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The. Town of Barnstable
Department of Health Safety and Environmental Services
059.
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
July 20,2000
Paul R.Tardif,Esquire
Ardito,Sweeney,Stusse,Robertson&Dupuy,P.C.
Mattacheese Professional Building
25 Mid-Tech Drive,Suite C
West Yarmouth,MA 02673
Dear Attorney Tardif:
I received your letter of July 14,2000 and your rendition concerning this two-family home with one house
manager. This is,in my opinion,in full compliance with zoning.
Best of luck.
Sincerely,
Ralph M.Crossen
Building Commissioner
RMC:cah
g000720b
ARDITO, SWEENEY,STUSSE,ROBERTSON & DUPUY,P.C.
ATTORNEYS AT LAW
MATTACHEESE PROFESSIONAL BUILDING
25 MID-TECH DRIVE,SUITE C
WEST YARMOUTH,MASSACHUSETTS 02673
EDWARD J.SWEENEY,JR. TELEPHONE(508)775-3433 RICHARD P.MORSE,JR.
MICHAEL B.STUSSE FAX(508)790-4778 BETSY NEWELL
DONNA M.ROBERTSON PAUL R.TARDIF'
MATTHEW J.DUPUY
CHARLES M.SABATT
CHARLES J.ARDITO,P.C.
"also admitted in MAINE
PLEASE REFER TO
FILE NUMBER
8184
July 14,2000
Ralph Crossen,Building:lnspector
Town of Barnstable
Building Department
P. O.Box 546
Barnstable, MA 02630
Re: 391 South Street,Hyannis,Massachusetts
Zoning District - RB
Dear Mr. Crossen:
It was a pleasure speaking with you on July 5,2000 regarding the status of the property at
391 South Street in Hyannis.
Please be advised that my client, Mr. William Condon,did, in fact,purchase the property
and is now ready to commence the operation of the building for the purpose of educating low
income individuals in the manner in which to maintain permanent housing.
As I indicated to you in my letter of June 1, 2000, on April 8, 1957, the then owners of
the property,James MacLeod and Virginia MacLeod,filed a Petition for a Special Permit under
the zoning by-law to permit the conversion of a dentist office to an apartment which was attached
to a separate living unit. On April 26, 1957, the Town of Barnstable Board of Appeals voted
unanimously to issue a Special Permit to permit the separate apartment to be maintained. I have
enclosed copies of both the Petition and the Facts and Decision for your review.
As you may remember, Mr. Condon seeks to house low income individuals and has hired
a house manager to oversee that purpose.
Attached please find a Affidavit of Faith Wood,the house manager in this case.
Page Two
Ralph Crossen,Building Inspector
Town of Barnstable
I have also enclosed for your review a floor plan of the'building and have indicated which
room will be occupied by the house manager. I have also indicated the location of the doorway
which will allow access to both units by the manager.
It is anticipated at this time that other than the house manager,there will be a total of five
unrelated individuals residing in the two units.combined. As such,and based on prior
conversations with you,it is my understanding that my client will be entitled to utilize the
property in this manner pursuant to the Town of Barnstable Zoning By-law §1.1(2) as an
accessory use in the R.B. Residential District. My client invites you to visit the site to view the
new doorway attaching the two units and to answer any questions you may have of him and the
use of his property. I would invite you to contact me if you have any questions or comments
regarding this project.
Thank you for your time and attention to this matter.
AAULR.
,
IF
PRT/jm
Enc.
cc: William Condon
07/06/00 13:14 FAX 15084302049 ASSO SERVICES HA R 03
JUL-e6-200A 13:07 P.e2/02
AFFIDAVIT OF FAFT1 l WOOD
1,FAIT$WOOD,hereby depose and state as b1lows:
I. My name is Faith Wood and I am the House 14lanager For the property at 391 South
Street,Hyannis,Massachusetts,owned by Dat, Star House,Ltd.,William Condon,
President.
Z. In my position as House Manager,I am respov Bible to the Majors in command at
the Salvation Army sand the Day Star House,I,td.Board of Directors.
Responsibilities as House Manager include Ou following:
A. To manage the House at 391 South Strt et,Hyannis,MA;
B. To sec Day Star House,Ltd.managed I a decency and In order,
C. To see that the property is managed in,rompliance with Day Star House,
Ltd:s agreements.
D. . To fulfill the mission statements of Day Star House,Ltd.
3. As House Manager,I will agree to live at 391 t outh Street,Hyannis,MA as my
principal residence,and to be in-house to moni for the compliance with the House
Roles on a full time basis. When I am not abk to be there,I will designate eldw my
daughter,Durine Wood,or other suitable man agers to make certain that
compliance is met by the residents.
4. I will insure that at all times,there is one respc usible party;n the house,as long as
there are residents in the house during those ti nes.
SIGNED UNDER THE PAINS AND PENALTIES 01 PERJURY THIS DAY OF
FAITH W4)OD
TOTAL P.02
KITCHEN
11'-2 1/2" 10'-9 1/4'
14'-0 1/2" 12
SUN ROOM
DINING AREA 8'-11 1/2'
D. mar'
cLo
O
'-1 1/4 BATH
BATH 0 '-81/4" 16-141/2"
��10'_2 � .
KITCHEN BEDROOM
LIVING ROOM
15'-91/2" 15'-41/4"
F-V
CLAD.
DINING FOYER
AREA
__J CLO.
=— Location of New Doorway
20'-2 3/4" CLO.
v
LIVING Roots FIRST FLOOR PLAN- 1/8"=1'-0"
ADpno"AND gELmvAnoNFOR:
14'-9" -11" MR ALLEN WHITE
i
FOYER 391 SOUTH ST.
® HYANNIS,MA.
IST FLOOR PLAN
. 'DRAM BY. SCALE: DATE: MAWM
1/8"=1'-0" 3/6199 A=1
16'-10 /2"
i � 18',8 3 "
a _
10'-6"
CLO. 12'-0 3/4"
BEDROOM BATH ML
BEDROOM
CLO.
CLO.
51AATH ROOM CLO. CLO.
CLO.
f
L Fu
14'_9"
s
14'-2 3/4"
BEDROOM
® CLO.
I SECOND FLOOR PLAN- 1/8"=1'-0"
-'' ADDlnCW 90RE"WATION FOR: ---
MR ALLEN WHITE
391 SOUTH ST.
HYANNIS,M.A.
2m FLOOR PLAN .
U"A%"BI: IlAll: DATE: OM`;
Q
1/8"=1'-0 3/6/99 AA=2
,
TOWN OF BARNSTABLE
Board of Appeals
,fin No ad Yn W* WMAM
Petitioner'
Appeal No. ,., _ w___ _ 1957
FACTS and DECISION
Petitioners 1t. It _ filed petition on . ►. IPA
requesting a 1310
MIMpermit for premises at -M.Afth moat. 20" in the village
of _ _ _ _... _ adjoining premises of
d
for the purpose of
"9ll�dll :... �L..+. ...�111 ►._!�l�i�1�... .. .. 1 !l�dlR..._ -__.��.__.._ .
Locus is presently zoned in _......_..._..._...... . .:._.._. .. ._..__ _.__ ...._ _ ....._.
Notice of this hearing was given by mail, postage prepaid, to-all persons deemed affeeted and
by publishing in Cape Cod Standard ,Times, a daily newspaper published in Town, of Barnstable a
copy of which is attached to the record of these .proceedings filed with Town Clerk.
A public hearing by-the.Boar'd of.Appeals of the Town of Barnstable was held at the Town
Office Building, Hyannis, Mass.,. at _ P.M. __ _ !" �L_ .. _. 19
upon said petition under zoning .by-laws.
Present at the hearing were the following members:
Chairman ..
__.... .................. _. ...
• I.
At the conclusion of the hearing, the Board took said. petition under
t
advisement. A view of the locus was had by the Board.
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On . ....................__ .__ _. 19 ._, the Board of
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Appeals hound; 4
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Restrictions imposed: s
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Distribution:— Board,of Appeals
Town Clerk -Applicant Town of Barnstable
Persons interested
Building Inspector
Public Information By. ....._......
Board of Appeals Chairma jftb �w
1
DJ839T Z
t ' NAM
039•
'Ea NAB a
TOWN OF BARNSTABLE
` sPC—Cray �'Ch'Mt;
PETITION FOR VARIAN UNDER THE ZONING BYLAW
To the Board of Appeals,
Hyannis, Mass., Date "�W .... ....»»»..»»..».» 195.��.»
The undersigned petitions the Board of Appeals to.vary, in the 4nner and for the reasons
hereinafter set forth, the application of the provisions of the zoning by-law to the following described
premises. G �. ». ... »...».._..�� _.� .��!.��».°"'•`•••=•!�'»
Applicant: L2
(Full Namew�».. (winter A ress) e
Owner:
(Full Name) U (Winter Address)
Tenant (if any) : »... ......................»» . »....»... ..........».»................»....».............»...»»...,.............»»....Winter Addressj»»».......».»»...».......»......».
(Full Name) ,
a/ 0..I..�» .".........».....»......................» .»»...»»»».»»"..........»»........ ....,................
..».
1. Location of Premises ».»-3»`..1- •••- ••• ••••-+�"
(Name of Street) (What sectiono o!Town)
...» Area
2. Dimensions of lot »....»� .. »»...» .... .»»..... ». » ..f .» _»V
(Depth) (Square F "
(Frontage)
3. Zoning district,in which premises are located"..» ................•••• 1 • - "»••"......................................~
4. How long have you owned.above premises? "....... ..�. .......................
...».........."...._..................................".
5. How many buildings are now on the lot? » »»»» Z)" . »........»..."»......."..»
6. Clive size of existing buildings --awl ...Aba-_n.-�• --��=� »- --w �~a_ �
Proposedbuildings _».»_ .. »» » _f.."»..__ ». »» »»».»» »» »»»»_ »»_ ».» »»_V._»...._.»....
T. State present use of premises .. -»--- — » »»» ---•- »-» ...... -» "
AA8. State proposed use of premises ......:...... '. - "• » •--•_-••
9. (live extent of pr posed alterations » _» �.
»»».».».....».».... ........"...............»....................._.........
10. Number of'families for which build' g is to ke arranged .». »....».................................._............................"•••••••
11. Have you submitted plans for above to the Building Inspector? ........... .................................._»... .........................
12. Has he refused a permit? ".»....� ............».......».».»..,..»».."........... ». _.,�..-.....I.I�Z�(�....._........"...........
r
13. What section of zoning by-law do you ask to.be. varied? ..».. » ••••••
".» .. C»�....» .4..»».».. »...»....»»....».»............................»...............................»..»...»..............."...»...................................................."....................................
14."State reasons for variance»" ». .t��i.,¢. tr c _...".._ ....» »» .... r...........»....»...."........... "... ..
..............................._........._.
....»..................................»»»» ...».»....».»..........». ....»»».»..».»Respectfully submitte _.... ." ._ ."..
(Signat
Petition received by
(Address) `��� ""' 7`1
:!.^..'K—v.
Hearing date set7 30 "'».».»"»'.»...._....»._»».»:._.......».» 195....»...».
e Filing fee of required with this.petition.
* This form may, also be used for Appeals.
(Over)
THETOLLO'WING
IS/ARE THE" BEST .
IMAGES FROM POOR
QUALITY ORIGINAL (S)
MFE
DATA
TOWN OF BARNSTABLE
a CERTIFICATE 'OF OCCUPANCY
PARCEL ID 308 219 GEODASE ID' 22198 `
ADDRESS 391 SOUTH STREET '. _ PHONE
HYANNIS ZIP
. LOT .. -BLOC{ L O1 .'4S". T ry E _
' DBA DEVELOPMENT DISTRICT HY
:`PERMIT 41148, DESCRIPTION REMOVATED ,TO: 2 FAMILY (BLDG PMT 035957)
: PERMI.T; TYPE BCOO TITLE CERTIFICATE OF., OCCUPANCY
t.
''CONTRACTORS: t: Departnent of Health, Safety
ARCHTTEcTs and Environmental Services
;.
TOTAL FEES 1ME
' BOND .00 F
'.CONSTRUCTION COSTS $,00 �` �i►
758 CERTIFICATE OF OCCUPANCY - 1 PRIVATE 'P AB>I�,
!NABS, `
BUILD IS
r
DATE :ISSUED 09/20/1999- .,•-EXP I RATION `DATB .
THIS'PEI ;7 CONVEYS NC RIGHT TO(u T,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN-
CROACHMENTS ON PUBLIC P-^ocP— ERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR
ALLEY GRADES AS WEIR AS 1 SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS
PERMIT DOES NOT P.° t ITIONS OF ANY APPLICABLE SUBDIVISION.RESTRICTIONS. -
MINIMUM OF
IJ n PROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE; SEPARATE
FOR ALI ^� 1� �. (O f THIS CARD KEPT POSTED UNTIL FINAL INSPECTION
HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU PERMITS ARE REQUIRED FOR
PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MESH=
ANICAL INSTALLATIONS. "
OCCUPANCY. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.
, . � . e
.,UILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
�— 0—�`�
3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
2 �_..;fin,� � ," "BOARD OF HEALTH
OTHER: SITE PLAN REVIEW APPROVAL
WORK SHALL NOT PR =ED .'J"i"I_ PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS
a.THE INSPECTOR HAS A[ ��.OVED TI STRUCTION WORK IS NOT STARTED WITHIN SIX.
CARD CAN BE ARRANGED FOR BY
VARIOUS STAGES OF �ONSThUC MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA
:i•�ION. NOTED ABOVE. TION.
;f_: •
TOWN OF BARNSTABLE
CERTIFICATE' OF OCCUPANCY
PARCEL ID 308 219 ` GEOBASE ID 22196
ADDRESS 391 SOUTH STREET PHONE
HYANNIS ZIP -
LOT BLOCK k LOT SIZE
IDEA DEVELOPMENT - DISTRICT. HY I
PERMIT 41146 DESCRIPTION RENOVATED TO 2 FAMILY (BLDG PMT 036957)
PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY I
CONTRACTORS: Department of Health, Safety
ARCHITECTS: l and Environmental Services
5
TOTAL FEES: { THE
BOND $.00
CONSTRUCTION COSTS $.00
756 CERTIFICATE OF OCCUPANCY . 1 PRIVATE P. t I') ARrYSTABM
MASS.
i639.
BUILD Is
BY
DATE ISSUED 09/20/1999 EXPIRATION DATE
TOWN OF BAR"ASTABLE
BUILDING INSPECTOR
Uti� � c
_—..---
1`
TOWN ;t PMRNIGTABLE
BUI(,DING PERMIT
t'AFM, ?D 306 219
CEC1 ^SF 11) 2 193
Vjs 7tiGS 39' SOUTH
STREET
- Yµ )NE �..
14YA IN N,I S w
13LOCK _ I,0':' Ic T Z)7
CEVA O EEN .` DISTRICT 1r -...._. ,_
:36957 UESCk3 PTT.0t R.I NO AT s ON'S TO 2 9AXI"i V I
;.,cdliM" `i' 2'"'I?F MEMO!) TITLE k==. III E,t `I"T fjIf r:`."/ti C)11V
001NTRAC'1_`ORS: CAFa'^T1) PAUL, Department of Health, Safety
A RCi- °' - ,and Environmental_ Services
T.f. THE
BOND
Ci')lTO'.i'1�tJ'C;I?I�;d COSTS $130,0 fi30.00 � QA
34. RESIZ AD `�` T.T�'(,C+iG' I.. k'lI1IA"' : I?
*' BARNSTABLEY •
MASS.
1639. A�0
BUILDING DIVISION
BY
THIS'PEI fT CONVEYS NC RIGHT TO OCCUPY ANY:-STREET,ALLEY OR SIDEWALK OR,ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN-
CROACHMtNTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR
ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS
PERMIT DOES NOT F'ELEASETHE APPLICANT FROM.THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED
FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE-APPLICABLE, SEPARATE
1.FOUNDATIONS OR FOOTINGS
THIS CARD KEPT'POSTED UNTIL FINAL INSPECTION
a: PERMITS ARE REQUIRED FOR
7� 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU-
(AEAD'Y TO LATH). PANCY IS REQUIRED,SUCH BUILDING'SHALL'NOT BE ELECTRICAL,PLUMBING AND MECH-
ANICAL3.INSULATION.'.' OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. INSTALLATIONS.
4.FINAL INSPECTION BEFORE OCCUPANCY.
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
Cl
yz�
3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
(� 2 s� D�cjt� BOARD OF HEALTH y
OlNER: ' _ SITE PLAN REVIEW APPROVAL
�3 _WORK SHALL NOT PR EED k3Crci PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS
I.,-THE INSPECTOR HAS A1!'RPOVED'TI := STRUCTION WORK IS NOT STARTED WITHIN SIX. CARD CAN BE ARRANGED FOR BY
,VARIOUS STAGES OF �,ONSTHUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA-
' NOTED ABOVE. TION.
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Q___� The Commonwealth of Massachusetts
Department of Industrial Accidents
� °_-f - _�� Olfice ol/�sestigations
l 600 Washington Street
Boston,Mass. 02111
Workers' Com/�/e//nsation Insurance
Affidavit
���/�riir�ltiiiroiiiii6ii�Coir�..�.r��iaiiiaiI: r / ////%����/ ����� iiiar.,..,,,.,,,,�e i 1V'/������������������������������������ ,..,,....
4�31JD17CZni?[[iitYtT/lt�'IIt2tYlE.•;������������
name: 2
9,I location: T
city phone#
❑ I arda homeotivner performing all work myself.
❑ I am a sole vrourietor and have no one working in any ca achy
I am an employer providing workers' compensation for my emplovees working on this job.
comonnv name: dJel / _ g,0_ IRil>�d:o'r Sr w G ,
I address: g 7: i/'� . . ;:.. :... .. : .: . .... .. _ .. ..
city L r y / �� phone#� ��/�S'7 7
insurnncc cn. Z� r411,111, 2n1icV# t. ..
❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who
have
the folloning workers' compensation polices:
compnnv name:
address:
dtv phone
tnsornnce Cry. -' •-' ` o ttv
:.:. ..:
......... ..
camnanv name: :..,.:;......•:;::.........
address-
city- ... phone
. ..
. .huaranceco. ov#
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of criminal penalties of a tine up to 51.500.00 and/or
one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Wte of 5100.00 a day against me. I understand that a
copy of tills statement may be forwarded to the Ounce of Investigations of the DIA for coverage verilleation.
I do hereby ce 'y under the sins and penalties of perjury that the information provided above is true and correct
Signature a Date
Print name &&[ / !A JO A t Phone# 7 7,:-19Y-7 Z
Ccon..
nly do not write in this area to be completed by city or town official
permitNcense q ❑Building Department
❑Licensing Board
mmediate response is required ❑Selectmen's OMceon: phone#; Dew Department
(mwuea 9l9S P1A7
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 comrz
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 receive:
trLstee 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 c.
building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewa:
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has
not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the
commonwealth nor ary 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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and
.supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. E
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the
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. The affidavits may be returned io '
the Department by mail or FAX unless other arrangements have been made. '
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions.
please do not hesitate to give us a call.
%////% MOM:
The Department's address,telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Invesugauans
600 Washington Street
Boston;Ma. 02111
fax#: (617) 727-7749
phone #: (617) 727-4900 eat. 406, 409 or 375
DEPRRTNENT Of PUBLIC SAFETY
~ CONSTRUGTIOH SUPERVISOR LICENSE
Humber mm� Expires:
1` Restrictedilq t.
r �yf C41td 15 RAIIWAY'BIUFFS
HYANNIS, NA B26B1 ;,
• �„NOME�INPROVEMENT,CONTRA
`Re9.lstration` �fZ0i1'1 CTOR
TYPeNDIVIDUAL �;
0
ULCAPRIO� �
G��,.,� s CIS STERLING.RD, rs
NI5
AOMwis MA 02601
TRATt7R 5f y LA
1
4
The Town of Barnstable
aL►aNsr49m t
MAM Department of Health Safety and Environmental Services
059.
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-8624038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
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: 42 a n�� ? /L/D yl Estimated Cost
Address of Work: 3q/ � /J- , ga ,1 n 1 p
Owner's Name:�� ��
s 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 MTROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
.2 1 %
.Date Con r Name Registration No.
OR
Date Owner's Name
q:forms:Affidav
• >mCMRAppwmftr
Table JS2.1b(continued) _
prescriptive PackaW for One and Two-Famiir Residential 11oddlap Heated with Fessil Fuels
MAXIMUM MINIMUM
Qlaang Glazing Ceiling Wall Floor Basement Slab Head4cooling
Amy(OA) U-value= R-value' it-value R-vaiuej Wall pa=cter Fgwpman Efliciencr'
pie It-value' it-value!
5"1 to 6500 Hearing Degree Dare'
Q 12% 0.40 38 13 19 10 6 Normal
R 12% 0.52 30 19 19 10 6 Normal
S 12% 0.50 38 13 19 10 6 ss AFUE
T 15% 036 38 13 25 N/A N/A Normal
U 1SY. 0.46 38 19 19 1 10 6 Normal
V 15•/0 0.44 38 13 25 N/A WA 83 AFUE
W 150/0 O.52 30 19 19 10 6 85 AFUE
X 19% 032 38 13 25 N/A WA Normal
Y 18% 0.42 38 19 25. N/A N/A Nomad
Z 18% M42 38 13 19 10 6 90 AFUE
AA 18% 0.50 30 19 19 10 6 90 AFUE
I. ADDRESS OF PROPERTY: .3 310
S
2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: �• w _31
3. SQUARE FOOTAGE OF ALL GLAZING: 3 / 6
4. %GLAZING AREA(#3 DIVIDED BY#2): / '410
S. SELECT PACKAGE(Q—AA-see chart above): C�
NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS
ARE AVAILABLE. ASK US FOR THIS INFORMATION.
BUILDING INSPECTOR APPROVAL:
YES: NO:
q-fore-1980303a
t
780 CMR Appendix J
Footnotes to Table J5.2.1b:
Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and
basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall
area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement.
For example,3 ft'of decorative glass may be excluded from a building design with 300 ft'of glazing area.
Z After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with
the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for
whole units: center-of-glass U-values cannot be used.
' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full
insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38
insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity
insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between
the conditioned space and the ventilated portion of the roof.
'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include
exterior siding, structural sheathing, and interior drywall. For example,an R-19 requirement could be met EITHER
by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to
wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction.
'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements,
or garages). Floors over outside air must meet the ceiling requirements.
`The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must
meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned
basements must be included with the other glazing. Basement doors must meet the door U-value requirement
described in Note b.
'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs.
' If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. If you plan to install more
than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest
efficiency must meet or exceed the efficiency required by the selected package.
'For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a
NOTES:
a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels.
R-value requirements are for insulation only and do not include structural components.
b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested
and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value
in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the
glass area of the door with your windows and use the opaque door U-value to determine compliance of the door.
One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35).
c) If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with
different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to
the R-value requirement for that component. Glazing or door components comply if the area-weighted average U-
value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors).
43
0
9'INSUTATION -
R39
2X10 16"O.C.
31/Y WSUTATION
W R 13
EXISTING 2X8 JOISTS
6-INSUTATION
R19
I II
II II
II II
I
II II
II II
I I
ADDITION AND RENOVATION FOR:
MR ALLEN WHITE
391 SOUTH ST.
HYANNIS, MA.
SECTION
1�
' 'DRgµN BY: SCALE: DATE: DRAWING P
it
3/6/99
F AA=3
1
LK y
16'-10 /2"
18'-8 3
0
10'-6"
CLO. 12'-0 3/4"
BEDROOM BATH XL
BEDROOM
CLO.
CLO.
5 " SITTING
'-0 CLO. CLO.
ATH CLO. ROOM -
o -
14'-9"
6r 14'-2 3/4"
BEDROOM
�g ® CLO.
SECOND FLOOR PLAN- 1/8"=1'-011
ADDITION AND RENOVATION FOR:
MR ALLEN WHITE
391 SOUTH ST.
HYANNIS,MA.
PND FLOOR PLAN
• DRAWN BY: 1/8"=
SCALE: DATE: DRAINNO
F
L_
r.
KITCHEN
1/4'
14'-0 1/2"
SUN ROOM
DINING AREA 8'-11 1/2'
D. IL
cLo.
O
'-1 1/4' BATH
BATH O 81/4" 16'-41/2"
KITCHEN BEDROOM
LIVING ROOM
15'-9 1/2" ®. 1 S'-4 1/4"
CLO.
jL
0 I
DINING FOYER
AREA Q.
==J CLO.
20'-2 3/4" CLO.
LIVING ROOM FIRST FLOOR PLAN- 1/8"=1'-0"
ADDITION AND RENOVATION FOR:
14'-9" 11" MR ALLEN WHITE
FOYER 391 NNIS,SOUT M
�i HYANIS MA..
mot---- w
1ST FLOOR PLAN
URAVM 9Y: SLATE: DATE: DRAWING
F 1/8"=l'-0" 3/6/99 A=1
F. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Parcel %%, j Permit#
Health Division C r nn
rl�t�_�Y�• , r Date Issued
-Conservation Division 03,E o
Tax Collector
V SE
!j Treasurer,. - p ROM TrIE
NGINEERING DIVISION P
Planning Dept. ONSTAUC TION:.
Date Definitive Plan Approved by Planning Board
Historic--;OKH Preservation/Hyannis^
Y
_S ��
Project Street Address � ��j 57t�.,
Village
Owner IV A Z � Address
r 7
"Telephone 771C / 41
Permit Request f J a t D d is"Z�i e-5 ye
,Square feet: 1 st floor:'existing /7DD proposed 2nd floor:existing 12,0 proposed Total new
Estimated Project Cost d0 Zoning District Flood Plain Groundwater Overlay
YConstruction Type a
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family > Multi-Family(#units)
Age of Existing Structure !%�9 fiI -t Historic House: ❑Yes g No On Old King's Highway: ❑Yes XNo
Basement Type: O.Full Crawl ❑Walkout ❑Other
j
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half:existing new
Number of Bedrooms: existing_ new ,
-- .yam,•'
Total Room Count(not including,baths):existing • AD new First Floor Room Count
Heat Type and Fuel: X as ❑Oil ❑Electric ❑Other
Central Air: ❑.Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes X No
Detached garage:J4 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 Proposed Use .. w_
BUILDER INFORMATION
Name a Telephone Number �'Dg'?L =X)9`7 7
Address d 4,04 44 License# 1J 75'
1)1 Home Improvement Contractor•# d
Worker's Compensation# 01, 3 $,
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO
SIGNATURE DATE �3
FOR OFFICIAL USE ONLY •_ _
PERMIT NO. ! -
DATE ISSUED
AI
` MAP/PARCEL NO. .
ADDRESS , VILLAGE r+ f +
OWNER �-
DATE OF INSPECTION: a
FO_ UNDATION
FRAMEC elm
t r Y : t . • r t s
INSULATION ld d" -L.
FIREPLACE
ELECTRICAL: ROUGli,'- ` FINAL
PLUMBING: ROUGH FINAL
-t GAS: ROU ii�'-+' FINAL i r. I t
FINAL BUILDING i
DATE CLOSED OUT 4
ASSOCIATION PLAN NO. + . 1
1
,�..., �-r-•'asy"�u,T{'��ra'�."..r`�.....rwwo+..,...,,..p�.;,ru:r.y^^7•s'+a+�n-.•+.rrF.:,•/". �L-t..-........-.,,..r..„--.+s+`�"*v.�°"Mv%..v'a.�.'.....+m.ods'""'"—."''""'-r.... _.., ..r_r`_. ---er ,.,
a
INEi The Town of Barnstable
BRAE. Department of Health Safety and Environmental Services
7� s639• ,0�
�Fo►9. Building Division
' 367 Main Street,Hyannis, MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Inspection Correction Notice
Type of Inspection
Location } ��.:�1 S ) Permit Number
Owridr Builder ��pad
One notice to remain on jobsite, one notice on file in Building Department.
The following items need correcting: (�
V
A
s
ram..
R' '\
Y'
i
Please call: 508-7910-622(7 for re-inspection.
Inspected by ` Jk �
Date 9
I
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel o� �. �/ ' Permit# 35 q 4
Health- +vision - 6-7 Date Issued
;: Fee
Tax:Collec
Treasurer
RLn1TfT1'. t'
Date-Bef+ai Ian Approved by Planning Board CIO
-kl� H Preservation/Hyannis
Y
'Project Street Address
Village f
,Owner Address D
p y
Telephone' s - - I S _ 119 ' -
Permit Request - Q
Square feet: 1 st floor:existing proposed 2nd floor: existing r proposed Total new
Estimated Project CJ i S Zoning District Flood Plain .Groundwater Overlay
Construction Type
Lot Size Grandfathered: ❑Yes 0 No If-yes,attach supporting'documentation.
Dwelling Type: Single Family ❑ Two.Family ❑• Multi-Family(#units).
Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No
1 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
� r
Total Room Count(not including baths): existing - new First Floor Room Count
Heat Type and Fuel: ❑Gas 0 Oil 0 Electric ❑Other
Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 0 No
Detached garage:O existing ❑new 'size - Pool:0 existing ❑new size Barn:0 existing ❑new size
Attached garage:O existing ❑new size Shed:0 existing ❑new size Other:
Zoning Board of Appeals Authorization O Appeal# Recorded❑
Commercial ❑Yes ❑No If yes,site plan review#
Current Use Proposed Use
BUILDER INFORMATION L10 aJR---L
Name � n,�-� Telephone Number Se) U
Address \3t-t$ X)e „AhI , L'aicense# o a
a� 0 Home Improvement Contractor#
Worker's Compensation#-J'c_ J - `l 9.5!�1_54 a �
ALL CONST C ON DE S RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATUR __ DATE
r i• f
FOR OFFICIAL USE ONLY - 4-
NPERMIT NO. �`' tJ�/ ✓ !j, _T + s _y - .' T ; i
DATE'ISSUED
MAP/PARCEL NO.
ADDRESS t r `= c }}, VILIAGE
OWNER- ,
DATE OF INSPECTION:
FOUNDATION t F
FRAME t,
. » INSULATION ! `.
FIREPLACE y '
ELECTRICAL: ROUGH FINALi
PLUMBING: ROUGH t "f FINAL:
GAS: ROUGH: FINAL f s
FINAL BUILDING 66
l r _
DATE CLOSED.OUT.
r. ASSOCIATION PLAN NO. A ± y
t f�, t� t ti6t
DEPARTjf
MENT OF PUBLIC,SAFETY
CON ,
ON SUPERVISOR LICENSE
f Expires:
-
r u�l 0INCE
Y Y t7ARN5TAOLE, I!A s 0166E
+ a>Q
t i
' " c
.,
- NONE INPROVENENT CONTRACTOR
> LI egistration
' 124871
INDIVIDUAL
EzpiretionkO9/04/99
cTho�as J Florence '
G� F Yoodside Dr
noMm„sraR Barnstable.NA 01668,,� x r.
e t own oi uarnsEaDie
Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building'Commissioner
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,iemoval,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. Estimated Cost $�S too
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 FU UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF P Y
I hereby apply for a permit as the agent of the owner.
-moo I a_ 7
Date Contractor Name Registration No.
OR
Date Owner's Name
q:forms:Afftdav
ib
--_- The Commonwealth of Massachusetts
Department of Industrial Accidents
� ---_ - =��� OlIice of/n�estigations
l ,L,Tz-.: `�� 600 Washington Street
Boston Mass. 02111
Workers' Compensation Insurance Affidavit
�in�"cap"r��a"t•���"t�"'///%��%%%%%///%/%//////%%/�////////%%' ""��t���'1`�l'Y�///�%////�%%%�%�%%�%////%/%%////�//////�//////%////�/%% '"'. -
name:
location: Z C 1
city r)hone#
❑ I am a home er performing all work myself.
❑ I am a sole proprietor and have no one working in any ca acity
ram an employer providing workers' compensation for my employees working on this job.
compnnv name:
address:
4
city:
hone#• - 3 94 5,0e)
insurance cn. olicv# 1 t-n — a cj
❑ 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:
company name:
address.
city phone#:
insurance cn. olicv#
comnanv name:
address.
city: ...- phone#-
.
insurance co. olicv#
/A �+ 3
Failure to se coverage required under Section 25A of MCL 152 can lead to the imposition of criminal penalties of a tine up to S1.500.00 and/or
one vears' prisonment as we as civil penalties in the form of a STOP WORK ORDER and aline of SI00.00 a day against me. I understand that a
copy of statement may be W ed to the OMce of Investigations of the DIA for coverage verincation.
I do he eby certify under the sins and penalties of perjury that the information provided above is tru,-and correct
Sitmaffe Date _
Print ne f; G� Phone# S 3 y�—�- 0
am
ofneW use only do not write in this area to be completed by city or town oMcial
city or town: permit/license# ❑Build:De
❑Licem
❑check if Immediate response u required ❑Select
❑Healt .
contact person: phone#; ❑Other
(:srstea 9;95 F]AI ,
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 contra -,
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 c:
trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a
dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of
another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or
building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renews:
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has
not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the
commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until
acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting
authority.
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
sup?Iying company names, address and phone numbers along with a certificate of insurance as all affidavits 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'Uw"or if you
are-equired to obtain a workers' compensation policy,please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the
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. The affidavits may be returned 10
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions.
please do not hesitate to give us a call.
The Department's address,telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
NUB of IQYesugaunns
600 Washington Street
Boston;Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 eat 406, 409 or 375
• i � � i � i I
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ALLEN J. WHITE
HOMESTEAD REALTY TRUST r,
405 SOUT11 STREET -P.O.BOX 979 '
]3YA]kiN1S, NIA 0601-0979 j.
VEIL.(508)775-1146
6. FjIX (508)778-1883 r.
y
` F 4/2.0/99 J
All Tenants and/or Lessees
L"
391. South S C. _S�au ,.
Hyannis,NIA 02601
Dear Tenants,
•
Please be adviml that the building that you occupy in part at 391 South Street,Hyannis,Massachusetts
has been declared unsafe and needs to be vacated,renovated and the number of units reduced. This has a
been clone by Order of the Town of'Bat nstable Building Division(see April 13, 1998 letter from the Town L
of Barnstable attached hereto). '
You have thirty(30)days to vacate the premises. However,I strongly suggest that yciu vacate the
premises as soon as possible. We realize that.this is an inconvenience to you but it is outside our control
and it is being done for your safety and welfare. We have no idea when the compliance will be able to be 3
made, when the work will be finished or the degree of work that we will have`to perform to complete:the
same.
Therefore,your occupancy either under a written lease or as a tenant at Will hereby tern inated. Your
obligation to om inote to pay rent while-you occupy the property remains in force.. You are required under
Town Order to vacate the property on or before Nlay 31"after that you will be in violation of the Town
Order and other action would have to teen.r.iken.
We have been in touch with the Barnstable ilousing Authority,the Housing Assistance Corp and Mr
Van Johnson of C. Johnson and Co. to help you in relocating. We are sorry for this major inconvenience,$
but it is beyond our control and;lour safety is the most important factor to
Sincere aui ►
en te,Ph.L►. r
4
The Town of Barnstable
• eaxrrsrne�, •
,' 9. Department of Health Safety and Environmental Services
'�Fo Mai" Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
April 13, 1998
Dr.Alan White
P O Box 979
Hyannis,MA 02601
Re: 391 South Street,Hyannis
TO WHOM IT MAY CONCERN:
Please be advised that the building at 391 South Street is unsafe and needs to be vacated and renovated.
This action should be undertaken immediately.
Sincerely,
Ralph M. Crossen
Building Commissioner
RMC/km
DATE DESCRIPTION OF WORKICOMMENTS INSPECTOR
(3
�c
Uri//7 to
c�Yw>,y Z,4;L/47 �4� V,::$
xu-
'222" �� .CS»��l/QOI/ di'c�/l�G�
i
DATE DESCRIPTION OF WORK/COMMENTS INSPECTOR
y-7-98 Apcatj '7 — 19'4k �
�PlA
SS y r 1 n Wo O a Cl-t.�- St �A t r t� W AS C4clQ d •
O m
3 � g �.�dd� 1�e�� 5 �s �N• 1 d1 o n 7t�, o )4,p r 1 -
Ll AS T Y%f l�o l�p�• 2 W A 5
S.) 4 'A pit y
11
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ru.
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1 �� � � , � ,lire 1�_ •. ,
1-23-199S 1 0: 1 SPM FROM HYANI%J 1.S FIRE DEPT. S08 778 6448 P. '.
HY NMS FRtE DEFARTIN[ENfT
HVANN g 95 HIGH SCHOOL RD. EXT. HYAMMIS, MA.02601
HEM!GILL
HAROLD S. BRUNELLE, CHIEF
vA0.'iiM1f ProUTANAAENE860f FIR tmAtiO.
i.,. MM PREVENTION BUREAU
BUSINESS PHONE:(508)775-1300 FACSIMILE PHONE:(508)778-6448
LT.DONALD IL Cl"SE,Jv.,CFI LT.EIFUC F.HUBL ER,0R
FIRE PREVENTION OMCER F RF- PREVENTION O1FF'ICIER
FACSDULE TRANSMITTAL, SHEET
THIS FAX IS GOING TO:
THIS FAX IS BEING SENT BY:
................L>n..,. i S,c,...ukzJ.kx.........--................................
SUBJECT OF THIS FAX:
................................ 91... ..uth.. trc ,L......................... .............................,,.......:.
EDATE: FAX NUMBER: NUMBER OF PAGES:
/93 ................. ............................ ..............-3 ......
(INCLUDES COVER)
NOTES:
............................... ......................................................................................... ....
............ ...........................................................,..............................................................,.....
1-23-199S 1 0: GPM FROM HYANN I S FIRE DEPT. S08 778 G448 P. 2
Massachusetts
Fire Incident Report
Hyannis Fire Department
FDID Incident No. Exposure #. Date of Time Of Arrival Time In
Day y of week Calf Time Service
01922 A980307 �� 4f2i98 Thursda U �
t 7 :55 1
11 7:50� 8:43
Address Zq/E— L7H
_ Census Tract
391 South Street yannis 6 0
¢ „
Type of Situation Found Type of Action Taken Mutual Aid
40 Hazardous Cond., Not 4 0 4 Remove Hazard t 4
Fixed Property Use Ignition Factor
"3 Through 6 Units." 4 2 2 l 00 No Fire Found
Occupant Name Occupant Telephone
Party Masters I
Owner Name Owner Address Owner Telephone
White Alen South St. j Sp8-77S_t 1 a6
Method Of Alarm Shift No Of Alarms # of Personnel Responded
I - Tole Na:ardou
Materials
Engines Tankers Aerial Other Vehicles Present
001 0001 o—c No
Fire Service Other Injuries
Injuries ® Fatalities f V i Injuries [�0 Fatalities LE I Rescues
Mobile Property PLoperty Use Is Car Insurance Company T
i
Mobile Property Make Year Model Color License Number VIN
Complex r� Area Of Origin
Estimated
Equipment involved In Ignition rorm Of Heat Of Ignition Loss
If Equipment Was involved In Ignition
Material Ignited Year Make Model Equipment Serial Number
Method of Exn uishrnent revel Of Fire Ori in Number Of Stories
Construction Type Detector Performance S r kler Performance
J
Extent Of Damage
Flame �� Smoke L—
Material Generating Most Smoke Type Of Material Generaj�nS Most Smoke
Avenue Of Smoke Travel Weather Conditions Com.manoina Officer
--•� t Capt Grant
1-23-1995 10: 17PM FROM HYANNIS FIRE DEPT. 508 778 6448 P. 3
Comment Page for
IncidentA
No. 980307 address s91 SOUTH STREET
Date of Report' 4/02/98 Commanding Officer Capt Grant _�
RESPONDED TO A REPORT OF SOMETHING SURNING POSSIBLY IN THE BASEMENT AT391 SOUTH ST.
REPORTED BY PAM MASTERS.
WE ARRIVED WITH SPQ AND FOUND A STRONG ODOR IN THE BASEMENT OUR INVESTIGATION LED US TO THE STEAM
BOILER WHICH WE FOUND HAD OVERHEATED.
WE SHUT DOWN THE BOILER AND PULLED THE FIRE-O-MATIC,
I REQUESTED DEPUTY GRANT TO THE SCENE FOR NUMEROUS CODE VIOLATIONS.
FURTHER INVESTIGATION REVEALcD SEVERAL SMOKE DETECTORS MISSING,BUILDING CONSTRUCTION UNSAFE.WE
ALSO AEDUESTED COM ELECT FOR AN EXPOSED ELECTRICAL METER ON THE OUTSIDE OF THE BLO.
DEPUTY GRANT CALLED LT, HUBLER TO THE SCENE TO DOCUMENT NUMEROUS FIRE CODE VIOLATIONS.(NO INSPECTION
APPROVAL TAGS ON BOILER AMC WATER HEATER.SHUT OFF SWITCH FOR SMOKE DETECTORS,
WE ATTEMPTED TO NOTIFY THE BUILDING OWNER MR.ALLEN WHITE TO INFORM HIM ABOUTTHE BOILER SITUATION
AND COULD NOT REACH HIM AT HOME.
DEPUTY GRANT AND LT. HUBLER WILL FOLLOW UP ON VIOLATIONS ON FRIDAY,
WE INFORMED THE TENANTS THAT THE HEAT IS SHUT DOWN DO TO 1301LER MALFUNCTION,
UPON RETURN TOOTS I CALLED MR.WHITES BUSINESS PHONE AND LEFT A MESSAGE TO CALL FD SO WE CAN INFORM
HIM OF VIOLATIONS AND CORRECTIONS NEEDED.
REPORT BY CAPT.CADRIN
v t&;tl-� C �sPc .� Toe_ f Ulu 0u 03AJ7C 0r>
' 4 V,�(`Tws SCwM -wz 6-
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4
The Town f o Barnstable
* B&ARN a E
9ibA MAW. ' Department of Health Safety and Environmental Services
'Eon" Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-90-6230 Building Commissioner
DATE: April 6, 1998
TO: Lt.Eric Hubler,Fire Department
FROM: Richard Burnham,Gas Inspector ,
RE: 391 South Street,Hyannis,Mass.
As per your request an inspection was performed at the above referenced location on April 3, 1998.
The inspection revealed the following conditions:
1) The boiler was vented into an unlined chimney. Correction requires venting this boiler
into a lined chimney,or it needs to be power vented.
2) New controls are needed.
3) Boiler needs to be re-wired and the water feeder needs to be changed. The low water
cut-out switch and pressure controls also need to be changed.
4) Gas piping needs to be tested and checked for proper BTU consumption.
5) Access into apartments is needed to check out the direct vent heaters and gas ranges.
/kI
TRANSMISSION VERIFICATION REPORT
r�
TIME: 01/10/1995 06: 20
NAME:
FAX
TEL
DATE,TIME 01/10 06: 19
FAX hdO./NAME 97786448
DURATION 00:00: 40
PAGE(S) 02
RESULT OK
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L ] [R308 219 . ]
LOCI 0391 SOUTH STRE CTY] 07 TDS] 400 KEY] 221968
----MAILING ADDRESS------- PCA] 1111 PCS] 00 YR] 00 PARENT] 0
WHITE, ALLEN J TRS MAP] AREA] 67AB JV] 310568 MTG] 0000
PO BOX 979 - 405 SOUTH ST SPl] SP23 SP31
UT11 UT21 . 27 SQ FT] 2682
HYANNIS MA 02601 AYB] 1900 EYB] 1965 OBS] CONST]
0000 LAND 46100 IMP 89900 OTHER 3300
----LEGAL DESCRIPTION---- TRUE MKT 139300 REA CLASSIFIED
#LAND 1 46, 100 ASD LND 46100 ASD IMP 89900 ASD OTH 3300
#BLDG (S) -CARD-1 1 89, 900 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE
#OTHER FEATURE 1 3, 300 TAX EXEMPT
#PL 391 SOUTH ST HYANNIS RESIDENT' L 139300 139300 139300
#Sl 06/80 24 $00054000 I OPEN SPACE
#RR 1511 0075 COMMERCIAL
INDUSTRIAL
EXEMPTIONS
SALE] 05/93 PRICE] 1 ORB] 8575/158 AFD] I B
LAST ACTIVITY] 07/21/94 PCR] Y
R308 219 . P P R A I S A L D A T 40 KEY 221968
WHITE, ALLEN J TRS
•
LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB
46, 100 3 , 300 89, 900 1 A-COST 139, 300
B-MKT
BY 00/ BY ME 5/88 C-INCOME
PCA=1111 PCS=00 SIZE= 2682 JUST-VAL 139, 300
LEV=400 CONST-C 0
----COMPARISON TO CONTROL AREA 67AB -- TREND EXCEEDS STANDARD
NEIGHBORHOOD 67AB HYANNIS
PARCEL CONTROL AREA TREND STANDARD
101 10 LAND-TYPE
461001 LAND-MEAN +0*1
1393001 178835 IMPROVED-MEAN -5006 25%
] FRONT-FT
] 100 DEPTH/ACRES TABLE 02
1000-.1 LOCATION-ADJ APPLY-VAL-STAT 1
LNR] LAND LFT/IMP]ADDS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES
COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC
FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?]
f
w.,
R308 219 . P E R M I T [PMT] ACT [R] CARD [000] KEY 221968
000000001
PERMIT-NO MO YR TYPE VALUE CK-BY MO YR .CMP NEW/DEMO COMMENT
[12379 ] [12] [95] [AD] 7001 [LK] [01] [96] [100] [NEW ] [HY ROOF ]
SIlI A ��
106
UPC 68021
( No.SM j
HASTINGS.UN
♦ f
RESIDENTIAL PROPERTY
1.7 MAP NO.- LOT NO. Hyanni8 FIRE DISTRICT SUMMARY
-219 STREET .391 South .St, H 7LAND
1 37 i o
IJ
., OWNER BLDGS. S ,
TOTAL 3 ,
LAND
RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: u
. BLDGS. L S
TOTAL
2 a LAND
- -2 '2 BLDGS.
y=- ertrude=-E •'.: 4-26-77-- 2498 349- 33'600 roraL
LAND
Ze tasp George T. 8'Georgia , 6-20-79 2938 166 $549 BLDGS.
TOTAL
LAND
mbbys Ia (444 BLDGS.
TOTAL
s NS '// o
S/a'03 LAND
BLDGS.
i
�:0 G TOTAL
LAND
j BLDGS.
TOTAL
I LAND
INTERIOR INSPECTED: V / ! BLDGS.
' DATE:
/" / i !• r'� K. t' i �`, .1._.6 LAND
ACREAGE COMPUTATIONS BLDGS.
Ct _
LAND TYPE # OF ACRES RICE TOTAL DEPR. VALUE TOTAL
HOI 7 10 wUU' /U U U LAND
C4A�, ONT
R BLDGS.
EAR'
TOTAL
WOODS 3 SPROUT FRONT LAND
_ REAR
• � BLDGS.
WASTE FRONT TOTAL.
REAR LAND
BLDGS.
TOTAL
LAND
' 7 10 BLDGS.
LOT COMPUTATIONS LAND FACTORS TOTAL
FRONT DEPTH STREET PRICE DEPTH% FRONT FT.-PRICE TOTAL DEPR. COR. IMF. VALUE HILLY TOWN SEWER LAND
ROUGH TOWN WATER O BLDGS.
HIGH GRAVEL RD. TOTAL
LOW DIRT RD. LAND
SWAMPY NO RD. BLDGS.
Cone.Blk.Walls Bsmt.Roe.Room St.Shower Bath BLDG. COST
Bsmt. _ 07,310
Cone.Slab Bsmt.Garage St. Shower Eat. PURCH. DATE
� F
Walls PURCH.PRICE. �p .
Brick Wells Attie Fl.3 Stain Toilet Room Rif RENT -F�• 60A✓�
Stone Walla fin.Attie Two Fist. Bath Floors L ��` sue•
Piers INTERIOR FINISH lavatory Extra -y
io �o
BsmL. F GAG 1 2 3 Sink Z /Lo. J!//� a .
% 'A Plaster Water Clo.Extra AIUe
EXTERIOR WALLS Knotty Pine Water Only ' /Y '�_' // f
Bsmt.Fin. /91
Double Siding (/ Plywood No Plumbing 5-U D
Single Siding Plasterboard Int.Fin, t • '
TILING el. f T + Q /Shin last ' /
Cone.Blk. _ G F P Bath Fl. Hest -I-
1 5v
Face Brk.On Int.Layout V Beth Fl.&Wains.
AuO Ht.Unit
Veneer Int.Cond. Bath Fl.3 Walls
- „mi.Brk.On HEATING Toilet Rm.Fl. r /• Z7
Solid Com.Brk. Hot Air Toilet Rm.Fl.b Wains. Plumbing + 9/ p
Tilling
_ Steam 6 QAI ✓ Toilet Rm.Fl.&Walls
Blanket Ins. Hot Water St. Shower.
Roof Ins. Iv V. Air Cond. Tub Area Totnl Z3
Floor Furn.
ROOFING COMPUTATIONS '
Asph.Shingle Pipeless Furn. // S.F. I
Wood Shingle No Heat
_ S.F. /
Asbs.Shingle Oil Burner /•�.T.T i l� ,G/9 ,
i � jo ,goat p R . _. ,,•
S.F. I
Slab Cod Stoker S� t7 S.F. !,�'.�Q 79 A v �X>Lde/eR /Ny/a/"' "aP)tit t4 s a P C'oA'a/
Electric
�•/�lYl'RI��`
Tile S.F. OUTBUILDINGS
ROOF TYPE Electric _
Gable Flat S.F. ( 1 2 3 4 5 6 7 8 91101 1 2 31415 6 718 9 10 MEASUI" "
Hip Mansard FIREPLACES S.F. Pier Found. Floor C l� .
Gambrel Fireplace Stack Wall Found. 0.H.Door / LISTE
FLO IRS Fireplace Sills.Sdg. I Roll Roofing -
_Cone. LIGHTING irDbls.Sdg. Shingle Roof
Earth No Elect. DATE!
Pine (,t/ Shingle Walls I Plumbing p
Hardwood ROOMS AIJ Z 3 G Cement Blk. Electric To
�.
Asph.Tlls' Bsmt. 1st TOTAL s Brick Int.Finish �E
Single 2nd 3rd FACTOR
REPLACEMENT 7�Z.3 U 3S Z FID D Z
OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. AC�TU.�A�L�"VAL.
0WLG. FN I ' •L S _ 3 De�7 •�� S�
r � OCR i s . Zoo ME 1977 a /i.5-o 3 //Y-s //so
3
4
6 .
7
9 f
"10
TOTAL
IOPERTY ADDRESS I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I CSTATE LASS I PCS I NBHD KEY NO.
0391 SOUTH STREET 07 RB 400 .D7HY 01/04/96 1111 00 67AB R308 219. 221968
LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T
Lana BYroate size D.--,,. v UNIT AD UNIT ACRES/UNITS VALUE oiplion WHITE. ALLEN J TRS MAP-
CD. FF-0n m/Au es LOC./YR.SPEC.CLASS ADJ. COND. PE PRICE PRICE Des#LAND 1 46,1DO
CARDS IN ACCOUNT -
10 18LDG.SIT 1 X .27 =10 237 71999.9 170639.9 .27 46100 #BLDG(S)-CARD-1 1 89,900 01 OF 01
-- #OTHER FEATURE 1 3,300 COST 1593uu
BAT.M..'S 4.0 u x C= 100 14000.00 14000.00 1.00 14000 3 #PL 391 SOUTH ST HYANNIS MARKET
A 0V2 BSMT S x i C= 100 3.3 3.35 1092 3700-8 #S1 06/80 24 $00054000 I INCOME
PLACE U X C= 100 3100.0C 3100.00. 1.00 3100 3 #RR 1511 0075 USE
EXI FIREPL U x C= 100 1300.0 1300.00 1:00 1300 B APPRAISED VALUE
RG1 DETGAR S 10 X 20 1970� C= 74 22.35 16.53 `--- 200 3300 F A 139,300
PARCEL SUMMARY
AND 46100
Ti I BLDGS 89900
M ; i 0-IMPS 3300
E TOTAL 139300
N CNST
T ' I DEED REFERENCE Type DATE gecortleC P R I O R YEAR VALUE
Book Page Ins, Mo. vr.D Sale,Prio. LAND 46100
S 8575/1581 I105/93 8 1 BLDGS 9320C
4993/042: I:04/86 205000 TOTAL 139300
3709/167: 1:04/83 75000
BUILDING PERMIT *EST 6 :APT......
Number l Date TYpe AmOri n,
LAND LAND-ADJ i INCOME SE SP-BLDS FEATURES BLD-ADJS UNITS
4
I 3300 14700
C1a55 Consl Total Vear Built Norm. Obsv.
U oils Units Base Rale A<II.Rate Ae1tg 1tYf Age Depr. Contl. CND. Loc. No R.G. Repl.Gos,New Atll.Repl.Value Stories Heig M1t Rooms e0 Rms Ba,M1s IF ix. Penywall F
41
000 100 100 65.05 65.05 00 65 29 66 100 09 89900 1.4 12 4.0 24.0
dod-s
pllon Rate square Feel Repl Cosl MKT.INDEX: 1.00 IMP.BV/D , 5/88 SCALE: 1 5 3 . ELEMENTS CODE CONSTRUCTION DETAIL
so 100 65.05 1092 71035 GROSS AREA 2682i FOUR FAMILY DWELLING CNST GP:00
FSF 90 58.55 498 29158 STYLE 05[_0_L_0_NIAL OL_D_____ 0.0
814 30 19.52 1092 21316 ! ! ESIGN AOJMT OD 0.0
xTc -----WALL- 12C ------ RD D.0
20 20 EAT%AC TYPE 090IL-HOT WATER 0.0
! I_N TER.FIN ISH OS LASTER 0.0
! FSF ! NTER.LAYOUT 12AVER--/NORMAL 0.0
! NTER.7UACTY 02SAME AS EX TER. 0.0
*------------49-----24----* FLOOR STRUCT_ _0240 JOISTI9EAM ( -6
D _ W ! B14 ! E LOOK COVER_
0$ INE FLOORIW6 0_0
E zptal area Au•_ Dase= 1 590 ! 1 6 OOf TTPE 01 GABLE-ASP HSH0.0
BASE E
BUILDING DIMENSIONS !
T ! LECTRiCAL 01 VERA_GE ______________0.0
A BAS W27 S14 W22 N30 E49 FSF N20 30 ! FO 46ATION OS TONE YACLS 99.9
W07 NO3 W06 S03 W11 S20 E24 FSF ! *_ ------ - - -- --- - ----- ----
-----27-----x
.. BAS S16 .. 814 N16 W49 S30 ldE.I6H80RH00D 67A8 HYANNIS
-----
L E22 N14 E27 .. ! 1.4 LAND TOTAL MARKET
! ! PARCEL 46100 139300
*-----22----* AREA 48683
VARIANCE +0 +186
STANDARD 25
Said �
106
UPC 68021
i No=F1_S �•ta, I
I HASTINGS. UN
P 339 592 28;7
US Postal Service
Receipt for Certified Mail
No Insurance Coverage Provided. -
Do not use for International Mail See reverse'.
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toa 4026 a/ p
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X I
PS Form 381 1,,Q015ember 1994 Domestic Return Receipt I
UNITED STATES POSTAL SERVICE First-Class MailPostage&Fees Paid
USPS
I Permit No.G-10
• Print your name, address, and ZIP Code in this box •
I
I
I `
Town of Barnstable
Building Division
M f 367 Main St.
I Hyannis, MA 02601
N
I
I
�TME \, e
. � rY a Town of Barnst idle
snaxsrns�, � �
Department of Health Safety and Environmental Services
i6g9. �0
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
April 25,1997
Allen White
Box 979
Hyannis,MA 02601
RR- (M-10R/P-719)
Dear Property Owner:
Our records indicate that your house at,391 South Street,is currently being used as a four-family home
contrary to Barnstable Zoning Ordinances. You must contact this office as soon as possible to either:
1) apply for a building permit to restore the property to a sWee-family home.
2) apply to the Zoning Board of Appeals for a variance
3) prove that these are legal four-family.
You must contact this office immediately to tell us what direction you wish to take.
Sincerely,
Gloria M.Urenas
Zoning En vrccrnent Officer '
GMU:lb
I
l�
7-
CERTIFIED MAIL-P 339 592 287
f9703I I
TOWN OF BARN STABLE
t1iA- SaPORT SII EMDNTASY/CONTINIIATI BPOBT
NAME ( T, FIRST, MIDD ) DIVISION /D
n O-A n/=
NOTE DETAILS i OBSERVATIONS-ITEMIZE EVIDENCE, SERIAL IS ETC-
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..............................................................
.... :::.. ::::...::::::::::::::::::::::::::::.:.::::::::::::::::.
a€
W€ HITE
391
� <:SOUT S REET
.... .::::.. ......... .....
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106
UPC smi '
No_1_ � I
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1�
sessor's Office(1st floor) Map —v Parcel d/ it
Date Issued
Fee s• O d
ngineering Dept. (3rd flo ) House# - BIKE
BARNSTABLE.
' MAS6.
19 ^,t6 •�
TOWN OF BARNSTABLE
Building Permit Application
Prol ct Stre. Address
Villagee�
.Owner -t? P Address
Telephone
Permit Request —
{
First Floor square feet I15-2)C
Second Floor square feet
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size Grandfathered?
Zoning Board of Appeals Authorization Recorded
Current Use ,r—�- Proposed Use
� P
Construction Type L2� �
Commercial Residential L�
Dwelling Type: Single Family Two Family Multi-Family.
Age of Existing Structure Basement Type: Finished rl/
Historic House )4-2), Unfinished
Old King's Highway kv
Number of Baths No.of Bedrooms
Total Room Count(not including baths) 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 PROI;WWILL BE TO
SIGNATURE -� DATE /
BUILDING PERMIT DEN D FOR THE FOLLOWING REASON(S)
+., FOR OFFICIAL USE ONLY
PERM N : z
DATE I SU D
MAP/P R EL NO.
r i e + e � • F # , a } t. - � .: a L.' j `. r .y t ry t
`
ADDR SS 1 VILLAGE
+
'
DATE` F I PECTION: * f, ��
FOUN ATI N
FRAME
INSULATION
FIREPLACE' ° f
ELECTRICAL, ROUGH FINAL F ;
MBING: ROUGH FINAL i ,• :� " , ": f
GAS: ROUGH f FINAL A : r ` g. r✓ t;
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
+` The Commonwealth of Massachusetts
Department of Industrial Accident
• _) ;�, -1� Olf�ceol/nveslfgalfons -
� 600 N'aslrinl ton Street r.
Boston,Mass. (12111
Workers' Compensation Insurance Affidavit
A leant tnformation: - Please PRiIVT'le tbl
namc: All
t
GOor
.2I am a homeow performing all work myself.
I am�owa.sole proprietor and have no one working in any capacity
i.-...t .v.Lu�+•�.,e-.v^.'+T-: 7 v - ..;�Y -.:.5'e•--r-�.qx-•.nn..f.�+n.S..,p.-
d I am an employer providing workers' compensation for my employees working on this job.
company name'.
address:
city: nhone#:
insunince co. nolicy
1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have
the following workers' compensation polices:
company name:
address:
ci : nhone#:
insurance co. Rolicy#
�... �....... �.t-r:,T•=-.;' -'..:. ircra,r-•.5:....a;R as�?�!r':• +te;a ,r :'Itgwh.• 7F-
comranv name:
address•
city: phone#•
ittc_urance co. policy#
;Attachadditional'sheetifnecessar .;:is': .�Y.srvr�twzrsFrgr f `Ridam«.a tf `n. «�.-- J+^�• .1 •
Failure to secure coverage as required under Section 25A of 119CL 152 calead to the imposition of criminal penalties of a fine up to S1.500.00 and or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
J do IJerehr certif} eider llie aims d e �erjuq•that the information provided above is true and correct.
Signature Date
Print name , "' Phone#
official use only do not write in this area to be completed by city or town official
city or town: permit/license# nt;uilding Department
Licensing Board
p check if immediate response is required pSelectmen's Office
,.
oNcalth Department
" contact person: phone#;. nOther
_••.:ems--•�,..r...r-•.�T.a►...r.�. _.. .. a..._... ... ... ,. wa..ssr....,v.wr..!t!:,-.r�w!.ae•r.r!'.'�_
Ire,7sed 3,195 P1A)
l
@Fhe Town of Bar&table
MAE& S Department of Health Safety and Environmental Services
-39. . P Building Division
367 Main Street,Hyannis MA 02601
Ralph Crosses
Office: 508 790-6227 Building Commissioner
Face 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"reconstruction,alterations,renovatio repair, erniration,conversion,
Limprovement,.remcn-1, demolition, or construction of an addition to 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 C=ptons, along with other
requirements
Type of Work: c' Est Cost
Address of Work: y�
Owner.Name:
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
rk excluded by law
_Job under SI,000
Building not owner-occupied
:Ocmer pulling own permit
Notice is hereby given that: CONTRACTORS
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE
ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor name Registration No.
OR -�
Date Owner's name .
• • TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE
JOB_ LOCATION
Number Street address gection of town
"HOMEOWNER61��
Name ��• ... � ° ...
Home phone Work phone ---
PRESENT 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 such homeowners to engage an in-
dividual for hire who does not possess a license, provided that the owner
acts as supervisor.
DEFINITION OF HOMEOWNER:
Persons) who owns a parcel of land on which he/she resides or intends to re-
side, on which there is, or is intended to be, a one to six 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 accaptable to the Building Official, 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 Building Code and other applicable codes, by-laws, rules and regulations. Stat
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 s procedures and requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwellings 35,000 cubic feet, or larger, will be required
to comply with State Building Code Section 127. 0, Construction Control.
HOME OWNER'S EXEMPTION
The code state that: "Any Home Owner 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
Home Owner engages a person(s) for hire to do such work, that such Home Owner
shall act as supervisor. "
Many Home Owners who use this exemption -are unaware that they are assuming
the responsibilities of a supervisor . (see Appendix Q, Rules and Regulations
for .licensing Construction Supervisors, Section 2. 15) . This lack of iwarenes
often results in serious problems, particularly when the ,Home Owner hires
unlicensed persons. In this case-our Board cannot proceed against the
inlicensed person as it would with- licensed_ Supervisor. ' The Home "Owner- actin
as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware of his/her responsibilities,. man
communities require, as part of the permit application, that the Home Owner
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 to amend and adopt such a form/certification for use in your community.
Assessor's ma and lot number .. . ....... Q �
p �.fJ................... THE TO
Sewage Permit number ... ...... .. .. .. a..r,-0I,.S' � UPTIC SYSTEM MUST
IN-7ALLED IN COMPLI' - sTeor$,
House number .... kiVi a H A''TICLE If STAT 9p N a
............................... r
SANITARY CODE AND Tb c�amo aye .
TOWN OF BARNSTABLB
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .......... ..............................................................................:.
TYPE OF CONSTRUCTION ...........
. .....................
/�...el.........................19.7
:... TO- THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location J Div" v�h bo y // i0i✓Its/ !. .......................................
ProposedUse .............. .............................................................................................................................
Zoning District .........................................................................Fire District
...................................................................�...........
Name of Owner L T•... ...Addresses ?? �a'� �z•...�! A40a S
..................................... .........................................
Name of Builder �Ll�..5...4; Ap$� �Address V. e��6
Nameof Architect ..................................................................Address ............./.......................................................................
Number of Rooms ......................Foundation .... 4.400 0-04-_ il.v........................................
1..
Exlerior .. �._L(./........................................:......Roofing ................ 4�mQ,.............................................
Floors C!; J. C g.,9..t7r . .................................Interior ............—
w Heating ..................................................................................Plumbing ...........................
,--................. �"3 v�a��
Fireplace ..:........... ...... ........................................Approximate Cost .................../.................................. . ..........
Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area ...............................'..........
So
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
O
v �oN3�E
6 ® �
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable.regarding the above
construction.
Name ........ .. :...................
` �
�
\ , '
/ ^
No Parmh {or .to'DW8ll '
—'r--r' -----'- -'' --. �
` . .
------....---------~---~-----' Y .
Location 3g1 St
--~~...�°*w,..~.^---------''
��
—''--~—''Hxa
`'--'nds—~—^-----------
�
Owner �� Fav
' ---. °..�~^--------------
Type of Construction Fname---�-------
--------------------------.
' '
Plot -------- — Lot ................................
Permit Granted ....MwAry..... .,--]V 79
Dote of Inspection ..................................'_lV
' Completed ^m�"� ' �l� �4`
~~'~ ' �-----~'--'��--'' � /
/
PERMIT REFUSED
` � ` � ^
__.,____._____~---'— lA
--.. '
.--------.—.---.------'+—.--. ' -
—.--.--~—..--.—.---...—.---',----
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—..---~---.- —.--.—.. . . .~~ .... . ��.
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---.----..----..--.—~..—^—.*----
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lg
7 pp ",e" --'z-------~----'�
.....................................................:''�r'--`—
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' /
___. _______,_—___~___,..—''�r^'
�
U 1
Assessor's map and lot number s,J. '7........ ... . � 411SINE
T
0 0�
f Q��
Sewage Permit number /.�.........
Z DAM-TABLE, i
Housenumber ........................................................:....... ....... r rb
�O 39• 6
pM a\
TOWN . •OF 'BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ..........4 ..................'`.. " ur`
TYPE OF CONSTRUCTION .......................................'� ' ` .. ... •� �......................................................... . " `' ::.........
'
bi ..r'!V
................................................19..:.......
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .. +.�.'. ,' ..i:.........f.......,....•......'.................t.. ........•.......•....:.......•.!...... ........................ ............................
ProposedUse .............. r. .......... .?..............................................................................................................................
a{
ZoningDistrict ........................................................................Fire District ..............................................................................
Name of Owner .....`.......... ............................................Address»:.. '.. Z......... C�ti.✓': .......... .»•.....:....`.....: ..'... ...' '
Name of Builder -^ .. i ... �3r ^ y' afi.Address : ..y ..f:: =*::`:f: . :::�:.: ..`.":.' .. ':..: a ."< "' r '"�i
•
Nameof Architect .................... .............................................Address ....................................................................................
Number of Rooms ............ '".. .....................................Foundation .......................'....::"."�":�..a.:.......................................
Exterior ........ fir ........... ..!1. .. .� .....................................Roofng ...................' rY7. ?,. ..............................................
r
Floors ..� lt.. . :_.. i' t ................................Interior .._... .
............................:.....................,,. ........
t
Heating ..................................................................................Plumbing ........... ...............................................................
6l1
Fireplace ..................................................................................Approximate Cost ................: ..... cr ..:: ::........................
Definitive Plan Approved by Planning Board ________________________________19________. Area t r
Diagram of Lot and Building with Dimensions
Fee .............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
t � .
W ,
w�.
1
I t.
Y
1 +
lr t f
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ....... ........':A......... '...`..`:f°s. ." .............. i
Fay, G A308 219
No Permit for ...8!;.r,.e.5.5.Q.rY...t.0..Dwel 1 ,
...............................................................................
Location ...s.t...................................
..............................Hy.annj5...................................
Owner ................. .... ...............................
Type of Construction ..(. .arm.e.................I............
................................. .............................................
L t
Plot ............................ Lot ................................
Permit Granted .........�.KWY..... ......19 79
Date of Inspection ............................ .......19
Date Completed .......................................19
P PER REFUSED
/ER...ff
...........................I................... ................ 19
....................... ...... ... ... .....................
............ .....................................
................ (........................................................
...........
.. ................................................................
Approved ................................................ 19
...............................................................................
.............................. ................................................