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"�� vn ��-f ��- r . _._ __ �. ,� ��� __ �. , . �:. __ - a. {� I i i .. . . a I THE Town of Barnstable CF TQ� do Building Department Services Brian Florence, CBO w anaivsrnsie. v� " � Building Commissioner Argo►rw+" 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable.Family Apartment Affidavit I, being.on oath, depose and state as follows: MY name is / I am the owner/resident of the property located at: The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: Aff Ip 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 t+�iCommis ioner listing the names and relationship of occupants in said Family Apartment. I also underst d that I am required to comply with all conditions imposed by the ZBA Special Permit and/or t e Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree cc to note he Building Commissioner immediately in the event of the sale of this property. the is no 1 r a Family Apartment at this location;please explain: z The apa ent has been dismantled. The ap went has been transferred to the Amnesty Program(Appeal No. ) Other. Sworn to under the pains and penalties of perjury this day of o 2019. Signature, Phone Number Print Name. p ' q:forms/famaffid.doc rev 11/08/13 Town of Barnstable Building Department Brian Florence,CBO TOWN Building Commissioner OF�ARN$rABLE 200 Main Street, Hyannis, MA 02601 ZQ18 www.town.barnstable.ma.us Office: 508-862-4038 Fax, 508-790-6230 11 V1y�0 Town of Bamstable Family Apartment Affidavit I, being on oath, depose and state as follows: i My name is I am the owner/resident of the property located at: dD ,,Z T T. 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 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 — nq 2018. �' '/'��"e L Zs-6#9-' 3 Signs a Phone Number i Print Name 6z © Y_,6_4'_/ C q:forms/famaffid.doc rev 11/22/2017 Town of Barnstable Regulatory Services Richard V. Scali,Diref6Qft OF BARNSTABLE Building Division Paul Roma,Building ConinION10YO 7 5 PH 12: 40 KAM 039. � 200 Main Street, Hyannis,MA 02601 www.town.ba rnstable.ma.us Office: 508-862-4038 DIVISION Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I.being on oath, depose and state as follows: . J My name is21�5_7" J am the owner/resident of the property located at: `7" 6 " The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: I 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 jis no longer a Family Apartment-at this location,please explain: The apartment has been dismantled. ' The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to under the pains'and penalties of perjury this 3 day f of 2017. D Signature - Phone Number Print Name q:forms/famaffid.doc ' rev 11/08/12 r Town of Barnstable Regulatory Services �T o�IKE t Richard V. Scali,Director -Building Division ABM ' Thomas Perry,CBO,Building Commissioner Ar i639. , � 200 Main Street� Hyannis, MA 02601 ED Mp'l wwwaown.ba rnstable.ma.us Office: 508-862-4038 Fag 508-790=6230C Town of Barnstable Family Apartment Affidavit Zz I,being on oath, depose and state as follows: " c My name is I am the owner/resident of the U., rn properly located at: � �o ter'✓lam cST s7' 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. I agree to notes the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to under the pains and penalties of perjury this 3 day of. 2016. &Z�F) 7 -� Signature _ Phone Number Print Name ".q:forms/famaffid.doc rev 11/08/12 Town of Barnstable oFE r Regulatory Services Richard V. Scali,Director •[OW OF BARNSTABLE BAMS nsLE. Building Division 4� i639 .� Thomas Perry,CBO, Building Commissioned QED MA'S s 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 IVI"' ax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is G 14e I am the owner/resident of the property located at: 6,1 % 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: R The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to 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 ofToaejqA C 2015. r � d� 276 Signature ' - Phone Number Print Name 2, 13?z� q:forms/famaffid.doc rev 11/08/11 Town of Barnstable Regulatory Services of top, Richard V. Scali,Interim Director ti Building Division TOWN Of 3A9RrVST/t,__LE "B Mass Thomas Per CBO Building Commissioner Ma r3'> > " j.kl 3:q� s6,9 �• 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 9;)._ax--508-;90:.:�230 0 In 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: - - - The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: CSIZ77- YZLI' 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 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 /a day of ,q U�,� 2014. p _ Signature Phone Number Print.Name q:forms/famaffid.do c rev 1-1/08/11 J Town of Barnstable *Permit* -z 70 � ' Expires 6 months from issue date Regulatory Services Fee 0 Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town,barnstable.ma.us Office: 508-862-4038 . Fax: 508-790-6230 EXPRESS PERAUT APPLICATION RESIDENTIAL ONLY Not Valid without Red J-Press Imprint ap/parcel Number el �operty Address `T 7 Coan i Y Secr . `57Ceel— Residential Value of Work S�©O •4y Minimum fee of$25.00 for work under$6000.00 wner's Name&Address t/7 C0Jr1--k few 7- Sl- /?�zCr7r1.-s britractor's Name 15 e l Telephone Number -SMC— tome Improvement Contractor License#(if applicable) - 14__Illy� e sew{-rf-appiicabie-) �Workman's Compensation Insurance Check one: - ®PRESS PERMIT ❑ I am a sole proprietor Iarn the Homeowmer APR 2 5 2007 I have Worker's Compensation Insurance TOWN OF BARNSTABLE zsuiance CompanyName Vorkman's Comp.Policy# :opy of Insurance Compliance Certificate must be on file. .ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping, Going over existing layers of roof) Re-side Replacement Windows/doors/sliders. U-Value_ (maximum,44) 'Where required: Issuance of this permit does not exempt compliance with other town department regu-Jationsi i e.:Historic,Conservation,etc, ***Note: Property Owner must sign Property.Owner.Letter of Permission, A copy of the Home Improvement Contractors License is required. ;IGNATURE; _- 1:Forms:expmtrg ,evise061306 1 he C.'ommonwealth c?j Massachusetts Department of IndustrialAccidents W Office of Investigations . a d 600 Washington Street Boston, MA 02111 "'w SV•�,. www.mass.gov/dia ' Workers' Compensation Iiiisurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Naive(Business/Organization/Individual): . Address: �7 Coy�i�i BPS i� SCPto/- City/State/Zip: ae a Phone:#: g Are you an employer? Check the'appropriate boa: general contractor and I Type of project(required):. . 1.❑ I am a empl 4. I am a oyer with ❑ g employees (fall and/or part;tim ).* have hired the s ib-contractors 6..❑New construction e . 2.❑ I am a•sole proprietor or partner- listed on the-attached sheet. 7. ff Remodeling ship and have no employees These sub-contractors have g, ❑Demolition , working for me in any capacity. employees and have workers' 9. [�Building addition [No workers' comp.insurance comp,insurance.$ d.ire re q u 5, ❑ 'We are a corporation and its 10.❑Electrical repairs or additions ] officers have exercised their 3,XI am a homeowner doing.all work 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13:❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indi cating such. lContractors that check this box must attached an additional sheet sbowing the name of the"sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.polidynumber. I am an employer that is providing workers'compensation insurance for my employees. Below is.thepolicy and job site information. / Insurance Company Name: Policy#or Self ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine rip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA-for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and.correct, Si atur Date: Phone0: offccial use only,. Do not write in this area, to be completed by city or town of rrciaZ City or Town: Permit/License# Issuing Authority(circle one): � .-I..Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6,Other ContactPerson: Phone#: Information and Instr°ucti®ns Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hiie, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a-deceased employer, or the ieceiver Ortrustee-of an individual partnership, association or other legal entity, employing employees. However the owner of a dwelling.house having not more than three apartments and who resides therein; or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not prod-aced:acceptable evidence of compliance with the insurance coverage required:" Additionally,MGL chapter 152,-§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work untii-acceptable evidence-of compliance with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,'by checking the boxes that apply to your situation and, if` necessary,supply sub-contractor(s)name(s), address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other.than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. B.e advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or.license is being requested,not the Department of Industrial Accidents., Should you have any questions regarding the law-or'-if you are required to obtain a workers.' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate-line. City or Town Officials. Please.be sure that the affidavit is complete-and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant. that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy'information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city-or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to brim leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, ---, please do not hesitate to give us a call. The Departrnent's address,telephone-and fax number:- ° �Commonwealth of Musaobuwtts Dopaxi ent of ladviWal Mci.dimts Office of Inyestigat ons 600 Washington Street Boston,MA 0.2111 Ter.#617-727-4904 ext 406 or 1-977 MASSAFE Revised 11-22-06 Fax 4 617-727-7749 www mass.goWdia • - r. Town of Barnstable yP�pF THE Tp��o� Regulatory Services '* " Thomas F.Geiler,Director BARNSMBLE, b 9. ,�� Building Division ArfD �a. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: ASS/G^-7/ JOB LOCATION: (. Gyrzk Se4-7- 57cPeT" 0 f number �! street village "HOMEOWNER': ZXj_&/%e) IX-1D!G name home phone# work phone# CURRENT MAILING ADDRESS: Y 7 Coe A7% 36,E f_ 5r- city/tom 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 requ*ments. 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 hireto 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 personas it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns, You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt I w + .� TOWN•OF BARNSTABLE BUILDING PERMIT APPLICATION Map 6191 Parcel Permit# ��1 Health Division Date Issue_d Conservation Division Feeo2J ©�' Tax Collector , Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board i Historic-OKH Preservation/Hyannis 3 = Project Street Address 77 Village 6 Owner 6C Address u��. ,Telephone 7 -05=Permit Request Request /I c s _ r .Y Square feet: 1st floor: existing 1Tgo proposed, 2nd floor:existing,+ proposed N,a Total new Estimated Project CoOt Tc-pt Zoning District Flood Plain .,,d Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No 'If yes, attach supporting documentation. Dwelling Type: Single Family Family ❑ Multi-Family(#units) Age of Existing Structure _gG Z.-s- Historic House: Cl Yes UNo On Old King's Highway: ❑Yes Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) "q- G Basement Unfinished Area(sq.ft) Number of Baths: Full:existing ye new Half:existing o-rgy; new sr,o/vt::C Number of Bedrooms: existing new •vows Total Room Count(not including baths): existing 4 new First Floor Room Count Heat Type and Fuel: ❑Gas t mil ❑Electric ❑Other Central Air:. ❑Yes &1q-o Fireplaces: Existing New Existing wood/coal stove: ❑Yes Qio Detached garage:❑existing ❑new size Pool: fisting L1,new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Y BUILDER INFORMATION Name .ri��, -i i�� ���.[�/,% �,or ,Telephone Number Address /License# O/4 2.3� le Home Improvement Contractor# 10316'6�_ Worker's Compensation# wz ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ✓?�r �; ,s,�.� �,` SIGNATURE DATE FOR OFFICIAL USE ONLY PFAMIT NO. DATE ISSUED MAP/PARCEL NO. IJ ADDRESS t , ,VILLAGE OWNER Al DATE OF INSPECTION- g FOUNDATION FRAME x INSULATION FIREPLACE - - . ELECTRICAL. ROUGH FINAL , PLUMBING: ROUGH FINAL. t ,• ry GAS: ROUGH FINAL sI- t , ' _ • ::. ,, FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r ; X The Town of Barnstable 9�A � Department of Health Safety and Environmental Services- Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work:ji r-Go Estimated Cost Address of Work: t/i:--��� Owner's Name: i-ye-e'w.i, �j•�r�,(.,/ �✓- lvr��� / Date of Application: a vwy 4-F I hereby certify that: Registration is not required for the following reason(s): [aWork excluded by law [ dab Under$1,000 Building not owner-occupied [owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. Date wne s am q:forms:Affidav --_:- _ -- The Commonwealth of Massachusetts 'j Department of Industrial Accidents + ��= _ "��-:^� .�� Olf�ce ollnsestigations E=' � =�a�:��' 600 Washington Street .......... s Boston,Mass. 02111 ������ / / / Workers' Compensation Insurance davit inicant�rurl3cz,%//////%%/.%%%%%/%% ` Yx111M�%��/%%%% name: G� i"� c� � L�3�"�,>��.� ;��- � �/ location: city iS//�ii�ni�(�TF' phone# -I—am a homeowner performing all work myself. (Tam a sole proprietor and have no one w/Oor/l%dnacDit�y ////%%/%/%%%/% %%% %❑ I am an employer providing workers' compensation for my employees working on this job. comnnnv name: address: _.. city: phone#: insurance co. nniicv# ////%/.//, El am a sole proprietor, general contractor, or eo (circle one)and have hired the contractors listed below who have , the folloMng workers' compensation polices: comnnnv name• address: ;..........,...: :,.:. :. city: phone#c :. ....... insurnnce ca. 01kV .. ... comnnnv name: .. :... .... . . ..;.:.�•.:.:..: address: city- phone#i insurance co. 2011cV ::.:::::;•::::: ::.:....:.: :::;.:::.:::>::;:::.:...::;:>::.;:;...:. Z: Faaure to secure coverage as required tinder Section 25A of MGL 152 can lead to the Imposition of criminal penalties of a tine up to S 1.500.00 and/or one vears'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that s copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify an e d realties o rjury that the information provided above is tru,and correct Silctature Date .� wx- 5M57 _ Print name Co "i Phone# �c � � env :.fncWuse only do not write in this area to be completed by city or tmm official own: permitlIIcense# CIBuiiding Department []Licensing Board kiflmmediate response is required ❑Selectmen's Olfice ❑Health Department person: phone#p ❑Other��� (rsnsen 9,95 P1AI Information and Instructions , I ` Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any coat—-; of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receive.- trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renews: of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the . commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have bees presented to the conuacting authority. Applicants _ Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance,coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicaaL Please be sure to fill in the permi license number which wfil be used as a reference number. The affidavits may be maned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a calL The Department's address,telephone and fax number. r The Commonwealth Of Massachusetts Department of Industrial Accidents Oice of wyesduatlons _ 600 Washington Street Boston'Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 1 ✓fie i�am�rno�uueal/`e,o�✓�aaaac�uaels la DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION2.SUPERVISOR LICENSE Number Expires: 4 RestticteMb ' le HAW, ,IRA I'LtY 47 COUNTY SEAT ST HYANNIS, NA 02601 h.:,.g'w�tlq�t���'��j iGK�ns�X04WI�s O�✓f7� JB�6 My*} HONE IMPROVEMENTVCONTRACTOR y Reg1strat10D,.-'—55} Type PRIVATE CORPORATION yy Expiration O1/06/00 s iKS� +3� h,yr4la,,.taat' ��.f_ a16 m'? r _' BRAILEY BUILDING COMPANY, INC i"Id LBrai. ey r F mINJMAMR 47,'-.i' Seat.St. Y Hyanns NA 02601 I ,�TN�ro TOWN OF BARNSTABLE Permit No. .,,32167 BUILDING DEPARTMENT I "a I TOWN OFFICE BUILDING Cash ." HYANNIS,MASS.02601 Bond ......... CERTIFICATE OF USE AND OCCUPANCY Issued to Gerald L. Brailey (Family Apartment) Address 47 County Seat Street Hyannis, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL.NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. August 1, 90 y� 19................. .. ........................ Building Inspector Assessor's map and lot number ....... ..... Q�FTNETO� i G �. SSewageG.S Permit number ................ .7AM.................. �y L Z IMUSTADLE, i House number ........................ .... ../.... ..` ..:..`..... ro rose ft O 1639. \00 4. TOWN OF BARNSTABLE BUILDING . INSPECTOR APPLICATION FOR PERMIT TO ............Cia struct-Add-iti aa....................el..: ................ TYPE OF CONSTRUCTION ....................W.Q0A..Frame...................................................................................... ...................19.88.. 1 TO THE INSPECTOR OF BUILDINGS:' ' The undersigned hereby applies for a permit according to the following information: Location .......�t7...Coti=y...►5.ea:�... uY.Poni s.3...NA................................................................................................ ProposedUse ..WQ...b.e.dr.QQ.1 �......................................................................................................�..+................................. Zoning District ...........................1,..^Q....................................Fire District .................. ................................. Name of Owner ........................Address ......1 7.....Qo:iaty...S.Qa t... ........... Name of Builder .B;V.a.iley...13,.dg...... O.....I=...........Address ......47...CQ--UntY...S-eat...a�?.t.....��,...712............ Name of Architect Bxalley..Bld g......Q0....I=...........Address ......,Sc me.................................................................... n Number of Rooms ............. brae........................................Foundation ................CQncr.et,e........10............................ Exierior ...............................2'.1.-.1.1..........................................Roofing ......................Maas...A...Asphault.................... Floors .................................Q0=r t.E;P'laad...................Interior ......................1/211...She.;>✓rack......................... Heating .............................ELectrd.0.................................Plumbing ....................Bath..VMG......................................... Fireplace .............................N/A.............................................Approximate Cost ......20.3-000.............r576 Definitive Plan Approved by Planning Board --------------------------------19--------. Area .._i q�...ft.... Diagram of Lot and Building with Dimensions Fee �!..'- . ............. .................... SUBJECT TO APPROVAL OF BOARD OF HEALTH ` 0 ay' b ' � 06, 77 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. Nam ,lr - .............. Construction Supervisor's License ..0,11.21 .................. A-I "-"-*BRAILEY, GERALD L. I !is Yy No 32167 Permit for ..B.Uil.d..Additi-on .*T ......... S in c 1e .Fqmi.ly..Dw.Q.11iUg.......... Location ... dQ11 A t...S.trae.t..... . .................. ........................................... Owner B.ra i.ley. .................. Type of Construction .......Frame..................... ........... .................................................................. Plot ............................ Lot ................................ Permit Granted ....AIA.gu.at...12............19 88 Date of Inipection ............................. ......19 Date Completed RL-Y...... .......19 7 Assessor's map and lot number �..," :r........ ` �OFTHETO�� Sewage' Permit number ` .4," `�`' iw... + i71 "v~ Z BJHBSTLE E. i House number .«........................�...�f............. .........'`...... 9O NAB& p� p 1639. \00 11 MAI a' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ............ ,c:t...%!7 r?i 3 C��?......................................� �//'%.. .......... TYPE OF CONSTRUCTION .....................rnne?.....:r" -nl�....................................................................... . ....... ...................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......�,z...(�,r1)t�'�V..:��'.��-.t...s�:.....:. v� �.�* .... a......................................................... ................................... ProposedUse ....tn...l:.r'r ................................................................................................................ Zoning District .......................................................................Fire District ................. ... /./t` Name of Owner .�:?!'.::�. ... :..... r.ai ' �v........................Address ......��...rc)1?.t�;j;u...:?�'.�:...����...� ;`..:..................... Name of Builder ...........Address `� <<�;"'.1. '....Spn-F at...... t?;•-..........:.......... Name of Architect fir,i 1 rz�r ?l d n,.. C?::... �,31.�'...........Address ......��^^, ............................................................... Number of Rooms 'nrt�A C"r�r:r*r4? . 'lr'tr .......................:...........................................Foundation ......................__.......,............................................... r Exterior ................................:.'Lr.. .l.........................................Roofing ...................... ...... ?s'.`i...! ... .... "h.. 1 ...:.................... Floors .Interior 1 /7...... 1, f,rvnr+!r T ) I Heating '. ...................................^:..'..�..'.......,...............`............Plumbing .......................:.........:..: r . .......................I.............. Fireplace .� pp ?n nr�n ...........................:......................................................Approximate Cost ............,. Definitive Plan Approved by Planning Board ________________________________19________ . Area _� ' • - '} Diagram of Lot and Building with Dimensions Fee J SUBJECT TO APPROVAL OF BOARD OF HEALTH (q 0 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name - .:.....! 1.... .......................................: . Construction Supervisor's License ...01.1...1.1. BRAILEY, GERALD L. A=291-166 No ..32167 Permit for .....Build Addition .................... ,.Single..Family..Dwelling LocatS,an .....47.__County.._Seat Street .................. .......................... yannis ................................. Owner ...Gerald L. BraileX Type of Construction .........Fr.ame... .... ...................... ................................................................................ Plot ............................ Lot ................................ Permit Granted .....August 12, 19 88 4 Date of Inspection ....................................19 4 I Date Completed ......................................19 PERMIT COMPLETED 1/1/„ Assessor's map:and lot number ......... Cr — �02 vWdST BE Sewage Permit number .... .. li'H gRTIC IN MMPItAIOdCE �� .. .�r L i f S�1ltARY It STATE { CF TN E TO R AM® TOM BARNSTI TOWN OF � i BARNSTODLE, � 1 i639 . T BUILDING INSPECTOR � �0 � , 74- APPLICATION,'�FOR y.PERMIT TO .......G.�CJ .$ u..4� :.......... .r'........ ......................... TYPE OF CONSTRUCTION ..... ........ n6'j�................................................................ ..........(.Q...... us1/�;;.........19..7 TO'THE INSPECTOR OF BUILDINGS: The undersigned'hereby applies fora permit according to the following information: / Location ......y. ...&JQ.G,.4�. .....�?.4.. 1.......�, .�'..........����/��//!4s....Y..2�l.� ............................... ProposedUse .......Z��eL r..'............................................................................................................................................. Zoning District ................... ...............................................Fire District .............. ...... !L(................................. ,L /, �� '......Address Name of Owner ..yi�...�'/.�.�.....s�.......s�........./.7!J�/.......',� ..... .� ..... .+� � ....�. .,... Nameof Builder ...................... ............................Address .................... ............................................ Nameof Architect ............... ...........................:....Address ................S.......... .............................................. Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing ........................��.:....................................................... Fireplace .......................................................Approximate Cost .......4,—,7 1 UO 4............................................ Definitive Plan Approved by Planning Board ________________________________19________- Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH Y 0 E�\ I hereby agree-to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. r Nam ,M ..�. ...................... 1 '• � Brailey, Gerald L. . ^ No —'7l7.l5B. Permit . � —�vate..� �� �a= -- -- — � --- �� . ' ' l ' —...'Y— — .. 4� Location ---...Con.......................Seat St ------. ^ a ' ----.----~----.------------.` . Ovvne, ---_Gmrald..I.�_Bzailey_____. ' ����e Typeof'Conohuc�on —�F���c�..���l............ ' —.----.---.---------,_.�—_--_. ' '""Plot �� '^ --------- ----------' , | , ' | - --' —_-- ---_ ' . � uutacf �� . ' c�� ^ Date C&noleted lq ' ' '~ ' 4.> ^'L°m°*uL. ~' , . PERMIT REFUSED . . -------.—...----------. l� . - '----'--------------'-----'--' _ '._.:...._,--.--..—..—...—.-----. -/ �, '—,,-------------.—.----~. - � —`~^^'—^^~'^'~---^'' � . ~ . . � . Approyod ---------------.. lg . . ^ --'r----'-------------'^'~--- , ��'............. ...............,���������,��,,'' . ` C,?/- /6/, cv� Assessor's map and lot number .......................................... z d rTP Sewage Permit number ....... TH E TOWN OF BARNSTABLE 13ARNSTAILE, PAS& 1639. Ar. BUILDING INSPECTOR ........................ APPLICATION FOR PERMIT TO ...... S.6�K�5................i.... TYPE OF CONSTRUCTION .....:7/ 0.K�A ........ ............................................................. ..........IR......\F":,:,��.........ig... ... ... ....... TO THE INSPECTOR OF BUILDINGS:' The undersigned hereby applies for a permit according to the following information: Location .... ......�5/-7 Z,/ .00 ...—Y........ ................... ....... ................................. ProposedUse ....... .......................................................................................................................................... ZoningDistrict ................... ......................................Fire District .............. t........................................ Name of Owner 41? Address ... Nameof Builder .................... ............................Address .................... ............................................. Nameof Architect ................�4��A...................................Address .................. ............................................. Numberof Rooms .:................................................................Foundation .............................................................................. Exierior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost ....... .................................................... Definitive Plan Approved by Planning Board ---------------------------------19--------- Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 9�0 f 0- �rl 4- I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. No ...........;...... Brailey, Gerald L. No .. `7158... Permit for swimming pool ....................................................................... Location .......47 County Seat St. .... ..................... ..............YnRnAs......................................... Owner ..........Geral. . d L....Brailey. . ................... . . .......... .... . ........ Type of Construction ...private fool ................................................................................ Plot ............................ Lot ................................ Permit Granted ...........Jun ...20.............19 74 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... A. FEE-- TOWN `OF BARNSTABLE, MASS. �b� e 19 0 tV. q � •� THIS IS TO CERTIFY THAT A PERMIT IS HEREBY GRANTED TO o� o V O (PROPERTY OWNER) (ADDRESS) a �03cs b "p a To ......................._. ........................................................................................................................................_._._ (BUILD) (ALTER) (REPAIR) W y� N y." ...................................................................................................................................................____.............................. .................................................................................._...._........... w M a F cc OF BUILDING) (APPROXIMATE SIZE) v O W op LOCATION .............................................................................................................. ................................................................................................................................... _ _.._ y (STREET AND NUMBER) (VILLAGE) NAMEOF BUILDER OR CONTRACTOR __...._.._...._......._..........................._................................................_.................................._........._.............__....._... APPROXIMATE COST d m(s I HEREBY AGREE TO CONFORM TO ALL THE RULES AND REGULATIONS OF THE TOWN -21 OF BARNSTABLE, REGARDING THE ABOVE CONSTRUCTION. at oP4o4) • V-" w N (gyp (OWNER) (CONTRACTOR) _................................._....._..___..................._............_....................................................................................... BUILDING INSPECTOR Subject to Approval of Board of Health. r , S 1 /L 1/7 d r � s o . _ : ,,�. _., .. �.. o .. ,; . . � ,, ,� ,- - ._ � - �� .. ;. .� ;; � - ;� . � _ .. � . '� ,- 1 ~. f � , i - -. �..�-i - L « 7;. � '. . :t t / - � - � - - .. { .. .. ._... .. .. - ._ �. .._ ... f � � .. � - c-.�� _ t _ t,:.. _.. .....,....... ., ..._ _ _.a .. ...� � � �.`'-'^mr- - - -------=---``--=--__..:---.,. •,::: =�.~� ._.._...m �.. -.....E -=N,� z --� -- e�v,-�, .,,,.,,..,�,. �,.��-�-,_ �..�..._._ �-_ Town of Barnstable Regulatory Services �t rqr Thomas F. Geiler,Director Building Division TOWN OF URNS�EU" BARNSTABLE, ' Thomas Perry, CBO Building Commissioner MAM ATFo �a 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us. Office: 508-862-4038 Fax:�508 790-62�8 STot DIVI 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: c 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 l am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment.I also understand that I am required to comply with all conditions.imposed by the ZBA Special Permit andlor.the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments.. I agree to note the Building Commissioner immediately in the.event of the sale of this property.. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. . The apartment has been transferred to the Amnesty Program(Appeal No.` ) Other Sworn to,under the,pains and penalties of perjury this ay of 2013. Signature Phone_Number Print Name q:forms/famaffid:do c rev 11/08/11" �- Town of Barnstable �- Regulatory Services °� rq Thomas F. Geiler,Director OF 'DARINSTABLE Building Division * �� Thomas Perry, CBO,Building Commissioner. 2012 - ; 9 Mass 039. A`e� 200 Main Street, Hyannis, MA 02601 Fc� www.town.barnstable.ma.us Office: 508-862-4038 DI 06,08-790-6230 Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: My name is L ' �� I am the owner/resident of.the a property located at: �D 6 ' 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. I agree to notes the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this day of 2012. D S Signature Phone Number Print Name C) q:forms/famaffid.doc rev 11/08/11 I Town of Barnstable ' Regulatory Services oFt ror:ti Thomas F. Geiler, Direct`orl Building Division + BMWSPABLE. • $C9 g 9 MAss. Thomas Perry, CBO, Building Commissioner! .i 1639. Aim 200 Main Street, Hyannis, MA 02601 fD MPS www.town.barnstable.ma.us Office: 508-862-4038 1'Qti;.0� ; Fax: 508-790-6230 Town of Barnstable, Family Apartment Affidavit I, being on oath, depose and state as follows: My name is L" / I am the owner/resident of the. � i9 �Gl property located at: �o S7`� oc�2,ai The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address- 0 Name &relationship to owner: Name & relationship to owner: The Family Apartment will be the primary fear-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notf 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. 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 ofn. 2011. G Signature Phone Number Print Name Town of Barnstable Regulatory Services OF'THE tON, Thomas F.Geiler,Director Building Division TOUIN O BA STABLE, ' Tom Perry, Building Commissioner . 9 MASS. g r`tn , 1639• �0 200 Main Street,Hyannis,MA 02601 L A" J N 19 5 pTfO MPS A www.town.barnstable.ma.us Office: 508-862-4038 DIVISION Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is O I am the owner/resident of the. property located at: li U 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'ihe event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. 1 understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 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 ZZ day of . 2010. Signature Phone Number. Print Name Q/bldg/forms/famaffi d Rev:12/08 Town of Barnstable Regulatory Services �FfME 1 � Thomas F.Geiler,Director 1 ) Orr O A RNSTABLE Building Division HARNSTABMASS.Mass. Tom Perry, Building Commissioner 2009 FEB I f PM 3: 22 M 9� 1 19. 1m�' 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us DIVISION Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: 7 My name is / Yon I am the owner/resident of the property located at: 7� The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: 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,'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 1 am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediate y in the event of the sale of this property. If there.is-no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this_9 day of 2009. Signa ure Phone Number Print Name Q/b I d g/fo rm s/fa m a ffi d Rev:l 2/08 Town of Barnstable Regulatory Services TIME Tp�w Thomas F.Geiler,Director (( _ ((]] R}},,.. H -rOT .i VvljSc i•i 4.J�3514{ ,,:�fABLE Building Division g eaxivsTnBr e, ' Tom Perry, Building Com iene MASS. �llj a o s a 11 03 1639. �m 200 Main Street,Hyannis,M 026�1 ATFp ,�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. YI am the owner/resident of the property located at: � Lyl=y The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: /d / Name & relationship to owner: 7` rl4&70 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. 1 understand that no subletting or subleasing of said Family Apartment is permitted. 1 understand that 1 am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. 1 also understand that 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 /0 2008. Signatu - - - - -•Phone Number . - Print Name D Q/bldg/forms/famaffid Rev:1/03 Town of Barnstable Regulatory Services J pFIME r Thomas F.Geiler,Director Building Division ; `==aAR; ?_APLE * snmvsTna Tom Perry, Building Commissioner 9�0 16 a. 200 Main Street,Hyannis,MA 02601 70157v �# E ; www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is _ / / I am the owner/resident of the property located at: D The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: 22"'1 Name'&"relationship to owner: v tl The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment,I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that 1 am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. 1 also understand that 1 am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. 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 41,7 2007. Signature Phone Number Print Name Q/bldgdormsdamaffid Rev:1/03 fOS�ti �FBARkSFA9LE 2006007 `6 PH ►= 24 ly,k&,J6 Via' .�r� �� �o, aoa.G .� .den .�✓r���/` Town of Barnstable Regulatory Services ptrTHE T°� Thomas F.Geiler,Director ` 0frjf STBI_E Building Division RUMSTnaM = Tom Per Building Commissioner 9� . '�' 2006 JAN 18 PM 1: 41 200 Mai ibg9 n Street,Hyannis,MA 02601 �rFo �s www.town.barnstable.ma.us ------------- DIVISION Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: My name is /�1 I am the owner/resident of the property located at: Map and Parcel Number '�;12 The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: Cc� 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, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to 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 2006. Signature _ Phone Number Print Name < .✓�` l>/ ��� Q/bfdg/forms/famaffid Rev:1/03 4 /L Town of Barnstable Regulatory Services �ptrTHE TO Thomas F.Geiler,Director Building Drvlisoi'r "' � • BARNSTAaLE, Tom Perry, Building Commissioner ?A a 9 MASS. �f f. 1e39. �0 200 Main Street,Hyannis,1VTA 02604 � � �� 4 r' Arf p ,�p www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is I am the owner/resident of the property located at: 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: 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. 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 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 2005. i -Signa ---Phone Number_~.. J °Print Name' YX9z/,:�// Q/bldg/forms/famaffid Rev:1/03 Town of Barnstable Regulatory Services °FTNE•t°� Thomas F.Geiler,Director T '!P F BAR<y:':TABLE ti Building DivisionIMIUA S + sAMSPABM • Tom Perry, Building Commissioner'-' MASS. 039• 200 Main Street,Hyannis,MA 02601 QED MA'S a 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 &We/ Z�2 I am the owner/resident of the property located at: �r�Ti� r7- f1c%9��2t >9, Map and Parcel Number 22� The ZBA granted me a Special Permit/Variance on Date Appeal No. The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name&relationship to owner: G� - C Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that 1 am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. 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 Olv day of •2004. Si 'Phone Number- PrintsNaine': 0 /�� Q/bldg/forms/famaffid Rev:1/03 Town of Barnstable Regulatory Services °PIKE T° Thomas F.Geiler,Director Building Division BARNSTABLE, Tom Perry, Building Commissioner y MASS. $ 1639. 200 Main Street,Hyannis,MA 02601 �ArED NIA'1 A Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: _l My name is ' ��� I am the owner/resident of the property located at: ell Map and Parcel Number a:7�Z — The ZBA granted me a Special Permit/Variance on Date Appeal No. The decision of the Zoning Board of Appeals has been recorded with the Registry of Deeds in Barnstable County: Book ' Page /o�) S/9 The following members of my family will be the sole occupants of the Family Apartment at the . aforementioned address: Name &relationship to owner: 0-0—f T—J, �y a, L(o_cA SO 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 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 j 7 zJL_ day of 2003. Signature Phone Number Print Name Q/bldg/forms/famaffid Rev:1/03 Town of Barnstable Regulatory Services °F11HE°�gy� Thomas F.Geiler,Director /6 °* Building Division 7 •.sAaxszasLe, Tom Perry, Building Commissioner v� ' . ,0� 200 Main Street,Hyannis,MA 02601 ATE��,IA 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: y Map and Parcel Number —Ce&/ The ZBA granted me a Special Permit/Variance on Date Appeal No. The decision of the Zoning Board of Appeals has been recorded with the Registry of Deeds in Barnstable County:. Book Page The following members of my family will be the sole occupants of the Family Apartment at the . aforementioned address: Name &relationship to owner: t�Co f--J' �c,r �y0 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 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 t t under the pains and penalties of perjury his day of 2003. Sworn o P P p J rY /7 Y Signature Phone Number Print Name Q/bldg/forms/famaffid Rev:1/03 Town of Barnstable Regulatory Services °FTHE tower Thomas F.Geiler,Director Building Division TOWN O BAR STABLE saxxsiasi E Peter F.DiMatteo, Building Commissioner Mass �� �FEB f�� v� ieg9. ,��' 200 Main Street,Hyannis,MA 02601 3: 19 Office: 508-862-4038 F . 508-790-6230 DIVISION Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is ' I am the owner/re ident of the property located at:. --m ; P 0.2 C'f Map and Parcel Number c2,I/ The ZBA granted me a Special Penn it/Variance on Date Appeal No. The following members of my family will be the sole occupants of the.Family Apartment at the aforementioned address: 9 Name &relationship to owner: 8 I L C 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 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.. Signature `% �L� Phone Number(J 19 8) 7)5 Print Name Qfbldg/formVfamaffid Rev:010702 s•• A,c�IDAVI'I' BARNSTABLE . being on oath, depose and state as follows: 1. I reside at � U .� `� � 2.) I am<the owner f the property located shown on Barnstable'Assess ' maps as MAP 9 Z PARCEL / 3.) I Do Do not have a Family Apartment at this location. 199 o : the Zoning Board of Appeals, on Appeal No. 4.) On granted me a Sp ial Permit/Vanance 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. 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. understand that I am requjrd to comply with all conditions imposed by the Board of Appeals in Appeal No. / 90 ra,_�L 12.) 1 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 Signature Print Naine COMMONWEALTH OF MASSACHUSETTS BARNSTABLE AFFIDAVIT I, -----z k—11--�11:�Q— ---��% /�c� --- eEg E I depose and state as follows: M R1 99 1.) I reside at____�"1_� � �_-_ _ _ BUILD RNSTAEX ING Di E 2.) I amJ/the own of the propert} loccated J t l at. shown on Barnstable Assessors maps as MAP_ __PARCEL_1e,,� 3.) 1 Do--_,✓ _—_Do not --have a Family Apartment at this location. 4.) On �_,, 199 O _, the Zoning Board of Appeals, on Appeal No.L9_ granted me a Special Permit/Variance to maintain a Family Apartment at the above address 5.) 1 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----- -C Relationship to owner: SOS_______________—______________________-- b) NAME-----_____-- --------------------------------------------------- Relationship to owner: Y 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.) 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 understw-id that I am re uired to comply with all conditions imposed by the Board of Appeals in Appeal No. -----�`� --------------- --- 12.) 1 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 perjuiy-this__ ___day-of -199- Signature ----- - ---- - Print N� 1 t. � Ae+ i j RECEIVED JAN 2 0 1999 COMMONWEALTH OF MASSACHUSE NO STABLE V BARNSTABLE, SS: AFFIDAVIT I , Q4 Aof Q ILc being on oath, depose and state as follows: 1 . ) I reside at q"-? CT(,c� h 1 �2�� �T 3�c,� • 0-1 q 2 . ) I am the owner of the property located at shown on BarnstableAssessors ' Maps as : Map '� f,, Lot 3 . ) On M, �y 1990 , the Zoning Board of Appeals, on Appeal No.1gr►,O ra , 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: S 'LoTT -�j j 9 / C.eG _ , Relationship to Owner: Sari (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 relatives) vacate said apartment , I will ..immediately_ not if the Building Commissioner in writing. . 8. ) I understand that no subletting or subleasing of said-,family apartment is. permitted. 9. ) - *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 . 10 . ) I understand that I am required to:.comply with all conditions imposed by the Board of Appeals in Appeal No. 1 -ice? -o?a 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' 1999'. (S igriature) (Plea Print Name) :. .� /�� COMMONWEALTH OF MASSACHUSETTS BARNSTABLE AFFrI'DA V LUIIVG ---- ----5 -------- on oath, depose and state as follows: 8 j998 1.) I reside at_____ _ 2.) I am the owner of the proper located at---- ------------ -- shown on Barnstable Asa'essors' maps as MAP_�2;-Z PARCfEI,__1 ___--_--__-- 3.) I Do____/_� --------Do not_______________have a Family Apartment at this location. 4.) On-1G 14 _ c;21-0-_____, 199 D__, the Zoning Board of Appeals, on Appeal No.1�190 granted me a Special PermitNariance 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---- Q_1 _ __ -J L _ Relationship to.owner:_--c�o,)------------------------ b):NAME -----------to owner: ---------------------------------------------------- 7.) The Family Apartment will be the primary year round residence for the above-identified family members. _ e 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. --1 - ----------------------------------------- -- 12.) I agree to immediately notify the building Commissioner in the event of the sale of the above- listed property. Sworn t6 under the pains and penalties of perjury this__'_ __day 'of a_n A , 199 _ Signature, _. . _ --- - --�J��9�/----- P nn ame --------------------------- of WE*orb, The Town of Barnstable Department of Health Safety and Environmental Services , �r,►sz.E, : Building Division 039. 367 Main Street, Hyannis MA 02601 ArFD MA'S A Office: 508-790-6227 Ralph M. Crossen Fax: 508-790-6230 Building Commissione December 31, 1997 The Brailey Residence 47 County Seat Street Hyannis, MA 02601 Re: Family Apartment located at the above address Dear Mr./Ms. Brailey, Our records indicate you have not filed an affidavit regarding the above referenced family apartment in 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 i QUERY PROPERTY: QUERY END QUERY PROPERTY PENTAMATION----------------------------------------------------------- 12/31/97 PARCEL ID 291 166 GEO ID 20033 LOT/BLOCK 8 DBA PROPERTY ADDRESS OWNER BRAILEY 47 COUNTY SEAT STREET GERALD L CAROL M BRAILEY HYANNIS 47 COUNTY SEAT ST HYANNIS MA 02601 PHONE DISTRICT HY DEVELOPMENT STATUS C ASSESSOR' S CODE CAPACITY (NOTES) ZONING DIST/ZOC RB SEWER SYSTEM FLOOD PLN/ELEV. WATER SYSTEM OKH? # BEDROOMS ZBA DECISION FAMILY APT LOT SIZE 11761 . 2 OPER/MGR NAME WET LANDS MULT ADDRESS USE 101 PROTECT DIST (N) EXT / (P) REVIOUS / NO (T) ES / PER (M) ITS / (V) IOLATIONS / (G) EOBASE / (E) XIT COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, s: AFFIDAVIT being on oath, depose and state as follows : reside at 7 �liyd� - 2 . ) I am the owne of the pr pert located at shown on arnstabl Assessors ' Maps as: ' Mapes On Lot�l Appeals, on Appeal--� 19�► the Zoning Board of 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 occupant- f the family apartment at the above address: (1) Name: i jil,� G',PPi9 Relations'lli,p to Owner: — (2) Name: QP,o- Relationship to Owner: 6. ) The family apartment will be the Primround residence for the above-identified familyary 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 pains and �- day of Q(�- Penalties of perjury this . TOWN OF BARNSTABLB BUILDING DEPT. Pie e PrintgName>e) EC ( � � ( II►. COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, ss: AFFIDAVIT I' being on oath, depose and state as f�oo�ws- 1 . ) I reside at 2 . ) I an the owner o f heproperty located at shown on Barnstable Assessors ' Maps as : Map — 029/ Lot_ 3 . ) On ���_, 1950, the Zoning Board of Appeals, on Appeal N 1i'94 ,�� 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: f the family apartment at the above address: (1) Name: Relat ionsh p to Owner: (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 /��O-�oZ Appeal No. agree to immediately notify the Building Commissioner ill the event of the sale of t Property. he above-listed Sworn to under the pains and penalties of perjury this -�_ day of 192 • (Signa re) (Please Print Narne) . COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, ss: AFFIDAVIT I , / , being on oath, depose and state as follows : 1 . ) I reside at , 2 . ) I am Jhe owner og the propert locate at shown on C stable Assessors ' Maps as : Map il- .��_, Lot 3 . ) On 19 9 , the Zoning Board of Appeals, on Appeal No. Ir 0,n2— 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 partment at the above address: (1) Name: ` Relationsh ' to Owner: U (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. 10 . ) I agree to immediately notify the Building Commissioner in the event of the sale of the above-listed property. Sworn to and the pains and penalties of perjury this day of 19 9 10 g i u r e) N lease int Name) MNOFBARNSrW COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, ss: AFFIDAVIT I , �,�Uv.La� 1 �'3�'�✓i.��, being on oath, depose and state as follows : 1 . ) I r e s i d e at 2 . ) I am the owner of the property located at shown on Barnstab e Assessors ' Maps as : Map ",!F!z , Lot /&�l 3 . ) On , 19 4U , the Zoning Board of Appeals, on Appeal N .1,4k,) -gJ,,2_ , granted me a special permit to maintain a family apartment at the above address . C 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: (1) Name Relationship to Owner: (2) Name: Fry- Relationship to Owner: SU�r-i.,•_�C auk • 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. B . ) 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 I_ day of 19 941 . 77 ( ignature) (Please Print Name) : ' 1 ra;;Np r�l't P��4 �i•'= v'y i~ � �� ym+.p�,1;5'tWi i ✓. . �i f .,v�J I�"v'�Y +� aof• cr.�r;... �, r..\1^ ^ys "_ .JM.,t,.,, `� Qi!, .<{kit �g�v `ev•:.'���T vi j' �,. '� )»(Y'�°S9 i �� .� ! ,, i"( ° 9� '�..'#''"�. ��S lff�i�ri r I,- TOWN OF BARNSTABLE 167 Permit No. ....32. BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash HYANNIS,MASS.02601 Bond .,.,..`.. A CERTIFICATE OF USE AND OCCUPANCY Issued to j L1('ZC?..L.l.i. ijL 1. "y iFC1112.1_L`i 'i�..J[:r ti:l Address 47 CJ;.:n-L S,:ia t St.z :': 'L Iiy'cl.tial:3 , USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND,IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. /? ............. ..........r..`c Building Inspector I Docc910,5ie 03-0-603 3.49 DAM6TABLE LAW CO!}RT AEGIS I RY (14 3 CLERK TOWN OF BARNSTABLE _ v:i ZONING BOARD OF A.PPEAL-S` SPEC I A.L PERMIT DECISION AND NOTICE ------------------------------------------------------------ APPLI CATION : 1 990-22 APPLICANT : MR . AND MRS . GERALD BRAILEY ------------------------------------------------------------ At .a regularly scheduled hearing of the Barnstable Zoning Board of Appeals , held on April 26 ; 1990 and .continued to May 10 , 1990 and May .24 , 1990 , notice of which was .duly published in the Barnstable Patriot and notice of. which was forwarded to. all . interested parties pursuant to Chapter .40A of the General. Laws of Massachusetts , . the . applicants , Mr ._ and Mrs . Gerald Brailey , applied to the Board for a Speciat Permit pursuant . to Section 3- 1 . 1 ( 3 ) (D) , Family apartments of the Zoning Bylaw to allow the creation of a family apartment by constructing a kitchen within an existing addition . The applicant ' s property is Located at 47 County. Seat Goad , Hyannis and is shown on Assessors ' Map 291 as lot 166 . It is in . a Residential. B Zoning District .. Plans . were submitted showing the first and second floor of the addition with the proposed kitchen .area . Also- submitted was a copy of the Building . Permit issued. for .the existing addition .. The Plans indicate that the two-story family apartment contains 1 , 034 square feet of total floor area consisting of two bedrooms., a bathroom and an open area where the proposed kitchen will be located . The applicants have stated that the main. dwelling contains . 2 , 074 square fee+ : FINDINGS OF FACT Based upon the information provided ,. the Zoning Board of Appea.is made the following.. finding . of fact: 1 Inasmuch as the building appears to be incompliance With the. Zoning, Bylaw and inasmuch as the applicant is not requesting .any exterior construction , .on.ly an interior kitchen , the Board finds that the project appears to be in comoliance with the Zoning Bylaw. The vote on the findings of fact was as follows : AYES : BURL I NGAME , BURMAN , LALL Y NAYES : NIGHTINGALE n DECISION : Based upon the information provided and the findings of fact , at a meeting held May 10 , 1990., by a motion duiy .made and seconded , the Zoning Board of Appeals voted to grunt the Specia.I Permit with the followi.ng conditions : 1 . There is t.o be no occupation of the fami.ly . apartment until the Building Commissioner has made an inspection of the premises to ensure that all structures on the property are in compliance with the .setback requirements ; 2 . The family apartment shall comply with . the Zoning Bylaw, specifically Section 3- 1 . 1 ( 3 ) (D) ( 'a through q ) ( see attached ) ; and 3 . Occupancy. of the .family apartment shall not exceed two ( 2 ) family members at any one time . The vote was as follows : AYES : BOY , BURLINGAM E , BURMAN , LALLY NAYES : NIGHTINGALE Note : Mr . Boy cast his vote .at the meeting . of May 24 , 1990 . D) Family apartment subject to the following: a) Not more than one (1) family apartment . Is provided. b) The. family apartment is within or attached to an existing residential structure or within an existing building located on the same lot as said residential structure. c) The residential character of the area Is retained as nearly as possible. d) The family apartment contains not more than fifty percent (50%) of the square footage of the e)tisting residential structure If being proposed as an addition thereto. e) All' setback .requirements of the.zoning district within which the famiiy apartment is being Located are. complled with. f) The property owner resides on the same lot as the family apartment. - g) The family apartment is occupied by members of the property owner's family only. h) The occupancy of the family apartment does not exceed two (2) family members at any one time. 1) The family apartment .Is the primary year-round residence of the family member(s) residing therein. j) The family apartment will not be sublet or subleased by. either the owner or family member(s) at any time. k) Scaled plans of any .proposed remodeling or addition to accommodate the family apartment have been submitted by the property owner or his or her agent to the Building Comm.lssloner and the Zoning Board of Appeals. I) Prior to occupancy of the family apartment. affidavits reciting the names and family relationship among the parties seeking approval have been signed and shall be signed annually thereafter for the duration of such occupancy. m) Prior to occupancy of the family apartment, an occupancy permit shall be obtained from the Building Commissioner. n) No such occupancy permit shall be Issued until the Building . Commissioner has .made a . final Inspection of the proposed . family apartment. o) Within sixty (60) days from the date authorized family. members vacate the family apartment, the owner or his or her agent shall remove any kitchen facilities In such unit and notify the Building Commissioner to Inspect the premises. .p) In addition to the provisions of Section 3-1 . 1 (3)(D)(o) above, upon vacation of any family apartment, the premises shall be restored as nearly as possible to their state prior to the . creation of such family apartment. q) The Building Commissioner shall have the right to further Inspect the premises upon which a family apartment has been vacated. at least three (3) times per year for three (3) years consecutive from the time of such vacation. r i Any person aggrieved by this. decision may appeal to the Barnstable Superior Court, as described in Section 17 of Chapter 40A of the General Laws of the Commonwealth of Massachusetts by bringing:.an action within twenty days after the decision has been filed in the office of. the Town Clerk. Chairman ' I, , 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 day of 19 under the pains and penalties of perjury. Distribution: Property Owner . Town Clerk Town Clerk Applicant Persons Interested Building Inspector Public Information Board of Appeals