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HomeMy WebLinkAbout0250 LONGVIEW DRIVE .. . ��- I� �.. .� �. r' TOWN OF BARNSTABLE BUILDING DEPARTMENT SERVICE U.S.POSTAGE>>PiTrvEYeowes S' : 200 MAIN STREET HYANNIS,MA 02601 . E ZIP 02601 $ 000.470 02 4VV 00003.36455 MA.Y. 01. 2018. MONICA BARROS 250 LONVIEW DRIVE HYANNIS, MA 02601 Iv.% A 03. DE 1 0005 /09/18 I g 20 �ao� R E R N u N DE R i NOT DELIVERABLE AS . ADDRESSED U;N AS L-E 1-0 -F 0R;WA-R-0 UTF BCe 02601400209 *1669-01099-09-15 02601'4002 �- it �! lr' l�3�� i(i#��1 �� ;i #1 �iiJ rt =� �# $'�T� �: . � i I _ _ _ . ._ i --- -- 3 _._--- - ----- .. - �:� � ._-._ a... ..� � -' '�.q,,.. ... � r .... �e.,�.1. .. _'" �1 y� `S f 'S r� � r .. 1 ,,� ,- / � - •1 i ,. i r �� ��' � �- r - 'tip vxcvF' ( ' . U.S.POSTAGE"PITNEY BOWES TOWN OF BARNSTABLE { w BUILDING DEPARTMENT SERVICES . 200 MAIN STREET ,.,,�.,,.. k f ZIP 02601 $ 000.470 HYANNIS,MA 02601 %''J-i- " I '� r' 02 4V9 } 0000336455MAY. 01, 2018. ��.�.�.�:.....=w_-.. .... �_::.�.-.� MONICA BARROS 250 LONVIEW DRIVE HYANNIS, MA 02601 ivli.iE v�15 DE i 0005109/13 ` +I-I VER ARI E QC,v9if5�„5[}ZE5CED 1i 91 NOT f,3�v1S�d i s _.��! -TC -O i A � -�aA�D ; tit (oir U,TF SCo 02 601>4010� iI 1�ii i Town of Barnstable Building Department IAMMBI.E. : Building Commissioner y Mass. 1639. .� www.town.barnstable.ma.us rFD N1p`l A Office: 508-862-4038 Fax: 508-790-6230 Office: 508-862-4038 Fax: 508-790-6230 May 1,2018 Monica Barros 250 Longview Drive Hyannis,MA 02601 Re: Family Apartment Hyannis,MA Dear Ms. Barros, Please complete the enclosed Family Apartment Affidavit and return it to the Building Commissioner's Office by May 11, 2018. On April 26, 2018,you should have received the Certificate of Occupancy for your property. You are required under S 240-47-1 of the Town Building Zoning Ordinances to submit an affidavit annually indicating the status of the Family Apartment. Failure to submit the affidavit is a violation of your Family Apartment approval and may result in the loss of your rights. If you have any questions,please contact me, at 508-862-4039. Sincerely, Brenda Coyle Permit Tech. Town of Barnstable + Building Department OpIME tpk, Brian Florence, CBO ti Building Commissioner ,,CAB 200 Main Street, Hyannis, MA 02601 9 MASS' i639• www.town.barnstable.maxs ♦� viuuu. _,vo-ov2-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows:. My name is I am the owner/resident of the property located at: 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, I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I 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 240-47.1 Family Apartments. I agree to note 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 day of 2018. Signature Phone Number Print Name q:forms/famaffid.doc rev 11/08/12 Town of Barnstable Building Department BARNSTABM : Building Commissioner ME MASS en 39. 0. � www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Office: 508-862-4038 Fax: 508-790-6230 May 1,2018 Monica Barros 250 Longview Drive Hyannis,MA 02601 Re: Family Apartment Hyannis,MA Dear Ms. Barros, Please complete the enclosed Family Apartment Affidavit and return it to the Building Commissioner's Office by May 11,2018. On April 26, 2018,you should have received the Certificate of Occupancy for your property. You are required under§240-47-1 of the Town Building Zoning Ordinances to submit an affidavit annually indicating the status of the Family Apartment. Failure to submit the affidavit is a violation of your Family Apartment approval and may result in the loss of your rights. If you have any questions,please contact me, at 508-862-4039. Sincerely, Brenda Coyle Permit Tech. Town of Barnstable Building Department oFt rq�, Brian Florence, CBO Building Commissioner RARNSTABLE, ; 200 Main Street,Hyannis, MA 02601 y MASS. 039. www.town.barnstable.ma.us ATEp��A ivo-ou2-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: My name is I am the owner/resident of the property located at: 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, I will immediately notes the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I 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 240-47.1 Family Apartments. I agree to note 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 day of 2018. Signature Phone Number Print Name q:forms/famaffid.doc rev 11/08/12 Town of Barnstable Building e : Ca Post"This>Ca,rd So That��t IszV�s�bleFromthe Street=A prouedPlans Must be Retamed,onlob andthis rd Must be Kept M WATA.B1Y. 6 !P11- osted Until'Final Inspectlon Has-Been Mayde � �' Permit n+ . hie aertifiate�of Occupancyy:Is Required,such Building shall Not be Occpledntll a Final Inspection hates been mde .. Permit No. B-18-4090 Applicant Name: Lloyd R Smith Vivint Solar Developer LLC Approvals Date Issued: 12/28/2018 Current Use: Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 06/28/2019 Foundation: Location: 250 LONGVIEW DRIVE, HYANNIS g Map/Lot. 251 140 � Zoning District: RC-1 Sheathing: Owner on Record: BARROS, MONICA 9 ,font ctor Name ,LLOYD R SMITH Framing: 1 Address: 250 LONGVIEW DRIVE sContractor License'�1�5688 2 CENTERVILLE, MA 02632 Est Project Cost: $3,410.00 Chimney: Description: Installation of roof mounted photovoltaic solakpals€ Permit Free: $85.00 Insulation: q, FeePald.;' $85.00 Project Review Req: Date; 12/28/2018 Final: s Plumbing/Gas ,� wl4 Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and theapproved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structu�esshal be in compliance with the local zoning by laws,and codes. Final Gas: This permit shall be displayed in a location clearly visible from access stYeet or.,road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Y Electrical The Certificate of Occupancy will not be issued until all applicable signatures byk e Building and Fire Off cials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing T, Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons c rac I ith unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: 11 Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT FtHET Town of Barnstable �o .�nrrsrwB�.E. Building Department-200 Main Street Hyannis, MA 02601 Tel. (508) 862-4038 Certificate Of Occupancy Permit Number: B-2014-08781 CO Issue Date: 4/26/2018 Parcel ID: 251-140 Zoning Classification: RC-1 Location: 250 LONGVIEW DRIVE, HYANNIS Proposed Use: 1010 Name of Tenant: Sprinklers Provided: Gen Contractor: GORDON ELECTRIC Permit Type: Residential- Type of Construction: Design Occupant Load: Comments: FAMILY APARTMENT FOR MOTHER IN LAW (CATHIE LOUISE SILVA) 2 (L Building Official Date: A Certificate of Occupancy is Required Prior to Occupying Space Building Code: 780 CMR 8th Edition Town of Barnstable pF ZHE!p� do Building.Department Services Brian Florence, CBO * RAMSenatis. v MASS g Building Commissioner . 039. �0 iOrFn nu•+" 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us 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 Da �WnrO I am the owner/resident of the p roPertY located at: 2S. 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-identifAed family members. In the event that the listed relatives vacate said apartmeix.,0 will imn�liate notes the Building Commissioner in writing. I understand that no sublettir r subleas`ing ofth id Family Apartment is permitted. ; I understand that I am required to file an Affidavit annually with uilding" Commissioner listing the names and relationship of occupants in said Famil A A p t ispartmAR. I a understand that I am required to comply with all conditions imposed by the SpecW Peat and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family artmenf I e to note the Building Commissioner immediately in the event of the sale of proper. L . 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 t der the pains and p, lties of perjury this day of (/ 19. Siarat&e Phone Number Print Name Mm.ia� q:forms/famaffid.doc rev 11/08/13 Town of Barnstable Building Department OFSHE tpk- Brian Florence, CBO ,XYY �o� Building Commissioner RARNS.ABA, : 200 Main Street,Hyannis, MA 02601 7 MASS. 1639. www.town.barnstable.ma.us �ArED MA'S A vuiuu. )vo-ov2-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: MON I (A My name is I am the owner/resident of the '-i En ProPertY located at: 2 N �� ��y En -77 The follo g members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: CAVIE '�;Q U Z Mrmek - m - LA 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, I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I 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 240-47.1 Family Apartments. I agree to note 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 un er the pains and pe ties of perjury this 2,0 day of MA V 2018. C,560 36q - �0 Signature Phone Number Print Name MONI V,AI CAR" q:forms/famaffid.doc rev 11/08/12 i own of narnstaDie Regulatory Service S L Richard V.Scali,Direct p,o,_: 1 ,��C,f,s.376 12-17—''t » snsxsr,�sze 2 J 14 1 O:3 M"S& � Building D1V1Slo`fa ARNSTABBLE LAND COURT REG I STR t639 Tom Perry,CBO,Building Con..--..--. 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 AGREEMENT FOR FAMILY APARTMENT I, the undersigned, being the owner of property situated at 250 Longview Drive, Hyannis, MA holding title under a deed recorded with the Barnstable County District Registry of the Land Court as Document No. C198574, being shown on Assessors' Map 251 as Parcel 140, hereby agree, certify,warrant and represent to the Town of Barnstable that the accessory attached apartment, which contains living quarters, is intended for use as a family apartment,for year-round occupancy. v This unit shall be used for a"Family Apartment"(as defined in Zoning Ordinances) which would require compliance with the Family Apartment Rules and Regulations. The family apartment unit must be occupied only by the property owner or a member(s)of the property owner's family as accessory to an owner-occupied single-family residence. Occupant of Main Residence: Monica Barros s Relationship to Owner. Owner Resident of Family Apartment Cathie Louise Silva Relationship to Owner: Mother-in-law (-- This unit shall not be rented as an apartment or as a single room,or in any fashion,which rental would be a violation of the Town of Barnstable's rules, regulations, and zoning ordinances. Prior to occupancy of this unit, affidavits reciting the names of occupants are to be recorded with the building department. This agreement shall be S updated whenever a change occurs or every calendar year. �- This Agreement shall be duly recorded or filed at the Barnstable County Registry of Deeds/Land Court for the purpose of alerting future owners of the property of this binding Agreement concerning the use of the property as herein stated. The consideration for this Agreement is the issuance of a building permit and/or certificate of occupancy by X the Town of Barnstable Building Department. 0 J WITNESS our hands and seals this _day oft 20 . TOWN OF'$ARNSTABLE: OWNER: !as e� i�� ��1/�G2��l�� Monica Barros Perry,CBO Building Commissioner THE COMMONWEALTH OF MASSACHUSETT BARNSTABLE COUNTY, SS Date Z t/ Then personally appeared the above-named (owner), aS and made oath as to the truth of the foregoing.'il strument,before in Z, Notary Public _ MyL TM6E B�` LINDA E.WILSON gsample R ABLE REGIST..RY:OF SEED FtWISTRY OF° E°s Notary Public A TRUE COPY,ATTEs' Omy Commonwealth of Massachusetts . 1ti�ER F. Meade, Repter �j, Commission Expires March 24,2017 °E,REGISTER li;�. c7 t��� �� • ., ..,J c:; ",.5�):,} ���.3 �s.:i.�J U L>r.,+`.�t�cs U(Li U t�c;:U J U i. ... �. �. �. J... �. - L'L: U t.. �. � J J �. �. .� J J.� ... ... � ._%J J v v�.,':J t: ..: J:��. .:U :� .. .�l.?�.. �. �.:L.'�:C.: C_'l:C:C'. V"U L;U U J�:U CJ C1 U'J U CJ U U C:)U J U '.�C_;U :J� �.= •= J"✓ C�J.7//� lr(J I V 4 R. 4 j, I' 1 1 l 1.+ t l;} Ud fE, i I,[ lyi " f;r I' j I"1 Q �r' fi11 Ao E rayl i A h _.t • `I ��y7 . � � - . � 1 �' �- ��S �� � _ o _- _ _ �- � � < < �� � � � � -� � � �, �= � Q G i _ . , � � � � _ � � � � ' ^r5 �� r � v (plc/ V i �� � C � e� ocI- � � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ' r F ET Application 0 16 Health Division Date Issued IQIJ Conservation Division Application F X z* Planning Dept. ? tS ' Permit Fee - Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis <Pr-oiect-Stre—et ddress 250 LON6VIEy4 Nave- ,P-a—�g f-1�AtJ N I$ Qwn,e--- Wick I r1.OS Address S�A AS A1510(16- -Perm"it--Request FAA ((,i APAIVA ! ' W I N V J AOW"EN�S, 0190 F$ S'101 Ak Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay PrDD ��oject Valuations �i�trruuction 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 (BUILDER OR HOMEOWNER) 1 Name-=1- tz� -✓Ot!:� ZTel_eplione,Number Address=1-M f 3"WS11 k 0 Lcerise o2-Oo I �---.r _ I�f3�y� / Hom, -ImprovemenfContractor-# Worker's Compensation # ALL,CONSTRUCTION DEBRIS,RESUL-TINE FROM THIS__PROJECT,WIL-L BE TAKEN,TO } SIGNATURE DATE-1-4- k ` FOR OFFICIAL USE ONLY t - r . ..APPLICATION# iL DATE ISSUED i MAP/PAFLCEL NO. j f ' . ADDRESS VILLAGE j�. OWNER DATE OF INSPECTION: ` tLj FO.UNDATIO.N um-,1,uSy , IC FRAME - - - j; - INSULATION .. FIREPLACE ELECTRICAL: ROUGH FINAL - _- 'E PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL I: FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. _ The Commonwealth of Massachusetts Department of Industrial Accidents -- Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ° Please Print Legibly Name (Business/Organization/Individual): ��� �(1 V✓ l/� vv � Address: V35 A-P-N 19'14AC- PVA'0 City/State/Zip: ,sA07(0 O 1 Phone #: 5 09—9 7— 228( �( 13 Are yo 'employer? Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. emodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. ❑ Building addition [No workers' comp. insurance comp. msurance.1 required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 LF]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. '*Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: TffC f2I�Aq,02_.S Tipl/`S�✓OIId 41 lam Policy#or Self-ins.Lic.#: OU B �E 76— r 7 Expiration Date: 0 7i0 Job Site Address: City/State/Zip: (�(MJV I S,0A 00&/ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D for insurance coverage verification. I do hereby ify r pains and penalties of perjury that the information provided above is true and correct. Si nature: - +, Date: 121 Phone#: �) .8— 7 ( � 2-2-9 3 A c �km�- Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f DATE(MMIDDIYYYY) A�Ro CERTIFICATE OF LIABILITY INSURANCE 12i3n4 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICAT't 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: Circle Business Ins Agcy Inc. PHONE FAX 247 Newbury Street ftv IC No): ADDRESS: Danvers, MA 01923 INSURE S AFFORDING COVERAGE NAIC# INSURER A:Safety Insurance INSURED INSURER B:Travelers Ins. Co. Contractor-Sub Contractor Name INSURERC:James River Ins. Co. Address INSURER o:Torus Insurance Anytown, MA 000000 INSURERE: 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN SR WVD I POLICY NUMBER MIDDN MMIDDIYYYY LIMITS C GENERALLJABILITY .Y Y 00057827-0 5/22/14 5/22/15 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISES rt nce) $ 50,000 CLAIMS-MADE 1z OCCUR - ME EXP(Anyone person) $ PERSONAL&ADV INJURY $ 1 ,000 000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGR EGA TELIMITAPPLIESPER PRODUCTS-COMPIOPAGG $ 2,000,000 X POLICY JECT PRo- LOC $ A AUTOMOBILE LIABILITY Y Y 6217675 - 4/13/14 4/13/15 COMB,I,NOtSINGLELIMIT $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED - BODILY INJURY(Per accident) $ AUTOS X AUTOS NON-OWNED PROPERTY DAMAGE $ - X HIREDAUTOS X AUTOS Per accident D UNBRELLALIAB X OCCUR Y Y 79490E131ALI 5/22/14 5/22/15 EACH OCCURRENCE - $ 1,000,000 _X1 EXCESS LIAB CLAIMS-MADE - AGGREGATE $ 1,000,000 DED RETENTION$ $ B WORKERS COMPENSATION UB4009T76-6-14 1/1/14 1/1/15 WCSTATU-LIMITSX OIR " AND EMPLOYERS'LIABILITY - ANYPROPRIETORIPARTNER/EXECUTNE YIN . E.L.EACH ACCTDENT $ 500,000 OFRCERIMEMBER EXCLUDED? 7 NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE-$ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) - Certificate Holder is listed as Additional Insured y` w CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN' Toby Leary Fine Woodworking In ACCORDANCE WITH THE POLICY PROVISIONS. 135 Barnstable Rd Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Paula Halas ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: 105 - 'din S✓✓�'"-t-��.��'�i 1� DUD— 400 '( I a 'ffi airs S l;usioi s Regulation4�r tV900, ro€� ksfrh 4.1C4i r e�I L"E,�is�attecz �, }� ntl t�8l� t h OME I1'+{IPl2&EMENT CONTRACTOR Tylae y� p A394 _ 1" �` `'�f tf��. E '' �� o- 811700416 $$ t y, flVr'3.tRGS>PpOfe'�UC3t I �.l) t�`�� .# '" e KING lNC „ lJ- 4605 t3"t ARNTCML s i r � E T Town of Barnstable Regulatory Services RARNSTABy IEg Richard V.Scali,Director 039. �'OTFDMA�16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, MOX4 f ta— Wrros , as Owner of the subject property hereby authorize 10V/ to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) ,"'Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installe and all final inspections are'performed and accepte Signature o er , Signature of A cant M0 VJ UX. � ate--s Print Name Print Name Date Q TO RM S:0 W NERP ERM IS S IONP OO LS Town of Barnstable Regulatory Services �oF roty,� Richard V.Scali,Director P Building Division f K BARNSTABLK ' Tom Perry,Building Commissioner Nrnss 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: 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. DEFINTTION 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 requirements. Signature of Homeowner f Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. _ HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s) for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in °your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 .b TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map parcel Application # Health Division Date Issued c� Conservation Division Application E@ S Planning Dept. Permit Fee ���� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address ` -5 0 Lo N-&y o Village [ 'l wu IV Owner !J 11M2'.Q5 "W4Vr� O V I LA' Address S� Telephone 50 5 - b -Y 0 N i C'.+ Permit Request _(_I�S7eil4fl 0 VQ nF� I N I_@t I Ua S(-(a wc-bu AD o r 7j oro V'l 1 AtSW UA-� (b Fiks/ rw4 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation WQ 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: 2'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 a '-f .. Total Room Count (not including baths): existing new First Floor Room ount £' Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/ oal stove r❑Y9 ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ nevV'''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 (BUILDER OR HOMEOWNER) -- [- ` Name Rq V Telephone Number 7-7`� 36— `� S � Address I35 �Xf�5-[AR License # U ` b05 Ivu" 4\f A_W 1V1 E A k- 02"1 Home Improvement Contractor# Email tkvac . N . co Worker's Compensation # y u`�dyTT7� ^ �~t I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO q W� Wi(/I I f SIGNATURE DATE I2 ' 3( , 15 FOR OFFICIAL USE ONLY .y ` APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION i, FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING k ti DATE;uCLQSED:O.UT ASSOC IAT10N.PLAN NO. . a Hie Camnromowkh qf-Massachusetft Diqp�&nent of bdusa-hd Accidents - O ce oflrrverQ��-vns 600 Washingtm Street Bostozz,MA 02UI wft'li?d assI ga'6 dia Workers' CampensatianInsuranceAffidavifi Biiildersf n"ctor-, ectricians/Plumbers App&.antt:Infarmation Please Priest ,ibly Name(Iltt6wmI tion(hu ividnal): TU T W WZbO VVQ'awl Alb- ddF 3 5 t3 A -n�5-Ti-3t/6 k A� City/S!a Nl S Phones 9 5 0 9 — Are y employer:'�Checkthe appropriate box: Type o#protect(required): 4_ I am a. contractor.and I 1_ I am a employer with ❑ 6- ❑Nlew -on employees(full andlorpairt- me * have l iredthe soli r�onirae aFs. 2"❑ I am a sole proprietor or partner- listed on the attached shi5et 7- ��g strip and hate no employees These solo-contractors have 8- worlang for roe m any cit5 c employees and have workers-9- ❑Building addition [No workers'comp_invrra t� nr0- comp_nasura recluired-] 5_❑ 'We area corporatimand its 10•❑Electrical repairs or additions offices have exercised their I I_ Plumbin airs or additions I❑ I am a hssmeowner doing all work officers � , myself [No workers'cozrrp_ right-oft i�tioaper MGL I?❑Itnofrepairs. i3�e required_]l c.152,§1(4),and we fine no employees_[No worker.€' 13_❑Q.ther comp-msi�required- *Any appbomt dixt checks box-91 Imst 411.0 fffi out the section below showing their vroiken'coimpensafioa policy iccEormxdma- T Homevvners arb a submit ibis of.I.Vit iTTfatEaE they are dning.R VM*and d M hire outside contractors IIm5I submit a IL1w affidffvk infiirstn sarh .TContoactors that cTixY this box must sttached an additaonsl sheet shoxemg the name of the sa4-c sand ststP whether oe not thost=entiues have onpioyees If the sub-contaacturs bade empIoyees,they must pmvide th—r workers'comp.policy number I am an employer that is pros igffng kt�orke-rs'conzpa L=tion vtsurartce far ncy employees Below is fat e policy and job site informa,tWI_ � Inswmce Gomp any Name: Ir4vt .f Policy;g cr Self-ins-Lim V �,l�A I —l Expiration Date. / Job Sites Address: 25 D LX K1b-V) N b 04✓' Cityistatej4_. .(-�' A/IVIJ /l✓jq D)W li#ach.a copy of the ssorke-rs'compensation policy declaration page(showing the policy cumber and expiration date). Failure to secure coverage as regtriredunder Section 25A of IiGL c 152 can lead to the imposition of'criminal Tnai ptlJies of a fine up to$1,500.00 andlor one-year in3pHsonment,as well as civil penalties in the farm of a STIOP WORK ORDER.and a fine ofup to S7250.00 a day against the.violator_ Be advised that:a copy of this stateramt maybe forwarded to the Office of fin estigatitms of the DIA for insurance coverage verffication- Ida#see c eel? �t der t prans nnrlpanaitiss afpettuy t3taffhs irr{arrriutian prauidec£abrnre is hzra(an�rt correct Siatataae: Date. Phone : 7 - 0ffjciaL use ortFy. Dor not write in flits area,to be compLotesd by tat}:or town of ciaL City or Town:. PermitlLicense# Issuing Authority{circle one): 1.Board of Health 2.Buff ing Department 3.Cityltown(Jerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 9-. 6 T T Informations and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute, an anployee is defined as"._.every person in 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 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, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for alay applicant who 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 any contract for the peLionnance of public work until acceptable evidence of compliance wit the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone numbtr(s)along with heir ceziznca;e(s) of insurance. Limited Liability Companies(_LC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance_ Tt an LLC or LLP does have employees, a policy is required_ Be advised that this affidavit may be submiued to the Depar atat of Indusft ial Accidents for confirmation of insurance coverage. Also be sure to sign and date the a;fidavit 711t affidavit sholild be returned to the city or town that the application for the permit or license is being requested, not the Department of Lndus, ial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed.below. Self-insured companies should enter their self-insurance license number on he appropriate line. City or Town Officials 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_ In addition,an applicant that must submit multiple pernit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant sbouid write"all,locations in (City or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is oa file for future permits or licenses. A new affidavit must be tilled out each year.Where a home owner or citizen is obtaining a license or permit not related.to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this aftidw"it The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwoa.n of Massachusetts Depa-rtmtat of Industdal Accidents Qff lee of favestiotians 6,UO Washingtan Strut Boston,MA 02111 Tel.9 617 727-49-Go w 406 or I Revised�24 07 Fax#617-727-�49 yr .rrrass gov/I€i.a ,aco o CERTIFICATE OF LIABILITY INSURANCE °�'�'' '°°/3/ `� 12 3/14 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(es)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 endorsemen s). PRODUCER CONTACT NAME: Circle Business Ins Agcy Inc. PHONE FAX 247 Newbury Street ADDRESS:IL Danvers, MA 01923 INSURERS)AFFORDING COVERAGE NAIC# INSURERA:Safetv Insurance INSURED INSURER 13:Travelers Ins. Co. Contractor-Sub Contractor Name INSURERC:James River Ins. Co. Address INSURER D:Torus Insurance Anytown, MA 000000 1NSUREltE: 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ALDL SUER POLICY EFF POLICY EJP LTR TYPE OF INSURANCE INSR WVO POUCY NUMBER (MMMD/YYM 1MMMDfYYYY) LIMITS C GENERALUABILITY Y Y 00057827-0 5/22/14 5/22/15 EACH OCCURRENCE $ 1,000,000 X COMMERCLALGENERALLIABWTY DAMAGE TO RENTEDEa o=rrencW $ SO OOO CLANS-MADE �OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1 00Q 000 GENERAL AGGREGATE $ 'Z 000 000 GEN'L AGGREGATE LIAAT APPLIES PER PRODUCTS-OOMP/OPAGG $ 2,000,000 X POLICY PRO LOC A AUTOMOBILE LIABILITY Y Y 6217675 4/13/14 4/13/15 CaaSINED SINGLE LI T $ 1,000,000 ANYAU1O BODILY INJURY(Per person) $ ALLOWMED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS AUTOS ereoti X NON-OWNED PROPERTYDAMAGE d,,, $ _ $ FB UMBRELLAUABX OCCUR Y Y 79490E131ALI 5/22/14 5/22/15 EACH OCCURRENCE $ 1 000 000 XEKCESSLIAB CLAIMS-MADE AGGREGATE $ 1,000 000 DED RETENTION$ $ WORKERS COMPENSATION UB4009T76-6-14 1/1/14 1/1/15 1 WC5TATU-TD X AND EMPLOYERS'LIABILITY ANY PROPRIERIPARTNEREXECUTIVE YIN E.L.EACH ACCIDENT 500,000 OFFICERMAEMBER EXCLUDED? 7 N I A (Mandatory In NH) EL.DISEASE-EA EIVIPLOYEE $ 500,000 If yes,describe under DESCRIPTIONOF OPERATIONS below EL.DISEASE-POLICYLIMrT s 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Rema*s Schedule,If more space Is required) Certificate Holder is listed as Additional Insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Toby Leary Fine Woodworking In ACCORDANCE WITH THE POLICY PROVISIONS. 135 Barnstable Rd Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Paula Halas ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The AICORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: I_ k} eAl t `J�1f i C�llX Wta*ta Wf11, office of Consumer Affairs & f urine S RegulHtion License or registration valid for inditiiduf use c3u1` = kbME IMPROVEMENT CONTRACTOR before the expiration date. If found return to.. T Office of Consumer ,affairs and Business Re lati yp } eg str t;iQn: 1 942 10 Park Plus - Suite 5170 xp r .ton: 8117J Q16 Private CorparatiQr Boston, M 0211 s TOBY LEARY FINE WOODWORKING, INC. ` p 46 LAFRANCE AVE HYANNI , MA 02601 l!��tltri>ti��ew+^t� �' ' Nt�t ��ftd w th ut signature. -- _. ._. I0�aachuaotts Dep r'tmon # : Sofbty k� 4 +re= t 13!5 , - i A► $ "Af3LT Commissioner 071i8=16 Town of Barnstable Regulatory Services �swxMASM x tEg Richard V.Scali,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 0kI I (,A- 13 G� Ord S , as Owner of the subject property hereby authorize —r3 G q to act on my behalf, in all matters relative to work authorized by this building permit application for: 2 d LZ Al' UGc-k\j /21 m/ (Address of Job) "'Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of App ant moml-(x 13arfas Print Name Prin� I2 -3f - I� Date Q TORMS:O WNERPERMISSIONPOOLS Regulatory Services THE r M Richard V.Scali,Director Building Division 4 i t Tom Perry,Building Commissioner 6 9. ��� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village . "HOMEOWNER': name home phone# work phone# CURRENT WJLING ADDRESS: 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 on(,- 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 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 who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q;'Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the--- permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC Revised 0613.13 1 lvlf`e . Coyle, Brenda From: Coyle, Brenda Sent: Tuesday, February 13, 2018 11:14 AM To: Melanson, Dean Subject: COO Signoff Permit Number B-2014-08781 Good Morning, Dean This Permit needs Fire to signoff for the homeowner's Certificate of Occupancy Family Apartment. This permit had a final on July 29, 2015. If you have any questions, please feel welcome to contact me. Thank you, Zre,da'G.yle Permit Tech. Town of Barnstable Building Department Ph: 508-862-4039 Fax: 508-790-6230 1 (Z9 CXO ��� �"' ��;' P Town of Barnstable Regulatory Services B"R"'r,S& Richard V. Scali, Director 1639. 10 ,a Building Division Paul Roma, Building Commissioner 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038. Fax: 508-790-6230 January 6,2017 Monica Barros 250 Longview Drive Hyannis, MA 02601 Re: Family Apartment Dear Property Owner, Please complete the enclosed Family Apartment Affidavit and return it to the Building Commissioner's Office by February 2,2017. You are required under Section 240-47.1 of the Town of Barnstable Zoning Ordinances to submit an affidavit annually indicating the status of the Family Apartment. Failure to submit the affidavit is a violation of your Family Apartment approval and may result in the loss of your rights.. If you have any questions, please call Brenda Coyle, Permit Tech., at 508-862-4039. Sincerely, Paul Roma Building Commissioner . r Enclosure I 'I Town of Barnstable Regulatory Services oFt"e Richard V. Scali,Director °* Building Division BAMSTMM Paul Roma,Building Commissioner 'gyp i 39. .�� 200 Main Street, Hyannis,MA 02601 rED MA'S www.town.barnstable.ma.us Office: 508-862-4038 l Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: My name is I am the owner/resident of the property located at: 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, I will immediately . notes the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I 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 240-47.1 Family Apartments. I agree to note 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 day of 2017. Signature Phone Number Print Name q:forms/famaffid.doc rev 11/08/12 . Town of Barnstable 4; 1ME Regulatory Services F Tp� o Thomas F.Geiler,Director Building Division * anivasrnst.E. v MA. g Tom Perry,Building Commissioner 16,39.i0lfo�.tp 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 508-790-6230 Approved: Fee: Permit#: =;a 0�5�0 3 HOME OCCUPATION REGISTRATION Date: i Name: +I Li OS LOB,t �l S' CS /46-L%O R �C44041?hone#: (�8)A.0 K-1 4 0 Address: 2-M G DoJC✓i��,.J�2 Villager t �'1 Name of Business: 4 (,t OS Co Type 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 Hcme 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 dwellin4 unit. I,the undersign d,Ild and wi bo restrictions for my home occupation I am registering.^Appliant: Date: 0g/ /'/V� Homeoc.doc Rev.5/30/03 YOU WISH TO OPEN A BUSINESS? 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 operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis;.MA02601 (Town Hall) 1° r DATE: (I < D Fill in please: APPLICANT'S YOUR NAME: AQ-� 0 - �.BUSINESS YOUR HOME ADDRESS:ZSD. GoAZ F � GcNr V L/i C'C.0 M/4 TELEPHONE # Home Telephone Number S'Q8)36p S 7lr 0 NAME OF NEW BUSINESS Gr oS. CGr C S TYPE OF BUSINESS. t-c J"72�cs 2c Js IS THIS A HOME QCCUPATI+DN, Have the bu . ' div�sio YES NO ' ADORES O.F Wall ES MAR/'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: 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 town. 1. BUILDING CO NER'S OFFICE This indivi ua(h s n infor y permit requirements VML pertain to this type of businesf?AUST COMPLY WITH HOME OCCUPATION ARULES AND REGULATIONS. FAILURE TO tho ..ed Sig ure COMMENT -2i > COMPLY MAY RESULT IN FINES, 2. BOARD OF HEALTH This individual ha inform f e per rpqvir ments that pertain to this type of business. Authorized Si ature**. COMMENTS: 3. CONSUMER AFFAIRS(LI N ING AUTHORI Y This individual has�b� ryin rrried of th a'n q irements that pertain to.this type of business. 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Not to Sole.;. , , , _ sty , y• yx" '•`Y ..* OP,}. r,,�!Tr.,"Cea � �M�.i�g•WW.'( _�.�l•�.w�p•*,"� � J s. �.• ' +'�� .�. � _ 1L •/ �o �J ''�� S,' \ I �:, , 1 a d.. �y ' ..• ,' r U�.' tie y 4�✓ r 1 t/S:�slid A�A_M J4�, -i OYAf1' MLi i a 1F•10 w s t X - 0.01 R_ •,�-^ OIST. e071 = zt� T FC17 Elty.-93 SO or OrM10 aP " 4' - SCH. 40 T I !� /1Q1, + t.Wv.Y/�r- _ .1a• - .. S. -w IIOt` •�. " J...�W SEC I ION Q T_ - nc° �R ss-sEcTION ,�' f�{•-�Q� ♦� _ 'f�• ' „. A f, . 24•: ElfeCtivf r% A s ue,re: a 3�ts H -10 I TR I Tl N BOX y 5 Y P Or 1 s&a 3/4�-1 1 i ; '� 4� -+.. S 3.�t � 3'.�t NOT To SCALE �.r wv+v+ra+r;•� , :; � 3 � - Efftc'We LeNth GENERAL NOTES ` e kof 3/r-1 1/Z' i SAIL ABSORPT al SYSTEM (SAS)moved"-, .o... r.-�. 1. Contractor is responsible for Oigsafe notification NOTE: ALL'00>MPOlIfJf1�MIJST HAVE 70 MATHW e' BEl�Dw GRADE 9octaln d T..t Ikr.1 FLvre6.00 o INFILTRAT❑R MODEL 3050 CH-20 LOADING>/ $LIMNER >Ir Dl1NBAR and protection of all underground utilities and pipes. No emadoos;.aa.nnr 0144• ___ 2. The septic tank and distr' upon box shall be set _ (OR EQUIVALENT) level on 6' of 3f4 -1 1/2 stone. NOTE- 0,,CRALL HEIGHT OF 04FLTRATW,1S JW /EFFECTIVE HEIGHT IS 24' 3. Backfill should be cban sgnd Or grovel with no f, stones over 3' in size. 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc. 5. The oontractor shall install this system in accordance with Title V of the Massachusetts state code, the approved plan • • - ,'. f�ERCOLATIQN ''TEST - and Local Regulations. 6. If, during installation the contractor encounters any / - soil conditions or site conditions that are different tir r Dote*of Percdation Test: rOV.'15. 2004 from those shown on the coil log or in our design Test- Ppfotmed By. CARMEN E.'SHAY, R.S. C.S.E. Failed installation must halt & immediate notification be ,ftwin Witnessed B� WAIVER ' .pe► 8orristable B.O.N.) Leach Tre EXCAVATOR• UNKNOWN made to Cormen E. Shay - Environmental Services, Inc. EXCA AI •Rat�:�NOW T1>rOn 2 MPI O 42' 7. No vehicle or heavy machinery shall drive over the septic system uniess noted as H-20 septic components. c ► 8. Install Tut-Tate gas baffles or equals on all outlet tee ends. f • 9. All Distribution Lines shall be 4- diameter Schedule 40 NSF PVC pipes. 0 Y4^-� 10. All solid piping, tees & fittings shall be 4- diameter Schedule Schedule 40 NSF PVC pipes with water tight joints. No. 1; `• • ~;� t 11. Municipal Water is Connected to ALL OF The Residence and Abutting r DEPTH SOILS fl11/ •� ----- --�i - Properties Within 150 Feet. - - 0 9&00 y Aboveground THE PROPERTY LINES ARE APPROXIMATE AND PmlJ COMPILED FROM THE SURVEY PLAN GENERATED BY r 4R EDWARD KELLOG. CIVIL ENGINEERS OF BARNSTABLE, MA ENTITLED 7.50SUBDIVISION PLAN OF LAND IN BARNSTABLE. MA 749 LOOM TEST HOLE 11 _,� --9g AND ILC PLAN NOT 28NTENDED 0 BE A SUDRVEY PLOATED T PLAN MBER 1958 9a+d � EXIST. 1000 gal. - , ELEV.- 98-00 O Septic To(* - co IT SHOULD BE USED FOR NO PURPOSE OTHER THAN p a THE SEPTIC SYSTEM INSTALLATION. ,� • s•_ 42- s o LOT - c h - ------ --- Deck % `` EXISTING LEACH TRENCH TO BE PUMPED OUT AND s �r� '• � I REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION 00 00 1 . NOTE: ANY STRIPPED OUT SOiI CONTAINING LEACHATE 4Q Mil Liner To Extend INCS7 LOT J50 FROM THE EXISTING LEACH TRENCHT TO BE DISPOSED From-Elev. 9 f.50 to 92:50 s D�00Y OF As PER BOARD OF HEALTH SPECIFICATIONS. BOUSB - fINC `� `_ -- -- -� - - NO WETLANDS ARE PRESENT WITHIN 200 OF THE PROPERTY - #240 GIRLGd �``\ ASSESSORS MAP 251, PARCEL 140 t_ N Perc PROJECT BENCH MARK i ,\ 104X 1 DENOTES PROPOSED Depth Perc: 42` to 60' TOP OF FOUNDATION I _ � SPOT GRADE Perc Rate- Lees Tltpr► 2 t11P1 ELEV. = 100.00 (Assumed)" I t I i C VIt X 104.46 DENOTES EXISTING Groundwater Not ODsprved I i i I 1� \��( SPOT GRADE ADJUST ONo poiserv#0 O..HEIev = Pone ------ ----------{--i i i ------ PL PROPERTY LINE 4 ASPHALT• i LOT49 _ DRNEMIAY i .NX'�1 96 PROPOSED CONTOUR } � ,• 13,000 SAY pest f/- I I Qv�" b \� -97 EXISTING CONTOUR DEEP TEST HOLE & g6" 100.00' ' PERCOLATION TEST LOCATION r �-11r owls Mw.rar<a 6 FOOT STOCKADE FENCE P LOT P LAN - L O 1V G VIA' W L0 R I VE .,t m �mmmliaii 'M' '""` OF PROPOSED SEPTIC SYSTEM UPGRADE .� >KAn as PIMP T (40 FOOT IGHT OF WAY) Im OWN.• ` PREPARED FOR r�u.Tvimnc i tflp!. M R . RAN DAL L D OY L E x f _ AT a LOCAL LL7L.� Q �T �. V L bG� I �/ / V itx M4t IR ,•'`� If -it-'!-I • ' •.� , .I .. �1 - pc #250 LONGVIEW DRIVE 1, Rpue(<t a.VPrdertvl te'r9dWm'tfe gWwC6 from'the SAS.to the L,ia IL w� + S� Foundation fri;im 20 foot aA 1?GO.f�-tar Mqc F010elble Complkl.c�. a Bova r H YAN N I S A x ,, .. ►+1••� w1.4'. ,. ;.,. , A 40 MIT Rubber.Liner.to M'Jr*i6 W W Shur pp/Q All 1 t1 � M t(i` .1+,� .1"r i '�7• 2!1- T•s. .�, ,T' - '/ S �.' ♦ .� - - - � T1e. w.:. - ` ' -. - - - � 'D✓�� / OF txr r.; Q a� 1N s EPARED @Y: , to co- (440 CVI�/J)W Min. W Title V) ,d„" ;_ �• y>, �r ,tee ,ram ; • r; + ++�• NurelgeE.ot.6edroom�:� I` o a /�Y: y ? ��fj N '. SHAY ';'*, :af'•�-,i-u. M�„ ,. OorbcSlel'�{Mder: .�z� 4 ° M CA l'1►1 T1,�[i G?L/Oa`y Minb kyrrl Per �LtI !. ,• T �j�. f ! /q ,. �p/� Q�' �y��_ t 00o Sop tip 20 _ S 1VWI)WNY.E1VTAL S.NRVICZS. INC. r elti..w .9tr •. _ t M'v.`1 '•�'.�•aZ'♦Y•4'� .q MYv USE•.•✓7!+Mr • `mil! 0 , a. L..;• ., , -10 -S011 J A ' -Using 'parCd"!'_"'dote O� c7 irllrl./4r>L ►_ _ . `.R END -SEE`TIOt� 0�4�d/sq- ft. x �44f: 3 �F P,O. BOX 627 . .. ,• t�- •. • c Cq lla :, p /y� EAST FAl.MOUTH MA 02536 I� ft X '200 iL,�` 144 l/r"�'! 1476.3b N17AR� -5 -0796 �,� . , �. �, • TEL FAX 508 48 tom,- t`1 T1Q­ -r hlA 6 Z'. CmE OEPT}t,Y .SEP 'SCALE: t =20 .- C DATE: NOV. 16, 2004 F, , asti {�,}:NK > AAI�C3 f] 1NIFlLTRATO�i HN1BfRS. �N SCALE: 1 =20 DRAWN 6Y: ES L.2• }.' .,, ,t .. ,-Yi' ♦c ` 1 ��..,,• S•' i_ "���J r., 4 S .¢ i.)�3' 'A�T�'R�7`�L ,DG 4iV �F 4""1iw..Sp ® MNf. „•M .. •a �: .. -w } ' .�5' Tone qa THE E1�1QS. - :PRpJECTj�Si1658 FlLENAIIAE: SD6S$PP.DWG SHEET .' ..r.•L. real'..-. ....• a .�. '.�„•r --- - -.�1I•li.i�T"-•fll�ilt�`i�Z'��._...S►P'iY .t".- A...�, it_-.a•w�.. ._: �'' �Y'- ��._ -�'k-=�'i j --- _-, ..� - .- ra._.....r'r" _ _.e.yr40-.• �.•.- ..� .. -- - ,._ .. _ ..