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0026 HELMSMAN DRIVE - Amnesty
V s U-1 J ACTI ._. Ulm ql Cn a 0 i 1 V � ,: {, ; f ,. Town of Barnstable Regulatory Services • sAxNsrasts, MAss. Richard V. Scali,Interim Director o;a. Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 r www.toWn.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 September 11,2015 Tom Gillooly 26 Helmsman Drive Centerville,MA 02632 Re:Former Amnesty Apartment Dear Mr. Gillooly, Pursuant our conversation on September 11,2015 you indicated that you wished to restore to single family.I have enclosed the Family Apartment ordinance for your review,along with the Restore to Single Family building application. Please contact me by October 1,2015 and let me know your intentions for the above property mentioned.If you have any questions,please contact me at 508-862-4039. Sincerely, Brenda Coyle Division Assistant Anderson, Robin From: Tom Gillooly[tgillooly1 @gmaii.com] Sent: Monday, July 28, 2014 2:04 PM To: Anderson, Robin Subject: Amnesty program Robin Anderson, Zoning Department, I wish to apply for the amnesty program in the town of Barnstable. I will be purchasing a house at 26 Helmsman Drive in Centerville, MA. The house includes a basement apartment. I understand that to meet all code requirements the apartment must have a second means of egress directly outside. Additionally, it must have smoke detectors installed that meet all code requirements. If there is any additional correspondence necessary, please do not hesitate to email me. Sincerely, Thomas E. Gillooly Sent from my iPad 1 II CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT rg# DEPARTMENT OF FIRE-RESCUE&EMERGENCY SERVICES tt CCU 1875 Route 28-Centerville, MA 02632-3117 1926 508-790-2375 x1 • FAX:508-790-2385 Michael J.Winn,Chief Martin O'L.MacNeely,Fire Prevention Officer Byron L.Eldridge,Deputy Chief Michael G.Grossman,Fire Prevention Officer July 23, 2014 TO: Tom Perry, Building Commissioner Building Department Town.of Barnstable 200 Main Street Hyannis, MA. 02601 In accordance with MGL 148, Section 28A, the Centerville-Osterville- Marstons Mills Fire/Rescue Department brings to your attention the following potential violation(s) of 780 CMR: Massachusetts State Building Code for your review and/or interpretation of same. NAME/BUSINESS: Residence ADDRESS: 26 Helmsman Drive, Centerville OBSERVANCE: Basement apartment created/legalized in 2003 without 2 means of egress Mass State Building Code 3603.10.1 (6th edition) Basement apartment created legalized in 2003 without upgrading the fire alarm system to the 6th edition of the Mass State Building Code 3603.16.13 Sincerely, in Ma eely ire Prevention Officer C.O.M.M. Fire Distric CC: Jeff Lauzon, Building Inspector Robin Andersen, Zoning "Commitment to Our Community" i i i YOU WISH TO OPEN A BUSINESS? i For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not.give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. j Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St.; Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is -required by law. DATE: (0 1 oul a Fill in please: APPLICANT'S YOUR NAME/S: USINESSS YOUR HOME ADDRESS: WX VON TELEPHONE # Hbme Telephone Number NAME OF CORPORATION: U I<' S NAME OF NEW BUSINESS ` Y TYPE OF BUSINES5 IS THIS A HOME OCCUPATION. 'E NO �/1 ADDRESS OF BUSINESS `-Q ,M 1 � A MAP/PARCEL NUMBER �� (Assessing) When starting a new,business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & IVlain.Street) to make sure you have the appropriate permits and licenses required to legally operate your usiness in this tolvn. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. _ f Authorized Signature** COMMENTS: i j 2. BOARD OF HEALTH n This individual has bee 11nn infq re n s pertain e .of the per requi that tai this type of business. i . ' Authorized Signature** COMMENTS: Xff 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has b info e o the licensing requirements that pertain to this.type of business. Au horized Signat re* i COMMENTS: S i j i 2�13/I Zjk Efficient Buildings, L_LC ,si,AB LE February 2, 2012 Town of Barnstable Attn: Thomas Perry, CBO 200 Main Street Hyannis, MA 02601 re: 26 Helmsman Drive, Centerville, MA 02632 (Karen Adler) Dear Mr. Perry: This affidavit is to certify that all work completed at 26 Helmsman Dr., Centerville, has been inspected by a certified Building Performance Institute (BPI) inspector. Work included air sealing, and installation of 544 sq. ft. cellulose (8") and 96 sq. ft. cellulose (4") in open attic floor, 128 sq. ft. damming, and venting.All work performed meets or exceeds Federal and State requirements. Sincerely, Steven C. White Owner/Managing Member Efficient Buildings, LLC Ra�S. '' , 'ii 1`ti .s .. .. IQ't,, f Y-..,S,r f✓ S:. .. .. .. . - ' f .I.., f 8 Jan Sebastian Drive, Unit 10, Sandwich, MA 02563 Tel: 508-888-1110 Fax: 508-888-1109 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION To'Y'viR4 Map ' Parcel' Application Health Division ` 2 ? Date Issued Z-. Conservation Division Application Fee Planning Dept. x ;Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address E I-M e) VLS Village Cam. N 116!Z V I C L. Owner X<A e 6 N A 0 L-612- Addressc- G 14W / 1 S0')c o77 C6 A44 Telephone 5off- "7U LI =11 ycl 6 .:� Permit Request //Z S 6 p c 1 N 1/v S uL n%�c� f}�'�'>�� 04 S 5)F e-EL i.v LC)S C(�t►r) JC C_vo�L��iL PrCL.LuL0sc rJ �jP6ly INIC 17--0 7-', [/ / M iv T S Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation r Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name S`r6 V6 IN/ C W i-1 J'TG Telephone Number L) Address FFIC NT `9OD& S LL-C�- License# C 50 J JP t� S�"13 ?tj U Home Improvement Contractor# `/ u S.N T�W 1 C L,a 5 toWorker's Compensation # tl LC L/ L( ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1AA S7C PSI S /�-�--5 )C_F C 1,? S (,1%/(G;J SIGNATURE Cam/ DATE z 1 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED, y' t MAP/PARCEL NO. { i } ADDRESS VILLAGE r OWNER DATE OF INSPECTION: FOUNDATION: FRAME INSULATION� _ FIREPLACE r ELECTRICAL: ROUGH FINAL } PLUMBING: ROUGH FINAL k 4 AS - ;� - ROUGH--'C� ' FINAL -- - - >f�FINAL BUILDING`= 4G j DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents k 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): f C-I E H T t W6-S L L C Address: Y �AN SE PE)AST1ic)N' tzlo City/'State/Zip: JA V D 0/C f-t MP DaS(P3 phone #: '50E- T 8e-- I l /Q Are you an employer? Check the appropriate box: �/ 4. ❑ I am a general contractor and I Type of project(required): 1.lY I am a employer with C 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. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity, employees and have workers' [No workers' comp. insurance comp.insurance.$ 9• ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.[1Plumbing 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 oe employees. [No workers' 13.2 Other =NS UL.AT't 0 t,� 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. /� Insurance Company Name: A � p Policy#or Self-ins. Lic. #: �_!-f�j J t� Expiration Date: 9 o?—oP 04D Job Site Address: City/State/Zip: 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 S 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 under thepains andpenaldes of p 'ury that the information provided above is true and correct Sienature: Date: Phone#: -d Sf ^ E_e 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#: CERTIFICATE OF LIABILITY INSURANCE D/14/201IUU/Y 914/ 1 1 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(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 C NTA T David Crawford NAME: Eldredge & Lumpkin Insurance Agency, Inc. PHONE (508)945-0393 FAx ac o (508)945-4048 697 Main Street E-MAIL :david@elinsurance.com INSURERS AFFORDING COVERAGE NAIC# Chatham MA 02633 INSURER ANational Grange Mutual Ins Co 14788 INSURED INSURERB:Commerce Group IG001 Caliber Building and Remodeling LLC, INSURERCAce American Ins. Co. - ARWC 22667 Efficient Buildings, LLC. INSURERD: 8 Jan Sebastian Drive #10' INSURERE: Sandwich MA 02563 INSURERF: COVERAGES CERTIFICATE NUMBER:Housing Assistance Corp 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 BEENREDUCED BY PAID CLAIMS. WSR TYPE OF INSURANCE ADDLSUOR - - <POLICY EFF POLICY EXP LTR POLICY NUMBER JWMIDDrfYYY`l IMMIDDIYYYYI, LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENT'*u PREMISES Ea occurtence $ 500,000 A CLAIMS-MADE OCCUR - 027360 9/15/2011 9/15/2012. MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG. $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY - EOM�BINdEDtSINGLELIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED BNVCS /16/2011 /16/2012 AUTOS X AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident) $ X UMBRELLA LIAR OCCUR - EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DIED I I RETENTIONS 027360 /15/2011 9/15/2012 $ C WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITYI ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $. 5OO OOO OFFICERrMEMBER EXCLUDED? ❑ NIA ' '. (Mandatory in NH) 4494P844 /2/2011 /2/2012 , E.L.DISEASE-fAEMPLOYE $ SQO QOQ If yes.describe under - DE`:GRiPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Carpentry. In conjunction with the Weatherization Assistance Program, the following entities. are named as Additional Insureds for Liability coverage under Pol #MP027360: National Grid Corporate Services LLC DBA National Grid, Action Inc. , Colonial Gas Co. & NSTAR Electric. 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. Housing Assistance Corporation, Att: Ruth Bechtold AuntoIRIIZEIDREPRESENrAnvE 460 West Main St. Hyannis, MA 02601 " David, Crawford/ELDDCl �c�!......r� ,..� >. !ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. DIS02S•"T".inn51 n1 Tho Ar'.r1Rrl nnmo anA.lrwtn Oro ronii-fo►ort mnrWi of annRn til:iss,t fiusetts- Dc' 1)artnient of Public.Safct} Boartteof Building Re.4ulations :ind Standards . Construction Supervisor License License: CS 96M Restricted to: 00 STEVEN WHITE : 147 RIDGEWOOD AVENUE i HYANNIS, MA 02601 .,-Expiration: 21=012 ' ( niuuia.i.o�cr Tr#: 19311 /!e Lo�n�noryuair� o ✓�avaac�u�aelta License or registration valid for individul use onl Office of Consumer Affairs&B siness Regulation Y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 169944 Type: Office of Consumer Affairs and Business Regulation Expiation $l1912013 LLC 10 Park Plaza Suite 5170 -- Boston,MA 021.16 EFFICt-:'T :fL-DLNGS.LLC- STEVEN 8 JAN SEESAIZ =.7ti DTZ-=3:. SANC0- -W %3o Undersecretary Not valid without signature tz der t �y. �<' SfABLE +;Aa9Thomas F.Geiler,Director 39• �,� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder rJ /4- �-��� ,as Owner of the subject property hereby authorize S !6-V8>v L. A)14 1 -L-" to act on my behalf, LFr--% C. iesN i --v�vo-i3INC S� L Z_ in all matters relative to work authorized by this building permit H E L M S MAN N TiE./Z V 1 e-i (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Xv� ft 4 6 Signature of Owner Signature of Applicant S i E V e/'i P t Name . RA Print Name ��-���✓ 7C s,4W4s Date Q'.FORM&OWNERPERMISSIONPOOLS Amnesty Apartments Last Name ADLER First Name KAREN 2nd Owner 2nd Owner Last Name First Name Map Parcel 19 0063 Property No 26 f Property Street HELMSMAN DRIVE Village CENTERVILLE State MA Zip 02632 Status lCertificate of Compliance Action Required Monitor Assessors Use Group ISingle Family Comp Per Issue 12/30/2002 Recorded Date 2/26/2003? Application# Permit Issued: C of C Total r7771 Program Total 1 Descripton 1 BEDROOM,2 PEOPLE,EXISTING,LOWER LEVEL Cert of Occupancy Issued: Cert of Compliance Issued 7/29/2003 Notes 7/28/2014 This property is for sale and new buyer wishes to apply for the Amnesty Program an email was sent to Robin Anderson.New prospective buyer Tom Gillooly is aware what is required to apply.Spoke with Tom Gillooly regarding the Amnesty Program,which he does not want to apply for,according to Tom Gillooly there are too many issues to resolve to bring up to code for Amnesty. He asked about the family apt.and I stated that the family apt is for a blood relative.He asked me to send him info on Restore to Single Family. I also,stated he would need to contact me with his intentions and I would be sending him a note with a deadline(drop dead date) y w } �YV eS 4 ) T T. _ - t µ 4 f d " r{ TO met vL t o.. �le�Gi-ausv� assi�te. . p 9 = 9 p xIns SAW ""sit; WAN �J = - Mr - am j, own"t"O'hy lai-` rn �M 1 q �Sy WAY mar � WTI loins- 11_0�4 �� 1, xr � Certificate of C�40. loco fa ompllan�e az w'. u e[ts taee Bu�ldm ,Code . +t'�' ``. This certificate io`dicates acre table minimum:hab�tabte requirements per Ma`ssach s-' S €:, ` - - P aF# - _ - - iA `s _ _ _ = and.lown of$ainstable.zoning ordinances inaccordance with;tlie Amnesiy proY ram t 45 i <" & g 6 F 1 ny - solo1 o OW too Uzi wX Amon `cation �26� eh lsmart Drive, Centerville,Sr Lo _,eXeeed2° ersons � � a :� _ Unz tCapa ty �orn o n j� ri 7Yl Sp � I ,eCL >•� �+ yyr: u�. .a4 �� �� � 4 'm� � � a;'° ,r*�' ��� 4 - x�. ,:,��. aY` a mAh..�, .y -ts� +'S � .',� � � �s `" _ a-'a m . _ �, _ T` 1VIlP No' 1:94/063 , ` =. tp��,a t V t w x, Q,aa".a �!{ �k _ _ < Al .,,� - r .. .. ... .. ,. _...�. ,.....,...,, z.,.. .,..� w�....... ..... .�«„�,.,.....-.._. >_,..�..,...m--...Po..�,.r,-z�.,....>:,.....*�a,r�...._,_ .-.s�..:.':a-,.,.. .._-.... .« a,,.,z:.....��.�„ .....ems.�",'_ a-r ,�' ��".�-�,,.'+ .x-_ x:�rt��,,.:«. ,a•:�.__.__ _-�`�vs�,�« The Town of Barnstable t"s' ,,� Office of Community and Economic Development 230 South Street �s"B Hyannis, MA 02601 1639 �ice► Office: 508-8624678 u1recwr Fax: 508-790-6288 ACCESSORY AFFORDABLE HOUSING PROGRAM Lk._,,..+✓aZub.�,.:��ivu., 3.z_,_..<:C3::'a�'..,,,.... S...wx ...,..�..�ZL,. .. W.Z,.x:. ..,..': TO: Tom Perry,Building Commissioner cc: Kevin J.Shea Lois Barry,Building Division FROM Robert Shea,BHA Housing Inspector DATE: 7�a��D 3 Map/Parcel 19 y/ C 3 / RE: Inspection at: a de-1 A nn tk&j Ce 4,4exv ,I/ I have conducted a State Housing Inspection of a single-family/multi-familydwelling owned by: Phone: 3 G S G-'r 3 address: l c l.m kr oci C V 1 Single-Family OR Multi-Family. Units: Unit Capacity. ' yt,s a cJ P , ` ( # Bedrooms: Unit Capacity. # Bedrooms: Unit Capacity: # Bedrooms: Unit Capacity: # Bedrooms: It was found to be in compliance with the State Sanitary Code. Would you please arrange to have the Building Department do it's final inspection of the property in order to grant the Certificate of Compliance for the unit(s). PASS 7 DATE 7 .�S" D TIME BY APPROVED: REJECTED: (The following items need correcting): An DATE hu /0 SIGNATURE Q:CommDev/PT/Monitor/Apprvl.doc CL �j"E r°' . Town of Barnstable *Permit#� Expires 6 months from issue date BABNSTABL[, : Regulatory Services Fee r v� 1639. ��� Thomas F.Geller,Di AlEO MA't A rector .. Building Division Tom Perry, Building Commissioner ^'PRESS PERMIT 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 JUN 3 0 2003 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY OF BARNSTABLE Q'I Not Valid without Red X-Press Imprint Map/parcel Number ;Zential Address �75"G Value of Work Owner's Name&Address Contractor's Name /l�f/�T� .R, Telephone Number_ .� g 9-/ //// Home Improvement Contractor License#(if applicable)_ 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 Workman's Comp.Policy 2Do� a ofZ2.�DOi Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Ee-side Replacement Windows. U-Value "�® (maximum.44) ❑ Other(specify) "`Where ;required: Issuance of this permit do of exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. I ***N roperty 0 er mus go Property Owner Letter of Permission. signature V ZTomu:expmtrg levised121901 I °Fz►E,° Town of Barnstable Regulatory Services 9 MAS& eg» Thomas F.Geiler,Director 39. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder . /7 ,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) c>26 111e5g.1�Sm1*1V i nature-of Owner Date Print Name M Q:FORMS:OWNERPERMISSION HOME IMPROVEMENT CONTRACTOR Registration: 100503 Expiration: 6/19/02 Type: Private Corporatio CARE FREE HOMES, INC. —,zf 6��w DANA PICKUP ADMINISTRATOR 239 Huttleston ave Fairhaven {g 0211.9 ..: ✓/ze �o n7irreo.uueal� o��/f/�c�a:sacluaelta .^ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number::CS 021330 Birthdaw 03/06/1955 Expires: 03/06/2004 Tr.no: 17888 Restricted:. 00 DANA J PICKUP 28 WATERFALL RDA ACUSHNET, MA 02743 Administrator 1 i Bk 16461 Ps 296 "022654EXHIBIT BABN,STABLE MASS, BARMAUX= 1Q? DEC- 30 P11 1: I ,6 9. to Mrt• Town of Barnstable Zoning Board of Appeals Comprehensive Permit Decision and Notice Appeal 2002 - 122-Adler Applicant: Karen Adler Property Address: 26 Helmsmen Drive,Centerville,MA Assessor's Map/Parcel: Map 194 Parcel 063 Zoning: Residential C Groundwater Overlay: GP Groundwater Protection Overlay District Applicant: The applicant is Karen Adler,with an address of 26 Helmsmen Drive, Centerville,MA. Ms. Adler is the individual to whom this Comprehensive Permit is issued for th6conversion of an'existing unit into an accessory affordable apartment in the basement of a single-family dwelling in accordance with all conditions of this`permit. Relief Requested: The applicant has applied for a Comprehensive Permit under the General Law of the Commonwealth of Massachusetts,Chapter 40B -g 20-23 and in accordance with the General Ordinance of the Town of Barnstable Chapter III,Article LXV,"Pre-existing and Unpermitted Dwelling Units and for New Dwelling Units in Existing Structures," more commonly termed the"Accessory Affordable Housing Program." The zoning relief necessary for this Comprehensive Permit to be issued is that of a variance to Section 3-1.3 (2) of the Zoning Ordinance-Accessory Uses to permit an accessory apartment unit to a single-family owner-occupied residential dwelling.The issuance of this Comprehensive Permit would allow for an owner- occupied single-family residence with an accessory affordable apartment unit located within the,basement of the single-family dwelling. Locus and Background: The property is a .65 acre lot that is developed with a 3-bedroom,3-bathroom,3,592 square feet single- family, Cape Cod style home. The applicant bought the property two years ago and an incomplete unit already existed at the time she bought the home. The applicant heard about the program through an Amnesty Ad in the local newspaper and decided to apply for the program. The accessory unit is in the basement of the principal single-family home. The unit is approximately 620 square feet. The locus is in a Residential RC,in the GP Groundwater Protection Overlay District. The unit has been documented to pre-exist before January 01,2000,and qualifies for the Accessory Affordable Housing Program as an Amnesty unit. Procedural Summary: -This appeal was filed at the Town Clerk's Office and the Office of the Zoning Board of Appeals. A public hearing before the Zoning Board of Appeals Hearing Officer was duly advertised and notice sent to all abutters in accordance with MGL Chapter 40A. The hearing was opened on December 11,2002 at which time the Comprehensive Permit was granted. The Hearing Officer,Gail Nightingale presided over the public hearing. Also present were Paulette Theresa-McAuliffe,Accessory Affordable Housing Program Coordinator, and Michelle McKinstry,Barnstable Housing Authority. Bk 16461 PS 29? �22654 Findings as to Standing and The Comprehensive Permit: At the December 11,2002 hearing,the Hearing Officer made the following findings of fact: 1. The applicant is Karen Adler with an address of 26 Helmsmen Drive, Centerville. Ms.Adler owned the property since January 25,2000 as documented and recorded at the Registry of Deeds in Book 12797,page 208. Ms.Adler is requesting the Comprehensive Permit to convert a pre- existing unit into an accessory affordable apartment. The unit qualifies for the "Accessory Affordable Housing Program" as an Amnesty unit that existed prior to January 01,2000. 2. The applicant was issued a site approval letter dated November 19,2002 from Kevin Shea, Director,Office of Community&Economic Development,qualifying the application for the Accessory Affordable Housing Program. The source of the subsidyis the federal Community Development Block Grant(CDBG)program 3. The rental unit is approximately 620 square feet and has,o bedroom.' It is attached to the single- family Ranch style home. 4. According to the Assessor's record, there is a total of three bedrooms in the main house. The unit is a studio and therefore constitutes a fourth bedroom. The property is serviced by public water and the site is in the GP Groundwater Protection Overlay District. The Public Health Division approved the septic system at the site for a total of three bedrooms as per the Housing , Amnesty/Public Health Form dated November 18,2002. Therefore,Public Health approves converted into the program with the condition that the property owner/a licant the unit to be conve p gr p p ty pp makes a"five foot cased opening(no doors) to eliminate the privacy of a bedroom" in the main house in the room which the applicant currently uses as her home office. 5. The Barnstable Housing Authority completed an inspection of the unit on September 25,2002. The unit was given a Pass inspection by the Massachusetts Certified Housing inspector. The applicant is aware that a final inspection by the Building Division will be required and that all improvements necessaryto assure that the unit meets applicable minimum state and local code requirements must be completed. 6. On October 18,2002,the applicant signed an Accessory Affordable Housing (Amnesty) Program Affidavit agreeing to comply with the programs requirements,including owner occupancy of the principal dwelling unit and further agreeing to comply with the provisions set forth in Article LXV(65) of the Town Ordinances that include their signing and recording of the Regulatory Agreement&Declaration of Restrictive Covenants. The subsidizing agency has determined that the signing and recording of the regulatory agreement qualifies the applicant as a "limited dividend organization" as that term is used under M.G.L.c.40B §5 20-23. 7. The applicant understands that the affordable unit will be rented to a person or family whose income is 80% or less of the Area Median Income (AMI) of Barnstable-Yarmouth Metropolitan Statistical Area(MSA) and further agrees that rent (including utilities) shall not exceed the rents established by the Department of Housing and Urban Development(HUD). 8. The Barnstable Housing Authority has committed to the monitoring of this affordable rental uiut. I 9. According to the Massachusetts Department of Housing and Community Development,as of October 1,2001,4.7%of the town's year-round housing stock qualified as affordable housing units. The town has not reached the statutory minimum under M.G.L. c. 40B �§ 20-23 or its implementing regulations. Under the Town of Barnstable's Local Comprehensive Plan, the use of existing housing to create affordable units and the dispersal of these units throughout the town is encouraged. 2 Bk 16461 Po298 022654 10. Based upon the findings,the project is deemed consistent with local needs because it adequately promotes the objective of providing affordable housing for the Town of Barnstable without jeopardizing the health and safety of the occupants provided all conditions of the Comprehensive Permit are strictly followed. Ruling and Conditions: Based upon the findings,the Hearing Officer ruled that the applicant has standing to apply for a Comprehensive Permit under the General Law of the Commonwealth of Massachusetts,Chapter 40B - %20-23 and in accordance with the General Ordinance of the Town of Barnstable Chapter III,Article LXV, "Pre-existing and Unpermitted Dwelling Units and for New Dwelling Units in Existing Structures," more commonly termed the "Accessory Affordable Housing Program." The granting of this Comprehensive Permit is to the applicant,Karen Adler.It is issued to permit an accessory apartment unit to a single-family owner-occupied residential dwelling of 620 square feet, subject to the following conditions: 1. The property owner shall occupy the principal dwelling as her year-round residence. 2. Occupancy of the affordable unit shall boot exceed twopeople. 3. This unit shall not be occupied by a family member. 4. To meet the requirements of affordability,the cost of housing (including utilities) shall not exceed the Department of Housing and Urban Development's (HUD) (or any successor agency) 80% rent limits as published from time to time. Eligible tenants shall have an income at or below 80% of the Area Median Income,adjusted by household size. Both the rent limits and income limits can be secured from the Barnstable Housing Authority or from the agent of the town implementing this program 5. All leases shall have a minimum term of one year. 6. The applicant shall have the unit re-inspected by the Building Division to assure that all necessary requirements are met according to minimum state building and fire codes. It shall also be reviewed by the Health Division to assure compliance with applicable on-site wastewater discharge requirements. 7. The applicant may select their own tenant(s) provided the tenants) meet all requirements of the program and provided that person(s) income is reviewed and approved by the Barnstable Housing Authority as a qualified individual. The applicant will be required to work with the Housing Authority to provide information necessary to document that the tenant(s) qualify. To insure that the unit is rented in an open and fair basis to an income eligible individual or family, the unit must be listed with the Barnstable Housing Authority(BHA) and the Housing Assistance Corporation(HAQ whenever a vacancy occurs. Also,the applicant must notify the monitoring agent of a vacancy whenever it occurs. 8. Every twelve months the applicant shall review the income eligibility of those individuals occupying the unit. No later than a year from the date of issuance of this Comprehensive Permit the applicant shall file with the Barnstable Housing Authority an annual affidavit listing the rent charged and income level of the occupant(s) of the unit. The applicant shall provide the Barnstable Housing Authority anyadditional information it deems necessaryto verifythe information provided in the affidavit. Upon any report from the Barnstable Housing Authority that the terms and conditions of 3 i Bk 16461 Ps 299 0-22654 this permit are not being upheld,the Zoning Board of Appeals or it's Hearing Officer shall have the ability to hold a hearing to show cause as to why this permit should not be revoked. 9. The Accessory Affordable Unit shall be affordable in perpetuity(as affordable is defined herein) unless this Comprehensive Permit is rendered void. 10. This Comprehensive Permit shall not be transferable to any other person or entity without the prior approval of the Hearing Officer or Zoning Board of Appeals. This decision,the Regulatory Agreement and Declaration of Restrictive Covenants and all other necessary documents shall be filed at the Barnstable County Registry of Deeds. If the ownership of the property is transferred,the Barnstable Housing Authority shall be notified within 60 days the name and address of the new owner. 11. All parking for the dwelling and accessory unit shall be accommodated on site,and no lodging shall be permitted on site for the duration of this Comprehensive Permit. 12. This Comprehensive Permit must be exercised and the unit occupied within 12 months of its issuance or it shall expire. Transmission of the Decision of the Hearing Officer to the Barnstable Zoning Board of Appeals In accordance with Part II, Section 4.02 and Part III, Section 3.72 of the Town of Barnstable Administrative Code,the hearing officer transmitted her written decision to the Zoning Board of Appeals on December 11,2002, and fourteen days having elapsed since said transmittal with the Zoning Board of Appeals taking no action to reverse.the decision,this decision becomes the decision for this Comprehensive Permit application. Ordered: Comprehensive Permit 2002-122 has been granted with conditions. Appeals of this decision,if any,shall be made to the Barnstable Superior Court pursuant to MGL Chapter 40A,Section 17,within twenty(20) days after the date of the filing of this decision in the office of the Town Clerk The applicant has the right to appeal this de ' ion as outlined in MGL Chapter 40B,Section 22. jvJ .3b 02 Nightingal , aring f er Date Signed ' da Hutche 'der,Clerk of the Town of Barnstable,Barnstable County,Massachusetts,hereb ,e �a certify that twenty(20) days have elapsed since the Zoning Board of Appeals filed this decisi no appeal of the decisio n ff in the office of the Town Clerk ���'` �� tl(1 '� `•. ! �1 i Signed and sealed day of (� under the pains andyeies&ofry; s JJJj�a �_ Linda Hutchenrider,Town Clerk f�� `'bLU EARNSTABLE REGISTRY OF DEEDS 4 E'k 16461 Ps2c?O 022654 02-26-2003 a 12 13F REGULATORY AGREEMENT AND DECLARATION OF RESTRICTIVE COVENANTS THIS REGULATO Y AGREEMENT and DECLARATION OF RESTRICTIVE COVENANTS,is made this 1"� day of 2003,by and between Karen A.Adler, 26 Helmsmen Drive, Centerville, MA 02632,and its successors add assigns (hereinafter the "Owner"),and the TOWN OF BARNSTABLE (the "Municipality'),a political subdivision of the Commonwealth; WHEREAS the Owner has been granted a Comprehensive Permit under Massachusetts General Law Chapter 40B and local regulations bythe Zoning Board of Appeals to permit the creation of an accessory apartment in an owner occupied dwelling which will be rented to a Low or Moderate Income Person/Family(hereinafter "Designated Affordable Unit";and NOW THEREFORE,in mutual consideration of the agreements and covenants contained herein,and other good and valuable consideration,the receipt and sufficiency of which is hereby acknowledged,the parties agree as follows: I. PROJECT SCOPE AND DESIGN: A- The terms of this Agreement and Covenant regulate the property located at 26 Helmsmen Drive, Centerville,MA,as further described in Exhibit"A" hereto annexed. B. The Project located at 26 Helmsmen Drive,Centerville MA will consist of one accessory apartment unit which will be rented to an eligible low or moderate income individual or family(the"Designated Affordable Unit" or the"Unit"). C. The Owner agrees to construct the Project in accordance with the terms of the comprehensive permit, Appeal No. 2002-122 and any plans submitted therewith and all applicable state,federal and municipal laws and regulations (A copy of the comprehensive permit is annexed hereto as Exhibit"B"). D. The Owner agrees to occupy the principal dwelling unit located on the property as their year round residence in accordance with the terms of the comprehensive permit. II. THE OWNER'S COVENANTS AND RESPONSIBILITIES: A- THE OWNER HEREBY REPRESENTS,COVENANTS AND WARRANTS AS FOLLOWS: 1 In receiving the comprehensive permit to create the Designated Affordable unit,the Owner agreed that the Designated Affordable Unit shall be set aside in perpetuity for the public purpose of providing safe and decent housing to persons of low income (herein defined as 80% or less of the median income of Barnstable- Yarmouth Metropolitan Statistical Area(MSA) and that the Designated Affordable Unit shall be deemed to be impressed with a public trust. 2. The Designated Affordable Unit shall be rented in perpetuity to a household with a maximum income of 80% of Area Median Income or less of the Area Median Income (AMI) of Barnstable-Yarmouth Metropolitan Statistical Area(MSA) and that rent(including utilities) shall not exceed the rents established bythe Department of Housing and Urban Development(HUD) for a household whose income is 80% of the median income of Barnstable-Yarmouth Metropolitan Statistical Area. In the event that utilities are separately metered, the utility allowance established bythe Barnstable Housing Authority shall be deducted from HUD's rent level. 3. The Designated Affordable Unit will be retained as permanent,year round rental dwelling units with at least one-year leases. 4: The Owner has the full legal right,power and authority to execute and'deliver this Agreement. 5. The execution and performance of this Agreement by the Owner will not violate or,as applicable,has not violated any provision of law,rule or regulation,or any order of any court or other agency or governmental body,and will not violate or,as applicable,has not violated any provision of any indenture,agreement,mortgage, I Bk 16461 P�291 g22654 mortgage note,or other instrument to which the Owner is a party or by which it or the Owner is bound, will not result in the creation or imposition of any prohibited encumbrance of any nature. 6. The Owner,at the time of execution and delivery of this Agreement,has good,clear marketable title to the premises. 7. There is no action,suit or proceeding at law or in equity or by or before any governmental instrumentality or other agency now pending,or,to the knowledge of the Owner,threatened against or affecting it,or any of its properties or rights,which,if adversely determined,would materially impair its right to carry on business substantially as now conducted(and as now contemplated by this Agreement) or would materially adversely affect its financial condition. B. COMPLIANCE The Owner hereby agrees that any and all requirements of the laws of the Commonwealth of Massachusetts to be satisfied in order for the provisions of this Agreement to constitute restrictions and covenants running with the land shall be deemed to be satisfied in full and that any requirements of privileges of estate are also deemed to be satisfied in full. C. LIMITATION ON PROFITS 1. The Owner agrees to limit his/her profit by renting the Designated Affordable Unit in perpetuity to a household with a maximum income of 80% or less of the Area Median Income(AMI) of Barnstable-Yarmouth Metropolitan Statistical Area(NSA) and that rent(including utilities) shall not exceed the rents established by the Department of Housing and Urban Development(HUD) for a household whose income is 80%of the median income of.Bamstable-Yarmouth Metropolitan Statistical Area. In the event that utilities are separately metered, the utility allowance established by the Barnstable Housing Authority shall be deducted fromHUD's rent level. 2. The Owner shall annually deliver to the Municipality and to the Monitoring Agent,as designated bythe Town Manager,proof that the Designated Affordable Unit is rented,the tenant's income verification,a copy of the lease agreement and the rent charged for the unit or units. Such information shall also be forwarded to the Monitoring Agent within 30 days of the occupation of the dwelling unit or units by a new tenant. The Owner shall notify the Monitoring Agent,as designated by the Town Manager,within thirty(30) days of the date that a tenant has vacated the Designated Affordable Unit. IV. MUNICIPALITY COVENANTS AND RESPONSIBILITIES 1. The MUNICIPALITY,through the monitoring agent designated bythe Town Manager agrees to perform the duties of verifying that the Designated Affordable Unit is being rented in perpetuity to a household with a maximum income of 80% or less of the Area Median Income (AMI) of Barnstable-Yarmouth Metropolitan Statistical Area(MSA) and that rent(including utilities) shall not exceed the rents established bythe Department of Housing and Urban Development(HUD) for a household whose income is 80%of the median income of Barnstable-Yarmouth Metropolitan Statistical Area.In the event that utilities are separately metered, the utility allowance established by the Barnstable Housing Authority shall be deducted from HUD's rent level. V. RECORDING OF AGREEMENT: Upon execution,the OWNER shall immediately cause this Agreement and any amendments hereto to be'recorded with the Registry of Deeds for Barnstable County or,if the Project consists in whole or in part of registered land,file this Agreement and any amendments hereto with the Registry District of the Barnstable Land Court (collectively hereinafter the"Registry of Deeds"),and the Owner shall pay all fees and charges incurred in connection therewith. Upon recording or filling,as applicable,the Owner shall immediatelytransmit to the Municipality evidence of such recording or filing including the date and instrument,book and page or 2 i Bk 16461 Po292 '"W22654 registration number of the Agreement. VI GOVERNING OF AGREEMENT: This Agreement shall be governed by the laws of the Commonwealth of Massachusetts. Any amendments to this Agreement must be in writing and executed by all of the parties hereto. The invalidity of any clause,part or provision of this Agreement shall not affect the validity of the remaining portions hereof. VIII. NOTICE: All notices to be given pursuant to this Agreement shall be in writing and shall be deemed given when delivered by hand or when mailed by certified or registered mail,postage prepaid,return receipt requested,to the parties hereto at the addresses set forth below,or to such other place as a party may from time to time designate by written notice. IX. HOLD HARMLESS: The Owner hereby agrees to indemnify and hold harmless Municipality and/or its delegate from any and all actions or inactions by the Owner,its agents,servants or employees which result in claims made against Municipality and/or its delegate,including but not limited to awards,judgments,out-of-pocket expenses and attorney's fees necessitated by such actions. X. ENTIRE UNDERSTANDING: A This Agreement shall constitute the entire.understanding between the parties and any amendments or changes hereto must be in writing,executed by the parties,and appended to this document. B. This Agreement and all of the covenants;agreements and restrictions contained herein shall be deemed to be for the public purpose of providing safe affordable housing and shall be deemed to be,and by these presents are,granted by the Owner to run in perpetuity in favor of and be held by the Municipality as any other pen-nanent restriction held by a governmental body as that term is used in MGL Ch. 184,Section 26 which shall run with the land described in Exhibit"A" hereto annexed and shall be binding upon the Owner and all successors in title . This Agreement is made for the benefit of the Municipality and the Municipality shall be deemed to be the holder of the restriction created by this Agreement. The Municipality has determined that the acquiring of such a restriction is in the public interest. The Municipality shall not be subject to the defense of lack of privity of estate. The covenants and restrictions contained in this Agreement shall be deemed to affect the title to the property described in Exhibit"A". XI. TERM OF AGREEMENT: The term of this Agreement shall be perpetual,provided,however,that the Owner of a Designated Affordable Unit or Units may voluntarily cancel the granted Comprehensive Permit and the terms and restrictions imposed herein. Such cancellation shall onlytake effect after: 1) expiration of the lease terms entered into between the Owner and Tenant occupying said unit and 2) notification by the Owner of said dwelling to the Zoning Board of Appeals of his/her desire to cancel the Comprehensive permit upon a date certain and the recording of said notice at the Barnstable County Registry of Deeds or Barnstable County Registry of the Land Court as the case maybe,thus rendering said Comprehensive Permit void. Upon the fi cancellation of the comprehensive permit,the property which is the subject matter of this restrictive covenant shall revert to the use permitted under zoning and the restrictive covenant shall be rendered void. 3 I XII. SUCCESSORS AND ASSIGNS: A. The Parties to this Agreement intend,declare,and covenant on behalf of themselves and any successors and assigns their rights and duties as defined in this Regulatory Agreement and the attached comprehensive permit. B. The Owner intends,declares,and covenants on behalf of itself and its successors and assigns (i)that this Agreement and the covenants,agreements and restrictions contained herein shall be and are covenants pinning with the land,encumbering the Project for the term of this Agreement,and are binding upon the Owner's successors in title, (n) are not merely personal covenants of the Owner,and(1) shall bind the Owner,its successors and assigns and inure to the benefit of the Municipality and its successors and assigns for the term of the Agreement. XIII. DEFAULT: If any default,violation or breach by the Owner of this Agreement is not cured to the satisfaction of the Monitoring Agent within thirty(30) days after notice to the Owner thereof,then the Monitoring Agent may send notification to the Municipality that the Owner is in violation of the terms and conditions hereof. The Municipality may exercise any remedy available to it. The Owner will pay all costs and expenses,including legal fees,incurred by the Monitoring Agent in enforcing this Agreement and the Owner hereby agrees that the Municipality and the Monitoring Agent will have alien on the Project to secure payment of such costs and expenses. The Monitoring Agent may perfect such a lien on the Project by recording a certificate setting forth the amount of the costs and expense due and owing in the Registry of Deeds or the Registry of the District Land Court for Barnstable County. A purchaser of the Project or anyportion thereof will be liable for the payment of any unpaid costs and expenses that were the subject of a perfected lien prior to the purchaser's acquisition of the Project or portion thereof. )UV. MORTGAGEE CONSENT: The Owner represents and warrants that it has obtained the consent of all existing mortgagees of the Project to the execution and recording of this Agreement and to the terms and conditions hereof and that all such mortgagees have executed consent to this Agreement. IN WITNESS WHEREOF,we hereunto set our hands and seals this 13 day of 1�66 ,20Q3 OWNER BY: s,� rin d: Karen A.Adler TOWN OF BARNSTABLE r BY: Signature Printed:Jo C.Xhmm,Town Manager 4 I COMMONWEALTH OF MASSACEiUSETTS Coup of Barnstable,ss: ,200.3 Then personally appeared the above-named ILR"LQ.s-1 . /`��as OWNER and acknowledged the foregoing instrument to be his/her free act and deed,before me. No eresa-McAuliffe P joe monwealth of °� .._.,..;husetts f 0 y mm...G xp es: .��a'�rwurr,e,,,� Ao s i� r t nrr,, ••�� COMMONWEALTH OF MASSACHUSETTS � County of Barnstable,ss: 2003 Then personally appeared the above named NN (2, K4/M ,Town Manager for the Town of Barnstable and acknowledged the foregoing instrument to be his/her free act and deed,before me. oWel h My Commission Expires: Linda R. Wheelden, (Votary Public "'�r��` •••���� � Commonwealth of Massachusetts My Commission Expires 2123/2007 -,r :fir • '� _'' ' ?� a, d 5 Bk 16461 1= s 295 .8??654 EXHIBIT t3-RC-4 0 r�y e ID�'QiY'4 bi9i1 QUITCLAIM DEED We,MICHAEL P.O'KEEFE and MARY V.O'KEEFE,both of 8 Menlo Street, Brighton,Massachusetts,for consideration of ONE HUNDRED SEVENTY NINE THOUSAND EIGHT HUNDRED AND NO1100($179,800.00)DOLLARS,grant to KAREN A.ADLER,Individual,of 26 Helmsman Drive,Centerville(Barnstable), Massachusetts,with QUITCLAIM COVENANTS,the land in Barnstable(Centerville), Barnstable County,Massachusetts,bounded and described as follows: LOT 26 as shown on plan of land entitled"'Highview Hills'Plan of Land in Barnstable (W.Barnstable-Centerville)Mass.for James K. Smith,Scale 1"=60',Oct.4, 1983, Rev.Nov. 25, 1983,Baxter&Nye,Inc.,Registered Land Surveyors,Osterville,Mass.", which said plan is duly recorded in the Barnstable County Registry of Deeds in Plan Book 379,Page 70. No portion of the fees in the ways shown on the above referenced plan are conveyed herein. Said premises are conveyed together with a right of way over the ways shown on said plan to be used in common with all others entitled thereto for all purposes for which ways are used in the Town of Barnstable. Said premises are conveyed subject the covenant,agreement and condition that that portion of Lot 25 lying between Lot 26 and Lot 15,as shown on the above mentioned plan,shall not be used as access and egress to Lot 25 from Helmsman Drive,it being agreed that access to Lot 25 shall be over a portion of Lot 24 from Cap'n Lijah's Road, all as shown on said plan. For title see deed recorded in Barnstable County Registry of Deeds in Book 4453,Page 247. Property Address: 26 Helmsman Drive,Centerville,MA WITNESS our hands and seals this ;2,�' day of �.vvr ,2000. BARNSTABLE COUNTY REGISTRY OF DEEDS Michael P.O'Keefe `— COUNTY EXCISE TAX REG OF DEEDS --------------------- (J �(Q,r RE tLLED Mary V.O Keefe - - BA Y DATE 01.25.'00 TOE 01/25/U0 MIN 01 00M tt9"? TAX $410.40 FEE t615.60 TOTAL $410.40 CHECK $410.40 CASH *6J.5 60 CLERK 1 NO.006517 TIME 13:07 1111 Town of Barnstable tMME '°''ti° Regulatory Services 'P Thomas F.Geiler,Director * snaxsrABM • KAMg Building Division 1639• �0 �''°rEc Mpt a Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 COMPLAINVINQUIRY REPORT Date: Rec'd by: Complaint Name: �,, p/Parcel— Location Address: of l� ti �ii�-ir� G /l /l/ice LAG Originator Name: Street: G ).Z Village: State: Zip: Telephone: Complaint Description: FOR OFFICE USE ONLY Inspector's Action/Comments Date:__ 9 1G —GZ Inspector: Additional Info.Attached i Q:forms:complaint FWET Town of Barnstable Regulatory Services . • SARNSI'ABLE, • 9 MASS. g Thomas F. Geiler, Director �p i6gq. ♦0 IE039 a Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 September 10, 2002 Karen Adler 26 Helmsman Drive Centerville, MA 02632 RE: Illegal apartment Map/Parcel: 194-063 Dear Property Owner: A review of our records including the permitting history of 26 Helmsman Drive as well as Zoning Board of Appeals records indicates that the use of that address as anything other than that of a single-family home is illegal. You are hereby ordered to discontinue the use of the above-referenced property as it is now being used and restore it to a single-family home. You are to accomplish this work and notify this office to inspect within fourteen (14) days of receipt of this letter. A building permit must be applied for to redesign the layout to accommodate the conversion. You must do this before you make any changes. You have the right to appeal this decision. If you so choose, we will be more than happy to help you. If we do not hear from you within the 14 days, we will be forced to seek criminal action against you. Very truly yours, (;�'- 9;;�' Gloria M. Urenas Zoning Enforcement Officer GMU/lb Q:020801A TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel—C�� Permit# FI Health Division l IF � Date Issued Z ��1 Conservation Division- / l 4` Fee t, i 00 Tax Collector ;Z o© / = c9 Treasurer S C S Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address a( H F_ -_M 5 M P,�i f)0, Village __ _C iv i TE` ,'J f£-L Owner ,J ,0LCF cz Address Telephone Permit Request c O i(J r c io �- Square feet: 1st floor: existing F i proposed 2nd floor: existing Coo v� proposed Total new 0 Valuation i-J.1©!), ���-- Zoning District a �—' Flood Plain C, Groundwater Overlay Construction Type Woo O -0®'A0 -lo 00 o Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ( Two Family ❑ Multi-Family(#units) Age of Existing Structure /a Historic House: ❑Yes 4INo On Old King's Highway: ❑Yes No Basement Type: W Full ❑Crawl jI Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new 6 Half: existing new Number of Bedrooms: existing 3 new 0 Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: &I(Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 26 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 e,4A Shed: ❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name 4/-vim z e�z Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION D BRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE &Zaz rt4 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED t MAP/PARCEL NO': t ADDRESS , VILLAGE r OWNER2 DATE OF INSPECTION: 1' _ FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL .t PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING [i DATE CLOSED OUT ASSOCIATION PLAN NO. ' t The Commonwealth of Massachusetts .......... _ De artment o Industrial Accidents = — exce 0/IOYCsdoz9OOs 600 Washington Street _ Boston,Mass. 02111 Workers' Cam ensation Insurance Affidavit/ name W 6;E A location ►NI S WI W t—� No city ri 1 E2 0 1 LL phone# �/� — S�3 I am a homeowner performing all work myself. ❑ I am a sole etor and have no one worldn 1n anv capacity ///O%/%/%%%/%//// //// %/%%/%/%//%%//////%%/%%///%/U//////�O�/O/ din workers' tmsation for my employees wozlang°a this]ob. I am an em lover rovi < rom espy name.. ::- ...... hone# . :::::;;::»'. ...:.......... .. :.::.:::.::....:: ..:�..::::::::::.;>;:.;.::..:::::::.:;::•:;,;::';:.,:;;Cio-;:ii^:;-:'::. Insurance ca. ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have lured the contractors listed below who have . the f ' ensation oIices: ollowm workers mp P ........._....................::: :: -:::: .......... : .:::::::::::.:::::.::::::::::::::::.:>:.::. I. cum anvname: ........ s. - 3::.. adtlres .... '+i;.:^`;'y.`::::::.:%;;:^ ....:...............:.....::... ';? :: ? `%z:? f `.ra`• ?3.2`•........ i%.......;i %:5 ..........................:......................:............:...................:::::............... ......... :::;::i;;::;i'';;:::i address., itbne. . ....:............:... :;;.: .-::i:hiiii::i:.:i.ii::^::'ii:ii:;:i:•:n:it......::: ............. ..::....::................ ....... ......::....: ::.:::r::•ii'.i.:!rv};.j:,�•%J::?:bill:•:i:4:i:•}}i}:: Fafluce to see+a a covera;e as repaired under section 25A of MGL 152 can lead to the imposition of erfmiml penalties of a Hue uP to S1,�vur one yam,imprisonment as wen u civil penalties in the form of a STOP WORK ORDER and a Hue of 5100.00 a day against tne. I understand that a copy of this statement maTqforwarded to the OMce of Investigations of the DIA for coverage veriHeation. I do hereby c the p ' of p that ike information provided above is&w.and forreft DatE /24YALI ./ Signature! �3 Print e ofncw use only do not write in this area to be completed by city or town oHidai petsrdttncense I$ ❑Building Department city or town: ❑Licensing Board �$e]ectmen's Office checkif Immediate response isrequired ❑Health Department - phone ii; — ❑Outer contact person um"0 9/93 PUU Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to providethe workers' o service ofanother ioner for C°eir employees. As quoted from the"law", an employee is defined as every,person in of hire, express or implied. oral or written. An employer is defined as an individual. partnership, association, corporation or other legal I of a deceased ems plover,or ay w the receiver c the foregoing engaged in a joint enterprise. and including the legal representatives trustee of an individual, partnership, association or other legal entity,employing employees. However the owner of a who resides therein,or the occupant of the dwelling house of dwelling house having not more than three apartments and w r 1, another who employs persons to do maintenance,construction or repairwo be such house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance who ha enew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the of its political subdivisions shall enter into any contract for the Performance of public work until commonwealth nor any P this chapter have been presented to the conrracnim- acceptable evidence of compliance with the insurance requirements Of authority. 0111 Applicants b the box that applies to your situation and Please fill in the workers' compensation affidavit completely,'by a ertificate of insurance as all affidavits may be supplying company names,address and phone numbers along o f insurance coverage Also be sure to sign and submitted to the Department of Industrial Accidents for can °n application for the permit or license is date the affidavit. The affidavit should be returned to the city or town that the app . e not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you arer lease call the Department at the number listed below. are required to obtain a workers compensation policy,p UNFR City or Towns bl The Department has provided a space at the bottom of th Please be sure that the affidavit is complete and printed sti ti you regarding the applicant. Please affidavit for you to fill out in the event the Office of Investigations has to contact y be sure to fill in the peimit/license mrmber which will be used as a reference number. The affidavits may be to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questsons. 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 0111ce of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 Qp THE Tp� �.CW.~ The Town of Barnstable MASS. g Regulatory Services �p i65 9• �•• Thomas F. Geiler,Director, rEa nv►'t Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-562-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. o � Type of Work: t I x 1 ( 5 H E O 'Estimated Cost 0 0 Address of Work: e 5 " (� Owner's Name: K n ►�� *3 'n Le j Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied 06wner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED ORK DO NOT HAVE CONTRACTORS FOR APPLICABLE PROGRAM OR GUAHOME IN MOVEMENT WAD UNDER MGL 142A. ACCESS TO THE ARBITRATION SIGNED UNDER PENALTIES OF PERIURY I hereby apply for a permit.as the agent of the owner. Contractor Name Registration No. Date OR Date Owner's Name q:forms:A ffidav:rev-070601 a , RESIDENTIAL: SHEDS - POOLS-DECKS-OPEN PORCHES- GAZEBOS DETACHED GARAGES FEE VALUE WORKSHEET ACCESSORY STRUCTURES >120 sq.ft.(Sheds,detached garages,gazebos,etc.) >120 sf-500 sf $35.00 $ >500 sf-750 sf 50.00 $ >750 sf- 1000 sf 75.00 $ >1000 sf- 1500 sf 100.00 $ >1500 sf-USE NEW BUILDING PERMIT APPLICATION DECKS x$30.00= $ (Number) PORCHES x$30.00= $ (Number) IN GROUND SWIMMING POOL $60.00 $ ABOVE GROUND SWIMMING POOL $25.00 $ RELOCATION/MOVING $150.00 $ (Plus above fee if applicable) PERMIT FEE $ Q:forms:dkcost eff:082301 The Town of Barnstame BARN �LF- Regulatory Services 16?9. ,,�• Thomas F. Geller, Director E0 FA0' Building Division Peter F. DiMatteo, Building.Commissioner 367 Main Street.Hyannis MA 02601 Fax: 508 i 90-6230 Office: 508-862-4038 HONIEONVNER LICENSE E=&IMON Please Print DATE: i l l b I L.<_ JOB LOCATION: �� L' S M 1J village number stt� o�� �a ' ° ° "HOMEOWNER": K P, blame ph=c# work phone a# aatae CURRENT MAILING ADDRESS: city/town t zip code The current exemption for"homeowners"was extended to include owner-occuoted dwellin-s of six units or less and to allow homeowners to engage an individual for hire who does not possess a license.9MX the owner acts as supervisor. Dg'SIITION OF HOly>EOwNER to reside.on which there is.or is Person(s)who owns a parcel of land on which he/she resides C" accessory to such use and/or intended to be,a one or two-family dwelling,attached or detach ed SUUcWresstructures. A person who constructs more than one home in a two-Year penad shall not be considered farm Official on a form acceptable to the a homeowner. Such"homeowner"shall submit to the Building uildinc Official,that he/she shall be res onsible for all such work er under the buiidin� etmit. B e (Section 109.1.1) The undersigned"homeowner'assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations' enisrred" meowner'certifies that he/she understands the Town hBwarnstablill mPBuWd said The and requirements and that he! Depar�men f cur inspection procedures and procedures and re u nts. Si ' 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 EU3WTION w�for which a building permit is required shall be exempt from the The Code states that: "Any homeowner performing Supervisors provi�that if the homeowner engages a provisions of this section(Section 109.1.1-Licensing of wnsttuctioti uP person(s)for hire to do such work.that such Homeowner shall act as snPervls�assuatitig the responsibilities of a supC1visor(see Mary homeowners who use this exemption are unaware that they Section 115) This lack of awarenes s often eed against she Appendix Q.Rules&Regulations for licensing CoIn asuurtion Suptsvis �• in this case.our Board cannot proceed serious problems•particularly when the homeowner him unlicensed p as Supervisor is ultimately responsible,an of the permu unlicensed person as it would with a licensed Supervisor. The home°anabi�a.many communities require.asap a of this issue is a To ensure that the homeowner is fully aware of his/her mp responsibilities of a supervisor. On the 1 ouPco�nunisy appiicauon.that the homeowner certify that he understands the rap form currcndY used by several towns. You may are t m=d and adopt such a form/cutification for use in y Q:F0Rr1S:ElEN1M, r . • A0p1. �, c�S• � q 'a q � G Lo do Cal I certify that this property is'C located in Flood Hazard Zone C >o side the 500 'year flood) as identified 11 by the Department of Housing and Urban Development (HUD) . � Date Dec. 3" iyy!F CERTIFIED PLOT PLAN --<�,,N LO CATIO N W, [ N ......,STA�( (ram 1��4GeY l SCALE ! �� Ao I Reg n Kr a f DATE D�3i If9p ,. e��o PLAN REFERENCE ,44�i!vg 4o /� G •`1• ►fie^;:�'". �'C; ,70. . ., . . . . . . .. . .. . . . . . . . . . I certify to Cape Cod Bank aTrust and its title ins.co. that there are no visible encroachments THE LOCATION OF THE ORt01NAL DWELLING or easements except as shown and that this SHOWN HEREON,EITHER WAS IN COMPLIANCE WITIH THE LOCAL APPLICABLE ZONING BYLAWS plan was prepared under my immediate IN EFFECT. WHEN CONSTRUCTED (WITH supervision. RESPECT TO HORIZONTAL DIMENSIONAL REQUIREMENTS ONLY),OR EXEMPT FROM LVIOLATION ENFORCEMENT ACTION UNDER M.O.L. TITLE VI1,CHAPTER 40A,•SECTION T,UNLESS OTHERWISE NOTED OR SHOWN HEREON. TFTI F rolur s NOTES .- Chi H 64r3 c E ZDCt rTIr-A - SXIL. 6,4E5LE Lou vER-S RA I«s FRc►A 4 - j3oA-zD 4- 13ra i�iJ S� 171�1CY � � W I ►� C>ovJS ASPHALT SIIINCiLES p,Tck' i l�1} � _ •I 1 I Solve i�at • ` 4s , V �� l� �" PINE :�or✓ �OI�RD� � I � � :� � � .,; , ��.dUT 2xN 2ArTP—P- i I i t ALL 4A VE a�Xy,• .e I G END Loul�� ,�� PL ATia Cnr�r S�DwN) ' qXy 6Lbc.K1NCr I I , ✓E� &57 7:� • 'Pi�y�OCD ' 'i00� JO�StS I 'i � i � I rZ 'Xi6 � . eve Ach � � � t u t.�x 12.x 16 S WEta Zx s PA-PrEP.S Z�t0.�. N�T 'PINE IROAr" -R %us rs 6,q r3 c E,-Vo [-4 U VL—:-izs raw 2 Tuk sJwS Bay- Joni 2-)Lg P.T. a� S 0 N("1, TU lw-s r 3G"_ '�� C�2A V--- f 2' 5T' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map�19 Parcel_—= - Permit#� CO ivision �' G 1. l Date Issued '2I -I,e�sertttbn Division Fee Tax Collector— SEPTICSYSTEM MUST BE. Treasurer INSTALLED IN COMPLIANCE Planning Dept. WITH TITLE 5ENVIRONMENTAL CCDE.A ID Date Definitive Plan Approved by Planning Board Tax , -7ciuq ;, t Historic-OKH Preservation/Hyannis ; Project Street Address "-Q Village N (_`_ � - Owner Address QGo l e k t Telephone C) Permit'Request �r4. �"�� x / � � Q CA � l i Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation ! -TOW Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area'(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other f Central Air: ❑Yes ANo Fireplaces: Existing New Existing wood/coal stove: ❑Yes Flo Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use K_-\MC< C-A_&A \"Cx�\ BUILDER INFORMATION Name�t A-A A kr-x 42 Telephone Number.? Address I o C7 ©�-��� • NCC��(\k.Ys�h License# C) KA� O q Home Improvement Contractor# !a!5� / ((, Worker's Compensation#3,,:� V��' �' 1_ CCi 1:-) ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE /'� DATE -�tl s I �- - FOR OFFICIAL USE ONLY PERMIT NO. _ DATE ISSUED r MAP/PARCEL NO. - - ADDRESS VILLAGE OWNER," Olt DATE OF INSPECTION FOUNDATION 50-nlo GCS' v/31 /or FRAME INSULATION s.> FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH t-- FINAL GAS: ROUGH ' FINAL' - FINAL BUILDING ; ;� ,�' .• DATE CLOSED OUT t' ASSOCIATION PLAN NOJT3 '. CF 7ME T� The Town of B• arnstable •wsivs-r�st.s. 9q, i' : ,0$ Regulatory Services 1°rED MA't Thomas F. Geiler, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: �S2m_� A�-i nc1 Estimated Cost T(� r Address of Work: 14-0 A C. � KIC 1 J'A C� Owner's Name: C\ o Date of Application: 4; dJ I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law []Job Under$1,000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: s r5 oI »5E Date Contrac Registration No. OR Date Owner's Name q:forms:Afdav _ The Commonwealth of Massachusetts PA—+ =r� `—•_� Department of Industrial Accidents ,o �= � , �_• OlJlceot/m�est/gadoos _ — 600 Washington Street - Boston,Mass. 02111 -- Workers' Co m ensation Insurance Affidavit name: -XkQt2AN MAWNE location city C-&N-r6-yuo Lk4- M,6 OZG32 vhcme# . o9-3F=Z 0 0 ❑ I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one woddn in aav achy I am an employer providing workers' compensation for my employees woridng on this job. giiabttny name e .................... 8ress :. ,.. . irk . !; » >'.< a .•;y�::: j���f� :::.. :.. bane# •��>:�_ .... , . %.>:•:Y:::::i::.i�..:}:o-:.:.;i f::-::}:::;:.:..>:.:>.[ ......... N. - :::::x;:;^:;:+':.:x;;.;-..:::r:;:;::;?::;:::: :•7a:::.:•.>}:>:ri;;;ii;:>i::r;::;i::;::.r:a:::i i;}>i4:Y;:i�:}:i:�;:::.`:;,3,;.:;:}..::.. .. ansarance�ca:::::<:.�<:;:::::;.; .. .:.::;,. ::..,::. :::,,::::..:,;::,;;.;.}:::;«:,::.;::;.;::;:.:. olioV.#...:..:.. :... .::.:..:.:: ::.:.:. :.. .:.::. ... ....... . .. /: ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers compensation polices: :. com an name. :.::.;::.;:;.:<.}•.;;>} .::.::.;.:.} :<: . ................ XX i;:•:•:•};:t•}:t•;x;•;}:tt•:•}:}}:t•;:-}:.:•:>:.}r}}::.;:a:•r::-:::•}:•:t•::•>:;•}:;•}}:•}rr:;•}::•}:•}:_:•>:•::�}:•}:a:•:::.�::::::.:�:::::;>::•.•:::•::•:::::•:::::::::::t•}>}>}:}}:•}::::t. i�i-:::-::::.�:::.�::::.�::.;::>:t�::-:}�;•::•::c•}:.>r:•;:t<•:•r:->:;t:;•:;:•:}:;;;;;<::•::;;:;;•:{:::'::?:::::':::'::':}:=::i':;:':�:<::;:;:;%:.::.�:.»:.;:.:.::•}>r:tc::t•:: .MK,.:.........................r......:.... .................................... }.r...........w.r............-..........::: .......... .. ............ ..... .... ............................:........v..w::,...:t..:...n............................ ........................... II ....................................x......x n.. ................... ..................\v..v......�....:...... .............:•:v::•.v:::::•:;., .v:::::: w. ' :#'.,i:�is viii:::::.::�::�:�::::.;_�;.:.;{.}.}�:::::.:::::-i::.:...:.:::..........: :.... :t ::'%:.:r:'2% .': .%-:2t:;::; i :;:: :i:::'•::::::r::: ;:::::is:::i::i::i::r::s:%;::;:::}i:::i:::i:::::::::}.;q;;;.;.x•::•xa: tMnvSR{F%namC."`'.': :o-}:>::os:a;:.};: <+::;:: "`dilres sir A �h da >>...... ::::.:.::::::::::::.::::::.:::,.:..............::... ...FaU a to seem a coverage as required under Section 25A of MGL 152 can Ind to the huposidGIM of cdMiaal Penalties of a fine up to SlAMOO and/or one years'imptisonueat as well as civil penalties in the form of a STOP WORK ORDER and a fim of 5100.00 a day against me I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage veriffaHon I do hacby aw pen perjury that the information provided above is trmrl� cd signatur certify the e Date S I Pont name . Phone# roflIdal use only do not write in this area to be completed by city or town offida1 or town: penn"cense# ❑BWIding Deparhnwt ❑Ucensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; - ❑Other Crewed 9195 PIA) Information and Instructions b Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any 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 c: trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewf of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the==acting authority. Applicants r Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and ly ing ying company names,address and phone numbers along with a certificate of insurance as all affidavits may be k j -: 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 b j 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. a 4 Y City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/Iicense number which will be used as a reference-number. The affidavits may be retained fir the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. FEEM The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Invesfigallons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 EST/MA TED PROJECT COST WORKSHEET LIVING SPACE Value (high end construction) square feet X$115/sq. foot= (above average construction) square feet X$96/sq. foot= 115 Zo (average construction) square feet X$57/sq. foot= GARAGE (UNFINISHED) square feet Xr$25/sq. foot= PORCH square feet X$20/sq. foot= -�D '3 square feet X$15/sq. foot DECK = Z OTHER square feet X$??/sq. foot= Total Estimated Project Value f OYO In accordance with the provisions of MUL c 40, S 54, a condition of building permit Number is that debris resulting from this project will be disposed of in a properly licensed solid waste disposal facility as defined by MUL e 111,8150 A The debris will be disposed of in : Patio Rooms of Boston, 100 Otis Street Northboro (Name and location of facility) (Sign.ature of permit applicant} Date: Property Owner Must Complete and Sicrn This Section If Using A Builder as Owner of the subject property y a,�t ori?e Bettari viva?Miry ootrrs (d.b.a.—Patio Roo_7as of to act on n ny behalf, =n all matters r ela t v-t0 work a,l'hoi z-d by this building nertl7tt ap711 CaL10Tl nr (a.d.dress of job/) /9 �3 UI afore Of Owner Date n '7 A t 1 Owner or 3aflider (as rjeuL Ot G'tli�er� _gust Co npiet2 and Si.n i�I:S vFC OTt I (�� La , as Owner/Authorized Agent hereby'dAare that the statements and informa,ion on the foregoing application for (address of joib) �( g IS �1 `� titre and accurate, to the best or my knowledge and belief. Signed under the pains and penalties of perjury. SL rint Nam Signature of Owner/Agent date 9 , 55 �1��►C, a �; �9`J,� i 0- vti 0� DECIG � G� 1 a ` S � I certify that this property is \ located in Flood Hazard Zone C (out- side the Sao 1 year flood) as identified �\ by the Department of Housing and Urban Development (HUD) . ` Date L&c. 31 /y'yj CERTI FI ED PLOT PLAN LOCATION SCALE .!.��- ¢°'.. .... DATE Reg. PLAN REFERENCE S.�k�i v o de- 3�9 I certify to Cape Cod Bank &Trust and its title ins.Co. THE LOCATION OF THE ORIGINAL DWELLING that there are no visible encroachments SHOWN HEREON ,EITHER WAS IN COMPLIANCE t as shown and that this WITH THE LOCAL APPLICABLE ZONING BYLAWS or easements except IN EFFECT. WHEN CONSTRUCTED (WITH plan was prepared under my immediate RESPECT TO HORIZONTAL DIMENSIONAL . supervision. REQUIREMENTS ONLY),OR EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER M.G.L. TITLE VII ,CHAPTER 40A,-/ pG�T. OTHERWISE NOTED OR SHOWN SECTION HE HEREON. �/�e� /-l. /�DL�72 0 Sent By:- STEPIS; 508 362 5030; Apr-27-01 5:0iPKJi; , Page 1/1 ;i TOWN OF BARNSTABLE LOCATION SEWAGE#' PILLAGE__ `InP,'i/�:%I ASSES'SOfUS MAP&LOT/,�4 1.� INSTALLER'S NAMB&PHOIKE NO. =, SEPTIC TALC CAPACITY `•^a jvY•i J �k } LEA . INO F°ACII..ITY, (type) %• }✓iJ'",4.i �iJ',G+' �t�r l�• (SILO}_r5: �. �. NO.OF BEDROOMS 5 i 9r ILDER OR OWNER k'.*».,*�m1 DA H: / - C0M?L,LkNCE DATE-_._1 ` - ��- •✓> geparmion Distance Between the: Maximum Adjasted CirouadwaterTable and.Bottoln of Leaching Facility Feet Nvate`dater Supply W til and Leaching Facility.(if any wells exist on site or within 200 feet of loathing facility) Foot Edge of Wedand and Leaching Facility(If any wetlands exist within 300 feet oa It,, faeau�) Furnished by AA 4 26 .NE LMSMAN' DP— cert?� QV IU& MA OZ63 Z _d,, f � f f it I � f € 1-0 ILI] IZ-2 Z`t4�1 1P�oPf� �i.ao2 D�U� QLDN ur...... E L s 0AN1 Gt>4LS._aS P'0In sFwp l,c: • P13�. ..StQ�_ Suts�4a, Sa(.lO IbLoL N&XAS SOH) •: -cry�P�� . zxa._.c.�bnn 5 IZ"_oi4_ K.4$° .C>Eep �C6S: w�i�n�cN LS U�ft�4u.12.(A, -Q,9-P09--'0. .C-N(J=%VGCIP ..5/y x6.. oELK1S�1E� �t OEc SAI62 . .{ 1-�E►�tA? t_. MAX -cR640. Ai Tv Kfk IJ � \ t i.\ o:h+,yr���� V. LAYOUT PLANS WALL �ECrioNc,-,? EXISTING BUILDING i �1 f, (IAAX �... _ (MAX) { DM Q r f ST'IJDfO SIDI�WALL(A) STUDIO SIDE WALL(C) _.—.._.._.._.___....--- ---'---.__------ WALL -aa� L a --- A55LM6LY DETAILS -, 5 rUDlo 1 00P,,PI Aid (NO1r10'SG{XLE) ALUM.PAIIEL I IAhIGI P L CONNECfS'i'OWALLS'IUDS ;;i OKP.00f PAP'I'f P5 r t d' SEE AI LOWAIXE I OAP 96 (b1AX) f' -ADLE FOP.PANCI 517C5 I'�\\ » q; MINIMUM 51.OVE'1:12- r-- :a {. GU1'fEr,FASCIA---f_r, tti \---IJaEP SUI'I'OPT 13EAM —5TUDI0 Ff;ONT WALL(B)' N:AN50M(OI'TIONAI_) ALUM.51..IfJII�IG _ ALLOWADLL LIVE LOADilnhLl= FOR 1.1 F-f. FANI_L rWIII.I '10 1=T,OK L.F55 .55'I:PP�A�t NI I J �6_4:J')rI 6P15 POOR OF,wnfDowl 0p F 15 P15F .30 3F I'SF 'E9r 15 r5r 50 1`5 PSr IIG frAPrEDGLA65-IC 31;1IC ' �'IIC SLIDING POOP ON 5-11-_I3'-PC f F4 — — 5'fU 51:C'I'ION V/I'l l I D001, I� i NOTLS I-OI; D10 CONS'f(:UCTION FLOO ? PCIIAIIrua_ I 11.WIND LOAD5=20 P5F 1D.Af36Pl VIA110115 I I r f 1 S17:UG'I-UPAL MLMUCPS$I TALI_COMI-"PISIi 6063 16 ALUMItJIJM LXI kU510N5 FI:OVIDI:D 1=01;f50 h9I'I I EXI'051JPF.A,P,,C D POOP ,': PECY./SLAP- - ---- ----_- —_ !i.DEAD LOADS=5 I'S1 Plvl DOOP L IUI LION _l 6Y CRAfI t311(1MAiJUFAC'1'UI:INCi COMPANY. 4V .4VIND04V — TYPICAL 5(UD10 5rCTION 6.DODP,AND WIND01^/LOCA'I'IOtJS \ +nirrurr i r L ALLOWADLF h0AlJ5 AP.E BASED UI'04J" 4/M=WINDOW Iv1UL1_IOIJ t�tv NOf FO:5M-E -THE C65 '&OF THE ULTIMATE).OAP/2.5 AVE IN1 EPGI IAIIC�I:A6l.E• U U'CI I `NNEI_ OP T'I IU'.LQAD AT 5PAN/120. '%.GLASS KNEE WAI_L5 APE I-IC=1,1011E'fC01vIB PANELS ON IPAC OF ------ -- —— I-IC/EP5 REFEKS TO CRAP(-BIL'1'S'II:UC'rI11:A1_ IN]EPCHANGEADLE WITH I'ANEL5. EP5=POLY5'fYPENE PAfdELS I'ANFL5 WITH ALUMINUM 5KIN5 BONDED-f0 5.WIDTH 01'13-VJAI_I.MAY VAPY I'L•f: H='fI-ERE IALLY",Or.1.F•I / , �� " n 1IONEYCOMBMOLYSfYRIi.NE COf,E5(3',qa%z" POOP/WINDOW LAYOUT UPTO 2�4f f. ALI1M 115'fIPFI:IdEI: "'''/ %IC \ 5t 10-0 x10-2 AND 6"7111CKNI:SSES.). a 9.AIJTI IODIZED FOR BETFERLIVING 0/1-1=OVr_PHANG 1I I t s j` ��.!c � --_ STUDIO EN( L05lll'C P5F=POUNDS/5Q.F00F ( AP,JACENI'FANI:LSAPI=CONNLfTLUU5ING DEALEP.LI�EOIdI-Y• g\ + �IJI J I)fAV�+{�ctfulQe';;,` PavGrlo.: GI_NL-SAL LAYOUT F=FAI,IEL VINYL GLL'A'I'Pi OP I Is. Ff=FEET' )'�f�'" t°f CALL upl ++tut. rnu0 iOxlO.chvg _ ALUM =ALUMINUM 5 :1"=50" PATE:11/27/2000 a J s.~ �UsI IT Z• L.•_�+'�...' =`fax�' _'i:i� �L.:i;��:- '��i I _ r-• �_�_-__�..,.,-j. - �-c�Z.._ . �._� �.�i.,l_.cti j_l_.,^j.`y�.La' 7 '.._..... :v y'.�1.._�. �til�.._._.�'�:� ... r T 'T �i f} `r. 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Cllf%j �VV4i il'✓ T�.�.'-_,1-_ -i __ T-_ j r'-+_1,111 Vt.�____7_ .. �11 C1 C�V il^_Ill -- c . _ t i i L rJi'iJTJNC �I�':�J,•._"'1 .'_iJ(J1; -(J`',`t _�=1i.�: O - - 1 7.0• '!: ilri ; - ,;1r,^r• 10 1': __ ='_S SL t JJt i 1cL1O !s :0 cl .hl!S _._ii 1 :'it`: ;ii1 '.i'_ I :]_-�J� t_�OyrICJ _�?` --^�, •�^'. ''�;� c;?� ij �� �i,' -?$ G:t. .;i • i oa •Msxt, 100 O is S_= M•p>.oae(S�s)393-040"0•?ax(508) G3A visius wrw.:7cr0s._om dirt ,!TV P,0S nit ;!(' �o 'l/J.•9�7d91.fi�.7.f/J✓.z��i oO /t'�✓ite�?.�u�sf✓� r.. BOARD OF BUILDING REGULATIONS License: CONSTRUCTIONSUPERVISOR Number CS. 070998 B i rthdate'.`.`0212011,967 Exp 02;20/2003 Tr.no: 7227 Restricted To:',,1.6}. ,.. ANDREW T MALONE:.' �. 41 WASHINGTON ST ,•2 NATICK, MA 01760 Adrninistr for TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION (Ma (Parcels OG.; Permit# �� 7 11 'CHealth Division 9� '9*9/e'A _�' � �` '�!'' Date Issued Conservation Division Fee Tax Collector Trea�s�u-r�er� SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENWONMENT'AL C-D- ,,11-NID Historic-OKH Preservation/Hyannis Project Street Address �� 2- Village C %Gl//�L PI'l Owner )(,Ve l * - Address Telephone 5-Odl Permit Request f' l / ©r— L- L 6e�.J_CZCIOX;7� J Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Estimated Project Cost ����- Zoning District Flood Plain Groundwater Overlay Construction Type i.A.,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 Z3,No On Old King's Highway: ❑Yes 01Pk Basement Type: -5-Eull ❑Crawl ❑Walkout ❑Other' Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 570 Number of Baths: Full:existing new Half: existing new Number of Bedrooms: existing 3 new Total Room Count(not including baths):existing new_ First Floor Room Count Heat Type and Fuel: -Z: Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes d:51No Fireplaces: Existing New ^ Existing wood/coal stove: ❑Yes No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage,7�isting anew size - hed:❑existing ❑new sized Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes -11_No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name. Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTIO t`4RIa- RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU� DATE _ D FOR OFFICIAL USE ONLY { PERMIT NO. t t • DATE ISSUED : MAP/PARCEL NO. ADDRESS VILLAGE OWNER r r DATE OF INSPECTION: FOUNDATION FRAME t INSULATION r , FIREPLACE •° - ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH-) L FINAL i GAS: ROUGH ' 7 ' • FINAL FINAL BUILDING y F DATE CLOSED OUT ASSOCIATION PLAN NO. t f F1HE The Town of Barnstable y y * BMWSTABLE, 9�A 16.39. $ Department of Health Safety and Environmental Services tFD MA'S A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner May 3, 2000 Ms. Karen Adler 26 Helmsman Dr. Centerville,MA 02632 Dear Ms. Adler: Your request for a building permit has been approved with the following conditions completed prior to construction: 1) Remove all work that has been done in the basement without the benefit of permits. 2) Have the building, plumbing and electric inspectors verify that this has been done. Thank you for your cooperation in this matter. Sincerely, Al ed E. artin Local Inspector am/aw _.......... --- - IG r cT I � Vzory f r f The Town of Barnstable HKE Department of Health Safety and Environmental Services Building Division BAMSTABM ' 367 Main Street,Hyannis MA 02601 MASS. 9� 1639. AtFpMA�a Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: 51 0 JOB LOCATION: owl(/ A604 Rug !I/l° 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,provide d 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' eowner"certifies that he/she understands the Town of Barnstable Building rocedures an e uirements and that he/she will comply with said Department utn' q p y pro equirem a re of Homeown Ap roval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing.Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN /P F THE . The Town. of Barnstable �STAS ' g Department of Health Safety and Environmental Services 9 ias9• .0 ,59 s Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Building Commissio Fax: 508-790-6230 ;:e- Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW. SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion. ion of an addition to any pre-existing owner-occupied improvement,removal,demolition,or construct building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Estimated Cost /�/� Type of Work: Address of`York: 2-C Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under S1,000 []Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING W ORK DO NOT HAVE TERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER , AL S O Z' I hereb p for a permit as e�ent o the er: Date Con or Name Registration No. OR e Owner's Name q:forms:Affidav . I zy The Commonwealth of Massachusetts -=_ - Department of Industrial Accidents Of/fCC 0f/ffYe5I%9811OOS - 600 Washington Street Boston,Mass. 02111 Workers Com ensation Insurance davitM . name J; � 14 �4— locatton � f �6eSAfl/ ` city `- hone# Jt� � 2 ��� I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one workingin aav ate► %%I am an %%/%/G%/%%%%%%%%%/�%%/%�%/�/%%%/%/%�%%%%/%//, employer mvidin workers' compensation for my employees working on this job.: coin nnv name. - ::::::5...:, ,. ............... ... _ address:::..'. :. :..::.::.;;:•.:.:..::...:;;.>:..;..:.:... ::. cltw': .. _ ...:.:. ;::.. - hone insurance co - 7 /////////% / / circle one and have hired the contractors listed below who I am a sole proprietor, general contractor,o omeown ( ' ) have the folio ng.w...o.:rk:.e.r.::s:':.. ... :: . ::.::................. .:;co pensation olices:wi : COn1D a n vn ante ' .`_ on sh: °i"i: ess addr ...::........ .. .... ...........: .............:.. ...................... ':�'>:'>:::: ;:.>:<� .:::•.:::>< :..::�:;:+�::..::..:>:�. .::.:•:.::<;:;:::�:;.::.::..:: �:• .:::.:..:.::::.::.......... he# ... � :....:............ >.:. .. .::..: ....:: . ..... //, ca a -------------- nv>name: .. address: :.... city _. Faffnre to secure coverage a'required raider Section 25A of MGL 1S2 can lead to the impositlon of crunni l penalties of a fine nP to S 1,500.00 and/or one years'impri+onment as weII a,civil penaltld in the form of a STOP WORK ORDER and a eae of$100.00 a.day against me. I understand that a copy of this statement may be forwarded to the OIDce of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature Date _ Print name Phone# ofgclal use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office []Health Department contact person: phone#; - ❑Other. (rmsed 9/95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to Provide workers' compensation for their employees. As quoted from the"law an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. . association, corporation or other legal entity, or any two or more of An employer is defined as an individual,partnership, the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of . another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance 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,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until this have been resented to the contracting � of chapter p acceptable evidence of compl iance with the requirements authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is ons being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers compensation policy,Please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legrbly. 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 peimit&ense number which wr71 be used as a reference number. The affidavits may be re rived to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would h-ke to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a calla The Department's address,telephone and fax number.. The Commonwealth Of Massachusetts Department of Industrial Accidents oftice 01 Imnast1gadons 600 Washington Street Boston,Ma 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 790 CM Appnd ,J • Table JS=b(eoadaaed) ' Preeripti►e Paeiraw for One sad Two-FausW ReideatW Baildiap Heated witb Fossil Fuels MAXIMUM MINIMUM Glazing Glazing Ceiling Well Floor Baste Slab Hating/Cooling t EIHci=-' Area!('K) U-vshd R411 d R-value' R-vald WAH Pe:aaeta F�iPmm Rrvalue' R value' Package 9701 to 6500 Heating Degree Dsve 12% 0.40 38 13 19 10 6 Normal Q Normal R 12%. 032 30 19 19 10 6 S 12%. OJO 38 13 19' 10 6 8S AFUE 15% 036 38 13 25 Normal N/A N/A U IS9i 0.46 38 19 19 10 6 Normal v 1S•/. 0.44 38 13 25 N/A N/A 85 AFUE w 1SY. 0M 30 19 19 10 6 85 AFUE X 12% 032 38 13 25 N/A N/A Normal Y 18% 0.42 38 19 25. 1 N/A N/A Normal Z 18•/0 0.42 38 13 19 10 6 90 AFUE AA 18•/. . OSO 30 19 19 10 6 90 AFUE I. ADDRES S OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE.OF ALL GLAZING: -0 © S 4. %GLAZING AREA(#3.DIVIDED BY#2): /O 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. i. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a C ' L 780 CMR Appendix J Footnotes to Table J$2.Ib: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 f of decorative glass may be excluded from a building design with 300 fl of glazing area. 'After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without'compression, R 30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof •Wall R.values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding,structural sheathing, and interior drywall.For example,an R 19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. Tl:e entire opaque portion of any individual basement wall with an average depth less than 50%below grade must mezt the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement d-scribed in Note b. The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3,4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment,the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J52.1 a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 035. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall,floor,-basement wall,slab-edge,or crawl space wall component includes two or more areas,with different insulation levels,the component complies if the x=-weighted average R-value is greater.than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted avenge U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 i- ,�• TOWN OF BARNSTABLE Permit No. _ __ r ________________ { 1LUSTllL Building Inspector cash � Yl ' OYRT \ OCCUPANCY PERMIT Bond Issued to .;uTes K. :ITdtll Address Wiring Inspector el Inspection date Plumbing Inspector _ -�' {• .! Inspection date Gas Inspector 4 4--jZ,4L Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. 19 Building Inspector FROM TOWN QP BARNSTABL E Mr. Francis Zahteine . ���.� � �� BUILDING DEPARTMENT Tawn, Clerk 367 MAIN STREET HYANNIS, k4A 026M Phone: 775-1120 E� I ma's SUBJECT: FOLD HERE o j DATE .. March 15 MESSAGE 1985 ��;•..��.,.�.5,.,•w�w , Work has been coupleted mler Pe7m t,#27455 a (?amp K. Smith),._' Y, Please release-Bond y J SIGNED _ 'DATE REPLY ' f •_ - SIGNED _ N87;RMI - - - RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY ' - - PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. Assessor's map and-lot number ..... THE ...:../9.1�r Sewage' Permit number ......:.. dJ.',�?'4 .............................. CEP SAVs��,�4,7�qR9s L Ns �. 4 �tW 2� � ��HGuse number .. ............... .. ..'.. ..... .. aaNaAs8T6039 n LE. 1 1 II �F0 NO d. -'TOWN 'TO WN OF BAR N�ST AB L E BUILDIXG 11SPECTOR APPLICATION FOR PERMIT TO .......... .GR1kStr.,AQt..Ng11.iRg............................................................... .. TYPE OF CONSTRUCTION ..... :... :Woad..I rame..:............ ........ ..... ..January..l•.6......................A.A.m.. TO THE INSPECTOR OF BUILDINGS: , The undersigned hereby applies for a permit according to the following information: Location Lot #26:Helmsman Drive,. Centerville .. ........ ... ................................................... ProposedUse ....Single Family...... ... ............ .................................................... .............................. ............. Zoning District t. .............................:...:.............................:.......Fire` Districf ............��At� �I7 ��.:QSt�ZY�.�ae................. Name of Owner. James K. Smith ....Address .....:....... 13aJ. atab e............................................ Name of Builder Ja111es K. Smith..............`........................Address Ba table............................. ............... ........... ............... Name of Architect ...............................:..........................:.....:.Address ...:..........................................: ` ive ` Number of Room ......F................:...................::...............,......Foundation ............PQL1xed.�CUlGx�tC................................. Exierior ........Clapboard ......................................Roofing:..................Asphalt..Shing.les.......................... Hardwood ' Floors dwood .........................:...............................~............Interior ..................Drywall.....................: Heating ...... ..................................................Plumbing ................2..Baths.........................:......................... Fireplace ......Q11@......................................................................Approximate. Cost ........,$:S.SrOD.Q.•00........................ ....... 1,3g Definitive Plan Approved'by Planning Board -----------------------__---------10----- Area .......................................... Diagram of Lot and Building with Dimensions Fee . SUBJECT TO APPROVAL OF BOARD OF HEALTHD r 36x26 16 x 24 Garage 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 .... C. .��.. ......... .. ...... v ... . �A l� Constru ti n Supervisor's License ..........`......�............. �. SMITH, JAMES K. � No 2.7.45.. ... Permit for One Story...............` Single Family.Dwelling...................... Location .. t..2.6......2.6..Helmam3n..Drive.... . ................. .............: y ................ Owner ..tilxM.9..K.. .SRtith............. ' Type of Construction ` XP .Zrams..................... .... • {. 5 . .. Plot .............. Lot ........................ January 21, 85 ; Permit Granted 19 s_. a Date of Inspection ....................................19 .:•. Date Compl�teo/. `.. ........19 r� pEsi��v oA 7-Q i s/�/6LE FA�1/L Y 3 BEO.eoONf �,, 31 'Jce.j5 /%toP JVO GQieB,.4GE G�/iC/OE.2 rNI p,r A¢tA . OA/L Y AX-o w - 3 I SEA/c 7A,V,s� O/S.42S,4L �/T�--USE /400 6',rJL• . r. .y�• �> '•�.3$ Z-f 1'2.3y 2& Z95 3.F_ BoTTa�yA.eF.d - So -5.1-= T-oT,4.L �.4/LrFLoW= .334 G•.�o. \��tl �� � pEs/G•s/ �E.P�oL4T/��V.2<JT�'/"/�/2.y/N. G��LE� \ / -� _- -. . 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