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Home My WebLink About0130 BRISTOL AVENUE - Amnesty A'sfiv L. . a uu i s Ox�brd NO. 752 1/3 ESSELTE 10% ® o 0 Town of Barnstable Regulatory Services ppZHE Tp� o Richard V. Scali,Director RAaxsrasr.E, Building Division MASS. Paul Roma,Building Commissioner 039. 'OTEpc+a 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us' Office: 508-862-4038 Fax:. 508-790-6230 i Approved: Fee: Permit#: Z HOME OCCUPATION REGISTRATION Date:Name: ,u P-A N /I N`P l7 e -50 us Al Phone#: q 14 60i�T Address: tqZ/S�� / A y V Village: . Name of Business: u A A --te n. p�� Type of Business: t'A i Nf EQ Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve She production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,.glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials, or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling I,the undersigned, a read anfl agree with the above restrictions for my home occupation I am registering. APPlicant: r r t Date: 2dl Homeoc,doc Rev.06/20/16 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must must do by M.G.L.-it does not give you permission to operate.) ou first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is required by law. DATE: s� j Fill in please: �'A s011 APPLICANT'S YOUR NAME/S: BUSINESS YOUR HOME ADDRESS: JL-Z" y1' <:,'r TELEPHONE # Hom�Tglgp #: /--�� E-MAIL: NAME OF CORPORATION: "f " NAME OF-NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATIPN? YES NO ��I _ I ( ADDRESS OF BUSINESS. . f� C MAP/PARCEL NUMBER I I Assessin9) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO T02 ain St. (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. PATION '1. BUILDING COMMISSION�ERCIISOE MUST COMPLY WITH HOME OCFAIL RE TO This individual has be .of an e e uirements that pertain to this type)obusinessRULES AND REGULATIONS \ AMPLY MAY RESUL_� �� INE�: Authorized Si n ure** COMMENTS: 2. BOARD OF HEALTH - This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS [LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: . , I . qb Town of Barnstable *Permit# � � Building Department)§er�vices Expires 6 mon/ts from issue dale ee snuaszeBM Brian Florence,CBrO® Building Commissioner MAES, J�5 .()D rFn t 200 Main Street,Hyannis,MA 02601U�, www.town.barnstable:ma.us ,r� Office: 508-862-4038 � ` f d �. � Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY q ! �� Not Valid without Red X-Press Imprint Map/parcel Numberj� �_ n ' Property Address I,�(� I [ 1'I V I Residential Value of Work$ - O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Ro-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is requic d. SIGNATURE: Q:\WPFILES\FORMS\building permit fonns\EXPRESS.doc 08/16/17 2'li-e ComwolnreaM of sadlrusdis I��eFz�cr,f 1rnilrrstrial`AccitleF�ts 600 Washington Sltreef Gastrin,A1`A 02111 tvrvt m=gov1dza Wiarkere Campensatsanlnsm-auce Affidav&$mldersiCantractarsMectrxms/Plmmhers AppHcant Tmfa=3iiun Please Primt Lem iIp Nm=03U,f �ann,f;rsn r�" - R� Address- 1,30 STo�- c Phono.-Ik- Are you an eatpkUer?Che-ckthe appropriate bc= ' Type of project a (reTlimd)- ra ❑L ElempIaye�p(adr part. ime * ❑I am a general confmckm and -final a hiredfTse sulr�kractom 6. Mesa consfira iatz �Ti 2.0 lam a sole proprietor organ sfed onfhe attached sheet. . ElRPmodelirrg ship and have no employees . Theme sob-can2ractors have �,❑De=Ution la dhare wodrs' ,�vp Dinar farrne is any �' � ��an # • 9. El B,uildiu�addition tV lJt G t& Comp.Vie: ccnnp-mertran required-j 3. El We are a-cotporafionand its 10-0 Fieoxica repairs ar-addition3.0I am a homeomaer doing alb work Offices have"rscised their 1 L❑Plutabiagrepais s or additibns. sel£ o wokkers' - right of exemption per MGL y msuraneere�uifeLj Y c.15Z§In andwe have no 1�❑Rflafrepairs employees-(Noworlers' i3_❑Other cozp-insurance required-] J . *Any apgB=tfat checabozl tmost sisa ffie�tha secBoabeLoa 53xEnamg @ieQwo�ces'c®peasaliaupoytgix�oamvua� I Fameawnemwho submit cbis sffi&ng indfczffmg&--y amdain.-agvrak-4&MMM autddecontna=mmst submitanews:Mdxt mdicsiian such rCo t�u2checicihisbmcmusts=r% maaddifianalshEdshovff=gffienzmeofthesate-cant=tDm sad stsiewhethesarnotfbaseawi&sbwe employees.Iftbesabtaatradaeshise enP1gYee,they mastrm ddett&wadmis'tamp.pally mmebrs I alll all etttpIa�r ffirrtisprmzdir��orkers'cot�rLsrr�ari i�szirarrca�vr rrt}*cmFln3�es SeTnpv is Ylt�pali��and jeb sd� irtfot irrab-arz IasuraaceCompanylfai ew 'Pffficy�ar�f--ms_I.i�.� I�piEafiaa.Dafe: ' Job Site A dr Cityl5tafelzip: Mach a copy of the workers°compensatiQapoELydectaration page(showing the poficy number and expiTltion date). FaRm,e to secure coverage as requirednade:r Sack-on 25A of MGL(--157 can lead to the imposition of cr mi nai penalties of a fine up to$I,540:OD an&Gr one year impdsonmeut5 as we11 as civil penalties in the form of a STOP WORK ORDER and a tine of up to$254-00 a day aaamst the violatar- Be adsdsed f mt a copy of this statemettit,utay be forwarded to the Office of Inestsgations of the DIAL for ins=ce cavemge t rnti� Ida&erghy irder frts prritcs ar�psrraItins a.flrer�ci?'fhattiEa icfornza#zmB prm-T aBmrw is bars ari�d arrrect Simaaiure Date i 2 Pitons 1�8 36 t?, aL uss aratfy. Da not as�reta gat tip area,irr be cairsgfete�d by r-ify artanv�t CRT or T'a n: Pernritll itense# )mdng Authority(tdrde One): L Board-of ffealth ,Ihiddiug Deparbnent 3.Cityfruvm Cletk 4.Electrical I'uspectas 5.Pbumibmg inspector 6.Other Contact Person: Phone#: — -- --- 6 r Town of Barnstable Regulatory Services dF Richard V.Scal4 Director 0 Building Division . Paul Roma,Building Commissioner ��i$ 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 i HOMEOWNER LICENSE EXEMPTION NZ4 1 Please Print DATE: 011 � JOB LOCATION: 1 v5)6�— PNE number street village "HOMEOWNER": CQjz)--&,f& kj�` SUS ,3s1 �� name {��1 home phone# work phone# CURRENT MAILWG ADDRESS: r y 13dy- �I y)1 MAR 0 2&)— Aityhown state zip code The current exemption for"homeo ers"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 buildingpermit. (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 and geed"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection proced d requirements and that he/she will comply with said procedures and requirements. Signature Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fomvs\E)TRESS.doc 06/20/16 Town of f BarnsWtrabi e _ *Permit# " Tres 6 months rom issue date �. Regulatory Services ll-* e MA & Richard V.Scali,Director 'L` 6 FD ' Building DivIS10l , Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ��]I O Not Valid without Red X-Press Imprint Map/parcel Number ` Property Address 130 3Qi SV(J%• Arm. CK Residential Value of Work$ 2-(.0•0D,, Minimum fee of$35.00 for work under$.6000.00 Owner's Name&Address Pao Cj a UbgJ6, Contractor's Name O�,t�o�� Vz— Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows < #of doors:15 *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE: Q:\WPFILES\FORWbuilding permit forms\EXPRESS.doc 01/25/17 Commorrirerrlth of Marsadusedts D,epartneut qf f'kd=, trid Acciderds Office of1m.wWgad&= . ' SdD Mashurglouy�treet Rarstcrn�AIA 02111 i-PFPi1zlflamgovMa; Workers' CampensafrcmInsuEmnceAffidavit:Bide>-dCnntractarsMectdci�ns(Fhoinbers Applint Iuformatian. Please Prbzt E 'bIp Name(E�=fza Address: 1,30 citytstn " Are YOU an employer?Check- the appropriate born ' Type of project(required}: I El4. I am a general conirsctor and I 6. New oansix�cfion❑ employees(Rd andfor part-time).* ❑ lime hired Hie aeir cank�a�rs 2. I am a sale proprietor orparbmr- Tidied on the attached sheet.. 7 ❑R=odeling ship and have no employees 9-sub-con base 9- ❑Demolitioa wod-inb forte in any capacifg employees andhare wo6cers' 9. ❑H,uildiug addition [Idaarrs' camp.i �rance comp_�„�•�, j 5. ❑ We are a�cc aporafion and its IO-❑Elegfdca repairs or additions 3.Xeiair am.ahomeorumerdoingalltrm& officers have�esascisedtheir 1L❑Fh=bsngre-paiasoradditions Myself o wo�rlrets' u of exemption per EI(Z 7 c.I52, 1 aadwehaveno I�❑Roofrepairs inenianre recluized�1 � ('� . employees-[No wo&ers' b.❑Other condo.msaras,ce required.) *Amy apg&amtdhatcbedabox inmnstaLsaflleat esectioabeIaashmaia�itie¢wo�cexs}compensaiinupoTiapinformsao� &aaleoaraetswlao Salt ibis�da«E indxraiing tBey Yifidm'81Fvra�c rho tfieahaE aa�decoatmtmrs�st.sahautanetvaffzds�t mdicabnfl sacs_ fCaa>zacQo�s Est cbecf fLis boot must Imchad sa ad ixB zl sheet amwi g than=.e of the sub-cantsctam sad staf a wbegm or not Those mdtks bnn- empluees.'if thesab-caatradneshm employ rhey�stpmt ide thou srorkess'ramp.palm mm�brs I alit art eutplopr Mat isprmidbW warkes compmstdurn in=rancs for ray emphlees Below is fiia pagcy imd job sde intfor nzatiom �ffiCe:GO�aIl�'1�E: ' I'aficy#or Self-ems.I ic. piratiaaDate: Job Tite Addre GifyfSfafed sp: Attach 2 copy of the workers'compensation.policy-decIarat7um page(showing the poficy number and expiration date). Failme to secure coverage as required under Section 25A of MGL c 157 care lead to the imposihm of criminal penalties of a fine up to$1,50O.OU aadlor one-year imprisonment:as w611 as civil peaalti,es,m the fort of a STOP WORK ORDERand afire of up to OO a dap aatast the violafar. Be adcased tiiat a copy of this sWement.maybe farvrarded to the Office of Invesfigaiions of the DIA for ihsuranct-coverage uredfl ion- , Ido her-4gby order fire pains andpenaNes a.fFerjury thatthe ircf ormaf ni-prolufed abnar a Fs true art�d c arrect Si2Batnre Irate: G�6 Pius 30 3960 a,�iaL�rxrtF}. D�a nrrt rr'rtta�ti�area,€rt be t:trrrnpletc�d by�arten�u rm�uial Cite or Thwa: PermitMicense# Leg Aaflority(cacleone): L Board of Health r.Building Depm m.cnt 3.CAyfrowa Clerk d.Electrical Inspector S.Phrm:bmg Impector G.Other Contact Person: Phone,#: - 6 luformation aura fustructions to W06X 'campensaiian for their empIoy�- M�cc In.ce#ts Ge�PaalLaws M req�es �oY� 1 � p this ,an e�layee is defJned as¢_ aypersonin.the service of another ffider any conixart ofhae, express or finpHe .oral or writrm . An employer is defined as can mfiyidnA partxrership,asmcb ion,corporation or other legal e�tdy,or any two or more . ofthe foregoing is aJ� •and mchadmgthe Iegal=presenteives ofa deceased employer,or Hie associafinn or othexlegal entrty,�ploymg�109�- However the yg or ttustee of an indrviffiA P . or file o OHM- owner of a dwelling house having not more than tbree apartments and who resides ffimeirt, c dWeIIIng house of another Soho e�Ioys pmmm tD do make,COnSfrIICt16II or repair work on such awepIDg house or on the gmnods or bmldmg aPPmt n�thereto sbannotbecanse ofsarh e�aploymedbe deemedto be an=aployea" MOL chapter I52,§25C(6)also states thataevaysfaf-e or local licensing agency sh2RwithhoId the issuance ar r eaewal of a$cease or permit to operate a Tress or to construct biffffk s is the corumonwealth for any S tiTi the incaTanCe coverage required_" applicantWILO has notprodnced acceptable evidence of cdmpTfance Additionally,MOZ chapter 152,§25C(7)states-IWth=the cozm amwcala nor aay ofi[s political snbE isians shall enter mto any contract for theperforman Z ofpublio workuntil acceptable evidence of compliancev hh.$e msm-E.m._ euffr ofth>_is chapterhaveteenp=mcaEdto the mnftarimg.aathoiiyy:' AppHaxids Ple are fill oiot tine woj='compensation affidavitcompletely,by d=Jdng&0 boxes that app1Y to your srtnafJ an and,if necessary,sagely sub-curt actar(s)name(s), addresses)and ph m mrober(s)along writ then=t1Eic2de(s)of or Li�dLiabfiityPa t=sbips(LLP)Td&no �IoYees other than the insnz-Ence. Laoit�d.I-iab�y Campantes(IZ� members or par ne as,are not rbquaed to carry wo]3Le compensation fiL= m If an LLC or LLP does have employees,apolicyisregnfivi. Beadvisedthat this affida:vkmaybesnbmit-�d to,theDepartmentof rndnsf W Accideat for conEmiima m of ft=m ce coverage Also be sure to sign and date the affidavit The affidavit should be r�tumed to$e city or town that the application for the permit or license is being requesir no t hire D epartm a of Irshstzial A c - m±L Mouldyon hate any questions regmdmg the lazy or ifyou are required to obtem a wozk=' compensationpolicLpleasecaaf2aDeparimeatEatflt,' nbeaHYLDdbeIDW- Self-fim�=npanies should cat rtheir. seIf-Tnsurmce1=WD=Mberan the appropriat 1me. City or Town Ofacials f Please be sure that tiro affidavit is complete andprintra IegIly. 'Ihe Departmenthas provided a space of the bottom of the affidavit for yonto fill out inihe event the Office oflnvm_-gafl=has to coutactyou Inmdiag applicant. Please be sure to fMmthe itpen censenumberwhichwry.beusedas areefr=cezrIImbez In adddion,an applicant that musE submit mu11Ie permrtllicease appIicdions in arty givenyear,need only submit one affidavit indicating c=ent p olicy infozmatioa(ifnm sary)and under-Tob SRM-AA&Me the,applicant should write"sII locations in (city or .t[) n)."A.copy of�a affidavitthiathas ben officiOY s m3Ped az ma kedbyAhe city or tovm maybe provided to i3re applicant as proof that a valid affidavit is on file,for fitfine p®its or liD=m A new affidme mist be filled of teach ny businez or cornm year.Whem a hom citizen.is owner or citiurnis obtaining a license or pcunit not relate caX Iete this affidavit er�al ve e ' tobleaves e#c.)saidpegsonisl?OTreq to a dog license orpennit evmP The Office of InyesffgEjinns woIIldlfke to thank you in advance for your cooperation and should you have any qmestions- please do nothesjta to gtQe m a call- The Tlepsrfinemfa ad&mr.,telephone and fax number: -TEt CW21tlr of 11acl�nst(s , Depaitnent cif is AOidents osfa �MA E2111 Fax#617-727 7M Kevised¢24-07 W W W-m&,v-gqTIffk Town of Barnstable Regulatory Services dE tbryti Richard V.Scali,Director Building Division t HARNSTABM Paul Roma,Building Commissioner MAM 039• �� 200 Main Street, Hyannis,MA 02601 Fp www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: 01� Please Print JOB LOCATION: number ((''�� stre�etl� village "HOMEOWNER": Hat- 13��"�^ SUS ,36) 3�� U name home phone# work phone# CURRENT MAILING ADDRESS: V0 6 1S NOS, ity town state zip code The current exemption for"homeo ers"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 and 'geed"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection proced d requirements and that he/she will comply with said procedures and requirements. Signature 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 lackof awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit formsEXPRESS.doc 06/20/16 Town of Barnstable Regulatory Services Richard V.Scali,Director 1;►`� Building Division. Paul Roma,Balding Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.as Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I a j c c(b y61\rt, ' ,as Owner of the subject property hereby authorize to act on my behalf in all matters relative to work authorized by this bu ld;ng permit application for. (, R 9.i LS Th l` 4W PYW)n LS_ MIA (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 in pections are performed and accepted. Signs a of Owner Signature of Applicant Print Name Ptint'Name Q Date QFORMS:OWNEUERMISSIONPOOIS Town of Barnstable .*Permit# e-l� Expires 6 months from issue dwe �s Regulatory Services Fee 3s; = saxxsrAIUX, MAC' Richard V. Scali,Director rAff Building Division Tom Perry,CBO,Building Commissioner MAY 0 3 2 i 200 Main Street,Hyannis,MA 02601 www.towmbarnstable.maus TOWN OF BAHIVS AABLI Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press.Imprint Map/parcel Number Property Address--136 DR13TOL AUE Residential Value of Works$ 1200-00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address MG'tr C � C� y6� Contractor's Name k a if Ce�6 C.C%rzf�5\`� Telephone Number.Sna -367�3 tO Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor . I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit., Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side t- �(] Replacement Windows/doors/slidefs.U-Value -27 (maximum.32)#of windows #of doors: �- ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is r quired. SIGNATURE: Q:\WPFILES\FORMS\building permit fonms\02RESS.doc Revised 040215 -�r ?lie Cmunromvealitit ofMawadi Tegs Depa7bmeut ofIndusfyid Accidews Office o0M.Wstigadom 600 Wadington Street __ Boston,MA 02111 immmasmgorldia Workers' Compensation Insurance ffdavit- ]B..uiildeFs/Cmftmzisr-JMecbcrcianslPhumbers Applicant Infarm a#$an Please Print F,e�"bIY -7 4- Adam 130 WOOL AT ��-eit3 l tam cmr>'s NAP Phone:-,rt-S p8 367 a3�6 C) 7ElAreu an employer? eckthe appropriate bax: 'Type of project(required). am a employer with 4 ❑I am a general ccatmctor and I' employees(fall armor part-time), art time). * 3iave hired the salt-camttacEors 6- El New constrn ion 2.El am a sole pzopEietor orpaz tour- Tisted on the attached sheet; 7. ❑Remodeling slv p and have no employees These sab-conftactars have 9- ❑Dean, Worl-ing far me in any capacity. employees and hate wogs' [No worloars'comp-i acnranre COMP-%isuranCe 1 9..❑Ruilc5ng acIdifica required-] 5_ ❑ We are a corpmmfim and its 10-❑Eled dCal repairs or additions 3.�f am.a homeowner doing all work ofiicets have wised their 1L0 Plumbingrepairs or zudditians mpsief[No workers' tight of em=pfibn per MGL L.❑Roafrepairs insun=e reed-]1 c.152,§1(,96 andwe have no employem Wo woslcess' 13-❑Other comp.insurance,required-] #stayKnHCsntfstcbeda box#l==also Mont*asectionb9ow:dW�gam-=w=jewcamp=mfi apaycyinfiommsaaa ��nmeoamers Who saha�tt this af#idasir in�cating#hey are rlaia�sIE Wu�aa�tfiea h¢e outside caatracmrsaaast snitmit a nem affida�t indicatiag sack. fCaastactoFs tbzt rbedr this box mast atteriv sa additional sheei shouTng the n=e of the sub-con=ctom sad state Whether Gnat thnse ewitkSbave empbyees.IftbesnB caattadv6haveempIo s,tTieYmustpmuidetbeir warkers'v=p.paHun=mber- I am an empZqyer ficat'is prauidirg ivarkers'compemniiaii insurance far wry'empLay�ee Below is the paLicl and job sr'te irzfbrmatiors Insurance Company Name 'Policy 44 or f ins.Lc-4: ExpindanDate_ Job Site Address` City Stafelzip: Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and expiration date). Failue to securer coverage as regdhed.under Section 25A of MGL a 1572 can lead to the imposition of caimmal penalties of a fine up to$L50a 00 andl'or one-year imprisonment,as well as civil peuallies.in Ifie form of a STOP WORK ORDER and a Rue of up to$250-0 0 a day apinst the violator. Be advised that a copy of this stateme t=ay be forwarded to the Office of Investigations of the DIA€ar insurance coverage vedfication- Ida hereby fI aatder the pains and penaWes qfpedasy thatthe� infbrau6=provi d a a is hire and correct Ss2nature_ Date_ O�S/" 6 Phone .SOS 3f—' -73%C) 0joW l=a only. Da cast tw*e in flab area,is be compLeted by city artomn offrdaL City or Town: PerffitlLicense ig Luring Aatls4rlty(dude onej: L Board of M21th 1 Building Department 3.Clitytrowa Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other contact Person Phone#- _nfor mation and lastrac ions M.as�ems Gc=al Lams chapter U2 regahes an employers`0 prffv&WOLI£ea.B'=31ptUSatlon for tileiF employees. pmsaanfto this sf�e,an.wgrky=is defined as."_.evray person m a service of aaother�der any contract ofhu�., express or impliecL oral or " Au av pioyEr is defined as-an indxviduat,partaet�,associatron,ccnporatton or oiizer legal enfdy,or ax[y two of more of the fior,going is a joint uprise,and mclndhig the legal sepres�f-olives of a dEceased employer,or e receiver or trasfee of m mdYvidual,puership,assoai,-d or otherlegal entity,employing emPloyees. However the owner of a dwelling horse having not more than 13aree apartmeats and vvho resides therein,or the occupant of the- dwEMng house of ano5ier who employs persons to do maims ce,cans ruct on or rPaa•work on snch dweIIing house or on.the grounds or builling appurtenant therein ffiOnotbeuanse of sash employmeutbe d=mIedt o be an employer." MGL chapb�r 152,§25C(6)also stars fhat"every state or IocaI Rcensi g agency sho withhold•Hie issuance or renewal of a Reese.or permit to operate a bgsmess or to construct buRdings in the comm o wealth for airy applicant who has not produced acceptable-evidence of cdmpf=m Wita tiro inc-irr-ance coverage regnse&' Additionally,MCsL chapter 152, §25C(7)sites mNeithorthe commmrwe:an nor icy ofits political subdivisions shall cur into any contract for the penance ofpublio vvor3cur�I acceptable evidsace of complian.cewith the iiJ.s¢rance. requiz-enjents of this chapter have been presented to the ca„fra�,a anthozify_" Applicascts Please fOl out the worb='compensation affidavit completely,by checking the boxes that aPPIy to your sitnation and,if necessary,snPply sub-confractar(s)name(s), aacbw(e s)and phone unmber(s)along with their cestitic at*) of insr¢ance. Limited Liability Companies(I.LC)or Limited LiebrTrty partnerships(LT P)with no employees other than the members or partaeas,are not required to carry worker'comPensation iasarance_ If an LLC or LLP does have employees,apolicy is require d. Be advisedthatfais affidavkmaybe sahmi.tDd to the Department of Industrial Accidents for confirm nion of irmir` ce coverage Also be sin a to sign and date the affidavit The affidavit should be retrm red to the city or town that the application for the permit or license is being rvinestA no t the Department of T„ri rT. aT!i_=denis_ Mb you have auy qu�hans�m.g the law or if you are recp=ed to obtain a workers' compensatonpolicy,please call the'Departmer¢atthemnmberlistedbelow, Self-fimiedcompariesshonldentertheir self-insurance license number on the appropriate line. City or Town Officials c - Please be sai a that the affidavit is complete and Aria ed IeglIy. The Department has provided a space at the bottom of the affidavit for you to fll out in the event the Office ofluvesf gait aS has to contact You regirrdmgthe applicant Pleas a be sin a to MI in the pen�jit(licrose comber which wM be used as a reference namber. Ia addition, an.applicant tfiat must sabinit multiple per .itlliceuse applimions in auy given year,need only s°bmit one affidavit indicatmg c=m3t policy infb=,-&on(if necessary)and under"Tob Site Address"the applicant should v site"all Iocxiicns a (may Or town)-"A copy of the-affidavit that has been. m offieiany stamped or amced by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fnt ll a pezmits or licenses A new a$tdavit must be fMed out each year.Where a home owner or cif is obtaiizing a license or permit not related to any business or commercial 76nfra-e CLo. a dog license or permit to bum leaves etc.)said person is NOT requirmd to complete this affidavit The Office of Investigations would h -to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a mM The Departments mess,telephone and fax number: Tha CDMMMWeattb�Of Ms, ach�t�s of lnd eparlmimt ial Aden Qf ac-e of Inve&tikatiom - Bo MA E2111 Fax 617727 7M Revised 4-24-07 gav I of tt�rqy, i F F + F T F� f -. , 0 ,� Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstabl a.us Office: 508-862-4038 Fax: 508-790-6230 Property O r Must Com etc and S' This Section Using Builder I. er of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this b ' ding permit app ation for: (Address of Jo ) Signature of Owner Date Print Name ` If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q g :WPFII.ES 0R AMuildin permit formsUMRESS.doc Revised o4o215 Town of Barnstable Regulatory Services ` dFs rqj, Richard V.Scali,Director ti Building Division Tom Perry,Building Commissioner KAM 1659. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEEMMON DATE: /V.3I I Please Print JOB LOCATION: I N3 V 13 P)J *- AUE ''number street village "HOMEOWNER": NI Ci rC 'C� ( �►rah SLE 3�60 name home phone# work phone# . CURRENT MAILING ADDRESS: P6 6Ga( Iq°3 lri M 07-60) °/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 reMonsible 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 undersi d `homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures r ements and that he/she will comply with said procedures and requirements. Signature of 14neowner Approval ofBuilding 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 EREEMMON 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 when the homeowner hires unlicensed persons. In this case,our Board cannot results in serious problems, particularly w proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. . To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 Town of Barnstable ZHE Regulatory Services � Tn. Richard V. Scali,Director STAB Building Division 9 MASS. �$ Tom Perry,Building Commissioner s639. iOrFn rna't°r 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: l2,* �3 Fee: '�S Permit#: a o so y S HOME OCCUPATION REGISTRATION Date: O Name: �g.P � 1�7� Phone#: Address:_ 0O Phis rL /,,it (ya H hi S ,lfrr Village: Name of Business:__Z—,E-,t l a P_e 6 ----------------- Type of Business: eel;- L'2h 7�?/ Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are.no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: IP120 l� Homeoc.doc Rev.103113 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: U��' Fill in please: APPLICANT'S YOUR NAME/S: Y.FP 6e, 5�t CSC BUSINESS YOUR HOME ADDRESS: t o t 1 9 1,61 V Up 4,2hi S na TELEPHONE # Home Telephone Number NAME OF CORPORATION: NAME OF NEW BUSINESS TYPE OF BUSINESS e6r h IS THIS A HOME OCCUPATION? YE9 NO ADDRESS OF BUSINESS MAP/PARCEL NUMBER a`T% D 9. (Assessing) When starting a new business there.are several things you must do in order to be in compliance with the rules and regulations of the Town of. Barnstable: This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO ISSIO ER'S OF ICE This individ al h s e ncnto d f a pe it re uire ents that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATIQN RULES AND REGULATIONS, FAILURE TO A hori i ** COMPLY MAY RESULT IN FINES. OM EN . } 2. BOARD OF WEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Town of Barnstable * Regulatory Services * BARNWABLE, MASS. zbgq' �� 039. i Thomas F. Geiler, Director Building Division Tom Perry Building Commissioner . 200 Main Street, Hyannis, MA 02601 Officer 508-862-4038 Fax: 508-790-6230 MEMORANDUM TO: Cindy Dabkowski FROM: Lois Barry DATE: 4/26/10 RE: AMNESTY CERTIFICATE Here is the Amnesty Certificate of Compliance (original for applicant and copy for your records) for: 130 Bristol Avenue, Hyannis" J030623a M '4 4 ; t Arnne�t: Pro ra�r Y n., J VTO HeIping ;to< makeafford�able housing poss�ble.�� Arb 4 '. .. �_. ,,.own qj 'g�- U,, V 34?5, ertl l c ate o o mp lance This certificate indicates acceptable minimum habitable requirements per,Massachusetts State Building Code kid and Town of Barnstable zoning ordinances in accordance with the Amnesty program. Owner Marcelo T. Cerq ueira Location 130.Bristol Avenue; Hyannis, MA Unit Capacity Stud'. "ot to exQfed two people tab Inspector M/P No. 291099 4/26/201-0 f Town of Barnstable Regulatory Services + BAMSTAeLE. « MASS. Thomas F. Geiler, Director t6g9. �� plE039 ' 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 April 26, 2010 Mr. Marcelo T. Cerqueira 130 Bristol Avenue Hyannis, MA 02601 Re: Family Apartment Dear Mr. Cerqueira: Enclosed is the Certificate of Occupancy for your family apartment. Sincerely, Lois Barry Division Assistant Enclosure faco Town of Barnstable Building Department - 200 Main Street BAP.Nsz"LE. *Mnss. Hyannes, MA 02601 A y � - 16��. . (508) 862-4038 RFD MA'I _ Certificate of Occupancy Application Number: 201001051 CO Number: 20100055 Parcel ID: 291099 CO Issue Date: 04/26110 Location: 130 BRISTOL AVENUE Zoning Classification: RESIDENCE B DISTRICT Proposed Use: SINGLE FAMILY HOME Village: HYANNIS Gen Contractor: PROPERTY OWNER Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: AMNESTY APARTMENT ISSUED TO MARCELO T. CERQUEIRA LL -/6-(" f&� Building Department Signature Date Signed P, INE TOW lbF BARNSTABLEBuilding Application Ref: 201001051 • BARNSTABLE, Issue Date: 03/24/10 Permit MAS& 9� i639• Applicant: CERQUEIRA,MARCELO T ArFQ MPS A Permit Number: B 20100472 Proposed Use: SINGLE FAMILY HOME Expiration Date: 09/21/10, Location 130 BRISTOL AVENUE Zoning District RB Permit Type: AMNESTY APT NO CONSTRUCT RES A' Map Parcel 291099 Permit Fee$ 25.00 Contractor PROPERTY OWNER Village HYANNIS App Fee$ License Num Est Construction Cost$ 0 , ` Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND EXISTING STUDIO APARTMENT,LOWER LEVEL THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: CERQUEIRA, MARCELO T BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 130 BRISTOL AVE INSPECTION HAS BE MADE. HYANNIS,MA 02601 Application Entered by: LB Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORAirY OR PERMANENTLY ENCROACHEMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS: MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 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.142A). r . a w .' Wig}' .. ri ".0 k.,- t. ..:.', „3-z,.:. �.` •.r'.' , .,. -.:_ .R... 4 N c`°4, � hSrxl.ize; BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health i ` TOWN OF BARNSTABLE BUILDING PERMIT,APPLICATION J ' !t Map Parcel �� ' :-,.,Application Health Division Date Issued Conservation Division ;Application Fee Planning,Dept: Permit Fee; fI� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis e 7. Project Street Address _1Q.- S ICU A-yA& Village h h I Owner 'MCA Y-Ce� 0 1" O t r(A u e I r&,1 Address Telephone J_f?1� 969 D Permit Request 5 I°1`I 1 l Square feet: 1 st floor: existing proposed ;2nd floor: existing proposed Total new Zoning District P1 Flood Plain Groundwater'Overlay Project Valuation 311 000.00 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting-docugntation. Dwelling Type: Single Family ' .. Two Family ❑ Multi-Family(# units) 'i Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's - ighway.�4❑Y ❑ No .. a, ca Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other rrn� Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing. new Half: existing new Number of Bedrooms: e ' n _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: �1 Gas ❑Oil ❑ Electric ❑ Other Central Air: .�r Y s ❑ No ; Fireplaces: Existing New Existing wood/coal stove: ❑Yes)J-No Detached gar xisting ❑ 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) YarG610 Name 7 C6' M Telephone Number Address b 30 13!e t SQL AY , License# Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ayig S} t FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER c r DATE OF INSPECTION: FOUNDATION FRAME INSULATION ' FIREPLACE t. ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL e. GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT t ASSOCIATION PLAN NO. BARNSTAI'LE LAND COURT REGISTRY p{.THE Ip� ti `OSjU_ !, ✓3 • y mores. g. ' fl • QED Md Town of Barnstable /-oning Board of Appeals Decision and Notice Comprehensive Permit No. 2009-029 Marcelo T. Cerqueira To legalize the use of a separate studio living unit as an affordable unit pursuant to Chapter 9 Article II S Section 9-14 of the Code of the Town of Barnstable Applicant: Marcelo T. Cerqueira Property Address: 130 Bristol Ave Hyannis, MA Assessor's Map/Parcel: Map 291, Parcel 099 Zoning: RB Zoning District Deed Reference: Certificate 187142 Applicant: The applicant is Marcelo T. Cerqueira, who resides at 130 Bristol Ave Hyannis, MA. Mr. Cerqueira is the owner of the property as evidenced by a deed recorded on October 15, 2008, at the �— Barnstable Land Court Registry, in Document 1,099,729 certificate number 187142. Locus & Background:. The subject property is a 0.26-acre lot, initially developed in 1959 as a single-family dwelling. Today the raised ranch style dwelling has 1,344 sq.ft. of living area. The lot is served by public water and a private on-site septic that is approved for a total of four (4) bedrooms. At some point an.additional living space that includes a kitchen area and combined living sleeping area situated in the lower level of the dwelling was added to create a separate living unit. ,It— Relief Requested: Mr. Cerqueira, as the owner of the property has applied for Comprehensive Permit pursuant to Chapter 40B of the General Laws of the Commonwealth of Massachusetts, and in accordance with Chapter 9 Article II of the Code of the Town of Barnstable. More specifically Section 9-14, the amnesty program provisions of the "Accessory Affordable Housing Program" for the additional living space in the dwelling. This permit is sought to correct the situation of an unpermitted apartment unit as provided for in the Town's Accessory Affordable Housing Program provided the unit is restricted to being affordable housing for qualified persons as required under Chapter 40B. The zoning relief necessary for this Comprehensive Permit is that of a variance to Section 240-13.A (1) Principal permitted uses in the Residential B Zoning District to permit a second independent living unit in the single-family zoning district. The issuance of this Comprehensive Permit would allow for the approximately 615 sq.ft. studio living unit to remain only if the unit is used as an accessory affordable apartment unit and the main part of the dwelling is owner-occupied. Town of Barnstable,Zoning Board of Appeals Decision and Notice, Comprehensive Permit No. 2009-029—Marcelo T. Ce.rqueira Procedural & Hearing Summary: The applicant initially made contact with the Accessory Affordable Apartment Program Coordinator and completed the Site Approval Application in February 6, 2009. Notice of the site approval application was submitted to the Department of Housing and Community Development on March 17, 2009, in compliance with 760 CMR 56.00 "Comp. Permit; Low or Moderate Income Housing" Based on that application, Town Manager, John C. Klimm issued the Site Eligibility letter on April 28, 2009. A copy of which was also transmitted to the Department of Housing and Community Development in accordance with the requirements of CMR 760 Section 56.04. An application for a Comprehensive Permit was filed at the Town Clerk's Office on June 3, 2009. A public hearing before the Zoning Board of Appeals Hearing Officer was duly advertised in the Barnstable Patriot on May 22, 2009 and May 29, 2009, and notice sent to all abutters in accordance with MGL Chapter 40A. On June 17, 2009, Hearing Officer, Laura F. Shufelt opened the public hearing at 6:05 p.m. The applicant, Marcelo T. Cerqueira, was present at the hearing. Cindy L. Dabkowski, the Accessory Affordable Apartment Program Coordinator with the Growth Management Department was also present. Mr. Cerqueira gave a brief explanation of the unit and cited that he understood the requirements of the program and the fact that he would occupy the home as his principal residence and the apartment unit would only be occupied by a qualified income tenant as year.round affordable housing. Ms Shufelt reviewed the file with the applicant to assure compliance with all of the program requirements. It was also noted that the comprehensive permit is not transferable and violation of the rules is cause for a hearing to rescind the permit. Public Comment was requested. Ms Shufelt cited that a letter dated June 9, 2009 from Lawrence T. and Elizabeth M. Cleary, owners of 20 Kent Lane, Hyannis MA, direct abutters to the subject locus, was received and entered into the file in opposition to the grant of the permits. She read the letter into the record at the hearing. At the public hearing, no one spoke in favor or in objection to the granting of the comprehensive permit. With Respect to the Cleary's letter in opposition, the Hearing Officer noted that this unit is being permitted pursuant to the amnesty part of the ordinance. To qualify to request the comprehensive permit under that part of the Accessory Affordable Apartment Program the unit had to exist prior to January 1, 2000. An April 28, 2009 affidavit from the Building Commissioner has been entered into the file to that effect. The grant of this comprehensive permit does not represent any greater impact to the neighborhood than that which has existed for the last 9 years. Therefore the grant of this permit does not represent a substantial determent to the neighborhood. In addition, the restrictions of the program and the required monitoring represents greater safeguard to the neighborhood that that which has existed. Ms Shufelt noted the proposed conditions that would be imposed in the permit and the applicant cited that he understood the proposed conditions and consents to abide by them. At that point, the Hearing Officer closed the hearing for public comment and proceeded to make finding to grant the permit and imposed conditions on the permit. Town of Barnstable,Zoning Board of Appeals Decision and Notice, Comprehensive Permit No. 2009-029—Marcelo T. Cerqueira Findings of Fact: At the hearing on June 17, 2009 the Hearing Officer made the following findings of fact. First with respect to standing-the Jurisdictional Requirements of the applicant to apply for a Comprehensive Permit under MGL Chapter 40B as identified in CMR 760 Sections 56.04 and the Town of Barnstable General Ordinance Chapter 9, Article II: 1. The applicant is Marcelo T. Cerqueira who resides at 130 Bristol Ave., !Hyannis MA. The applicant requested a Comprehensive Permit for an existing studio apartment within the lower level of the single-family dwelling as an accessory affordable apartment unit. 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" as an amnesty unit. . 2. Marcelo T. Cerqueira owns the property as evidenced by deed recorded on October 15, 2008 at the Barnstable Land Court Registry in document 1,099,729 certificate number 187142. 3. On April 28, 2009, a site approval letter was issued for the property by Town Manager John C. Klimm, in accordance with MGL Chapter 40B and 760 CMR 56. 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 particular application. Second, with respect of consistent with local needs 1. According to information submitted, at some point an independent studio living unit consisting of approximately 615 sq.ft. was created. The studio living area is within the lower level of dwelling. No valid variance or special permit was ever issued for the creation and use of that independent living unit. The studio living unit qualifies for this comprehensive permit under the amnesty program provisions of Chapter 9, Section 14 of the Code of the Town for a proposed new unit. 2. 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. , 3. The house is served by public water and a private on-site septic. The proposal has been reviewed by Thomas McKean, Health Director, and the property is approved for a total of four (4) bedrooms. 4. On February 6, 2009 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 County 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 the'appIicant's primary residence. 5. . The applicant understands that the affordable unit will be rented to no more than two persons 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. 6. According to the Massachusetts Department of Housing and Community Development, as of September 9, 2008, 6.8% 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 3 Town of Barnstable,Zoning Board of Appeals Decision and Notice,Comprehensive Permit No. 9 Marcelo Local Comprehensi ve Plan encouragess the e usee of existing housing to create affordable units and the dispersal of these units throughout the town. Summary: of Fact cited above, the Hearing Officer ruled ha Based upon the Findings has standing to apply for a Comprehensive Permit under The applicant Marcelo T. Cerqueira 40B and the Town of Barnstable's Accessory Affordable Housing Program, and MGL Chapter promotes the The proposal is deemed consistent with local theeTdo because Barn able without jeopardizing the objective of providing affordable housing for all conditions of the Comprehensive Permit are health and safety of the occupants provided strictly followed. Ruling and Conditions: rqueira for Hearing Officer La ura F. Shufelt ruled to grant the Comprehensive Permit in accordance with MGL to T. Chapter 40B and Chapter 9 of the Code of the Town of Ballow for a studio accessory affordable property at 130 Bristol Ave. Hyannis, MA. It is issued to ng d tons: apartment unit in accordance with the hall nofollowlt exceed two (2) people. 1. Occupancy of the affordable units on the property 2. The total number of bedrooms shall not exceed four (4). 3. The property owner shall occupy the dwelling as his primary residence. 4. This unit shall not be occupied by a family member of the owner all at all times be on-site. S. All parking for the accessory apartment and the main tde duration of this comprehensive permit. 6. None of the bedrooms shall be rented to lode costers ofhousing (including utilities) shall not 7. To meet the requirements of affordability, th r a single person household for the Barnstable exceed 30% of 80% of the median income fo MSA. In the eve nt that utilities are separately metered, the utility allowance established by the Town of Barnstable shall be deducted from rent level so calculated. that require the tenant to 8. All leases shall have a minimum term of one year an p Provide any. all information necessary to verify eligibility with the Accessory Affordable Housing Program. agent for the accessory I include verification of tenancy, affordability 9. The Growth Management Department shall serve as the monitoring , and g apartment. Annual monitoring s compliance with Housing Quality Standards (HQS) I for a building permit for the pre-existing accessory unit. Prior to 10. The applicant shall apply Hance, the Building Commissioner shall perm and certificate of compliance, Permit securing an occupancy p roved plans as submitted with the building p determine that the unit conforms to the appision and meets state building and fire codes. The Health Ddischargerelqueremelntsne that . application a applicable on-site wastewater the property is in compliance with applicant may select his own tenanrements of the t. The tenant shall emeeeV the requi 11. The ewed and approved by the Program as cited above and provided that persons income qualif Growth Management Department of the Town of Barnstable s a .iatio'ndnecessary to work with the Town to provide applicant will be required to given to the Growth ren doc ument that the tenant qualifies. The unit shall be urst notice most be g d fair basis to an income eligible individual. Whenever a vacancy occurs, and the unit must be listed with the Town. Management Department . 4 Town of Barnstable, Zoning Board of Appeals Decision and Notice, Comprehensive Permit No. 2009-029—Marcelo T. Cerqueira 12. Every twelve months the applicant shall review the income eligibility of the tenants 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, as Monitoring Agent, an annual affidavit listing the rent charged and income level of the occupant of the unit. The applicant and/or tenant shall provide the Town any additional information it deems necessary to verify the information provided in the affidavit. 13. Jpon.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 shall have the ability to hold a hearing to show cause as to why this permit should not be revoked. 14. 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. 15. This Comprehensive Permit shall be exercised and the unit occupied within 12 months of its issuance or it shall expire. Ordered: Comprehensive Permit No. 2009-029 has been granted with conditions. A written copy of this decision shall be forwarded to the Zoning Board of Appeal as required by the Town of Barnstable Administrative Code Chapter 241, Section 11 of the Code of the Town of Barnstable. If after fourteen (14) days from that transmittal and 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 Town Clerk's Office. The applicant has the right to appeal this decision as outlined in MGL Chapter 40B, Section 22. I, Laura F. Shufelt, as Hearing Officer for the Zoning Board of Appeals certify that a copy of this decision was transmitted to the Members of the Zoning Board on July 1, 2009 and that 14 days have elapsed with no action taken by any member of the Board to reverse the decision. lei; Laura F. Shufelt, 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 decisigrr has been fi -d in the office of the Town Clerk. Signed and sealed this Ida under the arcs and penalties of g Y _ G, . - p perjury. 11F, l /fr^l// -• Linda Hutchenrider, Town Clerk 5 f BARNSTABL€ LAND COURT REGISTRY REGULATORY AGREEMENT AND DECLARATION OF RESTRICTIVE COVENANTS THIS REGULATORY AGREEMENT and DECLARATION OF RESTRICTIVE COVENANTS,is made this jCcL day of SS.i)fem.bcK,2009,byand between Marcelo T. Cerqueira,of 130 Bristol Ave Hyannis, MA and isuccessors 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 1 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 follov�: I. PROJECT SCOPE AND DESIGN: S A. The terms of this Agreement and Covenant regulate the property located at 130 Bristol Ave Hyannis, S MA as further described in deed recorded herewith as Barnstable Land Court Registry, in Document 1,099,729 certificate number 187142 on October 15, 2008. B. The Project located at 130 Bristol Ave 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. 2009-029 and.any plans submitted therewith and all applicable state,federal and municipal laws and `j regulations. Said permit is recorded herewith as Barnstable Land Court Registry document i a3. (03'7 &certificate of title 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 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 8C% 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 bythe 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 executionn and performance of this Agreement by the Owner will not violate or,as applicable,has not violated an provision of law,rule or regulation,or an order of any court or other agency or governmental Y P I� Y g body,and will not violate or,as applicable,has not violated any provision of any indenture,agreement,mortgage, mortgage note,or other instrument to which the Owner is a parry or by which it or the Owner is bound,will not result in the creation or imposition of any prohibited encumbrance of any nature. 6. The Owner,at the time of execution and delivery of this Agreement,has good,clear marketable title to the premises. 7. There is no action,suit or proceeding at law or in equity or by or before any governmental instrumentality or other agency now pending,or,to the knowledge of the Owner,threatened against or affecting it,or any of its properties or rights,which,if adversely determined,would materially impair its right to carry on business substantially as now conducted (and as now contemplated by this Agreement) or would materially adversely affect its financial condition. B. COMPLIANCE The Owner hereby agrees that any and all requirements of the laws of the Commonwealth of Massachusetts to be satisfied in order for the provisions of this Agreement to constitute restrictions and covenants running with the land shall be deemed to be satisfied in full and that any requirements of privileges of estate are also deemed to be satisfied in full. C. LIMITATION ON PROFITS 1. The Owner agrees to limit his/her profit by renting the Designated Affordable Unit.in perpetuity to a household with a maximum income of 80% or less of the Area Median Income (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 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 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 by hand or when mailed by certified or registered mail,postage prepaid,return receipt requested,to the parties hereto at the addresses set forth below,or to such other place as a parry 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 attorneys 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 26 which shall run with the land described in deed recorded herewith as Barnstable Land Court Registry, in Document 1,099,729 certificate number 187142 on October 15, 2008 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 Land Court Registry, in Document 1,099,729 certificate number 187142 on October 15,2008. 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 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 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 merely personal covenants of the Owner,and (1) shall bind the Owner,its successors and assigns and inure to the benefit of the Municipality and its successors and assigns for the term of the Agreement. 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 M nicipah-ty may exelcise ally remedy available to it. The Owner will'pay au 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 alien on the Project byrecordmg 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. XII. 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,,;—day of 2009. OWNER BY: r' Signature A C Printed: \5 COMMONWEALTH OF MASSACHUSETTS County of Barnstable s: O t 0 a , 009 before me,the undersigned notary public,personally appeared I- Z ,the Owner(s),proved to me through satis factory evidence of ident' ication,which ere _ ,to be the person(s) whose name(s) is signed on the preceding or attached cement and ackn wledged to be that he/she signed it voluntarily for the stated purpose . 52 Notary Public Printed: My Commission Expires: 4 �, TWA Otl.S�lrT� COWWWSWN MITT$ f TOWN OF BARNSTABLE BY: TOWN WN MANAGER COMMONWEALTH OF MASSACHUSETTS County of Barnstable,ss: On this -'3 dayof�e�y2009 before me,the undersigned notary public,personally appeared the Town Manager for the Town of Barnstable,proved tome through satisfactory evidence of identification,which were�. e Aso��a /� -C t'0-;v !-,to be the person whose name is signed on the preceding or attached document and acknowledged to be that he/she signed it voluntarily for the stated purposes. -1 Notary Public Printed: e��f c p ! rs�j. '3�� My Commission Expires: f "Notary Public" �( ') Joyce A.Persuitte 4'►��f��f'1 Commonwealth of Mmac k*M My Ctxnm�"Eom an Rb.A 2016 I • 5 MAR. 11. 2010 2. 18PM NO. 358 P. 2 f r Kui IIII r NA Nu. 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Lien;'Sale A t v v► / flak - ( Special Canditionsr'Notes Scan Bill _ i Quick Entry Int Dt Billed Abt/Adi Pmt'Crd Interest Unpaid bal 03 Lltilihy nrc# 11;`04�'0$ i 53$53 Of}S 53$S3 r 00 r 0 F Custom+ r j 02�03%09 t 7i348 � 0{} �fi�s$ .911 7.13 3 T3451 00 00 . $ Name �6.15 . ., .. ' Fees:'Pen .O�l 5 Of} .00 0�v� 5.t7o .. ...._ I ,-.«...,..,F...,....M........................«,max.,�. . ....--......_.,....«.,......,...»,. «.�.....:....�....,.:«..-f„�.:.«,,,..." .....,....,..--......�......._..._..e-:.,�. Parcel Totals 2.$23. t1i 5.00 2,O44.13 3<01 87$.23 Prop Code Notes.'Aerts— -- -- -------- Due 03'11,201G E .,. Billing Dates Per Diem 30 JAN 1 Owner. C.ROP'LATO, PAULO A - Bill Ajdit Int Paid 5.22 i Reprint lie,v pry urp bras Preferences Dia_onestics 3 EE I I Displa,/transaction history for the current bill. r i r File Edit To&l Help. ^ Warning Type Descrrptioia Reference a DateIo1d' Prior Application ROOF-RESIDENTIAL COMPLETE/APPROVED 08/3&,2W3 Prior Application GAS RESIDENTIAL COMPLETE/CLOSED A.P'P 02,1812000 Prior Application WINDOW/SIDiNGRESIDENTIAL COMPLETE,iAPPROVED 89/03,12003 Prior Application PLUMBING RESIDENTIAL EXPIRED 1 EXPIRED '14/206 Prior Application HOME OCCUPATION COMPLETE?CLOSED APP 0&2t,2846 Unpaid Bill REAL ESTATE 2010 20 00003877 5521 07/0-1/200S `Unpaid'Bitl—REAL:ESTATE 2008 24 00ONS55 a -S784 06.130 2W8--) 5 { r' t�. l y d 1 �; FtKWE t Town of Barnstable BARNSfABLE * Regulatory Services 9`b 69• .�� Thomas F. Geiler,Director Building Division Tom Perry Building Commissioner 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 September 21, 2009 Mr. Marcelo T. Cerqueira 130 Bristol Avenue Hyannis, MA 02601 Re: Amnesty Apartment Dear Mr. Cerqueira: We have received the recorded Regulatory Agreement and Comprehensive Permit for the accessory affordable apartment at your address. A building permit is required whether the unit is new or pre-existing. We look forward to receiving your building permit application for the apartment. Please call me if you have any questions regarding the building permit process. Sincerely, Lois Barry Division Assistant amnbp I � P�°FtHE 1p�,� Town of Barnstable Regulatory Services 9�sn MASS.STABLE$ Thomas F. Geiler,Director 1639.'°TEnMa�A 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 ELIGIBILITY VERIFICATION Re: 3 0 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. This property is now eligible to apply for the Amnesty Program. Tom Perry ' Building Commissioner L� 9 6 I MAR. H, 2010 2: 18PM NO. 358 P. 2 r Kurt . r Mx NU. J u t. YJ.J GYJYJU 11•u4HI I rl To - Cindy VS . G f D�C:K g « BATH ,fir v ( '• y MASTER h KITCHEN • •—616' ED x • m DINNER b 3-0'x6B 6'•8' 2WX6=B' 20'-8 d =4'x 6 2 4'x 8'•.8' S'Wx 6'.81 a it d-0,x 6'-0' N LIVING - BED ' �- a BEb - 6=8'x4,0' I ''-0'YB:B' 3=6� 1 •-0- 2�4 x 2-4 x9 _ u --10 T -QLO d8'-0' -„ ISO Bristol Ave H yanniS- MA AIN FLOOR i - _ MAR. 11, 2010 2: 18PM NO, 358 P, 3 i i 48'-0' 26-0• 7t7' 1a:5• b —5c8•'�r L m x ITCHEN �`2 0 U OFI CCE 6' �a ' i29 LLI - x6 -0 2-0`z6=8' 4 q� x6=8' o m 2=4^x6'B' 2=B•x 21�10• N35-8' 8 � •- � up V 0 GARAGE BEDROOM 3'-O'x6-0` 31-0' 6'-0° -0'x6=8" 6=6' a,a, 48'V 6�4 Vv �t MAR. 11. 2010 2: 18Ph9 NO, 358 P, 2 ;j r KUPr I r HA I`rU. J u t• W elaUb 11.44Hr r rl �[0'• Cindy L4 b Zvw 5 j OCC:K � 6 3-0'x3-0' 2'-4'X9%6' o by Z-4'X3=6' U • BATH. •-_ h BA 2� I f y MASTER ` ' KITCHEN —s��' aE " DINNER CD Rid TW i 714 awlif B 2' ' 2u'xe=B' 4'x6cv 2�'xfr4- S%0'xV-S' N N N LIVING o F BED a BED N IT YBLB' 24'x3L6' 2'-41xSW L00- I� da,0- 130 Bristol Ave H lannis-MA A/N FLOOR - MAR, 11, 2010 2: 18PM NO, 358 P. 3 i I I I . i 28-0' y:]' � e y xKITCHEN2 0 ti OFICCE o ,,�(?\ 2'-o'x6-8' 41-0•x6'-8• f 2-4'x6.8' ~ q GARAGE BEDROOM -0'x6=8' 3-0'x6=0° 3=0'x6=0' ' I —81-81 91-11- s�-s• 48 0' s�1' I i 0FYNET Town of Barnstable *Permit# �y ze Expires 6 months from issue dale Regulatory Services Fee c;� � M6 R _ .Thomas F. Geiler, Director pIFD MA'S� Building Division Tom Perry, CBO, Building.Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number v `� Property Address �� V C�L�Gi V1 V-1 l� [Residential Value of Work 4, Q00.O�) Minimum fee of$25.00 for work under$6000.00 I Owner's Name&Address rcC10 �. C6 U611 ST—� Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) �,�, t C�t��r �(� NN�0' ❑Workman's Compensation Insurance soon Check one: �❑ I am a sole proprietor �� I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. . Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side (} Replacement Windows. U-Value 1`,VA, %� ) (maximum .44) hJ dto S *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pro erty Owner must sign Property Owner Letter.of Permission. Ho e Improvement Contractors License& Construct Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\Expr s\EXPRESS PERMIT.DOC Revise06O4O9 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street F Boston, MA 02111 l ` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information nC Please Print Legibly Name (Business/Organization/Individual): VD \<C,A Address:�3 City/State/Zip: NQ n nS Phone #: -36/ `3%o Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ 9. Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3 KI am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: I Policy#or Self-ins. Lie.#: 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi n er the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Q3 10`1 Phone#: 36 3 a S 6 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: f Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,b checkin the boxes that apply to our situation and, if PY g PP Y Y necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly.' The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia I Town of Barnstable p Regulatory Services BARNM STAB Thomas F.Geiler,Director , `r6 ,� Building Division ArFO�s Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION �J Please Print DATE: O 11 V(�3 '"' JOB LOCATION: 13 y 6C A L !)T, . number streetc� (� village )� ..HOMEOWNER': Gu )(0 name �`� home v lme phone# work phone# CURRENT MAILING ADDRESS: 1,O LJ� ) S I L AI( /qV h n i S W) 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 minimgr rocedures and requirements and that he/she will comply with said procedures and requir Signatu Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC �mE Town of Barnstable Regulatory Services " ay ea es Thomas F.Geiler,Director ��jOtFV 39. 0. � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using'A Builder t f as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this buikiii :permit application for. (Address of job) Signature of Owner Date 9 Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FO RM&O W N ERP ERM IS S ION Town of Barnstable FINE t� Regulatory Services o Thomas F.Geiler,Director i Building Division snaxsrnaze. v mass. $ Tom Perry,Building Commissioner 1 39- aim 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: 710 Fee: 4C?.s- " Permit#: ca ,0®lam r) HOME OCCUPATION REGISTRATION Date: Name: "3z ' �� Phone i r Address: / �5© Village: Name of Business: Type of Business: Map/Lot: a C 9 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. , • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pickup truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. + If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date a 3 '— O Homeoc.doc Rev.5130103 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: s N gmmjM M. Fill in please: Y APPLICANT'S YOUR NAME: -;� BUSINESS YOUR HOME ADDRESS: TELEPHONE # Home Telephone Number v? q-2 NAME OF NEW BUSINESS I 5 17XR,',-9 K elVel-)I-C-6 TYPE OF BUSINESS VW 'IV C,- IS THIS A HOME OCCUPATION(?.... _YES -ENO, a you ES— NO / ADDRESS OF BUSINESS 7 O !:�p MAP/PARCEL NUMBER ASS When starting a new business there are several things.you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST .GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and.licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has i formed any permit requirements that pertain to this type of business. ** . Authorized Signa ure COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: . 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of Business. Authorized Signature** COMMENTS: r� S— bSr V THE r, Town of Barnstable *Permit# 1 S' Fzp-res 6 mon fio s e to ,.�:..�; :Regulator - Services Fee 9 . .,A� _ .._ 1639 _,Thomas F.Geiler,Director '°TEcr�►+° :.. _:..._.:.::.:...::..._.::.•_Building Division" Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 -... .. a Office: 508-862-4038 Fax:-508-790-6230 :. .:..._:....: . ..... a . , ;.._ j .:''EXPRES:S-PFRlGHT-APPLICATION - .RESIDENTIAI. ONLY. Not Valid without RedX Press Imprint I UWN__0F BARNS A& 4ap/parcel Number ,p 'roperty Address 13 0 �eYs rB L 14'o mrf/r!S /2) 0 Z60 Residential Value of Work 6 19®i c-o Minimum fee of$25.00 for work under$6000.00 owner's Name&Address �t +0 A contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) to [AWorkman's Compensation Insurance t. Check one: ❑ I am a sole proprietor RI I am the Homeowner ❑ I have Worker's Compensation-Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side kfReplacement Windows. U-Value (maximum.44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. Signature JAJZ , /_ A��" Q:Forms:expmtrg Revise063004 Town of Barnstable *Permit Expires 6 m nths from issu� B,,, s,pB , : Regulatory Services Fee v MASS. m° Thomas F.Geiler,Director i63q. ♦� �'p'en►^��& Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 JUIV O Office, 508-862-4038 TQwN OF e��'NSTq�1003 U Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number y Property Address `J 02,1.3 2- ' [Residential Value of Work Owner's Name&Address /-rV &S766 AVE OFA/2�2ii//f b(si- 0463I2 Contractor's Name JGt4 tl Telephone Number l-S-b�/ 0�J Home Improvement Contractor License#(if applicable) /3Z4,9/ Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance ' Che k one: ` [►]'I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) [►f Re-roof(stripping old shingles) All construction debris will be taken to Aowr L�k ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Signature r Q:Forms:expmtrg Revised121901 r I i Board of Building Regulations and Standards HOME IM<�ROVEMENT CONTRACTOR . Reg�s3rafioo° 132691 ExpJraion 3l23/2005 f y #ndiwdual, pe SCOTT QUILTER SCOTT QUILTER 247 STRAWBERRY CENTERVILLE,MA 02632 Administrator °FTHE ta,, Town of Barnstable Regulatory Services • saxtvsT"LE. • Mnss. Thomas F.Geiler,Director 9� sbg9,39 a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, €b-::�S 'EAQAA1 , as Owner of the subject property hereby authorize_ .S&// �i�, Qv�L rL to act on my behalf, in all matters relative to work authorized by this building permit application for: 130 61 i51V1 '4 f, et'V h4O/i'l h4 (Address of Job) Signature of Owner Date D .SKOA2S Print Name C—tPc.Jr¢ K G L-E/< Q;FORM&OWNMERMISSION