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LL' '+b $: i l{}f �F r IP ' 14 .,f, 2Y � ! ,• 7 YPA it �h, /, 1, , t i41 "P, S ul y, 'Tu {' .r., } t ,�� , ai'' N i T r - q,.,, k ?#r1 "ry ;Y'r r k1" ' X6.t,�, E fia,5, taWY, 4 t k id' 1 A k l',.,'p:r. A' t. dK r t;;i w I.FJ t,,Xi'Vr :uG�rrkr,r:"XC A:..a;:.3I ..,,,: ;'g.M' r .`°fir.. a'wds',� ...tJrP1 ,`li'. rx,;„ 11�r,X'.i� ` '9''�° �b.� 'x 7•zll,�,,Tf.'� ' :.i+l'rL � ' 'r .,. .r�A ?41'$ ,.� e,� t'*.tt- r,rrrr H ' a. > a- r t,.at 1'- h L..:Ap G w IXr s9 d `` -17 T Town of Barnstable *Permit# ati fires 6 months from issue dale Regulatory'Services fee sexivsresrs, y Hasa Richard V.Scali,Diet �'�,� S Z5 . 0 6 �A 039• Aim �Jlsq�1 reo�a+ Building Division Paul Roma,Building Commis��eeT8 2017 200 Main Street,Hy RAMF 02601 www:town.barn 8ARNS Office: 508-862-4038 r ��L� Fax. 508-790-6230 EXPRESS PERNUT APPLICATION RESIDENTIAL-ONLY U Not Valid without Red X=Press Imprint Map/pazcel Number qq — . Property Address (° fi d 5 157 , C (Le— sidential Value of Work$ 44 Sv 6. Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address J V e_f v, Q 0 r --r L�tIYV��.� Contractor's Name D � I n 4 Telephone Number b 7"I `f 4- Home Improvement Contractor License#(if applicable) b'6 8 rT Email: Construction Supervisor's License#(if applicable) SS L, 6 ri 1 io L ❑Workman's Compensation Insurance Check one: , I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's-Comp.Policy,# Copy of Insurance Compliance Certificate must accompany each permit. Permit Re st(check box) = ' Re-roof(hurricane nailed)(stripping old shingles).All construction debris will betaken to Yd r—mL d`t'15�_ ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof), ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: QAWPFILESTORMSUilding permit forms\EXPRESS.doc 01/25/17 F .r.- A the Commormeakh ofMawadhffeft Ae1whffmt&f&dus&iaIAcddads O} -ce of1mwfigafians. 600 Wasl rhwi Ft street Boston,MA 02111 , iwvi-mass;goP1dia Worlors, C Iusur-auce ava S01derIi/ tracWrsMectriciansiPlumbexs APPHcant Informatian Joe King Please Print ec er erry Lane Name 1.4,.9+v. eu+h, Awirnr 0�6�3 Address: Phone: 508-775-6448 Citgf tatp *� Phone-.U-- - Are you an employer?:Qtecktheappropr1atebox: T of project r I.❑ lam:a 1 Keith. 4 ❑I am a general contractor and I Y e a (require* = employees(andkr part-fiime * have lured.flre sub con�acfon . 6. Ides oo , 2.(j7J am a sale proprietor or gartuer- listed on the attached sheep I ElRestiOdeliug ship and have no employees These:sub-contractors have g- ❑Demolifion and wo&ess' ' �uori�ug forme is atYp capacity- employees $ 9..Q S.uildiag addition ' [No S4 g'comp_insurance comp-insu an required-] 5. ❑ We are a corporation and its 10_❑Electrical repairs or additions 3.❑ I am a homeowner doing all work Officers-rave exercised titer 1 L Q Plumbing repairs or$dditiaars myseM a worbme - right of es�empfion per l (3L y afr s fium=e ewe&]► c.L52, §I(CX andwehavena 1r_ e.mgloyees.[No worms' 13.❑Other conp- ] 'Any apptirsntdat chedcsbos#1 mast also SIIocotthe sectimbelmshunin flmkwa&me cnmpensa5nmpa&cyinf mnstiom t Hameo men viba submit this sf5da«a infficating the}* all WCA and rhea hire a4It9&co=ftRctatsmnct Submit a neW affidadt kdi—no sadh. ICantmc I t5st ch-Ir l Es box nnist attaches as additional sheet shox��thenam�of the sad state sdhe2hea notfhase eatitiesba� employees.I€thesnl caat�d�oeshtve ezagiayers,tfie3'�sCpmsride Yheir tsada 'comp.galicy amatsez lam an s►ripI er flint is prauidirtg workers'corrrjrer►srdicrrt i�rsrrrattcs f or Rc}a enW&yees Hero►v is fltepa ccy rind job rite irrformatian. - . Insurance Company Name: Poficg AIL Cr Self-ius.Lic- Fatpiration Date: Job Sit�Addn= Cifylstatel�- Aftach 2t6py of the warkere compensation policy dedEaration page(showing fhe policy number and e=piration dale). ' Failure to secure coverage as regmred.nnder Section 25A of MGL c.1572 can lead In the imposition of criminal penshies of a fine up to SUOD 00 and.For sae-y&irimpr ispnment as well as civil peaall sin ihe fain of a STOP WORK ORDER and a fne of upto$25Q_OO a dap against#he:violator. Be advisedthnt a copy of this statement rnaybe hawarded fn the Office of Itrvestigations of the DIA,for insurance coverage verfcstian. Ido Irertetry cW*fy Muter Ste prares andpsnali�i�s o.�jsedrtry fhatths infarmafzvrrprovirled abm�a is bus and correct Sitrtature: -Date: Phone A- ��dv 7? � � �tf6 0joWd um ardJ. Do not acute in ibis grey to be rxrrrigTeted 6g city artoit-►l rr,07c&I City or Town: Permitlr cease;9 Issaing A ufiol ty(cat le one): L Board of Health 1.Bwlaimg Department 3.mown Clerk 4.Electrical Iaspeetoc S.Phimbing Inspector b.Other CBRtWt Person: Phone#- Tuformation and Instrnctlons e General Laws chapter 152 req>zaas aU employers to pravide wor$eas'�peusaiion far Chair employees. Pam=tto this sty,an E r-VZoy is defined as."_.evmy person in th a srrvice of another m3der auy coact ofhirr- eqr=orimpliecl,oral arvxiftm." An,=Tkym-is deed as"an individual,pmtoembip,assoc ti m,corporation or other legal=f± ,or any two or more of the foregoing engaged is a joint uprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,pmt eaship,amMislzon or otherlegal entity,employing eurployees. However the ownewr of a.dweIlmg horse having not more thin three apartments and who resides iherciu,or the occnpm3t of tba - dwaRing house of anodier who employs persons to do mahtmance,cons ftarf;on or repair work.on such dwelling horse or on the grounds or bud mg agpm-tEa l iereeto ffiO mt becanse of sash em3:ploymeart be deemed to be an employers." MQ,dupt=-l52,§?5q6)also sties thA"eYery'SWE-or local Hcen ing agency shall withhold the iss ance or renew2l of a fic— e,or permit to operate a hus tress or to consii-ar butidings in the commonwealth for any applicani who has not produced acceptable�evidence of comp�an�with the Insurance coverage regained. AddidonaIIy,M(H-cbapter 152,§25C(7)states fi mffie r tjr,co3�Im'UrwmIthnor any oftspoIdical subdivisions shall fl-n >niu any coairad for the pmfo= nc6 ofpnblio work unfll acceptable evidence of compliance with.the:insurance. requir=c rls of this chapter have been.presented in the con�813tTioUtY" A.pp4c-=-b Please fiIl oi± the workers' compensation affidavit completely,by c ec1c�hg the boxes that apply to your sitnaiion mcT if necessary,supply sob-co r(s)name(s), addresses)sndPhone mbez(s)aIongwiththeir cmtficate(s)of insuiance- Limited Liability Companies(LLC)or LimitedLiabi-EfyPazfn=:ships CLLP)wi$f.no employees other than the in=hers or partne:as,are not rimed to carry workers'compensaiian insr az = If an LLC or LLY does have empIoyees,a.policy is rmpi ed. Be advised that this afffida-vitmaybe submitted to the Deparx inert of Iudusfrial Accidenfis for confirmation of iuso¢ance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to!he city or town that the application for the peonit or license is being requester not the Department of Ldustrial A cQd Sbaoldyou have ate•gnestionsa the haw or ifyou am regdto obtain a woriaets' compensation policy,please call the Department at the mmber lis-tEd below: Se:If-insed companies should enter tlieir s elf insca�ce license number aa the approlrtia line. ur -- City or Town officials Please be Sore that the affidavit is coMple#e and printedlegiibly. The Department has provided a space at the bottom of the affidavit for you to fM out in the event the Office of Inv�'+�tf ins has to contact you mgarrna the applicant_ Please b e sure to fM in the pen�iYlicensc member which will be used as a=B= ce number. Iu addition,an applicant fliatmust submi l mu erm ltiple p ;tlt;cen r,applit sfians in any given year,need only submit are affidavit indicating eusent policy information(ifnecessary)and nnrI `rJob Site Addre&*the applicant should wr>fe"all locations in (ctiy or town)-"A copy of-tho-affidavit that has beta officially Sfaunped or ma&ed by the city or town may be provided to fhe - ' applicant as-rmoYthat a valid affidavit is on file for b:dm peunifs or licenses- A newt affidavitmust be filled ovt cash year.Where a home owner or citizen is abtammg a license or perinrtnot related to any business or commercial vent= Co-a dog license orpeonit to hum leaves eta.)saidpersan is NGTreq>mEdto complete this affidavit The Of Em of Tnvcsfigadonswouldhb--tothankyou.madvanceforyourcooperationandshoIIIdyouhavenanyquestions, please do nothesifaf to give us a call The Department's address,telephone and fax rnnnber Depaxt6imt Gf lad kAcf id nt �os#�I�E�11F Ta 4 617 --4900 mt 406 or 1-9771v3 A GAFF Fax 9 617'27'749 Revised 424-07 - R - gpvldia Town of Barnstable Regulatory Services M Richard V.Scaly Director Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using;A Builder h e-I.- e r , as Owner of the subject property hereby authorize d C a to act on my beh4 m all matters relative to work authorized by this building permit application for: (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 inspecti s are perfomned and accepted. j Sihaat6e-o er sig�ureofAppfficant ./ Da Print Name Print Name Date '. e • /�' ` - , Q:FOR?AS:OWNERPERMISSIONPOOLS . Town of Barnstable " Regulatory Services Richard V.Scali,Director 1 t Building Division MILNgrANA = Paul Roma,Building Commissioner MAM 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: JOB LOCATION: number street village "HOMEOWNER": - 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 Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 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 this issue is a form currently used by several towns. You may care to amend and;:adopt such a form/certification for use in your community. 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MASS GOVipp nse S ofRV va r: Town of Barnstable *Permit# Regulatory Services a 67o o use • =AarvsreaM • MASS. Thomas F.Geiler,Director 'Ar 1639 FD MP't Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town barnstable.ma us Office: 508-862-4038 Fax:.508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY e Not Valid without Red X-Press Imprint Map/parcel Number Z l �— Property Address 6 y C I S s Ce d �4 r t �C 0114 Q 26J a" Residential Value of Work 9 D a Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address � C.o�' �• Q "� J Q� 4 yG t NL iJ 49 e r Contractor's Name J at— KI)4q Telephone Number �.SO �77 - G V y8 Home Improvement Contractor License#(if applicable) ®� �+ �m�•.R� Construction Supervisor's License#(if applicable) AUG 12 2013 ❑Workman's Compensation Insurance Check one: I am a sole proprietor TOWN OF BARNSTABLE ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ® maximum.35 Replacement Windows/doors/sliders.U-Value �� ( )#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. . Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors.License is required. 213 SIGNATURE: nanroim rc%r(-MuRkhnildina nermit fhnns=RESS.doC � y The Crib monismealth of Massachusetts Dej artna ent of 1'ndarsbial Accidenft f1Yk of lnvesfiga ions 660 Washhvton Sh-eer Boston„Md#211.1 ?VfM.Ma3&gvv1dia Workers' Compensation Imuranee Affidavit:Bliziltiers/Contractors/EElectsicianstPLambers Applicant Information Please Print Legibly Warne Address: 3 Ciac t--b a arena C,±y/sta&zjp: 1A 1- Arm y rf- Pk v 2-6' 3 Plane 4- -57 o g 7 ?J' b Lfq� Are you an employer?Check the-appropriate box - Type of project(required): 1" 4. ❑ I am a general cmtractor and 1 6- ❑New constnetion Io * have hired the sub--contractors 9Thesr a sole F etoi or IasGed orgy the attaehed sfieet 7. ❑Remodeling - e sub-contractors have h ship andave no employees S_ ❑Demolition working for me in any capacity- employees and have weikers' 9. El Building addition [No ' comp-insurance cam""""`a' 1D_ Electrical of additions required-] 5. ❑ We are a corrpontion•and its ❑ repairs. 3_❑ I am a homeowner doing all work officers have exercised r 11_❑Plumbing repairs or additions myself[No workers'comp- right of exemption per 1r1GI. 12.❑F.00f repairs, insurance required]T c.152,§1(4} and we have no employees_[No wars' 13. er G.1�(/1 d owe comp-insurance required.] *Any applicam thst died box#1 also f lloet the section below shavring their warners'compensation paricy informatiam- I Homeowners wba submit this a€hdsvd mffic rting they ne doing mama*and them hire outside contr-xmrs mast submit anew affidavit indicating sacb- IContradnrs that rherk this bwt must attached an additinnst sheet 5m wiag the umne of the cWn and state wbether or not those entities hate engi ryees. Ifthe sub-ccntraciaes have employees,theyM=pxovide their waders'camp.policy number- ants this s►rnplt ar tl:rutispe�vid rug.workers'camp�rarrrl err is rrrrit^e for rra��etrigtoyi Edviv is than poHiry snot jab site irrfortasreh�rr. . Insurance Company Name: Policy;�or Sew ins.Lic. F r+tion late: Job Site Addrew: City/Stat&Yip: Attach a copy of the workers'compensation policy declamation page(showing the policy number and Mpirafion date). Failure to secure coverage as mquiredi under Section 2:5A of MGL c. 1.52 can lead to the imposition of criminal penalties of a fine up to S 1,50d OG an&or one-year imprisostmeit,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,,iolator- Be advised Hirai a copy of this statt m nt may be.forwarded to the Office of lkvestigations of the DIA for insurance cmwage veriffication 7 Mtn Jrsretry cerh;y under thepains a nrlpeas s ofyedM7 that the infot�raatrosn prnt�ided above is true n1nrl correct 5i Bate: Phone k U 7 s Co V b ©,fcirrI me ruraly. Do not tvrfte in this inert,to be c,'rtpleted by city ur tmal offictia1 . City or Town• PerrmitfLicense# =iug Authority(drde tine): . 1..Board.of Htaith 2.Building Deparhtnent 3.{ tyffown Cleric d.Electrical Inspecfar 5.Ph—mbizg Inspector 40,*1HE * �xxsrns[.s. 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 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder ' - f l � r• j -�/Qt uc li�rG �a Cr ;as Owner of the subject property hereby authorize J��- � to act on my behalf, in all matters relative to work authorized by this building permit application for: G4( C : Us s�- • C��r�zr •l�� /n (Address of Job) r Signature er Date J;1e,okW �• Q a Cv Prin Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on,the _ reverse side. Q:IWHILESTORMSIbuilding permit fbnws EXPRESS.doc �oc1HEZ Town of Barnstable P ~°^ Regulatory Services BRIM Asp Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office:. 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": 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.I) 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 Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 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. . �1e oawr�uaacvecrC�a�G aaclz�e , License or registration valid for.individul use only Office of Consumer Affairs&Busidess`Regulahou g ME IMPROVEMENT CONTRACTOR before the expiration;dnte. If found return to: Type egistration: 150889 Office of Consdmer.Affairs'and Business Regulation xpiration 5/5/2014 Individual 10 Park Plaza-Suite 5170. Boston,MA 02116 JOSEPH E. KING JOSEPH KING 36 CHECKERBERRY WEST YARMOUTH MA 02673 ' Undersecretary ; No Zt witho,0t-s� n .ure ` Massachusetts -Dapartment of Publkq Safety Board of Build `%!, :.yulat; ,�nd.Standard4 . Cons tructign Surcrnisur Specialt. License CSSL-099166 JOSEPH E 36 CHECKEIMERRY T W.YARMOVTH 0267 n Expiration Commissioner 01/24/2014 L , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 24q, Parcel i! Z Application # @LO 13 0(4 4 1 3 Health Division Date Issued 711 S/fJ Conservation Division Application Fee o7� Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board (✓ -7/ 1��13 Historic - OKH = Preservation / Hyannis Project Street Address L/ Village �1/6 Owner !� W Address �`� cklcls S� Telephone ,SO 8) 7 7 — t, 7/ff Permit Request e_1 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning Dis • t Flood Plain Groundwater Overlay Project Valuation Construction Type N � Lot Size Grandfathered: ❑Yes ❑ No If yes, attach s.M orting ccWum tation'. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's� ighway:-�Ye 7 ❑ No Basement Type: ❑ Full ❑ Crawl ❑Wa ut ❑ Other a = Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft), c Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existin wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use - - -- - Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 4HEk_T6AfV T2--A/T /q/9L2_L Telephone Number 5C Address '?.0- 'Roy 13 4� License # IV 4 HO RSTdN S 14=4.1-S 84 Home Improvement Contractor# Worker's Compensation # *02 W g' - WI-SA ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO N/4 SIGNATURE r DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE i OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 't .Etc R& CERTIF ICATE OF LIABILI ' ou„rTY INSURANCE °84111/°°""'^'' m,3 i THIS CERTIFICATE IS ISSUED AS A MATTER OF MFORMATION ONLY ANb CONFERS NO RIGHTS UPON THE CERTIFICATE DOES NOT AFFRMATNELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE CERTIFICATE ' THE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUNGAFFORDEDR )Y THE POLICIES AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT:t the certificate holder is an ADDITIONAL INSURED,the policy Pies)must be endorsed, 9 SUBROG,ATION IS WAIVED,subject 1u the terms and conditions of iNe policy,certain ;y re"ire an endorsement A statelrlerlt on this certificate does not confer certificate holder in lieu of such erHdorsement(s). n9ft to the. PROMI t 06082-001Oft i s 500 Granite Group,Inc. II (617)4784i500 (61Tp787761 Suite 3 Millon,MA 02IN iI INSURED INSURER AA.LM.Mutual kmwawe Con*a" 33758 it Ameripn Tellt8 Tabb Inc at s P 0 Box 1348 INSURER C. MarMns Mils,MA 02M !� COVERAGES CERTIFICATE NUMBER, j Baum REVISION NUAIBm THIS IS TO CERTIFY THAT 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 V*9CH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. TFE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. p EXCLUSIONS AND CONDITIOM OF SUCH POLICIES.LIMITS SHOVM MAY HAVE BEEN REDUCED BY PAID CLAIMS. VTR TYPE OF INSURANCE POLICY wa*m Y Lawn GENERALLIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE a OCCUR �Oe s MEDEXP(Anyomperson) $ PERSONAL E ADV INJURY s GENERAL AGGREGATE s ENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ i AUTOMOBILE L148MM ANY AUTO ALL SCHEDULED I BODILY NAM(Per parson) S AUTOS AUTOSx BODILY NJURY(Per aoriden9 i HIRED AUTOS AUTNON,0 AED s 1 �! s UMBRELLA LIAS OCCUR EACH OCCURRENCEs EXCESS LIAR CLAIMS MADE AGGREGATE _ y�Ey/p�low I I RETENTION s AINLO'YCO� N X A MEMMMUMSPECUTIVE N I A AWC4100 7026128-2013A 4/5/2013 4/5/2014 F-L EACH ACCIDENTER $ 10'� (Maror endy in NH) E.L.DISEASE-EA EMPLOYEE S 100,000 B&MMOPERATIONS below l 1 E.L.DISEASE-POLICY LIMIT $ 500,000 DEbCRIPTION of OPERATIONS I I:OCATION&I VEHICLES(Attach ACORD 1tM.dd'di1ional Remarks SdiedWe B more space is requbem II .I CERTMATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WELL 13E DELIVERED N ACCORDANCE NRTH THE POLICY PROVISIONS, AUTHOR®REPRES9iTATIVE a 1988-2018 ACORD COwOqATKft All riots reserved. ACORD 25(2010/05) Tm ACORD naln and logo are registered marks of ACORD i i. in < A The Com nwealth of Massachusetts Depardnent of Industrdl Accidents Office of Investigations .600 Washington Street tBoston,MA MII www.massgov/dia - Workers' Compensation Insurance Affidavit:_Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): l7 Address: �&V City/State/Zip: �IA�STD�S �1/l.�S ',l`7ff 6 hone Are you an employee Check the appropriate box: of project ,_., 4. I am a general contractor and I Type P J (regaireil): 1.t,y't am a employer with�_ ❑ � g . 6. New construction employees(full and/or part-time).* aye 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 sub-contractors have S. ❑Demolition working for me in any capacity. . �mPloyem and have workers' [No workers'comp.insawce comp.insurance.t 9. 0 Building addition required.] : 5. We are a corporation and its 10.[]Electrical repairs or additions: 3.❑ I am a homeowner doing all work officers have exercised their I I.(]Plumbing repairs or additions myself.[No workers'comp: right of exemption per MGL 12. Roof repairs insurance required.]t c. 152,§l(4),and we have no ❑ employees.[No workers' 13.[91&er comp.insurance required.] •Arty 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 attaclwd an additional shee4howing 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. lam an employer that is providing workers'compensation or insurance ee& Below is the f m1'a mP�1' Policy and job site information. Insurance CompanyName:.I. f1. t_n L JA1S'Vt@l4,wt`✓ Policy#or Self-ins.Lic. Expiration Date: Job Site Address: Eity/State✓Zip: is 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�5A 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Offlee of Investigations of the DIA for insurance coverage verification. I do hereby under theP and ofPedwy that the informa don provided a is true and correct Signature: A ��� Dater Phone#: 9 - AJ)3' Official use only. Do not write in this area,to be p onrpleted by city or town offlcial City or Town: _ Permit/License# Issuing Authority(circle one): l:.Board of Health 2.Building Department 3 Cityffown Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other - Contact Person- Phone#: Town of Barnstable MAS& Regulatory Services Thomas F.Geder,Director Building Division Tom Perry,CBO Building Commissioner , 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I � 4W Patqee ,as Owner of the subject property hereby authorize --'' ✓1: r r 11145 - to act on my behalf, in all matters relative to work authorized by this building permit application for: 5 f- . am/4Vve-fie- /K,4 (Address of Job) Signature of Owner Date , ry f Print.Name t Q:Fonns:expmtr$ Revise071405 e i ica e o ame esis ance PAGE Date Manufactured AZTEC TENTS " ¢, 2665 COLUMBIA ST INV NUMBER: 0178567 Sal 02/26/2010 TORRANCE, CA 90503 P.O. NUMBER: ' (800) 228-3687 : i.. CUSTOMER N0: AMER026 • � This is to certify that the materials described below have been flame retardant li I treated (or are inherently flame retardant). VehdOr Tneds,M.. llf : -. rytr ruin Mardi 25. - „ AMERICAN TENT &TABLE INC. Bruin Mesh F-222.06 x . y Celi(omle Comb. lam-Tez 12,14,36,18ox F-419.01 'tlyr' Coated Fabrics Clear Vinyl 16ga/20ga F-570.02 P.O. BOA 1348 DAF Clear Vinyl 16ge/20ge F-593.01 , { 381 OLD FALMOUTH ROAD UNIT 41 ,I DAF DAF F•593.02t I Marstons Mills, MA 02648 Exclusively Expo PolySateen Liner F-434.01y�g?y� ` r Ferrari Precontnint 502 F-444.01-Yt`ra`�•_ I Ferrari Precontraint 702 F•444.08 —$1 Phillips Textiles Phil-Tex Uner F•500.01 S# P/C Tech. Deco Cloth/Velon F•504.01 Sat � - Snyder Weatherspan F-140 11 ltx Tn Vantage Flresist Sunbrella F-368 05' 9.t Th Vantage Patio 500 F-121 02 Certification is hereby made that the articles described below hereof are made 1 Tn Vantage Big Top F-121 10 ' `from aflame-retardant fabric or material registered and approved by the ' TdVantage VanguardWeblon F-06901 ' ' California State Fire Marshal for such use. The fabric has been tested and mvanta9e Weblon/Coastine' F•06901 s passes NFPA 701 Large Scale. See chart to right for trade name of Ve�1dag °uresklnB1673,81515 F-53°U1 � ? flame-resistant fabric or material used and additionally referenced on the label Mt - of the fabric panel. , THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING David Bradley'` General Manager-Manufacturing I Name of Applicator or Production Superintendent Title of Applicator or Production Superintendent I A I �4 rT ITEMS MANUFACTURED TYPE PRODUCED ` 40x40 2pc Series 2500 SP UW S. 1 Stock#'5719, #5720 40x20 Mid Series 2500 SP UW _ S 2.,. Stock# 5721, #5722 a c� &Phd i i �o l l0.2-> oFt�t� Town of Barnstable ""Permit# � Regulatory Services E s6 Feemarr/rsjronr iesrrer/are aA srxst.E, 4� #Ass. Thomas F. Geiler, Director Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstab le.ma,us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid tpithon/Red X-Press Imprint Map/parcel Number CQ Property Address RAN _ -Residential Value of Work 3 " Minimum fee of$35,00 for work under$6000.00 Owner's Nam e & Address Sk p r Gqq et a r _ �a Lf e-il t Contractor's Name 11305E10tril Kitu4fG Telephone Number 50cd -77-5 Home Improvement Contractor License#(if applicable) 150 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: I am a sole proprietor 'PIE RWr ❑ I am the Homeowner A ❑ .I have Workers Compensation Insurance jl Insurance Company Name 0 SARMSTABLE Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request (check box) {it Re-roof(hurricane nailed) (stripping old shingles). All construction debris will be taken to ` o u — ❑ Re-roof(hurricane nailed) (not stripping. Going over existing layers of roof) ❑ Re-side #of doors Rep lacemen Wind o4vs/ `ors/sliders. U-Value (maximum .35) # of windows oZ— 54 *Where required: Issuance of this permit does not exempt compliance with,other town department regulations, i.e. Historic,Conservation,etc. 1 , ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License & Construction'Supervisors License is required, SIGNATURE: Q:\WPFILESIFORMSIbuildi, permit formslEXPRESS.doc Revised 0721 10' The Carnrnorryv allh Of,V'17ssachllsetts - - Department oflrrrlrrs1rial Acciilews . r— { -Ojfice ofInvestigatior;s. 600 Washington Street M Boston, M-4 0111 F"s n,ts-,n?.rnna.ss.gov ilia 'Workers' Compensation Insurance Affidavit: Bull ders/Cnrttr-acton/Electi.idins/Plumbers Appficant Information 'Please Print Le 'bly Joe lUng Na ne. 38 (lba,4a,h—, Aati-=ss: West Yarmouth, MA 02673 one: 5 88-775-6448 City/State/Zip. Phone# Are you an. employer? Check the appropriate boa.: Type ofproject(required): 1...❑ I am a employer with 4• ❑ I a3n'a general contractor and I employees(full audtorpart-tuue). * have hired.the sub-contractors 6- ❑.New construction 2..'o I am a sole proprietor orpartxer- listed on the attached sheet- 7- ❑Remodeling shipand have no employees gees These sub-contractors have p } _ 8. ❑.Deauolition working :for me in any capacity, employees acid have workers' .[No workers' comp.insur-ance comp-insurance.., 9. [].Building additio,u required.] 5. ❑ We are.a corporation.and.its 10.❑Electrical repairs or additions 3.❑ :I am a.homeowner doing all work officers have exercised their I L0 Plumbing repairs or additions myself. [No wrorkers' comp, right of eacemption per?WGL 1 2 %-Roof repairs insurance.regvimd.]t c_ 152, §1(4),and five have no eutP logfe a.s. [No workers' 110 Other cotnp.:insurance:required-] Any appficaut thatchecls box#1.niust also fill out they section beloia,sbowing theirrrorkers'compnsation policy inf'ortwtion. 7 Hoareowners who submit this.affidavit indicating they are doing sIC'work end then hire outside contractors must submit a uew affidavit indicating sncli tContractors that check this bras onset attached an sdditionaf sheet showing tbe:nsm=e of(he sub-cmtrxctnrs anal state whether or not those entities have employees. If the sutrc.ontaectorsbsve employees,ihey.must provide their warken'comp.policy number. T annt�u ev►plot en tdtrrtis pros idirng rtror&ors'oot7rp rtsatio�t itrsJtrrrrrce for rely e��cplaJ•ees. Betoiv is fhe policy and job site iff forty flftol4 Insurance Company Name: Policy#or Self-ins-Lc.#: Exptrntion I}a.te: Job Site Address: Cite/State./Zip: Attach a copy of.the workers'compensation policy declaration page(xhmidng the policy number and eapilration date). Failure to secure coverage as required under Se-ction 25A of 11ff.GL c. I52 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$250:0,0 a day against the violator. Be advised that a copy of this Statement may be forwarded to the Office of Investigations of the D.IA for-insurance coverage verification. I do hem y certify murder tho paints and penalties of pei jury that the it:forttia fort prat idad abatis is true and correct. Phone#: So 0O cigl-use ofthv, Do not trrite int this area,to be connipleted by cite or town of cial City or Town: Permit/License Issuing Authority(ciy;cle one): 1.Board of Health 2.Building Department 3. C:itytfown Clerk 4. Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#r pp THE 1p� , y DARNSTADLE, " MASS. g Town of Bar>nstable i61q: �0 Regulatory Services Thomas F. Geiler, Director Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 0260). www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A. Builder T, t e r as Owner of the subject property hereby authorize ,1 OSep� � +�Q to act on my behalf, „ in all matters relative to work authorized by this building permit application for: .(Address of Job) lye v.. .f� 02®JO Sig ature of ner Date- Print Nam S If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the reverse side. QAWPF1LESIF0RMSlbuilding permit forms\EXPRESS.doC .Revised 072110 o ti Town of Barnstable I * � ][regulatory Services M Thomas F. Geiler, Director 'r - 9. A��� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta ble.m a.us ` Office: 98-862-4038 Fax: 508-790-6230 ----------------------- HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER" name home phone N work phone N CURRENT MAILNG 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 bull ding (Section. i. • 109.1,1) c 5 --fi r The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. . The undersigned"ho leowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection 1.procedures and•requfrements and that,he/she will comply with said procedures and requirements.. + Signature of Homeowner Approval of Building Official •fit ....� Note: Three-family dwellings containing'35,000 cubic feet or larger will be required•to.comply-with the State Building Code Section.127.0 Construction Control. o s 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 ofconstruction 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 thatthey are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulirrions 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 ensue 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 unders'tanrks..the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care I amend and adopt such a form/certificatibn'for'use in your community. I' Q:IWPFILESIFORMSIbuilding permit fonns\EXPRESS.doc Revised 072110 - fie:i�an�noda^wea,`l� o�:./�aaaac%uae6�`a �; Office of.Consumer Affairs&Business RcomN, Oil License or registration valid for.individul useonly before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR. Office of Consumer Affairs and Business Regulation Registration 150889 10 Park Plaza;-Suite 5170 Expiration` 5/5i�2012 Tr# 294731 Boston,MA 0211,6 TYPe i� �niii�i`tlual�, �° JOSEPH E. KING JOSEPH KING r r 36 CHECKERBERRYN _WEST YARMOUTH`MA 026,h Undersecrdflry No and without.si reFm - Massachus-.Its- Dep.ai-t.irtchit W Public Safety Bond of::Buildint;<RegWations and Standards I Construction Supervisor Specialty License �t License: GS SLz 99166 i Restricted to z• , d , JOSEPH KING. 36 CHECKERBERRY.LANE W. YARMOUTH, MA 02673 Expiratit 1/24/2012 ('unnnissiuner Tr#: 99166 Joe King 36 Checkerberry Lane West Yarmouth, Ma. 02673 508-775-6448 Lic. #150889 1 v A-c=1 2 xew wuy l'yl-a4i�Ul'a'O Ivey- . is- ;aojo t i/o ✓ol�r Ott CEO.0 1 cf r✓ D N ^/ / 7 el X Roofing,Siding,Windows and Doors, Landscaping, Trucking etc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION.. Map Parcel:' , Application # Health`Division V 0&--t l Date Issued b` Conservation Division ; Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis V Project Street.Address Village C��IU f/�yl LLF Owner Address Telephone Permit Request d I�� to 91 ,bi A) Fxh,17 y A) Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Tota Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No es, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-F y (# units) Age of Existing Structure Historic House: es ❑ No On Old King's Highway: ❑y_;s ❑ No k it Basement Type: ❑ Full ❑Crawl ❑Walkout Other Basement Finished Area(sq.ft.) Basement Unfinished Area;(sq'ft) w Number of Baths: Full: existing new Half: existing - new =J'- Number of Bedrooms: existing _new To/Appeals Count (not includi baths): existing new First Floor RQom Coup ; Hnd Fuel: ❑ s ❑Oil ❑ Electric ❑ Other C ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Darag existing 0 new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Aar ge: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zrd of Appeals Authorization ❑ Appeal # Recorded ❑ Cl ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION BUILDER OR HOMEOWNER) Name S f � Telephone Number -Dal fj Address -Po A) �s � License # A) Home Improvement Contractor# �a 7 C> Worker's Compensation # �vi.99� 9 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE y DATE ✓,s �� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE OWNER ti DATE OF INSPECTION: FOUNDATION FRAME i INSULATION FIREPLACE k ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING m DATE CLOSED OUT ASSOCIATION PLAN NO. v ; The Commonwealth of Massachusetts �\ Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia ers Workers' Compensation Insurance.Affidavit: Builders/Contractors/El Please Print L bibl Applicant Information �-)q- pjl'' Name (Business/organization/Individual): r Address: � � City/State/Zip: 10' }'i°l ;a.5 /�'f Phone. : - Are,,you an employer? Check the appropriate box: Type of project(required): � 1 4. ❑ Lam a general contractor and I 1.!�1 am a employer with� 6. New construction employees(full and/or part-tirne).* have hired the sub-contractors listed on the attached sheet 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- These sub-contractors have ship and have no employees 8. ❑Demolition working for me in any capacity. employees and have workers' S Building addition [No workers' comp.insurance comp• a corpora 10. Electrical repairs or additions required.] 5. � We are a corporation and.its ❑ p 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ ns Plumbing repairs or additio myself. [No workers" orkers comp. right of exemption per MGL 12_[]Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.[4,MP er 17 /t: ,/7r comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. f Insurance Company Name: 5TV4PL" r1 olfel- f; Policy#or Self-ins. Lic..#:__x � � fixpiration Date: / !i City/State/Zip: Job Site Address: ,,,,��. Attach a copy of the workers'compensation policy declaration page(showing the policy number and eapiratiori age}�3 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 eerti under thepain -and penalties ofperjury that the information provided above is true and correct Signature: - Date: — Phone# d �y Official use only. Do not write in this area, to be completed by city or town offieiaL City or Town: PermitlLicense# 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 9. r.v.rsOX 53310 _ """-' HINL1 UONFERS NO RIGHTS UPON `THE CERTIFI( HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTENI Irvine, -3 92619 ALTER THE COVERAGE AFFORDED BY THE POLICIES BEI 800 854-3298 INSURED INSURERS AFFORDING COVERAGE American Tent 8,Table Inc. INSURER& St Paul Fire and Marine Insurance Co P O Box 1348 INSURER B: Travelers Property Gas.CO.Of Ameri Marstons Mills,MA 02648 INSURERC INSURER D: - - COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, N TAN ANY REQUIREMENT, TERM OR CONDITION_ OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUE[ MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS SO FE POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION A GENERAL LIABILITY _ CK00220040 DATE MM/DD DATE MM/DD LIMITSX COMMERCIAL GENERAL LIAB 01/21/09 ILITY - - 01/21/1O EACH OCCURRENCE $1 000000 CLAIMS MADE a OCCUR - FIRE DAMAGE(Any one fire) 100000 MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1 00O 000 GENT AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $2 000 000 X POLICY PRO-JECT LOC PRODUCTS.-COMP/OP AGG $1 000 000 AUTOMOBILE LIABILITY - - - ANYAUTO ALL OWNED AUTOS - COMBINED SINGLE LIMIT g accident) SCHEDULEDAUTOS BODILY INJURY HIRED AUTOS _ - (Perperson) _ g NON-OWNED AUTOS - BODILY INJURY - . (Per accident) $ GARAGE LIABILITY PROPERTY DAMAGE(Per accident) $ ANY AUTO AUTO ONLY-EA ACCIDENT $ 'OTHER THAN EA ACC $ - EXCESS LIABILITY AUTO ONLY: AGG $ OCCUR CLAIMS MADE EACH OCCURRENCE $ u AGGREGATE $ DEDUCTIBLE RETENTION $ -" - B WORKERS COMPENSATION AND XJUB5819Y97509 EMPLOYERS'LIABILITY 01/21/09 01/21/10 X WCSTATU OTH- - $ IT E E.L.EACH ACCIDENT '100,000 EL DISEASE-FA EMPLOYEE $100,000 A OTHER quipment Floater CK00220040 01/21/09 01/21/10 E-L DISEASE-POLICY LIMIT $500,000 pecial Form CAKA nnn Limit DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Deductible - -This certificate is issued as a matter Of proof only.*Except 10 days notice Of cancellation for.non-payment. CERTIFICATE HOLDER ADDtnoNiu INSURED;INSURERLETTER: CANCELLATION Sarah.MaCDOnald - SHOULD ANYOFTHE ABOVE DESCRIBED POLfCIESBE CANCELLED BEFORE THE EXPI RATION DATE THEREOF, THE ISSUING INSURER'.WILL ENDEAVOR TOMAIL30* DAYg�YRI�N 1440 Hyannis Barnstable Road Barnstable,MA 02630 - NOTICETOTHE CERTIFICATE HOLDERNAMED TOTHE LEFT,BUTFAILURE TODOSOSHALL - IMPOSE NO OBLIGATION ORLIABILITYOF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. ALIT ORIZE REPRESENTATIVE ACORD 25-S(7/97)1 of 2 ZA, #S3903741/M3266806 CXAJG © ACORD CORPORATION 1988 Town of Barnstable MASS �srasrast,e: « �63 1659 Regulatory Services . a� p Thomas F.Geiler,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section 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 application for: SA . 0CWAf'VJ'11eP MA (Address of Job) a?p 0 S' ature of e 5' 4 W Da fey- Print Name Qf0rms:expmtrg Revise071405 Resistance Certtjtcate of Plame, ISSUED of l wwfactore r FABRIC JOHNSON OUTDOORS I . NUMBER BINGHAMTON,NEW YORK 13902 ! NOVEMBER 1(}ta�s IN Manufacturers of the Ernest I F_9 40.01 { Tent Praducts!?es�tiea'Herein material inherently flame retardant as the redacts herein have been manufactured from This is to certify that p supplier. here after specified by the material NAME: AMERICAN TENT AND TABLE CITY: MARSTON MILLS,MA th Certification is hereby shade that: coed fPatne reta=den: chees!scat in m ce with +th �'anac+a. and have been tested in accordance with the The articles described an this certificate have been manufactured with an aR�' California State Fire Marshal Code. NFPA-i01*. UnderwritersMilita bofatory lame S' ti F e t S eci at'on rr^ t Tvve.color and weight of material 14=OZ vinvi WHITE BLOCK OUT [3escnonon of item cerimed �0. NfID FOR A 40' GENESIS Flame Retardant Process Used Will Not Be Removed By mashing And Is Effective For The Life Of The Fabric Snyder Manufacturing, Inc. Manufacturer of Flame Re+ardent Vir-vt Lam:na es TENT D pARTMEN jOHNSON OUT ORS N •Large State -------------------- uertij cate of Flame Reststance REGISTERED ISSUED BY ' Date of Manufacture FABRIC JOHNSON OUTDOORS INC. NUMBER BINGHAMTON, NEW YORK 13902 Manufacturers of the Finest NOVEMBER 2006 F-140.01 . Tent Products Described Herein This is to certify that the products herein have been manufactured from material inherently flame retardant as here after specified by the material supplier. NAME: AMERICAN TENT AND TABLE CITY: MARSTON MILLS, MA Certification is hereby made that: The articles described on this certificate have been manufactured with an approved flame retardant chemical in compliance with California State Fire Marshal Code, NFPA-701', Underwriters Laboratory of Canada, and have been tested in accordance with the Federal Test Method Sr)ecifications and meet or exceed the Military Flame Specifications of M C-43006G. Tvpe, color and weiqht of material 14 OZ vinvl WHITE BLOCK OUT I; Description of item certified: GENESIS 40X40 2 PC Flame Retardant Process Used Will Not Be Removed By Washing And i Is Effective For The Life Of The Fabric Snyder Manufacturing, Inc. '�O'ZG�4�� ' Manufacturer of Flame Retardant Vinvl Laminates TENT DEPARTMENT,JOHNSON OUTD aORSIN `Large Scale '280I4 ~°�^ No —'`--- Permit for ----' ' ingle --------------V ~------' G4Loco�on ---..���!��!�.. ------- ` ....................-enuex^u'll4a.................................. Owner .......�Yjgl.§.Q.Wro----------.. Typo of Construction ..Fxaooe---------. � --------------------------. Plot ............................ Lot ................................ - ' ' Permit G,onx*6 --.Juzaa.I2^...............1985 � -'-,Date of Inspection ------------lq Dote Completed ------------.]A � , - ~� � . � | L ` | .'Y9.:-.�` .... .` SCEPTIC SYSTEM MIST' B Assessor's map and lot number f .� HE c INSTALLED IN COMPL1 Sewage Permit number �r�.......7.D..I.:,.�`'.` �'�'����L� 9 .............. . ` H3TABLE�,ENVIRONMENTAL CODZYS House number ......................:.... M a 1639.REGU TOWN i �O OR h�0 TOWN 'OF BARNSTABLE r BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..............t I�.p...... N l /,l�/V, :.. I TYPEOF CONSTRUCTION ..........°...... ............................................................................................................ ......1-1.................... 9.......jq� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .........4..�.....` i•. .........��1.:.................`� . !.'..I... U...!... ......... ................................... � 13 ado lo. Proposed Use ............. ....... .... . jZoning District ........................ /� �"� ,..........................Fire District ................................................................................ Name of Owner ..�1#. ...J.. ..............Address ..�..../. ................. ............................................ j'� Name of Builder ......MI..Y� .......�.j�f��! > ...........Address :!%.....?.'.. ..Y ......(�..... . 1 Nameof Architect ..................................................................Address ..................................................................................... Numberof Rooms ......�......................................................Foundation .. !1 .......................................... Exlerior ...... (1r .......................................................Roofing .......f ,ll ............................................... Floors 1w" f....Interior I� ....�. •��� ............................ ............................................................................. ...................... Heating ���/! /i"'l....� .....GAIs..........................................................Plumbing .......... � ....).. -0 Fireplace .�'�!.> 1 \,ti.....................Approximate. Cost ..... j.................®.............................. Definitive Plan Approved by Planning Board -----------_-------------------19________. Area Diagram of Lot and Building with Dimensions Fee .�Dv SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS �141 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ... �.............. .............................. v.Construction Supervisor's License ....... ............... ... .... ... SOMERS, SYBIL � 28014 Addition ..,. No ............ Permit for .................................... .......Single...Fami.ly-DwellijIg................... ............. ........ ... ............. • Location 64 Childs.str.e.et;........................... ....................... .... ...............Pqntprvillle....................................... -T Owner'....SA?il..SQrn.QX$......................... ............ Type of Construction Xx'aloe.................. ............................................................................... Plot ......................... Lot ................................Permit Granted .....June...1.2 ...... 85 ....... . Date of Inspection ............................. ...... 9 Date Completed J4 ..... 9 e "N RECORD IN REGISTRY OF DEEDS "CIWN GJER, IN COMPLIANCE WITH SEC. 11 or-TOWN O BARNS 'ABLE `' �'ru'ABLE. CHAPTER 40A, M.G.I. Zoning Board of Appeals 'R6 MAR l l bH 8 53 y.Stepp} rl...P.,..._Dager.__._._..__ _...._. . _..._.., Deed duly recorded in the _........................._..._..w............ Property Owner y County Registry of Deeds in Book ......._........_........... .Sante...._......_...._..._........_..........__-...__._._.................................................. Page __..................... ...._._......_.................._._...................Re�istry Petitioner .District of the Land Court Certificate No. ........I..._........ ....._....._.......... Book ........................ Page .................. _lppeal ?vo. ...._...........�.y5�.-.�8._.......__................ < , ._.......................:........._........................................ 19 FACTS and DECISION Petitioner ._.........._........................... filed petition on ............._................................. 19 re uestin ................ a variance-permit for premises at 64 Childs St. _......................................................................................... ..., iii the pillage (Street) ............... adjoining premises of (see attached list) .................................... Locus under consideration: Barnstable. Assessor's Map no. - l`.............249_........................... tot ro. ..........:.................... i Petition for Special Permit: ER Application for Variance: ❑ made under Sec. ...................................._............................ of the Torn of Barnstable 7nping by-lags and Sec. __--.—.—......_.............................................................................. ......... Chapter —_Oa.. Mass. Ge-n. Laws .'or the purpose of ............to...allow...a.._family....apartment.........................................._.............._..............................._.................... Locusis pre::ently zoned in..... ......_—......—.........—.....RC......................................__................................................................................ Notice of this hearing was given by mail, postage prepaid, to all persons deemed affected and Barnstable Patriot by publishing in ne-%espaper published in Town of Barn tar& % copy 'oi which is attached to the record of these proceedings filed with Town Clerk. A public hearing by the Board of _Appeals .of the Town of Barnstable N as i:eld at the Town 7:45 M rch 5 86 Office Building, Hyannis. :Mass., at _ P.1lf. _.. i9 upon said petition under zoning be-laws. { Present- at the hearing were the following members: _...._Pschard•..L_... •Bov P.onald Jansson _ Gail Niahtinaale __ _........ . ... .......... .._.............._......_.........._......... ._----....... Vice- Chairman ...........DexLer_rsl-ss _..._. _ ___F1 ;7 abeath...1?orton_._._—.. 1 At the conclusion of the hearing, the Board took said petition under advisement. A view of the locus.was made by the Board. AppealNo.... ..... .......198.6.-�8.............................. Page ........................ of ..................._... March 6. ' 86On ......................_. ... ................................................................... 19 . ............ The Board of Appeals found Mr. Dager's brother-in-law presented the petition for a Special Permit to allow a family apartment at 64 Childs St. , Centerville in an RC zoning district. The petitioner desires to provide a small apartment for his mother-in-law who is a widow. The proposed apartment to be constructed at the side of the present two-story house - for which a building permit has already been issued. The present house is 36' x 24' , while the addition is one-story, of 26' x 26' with an unfinished attic. The tenant will be the sole occupant of the apartment. Dexter Bliss made a motion to grant the relief sought by the petitioner with the restriction that the second floor not be occupied - the motion was seconded by Elizabeth Horton. The Board voted uanimously to grant a Special Permit to allow a family apartment at 64 Childs St., Centerville - to be per the Plans submitted and subject to the provisions of the state building code. . Clerk of. the Town of Barnstable Barnstable County, Massachusetts, hereby certify that. twenty (20) days have elapsed since the Board of Appeals rendered its decision in the above entitled petition and that no appeal of said decision has been filed in the office of the Town Clerk. Signed and Sealed this ... dad of . ....._.._�......:?....-........__......._........ 19 under the pains and penalties of perjury. Distribution:— Property Owner ........................................._........_................................................._................ ___ _ Town Clerk Board of Appeals Applicant Town of Ba Persons interested Building Inspector .... _........ :... ._.........._Public Inf ........_........on By ........_........ _.... Board of Appeals - Chairman bcxi -e-> r C � .loseph D. DaLuz -Telephone: 775-1120 Building Commissioner Ext. 107 TOWN OF BARNSTABLE BUILDING DEPARTMENT TOWN OFFICE BUILDING HYANNIS, MASS. 02601 April 20, 1989 Stephen P. Dager 64 Childs Street Centerville, MA 02632 Re: Appeals No. 1986-18 Dear Mr . Dager: On March 6, 1986, as applicant(s) you were granted a Special Permit for a familypartment . "The intent of this by-law shall be to allow one ( l ) additional living unit, complete with kitchen and bath to supply a year-round residence for a member or members of the property owners family, . . . . . . . . . . . " In addition, the by- law also states that "The property owner, and the person or persons who- will reside in the family apartment shall sign affidavits before occupying said family apartment and further, all shall sign said affidavits each year said family apartment is occupied. . . . . . " . Within sixty (60) days from the date the person or persons residing in the family apartment vacate the premises , the owner or h_is representative shall remove the kitchen facilities and request the Building Inspector to inspect the premises . It is important that you understand that there are restrictions which relate to the applicant' s family living at the same premises. _ The use cannot be transferred. Conviction of a violation of this by-law is subject to a fine of $100 per day for each day from the established date of offense and, also, subject to a criminal complaint to issue from the First. District Court of Barnstable. Affidavits MUSt be signed and filed at the Building Commissioner's office between the hours of 9:30 A. M. and 1 :30 P. M. Monday through Friday. This by-law shall be strictly enforced. Peace, oseph D. Luz Building Commissioner JDD/km cc Board of Appeals -town Counsel ECORD IN REGISTRY OF DEEDS IN COMPLIANCE WITH SEC. 11 OFTOWN OF BARNSTABLE H,1RN')T48LE. "MARS. CHAPTER 40A, M.G.I. Zoning Board of Appeals 'R6 MAR 11 AM 8 53 i ........._St�p0....R.....D9 .__.._....____......._.................................... Deed duly recorded in the ...................................__............ Property Owner County Registry of Deeds in Book .............................. ..........Sa[t�........................................................_...._...._..__._._._................................._................ Page ....................... ...................:.................._................._RegisZr� Petitioner District of the Land Court Certificate No. ............. ....................... Book ........................ Page .................. AppealNo. ...._.......... .............................................................................. 1S) FACTS and DECISION Petitioner __.. .__..Stephen)..P._ _DdQeL._..._..._........_.........._......... filed petition on ................................................ 19 64 Childs St. requesting a variance-permit for premises at .............. ....._.............................................................................:.:...... in the village. (Street) Of ............ adjoining premises of _............._ (see attached list) .................................... Locus under consideration: Barnstable Assessor's Map no. ..............249........................... lot lio. ..1 2.................. Petition for Special Permit.- Application for Variance: ❑ made under Sec. _........................._......._........_.................. of the Town of Barnstable Zoning by-laws and Sec. ........................... Chapter 40A., •lass. (den. Laws for the purpose of to..aw..a family aAzrtment ....... .. . ............................................_.............................................. ............................._..........._..............._ _.__......._....-....._.._...__..._..........._...._._................................................................................................................................................ I, Locusis presently zoned in.......... .__. ...........K............._............_........__...................................................._............................ Notice of this hearing was given by mail, postage prepaid, to all persons deemed affected and Barnstable Patriot by publishing in newspaper published in Town of Barnstable a coPy of which is attached to the record of these proceedings filed with 'Town Cierk. A public hearing by the Board of Appeals of the Town of Barnstable «a,,; meld at the Town Office Building, Hyannis, Mass., at P.AI. M,arcl 5, a 86 _.._ 7w 4 5_ _ . _ __...................._.... ......................_..................... . �,. upon said petition under zoning by-laws. " Present at the hearing were the following-members: .,,.......,Ric.hard L....... Ronald Ja.n.ss.on... ......__...... .....Gail Niq.htingae . ................ .... ..._....._......... Vice- Chairman ...........Dexter...Huss.._.......... _ _ -___Ehzabeth...Horton......_..... K' � v At the conclusion of the hearing, the Board took said petition under advisement: A view of the locus was made by the Board. AppealNo...................19$ :.-Ja............................ Page ........................ of ........................ March 6, 19 86............ The Board of Appeals found On .... .... ...._.. .� ....................................................................................... Mr. Dager's brother-in-law presented the petition for a Special Permit to allow a family apartment at 64 Childs St., Centerville in an RC zoning district. The petitioner desires to provide a small.apartment for his mother-in-law who is a widow. The proposed apartment to be constructed at the side of the present two-story house - for which a building permit has already been issued. The present house is 36' x 24' , while the addition is one-story, of 26' x 26' with an unfinished attic. The tenant will be the sole occupant of the apartment. Dexter Bliss made a motion to grant the relief sought by the petitioner with the restriction that the second floor not be occupied - the motion was seconded by Elizabeth Horton. The Board voted uanimously to grant a Special Permit to allow a family apartment at 64 Childs St., Centerville - to be per the Plans submitted and subject to the provisions of the state building code. Clerk of the Town of Barnstable, Barnstable County, Massachusetts, hereby certify that twenty (20) days have elapsed since the Board of Appeals rendered its decision in the above entitled petition and that no appeal of said decision has been filed in the office of the Town Clerk. Signed and Sealed this dad- of ................�.!'...'?!�'............................ 19 ��............... under the pains and penalties of.perjury. Distribution:— PropertyOwner ....................................................................................................................................... Town Clerk Board of Appeals Applicant Town of Ba Persons interested / Building Inspector PublicInformation By ............................... .......................................................... Board of Appeals Chairman .r . r x�+r x!. • R249 142 a A P P R A I S A L D A T A KEY 158894 94 DAGER, STEPHEN P LAND BLD/FEATURES DUILDINGS NUMBER ZN/FL=RD— 1 65, 200 123,400 1 A l.�ST B--MKT 130, 400, 1 BY 00/ BY /00 Q—TNCOME::. PC:A=1011 PC::==00 "I ZE= 2404JUST—VAL 188,600 LEV=3 0 C:ONST—C: c a ----C:C�MPAFt T r N TO CONTROL AREA 49EB -- TREND EXCEEDS STANDARD NEIGHBORHOOD 49EB C ENTERV I LLE PARCEL CONTROL AREA TREND STANDARD 101 10 LANDLTYPE 652001 01 LAND—MEAN +0% 1886007 94109 IMPROVED—MEAN +31% .;5 1 FRONT--FT 1 100 DEPTH/ACRES TABLE 02 100%J LOCATION--AD_I APPLY—VAL—STAT 1 LNR 7 LAND LFT/IMP 7 ADJ w./SB/FEAT ETR]STRE hC T►JRE ARR I AREA—MEASUREMENTS. NOR 7 NOTES C OM I MARKET I NN I NC OME PMR I PERMITS ORR J 0RAPH I C FUNC:T I CAN—E 7 STRUCTURE-CARD NO—E 000 J DATA—E a XMT E?a COMMONWEALTH OF MASSACHUSETTS BARNSTABLE AFFIDAVIT I Stephen P.-D a g e r-------------------------- being on oath, depose and state as follows: 1.) I reside at________64 Childs St. Centerville 2.) I am the owner of the property located at 64 Childs St. _ 249 142 ---------------------------------- ---------------------------------------- shown on Barnstable Assessors' maps as MAP-- --PARCEL--- 249_142 3.) I Do- ----Do not X -have a Family Apartment at this location. 4.) On___ _________, 199____, the Zoning Board of Appeals, on Appeal No.______ granted me a Special Permit/Variance to maintain a Family Apartment at the above address. 5.) 1 understand that the Family Apartment may only be occupied by members of my family who are persons related to me by blood or by marriage. 6.The following members of my family will be the sole occupants of the Family Apartment at the above address: a) NAME Relationship to owner:------------------------------------------------------ b) NAME Relationship to owner:______—_ ---------- --------------------- 7.) The Family Apartment will be the primary year round residence for the above-identified family members. 8.) In the event that the above-listed relative(s) vacate said apartment, I will immediately notify the Building Commissioner in writing. 9.) I understand that no subletting or subleasing of said Family Apartment is permitted. 10.) 1 understand that I am required to annually file an Affidavit with the Building Commissioner listing the names and relationship of my family members occupying said Family Apartment. 11.) 1 understand that I am required to comply with all conditions imposed by the Board of Appeals in Appeal No. ---------- ---------- 12.) I agree to immediately notify the building Commissioner in the event of the sale of the above- listed property. Sworn to under the pains and penalties of perjury this loth day of_ January 1998_____ Signature Stephen P. Dager --------------------- - -------------------------------------------- Print Name QUERY PROPERTY: QUERY END QUERY PROPERTY PENTAMATION----------------------------------------------------------- 12/31/97 PARCEL ID 249 142 GEO ID 15889 LOT/BLOCK 5 DBA PROPERTY ADDRESS OWNER DAGER 64 CHILDS STREET STEPHEN P DAGER JACQUELINE HYANNIS 64 CHILDS ST CENTERVILLE MA 02632 PHONE DISTRICT CO DEVELOPMENT STATUS C ASSESSOR' S CODE CAPACITY (NOTES) ZONING DIST/ZOC RD-1 SEWER SYSTEM FLOOD PLN/ELEV. WATER SYSTEM OKH? # BEDROOMS ZBA DECISION FAMILY APT LOT SIZE 19602 OPER/MGR NAME WET LANDS MULT ADDRESS USE 101 PROTECT DIST (N) EXT / (P) REVIOUS / NO (T) ES / PERMITS / (V) IOLATIONS / (G) EOBASE / (E) XIT RECORD IN REGISTRY OF DEEDS ;01.1N CLERK IN CUMPLIANCE WITH SEC. it 01TOWN OF BARNS T ABLE ' 'pry'S T"EL E. '' cc CHAPTER 40A, M.G.I. Zoning Board of Appeals 'Rf MAR 11 AM 8 53 ..........SteghpO...P.,,....DAgex _._..._._......._.__.._ .__ _. Deed duly recorded in the _......................__.__.._............ Property Owner County Registry of Deeds in Book .......................... ..........�1!e..._........................................._.__•__...._................_...................... Page _...................... _.........._... .....Regisiry Petitioner District of the Land Court Certificate No. ........_............ ....._....._.......... Book ........._............. Page .................. AppealNo. _.._._........ _........................_...._.................................. 14) FACTS and DECISION (� Petitioner filed petition oil ............._.........................__.... 19 eestin_ a variance-permit for premises at 64 Childs St. ..........._._._.._...._................................................................................ ill the village:.0 (Street) Ole la--- adjoining premises of _ ... ..._ (see attached list) ` Locus under consideration: Barnstable Assessor's 'Map no. ...... lot no. 14� _........24°_...._.........__ . ... .................... Petition for Special Permit: Ej Application for Variance: ❑ made under Sec. ......................................._.................. of the Town of Barnstable Zoning by-laws and Sec. __.._.........................................................._............_........._.......... Chapter 40A.. Mass. Gen. Laws or the purpose of ._....... to,.allow a family,.apartment ......... ............. Locusis presently zoned in.......... _._ ..._._....................._......RC.............._....._.__........._........................................................ Notice of this hearing was given by mail, postage prepaid, to all persons dee.ne;i affected and Barnstable Patriot by publishing in newspaper published in Town of Barn a.'Ae a copy 'of which is attached to the record of these proceedings tiled with Town Cierk. A public hearing by the Board of appeals of the Town of Barnstable «: s meld at the Towii Office Building, Hyannis. Mass., at _..___7:45___ �' P.�l. M=rch 6, ig Sr, upon said petition under zoning by-laws. Present at the hearing were the followin_ members: .............icl�ard L......o ��_ _ .Ronald Jansson ..... Gail.Nightingale......_............ Richard Y __.........._.......................—........_...... Vice— Chairman ............De.:tes...Bliss............... ...___El izaheth...Horton._..__.... ..................................................__.............._........ �P-9 At the conclusion of the hearing, the Board took said petition under advisement. A view of the f locus was made by the Board. AppealNo...._...........12M-18............................ Page ........................ of ........................ March 6, On .................__._ ......................................................................................... 19 8.6............ The Board of Appeals found Mr. Dager's brother-in-law presented the petition for a Special Permit to allow a family apartment at 64 Childs St., Centerville in an RC zoning district. The petitioner desires to provide a small apartment for his mother-in-law who is a widow. The proposed apartment to be constructed at the side of the present two-story house - for which a building permit has already been issued. The present house is 36' x 241 , while the addition is one-story, of 26' x 26' with an unfinished attic. The tenant will be the sole occupant of the apartment. Dexter Bliss made a motion to grant the relief sought by the petitioner with the restriction that the second floor not be occupied - the motion was seconded by Elizabeth Horton. The Board voted uanimously to grant a Special Permit to allow a family apartment at 64 Childs St. , Centerville - to be per the Plans submitted and subject to the provisions of the state building code. 4 Clerk of the Town of Barnstable, Barnstable County, Massachusetts, hereby certify that. twenty (20) days have elapsed since the Board of Appeals rendered its decision in the above entitled petition and that no appeal of said decision has been filed in the office of the Town Clerk. Signed and Sealed this .....!.7-..... da} of ................. .!'..'.?.!4. 19 ��.... . under the pains and penalties of perjury. �J Distribution:— PropertyOwner .......................................................................................................................................... Town Clerk Board of Appeals Applicant Town of Ba Persons interested Building Inspector PublicInformation By ................_.............. .......................................... ........... Board of Appeals Chairman 15 g) The family apartment is occupied by members of the property owner' s family only. h) The occupancy of the family apartment does not exceed two (2) family members at any one time. i) The family apartment is the primary year-round residence of the family member (s) residing therein. j ) The family apartment will not be sublet or subleased by either the owner or family member (s) at any time. k) Scaled plans of any proposed remodeling or addition to accommodate the family apartment have been submitted by the property owner or his or her agent to the Building Commissioner and the Zoning Board of Appeals. 1) Prior to occupancy of the family apartment, affidavits reciting the names and family relationship among the parties seeking approval have been signed and shall be signed annually the for the duration of such occupancy. m) Prior to occupancy of the family apartment, an occupancy permit shall be obtained from the Building Commissioner. n) No such occupancy permit shall be issued until the Building Commissioner has made a final inspection of the proposed family apartment. o) Within sixty (60) days from the date authorized family members vacate the family apartment, the owner or his or her agent shall remove any kitchen facilities in such unit and notify the Building Commissioner to inspect the premises . p) In addition to the provisions of Section 3- 1 . 1 (3) (D) (o) above, upon vacation of any family apartment, the premises shall be restored as nearly as possible to their state prior to the creation of such family apartment. q) The Building Commissioner ' shall have the right to further inspect the premises upon which a family apartment has been vacated at least three (3) times per year for three (3) years consecutive from the time of such vacation. E) Windmills and other devices for the conversion of wind energy to electrical or mechanical energy, but only as an accessory use. COMMONWEALTH,�OF MASSACHUSETTS BARNSTABLE AFFIDAVIT 1, Stephen P. Dager , being on oath, depose and state as follows: 1.) I reside at 64 Childs St. Centerville 2.) I am the owner of the property located at 64 Childs St. 249 142 shown on Barnstable Assessors' maps as MAP PARCEL 249 142 3.) I Do Do not X have a Family Apartment at this location. 4.) On , 199 , the Zoning Board of Appeals, on Appeal No. granted me a Special Permit/Variance to maintain a Family Apartment at the above address. 5.) I understand that the Family Apartment.may only be occupied by members of my family who are persons related to me by blood or by marriage. 6. The following members of my family will be the sole occupants of the Family Apartment at the above address: a) NAME -- _ Relationship to owner:_ — b) NAME Relationship to owner:_ 7.) The Family Apartment will be the primary year round residence for the above-identified family members. 8.) In die event that the above-listed relative(s) vacate said apartment, I will immediately notify the Building Commissioner in writing. 9.) I understand that no subletting or subleasing of said Family Apartment is permitted. 10.) I understand that I am required to annually file an Affidavit with the Building Commissioner listing the names and relationship of my family members occupying said Family Apartment. 11.) I understand that I am required to comply with all conditions imposed by the Board of Appeals in Appeal No. .12.) I agree to immediately notify the building Commissioner in the event of the sale of the above- listed property. Sworn to under the pains and penalties of perjury this 10th day of January , 1908 Signature Stephen P. Dager Print Name Assessors map and lot. number .................................... 6 f, STEM MUST 2E y Sewage Permit number ...,.... C � R-CULATIU,.,'J a� TOWN yo�T"ETo� TOWN OF BARNSTABLE ! r ' i MASESTAELE, i "6 9. .e� BUILDING INSPECTOR O�Ea MpY pr APPLICATION FOR PERMIT TO ...... ........ .... ... �....... ............ .............................:.......... T TYPE OF CONSTRUCTION ............... �f K. .. .....FA4M14.1..­&.ice..e.1,VC.. . ............... " ....wo. .............................19.7.� TO THE INSPECTOR OF BUILDINGS1 The undersigned hereby applies for a,permit according to the following information: Location ... n.,,.r......... C,N it DS STR��7' CF-#aR V I F- ��� �......... .................................................................................................................... . .............. Proposed Use FAH 12.r Q W �'�' .............................................................................................................................................................................. ZoningDistrict .............................................I...........................Fire District .............................................................................. Name of OwnergA VJ D.........S.D./.&F.'S.. ................Address ... /� .`.s............. .... Name of Builder .J.'...1 ` ' .L VZ/ E.�7-1................Address,...9Q V 77 03 17..................1 .S................. .............. l.� 5, �� L UZ1F-T T'.. .....................Address .. Q.y..� ......t.3. .. >�YIq Nameof Architect ................................... ...................................... Number of Rooms ..... ..................................Foundation .. OV� ® Cd N'G R Ei7 /�....................... [................,........................... Exierior ....ti,/ t7� CE.�AR...SMI NCI-E-S, Roofing .....A.s -r......$#/YaLE. s .... ........ ................... .... ...................................... C/n r-T ......Interior ..,P.R./ ^(A�' Floors .............. ................................................................ .,...... ............I..................................................... Heating ...GRs...... or.. ... .....................................Plumbing .........../............. ...... ............................................ Fireplace ...Y4..S ........................................Approximate Cost aO Definitive Plan Approved by Planning Board ________________________________19________ . Area .....,,.... 7.. 00 Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF 'f D OF,/�iEALTH T �- 70 ip o ` 16Y I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. a ....... '...........I.................:......... Somers, David t. 17453 1 1/2 story, No ................. Permit for .................................... single family Swelling ................. ............................................................. Childs Street iLocati .......................................... ........... ..... 8enterville Owner David Somers ................................................................. Type of Construction frame i ................................................................................ tPlot ............................ Lot ..........#5.................. Permit Granted November 21 ...19 74 � Date of Inspection � t Date Completed ..5. /n,` /*" `*7�.......... t - PERMIT REFUSED i ................................................................ 19 . ............................................................................... 1 ti .......................................... .................................. i ............................................................................... I t i y Approved ................................................ 19 t r Assessor's map and lot number .... � `. / TSewage Permit number ..:.::......... .............................. ........ THETp�y TOWN N OF BARiNSTABLE Z 33A"STULE, i "6 ,e� BUILDING INSPECTOR �'E MPY h• APPLICATION FOR PERMIT TO .......................................... ...............................e� ...... ..'.�. ............................... TYPE OF CONSTRUCTION INC...... `� t .. .... ` ...... +�t..... ................ ........ o.v.............................19...'. .! TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .../-t.P.T.....�...........� I { ,P 3........"t..AFE— ..............i, r-q7 r-R I!� � L�............... ... ....`..................... ProposedUse �` t�f" ....................r �i" "�.... ........ .......................................................................................,......................... ZoningDistrict .......................................:................................Fire District .............................................................................. EJ3}..�i IRllrt l Nameof Owner ....�....................../...........................................Address .................................................................................... Name of Builder .:►.�...?`...�'....!�- f ' l ................Address ... bLJT J R M# ......................................... Name of Architect , cS 7" t V4ig '1 7r °...•...•...•.••..•.,.Address ....... ��'` X .............................. ............... ......................................................... Number of Rooms Foundation t� t� ...� R�` T ' ................................. ................................ ......................................... Exterior .... .f.. :{~:....Cr-. p4P;....`.�'y/. ci-c.'51..........Roofing ..... .�� P9AL� �'�f��� !S'............... ................ ..... ..................................... G f i✓ j- Floors ...,� .:�..................................................................Interior ....:...-............................................................................ f 4. . Heating .... .J //.?�........... ...........•..........................Plumbing ;. .............. ........... .......................................................... o tr3 Fireplace F ......................................Approximate Cost ........... ...............................................` :1. ............................................ Definitive Plan Approved by Planning Board ________________________________19________. Area Diagram of Lot and Building with Dimensions Fee ' r SUBJECT TO APPROVAL OF BOARD OFa'+HEALTH -ITS s + K 36f 1 i • � � I D Ij t; ' f I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..O;at..................... v' t.......................... Somers, David 1 1/2 story, No ................. Permit for .................................... single family dwelling Locatio� Childs Street Centerville ............................................................................... Owner David Somers ................................................................. Type of Construction .............frame ............................. ................................................................................ Plot ......................... .. Lot .........#5.................. November 21 74 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... i ..................... ......................................................... ..-.-.......,.y_.�.:.,•.�:..:•...^'�"ir:...�. _'�...r e"'_ `. ..; .:t r:y;,..-..,.,a.,� ;.A- ,,a,.�+,r'niti.r'f..+i/''*..f�. ,-'.�r.i e^...lX�'"('....�- - ,,:mow F- �..• FEE - y lhti. TOWN OF `'BARNSTABLE,^ MASS.t. � p V*vcmbar 19 74 .` to d THIS IS TO CERTIFY THAT A ERMIT IS HEREBY GRANTED TO y CA�_-- David Hyamic _........................... ....... .............._.................. (PROPERTY OWNER) (ADDRESS) Wild 1 1I2 L` O " 7C�,. • r. ......... ........_ __.__ ____ ... ..... .......o :. .[•)" Ub (BUILD) (ALTER) (REPAIR) _ c w� i E►# .Q.._ ... ......... .:._.:._ -------:.----------- b4 #Q # . ... .. (TYPE OF BUILDING) - _ e IAPPROXIMATE�S IZEI oA LOCATION .............._._....._....._......_.. ..__.__._ ... __._ .._. ....I. ....... ......... ......._ .----....».---... .' (STREET AND NUMBERI0_.. ,pp T +� y(VILLAGE)11011, - "s !!l!gggg NAME OF BUILDER OR CONTRACTOR __ _.».__.. _.».. _ _ _._.:. ... ' APPROXIMATE COST..........._..._.._ ,M I HEREBY AGREE TO CONFORM TO ALL THE RULES. AND REGULATIONS OF THE.TOWN OF BARNSTA.'.�B.LE, REGARDING THE ABOVE CONSTRUCTION."' t o P4 c'a F d - -(OWNER) _ (CONTRACTOR) wo, ..... s.`.. 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