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0110 KELLY ROAD
/�� �� 2� / .. . _ ._ _ ...� � � _ _ . . . , ;. . .. . , . . . ,1 _ . . - .� ,,, ��' t ... . . _ .. .� _ . . . � __ _ _ ,, _ . . : . a e _ . . ,. .. _. ,; .. ., .. � , ., . �. � � _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r Map Parcel Q S Application# �`!' �ud ' Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee Jed- Planning Dept. Permit Fee �- Date Definitive Plan Approved by Planning Board R� Historic-OKH Preservation/Hyannis - Project Street Address Q-k k it ki5 wo, J JLb0 Village kh I S a 4 Owner ti� � J4, Address Telephone 'So b 7 1' -4 `b S Permit Request Two SL04001-" , PA Ctdi-t-1k 02,K-1 ��, JkP&-.a -ay_6 � CR,t( Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new a� Zoning District Flood Plain Groundwater Overlay 7 Project Valuatio 00 Construction Type 14vAP6Wk'M Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 2 Two Family ❑ Multi-Family(#units) Age of Existing Structure' 45 Historic House: ❑Yes ZNo On Old King's Highway: ❑Yes d'No Basement Type: 0 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ®Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes O No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: f Zoning Board of Appeals Authorization__❑-Appeal-#- ==Recorded El .71 _ —— r t f Commercial ❑Yes ❑No If yes,site plan review,'# Current Use Proposed Use ILI®in e 6��,o/Jii a/L. BUILDER INFORMATION, Name � t 10 Telephone Num e'isr d ! S I dress Ito k--t L R-Ck License# ,�kyA-k h 15 Home Improvement Contractor# 0 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DAT R- !y fl t3(D FOR OFFICIAL USE ONLY f a. PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE _ OWNER G DATE OF INSPECTION: FOUNDATION FRAME q— (0—4 0 -INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH' FINAL' , FINAL BUILDING s ' . DATE CLOSED OUT r ASSOCIATION PLAN NO. S x . r t r i The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations a 600 Washington Street Boston, M4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Build ers/Contractors/Electricians/Pluinbers Applicant Information Please Print Legibly y Name (Businness/orD nizationadividual): �G la Address: Ito It t-Lt 4A f,- City/State/Zip: &A-tL f S V.cL t7-.6®i Phone#: GO`$ Are you an employer? Check the appropriate box: Type of project(required): er 1.❑ I am a emplo with 4.,❑ I am a general contractor and I Y 6..❑ New construction employees(full and/or part-time).* have hired the sub-contractofs 2.❑ I am a sole proprietor or partner- listed on the attached sheet:'$ 7• ® Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers' comp. insurance. g. [] Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.9 I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. ,.. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information' 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,50Q.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a mine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties of perpury that the information provided above is true and correct ature: Date: 06 Poneh #: 7 �I Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# 4 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#: r °FTFIE r°y, Town of Barnstable Regulatory Services sA"sz'ABLF. ' Thomas F.Geiler,Director 9 MASS. e 6.19. 0 Building Division Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than 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. ype of Work: aQ ve, �It►"Nl r'd o 1a 1'1�6vJ Estimated Cost /17 Address of Work: po Ke (�� ���kl� it ®��6t Owner's Name: S f; 1� ` Date of Application: I hereby certify that: Registration is not required for the,following reason(s): Work excluded by law ❑Job Under$1,000 []Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: . Date Contractor Signature Registration No. OR / v v Date Owner's Signature Q:wpfiles.forms:homeaffidav Rev: 060606 Table J&Ub(continued) Pmcriptive Packages for One and Two-Family Residential Bulldlags Heated with Tamil Fueh. MAXIMUM MINIMUM Glaring Glazing Ceiling Wall Floor I Basemen! Slab Heating/Cooling Area'CA) U-value= R-value R-value' R-value° Wall perimeter Equipment EtScteacy' Pie R-value° R-valuer 5701 to 6500 Heating Degree Days' Q' 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 10 6 ES"AfUE T 15% 036 38 13 25 NIA NIA Normal U - 15% 0.46 38 19 19 1 10 6 Normal V 15% 0.44 38 13 25 NIA N/A 85 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X 12% 032 38 1 13 23 N/A N/A Normal Y 18% 0.42 38 19 23 N/A N/A Normal Z 18% 0.42 38 13 19 10 6 90 AFUE AA 19% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: 0 kc f [�ukth,t c,,� kcL -07-60 I 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENER43Y REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-080303a f RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $5 Alterations/Renovations 50.00 Building Permit Amendment 5.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0041= plus from below(if applicable) ✓ALTERATIONS/RENOVATIONS OF EXISTING SPACE L so square feet x$64/sq.foot= 14,-32.0 x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041=. STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee Projeost Rev;063004 L 0 T 70 & SOUTH . 112 OF LOT 7/ a l 43/4 5. F. ~ av CORNER BULKHPd i Ar df s ive 18.' it tt Decw N t° ISOO OALLON SEPTIC TAMV e. OAK Is "�f f a 9 NI0 CAPACI TY'r pp TRA My • `T �� � ,''� t t . ��L CeYAAPBERB t�! S t STONE AROUND M /60 pa is ,Q� 1 r The land together with the buildings thereon, situated in Barnstable (Hyannis), Barnstable County, Massachusetts, bounded and described as follows: SOUTHERLY by a town way.known as Eldridge Avenue, as shown on a plan of land hereinafter mentioned, One Hundred Forty and 00/100 (140.00) feet; SOUTHWESTERLY by the junction of said Eldridge Avenue and a town -way known as Kelley Road on a curve with a radius of twenty (20) feet, as shown on said plan, Thirty-One and 42/100 (31.42)feet; WESTERLY by said.Kelley Road, as shown on said plan, Seventy (70) feet; NORTHERLY by the northerly half of Lot 71,.as shown'on said plan;. One Hundred Sixty (160) feet; and EASTERLY by a portion of Lot 68 and Lot 69, as shown on said plan,.Ninety (90) feet. Being Lot 70 and the southerly half of Lot 71 as shown on a plan of land entitled, "Subdivision of Land- Hyannis- Barnstable, Mass. as surveyed for Lizzie Mae Higgins, Scale 1 in. = 60 ft., Whitney & Bassett Architects & Engineers, Hyannis, Mass., June 1941, recorded with Barnstable County Registry of Peeds in Plan Book 65, Page 101. " < Said premises are conveyed subject to and with the benefit of all rights, rights of ., way, easements, appurtenances, reservations and restrictions of record,.insofar as the same are in force and applicable. L0'C*—r1C3k4 ® F C3 P v L.a kk*� 6"Y N o—F 13 Cu A—FE STANDARD LEGEND _"'~--•.._ NOTE:not all symbols will appear an a' map 97 „ GOLF COURSE FAIR�f l EDGE OF DECIDUOUS TREES t Q 2 92 (r y EDGE OF BRUSH ° ' •- ORCHARD OR NURSERY F CONIFEROUS TREES `~ EDGE OF AREA f OF.. . . ........., EDGE WATER DIRT ROAD DRIVEWAY l0E ---PARKING LOT PAVED ROAD ---- DRAINAGE DITCH PATH/TRAIL Y I -�2 91 0 0,`'L� PARCEL TINE NAP 110 E —--MAP# G 21—PARCEL NUMBER 1` 1860# HOUSE NUMBER E • .. � � i ./�" ..............._....r 2 FOOT CONTOUR LINE 1 1-O / ) Elevation basedon 2 CONTOUR / o / ...__.......................... i�4.9 SPOT ELEVATION VD " .. _ � •1 r..:x�x--� - STONE WALL FENCE RETAINING WALL RAIL ROAD TRACK � `•` ~ c:--_: STON E J ETTY ' SWIMMING POOL PORCH/DECK ) 0 BUILDING/STRUCTURE DOCK/PIER _ i HYDRANT 6 VALVE OO • MANHOLE ar ,292 _ \: o POST p'" FLAG POLE 19T O W N O F 8 A R N S T A 8 L E G E O G R A P H I C 1 N F O R M A T 1 O N S Y S T E M S U N I T v SIGN 18 STORM DRAIN w• PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representationsFDATASOURCES: Planimetrics(man-made features)were interpreted from 1995 aerial photographs by The lames 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD 0 UTILITY POLE ❑ TOWER National Ma Accum Standards at this do not re resent actual relationshi s to h cal ab ects n. Planimetdcs,to rah and v etation were ma d to meet National Ma Accuro Standards� _ ,$ ?�a; 40 P ry P P P Y� I Po9 P V, eA PPB P ry1 INCH=40 FEET* enlarged scale. on the map. of 1"=100'. Parcel lines were digitized from FY2003 Town of Barnstable Assessor's lox maps. LIGHT POLE O ELECTRIC BOX Town of Barnstable CF?ME fps Regulatory Services r i Thomas F.Geiler,Director gpBN$TABLE, � 019. Building Division � i6;9• �0 g . pTfD r"A�s Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstible.ma.us 508-862-403 8 Fax: 50 8-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print iATE 140 DBLOCATION: Ito K�C��y �I "`L�� number street village HOMEOWNER": WQ 7 name home phone# work phone# ;LJRgENT MAILING ADDRESS: I (O L`/tl - �t 02-Co� city/town state zip code [he current exemption for"homeowners"was extended to include owner-occupied.dwellings of six units..or less and :o allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFIIVITION OF HOMEOWNER person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one of two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building-Official;that he/she shall be responsible for all such wofk 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 proc dures and requirements and that he/she will comply with said procedures and require S. Signature of Hom, wner 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 homeowne'r performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1=Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." ' Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack•of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons.•1n this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that belshe 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:homeexeinpt The Town of Barnstable Department of Health Safety and Environmental. Services Building Division 367 Main Street,Hyannis,MA 02601 `�l - 3-862-4038 3.790-6230 PLAN REVIEW Nrrer: ��IZy W LS'f Map/Parcel: y S� )jectAddress: , � /�-�J Builder: O .W i 3e following items were noted on reviewing: viewed by: b te: — � a III o _ _.... . KV�1.rh' O- - " [•y��� ( r' I 3 { .QnoJn3 w.ti^ \iiu ��Y��y f A _ s-ti � f .c �;. a �?rfl ICtrJ� SEG7[[.V. �3ir�') o[/�Q. l�ll�LJ 1 iv z,4 OL PA -Q(uu-r, 16 ,t _ ,,,4 f�A 7c� o046 G,[, ' P �2 a ^ - I i t } i I l l� 1'`�`�y' SSG, ti�H���•iti yr'! A i ✓ ,r� �..: r _ ,, ,.. z. �x �57irxc _ _ r '• ,: r -------- --- - -+ __ ........_........ ... / _ - I it l.)(l•F ..•ter J,ell, 1 v. , ' •�-1. 1 l.� 1. - .._ ' . - f. `_ '�7 3; - �nrtEr7Q C.7J�: ':. ."', �. l r, ¢_p: �✓ ., :�•, .c•rf f _ 14 too e'$ r i i e 1 f 1 - i 1 . { r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map !19 '� Parcel Ig g TGWIN Permit# 72,S .2 6 Health Division f4/oZ°3/03 3'W '''1 Date Issued /6 Y Conservation Division 1I Z-3 10; J J � + '0,j Application Fee Tax Collector Permit Fee 217, SEPTIC SYSTEM MUST BE Treasurer INSTALLED IN COMPLIANCE: Planning Dept. VMW TITLE 5 ENVIRONMENTAL COIDE AMC Date Definitive Plan Approved by Planning Board TC INI REGUL,TIANS Historic-OKH Preservation/Hyannis Project Street Address l© Kelly z g \A rx K pu$ Village '= Owner f-Rai �c���lti Address i y0 Ke% Al ftltkru� 'Aca Telephone Permit Request lk ti XVL k1511 �=li Ky it7'` Square feet: 1 st floor: existing 1 15v 5h proposed 2nd floor: existing proposed f Total new 16 CIO Zoning District Flood Plain VLO Groundwater Overlay Project Valuation 10 C760 Construction Type Lot Size ' 3 3 if Grandfathered: ❑Yes . (9 No If yes, attach supporting documentation. r Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) ` Age of Existing Structure Historic House: ❑Yes Uh No On Old King's Highway: ❑Yes R6No Basement Type: 4 Full ❑Crawl Walkout ❑Other Basement Finished Area(sq.ft.) �{ Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half: existing new Number of Bedrooms: existing 3 new a� Total Room Count(not including baths):existing 5;_ new first Floor Room Count .Heat Type and Fuel: dGaS• ❑Oil ❑ Electric ❑Other Central Air: ❑Yes kAo Fireplaces: Existing l New Existing wood/GWstove: C2fYes ❑No Detached garage:❑existing; ❑new size l Pool: existing ❑new size Barn:❑existing ❑new size Attached garage:dexisting ❑new size / Shed:Cdexisting ❑new size Other: �— Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ _—_Commercial ❑Yes- D.-No If_yes,-site-plan review#r --- Current Use Proposed Use BUILDER INFORMATION. N ORMATION Name r~����i (.Ja. Telephone Number <oE 7;�(g755' Address -!(v X efl(e( 19 ff-/ty ktt e t License# C,(- Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY Ids - Y PERMIT NO. DATE ISSUED f MAP/,PARCEL NO. 1 ADDRESS VILLAGE , OWNER DATE OF INSPECTION: FOUNDATION II't FRAME '� /�i?/�? /ALZQ INSULATION /7/O ti FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ;; ,* , w:; ril DATE CLOSED OUT ; r' ASSOCIATION PLAN NO.+ The Commonwealth of Massachusetts M - = Department of Industrial Accidents - = exce of/nyestl= oOffs ` 600 Washington Street --_ Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: r - location Ito A kh C S city ( ���u phone# 0 I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one worl� in . ca acl I am an em 1 ravidin workers' compensation for my employees working on this job. g ............................:•:.�::.v:.�.,.,.n.:nr:nr:«::.Y:,`.....;,<{:•::::.}}:::.::.v,:•.}}}..} .::'{;..}:.>xv4:.}%},}•:<?Y<;:;�n:$$:ti.;..,�.$,.:;; ?.:< •.vw::::{:r.:.:.;•....,n, L...:..v:.v:•:.v:v..,rr::::tn...:.vi4'ti;ii::4?:i:$?:;:{::r'%:y:}vr:�.{.:u:;...;..,:, ......x:::n•:xr.:•nv::•vnu:w::::-:vv:•r:•:M'Y{{r•{.•J.r. u::::::•.:.v::::.v.•+}T:.;:}}:•.},:t:v:.:{:::.i}:•....;.. :}F v:... ...... r.:.... ...n.. ..,. r ............... ......}.....v.:............ :.+•.}:ri:i•},?•:•:•v:.v:..vv:::::;nT::::........nw:::::::}.:....n...:.n..:....,vv.; ::'Av....Sin .........f..............r. :..v...r... t.r.....n..:.ri n:. .....r.....+....•: r.........................,......................;..r.v............ .a v:v::.:::}.+:;•{;.ti•:, .. n.........:.. .. n..n...:.....F.. .....n..........• ....n...........v....• ........r.. ... w:::w:::::v:�::::.w:..•-:hwn•..:.:r..vv.:•.w•:::.t�v+.•htY'`.%%::+;Y.:}•:•:•v. •:.x r.....v...... ........x:rwr.:..7.:. .-...:..}•::.r:.. .......n......... ..n...........•v, n...: .. .. y�...n :.h ${ .. ..v. f ...........rx..r. .:.. .. ..h. ......n... ....r.. .... ...::::::h:4+J.i:.,:,.•!.i?.:::.'w:••: .}::::::.... ,•.v;:nY•}>:%•7•.......w::;.i7:iv:•. , .}:....n n.....n.....v.... a,...........n..r....n.: ...n,..,..:.,}.,..r•.. ..r.......r....,.....4 v..r.....a:..v.r. ... ........Y.......r .$....F......,....0 w.:rr...... nY�.. .......:...............:..},...r...... ......,J.....3. r:i r.......,.:...........x................h....r..............h,.,..rY...�.t.. ,..n....:....o...... .r.....r........ ..r.: ........,r. 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XXX Fai}m a to astute coverage as required under Section 35A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civfi penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me: I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification P I do hereby certify under the pains and penallies of perjury that the information provided above is trot and tarred Signature a� Date - - r Phone Print name ���• '� Q�^- # official use only do not write in this area to be completed by city or town official city or town permdt/license# C]Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office _ ClHealthDepartment contactperson: phone#; DOth°r, - o v sea 9195 PIA) Information and Instructions 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 contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or'renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,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 y� 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 maybe �. 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.licensers 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 event the Office of Investigations has to contact you regarding the applicant. Please affidavit for you to fill out in the be sure to fill in the permrt/license number which will be used as a reference number. The affidavits may be returiRl'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: ' The Commonwealth Of Massachusetts Department of Industrial Accidents amce of investigations 600'Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 . i °FIMEr�y Town of Barnstable Regulatory,Services BARNSraBLE, ' Thomas F.Geller,Director lEn � Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 - Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than 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: lacl ct� tomb Gcg�a� Estimated Cost fU Qc9v Address of Work: Ito keVo tt W Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law ❑Job Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: z Date Contractor Name Registration No. ,. R A il—� 2 Date Owner's Name ;RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 S0 , 0 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE 44i5l- square feet x$96/sq.foot= x.0031= '" plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE _1,),14(square feet x$64/sq. foot= 02 l {' 0 x.0031= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq. foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00 (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost 7za CMF.Apprndix! n Table J6.11b(coutiatt4 with Fou�7 Full p=.meriptiye Paakagca for dae and TrraF'amay Ae:ideatlal Saildiaga gaud - '1 MII�IM17i41 •Heating/Cooling MAXIMUM Walt Floor $ascrnoai Slab Glaring Glaang Ceiling palm Equlpmcrt Efficicncy� Arcs'{'/.) U-Yslus' R-value A-value A-values Rws� , &valuer P Se 5701 to 6500 He'&I Dcgm Day? Normal 6 11Yi 0.40 33 13 14 10 6 Normal !4" A 12y, 0.57 30 19 19 ' 6 95 AFUE g 12'/2 0.30 31 13 19 1d/A NIA 10 Normal T 15% Q36 33 13 � 6 Normal 15'/. 0.44 31 19 19 10 N/A 15 APUE u 33 13 2.5 N/A i5 AFVE v 15% 0.44 6 0.52 30 19 19 10 N!A Normal S3 ZS N/A" X 19% 032 31 N/A Normal Y Igy. 0.4Z 31 14 19 NIA 6 90 AFUE Z 18% 0.42 31 13 19 10 6 40 AFUE 0.50 30 19 14 10 f.A , ADDRESS OF PROPERTY: 1. , t q / SQUARE FOOTAGE OF ALL EX'IER.I:OR WALLS: en • � o 3. SQUARE FOOTAGE OF ALL GLAZING: c 4. c/o GLAZING AREA(#3 DIVIDED BY#Z): 5. SELECT PACKAGE(Q"AA-see chart above): OF G ENERGY REQUIREMENTS NOTE: OTHE INVOLVED THODS ARAYAM RLE. ASK U R Ting WOR.MATION- -BuILDING :-a INSPECTOR APPROVAL: YES: NO: q-fonas-580303a 780 CMR Appendix J Footnotes to Table J�.2.1b: doors, skylights, and e area of the glazing assemblies ('including sliding-glass Glazingarea is the ratio of the doors to the gross wall basement windows if located in walls that enclose conditioned space,but excluding opaque area, expressed as a Percentage. Up to 1%-Of the b excluded from the U-yalue e withs 300 ft'of glazing area.uirement. For example,3 ft of decorative glass may be excluded from a building design 2 After January 1, 199Y, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table 11.5.3a. U values are for whole units. center-of-gals U-values cannot be used. ' , The ceiling•R-values do not assume a raised or oversized truss constntction. If the insulation achieves the full insulation,thickness over the exterior walls without R�9 compression, R 30 CeilinguR-v aloes represent thon may be e slum of cavity insulation may be substituted for , insulation and R-38 m y ventilated ceilings, insulating sheathing must be placed between For Y g insulation plus insulating sheathing(if used). the conditioned space and the ventilated portion of the roof. Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing(if used). Do not include exterior siding, structural sheathing,and interior drywall.For example, an R 19 requirement could be met EITHER by R-19 cavity insulation OR masonry, ry,to Wall constru tionsulation plus 6 but do not ppl insulating �metalg. -frame construction, lion,ments to woad-$arise or mass(concrete, mY� g e as must over unconitioned spaces meet the sealing requirements eh as unconditioned crawlspaces, basements, d The floor requirements apply to floors or garages).Floors over outside The entire opaque portion of any individual basement wall with an average depth less than 50%bs doorselow conditioned de must meet the same R-value requirement as above-grade walls: Windows and sliding gins basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-vafue requirements are for unheated slabs.Add an additional R-2 far heated slabs. or 5. If You P1 ' If the building utilizes to install more elgbtricmeistancme=e one pieceuse of cooiance ling equipmeproach 3; nt, the equipment with the lowest than one piece of heating equip , efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town sea Table 15.2.Ia NOTES: a) Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levers, R-value requirements are for insulation only and do not include structural components. b) Opaque doors the building envelop e must have a U-valua no greater than 0.35. Door U-values must be tested or TJ-value and documented by the manufacturer in accordance with U aloe rating for that dooC test procedure or r not available,en from the inc include the in Table 11.'5.3b.If a door contains glass aggregate glass area of the door with your windows ande use t the opaque door aU Uaueue to d than 0 ermine compliance of the door. one door may be excluded from this requirem n (i.e. tY c)If a ceiling,wall,floor,basement wall,slab-edge,f�e area-weighted av space wall erage R-aluponent a is greater than a equal es,two or more areas to different insulation levels,the component complies the R.-Value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). i 4- THE Town of Barnstable r CF 1p� Regulatory Services,- Y STABLEThomas F.Geiler,DirectorMASS 1 . p.0� Building Division V en�� Tom Perry,Building Commissioner 200 Main Street,.Hyannis,MA 02601 r Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print r. DATE: l 0 JOB LOCATION:. ItoL 4 - .k a t-b number street will e "HOMEOWNER": S�CCK4 1.,eA� name home phone# work phone# - 11 CURRENT MAILING ADDRESS: \�H►�1~KI S IM o. city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners toengage 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 ofland 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_ ep rmit• (Section.109:1.1) The undersigned"homeowner"assumes.responsibility for cornphance'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 lie/she will comply with said procedures and requirements. Signature of Hom wner ry Approval of Building Official t Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that:."Any homeowner performing work for which a building permit is required shall be exempt from the provisions - of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the Homeowner engages a person(s)for hire.to do such . +.' work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly- ; when the homeowner hires unlicensed persons. In this case,our Board cannot proceed,against the unlicensed person as it would with a licensed b d 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 r : _ . 1 � I - y — -1 'J �+�•���•—:� ` . :74 W7 c. l , s j p 13 i -_ - r v , 1 2- 12 10 I rAA co %-% InI p h\ - i /\ 1. �kiS7i��► Nooae ,_—,/ erg k, ltA f - Z——--------- ,. _ -CL ------,---- . . O O f t p I - ' s ' • � .\.cam 6 k 1�\�„��5 y.,,r1�` 1i7 faP�Wtil� 1 I 7T i A o t it CO VN I " 00 �,�w { �Oqh. V w(/�.1\14t� .. rQ• V\� �Pt \�\'1\PG� 3 ��oA1�a Irhn�vJaon)- Oa14L 6s _ _ _ _ 6-'g,_•X�0••V-_0.'�•tnS�luS�o••��,�. -,k 4 S hod o (ci�� 6" w\1 w� (Lli �<�&,.KCsl�.l t CaCKekA k COA J �e C� q-y' 0.1 S AC B V—xy,04ld dl tSl• enl-,lJ�_ —�I�'R�•' �- 0 0- b 6 OQGIC QXK11ny f - /' I r f _ 4 ' 05 - �� 40T 70 6 SOUTH OF /4314 ' S F � COBrff@ BLQKi1£M j .F � t • S { � r fl ABOYEOUNO c 4 b EOGE Of O � - - �• aercxvao q * -..for um I - - � d 7 a SiOdFiARO1Up;-' _ s , J I; r L�f0 _ i EXHIBIT A The land together with the buildings thereon, situated in Barnstable (Hyannis), Barnstable County, Massachusetts, bounded and described as follows: SOUTHERLY by a town way known as Eldridge Avenue, as shown on a plan of land hereinafter mentioned, One Hundred Forty and 00/100 (140.00)feet; SOUTHWESTERLY by the junction of said Eldridge Avenue and a town way known as Kelley Road on a curve with a radius of twenty (20) feet, as shown on said plan, Thirty-One and 42/100 (31.42)feet; WESTERLY by said Kelley Road, as shown on said plan, Seventy (70)feet; NORTHERLY by the northerly half of Lot 71, as shown on said plan, One Hundred Sixty (160) feet; and EASTERLY by a portion of Lot 68 and Lot 69, as shown on said plan, Ninety (90) feet. Being Lot 70 and the southerly half of Lot 71 as shown on a plan of land entitled, "Subdivision of Land- Hyannis- Barnstable, Mass. as surveyed for Lizzie Mae Higgins, Scale 1 in. = 60 ft., Whitney & Bassett- Architects & Engineers, Hyannis, ' Mass., June 1941, recorded with Barnstable County Registry in Plan of Deeds Book 65, Page 101. Said premises are conveyed subject to and with the benefit of all rights, rights of way, easements, appurtenances, reservations and restrictions of record, insofar as the same are in force and applicable. Property Location: 110 KELLEY ROAD MAP ID: 292/058/ Vision ID: 22929 Other ID: Bldg#: 1 Card 1 of 1 Print Date:10/22/2003 15:13 TOP„O. UTILITZES,r;,STRT./ROAD LQCATIQN CURRENT ASSESSMENT ' CURRENT OWNER ., „ BERRY,KEVIN E&LYNNE M r!__::__6 ublic Wate:l sued Descri tion Code A raised Value Assessed Value as S LAND 1010 23,900 23,900 801 110 KELLEY RDSIDNTL 1010 82,800 82,800 YANNIS,MA 02601 eptic SIDNTL 1010 300 300 Barnstable 2003,MA SUPPLEMENTAL DATA ccount# 202541 Plan Ref ax Dist. 400 Land Ct# er.Prop. #SR Life Estate VISION DL 1 LOT 70PT Notes: DL 2 71 GIS ID: 22929 Totall 107,0001 107,000 RECORD OF OWNERSHIP BK-VOLIPAGE' SALE DATE /u v/1 SALE PRICE V.0 PRE VIO US A SSESSMENTS HISTORY BERRY,KEVIN E&LYNNE M 1912/ 77 Q 0 Yr. Code I Assessed Value Yr. Code Assessed Value I Yr. Code Assessed Value 2002 1010 23,900 2001 1010 23,900 000 1010 23,400 2002 1010 82,800 2001 1010 82,800 000 1010 70,400 2002 1010 300 2001 1010 300 000 1010 100 Total: 107 000 Total: 107,000 Total: 93,900 � „�EXLMPTIQNS � _ ak OT, ASSESSMENTS '�, This signature acknowledges a visit by a Data Collector or Assessor Year T e/Descri tion Amount Code Description Number Amount Comm.Int. APPRAISED VALUE"�SUMMARY Appraised Bldg.Value(Card) 76,600 Appraised XF(B)Value(Bldg) 6,200 Total: Appraised OB(L)Value(Bldg) 300 . ;NOTES ' Special Land Value raised Land Value(Bldg) 23,900 _u *ABOVE GRND POOL W/SLIDE VINYL LINED-,NO VALUE Total Appraised Card Value 107,000 Total Appraised Parcel Value 107,000 Valuation Method: Cost/Market Valuation et Total Appraised Parcel Value 1079000 f, m1 , nn �k a- r a E.HIS i", >. ,r, , . .. BUILDIN,,G PERMIT RECORD. VISIT/CHANG TORY Permit ID Issue Date Tvpe Description Amount Insp.Date I %Comp. Date Comp. Comments Date ID Cd. Purpose/Result B29257 4/1/1986 AD 4,000 6/15/1987 100 HY SUN RM 3/7/2001 SM 00 eas/Listed 9/15/1987 ML LAND LINE VA UATION SECTION B# Use Code Description Zone D Frontage Depth Units Unit Price I.Factor S.I. C.Factor Nbad. Ad'. Notes-Ad'/Special Pricing Ad'. Unit Price Land Value 1 1010 ingle Fam RIB 4 0.33 AC 203,000.00 1.00 5 1.00 63AD 0.35 PCL(.33,U10)Notes:10 1BLD 239900 Total Card Land Units 0.33 AC Parcel Total Land Area: 0.33 AC Total Land Valu 23,900 Property Location: 110 KELLEY ROAD MAP ID: 292/058/ Irsion ID:22929 Other ID: Bldg#: 1 Card 1 of 1 Print Date: 10/22/2003 15 CONSTRUCT�ON;DETAIL�, ; _ ,;SKETCH �t-y Element Cd. Ch. Description Commercial Data Elements Style/Type 1 Ranch Element Cd. Ch. Description Model 01 Residential Heat&AC 24 Grade - Average Grade Frame Type aths/Plumbing 19 Stories 1 1 Story Occupancy 0 CeilingfWall 16 ooms/Prtns 1 GAR 2 Exterior Wall 1 7 sbest Shingle %Common Wall 16 WDK 2 all Height oof Structure 3 able/Hip 3 Roof Cover 3 sph/F Gls/Cmp 3 CONDO/MOBILE HOME DATA Interior Wall 1 5 Drywall 22 21 Element Code Description actor 16 22 12 4 2 Interior Floor 1 0 Typical Complex 2 14 Carpet Floor Adj Unit Location eating Fuel 3 Gas Heating Type 5 of Water umber of Units BAS BAS 2 FOP C Type 1 None Number of Levels 5 BMT 25 02 %Ownership Bedrooms 3 3 Bedrooms Bathrooms 1 1 Bathroom COST/MARKET VALUATION 10 1 Full 12 4 Total Rooms Rooms nadj.Base Rate 60.00 Size Adj.Factor 1.07699 20 18 ath Type Grade(Q)Index 0.87 Kitchen Style BAS dj.Base Rate 56.22 Bldg.Value New 94,562 10 Year Built 1960 Eff.Year Built (A)1981 rml Physcl Dep 19 uncnlObslnc 0 MIXED USE Econ Obslnc 0 Spec].Cond.Code 1010 Single Fam 100 Specl Cond% Overall%Cond. 81 eprec.Bldg Value -,,<Kan OB-OUTBUILDING& YARD ITEMS(L)/XF-BUILDING EXTRA FEATURES(B) Code Description LIB Units Unit Price Yr. Dp Rt %Cnd Apr. Value FPLl Fireplace B 1 3,000.00 1981 1 100 2,400 BRR Bsmt Rec Room B 950 5.00 1981 1 100 3,800 SHED Shed L 36 8.00 1900 0 100 300 BUILDING SUB-AREA SUMMARYSEC?TOJV,_ ' Code Description Living Area Gross Area E .Area Unit Cost Unde rec. Value BAS First Floor 1,280 1,280 1,280 56.22 71,962 BMT Basement Area 0 950 190 11.24 10,682 FOP Open Porch 0 80 16 11.24 900 GAR Attached Garage 0 468 164 19.70 9,220 WDK Wood Deck 0 316 32 5.69 1,799 Grosse Area 94,562 Assessor's office (1st floor): o�?WE to Assessor's map and lot number Board of Health (3rd floor): / �V&6 fO " Sewage Permit number ti ........ i BAWSTADLE, Engineering Department (3rd floor): (j 39- 9 M i 6 �0 House number .....................: . ..�. Z..............� .�l�..�... D YPY a' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only _ a' TOWN OF - R BA --NST.ABLE BUILDING - IH-SPECT0R APPLICATION FOR PERMIT TO .... . ... ............. ................................ TYPE OF CONSTRUCTION ...... .C-... ..........f .. .................................................................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to tithe following information: Location .. ... . ....K f.�.l..�.d�........ � .............� (� L n�.S......................................................................... ProposedUse .......� c"t....n............ . M..................................................................................................................... Zoning—District .................................................Fire District .......Huya... ................................... Name of Owner .'�.��.`..���.�.�.. ...�1� �. �)Qddress . ... ..� .....�1. ...�..�.�. ...... .......Hwa-nnis� J Nameof Builder .... �.��.. .......................................Address .................................................................................... Nameof Architect .....NJ.�:..............................................Address .................................................................................... Number of Rooms ...........).....................................................Foundation ..... .rn.�' ........ .......................................... Exterior .....:a ha.��e.�......................................V,........Roofing s ` Floors7le ..... . . . ... ....cac-. ...........� .:.z..................................................................Interior . ........................................ Heating ...P1.x�.n.e ..........................................................Plumbing .......... ..o.0.! ..:................................................ n r � pry /\ Fireplace ....�.��.�..�--.....................................................Approximate Cost ....... M ..6_0................................ Definitive Plan Approved by Planning Board ________________________________19________ . Area +� ... �........:.......... Diagram of Lot and Building with Dimensions Fee ....... / tJ lJ ..................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH d: 4— y - ""w ���iN'.��MIMB�Y.NL�t*M'r3'A 1lP.YA�Mf�1� 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 :l.!.1'1?�1�.A...4�... . ..�. �� ....... .1 1.... tt U' r ,\ 2 Construction_Supervisor's License ............ BERRY, LYNNE & KEVIN A=292-058 No ..29257.... Permit for ......$.lAUd...Sun..Raam .......Single Famil ...................... Location .....110 Kelly Road ................................................ Hyannis ............................................................................... Owner Lynne & Kevin Berry .........:.............................. .................. Type of Construction ....Frame ................................................................................ Plot ............................ Lot ................................ Permit Gran`ed ............Agri.L..2.4...........19 86 Date of Inspection ....................................19 Date Completed ......................................19 r. J 0 ' d� Assessor's office"(lst floor): : c tJ 0�I ETC V Assessor's map and lot number ... ..l.. ...-".. .......... �t v f Board of Health (3rd floor): MUST CONNECT TO TOYM SM `k) tivs, aye Sewage Permit, number �..f. .......................................... :_ Z BARNSTABLE. Engineering Department (3rd floo ) q p �/ 90o M6 IL \0�F House number .................:.. .1:�.�.....:.......�, /..,..... aC9owaY a APPLICATIONS PROCESSED 8:30-9:30 A.M. and' 1:00-2:00 .P.M. only TOWN `OF •BARNSTABLE BUILDING INSPECTOR . APPLICATION FOR PERMIT TO .. ...Ao;)ITLOV...-...�Q .. .=............................................. TYPE OF CONSTRUCTION .... no'..d......I.Fra me................................................................... i 'P Ja TO THE INSPECTOR OF BUILDINGS:_' The undersigned hereby applies for ermit accordin to the following information: Is Location ..�...!. .... .w.l... . . ..... ... .................... .v"l..i.!..1�. ......................................................................... ProposedUse �t.e�n........R..0.0=-�.............................:..................................................................................... ............. ^^ ................................................Fire District ....... ..... .Q.t,) Zoning District .......!...1...�. ...s........... Name of Owner .�. r` . . .V..�.. ...it J� V . ddress .L..I.�.....�.4�,:.L�...: ...... ..... - _n— Name of Builder ....0w..ne4.....................................:.Address ........:...................:........................... ............................ Name of Architect .....l.V..f.�............................ .................. ...............................................................:.................... Number of Rooms ........... .....................................................Foundation ........... rn n ........................ ..........................................• Exterior ..... �, • �...............................................Roofing ...h.:5..�-�.a.I .....................: Floors1..!..I.e..................................................................Interior ..... :...: r .... 1`•................................. p.Q .........Plumbing .......... .. . Heating .. ... .........�................................................. ..... .............................................._ . Fireplace .... . .................................................................Approximate Costy��!% tV ....................... ... .. .................................... Definitive Plan Approved by Planning Board _______________________________19________ . Area . . �.O ................. Diagram of Lot and Building with Dimensions Fee •....... ..].°. SUBJECT TO APPROVAL OF BOARD OF HEALTH 44 Z6 �S Ole 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 .. .. .!... ... .......... .. n ' Construction.Supervisor's License .0..(.VUA........ 4 BERRY, LYNNE & KEVIN No .... Permit for .....Build..Sun -Room ..Dmellin&...................... Location K,911,y..RQad............. ................... .. ................... Aa............................................. -Z Owner ..;Lnine... ...... Bexry..... Type'-of Con struction ....... Frame................................... ................... ............................ ..................... ....... wPlot ..... ................... . Lot, .........I................ M 9- Permit j2rmtecl, ....4.rIA. 2.4.......... .......19., 86 'K Date of(Ospection ..... ...............................14 �7 Date, Cb pleted .................... ......T....... 31 1A I Town of Barnstable F Regulatory Services Thomas F.Geiler,Director Building Division snuvsrnai.E. v� : `�� Tom Perry,Building Commissioner 1 iOrE 3�s 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 5 8-790-6230 Approved: Fee: Gj.ao Permit#: HOME OCCUPATION REGISTRATION Date: Name: S�k�'y �" Phone#: 50? 6137 6 3£r 3 Address: 110 AkIIf `tA fly k'h h i S '^1>a , Village: ga-rn S;1362 Name of Business:_ 7ooi c,,,td, :S� Ca4 e_ n r*j i-lu ttKa lC Type of Business: .G-f 0 L WKAP-1011 Map/Lot: ke-X0, , Prtwc-e{ Sg 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 on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is 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: 10 I 0 Homeoc.doc Rev.5/30/03 i l TO ALL NEW BUSINESS OWNERS ' DATE: 10 1151 o Fill in please:. �. APPLICANT'S .,: YOUR NAME: a �22 �e,\o h BUSINESS , YOUR HOME ADDRESS: 110 I<4L d t& n So5 6556383 NTAKnif a. TELEPHONE _ Telephone Number Home 5709 SASS NAME OF NEW BUSINESS o wh SE-RR C-AfP.a ��- 1 TYPE OF BUSINESS ��+''�°����+ �2�0 tn� IS THIS A HOME OCCUPATION? YES LZLN Have you been given approval from the building division? YESL NO ADDRESS OF BUSINESS 1 10 K the •-cl rrkPLcs' MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below,you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.: GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSI NER'S O FICE This individual has rmed of n permit requirements that pertain to this-type of business. ut orized Sign ture** COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** Y COMMENTS: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. -it does not give you permission to operate-you must get that through completion of the processes from the various departments involved. **SIGNIFIES A PPRO VA L FORA BUSINESS CERT/F/CATEONL Y, Town of Barnstable ertnit n 6 RegulaoFIHE loy, to y Services ate: eiler G ,Direc tor�I�oi�s F. » uili�ng Division • IBLAIM ABLE. FO 1MAN. Tom Petry, Building Commissioner �plfD MP'�a 200 Main Sf e"xva, - ,MA 02601 C Fax: 508-790-6230 Office: 508-862-4038 TO �V1 BARNSTABLE SOLID ESE STOVE PERMIT ro - r is It Z Phone: CSo z3� �S �19 1 c�• Owner.. f v+n) Install at: A 10 l�l- LL.F Village: H r+�+,),S Map%Parcel `I Date: `I Stove A. New sed �-- ` B. Type: 4adian / Circulatingf, Z `" iAyJ st t co C k jam Manufacturer: A ,4, rU _Lab.No. k A .r, D 'Y Chimney 13 ��a uTo L to o last cleaning) �' se note date � Exrs m I existing,plea f A. New�(f B. Flue Size )e C. Are other appliances attached to Flue? D 're Type and Manufacturer E. iVlasonry: �s 1ne nlined Hearth A.-M—Ster als 2 i c 1 Z B. Sub Floor Construction: Coro c Installeer Q0I^L,v01 Address: mZVEI M2�-' 'N-3 Phone: N t� Location of Installation: f3A S I r � p IPBY' Please make checks payable Town of Barnstable �t< *This�co titutes an offl' lstoviermit after inspection,photographed, and approved by the Building Inspector Q:fonns:stove Rev122801 � � Q ��G � LL �' � /� yr� r� N � s /�� One Beacon I N S U R A N C E 10/4/02 Building Inspectors Office Hyannis, MA Insured: Kevin E & Lynne M. Berry Property Address 110 Kelly Road, Hyannis MA Policy M CBSR23381 Loss of : 09/27/2002 Claim #: OBL-051.18Y-BL71 Claim has been made involving.loss, damage or destruction of the above captioned property, which may either. exceed $1000 or cause Massachusetts General Laws, Chapter 143; Section 6 to be applicable. If any notice under Massachusetts General laws, Chapter 139, Section 313 is appropriate, please direct it to the attention of Ahis.writer and include.a reference•to the above- captioned insured, location, policy number, date of loss and claim number. Title: Property.Claims Adjuster. On this date, "I caused copies of this notice°to be sent to the persons named al ove at;tl a address indicated.above xbv:first class mail. Sincerely, Janet Manning Claims Adjuster JM/CM � Kv ,} n 'r fi C... �. a �: :.� - s E' a P•� .!7 r's�,.r,s �.1 a.;,% 9,�•.:£,;.E .�. i..a r 5.1 i,. � i, OneBeacon Insurance Group P.O.Box 55055 Boston,Ma 02205-5055 t 508.851.2500 f 508.851.2699 www.onebeacon.com 1; y„ Y{ e i F+ T :Mt:, .: � ^.� � � yr � n�'-s � �r �� +i��v$(�� •. �� �- .. .; e� ' k H T v r� I R � i a ;7;. ^.+w�,_ ry •*yv`,. r „ s , eJr z �a,:. :,-. v�����Iry r�M;�.,.y, � •' . 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IN Der $OX. - -=�-- 1�oU . , sta sTO tNMRT,.OUT Vf$r'' . tNY Rr IN, r .� . `• ,ago "' Awl 96. 7 4 Htt�H` CAP�VCf }' itt#tL.TRATOR gotrit Or 1." l C# tB 'R t AVJU$r t: 6 # TV NlA CERS'.W# .5't STONE AROUND Jd3'r x •J8 'I x t0"d 'iC rANK 6" Cf�GSVt�'!� $tOW 0R COMPACT�i�? l�ASE h'0 : near' TO SCALD' L a T 7a 4 J 1 Or L 4'T' 71 , � , . � !43 14 'S.F. LAWN dM COCtNE$ uLKtH�i10 f: OAX • A.DOVE �OUN:� f ax r car Naa ! 101.7 \ LAWN a i 1500 GALLON . .laf_ WINC TANK tw x i r GAB / IV. `A�'�\ H i8v OAK A. 4 M101 CAPACITY �N 1.40.pp" �•� � iOf tS0 Op ' jg'f I