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OF.ZHEt Town of Barnstable
Inspectional Services
.: P
H"�` r.B a Brian Florence,CBO
i639• s�0� Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
INSPECTION REPORT
Address ` 928 BUMPS RIVER ROAD, CENTERVILLE Case# C-19-176
Inspection Type Violation Inspector: lauzonj
;Description Date Unit Status Comment
lViolation 03/09/2020 FAIL Full apartment in what appears to be former
garage. Locking door separates apartment
± from main house. Smoke detector location
t above paddle fan. Informed owner of need to
restore to single family home and fix smoke
detector location as well as obtain a building
permit to create new bedroom.
Inspection Type : Violation Inspector: lauzonj
Description Date Unit Status Comment
i
Violation 07/27/2020 FAIL NOTICE OF VIOLATION DATED 3/13/20
SENT TO OWNER. NO RESPONSE. STREET
FILE CONTAINS AN EMAIL FROM BRIAN
FLORENCE TO ROBIN ANDERSON TO GIVE
MRS. NASH 90 DAYS TO OBTAIN A
BUILDING PERMIT. STILL NO APPLICATION !
I SUBMITTED. RECOMMEND FOR THE NEXT
j STEP IN ENFORCEMENT ACTION.
Violation 07/27/2020 FAIL NOTICE OF VIOLATION DATED 3/13/20
SENT TO OWNER. NO RESPONSE. STREET
FILE CONTAINS AN EMAIL FROM BRIAN
FLORENCE TO ROBIN ANDERSON TO GIVE
MRS. NASH 90 DAYS TO OBTAIN A
BUILDING PERMIT. STILL NO APPLICATION
SUBMITTED. RECOMMEND FOR THE NEXT
STEP IN ENFORCEMENT ACTION.
i
1 • • • • I
■ Complete items 1,2,and 3. A Signature
■ Print your name and address on the reverse X gent
so that we can return the card to you. ❑Addressee
■ Attach this card to the back of the mailpiece, B: Rec ' ed by(P' ed Name) C. D of Delivery
or on the front if space permits. �(L
1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes
If YES,enter delivery address below: )lo
C WVI,< , -
II�IIII�I I'I I I�I I I II I I I I I II I I I I I I I I I I I I II I I III 3, Service Type ❑Registered
erect M xpress®
❑Adult Signature ❑Registered Maim"
Adult Signature Restricted Delivery ❑Registered Mail.stncted;
9590 9402 3630 7305 4659 58 nrti ied Mail® elivery
�j_Certified Mail Restricted Delivery �RDetum Receipt for
❑Collect on Delivery Merchandise
9.
❑Collect on Delivery Restricted Delivery Signature ConfirmationTm_4rtir.Ie Number?ransfer_fcom SerVICe:/abeD ❑Signature Confirmation
7 017 10 0 0 010 40 I 6 7 5 7 1 5 7 lad Restnctertehvery Restricted Delivery
PS Form 3811,July 2015 PSN 7530-02-000-9053 <:Domesttc F?eturn Receipt ,
USPS MCK NG#
..... S`" �E first-Class Mail I
Postage&,Fees Paid
USPS
Permit No.G-10
A
9590 9402 3630 7305 4659 58
United States •Sender:Please print your name,address,and ZIP+�4®in this box*
Postal Service
IjVi% Ur ,�A ci�STAI3LE
BUILDING DIVISION
200 MAIN ST
i
°-7'v7ANNIS, MA 02601
i
��'--j!ffl.w,)hull Iilliliii i)'li!1111111W111411ji,1.i III ill! if!
Anderfi�omaobin `
From: Florence, Brian
Sent: Thursday, March 22, 2018 9:19 AM
To: Anderson, Robin
Subject: FW: 928 Bumps River '
Sorry Robin I forgot to copy you on my response to Arden...please see below.
Thanks for the update,
-Brian
From: Florence, Brian
Sent: Thursday, March 22, 2018 9:18 AM
To: Cadrin, Arden
Cc: Jenkins, Elizabeth
Subject: RE: 928 Bumps River
Hi Arden,
Thanks for the reminder, I had entered this into our enforcement system for tracking purposes. The property owner,
Nancy Nash met with us on 2/21/18. Ms. Nash did not want to enter the Amnesty program because technically she is in
a roommate situation with an elderly friend that she is caring for. There exists illegal apartment that is in violation of the
zoning ordinance and building code. She has been notified of that and has agreed to the following abatement plan:
• Create a bedroom on the first floor(in former garage)with a building permit.
• Reduce the number of bedrooms-on the 2"d floor by opening the closet between 2 bedrooms and making it a
master bedroom suite.
• Remove the stove in the garage'bedroom and install a cabinet in its place.
• Upgrade smoke detection system in accordance with building code requirements.
This will have the effect of turning the apartment into a bedroom. We agreed to give Mrs. Nash 90 days to obtain a
building permit and are waiting for her contractor to make application. Unfortunately at this point I think you can
probably close this out on your end. I will let you know if anything should change.
Thank you again,
-Brian
Brian Florence, Building Commissioner
Building Department I Town of Barnstable
200 Main Street
Hyannis, MA 02601
508-862-4038
Brian.forence@town.barnstable.ma.us
From: Cadrin, Arden
Sent: Monday, March 19, 2018 10:38 AM
.To: Florence, Brian
Subject: 928 Bumps River
1
Hi Brian; ,Z
Just following up that I have not received an AAAP Site Eligibility Application from the owner of 928 Bumps River,
Centerville. I have not had any contact with her after the first phone call one month ago.
Regards,
Arden
Arden Russell Cadrin
Housing Coordinator
Planning and Development Department
�wq � Town of Barnstable 1367 Main Street I Hyannis,Ma 02601
�a F arden.cadrin@town.barnstable.ma.us
p 508 862 4683 1 Website ( Business Barnstable I HVArts I Barnstable iForum
asSFisF y
i3. S��y"it
2
Town of Barnstable
Building Department Services
Brian Florence, CBO
Building Commissioner BARNSTABLE
200 Main Street Hyannis, MA 02601 BFRNSTA NlE -OE EWU-OIDIT•MYA9
�J xMSIW15 xR15.OSi9-201•e1F51 BPVNSTnBtE
� J � - 1639-2014
www.town.barnstable.ma.us �g
Office: 508-862-4038 Fax: 508-790-6230
March 13, 2020
Notice of Zoning & Building Code Violation(s) and Order to Cease,
Desist and Abate:
Nancy M.Nash and all persons having notice of this order:
As property owner/occupant of the property located at 928 Bumps River Road,Centerville,
Assessors Map 168 Parcel 043 and known as residential structure,you are hereby notified that you
are in violation of 780 CMR,the Massachusetts State Building c. 1 § R105.1, Zoning Ordinance of
the Town of Barnstable c. 240 § 11 (A)(1)and are ORDERED this date 3/13/2020 to: CEASE
AND DESIST all functions associated with the following violation(s)on or at the above mentioned
premises:
Summary of Violation:
On 3/9/2020 the Building Department observed violation(s)of 780 CMR,the Massachusetts State
Building Code c. 1 § R105.1, c: 3 § R311.1, c. 3 § 314.3 and the Zoning Ordinance of the Town of
Barnstable c. 240 § 11 (A).(1) specifically,an apartment created without the benefit of a
building permit or zoning approval.The apartment does not contain the two required exits
and smoke detector locations are not as required.
Summary of Action to Abate Violation:
In order to abate this violation and to avoid further enforcement action by this office, commence
immediately.upon receipt of this notice the following action: cease use of the apartment and
obtain all required permits for that of an approved use along with successful completion of all
required subsequent inspections.
And;if aggrievedby this notice and order; to show cause as to why you should not be required
abate the Building Code violation(s) in this notice, you may file a Notice of Appeal (specifying the
grounds thereof)with the Building Code Appeals Board within(45)days in accordance with
M.G.L. c. 143 § 100. And, if aggrieved by this notice for the Zoning violation,you may file an
Appeal within(30)days in accordance with M.G.L. 40A § 15. If, at the expiration of the time
allowed, action to abate this violation has not commenced, further action as the law allows may be
taken.
By Order,
#frgLV'4raKzon
Chief Local Inspector
(508) 862-4034
Jeffrey.lauzon@town.bamstable.ma.us
f
Town of.Barnstable
Building Department Services
Brian Florence, CBO
Building Commissioner :rs_�a
RNSTABLE
200 Main Street H annis MA 02601�J us•osnawue•wesr enxnsrae�
J 1639-2014 -
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508=790-6230
March 13, 2020
Notice of Zoning & Building Code Violation(s) and Order to Cease,
Desist and Abate:
.k
Nancy M.Nash and all persons having notice of this order:
As property owner/occupant of the property located at 928 Bumps River Road,Centerville,
Assessors Map 168 Parcel 043 and known as residential structure,you are hereby notified that you
are in violation of 780 CMR,the Massachusetts State Building c. 1 § R105.1,Zoning Ordinance of
the Town of Barnstable c. 240 § 11 (A)(1)and are ORDERED this date 3/13/2020 to: CEASE
AND DESIST all functions associated with the following violation(s)on or at the above mentioned
premises:
Summary of Violation:
On 3/9/2020 the Building Department observed violation(s)of 780 CMR, the Massachusetts State
Building Code c. 1 §R105.1, c. 3 § R311.1, c. 3 § 314.3 and the Zoning Ordinance of the Town of
Barnstable c. 240 § 11 (A)(1)specifically, an apartment created without the benefit of a
building permit or zoning approval. The apartment does not contain the two required exits
and smoke detector locations are not as required.
Summary of Action to Abate Violation:
In order to abate this violation and to avoid further enforcement action by this office, commence
immediately upon receipt of this notice the following action: cease use of the apartment and
obtain all required permits for that of an approved use along with successful completion of all
required subsequent inspections.
And, if aggrieved by this notice and order;,to show cause as to why you should not be required
abate the Building Code violation(s) in this notice,you may file a Notice of Appeal(specifying the
grounds thereof)with the Building Code Appeals Board within(45)days in accordance with
M.G.L. c. 143 § 100. And, if aggrieved by this notice for the Zoning violation,you may file an
Appeal within(30)days in accordance with M.G.L. 40A § 15. If, at the expiration of the time
allowed, action to abate this violation has not commenced, further action as the law allows may be
taken.
By Order,
L. Lauzon --
Chief Local Inspector
(508) 862-4034
Jeffrey.lauzon@town.barnstable.ma.us
i
Nancy M.Nash
928 Bumps River Road
Centerville,MA 02632
508-428-5150
Town of Barnstable
Building Department Services
Attention: Robin C.Anderson
200 Main Street
Hyannis,MA 02601
Re: Your letter of 2/22/18—Property Inspection
Dear Robin,
Thank you for your attention and guidance to help me correctly address changes
—— made to my home in recent years.
You made me feel comfortable working with you and I will follow up on your
suggestions.
Currently,I am waiting for Andy Powers to come by and evaluate the changes
that seem feasible to me and you.
I will contact you when the options have been reviewed by him and therefore I
will be able to firm up some simple renovations to bring me"up to code".
Thank you a ain for your time and kind consideration.
/Y
Nancy Nash
PS. I have included a copy of this letter for you to give to Brian.
Nancy M.Nash
928 Bumps River Road
Centerville,MA 02632
508428-5150
Town of Barnstable
Building Department Services
Attention: Robin C.Anderson
200 Main Street
Hyannis,MA 02601
Re: Your letter of 2/22/18—Property Inspection
Dear Robin,
Thank you for your attention and guidance to help me correctly address changes
made to my home in recent years.
You made me feel comfortable working with you and I will follow up on your
suggestions.
Currently,I am waiting for Andy Powers to come by and evaluate the changes
that seem feasible to me and you.
I will contact you when the options have been reviewed by him and therefore I
will be able to firm up some simple renovations to bring me"up to code".
Thank you again r your time and kind consideration.
f
Nancy Nash
PS. I have included a copy of this letter for you to give to Brian.
Aeje-�
on III
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Town of Barnstable
Building Department Services
Brian Florence, MAI
Building Commissioner BARNSTABLE
200 Main Street Hyannis MA 02601 °"""�"° "`"""''`'`°"° "�""°S
µARNST5w115. RVI- -COTES-MMNAI.E
7 7 1639•.2014
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
February 22, 2018
Mrs. Nancy Nash
928 Bumps River Road
Centerville, Ma 02632
Re: Property Inspection
Dear Mrs. Nash,
I am writing to confirm our discussion last week during a recent inspection of your home on the
afternoon of Feb. 161h. You will recall that I was present along with Local Inspector Robert
McKechnie and Fire Prevention Officer Michael Grossman of COMM FD.
I explained that this action was somewhat a departure from our normal protocol but because FPO,
Grossman thought a preliminary inspection may be helpful l agreed to participate. The general
goal was to provide you with options in order to legitimize your existing rental unit and identify any
significant code issues that may be required to be satisfied.
I suggested a few options that may possibly allow you to maintain the studio apartment as a rental
unit as well as preserving the tenancy of its current occupant. I provided you with contact
information for Arden Cadrin, Housing Coordinator(508-862-4383) as she can explain the
requirements and answer any questions'you may have concerning the Affordable Accessory Unit
Program. In addition, I recommended that when you speak to Ms. Cadrin you should inquire about
grants funds that may be available for necessary safety improvements.
At this time, I am also suggesting that you reach out to the Building Commissioner, Brian Florence
(508-862-4030) fora definitive determination of the state building code. He will advise you
accordingly. Please know that both FPO Grossman and I have spoken to the Commissioner
already and made him aware of your situation. He anticipates your call and looks forward to
discussing the matter with you.
Thank you for allowing us to assist.you in sorting out this matter. To be clear, we identified that
there are building and zoning violations:to be addressed.. Please consider this an attempt to
resolve the matter without engaging a more formal enforcement process. I do anticipate a
satisfactory resolution for all parties and as such you are respectfully requested to notify this office
of the appropriate remedy you have selected. The courtesy of a reply is requested on or before
March 9, 2018.
Sincerely, -
Robin C. Anderson
Chief Zoning Enforcement Officer
CC FPO Michael Grossman via email
r
r
Date: February 16, 2018
To: Building File
RE: Complaint: Illegal Apartment
Address: 928 Bumps River Road, CentervilUe
Originator: FPO Mike Grossman, COMM FD
Contact:
Complaint: Un-permitted apartment in annex
Enforcement Process Steps
13 1. Initiate local investigation: RA
13 2. Document/enter into system Yes
13 3. Contact Nancy Nash
4. Contact owner
5. Seek access to subject property Inspected by COMMFD 2/?/18
6. Seek administrative warrant (if necessary) NA
7. Notify state authorities of findings NA
13 8. Document conclusion
9. Referred
Property
Property is developed with a 4 bedroom -3 bath Colonial (1967).
2 ? 2018
FPO Grossman inspected property as part of the Senior Safe program and found an apartment unit on
the first floor in the converted garage.The owner advised that she needs the income in order to
maintain ownership of her house. FD requested an inspection in order to explore or provide options
with regards to apartment use and configuration.
2 16 2018
Inspection arranged with RA& Robert McKechnie to meet with FPO Grossman and check property.
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Parcel Detail Page 1 of 4
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MA
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Logged In As: Parcel Detail Tuesday,
November 19 2013
Parcel Lookup
Parcel Info
Parcel ID 168-043 I Developer
ILOT 20 T 20Lot
Prl,
Location'928 BUMPS RIVER ROAD I Frontage L135
Sec ___.. _ - ___ Sec,
Road' I Frontage
Village!CENTERVILLE I Fire IC-O-MM
District'
Town sewer exists at this Road Fo----- - --- ------- —)
_ {0194
address ._No Index
Asbuilt Septic Scan: Interactive
168043 1 Map
Owner Info
....... . _._- ........... ............... .......... ........... ...................
Owner!NASH, NANCY M
Owner
Streetl 1928 BUMPS RIVER ROAD Street2
..............
City 16ENTERVILLE State.MA Zip,' Country
Land Info
Acres 10.49 J Use lSingle Fam43L-01 Zoning'sPLIT RD 1,RC Nghbd 0106
Topography(Abovestreet Road Paved µ
UtIIIt12S Septic,Gas,Public Water Location'
Construction Info
Building 1 of 1
Year11967— Roof able/Hip Ext;Woodshingle
Built' Struct Wall'
{ Living 2424 1
Roof As hiF Is/C Gm AC Central/Half
L.
Area Cover p p Type:
Style;Colonial Wall Drywall I ROOmS'4 Bedrooms
Batht-
Model;Residential Floor Rooms
I R OmS'2 Full
Heat Total
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=10954 11/19/2013
Parcel Detail Page 2 of 4
v
GradeAveragePlus I Type;HotAir I Rooms Rooms
He — ----- Found- —
stories'2 Stories ) Gas I ;Typical
Fuel ation
M t
Gross:
`4393 y'
Area
Permit History
Issue purpose Permit Amount Insp Comments
Date # Date
11/7/2001
4/13/2001 Addition 52772 $20,000 12:00:00
AM
W Visit History
Date Who Purpose
5/28/2008 12:00:00 AM Paul Talbot Cyclical Inspection
11/7/2001 12:00:00 AM Martin Flynn Meas/Listed-Interior Access
9/15/1999 12:00:00 AM Donna Dacey Meas/Listed-Interior Access
6/25/1998 12:00:00 AM Lloyd Kurtz
W Sales History
Sale
Line Date Owner Book/Page pale
rice
1 7/6/2007 NASH, NANCY M C183576 $1
2 1/15/1983 NASH, ROBERT R & C90701 $0
NANCY M
W Assessment History
Save Building Land Total
# Year, Value XF Value OB Value Value Parcel
Value
1 2013 $212,200 $30,200 $33,900 $143,000 $419,300
2 2012 $217,000 $29,200 $31 ,100 $137,500 $4147800
3 2011 $2361500 $71300 $227600 $1377500 $4031900
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=10954 11/19/2013
Parcel Detail Page 3 of 4
4 2010 $2361900 $77300 $231100 $1391700 $4077000
5 2009 $2601400 $67600 $177700 $1617800 $446,500
6 2008 .$2687100 $67600 $171700 $173,200 $465,600
8 2007 $267,300 $61600 $171700 $173,200 $4647800
9 2006 $250,400 $61600 $187100 $181 ,000 $4561100
10 2005 $2237 500 $61 500 $187 500 $1667 500 $415,000
11 2004 $1827500 $6,500 $181700 $1667500 $374,200
12 2003 $1701200 $67 500 $18,900 $48,500 $244,100
13 2002 $1401700 $6,500 $900 $48,500 $1967600
14 2001 $1407 700 $67 500 $900 $481 500 $196,600
15 2000 $961300 $6,000 $500 $37,500 $140,300
16 1999 $96,300 $61000 $500 $37,500 $140,300
17 1998 $96,300 $61000 $500 $371500 $1407300
18 1997 $112,600 $0 $0 $33,700 $147,500
19 1996 $112,600 $0 $0 $331700 $1471500
20 1995 $112,600 $0 $0 $331700 $1471500
21 1994 $108,500 $0 $0 $231600 $133,300
22 1993 $1087 500 $0 $0 $23,600 $133,300
23 1992 $1237 300 $0 $0 $267200 $1507 900
24 1991 $1307000 $0 $0 $607000 $1917400
25 1990 $1301000 $0 $0 $607000 $1917400
26 1989 $130,000 $0 $0 $601000 $1917400
27 1988 $847200 $0 $0 $287000 $1137400
28 1987 $847200 $0 $0 $281000 $113,400
29 1986 $841200 $0 $0 $281000 $1137400
Photos
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=10954 11/19/2013
Parcel Detail Page 4 of 4
i
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http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=10954 11/19/2013
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map /ll� v Parcel f Permit# �Z
Health Divisions Date Issued" 3 �.
Conservation Division ^` U Fee
Tax Collector /X EPTIC SYSTEM MUST BE
I STALLED IN COMPLIANCE
�a CO IVC
Treasurer WITH TITLE 5
Planning Dept. ENVIRONMENTAL CODE AND
TOWN REGULATIONS
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address n e
Village
Owner P �J�fI�i / /0S,4 Address
Telephone IV-L 7 i
Permit Request l iyI _
Square feet: 1 st floor: existing 1.2 5 D proposed_ff— nd floor: existing 6 proposed 00 Y Total new 1 S�
Valwation -140o` 010 Zoning District Flood Plain Aga Groundwater Overlay /yo
Construction Type W -Do d -0 u/-e ony
Lot Size 0, !fy Acv-e Grandfathered: r9'Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family L" Two Family ❑ Multi-Family(#units)
Age of Existing Structure 311 y // Historic House: ❑Yes ®'No On Old King's Highway: ❑Yes &No
Basement Type: QZFull ❑Crawl & alkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) �t ou
Number of Baths: Full: existing new 1 Half: existing .® new .0
Number of Bedrooms: existing L/ new .®
Total Room Count(not including baths): existing new First Floor Room Count
Heat Type and Fuel: YGas ❑Oil ❑ Electric ❑Other
Central Air: &1es o Fireplaces: Existing / New n Existing wood/coal stove: ❑Yes Mo
Detached garage:❑existing mew size A X Pool: ❑existing ❑new size Barn:❑existing ❑new size
Attached garage:LYexisting ❑new size o Shed: Yexisting ❑new size D Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use lbw f/ 07 Proposed Use w r I t`►
l BUILDER INFORMATION
Name ���1 l��5 '1 Telephone Number _ Ll Z ,5 '1.5''J
Address License# Hb tM—e
f3v-,e-5 Rt it e— X oA Home Improvement.Contractor# `!O 41 r
L`e Worker's Compensation# .-----
ALL CONSTRUCTION DEBRIS RESULTING FRO THIS PROJECT WILL BETAKEN TO /Able
SIGNAT E ter/ DATE l� Gl
F
FOR OFFICIAL USE ONLY —
c
t PER'MIT NO.
DATE ISSUED 4 -
MAP/PARCEL NO3 } -
ADDRESS VILLAGE
OWNER
zr-
DATE OF INSPECTION
FOUNDATION
FRAME '
INSULATION
FIREPLACE
r—' ELECTRICAL: ROUGH; - =—r FINAL l
PLUMBING: ROUGH FINAL
GAS: ROUGH n, n FINAL
FINAL BUILDING r
DATE CLOSED OUT
ASSOCIATION PLAN NO.
I
r
F �
The Town of Barnstable
Regulatory Services
Thomas F. Geiler, Director
Building Division r
Elbert Ulshoeffer, Building Commissioner
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Fax: 508-790-6230
HOA'IEOWNER LICENSE EXEAU`TION
Please Print
DATE:
JOB LOCATION: q;W A[!Yn AS Rwe y
number / street village
"HOMEOWNER": LIP e/7l� Sf Sa
name D N / home phone# work phone#
• CURRENT MAILING ADDRESS: Il o n S S 1
CxhT e yt liy f�
city/town state rip 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,Rrovided that
the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s) who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is
intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or
farm structures. A person who constructs more than one home in a two-year period shall not be considered'
a homeowner. Such"homeowner'shall submit to the Building Official on a form acceptable to the
Building Official,that he/she shall be responsible for all such work Rerformed under the building permit.
(Section 109.1.1)
The undersigned"homeowner'assumes responsibility for compliance with the State Building Code and
other applicable codes,bylaws,rules and regulations.
The undersigned"homeowner'certifies that he/she understands the Town of Barnstable Building
Department minimum inspection procedures and requirements and that he/she will comply with said
procedures and re men .
tgn ,,pd Home 9woer
Approval of Building Official
Note: Three-family dwellings containing 35.000 cubic feet or larger will be required to comply
with the State Building Code Section 127.0 Construction Control. ,
HOMEOWNER'S EXEMPnON
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the
provisions of this section(Section 109.1.1-Licensing of construction Supervisors):provided that if the homeowner engages a
person(s)for hire to do such work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see
Appendix Q,Rules&Regulations for Licensing Construction Supervisors.Section 2.15) This lack of awareness often results in
serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the
unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities.many communities require,as part of the permit
application.that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a
form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:FORMS:EXEMPTN
1
ESTIMA TED PROJECT COST WORKSHEET
LIVING SPACE Value
(high end construction) r square feet X$115/sq. foot=
—42)L�-
(above average construction) square feet X$96/sq. foot=
(average construction) square feet X$57/sq. foot=
• GARAGE (UNFINISHED) ` square feet X:$25/sq. foot
PORCH square feet X$20/sq. foot=
DECK square feet X$15/sq. foot=
OTHER aiG �.e C r -3 5'�t, square feet X$/sq. foot
Total Estimated Project Value
J
�� 1
t[�
- ��
�,
4
� �
29'4
224 7'
m
M
v EXISTING
�__ rNEW
So
M M
t0
00
Existing t
- NEW-
4-4 6'10 _I
22'2 7'2
r 29'4
F EAST
Foundation on posts j
Walls plywood.wood shingles
sheetrock
Robert Nash
528 Bumps River Road
Centerville MA
i
6 4
a
'v
New i
22' 7'2
N Onew wi ow Existing
New
L
O �
door
9'2 dpor 5'5+ 3'—'I
wood shed 177 T2
New foundation 8 x14 on post
2x8 floor with plywood.
Walls 2x4, plywood, shingles.
Roof 2x8,asphalt shingles
S KE DETECTORS O.K. Plumbing bath laundry.
Plywood floor in existing garage
I L LId Window replacing garage door
® RNs3TA®LE NUILIDiNo 0 PT. Add door,two windows to existng
east wall of garage
Robert Nash
928 Bumps River Road
Centerville MA
ALL UIPIENSION LUMBER SNP
4 f{ BE KO SPF Na 2 On BETMR.
71
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ALL DIMENSION LUMBER SIIA .
1BE KO SPF No.2 OR SERER
• COLLAR TIE Q 4e"O.G.
Z x RAFTER
2 x CEILING JOISr a aC.
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preaipdve Pad�asa for Oao aad lift"wdd Buildup Hand wills Foug Fuh
MAXIMUM MEgUMM11M
mizing cups Cdlias wau Floor Bosco=
Am'('K) U-vaiv� &wald &vW=' Rrv.itos' w.0 . Add F1Gom
FRI to 6500 Rada;DCOM DAW
Q 12% 0.40 31 13 19 '10 ..6 Na d
i< 129s 0.52 30 19 19 10 6 No�md
S 12% 0.S0 3i - '13 19 10 6 LS AFUE
T 13% 0.36 31 13 25 WA WA Nand
U 13'�fi OA6 31 .19 -19.. .-10. 6 Noemd -
V 15% ow4 29 13 2S ,WA. WA 1S AFUE
W 13'yi 032 30` 19 19 10 6 1S AFUE
X 11% 3Z 31 13 :M WA WA Nonni
0.
Y 119E owl[ 31 19 2S ;z WA WA Nosmai
Z 11•b 0.42 >s 13 19 10 , 6 90 AFUE
AA IVA 030 30 19 19 " 10 6 90AFEM
1. ADDRESS OF PROPERTY: OL,`n JK
2.. SQUARE FOOTAGE OF ALL EXTERIOR WALLS.
3. SQUARE FOOTAGE OF ALL GLAZING: Ll
4. %GLAZING AREA(M DIVIDED BY#2):
S. SELECT PACKAGE(Q—AA-see chart above): v
NOTE: OTHER MORE INVOLVED METHODS,OF DETERMINING ENERGY REQUIREMENTS
ARE AVAILABLE. ASK US FOR THIS INFORMATION.
.1.
�r
BUILDING INSPECTOR APPROVAL:
YES: NO:
fo ms-t980303a
780 CMR.Appendix J
Footnotes to Table JS.7-1b: skylights, and
' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors,
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.I%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 fl of glazing area.
2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with
v the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.53a U-values are for
whole units:center-of-glass U-values cannot be used.
ll
' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the -38
insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R3
insulation and R 38 insulation may be substituted for R49 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,stucaual 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-b insulating sheathing. Wall requirements apply to
wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-flame 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 S. 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 grc=than 035.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 razing 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(035 for doors).
t-E
STANDARD LEGEND
NOTE:not all symbols will appear on a mop
MAP 168 1v 1
GOLF COURSE FAIRWAY
EDGE OF DECIDUOUS TREES
# 19 EDGE OF BRUSH
ORCHARD OR NURSERY
EDGE OF CONIFEROUS TREES
MAP 168 :MAP'1 ��
� 1' _ _------ __ ' ... _ MARSH AREA
5,7 _ • . . .._. EDGE OF WATER
••V✓. \ 101 /` ---MAI '1'68 __ _ _ - DIRT ROAD
/ j 4
DRIVEWAY
�—PARKING LOT
��•�� t J�19��g �—PAVED ROAD
/// ti��. a�, # 1
DRAINAGE DITCH.,,
MAP 1 68 PATH/TRAIL
\ / PARCEL LINE4 3 *"
Aw ito< ---MAP
k o - - 21 E---PARCEL NUMBER
# 928 `A,L; / zleaoIr HOUSE NUMBER
•,\ � � ,, ',, _ 2 FOOT CONTOUR LINE O
.< /i — — 10 FOOT CONTOUR LINE
\ s' �b �V' Elevation based on NGVD29
4.9 SPOT ELEVATION
MAP 168
STONE WALL
4 2 ,
# 920 �`` ' �� f `� h..__...h._ FENCE
., y.
�� RETAINING WALL
1AP 168
� /f 5 � � ��;// -•r--+--+--:-• RAIL ROAD TRACK
4 STONE JETTY
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1 SWIMMING POOL
902
----- �_} PORCH/DECK
7, - i,z C� EjJ ❑ BUILDING/STRUCTURE
DOCK/PIER
HYDRANT
1_ v e VALVE ® MANHOLE
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AA A
T O-W N O F B A R N S T A 6 L E G E O O• R A P N 1 t I N F O R M A T 1 O N S Y S T E M S U N 1 T O SIGN ® STORM DRAIN
N PRIMED Sw:,N EEEI *NOTE:This map is an enlargement of a **NOTE The panel lines are only graphic representations DATA SOURCES: Planimattics(man-made feonlres)were interpreted from 1995 aerial photographs by The lames o TOWER
l'=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD 0 UTIUTY POLE
w ..e _ National Ma Accuro Standards of this do not represent actual relationships to .
� 25 SQ p ry ps physical objects Corporation. Plonimetrics,topography,and vegetation were mapped to meet National Atop Accwary Standards
x 1 INCH=SO FEET* enlarged scale. on the map, at a scale of 1"=.100'.Pattel lines were digitized ham 2000 Town of Barnstable Assessor's tax maps. O LIGHT FOIE O ELECTRIC BOX
`_ _ -.-_ The Commonwealth of MassachUse=
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_ Department of In&urrialAccidents
01�ctollaptsllgatlods
600 Washington Street
Boston,Mass 02111
Workers' Ca m ensation Insurance Afridavit
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....... ....
Mims m req= under Seedoa 2SA of MGL 152 asa lmd to the inspoatd—of alai pem des of a Boa up to S UM00 and/c.
om fears'tmpmonmmt as wail as doff pmaltirs is the fo of a STOP WORK ORDER tad a floe of SIM00 a day against me. I tmdwlt=d aw s
copy of this statemmt may be forwarded to the Oil[=of es of the DIA for cavemp verl adoa
r
I do hereby certify raider-t/u: p v pQl�3'�dw infommdon pmWded above is�and correct
Daft: z/—/0
SigaatBre
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oincW use only do not write in this area to be computed by city or town oMcbd
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c3ucensia=Board
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❑Health DepartIllm
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Robert Nash
298 Bumps River Road
Centerville MA
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LOCATION MAP [*SUBJECT PROPERTY]
Abstracted from Town of Barnstable
Assessors' Maps, Map 168, Parcel 43
Scale: 1" ' 200'
g
l� ~ n,c .sue "`. F ,,�s Ss •;=^g"'^tl7'R�'._, y, '`.r,.,.
OVER FOR PHOTO ATTACHMENTS
FJIm9IiM1�WM�r�::Inl:W1�:ItlfA.:�15 WIM:,tiY nw• fJi:w r:,.•.'^.1:11:1;•,:, :'N7
FW 70A11004A
/Z-t
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d 0
PyoFTHETo�♦ TOWN OF BARNSTABLE
•
BAUSTLUX i
o pY. ��� BUILDING INSPECTOR
APPLICATION FOR PERMIT TO�5 .!! i��� �.......... .....................,. .............................................................
TYPE OF CONSTRUCTION "'''���� ` t � ��,�.°1/t
................................. .g. ................................
............�.................19�.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for ra permit according to the following information:
Location ....i: .T....... .d..............1�.v Nn 5..... .Ki..e.2... .r-O....... ... ..........................
ProposedUse .......... ..-......yt: .t.f. /......... .....................................................................
Zoning District ........................................................................Fire District .......�.J.�i.E�(,�j..��a°. .
Name of Owner .......d.�nf.5.... �dl/..C.:...Address .��1���..���111�....�1�.�.......(���/�t�r✓.
Name of Builder (Z)A...b-T,(.......hCiA/ *....... �.✓C.:.....Address
Nameof`Architect ..................................................................Address ....................................................................................
Number of Rooms [ ...........................Foundation ... akk ..
Exterior :.....S;( 1.�/J,6. �c•...............................................Roofing ........r / -/7.......... .......
Floors ... .....H ..............................................Interior ......... ............ .......................................
Heating ..... dl� �.......N�.7......4../..,...................Plumbing ....... .....................................
Fireplace .......O..qc...........................................................Approximate Cost .......13-5-a-. .......................................... .
Difinitive Plan Approved by Planning Board ________________________________19________.
/ 6G
Diagram of Lot and Building with Dimensions !
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
�,,,41-7 fdt1 F Sn/C
Name . . ........ .. ..
V" i)v�S,
I�
Quality Homes,- Inc.
No ''.107.:1... Permit for ..,two story,
single family dwelling
Location ...BZ?s_.River Roa........... .. - ..
Centerville
Owner ............Quality,Homes,,, Inc.
Type of Construction
YP ..........frame..................... h
................................................................................
i
Plot ............................ Lot .............. 2Q............
° c.�rneOELa. v
(2�
Permit Granted .............September................9...........19 66
V :
Date of Inspection ...........:19 t
........................
Date Completed ......................................19
PERMIT REFUSED
i I
................................................................ 19
............................................................................... I
............................................................................... i
...............................................................................
F
...............................................................................
i .
Approved ................................................ 19
i
...............................................................................
Engineering Dept. (3rd floor) Map Parcel ' D< Permit#'
House# '2 ' Date Issued L
3rd floor)(8:15'-9:30/1:00-4:30) J Feel
Conservation Office(4th floor)(8:30-9:30/1:00 V2:00)
Planning Dept.(1st floor/School Admin. Bldg.) �tMe'Oj'
'
Definitive Plan Approved by Planning Board 19 ;
BARNSTABLE.
-. MASS
TOWN OF BARNSTABLE' 'F°"��'��
' Building Permit Application
Project Street Address I o� t2j�� J2�D
Village
Owner AAA 4 i2-6-h— Address a
Telephone
Permit Request
+y E
• i
{
_First Floor sq a e f e Second Floor ' square feet
-Construction Type
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing New
No.of Bedrooms: Existing New
Total Room Count(not including baths): Existing New First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other
Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
Builder Information
eraser Construction
Name 71 Taragon Circle Telephone Number .
Cotu
Address 5o8 428 2292 License#
Home Improvement Contractor#
Worker's Compensation
NEW CONSTRUCTION OR ADDITIONS.REQUIRE A SITE PLAN(AS BUILT_ )SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO I
SIGNATURE DATE a FS'
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
A iMIT i0.
DATE ISSUED
MAP/PARCEL NO.
tr C4 t
ADDRESS ? VILLAGE
OWNER
DATE OF+INSPECTION:
FOUNDATION
FRAME
INSULATION „ . ► _ t
0—FIREPLACE
ELECTRICAL: ' ROUGH FINAL ' o y ..
PLUMBING: ROUGH ' FINAL
«. �: f - t _ r t , � .. . _.� 1r —. '• a .. r • t ,
GAS:. ROUGH FINAL F
FINAL BUILDING F
DATE CLOSED OUT ,
ASSOCIATION PLAN NO. x
{ F
The Town of Barnstable
Department of Health Safety and Environmental Services
' Building Division
w 367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building'Commissioner
Permit no.
Date 11
t
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: Estimated Cost a o
Address of Work: t� �'►'Y� S
Owner's Name: 6k'.-� to f)-Sscl
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
[3Work excluded by law
C]1ob Under S1,000
QBuilding not owner-occupied
QOwner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner.
Date . . .
Contractor Name Registration No.
OR
Date Owner's Name
q:fbr ms:Affidav
_ :;� ✓� -V/alft/!lZdlLU��'GGGUL..4�aa�'(.�IQQ�Lf.IQe�' '
HOME IMPROVEMENT CONTRACTORS,:REGISTRATIONVi
Board of Building. Regulations and` Standards :; J•.: f. '=
j
One Ashburton Place Room , 1301 T
Boston.•-Massachusetts,. 02108
HOME IMPROVEMENT CONTRACTOR a y x c 7 -� r -- ------
., 2,
Registration' 112536 Expiration04/06/99
TYP@ :DBA
r
Tii_ t;: x ,} ��NONE IMPROVEMENT CONTRACTOR
. ` y
Reistr do
i - '
t a�, � - ''
FRASER CONSTRUCTION ' 9 a n 112536
DEAN C . FRASER' ;, �! a �, 5r2 y ;TyPe
Y s+s� " '� Expiratios 04/06/99
71 TARRAGON CIR
COTUIT MA 02635 =:-
FRASER CONSTRUCTION
C. FRASER
ADmw,,%puMp 1 TARRAGON CIR
L COTUIT NA 02635
The Coniniontrealth of Alassachusals
Department of Industrial Accidents
;z '... � OII/ce ollnvesUgaUons -
„l' 600 fl ashitt,tun Street
Boston,Alas. 02111
Workers' Compensation Insurance Affidavit
location: t 1 TM EOCO- o /L
city �� 1 M/ r . phone
1 am a homeowner performing all work myself.
1 am a sole proprietor and have no one working in any capacity
tt ..ea:•^ Trz ,rs•-'err,'-.^.�r.� e !n '*or�f�74. _..w" :J `r -. _ .�.• �r+...�;w. •n�•+••. -
L.......as,�,.: 3: •.ns'-ari�r�.•re`e�... .w..dyr,.,. ..rarrrr...;:. _ - �;"
I am an employer providing workers' compensation for
my employees working on this job.
company name l': a��� C'MST/(XJG"T—101�
address: 17 / l /`ll2 vg-q e,)-I �f .
city CO phone#: -
insurance co its, {�t/�'(JetX �olic� # (�C,� / n1o7 l'SI
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:
cit3,: phone#•
insurance co. policy#
..5'._ .,i.bJilai..diT'•'.r4C ' ?, rd•1T ••;�r:' .,wn�, .'}:;r•' !^`.9 :""i:
_.».�'a,....-.ter_. +.._-_._.:..J.^a' ��.,...: asr` �tT"'�_ �.� �y' '7:i. - ` ! ''�- •,......`' "l''2K';yr+.::ui
company name:
----
address:
city. phone#•
insurance co policy#
;Attach additional shci:t itaecasary�;" w '-_.:. '= =as :•�..c. "1£• '� "ri oc �; —. �t. sa. a a`.
Failure to secure coverage as required under Section 25A of h1GL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of 5100.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the Mice of Investigations of the DIA for coverage verification.
I do hereby crryif dre airs d rttalties of perjurt•that the information provided above is true and correct.
Si nature Date
Print name —T>2t,9tJ 0 Phone#
Econtact
nly do not write in this area to be completed by city or town official
permitllicense# rlBuilding Department
Licensing Board
mediate response is required QSelcctmen's Office c'
�liealth Department '
n• phone M. rJOther
Revised R95 PJA) .•
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law', an employee is defined as every person in the service of-another under any
contract of hire, express or implied, oral or written.
An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of
the foregoing engaged in a Joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
L
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 evert•state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have
been presented to the contracting authority.
'i% i Y ;y.. •<<�.1!,' t. .� �. � �}4.y:,: ..liU.*. _.w.'f:'r•Z^`7!n 7 .. ... -
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 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.
77
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 to
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.
#.^YaM-�._Y!•-•-� • �:•V.!y,'.•. a.^'17YA19.!f.AV.!T1•.+.fv.i�y.4�n• .n..•"VAr �IAK�'-'.1!11�M���.1�.1.��M�A�^.f.4w•
A
-
x
The Departments address, telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
phone #: (617) 727-4900 ext. 406, 409 or 375
Engineering Dept. (3rd floor) Map �o O Parcel Permit# 1,2
►� House# Date Issued LI—
` Fee J
RML-rianApprovER19 ' BE..
� ARNSTARLE.MARFL
019.
`
TOWN OF BARNSTABLE
Building Permit Applic tion
Project Street Address ;_ 1,_2) '
Village
Owner Address
Telephone
Permit Request o A e_� o
First Floor glare feet Second Floor square feet
Construction Type `
Estimated Project Cost $ �
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
Age of.Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing New
No. of Bedrooms: Existing New
Total Room Count(not including baths): Existing New First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other
Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial p Yes ❑No If yes, site plan review#
Current Use Proposed Use
Builder Information
Name FRASFR ONSTRUCTiON Telephone Number
Address 71 TARAGON CIR. License#
COTU1T MA 02635 Home Improvement Contractor# 6
Worker's Compensation# �
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO YGf/JI(��{
SIGNATURE DATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
M
The Town of Barnstable
MASS, Department of Health Safety and Environmental Services
65 Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
For office use only
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.
ey Est.Cost
Type of Work: - _
Address of Work:
Owner's Name /'�-�-t//
Date of Permit 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 PL PROGRAM OR GUICABLE HOME ROVEMNT WORK DO ARANTY FUND UNDER MGL a 142A�
ACCESS TO THE ARBITRATION
SIGNED UNDER PENALTIES OF PERJURY
I hereb apply for a permit as the agent of the owner.
Date Contractor Name Registration No.
OR
Date Owner's Name
.� »•• ••J u.us�su:rtlfJ'f:'tLS Department of Induslh'iR!Accidents
Ofl�ceof/
" Alrest/go�/oos
600 Washington Street
Boston,Mass 02111
,,,,, Workers' Com ensation Insurance Affidavit
E rie* CONSTRUCTION���/
t'o
CL
508 428.229
❑ I am a homeowner performing all work myself, one
❑ I am a sole hetor and have no one workin in aav ca achy
/.D//%/a
❑ I am an emplovver providing workers'com000
pensation for my emplo es wor
o a anv ame:
BASER:CONSTRUCTION ye king on this job.
IAA
taty; (508 428-229
insurance co. �l _ •
or cv# S Y
❑ I am a sole have proprietor, neral contractor,or homeowner.(circle one)and have
the following workers'compensation polices.. hired the contractors listed below who
com 230v name:
address: ..
d
: ..
insurance cn
: . one
{
olii:v 0 ...:
...:.... :::.,:.. ..:
cam an name:
address:
prance ct►
FaUure to se iCv#
curs coverage as required under sew, 2SA ot:1iGL 152 .., 5° Yew'4nptf.+onment as weU as dvil pensides in the torn:of a Si'OPc VO to the Impositlon otcrlminal .y Y /i
COPY of this statement ma be tb pendtles ota fine up to s1.S00.00 aad/or
Y rwatded to the Ol>ice of Inv ORDER and a tine of$100.00 a day agalt)st me. I understand that a
estigations of the DIA fps coverage veriScatlon,
I do here,Y c un the ainlr enelties o e ' .
fp nary that the information provided above ks ftor and correct
tare
Print name 64 Date
oMCW use otdy do not w Me to thb area to be completed
by cW or town oflIdd
dty or town:
C checkit - penultAlenI
Immediate response b required �Hullding Department
Licensing Boast
contaet person: Salecdnen's OtDce
plmne o. a�Deparement
s
Ge+yed 9/9S P!A)
.fir
g :�:ta.;,'�rs�t,�: °m t.. .?✓.r�" .�t •, �yMj'" �_ ;�'r`." '"h,.-.:y,•a b.e 8°•c. Y. Z 7 �r'1t .'" ,� 'r`-,t° r•f{�s� � .i'F C:�.::r 44- wky9
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r; t 'on 112536 t-"i°' ,w��k Ex irat orn.04/0&Z,9% �r tip,
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Registration 112536 =
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pt:(3rd floor) Map : Parcel 3 eiS Permit# 9,3S� 7
House# 2�' r'JS Date Issued
Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee X ,00
Conservation Office(4th floor)(8:30-9:30/1:00-2:00)
Planning Dept.(1st floor/School Admin. Bldg.) ��He rod
Definitive Plan Approved;by Planning Board 19
BARNWABL6.
MA36.
TOWN OF BARNSTABLE
Building Permit Application
Project Street Address et,�eA (_Dty La T 4 a0
Village
Owner Address
Telephone
Permit Request 2�
CJ
Af—
First Floor . square feet Second Floor square feet
Construction Type
Estimated Project Cost $ �
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing New
No.of Bedrooms: Existing New
Total Room Count(not including baths): Existing New First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other
Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review# -
Current Use Proposed Use
Builder Information
Name Z)eGv✓l C F— Telephone Number
Address �7/ C11i License#
( e-�_Af� Z22$_ Home Improvement Contractor#
Worker's Compensation#&e_1 3/,15
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE G��+� ��� DATE 2� r?'
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
0
(y AJ
at , , - FOR OFFICIAL USE ONLY
3 Z,-
MIT NO. � -
DATE IS5UED ' a
MAP/PARCEL NO. ;
v , e I f r • - F - * � s t �
i S
DRESS VILLAGE ,
WNER I ,
e
DATE OF INSPECTION: µ
FOUNDATION
FRAME
INSULATION _
t
FIREPLACE '{i
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL `;
s
GAS: ROUGH FINAL }
FINAL BUILDING `
DATE CLOSED OUT
ASSOCIATION PLAN NO.
L
. : The Town of Barnstable
� g Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commi:
For office use only ,
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. f
Type of Work: Est.Cost J
Address of Work: �U x
Owner's Name
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under S1,000.
_Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Dat6 Contractor Name Registration No.
OR
• Tltc• CIIItltltuIIIi-caltll of Afassachusctts
a'
;.,i ''•`.�:N 1 - Depart/lIVIr1 of 111d"strlal.4cc1dellts
pfcPafIZW95flgaflans
61111 !t ashbrg;trar Street
,1 ay-L (12111
► ' Com cnstttion Insurance A1Td.ii*it
i IInn inf rm 6
Pi PRINT'
T cc c
06 finn•e
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capaciry
L•-- �...�..�.��_....-
I am an employer providin_ workers' compensation for my employees working on this job.
cmmwtm n tmr
uirirece�
• finnc�!•
,G I am meowner(circle otre) and have hired the contractors listed eio%%
a sole proprietor. ecneral contractor, or ho �-
the following workers' compensation polices:
cnm inv n tine•
adrlrccc�
finnc a-
cin
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incur-inrc rn. _ _ .�.. - ��:�•••*-^---t- ''..._
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rin••
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Attach additio_nai sheet if necesiacv •`' "'- ' '-""`���•Y'�""""'�`y
Failure insecure Coverage as required n er bectton 3A of,11GL 153 can iead to[he imposition of cnmtaai penalties of a line up to S1.;OU.Ur
une s cars*imprisonment a."veil its civil penalties in the form of a STOP%VORK ORDER and a fine of SI00.00 a day altainst me. 1 uaderstan
cc of 1nvcstittations of the DIA for coverage verification.
cope of this atatemcnt ma.' be furnnrded to the OLli
I do lierrbr rri}r•tt tiler the Fall'srnaltics f perjurr drat t/rc information prorided above is true rutd correct.
Date
Signature -
Phone
Print name G
'•otlicta�se univ do not write in this area to be completed by cite or town oRlcial
Itermit/licensr d _r"'luuiidinr.Department
Gin nr tmc n: C:Uccnsin!-suard
CJriectmen•a Orfrcc
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ME ;IMPROVEMENT`!CONTRACTORS .REGISTRATION -. }
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? nN 1,12536y, Expiration .04/06/99
f. "Type DBA ' i F _ ??
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.CONSTRUCT
Ht `ERASER ION AtT Registration :112536
DEAN C FRASER �« r �. r, F „{ s p 7� , . _ xj .gxr
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