HomeMy WebLinkAbout00220024 FRESH HOLES RD CIC
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---TO ALL NEW BUSINESS OWNERS � 9C717
DATE: i _
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Fill in please: "`jam immr SA'�kOS
APPLICANT'S "" �' 3y YOUR NAME: U ` `
BUSINESS 'W ge Y Uq HOME,ADDRESS: (nES
e
TELEPHONETelephone Number Home 3 09 9 C
NAME OF NEW BUSINESS x) TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? YES. NO L
Have you been given appr. f r the bu'Iding division? Y
ADDRESS-OF-BUSINESS��It" �1 L .D MAP/PARCEL NUMBER
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of t Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. Once'you have obtained the required signatures, listed
below,you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall). You MUST go to the following office to make sure you
have all the required permits and licenses..
GO TO 200 Main St. - (co r of Yarmouth Rd. Main Street) and you will find the following offices:
1.. BUILOING C MIOSIO R'S OF
This individual s b �n info ed of r req irements that pertain to this type of business.
i
A th ed Si nature**.
COMMENTS: -C—M-wwa— &�
2. BOARD OF HEALTH
This individual has r d the ermit requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has n infor ed of the It rements that pertain to this type of business.
Authorized Signature**
COMMENTS:
Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L.
-it does not give you permission to o erate-you must get that through completion of the processes from the various departments involved.
**SIGNIFIES APPROVAL FORA BUSINESS CERT/F/GATE ONL Y.
l�
Town of Barnstable
�TME l Regulatory ServicesIq CA
Thomas F.Geiler,Director 62
»STAB Building Division
v� MASS' $ Tom Perry,Building Commissioner
.9 i6g �0
A�E A 200 Main Street, .Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Approved:
Fee: CC)
Permit#:
HOME OCCUPATION REGISTRATION
Date: . OS
Name: 1`� i I- /Jd SA tA��to I� 0 c��2t:C
Phone#: O 7
Address: 22,5 Village: AN u l
Name of Business: N1
Type �—;p•��s e.A.V�
T e of Business: Map/Lot:
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the
activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual
alteration to the premises which would suggest anything other than a residential use;no increase in 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:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located
within that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there
is no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular
matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess
of normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There is no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
I,the undersigned,ha a read and agr " with the b ve restrictions for my home occupation I am registering.
Applicant: P
PP i to OS
• Date: �i ���
Homeoc.doc Rev.5/30/03
Town of Barnstable
406
Regulatory Services
THE 1p�
Thomas F.Geiler,Director TOWN Or ARMST ATHE
• Building Division
sna#vsrnaLE.
v Mass. $ Tom Per Building Commissioner f f= tt I I�
163q. `� �� g �E1�2 v � t. � # t
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 D I��I r Fax: 508-790-6230
Approved:
Fee: r1—O
Permit#:
HOME OCCUPATION REGISTRATION
Date:0 6 ! 1( 11
Name: � � 1•.C,�� K?C SOU RA Phone#: l S0
Ad ss: Z I l S (1 0L 6 a 12, Village: y� it Z,411
Name # s i ss:1U/ 0 e L ,I/ A
Type of Business: Sou& Cr— h E41179� Map/Lot:
IN'rENT: It is the intent of this section to allow the residents of the Tovnm of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of die 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:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located vvithin
that divvelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there is
no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,
odors,electrical disturbance,heat,glare,hunnidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,ii excess of
normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required fi-ont yard.
• There is no exterior storage or display of materials or equipment.
• There are no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,quid one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
.• No sign shall be displayed indicating the Customay Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed ii the Customary Home Occupation vvho is not a permanent resident of the
dvvvelling unit.
I,the undersigned,hav and agree wid1 tine above restrictions for my home occupation I am registeriig.
Applicant: Date:
Homeoc.doc Rev.01/3/08
YOU WISH TO OPEN A BUSINESS?
For Your Information: . Business certificates (cost$40.00 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 operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required bylaw.
DATE: O60 IZ Fill in please:
APPLICANT'S YOUR NAME/S: Vtglofti IOU ,I
BUSINESS YOUR HOME ADDRESS: �Y �h G S ha [40(, 6 h-01
36 —`P5SB - 0 60 �
1 4 TELEPHONE # Hbme Telephone Number a
NAME OF CORPORATION: L' SS - 3
!. NAME OF NEW BUSINESS (Al D C, ivt TYPE OF BUSINESS U r
IS THIS A HOME OCCUPATION? YES NO
M ADDRESS OF BUSINESS O MAP/PARCEL NUMBER24 Z) (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of .
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - [corner of Yarmouth
Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this toeirn.
1. BUILDING COMMISSIONER'S OFFICE This individual has been in o�med f ny permit requirements that pertain to this e f
�— MUST CM�L ' { HOME OCCUPATION
Authorized ture* RULES AND REGULATIONS, FAILURE TO
COMMENTS: G '
2.. BOARD OF HEALTH
This individual has be inf r �,cyf permit requirements that pertain.to this type of business.
Authorized Signature*
COMMENTS:
3. CONSUMER AFFAIRS[LICENSING-AUTHORITY)
This individual has bq/-" infor e licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
oFTHE rq,,, Town of Barnstable
Regulatory Services
" sAxi �.
MASS. ` Thomas F. Geiler,Director
� A99.
1 9,- Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 5087790-6230
March 8, 2011
Dear Property Owner,
This letter is to inform you that Regulatory Services canvassed the general area of Hiramar and
Fresh Hole Roads on Friday afternoon, March 4, 2011 in an attempt to assess the current
conditions of the properties located in this area. '
This department recommends that all landlords personally inspect their property in order to
obtain an accurate assessment of their individual rentals. For your convenience I am identifying
the findings in a generic list below:
• Broken window panes and storm doors.
• Failed glass
• Missing storm doors:
• Torn or missing screens'
• Broken glass strewn along the perimeter of dwellings
• . Broken glass surrounding dumpsters and in parking areas
• Peeling paint
• Uncontained outside storage of household trash
• Abandoned appliances outside
• Missing or clogged gutters
• Failure to post contrasting house numbers
• Rotting window sills and support posts
• Missing or broken outside lighting fixtures
• Blocked egress including a rear exit nailed shut.
In addition, landlords should confirm that all units have the adequate number of operable smoke
detectors properly placed as required and units relying on fossil fuels are also required to have
carbon monoxide detectors.
Please feel free to contact me directly at 508-862-4027 in the event that you require additional
information concerning this letter.
i erely,
rYQ —
Robin C. Anderson
Zoning Enforcement Officer
CC:Chief Paul MacDonald,BPD,Debra Dagwan,Town Council
t . FROM LYON EXPO+TENT/PROMO,* BUS. DICE PHONE NO. 509 779 5042 DE-C. 04 1998 02:37PM P1
INDIGO MANAGEMENT, INC.
POST OFFICE BOX 64
HYANNISPORT, MA 02647
(508) 778-5042
12-4-98
To: Ralph Crossen @ Building Dept.
Re: 22-24 Fresh Holes Road
Sir;
We hereby request a site visit by a member of your department related to the
following two items:
1) Certify #24 for re-occupancy
This side was unaffected by the fire, and has been inspected by Homestead
Construction (see enclosed letter), had the panel upgraded to 100amps by
Roger.Medeiros Electrician (see enclosed invoice), and Ted Hyora Plumbing.
ComElectric has reconnected the power,,and the unit appears to be "good to
go„
2) Unif #22. Advise us as to your department's requirements, beyond the obvious,
All furniture and contents have been removed. Panel has been upgraded to 100
amps by Medeiros Electricians. Majik Clean will be on-site today to spray for
smoke damage and odor.
Four windows have been replaced, as per building permit #34871, About 12
rafters appear to have been affected by the fire, but it seems that amounts to
smoke damage rather than structural damage. .
Sincerely;
Jeffrey A. Lyon - =- `
President
i FROM : LYON EXPD+TENT/PPDMD* BUS. DIGE PHONE NO. : 503 7 3 5342 DEC. 04 1998 02:37PM P2
BUILDING & REMODELING
Gate November 12 , 1996
Ta.: Mr . Jeff Lyon
From John q 'Pour ke
Re Property i3t 24 ,tv Fre3;;h Holes Rd , , Hysnni
Far your request Z vie.ited and inspected 'they prdpert:y at;
thy,•, above. address on 10 2/98 after the right .side. uni #
2 21 , had been dama,jed by fire . The purpose of my inspection
wa:: to determine if the left, ::ide of the duplex house , tanit
# 44 , was structurally sownd and safe to reoccupy .
Yes . the left side , unit # 24 . iS suitable for reoi cupanc.y
with the exQopt:ion of a few minor mai nvp-vance deta.i l�^ . The
contant.s of the attic above whilch were damaged by smoke cr'
�4at-er Whouid be removed . The o;;eri area .in the fire rated
wail between the attic sections needs to be Covered ove:-
with fire rated sheetrock . Ore oaf the window:., on the front.
of the house needs a. sash lock and screen, all else
appears acceptable .
please call me with any questions you may have ,
John O'Rourke
mass Const Supv Lic 0 042182 wy no restrictions
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Pp 86x 272 Ya Mouthport,MassjohusittS 02675 'S0$.362:3393 Mays. Reg. 0 114156
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��s �
y TOWN OF BARNSTABLE BUILDING PERMIT-APPLICATION
Map ,k� Parcel = 0 f Permit#
Health Division - 0�� ����y��. Date Issued
ENVIR® plr`e sUP
�C�
Tax Collector oG arc��� I NZAL"
Treasurer'
Planning Dept. f
Date Definitive Plan Approved by Planning Board
Historic-.OKH Preservation/Hyannis
_ .
Project Street nAddress
Village
Owner t f (3 i. ,. L (� �A n�- Slit Address
�`, C®�f y,� ��s , O2-C�Y,
Q
Telephone 0
Permit Request
Square feet: 1 st floor: existing O proposed 2nd floor: existing proposed Total new
Estimated Project Cost Zoning,District Flood Plain Groundwater Overlay
Construction Type
Lot Size L^'e ` Grandfathered: ❑Yes ❑No If yes,attach supporting documentation.
Dwelling Type: Single Family ❑ ;Two Family 0'-- Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes. *Ne- On Old King's Highway: ❑Yes a;�ALQ
Basement Type: ❑Full ❑Crawl ❑Walkout E=0ther S LA%
Basement Finished Area(sq.ft.) /`1 p_� Basement Unfinished Area(sq.ft) A� I-�'V_
Number of Baths: Full: existing. ® P>-Q new Half: existing new N A
Number of Bedrooms: existing new /i (A - -
Total Room Count(not including baths):existing new First Floor Room Count
Heat Type and Fuel: I&Gas ❑Oil ❑ Electric ❑Other '
Central Air: ❑Yes �ift- Fireplaces: Existing ^,0 New Existing wood/coal stove: ❑Yes
Detached garage:❑existing ❑new size ^-)a Pool:❑existing ❑new size Barn:❑existing ❑new .size
Attached garage:❑existing, ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal#A Recorded❑
Commercial ❑Yes AMo If yes,site plan review#
Current Use Proposed Use'
BUILDER INFORMATION
d Name Telephone'Number
Address License
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
4 "
02
SIGNATURE -��• ,e; DATE
j}
FOR OFFICIAL USE ONLY y ,'
PERMIT NO. V z-
DATE ISSUED
MAP/PARCEL NO.
14
ADDRESS' '.. 1 t VILLAGE
OWNER
DATE OF INSPECT(
FOUNDATION
FRAME i,
INSULATION;
FIREPLACE
ELECTRICAL: (ROUGH FINAL. ,
PLUMBING: ROUGH . FINAL -
GAS: " ROUGH (FINAL
FINAL BUILDING
/ • y n f _ e
J
DATE CLOSED OUT
ASSOCIATION PLAN NO.
The own ot Barnstable
Department of Health Safety and Environmental Services
Eo ' Building Division
367 Main Street,Hyannis MA 02601 :
Office: 508-862-4038 I' Ralph Crossen
Fax: 508-790-6230 Building'Commissioner
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-existirig 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. - I Ii -
�t�� 1 �,,,.�oa s -'- Pam'`
Type of Work: �{ �2 �- Estimated Cost
Address of Work: ®1 � v N�� '� S / �✓ f�M-� S
•d
Owner's Name:
Date of Application:
I hereby certify that:
Registration is•'not required for the following reason(s):
Work excluded by law
[5Yob Under S1,000
Building not owner-occupied
[gewner 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.
OR
Date / / er's Name
q:forms:Affidav
730 OAR Appends J
Table JS2.Ib(condoned)
prescriptive Packages for One and Two-Fatuity Residential Buildings Hated with Fossil Futh
MAXIMUM MINIMUM
Glazing Glazing Ceiling wail Floor Basement Slab Heating/Cooling
Area'(%) U-value= R-value' R-value' R value] wall pc:=cta Egwpmem Effrctencr�
Pachaae I I I R value` R value'
5701 to 6S00 Hating Degree Darn'
Q 1211. 0.40 38 13 19 10 6 Normal
R 12% 0.52 30 19 19 10 6 Normal
S 1211. 0.50 38 13 19 10 6 85 AFUE
T 15% 0.36 38 1 13 23 WA WA Normal
U 15% 0.46 38 19 19 10 6 Normal
V 15% 0.44 38 13 2S WA WA IS ARM
W 15% 0.52 30 19 19 10 6 83 AFUE
X 19% 0.32 38 13 25 N/A N/A Normal
Y 19% 0.42 38 19 25 WA WA Normal
Z 18% 0.42 38 13 19 10 6 "AFUE
AA 18% 0.50 30 19 19 10 6 90 AFUE
1. ADDRESS OF PROPERTY:
2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS:
3. SQUARE FOOTAGE OF ALL GLAZING.
4. %GLAZING AREA(#3 DIVIDED BY#2):
5. SELECT PACKAGE(Q--AA-see chart above):
NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS
ARE AVAILABLE. ASK US FOR THIS INFORMATION.
f
BUILDING INSPECTOR APPROVAL:
YES: NO:
q-forms-i980303a
780 CMR Appendix J
Footnotes to Table J5.2.1b:
Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights,. and
basement windows if located in walls that enclose conditioned space, but excluding opaque doors)to the gross wall
area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement.
For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area.
2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with
the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for
whole units: center-of-glass U-values cannot be used.
' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full
insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38
insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity
insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between
the conditioned space and the ventilated portion of the roof.
'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include
exterior siding, structural sheathing, and interior drywall. For example, an R-19 requirement could be met EITHER
by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to
wood-frame or mass(concrete,masonry, log)wall constructions,but do not apply to metal-frame construction.
'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces, basements,
or garages). Floors over outside air must meet the ceiling requirements.
`The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must
meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned
basements must be included with the other glazing. Basement doors must meet the door U-value requirement
described in Note b.
'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs.
' If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. If you plan to install more
than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest
efficiency must meet or exceed the efficiency required by the selected package.
'For Heating Degree Day requirements of the closest city or town see Table J5.2.1a
NOTES:
a) Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels.
R-value requirements are for insulation only and do not include structural components.
b) Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested
and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value
in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the
glass area of the door with your windows and use the opaque door U-value to determine compliance of the door.
One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35).
c) If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with
different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to
the R-value requirement for that component. Glazing or door components comply if the area-weighted average U-
value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors).
43
s - The Commonwealth of Massachusetts
+ _ .. ........
Department of Industrial Accidents
� -�-- -= t-�-�� Officeofi�lvestigatians
s; 600 Washington Street
Boston,Mass. 02111
Workers' Compensation Insurance Affidavit
name: rJ �` AA rl
location:
city ohone#
E-1 am a homeowner pertorming all work myself.
❑ I am a sole proprietor and have no one workin in a ca acity
P%%Irro%%///%
❑ I am an employer providing workers' compensation for my employees working on this job.
contpnny name:
address:
city: phone#:
insurance co. nolicy#
❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who
have
the folloi�ing workers' compensation polices:
company name:
address•
city: phone#•
..
insurnnce cn. PORV#.
company name- _. .;...:..:;: .... ..
address.
city^
phone
insurance CO. polig#
#+�w > %%//%%�%%/////�/%%/�////�%//D//// / /
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to 51.500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a
copy of this statement may be forwarded to the OIIIce of Investigations of the DU for coverage verification.
I do hereby certify under t pains and ies of periury that the information provided above is true and correct.
Signature ✓� `� S Date
Print name 1' L Phone# 0t—
official use only do not write in this area to be completed by city or town otIIciai
city or town: permit/llcense# ❑Building Department
❑Licensing Board
❑check if Immediate response is required ❑Selectmen's OMce
❑Health Department
contact person: phone#; ❑Other
(cnvea W95 PIA)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", an employee is defined as every person in the service of another under any coat z. .
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 recmve:c:
trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a
dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of
another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or
building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency;shall withhold the issuance or renewa:
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has
not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the
commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until
acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting
authority.
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is
being requested, not the Department of Industrial Accidents. Should you have any questions regarding the`law"or if you
are required to obtain a workers' compensation policy, please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the
affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be retuned io
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.
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
8111ce of imlesugatlons
600 Washington Street
Boston;Ma. 02111
fax#: (617) 727-7749
phone#: (617) 7274900 ext. 406, 409 or 375
The Town of Barnstable
'THE
o Department of Health Safety and Environmental Services
Building Division
BARNSPABLB. ` 367 Main Street,Hyannis MA 02601
MASS.
�prFO 1639.
Office: 508-8624038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
HOMEOWNER LICENSE EXEMPTION
Q � Please Print
}
DATE: ' U / 9 / (j
JOB LOCATION: DC �'�- lV ( / —a( t�y 1��✓ s�� S
number street /,� village
.HOMEOWNER": �� L �� a� ? �' `2 2 7y—
name home phone# work phone#
CURRENT MAILING ADDRESS: OZG /
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-aermit. (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.
Signature of Hom ner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the
provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for
hire to do such work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,
particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would
with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used
by several towns. You may care to amend and adopt such a form/certification for use in your community.
Q:FORM&EXEMPT
i
A
[ ] [R292 183 . ]
LOC] 0022 FRESH HOLES ROAD CTY] 07 TDS] 400 HY KEY] 203737
----MAILING ADDRESS------- PCA11041 PCS100 YR100 PARENT] 0
LYON, JENNIFER TR MAP] AREA] 63AD JV] 380787 MTG] 0000
FRESH HOLES RD TRUST SP1] SP21 SP31
PO BOX 611 UT11 UT21 . 14 SQ FT] 1440
HYANNISPORT MA 02647 AYB11945 EYB11980 OBS] CONST]
0000 LAND 17100 IMP 36600 OTHER
----LEGAL DESCRIPTION---- TRUE MKT 53700 REA CLASSIFIED
#LAND 1 17, 100 ASD LND 17100 ASD IMP 36600 ASD OTH
#BLDG (S) -CARD-1 1 36, 600 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE
#PL 22 FRESH HOLES RD HY TAX EXEMPT
#DL LOT 8 RESIDENT'L 53700 53700 53700
#RR 0576 0101 OPEN SPACE
COMMERCIAL
INDUSTRIAL
EXEMPTIONS
SALE] 11/96 PRICE] 100 ORBI C142747 AFD] I A
LAST ACTIVITY] 01/13/97 PCR] Y
S
R292 183 . P R A I S A L D A T A• KEY 203737
LYON, JENNIFER TR
LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB
17, 100 36, 600 1 A-COST 53 , 700
B-MKT
BY , 00/ BY ML 9/87 C-INCOME
PCA=1041 PCS=00 SIZE= 1440 JUST-VAL 53 , 700
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
171001 LAND-MEAN +Oo
537001 54197 IMPROVED-MEAN -320 250
] FRONT-FT
] 100 DEPTH/ACRES TABLE 02
1000] LOCATION-ADJ APPLY-VAL-STAT 1
LNR] LAND LFT/IMP]ADDS/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 [?]
t
R292 183 . • P E R M I T [PMT] ACTId*R] CARD [000] KEY 203737
000000001
PERMIT-NO MO YR TYPE VALUE CK-BY MO YR oCMP NEW/DEMO COMMENT
i
RESIDENTIAL PROPERTY
FIRE DISTRICT
MAP NO. LOT NO. Z SUMMARY
STREET Fresh Holes Rd. Hyannis x .•
` 73 LAND 3 kv,
BLDGS. 15S 6..)
i83 OWNER v*�G�l-✓ .� e�&t a �yd.V'/�...cy TOTAL ,.?33ua
rn
LAND _.
RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: BLDGS.
TOTAL
h"k Lawrence bf
G. R. LAND
Adhk
•! l�P. OI BLDGS.
"3 8�/5 TOTAL
Brace 1.3 • LAND
09111hL. Elizabeth C. , Trustee (LGL Trust) 12-19-7 Ctf. 6021 '
� BLDGS.
7R1< E ILLA E f;SSoc . TOTAL
LAND
C� DO f �.N �N C 1-1 N� BLDGS.
TOTAL
V T S S O N MoL. f7 a,, LAND
BLDGS.
TOTAL
LAND
BLDGS.
TOTAL
LAND
BLDGS.
INTERIOR INSPECTED: C TOTAL
DATE: —� 7i , LAND
ACREAGE COMPUTATIONS BLDGS.
ND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL
HODS �/o • �y b O 0 a ��'�� 3 0 LAND
CLEARED FRONT 0, BLDGS.
REAR TOTAL
WOODS&SPROUT FRONT ABLDGS.
REAR
WASTE FRONT
REAR LAND
BLDGS.
TOTAL
LAND
!i ® 01 BLDGS.
LOT COMPUTATIONS LAND FACTORS TOTAL
FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND
U/
ROUGH TOWN WATER rn BLDGS.
HIGH GRAVEL RD. TOTAL
LOW DIRT RD. LAND
SWAMPY BLDGS.
_ � LAND COST
Cont.Walls Fin.Bsmt.Area Bath Room Base SLOG. COST
Conc. Bik.Walls Bsmt. Rec. Room 777 St. Shower Bath Bsmt. '
fa PURCH. DATE
Cone. Slab Bsmt.Garige St. Shower Ext. Walls
PURCH. PRICE.
Brick Walls Attic FK&Stairs Toilet Room
Roof RENT
Stone Walls Fin.Attic Two Fixt. Bath Floors '
Piers INTERIOR FINISH Lavatory Extra
i
Bsmt. F 1' 2 3 Sink AlaL'
sQ r/= r/� Plaster Water Clo. Extra Attic O D
EXTERIOR WALLS Knotty Pine Water Only
Double Siding Plywood PI No Plumbing Bsmt.Fin.
Single Siding Plasterboard Int. Fin.
Wd Shingles TILING C!' !
:one. Blk. G F P Bath FI. Heat j- 1660
Face Brk.On Int.Layout Bath fY&Wains. Auto Ht.Unit
Veneer int.Cond. Bath Fl.&Wells Fireplace
Com.Brk.On HEATING Toilet Rm. Fi.
Plumbing
Solid Com.Brk. Hot Air Toilet Rm.FI.&Wains.
Tiling D
_ Li rFloor
Toilet Rm.FI.&Wells
Blanket Ins. ter G j St. Shower
Roof Ins. d. Tub Area Total
may•
urn.
ROOFING -2, COMPUTATIONS '
Asph. Shingle Pipeless Furn. S. F. �� o
Wood Shingle No Heat S.F.
Asbs. Shingle Oil Burner S.F. r
Slate Coal Stoker S.F.
rile Gas S F OUTBUILDINGS
ROOF TYPE Electric
Gable Flat S.F. 1 2 3 4 1516 7 8 9 10 1 2 3 4 5 6 7 8 9 10 MEASURED
Hip Mensard FIREPLACES S.F. Pier Found. Floor
Gambrel Fireplace Stack I Wail Found. 0.H. Door LISTED
FLOORS Fireplace ISills.Sdg. Roll Roofing
Conc._ LIGHTING Dble.Sdg. Shingle Roof DATE
Earth No Elect. Shingle Walls Plumbing
Pine �_
Hardwood ROOMS Cement Bik. Electrie
Asph.Tile Bsmt. 1st f j TOTAL r Brick Int.Finish ED
Single 2nd 3rd FACTOR OEL
REPLACEMENT 3 Y
OCCUPA CY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYYS. VALUE Funct.Dep. ACTUAL VAL.
DWLG. P A 'S` — .3 y 2 A 7
1
2
3
4
5
6
7
B
9
10
' TOTAL
PROPERTY ADDRESS I I ZONING DISTRICT CODE SP-DISTS.I DATE PRINTED I STATE pCS I NBHO
CLASS KEY NO.
0022 FRESH HOLES ROAD 07 RB 400 07HY 01/04/96 1041 00 63AD R 9
LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS
v UNIT I ADJ'D.UNIT ACRES/UNITS VALUE Description JAROff, DAVID B MAp_
,.antl By/Oa,c Sou:Dnnenson LOC./YR.SPEC.CLASS ADJ. COND. PE
PRICE PRICE
CD. r-c.De aLlnues #LAN D 1 17,100 CARDS IN ACCOUNT —
L 10 18LDG_SIT 1 X .14 =10 407 29999.9 122099.9 .14 17100 #BLDG(S)—CARD-1 1 36,600 01 OF 01
A #PL 22 FRESH HOLES RD HY
N BATHS 2_0 U X C= 100 7000.0 7000.00 1.00 7000 B #DL LOT 8 MARKET
D — NO BSMT S X C= 100 5.9 5.95 1440 86UU-3 #RR 0576 0101 INCOME
USE
A I APPRAISED VALUE
D 53.700
A U J PARCEL SUMMARY
A
T S LAND 17100
A T BLDGS 36600
M
0—IMPS
TOTAL 53700
F E N CNST
E N I DEED REFERENCE Try DATE R�p,oea PRIOR YEAR VALUE
A T Book Page 'n�I Mo v..p sale.P,qe LAND 17100
T C121359 I,O8/90 B 100 BLDGS 36600
U C106902 :I I:06/86 N 460000 TOTAL 53700
R C103688 :I :10/85 N 2400000
E BUILDING PERMIT *87 RENOVATION..
SN.— Dete Ty- Amount ...............
17100
LAND ,LAND—ADJ INC ME SE SP—BEDS FEATURES BLD—ADJS UNITS 1600—
................
Cnns,. Tpi ai vegar Bull, Norn OUsv.
G i:,ss I Uni,s U—s Base Rate Adj.Ra,e All,� 1'9 Age De pr. Contl. CND. Loc. is R.G. Repl.Cos,Ne++ Atll.Repl.`/slue S,ories Heigrit Rooms op Rms Batns •Fi>. Pertyavell 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 Ra,e Squ ,Feet Repl.Cos, MKT.INDEX: 1.00 IMP.BY/DATE: ML 9/87 SCALE. 1/00.75 ELEMENTS CODE CONSTR UC TION DETAIL
S BAS 100 55.25 1440 79560 GROSS AREA 4 0 TWO FAMILY DWELLING CNST GP:00
T *---------------------60--------------------* STYLE 17 _
R
U T%I - _- -_ --DESIGN ADJ MT 00 ------ -------- 0 0.
EXTER.WALLS 11WOOD SHINGLES 0__
'• REAAC _TYPE 11GAS—YARN AIR _
T R 0.
INTE .FINISH 04DRYWALL 0.0
24 BASE 24 INTER.LAYOUT 12AVER.A ORM
U AL 0-0
INTER.QUALTY 02SAME AS E_XTER. 0.0
R _
A - FLOOR+STRUCT 04CON _
CRETE SLAB 0.0
L p W! ! E LOOR COVER_ 04CARPET 0.0
------------
`a,Areas Ape = Base= 44 ! ! DOf TYPE _01GABLE—AS_P__H__S_H_____6-0
BUI LOING DIMENSIONS *----------------- --------------------x —LECTRICAI 01 VERAGE _ 0.0
A AS W60 N24 E60 S24 .. FOUNDATION 03CONC0EYE SLAB 99.9
---- ---- - --- ----------------------
L
NEIGHBORHOOD 63AD HYANNIS
LAND TOTAL MARKET
PARCEL 17100 53700
AREA 3871
VARIANCE +0 +1287
STANDARD 25
��� T041fN OF SAHNSTABLH
REPORTS HMDNTAHY/CONTINUATI H"POUT
Vo
NAME (LAST, FIRST, MIDDLE) C�jJ�l�"1 '� C�/ 1 �\'�-�✓ DIVISION /D�PT �Q�s\
NOTE DETAILS i OBSERVATIONS-ITEMIZE EVIDENCE, SERIAL OS ETC- �
S10 Q r
SUBtt2^_TED BY �! /' PAGE t '/