HomeMy WebLinkAbout0024 NANTUCKET STREET J
I
I
TOWN OF,BARNSTABLE BUILDING PERMIT APPLICATION
Map SZ(P Parcel 0 Application #
Health Division 2 Date Issued
Conservation Division Application Fee Z �G
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board I n
Historic - OKH _ Preservation / Hyannis
Project Street Address V4 ��'`J �� SCj
Village
Owner `fl®y(I L L13, Go W4i Address Z t3 Ocd-4*-) 51� 4-1 Awto-3
Telephoned
Permit Request D6%-40 J16
Square feet: 1 st floor: existing proposed 2nd floor: existing 0propoy
Rlyf�9i� sed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type APR 2 010
Lot Size Grandfathered: ❑Yes ❑ON`�,IfCypsUdiffaNTsuupporting documentation.
Dwelling Type: Single Family 5/ Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: R*�ull ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) 1 moo �3
Number of Baths: Full: existing ` new Half: existing new
Number of Bedrooms: Z existing —new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: 0-6as ❑ Oil ❑ Electric ❑ Other
Central Air: 2"'�e-s ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size — Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size — Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use VAC-44-flr Proposed Use bc-Ho
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name 5mn krL) Telephone Number
Address PO OM 23 8 20�-1�- h 4- License # CS
Home Improvement Contractor#
Email �l' 's`+�`' �°"`� +y Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
DATE SIGNATURE
FOR OFFICIAL USE ONLY
APPLICATION #
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH ` FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT '
ASSOCIATION PLAN NO.
Town of Barnstable
Regulatory Services
Richard V.Seali,Director
Building Division
Thomas Perry,CBO
Building Commissioner f ,t ,
200 Main Sbu% Hyannis,MA 02601'�
www town.barnstable.mams
Office: 508-862-4038 Fax: 508-790-6230
y
Property Owner Must .
Complete and Sign This Section.
If Using A Builder
!n
a S 6/h to as Owner of the subject property
hereby authorize Opechee Construction Corporation . to act on my behalf
in all matters relative to work authorized by this building permit application for:
213 Ocean Street,Hyannis MA,02601
(Address of Job)
*natut £oavaier Date
Print Nw4e
If Properly Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
QlWlf1PORM9ftfl gpermitfmmelffis3'MSS.d=
Rsvised 040215
The Commonwealth of Massachuse&
_ Department of InduytridAccidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers
Applicant Information M' Please Print Legibly
Name(Bussmess/organiz iowbdmdnai): Coo
Address: ?, M k1u o-o, D(L
City/State/Zip: (,g4uL 6 Phone#: LSQ 9- 06 6 J ct'b-tc 4
Are you an employer?.Check the appropriate bog: Type of project(required):
1.�am a employer with 4. � I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g, demolition
working for me in any capacity, employees and have workers' 9. ❑Building addition
[No workers' comp.insurance comp.msrrance t
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.E]Roof repairs
insurance required-It c. 152,§1(4),and we have no
employees. [No workers' 13.❑Other
comp,insurance required.]
*Amy applicant that decks box#1 must also fill out the section below showing their workers'compensation policy h&nnation.
t Homcowners who submit this affidavit indicating they arc doing all work and then hire outside contractors mast submit a new affidavit indicating such.
tantractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
-ram an employer that is providing workers'compensation insurance for my employees. Below is the policy a d job site
information.
Insurance Company Name:_ l p Cry 4- P6 U-
Policy#or Self-ins.Lic. Expiration Date:
Job Site Address: N *J#0-ULktq- Sr 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 a 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby c fy under the pains and penalties of perjury that the information provided above is true and correct
Si ature: Date:
Phone#:
Official use only. Do•not write in this area,to be completed by city or town offidaL
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector.
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. .
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such-employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C( )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(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should writg"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe 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
(Le.a dog license or permit to bum 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 Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
6.00 Washington Street
Boston,MA 02111
Tel.#617-727-4900 ext 406 or 1-877-MASSAFE
Fax#617-7-27-7749
Revised 4-24-07
vww.mass.govfdia .
DATE(MMIDDIYYYY)
CERTIFICATE OF LIABIL
ITY INSURANCE 3/8/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
McSweeney 8r Ricci Insurance Agency, Inc. PHONE FAX
420 Washington Street Arc o E 81-8 8-8600 AIC No
L :78 -843-880
E-MAI
P.O. Box 850984 AODREss:mrirece Lon mmcsweene 'cci.com
Braintree MA 02185 INSURER(S)'AFFORDING COVERAGE NAIC S
INSURER A:Contl e a Casualty INSURED SLTCO-1 INSURER B:TranS ortabon Insurance 567
SLT Construction Corp. INSURER C:Star Insurance Company
3 Marion Drive
Carver MA 02330 INSURER D:
INSURER E
INSURER F-
COVERAGES CERTIFICATE NUMBER:304144896 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ,
INSR ADDL SUER POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDYYY) fMMIDDIYYYY1 LIMITS
A GENERAL LIABILITY 6020263952 8/1/2015 7/1/2016 EACH OCCURRENCE $1,000,000
DAMAGEX COMMERCIAL GENERAL LIABILITY PREMISES
Ea occurrence $250,000
CLAIMS-MADE aOCCUR MED EXP(Anyone person) $5,000
X INC:X,C,U PERSONAL&ADVINJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000
POLICY X PRQ LOC $
B AUTOMOBILE LIABILITY 6020263935 8/1/2015 7/1/2016 $1 000000
? Ea accld.
ANY AUTO AUTOS TO BODILY INJURY(Per person) $
AS SCHEDULED X AUTOS BODILY INJURY(Per accident) $
HIREDAUTOS X NON-OWNED PROPERTY DAM
AUTOS Per accident $
$
A UMBRELLA LIAR Ix IOCCUR 6020263921 8/1/2015 7/1/2016 EACH OCCURRENCE $5,000,000
EXCESS LIAB CLAIMS-MADE
AGGREGATE 55,000,000
DED IX I RETENTIONSNone S
t; WORKERS COMPENSATION WC0737442 7!1/2015 7/1J2016 X WCSTATU- OTH-
AND EMPLOYERS'LIABILITY ,�/N TORY LIMITS ER
ANY PROPRIETOR/PARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED? N� N/A E.L.EACH ACCIDENT $1,000,000
(Mandatory In
If yes,describe under E.L.DISEASE-EA EMPLOYE $1,000,000
.. ..
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 1$1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS[VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required)
Project: Hyannis Harbor Hotel, Hyannis, MA
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS.
200 Main St
Hyannis MA 02601 AUTHORIZED REPRESENTATIVE
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
Town of Barnstable
Department of Public Works
BAWMABM
382 Falmouth Road ; Hyannis , MA 02601
s www.engineering@town.bamstable.ma.us
Office : 508—862 -4090
Fax : 508—862 -4711
Mar
ch 30 , 2016
Subject : Disconnection from municipal sewer, of
24 Nantucket Street ; Hyannis
Map & Parcel 326 - 033
i Dear Sirs
This is to notify you that the property at 24 Nantucket Street ( Map & Parcel 326 - 33)
in Hyannis village, Mass. was disconnected from municipal sewer on March 30cn
2016.
The disconnection was inspected and accepted by the Construction_Projects Inspector
from the Town of.Barnstable DPW—Admin &Tech Support. A sewer compliance
record and a record drawing will be completed and filed in the Admin & Tech Support
office.
If you have any questions, or need additional information, please call Dave Anderson
at 508 — 790 - 6244.
Sincerely
f
David J n erson ; Construction Projects Inspector
Town o Barnstable DPW - Admin & Tech Support
L
�► One NSTAR Way,Westwood,Massachusetts 02090-9230
�VERSlJRCE
ENERGY
March 21,2016
Andrew Pike
Project Manager
Opechee Construction Corporation
11 Corporate Drive
Belmont,NH 03220
RE: 24 Nantucket Ave Hyannis
Dear Mr.Pike:
At Eversource,we're committed to delivering great service.
This letter serves as confirmation that,as of March 21,2016 the electric service to the above address
has been removed.
Based on this information,there is no electric power at this address and you may proceed
with the demolition. If you have any questions,please contact meat(781)441-3381.
Sincerely;:
Paul A. Bowe
Customer Service Engineer
9
BIKE Department of Public Works 47 Old Yarmouth Rd.
Q► Water Supply Division P.O.Box 326Hyannis, MA.
sAMSTNUM # 02601-0326
y MASS. � TEL:508-775-0063
s6�4' • Hyannis Water System Operations FAX:508-790-1313
April 18, 2016
Town of Barnstable
Building Inspector
Town Hall
Hyannis, MA 02601
Re: 24 Nantucket Street—Acct# 606226—Map/Parcel: 326-033
Dear Sir:
Please be advised that the above water service was shut off at the curb stop and meter removed on April
6,2016. The service was cut and capped on April 18,2016. The owner has informed us that they are
demolishing the building.
If you have any questions,please call the office at(508) 775-0063.
Sincerely,
Jay Starck
�'Z
Hyannis Water System
r i
nationalg roe
March 11,2016
Leo MacDonald
24 Nantucket St.
Hyannis, MA
To Whom It May Concern:
RE: 24 Nantucket St,Hyannis,MA
This letter is to confirm that we have cut back the gas service to the building on March 7,
2016 on the property.
I can be reached directly at 508-760-7484 should there be any further questions.
P
cer y,
i el on
Gas Sales Support Representative
Cape Cod.
I
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-067715
Construction Supervisor t
JAMES L MCDONALD
14 JERSEY ST/PO BOX 23 '
BRANT ROCK MA 02020
Expiration:
Commis
sioner
ner
' 01/29/2018
f
B k 28199 . P:9.57 IrL2534.3
Es-12-241 o- a 01 :36�►
REGULATORY AGREEMENT
HARBORVIEW HOTEL INVESTORS, LLC and NOMINEE
213 OCEAN STREET, HYANNIS, MA 02601
This regulatory agreement ("Agreement") is entered into by and between the
Developers, Harborview Hotel Investors, LLC and HHH Ocean Street,.LLC,
("Developer") and the Town of Barnstable ("Town"), a municipal corporation, on this
dN' day of %77,0,z-2014, pursuant to Section 240-24.1 of the Barnstable Zoning
Ordinance and Chapter 168 of the Barnstable Code;
WITNESS:
WHEREAS, this Agreement shall.establish the following: permitted uses, density, and
traffic within the Development, the duration of the Agreement, and any other terms or
conditions mutually agreed upon between the Developer and the Town; and
WHEREAS, the Developer owns the property at 213 Ocean Street including parking
areas, Hyannis, MA, consisting of 3.8 acres, shown,on Barnstable Assessor's Map 326
as Parcel 035, title to which is recorded in Barnstable County Registry of Deeds Book
15837 Page 190; and is the named buyer in a Purchase and Sale agreement dated
October 31, 2013, for the property at 24 Nantucket Street, Hyannis, MA; consisting of
.18 acres, which is shown Barnstable Assessors' Map 326 as Parcel 33. Collectively,
the two parcels are"referred to herein as the Property; for purposes,of this Regulatory
Agreement, the "Property"does not
include the existing hotel and its operations currently located at 213 Ocean Street but
does include all site parking; the Developer desires to develop the Property pursuant to
this Regulatory Agreement; and
WHEREAS the Development will not require regulatory review under the Massachusetts
Environmental Policy Act (MEPA) or the Cape Cod Commission Act; and
WHEREAS the Developer has made application to the Planning Board pursuant to
Chapter 168 of the Barnstable Code; and
WHEREAS the Development is located in the Hyannis Growth Incentive Zone (GIZ)as
approved by the Cape Cod Commission by decision dated April 6, 2006, as authorized
by Barnstable County Ordinance 2005-13, Chapter G, Growth Incentive Zone
Regulations of the Cape Cod Commission Regulations of General Application; and
WHEREAS the Development is not subject to review by the Cape Cod Commission as
a Development of Regional Impact due to its location in the GIZ and due to the adoption
of Barnstable County Ordinance 2006-06 establishing a cumulative development
threshold within the.GIZ, under which this development may proceed and the-Developer
has submitted.a Jurisdictional Determination to the Town of Barnstable Building ,
Department to confirm the same; and
Bk ;2819.9 Pg58 #25343
WHEREAS, the Property is currently developed with 69.7% impervious lot coverage;
the Development will redevelop a portion of the Property currently used for parking;
proposed impervious lot coverage is 78.9%. These figures also include the building
footprints to account for the Nantucket Street lot; and.
WHEREAS, through the Regulatory Agreement process, including review of application
materials, supplemental information submitted; discussions with the Town Manager and
public testimony, impacts have been identified. These are: impacts to an already
overloaded parking system in and adjacent to the Hyannis Harbor area; increased use
of inadequate water delivery infrastructure on Ocean Street; and.increased use of Bay
Street by hotel clients; and
WHEREAS,the Town is authorized to enter into this Regulatory Agreement pursuant to
Chapters 168 of the Barnstable Code; and
WHEREAS the Developer will require zoning relief from certain provisionsof Chapter.
240 to allow individual kitchen facilities in hotel rooms, minimum parking, building story
requirements, front, rear and side yard setbacks and maximum lot coverage all as
further defined in condition number 1 b below; and
WHEREAS, the Developer will require relief from Chapter 112, Article Ill regarding'a
certificate of appropriateness; and
WHEREAS, the Town and Developer desire to set forth in this Agreement their
respective understandings and agreements with regard to the development of the
9 p
Property; and
WHEREAS, the Developer is willing to commit itself to the development of the Property
substantially in accordance with this Agreement; the Developer desires to have a
reasonable amount of flexibility to complete the Development and therefore considers
this Agreement to be in its best interests,and
WHEREAS, this Agreement shall vest land-use development rights in the Property for
the duration of the executed Agreement, and such rights shall not be subject to
subsequent changes in local development ordinances, with the exception of necessary
changes to protect the public health, safety, or welfare;
NOW THEREFORE, in consideration of the agreements and covenants set forth
hereinafter, and with other good and valuable consideration, the receipt and sufficiency
of which each of the parties hereby acknowledge to the other,.the Developer and the
Town do enter into this Agreement,and hereby agree to covenant as to the following
provisions:
,1. The Developer proposes to redevelop the Property as.follows:
a. The Developer seeks a Regulatory Agreement to develop the property for the
construction and operation of a new, freestanding, four(4) story hotel operating year-
round fortransient guests with up to sixty-eight (68)total guest rooms,each containing
I ,
Bk 2819.9 Pg59 #25343
its own kitchen facility and approximately 350 square feet in size. The new hotel
building is 33,795 square feet in total. In addition to the 68 rooms; the Hotel will also
contain a fitness center and lobby for use by Hotel guests only. The Developer is
Harborview Hotel Investors, LLC and HHH Ocean Street LLC. The property is
addressed as'213 Ocean Street, Hyannis, MA, located in the Harbor District(HD) and is
shown on Assessor's Map 326 as Parcels 035 and 24 Nantucket Street, Hyannis, MA
located in the Harbor District(HD) and is shown on Assessor's Map 326 Parcel 033.
Parking location for the new proposed hotel building will be located at the parking lot of
the existing hotel building (which is not subject to the Regulatory Agreement) located at
213 Ocean Street and 24 Nantucket Street. The total area of the property(s)subject to
the Application is approximately 3.98 acres.
b. The Regulatory Agreement seeks waivers from the Barnstable Zoning
Ordinances, and other ordinances of the Code of the Town of Barnstable, specifically in .
reference to the following sections:
i. Section 240-24.1.7 (A) Harbor District, (1) Permitted Uses, (j) Hotel
o Developer seeks waiver to allow hotel rooms with individual kitchen facilities:.
ii. Section 240-24.1.7 (C) Dimensional, bulk and other requirements
o Developer seeks waivers with regard to maximum building height(proposed 4
stories (44 ft) where only 2.5 stories are permitted) , front, rear,.and side-yard setbacks
(waiver of 10 foot minimum); and maximum lot coverage (waiver of 70% requirement).
iii. Section 240-52. Design and Screening standards. A.; Section 240-53.
Landscape requirements for parking lots. B. (1) (2) (3); Section 240-56 Schedule of Off-
Street Parking Requirements.
o Developer seeks relief from applicable parking requirements as follows: .
o Developer seeks waivers with regards to parking lot landscaping of 10% and the
waiver of the number of required trees. Parking lot landscaping (10% of the entire site
or 6,082 sq. ft.); Proposed is 4,898 sq. ft. Parking lot trees required (Parking lot of 177
spaces) 36 trees; Proposed 7.
o Developer seeks waiver of parking-lot line to lot line (waiver of 6-foot minimum,
where existing hotel has 0 lot line setback at some locations)
o Parking required is 1.2 spaces per unit(245) plus (1)for each employee in largest
shift(12), or 258. Developer provides 177 spaces, 204 with approved valet(1.0 space.
per unit).
o Developer seeks waiver of parking space minimum dimension requirement allowing
for smaller size spaces in certain areas on the site.
iv. Dumpster requirements:
o Developer seeks waiver from § 353-4 of the Code of the Town of Barnstable, Board
of Health Regulations,"Storage of Garbage and Refuse" Minimum setback for the
location of the proposed dumpster.
V. Chapter 112, Article III Hyannis Main Street Waterfront Historic District
Ordinance:
t
Bk 2819.9 Pg60 #25343
o Developer seeks waiver of requirement for a Certificate of Appropriateness from the
HMSWHDC guidelines. No additional free-standing signage is proposed.
vi. Section 240-68. Signs in the MB-Al, MB-A2, MB-B and HD`
Districts. C.
o Developer seeks waiver to exceed the maximum square footage of 50 sq ft allowed
in the district. Developer is seeking relief under the total allowable square footage in the
HD District of 50 sq feet. Developer anticipates proposing a 35 sq ft(7' Long by 5' high)
wall sign for the North side of the building and a 16.5 square ft(11' Long by 1'=6" high)
wall sign on the East side of the building.
2. The construction and operation of the proposed year-round hotel will result in the
following economic benefits:
■ New year-round and seasonal employment, both full time and part time. It is
estimated all positions that are currently seasonal (Mid April - October) will become year
round -26 total new full time positions. (General Manager, Front Office Manager,
Executive Housekeeper, Sales Manager, Director of Engineering, Shift.Engineers (3),
Accounting Manager, Life Guard(2), Security (1.5), Night Auditor(1.5), Front Desk
Clerks (4), Housekeepers (6), Housemen (2), Laundry Attendant(2).) In addition, it is
estimated an additional 11 new seasonal position will be created with the addition of the
68 rooms; (2 new front desk clerks, Housekeepers (6), Housemen (2), Engineer(2);
Sales Manager, Parking Attendant(2);
• Increase in Town property tax revenue. The additional tax revenue to the
Town will be$35,880.30 (based on Estimated Building Costs $4,500,000.00 x Town tax
rate of$8.22 per 1000 + Community Preservation Tax 3% of the Town Tax), plus a
Hyannis Fire Department tax rate of$15,930.00 ($3.54 per 1000), for a total estimated
annual tax of$51,810.00.
• Increase in Town hotel room tax revenue. The estimated hotel tax
revenue generated from this project will be$120,000.00 (based on an estimated
revenue of$2,000,000.00 at 6%); and
• Increase in year round commercial activity in the Harbor area.
3. In accordance with Section 168-6, the Developer, prior to being issued a
occupancy permit shalt be required to pay mitigation sums to the Town of Barnstable to
be used by the Town in its discretion for infrastructure improvements including the
extension of the water main on Ocean Street.
The Developer shall be required to pay$150,000 as follows; '
$30,000 upon issuance of occupancy permit; and
$30,000 each.year thereafter for the next four(4) years
Developer shall make payment to the Treasurer of the Town of Barnstable as directed
by the Town Manager's office:
4. Parking=As set forth on plans prepared by Baxter& Nye Engineering, entitled
Hyannis Harbor Hotel Addition, Revised through 11/8/2013. As per plans submitted. the
Bk .28199 Pg61 #25343
new plan with the Nantucket Lot shows 177 spaces (.86) per guest room, with the new
valet 204 spaces (1) per guest room. The Ordinance requires 1.2 spaces per room plus
1 for every two employees on the maximum shift. As a result, Developer seeks relief for
parking as set forth above.
5. Landscape -As set forth on plans prepared by Baxter& Nye Engineering,
entitled Hyannis Harbor Hotel Addition, Revised through 12/3/2013. The landscaping
for 24 Nantucket Street will also be irrigated.
6. Bonds: Prior to the issuance of a foundation building permit Developer will
provide a performance bond in an amount to be approved by the Planning Board or its
designee, said bond to be expended on the replacement of landscape materials if such
replacement becomes necessary. Any unexpended portion of said performance bond
(including interest) may be released by the Planning Board to the Developer or his
successor(s) after three years from the date of the initial landscape plantings, such date
to be determined.by the Building Commissioner, upon the request of the Developer;
7. Curb cuts-As set forth on plans prepared by Baxter& Nye Engineering,entitled
Hyannis Harbor Hotel Addition, Revised through 11/8/2013
8. Lighting—Currently being prepared by architect. It will meet Town standards. A
copy of the lighting plan shall be filed with Growth Management staff for review and
comment prior to the issuance of a building permit.
9. Signage- Developer is seeking relief under the total allowable square footage in
the HD District of 50 sq feet. Developer is proposing a 35 sq ft (7' Long by T high).wall
sign for the North side of the building and a 16.5 square ft(11' Long by 1'-6"high)wall
sign on the East side of the building.
10. Stormwater management—As set forth on plans prepared by Baxter& Nye
Engineering, entitled Hyannis Harbor Hotel Addition, Revised through 8/9/2013. This
does not include the parking area for the Nantucket Lot, which was included at the last
Planning Board hearing. A copy of the drainage plan for the Nantucket log shall be filed
with the Growth Management staff for review and comments prior to the issuance of a
building permit.
11. Crosswalk shall be provided -As set forth on plans prepared by Baxter& Nye
Engineering, entitled Hyannis Harbor Hotel Addition, Revised through 11/8/2013
12. Dumpster shall be located as set forth on plans prepared by Baxter&Nye
Engineering, entitled Hyannis Harbor Hotel Addition, Revised through 11/8/2013 on the
northern property line abutting Bay Lane.
13. Upon completion.of all work, a registered engineer or land surveyor shall submit
a letter of certification, made upon knowledge and belief in accordance with professional
standards that all work has been done in substantial compliance with the approved site
plan. This document shall be submitted prior to the issuance of the final certificate of
occupancy;
Bk ,28199 Pg62 #25343
14. Community Character- Proposed elevations were reviewed by the Planning
Board. Developer has met with the Historic District Commission, who has given a
positive recommendation with respect to the current design of the hotel as shown in the
elevations prepared by Pro Con, Inc., dated May 24, 2013.
15. Construction shall take place only between the hours of 7 AM to 5 PM Monday
through Saturday.
16. Use—The new freestanding, four(4)-story hotel building on the Property shall be
used as a hotel for transient guests operating year round. The hotel units shall not be
used as dwelling units. None of the hotel units shall be marketed, transferred, or sold
as Timeshare Units as defined in G.L. c. 183E as the same may be amended.
17. Project construction shall commence no later than three (3) years from the
finalization and approval of the Regulatory Agreement by the Town Council.
Construction shall be completed within two (2) years of construction commencement
date. These time periods may be extended upon request of the Developer and
approval by the Planning Board.
18. To the extent that referenced plans do not depict all of the findings and
conditions set forth in this Agreement, revised plans and shall be provided. In addition
to permits, plans and approvals listed above, any and all permits and licenses shall be
obtained;
19. The development rights granted under this agreement shall run with the land.
However, the Developer agrees that 30 days prior to any change of ownership of the
Property that written notice shall be sent to the Planning Board, Town Council, and
Town Manager and further agrees, that all terms and conditions of this regulatory
agreement and any amendments thereto,shall be binding on any successive owner of
the Property.
20. Pursuant to §168-9, the term:of the Agreement shall be (10) years from the
effective date of the Agreement. Notwithstanding the ten (10) year duration, once the
development rights are exercised within the time periods provided in Paragraph 17,
including any extension thereof by the Planning Board, all of the terms and conditions of
the Regulatory Agreement shall remain in effect until the development rights are no
longer exercised. ,
21. The Town hereby grants waivers from the following zoning requirements:
i. Section 240-24.1.7 (A) Harbor District, (1) Permitted Uses, (j) Hotel
o Developer seeks waiver to allow hotel rooms with individual kitchen facilities.
Section 240-24.1:7 (C) Dimensional, bulk and other requirements
o Developer seeks waivers with regard to maximum building height (proposed-4
stories (44 feet) where only 2.5 stories are permitted), front, rear, and side-yard
setbacks (waiver of 10 foot minimum); and maximum lot coverage (waiver of 70%
- Bk 2819,9 Pg63 #25343
requirement).
iii. Section 240-52. Design and Screening standards. A.; Section 240-53.
Landscape requirements for parking lots. B. (1) (2)(3); Section 240-56 Schedule of Off-
Street Parking Requirements. _
Parking requirements
o Developer seeks relief from applicable parking requirements as follows:
o Developer seeks waivers with regards to parking lot landscaping of 10% and the
waiver of the number of required trees. Parking lot landscaping (10% of the entire site
or 6,082); Proposed is 4,898. Parking lot trees required (Parking lot of 177 spaces) 36
trees; Proposed 7.
o Developer seeks waiver of parking-lot line to lot line (waiver of 6-foot minimum)
o Parking required is 1.2 spaces per unit (245) plus (1) for each employee in largest
shift (12), or 258. Developer provides 177 spaces, 204 with approved valet (1.0 space
per unit).
o Developer seeks waiver of parking space minimum dimension requirement allowing
for smaller size spaces in certain areas on the site.
iv. Dumpster requirements:
o Developer seeks waiver from § 353-4 of the Code of the Town of Barnstable, Board
of Health Regulations "Storage of Garbage and Refuse Minimum setback for
dumpster(s) locations to lot line
V. . Chapter 112; Article III Hyannis Main Street Waterfront Historic District
Ordinance:
o Developer seeks waiver of requirement for a Certificate of Appropriateness from the
HMSWHDC guidelines.
vi. Section 240-68. Signs in the.MB-Al, MB-A2, MB-B, and HD Districts: C.
o Developer seeks waiver to exceed the maximum square footage of 50 sq ft allowed
in the district.. Developer is seeking relief under the total allowable square footage in the
HD District of 50 sq feet. Developer anticipates proposing a 35 sq ft(7' Long by 5' high)
wall sign for the North side of the building andd-a 16.5 square ft (11' Long by 1'-6" high)
wall sign on the East side of the building.
IN WITNESS WHEREOF,the parties.have hereunto caused t s A ee t to e
executed, on the day and year first above written:
Na .
Dated this d� day of --/Z/,U ,
20 4
Town of'Barnstable _ Developer/ a estors, LLC
By Thomas K. Lynch By:7 Z
n, nager
Town Manager
Develo 6r/HHH Ocean Street, LLC
By: Eugene Goldstein, Manager
. ...f .� ._....
Bk 28199 Pg64 #25343
g �
f ate Y6zme,, Oostow, ffemv"emetts 0,211y3
William Francis Galvin
Secretary of the
Commonwealth May 23,2014
TO WHOM IT MAY CONCERN:
I hereby certify that a certificate of registration of a Foreign Limited Liability Company'
was filed in this office by
HARBORVIEW HOTEL INVESTORS LLC
in accordance with the provisions of Massachusetts General Laws Chapter 156C
on February 25, 1999.
I further certify that said Limited Liability Company has filed all annual reports due
and paid all fees with respect to such reports;that said Limited Liability Company has not filed a
certificate of cancellation or withdrawal; and d that,said Limited Liability Company is in good
standing with this office.
I.also certify that the names of all managers listed in the most recent filing are:JON E.
COHEN,DOUGLAS D.COHEN
I further certify tat the name of persons authorized to act with respect to real property
instruments listed in the most recent filings are:JON E. COHEN$DOUGLAS D.COHEN
C
In testimony of which,
T have hereunto affixed the
Great Seal of the.Commonwealth
on the date first above written.
J
Secretary of the Commonwealth
Processed By:sam
{
Bk 28199 Pg65 #25343
r
M �
G 'OotizmoizzoeaU
Jlate moue,, 0artan,, ./l/�c s�sac`iu�reft 02733
William Francis Galvin
Secretary of the
Commonwealth May 22,20114
TO WHOM IT MAY CONCERN:
I hereby certify that a certificate of organization of a Limited Liability Company was
filed in this office by
HUH OCEAN STREET LLC
in accordance with the provisions of Massachusetts General.Laws Chapter 156C on November
12,2013.
I further certify that said Limited Liability Company has filed all annual reports due and
paid all fees with respect to such reports;that said Limited Liability Company has not filed a
certificate of cancellation or withdrawal;and that said Limited Liability.Company is in good
standing with this office..
I also certify that the names of all managers listed in the most recent filing are: EUGENE
GOLDSTEIN
I further certify,the names of all persons authorized to execute documents filed with this
office and listed in the most recent filing are:EUGENE GOLDSTEIN
The names of all persons authorized to act with respect to real property listed in the most
recent filing are:EUGENE GOLDSTEIN
In testimony of which,
I have hereunto affixed the
r
Great Seal of the Commonwealth
on the date first above written.
Secretary of the Commonwealth
Processed By:sam _
BARNSTABLE REGISTRY OF DEEDS
THE Barnstable
Of raY
The Town -of Barnstable
BA MASS. All-America.CityLE, :
9 MASS. g .Growth Management Department
1639.
vMAC�,e 200 Main Street,Hyannis,MA 02601
Office: 508-862-4786 Jo Anne Miller Buntich ® .
Fax: 508-862-4784 Interim Director
2007
December 15, 2008
Mr. Anthony Folino, Jr.
24 Nantucket Street <I
Hyannis, MA 02601
RE: Informal Site Plan Review 048-08 - Redevelopment of_2 Nantucket`Streetn
r-Wyannis '
Dear Mr. Folino:
The above proposal was briefly reviewed by members of the Site Plan Review
Committee and-.this letter reflects that limited.review. In order to fully evaluate the
proposal, especially in terms of accessory uses, an engineered proposed site plan
depicting all of the involved lots may be required.
With respect to the "Schematic Design plan submitted, Town standards are; one
curb-cut per lot not exceeding 24 feet wide, all new construction including utilities
shall be elevated to not less than base flood elevation, parking shall-be designed so
vehicles need.not back onto a public way and a front yard landscaped setback of 10
feet.is required for this District. The District regulations also set parking and sites
design standards that include landscaping and parking locatioh.
In regards to the proposed land use(s), it cannot be permitted as-of-right under the-
Harbor District Zoning regulations (§ 240-24.1.7). Initial review suggests that two
variances maybe required. One from Section 240-24.1..7.A(1), provision "o" that
requires "all residential units [to be] located above the ground floor only", and a
second from Section 240-24.1.7.B(2) that limits multifamily development to "hot
more than seven units per acre." .Variance relief can only be granted by the on'ingcm CD
Board'of Appeals, and iris customary for staff to discourage variances from zgning.
A second permitting option may exist with respect to the proposed land u _issue
and perhaps certain site plan conditions. The property'is within the Growth -0
Incentive Zone and therefore may qualify for Regulatory Agreement a s pA ided s u}
for in Chapter 168 of the Code of the Town of Barnstable. In essence, this is N j
contract agreement between the developer and the Town.` c? r`.—
co m
y
In addition, the proposed redevelopment appears to trigger the Iriclusionary
Affordable Housing Requirements of Chapter 9 Article 1 of the Code of Barnstable.
The information contained.is preliminary only and not intended as a comprehensive
review. The decision of how to proceed lies with the applicant and their
consultants. Final determination for compliance to zoning is not made-until a full
and"completed application to the Building Division for building permit is made. If
you have any further questions, please call me at 508-862-409:
Sincerely
Ellen Swiniarski
Site Plan/Regulatory Review Coordinator
Copy: Tom Perry, Building Commissioner
JoAnne Buntich, Interim Director,Growth Management Dept.
Art Traczyk, Regulatory Review Planner/ZBA
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
of ,
Map � Yam. Parcel y Application# �UDI/ �val
Health Division Date Issued. i t b
Conservation Division Application fee
Tax Collector Permit Fee
Treasurer
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Rroject-Street--Address ��/ ��'������ �1���'�vr,� �"�$� eyC.0
,,,-Trelephone--_s049 94/ 777-1
Permit-Request �i�f'y7� �' �� � O��i� A6exrr
wk
Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new /
Zoning District lv5 Flood Plain kA5 Groundwater Overlay
�ProjectlVa(uatiom 'drCC� Construction Type
Lot Size 790U Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family id" Two Family ❑ Multi-Family(#units)
Age of Existing Structure 19,1qa3 Historic House: ❑Yes ANo On Old Kings ighway:�:]Yes'
❑No
Basement Type: J4411 ❑Crawl ❑Walkout ❑Other '
c
Basement Finished Area(sq.ft.) �� Basement Unfinished Area(sq.f IT-00
Number of Baths: Full:existing new Half:existing new:;
Number of Bedrooms: existing 3 new
Total Room Count(not including baths):existing new First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Electric ❑Other
Central Air: ❑Yes 00' Fireplaces: Existing New Existing wood/coal stove: ❑Yes
N11&Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size
AA 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
o BUILDER INFORMATION
CName---J Telephone Number 36/ 777
r�
Address- G✓�i�v v���i�v �/�� Z1A1;;7� License# 6 5 01
�litB/ /s-9S5 a�'a/ Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATU DATE
J
Y
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED fir`
k ol
MAP/PARCEL NO. ,
ADDRESS - VILLAGE ° 0
OWNER
0- J.
DATE OF INSPECTION: f
FOUNDATION
FRAME -
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
-
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT '
ASSOCIATION PLAN NO. ,
s, _
y
n
L
4.
' The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,M4 02111'
wfdw.massgov/dia '
Workers'Compensation 14surdnce Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organi=tionadividual): 4 y
id�.re s s•
City/StatejZip: Phone.#:
Are you an employer?Check the appropriate box: :Type,of project(required):,
4. I an a general contractor and I
1.❑ I am a employer with 6. ❑New construction .
y employees(full and/or part-time).*• have hiredthesob-contractors
4 ':'am a'sole proprietor or partner- listed on he'attached sheet 7. ❑Remodeling
ship and have no employes . These sub-contractors have S. ❑Demolition,
4 '*orldng for me in any capacity. employees3 and have workers'
P i tY ina„rxn #' 9. ❑But1dmg addition
[No workers' comp,itGM= comp, or 10.0•Electrical repairs or additions
5. �] We are a corporation and its
wed officers have exercised their 11.❑Plumbing repairs or additions '
3 I am.a homeowner doing all-work . g F
myself[No workers' ccmF. right b f exemption per MGL t 12.(]Roof repairs,
insurance.required.]t c. 152, §1(4),and we have no
j employees. [No workers' 13.❑Other
comp,insurance required•]
*Any epplieant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowoemy6o submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now affidavit indicating i;uch. s
$Contractors that check this box must attached on additional sheet showing the name of the sub-contractors and state whether ornot those entities have
employees, If the sub-contractors have employees,they must providb their worker,comp.pofidy number.
I ani an employer that is provldb%workers'compensation insurance for my employees. Below isthe policy and job site'
information.
Insurance Company Name:
Policy#or Self-ins.Lic.M Expiration Date: I
rob Site Address: �/ �t/� �•�•G� City/State/Zip:
Attach a copy of the workers'compensation policy declarafion page(showing the policy number and expiration date).
Failure,to secure coverage as required pndex Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine tip t0$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK,ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the-Office of
Investigations of the 1)IA for ins n—oe coverage verification
Ida hereby certify under the pains•and penalties of perjury that the information provided abovvg is true and correct
Si afore: Date: //! D
Phone �d �7�7
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):
J.Board of Health 2.Building Department 3. City/Town Clerk 4.EIectrical Inspector 5,Plumbing Inspector
6. Other
Contact Persow, •Phone#:
Information and In s tructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
.Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6).also states that"every state or local licensing agency shall'withhold.the issuance or
renewal of a license'or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for,the performance of public work until acceptable evidence of compliance 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(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
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 maybe provided to the
applicant as proof that a valid affidavit is`on file for future permits-or licenses. Anew affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
-''• The Commonwealth of Massachusetts 4.
Department of Industrial Accidents
Office of Investigations ,
600 Washington Street
Boston,MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 11-22-06 Fax#617-727-7749
www.mass.gov/dia
T.
Town of Barnstable
�OF'It HE tp��
Regulatory Services
BARNSrABLE, Thomas F.Geiler,Director
9 MA9S
q,,, i639• p.0 Building Division
rfD MA't .
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601 .-
www.town.barnstable.ma.us
Office: 508-8624038 Fax: 508-790-'6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION: / � Nds
number street .y village
"HOMEOWNER': A1.6r�U�/ J /��/��st�(1 �� � 6,6/p 7/7 _ ✓Og -77 577/1
name ! homephone# work phone#
CURRENT MAILING ADDRESS: �� /�d/v�r/ "" 464
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dw ni ellings of six uts or less and
to allow homeowners to engage an individual•forhire 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 B'dilding.Offrcial,�that he/she shall be
responsible for all such work performed under the building permit'. (Section 109.1:1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department,
minimum inspection procedures and requirements and that he/she will comply with said procedures and. .'**•
requirements. �, ` ,,:•, �, '`,, ,-'`
Signature of weer
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
` of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may caret amend and adopt such a form/certification for use in your community.
Q:for ms:homeexempt »
oF'THE T Town of Barnstable
ti
Regulatory Services
• SNAM AMSTABLK Thomas F.Geiler,Director
039.
Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-8624038 Fax: 508-790-6230
Property Owner Must
Complete and Sigu This Se on
,� If"Using A Builder,
1-5 Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by • uilding permit application for:
(Address o Job)
ignature Date
Print Name
If Propefty Own is applying for permit please complete the
Homeowners Ycense Exemption Form on the reverse side.
QTORM&OWNERPERMISSION
gvq�-
HIAl
7
���al�d,► jJr��a,� �rVa�G -
` Y
r goox,
e���
kYV57
APPLICANT.. FoLmo
TO WA I HYAmmrs
{ I.
ASSESS
73, 78, LOT 35
C % BY PLAN 85 115
h l, s
CQ
,.;,.Ur�r A., Col
0 p iii 11�.JL� #,2`t,i' BY PLAN _
�,
ASSE-`S.
LOT'1—
T �
ASSESS. o
LOT 33
BY PLAN•jo7133 36:00'
BY CALL.
NANT UC fE S'TR�'�T.
� 4
NOTES
q n�
I)PRE-EXISTING, NONCONFORMING '
2)DEED HAS NO DESCRIPTION OF LOT. LOT DRAIIIN FROM 1�4
ABUTTERS PLANS AND ASSESSORS MAP. q ! ^
3)ASSESSORS MAP DIFFERS FROM ABUTTERS PLANS
RECOMMENDATIONS e -'
1)AN INSTRUMENT SURVEY FOR THE PURPOSE
OF DETERMINING PROPERTY LXES ®� ®ro
2)PREPARATION OF A PLAN SUITABLE
FOR RECORDING AT THE REGISTRY OF DEEDS
FLOOD PANEL: 250001 _00_06_DFLOOD ZONE DATED i%2192 `
1 hereby certify that this mortgage inspection plan was prepared for.- Plan is For
STEVEN J PIZZUTI ESQUIRE Bank use Only
'he location of the building shown does --_--- fall within a special flood hazard zone. PLAN REF. = SEE NOTES
The location of the dwelling does ------ conform to the local zoning by-laws in effect Scale 1 30 6t the time of construction with respect to horizontal dimensional setback requirements — -----
cr is exempt from violation enforcement action under Mass. General La ws Ch. 40A -Sec. % Da te.' 1118�04
1PLEASE MOTE The structures on this inspection were located by tape not instrument and are approximate only. An actual survey is necessary
for a precise determination of the building location and encroachments, if any exist, either way across property lines. This inspection must not
be used for recording purposes or for use in preparing deed descriptions and must not be used for variance or building plan purposes. This
inspection must not be used to locate property lines. Verification of building locations, property line dimensions, fences or lot configuration can
orly be accomplished by an accurate instrument survey which may reflect different information than what is shown hereon. T,}is inspection is not
1"o be used for any purposes other than mortgage. Yankee Survey accepts no responsibility for damages resulting from said reliance.
YANKEE, iSUR VEY � CONSUL TANTS FA;Z 508-420-5553
Lax
.265, 40 INDUSTRY RD, MARSTONS MILLS, MA 02648 PHONE'508-4,26-0055 3ZF06 JS
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 2r •C�—
(� Parcel Permit# r �2 J
_`- -
Health Division � Date Issued Z 12 G
Conservation Division :Fee 2.v:
Tax Collector L
Treasurer �� �� cs2 c.� /�1�/l,�l�°
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address UV'A__d C,U_t
Village 1 >
Owner S Address
Telephone
Permit Request G- o
ell
Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new
Valuation X�0 Zoning District Flood Plain Groundwater Overlay
Construction Type '
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic Houser ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing new
Total Room Count(not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric 0 Other
Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size Pool: 0 existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑ No If yes, site plan review#
"Current Use Proposed Use
BUILDER INFORMATION
L�
Name b'�-� Telephone Number T J ?i2
Address C6 S License# J > O
�-P 0JJ S of Home Improvement Contractor# Z 7
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 0_V'gJQ
SIGNATURE DATE
s;
+ FOR OFFICIAL USE ONLY _
PERMIT NO.
DATE ISSUED
si MAP/PARCEL NO. .
ADDRESS VILLAGE
OWNER
;4 DATE OF INSPECTION:
- FOUNDATION
FRAME
i
` INSULATION
;y FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL `
I GAS: ROUGH FINAL
!C
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO. --
r
,r
ws
The Commonwealth of Massachusetts
Department of Industrial Accidents
• �"" � �=�'- , =� ; Ofliceol/ayest/gatioos
600 Washington Street
Boston,Mass. 02111
Workers' Co m ensation Insurance Affidavit
name:
location:
city phone#
❑ I.am a homeowner performing all work myself.
❑ I am a sole proprietor and have no one worlds is nay acity
y / /////%/ % ��VEX'
I am an employer providing workers' compensation for my employees working on this job.
comoanv name.
..: :::..:.
::..:: :
:...:.::..::.:>;:-;:-:<.;.;;;;:;:.:;..;.:::::::............................:.:::::.......:.....:..::.:::::::::::.:.:.....:.::....................::.::-:.::.::::...
address.::::.... . ....:..
insttraace,co:;..... _.... ... -: . .:..:;:,. : ::::.;:..,:.;...;:.::::,,,.,;,<.; oiit:v
❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who
have
the following workers compensation polices:
;::.:- :. .
::::;:.::.:-::;.:;:..;:.:..:..::.;:...;:::..:::.::.: ..:..:..::::::::::.:::...:
tom auvname. ........................- ...::;;;;;::;.: ::.: :
Srii`? >�i�5�tY�>???'i�?`}k''<'i� s�?tciiyyc% '? ? t '?%i'?�Y° ><r`t%'' k<'i�ii2'�iis�% 2r < i..
::•::::::...................................................................................... ...:.... ,..........
..............................................................................................................................
CitY:,::,.......:..:...... ......:. ,:.... 11 One
..................... ::::.�:::•.�::::.:�::::::::::::......:::::::•:::::.:::::.�:::::.�:.�.,::::.�::::..,....a.......
ttaore nce.ca.. . .... ........ . ........ ........
.... ..._..�:::.,:::.:.�:::•:..
............ ....._. _.......... .. ... ...........................
...:......::::::.::::.:.::..:::;::::....:...:....,................:..:..:..:::..:::.:::::.:._::.:;<.::::;::;.:::..
:::..........................:..::::::::. :::::::.::._:.:::....:............:...:::::..:::::•:::..:::.::::::::::::.:::::::.::.::.:::::..:.............................::::.::::::...:.....................::::::.::::::.:::::::::::.::..................
...................... .:::::.:::::.:::::::..:....:::.::.:.:..:::::.:.:::::::::::.:::::.:::::.:..:::::•::::.::::::::::::...:.::..:.::..:........................................:.:::._::::::::::.:::::.::::::::::::::::::::::.:..:.........................:..:
.....-.:_::::...:.
:ranmamRname: ;
address..
............... ::::.
................. ................................................. :....
... .:....e.pt;;::::[ }[;::;: i [? ?':a± <t t:?>t �i`''i2£ t<<<'`.....2+
;... ...........::::. ::: :.<:.:.:;.:.:.. :.:::...:,:.:;::;.:.;::;.:.;•.:;:::<;:.;:;:;::>::�::>;::: ,hies ii..:..........
::.............................................................................................I ..........
, ::::.::...:.:................, olicv
///..
FaOare to secure coverage as required under Section 2SA of MGL 152 can lead to the imposition of crladnal penalttn of a fine up to S1.Smoo and/or
one years'imprisonment as well as civil penalties in the forest of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a
copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verincation.
I do ha y c fy the pains and airs of p that the information provided above is tru'and correct
Si gns Date
Print name tP�'��- Phone#
ajj�;
ofirdai use only do not write in this area to be completed by city or town ofdal
city or town: peradt/llcwe# QBnnilding Department
❑Licensing Board
❑checkif Immediate response is required [:]Selectmen's Ofte
❑Health Department
contact person: phone#; ❑Other
UrYswd 9/95 P1A)
n
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 Iicensing 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,neitherthe
commonwealth nor any of its political subdivisions shall enter into any coact 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.
A"pplicants
=P l sse fill in the workers' compensation affidavit completely,by checking the box that applies to your situatiam and
'j, lying company names,address and phone numbers along with a certificate of insurance as all affidavits may be
, ,n
submitted to the Department of Industrial Accidents for capon of insurance coverage. Also be sure to sign and
Sate the affidavit. The affidavit should be returned to the city or town that the application for the pemut or license is
oeing requested,not the Department of Industrial Accidents. Shmld you have any questions regarding the"law"or if you
Ire required to obtain a workers compensatici policy,please call the Department at the number listed below.
--ity or Towns
'lease be sure that the affidavit is completo 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
)e sure to fill in the penmiUlicease member which wM be used as a reference number. The affidavits may be returfiR io
as Department by maul or FAX unless other airaagements have been made.
he Office of Investigations would Mce to thank you in advance for you cooperation and should you have any questions.
,lease do not hesitate to give us a call.
he Department's address,telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
0MC0 of Invesugatlons
600 Washington Street
Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617) 7274900 eat. 406, 409 or 375
• CF TF1E T� m
. . �= The Town of Barnstable
&AMSTABL&
MASS. �0� Regulatory Services
1°rEo 59. Thomas F. Geiler, Director
Building Division
Elbert Ulshoeffer, Building Commissioner
367 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: V Estimated Cost C)O,/ `DO
Address of Work:
Owner's Name:
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.
IGNED UNDER PE ALTIES OF PERJURY
I hereby apply for a permit s th a ent the owne
Date Contractor Name Registration No.
OR
Date Owner's Name
q:forms:Affidav
V,
r.
BOARD OF BUILDING REGULATION:
License: CONSTRUCTION SUPERVISOR ,
Number•:: CS 073387
Birth dafe1O/2911954
Eires�1`Q129/2002 Tr. no: 73387
Re tiGited.To: 00 i.
DONAL-D-A C.OX JR .,t
322'UNCOLN RD A '
HYANNIS, MA 02601 Administrator
` r
HOME IMPROVEMENT CONTRACTOR
Registration 127829
Type - INDIVIDUAL
Expiration 01/12/01
DONALD A. COX, JR.
322 LINCOLN RD
NIS MA 02601
ADMINISTRATOR
M1