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0259 OLD TOWN ROAD
__ ,. e �' _ — ; ____ -- -—,l _.._- ____� ____ � _--_ ._ -_ _ _��_ w_ i __, a . . � � I 7 i � 4 j _ Y ___.___ ____� fl __ Town of Barnstable Building Division A FVo 200 Main St. Hyannis, MA02601 � ;.° H METER 71097-.. yO� 40 . FA r Nick and Tina Perivolarak s �<;� 259 Old Town Rd. , Hyannis, MA 02601 _.,. /� �.... i� ` � ��-.,, _M / ` t �.... ` , ..... `, , � % __. , / __. � ,� __. �. - ' .. .... / _ ,, �. 1 i� Town of Barnstable o� Regulatory Services BMWSTABLE Thomas F.Geiler,Director 9 MASS. q, 1639. Building Division ATFp �s Peter F.DiMatteo. Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 March 18, 2002 Nick and Tina Perivolarakis 259 Old Town Rd. Hyannis, MA 02601 RE: Map 268 Parcel 007 Illegal Apartment do not like program restrictions through Amnesty Dear Mr. and Mrs. Perivolarakis: Our records indicate that your house at 259 Old Town Rd., is currently being used as a two-family home contrary to Barnstable Zoning Ordinances. You must contact this office as soon as possible to either: 1) apply for a building permit to restore the property to a single-family home 2) apply to the Zoning Board of Appeals for a variance 3) prove that this is a legal two-family. • ..j You must contact this office immediately to tell us what direction you wish to take. Sincerely, 11,, Gloria M. Urenas Zoning Enforcement Officer GMU/aw Q021502 Town of Barnstable *Permit# - alb Regulatory Services gee 6 months from issue date e� 1AEN8TABI.E. � � �,, MAas. g, Richard V.Scali,Director . 039• �0 M a 6' Building Division H91;t ' Paul Roma,Building Commissioner I pJ 2018 200 Main Street,Hyannis,MA 02601 ¢� � www.town.barnstable.ma.us � ' Y-- Office: 508-862-4038 Fax: 5Ar -790r6230 2, EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number n 2 � Property Address Residential Value of Work$` l_` AQQ,�Ob Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name ` � 5 Telephone Number Home Improvement Contractor License#(if applicable) R,;�O%k = Email: ez 3,1S lys b:yt Gates Construction Supervisor's License#(if applicable) *orkman's Compensation Insurance �- Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation insurance Insurance Company Name M4'r/®111A L G9A414,f Al v-1yaA L -11/.0 f/ &AA16 �\Workman's Comp.Policy# 4/c(. 6,00 Qll A Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed),(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A cop of the Home Improvement Contractors License&Construction Supervisors License is req re . SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 f 1 Ile Cowwomreah*of Afassadrusetts rwtne ut of r strid Acddem& Ohre Of IMVS*atiwu. 600 WashhWon Sheet Boston,MA 02111 wmmu masmgOvIdia Warkers' C Insurance AffnLwit:Suildexs/CrntractarslElec ricianslPhmnbers A>rGcznt Wm=fiGn c e' Please Print fie tly Address~ crtgfSta&zgY Phme Are you an employer?Qreckthe appropriate bom T of project r I am a general contractor and I Yl� P ] t ���'= 1.M I am a employes with. ❑ � 6_ [—]New corlstroctim employees(fall andfor part ime * lfave hiredihe sub-coatractors —�_ 2.El am a sale propdetotr orpartaw- Tisted on file attached sheep Ii�DCl�Vdelirrg ship and have no employees , nfese sub-c=ftactors have g_ ❑Demolition wodnag for me in any capacity. employees and have workers' 9. .El Snildiag addition [No WodMrs'comp.fiISa aoce comp.?„eR� I required_] 5_ ❑ We are a corpo2atim and its ME]Electrical repairs or ad&tious 3_❑ I am a homeowner doing all work officers have exercised their 1 L❑I!h robing repairs Of ad&fions o wa dmrs' a of ememptim per MGI. v myself insurancue d-]o - c.152,§I{4k aadwe bean no L.❑Roof repairs. employees_[No Wormers' aEl other comp-insrtrance repaired-] •Any Wficsatdmt cbeftboa#I nmst also Maotthe sw iaabelawklww g theirsv ame compem aft=Periegizffi== mL I Ifamea mxms wha submit dris afiidaeif IDdyCaf> d ey axe d=.-4 mU wa&end Boma hire aatm&contmctarsamct submit a neW affid t mdica ag s b- fCaatracft stintcbecYtw baxmaststiarheaansairimalsheetamcingthenasztieofthemh—camuscmtaaad mite whetherarnotthoseextideshave employees.I€tbasub-c��hsoeempIoyw-%&eymusrp=mdetlms vmdEe 'cmnp•PaHrYatmdsm I am aa2 eniglrryCrr fliatispreuidirrg n�orlcers'courpertsaftofr i�tsfarafrca for azys efrrplu}�eex Betoty is tlrepalicy arm jol�site in�otznatiott, Insurance Company Name: Palicy,or Self-ins-Lic_; F�piratiaaDate. Job Site Addres€ CngI5 �.tg: Attach a-mpy of the workers'comarpensationpolicy declaration page(showing the policy,mrmber and expiration date). Failam to secme coverage as required under Sm ion 25A of MGL c<157 can lead to the imposition of criminal peaaldes of a fine up 1a S1,50QOQ and for one-yea r uisostmeuf,as well as rises penalfit's in a fay of a STOP�dC}RI 4]RI�ER and a sae of up-to$Moo a clap aa`ainst the violatar_ Be adsased that a copy of this statement maybe forwarded to the Office of lavestegations of the DIAr for inshore coverage verifical ion- I do hereby certify ' s andpmatties ofpcdW7 thatthe igflbrmatfmj-prmided abm a i;trap and carted Sitmature: Date_ . It Phone t7,oldat use a my Dv ant witff in flax exec,to be ccingfeted by city rartetvn a,9'icrat Cky or'Town: PerrmtlLieense;g Issue=katharity(retie one): L Board of Health I Iudrog Departmmt 3.CltylTown flak 4.Electrical L=pector S.Ptusabh g Enspecter &Oth w cor"a Person: Phow it: 6 f -Information and lastrueffous � ct s General Laws chi �� P a 7yfs�ecarlirrc 152 aII 'to 'PPorkeas'comPeusaflanfra-fheff e¢rployees. Pm MjMtto fhis sib,an envkgv ee is defined as."_.evmypersdnin fe smvice of soothes under any cozffr�ofhire:, express or implied and or wzittenf An empiayg is defined as"an mdivfdnal,parf=rship,associ&on,axporatian or other legal Mir ,or any two or more of the foregoing engaged is a Joint entr and mclnd- the legal eseinafives of a deceased employer,or the receiver or truster of an iadivi parblasbto,association or other legal entity-,enxploymg Mpmy=S- However fhe owner of a.dwelling house havingnot more tban three apa tneuts and who resides merein,or the occupant of the - dwaMag house of auxd=who employs persons to do mamtimmm,causftuction or repair woi3c on such dwelling Jaouse or on the grounds or bmymg appmfi;nant lh=tD shall not becartse of sash employment be deemed to be an employer." 1�(3L chapter 152.§25C(6)also sti th rs at-every state or local licensing agency shall wiihhoId the issuance ar renewal of a license or permit to operate a business or to contract buildings in the commonwealth for any app&rant:w•ho has notproduced acceptable evidence of cdmpliance with the hnmxance.coverage required." Additionally,MGL chapter 152,§25C(7)stains fiTeitberthe.rrm= awcah nor;�:y ofitspoIifical subdivisions shall im MtD any contrail fortbepqrb=ance of2abho wo3kuob1 acceptable dvideam of compliazncewith&a insm-mce._ req=emcuts of this chapter have been presenhed.ID the co13fracinig aufhDZdy." Applicanls , please fal oirt the woii=' compensation affidavit couplet L by dicckmg ae:bones ffiat apply to your sffnadon and,if, necessary,supply sub-contrac Io s)mme(s), addresses)sndphone iizmber(s) alongwrththeir ceztificate(s) of ;mmnance. Limited Liability Companies(LLC)or Lmzifed Liabjity Ps(LIP)with no no es other than the members or pmt:aeas,are not rued to catty wolie' compensation Dance if an LLC or LLP does have employees,apolicy is required. Be advisedthd this affidavitmaybe submitted to the Department of Iudasfrial' Accidents for contfrmafion of aMM-a+rp coverage Also Be sure to sign and date the afrdavit The affidavit should be retb=ed to!he cify or town t$af the application for the pe=it or 1iceose is being requested,not the Department of Ln-dasf,J%1.s,cau1=f e Shanld you have any gnestions regarding the law or eyou at a requJred to obtam a woiirers' compensation policy,please call the Department at fhe nrmzber listed below.. Self-m mnmd companies should eater their self-ice license mmnher a a the agprapiiafo Ime. City or Town Officials Please be sore that the a$davif:is complets and priced legibly. The Department has provided a space of file botfaM of tine affidavit for you to fill out is the event tine Office of 7nvesfigaiioas has to corifact youregarding the applicant Please be suite to fill in tiie pen it ceizse inrnber which will be used as a reference number In addition,an applicant that must sabmii multiple peimitlIicense applit affi s in any even year,need only sohmit one affidavit mdicatmg=Mt policy fi founation(if necessazy)and under`Job S$�e A_d ess"the applir.A3t should write�aII loc ations za (may or. town)-"A copy of the affidavit that has been officfaIly.stomped or mm3ced by the city or town may be provided to the . applicant as-proof;tdzat a valid affidavit is on file for future permits or licenses A new affidavtmvst be filled oit each year.-Where a home owned or citizen is obt sing a license or peaint not related to any bns�or corvine m ial 4&e (ie.a dog liom=orpermit to bum leaves etc.)saidpersou is KOT=jrdred to complete iEs'affidavit The Of ofInvesligafms wouldliketo fi>ar_kyouin advaace foryour cooperation and sbovldyou have ray questions, please do not hest to give us a call The Departmeufs address,telephone anditaxnnmbra: CDMMWVMM-of Massach . - . �tc��.f Tts� fio� B MA Oil1F Faux#617 727 7749 Revised 4-24-07 �g r =Y i r Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division, Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office: 509-962-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I iA , as Owner of the subject property hereby authorize ��� ��10 .s`L (IlJ to act on my behalf, in all matters relative to work authorized by this building permit application for. Ot of -7-0 Lt.)24 oJ B ow"3 (M&es& 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 er Signatur f plicant r✓ P C LA A- S Print Name Print Name Date QYORMS:OWNERPERMISSIONPOOLS Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division IMANSTA1314 : Paul Roma,Building Commissioner XAM ��� 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. DEFINMON 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 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 / f Office of Consumer Affairs&Business Regulation License or registration valid for individul use only t� SOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - +Registration: 182094 Type: Office of Consumer Affairs and Business Regulation Expiration € 5/26/2017 Corporation r 10 Park Plaza-Suite 5170 t Boston,MA 02116 EXCEL BUILDING SYSTEMS COMPANY INC. RENATO DA SILVA 'R 1=` 8 JAN SEBASTIAN DR:STE25' SANDWICH,MA 02563 x+ x e Undersecretary Not valid wr out signattyr'e Massachusetts-Department of Public Safety Board of Building Regulations and Standards %instructi,nn SSunerviir'r , License: CS-098849 RENATO F DA SW A_�--� 8 Jan Sebastian Dilve It Sandwich MA 02363 Expiration Commissioner 06/20/2017 A Client#:38860 2EXCELBU DATE(MMMD/YWY) ACORD.. CERTIFICATE OF LIABILITY INSURANCE I 3129n016 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:B the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WANED,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 1 NAME:CONTACT — Dowling&O'Neil insurance Ag — , SC 81218N 5 973 Iyannough Rd,PO Box 1990 i E-MAIL ADDRESS;___ Hyannis,MA 02601 { INSURER(S)AFFORDING COVERAGE NAIC a 508775-1620 ,NSURERA,National Grange Mutual Insuranc INSURED INSURERS:Associated Employers Insurance Excel Building Systems Company,Inc {INSURER c:Safety Indemnity PO Box 436 1 INSURER D: Forestdale,MA 02644 `-- ---�—--- -- INSURER E: _ ------------. —_----- I'ZS RER F:^ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADD UBR POLICY EFF POLICY EXP Tp TYPE OF INSURANCE jpsR yyyp POLICY NUMBER MMIOD/YYY MMIDO/Y n_iLIMITS — A GENERAL LIABLLLTY MP02774T 016 02=01 T EACH OCCURRENCE S1,000,000 Xi COMMERCIAL GENERAL_LIABILITY 1 DAMA��,EE TO RENTED i i PREMI JTOR NTEDnce) $500,000 CLAIMS-MADE FX1 OCCUR i MED EXP_(Any one person) S 1 O 000 i PERSONAL&ADV INJURY $1 000 000 - y GENERAL AGGREGATE s2,000,000 GE LICY NL AGGREGATE LIMIT APPLIES PER: f (PRODUCTS-COMPIOP AGG $2,000,000 PO E T LOG i $ COMBINED SINGLE LIMB f C AUTOMOBILE ABILITY 6231596 2/09/2015 12/09n016 ,000,000 LIABILITY _)ANY AUTO BODILY INJURY(Per person) S T ALL OWNED X SCHEDULED S BODILY INJURY(Per accident) $ AUTOS AUTOS .PROPf--ERTY DAMAGE S —_--- NON-0WNED { ii ° Per acddem Xi HIRED AUTOS X AUTOS I 5 UMBRELLA UAB OCCUR I j EACH OCCURRENCE S i EXCESS UAB CLAIMS-MADEf 1 AGGREGATE S DED RETENTION ' - S 'WORKERS COMPENSATION I WCC500500981 B2016A 3l05n016 03/05n01 X _IQBy�WCSTATU- OTH- B AND EMPLOYERS'LIABILITY t; IMftS _ _ !ANY PROPRIETORIPARTNERIEXECUTIVE;IY,I ,E.L.EACH ACCIDENT _S5001000 OFFICER/MEMBER EXCLUDED N`t N/A t E L DISEASE-EA EMPLOYEE S500,000. I(Mandatory in NH) {_.:.--------- i it yea desrnbe under {E.L.DISEASE-POLICY LIMIT $500 000 DESCRIPTION OF OPERATIONS below V i L I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule.If mate space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(201 DM5) 1 of 1 The ACORD name and logo are registered marks of ACORD ran 4C1Ia77OgAA11q77Q0 Town of Barnstable , 'THE' Regulatory Services Cq Thomas F.Geiler,Director WZMA 114 « MAM g Building Division 6.39. Is Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us � ) Office: 508-862-4038 Fax: 508-790-6230 PERMIT# FEE: $ SHED REGISTRATION 200 square feet or less Location of shed(address) Village Property owner's name Telephone number S �S Size of Shed Map/Parcel# 0 � � Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. i TIRS FORM MUST BE ACCOMPANIED BY A PLOT PLAN i Q-forms-shedreg REV:05201 i N v i Iq f7i iy � . � � o it— ,,. oat \ . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued g a�L Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic OKH _ Preservation/ Hyannis Project Street Address Village ;S vfT Owner I m Address 6&L&__ 31 Eaz.44 A4 w og. Telephone Permit Re uest r 17 Q U.r Square feet: 1 st floor: existing propofType 2nd floor: existing peed Total new Zoning-gistri�6 od Plain Groundwat verlay r ProjectValuAon Construction a� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Tyke: Single'Family ❑ Two Family ❑ Multi-Family (# units) Age Exiswi g Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basftent Type: ❑ Fullw ❑ 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# T Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name /� ?� - y Telephone Number `D / AddressPZ2QZq,&4 WAO.ZLicense # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO - SIGNATURE DATE_ �S "- — 01 4 r FOR OFFICIAL USE ONLY `APPLICATION# � r DATE ISSUED - MAP[PARCEL NO. ADDRESS — VILLAGE '— f OWNER ' 1 DATE OF INSPECTION: FOUNDATION rk l r'f ' FRAME �a INSULATION FIREPLACE ELECTRICAL: ROUGH * FINAL r PLUMBING: ROUGH FINAL s GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED.OUT e t ASSOCIATION PLAN NO. t 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 � l ` ll-a7m7(Business/Organization/Individual): Addresses "�j - am I oil 0(ko g& 0 o� City/State%Zip Phone 0� Are you an employer? Check the appropriaoz: Type of project(required): 1.❑ I am a employer with �4 I;am,a general contracfoc and I— -�6.;-❑,New construction employees(full and/or part-time).* have hired the sub-contractors 6'� ' .2.0 I am a sole proprietor or parhier- listed on the attac_he`d sheet--..r T. Q Remodeling These sub-contractors have ship and have no employees 8. ❑Demolition workingfor me in an capacity. employees and have workers' Y P ty. 9. ❑Building addition + co irisurance.t. .:G-.*�. 3. [No workers comp.;insurance required.] 5. We are a corporation and its 10.❑Electrical repairs or additions F officers have exercised their 11. Plumbing repairs or additions 3.0=I ama homeowner,doingall,worker ❑ g P ` right of exemption per MGL myself. [No workers'comp. 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no .._..- °--- ---� T- ..---,�,} employees. [No workers' �9Other ?�]�Tr/�tn comp.insurance required.] —-F *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy infomnation. 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: Policy#or Self-ins. Lic..-#: Expiration Date: Job Site Address: Did --fou)3A kod o q ity/State/Zip: tA 1'T Attach a copy of the workers' compensation policy declara on 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 DIA for insurance coverage verification. I do hereby certify and r the is and penalties of perjury that the information provided above is true and correct. ��Si "afore:. Date. Phone#: 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their,employees. Pursuant to this statute,an employee 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 local 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 any 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 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 out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies.(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP.does have employees,a policy is required. .e advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the 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 permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"Lhe'applicant should write"all locations in__(city or town).".A copy of the affdavif that has been officially stampedjor marked liy the city Wtown may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled 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 bum leaves etc.)said person is NOT required to complete this affidavit. 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 Commonwealth of Massachusetts Department of Industrial Accidents office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-72777749 Revised 11-22-06 www.mass.gov/dia i Town of Barnstable Regulatory Services + L►RNSTABLE. • Thomas F.Geiler,Director NAM 1639. ,��� Building Division TED I�AA'I Tom Perry,Building Commissioner 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: 0 t JOB LOCATION: TVCdA number street p villag p "HOMEOWNER": Y/ 0 �® 'O�d� �Y 61 7 101 X 46- name home hone# work phone# CURRENT MAILING ADDRESS: '�� � t /4- 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 is. Sign r f 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:\YvrPFILES\FORMS\homeexempt.DOC °F rti Town of Barnstable Regulatory Services Thomas F. Geiler,Director ate` 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 i If Using A Builder ' as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date ~ Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on th Creve seaside-. Q:FORMS:O W NERPERM IS S ION AUG-21-2009 13:29 BC TENT & AWNING 50B 5BG .7177 P.003 ACORq CERTIFICATE OF LIABILITY INSURANCE °02/05/20099Y' PRODUCER Serial# 3032 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION KIRKILES&ASSOCIATES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE COMMERCIAL INSURANCE BROKERAGE LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 273 RIVER STREET NORWELL,MA 02061-2209 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: STAR INSURANCE COMPANY BC TENT&AWNING CO., INC. INSURER B: 25 BODWELL STREET INSURER C:. AVON, MA 0232E INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH gPOppLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ICTR NSR pDLTE EFFECTIVE PDATE MM/DDnON TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGE TO RRENTED $ PREMISES Eacccuren. CLAIMS MADE OCCUR MED EXP(Any oneperson) S PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY RCO- LOC: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) - ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS - BODILY INJURY $ NOWOWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE S 5 DEDUCTIBLE $ RETENTION $ $ P . WORKER'S COMPENSATION AND X TORY LIMIT R A EMPLOYERTIJABILITY WC0428730 1/1/09 1/1/10 ELEACHACCIDENT $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED9 EL DISEASE-EA EMPLOYEE $ 500,000 If Yes,describe under SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT IS 500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS THOSE USUAL TO THE INSURED OPERATIONS, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN TOWN OF HYANNIS ATTN: BUILDING INSPECTOR NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 200 MAIN STREET IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR HYANNIS, MA 02601 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108) ! 0 ACORD CORPORATION 1988 Total P.003 AUG.21.2009u.12r25PM CARDIOVASC. LAB CHILDREN'S HOSP. NO.603 P.2 e-#,16 Department of Industrial Accidents Offs of In vesfigations 600 WaShingtOu Street 008t8n,Mass, 02111 �gvfw s v/rl� W®�dteQs''Cj®'1'�rnxa_pAes>Lsa$amlaD .d�saa�lme� �9..�fcda�vti�t: �Ge®�er�.�l�aosdta�ss�s P £ NAME: Ci SiCact�>r7s: C:N l4 0232 Are you an employer? Check t£ne Mpproprdafe Bost: Busizess Type (Required): 1. ""*I am an Mployer with ,]moo employees(full 8. �] Retail and/or part-time)* 2. 9. Resrauranc/Bar/Eating Establishment 3. ❑ z am a sole proprietor orparmership and have no employees working for me in any capacity. 10. ❑. Office and/or Saks(incl.real estate,aut [No workers' comp. insurance required] 11. ❑ Non-prom 4, ❑ We are a corporation and its officers have exercised their right of exemption per c. 152, §1(4.), 12- ❑ Entertainment and we have no employees. [No workers' comp insurance required]'" 13. Manufacturing 5., We are a non-profit organizations, staffed by 14. ❑ Health Care volunteers, with no employees. [No workers' comp. insurance required] 15. C `Any applicant rbat checks box#1 must also kill out the section below showing their workers' compensarion policy information, ""If the corporate officers have exempted Themselves, but the corporation has ocher errtployees,a worl`ers'compensation policy is renuirec an organization should check box#1. lam an amplayeir th at b providing workers l compemsddDn tt�aasrax�scE aa' vny eaa�layens, �e�osv ��se palyoy'a orr�cr��tm��, lns ze tt STAP, lNSUANCR QQMZ&NY Ln r's. M t i dCAt l DRII &UPY. 0 or 961fins. .Lik, #, W0042&730 Attach a copy of the workers, compensation policy declaration page(showing the polaey number and expiration date). Failure to secure coverage as required under Section 25A of VIGL c_ 152 can lead to the imposition of criminal penalties of a to $1,500.00 and/or one-year imprisonment,as well its civil penalties in the form of a STOP WORK ORDER and a fine of up S250,000 a day against the violator, .Be advised that a copy of this statement may be forwarded to the Office of lnvesagatiom -DIA for insurance coverage verification. do fRereb i��aa�zd� �, a�ai�eratal 0}"PI,jUay YiZldt 2i92 infoYaracarfo?s provgderi l2bayE is prase earl corrLC� Signature �'� — Print Nate Qg3 ra L,Caujuol�o Phone 508 586-0900 Offz i l use onjy. Do fwi sys-iae ex ihkv arena to he tore{pierm by city nr 203m ofj7cial City of Town: Issuing Au1'horiry(circle one): l- hoard oCFlealth�. Building Clepararent 3. CitylTo�vr.Cleric , i icep;ink Bortrd�. Selectmen's Office 6. Miler - r AUG-21-2009 16:08 BC TENT & AWNING 508 566 7177 P.001i001 Certtjtcate of Flame Desistance REGISTERED ISSUED BY Date of Manufacture FABRIC JOHNSON OUTDOORS INC. NUMBER BINGHAMTON, NEW YORK 13902 MARCH 2O02 F-140.01 Manufacturers of the Finest Tent Products Described Herein This is to certify that the products herein have been manufactured from material inherently flame retardant as here after specified by the material supplier. NAME B C TENT INSTALLATION CITY: AVON STATE: MA Certification is hereby made that: The articles described on this certificate have been manufactured with an approved flame retardant chemical in compliance with California State Fire Marshal Code, NFPA-701*, Underwriters Laboratory of Canada. and have been tested in accordance with the Federal Test Method Specifications and meet or exceed the Military Flame Specifications of MIL-CA3006G. Type,color and weight of material 140Z. Vinyl WHITE BLOCKOUT Description of item certified: 20X30 ELITE PARTY CANOPY Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric Snyder Manufacturing, Inc. Manufacturer of Flame Retardant Vinyl Laminates TENT DEPARTMENT,JOHNSON OUT ORS IN •Large Scale i Total P.001 f The Town of Barnstable snxNsrns�. 39. Office of Community and Economic Development 230 South Street Hyannis, MA 02601 Kevin Shea Office: 508-862-4678 Director Fax: 508-862-4782 June 6,2005 Mr.John C.Klimm,Town Manager GaryR. Brown,Town Council President B amstable Town Hall 367 Main Street Hyannis,MA 02601 Re: James &Angela Cotellessa- 129 West Wind Circle,Osterville- a single-family accessory unit Ncholas &Tina Perivolaralds-`259 Old Town Road,Hyannis - a single-family accessory unit Gentlemen: This letter is to inform you that the Accessory Affordable Housing (Amnesty] Program has received requests for project eligibility letters under the Community Development Block Grant (CDBG) Fund and under Article H of Chapter Nine of the Code of the Town of Barnstable and the criteria for the Local Chapter 40B Program The Program Coordinator is reviewing the requests. If the Town has any comments on the projects, please forward them to me so that they can be addressed in the site approval letter. This letter gives you official notice of our receipt of the above application(s). We will issue a decision as to the acceptability of the sites and the consistency of this development within the guidelines of CDBG. i rely, beth Dillen,Program Coordinator Community&Economic Development cc: Town Attorney's Office Building Department Public Health Department Town of Barnstable P�oFt�TOwti • o� Regulatory Services '* BABNSTABLE, _ Thomas F.Geiler,Director 9 MASS. g 4,A 1639. ,0 Building Division �FG N►ptl A Peter F.DiMatteo. Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 March 18, 2002 Nick and Tina Perivolarakis 259 Old Town Rd. Hyannis, MA 02601 RE: Map 268 Parcel 007 Illegal Apartment do not like program restrictions through Amnes Dear Mr. and Mrs. Perivolarakis: Our records indicate that your house at 259 Old Town Rd., is currently being used as a two-family home contrary to Barnstable Zoning Ordinances. You must.contact this office as soon as possible to either: 1) apply for a building permit to restore the property to a single-family home 2) apply to the Zoning Board of Appeals for a variance 3) prove that this is a legal two-family. You must contact this office immediately to tell us what direction you wish to take. Sincerely, Gloria M. Urenas Zoning Enforcement Officer GMU/aw Q021502 � Y 'YTiC SYSTEM MUST SE Assessor's office(1st Floor): / p_ a d f/,�( ii Sv T pL D IN COMPLIANCE Assessor's map and lot n ber or P P " WITH TITLE 5 P��*THE TO`` Conservation e7l 9 ENVIRONMENTAL CODE AND Board of Health(3rd floor): 90 - `�'013t"Cry wREGULATIONS Dsas7T�DL Sewage Permit number 7 YYl Engineering Department(3rd floor): 'o 'e39. House number CMG%9? �o asr Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 'Build Ycreene--L ILn 61mA TYPE OF CONSTRUCTION to ig TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 26 Old 70tun leoo-d, Wo_ct g\,Ah., c�n Proposed Use &rr- Zoning District 2R Fire District Name of Owner Caro l e- Address 04 ,P Name of Builder ( Address Name of Architect Address Number of Rooms Foundation Exterior Roofing Floors Concre.6P, Interior Heating /V4 13-e. Plumbing /VdnP_ Fireplace Approximate Cost -A`/OOO Area .S Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. J---Name Construction Supervisor's License ZLu17 Q SMITH, CAROLE M. No 35788 Permit For BUILD SCREENED IN PORCH }` �. Single Family Dwelling Location 259 Old Town Road ` West-Hyannisport Owner ' Carole M— Smith ,i i . Frame Typee of Construction' IT Plot "Lot J ! Permit Granted April 16; 19. 9 3 _ `• i I � t ri t Date of Inspection 19•, _ _ Date Completed �' - .. ._ { 19 JJ r i ' i .. f. j.:,. HOME OWNER' S EXEMPTION The code states that : "Any Home Owner performing work for which a building ; kz,> permit 1s required shall be exempt from the provisions of this section {{f (Section 109 . 1 . 1 - Licensing of Construction Supervisors) ; provided Home Owner engages a person ( s) for hire to .do such work, that such'.Home = ' `" ����.: Owner shall act as supervisor. " an Home Owners who use this exemption are unaware that they are assuming�ea"_ $' ' the responsibilities of a supervisor see Appendix. . . P ( pp Q, Rules and Regulations r , for' Licensing Construction Supervisors, Section 2 . 15 ) . This lack . of Mrss ' awareness often results in serious problems, particularly when the Home_ ;- �4Owner hires unlicensed persons . In this case our Board cannot proceed y against :the: unlicensed person as it would with licensed supervisor. The„I . Owner acting as supervisor is ultimately responsible. ' To ensure that the Home Owner is fully aware of his/her responsibilities _ many communities regl.iire, as part of the permit application, that the Home =' } ;. Owner certify that h ,/she understands the responsibilities of a supervisors on .-the =last page of his issue is a form currently used by several towns.... ; You may, care to amen : and adopt such a form/certification for use in .your r community. t r r x�, e rt 5 aa atiw r L - t- 1Y.i IT, i. i � y, � T k TOWN OF BARNSTABLE BUILDING DEPARTMENT 7 y's f "{ HOMEOWNER LICENSE EXEMPTION A �}*-� a z'fhh +lJ ` , j Please 'print. K' ;DATE } i 6 / :. ATION 2� /} ,f 4. s a N u t tuber Street Address �1 Se tion Of {S HOMEOWNER" rt Name 65a3`�� zo3 6.� 62a' 5 , Home Phone Workr � t PRESENT` MAILING ADDRESS Phone y TOWn State 06•0 a Z p Code> r.' � The current exemption for -homeowners" ,occuoied dwellings of six unitsorlesswandas etoeaded to include owner low such homeowners to .' x ' gage An individual for hire who does not possess a license the; owner acts as : su ervisor. provided th$t ''..'DEFINITION OF = r t HOMEOWNER: °2 r Person(s) ou who owns a and on which he/she resides or, intends to , parcel of l E reside, - on which there is, or is intended to be, a one to six family }`; dwelling, attached or detached structures accessory to such use<<�z �. structures. , A person who constructs more than one home in a two-'year: f8rm period _hall not be considered a homeowner. 4 ` } t {t0 'ehe .Building Official on a form acceptable to t v�k Such "homeowner" shall submit ��,� :Y' that he she shall be res onsible for all such work eBuildin he Building Official, �Fa bui'�ding be rmit. (Section 109 . 1 . 1 ) under the The undersigned "homeowner" assumes responsibility ` liby for compliance with the State Building Code and other applicable pplicable codes , by-laws , rules and The undersigned "homeowner" certifies that he/ Barnstable Building Department minimum inspection she understands the Town of t requirements procedures and tt< HOMEOWNER'S SIGNATURE w r;APPROVAL` OF BUILDING OFFICIAL ' 'dry Note:, -Three family spa required to comply dwellings 35 , 000 cubic feet, or ' s Control. p y with State Building Code Section 127. 00, will be T , Construction MIBCS' i . ! -. :.:. -1�:,+.+ :s'_css ,,..t! x ,�.-•. °`f. iz4�x �::1 k n.:,_.' .iri r , ��ti.. , -r r a,,� �t:.vx at'. ._L. ., '. r ..., 4 .*'. ��: t.. '. a .. >. !a. ��:h ��:;.a �;� .. ,. �...,n.Y°� �� 1 ,':� 3 }"r ':'as... •'u ., :,� V ':5�• cE£ �./: ,iv t .,Y ,g�x ,.. :A: :;.[.� , �A- ..r2r ._ :h_�,..-.8 rn�4': '::`o •.e ,. -.+r, .w. a^x.�,. ,t.�„ >v .S. I)rj X* ,�' ' c e.w.z-sAs st: n , a .. ., .. '4x • •. ,:y,.At .. •¢ y, ,1Y.. ,.., I ,� , ..rr. ..:�... n ,- u' f+ .-,.ry]'xt ,�+ fi> f s {� •a fb r .f - '-1- I' vy.:4 .,...::�.nr.:-v, Y, {�.`.S� 1 �� .� :-�. R •-! .f.`Y.''{ 4 i <L. ,R c?. tiW.. 1 #^. yyyy��•• `'�}., k� ,�l _ P y y �t�'�!�...•T .,v` l,; .' x'i. _. _ .':'� ,'-. � - •, ..1 ;... .W<: , .t,..: - - _:s;.c ,,.. ,:...:- .e•, ... -. . .. ....., .��. ,:..,,.... .r-.y:_ _.. •.. ,.. .Fro,. -.'ti+� -, ..:: .. I-._,_.. .,_�.: .__ ._{�G.+..,... �. .. . ,�u..ts ,., :A.-4. n ^n.;t� - �t.�i,. �• ,:c .116 ,ro f. ;:.t fisi .wr. '.tx .a:« ^t.eL+°- � @:.,-.'a ..rr. ?.r dam'i y,'.°'� �°- 3;" •! y^+' r.:w ��:!� ,J.. ;3�' .II' ,$ ice:::^ t. - ;.:.�,. - •!'r,.. r�', - ,I - .i �� � i7 �x'i'':N� ..i .v� .� �' .:;� -it,$.d,�-,.'~ .�'.,<�..:,�_ ,.._ra +. .,•�i_ t:.?�tix,...:...':; � .�.' �, .l �"�''?4 t''.�,. '� v' tY;,,d�t >,.��"4Wi�aW�n. .;+-� r 1� , Jir ':1 '����...�F;k w,(sd•,::F r FF. .� .;; sit ; - � a: 7q, - ` ?3�`'a , f r F T' _ I . }14 gs CJ r 1 1 , 1 I I _ , , , a 1 ; i lop, PRO Ai .�O <7 l .,�_ . ,... rR .,.s ss.s� „4^+..,�a.. . „✓ar3^ "r., b^�,:. sc"�t.-,.'�x�.ur�'•4i.� _ �'.G.. ., �:....x,3.. dvM_'E,t...L:n: __ '.. _...��. -.• ..+.�...,.x�a �...0,.,. '4 'Tu:� �.r'�i:�'+ _ XtIA 0 LIN 4 vt o THE TOWN OF BARNSTABLE PAUSTABLE, ,639. BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....14V. j... TYPE OF CONSTRUCTION ..........dZ.5-0... . ............ .............................................. ............. TO THE INSPECTOR OF BUILDINGS: The undersigped hereby applies for a permit according to the following information: Location ..... ......................; Jf......C.�:a....7- ... .............. ProposedUse ......./-7-a-"1W141- ./............................................................................................................................................. ZoningDistrict .......................................................... .............Fire District .............................................................................. Name of Owner ......C.a�),Q.oc..........Address y.V) Nameof Builder Address ..............................tl................................................... Nameof Architect ...............4..................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Ex.lerior ................................................................................... Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ....... .. .......4z"?..0.24.e4.......................Plumbing ................/V —011V�c .............................................. e-.-N Fireplace ..................................................................................Approximatt- Cost .................7�0!p. Difinitive Plan Approved by Planning Board --------------------------------19--------- Nd (2 Y6 Diagram of Lot and Building with Dimensions (5 0 W > CA IX - M 0 I" Ul Uj Ld W q,"Q � 0 z I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name(Z.4�.�. ..... ............. Wood, Daniel C. C q No ...128 Permit for ........................ ............................................................................... Location ...........Old Town Road........................ West Hyannisport.................. Owner Daniel C. Wood f ................................................................. r 1 Type of Construction ................ rams ................................................................................ , I Plot ............ Lot ............5 ................... Permit Granted19 September 20 71 Date of Inspection ....................................19 Date Completed ate.¢/ .. -71......19 { PERMIT REFUSED 4 ................................................................ 19 " . , I > ............................................................................... ................................................... ........................ I 4 ............................................................................... 9 .................. ......................................................... Approved ................................................ 19 ............................................................................... ............................................................................... Assessor's,Office(1st floor) Map )6 8 ,? Parcel unit# S 'Conservation Office(4th floor)(8:30-9:30/1:00-2:00) !0 ,� Qi� Date Issued oard of Health(3rd floor)(8:15 -9:30/1:00-4:45) Fee d Xngineering Dept'. 3rd floor House# a•�, r�.. �as� r •BARIV6TARLE 1 19 lE0 MPS J D TOWN OF BARNSTABLE f 4 Building Permit Application . 1 Project Stree ress ,25g ®I(4' 7-0Lc/n_ ROC )p Village -gowns&J�he, ' Owner ('Am e-, m �43 j Address ` — Telephone(90 3 1�53-7.59''� Permit Request eYL0y&1L_16 L OF lllcee� . e=r G—r into 4;y1nQ Oirl, First Floor square feet 17 Second Floor square feet Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR E FOLLOWING REASON(S) r a , ` • FOR OFFICIAL USE ONLY r PERMIT NO. o DATE%SUED { MAP/PARCEL NO. ► " c i 5 ADDRESS A VILLAGE OWNER r x DATE OF INSPECTION: - FOUNDATION FRAME " ! INSULATION M ' FIREPLACE ELECTRICAL' ' ROUGH FINAL PLUMBING: ROUGH FINAL GAS: - `' ;i ,4 ROUGH FINAL FINAL BUILDING' /� f DATE CLOSED'OUT, ASSOCIATION PLAN NO. ' • t e - y y i + TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print... DATE, _ G� JOB_ LQCATIO - • Number Street address Section ®f t Name Efome phone Work phone • - PRESEkt I+ ILITG ADDRESS L �P•' aty .t® , State Zip cod ' d . The current exemption for "homeowners" was extended to include owner-occup dwellings of six units or less and to allow such homeowners to engage an i. dividual for hire who does not possess a license, provided that the owner acts as supervisor< DEFINITION OF HOMEOWNER: Person(sp who owns a parcel of land on which he/she resides or intends to side, on which there is, or is intended to be, a one to six family dwell attached or detached structures accessory to such use and/or farm structur A person who constructs more than one home in a two-year period shall not considered a homeowner. Such "homeowner". shall submit to the Building Off. on a form acgable to the Building Official, that he/she shall be resuon. for all such work performed under the building permit. (Section 109®1®1) The undersigned "homeowner" assumes responsibility for compliance with the Building. Code -and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requireffie and that he/she will compl 'with said procedures and requirements. HOMEOWNER'S S SIGNATURE APPROVAL OF ADILDING OFFICIAL � Notes Three family dwellings 35 , 000 cubic feet, or larger, will be require to comply with State Building Code Section 127. 01 Construction Controls HOME OWNER' S EXEMPTION The code state that: "An Rome Owner performing work for which a-wild: y permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 ® Licensing of Construction Supervisors) ; provided that Some Owner engages a person (s) for hire to do such work, that such Rome shall act as supervisor. " Many Rome Owners who use this exemption are unaware that they are assumi the responsibilities of a supervisor (see Appendix Q, Rules and Regul.ati for .licensing Construction' Supervisors, Section 2. 15) . Tbis lack Of awa often results in serious problems, particularly when the Home Owner hire unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Rome "der,* as supervisor is ultimately kesponsible. To ensure that the Rome Owner is fully aware of his/her responsibilities communities require, as part of the permit application, that the Hoffie 'Ow: certify that he/she understands the responsibilities of a supervisor. 01 last page of this issue is a farm currently used by several„ towns. You r care to ascend and adopt such a form/certification for use in your communa r l +` The Conlnlomeealth of 4fassachusclts �• se,i� --_��;_� Departmeut of ludustrial Accidents ` office offnl esffgalfons. 600.Ti•ashitq t!nStrcet Boston,A1asx (1 111 Workers' Compensation Insurance Affidavit name locition• .25q Old TOWa POQLd citv LAJeS6 N n js, jU A nhonc#(W-3 6-5,3'7,5q* .1 I am a homeowner performing,all work myself. 0 1 am a sole proprietor and have no one working in any capacity 1 am an emplover providing workers' compensation for my employees working on this job. i comp•tny n•rmc' address: city phone#• insurance co polite;# 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company n•rne- address• cth•• phone#• — In��r•tnce co policy# ��...-{� -.���.' �.. 4ClitilYT.:.•-'Y1�9—s yr„^.':��T!�irvfc-+y�"se,�� r _ _ T7�%PPi!JR�'. �'AS�"��i T.�R�7.t-+�Fc.!•^T4�!�"%'!°411•��.:r^':",�S company name• •Jddress- city• phone#• incur•tnce co policy# .Attach additional sheet if riecess .,;�K„.:...y.= A.,.;t:�t..M r t�ei :.,':77,4• :,,,:.rf. ^�'.•+ - 7 _ --. y±�.n' irw... 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 S1.500.00 and/or one rears'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the OMcc of Investigations of the DIA for coverage verification. I do herebt•certij under the pains and penalties ojperjuty that the information provided above is true and correct Si_nature Date 0%6h&- Print name Phone official use oniv do not write in this area to be compacted by city or town official city or town: permitAicense# rilluilding Department Licensing Board ` check if immediate response is required QSeleetmen's Office C311ealth Department contact person: phone#;. nOther • 'revised V95 PJA) The Town of Barnstable ' M Department of Health Safety and Environmental Services 1 `e Building Division 367 Main Street,Hyannis MA 02601 Ralph Crosser Office: 508 790-6n7 Building Commission F= 508-775-3344 For office use only Permit no Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MC-7-c, 142-a_rw.tires that the"reconstruction,alterotions,renovation,repair,modemiation,eonverston, ed improvement, retnovah demolition. or construction of an addition to any pre- owner 00�r building containing at least one but not more than four dwelling units or to stiruxxtues are adjacent to such residence or building be done by registered contractors,with certain aceeptions, along with other requirmnents• Type of Work:R ' r ��� _ �„ t _ Cost 3,500 . P�l�l%Lc) n r t i n rC Address of Work: 2S9 0/d T cc-e d,,,hl Owrter.Name• role Date of Permit Application: I henry certify that: Registration is not required for the following re ason(s): Work excluded by law Job under SI,000 Building not owner-occupied =Owner pulling own permit Notice is hereby given that: CONTRACTORS W ONERS PULLING THEIR OWN PERMIT OR DEALING VVTM UNREGIS'TE>ZED FOR APPLICABLE HOME IMPROVEiMENr WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c I42A SIGNED UNDER PENALTIES OF PERJURY I hcrcby apply for a permit as the agent of the owner. Date Contractor name Registration No. OR (tamer's name + PHELPS INC. 2036238618 P. 02 Vtl r . oe + ,gym V �:%,� ��h r VI J{1 l • � 1 j i Ll" QL4��oaµS iak • �'�/ice ��fli..,s� rvwi.�•,.N�- \ , 2-3• ' '�Z•,�y•Gdi1.l'EYs gfaax ;� CD - ���t� i 2. • � yam- ��,,,. >: .� i �� i i Carofe M smidt JRv 7 Sadffe !Aive M- 0 Granbyo CT 06026 Date 1 v Men lb2r. 7 19 g To: T Ors I t Cl<ea.n subject U Lc. o o ,ram S at �- P� t �nf 3 S� Fox !Cs -7 t �aaro 25 �1 Tow iM iz ` Dearnr r. I 0 d is rev I VJ s Fr ri N m W 0� � N i W t OD Oy OD III Signed TOWN OF 13ARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION S um er vja TO 0,2 -Y treet a ress ection Ot town_ "HOMEOWNER" CAc6ir �, vr„ t � � 7 C-, ame ome p one or PRESENT MAILING ADDRESSrg P one T �7 r,. �+ t ty/town t a t e ----- ZIPcoU- The current exemption for "homeowners" was extended to include owner-occu led dwellings of six units or ess an to allow such homeowners to en a e an p ivi ua for hire who does not possess a license, provided that theg tn- acts as supervisor. (State Building Code Section owner DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intend side, on which there is, or is intended to be, a one to six family dwelling,re- attached or detached structures accessory to such use and/or farm struct A person who constructs more than one home in a two-year period shall considered a homeowner. urbe on.a. form acceptable to thecBuiIdingwofficialllthabmhe/sh it to the Buildi.ngrOffbciz! , for all such work performed under the building e shall be responsible permit. ectlon The undersigned "homeowner" assumes responsibility for compliance _ Building Code and other applicable codes, by-laws, rules and re P ce with the State The undersigned "homeowner certifies that regulations. Barnstable Building Department minimum inspectionhe understands the Town of and that he/she will comply with said Procedures and requirements Procedures and requirements. HOMEOWNER'S SIGNATURE a llez APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet," or 1 arger, will be required to comply with State Building Code Section 127.0 Construction Control . 8 HOME OWNER 'S EXEMPTION The Code state that : Any Home Owner performing work Permit Is required shall be exem t for which a building — (Section 109. 1 . 1 p from the provisions of this section L Home Owner enIf from of Construction Supervisors gages a person s) for hire to do such °work , ) �tosucchdHometOwner shall act as supe.rvlsor . ,, hat Many Home Owners who use this exemption are unaware that the r the responsibilities for LicensingOf a supervisor (see A y are assuming, Construction Supervisors, ppendlx Q, Rules and Regulations often results In serious Sectlon 2,' 15) . This lack of awareness.__;,. Unlicensed persons. problems, particularly when the Home Owner hires In this �Unlicensed person as It would With licensedSBpard cannot as. SUpervlsor Is ultimately responsible . proceed against the - The Home Owner acting To ensure that the Home Owner Is full Communities require , as Y aware of his/her responsibilities , many certify that he/she understandsfthee permit responsibilities of a suer , application , that the Home Owner last page of thls . issue Is a form current ) care to amend t visor . On the and adopt such a form/certificateonbforeusea�ntowns . You may Your community. P i�_,,.�Pu� s � �ic� ,�`G�„�� �• - '. �'; _ ..... t.%`.�5.?�.'p �?, �,i, "c*.r,'"''"�'.,sa;a,.,.,e:Eg,e�r�w 3r"ti �v 1 b9�h. b_N•r' ,.�.'�C' `_w. �' i� __r�wrja'a. b.� d ,>•#� p�.•4 - a - ,,,Y:. ..u _ i:'t•.: :. -. „<.. :.:� ".: ' _ y..a,..E •;:+ ,x m - "Si?-'S":4.x ., ,y L . ,.. .",. ,�.,, .,,w 5,;-S,f.�.p»;.y�.�,,. ,.r -.,: % ..,..y:.; ..._..: . _rf ._.., »J r.'�'•F- '..'.T,.�F>r'5, :. -• :... rq` .��,,. +.. t}, ...rv:'u'. :?fY:: ''t ",.:M'",. •f... ,':a. .tx i4•e • :Qx V, <.f,.. ,p+ j.;' 3+y 3x= • ,59 w"�''� .:,'4$"' yn.�. "•`-'r. _ _ t e' '.:�y��.:.":`.. :.mom .. i;,� ..� `'.`c.�•' '.a'�'�r r_ � �`�{�2 � Sp d .i� `'' , 3�?' _ .te��- n .\.:.3• ... ".' � '.K> - u .^� ti-. �� r .._." �'Y.r. 3.w-C.�N' "�.� q�.,. k :.1 y. 'O•II.:. - ,ve lt,a`x.�,...e. 5.� ..-, ... .iu' _ -. ;. ;a. w.- ...q P' b• -i': Atr_ , 3,,i�•-. :n ..„� ..,. ..3 y,..,� »ea..,a �,.. -Y �_:7�`. ....._. '�".:'z ...,... -r�5--:liY` $e �`:'.-. ��rs�� -ayio' 7 �.. 10 fA AL y t�, `t ' Y� f4YT t 1 € - f � t o t t } 1 4 1 II7 yy f 1 i 11 zx. a. Ws S is �.r• {k �.1 r'�{ t l,a'� ':f ? 1 1: T t�. 7 it��' t ,^ ... - _ .Q 6.m - t paJ'Q vF5' 'fi#* 9s ( t•t s = { o'�f n t PJ { �—t `4 n =t. Sr,r 5"; - '' t� - .rkt 31, re lk 2= .fi#, z i^.�.," .i. � s, 7 f�.i, �! t •. 1 n t" .,. - <ti � -� , � d - e ��C/(, SU Assessor's office(1st'Floor): \ t ® ® � fF' SEM S MUST BE `TNE t Assessor's map and lot number. �s �� `,E �o o� Board of Health(3rd Jloor): r,'"Q #� `- Sewage Permit number r/',(9ge Zzv .Te4 Z BAHdSTLDtL 2 Engineering Department(3rd floor): tiRr .CODE��D rnea House number -#�Z Sc1 fi�iL�i TOWN REGULAMONS °o 3639• Definitive Plan Approved by Planning Board 19 ,Fc rpv a• APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO A °� 10 AI For r 8,0 A,- 4 6 yn f TYPE OF CONSTRUCTION �✓� F✓A^`Q TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �� old T oW R°i° d FJyArvw;spa rJr 6� �f Proposed Use Zoning District IQ 8 Fire District t-1Y! 't Name of Owner C'.r,6�e �'" �� Address p w ry e. ►-- Name of Builder Address Name of Architect Address Number of Rooms -7 Foundation c arc-0 e Exterior W°b 1'9�y S Roofing Floors T'r L-e Interior b r y wail Heating �`�`°�' t Plumbing -� Fireplace N Approximate Cost Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all,the Rules and Regulations of the Town of Barnstable regarding the above construction. Name �?�x✓+� �"� - � ? Construction Supervisor's License WA)e,r SMITH, CAROLE r. No 327'46 Permit For BUILD ADDITION ' Single Family Dwelling (Lot Location 259 Old Town Rd. 51) I`. Hyannisport Owner.Y Carole Smith Type of Construction Wood Frame Plot Lot Permit Granted March 29, 19 89 Date of Inspection 19 Dale Completed 19 A I a OIL i =) rn cA _�'`� (�� �t u- �f�S i � �' ���P�-� - - _ �� SECTION 8 HOUSING INSPECTION CHECKLIST NAME OF FAMILY PHONE NO. TENANT APPLICATION NO. ce o- o INSPECTOR PH DATE OF I CTIO O �P�: ` TYPE OF INSPECTION ❑ Audit ®`nr itial ❑ Special ❑ Reinspection ❑ Annual LAST INSPECTOR: INFORMATION STREET CITY, Number of Children r C r u i in family with HOUSING TYPE UNIT 7 J { z 6 �r (Check as appropriate) GRADE Elevated Blood Level STATE ZIP ❑ Manufactured Home �A`� ADMITS COMP MALE FEMALE ❑ Single Family Detached A ❑ .&-Duplex or Two Family B ❑ NAME OF OWNERO GENT AUTHORIZEDT, LEASE UNIT INSPECTED PHONE NO. MINORS ❑ 3 Family House C ❑ ❑ Row House or Town House DO ADDRESS OF OWNER OF AGENT` CHILDREN ❑ Low Rise:3 or 4 Stories ? (UNDER 6) including Garden Apartment • • ❑ High Rise:5 or more stories FAMILY SUBSIDY SIZE: ❑ Multi Family No.of rooms used for sleeping LOC ❑ YES.❑ NO ❑7Pass7L],eFail ❑ Inconclusive Date Passed (or could be used if unit is vacant), BUILDING PERMIT ❑ YES ❑ NO INSPECTION ITEM YES NO IN.- NO. LIVING ROOM PASS FAIL CONC COMMENT A LM INmALIDATE 1.1 Living Room Present 1.2 Electricity 1.3 Electrical Hazards 1.4 Security 1.5 Window Condition,Screens 1.6 Ceiling Condition 1.7 Wall Condition " 1.8 Floor Condition ITEM YES NO IN.- RNAL NNO-62.KITCHEN PASS FAIL CONC :a 4 n COMMENT INmA11DA. 2.1 Kitchen Area Present 2.2 Electricity X`` 2.3 Electrical Hazards 2.4 Security 2.5 Window Condition,Screens 2.6 CeilingCondition ^ 2.7 Wall Condition ^' 2.8 Floor Condition 2.9 Stove or range with oven (TT) (LL) 2.10 Refrigerator (TT) (LL) .� 2.11 Kitchen sink 2.12 Kitchen space for storage&prep 2.13 Ventilation ITEM 3.BATHROOM Pass as coNc COMMENT ,Nrt OV. NO. 3.1 Bathroom Present 3.2 Electricity .+ 3.3 Electrical Hazards 3.4 Security 3.5 Window Condition,Screens " 3.6 Ceiling Condition 3.7 Wall Condition ' 3.8 Floor Condition 3.9 Flush Toilet in enclosed room in unit 3.10 Fixed washbasin or lavatory in unit 3.11 Tub or Shower in unit 3.12 Bathroom ventilation _ ITEM 4.OTHER ROOMS USED YES NO IN.- COMMENT APPROV. NO. FOR LIVING&HALLS PASS FAIL CONIC WMILSATE 4.1 Room Code' 0 Room Location (Check One) ❑ Right/Center/Left (Check One) ❑ Front/Center/Rear "I. Floor Level �r 4.2 Electricity/Illumination 4.3 Electrical Hazards 4.4 Window Condition 4.5 Security - 4.6 Ceiling Condition .- 4.7 Wall Condition 4.8 Floor Condition 4.9 Natural Light 1 ROOM CODES: 1=Bedroom or any other room used for sleeping(regardless of type of room) 3=Second Living Room,Family Room,Den,Playroom,TV ROOM 5=Additional Bathroom 7=Garage 9=Other E 2=Dining Room,or Dining Area 4=Entrance Halls,Corridors,Halls,Staircases 6=Attic 8=Laundry White Copy for Agency-Yellow Copy for Landlord-Pink Copy for Tenant- ITEM 4.OTHER ROOMS USED YES NO IN.- FINAL ' NO. FOR LIVING&HALLS PASS FAIL CONC COMMENT INantAL�i V 4.1 Room Code'0 Room Location Check One ❑ Ri hUCenter/Left Check One ❑ Front/Center/Rear Floor Level 4.2 Electricity/illumination 4.3 Electrical Hazards 4.4 Security 4.5 Window Condition 4.6 Ceiling Condition 4.7 Wall Condition 4.8 Floor Condition 4.9 Natural Light 4.1 Room Code'0 Room Location, ,(Check One) ❑ Right/Center/Left (Check One) ❑ Front/Center/Rear_Floor Level a 4.2 Electricity/illumination 4.3�. Electrical Hazards 4.4 Security 4.5 Window Condition 4.6 Ceiling Condition 4.7 Wall Condition 4.8 Floor Condition 4.9 Natural Light 4.1 Room Code'= Room Location (Check One) ❑ Right/Center/Left (Check One) ❑ Front/Center/Rear_Floor Level 4.2 Electricity/Illumination 4.3 Electrical Hazards 4.4 Security 4.5 Window Condition 4.6 Ceiling Condition 4.7 Wall Condition 4.8 Floor Condition 'ROOM CODES: t=Bedroom or any other room used for sleeping(regardless of type of room) 3=Second Living Room,Family Room,Den,Playroom,TV ROOM 5=Additional Bathroom 7=Garage 9=Other 2=Dining Room,or Dining Area 4=Entrance Halls,Corridors,Halls,Staircases 6=Attic 8=Laundry ITEM 5.ALL SECONDARY ROOMS YES NO IN.- FINAL NO. Rooms not used for Living) PASS FAIL CONC COMMENT APPROV. INITIAL GATE 5.1 NONE Go to Part 6 5.2 Security 5.3 Electrical Hazards Other Potentially Hazard us 5.4 Features in an of these°Rooms ITEM 6.BUILDING EXTERIOR YES No IN.- No. PASS FAIL CONC COMMENT MP�O T INmaLroATE 6.1 Condition of Foundation 6.2 Condition of Stairs,Rails,and Porches 6.3 Condition of Roof and Gutters 6.4 Condition of Exterior Surfaces 6.5 Condition of Chimney 6.7 Manufactured Homes:Tie Downs 6.8 Manufactured Homes:Smoke Detectors ITEM HEATING&PLUMBING S No IN.- COMMENT . FINAL N0. PASS FAIL CONC ALMA INMALlDATE 7.1 Adequacy of Heating Equipment ty NiT E t3 i nT P5 LA '1_c, c=3. 7.2 Safety of Heating of Equipment 7.3 Ventilation/Cooling 7.4 Water Heater Gas/Elec/Oil 7.5 Approvable Water Supply 7.6 Plumbing 7.7 Sewer Connection ITEM 8.GENERAL HEALTH YES NO IN.- COMMENT APPROV.FINAL NO. AND SAFETY Pass FAIL CONC INMALIDATE 8.1 Access to Unit 8.2 Lead Paint,LOC ❑ Not Applicable 8.3 Evidence of Infestation 8.4 Garbage and Debris 8.5 Refuse Disposal 8.6 Interior Stairs and Common Halls 8.7 Other Interior Hazards 8.8 Elevators ❑ Not Applicable 8.9 Interior Air Quality 8.10 Site and Neighborhood Conditions 8.11 Entry Door Security / ❑ Not Applicable 9.1 Heating System Type ❑ Gas ®>"Oil ❑ Electric ❑ Other_____ ITEM YES NO IN.- i` °. ilFINAL. No. PASS k 'CONC COMMENT •anAUwITE .353 Asbestos Material .482 Smoke Detectors This inspection has been performed to determine compliance under the HUD/DI-I Section 8 Programs.While some of the inspection requirements may be similar or identical to provisions of the Icoal codes this-inspection:does not certify compliance with said codes.In all instances,it is the Owner's responsibility to maintain property to meet all applicable state and local codes and a tenant's right to request an inspection by the local code enforcement agency. Party Present at Inspection Inspector Signature Date Date Date :.,:::•:::•:.�:::::::.:•::.::•:::.a•.aa:•:::::.:•:.::::,,v.:::..aax:vtwnxykv.:v,,::...a..ax•.a::t:•nx:„v. ................................}.....n... ... :.nv.:xtt:•.�:::.::.• •?:•??????`??:LLv:•}:•}:h:^:^:•}}:•}???????"•:•}:{•:;tt^}•::::::.w::w:.:•.:...:v:wnL•:::::.:a::v.�.:v.�::.v....................:...................n...........va..:. .2Y.............................................}.........}. .........:....................:.......vv.........::a::w:::nw:.:•::•:::::..x:•v:v:::•.�w::::::vv:...4::.....y...•:..a:•.ua:ty v:vv:w:.:va:::..••w•;ii•}::;,}.i;;L•.v.}.L•..•} i357 titi�•}a«Nil :titi +M1$tij8:: ;•` ................ ..... . ............. . ......... .. ......:.:.:.. LDIN CARLE.., O SMITH 59< OWNR <>A<� O Dt . THY RYAN .NM MIR ti:%:};:;:{$•L.{t''4::�i::iii::;ii.'"•�.:i??''ti:y ;:j�}iiiiv:•� ?;:<?`�}�y:'•S�j�}':: .. •:••. nwn:::::v:w:. ••... vnw:.::•:::::•::.aaxx:v.::•.a:w.�.�::::::::.: ;CP:i.;h;;w:•::::ti•};;•}:iv:;•`.i;i;L�ii{Y;�.;tii{'•:i;•:i;;i;t;,4� :.vvavv:•.xxx •. .. :.xx:v.:•.::v:::anavx:xii>.v: ................. >.. �"��:�`•�`� at�:€> FOR HOME.::.�:.�:::.,..,:.: :�•;::::::: .:::::}::::. STATE---PEOPLE NOT BEING �> A C RED FOR O PRR P O ERLY W EARI N G ><OVER-COATS H IN T WE ATHER FATHER ETC. C < IN th11 Will : <« ............................. ISO T y: REFER TO B.O.H.—A,.....:.:...........::.. ::.::ems,:.::. OLD HER TO CA LL LL REP. KLI S OFF ICE. F E. O C ME WI <: >:..: «>` .: 6 1 r! � f I r - another who employs per . building appurtenant then i MGL chapter 152 sectioi of a license or permit to not produced acceptablt commonwealth nor any'o acceptable midence`of cc authority., ' Applicants Please fill in the�workers' supplying company names _ submitted to the Departme f 1 4 �U �r.e r.� .! •i• r .s`yt'-Ju•'"rl f�w*-.--!�,..(4 .i'+� ""J Y' ._'+,+1 Y.. ...�,y -t{4 Assessor's office(1st Floor): /�/ �i '� ' ` Assessor's map and lot number tA1s D / Q�OF THE Board of Health(3rd floor): Sewage Permit number co ��D _ Engineering Department(3rd floor): ,"'r"'"PO ;BeaMA8&ST&MLL . House number Z i639' D.9finitive Plan Approved by Planning Board 19 ��rpY d APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only " TOWN OF BARNSTABLE BUILDING ANSPECTOR APPLICATION FOR PERMIT TO N °�r' '0 F o r TYPE OF CONSTRUCTION h, A r 19 0 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..i"�"'r 0/d ru i"'"' boa d fpypNwiJpr + r L 6 Proposed Use X Ng 1 rA„" y Zoning District f{ Fire District Name of Owner C'.r �: S'^ Address Name of Builder �• � Address ' Name of Architect `—'""""- Address --�— Number of Rooms -7 Foundation c°rV O-e Exterior ° d s4nV4 I, S Roofing A,rP A Al T- Floors 7"'r L t C,q r p eT/N Interior O r y wq 11 rw Heating Plumbing s Fireplace a Approximate Cost /) Area Diagram of Lot and Building with Dimensions Fee G OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License //Wu G r t SMITH, CAROLE A=268-00.7'- No 32746 Permit For BUILD ADDITION 'Single Family Dwelling Location 259 Old Town Rd. (Lot 51) Hyannisport Owner. Carole Smith , Type of Construction Wood Frame Plot Lot Permit Granted March 29 19 89 Date of Inspection 19 Date Completed 19 No C�1��