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TO MAY 21 2010 Town of Barnstable *Permit#
P .:-:r ;�cpves 6 m f lvlss++r date
�'
y NSTA& Regulatory Services Fee
i
sttxrrsraHr.E,
77. i . ,gy
MASS. ThomasP, Geiler,-Director
pTfD MA't�`
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
fVot Vaiid rvifhout Red X-Press Imprint
Map/parcel Number
Property Address q,'r' L�S� ! 4.cr S
Residential Value of Work Vl G Cr6, G 6 lAinimum fee of S25.00 for work under S6000.00
Owner's Name&Address 4 0141
r r Tee S- '��0 '
Contractor's Name � �� . � � r t- � Telephone Number C6
Home Improvement Contractor License#(if applicable) C 9
Construction Supervisor's License# (if applicable) F 9 7 r —
❑Workman's Compensation Insurance
FChe k one:
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Vv orkman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will betaken to
❑ Re-roof(not stripping. Going over existing layers of roof)
✓[/Re-side
#of doors
❑ Replacement Windows/doors/sliders.U-Value (maximum .44)# of windows
*Where required: Issuance of this permit does no(exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
I.
�i
**"Note: Property Owner must sign Property Owner Letter of Permission.
•-A copy of the Home Improvement Contractors License & Construction Supervisors License is
vired. f y
oFIHEr� Town of Barnstable
Regulatory Services
IARNSTABIY- ' Thomas F. Geiler,Director
9� 1659. � Building Division
Ito MPS A
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
wwtiv.town.b arnstable.ma.us
Fax: 508-790-6230
Office: 508-862-4038
Property Owner Must
Complete and Sign This Section
If Using A Builder
I �� �(J�C ,as Owner of the sub)ect property
hereby authorize �� - � �/ `c`' to act on my behalf,
in all matters relative to work authorized by this building permit application for:
2 ci s TZ 4 ��� 0 5 7i:AV j ,
(Address of Job)
ASignature of Owner Date
Prn Name
If pro e Owner is applying for permit please complete the
Homeowners License Exemption Form on the. reverse side.
c
Town of Barnstable
o .
Regulatory Services
' BA-MSrABLE, i
Thomas F. Geier,Director
9 >~
�.i639. Building Division
��
p�FD 'y a Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Of Ce:. 508-862-4038 Fax: 508-790-6230
d HOMEOWNER LICENSE EXEMPTION
tr Please Print
DATE:
JOB LOCATION:
r
number street village
"HOMEOWNER":
name home phone 4 work phone it
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six uni s 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)
r. �
ility for compliance with'the State Building Code and other
The undersigned"homeowner"assumes responsib
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of Homeowner
i
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet orAarger 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 forrrAertification for use in your community.
Q:\W PFLLES\FO RM.S\h o m eex em p L.DO C
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husetts-Department of Public Safety - 6099�► `uoi;p'�dx3'"
Nlassac a -ulations and Standards b211N0 uo�eais% I
of Buildin�,Re„ 21013
Board Supervisor License 1N3W3^OadWI
Construction SUP Sp'ePoeaS Pug suo,a 3WOH
a InBa u jo i
75 t 2I Bwplm
-; CS 99 A '`` r,•' �� ' asrreeo2cie� P,eog
Licen �o 'n
R to-
estricted im.
-_
BILLY E CA�THEN
86 BETH
HYANN IS,
MA.02601
Expiration: .8/13/2011•
Tr#: 2150
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pepuriment of Public Safety t
Massachusetts- lations and Standards E: valid for individul use only
oard of Building Rego tion return to:
g reps
Constructbn.Supervisor Licensep$eoriratEon bate, If found Stan
s Lt tl►e exp s S
b�fbi•e =Regulation and
License: CS 9975 ild�sg. t30]
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1,,, f Boa►d of B on Place Rm
Restricted to 4� 4 shbu v
tr � .. ®ne A 021U8 4 }
goton,Ma
BILLY E ?CAUTHEN
M4
86 BETH LN _
wANNIS MA 02601
,
y' . . .. nature �, .,
, y� Expiration: .8/1 3120 1 1•
ot.valid without si
7r#. 2150
�
:�ornnussioner ---- � -
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E.
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Office of Investigations
pl 600 YYashington Street
Boston, NIA 02111
ems' www.rnass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legit
Name (Business/organization/Individual): V IG� L , C'
Address: C
City/State/Zip: ,`,V13 �q�' O�C,0,( Phone #: 6r(af a'�'U- 3kG 2�
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ 1 am a employer with 4. ❑ I am a general contractor and 1 6 ❑New construction
have hued the subcontractors
mploye'
masol prietor or partner-s (full and/or part-time).*e pro
listed on the attached sheet. 7. ❑Remodeling
2. I a
These srtb-contractors have g, ❑ Demolition
ship and have no employees
loyees and have Workers'
for me in any capacity. emp 9 ❑ Building addition
[No workers' comp. Insurance comp. insurance.$
required.]
5. ❑ We corporation and its 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions
right of exemption per MGL 12:.__.Roof.re airs ,.........:
�.. . .._._.__myself,..[No_Work�ls._cozr?P,... .. - _..-......_..._._.. .. _..._,.. - ❑ p
insurance required.) t c. 152, §1(4), and tive have no
employees. [No workers'
13.❑ Other /( e—Srdc�vy`Z
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy andjob site
information.
Insurance Company Name:
Policy# or Self-ins. Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date),
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct.
SrQnattue Date: t��2/ IL,o
Phone# Soh" a ?6 121
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
Information and Instructions
Massachusetts General Laws chapter 152 requires all employes 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 per to do maintenance, construction or repair.work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or,permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary, siipply 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
_.,.. ....ion insurance. an
....
members or partners,are not required to carry workers compensat If i 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 retumed 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 permitllicense 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 maybe provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 4-24-M 11,.],.17 rnACC onv/rlia
A _
Town of Barnstable *Permit#
Expires 6 mow&fr m issue date
Regulatory Services Fee
MASS
Thomas F.Geiler,Director
Build
ing.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 wkhortt Red X-Press Imprint
Map/parcel Number 1 Z) blLn
Property Address
5 Residential Value of Work S'00 D Minimum.fee of$25.00 for work under$6000.00
.`'l - � n
Owner's Name&Address
_��� rJ�C.M Y L-4 V%-.1 J--lllq c7,-,L '��-S
0�,�.4,W Iv.-• vw'i�
Contractor's Name :E�r:Se.r C nvs+r �Oy-) LC.C_ Telephone Number
Home Improvement Contractor License#(if applicable}
Construction Supervisor's License#(if applicable)
gf workman's Compensation Insurance Xe P R E S S PERMIT
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner FEB ® � 2012
a I have Worker's Compensation Insurance {
Insurance Company Name '}- U r i o Y ('i f t o rr- C C
o.
Workmen's Comp.Policy# 1 WC-6 1 0!R 9 ,4?0(h0j SOWN OF BARNSTABLE
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to f
❑Re-roof(not stripping. Going over existing layers of roof)
($.Re-side
#of doors
❑ Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,ie.Historic,Conservation,etc.
***Note:. Property Owner must sign Property Owner Letter of Permission.
of the Home Inwrovente t ctors License&Construction Supervisors License is
requir
SIGNATURE.
Q:I TMESTORMS\h0ding permit forma
Revised 090809
_..............
i
i
The CQNVWnWWM ofDlassachr<se i
1?V�ofIjV& trWA'j&.
Offee oflravestigations
600 Washbogton Sbea
Boson,MA 02111
wW-AWsLgovldia
Workers'Compensaiioa InsaMce AM& Baers/Contra
ldctors/Elt pians/P
A lic$nt Informatio Inmbers
Name(Basiness/ oalindi Pie�se P t L
r
Addmn:
CitylSieJZi : coif 1�,4 b 3
Are °n an em Phone#: 9a
ploys?C the a�uvtpriate bom
i. I am a employer with 4 ❑I am a general mar and I Type°f project(reulaued): i
z.EJemployees(full mWOr• e)* have hired the ors6. []New construction `
I am a sole proprietor M partaer_ listed on the attached shea
7.sbiP and have no employees Thesesub-corritactors have ❑R�wdeft . {
working for me in any sty emPloYees and have wOricers'
workers-
required.] 8 ❑Demolition j
workers'comp.insurance auce t 9. Q Building addition
3.❑I � COMP
we are a corporation and its 1O.M Electrical repairs or additions
eowner doing all wOk Officers have COMised their
myself[NO workers'camp. right ofMOUVion per ME I I.[]Plumbing repairs or additions
hmrance j t ' c 152,6I(4),and we have no 12-[]Roof repairs
eniployem[No workers' 13.0'Other
��aPA1�t that shocks boa#I�aL5oS11 onrt tie gyp. Ce )
i
t Ytitis taxes mdiftg dw aye doing an�and&w h= a oa
e kaftds Idw Ch chec mrst at�d an sir ybw rho mime oft6e 70�anbonit anew affidavit���sacfi.
lscommactots Save emploYep,t�mast provide their wodras'wnv ff and Stab whr.Yhwor aotthose entiEies have
. . 1 a1n apt smplo�ertht?ttit rverJters'ceos
6 °rma on I cef°rrr{t'° y .Bator is thePol 1' Job sfte i
Instaance C�,y Name: . �p»a f % I j
C'e j
Policy#M SeINns.Mc.#: W C O {
Job Site Address: ? ��a...� Expnattoa Date 2.6 020 ja
Attach a copy of the worimm'aompensadon tatwzrP= . t0s�V i( I
Failure m secure coverage as ct policy declaration page(showing the policy'lumber and I
roq�d nr�Section ZSA of
c 152 Casa Iead m the imposition �iraiion date).
fine up to$1,500.00 and/or one-year imprison,as well as civil position of caimmal penalties Of a r
ofup to$250.00 s day against$m vioiatm Be advised that a P in the form of a SLOP WORK ORDER and a fare
Investigations of fire DIA for innrance covemp verif cation cePY of this siatBmtMt may be forwarded tr?the Office of
j
1 do hereby eertE
r "s ofPa*y that the firformer M prov*W abM is true arrd cors�pt
OJ cPad useonly Do net ivrfte fir thfs wv%to be come-&dby y Or town o ff[
City Or Town: PerzowLicense#
Isaing Authority(drelo one):
L Board of Health 2.Building Department 3.City/Town Clerk el �l
6.Other > or S.PhambingInspect°t
Contact Person: I
Phone#: i
I
AC o FMSCON-01 MOSU
` ! CERTIFICATE OF LIABILITY INSURANCE IMTE M"MM"Y'
9126/2011
PRODUCER (508)676-0309 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Viiveiros Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
375 Airport Road HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR
Fall River,MA 02720 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC#
INSURED Fraser Construction LLC INSURER A:National Union Fire Insurance Company
P.O.Box 1845 INSURER B:
Cotult,MA 02636- -INSURER C
INSURER D: - -
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR AWL POLICY NUMBER CY EXPIRA LIMITS
GENERAL LIABMM EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY PREMISES $
CLAIMS MADE OCCUR MED EXP(Any one Person $
PERSONAL&ADVINJURY S
GENERAL AGGREGATE $
GM AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG S
POLICY LOC
AUTOMOBILE LIABILITY
ANY AUTO COMBINED)SINGLE LIMIT $
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULEDAUTOS (���^I )
HIREDAUTOS
BODILY INJURY S i
NON-OWNED AUTOS (Per ao0mrd)
PROPERTY DAMAGE S
(Pera=dent)
GARAGELUU3WTY AUTO ONLY-EAACCIDENT S
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY. AGG S
EXCESS UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR r I CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION S S
YKIRICERS COMPENSATION X I WC STATU- OTH
AND EMPLOYERS'LIABILITY Y I N
TORY LIMITS
A ANY PRoPRIETORlPARTNBusec=vE C008830601 912UM11 912&2012 EL EACH ACCIDENT S �
DFFlCE7LMEMSEREXCWDED7 a '
(MafplaLmy In NH) E.L.DISEASE-EA EMPLOY S
H�a,�desalDe carder
SPE&POROVISIONSbelow E.L DISEASE-POUCYUMTT S
OTHER
DESCRHi110N CIF OPERATIONS 1 LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORETHEE7PRATION
Fraser Construction,LLC DATE THEREOF,THE ISSUING INSURER"PILL ENDEAVOR TO MAIL 30 DAYS WRmEN
PO BOX 1845 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE To Do So SHALL
Co$Ilt,MA 02635-: IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER,ITS AGENTS OR
. - REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 26(2009M) ®IW2 009 ACORD CoRPoRATiON. Ali rights reserved.
The ACORD name and logo are registered marks of ACORD
9.4e -Camwwwweaa
Office of Consumer Affairs and gusiness Regulation
10 Park Plaza- Suite 5170
Boston Massach setts 02116
Home Improvement Con��hctor Registration
____..............___. Registration: 112536
-, Type: DBA
Expiration: 312312013 Tr# 209024
FRASER CONSTRUCTION CO.
DEAN FRASER
P.O. BOX 1845
COTUIT, MA 02635
Update Address and return card.Mark reason for change.
Address Renewal Employment Lost Card
OP-1-CAI 0 SOM•04/04-GIO1216 ��,/�!
Office* i me'�'i ors�c s nes�s egu ation License or registration.valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to:
Registration: 112536 Type: Office of Consumer Affairs and Business Regulation
Explration: 3123A013 DBA 10 Park Plaza-Suite 5170
Boston,MA 02116
wMR CONSTRUCTION CO. 7.,
DEAN FRASER '
p
104 TWINN VIEW LANE —
E FALMOUTH,MA&536 Undersecretary of va ut si re
• L
KAssaCfiusetts-Dep:tv-tment of Pubiie'S.Aty
Board of Building Regulations and Standards
Cohattuctfon Supervisor License
-License: CS 97WS
DEA .�Y k `"D ram,.
104 TMI41, M1. NE
EAST RALTF dZ36 ' ?
Expiration: 6I7=3
Commissioner Tr#: 46692
�IK Town of Barnstable
Regulatory Services
�vsr�sca,
nUes g Thomas F.Geiler,Director
i6;q. ♦0
�► " Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Officer 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
yi , as Owner of the subject property
hereby authorize a�ew '.), vcnCc s e/) (FRa�eAq��„�5�- 1 to act on my behalf,
in all matters relative to work authorized by this building permit
(Address of job)
Pool fences and alarms are the responsibility of the applicant. Pools
are not to be filled before fence is installed and pools are not to be
utilized until all final inspections are performed and accepted.
Signature of et Signature of Applicant
Print Name Print Name
Date
Q:FORMS:OWNERPERMISSIONPOOLS
i
�t Town of Barnstable
Regulatory Services
r RUMSTABLE, Thomas F.Geiler,Director
639. Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street
village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:-
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one or two-family,dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such.
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible:
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:forms:homeexempt
I
pF THE Tp�
Town(d Barnstable * ermit
Expires 6 months fro issue date
Regulatory Services Fee
BARNSTABLE,
r MASS' Thomas F.Geiler,Director
i639. �0 l
rfD MA'I A
Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number % /J';?-7
Property Address
❑Residential Value of Work 4 GU,D U Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address //I o—�-lc r'� ,u"r l-t)
Contractor's Name tC � ���Ls'��,d Telephone Number
Home Improvement Contractor License#(if applicable)
}
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance X-PRESS PER • IT
7 k one:
am a sole proprietor 0 C T 15 2009
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance TOWN OF BARNSTABL.E
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
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
#of doors
❑ Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows
*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
require
SIGNATURE:
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 090809
The Commonwealth ofMassachttsetts
Department of Industrial Accidents
Office of Investigations
I �Y
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): l� ( �i(f��Ls�c/ t �ta�(O,¢[fL/ -el
Address:
City/State/Zip: Phone #:
Are you an employer?C eck 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
airs or additions re Electrical
required.] 5. ❑ We are a corporation and its 10.❑ p
3.❑ I am a homeowner doing all work officers have exercised their l l.❑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�v
comp,insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
=Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp,policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy# or Self-ins. Lic.#: Expiration Date:
Job Site Address: 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 D1A for insurance coverage verification.
I do hereby certify under the pains
�and penalties of perjury that the information provided above iss trite and correct.
Signat ire: � ( Psi Date:
Phone#: Qf R�f0-3�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#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. if an LLC or LLP does have
employees,a policy is required. 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 perrnit/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
Fax # 617-727-7749
Revised 4-24-07
www.mass.gov/dia
THE Tqy, Town of Barnstable
Regulatory Services
a +
�anxr''sz�naIE Thomas F. Geiler,Director
i63q.
"Tf ru't 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
I, R N"7'!J Fr fi41)t % fy , as Owner of the subject property
hereby authorize A Z C?Ju7`N c i.,; to act on my behalf,
in all matters relative to work authorized by this building permit application for.
(Address of Job)
Signature�ofOwner Date
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:FORMS:O W N ERP E RM IS S I ON
of t►,F,�,,
Town of Barnstable
o Regulatory Services
" Thomas F. Geiler,Director
* MRNSr"LE, x
MAss.
9�A 1639. Building Division
rEo �a Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: .508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
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 responsible for all such work performed under the building permit under the building permit. (Section 109.1.1)
The undersigned"homeowner'assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the.
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that hdshe 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.
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oFiHE)°�ti The Town of Barnstable
BAR E.MASS. �
Department of Health Safety and Environmental Services
9 ASS.
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PrFO MP+� Building Division
200 Main Street,Hyannis,MA 02601
Office: 508-862-4038
Fax: 508-790-6230
Inspection Correction Notice
Type of Inspection��jj
Location ij �Vg Permit Number
Owner Builder
One notice to remain on job site, one notice on file in Building Department.
The following items need correcting:
Please call: 508-862-4038 fo e-inspection.
Inspected by
Date rP
/ ll
Barry, Lois
From: Mcauliffe, Paulette
Sent: Thursday,June 12, 2003 12:00 PM
To: Barry, Lois,
Cc: Perry,Tom; Shea, Kevin
Subject: RE: AMNESTY COMPREHENSIVE PERMITS
Lois,
Yes,we've been working with the property owner. Please send out inspector in order for the unit to be issued the
Certificate of Compliance.
Tom,
We have tweaked a usable "Approval Form"when Bob Shea completes his inspections and then refers them to your
department. Since the form is a standard memo from Bob to you, please forward copies of each to Lois whenever you
receive them in the future.
Thanks. PT
-----Original Message----- --
From: Barry, Lois
Sent: Thursday,June 12,2003 10:56 AM
To: Mcauliffe,Paulette
Subject: AMNESTY COMPREHENSIVE PERMITS
r
We have two final inspections scheduled for next week (311 Church Street, Comp. Permit dated 10/25/01 and
recorded 11/1/01 and 208 Ost./W.B. Road dated 6/21/02 and recorded 8/19/02). There is a clause that the Comp.
Per. must be exercised and the unit occupied within 12 months of its issuance or it shall expire. It appears that 311
Church Street has expired. Do you have an extension on this? How are you handling those that have expired?
1
Barry, Lois
To: Mcauliffe, Paulette
Subject: 208 Ost.-W. B. Road
just received a call from Ruth Franklin requesting a final building inspection for the above address. I have scheduled the
inspection for Monday. This address was not included in your previous email authorizing final inspections. Please send us
an email confirming this property is ready for our final inspection. Thanks.
1
The Town of Barnstable
BIKE � Office of Community and Economic Development
230 South Street
snxr�srea�.
Maas i63 Hyannis, MA 02601
� �
fD MIA'i Office: 508-8624678
virector Fax: 508-790-6288
ACCESSORY AFFORDABLE HOUSING PROGRAM
} OUSI�N�G�INSPECTION , PPROVAI,��1�10TICE
TO: Tom Perry,Building Commissioner
FROM Robert Shea, BHA Housing Inspector
DATE:
RE: Inspection at: :L G Y' O.sl w 6Wczr sTAbj& Mry
Dear Tom
I have conducted a State Housing Inspection of a single-family/multi-family dwelling
owned by „ • }�,�A N\`l c t✓
located at: 2�it (,'fit Gj 0 it q� D F Te a V-c
Single-Family Multi-Family: Units
Unit Capacity: 2 # Bedrooms: I
Unit Capacity: # Bedrooms:
Unit Capacity: # Bedrooms:
Unit Capacity. # Bedrooms:
It was found to be in compliance with the State Sanitary Code. Would you please arrange to have the Building
Department do it's final inspection of the properryin order to grant the Certificate of Compliance for the unit(s).
Sincerely,
Robert Shea
cc: Kevin J. Shea,Director DaWPASS ��laQl�7
Office of Community&Economic Development '
Lois Barry,Building Department Signature:
Q:CommDev/PT/Monitor/App rvl.doc
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Town of Barnstable
Zoning Board of Appeals EXHIBIT
Comprehensive Permit Decision and Notice
Appeal 2002- 57-Franklin
Applicant: cRuth-A-Franklin--*
Property Address: (208 Osteiville'=West Ba� instable Road;Osterville,�MA"�
Assessor's Map/Parcel: Map 121 Parcel 027
Zoning: Residential C
Groundwater Overlay: GP District
Applicant:
The applicant is Ruth Franklin,with an.address of 208 Osterville-West Barnstable Road, Osterville,
MA. Ms. Franklin is the individual to whom this Comprehensive Permit is issued for the conversion of,
ari.existing un-permitted one-bedroom adjacent apartment of a single-family dwelling as an accessory
affordable rental unit in accordance with all conditions of this permit.
Relief Requested:
The applicant has applied for a Comprehensive Permit under the General Law of the Commonwealth of
Massachusetts, Chapter 40B —S 20-23 and in accordance with the General Ordinance of the Town of
Barnstable Chapter III,Article LXV,"Pre-existing and Unpermitted Dwelling.Units and for New
Dwelling Units in Existing Structures," more commonlytermed the "Accessory Affordable Housing
Program."
The zoning relief necessary for this Comprehensive Permit to be issued is that of a variance to Section 3-1.3
(2) of the Zoning Ordinance—Accessory Uses to permit an accessory apartment unit to a single-family
owner-occupied residential dwelling.The issuance of this Comprehensive Permit would allow for an owner-
occupied single-family residence with an accessory affordable apartment unit located within the single-family
dwelling.
Locus and Background:
The property is a .50 acre lot that is developed with a 3-bedroom, 2-bathroom, 2,904 square feet single-
family,ranch style home. The applicant bought the property four years ago from her family who had a
family apartment built for the applicant's grandmother in 1952. The applicant has been renting the
apartment off and on since purchasing the property,and recently heard about the Housing Amnesty
Program through the Building Department and decided to apply for the program.
The accessory unit is attached on the ground level with the principal single-family home. The area is
estimated to be approximately 500 square feet. The locus is in a Residential RC, Groundwater
Protection Overlay District. The unit has been documented to pre-exist before January 01, 2000, and
qualifies for the Accessory Affordable Housing Program as an Amnesty unit.
Procedural Summary:
This appeal was filed at the Town Clerk's Office and the Office of the Zoning Board of Appeals. A
public hearing before the Zoning Board of Appeals Hearing Officer was duly advertised and notice sent
to all abutters in accordance with MGL Chapter 40A. The hearing was opened on May 15, 2002 at
which time the Comprehensive Permit was granted. The Hearing Officer,Gail Nightingale presided
over the public hearing. Also present were Paulette Theresa-McAuliffe,Accessory Affordable Housing
Program Coordinator,Kevin Shea,Director Office of Community and Economic Development and
Michelle McKinstry,Barnstable Housing Authority.
Findings as to Standing and The Comprehensive Permit:
At the May 15, 2002 hearing,the Hearing Officer made the following findings of fact:
1. The applicant is Ruth A. Franklin with an address of 208 Osterville-West Barnstable Road,
Osterville. Ms. Franklin has owned the property since February 18, 1997, as documented and
recorded at the Registry of Deeds in Book 1512, page 584. Ms. Franklin is requesting the
Comprehensive Permit to convert an existing apartment into an accessory affordable rental unit.
The unit qualifies for the "Accessory Affordable Housing Program" as an Amnesty unit that
existed prior to January 01,2000.
2. The applicant was issued a site approval letter dated May 13,2002 from Kevin Shea,Director,
Office of Community&Economic Development,qualifying her application for the Accessory
Affordable Housing Program. The source of the subsidyis the federal Community Development
Block Grant (CDBG) program
3. The rental unit is approximately 500 square feet and has one bedroom It is attached to the single-
f amily ranch style home.
4. According to the Assessor's record, there is a total of three bedrooms on the property. Two are
in the-main house, and one is in the accessory unit. The property is serviced by public water and
the site is in the GP Groundwater Protection Overlay District. The Public Health Division
approves the septic system at the site for a total of three bedrooms as per the Housing
Amnesty/Public Health Form dated March 29,2002.
5. The Barnstable housing Authority completed an inspection of the unit on March 18,2002. The unit
was found to be in need of minor upgrades. The BHA inspector noted the following on his report:
The exterior light fixture leading out of the apartment was broken and needs to have a new one
installed. The applicant is aware that a final inspection by the Building Division will be required
before he is given an Amnesty Certificate of Participation.
6. On April 30, 2002,the applicant signed an Accessory Affordable Housing (Amnesty) Program
Affidavit agreeing to comply with the programs requirements,including owner occupancy of the
principal dwelling unit and further agreeing to comply with the provisions set forth in Article
LXV(65) of the Town Ordinances that include her signing and recording of the Regulatory
Agreement&Declaration of Restrictive Covenants. The subsidizing agency has determined that
the signing and recording of the regulatory agreement qualifies the applicant as a"limited
dividend organization" as that term is used under M.G.L.c.40B %20-23.
7. The applicant understands that the affordable unit will be rented to a person or family whose
income is 80% or less of the Area Median Income (AMI) of Barnstable-Yarmouth Metropolitan
Statistical Area (MSA) and further agrees that rent (including utilities) shall not exceed the rents
established by the Department of Housing and Urban Development (HUD).
. Th Barnstable Housin Authority has committed to the.monitorin of this affordable rental
8 eg ty g
unit.
9. According to the Massachusetts Department of Housing and Community Development,as of
October 1, 2001,4.7% of the town's year-round housing stock qualified as affordable housing units.
The town has not reached the statutory minimum under M.G.L. c. 40B 5§ 20-23 or its implementing
2
regulations. Under the Town of Barnstable's Local Comprehensive Plan, the use of existing housing
to create affordable units and the dispersal of these units throughout the town is encouraged.
10. Based upon the findings,the project is deemed consistent with local needs because it adequately
promotes the objective of providing affordable housing for the Town of Barnstable without
jeopardizing the health and safety of the occupants provided all conditions of the Comprehensive
Permit are strictly followed.
Ruling and Conditions:
Based upon the findings,the Hearing Officer ruled that the applicant has standing to apply fora
Comprehensive Permit under the General Law of the Commonwealth of Massachusetts, Chapter 40B —
%20-23 and in accordance with the General Ordinance of the Town of Barnstable Chapter III,Article
LXV, "Pre-existing and Unpermitted Dwelling Units and for New Dwelling Units in Existing
Structures," more commonly termed the "Accessory Affordable Housing Program."
The granting of this Comprehensive Permit is to the applicant, Ruth Franklin. It is issued to allow for an
existing apartment of 500 square feet, subject to the following conditions:
1. The property owner shall occupy the principal dwelling unit as her year-round residence.
2. Occupancy of the affordable unit shall not exceed two people.
I This unit shall not be occupied by a family member unless permitted under the Town Manager's
criteria for the Local 40B Program
4. To meet the requirements of affordability,the cost of housing(including utilities) shall not exceed
the Department of Housing and Urban Development's (HUD) (or any successor agency) 80% rent
limits as published from time to time. Eligible tenants shall have an income at or below 80% of the
Area Median Income,adjusted by household size. Both the rent limits and income limits can be
secured from the Barnstable Housing Authority or from the agent of the town implementing this
program
5. All leases shall have a minimum term of one year.
6. The applicant shall have the unit re-inspected by the Building Division to assure that all
necessaryrequirements are met according to minimum state building and fire codes. It shall also
be reviewed by the Health Division to assure compliance with applicable on-site wastewater
discharge requirements.
7. The applicant may select their own tenant(s) provided the tenant(s) meet all requirements of the
program and provided that person(s) income is reviewed and approved by the Barnstable
Housing Authority as a qualified individual. The applicant will be required to work with the
Housing Authority to provide information necessary to document that the tenant(s) qualify. The
unit shall be rented on an open and fair basis. When a vacancy.occurs,the unit must be listed as
available with the Barnstable Housing Authority and Housing Assistance Corporation. The
applicant must notify the monitoring agent of a vacancy whenever it occurs.
8. Every twelve months the applicant shall review the income eligibility of those individuals occupying
the unit. No later than a year from the date of issuance of this Comprehensive Permit the applicant
shall file with the Barnstable Housing Authority an annual affidavit listing the rent charged and
income level of the occupant(s) of the unit. The applicant shall provide the Barnstable Housing
Authority any additional information it deems necessary to verifythe information provided in the
affidavit. Upon any report from the Barnstable Housing Authority that the terms and conditions of
3
this permit are not being upheld,the Zoning Board of Appeals or it's Hearing Officer shall have the
ability to hold a hearing to show cause as to why this permit should not be revoked.
9. The Accessory Affordable Unit shall be affordable in perpetuity(as affordable is defined herein)
unless this Comprehensive Permit is rendered void.
10. This Comprehensive Permit shall not be transferable to any other person or entity without the prior
approval of the Hearing Officer or Zoning Board of Appeals. This decision, the Regulatory
Agreement and Declaration of Restrictive Covenants and all other necessary documents shall be filed
at the Barnstable County Registry of Deeds. If the ownership of the property is transferred, the
Barnstable Housing Authority shall be notified within 60 days the name and address of the new
owner.
11. All parking for the dwelling and accessory unit shall be accommodated on site, and no lodging
shall be permitted on site for the duration of this Comprehensive Permit.
12. This Comprehensive Permit must be exercised and the unit occupied within 12 months of its issuance or it
shall expire.
Transmission of the Decision of the Hearing Officer to the Barnstable Zoning Board of Appeals
In accordance with Part 11, Section 4.02 and Part III, Section 3.72 of the Town of Barnstable
Administrative Code, the hearing officer transmitted her written decision:to the Zoning Board of Appeals
on 5/15/02, and fourteen days having elapsed since said transmittal with the Zoning Board of Appeals
taking no action to reverse the decision, this decision becomes the decision for this Comprehensive
Permit application.
Ordered:
Comprehensive Permit 2002-57 has been granted with conditions. Appeals of this decision,if any,shall be
made to the Barnstable Superior Court pursuant to MGL Chapter 40A,Section 17,within twenty(20) days
after the date of the filing of this decision in the office of the Town Clerk The applicant has the right to
appeal this decis' as utlined in MGL Chapter 40B,Section 22.
4kV
G Nightingale, earing er i Date Signed
g tt t
I, da Hutche der, Clerk of the Town of Barnstable,Barnstable County,Massachutfeby ..'•.8� t��r,.
certify that twenty(20) days have elapsed since the Zoning Board of Appeals filed thi d °i�iorad ;lit
no appeal of the decision has b en file, ' the office of the Town Clerk
Signed and sealed this day of _under anda$•ti
? the p
> d
..
Linda Hutchemider, Town Clerk t 1t;
BARNSTABLE REGISTRY OF DEEDS 4
oFt"E TOw TOWN OF BARNSTABLE
Office of Community and Economic Development
* BARMSPABM
v MAE& 367 Main Street, Hyannis,Massachusetts 02601
1639. a`� 508 862-4683 or 508 862-4695 Fax 508 862-4725
iOrED Mph
MEMO
To: Gloria Urenas
CC: Kevin Shea, Tom Perry,Robin Giangregorio
From: Paulette Theresa-McAuliffe
Date: August 28, 2002
Re: Attached Amnesty Deed Restriction
Dear Gloria,
Please find attached the following Deed Restriction that has come back from the Registry
of Deeds. This individual is now officially Amnesty Program and can be issued their
Amnesty Program Certificate of Compliance upon their final pass inspection.
Ruth Franklin, 208 Osterville-West Barnstable Road, Osterville.
As Deed Restrictions return from the Courthouse, I will continue to send the
date/stamped pages to you. Should you have any questions, feel free to contact me.
Thanks,
Paulette Theresa
i
CommDev/PTMEMGL07.DOC
6_.?K :L y_6 4,Y P 3 5- rn,2 4 p_
REGULATORY AGREEMENT
AND DECLARATION OF RESTRICTIVE COVENANTS
THIS REGULATORY AGREEMENT and DECLARATION OF RESTRICTIVE COVENANTS,is made
this ;`day of ,2002, by and between Ruth A. Franklin.of.208 Osterville-West
Barnstable;Road,-Ostervi e,,MA_02655-,and its successors and assigns (hereinafter the"Owner );and the
TOWN OF BARNSTABLE (the "Municipality"), a political subdivision of the Commonwealth;
WHEREAS the Owner has been granted a Comprehensive Permit under Massachusetts General Law Chapter
40B and local regulations by the Zoning Board of Appeals to permit the creation of an accessory apartment in
an owner occupied dwelling which will be rented to a Low or Moderate Income Person/Family(hereinafter
"Designated Affordable Unit";and
NOW THEREFORE,in mutual consideration of the agreements and covenants contained herein,and other
good and valuable consideration,the receipt and sufficiency of which is hereby acknowledged,the parties agree
as follows:
I. PROJECT SCOPE AND DESIGN.
A The terms of this Agreement and Covenant regulate the propertylocated at 208 Osterville-West
Barnstable Road, Osterville,MA, as further described in Exhibit"A" hereto annexed.
B. The Project located at 208 Osterville-West Barnstable Road, Osterville,MA will consist of one
accessory apartment unit which will be rented to an eligible low or moderate income individual or family(the
"Designated Affordable Unit" or the"Unit").
C. The Owner agrees to construct the Project in accordance with the terms of the comprehensive permit,
Appeal No. 2002-57 and any plans submitted therewith and all applicable state,federal and municipal laws and
regulations (A copy of the comprehensive permit is annexed hereto as Exhibit"B").
D. The Owner agrees to occupy the principal dwelling unit located on the property as their year round
residence in accordance with the terms of the comprehensive permit.
II. THE OWNER'S COVENANTS AND RESPONSIBILITIES:
A. THE OWNER HEREBY REPRESENTS,COVENANTS AND WARRANTS AS FOLLOWS:
1 In receiving the comprehensive permit to create the Designated Affordable unit,the Owner agreed that
the Designated Affordable Unit shall be set aside in perpetuity for the public purpose of providing safe and
decent housing to persons of low income (herein defined as 80% or less of the median income of Barnstable-
Yarmouth Metropolitan Statistical Area (MSA) and that the Designated Affordable Unit shall be deemed to be
impressed with a public trust.
2. The Designated Affordable Unit shall be rented in perpetuityto a household with a maximum income
of 80% of Area Median Income or less of the Area Median Income (AMI) of Barnstable-Yarmouth
Metropolitan Statistical Area (MSA) and that rent (including utilities) shall not exceed the rents established by the
Department of Housing and Urban Development (HUD) for a household whose income is 80% of the median
income of Barnstable-Yarmouth Metropolitan Statistical Area. In the event that utilities are separately metered,
the utility allowance established by the Barnstable Housing Authority shall be deducted from HUD's rent level.
3. The Designated Affordable Unit will be retained as permanent,year round rental dwelling units with at
least one-year leases.
4. The Owner has the full legal right,power and authority to execute and deliver this Agreement.
I '�
oFt�raY,,
Town of Barnstable
Regulatory Services
sAMszae Thomas F.Geiler,Director
9q, MASS.: �0� Building Division
A�F p MAy a Peter F.DiMatteo. Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 5087790-6230
March 4, 2002
Ruth A. Franklin
208 Osterville W. Barnstable Rd.
Osterville,MA 02655
RE: Illegal Apartment Map 121-027
Dear Property Owner:
Our records indicate that your house at 208 Osterville W. Barnstable Rd., Osterville is
currently being used as a two-family home contrary to Barnstable Zoning Ordinances.
You must contact this office as soon as possible to either:
1) apply for a building permit to restore the property to a single-family home
2) apply to the Zoning Board of Appeals for a variance
3) prove that this is a legal two-family.
You must contact this office immediately to tell us what direction you wish to take.
Sincerely,
Gloria M. Urenas .
Zoning Enforcement Officer
GMU/aw
Q030402
�orIHErotti Town of Barnstable *Permit# l t
ywP O,� Expires 6 months from issue date
" l Re uator .`saruvsTnat e, + g y Services Fee
MASS.9cb 1639. ,0$ Thomas F.Geiler,Director
ArEDN1°yA Building.Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
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 czj-� 42C✓ls�
+Residential Value of Work
Owner's Name&Address 1,Ty -��C�(�l �� L,l VJ
Contractor's Name 0-0-n-z i Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable) �+ p
� orkman's Compensation Insurance X'rb RESS PERMIT
Check one:
❑ I am a sole proprietor MAY 2 9 2002
❑ I am the Homeowner
I have Worker's Compensation Insurance(] TOWN OF BARNSTABLE
Insurance Company Name
Workman's Comp.Policy# 75 X 6 5/o I
Permit Request(check box) #
Re-roof(stripping old shingles) All construction debris will be taken to r '
-c o
❑Re-roof(not stripping. Going over existing layers of roof) co
GO
.>
❑ Re-side n -�
❑ Replacement Windows. U-Value (maximum.44) w
❑ Other(specify) w
r-
*Where required: Issuance d this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
Signature
Q:Forms:expmtrg
Revised121901
WE�►�, The Town of Barnstable
Department of Health, Safety and Environmental Services
Building Division
KAM
619.��� 367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Home Occupation Registration
Date: // Wy_f5'
Name: &4P
Address: 20Fr lam`•--W 844,�� Village:
Type of Business: w Map/Lot:. /a
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 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: ,o Date: /1—,o 1Y g.�
f
QUERY PROPERTY: QUERY END
QUERY PROPERTY
PENTAMATION-------------------------I--------------------------------- 03/04/02
PARCEL ID 121 027 GEO ID 6382
LOT/BLOCK DBA
PROPERTY ADDRESS OWNER FRANKLIN
208 OSTERVILLE-W/BARNSTA RUTH A
OSTERVILLE 208 WEST BARNSTABLE RD
OSTERVILLE MA 02655
PHONE DISTRICT CO
DEVELOPMENT STATUS C ASSESSOR' S CODE
CAPACITY(NOTES)
ZONING DIST/ZOC RC SEWER SYSTEM
FLOOD PLN/ELEV. WATER SYSTEM
OKH? # BEDROOMS
ZBA DECISION FAMILY APT
LOT SIZE 21780 OPER/MGR NAME
WET LANDS MULT ADDRESS
USE 101 PROTECT DIST WP
(N) EXT / (P) REVIOUS / NO (T) ES / PER(M) ITS /
(V) IOLATIONS / (G) EOBASE / (E) XIT
This value is not among the valid possibilities
f
QUERY PERMITS : QUERY END
QUERY PERMITS .
PENTAMATION----------------------------------------------------------- 03/04/02
PERMIT NUMBER 11868 PARCEL ID 121 027 208 OSTERVILLE-W/BARNST
PERMIT TYPE BHOMEOCC HOME OCCUPATION
DESCRIPTION WALLCOVERING
CONTRACTOR
PERMIT FEE 0 . 00 VARIANCE
STATUS Q APPROVED
CONSTRUCTION TYPE 753 GROUP TYPE
APPLICATION 11/27/1995 EXPIRATION
VALUATION 0 . 00 DATE ISSUED 11/27/1995 COMPLETED
DEPARTMENT-----STATUS---DATE-----DEPARTMENT-----STATUS---DATE----
(N) EXT/ (P) REVIOUS/ (C) ONTRACTORS/ PR(0) PERTY/ (I)NSPECTIONS/ (H) ISTORY/
(F) EES/ (A) RCHITECTS/ (V) IOLATION/ (E)XIT
QUERY PERMITS : QUERY END
QUERY PERMITS
PENTAMATION----------------------------------------------------------- 03/04/02
PERMIT NUMBER 28889 PARCEL ID 121 027 208 OSTERVILLE-W/BARNST
PERMIT. TYPE BPLUM PLUMBING PERMIT
DESCRIPTION 1WH.
CONTRACTOR
PERMIT FEE 20 . 00 VARIANCE
STATUS C COMPLETED
CONSTRUCTION TYPE 753 GROUP TYPE
APPLICATION 02/12/1998 EXPIRATION
VALUATION 0 . 00 DATE ISSUED 02/12/1998 COMPLETED 02/18/1998
DEPARTMENT-----STATUS---DATE-----DEPARTMENT-----STATUS---DATE----
(N) EXT/ (P) REVIOUS/ (C) ONTRACTORS/ PR(0) PERTY/ (I)NSPECTIONS/ (H) ISTORY/
(F) EES/ (A) RCHITECTS/ (V) IOLATION/ (E)XIT
QUERY PERMITS : QUERY END
QUERY PERMITS
PENTAMATION----------------------------------------------------------- 03/04/02
PERMIT NUMBER 28890 PARCEL ID 121 027 208 OSTERVILLE-W/BARNST
PERMIT TYPE BGAS GAS PERMIT - NEW METER
DESCRIPTION 1WH.
CONTRACTOR
PERMIT FEE 20 . 00 VARIANCE
STATUS C COMPLETED
CONSTRUCTION TYPE 753 GROUP TYPE
APPLICATION 02/12/1998 EXPIRATION
VALUATION .0 . 00 DATE ISSUED 02/12/1998 COMPLETED 02/18/1998
DEPARTMENT-----STATUS---DATE-----DEPARTMENT-----STATUS---DATE----
(N) EXT/ (P) REVIOUS/ (C) ONTRACTORS/ PR(0) PERTY/ (I)NSPECTIONS/ (H) ISTORY/
(F) EES/ (A) RCHITECTS/ (V) IOLATION/ (E)XIT