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0800 BEARSE'S WAY (38)
��� �I I Town of Barnstable yoFz�r� Regulatory Services o Thomas F.Geiler,Director Building Division MRNSTABLE. M+sSI. g Tom Perry,Building Commissioner ��Fot►�� 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: i HOME OCCUPATION REGISTRATION Date: / 60 Name: hone#: 7 7 L4 Address---.. J —l�Cv✓l 1f' I e��j V�llage:_J�L�� ✓0 "� Name of Business: Type of Business: [ i Q.Io 1 /� Map/Lot: . - 11,4`1 .N'I': It is the intent of this section to allow the residents.of the Town of Barnstable to operate a home occupation within single family dwellings, subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: e The activity is tamed on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. o Such use occupies no more than 400 square feet of space:. - O There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does pot involve the production of offensive noise,vibration,smoke,dust or other particular matter,' odors,electrical disturbance,heat,glare,humidity or other objectionable effects. . o There is no-stomge-or use of toxic or-hazardous materials,or flammable or explosive materials,in excess of normal household quantities. 0 Any need for parking generated by such use shall be met.on the same Iot containing the Customary Home Occupation, and not within the,required front yard. • There is no exterior storage or display of materi r� W� 44q���,� Y .There is no commercial vehicles related to the Customary Home CrccapadcQ other than one van or one pick-up-tr.uek-not.to•exceed•one ton.-capacity,and one trailer not to exceed 20 feet in length and not to -... . — exc=d 4 tires,parked.on the same lot containing Customary Home Occupation. • No sign shall be displayed indicating the Custoniaryy 8Yne4pi b4dgrVk e If the Customary Home Occupation is listed or adv, rtised as a business,the 'geet address shall not be 5 r included. _.: V 4,lFik�"5 • No person shall be employed in the Customary Home Occupation vvho'is iot a permanent resident of the dwelling unit . I, the undersigne have read and agree with the above restrictions for my home occupation I am registering. Applicant' c Date:. �I YOU WISH TO OPEN A BUSINESS? ,y For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to p a'Ve.Business Certificates are available at the Town Clerk's Office, 1 s`FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) E t N�� DATE: Cl Fill in please: . APPLICANT'S YOUR NAME/S: BUSINESS, `_�j YOUR HOME ADDRESS: lr°'t lt�ra� N .al yes bl ���JS S q- TELEPHONE # Home Telephone Number - - S r ;, 'fie a§uac I NAME OF CORPORATION: NAME OF NEW BUSINESS --1 TYPE OF BUSINESS C CL Rio �PS i S IS THIS A HOME OCCUPATION? ESQ �Nd oLcoo, pr/ ADDRESS OF BUSINESS_ �1 n MAP/PARCEL NUMBER o2/ 7 t1Q- W� (Assessing) When starting a new business there are severs hings you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate you siness in this town. 1. BUILDING COMMISSIONER'S 0Vd E KThis individual has en i of a y ermit requirements that pertain to this type of business. 3- uthorized Signature** �T iV)l�Sl COMPLY OMMENTS: ' r�� ' . v u' L- - AND TO 1 COMPLY MAY RMLT IN FINES.FAILURY 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �Gr�fi 1 i Map Parcel Permit# 3 s,�s Health Division `?-0 U wn war Date Issued /-;Z/ O'S Conservation Division Application Fee Tax Collector Permit Feet/ -c"d . 0 d Treasurer CONNECTED SEWER ACCOUNT Planning Dept. Date Definitive Plan Approved by Planning Board #--0 6 ��--- Historic-OKH Preservation/Hyannis Project Street Address Village /� Owner � i° �,�OSS1UXQS C.d/UW/A114?M Address bol/�i Telephone 792—949/ Permit Request lle! ' T Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain D Groundwater Overlay 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 BUILDER INFORMATION Name Telephone Number 79! Address �'� S�S /✓�' License# Z Z l7 9 64AK /1/L 6' Home Improvement Contractor# Worker's Compensation# �c 9�0 390 9 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO v— SIGNATURE DATE �� ` r FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE 4 OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH n FINAL S. - PLUMBING: ROUGH-;; FINAL GAS: ROUGH M FINAL co FINAL BUILDING oC _ DATE CLOSED OUT ASSOCIATION PLAN NO. I , v " The Commonwealth of Massachusetts ; Department of Industrial Accidents 600 Washington Street Boston,Mass. 02111 rkers' Co ensation Insurance Affidavit-General Businesses name: LL Q�� address' 097ap-,hone# 9 9 410 city Work site kocetion(full eddreasl a �� -S�s ❑ I am a sole proprietor and have no one Business Type: ❑Retail Restaurant/Bar/EatmgEstsblishment working in any capacity ❑Office❑Sales(including Real Estate,Autos etc.) (�I am an em to er with eta 1 es full& art time). ❑Other �I am an employer providing-workers' compensation for my employees working on this job. P. com�aav name Y address 'l�'/�'•�',`4r'��,��'�. �•LL�"• —• /e /./•7 ,�^/�� ../q tihon #• '.!B :`•. �• :.' �.�' �:�•" insurance.cb=•= ,r9` L` 06.'.# .202 I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: com an address: •. .�.,• ..' •-,.•,. fione-# coin•en: iYeate. .. ,• .. •.. . '. ' " t olicv# r Fallura Yo secure coverage as required Hader Section 25A of MGL 152 can lead to the imposition of criminal penalties of a One up to$1,500.00 and/or one years'imprisonment as well ctvll penalties in the form of a STOP wORK ORDER and a fine of S100.00 a day against me.I understand tbat p copy o{this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby c!;�+-r n the ains and penalties of perjury that the information provided above is u a d torte L ..� Data Signature - ' c q q print name • ~official use only do not write in this area to be completed by city or town official city or town: permittlicense# ❑Build'mg Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office Dliealth Department contactperson: phone#-, ❑0ther _ (Twined Sept 20M) Information and Instructions 1 eo Massachusetts General Laws chapter 152 section 25 requires all emp o3' provide workers' compensation for their employers tmeso in the service-of another under a�contract employees. As quoted from the"law", an employee is defined as every p 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. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance dr renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work untrl acceptable evidence,of compliance with the insurance requirements of this chapter have been presented to the contracting authority. , Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Department of rndustrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law" or if you are required to obtain a workers' compensation policy,please call the Department at the number listed Wow. City or Towns Please be sure that the affidavit is complete and printed legibly. The Departrnent 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 perrrit(license number which will b'e used as a reference number. The affidavits maybe returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. NNEME The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents on of IavMstipsdgns 600 Washington Street Boston,Ma. 02111 fag#: (617)727-7749 phone#: (617) 727-4900 ext.406 Client#: 34169 SCHERPRO .ACORD,,. CERTIFICATE OF LIABILITY INSURANCE T 1DATE 2/30/04D ) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION STARKWEATHER&SHEPLEY(MA) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 400 Blue Hill Drive HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 188 Westwood,MA 02090-2161 INSURERS AFFORDING COVERAGE NAIC# INSURED - INSURER A: Arbella Protection Ins. Schernecker Property Services,Inc. INSURER B: Federal Insurance Co. 179 Bear Hill Road INSURER c: American Int'I Group Waltham,MA 02451 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. t INSR DD' 7YPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION 'LIMITS LTR NSR DATE MMIDD/YY DATE MM/DD/YY A GENERAL LIABILITY 8500022200 06/01/04 06/01/05 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DAMAGES(Ea occurrence)RENTED $300 000 CLAIMS MADE Ex-]OCCUR MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 tOLICY AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1000000 JE T LOC A AUTOMOBILE LIABILITY 15805400002 '06101/04 06/01/05 COMBINED SINGLE LIMIT X ANYAUTO (Ea accident) $1,000,000 ALL OWNED AUTOS - BODILY INJURY $ SCHEDULED AUTOS - - (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESSIUMBRELLA LIABILITY 79823432 06/01/04 06/01/05 EACH OCCURRENCE s5,000,000 X1 OCCUR CLAIMS MADE AGGREGATE $S 000 000 $ DEDUCTIBLE $ X RETENTION $O $ C WORKERS COMPENSATION AND WC9683909 - 01/01/05 01/01/06 X OR L"TAT'U- O R EMPLOYERS'LIABILITY - ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE s500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT s500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Evidence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Schernecker Property Services, - DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'In DAYS WRITTEN Inc. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 179 Bear Hill Road IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Waltham,MA 02451 - REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #M113133 PSA © ACORD CORPORATION 1988 BOARD OF BUILDING REG� #License CONSTRUCTION SUPERVISOR Nun-- CS 084622 Birthdate 11/05/1970 Expires 11/05/2006 Tr:no; 84622 Restricted i00= TIM iMANNY j 22 QRCHARD ST CAMBRIDGE MA '02140 1 Administrator p l"��2/y11 S'S i io/� �ti