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0010 GOFF TERRACE
7.14r � �.J d- ,tI ��lr.ae, ..,,. . 1� ,.at .. .. ,9,i.'q,. .1.,!'t-r�.,.F} `A�:�r., r kM1 4 . ,'tM, a w, '.. ,T I '•:I+ ,. ,. J ..: .af; i .'.v. G - iF" " •..:,I. i T/,` s r 'r t ,. i f _. , k r�Yr.� .�4��t y, ,..t „..,�a v. �,,,�j t� _�}�` yy� L.�' r �ti, s,,ri„k� f y4 i.>J�... a s- r. .•4`y'�::.�';,,..4�,t.r.��,{fp. L(}r�'^�n:�,,-:P`:u, r,Via,,.�i. :�. Y'h..,, +. : ., -.,.., � d .��. �: ► or n r, fr+r.. _ .,-:., ...•..... .. s « 'F�'.. 'i a �. ��, Y<' .�fr .�r .� .lJt'.. ._. .N:.1 9 ...._ �_ ,,. t�R r � cif , r v. r � �• ��'� �" t� � wY � Y ���t �f�3j�' ��x� �7� 1���� }1'•I�17�1{��iyi �'�' �r� F y°�. : I Sr LSD Application numbe / .......� T47 Date Issued.......S-lZ...).. ................................... . � s6q. Building Inspectors Initials........ ..................... Ok AUG 272018 Map/Parcel........../ ..l.. l.. .. . I / 0, b TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: T . ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Y ..Address of Project: t, U --;-NUMBER �j STET VILLAGE Owner's Name: /'h/ �a��Phone Number. v�41 .Email Address: C' Cell Phone Number Project cost $ ;20,d ,yd7 Check one Residential v` _ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize yLS �cd7 � � to make application for a buil ' g permit 'in accordance with 780 CMR Owner Signature: Date: d TYPE OF WORK Siding 0 Windows (no header change) # 0 Insulation/Weatherization El Doors (no header change) # Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to. CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable) # S&4�e (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor , i �'o� Phone numbers-, ALL PROPERTIES THAT HAVE STRUCTURES OVER YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ a *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached..Provide a site plan with the location (s) of each tent If food is being served at your event please obtain a Health Department approval between the hours . of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I.understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature ;�� Date All permit applications are subject to a building official's approval prior to issuance. r t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/C.ontractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):-cY/g!� Address: 49 City/State/Zip: Phone 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 employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.4 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' . y p �'• t 9. ❑Building addition [No workers' comp.insurance comp.insurance. 10.❑Electrical repairs or additions required.] S. ❑ We are a corporation and its P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 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 affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy 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). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify u er the pains andpenalties ofperjury that the information provided above is true and correct Signafore: ,/ Date: 1;2 Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical 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 receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)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 number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 wAw,mass.govldia __....._-._._.__ -_............. __ ' .lime �cvrunaivae�a�,��a�i�uJeCl� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only , TYPE:Individual before the expiration date. If found return to: Reoistr'ation Expiration Office of Consumer Affairs and Business Regulation 106566= 07/23/2020 1000 Washington Street-Suite 710 BRIAN CLIFFOfRD i+,(`:� Boston,MA 02118 BRIAN D.CLIFFORb';r 10 GOFF TER srs CENTERVILLE,MA 02632 Undersecretary Not valid ythout Signature s. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards, Cons tr,.giti& itopy,rvisor CS-057710 �> I 1plres: 03/05/2020 BRIAN D CLIFFORDa 10 GOFF TERCE CENTERVILLE 263�2 ; ',N Commissioner l . ,X,6 � To D ERA#11' wn of Barnstable *Permit Faptres 6 mn� k �rontiar ie date/ * �axsTes 2012 Regulatory Services Fee KAM 16 A`m� Thomas F.Geiler,Director / Building Division • 7�ZCl- Tom Perry,CBO, Building Commissioner, 200 Main Street,Hyannis,MA 02601 !/ www.town.barnstable.ma.us Office: 508-862-4038 : Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number /711 Property Address gtzce ma& V7W1_V 1 L 1,-6: F( Residential Value of Work _ (J� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address " �� F. Contractor's Name 'Telephone Number (!;Z 7-p�D. Home Improvement Contractor License#(if applicable) �, l Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Che k one: Ev I am a sole proprietor . ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit.' Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows .2 oke/Carbon Monoxide detectors 4 floor plans marked with red Sand inspections requir Separate Electrical&Fire Permits required. llV 6 . *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A eopy of the Ho a Improvement Contractors License&Construction Supervisors License is r quired. SIGNATURE QAWPFILESTO building permit formslEXP S.doq Revised 05301 the Commonwealth of Massacknsetts partment o,jIndushial Accidetr Office o,f Inm gadons 600 Waskington,Street Boston,MA 02111 r�Tevi�nras�go�fdea � _ Workers' Compensation Insurance Affidavit:Builders/ContractorsJEIectcirians/P u nbers Applicant Information Please Print Legib' Name U- AMress: C ty'StnLeJZig: /�� < Phone#_. rIFOLI� Are you an emp r?Check the appropriate box: Type of project(required): LEI 0 I am a employer with 4. ❑I am a general contractor and I loyees(fall su�fvrgart-bme): have hired the sub-contractors 6. ❑New c�nstnuction 2. tam a sole proptietor or partner- listed on the attached sheet. 7- ❑Remodel These sub-contractors have ship and have no employees: 8_ ❑Demolition rv�cdking for me in any capacity- employeesand have wodms' 9. ❑Building addition. [No workers'comp.insurance comp,insurance I 5_ ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I ani a homeoii mer doing all work officers have fxrmsed tluwir ME]Plumbing repairs or-additions myself[No workers'comp. right of exemption per MGL 12.El Roof repairs insurance required.]i c.152, §1(4h and we have no �' employees.[No workers' 13_FD Ddrer C,[u comp-insures re4tur'ed-] •Rays hcaatthatchecksbox#1m stalsofillmuIhesectionbelowsh©wing:then wodeWcumpe�atian.p�y��+�m Homeowners who submit this offil it indicating they me doing an walk and then hire outside contractors mmst submit a new affidavit indicating sucli. IConuacmn that check this boat must attached am additiansl sheet dmviag the name of the sub-comn2cton and state whether ornm these entities hose emphryees. Ifthe,sub-ccmunctmbm mmpI rym%dLe?'mustPmvide tek workers'gip.policy number.. I am an emplvjw that is providbw workers'cor gmmadan insurance for my em Aha wen. Below is tihe policy and job site informatiotr. Lisurance Company Name:. Policy#or Self-ins.Lic.4: Expiration Date: Job Site Address: City/Stawzip: Attach a ropy of the workers'compensation policy declaration page(showing the policy manlier and expiration date). Failure to secure coverage as required under Section 25A of MGL c: 152 can lead to the imposition of criminal,penalties of a fine up to$1,500.00 an for one=Bear imprxsonUM3t,as well as civil penalties in the form of s STOP WORK ORDER and a fine ` of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of DIA for insurance coverage verification: I do hereby totepains and, a ofpidury that the in Jbrma&A-prodded ab is true and carrecat Date: Phone#: a,�rciad use only.: Do nat nacho in this arse,it*be compWod by city or town a icdat City or Town: Permit/License If Issuing Anth,ority(dr de one): L Board of Health -.Bolding Department 3.City Town Clerk 4..0ectrical Inspector S.Plumbing Inspector 6.Other: Contact Person: - Phone#: 6 A -. .. , IME DARNSPA 314 ; 9 ,m� Town of Barnstable Reglu�latoi Services Thomas F.Geiler,Director Building:Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis;MA 02601 www.town.barnstable.ina.us Office: 508-862-4038 Fax: 508-790-6230 Property ®caner Must Complete and Sign This Section If Using A Builder t as.Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) � q Signature of Owner .Date - Print Nam If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILESTORMSUilding permit forms\EXPRESS.doc Revised 051811 } �tME> 'Town of Barnstable Regulatory Services i s . MASS, " Thomas F.Geiler,Director pr i639. a fc r Building Division N+a g Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who 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 requirements. Signature of Homeowner 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 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 051811 rv� SLtD�� ! T UOLP. a _�.` _.. "``."tea_, � • _.. ,�,•,�.-..� �. W S _d , nn , 1 KAI SfPn �„, 3"',r'�~�'•... it r+i"ttt*,7ir"A^ft�`r'k`aC'�'�_^+f:�r*'�'�rfi''^"rt`.S.,i+P."fi*^n.,..�,T..�—�r.M..,,..r•},1*e M.`i��'S�.�Etanr+!"SiErY`�ffi":;Stia:.«5�`�a' N'�., ,w�i .,c ':�;-i^^'+�4't„'�`1!n"�,�'r-..'^ .:. ,yrq+,,: f, Assessor's office(1st Floor): ma and lot number Assessors p Board of Health(3rd floor): Sewage Permit number Engineering Department(3rd floor):V House number -f{` r �c .6}0. Definitive Plan Approved by Planning Board 19 D NOR 6 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF B�AR.NSTABLE i BUILDING ItNSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION W O O(t ya �3 :3 !_�74 19 Sly v TO THE INSPECTOR OF BUILDINGS: { The undersigned hereby applies fora permit according to the following information: Location ID co Proposed Use v'`? W� t F taP r ?. nin District P =Fire District .s9 g Name of Owner i S'tu } t'1 - Address Cie Name of Builder t�w`��— tAddress '���� Name of Architect Address Number of Rooms a- 1'Foundation Exterior CO 'Roofing Floors Interior '�--s 1 '" r . ,. v Heating '.Plumbing t;.• Fireplace Approximate Cost Area Diagram of Lot and Building with Dimensions Fee IW OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGSti I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License � 6L`'— CI FFORD, BRIAN & KYM A=171--108 /7/-Jogs �- No 33623 Permit For Addi-Lior, Single .Family Dwelling Location 10 Goff Terrace Ceiitervi lle Owner. Brian & Kym Clifford Type of Construction Frame Plot Lot Permit Granted March 26 , 19_ Date of Inspection 19 Date Completed 19 PERMIT COMPLETED 1;1LU f Y TOWN OF BARNSTABLE BUILDING DEPARTMENT S ssaasT : TOWN OFFICE BUILDING rua 4 HYANNIS, MASS. 02601 ''�o rnr�• MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit l as been issued for"W'building authorized. by Building Permit #. �z t2 ?7� ... ................................... ....._..... issued to !'/f.tl ffc!s rr� °r„G iLf w ..7 ,.�' ... _. �G �r �1 fir%;�t� '7 " f Please release the performance bond. .,,, .. 1 .. - +« a..:, r 'ter_• •.-a--�.V It-, •,;:...., ..A.y}„ _ k i oFtxero• TOWN OF BARNSTABLE . Permit No. 28872........ BUILDING DEPARTMENT { H°8;a I TOWN OFFICE BUILDING Cash °�cwr HYANNIS,MASS.02601 Bond .....x... � CERTIFICATE OF USE AND OCCUPANCY Issued to Brian & Kim Clifford Address Lot #22 & 22A, 10 Goff Terrace Centerville, Massachusetta USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. i ,..:2 7. 19 .......... lam^ r Building Inspector BUILDINGT 318d1SN2�t/8::10-NMOmm ! T - -7: � ,� MPERm P°� ', JOB WEATHER T H E R ,, : M CARD 19 PERMIT NO.S7 a °at3 1t 5 � ice" DDRESS (NO ) (STREET) lie � (CONiR•S LICENSE c STORY NUMBER OF (TYPE OF IMPROVEMENT) ' ' NO. (PROPOSED USE) OWELLING UNITS AT (LOCATION) U ZONING (STREET) DISTRICT—_ BETWEEN 'Y i (CROSS STREET) AND / (CROSS STREET) SUBDIVISION � • LOT BLOCK LOT SIZE BUILDING IS TO BE } FT, WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTI i } TO TYPE USE GROUP ; BASEMENT WALLS OR FOUNDATION REMARKS: (TYPE) I AREA OR VOLUME �. /y��. (CUBIC/SOU�RE FEET) ESTIMATED COST $ FEE OWN'I:R �— i ADDRESS BUILDING DEPT. ;�. THIS PERMIT CONVEYS C RIGHT TO OCCUPY ANY STREETe4ALLEY OR SIDEWALK OR ANYPART THEREOF, EITHER TEMPORARILY I PERMANENTLY, ENCROACHMENTS ON PUBLIC PROPERTY,. NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, PROVED. BY THE JURISDICTION. STREET OR ALL GRADS AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWER FROM.-THE DEPART PORARBE O OF ANY..qP DEPARTMENT OF PUBLIC WORKS. THE J.SSU.AN,C�,OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE UST 'BE AF �...l,CABLE SUBDIVISION RESTRICTIONS +' �.. S MAY BE OBA'f.�NE „,i:1 b CON. -.LION INSPECTIONS�REQUIRED FOR O'V'ED a T—' q- ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL"INSPECTION ANjAS SEE., E A ' I '1, FOUNDATIONS OR FOOTINGS. ' MADE: WHERE A ��«N P ON JOB AND THIS WHERE A�'R(;{�;q, I ��gµire °!LE_SEPARATE 2�•,PRIOR TO COVERING STRUCTURAL CERTIFICATE 'OF OCCUPANCY IS RE- MECHANI., ,�4�INSTALLATDtONSOR PRIOR To COVERING TO STRUC QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL �+r�--xND -3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. ",OCCUPANCY. ' POST THIS CARD SO IT IS VISIBLE FROM BUILDING INSPECTION APPROVALS PLUMBING INSPECTION'APPROVALS OM STREET 1 ELECTRICAL INSPECTION APPROVALS 1 _ ok i 3 . HEATING !NS?ECTING APPROVALS ER TON INSPECTION APPROVALS O:H E R ------------------------------ 2 Z I I - WLF7K^. LL NCT ?POCEFD UNTIL THE '!:,.NSP`CTCR `•AS APPROVED -�� PERMIT WILL BECOME N ILL AND STAGES A�ICUS VOID IF CONSTRUCTION iNSPECTIONS INDICAHIS CARb OF coNsraucTioN, WORK IS NDTSTA�RTtrDTHIN SIX MONTHS OF DATE THE CAN 9E ARPANGPKI ED + BY TELEPHONE :,`. cD ABOVE, • OR WRITTEN NO f)ON, .y .105EPH D. DALuZ TELEPHONE: 775-1120 Building Commiuioner - EXT. 107 TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING HYANNIS, MASS. 02601 December 20, 1985 Mrs. Brian Clifford 74 Camp Street Hyannis, MA 02601 Re: Lot 22 & 22A, Goff Terrace, Centerville Dear Mrs. Clifford: I have reviewed the above referenced plot of land in reference to Town of Barnstable zoning. The property is located in a Residence C zoning district and prior to February 28, 1985 the lot size requirement was 15,000 square feet. The lot has protection under the provisions of Chapter 40A - The Zoning Act - and is therefore a buildable lot. The Board of Health did observe and approve a percolation test. Upon the completion of a building permit application a foundation permit will be issued for the construction of your new home. I trust this will answer your concerns. Good luck with your long awaited venture. k Peace, Joseph D. DaLu� z ill —"'Building Commissioner JDD/gr �r , S��/ Assessor's ma and lot number. l � ��., SEPTIC SYSTEM MUS�I ,�j INSTALLED IN COMPLIANCE Bpi THE T0� <G l Sewage Permit number .....e:.-......... ..7.�s WITH TITLE 5 e�Q 'ENVIRONMENTAL CODE WN 's MAR33TADLE• House number ...................f ./... ............................... �o�6 _ TOWN REGULATIONS 900 "639 o Mar A, TOWN OF' BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO' ....:..... ....: .. ........ ........,. ................ ................................... TYPE OF `CONSTRUCTION 1..1... .......................................................................... ..�...............19 d TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: e, Location .... 1 .^L .��.d'.. ... ............ ...... .... ...... -...... Proposed Use ZoningDistrict ................ .(.�..........................................Fire District ........ b..................................................... �. mil, `� 'NameS of Owner ......... t-l!.`�4.Address ......... .. ... ..... .. ... 0 .... Name of Builder\ �?.. /�`��`!....................Address Name of Architect ........................ .....................................Address ... ............ ........................................ . ..... ...... .... .... Number of Rooms ............. ....................................................Foundation ..... ............... ..� :��'? Exterior ....�'eJ � .... .. Lr ... '.!!!!'` : ...................Roofing .....I.. ....... ..!.1 ....................................... Floors .............. ... .. /�GJ.............................�.......................Interior Heating ..`---.:`:.�. ....................................................Plumbing .........�.... .... � ............... ..... ... Fireplace ............�`...................................................Approximate Cost .....�.... . ............................ Definitive Plan Approved by Planning Board -------------------_-----------19________. Area . .'.'.". ..... . Diagram of Lot and Building with Dimensions Fee ......��.�`.. 1........ .............. SUBJECT TO APPROVAL OF BOARD OF HEALTH ID 1 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name 1/..... .. ............. Construction Supervisor's License ................... CLIFF.ORD, BRIAN & KIM No ... ... Permit for ...Two,..Story............ . ...... Single,_F1r�i�Y..Dwellia ..................... Location .....Lot 22, & 22A, 10 Goff Terrace........................................................... Centerville ............................................................:.................. Brian & Kim Clifford Owner ................:*,**,****,**,*................*'*"****,*,*,*"*** Type of Co' Frame nstruction .......................................... ................................................................................ Plot ............................ Lot i................................ Permit Granted ...........1alaua.r.y..22.........19 86 Date of Inspection .......................... .......19 Date Completed '.w...19 Assessor's ost floor): >, T THE ma a ro` Assessor's map and lot number ....�.�.�.'...,�.Q.B...... SFPTIC SYSTEM MUS ......... � Board of Health ,(3rd floor): Sewage Permit number . 91 �'' ��� � T5 l7 LE Engineering Department (3rd floor): f/ /� '� `�I)J/ !� t 'oo rb 9• House number .............................L ..........'✓ ..I..�f........'/� :� i , you ale APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M: only TOWN OF BARNSTABLE BUILDING INSPECTOR 0 APPLICATION FOR PERMIT TO ..�?...... ........ .. ................ ................................................................................. TYPE OF CONSTRUCTION .... Q. .....�`".C.�.e ............................................................................................ ........... . ...I.........................19 Ir .. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for.a permit according to the following information: Location �� � C... . `e................................................................:.................................... .................................. .. ................ Proposed Use ... . a:y� .' .....T... ...... ........... ... r`...����4�......... .g..'c...�.���'.. Zoning District .... Fire Distract .................. Nameof Owner . ........... ......................................................Address ...� ....�C .... .................................... Name of Builder ..... .`C`.!.......... . ...L...............................Address ..,37......RIA......... . .. ....................................... Name of Architect 1�:..G .. L1......................Address ...�D.....� � r � .................... t�G... �.. ........ �i�,(J ' '.....h e Number of Rooms ......a. ..................................Foundation ` '4 : Q -S Exterior ...G.�a� .................................................................Roofing........Roofing .....A-50,LJ Floors PP ...........................................................Interior ...�.!n... h�© ..................Plumbin .....!..... Fireplace .......K.OnL..............................................................Approximate Cost . i ®00,00 .......................................................... Definitive Plan Approved by Planning Board ________________________________19________ . Area ...;-. 5 .-.R............ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH Ila 'Rd ►z , qA 3u i �V OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the �TowoBarnstable regarding the above construction. Name ....v..;.......!t...... ................................... Construction Supervisor's License ................... 1` 7 CLIFFORD, BRJ_IAN D. Addition No Permit for ....Build...Ad.d.i..t- Sincrie Family Dwelling ........................................................................ Location ........ 0 Gof" Terrace .............:!_........................................ Centerville ............................................................................... Cl-ifford Owner .... Brian D _L. .............................................................. Type of Construction .........Frame...................... .... .. .. .......... ................................................................... Plot ............................ Lot ................................ Permit-Gran+ed .......September 1.1.,19 87 . ........... .. . Date of Inspection ................. .........19 Date\Completed ................... ....19 E i C ' z r a 1 �x Y all Apple-Briar Construction 10 Goff Terrace Centerville, MA 02632 (508) 420-0353 i „a t s TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print, DATE LOCATION /D . —� um e r tree t a ress /�e "HOMEOWNER" ection of town • ,. . . . See� _D ome p one �Qm� PRESENT.MAILING ADDRESS or Pone /v . Ylt.own . . , toe The : cur,rent exemption for . 7. "homeowners" was 1p; code dwellings. of six:.units..or ess an s extended to include :qurner-occupied ivi ua for hire. who. does not ° allow such homeoWrlers` to engage. an acts as supervisor. Possess a license (State Building Code Section Provided that the owner :DEFINITION OF HOMEOWNER: TZ- Per.son'(s.) who owns a parcel of land on which :side, on which there is, or is intended to be,, a she resides or intends to 'attached or. detached structures accessory to such r, A person who constructs more than one be, a one to six family dwelling, ;considered a homeowner. ch use and/or farm structures. `Consi ore acceptable to the Building home in a two-year period shall not be Such homeowner" shall submit to the Building Or'fic' ;for all such work ding Official, that he/she shall be res on iap, performed under the bui'iding permi - 'The undersigned " ection p slbl Theug homeowner" assumes responsibility for Compliance Building Code and other applicable codes, by-laws, rules P e with the State ;The undersigned and regulations. Barnstablegu9ldin homeowner" certifies .that he/she understands !and .that he/she willpcommint minimum inspection procedures and tre Toam of / comply with said procedures and requirements�:�irements HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three famil to comply with State dBelli gs 35,000 cubic feet,'`or- g Code Section 127 0 larger, wi11 be required Construction Control . I � 8 ' VA HOME OWNER'S .EXEMPTION The Code state that : permit is "Any Home Owner Performing work for which a building exempt from (section 109.1 .1 required shall be— Licensing the provisions of th.ls section . Home Owner engages a g of Construction Supervisors) ; Shall persons) for hlre -to do Such work , provided that. if a act as supervhsor . °° that such Horno Owner Many Home Owners who use this exemption ar the responsibilities a unaware that for. Licensingof a supervisor (see Ap;)endlx 0, they are assuming. Construction Supervisors, are and Regulations c, often results In serious Section 2. 15) . . This lack of awareness Unlicensed problems Particularly Unlicensed persons. In this y wh©n the Homo Owner hires Person as It would With Supervisor... Board isoannot as�isUpervlsor proceed against the Is .ultimately responsible, p The Horne Owner acting To ensure that the communities re HOME) Owner Is fully aware of his/her .responsi certif quire:,` as part of the bllltles, many Y that he/she understands permit application, that tf1o. �l-lonio last,pago of this Issue Is the responsibilities of a su orvls Owner care to amend a form currently Used b p or . On the . and adopt such a form/certification fore use Veral towns. You may us© In your community. -------------------------- a� ' s- SEPTIC SYSTEM MUST BE Assessor's office(1st Floor): /n INSTALLED IN COMPLIANCE Assessor's map and lot number / Board of Health(3rd floor): WITH TITLE 5 Sewage Permit number �;- 177 9 ,� ENVIRONMENTAL CODE AND Engineering Department(3rd floor): n L TOWN REGULATIONS ;D° MA&&t` House number /- 0 +639• Definitive Plan Approved by Planning Board APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO '.i�to 1 I A eq,-X TD TYPE OF CONSTRUCTION W 0(j -}�►'G,vti� 19 �l) TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the followingf information: Location ID co /� �1�`�`PV` to Proposed Use �'1 wen Zoning District Fire District 0e�� '`V'f '�� Name of Owner rta'�. { vv\ t � Address 11-0 Name of Builder C/W''�-0�— Address �� a Name of Architect 'Address Number of Rooms Al Foundation Exterior � Roofing Floors Interior Heating ND' Plumbing 176 Fireplace Approximate Cost Area Diagram of Lot and Building with Dimensions Fee Port OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. . 1 G Name- Construction Supervisor's License Otdsz�— 7 CLIFFORD, BRIAN & KYM a t t� No 33623 Permit For ADDITION Single Family Dwelling r Location 10 Goff Terrace Centerville ^ Owner Brian & Kym Clifford :Type of Construction Frame r a Plot Lot ? Permit Granted March 26 ; 19 90 I __ Date of Inspection 19 N mate RpUmpleted - 19 [C _ . m c I'p P ru £} r t3 // Assessor's map and lot number. ..... / THE . J,"Y Sewage Permit number .....9S..-..��. .r�.. F..:. �`�P ♦� Z 86SB3TADLE..1 House number ................... ./....9.......................................... ' rasa t �p 1639. `00 TOWN= OF BARNSTABL.E BUILDING INSPECTOR APPLICATION FOR PERMIT TO CL� �. - � '....................... TYPEOF CONSTRUCTION ................................ � � .......................................................................... 1� ........ ,cr�: ? Z?............19 � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... Q.. ...... z!.a'.. .. r:... ............� . : ..... ....' ....... .Cl..\ �........ ...... .............. Proposed Use ....... ! ........ ' { !!` .......................... .... . .. . .... ......... :. :Zoning DistrictT .....................Fire District ............. ..... ...................................................... : Name of Owner ..W....4.7..G. .... •tiiY3....�4. 1l(/t..Address ......r!. fl . ...�..'1?:. �3. ........ r Name of Builder ??.. .`...,f" ..............Address ................................................... . ..................... . 77 Name of Architect .......................................:..........................Address Number of Rooms ...................Foundation 7 Exlerior ..... .. ...... �Xa�. ........ � �y ................................. ....._., 1...� ......................Roofing ....... !-- ---------1. /��. .Interior "— _ .Floors :.�........ . ,,......................................... Heating �—.—." `�•� ..........................:.............Plumbing ......... .... � ................................................... Fireplace ........... ! �'71 i ............................................Approximate. Cosh 11 Definitive Plan Approved by Planning Board --------------------------------19--------. Area .......................................... Diagram of Lot and Building with Dimensions Fee. ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH z M OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town.of Barnstable regarding the above construction. Name .,...:................ Construction Supervisor's. License ......... ............. CLIFFORD, BRIAN & KIM A=171-108 No .... Permit for ...TWo,,,Story.............. Single Family Dwelling ............................................................................... Lot 22 & 22A, 10 Goff Terrace Location ................................................................ Centerville ............................................................................ i Brian & Kim Clifford r w Owner .................................................................. Type of Construction Frame � Pot ............................ Lot ................................ j jI - / Januar 22,....._. 86 Permit Granted .....................Y......... 19 Date of Inspection' ........19 Date Completed } �V a -3 y � � r F Assessor's offioe (1st floor): FtNEt Assessor's map and lot number .... .. Board of Health (3rd floor): 1 °� Sewage Permit' number ......................... ............................. 2 B9Sa9TODLL, S Engineering Department (3rd floor): © -) °o rb 9• e� ,House number '.......... �...... .�............ V`-� a OR a` t APPLICATIONS PROCESSED 8:30-9:30 A.M, and 1:00-2:00 P.M. only �R. �', TOWN OF BARNSTABLE BUILDIN-G INSPECTOR APPLICATION FOR PERMIT TO t ..`�`�l...C...........L.�..�............................................................................................. TYPE OF CONSTRUCTION ....wR."5 ..... ............................................................................................ .--....9 .........................19.. .? TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora permit according to the following information: Location �C �P+rHGC�y l.C'V1rU t�` � �� o�w+ fi SCYt�he� C j :.I....... '.............................................................1�..................................,................... Proposed Use ......................... Zoning District ............... ........' ........ ..............Fire District ............ �1 �Q �..?� u � �'U1 >f Nameof Owner ....................................:.................................Address ... ............................ ..................................... Name of Builder .................. ...( ���...... ........................Address .. 7.... .lr ..... /'!.�` �. Name of Architect '. .......................Address ...I......... ....................................................................... Number—of Rooms ...... .........................................:...............Foundation . y.......�dk� �... Exterior ...1 .( .C4 .................................................................Roofing ....I'�{-� Yl� �........................ �. Floors lT.......::...................................................................Interior ........ ��(��.................................................................... Heating .. .(..`.................................: ..:...................Plumbing .....!...©............. :. . ........ : ............. ......:... : Fireplace 6'` ...............................................................Approximate Cost ...5j.0...O�J.. Gt3 .............................................. Definitive Plan Approved by Planning Board --------------------------------19________ . Area 3 2 5).........t............ . 04 Diagram of Lot and Building with Dimensions 'Fee ................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 % ri f' �• �, rY�� OCCUPANCY PERMITS,REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of.*the Town of Barnstable regarding the above construction. Name /, :-x..... .................................. I/' Construction" Supervisor's License �J..`�����y.................. CLIFFORD, BRIAN D. A=171-108 i 71--1dS-' . No ...31183 Permit for ...Build...Addition Single Family Dwelling.......,. Location ..10 Go.ff. ....Terrac. . . ...e ... .. . .... .. .... .. ...................... -Centerville .....................................................................I......... Owner ......Brian. . ....D.....Cliffor. . . .d ............. .... .. .... .. .. ..... .. .... .... .. Type of Construction .....,Frame.. ... ........................... ............................................... ............................... s Plot ............................ Lot ................................ t Permit Granted .........Sept......11.........19 87 Date of Inspection .....................................19 Date Completed 19 Z a14 k,#A�e_ 1/3/6J ";• C i t { fit(` � t i 1 Lill SL�p£� s � l . � � kA 4 s to 4 b 'u ' c n n h V elc tiy t F fc T el . f 4 � ( � �C•�T.1_ j�(111��:M i � b f ' I i y I-2 e , ---------_... ------------ .............. -T- -LE, Fn I r. r i 4 -- - ._..._...... r • _.. _ f 10 � I tt r� f - . +ry IWO, i 2.v � ` �,�rl:' - got, y � � /a�� �� N •,i J/ • 4 90 + f 3 tl `1J N �? cl�w -� / _© 7r = ./ Assessor's omp(1st Floor): 06 to rAssessor's mace lot number / U D 1Mc Conservation G tn� Z SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANC .Board of Health(3rd floor): . a Sewage Permit number WITH TITLE 5 t 3es13r&nr9 Engineering (Department 3rd floor ENVIRONMENTAL CODE AN ao `6,9, j� House number P �/10 TOWN REGULATIONS Definitive Plan Approved by Planning Board 1g APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN ' OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 17(.��1 (�a-�, cyQ W t im w, t I� 1p c-� vK' a��j� TYPE OF CONSTRUCTION IINV oq 19 /f TO THE INSPECTOR OF BUILDINGS: The undersigned hereby appliesfor a permit according to the following information: Location 10 �o-� �P✓vACk—, Proposed Use ��° 'G e Tam (`' iocv- 4— Zoning District Fire District a V\feV,0d(,P � y �fG C�Name of Owner Name of Builder Address /0 eo -e" Name of Architect '"' Address (Number of Rooms / Foundation y , l�0el 11-e Exterior '' S417�z fss' C/7/1�4a"tKI Roofing Floors__��r.9�� U/��l Interior `�P��� Heating 0!/ /y� Plumbing Fireplace N Approximate Cost 30. U,q U Area 7-7 S 41 Diagram of Lot and Building with Dimensions Fee �• OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License ��� � i . L VIP- T_-LIF-PORED/, BRIAN & K.YM � r No �`- Q� -'Permit For BLD. GARAGE & FAMILY -APT. Single Family Dwelling Location 10 Goff Terrace ,Centerville } Owner : Brian & K.ym Clifford , Type of Consiruction Frame Plot - Lot , Permit Granted March 26, 19 92 t Date of Inspection ` 19 Date Completed 12 -)Ud ay 19 L w^i a v , r I f oFt t Town of.Barnstable BUILDING DEPT do Building Department Services Brian Florence CBO - C EB 01201g MUMSTABM 9�A MA3S. `�$ Building Commissioner TOWIN►OF 'Fn ww+" 200 Main Street, Hyannis, MA 02601 g�l'NSTABi www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: �/ �My name is�Y��� �' �' I am the owner/resident of the property located at: The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: 67IIA-74' '� -" ar4 4 Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit.annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this /sr day of 2019. Signature Phone Number Print Name��s 401 q:forms/famaffid.doc rev 11/08/13 Town of Barnstable 111111®ING Building Department �pT Brian Florence, CBO FEB 0 �sz��. • 2018 MM& Building Commissioner T®� Fs6 9. 200 Main Street,Hyannis, MA 02601 N OF BAftVSTA L www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Town of Bamstable Family Apartment Affidavit- 1, being on oath, depose and state as follows: �� � �ti � My name is �p I am the owner/resident of the property located at: /O e � _ 7�1G`e%6z— The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to iinder the pains and penalties of perjury this day of .1a 2018. Signature Phone Number Print Namerj �/ q:forms/famaffid.doc rev 11/22/2017 Town of Barnstable Regulatory Services a �tKE Richard V. Scali,Director Building,Division TABLE • � Paul Roma,Building CommissionerTO\NN S. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 t Fax:. 508-790-6230 Town.of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: - MY name is��1412. .,- 1�"�'' AI am the+owner/resident of the property located-at: Adr The following members of my.family will be the sole occupants of the Family-Apartment at the aforementioned address: ; Name &relationship to owner: Name&relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members.'In the event that the listed relatives vacate said apartment, I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with,the Building Commissioner listing the names and relationship of occupants in said Family Apartment..I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit' . and/or the Town of Barnstable Zoning"Ordinances Section 240-47.1 Family Apartments. I agree to notiA the Building Commissioner immediately in the event of the sale of this property.. - •If there,is no longer a Family Apartment at th.s location;please exYlain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. Other Sworn to the p ns and penalties of perjury this / day of I l 2017.. Signature / Phone Number Print Name q:forms/famaffid.doc f rev 11/08/12 Town of Barnstable Regulatory Services of *qy, Richard V. Scali,Director ti Building Division ` '" ',,& Thomas Perry, CBO,Building Commissioner iOrEn�A � 200 Main Street, Hyannis, MA 02601 www.town.b a rnsta b le.m a.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: My name is I am the owner/resident_4the " /} C located at: A� Lev Z" - ' property �w�� :�Z. The following members of my family will be the sole occupants of the Family Apartment avffie aforementioned address: Name &relationship to owner: z � Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified ' family members. In the event that the listed relatives vacate said apartment, I will immediately notes the Building Commissioner in writing. I understand that no subletting or.subleasing ofsaid. Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to'the Amnesty Program (Appeal No. ) Other Sworn to der the pains and penalties of perjury this day of,-=- 2016. � � . 57 Signature Phone Number " Print Name ��� q:forms/famaffid.doc rev 11/08/12 Town of Barnstable of E Regulatory Services ti u„ Richard V. Scali,Director asTABI E : Building Division v�Ar639-MAS& 01 Thomas Perry, CBO, Building Commissioner fD Mp`l 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us C� Office: 508-862-4038 Fad 08-790 J_6230. ZZE Town of Barnstable Family Apartment Affift it I, being on oath, depose and state as follows: My name is ���� CMG^ I am the owner/residen of the property located at: The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) _ Other Sworn t der the pains penalties of perjury this l/.044 day of 2015. Signature Phone Number Print Name q:forms/famaffid.doc rev 11/08/11 h - w N. Town of Barnstable Regulatory Services oFT"E ram, Richard V. Scali,Interim Director Building Division � a�r PA Rk L� RAMSTABM ` Thomas Perry, CBO Building CommissionMASSer r039. 0. 200 Main Street, Hyannis, MA 02601 �t�tr ° ' tAR o• A FD MA'S �.t"t �• i.:a www.town.barnstable.maxs Office: 508-862-4038 7,=,��F 508-790 6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is '�� I am the owner/resident of the property located at: The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: �� Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notes the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notes the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to er the pains and penalties of perjury this `"� day off 2014. Signature �— Phone Number Print Name y1-"_s� q:forms/famaffid.doc rev 11/08/11 own of Barnstable Regulatory Services �t rod Thomas F. Geiler,Director ti Building Division.. , MAS& Thomas Perry, CBO, Building Commissioner 1639. ,0� �Ar A 200 Main Street, Hyannis, MA 02601 www.town.ba rnstable.ma.us Office: 508-862-4038 ' Fax: 5087790=6230 Town of Barnstable Family Apartment Affidavit I,being on oath,depose and state as follows: My name is I am.the owner/resident of the property located at:. d Lac? s . The Toilowing members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship.to owner: DGr`` L/ ( 4 A-7) Name &relationship to owner: . The Family Apartment will be the primary year-round residence for tl� ove-idei�tlfied ' family members. In the event that the listed relatives vacate said apartment, I�w3I immediately.;' note the Building Commissioner in writing. I understand that no subletting or�:-s�° leasingf sai� Family Apartment is permitted. :. CD I understand that I am required to file an Affidavit annually with the Buil ing Commissioner listing the names and relationship of occupants in said Family Ap rtment. I-s.o '{ understand that I am required to comply-with.all`conditions imposed by the ZBA ecial Pe%it and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I ee� , to notes the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to'the Program (Appeal No: ) Other Sworn to under the pains and penalties of perjury this 9 day of `Js 2013. Signature ;: Phone Number Print Name r q:forms/famaffid.doc rev'1.1/08/11 f .. .xaueic; Town of Barnstable fw Regulatory Services x ., �'IKE Thomas F. Geiler,Director Building Division ELE BAMSrABIX, ' Thomas PerrMAMy, CBO,Building Commis's,'oner$ , AIM; 9 �ArFa 9.,�A��� 200 Main Street, Hyannis, MA 02601 8' 30 www.town.barnstable.ma.us -Office: 508-862-4038 D IVIC ij£T F 5-68-790-6230 Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: My name � I am the owner/resident of the property located at: � The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner 246 �14 Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment,'I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. 1 also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no-longer a Family-Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to under the pains and penalties of perjury this / ' day of, 2012. Signature Phone Number Print Name-t�.'� � c� . q:forms/famaffid.doc - rev 11/08/11 Town of Barnstable Regulatory Services. .-J of THE r�� ", � Thomas F. Geiler, Director ropy'?", BuildingDivision ; , "'0' �_ � �� BARNSfABLE, ' Thomas Per CBO Building Commissioner ` Mass. Perry, � f R� A�039. ,��� 200 Main Street,. Hyannis, MA 02601 / www.town.barnstable.ma.us b Office: 508-862-4038 Fax:V508-NT-6-230 Town of Barnstable, Family Apartment Affidavit I, being on oath, depose and state as follows: My name is -��7"��/ L �S I am the owner/resident of the property located at: /4 The followingmembers of m family will be the sole occupants of the Family Apartment at the e Y Y p Y P aforementioned address: Name & relationship to owner: �- /�/ ��--�. Name & relationship to owner: The FamilyApartment will be the rimar ear-rou' nd residence or the above-identified P P YY f family members. In the event that the listed relatives vacate said ap rara ment, 1 will immediately note the Building Commissioner in writing. I understand�that no subletting or subleasing of said Family Apartment is permitted.1 understand that I am required to file an Affidavit aAally with�ihe Building Commissioner listing the names and relationship of occupant is n said Family Apartment. I also t understand that 1 am required to comply with all contions imposed by he ZBA Special Permit and/or the Town of Barnstable Zoning OrdinanceslSection 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property.. _ If there is no longer a Family Apartment at this location, please explain The apartment has been dismantled. The apartment has been transferred to the Amnesty�Prograrn-((Appeal Other J Sworn to u r the ains and,penalties of perjury this 1,41 day of / 2011; p p P J Y ignature Phone Number Print Namet�g ��' bC Town of Barnstable Regulatory Services °F1HE tOk'4 Thomas F.Geiler,Director Building Divis f OF URNSTABU BARNSTABLE, Tom Perry, Building Commissioner 9 MASS. i639. 200 Main Street,Hyannis,Mtn A ArfO MA'S A � E—f� i. 13 c www.town.barnstable.ma.us Office: 508-862-4038DIVI a _ Fax: 508-790-6230 i Town of Barnstable Family Apartment Affidavit I, being on oath, depose and estate as follows: My name is I am the owner/resident of the property located at: h C9a x The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: 1k � cjl� Name & relationship to,owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. 1 understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn rider the pains and penalties of perjury this./.z"`� day of 2010. Signature Phone Number Print Name Q/bldg/forms/famaffid Rev:l2/08 Town of Barnstable . Regulatory Services �tHE tqy Thomas F.Geiler,Director .F Building Division 'Vtg ""3F SAnf4 SABLE aarwsTAsi,e, » Tom Perry, Building Commissioner MASS, 9�A 039. 200 Main Street, Hyannis,MA 02601 ��� A FEB 18 pM 1.: 29 tE0 Nlp'1 www.town.barnstable.ma.us Office: 508-862-4038 . Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit - I, being on oath, depose and state as follows: My name'is �V'`T I am the owner/resident of the. property located at: /U The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: Name & relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, 1 will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. 1 also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties-of perjury this day of 2009. Signature Phone Number Print Name V lCY Q/bId g/forms/famaffid Rev:12/08 Town of Barnstable Regulatory Services ;= P FTHE rOh/, Thomas F.Geiler,Director " a-yam Building Division ?99,Y. F �° sMttvSrna . " Tom Perry, Building Commissioner #�� ? 111 9�A 1639.. ��� 200 Main Street,Hyannis,MA 02601 as A l�O www.town.barnstable.ma.us "" . Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit. I, being on oath, depose and state as follows: My name is Ff'44/ I am the owner/resident of the property located at: /`6 vd The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship �dl/ e to owner. Name & relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, 1 will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 F am"ily Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Swor der the pains and pe lties of perjury this day of �2008.. i Signature Phone Number Print Name �v Q/bidg/forms/famaffid Rev:1/03 Town of Barnstable o /C Regulatory Services ;- 4 °FTHe Tod Thomas F.Geiler,Director C Building Division '0 H * snxNsrns�, * Tom Perry, Building Commissioner * 039. A�� 200 Main Street Hyannis,MA 02601 IWI AR ,' i www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable.Family Apartment Affidavit I, being on oath, depose and state as follows: My name is i��7 � � I am the owner/resident of the �y property located at: led Cho 7_el--r The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &.relationship to owner: C- Name & relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that 1 am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property.- If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this day of 2007. Signature Phone Number Print Name e1 4_ yz1 Q/bldg/forms/famaffid Rev:1/03 Town of Barnstable Regulatory Services °FINE l°� Thomas F.Geiler,Director Building Division� ` `j' 11i3.ti,t� i t L BARNSrnsi.E.g Tom Perry, Building Co� ids ' erZ i Mass. s639. 200 Main Street,Hyannis,MA AM 9: 59 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: My name is 12 51 19 K 14 1 I am the owner/resident of the property Ylocated at: � A- 1/1144"Map and Parcel Number 17// A6e The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: �� Ci/y� ,itf k A= Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this 2 a day of 2006. Signature Phone Number Print Name `-i�� Q/bldg/forms/famaffid Rev:1/03 Town of Barnstable Regulatory Services P�pFTNE tOk� Thomas F.Geiler,Director Building Division BAMSTAaLE, Tom Perry, Building Commissioner 9 MASS. 039• 200 Main Street,Hyannis,MA 02601 AIF� �A Www.town.barnstable.ma.uS F — A 8: 43 Office: 508-862-4038 F"Z1 5'68-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name isrl�� ' � I am the owner/resident of the property located at: I'd Map and Parcel Number 7 ��- The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: K4, 6 N. �i D ry' a1 Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. 1 understand that no subletting or subleasing of said Family Apartment is permitted. I understand that 1 am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. 1 also understand that I am required to comply with all conditions imposed by the ZBA in the Appeal No. identified above. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to nder the pains and penalties of perjury this 3 D day of J�A 2005. Signature / Phone Number Print Name �� Q/bldg/forms/famaffid Rev:1/03 a/c 'Town of Barnstable Regulatory Services °F�►+e tgk1, Thomas F.Geiler,Director,F r�,l 4v l S,LE Building Division [ * anxwsrnscE. * Tom Perry, Building Commissioner ' V MASS. 039. 200 Main Street,Hyannis,MA 02601 .. '` 011 ,t, a•r a Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I,being on oath, depose and �state �as follows: My name is �g''� C� �� °" I am the owner/resident of the 1017 -"-1 property located at: �" er- Map and Parcel Number / 7 / 55� The ZBA granted me a Special Permit/Variance on Z Z,Z Date Appeal No. The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: L Name &relationship to owner: Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA in the Appeal No. identified above. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this /(r` 4 day of /� / 2004. �0',161 -5 0,p- 5OC-1- e)35`j Signature /` Phone Number d' 771i Print Name Q/bldg/forms/famaffid Rev:l/03 6 �< Town of Barnstable / 1-1 Regulatory Services °trT IK*E Tops Thomas F.Geiler,Director a(�.�� �3 / RS TABLE Building Division snxxsTA Tom Perry, Building Commissioner 2003 JAPE 27 AM 8: 09 1639. .0 200 Main Street,Hyannis,MA 02601 �ArED MA't A Office: 508-862-4038J V' a° 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state gasp follows:. My name is AVILA I am the owner/resident of the property located at: Map and Parcel Number 17 © 19 The ZBA anted me a Special Permit/Variance on l �' p y Date Appeal No. The decision of the Zoning Board of Appeals has been recorded with the Registry of Deeds in Barnstable County: Book S/ Page O a_5- The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: / Name &relationship to owner: &1d el—74,0Gi Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA in the Appeal No. identified above. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other : nderworn to the pains and penalties of perjury this �ZG`� day of vl 2003. Signature _ G Phone Number Print Name Q/bldg/forms/famaffid Rev:1/03 Town of Barnstable 0 Regulatory-Services / Thomas F.Geiler,Director („ Building Division "TO W N Of BARNSTABLE BAMSTABM Peter F.DiMatteo, Building Commissioner MASS. 9�A 039. .•� 200 Main Street,Hyannis,MA 02601 2002 FEB I PM 2: 53 !EDP s Office: 508-862-4038 Fax: 508-790-6230 DIVISION Town of Barnstable Family Apartment Affidavit ` I, being on oath, depose and state as follows: r � � My name is �k 'ti �� I am the owner/resident of the property located at:: Map and Parcel Number � ©e The ZBA anted Special Permit/Variance on �' me a Date Appeal No. The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: C� � Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA in the Appeal No. identified above. I.agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other •T— Sworn to under the pains and penalties of perjury this ;j /_/day of `P� 2002. Signature Phone Number Print Name Q/bldg/forms/f amaffid Rev:010702 d. AMDAVIT BARNSTABLE g bein on oath, depose and state asafj3llows: 1.) I reside at L ��' /`�'� "` `r 2.) I am the o r of, property located at shown on Barnstable Assessors' maps as MAP 1 T I PARCEL IO 3.) I Do Do not have a Family Apartment at this location. 4.) On 199 . the Zoning Board of Appeals, on Appeal No. granted me a Special Permit/Variance to maintain a Family Apartment at the above address. 5.) I understand that the Family Apartment may only be occupied by members of Lay arnily i=-rho are persons related to me by blood or by marriage. 6.The following members of my family will be the sole occupants of the Family Apartment at the above address: /-4 a) NAME �v Relationship too r. t &L4 b) NAME Relationship to owner. 7.) The Family Apartment will be the primary year round reidence for the above-identified family members. 8.) In the event that the above-listed relative(s) vacate said apartment, I will immediately notify the Building Commissioner in writing. 9.) I understand that no subletting or subleasing of said Family Apartment is permitted. 10.) I understand that I am required to annually file an Affidavit with the Building Coarmiss'orer listing the names and relationship of my family members occupying said Family Apartment. 11.) I understand that I am required to comply with all conditions imposed by the Board of Appeals in Appeal No. 12. I ee to immediately notify the building Commissioner in the event of the sale of the a)ov�e•`�'""` ) ag listed property. Sworn to under the pains and penalties of perjury this /a ' day of "`I - — Signature Print Name COMMONWEALTH OF MASSACHUSETTS BARNSTABLE AFFIDAVIT f `_`"--- ------------------- being on oath, depose and state as follows: R 1.) I reside at �d---(JQ7` _ / 20t /Za -------- ----------------------- — ------------- 2.) I am the o er f�the pro erty located FEB 9. 3 1999 . _,� e-.;.� To at.--/ — Ca�_ ---_!r_--- ---------------------------- --wN o� shown on Barnstable Assessors' maps as MAP 7/ PARCEL _____ UtLDING Qom_ LE 3.) I Do—_—_K-------_---Do not.---------------have a Family Apartment at this location. 4.) On_ —g?!.1—_______- 199 �_, the Zoning Board of Appeals, on Appeal No. �07w�o granted me a Special Permit/Variance to maintain a Family Apartment at the above address. 5.) I understand that the Family Apartment may only be occupied by members of my family who are persons related to me by blood or by marriage. 6. The following members of my family will be the sole occupants of the Family Apartment at the above address: a) NAME _-- - --------------- ------- ------ - ----- Relationship too er:_ � b) NAME------'---------------------- ---------------------------------------- Relationship to owner:------------------------------------------------------ 7.) The Family Apartment will be the primary year round residence for the above-identified family members. 8.) In the event that the above-listed relative(s) vacate said apartment, I will immediately notify the Building Commissioner in writing. 9.) I understand that no subletting or subleasing of said Family Apartment is permitted. 10.) I understand that I ain required to annually file an Affidavit with the Building Commissioner listing the names and relationship of my family members occupying said Family Apartment. 11.) I understand that I am required to comply with all conditions imposed by the Board of Appeals in Appeal No. �1 =� —-------------------------------------------- 12.) I agree to immediately notify the Building'Commissioner in the event of the sale of the above- listed property. Sworn to under the pains Aiid penalties of perjury this. ___day of Signature -------------------- Print Name - --------------------------- �L COMMONWEALTH OF MASSACHUSETTS BARNSTABLE AFFIDAVIT ---------------------- * on oath, depose and state as follows: J p� sul eARJV4 /18 1.) I reside at_ZP_ & V 2 2.) I am the owner of the property located /p 6 199,18 at /a -�© -------------------------- - (5 C shown on Barnstable Assessors' maps as MAP_17; PARCEL_lv ;',, 3.) I Do___x______ ----Do not __have a Family Apartment at this location. 4.) On�b _ cam __________, 199 02 _, the Zoning Board of Appeals, on Appeal No.l``1_l`_ '49 granted me a Special Permit/Variance to maintain a Family Apartment at the above address. 5.) I understand that the Family Apartment may only be occupied by members of my family who are.persons related to me by blood or by marriage. 6.The following members of my family will be the sole occupants of the Family Apartment at the above address: a) NAME----G C ,4 --- �/` �-------- -- ----------------- ------------------- Relationship too er:_` b) NAME Relationship to owner: ------------------------------ 7.) The Family Apartment will be the primary year round residence for the above-identified family members. 8.) In the event that the above-listed relative(s) vacate said apartment, I will immediately notify the Building Commissioner in writing. 9.) I understand that no subletting or subleasing of said Family Apartment is permitted. 10.) I understand that I am required to annually file an Affidavit with the Building Commissioner listing the names and relationship of my family members occupying said Family Apartment. 11.) I understand that I am required to comply with all conditions imposed by the Board of Appeals in Appeal No. 1�� -J -------------- --------------------------------- 12.) I agree to immediately notify the building Commissioner in the event of the sale of the above- listed property. Sworn to under the pains and penalties of perjury this_o�G--day of Signature --- --------------- ------------------------------- ---------------- Print Name oFTME The Town of Barnstable Department of Health Safety and Environmental Services Building Division 16 Q. �� 367 Main Street, Hyannis MA 02601 ArED MA'S A , Office: 508-790-6227 Ralph M. Crossen Fax: 508-790-6230 Building Commissione January 5, 1998 The Clifford Residence 10 Goff Terrace Centerville, MA 02632 Re: Family Apartment located at the above address Dear Mr./Ms. Clifford, Our records indicate you have not filed an affidavit regarding the above referenced family apartment in quite some time. It is required under Section 3-1.1 (3) (D) (1) of the Town of Barnstable Zoning Ordinance that an affidavit be submitted annually for the duration of such occupancy. Please indicate the status of the family apartment on the enclosed affidavit return to this office by January 30, 1998. Enclosed is an affidavit for your convenience. Thank you in advance, Ralph Crossen Building Commissioner QUERY PROPERTY: QUERY END QUERY PROPERTY PENTAMATION----------------------------------------------------------- 12/19/97 PARCEL ID 171 108 GEO ID 9957 LOT/BLOCK 22 & 22 DBA PROPERTY ADDRESS OWNER CLIFFORD 10 GOFF TERRACE KYM L & BRIAN D CENTERVILLE 10 GOFF TERRACE CENTERVILLE MA 02632 PHONE DISTRICT CO DEVELOPMENT STATUS C ASSESSOR' S CODE CAPACITY (NOTES) ZONING DIST/ZOC RC SEWER SYSTEM FLOOD PLN/ELEV. WATER SYSTEM OKH? ## BEDROOMS , ZBA DECISION 92-09 FAMILY APT LOT SIZE 21780 OPER/MGR NAME WET LANDS MULT ADDRESS USE 101 PROTECT DIST GP (N) EXT / (P) REVIOUS / NO (T) ES / PER (M) ITS / (V) IOLATIONS / (G) EOBASE / (E) XIT QUERY PERMITS : QUERY END QUERY PERMITS PENTAMATION----------------------------------------------------------- 12/19/97 PERMIT NUMBER 5792 PARCEL ID 171 108 10 GOFF TERRACE PERMIT TYPE BADDI BUILDING PERMIT ADDITION DESCRIPTION 34909 GARAGE WITH APT. ABOVE CONTRACTOR PERMIT FEE 0 . 00 VARIANCE STATUS C COMPLETED CONSTRUCTION TYPE 438 GROUP TYPE 1 APPLICATION 03/13/1992 EXPIRATION VALUATION 30000 . 00 DATE ISSUED 03/26/1992 COMPLETED 12/30/1994 DEPARTMENT-----STATUS---DATE-----DEPARTMENT-----STATUS---DATE---- (N) EXT/ (P) REVIOUS/ (C) ONTRACTORS/ PR(0) PERTY/ (I)NSPECTIONS/ (H) ISTORY/ (F) EES/ (A) RCHITECTS/ (V) IOLATION/ (E) XIT I � �.IIAMSTABIXThe Town 'of Barnstable t; p z639. `0 , Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601. Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner December 8, 1997 - F Carvalho d' S 217 Buckskin Path Centerville, MA 02632 Re: Family Apartment located at above address ` Dear Mr./Ms. Carvalho, Our records indicate that there has been a change of property ownership since the family apartment had been approved by the Zoning board of Appeals. Therefore you must = contact this office as soon as possible to discuss the necessary steps towards compliance Y: 7 with the Town of Barnstable Zoning Ordinance. : Thank you in advance, Ralph Crossen - Building Commissioner x . QUERY PROPERTY: QUERY END QUERY PROPERTY PENTAMATION----------------------------------------------------------- 12/08/97 PARCEL ID 171 018 GEO ID 9868 LOT/BLOCK 21 DBA PROPERTY ADDRESS OWNER CARVALHO 217 BUCKSKIN PATH ROY MURIEL CARVALHO CENTERVILLE 217 BUCKSKIN PATH CENTERVILLE MA 02632 PHONE DISTRICT CO DEVELOPMENT STATUS C ASSESSOR' S CODE CAPACITY(NOTES) ZONING DIST/ZOC RC SEWER SYSTEM FLOOD PLN/ELEV. WATER SYSTEM OKH? ## BEDROOMS ZBA DECISION FAMILY APT LOT SIZE 14810 .4 OPER/MGR NAME WET LANDS MULT ADDRESS USE 101 PROTECT DIST GP (N) EXT / (P) REVIOUS / NO (T) ES / PER (M) ITS / (V) IOLATIONS / (G) EOBASE / (E) XIT 1J +7..- 81•C 145651 P9 105 a3861 S Town of Barnstable Zoning Board of Appea-t_s - Special Permit - - Decision and Notice Application: #1992 -09 Applicant : Brian and Kim Clifford Summary of Relief Sought: NY At a regularly scheduled hearing of the Zoning Board of PAppeals, held on February 20, 1992 , notice of which was duly published in the Barnstable Patriot, and notice of which was forwarded to all interested parties pursuant to Massachusetts General Laws Chapter 40A , the applicants , Brian and Kim Clifford, appealed to the Zoning Board of ' Appeals for a Special Permit to allow a family apartment above the proposed two-car garage pursuant to Section 3- 1 . 1 (3) (D) of the Zoning Ordinance. The applicant's site is shown on Assessor's Map/Parcel Number 171 / 108 and more commonly addressed as Goff Terrace, Centerville, MA, and is zoned .RC Residential District. The following Board members heard. this petition : Chairman Bliss , Gail Nightingale, Luke P. Lally, Elizabeth Nilsson and Gene Burman. Summary of Evidence : The applicant , Mrs . Clifford, presented her request to the Board for a Special Permit . She presented a plan to the Board and stated that the family apartment .will be located above a proposed two-car garage. The family apartment will contain approximately 672 square feet. Mrs. Clifford explained that the apartment will be occupied by her 'mother , who is in poor health, and has recently been divorced which necessitated the sale of her home. She also stated that she would like to have her mother nearby because of her mother's health problems . The Board questioned whether Mrs . Clifford had read and is aware of Section 3- 1 .. 1 (3)D of the Zoning Ordinance and its requirements dealing with family apartment. The Board also questioned whether the residence is the petitioner ' s legal residence. It has been established that the petitioners are aware of the requirements of the Zoning Ordinance and it .is their legal year-round residence. re Town of Barnstable ' Zoning Board of Appeals Special Permit M&Q ^ P7 Decision and Notice Applicant: Brian and Kim Clifford � Summary of Relief Sought: ^ At a regularly scheduled hearing of the Zoning Board of . Appeals, held on February 20, 1992, notice of which was duly published in the Barnstable Patriot, and notice of which was forwarded to all interested parties pursuant to Massachusetts General Laws Chapter 40A , the applicants, Brian and Kim Clifford, appealed to the Zoning Board of Appeals for a Special Permit to sallow ss family apartment above the proposed two-car garage pursuant to Section 3- 1 . l (3) (D) of the Zoning Ordinance. The applicant's site is shown on Assessor's nd more oommonl y �ddressed �as T��r-ac5e-, Centei"V' illEP, MA, and is zoned RC Residential Dist��ot� --- -� The following Board members heard this petition: Chairmen Bliss, Gail Nightingale, Luke P. Lally, Elizabeth Nilsson and Gene Burman. � Summary of Evidence: � The applicant, Mrs . Clifford, presented her request to the Board for e Special Permit. She presented so plan to the Board and stated that the family apartment will be located above a proposed two-car garage. The family apartment will contain approximately 672 square feet. Mrs. Clifford explained that the apartment will be occupied by her 'mother, who is in poor health, and has recently been � divorced which necessitated the sale of her home. She also � stated that she would like to have her mother nearby because of her mother's health problems. The Board questioned whether Mrs. Clifford had reed and is aware of Section 3-1 . 1 (3)D of the Zoning Ordinance and its requirements dealing with family apartment. The Board also questioned whether the residence is the petitioner's legal residence, It has been established that the petitioners are aware of the requirements of the Zoning Ordinance and it is their legal year-round residence. The Board also determined that the size of the proposed apartment, as it relates to total square- footage of the residential structure, is in compliance with the Zoning Ordinance. The Board discussed- the septic system on this site. It has been established by the petitioners that they will prefer to install a separate system, if necessary, for the family apartment. The petitioners also stated that the existing septic system complies with State Title V regulations and the family apartment can be tied into the existing system. The Board questioned, and it has been establi.shed .by the petitioner, that the proposed construction will comply with all setback requirements. No one spoke in support of the petition. The following public comments were made for the petition: Chairman Bliss mentioned that a letter dated February 20th was submitted by Eleanor Easton, closest abutter to the site, and was read into the record by Chairman Bliss . The letter addressed concerns of Mrs Easton regarding the family apartment. Eleanor Easton reiterated her concerns, one of which is the height of the proposed structure. Mrs. Powers questioned whether this would change the zoning in the neighborhood. Chairman Bliss explained that the neighborhood is still single family residential with an allowed family apartment. Mrs . Finan stated that the petitioners's should . maintain their property so that it is aesthetically pleasing. Finding of Facts: At the meeting of February 20, 1992, the Zoning Board of Appeals made the following finding of facts as related to Appeal # 1992-09:- 1 . That the petitioner meets the criteria of section 3- 1 . 1 (3) (D) of the zoning ordinance and any discontinuance of the premises as a family apartment, the premises shall be restored as nearly as possible to the state prior to the creation of such apartment. 2. Granting of relief sought by the petitioner is not detrimental to the neighborhood effected, or derogation of spirit and intent of the Zoning Ordinance. The vote was as follows : AYES: NILSSON, LALLY, NIGHTINGALE, BURMAN, CHAIRMAN BLISS Decision: Based on the finding of facts, at a meeting held on February 20, 1992, by a motion duly made and seconded, the Board voted to grant the Special Permit with the following restrictions: 1 . The applicants will comply with all provisions of Zoning Ordinance Section 3- 1 . 1 (3) (D) . 2. Family apartment will be built as per plan, submitted by the applicants, and contain approximately 672 square feet of floor area. AYES: NIGHTINGALE, NILSSON, LALLY, BURMAN AND CHAIRMAN BLISS. THE PETITION IS GRANTED. 4 f I Any per.-on agg_'_eved by t`_-:'_s decis;o= may appeal to t-e Eaz stable Suoe__.,_ Cour-, as desc__bec in Sector, 17 of C:.a=ce_ 40A o; e:`.e Gz_e__l Lames of t_`eBalch of I�=SsGC=LSeC_5 by br' ac__o, c._ch in t.:e-^_ty days after tHe decision has bee: f=1 e_ is t`-e off ce of the Tot.;--- Clerk. I, Clark of the Town of Barmascabie, Bartscable Councy, M—=ssachusects, hereby cardfy .that t-.;er_c-y (20) days have elapsed. si ce the Board of Appeals rendered its decision in the above entitled petit on and that no appeal of said decision has bee^_ filed in the office of the Tou-a Clerk. Signed and Sealed this day of 19 undo_ t`e pairs and.peaalt'_es of per uri. Dist__buc_on: - P=cpe==y 0;m"e: To ;. To Cle_`c u^.. Cle__c Anal'c nt Perso.s Inte_estad Bu-lding Inspect.._ Public I: or=t_or. Boa_- of Appeals 4 SSU M N Qv ,� � ,L= G2•o/ N 3GI• IA 2.v . �0 N ZONE' .C�'C 'I= 2oN 7- '20, VA o � o oh 0 0 1H OF I�qs�c r PAPUL RYLL N0.32448 0� ti / E LA Al N�O�Qa�� ig.r r S � 7�h�E -STeucT�.e'E �E,aiCT�a�j ,, . o iv T.�/� C-�..G ou.vo .c3� .�.✓ _�lJ�iVS TJI��'> `�,e�.�,$ ,gcc�.�.,>r�s S�-,c��Y o.✓ �.� .¢moo �xisT,S .•4� CAPE COD SURVEY CONSULTANTS 3261 MAIN ST./ROUTE 6A BARNSTABLE VILLAGE, MA 02630 -ep�'� /�-4< (617) 362-8133 -7- (e,7A-UD