HomeMy WebLinkAbout4340 FALMOUTH ROAD/RTE 28 409
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T Sip 92019
O�jN OFBgR
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^� Town of Barnstable Building
�avyrseu� tPost This Card So That at Is Visible From the Street`Approved Plans Must be Retained on lob and this Card Must be Kept Posted I
}Until Final Inspection Has Been Made •
Mp• Where a Certificate of Occupancy is Rw-required,such-Building shall Not beOccupied until a Final inspection has been madam e: Permit
Permit No. B49-2142 Applicant Name: KETCHEN ASSOCIATES LLC
Approvals
Date Issued: 07/16/2019 Current Use: Structure
Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 01/16/2020 Foundation
Residential Map/Lot 024,027 Zoning District: RF Sheathing
Location:C4340 FALMOUTH ROAD/RTE 28;COTUIT----3 Framing: 1
Contractor Name,
CMmer on Record: KETCHEN ASSOCIATES.LLC - Contractor Licensee 2
Address: 45 CH ESAPEAKE BAY ROAD
` Est Project Cost: $5,000.00'
OSTERVILLE,MA 02655 Chimney:
�T"A^T Permit Fee: $85.00
Description_: Convert existing.open space on seconfd floor into a 2nd Bathroom. Fee Paid: $85.00 Insulation:
Existing bathroom is on ist floor:the new bathroom Will beslocated
„Date: 7/16/2019 Final:
above the 1st floor bath,will include shower,toilet and single sink
Will also be creating a linen closet and closet for master bedroom
Plumbing/Gas
Project.Review Req: TEMPERED GLASS REQUIRED IF WINDOW..IS WITHIN 60' E ! /—( Rough Plumbing:
(MEASURED HORIZO.NTILLY)FROM THE,EDGE OF THE SHOWER4 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 bythis permit shall conform to the'approved application and the approved construction documents for whiclithis 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 forthe;entire duration of Final Gas:
'the.wodc uptilthe completion of the same. .
` Electrical
The Certificate of Occupancy will not be issued,until all applicable si'natures,bythe Building and Fire Officials are provided on this permit.
Minimum of Five Call Inspections.Required for All Construction Work: Service
1.Foundation or Footing
2.Sheathing Inspection "Y Rough:
3.All Fireplaces must be inspected at the throat level before firest flue Irving is installed
4.Wiring&Plumbing Inspections to be.completed prior to Frame Inspection Final:
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. `
"Persons contracting with unregistered contractors do not have access to the guaranty fund"(asset 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:
Town of Barnstable Building n
Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be KeptSrABLK
ntnSs.. Posted Until Final Inspection Has Been Made. Permit
sass ��
9 Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made.
Permit No. B-19-2142 Applicant Name: KETCHEN ASSOCIATES LLC Approvals
Date Issued: 07/16/2019 Current Use: Structure
Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 01/16/2020 Foundation:
Residential Map/Lot: 024-027 _ Zoning District: RF Sheathing:
Location: 4340 FALMOUTH ROAD/RTE 28,COTUIT Contractor Name:.`,_ Framing: 1
Owner on Record: KETCHEN ASSOCIATES LLC Contractor License:
2
S
Address: 45 CHESAPEAKE BAY ROAD Est.'Project Cost: $5,000.00
l Chimney:
OSTERVILLE, MA 02655 Permit Fee: $85.00
'Description: Convert existing open space on seconfd floor into a 26d Bathroom. # Fee Paid:, $85.00 Insulation:
Existing bathroom is on 1st floor.the new bathroom will be located ff
Date: 7/16/2019 Final:
above the 1st floor bath. will include shower,toilet=.and single sink.w
Will also be creating a linen closet and closet for raszJ
ter bedroom
Plumbing/Gas
Project Review Req: TEMPERED GLASS REQUIRED IF WINDOW IS WITHIN 60' j Rough Plumbing:
(MEASURED HORIZONTILLY) FROM THE EDGE OFTH,E Building Official
SHOWER Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six-months after issuance. Rough Gas:
All work authorized by this permit shall conform to the approved appl,icatio6and 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. Final 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. a . " Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire,Officials are provided on this permit. Service:
Minimum of Five Call Inspections Required for All Construction Work:
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 Low Voltage Rough:
5.Prior to Covering Structural Members(Frame Inspection)
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 ✓�
- -
tF1EO Application Number.....- .. �..y..- I
* MAS& * V oo- C Permit Fee..........�.J..`!.0............Other Fee........................
s639• � Z C r
OZ Total Fee Paid................. ...................................... ......
ba
TOWN OF BARNS E r7i Permit Approval by..... .On....? l�r. .t ......
BUILDING PEWIFT 0 q
Map............. ......................Parcel.........�. .. ... ..............
APPLICATION,
Section 1 — Owner's Information and Project Location
Project Address `t oac, 2�� Village Co wI I.¢�'r s (A
\ f
Owners Name C9 R (LY ���T C1�Frt �E�G�E� S{�ITT�S LLC 1
Owners Legal Address
City dS Q�I t L1 State Q Zip 0 Z(,95
Owners Cell# (sl`T &10 —Z2A E-mail GXF,TCN wy r(, C0 M
Section 2 —Use of Structure
Use Group ❑ Commercial Structure over 35,000 cubic feet
❑ Commercial Structure nder 35,000 cubic feet
Single/Two Family Dwelling
Section 3 —Type of Permit
❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use 1 „
❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm '
Rebuild ❑ Deck Apartment ❑ Sprinkler System
�0 Addition ❑ Retaining wall ❑ Solar
❑ Renovation ❑ Pool ; ❑ Insulation
Other—Specify. �P�� 2 �afiT�!P�o+h �N fi�c�s i�N C9 F�oo2 gypHCE
Section 4 - Work Description
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on 7 D \CSc1(Z V3cT . CohD�TV,r c�
ter F M ,\I ~ l_dcm - _ 0-1
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Application Number............................!.......................
Section 5—Detail
77
Cost of Proposed Construction e�, - K Square Footage of Project (sd,
Age of Structure ` . kW 2S��1 er Dig g Safe Number
# Of Bedrooms Existing Total#Of Bedrooms (proposed) 3.
110 MPH Wind Zone Compliance Method, ❑ MA Checklist ❑ WFCM Checklist 0 Design
Section 6—Project Specifies
P
J_
Wiring ❑ Oil Tank Storage ❑ Smoke Detectors
Plumbing ❑ Gas ❑ Fire Suppression
❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom
1
Water Supply Rr Public ❑ Private
Sewage Disposal ❑ Municipal` ICI On Site1F`
Historic District ❑ Hyannis Historic District ❑ Old Kings Highway
Debris Disposal Facility: F� � I am using a crane ❑ Yes dNo
M �- E
Section 7—Flood Zone
I
i
Flood Zone Designation j
Within or adjacent to.a wetland, coastal bank? Yes ❑ No ❑
Section 8—Zoning Information
I
Zoning District Proposed Use Q. c4�;h kAl, Lot Area Sq. Ft. G( QUO
Total Frontage 20L° Percentage of Lot Coverage 2 0 ' #of Dwelling U�is (on site)
- j
Setbacks Front Yard Required Proposed
Rear Yard . Required Proposed
Side Yard Required Proposed
Has this roe had relief from the Zoning Board in the past? -❑ Yes � .• No
property rt3' g P ,
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s Built Cards:Click card#Go view:Card#LI
Bam-any 2nd story area FPC Op
en Porch Concrete Floor REF Reference Only
First Floor,Living Area FT$ Third StoryLivi Area Finished r n9 (Finished) SOL Solarium
Basement Area(Unfinished) FUS Second Story living Area-(Finished). $PE pool Enure
Bam . GAR Garage
TQS Three Quarters Story(Finished)
Canopy
,GAZ Lebo UAT Attic Area(Unfinished) "
Loading Platform GRN Greenhouse UHS Half Story(Unfinished)
T Attic Area(Finished) GXT Garage Extension Front UST Utilit
y Area(Unfinished)
Carport KEN Kennet UTQ Three Quarters Story
Enclosed Pore (Unfinished)Mezzanine, Unfinished UUA Unfinished Utility Attic
Half Story(Finished) PRG Pergola
UUS Full Upper 2nd Story(Unfinished)
k Open or Screened in Porch PRT Portico WDK Wood Deck '
PTO Patio '
�F q
on De
Details Land
X
value $ 104,600 Bedrooms 2 Bedrooms USE CODE 1010
went Cost $160,847 Bathrooms 1 Full-0 Half Lot Size(Acres) 1.41
Residential Total 4.Rooms
l R Appraised Value $ 111,500
Conventional Heat Fuel Gas Assessed Value $i i 1,500
Average Heat Type Hot Air
€ x..
ig Built
1921
AC Type Central
e depreciation 35 interior Floors Carpet
Interior Walls 1)r}wall .
,Ama sqlB 1,012 �4
Earterior Walls mod Slingie k'
Barnstable Property Maps Page 1 of 1
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Location
Parcel:
024027
Address: 4340 FALm6UTH
ROAD/RTE 2E
Village: CT yr
Acreage: 1.41
Full Property Info ;
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Owner&Mailing Address
Owner. KETCHEN
ASSOCIATES LLC
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Mail Address: 45 CHESAPEAKE BAY # �.
ROAD
OSTERVILLE -'44360
MA , . #
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02655aw 'd xP # ?5`1
Assessed Value(FYI 9) t , " .� 43F3
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https://gi,s.townofbamstable,us/Html5Viewer/Index.html?viewer=propertymaps&run=FincIParcel&propertylD=024027&mapparb... 6/7/2019
Building Permit Application for 4340 Falmouth Road June 30, 2019
Section 4 - Work Description
This project would add a second full bathroom in this single-family home in Cotuit. It would include a
new toilet, sink and shower(no tub) in an existing 2"d floor open space. This new bath would be directly
above the existing 1;t floor full bath. DWV piping currently passes through the space and both hot and
cold PEX piping(not connected) and electric wiring was run to the space during permitted construction
completed and inspected in 2011. It is understood that the project will require the work of both a
licensed electrician and licensed plumber. Exhaust ventilation will also need to be added to the space.
The structure currently has 3 bedrooms and 1 bath. It is connected to town water and has the on-site
septic system rated for 3 bedrooms. In July 2019,the system is scheduled to have a Title V inspection
and be pumped. There have been no problems with this 1989 system which was inspected last in 2011.
=Y
1 ,
Space to be used for new bathroom. Hallway just outside bath leading to
DWV piping visible on far right wall. stairs and guest bedroom. Master
bedroom to immediate right and new
bath to immediate left
Building Permit Application for 4340 Falmouth Road June 30, 2019
Section 4 - Work Description
This project would add a second full bathroom in this single-family home in Cotuit. It would include a
new toilet, sink and shower(no tub) in an existing 2"d floor open space. This new bath would be directly
above the existing Vt floor full bath. DWV piping currently passes through the space and both hot and
cold PEX piping(not connected) and electric wiring was run to the space during permitted construction
completed and inspected in 2011. It is understood that the project will require the work of both a
licensed electrician and licensed plumber. Exhaust ventilation will ,also need to be added to the space.
The structure currently has 3 bedrooms and 1 bath. It is connected to town water and has the on-site
septic system rated for 3 bedrooms. In July 2019,the system is scheduled to have a Title V inspection
and be pumped. There have been no problems with this 1989 system which was inspected last in 2011.
Space to be used for new bathroom. Hallway just outside bath leading to
DWV piping visible on far right wall. stairs and guest bedroom. Master
bedroom to immediate right and new
bath to immediate left
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The Commonwealth of Massachusetts
� ►
Department of Industrial Accidents - !
Office of Investigations
600 Washington Street
Boston,MA 02111
www massgov/dia
Workers' Compensation Insurance Affidavit: Bulders/Contractors/Electricians/Pinmbers
Applicant Information Please Print Legibly
Name(Business ownindonandividual): {-1 .l➢R-Ela C�� i� C�i$at
Address' 4�
City/State/Zip: i t 6 V'01 Phone#: lStr tz16, - 2-ZG 9-
Are you an employer?Check the appropriate bor. 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 flee sub-contractors 6. ❑N u,onsiruction
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
wo for me in an aci employees and have workers'
YP t3'� 9. ❑Building addition
o workers'comp.insurance comp.insurance.#
�r�] 5. ❑ We are a corporation and its 10.❑El cal 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.❑Other
r comp.insurance required.]
*Any applicant that checks box#I must also t3D out the section below showing their workers'compensation policy infDmudion.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most 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 isproviding workers'compensation insurance for my employees. Below is thepoUcy'and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: City/StateJZip:
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 c der the pains and penalties of perjury that the information provided above is true and correct
Si - Date:
Ph �e#• ,
Official use only. Do not write in this area,to be completed by city or town ofj°icial
a
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 mainteuaace,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 coustaract;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 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
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 nnmbea 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 pennit(license number which will be used as a reference number. In addition,an applicant
that must submit multiple pennittlicense 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 fixture 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 4.06 or 1-877-MASSAFE
Fax#617-727-7744
Revised 4-24-07
www:Fnass.govldia •
Application Number...........................................
Section 9—Construction Supervisor
1:
Name Telephone Number
Address City State Zip
License Number License Type Expiration Date
Contractors Email Cell #
is 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.Attach a copy,of your license.
Signature r - Date
Section 10—Home Improvement Contractor
i Name 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
i Section 11 —Home Owners License Exemption
(
Home Owners Name:
Telephone Numbe(,SU 4 -1 2l Cell or Work Number �`7 ('x O- 22,(a�i
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 ed by 780 CMR and the Town of Barnstable.
f Signature Date
r ICANT SIGNATURE
C Signature DateZ:k//
Print Nam (_c,2tiC o Q y kFnIN,401 Telephone Number 617
E-mail permit to: C"LEre A mstj cam
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
Section 13— Owner's Authorization
i
I, �I_C0 E 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:
f
(Address of j ob)
Ze of Owner date
Print Name
.14
i 13,6„
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------------------ ----------------------- fi E---------------------- ---
A$.
M Bedroom 6' 14'
16' x 14' New full 13ath
-----14'-x-10
i 3�u
DVVV
closet
G Bedroom
11' ;x 10'
- -t
s
window
Ceiling Heights 36 6 9 6'9" 5'
1 < DWV
' Bathroom size 4
Wet
1
Race 6' 9 ceiling - 45 sgft = 'l
1
5' to 619" _ 25 sgft
Linen LL
Useable - 70 sgft s
Closet
Addition i
i ion of 2nd floor
Shower
bathroom to an existing °n
open space in a single- '
, Y J
family residence at 4340
Falmouth Rd, Cotuit.
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
O 0
Map C'2.y Parcel OTT Application #
Health Division Date Issued �- l
Conservation Division Application Fe
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Street Address 43�AQ FAIAMMA
Villages 1�1�
Owner Xe\Cum Assoclmr-_s L.u_ Address 4s-(.N'ESatAyrz 'i�Ay Ae
Telephoneo�� )
Permit Request I��NGyDT OF ��l Iz�C�Si#46 KaCI-1EE-14 tk QYPAVA jwi nP
glai ' l owpm&U1 , hav C BIHT S. C00AM,RS , F6e Cove.,4e.- . 1 i&k N6
Square feet: 1 st floor: existing 2,C0 proposed 250 2nd floor: existing proposed -- Total new
Zoning Distr'ict' RF- Flood Plain N4 Groundwater Overlay Ho
Project Valuation# 9 COO Construction Type
Lot Size 1, 4C(ZE$ Grandfathered: ❑Yes L(No If yes, attach supporting documentation.
Dwelling Type: Single Family 2( Two Family ❑ Multi-Family (# units)
Age of Existing Structure Q"D' IRS Historic House: ❑Yes W No On Old King's Highway: ❑Yes YNo
Basement Type: ❑ Full ❑ Crawl ❑Walkout ZOther AL uk
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) ZT�Q
Number of Baths: Full: existing O new _ Half: existing 0 new_
Number of Bedrooms: existing 0new
Total Room Count (not including baths): existing 1�0 new 6 First Floor Room Count
Heat Type and Fuel: Ud GaS ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes YINo Fireplaces: Existing—0--New Existing wood/coal stove: ❑Yes Colo
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ZNo If yes, site plan review #
Current Use QE!ikt0 'Al, Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name I�F_� LL.C_ Telephone Number 0,\1
,q,Address ~ C License # K�Q t1Y�P�Z
�? u3fN Q,� `lt�C l��'C Home Improvement Contractor# � 1(u I zz
Worker's Compensation # T) A
ALL'CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE 16 4Wki 2011
FOR OFFICIAL USE ONLY
k APPLICATION#
DATE ISSUED
' MAP/PARCELNO.
ADDRESS VILLAGE
OWNER
i
1
DATE OF INSPECTION:
7
FOUNDATION
FRAME -
INSULAI ION
` FIREPLACE - F
A
ELECTRICAL: ROUGH FINAL'
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL`
FINAL BUILDING ! .A7
F •
R •
ti DATE CLOSED OUT '
ASSOCIATION PLAN NO.
The Commonwealth of Massachusetts
Department of-Industrial Accidents
9G, Office of Investigations
600 Washington Street
`r Boston, MA 02111
www.mass.gov/din
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
r- l
Name (Business/Organization/individual): � '��� ksGak-ms `LC
Address: W �1aicSRpl^R CK �� -
City/State/Zip: i klie ft Phone #: 10
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: Q New construction
2.WI am a sole proprietor or partner- listed on the attached sheet. T 7. Remodeling
ship and have no employees These 'sub=contractors have g, Q Demolition
working forme in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.t
l 9: .0 Building addition ,
required:] :. 5. We area corporation and its _ ME] Electrical repairs or additions
3. I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself No workers' eom right of exemption per.MGL
Y [ P• 12.Q Roofrepairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.Q 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.
$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.
/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. 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 yefification.
do hereby cer ' rider a pai lt' s of perjury that the information provided above is true and correct.
signature: G - Date: MARC t4- 261(
Phone#:.
Official use only. Do not write in this.area, to be completed bycity or town offieiaL
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 who11 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 focal licensing•agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the c m omonwealth 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 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 pen-nit/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.
would like to thank you in advance for our cooperation and should you have any questions,
. The Office of Investigationsy Y P
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
T4,4.617-727-4900 ext 406 or 1-877-MASSAFE
Revised 4-24-07 Fax # 617-727-7749
www.mass.gov/dia
Town ofBarnstable
Regulatory Services
f+ARNSTABLE Thomas F. Geiler,Director
� Building Division
�Fatwts 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
/ Please Print
DATE: 16 M ARC u 2U 1
JOB LOCATION: 4,�N �'�Llblc�tiTH �� �`Tl�ll
number street village
"HOMEOWNER": I�=�l.�R: �I�T�_J LLC—
lame . (o � home phone work.phone#
�'
CURRENT MAILING ADDRESS: Hq C�CJ1tMAVP At*Ka
city/town state zip code
V
The current exemption fort'horneowners"was extended to include owner-occupied dwellings of six units or less
and to allow homeowners Iio°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 intendsao 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
minimu ra. pect' ro and requirements and that he/she will comply with•said procedures and
ire ts.
ig re of Ho eo✓er
Approval of Building Officiate
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 1.27.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, ,
Rules'&Regulations for Licensing Construction Supervisors,Section 2,15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns.You may care t amend and adopt such a form/certification for use in your community.
Q:forms:homeexempt
of IMEr
t BAMWABLE.
MASS.9. Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
Building Division
Thomas Perry,CBO ,
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 r t ,' Fax: 508-790-6230
Property Owner.Must
r .; t r. P ,'LA
&mpfete and Sign This Section
If Using A Builder
I, KE\eam ksoclAI� Wc- as Owner of the subject property
1 p p n'
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 Narne
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary tntemef Files\Content.Outlook\DDV87AAZ\EXPPESS.doc
Revised 0721 1-0
IRSD�partment of the Treasury
Internni Revenue Service
In reply refer to : 02448444'79
CINCINNATI OH 45999-0038 Mar: 08 , 2011 LTR 147C EO
27-517392.0 000000 00
00002797
BODC: NOBOD
KETCHEN ASSOCIATES LLC
HAROLD GREGORY KETCHEN SOLE MBR
45 CHESAPEAKE BAY AVE
OSTERVILLE MA 02655
015168
Employer Ide"ntification Number : 27-5173920
Dear Taxpayer :
We received your request of Feb . 25, 2011 , asking us to , verify
your Employer Identification Number (EIN) and name .
Your Employer Identification Number (EIN) is 27-5173920 . Please . keep
this letter in your permanent records . Enter your name and EIN on all
federal business tax returns and on related correspondence .
If you need forms , schedules , or publications ,. you can obtain them by
visiting the IRS web site at www. irs .gov or by calling toll free at
1-800-TAX-FORM (1-800-829-3676) .
Please call our toll-free telephone number at 1-800-829-0115 with any
questions you may have .
You also can write to us at the address shown at the top of this
letter 's first page .
When you write to us , please attach this letter and, in the spaces
below, give us your telephone numbe-r with the hours we can reach you .
You also may want to :keep a :copy of this letter for. your records .
Telephone Number ( ), Hours
We apologize for any inco_nvenience . we may have caused - you , a.nd thank
you for your cooperation .
U.S. Department of housing OMB No.2502-0265
L Settlement Statement and Urban Development
Type of Loan: 1. ❑FHA 2. ❑FmHA 3.El Conv.Unins.4. ❑VA 5. ❑Conv:Ins
File Number 7.Loan Number 140 8.Mortgage Insurance Case Number
NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked"(p.o.c.)"
were paid outside the closing;they are shown here for informational purposes and are not included in the totals.
NAME AND ADDRESS OF BORROWER: Ketchen Associates,LLC
45 Chesapeake Bay Avenue,Osterville,Massachusetts 02655
NAME AND ADDRESS OF SELLER: Household Finance Corporation,11
2929 Walden Avenue,Depew,New York 14043
NAME AND ADDRESS OF LENDER:
PROPERTY LOCATION: 4340 Falmouth Road,Cotuit Massachusetts 02635
.. SETTLEMENT AGENT: Kertzman&Weil,LLP,40 Grove Street Wellesley, MA 02482
LACE OF SETTLEMENT: 40 Grove Street,Wellesle Massachusetts 02482
SETTLEMENT DATE: March 7,2011 1 DISBURSEMENT.DATE: March 7 .
SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
A.GROSS AMOUNT DUE FROM BORROWER 400.GROSS AMOUNT DUE TO SELLER: -
)1.Contract sales price $125,000.00 401.Contract sales price $125,000.00
)2.Personal property 402.Personal property
)3.Settlement charges to borrower(from Line 1400) $3,675.00 403.
A. 404.
)5.
405.
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE:
)6.City/town taxes 03/07/2011 to 03/31/2011 $69.18 406.City/town taxes 03/07/201Ito 03/31/2011 $69.18
)7.County taxes to 407.County taxes to
)8.Assessments to 408.Assessments to
)9. 409.
10.Cotuit Fire District Bill $150.05 410.
ll. 411.
12. 412.
t0.GROSS AMOUNT DUE FROM BORROWER: $128,894.23 420.GROSS AMOUNT DUE TO SELLER $125,069.18
DO.AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500.REDUCTIONS IN AMOUNT DUE TO SELLER:
)1.Depositor earnest money $5,000.00 501.Excess deposit(see instructions)
)2.Principal amount of new loan(s) $0.00 502.Settlement charges to seller(Line 1400) $9,740.00
)3.Existing loan(s)taken subject to 503.Existing loan(s)taken subject to
)4. 504.
)5.
505.
)6. 506.
)7. 507.
)8. 508.
)9. 509..
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
10.City/town taxes to 510.City/town taxes to
11.County taxes to 511.County taxes to
12.Assessments to 512.Assessments to
l3. 513.
14.
514.
15.
16. 515.3rd Qtr fy2011 RE Tax w/int $413.65
Cotuit Fire Adj. $53.95 516.Cotuit Fire Adj. € $53.95
l7. 517.
18. 518.
19. 519.
t0.TOTAL PAID BY/FOR BORROWER: $5,053.95 520.TOTAL REDUCTIONS AMOUNT DUE SELLER: $10,207.60
)0.CASH AT SETTLEMENT FROM/TO.BORROWER: 600.CASH AT SETTLEMENT TO/FROM SELLER:
)1.Gross amount due from borrower(Line 120) $128,894.23 601.Gross amount due to seller(Line 420) $125,069.18
)2.Less amount paid by/for borrower(Line 220) $5,053.95 602.Less reductions in amount due seller(Line 520) $10,207.60
)3.CASH(From/T-'e)Borrower $123,840.28 603.CASH(I /To)Seller $114,861.58.
le,the undersigned,identified in Section D hereof and Seller in Section E hereof,hereby acknowledge receipt of this completed Settlement Statement on March 7,2011.
SELLER(S)
fouschold Finance Corporation,II
BORROWER(S)
.e ociates,
L. SETTLEMENT CHARGES
700.TOTAL SALES/BROKERAGE COMMISSION BASED ON PRICE•$125;000 00 @ 5 00%_$6 250.00
DIVISION OF COMMISSION LINE 700 AS FOLLOWS: Paid From Paid From
-
DIVISION$2 500.00 Borrower's Seller's
G
to LBS Realt rou Funds at Funds at
702. $3 750.00 to Kalstar Realty Settlement Settlement
703.Commission paid at Settlement ($5000 00 Retained by Broker)
704.Referral Fee to LPS AMS $6 250.00
BOO.ITEMS PAYABLE IN CONNECTION WITH LOAN: $1,250.00
-
801.Loan Origination Fee 0.0000% to
802.Loan Discount 0.000001. to
803.Appraisal Fee to
804.Credit Report to
805.Lender's.Inspection Fee to
906.Mortgage Insurance Application Fee to
307.Assumption Fee to
308. to
309. to
310. to
311. to
312. to
313. to
314. to
315. to
316. to
)00.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE:
)01.Interest from to at $0:0000/Da 0 da s
)02.Mortgage Insurance Premium for 0 Months to
)03.Hazard Insurance Premium for 0 Years to
)04. 0 Years to
)O5. to
1000.RESERVES DEPOSITED WITH LENDER:
1001.Hazard Ins 0 months at per month to
1002.Mortgage Ins 0 months at per month to
1003.City Tax 0 months at $163.03 per month to City/Town of Cotuit,MA
1004.County Tax 0 months at per month - to
'.005.Assessments 0 months at per month to
006. 0 months at per month to
007. 0 months at per month to
1008.Aggregate Adjustment
1100.TITLE CHARGES: W-00
101.Settlement or closing fee to
.102.Abstract or title search to Marsh,Moriarty,Ontell&Go
.103.Title examination $260.00
to Doonan,Graves&Longoria,LLC 104.Title insurance binder to $350.00
.105.Document preparation to -
.106 Notary fees to
107.Attomey's fees to Kertzman&Weil,LLP
(includes above item numbers:1101,1105,1106) 1 $1,200.00
108.Title Insurance to First American Title Insurance Company
(includes above item numbers: ) $500.00
109.Lender's coverage *None* @ $375.00 to Kertzman&Weil,LLP
110.Owner's coverage $125,000.00 @ $500.00 $125.00 to First American Title Insurance Company
111.Obtain MLC to Town of Barnstable
112. to $25.00
113. to
200.GOVERNMENT RECORDING AND TRANSFER CHARGES:
201.Recording fees: Deed $125.00 Mortgage Release(s)
202 City/county tax/stamps: Deed $337.50 Mortgage: $125.100
203.State tax/stamps: Deed $427.50 Mortgage: S337.50
204.Record MLC to Barnstable Registry of Deeds $427.50
205.Record POA $65.00
to Barnstable Registry of Deeds
300.ADDITIONAL SETTLEMENT CHARGES: $75.00
30LReimbursement to LPS AMS
302.Attorney Fee to Doonan,Graves&Longoria,LLC $125.00
303.Recording Fee to Holly Rogers $875.00
304.Overnight Delivery v $50.00
�'Fee to Federal Express
305.Wire Fee to Boston Private Bank&Trust
306.LLC Prep. to Kertzman&Weil,LLP $30.00
307.Filing Fee $950.00
to Kertzman&Weil,LLP $500.00
308.Overnight Courier Fees to Doonan,Graves&Longoria,LLC
400.TOTAL SETTLEMENT CHARGES(Enter on Line 103,Sec.Xand-Line 502,Sec.K) $20.00
the undersigned,identified in Section D hereof and Seller in Section E hereof,hereby acknowledge receipt of;his completed Settlement Statement(Pages I and$ion March 7,2011.$9;740.00
SELLER(S)
lousehold Finance Corporation,ll
BORROWER(S)
et en sociates, C
HUD Settlement tement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in accordance with this statement.
Clement.Agent:
Date:
986-2011 Standard Solutions,Inc.781-324-0550
RespaM W.
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Map rage i of i
Town of Barnstable Geographic Information System Raw Sear
Parcel Viewer Cretow Map Abrtterr tlap size .■ Zoom 0-11111111118
�., Turn map layers on/off by
S—JP�' selecting check boxes below
Town Boundaries
Road Names
Voter Precincts
Map&Parcel Numbers
Parcels
FEMA Q3 Flood Zones(Old Maps)
Will be Superceded in 2010
AE(100 yr Flood)
AO(100 yr Flood)
VE(100 yr flood w/wave action)
X500(500 yr flood)
L Neighboring Towns
D Water
Streams
1 C Jetties
(� Edge of Water
Marsh
Drainage Ditches
Water Bodies
Set Scale 1"=43 July 2DD9 Coastal I MAP DISCLAIMER Transportation
Copyright 2005-2010 Town of Barnstable.h1A AI dglds read.Send quatiom or rIXnel rds to GIS
BamstableMA v1.2.4015[Production)
Map Page 1 of 1
Town of Barnstable Geographic Information System w New Sear
parcel Viewer F Cuusbom Map Abuuera Map St. ■. zoom Out p p p O sl O 0 IIn
N{'g (a :R N. r�u —fl_ F:p ® a E=3PG Map: 025 Parcel: 013
Location: 4320 FALMOUTH ROAD/RTE 28
Owner. COTUIT FIRE DISTRICT
Location Information
Map&Parcel 025013
Location 4320 FALMOUTH ROAD/R
Acreage 29.56 acres
Current Owner
D25013 Mailing Address COTUIT FIRE DISTRICT
so
0
43ID P.O.BOX 1475
COTUIT,MA 02635
Appraised Value(FY 2011)
Extra Features $0
' - Out Buildings $5,100
' land $770,900
Buildings $327,400
4a4 Total Appraised $1,103,400
0 E
a 4a40
Assessed Value(FY 2011)
Extra Features $0
Out Buildings $5,100
Land $770,900
Buildings $327,400
Total Assessed $1,103,400
Construction Detail
Style Other Municip
Model Ind/Comm '
024025 Grade Average
4354
.. Stories 1
Exterior Wall Brick/Masonry
aa. Roof Structure Gable/Hip
Roof Cover Slate
Interior Wall Plastered
Interior Floor Quarry Tile
0 43 Feet *0. Neat Fuel Gas
P2�67
�' 9as3a Neat Type Hot Air
AC Type None
00
Set Scale 1"='43 I ;Aerial Photos ' MAP DISCLAIMER god�r '
Copyright 2DO5.2010 Taws of Bemslable,MA Aa rigtds reserved.Send questions a comments to GIs - 3
BarnstabteMA v1.2.4015[Production]
http://66.203.95.236/arcims/appgeoapp/map.aspx?propertylD=024027&mapparback= 3/16/2011
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2N Barn-any 2nd story area FPC Open Porch Concrete Floor
REF Reference Only �.
!tS First Floor,Living Area FTS Third Story Living Area(Finished) SOL Solarium
Basement Area Unfinished #' {
( ) FUS Second Story,Living Area.(Finished) SPE Pool Enclosure
3
N Barn
GAR Garage TQS Three Quarters Story(Finished) "
N Canopy GAZ Gazebo
UAT Attic Area(Unfinished)
Loading Platform GRN Greenhouse UHS Half St
T Finished aY(Unfinished)
Attic Area #
(Finished) GXT Garage Extension Front UST Utility Area(Unfinished)
P Carport KEN Kennet UTQ Three Quarters Story(Unfinished)
P Enclosed Porch MZ1 Mezzanine, Unfinished
UUA Unfinished Utility Attic
S. Half Story(Finished) PRG Pergola k `l
9P Open or Screened in Porch PRT Portico UUS Full Upper 2nd Story(Unfinished) fit.
WDK Wood Deckr
PTO Patio #�
r,
truction Details
F
�aiIIg Details Land '
ceding value $ 104,600 Bedrooms
2 Bedrooms USE CODE 1010
Oplacement Cost $160,847 Bathrooms
1 Full-0 Half Lot Size(Acres) 1.41 :a
Residential Total Rooms 4 Rums Appraised Value $ I11,500
e ': Conventional Heat Fuel
Gas Assessed Value $ 111,500
de;'^ Average Heat e
�'P Hot Air <.
r Built 1921
AC Type Central .
eFtive depreciation 35 Interior Floors Carpet
Interior Walls Drt��all
g Area sq/ft 1,012 Ezterror:Walls good Shin e
t
gl r
i
Commonwealth of Massachusetts
Town of Barnstable
iELA
twsrws[.E
i `gym° 200 Main Street(508)862-4038
T�MA�s PERMIT REPORT BY ADDRESS
Address: 4340 FALMOUTH ROAD/RTE 28,COTUIT
..:
,_. :.
.«..., - ..,.»....1 ...,.... ,. ;• � ,.. ..y.<,., �., �,. ..: ,a„.,,, .. ` � Wig* � .< .. •.:$..,;..�.,,.� ..a, ..:�.: � .�.a. .:.;. ;.:.�:' :
.> ns ectuon Ins ,ec#ed on; I s ectron . 1 s ectionn
, , . 11D., . ,eA .Ihcant Wo, ,Desc�
PermlltFor � arse .,. ....,
PIN � p
6-2011-01338 Closed Addition/Alteration ;024 02T PRQPERTY.OWNERS:'. '<RENOVATION OF AN' Building Final 9/27/2014 Pass. RMCK:
Residentialf� EXISTING KITCHEN,
s
NO EXPANSION OR
-
<,• 'STRUCTURAL s
-CHANGE SNEW
'CABINETS
T COUNTERS FLOOR,
U`,GHTING
B-49242 Closed Siding/Windows/Roof/Door 024-027 PAUL D LEARY STRIP AND REROOF Building Final 3/15/2001 Pass MTRO:
s. 16 SQ.:
E-2011-01338 '_Closed ElectricalAtld%Altei:' 024 027 PROPERTY OWNER, RENOVATIQN OF AN :.Electric Firial 9/28/2011 Pass WAMA.
EXISTING KITCHEN
NQ EXPANSION OR s
STRUCTURAL
r ' CHANGES;NEW
CABINETS
COUNTERS'FLOOR, Y
:x LIGHTING
E-2011-01338 Closed Electrical-Add/Alter 024-027 PROPERTY OWNER RENOVATION OF AN Electric Rough 7/19/2011 Pass WAMA:
EXISTING KITCHEN
NO EXPANSION OR
STRUCTURAL
CHANGES.NEW
CABINETS,
COUNTERS,FLOOR,
LIGHTING
E-2011-03377 Closed Electrical Semce 024 027: RP HINCKLEY&SON SERVICE UPGRADE Electric Service. 7/19/2011, Pass `' WAMA: r
T01U1)AMPERES
E-2011-03718 Closed Electical-Minor 024-027 RP HINCKLEY&SON WIRE AC UNITS Electric Final 7/19/2011 Pass WAMA:
1 of 2
Commonwealth of Massachusetts
O 1HE l '
Town of Barnstable
LL
MASS. 200 Main Street(508)862-4038
' PERMIT REPORT BY ADDRESS
:. IC ..:
,z
ectecl one= Ins ectlon.� Ins ctlon_.:
,a
.Parcel,lD
Status. amen.
G-20T1-01338., Glosed Gas 024 027 PROPERTY OWNER "; RENOVATION OF AN Gas Final 9/26/2011 y\Past RBUR:
EXISTING KITCHEN
{ NO EXPANSION OR
_ .
RUCTURAL
�= CHANGES.NEW.
CABINETS,
COUNTERS,FLOOR;
LIGHTING
G-2011-01338 Closed Gas 024-027 PROPERTY OWNER RENOVATION OF AN Gas Rough 8/15/2011 Pass RBUR:
EXISTING KITCHEN
NO EXPANSION OR
STRUCTURAL
CHANGES.NEW
CABINETS,
COUNTERS,FLOOR,
LIGHTING
P-2011-01338 : ,=Closed'' Plumbing 02402, 7 PROPERTY OWNER -`' RENOVATION OF AN Plumbing Final 9/26%2011 " Pass RBUR:'
r ;
k r
EXISTINGKITCHEN
NO E „
'. XPANSIQN OR ;s
STRUCTURAL -
CHANGES,NEW:
CABINETS, .
t
COUNTERS:FLOOR,
a •` r
L`IGWTING
P-2011-01338 Closed Plumbing 024-027 PROPERTY OWNER RENOVATION OF AN Plumbing Rough 8/15/2011 Pass RBUR:
EXISTING KITCHEN
NO EXPANSION OR
STRUCTURAL
CHANGES.NEW
CABINETS,
COUNTERS,FLOOR,
LIGHTING
Total Permits: 10 8000 516
2of2
q 34 0 qBARNWABM
-
16
s
nCP S Town of Barnstable a.I
Zoning Board of Appeals
y on Decision and Notice
Special Permit- 2007-114 — Garland -
Section 240-46 - Home'Occupation:
o_Qperate a Scrapbook.Studio in the Dwelling
Summary: Granted with Conditions
Petitioner: Michele L. Garland I �
Property Address: 4339 Falmouth Road (Route 28),Cotuit MA
Assessor's MapMarcel: Map 024, Parcel 067 N\�/
Zoning: Residence F Zoning District
Relief Requested and Background:
The property is a 0.57-acre Lot developed with a three bedroom, one story, single-family dwelling
consisting of 1,919 sq.ft. and a detached two car garage consisting of 864 square feet. The petitioner,
Michele L. Garland, is seeking to utilize a 336 square foot area attached to the dwelling as a
scrapbook studio home occupation in order to teach and assist groups in the construction and
designing of scrapbooks, and to sell materials for scrapbooking. The home occupation area was
originally a one car attached garage that had been�converted'to finished living space.
'The property has been before the Board on two prior occasions for a home occupation for which
permits were granted. They were; Special Permit 1989-011 issued to Bernard Bergeron for a dog
grooming occupation and Special Permit 1992-033 issued to Frank and Patricia Twyeffort,Jr., for an
antique shop.
A site plan was reviewed and an approval letter issued by the Site Plan Review Coordinator on
October 25, 2007; Apparently, the petitioner's occupation concentrates on instructions to small
groups, school children, scouting, church, community and neighborhood groups of all ages in the art
of scrapbooking. Instructions are now given outside of her home at small gatherings and at her
business/retail store in Cotuit which she intends to vacate.. As a side to those instructions, she
provides materials to the classes and scrapbooking items and papers for retail sales: .
Procedural & Hearin Summary:
Y ..
This appeal was filed at the Town Clerk's office and at the office of the Zoning Board of Appeals on
November2, 2007. A public hearing before the Zoning Board of Appeals was duly advertised and
notice sent to all abutters in accordance with MGL Chapter,40A. The hearing was opened December 5,
2007, at which time the Board found to grant the home occupation special permit subject t6 conditions.
Board Members deciding this.appeal.were, Ron S.Jansson,James R. Hatfield;,Jeremy Gilmore,John
Norman, and Chairman- Gail.C. Nightingale.
Attorney Mark:H. Boudreau represented the.:petitioner who.was also present at the hearing. Attorney
Boudreau gave a brief history of development and use of the lot. He cited that Ms. Garland now is
operating her business, "Simply Scrapbooking Co.", from an existing nonconforming site located on
Route 28 just west of this location.
/t1b �Ua /t/v
astable
rvices
irector
Sion
ommissioner
s,MA 02601
Fax: 509-790-6,230
CAL INSPECTION
ERMIT NUMBER
emut required in order to process inspection)
ate of Inspection
t an inspection under Massachusetts General
(Property Location)
Service Re-inspection
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Mai"ry 2 Parcel X.;!-7 rjS Permit# 49WO
Ar
Health Division 8 e Date Issued
Conservation Division Fee
Tax Collector G Jv�f
SEPTIC SYSTEM MUST BE
Treasurer 10 �o i�o INSTALLED IN COMPLIANCE
Planning Dept. WITH TITLE 5 ' . .
p aaNVI CNMENTAL CODE ANC
Date Definitive Plan Approved by Planning Board °CF*yLs3 fir,
Historic_-OKH Preservation/Hyannis
Project Street Address 3 t"'D
Village (?To tfi
Owner Address /SW
Telephone8
`Permit Request --eE ,Qmv&9 6- /Co 64
Square feet. Isst�t floor: existing proposed 2nd floor:existing proposed Total new
Valuation ��/� !�� Zoning District Flood Plain Groundwater Overlay-
Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family el' Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes A No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑Full 9 Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing . new Half: existing new
Number of Bedrooms: existing f new
Total Room Count(not including baths): existing new First Floor Room Count
Heat Type and Fuel: k]Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes ® No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑"
Commercial ❑Yes P4410 If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name ` ��6- 6"/4-J&0e yiOC_ Telephone Number (Q, �lp
Address License# 3') (I
L- ®i 092 Home Improvement Contractor#
Worker's Compensation# L_O l d
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO f/ Cd_4 rZ661e_ 01' �P4)
SIGNATURE "_ DATE /yZ,0/
- FOR OFFICIAL USE ONLY '
h `
PE*'MIT NO.
DATE ISSUED 4 ♦ .
MAP/PARCEL NO.
} Yl
AODRESS ` 'VILLAGE,
OWNER
DATE OF INSPECTION ,t
FOUNDATION
FRAME 4 _
INSULATION
FIREPLACE
ELECTRICAL: ROUGH = FINAL
PLUMBING: ROUGH- ' FINAL
GAS: ROUGH -7 FINAL
FINAL BUILDING 331W 1- - -
DATE CLOSED OUT Jam `
ASSOCIATION PLAN NO.
DATE(MMtDGli'Y)
ERTIFICATE OF LIAB SURANCE -7-
PRODUCE19
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ROGERS A GRAY.INS. AGENCY. INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
434 41OUTE 134 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. 0. BOX it;01
SOUTH DENNIS MA 08560.1601 {
INSURERS AFFORDING COVERAGE
INSURED INSURER A: TRAVELERS INSURANCE CONPA
P 0 Leary Builder Inc INSURER B:
S Elliawlll@ Road INSURER C:
Plymouth MA 02380 INSURER D: _
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
GC,RE —
INSA I TPI TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
A GENERAL LIABILITY I680351P6289TIA00 04/29/00 04/29/01 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE yglycna 1ha _ 300,000
CLAIMS MADE 7 OCCUR i MfD EitP(An one rwn $ 5,000
PERSONAL&ADV INJURY S 1,000,000
I { GENERAL AGGREGATE S. 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: ! PRODUCTS•COMPIOP AGO $ 2,000,000
POLICYEl FRO• LOC --
A AUTOMOBILE LIABILITY
810840H9913TIAGO 06/26/00 06/26/01 COMBINED SINGLE L;MtT $
ANY AUTO (Ea accident)
ALL OWNED AUTOS j BODILY INJURY 250,000
X SCHEDULED AUTOS
(For peracn) $
Y HIRED AUTOS BODILY INJURY., 500,000
x NON-OWNED AUTOS ' (Per accident)
I
PROPERTY DAMAGE $ 100,00C
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHER THAN Fly ACC S ---.._...
I I AUTO ONLY: AGO S
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE S —
DEDUCTSLE
RETENTION $ ! $
WORKERS COMPENSATION AND WG STATU- 0
A EMPLOYERS'LIABILITY 10UB709D750300 08/23/00 08/13/01
E.L.EACH ACCiOENT $ 100,000
EL. DISEASE-EA EMPLOYEE $ 500,000
E.L.DISEASE-POLICY LIMIT S 100,000
OTHER
II
DESCRIPTION OF OPERATIDNS&OCATIONSNEHICLEMCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
+ 0LQrFR ADDITIONAL INSURED;INSURER LETTER:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SMALL.
MA IMPOSE NOa$�g1� � 1E INSURER,ITS AGENTS CA
REPRESENTATIVES.
AUTHORIZED REPRES AT
ACORD 25-S (7/97) 10 ACORD CORPORATION IM
i17
�� TOO�IY!/ptO�It[dPQ�CiL d�/!/Cq,QQlZC1LClQP.C�
i
BOARD OF BUILDING REGULATIONS
' License: CONSTRUCTION SUPERVISOR
Number:'CS 032118
Birthdate 04/22/1948
e� ,Expires 04/22/2002 Tr.no: 21466
Restricted To: `00
PAUL D LEA .Y
9 ELLISVILLE RD ': (�•.•�,�i�� °�
PLYMOUTH, MA 02360 Administrator
r
�lce C�omvrnan�ur.¢�i a�✓l�auar.�r�.ralls
NONE IMPROVEMENT CONTRACTOR
a
Registration: 104640
Expiration: 7115102
Type: Private Corporatic
PAUL 0. LEARY. Builder Inc
Paul Leary
9 Ellisville Road
F ADMINISTRATOR Plylouth
MA 02360
FTHE
= 1 tips
• •
The Town of Barnstable
BAxxsTABLL
Department of Health Safety and Environmental Services
rEp�,,or a Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
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: P� _ Estimated Cost
Address of Work: T,210 to r?_7 7,
Owner's Name:
Date of'Application: 10
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded by law
❑Job Under$1,000
❑Building 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 fora permit as the agent of the owner:
Date "ft; Name Registration No.
OR
Date Owner's Name
q:forms:Affidav
: _----. y
-The Commonwealth of Massachusetts
RM-- = - Department of Industrial Accidents
4 _ &WC8 of/firosdoodons
' - 600 Washington.Street
Boston,Mass. 02111
Workers' Com ensation Insurance Affidavit
name:
location
city phone#
❑ I am a homeowner performing all work myself.
❑ I am a sole Proprietor and have no one workiz inarry capacity
%%%%-----
I am an e 1 roviding workers' compensation for my employees working on this job.
.. ...:: :oY ... .::::::...:.;:.:.:..... ... .....:. :.;::.;: ;:.;;;::.;
m an name::. "
.
::...::..;.
/
❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who
have
the following workers,
compensation
nsatio n polices:
:;.::;:.li.. ........ . ....
aw
t o an name; .
...
.:::.
e .
0
1i�tit�ice c
s3i>iY2>' `2%'i : i: `i:;;;; >:;;?> >.%:::%:%:;:i:>::;<.;:.;;;:<�;;:;:;;;.;;::
sn
...:::..::.:;:.;:....:.::..
addresss
'
xx
«i
en
..::::::....:::::::::::::.:::::......::... ..................
h
......................
- /
Fafiure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby c fy 7�thn;eatn,74of perjury that the information provided above is truo�med correct
Signature ��� Date 01 %�J/
Print name
-- �� Phone#�t/� �+
official use only do not write in this area to be completed by city or town official
city or town: permit/license# ❑Building Department
❑Licensing Board
❑checkif humediate response is required ❑Selectmen's Office
OF
❑Health Department
contact person: phone#; ❑Other.
(messed 9/95 PJA)
Information and Instructions ��,,
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law", 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 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and
supplying company names,address and phone numbers along with a certificate of insurance as all affidavits 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.
City or Towns
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 pi number which will be used as a reference number. The affidavits may be returned io
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you 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
fax#: (617) 727-7749
phone#: (617) 727-4900 ext. 406, 409 or 375