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1348 MARY DUNN ROAD
1 . -/(3. . , #/',.;7 -:-/if"g& "Pc/14 el , e l . , • m a d it. y 0 e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION allOd trtg Map Parcel O� —�U'2- Permit# -2 7 9' ,5 g �-/ -s 2 RHSSTAl8L E c/ Health Division " /Date Issued Ar nnn� S 9 0/ 9/ 21." JU _0 PH Lj: 0 Application Division o e A lication Fee Tax Collector le 4 p + T Permit Fee 5 I g e Treasurer -PS Planning Dept. Date Definitive Plan Approved by Planning Board • Historic-OKH Preservation/Hyannis Project Street Address lal-n5 c O t:tAr Q04c4� �rn c1 Village Ci-- /:. tom.¢- Owner h ',e0//I Address-/3YV "bay DUnh t e I3 Y4skide Telephone as -3(n7-- asetcy Permit Request 6 CO +*rt 04on. cons,54-►o oP +0 o aJd-ekcm Ja /7)00)5� O. cost_ a aci 101et [xd'r-DOM a Sc.' from ( condwrk JP.(rG f e f (G1 ll°✓ ✓! -tVUM Square feet: 1 st floor: existing 1032 proposed 1114 2nd floor: existing proposed Z--60 Total new Zoning District Nis to 441 rvirz - Flood Plain Groundwater Overlay Project Valuation SDK Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family OV Two Family ❑ Multi-Family(#units) Age of Existing Structure 56 nS Historic House: ❑Yes O'IVo On Old King's Highway: ®'Yes ❑No Basement Type: C 1-6 ❑Crawl 0 Walkout ❑Other • Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing _ new 2 `J Half:existing new Number of Bedrooms: existing new I =� Total Room Count(not including baths): existing new 7 First Floor Room Count Heat Type and Fuel: ❑Gas O"Oil ❑ Electric 0 Other Central Air: [0'Yes ❑No Fireplaces: Existing 2- New — Existing wood/coal stove: ❑Yes 111 Detached garage:❑existing 0 new size 10 v ZM Pool: 0 existing ❑new size Barn:0 existing ❑new size Attached garage:I existing 0 new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 0 No If yes,site plan review# • Current Use Proposed Use BUILDER INFORMATION 24,/ Name 003�'t, Telephone Number /�� 4,--1 Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO . SIGNATURE dA DATE 7 D / - ii - FOR OFFICIAL USE ONLY PERMIT NO. 1 DATE ISSUED • MAP/PARCEL NO. t ADDRESS -' '. • VILLA ` . GE OWNER ' . AoPI r%®A/ DATE OF INSPECTION: Irtg 3/6 V 0 ./‹. FOUNDATION e e a 6' S l y- '° d v p e i _ FRAME ICf'12-- O(e a 'f—® C.-- Pik INSULATION .6,/PI S V 1-- Vie- 6 " ,- '� S/F 1 FIREPLACE i ELECTRICAL: ROUGH FINAL F PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING • ( ) l f I.'-' r r t _DATE.CLOSED OUT • ASSOCIATION PLAN NO. i . J 4 =° ' .The ComrnanWeaith'of Massachusetts . .• •+ ,U • a7•finent of Industrial Accidents • 'ffJ ifs ! v �' 600'Washington Street • • • • - • -_! 1 • Boston;Mass..0211 X • �.t. • 4 Workers'.C m ensation.Insu • rance A.ffida'vit-General Businesses • • • address: ,, . 5•, • A A., QZfvC7. b e# _. .. . . , �j /• a{1;no r-�-.1�� state: . {.� • • esta ant/BaFIBat�ng F.stablishmeat• ' • full address :' ' ' []R et work site 1ocatiosi d have no one ' Blis ess e. D 0 Retail e[�Safes('including ReaYk�,state,Autos c. : [j x am.a g in,an capacity. an • U b s'` f� and capacity. ▪ time: L� �, er p Z%�/I///%f/i marking "etn'lo ees full Sc • //%/1 aril an:em.ploy �. �ersi compensation for my..' , 'employees •! .t working on this job•. . ,; ••: •( 1 proms ,� .., �. , •:•,�;.:•t}j.;i�l;.},7' :(f:' ..�• •, .�xy. .::'.=t 3. �•• •L^'•.{...lei:. j. •t14, •1, l�••,.......1. .: .«ir1•i �4.At rt±';ri''•'�f'.1•'.t1•�.%:Z':•' •tr . .r• r•t•,•11t'eici• .'.Y'ir r:•. r n. ttt••:i ' r • . . r:t1•ti; �' r.s:"•S,YZLt.I ti�i'• '1:''• 1 t:`l:)'t.,'•1 % .'? .:.•. •. • ,. •. t �. •:.s•:.t;I•;•,.t: i:;.; Y ,• 11.f,'. •:?:•;J:;'••:$': 9•�,• •l•q • }�•t J •• J' .1•� f• •t. •, 1:7 • ,fit•` , .. . 1 .. .• t;Ytl,t$:a:•!}r•J1•:". : 1•. ,• •trlf•A.•:t C: r v. • ••:ti:l rti r 1l�:ryby t� ::. CUzil•an • •Sees'.!, . ::7�]�„J[.•'X;.: ;.• .I::•j C.••• '�Y'�•. . 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' •.•'•' •.C•' ••y,▪••` > tti.f'. ,•ei JS7�n.;'y:1•'•1.• .. ,;.,:*:'tf' '•i:it: .1YR•�,:y':+1..1' ,h� %if• 'tt4j•:.1; �t. ,...'' .' •• •• •.,• •..'.,I,•• 1.•• , •f•ir•%.:.'1• S'• J• V .11 ,• t, ,I,:.ti 'L•• •:'f••' j tt:�I:•Jt,`f1.1.:•cie.7 ''•J•' S 1 el :!, .•'1 �''} •t•t 4. .'t t r aj1•• t1. y, p11C.'rfYf^ • �-'. •:•e ,:. .t..S a'•1 t•:: •Y�+' • '':gtr::01.,•.• z.y 1,•:. },i AL•./•1.. r'?Ser'•'`^• l{4h,11;;iL•} }:.{:':3• M... D t0 Pl ��'IlU SD�IOr insurariGrbt! penalties up imposition of crinifnal p e against me, I understand that}s enalries iD the foYm of a STOP WORK ODDER and a fine of 100.00 s'day g •j • e as required under Section 7.3A of MGT-r 152 can lead to e Failure to secure coverage as well as ctxilp coverage verification, . Otte years'imp be foveae dad to the Office of Investigations of the DlAfor coverag • copy f ant Fay ' a this statein• ' s nd enalties a erJury that the information provided aboveisis fr e a r cortect I do hereby c under the p P•. Data 7 `� 5a�atura l' • • hone# ` gt • ' . Print name official Inc only do not write in this area to be completed by city or town oificiai • []Building Department permitnicense# []Licensing Board city or town: • ❑Selectmen's Office []$ealth Deparbnen� [}•checisif immediate response is required []ether phone#; contact person: ' (:evhed Sept 2,00) s =_rC e Il .•T.• • • • .. O • ' 1•. • • ' ' • . Information'and Instructions. • r G eral I,aws'•chapter 152 section 25 regiiires all employers to providc•lvorkers' corppeeis�tid.for their•• Ivlvoye„5., s fromthe hlaw"., an employee is.defined as every person in the service of another under any contract �loyeeS; .As quoted � . . _ ... • of hire;express or imp a oral or.written. . ' partnership, association, co oration or other legal entity, or any-Iwo or rngre of An employer is defimied as a•n indindual,• � hip rP the foregoes engaged•in a joint e nterprise,and including the legal of a deeeased,employer, or' the•receiver or arbrersb1 association or other legal entity, employing employees. 'Hannifin owner of a .trustee of.an individt P p� occ ant of the dwelfin house bf �ot'More than three apartments•and•who resides therein, or the; up g • dwelling house hal' g••er'sbris to do•mamtezaance,constr repair lb Sp ctibn or r air work on such dwelling house•cjr on the grounds or another app• P. t thereto shall not because of such;eriployment be deemed to be an.exx loyer,••,•, , binding DPP , .. ,r . .. , :; •.'. , 152 section 25 also''siates fhat'every state or local licensing•ageney shall withhold the issuinct Or renewal ala chapter. t to operate a husjness or to construct buildings in the.commonwealth for any applicant who has of a license or permsthe instil:Ince not produced acceptableevld ii complisio with l enter into any contract for theperformanc o puublic work unt1t' cozx�.�wbalthnoz'.any.of}ts political subdivisions acceptable evidence of compliance with time insurance requirements of this chapter have been presented:to the contracting•. authority. • • Applicants :. • Please fib is the workers'compensation affidavit completely,by checking the box that applies to your situation., Please su 1 company name address and phone numbers along with a certificate of insurance as all affidavits may be submitted PP y to the Aepartrnnt'of Industrial�'ccidents for confurnation of insurance coverage. Also�be sure to sign and date the • affidavit Theaffidavit should be returned to the city or town that the application for the permit or license is being , az-tment ofTndustrial Acciderrts• Should you have any questions retard the''lava'or if•you are requestd.to att not the UeP lease call the D.epartr ant at the niunber listen.below. , .., . ���•y,yy a•worker'•comp ensation pglicy,p�. City or Towns . . , . • •' • • easebe sure that the affidavit is complete and.prm Plted 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 Pl:ease- ermit/licenna number winch will be used.as a reference number% The.affidayitts may.be returned tQ, be;sureto fillet theemeiitshavebeenmade,• • the D ep artinent by. or FAX•unless other;arrang . , '• • ' Y bu in advance for you cooperation and should you have any questions, please do not hesitate to give us a•calt... .• The Office of Investigations would h'lce fa'thank y .. , . ' / / / • The Department's address,telephone and fax number: . • • - ' • The Commonwealth Of Massachusetts• • I • D epartment.of Industrial Accidents • • . Mika of inestivatlella • • 600 Washington Street • • • • I • Boston,Ma. 02111 fax#: (617)727-7749 I .- J V{FG A 1 Catt'tlat.11,3) Fo f1 F`urlt, • Wild.td 7.,1h f prccar1I F'z kq a tar Etta slid Tr•t�'sa lty ldardig Euitditt 0 ErAiat arr(llrit 6.1 Nail Floor s ,g gG�Aling Calling Slab xIcyl Orilligggalliiikrr4Citc445,) k-v¢Iual I•y iuc{ 1C'Yxluc Rsil p cc gntrnt • r . Rr 07 r ting Degrra Ds, Normal 11111111111111111111113111 1a Now 6 0.30 111111111111111 1a a NW IS A. QOgg"F. 0.i2 30to Normala.sa ��Z���1j�� Namsxl reurs a.�6 . 1-�,� to u 11111111111110111111113910 ss A FtTE ® 0.44 10 Kong o,iz 30 ���e �� Normal oilNEM 11111111131111 ��!'� � Q0 AF J OEM 0,4a -� to ga.t..FLIE maw a,a2 t0 a,so � IMMO ' . 3yg na A-q A ADDRESS OF PROPERTY vSr 4 e OW 1 I 7• sQU�' �333 : FOOTAGE OF ALL TERO BALL • ' ,�3 / MARE FOOTAGE, ALL GLAZO' d(f� 4. % GLAZING AREA t#3 DIVIDED BY!Mt � 5 LS� BC� P ACACiB(CIAA-see chart above): , Q EXERaY RBQUIRBIYiETI'x5 .RMORE IEVoLVED METRC1D5 OF DOE � NOTE' OBAVAILABLE, ASI4.vS FOR,THIS LIILDDIG ThISPtCTOR APpROV AL, B NO' �5, q-forrna-980203L 1 P •► (%)..,,T„l Town of Barnstable ,. o Regulatory Services 9BARN ASS. 2, Thomas F.Geller,Director b,,,,.1039. ♦0 reD Nob. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost Address of Work: (13tif /►?ielail Q()Ax) ✓LQ- 8ftt,5774eic 14//1 • oZc3 Owner's Name: N(sJ¢ P 1Cr l 2/Li_( Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑B ilding not owner-occupied gOwner 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. 7/6 b 4 — R utAc ei l Date Owners Name Q:forms:homeaffidav Town of Barnstable CF ZME Tp� ,s .. � Regulatory Services tSTABLE, : Thomas F.Geiler,Director y mtnss. g %ED i639• �� Building Division MA't� 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: /C29 U n JOB LOCATION: / / X m fey LJ thui) /ZO 4mlov S number street village "HOMEOWNER": /`fS 4— p l c/egti 3(a -6.ocl q name home phone# /� /� work phone# CURRENT MAILING ADDRESS: l y 2 r) Y 4nJ�v 24 . 8 Pen-itQ 6 M 4''- . 0 24 30 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 re•uirj° eats. - • L-P,Lei-c.a-eL(' CAta- Signa re of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt '----" • RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $ 50.00 Alterations/Renovations $ 50.00 - Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE 112, square feet x$96/sq.foot= 3100 x.0041= 31! ' 73 plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) - 44 a L square feet x$32/sq.ft.= f 3''ZLI x.0041= 56 C� ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 j6-0 (plus above if applicable) �� Permit Fee Projcost Rev:063004 —moo • 2-51-0, op / FD �, ? I l, i (j '�i ibl , • �,' .,.z� 3 q Q �.�004 G 1 L I y' Ct RrE=i ti , .;0r IE,_ 'Q NtN_____, iNo I. • o- �r- 'v N n 11 N,, 1 ,z u, .,, : q e kti .--;ED rr1 C q) C. i 23 _c o ' I certify that this ty located in Flood Hazard Zone pCr( o is side the 500 year flood) f- by the Department of Housing ied Development (HUD) . and Urban Date •uo,✓ .30 /997 t `H OF : CERTI Fl ED PLOTPLAN ��, -o ED D ;� LOCATION .�.vvs .E-�C 4 .1 SCALE .......... moo' Reg, dNcBT�� DATE !1.4w3° / p y" ! PLAN REFERENCE .S NG• :�T,r/Z �` ICJ R� � . .:OIL lA o �' ��'S S ?dci't/ ON �e•ty.� 320 . . . . . I that thereto its title insurance . . . . .. . . . . . . . . .. ... . . . . . . . . . . . . . . company no visible encroachments I CERTIFY THAT THE . . . . . . . . . . . . . . or easements except as shown and that this SHOWN ON THIS PLAN IS �/.fTl.vG Dk/cCI_C/.vim Plan was prepared under- immediate LOCATED ON THE GROUND supervision. ' AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF • . .WHEN CONSTRUCTED. L/sA 17/cc/Z/44/ ��T2-7,M!�,� DATE yav3o i�9, REGISTERED LAND SURV OR .- 44 Town of Barnstable *Permit# 2.i)I15 'tI '' Expires 6 months from issue date ► f,, °� Regulatory Services Fee * BARNSTABLE, • Richard V. Scali,Director i6gp. �0 • prED MA't A Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 32(( Oli _606Not Valid without Red X-Press Imprint Map/parcel Number [Jl r/, /� Property Address/3 7 g MCti!.y ,Duon /E J4.-{,mslet. k, 172a : 06,26 J Residential Value of Work$ /5 0��� Minimum fee of$35.00 for work under$6000.00 t Owner's Name&Address . / ri 1 I /5M. Wiry 2.'omi i?d f jar2S a 0p 1116 , .6 2423 O Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor cp���3 P���nQ ® I am the Homeowner �J{y�f • ❑ I have Worker's Compensationat Insurance / /I c DEC 0 8 2015 Insurance Company Name Me— / //o�� y/!J-• -- STABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value , 30 (maximum.32)#of windows , #of doors: 125. ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is _required. SIGNATURE: (,��- A.CCLLLL , Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 The Commonwealth of Massachusetts ..... Department of Industrial Accidents '!_�' ! Office of Investigations =,, �' � 600 Washington Street Boston,MA O2111 rr ■ '' www.rltass_govidia Workers' Compensation Insurance Affidavit BmldersiContracturs/Electricians(Plumbers Applicant Information Please Print Legibly Name(BusimessDrganizationfndividual}. S2 Pi c ci ri l l i Address: 13YB Marct Donn kd City/StateiZip._>3a rn sA b t p Ma. ®263O aei sv,9 3 /2 i — 60 69 Are you an employer?Check the apiiropriate box: Type of project(required): I.LI I am a employer with 4. ❑I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. [I New construction 2.❑ I am a sole proprietor orpartne-- listed on the attached sheet. 7. ❑Remodeling ship and have no employees. These sob-contractors have g_ ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurancul g. ❑Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. I am.a homeowner doing all work officers have exercised their 11_❑Plnmbingrepairs or'additions [No workers' right of exemption per MGL myself - 12_❑Roofrepairs insurance required.]i c.152, §1(4),and we have no employees.[No workers' 130 Other tAA•v\?iz.A6/St,f,Wnl1, comp.insurance required_] •Any apphica t that checks box#.1 mast also fill out the section below showing their workers'compensation policy informatiom I Homeowners who submit this affidavit indicating they are doing all weak and then hire outside contractors mast submit a new affidavit indicating sorb ICantasctors that check this box must attached an additional sheet showing benzine of the sab-contractors and state whether or not those entities have emp9oyees.If the subtantractoeshave employees,they/mastprovide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for ray employees Below is the policy and job site information. Insurance Company Name: • Policy fi,or Self-ins.Lic.#: Expiration Date: Job Site Address: CitylState/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$1,5O0_O0 and/or one-year isrqxisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$25O_0O 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 carti ,ender tl _'is and penalties of perjury that the inforacatiou provided'above is and correct Siemature. 0 l^ .('_.l:..t606067 .i'�— Date: /02/6 / c Phones: 5)& 3ie Z- (lJ 0(0 67 Official use only. Do not write in this area,to be completed by city artown official City or Town.: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Bla ing Department 3.Cifyd Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: _ — 6 i • Information and Instructions f • • • Massachusetts General Laws chapter 152 requires all employers to piuvide workers'compensation for their employees.l P •o this stante,an ewpinyee is defined as."_.every person in the service of another under any contract of hire, express or implied,oral or written." An eznpfoyer is defined as an partnership,association,corporation or other legal r=ntiiy,or any twu or more of the foregoing engaged in a joint enterprise,and including the legal.Lel,,.esentatives of a deceased employer,or the recei er or trustee of an mdiyicinal,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 ma'mtManee,construction or repay work on such dwelling house or on.the grounds or brilrTing appurbenanrtthereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,Mal chapter 152, §25C(7)states`Neither the cOramonwealfh nor iay of its political subdivisions shall enter Tin;o any contract for the performance ofpublic work until acceptable evidence of compliance with the in uran ce. requirements of this chapter have been picapntPrl to the contrasting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation anri,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their cei tidcate(s) of insurance. Limited Liability Companies(LLC)or Limited T.iahi±tyPartaersbips(LLP)withno employees other than the members or partners,are not required.to carry workers' compensation insurance. If an LLC or T.T.?does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and dated-re af-i�davi-h The affidavit should be returned to the city or town that the appliraiion for the permit or lir- nee is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below Self-insured companies should enter their self-insurance Iir se number on the appropriate line. City or Town OffiriaTs Please be sui c that the affidavit is complete and printed legibly. The Department hay provided a space at the bottom • of the affidavit for youth 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 permitllirpnse applications in any given year,need only submit one,affidavit indicating current policy inform alion.(if necessary)and under"Job Site Address"the applicant should write"all locations in • (city or twn)_"A copy of tiie affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as Proof that a valid affidavit is on file for future permits or licenses_ A new affidavit must be fined out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (ie. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit • The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call • The Department's address,telephone and fax number: ' . The Commattwean of Massachnsi-itts - •-• ' De az1ment of 1ndhstial Accidents OfUce ref Jrmestigatioais 604-Washington Street Bastin,MA 02111 • Tel.4 617' 7-494 406 or I-877-MAS AFE Fax 4 617-727-7749 Revised 4-24-07 • Nev w w.ma s gogf dia Town of Barnstable • Regulatory Services • ///��FtHE reiy,, Richard V. Scali,Director .••„., t Building Division t BARNST'ABLE. ' Tom Perry;Building Commissioner prE 5 1. 0" 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION 7 Please Print DATE: Ivyg1/5-- JOB LOCATION: /,_ h /' /l{ I DUp ini RRd__ rf2 6Q 3/71,1'J/e 'number street / / £ village /_ "HOMEOWNER": /-j.5� / /. et l f7 Ill g,J V,�"'�t16 V `/ O$ 7/1-- /6 6-6 name � �y home phone/# work phone# [/ / /a' Y CURRENT MAILING ADDRESS: / (3 r Penn p(i 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 r� events and that he/she will comply with said procedures and requirements. tom. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 L • ., OF THE -'+ j r r + BARNSTA�AIFBLE., r ,0� Town of Barnstable D A'I� Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 ' www.town.barnstable.ina.us Office: 508-862-4038 • ? Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder • I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: • W (Address of Job) Signature of Owner - Date Print Name • If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 AFFIDAVIT OF PAUL ROMA TOWN OF BARNSTABLE V. RANDOLPH GOLD 1) I am a Building Inspector in the Town of Barnstable and have served in this capacity since December 20, 2004. 2) On June 15, 2005 I received a complaint from Lisa Piccirilli, 1348 Mary Dunn Rd., that her neighbor, Randolph Gold of 1360 Mary Dunn Rd., had installed a pool that is, "...now located on our property...." 3) In response to this complaint , I made a site visit on that same day and saw a pool, its pump equipment, a wood picket fence, and a chain link fence. The pool was orientated differently than on the plan submitted for the building permit for the pool. The fences distorted where property lines might be. Without an accurate survey, I could not determine the location of the pool. 4) On June 22, 2005 I met with Mrs. Gold and we discussed the orientation and placement of the pool,the concerns of Ms.Piccirilli, and the setback requirements of the town. Mrs. Gold said that she was trying to work out a land swap/ sale with Ms. Piccirilli. 5) I discussed separately with Mrs. Gold and Ms. Piccirilli the need of having an accurate survey of the location of the pool. 6) In early September, 2005 Ms. Piccirilli dropped off a copy of the survey she had done dated September 1, 2005, showing her property, Mrs. Gold's property, and the location of the pool. 7) I discussed with Mrs. Gold her right to have her own survey done, but based upon Ms. Piccirilli's survey the pool was encroaching into zoning setbacks. Mrs. Gold repeated that she was trying to work out a land swap/sale. Ms. Piccirilli later said this would not happen. 8) On September 27, 2005 Ms. Piccirilli dropped off to this office a copy of a fax sent to her by her surveyor showing a detail of the larger survey of 9-1-05. This detail showed the pool apron was between 1'-1.3' from her property line and that the pool equipment pad was on her property. 9) I met again with Mrs. Gold and discussed this information.She repeated the land sale/swap possibility. Ms. Piccirilli again later said this sale/swap would not happen. t 10) On October 10, 2005, I sent a letter to Mrs. Gold to confirm our conversations. The pool and its equipment are located differently than on the site plan supplied with the permit application; the pool is too close to the property line; the pool equipment is located on her neighbor's property; the pool and its equipment must move to comply with zoning; and she does have the right to appeal this decision and to have her own survey. 11) On October 31, 2005, I made another site visit and took photos of existing conditions. Nothing had changed from previous visits except that the pool pump/had been moved. 12) To my knowledge, Mrs. Gold did not have her own survey done;but did appeal the decision to move the pool. On November 15, 2005 The Zoning Board of Appeals denied her request for a variance. 13) Mrs. Gold and I spoke of the need to move the pool and she again spoke of the possibility of a land swap/sale. 14) On May 17,2006 I again made a site visit and took photos. There was no change to conditions as they had been. - 15) On June 30,2006, I sent a letter to Mrs. Gold stating that the appeal period had expired and that the pool must be moved or removed. 16) On August 2, 2006, I sent a CEASE AND DESIST letter to Mrs. Gold because the pool had not been moved or removed. I have seen no effort on Mrs. Gold's part to comply with any of these requirements. Signed under the pains and penalties of perjury on this 28th day of February, 2008. Paul Roma Local Inspector Town-of Barnstable Message Page 1 of 1 Roma, Paul • To: Palkoski, Christine Subject: RE: Roma Affidavit 250208 Christine, There was an error in transcription on item.11 of my affidavit of 2-28-08. It should read, "Nothing had changed from previous visits except that the pool pump/pad had been moved." I made the corrections on copies of the affidavit here. I'll drop off a corrected copy at your office today. Paul - Original Message From: Palkoski, Christine Sent: Monday, February 25, 2008 12:32 PM To: Roma, Paul Cc: Perry, Tom; Weil, Ruth Subject: Roma Affidavit 250208 Paul, Attached please find a very basic draft of an affidavit in the Gold case. I need you to add/outline all of your involvement in this matter. For example, how you got involved,who you spoke to and the content of the conversations, and any other information that is pertinent in this matter. Since time is of the essence (this needs to be filed before April 9th) I would greatly appreciate it if you could have this back to me by the end of the week. If you have any questions, please ask me. Thank you. Christine • l 1 2/29/2008 Town of Barnstable P`00:HEro�ti Regulatory Services • • h ,.psi', °* Thomas F.Geller,Director I semsreste, Building Division 40 s6 A m p,+ TAm:Perr-y.Building Commnssioner lFD MP'� .. - - 2000 Mam,St c t,. Hyannis,MA 02661 • - - 508-790-6230 Fax 50 )ffice: 508-862-4.03,8 � _ REPORT '. . C OMPLAAINT/TQUIRI REP O • Date: _. ' 1 5. • . Rec'd by: . Complaint Name: 4}1 '2 -& -zL Map/Parcel.. L3 of / i 3 -- 31,6 l� Location •Address: /3 156601Si1/ � ��'�� �`��� ids• . Name: - . .15. P Ice/ea-Li• ' k-j c7diA _ Originator Street: f 3 61&' iMAvz-y 6(.;rvlu •. 24 . Village:C v f,4 oal State: . INIA ... Zip: 0•2_(3 O • • • Telephone: Ste" 3 Ca Z _ Ca UCoq Complaint Description: /,.,n Cv`i-71 or) Q r 002_ 1S Al • 4-1 /'OOL- J 45 Al0w 4 t? &-r.€4 O o v/2 72 FY-De irk/ 1 �en 0 ut FOR OFFICE USE ONLY. • Inspector's Action/Comments Date: .`h'- .r .S 0 c� Inspector: -ru.� , � �' 6 d--,-A-e a -- rt .- RJ, "V-v� A-C—A/LA 0 • .SCVI liJ:�'v •'.'J CJO-f 11- 7a lULil..: '..4-`LLJ.Ju;1 ...-. - r q u.l • • . j, c .1.' ....1-: .' i• ,. . Y' t' . I 14 r. A.M. 334/4 o. �O• ''� QJ, v , PISS. ,4r1.3E0 a �y -.42, �_ :,?,'"w m. ' �. I .D3 A.AM. 334/17 6 pa r/ : O i `�'" . f P. A.M. 334�'3S 4.11� 334/5 p `5— A.Al 334/12-2 .CV �,• . Y co o j O •o•(o VJ • 1� '1 • i o • A. W. _334/37 A. 334j14-2 ,s�,eo�oo • °o 'coif) E o� ,, A.M. 334/14-I %` O3 0 L 2 y• i A.M 334%B-2 I • 0W:VcRS' 1I1'GR L) J. BOA GLI D & REBECC4 I PETERS IiES: ZONE• 'RF-1" This MORTGAGE INSPECTION Plan Is or FLOOD Z0.1''E 'C'<; sank �s Only ' ! t')w�v _ '_ 4�% REGISTRY OWNER.:. N.cR112_:L.X_4AakLy' _it ja eG.:t.Y P,r1'TERE f VEEP REF: _5,52,�.i -8UYER- ii4LVVY-R � -. w; ., "yam_ ATE: _Q ls�s�s JJ.... PLAN REF: •e39,�12L?_ I /I _SC A�. :Z,r_ Re_ tiF,T, I HEREBY 'CERTIFY 'TO A _ =1_A .6P----- -' �0 _ --_TH.AT THE BUILDING- �M '�'AIv'hEE SURUEYx HC FOT ON THIS PI A..N I : LOCATED ON THE GROUND AS PAb� I 4 SHOWN. AND THAT ITS; POSITION COLS ____ CONFORM coCONSCiLTANT�� TO .HE ZONING LAW SETBACK REQUIREMENTS OF THE EW a" �' 40B INDUSTIt�:, ROADP F TO WN •CF EA.RA'�T it _ �a 2O�d u, 4 .AND THAT \ ',���� MARST0;1S•IvI.[LIS MA 02648 yr DoEs A-TOT LIE WITHIN THE SPECIAL FLOOD HAZARD - ' r�`�!►a � TEL 4'6 0055 �` AREA A~._ SHOWN ON THE H.C.D.' MAP DATED_B/19,Z8.,`1_� ` FAX 420 55R3 _ �. 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(„4,41 lLS__r4 li Ccn.:1 Ili i I ! ,_ _ --+---7,- 47- -•,:---71- --i ! __.!I 1 i 314. Ili. , i- - - 1---- ti 1 r , r 1 1 . 1 • 1 , , , 1 . , I D 1 .::•::, ,.. I I I • I. --)I_ ..,_' -t---, , ! I 1 i . i , , , - ! , , 'LL I ,.,. i I i ..._, ...._.. _ _. 1 J. 4- Ii- i-- , 1 . . I • i I i 1 i . I . . r , , 1 , ; _i .1 ___, .., __,_ I, , , , --i 1 •7 --i . _ . . . . . . , • 1 1 _1 _ 0 er. . . , , GENERAL NOTES : ® f' I 2 1.) ZONING INFORMATION 8 W ZONING DISTRICTS: RF-1 & RF-2 FLAX ::POND a OVERLAY DISTRICTS: AP AQUIFER PROTECTION PLAN BOOK 239 PAGE 123 CONRAIL Z CB DH FND N/F GEORGE A. & MARGARET FLORENTINEI ..,LiMINIMUM CURRENT ZONING REQUIREMENTS: pC 1 MINIMUM AREA: 43,560 S.F. a Y cv MINIMUM FRONTAGE: 20' �oc) .44-WE �' I m MINIMUM WIDTH: 125' 4, , FRONT YARD = 30' SIDE & REAR YARD = 15' i — __? ZONE Mfg. mi.... RF 2 c © ZONE RF ---�.�6ARNyr MINIMUM AREA: 43,560 S.F. /� MINIMUM FRONTAGE 20' C PAS I MINIMUM WIDTH: 150' a S sj• I FRONT YARD = 30' SIDE & REAR YARD = 15' LOCUS MAP 4r a•F 2) A VILE SEARCH WAS NOT DONE FOR THIS SITE; SHOULD ONE 1 2000' 0 BE REQUIRED IT SHALL BE PERFORMED BY OTHERS. a a) THE PROPERTY UNE INFORMATION SHOWN IS BASED LOCUS PROPERTIES COMPRISED OF : a ON CURRENT AVAILABLE RECORD INFORMATION ASSESSOR'S MAP 334 PARCEL 012-002 las 4' AO"re" I pLAN BOOK T 4 PAGE 87 CONSISTING OF PLANS AND DEEDS. PLAN BOOK 320 PAGE 88 - LOT 2 g I N/F BARRY L do JOYCE KEVORKIAN PLAN REFERENCES: DEED BOOK 11,096 PAGE 149 PLAN BOOK 320 PAGE 88 OWNERS/APPLICANTS USA PICCIRIW b PLAN BOOK 239 PAGE 123 1348 MARY DUNN ROAD A 4.) COMMUNITY PANEL NUMBERS 250001 0005 C CUMMAQUID, MA 02630 THE FLOOD INSURANCE RATE MAP DEFINES THIS AREA AS ZONE C, ASSESSOR'S MAP 334 PARCEL 005 'PLAN BOOK 239 PAGE 123 AN AREA OF MINIMAL FLOODING. PLAN BOOK 318 PAGE 58 - LOT 3 i 0.92* ACRES CB DH FND PLAN BOOK 239 PAGE 123 M DEED BOOK 13,595 PAGE 189 HG j / m S OWNER/APPLICANT: RANDOLF R. DUNN ROAD � �`' E� ' � '�' Wnpp 8 ��� tau E k 1360 MARY DU 36d CUMMAQUID, MA 02630E 4 ^I g. I it* po CONc�terE APRON �In 1.; �� g k`-' --I POOL -. S i '54'25 E 3 Amy TD ' t� ..P C� Q . � � I ELECTRIC • RISER c~ &IOW -1 CB OH FND 1 a:.. _ _ . N -POOL EQUIPMENT Plan of Land at �."''1++ PAD 1360 & 1348 Mary Dunn Road I M 4' CHNNUNK FENCE 77 5' 77 Cummaquid, Massachusetts 1 oRY BARED FOR - _ 1.....) pi _ _:,,- ---- \ 1 // I /,ns ING/' ,rooD EI Lisa Piccirilli I I+ •'134a TM I �N"'' I • I 1 1 /(ir 3 Existing Conditions Plan F-�-I .=4 a I 1 / PUN BOOK 320 PAGE 88 rf g RAN BOOK 320 53 545t PAGE 88 I 1 4 * ACRES gr.3,598* ;.23i ACRES BAXTERNYE ENG G & SURVEYING 1 H I J Registered Professional Engineers and Land Surveyors . . . . . ...- (02:0; ,,,, 812 Main Street,Osterville,MA 02655 75.4 Phone-(508)428-9131 Fax-(508)428-3750 30 0 30 60 0 SCALE IN FEET M SCALE 1" = 30' DATE: 09-01-05 7 a W 230.00' 70.00' W REV. DATE REMARKS c LOT 6 N 82'03'00• W 300.00' 1D • i$ m W g g PLAN BOOK 320 PAGE 88 8 h q Ca 1 1 N/F KENNETH M. JANSSON d �i o DEED BOOK 2,672 PAGE 193 300.00' _ _ = 162.58' i t p� NUMBER z - — — — — — N 82'03'00• W 462.58' TD m g a PARCEL 8 M 1QL6 r) PLAN BOOK 354 PAGE 66 (SH. 5 OF 5) 0:\2005\SURVEY\WRKSHT\2005-081—WS.dwg PUW BOOK 268 PAGE 43 N/F RON S. & MARCIA C. JANSSON N/F KENNETH M. JANSSON 2005-81