Loading...
HomeMy WebLinkAbout1071 SHOOTFLYING HILL RD k � c r b: : a VIM � Town of Barnstable ._.� Buildin ' Tost This Card So•That it'is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept v M^FS. 'Posted Until Final inspection Has Been Made. Pc eo '� ;. o -p y - q�uired,such Building shall Not be Occupied until a Final Inspection has been made. rermit Where a Certificate of�Occu anc �s Re � .. ._...... - - �•� ,y ,- Permit No. B-20-1745 Applicant Name: Steve J Spengler Approvals Date Issued: 07/09/2020 Current Use: _ - Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 01/09/2021 Foundation: ° Location: 1071 SHOOTFLYING HILL RD,CENTERVILLE Map/Lot: 191-026 Zoning District: SPLIT. Sheathing: Owner on Record: CERQUEIRA, MARCELO T Contractor Name: STEPHEN J SPENGLER Framing: 1 Address: 1071 SHOOTFLYING HILL ROAD Contractor License` `CS-071546 2 CENTERVILLE, MA 02632 Est.Project Cost: $ 12,540.00 Chimne _ Y:. Description: Installation of roof mounted photovoltaic solar systems, 18 panels Permit Fee: $ 113.95 5.76kW Insulation: 9 Fee Paid: $ 113.95 Project Review Req: Date: 7/9/2020 Final: Plumbing/Gas !d' :Rough Plumbing: g This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months aftAM[WeOfficial Final Plumbing: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Service: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection - 5.Priorto Covering Structural Members(Frame Inspection) Final 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final: Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: S r o� •d Application number.. .. . R, Fee ..................................... MAW Building Inspectors Initials... ..J:' ..........�. .... SEP 12 2619 Date Issued:..a::..! .—..1q... ..C�. TOWN O� BAHNSI-PA B L E lql Map/Parcel............ ....... ......:........... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION ' Address of Project: 107/ 5 No0rE1X1 f�j c • ( t iL teD CESN U)LL NUMBER STREET VILLAGE Owner's Name: M n rcclo C6!9 UE\\rC/) Phone Number S0',3C 7--�W0 Email Address: y!p NE algsrkmCTIClr)�060 O Cell Phone Number -3�6 0 Project cost$ `5(7)0 Check one Residential X Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize • OWGJ() G 7bo' to make application for 'lding permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK Siding Windows(no header change)# (0 ❑. Insulation/Weatherization Doors(no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of s les) Construction Debris will be going to &rnS bl i - CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY/S IN u�rrnniP niCrn�P*r VA1I AAA/CT/1DTw#A# IJIC7*^01,r ADDD^1/AI DCC^DC A DCDAAM PAA#DC 1CC11Cn APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total s Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 201bs. or> Yes No ,if yes,a gas permit is required. Natural Gas Yes No ,if yes,a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION l� Homeowrler's Name: Telephone Number. ? '°3�6 Cell or Work number 65 �-1 C I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature j Date All permit applicati ns are subject to a building offwial's approval prior to issuance. 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): wrc(d() W U6 M vZ-N ! Address: S,�jU� �. 1n HI�� City/State/Zip: A �1 Phone#: `.' 6_7`3b'S�J Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).*. have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. . 7. '❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• t 9. ❑Building addition [No workers'comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other. comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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 sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job'site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify Ader the pains and penalties of perjury that the information provided above is true and correct Siggafore: 'f Date: Phone#: .� -3 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#: i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their 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. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 . wwW.mass.gov/dia Town of Building SAM4ABM 1 Post This Card So That it is Visible From the'Street-Approved Plans Must be Retained on Job and this Card Must-be Kept I p Posted Until,Final Inspection Has Been Made. it ib34 �1$ t Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until,a Final Insp ection h as been made Permit NO. B-19-2500 Applicant Name: AU REALTY CORP Approvals Date Issued: 08/07/2019 Current Use: Structure Permit Type: Building-Restore to Single Family Expiration Date: 02/07/2020 Foundation: Location: 1071 SHOOTFLYING HILL RD,CENTERVILLE Map/Lot: 191-026 Zoning District: SPLIT Sheathing: Owner on Record: AU REALTY CORP � Contractor Name:`,,,,BRAULIO BRITO Framing: 1 Address: 128 MAIN STREET Contractor:License: CS-110548 2 HYANNIS, MA 02601 _. Est. Project Cost: $ 1,500.00 Chimney: Y Description: remove apartment over garage- by removing,kitchen and turn into Permit Fee: $85.00 non commercial office space I Insulation: Fee Paid $85.00 f _ Final: Project Review Req: NO SLEEPING. HOME OFFICE WITH BATH ONLY.ACCESSORY Date: 8/7/2019 USE TO SINGLE FAMILY HOME ON PROPERTY'ONLY.-.. Plumbing/Gas i Rough Plumbing: �- ° Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the,approved construction documents for which this permit has been granted, Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. u Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. I Minimum of Five Call Inspections Required for All Construction Work:_ Service: 1.Foundation or Footing . i Rough: 2.Sheathing Inspection - 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: - 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT i3UILDING DEPT. Application Number. �.S-.o.(o............. AUG 0 1 .2glq . ..... .... MASS. Permit Fee..........4?.S...................Other Fee,........................ 163 TQVv ni TotalFee Paid..................................................... ......... ...... 1JTOWN OF BARNSTABLE Permit Approval by....7......................... ..-7................. BUILDINGPERMIT %Map............. .............Parcel.......0..................................... APPLICATION _S r—�— Section 1 — Owner's Information and Project Location Project Address —Village JgzaKbjj� Owners Name Owners.Legal Address_:)(Y) 0QS,('A -99A— city State zip 2-60 k Owners Cell # � E-mail T�t-n Ger, r+Vl' go Section 2 —Use of.Structure Use Group_ F-1 Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,00 0 cubic feet 19/single/Two Family Dwelling Section 3 — Type of Permit ❑ New Construction R Move/Relocate Accessory Structure [Change ofuse El Demo/(entire structure) El Finish Basement El Family/Amnesty El Fire Alarm Rebuild El Deck Apartment Sprinkler System ❑ Addition E] Retaining wall Solar El Renovation El Pool 0 Insulation Other-Specify Section 4 - Work Description —&Jet Cc-L. Last undated: 11/15/2019 t Application Number.................................... Section 5—Detail Cost of Proposed Construction ' l600 Square Footage of Project &Q0 Age of Structure Dig Safe Number #Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method, MA Checklist ❑ WFCM Checklist ❑ Design . i Section 6—Project Specifics j r ' ❑ Wiring ' ❑ Oil Tank Storage' ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Add/relocate bedroom ❑ Heating System Masonry Chimney Water Supply Public ❑ Private , Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No f Section 7—Flood Zone i Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑ No u Section 8—Zoning Information i Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed , Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes No Last updated: 11/15/2018 Mass. Corporations, external master page Page 1 of 2 w W Corporations Division Business Entity Summary . ID Number: 463663321 j Request certificate New search Summary for: ALJ REALTY CORPORATION The exact name of the Domestic Profit Corporation: AU REALTY CORPORATION Entity type: Domestic Profit Corporation Identification Number: 463663321 Date of Organization in Massachusetts: 09-18-2013 Last date certain: Current Fiscal Month/Day: 12/31 Previous Fiscal Month/Day: 12/31 The location of the Principal Office: Address: 182 PITCHERS WAY City or town, State, Zip code, HYANNIS, MA 02601 USA Country: The name and address of the Registered Agent: Name: JUAN MARICHAL Address: 128 MAIN STREET City or town, State, Zip code, HYANNIS, MA 02601 USA Country: The Officers and Directors of the Corporation: Title Individual Name Address PRESIDENT JUAN MARICHAL 182 PITCHERS WAY HYANNIS, MA 02601 USA TREASURER JUAN MARICHAL 182 PITCHERS WAY HYANNIS, MA 02601 USA SECRETARY JUAN MARICHAL' 182 PITCHERS WAY HYANNIS, MA 02601 USA DIRECTOR JUAN MARICHAL 182 PITCHERS WAY HYANNIS, MA 02601 USA Business entity stock is publicly traded: ❑ http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSuinmary.aspx?FEIN=463663321&S... 8/7/2019 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Bnflders/Contractors/Electricians/Plumbers Applicant Information r Please Print Let?ibh► Name(Business/Organinwon/Individual) Address: 0 w t c✓x City/State/Zip: C,- 'S P v Z 60 Phone#: Are you an employer?Check the appropriate bog: Type of project(required): 1,❑ lam a employer with- 4. ❑ I am'a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in 'capacity. employees and have workers' � t 9. ❑Building addition ur[No workers'comp.insurance comp.insurance. Irequirede] S. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.Ef I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MOL 12.❑Roof repairs insurance id.]t c. 152,§1(4),and we have no employees.[No workers' 13. Other u comp.insurance required.] *Any applicant that checks box#1 most also fin 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 snb�ontractws and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is provi ft workers compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.M 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 insuran caverag 'on. I do hereby certify the pains and p Si ofPedwy that the information provided above is true and correct Date: p N Phone#: e�Q�' �7 —C 7 C(r Oj,j7cial use only. Do not write in this area,to be completed by city or town qftiat 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 M 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 or trustee of an individual, aria association or other le 1 1 =. However the receiver ��Y employing�P o3'�partnership, 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 grc mds 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." 4 Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability 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 pemiit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would Me 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 Aecidentsi Qifiue of Investigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877-MASSAM Fax#617-727-7749 Revised 4-24-07 wwwmass.gov/dia The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Bulders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatimandividual): Z)�' l `U�J�J a Q-e-S Address: .,rJ 01AfJlle-1 lam► �n9e�v► �qo City/State/Zip: 1�a * b Q O A t' � Phone#: Qzffa— Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 1 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 m the attached sheet. 7• ❑Remodeling ship and have no employees These sub-contractors have S. Demolition workingforme in an capacity. employees and have workers' Y aP tY• 9. ❑Building addition [No workers'comp.insurance' pomp.msurance t 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 I LEI Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13•[ ther r rl Se 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 most submit a new affidavit indicating such. tContcactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. ` I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.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 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 under the penalties of perjury that the information provided abov is true and correct Si Date: Phone#: . Ojjicial use only, Do not write in this area,to be completed by city or town of 1ciaL City or Town: Permit/License# Issuing Authority(circle one): ' 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector, 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to constrict buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coveraie 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 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 retumed 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 Off cials 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 permitllicense 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. The Department's address,telephone and fax number: 'The Commonwealth of Massachusetts ' Department of Industrial Accidents f�'tce ofInvestigataeus 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax##617-727-7749 WWW:maw.gov/dia • s A � x t DR . r 3 � .,a Ib3...�s� �a i } � � #.e:....rw' >: x+nk.- } q g •�s , _ . ,#, �qa .y„e `�sir. i s fly' ➢gw�., w R.{rf�, r _ 2®'@YA0:, 4 Ov r - _ : � '. 4�. yy I �� L �_- P4 Z •-..9.�� K..€..✓ �N �Y""lPi�' �� AN'}'' �•Jw- ��4'Y�'a{ i YF�e9q. i� .. •�'•-wE,ki '. .�'M1a Y 1 d� ♦N 'd � i '3+R_ i �' MY'rd wYd '_ ` - _ � • e �+" � r:'4. � .'+t" ��a� Each '�;'�k� � �-r +-r. gg 5 a � .ra✓N S'" �� ��A ��y�l�. crn���1'. r,y�.,.r R �;H'q� ^'4p�'�+45' .rayr. . j. .. 'J+kt`Xi 'i'v' �L'93;• Y {y t,jr'ey`H' ,xrry�f !" `{•' $'i `�";}�@pq� ` .. . - - M g� �„��q'�'aY't�K�'9e 'Rc4'�4�,�yr�t,�:� 'i4�, 'z,n:"�,� �*•. r� r �"� " ,° P. }r. *,. j yy Application Number........................................... Section 9- Construction Supervisor Name 2)(1-,L,- r Telephone Number Address V C State "� Zi O Z-J � �2H� ty `� �-P_yt�l 5 p ®� License Number C o License Type Expiration Date 05 Contractors Email U"Cell # 7) I understand my responsibilities under the rules and regulations for Licensed Construction-Supervisor'in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation re ed by 780 CMR d the Town of Barnstable.Attach a copy of your license. -i, Signature Date nu Section 10—Home Improvement Contractor Name_ �C.� � ((/l{ Telephone Number Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by.780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: SvG.VIN MC4 I Cy- Telephone Number C20 Jr- Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation require CMR.an a Town of Barnstable. Signature Date / �S T SIGNATURE Signature Date Print Name k Ue^&A ���,' Telephone Number per—1 --(,o 7 0 J, E-mail permit to: 0d/0 (1 C4tn Last updated: 11/15/2018 1 Section 12 —Department Sign-Offs {{ 1 Health Department ❑ Zoning Board(if required) Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ ~ i Conservation ❑ `"' For commercial work,please take your plans directly to the fire department for approval I Section 13— Owner's Authorization i as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name j 4 Last updated: 11/15/2018 � l Z- z- CP II 'p BUILDING D PT. AUG 012019 T®Wiv Of 8;-nH V fA8.LE. i �. _�. . � _ �_ . .. L .ti ' . . _ . . _ r .� _ _ .� _:: t � ,.=. � f �., �� �� [� _. -- ._ _. .. G _. Ce.:. � _ �. _ _ _ e _ _ _ _ C9,[Rl_C?-.;�23 ry _ '� _ _ _ �H 7 _ _�� _ ^7 'J':�v� +- trnif4'. ... .. -.. � _. .y .,, _ _. � �1n i '� � .W Town of Barnstable Regulatory Services Thomas F. Geiler,Divecto V OF €„ TABL­ Building Division * BAMSTMIX ' Thomas Perry, CBO,Building.C4ji*ssioner 1 MAM �e1639. 200 Main Street,.Hyannis,NC 02601 www.town.barnstable.ma.us Office: 508-862-4038 ;€ b Fax: 508-790-6230 ` Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: My name is ,DSO— I am the owner/resident of the property located at: /071xx� The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship'to owner: Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment,Twill immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship'of occupants in said Family Apartment.1 also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. . If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to under the pains and penalties of perjury this day of - 2012. Signature Phone Number Print Name �i� �S° �/�' —4a/ GG Al - -a q:forms/famaffid.doc , rev 11/08/11 Town of Barnstable 0 Regulatory Services °F1He rod, Thomas F.Geiler,Director Building Division a� _ AJ,LE anxivsrnaiE Tom Perry, Building Commissioner v� MASS 0� ?U1' J1_'N -o W1 9' 0 6 s63p. 200 Main Street,Hyannis,MA 02601/. ArfD �a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: MY K name is � r� U �� � S am the owner/resident of the property located at: D Z Sh CX3 fr i n Map and Parcel Number The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationshipto owner: 0Zi7__r14fW6_67W�2d222 Name &relationship to owner.: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, 1 will immediately notify the Building Commissioner in writing. 1 understand that no subletting or subleasing of said Family Apartment is permitted. _ I understand that I am required to file an Affidavit davit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this ate_day of 2006. . Signature Phone Number Print Name Q/bldg/forms/famaffid Rev:1/03 Y ---- - _ - t 4� x rt¢ .wry 6^ig L "'Y - y 12 _ - i 1 i � y f r Town of Barnstable Regulatory Services oF1"E Toyti Thomas F. Geiler, Director t"STI AL.E Building Division,; 56 rissione'^R's'"B Mass Thomas Perry, CBO Building Comm pt 039. A�� 200 Main Street, Hyannis, MA 02601 EO MAC www.town.barnstable.ma,us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable, Family Apartment-Affidavit I, being on oath, depose and state as follows: My name is /-a"f Q_ I am the owner/resident of the- property located at: A0 S The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to.owner: Name & relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said.apartment, 1 will immediately note the Building Commissioner in writing.,l understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special P m t -/ and/or the Town of Barnstable Zoning Ordinances Section-240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment"ofthis location, please explain:. The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No,,,-, ) Other Sworn to under the pains and penalties of perjury this day of 2011: Signature Phone Number 65� Print Name .C.GLC/'Q_ --n � Town of Barnstable Regulatory.Services F1HE rON� Thomas F.Geiler,Director 0 F'f ,. BuildingDivision 'TOWN a� ���.:�� � LE * saxxsrnaLE. Tom Perry, Building Commissioner MASS. 200.Main Street,Hyannis,MA 02601 y � - P, 9: 13 Al fps A www.town.barnstable.ma.us .m, Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: / a_S My name is �/� I am the owner/resident of the . property located at: la S ,cS�T, l p Y G� M14- The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to'owner: a�/ Name & relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately i notify the Building Commissioner in writing. I understand that no subletting or subleasing.of said Family Apartment is permitted. I understand that.I am required to file an Affidavit annually with the Building _ Commissioner listing.the,names and, relationship of occupants-in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit ' zi�'dlor the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. 1 agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled: The apartment has been transferred to the Amnesty Program (Appeal No. ) Other t Sworn to under the pains and penalties of perjury this day of a� ' 2010. Signature Phone gumber Print Name S Q/bldgdormsdamaffid Rev:12/08 Town of Barnstable Regulatory Services pFt►+e rqk, Thomas F.Geiler,Director Building Division �, ` BARNSTABLE, ' Tom Perry, Building Commissioner' �. g g-Z 200 Main Street, Hyannis, MA 02601 . 'OIFn��s www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is _ l_6�Ea" L /� i'f 425z_ ' I am the owner/resident of the property located at' %%'71 /` ?7G /7%11V& The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: Name & relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment,.I will immediately notify the Building Commissioner in writing. 1 understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with.the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this '/ day of �JO1 qk� 2009. Signature ,� Phone Number. Print Name 1-67 U t Q/bld g/forms/famaffi d Rev:12/08 Town of Barnstable Regulatory Services F1HE t°y, Thomas F.Geiler,Director BARNS ti 1� V1H "'I BARNS 1 ABLE Building Division ' saxxSTABLE. " Tom Perry, Building Commissioner?000 JAN 416 AM 1 13 07 9 MASS. Q� ieS9• �� 200 Main Street Hyannis,MA 02601 Alfp ,t a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is /4 YQ J• /)QS/.�- I am the owner/resident of the property located at: 4/V 'q a w tooGL The following members-of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: C Aro#ler-/ _. r I Name & relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. } I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. 1 agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ). Other Sworn to under the pains and penalties of perjury this /(/ day of Jdayfila 2008. 17 Signature Phone Number Q— Print Name Q/bldg/forms/famaffid Rev:l/03 Town of Barnstable 1 i O Re gulatory atory Services TIME rqy� Thomas F.Geiler,Director Building Division j 3 8{ BARN TMBLE, Tom Perry, Building Commissioner 9 MASS. 1b39. 200 Main Street,Hyannis,MA 02601 �1 1„y Pi ++� tt ArEOMA'IA �� J� �� �itt`� L.' t www.town.barnstable.ma.us Office: 508-862-4038 D'V�'F'ax1 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is �U_ra �\�� I am the owner/resident of the property located at: Ozz 2�2 le"nUi Ize The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: Name.& relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. 1 understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that 1 am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale.of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has,been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this �� day of JeA 0. 2007. Signature" Phone Number' Print Name Q/bidg/forms/famaffid Rev:1/03 z Town of Barnstable Regulatory Services THE r ti Thomas F.Geiler,Director 41 to" Ia 1 .A ` "�,���� wilding Division saxtvsTnate. Tom Perry, Building Commissioner .p Mass. 1630. 200 Main Street,Hyannis,MA 02601 AlF p 1iAPL4 A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit i I, being on oath, depose and state as follows: My name is Uf6L1Je 0 I am the owner/resident of the property located at: v S -r i ►1� d20-1e.ruill� Map and Parcel Number The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: Odf+hqU) W - m 01 l bLemy- Name &relationship to owner: f The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that 1 am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA in the Appeal No. identified above. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this day of e h 2005. (09 77/- Signature->i. U Phone Number Print Name. la-ara- J . �eufo'SA' Q/bldg/forms/famaffd Rev:1/03 TOW OF\l�rn�blQ cgfx) Nui n S ,eQ.t M6- Oa. 1. I a �Id_r 10 D wmz . - dx� a s - O D x zz� t5 � }.. 9. Town of Barnstable Regulatory Services ptrIHE'rop, Thomas F.Geiler,Director 1,"F ; ti Building Division ; 31 snxxsTns[E, + Tom Perry, Building Commissioner.;: . `0�' 200 Main Street,Hyannis,MA 02601 ;o;0 Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: My name is o I am the owner/resident of the property located at: �1 ZAk�: Uzi) remkM 1/e � p Map and Parcel Number 9 _Pg rceL G oZ 4 The ZBA granted me a Special Permit/Variance on L - 2-5_y 5 Date Appeal No. The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &.relationship to owner: ' �c �/ "' S Al Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing.I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA in the Appeal No. identified above. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) P Other Sworn to under the pains and-penalties of perjury this iuday of .JA tKlf 2004. "15acq -7/ 7528 gnature Phone Number Print Name . Q/bldg/forms/famaffid Rev:1/03 Town of Barnstable Regulatory Services O J< °F1HE►ok� Thomas F.Geiler,Director / Building Division BARNSTABM ' Tom Perry, Building Commissioner y . MASS. 1639. 200 Main Street,Hyannis,MA 02601 AlED MA'1 p Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable F a e amply Apartment Affidavit I, being on o"deposeate as follows: My name is I am the owne/r/resident of the property located at: l® J �GL L—�// 1�Y 1 / JAL Map and Parcel Number The ZBA granted me a Special Permit/Variance on J` 15 g Date Appeal No. The decision of the Zoning Board of Appeals has.been recor ed with the Registry of Deeds in Barnstable County:_Book r Page` r The following members'of my;family will be the sole'occupants of the Family Apartment"atthe aforementioned address:' ? - i/ r Name &relationship to owner-,— Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. 1 also understand that I am required to comply with all conditions imposed by the ZBA in the Appeal No. identified above. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other S rn t under the pains and pena lties f o perjury p p this day of � 200 P J �' � Y � 3. . / � ignature ;. Phone Number Print Name Q/bldg/forms/famaffid Rev:1/03 11'�A/p 9 Town of Barnstable O/C) Regulatory Services P�pF"THE'TOk� Thomas F.Geiler,Director Building Division sAxtvsrasi E, Tom Perry, Building Commissioner 9 '. MASS. $ 039• 200 Main Street,Hyannis,MA 02601 ��TFD MA'1 A Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment artment Affidavit I,being on oath depose ands ate as follows: My name is I am the owner/resident of the property located at: P y Map and Parcel Number The ZBA granted me a Special Permit/Variance on Date Appeal No. The decision of the Zoning Board of Appeals has.been recorded with the Registry of Deeds in Barnstable County: Book Page The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner — � Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA in the Appeal No. identified above. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other S rn t under the pains and penalties of perjury this day of 2003. ®� 70 ��(_�Y Signature _ Phone Number Print Name Q/bldg/f6mis/famaffid Rev:1/03 Town of Barnstable Regulatory Services °f t►+E low Thomas F.Geiler,Director C Building DivisbIN OF BAR S` ABLE G z snxtvsTwatE, . Peter F.DiMatteo, Building Commissioner 9Qj %639. ,m� 200 Main Street,Hyannis,'FEB11 9 AM I ArF p NIA s Office: 508-862-4038 , Fax:. 508-790-6230 ON Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: My name is - I am the owner/resident of the property located at: 1&7/ Map and Parcel Number The ZBA granted me a Special Permit/Variance on -� ��j .�S✓�. Date Appeal No. The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: U-) 06M,0�_oI CAJ Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA in the Appeal No. identified above. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to under the pains and penalties of perjury this I day of fif 2002. Signature Phone Number /0- a 7 7� Print Name Q/bldglforms/famaffid Rev:010702 COMMONWEALTH OF MASSACHUSETTS 9 BARNSTABLE AFFIDAVIT '0 4 'rlelA C ` ,being on oath, I, depose and state as follows: 1.) I reside at�)137/ 6� 1'G�S�/�CF ,�. �G�l�y/ t"� 11A 2.) I am the owner _ f the pro erty located eQ'y at 1 15)�1 �a�� t/✓ f �/YI �T ,�dd shown on Barnstable Assessors' m ps as MAP PARCEL 3.) I Do_ V"'� Do not have a Family Apartment at this location. 4.) On -.102_�o �, 199 , the Zoning Board.of Appeals, on Appeal No.�XS oa a Special p_r*n"� ,r an?tice to -maintain a.Family Apartment at the above address.gmnt / 5.) I understand that the Family Apartment may only be occupied by members of my family who are persons related to me by blood or by marriage. 6.The following members of my family will be the sole occupants of the Family Apartment at the above address: a) NAME Relationship to owner: b) NAMF,7v�"O, � Relationship to owner: 7.) The Family Apartment will be the primary year round residence for the above-identified family members. 8.) In the event that the above-listed relative(s) vacate said apartment, I will immediately notify the Building Commissioner in writing. 9.) I understand that no subletting or subleasing of said Family Apartment is permitted. 10.) I understand that I am required to annually file an Affidavit with the Building Commissioner listing the names and relationship of my family members occupying said Family Apartment. 11.) I understand that I am required comply with all conditions imposed by the Board of Appeals in Appeal No. —T 12.) I agree to immediately notify the building Commissioner in the event of the sale of the above- listed property. Sworn to under the pains and penalties of perjury this day of ;nnt J Name I COMMONWEALTH OF MASSACHUSETTS BARNSTABLE RE Gi'' I, -- --- ---- ------ ----- --------- - b�l °j `�99 depose and'state as follows: i�, K.. 3, s W ---- 1.) I reside at`�Ito 7 /, . LE ARN 2.) I am the owner of the property located ;U shown on Barnstable Assessors maps as MAl'__j tL-------PARCEL_d--------------- 3.) I Do_- ____�Do not___________ __have a Family Apartment at this location. 4.) On__ _ te Zoning Appeals, on ��--°Z'� 199------ � �rh Z g Board of PPe-� Appeal No._Qt�_A3 granted me a Special PermitNariance to maintain a Family Apartment at the above address/. 5.) I understand that the Family Apartment may only be occupied by members of my family who are persons related to me by blood or by marriage. 6.The following members of my family will be the sole occupants of the Family Apartment at the above address: a) NAME---------- 014 Af 6 bA Al------------------------------------- Relationship to owner:_________s - ----------------------------- - b) NAME-----------------------_---_----------_--------_------------------------- Relationship to owner-------------------------------------- -- ----------- 7.) The`Family`Apar"tment:will be the primary year round residence for the above-identified family members. 8.) In the event that the above-listed relative(s) vacate said apartment, I will immediately notify the Building Commissioner in writing. 9.) I understand that no subletting or subleasing of said Family Apartment is permitted. 10.) I understand that I am required to annually file.an Affidavit with the Building Commissioner listing the names and relationship of my family members occupying said Family Apartment. 11.) I understand that I am required to comply with all conditions imposed by the Board of Appeals in Appeal No. ___________-— c =" /C � - - - -------------------- 12.) I agree to immediately notify the Building Commissioner in the event of the sale of the above- listed property.- Sworn to under the pains and penalties of perjury this_ __day of----- ----, 199_-7___ Signa ---- - -- ------� ----------------- Print Name I -------------- � ��----- -� I--------------------- COMMONWEALTH OF MASSACHUSETTS BARNSTABLE AFFIDAVIT '0WN depose and to as follows: F //VQ® 4 8 e 1.) I reside at /d '7� 671 2.) I am the owner of the p operty located Q shown on Barnstable Assessors' maps as AP_ Z 9_j—PARCEL__O� _____ _— 3.) I Do_—___ ----Do not _have a Family Apartment at this location. 4.) On_�'/v' _ }, 199pthe Zoning Board of Appeals, on Appeal No. ------ granted me a Special Permit/Variance to maintain a Family Apartment at the above address. 5.) I understand that the Family Apartment may only be occupied by members of my family who are persons related to me by blood or by marriage. i 6. The following members of my family will be the sole occupants of the Family Apartment at the above address: A) NAME ------------- ---------------- Relationship to wner:__ _ __—__—_ -------- 3. ..a .1..>�` .. b) NAME Relationship to owner: ----------------------------------------------- 7.) The Family Apartment will be the primary year round residence for the above-identified family members. 8.) In the event that the above-listed relative(s) vacate said apartment, I will immediately notify the Building Commissioner in writing. 9.) I understand that no subletting or subleasing of said Family Apartment is permitted. 10.) I understand that I am required to annually file an Affidavit with the Building Commissioner listing the names and relationship of my family members occupying said Family Apartment. 11.) I understand that I am required to comply with all conditions imposed by the Board of Appeals in Appeal No. '12.)T'agreelto-immediately notify the building Commissioner mi the event of the sale of the above- listed property. .Sworn to under the_aims"and penalties of e ' this _ P P P �J�Y � .__day of--- ----� 1991�� Signature , Print Name - ------------ 4 �c1 ----Cx 1774 _el/----------------- of The Town of Barnstable Department of Health Safety and Environmental Services s�xivsrnsr.E Building Division �� 367 Main Street, Hyannis MA 02601 QED MA'S s , Office: 508-790-6227 Ralph M. Crossen Fax: 508-790-6230 Building Commission January 26, 1998 The Hogan-Campbell Residence 1071 Shoot Flying Hill Rd Centerville, MA 02632 Re: Family Apartment located at the above address Dear Ms. Hogan-Campbell, Our records indicate you have not filed an affidavit regarding the above referenced family apartment in quite some time. It is required under Section 3-1.1 (3) (D) (1) of the Town of Barnstable Zoning Ordinance that an affidavit be submitted annually for the duration of such occupancy. Please indicate the status of the family apartment on the enclosed affidavit return to this office by February 15, 1998. Enclosed is an affidavit for your convenience. Thank you in advance, wli Ralph Crossen Building Commissioner QUERY PROPERTY: QUERY END QUERY PROPERTY PENTAMATION----------------------------------------------------------- 12/08/97 PARCEL ID 191 026 GEO ID 11427 LOT/BLOCK 17A DBA PROPERTY ADDRESS OWNER HOGAN ® 0,&, 1 1071 SHOOTFLYING HILL RD PATRICIA E CENTERVILLE 1071 SHOOT FLYING HILL RD CENTERVILLE MA 02632 PHONE DISTRICT CO DEVELOPMENT STATUS C ASSESSOR' S CODE CAPACITY (NOTES) ZONING DIST/ZOC SPLIT SEWER SYSTEM FLOOD PLN/ELEV. WATER SYSTEM OKH? # BEDROOMS ZBA DECISION FAMILY APT LOT SIZE 32234 .4 OPER/MGR NAME WET LANDS MULT ADDRESS USE 101 PROTECT DIST (N) EXT / (P) REVIOUS / NO (T) ES / PER (M) ITS / (V) IOLATIONS / (G) EOBASE / (E) XIT IME BARNErrABM A ' ,,� The Town of Barnstable Department of Health Safety and Environmental Services - -- - Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 4 Building Commissioner December 8, 1997 Hogan 1071 Shootflying Hill Road Centerville, MA 02632 Re: Family Apartment located at above address Dear Ms. Hogan, Our records indicate that there has been a change of property ownership since the family apartment had been approved by the Zoning board of Appeals. Therefore you must contact this office as soon as possible to discuss the necessary steps towards compliance with the Town of Barnstable Zoning Ordinance. F Thank you in-advance, l Ralph Crossen Building Commissioner Town of Barnstable Zoning Board of Appeals Decision and Notice Appeal No. 1995 -Campbell Special Permit-Family Apartment Summary Granted with Conditions Applicant: Patricia Campbell Property Address: 1071 Shoot Flying Hill Road,Centerville, MA Assessor's Map/Parcel 191/026 Area 0.74 Acres Zoning: RD-1 Residential D-1 Zoning District. Groundwater Overlay: AP Aquifer Protection District Applicant's Request: Special Permit for a Family Apartment Section 3-1.1(3)(D)Family Apartment Filed October 3. 1995; Public Hearing November 15, 1995, Decision Dec.29, 1995 Background: The Applicant is seeking a Special Permit for a Family Apartment pursuant to Section 3-1.1(3)(D) of the Zoning Ordinance for a Family Apartment. for her daughter and son-in-law. The property is shown on Assessor's Map 191, Parcel 026 and is commonly addressed as 1071 Shoot Flying Hill Road, Centerville, MA. This lot is 0.74 acres and is located in a RD-1 zoning district. The area is generally residential in nature and lot size range from 1/2 to 3/4 acre lots. There are two structures on the lot. The apartment is in existence and is located above the existing detached garage. Procedural Summary: This appeal was filed at the Town Clerk's Office and at the Office of the Zoning Board of Appeals on October 03, 1995. A Public Hearing before the Zoning Board of Appeals was duly advertised and notices sent to all abutters in accordance with MGL Chapter 40A. The hearing was opened on November 15, 1995, at which time the Board found to grant the appeal with conditions. Board members hearing this appeal were Ron Jansson, Richard L. Boy, Emmett F. Glynn, Thomas DeRiemer and Chairman Gail Nightingale. Attorney Arthur Hyland represented the applicant in this request for a Special Permit. He addressed all of the requirements specified in Section 3-1.1(3)(D)citing that this is the only apartment existing on the property and that it was developed and occupied by family members. It was developed in an existing detached garage, on the second floor and did not change the residential character of the lot. He noted that the apartment occupied some 472 sq.ft., and is less than the maximum size of 50%of the principal dwelling which is 1,296 sq.ft. The structures all meet the requirements of the district's setbacks as shown on a survey plot plan of the property. The property owner and the residents of the family apartment are year round, permanent residents. Occupancy of the apartment.is by two family members as documented in the affidavit submitted. He also stated that the applicant is aware of the other requirements of the family apartment, the annual affidavit filing, occupancy permit and requirements if and when it is vacated. He stated that the applicant will maintain the apartment unit in full compliance with the provisions of Section 3-1.1(3)(D). Attorney Hyland addressed the staff report and submitted hand drawn layouts of the unit to further clarify it size. He stated that the applicant will comply with all requirements of the Health Department including meeting of the new Title V requirements for on-site septic system. The Board asked Attorney Hyland if he knew why a petition was circulated and submitted to the Board requesting that the Board not grant the family apartment Special Permit. He stated that he does not know why this petition was circulated or what the reason for objecting to it was. Public was asked to comment. Speaking in favor were Steve Everett, Charlene Antrim, and Kelly Sandford. Speaking in opposition was Paul Webster, an abutter. His main concern was the barking dogs. Richard Lajava was concerned regarding the disposal of the waste material. When the septic system is corrected, he will have no objection to the family apartment. Zoning Board of Appeals-Decision and Notice ' Appeal No. 1995-152-Campbell Finding of Facts: Based upon the testimony given during the Public Hearing on this appeal, the Board unanimously found the following findings of fact: 1. The property at issue is located at 1071 Shoot Flying Hill Road, Centerville in an RD-1 Residential D-1 Zoning District and AP Aquifer Protection District. 2. The petitioner is seeking a Special Permit which is allowed under Section 3-1.1(3)(D), and based upon the testimony given, the petitioners do comply with the provisions of this section. 3. The property consists of a lot that is approximately 3/4 acre. The present use of the property is residential with a single family residence. There is a garage with a family apartment. 4. The proposed family apartment does not exceed the allowable square footage and the occupants are family members that are year round residents of the Town of Barnstable. 5. In granting the relief, it would not be in derogation of the spirit and intent of the Zoning Ordinance nor would it be detrimental to the neighborhood. f Decision: Based upon the positive.findings a motion was duly made and seconded to grant a Family Apartment Special Permit in accordance with 3-1.1(3)(D)with the following conditions: 1. The petitioner at all times must comply with and maintain the family apartment in compliance with the provisions of Section 3-1.1(3)(D). Failure to do so may result in the revoking of the Special Permit. 2. The petitioner must comply with all Title V Regulations and Department of Health Regulations. 3. Prior to occupancy, affidavits listing the names and family relationship among the parties seeking approval have been signed and shall be signed annually thereafter for the duration of the occupancy. 4. This Special Permit is not transferable and is only issued to the Applicant. The Vote was as follows: AYE: Ron Jansson, Richard L. Boy, Emmett F. Glynn, Thomas DeRiemer and Chairman Gail Nightingale NAY: None Order: Special Permit Number 1995-152 has been granted with conditions. This decision must be recorded at the Registry of Deeds for it to be in effect. The relief authorized by this decision must be exercised in one year. Appeals of this decision, if any, shall be made to the Barnstable Superior Court pursuant to MGL Chapter 40A, Secti n 17, with twenty (20) days after the date of the filing of this de7co?7 ion in the office of the Town Clerk. 1995 G ightingal Chairman Date Sig ed I Li a Leppanen, Clerk of the Town of Barnstable, Barnstable County, Massachusetts, hereby certify that twenty (20)days have elapsed since the.Zoning Board of Appeals`led this decision and that no appeal of the decision has been filed in the office of the Town Clerk. Signed and sealed this day of 1995 under the pains and penalties of perjury. Linda Leppanen, Town Clerk 2 R191 091.»-------»-»» PCA: 1011------»DIST: 300---- 10 CO» N----� KEY: 00114888 CTL:2012 LOC• 0166 KNOTTY PINE LA REA: JV. UT1: UTZ- 38 AREA: 418C ROLL SEQ: 27.1475N8LDG(S)-CARD-1 gCMLEGEL• WILL L & DEBRA NLAND 166 KNOTTY PINE LANE "It. 166 KNOTTY PINE LN NDL LOT 22 CENTERVILLE MA 02632 _NRR 0347 0271 _.. SALE 0587 C1109 - ---------»-«-- PC A: 1011 »-_-DIST: 300---- 10 CO «-----„ ' KEY: 0011.4897 CTL:2001 LOC.�0154 KNOTTY PINE LA REA: JV: UT1: -- UT2: 67 AREA- 419C ROLL SE a: 33.5006NBLDG(S)-CARD-1 LEJAYA, RICHARD Jd ARLENE V NLAND ; 400 NPL 154 KNOTTY 154 KNOTTY PINE LANE MOTHER FEATURE NRR 0847 0100 CENTERVILLE MA 02632 NOL LOT 23 _. SALE 0000 C5215 -CENTERVILLE..----.-... .. ..----- MCL22 ' --- 0 ---------»-««-PC A: 1011 -----«DIST: 300 -- 10 CO ---«« M KEY: 00114904 --CTL:2001 LOC: 0146 KNOTTY PINE LA REA: JV: UT1: UTZ: .64 AREA: 418C ROLL S;O: 32.8008NBLDG(S)-CARD-1 gTANARD• MARY ELLEN LAND 146 KNOTTY PINE LANE NDL LOT 24 LC32898-8 SAL R19111 CENTERVILLE MA �2632 NRR 0847 0100------»»--»--»- _----- R191 094 » PCAe 1011 DIST: 300 10 CO M KE'F. 00114913 CTL: LOC• 0136 KNOTTY PINE LA REA: JV: UT • - UTZ: .61 AREA: 418C ROLL SEO: 13969 MORIN• STEVEN T-& KAREN D NLAND 1 32.500 NBLDG(5)-CARD-1 PO 80% 2162 NPL 136 KNOTTY PINE LN CENT NDL LOT 25 LC2 CENTERY2162 MA 02632 NRR 0847 0100 SALE 0889 C1181 ILLER191-095.---------»------PCA: 1011 ---»--DIST: 300--------- 00»-- 10 CO»--------M KEY: 00114922 CTL:2001 LOC• �126 KNOTTY PINE LA REA- JV: UT1: UTZ: .61 AREA: 41BC ROLL SED: 15418 WHITE. RICHARD S MLAND 1 32.500 NBLOG(S)-CARD-1" ' NPL 126 KNOTTY PINE LN' NDL LOT 26 BARBARA T WHITE pRR 0347 0100 SALE 0000 C5247 126 KNOTTY PINE LANE CENTERVILLE MA 02632 _. ..._ __--- _---_-..__ -»-• R211 002.-----«--»-»---PCA: 1301 -------DIST: 300 10 CO -«« M KEY: 001131217 CTL: LOC• 0000 SHOOTFLYING HI REA: JV. UT1: UTZ: 13.90 ApBLDG(S)-CARD`151Q: 124.1007#LAND FERGUSON, GEORGE & R191 02T PC A.- 1011 DIST: 300 10 CO KEY: 00 14281 CTL: LOC 1055 SHOOTFLYING HE REA: JV:419470 NAP: COON.1 .7 AREA:. 42AC ROLL SRO: 39,1009ABLDG(S)-CARD-1 1 1 RUSSELL 0 JA2i Id ENE ILAND 1S3 MASON MILL ROAD MOTHER FEATURE 1 13.600 NPL SHOOT FLYING HILL SHERBORN MA 01770 S0�ELOJ6906C1 2 52070946 4 I TE NRR 1484 0100 R191 028.---------»------PCA: 1011 DIST: 300---- » ---_--10 CO - - _-MAP:- KEY: 07114290 CTL:2001 LOC• 1045 SHOOTFLYING HI REA: JV: .72 AREA: 42AC ROLL SEQ. 15444 YUIiLKINS. RUSSELLUN2& CAROL NLAND 1 38.600 NBLDG(S)-CARD-1 1 1: 1045 SHOOT FLYING HILL RD NPL 1045 SHOOT FLYING HILL OL SALE L0989OT 5[1184964 I i CENTERVILLE MA 02632 NRR 1484 0100 ------- ---- 235.--- --»------PCA: 1011- DIST: 300 10 CO «------» KEY: 00116298 CTL: LOC• 1035 SHOOTFLYING HE REA: JV:419504 MAP: R191 UT1: UTZ: .71 AREA: 42AC ROLL SEa: 38.2689 300 NBLOG(S)-CARD-1 1 _12 NARDONE ROSANOND C NLANDOIL PO BOX S32 NPL 1035 SHOOT FETING CENT SALELa4904C120215 IA 101 EAST OCEAN DRIVE 9403 NRR 1484 0100 KEY COLONY BCH FL 33051 ------------ -»--» -»-»---------------- R191 029.»-------«-«-_-PCA: 1011 DIST: 300 10 CO MAP: KEY: 02914307 CTL: LOC• 1027 SHOOTFLYING HI REA: JV: UTi: UTZ: .83 AREA: 42AC ROLL S;G: 42.30030BLDG(S)-CARD-1 1 3 DUNNETT• JAMES 8 NLAND LORRAINE DUNNETT MOTHER FEATURE 1 600 KS1 09/80524 S0006000I 1027 SHOOT FLYING HILL RD NDL LOT 13 & 12B SALE 0000 C83016 CENTERVILLE MA 02632 NRR 1484 0100 R191 018.J02 PCA: 1011 DIST: 300 10 CO MAP: KEY: 0D114192 CTL: LOC• 1064 SHOOTFLYING NI REA: JV UT1• UTZ: .64 AREA: 42AC ROLL SRO: 36.9002NBLDG(S)-CARD-1 1 60 HOGAN•LISA N & KELLY A NLAND 1064 SHOOT FLYING HILL RD NPL SHOOT FLYNG HILL RD CC OE SALELO181848521204 I CENTERVILLE MA J2632 NRR 1484 0326 --- ------------- ---11 PCAe 1011--------DIST: 3----- 10 CO ----»»-MAP: KEY: 00114183 CTL: » LOC: 1070 SHOOTFLYING NI REA: JV: _ .46 AREA: 42AC ROLL SEO: 13517 IINDGREN. SHIRLEYTL NLAND 1 32.700 OSLOG(S)-CARD-1 1 3� BOX GRE29S INN 1070 NSN SHOOT FLYING HILL R CENTERVILLE NA 02632 NDL LOT 1A tlRR 1484 0176 p73 PC A: 1011 DIST: 300 t KEY:R191 MUM CTL:3003 LOC. 0020 KNOTTY PINE LA REA: 10 JYO • • • UT1: "-'UT2: .36 AREA: 418C ROLL S;O: 27.2524ABLDG(S)-CARD RUGGLES. RAYMOND J NLAND I SHAWNUT MORTGAGE COMPANY :LAND 20 MADDAKET LANE CENT SALEL12912C125' CORPORATE CENTER WEST NRR 0847.0160._- -433 SOUTH STREET W HARTFORD CT 06110 .- ` ' « »-«PCAe-1011 DIST: 300 10 CO KEY. 00114673' -CTL: _ LOC 0009 MADDAKET LANE REA: JV.286318 M R791 070 UT1: UTZ: .30 ASLAN0418C ROLL 510: 26.0004NBLDG(S)-CARD-1 LIPINSKI• THOMAS d ANGELA NPL 9 MADDAKET LANE CENT NOL LOT 23 48 GORDON ST -- PINE *SOMERVILLE. ---'-MA 02144 ORRSAL 0942 0072161384I TE22 NSR KNOTTY ---- R191 088.w«-«-«-»«-PCAe-1011 » »DIST: 300« 10 CO KEY: 00114851 -"'UTL- 1038 AREA. 418C1 ROLLISECLA REA18132JV: UT1: 1 27.700 pBLDG(S)-CARD-i CROYELL. JONN J JR d SANDRA NLAND A19 19C 157 FLEETWOOD PATH NPL 195 KNOTTY PINE LANE L LOT MARSTONS MILLS ''"MA 02648 NRR 0847 0170 SOLE 1189C1 ----- »-- -»-»-_------- -- »- «-»- »-»--- DIST: 300 10 CO R191 087. PCA: 1011 KEY1 0p114842 --CTL: LOC• 0185 KNOTTY PINE LA REA'S171JV•286327 ►' UT1: -'--" -- UTZ: .53 AREA: 418C ROLL S'oe 30•700 NBLOG(S)- ARD-i MILLER• JOHN LAND PHYLLIS A MILLER NPL 185 KNOTTY PINE LN NDL LOT 1 1S COLUMBUS AVE NS1 06/81 14 $00021200 I SALE10000 C8694 NO EASTON "'---_-MA 02356 NRR 0847 0150«----_- »----«--» R191 089.-- PCAe-1011 DIST: 300 10 CO KEY: 00114860 CTL:2001 L043 AREA: 418CTROLLTY ISEQNE . REA12515JV:286336 N UT1: NLAND 1 28.700 MBLOG(S)-CARD-1 FITZSIMMONS• SHANNON D & pPL 20D KNOTTY PINE LN NDL LOT 20 LC 3 FITZSINMONS• K847 ATMERINE i N51 06/81 14 f00021200 I SRR ALE007940C1345 200 KNOTTY PINE LN #UP FY96 CENTERVILLE MA 02632 ----------------------- �� In `� r R191 090. - -------PCA: 1011 -------DIST: 300---- 10 CO----- - KEY: pp114879 UT2;2001 L039 AREA: biBCTTY ROLLINE SEQIA REg11184JY:375'123 M r UT1: 1 27,900 #BLOG(S)-CAR0-1 ANTRIM, JOHN P, SR ILAND 1,000 #Pl 194 KNOTTY 194 KNOTTY PINE LANE #OTHER FEATURE 1 0S1 06/81 14 SO CENTRVILLE MA 02632 00LIS2 LOT 2 1 1 f0005450C I ORR 0347 0100 .. .. ...� I.- 17Y'3 iHGHevr vn -..____ R211 002LEGAL CONTINUATION , LAUGH C #PL SHOOT FLYING HILL RD OR 1484 0688 BOX FERGUSON;US #SR ANNABLE POINT ROAD SALE 0000 2446/ CENTERVILLE MA 32632---- ------------------------------------------- R211 001.302------------- PCA:--1011 DIST: 300 10 CO KEY: 00323452 CTL:2001 LOC• 0153 ' INDIAN TRAIL REA:4865JV: .31 4REA: 42AC ROLL SEQ: #LAND SILVER, KATHLEENuTl: UT2. MS2:SPLIT101185 XSILVERRYDER, KATHLEEN pp(LD153)INDIANITRAILiCEN000 ORR 192028 153 INDIAN TRAIL SALE 0494 91591 CENTERVILLE MA 02632 kCL22 -----___ -------------` R211 034.-----------------PCA: 1011--------DIST: 300---- 10 CO KEY: 00131468 CTL:2001 LOC: 3119 INDIAN TRAIL REA: JV: UTZ: .57 AREA:EA: 42AC ROLL SEQ: 35,122421. LDG(5)-CARD-1 DIXON, SCOTT D #lANO P O BOX 28 #PL INDIAN TRAIL CENT SALEL0586 62671 CENTERVILLE MA 02632 _ORR 1920 0038________ _-_----�-_ R190 223 -- --PCA: 1011 -------DIST 300 LOC: 1109 SHOOTFLYING ----10 JYO KEY: Op1338p7 CTL: YING HI REA:1396 UT1: UT2: .46 AREA: 42AC ROLL S'Q: 32,70U9pBLDG(S)-CARD MUILEN, JcANNE 1, TRUSTEE #lANO P O BOX 692 kPL 1109 SHOOT FLYING HILL SALEL0294 9C531 CENTERVILLE MA 02632 ORR 1484 0131------- ---___ R191-8p27.- ---Y-- PCA: 1011 DIST: 300 10 CO KEY: GU114281 CTL: LOC• 1055 SHOOTFLYING HI REA: JV:41947C i UT1: UT2.: .73 AREA: 42AC ROLL SEQ: 1299 COON, RUSSELL 0 JR i IRENE GLAND 1 39,100 #BLDG(S)-CARD-1 133 NASON HILL ROAD #OTHER FEATURE 1 13,600 #PL SHOOT FLYIN SHERBORN MA 01770 SODL ALELOT 16CLC24654 I TE ORR 1484 010U ------------------------------------------- -------------------„. R191 028. PCA: 1011 DIST: 300 10 CO KEY: 03114290 CTL:2001 LOC• 1045 SHOOTFLYING HI REA: JV: UT1: UT2: .72 AREA: 42AC ROLL SEQ: 15444 WILKINS, RUSSELL .A & CAROL #LAND 1 38,600 #SLDG(S)-CARD-1 IU45 SHOOT FLYING HILL RD #PL 1045 SHOOT FLYING HILL #DL LOT 15 LC24 CENTERVILLE MA 02632 ORR 1484 0100 SALE 0989 C11e4 ------ ---------- ----------R191 235. -------PCA 1011 DIST: 300 10 CO KEY: 00116298 CTL: LOC• 1035 SHOOTFLYING HI REA: JV:419504 M UT1: UT2: .71 AREA: 42AC ROLL SEQ: 26898 NARDONe, ROSAMOND C #LAND 1 38,300 #BLDG(S)-CARD-1 PO BOX 732 #PL 1035 SHOOT FLYING CENT #DL LOT 14 LCc 101 EAST OCEAN DRIVE 10403 ORR 1484 0100 SALE 0490 C1202 KEY COLONY BCH FL 33051 _ -_________---- ----------- R191 029.---------_-�---PCA: 1011 DIST: 300 10 CO KEY: M 114307 CTL: LOC• 1027 SHOOTFLYING HI REA: JV: R UT1: UT2: .87 AREA: 42AC ROLL SEQ: 12339 DUNNETT, JAMES B #LAND 1 42,300 #BLDG(S)-CARD-1 LORRAINE DUNNETT #OTHER FEATURE 1 600 #PL 1027 SHT FL j 1027 SHOOT FLYING HILL RD #OL LOT 13 B 128 0 51 09/80 24 fC CENTERVILLE MA 02632 #RR 1484 0100 SALE 0000 C8301 R191 p18.]02--------------PCA: 1011 DIST: 300---- 10 CO~--------M KEY: M 114192 CTL: LOC• 1064 SHOOTFLYING HI REA: JV: UT1: UTZ: .64 AREA: 42AC ROLL SEQ: 13026 HOGAN,LISA M d KELLY A #LAND 1 36,900 #OLDG(S)-CARD-i 1064 SHOOT FLYING HILL RD kPL SHOOT FLYNG HILL RD CEN #DL LOT 18 CENTERVILLE MA 32632 #RR 1484 0026 SALE 1285 4852/ ----------------------------------- R191 U13.J01 PCA: 1011 DIST: 330 10 CO KEY: 00114153 CTL: LOC. 1070 SHOOTFLYING H( REA: JV: UT1: UT2: .v6 AR=A: 42AC TOLL 13517 �INDG3EA, SiIRL_Y _ 10'1) ---------------------------------»-------------------------- R191 039. PCA: 1011 DIST- 3p0 TO CO RAF KEY: M 114405 CTL: LOC• 1084 SHOOTFLYING HI REA�2114JV: UT1: UT2: .9b AREA: 42AC ROLL SEQ: 42,900 #BLDG(S)-CARD-1 1 DAHLSTROM, INEZ F B NLAND GIAC06dI. MICHAEL J #PL 1094 SHOOT FLYING HILL SALE10990p7286/2.- 1094 SHOOT FLYING HILL RD #DL LOT B J CENTERVILLE MA 02632 ------------------------ R191 072. PCA: 1011 DIST: 300 10 CO MAP KEY: 00114691 CTL: LOC• 3231 KNOTTY PINE LA REA• JV: Ui1: UT2. .TO AREA: 41BC ROLL SEQ: 33,900 0 LDG(S)-CARD-1 1 LAMBERT, ROSALIE L TR #LAND #PL SHOOT FLYG HL KINGSLEY 30ROON RLTY TRUST 00L LOT7181602461484 01T9 #SR SHOOTFLYIhG H 231 KNOTTY PINE LANE CENTERVILLE MA 02632 SALE 1184 C98896 V-----_-- -»--------�- ST: 30 . R191 040. PCA: 1011 GIST: 300 10 CO KEY: 00114414 CTL: LOC. 0217 KNOTTY PINE LA REA'1503JV•286292 MAP UT1: UT2: .36 AREA: 41BC ROLL SEQ' 27,200 #BLDG(S)-CARD-1 1 SCANTALIDES,ALEXANDRA K TR #LAND 21 35 HA MPDEV AVE #PL 217 KNOTTY PINE LANE #DL LOT BURLINGTON MA 01803 ORR 0897 0115 0942 0115 SR SALE 1294 MKET LANE C131353 R191 071.---------------- PCA: 1011 -------DIST 3D0»-- 10 CO MAP. KEY: D0114682 CTL:2001 IOC: 0230 KNOTTY PINE LA REA: JV: UT1: UT2: .46 AREA: 418C ROLL SE : 29.1002#BLDG(S)-CARD-1 1 EVERETT, STEVE M #LAND #PL 230 230 KNOTTY PINE LANE KNOTTY PINE LN CENT ORR LOT 084710 56 159 1, CENTERVILLE MA 02632 # LC24654C SR SHOOTFLYINGHILLRD- -»-SALE 0994_C1351 . - --------------------»------- - - R191---- 10 CO 025 PCA: 1011 DIST: 300 MAP: KEY: Op1�4263 CTL: LOC• .'7214 KNOTTY PINE LA REA: JV: UT1: UT2. .41 AREA: 419C ROIL SEQ: 28,400 #SLDG(S)-CARD-1 1 YEBSTER, PAUL #LANDDL MARY R WEBSTER #PL 214 KNOTTY PINE LN CENT SAL EL01820087871 214 KNOTTY PINE LN #RR 0847 0168 CENTERVILLE MA 026.32 _------------------------- Cap e Cod Times PROOF OF PUBLICATION Legal Notices 125 legal Notices 125 1 Town of Barnstable Number 1995-157 Zoning Board of Appeals Maurice M.and Rose A.McE- Notice of Public Hearing voy have petitioned the Zoning Under The Zoning Ordinance Board of Appeals for a Use Vari- for November IS,1995 ante to Section 3.2.10)Principal To all persons interestedn,or Permitted Uses of the Zoning Or- affected by the Board of Apipeals dinance, to permit an outdoor under Sec.11OfChapt9r40Aofthe commercicl parking lot. The Generc,l Lows of the Common- property is shown on Assessor's wealth of Massachusetts,and all Map 327, Parcel 142 and is com- amendments thereto you are manly addressed as 52 South hereby notified that: Street, Hyannis, MA in a PRD 7:30 P.M. Campbell, Appeal Professional Residential Zoning Number I"S-IS2 District These Public Hearings will be Patricia Campbell has ap- held in the Hearing Room,Second Pealed to the Zoning Board of An. Floor, New Town Hall,367 Main Peals,pursuant to Section 3- Street, Hyannis, Massachusetts, I.1(3)(D)of the Zoning Ordinance on Wednesday, November 15,' for a Special Permit fora Family 1995. All plans and applications Apartment. The property is may be reviewed at the Zoning shown on Assessor's Map 191, Board of Appeals Office,Town of Parcel 026 and is commonly ad- Barnstable, Planning Depart- dressed as 1071 Shoot Flying Hill ment,230 South Street,Hyannis, Road,Centerville,MA in a RDA MA. Residential D-I Zoning District. Gail Nightingale,Chairman 7:45 P.M.Molloy,Appeal Num. Zoning Board of Appeals berI"S-153 - 10130A1/6195 William&Jeannette Malloy are petitioning the Zoning Board of Appeals for a Variance to Section 3-1.1(5)Bulk Regulations or such Provisions of the Zoning Ordi- nance as may be applicable.The Property is shown on Assessor's Map 2S2, Parcel 1S8 and is com- monly addressed as Lot 175 Cot- tonwood Lane,Centerville,MA in a RD-) Residential 0-1 Zoning District. 8:00 P.M.Sol(go,Appeal Num- ber I"S-IS4 Thomas E. Soligo has Peti- tioned for a Variance to Section 3- 1.3(5) Minimum Rear Yard Set- back requirements of the Zoning Ordinance to permit an existing deck to encroach 6 feet Into the required 10 f(wat rear yard set- back.The property is shown on Assessor's Map 194, Parcel 079 and is commonly addressed as 25 Helmsman Drive, Centerville, MA in a RC Residential C Zoning District: 8:15 P.M.CID-TREY INC.,Ap- Peal Number 199S-1SS Cid-Trey,Inc.is appealing the Zoning Board of Appeols the deci- Sion of the Building Commission- er in accordance with Section 5- 3.20).The petitioner is to present evidence to establish the use of a second apartment is In fact a use which predates the adoption of Zoning.The property is shown on Assessor's Map 308, Parcel 123 and is commonly addressed as 438 South Street, Hyannis, MA in a R B-1 Residential B•1 Zoning . District. 8:20 P.M.CID-TREY INC.,Ap- peal Number I"S-1S6 Cid-Trey,Inc.is petitioning the Zoning Board of Appeals fora Use Variance to Section 3.1.2(i)(A) Principal Permitted Uses,to al- low the use of a second apartment in the barn located on the Prem- ises.The property is shown on As- sessor's Map 308,Parcel 123 and is commonly addressed as 438 South Street, Hyannis, MA in a R.B.-I. Residential 8.1 Zoninq �i DECLARATION OF HOMESTEAD ELDE Doc z 882,542 0g-`}1- t1234 V OR DISABLED PERSON -iaao a� IT I TRY tti�eY I Lve3 j owningr nd occupy'ng as a prm 'pal residence re estate at 15 In Massachusetts being 62 years of age or older being physically or mentally disabled,.evidenced by the attached certification, and because of such disability, not able to engage in substantial gainful employment. Ownership Evidenced by: _Deed from dated I and recorded in Barnstable Registry of Deeds in Book ,Page i Certificate of Title# registered in Barnstable County Land Court. Shown as Lot: : , On Land Court Plan Inheritance from , Probate Court Docket#: County Probate Court. hereby declare a homestead in said premises under the provisions of Chapter 188,Section 1A of the General Laws of Massachusetts. Executed as a sealed instrument this 'f� day of a�/ ,20 0 I I I COMMONWEALTH OF MASSACHUSETTS I/tb)_,ss �C a- I 20 boZ Then pens appeared the above named r&I"z4o, - ` known to me to be he person(s)who executed the foregoing instrumenj ackno ged the-same to be fr act and deed, before me, �je otary b c -e1 e r a�r a�� My Commission Expires: 6� -. Pv 7r a BARNSTABLE REGISTRY OF DEEDS l'r� r OUITCLAIN DEED I, Laura J. DeRosa (formerly known as Laura J. Hogan) of Centerville, Massachusetts IN CONSIDERATION OF ONE HUNDRED THOUSAND FIVE HUNDRED AND N01100 DOLLARS ($100,500.00) PAID grant to STEVE M. EVERETT, Individually, of 230 Shoot Flying Hill Road, Centerville, XA 02632 WITH QUITCLAIM COVENANTS The land, together with the buildings thereon, situated on the Westerly side of Shoot Flying Hill Road, at 230 Shoot Flying Hill Road, Centerville, in the County of Barnstable and Commonwealth of Massachusetts, being shown as Lot 19 on subdivision plan 24654-C dated September 1968, drawn by Barnstable Survey Consultants, Inc. , Surveyors, and filed in the Land Registration Office at Boston, a copy of which is filed in Barnstable County Registry of Deeds in Land Registration Book 380, Page 58, with Certificate of Title No. 60164. Granting also the right, in common with others to use Knotty Pine Lane and Maddaket Lane for all purposes for which ways are used, . including, without limitation thereto, providing of access to and from Shoot Flying Hill Road and the installation and maintenance of water, sewer, electrical and other utilities and services, such installations or installations to be put in place by the owners of Lots 20, 21 and 23 on the above-mentioned plan. Said land is subject to and has the benefit of rights and reservations set forth in Document No. 173,623 and further subject to restrictions set forth in Document No. 134,765. . FOR TITLE REFERENCE SEE CERTIFICATE OF TITLE NO. 92133. �y Qez ty, p.i CJ TC .fr f'1 ro l ,; ' �; r.. �>• try r r1 1 C t F } EXECUTED AS A SEALED INSTRUMENT THIS 30 zz DAY OF SEPTEMBER, 1994. Laura J. DeRosa STATE OF MASSACHUSETTS 30 Barnstable, SS: September *6-, 1994 Then personally appeared the above named Laura J. DeRosa, as aforesaid, to me known to be the person who executed the foregoing instrument, and acknowledged that she executed the same as her free act and deed. WT Not ub c .T�y C1%rvd � •ekl<</ My tOmissionaxpiress������ BARNSTABLE REGISTRY OF DEEDS 5� RI'I!nrin f'r. Official Website of The Town of Barnstable =Property Lookup Page 1 of 5 L Select Language I v Assessing Division Property Lookup Results = 2013 367 Main Street,Hyannis,MA.02601 p«BACK TO SEARCH« Print Frle Owner Information - Map/Block/Lot: 191 1 026/-Use Code: 1010 Owner Owner Name as of 1/1/12 HOGAN,PATRICIA E Map/Block/Lot GIS MAPS 1071 SHOOTFLYING HILL RD 191 /026L CENTERVILLE, MA.02632 Property Address Co-Owner Name • " 1071 SHOOTFLYING HILL RD. Village:Centerville. Town Sewer At Address: No, GIS Zoning Value:SPLIT RD-1;RC Assessed Values 2013 - Map/Block/Lot: 191 /026/- Use Code: 1010 2013,Appraised Value 2013 Assessed Value Past Comparisons Building $83,000 $83,000 Year Total Assessed Value Value: Extra $36,400 $36,400 2012-$270,700 Features: - 2011 -$283,400 Outbuildings: $43,900 $43,900 2010-$284,200 Land Value: $120,600 $120,600 2009-$316,700 2008 $362,700 2013 Totals $283,900 $283,900 2007-$333,300 Tax Information 2013 Map/Block/Lot: 191 /026/- Use Code: 1010 Taxes a C.O.M.M.FD Tax(Residential) $420.17 Community Preservation Act Tax.$74.61 Fiscal Year 2013 TAX RATES HERE Town Tax(Residential) $2,486.96 $2,981.74 Sales History - Map/Block/Lot: 191./026/ - Use Code:1010 History: Owner: Sale Date Book/Page: Sale Price: HOGAN, PATRICIA E 6/14/1979 C78472 $0 Photos 191 1 026/ - Use Code: 1010 40 http://www,.town.bamstable.ma.us/,Assessing/propertydisplayscreenl3.asp?ap=0&searchpar..." 5/6/2Q13 \,�, .5 ♦r .. ^t;�•!!`r'grj'g.""-CT'. Y'-�}.2! rr--Y�./ "'ram— .., ... ;. As sstfr's map'�d lot_number ��.��a2�a r.r,[`�TJ��^(�•'�J/Y), 'f''' .J' f•� , ti oGTME > ?''.•�.�. ,. . .��{ y. _c �" - 5''! ... f_r rQ.L •`, h 'r'.�, Qr ' ��S f .fR t.7 i�� Y -. lf., t '` ', / L t O. 4+ 0 "� Lfl.,T• \ ..'.`c -i,Y� cq O�Y{r O.A '.��5; �°1e`R�l. Sewb e"pPerm t ,number;r �I , , .Y.�. ... - I•+� '' v + . — <J h �� S�S•YY�T�n [• ;/ •!' ,�- .':- ;. S 1' r p, ('� C• f 1't '. 1 J "11 j� � F! L � I ' i•< 1 .. :, r i'Fn t;7 1'�' ��Y�' ti •3.Gl R f' +2 k.i_.W,rT •� House rtlimber� .m t.,s .� r `ar, r ! 1, ?, p so• 'EQ t �r zR.;N� TABLE Ao' . yam, t k }rl ri' < :s. •Y. i i j.. �l{C,�J. } 't•'I i t�� 1 i r j�'1�'1. a'�'�1� •7N 4 5�'.a: y i.� r�'/'y'}+TeHN�+r ri.� 5( ,.h t ..F�fC _. T t � 11�'S a� L � �. a {r' -t L ,/ � `��.`a'°�� d 7 t'1�5, !'`�-..F� f�e ' �'� �:7 � .ei }� 1 i i'�" i 7•i i,.�t6,$j .-� ? > ti• � � ;: � "W5-! l 4�5��" r. �. .1 'i ..� �.{�. i w•• •-h A 5ry�.f,'rS *,y S� tir r '�• G y� 7ytt' '`�*` 7 p ,f°ryw =" y r' a <.' ,a,1�i �S .tf.,� f •+�°.};, D y"y`�-1 e - "7 tlt?l+.rt�F7r,�.i f..+`>.rr .i7�• {"( F �i'k k r!{ I #p* Jr' o - r�•_r . 1� r�B%�.�U�_I�.;D �C1`O R,. 1y'Y. �J ..p'h Q-•„�` yy {� � i ♦ r ',f S � t F i ..• �." +�,,�, h� �j �,, .4ti. 1";m� t y�` J ^�4"r •yaeWft'� r�f• �s� E�' ,7 J��� i i c (, 1 r e �. . � c:'i:•'ems'�r r �`�w�r�k�' I. 'x" ; Lt^� r 9; i. '� �sia '^`a' j�ii+,,j Y�'• ram• "�'` ,u+S �S � c 1 3 .f"1 .`h + F ?F �.. b`x" '• ,rld a �tr i�r},y Ir ✓ }h1; r�i�, 7�';`r j a. �}�, '� .:54�1 u'`u � 1�, d ,'eta a .••,M,� '' •�tii.'r" ?�,r a.r.,�4 t� ._s n x"r°`?`-• �l�r .'F M�L�,r'k"•'-a+'• y, i v i�t r. '7v •(; .,tj ^. r h4a� c v:cc �'�. �- �i,.r r f .? FrJ � + Jh P c tf t x t% r .V�r < r 'Y'� J :.:l::iii::1�S: �.5�'1Y x. 1 ✓;Lriij j. i - �••3-h.Z � Y ! 7 ��c � Q. t.. le►P UCATIONR-Ic01�PERMIT-,tO .'� -3r,7- 5 +��.�: "r r``. 4.f 2L.}. { 4 •.b { r E .� ,1...Le4.:i w. ;t.;j•� C']' ..1 �YXk r r ef�%Sri+:n .?i ik (y�.. 't" ^� �{a'.�f � v,��.�t'�1 vy � 3 f� ^n 5..._'��r5'. %r'.. ` ��35�". `�LRt 1 fi'f"..• r,�yi� 4'��b�r i f�'-w,fyw55 ` 3 7,23 lf E OF,,CONSTRUCTIOW{; z � s,4i d 'ir i 7' ,�� "�� 0•:'V ' �.a lj, ° �r t rtY ? e � �, S w � v � ��a: .d ,.aC , ' ti r.y h�f-Ci •,K( � �.r -y•r a F' h •�"f`�;S h �._•Y t c� �...k. c s nY; �K 3 h ' Fra: ,.Y r$.. •[ F •r'-�. Y • '�� �y r• r j s t M r d p '`fit 6 4 t Y Z 7.1�r r r } r t•'F �,_ - ,�.�c� r• �1 � r, � t � ', iY�> s r T .. r • . / �. s. •,r �g;i }�'w-r-i M71 �� .� µ'{.•gf. �" Yr{ O.. ! ` .••.•:•1{ • ••• ••••t•• •.11��� r�9 F� 11VSp CTO F,�'Bt;�ll'DIIVG 1 ,. "� '• r�„ r r�r,; c '(��'�}y�'= •t-) .]• r° ,y r � t 5• ^:r-' +�-• -#�. I+`t y „ice f :.". r� q Y '0'j;:,5r1b.'. -.i,�4a r. .r'h '+�^� n`' a 4 �r"�ir' tb';thez following lnforrnatlort f� iid hec0herebyfr�ipp�le`s_ or a ;perirtlt2aaorcling y. 4 � �»-f •/I, ]� 1 }ram 1 ` I I P �1f Location' .,�f) -//.� r t,• •' ' Proposed Use .. °,, .&' (-- •••• "' •• ,f Fire District...................... y } Zoning '_Districf ..................... _ Nome of Owner Address ;( �—Z. ,�k:ao 1 .-1 a� Address ....Zcrl.w A.WC 1 �•►¢ � � ) . 17L } Name'of Builder,....::, W�. n/• 1 t• , ... M � Name�of.�Architect ............................ ...:. .............. ... .... .Address s - .............Foundation .. e.Ll&j. l.1L.fi! .... ..... Number of:.Rooms ... .... �f .... .. Roofing 4 .. .tt`i� cc /.. j Exterior !�/ . Floors �.. S'.l'1.:�.!V.q......... ...... .;�:. .. ...................... Interior ....................... ..... ............................................. t� ;�---- Plumbing Heating, ,. � 5 y ., f� c •• 'i O� > 1 �( j •.,�- F7replacer� s 1 Approximate Cost ... ........ ...... • f . Definitive Plan-Approved,-.by Planning Board Area ........ti...�:./.... .... g g . Dimensions Fee .. .../�..J t..�rr�......... , Dia ram:of Lot and Buildin with SUBJECT.'TO APPROVAL OF.'BOARD OF HEALTH r7 41 LP t i � y 9 4 the above_ Barnstable regarding rdin e hereby agree to;.conform to all the Rules and,Regulations of the Town of Bars g g., construction. Name ..; 1 .: �� ... .x............................................. �HOGAN..r�_�° '-r"� ice=,c. � _ r - _ y . . . ,� = ., ... • . PAT ti].91a`26` � ,t eax r � - Z Vl $ S _ m rr _ rr p N , ys k— .J r RA'�IE G J r o L fo 2.C4.S P or BUILD F ... GFS $'. E_. r a� - ermit f i Q , C. m L N' Arce�s, r � rr:fir r 's_ `� —� - C 1Z ..r0 . O O - !1 '� n ti 1 �`•.�_ .1 ' -iT7f - . .. s. $QYm Aloie.],1,in _ m v . o �- ° N N l } Location �� lrg try '. y �, ^ - o o Q y� m Cr 3Q r a o n Owner` P.at.'Hogan r: o -� ,w r - t n Type of Consttud ...... F'r3m _ m + , i� f� : c o 1: NZ 3 ell -k Y '•• �'j'1 Al l Piot ... LQi ,b d Q1 t 1 Perit.Granted .p NCv m o em" •- i.. 1 9` $;Q' o '' = �,. kA Date of Inspectio A �r�. 9.9 °i �,�` ,; -0 Date Completed 9', z rr Q o o c QOr ! _ r ` •_j ` \ _- C� CD PERMI• CD REF ,.s.7g®¢ _.,.. .j .� f _ ✓' j. _� 1 ,r 'i-a 1 - ,*" M . o.� -,.t err )r : :i- _, - O _ a+ • L [ t�' -cam �•. Lf• ' _ O ............. .. A""'; � �_� .� ' \{ Irk• � lr ..7 � � ........ ? ....... .. �.. cu fm .P Qvecl''.a�Oa L ..... ........... .... ... . r I ^} x - . 41: _ - Application numbe ../.............:�.... .... 'tt Fee .. .. �J + .................. ........................................ - ` ,` Building Inspectors Initials..2 ..R.. s16� o. pia Date Issued...!! .^ — .. i. � � ... ........ ..... �� � Map/Parcel........... o... .................... �® TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 0-11 0 Kv NUMBER S E VILLAGE Owner's Name: Le� Phone Number 'S q-C-,'7 YS Email Address: �-�UPhone Number �� Project cost$ Check one Residential L--'- Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a buil ' t in accor with 780 CMR Owner Signature: Date: TYPE OF WORK U Siding ED Windows (no header change)# Insulation/Weatherization Doors(no header change)# Commercial Doors require an inspector's review t..0"Roof(not applying more than 1 layer of shingles) Construction Debris will be going to ctt c�S CONTRACTOR'S INFORMATION Contractor's Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# l:-� I ' 0 44 7 (attach copy) Email of Contractor 0&9--C�oq- V'- �v, t'1�[ Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER.........................................;:::.......,.�; .. *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or> Yes No , if yes, a gas permit is required. Natural Gas Yes No ,if yes, a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit ap acations are subject to a building official's approval prior to issuance. �= The Commonwealth of Massachusetts Department of Industrial Accidents — — Office of Investigations _ 600 Washington Street - Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatiowhdividual): � kep A, Q Address: A -� City/State/Zip: t C Phone#: S d T7�(' Are you an employer?theck the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. 1 am a general contractor and I 2.[�ployees(fall and/or part-time).* have hired the sub-contractors 6. ❑New construction I am a sole proprietor or partner- listed on the attached sheet. 7. [a'Remodeling ship and have no employees These sub-contractors have g. 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 employees, No workers' 13.1-1 Other comp,insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state Whether or not those entities have employees, if the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.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 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-ve.P:99atie I do hereby certify under t airs and penalties ury that the information provided aPovi is true and correct Signature: Date: ff Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#: 1, � C- 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 shafl 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 number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city-or town-that the application for the permit or license is being requested,_not the Department of ' llG-J�--- ramrirarj to nlitain a workers' Ind strnal Accidents. ShoulQyoul3aw;airy UUUUz,LQ;r, u 5 Y 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 permi0cense 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 maybe 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 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 De4partnent of Thdust al Accidents Office of-Investigations 600'Washii a gton Street Boston,`MA 02111 TeL#617-727-4900 ext 406 or 1-977-MA.SSAFE Fax#617-727-7749 Revised 4-24-07 Www m=,gov/dia 9"'SN✓' .. mas's blu Nj Olaf, ji, g _ 1r IQn �C W' i•'W+i' 1 w e.N t-.•r`b.is .p 1 _ rkT•:6 * r - cw f,.,�ka, ft* 74 J � , x� a r 5 ,a.1 �' i r4 :�C•e�R i_u 4'a"T,. <.,t, - � , fK,�.4r.��nr�, .ro �.. "{'"t> F%'Rr �,�v^�+`�t �"'#�3 �` �*- .l �., ,A ,i, far'� ��,�"'T`_`+•M+ a.�- �� 'v'v.��c,r��. .. "�`r� R�';�� �&i"��'.� )I � 5 � �_,A ��yy to �'#•Ni€ ��,k` '�. Doc: 1v102.399 12-05-20031 11 :03 BARNSTABLE LAND COURT REGISTRY THE COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE OFFICE OF THE COLLECTOR OF TAXES INSTRUMENT OF TAKING I,MAUREEN E.NIEMI, Collector of Taxes for the Town of Barnstable,pursuant and subject to the provisions of General Laws,Chapter 60, Sections 53 and 54,hereby take for said Town the following described land: Hogan,Patricia E. Land located at 1071 Shootflying Hill Road,in Barnstable shown as Assessors' Parcel ID 191026,being Lot 17-A on Land Court Plan 24654-A,Registered At Barnstable Registry District Certificate 78472,Document 252589. Said land is taken for non-payment of taxes as defined in Section 43 of said Chapter 60 assessed thereon to: Hogan,Patricia E. for the year of 2005,which were not paid within fourteen days after demand therefore made on October 17,2005, and now remain unpaid together with interest and incidental expenses and costs to the date of taking in the amounts hereinafter specified,and after notice of intention to take said land given as required by law. 2005 TAXES REMAINING UNPAID $ 2195.62 INTEREST TO DATE OF TAKING $ 1200.49 INCIDENTAL EXPENSES AND COSTS TO DATE $ 58.40 DEMAND $ 5.00 SUM FOR WHICH LAND IS TAKEN $ 3459.51 WITNESS my hand and seal this 5`f'day December,,2008 Collector of Taxes for the Town of Barnstable aureen E.Niernf THE COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. On this 5'h day of December,2008,before me,the undersigned notary public,personally appeared Maureen E.Niemi,personally known to me,to be the person whose name is signed on the preceding document and acknowledged to me that she signed it voluntarily for its stated purpose as Collector of Taxes for the Town of Barnstable. BARSARA HARRIS NOTARY PUBLIC Barbara Harris,Notary Public commonwealth of Massachusetts My commission Expires My Commission expires: 09/24/2010 September 24.2010 BARNSTABLE REGISTRY OF DEEDS Patricia Hogan Campbell (Gorman) CapeCodOnline.com Page 1 of 1 r i w,. Patricia Hogan Campbell (Gorman) December 07,2004 2:00 AM CAMPBELL—Patricia(Gorman) Hogan,64,died Saturday, December 4,2004 at Cape Cod Hospital after a brief illness. She was the wife of Walter Campbell. She was also the wife of the late John F. Hogan. Mrs. Campbell was born, raised and educated in Boston. She moved to Cape Cod in 1979 with her family.After raising her children she attended Cape Cod Community College and worked for the Barnstable School Food Service and worked many years for the V.N.A.of Cape Cod before her retirement. Mrs. Campbell enjoyed traveling,gardening,friends and family and beloved Patriots and Red Sox fan. Survivors include two sons,John Hogan and Matthew Campbell, both of Centerville and four daughters: Laura DeRosa and Kelly Sanford of Centerville, Lisa Pappas of Forestdale and Maureen Kent of Coventry,CT.Also two brothers, Kevin Gorman of Charlotte, NC and Donald Gorman of Arlington, MA, ten grandchildren and many nieces and mephews.A funeral mass will be held on Wednesday, December 8,2004, at 11 AM,at Our Lady of Victory Church,230 South Main Street, Centerville, MA. Burial will follow at Mosswood Cemetery in Cotuit, MA. Please everyone meet at the church. Memorial donations may be made to The Champ Youth Home, 83 School Street, Hyannis, MA 02601. Copyright©Cape Cod Media Group,a division of Ottaway Newspapers,Inc.All Rights Reserved. http://www.capecodonline.com/apps/pbcs.dll/article?AID=/20041207/OBITS02/312079953... 6/5/2013 r �e�o. _ a Town of Barnstable Zoning Board of Appeals Decision and Notice Appeal No. 1995-152-Campbell Special Permit- Family Apartment Summary Granted with Conditions Applicant: Patricia Campbell Property Address: 1071 Shoot Flying Hill Road, Centerville, MA Assessor's Map/Parcel 191/026 Area 0.74 Acres Zoning: RD-1 Residential D-1 Zoning District. Groundwater Overlay: AP Aquifer Protection District Applicant's Request: Special Permit for a Family Apartment Section 3-1.1(3)(D) Family Apartment Filed October 3. 1995; Public Hearing November 15, 1995, Decision Dec.29, 1995 Background: The Applicant is seeking a Special Permit for a Family Apartment pursuant to Section 3-1.1(3)(D) of the Zoning Ordinance for a Family Apartment. for her daughter and son-in-law. The property is shown on Assessor's Map 191, Parcel 026 and is commonly addressed as 1071 Shoot Flying Hill Road, Centerville, MA. This lot is 0.74 acres and is located in a RD-1 zoning district. The area is generally residential in nature and lot size range from 1/2 to 3/4 acre lots. There are two structures on the lot. The apartment is in existence and is located above the existing detached garage. Procedural Summary: This appeal was filed at the Town Clerk's Office and at the Office of the Zoning Board of Appeals on October 03, 1995. A Public Hearing before the Zoning Board of Appeals was duly advertised and notices sent to all abutters in accordance with MGL Chapter 40A. The hearing was opened on November 15, 1995, at which time the Board found to grant the appeal with conditions. Board members hearing this appeal were Ron Jansson, Richard L. Boy, Emmett F. Glynn, Thomas DeRiemer and Chairman Gail Nightingale. Attorney Arthur Hyland represented the applicant in this request for a Special Permit. He addressed all of the requirements specified in Section 3-1.1(3)(D) citing that this is the only apartment existing on the property and that it was developed and occupied by family members. It was developed in an existing detached garage, on the second floor and did not change the residential character of the lot. He noted that the apartment occupied some 472 sq.ft., and is less than the maximum size of 50% of the principal dwelling which is 1,296 sq.ft. The structures all meet the requirements of the district's setbacks as shown on a survey plot plan of the property. The property owner and the residents of the family apartment are year round, permanent residents. Occupancy of the apartment is by two family members as documented in the affidavit submitted. He also stated that the applicant is aware of the other requirements of the family apartment, the annual affidavit filing, occupancy permit and requirements if and when it is vacated. He stated that the applicant will maintain the apartment unit in full compliance with the provisions of Section 3-1.1(3)(D). Attorney Hyland addressed the staff report and submitted hand drawn layouts of the unit to further clarify it size. He stated that the applicant will comply with all requirements of the Health Department including meeting of the new Title V requirements for on-site septic system. The Board asked Attorney Hyland if he knew why a petition was circulated and submitted to the Board requesting that the Board not grant the family apartment Special Permit. He stated that he does not know why this petition was circulated or what the reason for objecting to it was. Public was asked to comment. Speaking in favor were Steve Everett, Charlene Antrim, and Kelly Sandford. Speaking in opposition was Paul Webster, an abutter. His main concern was the barking dogs. Richard Lajava was concerned regarding the disposal of the waste material. When the septic system is corrected, he will have no objection to the family apartment. Zoning Board of Appeals-Decision and Notice Appeal No. 1995-152-Campbell Finding of Facts: Based upon the testimony given during the Public Hearing on this appeal, the Board unanimously found the following findings of fact: 1. The property at issue is located at 1071 Shoot Flying Hill Road, Centerville in an RD-1 Residential D-1 Zoning District and AP Aquifer Protection District. 2. The petitioner is seeking a Special Permit which is allowed under Section 3-1.1(3)(D), and based upon the testimony given, the petitioners do comply with the provisions of this section. 3. The property consists of a lot that is approximately 3/4 acre. The present use of the property is residential with a single family residence. There is a garage with a family apartment. 4. The proposed family apartment does not exceed the allowable square footage and the occupants are family members that are year round residents of the Town of Barnstable. 5. In granting the relief, it would not be in derogation of the spirit and intent of the Zoning Ordinance nor would it be detrimental to the neighborhood. Decision: Based upon the positive findings a motion was duly made and seconded to grant a Family Apartment Special Permit in accordance with 3-1.1(3)(D)with the following conditions: 1. The petitioner at all times must comply with and maintain the family apartment in compliance with the provisions of Section 3-1.1(3)(D). Failure to do so may result in the revoking of the Special Permit. 2. The petitioner must comply with all Title V Regulations and Department of Health Regulations. 3. Prior to occupancy, affidavits listing the names and family relationship among the parties seeking approval have been signed and shall be signed annually thereafter for the duration of the occupancy. 4. This Special Permit is not transferable and is only issued to the Applicant. The Vote was as follows: AYE: Ron Jansson, Richard L. Boy, Emmett F. Glynn, Thomas DeRiemer and Chairman Gail Nightingale NAY: None Order: Special Permit Number 1995-152 has been granted with conditions. This decision must be recorded at the Registry of Deeds for it to be in effect. The relief authorized by this decision must be exercised in one year. Appeals of this 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. , 1995 Gail Nightingale, Chairman Date Signed I Linda Leppanen, Clerk of the Town of Barnstable, Barnstable County, Massachusetts, hereby certify that twenty (20)days have elapsed since the Zoning Board of Appeals file d this decision and that no appeal of the decision has been filed in the office of the Town Clerk. Signed and sealed this day of 1995 under the pains and penalties of perjury. Linda Leppanen, Town Clerk 2 Town of Barnstable ja i; X% U.S.POSTAGE$'airNeveowEs Building Division 200 Main St. _. Haannis. MA 09601 ZIP 02601 $ 000.460 02 1NV . 0001383424 AP.R. 30. 2013. Hill Road 02632 a � _ .L .b ' In 1 ---------------------------------------- Town of Barnstable f U.S.POSTAGE>>PITNEY BOWES Building Division 200 Main St. Hyannis, MA 02601 r ZIP 02601 $ .460 02 1 YV 0001.38.3424 APR. .30. 201.3. Laura DeRosa 1071 Shootflying Hill Road Centerville, MA 02632 . ,y.?R ;_114` EXP RT!a T u mi d DER0-S A jt _ j to N ^ BARNSTABtE i ' 6" Div. A f r Y. . 1. aos �� Sheer �t��sd��.._ _ iS t.(�u rw � - G��1�''' �l,t,�t<�-/n�-t l v c�C- .::n 'µw;r•=;ax: ,,.,w,8arv,,.,: 771 rr,."a.+«,,�a,u-,."aws http,jjFalrnouth.patriotproperties.comiSumrnary.a p?AccountNurnber=9443 Li+re Search r `; �, ��. �., �• � � :era . , _� �. _., . t �. ,.,, ;, P.a aE Fa4 ices � ,�;.a. � m �' �79 Summar ,a, _kb �, -- .. w.. :. �:: , e=. y . a: , x: ,,, .� ...a.. :;c,. -,.r t•-':�.a G. ., , a.a,i... ,.,� .R ,$., ml a4, .:2 xt , + a- u q.k ..m�s. sue, „a; tl „v a'+ Px k x, s-.. x + •. �3 65''a�':; ' $_ :N":.='.•w ;=aw.*4'a;a$N$&�.*a",,. 4a+*+'r€ .., .+�,2 W 'R a: •: "P ta'5e<a .. �':,' a ass. _ ''k �i *»... ,. >,.y�Y: s , :. - ATM-*I Card. 1 of f Location 205 LAKE SHORE DR [--Property Account Number PFNECREST Parcel ID 27 b5 Ildl (}Ia4 Old Parcel ID Current Property Mailing Address -� Owner LACERTE TRUSTEE GHI.SLAINE C City WEST HYANNISPORT GHISLAINE C LACERTE REV TRUST State MA Address PO BOX 2 Zip 02672 Zoning RC Current Property Sales Informetian Sale Date 61112007 Legal 'Reference 22076-82 Sale Price 1, Granter Seller LACERTE,GHISLAINE C Current Property,,Assessment Card l Value Year 2013 Building Value 1.05,400 Xtra Features Value 400 Land Area 0.241,g,& N"ISIA10 Land Value l71 �t14 -- Total Value 276,800 Narrative Description his property contains 0.241' acres aft rid airily lassifed as ONE FAMILY with a[n Ranch style building, built about 1957, having Vinyl Shing exterior and; � halt roof cover, with 1 units ,.4 tote rd Us], 2 otal l�edf`<�am s , 1 total baths , 0 total half baths , a total 314'bath:s �> Legal Description %r n 31t4�.b71VU tJ i:mlrl., °.;�.:# u. w' .,_' ^. as :. x •... y,. .-......, A r a Done t , : fi s#` , 4 #,, iI >" Inter r1 1�Q% l tarn Inbox: MicrosoFt OutL.. Ton of,Falmouth-.A Mom S stem Menu T,.. # Ircation Entr. --Mu., � mar: ::: - � s- �12.45rPM: Sum. Window � i [ ] [R191 026. ] LOC] 1065 SHOOTFLYING HILL R CTY] 10 TDS] 300 CO KEY] 114272 ----MAILING ADDRESS------- PCA] 1011 PCS]00 YR]00 PARENT] 0 HOGAN, PATRICIA E MAP] AREA]42AC JV] MTG]0000 1071 SHOOT FLYING HILL RD SP1] SP2] SP31 UT1] UT21 .74 SQ FT] 1296 CENTERVILLE MA 02632 AYB] 1965 EYB] 1975 OBS] CONST] 0000 LAND 39300 IMP 130200 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 169500 REA CLASSIFIED #LAND 1 39,300 ASD LND 39300 ASD IMP 130200 ASD OTH #BLDG(S)-CARD-1 1 90,700 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #BLDG(S) -CARD-2 1 39,500 TAX EXEMPT #HN 1071 - RESIDENT'L 169500 169500 169500 #SN SHOOT FLYING HILL RD OPEN SPACE #DL LOT 17A COMMERCIAL #S1 05/79 21 $00043900 I INDUSTRIAL #RR 1484 0100 EXEMPTIONS SALE]00/00 PRICE] ORB]C784720 AFD] LAST ACTIVITY]00/00/00 PCR]Y R191 026. A P P R A I S A L D A T A KEY 114272 HOGAN, PATRICIA E LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RD- 1 39,300 130,200 2 A-COST 169,500 B-MKT 99,700 BY 00/ BY ME 11/88 C-INCOME PCA=1011 PCS=00 SIZE= 1296 JUST-VAL 169,500 LEV=300 CONST-C 0 ----COMPARISON TO CONTROL AREA 42AC -- --MAY NOT BE COMPARABLE-- NEIGHBORHOOD 42AC CENTERVILLE PARCEL CONTROL AREA TREND STANDARD 10] 10 LAND-TYPE 39300] LAND-MEAN +0% 169500] 98925 IMPROVED-MEAN +32% 20% ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 100%] LOCATION-ADJ APPLY-VAL-STAT 1 LNR]LAND LFT/IMP]ADJS/SB/FEAT STR]STRUCTURE ARR]AREA-MEASUREMENTS NOR]NOTES COM]MARKET INC]INCOME PMR]PERMITS GRR]GRAPHIC FUNCTION-[ ] STRUCTURE-CARD NO-[000] DATA-[ ] XMT[?] R191 026. P E R M I T [PMT] ACTION[R] CARD[000] KEY 114272 00000000] PERMIT-NO MO YR TYPE VALUE CK-BY MO YR %CMP NEW/DEMO COMMENT [ l [ ] [ ] [ ] J [ ] [ ] [ l [ ] [ J [ ] [?] Town of Barnstable Gy Building Department Complaint/Inquiry Report 7 Date: - - 9 S Rec'd by: Assessor's No.: / 91-Da 77/` 7.5"a7-P Complaint Name: Location Address: /6 ✓� ��` � � / M/P [ L Originator Natne: Street: /G 7 Village: ( State: Zip: G 3� Telephone: D/C 7 7 'l 1 Complaint a Description: -� Inquiry Description: a For Office Use Only Inspector's C� Action/Comments Date: / 1�/ �S Inspector. a� Gti �t a 1 Follow-up Action w Additional Info. Attached Copy Distribution: 4Vhr'te-Department Me 3 eBow-Inspector Pink-Inspector(Return to Office Manager) --�--'--`F- -:�'=-'- ----------'----- -------------.— PURCH. DATE :onc. Slab Bsmt.Garage St. Shower Ext. Walls _ _- ---- PURCH. PRICE Irick Walls Attic FI. &Stairs. Toilet Room Roof RENT :tone Walls Fin'.Attic Two Fixt. Bath ----- --- - RENT Floors iers INTERIOR FINISH Lavatory Extra ------- --------- --- q Ismt. F f 2 3 Sink - --' --- Attic - /4 '/: r/4 Plaster Water Clo. Extra - ------ ------------------- U"`T EXTERIOR WALLS Knotty Pine Water Only __-__ -____________-_-_ N. /•".{ ouble Siding Plywood No Plumbing - Bsrnt. Fin. ingle Siding Plasterboard - Int. Fin. wJ -- Shingles TILING ✓C- anc. Blk. G F P Bath Fl. _ Heat ------ /.- ----/_� ace Brk.On Int. Layout / Bath .&Weins. Auto Ht. Unit OdU Veneer Int.Cond. Bath FI. &Wells , Fireplace f ----- S /y /9� /J- 6G. EL'D/�p/U om. Brk.On HEATING Toilet Rm. FI. - -- Plumbing 7 ,20 olid Com. Brk. Hot Air Toilet Rm.FI. &Wains. / Tiling - Steam Toilet Ron. FI. &Walls 3G •lanket I'ns. Hot Wate St. Shower / oof Ins. Air Cond. Tub Area Total J y Floor Furn. _ ROOFING yyvrS COMPUTATIONS / .sph. Shingle Pipeless Furn. // S. F. lood Shingle No Heat % S. F. 5/ O Q ,sbs. Shingle Oil Burner / S. F. late Coal Stoker S. F. He Gas - S. F. OUTBUILDINGS ROOF TYPE Electric able Flat S. F. -_ 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 MEASURED !ip Mansard FIREPLACES S. F. Pier Found. Floor �_ _,_�l, ;• lambrel Fireplace Stack - Wall Found. 0.H. Door LISTED FLOORS Fireplace Sgle.Sdg. Roll Roofing onc. LIGHTING Dble.$dg. Shingle Roof arth No Elect. - - DATE - Shingle Walls Plumbing ine lardwood ROOMS Cement Blk. Electric PRICED .sph.Tile Bsmt4 f 1st TOTAL Brick Int.Finish :ingle 2nd 3rd FACTOR (_;� REPLACEMENT OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL. >W LG. rG m / y.�. /G'%I. a%"� I �-+' �r a 3 S6 �.� 0 3(a 3 .2 63 3 r 4 5 I 6 - I 7 B 10 j 771- 7s,Zq RESIDENTIAL PROWRTY MAP NO. LOT NO. FIRE DISTRICT SUMMARY STREET 1071 Shoot Fl,;inl( Hill Rd. Centerville 191 26 ----------- ----- 13 LAND 0 3 O C-�0 BLDGS. OWNER 0) TOTAL 3 0 7 S LAND RECORD OF TRANSFER DATE SK PG I.R.S. REMARKS: Lot # 1 7A LC #24654A BLDGS: rn TOTAL q ��J LAND BLDGS. Hogan, Patricia E. 6-14-79 Ctf. 7847 ($43 900. TOTAL -- -- ---L/ -- - LAND S h o o 7 )l1/;A/ �Y i / d _ BLDGS, T n J _ TOTAL /'� r Z V I l/ �U C(� 0 cJ 6 Z ---- -- -- - LAN D - -S'�., ----- BLDGS. TOTAL LAND — — l C/{M►t'" Z2G ys iY01'b lN� ��/��� � BLDGS. TOTAL -------�— ---- LAND BLDGS. -------- - -- 0) -- TOTAL LAND INTERIOR INSPECTED: BLDGS. DATE: 3 - 7 TOTAL X 3 v� ��✓e11,1;z%l ". LAND ACREAGE COMPUTATIONS a) BLDGS. LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL HOUSE LOT '�O o ZV2 0 O /0 3 O U LAND CLEARED FRONT BLDGS. REAR TOTAL WOODS&SPROUT FRONT — LAND REAR BLDGS. WASTE FRONT TOTAL REAR LAND -- --- -- _ BLDGS. TOTAL . ---- -------- --- -- . LAND / ---------- ----------- ----- BLDGS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT. PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ROUGH TOWN WATER rn BLDGS. HIGH GRAVEL RD. TOTAL LOW _ DIRT RD. LAND - —---_- -_-- --- —----— SWAMPY_ NO RD. a) BLDGS. TOTAL ROPERTY ADDRESS - STATE KEY NQ. ZONING DISTRICT CODE SP-DISTS.I DATE PRINTED I I PCS I NBHD v CLASS 1065 SHOUTFLYING HILL R 10 RD-1 30C 1000 07I09/95 1011 0) 4-As R191 0cb. 114272 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS Ty UNIT ADJ'D.UNIT Lana By/Date sae Dimension ; ACRES/UNITS VALUE Descnpuon / CD. FF oe Ih/Aces ,LOC./YR.SPEC.CLASS ADJ. COND. PE PRICE PRICE H O GA N i PATRICIA E MAP — CARDS IN ACCOUNT .— @ATHS 1 .0 U 1 X I C= 100 I 3500_0' 3500.00 1.00 35t�0 3 �2C>F 02 i CST^ ��- i I I ARKS' 9970C INCOME A SE i CI I I I I APPRAISED VALUE J i ( I A 169.500 U OARCEL SUMMARY ,,,U 39300 S - LDGS 13C20C k _ i I I I —+IMPS rv1 i I I i i -0TAL 1-95nn E I I I li C N S T I I i I I I I I DEEDDEED RI— DATE I� o oea R:O( YEAR v ik i u E .. `. I I I BOOk Page Ins:, —I S.Ins PriEi A y✓ LDG� 1�3 v}?aniv OTAL 1A 511C i I I I I BUILDING PERMIT Number Dale Type I Amount LAND LAND—A DJ INCOME RISE i SP—ELUS i FEATURES BLD—ADJS UNITS 3500 Consl. Total Vear B It Norm. Obsv Units I knits I Base Rate I Atlj.Rate AClual I Age Depr. Cpntl. CND I Loc 14e R.G Repl Cost Naw Atll Repl Velue $tone= Height Rooms Rms eama I Fix. Pertywefl Fee. 08C 000 100 100 72.10 72.10 00 71 23 76 100 76 51951 .39500 1.;3 2 1 1.0 3.0 I—Descrlptiu Rale Square Feet Rep1.Cost MKT.INDEX: 1 e O0 IMP.BYIDATE: 1 1/88 a8 SCALE: 1!01.l�� ELEMENTS CODE CONSTRUCTION DETAIL I BAS 100 I72.10 672 48451 GROSS AREA 672 o NSl ------ .:J - -----24----------* STYLE 13'ARAGE X OTRS 0.0 i JD ------------------0:0 j - E�IGti ADJMT ! ! -XTC;4.da1L5 - -TT SNrNGL-ES---_0=0 I ! EAT/AC-TYPE- -03 LYCTRZ-C----------K0 ! ! NTFR.-FIWSH- -J4 RYWALL-----------0:0 ! ! I NTC4 LAYGUT- -1Z I VICR 1YffRMAt-----U.O ! ! INTtT:lUACTY- -J2 3 AKr-AF-EXTFIT.- _T.-O i ! ! FLJJR-3TR-UCT- -;J4 ­0WCRETE-SLAG---- :O D W 28 BASE 28 E LDJ;R-C_JVER-- -04 71TFPET-------------T:O E Total aeas Auz= Base= 672 J 1 A dL E=WS- P H ._0 BUILDING DIMENSIONS ! ! LEFrR I-CXE _GT VFRAGF TI.O T BAS W24 N28 E24 S28 :. ! ! O;I;Y6AT-1-UN--- JSLUNC,ETE-StA-9--9Y=9 A ! i L LAND TOTAL MARKET ! ! PARCEL *-----------24----------X AREA VARIANCE +0 +0 STANDARD 'ROPERTY ADDRESS I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED STATE CLASSPCSNBHO KEY No. 1005 SHOOTFLYING HILL R 10 RD-1 300 loco 07/09/95 1011 JJ 42A ' �RJ91 0 6 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS Ty, UNIT 'ADJ•D.UNIT tans By/Dale s=e omenson LOC./YR.SPEC.CLASS ADJ. COND. PE PRICE PRICE ACRES/UNITS VALUE Description H O uA N P PATRICIA E MAP- CD FF.De mlAcreS 4 L A N D 1 39.300 r- CARDS IN ACCOUNT - i. 11D 18LDG.SIT 1 X .7 =10 1181 44999.9 53099.9 .74 39300 #3LDG(3)-CARD-i 1 90.700 01. OF 02 JLD�(S)-CARD-2 1 39.500 COST 169500 (BATHS 2.0 U X C= 1001 �' 7000_0 7000.00 1.00 70Ji J 14N 1071 MARKET 99700 1/2 3SMT S X c= lOUI I 3_2 3.2Q 1296 41J0-3 I43N SHOOT FLYING HILL RD A0 i _ I i . I 'NCO OM8LA c= 45.1 b50 2 !PJS 4 C= 101 1cg W IFIRFPLACE Ii Y 0 000 1.00 .3101 a 131 05/79 21 $00043900 I (APPRAI SED VALUE 4RR 14b4 0100 IA 169.500 IP. r SUMMARY q Si I i I AND 39300 i _�Lbl:S 130200 M j IO-.ImpS t /I D I AI_ 16950G -_ l � I I t>y is H S I n t I I I DEED REFERENCE Type 1 ATE Roc dr R I 0 R Y E P 1 UE A`R VA_ I I I I age "-at �� Jelea Pr- i 'Book P 1MO. Y it A ,L 393 0 0 C78472L' I ``1U100 "-r 130200 - 'v T OTAL i 6rn I I. 5CC.: BUILDING PERMIT �I Nu- Date Type 1 Amounl 1 ! LAIND LA_N4-A DJ I•NCOIME I SE SP-SLDS FEATURES EILD-ADJS UNITS I 39300 35300 81570') 11172 ND Class Const. Total es a Year Built Norm. OEsv. 1 I Unirs Units - Re' � Atll.Rate A I Age Depr. Contl CND Loc °-e R G Hepl Cost New A01 Repl Value $tones I MBighi Rooms Rma Baiha •Fia. Ptutywetl Fec. 01C 000 100 100- p58.10 58.10 65 75 19 80 100 80 113313 90700 1_9 6 4 2.0 3.0 Descr,phon Rale s"".Feet Rep'.Cost MKT.INDEX' 1-0 D IMP.BY/DATE, ME 1 1/8 S SCALE: 1/D G.5 8 ELEMENTS CODE CONSTRUCTION DETAIL I aAS 100 58.10 1296 75298 GROSS AREASINGLE FAMILY DWELLING CvST GP:iJO FWD 85 8.50 320 2720 *----- F �4-----* STYLE 03RANCH 0.0 --- -------------------0.--- � FWD ! DESIGN aDJMT 00 0 12 i ----F-RA------------ - J cxTLR.�dALLS J1 .1O-O D ME C.0- i 20 AEATIAC TYPE J4JIL ---------------0.0 *--------*36---20----* 1 NrER.FIN:ISH 00 - ------- 0.0 8 ! IN TEA.LAYOUT -if. ----------------- 0.0 NTrR.JUALTY G2 'AmE AS EXTER.--0.0_ _ i a- LOJR SRUET -j0 ---------------------0.0 W ------Ap E Total Areas Avw_ 320 ease n 1 296 ! ! 00F TYPE -- -00 ------------------ D.O T _ _ _________________ BUILDING DIMENSIONS 36 BASE 3b LECTRICAL _00 0.0 8AS W36 N36 E36 FWD S08 E04 N20 ! ! 0DA-6AT10A J0 99.9 A W24 S12 E20 .. BAS S36 _. ! ------ -- -- ---------------------- ------ - - ------------------ NEI6H90RHOOD 4�2AC CENTERVILLE L ! ! LAND TOTAL MARKET ! ! PARCEL 39300 169500 - * ---------36---------X AREA 3297 VARIANCE +0 +5040 STANDARD 20 F/Assessor's Office(1st floor) Map / ParcL�1,1�_1�4t !elltssued P Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) � //� e Engineering Dept. (3rd floor) House# /d�� ( .o w raFE ro, R SEPTIC SYS �� D 19 INS ITAL_LED I WITH �• TOWN OF BARNSTAB= .> RONM`ENTAL � `R Building Permit Application , Project Str et Addr s l e7/ 5�14 J� Village y Owner Address 5 R In r 1;�'felephone, 71 'I5-tz Z-11'e'rmit Request IJr aso �d First Floor square feet ' Second Floor square feet ,,,/Estimated Project Cost $ �� Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type / Commercial Residential. Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name - Telephone Number 7 / Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE BUILDING RMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY " PERMIT NO. DATE ISSUED ! r MAP/PARCEL NO. - - a - ADDRESS'i f VILLAGE ! T OWNER DATE OF INSPECTION: FOUNDATION 4 FRAME INSULATION FIREPLACE r t ELECTRICAL: ROUGH ! FINAL ' PLUMBING: ROUGH FINAL s GAS: ROUGH FINAL FINAL BUILDING ' -74 'DATE CLOSED OUT' A) € � I ASSOCIATION PLAN NO. r ' J The Commonwealth Of Alassachusettti sria - �jyy Department of Industrial Accidents )` :� •�� 011fceo//aeest/gallons 60#H'ashinrtun Street Boston,Alas. f12111 Workers' Compensation Insurance AlMdavit wow �Il��"':,';;,.;r�o���� Please PR1N'i'le bly •�-`"�-` ---T— 1 C' y r •-7 II A a 6 a�-- phone 11� �oZ I am a homeowner performing all work myself. ❑ 1 am a sole proprietor and have no one working in any capacity ❑ 1 am an employer providing workers' compensation for my employees working on this job. cmmnin3-name, -- addrevs• cih• nhnne#: incur.ince co. pnlicv# _ .tip J. ❑ 1 am a sole proprietor, general contractor or homeowner, circle one and have hired the contractors listed below who have the following workers' compensation polices. 4.11�comnam•n•tme*,100"address: incur�nce ce peiicv# !.:•.:r�,:- :� r.T�'• ..._. K'flt:/;.fG:..:7t��?'?T.?..:���R' r .. i"r.• 7M!'•�![!'.�:9!.. •. :F! ctimnam•name: _ -` _ address- city: phone#: incurs ice co poliey# Atiachadditioaafsheetifnec :•n w%� --a:�"^*r+"' ''�.:``:• :T: ',�'"• `" Y — - �.•• .�..� o. Failure to secure coverage as required under Section�25A of 51GL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. I understand that a cop}•of this statement may be forwarded to the Once of Investigations of the D1A for coverage verification. l do hereht•cert' der t/re pains and penalties ojperyun•that the injornmtion prm7ded above is true and cemcL S natu zV-11ate y�' Print name je official use only do not write in this area to be completed by city or town official City or town: permitilicease# riBuilding Department OLicensing hoard O cheek if immediate response is required OSeleetmen's Office (3lieallh Department contact person• phone tt; nOther (wised 1-9S P1A) The Town of Barnstable MDepartment of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Ctossen F= 508-775 3344 Building Commissior For office use only Permit no. j Date , AFFIDAVIT SOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERNM APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair;modernization,conversion, improvemM.remo%%L demolition. or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dvxMng units or to straw which arc adjacent to such residence or building be done by registered contractors,with certain ex dons, along with other rcquiraneats. - Type rk of Wo "e—L-160 ta?Ae4Est. Cost F Iry /Address of Work: 1V71 � � fl—y/ ////z If 4j . Namr- Date of Permit Application: 1-2 I herzb%certify that: e. Registration is not required for the following reason(s):. _Work excluded by law Job underS1.000 eiIding not owner-ooarpied puilrrrg own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH SiMED CONTRACTORS FOR APPLICABLE HOME IMPROVENIFNT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERTURY I hereby apply for a permit as the agent of the ow-nee. Date Contractor name Registration No. 5 --- rmn 's name . TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION" '.' . mmm Please print. - CATION �i L , ,V -Number Street address Section of town. �EOMM*EOWNER'i fy� c i o���% ( ter !/ - 1 / 7s- � c Name Home phone Work phone - . PRESI DkT MAILING ADDRESS 67/ CE XfAl � c �ty .t�wn State zip cod The current exemption for "homeowners was ' extended' tO include owner-®ceup ,. : dwellings of six waits or less and to allow such homeowners to engage an i : dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(sy who owns a parcel. lof ' land on which he/she resides or intends to side, on which there ' is, or is intended to be, a one to six family dwellih attached or detached structures_ accessory to such use and/or farm structur A person who constructs more than one home in a two-year period shall not considered a homeowner. Such 'homeowner". shall submit to the Building Off, on a form accp-ptable to the Building Official, that he/she shall be respon: for all such words performed under the building permit. (Section 109.1.1) The undersigned ' "homeowner" ' assumes ..responsibility for .compliance with the Building. Code - and other applicable codes, by-laws, ' rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requireme and that he/she will comply said procedures and requirements. HOM"MEOWNER°S SIGNATU APPROVAII: OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or, larger, will be.;,require to comply with State Building Code Section 127. 0,' Construction- Control. HOME OWNER° S EXEMPTION 9 -e. The code state that: "Any Home Owner perforpi-Ang work for which a &ilda permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Ligensj4uj- of Construction Superv* ors) , provided that Home Owner engages a person(s) fore to do such work, that such Home shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assumi the responsibilities of a supervisor (see Appendix Q, Rules and Regulati for licensing Construction' Supervisors, Section 2, 15) . This lack Of awa often results in serious problems, particularly when the Rome Owner hire unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor® The Home "der: as supervisor is ultimately responsible. s: To ensure that the Home Owner is fully aware of his/her responsibilities communities require, as part of the permit application, that the Home Own certify that he/she understands the responsibilities of a supervisor. Or last page of this issue is a form currently used by several towns. You r care to amend and adopt such a form/certification for use in your commune BARNSTABLE COUNTY REGISTRY OF DEEDS _ JOHN F . MEADE , REGISTER REGISTER RECEIPT # : 1995 31476 RG17OR PRINTED: WED 12/27/95 9:48 : 19 BATCH : 8540 CUSTOMER : N/A PAGE : 1 BOOK-PAGE : 9987 234 RECORDING FEE : 11 . 00 INSTRUMENT # : 65458 POSTAGE : . 32 RECORDING DATE : WED 1995- 12-27 9 :44 MARGINAL REF FEE : . 00 ADDRESS : 1071 SHOOT FLYING HILL ROAD COPY FEE : . 00 CONSIDERATION : . 00 COUNTY EXCISE : . 00 TOTAL AMOUNT DUE : 11 . 32 STATE EXCISE : . 00 PAID BY : CHECK 6089 ------------------------------------------------------------------------------------ GTOR/GTEE GROUP : 001 TOWN : BARN BARNSTABLE INSTRUMENT: N NOTICE OR CAVEAT GRANTOR : GRANTEE : DESCRIPTION : SHOOT FLYING HILL RD MARGINAL REF BOOK-PAGE : GRANTORS : CAMPBELL PATRICIA (&0) BARNSTABLE TOWN OF (APPEALS &0) GRANTEES : NONE RECORDED -------_-------------------------------------------------------------------------- RETURN ADDRESS PATRICIA CAMPBELL 1071 SHOT FLYING HILL RD CENTERVILLE MA 02632 --_-__--------------------------------------------------------------------------- t I L 71 7 Assessor's map and lot number /.. Z. ....:.....,� , � f yOFTHEro� Sewage Permit number .:... ....iI:YC?...... ........................ 8EP=SMEM LE, i House number ......................................................................... InCID + o YAY TOWN :OF BARNS. �� coDl` ar�D REGULATIONS BUILDING INSPECTOR APPLICATION FOR PERMIT TO .. l� (9fi. .A..G.'..1�........................................ ..tic... ......... ................................ TYPE OF CONSTRUCTION .......... .a.0". ;......... -&M-C....................... TO THE INSPECTOR OF BU(LDINGS: . The undersigned hereby applies for a permit according to the following information: Location ......�t!1... ................ A..4...............��l..l......!�...... 4.1.....!C..ex................................................................................ ProposedUse .......0.41eh G.E4=�r............................................................................................................................. . .......... ZoningDistrict ,QQ ................................Fire District ..:.............................................:. Name of Owner .... ......� .�.��.�..N...........................Address l�Q.Z......S5AA .f ..ff f4?&....... 4a�....��. Name of Builder �..... K. Eel)...........Address .l -VaW.!!L E.C.t< �...a... �a�tV 4 J.� !�-•�•- .... .. .. . ..... Nameof Architect ..................................................................Address ................................:................................................... Number of Ro s .............Foundation c CN!r., ..C......................................... ..................................................... Exterior ..f.........lF! 7q.40AE.............................................Roofing ... '7�4L..,. ................................:...:....... Floors ...... �.................................................. .................................................................................... f + ....Plumbing 1 Heating ............. g .................................................................................. t.................................................................. Fireplace ..................................................................................Approximate Cost ..Cf:............ .......... . . Definitive Plan Approved by Planning Board - - -- - - 9 ---. Area------ ------- Diagram ........f...../........ of Lot and Building with Dimensions fee cad SUBJECT TO APPROVAL OF BOARD OF HEALTH ,7 Z1 -t` F S J� i afj J a ' _� 3 . I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............ ............L/.. ... ................. HOGAN, PAT '• No 22645„_ Permit for ....Build„Frame„tea$-age ... - Accessory'...to...��..W.el.l. :#ig................. Location , 1071 Sho. ....ot Fl.yiRg...H 11...Road ..... .... .... f Centerville ............................................................................... Owner .......Pat Hogan.............. Type of Construction Frain ` `....................... ................................................. _............................. Lot ................................ r Permit Granted ,,;November 5, ;19 8 0 Date of Inspection ............................:.......19 Date Completed ."��.19�'� _ PERMIT REFUSED _ .........................:..... 19 ........... . . .. ........................................ r ........... .......................................... • ..............;.. ............. $ . . ................. ..................... m`.ro0 — Approve,,,_.. �$ 19 ..............� . ..... .......................................... ............................................................................... �- Assessor's map and lot numberr� �— �.�,�yr: ......................... t • Sewage Permit number __ e...................................... Z BARNSTABLE, i House number .............. qO Man& p 2639. 9� '�TEp YFY Or TOWN OF BARNSTABLE BUILDING INSPECTOR ..........j a X t.A. .. :...f APPLICATION FOR PERMIT TO �'?. ;;t.•...................:...... TYPE OF CONSTRUCTION ..........I•J. ^. 1 ...........��~+c?A wt t= :...........:................................ � A .......................... ..`... ......19. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... .............. �. *:3 .:�..... 1 �� %.�' .... .:...d. ..... .La...........................:........:...r: r' ProposedUse ...... I ?+.{'. ...............................................................................................:............................................ ZoningDistrict .................................................j........................Fire District .............................................................................. Name of Owner ....ea..�........ `.l����.. ..LL!........................Address ........ ....... .,/1....!F��. Name of Builder �� Y�,ll+ ....A '(�� ,�a -" ! ��...........Addressh.....%��n���l , � ? t� t { !?... rJ !;1„l? 1 ;• , . _. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms r- ..................................... � ...................................�..............................Foundation *::.::�....../`;'';�� �' /hJ �� Exterior ..... ......77. ........................Roofing ........................................ Floors �rN �, F1 J `�` .............Interior -"` Heating ....................................................... ...Plumbing Fireplace .......................................... ...................................Approximate Cost �J1/)..p:v";....................... ^. Definitive Plan Approved by Planning Board ________________________________19--------. Area ......... .......................... Diagram of Lot and Building with Dimensions Fee �0 SUBJECT TO APPROVAL OF BOARD OF HEALTH 23 i '^ram. I --•-------,-�-..._...,--.� � J .� � � 1 i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name : ? ..�;�. „ ... ` f �: ... ` .............. y HOGAN, PAT BUILD FRANI�--- RAGE Location ..... . 51.V*1* Rd Frame ` Type ofConstruction -------------- ` ' -------'------------------- � ' — ' --t ...z....................... Granted N Permit_ _ -- ' Date of Inspection Completed ' - �o�e Completed ' � PERMIT/ � ' REFUSED ' - ......'. ' '... ' ..........'' , '--' ' ' --'' -----�����'�--'— —f---' v* ` —.—. --. ----------. ' .- . M�Fr�--.. ---------. � � Approved ................................................ 19 -------'------'—'----~'-----^ -------'------'—^--^^--^—^^^—^' '