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0630 MARINER CIRCLE - Amnesty
�o3D M421-f-�e� C;�,-�to 1 1 1 i ' I t -3a� Town of Barnstable *Permit# �0 Regulatory Services fEeees 6monthsfrom issue date n lABNSfABI.E V Richard V.Scali,Director 1639. Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address ' 3p cs,mc t Residential Value of Work$_; ,000 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address GEC, t-Tv P, (mac,N ca I r j iz?)Q r"r-c C ( r,r L Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor 91 am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) 9 Re-side [Replacement Windows/doors/sliders.U-Value 430 (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: QAWPFILESTORNIMbuilding permit forms\EXPRESS.doc 06/20/16 17m Cor> momveakh of Ma mdrusetts Depwhxent efrut ia&ial Accidents l?ffice of 1Mzesdgdrtrcrrrs. 600 Washington Street -- Boston,41A 02111 Warkere Campensafion Inm=ce Afdawt:Budders/Cantracturs I cmnstPhunbers AppUcant Infmrmatian Please Print Add>ess. 630 /tea(-0r\cd c cCt Citylsta ram —eo f rA r' �l a 02635 Phone a8 7 G- is 3 Are You an eurployer?.Checkthe appropriate bor: genera Type of gralect(required):I.Elrt I a a employes with El am a t �etal contractor arc€I 6. ❑New rtim employ(full andlor part-time).* have hired1he sub-cofactors f 2.❑ I am a sale proprietor orpartaer- fisted onthe attached sheet. .I- LV] ode . sip and have no employees These smb-contractors have & ❑Demolition working fmmain any capacity. employ and have workers' fNo SG�s'comp.fiance Comp-i,n¢ ranrr Itquired- 9..❑�tlilC additlo72 1 5. ❑ We are a corporation and its 1OL❑Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 1L❑Flumbsng repairs or additions myself,[No workers'0DMP_ right of esempfion per M(M I?-El Roofrepairs inmzra^^eregaired_j i c.152,§I(4h aadwehaveno employees.[Nowor=s' 13-❑other cow-i„mmme,required-). 'Any app&cmSdhat chet3mbox f1 mast also Moutthe sectionbgwsl tdug&&wodces'camj)ensa �n npaHcyirnraaon. I H..marnet.Vft sub=&dds.affidavu in g atey are 8mnz in vrak snd then hire autsider.+ntxce==ast submit a nEw 2Mdzvt mdiearina sad TCant<acdaaITle cbecltthis box mast attach on additional sheet shoumag thenameof the�and state whether ornotthase entitiesbaee employees.I€thesnUtontzactarsMuevnplvyw-%dheym=stpmvidetheir Rorkea'tamp.policy number- lam au erripr flint is prouiducg�varkets'eodrrperesatian ursairarrce f br axe}s¢arpfvl�ees $etobv is flt¢prrticy�dud job rrt� informadam Insurance Company Name- Policy 441 or Self-inL Iic-t Fxpi€aEonDale: job�Adddre= �3U �Gt'� nct �c� (e- CitylStat zE P: / it 2.63� Attache a-c-opy of the workere compensationpolicf declaration page-(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A o€MGI.m IV can lead to the imposition of criminal penalties of a fine up to 1,54a DU aadlor uric=gesriutprisoumeut,as well as rii�penalties in the farm of a STOP WORK ORDERand a f-me of up to MOO a day a6-ainst the violator. Be a&ised that a copy of this statement maybe forwarded to the Of of IrrvesEcgati,ons ofthe DIA for msu=ce coverage verifrtaion- I*fwr,-Iry csrkjy undderr die pains and penalties o'.�FedW7 thatthe iuformiE arrpradridedabm a is bars and carrect Sitmait:re: v�` Date - Phone 77G " 26 Piraae�: . O, rat use ardy. Do rot rrrita in dds area to be wmpfeted by city artowrr a;0`iftlaL Chy or Town.: Permitff kense; Issuing Anfhority(carte one): L Board of Health 1 EwIffing Department 3.fityITawn.Clerk 4 Flech ical fimpectnr S.Plmmbiag Enspecior 6.Other Comtact Person Phone-it: ormation and Instructions h&msachmetts Geineaal Laws chapfr<r 152 regrares all e�loyers to provide wou�as'camPeon for their employees- p this ,an arPtayr -is service of Mothed MICIM any cotact ofhae, egress or implied,oral or veiftftu_" An mmpIvyer is 11-f-ed as"an indiyidIIal,parfnaahip,associ a ion,axpME ion or outer legal entity,or any two or more of the foregoing engaged is a Joint else,and including iiie legal represent;L&es of a deceased employer,or the receivcr or tree:of an individual,pMtneip,association or ofherlegal catty,employing employees- However the owner of a.dwelling horse havingnot more than tbree aPEdmeu is and wha re"dss therein,or the octet of the - dwelling hose of anofhm who employs pmssdms to do mainfrnan ce,caus act on or repair wmk-din such dwelling horse or on the grounds or bMZdmg appurf mzr¢thereto shall not becanse of Bach emplaym erd be deemed to be an employes." Mtn cbRptrr 152,§25C(t7 also states that"every state or local licensing agency shall wrEhhold$ire issuance err renewal of a license or permit to operate a business or to construct bmZdings in the commonwealth for any applicantw•ho has notproduced acceptable evidence of compliance witty the ffism-ance covexage ram -" Additionally,MGL chapter 152,§25CM states-Neacrfhe cnmmqmwcal&nor.a'ny ofitspoIiiical subdivisions shall enfr-s into any contract for the penance of Hr,work u cbl acceptable evidence of compliance vith the ins-�co•- reqm-emets of this chapter have been presented to the CUnf ram, Suhozcty." APPlica 13 Please fDl out the wort =,compensation affidavit completely,by duecldag sb a boxes 1hat apply to your situation and,if necessary,supply sob-mn{r or(s)name(s), addresses)and Phone mmmbea(s) along with their=ifrca±e(s) of imsmance. LimitedLiabz7ity Companies(LLC)or LimitedLiability'Partnembups(LLP)withno employees other f-umthe members or pars,are not rbgaked to cagy woii m-e compensafion jus Trace- If an LLC or LLP does have employees,a policy is requited. Be advise-dfiivatthis affidayitmaybe submitted to the Department of IndUstial Accidents for confsmation of fin=�.ce covesage Also Be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for file pewit or license is being regnesbA not the Department of h2da ftial Accide s. Shauldyou bane any questions regarding the law or ifyon are requited to obtain a wormers' compensation-policy,please call file Dep arum eat at the nummbea listed below. r Self-fim ed companies shouId en their self fi s ance license number am�the appropriate line. City or Town Officials f - Plmse be sure that the affidavit is complete and prh:fed.IegibIy. The Departmenthas provided a space at the boft0i of the affidavit for you to fill out in.the event the Office ofluvesiigations has to contact you rcgauffmg the applicant: Please:be sure to fill in the pen It t cense nwnber which will be used as a referc ce number. Im-addidon,an applicant that must submit n VUYTle pellicense apphtations m any given year,need-only submit ant affidavit mclicaimg con ent policy information(if neczssy)and under`Job Site Address"the applicant should write"all locations nr (city or_ town)-"A copy of the-affidav-kthat has been officially stamped or maimed by&c,city cr town maybe provided te the . applicant as proof that a valid affidavit is on file for fatale permits or licenses A new affidavitmust be idled oil each year.Where a home owner or citizen is obtaining a license or pe=it not related to any business or commercial vmff=m (i-e. a dog license or peurit to bum Ic;aves eta.)said person is NOT regr�$d in complete this affidavit The Of of Inv�ems would Ece to thank you is advance for your cooperation and shouTld you have any questions, please do not hest33to to give us a caI L The Departments atidrsss,telephone and fax number: Dent cif�AGcidentl Ted..*617' -4- Mxt 406 Or 1-977 1& SSAFR Fax It f 1'-727 774 Revised 4-24-07 - ��d t �"E Town of Barnstable Regulatory Services ` MAM Richard V.Scan,Director 1"9. � Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my beh4 in all matters relative to work authorized by this building permit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature-of Owner Signature of Applicant Print Name Print Name Date QTORMS:OWNERPERMSSIONPOOLS I Town of Barnstable r Regulatory Services ATM Richard V.Scali,Director Building Division `* sARIsrAEM Paul Roma,Building Commissioner &639. ��� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION r � ��'� Please Print DATE: JOB LOCATION: 1 13 O _,M ok Q c pd\cr L 1 arc l L Xiq-7or,er street village "HOMEOWNER": LSO a) [-7 7 G--l 5 3G Sin e__ name home phone# work phone# CURRENT MAILING ADDRESS: G?b /M CA` t-t IBC f C. 1� (C city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures d requirements and that he/she will comply with said procedures and requirements. Sign a of Hom er Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall-act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rides&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 personas it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities, many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 Town of Barnstable Building T [ Card.So That[t[s.U[s[ble-From the:Street �A�rtroved Plans Must be Retalned,o`n JobBand!th[s Card Must be,Ke,t ` pp¢ fi' p • M Posted Until,Final=inspection Has Been Made ; f .. Ham' e st�*ocr° Where a Cert[ficate�afOccupancy[s Req ed,such Buitd[ng shall Not be Occup[ed unttl a Final Inspect[onEhas�been�made Permit No. B-18-1646 Applicant Name: JE Olson Carpentry LLC Approvals Date Issued: 05/23/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/23/2018 Foundation: Location: 630 MARINER CIRCLE,COTUIT Map/Lot 023-057 Zoning District: RF Sheathing: Owner on Record: LINCOLN, PETA-JON Contractor.Name JE Olson Carpentry LLC Framing: 1 z Address: 630 MARINER CIRK Contiactor License �186368 2 : .. COTUIT, MA 02635 Est 4 Project Cost: $960.00 Chimney: x y: Description: re-side Perm[t;Fee: $35.00 Insulation: Project Review Req: Fee Paid;- $35.00 Date 5/23/2018 Final: E Plumbing/Gas �" � - Rough Plumbing: ,Building Official Final Plumbing: "04 11, This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within siz moon hs after issuance. Rough Gas: All work authorized by this permit shall conform to the approved applicat onand the`approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws ,d codes. Final Gas: This permit shall be displayed in'a location clearly visible from access street or road and shall be maintained open for public nspectian for the entire duration of the work until the completion of the same. Electrical aWA � r The Certificate of Occupancy will not be issued until all applicable signat�urresby the Building and Fir�e�Officials are prvided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:. 1 1.Foundation or Footing , , ', Rough: 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable Building PostThis Laid So That rtas Uisib,le From;the 5tceet ;A `` royed;'Plans?Must=be Retained onxJob;and;th�sCard Must be Ke t s Permit Where a'Certificate;of OCcw anc, ;is'Re,wired;such Bu�ldm shall Not be,Occu ied un`tilsa.Final ins ection has been made u: Permit No. B-18-1646 Applicant Name: JE Olson Carpentry LLC Approvals Date Issued: 05/23/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/23/2018 Foundation: Location: 630 MARINER CIRCLE,COTUIT Map/Lot 023-057 Zoning District: RF Sheathing: Owner on Record: LINCOLN,PETA-JON Contractor Nameo� JE Olson Carpentry LLC Framing: 1 Address: 630 MARINER CIR Contractor License 186368 2 r � COTUIT, MA 02635 �� � ��Est Project Cost: $960.00 Chimney: Description: re-side s Permit fee: $35.00 Insulation: Project Review Req: s Fee Paid $35.00 ' Date 5/23/2018 Final: i 3 _ Plumbing/Gas Rough Plumbing: rF X 77 ;�•/` fin'" y % r F � r Building Official Final Plumbing: 41 This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within six months;after issuance. Rough Gas: It All work authorized by this permit shall conform to the approved application and the`approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structuresshall be incompliance with the local zonmgby laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street o oadkand shall be maintained open fore b6c inspection for the entire duration of the work until the completion of the same. - Electrical 77 � . The Certificate of Occupancy will not be issued until all applicable signateres by the Building and File Officials are provided on ih permit. Service: Minimum of Five Call Inspections Required for All Construction Work: _ 1.Foundation or FootingA ru �� Rough: 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �- 1.8..1.E �S- ..................... Application number. ........ ••Date Issued......... ..1. a .. WOW MAY232�1 Building Inspectors Initials... ....... .....:................... � I ABLE U1�I�g1� �HtiIV� Map/Parcel..........U�..... ........ ................ TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY JNFORMATION Address of Project: (�3 b I r� �-� C F rG I-e- NUMBER STREET VILLAGE Owner's Name: ) C,'� o �� Phone Numb �3.6 Email Address: Cell Phone Number Project cost$ 6 Check one Residential '� Commercial OWNER'S AUTHORIZATION As owner of the above property I h y authorize n o to make application uildin e t in accordance with 780 CMR Owner Signature: Date: S' 1 TYPE OF WORK Siding ❑ Windows(no header change)# ❑ Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable) # Kb 3 L 8 (attach copy) Construction Supervisor's License# C S 0 (attach copy) Email of Contractor D15e)v� a r M+r - Op��Phone number 2-1 �S 2-� ALL PROPERTIES THAT HAVE STRUCTURES OV 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN ---A RAN ./.C•f/ 0141 ADODMIA► RIPIMPF a PFRM►T CAN BE ISSUED. APPLICATION NUMBER............................................................ , *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X - Additional tent,dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4;30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit app acations are subject to a building official's approval prior to issuance. 1 . v� �e [porrvr�umuleal�a��f eeo�uaelza Office of Consumer Affairs&Business Regulation _ HOME IMPROVEMENT CONTRACTOR TYP LLC Registra&onNExpiration 18668� 11/01/2018 JE OLSON CARR JOHN OLSON 4 JUNE LANE 1 E.SANDWICH,MA 025 Undersecretary' Massachuseft� of De•artm,ent of Public Safety...;" � p y. 'Board of-Building Regulations and Standards;` License: CS-109725 Construction Supervisor r y, *3`p JOHN OLSON 6 WILLLOW STREET,s ` SANDWICH MA 02.1 r2 nn II ` ... Expiration: -} Commissioner 06/31/2019 u I v/ee ipont�narxuseolC�c a�C�ac�ucer,CLo Office of Consumer Affairs&Business Re uI !Ion__ i I HOME IMPROVEMENT CONTRACTOR — TT��PE:LLC Registrafion Expiration 11/01/2018 JE OLSON CARF2E JOHN OLSON ? q r 4 JUNE LANE `°,,, ,e'� I' E.SANDWICH,MA 0253° Undersecretary-L- MassachUsetbi Department of Public Safety ! Bcard of Building Regulations and Standards License: CS-109725 'S1 Construction Supervisor v JOHN OLSON `kt 6 WILLLOW STREET SANDWICH MA 02563, 01 Expiration: v Commissioner 019 ;. 05/3112, The Commonwealth of Massachuseft Department of IndustrialAecidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia 'Workers' Compensation Insurance Affidavit:Builders/Contractors/El Plei se P�twnb b Apphcant Information Name(Business/Orgmizatl on/Individual): C ��� ���► (a-2�n �1 (—L �-- Address: �- City/State/Zip: S� `Ch a Zs3�' Phone#: �` 1 Z Are.yon an employer?Check the appropriate box: Type of project(required): 4. ❑I am a general oontraetor and I 6. ❑New construction 1.�I am.a employer with�_ have hired the sub-contractors employees(full part-time).* listed on the attached sheet. 7• Remodeling 2.❑ I am a sole proprietor or partner- These sub-,out notors have . g, ❑Demolition ship and have no employees employees and have workers' 9 ❑Building addition working for mein any capacity. comp.insures ce# o workers'comp•insurance 10.❑Electrical repairs or additions [N 5. ❑ We are a corporation and its required.] officers have exercised their 11.❑Plumbing repairs or additions 3.El am a homeowner doing all work right of exemption per MGL 12,❑goof repairs myself[No workers'comp. c.152,§1(4),andwe have no 13 Other insurance required]t employees.[No workers' COMP.insurance required-] * licant that checks box#1 must also fill out the section below showing their workers'compensation policy in'°'�'aPP are doing all work and then hire outside eontmetors must submit anew off davit indicating such. t Homeowners who submit this affidavit in they g the name jContractors that check this box must attached an addrho pro�de their workers,°comp policy nnumber�d �or not those entities have employees. If the sub-cont�rs have employees.they �'ob site 1 am an employer that is pr oviding workers'compensation insurance for my employees. Below is the policy J information. Insurance Company Name: I- Expiation Date• 2- Policy#or Self-ins.Lie.#: ^ ' ' ," ' ' --��g�� Job Site Address: ,3 b m o,,T 6"` G � City/State/Zip: compensation policy declaration page(showing the Policy number and expiration date). Attach a copy of the workers' comp P y enalties of a Failure to secure coverage as required under Section 25A of MOL c.152 can lead to the imposition.of criminal p fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be,forwarded to the Office of Investigations of the DIA for insurance coverage verit3cation. I do hereby certify u er thepains andpenalties ofperjury dud the info rmation p rovided above is true and correct Date:L5� 6 23 I Signature: Phone#: �- E[6.Other only. Do not write in this area,to be completed by city or town official, - - Permit(License# Town: hority(circle one): ector 5.Plumbing Inspector Health 2.Budding Department 3.City/Town Clerk 4.Electrical Insp Phone#: son: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person id the service of another under any contract of hire, express or impIied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartment and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate_a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage'required." Additionally,MGL chapter 152,§25C( )states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers'compensation insurance. If an LLC or LLP does have employees;a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also-be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided,to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i,e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The CQMMC nwealth of Massachusetts DOPartment of Industrial Accidents fie of luvesugations 600 Washington St>E'eet Boston,MA 002111 Tel. 617-727-4404 ext 406 or 1- MASSAFE Revised 4-24-07 Fax#617 727-774.9 WWw.mass,90VIdla ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDnmrY, A0 01l05/2018 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 endomement(s). PRODUCER CONTACT NAME: Lois Ferreira PAUL PETERS AGENCY INC P"�"o (508)548-2500 aC No): E-MAIL i los aul etersa enc ADDRESS: @P P 9 Y•com 6 FALMOUTH HEIGHTS RD INSURERS AFFORDING COVERAGE NAICn FALMOUTH MA 02541 INSURER A: LIBERTY MUTUAL FIRE INS CO 23035 INSURED INSURER B: JE OLSON CARPENTRY LLC INSURERC: INSURER 0. PO BOX 1792 INSURER E: SANDWICH MA 02563 INSURERF: COVERAGES CERTIFICATE NUMBER: 227200 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDDY EFF MPOMIDD YY LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DA AGE TO RENTED CLAIMS-MADE1-1 OCCUR PREMISES Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑jEa LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Me accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS er accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION X I PER STATUTETH ER AND EMPLOYERS'LIABILITY YIN A OFCEOPRIETOR/PARTNERfEXR/MEMBEREXCLU ED4ECUTIVE NIA NIA WA WC231S613735017 08/27/2017 0$/27/201$ E.L EACH ACCIDENT $ 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govAwd/workers-compensabon/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Sandwich MA 02563 Daniel M.CrcWLay,CPCU,Vice President—Residual Market—WCRIBMA 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Town of Barnstable Building Post This Card So3That it's<V�sible From the Street 3,A rouetl,Plans.Must-be-RetaMned,on;,J.ob"and; h,is CardM.ust be l<e t , SARYNSUBM Where a�,Certificate,of Oecw anc ��s Re uresuch Buil„tlm shall Not--=be Occu iedauntd.a Final;Ins ection has been made Permit a .,�.�w,,,�u„M.. , � ,•r, a �pM ,.y�.�. ,n.q,. .,,, . :: g,:�r:9.��.. ,:.,; .... �. : ;,�p. ....,,�,� „ ��� �. �..... �.t,..n ...;...� �.,:..� �;�... Permit No. B-18-1246 Applicant Name: JE Olson Carpentry LLC Approvals Date Issued: 05/18/2018 Current Use: Structure Permit Type: Building-Deck Expiration Date: 11/18/2018 Foundation: Location: 630 MARINER CIRCLE,COTUIT Map/Lot: 023 057 Zoning District: RF Sheathing: Owner on Record: LINCOLN PETA-JON F Contractbr Name• JE Olson Carpentry LLC Framing: 1 iContractortLicense 1°86368 Address: 630 MARINER CIR 2 COTUIT, MA 02635 x 4 Est Project Cost: $ 15,300.00 Chimney: Description: Remove existing 20x12 deck Build new deck 27>x14 w/4x4"stair Permit Fee: $ 110.00 Insulation: platform Fee,Paid€ $ 110.00 Project Review Req: Note: Ledger must be flashed properly ` Date 5/18/2018 Final: Plumbing/Gas ft Rough Plumbing: BuildingOfficial Final Plumbing: This permit shall be deemed abandoned and invalid unless the work ahorized b'this permit is commenced within six monthsfafter issuance. Rough Gas: ut :x, All work authorized by this permit shall conform to the approved application and the approved construction documents;for which this permit has been granted. All construction,alterations and changes of use of any building and structures sh�allbe in compliance with the local zon�in&by taws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. s � x r_ Electrical s Service: The Certificate of Occupancy will not be issued until all applicable signatures bathe Building andFire Officials areprovided on this permit. xx- Minimum of Five Call Inspections Required for All Construction Work 1.Foundation or Footing � .', � ...,. \ Rough: 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Psior to Covering Structural Members(Frame Inspection) 6.I-nsulation Low Voltage Final: 7.l4nal Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 1 I L AgpficationNumber. ................ IC� DoterFee...... ...........RARN6TASLE, f PeimrtFee................:. .......MAM d . ...........DING Lomi, proval by...4�`�................. TOWN OF BARNSTABLEAPR 2 5 _ BUILDINCH. PERMIT-oWN OF BARD..�.. ......Parma.. .. ......... ......................................... APPLICATION Section I-- Owner's Information and Project Location w Village Project Address Owners Name P,� LA)w ••` I al Addresses owners Leg E State ;+1`'l Zip 02 E 3 S City L �In ri owners Cell# S `6 ' C ° S 3 E-mail Section 2—Use of Structure ❑ Commercial Stracture over 35,000 cubic feet Use Grroup ❑ Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3 —Type of Permit Q New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use Finish Basement ElFamily/Amnesty El Fire Ala ElDemo/(entire structure) ❑ A artment ❑ Sprinkler System Rebuild � Deck p ❑ ❑Addition Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 -Work Description ' 2 c+ c C X , c I u TacttmdatP&-2/9/2018 i Application Number.................................................... Section 5=Detail Cost of Proposed Construction kS ,3 c�•�2 Square Footage of Project 3 7 T Age of Structure Dig Safe Number Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage Smoke Detectors [] Plumbing El Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom i Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone j Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section S—Zonis Informatio n n Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? El Yes El No Last undated_2/9/201 S r � Q y i SYA >??i` t� OF17SE1 TO Ids' RIS if3�l;x=`-� H €7t14° 5; E 'C LOT T 115 �T 3 + T �o Na v )'aj �p u►JA, .gyp i to -0 l �F .O t Q N � dziCI PLAN SHOWING FOUNDATION LOCATION G O T UI T.. MASSACHUSE T T S OWNED BY: CONGTr-(X-Ti0t-S CO. 04C, SCALE 1 "- ICJ' DATE: J v L 1`38G NORMAH GROSSmAN------REG/STEREO LAND SURVEYOR I HEREBY CERTIFY THAT THIS FOUNDATION IS LOCATED ON TIHE LOT AS SHOWN AND CONFORMS TO THE TOWN OF BARNSTABLE ZONING REGULATIONS REGARDING s. SETBACKS FROM STREET LINES AND LOT LINES . GROSSMAN NORMAN GROSSMAN R.L. S. DATE 1 Department of IndusfrialAccidents Office of Investigations 600 Washington Street - Boston,MA 02111 www.mass.gov/dia - Workers' Compensation Insurance Affidavit:Binders/Contractors/Electricia- s/Plumbers Applicant Information Please PrintLevibly_ Name(Business/Organizaiian/IndividuaI): •� O�So n C Q.f iz L t—C. v Address: Lf L City/state/zip: rt�1 w,'e,i� g: o z s 3 Phone Are you an employer?Check the appropriate bow Type of projecE(required): 1.❑ I am a employer whh 4. ❑I am a general contractor and I 6. New aonsiructim employees(foil and/or part time).* have hired the sob-contractors 2.J� I am a sole proprietor or partner- listed on the attached sheet. 7. ❑REmodeli ag These sub-contractors have g, Demolition ship and have no employees working for me many capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insirance comp.ins�amce.$� required.] 5. [] We are a corporation and its 10.0 Electrical repairs or additions re 3.El I qu a homeowner doing all work officers have exercised their 11.[]Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.0 goofrepai s insur,�ce re ed. t c.152,§1(4),and we have no 4� ] employees.[No workers' 13.❑Other comp.T sormr-erequired.] *Auy applicant that cbxks bnx#I mast also fiil out the section below showing flmir workers'compensation policy information. l f Homeowners who submit this affidavit indicating they are doing all work and thou hire outside contractors mast submit a new affidavit indicating such. �Gontractors that check this box must attadhed an additional sheet showing the name of the sub-contractors and state Wbether or not those entities have employees. If the sub-Dontractors hate employees,they must provide their workers'camp,policy number. I am an empLayer that is providing workers'compensation insurance for my employees. Below is the policy anal job site information. Insm•ance CompaayName: LA--4!4 w '^ Policy#or Self-ins.Lic.#: 1r�e 2�i 15 t'�� S� t Expiration Date: $ )1-4 lSS Job Site Address: �3o Attach a copy of the workers'compensation policy declaration gage(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the hmposition of criminal penalties of i fine up to$1,500.00 and/or one-year hnprisoimmd,as well as civil penalties i a 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 u der the amswand penalties ofperjury that the informationprovided above is true and correct. Si �C/'W✓ \ Date: Phone# — ocial use only. Do not write in this area to be coiqleted by city or town official City or Town: Perinit/License# Issuing Authority(circle one): 1.Board of Health 2.Building D apartment 3.City/Towa Clerk 4.EIectricalInspector 5.Plunbinglnspector. 6.Other Contact Person: Phone#: TOWN OF BARNSTABLE PERMIT CHECKLIST Sign off .Ours for Health: and. Conservation are 8-9:30 &m. and 3:304:30 p.m. A complete permit applicaff'on inclades ffling all se-efians 1-13 1. NEW STRUCTURES/REMODELING/RENOVATION/ADDITIONS ❑ Site Plan showing setbacks of proposed and existing structures ❑ Commercial—One complete set of full sized plans one reduced 11"xl7" (plans may require a stamp by an architect or engineer). Residential-4 Sets of floor plans no larger than 11"x 17"smoke/co detectors marked ❑ Worker's Comp. Affidavit and policy(if required) ❑ Res Check or COM check from the 2015 International Energy Cod Council(1ECC) ❑Letter of financial Interest for new houses only(not required for rebuild after teardown) ❑Performance bond made out for$4.00/foot of road frontage(new construction only) 2. DEMOLTION OF A BUILDING (NOT PAR(TIA!) ❑ Everything above plus shut off letters from following utility companies: ❑ Gas ❑ Electrical ❑ Water ❑' Sewer(if required) 3. DECKS/PORCHES/GAZEEBOS/INSULATION/SOLAR/POOLS/SHEDS r Site Plan showing proposed location Construction plans showing framing detail(if new framing), ❑ Pools—Barrier details,pool specs (engineers design) Workman's Comp Affidavit and policy(if required) FAMILY APARTMENTS ❑ Section 1 Plus: ❑Family Apartments are subject to approval from the Building Commissioner. Agreement must be signed, notarized and recorded at the Registry of Deeds and returned to the Building Department. Massachusett- Department of p .Board of Buildingublic Safety Regulations and Standards'; License: CS-109725 Construction Supervisor JOHN OLSON e WILLLOW STREETt� SANDWICH MA 02563 4'�L�, n r .COm missinner Expiration: - 05/31/2019 office.of Consumer Affairs_&.Business Regulation HOME IMPROVEMENT CONTRACTOR TY,�E:LLC Aegistragc)bN Expiration 18fi36. 11/01/2018 JE OLSON CARP= ire JOHN OLSON � 4 JUNE LANE E.SANDWICH,MA 0253'7 Uhderseeretary j i f ° t k Y lb Z_ .rs . ter+ � J S Sc ®� S M +B� \ I ILL �kP O y� 3 ! s � � S 0 S � k Lt _ u 1 1� a► Application Number........................................... L'. a Section 9—,Construction Supervisor Name g��h-� 5 a & Telephone Number :1 Address City 6. swncf.ua l c Iti State ma- _Zip o 0-5'3- License Number(5 Lp q 4 2�5 License Type Qi eKS Fr,'c F� Expiration Date S 131 v 1 q Contractors Email 0 ISon Car en4- 2)0'J1"GK'C_-&'VX Cell# �q y-5z i-n"19 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required b 780 CMR and the the Town of Barnstable.Attach a copy of your license. . Signature Dateql z S1 1 6 Section-10—Home Improvement Contractor Name J'.Ln (So Telephone Number • 1:4-+4 7 5zQ Address tj J�rt (.a v� City state _Tip o2S3� Registration Number N6 b G Expiration Date III 1 12 a t lir I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and docTmmentation required y 780 CMR and the Town of Barnstable.Attach a copy of your HIC... Signature Date t 1 z S I it Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature -A. Date I Print Name �,,,� ©� 1 Telephone Numbers E-mail permit to: 01 C a r e-P_ r j p �!, r Section 12 -Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) El Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13—Owner's Authorization I as Owner of the-subject property hereby ' to act on my behalf- in all authorize matters relative to work authorized by this building permit application for: i (Address of job) date Signature of Owner i P Print Name Last undated:2/9201 S j i Town of Barnstable Regulatory Services 98 MASS e. Thomas F. Geiler, Director �AtEDMp2lA1� Building Division Thomas Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 March 24, 2008 Peta-Jon Lincoln 630 Mariner Circle Cotuit, MA 02635 Re: Amnesty Apartment Dear Property Owner: Enclosed is the Certificate of Occupancy for your Amnesty apartment. We have prepared the Amnesty Certificate of Compliance and forwarded it to the Amnesty Program Coordinator. Sincerely, Lois Barry Division Assistant Enclosure amnco .1....,,. -µ,.:.k, f�"y,.s.., ' ." , .,..r.-Y1..: �"'"e` '�.a3"_�, ' ;.B,a:A. 'C•"'.` .�,'�w!+.cA :, .arr. -"i-`: �c�.'1•+5. c.. s P".`•.+.a" :'9:' ..Y. a' ,t;-•� m ai .,.', - v�x,,.i*- . '' :_ ... -_ -.. _,..:. 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(J�( i : -l`^ t :k 1 A I »::: F ,b Y F { T a_Fr 3/20/2008f T h h y a `Y < } a k F r tee z" Y x '' i . .w...r .;w�,:o-v....:,...,..,,,.c.,,vs...,.w�,ntw,.:,:inm o,_,'2guar:..x+,uW.vuar,awa ai��anxGnl>w,i;s;�'4ak-..ro x .,...[xm., ,x w. 1'1 .. •• ." ., .. ,_,,.,: ,r„v -,..,.. ,..,_s.,..,. ,.. ...,.,,:.,.,. ,,...,x.uo.,.... llw .>uh,clw.Ytt.aNis'uaitiPSil}•a `.yli ltil'S'2^titi� Y:!�4i1Y".&C`:i 1L�Ft,*svwc3P,n°R3S.'StiV'ik}A"�r�}l4`':.A�,•Yi Town of Barnstable Building Department - 200 Main Street ELAMST"TZ, • Hyannis, MA 02601 9 MASS (508) 862-4038 i639. �� ArE p�a Certificate of Occupancy Application Number: 200801355 CO Number: 20080052 Parcel ID: 023057 CO Issue Date: 03/20/08 Location: 630 MARINER CIRCLE Zoning Classification: RESIDENCE F DISTRICT Village: COTUIT Gen Contractor: PROPERTY OWNER Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: AMNESTY APARTMENT ISSUED TO PETA-JON LINCOLN Building Department Signature Date Signed '�tNETpy� TOWN OF BARNSTABLE Building Application Ref: 200801355 BARNSTABLE, Issue Date: 03/17/08 Permit 9 MASS. �p 1639• ,0�a Applicant: Permit Number: B 20080488 Proposed Use: SINGLE FAMILY HOME Expiration Date: 09/14/08 [Location 630 MARINER CIRCLE Zoning District RF Permit Type: AMNESTY APT NO CONSTRUCT RES Map Parcel 023057_ Permit Fee$ 25.00 Contractor PROPERTY OWNER Village COTUIT App Fee$ License Num Est Construction Cost$ 0 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND EXISTING,(STUDIO,LOWER LEVEL THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: LINCOLN, PETA-ION BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 630 MARINER CIR INSPECTION HAS BEE DE. COTUIT, MA 02635 Application Ente-ed by: LB Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET;ALLY OR SIDEWALK OR ANY.PART THEREOF,EITHER TEMPORARIL OR'PERMANENTLY. ENCROACHEMENTS ON PUBLIC PROPERTY.,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE;MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. f 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. l WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). +r kU " a„ BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health r , PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 03/13/08 TIME: 16:21 r ------------------TOTALS------------------ I PERMIT $ ,PAID 50.00 AMT TENDERED: 50.00 CHANGEPLIED: 50.00 APPLICATION NUMBER: 200801355 PAYMENT METH: CHECK PAYMENT REF: 579 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map V��j Parcel 051 Application# Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. Permit Fee C� Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis k i — 4;1-14 ej S 7' Project Street Address Village 6A l.7 Owner — 4 v1 Address Telephone Permit Request Square feet: 1 st floor:existing proposed 11A 2nd floor:existing proposed 111d Total new ` Zoning District Flood Plain Groundwater Overlay we Project Valuation Construction Type n Lot Size 0.6q Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family( Two Family ❑ Multi-Family(#units) Age of Existing Structure g g Historic House: ❑Yes o 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 i Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: Q Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing mew size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: ]� r•J 2 Zoning Board of AppeaZo orization Appeal# O zS__O 3 Recordedl� �- Commercial ❑Yes If yes, site plan review# , 3 Current Use Ja_gw a� Proposed Use BUILDER INFORMATION c Name e Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE .3 13 D FOR OFFICIAL USE ONLY Z PERMIT NO. - DATE ISSUED MAP/PARCEL NO. _ ADDRESS `> r VILLAGE' f ` OWNER - DATE OF INSPECTION: FOUNDATION t FRAME l INSULATION i I FIREPLACE ELECTRICAL: ROUGH FINAL :- i PLUMBING: ROUGH FINAL - ti GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT " ASSOCIATION PLAN NO. - - i t Town of Barnstable Zoning Board of Appeals Comprehensive Permit Decision and Notice i Appeal 2005-23 —Lincoln I Decision - Chapter 40B Comprehensive Permit i Applicant: Peta-Jon Lincoln i Property Address: 630 Mariner Circle,Cotuit MA Assessor's Map/Parcel: Map 023,Parcel 057 Zoning: Residential F Zoning District Applicants: The applicant is Peta-Jon Lincoln,who resides at 630 Mariner Circle, Cotuit MA.Mr. Lincoln was granted title to the property by deed recorded in the Barnstable Registry of Deeds on October 5, 2004 as recorded in Book 19104,Page 170. Relief Requested: The applicant has applied for a Comprehensive Permit under Chapter 40B of the General Laws of the Commonwealth of Massachusetts, and in accordance with Article 11 of Chapter Nine of Part I, General Ordinances, of the Code of the town of Barnstable,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 accessory affordable apartment unit in the basement of the principle dwelling. Locus and Background: The property at issue is a 0.59-acre lot located at 630 Mariner Circle in Cotuit. The lot was developed in 1980 with a single-family,ranch style home.The effective living area of the main residence is. 1,339 square feet.The accessory apartment is a studio unit located in the basement of the main residence. The square footage of the rental area is approximately 650 square feet. The lot is served by public water and on-site septic, and is located within a Wellhead Protection Overlay District. On January 20, 2005,the town of Bainstable's Public Health Division reviewed the septic and approved the property for a total of three(3)bedrooms,provided that the storage room or"den"in the I basement not be used as a bedroom,as there is no window for a means of egress.The property owner has agreed to maintain the basement apartment as a studio unit to comply with this condition. Procedural Summary: A site approval letter was issued for the property by Kevin Shea,Director of Community&Economic Development on January 20,2005, in accordance with MGL Chapter 40B and 760 CMR. Elizabeth Dillen, Program Coordinator, sent notice of the site approval letter to the Department of Housing and Community Development in accordance with the requirements of CMR 760. An application for a Comprehensive Permit i was then filed at the Town Clerk's Office and the Office of the Zoning Board of Appeals on January 20, 2005. A public hearing before the Zoning Board of Appeals Hearing Officer was duly advertised in the Barnstable Patriot on January 28, 2005 and February 4,2005, and notices were sent to all abutters in accordance with MGL Chapter 40B. . i On February 16,2005 Hearing Officer Gail Nightingale presided over the public hearing. The applicant, Peta-Jon Lincoln,was present at the hearing. Elizabeth Dillen,Program Coordinator of the Office of Community and Economic Development was also present. Ms.Nightingale reviewed the file with the applicant to assure compliance with all of the program requirements. i - i Findings of Fact on the Comprehensive Permit: j At the hearing on February 16; 2005 the Hearing Officer made the following findings of fact: I 1.The applicant is Peta-Jon Lincoln who resides at 630 Mariner Circle, Cotuit MA. He is requesting a Comprehensive Permit to convert an existing studio apartment in the basement of the main residence into an affordable rental unit.The conversion of the unit to an accessory affordable unit within a single- family owner-occupied residential dwelling qualifies for the"Accessory Affordable Housing Program." I 2.Peta-Jon Lincoln was granted title to the property by deed recorded in the Barnstable Registry of Deeds on October 5,2004 as recorded in Book 19104,Page 170. 3.A site approval letter was issued for the property by Kevin Shea,Director of the Office of Community &Economic Development,,on January 20,2005, in accordance with MGL Chapter 40B and 760 CMR. On that same day Elizabeth Dillen,Program Coordinator, sent notice of the site approval-letter to the j Department of Housing and.Community Development in accordance with the requirements of CMR'760. Thirty days have elapsed since the transmittal and no issues were communicated from the Department of Housing and Community Development on this particular application. 4.The proposed accessory affordable unit is approximately.650 square feet, and is located in the basement of the principle dwelling. 5.The applicant is aware that the unit must meet all applicable building codes to be occupied and that the Building Division and Fire Department will also be inspecting the unit for compliance with all applicable building and fire codes. 6. The house is served by public water and private on-site septic and is in an identified Groundwater Protection Overlay District.The proposal has been reviewed by Thomas McKean,Health Director,and he has approved the use of the existing on-site septic system,provided the total number of bedrooms on the property does not exceed three(3)and the den in the basement is not used as a bedroom. 7. On December 14, 2004 the applicant signed an Accessory Affordable Housing Program Agreement Affidavit that commits,upon the receipt of a Comprehensive Permit,to the recording at the Barnstable Registry of Deeds, a Regulatory Agreement and Declaration of Restrictive Covenants. That document includes restricting the unit in perpetuity as an affordable rental unit and requires that the dwelling be owner-occupied as his year-round residence. 8.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 30% of the monthly household 2 income of a household earning 80% of the median income,adjusted by household size. In the event that utilities are separately metered,the utility allowance established by the town of Barnstable shall be deducted from rent level so calculated. 9.According to the Massachusetts Department of Housing and Community Development, as of February 16,2005, 6.3%of the town's year round housing stock qualifies as affordable housing units. The town has not reached the statutory minimum of affordable housing under MGL Chapter 40B Section.20-23 or its implementing regulations. The Town of Barnstable's Local Comprehensive Plan encourages the use of existing housing to create affordable units and the dispersal of these units throughout the town. Finding Summary: Based upon the findings, the Hearing Officer ruled that the applicant has standing to apply for an affordable housing Comprehensive Permit under.MGL Chapter 40B and the Town of Barnstable's Accessory Apartment Program. The proposal is also 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: I Based upon the findings, a ruling was made to grant the Comprehensive Permit in accordance with MGL Chapter 40B to the applicant,Peta-Jon Lincoln. It is issued to allow for the creation of a studio affordable housing unit in accordance with the following conditions: i 1. Occupancy of the affordable unit shall not exceed one person. I 2.The property owner shall occupy the principal dwelling as his year-round residence. 3.This unit shall not be occupied by a family member of the owners. 4.The total number of bedrooms on the property shall not exceed three(3)and no future bedrooms may be added to within the unit or on the property. 5. The storage room or"den"in the accessory apartment shall not be used as a bedroom. i 6.All parking for the accessory apartment and the main dwelling shall be on-site. 7. To meet the requirements of affordability, the cost of housing(including utilities)shall not exceed 30%of 80%of the median income for a single individual for the Barnstable-Yarmouth MSA. In the event that utilities are separately metered, the utility allowance established by the town of Barnstable shall be deducted from rent level so calculated. 8.All leases shall have a minimum term of one year. 9. The applicant must apply for a building permit for the accessory unit and secure an occupancy permit and Certificate of Compliance for the unit from the Building Division. The Building Commissioner must determine that the unit conforms to the approved plans as submitted and approved and meets state building, fire and sanitary codes. The unit and dwelling shall also be inspected by the Health Division to assure compliance with applicable on-site wastewater discharge requirements. 10. The applicant may select his own tenant provided the tenant meets the requirements of the program as cited above and provided that person's income is reviewed and approved by the Office of Community 3 &Economic Development of the town of Ba rnstable a as a qualified individual. The applicant will be required to work with the town to provide in formation nformation necessaryto document that t the tenant qualifies. The unit shall be rented on an open and fair basis to an income eligible individual or family. Whenever a vacancy occurs,notice must be given to the Office of Community&Economic Development and the unit must be listed with the Town. 11. Every twelve months the applicant shall review the income eligibility of the individual occupying the unit. No later than a year from the date of issuance of this Comprehensive Permit shall the applicant file with the Office of Community&Economic Development of the town of Barnstable an annual affidavit listing the rent charged and income level of the occupant of the unit. The applicant shall provide the town any additional information it deems necessary to verify the information provided in the affidavit. Upon any report from the town that the terms and conditions of 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. 12;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 Barnstable County Registry of Deeds. If the ownership of the property is transferred,the Office of Community&Economic Development of the town of Barnstable shall be notified within 60 days the name and address of the new owner. I 13. This Comprehensive Permit must be exercised and the unit occupied within 12 months of its issuance or it shall expire. i I I i i 4 Ordered: Comprehensive Permit 2005-23 has been granted with conditions. A written copy of this decision shall be forwarded to the Zoning Board of Appeal as required by the Town of Barnstable Administrative Code Part II, Section 4.02 and Part III, Section 3.72. If after fourteen(14)'days from that transmittal the Members of the Zoning Board of Appeals takes no action to reverse the decision, this decision shall become final and a I copy shall be the filed in the office of the Town Clerk. i Appeals of the final decision, if any, shall be made to the Barnstable Superior Court pursuant to MGL Chapter 40A, Section 17,within twenty20 days after t( ) he date of the filing of Y g this decision in the office of the Town Clerk. The applicant has the right to appeal this decision as outlined in MGL Chapter 40B, Section 22. i 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 a written copy of the Comprehensive Permit decision to the Zoning Board of Appeals on February 16, 2005. Fourteen(14)days have elapsed since the transmittal to the Board, and no Board Member has taken action to reverse the decision. Ga' ightingale, aring Officer Date Signed i .I Linda Hutchenrider, Clerk of the Town of Barnstable,Barnstable County,Massachusetts,hereby certify that twenty(20)days have elapsed since the Zoning Board of Appeals filed this decision and that no appeal of the decision has been filed ir1 the office of the Town Clerk. j Signed and sealed this L� day of v ,(i�-� fi'o under the pains and pena'_ties,af perjury. i Linda Hutchenrider,Town Clerk 5 Bk 19719 ma`s 14 "E'r-24101 C14—13—'fie e5 5 1 1 = 56u REGULATORY AGREEMENT AND DECLARATION OF RESTRICTIVE COVENANTS THIS.REGULATORY��11 REEMENT.and DECLARATION OF RESTRICTIVE COVENANTS,is made this day of 2005,by and between Peta-Jon Lincoln of 630 Mariner Circle, Cotuit MA 02635 and its successors and 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 by the 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• C. The terms of this Agreement and Covenant regulate the property located at 630 Mariner Circle, Cotuit MA 02635 as further described in deed recorded herewith as Barnstable County Registry of Deeds Book 19104,Page 170. B. The Project located at 630 Mariner Circle, Cotuit MA 02635 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 comprehensive permit Appeal No. 2 005-23 and any plans submitted therewith and all applicable state, federal and municipal laws and regulations. Said permit is recorded herewith as Barnstable County Registry of Deeds Book 7 Page 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 earning at or below 80% of the area 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 the Area Median Income (AMI) of Barnstable-Yarmouth MSA and that rent (including utilities) shall not exceed an amount that is affordable to a household whose income is 80% of the median income of Barnstable- Yarmouth MSA. In the event that utilities are separately metered,a utility allowance established by the Barnstable Housing Authority shall be deducted from the rent level. 3. The Designated Affordable Unit will be retained as a permanent,year round rental dwelling unit with at least a one-year lease. 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, mortgage note,or other instrument to which the Owner is a parry 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 (AM) of Barnstable-Yarmouth Metropolitan Statistical Area(MSA) and that rent (including utilities) shall not exceed an amount that is affordable to a household whose income is 80% of the median income of Barnstable-Yarmouth MSA. In the. event that utilities are separately metered,a utility allowance established by the Barnstable Housing Authority shall be deducted from the rent. 2. The Owner shall annually deliver to the Municipality and to the Monitoring Agent,as designated by the 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 by the 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 MSA and that rent (including utilities) shall not exceed an amount that is affordable to a household whose income is 80% of the median income of Barnstable-Yarmouth MSA In the event that utilities are separately metered,a utility allowance established by the Barnstable Housing Authorityshall be deducted from the rent. 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 immediately transmit to the Municipality evidence of such recording or filing including the date and instrument, book and page or 2 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 the 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 attorneys 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 permanent 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 deed recorded herewith as Barnstable County Registry of Deeds Book 19104, Page 170 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 int.PrPst. 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 deed recorded herewith as Barnstable County Registry of Deeds Book 19104,Page 170. 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 only take 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 may be,thus rendering said Comprehensive,Permit void. Upon the 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 )(II. 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 running with the land,encumbering the Project for the term of this Agreement,and are binding upon the Owner's successors in title, (iii) 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. )(III. 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 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 mayperfect such a lien on the Project byrecording 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 any portion 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. M. 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 Iday of ,200� OWNER BY: }� 7 signardre Printed: Peta-Jon Lincoln COMMONWEALTH OF MASSACEiUSETTS County of Bamsta e,ss. On this�// ""day of 20<before me,the undersigned notary public,personally appeared the Owner(s) ,proved to me through satisfactory evidence of identification,which were �t,{ - ,to be the person(s) whose name(s) is signed on the preceding or attached document and acknowledged to be that he/she signed it voluntarily for the stated purposes. Notary Pu lic Printed: / �/ j / My Commission Expires: ELIZABETH ANN DILLEN 4 Notary Public Commonwealth of Massachusetts My Commission Expires October 27,2011 TOWN OF BARNSTABLE BY: Signature Printed:TOWN MANAGER COMMONWEALTH OF MASSACHUSETTS County of Barnstable,ss: On this 1,6Z4day of zQt2/�-- 20_c6before me,the undersigned notary public,personally appeared Soh r. C,KL;m m ,the Town Manager for the Town of Barnstable,proved tome through satisfactory evidence of identification,which were ner5lmafGu, Khyion ,to be the person whose name is signed on the preceding or attached document and acknowledged to be that he/she signed it voluntarily for the stated purposes. _ C otary Public Printed: Sh/,fee My Commission Expires: OFFICIAL SEA[ •J - SHIRLEE MAY OAK,NOTARY PUBLIC COMMONWEALTH OFMASSACHUSETTS nay c.=M E xpires 3rzan_oos 5 ;?- vim IPA I` O I a i VI f cl/ vi W O DR DATE CLASSN Z O : w REV oc 1, RAYTHEON ENGINEERING SKETCH ONLY f Barry, Lois From: Dillen, Elizabeth Sent: Thursday, March 13, 2008 10:44 AM To: Barry, Lois Subject: RE: 630 Mariner Circle Yes-amen! S„eciat Projects Coord.Inator Growth Maragewievi.t Departmce,,t Towr of Barnstable 367 rMaiN.I.Street, H_yart.nis MA Tel,508.862.4683 fnx 508.862.4782 -----Original Message----- From: Barry, Lois Sent: Thursday, March 13, 2008 10:00 AM To: Dillen, Elizabeth Subject: 630 Mariner Circle Beth, Owner has started bldg per process and will submit after BOH sign-off. When submitted, shall I sign off for you? Lois f 1 of tKWE tom, Town of Barnstable Growth Management Department rED"AP�� Accessory Affordable Apartment Program 367 Main Street, Hyannis, MA 02601 Office: 508.862.4678 Fax: 508.862.4782 1/14/08 RE: Building Permit Application & Final Inspection Dear Mr. Lincoln: Per your written request to the Zoning Board of Appeals (enclosed), you were granted a six month extension to secure an occupancy permit for your accessory affordable apartment. This extension will expire on March 25, 2008. If you do not secure an occupancy permit, the comprehensive permit will be revoked at the April hearing and you will be required to dismantle the unit and cap the utilities. To assist you with this process, I have enclosed another Town of Barnstable Building Permit application. Please contact Lois Barry in the Building Division at (508) 862-4039 to schedule an appointment. She will be happy to help you through the process. Lois is available on Mondays, Tuesdays and Wednesdays. You will be required to provide five copies of a clear floor plan for both the main house and the apartment which indicates the square footage of each room as well as the total square footage of both dwellings. Smoke and carbon monoxide detectors must also be clearly labeled on the plans. A Building Division inspector will then conduct the final inspection of your accessory unit. After the unit passes inspection a certificate of occupancy will be issued by the Building Commissioner and mailed to you. Once you have received your certificate of occupancy you may select a tenant for your accessory affordable unit. Please feel free to contact the Growth Management Office with any questions or concerns. Cc: Lois Barry, Building Division SINE Town of Barnstable BARNSTABLE, : Regulatory Services 94� ,•� Thomas F. Geiler,Director ATFO MA'S A � Building Division Tom Perry Building Commissioner 200 Main Street; Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 November 26, 2007 h Mr. Peta-Jon Lincoln C 630 Mariner Circle Cotuit, MA 02635 ` Re: Proposed Accessary Affordable Apartment Dear Mr. Lincoln: We have received the extension to March 25, 2008 of the Regulatory Agreement and Comprehensive Permit for the accessory affordable apartment at your address. As you know, a building permit is required whether the unit is new or pre-existing. We look forward to receiving your building permit application for the apartment. Please call me if you have any questions regarding the building permit process. Sincerely, Lois Barry Division Assistant ?- /,71 7119 7cc: Linda Edson Jo Ann Buntich Jamnext I Town of Barnstable Zoning Board of Appeals Gail Nightingale-Chairman �^,Fo;9.,.�0� 200 Main St-.eet,Hyannis,Massachusetts 02601 Phone(508)862-4785 Fax(508)862-4725 Growth Management Department 367 Main Street,Hyannis,MA 02601 Ruth J. Weil-Director In accordance with the attached request of Peta-Jon Lincoln, 630 Mariner Circle, Cotuit, dated September 7, 2007, regarding Comprehensive Permit Appeal # 2005-023, and upon the vote of the Zoning Board of Appeals taken at their public hearing on September 26, 2007, I hereby grant a six-month extension of this appeal. The original decision or. Appeal # 2005-023 was certified by the Barnstable Town Clerk on March 24, 2005. Mr. Lincoln did not complete the process within the required timeframe. Therefore, the extensior_ is necessary in order that Mr. Lincoln may apply for a building permit and receive an occupancy certificate for the accessory unit so that it may be rented to an income eligible tenant. Said Comprehensive Permit#2005-023 is hereby extended until March 25, 2008. Signed, G 1 C.Nightinga H ring Officer Zoning Board of Appeals Dated: Barry, Lois From: Barry, Lois Sent: Thursday, April 06, 2006 1:17 PM To: Taylor, Madeline Subject: 630 Mariner Circle, Cotuit Hi Madeline, We had a call today from an appraiser about this property. They never did pull a building permit to finalize the Amnesty process, and I see they received their approval last April. Have they heard from them? Do you know if they're moving forward? Lois 1 JUL.-14-20oz 09 %oz PM CaMMUNITY. INSPVCTOR$ ®84132®2s 1?_ ®2 Town of Barnstable OffIce of Community and Economic Development 230 South Street,My=xzis,MA 02601 $ $ Office: 862.4683 Fax: 862.4782 �! Dmal: aammedey RQwn.b�s�,meS18 TO: Tom Perry,Building Coma issio:wr 04 Lois Barry,Building Department FROM Robert Shea RE Ins efiioin att p/Pcl�,�/�l►J / , I have conducted a Howing Inspection of a dwelling owned by:-- tat tatc 2i dij --- Phone - addesss: .� Single Pu aily OR Multi P=91r- UrIt # Bedraonsa yea b'e �5 ��� Unit apacity+ # Bedrooms Unit Capacity: # Bedrooms Unit Opacity: # Bedrooms This unit wn found to be In wmpliawe with the State Sanitary Code.Pkase arrange for the BuWing Department to do its final inspection of the property in order to great a Cerdf ucate of ClompknCe for the Signed Daee �,� U ert Shea ,1 •1• :� gyp., y'�j .y''yM.eel.. i : .. ...... .. . �.!:1. RT} II DAB ii6.i11.1 B 8 W r APPIkL T iL/D ■IJE M i t ee/ f 'T'!1e following items Sneed correcting: SIGNATLU., SiF'd TSO'UN iN3Wd0-13A3T'033-W03 3-I3ylSN;tJHEI Wd22: :5@ r_i4'S T 1 n f oFtKKE r Town of Barnstable BARNSppBM : Regulatory Services 'a 9. Thomas F. Geiler,Director AjFD Aar A Building Division Tom Perry Building Commissioner 200 Main Street, Hyannis, MA 02601 Office: 508-862-.4038 Fax: 508-790-6230 April 19, 2005 Peta-Jon Lincoln 630 Mariner Circle Cotuit,MA 02635 Re: Proposed Accessory Affordable Apartment 630 Mariner Circle, Cotuit Dear Property Owner: We have received the recorded Regulatory Agreement and Comprehensive Permit for the accessory affordable apartment to be created at the above-referenced address. A building permit is required whether the unit is new or pre-existing. We look forward to receiving your building permit application for the apartment. Please call me if you have any questions regarding the building permit process. Sincerely, Lois Barry Division Assistant J040616a The Town of Barnstable • r t BASTAB� « 9� 9. ,.� Office of Community and Economic Development SEC N1A�A 230 South Street Hyannis, MA 02601 Kevin Shea Office: 508-8624678 Director Fax: 508-8624782 December 17,2004 Mr.John C. Klimm,Town Manager GaryR Brown, Town,Council President Barnstable Town Hall 367 Main Street Hyannis,MA 02601 Re: Peter Lincoln 630 Mariner Circle, Cotuit- a single-family accessory unit Ronald Tosti- 141 Highland Ave, Cotuit- a single-family accessory unit Teresa Downey- 117 Gleneagle Drive, Centerville- a single-family accessory unit Charles Hetzel- 55 Seabrook Road,Hyannis- a single-family accessory unit Gentlemen: This letter is to inform you that the Accessory Affordable Housing (Amnesty) Program has received requests for project eligibility letters under the Community Development Block Grant (CDBG) Fund and under the General Ordinances of the Town of Barnstable,Article LXV- Pre-existing & Unpermitted Dwellings and the Criteria for the Local Chapter 40B Program. The Program Coordinator is Pviewing the requests. If the Town has any comments on the projects, please forward them to me so that they can be addressed in the site approval letter. This letter gives you official notice of our receipt of the above application(s). We will issue a decision as to the acceptability of the sites and the consistency of this development within the guidelines of CDBG. Sincergly, Kevin Shea,Director Community&Economic Development cc: Town Attorney's Office Building Department Public Health Department Assessor's map and lot number ..... 'VC//'%— -7— THE Sewagg Pet number ...... 0............. ........................ SEPTIC SYSTEM M INSTALLED IN COM. ABLE, House number ......................... .Cl................................. T 0 W Tvq OF BAR MIS 11"B"I'L E BUILDING I-NSfECT0R APPLICATIONFOR PERMIT TO ........................ .................................................. ............................................ TYPE OF CONSTRUCTION ...... ... ... . ... .. ............. ...................................... ............ . .. .. ..................19...... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according tq the following information: Location ... /1,5........Oeo�. ... ...... ............................................................................................ . ................... ProposedUse ............21010�e- .........................................I....................................................................................... 0.el _7 oningDistrict .......................................................... ............Fire District .............. ......................................... —........... .... ......... ... ....Address ......................... Name of,Owner-.AA*&V—. -V.. ...../N -a-- M Name of Builders.,, ... Address ..................................................................................... ,000 ". 4 ............................ .Name of Architect ..................................................................Address ...................:................................................................. Number of Rooms V Foundation .... . .. :� ........ . . ................................ ... ...... ..... ....Exterior A.4....lia ............ ...........Roofing ........... .. .............. ...... ... ....... ...... ...................... Floors Interior . .......... . ..... .........YZ.. ..... ................... ................................... ................................................ Heating ....... ........ 1 -40......................Plumbing ........ .. . ..... Fireplace ........................... .......................................Approximate Cost ......... /................... ........I................. Definitive Plan Approved by Planning Board ------- )7A 91............... Diagram of Lot and Building with Dimensions Fe . ........................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH �� I 16 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarcling the above construction. Name ..... .. ... ... .... ............... .. ... .. ........ .. .... THEO CONSTRUCTION No ..2.2.39.4.. Permit for ..One...S.t.Qry.......... Single Family ............... uocati�n .T.Q.t... ...6.3.R...Mar.jner...Circle Cotuit - .................................................................. ......... 4 Theo Construction Owner .................................................................. Fr Type of Construction .......................................... a Frame ................................................................................ Plot ✓............................ Lot ................................ _ t _ Permit Granted Date of Inspection .:......... .......................... 19 C) 6 �<>• Date Completed .� ..�... PERMIT REFUSED ...........'" .'t............................................................ ........................................................... .......... . ....................................................... .......... ................................................. Approved ................................................ 19 ............................................................................... r ............................................................................... _'' �ffi POT N WAS[rII4T AkA3`� Fii4l4 *f*9 "RL*"T&URV>�:Y AND 19 F'OR i H.E USE O -THE "4OWM ON1q•Y.,+ i1NDER NO CIRCIJM ` Q S'TANCf.t$ ,-AR,1* OFTSET'S TO BE USED FOR PE $.WALLS, HEDZSES, L-Tc. " Ile S . N *sG Vi�• IQ o 41 Z 3! 90 I 13� PLAN! SHOWING FOvIVoA .TKO LOCATION C OT'UIT, iWASSACHUSE T r S OWNED BY: SCALE VATE: NORAIAH GROSSMAN------REGISTERED LAND SURVEYOR I HEREBY CERTIFY THAT THIS FOUNDATION IS LOCATED ,ON nHE LOT AS SHOWN AND CONFORMS TO THE TOWN • ^ OF BARNSTABLE ZONING REGULATIONS REGARDING RRw10 �`� SETBACKS FROM STREET LINES AND LOT LINES . ROSs `12715 O , J i ';i����,a.,._. _.r� .�� 7 .25'� `erg-�•. NORfJAN ltGROSSMAN R.L.S. DATE J TOWN OF BARNSTABLE Permit No. ----------_. 1 "�n.0 Building Inspector "iva Cash ------------------------ eo '639. \ °" OCCUPANCY PERMIT Bond --- —--1 ``No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Trt@O Construction CO) Address Souttl Yarr►louth . t Wiring Inspector - �_. :!� -� Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department 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. 19... _ .................................................................._._.......__................-_.._._._ Building Inspector i I