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Mr. Brian Florence
Building Commissioner
200- Main Street ��,�, -, 'V
Hyannis, MA 02601
Dear-Mr. Florence,
This letter is in reference to an addition to 284
Monomoy Circle in Centerville, MA. At issue is the
doorway entrance from the main house to the new
addition as it varies from the original plan..
The addition will function as the primary office for my
consulting business. We determined that the best
place for my computer equipment is against the wall
abutting the main house and we instructed..the
electrician to install the necessary outlets. It also
allows me to have easy access to my filing cabinets.
If we increased the width of the doorway there
wouldn't be enough room for the equipment that is
critical for the operation of the business.
Thank.you for your attention to this ,matter.
Ve Truly Yours,
homas F. Gledhill
' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Al
Map Parcel Application # �p
Health Division Date Issued /- 2--.17 �
Conservation Division Application Fee
Planning Dept. g3o
Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Street Address C:.h
Village r,
Ir , r-
Owner S S lit h A 6, C,L,-h s Address An v Pi g
(Telephoned
�lrmit•Request 61AO t Vri C�l c(N
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
i
Project Valuation 5 Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes", ttaach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units SET
Age of Existing Structure Historic House: 0 Yes ❑ No' On O d•Kirk �' Wd hw : ❑Y g g T g�s,���,g ay es ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other 0wNOFRA��
ol
ABLE
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing —new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing. ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
_APPLICANT INF RMATION
�G /'! /"- rGi c,� (BUILDER OR HOMEOWNER)
Name` ;,> �,c � D SS elephone Number
Address > G CJ Lrcense#
Hine-improvement Contractor# z� 51
�. G e 7
,Email y / G✓ Ol/ Worker's Compensation # `
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
DATE SIGNATUREG/
i A
•
FOR OFFICIAL USE ONLY
APPLICATION #
N
DATE ISSUED
MAP/ PARCEL NO.
r
ADDRESS VILLAGE
5 OWNER
€ DATE OF INSPECTION: �P���
FOUNDATIONO,�)! +o•Z �AZ ( ob<
FRAME -f �a"21740V*- Pq&gE o6(1.f-? j'j:
INSULATION ?
FIREPLACE
ELECTRICAL: ROUGH FINAL
f PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
A
ken put ih j6
Z.//er c-
9
ti DATE CLOSED OUT
ASSOCIATION PLAN NO.
4 C , ss- r ... 3
The
BaBifioni M4 02111 .0
Warlmrs' CompensatiallInsarmce AffidaviL S�afldexM/Ckmfwbaks/Ekc&i Lmy hmabers
AppHcmt
Iafmrmattnz Please PHmt
VA
Are you an employer?Checicthe appropriate bam
L❑ I am a 1 v� 4. El am a general aonfmctor and I Type of project(require _
* frve hired Me si r-contnctm 6- ❑New construction• employees(full a�ifor gart�imo�_ .' .
2.iMm I a a sale proprietor orpattuer- listed oaffte atWche d sheet ❑Renaode
and have no 1 These=b-c= ct=.have
p �P $ ❑Demolition
v -;na forma in any capacity_ WTIO ees andhave worms' `
# 9. El�ad�ou
jAT�I P msu�ce 5_ ❑ We:are a corporafifln and its %lo-❑Eleichical repairs or adds
3_ I am a.homeoner officers have�rc-ssed fl=ir
❑ doing a1I t�ori� 1L'Q Plumlmzgrepaiss or adrJ dams
mpsd€[No wozkers'comp_ .light of exemption per MO- 'L❑Roof repairs
in�r d-]E c.>:52,§I{4)�andwebaveaa ,
employees_[No wA=, 13<❑(?flier
cow_insurance required.]
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lam arrigsr tl�atis pratar7irtg iuorkers'cam p;easrdrrrt irrsrirarresar enrpFiay�ee $e€riav is fihe pa8cy a j�Fi site
Iawmce Company Nam:
Paficy 44,or Self-inL li / �- xF sl3afe: 3" Z2'
Job Sits Address_ 0 C" IS G l�r
a � 2 63z -
Attach a copy of the yr ariu re compensati polfcy declamfion page-(shaming the policy number anal espa-ation date).
Fad to serum amerage as regwednuder Section 25A of MGL m 15�7 can lead to ffie imposition.of criminal penahi,es of a'
fine up to$UOD OO aadfor one-yearunlmso==It as vaell as civil penahi,s Jn fie farm of a STOP WORT€RDEI and a RM
of up to$25M a dap a aimst the violafor_ $e advised fhaf a copy fhis sit maybe ceded to the Office of ..
Isvvesans of fine DIA for insamom coverege on-
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R Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
glegistration: 1;58Type: Office of ConsumerAffairs and Business Regulationpiration:Z1/23/2018 pgq 10 Park Plaza-Suite 5170
;; Boston,MA 02116 '
ALL PHASE HOME I`MPRO+VEMENT P'
VICTOR GROSS
46 FOSTER HOWARD'`RD
POCASSET, MA 02559 Undersecretary '
iI Not valid without signature
Massachusetts Department of Public Safety
JI lug
Board.of Building Regulations and Standards
License: CS-105297
'Construction Supervisor
JOHN P GRAHAM
14 TOLMAN ST
SHARON MA 02067 '
jo
Expiration:
Commissioner 05/01/2017
s
_ .. •lam
Town of Barnstable
Regulatory Services
Richard V. Scali, Director
Building Division
EAMMAINUC, ` Paul Roma,Building Commissioner
YAASS
/ �`�� 200 Main Street, Hyannis,MA 02601
www.town.barnstable.nuLAs
Office: 508-862-4038 , _ Fax: 508-790-6230
HOMEOWNER LICENSE EXENIMON
Please Print
DATE:
JOB LOCATION:
number street vWage
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
cityhown state zip code
The current exemption for"homeowners"was ded to include er-occupied dwelling of sic units or less and
to allow homeowners to engage an individual for who does no possess a license,provided that the owner acts
as supervisor. .
DEFINM OF HO WNER
Person(s)who owns a parcel of land on which he/she r ides or• tends to reside,on which there is,or is intended to'
be,a one or two-family dwelling,attached or detached a accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year o shall not be,considered a homeowner. Such j
"homeowner"shall submit to the Building Official on a fo ceptable to the Building Official,that he/she shall be
re onsible for all such work Rerformed under the building t (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for c m fiance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she unde ds th Town of Barnstable Building Department
minimum inspection procedures and requirements and th he/she comply with said procedures and
requirements. ;
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35 000 cubic feet or larg will be required to comply with the
State Building Code Section 127.0 Construction Co-n ol.
HONIEO R'S EXEMPTION
The Code states that: "Any homeowner erforming work for whi a building permit is required
shall be exempt from the-provisions of this sectio (Section 109.1.1-Licens' g of construction Supervisors);
provided that if the homeowner engages a person s)for hire to do such wor that such Homeowner shall act
as supervisor." `
Many homeowners who use this exemp n are unaware that they are saming the responsibilities of
a supervisor(see Appendix Q,Rules&Regulati:ns for Licensing Construction upervisors,Section 2.15)
This lack of awareness often results in serious p oblems,particularly when the meowner hires unlicensed
persons. In this case,our Board cannot proc , against the unlicensed person as it would with a licensed.
Supervisor. The homeowner acting as Super or is ultimately responsible.
To ensure that the homeowner is full aware of his/her responsibilities, any communities require,
as part of the permit application,that the ho eowner certify that he/she understands the responsibilities of a
Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend ,
and adopt such a form/certification for use in your community. -
r
t 1
Town of Barnstable
Regulatory Services
Richard V.Scali,Director
KAM
►`� Building Division
Paul Roma,Building Commissioner v
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 509-790-6230
Property Owner Must ,
Complete and Sign This Section
If Using A Builder
L '25 01 c \(\" 00c-�(NS _,as Owner of the subject property
hereby authorize 1�a Ou>c (rl{n�� :IN\(\ (1'ic��c o�act on my behalf
in all matters relative to worm authorized by this building permit application for.
(Address o Job)
**Pool fences and alarms are the responsibility of the applicant Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
Signature of Owner Signature of Applicant
Print Name Print Name
►�-ate
Date
QTORMS:OWNERPERMISSIONPOOLS
U
-PRESS PERMIT Town of Barnstable *Permit# �d t�(3
Expires 6 mon a from issue date
AUG Regulatory SriV1CeS Fee
5—
TOM OF BARNSTABLE Thomas F.Geller,Director C
Building.Divisi®n
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS.PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number 190��11
Property Address .29-A N--10r-1orn0-.1 Ci 1C:C CC-rA1- yV0 kr✓ 02 L11 b --
'Residential Value of Work zed Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address 0"/i ok a- f�u w V-1 S
Contractor's Name Ai Ir Sc)�c Cco, CAI Icit Telephone Number( SAX)
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman'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#
Copy of Insurance Compliance Certificate must be on file.
Permit 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. U-Value (maximum.44)
*Whererequired: 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.
Home Improvement Contractors License is required.
SIGNATURE: ulc
Q:Forms:expmtrg
Revise071405 '
t ne c,ommunweacrn uJ lnussucnuyeccs
•'' Department of Industrial Accidents
Office of Investigations
' d 600 Washington Street
' Boston, M4 02111
www-mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Z��n Vk' 6 SU SCA Q a v\J S
Address: Mo--\O o-,J G,—cAc—
City/State/Zip: CC,,,-�V*A- t I ,V4 -n� Phone#��8> - 40
Are you an employer? Check the-appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 7• ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition
[No workers' comp. insurance 5• ❑ We are a corporation and its
required.] officers have exercised their 10.❑ Electrical repairs or additions
3 I am a homeowner doing all work right of exemption per MGL 11.❑ lumbing repairs or additions
myself.[No workers' comp. c. 152, §1(4),and we have no 12. Roof repairs
insurance required.] t employees. [No workers' 13. Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.'
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
TContractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.policy information.
I am an employer that is providing workers compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,50Q.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct f
Si ature: Date: 1 OCo
Phone#:
Official use only. Do not write in this area,to be completed by city or town officiaq
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 �I
6. Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hue,
express or implied,oral or written."
An employer is defined as "an individual,partnership, association, corporation or other legal.entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who.resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or .
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone numbers)along with their certificate(s) of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an I.LC 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 Deparnnent 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 mast submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write "all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. � 617-727-4900 ext 406 or 1-577-'MASSAFE
V 617-727-7749
Revised 5-26-05
WWW.MaSS.gOV%aim
�i
A^-lessor's .map and lot number
�•; C ,sMEM MUST BE
INSTAIILED. IN COMPLIANCE
q
` Sewages Permit number ...........+. ... ..... .... TICL I1-S E
WITH AR E
SANITARY CODE. AND
�ofTHETo�� TOWN OF! BARNSPMff °-#?'f"m'x
Q
HARHSTAM-. i
90 M6 q 0`� t: R' �vI'I.DIHG INSPECTOR
Op,
�E�MpY A`��yy ' e�
APPLICATION FOR' PERMIT TO .. . .........................................................................................
r' TYPE OF CONSTRUCTION ............... .
c,
TO THE INSPECTOR OF BUILDINGS:
The undersign,0 h eby applies for a permit according to the followinginformation:
Location hrl-
ZA
.....................................
AProposed Use ...... ...........: :............................................:........................................................,.........................
Zoning District ....... ....................A.......................................Fire District ......................... ....
Nameof Owner Q., .........................................Address .............................:.... !. ... ,. ...................................
Nameof Builder ....................................................................Address ....................................................................................
Nameof Architect ...........................................:......................Address ....................................................................................
Number of Roo ............1..
�}...................................................Foundation ...........,.:.. ............ .......................
Exierior ..... ..... ........ .. ..... .....................................................Roofing ......... ..... ...
Floors Interior .:....
..... � .. .. .... ................. ...... .....6& .................................
��ff .............................Plumbin ..............................
1-seating .....,...��.....:!... �....�.`T.... ., g ....................................................
Fireplace .. ..... ..... ... .. � .,. ......................`............Approximate Cost ,. ..!.. ..........................................
Definitive Plan Approved by Plann' g Board ________________________________19________. Area .`7. ..... :. ......
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
160
f
R
4 %
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regagdin he above
construction.
Name ...: : .... :.. ... .. ............................
�.
Small, Alan E.
r. 17154 one ,story
No ................. Permit for .................................
single family dwelling
.............................;.................................................
Location*.................Monom-.o-..y....Circle-.-.-..........................
Centerville
................................................................................
Alan E. Small
Owner ..................................................................
frame
Type of Construction ..........................................
............. .I................................................................
Plot Lot .........9t.66................
Permit Granted ............:9.......jlq Ap.. ....19 74
7 7
Date of Inspection lIZ7-1
Date Comp
leted ..... ........ ............19
PERMIT REFUSED
................................................................ 19
........... ...................................................................
0...............
.............................................6............
. ........................ ......................................................
............................................................
rS
Approved ..... 19
...............................................................................
0
,;--* ............. ............................................................
1.
Addition to to
284 Monomoy Circle
Centerville, MA
Mark Sangiolo,Architect
23 Willow Street
W. Harwich, Ma o2671
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- REV. 1 : 12-06-16 ADDED BUILDING ADDITION MGC
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PROPOSED PLOT PLAN
284 MONOMOY CIRCLE
CENTERVILLE, MASSACHUSETTS
OF I CERTIFY THE LOCATIONS AND TIES SHOWN ON THIS PLAN RESULT. PREPARED FOR
tH' 'WA
FROM AN ACTUAL SURVEY MADE ON THE GROUND ON THE DATE
p? JAM 'fG� OF FEB. 23, 2016. TOM G LE D H I LL
E o 284 MONOMOY CIRCLE PETE RSON
� No.34824
CENTERVILLE, MA 02632
SUFNvO� GISTERED PROFESSIONAL LAND SURVEYOR DATE
DATE SCALE DRAWN FIELD . CHECKED
AM
gl ALPHA SURVEYING AND ENGINEERING INC. 2/23/2016 1"=30' AMC RAP/AMC RAP
can 695 WAREHAM STREET SHEET NO. DWG. NO. JOB. NO.
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„ SURVEYING AN MIDDL(508)E295-5505 MASSACHUSETTS 02346 1 o f 1 16107.d wg. 1610 7
ENGINEERING INC_