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M'411�� - � �,�.i I � � ? 11 t", I , , ' I - I­Rl"�Vlu 11 � , ki� , ,�ill",Ii"���ill-.'���',�ll,�'I'll��ili�.i'i'i'i""""', � W �' Ii , TT H-1131 ,�t��'Ir",�,,�;�A�1,11'�'�i�"i'lli���lf,��,��� M 1 - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ��'7 ®� Parcel Application # . I zdl Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village �L�""-f'-I�L3 l Owner YI-\la 'Rd5>N1 -7_jwW e t a Address 16-7 �N Telephone Permit Request e`itryJ��c e'�ea Square feet: 1 st floor: existing proposed ® 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 8-7CO. oU Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family UK' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old Ki © Highwa9a+ ❑1 ❑ No Basement Type: ill ❑ Crawl ❑Walkout ❑ Other o Basement Finished Area (sq.ft.) (o$ Basement Unfinished Area (sq.ft) 1 Number of Baths: Full: existing new Half: existing / MAV cn Number of Bedrooms: Z, existing 0 new m o r.�, 0 Total Room Count (not including bath;): existing new First Floor Room Count Jr Heat Type and Fuel: ❑ Gas ❑'Oil Ck'ffl'ectric ❑ Other Central Air: ❑Yes Flo Fireplaces: Existing New Existing wood/coal stove: ❑Yes Yi o 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 @<o If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name /�i�,O Jsdl� ,y7" Telephone Number ���li �-�� - Address > .1fo el License # Kr go o d Home Improvement Contractor# ���^/�;7 Worker's Compensation # ��i?_;3z iT 12 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4 SIGNATURE r DATE /� FOR OFFICIAL USE ONLY APPLICATION# F DATE ISSUED ` MAP/PARCEL NO. ADDRESS VILLAGE OWNER - H f. ;y ` r DATE OF INSPECTION: FOUNDATION FRAMEC&ROtle,11-5 INSULATION e )13 i FIREPLACE S i ELECTRICAL: ROUGH . FINAL ! t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT - 4 ASSOCIATION PLAN NO. �.:�++ f �r #s•u ,�i4 + The Commonwealth ofHassachusetts Department of Industrial Acci i'erz0 , Off ice of.Investigadons 600 Washington Street _ Bostoi;MA 0.2111 www.mass.gov/4`a Workers' Compensation Insurance Affidavit: Binders/Contractors/Electricims/Plumbers Applicant hiforniation Please Print Legibly Name(Bnsmess/c>g+n;�ndivia4: / �• /�i�v �S�C.✓�r • •Address: '. � D �01C Z'z l - � . - •• ', • city/state/zip:' �� ?? - 0-7 Phone.#:' 30S_Ne aY 3 Are you an employer? Check the appropriate bow Type of ectre ro uir . I g p ] ( q ' 1. Tam a employer with 4 ❑ .:am aeneral contractor and I 6. New construction . .. employees(full and/or part time).* ' have hired the sub-contractors ❑ 2.❑ I am a'sole proprietor or partner listed on the'atfached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have '8. ❑Demolition Worldforme in capacity. employees and have workers' g any ap tY. '9. ❑Building addition [No woilcers' comp.insurance- comp.insurance. #' required-] 5. ❑ We are a corporation and ifs 10.❑Electgcal�epairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions Myself. [No workers' comp. right df exemption per MGL • 12.❑Roof repairs insurance required]t P. 152, §1(4),and we have no employees.[Noworkers'. 13.❑ Other ' comp.insurance required] *Any applicant that checks box#1 must also fIl out the section below showing thee works'corupmsation policy information t Homeown=s who submit this affidavit indicating They are doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors$uat 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 lhoir workers'camp.policy number. 'I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy andjob site information Insurance Company Name: 7R9"u S ,- k.1 6o , Policy#or Self-ins.Lic.# � T y 'f� �� �0./f Expiration Date: Job Site Address: /-(; % -�/l' OC�c� City/State/Zip e /2f,� ® J Attach a copy of the workers' compensation policy declaration page`(shovdng 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 farm of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator."Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurrance coverage verification. 9 I"do-hereby certify un - e pains as of perjury that the information provided above is true and correct Si fore: Date: Phone Officinl use gnly. Do not write in this area to be completed by city or town afficiaL 'City,or Town: PermitlLicense# Issuing Authority(circle one): .'L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Aga 79r3 12 CERTIFICATE OF LIABILITY INSURANCE T11$CH27WA-M 6 AS A YATM R OF W-ORYATION ONLY Aim CONFFRS HO Rom"t M IPON THE HOiAM TH6 ta71RCATE DOES..NOT AFRRilA7NE1.Y OR NBGAMBLY AMEWD EECiM.OR ALTER THE COYBiAGEAFF01tOW BY THE OleS BELOW. TM CafflRCATE OF NSURANCE D06S NOT COttSTME A CON7 =BETWAMN 7M SUMS REF /iil{fE OR PRO LEM AND 7HE C9it RCATE HOiML rIPORTA1�ii: ff the ear6�te is an ILLS Sha pO"M)Trost de eada m& B 1WA NE to the terarsa - ofthe poft cwWm poncin amy require nn A dat wmd oaths a aatooaief roh Sie cer67icade holder b Ysaofsucb PRooucel Ida gmKmm f�aglaOn insurance Agency, Mac. 50 71— 660 (508) 77 1135 PO Boa 355 not 411 Rama 28 West.Yarmouth, NX 02673 DBU8HtA-Zravel insurance maw easuaa e a David a..Hodsdon, II I c. DBIL Hodsdcn Construction Mama, PO Hoz 221 Yar> ontlapost, NA 02675 )N - COVERAGE$ t�tTIRMTE M IIBEft REV SiON MUM Elb 7HlS tS iO CBUW THAT.TtE POLICES OF�AI�ICE LISiED BE WV HAVE BEEN ISSI 7�0 TM DISIAED NAMED ABOVE 7t�FmmCU Y WDIEATE�. NO)VIKf WANOM MY i6SWE34MT,76BA OR OONDi7DN OF ANY CONTRACT OR OTH R DOC MB(P VYItEi CT TO TE1S :CERi1FECATE MAY_Bt EBBED OR MAY PE RTAK THE NUMNCE AFFORDED BY THE E HE FmH M TO ALL THE POLICIES E7CUX30NSANDC0NWMW OFS M POUCES.LINTS SHMM MAY HAVE l�l fi�LICE�BY PAD(LAW' 7VPEOFStm auCY NuaeE uuls GENERALUADLnY E#=OCCt�i i ae s • COIYERCNLOENmLLIA Uw CLA9SMADE OCCUR IEDEW ) i PHZSOINL&ADVi S GENSVL Q1 8 OENLA al�A7ELYTAPPLESPER PRODUCTS-CO AO6 i POLICYFl LOC S fiU7Ol10BLEiUA>)Ll7Y. , ANYAUiD e0DLY9UDR ow i ALLLLOO aODLYNiMOW 0 FURt�'AUiOS AAUUTOS i is OCCUR 8MOCCURREN E S E>Gr.ESSLU1Bs: AQCsAEBAITE i D® 8 7P�4321R40Al2 . 7/29/12 7/29/13 g =STA7u- AND9pLOOWUAMLIiY ANY *IN MIA , EL s 100 000 OFFICE[i1AcFxCLID 100 000 ° N a 7)orls F-um 500 000. CESCRlP=MOFFO�P�9i�Ap7f�=- 1L�OC►KMCH�SwHENCLES(AfthA�C.wOt�IDWI.Ad�dRmouftSdbedab.Rnamopmisf&Wmq 152. fa>erly homes & prsvate garages AVID RMSDON Is zzcvaDBD ftW W0F41a=* 00�R�T$ATIC®T COVSRAE� C9tTIFMTE HMER CANCELLATION ;.:. SHOULD ANY OF TIE ABOVE EES�ED BE CANCELLED BE UIE .._ :.. TIE EXRRA?ION DATE THEREOF. NDTiCE !� N ToifiII of Yarmouth AOCORDANCEMII7N BE POLCY PROVARONS. .... South Yarmwth, l�+i 02664 - AlIS10itM IIYE , /J/r���♦ Phil] oa ®1s88-Z010ACOR0 Ai rlgVks ACMD25(MbOo Thu ACORD=me and t are r+egkftmd antics oaf ACORD Office ot�o s°u e��� i es egguut tion" V 'i HOME IMPROVEMENT CONTRACTOR Registration: 105172 Type: g Expiration 7/16/2014 DBA A TIC CAPE,BUILDERS David Hodsdon I I 20 Nimble Hill Dr61, -,8 Yarmouth Port, MA 02675 Undersecretary :Vl;usachtrsctts - Department of,Public Safeh Board ot'Buildiri" Re�lul:ttioitsatt(I Stan(Ia-d: Construction Supervisor License License: CS 69860' DAVID S HODSDON II6 3 PO BOX 221. x YARMOUTHPORT, MA 02675 Expiration: 5/11/2013 (ommissiimE'r Tr#: 15909 o License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer,Affairs and Business Regulation. 10 Park Plaza-Suite 5170 Boston,MA 02116 of valid out signature Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS , Town of Barnstable F- f Regulatory. Services f Thomas F..Geaer, Director Building Division . Tom Perry Buffldbg Cornmissianer 200 Main Street,Hyannis,MA 02601 www.town barnstable.ma.rrs . Office: 508-8624D38 Fax: 508-79M230 Property Owner Must Corriplete and Sign This Section - If Us np ABuilder I, rO SEI� fit/ .l ;as'Owner of the sub1ject Pmpeny hereby authorize j j,�j/�= j�-�L� ���l/t� to act on my schff, L'all~matters relative.to wow aurho=, d by,this buE Permit application for. �O C/i' (Ad s of Job) S of Owner � - Date: �iA- y ll � `U �r ` S Prirn Dame 1 If Property_ r is applying for pen-nit . lease co lete the Homeowners License Exemption Farm on the r side Torn of Barnstable ;{ ; o� Reguiato ry Services f Thomas F. GeUer�Director . F. Rl R1Q(�Pl1TT' ,.x t L Building Division Tom:Per T.,$fig Coarmissioner 200 Main Street, Hyannis,MA 02601 www.tvwn.barnsfahle.ma.ns Office: 508-862-4-038. Fax: 509-790-6230 HOMEOWNER LICZXSS MMMO21 Please Phut DATE JOB LOCATION: j nrmmber street vrMEP "HbMEOWNER'". _ name home phone# work phone# CURRENT MAII NG ADDRFSS: cityhown start zip oode The current exemption for"homeowners"Bras extended to include owner-occupied dweltinzs of six units or less and to anDW homeowners to engage an individual,for hire who does not possess a license,provided that the owner acts as supervisor. . DEFINITION OF HOMEDWXER Persons)who owns a parcel of land oa which he/she resides or intends to reside, oa which there is, or is intended to be; a one or two-family dwelling, attached or dztached structures accessory to such use*and/or farm strurta-es. A person who constructs more.than an-home in a two-year.period shall not be considered a homeowner.' Such "homeowner"sh&U submit to the Building Official on a form acceptable to the Building DTRGia.l, that he/she shall Ise responsible for 0 such work perf rmcd 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 B arnstable Ruildiag Department minimum inspection procedures and requu�ments and that he/she wiU comply with said procedures and requirements. Sigoatruo of Homwwncr Approval of Building Of5eial Note: T[see-iiamily dwellings contau�g 35,DOO cubic feet or r wM be to ca 1 with the � requru�d mp Y Stain Building Code Section 127.0 Construction ControL HOMIKO VENMIS=MFnDN The Code states that "Any hommwner pa forning woik tar which a building pQrmt is required sha I be==rapt from the provisions of this section(S=tinn 109.1.1-Licensing of construction Supervisors);provided that if the homwwncr engages a pcason(s)for hue to do such' wort;that such Homeowner shaIl act as supavisor." Many homeowmers,who use this aemption am unaware that they art assuoung the responsibilitirs of a supervisor(sec Appendix Q, Rules'&Regulations for Licensing Construction Supervisors,Section 21S) This lack of awumcas o&cu rssnits in scdous problems,particularly when the homcowmer hires unlicensed persons;In this casq mr Board cannot proceed against the unlicensed pawn as it would with a licensed Supervisor, Tbo homeowaet acting as Supervisor is ultiuratnly rmpomsrble To cumm that the homwwner is faDy awa=of histh rm?ons Brim,many communities rapire,as part of the permit application, that the hemeoRna certify that hchhe tmdc stands the rsponsrbrTitics of a Supervisor, On the last page of this issue is a farm cmautly vsrd by sevrral towns.-You may cuci t ionmd and adopt such a f r=/czzti5cation for use in your comanmity. Q:\WPFILPMRMMameexemptDDC Pot, Lilt l CG n IA P ROG) � ( r)c4 fi n ; Skec1 ?4Opose-D 13fiSerYllemT pirtm 5c41•e, �Iq f'6� _ : ;3 DL i J. J ' E -,jl� -T F s 1S7lie -- -— - : - -- L.._ _ .. .. ..ems � _ 7 - .• ' �q _;1�---U: a — t 1 V � - � t � — ci (. Ln x + - U N ci t �y mabi ii ct J� A t ` b' Ii i i �L2 oc .5 e _ r+.yy).e.�eT 1 �.7AP N ew 1 Ir5 be 4rA �FLp yeas .�. j I 1 1� I� 42• I 1 II ' 2 � I _. NGeI 1.1�1.5?..2.�GIU 1oiST ha - e a� mm NV N4 Ni }Sir 161 all As 1- vtc f � Y if Oct 1�i1 �Il1 im, it t lti�; t tll"at t F - It�� i i ic� I �, a 6 D q Ar , 1 s r w t i «^ low. of jW 7 u Y 1 • 1' �� lI • ri z 4 b � ; S, � � � � � `'��, �.`•� rSr Y' il�t.. 1-„ Jigl t ��. 01 IL k ww m !•� t' il'1 i !r' .1 • tt x � �� � .. � �f � .-�. � � r _(l '1_1.T 11' It�t Itl• µ � ...,�.< r �, ' JA W err^'`• I 1.n q'�" a IF 14 � w a City Clerk 'Doing Business As' Search I City of Boston Page 1 of 1 'Doing Business As'(DBA)Database search 4 Show Search Parameters J 10 ` - l items in 1'a es 1 Page size: � , i P 9 , Business Name:R C REALTY , File Number:090417N ° Date of Filing:2/2/20D9 Type of Business: Business Address:45 JOHNSWOOD RD BOSTON MA 02131 Owner Name:ROZENZWEIG,KATYA 45 JOHNSWOOD RD ROSL 02131 Owner Address: a 1 Page size: 10 1 items in1 pages . ri Y- . • YJ -�- r r OIL VV c N httpJ/v w"cityofboston.gov/citycler'k/dbasear6h/Defaiilt.aspx?business :address=45%20jW...--,-J75/201,3 Katya Rosenzweig - Google+ Page 2 of 3 Join Googoe+ . Join now and conned with the people who matter most'. University in Art and Art History.PhD in Art History"Russian avant-garde in the context of European culture". Studied photography in Moscow, then worked at the Academy of Fine Arts at the Department of Architecture. Concentrated on architectural photography and research. Has published several articles on Russian constructivism and modernism, including publication on Malevich and Filonov, translated in English. On 1987 emigrated to US with family. Sirice that time lives in.Boston wher, continue to study photography at New England School of Photography.Participated at several group exhibitions at NESOP, member South Shore Camera Club and received first place in print competition in 2012. Also published articles in Boston art magazine Art of New England, Contact and ARCA. My artistic.credo. Since I started to make my film prints at school, I developed my preference to Black and White photography.) believe that image in the head of Artist is predominate. Through the study of light my artistic vision always makes selection on the details. l like street photography.and-night scenes. At my selection you can see my recent works from my project,"Urban Nature". I love Boston an bostonians, appreciate;climate and nature of New England and like to travE My favorite photographer is Ansel Adams who always teach me to be honest and open minded.. Katya Rosenzweig Occupation Photography Employment RC RE Broker, present y Education Moscow State'University Fine Arts, History, Philosophy. https:Hplus.google.com/112080187826360311414 2/4/2013 Katya Rogenzweig.- Google+ Page 1 of 3 +You Search Images Maps Play YouTube News Gmail Drive Calendar. More- Katya Rosenzweig Add to circle: - x osts About Photos P LVideos b Contributor to [] Katya:rosenzweg@Gmail.com ` , https://plus.google•,co,m/112080187826360311414 2/4/2013 u �r I \ ��\ ,, '' ---Z.J �e�iC ,' -.._ � ram,: "� ']"'-_• �'Y t/�� L ' ben'St S9k� -- S_ou_th St c G - a____ OS-RC st f O -UP .-- Ud :._ 0 , 3 F=4(Y- ,. Belgrade Ave --- - -77-1 lj� -4 FT L v F 6^ 0 4 �Sp\ \\ ZC�\ i �/ •\ j�°r ti O _ 1tyasellshomes.com: Boston, Dorchester, and Newton, Real Estate - Katya Rosenzweig Page 1 of 2 [X] Website Information Web Site Information :. ❑Site Info ❑Whois ❑Traceroute ciRBL Check . Site Info 0 . Who Is . Trace Route . RBL Check . What's My IP? 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AdChoices[D 1.8k �. _ Document size.7_�,090 b'tes More info:Who.s-Trace Route- RBL Check ttr KATYASELLSHOMES.COM- Site Location Country/Flag us United.States City/Region/Zip Code Englewood, Colorado 80111 Organization NTT America Data Centers- San Diego Internet Service Provider NTT America KATYASELLSHOMES.COM-DNS Information IP Address 168:143.186.119-Whois- Trace Route- RBL Check http://dawhois.com/site/katyasellshomes.com.html _ 2/4/2013 s A. v` tatyasellshomes.com: Boston, Dorchester, and Newton, Real Estate - Katya Rosenzweig Page 2 of 2 Domain Name Servers ns2.z57.net 209.75.14.6 nsl.z57.net 209.75.14.5 ns3.z57.net 174.129.5.239 Mail Exchange croshard-01.z57.com 209.75.1.4.16 Site Response Header .Response HTTP/l.l 200 OK Server Apache/2.2.3 (CentOS) Date Tue, 12 Apr 2011 22:02:59 GMT Content-Type text/html; charset=UTF-8 logger99=70.59.126.251.1302645779848340; Cookie path=/; expires=Mon, I I-Jul-11 22:02:59 GMT IP Index TLD Index Domain Index Site Index Copyright©2012 dawhois.com http://dawhois'.com/site/katyasellshomes.com.html 2/4/2013 RC Realty -- Category: Home Services Real Estate Real Estate Services Real Estate Services [Edit] i 45 Johnswood Rd Boston, MA 02131 Neighborhood: Roslindale ; (617)676-3048 http://www.katyasellshomes.com/ g"-sx Add Photos Nearest Transit Station: Cummins Hwy @ Sherwood St(14, 192, 30) Cummins Hwy @ Brown Ave(14, 30) 93 Cummins Hwy Opp Sherwood St(14,30) Edit Business Info .# Work Here?Unlock This Business Page i Send to Friend Bookmark Send to Phone Write a Review .......... ......... _ _... 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MELROSE, MA Expired- Beyond 1 Sales It Brokers ROSENZWEIG Renewal Cycle Real Estate SAMUEL CHELMSFORD, Expired- Beyond 1 Sales EtBrokers Broker ' 61231 ROSENZWEIG MA Renewal Cycle Real Estate VLADIMIR Expired- Beyond 1 Sales Et Brokers Salesperson 9042743 ROSENZWEIG BELMONT, MA Renewal Cycle' Your search has resulted in 12 licenses Note: If the licensee cannot be found by name and the name typically has apostrophes, spaces, hyphens or periods try doing the search again without these characters. Examples: If the last name is"O'Donnell", try searching for"ODonnett"or"0 Donnell" http://license.reg.state.ma.us/public/pubLicRange.asp?profession=Real_Estate. Broker and... . 2/4/2013 katya rosenzweig - Google Search Page 1 of 2 +You Search Images Maps Play YouTube News Gmail Drive Calendar More- __. .. ............ .... katya rosenzweig ri . . 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Win a Wedding Package Today!- Read Client Experiences 1 2345678910 Next Advanced search Search Help Give us feedback Google Home Advertising Programs Business Solutions Privacy&Terms About Google http://www.google.com/ 2/4/2013 Parcel 1903735000 - City of Boston Page 1 of 3 Assessing On-Line Map New search Parcel ID: 1903735000 Address: JOHNSWOOD RD BOSTON MA 02131 Property Type: One Family Lot Size: 2,762 sq ft Owner on Sunday, ROSENZWEIG KATYA January 01, 2012: Owner's Mailing Address: 45 JOHNSWOOD RD ROSLINDALE MA 02131 Residential Exemption: Yes Personal Exemption: No Value/Tax Current Owners Assessment as of 1 ROSENZWEIG KATYA Sunday, January 01, 2012, statutory lien Ownership information last updated by City of Boston Assessing on December 26,2012,and will date. not reflect changes made since then. FY2013 History Building $342,900.00 I Value Y value: I Fiscal Property Assessed FY2013 Year Type Value Land Value: $101,400.00 One FY2013 2013 Family $444,300.00 Total One Assessed $444,300.00 2012 Family $429,600.00 Value. 2011 Family $429,600.00 FY2013 Tax Rates (per One thousand): 2010 Family $433,900.00 Residential: $13.14 2009 One $456,900.00 http://www.cityofboston.goV/assessing/search/default.asp?mode=reval&pid=1903735000 2/5/2013 Parcel 1903735000 - City of Boston Page 2 of 3 Family Commercial: $31.96 2008 FOmeY $483,800.00 FY2013 ,One Gross Tax: $5,838.10 2007 $500,500.00 Family ne Residential $1,724.47 2006 FaOml $447,100.0.0 y Exemption: One - Personal 2005 Family $416,000.00 Exemption: $0.00 FY2013 Net 2004 One $388,800.00 Tax: $4,113.63 j Family ne 2003 FaOm ly $325,300.00 2002 Residential 7 000.00 Abatements/Exemptions Land $ The FY2013 deadline for filing an Abatement _ 2001 Residential $7 000.00 application was Friday,February 01,2013. Land ' However,additional documentation on Abatement applications already on file are 2000 Residential $6 400.00 currently being accepted. Land ' A Residential Exemption has already been Residential granted for this parcel. j 1999 Land $6,400.00 To file a Personal Exemption Application 1998 Residential $6,400.00 (Elderly,Blind,Surviving Spouse,Veteran)for Land ' FY2013 click here Residential 1997 Land $6,400.00 I Residential Attributes l 1996 Land $6,400.00 Residential LAND 1995 $6 400.00 Topography: Steep Slope. Land ' Lot Size: 2762 1994 Residential $7,700.00 Land BUILDING 1 1993 Residential 700.00 Style: Colonial Land Residential 2412 Land $ Square Feet of 1992 $8,100.00 Living Area: _ Residential Exterior Good . 1991 Land $8,100.00 Condition: Exterior Wall: Alum/Vinyl 1990 Residential $8,100.00 Land . ' Grade: Average Residential Overall Good 1989 Land $8,100.00 Condition: - Residential http://www.cityofboston.gov/assessing/search/default.asp?mode=reval&pid=l903735000 2/5/2013. Parcel 1903735000 - City of Boston Page 3 of 3 .fi Stories: 2 t 1988 Land $4,700.00 Total Rooms: 6 1987 Residential $3,800.00 Bedrooms: 3 Land Bathrooms: 2 1986 Residential j $3,100.00 Half Land Bathrooms: 1 Residential 1985 Land $3,500.00 Bath Style 1: Modern Bath Style 2: Modern *Actual Billed Assessments Bath Style 3: Modern Number of 1 Kitchens: Kitchen Style: Modern Heat Type: Forced Hot Air Air Y Conditioning: Interior Good Condition: Interior Finish: Normal View: Average View Quarterly Tax Bill and Payment Information forthis parcel forFY2012 and FY2013. Visit My Neighborhood for information on city services related to this parcel. Questions?For CURRENT fiscal year tax bill Questions,contact the Taxpayer Referral'& Assistance Center. For PRIOR fiscal year tax payments,interest charges&fees,etc.contact the Collector's office at 617-635-4131. - t 9 http://www.cityofboston.gov/assessing/searcll/default.asp?mode=reval&pid=1903735000 2/5/2013 Town of Barnstable • of s�tom, 'Regulatory'Services o Thomas F. Geiler,Director T Building Division a.�xxsTAst.E. r� MASS. * Tom Perry,Building Commissioner 'DTfo � 200.Main Street, Hyannis, NfA 02601 Office: 508-862-4038 Fax: 50 90-6230 Appro d: Fee: Permit#: HOME OCCUPATION REGISTRA Date: Name:. Ly Phone . Address: l �` ge: �i��i�� h Name of Business: - Type of Business:AE —.Map/Lot,iL, ! '— INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings, subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling, there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than'a residential use;no increase in tia c above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following,conditions: The activity is carved on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space: • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside.evidence of such use. • No traffic will be generated in excess of.normal residential volumes. • The use does pot involve the production of offensive noise, vibration,smoke,dust or other particular matter,' odors, electrical disturbance,heat,glare,humidity or other objectionable effects,-. •: There is no-stomge•ormse of toxic-or-hazardou$materials, or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be m'Eo'n the same lot containing the Customary Home Occupation,..and not within the required front yard. There is no'exterior storage or display of materials or equipment There is no commercial vehicles related to the Customary Home Occupation, other than one van or one , pickup-t�tek-not�.•cxceed•one;ton-capacity, and one trailer not to exceed 20 feet in length and.not to — exc�=d 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupadbn. • If the Customary Home Occupation is listed or advertised as a business, the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit . I,the undersigned,have read anda ee with the above restrictions for my home occupation I am registering: YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 f s . A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: I " please: � ta� �f4; io- 4 APPLICANT'S YOUR NAME/S: BUSINESS Y �R HO E ADDRE �, `I+„fir�nyr� a�, TELEPHONE # HomeTele hone Number r — p '.I 7.'t'S'df`i.:n•te�n`7 Q;$.I�G�M'jY NAME OF CORPORATION: ) NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A.HOME OCCUPATION? E, ' NO ADDRESS OF BUSINESS D r ./ MAP/PARCEL NUMBER ` ! '�� f5��AssessingJ. When starting a new business there are several things you muust ao in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmo/ Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in his to n. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. P. Authorized Signature** `l COMMENTS: 2. BOARD OF HEALTH This individual has.b infor d ote rraiit re iremants that pertain to this type of business. Authorized nature** , COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual h s b en ' rmed the lice requirements that pertain to this type of business. ' x , i 1 uthorize ignature** COMMENTS: YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30 00 f s A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you perm'i`ssion to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: / -Fill in please: w APPLICANT'S YOUR NAME/S: l f �t✓l BUSINESS Y �R HO E ADDRE z TELEPHONE # Home Telephone Number 0 rIn ZM, NAME OF CORPORATION: TY NAME OF NEW BUSINESS TYPE OF BUSINESS C IS THIS A HOME OCCUPATION? ES NO r ADDRESS OF BUSINESS O � .f MAP/PARCEL NUMBER � `(/`� ! -2 5 �- Assessing) When starting a new business there are several things you mus do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmo h Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in his to n. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. p i� Authorized Signature*.* COMMENTS: 2. BOARD OF HEALTH This individual has.-b infor d o he rmit re irements that pertain to this type of business. Authorized nature** - COMMENTS: r 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual h s been rmed the lice requirements that pertain to this type of business. ` ' uthorize ignature** COMMENTS: R,7# d 't'^' �. ".. +,'�, "Ir - IT 19 �c R : EW —*s. aF, +dam"' },-'�•'' R;- �"a� " `. ARO �s . fit - �a""%".,.keE ( 1162 . f�' ' c S1r T7 t : f ' i — � _� � � � � it �• is f� ...r � K � 3 —�i•�w} r�. f i �. :)SEPH D. DALUZ _ a Building l nprcw � TELEPHONE: 775-1120 EXT. 107 TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING HYANNIS, MASS. 02601 February 29, 1980 Mr. Carl Chapman Box 228 Centery 11e, :Ma - 02632 Dear Mr. Chapman: I received a call on Thursday February 28th that McDuff Construction, of which you are a partner, is conducting an office at Jones Road and Grist Mill Park a residential area in Marstons Mills. Such a practice is in violation of the- zoning by- law and must cease. Therefore, I expect the office to be removed by March 15th in order to avoid any litigation. I trust that we may expect your continued cooperation. Peace ( seph,o D. 'Daluz Building Inspector JDD/df j ' i pvl�� � YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30�L4-yeaCs_L A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you per miss n to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: —Fill in please: APPLICANT'S YOUR NAME/S: l S VVE r 1 i i n��EDDRE BUSINESS YIr Ll'L� l r. P ii t TELEPHONE # Home Tele ho N mber r t r NAME OF CORPORATION: NAME OF NEW BUSINESS TYPE OF BUSINESS C IS THIS A HOME OCCUPATION? ES' NO / y - MAP PARCEL N UMBER � 7 Asse°ssin ADDRESS OF BUSINESS (? � / � g) , When starting a new business there are several things you mus do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmo h Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in his tolUn. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH r d)oh e unit re ire ments that ertain to this a of business. This individual has.b infop tyP Authorized nature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual h s been ' rmed the lice ' requirements that pertain to this type of business. uthorize ignature** COMMENTS: OSEPH D. DALUZ - - Duildirg In:rrcto- .TELEPHONE: 775-1120 - =EXT.,107 TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING HYANNIS, MASS. 02601 February 2 9, " 19 8'0 Mr. Carl Chapman 1'07C1if=tonLane Box 228 a� Cent:ervlyle =Ma-.= 026.3.2 Dear Mr. Chapman: I received a call on Thursday February 28th that McDuff Construction, of which you are a partner, is conducting an office at Jones Road and Grist Mill Park a residential area in Marstons Mills. Such a practice is in violation of the zoning by- law and must cease. Therefore, I "expect the office to be removed by March 15th in order to avoid any litigation. I trust that we may expect your continued cooperation. " Peace ��oseph D. Daluz Building Inspector JDD/df I - z r I � Aj - f s 'saps l: wr_ r i ' 1 i 9 � � i i 1l .I •1 i 1j • 4 e—.3 —# w t3 .r— "ca � t 3 54 LJ C:3 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 f s . A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1 FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) a r DATE: mill in please: APPLICANT'S YOUR NAME/S: l VIE l BUSINESS YOUR HON AE ADDRESS, ' TELEPHONE # Home Telephone Number r — z:�y � at NAME OF CORPORATION: NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? VES' NO / (� ADDRESS OF BUSINESS MAP/PARCEL NUMBER C ����[Assessing) When starting a new business there are several things you must-do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmo th Rd. & Main Street) to.make sure you have the appropriate permits and licenses required to legally operate your business in his to A. 1. BUILDING COMMISSIONER'S OFFICE" This individual has been informed of any permit requirements that pertain to this type of business. \��� o Authorized Signature* " ' COMMENTS: :_ 2. BOARD OF HEALTH This individual has.-b infor ldo �he, rmit requirements that pertain to this type of business; Authorized nature* COMMENTS: 3.'CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual h s been rmed the lice requirements that pertain to this type of business. uthorize ignature** COMMENTS: JOSEPH D. DALUZ TELEPHONE: 5-1120 Building /nyrtrto 77 EXT. 107 TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING HYANNIS, MASS. 02601 February 29, 1980 Mr. Carl Chapman._ J- V107 Clifton_Lane Box 228 (Centerville.,_Ma-.-0.2.632 Dear Mr. Chapman: I received a call on Thursday February 28th that McDuff Construction, of which you are a partner, is conducting an office at Jones Road and Grist Mill Park a residential area in Marstons Mills. Such a practice is in violation of the zoning by- law and must cease. Therefore, I expect the office to be removed by March 15th in order to avoid any litigation. I trust that we may j expect -your continued cooperation. i Peace "oseph D. Daluz Building Inspector JDD/df 1 O^ l t - QZ CIS i Town. of Barnstable of YKE r, Regulatory Services o Thomas F. Geiler,Director Building Division v MASS. �� Tom Perry,Building Corninissioner 200 Main.Street, Hyannis,NfA 02601 ' Office: 508-862-4038 Fax:/5090-6230 Appro d: Fee: Permit#: SOME OCCUPATION REGrSTRA /. Name . Phone Address: l� / �(� ge: `�- Name of Business: ' Type �,/of Business: Map/Lot l 7' za MT EN T: It is the intent of this.section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings, subject to the provisions of Section�1.4 of the Zoning ordinance, provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector, a customary home occupation shall be permitted as of right subject to the following conditions: Y The activity is carved on by the permanent resident of a single family residential dwelling unit,Iocated within that dwelling unit. • Such use occupies no more than 400 square feet of space: There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No-traffic will be generated in excess of normal residential volume9. • The use does not involve the.production of offensive noise, vibration,smoke,dust or other particular matter, odors, electrical disturbance,heat,glare,humidity or other objectionable effects, • There is no-storage-or.-use of toxic or-hazardoug materials, or flammable or explosive materials, in excess of normal household quantities. • Any need for parking generated by such use shall be meE:on the same lot containing the Customary Home Occupation,,and not within the required front yard. • There is no exterior storage or display of materials or equipment ;There is no commercial vehicles related to the Customary Home Occupation, other than one van or one pick=up-tiuc-k not to•exceed-one,tori zapacity, and one trailer not to exceed 20 feet in length and not to — exed 4 tires,parked•on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Cuistomary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business, the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit . I, the undersigned,have read la ee with the above restrictions for my home occupation I am registering. J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Nlap Al Parc 1 205 Permit# • 70 2 �9Health Division l Date Issued 13 /9 1<0 Conservation Division 4d Fee (0,-2�-dam Tax Collector - PTIC SYSTEM M Treasurer /(� �ZoDU UST BE INSTALLED IN COMPLIANCE Planning Dept. WITH TITLE 5 Date Definitive Plan Approved by Planning Board av �'" �"'` ENVIRONMENTAL CODE AND TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address/0 Z ��/, j '� ''� a k e Village 1N Hq 00 i S F-T Owner /V a _ Address l 7 ` ' L/ QG Telephone 5 0g J9j�2 L/'� Permit Requester y� f� g proposed 2nd floor: existing proposed Square feet: 1 st floor: existing_ p p g Total new. L Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Type t7 Lot Size � Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 4 0' Historic House: ❑Yes V`No On Old King's Highway: ❑Yes t o Basement Type: VFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 1J &k/ S 4 e Basement Unfinished Area(sq.ft) /0 D D Number of Baths: / Full:existing new Half: existing new '— Number of Bedrooms: existing 2- new �— Total Room Count(not including baths):existing new �-�" First Floor Room Count Heat Type and Fuel: ❑Gas �il ❑ Electric ❑Other Central Air: ❑Yes VNo Fireplaces: Existing V New Existing wood/coal stove: ❑Yes No Detached garage:Ealing ❑new size Pool: ❑ex isting ❑new size Barn:❑existing ❑new size Attached garage:❑existing El new size Shed: ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE e� /� DATE K L L. c i FOR OFFICIAL USE ONLY PERMIT NO. �� ` DATE ISSUE f MAP/PARCEL NO. *j r ADDRESS VILLAGE ` OWNER , s G DATE OF INSPECTl,0N: FOUNDATION hir FRAME ' - I% INSULATION � "� ` y, ''' -• C, • FIREPLACE ELECTRICAL: ROUGH,,.,.. FINAL e;i . PLUMBING: ROUGH}•— . ' FINAL GAS: ROUI � FINAL FINAL BUILDING r 2 m rpt + DATE CLOSED OUT ASSOCIATION PLAN NO - �.^ •� i� The Town. of Barnstable OF IME l Department of Health Safety and Environmental Services Building Division BARNSPABL& ' 367 Main Street,Hyannis MA 02601 MASS. 9� 1639. 10� A�Fp MAC A , Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION �n Please Print DATE: S v JOB LOCATION: l �^ y 0 / �number ff street Village oe ..HOMEOWNER": 4-L-k nam ome phone# work phone# CURRENT MAILING ADDRESS: ` e `S Q Ar4 t— Ce (f I-e r --V`e-C e D 2 C'3 2 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. / �la�ct Le ee Signature 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 to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN f ESTIMATED PROJECT COST WOR&SHEET Value LIVING SPACE And square feet X$551sq. foot= G RAGE (UNFINISHED) tl(- y square feet X S251sq.,foot= PORCH 'U-0 square feet X S20/sq. foot DECKS square feet X$151sq. foot= 1. 0 THER V1 u ��I �� square feet X M/sq. foot 2 �� Total Estimated Project Cost 2 _9909!5b The Commonwealth of Massachusetts Department of Industrial Accidents - �.•- 600 Washington Street Boston,Mass. 02111 • Workers Com��tion Insurance AM name: 1,Mq Le_�Vi. location 107CIP/ 14 le" ci V V . (� 1i( l•S I am a homeov&er performing all ork myself. ❑ I am a sole Pr rietor and have no one workin in anv ca achy % I am an employer providing workers' compensation for my employees working on this job. cow nnv name. ...........:.:... address . ;:.,. phone# > .. :.::.:: ...::::::•:.::::.. . ....:::.::......::.. .:::....:. :.: :... iMurance co: »:»:: olicv# I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the followingworkers' compensation polices: .. es: ... .................. . .:..:::.:.:.:.:::..::::..:.:..... ....................... cow anv name. :......::.. .... .. ..::: address - .........:.: ph itv�``� of tnsnran or .. ...... address: ;.. ensif:_ i'::;.....:... rid, nh of iajinrariceCVFailure to secure coverage a,required wider Section 25A of MGL 1S2 can lead to the imPostHon of criminal penalties of a One up to S1,500.00 and/or one years'imprisonment as well as dva penalties in the form of a STOP WORK ORDER and aline of$100.00 a day against me. I understand that e copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certd fy under the pains and ppenalties of perjury that the information provided above is true.and correct /%/�/ e b e �� Date D �, l q . ® D Signature Print name M a ,Lr ze: Phone# so � D � ' 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 ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised 9/95 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quo ted from the"law , an employee loyee 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 rise and including the legal representatives of a deceased employer, or the receiver or the foregoing engaged in a joint enterprise, dmg g eP g � g� J 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 r Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situatiim 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 permidUcense number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would lice 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 _ 11mce of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#:.(617) 727-4900 eat. 406, 409 or 375 THE Tp�� The Town of Barnstable anxr+sraet.z. - MAS& $ Department of Health Safety and Environmental Services 059.{A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissions- 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:�K `C ve-- 2 u ro h'C P timated Cost 2 D 0 Address of Work: /'fin, Lee R40k p p Owner's Name: e-b e_71 A'/ Date of Application: �s . (7° 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 2Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. Date Owner's Name q:forms:Affidav r y. IF � 150. } Rl130.00' Y TOT �J •ri D•0HSE. LOT 6 rA RES 201V-r, "RB" This MORTGAGE INSPECTION Plan is For FLOOD ZONE- "C" I Bank Use OnjX __REGISTRY O�N'aNER: MAMAR DEED REF: -2'Q,?. 8--__ -.----BUYER: �f 7_ A' E&ff y---------.•- ---- _ DATE: _ ��85 -------- PLAN REF:_L,3 __-- ----SCALE:1 ao''�- FT_ - I HEREBY CERTIFY TO 41, �1 X7'� lJ, P _-_THAT THE BUILDING ��or YANKEE SURVEY SHOWN ON TH?S_PLAN 15 LOCATED ON THE GROUND AS .��` SHOWN AND rtAT.ITS POSITION DOES _ CONFORM PAUL cONS j�1- M TO THE ZONING LAW SETBACK REQUIREMENTS OF THE ��A. N INDUSTRYIT ROAD .TOWN OF __B�I.RNS ------,AND THAT IT DOES- MTOT LIE WITHIN THE SPECIAL FLOOD AZARD � NO" MAR�TobIS MILLS, MA. 02848 AREA AS SHOWN ON THE H.U.D. MAP DATED-?f_ �9?__ �F6JStE�E TEL, 42B---0055 c it -Pane 250001 0008 D N o� FAX �20-5553 THIS PLAN NOT MADE FRO UMENT PAUL A. j4k A w PLS —^ SURVEY NOT TO BE USED FOR FENCES ETC. 17144 DPG TOTnL P.01 Town of Barnstable PlanningDepartment . pl. Staff Report Ron Molinari - Appeal 2000-94 Variance-Section 34.1(5)Bulk Regulations-Minimum Lot Area Date: October 19,2000 To: Zoning Board of Appeals Approved By: J66kie tsten, Principal.Planner Drafted By Art Traczyk, Principal Planner Applicant: Ron Molinari W "!.rr., Property Address: ... 8107 Crdton Lane,West Hyann1.sport Assessors Map/Parcel. Map 247,Parcel 153 8 Parcel 205 Zoning: RB Residential B.Zoning District Groundwater Overlay: AP Aquifer Protection District Filed:September 22,2000 Hearing:October 25,2000 Background Information This appeal was submitted at the request of the Board. As the members will recall, on September 13,this locus was before the Board seeking to overrule the Building Commissioner's finding that the lot was unbuildable due to common ownership of undersized lots(Chapter 40A, Section 6). The application in this case has cited two lots,the second lot-No.205-is owned by a Maya Lebedinsky. that lot has been developed for 35 years. In past cases,the Board has determined that both lots would require relief. The two lots involved are: 1. Developers Lot No. 67A-today Assessors'Map 247 Parcel 153. This parcel is a vacant 0.18 acre lot . addressed as 9 Pine Crest Road. It has been owned by Irene Molinari Trustee dating.back to.May 14, 1988. 2. Developers Lot No.68A-today Assessors'Map 247 Parcel 205. This parcel is a developed 0.20 acre lot addressed as 107 Clifton Lane. It is developed with a one-story,1,084 sq.ft single-family dwelling. The structure was built in 1965. It is owned by a Maya Lebedinsky who purchased the property on July 10, 1995. The applicant has submitted a site plan for the development of the vacant lot with a three bedroom home measuring 32 feet by 24 feet. Staff Review, The subject lots were created in 1955 by a plan entitled"Re-Subdivision of a Portion of'Block F as Shown on a Plan Recorded at Barnstable Registry of Deeds Bk. 76, Pg. 1 -Land at West Hyannisport, Mass. property of Alphonso Cannata"dated January 19, 1955 and recorded in Plan Book 139 Page 5. The lots when created in 1955 were 8,880 sq.ft and 8000 sq.ft and met the minimum requirements for the district. In 1956 the site was zoned RA Residence A-1 District requiring an minimum lot area of 7,500 sq.ft In 1957, the area was rezoned to RB-1 Residence B-1 Zoning District by Article 53 of the Annual Town meeting. That district required a minimum of 10,000 sq.ft lots. • 1 r TOWN OF BARNSTABL U Zoning Board of Appeal SEP 2 2 Application for a Varianc f TOWN OF BRRA'STABLE ZONING BOARD OF A.F`l-LS Date Received For office use onl Town Clerk's Office: Appeal# "' 916 Hearing Date /C> Decision Due The undersigned hereby applies to the Zoning Board of,Appeals for a Variance, in the manner and for the reasons set forth below: Applicant Name: rdN Hdt uuAtZ • 'Thl/Stl . Phone: Applicant Address: LIo PT'rDIZ#Jrrl P&An �l• U�t1c�c Property Location: LOT: _ 01NF— C2F-Tr to. W. tltiMM% FdW INfP<f Property Owner. 8.dl t&lllQ< <fh;�ST. 2d�/1 ,r� Hf r_wm iohe:-IM S'(o2- S�iO-- 4lrr Address of Owner. ArTT EtTej if applicant differs from owner,state nature of interest:f Assessor's Map/Parcel Number. 7 / Zoning District: ]Z. Number of Years Owned: I Groundwater Overlay District: A n Variance Requested: 3— f • 1 5� ZUUL I,"UL no4s Cite Section$ Tide of the Zoning Ordinance Description of Activity/Reason for Request 9 &2a-r n '14 15 NDN jut L�q� _tom UbLb G2, 19")W 6 :—n COUSMISKE-tl it BAh DAD L' tom' Attach addi6ional sheet if necessary Does the property have any existing Variance or Special Permit issued to it? )Qo Permit No.: If the applicant differs from owner,the applicant will be required to submit one original notarized letter,copy of a proposed purchase&sales agreement or lease,or other documents with the application to prove standing and interest in the parcel or structure. w lauxW114 0 Z4I / , /I I /l : , • u , , 1 , I I11 ;;.q •i:Ri' n>' e'N:'>5 d( Tr°'ktl7lP b`i Mstkll 4' Ju• Mf'I ,.4. �}. k'""ji^G, �i G .' "° rr .,,Z< "r87 -•!,\ G �r M.t: ,$x .�s�f ,✓;Af.;'..c.fl� :rrJ. �:Jrfi'f; .,hiY2. �hr � u '4r;... '�'r.2 .. '�rw,:i�', ..,✓,., i r�,��1. 6flt.� .Fi { G iFlr4i10rr, ..c. r :wyAd ^F,sG tr7r y.arc § a13' aah •-SjR��+.O ,� , i+i iHf 9.� fY P 1 ° ♦ 1 *7,p°y,-x1yL�. I. I Dist.1 •erjftp. Life 1:I 1131. O 1 PLY /I n .II II e, �°.,: .o, r1 ..€a.. 's .,_ . a r ,-. .. :n:=a �.< P �e .. x-1( .,..., ,ur r. �t., � •{ u..,� � E)F,�q tx,�,�.,�. „r_'7. a..e r�',o_.9.d.5 € v f< .i <a,• 7 �; z. d e .a=9 � sc. ,r �, {.. t�-r. �`r` ^a t/, •Y..!� ,.,. .3 .�. �t d,.. .4'. ,,.. ...;: ,.a^'r lied: «n�. - a rr: 3?- >2r: :'7.4'.F,..a 111)LY' ,Xi 1AEEVIoil 1 I I'1 1 r r r �, .I I r IjIJ r 1 sondP Appraised Bldg.Value(Card 0 Appraised OB(L)Value Idg) Special Land Value Appraised 1 \ 1 \ . \- 26,600 l \ Appraised I 600 Total AppraisedParcel Vakw 26,6 l l ValuationMethod: 11r Aet Total I I _1 \ v l , ^E.: ..w is^.. ..,,. Anv .,,,.. ;tsa e.. :.:: N .. i r � ,. v ', d. :.:.r• i,• .." o �:, -.,.:. .. a• :. '., y.„ 's f...d. ,�.f..,. .r '-sr ,' ?::ra.u. .✓..,.,..' 7 .r.:, k 't .d c'^,.y,,.p.« ,:� 'xF'S. .3#3f�' }._ 9 ,.,�..a .. .,,a,- :F,. att, ,,.,., ,,, ,..ke..aa9 � t da,�$l��n .•. aFr<.:,C?. ...�s�._.'ra..., .,:.iE;°..,r�„x ,> .., . :.'.,::,. „n .N rt' r. n.. _. ...,.r59,.i,.,.....c :..,....�it7f ..f,.»�., e•���cz�►r�•rar.�� �. „ -, ���t��tQ'r�f/r.•r� ;.....�...,.. . t�L��r ,�� ��••.1�-�zni,.ar►n� u' ...� > .,a. .11 •: .. fl, �. . 1 .,.. .,." >. ., ;,.: .: M .. ��� ���,.�Y ::.7�'.w>5f�.n..k.��rPi_r_,na.,Fdr..�.,'r:S�,3i`� 1,:�1»e.�t. �._a.. " �)';c)tl�' LaIL'3�!'�L'd� [r���n��P��i:rr�n�rsrrrra- rr,�.� �����.-*�nr►r II i l '1: I F i; I'I'I II II II I •� I K 1'r • I'I II rll li' II 1 r,-�r11111r-1yC7nIqL77T1.� CR -�1Qt41ll1 operty Location: 107 CLIFTON LN MAP M: 247/205/ Vtston ID: 17521 Other ID: Bldg#: 1 Card 1 of 1 Print Date.10/1812000 Nam veserwaan Mae ApprabedValue sense Value 7 BETTYS POND RD F lUlU NTL 1010 53,300 , 801 ; ANNIS,MA 02601 53300 Barnstable 2000,MA ::: oun an ax Dist 300 Land Ct# "Prop. LR ISION DL 1 LOT 68A Notes: DL 2 GISID: o MIMI r. sense value r. o ease value r. o Assemea value RINCI,MARGARET B TRS 7025/008 OL15/199 U I 1 A RINCI,MARGARET B TRS 7025/008 OVIS/199 U 1 1 A 19" 1010 53,300 998 1010 53,300 RINCI,MICIiAEL J 6040/177 IV1S/19 U I 1 .B MAN,CARL W 2762/301 Q 0 0 0 0 , I his gn re ow ges a a aCollector or Assessor ear lypelvescriplion AMOunt lyunwer Lamm ME / 51,100 Appraised Bldg.Value(Card) Appraised XF(B)Value(Bldg) 2,200 o Appraised OB(L)Value(Bldg) 0 Appraised Land Value(Bldg) 27,000 Special Land Value Total Appraised Card Value 80,300 Total ValuationwisedPal Value 80,300 Method: Cost/Market Valuation e oI Appraisedarea value vumu, ermrIssue Date escr on ou amp. amp. ommen aMOM, Purposemejulf ranep n Unit Price Factor Description Zone ROWS-AdjlYpeCtatr cing Adj. UnUPrice Lana value Single am TA sr C14.2%U I Up ofb-.q w 133,1100.0 I ME aritaw U" U.ZU�Cj Parcel I MatMAMMI bJU AUI jawLand , I-IN. bHNUC VVLn I LI\yyL-rn . owl. , �v ABSORPTION SYSTEM r 3.0 TEST HOLE I TEST HOLE 2 0" ELEv. = 31.8 0- ELEV. 2%MIN,GRADE 121• Fill _ 12" FlII SANDY LOAM SANDY LOAM 2-MIN.DOUBLE WASHED 1-B -1/2"STONE 24- gjA 1 OYR 3/2 24" /A IOYR 3/2 SANDY LOAM SANDY LOAM I';,:.r.; ;.�;•,,. B IOYR 5/6 36.. B IOYR 5/6 12� 3120 I %?..: 13' 3/4--1-1/2" :C%'._�Ia * 36.. OOUBLE WASHED STONE — �+J 2920 — 2'-W S 5'=50 W ,2'-0' 4�3;T0T.EFf,LENGTH GI Et�FrF 11 1 - � mmmmMml ,bar MED.SAND MED.SAND _ ) I IOYR 5/6 IOYR 5/6 1/ \I 120" 1 C1 21.8 138" I C 1 19.5 OBSERVED GROUND WATER: NONE INFILTRATOR DETAIL ADJUSTED GROUND WATER: 242 PERCOLATION RATE: 5 MIN./!NCH NOT 10 SCALE SOIL CLASS: I EFFLUENT LOADING RATE: 0.74 GPD/SF SOIL EVALUATOR: J.E.LANDERS-CAULEY CERTIFICATION NUMBER: WITNESS: BOARD OF HEALTH, TOWN OF BARNSTABLE DESIGN DATA DATE OF TEST: MARCH 6.2000 %1309F.R OF BEDROOMS 3 G.,.D./BCD`OOM 0W 110 CG.D. GENERAL NOTES GARBAGI: V:SPOSAL No LEACHING REQUIRED 330 G.9.D. ! ELEVATIONS BASED UPON NGVO DATUM. LEACHING PROVIDED 453 G.P.D. 2. ELEVATIONS AND LOCATIONS SHOWN ON THIS PLAN SEPTIC TANK REQUIRED 1500 GALLONS ARE NOT TO CHANGE WITHOUT WRITTEN APPROVAL SEPTIC TANK PROVIDED 1500 GALLONS OF THE ENGINEER AND THE TOWN HEALTH AGENT. SIDEWALL AREA =243.3 S.F. 3. ALL SYSTEM COMPONENTS ARE TO BE INSTALLED IN BOTTOM AREA = 368.8 S.F. ACCORDANCE WITH S.E.C. TITLE V AND LOCAL HEALTH TOTAL PROVIDED- 612J S.F. it 0.74 - 452.9 G.P.D. RULES AND REGULATIONS. 452.9 G.P.D./TRENCH x I TRENCHES= 452.9 G.P.D. 4. ALL PIPES ARE TO BE CAST IRON OR P.V.C. SCH. 40. 5. THE BOARD OF HEALTH AND/OR ENGINEER TO BE NOTE: EXCAVATE TO EL. 28.0 OR LOWER AS SOIL NOTIFIED WHEN SYSTEM IS COMPLETELY INSTALLED CONDITIONS REQUIRE TO REMOVE ALL TOPSOIL, SUBSOIL, AND READY FOR INSPECTION. CLAY OR OTHER UNSUITABLE MATERIAL BENEATH THE 6. NORTH ARROW IS NOT TO BE USED FOR SOLAR INLET INVERT OF THE SOIL ABSORPTION SYSTEM FOR ORIENTATION. A DISTANCE OF 5'MIN., AND BACKFILL WITH CLEAN SAND,PER 31OCNIR 15.255:3. +� 'k m , REV BY DATE DESCRIPTION is' SITE 8 SEWAGE. DISPOSAL PLAN LOT 67A, #9 PINE CREST ROAD LOCUS g BARNSTABLE, MA. J „ �� B• CIA ROAD APPLICANT: WILLIS MICHAELSON ADDRESS: 473 PINE STREET "aI K.INe CENTERVILLE, MA.02632 ENGINEER: NORMAN GROSSMAN, R.P.E. LOCUS MAP--- SCALE:r-2000' 10 MARSH VIEW ROAD ZONING DIST. FLOOD ZONE ELEVATION I MAP NO. EAST FALMOUTH, MA, RB C --- 500010008D 508-548-1920 MAP SEC PCL LOT. I HSE SCALE DATE I DWN.BY /CK'D BY PLAN NO. 247 153 67A 49 AS NOTED MAR IO,9000 1 JTH / NG H-634 Ieose�Zwe�c� t o�t�oy q y ba os J--c,^t^ov,4 ? 2 Mc, 02,Y78 S �Sb�YOWOOJ �oS�►�a�t` �a, �213 tubers, etc. .1 businesses and another for builders, must fill out the appropriate affidavit -s'.compensation, or that the business aired to carry a policy. If the business y must provide a copy of said policy ising agency is to keep the affidavit on er, if a city or town{agency must issue one affidavit for that business or' ote that a new affidavit must be filed s' compensation policies are renewed' t of Industrial Accidents (DIA) may s part of our efforts to enforce the our agents every courtesy. If you 617-7274900 ext. 560. We thank vor. P s. ov/dia/EN2LOYER/Affidavits.htm. ri Qnn �l 2 South Shore Wood Pellets - Brands and Info Barefoot is a small manufacturer supply one of our top selling pel recession they have very little raw superior product. We can only Barefoot Pellets place your orde increase Barefoot Pellets are exceptional in Quality and Consiste cleanliness of the raw material used to make their pellets. hardwood species from the renewable & sustainable fores include Cherry, Maple, Red Oak, Hickory, Walnut, and Whi content due to the quality of the hardwood raw material us low emissions, clean burning and high heat. Barefoot Pre Fue/printed on their bag. If the pellet you are currently usin a hardwood pellet. Barefoot Premium Plus is a ood hot If you own a Harmon Pellet Stove you will not ever burn a Permium Plus. Barefoot has a heat output of 8,300 plus BTU and ash co, f 6 ornj TI « +` 7oz aff youz#zirzti.29 Heads 508.428.8700•fax 508.428.8524 �www.lujeanprinting.com 4507 Route 28•Cotuit, MA 02635 'ME Town of Barnstable Regulatory Services ass ce. Thomas F.Geiler,Director Eo;o. & Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 December 11, 2012 Katya Rosenzweig 45 Johnswood Rd. Roslindale, Ma. 02131 RE: 107 Clifton Lane, Centerville Map: 247 Parcel: 205 Dear Property Owner: In accordance with 780 CMR RI 13.2 you are hereby notified that a stop work order has been issued on the above property for violation of 780 CMR R105.2 which states in part "It shall be unlawful to construct, reconstruct, alter, repair, remove.:.without first filing a written application with the building official and obtaining the required building permit and all other required permits therefore." The following issues must be addressed: 1) Electric and plumbing permits are needed with the required subsequent inspections. 2) Building permit needed for the work in the basement. 3) All work must be compliant with 780 CMR. Thank you for your immediate attention in resolving the above violations. Please do not hesitate to contact this office,if you have any additional questions. By Order, We . uzon Local Inspector j effrey.lauzongtown.barnstable.ma.us (508) 862-4034 V J , Assessor' map and lot number ...� . .... -�.. v'� �r �U s • �� � CF THE t0 Sewage Permit number `S SMEM MUST y IN GY IS COMPLI 9TADLE, i 0 House number ......................................................................... . WITH TITLE 5' 9°o M6 9 gem 1 - ENVIRONMENTAL C0f At'�°�aYa TOWN OF BARNSTA-BLE BIUILDING INSPECTOR APPLICATION FOR PERMIT TO .. . .... ...�Jri-C ....... TYPEOF CONSTRUCTION ................. ............................................................................:................. ......../.�........g.P..�. TO THE INSPECTOR OF BUILDINGS: r ; The undersigned hereby applies for a permit according to the following information: Location /f ......................................................................................................................... 1.... , Proposed Use , ................................................... .........................................I......................... .. . ... ... .. .......... Zoning District ........ ....... ......................................... ..Fire District .... ... ........................... Name of Owner ....Address .... ...... .. .. e ...I.�. p Name of Builder ..�/ // .. . .. .. .... ............................Address Q, Name of Architect ...... A / ..............................Address ................... .......................................... Number of Rooms .............../..................................................Foundation Exterior ...4)"V4... .. 16�0- Floors ....... .. .... . ........................Interior ....... . ...... .. ............................................................ Heating ..... . � ............ ........................Plumbin ............................................................ Fireplace Approximate.Cost ..... .................................. ............. ... .................... Definitive Plan Approved by Planning Board -------------------_-:_- � 7�! V - 19 ---. Area :... .................. . 6© Diagram of Lot and Building with Dimensions Fee � SUBJECT TO APPROVAL OF BOARD OF HEALTH /2 0 2- 7 ' I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam ... ............ CHAPMAN, CARL W. 1 . No ..2.2.4.9.9.. Permit for ..ENCLOSE PORE .....Single.. M1.1y..Dve.11ilig................ Location I.Q.T....C.Iift.0a..Lame.................. ' ....................W.eat...UY.Lu ispa t.................. { Owner ......Czar.1...Wn ...Chapman..................... Type of Construction ...Exame.......................... t Plot ............................ Lot ................................ Permit Granted .....Sept2mber...10i.19 80 't '- Date`of'Inspection ...................................:19 Date Completed ... I P ERMIT REFUSED F 1 ........ *.................................. 19 ........ ................................................... i ....... .G•..................................................... .....n.ff. ...................................... ................. I• j 4':. - - Appro'eSt ......................................... 19 ............... . ............................................................ , ........... .............................................................. . Assessor's map and lot number ... -'� ' ,/� ��,vj- 'j� y....................... �j Sewage Permit number ... �rlf> a'�,i= n�/z�.: Z BABHSTADLE, i House number ......................................................................... so rhea p 1639. \00 a TOWN OF BARNSTABLE f� 4 r BUILDING ' INSPECTOR APPLICATION FOR PERMIT TO f f7 a r 1' t'� .? �,• qt ......... i r........................ ............................ . ...`.:........................... .......... �. TYPE OF CONSTRUCTION ..................� .::a: ..................................................... ...... . -.F.., ........:...:...........19 f TO THE INSPECTOR OF BUILDINGS: - The undersigned hereby applies for a permit according to the following information: Location .. ..`....%....i..... ... .............. t.............................................................................:............ ProposedUse .. .................. ....: ':d.:................................... ................................................................................................. Zoning District L Fire District .....................................�.. .I. [ k (f ,............... lif r Name of Owner iL �r.: �.. ,1,���� ,�;-.......Address ...... ................T . / '11.:,^%�; .. ... `... ......... � ...... Name of Builder i '" T j%' ..?.. `.:'..............Address --z`'- Name of Architect ................Address ' Number of Rooms 01 / ..................................................Foundation ....... t Exterior ' j i.............. Roofingr :�..:. ^..:'....................1.:...t ................ Floors `` r / I!........:..tfr.f �.,.F�7� Interior ....... %L`r +<!`...... ............✓................................ .................... Heating .............. ~t........ ......................................................Plumbing ........... ?........:... ................................................... Firepp Approximate Cost .. %trs� lace ......... :................................................... Definitive Plan-Approved by Planning Board ________________________________19--------. Area AV) k F/...�T%..�!�U 001 Diagram of Lot and Building with Dimensions Fee .I . —................ . . ........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and .Regulations of the Town of Barnstable regarding the above construction. Name..............:... ....... -' n----�e:,...:......... v CBAJ?MAN, CABI, W... p }\=347-30 . . r . \ ' o �RA ��'' Permit for g�q �� E���_ . '' , ........ —'-------' ... -----' ..... --' Location- --`—' T'y---- -----'-----'~ ------' < Owner ....QXU..]�,—!� ...................... Type of Con � � � Plot Lon ' ' O � � uou; Comple(ted ......................................19 ( / PERMIT — —.. 19 ~T—..7' ..... — —' 'r ' ---------' U .....................� ................. ................................. / ' ....................... ----^^^—^'—'—'—^^----' ^ . ,__'~`,....,____'_'_',,,___'~__~~,,' Approved , ---------------- lA � --------^—.-----^.--.—~..—.....—. - ----------,...—.-------.--...... oIUvi A OFFICIAL INSPECTION,FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART SYSTEM INFORMATION a, Property Address: 107 Clifton Lane Owner: Centerville,MA Date of inspection:Maya Lebedinsky July 30,2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 02 Number of bedrooms(actual): a DESIGN flow based on 310 CMR 15.203 (for example:-110 gpd x a of bedrooms): a 2 v Number,of current residents: e2 Does residence have a garbage grinder(yes or no):_Nu. Is laundr% on a separate sewage system'(yes w no) Alt, [if yes separate inspection required] Laundry system inspected-(yes or no): A4,�y Seasonal use:(yes or no): No Water meter readings, if available(last 2 yearsLsage(gpd)): 62 = 1 cl oo o o, 1(o 5 O I = 02 f(000 pot P o h s , Sump pump(yes or no): No ' Last date of occupancy: 0 C C'j d ; COMMERCIAL/INDUSTRIAL Type of establishment: _ Design flow(based on 310 CMR 15.203): _ _-_gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):— Industrial waste holding tank present(yes'orX( or Non-sanitary waste discharged to the Title 5 Water meter readings, if available: Last date of occupancy/use: .OTHER(describe): GENERAL INFORMATION Pumping Records. Source of information: P,h Was system pumped as part of the inspection(yes or nu): YE s If yes,volume pumped: Boo gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption.systetn _Single cesspool ZOverflow cesspool —Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) ; Innovative/Alternative technology. Attach a copy of the current operation and.maintenance contract(to be obtained from system owner) _Tight tank —Attach a copy of the DEP approval Other(describe):. Approximat 11 e age of all components. date installed(if known)and source of information: 1 Were sewage odors detected when arriving at the site(yes or no):No I Alf Commonwealth of.Massachusetts Title 5 Official Inspection Form y Subsurfa ce Sewage Disposal System Form -Not for Voluntary Assessments 107 Clifton Lane, Centerville` -- -- — M Pro.perty Address ------ - —_-- Katya Rosenzweig -- - - April 6,2010 Owner Owners Name MA 021- 31 State Zip CodeCode Date of Inspection information is 45 Johnswood Road, Roslindale required for every City/Town page. C. Checklist been done..You must indicate"yes" or." Check if the following hav e no" as to each of the following: Yes. No in information'Was provided by the owner, occupant, or Board of Health ® Pumps g . Were any of the system components pumped out in the previous two weeks? ❑ ® received normal flows in the previous two week period? ® Has the system rec art of Have large volumes of water been introduced to the system recently or as p ❑ . ® this inspection? d examined? (If they were not Were as built plans of the system obtained an . ® available note as N/A) Was the facility or dwelling inspected for signs of sewage back up?:_ ® 0 Was the site inspected for signs of break outs Were all system components, excluding the SAS, located on site? ® opened,,.and the.interior of,the tank septic tankmanholes uncovered, op rial of construction, e to Were the p baffles or tees, ma ® . ball 0 f the ❑ condition � inspected for the co ndi dimensions, depth of liquid, depth of sludge and depth of scum. ants if different from owner) provided with Was the facility owner(and occup a disposal systems? ® information on the proper maintenance of subsurface sewage on the site has. The size and location of the:Soil Absorption System`(SAS.) been determined based on: elan at the Board of Health. [] Existing information. For example, a p ` ; ® of the failure criteria related to Part C is at issue Determined in the field (if any 310.CMR 15.302(5)1 �' ❑ approximation of distance is,unacceptable) [ i D. System information Residential Flow Conditions 2 _- � , F: Number of bedrooms (actual): Number of bedrooms(design 220 gpd: DESIGN flow based on=310 CMR 15.203 (for exampleI'll 0 gp d x#of bedrooms): - - I osel Syslam•.Pape 6 of 17 1 ,i Title official Inspection Form.Subsurface Sewage Dlap u t5ins•09108 _ Commonwealth of Massachusetts , j J Title 5 official Inspection Form 'S Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . t M 107 Clifton Lane, Centerville Property Address �. Katya Rosenzweig e Owner Owner's Name information is 45 Johnswood Road,Roslindale` MA 02131 April 6`2010 required for every p page. Cityrrown State Zip Code. Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms ' on the computer, use only the tab 1. Inspector key to move your cursor-do not Troy Williams use the return key. Name of Inspector ° Troy Williams Septic Inspections Company Name ---— 19 Hummel Drive Company Address 4 ream, South Dennis _ MA 02660 1 Cityrrown State Zip Code 5081385-1300 — -- _ S1682 1 Telephone Number License Number ''_ B. Certification ;--t I certify that I have personally inspected the sewage disposal system at this address and thane information reported below is true, accurate and complete as of the time of the inspection. Thoinsp,�tion was performed based on my training and experience in the proper function and maintenances on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system.- Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority A of April 6, 2010^ Inspector's Signatufe Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If.the system is a shared system or has a design flow of 101000 gpd or greater,.the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving,authority. ****This report only describes conditions at the time of.inspection and under the conditions of use at that time. This inspection does not address how the system will perform'in the future under the same or different conditions of use. 15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page.1 of 17 %E rqy� Town of Barnstable Regulatory Services • BAMSPABLE, NAM. - . Thomas F. Geiler,Director ' Building Division '0rF0 Ma+A . Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 50.8-790-6230 January 31, 2013 Katya Rosenzweig 107 Clifton Lane Centerville, Ma. 02632 RE: 107 Clifton Lane,Centerville, Ma. Map: 247 Parcel: 205 Dear Property Owner: This letter is to follow-up on an application submitted to do work at the above referenced - address. Unfortunately,the application can not be approved at this time because of the following: 1) Application appears to contain erroneous information which would render it incomplete. 2) Construction documents show a unit capable for independent living which would create a zoning violation in need of relief from the zoning board of appeals. Applicants must comply with all applicable laws and regulations before a permit will be issued. Respectfully, je auzon Local Inspector Jeffrey.lauzongtow rn n.bastable.ma.us �P� . ` 1°rJ (508) 862-4634 r: PERMIT, PAYMENT_RECEIPT TOWN--OF BARNSTABLE BUILDING DEPARTMENT 200 MAI�:STREET HYANNIS"MA 02601 DATE: 01/14/13 TIME: 09:45 -----------------TOTALS----------------- PERMIT $ PAID 100.00 AMT TENDERED: 100.00 AMT APPLIED: 100.00 CHANGE: .00 APPLICATION NUMBER: 201300288 PAYMENT"METH: CHECK PAYMENT REF: 1454 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map -7 a 66- Parcel Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address _157 44" A Village Owner MAW H)qT YP l2oSaAlY_ -e-I C, 7�uSt-- Address l a'l (f ,i M awtek u i I ke Telephone__ Permit Request /"/N!SlL Anse_ ?�/U Y SWe_ % AQWR )2uh o R a6en1 4"L ( �� binAl ) �i°L� r'-rauni n�� m�A�r�,e-� 1- /� u�4. T Square feet: 1 st floor: existing 1,&4proposed o 2nd floor: existing proposed cs Total new Zoning District Flood Plain Groundwater Overlay Project Valuation _7 Jon.0- Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family W,'- Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: 2"rull ❑ Crawl ❑Walkout ❑ Other Exit (xe(k6Aa Sng1t Wn y Basement Finished Area (sq.ft.) tal 1 Basement Unfinished Area (sq.ft) llel.. Number of Baths: Full: existing i new Half: existing / new / Number of Bedrooms: existing _new w ,..* ` Total Room Count (not including baths): existing j- new First Floor Room Counts C:) Heat Type and Fuel: ❑ Gas alb II LWElectric ❑ Other Central Air: ❑Yes 2'&o Fireplaces: Existing I New Existing wood/coal stove: 9,Yes�C�i'�Qo Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ o� 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 �A+�AR Telephone Number s �8 . S S- " 2 2 8 Addrblss 1_(9 :� C I `W-o rl E�, License # 1 CXr? /V 26 :�iO Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE I / S FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION i FRAME i INSULATION j FIREPLACE i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT _ ASSOCIATION PLAN NO. '- I TOWN OF."BARNSTABLE BUILDING PERMIT APPLICATION Map�-7 d2�� Parcel j , Application # Z 8 Health Division Date Issued Conservation Division: Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address Village (feAJ1'-el-U I �1,2 Owner knTYla RaSoQ%_ y e-1 7TUSLe Address 107 6 1&m A Celutel-u 1 11-_.e. Telephone .509 5-5-5 , g Permit Request 9/_iy8 A h Se err eAj t - i t��i/L> /2`i 1� /�uiu0/-►/ 51ni1t % Stia W Q, 5�n i 1ZM o-Af 0,0-eN fovea- ( sew plrlN ) -rile krawu rit-J 460k - Square feet: 1 st floor: existing 104- proposed o 2nd floor: existing proposed G Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 7 .700.�6 Construction Type'.",1 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. ` � J Dwelling Type: Single Family ®` Two Family,-.❑ Multi-Family (# units) ' '� " -, r N� Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: 5"Full ❑ Crawl ❑Walkout ❑ Other" IF'XI (ZQ(F h-etqn; Srpn= Luall_� Basement Finished Area(sq.ft.) �(.! ``° __Baser>�ent Unfinished A`rt _ a ea (sq:ft) z�t - Nurnber-of Baths: Full: existing I new Half: existing / new / Number of Bedrooms: 7__ existing _new « u Total Room Count (not including baths): existing 5' new First Floor Room Count Heat Type and Fuel: ❑ Gas Ell Oil ErElectric ❑ Other - Central Air: ❑Yes I"No Fireplaces: Existing 1 New Existing wood/coal stove:-U Yes�O'No Detached garage: 0`ex sting❑ 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 ❑f Appeal # Recorded ❑ Commercial ❑Yes ❑ No ;If yes, site plan review # 1 �rf� Current Use `` Proposed Use APPLICANT INFORMATION 'F -- (BUILDER OR HOMEOWNER) f p �U Name 'lA C�') Tele hone Number 2 C/ Address _S C ( License # AAA 0 ?6 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO l SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. j > t°Katya Rosenzweig k y �A& Clifton Ln s . a Centerville, MA 02632, i - Town of Barnstable r x: 200 Main Street Hyannis, MA 02601,; February 11,2013 To who it may concern, 4 . _ �qt , Y - _a . y ' c -' P.. ... � R u t a,,ff{ .LL • e. --.Y. � s2 #^,, �":.Yi L v'�. � .. The intent of.this letter is to clarify,the plans,I,submitted earlier with the application .for a building permit for the basement update 'ofmy, house located on 107f:Gllfton f In, ' Centerville MA 02632. t- Y" j= The headroom of the entrance) mto the left part of the'basement.', is not consistent with current Building Code's`Reg ulations.(see sketch}. ` ,:• h ,. had made an- Inquiry 16BBRS regarding,'obtainingna.building variance° The inspector ,t explained to°-me'that I do-,not need # `apply-•to the board. The only•way to_soive. the P.roblem with"`Code's' regulation::-consistency is to.make"the other entranceY6'6" in the same <hobby;,;room*(see plan): u submitta new plan where I show th"e additional`entrance 6'6' to the "hobby'.'room sand sketch of stainivay with all the appropriate measurements _.* , .•sb � 4 r'F. '§ Ewa '..F v. 041 1 - Sincerely arKatO Rose zwelg qk r � .a .. x,.. - u �Y. ✓ _ is _ M � > ^ rti^' r a ti W k. ` 1y... i L ' u.. 7 _ �, - � t - , { AAA MID 1 LIP ,mow , f !` TOW t r - � _f Oft . , n � . ! '•t _..- _ s , t J i �9iAY so .. :2oil! - :.T'.Syj� .. A Lill to QTTQQ aim. awn b 4 Mp CIA S t � .:... .;: LAM Soil Ad . " i d & •� '.� " . 6 : x��t .,.. ts . :.-' ii 10004 Of y ur -- -.s ..:.e.w. all AM ! 1 LOU �.,:�` r --��G. -�"� .- �rta vim..I �L� �%�.� � �}'�i+d�' a,.,,.���✓�f s� -�7_17TOY MT -_ .. �, � `4> 4s 3 alal Aft AP t A _ :-... _.. y f .., y LT 4Liz 1 ' HY to J ALIT r lit . � t 1 1 } ; { I : .rJ. ..4.d.J M L +4144+1 { JAM - • oil TAIM ! Pill . - 4 1 i 1 0 . i :.'A d.,{,.l,:a= l: t :. ,..a_,:.5w,.1.W:L,S4Ea 1.,:fi_.� t..,x,i�;::dr nV.,. e.h. ; ! ....;}, ;.•.. : • I_J..4 !-1-L....I...I..-. L_J. :_.I._....I.. 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I I I . -- - _ - I : ,1 ' IT i Y-- Jl— �� ^_ - - I..J _ - .1 . 1I, f- _ -IfJr � _ _ -J_�An L . _ I J -1 1 ! I _ _1 __.__I_J_I Ij -_-- .I I -i �-- F-.N- ,- -I —.-=— —.- --- _-- _- ---_ --_- -__=-- -.-_--- -- - — _—J-- - — _-- _-_--_-- - _- — _.- _-. I i-__LIi_.LIII_,IILI._.i�III__,____.,IILI_-. ..LIII-:J�IIIL.-._,.LII!--_.._.,_.IIII!_1 II!._III___!LII__._-J!!II. !III!_,;I--..LILIi-._J-..-III�_ 'ILI.._-!LII.�...;�II_-�i!.--.•lI�-. I!!L.- ,,I!__. __I!_?I� II��:II__�I. ,II..!I!_- LII._..II ;� -1!I�'-...._-:II!I...-__JII..II._L,I!._..1!i,-.'..a!LI__.iI'_-i.!_-:;.I`_I. I I I_I _ I I I !I _ -II--I_I_: _.__ I_L-I J. ! _iI --- II-- - �� .� �.,I_.I_�.�__I ! -� � .�-I I ; ! ; ' ! • ; I , : ; , I , I ' I ; , : , ! ! I , ; I, U-012- � � -(- I S { Katya&Max Rosenzweig 107 Clifton Lane Centerville,MA 02632 T 508 957 2928 katya.rosenzweig@gmoil.com February 4, 2013 Jeffrey L. Lauzon Building Inspector Town of Barnstable 200 Main Street Hyannis, MA 02601 Dear Mr. Lauzon, We are in receipt of the communication from-the Barnstable Building Division, dated January 31, 2013, signed by you in which you deny our application for an issuance of building permit for our resi- dential home, located in the village of Centerville, address of 107 Clifton Lane. This letter is a response to the aforementioned denial. We humbly ask you to consider our request again, as we believe that our intentions were not presented clearly in the initial application.,We be- lieve that our project, though small in scale will benefit both the artistic and the economic interests of our community. Respectfully, we disagree with your decision as written in part 2 of the aforementioned letter, which states, " Construction documents show`a unit capable of independent living, which would create a zonig vio- lation We beliee this to be the main reason for denial of the requested building permit. Therefore we are resumbmitting updated constructions plans, attached to this document. We ask you to reconsider your decision, taking into account the foregoing facts: r 1:Our propery of 107 Clifton Lane, Barnstable MA is, small 1154 sq 2 bedroom home, is structurely incapable of supporting of 2 family dwelling unit. - 2. The propery has always been a residential one family dwelling space and has never been used for any other purpose that one which is permitted under zoning laws. 3. The intent of the project we propose is chiefly winterization of the existing structures to achieve better energy conservation and protection from wild life, vermin, and more harsher weather condi- tions, whose prevalance and re-occurency frequency and is now becoming more and more evident each year around Cape Cod. Therefore we require instillation of insulation, repair of windows and modification of existing egress for better protection from nature. 4. Concomintantly, we are also hoping to update the already existing basement living space to better suit our daily living needs. The quality of the small ground floor living space necessitates creation of more storage space. We also would like to modify already existing plumbing in the l r aundry area to support a shower and a toilet. 5. Katya Rosenzweig's hobby is a creative photography. She requires a dark room, and small modifi- cations with the light spaces, and flooring in order for her-to create her award winning instillations. She is member of the Barnstable Art Association, a retired art teacher, with many years of contrub- tions to the community. We therefore ask you for redress. We sincerely value yout time, and hope you will grant our small project the necessary building permits. We are always available for further clafication by either emial, phone or in person to answer any and all questions. Thank you for your promt attention in considera- tion of this matter. Sincerely yours, Katya & Max Rosenzweig Page 2 t fit' e ILA V 11� r� �. ---aft. o as o Ll i I r � . pp :vo SIR 1. 9` t ap C ` + INN 1 re ON N . e - ,� �' 1� —� c �a �-�-� ` � � 4l -—, .� 0 os a ) S,< . ,�,' ,.� �' .� c T , , W /' - . --- �� � I �- ��� � � � � � � © � �� . �. �} �; �� ,� � �� .�, - t _ r � � o ..� o (� ._. _ � �--- � '-� TZ ti ro .�41 ILA 01 a l� O s � T I. c 1 i t; ri VA �` �' �° Via. • ��� x` C^lan�vrw• .aye-s-r `.s.f'. .. - LA jL I I OD i i� l T i Ilk I Qp 1 600 Washrn A Street > - . Bostarz MA 02X11;, w www.mass gnldia Workers'.ComP ensation-insurance Affidavit Builders/Contractors/Elecfridans/Piumbers Applicant imforrnadon Please Print Le iblY Name(Business/Organrzation/Individual) �► Y pt .� w l � .Address:' City/State/Zip: � Z o� Phone Are you an employer? Check the appropriate'bog: _T`ppe of protect(requu-ed) 4. I am a'general.contractor and I 1.[] I am a employer with" -: 0 6. .0 New consteuchon .: employees (full and/or part-time).* have hired the ahb-contractors 2:El I am a'sole proprietor orpariner- listed�on the•attached sheet. 7. RORemodeling ship and have no employees These:sub-contractors have •8. .❑Demolition workingfor me in any P, ca acify employees and have wo rkers' .. 9. ❑Building addition [No workers'.comp.insurance .' comp insurance.$ 5. Q:We are a corporation andits ' 10.[��-Plectacalrepairs or additions officersave ex ercised their. 11. lamb' repairs or additions -3. I am a homeowner.doing 01'work .. P myself [No workers' comp right 6f exemption per MGL 12..E Roof repass insurance required]t c:.152, §.1(4),:and we have no . . . .. o workers'. .: e to ees. 13.❑ Ot}ier mP y . L?`T . comp;insurance required_] ` *Any applicant that checks box#1 mnst also fill out the section below showing their workers'eompensation.pohcy mformahon t Homeowners who subnut this affidavit indicating fhey 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 naive of the sub-contractors and state whether or not those entities have employees. If the sub-contactors have employees,they must provide their workers'conrp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and joh.site ' information. _ 3 Insurance Company Name: Policy#or Self-ins.Lic.# Expiration Date. Job Site Address: . : r 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 ri-,.r d.tmder Section25A of MGL c..152.can lead to the.imposition of criminal penalties of a fine tip 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification.F I do hereby certify and r ains•and penalties of perjury that the`reformation provided above is true and correct 1 Si afore: Date a a' j Z j Phone 4- 5b Official use only. Do not write in this area,to be comp fete d by-cily.or town olciaL '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. Phase# ;. . 3 • N i Massachusetts CGeneralLaws chapter 152 requires all.-employers to provide workers'compensandn:for ir employees' P snant to this statate;.an employee is.defined as".:.every person' the service of another under any contract of Lure, express or implied,oral'or written:" An employer is defined as:"an individual,'partnership,association,corporation or other legal entity,or any :or more of rite foregoing engaged?p,a jo�fir nteipnse,and inchiaIng ttie�legal.regresentahves.of a.deceased employe-;or the. ---- o_ .x_; --However - - — recmver or tmgtee'of in midiVidfi4 partngslvp,assaciaMxt or'c/ther egad a iily,emp oyiWC ogees. . owner.of a dwelling house having not more than three apartmenfs and who resides""rein, or theccupanof the t dwelling house of another who employs pegs t�do mazntenabees cbnsnnctton orFrepairvoi2c on sua h tipieIl7ugrhouse y or on the grounds or bvbldntg a�purfenant d`shadl�not be, azise of sack employment be deemed to be anloer." t MGL chapter 152,.§25C(6)also states that"every stare or Local Licensing agency shaII ePithhold the issuance or renewal of.a license orp.ermit to'operate a business or to:constrngt buildings in the coniimonwealth for any app4cant who.has notprodneed-acceptable evidence of compliance with fhe.insnrance coverage required:" Additionally,"MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall emter.into anyconfract for-the periomlance of public work until-acceptable evidence of compliance with the in.�_nce requirements of this chapter have been presented'to the contracting authority." 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),addresses) 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 ihis 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 compan_im 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 D epartment has provided a space at the bottom of the affidavit for you to fill out:in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number.In addition,an applicant that must submit multiple pemmit/license applications in any.given year,need only submit one affidavit indicating cui ent policy inforrnation(if necessary)and under"Job Site Address"the applicant should write.,"all•locaiions in � (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for fature 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 fo 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 j The•Office.of Investigations would like to thank you m advance for your cooperation and should you have any questionfis, please do not hesitate to gives a Callw ` The Department's address,,telephone-and fax number: - h! ,,Commuu `W of Massarh t+�, : .. ..., ,rk� a _•._d + 1-�' yam+4�.i . l�Qpar�latMt Of tnk�q. 'al A G�xdmtf OM- CP of luv�t.pmft is.' �fkf ashiagta i B.o�tbn, MA€2111 7d.# f 1`�•-727-4%0 ext 406 of 1.- -I SA Fax#617--'�27-' 74 Revised 11-22-06 The Commonwealth of Massachusetts : Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,AM 02111 ` www.mass gov/dia .Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Le gib Name vain / ganizatio dividual):. I�d1. l Address: /0 / co), t-it i City/State/Zip: Phone.#: Are you an employer?Check the appropriate ox: 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 stab-contractors 6. ❑New construction . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet 7. �{emodeling ship and have no employees These sub-contractors have "g, Demolition working for me in any capacity: employees and have workers' co insurance. 9. ❑Building addition [No workers comp.insurance comp. required.] 5. ❑ We are a corporation.and its 10:❑Electrical repairs or additions officers have exercised their. 11. Plumbing repairs or additions . 3.❑ I am a homeowner doing all�work ❑ • g P myself- [No workers' corop. right df exemption per MGL . 12.❑Roof repairs insurance required.]t c:152, §1(4),and we have no employees.[No workers 13.❑ Other comp.insurance required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 'I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: Policy#or Self-ins,Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page*(showing the policy number and expiration date). Failure.to secure coverage as required undei 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I�do hereby ce a pain and penalties of perjury that the information provided above is true and correct VSignatore: Date: �f Phone#' Official use only. Do not write in this.area,tb be completed by city or town official. City or Town: Permit/Ucense# Issuing Authority(circle one): ; .1_Board of Health 2.Building Department 3. Citygown Clerk 4.Electrical Inspector 5:Plumbing Inspector 6. Other Contact.Person: Phone#: . i f Katya Rosenzweig 107 Clifton Lane Centerville,MA 02632 T 508 957 2928 katya.rosenzweig@gmail.com f February 3,2013 Town of Barnstable Building Department 200 Main Street Hyannis; MA 02601 To who it may concern: This. letter is a response to the communication from the Barnstable Building Division, dated January 31,2013,informing me of the denial of an application for an issuance of building permit. I am the owner of the single family residential home,located in the village of Centerville,address of 107 Clifton Lane. j The intent of this.letter is to offer an explanation for my plans to winterize and remodel the basement of my home.This house is a small one family 2 bedroom house (1154 sf) on the corner lot. I did not engage in any repairs inside the house since the original purchase in 2004. At no point had I any intent to build. an apartment in the basement.My plan is to winterize the basement, fix broken windows, and install 'insulation to conserve energy.The.absence of proper insulation attracted mice and small animals,especially in the winter time.I would like to do some remodeling and updating: to add a shower and toilet in laundry room and install two closets,due to the lack of storage space on the main level. My hobby is creative .photography. For this purpose I need increased storage for my equipment and counter space and proper lighting to engage in my work. I am an artist and a member Barnstable Art Association. Sincerely, Katya Rosenzweig'. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ' Boston,MA 0211I ` - www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):. I`,om(61) hhe-a-ea6f Address: City/State/Zip-.-O�3 Vr4-k.mcuL-,- . (594nC Phone.#: Are you an employer?Check the appropriate bog: ; Type of project(required):. 1.❑ I am a employer with 4. I am a general contractor and I * have hired the sub-contractors 6. ❑.New construction i �employees(full and/or part time): . 2. a`sole proprietor or partner- listed on the-attached sheet': 7. n Remodeling ship and have no.employees These sub-contractors have '8. Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition ' [No workers' comp.insurance comp.insurance.#' required.] 5. We are a corporation and its 10.E Electrical repairs or additions '3.❑ I am a homeowner doing all-work officers have exercised their ' 11:❑Plumbing repairs or additions.. • myself [No workers'comp. right of exemption per MGL . 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.El Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section belowshowing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 'I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site. information Insurance Company Name: Policy#or Self-ins.Lic.#: . Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be.advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification I do-hereby certify icnd r the pains a d penalties of perjury that the information provided above is true and correct Signature Date: Q�. J Phone# Offlcial use only. Do not write in this area,to be.completed by city or town official.. 'City or Town: Permit/License# ` Issuing Authority(circle one): .1.Board of Health 2,Building Department.3.City/Town Clerk 4.Electrical Inspector,5.Plumbing Inspector 6. Other Contact,Person: Phone#: ' �11 FIN pmv t , . clit c (ZIP ,Ilk I I c 0 r ' OE■ON<■Iti■ ■i�A���■■� wti �■■I■■'■■nl■ ■■��■■■■■1�■■■■■vrll�■r■■�■■■■■■■■w■ ..SOME■■ SEMEN SUMMERS■soon:... �.■sMEN■M■ MEMO .■Ci, /CaiiGi..io ■■ r►\y■ ■■NEB■■a■ MOSS■ a i ■MEN OM■■E NEON OEM ■.MOMS. 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I 1 I . I. I. i .� I I I I I ( ..I. I I I -I r'Y 1 'I .� , -� j 1 I yi I I '.I I I I I , I 1 4, I I i I .'1 I �, I. I' I I I I ;I I i I i ' I 1 I I. I I I 1,!rl. � T ram, Tom of Barnstable Regulatory Services * aaxxsresr$ .R Thomas F.Geiler,Director.. mass $pjFD MA't Aye BuRding DivisioII .. y Tom Perry,Building Commissioner 200.Main Street, Hyannis;MA 02601 www.town.barnstable.ma.us Office: 508-862-4.03 8. Fax: 508 790 6230 . O HME• OWNER LICENSE EXEMPTION Please Print .: DATE: JOB LOCATION: number ' Stith. village iD ..HOMEOWNER" � ► �I t ` / s name J� `\ home phone# work phone# . CURRENT MAILING ADDRESS: 1 city/town state ,zip code The current exemption for"homeowners"was extended to include owner-ocoupie`d dvelliirsf©£,'siS tsE'or T;s5� nd "? ; 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 r 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 aon a fdrm acceptable to the Building�Ofiicial;that e/she.,shall be responsible for all such' o lje rmed under-the A' 'ijiei'mit. (Sechon:109.'l )t , 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 mspec on ores and requirements and that he/she will comply with said procedures,and requireme Signature of Homeown 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 perforining work for which a building permit is required sfiZj a�gixetijpt{f m he provts of thrs.section(Section 109.1,1 -Licensing of construction Supervisors);_provided that if the homeowner engaies a person(,,)"8riii',9,to4 such° ' l `�° work,that such Homeowner shall act as supervisor "z i 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 t- Supervisor. The homeowner acting as Supervisor is ultimately responsible. ; t n- +. .'ice .1 ti 3 : To ensure that the homeowner is fully aware of his/her responsrbilities,many communitiesyeguire,as part of the pe it application;1 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 severaLtowns. You may care tamend'and adopt such a form/certification for use ip your community.. Q forms:homeexempt TovcTn of Barnstable Regulatory°Services'. RAWWABIA Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862 4038 Fax: 508-790-6230 ,. Property Owner Must Complete and Sign This Section If Using A Builder Ar as O et of the su bject pr operty hereby authorize reo, 14CA to act on my behalf, in all matters relative to work a o=' ed by this b ding permit' Oz6 ( ddre f Jo ): Pool fences and alarms re the r ponsibility of the applicant. Pools are.not to be filled or u ` ' ed before fe ce is installed and: all final inspections are perfor d and accepte ignature of Owner Signature of Ap cant i/a4hA Wei Print Name Print Name bat ' QTORMS:OWNERPERMISSIONPOOLS 6/2012 EMAS1S�ACHFUS�ETTS / ,/� . . m •. .. - - :. .:ilia � ��f� ����N Hf ! ., a'ii:.1 - . '10`21 20 `0 NONE// r 1 1 -.aw!r t5 3 2� fi class 6 2 nEshl�' ts\sec f e2 5•�15�� a rr auL 'IB'�iO ry 4� /2 — - rr a 45 JOHN$WOOD ROAD �1 -� /�"'�4_ ,ROSLJNDALE MA 02131 374� 7 � f �a -17 //5 oo tazi•m+o wvai t�000 /,r / r Q b a b - 0 v�" - r+- r0 va o r'cn rt - LN — ' 1 77 AP It Lo '.;r. N- .. t ; M rrr ^ i , _ •