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0044 BETTY'S POND ROAD
M, 44 BETTYS POND RD c�,ad7 d t CAc af r / _ _ � 3{ � Sl � 1 f a i F. I� I' � 1 309003007 -� TOWN 0f BARNSTAB1E NO FEE M (MTRATION AND CERTIFICATION FORM FOR FORECLOSING/FORECLOSED PROPERTY Thank you f ,ism in accordance with Town of Barnstable Code chapter 224 se 'NIP? [+ and 224-4. Please complete one form for each property in foreclosure t (section 224-3)or already foreclosed for which possession has been taken(section 224- 4). Please file the original with the Building Commissioner and a copy with the Chief of the Fire District in which the property is located. If you claim you are exempt from registering under Massachusetts law,please state the reason(s) and complete section 1 (property information) and the first paragraph of section 2 (foreclosing party, court, etc. and foreclosing party representative,but not other representatives and attorney) so that the Town can review the exemption and update its records: Section 1 —Property Information Property Address: 44 BETTYS POND RD, HYANNIS, MA 02601 Assessors Map#: UNKNOWN Parcel#: M290L092001 Land area and description ONE FAMILY 2 STORY HOUSE Building(s)description and contents ONE FAMILY DWELLING Occupied: Occupant(s)(if borrowers so state and include name(s)) RUSSELL,THOMAS Phone: UNKNOWN email: UNKNOWN other: NA Vacant: NA Date: NA Anticipated Length of Vacancy: NA Last occupant(s) )(if borrowers so state and include name(s)) RUSSELL, THOMAS Phone: UNKNOWN email: UNKNOWN other: NA Has possession been taken NA If so,please explain and complete and file the maintenance and security plan form(unless exempt as stated above) NA Section 2-Foreclosing PaM Information Foreclosing Party (full name/title) CALIBER HOME LOANS Foreclosure Case Court: UNKNOWN Docket# UNKNOWN 309003007 Date filed: UNKNOWN Current Status: ACTIVE FORECLOSURE Foreclosing Party's representative(s) for property(entry, management,repair, etc.)(name,title,): PROPERTY PRESERVATION Company(if different from foreclosing party): CALIBER HOME LOANS Address: 13801 WIRELESS WAY OKLAHOMA CITY OK 73134 FCFirstLegalPropertyRegistration@caliberhomeloans.com Phone: 858-683-8430 email: other: If an exemption is claimed,please do not complete the remainder.. Other representative(s) (if foregoing representative is primarily responsible for property and/or foreclosure and is most likely to be able to address town matters concerning the property and/or foreclosure,please so state and do not complete contact information (i. e. "none" or"see above")). PROPERTY PRESERVATION CO TO RECEIVE VIOLATION NOTICES Name, title, other: CODE COMPLIANCE Company(if different from foreclosing party): SAFEGUARD PROPERTIES Address: 7887 SAFEGUARD CIR., VALLEY VIEW OH 44125 Phone(s): 800-852-8306 email(s): N/A other: NA Name,title, other: NA Company(if different from foreclosing party): NA Address: NA Phone: NA email: NA other: NA Attorney representing foreclosing party Firm name (if different from attorney's name): PRESTIGE GROUP SERVICES Address: 128 BARTLETT AVE. 3rd FLOOR, WEST CREEK, NJ 08092 Phone(s): 609-879-6558 email(s): NA other: NA I acknowledge that the information provided is accurate and correct. I also understand that any inaccurate information will result in non-compliance with section 224-3 of chapter 224 of the Code of the Town of Barnstable. Date: 1/16/2020 Name:Safeguard Properties Title: 309003007 I hereby certify that the above-named foreclosing party is in compliance with the provisions of section 224-3 of chapter 224 of the Code of the Town of Barnstable. Date: Building Commissioner, Town of Barnstable 1117/�n J� E3 A "-STA BILE i T C ' CL E 1 vpfrUiE r'. 01. BARNSTAst; MASS 9� ib39 i Town of;Barnstable:- Zoning Board of Appeals Decision and Notice Compreherisive'Permi"t No.2007 112:-Russell; Chapter 40B Com, prehensive Permit Summary: C.Compreliensive Permit No 2007 112;is rescinded Applicant: Thomas J ,R-,us effandI.Mkhelle,D..Russell Property Address: �44'Betty's Pond Road, Hyannis,MA; j Assessor's lY vmarcel: Map M,Parcei.092-.001 Zoning: Residential$,Zoning Disffiov DeedReference: Book 9353„;Page 207 Permit Reference:, Book.22659_Page MI.' Locus and'Background The applcantsapplred for a Corriprehensve Permit under Chapter 40B of'the General::Laws of the - Rnmonwealtli of,Massachirsetts, and ,rn accordan.'ce with Article lI of Chapter Nine of;tfie Code of the town o£Barnstable,,more commonly termed the "Accessory ,Affordable Housing 'Pro Comprehensive Permit Number 2007-112 was issued;to the applicant on November 7, 2007`and; a Regulatory Agreement and Declaration of. Restricted Covenants were recorded at the Barnstable County Registry of Deeds on rebruaiy 8, 2008.in Book 22659,Page 165.; The Applicants are:no longer participating in the Accessory Affordable Apartment Program and therefore the Comprehensive`Permit.No.2001411,must be:rescinded Procedural &:Hearing Summary: public hear7ng ao.rescind Comprehensive.Permit:No.:2007°,,l L2 was duly advei t sed and notice: -sent to abutters and.the property owner all in accor•.dance with MGL Chapter 40:A:. The hearing; was opened on.ApriI�.24,. 2019 at;;wliicli tirrie the Hearing Officet, .Alex Rodolakis; made the following findings and decision; Findings;of Fact:= 1. The 'applicants, Thomas J Russell and 1Vlrchelle D Russell, were granted; Comprehensive Perm rt 2007 1,1,2 for an accessory affordable apartment at 44 Betty's; Pond'Rog,.' Anis,MtA.. . S a i Tow- of`I3arnstat lo,Zoning 13oard'of Appeals Comprehensive"PermitNo.2007-11.2—k.wsell is.rescindedl. 2 The applicants, Thomas.T Russell and:Michelle D: Russell, are;`rio longer parti 9 in the Accessory affordable Apartment:Program 3. On March 6, 201;9; the Accessory Apartment Program Coordinator'took aetlon to rescind Comprehensive Permit No. 2007 1'12; i Ordered: Comprehensive:Permit number 2007-112 is rescinded: A,written copy:of this decision shall be forwarded to`the Zoning Boaid of:Appeal as required by the Town:of Barnstable Admimstrat>ve Code Chapter 241, section:1-1. If after fourteen(14).days from,that transmittal the Members of the Zoning$oard of Appeals takes no action to:reverse the. _decision,this decision shall become final and azeopy,shall be therfiled in the office of the Town l Clerk: i Appeals;of the final:decision, if any, shatlbe m:,ad el to t Barnstable Super ox Cou11 pursuant to ' IvIGI. Chapter :40A, Section 17,, within.°twenty (20) days.,after the date b,' he filing; of this. decision n the office ofahe"Town='Clerk: The;applicant ha"s:the right,to appeal.this decision.as outlined'n MG ,,Chapter 40B, Section 22;:. i .. I a AIex,R iolakis;Hearing Officer Date" "igne I . j i I 1 I 'I, Ann Quirk, Clerk,of the Town of Barnstable; Barnstable County;lVlassachusctts hereby certify that twenty (20)days have elapsed since the Zoning Board of.Appeals filed thi.s decision and that no appeal of the decision has been,filed in the office of the ,I.'own Uerk,. j i Signed and sealed this clay of 4 U1 l9_ underIhe pains and penalties-of perjury. 01 Ann Quirk, Town Clerk; _ 1 • i O �tAk 7 Utz? N5TAn F BARNSMB;tE.REGI.STRY OF DEEDS .ttii P� � Town of Barnstable fig` Building •. Post This Card Sa Thad#pis Visible Fr,,omihe Street°A roved PI ri Must.;be•Retained oJbban' thisA;Card M;ustb'e,Ke ♦ Akf�tTCA[it8, § '� . r Pp b ''..$ r ;y, '#r, M" Posted Until Ftnallnspectian Has Beert Made: * „ ff " '. been made ] Permit W.hereaGert�ficate of Qccupancy is Required;such Buildmgshall=Not be Occupied until a F�na1 Inspectlon has Permit No. B-18-3641 Applicant Name: RICARDO TERSAROTTO Approvals Date Issued: 05/13/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 11/13/2019 Foundation: Residential � Map/Lot 290 092 001 Zoning District: RB Sheathing: Location: 44 BETTY'S POND ROAD, HYANNIS F Contraor rn Nae RICARDO TERSAROTTO ct Framing: 1 Owner on Record: RUSSELL,THOMAS J&MICHELLE ContractoWL en CS 109137 2 Address: 44 BETTY'S POND ROADy x Est 111,� Proect Cost: $85,000.00 Chimney: HYANNIS, MA 02601 s �Perrn Fee: $508.50 Description: renovate existing master bedroom/bath due wprevious fire. . Insulation: t Fee Paid $508.50 Replace existing framing memvers as required new finishes N " Date 5/13/2019 Final: 4,. Project Review Req: - •s Plumbing/Gas z � Rough Plumbing: �R77 _ , m_. uilding Official " ,B Final Plumbing: This permit shall be deemed abandoned and invalid unless the work ablAR ed by tl is permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and strUcctures�shall'13e,in compliance with the local zon ng�by laws a d codes. This permit shall be displayed in a location clearly visible from access street?oriroad and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. 4, Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are providetl on this permit. Minimum of Five Call Inspections Required for All Construction Work g , Service: ff .: — 1.Foundation or Footing 2.Sheathing Inspection J Rough: 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 Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: 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. "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 C� All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: 2�r�� c�� i /�2�� � Town of BarnstableBuilding P�ostThrs�Gard So;That it is Visible From fheaStreetA ,'royed;Plans Must be`Retamed.on Job andthis Cad,Must be Ke t ".y3 '° :: Mk2ilTE'AHLB, � Via,. ��` , ,� pP� � '. �� ^p y • 6 P�osted`UntilFinal Inspection Has Been Made ,at i ° Where a Gert�ficate of,O�c"cuN an'c.'"zisRe"" ired4'such Buildm`s all Not be Occu � tluntil a'F�naUl'ns ection has.been made Permit .,.�,..' '"k :".`�.. ?x:3 :.... .h: -�>. _p.aa`:.Fzy�.:•Qw:»,,,,...�:z...!.t +.....,�.. �.;:.. a .,g tm' fi....,.,. ,.,w.., p.., .: a. «�r �,:a.'o€'«:.,.,«-..,..gip.h;..._,�,:...i.«... :;�...�:.x„a .,'F ..... �. �..,,d., Permit NO. B-18-3641 Applicant Name: RICARDO TERSAROTTO Approvals Date Issued: 01/14/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 07/14/2019 Foundation: Residential Map/Lot: 290-092-001 Zoning District: RB Sheathing: Location: 44 BETTY'S POND ROAD, HYANNIS Contractory Narne'`� RICARDO TERSAROTTO Framing: 1 Owner on Record: RUSSELL,THOMAS J&MICHELLE ) ContractorLicense G5<109137 2 Address: 44 BETTY'S POND ROAD aE � Cost: $85,000.00tPrJt Chimney: HYANNIS, MA 02601 r Permit Fee: $483.50 � Insulation: Description: renovate existing master bedroom/bath due to previous fire. Replace existing framing memvers as required newfinishes F�eePaid $483.50 Date 1/14/2019 Final: Project Review Req: . � Plumbing/Gas 1 �- Rough Plumbing: . ...... : . Building Official Final Plumbing: h i k Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorised b this ermit is commenced within six months after issuance. p Y . p f _> Final Gas: All work authorized by this permit shall conform to the approved application and th9approved construction documents f6r6 hi h this permit has been granted. All construction,alterations and changes of use of any building and structures,shall bgin compliance with the local zonmg�bylaws aril codes. This permit shall be displayed in a location clearly visible from access street or,:road�and shall be maintained openafor public inspection for the entire duration of the Electrical � e x work until the completion of the same. Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officals are prou�ided on this permit.. Rough: Minimum of Five Call Inspections Required for All Construction Work: ' " 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection j� 5.Priorto Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Persons contrac ' unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: tip AppliccationNtunbet....J..,l.A......4Y�..:,./................. 4 'I'Vel '0" °'A°NSTA3LE Lly t =AWWAS " I 3 S o f names. Permit Fec...... .. .....Other Fee........................ .19 TotalFee Paid..................................................................... TOWN OF BARNSTA:BLE� : Permit Approval by.... .. .....on.. :�..1,..�?� ,Y... BUILDING PERMIT MV.......(>22 A..................Parcel.......... ®1� ..... �:..:.APPLICATION Section 1— Owner's Information and Project Location Project Address '' Village Owners Name Owners Legal Address City 44b4j-sis _State Zip_Z�Z(,� Owners Cell# E-mail I Section 2--Use of Structure j i Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial-Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3—Type of Permit g a ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck . Apartment ❑ Sprinkler System j [] Addition [] Retaining wall ❑ Solar if i� enovation El Pool ❑ Insulation . Other—Specify Section 4-Work Description n n if • � �` it t ApplicationNumber.................................................... Section 5—Detail a Cost of Proposed Construction Square Footage of Project 6� Age of Structure Dig Safe Number #Of Bedrooms Existing Total# Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist 0 WFCM Checklist F� Design Section 6--Project Specifics "iring ❑ Oil Tank Storage 21'smoke Detectors h [ Plumbing ❑ Gas Fire Suppression ER Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply D Public ❑ Private Sewage Disposal Municipal ❑ On Site , Historic District ❑ Hyannis Historic District ❑ Old Kings Highway i F Debris Disposal Facility: ��i �c/ T am using a crane ❑ Yes ❑ No r h Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland,coastal bank. Yes El No Section 8—Zoning Information 1 Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks . Front Yard Required Proposed ;I s ;I J �I Rear Yard Required Proposed Side Yard Required Proposed 1 Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No i i 1 's Application Number........................................... Section 9—.Construction Supervisor Name ►C 2+'Jn �►Z�4 Telephone Number Address ) J21>945[�:j _&;g�, City +2jt�i o,Z� State MA= Zip 6 -?f License Number S - ) I License Type Expiration Date 1 ,z' Contractors Email Cell# I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the MassgachBuilding Code. I understand the construction inspection procedures,specific inspections and documentatio 0 CMR and the Town of Barnstable.Attach a copy of your license. 9 p Signahu. Date /0 4 //_Z: i 1 Section-10—Home Improvement Contractor Name �'' CE4,2A�� ,mks ;�'a Telephone Number Address )( � � AV4,- City ml— 6 V State Zip C)IX-7 c d Registration Number E �. xpiration Date 11 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 e 780 CMR and the Town ofBamstable.Attach a copy of your H.LC... f Signa a Date Section 11 —Home Owners License Exemption r I Home Owners Name: C �I Telephone Number Ceti or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 4 i CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and I documentation required by 780 CMR and the Town of Barnstable, r i Signature Date II APPLICANT SIGNATURE I; Signature 'y ku��2.y7 Date t ` g I Print Name �� L S' i �,S L Telephone Number E-mail permit to: v A, i Section 12—Department Sign-Offs f ' I 3 i nt ❑ Zoning Board if required) © _ Health Departure g ( Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the pre department for approval fi Section 13—Owner's Authorization y b as Owner of the subject property hereby au orize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signa e o wne date t y / Print e f 4 r I i I i s p 1 i 1 e A�p® CERTIFICATE OF LIABILITY INSURANCE DATE(MMDO/YYYY) .E THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS l29/2018 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($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the II les m Po cy( )must be endorsed. If the terms an SUBROGATION IS WAIVED,d conditions of the policy,certain policies may require an endorsement. A statement on thise E Subject o certificate holder In lieu of such endorsement(s). certificate does not confer rights to the PRODUCER NAME:IT Stephen G,Gutro,LIA,CPIA,CISR,NP Gutro Insurance Advisors,LLC E 817.697-4406 P.O.Box 514 W.W: 5087-786-5969 Marlborough,Ma.01752 MASS: gutro.LIA@gmail.com INSURE S AFFORDING COVERAGE r1AiC# INSURED INSURERA: Markel:Evanston Insurance Company 35378 Premium Framing,Inc. INSURER e: Ace American insurance company 22667 � INSURER C 11 Airport Road INSURER 0- Hopedale,Mass.01747 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. LTR TYPE OF INSURANCE IN POLICY NUMBER gq»yp fumy AP LIMITS COMAAERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000iren CLAIAAS MADE OCCUR PREMISES Ea occuce $ 100,000 one person) $ excluded X Y 3C42530 03/28/2018 03/28/2019 PERSONAL 8 ADV INJURY S 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRO- �LOC GENERAL AGGREGATE $ 2,000,000 POLICY® ___-HOTHER: PRODUCTS-COMP/OP AGG $ 2,000,000 r '� ' AUTOMOBILE LIABILITY - $ Ea acddenl b ANY AUTO BODILY INJURY(Per person) S ALL OWNEDLAUTOS LED _ AUTOS NED BODILY INJURY(Per acddenl) S AUTOS HIRED AUTOS $ Per accident $ UMBRELLA LIAR OCCUR EXCESS LIAB CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE IS DED RETENTIONS tK WORKERS COMPENSATION - $ AND EMPLOYERS LIABILITY YIN STATUTE ER MA ANY PROPRIETOR/PARTNEWEXECUTIVE If ea, NIAYB OFFICEMMSER EXCLUDED7 FN 9F742046 05/28/2018 0528/2019 E.L..EACH ACCIDENT $ 1,000,000 (Mandatory Indesede under EL.DISEASE-EA EMPLOYE11$ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Subsidiaries and partners as additional Insureds If required by written Contract.on all policies accept workers compensation Coverage is Primary and non-contrtibutory if required by contract,Waiver Of subrogation on General Liability CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE Thiomas J.Russell ACCORDANCE VWTH THE POLICY P Sl0 44 Betty Pond Road Hyannis.Ma.02601 AUTHORIZED REPRESENTATIVE T ©1988-2014 ACO PO A served: ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD .P Massachusetts Department of Public Safety Board of Building Regulations and Standards e License: CS-109137 k Construction Supervisor ° RICARDO TERSARQTTO 11 GIBBON AVENUE,APT G1 4 + MILFORD MA 01767 `-'4-- Expiration; Commissioner 01/21/2019 oftfce of Consumer Affairs&Business Regulation d HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TMPE: Mdual before the expiration date. If found return to: ExplraHon Office of Consumer Affairs and Business Regulation i it , 10 Park Plaza.Suite 5170 i RICARDO TERS/WQTTQy Boston,MA 02116 4 ti�4K t RICARM TERSAROTTO . 11 GIBBON AVE.APT f31 � r" MrIFOR°';uA 01757 Not va ithout signature Undersecretary F V im`Z'/ ) r- 35 62 r �•� G Cam -, .f rhe_Cammoriwealth of, lassachusettr_ — Deparbnent of Industrial Accidents Office of Investigations. 600 Washington Street Boston,MA 02111. ! I. www.mass.gov/dia Workers Compensation Insurance Affidavit: Build ers/Contractors/Electricians/PIambers Applicant Information Please Print Legiblv Name (Btuin:sstorganizadonnndividueI): Address: 4-1 4 eo(6 City/State/Zip: l Phone#: Are you an employer?Check the.appropriate b : 1.❑ I ani a employer with Type of project(required): 4.° am a general contractor and I employes (full and/or pate) ; have hired the sub-contractors; 6' ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have workingfor in 8. 0 Demolition any capacity.. employees and have workers' [No workers'comp.insurance comp. insurance.: .9• []Building addition.` required.] 5.;Q We are a corporation and its _ 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. i right of exemption per MGL , insurance required.]t c. 152, §I(4), and we have no 12.❑Roof repairs employees. [No workers' I3.216ther p 2 comp, insurance required.]Any applicant that ehecla box#I must also fill out the section below showing their workers'compensation policy infbr natioa. Homeowncrs who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new a$idavit 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 employes,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information, r Insurance Company Name: _ I Policy#or Self-ins. Lic.It . Expiration Date: i 1 � Job Site Address: - ----t 'City/State/Zip: Attach a copy of the workers compensation policy declaration page(showing the policy number and expiration date). o 1 Failure to secure coverage as required under Section 2 5 A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 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 S250.00 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!verincation I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct .at iature: Date: Phone=. F I O icial use only. Do not write in this area, to be completed by city or town official City'or Town: i I Permt/License I Issuing Authority(circle one): 1. Board of Health, 2. Building Department'3 City/Town Clerk - 6..Other l 4.Electrical Inspector o.Plumbing Inspector j Contact Person: � __� Phone r: � ��- ��-i i i i - � Town of Barnstable Building , 'Gat t�edUnsto PermitkWhereCe . of O.ccu anc .ads Re u�red,such Builtlm shall••Notbe Occupied until a Final,lnspection,has been:,made 3 �. , Permit NO. B-18-867 Applicant Name: FRANCIS V WARD,III Approvals Date Issued: 04/13/2018 Current Use: Structure Permit Type: Building-Trailer Expiration Date: 10/13/2018 Foundation: Location: 44 BETTY'S POND ROAD, HYANNIS Map/Lot290 092 001 Zoning District: RB Sheathing: Owner on Record: RUSSELL,THOMAS J&MICHELLE Contractor Name AMERICAN MOBILE HOMES INC. Framing: 1 Address: ,11 44 BETTY'S POND ROAD --Co"fficct r License; 106386 2 00, HYANNIS, MA 02601 a --Est,-,,,,aProject Cost. $ 17,000.00 Chimney: Description: Install a 12x60 Temp Mobile Home to be used.as living quarters _ Permit Fee: $25.00 while the family rebuilds their fire damaged home Horne will be 4 Insulation: $25 located on site for approximatley 9 months 4/1-5/201.8 Ol/15/2019. �Fe'ePaid .00 Date 4/13/2018 Final: Project Review Req: a Plumbing/Gas v /� .. .-.... Rough Plumbing: . Building Official All Final.Plumbing: 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 appl cation and the"-,approved construction documents for which this permit has been granted. _vyk Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by lawsand codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for py,is inspection for the entire duration of thewm work until the completion of the same_ Electrical s Service: The Certificate of Occupancy will not be issued until all applicable signatures by the�BuildIng and�Fire Qfficials are:provided on this permit. Minimum of Five Call Inspections Required for All Construction Work:,- . 1.Foundation or Footing w Rough: 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: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. 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 n r THE - �.V'4 ApplicationNumbe ... ;..................... �► .E. ' Permit Fee... Wf o s G' 03 Total Fee Paid....... ........... ...... TOWN OF BARNSTABLE Permit Appro al by.......°.....`.�.............oa... BUILDING PERMIT sec t APPLICATION Section I — Owner's Information and Project Location e Address VT71ag -tt 2�1 !� Project A Owners Name—71wKc�S �(.S 5 � Owners Legal Address City State -- zip —1+La" Owners Cell# 5US—d9 a-t>L-3 E-mail Section 2—Use of Structare Use Group ❑ 'Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet- D—Single/Two Family Dwelling Section 3—Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory.Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement El Family/Amnesty ❑ Fire.Alarm. Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation- ❑ Pool ❑ Insulation Other—Specify Section 4 -Work Description T.RI nndated:2J9201 8 Application Number................................................ .. , Section 5—Detail Cost of Proposed Construction Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wmd Zone Compliance Method MA Checklist ❑ WFCM Checklist ❑ Design Section 6-Project Specifics, ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors [] Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply IJ Public ❑ Private Sewage Disposal 'Municipal ❑ On site Historic District [] Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: iDDL c L — I am using a crane ❑ Yes ❑ No 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 Yard Required -'Proposed, Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last undated_2/92018 0110111 Town Boundary _ ` f 123-a56 .Parcels FY2o18 Address Street Numbers. Buildings �. Decks/Patios - 290 091 or Above Ground Swimming Pools p ;,i [./ - -- $�80 Qa In Ground Swimming Pools ® Paved Walkways --- Unpaved Walkways '�"' \ SS ` -- Vti.d - Paths rrg� tt DTVIION. - ® Stairways '- ' .. .. .. .. f I V Paved Roads \� Unpaved Roads =: Paved Driveways �. .. Unpaved Driveways .. :. .. .. .. - .. +* .. .. Painted Lines Paved Parking.Lots:. Unpaved Parking Lots ... Bridges .. :. .. .. ., .. Railroad ' + X Fences .. :. Guardrails .. — Retaining Walls �, ... ... 290-092-001. #44 o Stone Walls -r Other Walls Hedges .. 00 :Sports Areas '. - .. .. .. Golf Areas Decks/Piers :.. ..: ...: .. .. .. .. Boardwalks 1 Jetties p . Streams ..` ... — - Drainage Ditches 290-0863 ; C) Marsh Areas - - .... .. #47 0. Water Bodies X Spot Elevations(NAVD88) ------ O Topo to ft Contours(NAVD88) .. .. .: Topo z ft Contours(NAVD88) Wooded Areas Street Trees xCatchbasins -------•-----------••---^, ., _ .. .. .. .. .. Monuments Lamp Posts O Satellite DishUL Manholes " ®®Fuel Tanks @ Q Utility Poles 100 Water Tanks + Signs 290-092-002 290�085 ; Flagpoles #�'38 •` t .. .. #33 -• Data Source Human-made features, Disclaimer This map is for planning purposes only. It is 1 inch=$0 feet N Town®f�Al'E11 lC hydrography,topography,and vegetation were Parcel lines on this map are only graphic not adequate for legal boundary determination ConS�atjon DiVi,don interpreted from 2014&2oo8 aerial photos representations of Assessor's tax parcels.They or regulatory interpretation.This map does no I - . I . - Feet and may have been updated from more current are not true property boundaries and do not represent an on-the-ground survey. 0 5: 10 20 30 40 W E http://w .tow bamstable.ma.us - zoo Main Street,Hyannis,MA oz6ot sources. Parcel lines were digitized from represent accurate relationships to physical Enlargements beyond a scale of i"=too'may -. .. IIVn I—— n...........M-A.....,.....,-+....... ___.__1 __—______.._._--I..-»__-i_- _._._ 1._—_- ___�__�_ � 6F2e 1ponv�no�uoetuCC�oC�/�aaaccc�ccae .i License or registration valid for individual use only Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration ';'1.06386 Type: Office of Consumer Affairs and Business Regulation Expiration:- =7/23120;18 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 AMERICAN MOB ILEHOMES4INC FRANCIS WARD 51 MOORE RD E.WEYMOUTH,MA 02189- Undersecretary Not valid without signature Commonwealth of Massachusetts Division of Professional Licensure , Board of Building Regulations and Standards - Con st`PftmiN p7rrvisor CS-057291 UP ires: 09/17/2019 t FRANCIS V WARD, 51 MOORE R(�QD "� f EAST WEYMOU,TTi�MA 0�1� 50 t 1 r LSS 3 Commissioner V""' mold i ��e rpo�rrvnuvr2caecz��a�C%f�aaaac�ucueCT..i '� Office of Consumer Affairs&Business Regulation I License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: a Registration;'--`'106386 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Expiration 7/23/2018 Private Corporation Boston,MA 02116 AMERICAN MOBILE,HQMES'-JNCi;'.(" FRANCIS WARD ^ '} 51 MOORE l�'t E.WEYMOUTH, MA 02189 r Undersecretary Not valid without signature Construction Supervisor Unrestricted-Buildings of any use group which contain less than 36,000 cubic feet(991 cubic meters)of enclosed space. r Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl - _ i 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): American Mobile Homes, Inc Address: 51 Moore Rd City/State/Zip: Weymouth, Ma 02189 Phone#: 781-331-0333 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓ 1 am a employer with 12 4. I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2. 1 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 [No workers' comp.insurance comp. insurance.: required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. 1 am a homeowner doing all work officers have exercised their 11. 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 13.✓ Other tetemp mobile 1- employees. [No workers' comp:insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then.hire outside contractors must submit a new affidavit indicating such. ` Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Granite State Ins. Co. Policy#or Self-ins.Lic.#:WC 360 3470 Expiration Date: 8-12-18 Job Site Address: 44 Betty's Pond Road City/State/Zip: Hyannis 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. 1 do hereby certify nder/theain and penalties of perjury that the information provided above is true and correct Signature: v_ Date-3'27-18 • Phone#: 1-331-0333 Official use only. Do not write in this area,to be completed by city or town official A 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#: Town of Barnstable , Building Department Services ' B"x'"g''''a' Mass. Brian Florence,CBO 1639. �� Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize AlVtef l i� to act on my behalf, in all matters relative to work authorized by this building permit application for: �q ZL 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. h AAA - Signature of Owner Si ature of Applicant nt Name Print Name Date . Q:FORMS:OWNERPERMISSIONPOOLS Rev:08/16/17 ♦ t t ` , • rY +d LegendfillParcels 0c At, \, Town Boundary 290077 29009 #70 #76 Railroad Tracks Buildings 290088 Painted Lines 1 _ ti 290072 Parking Lots Paved 290089 at qk �I^ _"' �i #145 unpaved j Jl ti Driveways 67 0Paved ._ .. unpaved -. Roads 90©87: a 3 C Paved Road vau 290091 ' t.unpavad Road Bridge Paved Median a 4 • --Streams - r a!•r 1 ;� 2#554 /2 Ike,C�I # y ` ._ a - `...ar. _. Marsh --y u T Water Bodies it 290086 V. trom�+, r At r � ' ; 290085 9 Eg tit^ � IL . v 290092002 I CT #3806 lY 290081 � o 290082 I 90084 CD #27 s ><-#60 I �290093002CND1 " , # p r } „ 0Ty O O 29 26 _ 29003 001CND 0 , �76 Map printed on: 3/26/2018 This map is for illustration purposes only.It is not Parcel Ives shown on this map are only graphic Town 0 11I1SUrbJ GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are ,,,�nnrrr��� Feet regulatory interpretation.This soap does not represent not true property boundaries and do not represent 367 Mai]3;6'Freet,HyaS MA 02601 0 83 167 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the ma $08-862- reflect current conditions,and may contain such as building locations. �� Approx.Scale:1 inch= 83 feet cartographic errors or omissions. gis@tbtvn.barnsta.ma.us Fq , r • Application Number........................................... Section 9-.Construction Supervisor Telephone Number -Zg I - 3 1 p--s--s- Address S( City State lea— , Zip 02.4 $ 5 License Number_Ly 7 Zf�( License Type C_5 Expiration Date Contractors Email.F,J���cief i C_ MDb�l2�nt �Ceil C�- 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 proceduures,specific inspections and documentation required by 780 CMR and the Pown of Barnstable.Attach a copy of your license. Signature ' Date. .3, Z 7,/R } Section-10-Home Improvement Contractor Name d�? u�-QS�,kelephone Number OD — Z-3 Z Address City State Zip 1 ZL S Registration Number /L)(, 3R, Expiration Date '? 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 re ' d by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Z 7 l Section 11—Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number E I understand my responsibilities under the ruffles 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 APPLICANT SIGNATURE SignatureDate Print Name Telephone Number 71?1 -351- 0 E-mail permit to: tc�c�✓�-�oz�ted °ou,__ - .i ... ..... ... .... Section 12—Department Sign-Offs Health Department ® Zoning Board(if required) Historic District ❑ Site Plan Review(if required) ❑ Fire Department 0 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) i Signature of Owner date Print Name t Last undated:2/9/2018 A MM DD yyyyDelete NFIRS -1 191922 U 1 011 1 131 1 2018 1 118-0000266 11 000 Change Basic FDID * State* Incident Date * - Station Incident Number Exposure* P * []No Activity Check this box to Indicate that the address for this incident is provided on the Wildland Fire Census Tract A 4 $ Location* Nodule In Section B "Alternative Location Specification". Use only for Wildland fires. 0 ®street address 48 " IBETTYS POND ROAD 11 ❑Intersection Number/Mile ost Prefix P Street or Highway Street Type Suffix ❑In front of '' ❑ I Rear of J HYANNIS IMAJ 102601 1 ❑Adjacent to Apt./Suite/Room City State Zip Code I ❑Directions Cross street or directions, as applicable Incident e * Midnight is 0000 C Type E1 Date & Times E2 Shift & Alarms 111 (Building fire Check boxes if , Month Day Year Hr Min Sec Local option Incident Type dates are the same as Alarm ALARM always required IR 1 I I.I D Aid Given or Received Date' Alarm * 01 13 2018 117:40:16 hi I I_I �J * Shift or� Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 QMutual aid received 01919 11�II El Arrival * - 01 13 1 20181 17I 44:30 I E3 2 ❑Automatic aid L@CV. Their MID Their 3 []Mutual aid given State CONTROLLED Optional, Except for wildland fires Special Studies 4 ❑Automatic aid given I I ❑Controlled -L_J " 1 - 11 Local Option 5 []Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I N None Incident Number Last Unit ' n Special Special J ❑ ® Cleared J, u I 20181 20� 13.34 Study ID# Study Value- F Actions Taken* G1 Resources * G2 Estimated Dollar Losses & Value ❑ Check this box and skip this LOSSES: Required for all fires�if known. Optional section if an Apparatus or, for non fires. 11 (Extinguishment by fire I Personnel form is used, None Apparatus Personnel property $� 1 , 070 , 000 ❑ Primary Action Taken (1) Suppression 1 0005 1 • 0017 contents $� O10 000. N 10 IFire control or ❑ Additional Action Taken (2) EMS-� 0001.I �Q0�3I PRE-INCIDENT VALUE: Optional 101 (RAPID INTERVENTION TEAM ether L 0004J 0004J property $1 , 000 1 000 Additional Action Taken (3) - ❑ Check box if resourcecounts. include aid received resources. Contents, $L , 000 , 000 ❑ Completed Modules H1*Casual ties❑None B3 Hazardous Materials Release I Mixed Use. Property QFire-2 Deaths Injuries N ❑None NN Not Mixed X Structure-3 Fire 1 Natural Gas: slow leak, no evavatioa'or Harmat actions 10 Assembly use '' II I ' 20 Education use ❑Civil Fire Cas.-4 Service L.� � ❑ ❑X 2 [:]Propane gas: <21 lb. tank (aa in hie BBQ grill) 33 Medical.use ❑Fire Serv. Cas.-5 �� 1 001 3 I ❑ 40 Residential use Civilian Gasoline: .,ehsole feel tank or portable container ❑EMS-6 4 ❑Kerosene: fuel burning 51 Row of stores Detector s egaipmant or portable aiorage• 53 Enclosed mall ❑HazMat-7 Required for Confined Fires. 5 .[]Diesel fuel/fuel Oil:vehicle fuel tank or portable 58 Bus. & Residential ❑ ilWdland Fire-8 1FIDetector alerted occupants 6 []Household solvents: home/office spill, cleanup only 59 Office use nX Apparatus-9 7 ❑Motor oil: from engine or portable container 60 Industrial use QPersonnel-10 2E]Detector did not alert them 8 ❑paint: from paint ans totaling<ss gallons 63 Military use Arson-11 65 Farm use ❑ O Unknown 0 ElOther: special Harmat actions required or spill>55ga1., QQ rJOther mixed use Please,coinolete-the Harmat form J Property Use* Structures 341[:]Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs . 342❑Doctor/dentist office - 57 9 []Motor vehicle/boat sales/repair 131 ❑Church, place of worship 361 Prison or ail .not juvenile❑ j � ] 571 ❑Gas or service station 161 ❑Restaurant or cafeteria 419 1-or 2-family dwellin❑ y g 599 Business office 162 ❑Bar/Tavern or nightclub -429❑Multi-family dwelling 615 ❑Electric generating plant 213 ❑Elementary school or kindergarten 439❑Rooming/boarding house •629 ❑Laboratory/science lab 215 ❑High school or junior high 449❑Commercial hotel or motel 700 ❑Manufacturing plant 241 College, adult education ❑ 459❑Residential, board and Gaze $19 ❑Livestock/poultry storage(barn) 311 ❑Care facility for the aged 464 onresentia 331 ❑Hospital ❑Dormito�/barracks 882 ❑N - id l parking garage 519❑Food and beverage sales 691 ❑Warehouse Outside 936❑vacant lot 981 ❑Construction site 124 ❑Playground or park 938 ❑Graded/care for.plot of land 984 ❑ Industrial plant yard 655 ❑Crops or orchard 946 ❑Lake, river, stream 669 ❑Forest (timberland) 951 Railroad ri ht of Lookup and enter a Property Use code only if ❑ wa g y you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 Other street ❑ Property Use 1400' 919 ❑Dump or sanitary landfill -. 961 ❑Highway/divided highway 931 ❑Open land or field 962 ❑Residential street/driveway lResidential, Other. NFIRS-1 Revision 03 11 9 Hyannis Fire Department 01922 01/13/2018 18-0000266 f R1 Person/Entity Involved 'Local Option ' I Business name (if applicable) I f I Area Code Phone Number ' f ❑Check This Box if Mr.,Ms., Mrs. First Name - MI Last Name same address as Suffix incident location. Then skip the three duplicate address lines. Number ?refix Street or Highway Street Type Suffix Post Office Box Apt./Suite/Room City State Zip Code More people involved? Check this box and attach.Supplemental Forms (NFIRS-SS) as necessary I �2 ownerSame as person involved? El Then check this box and skip The rest of this section. Local Option Business name (if Applicable) I I .Area Code. Phone Number ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. I I L Then skip the three L—J duplicate address Number Prefix Street or Highway Street Type Suffix lines.. I I .� I - (Post Office Box - Apt./Suite/Room .City - - State Zip Code - L Remarks Local Option . Caller Name DEAK Caller Phone 617-833-1139 cad ; 2018/01/13 17:44:30 - 826 AT EVENT MANNING IS 4 cad ; 2018/01/13 17:44:34 - 829 AT EVENT MANNING IS 0 cad ; 2018/01/13 17:45:24 - 802 AT EVENT MANNING IS 1 cad ; 2018/01/13 17:58:30 - 823 AT EVENT MANNING IS 6 cad 2018/01/13 18:07:46 - 806 AT EVENT MANNING IS 1 . cad 2018/01/13 18:19:11 - 53 YAR AMB AT EVENT MANNING IS 0 cad 2018/01/13 19:19:05 - 305 COMM ENG AT EVENT MANNING IS 0 cad 2018/01/13 19:19:38 - 202 BAR ENG AT EVENT MANNING IS 0 cad 2018/01/13 17:42:39 REPORTED STRUCTURE FIRE cad ; 2018/01/13 17:45:40 HEAVY FIRE SIDE C 2.5 STORY WOOD FRAME, HANDLINE GOING INTO OPERATION cad ; 2018/01/13 18:04:35 BULK OF FIRE KNOCKED DOWN, CO'S SEARCHING cad ; 2018/01/13 18:05:09 BURN VICTIM, MED. FLIGHT REQUESTED, 25 MIN ETA L Authorization 1201102 lWebb, David M. IIFFt/EMT-P I 1 01 14 2018 Officer in charge ID Signature Position or rank Assignment Month Day Year Check Box if® 1201102 Webb, David M. I FF/EMT-P ) ( �J U 2018 same as officer Member making report ID Signature - Position or rank Assignment - Month Day Year in charge. - Hyannis Fire Department 01922 01/13/2018 18-0000266 i MM DD YYYY _D1922 U 11 13 2018 ( 1 18-0000266 '000 complete FDID State Incident Date Station Incident Number Exposure Narrative Narrative: Caller Name DEAK Caller Phone 617-833-1139 cad ; 2018/01/13 17:44:30 - 826 AT EVENT MANNING IS 4 cad ; 2018/01/13 17:44:34 - 829 AT EVENT MANNING IS 0 cad 2018/01/13 17:45:24 - 802 AT EVENT MANNING IS 1 cad 2018/01/13 17:58:30 .- 823 AT EVENT MANNING IS 6 cad 2018/01/13 18:07:46 - 806 �AT EVENT MANNING IS l cad 2018/01/13 18:19:11 - 53 YAR AMB AT EVENT MANNING IS 0 cad 2018/01/13 19:19:05 - 305_COMM_ENG AT EVENT MANNING IS 0 cad 2018/01/13 19:19:38 - 202 BAR ENG AT EVENT MANNING IS 0 cad ; 2018/01/13 17:42:39 REPORTED STRUCTURE FIRE cad ; 2018/01/13 17:45:40 HEAVY FIRE SIDE C 2.5 STORY WOOD FRAME, HANDLINE GOING INTO OPERATION cad 2018/01/13 18:04:35 BULK OF FIRE KNOCKED DOWN, CO'S SEARCHING cad 2018/01/13 18:05:09 BURN VICTIM, MED FLIGHT REQUESTED, 25 MIN ETA cad 2018/01/13 18:05:49 WB294, Y57 TO•HYFD HQ cad ; 2018/01/13 18:31:36 Y53 AT THE AIRPORT WITH BURN VICTIM, MEDFLIGHT 5MIN OUT cad ; 2018/01/13 18:14:14 UTILITIES SECURED cad ; 2018/01/13 18:35:55 COMMAND REPORTS NO EXTENSION, SECONDARY SEARCH BEING CONDUCTED cad ; 2018/01/13 18:46:38 COMMAND REQUESTING C800 FOR EQUIPMENT AND TOOLS cad ; 2018/01/13 19:15:50 RELEASING M/A COMPANIES, E826 REMAINING ON 'SCENE cad ; 2018/01/13 20:06:37 NATIONAL GRID TO LOCATION cad 2018/01/13 20:12:56 NSTAR ON LOCATION cad 2018/01/13 20:13:25 CAR 806 REMAINING ON SCENE WITH GAS AND ELECTRIC CO Hyannis Fire Department 01922 01/13/2018 18-0000266 MM DD YYYY i01922 U u LL3J 2018 A 18-0000266 000 complete FDID * State* Incident Date * Station Incident Number * Exposure * Narrative Narrative: Received a 911 call by a neighbor of 48 Betty's Pond Rd for a structure fire. The caller reported that the occupant of the house is confined to,his bed. Responded with 4 members on Engine 826 and 5 members on Tower 829. Fire alarm toned out •a first.alarm assignment. While en route, Fire Alarm advised responding units that the occupant is out of the building and PD report that the house is fully involved with fire. While responded (@ West End Rotary) we visualized large amounts of grey smoke coming from the rear, of -a,Betty's Pond Rd. structure and fire coming from 2-3 ventilation points. I decided to direct FF Morizio to attach supply line to hydrant and 826 forward laid to structure fire from the hydrant on intersection of West Main and Betty's Pond. Once at the hydrant, I reported to FA that we had heavy fire and smoke from side Charlie of the structure and to go to a "working fire" assignment. Engine '826 laid approx. 600-700' of 4" supply line and positioned on side alpha/bravo corner. Tower 829 positioned on side alpha/delta corner. Once dismounted from 826, I directed FF Austin to pull a. l 3/4 handline from the rear gated wye down the side delta driveway. The fire victim was being attended' to by 2 BPD officers. The victim was alert and conscious, FA already requested a mutual ambulance to the scene. Both, 826 and 829 drivers attended to the fire victim until Yarmouth Ambulance' 53 arrived. Approximately 1 minute after first FD unit's arrival, 802 arrived and took command. There was heavy fire and dark grey smoke venting from 3 ventilation points on'th_e large first floor side Charlie bedroom. FF Austin and I took the charged 1 -%" handline into side Delta/Charlie doorway into fire room for fire extinguishment. 829's crew split up into 2 units. One was the back-up 1 %" handline and extinguished fire on side Charlie windows. The • t other crew began a primary search of lst floor and '2nd floor of the main building. 8291s back-up line crew entered fire room's door behind 826's crew to perform primary search of rooms involved with fire once they could gain access past 826's-handline. Fire was under control in approx.15 minutes. Secondary searches were conducted, nothing found. 806 and 802 (Command) began the initial fire investigation. All first arriving units claim that there were no smoke detectors activated. It appears that many of the house's detectors are disconnected from being . hardwired, missing, or back-up batteries are missing.- ,Gas and Electrical representatives were requested for utilities disconnects. 806 disconnected gas at the meter. BCI responded to scene for photos. Significant overhaul was conducted on the fire room by multiple `HyFD and mutual aid units. Eversource disconnected the electric to the building, National Grid secured the gas service to the building, and Wayland Restoration was requested for securing the property. The ex-wife and property rep for the house denied via phone to respond and sign for approval of Wayland Restoration to secure property. The property was left unsecured at the property reps request. Lt. Webb 1/14/18 Report of Deputy Chief Dean L. Melanson I responded from home for this reported structure fire. While enroute 'on North Street I was"• able to visualize this home and saw mulitple colums of fire coming ••from the sturcture.I •am familiar with this home, having responded here before. I arrived on Betty's Pond and began a scene size up. I observed the operators of L-829 and E-826 tending to ,a burned occpant on the Hyannis Fire Department 01922 01/13/2018 18-0000266 MM DD YYYY ,01922 U I 13 2018 u 18-0000266 000 complete FDID * State* Incident Date * Station Incident Number * Exposure * _ Narrative Narrative: ground at the street. I spoke .with him briefly and he stated he was the only one home. I conducted a size up of the building and observed that theobvious fire was .located in the one story rear portion of the structure with fire 'fire coming out the exterior windows and doors of this bedroom, the occupants bedroom. Crews has stretched one handline to the driveway area and were in the process of stretching another handline. My360 of the building revealed burning vinyl siding had dropped down inot a debris pile and a lower flat'roof on the C Side. We had non- .pressurized smoke coming from the front two story section on both floors, all doors and windows of the 2 story building were intact, closed and-did not appear to have any smoke staining. The first floor windows located on the B Side. Deck.area closets to .the bedroom showed smoke staining but no heat cracks. I was able to enter the 2 story section of the home through the D Side main door. I encountered moderate warm smoke. I heard a device - possibly a CO detector beep once or twice. Smoke conditions thickened as I moved towrds the dining room and hall to the fire bedroom. I exited and closed the exterior door behind me. The first handline was begining to make an interior fire attack. I directed the 2nd line- to attack the exterior over-lapping fire coming out on the C-Side as well as .the drop down fires. Car 807 (Cap.t Kenney along with E-826 FF Morizio and L-829 FF Dalmau) were now on scene and I combined them into and adhoc company•. under Captain Kenny. I assigned them to conduct a primary search of the main building as well as look for any fire extesnion inot .this area., I made the members on the back up ,line aware of this and they repositioned inot the D Side driveway to be able to move to this area if needed. The fire was quickly knocked down. C-807 reported no obvious fire .extension inot the main building and negative results on the primary search. L-829 reported negative results on the primary search of the fire area. I spoke with the members providing patient care and requested that Flre Alarm get the availability of a Med-Flight helo in the event the patinet need to be flown to a burn center. COMM Engine 305 arrived on scene, set-up at the hydrant and then moved the supply hose line out of the street to facilitate getting Yarmouth ambulance 53 up to the patient. •yarmouth 53 arrived and began patient care. Through C-MED theu' confirmed the. need for a Med-Flight Helo. They then responded to Barnstable Municipal Airport to meet Med-Flight. Fire Alarm was. in direct contact with the Med-Flight Helo and requested a patient status update which I gaveto Fire Alarm a brief patient. COMM E-305 reported up to the scene along wtith Barnstable E-202. E-305 relieved HyFD units low on air and E-202 was assinged RIT. + C-806 (Capt/FPO Rex) arrived on scene and began an investigation. He was able to have a discussion with the occupant before he was ttransported.and learned that the occupant had accidentally casued the fire -See fire inevtigation report. Based on this information and t hat provided by the bystanders who had removed the occupant to the street we were able to release the fire area for final overhaul and extinguishment. Crews were rotated through assingements. E-823 arrived and secured the utilities. Secondary searched were conducted through the entire building with negative results. Overhaul operations determiend that the fire had not spread to the main building, the fire area was opened up, debris was brought outside and wet down. All areas were checked multiple times for hot spots and other issues. The building and the debris were given one final wet down and we then began clearing the fire apparratus. I spoke with family members who were on scene (cousins from Alabama) but they .did not desire to take control of the property. They contacted the ex-wife of the occupant (who had some control of the property as she was said to still be on the deed) Captain Rex stayed on scene to attempt to work out someone taking control of the property. I spoke with Captain Rex via cell phone and he stated that the',ex-wife stated she was 'not able to come to the scene to take control of" the property or get a restoration company to be Hyannis Fire Department 01922 01/13/2018 18-0000266 MM D''D YYYY 01922 U 1 J LIJ3 2018 18-0000266 000 Complete MID State Incident Date Station Incident Number } Narrative _ * Exposure. * .. Narrative: authorized to board up the home. As such we had Fire -Alarm request the Electric and Gas companies respond to the scene to properly secure their utilities. Once this was accomplsihed C-806 cleared the scene. Hyannis Fire Department 01922 01/13/2018 18-0000266 - MM DD YYYY ❑Delete 101922 I U 01 13 2018 1 I18"-0000266 I 000 ❑Change _ir -2 Fire FDID * State* Incident Date * Station Incident Number * Exposure * ❑No Activity B Property Details C On-Site Materials[:]None Complete if [here were any significant amounts of commercial,industrial, energy or OT Productsagricultural products or materials on the Property, whether or not they became involved Enter up to three codes. Check one Bl I 0 0 02I ❑Not Residential or more boxes 1.for each code entered. l Bulk storage or warehousing Estimated Number of residential living units in I ' I 12 Processing Or manufacturing building of origin whether or not all units On-site materialmaterial (1) 3 Packaged goods for sale became involved 4 Repair or service ' 1 Bulk storage or warehousing $2 I 001I ❑Buildings not involved ° �J I 12 Processing or manufacturing Number of buildings involved On-site material (2) 3 Packaged goods for sale 4 Repair or service B3 I ❑None 1 Bulk storage or warehousing Acres burned I 12 Processing or manufacturing (outside fires) []Less than one acre on-site material (3) 3 Packaged goods for sale 4 Repair or-service Cause O Ignition Human Factors D Ignition El ❑check box if this is an exposure report. Contributing To Ignition skip to section G Check all applicable boxes Dl 121 1 jBedroom - < 5 persons,, .I 1 ❑Intentional 1 [:]Asleep ❑None Area of fire origin * 2 []Unintentional. 2 ❑Possibly impaired by 3 ❑Failure of equipment or heat source alcohol or drugs D2 ��T � Undetermined I 4 [:]Act of nature 3 ❑Unattended person l� I 5 ©Cause under investigation 4 [:]Possibly mental disabled Heat source * U Cause undetermined after investigation; 5 ®Physically Disabled D3 LW Undetermined E2 Factors Contributing To Ignition 6 [:]Multiple persons involved � � Item first ignited* i Check Box if fire spr ®None 7 ❑Age was a factor ❑was confined to object LW I (Undetermined of origin I Estimated age of Factor Contributing To Ignition (1) D41 I I person envolved Type of Required only if item first) first ignited ignited code is 00 or <70 (-� Factor Contributing To Ignition (2) 1 ❑Male Q ❑Female Fl Equipment Involved In Ignition F2 Equipment Power G� Fire Suppression Factors ❑None If Equipment was not involved,Skip to Section G L I Enter up to three.codes. [:]None Equipment Power Source Equipment Involved F3 Equipment Portability 1� Fire suppression factor (1) - Brand I I 1 ❑Portable Model I I 2 ❑Stationary Firsuppression factor (2) Serial #I I Portable equipment normally can be moved by one person, is designed t I be use in multiple locations, and U Year I ) Fire suppression factor (3) requires no tools to install. gl Mobile Property Involved $2 Mobile Property Type & Make Local Use ❑Pre-Fire Plan Available ❑None some of the information presented in this report may be based upon reports 1 ❑Not involved in ignition, but burned Mobile property type from other'Agencies 2 ❑ [:]Arson report attached Involved in ignition, but did not burn - 3 ❑Involved in ignition and burned []Police report attached „ Mobile property make . ❑Coroner report attached [:]Other reports attached Moblie property model Year _ License Plate Number - State VIN Number NFIRS-2 Revision 01/19/99 Hyannis Fire Department 01922 01/13/2018 18-0000266 IStructure Type* 12 Building Status * I3 Building* 14 Main Floor Size* 14FIRS-3 If Fire was In enclosed building or a portable/mobile structure complete Height Structure the rest of this form _ _ Count the ROOF as part Fire 1 ®Enclosed Building 1 [:]Under construction of the highest story 2 ❑Portable/mobile structure 2®occupied S operating 3 ❑Open structure 3❑idle, not routinely used 1002 u , 1 002 , 1 100 4 ❑ Under major renovation Total namber of atoriea Total square feet 4 ❑Air supported structure at or abo a grade 5 ❑Tent 5❑Vacant and secured '�R i '6❑Vacant and unsecured 6 ❑Open platform (e.g. piers) 1 001 7 ❑Under round structure 7 [:]Being demolished Total wear of atoriea I � ' g (work areas) ❑ l� 1 BY below grade u ❑Connective structure O other , 070 , 030 8 (e.g. fences) - 0 ❑Other type of structure U❑Undetermined Lenght in feet Width in feet J1 Fire Origin * J3 Number.of Stories K Material Contributing Most Damaged By Flame To Flame Spread [:]Below Grade Count the ROOF.as part of the highest story Ski To 001 El OR if no flame spread p Story Of fire Origin - - - OR same as material first ignited Section L Number of storied w/ minor damage OR unable:to determine (1 to 24% flame damage) J2 Fire Spread* R1 Number of stories w/ significant damage 1 ❑Confined to object of origin (25 to 49% flame damage) Item contributing.most to flame spread 2 ®Confined to room of origin Number of stories w/ heavy damage K2 3 ❑Confined to floor of origin (50 to 74% flame damage) i� - _ _ Type of material contributing - Required only if item 4 ❑Confined to building of origin - most of flame spread contributing Number of stories w/ extreme damage 5 ❑Beyond building of origin (75 to 100% flame damage) code is 00 or<70 Ll Presence of Detectors * L3 Detector-Power Supply L5 Detector Effectiveness (In area of the fire) Required if detector operated N ❑None Present Skip to 1 ❑Battery only section M 2 ❑Hardwire only 1 ❑Alerted Occupants, occupants responded 1 ®Present 3 ❑Plug in 2 []Occupants failed to respond 4 ®Hardwire with battery 3 ❑There were no occupants. U ❑Undetermined 5 ❑Plug in with battery 4 ❑Failed to alert occupants 6 ❑Mechanical U Undetermined L2 Detector Type 7 ❑Muitple detectors s power supplies L6 Detector Failure Reason 1 ®Smoke 0 ❑Other Required if detector failed to operate . 2 ❑Heat U❑Undetermined 1 [:]Power failure, shutoff or disconnect 3 ❑Combination smoke - heat L4 Detector Operation 2 [:]Improper installation or placement 4 ❑Sprinkler, water flow detection 1 ❑Fire too small 3 ❑Defective to activate 4 ❑Lack of maintenance, includes cleaning 5 ❑More than 1 type present 2 ❑Operated 5 ®Battery missing or disconnected O Mother (Complete Section L5) 6 ❑Battery discharged or dead 3 PgFailed to Operate 0 ❑Other (Complete Section L6) , U❑Undetermined U❑undetermined U ❑Undetermined Ml Presence of Automatic Extinguishment System * M3 Automatic Extinguishment Automatic Extinguishment N ®None Present System Operation System Failure Reason Required if fire was within designed range Complete rest Required if system failed - 1 ❑Present of Section M 1 ❑Operated 6 effective (Go to M4 Type of Automatic Extinguishment System 2 ❑Operated & not effective (M4)1 El system shut off Required if fire was within designed ran 3 [:]Fire too small to activate 2 ❑Not enough agent discharged gn range of AEs 1 ❑Wet pipe sprinkler. 4 []Failed,to operate (Go to M5) 3 ❑Agent discharged but did 0 ❑Other not reach fire 2 ❑Dry pipe sprinkler 4 ❑Wrong type of system 3 ❑Other sprinkler system U❑Undetermined 5 F1 Fire not in area protected 4 ❑Dry chemical system 6 []System components damaged 5 stem M4 Number of Sprinkler - ❑Foams y Heads Operating 1 7 ❑Lack of maintenance 6 ❑Halogen type system ❑ $ Manual Intervention 7 ❑Carbon dioxide (CO 2) system Required if system operated, 0 Other 0 ❑Other special' hazard system U❑Undetermined U Undetermined Number of sprinkler heads operating NFIRS-3 Revision 01/19/99 Hyannis Fire Department 01922 01/13/2018 18-0000266 YYYY NFIRS - 4 ' •01922 MA 11 1 13 1 I Delete 2018 18-0000266 000 civilian Fire FDID * State* Incident Date * Station Incident Number * Exposure * ❑Change Casualty $ Injured Person * 1 ®male 2 ❑Female C Casualty Number Thomas I I Russell ( I 1J 1LE�3��ame '�` a9 Name u iX Casualty Number D Age E1 Race F Affiliation H Severity White 1 ❑ 1 ®Civilian 63 Months(for Infants) 2 Black ❑ ® 2 ❑EMS; not fire department Age 3 ❑Am. Indian,Eskimo 3 [:]Police 1 [-]Minor 4 ❑Asian 0El Other ❑Other, multi-racial 2 ®Moderate ❑Hispanic Month Day Year Hour Minutes - I Cause of Injury J Human Factors K Factors Contributing 1 ®Exposed to fire products including Contributing to Injury to Injury flame heat,smoke, & gas ❑None ❑None 2xposeo toxic um es other Enter up to three contribut ing factors [:]Exposed t ti f Check all applicable boxes than smoke u 3 ❑Jumped in escape attempt 1 ❑Asleep Contributing factor (1) 4 ❑Fell, slipped or tripped 2 ❑Unconscious 5 ❑Caught or trapped 3 []Possibly impaired by alcohol 6 ❑structural collapse 4 ❑Possibly impaired 7 ❑Struck by/or contact with object by other drug Contributing factor (2) 8 ❑Overexertion 5 ❑Possibly mentally disabled 9 ❑Multiple causes 6 ®Physically disabled 0 ❑Other 7 ❑Physically restrained U❑Undetermined 8 ❑Unattended person Contributing factor.(3) L Activity When Injured Ml Location at Time of Incident M3 Story at Time of Incident Complete ONLY if injury occurred INSIDE 1 ❑In area of origin and not involved Story at START of incident I I Below Grade 1 ❑Escaping 2 ❑Not in area of origin & not involved - 4�❑ 2 []Rescue attempt 3 ❑Not in area of origin, but involved 3 ]Fire control 4 ®In area or origin and involved M4 Story Where Injury Occurred 4 ❑Return to fire before U []Undetermined Story where I injury ❑Below Grade COntT01 ,occurred, if different 5 ❑Return to fire after M2 General Location at Time of Injury from M3 Check ONE Box. If undetermined, leave - control blank and skip to Section N. 6 ❑Sleeping M5 Specific Location at Time of Injury 7 t t bl Unae o act Skip To ® 1 ®In area. of fire origin complete ONLY if casualty NOT in area of origin` 8act Section N [-]Irrational 2 [:]Inbuilding, but not in area I. 0 ❑Other 3 ❑Outside, but not in area 21 (Bedroom - < 5 persons; U❑Undetermined Skip o Specific location at time of injury Section M5 N Primary Apparent Symptom Q :Primary Area of Body Injured Q Disposition 01❑Smoke only, asphyxiation 1 Head 11❑Burns & smoke inhalation ❑ ®Transported to emergency care facility 2 ❑Neck & shoulder 12®Burns only 3 ❑Thorax Remarks Local option 21❑Cut, laceration 4 ❑Abdomen 33❑Strain or sprain 5 []Spine 96❑Shock 98❑Pain only 6 ❑Upper extremities Look up code only if the symptom is NOT found above 7 ❑$ ❑Internal . Primary apparent symptom 9 ®Multiple body parts NFIRS-4 Revision 11/17/98 Hyannis Fire Department 01922 01/13/2018 18-0000266 1 DD YYYY 1 .- 01922 U �1 13 2018 1 J 18-0006266 000 Delete SIRS - 11 Arson Ex FDID * State* Incident Date * Station Incident Number * Exposure Change $ Agency Referred To None Street Address _ - Their Case Number (Agency Name ' I 'City I I - I Their ORI - u Agency Phone Number State Zip Code Their Federal Identifier (FID) Their FDID C Case Status D Availability of Material First Ignited 1 n Investigation open 4 Closed with arrest 1 QTransport to scene 2 ®Investigation closed 5 ❑Closed with exceptional 2 ®Available at.scene 3 FlInvestigation inactive clearance U Unknown E,' Suspected Motivation Factors Check up to three factors.; 42 El vanity/recognition 54 Burglary 11 FlExtortion 22 ❑Hate crime 43 ❑Thrills 61 Homicide concealment 12 Labor unrest 23 Q Institutional 44 ❑Attention/sympathy 62 [:]Burglary concealment 13 ❑Insurance fraud 24 n Societal 45 Sexual excitement 63 Auto theft consealment 14 ❑Intimidation 31 F1 Protest 51 Homicide 64 Destroy records/evidence 15 n Void contract/lease 32 Flcivil unrest 52 Suicide 00 ElOther motivation 21 ❑Personal 41 Fireplay/curiosity 53 Domestic violence UU ❑Unknown motivation F Apparent Group Involvement H Incendiary Devices select one from each category Check 1 ❑Terrorist group up to CONTAINER NN None three factors - 2 FlGang 11.Q Bottle (Glass) 14 Pressurized Container 17 ❑Box 3 Anti-government group 12 Bottle (Plastic) 15 [:]can. 00 ElOther Container 4 FlOutlaw motorcycle organiation 13 Jug 16 Q Gasoline or fuel can UU Unknown 5 Elorganized crime 6 Racial/ethnic hate group IGNITION/DELAY DEVICE' 7 Religious hate group 11 []Wick or Fuse .17 ❑Road flare/fuse NN E]None 8 FISexual preference hate group 0 Other group 12 Candle 18 Chemical Component N No Group involvement, acted alone 13 ❑Cigarette a Matchbook 19 Trailer/Streamer U ❑Unknown 14 Q Electronic Component 20 open flame source 15 ElMechanical Device 00 Other delay device Gl Entry Method 16 Remote Control UU Unknown FUEL NN None Entry Method G 11'Q Ordinary Combustibles 16 ❑Pyrotechnic material 2 Extent of Fire Involvement on Arrival 12 �Flammable gas 17 �Explo.sive material. U (Flame and smoke showing 14 ❑Ignitable liquid 00 ❑Other material Extent of Fire Involvement 15 Ignitable solid Utz Unknown I Other Investigative Information J Property Ownership K Initial Observations Check all that apply , Check all that apply �Code violations 1 Windows ajar 5 Fire department forced entry 1 - 1 ®Private 2 Doors ajar 6 Forced entry erior to FD arrival 2 Structure for sale 2 E]City,town village,local -3 Doors locked 7 El Security system activated 3 Structure vacant 3 County or parish 4 ,®Doors unlocked-.8 ❑Security-present,(didn't activate) 4 Other crimes involved' 4 [:]State or province 5 Illicit drug activity 5 Federal L Laboratory Used Check all that apply 6 Change in insurance 6 F1 Foreign 7 Financial problem 7 E]Military 1 Local 3 E]ATF 5 Other 6 �Private 8 Criminal/Civil 0 Other 2 State 4 FBI Federal N ®None actions pending NFIRS-11 Revision 11/17/98 Hyannis Fire Department 01922 01/13/2018 18-0000266 SST l /;�. ti __...._.._._ i I • i j - � 9 g,,, d } ~.2 a A �,rlf".f'l;+'js•`�.'�,�Ld�'''�' �' .+',i< •�:�;,; �'•rT,a�i'C'�' Er��,�' 4 3t -w?r...w :n .. . wr a:..ezx,.•wp ,ai.. „3. ...� .-- m;..�... n ..er> o.-,R .,..«...,,w- ,z.s.. f' -^{ .a. .s.,..'e,.. w .... 4_a;rF." `4•ea.-. +!;" 'W.'' ."t'f"""aW.,.. ,YF"." .."a.`..." 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I - . �' .-I # :'} -- This certificate indicates acce table miiumum'habitable.'re u�rements`er Massachu`1.1 setts%State Bu'ild�n Code ` ' *. :, w P . 9 P ', g ti �r .. 11.� and Town of Barnstable zonin ordinances m accordance with the Amnest `"ro ram:?' 11g g GYP111� � � 3 t Y t;t `Ovine Thoriz"11as J Russell &;Michelle D Ru'ssell y Y ' •n r a ;`t ,.rE. ' i €3` 5 a7 f �¢ t* f , Location ;'44 Bett s Pond Road H annis M f ,.ry ` 1. Y Y A° J Unit Ca `acit necbe oom riot toexceed,two eo le ' " P Y Inspector � . __ W 11 .I - �-'� 2� x.:: i kax 1. M/P No �292092001 �1.11 '> w �i , rx 3/10/2008 t ;..� t� * . I . ,r - ,. , .. . .. ,..' '� _S., i .. _ ._.. , ,. .,.� . ..... ,. ... ...�1...,,d,,...r......,....w.......,.+ {. .............. t.....u.w_v t{r t r �t�Eti Town of Barnstable Building Department - 200 Main Street ASTABLE, * a Hyannis, MA 02601 9�A b a� (508) 862-4038 of . Occu anc Certifica' tey Application Number: 200801015 _ CO Number: 20080043 Parcel ID: 290092001 - CO Issue Date: 03105/08 q Location: 44 BETTY'S POND ROAD T Zoning Classification: RESIDENCE B DISTRICT Village: HYANNIS Gen Contractor: PROPERTY OWNER Permit Type: RC00 , � CERTIFICATE OF, OCCUPANCY RES. Comments: � ;.f Building Department Signature Date Signed SINE , TOWN OF BARNSTABLE Building °�► Application Ref: 200801015 Permit * aAxxszASLE, + Issue Date: 02/26/08 _ 9 MASS. Qppr117 9.at Applicant: RUSSELL,THOMAS J&MICHELLE Permit Number: B 20080362 Proposed Use: SINGLE FAMILY HOME Expiration Date: 08/25/08 Location 44 BETTY'S POND ROAD Zoning District RB Permit Type: AMNESTY APT NO CONSTRUCT RES Map Parcel 290092001 Permit Fee$ 25.00 Contractor PROPERTY OWNER Village , HYANNIS App Fee$ License Num OWNER Est Construction Cost$ 0 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND AMNESTY APARTMENT WITH NO NEW CONSTRUCTION THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: RUSSELL,THOMAS ju MICHELLE BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 44 BETTY'S POND ROAD INSPECTION HAS BEE MADE. HYANNIS, MA 02601 Application Entered by: LB Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET ALLY,OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PE ANENTLY. ENCROACHEMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED'.UNDER THE BUILDING.CODE,MUST.BE APPROVED BY THE RISDICTION'. STREET:OR ALLY.GRADES AS WELL AS DEPTH AND-LOCATION OF PUBLIC SEWERS"MAY BEOBTAINED FROM THE DEPARTMENT OF PUBLIbWORKS THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE.ACCESS TO GUARANTY FUND(as.set forth in MGL c.142A). Ss BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 3 d rC 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Healih M,ri ell + }} a 1 4 I J , �1 A „ i v wry 1 I r y9 . , ��I'/'.✓�/."*��..W i�P� /��'� �,-.i�3°'/'�--.f�•-.�.v'e:: ale':'r,,r feel.i�i.�•. �'..s'',.�,: i 9. q r op 2ST� f G-.c 162 /0 i Barry, Lois Subject: Thomas J. Russell Location: 44 Betty's Pond Rd Hyannis MA 02601 Start: Wed 5/12/2010 3:30 PM End: Wed 5/12/2010 4:00 PM Show Time As: Tentative Recurrence: (none) Meeting Status: Not yet responded Required Attendees: Dabkowski, Cindy; Perry, Tom Hello Mr. Perry This address has an active Accessory Affordable Apartment; Comprehensive Permit No. 2007-112. 1 need to go over the conditions of the Comprehensive Permit with Mr. Russell and collect outstanding monitoring documents. There has not been a site visit since 2006. Cindy Dabkowski { �. .. �� .� �, � / �� Co � � _ - - - Barnstable Assessing,Search Results FOP Open or Screened in Porch TQS Three Quarter' l Town of Barnstable Regulatory Services .• Thomas F. Geiler, Director wnvsreate.MASS 9� 1639. .�� Public Health DiVl*SI* QED IVIA�A Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 10 2007 Ms Michelle Russell 44 Betty's pond Road Hyannis,MA 02401 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,Title 5 The septic system owned by you located 44 Betty's Pond Road,Hyannis, MA was last ° inspected December 6"`2006 b ames D. Sears, certified septic inspector for the State of Massachusetts. The inspection of your septic system.showed that your system"fails" under the guidelines of 1995 TITLE 5 (310 CMR 15.00)clue to the following: Leaching pit was full,backing up into D-Box and.septic tank was full of waste. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HE TH DEPARTMENT T om c ean,R.S., C.H.O. Agent of the Board of Health h� ,. Fee —c No. . . i 1. Entered in computer: THE CO MONWEALT�H OF MASSACHUSETTS 00-0-6 .PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ` Zipplication for �Diopooal ,pgtem COMtruction Permit Application for a Permit to Construct( ) Repair(kj Upgrade ] Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No.44 �fJA/�` Y�Z(d�7 Owner's Name,Address,anfl/Tel�]�Io, c� h`Y� .�9 ��4���1�f�©Sn�/1� �rivjSa�� Assessor'sMap/Parcel Z9d 92'- 1 Installer's N e,Address,a Tel.No. Designer's Name A�dr�S�an_3 TP�IN Type of Building: Dwelling No.of Bedrooms Lot Size ZO ge�O sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 4-44 gpd Plan Date Z-- L lP_ ZaG Number of sheets / �-d Revision Date Title < < - d .�. Type of S.A.S. t UU� Size of Septic Tank erl a,9 x Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Envir mental Code of to place the system in operation until a Certificate of Compliance has been issued by this Board of a Signed- s_ Date Application Approved by Date" 1 Application Disapproved by: Date for the following reasons Permit No. 26 0-1 Date Issued ` THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance -- THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired �O Upgraded (X ) Abandoned( )by �J �� lJ�1cr d r7 f has been cons cted ityaccordance at fl C f ! 8C with the provi ns of 'itle 5 and the for Disposal System Construction Permit dated / r.. -- Installer ��'1h� S�P�� Designer�" St/�✓�° l Approved desi flow �, gpd #bedrooms_ The issuance of this permit shall pt bed c strued as a guarantee that the system furt'�E, gjrl as Designed; Date 7 Inspector L - ----41 ---=-------- f Fee No. ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION=BARNSTABLE, MASSACHUSETTS ligo5af 6pgtem COU,OtructiOtl Permit Permission is hereby granted to C/o%�struct ) /�epair (fir ) Upgrade (X ) Abandon ( ) System located at f��t7 i S r� ((' d)i Pi,S and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. . Provided: Constru tion rr)us�completed within three years of the date of this permit. Date Approved b}I _ I e' bruary 2700& � February 2008 March 2008` MrT;W, T F 'S � S M �'T W T F, ,S F1__ 1 2 1 Wednesday 3 4 5"c 6 7 8 9 2 ,3 ;4 51 6 7 8 . '. 10 1112 13 14 15:16 9101112131415' �V 1819'20 2122 23 ,716 17 18 19 20 2122 + 2425 26 27 29,29 23 2425 26.27 28 29 s 30311 Notes"" am p 00 Office hours v L 900 Code Issues--Jim Bowes(200 Main) 10 00 11 00 7 Senior Managers Meeting (Sel.Conf. Room) . L . i 2 pm L LUNCH 100 571.30"Michelle Russell,508 685 3814,'at 44 Betty's Pond.Rd,.Hyannis,.final"Amnes 00 Site Visit(61 Angell 508 889 0637) c , 2 - 00 3 4 00 5.00 6-00 Y ' Perry,Tom 1 2/26/2008 11:21 AM . F e b r u a �� �0 0� February 2008<° } y'March 2008 . � S.�M Ts W 'T F.'S S•M �T W T F , � 1�.2 ,R 1 Wednesday 3 4 5, 6 7 8 9 T2 3'4�5 6 7 8 , 10111213'14 1516 `.9 10 1112 131415 17�18 19 20 21 22 23. ',` 16 17 18 19 20 2122 2425 262T28 29 2324 25 26 2728 29 ' :30 31 Notes'. am p 00 Office hours v L goo % Code Issues--Jim Bowes(200 Main) 1000 1♦ 00 Senior Managers Meeting •(Sel.Conf. Room) 1 L 12 pm L LUNCH 100. 1:30 Michelle Russell;.508 685;3814,,at 44 Betty's Pond-Rd,Hyannis,•final:Amnes 100 % Site Visit(61 Angell 508 889 0637) 300 Y4 00 5 00 60° Perry,Tom 1 2/26/2008 11:21 AM,. t, I 1 ' i t r i yy ;Roc:- 7-71 ��,��,� ��•��� w i J � } f.. ._._........._...._.__... ...... .. i ! E �i SIP, �, -10 9. q k r 1 ,>'`£ t�I:/;-yy'.�`�'..��",,'•(mid"''!' �` � .+'7s': �I'"��', t.r'',,�,�'� fr;) o3 t PERMIT PAYMENT RECEIPT + � TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 02/26'108 TIME: 09:51 ------------------- ----------- PERMIT $ PAID 50.00 AMT TENDERED: 50.00 ` AMT APPLIED: 50.00 CHANGE: .00 _ APPLICATION NUMBER: 200801015 PAYMENT METH: CHECK PAYMENT REF: 705 TOWN OF BARNSTABLE BUILDING PERMIT APPLIC O 3 Q Map Parcel '00 I/ Permit# �U 0 o Health Division Date Issued Z /�A�T Conservation Division Fee . 6U Tax Collector Appliea ton fee a 6� �ow Treasurer Planning Dept. Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address 44 2khS 2ni 79a4k Village S n/, �C 4- J s�re�/1 Owner Address Telephone �4 g� Permit Request S - Q f Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new evVValuation Zoning District Flood Plain Groundwater Overlay V Construction Type Lot Size ( �51 Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. 1 Dwelling Type: Single Family Two Family O Multi-Family(#units) ; 1� Age of Existing Structure � Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes CV46zo Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 1�� Number of Baths: Full: existing / new Half: existing / new Number of Bedrooms: existing f" new Total Room Count(not including baths): existing 7 - new First Floor Room Count J Heat Type and Fuel: 'Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes �tH1�lo Fireplaces: Existing New Existing wood/coal stove: ❑Yes W-Ro' Detached garage:®'existing ❑new size Pool:0 existing ❑new size Barn:O existing ❑new size Attached garage:O existing ❑new size Shed:�isting 0 new size Other: Zoning Board of Appeals Authorization/Appeal# -7 Recorde Commercial ❑Yes U No If yes,site plan review# Current Use Proposed Use U WW BUILDER INFORMATION " Name (� f�/�J�iC� Telephone Number Address License# 1 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. 1 E. ADDRESS VILLAGE OWNER 4 DATE OF�INSPECTION: C FOUNDATION FRAME INSULATION FIREPLACE i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL , FINAL BUILDING DATE CLOSED OUT i ASSOCIATION PLAN NO. { A'U f Y 1 Bk 22659 P:0161 �676u f 02--08-2008 Q 02-OSP BARNSTAB E ' '07 V b 0 2 P 1 •19 Town of Barnstable Zoning Board of Appeals Comprehensive Permit Decision and Notice Appeal 2007-112-Russell . Decision-Chapter 40B Comprehensive Permit Applicant: Thomas I Russell&Michelle.D.Russell Property Address: 44 Betty's Pond Road,Hyannis,MA Assessor's Map/Parcel: Map 292,Parcel 092-001 Zonfmg' Residential B Zoning District Applicants: The applicants are Thomas&Michelle Russell,who reside at 44 Betty's Pond Road,Hyannis, Thomas&Michelle Russell were granted title to the Propertyya�i , le C Registry of Deeds on September 6, 1994 as recorded in Bo 9353 and Paged20�the Barnstable County Relief Requested; The applicants have applied for a Comprehensive Permit under Chapter 40B of the General Laws of the Commonwealth of Massachusetts, and in accordance with Article II of Chapter Nine of the Code of the town of Barnstable,more commonly termed the"Accessory Affordable Apartment program.,, The zoning relief necessary for this Comprehensive Permit to be issued is that of a variance to Section -. 14 of the Code-Amnesty Program to permit an accessory apartment unit within asingle-famil owner- affordable 9 occupied residential dwelling.The issuance of this Comprehensive Permit would allow for an accessory affordable apartment unit attached to the principal residence. . Locus and Background: The property at issue is a 1.51 acre lot located at 44 Betty's Pond Road in Hyannis. The'lot was developed in 1925 with a single-family cape style home. The effective living area of the main residence is 2,608 square feet.The accessory apartment is a one-bedroom unit attached to the The square footage of the rental area is approximately 575 square feet.The residence. The lot is served by public water and on-site septic,and is located within a Wellhead protection Overlay District.The town of Barnstable's Public Health Division reviewed the application,and on July 18 2007 approved a total of four(4)bedrooms at the property with the existing on-sites tic Procedural Summary; septic system. A site approval letter was issued for the property Town 2007, in accordance with MGL Chapter 40B and 760 CMR. Notice of the siteanager approKlival letter was sen on September t the Department of Housing and Community Development in accordance with the requirements ant to the An application for a Comprehensive Permit was then filed at the Town Clerk's O fi 760. of the Zoning Board of Appeals, Office and the Plan encourages the use of existing housing to create affordable units and the dispersal of these units throughout the town. Finding Summary: Based upon the findings,the Hearing Officer ruled that the applicants have standing to apply for a Comprehensive Permit under MGL Chapter 40B and the Town of Barnstable's Accessory Apartment Program.The proposal is also deemed consistent with local needs because it adequately promotes the objective of providing affordable housing for the town of Barnstable without jeopardizing the health and safety of the occupants provided all conditions of the Comprehensive Permit are strictly followed. Ruling and Conditions: Based upon the findings,a ruling was made to grant the Comprehensive Permit in accordance with MGL Chapter 40B to the applicants,Thomas&Michelle Russell.It is issued to allow for a one-bedroom accessory affordable apartment unit in accordance with the following conditions: 1.Occupancy of the affordable unit shall not exceed two persons. 1 2.The total number of bedrooms on the property with the existing on site septic system shall not exceed four(4). ' 3.The property owners shall occupy the principal dwelling as their principal.residence. 4.This unit shall not be occupied by a family member of the owner(s). 5.All parking for the accessory apartment and the main dwelling shall be on-site and no lodging shall be permitted for the duration of this comprehensive permit. 6.To meet the requirements of affordability,the cost of housing(including utilities)shall not exceed 30%of 80%of the median income for a single individual for the Barnstable MSA. In the event that utilities are separately metered,the utility allowance established by the town of Barnstable shall be deducted from rent level so calculated. 7.All leases shall have a minimum term of one year. 8 The Growth Management Department shall serve as the monitoring agent for the accessory apartment. 9.The applicants must apply for a building permit for the accessory unit,whether the unit is new or pre-existing. Before securing an occupancy permit and certificate of compliance,the Building Commissioner must determine that the unit conforms with the approved plans as submitted with the ` building permit application and meets state building and fire codes.The Health Division must determine that the dwelling is in compliance with applicable on-site wastewater discharge requirements. 10.The.applicants may select their own tenant provided the tenant meets the requirements of the program as cited above and provided that person's income is reviewed and approved by the Growth Management Department of the town of Barnstable as a qualified individual. The applicants will be required to work with the town to provide information necessary to document that the tenant qualifies. The unit shall be rented on an open and fair basis to an income eligible individual or family. Whenever a vacancy occurs,notice must be given to the Growth Management Department and the unit must be listed with the Town. r , 11.Every twelve months the applicants shall review the income eligibility of the individual occupying the unit. No.later than a year from the date of issuance of this Comprehensive Permit,the applicants shall file with the Growth Management Department of the town of Barnstable an annual affidavit listing the rent charged and income level of the occupant of the unit. The applicants shall provide the town any additional information it deems necessary to verify the information provided in the affidavit. Upon any report from the-town that the terms and conditions of this permit are not. being upheld,the Zoning Board of Appeals or it's Hearing Officer shall have the ability to hold a hearing to show cause as to why this permit should not be revoked. 12.This Comprehensive Permit shall not be transferable to any other person or entity without the prior approval of the Hearing Officer or Zoning Board of Appeals. This decision,the Regulatory Agreement and Declaration of Restrictive Covenants and all other necessary documents shall be filed at the Barnstable County Registry of Deeds. If the ownership of the property is transferred,the Growth Management Department of the town of Barnstable shall be notified within 60 days of the name and address of the new owner. 13. This Comprehensive Permit must be exercised and the unit occupied within 12 months of its issuance or it shall expire. Ordered: Comprehensive Permit 2007-112 has been granted with conditions. A written copy of this decision shall be forwarded to the Zoning Board of Appeal as required by the Town of Barnstable Administrative Code Chapter 241,section 11. If after fourteen(14)days from that transmittal the Members of the Zoning Board of Appeals takes no action to reverse the decision,this decision shall become final and a copy shall be the filed in the office of the Town Clerk Appeals of the final decision,if any,shall be made to the Barnstable Superior Court pursuant to MGL Chapter 40A, Section 17,within twenty(20)days after the date of the filing of this decision in the office of the Town Clerk. The applicant has the right to appeal this decision as outlined in MGL Chapter 40B, Section 22. In accordance with Chapter 241,section 11 of the Town of Barnstable Administrative Code,the hearing officer transmitted a written copy of the Comprehensive Permit decision to the Zoning Board of Appeals on November 7,2007. Fourteen(14)days have elapsed since the transmittal to the Board,and no Board Member has taken action to reverse the decision. a� a Gail dightingal6Hearing fficer Date Signed 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 ffice of the Town Clerk Signed and sealed this /AO-A— y o 7 uM-&-the pains and penalties of perjury. j Linda Hutchenrider,Town Clerk REGULATORY AGREEMENT AND DECLARATION OF RESTRICTIVE COVENANTS J THIS REGULAT9�REEMENT and DECLARATION OF RESTRICTIVE COVENANTS,is made this day of ,2008,by and between Thomas J.and Michelle D.Russell of 44 Betty's Pond Road,Hyannis,MA bnd its successors and assigns (hereinafter the "Owner"),and the TOWN OF BARNSTABLE (the"Municipality"),a political subdivision of the Commonwealth; WHEREAS the Owner has been granted a Comprehensive Permit under Massachusetts General Law Chapter 40B and local regulations by the Zoning Board of Appeals to permit the creation of an accessory apartment in an owner occupied dwelling which will be rented to a Low or Moderate Income Person/Family(hereinafter "Designated Affordable Unit");and NOW THEREFORE,in mutual consideration of the agreements and covenants contained herein,and other good and valuable consideration,the receipt and sufficiency of which is hereby acknowledged,the parties agree as follows: I PROJECT'SCOPE AND DESIGN: A. The terms of this Agreement and Covenant regulate the property located at 44 Betty's.Pond Road, Hyannis,MA as further described in deed recorded herewith as Barnstable County Registry of Deeds Book 09353&Page 0207. B. The Project located at 44 Betty's Pond Road,Hyannis,MA will consist of one accessory apartment unit which will be rented to an eligible low or moderate income individual or family(the"Designated Affordable Unit" or the"Unit"). C The Owner agrees to construct the Project in accordance with the terms of comprehensive permit Appeal No.2007-112 and any plans submitted therewith and all applicable state,federal and municipal laws and regulations. Said permit is recorded herewith as Barnstable County Registry of Deeds Book &Page _. D. The Owner agrees to occupy the principal dwelling unit located on the property as their principal residence in accordance with the terms of the comprehensive permit. II. THE OWNER'S COVENANTS AND RESPONSIBILITIES: A. THE OWNER HEREBY REPRESENTS,CbVENANTS AND WARRANTS AS FOLLOWS: 1 In receiving the comprehensive permit to create the Designated Affordable unit,the Owner agreed that the Designated Affordable Unit shall be set aside in perpetuity for the public purpose of providing safe and decent housing to persons earning at or below 80%of the area median income of Barnstable Metropolitan Statistical Area(MSA)and that the Designated Affordable Unit shall be deemed to be impressed with a public trust. 2. The Designated Affordable Unit shall be rented in perpetuity to a household with a maximum income of 80%of the Area Median Income (AW of Barnstable MSA and that rent(including utilities)shall not exceed an amount that is affordable to a household whose income is 80%of the median income of Barnstable MSA. In the event that utilities are separately metered,a utility allowance established by the Barnstable Housing Authority shall be deducted from the rent level 3. The Designated Affordable Unit will be retained as a permanent,year round rental dwelling unit with at least a one-year lease. 4. The Owner has the full legal right,power and authority to execute and deliver this Agreement. 5. The execution and performance of this Agreement by the Owner will not violate or,as applicable,has not violated any provision of law,rule or regulation,or any order of any court or other agency or governmental body,and will not violate.or,as applicable,has not violated any provision of any,indenture,agreement,mortgage, mortgage note,or other instrument to which the Owner is a party or by which it or the Owner is bound,will not result in the creation or imposition of any prohibited encumbrance of any nature. 6. The Owner,at the time of execution and delivery of this Agreement,has good,clear marketable title to the premises. 7. There is no action,suit or proceeding at law or in equity or by or before any governmental . instrumentality or other agency now pending,or,to the knowledge of the Owner,threatened against or affecting it,or any of its properties or rights,which,if adversely determined,would materially impair its right to carry on business substantially as now conducted(and as now contemplated by this Agreement) or would materially adversely affect its financial condition. B. OOMPLIANCE The Owner hereby agrees that any and all requirements of the laws of the Commonwealth of Massachusetts to be satisfied in order for the provisions of this Agreement to constitute restrictions and covenants running with the land shall be deemed to be satisfied in full and that any requirements of privileges of estate are also deemed to be satisfied in full. G 111vIITA710N ON PROFITS 1. The Owner agrees to limit his/her profit by renting the Designated Affordable Unit in perpetuity to a household with a maximum income of 80%or less of the Area Median Income(AW of Barnstable Metropolitan Statistical Area(MBA)and that rent('including utilities)shall not exceed an amount that is affordable to a household whose income is 80%of the median income of Barnstable MSA. In the event that utilities are separately metered,a utility allowance established by the Barnstable Housing Authority shall be deducted from the rent. 2. The Owner shall annually deliver to the Municipality and to the Monitoring Agent,as designated by the Town Manager,proof that the Designated Affordable Unit is rented,the tenant's income verification,a copy of the lease agreement and the rent charged for the unit or units. Such information shall also be forwarded to the Monitoring Agent within 30 days of the occupation of the dwelling unit or units.by a new tenant The Owner shall notify the Monitoring Agent,as designated by the Town Manager,within thirty(30) days of the date that a tenant has vacated the Designated Affordable Unit. III. MUNICIPALITY COVENANTS AND RESPONSIBILITIES 1. .. The MUNICIPALITY,through the monitoring agent designated by the Town Manager agrees to perform the duties of verifying that the Designated Affordable Unit is being rented in perpetuity to a household with a maximum income of 80%or less of the Area Median Income(AW of Barnstable MSA and that rent (including utilities)shall not exceed an amount that is affordable to a household whose income is 80% of the median income of Barnstable MSA.In the event that utilities are separately metered,a utility allowance established by the Barnstable Housing Authority shall be deducted from the rent. IV. REOMING OF AGREEMENT: Upon execution,the OWNER shall immediately cause this Agreement and any amendments hereto to be recorded with the Registry of Deeds for Barnstable County or,if the Project consists.in whole or in part of registered land,file this Agreement and any amendments hereto with the Registry District of the Barnstable Land Court(collectively hereinafter the"Registry of Deeds"),and the Owner shall pay all fees and charges incurred in connection therewith. Upon recording or filling,as applicable,the Owner shall immediately transmit to the Municipality evidence of such recording or filing including the date and instrument,book and page or registration number of the Agreement. 2 V. GOVERNING OF AGREEMENT: This Agreement shall be governed by the laws of the Commonwealth of Massachusetts. Any amendments to this Agreement must be in writing and executed by all of the parties hereto. The invalidity of any clause,part or provision of this Agreement shall not affect the validity of the remaining portions hereof. VI. NOTICE: All notices to be given pursuant to this Agreement shall be in writing and shall be deemed given when delivered by hand or when maned by certified or registered mail,postage prepaid,return receipt requested,to the parties hereto at the addresses set forth below,or to such other place as a party may from time to time designate by written notice. VH. HOLD HARMLESS: The Owner hereby agrees to indemnify and hold harmless the Municipality and/or its delegate from any and all actions or inactions by the Owner,its agents,servants or employees which result in claims made against Municipality and/or its delegate,including but not limited to awards,judgments,out-of-pocket expenses and attorneys fees necessitated by such actions. VIII ENTIRE UNDERSTANDING: A. This Agreement shall constitute'the entire understanding between the parties and any amendments or changes hereto must be in writing,executed by the parties,and appended to this document. B. This Agreement and all of the covenants, agreements and restrictions contained herein shall be deemed to be for the public purpose of providing safe affordable housing and shall be deemed to be, and by these presents are,granted by the Owner to.run in perpetuity in favor of and be held by the Municipality as any other permanent restriction held by a governmental body as that term is used in MGL Cyr.184,Section 26 which shall run with the land described in deed recorded herewith as Barnstable County Registry of Deeds Book 09353 &Page 0207 and shall be binding upon the Owner and all successors in title. This Agreement is made for the benefit of the Municipality and the Municipality shall be deemed to be the holder of the restriction created by this Agreement. The Municipality has determined that the acquiring of such a restriction is in the public interest. The Municipality shall not be subject to the defense of lack of privity of estate. The covenants and restrictions contained in this Agreement shall be deemed to affect the title to the property described in deed recorded herewith as Barnstable County Registry of Deeds Book 09353&Page 0207. IY, TERM OF AGREEMENT: The term of this Agreement shall be perpetual,provided,however,that the Owner of a Designated Affordable Unit or Units may voluntarily cancel the granted Comprehensive Permit and the terms and restrictions imposed herein. Such cancellation shall only take effect after. 1) expiration of the lease terms entered into between the Owner and Tenant occupying said unit and 2)notification by the Owner of said dwelling to the Zoning Board of Appeals of his/her desire to cancel the Comprehensive permit upon a date certain and the recording of said notice at the Barnstable County Registry of Deeds or Barnstable County Registry of the Land Court as the case maybe,thus rendering said Comprehensive Permit void. Upon the cancellation of the comprehensive permit,the propertywhich is the subject matter of this restrictive covenant shall revert to the use permitted under zoning and the restrictive covenant shall be rendered void X. SUCCESSORS AND ASSIGNS: A. The Parties to this Agreement intend,declare,and covenant on behalf of themselves and any successors 3 and assigns their rights and duties as defined in this Regulatory Agreement and the attached comprehensive Permit- B. . The Owner intends,declares,and covenants on behalf of itself and its successors and assigns @ that this Agreement and the covenants,agreements and restrictions contained herein shall be and are covenants running with the land,encumbering the Project for the term of this Agreement,and are binding upon the Owner's successors in title,(ii)are not merely personal covenants of the Owner,and`(in)shall bind the Owner,its successors and assigns and inure to the benefit of the Municipality and its successors and assigns for the term of the Agreement. M. DEFATJLTc If any default,violation or breach by the Owner of this Agreement is not cured to the satisfaction of the Monitoring Agent within thirty(30)days.after notice to the Owner thereof,then the Monitoring Agent may send notification to the Municipality that the Owner is in violation of the terms and conditions hereof. The Municipality may exercise any remedy available to it. The Owner will pay all costs and expenses,including legal fees,incurred by the Monitoring Agent in enforcing this Agreement and the Owner hereby agrees that the Municipality and the Monitoring Agent will have alien on the Project to secure payment of such costs and expenses. The Monitoring Agent may perfect such alien on the Project by recording a certificate setting forth the amount of the costs and expense due and owing in the Registry of Deeds or the Registry of the District Land Court for Barnstable County. A purchaser of the Project or any portion thereof will be liable for the payment of anyunpaid costs and expenses that were the subject of a perfected lien prior to the purchaser's acquisition of the Project or portion thereof. XII. MORTGAGEE CONSENT: The Owner represents and warrants that it has obtained the consent of all existing mortgagees of the Project to the execution and recording of this Agreement and to the terms and conditions hereof and that all such mortgagees have executed consent to this Agreement. IN WITNESS WHEREOF,we hereunto set our hands and seals this day of 2008. OWNS OWNER BY: BY: Signature . Printed:Thomas J.Russell Printed:Michelle D.R sell COMMONWEALTH OF MASSAC HUSETTS County of Barnstable,ss: On this 2Z. da of.Llt-AiA -2008 before me,the undersigned notary public,personally appeared t ,the Owner(s) roved to me through satisfactory evidence of identification,which were ,to be the person(s)whose names)is signed on the preceding or iA documeny a,6448nowledged to be that he/she signed it voluntarily for the stated Notary Public Printed: My Commission Expires: w . M.SCOTT CARR Notary Public ' Commonwealth of Massachusetts 4 .��n My Commission Expires Jun 18,2010 TOWN QP+,BARNSTABLE BY TO MANAGER GOMMONWEALTH OF MASSAC HUSETTS County of Barnstable,ss: On this'3k4 o 2008 before me,the undersigned notary public,personally appeared Tc*m ►m rn�wn Manager for the Town of Barnstable,proved tome through satisfactory. evidence of identification,which were if rh Aumeem-'.ki ,,to be the person whose name is signed on . the preceding or attached document and-acknoVeqed to bkhat he/she signed it voluntarily for the stated purposes. Notaryyublic ` Printed I � �/�-�t My Commission Expires: I OFFICIAL SEAL $t►IRLEE�Y ffTM0FWM My CommJH2 5 .........__._ .. r/3 Fl -51 CA t�l 7 }� r E T`''' i - r 1t f i / f - 9 8 . _. _. a �,._.,,.,..,... :. ., ,r'.3., ' Barry, Lois From: Dillen, Elizabeth Sent: Tuesday, February 26, 2008 10:01 AM To: Barry, Lois Subject: RE: 44 BETTY'S POND ROAD Yes, please-thanks Betk D�Hen Special Projects coorrUnator Grolvt4 Ma:l.agennent Departkisent Town of Barnstable 367 ✓v1ainStreet. Hyannis MA Tel 508.862.4.683 Fax508.862.4782 -----Original Message----- , From: Barry,Lois Sent: Tuesday, February 26, 2008 9:59 AM To: Dillen, Elizabeth Subject: 44 BETTY'S POND ROAD Hi Beth, Shall I sign off on this Amnesty building permit application for you? 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map goo 926a/ Parcel o? ,� Application# Health Division Conservation Division 461�'Y`� d n`' ,`', '; "', �: ( ( Permit# Tax Collector Date Issued Treasurer 1W< <,k'ju Application Fee 64 U0 Planning Dept. Permit Fee - Date Definitive Plan Approved by Planning Board 01C Historic-OKH Preservation/Hyannis Project Street Address _ mil/ SZAEM s lP(W01 Rd Village A Pew r Owner aamoos--. M ch'aLLe Alrs-eLL Address e/Y e77�i} �aar� ,Paf t Telephone $- 6(?5 - 3ffy Oe 5-0ol- 77 -- !Z - IVf,5 2ufd Ala, Permit Request`2em604- C_hAeO Ce1LJ0q rOosT 2,o�=7'Ptz� �ee�n yhnbn,eg edal= c�`ri,Vr��iar tlegTl�v , oPr PCX-&- &14LZ Square feet: 1st floor:existing Z24JI proposed 2nd floor:existing proposed Total new N� Zoning District Flood Plain Groundwater Overlay Project Valuation / BU oa Construction Type Peodowi�, Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure -'W-r4ec Historic House: ❑Yes 3"No On Old King's Highway: ❑Yes Flo Basement Type: Gull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing Z new _. Half:existing new -0 Number of Bedrooms: existing 3 new _ TUa!Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes dNo 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 ,0 Yes ErNo If yes,site plan review# Current Use PCoposed-Use- BUILDER INFORMATION Name Oc&w 4,F � e_ Telephone Number jde- r27/- _?//D Address 2- j`] d RN?f/a/ Ox- License# -&tip P A//JJNA 0,2 40 Home Improvement Contractor# /4'0/ZI Worker's Compensation# 44! e92 - t/A-g(. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN T% _,Sd-gAeu v- Ok A" -Q,-, /� nrP eoucv( IL SIGNATURE DATE FOR OFFICIAL USE ONLY `n PERMff NO. DATE ISSUED MAP/PARCEL NO. j ADDRESS VILLAGE OWNER F ' r i r I r DATE OF INSPECTION: FOUNDATION ; FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL , GAS: ROUGH FINAL FINAL BUILDING ' DATE CLOSED OUT ASSOCIATION PLAN NO. � r r 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance davit: Builders/Contractor ectricians/Plul*hers Applicant Information PAvase Print Legibly ��� Name (Business/Organizationadividual):-4#tW(�z�— ,P /Aic,, Address: —9,-7 :7k-&t23a - - City/State/Zip: InA /J?.ga> Phone#: 'S4Df - 7 7f ,31 a Are ou an employer? Check the-appropriate box: Type of project(required): 1. I am a employer withQ_ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietof or p artner- listed on the attached sheet:'$ 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11- Plumbing repairs or. additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ R f rep insurance required.] t employees. [No workers' camp.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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lie. #: 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 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 cetWft under the pains anted penalties of perjury that the information provided above is true and correct. Sipature Date: -P12,)'/0 e Phone#: 0/7i_3r« Official use only. Do not write in this area,to be completed by city or town official i City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk a.Electrical inspector S.Plumbing inspector i 6. Other Contact Persons: Phone#: I Town of Barnstable ti A � Regulatory Services ��'"BUZ, Thomas F.Geiler,Director Mass. 1619. Building Division Tom-Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than foul 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: ����S Estimated Cost Ya7�'' Address of Work: NOON a 1,1t4,IlI✓y1 S Owner's Name: 7&22,o i eh Qu-PI iG1�J'S�tZ 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 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 agent o e o er:. — 2 Da Contractor Signature Registration No OIR Date Owner's Signature Q:wpfiles.for=:homeaffidav Rev: 060606 l 1 Date�8/22/2006 Time: 10:27 AM To: ® 9,1,508 775 2848 R✓tG Ins. Agcy. Page: 001 Client#: 23059 OCEAINCI ACORD,. CERTIFICATE OF LIABILITY INSURANCE 08/2tio6D""") PRODUCER ITHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 341 Court Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O.Box 3700 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ' Plymouth,MA 02361-3700 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Arbella Protection Co Oceanside Inc INSURER B: American Home Assurance Aft: Paula Clark INSURER C: 217 Thornton Drive INSURER D: Hyannis„MA 02601-8105 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1N5K AM' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSR DATE MMIDD/YY DATE MM/DDIYY LIMITS A GENERAL LIABILITY 8500029947 01/01/06 01/01/07 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREIS ES E o inn $1 OO OOO CLAIMS MADE Q OCCUR - MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1 OOO OOO GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG s2,000,000 POLICY PRO LOC JECT A AUTOMOBILE LIABILITY 58456400002 01/01/06 01/01/07 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEOULEDAUTOS (Per person) X HIREDAUTOS r6ODILY INJURY $ X NON-OWNED AUTOS (Per accident) X Drive Other Car PROPERTYDAMAGE $ (Per acciden t) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ A EXCESS/UMBRELLALIABWT! 4600029948 01/01/06 01/01/07 EACH OCCURRENCE $2 000 000 X OCCUR CLAIMS MADE AGGREGATE $2 OOO OOO $ RDEDUCTIBLE $ X RETENTION $10000 $ B WORKERS COMPENSATION AND WC8934686 01/01/06 01/01/07 weSTATU- oTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT URN 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Fire Restoration 8122106 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL in DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL TOO Main St. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Hyannis,MA 02601 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE F ACORD 25(2001108)1 of 2 #S23842/M23615 JB O ACORD CORPORATION 1988 + _T�e{gar►vrreo.uuea�l/a.a�./�aaoac�ivaelCa Board,of Building Regulations and Standards HOME'IMPROVEMENT CONTRACTOR Reg istratron• 10621lug- 7 Expirat ( ' ��ion6/9/2008 � # ' � TYPO Su0plement Card OC6ANSIDE,INC`-- l i t f i PETER LAROC}1i= 217 Thomton Dr Hyannis,.MA"02ti01 i Administrator i 7. N I - w 1 i:'�I s :. 7 w'BOARD OF Bill DING REGtyLATIONS of - V - E nt kt<ro -. 4icettse ONSTRUTtONSUPERVISOR _ Numbs . {073097 ' t s 06 Tr no 5900 0 .PETER M TARO '. { It3 CEDRIC ROADcd Ir CENT I: q + �' Cominisaloner x� ' .r- u ofINEt Town of Barnstable Regulatory Services * BARNSTABLE. y MASS. Thomas F.Geiler,Director 039. p e 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 A Builder L /V/ �� /�L�S.S'.GL.� , as Owner'of the subject property hereby authorize Zk.e— to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Si ature of Owner Date Print Name Q YORMS:O WNERPERMISSION Cei I i~ 1 �us6CCd7 l o� �d dG Cllt�� ejoodao leO a 16 [ p 1a a i i— /7y/9tW/S r k a k r \, I� — q �n ° 1 �� vVVv �� e ii Q41 O t s�'{j b � � `•v. n� l J e- sw �- �r�� •■`��yyi - � � � i FY Ilk K i' Y tra '•� _ T may., ;S l '�q � �. 7 ` - .•tea � 1 T_ Aw ANIF ♦ �-v=.v-,, � .�--���� - y ..- � fir:. r y ri do I r 2 P &t4 t— S �� s �� 0 o N � I Im n r - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map o?>d Parcel Cfo? �(� / Application# 0,(Q66 A171V7 Health Division Conservation Division Permit# Tax Collector Date Issued /oZ P, 6 Treasurer Application Fee J�® Planning Dept. Permit Fee �� n Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address !W �C Village A//�r��/��-5 Owner� �%r /1 , G Address Telephone �/_2Y-ZoS, ���f-IZI Permit Request kc� 7-6 Of 41 � Square feet: 1 st floor: r qexisting- proposed 2nd floor:existing propo Total ne Zoning District Flood Plain Groundwater Overlay 4-Project Valuation &00 Construction'Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. m, 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) P Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new t �I Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new- size- Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No . If yes, site plan review# Curr se J 1117 Proposed Use BUILDER INFORMATION N am e AlMiql 91, gr Telephone Numberh Address ' Y %z6yK16AIZ License# �V,3, /7Z Dot.(oO/ Home Improvement Contractor# Worker's Compens ti n# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL!BE TAKEN TOE S SIGNATURE v DATE / -UGr, t FOR OFFICIAL USE ONLY y f I - � r 1 PERMIT NO. i r _ i DATE ISSUED MAP/PARCEL NO. , i ADDRESS, VILLAGE , OWNER t i DATE OF INSPECTION: FOUNDATION 4 FRAME & K I - J INSULATION 0� t 0 { FIREPLACE t t ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i J The Commonwealthh-ofMassachusetts 'a Department of Industrial Accidents t• i 6 Office of Investigations �1. •° 600 Washington Street Boston, MA 02111 - t www.inass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):,Z/—, ,/l?,!51—,.j Address: y City/State/Zip:_zil22.�it ' !X/�"U�f�G/ Phone#: Z4�(Z ; Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6 employees(full and/or part-time).* have hired the'sub-contractors New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet.$ 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers' comp;insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its requiied j officers have exercised their 10.❑Electrical repairs or additions 3.&?f am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions . myself, [No workers' comp. c. 152, §1(4), and we have no 12.❑Roof repairs insurance required.]t 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. r Homeowners who submit this affidavit indicating they are doing ail 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 their workers'comp.policy information. Tam 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: fob 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 . :me 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 )f 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. ado hereby certify under the pains and penalties of perjury that the information provided above is true and correct 3i afore: Date: —Q. ?hone 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#: -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 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(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-contractor(s)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 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 burn 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 De aitment of Industrial Accidents P . Office of Investigations 600 Washington Strut Bastoil,MA 02111 Tel. # 617-7-27-4940 ext 406 or 1-8.77-MASSEAFE Fax##617-727-7749 Revised 5-26-OS wwwma.ss.gov/dia E .L v ry u V1 LAl Llw7l."ux%w Regulatory Services RARxsz'a3Lr, ' Thomas F.Geiler,Director 9 •i+uss. , � fp�►`� Building Division Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town,barnstable.ma.us fice: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IlYIPROVEMENT 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 orb adding be done by registered contractors,with certain exceptions,along v�ith other requirements. Type of Work: j��� <�C'_ %C�/f,� Estimated Cost Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law DJob Under$1,000 OB ding not owner-occupied ' �er pulling own permit Notice is hereby given that: OV7NERS 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 Signature Registration No. OR L��� DateOwner's Signature Q:wpMes.forms:homezffi day Rev: 060606 __ I r .. C n �oFZHe rq� Town of Barnstable do Regulatory Services BARNSTABM Thomas F.Geiler,Director � b 9 .0� Building Division pTED A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 ------------------- HOMEOWNER LICENSE EXEMPTION l/ / Please Print DATE: // 02/—`0 JOB LOCATION: number , / street g Q village "HOMEOWNER": //7'�J/y�S 7r" //Is`f�p/�� 22,S6;;-_ name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Si twe of Homeowner 1� Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt ONLUMJ3d H03 0381(103d 38d 398n1V'NOIS H109 3iVa 1N3W1MM HIA 31VO '1d30 MOVE 31St11SNNdS 03MTM S 1010313a DOWS yO-e 0atr,49 3000 9NKPIA9 SI1HnHOVSSVIN Ed 0311VISNI 39 isnw pp Sv%VIV 301XONOIN N09dVO 1 /L b �6 vQ i1JE p°v(2 0 t�s2 —119-1 R ` RE-ROOFING/RESIDING (COMMERCIAL) ❑ ' If located in O-KH or Hyannis Historic District- Certificate of Appropriateness required unless'same color/same materials specified on application R_ L w�1 ❑ i Map/parcel number Approval Sign'-offs from: 'Tax Collector ❑ Treasurer ' ❑� - # of squares of-shingles or square footage of roof or sidewall to be shingled/sided ❑ : Specify,stripping old shingles or going over old roof. If going over ❑how many roof layers existing now ❑what size are rafters? What is span? ❑ Owner's name & address ❑ Project valuation must be entered ❑ Builders Information ❑ Signature ❑ Workman's Comp. Form. Copy of Insurance Compliance Certificate must be on file. ❑ No license is required for commercial work. ❑ Application fee ❑ Permit fee ❑ Property Owner must sign Property Owner Letter of Permission. l 1 f Ve _� q-forms/bldgpermits/permitchecklists rev. 101106 J' I .. 'WJJ l RE-ROOFING/RESIDING (COMMERCIAL) If located in OKH or Hyannis Historic District- Certificate of Appropriateness required unless same color/same materials specified on application ❑ Map/parcel number Approval Sign-offs from: ❑ Tax Collector ❑ Treasurer ❑ # of squares of shingles or square footage of roof or sidewall to be shingled/sided ❑ Specify stripping old shingles or going over old roof. If going over ❑how many roof layers existing now ❑what size are rafters? What is span? ❑ Owner's name & address • i ❑ Project valuation must be entered ❑ Builders Information ❑ Signature ❑ Workman's Comp. Form. Copy of Insurance Compliance Certificate must be on file. L ❑ No license is required for commercial work. ❑ Application fee ❑ Permit fee ❑ Property Owner must sign Property Owner Letter of Permission. 'r w q-forms/bldgpermits/permitchecklists rev.101106 ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ce 700 Application# Health Division Conservation Division w Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Appro ed by Planning Board Historic-OKH b� Preservation/Hyannis Project Street Address '? Village Owner � � 1� USSR Address ���i�/ h/��9 �/�S Telephone �� a Ds.? Permit Request cf 7 J Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ®00 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family Multi-Family(#units) Age of Existing Structure Historic House: 0-Yes ❑No On Old King's Highway: ❑Yes 0'0 Basement Type: ulI ❑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: was ❑Oil ❑Electric ❑Other -- 1 Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coaEsfove: ❑des Ji 'I o t Detached garage:dexisting ❑new size Pool:❑existing ❑new size Barn:❑ex ,ng ❑& size Attached garage:❑existing ❑new size Shed:Ve existing ❑new size Other: M Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Telephone Numberb� Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ��/y� SIGNATURE _ DATE FOR OFFICIAL USE ONLY t PERMIT NO. DATE ISSUED + } MAP/PARCEL NO. i ADDRESS VILLAGE OWNER F f1 3 r DATE OF INSPECTION: FOUNDATION t j FRAME INSULATION FIREPLACE Ir ELECTRICAL: ROUGH FINAL r j } PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL I t FINAL BUILDING 3 i S " • t DATE CLOSED OUT s ASSOCIATION PLAN NO. e i The Commonwealth of Massachusetts Department of Industrial Accidents 9.2 Office of Investigations d 600 Washington Street Boston,MA 02111 M 5� '� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers �Appplicant_In-formation Please Print Legibly C Nn g zaam on/Individual): 1 '/;� � �Ad'dr s: City/State/Zip: O/ Phone.#: Are you an employer?Check the appropriate box: Type of project(required):. 1.❑ I am a employer with .4. ❑ I am a general contractor and I 6. New construction . employees(full 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 workingfor me in an capacity. employees and have workers' Y P ty• �. 9. ❑Building addition [No:workers' comp.insurance comp. insurance. t' 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions �L�'I l h mew er.doing-all worker° cers have exercised their 11.❑Plumbing repairs or additions myself.'[No workers"comp. right of exemption per MGL 12.❑ Roof repairs r.-Fins our nce 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. *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.#: 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 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 certi under the pains and penalties of perjury that the information provided above is-true-and-correct. Si `atu e:-' 1�.7. Date — _ Phone#: 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#: 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 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 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 rxzth 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-contractor(s)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 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 Department of Industrial accidents Office of Investigations 600 Washington Street Boston,MA 02.111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia a °FVE1 Town-of Barnstable Regulatory Services sasr ASS.cam, � M� Thomas F.Geiler,Director 6 MP M Building Division '�a b 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 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 adj acent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. yp o Wo k: - Estimated Cost F Address.of Work: I hereby certify that: Registration is not required for the following reason(s): VJ�ober ed by law ,000 owner-occupied• g 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 fora permit as the agent of the owner: Date Contractor Name Registration No. OR Date Q:forns:homenfndav r ' s THE Town of Barnstable �F 1p� Regulatory Services swxtvsrnsLe. : Thomas F.Geiler,Director 9 MASS. Q,A i639• ,� Building Division lfo nlw� 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 �--.------JO.,�B,LOCATION: _, �7 iy � �CJ/C /X� _ T:,�number,`.f street village "HOMEOWNER": iyN //L�,//�// home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedure and requirements and that he/she will comply with said procedures and n I requ' ents. ignatGr-e of Homeowner' - "° '. s • Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt �=o4, 3 '\ Io rCl"� S FiVD 1 c:' 6 -9 J J�� c tide PARCEL a lVO,vCOlvo"R,WING GONG. 'PS Th,s 'crP or� F INSPECTION 7nly �`LvOD ZO:V_ .C. : °an, 17'EG;�TP ! OWNER: lOrvREF '0 — , - - %— PLAN p.7 - � ' vPtiCERTiF Y TO _� , 1�y'E--.------ GV G,�---\--I�-- ^---i.i T T�.� �LiLDI,NG 11`I TF =L,�,J 10.. _,:. ., r�� TH E ' \ �-.AT tl_ EMON DCE_ -- !4 y c PAL � \may • .� . � ZGl ING LAW S�T= =.CK °ZQL•IREME"TE OF Ti-' = A. 0- �4F'V�fl aEL�___ ____ �•�'D TI'`` F� (Tr'P4 JD( � c,v :` -``_GT✓ LIE WITHIN �i=ECI..L FLOOD HAZARD ��� Na - �. ON, T F E 's i i � I r i � r --= - -_- Ll 'l1V�i � '' Fee r Entered in computer: THE CO MONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0[pplicati01l for ;DigpD.�al �bp5tem COn.5tructi0n Permit Application for a Permit to Construct( ) Repair()tj Upgrade ) Abandon( ❑Complete System ❑Individual Components Location Address or Lot No.¢! �lJIV7- ����✓J Owner's Nam�ddres�sean/�iTel i0. � Y9i✓ .AI9 Assessor's Map/Parcel Z96 92- 1 Installer's N e,Address,a Te).No. 6 Designer's Name A?d and Tyl.N (�f l/ N /T �/ - 1r�1/G Type of Building: Dwelling No.of Bedrooms Lot Size l0�9QD sq.ft. Garbage Grinder ( ) Other Type of Building ,TI No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Z- l�— 2,VU:7 Number of sheets �Q Revision Date Title Size of Septic Tank d V Type of S.A.S. t V411— a° x Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement:. The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Envir mental Code of to place the system in operation until a Certificate of Compliance has been issued by this Board of a _ - - Signed Date Application Approved by Date ! Application Disapproved by: Date for the following reasons Permit No. _16 01 1 -��lJ� Date Issued —_ ------_--_ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate Of Compliance -- THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired �X Upgraded (X ) Abandoned( )by / v Q Y►✓ ✓/ � /� t ) ?t t) , cl <( `�n has been cons>yucted in,accordance a 8C ? f I� �i; with the provisions/of 'itle 5 and the for Disposal System Construction Permit No. , ,�. dated -- Installer ��V�1<� S�PI/ Designer Z" f SlJII-✓'e. 1 #bedrooms' / Approved desi- flow {; gpd The issuance of this permit shall dot b. co strued as a uarantee that the system furictlor<as designed:' Date fir'` Inspector ---------------------�,-------- 4 I ��� all No.� n Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION=BARNSTABLE, MASSACHUSETTS lizpOaY J§pgtem Cong1ructiOn Permit Abandon Permission is hereby granted to 5�jo struct� )/ �epai/r�(r ) Upgrade (X ) ( ) System located at . 6.PtA/ 1 S �/ "rJ �Y '14 //' d and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constru tion njust be completed within three years of the date of this permit. I Date 2 j J Approved bX','% C%' BARPQ U81 E KASIL '07 NOV 26 P 119 Town of Barnstable Zoning Board of Appeals Comprehensive Permit Decision and Notice Appeal 2007-112-Russell Decision- Chapter 40B Comprehensive Permit Applicant: Thomas J.Russell&Michelle D. Russell Property Address: 44 Betty's Pond Road,Hyannis,MA Assessor's Map/Parcel: Map 292,Parcel 092-001 Zoning: Residential B Zoning District Applicants: The applicants are Thomas &Michelle Russell, who reside at 44 Betty's Pond Road,Hyannis,MA. Thomas&Michelle Russell were granted title to the property by deed recorded in the Barnstable County . Registry of Deeds on September 6, 1994 as recorded in Book 9353 and Page 207. Relief Requested: The applicants have applied for a Comprehensive Permit under Chapter 40B of the General Laws of the Commonwealth of Massachusetts, and in accordance with Article II of Chapter Nine of the Code of the town of Barnstable,more commonly termed the"Accessory Affordable Apartment Program. The zoning relief necessary for this Comprehensive Permit to be issued is that of a variance to Sect ion14 of the Code—Amnesty Program to permit an accessory apartment unit within a single-family o wner9 occupied residential dwelling. The issuance of this Comprehensive Permit would allow for an accesso affordable apartment unit attached to the principal residence. n' Locus and Background: The property at issue is a 1.51 acre lot located at 44 Betty's Pond Road in Hyannis. The lot was developed in 1925 with a single-family cape style home. The effective living area of the main-residence is 2,608 square feet. The-accessory apartment,-is a-one-bedroom unit_attached to the.principal-.residence. cThe.square footage of the rental�area is.approxirnately 575 square-feet. The lot is served by public water and on-site septic,and is located within a Wellhead Protection Overlay 18, District. The town of Barnstable's Public Health Division reviewed the application, and on J approved a total of four(4)bedrooms at the property with the existing on-site septic system; 2007, Procedural Summary: A site approval letter was issued for the property by Town Manager John Klimm on September in accordance with MGL Chapter 40B and 760 CMR. Notice of the site approval lette w o the sent t o the Department of Housing and Community Development in accordance with the requirements of C An application for a Comprehensive Permit was then filed at the Town the Zoning Board of Appeals. Clerk's Office and the Office7o 0 s' t. Plan encourages the use of existing housing to create affordable units and the dispersal of these units throughout the town. Finding Summary: Based upon the findings,the Hearing Officer ruled that the applicants have standing to apply for a Comprehensive Permit under MGL Chapter 40B and the Town of Barnstable's Accessory Apartment Program. The proposal is also deemed consistent with local needs because it adequately promotes the . objective of providing affordable housing for the town of Barnstable without jeopardizing the health and safety of the occupants provided all conditions of the Comprehensive Permit are strictly followed. Ruling and Conditions: Based upon the findings, a ruling was made to grant the Comprehensive Permit in accordance with MGL Chapter 40B to the applicants,Thomas&Michelle Russell. It is issued to allow for a one-bedroom. accessory affordable apartment unit in accordance with the following conditions: 1.Occupancy of the affordable unit shall not exceed two persons. 2.The total number of bedrooms;on the property with the existing:on site septic system shall,tiot (exceed four.(4.). ^ 3.The property owners shall occupy the.principal dwelling as their principal residence. 4.This unit shall not be occupied by a family member of the owner(s).' 5.All parking for the accessory apartment and the main dwelling shall be on-site and no lodging shall be permitted for the duration of this comprehensive permit: 6.To meet the requirements of affordability,the cost of housing(including utilities) shall not exceed 30%of 80%of the median income for a single individual for the Barnstable MSA. In the event that utilities are separately metered,the utility allowance established by the town of Barnstable shall be deducted from rent level so calculated. 7.All leases shall have a minimum term of one year. 8.The Growth Management Department shall serve as the monitoring agent for the accessory. apartment. ' I 9.The applicants must apply for a.building permit for the accessory unit,whether the unit is new or pre-existing. Before securing an occupancy permit and certificate of compliance,the Building Commissioner must determine that the unit conforms with the approved plans as submitted with the building permit application and meets state building and fire codes.The Health Division must determine that the dwelling is in compliance with applicable on-site wastewater discharge requirements. 10. The applicants may select their own tenant provided the tenant meets the requirements of the program as cited above and provided that person's income is reviewed and approved by the Growth Management Department of the town of Barnstable as a qualified individual. The applicants will be required to work with the town to provide information necessary to document that the tenant qualifies. The unit shall be rented on an open'and fair basis to an income eligible individual or family. Whenever a vacancy occurs,notice must be given to the Growth Management Department and the unit must be listed with the Town: 3 11. Every twelve months the applicants shall review the income eligibility of the individual occupying the unit. No later than a year from the date of issuance of this Comprehensive Permit,the applicants shall file with the Growth Management Department of the town of Barnstable an annual affidavit listing the rent charged and income level of the occupant of the unit. The applicants shall provide the town any additional information it deems necessary to verify the information provided in the affidavit. Upon any report from the town that the terms and conditions of this permit are not being upheld,the Zoning Board of Appeals or it's Hearing Officer shall have the ability to hold a hearing to show cause as to why this permit should not be revoked. 12. This Comprehensive Permit shall not be transferable to any other person or entity without the prior approval of the Hearing Officer or Zoning Board of Appeals. This decision,the Regulatory Agreement and Declaration of Restrictive Covenants and all other necessary documents shall be filed at the Barnstable County Registry of Deeds. If the ownership of the property is transferred,the Growth Management Department of the town of Barnstable shall be notified within 60 days of the name and address of the new owner. 13. This Comprehensive Permit must be exercised and the unit occupied.within 12 months of its issuance or it shall expire. Ordered: Comprehensive Permit 2007-112 has been granted•with conditions. A written copy of this decision shall be forwarded to the Zoning Board of Appeal as required by the Town of Barnstable Administrative Code Chapter 241, section 11. If after fourteen(14)days from that transmittal the Members of the Zoning Board of Appeals takes no action to reverse the decision, this decision shall become final and a copy shall be the filed in the office of the Town Clerk. Appeals of the final decision, if any, shall be made to the Barnstable Superior Court pursuant to MGL Chapter 40A, Section 17,within twenty(20) days after the date of the filing of this decision in the office of the Town Clerk. The applicant has the right to appeal this decision as outlined in MGL Chapter 40B, Section 22. In accordance with Chapter 241, section 11 of the Town of Barnstable Administrative Code, the hearing officer transmitted a written copy of the Comprehensive Permit decision to the Zoning Board of Appeals on November 7, 2007. Fourteen(14)days have elapsed since the transmittal to the Board, and no Board Member has taken action to reverse the decision. "4' A Gail di ghtingal ,Hearing fficer Date Signed 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 beeiled in t ffice of the Town Clerk. Signed and sealed this /J day c P,�., ,'-/-tyc-�? under the pains and penalties of perjury. Linda Hutchenrider,Town Clerk 4 n A w REGULATORY AGREEMENT AND DECLARATION OF RESTRICTIVE COVENANTS THIS REGULATO AGREEMENT and DECLARATION OF RESTRICTIVE COVENANTS,is made this 2U dayof ( ,2008,by and between Thomas J. and Michelle D.Russell of 44 Betty's Pond Road,Hyannis,MA and its successors and assigns (hereinafter the "Owner"),and the TOWN OF BARNSTABLE (the "Municipality'),a political subdivision of the Commonwealth; WHEREAS the Owner has been granted a Comprehensive Permit under Massachusetts General Law Chapter 40B and local regulations by the Zoning Board of Appeals to permit the creation of an accessory apartment in an owner occupied dwelling which will be rented to a Low or Moderate Income Person/Family(hereinafter "Designated Affordable Unit");and NOW THEREFORE,in mutual consideration of the agreements and covenants contained herein,and other good and valuable consideration,the receipt and sufficiency of which is hereby acknowledged,the parties agree as follows: I. PROJECT SCOPE AND DESIGN: A. The terms of this Agreement and Covenant regulate the property located at 44 Betty's Pond Road, Hyannis,MA as further described in deed recorded herewith as Barnstable County Registry of Deeds Book 09353 &Page 0207. - B. The Project located at 44 Betty's Pond Road,Hyannis,MA will consist of one accessory apartment unit which will be rented to an eligible low or moderate income individual or family(the"Designated Affordable Unit" or the "Unit"). C. The Owner agrees to construct the Project in accordance with the terms of comprehensive permit Appeal No. 2007-112 and any plans submitted therewith and all applicable state, federal and municipal laws and regulations. Said permit is recorded herewith as Barnstable County Registry of Deeds Book &Page _. D. The Owner agrees to occupy the principal dwelling unit located on the property as their principal residence in accordance with the terms of the comprehensive permit. II. THE OWNER'S COVENANTS AND RESPONSIBILITIES: A. THE OWNER HEREBY REPRESENTS,COVENANTS AND WARRANTS AS FOLLOWS: 1 In receiving the comprehensive permit to create the Designated Affordable unit,the Owner agreed that the Designated Affordable Unit shall be set aside in perpetuity for the public purpose of providing safe and decent housing to persons earning at or below 80% of the area median income of Barnstable Metropolitan Statistical Area(MBA) and that the Designated Affordable Unit shall be deemed to be impressed with a public trust. 2. The Designated Affordable Unit shall be rented in perpetuity to a household with a maximum income of 80% of the Area Median Income (AMI) of Barnstable MSA and that rent (including utilities) shall not exceed an amount that is affordable to a household whose income is 80% of the median income of Barnstable MSA. In the event that utilities are separately metered,a utility allowance established by the Barnstable Housing Authority shall be deducted from the rent level. 3. The Designated Affordable Unit will be retained as a permanent,year round rental.dwelling unit with at least a one-year lease. 4. The Owner has the full legal right,power and authority to execute and deliver this Agreement. 5. The execution and performance of this Agreement by the Owner will not violate or,as applicable,has not yiolated any provision of law,rule or regulation,or any order of any court or other agency or governmental body,and will not violate or,as applicable,has not violated an provision of indenture,agreement,mortgage, Y PP Y P any.Y g L I mortgage note,or other instrument to which the Owner is a party or by which it or the Owner is bound,will not result in the creation or imposition of any prohibited encumbrance of any nature. 6. The Owner,at the time of execution and delivery of this Agreement,has good,clear marketable title to the premises. 7. There is no action,suit or proceeding at law or in equity or by or before any governmental instrumentality or other agency now pending,or,to the knowledge of the Owner,threatened against or affecting it,or any of its properties or rights,which,if adversely determined,would materially impair its right to carry on business substantially as now conducted(and as now contemplated by this Agreement)or would materially adversely affect its financial condition. B. COMPLIANCE The Owner hereby agrees that any and all requirements of the laws of the Commonwealth of Massachusetts to be satisfied in order for the provisions of this Agreement to constitute restrictions and covenants running with the land shall be deemed to be satisfied in full and that any requirements of privileges of estate are also deemed to be satisfied in full. C. LIMITATION ON PROFITS 1. The Owner agrees to limit his/her profit by renting the Designated Affordable Unit in perpetuity to a household with a maximum income of 80% or less of the Area Median Income (AMI) of Barnstable Metropolitan Statistical Area(MSA) and that rent(including utilities) shall not-exceed an amount that is affordable to a household whose income is 80% of the median income of Barnstable MSA. In the event that utilities are separately metered,a utility allowance established by the Barnstable Housing Authority shall be deducted from the rent. 2. The Owner shall annually deliver to the Municipality and to the Monitoring Agent,as designated by the Town Manager,proof that the Designated Affordable Unit is rented;the tenant's income verification,a copy of the lease agreement and the rent charged for the unit or units. Such information shall also be forwarded to the Monitoring Agent within 30 days of the occupation of the dwelling unit or units by a new tenant. The Owner shall notify the Monitoring Agent,as designated by the Town Manager,within thirty(30) days of the date that a' tenant has vacated the Designated Affordable Unit. III. MUNICIPALITY COVENANTS AND RESPONSIBILITIES 1. The MUNICIPALITY,through the monitoring agent designated by the Town Manager agrees to perform the duties of verifying that the Designated Affordable Unit is being rented in perpetuity to a household with a maximum income of 80%'or less of the Area Median Income (AMI) of Barnstable MSA and that rent (including utilities) shall not exceed an amount that is affordable to a household whose income is 80% of the median income of Barnstable MSA.In the event that utilities are separately metered,a utility allowance established by the Barnstable Housing Authority shall be deducted from the rent. IV. RECORDING OF AGREEMENT: Upon execution,the OWNER shall immediately cause this Agreement and any amendments hereto to be recorded with the Registry of Deeds for Barnstable County or,if the Project consists in whole or in part of registered land,file this Agreement and any amendments hereto with the Registry District of the Barnstable Land Court (collectively hereinafter the"Registry of Deeds"),and the Owner shall pay all fees and charges incurred in connection therewith. Upon recording or filling,as applicable,the Owner shall immediatelytransmit to the Municipality evidence of such recording or filing including the date and instrument,book and page or registration number of the Agreement: 2 I V. GOVERNING OF AGREEMENT This Agreement shall be governed by the laws of the Commonwealth of Massachusetts. Any amendments to this Agreement must be in writing and executed by all of the parties hereto. The invalidity of any clause,part or provision of this Agreement shall not affect the validity of the remaining portions hereof. VI. NOTICE: All notices to be given pursuant to this Agreement shall be in writing and shall be deemed given when delivered by hand or when mailed by certified or registered mail,postage prepaid,return receipt requested,to the parties hereto at the addresses set forth below,or to such other place as a party may from time to time designate by written notice. VII. HOLD HARMLESS: The Owner hereby agrees to indemnify and hold harmless the Municipality and/or its delegate from any and all actions or inactions by the Owner,its agents,servants or employees which result in claims made,against Municipality and/or its delegate,including but not limited to awards,judgments,out-of-.pocket expenses and attorneys fees necessitated by such actions. VIII. ENTIRE UNDERSTANDING: A. This Agreement shall constitute the entire understanding between the parties and any amendments or changes hereto must be in writing,executed by the parties,and appended to this document. B. This Agreement and all of the covenants, agreements and restrictions contained herein shall be deemed to be for the public purpose of providing safe affordable housing and shall be deemed to be, and by,these presents are,granted by the Owner to run in perpetuity in favor of and be held by the Municipality as any other permanent restriction held by a governmental body as that term is used in MGL Ch. 184,Section 26 which shall run with the land described in deed recorded herewith as Barnstable County Registry of Deeds Book 09353 & Page 0207 and shall be binding upon the Owner and all successors in title. This Agreement is made for the benefit of the Municipality and the Municipality shall be deemed to be the holder of the restriction created by this Agreement. The Municipality has determined that the acquiring of such a-restriction is in the public interest. The Municipality shall not be subject to the defense of lack of privity of estate. The covenants and restrictions contained in this Agreement shall be deemed to affect the title to the property described in deed recorded herewith as Barnstable County Registry of Deeds Book 09353 &Page 0207. IX. TERM OF AGREEMENT: The term of this Agreement shall be perpetual,provided,however,that the Owner of a Designated Affordable Unit or Units may voluntarily cancel the granted Comprehensive Permit and the terms and restrictions imposed herein. Such cancellation shall only take effect after: 1) expiration of the lease terms entered into between the Owner and Tenant occupying said unit and 2) notification by the Owner of said dwelling to the Zoning Board.of Appeals of his/her desire to cancel the Comprehensive permit upon a date certain and the recording of said notice at the Barnstable County Registry of Deeds or Barnstable County , Registry of the Land Court as the case may be,thus rendering said Comprehensive Permit void. Upon the cancellation of the comprehensive permit,the property which is the subject matter of this restrictive covenant shall revert to the use permitted under zoning and the restrictive covenant shall be rendered void. X. SUCCESSORS AND ASSIGNS: A. The Parties to this Agreement intend declare and covenant on behalf of themselves and an successors � Y 3 I , and assigns their rights and duties as defined in this Regulatory Agreement and the attached comprehensive permit. B. The Owner intends,declares,and covenants on behalf of itself and its successors and assigns (i)that this Agreement and the covenants,agreements and restrictions contained herein shall be and are covenants running with the land,encumbering the Project for the term of this Agreement,and are binding upon the Owner's successors in title, (ui) are not merelypersonal covenants of the Owner,and (1) shall bind the Owner,its successors and assigns and inure to the benefit of the Municipality and its successors and assigns for the term of the Agreement. XI. DEFAULT: If any default,violation or breach by the Owner of this Agreement is not cured to the satisfaction of the Monitoring Agent within thirty(30) days after notice to the Owner thereof,then the Monitoring Agent may send notification to the Municipality that the Owner is in violation of the terms and conditions hereof. The Municipality may exercise any remedy available to it. The Owner will pay all costs and expenses,including legal fees,incurred by the Monitoring Agent in enforcing this Agreement and the Owner hereby agrees that the Municipality and the Monitoring Agent will have.alien on the Project to secure payment of such costs and expenses. The Monitoring Agent may perfect such alien on the Project by recording a certificate setting forth the amount of the costs and expense due and owing in the Registry of Deeds or the Registry of the District Land Court for Barnstable County. A purchaser of the Project or anyportion thereof will be liable for the payment of any unpaid costs and expenses that were the subject of a perfected lien prior to the purchaser's acquisition of the Project or portion thereof. XII. MORTGAGEE CONSENT: The Owner represents and warrants that it has obtained the consent of all existing mortgagees of the Project to. the execution and recording of this Agreement and to the terms and conditions hereof and that all such mortgagees have executed consent to this Agreement. IN WITNESS WHEREOF,we hereunto set our hands and seals this day of )C 'vtZ -1 2008. ' OWNS OWNER BY: BY: Signature Printed:Thomas J.Russell Printed:Michelle D.R sell COMMONWEALTH OF MASSACHUSETTS County of Barnstable,ss: On this 2.7v da of, LkX- 2008 before me,the undersigned notary public,personally appeared i ,the Owner(s) roved to me through satisfactory evidence o identification,which were ,to be the person(s)whose i name(s)is signed on the preceding or a a, documen cknowledged to be that he/she signed it voluntarily for the stated S. Notary Public Printed: My Commission Expires: r `{ M.SCOTT CARR Notary Public i` c+ Commonwealth of Massachusetts 4 My Commission Expires Jun 18,2010 C • TOWN OP.BARNSTABLE BY: TO MANAGER COMMONWEALTH OF MASSACHUSETTS County of Barnstable,ss: On this,�,3 'day o Cr, 2008 before me,the undersigned notary public,personally appeared Tc*� (�., jC� Imo; m ,the Town Manager for the Town of Barnstable,proved to me through satisfactory evidence of identification,which were C' , 6� �Ir .11a�! to be the person whose name is signed on the preceding or attached document and.ac c,MAged to b�Aat he/she signed it voluntarily for the stated Purposes. xi Notar( ublic Printed: My Commission Expires: OFFICIAL SEAL SHIRLEE MAY OAKLEY F NOTARY PUBLIC COWOMAMOMMMIMS oFt►,E r�,,,, Town of Barnstable BAMSTABLE. : Regulatory Services 94, a 9• �•� Thomas F. Geiler,Director AjEp��a ' Building Division Tom Perry Building Commissioner 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 February 12, 2008 Mr. &Mrs. Thomas J. Russell 44 Betty's Pond Road Hyannis, MA 02601 Re: Proposed Accessory Affordable Apartment Dear Mr. &Mrs. Russell: We have received the recorded Regulatory Agreement and Comprehensive Permit for the accessory affordable apartment at your address. A building permit is required whether the unit is new or pre-existing. We look forward to receiving your building permit application for the apartment. Please call me if you have any questions regarding the building permit process. Sincerely, Lois Barry Division Assistant amnb P �FTHE ram, Town of Barnstable Regulatory Services * snxxsrns[.E, v MASS. Thomas F. Geiler,Director �p 1639. tFD MA'S A Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 50&790-6230 AMNESTY APARTMENT ELIGIBILITY VERIFICATION Re: eel Date 4 After reviewing the street file of the above named property, I verify, to the best of my knowledge, that the apartment was in existence before January 1, 2000. This property is now eligible to apply for the Amnesty Program. Tom Perry Building Commissioner Property Location: 44 BETTYS POND ROAD MAP ID:290/092/00 1// Bldg Name: State Use:1010 Vision ID:22298 Account#196200 Bldg#: 1 of 1 Sec#: 1 of 1 Card 1 of 1 Print Date:07/12/2007 14:14 r a. ..., T. .. _ n M ON.DETAILe<C.O]VTILVi�D'D._,"�`��„r„_�_� +a' x_.r Element Cd. I Ch.Pescription Element Cd. I Ch.Pescription Style 04 Cape Cod 26 Model 01 Residential Foundation 01 Poured Conc. Grade C Average BAS a$Al, tories 1.5 1 1/2 Stories Bath Split1 p 2 Full+1H Occupancy RAN 4 22 3 2 Exterior Wall 1 14 Wood Shingle Code escri tion Percentage FEP cam`` 07_ -JUL 1.2 P z5 V xterior Wall 2 1010 Ingle Fam MDL-01 100 8 Roof Structure 03 able/Hip oof Cover 3 sph/F GIs/Cmp 22 2 Interior Wall 1 04 Plywood Panel Interior Wall 2 Yr ,, `COST/111i1RKF7 VALV�4TION�` 4- Interior , g Flr 1 14 Carpet dj.Base Rate: 5.95 20 Interior Flr 2 2 Hardwood Section.RCN: 50,238 Heat Fuel 2 it et Other Adj: .00 BAS eplace Cost 50,238 Heat Type 5 of Water 4 BMT 2 YB 925 C Type 1 one yB 987 Total Bedrooms 4 Bedrooms ep Code 20 Total Bthrms z Remodel Rating 12 20 Total Half Baths 1 Year Remodeled 12 Total Xtra Fixtrs Dep,% 20 FHS Total Rooms 7 Rooms Functional Obslnc D WDK BAS BMT BAS ath Style External Obslnc 18 1 6 BMT ? Kitchen Style Cost Trend Factor 12 2 2 Condition 12 20 %Complete - . Overall%Cond 30 pprais Val ZOO,200 ep%Ovr Dep Ovr Comment isc Imp Ovr isc Imp Ovr Comment Cost to Cure Ovr Cost to Cure Ovr Comment OBOUl911TLDING4„Y. RD'ITEMS(L)/.' ° BUILDING EXTRA"FEATi1RES(B)` �,$;., Code escri lion ub ub Descri t B Units Unit Price Yr Gde Rt Cnd %Cnd r Value GR2 Garage-Avg 52 5.00 1950 1 100 '-800 SHED Shed L 63 8.00 1990 1 100 400 �•—ram— SHED Shed _ 0— .00--1990--.4..-1 ,,..,_.,100 500 w t P--.TX— ztra Apartmt B 1 ,000.00 1987 1 100—6,400 No Photo On Record „sBUILDINGSUB;AREA= Code IDescription Living Area Gross Area E .Area Unit Cost Unde rec. Value AS First Floor 1,832 1,832 95.95 175,780 MT Basement Area 0 1,312 16.31 21,397 EP Enclosed Porch 0 176 28.89 5,085 HS Half Story 260 520 88.20 45,864 V*IDK Wood Deck 0 216 9.77 2,111 T1L Gro.vs l iv/l eave Area:1 2.0921 4.0561 250,238 Property Location:44 BETTY'S POND ROAD MAP ID:290/092/00l// Bldg Name: State Use:1010 Vision ID:22298 Account#196200 Bldg#: 1 of 1 Sec#: 1 of 1 Card 1 of i Print Date:07/12/2007 14:14 RUSSELL,THOMAS J&MICHELLE 1 Level 6 eptic i Paved Description Code* J Appraised Value Assessed Value 44 BETTWS POND ROAD as RESIDNTL 1010 206,600 206,600 801 ublic Water -RES LAND 1010 234,100 234,100 2007 Visions Data,MA SIDNTL 1010 4,700 4,700 HYANNIS,MA 02601 n UPPlEMENT:4L DATA .,. .# s,rt. S Additional Owners: Other ID: Plan Ref. Tax Dist. 400 Land Ct# er.Prop. #SR Life Estate VISION DL 1 LOT B Notes: DL 2 GIS ID: 22298 ASSOC PID# Total 445,T001 445,400 S4LE,PRICE.Y.,._C. RUSSELL,THOMAS J&MICHELLE 9353/207 09/15/1994 U 1 91,000 A Yr. Code i Assessed Value Yr. Code Assessed Value Yr. Code I Assessed Value RUSSELL,THOMAS J&MICHELLE 9353/207 09/15/1994 U 1 91,000 A 006 1010 191,500 2005 1010 162,800 2004 1010 135,900 SYLVESTER,JON J&MARY E 9353/200 09/15/1994 U I 1 F 006 1010 230,300 2005 1010 191,900 2004 1010 127,600 KOKKO,HILDA H DTH CERT 9353/205 U 1 A 006 1010 4,900 005 1010 5,100 004 1010 5,200 BARTELL,OLGA DTH CERT 9353/204 U 1 A OKKO,WILLIAM DTH CERT 9353/203 U 1 A Total: 426,700, Total: 359,800, Total: 268,700 _;„EXEMPTIONS, € W y , x,„_ OTMERIASSESSMEIVTS ,,' >z This signature acknowledges a visit by a Data Collector or Assessor Year Tvpe Description Amount Code Description Number Amount Comm.Int. 0 5C RESIDENTIAL EXEMPTION Appraised Bldg.Value(Card) 200,200 r �4SSESSINGNEIGHBOR_IIOOD ,, r r� ,rtr? Appraised XF(B)Value(Bldg) 6,400 NBHD/SUB NBHD NAME STREET INDEX NAME TRACING BATCH Appraised OB(L)Value(Bldg) 4,700 PF02/A Appraised Land Value(Bldg) 234,100 Special Land Value 0 1 Total Appraised Parcel Value 445,400 Valuation Method: C ,i Adjustment: 0 et Total Appraised Parcel Value 445,400 _... �s ,i. a.... ..-r.,. ._ _.. _ ..t.,,.�--r.^r,.r Caw. . ,_ _-,., .;:.. a:,......,,._<... .,, .. a_,...._'i�.:.......,.. .�.i: .-. ., .:.. J -. .n 1 „ .Y.. ...^.{.. x.,u. �.., ... �-, _ �. VISIT/:_CHANGE;HISTORY �: �.�..:, _ � _ Permit ID Issue Date Typ e Description Amount Insp.Date %Comp. Date Comp. Comments Date Typ e IS ID Cd. Purpose/Result 86610 09/01/2005 WD Wood Deck 4,800 0 4/18/2001 SM 10 3rd Visit-2nd Notice Left 3/23/2001 SM 09 2nd Visit-1st Notice Left 2/26/2001 SM 01 eas/Est 8/15/1995 ML , .. ..:.. .. u ,.. . .. .. •. t-, �:� .,.,: ,..�., .u., '"„;.s. ��......,,._:..- B Use Use Unit I. Acre C, ST. # Code Description Zone D ro-ta a Depth Units Price Factor S.A. Disc Factor Idx Ad'. Notes-Ad' Special Pricing d'. Unit Price Land Value 1 1010 Single Fam NML-01 RB 4 1 1.00 AC. 172,000.00 1.00 5 1.0000 1.00 PF02 1.20 AUNT BETTS POND 206,400.00 206,400 1 1010 Single Fam MDL-01 RB 4 1 0.51 AC 25,800.00 1.76 R 1.0000 1.00 PF02 1.20 54,373.50 27,700 Total Land Value: Total Card Land Units: 1.51 AC Parcel Total Land Area: .51 AC 234,100 °FIME 1py, Town of Barnstable ti Regulatory Services • BARNSTABLE, v MASS. g Thomas F.Geiler,Director �A 039. �0 rFD MA'S16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4024 Fax: 508-790-6230 July 9, 2007 Mr. &Mrs. Thomas Russell 44 Betty's Pond Road Hyannis, MA 02601 RE: Illegal Apartment-44 Betty's Pond Road Hyannis , MA 02601 Map : 290 Parcel : 092-001 Dear Property Owner This letter is to inform you that you currently are in violation of Barnstable Zoning Ordinance 240-11 You must contact this office by July 31 , 2007 to arrange to bring the above address into compliance or be subject to fines of no more than $300.00 per day of non-compliance. Thank you for your attention in this matter. By Order, Linda Edson Amnesty Zoning Enforcement Officer Building Department Q:zoning5 FTME 1ph, Town of Barnstable O Regulatory Services vMASS. $ Thomas F.Geiler,Director �p 1639. ♦0 lFDMa+" 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 July 18, 2007 Ms Mary Momoso 44 Betty's Pond Road Hyannis, Ma 02601 Re: Accessory Dwelling Unit Dear Ms Momoso: A recent review of our records found no evidence of an approved building permit as required for the construction and use of the existing accessory dwelling attached to the primary structure located at 44 Betty's Pond Road, Hyannis. This property is located in the Residential B zone and is therefore limited in use to that of a single-family dwelling. A search of the Board of Appeals database failed to identify any form of approved zoning relief. I hope you this information is beneficial to you. Please feel free to contact me directly at 508-862-4027 in the event that you have additional questions. cerely, Robin C. Giangregorio Zoning Enforcement Officer oFtHE ro,,, Town of Barnstable Regulatory Services r w a ■ an ASS.Mass. Thomas F.Geiler,Director y M �n �'OtE1639. &0 Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 November 27, 2006 Mr. &Mrs. Thomas Russell 44 Betty's Pond Road Hyannis, MA 02601 Re: Illegal Apartment: 44 Betty's Pond Road Hyannis, MA 02601 Map: 290 Parcel: 092-001 Our records indicate that your house at the above-referenced location is currently being used as a multi-family home,which is contrary to Barnstable Zoning Ordinances. Violation of zoning ordinances is a misdemeanor, conviction for which results in a criminal record. You must contact this office within 14 days to either: • Apply for a building permit to restore the property to a one-family home • Apply to the Amnesty Program • Prove that this is a legal multi-family home. Please contact this office immediately to tell us what direction you wish to take. Sincerely, Linda son es Zoning Enforcement Officer uilding Department gforms:zoning3 I_ Parcel Detail Page 1 of 3 10 9 II t r / Logged In As: Parcel eta I I Tuesday, Novernb Parcel Lookup Parcel Info _. ............ ......... __......... Parcel ID.`290-092-001 Deve open LOT B Location i44 BETTYS POND ROAD Pri Frontage 345 Sec Sec Road Frontage .............................. ......... ............... __. _......... Village HYANNIS Fire District;HYANNIS ............................ ......... SewerAcct'; Road Index 0121 Interactive Map w Owner Info ...... ... ...................... _ ....... __._ ....... _ ....... Owner`RUSSELL, THOMAS J& MICHELLE Co-Owner ......... .. Streeti :44 BETTY'S POND ROAD Street2 city HYANNIS State=MA Zip 02601 Country US Land Info ....... _. ....... _....... Acres 1.51 use`Single Fam MID zoning RB Nghbd PF02 TopographyLevel •.m.._. Road Paved Utilities;Septic,Gas,Public Water Location Construction Info Building I of 1 .....__.....__. _ ......... Year' Roof,;Gable/Hip Ext;Wood Shingle Built= Struct t Wall Effect Area2608 "" " " """� Cover Roof'Asph/F GIs/Cmp AC 1None`None Type Style jCape Cod IntPlywood Panel Bed ,4 Bedrooms Wall --- Rooms Model `Residential IntHardwood Bath ,2 Full + 1 H Floor Rooms ......, _ T ......._..._.., w...._...._ .,, - " ..,....._ Grade;Average ype`Hot Water Rooms ? Rooms http://issql/intranet/propdata/ParcelDetail.aspx?ID=22298 11/28/2006 Parcel Detail Page 2 of 3 ....... ... ......._.._. Qe Heat, _ Found- stones 1 1/2 Stones Oil Poured Conc. __ Fuel ation 3' u Permit History_. Issue Date Purpose Permit# Amount Insp Date Comments 9/1/2005 Wood Deck 86610 $4,800 Visit History _._....._.. ._...... Date Who Purpose 4/18/2001 12:00:00 AM SM 3rd Visit-2nd Notice Left 3/23/2001 12:00:00 AM SM 2nd Visit-1 st Notice Left 2/26/2001 12:00:00 AM SM Meas/Est 8/15/1995 12:00:00 AM ML Sales History._.. ._... ....._._. _..... _.. — Line Sale Date Owner Book/Page Sale P 1 9/15/1994 RUSSELL, THOMAS J& MICHELLE 9353/207 2 9/15/1994 RUSSELL, THOMAS J& MICHELLE 9353/207 3 9/15/1994 SYLVESTER, JON J & MARY E 9353/200 4 KOKKO, HILDA H DTH CERT 9353/205 5 BARTELL, OLGA DTH CERT 9353/204 6 KOKKO, WILLIAM DTH CERT 9353/203 7 BARTELL, OLGA M-792 9353/202 8 SYLVESTER, JON J & MARY E 3024/71 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Para 1 2006 $185,100 $6,400 $4,900 $230,300 2 2005 $159,000 $3,800 $5,100 $191,900 3 2004 $132,100 $3,800 $5,200 $127,600 4 2003 $126,300 $3,800 $5,500 $60,900 5 2002 $126,300 $3,800 $5,500 $60,900 t 6 2001 $105,500 $0 $5,000 $60,900 7 2000 $94,000 $0 $5,000 $41,400 http://issql/Intranet/propdata/ParcelDetail.aspx?ID=22298 11/28/2006 f Parcel Detail Page 3 of 3 8 1999 $94,000 $0 $4,000 $41,400 9 1998 $94,000 $0 $4,000 $41,400 ; 10 1997 $84,100 $0 $0 $41,400 11 1996 $84,100 $0 $0 $41,400 12 1995 $87,300 $0 $0 $41,400 13 1994 $81,700 $0 $0 $49,700 14 1993 $81,700 $0 $0 $50,400 15 1992 $92,700 $0 $0 $55,200 16 1991 $112,500 $0 $0 $80,800 17 1990 $112,500 $0 $0 $80,800 18 1989 $112,500 $0 $0 $80,800 19 1988 $70,900 $0 $0 $45,000 20 1987 $70,900 $0 $0 $45,000 ; 21 1 1986 1 $70,900 $0 $0 $45,000 Photos http://issql/intranet/propdata/ParcelDetail.aspx?ID=22298 11/28/2006 `_ � � I �, `'1,,�1 `��l �� ������� � 7 �� �33 � - � G � S . 7 , `� t : RESIDENTIAL PROPERTY MAP NO.`. :LOT NO'.,: FIRE D1srRlcT SUMMARY STREET .44:Bett t S Pond'Rd'. , on Betty's Pond,Hyannis LAND H 73 BLDGS. ?SOS A2 0. 92-1 OW N E R TOTAL RECORD OF TRANSFER DATE BK PG 1.R.S. `REMARKS:Lot B (8-1 B-84A) 3 0 LAND qo�- GS. r�" r�... PPort. B EaP TOTAL I � . Sd 290-92-2j..Sla 81 #GS. Q Ot a s�ff il `Sylvester,`Jon J. & Mary E.. 12-3-79' 3024 71 ( 65,10 . -3 7 i,-%,Z> 2. LAND -}� �\D. N NN1S 04 0169 Go Q Gl� p j �� BLDGS. TOTAL � � bgrt / 70 0 LAND - BLDGS. Qt TOTAL LAND BLDGS. TOTAL LAND BLDGS. 01 TOTAL LAND INTERIOR INSPECTED: r / 0) BLDGS. TOTAL /�� ! / ��r/ DATE: / /f�L'�V ✓U „2 !LAC LAND ACREAGE COMPUTATIONS LNG BLDGS. LAND TYPE #.OF ACRES PRICE TOTAL D E P Fy. VALUE TOTAL, HOUSE LOT � 00 ]ODU B p-o /T ;700 LAND CLEARED FRONT - BLDGS. REAR TOTAL WOODS&SPROUT FRONT LAND REAR 'S 1 `t U oO p O _ U:i Q 0) BLDGS. WASTE FRONT TOTAL REAR LAND BLDGS. TOTAL C _ LAND •V jt! J D BLDGS LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ROUGH TOWN WATER m BLDGS.. HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND SWAMPY NO RD. BLDGS. TOTAL �?onc.Walls "' Fin. Bsmt.Area ;V Bath Room..,: ✓ Base // _-'_�/) 7 a eLDG. ZOST "y_ '/�T Conc.Blk.Walls. Bsmt.Rec. Room St, Shower Bath a 'y� Bsmt. :one.Slab Bsmt.Garage -- -- F URCH. DATE St.Shower Ext. Walls _ — PURCH. PRICE. .�./• .. Brick Walls Attic Ff.&Stairs Toilet Room Roof RENT hone Walls Fin.Attic Two Fixt. Bath Floors ✓' S A 'Tars INTERIOR FINISH Lavatory Extra ' „/s '�f4 3smt. F 1 2 3 Sink —ram" 1+ �T� 5 a <. . r/: �/4 Plaster Water Clo. Extra Attic __-J?-ram r'L d'. �"l' /> N- �+e. EXTERIOR WALLS Knotty Pine Water Only C�'21 )ouble Siding Plywood No Plumbing Bsmt.Fin. ✓ll GF! I ya Tingle Siding Plasterboard I/ Int.Fin. �00—vhingles - TILING (ie. ;one. Blk." G F P Bath Fl. Heat ]�(J Face Brk.On Int.Layout ✓ Bath JO&Wains. Auto Ht.Unit Veneer Int.Cond. ✓ Bath Ff.&Walls I ✓ Fireplace ,om. Brk.On HEATING Toilet Rm.Ff. Plumbing - iolid Com.Br.k. Hot Air Toilet Rm.Ff.&Wains. -- " Tiling Steam Toilet Rm.Ff.&Walls Blank �/ Hot Water A/� St. Shower Roof Ins. Air Cond. Tub Area Total Floor Furn: ROOFING COMPUTATIONS Asphi'Shingle Pipeless Furn. S. F. .17 3✓�� �a U. I Wood Shingle No Heat S. F. /.S 70 Asbs. Shingle Oil Burner S.F. 6'/3 : y Slate Coal Stoker Fr D S. F file Gas S.F. ROOF TYPE Electric s �?�1n 0 OUTBUILDINGS Gable Flat S F. / _ S/ 7 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 819 10 MEASURED S. F. Pier Found. Floor Hip" Mansard' FIREPLACES- Gambrel Fireplace Stack Wall Found. 0. H.Door LISTED-- FLOORS Fireplace Sgle.Sdg. Roll Roofing Conc. LIGHTING _ Dble.Sdg. Shingle Roof Earth No Elect. DAT Shingle Walls Plumbing Pine, I I Hardwood ROOMS Cement Blk. Electric Asph. ——]—— Bsmt. 1st TOTAL - 0 3. Brick Int. Finish PRI -D Single 2nd 3rd FACTORa- REPLACEMENT -4/.3 66--L-YPA CY COI1NSTRUCTION- SIZE AREA CLASS AGE[ REMOD. COND. REPL. VAL. Phy.Dep. pHYS. VALUE Funct.Dep. ACTUAL VAL. DWLG. . .� '�•7y % ��.?✓ C.S J/.S1'%'3 _L .- .-?;3 G S 7 "-?2 3 2. 9 8 L V/'v �. 3C 3 Z .�i� 'L.- -S 3/3 Z S v S� Sb r 6 7 i 6 e. tT':',•',w. ,, j TOTAL - 7 T�•'C.. .[,,�.q � s t. tp s i !lie .Town of Barnstable .�xrrsrns�, Department of Health Safety and Environmental Services A�iro +°i Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner January 22, 1997 Thomas and Michelle Russell 44 Betty's Pond Road Hyannis,MA 02601 Re: 44 Betty's Pond Road,Hyannis Dear Mr.and Mrs.Russell: I regret to inform you that as a result of the Zoning Board of Appeals action you must make some changes to your apartment so that it comes back into compliance with zoning. Please come in to see us to make arrangements for this conversion. Sincerely, Ralph M.Crossen Building Commissioner RMC/km cc Gloria Urenas,Zoning Enforcement Officer L Town of Barnstable V Planning Department Staff Report Appeal No. 96-141 Special Permit Pursuant to Section 4.4 Nonconformities Appeal No.96-142 Use Variance Russell �► Date: November 01, 1996 To: Zoning Board of peals From: Approved By: Robert P. Schemig, Director Reviewed By: Art Traczyk Principal Planner Drafted By: Laura Harbottle,Associate Planner Applicant: \ Thomas&Michelle Russell Property Address: 44 Betty's Pond Road, Hyannis Assessor's Map/Parcel Map 290, Parcel 92-1 Area 1.51 acres Zoning: RB Residential B Zoning District Groundwater Overlay: GP Groundwater Protection District Appeal No.96-141 Special Permit Pursuant to Section 44 Nonconformities Filed October 4, 1996 Public Hearing,November 6, 1996 Decision Due February 3, 1996 Background: The property is located at 44 Betty's Pond Rd., Hyannis, and consists of a 1.51 acre lot which contains a wood frame dwelling, garage, pool and several sheds. Assessor's records list the property as a single family dwelling. The property is located in the RB Residential B Zoning District,where single family dwelling is the only allowed use today. The applicant is requesting relief in two forms: 1. a Special Permit to alter a pre-existing nonconforming use, or 2. a Use Variance to permit the continued existence and change of the two-family dwelling. The existing apartment is being proposed to be relocated to a garage attached to the house. Work had started on this change and the Building Commissioner issued a Stop Work Order for any interior work until zoning relief could be obtained. Staff Review and Comments: Zoning History-Special Permit: From Staff research the history of zoning of this locus appears as follows: • Originally zoned in 1951 as Residents A Zoning District which permitted as-of-right single and two-family dwellings. • Changed to RA-1 in 1956 with the comprehensive rezoning of the Town. This permitted single family dwellings and two family dwellings by Special Permit Only. - • In 1969, it was rezoned to RB as part of Comprehensive Rezoning. That district permits only single family dwellings. To secure a non-conforming Special Permit for this use-a two-family dwelling on a single lot- the applicant will have to substantiate that the use predates 1956 and was legally created. No plans for the proposed apartment were provided. The applicant should provide a site plan showing parking spaces and floor plans of the apartment showing the room layout. If the two family dwelling is permitted by the Board, it is recommended that occupancy be restricted and the total number of bedrooms capped given the location of the site adjacent to Betty's Pond and the on site waste water disposal. Does the on-site septic system meet current Title V requirements? Use Variance: If the Board cannot find to grant the Special Permit, it may wish to consider the Use Variance. The locus of this appeal is more than 300 feet off of West Main Street and therefor pp r meets . is with the requirements q ents of Section 5-3.2 (5). The area has been iden tified as an Area of Critical Concern by the Board of Health. These areas of concern have been located based upon the failure of a majority of the on-site septic systems in the area. This lot is also in a Groundwater A • y Appeal No. 1996- 141 Russell • Protection District and is known'to have a nitrate loading level in excess of 5 ppm which exceeds recommendations for the GP District(Board of Health Regulation). If a variance is required, the applicant must substantiate those conditions unique to this lot that justify the granting of the relief being sought. If the Board finds to grant the Special Permit or Use Variance, they may wish to consider the following conditions: .1. The two family structure shall contain no more than a total 4 bedrooms. Total occupancy of the two-family structure shall not exceed six persons. 2. The locus shall comply with all Town of Barnstable Building, Conservation and Health Department Regulations. 3. The two-family structure shall be limited to a gross area of 1,832 sq. ft. 4. There shall be no further division of this lot. • 5. The septic system shall meet current Title V requirements without a variance. 6. If in the future public sewers or communal wastewater treatment is provided, the site shall hook up to such system within six months of their availability. Attachments: Applications Assessor Map Plan Reduction copies: Applicant/Petitioner . • TOM of BARIT • S2AA7.x ' z°==J Board of Appeals -- •i ,_ '.AQalicst=ea for a saecial Per=it Date Received ♦�} _ a Town CW J lJ .� ergs of=ice office use _-": ,A peal _ 4 8 a- ag Data r/ D c'_sion Due The undersigned hereby applies to the Z` ,, ,Pe Wit, in the manner and for the reason re aster set L' ..f== a Special-.- Applicant Name: Thomas Russell and Michelle Russell Phone 5 _ Applicant Adcress; 44 Bett ' OS) 778 1336 y s Pond Road, Hyannis, MA 02601 Prcper_y Lccat:on: 44 Betty's Pond Road, Hyannis, MA 02601 p"'pertf Owner: Thomas Russell and- Michell e Russell Pho Acd+ess of .aver; 44 Betty' s Pond RoH Hyannis, ne L5�8177A-1 �16 y , 02601 • Sf app�r�t dttfera $tom Wmer, state mature of :aterestt M=bEr of Years owned: 2 veers Assessors Map/Parcel Number:: 290 / 92-1 Zoning District: Groundwater Overlay �g District: AP Special Pewit Requested: Alteration of a pre-existing, Non-confo C.:Ze sec=.Z= & T1zle er the Zoning ordinanc na use. Description of Activit-.I/Reason for Request: To re-locate Non-conforming apartment use of an existing a 8 g portion of the structure previously used for apartment purposes. Description of gcnst_::'� •- ..ion Activit-y (if applicable) : apartment to conform with current Building Codes Upgrade Pre-existin Proposed Gross Floor Area. tc be Added: 0 Altered: Existing Level of. Develolmeat of the Property - Nu.:.ber of Buildings: 5 Present Use(s) : House with attached Apartmp_rtress :'cow Area:2008 plus �,. 3 sheds, 1 detached Gage v 3 _• sc. --- detached garage APPlicatioa for a special Pelt ' Is the praperty located in as His f District? yes ORH use Only: Yes (J No Plan Review Number Data Approved Is the building a designaze d Histori � c admar 7 yes no Historic Preservation Denaz =entsuse Only: Date Approved Have you applied for a buil Has the Building Znsvector ding ermitZ i Yes �Cl No Csfus8d a perai�T [I All applications for a. S Yes ICl No [J prccess must be successfuglel=� Pe_*�t �quise approved Site Plan. That to the Zoning "Card. o f Apoeals.pleted prior to submit,,,ing this application For Huildina oenar rent use only: Not Required - singis Family Sits Plan Review Number (J Date Approved Signature: The following infornat+on must be s reautdme Of est: f ling, failure supply this may result is a denialubmitted With the �of your y ) Original sig arires.the -c=:zpletad appZicatian fans, each with Five (5) copies •of a certified the dimensions ofpropest? sur9eY !Plot plan) showing sur--eunding roadways and land, all l °i�tlands, water bodies and the land. the location of the existing i=rcvements on Five (5) ccples of a praposed a3ta fmproveiaeat certified profession Pam, drawn by a is recu=sd for all = sad approved by the Site Plan Review Committee Show the Proposed development activities. This plan must exact location of all proposed improvements and alterations on the land and to at=ctures. 4-7.5 of the Zoning OrdinanceSee Contents of site Plan•, section , for detailed reaui��emeats. The applicant may emit assist the .Board in any additional supporting documents to �inq its deter—;nation. Signature: A 0 scant Data s Or Agents Signature Agents Address: r ✓' /liJg� -� S -cr Phone 7 /- �f d�y �1 > .J h/7r9 ALL o/ Fax No. r # :TOWN OF BARNSTABLEs Zoning Board of Appeals - Application to Petition for a Variance - - Date Received Town Clerk office. For office Use only: Appeal # OCT Hearing Date Decision Due The undersigned ' •hereby applies. to the Zoning Board o Appeals for a Variance. frcm the Zoning ordinance, in the manner and for the_::reasons hereinafter set forth: Petitioner Name.:Thomas Russell and Michelle Russell ( 508) 778-1336 Petitioner Address: 44 Betty' s Pond Road, Hyannis, , Phone MA 02601 Property Location:. 44 Betty' s Pond Road, Hyannis, MA 02601 Property owner: . Thomas Russell and Michelle Russell phone ( 508 ) 778-1336 Address of Owner: 4.4 Betty' s Pond Road, Hyannis, MA 02601 If petitioner differs from owner, state nature of Interest: Number of Years Owned: 2 years Assessors Map/Parcel Number: 290/92-1 Zoning District: RB Groundwater Overlay Districts AP Variance Requested: 5-3 . 2( 5) General Powers: Variances and . Use Variances Cite Section & Title of the Zoning Ordinance Description of Variance Requested: Use of existing structure for apartment use within the RB Zoning District, Description of the Reason and/or Need for the variance: to legalize prior use of existing structure for apartment use. Description of Construction Activity. (if applicable) : Renovation of Are-exist-tng apartment to conform with current Building Code. Existing Level of Development of the Property - Number of Buildings: 5 House with attached Apartment Present Use(s) : 3 Sheds, 1 detached Garage 2008 plus a60 detached Barge Gross Floor Are sq t Proposed Gross Floor Area to be Added: 0 520 Altered: Is this property subject to any ether relief Variance o( r special Pe +- the Zoning Board of Appeals? p mot) from if Yes, please list anneal Yes ( ] No [ I IOPERTY ADDRESS 0044 BETTT'PpNO ROAD I I ZONING DISTRICT CODE SP•DISTS.I DATE PRINTEDI I ANOiOTNER FEATURES DESCRIPTION 07 RB 4OO STATE L.no a,,Ouo _ ADJUSTMENT FACTORS 0 CLASS PCS NSHD CO FF Oa,trvwc.os OC.IY.R.SPEC.CLAS ADJ. COND. P 10 1.B LD 6.S I T 1 UNIT . ADJ'D.UNIT KEY NO. PRICE PRICE ACRES/UNITS VALUE o..a,pla„ RUSSELL.; THOMAS J6 .NICNELLE NAP- 11 1aEsiouAL 1 X 1 =10 N=120 100 29999.9 x •5 =10 H=120 .1i8 •35999.9! #LAND 1 i1.i00 6000.0 .10656.0/ 1.51 35400 llOLDGIS),r CARDS IN ACCOUNT - BATHS 2.1 U .51 5400 +POTHER FEATURE 1•; 84.100' 01 R61 DETGAR S X 100 3.400 of •01 A SHED S 17 x 22 195 C= 9519.3 9500.0 APL 44 BETTYS POND RD p 9 38 19.3 1352 9500 e. ODL :LOT B. . ARKET 800 SHED 195 C= 43 7.3 352 INCOME ,1 S 5 x 10 197 C= 84 11�� 5.03 63 2300 F ORR 0121 .0345• 9.82 USE s S0 S00 IF- APPRAISED VALUE I A 1280900 M PARCELISUNMARY E AND 41400 N BLD6S 84100 T 0-IMPS 3400 S OTAL 128900 EEO N CNST =. DATE Sook p� �,.,. Mo YI plift. PRIOR TEAR TEAR VALUE 9353/2071EI09/94 A AND -41400 9353/207YEib9/94 A 91000 LOSS 87500 9353/ 91000 OTAL 200iEI;p9/9i F 1 128900 LAND LAND-ADJ INC ME 41400 SE SP-BLDS N euILOINOPETy" LAND ADJUST:fOR FEATURE BLO-A' UNITS wIa TY0' "" VIEW c a:: can:l TOI,I 34 0 9500 Units Umly B.«R.ia Ysv u 'AOI Rala A Apa Naf1n. OOsr. 01 C 000 110 110 wa. cane. CND. Loc. %R a. AI C.,1 Na.57.50 63.25 25 75 19 80 "°'"'°' Yµ» Orsc.pua„ 9 0 7 0 NNp1,i Roan. Rms sul. •Fix. p 8AS 100 R+u sw.�as«I Rrp1 Co.$ 120206. rlw.E►.e. 63_2 5 S 2 0 MKT.INDEX: 1.00 IMP.eY/DATE: ML. 8/95 84100 1.5 7 4 1SB 100 63.25 32890 SCALE: 1/00.30 2.1 9.0 FWD 8 5 312 1 9 73 i IA�CA-M y N G- EIEMENTB ODE CO"STRUCT1pN DETAIL- 8.50 216 1836 N.* 26-re* CNST P: 1S8 100 63.25 480 r 20FFS 20 STYLE 04CAPE BEY 12 30360 _ __ C 5 12.50 176 ! .! DESIGN. 6iFly. -02D�SIbK AOJIjST'�AO� OD FF6 30 18.98 2870 ExAER:ii�iCCt -, i1 _6b SHfASLSt,'---0 015 42 26.57 520 3816 *-*22-�. EA.TIEt'-TYPE .-1 I_& 520 13816 ! ! IN,rlkA IIlf31(. -02 6t�E IjIEIFUZZONSD---R BEY jlITEB:LAYbUy. .-i21iVER .. b!lACTY-. -02sii�i� AS--XT --�� x ;Ta,I A.«, A,,,_ 912 e.«. 1312 Y ! ISO ! iLOdit_-SrRl7t3': -02w_7jbiSjjjj_ M-----G- SUILDINODIMENSIONS 2i 2i E7LOOR_ EOVER.- -05CARPET-(I-HDYp --Q� BAS Y20 1SB Y12 N04 FYD Y12 N18 ! ! BbO� fir-t---- -Ol G_dEt;'j[ H 'yTO--- 0. E12 S18 ISO N22 E12 S26 *-12+--20-* ELl;CTRIAIIC -- -01 -vEEE6�-----Aa �� BAS N26 ISO N24 BEY N22 FFG Y04 *12* !BASE ' ! FOUNDATION -01 N20 E26 S20 Y22 BEY E08 S22 18 18 26 26 - - --- --- W08 1S13 E20 S24 Y20 .. OAS ! 11S8! 815 ! -----AEIfNAblt 666 62At-WAN-Vt ------ i E20 S26 .. 815 Y20 U26 E20 S26 FWD* ! ! LAND *-12+--20-X PARCEL' 41400 128900 TOTAL MARKET AREA VARIANCE 1229 ♦0 ♦l1229 Q i O 7 C'B FjVD a N � PARCEL 'E r`�, •� SHED - `` DLjCK C7 POOL c, I FND �- wc h'Cc .Y 4. 744 SHED O GAR S Wide t ear emen lY PARCEL A rvoTE.. PRE-EXISTING NONCOrVFOR;VlNG �J ES. ZONE.- "RS This MORTGAGE I VS P ECTIO N Flan is For FLOOD ZONE.' "C" 0 WN; -LMa _ _ — ., Hank Pse Only EED REF: _3024/� — — — REGISTRY `OWNER: JOrV I do :fAF,Y E. �YL ✓6'STEP DATE: B;251,4 — _ _— — —2 U BUYER: -aCYA: .J 1• CHF�L�D_R FLL —_ PLAN REF: �C�. E: I' = so' HEREBY CERTIFY TO xyJ1,���V ��l JC�'1�'�I� _ -- — - --- - - CORPORa 710N _ _-THAT THE BUILDING `tH 11;F era YANI<EE SURV� 1 :HOWN ON THIS PLAN IS LOCATED ON THE GROUND AS :HOWN AND THAT ITS POSITION DOES ____ CONFORM Pik" �y CONSULTANT-S '0 THE ZONING LAW SETBACK REQUIREMENTS OF THE A. SOB (SUITE 1) 'OWN OF —_—BARNSTa4KC ______AND THAT meRfrnew y INDUSTRY ROAD T DOES_ NOT_ LIE WITHIN THE SPECIAL FLOOD HAZARD NO' '1�"TCNS MILLS. REA AS SHOWN ON THE H. U'D. MAP DATED_7._?/9? Ls -�STEa�� a�< "EL: 26-00�� ice', �'�'. �� .• r _... _..._ 62 ell a TO Mae ! ir• tr' I w s+ � •a .ta ui • L'8 pit T3 . •��' 74-Z 1.01� � 72 •0 MAC Te 00y� �. 38 . O NS.t •., - .. �vr Q T 0 N.Yt' • I.WOK .r ` 1•.c . 11•L �•' .1•K .144 Y AnC o %&*AL 67. 35 8 0♦ +s•� ins 1• 7M1 S .tfi AL 1 I %As•s i l� i f4i NO M ► .a•y o D . •G ii O % Av#r a rrrs POND' so MAC -� i••�ta • M u..r.W.. � F qL•s 3Z AS•& t s..c 61 JitC-i ea• 31 2 Q d+ �~ I�iG z• j,�t•64ac 21K .r•.� n ,r 01 w 169 .D'IIIC F + t3 . y,r.•T.rt u (•sM. of .btt � iv t P J149 3 w I�OwarHr• a •4D•N a � ye ♦� •.a. (� I» i IIK r O ...e. Cwa- tT M LAW".rrs• Ott '♦ ar j • .• M.Mf Ytii. Its < < * REV 9Y A 1 I 100 a L 1/1 $ I gT Moe/.. ± Csrx COD muLoDy Tt •aL�- IIZ 2T0 28 TON Ii NM J 1I s 1.�l�Iti. ♦ i� �, 268 2D 1 ./ 1 ►�� 26� 28 579 .� a� r w wit•n �1(, s�r►� �•` 1 �12/9o - /o/o9a -00i C - -! 77?�i SERVING CAPE COD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION t Map aQ0 arcel a"/ oa / Application# Health Division Conservation Division Permit# Tax Collector Date Issued g Treasurer 0f Application Fee Planning Dept. Permit Fee �Is�i 00 Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address S 1 a Village � Owner A pd �- I .p cAlun ssl 1 1a,0� AddressRV l Telephone - Permit Request 5 Z te- L) Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) J 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 , �wt C Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Ye`s 0'No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new"size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: ;nt'l Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ ' Commercial ❑Yes ❑No If yes, site plan review# Current-Use Proposed Use BUILDER INFORMATION --� NameT�-f /i l� �,�� 5 �T,�tC Telephone Number /—`� 0 3_S Address VyltJ��1/-Z T� License# 57�i l 06 B Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOy SIGNATURE 4meln / �R I DATE $ / S'- ��k i ` FOR OFFICIAL USE ONLY > PERMIT NO. D k*M ISSUED PARCEL NO. ADDRESS VILLAGE OWNER t DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE F ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r t } k t I y r.. a ET. o _ � J ZQ E I � . FRIEDLINE&CARTER ADJUSTMENT, INC. 436 Main Street, P. O. Box 338 Hyannis, Massachusetts 02601 Tel. (508) 771-3232 FAX (508) 790-2344 TO: ( YB 'ding Commissioner or Inspector of Buildings ( ;Board of Health or Board of Selectmen O Fire Department TOWN OF Barnstable TOWN HALL Barnstable, MA RE: Insured: RUSSELL, Thomas&Michelle Property Address 4 44=Betty's;Pand'Road=l Hyannis, MA Policy Number: 0854105 Type of Loss: Fire Date of Loss: 8/15/2006 File#: 105127 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. General Laws, Chapter 143, Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of this writer and include a reference to the captioned insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by First Class Mail. D. A. BENTLEY Adjuster 8/16/2006 Edson, Linda To: Taylor, Madeline Subject: 44 Betty's Pond Rd Hyannis BOH says that they are still working on the septic plan. Linda 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0110 Parcel ®"LAt Permit# Health Division �'� �� ��3 �� �< ' Date Issued Q-L-DS Conservation;Division u�31 SEPTIC SYSTEE— L °06 Tax Collector - INSTALLED IN CO LIANCE WITH TITLE 5 Treasurer ENVIRONMENTAL CODE AND Planning Dept. TOWN REGUIN69*in By Date Definitive Plan Approved by-Planning Board Approved By Historic-OKH Preservation/Hyannis Project'Street Address Al-�f ® t Village 107 �- Owner 1 e4 Address- Telephone - �®��s Permit Request 1 o e-e ! A%o Al"6-`-- A9 e C-� e- Sq lfeet: 1 r• xisting proposed 2nd floor: existing proposed Total ne_wT aluation Zoning District Flood Plain Groundwater Over,,, Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentatio .Y Dwelling Type: Single Family ®' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes O-fqb On Old King's Highway: ❑Yes aW-No Basement Type: U�ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ®-M-oo If yes, site plan review# 11 Current Use 4'e�C—il Proposed Use BUILDER INFORMATION Name Telephone Number O 7 7 V'rd« r Address 174 7 ;gfvc License# ® 3 1 f f0 C ��-lii 6 i lL C 2 Z ®Y Home Improvement Contractor# ® 2 3 J—rf Worker's Compensation# ALL CONSTRUCTION DEBRIS -RESULTING FROM THIS PROJECT WILL BE TAKEN TO,. SIGNATURE DATE ^� a � t p. FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: r FOUNDATION f r FRAME INSULATION 1="�„ A co m � v t— it FIREPLACE •.J }+� /tip .. .� F. Sl I !/ !, a ELECTRICAL: Zi (ROUGH? FINAL r) ; tTrt p = PLUMBING: ROUGHQ FINAL tX7S QC�? GAS: M TROUGH FINAL FINAL BUILDING ' r , r DATE CLOSED OUT ASSOCIATION PLAN NO. - f h I The Commonwealth of Massachusetts Department of 1`ndustrial Accidents Office.of Investigations + a 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Auplicant Information Please Print Legibly Name (Business/Organization/,Irn�dividual): , cs Address: Po h� P City/State/Zip: s - / I ® ti-�'e/ Phone# � Are you an employer? Check the-appropriate bog:. Type of projed(required):' 1.❑ I am a employer with 4. ❑ I am a general contractor and I emp y 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.�am a sole proprietor or partner- listed on the attached sheet t 7. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. g, ❑ Building addition [No workers' comp.insurance 5•_ ❑ We are a corporation and its officers have exercised their 10:❑ Electrical repairs or.additions required.] 3.❑ I am a homeowner doing all'work_____ :_ right of exemption per MGL 1.1.❑ Plumbing repairs or additions myself. [No workers' comp: _ c. 152,§1(4),and we have no. _ 12:❑ Roof repairs insurance required.] t .. employees. [No workers' 1.3.❑ Other ,0eC,1r camp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information c`a 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 their workers'comp: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.#: 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 up to$.1,SOO,.OQ and/or one-year impriso�ent, 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 maybe 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: 000, Sizaature: Date: -7- 'ems Phone#: 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: 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"P4 lu�auaL...p�eql4�aSsociation,Forporation or other legal entity,or any two or more of the foregoing.engaged in a joint enterprise,and including the legal representatives to a deceased aj�pemployees. er the receiver or.trustee of an individual,partnership, association or other legal entity, employing emp Y and who resides,therein,or:the occupant of the owner of a dwelling house having not more than three apartments _.. dwelling house of another who employs persons to do maintenance, constriction or repair wofkVn such dwelling house appurtenant thereto shall not because of such employment be deemed to be an em "ployer. or on the grounds or building I'Y`_- g g �' - MGL chapter`152,§25C(6)also states that``eve state or_local licensin a en_ shall withhold the issuance or.-;Ten of a license or permit to operate a business or to construct buildings in'the comjionwealth for any applicant who has not produced acceptable evidence-of compliance with the insurance coverage required." ter 7 states"Neither the commonwealth nor any of its'political subdivisions shall Additionally,MGL chap .. 152,§25C( ) c work anti acceptable.evidence of compliance with the insurance enter into any contract for the performance of publi 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.supply sub-contractors)name_(s),address(es) and phone numbers necessary, ) 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' ationpolicy,please call the Department at the number listed.below.. Self-insured companies should enter th e compens ir 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 app lict Please be sure to fill in the permrt/hcense number which will be used as a reference number. In addition, an applicant applications in any given year,need only submit one affidavit indicating current that must submit multiple permit/license policy information(if necessary)and under"Job Site Address"•the applicant should write"all locations in (city or town)."A copy of the.af fidavit 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 . -• Department of Industrial.Accidents ..Office of Investigation 600-Washington•Street . Boston,MA 02.111.. Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-7274749 Revised 5-26-05 www.mass.gov/dia Town of Barnstable ti ♦. s . Regulatory Services ° MAM eA�•'gT�'a''�' ' Thomas F.Geiler,Director 'OIED 39. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us $;y Office: 508-862-4038 : .. . _ -}# Fax 508°- `790 6230 Property Owner Must r Complete and Sign This Section`_ If Using A Builder s I, s'Owner of the subject property hereby authorize ID-� ,447/0&1:41 LZeJ to act'-on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Z 5� riot Name • ".'' Q:F0RMS:07 NERPERMISSION ' f _ _ Qv ,, �oFIME rays Town of Barnstable .Regulatory .Services ' BAHNSTABLE, ' Thomas F.Geiler,Director p MAss. g �Ar i639' ate. Buildin Division. en ru►� g Tom Perry,Building Commissioner 200 Main Street; Hyannis,MA 02601 i Office: 508-862-4038 Fax: 508-790-6230 Permit no. :' r, , 1 a _ 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. j� CIO!� e- Estimated Cost -- �� Type of Work: ®_Op' �.. Address of Work Owner's Name: ` Date of Application: 3 ® ®S I hereby certify that: Registration is not required for the following reason(s): .❑Work excluded by law ❑Job Under$1,000. []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: > Date Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav R=off. 34 n� C. a FAD. X PAIR CEL B SHED - TC iP00L.Re F::VD c ' GAR S rIFD G.=R W1� C ' ' PSI RCC L A Iwo TE' FR -EXISTIA'C NONCONFORMING s ZONE. ",?2" This MORTGAGE IN-S P ECTIO Flan is =or FLOOD ZONE. "C" r'V!V: rJ/ Y VlV Fank 1.'se Onl,/ D REF: �Q��;7� — — REOLS77 OWNER: JONI & :tIA.R. Y E =Y� ✓ STFr? Y _ �"T E: B;'?5!g� — — - E U YE P,: 1r�' a�✓ C, L Y7 y C� PLAN REr —= ERTiFY TO J\EE N ON T is 01 AN IE LGC.-T� ru I'HE TrE BUILDING 1H ;` re \ �r� . ED 0 GROUND A� 'c r AN"' TrAT IT--- OCITIGN DC Er CGNFGR!� � PAl.'L ��• � v � :n^EGNINC� LAW H-=.,C:C REQUIREMENTS OF T :E < � �. � -pg ' T-- - ,-I- O — — C! — —. ------.-.—_I - f — =.uD NDtQ7 . ~O. N Tuyl� iN C OGD IAZArD i `.IAR_ MIL: ..L. ` 1 ffo l D - I � / C Q, i� 'Y L/le v� E LL 1 A x %. B'.QARp��;P B'U�IiLD;IIW`�REG�UIL�A�TICOJN�S � LiCe:rlse. C:�,NSTR�UCTIO'N SU!PERUF�:O'R l NGiibe f~ 0341106 I — a _ 7 Tr.no: 13983 �e Rd a PETER G MAiND;,y PO'BOX 1647 0 � r HYA�NNIS, MA 02601 y" Q. . Gwo-is4ioner ✓die -V�+�no�uuea�,ut o�✓�auc�w.aetC6 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registib'# 102359 r - � 06 PETER G.MAN d Peter Mandravell ,-- y 75 Betty's Pond Ro Hyannis,MA 02601 Administrator y a 4 c FiVD , = := :•: C ' C- wide (ne n eae PA FCEL a moo ;YOTF 1vol CO1vFOR'wl'vG V �% ZONE.. FB This MOP:TGAGE INSPECTIGti Y'an For -yr 'VI�Lu n :sP iL✓OD ZO.Y . -C REF '0 � �— — — REG�� iFY OWNEReul/ : jr/v i & I.t/�r V ;� ------T^--- i fi AT Ti .-E e i LJI vG - V Tr• A;v ;.` f OC L . i� "Fi- Rr' ND y AND T r iT� cO G mil' + a� �,r HA CfTIG.v UCLJ CJ�'CCB`.q Plt13L `y E �CNING LAW SET�AC ( ?E�l'[FE' w - -.. 0, 4E TE OF T :- A c- `wT-° LIE !Y ELE___^---------''` D TE�.�.l � " NcfTr.L�! cn �'DL: . ::.n... ITHiN t �FECI.`L ^�0_OD HAZARD ��\ ° �_ f� _'C�� MI 0Y4f 0V THE H. f.: `.� ^� Tr ?' Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee -16'# Thomas F.Geiler,Director Building Division X-PRESS PER P57 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 MAY 3 1 2006 www.town.barnstable.ma.us Office: 508-862-4038 TOWN OF BAR.146POL930 EXPRESS PERMIT APPLICATION - RESIDENTIAL, ONLY Not Valid without Red X-Press Imprint Map/parcel Number/®— 7 d — &b' Property Address �j C�[ l S �o �VI Residential ValueofWork`., (� ' ( Minimum fee of$25.00 for work under$6000.00 Owners Name&Address yy CE'TT P,�)A.4h Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) l* 7�� Construction Supervisor's License#(if applicable) ❑Workman's:Compensation Insurance E rs Checl�'one: 1. ❑,•I:am a sole proprietor : I am the Homeowner I have Worker's Compensation Insurance ' Insurance'Company Name Workman's Comp.Policy# F0 - Copy of Insurance Compliance Certificate must be on file. _ r— d. 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. U-Value (maximum.44) *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. Home Improvement Contractors License is required. f SIGNATURE: Q:Forms:expmtrg Revise071405 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/Plum hers Applicant Information Please Print L eldbl Name(Business/oro nization/lndividual): Address: A-X0L )C, City/State/Zip: rq[&,,V_r9 &4 4oZ�,��hone#; S Are you an employer? Check the appropriate box: Type of project(required): 1.K I am a employer with oZ 4. ❑ I am a general contractor and I 6 employees(full and/or part-time).* have hired the sub-coutractons New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t ( Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. g, ❑ Building addition [No workers'Comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers' comp, c. 152, §1(4),and we have no 12.fKJ Roof repairs insurance required.] t employees.[No workers' 13.❑ Other comp.insurance required.] *Any applicant that cheeks 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 andthen hire outside contractors must submit a new affidavit indicating such xContractms that check this box must attached an additional sheet showing the name ofthe sub-contractors and their workers'comp.policy information. I am an employer that Is providing workers'compensation Insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: -�I�/L /LtCrAI;JiJl2 I Policy#or Self-ini.Lic. #: O lJ 6 -z-9 3(a dZ Expiration Date: '7/9? Job Site Address: Z7,61 �F&fi 3 ) 0 V�> City/State/Zip: k�tel► Attach a copy of the workers' compensation policy declaration page(showing the policy nu beer 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$1,50Q.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 D1A for insurance coverage verification., 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature �� �. n�/�� � Date nn Phone#: 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 Departimezat 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: 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,parmership,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 c employment be deemed to be an employer." or on the Quids or building appurtenant thereto shall not because of such emp yin emp y E 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 ofpublic 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),addresses)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 eater 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 minuet 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. Anew 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 Departrnent of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSA E Fax+;617-727-7749 Revised 5-26-05 W-W7W.mass.01ov/dia r aFSM�r Town of Barnstalble �o '^ � Regulatory Services BAMSTAMLA Thomas F.Geiler,Director �'A>f1639.3� Building Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 wvww.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Oder Must Complete and Sign This Section If Using A Builder I, 7-21D�, 5 X,,`( l ;DVS &j:�6 ,as Owner of the subject property hereby authorize 00A5;W1 to act on my behalf, in al matters relative to work authorized by this building permit application for. '/�5�i�itli�s. (Address of Job) Signature of Owner Date Print Name Q TO RM&O W NERP ERMIS S ION r .x N y Board oC Building Regulations and Standards lugHOME IMVROVEMENT CONTRACTOR Registration ,.,141775 Expiration =2151�2008 +t TYPe 'fib A`iduaI CHARLES H.AUO�EnE III £4;1 CHARLES AUDETTE `- _ 4 HARBORVIEW DR Administrator - EAST FALMOUTH,MA 02536 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID �ATE(MWUD9/ COAST-2 05/09/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Anderson Ins. Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE member of the SAN Group HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 933 Webster Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Marshfield MA 02050-3423 Phone: 781-834-6578 Fax:781-837-3756 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: American—Zurich Ins. Co. INSURERB: Patrons Group 14923 Coastal Carpentr NSIJRERC: 34754 Charles H. Audet a III dba' rhs Commerce insurance Company 4 Harborview .Drive INSURERD: East Falmouth MA 02536 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DDlYY) DATE(MWDD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 B X COMMERCIAL GENERAL LIABILITY CTR0006892 07/28/05 07/28/06 PREMISES(Eaoccurence) $50000 CLAIMS MADE X❑OCCUR MED EXP(Any one person) $5600 PERSONAL&ADV INJURY $1000000 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OPAGG $2000000 X POLICY PE4 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ C ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS RHM942 01/11/06 01/11/07 (Per person) $100000 HIRED AUTOS BCDILY INJURY NON-OWNED AUTOS (Per accident) $ 300000 PROPERTY DAMAGE $ 100000 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR El CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X TORY LIMITS I ER EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE 8062B36205 07/28/05 07/28/06 E.L.EACH ACCIDENT $100000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $.10 0 0 0 0 If yes,describe under SPECIAL PROVISIONS below E.L_DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER CANCELLATION CONBOYI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BU`r FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR William Conboy 55 Needles Lane REPRESENTATIVES.. N. Falmouth MA AUTHORI SENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 �3 r'r-.'�`�""^..'r".+�-"`w�•-.......*-�.`."'v.-....��..`.r.-��.�-.1^''`^_"1-.v..--..-.----....�'`-.-^r"�...._._s-_.�..-..r'�.-_�-ti-...,..--p•'t/-..+.--�-..,_-....-../--..r....�.r�..r-.'.�..-.-'�-.-.-. Assessor's map: and_lot number 0�.90. f-- • /— C � sEPTA Y T�-R,y ry I rD, I CC u ,{ � II��TAL �. Sewage'Permit number .. .... ....................... ARM",t y !9 4WITI-! SAlTARRY C Q�ofTNETo�� TOWN OF BARN ' ' � 8AHB9TODLE, i "AB` DUILDING INSPECTOR 039. `00 �Q MPY{t• t APPLICATION' FOR PERMIT TO ................ ....................... TYPE OF CONSTRUCTION ..............C.�!`.(!!'i!!mef..... P...J/..�rt�ts!.L........................................ . ............. . ... ..... .. 1 . . ...............1 ...............19...7✓�' ''TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according 1to�the following information: Location ............0. !....T..Q.!l.! ........ .�................ r..........................:................................................... Proposed Use ........8.I'j1M 1.N.P......d..0.®z.............f.. .r... .X......J.9�...'................................................................. ZoningDistrict ............ ...............................................Fire District .............................................................................. Name of Owner JV1!r.d......I.T.f <kei.1..(................Address /5 ... ...�..0IOU �0 Name of Builder .... .A..Y.... 1''/.N �,.>�... ..:T!1 Address 19.17 4t0.(`:u"5..I.A- 4/..e.....ed........... Nameof Architect ...................... .....................................Address ..................... -.......................................... Number of Rooms '.�-T :. :.......................Foundation ..............L !Jl................................................ Exierior .....................................................................................Roofing ................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing ..................�................................................................ Fireplace ....................:..............................................................Approximate Cost ........ 3 ® oo° oa ............................................................ Definitive Plan Approved by Planning Board -----------_------_-----------19_______. Area ............ ............. ......... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 I hereby agree to conform .to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....e .:J,P ;! `t� _�! ......... ..... .. . ....... N� � I Hackett, Willard 17729 Ak private swimming No ................. Pernii-i for .................................... po&l ............................................................................... Betty's Pond Road Location ..........................:...................................... Hyannis ......................... ................................................. Willard Hackett Owner .................................................................. Type of Construction ...........pool....................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ..........June............ .........19 75 ......... .. Date of Inspection .............19 Date Completed ...............19 PERMIT REFUSED ................................................................ 19 . ............................................................................... ................................................................................. . ............................................................................... . ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... Assessors map and lot number ....................................a f t rI' ' I; Sewage Permit number T"Er°�� TOWN OF BARNSTABLE �Q o� f . Z BARNSTABLE, "6 9 G M BUILDING INSPECTOR O� AY a 9 APPLICATION FOR PERMIT TO .......... .�1 ?................"................�, .......r..7 0......................................... r _ TYPE OF CONSTRUCTION .....................�!,t►;Ua. Al(1,M d !/V v14 L. ......................................................................................................... r .................... r. �.......................19.21, TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 7 Location u• ..R! � Yr►1/UrG,I S ..................... r ..................�. f Proposed Use ......... It11,i'1'1/r1r 'vl, 7 �d .......................................... ................ .................................................................� .. ...... ZoningDistrict ............... .......................................................Fire District .............................................................. I Name of Owner V! .�+r ...... r �' .... ..... . ...... .........:..........d. ...........Address ..................... Name of Builder t Lt� ....$PrZ rt+k1.�'..&t..-7".C.Address ...... �...... t�xl S til t ..�. }. � ..... Nameof Architect ....................:::...........................................Address .......................................................... Number of Rooms ._._ t: t�Lv��rrt7' Foundation ............. .....................:.................................... Exierior ....................................................................................Roofing .................................................................................... Floors ............................................................Interior ..............................�`._.............................................. Heating .................... ....".. ............................................Plumbing .................................................................................. .... Fireplace ..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board _______________________________19________. Area J5 1.`4 1 h Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH ft��f . Q I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......,.? ..........~!'v ........ ...... _ iC1G....... Hackett, Willard A=290-92 /VoeCrrd No ...17729... Per�ii?�for ,,.Private swimming ..................... pool ............................................................................... Betty's Pond Road Location��.............................:............................. Hyannis ............................................................................... Will rd Hackett Owner .................... .......................................... pool Type of Construc ion .......................................... ................................................................................ Plot ................. Lot ................................ Permit Granted .........June._6............:.....19 75 Date of Inspection ................ ................19 Date Completed ...................19 PERMIT REFUSED ........................... 1............................... 19 .1 .... .............................. ...... ................................... ............................... . ........................................... Approved ................................... ............ 19 ............................................................................... t _,r Town of Barnstable Planning Department" Staff Report Appeal No.96-141 Special Permit Pursuant to Section 4-4 Nonconformities Appeal No.96-142 Use Variance Russell Date: November 01, 1996 To: Zoning Board of ppeals From: Approved By: Robert P. Schernig, Director Reviewed By: Art Traczyk Principal Planner Drafted By: Laura Harbottle;Associate Planner Applicant: Thomas&Michelle Russell Property Address: 44 Betty's Pond Road, Hyannis Assessor's Map/Parcel Map 290, Parcel 92-1 Area 1.51 acres Zoning: RB Residential B Zoning District Groundwater Overlay: GP Groundwater Protection District Appeal No.96-141 Special Permit Pursuant to Section 4-4 Nonconformities Filed October 4, 1996 Public Hearing, November 6, 1996 Decision Due February 3, 1996 Background: The property is located at 44 Betty's Pond Rd., Hyannis, and consists of a 1.51 acre lot which contains a wood frame dwelling, garage, pool and several sheds. Assessor's records list the property as a single family dwelling. The property is located in the RB Residential B Zoning District, where single family dwelling is the only allowed use today. The applicant is requesting relief in two forms: 1. a Special Permit to alter a pre-existing nonconforming use, or 2. a Use Variance to permit the continued existence and change of the two-family dwelling. The existingapartment is being { p g proposed to be relocated to a garage attached to the house. Work had started on this change and the Building Commissioner issued a Stop Work Order for any interior work until zoning relief could be obtained. Staff Review and Comments: Zoning History-Special Permit: From Staff research the history of zoning of this locus appears as follows: • Originally zoned in 1951 as Residents A Zoning District which permitted as-of-right single and two-family dwellings. • Changed to RA-1 in 1956 with the comprehensive rezoning of the Town. This permitted single family dwellings and two family dwellings by Special Permit Only. ' • In 1969, it was rezoned to RB as part of Comprehensive Rezoning. That district permits only single family dwellings. To secure a non-conforming Special Permit for this use-a two-family dwelling on a single lot- the applicant will have to substantiate that the use predates 1956 and was legally created. No plans for the proposed apartment were provided. The applicant should provide a site plan showing parking spaces and floor plans of the apartment showing the room layout. If the two family dwelling is permitted by the Board, it is recommended that occupancy be restricted and the total number of bedrooms capped given the location of the site adjacent to Betty's Pond and the on site waste water disposal. Does the on-site septic system meet current Title V requirements? Use Variance: If the Board cannot find to grant the Special Permit, it may wish to consider the Use Variance. The locus of this appeal is more than 300 feet off of West Main Street and therefor meets with the requirements of Section 5-3.2 (5). The area has been identified as an Area of Critical Concern by the Board of Health. These areas of concern have been located based upon the failure of a majority of the on-site septic systems in the area. This lot is also in a Groundwater Appeal No.,1996- 141 Russell , } it Protection District and is known to have a nitrate loading level in excess of 5 ppm which exceeds recommendations for t the GP District(Board of Health Regulation). If a variance is required, the applicant must substantiate those conditions unique to this lot that justify the granting of the relief being sought. If the Board finds to grant the Special Permit or Use Variance, they may wish to consider the following conditions: 1. The two family structure shall contain no more than a total 4 bedrooms. Total occupancy of the two-family structure shall not exceed six persons. 2. The locus shall comply with all Town of Barnstable Building, Conservation and Health Department Regulations. 3. The two-family structure shall be limited to a gross area of 1,832 sq. ft. 4. There shall be no further division of this lot. 5. The septic system shall meet current Title V requirements without a variance. 6. If in the future public sewers or communal wastewater treatment is provided, the site shall hook up to such system within six months of their availability. Attachments: Applications Assessor Map Plan Reduction copies: Applicant/Petitioner i LA • TOWN OF BARNSTABLE Zoaiag Board of Appeals :. A�licst=cn °'fora sneciai Permit . ...,, Date Received -- - �" " --- - -< i ' r ' ,:;' �.Fo} office use o t Town Clerk office n_v: A real # acing Date jq D cision Due The undersigned hereby applies to the ZF Pe_� for the t, in the manner and 6AjQg Board of Annealsifcr a Special reasons hereinafter seth; Applicant Name: Thomas Russell and Michelle Russell Phcne Applicant Address: 44 Betty' s Pond Road, Hyannis, MA 02601 (508) 778-1336 Property Locat4on: 44 Betty' s Pond Road, Hyannis, MA 02601 Property owner: Thomas Russell and. Michelle Russell , Phone ( 5081778-1 AdcL-ess of .owner: 44 Betty' s Pond Road, Hyannis, MA 02601 ��� It app tit dtttera �® owner, stars nature of :utarese: Aumber of Years owneds 2 years Assessors Map/Parcel Number: 290 / 92-1 Zoning District: _RR Groundwater overlay District: AP Special Permit Requested: Alteration of a C-i sectien T1t.Lepre-exlNon-confroi = Zon nc O ainaneeQ use. Description of Activity/Reason for Request: To re-locate a pre- xigti „g, Non-conforming apartment use of an existing portion of the structure previously used for apartment purposes. - Description of ganst_--sc non Activity . (if applicable) : Upgrade Pre-existing apartment to conform with current Building Codes Proposed Gross Floor Area to be Added: 0 Altered: S2n Ezistiaq Level of. Development of the Property - Nurber 5 Present Use(s) : House with attached Apartmp-niress elcof Area 2008• plus ,. 3 sheds, 1 detached Gauge p sc. f:.. 3�detached garage z • s Application for a Special Permit Is the property located in an Historic District? Yes [] No � If Yes OKH Use only: Plan Review Number Date Approved Is the building a designated Historic Landman 7 Yes [] No 1•f Yes Historic Preservation Departent Use Only; Date Approved Have you applied for a building permit? �] [1 Has the Building Inspector refused a pe=it7 Yes No Yes ¢c] Na [1 A11 applications for a special Pe_*mit recuire an approved site Plan. That to the must be successfully completed prior to submitting this application to the Zoning Board of Appeals. For Building Department Use only: Not Required - Single Family [ l Site Plan Review Number Date Approved Signature: The following information must be submit.ed with the an at the r time failure to supply this may result in a denial of your Three (3) copies of the completed application fora, each with original signatures. Five (5) Copies -Of a certified the dimensions of the land property survey (Plot plan) showing sur_-ounding roadways all locatWet-laion o f water bodies and the land. y and the location of the existing improvements on i i Five (5) copies of a p certified professional by theSitepPlan Review drawn by oamiittee is required for all proposed development activities. This plan must show the exact location of all proposed improvements and alterations on the land and to structures. See "Contents of site Plan", Section 4-7.5 of the Zoniaq Ordinance for detailed requirements. The applicant may submit any additional supporting documents to assist the Board in making its determination. Signature: Data App icant's or Agents slanature Agent•s Address: Phone 77/- hod ce- ;s /W'e4 ic6 o/ Fax No. k l l/ ROPERTV ADDRESS ZONING I DISTRICT CODE SP--DISTS.I DATE PRINTED I STATE I pCS I NBHD._- 0044 BETTY'PONO ROAD CLASS O7 RO 400 O7HY KEY NO. LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS Laed epoale Sae D.-a.,,As LOC./YR.SPEC.CLASS ADJ. COND. vP UNIT ADP I UNIT gCRES/UNITS VALUE Oeatriplbn RUS�SELL. THOMAS`JB, ,MICHELLE MAP- cD FF De mrAcrea PRICE PRICE 10 1BLDG.SIT 1 X 1 =10 H=120 100 #LAND 1 41.400 CARDS IN ACCOUNT - 11 1RESIDUAL 1 X .51 =10 H=120 .148 29999.9 35999.9 1.00 36000 #BLDG(S)TCARD-1 1 . 84.100- 01 6000.0 10656.0 .51 5400 MOTHER FEATURE. 1.: 3.400 OF 01 RPL 44 BETTYS POND RD BATHS 2.1 U X C= 100 95 00.0 9500.0 1.00 9500 B. MOL LOT 8.. . ARKET 1 OD R61 DETGAR S 16 X 22 195 C= INCOME A SHED _ 43 19.3 7.3 352 2600. F ORR 0121 .0345 USE - � SHED S 5 X 10 197 C= 11.7 5.03 63 300 F 84 11.7 9.82 50 500 F. APPRAISED VALUE U A 12801900 $ PARCELISUMMARY T ' AND 41400 M SLOGS 84100 0-IMPS 3400 E TOTAL' 128900 N N CNST T DEED REFERENC T- DATE R�,da PRIOR YEAR VALUE $ Book Pao, Ina. MO. v..p salq PHw AND -41400 9353/2071EI09/94 A 91000 GLOSS 87500 9353/20tftI:09/94.A 91000 TOTAL •128900 9353/2001 1�iEI�09/94 F 1 BUILDING PERMIT LAND ADJUST.FOR LAND LAN D-ADJ INC ME SE SP-OLDS FEATURE BLD-ADDS UNITS NumWr =.-T-P-14-- Al ,ad VIEY41400 .340 9500Class Consl TotlBase Rele Atl Rale rear BoillNam Vnils Urals 1 q 19 A� NOep. Cond CND. Lot. %R.Q. Real.Coal New Adl.Rapt.Valor Stories01C DOO 110 110 57.50 63.25 25 75 19 80 'I"b"' F- 90 p70 12D206. 84100 1.5 7 4 . 2.1 9.0 Des[npLOn Rate Square Feel Repl Cost MKT.INDEX: 1.OD IMP.BV/DATE: ML 8/95 BAS 100 63.25 520 32890 SCALE: 1/00.30 ELEMENTS CODE CONSTRUCTION DETAIL 1$8 100 63.25 312 19734 N L F I :DW L ING CNST GP:00 FWD 85 8.50 216 1836 N-*-26--* STYLE O4CAPE COD 0. 1SB 100 63.25 480 30360 2OFFG. 20 DES16N- AOJMT. O2DESI6N ADJUST 1Q. BEY 125 12.50 176 2200 !_ ! EkfiER.YALLS---. i1 OOb SHINGLE$,----Q FFG 30 18.98 520 9870 * *22 *. EA.f1AC fYPE. ._100ILLN'Y=ZONED -_ Q. 015 42 26.57 520 13816 ! ! IIITER.FINIPf. 02P(MiLIN6 ---Q� BEY IlISEk.LA1�8U`E.. i2AVEb_-lNbbF1A� ---Q: ! ! INTEROIfALfiY-. 02SAMF .AS FITTER. Q. *-*20-* FLOOA STRUt�: 02wO JaIS_T7_BEIfM---6:D Y ! 15O ! E7LOOR COVE_R_. 05LARPFT B HD_YD____Q. E Total Areas Aua. 912 Baa.. 1312 24 24 ------ -- BUILDINGDIMENSIONS ROOF fiYPE -01GABLE�ASPH fR Q: T BAS Y20 1SB Y12 N04 FYD Y12 N18 !_ _! ELSEfA2CAL7 -01 YER716E ----:-----Q� A E12 S18 1S8 N22 E12 S26 *-12* -20 * FOUNDATION 01POURED -CbNC 5F4. - *12* !BASE ' ! ---------- -BAS N26 1S8 N24 BEY N22 FFG YO4 L N20 E26 S20 W22 .. BEY E08 S22 8 8 26 26 NEISAAait OOb 62At F11AANf§------- Y08 1SB E20 S24 Y20 .. BAS .1SB! BiS ! LAND TOTAL MARKET E20 S26 .. 815 W20 M26 E20 S26 FYD* ! ! PARCEL' 41400 128900 .� *-12*--20-X AREA 1229 VARIANCE a0 +10381 ' _ LAWMac MAG-3 4. 1p �. �•" NL 4L t•i t•t • Its 73 Jj IAIK 0 ,M•• .4.Z 1.0172 p' 10 '.t>Zii L L O s = O /6•1 H•1••I ® O 40 �•�. 'V _ 76 QV AL �Q 1 l !1 sc 40116JOAC PO Ac IY 89 37 •' JSAC 1••c se-2. 91 36 • -S w•r t.e�.. ,via ►s 87 q 35 3 c• JFAC ies j1w w 1� 1 At-1 • .11i O I.S1.� 34 y • l3 o ,.�s... 33 26A O 85: Af/MT BETTS. POND 11t•t - •-s... COOir w Clow e i von' ,I 11•G t•'o e2 214 1 � � w .b'pC w I us AL wwnt gtt.•t sA y d r Wy io JOK i 3 w •Ptwnvrawt- a 9j-1 ao1()r 1 'e I f •... i rK 98 e• o O w • +. WMA ;tt• .es 1'1• a r . 404C 40 11a M c > 1a REV BY A 1 ORIGINAL IS. 100 210. IL 270 2a p,1oel.. �. y,_ "Ps cou 14 LOoY TiN-T t STATION Is Y1n o 1.�l3A& + to 26929 zee U 579 1 d • Town of Barnstable Planning Department Follow-up Staff Report Traffic Review Appeal No. 1996-115-Mobil Oil Corporation Special Permit-Section 4-4., Nonconformities Date: October 24, 1996 To: Zoni4Bo of A eals From: Approved By: Rob ernig, Director Drafted By: Art Traczyk, Principal Planner Applicant: Mobil Oil Corporation Property Address: 1734 Route 28, Centerville, MA Assessor's Map/Parcel 189/132 Zoning: RC Residential C Zoning District Groundwater Overlay: AP Aquifer Protection District Appeal No.96-115 Special Permit in accordance with Section 4-4, Nonconformities Background: At the September 11, 1996 hearing of this appeal, the Board requested: • the applicant to submit a traffic study to be reviewed by the staff and • requested the staff to update the Board on the possible reconfiguration of Route 28 and Old Stage Road intersection. Intersection Planned Improvements: Attached is an illustrated copy of the latest revised proposal for the improvements to the intersection of Route 28 and Old Stage Road (see Attachment A). That plan illustrates; • Route 28 is to have a 5 lane cross section -two lanes in each direction and a-left turning lane. • Old Stage Road is to have a 4 lane cross section with the northern section having a bleed-off right hand turning lane and a dedicated left-hand turning lane. The North.and South flows are to be divided by traffic islands of some type of textured concrete pavement to differentiate them from the roadway asphalt roadway surface. • The intersection signals are to be completely upgraded and pedestrian crosswalks and walk lights incorporated. The existing bicycle trail along Route 28 has been rebuilt closer to the south edge of the Roadway layout. • Route 28 west of the intersection narrows back down to the two lane section just after the Mobil Station site. Review of Traffic: A traffic study, from Atlantic Traffic& Design Engineers, Inc., was received by the Board's Office on October 07, 1996. Staff has reviewed the conclusions and data presented and extends the following comments for consideration. Staff is concerned that the actual counts.made by the applicant may not be consistent with the counts of the Cape Cod Commission nor with the previous traffic study for the site performed in 1986. The 1986 traffic study for this locus was made as a part of Appeal No. 1986-94. That appeal allowed this Mobil Station to be rebuilt and expanded in 1986. As reported from Atlantic Traffic& Design Engineers, Inc., in this newest traffic report, the counts were taken on June 28, 1996, from 4:00 p.m. to 6:30 p.m. and on June 29, 1996 from 7:00 am to 9:00 am. Those limited time frames and collection dates may have attributed to the low figures attributed to Route 28 and Old Stage Road. Appeal No. 1996-115 Mobil corporation The following table compares the traffic figures of the various studies and times Table-Comparison of Traffic Figures: P 9 1996 Atlantic 1986 HW Moore 1994-95 Cape Cod Traffic Study Mobil Traffic Study Commission Data Observed Weekday Peak Hour 5:00 to 6:00 p.m. 4:30 to•5:30 p.m. 6:00 to 7:00 p.m. Route 28 West of Old Stage Road 4:00 to 5:00 Eastbound 737 801 No Data Westbound 837 1306 1019(1992 data) Route 28 East of Old Stage Eastbound 966 1057 No Data Westbound 683 1615 793(4:00 to 5:00 p.m.) 900(6:00 to 7:00 p.m.) Old Stage Road North of Rout 28 Northbound 338 737 600(4:00 to 5:00 p.m.) Southbound 499 526 No Data Old Stage Road South of Route 28 Northbound 370 452 No data Southbound 355 294 No data Also of concern is the comparison of the intersection turning movements diagram found by the applicant in 1996 and by the Cape Cod Commission in 1988 (See Attachment B). The traffic movements documented in both are peak and it is obvious that those of the Commission (1988 data)are higher than those found by the Applicant(1996 data). If this is the case, can the consultant cite and justify why the traffic counts and turning movements declined? Have the figures presented been adjusted for the time period they were done in?And could the weather conditions have affected the traffic counts? In consideration for the existing and potential future turning movements to the site, staff compared the information submitted with data from the ITE Trip Generation Manual 5th edition, for 6 fueling stations and a 2,034 sq.ft. convenience mart. ITE Land Use Code No. 853-Convenience Market with Gasoline Pumps-was used in this comparison. According to that information, Trip Generation based upon the number of gas pumps at the evening (p.m.) rush hour would occur between 4:00 to 6:00 p.m.. According to that manual, the expected turning movements in and out of the site-vehicle turning movements-during a one hour rush period could be expected to range from 46 to 690 (Range Values are 7.6 to 115 turning movement per pump) The expected average would be 124 turning movements during the peak hour. (Average 20.6 per pump). The applicant's presentation states that there are now 189 turning movements as observed and that the prospects for the future turning movements with the proposed changes would be 201 turning movements. These figures are within the probable range expected by utilizing the ITE manual and are above the average. Also in support of this conclusion is data presented in the 1986 traffic study which documents that the average fueling time per pump is 3.5 minuets. Using that data the total number of vehicles that could be serviced at the 6 existing pumps at peak hour would be 102 vehicles (accounting for 204 turning movements). If the figures presented for turning movements are lower than what normally would occur and if those observed turning movements on to the site are lower than normal, staff would be concerned for possible waiting time and stacking of vehicles on the site. If in the future the peak hour should find that more than 2 I -� A Appeal No. 1996-115 (Mobil O' rporation +' 1.02 vehicles are entering the , the internal circulation and car staking wd be a critical issue. The applicant should be prepared to document the number of cars that can be accommodated on the site waiting for a fueling station and that sufficient interior circulation and exiting and entering will still exist. According to the applicant, it appears the anticipated increase in traffic to the site would'be only 11 vehicles during the PM rush hour(12 turning movement or 6 vehicle plus.5 vehicles attributed to service bay traffic): The study notes that most of the traffic to the site would be from existing traffic already on the surrounding roadways. Staff is in full agreement with this conclusion and as future support, the elimination of the service bay would reduce the number of trips on Route 28 and Old Stage Road as vehicle maintenance. within a service station fends to be destination oriented trips. The conversion may also eliminate some left hand turning movements along Route 28 given that their is no convenient store located on that side of Route 28. The Board should note that the ITE manual has only limited dated on the weekend traffic generation for the proposed use. However from the,limited samples it appears that there is a tremendously increase in vehicle use and turning movements on weekends-Saturday and Sunday. The initial data.generated by the ITE Manual suggests the range of turning movements at peak hour would be between 166.87 to 731:5 movement per pump or in this instance 996 to 4,386 turning movements. According to the applicant the Saturday traffic peak hour occurred between 1:00 and 2:00 p.m. and consisted of 247 turning movements (or 123 vehicles). Saturday peak of 247 turning movements (or 123 vehicles) seems to confirm the conclusion of the ITE Manuals that there is considerably more traffic generation during the weekends than weekdays. According to the Cape Cod Commission Route 28 at this intersection operates at an overall Level of Service (LOS) of"F". The applicant has segmented the movement patterns at this intersection and identified a level of service for each turning movement. That level of service ranges from"B"to"F", the majority of which is"D". This again appears to be inconsistent with the LOS found by the Cape Cod Commission. A higher level of service would be found if the basic traffic counts were less than those used by the Commission. The Board should keep in mind that the present situation on Route 28 and Old Stage Road will be completely changed and the level of service will be greatly improved by the proposed improvements. LOS at this intersection should be more in the range of"B'to"C". The signaling at Phinneys Lane and Route 28 and the coordination of that signal with the Old Stage Road signal will also improve the LOS on individual drives along Route 28. . Attachments: Applications Assessor Map Plan Reduction copies: Applicant/Petitioner 3 Appeal No. 1996-115 Mobiworporation • Attachment A Illustration of the latest proposal for improvements to the intersection of Route 28 and Old Stage Road Source: Sheet 1 -Landscape Plan for Route 28 Improvements-Fall 1996 4 Appeal No. 1996-115 Mobil rporation • Attachment,B Comparison of the intersection turning movements diagram. Source: Route 28 and 132 Corridor Study-Cape Cod Commission 1988 Source: Traffic Study-Mobil Service Station-Atlantic Traffic&Design Engineers, Inc,. 1996 5 Appeal No. 1996=115 MobilWorporation • ' Attachment A Illustration.of the latest proposal for improvements to the intersection of Route 28 and Old Stage Road Source: Sheet 1 -Landscape Plan for Route 28 Improvements-Fall 1996 A O� .� .:r 1. °•ddt. •.,i +:••:�`' •.ptx`''ild ii.AS-i- ,•�'L:S •I'Vi'Q"tY�.i fB�.Q,itat�i•ti:N {r:-. .rti r•..r r ,r + ,y..ff*^ r�s*' �,;.+-., -� P.a�:.•l, •.f' 1•.r I f a 1 {.... 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'R � Wi+"° 7;: ! �.'� .S•.J+,, `f,`f e •.f:r •'J.^r "`ate• �i {�' 1 �I z 4.1 _ S^7%' T'�.- '1i,•`�•: t M� r",i.R • i L � _.• t,.. .,,.;`.°'' ;p.., •F'+� v 1{•i t+...c*:'i.:•�:•!.'•-� tt � . •, ;y•.l'•. � 1 s�� s„t �+E)} � '� w'Y`w�t rW�'w'Yj�..,• qt .t' �• �, �� f A,a t..!•.•ft"�r1}7,.a;..! •4'9r�+w� . t.� / t .i - _ ' � 't• .p, r ,:.` ' a.��l�. f•,,�, 1 µ Y �'r.9f ,LY•'•la iT 4.(7'} � � 'LL jpizl' 4 4 i Appeal No. 1996-115 Mobil corporation �. Attachment. B Comparison of the intersection turning movements diagram Source: Route 28 and 132 Corridor Study-Cape Cod Commission 1988 Source: Traffic Study-Mobil Service Station-Atlantic Traffic&Design Engineers,Inc;. 1996 ROUTE 281132 CORRIDOR STUDY ARE =Ape, v L.to7 4 •b tot 323 4--- 60 j \► 79 se - 783—i 111 240 • 28 � e 6 fe . : • .47 E f t �c 9earse Pd Mobil .. Wequaquet SITE & Lake Gad as% L 9 N M A.22 N r50 _ 66 612 t0 M �— �' 143 N *— STATE HIGHWAY ROUTE 28 C. tq9�- ,4-r La.M- C- -i rR�''* �, � t=k-�neering Dept. (3rd floor) Map Parcel Pot# Houser Date Issued a Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Feel ` -,Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) x� �I�`�1b �\�`r� eX���i P-1 Do nard 19 RARNSTARLE. TOWN OF BARNSTABLE Buildin=Pli cat' r� Project Street A dress Village Owner rL Address Telephone Permit Request ,, First Floor �� square feet Second Floor square fee Construction e Estimated Project Cost $ i Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family U1wo Family ❑ Multi-Family(#units) Age of Existing Structure --t— Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) X,2, Basement Unfinished Area(sq.fft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing -5---- New First Floor Room Count Heat Type and Fuel: lamas Oil ❑Electric ❑Qther Central Air ❑Yes Fireplaces: Existing AJd New Existin wood/coal stove ❑Yes o g Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) Q Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# ° Current Use Proposed Use Builder Information 0 Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) l�N'- '1✓tigineering Dept.(3rd floor) Map a Parcel()9,1 Q C) P # House 11 14 Date Issued ,f^ Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) /Feev�S� ,I ,Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) �A Q �,�M�a �l� � A�`��� 2� Planning Dept. (1st floor/School Admin. Bldg.) Definitive Plan Approved by Planning Board *,, 19 ,� • BABNSTABLE, MAS& y �FOlAPr�`� TOWN OF BARNSTABLE Building Pemut Application Project Street Address Village Owner �� jy��,� Address Telephone Permit Request,A.g,r �-�,� �J /a,e n�✓/� ��J?.t� .7�" ,�, (� �`I o�r��r 4� .�-cam• GD L'.i ��c� 0 � First Floor l 7 7 D 14--t ) square feet Second Floor square feet r Construction Type Estimated Project Cost $ � D?�t Zoning District Flood Plain Water Protection v Lot Size Grandfathered ❑.Yes ❑No Dwelling Type: Single Family La Two Family ❑ Multi-Family(#units) Age of Existing Structure % p 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.fftt) Number of Baths: Full: Existing New Half: Existing T, -Xl— New No.of Bedrooms: Existing _ New Total Room Count(not 1.including baths): Existing .-r- New First Floor Room Count Heat Type and Fuel: © /❑Oil ❑Electric ib ❑Other Central Air ❑Yes ONO Fireplaces: Existing New Existing wood/coal stove ❑Yes ' p'No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) } ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use 6 Builder Information Name /�'T�fJ'YI�J�._.� Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) i �THE i • The Town of Barnstable "MAM Department of Health Safety and Environmental Services 1�h`� P Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-790-6227 Building Commissioner Fax: 508-790-6230 For office use only 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 Est.Cost d2) Address of ork• Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law _ _ ob under SI,000- _Bui of owner-occupied Owner pulling own permit Notice is hereby given that: ERMIT OR DEALING OWNERS PULLING THEIR APPLICABLE HOME E"ROVEMENT WORK DORNOT HAVE GISTERED CONTRACTORS ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date. Contractor Name Registration No. OR Date (� Owner's Name '•� ! :"= he Commonwealth of Alassachuse s Department of Industrial Acciden4 4 l� VMCeoJ/nvest ff,7AVns 600 1Cashia,;ton Street Boston,Alas. 02111 Workers' Compensation Insurance Affidavit t r t p o _. 1 c f— p r c 12hone# 9l am a ho eowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity e' ors»• -^ - •. '• ''x <.,.,t. "T.:w't".. . * ?"kt�J"`.' rfi'..-'. -r.'°r;"-Wr.':.. t:..:.,:�C..:..:._: .za..�..::ars 'a�r.wiu wa�.�:'�' .,..- _,y;�vr„r' ....:.. ...... ......... z::r.;,...,,-..:-A7'1� ^•�+.,a-+w,t� .I am an employer providing workers' compensation for my employees working on this job. company name: address: city: Phone#• insurance co, polio•# R77 y .9�9•Y•+w�Egy ,p•M!-, M!8,,�,..„ R,'f+,A.'Ri.,•} .++w(�N. rl I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: address cih'• phone#• insurance co. policy# company name: address: city phone#• insurance co, policy# 'Atiachh additioriafshcef if'necessary <F � "4 fs ■ 'r tTf., � f •�a ax•y _5_ _" " ee.a"T'""�.+y"' Failure to secure coverage as required under Section 25A of ntGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as-well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. Z hereby certify tinder the pains andpenalties of perjun'that the information prodded above is true and correct. ature 7 — 9 Date Print name Phone# 511- -- 3 official use only do not write in this area to be completed by city or town official city or town: permittlicense# Building Department OLicensing board D check if immediate response is required Selectmen's Office (:1I1ealth Department contact person: phone#; nOther �F irevued 3/95 P1A1' • Information and Instructli s - , w Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service oi"another uiider any contract of hire, express or implied, oral or written. An enrpl(tver is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoino 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 tlie�' dwelling house of another Nvho 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 emplover. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or rencival of a license or permit to operate a business or to construct buildings in the common-wealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. iXa Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. Tile affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. Tile affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to ;ive us a call. Y^Yi..'MT,'- '•.•.,n .!'r..'x »�'IA.I(tp„1Tq +R.%•Sly. Z"' At}.P _ r1'��,�r''�^�T 'A�1�9!'Ya• Z.f.�CT RC V�'P�'N'Vt►NVT `'+n.n�/• .. .. -..y y y ... .. .'..: . ....... . 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 nW. fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 l U EXISTING HOME cu WINDOW SCHEDULE o TYPE MANUFACTURER'S UNIT ROUGH OPENING I REMARKS ' ON A ANDERSEN OR EQUAL VERIFY INFIELD DOUBLEHUNG z B VERIFY IN FIELD AWNING ANDERSON OR EQUAL O �lO C JELDWIN VERIFY IN FIELD STEEL V N oho W D N 1.CONTRACTOR TO VERIFY ALL WINDOWS WITH OWNER AND ROUGH OPENINGS A .4 C 1. WITH WINDOW MANUFACTURER PRIOR T ORDERING F WINDOWS 00 GO O ` O 2.ANDERSEN 400 SERIES WINDOWS WHITE EXTERIOR W/HIGH PROFILE EXTERIOR/INTERIOR TUB GRILLES W/SPACER BAR.LOW-E HP 4 GLAZING W/SCREENS&METRO HARDWARE Q� O O 30X20 BATH D W 28G8 O NOTE: MASTER BEDROOM SUITE TO INCLUDE NEW PLUMBING AND ELECTRICAL, NEW INTERIOR FNISHES. ri 28G8 S NOTE: REPLACE ALL FRAMING 3ox48 3ox4a O MEMBERS THAT ARE DAMAGED FROM FIRE. MEMBERS A O A INCLUDE WINDOW HEADERS, JACKS AND STUDS, CEILINGS O O NEW VINYL JOISTS, STRAPPING, ROOF RAFTERS ETC.-REPLACE W SIDING EXTERIOR WOOD SHEATHING NEW VINYL - AS REQ'D. NEW ROOFING SIDING OVER MASTER BEDROOM MASTER BEDROOM O 4" RECESSED LIGHT (SOFT WHITE LED) SUITE ONLY. coo Z p O SMOKE/CO DETECTOR a 0 O c Q O O G' 30X48 88G8 A H con Barnstable Bldg. Dept. d' Approved by: �� 54' 30X48 30X48 1 A Permit #: A NEW VINYL SIDING I _ MASTER BEDROOM FINISH — 44 BETTYS ROAD TOTAL LIVING SPACE 405 S.F. ' SCALE: 1/4" — 1'-0" , DRAWN BY: CBH DATE: 10/26/18 ,F f r J` y _ U .aa � EXISTING HOME WINDOW SCHEDULE o TYPE MANUFACTURER'S UNIT ROUGH OPENING REMARKS ' A ANDERSEN OR EQUAL VERIFY IN FIELD DOUBLEHUNG Z B ANDERSON OR EQUAL VERIFY IN FIELD AWNING CJ R3 O C JELDWIN VERIFY IN FIELD STEEL F% � 00 W � rl 0 D N 1.CONTRACTOR TO VERIFY ALL WINDOWS WITH OWNER AND ROUGH OPENINGS+fl Q M WITH WINDOW MANUFACTURER PRIOR TO ORDERING OF WINDOWS F♦i c- 2.ANDERSEN 400 SERIES WINDOWS WHITE EXTERIOR W/HIGH PROFILE EXTERIOR/INTERIOR TUB GRILLES W/SPACER BAR.LOW-E HP 4 GLAZING W/SCREENS&METRO HARDWARE O O � 3 B° DATH D W O• 2b68 O NOTE: MASTER BEDROOM SUITE TO INCLUDE NEW PLUMBING AND ELECTRICAL, EQ NEW INTERIOR FNISHES. 2868 S NOTE: REPLACE ALL FRAMING sox4a O 3ox48 MEMBERS THAT ARE DAMAGED FROM FIRE. MEMBERS A C A INCLUDE WINDOW HEADERS, - JACKS AND STUDS, CEILINGS O O NEW VINYL JOISTS, STRAPPING, ROOF RAFTERS ETC. REPLACE W - 51DING EXTERIOR WOOD SHEATHING NEW VINYL AS REQ'D. NEW ROOFING SIDING OVER MASTER BEDROOM MASTER BEDROOM O 4" RECESSED LIGHT (SOFT WHITE LED) SUITE ONLY. O SMOKE/CO DETECTOR a 0 - C O O t Q F, Gq G` 30X48 [--� 2868 A Barnstable Bldg. Dept. / 30X48 30X48 Approved by: A A Permit #: NEW VINYL SIDING MASTER BEDROOM FINISH - 44 BETTYS ROAD SCALE: 1/4" TOTAL LIVING SPACE - 405 S.F. DRAWN BY: CBH DATE: 10/26/18 4