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FORM3o HOBBS&WARREN,INC. THE COMMONWEALTH OF MASSACHUSETTS
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Address .T T� ccupan J ,
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Floor Apartment No. No.of Occupa is 1 J�
No.of Habitable Rooms No.Sleeping Rooms
No.dwelling or rooming units No.Stogy
Name and address of owner cJ► W/ �11
c31 / Remarks Rp. Vlo.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers: '"
Drainage ,
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs,Porches:
Dual Egress:and 0 st'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof nIstb
Gutters, Drains:
Walls:
Kit) IN's' 'POUT11�11—
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness: ,
Stairs:
Lighting:
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall Floor Wall Ceilin
Hall Lighting:
Hall Windows: '`
HEATING Chimneys:
Central ❑Y G N' Equip. Repair _ �-
TYPE: Stacks,Flues,Vents: Ybl ADO
PLUMBING: Supply Line:
❑ MS ❑ST ❑ P Waste Line:
H. !ty and Vent(s)'
ELECTRICAL Panels,Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen.Cond. Distrib. Box:
Gen.Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Wails Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom j ;
Pantry
Den - e ,.. . . ,.•. y_ <,.. •r
Living Room
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facll. Sup.Ten.,Gas,Oil,Elect.:-
Stacks,Flues,Vents,Safeties: -
Kitchen Facilities Sink `4
Stove
Bathing,Toilet Facil. -Vent.,Plumb.,Sanit'n.:
Wash Basin,Shower or Tub:
Infestation Rats, Mice, Roaches or Oth ,r
Egress Dual and Obst'n:
General Building Posted
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED I N WHICH f
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL—BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF.,THE CODE`OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION REPO S SIGNED AND CERTIFIED UNDER THE PAINS D
PENAL F PERJURY q
INSPECTOR ITL
DATE TIME";````'"` t r<;� � .�:-. ..��•P. t:
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
e' a '
F
TOWN OF BARNSTABLE a
SAFETY AND �•. `�
OF HEALTH SAF ,
DEPARTMENT ,
ENVIRONMENTAL,SERVICES
BUILDING DIVISION k
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STOW CVO""K F
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THIS STKUCTURE ANDIOR PREMISES HAS BEEN „+
INSPECTED AND THE FOLLOWING VIOLATIONS z ,
OF THE BUILDING CODE aND/OR ZONING
ORDINANCE HAVE BEEN FOUND:
--
„ AMA 1
2) i
p a 3)
i)
YOU ARE HEREBY NOTIFIED THAT
NO ADDITIONAL WORK SHALL.BE UNDERTAKEN
a UPON THESE PREMISES,OR THE PREMISES
r = OCCUPIED UNTIL THE ABOVE VIOLATIONS
' ARE CORRECTED.
ANY PERSON REMOVINGTH'S NOTICE WITHOUT
PROPER AUTHORIZATION SHALL BE LIABLE
TO A FINE OF NOT LESS THAN FIFTY,NOR '
MORE THAN ONE HUNT:RED DOLLARS.
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Date
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Barnstable Assessing Search Results Page 1 of 2
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Home: Departments:Assessors Division: Property Assessment Search Results 2 l�
New Search
9 ALDEN WAY
Owner: 2006 Assessed
Values:
DILSIZIAN, BEDROS H&ANI R Appraised Value Assessed Value
Map/Parcel/Parcel Extension Building Value: $64,800 $64,800
307 /259/ Extra Features: $0 $0
Outbuildings: $0 $0
Mailing Address Land Value: $ 177,800 $ 177,800
DILSIZIAN, BEDROS H&ANI R
%LEEDY,.KATHLEEN R Totals $242,600 $242,600
1377 CHOXES CHASE WEST
GREEN CASTLE, PA. 17225
_ I
Tax Information:
Tax information is currently not available for 2006
1 C 9 try
Construction Details at) �ST- k
Property Sketch Legend
Building told
Building value $64,800 Interior Floors Carpet U (I
Chu-
Style : Cottage Interior Walls Drywall Y
Model Residential Heat Fuel Gas
Grade Average Minus Heat Type Hot Air
Stories 1 Story AC Type None
Exterior Walls Wood Shingle Bedrooms 2 Bedrooms
Roof Structure Gable/Hip Bathrooms 2 Full fr.
f„
Roof Cover . Asph/F GIs/Cmp living area 678 ,iN� � 1�:
t r a flt a xo}^,:yr
t, t i a .t ra rr i
�i Y t3 p4g 9 4
Replacement Cost .$80952 Year Built 1939
Depreciation 20 Total Rooms 4 Rooms
Land
M Lot Size(Acres) 0.1
Map requires Plug in:
htti)://www.town.bamstable.ma.us/assessing/assessO6/displayparce106.asp?mapparback=pa... 3/28/2006
Barnstable Assessing Search Results Page 2 of 2
Appraised Value $ 177,800 Interactive Property Map:
I have visited the maps before
Assessed Value $ 177,800 Show Me The Map rxq
April 2001 photos available
Sales History:
Owner: Sale Date Book/Page: Sale Price:
DILSIZIAN, BEDROS H &ANI R Apr 15 1985 12:OOAM C101147 $54,500
FOX, ROBERTA Feb 15 1984 12:OOAM C95404 $36,500
SHEPPARD, PHILLIP A Jul 15 1981 12:OOAM C86237 $33,000
Extra Building Features
Code Description Units/SQ ft Appraised Value Assessed Value
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 UST Utility Area(Unfinished)
(Finished)
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/assessing/assess06/displayparce106.asp?mapparback=pa... 3/28/2006
y
OFTME tp� Town of Barnstable
P` ti Regulatory Services (g '
Thomas F.Geiler,Director v
" BARMSTABM Building Division
y MAM.
1639. Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: .508-862-4038 Fax: 508-790-6230
March 31, 2006 `
Kathleen Leedy
1377 Choxes Chase West
Green Castle,Pa 17225
Re: Illegal Apartment
Property ID: Map 307-Parcel 259 .
Locus: 9 Alden Way,Hyannis
Dear Ms Leedy:
A recent review of our records,including the permitting history and the Zoning Board of Appeals
records,indicates that the present use of your property located at 9 Alden Way, Hyannis is
limited to that of a single-family home; any other use is illegal.
Be aware that it has been reported to this office that this property has been divided into two
complete independent living units containing one bedroom each. Our files do not contain
evidence of any permits for this alleged work nor as stated above,has any zoning relief been
-.-._— granted-to allow a use other than a single-family. You are advised to take immediate action to
restore the property to a single-family home. A building permit is required in order to
reconfigure the subject space to its original use,including the complete removal of the kitchen in
the accessory unit. In the event that this information is not correct,please make arrangements
with me to inspect the premises accordingly.
It is my understanding that you are now working with Local Inspector Jeff Lauzon to resolve the
stop-work order issued for the un-permitted construction of a second story.Your.intentions with
regards to this addition must be declared for the record. Please contact me at your earliest
convenience to discuss these matters. Be assured that your failure to contact me or otherwise
comply with this notice will result in a$200.00 fine and possibly criminal action. I must hear
from you by April 7,2006 to confirm your intention. You may reach me directly at 508-862-
4027.
cerely,
kb
Robin C. Giangregono
Zoning Enforcement Officer
J:\Illegal Apartments\9 Alden Way 1.DOC
Certified mail 7005 1820 0004 6479 2050
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Barnstable Assessing Search.Results Page 1 of 2
Home: Departments:Assessors Division: Property Assessment Search Results
New Search
9 AL DEN WAY
Owner: 2006 Assessed
Values:
DILSIZIAN, BEDROS H &ANI R Appraised Value Assessed Value
Map/Parcel/Parcel Extension Building Value: $64,800 $64,800
307 /259/ Extra Features: $0 $0
Outbuildings: $0 $0
Mailing Address Land Value: $ 177,800 $ 177,800
DILSIZIAN, BEDROS H &ANI R
%oLEEDY, KATHLEEN R Totals $242,600 $242,600
1377 CHOXES CHASE WEST
GREEN CASTLE;PA. 17225
Tax Information:
Tax information is currently not available for 2006
Construction Details
Property Sketch Legend
Building
Building value $64,800 Interior Floors Carpet
Style Cottage Interior Walls Drywall
Model Residential Heat Fuel Gas
Grade Average Minus Heat Type Hot Air `
Stories 1 Story AC Type . None
a,�vt 113 s 1,Y�3 33�(Hr 3 ��',ie
Exterior Walls Wood Shingle Bedrooms 2 Bedrooms
Roof Structure Gable/Hip Bathrooms 2 Full € 33 r!5
�`R,mmt
3 3W�
Roof Cover Asph/F GIs/Cmp living area 678
Replacement Cost $86952 Year Built 1939
Depreciation 20 - Total Rooms 4 Rooms
Land
Lot Size(Acres) 0.1
Map requires Plug in:
http://www.town.bamstable.ma.us/assessing/assessO6/displayparce106.asp?mapparback=ad... 3/30/2006
Barnstable Assessing Search Results Page 2 of 2
Appraised Value $ 177,800 Interactive Property Map
I have visited the maps before W' +
j�
Assessed Value $ 177,800 Show Me The Map
April 2001 photos available
Sales Hist®
Owner: Sale Date Book/Page: Sale Price: f
DILSIZIAN, BEDROS H &ANI R Apr 15 1985 12:OOAM C101147 $54,500
FOX, ROBERTA Feb 15 1984 12:OOAM C95404 $36,500
SHEPPARD, PHILLIP A Jul 15 1981 12:OOAM C86237 $33,000
Extra Building Features
Code Description Units/SQ ft Appraised Value Assessed Value
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 UST Utility Area (Unfinished)
(Finished)
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)
Ihttp://www.town.bamstable.ma.us/assessing/assessO6/displayparce106.asp?mapparback=ad... 3/30/2006
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U.S. Postal ServAlliceTM
C-ERTIFIED MAILTM REGEIPT
(Domestic,MaillOn/y;No Insurance Coverage,Provided)
�F,o�,d&Iiverytinformation vv�4t our�w�-bsite aat www.asps.com�
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PS Form 3800,_June 2002 See Reverse for.lnsirurtions
Certified Mail Provides:e A mailing receipt an(es� aa)ZOOZ eun('008E Wood Sd
e A unique identifier for your mailpiece
o A record of delivery kept by the Postal Service for two years
Important Reminders: r 1
a Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile.
o Certified Mail is not available for any class of international mail.
o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables,please consider Insured or Registered Mail.
o For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is
required.
o For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted-Delivery".
o If a postmark on the Certified Mail receipt is desired,please present the arti=
cle at the post office for postmarking. if a postmark on the Certified Mail
receipt is not needed,detach and affix label with postage and mail.
IMPORTANT:Save this receipt and present it when making an inquiry.
Internet access to delivery information is not available on mail
addressed to APOs and FPOs.
THE Town of Barnstable
F T
Regulatory Services -"
w Thomas F.Geiler,Director
* BARNSTABLE, ' Building Division
Mass.
9�A 2639• ,m� Tom Perry, Building Commissioner
lFn �A 200 Main Street Hyannis,MA 02601
Office: .508-862-4038 Fax: 508-790-6230
March 31, 2006
Kathleen Leedy
1377 Choxes Chase West
Green Castle,Pa 17225
Re: Illegal Apartment `
Property ID: Map 307-Parcel 259
Locus: 9 Alden Way,Hyannis
Dear Ms Leedy:
A recent review of our records,including the permitting history and the Zoning Board of Appeals
records, indicates that the present use of your property located at 9 Alden Way, Hyannis is
limited to that of a single-family home; any other use is illegal.
Be aware that it has been reported to this office that this property has been divided into two
complete independent living units containing one bedroom each. Our files do not contain
evidence of any permits for this alleged work nor as stated above,has any zoning relief been
granted•to allow a use other than a single-family. You are advised to take immediate action to
restore the property to a single-family home. A building permit is required in order to
reconfigure the subject space to its original use,including the complete removal of the kitchen in
the accessory unit. In the event that this information is not correct,please make arrangements
with me to inspect the premises accordingly.
It is my understanding that you are now working with Local Inspector Jeff Lauzon to resolve the
stop-work order issued for the un-permitted construction of a second story.Your intentions with
regards to this addition must be declared for the record. Please contact me at your earliest
convenience to discuss these matters. Be assured that your failure to contact me or otherwise
comply with this notice will result in a $200.00 fine and possibly criminal action. I must hear
from you by April 7,2006 to confirm your intention. You may reach me directly at 508-862-
4027.
cerely,
kb
Robin C. Giangregorio
Zoning Enforcement Officer
J:\Illegal Aparptments\9 Alden Way 1.DOC
Certified mail 7005 1820 0004 6479 2050
I
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 301 Parcel Application#
Health Division
Conservation Division Permit#
Tax Collector r h Date Issued
Treasurer - Application Fee J
Planning Dept. Permit Fee �-
Date Definitive Plan Approved by Planning Board 0
Historic-OKH Preservation/Hyannis
Project Street Address A41 de n G)a nn d s
Village 1 !-:5
Owner %Aeen R , K'e ed Address l fi eo I i'TJyf ,M A
Telephone 11 !t 19-1 q� D 1 1l>a-6 B
Permit Request (�// -h S'ireAc,� <:� d YM 4eK A0 L®iVt"/CWC
Square feet: 1 st floor:existing (a 7 8 proposed�2nd floor:existing O proposed D Total new
ZoningDistrict R N Al Flood Plain Groundwater Overlay k
Project Valuation Construction Type AJ y ed 1 1 OLoc 4E t
Lot Size 1 CCG� C Grandfathered: ❑Yes ❑ No If yes,attach supporting=documentMon.
(Ji
C:)
�r
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure 7 �'S. 1 3 , Historic House: ❑Yes W-Ko On Old King's Highway: ❑-es No
10,
Basement Type: ❑ Full ❑Crawl ❑Walkout G16ther PaAe-fiAi /0 k 1
Basement Finished Area(sq.ft.) D Basement Unfinished Area(sq.ft) 2-4
Number of Baths: Full:existing new Half:existing d new d
Number of Bedrooms: existing new
Total Room Count(not including baths):existing -3 new First Floor Room Count 3
Heat Type and Fuel: A Gas ❑Oil ❑Electric ❑Other
Central Air: ❑Yes )0 No Fireplaces: Existing New Existing wood/coal Move: OfYes �No/
Detached garage:❑existing ❑new size N o Pool:❑existing ❑ r
new size A O Barn:❑existing O new size NO
Attached garage:❑existing ❑new size AfO Shed:❑existing ❑new size_ Other: i
Cn
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial '❑Yes _ ®'No/ .If yes,site plan review#
Current Use i le #� ot, dwa�he'r Proposed Use `L �W eo'?
BUILDER INFORMATION
Name Telephone Number l c)Da X10L
Address License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOGt�rS o ►tu
SIGNATURE i DATE �"� G
FOR OFFICIAL USE ONLY
PERMIT,NO.
DATE ISSUED
P PA
RCEL ARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION.
FOUNDATION
FRAME
r r
INSULATION � - - = PfL-
FIREPLACE i
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL _
GAS: ROUGH FINAL
FINALQ -
FINAL BUILDING
DATE CLOSED OUT 1 _
ASSOCIATION PLAN NO.
The Commonwealth ofMassachusetts
Department of Industrial Accidents
Office of Investigations `
600 Washington Street
Boston,MA 02111
' www mass.gov/din
Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legg Y
Name (Business/Organization/Individu4 ka4 /�e
Address:
City/State/Zip: &n—lV7 r) 16 ) �Phone#:
Are you an employer? Check the-appropriate boa: Type of project(required):
1.❑ I am a employer with 4• ❑ I am a general contractor and I 6. ❑New construction
employees(fall and/or part time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet $ ❑ Remodeling
ship and have no employees These sub-contractors have 8: ❑ Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑ Miding•addition
(No workers' gomp.insurance 5, ❑ We are a corporation and its
required,] officers have exercised their 10.❑ Electrical repairs or additions
3.9 I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions
myself.(No workers' comp, C. 1521§1(4),and we have no 12.❑ Roof repairs
insurance required.]t . employees. (No workers' 13.0 Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation pobcyinformatioa:
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must subunit a new affidavit indicating such
tContractars that check this box must attacbed an additional sheet showing the name ofthe sub-contractors sad their workers'caarp,policy information.
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.#: ExpirationDate:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(shoiwing the policy number and expiration date).
Failure to secure coverage as regmied 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 oi'a STOP WORK ORDER and a fine
of up to$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby certify under the pains and pena e of perjury that the information provided a$ove is true and correct:
Si afore: Date: S o 6
Phone#; ' �d
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/hicense#
Issuing Authority (circle one):.
1.Board of Health 3.Building Department 3.Cityff own Clerk a.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: phone#:
lni®rinati®n ana imstructiuns
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 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 wlio 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 coliance 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(LLQ or Limited Vabiity Partnerships(LLP)with no employees other than the
members or partners, are not required to carry worker' 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 of ildavit. The•affida*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 tlood micr 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 permi0icense number which will be used as a reference amber. In addition,an applicant
that must submit multiple permit4icense 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. Anew affidavit must be filled out each
year.where a biome 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 burn leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would hike 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 1mvestigations -
600 Washington Street
Boston, MA 02111
Tel. 617-727-4900 ext 406 or 1-a77-MASSAFE
Revised 5-26-05 Fay# 617-727-7749
www.mass.crov/dia
Town of Barnstable
r
Regulatory Services
MlE'
ASS. ` Thomas F.Geller,Director
139.
°pEcra`0 Building Division.
Tom Perry, Building Commissioner
200 Main Street, Iiyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
Property Mier Must
Complete and Sign This Section
If Using A Builder
I, \-k k e dy ,as Owner of the subject property
hereby authorize /Yl CS /7 Re-f eK6'P ► to act on my behalf,
in all matters relative to work authorized by this building permit application for.
�-
(Addres o Job)
Sig ature of Owner Date
kztN
Print Name
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Q TO RM S:O W NERPERMIS S ION
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ZNE Town of Barnstable
' DF �p� x .
Regulatory Services
* snRtvsTasts, Thomas F.Geiler,Director
9 e 9 .�� Building Division
43�Fo � 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
DATE:
Yl`l /O vd Please Print
JOB LOCATION: / Id to., W / IT a," 1 J
number street v village
"HOMEOWNER":Xa6 tie.n R, ke to d ? ? 9 7 707nl /�-
name / home phone# work phone#
CURRENT MAILING ADDRESS: �`�
%
ity/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.
DEFIMTION 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 of 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
regonsible 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' ection procedures requirements and that he/she will comply with said procedures and
requir nts.
Si attire of Homeowner
Approval of Building Offici
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control..
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:forms:homeexempt
f
�oEVE,� Town of Barnstable
Regulatory Services
BAMSfABL&. ' Thomas F.Geiler,Director
hiAM
�`6 i639'
°' g`0� Buildin Division
r�+
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 509-862-4038 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERPvIIT 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: 84t tee Estimated Cost
.Address of Work: I 40 / 1 i'
V .
Owner's Name: . 44 I►lee e 7
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
QWork excluded by law
❑Job Under$1,000
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
R
Date wner's Name
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PROPOSED MODIFICATIONS MICHELE C. TUDOR, P.E.
Consulting Structural Engineer
�- 123 Cottonwood Lane, Centerville, Massachusetts 02632
EXISTING RESIDENCE at Drawn W: MCT Date: 05/17/06 Drawin
9 AMEN ,WAY Scale: None I¢` ` " Rev. 0
HYANNIS, MA t o S K— I
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FORM30 HOBBSB WARREN,INC. THE COMMONWEALTH OF MASSACHUSETTS
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Address P /
Floor Apartment No. TNo.of O cc upa is
No.of Habitable Rooms No.Sleeping Rooms ,.
No.dwelling or rooming units No.Stor'
Name and address of owner
c3 Remerke Rep. Vlo. a(,
YARD Out Bld s.: Fences:
c Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs,Porches: .
Dual Egress:and 0 st'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof $l�
Gutters,Drains: W-1 us
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Li htin r
STRUCTURE INT. Hall,Stairway: -
Obst'n.:
Hall,Floor Wall Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central LJ 'j,N—.---'E ui -.Re ail
TYPE: Stacks, Flues,Vents:
PLUMBING: Su ply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels,Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen.Cohd. Distrib.Box: `
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom -—Pantry
Den j
—Living Room
Bedroom 1 '
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas,Oil,Elect.-
Stacks,Flues,Vents,Safeties: ;.
Kitchen Facilities Sink {'
Stove
Bathing,Toilet Facil. Vent.,Plumb.,Sanit'n.:" - '
Wash Basin,Shower or Tub:
Infestation Rats, Mice,Roaches or Oth
Egress Dual and Obst'n:
General Building Posted
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED I I N WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF,:-THE CODE;OR THE-b
AUTHORIZED INSPECTOR.(See Over)
' THIS INSPECTION REPO AS SIGNED AND CERTIFIED UNDER THE PAINS D
PENAL F PERJURY O q
a.
/ .• -
44
INSPECTOR ` ITL
DATE TIME' ."Pht
As 60�En
A.M.
THE NEXT SCHEDULED REINSPECTION � P.M.
4jMRTGAGE ,L���TLON PLAN
APPLICANT. PETERSON TO WN.' HYANNIS
,
/ 6 . 00,
LOT 10
"SE
LOT 14
g LOT 12
64.98, _
F L yr
SIEPHEN 1
NOTES. DOYLE
'S59
1) PRE—EXISTING, NONCONFORMING.
2) FENCE & DRIVEWAY APPEAR TO BE
ENCROACHING IN FIELD.
FLOOD PANEL- 250001 0006 D FLOOD ZONE. C"__ DATED., 712192
I hereby certify that this mortgage inspection plan was prepared for- Plan is For
HOMELAND FUNDING SOLUTIONS, INC. Bank Use only
The location of the building shown does _,NQ'T_ fall within a special flood hazard zone. DEED REF. = CTF,,,v 178835
Per taped inspection it appears the location of dwelling does -- conform to the local by-laws PLAN REF. = 14885—E
in effect at the time of construction with respect to horizontal dimensional setback requirements -------
or is exempt from violation enforcement action under Mass. General Laws Ch. 40A -Sec. 7 Scale 1 = 30' FT.
Referenced Deed subject to and with the benefit of all rights, rights of way, easements, reservations —
and restrictions of record, if any there be and insofar as the same are of legal force and effect. Ida te; 1212fO5
PLEASE NOTE. The structures on this inspection were located by tape not instrument and are approximate only. An actual survey is necessary
for a precise determination of the building location and encroachments, if any exist, either way across property lines. This inspection must not
be used for recording purposes or for use in preparing deed descriptions and must not be used for variance or building plan purposes. This
inspection must not be used to locate property lines. Verification of building locations, property line dimensions, fences or lot configuration can
only be accomplished by an accurate instrument survey which may reflect different information than what is shown hereon. This inspection is not
to be used for any purposes other than mortgage. Yankee Survey accepts no responsibility for damages resulting from said reliance.
PHONE 508—42B—0055 YANK �l SUP V Y CONS UL TA NTS
Fax 5oe-4z0-5553 UNIT 1, 40 INDUSTRY RD, MARSTONS MILLS, MA 02648 38182 JS