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0100 BLUEBERRY HILL ROAD - Amnesty
a xm LIU I I 4 ���`�'' _ /l�© � � '' 4 r i ��! �� �,,� I oFTHE 1p� Town of Barnstable O Inspectional Services BARNSTASMAS&M p Brian Florence,CBO A i639 �0°' Building Commissioner TfD MAt a 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us INSPECTION REPORT Address : 100 BLUEBERRY HILL ROAD, HYANNIS Case# C-19-293 Inspection Type Violation Inspector: lauzonj _._ ...�_ ....... _......_............... _..-__........ .......- -_._ _. ..-_.. ......_ _ -_ _. ....... _-- .. - -- - Description Date Unit Status Comment Violation 01/02/2020 PASS 5/2/19 SITE INSPECTION NO EVIDENCE OF BUSINESS PRESENT.YARD CLEAN FROM SCRAP METAL. _........... -- - --- _.__..._.................._........-- ._.._ _._T__._.._._-�� -------- I i ._.. .. .. _. r1 f �V 2016 S Corporation Return prepared for: RODNEY'S PROFESSIONAL SERVICES INC PO BOX 2601 Hyannis,MA 02601 BUILDING DEPT APR U 2 2019 TOW N OF WAIST ABLE KINGS TAX SERVICE 11 ENTERPRISE RD#21 HYANNIS, MA 02601 (774)470-2440 112�5 U.S. Income Tax Return for an S Corporation OMB No.1545-0123 Form ►Do not file this form unless the corporation has filed or is n 0 Department of the Treasury attaching Form 2553 to elect to be an S corporation. �L 16 Internal Revenue Service ►Information about Form 1120S and its separate instructions is at www.irs.gov/form1120s. For calendar year 2016 or tax year beginning Apr 25 2016, ending Dec 31 20 16 A S election effective date Name D Employer identification number 04/25/2016 TYPE RODNEY'S PROFESSIONAL SERVICES INC 81-2379138 B Business activity code Number,street,and room or suite no.If a P.O.box,see instructions. E Date incorporated number(see instructions) OR PO BOX 2601 04/25/2016 238320 PRINI City or town,state or province,country,and ZIP or foreign postal code F Total assets(see instructions) C Check if Sch.M-3 attached❑ Hyannis MA 02601 $ a ffmassDOT CERTIFICATE OF REGISTRATION RMV Division e e eswryeo MotoreVehkim meW" �.� ReglsVyof Metor Vehkles M.C.L.Chapter 90 Section 24B makes it a crime to alter this Certificate PLATE TYPE REGISTRATION NUMBER REGISTRATION TYPE EFFECTIVE DATE MONTH YEAR ITRANSACTIONNUMBER PAN 8VV863 PASSENGER 04/02/19 !7REGISTRAR 03 20 02909254110102 MFRS MODEL YEAR N1A10: MODEL BODY STYLE/TYPE COLOR d Without Official IF VEHICLE OTAL REGISTERED 2010 LEXS RX SEDAN RED CARRYING WEIGHT FOR A ure of Registrar PASSENGERS COMMERCIAL VEHICLE FOR HIRE OR TRAILER. VEHICLE IDENTIFICATION NUMBER INSURANCE COMPANY TIER787245 NUMB MAXIMUM NUM2T2BK1BAOAC057OF 784 COMMERCE INSURANCE //�� PASSENGERS THAT CAN BE RESIDENTIAL ADDRESS(IF DIFFERENT) /��� SEATED. 99 BLUEBERRY HILL RD HYANNIS, MA 02601 NAMES)OF OWNER(S)AND MAILING ADDRESS FEES RODNEY, COURTNEY A REGISTRATION 30.00 BX 2601 BUILDING DEPT TITLE 0.00 HYANNI S, MA 0 2 6 01-7 6 01 SPECIAL PLATES 0.00 APR 0 2 2019 SALES TAX 0.00 JU TOTAL 30.00 TOVvN OE MASSACHUSETTS DEPARTMENT O RTATION REGISTRY OF MOTOR VEHICLES DIVISION The records of the RMV database constitute the official status of the vehicle registration. SPECIAL MESSAGE. CHANGE OF ADDRESS IF THIS VEHICLE IS NEWLY ACQUIRED, IT MUST BE INSPECTED WITHIN SEVEN (7) DAYS STREET ADDRESS OF REGISTRATION. CITY,STATE,ZIP CODE Important Information for Vehicle Owners Every person operating a motor vehicle shall have the Certifi- Return the registration plates to the RMV immediately if: cate of Registration for the motor vehicle and.for the trailer,if any,and his/her license to operate,upon his/her person or in -The vehicle has been sold or junked and the registration is not the vehicle,in some easily accessible place. going to be transferred to another vehicle.Keep a Copy of the Bill of Sale, Title, and completed Reassignment of Title 0 r your By law,you must report any change of address to the RMV within records to document the transfer. 30 days in writing.Address changes can be made on the RMV website:www.mass.gov/rmv or by mail to:RMV, You move to another state and you register the vehicle in that state. P.O.Box 55889,Boston,MA 02205-5889.Once you have reported The insurance policy is not renewed or is cancelled and there is the address change to the RMV,please write corrected address no plan to obtain a new policy. in box provided above. Transferring Your Plates: Massachusetts law (M.G.L. Chapter 90, Section 2) allows you to transfer valid registration plates from this vehicle to a newly acquired new or used motor vehicle or trailer while you obtain insurance and a new registration.All of the following must be met: 1.You are at least 18 years of age and you own the motor vehicle or trailer identified on this Registration Certificate;2.You transfer ownership of this vehicle to another person or permanently lose possession of it(such as through repossession,etc.);3.The newly acquired vehicle is of the same vehicle type(passenger vehicle to passenger vehicle,trailer to trailer,etc.);the same registration type (passenger to passenger,commercial to commercial); and has the same number of wheels;and,4.The seller and buyer properly complete the Assignment of the Certificate of Title(for the newly acquired"used"vehicle)or Certificate of Origin(if a"new"vehicle). If all of the above are met,you may operate the newly acquired vehicle with the transferred plates up to 5:00 pm of the 7th calendar day following the date of transfer(or loss of possession). The day of transfer or loss is day#1. During those 7 days,you must carry the Bill of Sale (or the dealer's Purchase Contract)for the newly acquired vehicle and this Registration Certificate when operating the vehicle. See FAQs About the Seven-Day Registration Transfer Law on the RMV's website at www.mass.gov/rmv. No Insurance Card Required:Massachusetts's law does not require an insurance card. The law,M.G.L.Chapter 90, Section 34A and Chapter 175, Section 113A requires the vehicle's owner to maintain a compulsory motor vehicle liability insurance policy or bond for bodily injury coverage and property damage insurance. If an insurer is identified on the face of this Registration Certificate, it is required by law to electronically notify the RMV(Registry of Motor Vehicles)if coverage lapses.The vehicle owner is then notified by the RMV to obtain new insurance.within 10 days or the registration will be revoked.Bonds are filed with the State Treasurer 4 office. Be first in line by going online at www.mass.gov/rmv Schedule a Road Test Request a Duplicate Title NEED TO VISIT AN RMV OFFICE? Renew Your Driver's License Request a Duplicate Registration Renew Your Registration Change Your Address SAVE TIIVIE Pay Citations/Court Hearing Fee Cancel My Plate/Registration Complete Your Replace Your Driver's License Order a Special Plate Application Online! VISIT OUR WEBSITE FOR A FULL LIST OF AVAILABLE TRANSACTIONS SPI3061T 0812016 A. !Fm_ assDOT CERTIFICATE OF REGISTRATION RMV Division 0 o Reghay of Motor VehIcIm M.G.L.Chapter 90 Section 24B makes it a crime to alter this Certificate PLATE TYPE REGISTRATION NUMBER REGISTRATION TYPE EFFECTIVE DATE MONTH YEAR TWISACTION NUMBER. PAN I8VV853 PASSENGER 04/02/19 � ... . 03 20 02909254110101 MFRS MODEL YEAR MAKE MODEL BODY STYLE/TYPE COLOR Not valid without official IF VEHICLE TOTAL REGISTERED 2003 CHEV EXPVAN VAN WHITE CARRYING ENGERS COMMEERCIARL VEHICLE signature of Registrar FOR HIRE:*� OR TRAILER VEHICLE IDENTIFICATION NUMBER INSURANCE COMPANY TIT.NUMBER REGISTRAR MAXIMUM NUMBER OF 1GCHG35U431147044 NGM INSURANCE COMP BL553806 PASSENGERS THAT CAN BE . . RESIDENTIAL ADDRESS(IF DIFFERENT) SEATED. 99 BLUEBERRY HILL RD HYANNIS, MA 02601 NAME(S)OF OWNER(S)AND MAILING ADDRESS - FEES - - - - . RODNEY, COURTNEY"A BUILDING D EPT. REGISTRATION 30.00 BX 2601 TITLE 0.00 HYANNIS, MA 02601-7601 APR O 2 20�9 SPECIAL PLATES 0.00 SALES TAX 0.00 - TOTAL 30.00 TOWN OF BARNSTAB E MASSACHUSETTS DEPARTMENT OF TRANSPORTATION - REGISTRY OF MOTOR VEHICLES DIVISION The records of the RMV database constitute the official status of the vehicle registration. SPECIAL MESSAGE CHANGE OF ADDRESS IF THIS VEHICLE IS NEWLY ACQUIRED, IT MUST BE INSPECTED WITHIN SEVEN (7) DAYS STREET ADDRESS OF REGISTRATION. CITY,STATE,ZIP CODE Important Information for Vehicle Owners Every person operating a motor vehicle shall have the Certifi- Return the registration plates to the RMV immediately if: cate of Registration for the motor vehicle and for the trailer,"if any,and his/her license to operate,upon his/her person or in The vehicle has been sold or junked and the registration is not the vehicle,in some easily accessible place. going to be transferred to another vehicle.Keep a copy of the Bill of Sale, Title, and completed Reassignment of Title for your By law,you must report any change of address to the RMV within records to document the transfer. 30 days in writing.Address changes can be made on the RMV You move to another state and you register the vehicle in that state. website:www.mass.gov/rmv or by mail to: RMV, P.O.Box 55889,Boston,MA 02205-5889.Once you have reported The insurance policy is not renewed or is cancelled and there is the address change to the RMV,please write corrected address no plan to obtain a new policy. in box provided above. Transferring Your Plates: Massachusetts law (M.G.L. Chapter 90, Section 2) allows you to transfer valid registration plates from this vehicle to a newly acquired new or used motor vehicle or trailer while you obtain insurance and a new registration.All of the following must be met: (.You are at least 18 years of age and you own the motor vehicle or trailer identified on this Registration Certificate;2.You transfer ownership of this vehicle to another person or permanently lose possession of it(such as through repossession,etc.);3.The newly acquired vehicle is of the same vehicle type(passenger vehicle to passenger vehicle,trailer to trailer,etc.);the same registration type (passenger to passenger,commercial to commercial); and has the same number of wheels;and,4.The seller and buyer properly complete the Assignment of the Certificate of Title(for the newly acquired"used"vehicle)or Certificate of Origin(if a"new"vehicle). If all of the above are met,you may operate the newly acquired vehicle with the transferred plates up to 5:00 pm of the 7th calendar day following the date of transfer(or loss of possession). The day of transfer or loss is day q1. During those 7 days,you must carry the Bill of Sale (or the dealer's Purchase Contract)for the newly acquired vehicle and this Registration Certificate when operating the vehicle. See FAQs About the , Seven-Day Registration Transfer Law on the RMV'S website at www.mass.gov/rmv. No Insurance Card Required:Massachusetts's law does not require an insurance card. The law, M.G.L.Chapter 90, Section 34A and Chapter 175, Section 113A requires the vehicle's owner to maintain a compulsory motor vehicle liability insurance policy or bond for bodily injury coverage and property damage insurance. If an insurer is identified on the face of this Registration Certificate, it is required by law to electronically notify the RMV(Registry of Motor Vehicles)if coverage lapses.The vehicle owner is then notified by the RMV to obtain new insurance within 10 days or the registration will be revoked.Bonds are filed with the State Treasurer t office. Be first in line by going online at www.mass.gov/rmv Schedule a Road Test Request a Duplicate Title NEED TO VISIT AN RMV OFFICE? Renew Your Driver's License Request a Duplicate Registration IE Renew Your Registration Change Your Address SAVE Pay Citations/Court Hearing Fee Cancel My Plate/Registration Completee Your Replace Your Driver's.License Order a Special Plate Application Online! VISIT OUR WEBSITE FOR A FULL LIST OF AVAILABLE TRANSACTIONS SP13061 T OSJ2018 v: f m_ �ss__DOT CERTIFICATE OF REGISTRATION RMV Division `�� Registry of INotor.VeMcln e�i mn _ M.C.L.Chapter 90 Section 24B makes it a crime to alter this Certificate PLATE TYPE flEGISTRATION NUMBER REGISTRATION TYPE ffFECTIVE DATE MONTH YEAR TRANSACTION NUMBER PAN 8VV873 PASSENGER 04/02/19 . ... . 03 20 02909254110103 MFRS MODEL YEAR MAKE JMODEL BODY STYLE/TYPE COLOR - Not valid Without official- - IF VEHICLE TOTAL REGISTERED 2003 CHEV SILVER PU GREEN CARRYING WEIGHT FOR VEHICLE signature of Registrar FOR HIRE: OR TRAILER. - VEHICLEIDENTIFICATION NUMBER INSURANCE COMPANY - [ITLEMBER REGISTRAR MAXIMUM NUMBER OF2GCEC19V731335332 COMMERCE INSURANCE 998775 //�] PASSENGERS THAT CAN BE RESIDENTIAL ADDRESS(IF DIFFERENT) - SEATED. 99 BLUEBERRY HILL RD HYANNIS, MA 02601 NAME(S)OF OWNER(S)AND MAILING ADDRESS -_ FEES - RODNEY, COURTNEY A BUILDING D E PT. REGISTRATION 30.00 BX 2601 TITLE 0.0 0 HYANNIS, .MA 02601-7601 SPECIAL PLATES 0.00 APR 0 2 2019 SALES TAX 0.00 TOTAL 30.00 TnWN OE T MASSACHUSETTS DEPARTMENT OF TRANSPORTXTION REGISTRY OF MOTOR VEHICLES DIVISION _ The records of the RMV database constitute the official status of the vehicle registration. SPECIAL MESSAGE CHANGE OF ADDRESS IF THIS VEHICLE IS NEWLY ACQUIRED, IT MUST BE INSPECTED WITHIN SEVEN (7) DAYS STREET ADDRESS. OF REGISTRATION. CITY,STATE,ZIP CODE Important Information for Vehicle Owners Every person operating a motor vehicle shall have the Certifi- Return the registration plates to the RMV immediately if: cate of Registration for the:motor vehicle and for the.trailer,if any,and his/her license to operate,upon his/her person or in The vehicle has been sold or junked and the registration is not the vehicle,in some easily accessible place. going to be transferred to another vehicle.Keep.a copy of the Bill of Sale, Title, and completed Reassignment of Title Tor your By law,you must report any change of address to the RMV within records to document the transfer. 30 days in writing.Address changes can be made on the RMV website:www.mass.gov/rmv or by mail to:RMV, You move to another state and you register the vehicle in that state. P.O.Box 55889,Boston,MA 02205-5889.Once you have reported The insurance policy is not renewed or is cancelled and there is the address change to the RMV,please write corrected address no plan to obtain a new policy. in box provided above. Transferring Your Plates: Massachusetts law (M.G.L. Chapter 90, Section 2) allows you to transfer valid registration plates from this vehicle to a newly acquired new or used motor vehicle or trailer while you obtain insurance and a new registration.All of the following must be met: t.You are at least 18 years of age and you own the motor vehicle or trailer identified on this Registration Certificate,2.Youtransfer ownership of this vehicle to another person or permanently lose possession of it(such as through repossession,etc.);3.The newly acquired vehicle is of the same vehicle type(passenger vehicle to passenger vehicle,trailer to trailer,etc.);the same registration type (passenger to.passenger,commercial to commercial); and has the same number of wheels;and,4.The seller and buyer properly complete the Assignment of the Certificate of Title(for the newly acquired"used"vehicle)or Certificate of Origin(if a"new"vehicle). If all of the above are met,you may operate the newly acquired vehicle with the transferred plates up to 5:00 pm of the 7th calendar day following the date of transfer(or loss of possession). The day of transferor loss is day#1: During those 7 days,you must carry the Bill of Sale (or the dealer's Purchase Contract)for the newly acquired vehicle and this Registration Certificate when operating the vehicle. See FAQs About the Seven-Day Registration Transfer Law on the RMV'S website at www.massw/rmv. No Insurance Card Insurance Card Rewired:Massachusetts's law does not require an insurance card. The law,M.G.L.Chapter 90, Section 34A and Chapter 175, Section 113A requires the vehicle's owner to maintain a compulsory motor vehicle liability insurance policy or bond for bodily injury coverage and property damage insurance. If an insurer is identified on the face of this Registration Certificate, it is required by law to electronically notify the RMV(Registry of Motor Vehicles)if coverage lapses.The vehicle owner is then notified by the RMV to obtain new insurance within 10 days or the registration will be revoked.Bonds are filed with the State Treasurer t office. Be first in line by going online at www.mass.gov/rmv Schedule a Road Test Request a Duplicate Title NEED TO VISIT AN RMV OFFICE? Renew Your Drivers License a Request Duplicate Registration q P 9 Renew Your Registration Change Your Address SAVE TIME Pay Citations/Court Hearing Fee Cancel My Plate/Registration Complete Your Replace Your Driver's License Order a Special Plate Application Online! VISIT OUR WEBSITE FOR A FULL LIST OF AVAILABLE TRANSACTIONS SPI3061T OB/201 8 w 1 % N791,77550-W o _ o � EXISTTNG R=1684.11' SLAB L=33.98' Tan=16.99' A=1'09 22" X i O, k� CATF O h E�3 '. 2!! Q�0 oW oc O G E \�AG y I 0 ' 0 R BL vE��� N7 R=32.89' 68.2 je��V L=50.34' Y y Tan=31.60' �L L ROAD 6=87*42'10" FOUNDATION PLOT PLAN DCE #15-215 PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT, NOT FOR ANY OTHER USE LOCATION #100 BLUEBERRY HILL HYANNIS,MA SCALE : 1" = 30' DATE : SEPT. 17-2015 PREPA OF gsLI REFERENCE MAP 249 PARCEL 74 DB 1441 PG 1089 0� A. L �� 1 HEREBY CERTIFY THAT THE STRUCTURE OJALA N SHOWN ON THIS PLAN IS LOCATED ON THE No.40980 GROUND AS SHOWN HEREON. off 508-382-4541 �q FF S S%�� fax 508-362-9880 N0 S U RV E� downcope.com 0 own cope eodineeaq'ire, �- gD lan engineers CA_k CT _0- J land surveyors -------- -------- 939 Main Street ( Rte 6A) ------------ ------ YARMOUTHPORT MA 02675 DATE REG. LAND SURVEYOR TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Srx� Map " I Parcel v� I Application # C�6/C a h,Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address /OJ5 �3t-L/t- � R f Village &A&? Owner RAKIV4NO A, /DI,4f'Ale JR • Address 166 OgA✓d z r�)P. Telephone Permit Request G f3u�_J G1WAq--- 22 9 26 TA cNe c,4 AIL_ �Z SFr, I'°Te Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Val uatio4L6_ (Lr ' Construction Type S M4�A e Lot Size /0 7`xx /6 9' Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure 46 Ye44Ls Historic House: ❑Yes 12LNo On Old King's Highway: ❑Yes W No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other_ awO�T Basement Finished Area (sq.ft.) Basement Unfinished Area (sq,.ft) Number of Baths: Full: existing new Half: existing `" ; new Number of Bedrooms: existing _new `' R Total Room Count (not including baths): existing new First Floor Room Count.:, - e Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other NOT UJ Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood coal stove: Jibs No Detached garage: ❑ existing 4 new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size_ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ��✓})'MD �� �i�y/(/I� Y{�', Telephone Number /-\56 7�3-31a7 Address lD,4 &o1 �S'� �/ /�1� License # Home Improvement Contractor# Email Worker'sCompensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE —DATE. _�.�f5 FOR OFFICIAL USE ONLY ell Y APPLICATION# r DATEISSUED F MAP/PARCELNO. ADDRESS VILLAGE OWNER t. - 'r'. DATE OF INSPECTION: FOUNDATION r FRAME ' INSULATION , c FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r' GAS: ROUGH FINAL FINAL BUILDING ti DATE CLOSED.OUT AS PLAN NO. r the t;ommanwea&m oJmassacnuseus : .Department Of r]IljllS*W Acci&n& Office of bwestigations ` 600 Washington Street Boston,MA 02111 www.mass gov/din Workers' Compensation Insurance Affidavit:Buiilders/Contractors/EIectricians/Plumbers Applicant Information _,//) Please Print Legibly Name(Business/organizationm dividuo):_ y i� A �/�KV_-C. YK. Address: Ara ire 41 ) ! 2D City/State/Zip: 14 VAJLe, Phone Are you an employeri Itheck the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I employees(fbH and/or part time).* have hired the sub-contractors 6 New constriction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These ors have S. []Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers'comp.insurance comp.insurance.t required.] S. We are a corporation and its 10.❑Electrical repairs or additions 3. I am.a homeowner doing all work ' officers have exercised their I LE]Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c.152, §1(4),and we have no employees.[No workers' 13.❑Other 6*-'AY 4 �2 comp,insurance required] *Any.applicant that checks box#1 must also fill out the section below showing theirworkers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional shoot showing the name of the sub-contr actors andst d:whether or not those entities have employees. If the sub-contractors have employees,they mast provide their workers'comp,policy number. I am an employer that isprovuUng workers'compensation insurance for my employees. Below is tiepoliey andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.# Expiration Date: Job Site Address: sty/Stt/7ip: - Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can Iead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK-ORDER and a fine of up to$250.00 a day against the violatdr. Be advised chat a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and/penalties of perjury that the information provided above is true and correct Sioafzue: QL !' �`'I Date: Phone#: Offwigl use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions'- Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this siatate,an employee is defined as"._.every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged m'a joint enterprise,and including the legal representatives of.a.deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter-152, §25C(17 also states that"every state or local licensing agency shall Withhold the issuance-or renewal of a license or permit to operate a business or to construct buildings in.the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall entry into any contract for the performance of public work until acceptable evidence of compliance with the i r==ce req�ents of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitfed to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be retumed to the city or tows 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 pcimW icense applications m 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 f itzure 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 (Le. 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 a:�ay questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. Tha Commoni�aalth of Massachusetts Dgpartmont of Industrial Accidents almee,of kvestigatiorrs 600 washivan street. ' Boston,MA 02111 TeL#617-727-4900 ext 406 or 1- 77-MAZ� Revised 4-24-07 Fax#617-727-7749. ww .mm g-ovldia I Town of Barnstable z Regulatory Services P�oF raif,` Richard V.Scali,Director ; Building Division � 4 RrE Tom Perry,Building Commissioner 9�A 1 A��� 200 Main Street, Hyannis,MA 02601 rE° t www.town.barnstable.ma us Office: 508-862-403.8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION _ Please Print DATE: [ `�'� � JOB LOCATION: /OV /,L u,,--- 8 1 rKZ yi'f/ /)P AK4AV N)r S number/� tt village "HOMEOWNER": /84r D//.I� Ai!p V AIX Th <^Jail � 3 7 ��91VJQ name ) home phone# work phone# CURRENT MAILING ADDRESS: /)G /3 LUo= cityAnwn state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. S afore of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFU-ES\FORMS\building permit forms\EXPRFSS.doc Revised 061313 ' i Town of Barnstable Regulatory Services Richard V.Scali,Director i639. o�. 16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder rj1/ Jd, , as Owner of the subject roP e l P , nY hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q TORMS:O WNERPERMISSIONPOOIS AWVC Guide to Wood Construction in High Wind Areas: I10 fnph Wind Zone ' Massachusetts Checklist for Compfiance (7s0 Cik1R5301.Z.1.r)t Loadbearing Wall Connections Lateral (no.of 16d common nails).......:........................(Tables 7)..................................................... Non-Loadbearing Wall Connections Lateral(no.of 16d common nails)................................(Table 8)....................................................... Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans ........................................ .._.(Table 9)......................... .i�L Sin Plate Spans ........................................................(Table 9).................................. ft in._<11' Fun Height Studs (no.of'sfuds)....................................(Table 9).....................-.............. ..... .... Non-Load Bearing Wall Openings(record largest opening bUt check all openings for compliance to Table 9) Header'Spans..........................................".......-.-.-_--(Table 9)................................../o'ft' in.512' Sill Plate Spans............................................................(Table 9)..-._........-........_ _ < Fun Height Studs (no. of studs)....................................(Table 9)....................................................... Exterior Wall Sheathing to Resist Uplift and Shear Simuttaneously4 Minimum Building Dimension,W Nominal Height of Tallest Opening z ............•......................•.........................._.___..._..__....7] 5 6`8" SheathingType.............................................(note.4)................................................... C D x Edge Nail Spacing..:.............:........................(Table 10 or note 4 if less)._.........._.......... in. Field Nail Spacing...........................................(Table 10).........................................._..__.. in. Shear Connection (no.of 16d common nails)(Table 10)......................................................._ Percent Full-HeightSheathing........:...............(fable ID).................................... ° 5%Additional Sheathing for Wall with Opening>6'87(Design Concepts).................... Maximum Building Dimension,L Nominal Height of Tallest Opening2..................................................................:...... 5 618` SheathingType..............................................(note 4).............................................-...... — Edge Nail Spacing.........................................(Table 11 or note 4 if less)........................ in. Feld Nail Spacing.......................................:..(Table 11).............-.................................... in. Shear Connection(no. of 16d common nails)(Table 11)....................................................... Percent Full-Height Sheathing......:..............•.(Table 11)............................................:-------—% 5%Additional Sheathing for Wail with'Opening> 6'8`(Design Concepts).................... Wall Cladding Ratedfor Wind Speed?.............................................................. ............................................................... ' 5.1 ROOFS Roof framing member.spans checked?........................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ...................................................(Figure 19) ....._....... ft 5 smaller of 2'or V3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uprift................................................(Table 12).............................................U= plf Lateral.............................................(Table 12)..............................................L= plf Shear...........................:...................(Table 12)............................................S= plf Ridge Strap Connections,if collar ties not used per page 21... (Table 13)............ plf Gable Rake Outfooker..................:........................(Figure 20) ............. ft-<smaller of 2'or 112 ' Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors - Uplift......... ...........................(Table 14)....................................... _.U= lb. Lateral(no_of 16d common nails)...(Table 14)............... .. = . Roof Sheathing Type....................................................(per 780 CMR Chapters 58 and 59)............ } C Roaf'Sheathing Thickness....................................:..... ....................................0........ in.?7/16'WSP Roof Sheathing Fastening.............................................(Table 2)........................................................._ Notes: ' -1. . This checklist shall be met in its entirety,excluding the specific exception noted in 2, to comply with the requirements of 78D CMR-5301.2.1.1 Item 1. If the checklist is met in its entirely then the following metal straps and hold downs are.not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 1Ba and Figure 18b 2. 'Exception:Opening heights of up to 8 ft.shad be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade. f � ' ATYC Guide to Wood Construction ui High Wind Areas:11 D trzph W nd Zone Massachusetts Checklist for ComOliance (7s0 C>ti R 5301 2.1.1)' E✓1 check _ CanViian= 1.1 SCOPE. WindSpeed{3-sec. gust).......:........................................................................................................... 110 mph WindExposure Category..................................................................--•.................._.............................._....:_-_C Wind Exposure Category..:.............Engineering Required For Entire Project....................................... 1.2 APPLICABILITY .Number of Stories (a roof which exceeds B.in 12 slope shall be considered a story)�_stories 5 2 stories < F 12:12 RoofPitch _.........--.................:........................................ (Fig 2) ------•---_......._....______........_... Mean Roof Height ......................=: _(Fig 2)........................................:... BuildingWidth,W .............--..................................-.....-----•(Fig 3)...................:.........:........-_.:....._ft _90� Z 60 BuildingLengifl,L ......................._.......................--:..........( g )........................................:........— -BO 22 Building Aspect Ratio(L/1� ................................................(Fi 4 9 4)................................................. <_3:1 Nominal Height of Tallest Opening .....(Fig 4 1.3 FRAMING CONNECTIONS General compliance with framing connections.............:......(fable 2)............................................................... 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.............................................................................................................................. ConcreteMasonry.................................................................... .............................................:................. 2.2 ANCHORAGE TO FOUNDATION"' 518'Anchor Bolts*imbedded or 51B'Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing-general ........................................:.(Table 4)..............___:.............................. in. G' Bolt Spacing from endrjoint of plate................:......... (Fig 5)..................................... m.<6 -12", Bolt Embedment-concrete.........................................(Fig 5)..........................................-••-- in.>-T. :Z ry.................... ....._.........(Fig 5 ......._....-_... in.>.15' _ Bolt Embedment-mason ...... ( g ).....:......:.............. � PlateWasher..::..................................•--._..........._.........(Fig 5)..............................................>3'x 3'x W X �r 3.1 FLOORS Floor•framing member spans checked ...-....................... (per 7B0 CMR Chapter 55)........._...._.........•ft<12' ' Maximum Floor Opening Dimension...................................(Fig 6)....._...........................................— Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6).............................:......... MtLdmiim Floor Joist Setbacks Suppoi1ing Laadbearing Walls or Shearwalf...._..........Fig 7).....................................................T ft 5 d (10kyeTa Maximum Cantilevered Floor Joists Supporting Loadbearing Walls'or Shearwall................(Fig 8)......................................_.._....:....._ft s d -FloorBracing at Endwalis....................................................(Fig 9)..............-........-_................._-........ ......__. ..................(per780 CMR-Chapter 55)............_.-__-__:___. ' Floor Sheathing Type ......................._.........---•- .......... Floor Sheathing Thickness ................................................(per 730 CMR Chapter 55)..................... in- Floor SheathingFastening._......".........................................[fable 2)_.—d nails at in edge/ to field 4.1 WALLS Wail Height Laadbearing walls...............................:....................._.(Fig 10 and Table 5)........................... ft <10' 2k I v Non-Loadbearing walls....._:.....:...................................(Fig 10 and Table 5)._.........__......._...._._ft's 2D' Wall Stud Spacing (Fig 10 and Table 5)................... _in._<24'o.c. � P 9 Wall Story OfFsets .....................:..(Figs 7&8)............................................. ft s d ' 4-2 EXTERIOR-WALLS' Wood Studs Loadbearing vti ails....................._.................................(Table!•)...........................-.mac g/ -$ft o in. 5 - $ Non-Laadbearing walls...............................................:(Table )..............................2x•� ft O in..— -— Gable End Wall Bracing' Full Height Endwail Studs..................__. (Fig 10)....................-. ........ WSP-Attic Floor Length................::..........:...................(Fig 11)............................................ ft�:Wt3 Gypsum Ceiling Length(f WSP not used)...................(Fig 11)............................................ ft z 0.9W - and 2 x 4 Continuous Lateral Brabe @ 6 ft o.c...(Fig 11)............................................ or 1 x 3 ceiling furring strips @ 16'spacing min.with 2 x 4 blocking @ 4 ft_spacing in end joist or truss bays Double Top Plate SpliceLength .......................................................•Fig 13.and Table 6)_................_........_..._...._ft Splice Connection (no.of 16d common nails):.............(Table 6)......................................................... r ATVC Guirle to Wood Cansirtiction in High HlhdAreas_ II0 nzplr frixrdZone Massachusetts Cheeldist for Compliance(780 C M R5-301!J:1)' 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percer)t Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7116"and be installed as follows: 1. Panels shall be installed With strength a)ds parallel to studs. n. All horizontal joints shall occur over and be nailed to framing. r,L On single stD y construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates, band joists,and girders shall be a double row of Bd staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment 5. Glazing protection:a)new house or horizontal addition—required if project is 1 mile or closer to shore(generally,south of Rte.28 or north of Rte.6) b)vertical addition—not required unless there is extensive renovation to the first floor c)replacement windows—needs energy conservation compliance only(chap 93) 6.Ao`od Frame Cons truetion,Manual F.CM f'or 110 MPH,'Exposure B maybe obtained from the American Wood Council (W _)�_. (AWC)website. Wf iEN TM IDLERFSI b DN FFIAAdm usEM NAILS 'AT8'n.c • 11 11 1 It 11 1 tl u r n 1 11 l yl I u n n n t t ll 11 H r ! - o t tru it m n ii X r - z 1 1 tug tt li. i •� �i ii 1 IL to t r 1 1 .i i i� 1 ! ! FRAMING >. t 0 �� u � _ ! EDGEW-ERMH?IATE j1 Lt tiI L • 1 SO ii ii F i Y' � r;r-- *_ r tt�J 11 it 1 i ; 3� WAR j 1 T r~ SrAGGEDED 3+�� NAE S�AGkJG I NAIL PAT1N PANE. ` krrE1 - 1 t RAtOE EDGE pQ[1Hr.E NAIL EDGE sPACVG DETAL See Dated fln Next Page Vertical and Horizontal Nailing Detail for Panel Attachment Vertical and Horzontal Nailing for Panel Attachment 2+ate �x ila0j,T- v oyop �jD M _; a y; 5• _ ti _ s -, a*•-- . 71 1 Town of Barnstable Building Department - 200 Main Street BARNSTABLE, * Hyannis, MA 02601 MAC. i639- g (508) 862-4038 Qb �� ArFO MA'i A Certificate of 0ccu anc p Y Application Number: 201102020 CO Number: 20110098 Parcel ID: 249074 CO Issue Date: 07/06111 Location: 100 BLUEBERRY HILL ROAD Zoning Classification: RESIDENCE B DISTRICT Proposed Use: SINGLE FAMILY HOME Village: HYANNIS Gen Contractor: PROPERTY OWNER Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: FAMILY APT. ISSUED RAYMOND PAYNE II FOR SON RAYMOND PAYNE III Building Department Signature Date Signed TOWN OF BARNSTABLE Building ZNE 201102020 * BARNSTABLE, * Issue Date: 06/20/11 Permit 9 MASS. �A 1639• Applicant: PAYNE,RAYMOND A Permit Number: B 20111228 rFD MA'I A Proposed Use: SINGLE FAMILY HOME Expiration Date: 12/18/11 Location 100 BLUEBERRY HILL ROAD, Zoning District RB Permit Type: FAMILY APT W/NO CONST Map Parcel 249074 Permit Fee$ 35.00 Contractor PROPERTY OWNER Village HYANNIS App Fee$ License Num OWNER Est Construction Cost$ 0 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND CHANGE TO FAMILY APARTMENT RAYMOND A.PAYNE III- SON THIS CARD MUST BE KEPT POSTED UNTIL FINAL TO RESIDE INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: PAYNE,RAYMOND A BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 100 BLUEBERRY HILL RD INSPECTION HAS BEEN MADE. HYANNIS,MA 02601 Application Entered by: PC Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENtLT_ENCROACHMENTS ON PUBLIC.PROPERTY,NO SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY.GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT Of PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THEAPPLICANTFROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 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. 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.I42A). } A 2 Sa p � N Foff :�., a Y ,r `:, -- &a r BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 .� �` CC 1 Heating Inspection Approvals Engineering Dept r l Fire Dept 2 Board of Health TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map i Parcel �'� Application # Health Division Date Issued ( a � Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation /Hyannis Project Street Address 100 G 11-h11 AoGd , Village -fAl(An n \L S f Owner 0 Q r Q rd A— PCA 111 j/l P- Tr Address 00d Telephone Of -�Permit Request 6;4 raGc- A f�T Square feet: 1 st floor: existing proposed 2nd floor: existing-proposed Total new Zoning District Flood Plain Groundwater Overlay P Project Valuation Construction Type Lot Size . Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family U/ Two Family ❑ Multi-Family(# units) Age of Existing Structure `I Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:. Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) } Name ;'1 �///�N� � > � � �� Telephone Number ZZ��J�d Address L 1/ al'I License# T/ Home Improvement Contractor# Worker's Compensation # CS1ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED y MAP/PARCEL NO. ADDRESS VILLAGE OWNER . DATE OF INSPECTION: FOUNDATION t FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. E i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorslEIectrici-ans[Plumberg _ A Please Print Le bI Applicant Information . ' PP � Y_ 4 am_LB($�iness/Org�izationlEndividaan: J1V-YM oM2 /9-, //9�/�,� ) �� Phone.#: I'S° -7�S -3/G 7 Are you an employer? Check the appropriate box: rE] ject(required): 1.❑ I am a employer with 4. I am a general contractor and I construction employer-&(full and/or part-time).* have hired the stab-canttactars 2❑ I am a'sole proprietor or pariner- listed on the attached sbeet deling ship and have no employees These sub-contactors have . olition employees and have workers' working for me in any capacity. 9. ❑Building addition [NO wot� st ers' COIDp.intranrr. comp.insurance. t qires] 5. We are a corporation and its 10.❑Electrical repairs or additions rbTu r3=�sI a hameowncr doing all work officers have exercised their 1 LFJ Plumbing repairs or additions myself[[No workers' comp. right of exemption per MGL 12.❑Roof repairs U==reqircd]t c. 1.52, §1(4), and we have no MS employees. [No workers' 13.❑Other comp,inn,rancc regtured_] 'Amy applicant that ehwl5 box 01 must also f n out the smtim below showing their wmi='=mp=sat4on poky infanvation. t Horneownrse who submit this a$davit indicating they are doing all worlcaad then hire outside conbvctnrs must submit anew affidavit indicating wu L tcm*actorm that cbmlc this box must aftrhed an additional sheet showing the name of the sub-=t udton and stain whether or not those enti6cs have emplayees. If the sub-cantrwbm have enployxs,tbey must provi&their workers'wrnp.policy number. I am an employer that is providing workers'compensation insurance for trey employees Below is thepolicy and jab site information. Insuranza Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/state/zip- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip 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 thn violator. Be advised that a copy of this statcmerit may be forwarded to the Office of Investigation of the DIA for inn anee coverage verification. I do hereby certify under the pains-and penalties of perjury that the information provided ab^ore is true and correct eA o Date: Phone#: Official use only. Do not write in this area,tb be completed by city or town officW City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Town of Barnstable �OfTNE ropy �w� o Regulatory Services ' Thomas F. Geller,Director HARNSTABi.E, • . S• MASS. 1639. Building Division PrFO �a Tom ferry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Rmw.town.b arnsta b 1 e.ma.us Office: 508-862-4038 Fax 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE:- /J -/z C�JOBIL—bCA oN /OD �1 ae A'6E/w K .1/��led aft—.'Wi S number street village "HOMEOWNER" a GYJ 1y-2—� X.tfP �h f'�56�" / 75— 3 J� ,,name home phone# work phone# CIJRR_ NT•MAILENGADD_RROS'•_�/�N► 2 city/town state rip 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. DEFNrrION 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 dwe tin ,gattached or detached structures accessory to such use and/or farm structures. A 1 person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. s� w . ' _ c.of-Homcowncr,��n 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 Supcm.sors);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(sec Appendix Q, Rules&Regulations for Licensing Construction Supervisors;Section 2.15) This lack of awareness often results in serious problcns,particularly when the homeowner hires unlicensed persons_ In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homcowncr 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 hdshe understands the responsibilitics of a Supervisor. On the last page of this issue is a form curr.ntly used by v,,,,,, v rare t amend and adopt such a form/certification for use in your community. Town of Barnstable Regulatory Services 1ARNSTASLS. ' Thomas F. Geiler,Director MAsa Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.b2 rnsts ble.m a.us Office: 508-862-403 8 Fax: 508-790-6230 Property OWner Must Complete and Sign This Section If Using .A Builder 5 I as Ower of the subject ro er ty hereby authorize to act on my behalf, in altmatters relative to work authorized by this b ding permit apph lion for: (Address off 0 ) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on tb:e reverse side. fe i I t fU i S i ru vI Ll ru ru �I 3 Z c---L ,�.-L .i L !1 i i i i' 4 `\w- �- - r Ii Ql 1� 00 w 01) 00 � at, .►' �__-- _ _ I _- .DNOD • V I �t a .2 I`'�I S 9 -�9 ,t F _t IiAR7TSTAHLE. .... qEo 9. ,e '12 ,AUG.-8 P 1 .14. Town of Barnstable Zoning Board of Appeals Comprehensive Permit Decision and Notice . 'Comprehensive Permit No. 2012-0017 Payne Chapter 400 Comprehensive Permit Summary: Granted with Conditions Date: July 11, 2012 Applicants: Raymond.A. Payne Jr. Property Address: 100 Blueberry Hill Road Hyannis, MA ,assessor's Map/Parcel: Map 249, Parcel 074 Zoning: RB Zoning District Zone of Contribution GP and WP District. Recording Information: Deed Reference: Book 1441 Page 1089' Date Application Filed June 28, 2012 Date Hearing Opened July 11, 20122 Date of Decision (Closed): July 1.1,2012 Property Ownership: The applicant is Raymond A. Payne Jr. and occupant of 100 Bluebery H i I I Road Hyannis, MA as evidenced by deed recorded in the Barnstable County Registry of Deeds onJuly 1, 1969 in Book 1441, Page 1089. A copy of which has been submitted for the record. Relief Requested: Mr. Payne has applied for a Comprehensive.Permit pursuant to Chapter 40B of the General Laws of the Commonwealth of Massachusetts, and in accordance with § 9-15 of the Code of the Town of Barnstable, more commonly termed the "Accessory Affordable Apartment Program". The permit is sought to allow for an affordable apartment accessory to a single family home as provided-for in the Code of the Town of Barnstable and restricted to being affordable housing foroqualified persons as required under Chapter 40B. This existing apartment has recently been utilized as a family apartment. The zoning relief necessary for this Comprehensive Permit to be issued is that of a variance to Section 2.40-14 (A) Principal permitted uses in a RF Zoning District to permit an accessory apartment unit. above the detached garage. The"issuance of this Comprehensive Permit would allow for a separate; approximately 660 square foot,,studio style accessory affordable apartment. Locos: The subject property is a .37=acre lot located at 100 Blueberry Hill Road Hyannis. The lot was developed in 1967, with a Cape Cod style home. The living area of the dwelling is approximately. ` 2,077 square.`feet. Town of Barnstable,Zoning Board of Appeals Decision and Notice,Comprehensive-Permit No.2012 017-Payne Site Conditions . The lot is served by public water and on site septic. The Town of Barnstable's Health Director.Thomas McKean reviewed the application, and has no objections to a total of three(3) bedrooms for the entire. property: Procedural & Hearing Summary. A site approval letter was issued for the property by Acting Town Manager Thomas K. Lynch on June 1:1, 2012 in accordance with MGL Chapter 408 and 760 CMR 56.00. Notice of the site approval letter was sent to the Department of Housing and Comillunity Development`in accordance wiffilhe requirements'of CMR'760 56.00. An application for a Comprehensive Permit was filed at the Town Clerk's Office on June 28,2012. A.public hearing before the Zoning Board of Appeals Hearing Officer was duly advertised in the Barnstable Patriot on June 15, 2012 and June 22, 2012, and notices were sent to all abutters in accordance with MGL Chapter 40B. The Public Hearing was opened on Jujy 11, 2012 at 6:00 p.m. by the Hearing Officer Laura F. Shufelt. The applicant, Raymond A. Payne Jr. was present at the hearing. Cindy L. Dabkowski, Accessory Affordable Apartment Program Coordinator was also present. Laura F. Shufelt read the proposed conditions to the applicants. Mr. Payne consented pp y e to thc. conditions. Mr. Payne gave testimony as recorded in the hearing minutes filed with the Town Clerk The Hearing Officer opened the hearing to public comment. No one spoke. The July 11,-2012 hearing was closed by the hearing officer at 6:30 p.m. On July 11, 2012 the hearing officer granted comprehensive permit No. 201Z017 with conditions. A written copy of this decision shall be forwarded to the Zoning Board of Appeals as required by the Town of Barnstable Administrative Code Chapter 241, section 11. 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 copy shall be the filed in the office of the TownClerk. Findings of Fact: ' At the hearing on July 11, 2012 the Hearing Officer made the following findings of fact: 1. The applicant is Raymond A. Payne Jr. who is the owner-occupant of;:the property located at 100 B I ueberry.H I I I Road Hyannis,.MA. 2. Raymond A. Payne Jr.granted title to the property by deed recorded in the Barnstable County Registry of Deeds on July 1; 1969 in Book 1441, Page 1089: - 3. On June 11, 2012, a site approval letter was issued for the property by Acting Town Manager V Thomas K. Lynch,.in accordance with MG Chapter 40B and 760 CM 56.04 (4). Notice of the site approval letter;was sent to the'Department of Housing and Community Development, in'accordance with the requirements of 760 CMR 56.04 (2):; and no issues were communicated from the Department on this.par6cular application. 4. The proposed accessory affordable unit is approximately 660 square feet in living area and is located above the detached garage. 5. The applicant was.informed that.the AAAP unit•shall meet all applicable health and 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. flown of Barnstable,Zoning.Board of Appeals Decision and Notice,comprehensive PennitNo.2012-017-Payne 6. .The.house is served by public water and on site septic. The proposal has been reviewed by Thomas McKean, Health Director, and he has no objections to a total of three (3) bedrooms at the.property. 7. On May 2- 2012 the applicant Raymond A. Payne Jr. sighed-an Accessory. Affordable Apartment.Program affidavit that commits, upon-the receipt of a Corriprehensive Permit,to the recording of a Regulatory Agreement and Declaration of Restrictive Covenants, in a form satisfactory to the Town Attorney, at the Barnstable County Registry of Deeds. These documents restrict the unit in perpetuity as an affordable rental unit. ..8. The applicant is aware that the affordable unit shall be rented to a person or family whose income is 80'% or less of the Area.Median Income (AMI) of the Barnstable Metropolitan Statistical Area (MSA) and agrees that rent(including utilities) shall not exceed 30% of the monthly household 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 cleducted from 'rent level so calculated. 9. According to the Massachusetts Department of Housing and Community Development, as of August 31, 2011, 6.65% 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. 10. The Town of Barnstable's Comprehensive Plan encourages the adaptiveuse.of existing housing stock to create affordable units and the dispersal of these units throughout Barnstable Summary: The Hearing Officer ruled that the applicant Raymond A. Payne Jr. has standing to apply for a Comprehensive Permit under MGL Chapter 40B and the Town of Barnstable's Accessory Apartment Program. The.proposal was 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. Conditions: Hearing Officer Laura F. Shufelt ruled-to grant Comprehensive Permit No. 201.2-017 with conditions in accordance with MGL Chapter 40B and Article 11 of Chapter Nine of Code of the town of Barnstable, more commonly termed the "Accessory Affordable Apartment Program" to.the applicant, Raymond A. Payne Jr. who is the owner and occupant of the;property located at 100 Blueberry Hill Road Hyannis,.MA. As seen on map 249 as parcel 074. This Comprehensive Permit allows for a one bedroom apartment unit in accordance with the following conditions: 1. Occupancy of the affordable unit shall not exceed one (1) person. 2. The total number of bedrooms'on the property shall not exceed'three (3): 3: The accessory unit shall NOT atany time be occupied by a family member of the owners: 4. All leases shall have a minimum term of one year and have provisions that require the tenant to provide any and all information necessary to verify eligibility with the AAAP 5. 'On February 7, 2012, the applicant was sent written copy of the inspection findings* submitted for record, that the unit must meet all applicable health and building codes to be'occupied and that the B.uil:ding.Division and Fire Department will also be inspecting the unit forcompliance ' with all applicable building and.fire codes. _ 3. Town of Barnstable,Zoning Board of.-Appeals Decision and Notice,Comprehensive Permit No.201MV0 Payne 6. All parking for the accessory apartment and the principal.dwelling shall at all times be on-site. On street parking for all structures and uses on this property is expressly prohibited 7. Lodging or renting of rooms is prohibited for the duration of this Comprehensive Permit. 8. To meet affordability requirements,the rent charged (including utilities) shall not exceed 30 of 80% of the median income for a l ousehold for the Barnstable MSA (adjusted for family 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. . AAAP Coordinator'shall be.the monitoring agent for the accessory apartment. Annual monitoring shall include verification of tenancy,affordability, and compliance.with Housing Quality Standards (HQS). The cost for HQS monitoring shall be covered-by the homeowner. The fee for the initial monitoring of affordability and annual certification inspection of the accessory unit shall be the same as the Health Department fee for the rental registration. program. Currently that fee is $90.00 per unit. 10. The applicant shall apply for a buildingipermit for the accessory unit; whether the unit is new or pre-existing. Before issuing an occupancy permivand certificate of compliance, the Building Commissioner shall determine that the unit conforms to the approved,plans.as submitted with the building permit application and meets state building and fire codes. The Health Division .shall determine that the dwelling is in compliance with applicable on-site wastewater discharge requirements. 11. The applicant may select his own tenant(s) from the prospective tenarits supplied by the Administrator of the.Ready to Rent List. The tenant must meet the requirements of the Accessory Affordable Apartment Program. The tenant's income shall be reviewed and approved by the Growth Management Department. The applicant shall work with the AAAP Coordinator to provide necessary information and documentation of tenant income eligibility. 12. The unit shall be rented on an open and fair basis to an income eligible individual, Whenever a vacancy occurs,'notice shall be given to the Growth Management,Department and the applicant shall request potential tenants from the administrator of the Zeady to Rent List. The applicant shall pay all fees associated with accessing the Ready to Rent List. In the event that the Ready to Rent List is not in effect as of the date that the Building Department issues its occupancy permit, the applicant may select the tenant after open and fair marketing, providing that documentation of the same is given to the AAAP Coordinator and the AAAP Coordinator Approves the tenant selection process. 1.3. Should the accessory affordable apartment become vacant the property owner shall . immediately notify the Accessory Affordable Apartment Program Coordinator.The property. owner shall-also notify the AAAP Coordinator of their request for potential tenants from the . Ready to Rent List administrator. 14. Every twelve months the applicants shall review the income eligibility of the AAAP unit tenant. No later than•a year from the date of issuance of this Comprehensive Permit, the applicants shall file with the AAAP Coordinator, as Monitoring Agent, an annual'affidavit stating the rent charged and.income of the unit tenant.-The property owners and/or-tenant shall provide the AAAP Coordinator any additional information deemed necessary to verify the information provided-in the:affidavit. 15. Upon any report from the Monitoring Agent that the terms and Conditions of this permit are not being upheld, the Zoning.Board of Appeals or its Hearing Officer,may hold a hearing to show - cause as to why this permit should not be revoked: . 4 Town of Barnstable,Zoning Board of Appeals ` Decision and Notice,Comprehensive Pennit No.2012-017-Payne . 16. This Comprehensive Permit shall NOT be transferable to any other person or entity withoutahe 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 recorded at the Barnstable County Registry of Deeds 17. Should ownership of the subject property transfer.the permit holder identified herein shall notify-the AAAP Coordinator and provide, within 60 days of the datebf transfer, the name and current contact information for the new owner of the subject property,. 18'.This Comprehensive Permit shall be exercised, all conditions met, and the unit occupied withintwelve (12) months of.its is'suance.or it shall expire. Ordered: Comprehensive Permit number 2012-017 has been granted with conditions. A written copy of.this decision was forwarded to the Zoning Board of Appeals-as required by the Code Chapter.241, section 11 of the Town of.Barnstable Administrative code.. If after.fo.urteen (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.copy shall be filed in the office of.the Town Clerk Appeals of the final decision, if any, shall be made to the Barnstable Superior Court pursuant to MGL Chapter 40A, Section 17, within twenty (20) days after the date of the filing of this decision in the office of the Town Clerk. The applicant has the right to appeal this decision as outlined in MGL Chapter 40B, Section 22. Laura F. Shufelt, Hearing Officer Date Signed .1 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 decisi has been filed in the office of-the Town Clerk. Signed and sealed this ' `day , (�/,� u er the pans and penalties.of eriur p . y mda Hutchenrider, Town Clerk 5 �= �f� it# F`� .A 94 ���4�_01 , REGULATORY AGREEMENT AND DECLARATION OF RESTRICTIVE COVENANT'S THIS-REGULATORY AGREEMENT and DECLARATION OF RESTRICTIVE COVENANTS;ismade this 10,h day of September,2012,by and between Raymond A.Payne Jr. of 100 Blueberry Hill Road Hyannis,MA 02601 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, TPIEREF •RE NOW O in mutual consideration of agreements d covenants herein,and other.Nthe an ov ants contained good'and valuable consideration.,the receipt arr&sufficiency of which is hereby acknowledged,the.parties agree as follows: I. RILOX CT SCOPE AND DESIGN: A. The terms of this Agreement and Covenant regulate the roe located at 100 Blueberry Hill Road �' � property rtY riY Hyannis, MA 02601 as further described in deed recorded herewith, as Barnstable County Registry of. Deeds Book 1441&,Page 1089 date July 1, 1969. : B. The Project located at 100 Blueberry Hill Road Hyannis,MA 02601 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.2012-017 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 &Page G D. The Owner agrees-to occupythe principal dwelling unit located on the property as their principal residence in accordance with the terms of.the comprehensive permit. H.- THE OWNER'S COVENANTS AND RESPONSIBILITTESc A. THE OWNER HEREBY REPRESENTS,COVENANTS AND WARRANTS AS FOLLOW 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 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 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 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. 1 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 anyprovision of law,rule or.regulation,or any order of any court or other agency or governmental body,and will not violate or,as.a licable,has.not violated an provision of_an indenture,agreement,mortgage,a FP XP y. g g g mortgage note,or other instrument to which the Owner is a partyor.bywhich it or the Owner is bound;will aQt 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 ad.'versely determined,would materially impair its right to carry on business substantially as now conducted(and as now contemplated bythis Agreement) orwould materially adversely affect its financial condition: B. COMPLIANCE The Owner hereby agrees that any and all requirements of the laws of the Commonwealth of Massachusetts to be satisfied in order for the provisions of this Agreement to constitute restrictions and covenants.running with the land shall be deemed to be satisfied in full and that any requirements of privileges of estate are also deemed to be satisfied in full. C. LIMITATION ON PROFITS 1. The Owner agrees to limit his/her profit by renting the Designated Affordable Unit in perpetuity to a - household with a maximum income of 80% or less of the Area Median Income(AMI) of Barnstable Metropolitan Statistical Area A and that rent(including utilities shall not exceed an amount that is P . � ) ( g ) affordable to.a household whose income is 80% of the median income of Barnstable 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. III. 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 perpetuityto a household with a maximum income of 80% or less of the Area Median Income (AMI) of Barnstable 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 MSA_In the event that utilities are separately metered,a utility allowance- established by the Barnstable Housing Authority shall be deducted from the rent. IV. 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 RegistryDistrict 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 registration number,of the Agreement. 2 . . V. GOVERNING OF AGREEME ': This Agreement shall be governed bythe 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. VI. NOTICE: All notices to be given pursuant to this Agreement shall be in writing and shall be deemed given when delivered bphand 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 mayfroin time to time designate bywritten notice: VII. 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. VIIL 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 are ranted b the r Owne to run inperpetuityin favor of and be held b the Municipality as an other presents g Y Y P tY Y permanent restriction held by governmental.a bodyas 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 1441' &Page 1089 date July 13 1969 and shall be binding upon the Owner and all successors in title . This Agreement, is made for the benefit of the Municipality and the Municipality shall be deemed to be the holder of the restriction created by this Agreement. The Municipality has determined that,the acquiring of such a restriction is in the public interest. The Municipality shall not be subject:to the defense of lack of privity of estate. The covenants and restrictions contained in this.Agreement shall be deemed to.affect the title to the property described in deed recorded herewith as deed recorded herewith as Barnstable County Registry,of Deeds Book 1441&Page.1089 date July 1, 1969. IX. TERM OF AGREEMENT: The term of this Agreement shall be perpetual,provided,however,that the Owner of a Designated Affordable Unit or Units may voluntarily cancel the granted Comprehensive Permit and the terms and restrictions imposed herein. Such cancellation shall onlytake.effect.after: 1) expiration of the lease terms entered into between the Owner and Tenant.occupying said unit and 2) notification by the Owner of said dwelling to the Zoning Board of Appeals of his/her desire to cancel the Comprehensive permit upon a date certain and the recording of said notice at the Barnstable County Registry of Deeds or Barnstable County Registry of the Land Court as the case 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 L X. 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, (ii) are not merelypersonal covenants of the Owner,and(in) 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: M. DEFAULT: If any default,violation or breach by the Owner of this Agreement is not cured to the satisfaction of the Monitoring Agent within thirty(30).days after notice to the Owner thereof,then the.Monitoring Agent may send notification to the Municipality that the Owner is in violation of the terms and conditions hereof. The Municipality may exercise any remedy available to it. The Owner will pay all costs and expenses,including legal fees,incurred by the Monitoring Agent in enforcing this Agreement and the Owner hereby agrees that the. ' Municipality and the Monitoring Agent will have.alien on the Project to secure payment of such costs and expenses. The Monitoring Agent mayperfect alien 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 anypordon 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. XI1. 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 Oday of 5e PbYI be(/ 2012: OWNED BY: si , - -- Printed:..AArivtE up A 41>Wr^ .,ir-. COMMONWEALTH OF MASSACHUSETTS . County of Barnstable,ss: On this ldth day of September,2012 before me,the undersigned notary public,personally appeared G;U nf) the Owner(s),''proved to me through satisfactory evidence of identification,which were { �V l 1iP v S �(, jSYO 53��'{�� ,to be the persons) whose narne(s) is signed on the preceding or attached document and acknowledged to be that he/she signed it ` voluntarily for the stated purposes. N-/V�A� A . Not ublic Printed: Cindy L.Dabkowski y Commission Expires:February 29,2016 4. CINDY L: DABKOWSKI ' Notary Public COMMONWEALTH OF 1�Ip my commission.Expires. February 29, 2016 TOWN OF BARNSTABL) 13Y: TOWN M. AGER 'COMMONWEALTH OF MASSACHUSETTS County of Barnstable,ss: On this i 1 day of�j/.�j%4 2012 before me,the undersigned notarypublic,personally appeared i •I-c,•n&4.1 ` ,the Town Manager for the Tow_n of Barnstable,proved to me through satisfactory evidence of identification,which were , �'�• _ ,to be the person whose.name is signed on . the preceding or attached document and acldnowl6dged to be that he/she signed it voluntarilyfor.the stated purposes. r r • r s lv'Otaly PUb11C a a"e 'M 9 aO�Pea � yCmmisionExpies:irinted: iy ' J Gyi �M� �H 4f��"�� �� �N o � m g B b • nr�neeoea i i 5 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION If C)Z,67Z Map d/ Parcel App lication # Health Division Date Issued (.0 L)o I 41 A�c Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board &; Z`-) Historic - OKH _ Preservation / Hyannis Project-Street—Addr ss ��°� 19401E F A)� MZJ RO 4 Village h, /A,-k x a� 81 v � Owner �1�'r�� � ��",�� A Address � �� �A% f,�W Telep� S08-775 3167 -50B-77-Y -3 7 (!Le Request •fir 2�m'o Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new �a ZoningDistrict Flood Plain Groundwater Overlay Y I.a CV (-Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting,documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) , Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other - Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: D:Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: 0 existing``❑ neW size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: : Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ' Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER), p _ Name A X Telephone N b r Address License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR-OFFICIAL USE ONLY t APPLICATION# DATE ISSUED MAP/PARCEL NO. C , 1 ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION FRAME INSULATION ix t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT � L y . ASSOCIATION PLAN NO. SMO rCTORS REVIEWED T BARNSTABLE BUILDING DEPT. DATE FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING 11 11 131 ,92 qo 4c — 9a� \ -2W � ss----------------- ' N �I SKtf h•� �� �J G � e f • �1.a.wc� ���ru�� I_— � i b g T--- - i 1C2au-'.��SPA4�> �Q C2��i.L?L SPtc�: Town of Barnstable Regulatory Services * 1ARNSCABLE, MAS& Thomas F. Geiler, Director Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Regarding: 100 Blueberry Hill Road Dear Mr. Payne: Enclosed please find a copy the Town of Barnstable Growth Management Department letter and their requirements to rescind the amnesty apartment. You must comply with the instructions, which have been outlined in their letter. If you have any questions, please contact Cindy Dabkowski at 508-862-4743. Sincerely, Brenda Coyle Principal Assistant Building Department %` Town of Barnstable Zoning Board of Appeals Accessory Affordable Apartment Program Notice of Public Hearing under the Zoning Ordinance 6:00 P.M. -Wednesday, July 13, 2011 To all persons interested in or affected by the Zoning Board of Appeals under Section 11, of Chapter 40A of the General Laws of the Commonwealth of Massachusetts, and all amendments thereto you are hereby notified that the following Public Hearings shall be held on Comprehensive Permit applications pursuant to Chapter 40B of the General Laws of the Commonwealth of Massachusetts and in accordance with Section 9-14 and 9-15 of the Code of the Town of Barnstable: Hearing to Rescind Comprehensive Permit At the request of the Monitoring Agent,the following Show Cause Hearing shall be held to rescind Comprehensive Permit previously issued pursuant to MGL Chapter 40B and Section 9-14 or 9-15 of the Code of the Town of Barnstable: Comprehensive Permit No. 2007-034 Payne issued May 31,2007 to Raymond A. Payne for 100 Blueberry Hill Road Hyannis,MA shown on Assessor's Map 249 as parcel 074. These Public Hearings will be held at 6:00 P.M. in Barnstable Town Hall, 367 Main Street, Hyannis, MA, Hearing Room, 2"d Floor on Wednesday, July 13, 2011. Plans and applications maybe reviewed at the Growth Management Department (3`d Floor Barnstable Town Hall), 367 Main Street, Hyannis, MA 02601, or for more information contact Cindy Dabkowski, Program Coordinator at 508-862-4743. Barnstable Patriot Laura F. Shufelt, Hearing Officer June 17, 2011 and June 24, 2011 Zoning Board of Appeals Barnstable OFtHE .. . �� do AVI fte icaCltll BARNSTABLK 1 ' MASS. F .��' The Town of Barnstable 'In ►� Growth Management Department www.town.barnstable.ma.us/growthmanagement 2007 Jo Anne Miller Buntich Director June 10,2011 Raymond A.Payne 100 Blueberry.._Hill_Road Hyannis,MA 02601 Dear Mr. Payne ; The Zoning Board of Appeals show cause hearing is scheduled for July 13, 2011 at 6:00 p.m. I will need you to submit to this office no later than June 27,2011, 18 first class stamps $0.44 (to notify abutters of the hearing) and 18 post card stamps. Postcard stamps are-$0.28 (to notify abutters of the results) This hearing will be held in the Hearing room on the second floor of the Town Hall building located at 367 Main St Hyannis,MA 02601. Prior to the hearing you should be prepared to submit a check made out to the Town of Barnstable in the amount of$175.00. If you have questions please feel free to contact me. Thank you S Cindy Dabkowski Affordable Accessory Apartment Coordinator Growth Management Department 367 Main St -Hyannis,MA 02601 508-862-4743 367 Main Street,Hyannis, MA 02601 (o)508-862-4678(f)508-862-4782 Engelsen, Jennifer From: Perry, Tom Sent: Wednesday, April 27, 2011 8:15 AM To: Engelsen, Jennifer Cc: Roma, Paul Subject: RE: Amnesty to Family All the applicant needs to do is drop out of amnesty and go to family.There is no rescission necessary -----Original Message----- From: Engelsen,Jennifer Sent: Tuesday,April 26, 2011 2:09 PM To: Perry,Tom Subject: Amnesty to Family Just wondering if you have heard from Cindy Dabkowski regarding 100 Blueberry Hill Road and the rescission process? I am sitting on the permit waiting to give it to Paul. Thanks, Jen 1 Engelsen, Jennifer From: Dabkowski, Cindy Sent: Monday, April 25, 2011 11:28 AM To: Engelsen, Jennifer Subject: Payne - Family Apartment Good Morning Jen Did Mr. Payne fill out an application for family Apartment? If so, what date did he do that? Need this information to begin the rescission process? Thank you Cindy 1 r Town of Barnstable ~� Regulatory Services 9 MASS. Thomas F. Geiler, Director �ATF039. A 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 January 6, 2009 Mr. Raymond A. Payne 100 Blueberry Hill Road Hyannis, MA 02601 Re: Amnesty Apartment Dear Mr. Payne : 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 . , dxw? _ ...K, .,w,,,;; -"?a +"' "�::x rvY .fir';,....-x:,^ r,,^,.+v Mr„^_'r.,: e• p k4^ ,�w .::^�i v.'-xr''' t : ;�'a, 'x .:=.9ra 4�. y".""',^f, y , , ,� :��., ' :t. 't - .,.f-. :.: r� .. ., F k, " '.__' :. s• }r ,.,,c 4 :-:,7 a r%t dx, a ,.5, ,t,:;fs.;.'` ?� „ :t?*. x ms}- :N� :, ,..T•.' 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I� , ".�AI—,s ' � ,: t ram: ? r a t ;r Thts.certtficate tndreates acce table.mtmmum habttable re utrements erMassachusetts St1te.Bwldtng',Code , r, P 9 P r.. a :r. ,T - x t 5,,. !and Town of Barnstable zomn ordinances,in accordance with the:-R;mnest . ro lam g I g c Owner Raymond A Payne r F Location 1,00 Blueberry Hill-Road, Hyannis;MA ti .-'-1,1_',..��'_�0.:��-14��,�,-I."_1'I�-I�-.-,.,' Unit Capacity One be omj` n t to exceed two eo le y A Inspector t c.. . r riI. 1. , , . r M/P N, 249074 J5 _ 9i ..rt k _ 1%Sf2009 . y--_'` I� ei `"ET° Town of Barnstable ' Building Department - 200 Main Street BARNSTABLE, * Hyannis, MA 02601 MASS 9�A 16�9. , (508) 862-4038 rF0 MA'I A Certificate of Occupancy Application Number: 200704875 CO Number: 20080231 Parcel ID: 249074 CO Issue Date: 01/05109 Location: 100 BLUEBERRY HILL ROAD Zoning Classification: RESIDENCE B DISTRICT Proposed Use: MULTIPLE HOUSES ONE PARCEL Village: HYANNIS Gen Contractor: PROPERTY OWNER Permit Type: RCOO CERTIFICATE OF OCCUPANCY RES Comments: AMNESTY APARTMENT ISSUED TO RAYMOND A. PAYNE 0 Building Department Signature Date Signed 09-16-201 1 01 a 25a ry,• TC v. j AUG -1 R30 '52 FD Town of Barnstable Zoning Board of Appeals Comprehensive Permit Decision and Notice Comprehensive Permit No.2007-034-Payne Summary: Comprehensive Permit No.2007-034 is rescinded Applicant: Raymond A.Payne Property Address: 100 Blueberry Hill Road,Hyannis,MA Assessor's Map/Parcel: Map 249,Parcel 074 Zoning: Residential B Zoning District Recording Information Deed Reference: Book 1441 Page 1089 Permit Reference: Book 22210 Page 151 Background: Comprehensive Permit No.2007-034 was issued to Raymond A.Payne on May 31,2007. The permit was issued under the Accessory Affordable Apartment Program pursuant to Chapter 9,Article II of the Code of the Town of Barnstable. The Permit was issued to convert and existing one bedroom apartment n located above the detached garage into an accessory affordable apartment.The Permit and the Regulatory Agreement and Declaration of Restrictive Covenants were recorded on July 24,2007 in Book 22210 Page 00 . 151. x 0 On April 20,2011 the applicant submitted an application to the Building Department for a family apartment. The Accessory Affordable Apartment Program does not allow family members to occupy the affordable unit;therefore the owners can not use the comprehensive permit to maintain legality of the p' unit. N N c Procedural Summary: a A show cause hearing for comprehensive permit number. 2007-031 was duly advertised in the Barnstable Patriot on June 17,2011 and June 24,2011,and notices were sent to all abutters in accordance with MGL Chapter 40B. Hearing Officer Laura F. Shufelt opened the public hearing on July 13,2011 at 6:00 pm. The applicant, Raymond Payne,was not present at the hearing. Cindy Dabkowski of the Growth Management Department was present. Ms.Shufelt reviewed the file and ruled to rescind comprehensive permit number 2007-034 Payne. t Findings of Fact on the Comprehensive Permit: At the hearing on July 13,2011 the Hearing Officer made the following findings of fact: 1. On April 20, 2011 the applicant Raymond A. Payne submitted an application for a family apartment. 2. Condition four of Comprehensive permit number 2007-034 prohibits family members of the owner from occupying the accessory unit. 3. The Accessory Apartment Program Coordinator took action to rescind comprehensive permit number. 2007-034 f Bk 25684 Pg 345 #45944 Town of Barnstable,Zoning Board of Appeals Decision and Notice,Comprehensive Permit No.2007-034 Payne is rescinded A written copy of this decision was.forwarded to the Zoning Board of Appeal as required by the Code Chapter 241, Section 11 of the Town of Barnstable Administrative Code. 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 copy shall be the filed in the office of the Town Clerk. Ordered: Comprehensive Permit number 2007-034 Payne has been rescinded. Appeals of the final decision,if any,shall be made to the Barnstable Superior Court pursuant to MGL Chapter 40A,Section 17,within twenty(20)days after the date of the filing of this decision in the office of the Town Clerk. The applicants have the right to appeal this decision as outlined in MGL Chapter 40B,Section 22, Hearing Officer Date Signed 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 ft�ed in the office of the Town Clerk. AJ Signed and sealed this day o under the pains and penalties of perjury. ,11 /lllll���r. Linda Hutchenrider,Town Clez ',�O. y(�[. '•CPr . . 1 QQ 41 rC X .pp BARNSTABLE REGISTRY OF DEEDS 2 t s. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 7 a bcrTo Map ;2- �/ 9 Parcel 0 7 6!� : 3Q Application# Health Division ? Conservation Division �YJ � Permit# Tax Collector - ,' t�, Date Issued ���► 7 AO' r Treasurer Application Fee !w Planning Dept. Permit Feet Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis � 1 Project Street Addre s -100 AbA ,01&rn2r-" Ua f� A=� Village D Owner 1 Address Telephone b Permit Request aA Square feet: 1 st floor:existing 1356 proposed 2nd floor:existing —7466 proposed Total new Zoning District Flood Plain Groundwater Overlay w1( Project Valuatio Construction Type Lot Size p Grandfathered: ❑Yes ❑No If yes, attach supporting documentation: DwellingType: Single Famil Two Family ❑ Multi-Fam' #units Yp g Y Y ) Age of Existing Structure Historic House: ❑Yes �No On Old Kin 's Highway: ❑Yes No g 9 9 Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 2—S3 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: X11 Gas 11 Oil Wlectric ❑Other 4 C' ( Central Air: ❑Yes XNo Fireplaces: Existing New Existing wood/coal stove: ckYes�: ❑No -� �. Detached garage:9existing ❑new size TV91 ° Pool:❑existing ❑new size Barn:❑existing D�new csize 4�r Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: cn F Zoning Board of eals Authorization '95 Appeal# f�®(��— 0 3 Recorde Commercial ❑Yes No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ��� r FOR OFFICIAL USE ONLY 4 PERMIT.-NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER 1 DATE OF INSPECTION: ` FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH + FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL i FINAL BUILDING + 111 j DATE CLOSED OUT ASSOCIATION PLAN NO. _ 1 SMO ETECTDRS REVIEWED BARNSTABLE BUILDING DEPT. DATE FIRE DEPARTMENT DH.TE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING ryT i 1- 1 ' 3�vt a G�tif�J � CA i i�� �b 9-� �-------- -- -_._ ..._ �t � I � ( � L _; � � � � � � C _. � i1- j � ! i i � -`L I lei ��� �—.... __. �._ .' �__ � V �� �yry u �� �` 17 C S __' i j� , I 4- - —l— z� �, 1� I Bk 22210 P:u 155 `43665 REGULATORY AGREEMENT AND DECLARATION OF RESTRICTIVE COVENANTS THIS. GULATORY REEMENT and DECLARATION OF RESTRICTIVE COVENANTS,is made this day of f ,2007,by and between Raymond A Payne of 100 Blueberry Hill Road, Hyannis,MA an its successors and assigns (hereinafter the "Owner"),and the TOWN OF BARNSTABLE (the "MunicipaW'),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: A. The terms of this Agreement and Covenant regulate the property located at 100 Blueberry Hill Road,Hyannis,MA as further described in deed recorded herewith as Barnstable County Registry of Deeds Book 1441,Page 1089. B. The Project located at 100 Blueberry Hill Road,Hyannis,MA will consist of one accessory apartment unit which will be rented to an eligible low or moderate income individual or family(the "Designated Affordable Unit" or the "Unit"). C. The Owner agrees to construct the Project in accordance with the terms of comprehensive permit Appeal No. 2007-034 and any plans submitted therewith and all applicable state, federal and munic' 1 ws and regulations Said permit is recorded herewith as Barnstable County Registry of Deeds Book-- &Page D. The Owner agrees to occupy the principal dwelling unit located on the property as their principal 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 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 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 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 party or by which it or the Owner is bound,will not result in the'creation or imposition of any prohibited encumbrance of any nature. 6. The Owner,at the time of execution and delivery of this Agreement,has good,clear marketable title to the premises. 7. There is no action,suit or proceeding at law or in equity or by or before any governmental instrumentality or other agency now pending,or,to the knowledge of the Owner,threatened against or affecting it,or any of its properties or rights,which,if adversely determined,would materially impair its right to carry on business substantially as now conducted (and as now contemplated b this Agreement) or would materially P Y � ) Y 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 n,mmng with the land shall be deemed to be satisfied in full and that any requirements of privileges of estate are also deemed to be satisfied in full. C. LIMITATION ON PROFITS 1. The Owner agrees to limit his/her profit by renting the Designated Affordable Unit in perpetuity to a household with a maximum income of 80% or less of the Area Median Income (AMI) of Barnstable 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 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. III. 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 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 MSA.In the event that utilities are separately metered,a utility allowance established by the Barnstable Housing Authority shall be deducted from the rent. IV. RECORDING OF AGREEMENT: Upon execution,the OWNER shall immediately cause this Agreement and any amendments hereto to be recorded with the Registry of Deeds for Barnstable County or,if the Project consists in whole or in part of registered land,file this Agreement and any amendments hereto with the Registry District of the Barnstable Land Court (collectively hereinafter the "Registry of Deeds"),and the Owner shall pay all fees and charges incurred in connection therewith. Upon recording or filling, as applicable,the Owner shall immediatelytransmit to the Municipality evidence of such recording or filing including the date and instnnment, book and page or registration number of the Agreement. 2 `7 V. 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. VI. NOTICE: All notices to be given pursuant to this Agreement shall be in writing and shall be deemed given when delivered b hand or when mailed b certified r y y o 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. VII. 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 attorney's fees necessitated by such actions. VIII. 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 2.6 which shall run with the land described in deed recorded herewith as Barnstable County Registry of Deeds Book 1441, Page 1089 and shall be binding upon the Owner and all successors in title. This Agreement is made for the benefit of the Municipality and the Municipality shall be deemed to be the holder of the restriction created by this Agreement. The Municipality has determined that the acquiring of such a restriction is in the public interest. The Municipality shall not be subject to the defense of lack of privity of estate. The covenants and restrictions contained in this Agreement shall be deemed to affect the title to the property described in deed recorded herewith as Barnstable County Registry of Deeds Book 1441, Page 1089. IX. 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 ounty Registry of Deeds or Barnstable County Registry of the Land Court as the case maybe,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. X. SUCCESSORS AND ASSIGNS: 3 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, (ii) are not merely personal covenants of the Owner,and (iii) 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. XI. DEFAULT: If any default,violation or breach by the Owner of this Agreement is not cured to the satisfaction of the Monitoring Agent within thirty(30) days after notice to the Owner thereof,then the Monitoring Agent may send notification to the Municipality that the Owner is in violation of the terms and conditions hereof. The Municipality may exercise any remedy available to it. The Owner will pay all costs and expenses,including legal fees,incurred by the Monitoring Agent in enforcing this Agreement and the Owner hereby agrees that the Municipality and the Monitoring Agent will have alien on the Project to secure payment of such costs and expenses. The Monitoring Agent may perfect such a lien on the Project by recording a certificate setting forth the amount of the costs and expense due and owing in the Registry of Deeds or the Registry of the District Land Court for Barnstable County. A purchaser of the Project or 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. MI. 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 WI-EREOF,we hereunto set our hands and seals this/4-1!iay of 2007. OWNER BY: L�4^44AA h1'1. ,-P1.1L41yV1 s" Printed:Raymond A.Payne COMMONWEALTH OF MASSA=ETTS County of Barnstable,ss: On this_e day of 2007 before me,the undersigned notary public,personally appeared <1 rs d 06,V4e ,the Owner(s),proved to me through satisfactory evidence of id ntificaiion, ch were 4114�6. �> f6zdz 4S, ,to be the person(s) whose name(s) is signed on the preceding or attar e�i d document and acknowledged to be that he/she signed it voluntarily for the stated purposes. Notary Public Printed: o My Comnvssion Expires,,Z,ye " -Zv/4/ 4 TOWN STABLE BY: ;7NMANAGER COKMONWEALTH OF MASSACHUSETTS County of Barnstable,ss: On this a day of 2007-before me,the undersigned notary public,personally appeared C� �- irnr+n ,th Town Manager for the Town of Barnstable,proved to me through satisfactory evidence of identification,which were t _,to be the person whose name is signed on the preceding or attached docume acknowl ged to be that he/she signed it voluntarily for the stated purposes. t Not Public Printed: My - sion Expires: OFFmsM� MANAOUM MYCmm E*m MM 5 BARNSTABLE T0W11 ;;; ;� '07 MAY 10 P' :20 Town of Barnstable Zoning Board of Appeals Comprehensive Permit Decision and Notice Appeal 2007- 034 -Payne Decision - Chapter 40B Comprehensive Permit Applicant: Raymond A. Payne Property Address: 100 Blueberry Hill Road, Hyannis,MA Assessor's Map/Parcel: Map 249, Parcel 074 Zoning: Residential B Zoning District Applicants: The applicant is Raymond A. Payne, who resides at 100 Blueberry Hill Road, Hyannis,MA. Mr. Payne was granted title to the property by deed recorded in the Barnstable County Registry of Deeds on July 1, 1969 as recorded in Book 1441,Page 1089. 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 II of Chapter Nine of the Code of the town of Barnstable, more commonly termed the"Accessory Affordable Apartment Program." The zoning relief necessary for this Comprehensive Permit to be issued is that of a variance to Section 9- 14 of the Code—Amnesty Program to permit an accessory apartment unit adjacent to,a single-family owner-occupied residential dwelling. The issuance of this Comprehensive Permit would allow for an accessory affordable apartment unit above the detached garage. Locus and Background: The property at issue is a 0.37-acre lot located at 100 Blueberry Hill Road in Hyannis. The lot was developed in 1967 with a single-family cape style home. The effective living area of the main residence is 2,965 square feet. The accessory apartment is a one-bedroom unit located above the detached garage. 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. The Town of Barnstable's Public Health Division reviewed the application, and on February 15, 2007, approved a total of three (3)bedrooms at the property with the existing on site septic system. Procedural Summary: A site approval letter was issued for the property by Town Manager John Klimm on March 16, 2007, in accordance with MGL Chapter 40B and 760 CMR. Notice of the site approval letter was sent to the Department of Housing and Community Development in accordance with the requirements of CMR 760. An application for a Comprehensive Permit was then filed at the Town Clerk's Office and the Office of the Zoning Board of Appeals. A public hearing before the Zoning Board of Appeals Hearing Officer was duly advertised in the Barnstable Patriot on March 30, 2007 and April 6, 2007, and notices were sent to all abutters in accordance with MGL Chapter 40B. On April 25, 2007 Hearing Officer Gail Nightingale presided over the public hearing. The applicant, Raymond Payne,was present at the hearing. Madeline Taylor,of the Growth Management Department was also present. Ms.Nightingale reviewed the file with the applicant to assure compliance with all of the program requirements. Findings of Fact on the Comprehensive Permit: At the hearing on April 25, 2007 the Hearing Officer made the following findings of fact: 1. The applicant is Raymond Payne who resides at 100 Blueberry Hill Road, Hyannis, MA. He is requesting a Comprehensive Permit to convert an existing one-bedroom apartment above the detached garage into an accessory affordable apartment. The conversion of the unit to an accessory affordable unit within a single-family owner-occupied residential dwelling qualifies for the "Accessory Affordable Apartment Program." 2. Raymond Payne was granted title to the property by deed recorded in the Barnstable Registry of Deeds on July 1, 1969 as recorded in Book 1441, Page 1089. 3. On March 16, 2007 a site approval letter was issued for the property by Town Manager John Klimm, in accordance with MGL Chapter 40B and 760 CMR. Notice of the site approval letter was sent to the Department of Housing and Community Development, in accordance with the requirements of CMR 760, and no issues were communicated from the Department on this particular application. 4. The proposed accessory affordable unit is approximately 650 square feet, and is located above the detached garage. 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 Wellhead Protection Overlay District. The proposal has been reviewed by Thomas McKean,Health Director, and he has approved a total of three (3)bedrooms at the property with the existing on-site septic system. 7. On December 13, 2006 the applicant signed an Accessory Affordable Apartment Program Agreement Affidavit that commits,upon the receipt of a Comprehensive Permit, to the recording of a Regulatory Agreement and Declaration of Restrictive Covenants at the Barnstable Registry of Deeds. That document will restrict the unit in perpetuity as an affordable rental unit and requires that the dwelling be owner-occupied as his principal 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 the Barnstable Metropolitan Statistical Area (MSA) and further agrees that rent(including utilities) shall not exceed 30% of the monthly household 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 April 25, 2007, 6.2% 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. 2 Finding Summary: Based upon the findings,the Hearing Officer ruled that the applicant has standing to apply for a 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: Based upon the findings, a ruling was made to grant the Comprehensive Permit in accordance with MGL Chapter 40B to the applicant, Raymond Payne. It is issued to allow for a one-bedroom accessory affordable apartment unit in accordance with the following conditions: 1. Occupancy of the affordable unit shall not exceed two persons. 2. The total number of bedrooms on the property with the existing on site septic system shall not exceed three (3). 3. The property owner shall occupy the principal dwelling as his principal residence. 4. This unit shall not be occupied by a family member of the owner(s). 5. All parking for the accessory apartment and the main dwelling shall be on-site and no lodging shall be permitted on-site for the duration of this comprehensive permit. 6. 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 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. 7. All leases shall have a minimum term of one year. 8. The Growth Management Department shall serve as the monitoring agent for the accessory apartment. 9. The applicant must apply for a building permit for the accessory unit,whether the unit is new or pre-existing. Before securing an occupancy permit and certificate of compliance, the Building Commissioner must determine that the unit conforms with the approved plans as submitted with the building permit application and meets state building and fire codes. The Health Division must determine that the dwelling is in 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 Growth Management Department of the town of Barnstable as a qualified individual. The applicant will be required to work with the town to provide information necessary to document that 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 Growth Management Department and the unit must be listed with the Town. ' 3 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, the applicant shall file with the Growth Management Department 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 the Barnstable County Registry of Deeds. If the ownership of the property is transferred,the Growth Management Department of the town of Barnstable shall be notified within 60 days of the name and address of the new owner. 13. This Comprehensive Permit must be exercised and the unit.occupied within 12 months of its issuance or it shall expire. Ordered: Comprehensive Permit 2007-034 has been granted with conditions. A written copy of this decision shall be forwarded to the Zoning Board of Appeals as required by the Town of Barnstable Administrative Code Chapter 240, section 11. 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 copy shall be the filed in the office of the.Town Clerk. Appeals of the final decision, if any, shall be made to the Barnstable Superior Court pursuant to MGL Chapter 40A, Section 17, within twenty (20) days after the date of the filing of this decision in the office of the Town Clerk. The applicant has the right to appeal this decision as outlined in MGL Chapter 40B, Section 22. In accordance with Chapter 241, section 11 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 April 25, 2007. Fourteen (14) days have elapsed since the transmittal to the Board, and no Board Member has taken action to reverse the decision. Gail ightingale, fing Of r Date Signed I, Linda Hutchenrider, Clerk of the Town of Barnstable, Barnstable County,Massachusetts,1ereby certify that twenty(20) days have elapsed since the Zoning Board of Appeals filed this decision and that no appeal of the decision has bee filed , the office of the Tgwn Clerk. Signed and sealed this �j day o/ �24vj �' under the p ins and:pcmalties of.peijtiry. Linda Hutchenrider, Town Clerk 4 Town of Barnstable Regulatory Services yBMWSTABM MAW. A Thomas F.Geiler,Director �'OTE039n. e Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 October 18, 2006 Mr. Raymond Payne 100 Blueberry Hill Road Hyannis MA 02601 Re: Illegal Apartment: 100 Blueberry Hill Road Hyannis MA 02601 Map: 249 Parcel: 074 Dear Property Owner: Our records indicate that your house at the above-referenced location is currently being used as a multi-family home, which is contrary to Barnstable Zoning Ordinances. Violation of zoning ordinances is a misdemeanor, conviction for which results in a criminal record. You must contact this office within 14 days to either: • Apply for a building permit to restore the property to a one-family home • Apply to the Amnesty Program • Prove that this is a legal multi-family home. Please contact this office immediately to tell us what direction you wish to take. Sincerely, Lin dson esty Zoning Enforcement Officer Building Department gforms:zoning3 Map Page 1 of 2 Town of Barnstable Geographic Information System New Search H, Parcel Viewer I FCustom Map Map Size Zoom Out In AM, y ® 7PG Map: 249 Parcel: 074 F 2SO001 Location: 100 BLUEBERRY HILL ROAD I 49069 4 24 t70 .249071. #Q79 Owner: PAYNE, RAYMOND A 249072 56 �#64� 1249:C373P�:: 24913 #82 2490 __.___..._..._..__. _.-----__...._..__._.._..__._..._..__._._.....__._.._..__._____._.__........ 49t18 #a52 #"10 - Location Information 42 Map & Parcel 249074 49067 250044 Location 100 BLUEBERRY HILL ROAD 2:: 249n77 �` 249075tiQ2 #895 249153 Acreage 0.37 acres #•59 249076 �� g#81 49083 105S0O1 Current Owner 131 249' 78 Mailing Address PAYNE RAYMOND A 50 249122 n 100 BLUEBERRY HILL RDA 249123 f 77 249 4 HYANNIS, MA 02601 24.9079 40A2 249125 3 21 1491 6S � :#lib 249126 Appraised Value (FY 2006) #67 #113 249127 Extra Features $7,900 249 UW #t23 249©80 2491 6 *76 249119 : Out Buildings $1,700 #72 #57 # Land $136,000 r7 249130 "fir 249115 249117 # 76W 249129 - Buildings $289,500 #,56 24911.8 A. 112 128 Total Appraised $435,100 9081 #4: 249 PP '83 `61 122 249114 Assessed Value FY 200 # 39 24.91'13 i Extra Features $7,900 2405 24 1 • ` t #474Og4R Out Buildings $1,700 " ' 744 249111 Land $136,000 Buildings $289 500 I Total Assessed $435,100 Set Scale 1" = 211 Aerial Photos �F Copyright 2006 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS BarnstableMA v0.2.7 [Production.) http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=249124 10/18/2006 RA o rt'C2 St 2E ►l n /l /1 MIA AA n n A ,41 oo f i I WALL S� S � C _ t J V v (/ /7 �v(J!�(.'tJG�� Ld S� tL t . r-n v of I) ArT/D Al Vtl/4Zt- I F,nvw6 S ' ►� 8�'G1Srt�lil� �L,a�� Su�l� 7�tcl� The• olvn of Barnstable 4 .�l 5 VAR, 1, 2U07 1 '04PM NO. 269 P. The Town of Barnstable Growth Management ]Department h 367 Main Street,Hyannis,MA 02601 Office: 509-862-4678 Ruth I Weil,Director Fax_ 508-862-4782 FAX DATE: March 1, 2007 TO: Linda FROM, Maddie RE: 100 Blueberry Hill Rd, Hyannis FAQ(: 790-6230 # pages: 2 including cover sheet Linda Vol forwarding you the letter that Mr. Payne sent me as proof that his apartment existed prior to 1/1/2000. Let me know if Tom approves this. Thanks, Maddie Town of Barnstable °^ Regulatory Services • sAxxszAsLE, y MASS. g Thomas F. Geiler,Director �A .i6gq ♦0 rF1639 Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 AMNESTY APARTMENT VERIFICATION Re: ,iJiS C� After reviewing the street file of the above named property, I verify, to the best of my knowledge, that the apartment was in existence before January 1, 2000. SPA Tom Perry Building Co mmi sioner vAR, 1. 2007 .1 :05PM NO. 269 P, 2 Housing Division Barnstable Town Mall 2(lu1 MAR - I PN 1: 04 South Street Hyannis,KA02601 Uijri�I Attr Madeline My son lived in a 1 Bedroom apartment that is over our.garage at 100 Blueberry HUl Rd. Hyannis,MA 02601. Raymond A.Payne,M lived in the apartment from raid 1989 to mid 2001. Raymond A. Payne,Jr. Raymond A.P e,M Town of Barnstable IMM� E Regulatory Services r-- - ---- _ ._ -- ----- -- - Thomas F.Geder,Direc 2.5 C 17 P 9 121 3 16 v u 4- . an�vsr�si.e, �o t-z '� `""S&039. Building Divisiol 20 201 1 & s 1 2 559-* 10�Ev �► Tom Perry,Building Commissioner--- — 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 AGREEMENT FOR FAMILY APARTMENT I(We),the undersigned, being the owner(s)of property situated at 100 Blueberry Hill Road,Hyannis MA, holding title under a deed recorded with the Barnstable County Registry of Deeds or Barnstable County District Registry of the Land Court in Book 1441, Page 108,90r as Document No. ; being shown on Assessors' Map 249 as Parcel 074, hereby agree, certify, warrant and represent to the Town of Barnstable that the accessory attached apartment, which contains living quarters, is intended for use as a family apartment, for year- round occupancy. This unit shall be used for a"Family Apartment" (as defined in Zoning Ordinances) which would require compliance with the Family Apartment Rules and Regulations. The family apartment unit must be7mccu ied o b --o p y�the property owner or a member(s) of the property owner's family as accessory to an owner-occupied singleifaniily residence. 'q s Occupant(s)of Main Residence: Raymond A.Payne Jr. C) Relationship to Owner: Owner 6 cry Resident(s)of Family.Apartment:Raymond A.Payne Ill, tv Relationship to Owner: Son CO M This unit shall not be rented as an apartment or as a sing le room, or in any fashion,which rental would be a violation of the Town of Barnstable's rules, regulations, and zoning ordinances. Prior to occupancy of this unit, affidavits reciting the names of occupants are to be recorded with the building department. This agreement shall be updated whenever a change occurs or every calendar year. This Agreement shall be duly recorded or filed at the Barnstable County Registry of Deeds/Land Court for the purpose of alerting future owners of the property of this binding Agreement concerning the use of the property as herein stated. The consideration for this Agreement is the issuance of a building permit and/or certificate of occupancy by the Town of Barnstable Building Department. WITNESS our hands and seals this ay of 20j-/. TOWN OF BARNSTABLE OWNER(S) By: v lam. P Rayrriond A.Payne Jr. omas Perry,Buildin C ssioner THE COMMONWEALTH OF MASSACHUSETT BARNSTABLE COUNTY, SS Date Then personally appeared the above-named. (owner), , and made oath as to the truth of the foregoing instrument,before me. Notary P lic My Commission Expires: gsample , , 6. i ��� �.. �.�._�. _ _ ._ � r. . • -^t. 1: F � � - k - - � - � 4 k i` _ ._ ._ tt _ i 6 ; - _ �. s __. n. _ „a i ! I Town of Barnstable Regulatory Services oF1"En Thomas F. Geiler,Diree%4AJ J QF ,ZTKUL Building Division , STA Thomas Perry;CBO,Building C0J'I)fiiAi%ie? - 37 ier 1639' 1% 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 DIVISION Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is Al A Pa rW� -`- I am the owner/resident of the property located at: ,� �y �/i y/l,t9V Hy,✓1 A/ry `S The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: .Name &relationship to owner: Sa� i�4�'m e� veer , ^�%�' � Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this _ day of 2012. 5a -z z 5 a Si p" atuii Phone Number Print Name 17,4Y1syew,0 /4 q:forms/famafd.doc rev 11/08/11 { Engineering Dept: (3rd floor) Map Parcel C1 : Permit# House# /Oa ;,8� ,0./` v✓EGG/�ipate Issued k a. Board of Health(3rd floor)(8:15=9:30/•1:00-4:30) ® "lo Fee Conservation Office(4th floor)(8:30- 9:30/1:00=2:00) - ZG �' 1NS7. Ep I I - MU 'r Planning Dept (1st floor/School Admin. Bldg.) De ' iv a pproved by Planning Board- 19 BARNSTARLE. 1 _ MAS& v J QED 39. TOWN OYBARNSTABLE Building Permit Application Project.Street Address : l�� &t'u.� lrlr i /� , Villager '1-1 Ru�4 ku l d S r f OwnerT�AT,c'1CJCs d �I /�i9YWE ji, Address /do 3Lu %'�eyy�l �1,'r! '�2d �C►. Telephone d 8- 3 I G - q :Permit Request � C1L► �. " F First Floor / Z square feet Second Floor square feet Construction Type T' T(t)ba Estimated Project Cost $ �°Ga Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family [Af Two Family ❑ Multi-Family(#units) Age of Existing Structure /y6y Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: 0 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No . Fireplaces:Existing New. Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) - • ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name GL Telephone Number Address License# Home Improvement Contractor# rt Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THFOLLOW NG REASON(S) _ - I FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO: ADD RESS ESS VILLAGE` x ' E OWNER . '_ _ ° -- -, •.W �� . _ a a.,` • ... ,' 1 A ( � f + ` - ..X ^ :`. ^ r.f t. _ ' �-� ' .5� ; DATE OF INSPECTION: FOUNDATION FRAMEY s INSULATION r— F FIREPLACE '1 ELECTRICAL: ' ROUGH ' FINAL t PLUMBING: TROUGH FINAL GAS: ROUGH f FINAL FINAL BUI€6)lNG'° x ' DATE CLOSED OUT ASSOCIATION PLAN NO. E 9 4 b J • TOWN OF BARNSTABLE ' - . . BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION lease print. DATE g'Z 77 JOB LOCATION /va L uG / e d6 12 w Number Street address Section of town "HOMEOWNER" 775- 31 ej-7 Nafae Home phone Work phone PRESENT MAILING ADDRESS "'• City town State Zip code The current exemption for "homeowners" was extended to include owner-occupies dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends to re- side, 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 Offic'_ on a form acceptable to the Building Official, that he/she shall be resnonsih for all such work performed under the building permit. (Section 109.1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the St Building Code c and other applicable odes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comp with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings. 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 01 Construction Control. �,, _ \ / STANDARD LEGEND i ' 5 . -J _-_ / \ 5 8° J d / note:not all symbols will appear on a map ll r a r-...........__� ••.....,� \ \ '`- .->a, GOLF COURSE FAIRWAY r .._._._..__..._, I °"3 DECIDUOUS TREES g° 7 \ \ ' ..__.. ........ .._ EDGE Of BRUSH Y 1 � / _....-- ., ORCHARD OR NURSERY ....,,.' -.z CO I ` - L.—.__,,.v _ 71 NIFEROUSTREES ,J: \ 5 �.'� MARSH AREA , l .......Z_ '=_-•_. - ,� EDGE OF WATER -. (T � DIRT ROAD \J / I UfDRIVEWAYS <�._".. ..,_/ -- _____ - h• `\ E---,—PARKING LOT PAVED ROAD \ ' < DITCHES PATH TRAIL / C S ..= \ \ / q o PROPERTY LINES J 1 \"� �q -, rr / \ LOT ACREAGE 21—PAR EL NUMBER / HOUSE NUMBER _/ ?�-<° ^-tl` 2 FOOT CONTOUR LINE k --. 10 FOOT CONTOUR LINE 72 J 36 AC Y , �"••'i. '" ' ( x" SPOT ELEVATION / 73 �-E�:36.AC 1 ,'' STONE WALL -,•- ,. /�. L� r, i 1 !`� ,, �l� "--� /� FENCE 1 � f ` f -\, •/ .,"'_,.' •\ / RETAINING WALL RAIL ROAD TRACKS TELEPHONE POLE '-+ :• _--- ;� •rO.37 AC STONE JETTY -,' SWIMMING POOL _ ..._ .. PORCH/DECK , r � l tF° BUILDINGS/STRUEURES �/ �����--,-, � /, I ♦ + LUCK/PIER/JETTY ASSESSORS MAP BOUNDARY , ITE MAP ' i x 7.0.8.GEOGRAPHIC INFORMATION SYSTF MS UNIT 5 �,i 8° i r r d, 0 30 60 \ / SCALE: n feet `7 / _ / i �., Property lines shown on this Ian 1 INCH =60 FEET �\ are for assessing purposes only N }, \ G relationships i `H e and do not represent actual � to physical objects fE ,H:hax'dR�aiunn 0.35AC. 0.37AC Y - 7MIT] JI NDiE IIIE PAR([1IINE THEY ONE NOT"'N"ITRUE ACATIO NiAIlINS of 5 ° PROPERTY B011NDARIE5 THEY ARE NOT iAllE LOCATIONS<ihe394 !: r / FROM 90N,TOPOGRAPHY IANDGH S,PHOTOGRAPHY HOTO R A DATA INTERPRETED r ° ,�.,/ FROM 19A91AERIT OVERFLIGHTS,A DI HYOIA I1 100' I,J-� \; MAPPED Al OD.PARCEL DATA DIGITIZED FR =R(�1 i ��`..:� 1 A DS IGOGRA i V I i `•� j,.. 1 ��l 1 ENGINEERING ASSESSORSMAP51995 r µq f I P r �. 1 OFFICE AND MODEL HOMES: PINERIDGE ASHLEY DRIVE, CENTERVILLE, MASS. ��%f/ (�� TEL. (617) 775-6812 (617) 428-9101 gal 000 00❑ k7 Tne le WOOD DECK Cape living at its best— intriguing country kitchen with dining area separated from spacious living room by WITH SEATS complete red brick fireplace wall. Sliding glass doors lead to massive deck. Three charming large-closeted bedrooms, 2 full ceramic baths. Complete wall to wall carpeting and Whirlpool appliances. Full basement and oversize garage. Beautifully landscaped for easy care. BEDROOM AWN BEDROOM OR DEN LIVING ROOM 13'x 11'4'. 20'x 13' c. c 13'x 11'4" GARAGE N 12'x 22' Builder on premises daily (including Sundays) 9 a.m. —6 p.m. FOYER B'x 12' MASTER BEDROOM c. F ° W DIRECTIONS: 14'-6"x 12'.B" = O m ^ F%� DINING COVERED m O g m 12 x 14 ENTRANCE Cross Sagamore Bridge, follow Rt. 6 to Rt. 132. Right on Rt. 132 for 11/2 miles to right at traffic I_I light (Phinney's Lane) 2 miles on Phinney's Lane to right on Rt. 28. 1/4 mile on Rt. 28 to right at Old Stage Rd. (Howard Johnson's and Mobil station at traffic light) 11/2 miles on Old Stage Rd. to PINERIDGE on left. ( 68' y G' 6 F: ------------- 36 1 b G v� 3/y� d2c1� Nei �Jv ----------------- N be t 1 �U o• %�4X 1�y Q Assessor's map and lot number ..... � �FTNETO • r SYSTEM MUST Sewage Permit num ber SEPTIC o INSTALLED IN COMPLIA WITH TITLE 5 = 339SBSTADLE, House number j4?...........................................................:...... A M6 s• 0� ,ENVIRONMENTAL CODE '�, TIONS TOWN OF BARNS'A L BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....&? .>r.1)...... ..................................................................... } TYPE OF CONSTRUCTION ..... .c' .......................................................................................................... ........................19 f 'TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the. following information- Location /1 ... .......................... 1 ...�.�..^.... t .../.��.119 1:......�[.�. ll. !��..... ................................... ........ . ...................... ProposedUse . '?.............................................................................................................................................. Zoning District ............. ....................................................Fire District .Cf !1 � l/ ® .�1///�.�.......................... Name of Owner � 41y!! . 4 �2r/ ...................Address le, J.. GUi? ..�<..�%�M.................... Name of Builder J� "e ..Address Name of Architect .... ...............................................Address ........................................ ............................................ // Number of Rooms r�n"�'' .............................Foundation .r���...��/.. FAA'/6. �...fi�.� � fvGl''j Exterior .... !. lT�.. / °..........� � e'�����i....................Roofing .. P✓ .1.. �dlA��l% ............................................. Floors '1'/F.��.... ? ../.. ...................7�R..'fl. t..............Interior ...16,54 _! LYE................................................... HeatingGC/`.............................................................Plumbing ......M � ,.................................... ... ............................... p 4 Fireplace .. p.dd ..............................................................Approximate Cost J/ ..!Jl>. .. ... ................................... .. Definitive Plan Approved by Planning Board ________________________________19________. Area Diagram of Lot and Building with Dimensions Fee .......<..!'. SUBJECT TO APPROVAL OF BOARD OF HEALTH A6 P. y VQ re t4. tt �01 o C5 O 4 r� � C • t a r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. .................... Name la.rm. 4 .A. P. Construction Supervisor's License ..0.1. 3! .......... .... ................... PAYNE, RAYMOND A. JR. 28541 Addition '--Jwo ................. Permit for .................................... ........S.ing.l.e...Family...D.wel.l.i.ng....................... . ...... . . ...... ...... . ...... . . .... Location ....1.00...B.lueb.e.rry...Hill. ...Road........... ..... .. . .... . ...... . ...... . .................. annis............................................. Owner Raymond A. Payne, Jr. .................................................................. Type of Construction ....Frame...................................... . ............................................................................ Ploit ............................ Lot ................................. Permit Granted ...Octaher...L.5..............19 85 Date of Inspection ... 19 Date Completed ......................................19 cc 064 40 The Town of Barnstable '� ,e�' Department of Health Safety and Environmental Services "9► Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissions For office use only t Permit no. Date AFFIDAVIT ' HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with ce ain exceptions,along with other requirements. Type of Work: ?ov6 A Est. Cost �S� Address of Work: /®b �nerlsName A �eofermit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING ' WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL G 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the a t oft a owner. 4 lim-441A4 a, Date C 1191 Name Registration No. OR M The Contnton ivealth of Afassac h w eas Department ojlndustrial Accidents ii. ` flicea/lnvesU9211ors Vi' \ i 600 11'ashittl;fait Street Bosto».A1axs. 02111 Workers' Compensation Insurance Affidavit _.Pli se PRINT Ieb �c�tion•,�bd �L �r /j2 Y�J y� I� �� am a homeowner performing all work myself. `I am a sole proprietor and have no one working in any capacity �'!•+ 1.....�.—.+MM.i.sw��rS T..�wr�:/.7�7xr!v�.T .. .^'�..�/��•w.�r.�..T..•.�w.�.I;• �w+'.._r....�... [j 1 am an employer providing workers' compensation for my employees working on this,job. comnanv name: address• city: Rhone#• insurance co. pour # [1 I am a soie proprietor. general contractor, or homeowner(circle are) and have hired the contractors listed below who have the following workers' compensation polices: comnanv name: address• cih: nhonc#• insurance ro. Holier 0 � •i-"."_ ,_..'=wry.._ _ _�.�t.._ a =- -- �P-__•':,:S��l<iT•'S!1aw•y .�7T.:.__ _ .�.�...�_..._...-.T_ cmmpanv natnc: address- city: nhonc#: insurance co policy 0 Attach additional sheet if necessary-= :r ^- __ --+ :�� _' a.'�'r.•�`._y�'' _ ':'~'�— Failure to secure curerace ns required under Section:SA of N1GL 152 can lead to the imposition of criminal penalties ol'a lineup to S1.500.00 andiur one wears' imprisonment as swell as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that n copy of Misstatement may be forwarded to the One of Investigations of the DIA for coverage verification. I do hereby cerrift•unrle r-pains and penalties of perjun•that the information provided above is true and correct.es Si.nature —P-,�� " 47 Dat / G-2 7�7 Print name Phone# wrcrr (.<offlcial use unly do not twrite in this area to be cumpieted by city or town official r� city or totwn: permit/license# nlluilding Department (31.icensiog Huard I]check if immediate response is required C3Sclectmen's Office t C)llcalth Department phone#: rnOthcr contact person: is r Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for the employees. As quoted irom the -law'% an emplitree is defined as every person in the service of :mottle under any contract of(tire, express or impiied. oral or written. An enrplarer is defined as an individual. partnership, association. corporation or other legal entity•, or any two or mo: the foregoing en�-a�_ed in a,joint enterprise, and including the le-al representatives of a deceased employer. or the receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However tl•. owner of a dwelling house haying not more than three apartments and who resides therein. or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwellin`_ he or on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employe MGL chapter 152 section 25 also states that even- 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 commoirweaith for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit compietely, by checking the box that applies to;your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law"or if you are require: to obtain a workers* compensation policy. please call the Department at the number listed below. C►tv or towns Please be sure that the affidavit is cornplete and printed legibly. The Department has provided a space at the bottom c the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding tite applicant. Pie be sure to fill in the permit/license number which will be used as a reference number. 77he affidavits may be returned the Department by mail or FAX unless other arrangements have been made. The Office of Investi=atioils would like to thank you in advance for you cooperation and should you have any questic please do not hesitate to give us a ca11. The Department's address. telephone and fax number. The Commonwealth Of Massachusetts N Department of Industrial Accidents �r•,. _.. Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 n.tinnn ��it7) 727-4900 (%,t_ 406. 409 or37S The Commonwealth of Massachusetts ' Department of Industrial Accidents " Office of Investigations 600 Washington Street << Boston,AM 02111 www.mass.gov/dia " Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information -9 Please Print Legibly Name(Business/Organization&dividual): Address: City/State/Zip: Phone.#: 3!5r -7 Are you an employer?Check the appropriate bog: .Type of project(required):. 1.El I am a employer with 4. ❑ I am a general contractor and I 6 New construction . employees(full and/or part-time).* • have hired the sub contractors listed on the-attached sheet. 7. ❑Remodeling 1.0 I am a•sole proprietor or partner- These sub-contractors have ship and have no employees 8. Demolition employees and have workers' working for me in any capacity. 9. ❑Building addition comp, insurance.$" [No workers comp.insurance 10.❑Electrical repairs or additions r ed.] 5. [] We are a corporation and its 3. I am a homeowner doing all work . officers have exercised their ME]Plumbing repairs or additions ' myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.0 Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam' an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$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 maybe forwarded to the Office of Investi ations of the WA for insurance covers a verification. I do hereby certify under the pains•and penalties of perjury that the information provided above is true and correct. - Date; Si ature: Ph 7 Official use only. Do not write in this area, tb be completed by.city or town official City or Town: ' Permit/License# Issuing Authority(circle one): .1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: �L ETati Town-of Barnstable Regulatory Services s"rr Thomas F.Geiler,Director y MASS. �prE e3 BuRding bivision D MP Tom Perry,Building Commissioner 200 Main Street, Hyanri ,MA 02601 Office: 509-862-4038 Fax; 508-790-6230 Permit no. Date • AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 1.42A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion, •improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than for<r dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost 0.� S� Address of Work: 61-0 Owner's Name: Date of Application:_ Q 44 , g 7 I hereby certify that: Registration is not required for the following real on(s): []Work excluded by law ❑Job Under$1,000 OBuil. ' not owner-occupied pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORD DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. • SIGNED UNDER PENALTIES.OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR . v 2dte er's Name oF'THE rp� Town of Barnstable Regulatory Services EAMSTAEM : Thomas F.Geiler,Director MASS. �pt i639• a.�� Building Division - ED fMA'I Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 y HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: t number street /// village "HOMEOWNER": name IF home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable.Building Department. minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. v ignatur of Ho eowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109,1.1-Licensing of construction Supervisors),provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the,permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt iTHE TOWN OF BARNSTABLE BARNSTABLE, M JAW8& 039. 11 NO BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...dalZY...d.....Me../a/ -6z C TYPE OF CONSTRUCTION ...yra ewe................................................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..z .... a�. Y Proposed Use ...... . . .... .................................................I...................................................... ....... ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner 4 ..............Address �'Q... W'* Name of Builder 7 a...............Address Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms ..............I..................................................Foundation ...)IMMe(! ............................... � ;e Roofing ..A1jW)a11t1........................................................ Exterior e�6w-�Al..... Floors ......& ..............................Interior ........ Heating ........ ............................Plumbing T .l _ Fireplace .......1 ...........O��Ce.._ ..........................................ApproximatL Cost ...... .'Difinitive Plan Approved by Planning Board -------------------------------19 (72k 0 FOR Diagram of Lot and Building with Dimensions THE,PROPO.SEDMETHOD OF PROVIDING SANITARYWATER SUPPLY, SEWAGE' DISPOSAL > AN.DDRAINAGE ISH-E13EBY APPROVED m TOWN -OF BARNSTABLE, z U) BOARD OF HEALTH v M0 U) > M Z7 C-P L9 0 M M > M Y H It Odd I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... ..4............................ | Payne, Raymond A. Jr. No ...�9�... Permit for ........9�]M..AtgKY."...... � _.- . ��l�l��' ��� 1 w4� � Location Hill Roads ' -----'�X!�Mni s................................................ ` Owner .............. ...... . � . Type of Construction ......fMrW--------.. \ . � | ' -^^^^^..................................... ........ .......^^^^--`' / / Plot ............................ Lot --...~.��o................. . | � ^ ' Ao ' Permit Granted --. ~............3.......... -.]V -^ , Do*s of Inspection .... '� ^�-----..l~x�4» /�u/ -r- — - , Dote Completed ...................................... � � | / PERMIT REFUSED ` / � .____,_-_.--.----------.- lg . ' ------^--------------------- ` ' ^---.-_...--------.---...------,' ` ...~------.---.---..~--.--~----. ---------'~'-------'~-^'-^---^' . � Approved .................................................. lq � , ' -------..------.--------..-.-.. . '----------------~--^^'~'--^'^' � U � � 0 ' | Town of Barnstable Geographic Information System May 5, 2015 250001 #979 249072 #76 }„g " �2Z 248073 #62 ' V ," �����r� �•� �" 250044 #995 84 UEgE�RrH�LE R� ,i O l 249076 #$1 249075002 #99 249075001 0 23 Feet #105 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:249 Parcel:074 a boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map Owner: PAYNE, RAYMOND A JR Total Assessed Value:$369900 are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.37 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location: 100 BLUEBERRY HILL ROAD ° such as building locations. Buffer r,