n AU ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION :y Map Parcel ? Permit# 5 1/_ Health Division -- �-✓� G ?%�/ Date Issued 2 `t— Conservation Division SEPTIC SYSTEM m Tax Colle or - Z INSTALLED IN COMPI.IAN'CE Treasur � t116.la— WITH TITLE 5 ENVIRONMENTAL CODE AND Planning ept. TOWN REGULATIONS Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address o Village11), Owner _V- AAddress Telephone L 0 _aZ 1-1 t a Permit Reques 6 Square fee st floor: existing proposed 2nd floor: existing proposed Total new Valuation (1 600 Zoning District Flood Plain Groundwater Overlay Construction Type//O Lot Size 63 -2 , -7 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: ❑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:Cl existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes X No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION F p Name 4elephone Number Address IY `,2L License# Home Improvement Contractor# Worker's Compensation# f U�6d7x vet-,4—d ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO nQ _ -,MLC SIGNATURE DATE i s t ` t FOR OFFICIAL USE ONLY R PERMIT NO. i f DATE ISSUED 5 MAP/PARCEL NO. ADDRESS " VILLAGE ' QWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE = m, ELECTRICAL: 'ROUT GH g t' FINAL- v PLUMBING: ROUGiI d FINAL `GAS: i ROUG17H� FINAL r FINAL BUILDING i t. DATE CLOSED OUT ASSOCIATION PLAN NO. • •s �J 1 1 11 1 1 � 1 1 1 1 1 1 1 ,I 11 1 II1 1 .1 1 . I 1 ••. •, _I ♦11111:1I `✓.11 / 1 • II ' �11111 1 •'1 •,. 1 ' . 1 I •. RM ■ 11Wlll 4it.iopel-lk.)qwiAa# l)f / 1 . I 1 1, 1 . It 1 1 �. 1 ♦1 1 . . �• . . • ••1 1 1 . 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I •1 , w1/. 111 wll .1 •1 loll/1 1 w 1_1 1 • • 11 11 .1 •.-1•�1 i• • • 1 •'•11/11 w/ .11 1 I lel/_e �.•• 1 1 � I 111 w/l 1 1 • I_e • �' •1 /1 • • • •111 • e ' I I el 'ell • III • 11 11 It w/l •1 , ie •' • 1 w • '✓.0 •t1 1 1• •'•111 Y. « • • 1 w•r: •III • /1 • 0 ✓.111 r -� un1_• II 16 ell illII •w•1111 ••.+/ I11111 1 w • 1 1 1 _1 /11111 •w Mr. •I a IA 11 1 • set w/l • • 11 •) III a /I • .11 • w1I wIIA 1 •_wl 11✓• I .. • all w • 'Y•1• •11 '• I • 11 .1/ • II 1 ' .11 V • • / V•• I w .1• •11 / I 1 • • • I .11 • 1 w . •I ' • • e• •Y 11'•t • •1 �'= I 1 • Ill web •• w/. • I •11 .I/ I Y•• 11 111 •.1 1 1 11 11 1 1 1 � 1 ' 1 •11 1 1 1 1 / 1 1 I I I 1 1 1 1 1 1 1 I • I 1 1 / • 1 1 / 1 1 1 1 1 1 • III � I I 11 1 °p Ine rpm ti �. le The Town. of Barnstab LAMS aM M g Regulatory Services s639• �0 - 059 Thomas F. Geiler, Director Building Division Peter F. DiMatteo,Building Commissioner 367 Main Street,Hyannis MA 02601 . ffice: 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: q X 3 J Estimated Cost 41 Address of Work: O t� Owner's Name: LA Date of Application: I hereby certify that: Registration is not required for the following reason(s):. []Work excluded by law []Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED. CONTRACTORS FOR APPLICABLE HOME IMPROVE MqT 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 a ent of the owner. . a m aW Date UContractor Name Registration No. OR Date Owner's Name q:forms:A f fi div:rev-070601 I PLAN REF 121155 -- A.M. 217/19WB _ MH6 MHB ZONING: "RF" ASSESSORS MAP 217 t R.P.O.D.: 2 ACRE BARN 32O•28' FLOOD ZONE. "C" 3 56 06"TN4. ' '.� NO � 80.6 36,�... 8 0' .... SEPTIC IN o FRONT o . SE....... PER OWNER o : USE,,..,,...� o 2026,...,,— o 3 . 00 o :...... # w 4 � D 30.0 pRO pOSE'D oo ................:...:::::8.1 N O 110.7" d �.....,,......35. g 00 POOL O o � 12.O'o c� �, :co o A.M. 217/1 b y v SCpRORCND of -o _ -- 1'1z 2.0 - AREA=32,671f S.F. 40.0 9.9..::;:;:: pROpOSE'D o .,.....,...,.. M ADDITION �� G, V rn - O tV 40.0 p �"� .a• � ,40„w 150.00 o NO3°59 w .%1 z - N OF 6P N GNP p`( N :: \. :., I � ` N035.9'40"W ;HSE ' A.M. 217/54 PLOT. PLAN Off' LAND E •LANE SITUATED AT MAGGI )026 MAIN STREET LOCUS MAP I CERTIFY THAT THIS SURVEY AND PLAN WERE MADE r,T�1 ST BA R A TS TABLE j E IN ACCORDANCE WITH THE PROCEDURAL AND TECHNICAL /�/vl/ 1�l 1 LJ f J WEST BARNSTABLE STANDARDS MR THE PRACTICE OF LAND SURVEYING IN.777 PREPARED FOR. T OMMONWEALTH OF MASSACHUSE775 . � �. o➢ RT �c KA THL�'EN PAUL A. MERITHEW, P.L ROBE' COLONY PIERCE' BA Y COL PAM A. H MAY.22; 2001 No. YANKE'E' SURVEY CONSULTANTS �l 40 INDUSTRY ROAD GRAPHIC SCALE UNIT' 1, P. 0. BOX 265 �r3 g 6 LOCUS 30 0 15 30 6U 120 MARSTONS MILLS, MASS.. 02648 428-0055 FAX 420-5553 TEL. ( IN FEET ) J,# 52728 CM 1 inch 30 ft. �M:�\`�\.= ';� ti `.��� r tip, •: �-`:;``�?� —c, .�. —.��..; ��. .y �v . ..t_.u..e..-s.r.._r..�....-rJ.>aviSL.'1".wlw.—�..0 La•1.ilLavd�.i1 S.�.c._. .. ....w.....+v.....,n. .. �` ...r._. .. .. ....-.�. _.... .... �.-r ._...-e_..�_......a_.w F.i�. •A 1 ,j 18 x 36' Rectangle 1 ! 6 5TEP 2 UNIT 4 8 8 8 8 } 4' 5 5 +. 8 ,8 18' 2 5TEP PANEL 2 LIGHT 10' 40'3" UNIT OPTION / I 1 � 8 5 5 4' o�aao-o- 3'I4 WATER DEPTH MUST BE 5' MINIMUM T 0" 2"MINIMUM PREPARED BOTTOM TYPICAL CORNER i 42 �, 6' ��- W -�---- 12' j � - RECTANGULAR i FILLER 05180 j PACER j RADIUS- FILLER 05181 ! (NOTE mri p�o s wlt�hr, 5thecmoplast a step am A fame=Is;regwred own ea his de of step-unit'. 18 X 36 o s x'Mv;' � COPING LAYOUT 18 X 36 W/Center Stairs I: Striiclurews designed for use belo�w�grade ando„nly%as Where the ground water ' ble#roiminu f 6;betowzthe,�pope�d fimsed grndes.�,^ r�� .� 12 12 a 18 x 36 w/Side Stairs I �2rC�Backfiliwithclennearthfreeofrootsenddebns•Donotnllowtheheightofbacill DESCRIPTION PART# 1 to M i d �water to exceed the height of Ihe,weter m the pool by mote than 6 nor water to exceed backfil�f RADIUS CRN. 8 9 7 7 05102 8'PLAIN PANEL i i3PourZSWSoncreteIN� garoupdenne e. nmete rtu�tmumSydeep 5-12'SECTIONS 1 1 1 8'SKIMMERPANEL 05104 4; 3 wtdeconcretedecklstobepouredatleast3 thicknessnndaslopeofl/4 tolyawaytrom 4-a,5ECTION5 6 2 2 2 8'RETURN PANEL 05108 6 iFm¢ bottom is to 22 m mum'of�t�table matennl or undularbed earth 1 6'PLAIN PANEL 05112 T 1 ' 1&,1v buoys is to.be'permanently;attached P'0", O to the shalNowrside o 12 12 8 2 5'PLAIN PANEL 05118 the point oGfirst slope change I 54(toptng;;copiik.,Wnginsare�pproxinun. Cutsma� b Peededons"ightsecuons 2 2 2 4'PLAIN PANEL 051'23: forproperfit„Radiuscorhetsare2x,r y't :�;,;r�� i ADJUSTABLEA-FRAME 3'PLAIN PANEL 0512 1 4 '8onsttu yDtawings7, esedngs sndcnotes.ure for tllustrauv�tputposes 1 "onl Different methods and recauuons may be dictated by.venous ground=onditions"x- 2 1 3 2'PLAIN PANEL 05129 . tThisistobe`determinedbyandisthe"responsibihtyyftheconunco whoisnot'en'agentofth 1'PLAIN PANEL 0 132 manutacnRrofthee ompoin�pn� 'c �q 1212 13 A-FRAME 188, 9Instal�lalioy ins to be _one iaccoidetice with-all federal"smte and-Dora• IdingS,t _ 4 t} 4 RECTANGULAR FILLER ipdes ii well as N S P 1.,suggested standards, � -t• y 4 4 4 RADIUS FILLER 05181 4 SAFE NO EAti` 8"MIN. GRECIAN FILLER 05183 zPoo bottom configurations are„for tllustratrve p ses only�The'configu 25 0 P.S.I. `rauon'sliown confortnsxwtth current°N SiPIrsuggestedrummumstandards 1 1 1 NUT&BOLT PAK 05201 �. y p az_ _fr_ .:.i,c t R oiYfarriim�i dtvme;eautotnen[:.Ifadt mgy CONCRETE 1 1 RADIUS CORNER COPING PAK i Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 128202 Expiration: 03/10/2003 Type: PRIVATE.CORPORATION HOLIDAY POOLS i VVA�TER ZUfCSKY �. 53 CAYUGA AVE VAE-HPEE,!MA 02649 f • - Adntinistratnr . � r r,o1 :iitaieu .(1�(ttao O 4,c.IKG�(dtAl.li rw NlLlal' ~JAY TJK tP t{IIN[9 110t Mt Ni,CSte����AltOlt[[ +.�■� .y/ 3 ppyy��,,��i�ap��y ' ®15EE SECT.13F2 irtD 1I .s• 1 .' 2y -PLANS OT ER ROR LOCAMOM IT '- EMS I F•=� • - g-O BRACEI J f 1 • 9 1, N C►GAIYSTEEL PANEL Cmy FAE_FABRIG(TED RD _ .. I � ASSOA e-D�e P DIAGONIL FRACE A D 2 AN.BOLTS wAAS RS TTP D L RY.R6pG4G4Lv.E, AND z Ye51/EA5 1NYL LIN A ISEE SECT.LV2 AND T E-RumaCATED PLANS FDA LOCATIONS STAR ASSENw •1 a-S/eP N.BOLTS �9 OTHER REYSN OkMX STAIR UE NUTS AND wASNEyB 1 TTP n PRE-FABRICATED 20 NILT/0065. STAIR ASSEMBLY VIj(YL�E�� M(YL lRE7i / GA.GALY STEEL STAR LIE r STIUA lJE MB47S yr CORER RWEL / ��. PANEL END T7P.EA - - i SERIES 550 6 650STAIRCORNER 1 SERIES 7r,]O STAIR CORNER r1 SERIES 850,950 6 1050 STAIR CORNER n PILP Ate R PUMP A. SADAlET1 S S E 1Aoroa MOTs+ oN A'FRAtE ASSEMBLY '7 2 _ j{ — ♦— —•— — 1 TTF1CaL ME71E Show" 8 �� RLTER ' sLTER I v —f- 2 - L F ►--- ►— ►�� RETURN PCIH-HENTLI i �• t 3 TTACtED 1 N 2 ,�••� I �� I _,Po, T LINE J/ TrPKx w.ETEq U�r '- .Rv= I rr `� ' T 7 z 3Sal. SAFETY L,E >r-:�..:- ' -r": IS(.oEO - key' 1: n T W S �PORTIQM Y8J1 S I �1AT 5 a. PVYP ANo�l A • . 2 ..x YOfOR�I�1�T`"'II /(rL��J ..• '- F m lI ?� � PaEaExrS m co 0 - 1 FLAT YE s A t^.5.. iT-. • .( J r AREAS ..: sp m T p STARS ARE , Ec L_—►---} ONAL OR WAY BE O o mzr':". ss SUaFAREAe�GAL.GB �m�s°T 1 _ m w StU SOw�'16a2 -d2jL SE SIRFAEEA 6 J6E!ffiOAL_M X MOOT v 0(36 Aa&SF SINEAREA L 2.00 GAL 3 W m 20'OW-M SF SLMYEAS 222MCAL-CAP 3 SERIES 2000 8 2050 1NGROU T7PICA L ND A•FRA wN 11 WHOM ASSE SM D 0wN v O SZE SHOWN.0%44 784 SF S Fff AREA 62M L.00 GACAR RIP AND _ PERfuNE]E7LT ATTCLO ��. c LTEP MOTOR STAIRS ARE OPTIO SJIFET7 ll(E r9c_ME RED SERIES 2100 8 2150 W GROUND sScM tB.26.ae so•EL.622 SE SURE AREA I z uSLs+s ARE IS 26926 GAL.CAP 1 t � SERIES 2000 8 2050INGROUND T1ONAL PE�ACHED �R AwdE(MW T LINE .+•.J.: rREPRED IKR(lOMS -((' �.'acY - -..vt REPRESENTS ..�-,',c - •.: :-. 4'a 1 y=� FLAT AREAS N 1 4 I1 1 - ` �• �O\ 1'FRAt�E ASSELBIT O�G• L-♦---�.-1 2 T7PIUl w1/OE Stg1vN S llFlf� UM SHOv 16.7/567 SE SURF ARE&L 20720 CAL CAP S NF. Prn ALSO mNA%_ l• aI'71a SFSLRFMEA.L2493S GAL.CAP 2MV ea3 SF SURF.AAEA.L M23 CAL CAP . SERIES 2100 8 2150 NGROUND I TravelersPropertyCasualty I WORKERS COMPENSATION n M.*.m TravelersGroup AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 (.A)' POLICY NUMBER: (6KUB-627X481 -A-01 ) RENEWAL OF (6KUB-627X481 -A-00) . INSURER: THE TRAVELERS INDEMNITY COMPANY NCCI CO CODE: 1 134-1 I- INSURED: PRODUCER: HOLIDAY POOLS INC MYCOCK INS AGCY PO BOX 61 20 SCHOOL ST MASHPEE MA 02649 PO BOX 437 COTUIT MA 02635 . Insured is A CORPORATION Other work places and identification numbers are shown in the schedule(s) attached. 2.' The policy period is from 04-22-01 to 04-22-02 12:01 'A.M. at the insured's mailing address, 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compen- sation Law of the state(s) listed here: MA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in `— item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit o= Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT WC 20 03 06 D. This policy includes these endorsements and schedules: o SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 0 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 04-20-01 WC ST ASSIGN: MA OFFICE: ORLANDO INDUS AFF 161 PRODUCER: MYCOCK INS AGCY 297SB 2 0'0 , 1 1 3 Application to (91b Ring'g A9igbbiap Regional T�iotorir �Digtrirt Committee In the Town of Barnstable =`' M w CERTIFICATE OF APPROPRIATENESS ti C/) N Application is hereby made, with four complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings, or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior building construction: ❑ New ® Addition ❑ Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial ® Other /N -1-',ow .4PRI 2. Exterior Painting: 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ ReOther ng Existing Sign 4. Structure: © Fence El Wall ❑ Flagpole /N 6-2ovN0 Poo L TYPE OR PRINT LEGIBLY: DATE ADDRESS OF PROPOSED WORK a1-0 /PEA/,J $i- %J.:/24iiN.!�r /ASSESSOR'S MAP NO. a/7 . OWNER / %N�lr� M d'//:&cam ASSESSOR'S.LOT NO. O/? HOME ADDRESS aQ,dX M,4itit ST. TELEPHONE NO.. 501 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any Oublic street or way. (Attach additional sheet if necessary.).' r3,4 aj3AnA A4orue5- i'U m-41,J SJ. 4,-/. /2,nl1/STA,1l ,V4. �- M2�Mh S r 0NA1 r 6'L4f rr4/s ze cif .+oA,4-MP-5 -J014Al *1.4 � c RAliffI S>. /?Qa.vsTer Mgt M S o0/J✓,1 TIw 1lid sf AIAI—Me IVA AGENT OR CONTRACTOR DA I D 6 V1 . TELEPHONE NO. ADDRESS ��� %/�"12. I-AAl, MA%?STDiI/$ 1.414,1S J'✓I�, © /Jd' J DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. eu o , T i+/ /Jb0/TioiJ o f A �� X 1/d 1ti_�,, ✓ . Tv F_xlsTrr�• �6��//ia� ., d.00 G,v��%� t.%��� 9L STt�Gic.oAF_(S'GiLi_",�iV Alwv vP yA" * o0601- . �6vj i� z/B vHb.J9ae z �. Signed Owner onfract -Agent Far Cam ee Use Onl is Certificate is hereby A RF-WNV59R Date D I. ppry is MAY 16 2001 ittee Members' Signatures: . . TOWN OF BARNST-4 LE r OLD KING'S HIGH AY 2001 Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION C /_h// SIDING TYPE CT f�l�_ S/�l7)✓�/_Ir COLOR /3e*77 IW011e ya M gr:4/L5/ 6Ae/ 9C_ /9 CHIMNEY TYPE y1 5�L �bCJ�$ lZ COLOR of IU(C IC. ROOF MATERIAL A 4 R/✓)L7- SlliAlG�Ie_ COLOR MO/PLe PITCH WINDOWS DGvl',L 11PAG 1-Cm_r_MzNTCOLOR. SIZE VA&Iet's TRIM COLOR G-c//,//7-,6 DOORS SS 546✓0,JD COLORS,,36Wd• /VA0/1._" T n-n_yrowrdG �ni /,/c SHUTTERS f/01771C., COLORS/�F•��T /�fGold r/12IJyToAIX) AC/I/,/ GUTTERS /,� �/�✓J it/UNl COLORS G✓�,//jf DECKS /V O MATERIALS n l GARAGE DOORS COLORS L SKYLIGHTS SIZE t7 COLORS ` M D SIGNS /t✓Q COLORS MA`( 10 2001 .. WN OF BARNSTA AY 5CI�r�✓ TG ,S HIGHW • e ,—���„�., �� Gip KING FENCE 9� Gi!/�1��1 ,C�n/1� COLOR /►i v/��L G3/ CNgi.,' NOTES. Fill out completely, including measurements and materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape j plan and elevation plans, when applicable. SPECSHT Revised 11/98 Assessors map and lot number ....... • -•..... .......................... � Bpi THE TO Sewage Permit number ...... ........................... saw House number �d��v /`/G�/t�/ St� �3nc s IN� y E. ........................ . ... .. ........................... ........ ALM w O tb39• �0 ENVIRONMENTAL CO ° TOWN OF BARNSTAB' "L�G��►T�ONs BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....�1.2..P.t(............................................... .......... TYPE OF CONSTRUCTION ................................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....Oxd.g..6.....1Va./..V......�.i......w.....��1.C�./�CS.°.......................:................................................... ProposedUse .....A.TQ.12.a.�..`.P....... ................................................................. ZoningDistrict ......... .... .....................................................Fire District ....................................../........................................ 6 Name of Owner .. ..... ... .. ... .. . ... . .. 2�.�............Address �. �� � � �.../..�.././...t5. Name of Builder . p�...../✓•!s ?/.//6l ..............Address ..�....../—? �.A.(..............:... ..�.�.?.................... Nameof Architect ..................................................................Address .................................................................................... lJ��. ! S Number of Rooms ..................................................................Foundation ....... ................................................. Exterior l.k� .. C�Y..W..�r�....lb)J..Y...(...................Roofing ... .S ...v[..1��!.. ............................................... v Floors .........................................Interior .................................................................................... HeatingPlumbing .................................................................................. 50 I Fireplace ..................................................................................Approximate Cost ....1�. ........................................... ............... Definitive Plan Approved by Planning Board -----------------------------19 —--• Area c .� t ................... Diagram of Lot and Building with Dimensions Fee / SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 01 Namej�••• •••••.... .... �............................. Bearse, Robert 21266 storage shed No .�............. Permit for .................................... ............................................................................... 2026 Main Street Location ................................................................ West Barnstable ............................................................................... Owner .............Roberi-.-Bearae........................ Type of Construction ..............f ram................. ............................................................................... Plot ............................. Lot ................................ Permit Granted ...........Mgy.. ................:.19 79 Date of Inspection ....................................19 Date Completed ..................... 19 PERMIT REFUSED ti .................................................... ......... 19 ....................................................... ....... ...... ..................................................... ................................................. n ............................................... wo , Appr ..... ..S................................. 19 'Fn 0 ................................................... ................. ............................................................. Assessor's map and lot number • 02 � �� . ..,.......' � �j/ � THE S00age Permit number .....:........ s '? ....................'....... �) = BAWSTADLE, i #� House number �Y..........................,......... �p '1639, �1 mik"i l TOWN OF BARN.STABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO Z i, Cr..................... a c� '. ........................................................... TYPE OF CONSTRUCTION ....(t> 0 C _!!!r. ..................................:. ...................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location � ......./..:/l..0 /.ill........... .......u�......:�%r ,{_�,/i(C •........................................................................... ................ Proposed Use ....... .7,. .` ...... r./...f:. W ZoningDistrict ..........................................................................Fire District ................................................................, ll ............ Name of Owner .. ......:..............................:!:............................Address � W ? U2 ' Nr� ,...... lo� / �s. ? . ��.� � Cep ✓, n � Nameof Builder ..:........../�................. Address ................... ................................ .........:.................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ................................:...a.............................Foundation `%4G C; 4 {�/ �' AZ 5 ..../..............,7................................................. Exierior f.00�T 2„S'.n7 f t�..l.! .....1'..`,1,V.. ...................Roofing .� 5�f, ��?h, /,,....................../ ...........y................. . Floors ..................................Interior �... .. ...................__ •-_ Heating ..................................................................................Plumbing .................................................................... Firepp ............Approximate Cost �, — r, lace ....................................... ............................ 4 ............ ......(................................. Definitive Plan Approved by Planning Board ______________________________19_______. Area ....... .................................. Diagram of Lot and Buildingwith Dimensions .. ' �4 9 Fee ........�?�................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH t� rye. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Namek..... ................................. r Dearoe, Robert-, 21266age shed^J`---- '='k for --------—...�r � ' ' -----------.--------------.. ' 2026 Maio Street ' Location ---------------------. ' . ' ` ' West Barnstable ---------'-----------------' Owner ---. 'Bearsm`--------' ' Type of Construction .............frame.................. � . ` . ^ - / plot Lot ' cuuy ' / Date of Inspection , -_- Completed_ ...................................... . ' . . ' � ' PERM1,111 ` ` , .......................... lA - . . ----. ------.. ' ~ ................ ' .... '/ . ---'—^~�-- '''^ --^—'----- ��L. �`................................................ ' ----.. ' \ —.�... - ` ' - , ' —_-------------- lQ ' Approved� .'--,.---',----------.--------. . ----.--------------------.— � . � Assessor's map and lot number ....i t.....R/."..••".... _::... ,.. f rC�.•, i�c 'c-f 1. s� - s 27 .Gv �i t ter►-/tt /!L r `'� ., -� � �. C � I Sewage Permit number ........................:.......:......:.................. , TOWN OF BARNSTABLE �F7NEt0 A BA"STODLE, i 19 63 y BUILDING INSPECTOR _ 0 pY a' s _ F , APPLICATION FOR PERMIT TO A� �� fN ............................................ ................. .......(......................................... TYPE OF CONSTRUCTION L<C/D p .......... i..... ^f�. P........................ ...... ........................................................................ ............... ...................�9. TO THE INSPECTOR.OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ///7/A/ t.1/O C �r7/• /��' / ,� �/. R` ............................ .................. ..... ............ ............................................................................................. ProposedUse .............................................................................. —*............ j � / Zoning District ...!..� : .....................................Fire District ��P r -/ �� �N r � 6 1 e ...................... r J......................../...............................�................. / • Name of Owner I'/S ' �... ..../ P• /��. ........Address ........................ �/�!"L cttP �t � ... ...:.. . . �1��/�.../r /3/ � / %S/'- ���,��� Nameof Builder .............................................Address .......................................................... ...................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ........ .....................................................Foundation ....T.70..^. .................................................. C(��(�{./.....•.�//I/ /L F "ti'( 4 Z/AOi:t iRoofi ng 1 / C Exterior ............... ................. ........... ........ ..... ........................................................ Floors ...../�/ r; is C�J Interior ......��.. F; ? / / -) L� �/1 ....................................................................... .... ........................................................... - 7� J Heating ....... �........ /............. ...`.. r •.....Plumbing ... .. ....,�..... ............................ .� Fireplace ........1........................................................................Approximate Cost ....... 4G 6 ........................................... Definitive Plan Approved by Planning Board -----------_------__--------- _______. Area Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 - I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. n! Name .. lr:....`..............1,arv1-....;:...,••;•`........................... Beat�e, Robert 19921 remodel dwelling No ................. Permit for ..................................... ............................................................................... Locatia?0,';�� Main Street n ................................................................. Barnstable ............................................................................... . Owner ............—obert Bearse ................................................... frame Type of Construction .. ....................................... Plot ....... ........ .......... at...�... /.. ............ ...... ronte /Rebruar ..2..........19 78 Permit G d ....................... Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ........................................... .................... 19 //..1-7... . .... .......... ................ . ........................... ...................... ............................... ...... ............................... 1.!...... .../ I ............................... .... Approved .......... ...............L.C. K r. . ..... ...... .� ..... ............................................................................... r Assessor's map and lot number ... ... .1....1..:..h+...).. �wll-.cid�� �'CwecGis�� ddd"" � fj �f iriuw it L. c` — f s Vs Sewage Permit number .......... ...........G..GGW. ................. u TOWN' ' OF BAR.NSTABLE BASB9TADLE, i j "6q � 1U1LDIHG INSPECTOR ou a- t} Gt a; UI mAPPLICATION PORE PERMIT TO .... .?e. .Wle ......... .......... .............................. fI CJ _ - TYPE OF CONSTRUCTION ..................................... ..../.`C� / �. ....................................................................... vv. .�... ...................19./,�J TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to+the following+information: Location ... /V J Y (.(/ P/?/Y.S. ...�2.//4f ........ ............. ProposedUse ...... �.��6„6`� 1. ........................................................................................................................................ Zoning District ...)? ......................................................Fire District ......... ......... .......... ................... ... ................. Name of Owner Z-PC.If.1.?.. .. . ��.af .s. ....Address Name of Builder .�� .../ ... 3 t.s.... .�. ../`y".Address .` .��/..4� ......C7/!/ / "(� ........................ ------------ Nameof Architect ...........................................................:......Address .................................................................................... Number of Rooms ........�.....................................................Foundation ... .�U. .. .................................................. Exierior ................... .................................................. ,� � sec Floors .Interior Heating ....... �1. ^ G�..!.. ..�.Z......��...��f�. ��Prumbing ............. w l c� ............................ Fireplace ....... .......................................................................Approximate Cost ..... ./........................................ Definitive Plan Approved by Planning Board -----------_______-----------19________. Area .... ....—...................... Diagram of Lot and Building with Dimensions Fee �0 SUBJECT TO APPROVAL OF BOARD OF HEALTH S lR" �1a1� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Bearmmv Robert � 19921 remodel dwelling No -----.. Permit for ----------..��~ -------------.------.------ Maim Street . Location --'.-----_-----.-----, West Barnstable -----------..-------------- � ' ��v��r— ��arm�| �wvner —.--...-- —..------.-----.. f ramm Typo of Construction .......................................... ' ---------^'-^---'----------- Pkot ---------. Lot ----------.. � . February ^ ` ' 2 78 Permit Granted ------..---'-...'lV � ' . . ' � . Date of | l�Inspection --------'`--- 3 ' 4 . � uo/a Completed ----.. .�?K ��/r ......./9�� ' ' � � . i PERMIT REFUSED , ----._—.---.—..—.._—....... 19 . ~---.----.—.---.------.------.. � � � . � » � ^--..,~~....—.—...........^....—..--.^,... . � � ` ^ ...'.........,,',,,...'...,,,,,,'..........,,..................''' ----.-----~---.-.--.-------~... ^ �. . , / . ` Approved ................................................ 19 ^ ' ---------------^—^---^—~—'—'' ` -------.-----.-------~—........ ^ � � � �� ^ Q -1 U e a I � m tl r 1 f y 1 Ir 1 l fn i FV i I . 1 ,1 b I . ! } c � l \ 1 L O r I Z 4 N d �n F � T� -- •J1�I I� ���&' I pL 0 ,6 --_ .— IC JJIF ifl r N A I �c 5 w i rm fis � I I I nx• tp � � ' n SSACHUSETTS R. CO MMOr7' 7EALTH OF MA. =E`= DErAIUNfENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREIrT BOSTON, N ASSACHUSETTS 02111 fames.: Canaoei �o.-n-sstone WORKERS' COMPENSATION INSURANCE AFFIDAVIT 1, � t/' �a � . �v9oY • (licensee/permiacc) with a principal place of business/residence at: GZ 1 '^%AA^ �ie�. Lekt,a— lMAI's 4�s U`T t Gl s d�t'l Grl. b Z� cF� (City/State/Zip) do hereby certify, under the pains and penalties of perjure, that: j [ ) 1 am an employer providing the following workers' compensation coverage for my employees"working on this job. Insurance Company Policy Number [t4�1 am a sole proprietor and have no one working for me. [ ) . 1 am a sole proprietor, general eontraaor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation insurance policies: Name of Contractor Insurance Company/Policy Number I Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number 0 1 am a homeowner performing all The work myself. i TN'OTE. Pleasc be aware that while bomeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more than three units in which the bomcowner also resides or on the grounds appurtenant thereto arc not gcneralll• considered to be employers undcr the Workers' Compensation Act (GL C. 152,sect.. 1(5)), application by a homeowner for a lieeosc or permit may evidence the 1ega1 sutus of in employer undcr the Workers' Compensation Act. 1 understand that a copy of thii statement will be fon+•ardcd to the Department of Industrial Accidents'Of<iee of Insurance for.coverage verification and that failure to seeurc eovctagc as required under Section 25A of MGL 152 can lead to the imposition of_r,6minal penalties consisting of a fine of up to S1500.00 and/or imprisonment of up to one year and civil penaJues in the form of a Stop Work Order and a fine of S 100.00 a day against me. Signed this 'R day of 5 � � , 19 Y49 VIA" Li cen see/Perm irt4/ Licensor/Permittor . THE COMMONWEALTH OF MASSACIiUSETTS Home Improvement Contractor Registration Registration No. One Ashburton Place • Room 1301 I Boston, Massachusetts 02108 0 Check numbers Appli4tion for Registration as a Effective Date Home Improvement Contractor or Subcontractor Expiration Date MGL Chapter 142A, CMR 780.6 I Date I. Applicant name b AV 11) Print the name of the individual or business applying for the registration 2. Applicant type: Ud.Individual ❑ DBA ❑ Partnership ❑Trust ❑ Private Corporation Publi c Corporation 3. _ Number of Employees Q 4. Address _tZI 7_►►«fpe� l.� !/Kctv55ftM5 l�'+'�`�ls tM� 026� v Print street and Number(P.O. Box not acceptable) city (S r1 ) �t28 •�a3o State lap Telephone Numbcr S. Individual responsible for Home Improvement Contracts_ (5,,4 O y s av� 6. Title of individual responsible for Home Improvement Contracts -�w�v- 7. Does the applicant or responsible individual hold any other construction related state,city,town lianas or registrations? [� If yes,complete the table below. Use additional paper if necessary, ❑ Yes No 'type license or registration Issued By Ucensc or Expiration Exp Name of Ucenx Holder registration number Date *. O 5 5 40 � zls" 951 G.,+or 8. List all partners,tm3tecs,officers,directors and major owners(10% or greater of ownership)of an appliani partnership or corporation below. Ilse additional paper If necessary. ' t See Instructions on the back) Last First, Middle initial Title in Applicarit'Buslness 96 Owner Address 9. Is the applicant claiming exemption from the registration fee? (See the Instructions on the back) ❑ If yes,include a copy of a current Construction Supervisor license or motor vehicle repair shop license or registration. Yes No 10. Registration fee enclosed. $ Guaranty Fund fee enclosed. $_ /D O.00 Punaant to Massachusetts General taws Chapter 62C scclion.49& 1 certify under the penalties of perjury that 1, to wy best knowledge and belief, have filed all state tax returns and paid all stale taxes required under law. Signature of of applicant or plicant's «pr tativc : Title held with applicant A falaa atwwer 10 any question in this.appllcatlon corslllutee wounds for auspencion or revocation of the applicants'reglelratlon. COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY I' OF lugMASSACHUSET 1010 COMMONWEALTH AVE. i TS BOSTON,MA 02215 �V ; LICENSE i CAUTION I EXPIRATION DATE j CONSTR GUPERVISOR . � FOR PROTECTION AGAINST 0 2/2 8/19 9 S EFFECTIVE DATE LIC-NO. i THEFT, PUT RIGHT THUMB RESTRICTIONS PRINT IN APPROPRIATE 1 G ('o C 3/01 /19 9 2 057540 BOX ON LICENSE. 1 R 2 FAMILY HOME. 1gDAVID J GADY J° 1 21 TIMBER LANE BLASTING OPERATORS IZMARSTONS MILLS MA 0264 MUST INCLUDE PHOTO. cm PHOTO(BLASTING OPR ONLY) FEE: I O o NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY (� HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER' l �' THIS DOCUMENT MUST BE « SIGN NAME IN FULL ABOVE SIGNATURE LINE F LICENSEE ... SIGN THECAR HOLDEREDON PERSON OF' THE HOLDER WHEN EN- (/" v COMMISSIONER OTHERS-RIGHT THUMB PRINT GAGED IN THISOCCUPATION� \ i Cori 0 t� 1 � r ` \ J i � ;sue 0 ` v N ` 3 : C o ro ^ h 00 } ~ 4 /Co.paqr �,- !-77777= ' 4 REBEL.' .ACRES _` = WEST BARNSTABLE, MASS•BIEL6M To - G ARL k AVA G. SA LO . $GALL i lmm-4o rr M^r 2ro 66 Application to giN NS+pP N -a GP PPP O fly tf�;l OPfM+NpP``�P�' Old Kings Highway Regional Historic District Corn 2 21993, ' in the Town of Barnstable for a NsrAeLE A CERTIFICATE OF APPROPRIATENESS Application is hereby made, id triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building 10Addition ❑ Alteration Indicate type of building: J�J House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign �-- 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ .Other �2� �� ��Ca�z� �u•[_.t�i�� (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY L_ DATE ADDRESS OF PROPOSED WORK 2C/�" l2f L9 (3-12!�r/Yt��� ASSESSORS MAP NO. OWNER , ASSESSORS LOT NO. HOME ADDRESS AIL TEL. NO. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). , AGENT OR CONTRACTOR /� TEL. NO. ADDRESS DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). Owner-Contractor-Agent Space below line for Committee use. Received by H.D.C. Date The Certificate is her by ate nl I D I ULU V LL 0 By Approved ❑ IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ r o Pr 44�� w EiE� I l v • Town of Barnstable Planning Division - Staff Report Appeal 2001-113—Robert&Kathleen Pierce Special Permit - Section 3-1.1(3)(D) - Family Apartment Date: September 28, 2001 To: Zoning Board of Appeals Art Traczyk,Principal Planner Petitioner: Robert J.Pierce and Kathleen M.Pierce Property Address: 2026 Main Street West Barnstable,MA Assessor's Map/Parcel: Map 217,Parcel 018 Zoning: Residential F Zoning District AP-Aquifer Protection Overlay District RPOD-Resource Protection Overlay District Filed:July 19,2001 Hearing:October 03,2001 Copy of Public Notice: Robert J.Pierce and Kathleen M.Pierce have applied for a Family Apartment Special Permit in accordance with Section 3-1.1(3)(D)of the Zoning Ordinance. The property is show on Assessors Map 217,Parcel 018,addressed 2026 Main Street West Barnstable,MA in a Residential F Zoning District. Background &Review: The application before the Board in Appeal 2001-113 is for a special permit family apartment in accordance with Section 3-1.1(3)(D) of the Zoning Ordinance. According to the Assessor's record Kathleen M. Pierce owns the property. It is a 0.76-acre lot developed with a two-story 2,802 sq.ft. three- bedroom single-family dwelling. The property is served by private well water and on-site septic. According to the records,the dwelling was built in 1935. It appears the lot is a pre-existing non- conforming lot'. The structures located on the property meets required setbacks. The applicants are proposing a 24 by 40-foot, 1.5-story family apartment unit as an addition to the existing dwelling unit. The total area of the apartment unit is to be 1,298 sq.ft. No interior plan for the layout of the unit was submitted. According to a proposed site plan the addition will conform to the required setbacks for the district. The applicant/owner have identified themselves as proposed residents of family apartment unit. The future occupants of the dwelling have not been identified. Paragraph g of Section 3-1.1(3)(D) reads "The family apartment is occupied by members of the property owner's family only." It appears that there may be some extenuating circumstances that are driving this application. The applicant should be prepared to document those circumstances and identify who will occupy the principal t Note-Lot is deficent in area and in frontage. Planning Division-Staff Report dwelling unit. An interior layout of the proposed family apartment unit should also be submitted for the record. Special Permit Findings: In addition to meeting all of the provisions of Section 3-1.1(3)(D),the granting of a Special Permit requires the following finding of facts to be made by the Board: • that the application falls within a category specifically excepted in the ordinance for a grant of a Special Permit, • that after evaluation of all the evidence presented,the proposal fulfills the spirit and intent of the Zoning Ordinance and would not represent a substantial detriment to the public good or the neighborhood affected. Suggested Conditions:. If the Board should find to grant a permit, it may wish to consider the following conditions: 1. Development of the family-apartment unit shall be substantially in accordance with plans presented to the Board entitled: • "Plot Plan of Land situated at 2026 Main Street West Barnstable prepared for Robert &Kathleen Pierce" dated May 22, 2001 and drawn by Yankee Survey Consultants, and • "Pierce Family Apartment" building elevation drawing by David Gady. 2. Development shall comply with all requirements of the Old King's Highway Historic District Commission. 3. The family unit shall not exceed 1,290 sq.ft. 4. The property and apartment unit shall be maintained in full compliance with the requirements of Section 3-1.1(3)(D) Family Apartments. 5. The family apartment affidavit shall be filed annually with the Building Division. 6. The development shall conform to Tittle V requirements of the Board of Health, all applicable local and state building requirements. Copies: Petitioner/Applicant Attachments: 2 Planning Division-Staff Report Family Apartment Regulations Copy from Town of Barnstable Zoning Ordinance Section 3-1.1(3)(D) Family Apartment subject to the following: a) Not more than one(1)family apartment is provided. b) The family apartment is within or attached to an existing residential structure or within an existing building located on the same lot as said residential structure. c) The residential character of the area is retained as nearly as possible. d) The family apartment contains not more than fifty percent(50%)of the square footage of the existing residential structure if being proposed as an addition thereto. e) All setback requirements of the zoning district within which the family apartment is being located are complied with. f) The property owner resides on the same lot as the family apartment. g) The family apartment is occupied by members of the property owner's family only. h) The occupancy of the family apartment does not exceed two(2)family members at any one time. i) The family apartment is the primary year-round residence of the family member(s)residing therein. j) The family apartment will not be sublet or subleased by either the owner or family member(s)at any time. k) Scaled plans of any proposed remodeling or addition to accommodate the family apartment have been submitted by the property owner or his or her agent to the Building Commissioner and the Zoning Board of Appeals. 1) Prior to occupancy of the family apartment,affidavits reciting the names and family relationship among the parties seeking approval have been signed and shall be signed annually thereafter for the duration of such occupancy. m) Prior to occupancy of the family apartment,an occupancy permit shall be obtained from the Building Commissioner. n) No such occupancy permit shall be issued until the Building Commissioner has made a final inspection of the proposed family apartment. " o) Within,sixty(60)days from the date authorized family members vacate the family apartment,the owner or his or her agent shall remove any kitchen facilities in such unit and notify the Building Commissioner to inspect the premises. p) In addition to the provisions of Section 3-1.1(3)(D)(o)above, upon vacation of any family apartment,the premises shall be restored as nearly as possible to their state prior to the creation of such family apartment. 3 w Planning Division-Staff Report q) The Building Commissioner shall have the right to further inspect the premises upon which a family apartment has been vacated at least three(3)times per year for three(3)years consecutive from the time of such vacation. 4 TOWN OF BARNSTABLE 55 70^iAy-B�ar�-a��4p ea s Applicati for if, Special Permit Date Received { I ( For office use only: Town Clerk's Office: '1` J U L 10 2001 ii Appeal# Hearing Date AV " `I ( --- BARNSTABLE Decision Due ,R F APPFAi The undersigned hereby applies to the Zoning Bo� pears-forea pecial Permit for the development and maintenance of a Family Apartment in accordance with Section 3-1.1(3)(D)of the Zoning Ordinance, in the manner set forth below: Applicant Name: L4 T/(.t)c_�,,J M. �'JFf2GT , Phone: �74) Applicant Address: o� d �IIJ i-j Sj• ice✓- r��/f,,r/S/�3 L jy,0 Q /�� Property Location: SJtM/_ /J-s /J✓3��vF_ Property Owner. / T/Jl �/ M. /`l2Gs�% , Phone:(M)3 e�2-CP-/J Address of Owner. Ii n., r AS A rrVf If applicant differs from owner, state nature of interest. ,Assessor's Map/Parcel Number. 1-/7 4v? Zoning District. Number of Years.Owned: Groundwater Overlay District: The Family Apartment is to be developed: j ) within the existing single family structure -W as an addition to the existing single family structure [ ) in an existing accessory building [ ] other-please explain: The Family Apartment is to be occupied by the following family member(s): Name: 14)13h r -I - &/5;LZ� Relationship to Owner(s): s'CL,4- Name: /t-/• 2j a:Q;,r Relationship to Owner(s): Does the property have any existing Variance or Special Permit issued to it? Yes Permit No.: Existing Level of Development of the Property -Number of Buildings: Present Use(s): I..L;,J L� Existing Gross'Floor Area of the dwelling': y s�� sq. ft. ' 1 Existing Gross Square Footage is found on the Assessor's Field Card which can be obtained at the Town of Barnstable Assessor's Office,Town Hall. Application for a Family Apartment Special Permit-Page 2 Proposed Floor Area of the Family Apartment j a 9 k sq.-ft. Proposed Gross Floor.Area to be Added (if any):,P,.A VD sq. ft. Description of Construction Activity (if applicable): Attach additional sheet and plans if necessary Is the property located in a designated Historic District?...........:.......................................... Yes VJ No [ j If yes . DQ-Old King's Highway Regional Historic District Date Approved (if applicable) [ ]-Hyannis Main Street Waterfront Historic District Date Approved (if applicable) Is the building a designated Historic Landmark?.................................................................. Yes[ j No[�Q Is the property served by public Water?............:.................................................................. Yes[X] No[ ] Is the property on private septic?.........................:...........:..................................................... Yes UQ No[ I.- If yes, does the present on-site septic system meet Title V?..................................:Yes Dq No [ J The following information must be submitted.with.the application at the time of filing. ,Failure to do so may result in a denial of your request. • Three(3)copies of the completed application form and Family Apartment Affidavit,each with original signatures. • Three(3)copies of a certified:.property survey(plot plan)and one(1) reduced copy(8 1/2"x 1Il or 11"x 17")showing the dimensions of the land, all wetlands,water bodies, surrounding roadways and the location of the existing improvements on the'land. Three(3)copiies of a proposed layout plan for the family apartment with dimensions shown. Three(3)copies of a proposed site improvement plan and one(1) reduced copy (81/2"x 11"or 11." x . 17"), if applicable. The applicant may submit any additional supporting.documents to assist the Board in making its determination. Signature:. Date: 7 57_D/ Applicant's or Representative's Signature Representative's Phone: Address: Fax No.: Town of Barnstable Family Apartment Affidavit �IFh-CI1; , being on oath, depose and state as follows: 1. I reside at ,10 MA P1-J9 AAlYr,O&,F, that I have owned since AV(-•14 f and which is my domicile and principal residence. The property is shown on Barnstable Assessor's Map and Parcel ot/ /���. 2. On , the Zoning Board of Appeals, in Appeal No. , granted to me a Special Permit to develop and maintain a Family Apartment in accordance with Section 3-1.1(3)(D)of the Zoning Ordinance and in agreement.with the condition(s)of that Special Permit at the premises above. -3. The following members of my family will be the sole occupant(s)of the Family Apartment Unit: Name: /?N/'�f&, L PA-C-A 15 Relationship to owner. CC4L Name: P10Ajx , Relationship to owner. 5 1 I understand that the Family Apartment: * shall only be occupied by members of my family who are persons related to me by blood or by marriage, * shall be the primary year-round residence for the identified family members, * shall not be sublet or subleased to any other person(s), and * shall at all times;be:in compliance with all conditions of the Special Permit issued by the Zoning Board of Appeals, including plans and commitments made in the application and4pproved by the Board. This affidavit shall be filed annually with the Building Inspector's Office and if the unit shall be vacated by 'the above identified family members, I shall within 30 days notify the Building Inspector's Office of that and shall immediately proceed with the removal of the Family Apartment Unit In the event of the sale or transfer of ownership of the above property, I shall notify the Building Inspector's Office and shall surrender the Special Permit for this Family Apartment. Sworn to under the pains and penalties of perjury this day of Signature: _ Name: (Please Print) '� - , Phone: Mailing Address: oZoo26 �y � 5f Gu. �C�a.,.u�ale ! � rb2�l P The reason that we want to build an in-law apartment is to be near our daughter and her family so that we can offer them the support that they will need..We are the grandparents of a three-year-old severely developmentally delayed little girl. This little one will need extensive physical and occupational therapies. In addition she has a muscle disorder that interferes with her flexibility and with her expressive skills. Her future development is unclear at this time. Sara is a happy and wonderful bundle of energy and she requires near constant one on one attention to keep her safe. Since so much attention must be focused on Sara her six-year-old brother Jake also needs extra attention. It is our hope that our being in a family apartment will offer extra attention to the children and will provide our daughter and her family much needed relief In addition, because are all aware of how limiting long term Managed Health Care is we believe that by our downsizing and by our daughter and her husband purchasing our home that we will be better able to reach out with financial assistance as Sara's needs arise: .Thank you for your consideration in this matter. \' 6 h W1211 2000 00' -- 4q \ m �\ W2 1 5-5 \ t{5 - t1N0 \ W 2�m�00 2 Me ie r '~F ask'5 e s W f k 7 z�t��j114t+fy lfm�a�0 f 3 Y 50-2 111 Wn } U0o 6A AM IWIF,11 W►m si 9 210 \ !{ 1 2 tTv�{ \ e41 0 2 rlen{ 3G 7� W00 Wr a W216TfsS 1W216 119oS1 \ t240 Appeal #2001-11.3 N_ ... MAP 217 PARCEL 018 j.. W-` S-E ROBERT & KATHLEEN PIERCE s SOLE: P=200' West Barnstable *NOTE. Planimetd, lopography,and **NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimetria(man-made features)were interpreted from 1995 aerial photographs byThe lames aegemtion were mapp�to meet National of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD Map Accuracy standards at a scale of do not represent actual relationships to physical objects Corporation. Planimetric,topography,and vegetation were mapped to meet National Map Accuracy Standards V=100'. on the map. at a scale of 1"=1ff. Parcel lines were digitized from 2000 Town of Barnstable A-Wso(s tax maps. p:Unicrobeth\zoning\217-018.dgn 09/11/2001 09:09:28 AM Property Location: 2026 MAIN ST./RTE 6A(W.BARN.) "MAP ID: 217/018/ Vision ID: 15460 Other ID: Bldg#: 1 _ Card 1 of 1 Print Date:09/11/2001 10:*5 CURItEN, Ofi NER , . ,>WIT _O,PO. U7ILITIES S�TRT/RO�1p ;LOyCATCQN CUR1RL'NF74 ESSMEN�T � .r PIERCE,KATHLEEN M 1 Level Pas 1 Paved Description Code Appraised Value Assessed Value 026 Well S LAND 1010 63,400 63,4 MAIN STREET eptic S IDNTL 1010 130,800 130,800 80l BARNSTABLE,MA 02668 _ 1 D�y Barnstable 2001,MA .. i SII,PPL�ES,M,E=I�fJL., I�TI�. ,..�. Account# 133885 Plan Ref Tax Dist. 500 Land Cdf er.Prop. #SR Life Estate VS DL 1 LOT 1 Notes: 1 1 DL 2 I �'ON GIS ID Total 194,200 194, ,. REC®RDO F OWi�'ERSHIP - IGYOP.4GESAL$ �l>OUS,4SS?EtS'SNIEN�TrSHIS�OR;Y •' '�" PIERCE,KATHLEEN M 4670/260 08/15/1985 Q I 137,000 Yr. Code Assessed Value Yr. Code Assessed Value Yr. I Code I Assessed Value ALIMENO,KENNETH F ETAL 3411/267 Q 0 2000 1010 35,300 999 1010 35,300 998 1010 35,300 2000 1010 134,100 999.1010 134,100 998 1010 134,100 2000 1010 1,800 999 1010 1,800 998 1010 1,800 Milk. WIN% MP�TIONS„�3� ��,`��° " R-N 13 �� �O�THERA,SSESSMEN¥TS, This sl�natureacknowled acknowledges Total: 171200 Total 00 r� ' �" � ' ` I r g g sit by a Data Collector or Assessor Year T e/Descri tion Amount Code Description Number Amount 4 I Comm.4Int. APPRISED YrALl1ES1 0UY11 � Appraised Bldg.Value(Card) _ 125,700 Appraised XF(B)Value(Bldg) 5,100 TotalAppraised OB Value(Bldg) Appraised Land Value(Bldg) 63,400 Special Land Value Total Appraised Card Value 194,200 Total Appraised Parcel Value 194,200 Valuation Method: Cost/Market Valuation -, e to A a a ..� Mom• ,„ B.._,.�' ;.. _;r .._'e-...� 1 -"3 FY `"' #;.,"" . -� U-al p t T pr 'atse d Parcel V I ue 194,200 RE CommPermit 4 Issue Date T e Description Amount Ins .Date %Com . Date Com . Comments Date ID Cd. Pus ose/Result B36194 9/1/1993 AD 9,300 1/15/1994 100 B ADDIT' 4/25/2000 PT 00 eas/Listed x�� � 3 `�"��. �-�,,� .. � �,:. : a �" �' �'1.h�• L�Il� dAL�UA ION ON c ,: B# Use Code Description Zone D ronta a Depth Units Unit Price' I.FacTOO C.Factor Nbad. Ad'. Notes-AdYS ecidl Pricin Ad Unit Price Land Value 1 1010 Ingle Fam RF 5 1 0.76 AC 116,000.00 1 1.00 88AB 0.72 PCL(.76,U10)Notes:10 1BLD 83,368.09 63,400 x - Total Card Land Units 0.76 AC Parce[Total Land Area: 0.76 AC Total Land Valu _ 63,400 Property Location: 2026 MAIN ST./RTE 6A(W.BARN.) 1& 217/018// Vision ID:15460 Other M: Bldg#: 1 Card 1 of 1 Print Date: 09/11/2001 10 ... COYNS7R!- CTIQN "; �9ILF r. 1a: Element Cd. Ch. Description Commercial Data Elements Style/Type 6 Conventional.- Element, Cd. Ch. Description odel 1 Residential Heat&.AC BAS 20 WDK 20 rade Average Grade Frame Type Baths/Plumbing 10 10 11 Stories Z 2 Stories 20 4- Occupancy 0 CeilingfWall 20 ooms/Prtns, 24 Exterior Wall 1 14 Wood Shingle /o Common Wall 1 2 Wall Height Roof Structure 3 able/Mp Roof Cover 3 sph/F GIs/Cmp 20 HOME D�T9 HS 20 28 InteriorBAS Wall 1 3 Plastered Element ode Description actor 2 MT nterior Floor 1 9Pine/Soft Wood Complex 2 Floor Adj Unit Location Heating Fuel 03 Gas Heating Type 05 Hot Water a umber of Units C Type 01 None Number of Levels 6 3 /o Ownership Bedrooms 03 3 Bedrooms Bathrooms, Bathrooms '_ C4S�1%MAItIfl ,'YLl1A�7,.'On'. '" rr' 0 2 Full Total Rooms 7 7 Rooms nadj.Base Rate 60.00 ' Size Adj.Factor 0.92962 Bath Type Grade(Q)Index 0.92 28 Kitchen Style BAS 24 Adj.Base Rate 51:32 BMT Bldg.Value New 157,142 24 Year Built'.' 1935, ff.Year Built (G)1980 rml Physcl Depi 20 uncnlObslnc 0 � �; � MLYEDUSE , conObslnc 0 pecl.Cond.Code 1010 Single Fam 100 Specl,Cond �verall%Cond. 80 eprec.Bldg Value r3O7TB�U1LDING&,.Y1VlS(LJ��° B�IrGXfiE22 ;5 ) : Code Descri "tion LIB Units Unit Price Yr. D Rt %Cnd Apr. Value FPL2 irepl-1/2Sty B 2 3,200.00'1980 1 100 5,100 Code Description Living Area Gross Area E .Area Unit Cost Unde rec. Value BAS First Floor 2,096 2,096 2,096 51.32 107,567 BMT Basement Area 0 1,200 240 10:26 12,317 FHS Half Story 706 1,008 706 35.94: 36,232 WDK Wood Deck 0 200 20 ' 5.13 1,026 N Gros iv ea e r a 2 802 4.5041 3 062 d 157 142 A.M. 217/19WB - MHB MIIB PLAN REF 121/55 ZONING. "RF" BARN ASSESSORS MAP 217 320.25 R.P.O.D.: 2 ACRE jV03°56006"W FLOOD .ZONE- "C" •tea ' � •- - 80.6 tV 3B.5' 8.0' a 0 o,,,, SEPTIC IN '-• �9' FRONT _3s.__---, 30.0 -- -- - 'r ,"15.8 HOUSE,,,,,,,,•+� PER OWNER a' Cb 1 PROPOSED goo cn 4 p'':%::::::=# ooq;;::::::: tt ,,,,,,,,,,,,,,,.,,.%%, %8 I o � POOL 10 110.7' Cp -- --- ' SCREECHD �-,c� ;.� iv O POR ,. 20' A.M. 2171.18 ZZ 1 ..,, 40.0' 99';;;;� ; AREA=32,671E S.F. t 1 uv PROPOSED N tv o, io ADDITION o 0 �. tv w O 1 - O 40.0' 24.3' 00 150.00 , %%% IP 185:12 1V03 59 40 �' �o � E A.M. 217/54 PLOT PLAN OF LAND LOCUS MAP " MAG GIE LANE SITUATED AT 20 I CERTIFY THAT THIS SURVEY AND PLAN WERE Ic 26 MA IN STREET WEST BARNSTABLE `� IN ACCORDANCE. WITH THE PROCEDURAL AND TECHCHNI:^AL STANDARDS NYJR THE PRACTICE OF LAND SURVEYING IN T�lr7—�m �AR��� TOMMONWEALTH OF MASSACHUSETTS WEST ABLE A�� Z� PREPARED FOR. PA A MERITHEW, P.L S. DAT BAY COLONY RR ROBERT & KA THLEEN Pam` �� PIE] U—.-s A. �, , 43 M S a y MAY 22, 2001 y O. xz `��� �'�� � `�°° YANKE.E' SURVEY CONSULTANTS g�6N LOCUS GRAPHIC SCALE LTANTS l� 30 UNIT 1, 40 INDUSTRY ROAD - p 15 30 60 120 P. 0. BOX 265 MARSTONS MILLS, MASS 02648 �. ( IN FEET ) TFY.• 428-0055 FAX 420-5553 1 inch 30 ft. 1 J# 5,2728 CM : .. i iC .. n _ "r • r _ : W . , • w , : ' r - 7'' i I i _ I , _ r I _ ; Y� \\ t , : : • . . . _.. : �J 1 : i b : i _ : , __ . . : 1 , 1 : : Assessor's office(1st Floor): Assessor's map and lot numbs - SEPTIC SYS IT' E Conservation(4th Floor): —9' r - INSTALLEDi E Board of Health(3rd floor): y WIT" Sewage Permit number ENNtRCiNM Engineering Department(3rd floor): : ^®� f� TOWN REG House number oL Definitive Plan Approved by Planning Board APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE SUILDIAG INSPECTOR APPLICATION FOR PERMIT TO I�TYPE OF CONSTRUCTION + S e,,o+ a`f 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �20 A& 2rt= �ot�4. Gt d�ctvr�5 -l�le, Proposed Use po O"VK Zoning District Fire District w Re,V.t"4e,6le, Name of Owner `e-1rG,L, Address 2 d)ZA, 72.-f- 4,� i Name of Builder ya'-V lt, Address i f Tawb�— Lam Wl,G1,((t Name of Architect " ' ` Address Number of Rooms D n!12 Foundation Exterior 0-- •S G----!dt* (e- Roofing A5,0 Ana l+ Floors Interior Heating ��� ��-{� Plumbing �'it1rAA¢y' Fireplace Approximate Cost o D • tso Area 74o 3 z S pB Diagram of Lot and Building with Dimensions D, 0 4 Fee d o //. 0 � 16,0 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name �.��s✓ Construction Si ipervisor's License PIERCE, BOB & KATHY i R10 36194 permit For ADD TO DWELLING j — Single Family Dwelling Location 2026 Route 6A 4` - n West BarnstahlL- s --R Owner" Bob & Kathy Pierce ` Type of Construction Frame -• - Plot Lot ` � Permit Granted September 2'4,19r 93 - Date of Inspection: v 1 Frame 1'g - a a Insulation Fireplace 19 Date Completed �o 19 e 0 "T,d •� 71• 0 Y a i r 1 5 • Y I � t Town of Barnstable CF THE Tp� do Building Department Services Brian Florence, CBO * tARNSPABLE. v4� MASS. ��$ Building Commissioner ArED MA'S A 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: My name is // I am the owner/resident of the property located at: o)oa-40 M0_4�L GJCcSf �G�nS �rd��-f ��9 OdGlo P The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: Name &relationship to owner: lever The Family Apartment will be the primary year-round residence for the-above-identifiedq family members. In the event that the listed relatives vacate said apartment, Lwill immediately e note the Building Commissioner in writing. I understand that no subletting orjvbleasing'of.said? Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building v- o Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that 1 am required to comply with all conditions imposed by the ZBA Special Permit �—� and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I*ee w to notify the Building Commissioner immediately in the event of the sale of this property. rn If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this /3 day of „ 2019. T)t-�(I �L -,?3I y Signature Phone Number Print Name q:forms/famaffid.doc rev 11/08/13 Town of Barnstable Building Department oFt►+e rq�� Brian Florence, CBO c* Building Commissioner BARNSfABLE, : 200 Main Street,Hyannis, MA 02601 y MAss. s63q. �0 www.town.barnstable.ma.us �AjFD MA'S a -Yvo-ov2-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is I n6 I am the owner/resident of the property located at: jilt S C�G l�S 6�-e /►'I�' O�-li t`o n The following members of my family will be the sole occupants of the Family Apattment at die aforementioned address: N Name &relationship to owner: #k_z 1 /91 P/C- `/YID AA?� `rn/1G Name &relationship to owner: i';i-el— The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ). Other Sworn to under the pains and penalties of perjury this ) 7 day of 2018. Signature Phone Number Print Name a"-)eXza q:forms/famaffid.do c rev 11/08/12 Town of Barnstable Regulatory Services Richard V. Scali,Director Building Division BMWSTABM MAM Paul Roma,Building Commissioner 039. 200 Main Street, Hyannis,MA 02601 www.town.ba rnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of.Barnstable Family Apartment Affidavit I,being on oath, depose an/d state as follows: My name is 'I 6 t 06 Ile I am the owner/resident of the property located at: Ma✓ s �- The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: rn Ig*me &-'relation hip to owner: ¢ rn lime &relatio hip to owner: a i f2�.t— �l �"� h?D Cl- co T -Family Apartment will be the primary year-round residence for the above-identified o family me Tiers. In the event that the listed relatives vacate said apartment, I will immediately 2!! notes the RI-ilding Commissioner in writing. I understand that no subletting or subleasing of said o Family Apartment is permitted. t— C I understand that I am required to file an Affidavit annually with the Building: Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred.to the Amnesty Program(Appeal No. ) Other Sworn to under the pains and penalties of perjury this day of Vany 2017. -��a- 33 y Signature Phone Number Print Name l��l l t �dne�► e q:forms/famaffid.doc rev 11/08/12 Town of Barnstable Regulatory Services oFti� Richard V. Scali, Director Building Division BAMSTBM MASS. Thomas Perry, CBO,Building Commissioner ` o ArEo039.�a 200 Main Street, Hyannis,MA 02601 ZE w www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790 N�30 cam= � rr Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state.as follows: /�My name is ' Qn ae AA 1 I am the owner/resident of the property located at: 0 d(o �' The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: �ze°e- �- Name &relationship to owner: The Family Apartment will be-the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notes the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment,is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to under the pains and penalties of perjury this /0 day of 2016. Signature j/ Phone Number Print Name /� �i, Do i-e_ q:forms/famaffid.doc rev 11/08/12 Town of Barnstable Regulatory Services Richard V. Scali,Director TOWN OF BAIRNSTABLE Building Division ;,�i� , N _7 PM 12: 13) �t6p�0 Thomas Perry,CBO,Building Commissioner �' 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us DIVISION Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I,being on oath,depose andstate as follows: My name is ��-//1 ���� I am the owner/resident of the property located at: 016 a, O 17�1) The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name&relationship to'owner: ?dh_ev f �C-� Name&relationship to owner: k4hleQ._ Af�i�-C The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notes the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to under the pains and penalties of perjury this__day of 2015. a - 3 .3 Signature. Phone Number Print Name �1ell, ,o q:forms/famaffid.doc rev 11/08/11 Town of Barnstable Regulatory Services �oFTMEtw,ti� Richard V. Scali,Interim Director TO�e�N ®� 6ARNSTABk..0 Building Division Thomas Perry, CBO,Building Commiss�} er , 9`ber i63� 0. 200 Main Street, Hyannis, MA 02601�� `�AN �` �`� ' o FO MA'S www.town.barnstable.ma.us Office: 508-862-4038 � V��t 'FaX 508!-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is (7 �O�l - I am the owner/resident of the property located at: The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: ?6J/ /-,/1 el-6-- Name &relationship to owner: A?k Ae-pi 11041 L2_ — 177,:5-A� The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notes the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notes the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this /J�_ day of G v 2014. Signature Phone Number Print Name 00/??f q:forms/famaffid.doc rev 11/08/11 r t � ,i� t 1 � t ... { t �, I t f r i Town of Barnstable Regulatory Services of Thomas F..Geiler,Director Building Division TOWN OF BARNSTABLE ILAMSUBM Thomas Perry, CBO,Building Commissioner 200 Main Street, .Hyannis, MA 026ffl jAN 15 A,i 11• 30 Ep q�p2l www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 DIVISION Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is � O0.4 Gh:W I am the owner/resident of the property located*at: doj,& The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: -« — A4VU/ Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to under the pains and penalties of perjury this /02. day of 2013. a- �3y Signature Phone Number Print Name ! J q:forms/famaffid.do c rev 11/08/11 Town of Barnstable Regulatory Services Thomas F. Geiler, Direct Building Division r & 11N OF BARNSTABLE IIALMSTM IX ' Thomas Perry, CBO, Building CoriimissioueD -'Al'xr f .N 12: 23 po 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is �/i j (f/1 G' � I am the owner/resident of the property located at: The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: AMe.,— Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit andlor the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this�_ day of 2012. 6 d 3 3IV Signature Phone Number Print Name q:forms/famaffid.doc rev 11/08/11 ' i Town of Barnstable Regulatory Services oFt"e Thomas F. Geiler, Director,','°a b',;_ Building Division s MAS&�e Thomas Per CBO, Building Commissioner, "y 9: 13 Mass �+, Perry, g A i639. 200 Main Street, Hyannis, MA 02601 tEp Mp.�A www.town.ba rnsta ble.m a.us Office: 508-862-4038 - Fax: 508-790-6230 Town of Barnstable, Family Apartment Affidavit I, being on oath, depose and state as follows: l My name is I am the owner/resident of the property located at: MGG/.Z, /I- dd L �. The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: / ^ Name & relationship to owner: Name & relationship to owner: -1�2/' The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, 1 will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. 1 also understand that 1 am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. 1 agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this day of 2011. Signature Phone Number Print Name el% n ' Town of Barnstable Regulatory Services pF1H8 rqy� Thomas F.Geiler,Director TO 11H 0- fi U. Building Division MUMSTAaLs, Tom Perry, Building Commissioner ,.,., �, u n•n MASv 03 �� 200 Main Street,Hyannis,MA 02601 2' 21 0 ��fo www.town.barnstable.ma.us LJI V S 01 Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is �' 00 ')e I am the owner/resident of the property located at: o)661(o The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: Name & relationship to owner: �- The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. 1 understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.] Family Apartments. 1 agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this day of J_�L4qd 2010. -3 319 Signature Phone Number Print Name Q/bldg/forms/famaffid Rev:12/08 ft Town of Barnstable Regulatory.Services oFVe tor._ Thomas F.Geiler,Director Building Division �' �' BAR16TASLE * saxxs-rnsre. Tom Perry, Building Commissioner rrp 9� r . ,0$ 200 Main Street, Hyannis, MA 02601Y `�� 15 ` 44 , ATFO Mp l A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name•is Af& I am the owner/resident of the property located at: 20 a f The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: Q74 1 Name & relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that 1 am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. 1 also understand that 1 am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. 1 agree to notify the Building Commissioner immediately in*the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this /Q day of gnu 2009. AdI6 W A//_�zj/� Signature Phone Number Print Name P A a 461 Q/bldg/forms/famafd Rev:12/08 Town of Barnstable Regulatory Services pFIME goy, Thomas F.Geiler,Director Building Division l p�'dP� `�� BARNS I.Al�LE BARNSfABLE, ` Tom Perry, Building Commissioner gg�J p@y p y MASS. g 2Q00Qg JAN 16 {lt1 U 039' .0 200 Main Street,Hyannis,MA 02601 �pTFv �a www.town.barnstable.ma.us DIVISION Office: 508-862-4038 Fax: 508-790-6230 I Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is &ne-`l'.e4s I am the owner/resident of the property located at: a0 a.(o n S-kee_4- The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: XCW-Ale?ii f �P�c-� ' /Y)y�'�ie/ Name & relationship to owner: to,P/'C-e- — 4—Ael— The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. 1 understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. 1 agree to notify the Building Commissioner immediately in the event of'the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this day.of J6, 2008. A/JJ' 5a - a -3,3 y 9 Signature Phone Number Print Name Af Q/b IdVforms/famaffid Rev:1/03 ITown of Barnstable Regulatory Services OFINE r Thomas F.Geiler,Director Building Division 0�,� ,, •;: ;rwito5i�8LE r a BARNSTABLE, ' Tom Perry, Building Commissioner MASS. 9�A a639• 10� 200 Main Street,Hyannis,MA 026017o l JAN 24 PH 2: 26 rFD .�p www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is I am the owner/resident of the property located at: i 1 -e5-L `367,91S `' _ / 0oZtJ�o 8' The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: Name &relationship to owner:-- QOL�-e-r-l / — i`rLi►�- The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. .I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. 1 also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this db� day of 2007. - -33 'Signature Phone Number Print Name D Q/bldg/forms/famaffid Rev:1/03 Town of Barnstable C Regulatory Services �pVAE lq Thomas F.Geiler,Director N O BARN5i:ABLE Building Division RAMSTA13M • Tom Perry, Building Commissioner MAW�b g 2006 JAN 18 PH 1: 41 1639• ,� 200 Main Street,Hyannis,MA 02601 ATE pr a www.town.barnstable.ma.us DIVISION Office: 508-862-403 8 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is r1e- I am the owner/resident of the property located at: eau A, A Siy: p + ( de 54-- Ba(nAb/C Map and Parcel Number o2 I b g The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: gc%er Name &relationship to owner: V'A"�U r' EVI4 MD 4-he The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, 1 will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. 1 also understand that 1 am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this /3 day of o_jue�U 2006. 36 c ." / 9 , Signature. : : Phone Number Print Name Ael IDOne k e Q/bldg/forms/famaflid Rev:1/03 Town of Barnstable Regulatory Services pF'THE�0 Thomas F. Geiler,Director i0et4�1 U O, tZtiS It�BLE Building Division 23 BA WABLE. ' Tom Perry, Building Commissioner 2005 ,UL `fi 039. ,0� 200 Main Street,Hyannis,MA 02601 lFnr a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is I am the caner esident of the property located at: 14 O,A el;n S JLUf � S ��sv►5 51 L f/�!9 Oab&g Map and Parcel Number P)e-p a 1-7 The decision of the Zoning Board of Appeals has been recorded with the Registry of Deeds in Barnstable County: Book icy 0 3 Page /3 V The following members of my family will be the'sole occupants of the'Farn-ify Apartment at'ihe aforementioned address: Name & relationship to owner: ed he'l`CK Name & relationship to owner: 17Gt A lee vl_ � �e_ �mo��e� The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, 1 will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA in the Appeal No. identified above. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this 9 day of TLj/7-e 2005. 3&a ?JY 7 Signature Phone Number Print Name Aell Q/b1dg/forms/famaffid2 Rev:1/03 i Ft ram, Town of Barnstable Regulatory Services BAM� sABM Thomas F. Geiler, Director �AlFO MAC A,0 Building Division Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 June 27, 2005 Kelli Donehey 2026 Main Street West Barnstable, MA 02668 Re: Family Apartment 2026 Main Street, West Barnstable Dear Ms.Donehey: Enclosed is the Family Apartment Affidavit for you to complete and return. We will be sending you this form every year. I'm so glad that you were able to record the family apartment decision and get your Certificate of Occupancy. Sincerely, Lois Barry Division Assistant Enclosure i Town of Barnstable Zoning Board of Appeals t .i\ M;t Decision and Notice `•'`' `,.`.. �.;'l; Appeal 2001-113 -.i'! "; - 'j : 5 6 Robert & Kathleen Pierce Special Permit ,- Section 3-1.1(3)(D) - Family Apartment Summary: Granted with Conditions Petitioner: Robert J.Pierce and Kathleen M.Pierce Property Address: 2026 Main Street West Barnstable,MA Assessor's Map/Parcel: Map 217,Parcel 018 Zoning: Residential F,Aquifer Protection Overlay and Resource Protection Overlay Districts Background &Review:. Appeal 2001-113 is an application fora special permit family apartment in accordance with Section 3- 1.1(3)(D)of the Zoning Ordinance. According to the Assessor's record Kathleen.M.Pierce owns the property. It is a 0.76-acre lot developed with a two-story 2,802 sq.ft.three-bedroom single-family dwelling. The property is served by private well water and on septic. According to the records,the dwelling was built in 1935. The lot is a pre-existing non-conforming lot in respect to area,and the structures located on the property meet required setbacks. The applicants are proposing.a 24 by 40-foot, 1.5-story family apartment.unit as an addition to the existing dwelling. The total area of the apartment unit is to be 1,298 sq.ft: According to a proposed site plan the addition will conform to the required setbacks for the district. Procedural&Hearing Summary: This appeal was filed at the Town Clerk's Office and at the Office of the Zoning Board of Appeals on July 19, 2001. An extension of time for holding the hearing and for filing of the decision was executed between the applicants and the Board. A public hearing before the Zoning Board of Appeals was duly advertised and notice sent to all abutters in accordance with MGL Chapter 40A. The hearing was opened October 03,2001, at which time the Board granted the special permit for the family apartment with conditions. Board Members deciding this appeal were Daniel M. Creedon, Thomas A. DeRiemer, Jeremy Gilmore, Randolph Childs and Vice Chairman, Gail Nightingale. The applicants Robert-and Kathleen Pierce represented themselves before.the board. The explained that.they intended to sell the property to their daughter and son-in-law who will occupy the single family dwelling. The applicants will move into and occupy the accessory family apartment unit. The situation was precipitated by the special care needed for their .grandchild. An interior plan for the layout of the unit was submitted to the file. The applicants noted that they had read and understood all the condition for.the issuance of the special permit and would abide by all of those conditions. The public was invited to speak and no one spoke in favor or in opposition to this appeal. Findings of Fact: At the hearing of October 03, 2001,the Board unanimously found the following findings of fact:. 1. The applicants in Appeal 2001-113'are Robert J. Pierce and Kathleen M. Pierce,who reside at 2026 Main Street West Barnstable,MA in a Residential F Zoning District. The parcel is shown on Assessors Map 217 as Parcel 018. 2. They have applied for a Family Apartment Special Permit in accordance with Section 3-1.1(3)(D)of the Zoning Ordinance. The applicants who presently reside there own the property. They will be the occupants of the family unit and their daughter and son-in-law will own and reside in the single—family dwelling. i 3. The total area of the apartment unit is to be 1,298 sq.ft. That is less than 50%of the size of the existing dwelling of 2,802 sq.ft. 4. The lot is 0.76-acres in size and the existing and proposed structure meets the required setbacks for the district. 5. The applicants have indicated that they have read and understand the condition imposed in the issuance of a family'apartment permit and have agreed to abide by those conditions. 6. The application falls within a category specifically excepted in the ordinance for a grant of a Special Permit and after evaluation of the evidence presented,the proposal fulfills the spirit and intent of the Zoning Ordinance and would not represent a substantial detriment to the public good or the neighborhood affected. Decision: Based on the findings of fact,a motion was duly made and seconded to grant the family apartment permit subject to the following conditions: 1. All-construction shall be in accordance with plans presented to the Board today and initialed by Mr. Daniel Creedon and identified with today's date of 10/3/01, including plans entitled Pierce Addition. 2. Development shall comply with all requirements of the Old King's Highway Historic District Commission. 3. The family unit shall not exceed 1,298 sq.ft. 4. The property and apartment unit shall be maintained in full compliance with the requirements of Section 3-1.1(3)(D)Family Apartments. 5. The family apartment affidavit shall be filed annually with the Building Division. 6. The development shall conform to Title V requirements of the Board of Health,all applicable local and state building requirements. The vote was as follows: AYE: Daniel M. Creedon, Thomas A. DeRiemer, Jeremy Gilmore,Randolph Childs and Vice Chairman, Gail Nightingale NAY: None Ordered: Special permit 2001-113 has been granted with conditions. This decision must be recorded at the Registry of Deeds for it to be in effect. The relief authorized by this decision must be exercised in one year. Appeals of this decision, if any,shall be made pursuant to MGL Chapter 40A, Section)7,within twenty(20) da s after the da e of the filin of this decision. A copy of which must be filed 'n the office of the Town Clerk. b p it Nighti le, Vice hairman Date Si ned I Linda Hutchenrider, Clerk of the Town of Barnstable, Barnstable County,Massachusetts,hereby certify that twenty(20)days have elapsed since the Zoning Board of Appeals filed this decision and that no appeal of the. decision has been filed in the office of the Town Clerk. Signed and sealed this ( �'day of , fperjury,...,p pe ,o Linda Hutchenrider,Town Clerk • f 2