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HomeMy WebLinkAbout0008 CAPTAIN BELLAMY LANE AV` �RT :>, o r o t h i o r, A TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ?10 Parcel Application# Health Division Conservation Division Permit# Tax Collector Date Issued O"'t Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village Ce cam) Owner b M 1`cA Address �[1-6 fA t n 6P f I� k.V1 Telephone IT ^` 1?E Permit Request da 0 AA CAL C; -- Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic 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 Number 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 Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal#' Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# ---Current Use - _ r osed Use BUILDER INFORMATION M� C�c� d' N'o fZ t44 S�F�-M)D j �I'� az..C(a S--3 a C Porn If Named Telephone Number—•1QL4-5��(o- 0��;5�C�f IeZ Address License# 44 2.:.6 fP - Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO CSIGNATURE'""` FDA EE �/IaOJU� L . FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. i �oF THE Tpy, Town of Barnstable " Regulatory Services h c� Thomas F.Geiler,Director * BARNSTABLE, • - � 9 MASS. g i639• ,0 Building Division rFD MA't A. Tom Perry;Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION n Please Print JOB LOCATIO/ nPIIC� ry l /ten �eiNe [ l number street' � village I "HOMEOWNER -" �� //�no d4_ 56-6- `7-7W� 7 �`1—��10— �L-/ name home phone# work phone# CURRENT-MAILING city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who 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 performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and require ents. Sign ie o Homeo_ e r - . Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which abuilding 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 persons)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:homeexempt IN �oFTHE l Town of Barnstable Regulatory Services 9'"M'STAB` � Thomas F.Geiler,Director qje sb3q• ♦0 lEo",p�p Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. /� .p�� --Type'of W jk�-tGUGi�( -H O r.�Estimated Cost Address­of Workc--F—Q- -L(J±1CAf(1 J Cp ms/ Owner's Name: t-Date-of:Apphcation: r_l� o�[�''�� I hereby certifythat: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑B ilding 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: Date Contractor Name Registration No. OR 7 40 Date wnei's Name Q:fomns:homeaffidav I he Gommonwealth.o,j Massachusetts Department oflndustrial Accidents Office of Investigations ' a 600 Washington Street Boston,MA 02111 ,w s�• www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LetZilaly dame{Business/Organizatiowhdividual): . G P,cpp cz �— Address f(1 4 Q City/State/Zip: __ X11�P.�y I Le, Mrl2(�'))Phone:#: ,` - cc ,Are you.aa=employer? Check the'appropriate box: 4. I am a general contractor and I •Type of project(required):, . 1.❑ I am a employer with ❑ g employees(full and/or part-time).* have hired the stab-contractors 6. New construction . 2.❑ I am a•sole proprietor or partner- listed on the•attached sheet. 7. ❑Remodeling shipand have no employees 'These sub-contractors have g• ❑Demolition ' working for me in any capacity. employees and have workers' 9. J�(Building addition [No workers' comp.insurance comp.msurance.t d.uire req ] 5. ❑ 're are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3 Iafnahomeowner�domg<all;work ', 11.❑Plumbing repairs or additions �--�—m self o",worker_s' co right of exemption per MGL 6 ' c. 152 1 4 and we have no 12.❑Roof repairs insurance required.]t , § ( )� employees. [No ❑ workers' 13: Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavitindicating such. #Contractors that check this box must attached an additional sheet sbowing the name of the sub-contractors and state whether ornot those entities have eMployeeS;r If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers compensation insurance for my employees. Below is.thepolicy and job site information. Insurance Company Name: Policy#or Self ins.Lic•#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failurejo. secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the ILIA-for insurance coverage verification. Id do hereby certify under the pains and penalties of perjury that the information provided above is true an'd.correct,' �Date�— -"; Phone R 61- Official use only.. Do not write.in this area, fo be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): .-I..Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector 6, Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"..,every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a-deceased employer, or the =eceime.rtrus a te e-of an individual.partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein;or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal.of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant-who has not produced,acceptable evidence of compliance with the insurance coverage required! Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work until•acceptable evidence of compliance with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Comp anies•(LLC)or Limited Liability Partnerships(LLP)with no employees other.than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. B.e advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or.license is being requested,not the Department of Industrial Accidents;- Should you have any questions regarding the law•or if you are required to obtain a workers.'. compensation policy,please call the Department at the number listed below. Self-insured companies should-enter their self-insurance license number on the appropriate-line. City or Town Officials. Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy'information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city-or town),"A cbpy of the affidavit that has.been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses, A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dbg license or permit to brim leaves-etc.)said person is NOT required to complete this affidavit, The Office of Investigations would like to thank you in advance for your cooperation and should you have any questi please do not hesitate to give us a call. The Department's address,telephone-and fax number; e C013=011WI J.th of Massaehusetts laepa m t of a i.eoz&nts Office of InvestigatioM 600 Washington Street Boston,MA 0.2111 Tel.#617-7-27-490.0 ext 406 or 1-8 77-MASSAFE Fax 4 617-727-7749, Revised 11-22-06 www.masS.gavldia I The Town of Barnstable BA MASS-LE. M • Department of Health Safety and Environmental Services Y ASS. $. t679' �0 p�FOMA Building Division 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Location D (`'Cak", Qe Gl u,,;� Permit Number Owner Builder One notice to remain on job site,one notice on file in Building Department. The following items need correcting: I ` 2-0 AC-QAJ Ckr06t.1%-'-- 68 R" C 0 ki 0 e-d�a onts � �0c� 90-7 Please call: 508-862-4048-for re-inspection. Inspected by Date The Town of Barnstable BA MAS,'BLE. MASS. ' Department of Health Safety and Environmental Services -- 7 g. i679. �0 plFD MAC s. Building Division 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection M �. Location u n to, P� (u �� Permit Number Owner Builder One notice to remain on job site,one notice on file in Building Department. The following items need correcting: rcyt w. a r �U J 1 P rJ a1GS Uiff 4l V�V . .r d�X 3 u 1 J 'i �l�D/6 6 y o3)! Please call: 508-862-40-8 for re-inspection. ' Inspected by -Utt"' � �— Date S Vl/6/a(0 JAI- 0 e 0 \1 47.12 �� N 0 30.00 Q CB/DH o Q i CB/DH ^'s o / pa. 'V 6� M0 8, << __j C� � A.M. `30'�L /� m 230/191 O a AREA-20,111 t S.F. 727 O Q ! Q I CB/DH � 7 J I Q I , CB/DH LL ,.,,,, 00 W HOUSE;; Y �> #g W ►p Q 4 „ o % 21 180 i o r•� O N gspti�� (0) NEW J FOUNOATjp N i 46.00 ^ N ,►� i— N77 24,OSY �' i z z W i Q� QW / 160.00 i W A.M. PREPARED FOR: 230/136 VAUGHN HOME BUILDERS FOUNDATION CERTIFICATION (AS-BUILT) f#8-CAPT_.—BELLAMY LN,-CEN:TERVtLLE 1.1 MAR. 31, 2006 IJOB# 1044 SCALE: 1"=30' PLAN REF: 395 90 DEED: 11063 299 �s AA.4 ASSESSORS MAP 230 PARCEL 191 ��►�4�N0;14,s5�®�� MacDougall Surveying ZONING: RD-1 30-10-10 - FLOOD ZONE: C ���s'ea�o s��°v & Associates I CERTIFY THAT THE FOUNDATION ON THIS PLAN EXISTS a g PSTEPHEN P.O. BOX 2428 ON THE GROUND AS SHOWN AND MEETS THE ZONING ® � 00'fl ® Mashpee, Ma. 02649 SETBACK REQUIREMENTS FOR THE TOWN OF BARNSTABLE ® ��, �37559�-4 a ph. (508)419-1086 .t ®® � ✓'_= %off fax. (508)419-1087 4-,-� email: macdougallsurvey PROFESSIONAL LAD SURVEYOR-- DATE To @comcast.net TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Z 3 eo Parcel L.a f I9 �� -; Application# i Health Division 6 b 97-N Conservation Division a �s4Z !®lam '' Permit# 5 Tax Collector Date Issued 7 �. Treasurer d 0 Application Fee Planning Dept. ;.-r Date Definitive Plan Approved by Planning Board LIMITED TO= OF BEDROOMS Historic-OKH Preservation/Hyannis { gs►terwe�tl ^ h�3{�� S7�rc�j�,nwk/N' Nvtn Project Street Address ivo Village a- Owner � Nr� '-( � M fD°'' Address' P ✓ ,��zz . Telephone 77�1 /(o Permit Request A~i46H ..Zq 'x46 J A-PrDi P ig e� E-A(Sija/ti Hoes 1 . DR,V6 041,E V)Azo SPAc` ai;uS r s 7-5 ,LF P&A 4 ReD p_da 84 Square feet: 1st floor:existing /L 3 Z proposed Ilo 4- 2nd floor:existing, proposed Total new,�2 33, Zoning District Flood Plain Groundwater Overlay " Project Valuation /®0 k Construction Type 4),00P E_ Lot Size Zu l t Z S - Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family N Two Family ❑' Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes 3No On Old King's Highway: ❑Yes Flo Basement Type: 2(Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new 2 - Half:existing new Number of Bedrooms: existing 2_ new ,> Total Room Count(not including baths):existing new First Floor Room Count Heat Type and fuel:, 1 as ❑:Oil ❑Electric ❑Other Central Air: ❑Yes 0 No Fireplaces: Existing New f Existing wood/coal stove: ❑Yes B1- Detached garage:❑existing FAnew size %✓A Pool:❑existing ❑new size Barn:❑existi g ❑new !--size • �i A r Attached garage:❑existing Crnew size O_4 0 Shed:❑existing ❑new size a/ Other. A Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes &No If yes, site plan review# r Current Use S, 67b_`� Proposed Use �J�@ vO) BUILDERINFORMATION Name 449L1)6-Mf0 / 1 Telephone Number .-ye �t2l 3S7-j _Z1 Address 34 6AE47f ;-ba_ _/Z!) License# � D�•I b ��} 02- 56 Home Improvement Contractor#.--.- Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ?� 'd y FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL'NO. ADDRESS VILLAGE 4 . OWNER DATE OF INSPECTION: FOUNDATION 3 � FRAME INSULATION %p 6 r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH ® FINAL 0 GAS: ROUGH _ FINAL FINAL BUILDING 0 Orr w DATE CLOSED OUT Q r 0 ASSOCIATION PLAN NO. 0 !1 1 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE - New Buildings $100.0.0 Residential Addition $50.00 Alterations/Renovations $50.00 Change of Contractor/Builder $25.0.0 FEE V.&LUE WORRSBEET -NEW IZWG SPACE D_square feet x$96/sq•foot b 2, 11 o x.0041= plus frombelow(if applicable) ALTERATIONSIRENOVATIONS OF EXISTING SPACE square feetx$64tsq,foot— x,0041= plus frombelow(if applicable). QARAGES'(attached&detached) 10 70 squaw feetx$32/sq,ft._ r9 4ux.0041a 2 Q,1 to ACCESSORY STRUCTURE>120 sq.ft.. >120 sf-$00 sf $35.00 >500 sf-750 sf 50.00 . >750 sf-1000 sf 75,00 >1000 sf- 1500 sf 100,00 >1500 sf-Same as newbuildingpermit: , square feetx$96/sq,foot= x.0041= STAND ALONE PERMTS Open Porch x$30.00= (number) Deck x$30A0= (number) Fireplace/Chimney x$25.00= (number) .Inground Swimming P ocl $60.00 Above Ground Swimming Pool $25.00 RelocatiomMoving $150,00 (plus above if applicable) PerrnitFee f e Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement_Contractor Registration :.: Registration: ype: Private or ion Expiration: 6/19/2006 > VAUGHN HOMEBUILDERS, INC,_ Joseph Vaughn 34 GREAT HILL RD. SANDWICH, MA 02563 -' Update Address and return card.Mark reason for change. Address Renewal ❑ Employment Lost Card ✓�ie�anrmwozaeal/� o�✓�aa�ac�ivaetla Board of Building Regulations and Standards License or registration valid for individul use only I HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 100513 One Ashburton Place Rm 1301 Expiration: 6/19/2006 Boston,Ma.02108 Type: Private Corporation VAUGHN HOMEBUIL_D_ERS,ING- Joseph Vaughn 34 GREAT HILL RD. ,, /aA rR,f SANDWICH,MA 02563 Administrator 6&01 valid without sig tore ✓1."e.n¢~.a.19 a��e�uceel�4 BOAfto OF BUILDINGREGULATIONS License CONSTRUCTION SUPERVISOR .: f Number CS O46236 `'� 007' Tr.no: 8487.0 � Reh. s1� t6 i JOSEPH C 34 GREAT HILL SANDWICH, MA 02563 t;orninisslorer I The Commonwealth of Massachusetts Department of Industrial Accidents Office.of Investigations d 600 Washington Street Boston,AM 02111 s�•'' www mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/P'lumbers Alpiflicant Information C Please Print Legibly Name (Business/Organization/Individual): 17 y Address: c 1 City/State/Zip: �> 17/�l C F D ZS �775 Phone#: Z4 Are you an employer? Check the-appropriate box:. Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑ Remodeling ship and have no employees These sub-contractors have . 8. ❑ Demolition workingfor me in an capacity. workers' comp. insurance. y p tY 9. Building addition [No workers' comp. insurance �5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3.ElI am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs.or..additions... c. 4 ,and we have no myself. [No workers' comp. � 152,§1O 12.0 Roof repairs insurance required] t employees. [No workers' 13.[_1 Other comp.insurance required.] ,Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information: Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must.submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. .r am an employer that is providing workers'compensation insurance for my employees.'Below is thepolicy andjob site nforrnation. nsurance Company Name: Micy#or Self-ins.Lic.#: Expiration Date: lob Site Address: City/State/Zip: attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). aihire to.secure coverage as required under Section.25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine up to$.1,500•.00 and/or one-year imprisonment, as well as.civil penalties in the form of a STOP WORK ORDER and a.fine If up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of . Investigations of the DIA for insurance coverage verification. do hereby certi n e pains and penalties of perjury that the information provided above is true and correct ji ature:. 'hone# Official use only. Do not write in this area,to be completed by city_or town officW City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees Pursuant to this statute, an employee is defined as"...e ery very person in the.smite 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:tlte owner of a dwelling house having not more than three apartments and who resides therein,or,the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work-on such dwelling house. or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or a business or to construct buildings in the commonwealth for any renewal of a license or permit to operate applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its'political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), addresses) and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners; are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below.. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure'to fill in the permit/license number which will be used as a reference member. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the.affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is-on file for.future permits or licenses..Anew affidavit must be filled out.each en is obtaining a license or permit not related to any business or commercial venture year.Where a home owner or citiz (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and.fax number: The Commonwealth of Massachusetts . _ Department of Industrial.Accidents office of Investigations r. 600-Washington.Street . Boston, MA 0211 L. Tel. #617-727-4900 ext 406 or-1-877-MASSAFE Fax#617-7274749 Revised 5-26-05 wwwmass.gov/dia J FROM :RIDER RISK FAX NO. :5085647272 Feb. 22 2006 01:29PM PI/1 ORDny. .. w. . PROO�CEB lJ ter.<r. f I y - --- �� _ •.r+`::,,roxit;K.,:�R'FSQ."v.h '.r.,:dtx±!y.. :f>r - f "L�NO-30.ff ..� ,. ..... THIS, �� "` �. .:> .•02E 12eRMUOPlYvI:.. 2/06 C&MRCATE IS ISSUED A8 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE RIDER RISK SPECIALISTS M'DER• THIS CERTIFICATE DOES NOT AMEND, EXTEND OR INSURANCE AGENCY, INC. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P-O.BOX 115 --- -Pghi!!AN;Eg�RD!NG COVERAGE CATAUMBT COMPANY —MA 02534-0115 A U.S-LIABILITY INSURANCE COMPANY__ MPANY VAUGHN HOME BUILDERS, INC, co o GRANITE STATE INSURANCE COMPANY 34 GREAT HILL ROAD COMPANY — SANDWICH, MA 02563 C _ COMPANY -- —— —. _— w`3k':�� ;?#3..:x'>. ,Y¢� .. �; --'`-£tp{' .> .,,;s:�;;z..:•:.d�,ssiaEa��=,raggs:s�'e-.s.-«�•1�>4v��#<��_,ca,`< -,......•. ''.�:: ' '•-� '.�.'�'�4�'.'n.,:x. - b/d.dcf w"� 45= "n<fndShtSLF�:„':[ ±n-.i.-i%.3r�. THE 16 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED IOW HAVE BLN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING O ANY RFAUIRpNENT.TERM OR CONDITfON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PL ITAW,THE INSURANCE AFI OROED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.LIMBS SHOWN MAV NAVE BEB�REDUCED BY PAID CLApu�. LTR TYPE OF BiBygANCE; POLICY NIAMBBI— POLICII®CECi1V8 PQ{LCv BfPIMTWN — ..— —_.. ..— OATBIMMRODITY) OATEIMM/OWW) UWTB GENIBAL LIABMTY �A C£N. AGGREGATE 16 0 0 000 X COMMERCIAL ,PRODUCTS-COMP/OPAGO 5600,000 JCLAIMS MADE LX]orI l!R PERSONAL d AD IN,RI V RY e300,000 A OWNER'S6COA7AACTOR•sPROT CL 1130927C 10/19/05 10/19/06 EACHOCcuRRd4cE e3001 000 DAINAGIIA.Y.*.) 150,000 MEG EXP(Any aim p0Ie0n1 05.00 0 AUTOMOBILE UABILITY ANY AUTO COMNINED SINOLE LIMIT 0 ALL OWNED AUTOS — NUdLYlNlLlRY 0 SCHEDULED AUTOS wat Pm" HIRED AUTOS — NON•OWNED AUTOS BODILY INJURV 0 .— — PROPERTY DAMAGE 0 BARAft LIABILITY _AUTO ONLY-EA ACCIDENT 0 ANY AUTO .. .. bra -..,,,.,n,,•-x OTHER THAN AUTO '— '—• FACH ACCIDENT 0 AO(IREGATE 0 EXCFR6INABILRTY RAC"OCCURRENCE o UMBRELLA FORNI AGGREGATE 0 OTHER THAN UMBRELLA FORM WOIBLERB COMPENSATION AND 0 ®APLOYEIE'LIABILITY X TD srgtu• OTH• u`"-s>rxv:;;:,>;>rx'�:.dx�� : NY LIMIT C•11 `'?;,,"e.• ...";S: FI EACH ACCIDENT $10 0,0 U 0 '� B " PR�TD"` X INCL WC 231 35 50 6/17j05 6/17/06 PARTNERS/EXECUTIVE EL DISEASE•POIJCYUL41T 0500'_000 OHER ARE: EXCL OTHER EL DISEASE-EA EMPWYEE I 010 0, 0 0 0 Ducal TION OF OPERATIONS"CATIDIA►SIyF7B uwspLcmL nmB „3. ..,i.•wn W{..:: ,fpy'd)a: �'�.>v y }''•J?��,-.9-p�S �}q:;� � 4> :L'::1.y: :fL9•<.:::T• a '�•s��<.3''',i/.�-'< .Y5^ x� $� ,��:, . '-... a'...-..: .....s..(rsz{' ].ay..�.%:�4.n.L�:^:-��`i`r��'.v,'-.-�i�.•,-i4!.��.r>.-'<'...��q;i"S:Z w'n�<G:':•:�b - w........... . .r d,{'" - !s-`tea•. -Md:'�<al�::fp:%< :•.�y$-{Y:y'Fy�Y.:�.`:`:S^�{y' H• .. . - ;S.- b<'YY.:::-�.�iF'%•«F:S�..Y.:�•>i'n4Y.N:;l.14.2vnviZlb�NriM.�,di.:i:<Cii�<:ShiC`.::v.lfil'riFE• SNOL" My OF THE ABOVE DROCRIBED POLICIES BE CANCELLED BEL011E'THE TOWN OF BARNSTABLE EKPIRAT►ON DATE TIIWEOF, THE RISIANO 6OMPAHv WILL MDEAVOR TO MAII. 10 DAYS W ITTM NOTICE TO THE CERTIFICATE HOLM mmeb TO THE LEFT. BUT FAIURIE TO MAIL WC"NOTICE SHALL BRPOSE NO TION 00 LIABILITY 508 4 2 8-318 6 or- ANY BBIID u cow-A. ITS RFPRIC�ENTgTIYE9: AUTHORo!® ATRRe <-�•- >; :i�-: ,f x:t��, �k„,�.'. 'iY.a'�ii�y:,c'�Zla".'.v'^a�•2x: r�S. ••3:i' �Stt•' � - - - r °FzT Town of Barnstable Regulatory Services BAMSTABM ' Thomas F.Geiler,Director Mass. g Buildin Division '°Tfo rna+' . Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence.or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: (I.W 0& 110 a./ 6 ADD l % 0 Estimated Cost Address of Work: 9 d/t_P j 6 1nl Owner's Name: E7160 K 6F— .o%a LIA 65--r..14, Ot 1 Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date � -' Cotrtractor Name Registration No. OR Date Owner's Name Q:forms.homeaffidav Town of Barnstable ti Regulatory Services MAM Thomas F.Geiler,Director '°�EONu•'�",� Building Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 62601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 2 o r'!�,-e- -,j �c,� ;r. J ,as Owner of the subject property hereby authorize p 0 a-J c, to act on my behalf, in all matters relative to-work authorized by this building permit application for: (Address of Job) _C 00_ 0 Signature o er Date e©(- e— J —_ Print Natmd Q TORMS:OWNERPERMIS SION TAble JS Z1b(eon#nued) •ih Focsl11�'ttd; p glue Pujullea for dug aad 7 o4odly Resld led eatW EvJ1d1uV BMW td h1x3aMNiMZTM •Hes�n8lt�aiin Glizgag Glazlal Cr13Us6 Wail Floor .Sasemrat p�atetet P�� d� va Aram�'l.� V.Ygw R y4uw A nine R:YOUX, R.Y � R•Ysinei 3101 to dd00 Ae'stint DegtYteDan, , • O.#0 �•_31 I3 _ -_"Z9_ =I0 d ?3oraasl - Q. 111. 6. formal ' � ul. 0.�1 30 • .. ..14 ,19 10 6 ••83, 8 . 3 117.• O.SO 38 13 I9 10 NJA , iin — _ _CAS 3>; 19 19 10• •• 0.44- 38 ' T3 3S P1lt►0 .SZ• 30. 19' 19 10. VA 031". 38• 13 21 ?VA Nosasal 0.+41• 33 19 3i AVA N(A. 0.4Z. S8 13 19 10 19 19 10 8 .99 A 1.•ADDRESS OF PAdpERTY; ' . " ;• _ . BQ OTAGE OF ALL g�TBRtO1�WALL'S:: ' -•-��®• - -- ;_ - 2. UAAE Fq VARB FdOTAGE'OF ALL'OtAZING: . . 4, °fa GLA CN AREA�03 brMB 7.BY#Z). ,•� ' 5. SELECT PACKAGE(Q--AA-see chart!►boys); (� .. NO.,M, O33 tMOU WVOLVED METRODS'OF DtTERTA NINO MmRQY REQU 'TS . .ARE AVAILABLE. ASK US FOR.THIS MORMATION,. . y. BUIDING n;SPECTORAPPROYAL. ' NO; ' , gdarms•Z9S4343a 47.12 SEPTIC SYSTEM SHOWN IS DRAWN FROM AS-BUILT ON FILE AT THE TOWN HEALTH DEPARTMENT •12 58 68 EX. DECK EX. o TANK DWELLING CO 9.98 o o� 0� 7196 0 760.00 MAP 230, LOT 191 #8 CAPTAIN BELLAMY LANE CENTERVILLE, MA LOT AREA 20,112 SF EX. DWELLING AREA- 1240 SF EX. LOT COVERAGE= 6.190 CER TIFIED ' PL 0 T PLAN SCHMID T RESIDENCE I CERTIFY THAT THE IMPROVEMENTS SHOWN OF w Ass #8 CAPTAIN BELLAMY LANE ���` HAVE BEEN LOCATED WITH AN INSTRUMENT ��P 9�y CENTERVlLLE, MA ORAbVN: Res ? DATE:APR. 29, 2003 SURVEY. a ROBB �, d JOB #: E00407 c SYKES SCALE:i =30 DWG. CPP No. 35418 EASTBOUND d3 LAND SURVEYING, INC. �a P.O. BOX 442 ROBB SYKES, P.I& 'DATE FORESTDALE, MA 02644 508-477-4511 i 1 230172 `, z Mi 230173 y� 230137 #810 250011 (L� # s #33 W 20122 230174 r #7' ' ,C1O 230175, 230191 T '9Q " — 0 #13 :S #8 .# > ;230121 #43 W 250010 M1 r Z #12 230177 t 35 230176 i #27 '�;I i156 230178 a j . x _I�eajth Safe Departmen The 'Town of Barnsta Me Building DiviSiOn NIA 02601 50-862,4036 5 -790-62 `VI - . . _ g"yZL � � dr°���'.� �4.. ��C�*••'.R-.�_.._�_.1413.E ,,ll � t r (� kE Vc V �..� ...-up l Daniel E.. Braman, P.E. 189, Harbor Point Rd. .. "Cummaqui44 MA 02637-0361 2 � 2 t � o NkAt S S S-rpr 'f; t� cr c�� Co G � � E W L c-, a 40 x i 2-,,p 4cq® -` V,3t� x- � 1 t�ay%Li 8e-6i(5, ��� ter'" � lv►�e�t.�c�nS cat � . of o� DA r� o T MAN R t Pl L R2�MSBEAM V2 . 0 - Gravity Beam Design Lj-censed to: Dan Braman, P.E. Job: Schmidt Residence Steel Code: AISC 9th Ed. • SPAN INFORMATION: Beam Size (User Selected) = W14X61 Fy = 36. 0 ksi Total Beam Length (ft) = 26. 00 Top Flange Braced By Decking LOADS: Self Weight = 0. 061 k/ft Line Loads (k/ft) : Distl Dist2 DL1 DL2 Pre DL1 Pre DL2 LL1 LL2 0. 00 26. 00 0 . 180 0 . 180 0 . 000 0 . 000 0 . 480 0 . 480 SHEAR: Max V (kips) = 9. 37 fv (ksi) = 1. 80 Fv = 14 . 40 . MOMENTS: Span Cond Moment @ Lb Cb Tension Flange Comp Flange kip-ft ft ft fb Fb fb Fb Center Max + 60 . 9 13 . 0 0 . 0 1 . 00 7 . 93 24 . 00 7 . 93 24 . 00 Controlling 60 . 9 13. 0 0 . 0 1. 00 7 . 93 24 . 00 --- --- REACTIONS (kips) : Left Right DL reaction 3. 13 3 . 13 Max + LL reaction 6. 24 6. 24 Max + total reaction 9. 37 9. 37 DEFLECTIONS: Dead load (in) at 13. 00 ft = -0. 133 L/D = 2338 Live load (in) at 13. 00 ft = -0.266 L/D = 1173 Total load (in) at 13 . 00 ft = -0 . 399 L/D = 781 ngiraering Dept.(3rd floor) Map., 3 0—Parcel , � .Permit# lp� � House# g g �- Date Issued' — Boarq.of Health(3rd floor)-(8:15 -9:30/1:00-4:30) Fee t �� Conservation Office.(4th floor)(8:30-9:30/1:00-2.00) Planning Dept.(1st floor/School Admin. Bldg.) tNE , Definitive Plan Appioved by Planning Board 3. �s 19 g. T TIC SY TEE UED ANCE ' TOWN OF,FBARNSTA� ERmONME M' ODE AND '^ ' L d Building FefrmitApplication TOWN REGULATIONS f ao. Project Street Address Village C � tt r --2 N lit L Z. --� ��� LD�T ZD Owner . �57Ct ryy-S 4 tv 1-1'/0©S f i' Address � O y� 3 /°-`7. Telephone 5D9' ,;71/7.26--5-0 �' ��lL7`'`e/V iLL'�`' fi3 cz O ric.2 Permit Request y L re i'n cr t'n L-/ 4e,731'C c<- First Floor �? C square feet Second Floor square feet Construction Type t t-r C"A -1' in c4,I`Q �� �, Estimated Project Cost $ 5 QQd OC Zoning District Flood Plain Water Protection Lot Size �-{ Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#u its) Age of Existing Structure /1/0 IV--e . Historic House ❑Yes io 1 On Old King's Highway ❑Yes Basement Type: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) v Basement Unfinished Area(sq.ft) -L0 9 2 Number of Baths: Full: Existing New C*Z Half: Existing New No. of Bedrooms: Existing New 3 Total Room Count(not Zincding baths): Existing New S Firstfloor Room Count Heat Type and Fuel: ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No - Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ///a/,� e YAttached(size) e o� oZ 30�, S F ❑Barn(size) N/a<y-e ❑None ❑Shed(size) ivy ❑Other(size) /I/ C�"/J Zoning Board of Appeals Authorization ❑ Appeal# Recorded Q� Commercial ❑Yes .❑No If yes, site plan review# - Current Use /(i (11V/-e Proposed Use �'�' y�cy� �—ty n GS• CLrh L. (� Builder Information Name (�IS I l� CA L U�t�VYI�,S Telephone Number 7 7/3 0 5Q Address t3 ,� �� t_n4 A- 0 License# 0 10 S /4-GfGC h n /-S ? Home Improvement Contractor#` Lf c Worker's Compensation# GUG "!/ 7?0 tS" 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 r7. DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) �l r _ FOR OFFICIAL USE ONLY ' .~a` j , _ • •3 - . .. . .. " I - � - - ..ter PERMIT NO. l/3(:: DATE ISSUED r MAP/PARCEL NO. ADDRESS - VILLAGE OWNER DATE OF INSPECTION: -. k FOUNDATION FRAME INSULATION FIREPLACE EL"ECTRICAL:. . ROUGH ., ' " FINAL t PLUMBING: "• 1H � F- • .; FINAL -- �` FINAL GAS: ce * Ir FINAL BUILDING b ` - " a DATE CLOSED OUT ASSOCIATION PLAN NO'? r , - KE The,\Town of Barnstable t benartment:of Health Safety and Environmental Services MAS& P 143 0�0� Building Division N367 Main Street,Hyannis,MA 02601 Office: 504-790-6227 Ralph Crossen Fax: 508�790-6230 fi' Building Commissioner Inspection Correction Notice Type of Inspection Location , C ��p (t -.-.mot Permit Number J. 3 G V n U - Owner ;. Builder One notice to remain on jobsite, one notice on file in Building-Department. The following items need correcting:(C-A 1A O v 2. l a 1 Please call: 508-790-6217 for re-inspection. Inspected by /' C� Date /,;� � l.117 p M 'S �OFtNE Tpy The Town of Barnstable BARNSTABLE.p• Department of Health Safety and Environmental Services • MASS. 0 t67q. N0 �FD,M+a Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230Building Commissioner Inspection Correction Notice Type of Inspection � , '� . s -. _ '-,e Location Permit Number Owner li' t:, . '�✓t� i r Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: 5e -T- I i i Please call: 508-790-6227 for reeinspection. Inspected by 'M-1 Date `' C}uw. !i , f20ad _... .! �10 wide . . . ca 1 . CaP�• � � 3' aeUamq .Cane 50 wade .Cot 20 _ j Ex�ST��y z D Fov ti tj. 1 � Q It I { I ( f Jhe oundati o a wwn id. .located ay _ .Cot 19 1 +- -ahow� and meet4 the ae tback lteyuw - I a o .the 9ow►i o gatn tabdz, Site plan of;.Panda irc Center itte,. t"19 . t3 gvto O a s w a Lcwi aeco!id ed _ . ! . p, _ , { in Gook 395 pdc�e. 89.: _.j. scaLe_°L11-30.ii �cte 6-28 `.97' + + s Al,L Cape. Fes. Lt R ka ibo�t IZd, kgannj4, N14 02601 } t i µv !.! S- � A 1 Li/ The CwYnnoh-we"Ith t(f lfassac•husctt.v Depurtitietil ilrlitdir.clrial.4cciticirts . - %� t 1 f n j f .` .` (0fflcrea�/tlinve�dlostlons 600 If'usll ill l;9rr►t Street Wurkers' Compensation Insurance Affidavit 3kLiS111m 713 u 1 am a homeo"s'rier nerr'orTning all work rnyself. I� 1 am a sole proprietoir and hive no one �\ori,in-,in any capaciiy a__r .`=�...��..-- .���: _ _ ...ate ,.,:. .�• ..'..�'..�.-,...,,..,._---_-v.... . ...,........,--•-.•..�..+,.....,.�..�.�:.'�.".".•:'-":'=�_� LO �i�arn art employer providing workers' compensation for my-tmpk),yees t,A�orkinn on:his job. C-)C — s .�._LZ-1 4 . �.,_.-......._. _............'___. :.....w.—_..._..-_a+...-_�sue....+...., -~' + .��.tt...aA....--.... '........�� .... .......�.., • ...�. i am n sole• proprietor. general contractor,or,homeowner(circle one) and have :aired :he contractors Iistedbeow who have the following_ Workers? compensation polices. /( yUm iiR a ._�LS r_Sc. _ .�. _____ •_LZ__i _�� g.L _- ,_ r.a._ �__.. -- >� �IYJ 1r c¢ • � _ CS L. I1� _ � ink rnnS7�;e,����.�L !t`�_�1�,�._-.C_L_l.i."2 ._�.,_Yl�_.__.5..._i�s�.dt^.,!!S�'__�..�_fie.._._i� �• ✓_L��_a�Z....l ---•- �tnr�n�,�-tt��:....�.1_p.C�..P-_4!•_.___ ._(---' G2,. _.�;g..�._Y... � � {+J 1 f •��'1�'t�L_.:��.��_! - U _ _ � . . . 'kitach addiiiinut sher_i ifncrcay,tn `a.c: -.. .1 .�.x,�-~ +s�. .«:tT; w:. ,�r; "-- •�- Faifurt to secure•e'o%crarc as required under Section 25A of AfCf,. fSe r.AB iced to the imposition of criminal pcnal'ics 01 s fine up to Sf•500.00 and/or vnr}carp'intprisntiincnt a;:rr eii as clvi!pcnaifics'in the farm of a 'STOP tV ORK ORDER and it fine of r-itt0.(tt}a dev against me. t understand that a cif% of(fits:tMicmcot nia} I)c forte itrdcd to tftc or icc or invcsai 'etions or ihr Dtri for covernFe veriricaiion. 1 do trcreh.r cerOi w ler the pi ins nrrif penoffics r)f Per , r-❑ ,he tnforrralion rrovided above is!rue and correct ` Date Phonc f `� _3 . YH�.rl bafWtlC...••�� - �_ �-. ••••�l/•..mneYln,i�i�w.aa....al•1_ --- '4 nn'ieiai t:�c on1% do no; e1rim in ifiis arcs to bt c_.nrifrt.d bN tan•or town(im. cia1 tiir n,•ra,.��n:."--..- _.__.,.__._.._.__...._.._.___W�_.--.__._.......-_ rri rr.,it..% kcrise d_� .__.____,_„_._�liuildirtt;Department []check if iminediate response is required CSCleetmrn'r()fncc r;i i-n'.fa Drpi,rtmcni contact person:_ -- phone a:.._�_._._.__..._ _ P`"1 }il:::rV-_• irrncd I 1 r ! I �yN ttL_GEr�nriSH/HSLEJ''�� m ____swnn Wuvc¢ LLAr�swsxrvc, , EB LEy'r cL EVA710N :!,<': ., i_ - RIGHT ElEv47LON. <va'•r-o-) - i i 1 FPO VT ��'-�VnT!•�N �!ia"a'.,') .e, 61L C. j - _IQ3v r; I 7== L -F .2.1-aP-1Nk-G01rf-F'X—'FOR —.----- " ':-.Yi•f cOwc'TItLSO Le LLY COL. _ _ " K.:S �I I a^ s, I ` — • n c w. o, 1 plN1H MFlEN GhK7SCE --Mvittr Room i 4^ - 7.�• t. f II y ro'B• F is BETJ200M ----_FjFiS.T.:FLOOR'PL/VN-=:..._ j • •'~ - t 77 DEP1'1RTTIENT OF PU LIC SAFETY 2110 ONE ASHBURTON PLACE, ;RM 1301 PA BOSTON, MA 02108-1618 CONSTRUCTION SUPERVISOR LICENSE FEB 15 .96 Number: Expires: P.S. Restricted To: 00 ' SPIROS A BALODIMAS Ll �. Detach bottom, fold si 35 CARLA RD gn on $ 1 �' back, 'and laminate license card. HYANNIS, MA 02601 1 Uo Keep top ,for receipt and change UC, r of address notification. . _ �� ✓/ze �a�rmw�:cuealr/z o�.i��zaactc�iueett I Restricted To: 00 DEPARTMENT OF PUBLIC SAFETY (� G l U ' CONSTRUCTION SUPERVISOR LICENSE 00 - None Humbert -Ex' ires: . . p 1+,' - 1 & 2 Family Names Restricted Tot 00 - Failure to poss ess a cur rent edi 'tian P of the sac' huset is State Buulding Code ►W 4Vytw SPIROS A BALODINAS . is cause for revocation,9f this license. 35 CARLA RR ' NYANNIS, NA 02601 ' I f f a7lGllf (0/ffe Ol JEFFERY JOHNSON TWELVE CENTER PLACE 1550 ROUTE 28 CENTERVILLE,MASSACHUSETTS 02632 Jeffery Johnson May 14, 1997 Telephone(508)790-5776 Sean F.Eagan Facsimile(508)775-6029 Mr. Ralph N. Crossen Building Commissioner Town of Barnstable 367 Main Street Hyannis, MA 02601 Re : Lot 20 Captain Bellamy Lane, Centerville, MA Assessor Map 230, Parcel 191 Dear Mr. Crossen: Please be advised that I have examined the record title to the above-captioned lot and the abutting parcel, and I find as follows : 1) Deed dated March 17, 1987 from Greek Community of Cape Cod, Inc. to George Tjaerlis and Amelia Tjaerlis recorded at Book 5652, Page 35; and 2) Deed dated June 15, 1990 from George Tjaerlis and Amelia Tjaerlis to George Tjaerlis and Amelia Tjaerlis, Trustees of The George Tjaerlis and Amelia Tjaerlis Revocable Trust recorded at Book 7197, Page 343 . Since the deed from the Greek Community of Cape Cod, Inc. to- date, this lot has remained in separate and distinct ownership from any abutting lot . Pursuant to the Town of Barnstable Zoning By-Laws, Section 4 (see attached copy) , this lot was deeded out within the "plan protection freeze period" in separate and distinct ownership. At the time of the conveyance there was a recorded release of the Covenant. (see attached) . It is my opinion that under the Town of Barnstable Zoning By- Laws, this lot is protected and is a separate buildable lot . Sincerely yours, iIti JJ/nw Jeffery Johnson, Esquire Enc. g\wpfi1es\re\tjaer1is.1tr 115 C) was recorded or endorsed on a plan that conformed to zoning f when legally created; and D) conformed to applicable zoning requirements as of January 1, 1976 . f The protection afforded by this paragraph shall become vested upon the sale or transfer' of the lot so protected into ownership separate from that of adjoining lots or the building thereon of a residence . 3) Approval Not Required Plan Protection: Any change in uses permitted under the Zoning Ordinance shall not apply to any lot created by a plan endorsed by the Planning Board as a plan not requiring approval under the Subdivision Control Law for such period of 3 years from the date of endorsement, as provided by G.L. Ch. 40A, Section 6 . 4) Subdivision-Plan Protection: Any change in the Zoning Ordinance shall not apply to land shown on a plan under the Subdivision Control Law by a duly submitted and endorsed definitive subdivision plan, or a preliminary plan followed within 7 months by a definitive plan, for such period of 8 years from the date of endorsement, as provided by G.L. Ch. 40A, Section 6 . Any legally created lot with a recorded release from covenant of the Planning Board that has been sold or transferred into separate ownership and control from any adjoining lots within 8 years from the endorsement of the original subdivision plan shall be exempt from any dimensional or bulk zoning changes and shall not lose its status as a single buildable lot under zoning. 5) Merged Lots: Except as otherwise provided herein, lawfully nonconforming lots that are adjoining and 'held in common ownership, or under the control of the same owner, shall be treated so as to conform _ so far as possible with the minimum area requirement of the zoning district in which they are located. No lot so merged, or portion thereof, may be changed or transferred in anv manner that will increase the degree of nonconformity unless a special permit r:J I eno►4525 Fur 105 • FORM G 24262 , CERTIFICATE OF PERFORMANCE (Covenant Approval Release) t Barnstable Massachusetts, i • —Anri2 �e .l9 85 ' The undersigned, being an authorized agent of the Planning Board of Barnstable, Massachusetts, hereby certify that the requirements for work on the ground called for by the Covenant dated Mar_ _h 29 _19 85 , and recorded in Barnstable District Deeds. Book 3 Page_L, (or registered on Certificate of Title No. Document have been completed to the satisfaction of the Planning Board as to Lhe r'oliowing enumerated lots shown on Plan entitled " Centerville Barnstable Mass. PZan 2L land in ; Arced byGreenbrier Development Cory recorded with said Deeds, Plan Book 395 " Page 89-91 (or registered in said Land Registry District, L. C. f and said lots are hereby released from the restrictions as to sale and building ) ' specified thereon. Lots designated on said plan as follows: All lots SUBDIVISION 1 529 Authorized Agent dith J. F ench,Chairman Planning Board of the Town of Barnstable, COMMONWEALTH OF MASSACHUSETTS Barnstable, Massachusetts, ss AnriZ 29. _.19 8: Then personally appeared Judith J. French + flt f th Planning Board of the Town of Barnstable, Massachusetts and aacknowledged uthorized ethe oforee going instrument to be the free act and deed of id Planni Board before me. Not ry"Pub After recording return to MY commission a pires: „, o, hni- 31 logo Town of Barnstable Planning Board Town Office 367 Main Street KYannis. Mass. 02601 ANAP FINAGM HAY 985ICES �CV�j MABBACI{USETTB QUITCLAIM DEED 6/IOnT FpnM (1'kDIVIDUAL) 801 r WE, GEORGE TJAERLIS and AMELIA TJALRLIS, husband and wife, as tenants by the entirety, both , .., of 2255 Philippine Drive, Apt, 43, Clearwater, FL County,M.lssad3usctts, 34623 " bvivq-,xmxar7irA for consideration paid, and u1 full consideratiou of ONE ($1. 0 0) DOLLAR grant to GEORGE TJAERLIS and AMELIA '1JAERLIS, Trustees of THE GEORGE �JAERLIS a d AANN��ELIA JJA5gNLz R17VOCABLE TRUST, under p Family Trust reement �aterl April li, 1 90 of 2255 Philippine`D;_ive,- Apt. 43, Clearwater, with rintlrlittitt nntritanla FL 34623 tbelandin Centerville, Barnstable County, Massachusetts, and described as follows: [Description and encumbrances,if 2110 LOT 20 as shown on a plan of land in Centerville, Barnstable, Massachusetts for Greenbrier Development Corp. , drawn by AJM and checked by RBE, dated January 10, 1985, Scale 1 in. = 40 ft. , Eldredge Engineering Co, Inc. Reg. Civil Engineers & Surveyors, 712 Main Street-, Hyannis, Mass. , said plan being recorded in the Barnstable County Registry of. Deeds in Plan Book 395, Page 90. Together with a right of way over Captain Bellamy Lane as shown on said plan in common with others who are now or may hereafter be entitled thereto for all purposes for which roads are customarily used in the Town of Barnstable, but reserving to the Greek Community of .Cape Cod, Inc. the fee interest in the above described private way and the right to extend the way to land, roads or'other ways adjoining the subdivision subject to the rights of the Grantees and others who may become entitled to use the way in common with the Grantees. In the event the lots are developed for some purpose other than residential use, then paragraph• 20 of the Protective Covenants r�=rded in Barnstable County Registry of Deeds in Book 4618, Page 248 shall apply. Said land subject to Protective Covenants, Restrictions, Rights and Reserva- tions recorded July 10, 1985 at the Barnstable County Registry of Deeds in Book 4618, Page 248. For our title, see deed to us recorded in Barnstable County Recjis•try of Deeds in Book 5652, Page 35. < �(vtti illttrnn ...our.:,Lhand s and seal s this................ ....,.. day of. �I �..19..90. ................................................................... ... / •• .J........................... George Tjaerlis .......................................................................... �">1/.�r-i_......./. eta_4�✓nl......................... Amelia Tjaer is .......................................................................... ........................................................................... (gilt (Qnntmnnwrttlill of €t marllanrfin _ Barnstable, ss. �Sr 19 90 771cn personally appeared tic above named George Tjaerlis and Amelia Tjaerlis and acknowledged the foregoing instrument to be their free act and de befor me �. . �2{_t �4j_LA - ... Notary Public—yJ;s[i6Vy*T_ a r p M commission er tires (J 1 (sIndividual—Joint Tenants—Tenants in Common.) Cl4AP•rLR 183 SEC.6 AS AMENDED BY CllArrER 497 OF 1969 Every deed presented for record shall contain or have endorsed upon it the full name,residence and post office address of due grantee and.a recital of the amount of the full consideration dueteof in dollars or the nature of the other consideration Iherefor, if not delivered for a specific monetary sum.The full consideration shall mean the tonal price for the conveyance without deduction for any liens or encumbrances assumed by the grantee or remaining thereon. All such endorsements and recitals shall be recorded as part of the deed. Failure to cornplr with this section sball not affect the validity of any deed. No register of deeds shall accept a deed for recording unless it is in compliance with the requirements of this section. e0m;,052rs: 035 22830 t rr INC. - ! GREEK COMMUNITY OF CAPE COD a corporation duly catahlished tinder the au's of The Commonwealth of Massachusetts i't's'ness at Strawberry Hill Road t Route 28, and having it' usual plat'c "< Hyannis, Barnstable Cuunty, ?las;avhusclts, in cn sidcratiun of ONE HUNDRED ($100.00) DOLLARS r E grants to GEORGE TJAERLIS and AMELIA TJAERLIS, husband and wife as tenants by the entirety, of P. 0. Box 254, South Dennis, MA 02660 With guilrlaim rnnrnanta the land in Centerville, Barnstable County, Massachusetts, and described as follows: i Lot 20 as shown on a plan land ;a Centerville, Barnstable, Massach::- p - _ setts for Grcenbricr Dcvelc=-cnt Corr., arawn by AAM one. chccke6 by RBL, dated January 10, 1985, Scale 1 in. = 40 ft., Eldredge Engineering CO., i Inc. Reg. Civil Engineers S Surveyors, 712 Main Street, Hyannis, Mass. , said plan being recorded in the Barnstable County Registry of Deeds in Plan Book 395, Page 90. Together with a right ri way over Captain Bellamy Lane as shown on said plan in common with others woo are now or may hereafter be entitled thereto for all purposes for which roads are customarily used in the i but reserving to tPhe Grantor the fee interest in Town of Barnstable, the above described private way and the right to extend the way to lanai roads or other ways adjoining the subdivision subject to the rights of the Grantee and ot.`.ers who may become entitled to use the way in cc on with the Grantee. In the event the lots are developed for some purpose ) other than residential use, `. .2n paragraph 20 oc the Protective Covenants recorded herewith shall apply. Said land subject to Protective Covenants, Restrictions, Rights and Reservations recorded July 10, 1985 at Barnstable County Registry of Deeds. • For our title, see deed to us recorded in the Barnstable County Registry of Deeds in Book�pq , Page.U. f I I I I I i -vir.0 SHORT FORM (INDIVIDUAL) 881 v ^ S' 1 800QJG52 nce 036 GREEX COMMUNITY i OP CAPE COD, INC, ha, eau ed its corporate bevel lu bo herntu sQucd sad thew delivered in idts name and behalf by s'/�rh!'� LAk�J Pr<•sentr to be signed, ecknowled Its , F.yr ged and hereto duly autboriaed,this v day of /}'�flAl'[1` In the year one thousand nloe hundred sad d + Signed and sealed In presence of Y f< II BARNSTABLE +uul>IIIIQ4IIIC)[ tli{ gc8 ` Y. - 19 Then personally appeared the above named ( P��/(' 4 ALN I and acknowledged the foregoing instrument to be the free act and deed of the GREEX COMMUNITY tG. OF CAPE COD, INC. 6' before me My commission expires ..;(XMW'KXkA5c>nt I Vi- to z R[CCCG[u aPK a e 7 i jot • , Lam:. t ..r • ys?n-1' r`.'r!i r!�rt•-Y::+i:::�: "rt •/'ALt��'+._.•_., .��.�;,..— .. � a.i _. == � sa :. _ •- 7 5 J. . "' Sa O3 7 c/1 a A,) °NJ N � Q W o�2 Qc n U / 7 7 0 �eq N n \ 3EAW h 17 e o so GSM,; . .ti O IV I8 ► 18d �O \ �•-� J�� d� ��- V� d to Q-�- �a �5M 7 '7- 3 Cj p'�03 �, o ( 5 �- CAP �APP Q - iaa.) .1 a LIP PCX Ia � J� i6 ,C2 D5 G� 55 Zg TOWN OF BARNSTABLE -,t CERTIFICATE OF OCCUPANCY PARCEL ID 230 i9l, .; GEOBASE ID 35850 I CENTEVILLE ZIBADDRESS 8 CAPT4'IN BELLAMY LANE PHONE k LOT 20 ; BLOCK j LOT SIZE DBA DEVELOPMENT �' DISTRICT CO HFAIT TYPE OF jYY ERIPTION CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: BOND $.00 OxTi�E CONSTRUCTION COSTS $.00 * BARNSTABLE. MASS. 039. BUILDI I• IS�IO ' ' BY I DATE ISSUED 10/24/1997 - EXPIRATION DATE A TOWN 01 = STA%E }3CTIL01'NG PERMIT PARCEL ID 280 191 GEOBASE ID 35656 . ADDRESS 8 CAPTAIN BELLAMY LANE ' PHONE m Centerville A r ZIP LOT 20 BLOCK _ .LOT SIZE DBA DEVELOPMENT DISTRICT CO _ y PERMIT 23640 DESCRIPTION. SINGLE FAMILY DWELLING � PERMIT TYPE, BUILD - ._-TITLE NEW R;ESIDENT�S�,L, BLDG PM'T' . �. CON'T'RACTORS: . BALODIMAS,- SPIROS A. Department. of Health, Safety:: ARCHITECTS:. .' and Environmental Services TOTAL FEES: .001J50. f BOLD $.00 rn THE" CONSTRUCTION" CJSTS = $55.,000.00 - \101 SINGLE FAM. HOME" DE CHED' 1 PR'IVATF',i BARNWABLE. *_ x MA83. OWNER ANTIPOSTI , ,JAMES ADDRESS ED BOX 3 1.7 CENTERV I LLE MA 4. BUILDI!�FGs,D,I1 ON F i BY DATE ISSbFD 01fi/OS/159.7 xPxR�TION DATA: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS 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 RELEASE THE 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 PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE �'gNICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS • i CLJr Q7 647 Q.7 2 �� 1 d �� fvr 2 2 6 -Z 97 1 ' JiEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT ` 2..j EA/LTH OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED LfNTd PERMIT WILL.BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED'ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS- ' TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. ,'TION. . ..-i-. '— '�_..- --:... ._F _.:,.- " -`�,-'+.-._.. -..S �r- _._,...- ',a.}'4••-'n...w.-=.'eW..tti�wxwY R.w±ta..- t--tuv..�l+U.tN m.era J'S.b M+ti.¢.t e...s.,,. -.M.i+. ...1 u..i....u.mrl.svL ter:,... . AW Bu $ ?s `r P IT INU 1 ckel f - "z I w Y v BAR BUILIJAHEPT. DATE FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING a - i 1 � V e. . Y U CA �r -1 e Q- u v� Fri . C t,f � i- --s�7'n�-tr-�tE'ctGCT10�.1 -`='QT�,1T--tee-cYi.Tie... • / ` .' • ,, �14E�7-J��.ZZ'CC[SEC.'TC1TZ-6�-t]�STC,.I�I' .:.. F TQ 5 S i _ 11 4 r Y l .. � II Y p a' X � I I Q i; XeZ J OD; Cj _EYES OOM i l 91f� I -OODCTI-Y li it i . illl i i I - _.I.lEG7'BSi.CS-Ttal'Yh�:7-�"' Z:,2/iV G=1'dlZCdt-LCC'LS;St��STC��I'. ; �... sjlolos Strawberry Hill Y --_ Road 40 ' wide \ 4 P \ �' Lot 2 0 '• 3 7 20112 s f Capt. i 3 Bellamy i Lane 50 ' wide A 5 ' over dig is --- ;��7.`• if th necessary e -- - __; Sob requires it �.o { Lot 19 Use 8 high capacity Profile no Scale Infiltrators as shown with 3 ' of stone w a _c/{ I ; fnd � I�v 1500 9 B ' ro �• Septic design - No. bedrooms 3 -Req. leaching33-0 gpd Reg. tank 1500 gal . r _z Disposal no 15x24=360x.74=266 . 4 78x2=156x. 74= 115 . 4 382 . gpd z 4 i Site Plan of Land in Centerville, MA For James Antiposti Being lot 20 as shown on a plan recorded in book 395 page 89 . Map 230 pcl 191 Elevations are on N G V D P# 8955 � • , ..P Made 5-29-97 , Wit. J. Dunning Date: Agent Barnstable Board of Health i No water encountered , � =� MAR Perc. less 2 min per 1" Date 6-4-97 Scale 1 . =30 �'�� frli.' All Cape Engineering 49 Harbor Road / o S Hyannis, MA 02601 -T S 4 S 12 a� _. SauNy I z•33 Rw LO N M Vv1 qX4 Oe L INS/�7 e4V dCI { r , ZF O i I i IZO ! .39490 I j