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Town of Barnstable
Building Department Services
Brian Florence,CBO
Building Commissioner
* BAixx �g 200 Main Street,Hyannis,MA 02601 O��
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039. www.town.barnstable.ma.us O� � Q
Office: 508-862-4038 F� 509*0-6�,XO
Approved:
Fee:
Permit#:
HOME OCCUPATION REGISTRATION
Date: 0000i
Name: ao e 6eYadn 5ISP0 Phone#: 5®�- �ti8- oy6
Address: 19-:� 61(cwe S�r2C4 Village: 8 y lei?/5 -07A-W60f
Name of Business: Ted it
Type of Business: i i le, o a r Map/Lot: 2'D
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the
activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual
alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal
residential volumes;and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located
within that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and
there is no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular
matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess
of normal household quantities.
• Any need for parking generated by such use shall be met or.the same lot containing th Customary Horne
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There are no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,and one trailer not to_exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is-listed or•advertised as a business,the street address•shall-not-be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering.
Applicant: Date: U6
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Homeoc.doc Rev.06/20/16
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y e Application numb r. �. ..... ..........3 ......
Q� Fee.. ....................... . .. .... ............. ..............
Building Inspectors Initials..... . ..................
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Date Issued...'.... ....1
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Map/Parcel... ..1..0......./ ...................
TOWN OF BARNSTABLE,
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project:
NUMB R STREET VILLAGE
Owner's Name:_17 Phone Number 5 lv`7 y5
63
Email Address: o� f 2G��-YCJ �,��' Cell Phone Number
Project cost$ 0 0 0, Check one Residential Commercial
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize
to make application for a building in accor ce with 780 CMR
Owner Signature: Date: f ' S--
TYPE OF WORK
Q Siding Windows (no header change)# y E-1 Insulation/Weatherization
0 Doors(no header change)# Commercial Doors require an inspector's review
Roof(not applying more than 1 layer of shingles)
Construction Debris will be going to c. ,1��r,Q�
CONTRACTOR'S INFORMATION '
Contractor's name ,(,,
Home Improvement Contractors Registration(if applicable)# 00 1 (attach copy)
Construction Supervisor's License# &5-- imscif (attach copy)
Email of Contractor &pt,6ock4-ree�-4wa ^ Phone number
ALL PROPERTIES THAT AAVE STRUCTURES OVER YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
APPLICATION NUMBER
*For Tents Only*
Date Tent(s) will be erected Removed on number of tents total
Does the tent have sides? Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X X , X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a: for profit non-profit event
Check one: Food served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent
Fuel source being used LP tank 20 lbs. or>Yes No___,if yes, a gas permit is required.
Natural Gas Yes No ,if yes,a gas permit is required.
If food is being served at your event please obtain a Health Department approval between the hours
of 8:00am-9:30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front back left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's,Name:
Telephone Number Cell or Work number
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection procedures,specific inspections and documentation required by 780
CMR and the Town of Barnstable.
Signature Date
APPLICANT'S SIGNATURE
Signature Date
All permit a cations are subject to a building official's approval prior to issuance.
The Commonwealth of Massachusetts
Department of Industrial Accidents '
Office of Investigations
_ 600 Washington Street
- Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers
Applicant Information Please Print Le 'bl `
Name(Business/Organization/Individual): �L l�E a QA-- 00�(—SJatlx
Address: ( ?;F � ✓' -�
City/State/Zip: t Phone#: ,r2°�' ' _ 7 4 r
Are you an employer?Check the appropriate box: Type of project(required):
l.❑ I am a employer with 4. ❑ I am a general contractor and I
mployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.[�' I am a sole proprietor or partner- listed on the attached sheet. 7. [ 'Remodeling
ship and have no employees These sub-contractors have g. Demolition
working for me in any capacity. employees and have workers'
9. ❑Building addition
[No workers comp.insurance comp,insurance.
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself [No workers'comp. right of exemption per MGL 12.[j�Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 131-1 Other
comp.insurance required]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contactors have employees,they must provide their workers'comp,policy number. .
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: - Expiration Date: `
Job Site Address: City/State/Zip: -
Attach a copy of the workers' compensation policy declaration page(showing the policy number"and expiration date). `
Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as weli as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for Mi su ace cove _ verification.
I do hereby certify under pains andpen It es ofperjury that the information provided above is true and correct:
Signature: Date:
i
Phone 6
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority (circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: .
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persohs 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 comonwealth for any
m
applicant who has not produced'acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states`Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to-your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(L LC)or Limited Liability Partnerships(UP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city-or town-that the application for the permit or license is being requested,not the Department of
—"r
�- i-� arnTirerl to nhtain a worker8'
Industrial Accidents. Should you rzave auy yuesu s«sue ems" �Y -
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 permitlliceuse,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 f stare permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would hie to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number.
The CamMenweaJ&ofMassachusdts
Department of Tndustdal Accidents
Office of Investigations
600 Washington S reel
Boaon,ILIA 02111
TeL##617-727-4900 ext 406 or 1-977-MASSAFE
Fax# 617427-7749
Revised 4-24-07 wwwm gavldia
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Cape Cod Court Reports Page 1 of 1
BARNSTABLE DISTRICT COURT
December 6,2011
In court December 5,2011
ARRAIGNMENTS
BELYICH,Elena N,4,93 Grove St,Hyannis;larceny of a motor vehicle,December 4 in Barnstable. Pretrial
conference scheduled for January 6 2012.
BORGES,Nathan D,22,797 Old Stage Rd,Centerville;unlicensed operation of a motor vehicle;improper
operation of a motor vehicle;Class B drug possession,'Percocet,December 3 in Barnstable. Pretrial conference
scheduled for January io 2012.
�BROKOECHUK,Rana,20,93 Grove St,Hyannis;larceny of a motor vehicle,December 4 in Barnstable. Co-
defendant with BELYICH. Pretrial conference scheduled for January 6 2012. According to police reports,an officer
arriving on the scene of a car theft found two males speaking with an officer on the scene. One man said,"those girls
took my car." He reported inviting both women back to his home after Embargo closed. He emerged from his
bathroom to find them gone with his vehicle,a.dark-colored Toyota Camry: He and-the other male were able to block
the women in the stolen vehicle with another car as police arrived. Brokoechuk and Belyich were in the Camry and
were arrested.
http://www.capecodtoday.com/blogs/index.php/Court 12/6/2011
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