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S !. r t 9r %� 1 rt ii r t ! .,t t •'� r , i g fi ar p ! 11 t (�r-- f e t $ t 'R F �f } � {ry1y}j � e t?` I V 1 f 1 � t t 'ryx} � •:� QQ 'f 4 r' r �� t L r' s. t� 4 A a ,tE `oy �,r t r x i' r' €� ! 4, at ra + 4 ,r t J T 4 'ti.{ r � i !, z• , � t M< '�r3 t `I rr ,! .� ,3 � ! i .! 3{" -J�+ , j � S' r r•' t D. a7 ,}yrrj a Y. An({p { 1, f�' •k 4r � h . '.t .' •.r f ' ..i.. ;T.. .' a e ,. il ff •i /,, >E,. ,�" l�. '1:: ,±i i � . .,..,. .. fit, rr. �.. .r. t 11 ., *,r, ,. ,�, .� d .'�• $31 9 q �.''�r � 1 R :A'� A.� :1, ] 1 �} a f , T i '� �` ! r 3t ! } � '��� p� � P: � ..�'n' ( •�i i"`r y,. . /$t�,' �, rt r',h f. , n,�� Q ,1� ..t.,h.,f �iA ,�.S I iflpt tt i .T ,{ �: e (,�• fr :Cx y d r:,J��,7i i?: i, d t „r,, t � .F •�. r' e r + • • `f J+F :r.,_ T'., '!' r ,j'�S.(a a. :r•' p PGa. ` ,T'" 4qa. {' fif ..I .r � �, rt,- L .1 ,.�. "ti '9�r .� �'� ''�:• i '� � r 1 �•, 'a �, }r t "t+. ,r{ r, i y ¢A,,: �.., , i .�$, �t�. �k ,+, .. t � y.:. ., <. a ,, .��. �i h ,�' �i�+jr'k ry `u��,:. r� u , , r •• '�. t n/LL w BkI 120 BARNSFABLE, MAss: � s63S1. ArFb{VIR'�A TOwn of Barnstable Zoning Board of Appeals Decision and Notice Comprehensive Permit No.2007-051 -Pike Chapter 40B Comprehensive.Permit Summary: Comprehensive.Permit No. 2007-051 is rescinded Applicant:: Dorothy M. Pike Property Address: 404 Great Marsh Road, Centerville, MA Assessor's Map/Parcel;: Map 19.0, Parcel 080 Zonings Residential D-1 Zoning District Deed Reference: Book 1322'Page 006 Permit Reference:` Book.22,210 Page 160 Locus and Background: The applicant applied fora Comprehensive Permit under Chapter 40B of the General Laws of the Commonwealth of Massachusetts, and in accordance, with Article 11 of,Chapter Nine of the Code of. the town of Barnstable, more commonly termed the "Accessory Affordable Housing; Program Comprehensive Permit, No, 2007-051 was issued' to the applicants on May, 23 2007 -and. ;a Regulatory Agreement and.Declaration of Restricted Covenants were recorded at the Barnstable Registry of Deeds on July.24,2007 as Book 2221;0 Page 165. The Applicant; Dorothy K Pike no longer owns the property and therefore Comprehensive "Permit No. 2007-051 must be rescinded: Procedural &Hearing Summary: A public hearing to rescind Comprehensive Termit No..:2007-051 was duly advertised and notice sent to abutters and the property owner ail in_accordance with:MGL Chapter 40A. The hearing was opened on October 28 2020 at which time the Hearing Officer, Alex Rodolakis,.made the foltoM4findings and decision: Findings of fact: L, The applicant,' Doro;th M. Pike -was ranted:�Com rehensi e�Pe it - Y g p v rm No. 2007 05.1 for an Accessory Affordable Apartment at404 Great Marsh.Road,.Centervi le, MA:. 2: 'The applicant; Dorothy M. Pike,no longer owns the property:: Town of Barnstable,Zoning, Board of Appeals Comprehensive Permit No.2007-051—Pike is rescinded 3. On September 17,2020, the Accessory ApartmeniPrograrn Coordinator took action to rescind Comprehensive Permit No. 2007-051 Ordered; Comprehensive Permit No. 2007.051 is rescinded: A written copy of this decision shall be forwarded to the Zoning,Board of Appeal as required by the Town of Barnstable Administrative Code Chapter 241, section 11. If after fourteen (1.4)days from that transmittal the Members of the Zoning Board.of Appeals?takes no,action to reverse the: decision, this:decision shall.becorrie.final and a copy shall be the fined in'the office of'the Town: Clerk. Appeals of the final decision,,if'any, shall,be made to the.Barnstable Superior Court pursuant to. MGL Chapter 40A, Section 17, within. twenty (20) days after the date of the filing of this decision in the office of the Town.Clerk. The applicant has'the right to appeal this decision as outlined in MGL Chapter 40R Section 22. r0 Alex Rodo PSI.Hearing Off cer Date Signed I, Ann Quirk, Clerk of the Town of B`arnstable,'Barnstable County,Massachusetts, hereby certify thattwenty (20) days.have elapsed since the,Zoning Board of Appeals filed.this decision and that no appeal of the decision.has:been'fled it 'the office of'the.Town Clerk. Signed and sealed this day ofnder the`pairis and penalties,of perjury, Ann Quirk,,Town Clerk BARNSTA E REGISTRY of DEEDS John F. Meade, Register r (� �IME Town of Barnstable *Permit# Expi months from issue date *3 Regulatory Services Fee BARN LK i639 a ESS PERM hard V.Scali,Director �D Mid Il AUG .2 5 2015 Building Division Tom Perry,CBO,Building Commissioner TOWN OF gA R N S TA Bre Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-403'8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL. ONLY r` 1 Not Valid without Red X-Press Imprint Map/parcel Number � U V� Property Address f�f "4 T4 1'd K�A Pry /f' Iqn/w Gd [Residential Value of Work$ 1-gao Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address _ _00 j b j P p Contractor's Name /� oti �1°i �"#J Telephone Number Tat ��j0 Z9� Home Improvement Contractor License#(if applicable) AIJOJ 7 Email: l—, L+ Y,—,4 ,��•- Construction Supervisor's License#(if applicable) aworkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# ©2 2 Copy of Insurance Compliance Certificate must accompany each permit. Permit Req st(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Y4/,,j6t4 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of t e Home Improvement Contractors License&Construction Supervisors Licensees require SIGNATURE: C:\Users\Decollik\AppData\i.ocallMicrosoft\Windows\Temporary Internet Files\Content.Outlook\2PiO1DHR\EXPRESS.doc Revised 040215 r t, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYYII THIS CERTIFICATF IS 14CIIFn e¢ a lunrrco _nc wcn 03/ 2015 ..r=v ONLY AND CC)NFEHS NO kiGHI(S UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE I COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pOlicy(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on I thia �o.tlr;— goys certificate holder in lieu of such endorsement(s). - "�• c n„cr Riga's to ilie PRODUCER. SCHLEGEL INSURANCE BROKERS INC NAME. PAUL SCHLEGa PHONE 508-771-8 34 MAIN STREET CAWA o,Ext): (uc._No508-771-0663 E-MAIL —.._ -._�- �..-_ ). AooREss: SCHLEGELINSU�2ANCE@GMAIL.COM WEST YARMOUTH MA 02673 — ------- ---- INSURE�R�(5)�AF�FO—R-DIN—G COVERAGE NAIC d INSURER A:COLONY INSURANCE wsuae0 INSURER B:CNA. Timothy Keating Dba Keating Construction --- INSURER C 54 Lower Brook Road ----- --___ T- _—_ INSURER D: I�- INSURER E: I South Yarmouth, MA 02664 NsuRERF: — -- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 'HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE FOUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIC 7 rr_"I"ICATr_ "4,Ay DE ;3GUED OR WAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES, DESCRIBED HEREIN IS SUBJECT TO ALL THE- TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY EFF POLICY EXP `-- --- _ INSR WVD POLICY NUMBER (MM/DDIYYYYJ (MMIDD!YYYV) LIMITS p j GENERAL LIABILITY GL3594908 03/20/201403/20/20151 EACH OCCU RR — 00 ( COMMERCIAL GENERAL LIABILITY I03/20 1 PREMISES/Eaocc, c i 5QQ.000Q � CLAIMS MADE X OCCUR—I--' I MED EXP(Any one Pers 'T` on) j 5 5,000 PERSONAL.&ADV INJURY r$ 1,000,000 . GENERAL AGGREGATE S 21000,000 i GGN'(-AGGREGATE LIMIT APPIJES PER: I PRODUCTS-COMP/OP AG. 2,000,000 r- ���j POLICY I I.F�O I^i LOC I I ------- AUTOMOBILE LIABILITY i (Ea accident) I S I I ANY AUTr) I I BODILY INJURY(Per Person) S !� ALL OVdNF_D 1 SCHEDULED I yAUTOS _I AUTOS I BODILY INJURY(Per a cc,denq S -— I HIRED AUTOS NON-OWNED I I t_ AUTOS I I ROP- 7Y DAMAFIr---I i _ i I I I ' ) (Per accident) ! ! I UMBRELLA LIAB I j OCCUR EACH EXCESS L OCCURRENCE 5 IAR CLAIMS-MADE j I AGGREGATE DED I RETENTION $ ' —..._ �.-.—.-----__- B i WORKERS COMPENSATION S ANrt F MPI_nVFCS'!LL__111- 0224N37-2-10 103/09/201403/09/20].5, WC S7n U- OTH.I Y!N I l- ! ivRi iiiuiiTS pK ANY PROPRIETOR!PARTNER/FXECUTIVE I03/09/2015 03/09/2016 E.L.E4CH ACCIDENT �_ i CFF!CER!MEMBER EXCLUDED? N I A 15 100,000 (Mandatory in NH) II yes.descnbe under ,« I E.L.DISEASE-EA EMPLOYEE 5 100,000 DESCRIPTION OF OPERA NONS below I I LDISEASE-POLICY LIMIT S 500,000 I DESCRIPTION OF OPERATIONS i LOCATIONS/VEHICLES(Attach ACORD 101.Additional Remarks Schedule,if more i 1 ' space is required) TIMOTHY KEATING HAS ELECTED TO BE COVERED UNDER HIS CURRENT WORKERS COMPESNATION POLICY CERTIFICATF HQI pFR CANCELLA I iON •nr SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIV 198E-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name anti Inns aro rPnicloroA m�r4c r e�n_oT r The COMMOR",ealth of Irrssa useft Dep »rent of lnd�sb�al Accld'e�s lJ�rce of Irivesti�atio�s 600 Wasi°riirgtlon Street �osdon,` f 0211 tt»tvrr:massgovldia Workers' Compensaiion Iniurance cians/Plumbers Autfic-mt Information Please Print L.eea`b Name A&S1: city/state/Zip: /I U kLA Are you an emp r?Check the appropriate boa: I'll Type of project(require 1. a employer with _ 4. ❑:I am a general ccait<sc�r and I employees full an&or -ume b: New construction ( )s have hired the sub-cofltisctats 2.❑ I am a sole�gsiet&or par(= listed oil the attacked sheet. ? �J Remodeiiag ship and have no i s �-contactors lt>3 ve P 8: ElDewhtion wott� forme is any capacriY employees and luny workers' COW. in .l 9 ❑Builttrng addition �To wor�ets'camp-ittstttance , veq .] 5 ❑ e are a co:poratitm and a lU.❑Electrical repairs or additions. 3.❑ I am a kamtr doing all yvoric.. .: offioers'have exercised their 1�_0 ply reps or additions £ o vvorlaets of exemption per A�IGL 12.❑Roof t epaics mY � right ins a nce required.] c 152,`§1(4X tad we have no employees:[No wodms' 13.❑�Zher comp.insurancere5l ] *IPAW R plfcant:dnt checks boat#1'.mmst also Mi ant the section below showing th&a wu&eW cony ensad-PQNC9 who submit this affidavit indisstigg t6 jr ace doing an vmi.a then bite once ca=20 uts umst submit a new afftdsvit Ind dniug such. tCeatrecdor elm a beds this box�t anached an additiand sbw showing the mode of ft end stae wheel=of Mort tTmse have envoyaes. If the s¢b c4atiacttns base Mplayws they must Fold&their workers'comp:poh"cg anmber. I am an employer that isprtrviaiit�waurlrexs'conrpettsatiori Instatrttrce for�tutgnto,}rees.. Bdowis die polic y a#W job site.` itrforwttrlton. - Insurance Company: me:_ C Policy i!or Self ins_Lic #. ©2 2 /v 2 /U Expirgtian Date: Jib Site Ades: Ll0 Y ��e�e f'�''� �ti � cityestate�zp: pn ��� P ! 9 Attach a copy of the workers'compensation policy declaration page(showing ther,policy number and expiration date). Failure to secure coverage as menu d undu Siechon 25A of MGL c 152 can lead to#lie imposition of criminal penaWeS of Sue up to S 1,500.OQ andlor one-year tnnpzrso as well as civil p nalfi in the'foiai of a STOP WORK ORDER and a fsne } .. of up to$250.00 a day against the violator. :Be advised t11at a a opy of this statenrneat may be frnvaarded to&e Office:of InvesngadM of the DIA far insurance coverage vacation. I do Iterc�by c f'under a pains aged perta es of pedurt'that tits inforiami tote awe is tnae d come Da _ Oicial only.`Do nirt tFrtta in this area,ttr be completed i3y city or town cta1 City or?own: PermitlLiceuse# Inning Authority{circle one): IS of Her th Z.Building pepartcnent 3:Cityffown Clerk 4.Electrical Inswaor S.Plumbing Inspector 6Other Contact Person: Phone#: 6 I URNMEIM 9. 039. Town of Barnstable 1� Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 9, f the subject property hereby authorize t G d� to act on my behalf, in all matters relative to work authorized by this building permit application for: G>r4 A!ftfiSh V N'�- , (Address of Job) Signature of Owner Date ezk-�c� Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Tntemet Files\Content.Outlook\2PTOI DT-TR\EXPRESS.doe Revised 040215 fJ Massachusetts -Department of Public Safety Board of Building Regulations and Standards 'Construction Supern'isorSpecialh License: CSSL-099351 u Tim B Keating = 54 Lower Brook RoadI r South Yarmouth SIA 02 6 9 J'�"" Expiration Commissioner 05/11/2016 ommissioner--- — v�rrrrcv�r �. ✓fie�arrvrisa�zcueczlC/t o�.�aaaac�uaetla= - Office of Consumer Affairs&B siness Regulation HOME IMPROVEMENT CONTRACTOR . Registration: -M43053 Ty e P • Expiratio.r--_'VA.4/2016 •.DBA -TIMOTHY KEATIN�Gk-}a-i 54 LOWER BROOK, SO.YARMOUTH, Undersecretary .5 e. LicensearYegistration valid for individul use-only before the expiration date. If found return to: ` Office of Consumer Affairs and Business Regulation Boston,�MA U2IIF. ;s_-. • r i Not valid without signature j. CAPECOD INSULATION El®® 'r' pawl rRlR OE453 :tnm., tPRAi LOAM 9Y31Ery OE0 � jj) e RgTTt 4ullln> iN3lIEAiIOry Cllllrv05 (f{ 1-80G-696-6611 'Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: Y $ —% Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the sptc1fications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village bof-b P.fi �-�. e �o� Care -t ►v"�.,s����_ C e� `,1 Insulation Installed: Fiberglass Cellulo�5 R-Value Restricted Unrestricted Ceilings Slopes ( ) ( ( ) ( ) ( ) Floors/Si�`� t�5 ( ( ) (l°( ) ( ) 0140 Walls ( } ( ( } } ( } Sincerely (7) He y E Ca sidy r, President Ca e Cod sulation, Inc. Fro ' TOWN OF BARNSTABLE BUILDING PERMIT O Map �90 Parcel 080 Application # Z Health:Division ' Date Issued 3h0 11 y _Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address I � Village. v �� Owner. U® e/ Address Telephone U"' Permit Request vt/ �W�� ✓� y •r Square feet: 1 st floor: listing proposed 2nd floor: existing proposed Total new a Zoning District Flood Plain Groundwater Overlay :Project Valuation Construction Type LI a Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: Yes No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other C-3 Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals othorization ❑ Appeal # Recorded ❑ ❑Yes No Commercial If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) ' I Name `�' �W tJ Telephone Number Too Address � License# d Q �/ _VV 0/ Home Improvement Contractor# 1"✓� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WIL�TAKEN TO SIGNATURE DATE i FOR OFFICIAL USE ONLY .y APPLICATION# DATE ISSUED MAP/PARCEL NO. - r _ ADDRESS _ VILLAGE OWNER E DATE OF INSPECTION: ;•FOUNDATION FRAME 'F INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL- PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Musing Assistance Corporation Cape Cad HOMEOWNER I RESIDENT WEATHERIZATION WORK PERMIT&FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM 1F YOU ARE THE APPLICANT HOME OWNER. hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation (herein after referred as "Agency") on the property located at: The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping &caulking of windows and doors, insulation of attics, sidewalls & basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be done at my home I agree to the following: i. I give permission to the"Agency"its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement as listed and freely give my consent: " Home Owner: (Signature} Date:=f--I-- �: ` f ` St - Agent: (signature) Date: - HAC approved Weatherization Company :CMQ Adam T Incorporated All,Cape Energy Alternative Weatherization Building Performance Contracting T..LC (:Cape Cod.Insulation Cape Save Frontier Energy Solutions Lohr Home Improvement . Resolution Energy Conservision Massachusetts -Department of Public Safety \ , Board of Building Regulations and Standards. Construction.Supers isor License: CS-100988 HENRY E CASS11 ; r, 8 SHED ROW WEST YARMOIPTH 2 Expiration Commissioner 11/11/2015 r JR1J/01�r< c;ft l l� c C�' l l cr,J.:1E C 1•lf�J�' J COrl I S1.11-1jer Aff llt'5 and Business Ri: �gLllallC)[] 10 Park Pan - SUite 5170 - I3c �tc�Jl M�lssa�llu��tts 02 l6 `I I-Io111e Ir11provemem C 01 tractor Registration ReWstf'E10011: 15J5(37 . 1'Yhe: 101ivate Coroi)ra(ioII Expiration: 12l-1 5/2t)14. 'I't ?J.loJ l C;0D 1N3UI..:AI IO(v INC 1IIA10" C;ASSIDI, . It:i f�1:Al=�i:)ON CIRCLE t) YAh NIOU-1_H, MA 02664 UpdtttcAtldress anti rufurIl clu d. 11'lurl. JT.,I. n l'ur"illangt• 1...� A(MIcss L I ltcnolvnl ! l!:ntltlu}ntcnt ( I I:•u3tC;n'd i t „n,uuiri' \lluirs nusu;css Rquiotinu 1 iccnsc of tegutrauun t tlttl for in-divitlul Ilse unl), �,t 4'iilt1lV1r IIVIN*C.iVEME.N I CON I RAC I'OR hclwc the csltualtutl tlatc: 1f fuuud rcluru tu; �bI'�`l' 4'`.I:'IlQlilnl If) !)d7 ]ype: Oflieeof Consumer Affairs mal Busincss Regtrlttl.iuu Yf;f•v,u,uu ii. Il1'i/ 0141. F'nv:ale l:orporaticii lU -k Plaza, Suitc 5170 liusmi,61A,02116 Ilutivisit;rctur)' otvill 1liltio t n;tl tt. t. ` The Coma:onwealth of Massachusetts I i :,�.. Departaiertt of Industrial Accidents t Qjftce of Investigations 600 Washington Street Boston, l'l'lA 02111 l www.rrrass.govIdia I Workers' Cori penis;atiOu Ytxsurance Affidavit: Builders/Cobtrac�tors/Electricians/Pluinbers � , g9ze.uttt it�torx�yaty�n V,i.11ic (liusuiess/Qrgani2a6ott/lndividu4l): J ' z tatty/StaC/z G ,fir.- �/» �TGG. ,j Phone #: ;/, s J % :err you as et luployer? Check the appropriate box: 1.IS..1 ,un a 4trtployer with: j ❑ i am a general conaactor and i type of project (required): _ Ctnployecs (ftill ancVot part-time).* have hired the suh contractors 6. [] New construction atrt a sole proprietor or partner- listed on the attached sheet: .7. [] Remodeling snip and have no employees These sub-contractors bave $, (� Demolitzoa tivorkwg for Inc in airy capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9. ❑ Building addition rtiquirtd:] 5. We are a corporation and its' '.10.[] Electrical repairs oraddicions 3.0 1 am a horneowner doixag all work officers have exercised their J.El Plumbing repairs or additions myself. [No worker' comp. right of exemption per MOL .r c. 152, §1(4), and we have no iuxurance required.] 12,F Roof repairs l atn a homeowner actin as a 13. Otber B employees. [No workers � general contractor(refer to #4) comp.insurance required.] ry pplic tut that chccJcs box#-1 mast also fill out the section below showing their worker'cumpcnsatiodpolicy infanudtiou. k loutcowuca who submit thin affidavit indicating they arc doing ill work and then hire uutsidc contactors must submit a new affidavit indicating such. : oauuctur-s that chcck this box raust attached an v4dirionul sheet showing the nano of the sub-coumtctorx and state whether or not those cntitica have cuq,luyccv. if tttc sub-4ontractors have cmploycas,they must provide their worker'comp:policy number. /um ern employer That is providing workers'compensation insurance foamy employees. :13'elow is the policy and jab site rrfo�rncrpurt , / ltt,urautcc C:otupany Name Policy r<or Self-ins. Lie. #: 5 Expiration Date: f ' //�z Job Sire.addr'ess:,Av I City/Srtte/Zip:(^. N" VWt•�/ ""7" artaett A cupy of the workers' compensation policy declaration Me(showing the policy ►itimber and expiration date). Failure to set:urc.covcrage as required under Section 25A of Iv1GL c. 152 can lead to the imposition of criminal penalties of a ri.nc up to b 1,500.00 and/or one-year imprisoninent, as well as civil penalties iu the form of a STOP WORK ORDER and a fine of up to 1;2J0.00 a clay against the violator. Bc advised that a copy of this statement may forwarded to the Office of lnvcsiig,aoax of the DIA for iw3ufaucc coverage verification. 1 do hereby I3 certri � nder the i bnd penalties:of perjury that the information provided above is t rand correct ( , Date C ` qj, U,q u.Tc only. Do not write in this area, to be completed by city or tower official i Citw ur'l'uwta: -� PermitlLIceasc# I934ing.Authority (circle oue): 1..lio;trtt Of Health 2, Buiydiug Depuriment 3. City)Towu Clerk 4.Eiectricai inspector 5. Plui abIlig Inspector ' 6.Other l,V ttr$Lt r er3ou. Phone#; — CAPECOD-27 MYOUNG DATE(MMIODIYYYY) �.._ CERTIFICATE OF LIABILITY INSURANCE �-- _71D12D'13' I HIS CEF41=1CATE. IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE;CERTIFICATE HOLDER,THIS CERTWICATIE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ULLOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TKE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ---.------..___—.--------_.---_._.__.._.._.__ _--�—_ _ ___—.. �— T____. _ �.----..._.__ ..:_..__._..___..--........_._: -----. u41POI1TAN"r: ----If the COrtifiC.vtu holder is an ADDITIONAL INSURED,the policylles)must be endorsed. if SUi3ROG:ATION IS WAIVI-D,SUbjactio i Lllu turnts and conditions of the policy,certain policies may require an ondorsoment. A Statement on this certificate does not confer rights to 111u Ca16hCdLe"Miler in lieu of such undl�rsurnent s . uccr+ Licontie IF PC 614062 CONTAC� .. NAME_ Margaret Young IhuE)urs 6Glay IIISU tl raC�i Agenl:y, InC. 14,N Rtu 134 UAIc o Ext jSuUHI Deuniti,IVIA U�G6U EMAIL ADDREss:myoung r rogurSHra .corn - INSURERS AFFORDING OOV Gf2AGL tlA1Cp INSURERA;PEERLESS INSURANCE COMPANY INSURER 6;COMMERCE INSURANCE COMPANY L,<tpU Cud IrlSulaLlOn, lnC. INSURERC:E_vanston Insurance Corr►�an ILI Reardon Circlo INSURER o:ATLANTIC CHARTER INSURANCE GROUP :iuuth Yarrrtouth, IVIA 0_1664 INSURERE: INSURER CUVERAGES CIERTIFICATEE NUMBER: _ REVISION NUMBER: _ ......_._-_-..—----- -.__ -.-_.__ —_._ _----_-- -�____ _ __._.._ u5 IU GEE l It Y THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE-'FOR THE 1 01.1 Y PERIOD Iwuu:.AlL.0 NOrV'JI rHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RL-aPECl 10 WHICH THIS cHI11`ICAIL MAY 6E ISSUED OIS MAY PERTAIN, THE INSURANCE AFFORDED,BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 1-0 ALL.IHETERMS, I nCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. A-DDC SU[3R IC7 EF POLIC`.Y EkP I,(µ IYNk OF-INSUKANC M;--_ .POLICY NUMBER MMIDO/Y M/n01Y Y `LIMIIS I ULNOkALLIAUILI" 1'ACH 0 CCURRLNCE y 1,000,U00 nAMXGE-TO'RCNTED_,_...- i A X L:uhllvltt.L:wL GtNERAL LIAUIu rY CBP8263063 411/2013 41112 14 PREMISES IEa o4�urancgL_ _ 100,000 Ci.AIMS MADE X OCCUR ME0 EXF(A+1Y unu I fa9R) _. —� 5,000 ' I - _ -----------L-- ---- - ____ PER50NAL,"A0V INJURY D DD,000 j 'ODO DDO GENERAL AG(iRCGA'I'E PRODUCTS-6OMPlOP AGG S 2,000,000 ut I•+t A I t-L IMI'I-AI'PL I_ES PER:. - cl I. l_.. _l ,000,000 AU IOtdUUILic 1-IAMILI IY 1 Ea�La ------------ U AN AUIU 13MMBCKVMK 41112013 4A12014 BODILY INJURY(Ptifpmison) $ rill UWI`ILU ---- SCI-ILDULEp ,. BODILY INJURY(Per ecGJd(l) 5-_ autos X AUTOS N"ROpE�; NGN-ONED YY PER Al TY X I,11*11AU10S X W AU10s L ----11 - — i I X unluncLLA l INkl X OC'C.UI-t -- kAC.l1 04CURRLNCC— ;b .. 1,0D0,UD0 � . C I T.kss LIAtJ `XONJ453512 4/112013 4/1/2Q'14 - — 1,OOp,000 CLAIMS MADE AGGIxLUAI-C- �— Uc.0 X�_- kE{LN'PION ' 10 00U — —_ QTI I w llahrfp l:UMNkNSN r1UN— � AND t:hINL01'tR a'LIAFJILI IY la AN)t nin^Rlt l'l]n/PNR I NLWEXECU rIVE YIN WCA00525904 6)3012013 6130120'14 E.L.EACH ACCIDEN T b 1000,000 t.Z tKWEMO:R EXCLUDED? � N l A ��-- - _,._ _ 1 000,000 Ihlooda(u+y in NH) E.L.DISEASE-EA rMPLOYClr t — 1 u rvo dWGiU.urrUar -- 1 UOO,UUU 11r.tiCRlf'I ION OF OI'ERA'I'IOIVS Ualow ' F.L.DIJL,AbI�-POLICY LIMN j Lr iiaul'ri i4v 01,Ur•1=RA 110NS/LOCA I IONS I VLHICLtS (Attach ACORO 101,Addiliupal Rnmarks Schedule,Ir mora>pacn Is,nquhnY)— ---_T -- __ - - IWu(hurs Compuruation inctudos Officers or Proprietors. !AUuuonal InouiuLl statue is providud under the General Llabilitywhen required by written contractor agreement with the Certificate Holder. i;l:Rl1FlCATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIQED POLICIES Df_CANCCLLED REFORE THE EXPIRATION LATE THEREOF, NOTICE WILL OL= UELIVEREO IN Cape Cod Instilation, 111C ACCORDANCE WITH THE POLICY PROWSIoNS. r - AUTHORIZED RLPRESENTATIVL —� �U) b -- - - ©1988-2010 ACORD CORPORATION. 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(508) 862-4038 ATFD MA'I A , Certificate � of Occupancy Application Number: 200704722 CO Number: 20080036 Parcel ID: 190080 CO Issue Date: 02/20108, Location: 404 GREAT MARSH ROAD Zoning Classification: RESIDENCE C DISTRICT Village: CENTERVILLE Gen Contractor: PROPERTY OWNER w Permit Type. RC00 CERTIFICATE OF OCCUPANCY RES Comments: AMNESTY APARTMENT ISSUED TO DOROTHY M. PIKE 4 0� Building Department Signature Date Signed �'IKE� TOWN BARNSTABLE Building * Application Ref: 200704722 * BARNSTABLE, Issue Date: 09/14/07 Pe.rm.it 9 MASS. �j 1639. Applicant: PIKE,DOROTHY M ArFO��A Permit Number: B 20072236 Proposed Use: MULTIPLE HOUSES ONE PARCEL Expiration Date: 03/13/08 Location 404 GREAT MARSH ROAD Zoning District RC .Permit Type: AMNESTY W/CONSTR RESIDENTIAL Map Parcel 190080 Permit Fee$ 25.00 Contractor PROPERTY OWNER Village .CENTERVILLE App Fee$ 50.00 License Num. OWNER Est Construction Cost$ 0 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND AMNESTY APT, STUDIO,IN DETACHED GARAGE,REMOVE KITCHEN FMWARD MUST BE KEPT POSTED UNTIL FINAL 2ND APT, 2ND FL,DETACHED GARAGE(TO BE STORAGE ONLY) INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: PIKE, DOROTHY M BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 404 GREAT MARSH RD INSPECTION HAS BEEN MADE. CENTERVILLE,MA 02632 Application Entered by: JL Building Permit Issued By: UK lAe�.. THIS PERMIT CONVEYS'NO RIGHT TO OCCUPY ANY STREET,ALLY'OR SIDEWALK OR AN ART THERCOF HE TEMPORARILY OR PERMANENTLY: ENCROACHEMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER.THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION. . STREET ORALLY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM:THE DEPARTMENT OF'.PUBLIC WORKS: THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE,APPLICANT FROM;THE CONDITIONS'OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A) BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 . 2 ` 2 3 1 Heating Inspection Approvals Engineering Dept n, 0 Fire Dept 2 Boar of He Ith i oFtHE rq,,, Town of Barnstable Regulatory Services • BARNSTABLE, * , MASS. Thomas F. Geiler, Director 1639. AtEprs Building Division Thomas Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 February 26, 2008 Ms. Dorothy M. Pike 404 Great Marsh Road Centerville, MA 02632 Re: Amnesty Apartment 404.Great Marsh Road Dear Ms. Pike: Enclosed is the.Certificate of Occupancy for your Amnesty apartment. We have prepared the Amnesty Certificate of Compliance-and forwarded it to the " Amnesty Program Coordinator. Sincerely, Lois Barry Division Assistant Enclosure amnco MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Townjt&/lf��'/j$�.� MA. Date: e Permit Building Location:�� r� ✓r v "` Owners Name: O L` - I'A Type of Occupancy: Comm cial ❑ Educational ❑ In ❑ Institutional ❑ Residentia New: ❑ Alteration Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No❑ FIXTURES o: 07 w � - Ui Z w N V . m w 0 W w v to H _ W w Z F _J } W Z fA 2 'W W (7 W 16- Z IW- W 0 Q 0 Z F- O w cn w m 0 O H: W > U v Z to (9 ~ w o7 0 a = 0 n. M w w o Z w } w N J F H .O Z J (9 u- I... H H W W W W LL (9 O = = m > 0 Z 0 z w Q Q Q = g 0 a ix I—w > > 3 3 3 0 0 SUB BSMT. BASEMENT 1 FLOOR 2 N u FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: El Corporation Address: City/Town: State: ,�/ [ ❑Partnership Business Tel 1 ll'L��I1�0 Fax: ❑Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes❑ No❑ If you have checked Yes,please indicate the.type of coverage by checking the appropriate box below. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware-that the licensee does not have the_insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this.permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and information I have submitted:,(or;entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations eerto_rmed'`' er:the-permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code an C t 42 of the General Laws. By Type of License: ' El Plumber El ' Gas Fitter Title. Master Signature of Licensed f%-m'ber/Gas Fitter City/Town Journeyman License NUni dr APPROVED OFFICE USE ONLY ❑LP Installer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town j k ' r�`l�/'�/ MA. Date: � Permit# ! ce Building Location:s� � Owners Name: Type of Occupancy: Commercial Educational Industrial Institutional Residential ' a New: Alterations Renovation: Replacement: Plans Submitted: Yes 0 No FIXTURES z z m O W to to Q y } J H J IIY- d' ul ° zCO) aU) zm z Yx a LOU' N x�. 0 z1 z O %J a . u u- ul wu) aO3 v > a W _wvI- m w Q pO zv1- 1- 0 O x � a a a a rn 3 3 O SUB BSMT. BASEMENT 1 FLOOR 2 NFLOOR 13 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 1H FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: EjCorporation Address:. . City/Towne State: MA Partnership Business Tel: Fax: Li Firm/Company VVW Name of Licensed Plumber:I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YesF If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity Bond 01 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only ( Signature of Owner or Owner's Agent Owner Agent Lll., .�, I hereby certify that all of the details and information I have submitted(or entered)regarding this application are=true-and-accurate to the best of my . Knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance with all j Pertinent provision of the Massachusetts State Plumbing Code and Ch ter 142 of the al Laws. [Biiy I Type of License:tles ✓ Plumber Signature of Llc P tuberMaster tyfrown! �,- a Journeyman License Number: 'APPROVED OFFICE USE ONLY Y MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town j V y MA.���,.. ,...�,�:...�.�,.��. � Building Locationa� err Owners Name: Type of Occupancy: Commercial;- Educational ' Industrial r. Institutional Residential ' New: Alterations Renovation: Replacement:0 Plans Submitted: Yes No FIXTURES z z CO) M__J O d' V) z U) N CO Q W 2 I- W Z a W z I-- YU w 0 Q: �: U) _ !A N z P W Z N O z H O m y a W �n �- 2 U) Y V) J a X o LL Q N o Qq Q z 0 a� z W W W J a a N O N H > > O O z ? O N ~ . _ J Q O Q O = J Q Q Q Q a m m o o tL O ,x Y J g m m 1- D O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 IHFLOOR 5 1 H FLOOR 6 FLOOR 7 FLOOR 8 1H FLOOR Check One Only Certificate# Installing Company Name: -,jf ' 4�V Corporation . Address:� ,33City/Town State: MA _ 1 _ � Partnership Business Tel: ' 'Fax: ----� - Firm/Company - Name of Licensed Plumber:+ �� INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YesNa, If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy k Other type of indemnity 1, Bond01 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only. Si nature of Owner or Owner's Agent Owner L Agent I hereby certify that all of the details and information I have submitted(or entered)regardiag.this-application are-true•and-acc-urate to the best of my Knowledge and that all plumbing work and Installations performed under the permit issued for this application will be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Ch ter 142 of the al Laws. BYI . _._FTypeet, - xn se: i :,Title+ _ Signature of LIc P tuber y _ .qCity/Town r --_- er APPROVED OFFICE E USE ONLY nyman i License Number: I ' ' ,� �t �- 4 � � �� - �� --_ �ra vt SZ I --� i I i i - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' , Map / ?V Parcel O a •d Permit# ; CT 0 d yam, Health Divisior fr wU Date Issued Conservation Division ;i.r, r, , [ �,. Fee 06,AvrAj 7' � l Tax Collector Application Fee ��7. O 0 Treasurer Planning Dept. _ k i s J Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address 4 0 7 (r re4/y!Ll M Alk�s k _A_0_� Village —Q�✓ t< Owner 0 ESL Address Telephone. —7 -75S 309 Permit'Request Ci Ajt 0-1-j Zn C4( s 1-0z ®`lL/ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation Zoning District 9 Flood Plain Groundwater Overlay Construction Type r Lot Size ® ✓ 0 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Fa 4 ❑ Two Family ❑ Multi-Family #units) Age of Existing Structure [-, Historic House: ❑Yes No On Old Kin 's Highway: ❑Y g g ges ,No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing ❑new size Pool:O existing ❑new size Barn:Cl existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorizations Appeal# &Q00 / "0 51 Recorde Commercial ❑Yes ❑No If yes,'site plan review# Current Use Proposed Use BUILDER INFORMATION Name "C/ziq� Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE y FOR OFFICIAL USE ONLY i PERMIT NO. 1 DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: i FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH ` FINAL I 4 GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ` ASSOCIATION PLAN NO. f BARNST.ABLE TOWN C ffrA°LF. ` 07 JUN -7 A10 .50- 679• FD Town of Barnstable Zoning Board of Appeals Comprehensive Permit Decision and Notice Appeal 2007-051 Decision - Chapter 40B Comprehensive Permit Applicant: Dorothy M. Pike Property Address: 404 Great Marsh Road, Centerville, MA Assessor's Map/Parcel: Map 190,Parcel 080 Zoning: Residential D1 Zoning District Applicants: The applicant is Dorothy M. Pike,who resides at 404 Great Marsh Road, Centerville,MA. She was PP Y granted title to the property by deed recorded in the Barnstable Registry of Deeds on December 22, 1965 as recorded in book 1322,page 006. Relief Requested: The applicant has applied for a Comprehensive Permit under Chapter 40B of the General Laws of the Commonwealth of Massachusetts, and in accordance with Article II of Chapter Nine of the Code of the town of Barnstable,more commonly termed the"Accessory Affordable Apartment Program." The zoning relief necessary for this Comprehensive Permit to be issued is that of a variance to Section 9- 14 the Code—Amnesty Program to permit an accessory apartment unit adjacent to a single-family owner- occupied residential dwelling. The issuance of this Comprehensive Permit would allow for an accessory affordable apartment unit attached to the detached garage. Locus and Background: The property at issue is a 0.5-acre lot located at 404 Great Marsh Road in Centerville. The lot was developed in 1958 with a single-family ranch style home. The effective living area of the main residence is 1,344 square feet.The accessory apartment is a studio unit attached to the detached garage. The square footage of the rental area is approximately 500 square feet. The lot is served by public water and on-site septic, and is located within an Aquifer Protection Overlay District. The town of Barnstable's Public Health Division reviewed the application, and.on April 23, 2007, approved a total of three (3)bedrooms at the property,provided the existing septic system is replaced. Procedural Summary: A site approval letter was issued for the property by Town Manager John Klimm on April 23, 2007, in accordance with MGL Chapter 40B and 760 CMR. Notice of the site approval letter was sent to the Department of Housing and Community Development in accordance with the requirements of CMR 760. An application for a Comprehensive Permit was then filed at the Town Clerk's Office and the Office of the Zoning Board of Appeals. i ` C ;A pubBo hearing before the Zoning Board of Appeals Hearing Officer was duly advertised in the Barnstable Patriot on April 27, 2007 and May 4,2007, and notices were sent to all abutters in accordance with MGL Chapter 40B. On May 23, 2007 Hearing Officer Gail Nightingale presided over the public hearing. The applicant, Dorothy Pike, was present at the hearing. Madeline Taylor of the Growth Management Department was also present. Ms.Nightingale reviewed the file with the applicant to assure compliance with.all of the program requirements. Findings of Fact on the Comprehensive Permit: At the hearing on May 23,2007 the Hearing Officer made the following findings of fact: 1. The applicant is Dorothy Pike who resides at 404 Great .Marsh Road in Centerville. She is requesting a Comprehensive Permit to convert an existing studio apartment attached.to the detached garage into an accessory affordable apartment. The conversion of the unit to an accessory affordable unit within a single-family owner-occupied residential dwelling qualifies for the "Accessory Affordable Apartment Program." 2.The applicant was granted title to the property by deed recorded in the Barnstable Registry of Deeds on December 22, 1965 as recorded in book 1322,page 006. 3. A site approval letter was issued for the property by Town Manager John Klimm on April 23, 2007, in accordance with MGL Chapter 40B and 760 CMR. Notice of the site approval letter was sent to the Department of Housing and Community Development in accordance with the requirements of CMR 760. An application for a Comprehensive Permit was then filed at the Town Clerk's Office and the Office of the Zoning Board of Appeals. 4. The proposed accessory affordable unit is approximately 500 square feet, and is attached to the detached garage. 5.The applicant is aware that the unit must meet all applicable building codes to be occupied and that the Building Division and Fire Department will also be inspecting the unit for compliance with all applicable building and fire codes. 6. The house is served by public water and private on-site septic and is in an identified Aquifer Protection Overlay District. The proposal has been reviewed by Thomas McKean, Health Director, and . he has approved a total of three.(3)bedrooms at the property,provided the existing septic system is replaced. 7. On February 13, 2007 the applicant signed an Accessory Affordable Apartment Program Agreement Affidavit that commits,upon the receipt'of a Comprehensive Permit,to the recording of a Regulatory Agreement and Declaration of Restrictive Covenants at the Barnstable Registry of Deeds. That document will restrict the unit in perpetuity as an affordable rental unit and requires that.the dwelling be owner-occupied as their principal residence. 8. The applicants understand that the affordable unit will be rented to a person or family whose income is 80% or less of the Area Median Income (AMI) of the Barnstable Metropolitan Statistical Area (MSA) and further agrees that rent (including utilities) shall not exceed 30% of the monthly household income of a household earning 80% of the median income, adjusted by household size. In the event that utilities are separately metered, the utility allowance established by the town of Barnstable.shall be deducted from rent level so calculated. 2 9. According to the Massachusetts Department of Housing and Community Development, as of May. 23, 2007, 6.6% of the town's year round housing stock qualifies as affordable housing units. The town has not reached the statutory minimum of affordable housing under MGL Chapter 40B Section 20-23 or its implementing regulations. The Town of Barnstable's Local Comprehensive Plan encourages the use of existing housing to create affordable units and the dispersal of these units throughout the town. Finding Summary: Based upon the findings, the Hearing Officer ruled that the applicant has standing to apply for a Comprehensive Permit under MGL Chapter 40B and the Town of Barnstable's Accessory Apartment Program. The proposal is also deemed consistent with local needs because it adequately promotes the objective of providing affordable housing for the town of Barnstable without jeopardizing the health and safety of the occupants provided all conditions of the Comprehensive Permit are strictly followed. Ruling and Conditions: Based upon the findings, a ruling was made to grant the Comprehensive Permit in accordance with MGL Chapter 40B to the applicant,Dorothy Pike. It is issued to allow for a studio accessory affordable apartment unit in accordance with the following conditions: 1. Occupancy of the affordable unit shall not exceed one person. 2. The total number of bedrooms on the property shall not exceed three (3). 3. The property owner shall occupy the principal dwelling as her principal residence. 4. This unit shall not be occupied by a family member of the owner(s). 5. All parking for the accessory apartment and the main dwelling shall be on-site and no lodgers shall be allowed on-site for the duration of this permit. 6. To meet the requirements of affordability,the cost of housing(including utilities) shall not exceed 30%of 80% of the median income for a single individual for the Barnstable MSA. In the event that utilities are separately metered, the utility allowance established by the town of Barnstable shall be deducted from rent level so calculated. 7. All leases shall have a minimum term of one year. 8. The Growth Management Department shall serve as the monitoring agent for the accessory apartment. 9.The applicant must apply for a building permit for the accessory unit, whether the unit is new or pre-existing. Before securing an occupancy permit and certificate of compliance,the Building Commissioner must determine that the unit conforms with the approved plans as submitted with the building permit application and meets state building and fire codes. The Health Division must determine that the dwelling,is in compliance with applicable on-site wastewater discharge requirements. 3 10.The applicant may select her own tenant provided the tenant meets the requirements of the program as cited above and provided that person's income is reviewed and approved by the Growth Management Department of the town of Barnstable as a qualified individual. The applicant will be required to work with the town to provide information necessary to document that the tenant qualifies. The unit shall be rented on an open and fair basis to an income eligible individual or. family. Whenever a vacancy occurs,notice must be given to the Growth Management Department and the unit must be listed with the Town. 11. Every twelve months the applicant shall review the income eligibility of the individual,occupying the unit. No later than a year from the date of issuance of this Comprehensive Permit, the applicant shall file with the Growth Management Department of the town of Barnstable an annual affidavit listing the rent charged and income level of the occupant of the unit. The applicant shall provide the town any additional information it deems necessary to verify the information provided in the affidavit. Upon any report from the town that the terms and conditions of this permit are not being upheld, the Zoning Board of Appeals or it's Hearing Officer shall have the ability to hold a hearing to show cause as to why this permit should not be revoked. 12. This Comprehensive Permit shall not be transferable to any other person or entity without the prior approval of the Hearing Officer or Zoning Board of Appeals. This decision,the Regulatory . Agreement and Declaration of Restrictive Covenants and all other necessary documents shall be filed at the Barnstable County Registry of Deeds. If the ownership of the property is transferred,the Growth Management Department of the town of Barnstable shall be notified within 60 days of the name and address of the new owner. 13. This Comprehensive Permit must be exercised and the unit occupied within 12 months of its issuance or it shall expire. Ordered: Comprehensive Permit 2007-051 has been granted with conditions. A written copy of this decision shall be forwarded to the Zoning Board of Appeal as required by the Town of Barnstable Administrative Code Chapter 241, section 11. If after fourteen (14) days from that transmittal the Members of the Zoning Board of Appeals takes no action to reverse the decision, this decision shall become final and a copy shall be.the filed in the office of the Town Clerk. Appeals of the final decision, if any, shall be made to the Barnstable Superior Court pursuant to MGL Chapter 40A, Section 17, within twenty (20) days after the date of the filing of this decision in the office of the Town Clerk. The applicant has the right to appeal this decision as outlined in MGL Chapter 40B, Section 22. In accordance with Chapter 241, section 11 of the Town of Barnstable Administrative Code, the hearing officer transmitted a written copy of the Comprehensive Permit decision to the Zoning Board of Appeals on May 23, 2007. Fourteen (14) days have elapsed since the transmittal to the Board, and no Board Member has taken action to reverse the decision. 617107 Ga ightingale, -aring Off er Date Signed 4 ,I, Lindy Hutchenrider, Clerk of the Town of Barnstable, Barnstable County,Massachusetts,hereby certify that twenty (20) days have elapsed since the Zoning Board of Appeals filed this decision and that no appeal of the decision has file i the o ice of the Town Clerk. Signed and sealed this — day Q under the pains and penalties:of..perjury. Linda Hutchenrider, Town Clerk 5 Bk 22210 Pa 165 `w'-4r3667 07-24-2007 a 02 0 29so REGULATORY AGREEMENT AND DECLARATION OF RESTRICTIVE COVENANTS THIS REGULATORY GREEMENT and DECLARATION OF RESTRICTIVE COVENANTS,is made this day of ,2007,by and between Dorothy M. Pike, 404 Great Marsh Road, Centerville,MA and its successors and assigns (hereinafter the "Owner"), and the TOWN OF BARNSTABLE (the "Municipality'),a political subdivision of the Commonwealth; WHEREAS the Owner has been granted a Comprehensive Permit under Massachusetts General Law Chapter 40B and local regulations by the Zoning Board of Appeals to permit the creation of an accessory apartment in an owner occupied dwelling which will be rented to.a Low or Moderate Income Person/ Family(hereinafter "Designated Affordable Unit");and NOW THEREFORE,in mutual consideration of the agreements and covenants contained herein,and other good and valuable consideration,the receipt and sufficiency of which is hereby acknowledged,the parties agree as follows: I. PROJECT SCOPE AND DESIGN: A. The terms of this Agreement.and Covenant regulate the property located at 404 Great Marsh Road, Centerville, MA as further described in deed recorded herewith as Barnstable County. Registry of Deeds Book 1322 &Page 006. B. The Project located at 404 Great Marsh Road, Centerville,MA will consist of one accessory apartment unit which will be rented to an eligible low or moderate income individual or family(the "Designated Affordable Unit" or the "Unit"). C. The Owner agrees to construct the Project in accordance with the terms of comprehensive permit Appeal No.2007-051 and any plans submitted therewith and all applicable state, federal and municipal laws and regulatio . Said permit is recorded herewith as Barnstable County Registry of Deeds Book p� &Page + _. D. The Owner agrees to occupy the principal dwelling unit located on the property as their principal residence in accordance with.the terms of the comprehensive permit. II. THE OWNER'S COVENANTS AND RESPONSIBILITIES: A. THE OWNER HEREBY REPRESENTS,COVENANTS AND WARRANTS AS FOLLOWS:. 1 In receiving the comprehensive permit to create the Designated Affordable unit,the Owner agreed that the Designated Affordable Unit shall be set aside in perpetuity for the public purpose of providing safe and decent housing to persons earning at or below 80% of the area median income of Barnstable Metropolitan Statistical Area (MSA) and that the Designated Affordable Unit shall be deemed to be impressed with a public trust. 2. The Designated Affordable Unit shall be rented in perpetuity to a household with a maximum income of 80% of the Area Median Income (AMI) of Barnstable MSA and that rent (including utilities) shall not exceed an amount that is affordable to a household whose income is 80% of the median income of Barnstable MSA In the event that utilities are separately metered, a utility allowance established by the Barnstable Housing Authority shall be deducted from the rent level. 3. The Designated Affordable Unit will be retained as a permanent,year round rental dwelling unit with at least a one-year lease. 4. The Owner has the full legal right,power and authority to execute and deliver this Agreement. 5. The execution and performance of this Agreement by the Owner will not violate or,as applicable,has not violated any provision of law,rule or regulation,or any order of any court or other agency or governmental body,and will not violate or, as applicable,has not violated any provision of any indenture,agreement,mortgage, mortgage note,or other instrument to which the Owner is a parry or by which it or the Owner is bound,will not result in the creation or imposition of any prohibited encumbrance of any nature. 6. The Owner, at the time of execution and delivery of this Agreement,has good,clear marketable title to the premises. 7. There is no action,suit or proceeding at law or in equity or by or before any governmental instrumentality or other agency now pending,or,to the knowledge of the Owner,threatened against or affecting it,or any of its properties or rights,which,if adversely determined,would materially impair its right to carry on business substantially as now conducted (and as now contemplated by this.Agreement) or would materially adversely affect its financial condition. B. COMPLIANCE The Owner hereby agrees that any and all requirements of the laws of the Commonwealth of Massachusetts to be satisfied in order for the provisions of this Agreement to constitute restrictions and covenants nu g with the land shall be deemed to be satisfied in full and that any requirements of privileges of estate are also deemed to be satisfied in full. C. LIMITATION ON PROFITS 1. The Owner agrees to limit his/her profit by renting the Designated Affordable Unit in perpetuity to a household with a maximum income of 80% or less of the Area Median Income (AMI) of Barnstable Metropolitan Statistical Area (MSA) and that rent (including utilities) shall not exceed an amount that is affordable to a household whose income is 80% of the median income of Barnstable MSA. In the event that utilities are separately metered,a utility allowance established by the Barnstable Housing Authority shall be deducted from the rent. . 2. The Owner shall annually deliver to the Municipality and to the Monitoring Agent,as designated by the Town Manager,proof that the Designated Affordable Unit is rented,the tenant's income verification,a copy of the lease agreement and the rent charged for the unit or units. Such information shall also be forwarded to the Monitoring Agent within 30 days of the occupation of the dwelling unit or units by a new tenant. The Owner shall notify the Monitoring Agent,as designated by the Town Manager,within thirty(30) days of the date that a tenant has vacated the Designated Affordable Unit. III. MUNICIPALITY COVENANTS AND RESPONSIBILITIES 1. The MUNICIPALITY,through the monitoring agent designated by the Town Manager agrees to perform the duties of verifying that the Designated Affordable Unit is being rented in perpetuity to a household with a maxirr,um income of 80% or less of the Area Median Income (AMI) of Barnstable MSA and that rent (including utilities) shall not exceed an amount that is affordable to a household whose income is 80% of the median income of Barnstable MSA.In the event that utilities are separately metered, a utility allowance established by the Barnstable Housing Authority shall be deducted from the rent. IV. RECORDING OF AGREEMENT: Upon execution,the OWNER shall immediately cause this Agreement and any amendments hereto to be recorded with the Registry of Deeds for Barnstable County or,if the Project consists in whole or in part of registered land,file this Agreement and any amendments hereto with the Registry District of the Barnstable Land Court (collectively hereinafter the "Registry of Deeds"),and the Owner shall pay all fees and charges incurred'in 2 connection therewith. Upon recording or filling,as applicable,the Owner shall immediately transmit to the Municipality evidence of such recording or filing including the date and instrument,book and page or registration number of the Agreement. V. GOVERNING OF AGREEMENT: This Agreement shall be governed by the laws of the Commonwealth of Massachusetts. Any amendments to this Agreement must be in writing and executed by all of the parties hereto. The invalidity of any clause,part or provision of this Agreement shall not affect the validity of the remaining portions hereof. VI. NOTICE: All notices to be given pursuant to this Agreement shall be in writing and shall be deemed given when delivered by hand or when mailed by certified or registered mail,postage prepaid,return receipt requested,to the parties hereto at the addresses set forth below,or to such other place as a party may from time to time designate by written notice. VII. HOLD HARMLESS: The Owner hereby agrees to indemnify and hold harmless the Municipality and/or its delegate from any and all actions or inactions by the Owner,its agents,servants or employees which result in claims made against Municipality and/or its delegate,including but not limited to awards,judgments,out-of-pocket expenses and attorneys fees necessitated by such actions. VIII. EN IRE UNDERSTANDING: A. This Agreement shall constitute the entire understanding between the parties and any'amendments or changes hereto must be in writing,executed by the parties,and appended to this document. B. This Agreement and all of the covenants, agreements and restrictions contained herein shall be deemed to be for the public purpose of.providing safe affordable housing and shall be deemed to be, and by these presents are, granted by the. Owner to run in perpetuity in favor of and be held by the Municipality as any other permanent restriction held by a governmental body as that term is used in MGL Ch. 184, Section 26 which shall run with the land described in deed recorded herewith as Barnstable County Registry of Deeds Book 19686 & Page 215 and shall be binding upon the Owner and all successors in title. This Agreement is made for the benefit of the Municipality and the Municipality shall be deemed to be the holder of the restriction created by this Agreement. The Municipality.has determined that the acquiring of such a restriction is in the public interest. The Municipality shall not be subject to the defense of lack of privity of estate. The covenants and restrictions contained in this Agreement shall be deemed to affect the title to the property described in deed recorded herewith as Barnstable County Registry of Deeds 19686 Book&Page 215. IX. TERM OF AGREEMENT: The term of this Agreement shall be perpetual,provided,however,that the Owner of a Designated Affordable Unit or Units may voluntarily cancel the granted Comprehensive Pemut and the terms and restrictions imposed herein. Such cancellation shall only take effect after. 1) expiration of the lease terms entered into between the Owner and Tenant occupying said unit and 2) notification by the Owner of said dwelling to the Zoning Board of Appeals of his/her desire to cancel the Comprehensive permit upon a date certain and the recording of said notice at the Barnstable County Registry of Deeds.or Barnstable County Registry of the Land Court as the case may be,thus rendering said Comprehensive Permit void. Upon the cancellation of the comprehensive permit,the property which is the subject matter of this restrictive covenant shall revert to the use permitted under zoning and the restrictive covenant shall be rendered void. 3 .T X. SUCCESSORS AND ASSIGNS: A The Parties to this Agreement intend,declare,and covenant on behalf of themselves and any successors and assigns their rights and duties as defined in this Regulatory Agreement and the attached comprehensive permit. B. The Owner intends,declares,and covenants on behalf of itself and its successors and assigns (i) that this Agreement and the covenants,agreements and restrictions contained herein shall be and are covenants running with the land,encumbering the Project for the term of this Agreement,and are binding upon the Owner's successors in title, (ir, are not merelypersonal covenants of the Owner, and(id) shall bind the Owner,its successors and assigns and inure to the benefit of the Municipality and its successors and assigns for the term of the Agreement. )(I. DEFAULT: If any default,violation or breach by the Owner of this Agreement is not cured to the satisfaction--of the Monitoring Agent within thirty(30) days after notice to the Owner thereof,then the Monitoring Agent may send notification to the Municipality that the Owner is in violation of the terms and conditions hereof. The Municipality may exercise any remedy available to it. The Owner will pay all costs and expenses,including legal fees,incurred by the Monitoring Agent in enforcing this Agreement and the Owner hereby agrees that the Municipality and the Monitoring Agent will have a lien on the Project to secure payment of such costs and expenses. The Monitoring Agent may perfect such alien on the Project byrecording a certificate setting forth the amount of the costs and expense due and owing in the Registry of Deeds or the Registry of the District Land Court for Barnstable County. A purchaser of the Project or any portion thereof will be liable for the payment of any unpaid costs and expenses that were the subject of a perfected lien prior to the purchaser's acquisition of the Project or portion thereof. MI. MORTGAGEE CONSENT: The Owner represents and warrants that it has obtained the consent of all existing mortgagees of the Project to the execution and recording of this Agreement and to the terms and conditions hereof and that all such mortgagees have executed consent to this Agreement. IN WITNESS WHEREOF,we hereunto set our hands and seals this!!'day of 2007. OWNER BY: ^ r! d Si natum Printed:Dore, M. ike CONEVIONWEALTH OF MASSACHUSETTS County of Barns abless: On this day of 2007 before me,the undersigned notary public,personally appeared the Owner(s),proved to me through satisfactory evidence of identification,w ' h were ,to be the persons) whose name(s) is signed on the preceding or attached do-&1ment and acknowledged to be that he/she sighed it yoluntarily for the stated purposes. L; —Notary Public MADELINE P.TA LOR Printed: My Commission fires: Notary Public omffimweOt4Massachusetts My Commission Expires 4 Dac®mb®t 419009 TOWN 7OFSTABLE BY: TO MANAGE COMMONWEALTH OF MASSACHUSETTS County of Barnstable,ss: On this day of mn thV2007 before me,the undersigned notary public,personally appeared l i r wn Manager for the Town of Barnstable,proved to me through satisfactory evidence of identification,which were k4ialUY) ,to be the person whose name is signed on the preceding or attached ocum nt acknowledg d be that he/she signed it voluntarily for the stated purposes. i ..Not Public Printe 'L Yif�I ►l��t ,QC�� My Commission Expires: .EE MAY OAI�Y bh Comm.F.xv�+312 5 Y Department of Industrial Accidents ' Office.of Investigations• ' 600 Washington Street Boston,MA 02111 5. www massgov/dia - Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Auulicant Information Please Print Legibly Name (Business/organization/Inddual). Address: �O y � ,P� i/�Ct l� S / • City/State/Zip: o, Phone#• Are you an employer? Check the-appropriate box:. a of ro ect(required):. Type P l ( 4 ) 1.❑ 1 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.❑ I am a sole proprietor or partner- listed on the attached sheet $ 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. [] Demolition working for mein any'capacity. workers' comp.insurance, g. Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or.additions wed.] officers have exercised their eP I.LZ I am a homeowner doing all work right of exemption per MGL T fl-❑ Plumbing repairs or additions myself. [No workers' comp. C. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers% comp.insurance required.] 131 Other '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 tcontracton,that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'c policy information,omp Po Y t am an employer that is providing workers compensation insurance for my employees- Below is the policy and job site fnformation. Insurance Company Name: Policy#or Self-ins.Lie.#: 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 .p to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. l do hereby certify under the pains and penalties of perjury that the information provided above is true and correct attire:. �J Date: Phone#: r use only. Do not write in this area,to be completed by city,or town official, Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health L.Building Department 3.City/Town Clerk 4..Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#• Information an"d 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 Wan ju�al :partnegbV,: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 u partnership, association or other legal entity,employing employees. Howev.,er:the individual, gyp, receiver or trustee of an � �P of the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant dwelling house of another who employs persons to do maintenance,construction or repair work-on such dwelling house all not because of such employment be deemed to be an employer." or on the grounds or building appurtenant thereto sh 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 nnmber(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners; are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of industrial Accidents. Should You have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below, Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom you regarding the applicant of the affidavit for you to fill out in the event the Office of Investigations has to contact Y g g �applicant Please be sure'to fill in the permiMicense number which will be used as.a reference number. In addition, an 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-avalid affidavit is-on file for.future permits orli6euses..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 do license or permit to burn leaves etc.)said person is NOT required to complete thus affidavit. g 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 9ff Investigations 60Q Washin on•Street Boston,MA 0211 1. . . Tel.#617-727-4900 ext 406 or•l,877-MASSAFE Fax#617-7274749 Revised 5-26.05 v;Nm.mass.gov/dia E Town of Barnstable Regulatory Services • Thomas F.Geiler,Director it�. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. A/ Type.of Work: kel v� / �� I/" Estimated Cost ti Ad Address of Work: Owner's Name:_ Tof Date of Application: `7 �� /.� cl-7 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Buil mg not owner-occupied ner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH.UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Date Owner's Nad QIorms1omeaffday �FTHE lqk, Town of Barnstable Regulatory Services BABNSTABLE, : Thomas F. Geiler,Director MASS. i639• A.�� Building Division f0 MA'1 Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE LICENSE EXEMPTION Please Print �J DATE: ? j Tf JOB LOCATION: number // street village "HOMEOWNER": —7 name A 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 requiryRents. 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:forms:homeexempt AFAUG. 7. 2007 9: 50AM BARNSTABLE BCARD OF HERLTH N(NO. 91$ P P. 2/2 Town of Barnstable lie alth JWpeotor Moe Hours Regulatory Services 1::00-9:30—2:00 Thomas 7.Geller,Director URN MAM L public Health Division se�9• 4 " Thomas McKean,Director 200 Man Sheet,Hyannis,MA 02601 Fax; 509490-6304 Office: 508-862-4644 �lVIN1:STY P OGRAM APPLXCA,�1'C — SEPTIC UESTIONNA l. General Information: Size of Property; Address: Y Map I q a Parcel Name: Phone#' 2a. How many bedrooms exist at your property now?? 2b. Are you planning to add any bedrooms? If yes,how many? 2c, How many bedrooms total are proposed at This property(including the amnesty uuit)n 2dr Please include a copy of the floor plans for the er► re property-showing the existing rooms fn the home plus the proposed amnesty apartment and/or addition. please label each room cle I on the p ns YES or 3. Is the dwelling connected to public sewer? N If tho dwelling is connocted to publio sower, qkip questions 04 tbzougb 4t9 below. 4. Location of dwelling is INSIDE or Q�b a Zone of Contribution to public supply wells? 5, Is the dwelling oonaected to an ONSITE WILL or to UB W.�TER? 6, Is a disposal works construction permit on filo7 YES :%or ',NO 6a. If yes,how many bedrooms were approved according to this permit? bedrooms, for contraction of additional bedrooms? YES,:.:or 'WO 7, Were any building permits obtained S. is thore an engfacered saptic system.plan on f le'at rho Health Division? . YSS 9. Has the septic system been inspected by a DEP certified inspector within the last two years? XES or NO ......r.w...■�r. - FOR OMCa Use ONLY The Public Health Division has no objection to�!bedrooms at this property. I� Special Conditions- ' q 61; �• Signed: Date; Q;/hsa16 169/p»1��Sty y � 707 p A . z - Y SMOKE DETECTORS REVIEWED E BL U DING DE DATE FIRE DEPARTMENT ` DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING s7' r Aug. 7. 2007 12: 59PM No. 0613 P. 3 T 4�F del"'' c� ct�io* �Y a o 0 7 �_ � 6 ` i w� tz,� 0 o , lyle,� �6-V �- rv� o - - O� Nt, �w `VN +r (1:FileiXtit Edit. Teals +}alp t fJU b— I P31..�]. fi. �'.p:,®^aOf— Action * Y r ;t, Deta1 ' — P' plic&ian2f)(04722, .,. 5 � 'a Ppltcartt" ° =`PROP+ERTY0 . tatus.�, 3D fi : DENtED 1 CaIleG4 Ilepa, ent -$UaLDlr O DEP�RTh�E 1Tp 1 _; � ` ` i� r , _ � HIKE:'DOROTHYM ClosGfDerrr Praject�'Atcttvihf 550 ]N ]EST`f V /C0NS RES91JElNT L, `' aCarrctraetar q B �D ion n 1 ' AN N T'�APT,STU,D70,IN DETACI3E�fl� ICE,Rv NOVE XII HEt�FRO1 �# U. �11751neS5 .� + ' ' Descripian � NDi?t$ RTt� 1T 2N'DCJi7;RDETA {ED,OE "` +� v � k ! 5� ++aM'�• H �✓+.mrv� mW= CMS�*- k +Mw�'✓M0.kawwnN.:w�£Y �.n9��i+4''�.. Y+N�tS'-�+ �&1�Nci�d.� N��n P ± 'r € r ...,�.�..-�.. ^' ,,,,ywf�.' a.g g*} r Pfa Eft' 'flJpelt�d�USe` an-Conriom,Jn - D eS!� IISC k� $eR17t�5 y° Properfi� Reactivate � Location _ Un 41 ' '6astir g i!se 1090 f ULI Adjust 1 aes + Street GREAsT lARSH FOOD e k k � zoning ,RC:'RESJD+ ( 9 f Parcel . �:.... ..«.» H& ar^,• "� -€�a'-��'� xN`+ t,Nc..w ;� g "y '�v.;t °. r at€ ."� +� �� GENT E tTER,Mb`LEw� �fib � PSI �. " '�y�- 6 as a�H '�� �' s r m k '—A i DISC 4.l ig "'t n a s + N ,;, w•••# + t t < �' Subdt:islondlot 'p_dj�ffY HISt[9!' get�dwaV'en u_ w p,. � xv ' iPraposbdi1se logo m l and �.' i- " iilJd(� t� e ate'a'.# i �• Location iIBSC 6 LOT DSO Rio 7; � �1#. 'r {s 111 a a " 5 i ofz t, Bf3io k r a-s umm�Pefftaft ' ' •.'xx '.s +# 3 *'�, 4 N+wA.t= r# SNt *q $£N^s' Nr sl Ca n9i�� a � a �- _ ,'ff¢'17r -M 'a -F�`e •hPr�P ;V .: -i i 'aVlf � _ 't?a ;i Plan Rev�lew _ PrerequisitEs'. }Haif `Restr ( Nafiaes I `,$ands Sib-Auddcs is ( Text p.� I t.. E3 P�aar Histary� lnspetlansx t�iialatafis Revle +s ( L3 Open Items � ' luernings ? (a Find ReldtedE a - ; d fit ... J. re �t ` t ^ t:' #'. C1aS2 Gen ,If1E CUr,r,e 5t cppllCcGtJOn, `' - r File Edli Todli'�i!H, p nt- - — G �i tl tX7 �`'� - '.�$�, {��4, i 0� "LEI '4 j 6'`8�9 jiPre7eGUIS e � Jee d3'� � PRll7VCd r Stcf�lU� l,`__ tTtMe SUS 2 f t' '' I' dot Hisfi0r ` HE'I'LT APPROVAL M DSTR XELG. TAX APPROVAL 630 WORK APPROVAL 6300 EL 77, 77,77,11 , .� r 5 zLS.R=" fr. - st"`5 g, y,'e."'§ ' •�{ ��° Prerequ{��teN1JS aA� 1ESTY t t ax $ ___. ,� n..,.+.. r Nws.... C'"4T�°.`° ,q,Y,yrvxpw 'n"'tv'"t {�� ":+e•xn+ �, '+iY' jJ"'q% (E cti0nhype APPROVAL � € j �- *- ��� a r 144 T� + jResj;�n, t lejde t L'1 `r1:f INESTtlrspedi0ri vpe `' z;r a�dA tv� � # e Status w� lGdll�T�Sp F u �l �t s a €- t r „° c -a'F".�` t.�� r < c..'#ellt Cdde " s g a Oiby6d w k` f a n* ":."w.a. .. w'" vr" ;sR-^- �-fir= ' - 41. Al IF mp ............ 3� r =x ea vi S" w+ L °i ��►+Ela,, Town of Barnstable Regulatory Services 9anx►v "Le.MASS. ' Thomas F.Geiler,Director 16;o.,A`e Building Division Thomas Perry,Building Commissioner . 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 October 31, 2006 Mrs. Frederick Pike 404 Great Marsh Road Centerville MA 02632 Re: Illegal Apartment: 404 Great Marsh Road Centerville MA 02632 Map: 190 Parcel: 080 Dear Property Owner: Our records indicate that your house at the above-referenced location is currently being used as a multi-family home,which is contrary to Barnstable Zoning Ordinances. Violation of zoning ordinances is a misdemeanor, conviction for which results in a criminal record. You must contact this office within 14 days to either: • Apply for a building permit to restore the property to a one-family home • Apply to the Amnesty Program • Prove that this is a legal multi-family home. Please contact this office immediately to tell us what direction you wish to take. Sincerel , Lind dson esty Zoning Enforcement Officer Building Department gfonns:zoning3 Map Page 1 of 2 i Town of Barnstable Geographic Information System New Search H, Parcel Viewer Custom Map Map Size Zoom Out In )PG Map: 190 Parcel: 080 F A K 1!y F 190097 Location: 404 GREAT MARSH ROAD I 190220 <112 E Owner: PIKE, FREDERICK E 190 8. Location Intorrnation t1?S Map &Parcel 190080 Location 404 GREAT MARSH ROAD t',,, � 190p98 Acreage 0.50 acres , s Gterrent Owner 190079 �� FREDERICK E #`ffi420 Mailing Address PIKE, DOROTHY M PIKE 404 GREAT MARSH RD CENTE L RVI LE MA 02632 ff Appraised Value 001 Extra Features $3,300 ✓`` #37$; Out Buildings $0 !�RLA9 � Land $159,900 190190 ' / „ Buildings $113,000: Total Appraised $276,200 19 12 Extra Features. $3,300. Out Buildings $0 19Cf24 . #TS Land $159,900 Buildings. $113,000 Set Scale 1 168 I April 2001 Hi Res Total Assessed �276.200 Copyright 2006 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS BarnstableMA u0.2.7 [Production] http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=190080 10/31/2006 Map Page 2 of 2 http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=190080 10/31/2006 Town of Barnstable *Permit# Expires 6 months P t s.f 4 issrom a date Regulatory Services Fee Thomas F.Geiler,Director X-PRESS PEA 'TBuilding Division NOV 17 20,Jom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN OF BARNSTABLevww,town.barnstable.ma.us Mice: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint i/parcel Number V )erty Address � ao Zesidential Value of Work �� - —. Minimum fee of$25.00 for work under$6000.00 ter's Name&Address o tractor's Name Telephone Number ie Improvement Contractor License#(if applicable) 'crnxse-#-{-if-appiieab}ej lorkman's Compensation Insurance Check one: ❑ I am a sole proprietor [;KI am the Homeowner ❑ I have Worker's Compensation Insurance -ance Company Name cman's Comp.Policy# of Insurance Compliance Certificate must be on file. it Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) (� Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. ATURE: a is:expmtrg )61306 The Commonwealth-of Massachusetts 6 Department of Industrial Accidents Office of Investigations 600 Washington Street �Kr sj Boston, MA 02111 www-mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leffibly Name (Business/Organization/Individual): Address: City/State/Zip: - Phone#: Are you an employer?Check the appropriate bog: Type of project(required): 1.El am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hiredthe•sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp:insurance, g, ❑Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its ,q required.] officers have exercised their 10.0 Electrical repairs or additions 3.�1 I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions . myself. [No workers' comp. e. 152, §1(4), and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp.insurance required.] . 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. tam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. [nsurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: fob Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 7ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a :me 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 )f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby certif under the pains and penalties of perjury that the information provided above is true and correct. 3i ature: Date: ?hone#: 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#: J6 -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 ,-,ecess.ary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance, If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to.the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department.of Industrial Accidents. Should you have.any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy.information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining.a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. Tse Department's address,telephone and fax number: The.Commonwealth of Massachusetts Department of Industrial Accidents E}fiee of Investigations 600'Washington Strut Bostoh,MA 02111 Tel, # 617-727-4-900 ext 406 or 1-8.77-MASSAFE Fax#i'617-727-7749 i Remised 5-26-OS www.mass-gevldia a � �d °`THEr°�. TOWN OF BARNSTABLE 8ASH9TADLLNABL p pyAr. BUILDING INSPECTOR APPLICATION FOR PERMIT TO ................oh /V ...........::....................................................................... TYPE OF CONSTRUCTION �s� -5 z*�/O ..................19 ' TO THE INSPECTOR OF BUILDINGS: The undersigned �hereby /applies for raa permit according to the following information: Location ....:.....a..(/ (7 /l ll../•• /!ll.. !/ .. .1/� Proposed Use ........:.. ...... ... ........... ....................................................... Zoning District ................l..1..0.............................................Fire District ...... `E...... Name of Owner � f�F�J.�>� .. !!QOT/i�d.!/.�dd es�.... 0. .. J�� r ..................... Name of Builder .. /�. ,��.... /a........` :...............Address ...........�...... ........... .................................. Name of Architect ..........:...J�/... ..................................Address ........ /yl ................................,......................... Numberof Rooms ..................................................................Foundation ........ r4 b�1 ' .......................................:....... Exterior .......CfA0�X......`�1 e/ /V�r'L. .l..........................Roofing �T,°.<•/�f fi/�/Yi�t ................. Floors ......................C,62V".7......................................Interior .....W.F!...........��?S...................................:.. Heating ...........................................................:......................Plumbing .....................:. ......................................................... Fireplace ..:..-.-......... ..C - - Approximate Cost ..: DD :.....:.......`... _ Definitive Plan Approved by Planning Board _ ____________________________19________. f �y Diagram of Lot and Building with Dimension SUBJECT TO APPROVAL OF BOARD OF. HEA TH a LTS N t �' do M � ` 44 THE PROPOSED MET-HOD OF PROVID �, SANITARY WATER SUPPLY, SEWAGE DISPOSAL AND DRAINAGE IS HEREBY APPROVED -MX&*,41-,✓G _�� vvc��c�. A . �ko- S�w �e" -7'3' �'L TOWN OF BARNSTABLE A LICENSED IgUARCEI MbCALMAIN SEW dV /i' �/�� �6fl5 PERI ,IT. ANC INSTALL SYSTEM. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... .. .. + . ���_ ` -4: ✓ - . .. ... ............... Pike, Frederiok ]Q, & _ _ { ' No -..15^219.. Permit for -__.��Ff�Za............. . l ---'-~~'-----^^^--^-'--`'-'---~^^' | / Locoti ° ~-'Y- � _f�oad.._._._.__ . . _ | | ........................-��:���:���:---------... Frederick E. & Doroth P1ke � Type of Construction -.------����@�---- --~-^^^^--'—'--~'---------'~^'---- [� I) �� ~| Plot ----.----,. Lot ---.--������77t :c ~` Jnl� � Permit Granted --^ �� Date of Inspection7/ _. ___ Completed` _ _ ` .u�r��^pVA)A nm. , ^//� � 5�- Ok PERMIT RE SEC . ...~ .. . l� ' �� �� -� �� � -.-' .- .-.. .. .-----------. � �� ^��' �� ���-��� � . -- �, �� ' v - - ` , � . '- ^ -'--'-'--^'-~^^^^^^-------`----`'--' . . "� J / °4 —_.-------.----.-..--.--_--.-----. `~~~`~^~'~'---'--`^^'~'--``-`--^'`'~'----'~'' / �u `---.-------.--.-..-._.-.._.,--.-.-,. r ' ~ | � ' Y Approved .................................................. 19 ` ^ / -------.--.--.-.-~--_-,-~..~.-,~ ' | --------.-----.~..---,-........- � ' r � ,*THET��♦ TOWN OF BARNSTABLE 1639. 8ABB9TADLS, i �o yar a• BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....G.. !/. E...... ... 0! .1...(� C ...:..............:................. TYPEOF CONSTRUCTION ..................................................................................................................................... ........ .1.::5........194V J TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...... 'T.......(9" Y ...���G% J� ....... /'�..................4� �/ .. . . ProposedUse .......lf ......., - ..... � f .... 1���f................................................................................ Zoning District ........................................................................Fire District ....... T �����. Name of Owner ...r.........Address ...f,04�. ��✓��1�., ............. Name of Builder ..... l"li �l ...................................Address .............�.c/`/��................................. ................... Name of Architect C r ....................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .....�� � ..................................................... Exterior .......... ....................................................Roofing ...... J�/1�� ....:............................................. r�/ Floors !'k' .............................................................Interior ........ /YOr ......./. 1 .....:......................... Heating ................/W ........1,011 J.........-..All........Plumbing ...... ......'.............................................. Fireplace ................. .........���C/f.............ApproximatP Cost ..... DQ : . Difinitive Plan Approved by Planning Board ________________________________19________. D � Diagram of Lot and Building with Dimensions O � m w CDC H _ ► � � W < � mW z 2 Q c �n �� z � � Q ' uj T a Uj - � U Q ¢ O d cn ul ra. z zz 01 ✓�j�ao% M. z hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Iake^ FrederickE° Jr. ^ ' 0��K �� � ���� ��� � � ��v� No —J32.15.. Permit for .........PX������.����� / ...................I.Q.rgh................................................ Location --40b. . ............. ...................... ................................ . . � . Owner --.. ..�A.. ..�-r°___ Typo of Construction ---..�X.an.0.................... -----.---------.---------.-- . Mot ............................ Lot ................................ . . ' . . ! - Permit Granted ---..J` --- �..��..' ' '..l9 70 l ` . - --- —..� Dote of Inspection ����."�'�...AJ ...lg 70 ' - Dote Completed ...................................... . � / . PERMIT REFUSED . ~ ` .....................................................:.......... lV � . '-------~—'----------------'' —,_----.—.—~~----.--.-----.—.— _.--_----------------.--.--.. ' , ----.~-..—....—..-----..—..----..- � ' ~ Approved .............................................. lQ -------.----------~----..---. ' � ----------.--------~.—,----- ^ | ' | ^ '