HomeMy WebLinkAbout0867 STRAWBERRY HILL ROAD i.
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Town of Barnstable Building
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'Post This Card So That it is Visible Frorn the Street ,Approved Plans,Must beRReta1e on Job and�this Card Musthbe Kept
mA �$ iPosted Until Final Inspection HasB.een Made -
err "� Where a;Certificate of Occupancy is Requi ed,such Building shall Not be Occupied until a Final Inspection has been made
�_ ,._:,_.. .a,
Permit
m .
Permit No. B-19-2332 Applicant Name: SABATINELLI, BRUCE Approvals
Date Issued: 08J09J2019 Current Use:. Structure
Permit Type: Building Addition/Alteration-Residential Expiration Date: 02/09/2020 Foundation-.
Location: 867 STRAWBERRY HILL ROAD,CENTERVILLE Map/Lot: 230-172 Zoning District: RD-1 Sheathing:
Owner on Record: $ABATINEiI1, BRUCE Conf'ractorNNamer;..BRIAN CLIFFORD Framing: 1 °J y
Address:
867 STRAWBERRY HILL RD Contractor license:_ 106566 2
CENTERVLLLE, MA 02632 = Est Project Cost: $ 10,000.00 Chimney:
Description: (2) Doghouse Dormers 8/9J202
.:ist Extension to expire 0 Permit Fee: $ 151�.00
Insulation:
Project Review Req: DORMERS ONLY. Fee Paid $ 151:00 /
' y Date 8/9/2019 Final: /
d
Pt' Plumbing/Gas
Rough Plumbing x
r ,
f 'Building Official
FinaLPlumbing:
This permit shall be deemed abandoned and'invalid unless the work authorized by,' spermit is commenced within six moho after`issuance.
All work authorized by this permit shall conform to the approved applicationiand.the approved construction documents,for whichthis 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.,
. ; Final Gas: �.
This permit shall be displayed in a location clearly visible from access street or road andshall be maintained'open for public inspection for the entire duration of<the
work until the completion of the same. "
Electrical
The Certificate of Occupancy will not be issued until all applicable signatdreesyt,byffie B ilding and"Fire Officials are provide on this,permit• Service:
Minimum of Five Call Inspections Required for All Construction Work-,
y
1.Foundation or Footing
Rough:
2.Sheathing Inspection F ,
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
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
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Town of Barnstable RECEIPT°=
" 200 Main Street, Hyannis MA 02601 508-862-4038
Application for Building Permit
Application No: TB-19-2332 Date'Recieved: 7/18/2019
Job Location: 867 STRAWBERRY,HILL ROAD,CENTERVILLE
Permit For: Building-Addition/Alteration-Residential
Contractor's Name: BRIAN CLIFFORD State tic. No: 106566
Address: 10 Goff Ter Centerville MA 02632, , Applicant Phone:
(Home)Owner's Name: SABATINELLI,BRUCE Phone:
(Home)Owner's Address: 867 STRAWBERRY HILL RD, CENTERVILLE,MA 02632
,Work Description: (2).Doghouse Dormers
Total Value Of Work To Be Performed: $10,000.00
Structure Size:— 0.00 0.00 0.00
Width Depth +Total Area
I hereby swear and attest that 1 will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before
he/she engages in work on the above property in accordance with the Workers Compensation Act(Chapter 568).
I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by
filing a waiver with the appropriate District Office;and that a sole proprietor of a business'is not required to have coverage unless he files his intent to
accept coverage.
I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have
been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the
Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and
specifications. All information contained within is true and accurate to the best of my knowledge and belief.
All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24
hours in advance.
Signed: SABATINELLI,BRUCE 7/18/2019
Applicant Date Telephone No.
Estimated Construction Costs/Permit Fees
Total Project Cost : $10,000.00 Date Paid Amount Paid Check#or CC# Pay Type
Total Permit Fee: $101.00 7/18/2019 $101.00 10695 Check
Total Permit Fee Paid: $101.00
�TI3IS IS NtT PE ME—
Town of Barnstab_ leBuilding
Post This Card So That it is U�sible From the Street Approved Plans Must be.Retamed°on.Job andythis.Ca�d Must bE Kept
6A7LNSTACi1.E� ` ... ��� fly x T 3 '�': '.,+ •
v '"" Posted Uriil FinalYlnspection Has Been Made * 3f,,
� aWhere a Certificate of Occupancyis Required,such Bdmg shall Not be Occupied until aaFnal Inspectioha�s been made
Permit No. B-19-2332 Applicant Name: w SABATINELLI, BRUCE Approvals
Date Issued: 08/09/2019 Current Use: Structure
Permit Type: Building-Addition/Alteration-Residential Expiration.Date: 02/09/2020
Foundation:
Location: 867 STRAWBERRY HILL 120AD,.CENTERVILLE Map/Lot 230 172 Zoning District: ;RD-1 Sheathing:
Owner on Record: SABATINELLI, BRUCE Con m tractor.Nae .,BRIAN CLIFFORD Framing: 1 .
Address; 867 STRAWBERRY HILL RD ContractorLicense? 106566 2
CENTERVILLE, MA 02632 4r Est Project Cost: $ 10 000.00 Chimney:
x ,
Description: (2)Doghouse Dormers „y s ', Permit Fee: $ 101.00
Insulation:
Project Review Req:. DORMERS ONLY. (, Fee Paid $101.00
Date 8/9/2019
Final:
Plumbing/Gas
Rough Plumbing:
Building Official i
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afterJssuance.
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 orroad.and shall be maintained open for public inspection for the entire duration of the Final Gas:
work until the-completion of the same.
"Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Bui►ding and Fire Officials are provided on this'permit.
Minimum of Five Call Inspections Required for All Construction Work:; Service:
1.Foundation or Footing y
2.Sheathing Inspection „" Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 1. 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 i
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 o`n site
r.
Final:'
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT' ��
___ _ Town of Barnstable wW .. .� _ g
Post This Card So That it is Visible From the S —pp, ,- l n M"—u,..__—e- .- Jo _� @ p
rerA>�. t treet-A roved Plans Must be Retained on Job and this Card Must be Kept i
MARR , ," Posted Until Final Inspection Has Been Made. j
16s9. , Iperm1
o IWhere a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection.has been made. i
Permit No. B-19-2332 Applicant Name: SABATINELLI, BRUCE Approvals
Date Issued: 08/09/2019 Current Use: Structure
Permit Type: Building-Addition/Alteration- Residential Expiration Date: 02/09/2020 Foundation:
Location: 867 STRAWBERRY HILL ROAD,CENTERVILLE, Map/Lot: 230-172 Zoning District: RD-1 Sheathing:
Owner on Record: SABATINELLI, BRUCE Contractor Nami:",-BRIAN.CLIFFORD Framing: 1
Address: 867 STRAWBERRY HILL RD Contractor License: 106566 2
CENTERVILLE, MA 02632 Est. Project Cost: $ 10,000.00 Chimney:
Description: (2) Doghouse Dormers ) ` }. Permit Fee: $ 101.00
Insulation:
Project Review Req: DORMERS ONLY. Fee Paid� $ 101.00
� € �
_
Date: 8 9 2019 Final:
Plumbing/Gas
Rough Plumbing:
._.. Buildin Official
3 Final Plumbing:
� g:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.
r All work authorized by this permit shall conform to the approved application and-the approved construction docume,nts for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures shall be incompliance 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. '
i
— --- - 7 Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building andlFire Officials are provided on thispermit.
Minimum of Five Call Inspections Required for All Construction Work: Service:
1.Foundation or Footing
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
~O Application Number:.,Lt!!�
................................ .......... ................
GILDING DEPT
BABNSPABLE, :
MASS. Permit Fee.......................................Other Fee........................
s639. JUL-..18 2019
TOWNOF B Total Fee Paid................................................................ ......
ARNSTABLE
TOWN OF BARNSTABLE Permit Approval by..... .. .........................on....���..i .........
BUILDING PERMIT So
Map........ .... .............. arcel.............................................
APPLICATIONS N a iFMAq--L
Section I — Owner's Information and Project Location
Project Address 4/1 Village /�'. .�ilelo
Owners Name .*&
Owners Legal Address F J��oG ��� / /�r?'G� 4(4vl
City State 41V Zip O�->
Owners Cell# E-mail
Section 2 —Use of Structure
Use Group ❑ Commercial Structure over 35,000 cubic feet
.y
❑ Commercial Structure under 35,000 cubic feet
Q Single/Two Family Dwelling
Section 3 —Type of Permit
❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use
❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm
Rebuild ❑ Deck Apartment Sprinkler System
❑ Addition ❑ Retaining wall ❑ . Solar
Renovation El Pool El Insulation
Other—Specify duo 0
Section 4 - Work Description
. . ---
Application Number....................................................
s r
Section 5—Detail
4
Cost of Proposed Construction .d Square Footage of Project /00.,
Age of Structure Dig Safe Number
# Of Bedrooms Existing 3 Total#Of Bedrooms (proposed)
110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design
Section 6—Project Specifics
❑ Wiring Oil Tank Storage ❑ Smoke Detectors
❑ Plumbing ❑ Gas ❑ Fire Suppression '
a
❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom
a
Water Supply Public ❑ Private
Sewage Disposal ❑ Municipal aOn Site
Historic District ❑ Hyannis Historic District ❑ Old Kings Highway
Debris Disposal Facility: Pqos14.b r ar<14�I am using a crane ❑ Yes ❑ No
Section 7—Flood Zone
Flood Zone Designation ,
Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑
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 j
Rear Yard Required Proposed i
Side Yard Required Proposed
Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA.02111
www mass gov1i a
Workers' Compensation Insurance Affidavit: Bulders/Contractors/Electricians/Phmabers
Applicant Information Please Print Legibly
Name(Business/o%mizatim/lndividuai)•
Address: ,
City/State/Zip: Phone#: 5�O 7 ?$•_O so
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
Ell6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These ors have 8. ❑Demolition
workingfor me in an capacity. employees and have workers'
Y aP tY• = 9. ❑Building addition
[No workers'comp.insurance comp.insurance•
required.] 5. ❑ We are a corporation and its 10.0 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. rat of exemption per MGL 12.❑Roof repairs .
insurance required.]t C. 152,§1(4),and we have no
employees.[No workers' BE Ofher
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 hue outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the sub-c ontractnrs 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/Statelzip:
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 under the pains and n o that the information provided above is true and correct
,r7
Date:
Phone
Official use only. Do not write in this area,to be completed by city or town oftial
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical 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 id 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 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 time 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 cant'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 time 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 time Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate lime.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to drank 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 Aoddents
Office of Investigations
600 Washington Street
Boston,MA 02111 -
Tel.#617 727-4900 ext 406 or 1-877-MA►SSAFE
Revised 424-07 Fax#617-727-7749
w:mass.gov/dia
- - ---- -- - - --- --
Application Number......................
I
Section 9= Construction Supervisor
Telephone Number,"—��
Address /® �o � City &Ayy State Zip 62(�.>
f License NumbevZ—&<7770 License Type iration Date :S 2_02z;,
p
Contractors Email Cell#��
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 790
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required 7 C Town of Barnstable.Attach a copy of your license.
Signature Date >1149 `�
Section 10—Home Improvement Contractor
i
Name? y Telephone Number✓Ua'r-���fir'/
Address A 498 City State Zip 40062-3 a
Registration Numb Expiration Date a r)'
f
r 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 KI.C...
Signature Date
j Section-l:1=Home Owners License Exemption_ J
F Home Ownefs 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 B le. ,
Signature Date
APPLICANT SIGNATURE
Signature Date?
Print Name fU C e_wl-f Telephone Number.5� 778'O_5O
E-mail permit to: %e-x-�
Section 12—Department Sign-Offs {
-Health Department Zoning Board(if required) ❑
Historic District ❑ Site Plan Review(if required) ❑
Fire Department ❑
Conservation ❑
For commercial work,please take your plans directly to the fire department for approval
L
Section 13 —Owner's Authorization l
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)
r
Signature of.Owner. date
♦4\ { w���t11k
Print Name --- '�
q
f
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map �® Parcel / --- Application #
Health.Division Date Issued 1
Conservation Division c� ,' Application Fe J p
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic OKH _Preservation/Hyannis
r;
Project Street Address 27 S' aw)� ,ohrw tea,4
Village jf Cyl� "-s-S D,163-N--
Owner 5 Amy A� /' v� Address
Telephone
Permit Request Y 4--9A-
Square feet: 1 st floor: existing P, proposed 2nd floor: existing Sy6 proposed--jo—Total new
Zoning District Flood Plain /-)° Groundwater Overlay 170
Project Valuation off. Construction Type f. M Z2
Lot Size , y Grandfathered: '❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family J:k' Two Family ❑ Multi-Family(# units)
Age of Existing Structure d ar Historic House: ❑Yes WNo On Old King's Highway: ❑Yes a'No
Basement Type: ®'Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: off_ existing new
Total Room Count (not including baths): existing _knew First Floor Room Count
Heat Type and Fuel: e as ❑ Oil ❑ Electric ❑ Other
Qentral Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove:`:PO Yevff No
Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size — Barn: ❑ existing ❑ n w ��e=
,f ,.
Attached garage: A/existing ❑ new size =Shed: ❑ existing ❑ new size — Other: ,
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes O'No If yes, site plan review # �: -r►
Current Use ��s141r61L A nt Proposed Use d
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name Telephone Number d
Add re s License #
Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE L=-J=
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
. F
ADDRESS VILLAGE _
:r..
OWNER
DATE OF INSPECTION:
FOUNDATION
i >
FRAME
s INSULATION
FIREPLACE
'= ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
I FINAL BUILDING
r
iS
i
' DATE CLOSED OUT
ASSOCIATION PLAN NO.-
w .
er
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 PIease Print Legibly
'Name(Business/Organimtion/IndividuaI): Rr UC,,-
Address: . S[n-1 5 t V'� �a ✓v,� 1n �?c
City/State/Zip: V- QZ12aone M 5CZ 3 3 7- �5 7 OAS
Are you an employer?Check the appropriate bogs 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 ❑ ew construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. MRemodeling
shipand have no employees These sub-contractors have
8. []Demolition
working for me in any capacity. employees and have workers'
comp, insurance. 9. ❑Building addition
workers' comp.insurance P•
equired.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3. I am a homeowner doingall work officers have exercised their 11. Plumbing re❑ g pairs 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' 13.0 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,
lContractors 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 haveve mployees,they must provide their workers'comp,policy number.
I am an employer that isproviding workers-6 s"r mpensation insurance for my employees.-Below is thepolicy andjob site
information. �-
Insurance Company Name:
J�.✓
Policy#or Self-ins. Lic.#: Expiration Date:
Job Site Address: City/State
-'
Attach a copy of the workers'.c6mpensation policy declaration page(showing the policy num end expiration date).
Failure to secure_c_oyerage as required under Section 25A of MGL c. 152 can lead to the imposition of crim iial_enalties 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 Off ce of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and pe alties ury that the information provided above is true and correct
Si Lure: Date: ,7-6
Phone#:
1� a� p�'c�lj7 �'fi i:fie�iY-`u-ci S'�ci 2iS`�i��r7 C cECi'aY�ly or town ojjzci
City or Town: Permit/Ucense#
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#:
Town of Barnstable
� s
Regulatory Services
RAMS,MLE, : Thomas F.Geiler,Director
y MASS.
�A 1619° Building Division
a Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
�g Please Print
DATE: 6�
JOB LOCATION: b
number street village
name _ home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners",was extended to�include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor. +
DEFINITION OF.HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to
be,a one or two-family dwelling,attached or detached structures accessory to such use and/or_farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for.compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations. -
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of Home er
1 v
Approval of Building Official
Note: Three-family dwellings''containmg:35 000_ cubic feet or larger will be required to'comply with the
State Building Code Section 127.0Construction'Control. .
HOMEOWNER'S EXEMPTION
The Code states that "Any homeowner performing work for which a building permit is required shalt be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q
Rules&Regulations for Licensing Construction`Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a fotrri/certification for use in your community.
Q:fotms:homeexempt
°� ETa�ti Town of Barnstable
Regulatory Services
* saxxsx►s�,
v nrnss. Thomas F. Geiler,Director .
�p 16gy �0
TEnr Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-623 0
Jt
Property Owner Mugt.
L c f- , 'Complete and Sign This Sect one;
If Using A Builder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit
(Address of Job)
Pool fences and alarms are the responsibility of the applicant. Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
Signature of Owner Signature of Applicant
nrintName nrinrIZ2-t e
Date
Q:FORM&OWNERPERMISSIONPOOLS 62012
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OLIIENT._,.._... SHOWN ON . TH13 PLAN 13 LOCAT[®
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s '^:CIV.tL ,AND M. GONFOAMS TO. THE 2ONIN9 LA1E.O ��
NIGINEER SURVEYOR ORi®Y' .. OF;-�RN�TABLE .MASS
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cif.my, /z..—g- = V B g
7t2' IiAA1N STREET 1_.._
!y 4 M fl 1 ^ .A S c: s�►'.�i Y':.—L- ..:r. t ii:a il�: . .1�11 id Its A k U 5 U R V it y.0
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
®6
Map v Parcel Application# i; �(J ` G '
Health Division
Conservation Division Permit#
Tax Collector Date Issued
Treasurer Application Fee d�
Planning Dept. Permit Fee C>��
Date Definitive Plan Approved by Planning Board �1 r p 0
Historic-OKH Preservation/Hyannis d
Project Street Address `f� -S- —rA w r r`I � f/ 11� •
Village �'�o 91`- r y f // /V A
Owner , 3,r u a=P Sa &n-ri A -e Address
Telephone ;5 oo .!. FZ2 -25 6 g 1
Permit Request (�g� Pa rT Q:fMf1u n l
Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new
*r
Zoning District Flood Plain C Groundwater Overlay
Project Valuation d coo0 Construction Type &t&
locil—
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family i Two Family ❑ Multi-Family(#units)
Age of Existing Structure 40 4-eAI'9 Historic House: ❑Yes UAo On Old King's Highway: ❑Yes 0,No
Basement Type: Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) I S -50^ JI
Number of Baths: 1, Full:existing t,' new Half:existing new
Number of Bedrooms: existing new
Total Room Count(not including baths):existing 1 new First Floor Room Count A
Heat Type and Fuel: YGas ❑Oil ❑Electric ❑Other
Central Air: ❑Yes ❑No Fireplaces: Existing 4Z New Existing wood/coal stove: ❑Yes Alo
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size
Attached garage:Zxisting ❑new size Shed:Coexisting U�rnew size /0A0, Other: l
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ ,
Commercial ❑Yes ❑No If yes,site plan review#
Current Use Proposed Use
ILDER INFORMATION
Nam Telephone Number �'O�— 790
Address License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
c
FOR OFFICIAL USE ONLY
a
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING �3/�
DATE CLOSED OUT
ASSOCIATION PLAN NO.
J
t ne uommunweaan of Inussucnusetta
f Department of Industrial Accidents
Office of Investigations
600 Washington Street -
Boston, MI 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluinbers
Applicant Information Please Print Legibly
X_
N,aMe.(Business/Organization/Individual): A '
Address:-, 67
City/S.tate/
Zip
: "Pa9ro Phone #:
---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 1 6
employees((full and/or part-tune).
* have hired the sub-contractors ❑ New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet $ 7, ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition
[No workers' comp. insurance 5• ❑ We are a corporation and its
officers have exercised their 10.❑ Electrical repairs or additions
required.] o
* �I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs o additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers' 13 ❑ Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information:
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob 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 ceerrrttify under the pains and pen of p ' ry that the information provided above is true and correct
Signature:� Date: `7
Phone#:
Official use only. Do not write in this area,to be completed by city or town q ffaciai
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: Rhone#:
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 hae,
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 burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. T 617-727-4900 ext 406 or 1-1077-MASSAFE
Fax Y 617-727-7749
Revised 5-26-05
w-ww.mass.gov/cua
°EIME�° Town of Barnstable
Regulatory Services
` s^MASS. Thomas F.Geiler,Director
� Mass. � �
�'0tfp 39�p e Building Division
Tom.Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion,
improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: Estimated Cost
Address of Work:
Owner's Name:
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded by law
❑Job Under$1,000
lding not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES.OF PERJURY
I hereby apply for a permit as the agent of the er:
Date Contractor Signature Registration No.
• R
Date Owner's Signature
Q:wpfiles.forms:homeaffidav
Rev: 060606
Town of Barnstable
o� Regulatory Services
Thomas F. Geiler,Director
= BAMSTABM
9� MA3 Building Divisf6n ,U �?l
# ?dt C► r
lf��►'�°' Tom Perry,Building Commissioner �' 2%)
200 Main Street, Hyannis,MA 02601
www.town.barnstable ma:us _.
Office: 508-862-4038 Fax: 508-790-623t
CD
PERMIT# �O�(p c�d `1 FEE: $
rJ�2�/b(v
SHED REGISTRATION
120 square feet
or less
Location of shed(address) Village
Property owner's name Telephone number
rc� x d3o 1 7,
Size of Shed Map/Parcel#
Signature Date
Hyannis Main Street Waterfront Historic District?
Old King's Highway Historic District Commission jurisdiction?
Conservation Commission(signature is required)
Sign off hours for Conservation 8:00-9:30&3:30-4:30
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE
COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE.
PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED BY A
PLOT PLAN
Q-forms-shedreg
REV:042506
r,
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1 �\�' ��`` V��'0�• � Ate'
PAUL A.
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LOT 3 10(� _.. _ °'itot ►� ��"
FLOOD PANF,'L 2_ qO-(-1_--0_00_5_C_ FLOOD ZG!"F
1 .;herebv certrlp that this mortgageinspectirlr plat, was- prepared for: Plan is For
Rank. Use Ur; V
_.4.4fERK_A S_b�rHOLE.SALE LEND R __
The locetior of the building shown does �IV�.Z..__ fall within a special frood hazard zone. j Pt_4/V I EF
_ - conform .to the Ircal zoning by-laws tr effect ?,1
The location e! the dx li'inE does B 4GQ�F .l = 3 r'/
at the tin-io of construction Prith respect to horizontal dimen,-fjonai setbacx rp(juirerrrr--nts' -"" -
or is exempt from aiolation enforcement action under Moss. r-,eneral Law-, Ch. 4UA -sec 7 nct�P
r'LEASF NOTE :7he structures or, this inspection were located by taoe not iustrunert and are epproylnate only An act:>>ai surmz) ne �ss�:y
for a precise determination of the building location and er,_roachmen!s, if sn.r exist, either wly across property lines This ;nspection m.r:st rot
be used for recording purposes or for use in ,:preparing deed dev riptions and must not be used for urrierr.e or budding plan purposes
inspection must not be used to loceie property fines. Verification of building loccafions, prnp�rty line dimersicns. fences or int �.orLq:ra✓ro;1 ,:<,:
oniLO
v be accomplished by an accurate instrument survey which n*a.y reflect differert. information then what is shown hereon. This inspect.;on is no,'
e used for anv purposesot?er than mortgage. Yankee .S.rv-ey ac-re is nno respunsrbbilit-yvfor)rda/ymages'ye@resuiting from said refianoe
Q[ rT ..rT `r � YT %rt 1 -}.rJ.rJ3
.BOX �b'S. -10 NDU TRY RD. MAR,570Ar5' MILLS. AM OcE•18 PHONE. 508 428—00575 35'51 d LM
OPINE T Town of Barnstable
Regulatory Services
BARNMBLE' ' Thomas F.Geiler,Director
9 Mass.
1639. a Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
July 20, 2006
Bruce Sabatinelli
867 Strawberry Hill Rd.
Centerville, Ma. 02632
RE: 867 Strawberry Hill Rd., Centerville,MA, Map 230 Parcel 172
Dear Mr. Sabatinelli:
It has come to the attention of this office that a shed was built on the above referenced
property. The construction of the shed is in violation of the local zoning ordinance. The
violation is two-fold. First, the shed is required to be registered with the Town of
Barnstable. Second, it is required to meet local setbacks. The shed as it currently exists on
the property, does not conform to local setbacks and requires a variance issued by the
Zoning Board of Appeals. The variance must be obtained before a registration may be
issued. Application for a variance must be filed with the Zoning Board of Appeals by
August 2, 2006. After that date, if application for variance is not made or is denied; the
shed must be removed or you shall be subject to fines levied.in the amount of no more
than three hundred dollars per day for each day the violation continues. Also, the building
permit for removal of the car port must be picked up and the car port removed by August
2, 2006 or additional fines may be levied. Thank you for anticipated cooperation in this
matter. If I may be of any assistance to you, or if you have any questions, please call (508)
862-4034.
Respectfully,
Jeffrey L.Lauzon
Local Inspector
Q:zoning5
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•TM� TOWN OF BARNSTABLE
. Permit No. i,;2----------------
{ .�. : Building Inspector cash ___---
- -
+eiw
Bond X____1
OCCUPANCY PERMIT ------
Issued to Greenbrier Corz;- Address
Lot 1, 857 Strawberry Hill Rand- Coant-ar.,41;a
Wiring Inspector Inspection date
Plumbing Inspeetor � M Inspection date y
Gras Inspector t .fin f � t`� r t., .p "a Inspection date? /S"or A"
xEngineering Department`. Inspection date
Board of health ern lM .r1 Inspection date
THIS PERMIT WILL NOT BE VALID, AND THE/BUILDING SHALL. NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
- �19 �
C Building Inspector
x s4 A -
r
3
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
s ssaYiia % TOWN OFFICE BUILDING �.
HYANNIS, MASS. 02601
MEMO TO: Town Clerk
. FROM: Building Department
DATE:
An Occupancy Permit has been issued for the'fiuilding authorized by
Building 'Permit
#._ » ._»»_,»-»».» ._................... .......»y ......:.... . .............
issued t0 ..�?1. �t�: if„t ! .... ». .. ..... k /�
Please release the performance bond.
Assessords�niap and lot number ......a alp . .�..................... `
> Q OF THE
tp�y
Sewage Permit number ........................................................
✓ -7 Z BAMSTADLE. i
House number .............r� l M"°a
.. �p 1639. \0�
�0 YPY a•
TOWN OK -BARNS.. TABLE
BUILDING I SPEC TOR
• APPLICATION FOR PERMIT TO .....ra,.. .........
f
TYPE OF CONSTRUCTION .....:.!it...r,?C��. tpL. .................................................. ......................
................... .19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ..... T� 4,,).�F� �� ....... !`i?.. ... .. v
Proposed Use ......- G....
.....
.. G/yl� ...........................................
Zoning District .... . .7.1....... .................................Fire District ..... /....d............................ ...........................
Name of Owner ..... %?' ,f'v7 �r ...... ...............Address ..... c. )".. 1 ...... .
Nameof Builder ......... �f. .. .. .................................Address .......................... ......................................................
Nameof Architect ..................................................................Address ...........................................:........................................
Number of Rooms ..... ........................................................Foundation .... Lr ..(.. !t".�'P.....
/ / l �..........
Exterior ......(�AjI6 .5-40. .GI��.. ......Q.A6'.....5....Roofing ... ... h ,..)� .............................
Floors 1 �' ... :....tQl /....//,`f?.. ..........................Interior ...:.......<..(..� �.�
6 -Heating-
..../........ ......................Plumbing ................, ..,........ ...............................................
Fireplace ......?:.(..�✓.......................................................... ......Approximate Cost ........, 7'67� ��/)
Definitive Plan Approved by Planning Board _____ _ � �a 19 Area ..........................................
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH 1
/ 0K f
7fs�r7 z
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
- I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ........ .............
Construction Supervisor's License .... .. ...�
F
GREENBRIER CORP. A=230-119
No.1...23218 Permit for 1' Story
` Sin le Famil Dwellin
Location
Lot 1, 867 StrawberrY. ....ill Road
..................................................... . H....
Centerville
...............................................................................
Owner Greenbrier Corp.
...................................................................
Type of Construction ....Frame
................................................................................
Plot ............................ Lot ................................
Permit Granted ......JuI.y...17..................19 85
Date of Inspection ....................................19
t ,
Date Completed ......................................19
i
Ar o
As ;ssor's+map and lot number ......113...."..IJ...T............. *THE
Sewage .hermit number ....... �
WIT, T:6 LE 5 ALLED
BABNABT&LE. i
House number ' `] �A r
..1........................................... liti � i�ut ` ^f i639- 0�
AL
C.
• /r r- �'0 YAK p'•
' 'R4?,li r
t .�Park
TOWN OF BXRN' STABLE
BUILDING I SPECTOR
APPLICATION FOR PERMIT TO ...:. .. . .. .. .. ... ............ ..�...................:.:..........
TYPE OF CONSTRUCTION ....... .. .00 /O��I..<.................................................. .....................
....................S.. ��.......19 ��
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the fol owing information:
Location .... �.1.... ` ....... 71 GPI'".. ....1..✓.. .. c.....l,.r!1.... . � ..............................
Proposed Use .....-?1.. :e.... Cc. If. .:........................................... .....................
Zoning District ... ... ... .. ...` /...........................................Fire District ...... ...... ..................
............,..........................
Name of Owner ...... �'� (.. ......................Address ..... ..c. .....✓...��..... rl..
Nameof Builder ..............�~.. ..��...................................Address ......................................................................
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ......W..........................................................Foundation ....��.:.....��..��L�.S�� .... ...........
l � r
Exterior ..... l �l!1... l.S,�...... ...C/.4' ..... ....Roofing ....1�...�f.� .. ...................................
Floors ..� .... .....Cl�(/?.. ..................Interior ... . ... .C. ..��.�...............................................
Heating .... ...... �c.l.. � ..K�C�....... ..�.J.,..(......................Plumbing ............... .. 5..............................................
Fireplace ......v. ...0......................................... ............ ......A roximate Cost ........... ...�.J• .. �.
Definitive Plan Approved by Planning Board _____ 19 Area
Diagram of Lot and Building with Dimensions l/2Q1,IJX/ Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH P
�r t9�
• 1�X Hai
01
OCCU1
P NCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
' Name ....... .. ... .<: . /......
Construction Supervisor's License ...............`� .. ...�
QttENBRIER CORP.
Ne2�118 I' Story
................ Permit for ....... ...........................
SiTigle Family Dwelling
............................1.1....1........
..........................1.1.11.1........
Lot 1, 867 Strawberry Hill Road
L6�ation ................................................................
Centerville
... ..................0.............................................................
I.
Greenbrier Corp 0
Owner ................................................................... J,
Type of Construction .....................Frame.....................
................................................................................
Plot ............................ Lot ................................
rt
85
Permit Granted ........4XY..k7;........
Date of Inspection .....................................19
Date Co4 te�ple ... -�Y......... ...... 9
6 0 7Z
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-� �' CERTIFIED PLOT PLAN
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ECA,LE�:I =¢v DATE$ 57;7
1. CER?IfY THAT -THE' Tio.✓''
4LICNT,..,.._._...
SHOWN:-,VA THIS PLAN I$ LOCAT90
oiSTLRE REOISTERED u.9�
,10� IoIA. ...... ON. TNE. `AROUND A8 INRICATED A11�1
t,AND CONFORMS TO THE ZONING LAWS '
tN INEER SURVEYOR Olt toys . ........... pr :R RNqTA1iLE MASS ,� p
712' MAIN STREET �° C11.iY6
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�. Y.v4 '+1r11R. ".'.:AS e ; ftfci'- O%N6 SURVEYOR
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JA
• • . • - •
Town of Barnstable
P�oFz"E'°�+ti Regulatory Services
r a
Thomas F.Geiler,Director
'" ASS.Mnss. # Building Division
y �a
1639. ♦0
ArE p MAC° Tom Perry Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
COMPLAINTANQUIRY REPORT
Date:7— 13 '-0 Rec'd by: �
Complaint Name: Map/Parcel C;2c30
Location � W
Address:
Originator Nam -
Street:
Village: State: Zip:
Telephone:
Complaint Description: 0e2 D 7
7- 61-Z
iFOR OFFICE USE ONLY
Inspector's Action/Comments Date: 7)� /b(o Inspector:
SIDE WORK ' Ua CARNK-1 ASTR f5A)C"1% 4Vs*JG
bN C 'T CKS
Additional Info.Attached
Q:forms:complaint _
;.a
Town of Barnstable
F
l Regulatory Services
Thomas F.Geiler,Director
• avuvsTaar.e,
s Building Division
9 MASMS. Tom Perry,Building Commissioner
tb39. ♦0
AiEp 39 ► 200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 50 -790-6230
Approved:
Fee: o?:S •p�
Permit#:
HOME OCCUPATION REGISTRATION
Date
Name: Phone#:�'O O `��� D 6
Address: Village:
Name of Business:
Type of Business: Map/Lot: �g2o GoT.-
Zoning District ,Zoning Districts RF and RC-1 require Special Permit from Zoning Board of Appeals.
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity
shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the.
premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;
and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located within
that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there is
no outside evidence of such use.
• No.traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,
odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of
normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There is no commercial vehicles related to the Customary Home Occupation,other than one van or one
pickup truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
I,the undersigned,have read and agree with th aboverr 'ons for my home occupation I am registering.
Applicant 4Date:,
Homeoc.doc Rev.5/30/03
`+ TO ALL NEW BUSINESS OWNERS
DATE: g—`77-03
Fill in please: W, vwA` sir
APPLICANT'S ti R YOUR NAME: C`e
BUSINESS ' YOUR OME F�ESS: Ael
TELEPHONE Telephone Number[Home]_
NAME OF NEW BUSINES T S TYPE OF BUSINESS
IS THIS A HOME OCCUPATIQN? -p _YES N
Have you been given approval from the b ilding divis' ? YE N g
ADDRESS OF BUSINESS ST MAP/PARCEL NUMBER.?S Q/7�
When starting a new business there are se al.things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist ou in obtaining the information you may need. Once you have obtained the required signatures, listed
below,you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to
the following office to make sure you have all the required permits and licenses..
GO TO 200 Main St. (cor f Yarmouth Rd. &)Main Street)and you will find the following offices:
1. BUILDING C MI IONE S F
This individual h s be infor fn t quire ents that pertain to this type of business.
o i d re
COMMENT • C
2. BOARD OF HEAL"
This individual has be informe of a perm' is that pertain to this type of siness.
A� rize.'Sgnatur
COMMENTS:
3. CONSUMER AFFAIRS(LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L.
-it does not give you permission to operate-you must get that through completion of the processes from the,various departments involved. .
**SIGNIFIES A PPRO VA L FOR BUSINESS CERT/F/CATEOft Y.
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Nov
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rg, z Q,
Act
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