Loading...
HomeMy WebLinkAbout0412 BISHOPS TERRACE - , . -� �. Imo.. ��,��`�S � � - --_---- --- - -- --- j I � i , � � � , � w � ` �� � a� i � \� �A/gL aw-� -77,�- i Town of Barnstable - • �tio Building Department Services Brian Florence, CBO 9 MASS. $ Building Commissioner i639 �0 '°lFnww+° 200 Main Street;Hyannis,MA 02601 . www.town.barnstable.ma.us Officer 508-862-4038;. -Fax: .508-790=6230 Town,of Barnstable Family Apartment Affidavit I,being on oath, depose and state as.follows: My name is S I am the owner/resident of the property located at: Lf fZ The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: -w r � Name &relationship to owner: 1;�, `�i Name &relationship to owner: a ». The Family Apartment will be the primary year-round residence for'the above-identified family members. In the event,that the listed relatives vacate said apartment, I will immediately noti the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that 7 am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. Other Sworn to under the pains and penalties of perjury this day of 2019. 53 CJ Signature Phone Number Print Name q:forms/famaffid.do c rev 11/08/13 Town of Barnstable Building Department .. Brian Florence, CBO Mass. Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as�follows: My name i � /S�r I am the owner/resident e o property located at: �; 2. g C S �' -C S' C) z The following members of my family will be the sole occupants of the Family Ap ment aOthe ca aforementioned address: p r— / L/ NO cza Name & relationship to owner: A Name & relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit andlor the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to under the ains and penalties of perjury this day of 2018. 'L17 " o76 SW 3 Signattirg Phone Number Print Name --VA V 1 r C LDS' q:forms/famaffid.doc rev 11/22/2017 Town of-Barnstable - Regulatory Services Richard V. Scali,Director, Building Division "B Paul Roma,Building Commissioner ' °fin,39. 200 Main Street, Hyannis,MA 02601 ' www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 < z Town of Barnstable'Family Apartment Affodayit I,being on oath, depose and state as follows; My name is /� -u I'D i �r� I am-the owner/resident of the cm property located at: 14�1 Bn 4 6 t: H&f-C - The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: 14 I- 14 f Name &relationship to-owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment,I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions.imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in"th`e event of the sale of this property. - If there is no longer a,Family Apai nient at this location,please explain: The apartment has been dismantled. ; The apartment has-been transferred to the Amnesty Prograrn(Appeal No. _ ) Other _ t Sworn to under the pains and penalties ofpedury this day of JAM 2017. Signature Phone Number Print Name q:forms/famaffid.doc rev 11/08/12 Town of Barnstable C,- Regulatory Services of l°i�ti Richard V. Scali,Director L °* Building Division " 9 �' Thomas Perry, CBO,Building Commissioner E p 3 1% 200 Main Street, Hyannis, MA 02601 `73 wwwaown.barnstable.ma.us co Office: 508-862-4038 Fax:,508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, de ose and state as follows: My name is. %' ' I am the owner/resident of the property located at: 0 The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: 14 14t, G ��f (/S 04 h 2j A.APV Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notes the Building Commissioner`in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: w The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to.under the pains and penalties of perjury this 2_' 2 day of 2016. - - Signatur Phone Number Print Name_-.--_P q:form s/famaffi d.do c rev 11/08/12 Town of Barnstable FTHE Tp�, Regulatory Services Richard V. Scali,Director BARMSfABLE. * Building Division 9 MASS. 039. a.� Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.tow n.b a rnsta ble.m a.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is V l /li' l 1�C ( (� I am the owner/resident of the property located at: The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notes the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apt tmenis. I_agreeu` to note the Building Commissioner immediately in the event of the sale of this rVerty. tea:, If there is no longer a Family Apartment at this location, please explain: ,, , The apartment has been dismantled. - `' The apartment has been transferred to the Amnesty Program(Appeal No. ' ) , Other Sworn to under the pains and pen alties of perjury this 0 day of ., 20151-f o© -- 5 3 �1 error n Signature p Phone Number Print Name Ili q:forms/famaffid.doc rev 11/08/11 Town of Barnstable Regulatory Services oFTME ro Richard V. Scali,Interim Director �Q w1F 1 R-B.A51 E Building Division BL LF�� Thomas Perry, CBO,Building CommissiMt4-rJAN' In 'M 11: 59 Ar%639. 0. 200 Main Street Hyannis, MA 02601 En�r Y www.town.barnstable.ma.us Office: 508-862-4038 I)TVN I CTax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is�C�V i /1( �— t I I am the owner/resident of the property located at: (2_ t C k.&Itt(s , CIA 226 o The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: 400 Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notes the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to f le an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to under the pains and penalties of perjury this_ day of .l OWt 2014. ,Signature Phone Number Print Name./� A- . q:forms/famaffid.doe ` rev 11/08/11 OR i 11 a i dVa Zq- lk ypt, x, % V. IM M $ s 11 -4 tl 3 s - ,r «` S der } d 5r :. �t� ,( 1. -t+< , - g #, � I a=tea �3 I Ai £ 4T i } # r-" ; , ,tw 5 ! "-x^ amax.Ai .. u' x > - k y^'. r >S c:- 3 : Y y 'fin.. x -,'.« kr. '+r' i ' -S k gt•s, , � x i ' g x t x A ' k - -�— for' <a �' �, ,' - u 4 +'� -+�-� `� �,, , d !p ?'1�.t'-. {, _- J" _�` Sa "`' 5� >i -I VIE�.a<'-'' �" t"A;>k t � IN t 3-.? f "d . o r E-+'.' >` .zv a' ya .., 3 p s ,�- a ak % Ffi %" 4"': 1 �>? i ,§ . , y w-, - t V ems. r R c.i�,:F€" - F+ ,k ,P,4w,,�,' rc' +k � � ` .:' , "`� .' ar°YA,t11 k�.',+;..1 :*. p`'F 4`yg.. �;r,'?:r h kl�D.�' k`+q .-,ii t ' > cy > b J # .reGdt+ '�, -:�+ :.. a T',>. (' °1.ugr t.�y t ',—,, 1 " a. �� ",.i yF�' �c'-� �." r I '4: > r ,ter 1 +. c3 , �`.i, �- - t ' ax % �s € # } A 11 Fie- % � 7 4 °�€ +E, lkim f > r + ±- A - s r �- ' ; S ' a ''� a y yiv i «ty m _ .'i" «' :� e;r;''4 =,. 4='�'.',(� " s'.' +:""�"�r ��#' � a.� .: ,« ter y ,i �£ y , _ - 'b 8., �' f � `u;.`ss g1-1 �€ Rh mac. , � -43 ' �r3,� Al Ia >., r' ;« * s�' m's '� .� ri5 # r °. o x— 3 Y g s S' r t r a. t �r it: . 1�1� *3 6 r SaeM.t 4 :s w t ^ ,+x i+. - a a-a V" I fig +y, � 'r,� ' "`« �.. �+. 1 " r xi w -g, rh `i �3r�t �. �`r " �i '4 �"k. � , dcr 1. =� �S ,�9 ,I 4�. Y mom.- ,w€'- x a _ t. .;> rr{ ;A, r i" -.t m fir .'',;. k " + i ,i s "`""' « '' `" �' .s� t, a Y � s n,..Y ., -'So,.,,Y � r _: Y I,,a o `"f It r 11 --' A, ys' 3, z fr. I �'' ^#.*9`' �`'t I^ .,� ; - - } A s tht . ,. Te 'i c* `ate s - . � 1: L; .�:_ , 1-< .:.'- - >4' i.. '' d- _ - - s. . . ` I '! � ,- F - ' p✓ Y } y _ 5 ,. - _ 2. . tY. A Y r Vie: - .. , 5i '.. 1.4 .. r ._ - t. . r r� k i .:.:..'. I " i - 1. _ , .:.:h f f ''j R'. I. p h t A ... - - . .. .�/ �-�r I V � . .. ., � :. f .r t ; _ f } IIJjs �T►,E r Town of Barnsta Ire Permit p Ex�gy�res 6 months from issue date Building Department Fee RAMSrwBLE, : Brian Florence, CBO f v , ��' Building Commissioner • iOrEo t oet A 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RES,`i ��ENTIA;L_ONLY Not Valid without Red X-Press Imprint"{"- "�' Map/parcel Number M '671 1 I 7P 2 2 2011 Property Address f Z- S D �4 Residential Value of Work$ f� 15 j} Minimum fee of$35.00 for work under$6000.00L Owner_'ss-N me&Address 1 zT i 6 I Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance - Check one: ❑ I am a sole proprietor I am the-Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is . re aired. SIGNATURE: QAPMESTORMSTMESS2017 i t r . y 271e Comurorrivea h of Massfft iusetts Depraraffma rr,f rndustrid Accidents i� Q}Tce of 1Fumd9atians ` 6.00 Washington Street -- gastrin,MA 021II -- nrvtu massgmfdia Warlcers' Campensafion Insurance Affidavit;Builders(ContractarsM cianslPlumbers Applicant Inf4rmafran f/ Please print E��1ly �Citgl l-atel ig. a ' bZ60! ' Phone-4--- .Are you auemplgger?tbeckthe appropriate bom ' T of project r I.❑ I am a em I t� 4. ❑I am a general contmciar and I Yl� F ] ( ��dl'= P°� • 6. ❑New oonsEcaciioa employee$(fall andfor pars-ime)v* have hued the sub-contractors 2.❑'I am a sale proprietor orpaatner- Tested o-rtthe attached sheet. 7. ❑Remodeling n�^� These sob-con f actam have "``3'and have flo e-mplac4*ees. $.-❑Demolition wodang for me ia.any capacity. employees and have workers' 9. ❑Building addition [No wadoets' comp:i asuraoce Coop-MSMM MI` 5. ❑ We are a cosparatiun and its' 10❑Electrical repairs or adcRE-OW �etp red of have•exercised f mk r3._ T._am a homeou�er doing all work 1 L❑Plumbsngrepaiss or additions mys-e [No wokere lry❑Roof r tight of emempEon per MGL �s insurance ct]r c.152,§1(4),andwe have no employees.WowoAers' 0-El comp.insurance required_] 'Any a ppEi�6atchedmboar1— Elsa fiIlaatth�esecdomb9awskm� grlie woffcedcompeasatica parkyiaEormsa�. #ffamwwae=wba submit&r.Efdaiii fibffcm g they am&iag zuva*audifienbue out i&contmaommast sa'Smita new affidadt mdirmain sorb.. s fCau=ctotsthst,h,,k Lis boxsmstaffirb =.addM—lsheetsbvwing the naoteofftsob-c=txchrs and statewbetornottboseeoMteshwe emphuees.Iftbesub-=txcti=bave employees,dRjrmmstpravidetlu&umrke&b=p polity numbeL -Tam are etttpia�xr tliatispra}zriir yt�orkers'catttpertsati�rt inszuattca for m}*errtpla,}�ees BeIoa�is tliepaliry arrnT job she informaLian Insurance Company Name: POTicy 44,or self-ic s.Ec-4 Ibpirdion Date: Job Site Address` l`L �S 6 I e C�- `Cifylsftw Ai ch-a copy af&e wort-ere compensationpolicy'dect2ration page(showing the policy amber and e•=pa-ation date). Failwe to secure coverage as requiredunder Section 25A of MGL c..157—can lead to the imlposifioa of csiminai penalties of a fine up to S1,54UOD avdror one-yeasimpFisonmest,as well as cio, peuaities.in the form of a STOP WOKIK ORDERand a fim,e of up to$250.OQ a day against the violator. Be adtdsed that a cry of this statement mmy be forwarded to the Office of IFaveslrgafiom ofthe DIA for insurance coverage vedffmtism I rIa hemby cerhfi,nurgr thepains and iahhks aft' m jury&&flee ihformi au pt m*kd ahm o Is bw and correct I PJ_ Phone 0-7 S'D S �RgD O,fJ`rdal um anl. Do ttet write art thi�;area,trr be cwtapleted by c4 ortoirn affrcral. City or Town.: PerniMaicense# h aing Authority(circle one): L Board of Health 2.Bui[Tmg Department 3.Citgrown Clem 4.Electrical Ynspector S.Phambiitg Imspecter 6.Other Contact Person: Phone 9: ormation and usttuctions eosaflon far then I , Massacbsse#s G�eaalLaws chaps 152 regon-es all er�Ioyers'fn Provide worms'°amP emp ogees. pM-S this Mate,an eapb*yne is deed as.6_cverypesonin ffie seavice of another under any contract ofhaeS esp}ress or implied,Ord or Veit " An �Ivy�is deemed as'yen individual,partnesb�,assc)c im,corporaion or other legal entity,or any t970 or more _ .out - er ar the aJ andmchidmgthelegalrepresenfativesofadeceasedemploy , of the fnregomg�g�in �e� . receiver or trustee of an individual,paz�ghzp,associafian or ocher legal entity,employing eir<ployees. However the owner of a dweIImghouse havingnot more Henn three apartme ±s andwho resides therein,or the occupant ofthe- &Zllinghouse of another who emplays pans tD do ice,concd-mrt;an or repair WDIiC on such dweIlmg house or on the grounsis or bui'ldmg aPpur�tliemto shallnDtbecause of such emplaymeatbe deemed to be an employer_" MGL chaptor 152,§25C(6)also sues that'every state or local licensing agency shallwithhoId ffie issuance ar renewal of a Tic— a or permit to operate a business or to construct buildings in the commonwealth for nay applicant who has not produced acceptable evidence of compliance with.the insarance.cove ageregaired" Additionally,M(ff chapter I52,§25C(7)states-Nio her tine coffin mxwealth nor nap of its political subdivisions shall enter m� any cont-ad for the perfm=mce ofpublic wozicu acceptable evidence of compliancevt*tih the insu'�ce. regim=�eZds of this cbapter.have been PrMCut:dto the co±L�auihorifyy." Applicants Please fill oBt the wotkea ,compensation affidavit comple y;by checking i`h a boxes that apply to your situatiion and,if necessary,suPply sub-mute r(s)nem e(s), address(es)and Phone rnjbea(s) along with thou cm tficat*)of �dnce. Limited Liability Companies(I LC)or LimitedLiab>ZityPartncmbips(LLP)wrthno employees Other than the members or partners,are not regimed to cagy wozIes'eortipensafion i sarmce. If an LT-C or T T p does have employees,a policy is recta¢ed. Be advised that this affidayit maybe snbmi;ted to the Department of Industrial Accidents mr confirm afion of ms mace coverage Also Be sure to sign and date the affidavit The affidavit should be-retomed to$e city or town that the application for the permit or license is being request not the Departncaf of . Ladnst,-ial A-ccid fs. Shouldyou have ally questions regarding the law or ifyou are required to obtain a workers' compensationpoficy,please call theDeparfinenfat the numberlistedbelow Self-insuredcampaniesshouldenfYz- their s elf-i acman ce license number on fhe appropriate line. City or Town.OfFmcialc f please,be sine that the affidavit is complete and prirded legibly The Department has provided a space at the both= of the affidavit for you to frill out in the event the Office offuvesfigations has to comtact you regarding the applicant P leers a be gene to fiOl in the penaitllicease rnnnber which will be used as a reference number_ Tn addition,an applicant $at muA sabmii multiple pemifllicemse applit atons in arty given year,need only sabmit one affidavit mdicatng eoa-ut p olicy i ifb ation Cif neceseaq)and mider"Job Site Adder "the applicant should v fit-"all Iocatio s is (may or town):"A copy of the affidavit:that has been officially stamped or mocked by the city or tows maybe provided to the ' applicant as proofthat a valid affidavit is on file for fuime'pexni fs or licenses Anew affidavit must be filed out earn year.-Where a homeowner or citizen is obtaining a Iic=-;c or permit not related to any business or commercial venture (Le. a dog license orpennit to bum leaves eta.)said person is NOT regriaed to complete this affidavit The Office oflnvcsfigalionswouldliTco-tothankyoum advance for your cocpmzftouand sbould.youhave any questions, please do not hesitate to give vs a call The Departmenfs address,telephone anti faxn�er_ - The Cammawmlft of Massa.ch - ' _ I)epadmtt aflu&istdel Aouidennts- f�t�e of T.�e�izg�t[a� Boston=MA Q111 TqL 41' 617.727-49CG Cxt 06 or I--VT 1v�A� Fax 9 617` 27-7749 lf-vised424-o7 ,� gfdia °FtHE i � Town of.Barnstable °i Building Department MASMvBAMSMM Brian Florence,CBO s6;q. g � Buildin Commissioner prED MP'�h 200 Main Street,Hyannis,Na 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section t If Using A Builder ..; , I `� Zsubject property hereby authorize ` to act on my behalf, in all matters relative to work authatized by building permit application for: (A ess of Jo r **Pool fences-and al s are the responsibility e applicant. Pools are not to be filled r utilized before fence is installed a.nd all final inspections are p rfortned and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNERPERMLSSIONPOOLS Rev:10/17 i V 11 iR yl Jll cal iif7 L64"JL%l �oFtHe r � Building 1)epartment . o� Brian Florence CBO • Building Commissioner nnxxsrwsLE, 9� MASS. ,�$ 200 Main Street, Hyannis,MA 02601 '°Ten 39- www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION, h Please Print JOB LOCATION: +G. number street village C--"HOWOWNER":-:DAuZj ! ' /r /!S name home phone# work phone# CURRENT MAILING ADDRESS: M/o:"a r- -MA .city/town state up 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 buildine 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 requirem Signature.of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners.who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. rti opt doe- Town of Barnstable *Permit# Tres 6 mon hs rom issu dates Building Department Services fee 9IMANSTASIX�! Brian Florence,CBOKAM � a� 163g6 �� Building Commissioner a�u 200 Main Street,Hyannis,MA 02601 SEP 12 Zo www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF FNSjBLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY _ Not Valid without Red X-Press Imprint Map/parcel Numbers Property Address � .�� `" "�' Iy4\1 V uy :s %Residential Value of Work$` 1�62(.V y o Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address, Contractor's Name l v 5��� Telephone Number G� Home Improvement Contractor License#(if applicable) � Email: WSA S Construction Supervisor's License#(if applicable) _ ; orkman's Compensation Insurance , Check one: r ❑ I am a sole proprietor I am the Homeowner , I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows E #.of doors: ' 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner ust sign Property Owner Letter of Permission. A copy oft nane mprovement Contractors License&Construction Supervisors License is required. SIGNATURE: n . QAWPFILESTORIvIS\building permit forms\EXPRESS.doc 08/16/17 17ze CommompeaIth rf -4&w rdJiasetts . D,eparhmerrt o,frrrrl=&id Accid=ft Of)we Qf 1MMWW Lions 600 Washfiz ton Street Boston, A�21►11 17 Fsn-s&mass, mt�din Workers' Compensation Insurance Affidavit Btdlders/Contraa ursfEl lum ecfrcians(F h ers Auplicant Information Please h int Name Address: q0k CitylStatef � � l�Nc��e� 9 P I M n0 Are Tr on employer?Check appropriate box:.' Type of project(required)- 1. I am a la with 4. ❑I am a general contisctor and I 6. [-]rR �P a * have hired.the sub=cos actors Ioyrees(full a�`or par�time�.2.DI am a sole proprietor orpartner- listed og the attached sheet: 7• v g . slip and have no employees These sub-cordractors have $_ ❑Demolition wodong for me is any capacity. employees and have worms' 9. Buildingaddition comp.Msurranl 4 W 13'comp-insurance ❑ required 5. ❑ rc We a a corporation and its 10❑Electacal repairs or ad�ions officers have exercised their 3.❑ I am.a homeowner doing all work' 1L❑P1u mbingrepai:s or additions. right of won per MGL ❑ repairs. myself�o wailcers'aOmF c.Li2, 1vae have no Other Hoofepair insurance required.]T § (4)'and we Other cess employees.[No wmd ' camp-Msurance required-] &Any app&M tifhat cbedabox R nmst also fillo ithe secf<onb9owshmmag dmkvmxffzets'campeasatiaupolicyiafiormatioaL l Kamen a nem who subaut ibis afUmlt iufficatmj they am doing ail wait sud&=hire outside coatracto:s amst submit a new afda¢Bt kdicariag sack ZC==ctMff=ebec8this bane mast attar saadditional shad dum ngtheaztaeof the nb-cantwAm and styewhathet oroat-Erase emi*shwe employees..Iftbesd-caabactnashaveemployee%theynnurprnuidetheir wurken'a=p.palicynumber- I ant an employer fleatispratading wark¢rs cotrrperrsatimt innarancefor in ertrpptoyem Better is the policy and jab ske inf ormatton. Insurance Company Dame: Policy i,,or Self-ins.I.ic.4' F-piradonDate: Job Site Address: citylStatel,7.tp: Attach a copy of the workers'comrcpensationpolicy declaration page(showing the policy number and expiration date).. Faffim to secure coverage as required under Section 25A o€MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,50a Q0 andfor one-year imprisonment as well as civil penalties in the farm of a STOP WORK ORDERand a fsme of up to$250_00 a clay against the'violator. Be advised that a copy of this statement maybe forwarded to the Office of InvesEgations of the DIAL for insurance coverage yerification_ I dra hereby cgrhfy uidTns andpajahYes of Feuer°thattha inrfbr manor prm-bW abmne is bare and correct . ` sienatur-e- Date- CA Phone i€ Offw fil Liss a my Do not waste la this area,to be evimpleted by city ortotrn official City or Town: PerraitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3:Cltyf£own Clerk 4.Dectrical Inspector 5.Plumbing Inspector 6.Other Contact Persom Phone 9: 6 Information and Instructionsx. Massachusetts Geb.Paat Laws chaptu a 152 regaaes all employers'to provide wo6eas'compens•8tion for their CMpIoyees. . pMzaant-tD this 5fttut,-,an ezT1.oyee is defined as.¢,..evM:y person in the service of der under any contcad of]ire, express or implied oral or wrftm." An,employer is defined as"an individual,partnership,associafi&oi corporation or other legal entity,or any two or more of the foregoing engaged in a Joint uprise,and including the legal representatives of a deceased employer,or the receiver or ltl=tee of an mdividnal,partnership,association or other legal entity,employing employees. However the owner of a dwelling horse having not more than three aparfinects and who resides therein,or the occupant of the - dw Hi g house of another who employs persams to do maitman.ce,construction.or repair wont on such dwelling house or on the grounds or building appurfeDanttheretn shall not bwanse of each employment be deemed to be an employer." IMGL chapter 152,§25C(6)also sues that:'every state or local licensing agency shall withhold ffie issuance ar renewal of a ficen a or permit to operate a business or to construct bu fldiags in the commonwealth for any . applicant who has not produced acceptable evidence of cdmppance with.the insurance covexage regnired." Additionally.MGL chapter 152, §25C(7)states"Neither the catmn.awealth nor jay of its political subdivisions shall 'o ric uu table evidence of Ii4ace with fhe ins c-6.. � antes into any COmtraCt for the perfozmance ofpnbh wa acceptable �mP reTtm emus of this chapter have been prescnied to the contracting aithozitY." Applicant& Please till out the workers'compensation affidavit completely,by chwldng the boxes that apply to your situation and,if necessary,supply sob-.contractor(s)names), ad&ms(m)and phone nvmber(s)along with their certffcate(s)of i omzance. L>mited.Liability Companies(LLC)or Limited Liability Partnerships(LLP)'withno employees ocher 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 a$dayk maybe submitted to the Department of Industrial Accidents for conf¢mation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be reimmned to ffie city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Shouldyou 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 Ime. City or Town Officials f Please be sure that the affidavit is complete and prime legibly. 'Ilse Department has provided a space at the bottom of the affidavit for you to fib out in the event the Office of Investigations has to contact you regarding the applicant- Please' be sine to fill in.the penmitllicrose member which will be used as a reference number. In addition,an applicant that must submit multiple pennit/liceuse applitatims is any given year,need only submit one affidavit indicating cosent policy in. =&tiou Cif necessary)and umder"Job Site Address"tie applicant shou?Id write"all locations in (c Y or town)"A copy of the affidavit that has been officially stamped or maimed by the city or to may be provided to the applicant as proof that a valid affidavit is on file for futon pem#s-or licenses A new affidavit must be filled out each year.Where a home owner or citizen is obtibaiog a license or permit not related b any business or commercial ventz'e (ie. a dog license or permit to bum leaves eta.)said person is NOT rujahmd to complete this affidavit The Of of Investigations would hike to hank you in advance for your cooperation and should you have any questions, please do not hesitate to give tie a call The Department's address,telephone and fax giber: T1lt CGMMM tbE of nsett, ' Delta dment cif 1i AWident% ��of�•�e�g�tio--� Bad MA 0�1 II, T�1. 6Z� -4900 eXt 4€6 W 1--977 MA SSAM Fax 9 617 727 7M Revised 4-24-07 �� I Town of Barnstable Building Department Seces . .� g De P Services Brian Florence,CBO UAM h`� 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 1 T b 1 as Owner of the subject property hereby authorize �t�Y � ��� to act on ray behalf, in all matters relative to Work authorized by this building permit application for: (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner ' . Signature licant Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS Rev:08/16/17 ! Town of Barnstable Building Department Services w Brian Florence,CBO Budding Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE F.ItENIPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAH ING 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. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control, HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building pem it fomu\EXPRESS.doc 08/16/17 v Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constrution'Supervisor er _ CS-098849 `✓ Ezpires: 06/20/2019 RENATO F DA-SILVA P.O.BOX 436 FORESTDALE MIA 0264t g ltt 'ISO i Commissioner . Office of consumer Affairs&Business Regulation r HOME IMPROVEMENT CONTRACTOR F - l TYPE:Corporation Registration valid for individual use only Registration , Exofratfon before the expiratiorrdate. if found return to. 182004 =05/25/2 r Office si ce of Consumer Affa' and Business Regulation019 10 Park Plaza Suite 70 ness Regulatio , EXCEL BUILDING SYSTEMS COMPANY INC.' _ Boston,MA 0211 J t RENATO DA SIL A 8 JAN SEBASTIAN DRi_STE 9 E SANDWICH,MA 02563—' Undersecretary Not without Signature n _ r , y 5 Client#:38860 2EXCELBU ACORD„. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/22/2017 TNIS.CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:if the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER k2m"E:cr Dowling&O'Neil Dowling&0' Neil Insurance Agency PHONE � Fax a/c No ;508 775-1620 � No): 5087781218 973 lyannough Rd,PO Box 1990 E-MAIL COiQdoins.com ADDRESS: . Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAIL# 508 775-162620 INSURER A:NGM Insurance Company 14788 INSURED Excel Building Systems Company,Inc INSURER 13:Associated Employers Insurance 11104 �- PO Box 436 INSURER C:Safety Indemnity Insurance Comp 33618 Forestdale,MA 02644 INSURER D: 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 MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ' ITS TYPE OF INSURANCE ADDL UB POUCY EFF POLICY EXP WSR WVD POLICY NUMBER MM/DD MMID LIMITS A GENERAL LIABILITY MP02774T 017 02/22/201 8 EACH OCCURRENCE $1 O00 000 X COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES Eaoccurrence $500 OOO CLAIMS-MADE �OCCUR MED EXP(Any one person) $10 OOO z PERSONAL&ADV INJURY 1,0NIM N GENERAL AGGREGATE $2 000= GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $Z OO 000 O POLICY JE PRO- LOC , $ C AUTOMOBILE LIABILITY 6231596 2/MO16 12/0 M1 CEOaMBINd'n SINGLE LIMIT') 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL AUTOS OWNED Ix AUTTOSU�DBODILY INJURY(Per accident) $ X HIRED AUTOSNON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB occuR EACH OCCURRENCE $ ° EXCESS LIAB CLAIMS-MADE ` AGGREGATE $ DED RETENTION$ $ B AND EMPLOYERS' YER 'LIABILITY IONILIT WCC50050098182017A 017 03/05/2O1 X wC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $SOO O00 OFFICER/MEMBER EXCLUDED? FN N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500 000 n yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Rernaft Schedule,If more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town Of Barnstable THE ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Maid Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE MGM ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD iLC1 RR1 R7/Mi RRi Rd rRn Regulatory Services �n rqy Thomas F. Geiler,Director,, ti Building Division 's 11 BAMSTABM ' Thomas Per CBO Buildin Commissioner 9 �'� g `be 1619. �� . 200 Main Street, Hyannis, MA 02601 }t�ty4 t f. www.town.barnstable.ma us Office: 508-862-4038 Fax: -508-79076230 DIVISION _ Town of Barnstable Family Apartment Affidavit 1, being on oath, depose and state as follows: My name is Av 7 i® ( � �r�' I am the owner/resident of the property located at: - The following members of my-.family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: Name &relationship to owner: Y The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately note the Building Commissioner in writing. I understand that no.subletting_or subleasing of said Family Apartment is permitted. I understand that-1 am required to file an Af davit.annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the`ZBA Special Permit. and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. . If there is no longer a Family Apartment at this location,please explain: The apartment has beenfdismantled: T The apartment has been transferred to the Amnesty Program(Appeal No: ) Other. Sworn to under the pains and penalties of perjury.this ( day.of 2013. Signature. Phone Number - Print N e q:forms/famaffid.do c rev 11/08/11 Town of Barnstable Regulatory Services. of Thomas F. Geiler,Direc-to 1r 0' *eta ' '-Building Division MASS. Thomas Per CBO Building Commissioner F Mass. �,, Perry, � g is= . e� 0 3g6 �.• 200 Main Street, Hyannis, MA 02601 www.town.barnstable.maxs Office: 508-862-4038 ' � =Ri J Fax: 508-790=6230 Town of Barnstable-Family Apartment Affidavit I, being on oath, depose and state as follows: My name is �p C► t1¢/. 4 t- I am.the owner/resident of the property located at: t s Ito D rs GUY' - The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified ' family members. In the event that the listed relatives vacate said apartment, I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. 1 agree to notes the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has.been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under,the pains.and penalties of perjury this f 3 day of JA41.1 2012. r3 p c 3 S gnature Phone.Number Print Name i t- t. S q:forms/famaffid.doc rev 11/08/11 �. Town of Barnstable Regulatory Services °FTHe roy� Thomas F.Geiler,Director Building Division SARNSPABLE, Tom Perry, Building Commissioner 9 MASS. 1639. 200 Main Street,Hyannis,MA 02601 ��rFG Nlpl a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is :�77PM 11 9� ? (4 l �(,S I am the owner/resident of the property located at: 1 bi MI 5 The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: iA �t (/ s . 14„ 0 � ,off Name& relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA'LSpecial Permit , andlor the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apa�tments. I Dee to notify the Building Commissioner immediately in the event of the sale of this gyp.'gypp erty. If there is no longer a Family Apartment at this location, please explain`. ts-) M The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. { � Other Sworn to under the.pains and penalties of perjury this day of \J 1t.0 2010. �5 3� . r Signature _ Phone Number Print Name. f t Q/bldg/forms/famaffid Rev:12/08 Town of Barnstable Regulatory Services �'I�tqy, Thomas F.Geiler,Director UF' 8A0STABLE Building Division - snxxsrnaLE,g Tom Perry, Building Commissioner 2009 JAN 13 AM I1: 35 iegq. ,m 200 Main Street,Hyannis,MA 02601 AlfD ,�A www.town.barnstable.ma.us W99 Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name'is =12,4/t�z I am the owner/resident of the property located at: 1 Z p(c The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: 244 /-/(" /S Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members, In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. 1 understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that 1 am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. 1 agree to notify the Building,Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. Th-apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this day of 2009. Sig ature Phone Number Print Name �� /�V 1- Q/bldg/forms/famaffid Rev:12/08 Town of Barnstable Regulatory Services ptr11HE Thomas F.Geiler,Director Building Divisions 0�' ^' t �-E • r BMWSI'ABLE. Tom Perry, Building Commissioner 7 MAss g n gQ FEB ~5 A ! 5 s6;9• �m 200 Main Street,Hyannis,MA 026U1 ATED �A WWw.town.barnstable.ma.us t�s�l�1OPI Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: Gi/1 t � � �1. � My name is . � I am the owner/resident of the V-- property located at: q!, _ r C- ,-n t2 e.. 2-G� . •The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name& relationship to owner: -r t ��� —` {� o A4 Name & relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, 1 will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. 1 understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. 1 agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this day of F.: s 2008. - Signature Phone Number Print Named/ il�,�-t/ l�-f •`��� Q/bldg/forms/famaffid Rev:l/03 Town of Barnstable o �- Regulatory Services /Z- f1ME TOy, Thomas F.Geiler,Director ti Oe i+ Building Division sn ASS. E MASS. � Tom Perry, Building Commissioner n� 1639• ,0� 200 Main Street,Hyannis,MA 02601AN 22 j 56 ArFD��p www.town.barnstable.ma.us f' Office: 508-862-4038l yl Fax:8 90-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is '3>A-V l2 P, l 1 LG S I am the owner/resident of the property located at: i 0!4 is 1 6-2 h 0 / The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: J14 l� Name &relationship to owner: `- - The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, 1 will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. 1 also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the-pains and penalties of perjury,this V day of 2007. . Signature _ _ Phone Number Print Name V- 1 P /�' j 7 % L L S h Q/bldg/forms/famaffid Rev:1/03 K Town of Barnstable Regulatory Services °tr'THE rOy, Thomas F.Geiler,Director Building Divisiont;E }; SiFSLE '* BARNSznsL& : Tom Perry, Building Commissioner Mnss. 039. `0$ 200 Main Street,Hyannis,MA 02601 ZQ� `���zJ FPS l .eIFD MA'1 A 2' www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: My name is ff r I am the owner/resident of the property located at: 12L Map and Parcel Number The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: / Name & relationship to owner: //I (7` �� Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. 1 understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this day of V!� 2006. Signature �, _ _ Phone Number Print Name Q/bldg/forms/famaffid Rev:1/03 Town of Barnstable a /C Regulatory Services , �6 oF1Ne toy, Thomas F.Geiler,Director r, ,�.r - g 3 'gt:; tr' i A k sksifkT L y w Building Division * BARNSTABLE, Tom Perry' BuildingCommissioner 2' 5 FE 1 ' J 9 MASS. $ 7 :i7 1639. .m 200 Main Street,Hyannis,MA 02601 ArEG Mp'I A www.town.barnstable.ma.us 01 V'!S 101 Office: 508-862-4038 Fax: 508-790-6230. Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: " My name is _ I am the owner/resident of the property located at: Map and Parcel Number 0�hg/ "C2� PARCH—C ° � The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: rv,o ,� Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate-said apartment, I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. 1 also understand that 1 am required to comply with all conditions imposed by the ZBA in the Appeal No. identified above. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. ' The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this /Z/ iL day of ���„��,� 2005. Signature Phone Number Print Name eq;�?n 0- Q/bldg/forms/famaffid Rev:1/03 > , F Town of Barnstable ' Family Apartment Affidavit being on oath, depose and state as follows: ---n� 1. I reside at - T � ��v `C that I have owned since and which is my domicile and principal residence. The property is shown on Barnstable Assessor's Map and Parcel 250 17 . 2. On r ;u 75r , the Zoning Board of Appeals, in Appeal No. MSt-4/2 , granted to me a 1 Special Permit to develop and maintain a Family Apartment in accordance with Section 3-1.1(3)(D) of the Zoning Ordinance and in agreement with the condition(s)of that Special Permit at the premises above. 3. The following members of my family will be the sole occupant(s) of the Family Apartment Unit: Name: l'1 m , Relationship to owner: AiJne) .� Name: , Relationship to owner: I understand that the Family Apartment: * shall only be occupied by members of my family who are persons related to me by blood or by marriage, * shall be the primary year-round residence for the identified family members, * shall not be sublet or subleased to any other person(s), and * shall at all times, be in compliance with all conditions of the Special Permit issued by the Zoning Board of Appeals, including plans and commitments made in the application and approved by the Board. This affidavit shall be filed annually with the Building Inspector's Office and if the unit shall be vacated by the above identified family members, I shall within 30 days notify the Building Inspector's Office of that and shall immediately proceed with the removal of the Family Apartment Unit. In the event of the sale or transfer of ownership of the above property, I shall notify the Building Inspector's Office and shall surrender the Special Permit for this Family Apartment. Sworn to under the pains and penalties of perjury this day of .2 Signature: Name: (Please Print) VIP 14I t..L-s , Phone: 92 4-56C_ —01 0 6 Mailing Address: Y fZ -91 lSH6 P-S %Z= P H yAAJ/If(S 11A 02 601 Town of Barnstable Ile Regulatory Services Zd °FIME rokti Thomas F.Geiler,Director Building Division 2 9 BA UrAABLe,$= Tom Perry, Building Commissioner �33 F 3 �` '• 2 1639. 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit Nbeing on oath, depose and state as follows: My name is Jc/��i ���' /���s I am the owner/resident of the property located at: if 4 Map and Parcel Number 0 7/ The ZBA granted me a Special Permit/Variance on �G Date Appeal No. The decision of the Zoning Board of Appeals has been recorded with the Registry of Deeds in Barnstable County: Book 0/y0 Page 7 The following members,of my family will be the sole occupants of the Family.Apartment at the aforementioned address: Name &relationship to owner: i;r) Z -49,{� Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA in the Appeal No. identified above. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains-and penalties of perjury this day of 2003. 7W �, "oF- 77.E FF40 F Signatur Phone Number Print Name Q/bldg/forms/famaffid Rev:1/03 Town of Barnstable D -� Regulatory Services OF1ME lqy, Thomas F.Geiler,Director Building Divisi WR p BARhSTABLE, r snaxsTABM Peter F.DiMatteo, Building Commissioner MAS& 200 Main Street,Hyannis,MI. FE8 21 QM 1' 48 lED MA'S A Office: 508-862-4038 ` Fax:.508-790-6230 "MJIViS10N Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: J- J My name is �i;�n ✓ M �{1/ S I am the owner/resident of the property located at: 1112 s o�o 'S' /eiowce_ j/-4./ci.hnf'S 611 Map and Parcel Number The ZBA anted Special Permit/Variance on 9 4 D C/� �' me a P Date Appeal No. The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: ' l Name &relationship to owner: A91) Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA in the Appeal No. identified above. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this day of 2002. lgnature/ Phone Number 9'FW Print Name Q/bldg/forms/famaffid Rev:010702 COMMONWEALTH OF MASSACHUSETTS pp / BARNSTABLE AFFIDAVIT being on oath, depose and state as follows: I� f 1.) I reside 2.) I am the owner ownerr of the property located /I at '7�� CJ i(S/�m D GCS ��rf �' fYAlw f7/// In shown on Barnstable Assessors' maps as MAP Afd TT PAR L 7 3.) I Do X Do not have a Family Apartment at this location. 9/ —0�6,p, 4.) On , 199 , the Zoning Board of Appeals, on Appeal No. ante?me a Special Permit/Variance to maintain a Family Apartment at the above address. 5.) I understand that the Family Apartment may only be occupied by members of my family who are persons related to me by blood or by marriage. 6.The following members of my family will be the sole occupants of the Family Apartment at the above address: a) NAME Relationship to owner: /✓0 /--h c b) NAME Relationship to owner: 7.) The Family Apartment will be the primary year round residence for the above-identified family members. 8.) In the event that the above-listed relative(s) vacate said apartment, I will immediately notify the Building Commissioner in writing. 9.) I understand that no subletting or subleasing of said Family Apartment is permitted. 10.) 1 understand that I am required to annually file an Affidavit with the Building Commissioner listing the names and relationship of my family members occupying said Family Apartment. 11.) I understand that I am required to comply with all conditions imposed by the Board of Appeals in Appeal No. 12.) I agree to immediately notify the building Commissioner in the event of the sale of the above- listed property. Sworn to under die pains and penalties of perjury this 7 day of Signature - P • ame COMMONWEALTH OF MASSACHUSETTS BARNSTABLE s,—` AFFIDAVIT I `te / lam/. 7 ------------- ------------------------- �ein on oa depose and state as follows: 2 1999 1.) I reside 2.) I am the owner of the property located at--- 2--vrL5 v J -T-LIta C � — — ----- — ------------------ shown on Barnstable Assessors' maps as MAP PARCEL____________________ 3.) I Do-- Do not_____—_- —have a44wrAy Apartment at this location. 4.) On---------------------, 199__—, the Zoning Board of Appeals, on Appeal No.______ granted me a Special Permit/Variance to maintain a Family Apartment at the above address. 5.) I understand that the Family Apartment may only be occupied by members of my family who are persons related to me by blood or by marriage. 6. The following members of my family will be the sole occupants of the Family Apartment at the above address: a) NAME -------------------------- — Relationship to owner: c,;-'___ b) NAME Relationship to owner:___________ 7.) The Family Apartment will be the primary year round residence for the above-identified family members. 8.) In the event that the above-listed relative(s) vacate said apartment, I will immediately notify the Building Commissioner in writing. 9.) 1 understand that no subletting or subleasing of said Family Apartment is permitted. 10.) I understand that I am required to annually file an Affidavit with the Building Commissioner listing the names and relationship of my family members occupying said Family Apartment. 11.) I understand that I am required to comply with all conditions imposed by the Board of Appeals in Appeal No. 12.) I agree to immediately notify the Building Commissioner in the event of the sale of the above- listed property. q Sworn to under the pains and penalties of perjury this____-1_day of____ /2-____, 199_ Signature - ---- --------------------------------------------- tie COMMONWEALTH OF MASSACHUSETTS BARNSTABLE AFFIDAVIT / rod — - - ---------------------------------, being ,, depose and state as follows: "'' Lp�`rrAeCF l.) I reside aty_l�r ,��s o � jg 2.) I am the owner of the property located r shown on Barnsta le Assessors' maps as MAP __PARCEL__________---------- 3.) 1 Do------ —___--_Do not_______________have a Family Apartment at this location. 4.) On___ __________, 199-___, the Zoning Board of Appeals, on Appeal No.______ granted me a Special Permit/Variance to maintain a Family Apartment at the above address. 5.) I understand that the Family Apartment may only be occupied by members of my family who are persons related to me by blood or by marriage. i 6.The following members of my family will be the sole occupants of the Family Apartment at the above address: ' l a) NAME-----A''�t C. '�lS - ---------------------------------------------------------- ---- Relationship to owner:---/yo 6h e-------------------------------------------- b) NAME Relationship to owner: 7.) The Family Apartment will be the primary year round residence for the above-identified family members. 8.) In the event that the above-listed relative(s) vacate said apartment, I will immediately notify the Building Commissioner in writing. 9.) I understand that no subletting or subleasing of said Family Apartment is permitted. 10.) I understand that I am required to annually file an Affidavit with the Building Commissioner listing the names and relationship of my family members occupying said Family Apartment. 11.) 1 understand that I am required to comply with all conditions imposed by the Board of Appeals in Appeal No. ---------------------------------------- 12.) I agree to immediately notify the building Commissioner in the event of the sale of the above- listed property. Sworn to under the pains and penalties of perJury this_______day of_Ja n��r __, 199_17 Signature Print e / l -\:�e n -2& -----------=-------------------------------------------------------- QUERY PROPERTY: QUERY END QUERY PROPERTY PENTAMATION----------------------------------------------------------- 12/30/97 PARCEL ID 250 071 GEO ID 15987 LOT/BLOCK 8 DBA PROPERTY ADDRESS OWNER HILLS 412 BISHOPS TERRACE JENNIFER M & HILLS ANN C HYANNIS 412 BISHOPS TERRACE HYANNIS MA 02601 PHONE DISTRICT HY DEVELOPMENT STATUS C ASSESSOR' S CODE CAPACITY (NOTES) ZONING DIST/ZOC RC-1 SEWER SYSTEM FLOOD PLN/ELEV. WATER SYSTEM OKH? $# BEDROOMS ZBA DECISION FAMILY APT LOT SIZE 18730 . 8 OPER/MGR NAME WET LANDS MULT ADDRESS USE 101 PROTECT DIST GP (N) EXT / (P) REVIOUS / NO (T) ES / PER (M) ITS / (V) IOLATIONS / (G) EOBASE / (E) XIT 01 COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, ss: AFFIDAVIT I, - > �"' �' '° 'h�s being on oath, depose and state as follows : 1 . ) I reside at aa, s • 2 •7 I am the owner of the property located at shown on Barnstablessessors ' Maps as: ' Map c Lot 71 3 . ) on .� 19 2`L-i' the Zoning Board of Appeals, on Appeal N,?� , granted me a s ecial Permit to maintain a family apartment at the above address. 4 . ) I understand that the family apartment may oinly. be occupied by .members of my family who are persons related to me by blood or by marriage. 5 . ) The following members of my family will be the sole occupants of the family apartment at the above address: (1) Name: -E�>�c�� Relationship to Owner: da-10& (2) Name: Si Relationship to Owner:__ �1,,� 6 . ) The family apartment will be the primary year round residence for the above-identified family members. 7 . ) In the event that the above-listed relative(s) vacate said apartment, I will immediately notify the Building Commissioner in writing. 8• ) I understand that no subletting or subleasing of . said family apartment is permitted. 9. ) I understand that. I am required to annually file . an Affidavit with the Building Commissioner listing the names and relationship of my family members occupying said . family apartment . 10 . ) I understand that I am required to;.comply with all conditions imposed by the Board of Appeals in Appeal No. 10 . ) I agree to immediately notify the Building Commissioner 'in the event of the sale of the above-listed property. Sworn to unde the pains and day of " 19 penalties of per this .9 /0C FL ��� � (Signature) JV0Vra (Please Print Name) : ii, COMMONWEALTH OF MASSACHUSETT'S BARNSTABLE, ss : 'AFFIDAVIT I ' �ed �S being on oath, depose and state as follows : 1 . ) I reside at ll, n 4 �r l 2 . ) I am the owner of the property located at 31-s Hv/?s_ /Orls shown on Barnstable Assessors ' Maps as : Mapes° rZ! 3 . ) On 19�, the Zoning Board of Appeals, on Appeal No. granted me a special Permit to maintain a family apartment/at the above address. 4 . ) I understand that the family apartment may only be occupied by .members of my family who are persons related to me by blood or by marriage . 5 . ) The following members of my family will be the sole occupants of the family apartment at the above address: Relationship to Owner ' (2) Name: ��� � -- Relationship to Owner: ' 6 . ) The family ap,�jrtfTlPnt will be the primary year-. round residence for the above-identified family members. 7 . ) In the event that the above-listed relative(s) vacate said apartment., I will immediately notify the Building Commissioner in writing . 8. ) I understand that no subletting or subleasing of said family apartment is permitted. 9. ) I understand that. I am required to ;annually file an Affidavit with the Building Commissioner listing the names and relationship of my family members occupying said family apartment. 10 . ) I understand that I am required to;.comply with all conditions imposed by the Board of Appeals in Appeal No. 10 . ) I agree to immediately notify the Building Commissioner in the event of the sale of the above-listed Property. Sworn to under the P ins and penalties of perjury this day of ignature) (Please Print Name) : DOTI JMN OF SWABLE 191' euanarso�r ------------- J COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, ss: // AFFIDAVIT 1 n� T�Ti being on oath, depose and state as follows :1 . ) I reside at ,�"�-P- 2 . ) I am the owner of the property located at a- �iSI�Q�� LlZi4GQ f f y/wo/Jis IX4 shown on Barnstable Assessors ' Maps as : Map -,SD , Lot -7/ 3 . ) On M11-V 2 S 19 3b , the Zoning Board of Appeals, on Appeal-No. _/9Y- -1f A , granted me a special permit to maintain a family apartment at the above address. 4 . ) I understand that. the family apartment may only be occupied by members of my family who are persons related to me by blood or by marriage . 5 . ) The following members of my family will be the sole occupant; of the family apartment at the above address: (1) Name: j*0 r?/sc i//,g �• N.`LL S _ Relationship to Owner.- 121 e t to'TZ (2) Name Relationship to Owner : • 6 . ) The family apartment will be the primary year- round - residence for the above-identified family members . 7 . ) In the event that the above-listed relative(s) vacate said apartment., I will immediately notify the Building Commissioner in writing. E3. ) I understand that: no subletting or subleasing of said family apartment is permitted. 9. ) I understand that. I am required to annually file an Affidavit with the Building Commissioner listing the names and relationship of my family members occupying said family apartment . 10 . ) I understand that I am required to:.comply with all conditions imposed by the Board of Appeals in Appeal No. 10 . ) I agree to immediately notify the Building Commissioner in the event of the sale of the above-listed property. Sworn to under the pains and penalties of perjury this day of 19 910. (Signature) (Please Print Name) : /�,�,v Cd. / •�S COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, ss: AFFIDAVIT I . � being on oath, depose and state as follows : 1 . ) I reside at �/02 I am the owner of the property locatedV_;� shown on Barns able Assessors ' Maps a : Map , Lot 7/ _. 3 . ) On Z 19 , the Zoning Board of Appeals, on Appeal-to. , granted me. a special permit to maintain­a family apa,i tment. :at the _above .address . ' - ,r 4 : ) I understand that the family apartment -may-only be occupied by members of my family who are persons related to me by blood or by marriage . 5 . ) The following members of my family will be the sole occupants of the f ily a ; rtment at the above address: (1 ) Name: a Relationship to Owner. `W4 , ru e,- (2) Name: Relationship to Owner: 6 . ) The family apartment will be the primary year- round residence for the above-identified family members . 7 . ) In the event that the above-listed relative(s) vacate said apartment, I will immediately notify the Building Commissioner in writing. 8. ) I understand that -no subletting or subleasing of said family apartment is permitted. 9. ) I understand that I am required to annually file an Affidavit with the Building Commissioner listing the names and relationship of my family members occupying said family apartment . 10 . ) I understand that I am required to comply with all conditions imposed by the Board of Appeals in Appeal No. agree to immediately notify the Building Commissioner in the event of the sale of the above-listed property. Sworn to under the pains and penalties of perjury this day of 19-7. (Signature) (Please Print Name) : 4/0 t) �. ,�•�s SENDER: Complete items 1 and 2 when additional services are desired, and complete items 3 and 4. Put your address in the"RETURN TO" Space on the reverse side. Failure to do this will prevent this card from being returned to you.The return receipt fee will provide ou the name of the person delivered to and the date of delive .Fora itiona ees the following services are avai a e.Consult postmaster or,;ees and check ox es for additional service(s) requested. 1. Show to whom delivered, date,and addressee's address. 2. ❑ Restricted Delivery (Extra charge) (Extra charge) 3. Article Addressed.to: 4. Article Number RwV1 _17Pol7 OILI2, Type of Service: Y_r ❑ Registered El Insured r ®:Certified ❑ COD El Express Mail ❑ Return ReceiT-t K- cc,vt v-L S m j for Merchandise L p26O Always obtain signature of addressee or agent and DATE DELIVERED. 5. Si re =Address 8. Addressee's Address (ONLY if X requested and fee paid) 6. t6i6iiature —Agent; X 7. Date of Delivery r PS Form 3811,Mar. 1988 +►. U.S.G.P.O. 1988-212-865 DOMESTIC RETURN RECEIPT l UNITED STATES POSTAL.SERVICE OFFICIAL BUSINESS SENDER INSTRUCTIONS Print your name,address and ZIP Code in the space below. • 'Complete Items 1,2,3,and 4 on the reveres. MMMMM150 • Attach to front of article If space permits, otherwise affix to back of article. PENALTY FOR PRIVATE • Endorse article "Return Receipt USE, $300 Requested"adjacent to number. RETURN Print Sender's name, address, and ZIP Code in the space below., TO 2-, J30" I +YYt.✓wry 5�Uyi..e-►-- O cave i Y ail 5 1 VJ l e � -3 io`7 -Mm-t-Y, S ���a vt ✓l p 2-(S0 � �I (9 � 2 P 017 02; 4 288 RECEIPT FOR CERTIFIED MAIL NO INSURANCkOVERAGE-BROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) Sent to C. is Street and 1 e v4 cs2 P.O.,State and ZIP Co e 4 5 Z6o/ Posta e S Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt showing to whom and Date Delivered Ln co Return Receipt showing to whom, Date,and Address of Delivery m j TOTAL Postage,and;,fz. W S � S Postmark or Dateco 0 Cn E N ti STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES.(see front) 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier. (no extra charge) 1 , 4 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,wdetach and retain the receipt,and mail the article. ^t 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card„Form 3811,and attach it to the front of the article by means of the gummed ends if space per- mits. Otherwise,affix to back of article. Endorse front of article RETURN RECEIPT REQUCwSTED adjacent to the number. 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. 6. Save this receipt and present it if you make inquiry. �. U.S.G.P.O.1987-197.722 10seph u. DaLuz 75-.1I20 :Telephone Building Commissioner '� one: i7 07 TOWN OF BARNSTABLE BUILDING DEPARTMENT TOWN OFFICE BUILDING - HYANNI:S, MASS. 02601 September 5 , 1989 Ann C. Hills 412 Bishops Terrace Hyannis, MA 02601 Dear Mrs . Hills : On April 20, 1989, this office mailed a letter to you . outlining the conditions set forth in the Zoning By-law Pertaining to family apartments. In that letter, the importance of the required affidavit was stressed. You will note that the penalty for a zeroing violation was also outlined in your letter . This letter is, to advise you tnat, unless the affidavit is received by this Ofrice within ten ( 10) days of receipt of this letter, 1 will be forced to file a complaint. in the First District Court at Barnstable. Each day the violation continues will constitute a separate offense. Peace, e-seph D . DaL z Building Commissioner JDD/km cc Board of Appeals Town Attorney ` s O • e L Joseph D . DaLuZ Telephone : 775-1120 Building Commissioner Ext. 107 TOWN OF BARNSTABLE BUILDING DEPARTMENT TOWN OFFICE BUILDING HYANNIS, MASS. 02601 April 20, 1989 Ann C. Hills 412 Bishops Terrace Hyannis , MA 02601 Re: Appeals No. 1986-42 Dear Mrs . H ills : On May 29, 1986, as applicant(s ) you were granted a Special Permit for a family apartment . "The intent of this by- law shall be to allow one ( 1 ) additional living unit, complete with kitchen and bath to supply a year-round residence for a member or members of the property owners family, . . . . . . . . . . . " In addition, the by- law also states that. "The property owner, and the person or persons who will reside in the family apartment shall sign affidavits before occupying said family apartment and further, all shall sign said affidavits each year said family apartment is occupied. . . . . . " . Within sixty (60) days from the date the person or persons residing in the family apartment vacate the premises, the owner or his representative -shall remove the kitchen facilities and request the Building Inspector to inspect the premises. It is important that you understand that there are restrictions which relate to the applicant's family living at the same premises. The use cannot be transferred. Conviction of a violation of this by-law is subject to a fine of $100 per day for, each day from the established date of offense and, also, subject to a criminal complaint to issue from the First District. Court of Barnstable. Affidavits must be signed and filed at the Building Commissioner's office between the hours of 9:30 A. M. and 1 :30 P. M. Monday through Friday. This by- law shall be strictly enforced. Peace, , 77 Joseph D. G1a(Luz Building Commissioner JDD/km cc Board of Appeals Town Counsel r �'tCORa IN REGISTRY OF DEEDS !I� C(!i IwiAsJCE. WITH SEC. 11 oITOWN OF BARNSTABLE ��.wR `In STABLE. INIASS. CHAPTER 40A, M.G.I. Zoning Board of Appeals 'R6 JUN -6 PM 1 37 Ann C. Hills I ............................ Deed duly recorded in the Property Owner County Registry of Deeds in Book .............................. .........5 .................................................................................................................. Page ......................... ............................................................Registry Petitioner District of the Land Court Certificate No. ........................7 ........................ Book ........................ Page .................. Appeal No. ...._...1986-42 ....................... 19 FACTS and DECISION Petitioner Anti C. Hills filed petition on ................................................ 19 ....................._......_....................... ........_.............._........................................ requesting a variance-permit for remises at .......411 Bishop,'s„Terrace q g P P ............. . in the village (Street) of ............Byarlrlis........................................................... adjoining premises of ................. (see attached list) .................................... Locus under consideration: Barnstable Assessor's Map no. .........250................................... lot no. ...........71........... Petition for Special Permit: [N Application for Variance: ❑ made under Sec. ...............V.............................................. of the Town of Barnstable Zoning by-laws and Sec. ........................................................................................................................ Chapter 40A., Mass. (den. Laws for the purpose of t11 dif katian...Qf.._a...$W_cid F.emut....t.Q ;E0r[1Uy....................... ..........................................................................ap�. nt.......................................-................................................................................................................................... Locus is presently zoned in.......................lc=l, ........................................................................................................................................................ Notice of this hearing was given by mail, postage prepaid, to all persons deemed affected and by publishing inBarnstable Patriot newspaper published in Town of Barnstable a copy -of which is attached to the record of these proceedings filed.with Town Clerk. A public hearing by the Board of Appeals of the Town of Barnstable was held at the Town Office Building, Hyannis, Mass., at P.M. ...._.....................mom..15,.................................... 19 86 , upon said petition under zoning by-laws. Present at the hearing were the following members: ...........Luke.. P.,...L l l y.........................._ .........._.........Rigt. Lot:...Jany............. .................IRQna 1,d...aiEnas.................. Chairman Gail Nightingale Dexter Bliss ' At the conclusion of the hearing, the Board took said petition under advisement. A view of the locus was made by the Board. AppealNo...._._.......... ............................. Page ........................ of ........................ On ............................My...29.........:......................................................... 19 .....8�i......, The Board of Appeals found Ann Hills presented her--petition for the modification of a Special Permit to allow the abandonment of a professional office, by virtue of a prior grant of the Board, and to construct .in its stead ar_family apartment in an attached garage at 412 Bishop's Terrace, Hyannis in an RC-1 zoning district on a lot containing 18,750 square feet. The petitioner is a widow and would like to have her elderly mother-in-law reside in the family apartment. The petitioner has complied. with all of the restrictions of Section V. Ron Jansson made a motion to grant the relief sought with the stipulation that the office use be discontinued - to be a condition of the Special Permit - the motion was seconded by Dexter Bliss. The Board voted unanimously to grant the Special Permit to allow a family apartment at 412 Bishop' Terrace Hyannis. I JU N t... A r/oo J S L 7' Clerk of the Town of Barnstable Barnstable County, Massachusetts, hereby certify that twenty (20) days have elapsed since the Board of Appeals rendered its decision in the above entitled petition and that no appeal of said decision has been filed in the office of the Town Clerk. Signed and Sealed this �:2.......... day of ............... ....r............................... 19 ............. under the pains and penalties of perjury. Distribution:— PropertyOwner ........................................................................................................................._............... Town Clerk Board of Appeals Applicant Town of Barnstable Persons interested Building Inspector Public Information By .................... ..........�....... ...,�hl............. Board of Appeals Chairidan All R250 071. A P P R A I S A L D A T A KEY 159875 HILLS, ANN C LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RC- I 50, 300 :'goo 114, 300 2 A-COST 165, 500 B-MKT 83, 600 BY 00/ BY ML 1/88 C-INCOME PCA=1011 PCS=00 SIZE= 1 157 JUST-VAL 165, 500 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 50AC -- --MAY NOT BE COMPARABLE-- NE I G HBOR1-O iD 50AC HYANNIS PARCEL CONTROL AREA TREND STANDARD 103 10 LAND-TYPE 503o01 102000 LAND-MEAN -51% 1655003 75048 IMPROVED-MEAN +52% 25% I FRONT-FT I 100 DEPTH/ACRES TABLE 02 100%] LOCATION--ADJ APPLY-VAL-STAT I LNRILAND LFT/IMPJADJS/SB/FEAT STRISTRUCTURE ARR3AREA--MEASUREMENTS NORINOTE: Cl-11113MARKET I NC:IINCOME PMRIPERMITS ORRA GRAPH IC FUNCTION-[. I STRUCTURE-CARD NO-10001 DATA-[ I XMTE?3 it - --------- -- -- -- -- -- - -- --- ----------- ------------- ----- --- ------------- •r.; Sr, j � r I I 3 C R250 071 . ] LOC 1041'2 BISHOPS TERRACE CTY 3 07 TD' 3 400 HY KEY] 15 875 ----MAILING .ADDRESS------- P( A 3101 1 PC S 3 oo YR]00 PARENT] t� HILLS, ANN C MAP3 AREA350Ai_ JV3 MT030000 412 BISHOPS TERR `P1] 1P23 .Sp:33 UT 13 UT2 3 . 43 SQ FT 3 1157 HYANN I S MA 02601 AYB 3 197'2 EYB 31975 OBS] CONST 3 0000 LAND 50300 IMF' .114:300 OTHER 900 ----LEGAL DESCRIPTION---- TRUE MKT 165500 REA C.LA'=S I F I ED #LANE► 1 50,300 ASD LND 50300 ASD IMP 114300 ASD OTH 900 #BLDG(S)-CARD-1 1 74, 100 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #OTHER FEATURE 1 900 TAX EXEMPT #BLDG(S)-C:ARD 1 40, 200 RES I DENT'•L 83600 165500 165500 i #PL 412 BISHOP TERRACE OPEN SPACE #DL LOT 8 COMMERCIAL #RR 0126 0125 INDUSTRIAL a EXEMPTIONS ':ALE]i 0/00 PRICE] ORB]C557770 AFD] LAST ACTIVITY312/02/87 PGR]Y I A= CARD 0011 1 M P R 0 V E M E N T / ADJUSI- Ilf-':: Nl' K:EY 3 15 9 8 W--'.i PCA21011 SCT SIZE/ L—LOC COND ADWR250 071 . CLASS/CATO CDP DIMENSIONS I—COND YR uSE .DEP ADi—PRICE UNITS VALUE'-.-- EBATHS 1 . 0 CCU C x c 1E E ) 1003 3500. 0033 1 . 003 3500 B CFIREPLACE CCU C x C 3C E 1 1001 3500. 0033 1 . 003 3500 B LBRR REC RM ECS E x E .1 1. E 3 1003 8.7533 5793 5100 B WHED ccs C 8 x 8 c 3c c 1 1003 13. 3031 643 900 F E K E 3 1 33 1 C 3C c 3 3 1 :1 3 31 1 C C C C 3C C j 3 33 ::1 1 3C C 3 1 31 1 C ic c 3 33 1 I ic c 3 :1 :3 :3 ::1 1 Y C 3 :1 3 :1 E ic E 1 :1 3 .1 1 C c C E K c I -1 3 :1 1 is c E E :1 1: c 3 :1 31 :1 C C c C 3E C 3 :1 33 1 1: c c 31: E 3 :1 3 .3 1 c c F I Ic c 3 ::1 31 1 SP—BLD BLD—ADJ TOTAL—FEAT 12100 90o 900 UNITS 001 00015987 00010028*3 TOWN OF BARNSTABLE 1999 STREET LISTING V STNO NAME YOB OCCUPATION V STNO NAME YOB OCCUPATION 190 FOWLER, DEREK J 1980 234 GAZZOLO,,DAVID P 1954 SURVEYOR 190 FOWLER, Ell EEN M 1953 ADM.CLK w 234 WOODARD, COLBY W 1970 190 FOWLER, GERALD F 1950 FIBER.TECH. ' 246 TWOMEY, EDWARD J 1931 WAREHOUSE •' 190 FOWLER, RHONDAJ 1976 + 246 TWOMEY, JOAN E 1936 RETIRED _ • 199 RYAN, DOROTHY C 1924 RETIRED 260 ALLBECKER, HELEN D 1950 CLERK • 199 RYAN, WILLWM J 1951 BUILDER 260 ALLBECKER, KAREN R 1980 STUDENT • 205 GRIFFIN, EDWARD M 1948 SALES * 260 ALLSECKER, KATHRYN EUZABET1977 STUDENT ' 205 GRIFFIN, ELLEN D 1950 CLERICAL * 260 ALLBECKER, NED A 1946 CORR OFF • 205 GRIFFIN, KELLY 1976 ASST TEACHER * 261 GURNEY, DIANE 1942 • 205 GRIFFIN, MICHAEL E 1979 STUDENT 273 HINGSTON, GREGORY 1981 205 GRIFFIN,JR EDWARD 1978 BAKER 273 HINGSTON, JOEL 1980 ' 273 HINGSTON, UNDA A 1948 HOUSEWIFE BISHOPS TER 273 HINGSTON, THOMAS P 1942 MANAGER + • 274 CHILDS, DAVID 0 1947 ORTHO TECH 12 CARLMAN, LENA R 1914 RETIRED , - 274 CHILDS, PAMELA 1947 HOUSEWIFE 21 HOGAN, LORING S 1937 CLERK * * 285 MEALEY, JOSEPH M 1954 JET ENG MECH 21 HOGAN, PAULA A 1937 BAKERY MGR w + 297 DUDASH, DAWN M 1948 21 WILLARD, MARYANN 1958 BAKER w 297 HAYES, BRIAN D 1958 WAITER 26 CARLMAN, MARY A 1910 HOUSEWIFE * Y97 REYNOLDS, MARY ELLEN 1950 RN 35 GAZZOLO, ROGER J 1926 RETIRED + 298 BOUROUE, NORMAN B 1928 RETIRED 42 BARROWS, MARY A 1949 WAITRESS , ' 42 BARROWS,JR DAVID 1957 COOK 298 B , , VIOLET R 19 ADMIN.SEC ' 42 HURTT, KATHY L 1959 309 LUCIENCIEN NANCY J 195252 METER READER + 310 BARTORELU, AMY M 1954 BOOKKEEPER 47 FONSECA, CARROLLTHONAS 1932 RETIRED 310 BARTORELU, GENE W 1952 STORE CLERK • 47 FONSECA, MARIA M 1933 HOUSEWIFE 310 BARTORELU, JAY M 1974 CHA 56 BALL, BARBARA E 1933 HOUSEWIFE * 323 KITCHENS, ANN F 1931 RETIRED * 56 BALL, ROBERT K 1929 RETIRED 323 KITCHENS, DANIEL J 1953 STORE MGR 61 CROWLEY, EDWARD W 1969 RETAIL SUPER. 323 KITCHENS, JAIMIE M 1975 • 61 CROWLEY, JAMES C 1941 STORE MGR " 323 KITCHENS, JOHN P 1958 UNEMPLOYED ' 70 BORGES, ELISABETH W 1916 RETIRED •75 ROBERTS, MARY 1962 323 KITCHENS, JOSEPH B 1921 RETIRED • • 87 READ, EVELYN E 1943 GEN MGR 324 CHEETHAM, SUSAN L 1947 HOME AIDE 52 87 READ,JR WARREN A 1963 TRUCK DRIVER • 324 MULLSCOUTO COUTO,BENJA IC C 1960 ' Be CARPENTER JENNIFER A 1973 CONSTR.CLEANUP , 324 MULLEN IEWIC , CAROL A 1940 • 88 . CARPENTER, JOHN E 1971 335 JANUSZKIEWICZ, MARY JANE 1940 ADMIN ASST ' 100 CARP NI, ER, JOHN 1971 335 JANUSZKIEWICZ, SARAH 1968 BANK TELLER • 100 BALDINI, STERYL R 1962 336 VALENTI, MARIN R 1931 NURSE AID 110 PURMORT, CAROLA 1961 ATTY 34 N , VERONICA M 1951 + ' 349 MONAHAHAN, ANN J 1923 110 PURMORT, GARY LAWRENCE 1967 PAINTER , ' 115 FINDLAY, ALAN C 1951 AUTO SALES 360 RUTKAUSKAS, A RONIKA 1951 RETIRED • 115 FINDLAY, SANDRA MAUREEN 1945 OFF CLERK 361 MERNA, DON L D R 1951 HOMEMAKER • 120 GREENE,SR SCOTT C 1972 361 MERNA, DONALE C 1908 SALESMAN ' 120 SEELY, CHRISTINE V 1949 SCHL BUS DRIV 361 MERNA, LUCILLE G 1946 HOMEMAKER ' 128 MILLER, HEATHER ANNE 1976 � 374 BOISSONNEAULT, JUUA A 1946 HOMEMAKER • 128 MILLER, HEATHER J 1976 RETIRED w 374 BOISSONNEAULT, PETER R 1945 MAINT SUPERV ' 128 MILLS , PATRICIATIA R 1937 HOUSEWIFE • 374 BOISSONNEAULT, RENEE C 1976 STUDENT ' 128 TIVEY, RUSSELL C 1953 TRUCK DRIVER • 374 BOISSONNEAULT,JR PETER R 1972 AIR ENG TECH • 139 GILMER, PATRICIA A 1950 SALES 385 DIMICHELE, USA J 1956 BOOKKEEPER • 385 PRICKETT, CLAYTON S 1957 FOREMAN ' 142 FELLOWS, HERBERT W 1929 • 386 HOKE, DONNA L 1959 PERS.MGR. • 142 FELLOWS, JOAN T 1932 * 386 SMITH, NANCY G 1947 R N " 142 GARDNER, CARA E 19TY STUDENT • 398 MACIORKOSKI, SUNYA J 1926 RETIRED ` 142 GARDNER, ERIC L 1974 STUDENT * 398 MACIORKOSKI, WALTER S 1922 RETIRED 142 GARDNER, RANDALLM 1950 MINISTER * 399 ANDERSON, SONYAE 1971 SALES • 142 GARDNER, SHARON J 1950 HOMEMAKER , * 151 CONNORS, KAREN M 1958 399 ANDERSON,JR JOHN C 1969 SALES * 154 GOLDBERG, KATHRYN L 1952 * 399 DANNEWITZ, ZEPH S 1971 BARTENDER * 154 GOLDBERG, LARRY D 1947 399 MCDOWELL STEPHEN A 1969 ' 1938 NURSES-AID 399 WELLBELOVED-GLAIR D 1970 * 161 CARLSON, MARY ELLEN 1961 STUDENT SALES , ,.412�HILLS, NA N C 161 CARLSON, PATRICIAN 1961 STUDENT , � - * 164 PALMER, MARK H 1862 412 HILLS;JENNIFER M 1966 177 DRAKE, BRIAN J 1980 dj?_ r LUDINGTON,-MICHAELB—..-"1970 177 DRAKE, JOHN P 1981) 424 NOVAK, SUSAN L 1949 1 " 177 DRAKE, 436 CENTENO, MARIA M 1947 UNDAJ 1947 CLERK * 440 ARMS, DALMAN 1949 HOUSEWIFE ' 177 DRAKE, ROBERT W 1946 DRAFTSMAN * 440 ARMS, ROBERT A 1947 ORDERLY * 180 MUNROE, DOROTHY M 1918 RETIRED 442 LUSSIER, BETHANY 1981 STUDENT * 180 OCONNOR, PATRICIA J 1957 SECRETARY * 442 SANTOS, BRANDY L 1974 SALES • 180 OCONNOR,III ROBERT W 1960 DIR PURCHASE + 446 KIPNES, CHARLES D 1965 ACCT/REST OWNR ' 191 DRAKE, DOROTHY M 1923 RETIRED 451 GILBERT, DAVID M 1954 TRUCK DRIVER * 191 DRAKE, EARLE R 1917 RETIRED 451 GILBERT, VIRGINIA C 1954 TEACHER • 194 MOONEY, ELLEN M 1968 STUDENT * 454 SYLVIA, LAURIE M 1964 HOMEMAKER • 194 MOONEY, GUY L 1970 UNEMPLOYED * 455 CARVEN, MARIANNE 1948 RN ' 194 MOONEY, SYBIL A 1941 LAB TECH 455 ZAMPINO, MARK E 1955 PAINT CONTRAC 205 ANDREWS, ROBERT O 1951 + 458 FREIRE, CARRIE P 1981 STUDENT 205 HOUDE, RONALD 1951 MAINTENANCE , 458 FREIRE, JESSICA V 1977 205 SARKINEN, EDITH 1920 HOUSEWIFE w 458 SANCHEZ, ISIDORA G 1946 HOUSEWIFE I 217 BROCK, JANET L 1940 KEYPUNCHER + ' 217 BROCK, ROBERT H 1912 RETIRED 460 MARTIN, JOANN L 1955 CLERK • 231 DIRAC, JOAN M 1931 RETIRED + 460 MARTIN, JOHN A 1952 SALESMAN 461 CALL, ARDITH LOUISE 1962 ' 231 REINHEIMER, AUCE M 1903 RETIRED * 461 CALL, CAROL F 1941 SECRETARY • 234 ADAMS, MICHELLE P 1973 • 234 ANDERSON, DAMES E 1969 ! 462 BEARSE, MICHAEL L 1962 CARPENTER 462 GOMES, GLENN R 1946 *INDICATES VOTER 24 oF'ME The Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street, Hyannis MA 02601 ArFD MA'S a . Office: 508-790-6227 Ralph M. Crossen Fax: 508-790-6230 Building Commissione December 30, 1997 The Hills Residence 412 Bishops Terrace Hyannis, MA 02601 Re: Family Apartment located at the above address Dear Ms. Hills, Our records indicate you have not filed an affidavit regarding the above referenced family apartment for quite some time. It is required under Section 3-1.1 (3) (D) (1) of the Town of Barnstable Zoning Ordinance that an affidavit be submitted annually for the duration of such occupancy. Please indicate the status of the family apartment on the enclosed affidavit return to this office by January 30, 1998. Enclosed is an affidavit for your convenience. Thank you in advance, Ralph Crossen Building Commissioner ''+�a ,,•'E x � n. '`�,r3 "- ,a3"* " 1:-- ac,s y ' ..n �y 4�`ui^f¢ •. r Q 'f `r k t'� = ,a"' "41 12 ' ^, 4 a'. 9 Ji .. ..� � _ d a i!w `` .. �� '.'r�; fix*;�,. ''� .� sx� rs _ �� ��, ...• � 3+� , ���{. Jt •� 'k ; 44 40 o To $� .��� "' ��•��A, ��, � tg ,s��' ��"V:.s -. s - , `,Ya;;•, .a4 ' .A'; ^Y; �` "3 ".N eq,• ? is may;.+ °A��',�44 �i.� �t �`"�.� a�^ :.���y� r � a �i �. � y •rs , r .off i k �$ F e.`F,�.- _ � "r�` .' �,^� S f��,�e.. �Y� ,. ��s i, �.tea �•,�,w:.. � �,�, n"�e krr�' e ;# �,. §s gr ikd Aw- IMP 4«ipON% ek ,c 41, a K `Aj .fit} „ g c fivTA M s�t . kv s£A' r.' S �� Y C Tk 1 , F , , oFSHF toy Town of Barnstable Permit# rl <{ Expires 6 m orahs from issue date Regulatory Services Fee swxxsrns[,e; Thomas F. Geiler, Director /fS ti T, hcnss. 1e39. Building.Division "rEd►,nat a Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis., MA 02601 www:town.b arras tab le.ma.us Office: 508-862-4038 Fax: 5087790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address ❑Residential Value of Work Minimum fee of$25.00 for work under $6000.00 Owner's Name&Address I r art -- 4-1 12 7—C-r'r , IYIiT_ems Contractor's Name Telephone Number Home Improvement Contractor License# (if applicable) PERMIT ®(�.®®��yy yryryy�� yp�u ❑Workman's Compensation Insurance dX 77 ';,,5 R. .z Check one: ❑ I am a sole proprietor JUL 2 5 2008 �( I am the Homeowner I.have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit 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 a/7P_ .. iV d e 0,7 zlu ❑ Replacement Windows/doors/sliders. U-V (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.musesign Property.Owner Letter of Permission.- A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:\WPF[LESTORMS\building permit forns\EXPRESS.doc d* The Commonwealth of Massachusetts Department of Industrial Accidents 01 Office of Investigations 600 1Washin'g-ton Street Roston,MA 02111 www.mass.gov/dia Workers' Compensation Ynsurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information ,f i1 Please print Le 'bl �2I11e(BusincsslOrganizationJlndividaa�G{ V I CGI" � (T f � S Address: 2. / ,S TeIrr _ ity/StatdZip: 64 Phone.#: A.re you an employer? Ch ck the appropriate bwc F7. 0 oject(required): 1.❑ I am a employer with 4. [] I am a general contractor and 1 construction employees(full and/or part-time).* have hired the sbh-cont actors 2.❑ I am a•sole proprietor or putner- listed on the attached sheet odeling ship and have no employees These and have workers'sub-contractors have g. Demolition wor'<ing far mein.any capacity. employees9. .[]Building addition i [No workers' comp.-nu cam urancc p.ms1r,ance.t 5. [�.We arc a corporation and its 10.(]Electrical repairs or addition X officers have exercised their i LE]Plumbing repairs or addition 31 am a homr_owncr doing all workn�,sel£ [No workers' coin. right o£exemption per MGL12:❑goof repairs inm=ce ruviied_]t c. 152, §1(4), and we have no r-mployees. [No workers' 13.[ 6thcr comp.firs ncc rcgiured] kAny applicant that chcckc box f-I roust also fill out the section blow sbowing their workers'carrpcas4on Policy information- f Ilorneownezt who submit this affidavit-in ,catiag ffrcy azz doingall work and then hire outside contractors mustsubrrrit enew affidzvitindima g such IContractors that cbmic this box vmst attached an additional sheet showing the name of the sub-canhactrns and state vrhetha or not those enti4m have cuployecs. If the s;ub-confw-bwm have employees,they must provide ilres workrrs'curnp.poEuy number, I am art employer that is providing workers'co tpensation insurance for my employees. Below is the polity and job site information. 3 Innirancc Company Name: Policy#or Sclf-ins.Lie.#: Expiration Date:, rob site Address: City/Stddzip: Attach a copy of the workers' cotnpeusation policy declaration page(showing the policy number and expiration date; Failure to secure coverage as requimd under Section 25A of MGL c. 152 can lead to the imposition of erinranial penalties of: fine tip to$1,500.00 and/or onr-year inprisonmcut, as well as civil pmaitses is the form of a STOP WORK ORDER and a t of up to$250.00 a day against the violator. Be advised that a copy of this statLmcrit may be forwarded to the Office of vesti 'ons of the DLk for insurance coycrago vcrification. Ida erehy/c rider the p and ersalties f pe ' ,Cth at the information provided above is true and correct Batt: Phone O JS.cW use only. Do not write in this area, to be compMted by city or town official City or Town: PermitUcense# Isstri.ng Authority(circle one): 1.Board of Health 2.Building Department. 3. City/Towa Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other i °FtHErati Town of Barnstable Regulatory Services BARHAS. ass. .Thomas F. Geiler,Director A 1639 ArEoya 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 er Must Z'xo Ow 'I p Complete and S' n This Section If Usi A Builder Z , as Owner of the subject property hereby authorize to act on my behalf, in all.matters relativ to work authorized by this building permit application.for: (Address of rob) Signature of Owner Date , Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. j Town of Barnstable w��of"(HE ram,o Regulatory Services y 4 Thomas F.Geller,Director • BARNSTABLE, . Building Division prED �a Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 www.toyvn.b2rnstable.ma.us Office: 508-862-4038. Fax: 5.08-790-6230 HOMEOWNER LICENSE EXEMPTION, Please Print DATE: 0 �- . 1 Ioa'LOCATION:, 0 2yl o�-/12 �s• — number (. shccto- q village "HOMEOWNER�/'� (��Cl� t' / ` f��S O name home phone# work phone# CURRENT MAILING ADDRESS: 2- D � ci�to state rip code The current exemption for"homeowners"was extended to include owner-occuRiied 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 bomeowner. 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 e ents. 'z ignature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be.required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 1o9.1.1-Licensing ofconstruction 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 aTc unaware that they are assuming the responsibilities is a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supesors,Section 2.15) This lack of awareness often results in serious problems,particularly rvi 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 responsrblc. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, esponsibilities of a Supervisor. On the last page of this issue is a form currently used by that the homeowner certify that hdshe understands the r several towns. You may care t amend and adopt such a form/certification for use in your community. A_ 05/$1/2006 10:29 5087786448 HYANNIE FIRE PAGE 01 HYANNIS FIRE DEPARTMENT 95 HIQH SCHOOL RD.EXT. HYANNIE, AAA,02801 'Ai 1 y f# C'� ik r � ��fz;'' C L HAROLD S. BRUNIELLE, CHIEF � IFME PREVENTION BURENU 1JU - I Ah 8• 33' BUSINESS PHONE:(508)775-1300 FACSIMILE PHONE:(508)778.644.8 SD LT. ONAJLD H.CIi ME,JR.,CFIems� TIRE PREVIP 1 ON OMCI13R F$RV'W ,� ri®I�OFFICER 'Qu AGENCY NOTIFICATION K"'Building /f. Health wiring Gas Consumer Affairs Pursuant,to.Mass snerail Law, Chapter 148:28A:.and 527.0 IVIR 1.00, the above agericy is hereby_ notified.t l a hazard or violation is believed to exist relating to tie above agency'sJurisdiction. The hazard or.violation noted is not within the inspectors code of-enforcement or;jurisdiction. r The following has.been reported in person or by phone on this.date: / for the property located at' �/ �.'� 1- f in.Hya ni ... 2) 4) Owner of record: ��<✓ ���� phone: � • Fire Prevention Office cc:street Ella rev, 1/2000 Z 0� r a saffre rids vox rt aemeeddrossas .uavtQ .R"1.1115 incident location. Mr.,Ms.,Mrs. First,Name MI Last Name Suffix Then skip the three duplicate address 412 I 81SHOPS I I TEES ZBR� ber k"p"o®t Prefix Street or Highway atroot Type svill. ___J ' Hyannis`_ I Poet Omoe Box AptAuite/Room City MA 0260. 1 state zip Code ®More people Involved? Check this box and attach Supplemental Forms(NFIRS-IS)as necessary. sameK2 own"' ®Thonni®cckthisboanoskip David Hills — J 1508-775-8808 Local Option the rest of this section. w SWISS name""""jif"epp-"Iiae"bf"ef"�'"-�' Phone Number semeaddrebsoexae t 1 (David 14111s incident location. Mi.,Ms.,Mrs. First Name MI Last Name Suffix Then skip the three � � Onesoataadareu L 412 L ,_1�BISHoPs TER ' TER( Ones. � Street Type Suffix t II I Hyannis I. Prefix treelwMlgnwAt./Sul _...J 1................................. ......_.,..,................-........._.................._ Post Office _.-------.....-----..... p coy LMA 02601 State ZIP 0440 e RYma►bls: 0� LocalOptlon ITEMS WITH A MUST ALWAYS BE COMPLETEW More remarks?Check this box and attach Supplemental Forms (NFIRS-18)as necessary, M Authorization 7701 (Eric Ft Farrerlkc�l E. —J ( Captsim. /l �!lT lSuppressi� 05 1 L 2i I L2006 Officer In oharge ID Sgnatwe - Positron or rank Assignrrrent Month Day Year Check box If Until as ggser rn g E. _.... Lri L_.._ �ooF �' p 17701 I Errc R )r axcenkopf E. J Main JEIv1'1' (Suppressdon OS 2 1„1 (yl8m6er makin (eport It) Slgnatuty Poortlon or rank Asaignment Month Day Yedi A260482 - c-xp 0, S12112006 It page 2 of 2 05/31/2006 10:29 5087786448 HYANNIS FIRE PAGE 02 A ,,�" � O Delete ffS - 1 L_01922 u L.S121/2U06 j 001 I L �,200482 1 U ® Change Stile * Incident Date Station inaidem Number AIL, expos ® IVO IgCtivity ®�$IC. Check this box to indicate that the address for Poe Incident is provided on the Wiidtand Fire LS Census Traci Location ❑ Module in Willett 9"Alternative location SpeoiffoatlorC Use only for wlldland fires. Li 1 U ® Street Address ` ❑ Intersection i.,,. .412 I)31HOYS TERRACE J i TERj L _J ❑ In front of - - r rtighWay ree(Tyne Suffix [� Rear of Hyannis � l MA�J � Q2601 - J.. ie/�R w ( pltyG .o,.... � . .. _ ....�. _-.. . ...- b'.CA-f9.. L�._....._.- ...J ❑ Adjacent to u t Zip Code ® Directions13 it roes q�drt w 'inicriona,as oppilcatie C Incident Type �1 • Dates&Times Midnight is0000 E2 Shifts&Alarms 746 !CO detector activation, n0 Local Option p I Check boxosIt Month Day Year Hour Inclaent type dotes are the A S t i 11 _... ...._- ....,..•... ALARM aWays rsgvired — , same are Alarm ®Aid Given Received Date. Alarm 05 J 211 120061 i 23:33 1 5hlfto No OfAlarmOistrlct Platoon The r FDIC) Their Ar►iValy �4 .O I L 1 i ZQa�i or old not arrive -...._-. 1 ❑ Mutual aid received ARRIVAL re wired,unleas Canceea 1 ( J I i �3 Special Studies 2 C A matic aid recv, 23:4Q 1 3 ❑ Mutual aid given state LocelOption CONTROLLED optional,except Mr wxd�e�+d Gres 1 4 © Automatic aid given I Controlled 05 J 21 j !2006 1 J j 5 ❑ era given I ! N 9 None ( '—j Last Unit LAST UNIT CLEARED,raquirod except wl{alone broil SVBdaI Spacial Tfie(r I'riclr lrrumbiar I I 8tu4y toe Srudy Value Cleaned 05 L2-J 2006 L23'S2I F Actions Taken 1 Resources G2 Estimated Dollar Losses &Values Check tn16 box end skip this sarilon K an I LOSSES: Required for all fires if known. optional for non Ares. 86 invests ate ❑ Apperaius or Personnel form is used. l—._._) I' g ---� —....... . Non Primery Action Taken(1) Apparatus Personnel Property Suppression ' j 3 I 64 Shut down s stem i Contents Additional Action Taken(2) EMS L 0- l Q J PRE-INCIDENT VALUE: Optional J.l Other JQ J 0 J Property J ❑ O Cnecx box If resource Additional Action Taken 9 m counts include aid ❑ "Woo resources. Contents j U Completed Modules H1 *Casualties Z None H3 Hazardous Materials Release Mixed Use Property Deatns Injuries ❑Firc-2 Fire N® N� ' NN® Not mixed Service 1 ® Natural gas'slow leak,no evacuation or HezMel actions 10 ❑ Assembly Use C� 5tructurc-3 0 0 ..-,_._� 2 Propane gas:421 lb.tank(as in home 8eQ grill) 20 Education use ❑Civilian Fire e�as•-4 q ❑ 33 © Medical use 3 Gasoline.vehicle fuel tank Or portablq container ❑Fire Serv. Casualty civilian I Q Q ® 40 ❑ Residential use r�lr M$-6 `----, J„„ p i�erOS@ne;rtlel burning equipment or portable 6tcrogs gt Row of stores L❑.A HazMat-7 -�—� �_.•-.. S ❑ Diesel fuel/fu@I oil:vehicle fuel tank or portable storegi 53 Enclosed mail H2 Detector 6 ❑ Household solvents:Home/offioe spill,cleanup only 58 ❑ Business&residential ❑ W)ldl$nd Fire-8 i ReoWrea for conArrrtedfires. 7 ❑ Motor Oil:from engine of portablecontelner ! 59 ( Office ❑Apparatus-9 60 ❑ Industrial use 10 Detector alerted occupants . S Paint:Mont paint cans totaling<55 gallons ❑ Personnel-I 0 1 ❑ � ❑ Military use 2[3:Detector did not alert them 0 ❑ Other:speclei HatMat actions required or spill,55 gal., fib ® FBrm Use U❑i Unknown Please complete the NazMat form 00 ❑ Other mixed use J Property Use Structures 341 ❑ Clinic,Clinic Type infirmary 539 ❑ Household goods,sales,repairs 131 Church,place of worship 342 ❑ Doctor/dentist office 679. [3Motor vehictelboat saleelrepairs 161 ® Restaurant or cafeteria 361 ❑ Prison or jall,not juvenile 571 ❑ Gas or service station ®162 Barltavem or nightclub 419 p 1-or 2-family dwelling 599 ❑ Business office ❑ 429 ❑ Multi-family dwelling 615 ❑ Electric generating plant 213 ❑ Elementary school o►kinda►gert. .4U ❑ ,Rooming/boarding house 928 ❑ Laboratorylscience lab 215 ❑ High school or junior high 449 ❑ Commercial hotel or motel 700 ❑ Manufacturing plant 241 ❑ College,adult od. 469 © Residential,board and care 019 0 Livestock/poultry storage(barn) 311 ❑ Care facility for the aged 464 ❑ Dorm itorylbarracks 882 ❑ Non-residential parking garage 331 ❑ Hospital 619 ❑ Food and beverage sales 891 ❑ Warehouse Outside on ❑ Vacant lot gel ❑ Construction site 124 ❑ Playground or park 938 ❑ Gradedlcared for plot of land 964 ❑ Industrial plant yard 666 Crops or orchard ❑ 946 ❑ Lake,river,stream 669 Forest(timberland) ❑ 951 ❑ Railroad right of way i 807 Outdoor storage area[3 Outdoor ❑ Other street Look up and enter a 919 (3 Dump or sanitary landfill 061 ❑ Hi hvuayrdlvlded highway ProperM Use coda only If Property Use 4 19 $31 Open land or field 9 g y you have NOT yhe,,k,a e ❑ 992 ❑ Residential stroWdrivoway Pr000rty Use box'. �•l or z family dwelling I '. . .-- •... .OU!1R�F.lha1VW JYIINB �, Person/Entity Involved _ _ 1508-775-8$08 Local option u616964 name(if applicable) Phone Number i �j f'4 -may rs�? b '� ''., k '�''" T" ;il�:��' ,a� '�;' •.�.. ��53��,, ,h,�h.. „�,. �� .�,rt;�—"- ;,u �_, Y- - - - — AsWssor's�map and lot number,..:: ..... I E l��♦ Sewage Permit number ` ........... q ..•` ' Z AUSTAD i House number ......... B LIE, 1....................................k...................... 9� MABa 1639- t 'E�YPy A`' TOWN : OFF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO. . TYPE OF CONSTRUCTION ..... p<1. ..:/ 1 .....Fe-6., /. ...41;A909.4FA.A9.GP..4.4.7.w�.. . .............. �.......t9.5..?t f TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location '7/0� 'Q�SNo.... %E2e�E f/y���/S .......... ....................................... ........`` ............. .i. ............................................... ................................... ProposedUse ..........�r/�2�6 E CT�oQJ..:....................................................................................................................... ...Fire District Zoning District ..................... ../.........................../../.............. ..........................................'../................................. Name of Owner .CN exfs./` £ �,u.1 �, Ni'cs '�//� ,Q/sHgRs�.Ea�.9eE /4 4,0A)IS .............................................Address ................................................ ......... Name of Builder ......Address ��J't7�' E�.................................. .................................................................. Nameof Architect ........... ...........................................Address ............................................................ Number of '.Rooms .............NIA............................................Foundation .....:..Ga�o� e7,E................................................. Exterior tjC/STiDG tJoop cSNiJEl4 cS{QiA►G Roofing ......�1` q[7 cSh�iA1G[&5 ................................................. roj6,3k £�eoo✓E DE i�/G N// Floors. .........................................................:...........................Interior ......................(A............................................................. _ Heating /yo'Jf ......Plumbing NON4 ............................................................................ .................................................................................. Fireplace .......... Approximate Cost .......v....OrDn:..:....................... Definitive Plan Approved by Planning Board"---------------____-----------19:_______ . I Area60 Diagram of Lot and Building with Dimensions ��� Fee t?...... ....... .... .................... SUBJECT TO APPROVAL OF BOARD OF HEALTH �9YE0 DR1►/�'4?I . 1-4 I, ti 2� o EyaST�✓'G - oe- use _..�_�—._._.�:.*0� ;� � �� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and :Regulations of the Town of Barnstable regarding the above construction. �1 Name :.. . ..QlhGh,.. .............................. . ... Construction Supervisor's License ..... r HILLS, CHARLES K, & ANN C. 26156 TWO CAR Garage No ................. Permit for ° ' :Single Family Dwelling. f , \« Location 412 B.ishops. .. ......... . Terrace r ,,.......... f.. .......... .. ............... . Hyannis 3._ .......... ..................................................... ........ Owner Ch'arle`s K. & Ann C. Hills ..... .................................... ... ..:. Frame .... Type of Construction .......................................... e II€ ............................................ ................ Plot ............................ Lot ............:................... Sri, •4•_ � ' w.. Permit Granted .. ..MarcZ:.12,...:............19, 84 - Date of Inspection .................................... t Date Completed ...."T^.......� .................19a a\ r e Mspssor.i:.map rancl!_lot number ... ..... ..... .2.................. ck STHE Sewage,,.Perrnit-'!number ................................... 4AiL33TAX .............. ries .............................................House number ............. '634 am HA STABLE, TOWN '0 IF RA�, INS PEZI TOR BVII APPLIIC:AT16N"F0k` kltMllfib • N E i TYPE; R15 .6-Y ..........e- I ...............fir......... 1 ggJI 7....... ...................... .. zf! TO THE.' INSPECTOR QF'BUILDIN6t The, undersigned `hereby, applies .for a permit,a"ccordi ng to 'the-f61lo 'w ihg information: 0-dation ........ -/�"). -,-�-1� * - ................................................ .......................... ..... ... --e i�ef.......... ��`...................... L .. ............. ........................... P 'd; Use. ............ ....... .. ................ .................... .......................... 'r10 os ............... p e .............................. ................................ r Fi District .......... ....................................................... Zoning, District District ..................... .............................. ............ire ................. • ,2 e - - ') _. / / /-/ ' -/�- X : Name, of Owner CAI.-7...(...... ................... ....................................................................................... ........ .. Name of ,Builder . .......I .......... .........I. . . .. ".Address .. ...... .......................... . .......... . 2.1 Name, of,Architect-m........ N� Address ...... ................................................... ... .. .... �O Number' of .Rooms ....Foundation ................................................ ....................................................... ............ ................ Ex'tel or . ........ ........................ ..... . .­.' .........................................I.fi....................... . .... . ... Rdofinq ..........& lc or' ...............1. ..................................................... ............. ........Iriteri ............. OWS; ....... H'eating' ......................................... PI MbIng- ........ ............................................ . . .... . ...... .. Fireplace ................................................................ �o ................................... .irepI .Approximate: C si ............. .... . .. 04finith, e:Plah Approved. by. Planning Board Board ---- - ----- -- Aieu.,N , S 7.6 j Diagram of Lot and, guild hg�,_with V pensions Fee . . ... . .... ................ ..................... .. SUBJECT To' APPROVAL OF 6OAkb,,o_F,:4ALTH% YV —7— fp 2 0# P41 7� OCCUPANCY*PlEkWts REQUIRM:EOW;NEW I)WELLINGS I hereby of regarding the"(6 ove ere y agr'i4 ta"Corif0im, fo-,,mll the Rules and RegUlation� the of Barnstable-re�qrclir construction.':; 7 I-Alt Name ...... .................. ... .....Construction Supervisor's License .. L/ - ; :HILLS CI3ARLES K C• - y. . - - t: _ r c.' a — '7126156 3 'Itao Car Garage o. Permit. .for - a S]Ilgle�Fanu ly Dwelling r• �r 1 1 �, er S; Wei, J} Z-.. Location 412 Bishops Terrace q`1 ., 1; HX :> :Charles 'IC•, & Ann C Hills, q r. Owner n �.r, —+ C1 + - f 'Constr cti-n _T e o u o , Owl Plot Lot : OIL Nlareh '12, Kai 84 - ., Permit'Granted } a it, .r .( Date 'of•Inspection - 19 , _ _ jy a. •• _ 4 N Date Com le#ed" 19 • z r II TV . ! = — of S 710 WE • Lti •4 - ' f 4.- 1 -Y04 VAIL p , pool AN, f. - -fit/ r,y by , ` a5� y y $ _•t, .. - s ,L a' .i _ a•" ' 7 .0p 0 a ;o — - a , i c .^ TO 7 �� TIME AM . P u[, PM AREA CODE 0 OF NO. N EXT. E M - E M S E s M G p E SIGNED PHONED[:] BgCK CALL RETURNED SEE YOUO AGAIN ALL WAS IN URGENT -22 Ste--'7/ QyOFTMElO�` TOWN OF BARNSTABLE NARNSTANAM ,,� BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...... .. . ............. .................. ...:... ... ........ ............................ ....... TYPE OF CONSTRUCTION ... .>' � �. ' . G� .. .....(................. .. ... . N x ....... ..........19...F.. 'h TO THE INSPECTOR OF BUILDINGS:,1/ The undersigned hereby applies 7a ®permit according to the'following information: 77 Location ....�. ......�:.....C::s '............ t ... .. ..... �,. ..... .. 4. .�' .. .. ......................... ProposedUse tom. .:. .. .. .................................................................................................................. ZoningDistrict 1.':..�........ .........................................Fire District ......................................................... .............. Name of Owner ..IuA.C ,... ,�. Address ..J...���..f!!�.:.. G't `.....J '..... &- �%'tJe.t y Name of Builder Address ................................ ................................. .................................................... Nameof Architect ..................................................................Address ........................................................................... /� t< Numberof Rooms ..................................................................Foundation ............... `! �1.,...................................... Exterior ..... ........ ...Roofing �. � Floors71.............................................................Interior .........Z-........................ ...,...................... Heating ...... ...... L ......................................Plumbing ........., .................................................................... Fireplace ......X.......................................................................Approximate Cost ....../ ................................................:... j� Definitive Plan Approved by Planning Board -----------__________________19 Diagram of Lot and Building with Dimensions SUBJECT TO &PROVAL OF BOARD OF HEALTH 1Ls 0Q � , 0 0 0 � d � LL. w\aa.. 00 � OcnQy� OJpp CLCL M UA- � oc N 53 0 0~ LLJ Z I hereby agree to conform to all the Rules and Regulations of the To n of Barnstable re arding the above construction. Nam Ci4 .... . . E. DaCeY. William -~ �r° �roa ^ ' ^ No --,-1+95p_.— Permit for --_—.—.�����.--... single family _.—.—..��/��.-.�����x—����.����..------. ! ` Location ....... ..�a��u��-------- ' .............. ---^^'-.. ......................................... . Owner ---.. _E._Zkuo�J[ �r- __. Type of Construction ............%]rAm................... -.—.~--..~...—.--.._----..—...--.—.— ^| ' | Plot Lot �R ( ---------- ----'^°`----'' . ' ' f ` | | Perm Granted 'April 2" lg 7Permit Date of Inspection � | ~ Date Completed Cp'"pleten | _�r / / \ PERMIT REFUSED ,.,....—.-.-_.._—...—.~.—.—.~..—. 19 ' + � -''-----------------'---'---''—'-- //b �L/ �� `�~ . -��� �� ���� . . . �� ~ ----_-----------------.—.-..---.— �� ,.--.—.—.---~,-.-......~..,...--.—._.~.., � ' D ` Approved ................................................ lg i ' -------''----'-----~—^^^^—^^^^'—`' ` -----------`—'----^^^^--^-^`^^— . L �_�-