HomeMy WebLinkAbout0016 PATRIOT WAY ,
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Date: August 2, 2017
To: Building File
From: Robin C. Anderson, ZEO
Re: Illegal Apt in basement-egress issues
Location: 16 Patriot Way, Centerville
Conditions: Cloudy,Warm & Humid-
BIRST TEAM: Patrick Franey, LI, Tim O'Connell, Health,FPO Martin McNeely,
COMM FD, Therese Gallant, Consumer Affairs Officer, Robin Anderson, ZEO
Property is a single family ,1 %2 story half Cape-constructed in 1976 with 2 bedrooms and
2 baths on .36 acre.
Contacted by Mike Grossman at 3:45 on 8/1/2017 concerning a complaint about a tenant
landlord dispute over.an illegal basement apartment with improper egress.
Chief Wynn requested a BIRST ASAP. I arranged for a team to report to the subject site
on 8/3/2017 at I IAM.
History
' Property has a 2 bedroom deed restriction.
Restraining order between tenants expired'8/l/17.
Female tenant in basement has son that visited on week-ends although not lately.
Team`was assembled at the site at 11AM. No occupants found on site. Walked property
and noted lack of egress to basement. A lower level apartment was identified by the
complainant/resident as well as a lack of egress.
Officer Gallant was able to contact the property owner. He agreed to meet at the site
within 15.mins. The actual owner, Thomas Goodwin was noted be recently deceased but
his son is residing in the,dwelling with a friend and his girlfriend. A lab/pit mix was
cratedinIthe living room. We were advised that a woman was living in the basement.
The only access to this area was the interior:basement door.
outside Conditions:
Found trailer with debris and couch and mattress outside next to driveway.
Found.fire pit in rear yard.'
Noted lack of egress to basement.
Some recyclable bottles and trash on rear deck.
Primary Dwelling.
Kitchen, bath,living room and 1 bedroom on first floor.
Second floor- 1 bedroom and closet.
Lab/pit mix in crate (too small). Occupants claim they are pet sitting.
r
Lower Level— 16 Patriot's Way
Found this'area to be divided into areas. A queen bed.at the foot of the stairs to the left.
On the right was a bar with food, alcohol, microwave, glasses etc in and around a bar.
A segregated space contained a bed and toys. The far end served as a walk-in closet.
There were no windows or bathroom.
Enforcement Action .n
Patrick issued an exit order for the basement.
Tim.advised property is limited to 2 bedrooms.
Everyone reminded owner's son that no one can sleep in basement.
Lan. ord.to notify female tenant of exit order and:to make arrangements to pick up her
belongings.
Chief Wynn and FPO MacNeely advised the occupants concerning.the fire pit.
Advised unable-to burn pallets , y
Owner's son advised to obtain a building permit to restore to single family in order to
close out the complaint; no-need.to wait but can start.paperwork immediately as.a good
faith effort. (Because the actual owner was recently deceased the permit cannot be issued
until.appropriate documentation is supplied concerning the estate.
FD advised occupants to add one (1) smoke detector and a CO detector on each level.
Notes':
p
Did,not observe'a bathroom or sink in lower level. Area was accessible only through the
interior door. Tenant must-be utilizing the front door and first floor lay. Property was
not a registered rental and had not been inspected. Because there is a 2 bedroom deed
restriction on the property the lower level cannot be converted into a bedroom or any
form of an apartment unless the septic can upgraded to include more capacity andahe
deed`restriction is rescinded.
2 •
Town of Barnstable
oFt"Fro,,, Regulatory Services
Thomas F. Geiler, Director
• BARNSTABLE,
MASS. g Building Division
i639• �0
1639 i Thomas Perry, CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXIT ORDER
DATE: ✓5 Z. Zo/7
LOCATION: l le �a yi-;01' �i/u/� C•er-tzrv���L, /�/d,(�
UNDER THE PROVISIONS OF 780 CMR, THE STATE BUILDING CODE,
SECTION 3400.5.1, YOU ARE HEREBY ORDERED TO IMMEDIATELY
DISCONTINUE THE USE OF THE CELLAR/BASEMENT AREA FOR SLEEPING
PURPOSES.
LOCAL INSPECTOR
IGNATURE OF RECIPIENT
ODEM DE SAIDA
DATA:
LOCALIDADE:
DE ACORDO COM 0 PROVISORIO 780 CMR, CODIGO DE CONSTRUCAO DO
ESTADO, PARAGRAFO 3400.5.1, VOCE ESTA ORDENADO DE DEIXAR DE
USAR, IMEDIATAMENTE, A AREA DO PORAO/BASEMENT PARA 0
PROPOSITO DE DORMIR.
INSPETOR LOCAL
ASSINATURA DO RECIPIENTE
Town of Barnstable ��*Permit#�
Expires 6 months from issue date
Regulatory Services Fee
» snaxsriiq.
v� 1 `0$ Thomas F.Geiler,Director
,e�FO MA't A )5 �''3'I3
Building Division
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 t
Property Addresst J ��
❑Residential Value of Worl � [�, Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address /q
�-
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance MAY 0 8 209
Check one:
❑ I am_a sole proprietor
Cg am/t'he Homeowner TOWN OF BARNSTABLE
❑ I have Worker's Compensation Insurance
Insurance Company Name C2 C 4,
Workman's Comp. Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
�e-side
#of doors
replacement Windows/doors/sliders.U�Valu-eI, -" " - (maximum.35)#of windows 17-
❑ 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 the Home Improv ent Contractors License&Construction Supervisors License is
required.
SI.GNA.T_
Q:IWPFILESTORNIMbuilding permit form. XPRESS.doc
Revised 053012
The Conomomsealth of Massachusetts
in Depa phnent ax,f Indusftial Accidents
Office of Investigations
' 600 Washingtan Street
6� Boston,.MA 02111 .
n�nrw.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/+Contractors/Electl'iciansfPlumbers
Applicant Information Please Punt Legibh
�IVam�e(Business/oeg�,��ationadividual),_;� �
Cty'fState(Zip:' t,✓ `� Phone
Are you an employer?theck the appropriate box. Type of project(required):
contt d I racor an
1.El I am a employer with 4. ❑ I am a � 6. ❑New construction
employees(full and/or part-time).* have hired.the snob-contractors
2_❑ I am a sole proprietor or partner- listed on the attached sheet, 7. ❑Remodeling
ship.and have no employees These sub-contractors have & ❑Demolition
working for in any capacity. employees and have workers'
[No workers'comp.i•�s� p.2fe comp.insuranr ❑Building.addition
required.] 5. ❑ We are a corporation.and its M❑Electrical repairs or additions
3� e 'i officers have exercised their
I am a hoxn�wner doing all work 1 l..❑Plumbing repairs or additions
T —myself, [ o workers'c right of exemption.per MGL
tnsauaztce'required.]r C. 152, §1(4),and we have no i2.0 Roof repairs,
employees.[No wodcers' 13.❑bthen
comp.insurance required.]
•Any applicant that checks box#1 must also fill out the section below showing their worlters'compensation policy information-
Homeowners who submit this affidavit indicating they are doing all wat and then hire outside conttwtors must submit a new affidnit indicating such.
lcontracrars that cheek this boat in=attached sm additional sheet showing the name of the sub-conrractors and state whether or not those entities hate
employees. If the sub,contmaors have employees;they must:provide their ouorkers'comp.policy number.
I am an employer that is proi4d ng workers'compensadon insurann?for my employee& Below is the polity and job site
information.
Insurance Company Name:
Policy 4 or.Self-ins-Lic.#: Expiration Date:
Job Site Address: City/state/zip:
Attach a copy of the wGrkers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the.DIA for insurance coverage verification-
Ida hemby cethj(y order the pains and 91111, s ofpedi that the information provided aboue is true and correct
SI
�O e#- ®1
Official use only. Da not write in this area,to be campleted by cif},or town official
City or To-%m: Permitll icense#
Leming.kutbority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#-
6
{
°FIHE T � " Town of Barnstable
P °^ Regulatory Services
BAMSTABLE, * Thomas F. Geiler,Director
9 MASS.
�'ATe0
3A Building Division
Tom Perry,Building Commissioner.
200 Main Street, Hyannis,MA 02601
www:town.ba rnstable.ma.us
Office:. 508-862-4038 Fax: '508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DAT-E� tZl/I
���- i - L
JOB LOCATION: T
numJ street -:� village
"HOMEOWNER - - a>lJ. �6 b 6
home phoned r"work phone#
CURRENT MAILING- - RGSS: '1
- city%town tam` zip code
F
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 requirem is a hat he/she will comply with said procedures and requirements.
igna ure_of_,o n -
Approval of Building Official
Note: Three-family dwellings containing 15,000 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:IWPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 070110
OF THE Tp�
P� ti
+ BARNMBLE,
MASS.
Town of Barnstable
prfD MAC A
Regulatory Services
Thomas F. Geiler, Director
Building Division
Thomas Perry, CBO
Building Commissioner
260 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 ;- Fax: 508-790-6230
ti
Property Owner ust
Complete and Sign is Section ,
If Using A ilder
as Owner of the subject property
hereby authorize to act on my behalf,
in all rnatters relative to work authorized by s building permit application for:
(Addre s of Job)
Signature of Owner Date
Print N ame
If Property Owner is applyin for permit,please complete the Homeowners License Exemption Form on..the
reverse side.
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 070110
�C
°Ftr Town of Barnstable *Permit#-.;ezf `s �b
1� Expires 6 months from issue date
°s Regulatory Services Fee c_,2': 60
ES Thomas F.Geiler,Director
MASS.
�� 1639. .�� R4117' Building Division
Al fn MPS a JA N 2 9 2009 m Tom Perry,CBO, Building Commissioner
�-Ow 200 Main Street,Hyannis,MA 02601
OF SARNSTgS�� www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
G Not Valid without Red X-Press Imprint
Map/parcel Number ! Z�
Property Address &K67-7, l 1 �(� _ 0 �
Residential Value of Work /Y /Zo) Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address {n l✓l
Contractor's Nam'e:2� Q Telephone Number lr2&
Home Improvement Contractor License#(if applicable)
f'UWorkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
® I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp. Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
4 Replacement Windows/doors/sliders.U-Value 3- `� (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of.Permission.
A copy of the Home Improvement Contractors License is required.
x
SIGNAT
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revise020108
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
'600 Washington Street
Boston,MA 02111
s. www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): .j
Address: Av, ,
City/State/Zip: �_d2_6�ne.#: ;�j22Z 6111?1
Are you an employer?Check the appropriate box: Type of project(required):
1.El am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-tim.e).
* have hired the sub-contractors 6. ❑New construction
2:❑ I am a sole proprietor or partner- listed on the attached sheet. 7. .❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp.insurance. comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3 ] I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers'comp_ right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152,§1(4),and we have no l
employees. [No workers' 13.10 Other (,cJ)J440(�-�
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 sub-contractors and state whether or not those entities have
employees. If the subcontractors have_employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi u der the pains.and p alti f perjury that-the information provided above is true and correct
Si Date:
Phone#:
Offwial use only. Do not write in this area,to be completed by city or town offWal
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service o another under any contract of hire,
express or implied,oral or written."
E
An employer is defined,as"an individual,partnership,association,corporatio or other legal entity,or any two or more
of the foregoing-engaged m alomten rpnse mlu3ui`g the legal represe tiveg�fdecased empi�er,--orrthe-- --- ----
receiver or trustee of an individual,partnership,association or other legal a 'ty,employing employees. However the
owner of a dwelling house\lhaving not more than three apartments and who esides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,cons ction or repair work on such dwelling house
or on the grounds or building a purtenant thereto shall not because of su employment be deemed to be an employer."
152 25 also states that"eve state or local licen n agency shall withhold the issuance or
MGL chapter ,§ C(6) "every g g Y
renewal of a license or permit to°operate a business or to constru . buildings in the commonwealth for any
applicant who has not produced acceptable evidence of corn lia ce with the insurance coverage required."
Additionally,MGL chapter 152, §25C(i)states`Neither the co onwealth nor any of its political subdivisions shall .
enter into any contract forl the performan a of public work until ceptable evidence of compliance with the insurance
requirements of this chapter have been pre nted to the contrac�, g authority."
Applicants
Please fill out the workers'compensation affidavit millet it',by checking the boxes that apply to your situation and, if
necessary,supply sub-contractors)name(s),address( phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limit lability Partnerships(LLP)with no employees other than the
members or partners,are not required to cant'workers' d ensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affi, t't y be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Als b sur to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for t]#e p rmit o 'cense is being requested.,not the Department of
Industrial Accidents. Should you have any questions r tgar ing the la or if you are required to obtain a workers'
compensation policy,please call the Department at the er listed be w. 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 print d /If
ibly. The Departm\da
rovided a space at the bottom
of the affidavit for you to fill out in the event the Offi e Investigations has c ou regarding the applicant.
Please be sure to fill in the permit/license number whi will be used as a refe . In addition,an applicant
that must submit multiple permit/license applications any given year,need mit o . affidavit indicating current
policy information(if necessary)and under"Job Site dress"the applicant srite"all cations in (city or
town).".A copy of the affidavit that has been official] tamped or marked by or town ma be provided to the
applicant as proof that a valid affidavit is on file for fure permits or licenses. affidavit mus a filled out each
year.Where a home owner or citizen is obtaining a licpse or permit not relate business or co . ercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required tote this affidavit.
The Office of Investigations would like to'.thank you in advance for your cooperation and should you have any q estions,
please do not hesitate to give us a call. ! i
S
The Department's address,telephone-and fax number., 4 �;
The Commonwealth of Massachusetts
Department 0 Industrial Accidents
Office a Investigations
600 VV hington Street
Boston,MA 02111
TO. #617-727-4900 ext 4Q6 or 1-877-MASSAFE
Fax#617-727-7749 i..
Revised 11-22-06
www.mass.gov/dia
tTo,4� Town of Barnstable
Regulatory Services
s r
� r
Thomas F.Geiler,Director
1619. a�m 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
Property Owner Mus
Complete and Sign This ection
If Using A Build
I, KI'MLI , as-Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work thorized by this uilding permit application for.
is /G /` 60263Z
(M&s f J
9
ignature of er a J
-Pat Mme
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:FORMS:O WNERPERMISSION
r
Town of Barnstable
THME
Regulatory Services
Thomas F. Geiler,Director
PIE .p 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
HOMEOWNER LICENSE EXEMPTION
�j Please Print
DATE
JOB LOCATION: 11 to 7 6v (/d I 1
nu5ber street /� village
W
"HOMEONER7A A r'1 C'04.,14 J10�- �� �/1-61XF>
name home phone# work phone# /
CURRENT MAII.WG ADDRESS:
Ile—
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.
DEFWMON 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 buildinepermit, (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,BuildingDapartment
minimum inspection procedures d requirements and that he/she will comply with said procedures and
re
a
5ignaturc of Hom caner
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 1 D9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such
work,that such Homeowner shall ad as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the respom'bilities of a supervisor(see Appendix Q,
Rules&Rcgulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness otien 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:forrrs:homcw empt
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Asjessor's}map and lot number .., .:'Z ......;7..... 4,7
SEPTIC SYSTEM MUST BE
INSTALLED IIV C
Sewage Permit number -fps............. OMPLIANCE
g WIT ART
ICLE II STATE
SSA IC
C �FT�ET TOWN O F B A R 1' L`� TOWN
BARISTOHLE, i
MA86
9�0 1639 9 _
o�aYa, BUIL.DIHG INSPECTOR .
c APPLICATION FOlk PERMIT TO. ........ .r! .� 1.............................................................. ..... .......
TYPE OF CONSTRUCTION ............. e' r' ../ .. 4.........................................................................
eJdl ........../.�................19.7.�,
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the followi g information:
Location ... ..... .. G�G'..�...... ....C.�/.tJ.,J .�Fre�. /�!/•E'. ..... . . .... .�eL.. .�P./:�1�� �„�....
ProposedUse ....J.�.c� .e..,.... a r<.�......iL•�',5 s.rl.R...c�.n.. .................................... ...............
f /
—l. :� ..... _,............Zoning District .............1 ........ .....Fire District .....
o
Name of Owner .....,rf.c..11r7`1&'L''.. ��. f..l tJ� ..Address �. � ��..�..............
i
Nameof Builder ...................... t.. .............................Address ....................................................................................
Nameof Architect .................. .............................................Address ....................................................................................
Number of Rooms ........... ETLIr ..................................Foundation ........1. .a�.. ..;.--. .c?t. �. �...
loe
Exierior ... s....�i�..a. pF�,. .........................Roofing .......44..F. .�. .. c... � .
�... ... .................
Interior ........... ��. .. ..�. :.� .
Floors ...... F,�.r...�p.r� �................
Heating ��5... ...... ...........Plumbing ...... ./ ... .....................................
Fireplace ��.........................................................Approximate Cost..........
; QQ
Definitive Plan Approved by Planning Board ---------------_---------------19________. Area ;l�,,..t..........................
Diagram of Lot and Building with Dimensions Fee ...:7...... ... ....................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
r /,i"` Uf''" f rya ' �✓
�.
Name . . .. ... . y.. ,. .�-t ./.0 �...
R. Arthmllama, Inc.
�
/
CA', 18534 � ' l I/2 story,
mp ................. Permit for .................................... .
single family
----''
Location —.. --------
' ~ '
. Cmtemn,1lle
----.---------------------- `
.
' R. �r�bor Williams ,, 00
Owner -- .. ^ ° ^
( ' ---------------~---
frame
Type of Construction ..........................................
� ( ^
-----------------------.--- .
' �
>
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, Plot ................ ��
---'' w^—^-------''
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> ' July 20 76
� Permit Granted ------...------]V
`
`
Date of Inspection' --. ._---lg
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' Date Completed �.� �..��..��--.]g
' '
. -
\ PERMIT REFUSED
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----.,_--.. -----------..
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| ^._........--.~---------~---.~..
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.' Approved ................................................ lg
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................