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1
y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION )
Map Parcel 0 rfrpit# (<,6�
7 ra4#� oi"�e�� �EA
Health Division Q��N g e. 6/16 Date Issued
2004 MAY I 0 1
Conservation Division (�V LP/0`t -r% A�p akAe
Tax Collector 4 Permit Fee •ti
Treasurer Uf VAiIfIC SAY EI01 MUST BF
D IN
Planning Dept. INSTAL WITH TITLE 5LIANCE
Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND
y TOWN REGULATIONS
Historic-OKH Preservation/Hyannis
Project Street Address �J4 �Le L,,_
(/ Village /7 V r4 ✓t L L d� �6 r
Owner S�l t° � 1 15 7:4E Address
Telephone
Permit Request C=A-1_la-fL02# — Cox a L�y0 tp I,N L i V I 2Uo kI TUt-tw
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 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 8s)No On Old King's Highway: ❑Yes 3<0
Basement Type: C9'Full Cl Crawl ❑Walkout Cl Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing f 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: D]Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size Pool: Cl 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 C+I'No If yes, site plan review#
Current Use �+�5 o K f-PA, Proposed Use
BUILDER INFORMATION i�AP '^X 71f, 6 k 6 6
Name_5' "F i� Telephone Number _,fie?. '7'7/ 6p .'¢-
Address _,�In License
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
G�IGNATURE DATE _ 0 � ,
r
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED R '
MAP/PARCEL NO.
L,
,
t
ADDRESS.,` ' VILLAGE
OWNER
DATE OF�INSPECTION:
1; FOUNDATION
FRAME Af,9 fi ® AL C ®. Zw
C/a c-/,O-y 1gyr
r INSULATION d I^I ,S
FIREPLACE
t
_.� ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH7 rrl FINAL
GAS: ROUH FINAL
cu m
FINAL BUILDING ?, rn
} mcz
' 1 0
' DATE'CLOSED OUT..
ASSOCIATIONtPLAN,NO'.
L
The Commonwealth of Massachusetts
Department of Industrial Accidents'
600 Washington Street
Boston, Mass. 02111
Workers'.Coin ensation.Insurance Affidavit-General Businesses
AM
,y.
' • address: ... .
city f�.tl �rQ J 1% P O a. state /4 ziy' 9 °9 yhone# 7/ 7$
work site location full address
I am•a sole proprietor and have no one Business flYpe: El Retail[]Restaurant/Bar/Eating Establishment
working in any capacity. []Office❑ Safes (including zal Est Autos etc.)
em to er with ..ein'.lo ees full& art time'. ❑ Other' -Min-0 4 ' ' .
orkers' compensation for my em loyees working on this job.,
.
'din P
o rovi v�
1 _ .
. � I am an emu ',p .g' ... ,•;'
coin"an MaIIlEr .. 'i,t-:,•, :_.+':.'.�•.;<: ' - _ ..
ad ssE a•'e' ' •:a _r
5••
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Siisiirarice.co ' : •!'' '' `� /
am a sole proprietor and have hired the independent contractors listed below•who have the following workers'
compensation polices:
Com'`an• naine: 'C. r '•f:'.::'•' '(
.. •.t •h':.j. ' .< i •' :t.1. :L _
address:. .s. ., ��;�� ::�•::::• •..:..
lioiie'#:
�:t:. ems: :•+"yI'. ::1.:;:•: .}.' .r 'r• �.t•
insurance'co. .;.. :... :: ///%%�/�//l///�_
coin'ari• naii�ie. ,. .,f,;: .. _
addresse. .i :. •
,
. r
r....
ci . •done# :,: ',c•, ,'.
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
one years'imprisonment as well as civil penalties In the form of a STOP WORK ORDER ands fine of$100.00 a day against me. I understand that a
copy of this statement maybe forvrerded to the Office of Investigations of the DIA for coverage verification.
I do hereby ertify under the pains and penalties of perjury that the inform ation provided above is true and correct
'ienature Date
Phone#
Print name
official use only do not write in this area to be completed by city or Town official
city or town permit(liceuse# []Building Department
[]Licensing Board
❑Selectmen's Office
[D cheep if immediate response is required ❑Health Department
contact person•
phone#; ❑Other
(revised Sept 20M)
Information and Instructions
Massachusetts General Laws chapter 152 section 25.requires all employers to provide workers' compeps_atioii for'their.
employees: As quoted from the 19w", an employee is.defined as every person m the service of another under any contract
of hire; express or implied; oral or.written.
An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of
the foregoing engaged in ajoint 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 bf th64d yelling house of
another who emplo3�s.persons to do.maintenance, construction or repair work on such dwelling house'or on the grounds or
appurtenant thereto shall not because of such,employment.be deemed to be an employer
budding. FP ..
MGL chapter i.52 section 25 also'states that ever.-state*or local licensing agency shall*`Ylthhold the issuance or renewal
operate a business or to construct s in the.commonwealth for any applicant who has buildings of a license or pernoit.to p g
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 is the workers' eorrPensatio`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 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 list, :bglow. ,
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 nunriber. The.affidavits.may.be returned to
the Department by.mail or FAX.umless other'arrangements have been made.
The Office of Investigations would life to thank you in advance for you cooperation and sliould 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
Bfiee of IeitestWNns
600 Washington Street
Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617) 727-4900 ext.406
r
61HE r Town. of Barnstable '
P oyo R.egulatory Services
• Thomas F.Geiler,Director
i anxr�s-r� ,
� 1619, ,�� Building Division
''t6D MA'S M
Tom Perry,Building Commissioner
' 200 Main Street, Hyarmis,MA 02601 ,
Fax: 508-790-6230
Office: 508-862-4038
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMiT APPLICATION
MGL c.142A requires that the . or onstrtruction of an add ti n to mypr-exi ttiag n,repair, o�wProcc*ed lon:
-improvement,removal,demolition,
dwelling units or to structures whic
b��g containing at Least one but not more than four h are adj scent to
such residence or building be done by registered contractors,with certain exceptions,along with other .
requirements, .
M.,2� � '(iQ.4'I-C CJi°� _Estimated Cost
Type of
W
ork: .
D�
Address of Work: ,
N
Owner's Name'
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
[]Work excluded by law
[blob Under$1,000
[]Building not owner-occupied '
Downer pulling own permit
Notice 1$hereby given that:
OyMRSPULLING THEIR OWN PERMIT EIl UROVEMENT WORKDO NOT HA.YE
CONTRACTORS FOR APPLICABLE HOME
ACCESS TO TEE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDERPENALTMS OF PERJURY '
I herebyapply for apermit as the agent of the owner:
Contractor Name RegistrationNo.
Date
OR
' r_ e Ownez's Name '
Town of Barnstable
Regulatory Services
BABNSTABLE, : Thomas F.Geiler,Director
y MASS.
i639• , Building Division
rF0 MA't
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-8624038 Fax:.508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: 0 7-0 41/
JOB LOCATION: � L G /L �i /Z
number j `�-- j i street a�L village / Q
"HOMEOWNER": r�l'L-C/ r cJ 1 !�� -f—A / ! 8 6�r0 v 06v 1
name // home phone# work phone#
CURRENT MAM24G ADDRESS: C20 (P� VL 2 0
1" Peprt-- 7
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
requireme
Signature of Homeo r
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
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FRIEDLINE& CARTER ADJUSTMENT, INC.
436 Main Street, P. O. Box 338
Hyartuis, Massachusetts 02601
Tel. (508) 771-3232
FAX (508) 790-2344
TO: wilding Commissioner or Inspector of Buildings
( ) Board of Health or Board of Selectmen
( ) Fire Department
TOWN OF Barnstable
TOWN HALL
Hyannis, MA
RE: Insured: BATISTA, Salete
Property Address: 20 Glen Road
Hyannisport, MA
Policy Number: HP0449680
Type of Loss: Fire
Date of Loss: 4/23/2004
File#: 99551
Claim has been made involving loss, damage or destruction of the above captioned
property, which may either exceed $1,000.00 or cause Mass. General Laws, Chapter 143,
Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 3B is appropriate,
please direct it to the attention of this writer and include a reference to the captioned
insured, location, policy number, date of loss and file number.
On this date, I caused copies of this notice to be sent to the persons named above at the
addresses indicated above by First Class Mail.
R. M. NEGUS
Adjuster
5/25/2004
OPINE ram, Town of Barnstable
Regulatory Services
Thomas Y.Geiler,Director
: suuvsr,�is. : .
•�' Building Division
Ajep►'�►+a Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038
Fax: 508-790-6230
FEE: $ S.
SHED REGISTRATION
120 square feet or less
C VA �� 41 A � A/
Location of shed(address) Village
i e 13,E .I�: 1�
Property owner's name
Telephone number .
® x �09
Size of Shed Map/Parcel# ?
7,
Signature —
Date a
w
cap co rn
Hyannis Main Street Waterfront Historic District?
Old King's Highway Historic District Commission jurisdiction?
Conservation Commission(signature required) /�6 VII,;
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE
COMIVIISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE,
PLEASE SEE.THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED By A, PLOT PLAN
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Town of Barnstable
�t Regulatory Services
1% Thomas F.Geiler,Director
Building Divisions
NAM * Tom Perry,Building Commiss one�r-r
iOTEp i�•t► 200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 N'l V4 Fax: 508-790-6230
Approved:
Fee: V;Q�Z'5'
Permi0f:
HOME OCCUPATION REGISTRATION
Date:
Name:� a:�t S�6 Phone#:
Address: c� ��9�e Ill Village: H M n vl, ,)-S PAr �
Name of Business:_0 �
Type of Business: t Y- 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; Vi
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 carved 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,have read an ee with the abov estrictions my home occupation I am registering. n
Date:
Homeoc.doc Rev.5/30/03
TO ALL NEW BUSINESS OWNERS
DATE:_
Fill in please: `
APPLICANT'S ° t ti' YOUR NAME: f i n, P
BUSINESS YOUR HOME ADDRESS: Q 0 G,P � t
`
TELEPHONE s ` Tell]e hone Number Home
"" -
NAME OF NEW BUSINESS TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? YES NO Q
Have you been given approval fro the building division? YES NO 117
ADDRESS OF BUSINESS o2 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 the 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) or if you get the business certificate first you MUST go to
the following office to make sure you have all the required permits and licenses..
GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) and you will find the following offices:
1. BUILDING COMMISSIO 'S OFFICE
This individual has en infor e of any permit requirements that pertain to this type of business.
Authorized ignature
COMMENTS: ckw t
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 ha,�b en inf ned of t�li s' requirements 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.
1 -it does not give you permission to operate-you must get that through completion of the processes from the various departments involved.
**SIGNIFIES APPROVAL FORA BUSINESS CERTIFICATE ONL Y.
Town of Barnstable
P�o.0KE A tic Regulatory Services
Thomas F.Geiler,Director
r r
BA MASS. ' Building Division
9 MASS. �a
i639•
•
1°lEp.19 a Tom Perry Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
COMPLAINUIN UIRY REPORT
Date: — Rec'd by:
9
P
Com laint Name: Map/Parcel
Location X1
Address• d
Originator Name:
Street:
Village• State: Zip:
Telephone:
V do
Complaint Description: 1
a
FOR OFFICE USE ONLY
Inspector's Action/Comments Date: — r 7 Inspector:
7
Additional Info.Attached
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Q:forms:complaint
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION <)
Map 1 Parcel ,,_ }t* Permit#
Health DivisionKC;:O" I j ' `; Date Issued �l �� e 3
Conservation Division - P4 1J. /On 6-,�3 `` Application Fee
Tax Collector b, Permit Fer J S',
Treasurer u'l a`''�•_�
- SYSTEM MUST BE
Planning Dept. c. E A.LED IN COMPLIANCE
ME TITLE 5
Date Definitive Plan Approved by Planning Board ,- -',-,"_71, TAL C®DE A
Historic-OKH Preservation/Hyannis Y0101 F:E GUL ``.'IONS
Project Street Address 02,
Village HVA,,JAII�&J
Owner GZ kit 30�S)79 Address 220 /nor �-
Telephone 836_ $ G c 4
Permit Request OLCra ► e to 1"h Ct, o
l
Square feet: 1st floor: existing proposed 110 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Dot) Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family 9 Two Family O Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes 4 No On Old King's Highway: ❑Yes ❑No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
D(Basement Finished Area(sq.ft.) hJ ) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half:existing new
).(Number of Bedrooms: existing_ new
VTotal Room Count(not including baths): existing new First Floor Room Count
Heat Type and Fuel: 5�Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 0 No
Detached garage:0 existing ❑new size Pool: 0 existing 0 new size Barn:0 existing ❑new size
Attached garage:O existing 0 new size Shed:O existing ❑new size Other:
Zoning Board of Appeals Authorization 0 Appeal# Recorded❑
Commercial 0 Yes Z No If yes, site plan review#
--Current—Use.—_ _ Proposed Use
1 9 BUILDER INFORMATION
Name 6ct�e_It- 7�t,ks+a. Telephone Number _ —1_ 74 EGGi ( l)
Address ,20 Ie v�ry"\ "'RoA License#
HVA NN - Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE 1\_ \ -I r,)'S
l44
i FOR OFFICIAL USE ONLY
PERMIT NO. ,
DATE ISSUED
MAP/PARCEL NO. _
ADDRESS - VILLAGE
OWNER
DATE OF INSPECTION:
7-0
�4 FOUNDATION ( Fo tc
FRAME I
INSULATION
,1
FIREPLACE
,N ELECTRICAL: ROUGH FINAL
P
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING y T
DATE CLOSED OUT +
ASSOCIATION PLAN NO.
\ '
The Commonwealth of Massachusetts
- Department of Industrial Accidents
Office Valayesaffatfons
600 Washington Street
Boston,M
-= ass. 02111
'
_
`3 Workers'- Cam ensation Insurance davit
%/I s
name �/� .9 T/ L
ocatiorc 62-0 (�;',C e n )
ci
i1/H�S hone# 7,
I am a homeowner performing all work myself
❑ I am a sole vr rietor and have no one world. in ca achy
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i rovidin workers' compensation for mp em�lcr�ees working on this job.
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Fans a to secure coverage as requited under section 25A of MGL 152 can iead to the imposition at crhninal p esnaltia of a fine up to S1,500.00 md/or
one yam,imprisonment as weU as dvil penalties in the form of a STOP WORK ORDER and a fine of 3100.00 a day against me: I mndetstmmd that a
copy of this atatementmay be forwarded to the Office of Investigations of the DU for coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and carted .
Date -
Signature
Print name A E E -8,0��" S w Phone#
official use only do not write in this area to be completed by city or town official
city or town: petadt/llcense# ❑Building Department
❑Licensing Board
❑selectmen's Office
[Ic]ieckifirnmediateresponseisregnired []HealthDepattment
contactpetson:
phone#; der
��9ros rla7
E'ocs� 'Town of Barnstable
Regulatory Services
Bra-AMSTA ram. Thomas F.Geiler,Director
, 1639• � Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
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
e which are adjacent to
building containing at least one but not more than four dwelling units or to structures w
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements. O F f V)e-
C /
K 4 fi� 2 n V) Estimated Cost ��Q0o,o
YPWork•
I� T e of -
Address of Worker
Owner's Name:_
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
[]Work excluded by law
❑Job Under S 1,000
OBuilding not owner-occupied
[]Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME 1MTROVEMENT 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
�7 Date Owner's Name
r
RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE
New Buildings,Additions $50.00 g-0 • O
Alterations/Renovations $25.00
Building Permit Amendment $25.00
FEE VALUE WORKSHEET
NEW LIVING SPACE
square feet x$96/sq. foot= �l s O x.0031= SS, 7
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACE
square feet x$64/sq. foot= x.0031=
plus from below(if applicable)
GARAGES(attached&detached)
square feet x$32/sq.ft.= x.0031=
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.0031=
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
(plus above if applicable)
Permit Fee
projcost
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-------------------
VII
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780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS
THE MASSACHUSETTS STATE BUILDING CODE
FIGURE 3606.23b
FRAMING DETAILS
CUT PLATE TIED STAOOER JOINTS 4"OR
STEETWITH ANGLE GAOE USE SPLICE PLATES
STUN ENT OR SEE 780 CMR 36062.3.3
EQUNAI-EPr1' �
SINOLE OR
DOUBLE TOP
PLATE
FIRESTOP
AROUND PIPE
HEADER-SEE
TABLE 36062.6
WALL STUDS
SEE 780 CMR 36062.3' STUDS
OR TRUAMERS
v
U�U
a
iG N
SUBFLOOR FLOOR
JOISTS
FOUNDATION
------------ t PLE
__ wALL SEE
-- I 38606C.2M[
ANCHOR BOLTS EMBEDDED ---------------
IN FOUNDATION 6'0"O.C.
MAXIMUM L---------------------- --
FO ATION
WALLSTUDS
CORNER AND PARTITION POSTS
-- 1'BY 4"DIAGONAL
BRACELET INTO STUDS
NOTE:A third stud and/or anchor partition
intersection backing studs may be omitted through
Apply approved sh g or brace exterior walls with I" the use of wood backup cleats,metal drywall clips
by 4"braces let into studs and plates end extending from or other approved devices that will serve as an
bottom plate to top plate, adequate backing for the facing materials
See 780 CMR 3606.2.9.
For SI: 1 inch=25.4 mm,1 foot=204.8 mm.
TABLE 3606.2.6
MAXIMUM SPANS FOR HEADERS LOCATED OVER OPENINGS IN WALLS
HEADERS IN BEARING WALLS HEADERS IN
SIZE OF HEADER WALLS WALLS NOT
Supporting Roof Only One Story Above Two Stories Above SUPPORTING
FLOORS OR ROOFS
2-2x4 4 -
2-2x6, 6 4
2-2x8 8 . 6 - 10
2-2x10 10 8 6 12
2-2 x,12 121 10 8 16
For SI: 1 inch=25.4 mm,1 foot 304.8 mm.
1. Nominal four-inch thick single headers may be substituted for double members.
2,,_ Spans are based-on No.2 Grade Lumber with ten-foot tributary floor and roof loads.
534 780 CMR-Sixth Edition 12/12/97 (Effective 8/28/97)
L I O N F P R-r LI N EO MA B E *CCU RATE STANDARD LEGEND
P 28
-.-- NpOTE�not all symbols will appear an a map
R=�
2AMA
GOLF COURSE FAIRWAY
- � EDGE OF DECIDUOUS TREES
4 EDGE OF BRUSH
ORCHARD OR NURSERY
V-'-V-V EDGE OF CONIFEROUS TREES
MARSH AREA
-•--— EDGE OF WATER
-- - - DIRT ROAD
i _
PARKING LOT
�-- DRIVEWAY
PAVED
� - - ED ROAD
MAP 8 ------ DRAINAGE DITCH
AP 28 ----- Pam/TRAIL
PARCEL LINE**
_ mileE---MAP#
.. 21 PARCELNUMBER
#luo F HOUSE NUMBER
j 2 FOOT CONTOUR LINE
L -
............. —E� 10 FOOT CONTOUR LINE
.. ....
_ f Elevatlon based on N6VD29
i ..� 4.9 SPOT ELEVATION
MAP88 STONEWALL
^^ -X X- FENCE
M L l8 8 RETAINING WALL
RAIL ROAD TRACK
f
_ STONE JETTY
20 MA I 28 I SWIMMING POOL
PORCH/DECK
# 43 ° BUILDING/STRUCTURE
DOCK/PIER
Q HYDRANT
MAP0 a VALVE O MANHOLE
0 POST C7 HAG POLE
O W N . 0 F 0 A R N S T A 8 L E 6 8 0 A R A P M 1 C I N F O R M A T I O N S Y S T E M S U N I T a SIGN ® SMIM DRAIN
PRINEED ME M FEET *NOTE This map is an eniarperneM of a **NOTE:The porad lines are a*graphic representations DATA SOURCES:Planimehis(man-made features)were intetpreled from 1995 aerial photagraphs by The lames
1"=100 smle map and may NOT moat of property boundaries.They are not hue oration;and Smprllmlftrlc,
ny.Topogmphy and vegetation were It"reted from 1989 nodal photographs by GEOD UiilflY POLE a TOWER
20 4Q Nati000f Map Acamgr Stondorth atlhk do not represerrt oW mlahombips to physical obleds topoarophv and vegetation were mapped to meet National Map Aocuraq Standards UGIR POLE O ELECTRIC BOILNCR m 40 FEET* enlarged S00I9. on the map. 1°=IN.Pmad b'm w,ere d%Mzed from FY2OO2 Tawa of Barnstable Assessofs tax maps.
ign 09/16/02 02:41:04 PM
I
Town of Barnstable
CF THE Tp� .
Regulatory Services
�P
BAR AS Thomas F.Geller,Director
MIZ
Building Division
PIED �s Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
ice: 508-862403 8 Fax: 508-790-6230
HOMEOWNER LICENSE EXEB[]PTION
Please Print
DATE I, -�•� 21
JOB LACAnON: �Z ti�vl S PQR_T O2 6 g l
number street village
-
name home phone# work phone#
CURRENTMAUMGADbRBSS: ca-) of eL_
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'aparcel 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 andlor farm,structuies: 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 wor-kperformed 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...•:•
minimnm inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
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 wbo 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 flue unlicensed personas 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 su;h a form/certification for use in your community.
1-09-1 995 I 'I :05PM� FROM HYANN 1 S FIRE/RESCUE SOS 77B 6448 P. 1
HYA►NNIS FIR
E DEPART
MENT
95 HIGH SCHOOL RD. EXT. HYANNIS, MA, 02604
N CAC
HAROLD S. BRONELLE, CHIEF
er mae rcwARrxees nne MONO
., FIRE PREVENTION
oN BUREAU �r
BUSINESS PHONE:(5013)775.13W FACSIMILE PHONE:(508)778.6448
LT.DONALD H.CHASE,JR,,CFI LT.ERIC F.HUBLER,CFI
FIRE PREWNTION OFMCEEL FIRE PREVEk11'nON OFFICIER
AGENCY NOTIFICATION
Building
J Health
[ J Wiring
[ J Gas
[ J Consumer Affairs
Pursuant to Mass. General Law, Chapter 148:28A and 527 CMR 1.00, the above agency is hereby
notified that a hazard or violation is believed to exist relating to the above agency's jurisdiction.
The hazard or violation noted is not within the inspectors code of enforcement or jurisdiction.
The following has been reported in person or by phone on this date: __
for the property located at: in HyannisFo,--
4)
Owner of record, ILZ A�11/
1 G r c1 _UZW phone: r °TT 6 4/9 6.5-
Fire Prevention Office
cc;street file
rev. 1/2000 (o xco /
P
I ��A' 12 eA, ,o �p�
+-------------------- ACCOUNTS RECEIVABLE BILL INQUIRY ----------------------+
Action: Find Next Prev Browse History Detail Comments . . .
Query the receivables file.
Year Type Bill # Cust # Name
1998 RE-R 12759 63763 J & B HOME REALTY INC Comm? N
Parcel ID Property Loc/Ref
288-017 20 GLEN ROAD 288017
Int Date Billed Abt/Adj Pmts/Credits Interest Unpaid bal
1 01/28/98 675 . 83 . 00 675 . 03 . 06 . 86
2 08/29/98 751 . 63 . 00 . 00 . 00 751 . 63
3
4
Fees : . 00 . 00 . 00 . 00 . 00
1, 427 .46 . 00 675 . 03 . 06 752 .49
jMai71Addr/T
Owner: J & B HOME REALTY INC Discount . 00
PO BOX 188 Due 08/18/98 752 .49
HYANNIS PORT, MA 02647-0188 Per Diem . 00
Int Paid . 00
1 of 3
+------------------------------------------------------------------------------+
Building Department
Complainp&tquiry Report
—/rf
"-� / Rcc'd by: Assessor's
Date:
Complaint
Name:
Location
Address:
Originator Narne•
Street:
• �- State: Zip:
Villager
Telephone:D/E
Complaint ❑ /? �'
Description:
7-
Inquiry
Description:
For 0 ce Use Only
Inspector's Inspector:
Action/Comments Date:
rollow:up
Action
Additional Info. Attaclied
a py Distribution: White-Department Fde
Yellow-Inspector
Pink-Inspector(Return to office Manager)
�TMEt�►�, The Town of Barnstable
Department of Health, Safety and Environmental Services
MAM t�►suasfreu3tt:, Building Division
W �' 367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Ivl Crosser
Fax: 508-790-6230 Building Commissioner
Home Occupation Registration
Date: '- I- 9 -
Name: ::Ld,4L2'z ez,f it Phone #: Uh77 Z/,eW rY•
Address: -Q) .G ►
Type of Business: Map/Lot: �$2- Cam/1
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:
•i 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 trot customary in residential buildings,and
there is no outside evidence of such use.
•1 lie 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,!tumidity or other objectionable effects.
•V 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 Custorn..uT 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 Customan• Home Occupation who is not a permanent resident of the
dwelling unit.
I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering.
Date:�j (4 ._
Applicant:. �S
J
Homecc.doc
:
July 9, 2001
,..
Town of Barnstable: Building Department `
Town of Barnstable
Building Department
367 Main Street
Hyannis, MA 02601
To Whom It May Concern:
I, Celete Batista, presently lease the premises
gat 2QG1enlZoad;sHyasfrn�the owner, J & B Home Realty. I am
purchasing the property from the owner.
I have removed the bed from the basement, per the Barnstable
Building Department's request and further understand that no one may
-, sleep in the basement at any time, due to improper egress, per the
Barnstable Fire Department. I will not allow anyone to sleep in the
a. basement I the future until a legal bedroom is permitted by the Building
Department, built with proper egresses and inspected.
Celete Batista
cc:Lt.Chase,Inspector,Hyannis Fire Dept.
cc:Brian Salyards,President, J&B Home Realty,(seller)
. . . . . . . . . . . . . . . . . . . . . . .