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rTown of Barnstable
Building Department
ComplainVInquiry Report
Date G/ Rec'd by: Assessor's No.
d�� —ri0
lo
Complaint Name:
Locationd
Address:
M/P
Originator Natne: 7 7/
e
Street:
Village: State: Zip:
Telephone: D/E
Complaint
Description: !� G
Inquiry
Description:
s
For Office Use Only
Inspector's
Action/Comments Date:I CL_ Inspector.
d�)Ls < <'l �`.
Follow-up
.Action (,)I qd U\ - V► 3 A4
)ZV
Additional Info. Attached
Cop}•Distribution: White-Departrnent Fde
Yellow-Inspector
Pink-Inspector(Return to office Manager)
l .
® Conservation Office(4th floor)(8:30-9:30/1:00- •`00) •� �,� Date Issued �'�8 'q(�
02 Board of Health 3rd floor) 8:15 -9:30/1:00-4:45 � e ..,
Engineering Dept.(3rd floor) House# F ",„ 1� NCE
oor Schoo m. g. f E ME AND
e y an 19 �rU M, R-1 d "
EOIM�a
TOWN OF BARNSTABLL
Building Permit AP Dlication
P t Street dress ICJ
Village
StF�'R,xqN `
Owner 4aAddress
Telephone 9
.i
Permit Request ;
First Floor square feet
Second Floor square feet
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use
Construction Type
Commercial Residential
Dwelling Type: Single Family Two Family . Multi-Family
Age of Existing Structure JEW -f-13) Basement Type: Finished
Historic House Af0 Unfinished
Old King's Highway Afd
Number of Baths d2 No.of Bedrooms 3
Total Room Count(not including baths) (p First Floor
Heat Type and Fuel �_ Central Air Fireplaces /
Garage: Detached Other Detached Structures: Pool
Attached / Barn
None Sheds
Other
Builder Information
Name Telephone Number
Address License#
Home Improvement Contractor#
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY -
P RMIT NO. -
TE ISSUED
P/PARCEL NO.!' �
ADDRESS = VILLAGE j
OLER
DATE OF INSPECTION: r _
FOUNDATION
FRAME. r
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL _
GAS: ° 'ROUGH FINAL
FINAL BUILDING:;
T
DATE CLOSEIC0UTt:; '
ASSOCIATION:FLAN:-NO. } ;
f? ,
The Cunnytonwealtb of Massachusetts '
-- M: Dcpartmcmt of Industrial-Accidents
:1 ONee ollwestlgafluff
HIM— ;?` 600 If=li111r.fair Strect
Briton,Mass. 02111
Workers' Compensation Insumnee.Afriidavit
name:
Sky / phone# 21 — -7991
(am a h&neowner performing all work myself. '
I am`a sole proprietor and have no one working in any capacity `
0 1 am an emplover providing workers' compensation for my employees working on this job.
cnmoanv nnme:
nddresse
city: phone#•
insurance cn_ nolicy#
I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who havc
the following workers' compensation polices:
company name:
address•
ci •: phone#�
��
ins�� ��rn��nce cn__ policy
f-:7 'N.7.+7.�.- '.. Y!1•.y 1lL.'.11�Q�'�7'!�":�• �1�► .�.a'�.15 _ • r .�� �i ��'-• -• - - !-�
ctimpanv name:
nddress•
city: #:
insurance co- policy#
:Atinch additidnal'sheet if tiecessa .-'_yam" - +"�-�+" ±a rw:-J•..;:.fT —.,�
failure io secure coverage as re under Section 3A of AfGL 152 can lead to the imposition of[!'initial penalties of a fine up to6l'�0 0 and/or
une •ears'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. l understand that a
copy of this statement mad•be forwarded to the Once of investigations of the D1A for coverage verification.
I do hereby cerd y under the pains and penalties of peduty that the information pm ded above is ime and corrrect
Signatu � o. � Y Date a/ < ��
Print name/_ 1 ) 1 I� Phone# 5��� ' 7 71
official use only do not write in this area to be completed by city or town official
city or town: permit/license# rif3uilding Department
(3trcensing Board `
p check if immediate response is required 13Seiectmen's Office
Dlleaitb Department
contact person: phone#; MOther
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for their '
employees. As'quoted from the "law", an emplmree is defined as every person in the ,crvice of another wtdcr any
contract of-hire• express or implied• oral or,.+Titten.
An emplmrer is defined as an individual• partnership,association. corporation or other :-gal entity, or any two or more of
the form- in 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 Douse
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 1'S2 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 common-Wealth 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.
. .r •.::.s.«. :�� !: +�^�.,ij •�.,... .� fir^ v.• e• � _ ,r-'i
-tPPlicants
?lease fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names. address and phone numbers as all affidavits may be submitted to the Department of
ndustrial Accidents for confirmation of insurance coverage. Also be sure to sibs and date tlic affida�•it. 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 for
regarding the"law" or if you are required
co obtain a workers' compensation policy,please call the Department at the number listed below.
.. ......•....^.. ...i:.^ :: ...•: — ur.•,r .wi.t.97i!�' ..�w...:..•.rausa';%�:1'�>.i
:ity or Towns
'lease be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
he 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 permit/license number which will be used as a reference number. The affidavits may be returned to
he Department by mail or FAX unless other arrangements have been made.
'he Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
)lease do not hesitate to give us a call.
..,s..�.,. .
.. •�i ��•.r. ••M�'.:..ti.i+... 1 ^•� µ�'R• mow..F':•'::�
i he Department's address, telephone and fax number.
The Commonwealth Of Massachusetts
- Department of Industrial Accidents
Office of Investigations
600 Washinaton Street
Boston,Ma. 02111
fax#: (617) 727-7749
phone#: (617) 7274900 cat. 406, 409 or 375
. . The Town of Barnstable
eg Department of Health Safety and Environmental Services9. Building Division
367 Main Street,Hyannis MA 02601
Ralph Cmssea
Office: 508-790.6227 Building Commis
F= 508 775-33"
For office use only
Permit no._
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruaron,aiterations,renovation,repair,modernization,conversion,
imprwemcm.removal, demolition, or construction of an addition to any pte-aasdng owner occupied
building containing at least one but not more than four dwelling units or to structures which weadjacent
to such residence or building be done by registered contractors,with certain c=ptions, along with other
requirements.
Type of Work: Est Cost /2-6- 60
CAI
Address of Work:
0%mer.Name: �-�--
Date of permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law
ob under S1,000
Building not owner-ooarpied
Owner pulling own permit
Notice is hereby green that:
OWNERS PULLING THEIROWN PERMIT OR DEALING WIIHUNItEGISfF11ED 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 PERTURY
I hereby apply for a permit as the agent of the Owner-
Date Contractor name Registration Na
OR
1�- - to
n,,eOwner's name
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Town of Barnstable
Building Department
ComplainyInquiry Report
Date:
- 9 Rec'd by: Assessor's No.-Jo Lao 3
Complaint Natne: 4 �
Location
Address: c�
Originator Name:
Street:
Village: State: Zip:
Telephone: D/E
Complaint a . � e
Description:
Inquiry
Description:
For Of ce Use Only
,
Inspector's Z4 Q
Action/Comments Date: I U Inspector.
eA
Follow-up
Action
Additional Info. Attaclied
Cop),Disa budon: 147ute-Department File
S le,IV-jnsPector
Town of Barnstable �O
A roved Regulatory Services TOWN oF. ,BARNSTABLE
PP
Fee 0 d Thomas F.Geiler,Director 2002 DEC 19 PM 2: 2 7
Building Division
Tom Perry,Building Commissioner r
200 Main Street, Hyannis,MA 02601 01V S1-0
Office: 508-862-4038 Fax: 508-790-6230
e, Home Occupation Registration
Date: /o - o�b ls�-
Name:���� Tk �` Phone#: S I>V - 77/ D2�V f
Village:
Address:
Name of Business: a e
�A McTA ,
Type of Business: n d'A D Map/Lot:A0 C!50
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. 4�
• 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:
Ll.,m ring