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HomeMy WebLinkAbout0412 BEARSE'S WAY 7 �a .����s�s . r� __ __� � _ ,� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel `Application #W �� Health Division Date Issued /—A. lap Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address GUAR Village L6 A-�JIyI S Owner { Gil LuGi 2A/ Address Telephone a y 5z, Permit Request PQ M o U-e- S e Ti e j L wi (,L 7 q e c v it—?—ems r L� it_ R.t Pe, l9 T-fA,c v A- O ti'I L . Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total newZoning District Flood Plain Groundwater Overlay k-,,a . Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ 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 ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION L n s � �ST�vU-1�o� (BUILDER OR HOMEOWNER) Name KZ A-� Telephone Number Address Z- License # C ;C--A S 1 -7 g RDXL d 11,4 0,;-> 3 -70 Home Improvement Contractor# Email 44uet:4 o1/ /L,s y• Gd,w Worker's Compensation # a WG / Dag ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C-0 N S7_/Z,&G-ri orJ D U'`1/PS7-Pti SIGNATURE DATE a FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED f> MAP/PARCEL NO. `r ADDRESS VILLAGE r OWNER DATE OF INSPECTION: f = ` FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 4 DATE:CLOSED OUT 5+ ASSOCIATION PLAN NO. t `o yj p c� , ' ❑ ❑ Et t Th I�j as � ,�* �via � R� � G• �" � � � � � zzLON p' F �• " [ Pd w cece I &' ❑ Elpa PA a Z 8 ' t7 n y .x ,� (((PPP �p � � � •� �L � rp R w : Massacjaisct s Cien-eral Laws chapter 152 requires aII entloyers to provide workers'comparsatian for their employes tEm t-ta this sfatote,an errrp£oyee is defined as C__every person in the service of another inner any contract ofliie, expn scar hmplied, anal orwritteo_" . fin m,ptgyez'is defined as"an mdividnal,partaershT,association,corporai7an or other legal enfify,or any two or more of the foregoing engaged in aJou±mtogzise,and inalodingthe legal represmtatives of a deceased employer-or the receives or trustee of an individual,partoenhip,association or other legal entity,employing employee- However the owner Of EL dwf--H aghanse having not more than Three apartments and who resides therein, or the Dc-uupant of the - dweIlmg house of another who employs ptzsons to do maiatE-nance, canstzo Lion.or repair Rork on such dwelling house or an fhe grounds or building appurlenarst Thereto sbaIlnoi;because,of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also staffs f k"every state or Iacal lieazsing agency,shall withhold the issuance or renewal of a ticen5e or permit to upemte a bnsiness or to construct buildings in the common,vealth for any applicantwh6 has not produced acceptable evidence of compliance,with the insurance:coverage required.-' Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into a ' contract for the per-f=ance of public work until acceptable evidence of compliance with the insurance, r-e�ulaements of this chapter have been presented to the contrasting anozity." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to ycun-sitiation and if necessary,supply sub-contractar(s)namefs), addresses)and phone rrumber(s)along with their cer��ncatr�s) of insurance. Limited Liability Companies(LLC)or Lin s Liability Partnerships U-LP)withno employees other than the members or partners,are not required to carry workers' compensation in_sur-ance_ If an LLC or LLP does have employees;a policy is required. Be m advised that this affidavit may be submitted to the De w� Department of Indial Accidents for conf7rmation ofincnrance Coverage. Also be sure to sign and date the affidavit The affidaidt shoalld be r-t zmeed to the city or town that the application far the permit or license is being requested not the Department of Industrial',kc,cidenfs. Should you have any quesdons regarding the law or if you are required toobi=ir1 a��orkers' compensation policy,please call t�ae Dr-par went at the number listed below. Self-ins?n-ed companies should enter their self-in=nce license number on the appropriate line. City or Town Officials . Please be sure That the affidavit is completE and printed leg ly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office ofIuvestigations has to contact you regarding the applicant Please be sure to fill in the pemitllicen.se mnnber which will be used as a reference number. In addition-an applicant that must submit multiple pennitilicense applications in any given year,need only submit one affidavit indicating current a�ation(if necessary) and under"Job Siff Address"the a)plicant should vrriter'all locations in (city or policy inf town)."A copy of tine affidavit that has been officially stamped ar marked by�e city or town maybe prov�de d to the applicant as proof that a valid affidavit is on f1Ze for future permits or licenses A new affidavit must be filled o it each year_Where a home owner or citizen is obtaining a license or permit not relate-d to any business or commercial venture (i_e. a dog license or perms to bum leaves etr.)said person is NOT required to complete this afddal•Zt The Office o f Investigations would like to thank you in advance for your cooperafion and should you have any questions, please do not hesitate to give ni a call The Departmen_t's address,telephone and faxnunbex- ` � Co�valtb of Ma.-,ach . ofIUVC�S Guy Iastaa=MAt21I1 ReL.i!:L 617 7-4,CQ5 at4-D6 cox -977-hEkSSAFE S 4 -`27-7745 Revised 4-24-07 Client#:34309 MULTISTA ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1/13/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Maria Barnowski Starkweather&Shepley PHONE 401 435-3600 FAX 401-431-9326 A/C,No,Ext: (A/C No PO Box 549 E-MAIL mbarnowski@starshep.com ADDRESS: p•com Providence,RI 02901-0549 401 435-3600 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:American Safety Insurance INSURED INSURERB:AmGUARD Insurance Company 42390 Divvissiotate M Restoration Cape Cod INSURER C:Hartford Ins Group 19682 ion,Inc. P.O.Box 2210 INSURER D: Mashpee,MA 02649 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY MM/DDIYYYY LIMITS A GENERAL LIABILITY BINDER719709 1/01/2015 01/01/2016 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISESCEa o.Tur ence $50,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $5,000 X BI/PD Ded:5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PECTRO- LOC $ J C AUTOMOBILE LIABILITY BINDER719586 1/01/2015 01/01/201 COMBINED SINGLE LIMIT Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION R2WC510288 7/16/2014 07/16/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITYTORY LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $5OO OOO OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500 000 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE: 410 and 412 Bearseas Way Hyannis MA CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVES tp MO. S ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S654120/M653583 MBB Jan 13 15 06:40p Nancy Lucien 508-420-1011 p.1 a MTTTTJ_STAr1"U RESTORATION, INC. FIRE* FLOOD*WIND* SMOKE* HUItRIC.ANE*VANDALISM Fed ID#050515889 CONTRACTORS REGISTRATION#'140427 AUTHORIZATION TO PERFORM SERVICES AND DIRECTION OF PAI'MENT herein referred to as "Customer",authorizes MULTI-STATE RESTORATION,INC.,herein referred to as 11MU-LTI-STATE",to perform any and all necessary cleaning and construction services on Customers'property at: Q109=ea 4 e b Lc: 1&4, ca. - o i�1ti6!_ t)Q16 CZ Telephone: 9�1 and with respect to items that need to be cleaned at a remote location,to remove and clean such items as necessary. Customer authorizes .SC,D- icst_ Insurance Company,herein referred to as "Insurance Company",to directly and solely pay MULTI-STATE. If for any reason the check should come to be or be made payable to the Customer, Customer then agrees to pay MULTI-STATE immediately upon receipt of the check from the insurance company. In order to expedite payment to MULTI-STATE, Customer hereby appoints MULTI-STATE as attorney-in-fact,authorizing MULTI- STATE,to endorse Customers' name, and to deposit Insurance Company checks or drafts for MULTI-STATE services.Customer agrees to pay Customers'deductible in the amount of$ /.2 n 0 o. crQ that applies to this claim. If the loss is not covered by insurance,Customer agrees to pa the total amount to MULTI-STATE upon receipt of the invoice. - Signatiue of Owner It is my understanding that the services to be performed by MULTI-STATE will be f limited to those,which are authorized by my Insurance Company. Insurance Company Name - 5 rig Policy Number Customer agrees that MULTI-STATE is working for the Customer and not the. Insurance Company or agent/adjuster. Additional remarks: I have read this document atitl completely understand and Wee to same. i 6 ►, g " X 17' 3'' 1/P- aep-5eke c A-� HI-t Pro NrS Nth 1 Iq- /s . ' ��e ip�wr�aaauuealG�o���a,�lac�c�e'LZ'Q'�� r:,:- � ;-•_-------- - -- I' ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only. ME IMPROVEMENT CONTRACTOR. before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation egistration 140427 T F' F YP � 10 Park Plaza-Suite'5170 Expiration 10/15/2015' : Supplement :4,d Boston,MA 02116' MULTI-STATE,RESTORAT ION INC. CAPE COD RICHARD LAURIA00, ' a `P. O. Box 2210 ,WASPHEE, MA 02649 Undersecretary : Not valid without signature Massachusetts -•Department,of Public,Safety Board of Building R gulations and Standards Construction.Superi ishr I & 2 Family. License: CSFA-051784 RICHARD D LAURIA 1 LEAH DR Rockland. MA 02i70 ,- Expiration Commissioner 04/01/2015 (In �. e o •� z k O V M t � ti Lol � r � H (gn F � � ii PROPERTY ADDRESS ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED CSTATE LASS PCS I NBHD PAR KEY NO. 0412 FRESH HOLES ROAD 07 RB 400 07HY 01/04/96 1041 00 61AD R 96259 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS �, UNIT ADJ*D.UNIT La"d Byloate S"q D"ne".,on LOC./Y R.SPEC.CLASS ADJ. COND. P PRICE PRICE ACRES/UNITS VALUE Dd,_ptid, W I NE R, H O W A R O A TRUSTEE MAP I(Co. FFDa ,n,nues E #LAND 1 17,700 CARDS IN ACCOUNT — L 10 18LDG.SIT 1 X .11 =10 347 29999.9S 104099.9 .17 17700 NBLDG(S)-CARD-1 1 36,600 01 OF 01 A #PL 406 OFF 'BEARSE'S WAY COST 54300 N BATHS 2.0 U X C= 100 7000.00 7000.00 1.00 7000 a aDL LOT 58 MARKET D - NO BSMT S X C= 100 5.95 5.95 1440 8600-3 #RR 0576 INCOME A USE D APPRAISED VALUE D i A 54,300 A u PARCEL SUMMARY T S LAND 17700 A T SLOGS 36600 O-IMPS E TOTAL 54300 F E N CNST E N I DEED REFERENCE Type DATE s ono-- PRIOR YEAR VALUE A Book Page Mo. Y, D LAND 17700 T C129454 I,02/93 L 300000 BLDGS 36600 U C124898 : I:11 /91 L 60000 TOTAL 54300 R C117438 Ib5/89 B 1 . E BUILDING PERMIT —*NO ATTIC....... S N—be, De,e TYPe Amount LAND LAND—ADJ INC ME SE SP—BIOS FEATURES BLD—ADJS UNITS I 17700 1600 *87 RENOVATED 1 co"a. oral year B n No,m obs. I N F O A T DOOR. Class Units Units Base Rate Adl.Rate A 1fg Aga Dep,. Cond. CND. Loc- °ro R.G. Repl.Cast New Adj.Repl.Value Stories Heig nt Rooms ed Rms.Batas •Fia. Pe,tywell Fec. ................ 02C- 000 100 100 55.25 55.25 45 80 14 87 60 47 77960 36600 1 .0 8 4 2.0 8.0 Description Rate Square Feel Repl.Cos, MKT.INDEX. 1-00 IMP.BY/DATE: ML 9/87 SCALE: 1/00.75 ELEMENTS CODE CONSTRUCTION DETAIL S SAS 100 55.25 1440 79560 GROSS AREA 1440 TWO FAMILY DWELLING CNST GP:00 T *---------------------60--------------------* STYLE 17DUPLEX Oa '- ! OE3fGN-ADJMT -00 ----- -----0. R ! ! EXTER.WALLS f1i�00D SHINGLES 0. U ! ! REATIAC P TYE 1iGAS—WARMAIR______0. C _ - ! ! INTER.FINISH 04DRYW __ __ALL 0. T 24 BASE 24 i_NTER.LAYOUT _12AVER./N0 L_RMA 0._ U NTER._QUALTT 02 SAME AS EXTER. 0a0 R ! ! ! FLUORSTRUCT04CON'CRETE SLAB 0. A W! ! EFL00R_COVER _ _ T 04CARAE 0. A,eas A"aa Base= 1440 ! ! OOFTYPE ___ 01GABLE—AS PHS H_ 0.0 BUILDING DIMENSIONS #---------------------60--------------------X ELECTRICAL _Oi AVERAGE _____�__ ____ 0.0 A AS W60 N24 E60 S14 .. FOUNDATION i33CONCRETE SLA3 99.0 -------------- - --- --- L ---------- I ___ FI NEIGBORHOOD 65AD_ HYANNIS------- LAND TOTAL MARKET PARCEL 17700 54300 AREA 3871 VARIANCE +O +1303 STANDARD 25 OL RESIDENTIAL PROPERTY MAP NO. LOT NO. el 6 FIRE DISTRICT SUMMARY STREET O off BearseIs Way Hyannis H 93 LAND x u u 292 -�`'- BLDGS.TOTAL 162 OWNER l ..E �.:�,�...�,... y 0 6 __ .. LAND RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: �/(� �� BLDGS. 01 L TOTAL LAND BLDGS. TOTAL �v,p ^�. C � LAND :=Jon E1 i zabe/th'C Trustee LGL, Trust ` 12-19-7 Ctf. 50213 gee, 'l BLDGS. �G HOC TOTAL r� LAND C DO L,3&Al }!�/G /7 s.e AlTs BLDGS. S OS OAl Q- D / LANDL BLDGS. 0) TOTAL LAND CD BLDGS. TOTAL LAND INTERIOR INSPECTED: BLDGS. TOTAL I` DATE. _2 -7 7 fflll2zA2_ LAND ACREAGE CO U ATIONS BLDGS. D TYPE # OF ACRES PRICE TOTAL DEPR. VALUE .- TOTAL HOUSE /Z lo o a n -/;. 0 C. 4 a.o U LAND CLEARED FRONT BLDGS. REAR TOTAL WOODS✓I<SPROUT FRONT LAND REAR BLDGS. j WASTE FRONT .- TOTAL _ REAR LAND BLDGS. TOTAL LAND BLDGS. LOT COMPUTATIONS ti LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ROUGH TOWN WATER BLDGS. rn HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND f•UUIVUHIIVIJ '�Z ll..l . . no.Waft Fin.Bsmt.Area Bath Room Base LAND COST �•�,� ' � BLDG.COST ne. Blk.Walls Bsmt. Ree. Room St.Shower Bath Bsmt. _ ' PURCH. DATE nc. Slab Bsmt.Garage St. Shower Ext. Walls PURCH. PRICE F Stein . Ick Walls Attic Toilet Room Roof RENT ne Wells Fin.Attic Two Fixt. Bath Floors n INTERIOR FINISH Lavatory Extra _ mt. F 1 2 3 Sink yx 1/4Plaster Water Clo. Extra Attic r Zoo XTERIOR WALLS Knotty Pine Water Only uble Siding Plywood No Plumbing Bsmt. Fin. gle Siding Plasterboard IInt.Fin. lvaShingles TILING f v • e.Blk. G F P Bath FI. Heat e Brk.On Int.Layout Bath F.&Wains. Auto Ht.Unit veneer Int.Cond. Bath Fl.&Walls Fireplace . Brk.On H EATING Toilet Rm.FI. plumbing id Com.Brk. Hot Air Toilet Rm.FI.&Wains. Tiling Steam Toilet Rm.Ff.&Walls nket Ins. Hot Water jQh St. Shower f Ins. Air Cond. Tub Area #1 Total �y. Floor Furn. ROOFING 7 a nc 5 COMPUTATIONS ' h.Shingle Pipeless Furn. O S.F. 142 111V �> d Shingle No Heat S.F. s. Shingle Oil Burner S.F. ' Is Coal Stoker S.F. e Gas S. F. OUTBUILDINGS ROOF TYPE Electric ble Flat S.F. 1 2 3 4 5 B 7 8 9 10 1 2 3 4 5 6 7 8 9 10 MEASURED Mansard FIREPLACES S.F. Pier Found. Floor mbrel Fireplace Stack Wail Found. 0. H.Door LISTED FLOORS Fireplace Sgle.Sdg. Roll Roofing Inc.___ LIGHTING Dble.Sdg. Shingle Roof rth No Elect. DATE Shingle Walls Plumbing - e _ rdwood ROOMS Cement Blk. Electric ph.Tile Bsmt. 1st TOTAL ` � o ' Brick Int.Finish P D ngle 2nd 3rd FACTOR (. V REPLACEMENT a 3 t/7 A OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL. LG. le,A, y t ' 2 3 4 5 ` 6 7 B 9 -- !O • TOTAL,_,- 4 ' R292 162 . op P R A I S A L D A T A• KEY 203559 WINER, HOWARD A TRUSTEE LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 17, 700 36, 600 1 A-COST 54, 300 B-MKT BY 00/ BY ML 9/87 C-INCOME PCA=1041 PCS=00 SIZE= 1440 JUST-VAL 54, 300 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 63AD -- TREND EXCEEDS STANDARD NEIGHBORHOOD 63AD HYANNIS PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 177001 LAND-MEAN +Oo 543001 54197 IMPROVED-MEAN -320-. 250-o ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 10001 LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP] ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] R292 162 . is P E R M I T [PMT] ACTISR] CARD [000] KEY 203559 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR oCMP NEW/DEMO COMMENT [ J [ ] [ ] [ ] ] [ ] [ ] [ J [ J [ ] [ ] [ ] [R292 162 . ] LOC] 0412 FRESH HOLES OAD CTY] 07 TDS] 400 H KEY] 203559 ----MAILING ADDRESS------- PCA11041 PCS100 YR100 PARENT] 0 WINER, HOWARD A TRUSTEE MAP] AREA163AD JV1407606 MTG10000 P 0 BOX 434 SP1] SP21 SP31 UT11 UT21 . 17 SQ FT] 1440 HARWICHPORT MA 02646 AYB] 1945 EYB] 1980 OBS] CONST] 0000 LAND 17700 IMP 36600 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 54300 REA CLASSIFIED #LAND 1 17, 700 ASD LND 17700 ASD IMP 36600 ASD OTH #BLDG(S) -CARD-1 1 36, 600 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 406 OFF BEARSE' S WAY TAX EXEMPT #DL LOT 58 RESIDENT'L 54300 54300 54300 #RR 0576 OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE102/93 PRICE] 300000 ORBIC129454 AFD] I L LAST ACTIVITY] 08/29/96 PCR] Y Town of Barnstable Regulatory Services T01,7114 0r- 11_1�[11 -IS- j#F oFt Top, Thomas F. Geiler, Director Building Division 1fil" ? 12 N 1: 58 • .�i,� BARNSPABM ` Thomas Per CBO Building Commissioner v MASS. g Perry, g `bAr 1639. ,�e 200 Main Street, Hyannis, MA 02601 EO MA'S www.town.barnstable.ma.us }}" ,1p77 _ �• E Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable, Family Apartment Affidavit.. I, being on oath, depose and state as follows: My name is t �� I am the owner/resident of the property located at: D The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: Name & relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, 1 will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. 1 understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.I Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this C> day of J 2011. Signature Phone Number Print Name