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Town of Barnstable
Expires 6 months from issue date
Regulatory Services FeeS'- D
tares. Thomas F.Geller,Director
' Building Division S S PERMIT
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601 MAY _ 1 2007
www.town.barnstablema.us
Offiice: 508-862-4038 TOlI �-
EXPRESS PERbIIT APPLICATION - RESIDENTIAL ONLY Q�,`-f 7-0 Z Z-
Not Valid without Red X-Press Imprint
Map/parcel Number �`'ol` (P3���te 1-
Property Address
Residential Value of Work 1--7 6 4 Minimum fee of$25.00 for work under S6000.00
Owner's Name&Address es S � �0 ,V
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
I am the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
M,Ze-roof(stripping old shingles) All construction debris will be taken to wkt,54- P�GSRer;,S
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows. U Value (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,ie.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
Home Improv ent ntractors License is required.
SIGNATURE:
Q:Fornrs expn&g
Revise071405
Town of Barnstable
yP�pF 1HE Tp��o�
Regulatory Services
* BAANS'rA'oLE,
Thomas F.Geiler,Director
6 g �� 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
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: I
JOB LOCATION: 319� ��� CC14��i��`1 f4l C e )/ e
number street o village
"HOMEOWNER": V I(I� C
name �7 f hoypee phone# work phone#
CURRENT MAR INO ADDRESS: lQ'll`9 4 L,),L
C�� �lll M,�-
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 undersign "homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum ingbecti n proc,dares and requirements and that he/she will comply with said procedures and
re uif!emen .
gnature of Ho er
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control. .
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors),-provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner,shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly .
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:forms:homeexempt
e Commonwealth ofMassachusetts
Department of Industrial Accidents
Office.of Investigations
' 600 Washington Street
Boston,MA 02111 .
,�• www mass•gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
lZSlne (Business/Organization/Individual)" k ),A L4 9z
Address:
City/State/Zip: ..cealall& �� - Phone#:_ (�d ? e 0
Lre you an employer? Check the-appropriate box:. Type of project(required):-
0 I am a employer with 4. ❑ I am a general contractor and I
6. El New construction
employees(full and/or part time).* have hired the sub-contractors❑ I am a sole proprietor or partner- listed on the attached sheet:1 7. Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp.insurance. g, ❑ Building addition
[No workers' comp. insurance 5. ❑ We area corporation and its
required.] officers have exercised their
10.0 Electrical repairs or.additions
I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
yself.-[No workers' comp.- c.152,§1(4), and we have no. 12.❑ Roof repairs
insurance required.]t employees. [No workers,- 13.❑ Other
comp.incnran�required.]
ny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: N
iomeowners.who submitthis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
mtracton;that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. .
rm an employer that is providing workers compensation insurance for my employees.'Below is the policy and job site
Formation.
Durance-Company Name:
licy#or Self-ins.Lic..#: Expiration Date:
b Site Address: City/State/Zip:
tach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
lure to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
e 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 fm' e
up to$250.00 a day against the violator. Be advised that a copy of this statement may forwarded to the Office of
iestigations of the DIA for insurance coverage verification.
'o hereby certify punre pains tdpenafties of perjury that the information provided above is true and correct
attire:. Date:
one#:.
Official use only. Do not write in this area,to be completed by city.or town official
City or Town: PermitiLicense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#•
Information and Instructions
iassachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
ar;naut to this tatate, an employee is defined as"...every person in the service of another under any contract of hire,
Kpress or impli -,oral or written."
« artners., , association, corporation or other legal entity,or any io or more
,n employer is de as,:_an individua],.p P : :: .
f he foregoing engag in a joint enterprise, and including the legal representatives of a deceased employ;or the
ec.eiver or trustee of an dividual,Partnership,association or other legal entity,employing employees.,I3owevier:
v�ner of a dwelling house ving not more than three apartments and who resides therein, or the oc pant of the
welling house of another wh employs persons to do maintenance, construction or repair work, such dwellin ouse
,r on the grounds or building ap nant thereto shall not because of such employment be deemed to be an a oyer."
AGL chapter 152, §25C(6)also stat that"every state or local licensing agency shall wit hold the iss ce or
.en of a license or permit to op ate a business or to construct buildings in the commonweal or any
►pplicant who has not produced acce table evidence-of compliance with the insurance coverag equired.
Additionally,MGL chapter 152, §25C(7) tes"Neither the commonwealth nor any/of its politic divisions shall
;titer into any contract for the performanc of public work until acceptable evidence
comp. with the insurance
-equirements of this chapter have been pres ted to the contracting authority."
kpplicants ;
Please fill out the workers' compensation affida 't completely,by checking'the bo a at apply to your situation and,if
necessary,supply sub-contractors)name(s),addr s(es) and phone numbers) th their certificates) of
insurance. Limited Liability Companies (LLC)or invited Liability Partners ' LP)with no employees other than the
members orpartners; are not required to carry work ' compensation in If an LLC or LLP does have
employees,a policy is required. Be advised that this davit may be sub d to the Department of Industrial
Accidents for confirmation of insurance coverage. Al o be sure to si d date the affidavit. The affidavit should
be returned to the city or town that the application for th permit or ii a is being requested, not the Department of
Industrial Accidents. Should you have any questions reg ding the or if you are required to obtain a workers'
rtment at then er lis elow.. Self-insured companies should enter their
compensation policy,please call the Depa
self-insurance license number on the appropriate line. r
City"Town Officials .
Please be sure that the affidavit is complete and printed le y. a Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office o �vesri lions has to contact you regarding the applicant
Please be sure to fill in the permit/license number whi be us as a reference number. In addition, an applicant
that must submit multiple permit/license applications any given y ,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Si ddress"the icant should write"all locations in (city or
town)."A copy of the-affidavit that has been offici' y stamped or m by the city or town may be provided to the
applicant as proof that-a valid affidavit is-on file f future permits.or k es..Anew affidavit must be filled out.each
year.Where a home owner or citizen is ob '�a license or permit not r ted to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc said person is NOT re. complete this affidavit
The Office*of Investigations would like to you in advance for your coop ation and should you have any questions,
please do not hesitate to give us a call. /
The Department's address,telephone #fax number:
T�/The Commonwealth of Massachusetts .
Department of Industrial Accidents
t Office of Investigations
� e
1i 600 Washington•Street
Boston, MA 02111..
`Tel.#617-727-4900 ext 406 or-1-877-MASSAFE
Fax#617-7274749
evised 5-26.05 www.mass.gov/dia
a
Town of Barnstable Permit: ZA t 0(D
' Regulatory Services Date: 61 l o
I
otrTHE Tod, Thomas F. Geiler, Director
Building Division Fee: J,S
+ BARNSTABLE, « Tom Perry, Building Commissioner Z��l
9
6 �
v� MASS.. $ 200 Main Street, Hyannis, MA 02601
arFo ',�a www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
TOWN OF BARNSTABLE` �� �� ►�
t I
SOLID FUEL STOVE PERMIT
Owner: ( Vy�- Ir Phone: �S_- �� /' -2--XOG C'�I I
Install at: ���- dj G-r' Village: �I
Map/Parcel: Date:
Stove u
A. New/ U ed $EP 2 7 REC'D
B. Type: adia /Circulating
C. Manufacturer: Lab. No.
D. Model No.:
Chimney
A. New/ Existing (If existing, please note date of last cleaning) 1d)o
B. Flue Size i
C. Are other appliances attached to Flue?
D. Pre-fab Type and Manufacturer
E. Masonry: Lined/Unlined
Hearth ,
A. Materials: R l Cst
B. Sub Floor Construction:
Installer
Name: Address:
Phone:
Location of Installation:
H.I.0 Registration #
Construction Supervisor#
OR check c�Homeowner Installing, no license required
APPLICANTS SIGN TURE ��
APPROVED BY:
Please make checks payable to the Town of Barnstable
*This constitutes an of stove permit after inspection, photographed, and approved by the
Building Inspector
Q:forms:stove
Rev 103107
I
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f)rC'DS SE kRED FLU An aE �n�✓
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1 The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
+ a 600 Washington Street
Boston,MA 02111
'�k ,�• wtvw.mass.gov/dia '
Workers'Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): .
Address:
City/State/Zip: CeAWl Phone.#:
Are you an employer? Check the appropriate box: .Type of project(required):.
4. I am a general contractor and I
1.❑ I am a employer with � 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'attach ed sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g. Demolition
employees and have workers'
�torking for me in any capacity. t. 9, []Building addition
[No workers' comp.insurance comp, insurance.
required.]
5. [] We are a corporation and its 10.❑Electrical repairs or additions
'3�I am a homeowner doing all work. . officers have exercised their I LEI Plumbing repairs or additions
myself.[No workers'comp. right 6f exemption per MGL 12,0 Roof repairs
insurance re aired t c. 152, §1(4), and we have no
q ] employees. [No workers' 13 Other Ly�Q_
comp,insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowoers.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such,
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have
employees. If the sub-contractors have employees,they must providB 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 MA for insurance coverage verification.
I do hereby certify under a pains ttnd penalties of perjury that the information provided above is true and correct.
Date; �" ' W
Si ature: q —
Phone#: 2&6
Official use only. Do not write in this area, to be completed by.city or town official
City or Town, Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector
6. Other
Contact Person: Phone#:
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual,partnership,association, corporation,;or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
F
also states that"every state or local licensing gency shall withhold the issuance or
IvIGL chapter 152, §25C(6\
renewal of a license or perr it to*operate a business or to construct but dings in the commonwealth for any
applicant who has not pro.du a -acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL ehapter..152,°§` C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for.the perfo ce of public work until acceptab a evidence of�compliance with the insurance
requirements of this chapter have been resented to the contracting authoty."
\ i
i
Applicants ))
Please fill out the workers'compensation davit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contiactor(s)name(s),�ddress(es)and phone numbers) along with their certificate(s)of
insurance. Limited Liability Companies.(LLQ or Limited Liability P erships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensatio r insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this\affidavit may 4 submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. \',\be sure tal/sign and date the affidavit. The affidavit should
be returned to the city or town that the application for ttEe permit.oy license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law law or if you are required to obtain a workers'
compensation policy,please call the Department at the number 1d ted below. Self-insured companies should enter their
self-insurance license number on the appropriate-line.
City or Town Officials
Please be sure that the affidavit is complete'and printed legibly. Tlhie�Depaitnient 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 P ermit(license number which will be used as efererlce number. In addition,an applicant
that must.submit multiple permit(license applications in y given year,need only submit one affidavit indicating current
policy information(if necessary)and unifier"Job Site Ac ess"the applicanNshould write"all-locations in (city'or
town)."A copy of the affidavit that has been officially stamped or marked b`y` e city or town may be provided to the
applicant as proof.that a valid affidavit is on file for future permits or licenses , new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a�license or permit not related`,t any business or commercial venture
(i.e. a dog license or permit to burn leaves-etc.)sL6 person is NOT required to co lete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation d should you have any questions,
please'do not hesitate to give us a call. �f L
The Department's address,telephone-and fax number:.
biCom onwc—,alth of Mmsarhusetts
epazxz�nt ofndial A.ecidets '
Office of Imes# galtons
600 Washington Streot \
B•Won;.ALA 02111 =
Tell.,#f 17-727-4900 ext 406 car 1-877-MASSAFE
Revised 11-22-06 Fax#617-727-7749
www.inass.gov/dia
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--.- ._... .._. .._..... ......._ ......... ......... ............ ......._. ........ .- _ .... _._.-.....__.
Q. Who is responsible for making application for the
_ .
erm it?
Application for a permit is required to be made by-the owner or lessee or
their agent of the building (e.g.; the HIC registrant ). If application is made
other than by the owner, written authorization of the owner must
accompany the application. Such written authorization shall be signed by
the owner and shall include a statement of ownership and shall identify the
owner's authorized agent, or shall grant permission to the lessee..to apply
for the permit. The full names and addresses of the owner, lessee,
applicant and the responsible officers, if the owner or lessee is a corporate
body, shall be stated in the application:
Please note: It is the responsibility of the registered HIC to obtain all
permits necessary for work covered by the Home Improvement
Contractor Registration Law, M.G.L. c. 142A. An owner who secures
his or her own permits for such shall be excluded from the guaranty fund
provisions as defined in M.G.L. c. 142A..
Back to Top
Q. My contractor told me'l need to obtain the permits for:
my construction. May I obtain the�relevant permits from
- ---
my local building department, or is the c .
..
required to do that?
While you may certainly obtain your own permits, be aware that if you do,
you will fall into a homeowner exemption that will disqualify you from being
eligible to receive recourse through M.G.L-c. 142A, the HIC Law, or the
statutorily authorized-Guaranty Fund, should a problem arise. It is the
responsibility of the registered HIC to obtain all permits necessary for work
covered by the Home Improvement Contractor Registration Law M.G.L. c.
142A. If the HIC you are contracting with refuses, you may wish to
reconsider using that contractor's services:
,
Town of Barnstable
ti
Regulatory Services
BABNSTABLE. Thomas F. Geiler,Director
�f0.190. Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us I
Office: 508-862-4038 f'' Fax: 508-790-6230
Property Owne ust
Complete and Sig his Section
If Usinguilder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work aut rized by this building permit application for.
(Address f Job)
Signature of Owner Date
t
Print Name
If Property, Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
4
Q:FORMS:OWNERPERMISSION
r�,,
Town of Barnstable
oFt�
Regulatory Services
xAxxs7As . ; Thomas F.Geiler,Director
MASK.
9�A 1639. p,�� Building Division
rfD MA'I Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: �� l D
J&JOB LOCATION: r�_s 6 `-'
inumber street / ( / village C�
"HOMEOWNER": J�I Ca I�6 � ���P� 2�o S '23)— ?—
name home phone# work phone#
CURRENT MAILING ADDRESS: DG Cp I I Cr-e S+
city/town stat 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.
Sign re o Ho eowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:\WPFILES\FORM S\homeexempt.DOC
I
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Town ®f Barnstable permit: aao SSt�
Regulatory Services Date
ZHE r
woe oh, Thomas F.Geiler, Director _
Fee: r�S
Building Division
BARNSTABLE, Tom Perry, .Building Commissioner
Y MASS.
1639. 200 Main Street, Hyannis, MA 02601
°reo .tA www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
TOWN OF BARNSTABLE /0
SOLID FUEL STOVE PERMIT
56
Owner: JiM \4 ( n� Phone:
Install at: Village:
Map/Parcel: Dat G�
Stove
A. New/" s '
B. Type: RadiantRIC' n1ting
C. Manufacturer: ab. No.
D. Model No.:
Chimney
A. New/Existing (If exists g plea not date of'last cleaning) 6�
B. Flue Size 3Xl
C. Are other appliances atta ed to lue? IU
D. Pre-fab Type arid Manufa r
1 . Masonry: Lined/Unlined •
Hearth �' V
A. Materials: Fl B. Sub Floor Construction:
Installer
Name: Address:
Phone:
Location of Installation:
H.I.0 Registration #
Construction S ervisor#
OR-cheek. V Homeowner Installin c n reduir d
APPLICANTS SIGNATURE.
4� U
APPROVED BY:
Please make checks payable to the Town of Barnstable
*This constitutes an official stove permit after inspection, photographed, and approved by the
Building Inspector
Q:forms:stove
Rcv 103107
ti TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel a ,� � ,�� Permit#
Health Division �4-`�9 �S� � Y��'�,�,, Date Issued
Conservation Division 0- ��V/�® ` //T ®LPL
Tax Collector F , 1rowAf r, �® s CZ11
Treasurer
Plannin .Dep t.
9., ; . a;
Date Definitive Plan Approved by Planning Board r
Historic=OKH Preservation/Hyannis
Project Street Address `3 f y 0ce 6f,+161/yC CC We,4,0
Village I-I NY,0AW1 s J9,0
Owner ZI-XIA e ZAWj-ar,� "tr Address 382, veO 4&A/e-111 C. A
Telephone
Permit Request 161X 1-2- /4-11- Ale 4,ejY�n vt
y= ,
Square feet: 1 st floor:existing proposed 35`Ij�fe2nd floor:existing proposed Total new
Estimated Project Cost /6, 00 r Zoning District Flood Plain, C, Groundwater Overlay.
l Construction Type , f
Lot Size d'y ` Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family a Two Family 0 Multi-Family(#units)
Age of Existing Structure i' Historic House: ❑,Yes. LAo On Old King's Highway: ❑Yes JNo
Basement Type: ❑Full 0 Crawl ❑Walkout ❑Other
�\Basement Finished Area(sq.ft.) Basement Unfinished Area'(sq.ft)
Number of Baths: Full: existing new Half:existing new
Number of Bedrooms: existing new -
Total Room Count(not including baths):existing new First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑Electric Q Other
Central Air: ❑Yes ❑No Fireplaces: Existing New Existing
wood/coal stove. ❑Yes O No
Detached garage:O existing G(new size 1,0 - Pool:Q existing O new size "Barn:Q existing ❑new size
Attached garage:O existing O new size Shed:0 existing 0 new size Other:
Zoning Board of Appeals Authorization ZAppeal# /?M-= 44 R zr°") Recorded R(
Commercial ❑Yes ❑No If yes,`site plan review#
Current Use Proposed Use
• BUILDER INFORMATION
Name Telephone Number
Address '311 License# 0
��iO �'v✓�7 Home Improvement Contractor#.
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO -ct r,90 /zeZYre 1L)e �c�J
SIGNATURE DATE
r FOR OFFICIAL USE ONLY ;r
n PERMIT.NO.
DATE ISSUED
MAP/PARCEL NO.' •{ rt ' r. - _~ ^ - - !
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` DATE CLOSED.OUT
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Town of Barnstable
Zoning.Board of Appeals
Decision and Notice
Appeal Number 1998-108-Larson
Variance to Section 34.1(5)-Bulk Regulations
Summary: Granted with Conditions
Petitioner. Einar H.Larson
Property Address: 382 Old Craigville Road,Centerville
Assessor's Map/Parcel: Map 247,Parcel 022
Area: 0.19 acre
Building Area: 1,451 sq.ft.
Zoning: RB Residential B Zoning District
Groundwater Overlay: GP Groundwater Protection District
Background:
The property that is the subject of this appeal consists of a 0.19 acre lot in the village of Centerville and is
commonly addressed as 382 Old Craigville Road. It is improved with a one-story, 1,451 sq. ft. single-family
residence. The lots in this area of town are small, averaging about the same size as the subject lot
The property is located in a RB.Resident!al B Zoning:Districtwhich'requires a minimum 20 footfront.yard, 10
foot side yard and 10 foot rear yard setback. The applicant is proposing to construct a detached garage on _
the property which would encroach into the minimum required side and rear yard setbacks. The applicant
has stated that there is no other room available on the property for a detached garage due to the small size of
the lot. There is an existing shed on the rear of the property which the applicant intends to remove if the
requested relief is granted.
The applicant is seeking a Variance to Section 3-1.1(5) Bulk Regulations, in order to allow a detached garage
to encroach into the minimum side and rear yards required on this site. At this point in time, the applicant has
not submitted a site plan of the proposed garage. The degree of encroachment into required setbacks is,
therefore, not yet known. Staff suggests the applicant submit a site plan showing where the proposed garage
will be located and how far(in feet) it will be from property lines.
Procedural Summary:
This appeal was filed at the Town Clerk's Office and at the Office of the Zoning Board of Appeals on August
3, 1998. A 60 day extension of time for holding the hearing and for filing of the decision was executed
between the applicant and the Board Chairman. A public hearing before the Zoning Board of Appeals was
duly advertised and notices sent to all abutters in accordance with MGL Chapter 40A. The hearing was
opened September 23, 1998, at which time the Board granted the request with conditions.
Hearing Summary:
Board Members hearing this appeal were Ron Jansson, Gail Nightingale, Richard Boy, David Rice, and
Chairman Emmett Glynn. Ed Gardner represented the applicant, Einar Larson, who was present.
Mr. Gardner indicated the Larsons have lived at this location for 23 years and would like to build a detached
one-car garage. The lot is small and the applicant is seeking relief from the side yard setback in order to
build a 16x22 one-story garage. This is the only place the garage can be located. Mr. Gardner
demonstrated a number of proposals showing different placements of the garage on the lot but due to the
topography, three very large trees, the location of the septic system, the leeching field, and the shape of the
lot,this is the only feasible place to locate the garage. If the garage is moved sideways, they would need
relief from both the side and rear yard setbacks. If the garage is moved forward, the roof lines would not
1 :mac 1 :3 P I___e 19 8 21.8 2 Ll.
Town of Barnstable-Zoning Board of Appeals-Decision and Notice
Appeal Number 1998-108-Larson
Variance to Section 3-1.1(5)-Bulk Regulations
match. These are all unique Variance conditions that affect the locus but not the zoning district in which is it
located.
Public Comments: No one spoke in favor or in opposition to this appeal.
Findings of Fact:
At the Hearing of September 23, 1998,the Board unanimously found the following findings of fact as related
to Appeal No. 1998-108:
1. The petitioner is Einar H. Larson. The property in issue is 382 Old Craigville Road, Centerville, MA as
shown on Assessor's Map 247, Parcel 022, and located in the RB Residential B Zoning District and the
GP Groundwater Protection Overlay District.
2. The applicant is seeking a Variance to Section 3-1.1(5) Bulk Regulations, in order to allow a detached
garage to encroach into the minimum side yard setbacks required on this site.
3. Due to the topography of the lot, three very large trees which would have to be removed, the location of
the septic system and.the leeching field, and the different roof lines, this is the only feasible place to
locate this one-car, one story garage.
4. These are all unique Variance Conditions pursuant to MGL Chapter 40A, Section 10 that affect the locus
by not the zoning district in which is it located. '
5. A literal enforcement of the provisions of the Zoning Ordinance would involve substantial hardship,
financial or otherwise to the petitioner.
6. The relief may be granted without substantial detriment to the public good and without nullifying or
substantially derogating from the intent or purpose of the Zoning Ordinance.
Decision: -
Based upon the findings a motion was duly made and seconded to grant the Applicant the relief being sought
with the following terms and conditions:
1. The 16 x 22 one-car garage is to be built, and sited on the lot, in accordance with the plan submitted with
this appeal entitled"Plot plan of land located in Centerville, MA prepared for Einar Larson, dated July 21,
1998" as prepared by Yankee Survey Consultants.
2. The garage is to be one story only.
The Vote was as follows:
AYE: Gail Nightingale, Ron Jansson, Richard Boy,'David Rice, and Chairman Emmett Glynn
NAY: None
Order:
Variance Number 1998-108 has been granted with conditions.
This decision must be recorded at the Registry of Deeds for it to be in effect. The relief authorized by this
decision must be exercised in one year.
Appe Is of this decision, if,any, shall be made pursuant to MGL Chapter 40A, Section 17,within twenty(20)
day after the date of filing of this decision. A copy of which must be filed in the office of the Town Cleric.
b — 1998
Emmett Glynn, Chairman Date Signed
I Linda Hutchenrider, Clerk of the Town of Barnstable, Barnstable Co4rity, MaaacIjus&fts,$044y,certify that
twenty(20)days have elapsed since the Zoning Board of Appeals filed th.19' ecisiprr,and tha'fra appeal of the
decision has been filed in the offices of the Town rk.
Signed and sealed this day of 98 Lind ains`arid=per')altie of perjury.
Linda Hutchenridtr, ToWli ler =�o
2
9/2/98
mapper ZBAno shortno owner1 owned addr city state z1
247012 No. 1998 108 CYKER,JANKEL&SIMA P 6—box 816 W HYANNISPORT MA 02672
247021 No. 1998 108 FALLON JOSEPH F JR FALLON BARBARA 528 WINTER ST FRAMINGHAM MA 01701
247013 No. 1998 108 MIKUTOWICZ,JOHN F&GEORGE 30 ECHO RD MASHPEE MA 02644
247020 lNo. 1998 108 MELLO ROGER A&DONNA M %POZZI ELEANOR A 684 WASHINGTON ST HOLUSTON MA 01746
247014002 No. 1998 108 CAIN,MAURA E PO BOX 2011 CENTERVILLE MA 02632
247019 No. 1998 108 GROVER JOAN C 33 OLD CRAIGVILLE RD CENTERVILLE MA 02632
247014001 No. 1998 108 TRAUTMANN PATRICK& TRAUTMANN JOANN DIRICO 78 MAPLE AVE HSTGS-ON-HUDSON NY 110706
247015 No. 1998 108 KERWIN,SUSAN M&STEPHEN A 25 INDEPENDENCE RD BEDFORD MA 101730
247196 No. 1998 108 TIENKEN,CHAS W JR&ANN S&SMI %BERKSHIRE SAVINGS BANK P O BOX 1308 PITTSFIELD MA 01202
247018 No. 1998 108 BUDDINGTON PHILIP O ANITA H BUDDINGTON 334 OLD CRAIGVILLE RD W HYANNISPORT MA 02672
247096002 No. 1998 108 SMITH LAWRENCE E 2 DUSTIN CT MANSFIELD MA 02048
247077 No. 1998 108 NEARHOS MYRTLE E 21 FARM HILL RD W HYANNISPORT MA 02672
247076 No. 1998 108 POHLMAN ROBERT E®INA 97 CRYSTAL AVE STATEN ISLAND NY 10301
247075 No. 1998 108 HOFFMAN,MICHAEL J& LYNCH,CHRISTINE M 40 BENNETT ST APT 3 WAKEFIELD MA 01880
247163 No. 1998 108 MONTEIRO ANTHONY J MONTEIRO,DORIS R 60 FLORENCE ST HUDSON MA 01749
247082 No. 1998 108 SMEDBERG RICHARD N TR& SMEDBERG,BERNICE TR P O BOX 169 W HYANNISPORT MA 02672
247081 No. 1998 108 MCDONOUGH JOSEPH P 236 PROSPECT ST NORWOOD MA 02062
247065 No. 1998 108 BRUSTAS GARY P&NANCY 12 EDWARDS RD WATERTOWN MA 02172
247064 No. 1998 108 KATZ, HARVEY A& MURPHY-KATZ JUNE C 15 MASSASOIT,RD WELLESLEY MA 02181
247063 No. 1998 108 MURPHY,KENNETH B 3 FARM HILL RD BX 191 W HYANNISPORT MA 102672
247062 No. 1998 108 MANNING,JOSEPH H %MANNING,JOSEPH H REV 439 WEST ST BROCKTON MA 102401
247074 No. 1998 108 GLYNN LEONARD M %STATE STREET BANK M-12 225 FRANKLIN ST BOSTON MA 102110
247073 No. 1998 108 LEE,THOMAS F&CECILIA H 13 HARBOR HILLS ROAD CENTERVILLE MA 102632
247072 No. 1998 108 BOHNE,CAROL V 38 HARBOR HILLS ROAD . CENTERVILLE MA 02632
'247071 No. 1998 108 BIRDSALL,DAVID BIRDSALL,JUNE A BOX 47 YORKTOWN HEIGHT NY 10598
247044001 No. 1998 108 BURNS VIRGINIA M&GLYNN LEO %GATELY VIRGINIA M&GATELY, 46 MEAGER AVE MILTON MA 02186
247044002 No. 1998 108 IESSI,VITO&CATHERINE TR — 62 HILLSIDE AVENUE N RWOOD MA 02062
247022 No. 1998 108 LARSON EINAR H 9241 W BROWARD BLVD #3509 PLANTATION FL 33324 el
247023 No. 1998 108 FALLON,BARBARA M PO BOX 821 W HYANNISPORT MA 102672
247024 No. 1998 108 TSOULES EVANS W&IRENE 16 HERBERT RD WORCESTER MA 101602 rT'ti
47025 No. 1998 108 EMPLIT LEON&PATRICIA J P O BOX 126 W HYANNISPORT MA 02672
247026 No. 1998 108 MALLET,GRAHAM P PO BOX 213 W HYANNISPORT MA 02672 - p-L
247008 No. 1998 108 LORD KARL D&JANE E 34 CYPRESS STREET MEDFIELD MA 02052 !j�
247009 No. 1998 108 FULLER,FAY L 96 CLIFTON LANE W HYANNISPORT MA 02672
247194 No. 1998 108 SABATINELLI GUIDO BOX 249 W HYANNISPORT MA 02672
247195 No. 1998 108 SABATINELLI GUIDO P O SOX 249 W HYANNISPORT MA 02672 �!
247205 No. 1998 108 LEBEDINSKY MAYA 47 BETTYS POND RD HYANNIS MA 02601
247153 No. 1998 108 MOLINARI,IRENE I TRS& 9ANDERSON,
ARI,RONALD J 5 MEADOWOOD DRIVE HOLDEN MA 01520 T
247152 No. 1998 108 NASCO,CHARLES F P O BOX 413 W HYANNISPORT MA 02672 (;
247122 No. 1998 108 PAROJINOG,RICHARD G CIA PAROJINOG 127 CLIFTON LANE CENTERVILLE MA 02632 !��!
247121 No. 1998 108 FARRELL ROBERT& LI JACQUELIN 12419 SOUTH HOUSTON TX 77099
247123 No. 1998 108 BURNS,RITA F& MARGUERITE 1 28 SHERWOOD ST DEDHAM MA 102026 !
247119 No. 1998 108 ODONNELL,EDWARD R&CAROLE 171 STRAWBERRY HILL RD CENTERVILLE MA 02632
247120 No. 1998 108 BAKER,SAMUEL&MINNIE P O BOX 250 W HYANNISPORT MA 02672
247206 No. 1998 108 BAKER,SAMUEL&MINNIE TRS SMB CLIFTON LANE REALTY TR PO BOX 250 W HYANNISPORT MA 02672
247010 No. 1998 108 MCGANN DOROTHY E TR %MCGANN,WILLIAM J&WHELAN S 28 HICKORY DR NORTH RAYNHAM MA 02767 r!.�
247208 No. 1998 108 WALKER HAROLD C&MARIANNE 110 CLIFTON LANE CENTERVILLE MA 02632 I LI
247209 No. 1998 108 CHRISTO,JANICE&STEPHEN& IMICHELE,ANGELO&THOMPSON C 93 OSSIPEE RD W SOMERVILLE MA 02144 CC!
Page 3
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Asses _ 1 el 139 Qdeliar yaddressec� Opechee
Rl�ad. `tii`ttri RC Resldgr� p Restrict. _�
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uction of prtdnp requirements r tjuestlnp
a iieduct+onnm the requin:d twenty tparkir gpa¢;7t► ►e q 6:Sp�ea availed and
ft APPIi and site±parking available across Main Street in corrtmem with oiher Users
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Ik R 6 rd ofAM_ fora W.anan;e to Sectiari 3 l l.ls)
epulapans to permit relief from i;f+#d and rlsarsit 1tsCks fgret new gara>�e The pre5ppity
iststt n 6of—M�247 Rti W r=ar>i ra ominorttar SSat)00;$82 Old
MA inan q Ref�cJ�rttial s Zonin RisiriGt
i315 P.M rem Riepod>z' APhQar 1�eriW f9 iQ `
Re 's to the Zwsnp of appeals tw
Special{'emat PNmuent to
g SURC ni,Or Structure Nod used as Sin91e ar.Two-lramily
Llivellinp6,Sestle�i'r�1�t: 1 ExPanVIM 6f it F►res F�isong'N6nsdnfprm rig�uil l rig or iatnrc-
h";Section$11K ditionat ypo in-"*Highway Susin s_Ristiict-and Section s.
3 Special Petr fhe p titionerproposes to ex--nd the existinp r Riego's
Restaurant with i stare feet at On' tlCis€ixi9pri pane to s re:rnpvad and a hew
1 QD squana fit 4 be I�onstructl d,topetherwith pa091010 xpansion.lands;apin
erid other ills i The Is shown on Assessors Map 204 parcels 006 .
fA�73.addres ewohp Map 29+ Pa�Fat 0 �12,addressed 4a pap
a irarGei t>$9 443 addressees as9$4 f 'nau Road
ya ph Hyannis.
qQ eel Number 1998-11 Q_
10itcisftOf the&i11din0 - 1*0 drasdehne3$enalotter
'l cell W li}form yqu that yoin,r€quast for a permit
be d a reasons are that psyFhuthorapy is viewed as
trD ftexp tacftA. eKfnorrriai;householdtiaffic!The
es Map 100.Parcel 030 arid,1p commolily addres;ied as 35
MA in are RQ 1114604 sndal t ZAIi>+�g olstric�
ps
77
> l +mt+er 19 }1 t
H the} es �as R 1116 py e r f tear home n-i
P_ u rs Map t .l neei 03 ;and is eortttngnijr vdttressed as 35
MA in an AMI 6lesrc,gritlei R-1 Zoning District.
.. hell in the Hearing Room,Second Floor tVew Town Hall,367
r � husetts on Wednesday.September 2$, 1888 AN plans and
at the Zoning Board of Appeals.Office: `Fewn of Samstobls,
`ouch Sovote H nnis;Mitt
Z1 pf --------------
• _
_.
BARNSTABLE REGISTRY OF DEEDS
sT
� Sp,
PINE STREET a
oAD
A g \ c
P 4 \ o
01 , J ) 0 9 LOCUS CN ROAD
A
E
Co
7 t 2 r a
LOCUS MAP
i \ dCR \
ASSESSORS LOT 22
(fnd) AREA= 8448 ,S~Q. FT.
— — PLOT PLAN
OF LAND
LOCA TED IN
44
-� — — — — — — � ` BARNS'TABLE MA.
— — — -- — — — — ` LOT 21 (CENTER VILLE)
PREPARED FOR
382 - - ----- - 6
— -- -- — — -- - --o •- - EINAR LARSON
DATE.• JUL Y 21, 1998
— — - o 3 c
FLOOD ZONE "C"
BULK J,RB,y
HEAD �*' /6�x�• RERES. ZONE
LOT 23 gtww* S ASSESSORS MAP 247
MAW PLAN REF. 103175
0
SHE'D
O TO BE REMO VED)
10
loci
�j
Q ,-8
OF 8
MOWMEW
0�50 Yr LOT 12
SUR
CB LOT 209
(fnd)
I CERTIFY THAT THIS SURVEY AND PLAN WERE MADE GRAPHIC SCALE YANKEE ,SURVEY CONSULTANTS
IN ACCORDANCE WITH THE PROCEDURAL AND TECHNICAL UNIT 1, 40B INDUSTRY ROAD
STANDARDS FOR THE PRACTICE OF LAND SURVEYING IN 10 0 5 10 z° '° P. 0. BOX 265
THE MMONWEALTH OF MASSACHUSETTS. MARSTONS MILLS, MASS. 02648
(� TEL: 428—0055 FAX 428--5553
IN FEET )
PAUL A. MERI THEW, P.L.S. DAT 1 inch = 10 ft.
JOB# 51637 DPG