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0043 POTTER AVENUE
f Town of Barnstable 00HE rod Regulatory. Service v-m or- BA11 HISS i i.E Thomas F. Geiler,Director • Building Division ip $ ; BARNSTABLE, ■ y MASS. $ Tom Perry, Building Commissioner o19. A. 200 Main Street, Hyannis,MA 0260( www.to�vn.barnstable.ma.u-s."-r i111 Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: P-j s. Permit#: -`-t HOME OCCUPATION'REGISTRATION Date: 5''1 Maine: Phone V!5 Address: -QQ O r-ncl Wyz Village: Nanie of Business:__�� --�L �� � � ----------=---------- Type Of Business: GL'1W/I/�N� INTENT: It is the intent of this section to allow the'residents of the"hoa•dn of Barnstable to operate a home oecupatiort tiithill;single family dwellings,subject to the provisiotis of Section 4-1.4 of the Zoning ordinance, provided that the activity shall not be cliscernible front outside the divelling: there shall be no iuc'rc;se in noise or odor;uo visual alteration to the premises_wluch Would suggest Anything other than a residential use;no increase in traffic above Normal residential volumes; and no increase'n air or undwater pollution. After registration airith the Building Inspector,;i customary lionie:occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by[lie pernianrif resident of a single funily residential dwelling unit, located avitlaiil that clivelliug unit.. Such use_occupies no more thail 400 square feet of space. There are rio external alte.tatioirs to the dwelling,which are not customary in reside-ritial buildings, ind there is no outside evidetice of such use. No traffic will be geterated iu excess of normal residential volumes. • The use(toes not.involve the production of offensive noise, vibration,sllloke, dust or oilier jw-ticular m;ttter, odors,electrical disturbance,lleat,glare, humielity or other objectionable effects.. • These is'no'storlge or use of toxic or li nv-dous maten ds, or fl;inlnlable or explosive materials, in excess of norni2d household quantities. • Any need for parking generated by such use shall be Met on the same lot colltaiuitlg the Customary Home Occupation,mcl not within flee required front yard. • There is no exterior storage oi•display of niaterials or equipment. • There are no c•ominercial vehicles related to the Custcinlary Honle Occupation, other than one tau or orle pick-up truck not to exceed ogle.ton capacity,arld one tl-,liler not to exceed 20 feet injleiijh and not to exceed d fil=es,parked on the swine lot containing the Customary Honie Occ•upatiou: • No sign shall lie displayed i`ulicating the Customary Home Occupation. If the Custoni;uy Honle Occupation is listed rir advertised is a business,the street adds- ss shall not be included. . • No persoi shall be eniployed in the Custolin2u-y Horlte OCCUI)arion la•lul ins• ot;a pCllllalrClit resident of the ' .darellirrg unit,,: � 1, the undersigned, have read and agree tittle the whore restr-ii•tions'lor my home oa-upation I aril registerilr Applleailt: u �� ��d/l/ Date:' YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to bperate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) 19 4� fF DATE: Vd Fill in please: APPLICANT'S YOUR NAME/S: 11AAr, U1✓ BUSINESS YOUR HOME ADDRESS: '� V ,Q•�/ SIWA TELEPHONE # Home Telephone Number Sd NAME OF CORPORATION: AL NAME OF NEW BUSINESS H 1 — Yl` C Vj C TYPE OF BUSINESS tl-tecxn i n ' log z bjlpw ©rf1ce IS THIS A HOME OCCUPATION? V YES N ADDRESS OF BUSINESS 4- ;7cdt'T2r d I e ut MAP/PARCEL NUMBER (Assessing) 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. You MUST GO TO 200 Main St. (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMM SIGNER'S OPF�F, E This individual h bln�infcr o an per it requirements that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION u igfaatu * RULES AN[� REGULATIONS. FAILURE TO C MMEN S NES. �- , 2. BOARD OF HEALTH This individual has been in je of, he permit requirements that pertain to this type of business.. �— -�"�► t MUST COMPLY WITH ALL Authorized Signature** 107ARDOUS MATERIALS REGUI_A.7r)M;. COMMENTS: 3. CONSUMER AFFAIRS (LICENSIN AUTHORITY) This individual has bgwi info d f e licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: �'^ /ik�A^90M f ,f yy�-�.�_ .. a.a.,-„•� ,!i`� y� _�T�S F.� , - _ _ ' TyVek.- Tvvek Tyve HomeMap µomeW�a '.!R V, W�. - yy AN7HONVSPAFO x C.vU 1l'� CvN�S��►vN .. Town of Barnstable Geographic Information System w— September 15,2010 308279' SOUTH ST % 308063 #712 „. - _._ .,,w "•, .w__. _ ,:... 308001002 308002001 CND X v +� s #746 N'" 308�152 308161 308153�V8164 308162 f t 308283CNDx #70i�f#701 #539`' #535 #525 '` c 30800308165 #20002�ND #724 �'✓' j. �308145 1 s M1�30R001001 I R..,_ ... i #776 308150 Q 308164 308161 CND 11140 8� ,,."� •- ,r".,. 308143 �^"• #725 q[�y 308147 � O u � , .�^ 1 � 308166 ` � - #17 } 308155 308160 #24 r. 308170 _I y ii #24 #25 v W , _ 308148 1 RT38167 ,#33 36 308156 08159 290098 N n #765 #34 #35 308168 , --® #40 308149 3#849 #43` [{ 308157 308158 f § #64 J #45i _, §§ i 308169 ® ' „m 4✓ tC t #44 �.,._.�� ,.a... .:.,,.....m,. . ... ._ w. MAPLE AVE a i #67 307085 .[ 307083 30715 �y t i r 307084 #11 i ?? 3070L_' #45 '#15 ; , � ® 3070 6 307075 p, 13 #32 6 #7 07 307078 #14 - 307088 #53 #44 „ 289110 1 M. SUMM6R$1DE IN #35 „1 307070 a 307069 ®307074 T #25 � ;#19a 307 a 307071 Ell7k 307066 4 035 - #10197... #119 ' 307073 307072 #60 .. Feet ; #86 3# 2 5 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal' Map:308' Parcel:149 - Selected PBfCeI a Owner:AYLWARD,PHILLIP T&WENDY G Total Asses boundary determination or regulatory interpretation. Enlargements beyond a scale of Assessed Value:$305700 1"=100'may not meet established map accuracy standards. The parcel lines on this map j � � � , are only graphic representations of Assessors tax parcels. They are not true property Co-Owner: - Acreage:0.32 acres .Abutters boundaries and do not represent accurate relationships to physical features on the map Location:43 POTTER AVENUE such as building locations. Buffer 1 O ( OvSO�l mot► , Town of Barnstableermit# P� Expires 6 mont om issue e s * Regulatory Services Fee * * * SARNSPASL& >aass' Thomas F.Geiler,Director PERMIT Building Division SEP 2 T Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 ,TOWN OF BARNST.ABLE www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number :�10 fj�/ 43IF Property Address V r&11F— I A aN.4s 5 /V Residential Value of Work -zi Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address F,�v �'/� `, 6/� `'I✓ `7' Contractor's Name _ Telephone Number Home Improvement Contractor License-#(if applicable)--_^ Construction,Supervisor's.License-#-(if applicable) - ❑Workman's Compensation-Insurance - Check one: ❑ I am a sole proprietor I am the Homeowner - ❑ I have Worker's Compensation Insurance f-`Insurance-CompanyName � ,. 4 ��Qf67Y .d/ ell r Workman's Comp:Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be to ❑Re-roof(not stripping. Going over existing layers of roof) t r Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement.Contractors License& Construction Supervisors License is required. SIGNATURE: 17,A2' Q:\WP ILESTO S\building permit forms\EXPRESS.doc Revised 090809 Town rot Barnstable, P�OpIKE t ti A Regulatory Services + .Thomas F.'Geller;,Director BARNSTABLE, • ?; '`6A� Building Division y� i63 9. `�� p AlFD � Tom Perry,Building Commissioner" 200 Main Street; Hyannis,MA 02601 www.town.barnstable.ma.us' Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 1?4 'A i'l ^ JOB LOCATION: number street village "HOMEOWNER":��i`Y ✓��/ (J �c�L'> /J name home phone#f work phone#1 CURRENT MAILING ADDRESS: 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 to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER , Person(s)who owris a parcel of land on which he/she resides or.intends'to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures-accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner, Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under.the b iilding 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 be/ understands the Town of Barnstable Building Department minimum inspection procedures and r quirements and that he/she will comply with said procedures and requir en • �.• • .� .. y � ' Signaturebf omeowne t � Approval of Building Official J R Note: Three-family dwellingson ctaining,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 dosuch 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 resuhs in serious problems,pahkularly 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 care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORM S\homeex empt.DOC £ ' t i OFIKErp� Town of Barnstable Regulatory Services � r ' 7ARNSPABLE. ' Thomas F. Geiler,Director Mass 059.,a`g� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4 8 Fax: 508-740-6230 Property Owner Must Complete and This Section- if U r A Builder ,.as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorize by this building perrrut applica tion for: i 7f (Address o Jo Signature of ate T5 Z�4z�p Lu1ARV Print Name if Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:F0FJY1S:OWNERPERM1SS10N The Commonwealth ofVlassachusetts Department of Industrial-Accidents d Office of Investigations 600 Washington Street Boston, MA 02111 . _10M.inass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lefibly Name (Business/Organizaiion/Individual):;-�3 /�)P d ZwA T Address: r1Q City/State/Zip: _ Phone,#: ! b� Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I b. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7.'❑Remodeling ship and have no employees These sub-contractors have g. []Demolition working for me in any capacity, employees and have workers' 9 Building addition [No workers' comp. insurance comp.insurance.# required.] 5. [� We are a corporation and its 10.❑ Electrical repairs or additions 3 I required.] a homeowner doing all work officers have exercised their I I.0 Plumbing repairs or additions right of exemption per MGL . ,..._. ..., _ ...12.ORoof.repairs,......... . .. _. .._.._.._ insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.� Other F comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Na�;� — Policy#or Self=ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as 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. 1 do hereby certi under the pains and penalties ofperjury that the information provided ab ve is tru and correct. r) Signature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical lnspector�5. Plumbing Inspector 6. Other Information and Instructions Massachusetts General Laws chapter 152 requires all employersto provide workers compensation for,their employe es. 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 numbers) along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships (LLP)with no employees other than the -4 members or partners,are not required to carry workers compensation insurance If an LLC of I T P does have employees, a policy is required. Be advised that this affidavit 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 license is being requested,not the Department of industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. . City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may"be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum 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 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE .Fax 4 617-727-7749 Revised 4-24-07 www.mass.gov/dia