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0304 HIGH STREET - Amnesty
y ii .. 111'/...,1�,,{■l►�////I/.,1(^■,,, �.'j1n1,, , -... �-.-ma...w,..�m..2,..._-"•._—w• -w..+r.*.+Mw- C d .. t { 4 f, Narragansett Bay Insurance October 31, 2019 Barnstable Town Building Services _ o 200 Main Street Hyannis, MA 02601 o i NOTICE OF CASUALTY LOSS UNDER MASSACHUSETT � a - GENERAL LAWS, CHAPTER 139, SECTION 3B N RE: Policyholder: Stephen O'Donnell &Traci O'Donnell '— Policy Number: 10151324 Claim Number: 01 MA10151324 Date of Loss: October 16, 2019 Loss Location: 304 HIGH ST WEST BARNSTABLE, MA To Whom It May Concern: A claim has been made involving loss, damage or destruction of the above reference property which may either exceed$1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6,to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, date of loss, and claim number. Respectfully Submitted, Claims Department Narragansett Bay Insurance Company 401-725-5600 claimsinquiry@nbic.com PO Box 820 1 Pawtucket,Rhode Island 02862 t 401.725.5600 1 f 401.721.0700 1 www.nbic.com i fet ivy to Pno ka xffvr x te, Aorvol"n assi�te. '1 Barnstable ; . T "� 99P 'own ® ia�'�HL'�- i _'�" nJtH"Z -i „4i ACCy4��YY�i � 9 7sr$3 r ............. 9 y t M. R ;yy'•Aji •W &YOil- -l', 1 .... _ kiw2I C ertificate.. of Com liance This-certificafe'indicates acce table'minimum habitable re uirements: er Mas"sachusetts'State Buildin :Code . c j ,�,, z „m aa, . y t _,. :y , . an'd:Town.o€Bairistable zonm :ordinances in accordance with the Amnes. ro am g ty P , qr any"F•1. Y +P "' •',.c ''',�41{t� ?, �Y y / S 4/� 3 .Ai} 6 F ,,:( i -{ OR y+� t�..h .vn r Donnelli,.. r r J #O .`a•,t'+<n Yp,::i lti.v;. 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Y u r.: ,... ., a i'k, , : i�.... .a. x . .: • .:, :r .ck'.. 7: �� .d, ..£>tlro'`°'`i5. .:tr` , ..f 8 f,ril� .!t, t.,..r ;wa:"':�«.•.' _.$.;'rs. ;8'a?� �sk,� l.:y'aJ:K.. . � � 11/29/2Q17 �j�r' :,,, ��,P,,� � ., � -•. .. k ;l�. �, > :y,�. � �.�x � �, L� :. ,1 ..:i ... -x d.. w. ......a:8 .�� §... ".*,iw'is s• :n` t:, >t}•�.. � s., t& �:,,� •�,;-,'�•..: �' i r�: �:::i.., �x. .. .� m'a„i`^��€,�h:,z 2+�1�.u� m;�le;,.,Fm:'a�'A.,S.�dC:''�G�."' �.`.u...4ta.."'pA;-i:'`,t`h+u�::i�o w$k.u��?i�t�•_aU5��,kses:l�.�e„ �lS�.--:ay.�.s.,ccuwala:2:3.utii:+�%�.>.�.,.$�S'SP.z..bJr�'� �':� �>.•s�. s-!.'w�.r:Ea:..:�:. :r�ert °Fz"E ram, Town of Barnstable wwSTABL& = Building Department-200 Main Street �0`q Hyannis, MA 02601 �n 19. Tel. (508) 862-4038 Certificate Of Occupancy Permit Number: B-17-1882 CO Issue Date: 11/29/2017 Parcel ID: 111-027 Zoning Classification: RF Location: 304 HIGH STREET, WEST BARNSTABLE Proposed Use: Name of Tenant: Sprinklers Provided: Gen Contractor: STEPHEN J. O'DONNELL Permit Type: Residential-Single Family Type of Construction: Design Occupant Load: 0 Comments: Amnesty Apartment per Comprehensive permit No. 2017-005 - O'Donnell 2 11/29/17 Building Official Date: A Certificate of Occupancy is Required Prior to Occupying Space Building Code: 780 CMR 8th Edition Town of Barnstable Building ps z7his Gard S�Tha Vtstbl: rornrt e;Stree �ovedPlatis°Mus:be etatned one b ands hts;:Ca��M s h�eaKe r�nxsrxss R - t. \pP "s * "hos�edJint�Ftnallrns action as Bee :Made. � a�>�� � :� 4 � �� � u K a Permit cc tad; �ttl aFtnal:lns ectton has.beenma: '' �iMh�re'a CerttfiCate of O Gu a c �s Re, utred,such Buildtn shall Nat be O p, P ., Permit NO. B-17-1882 Applicant Name: STEPHEN J.O'DONNELL .Approvals Date issued: 07/03/2017 Current Use: Structure Permit Type: Building-Amnesty with Construction expiration Date: 01/03/2018 Foundation: Location: 304 HIGH STREET,WEST BARNSTABLE Map/Lot 111 027 Zoning District: RF Sheathing: ; Owner on Record: ODONNELL,STEPHEN&TRACI � Contract' Name STEPHEN J.O'DONNELL framing: 1.2: `t �7 Address: 304 HIGH STREET a Contractor License 179647 2 WEST BARNSTABLE, MA 02668 ��� k 16 W r ject Cost: $20,000:00 Chimney: Description: Amnesty Apartment over Garage attached.R mom ,2 existing Sky Permit Fee: $ 177.00 Insulation: Lights install new Velux Sky tights:Remove 2 Windows Install New fee Patd Stair and Floor and Window for Apartment avCode Required $177.00 2nd Final: eo/I 2-7 Egress. ,Date 7/3/2017 Project Review Req: Amnesty Apartment over Garage attached�J?ernove 2e tt i �� .- Plumbing/Gas Sky Lights install new Velux Sky Lights Remove 2 Wt'dows - Rough:Plumbing: Install New Stair and Floor and Window forApartme #as Code Building Official final Plumbing: Required 2nd Egress. This permit shall be deemed abandoned and invalid unless the work a by this permit is commenced within six n nth aft r issuance. Rough Gas:' All work authorized by this permit shall conform to the approved application and the approved construction documents for which ibis permit has been granted. All construction,alterations and changes of use of any building and structures i shall:be in compliance with the local zoning by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street of roa and shall be maintained open for public►inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signaturees bythe 8uildingande Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or footing t Rough: 2.Sheathing Inspection 3.All Fireplaces must.be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before OccupancyLow Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: Persons contracting with unregistered contractors do.not have access to the guaranty fund"(as set forth in MGL c.142A). Fire Department Building plans are to be available on site final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT =' Am r `t TOWN OF BARNSTABLE BUILDING P RMIT APPLICATION Map Parcel �°�7 Application Health Division �j l ,�, Date Issued l7 , Conservation Division Application Fe PlanningDept. &17 Permit Fee U p O WA/ �A 1, Date Definitive Plan Approved by Planning Board ? Historic OKH _ Preservation/ Hyannis Project Street Address 3& L/ Village Owner STD d ira'o o n ll Address ///9A ST Telephone Permit Request X-e yn6v,e d eY75/,27A 5A-1 lflbjs zh S,kd i1 ew 1✓e��j( /1�Q S, ke move d cy 1ho�d� ;�n f ti ew S/z+,"r o"J Aqx exi ) wi l-7 (�7 A5 `i- Square eet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District �' Flood Plain Groundwater Overlay Project Valuatiodzd I oyo Construction Type Lot Size ac ✓e Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Q4 Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ANo On Old King's Highway: ❑Yes No Basement Type: ❑ Full IQ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: 3 existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: RGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing �L New 0 Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:)qexisting ❑ 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) S e J- D�a��e�J sy8- `�s �� 7Y,570 Name Telephone Number Address 3 ay License# C S 78 737 �Jo✓r�5I�6T�, �� o4 Home Improvement Contractor# / 7 9 6 y 7 Email /G ,'(� �a `� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO -�"clldlt/,rcy SIGNATURE G'd f�'�� DATE 5 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: " FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ' DATE CLOSED OUT ASSOCIATION PLAN NO. r _ The ComnonweaU ofMassachusefts Depofent offndurh-ialAccidenfs ' ' Office of Ii vesfigations ' 600 Washington Street Boston,MA 02111 www.massgovldia Workers' Compensation Insurance Affidavit:Boulders/Contractors/Elecfriciam/Plmubers Applicant Information Please Print Leg j lk Name(BuSmeS aZBIL MhMrh,ri;o;ri„an; Address: '.3 d Y /-// S City/State/Zip: , 6cl,,-4 S &$ MA Od d,4 Phone#: - V- 81 d a Are you an employer?Check the appropriate box: Type of project(required): 1.El am a employer with A.00 I am a general contractor and I employees(fu11 and/or part-time). * have hired the sub-contractors 6 El.New construction2.N I am a sole proprietor or partner- listed on the attached sheet 7. Remodeling ship and have no employees These subcontractors have 8. []Demolition working for me in any capacity employees and have workers' 9. Buildm addition [No workers'comp.insurance comp.m mance t ❑ g required.] 5. We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work 11.❑Plumbing repairs or additions myself [No workers'comp. right , exemption per MGL 12.❑Roof repairs ,.r a inc „ce required.]t c.152 §I(4),and we have no employees. [No workers' 13.❑ Oilier comp,inenrance regaimd.] *Any applicant that checks box#I 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 hits outside contractors must submit a new affidavit indicating such. $Coutracftus that cheek this box must attached an additional sheet showing the name of the sub-contrzctnrs and state whether or not those entities have employccL If the sub-cuntractnrs have employees,they mast provide their workers'comp.policy number. I am an employer that is providing workers'conTecsation insurance for my employees. Below is the policy and job site usformaYiom Iusrumce Company Name: Policy#or Self-ins.Lic.# Expiration Date: Job Site Address: City/Siate/Tp: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section25A of MGL c. 152 can lead to the imposition.of criminal penalties.of a fine up to$1,50.0.00 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 statemert may be forwarded to the Office of Investigations of the DIA for mi sarance coverage verification.. I do hereby c the par;•zr�and penalfies ofperjwy that the information provided abope is true and correct Si (,,//JyCC�JJ Date: 5- /'7 Phone#: Official use only. Do not write in this area,to be completed by city or fawn o�`iciaL City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityfTowa Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#: ' l Information and Instructions Massachusetts General Laws chapter 152 requires es all employers to provide workers'compensation for their employees. Pur7iantto 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 anployer 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,pa ammhip,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 Iocal 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 ofpublie 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-contractors)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 maybe 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 t 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 permittlicense applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should writs"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 (Le. 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 CommaaWealth of Massachusetts Department of Industdal Aocidents offiee of jvestiptiow 600_WasbiVon Street Boston,MA 02111 TeL#617 727-4900 ext 4€6 or 1-977-MASSAFE Fax#617-727-7749 Revised 4-24-07 www mass_gov/dia ° r r r Town of.Barnstable t a F „ Zoning Board of Appeals; Corn pre hensive Permit Deciian and Notice Accessory Affordable:Apartrent�Pragram Comprehensive Perrriit`-No 2017 005 O'Dohnel) Summ.a.ry, Appr.,ove$,Wlth,C'ditiens' Applicants Stephen and Traci-O'Dannil! Property Address.,: 304 High Str:.O#f West Barnstable, MA:M 111 rr#�� ,r 7 t },} f.{^��t�Pi i Fr,r". .f.�rn,4 , iontot RF- :Residence F;Zoring,0istricf�. Resource Protection Overlay District, Summary.., Allow a-one=bedroom acc'essory,affordableapartment withirrthe-:principal d.w lingpursuant to th;e Code of the Town ofBarnstable,Chapter.9;Article I,I 'Deed ll''f- ence Deed Book 36043 Page 158_ Applicant/Site Control; The Appiicants.are Stephen and Traci O'Donnell,owners,and occupants of pr`o'pertyaatlressed 304 High Street; West.B"arnsta:ble, MA; The:AppUcants,zh'aye bee.n'the owner of the property srnce 2012;as eyidenced:by a;deed recorded at thexBarnstable County Regist ry:of Deeds on Jat�uary31,2012 as Book 26043 Page 158. A signed Affidavit dated''September 6 2016=declares that 304;High street,.West`Barnstable MA is the:primary:resi.dence of ;Stephen 1 O`t)onnell.: ,Locos The subJect.property;is al 0S acre;lot created by`a 1973 plan recorded at the Barnstable County"Registry of Deeds <as Book 274>P:4&42, The.lot front'4h His. Street The="property is improved with a:fi,832 gross square fo0 three:bedroomsingle family;dweli(ng(1,6301iving;area)constructod in;198'i The onto Ins,an; :attached two'car garage and ndooc-swimming pool Itis served;.by well and an ari-site septic ysterr: >B'ackground Stephen and Traci"C+'Donnell seek,,tQ cohVgrt:8A0`square-,feet o,the ex stmg,fir t;and econd floor of the attached garage'to a one bedroom Accessory Afforda 'e Apartment by,a Comprehensive Permit pursuant to Chapter:40B of ahe•Ge"neral laws ofthe Ooria'mpn�vealth of Massaehusetits,anal In accoxdance'with§;9-95 of` he Code of,the Town of Barnstable,more-commonly termed:-the;"Accessory,Affordable Apartment Program Procedural:&:Nea,ring:.Summary On September 5,2016,Stephen and,Traci OlOonnelt submitted an an a Site Approval.Latter as prescribed in:the Code of Massachusetts Regulations 76Q Section,56 00 and.pravided:for with;11:m the Accessory: Affordable Apartment Program of tie Town of Barnstable. The;:applicationwa.,sub"mitted as':a locaa initiated Chaptor 40B.:Notification of the application was submitted,to the 4epartmentof Housing and Carrimunity' peveloprnent A Site Approval Letter was issued f the Applicant fiar the subject property by'TawrrManager Ma"rlt;Ells an:October 6,2016. Ndtiee of the Site Approval;Letter was sent.ta th'e°Repa`rtment of Housing and Communrty Development in accord with the;requrements;'of CMR;760,5600" An applicationfor a Comprehensive Permlt;was filed at"the Town`Cle,rk's`Office<on becember 10,2016. AMpublc hearing before the Zoning,Board of Appeals Hea'ring Offacer was;duly advertised in:the Barnstable Patriot on December 23 and 3,0;20i6 and notices we`re sentao"all abutters in accardance with Section 11 of MGL Chapter �4QA:, . i 1 . ::Town of Barhstable�Zoning Board of Appeals Decisi0nr&Notice C,pri prehen-) PermitNq.;201?=005 'g poriiwl:° The.Hearing Qfficer,'i3Ha i Florence openedA Public Clearing on January 11,2017,at6 30 p.m Pre ent at the hearir�g,was: . i Findings=of Fact„ At the bearing,on January 11;2017""the Hearing Officer mad"e,the foClowing findings of fact; aG,oncemtng sfanding;-:the fight.of th'e applicant to seek a;;cornp"rehensive permit;the;ll'earing Officer found 1 The Applicants,Stephen;and Traci O'Donnell,;:are th:e:owners and.occupapts of thepro;perty located at 304: High Street,West Barnstable,"MA,as evidenced by,.a deed recorded,at the;Barnstable County Registry of Deeds onJanuary;31,2012 as Bdok:36p43 Page J 58,`,a signed Affidavit d`"aged September�0;2016 declares; that 3Q4 High street,West Barnstable is the primary,r,,esidence of St'aphen J'.O'Darinell, " Tie application,far a comprehensive;permit was made in accordance withthe Town of Barnstable s Accessory Af ordable Apartment Program,Chapter 9 Afti I 1I of the Cq'de o f the Town of Ba'rnsta610 That program[s stru m :a ced as a sfg10.9 M, M* miti uaidfe 0ln nate mfi accepted under the Code of Massachusetts Regulations 760;Secti...n 56.00.tha`t"governs grant af' comprehensive permits. 3:. in;accordance with MG`LChapter 406..a..nd 76p CMR 56„Q4 O,a_Site Approval Letter was issued fo the' AMON,I t.10 the sub)ect!property by Town Manager, Mark".Elis an 0etober 6,"2016. Notice of`the Site Approval letter was sent to the Department of Housing andCommunity Developient,in accordance with the; requirements of760 .MR%,04( ,arrd no issues were communicated from the Department on this a:pplicatio;n... Regardng;consistency with local needs,the Hearing 0`fficer found' 4. The Applicant s,proposing to convert 800 square feet on the existing first a:nd second,fioar of the attached'>> garage to a one 'edroom accessory apartment within the prncipai:dwelling: To permit the apartment as an accessory affordable unCt under Chapter 9"Article iI of the'Code would represent"no`perce vabl"e changen the, neighborhood. 5 The Build ng Cornrnissoner performed an"Initial review of the property and determined that anaccessory. apartment Unitcan be.created. n conformance with:applicable state buiidmg codes Prior to occupancy,a building permit shall be required and hardwired smoke detectors:an carbon monoxide detectors'shaI be" upgradotl%in tilled and"the un trshall meet"a l requirem,ents of'the W ding,Code. 6 The property=is<served by anon-site septic system^adequate to accommodate the.'additiion'of aone-bedroom unit on-A, 0 ro"ert ................. 7: The Applicant ha been informed that building and occupancy Permits shall be obtained;prior to occupancy of the.accessoryapartment Thisstep is required to,assure"final approval that the apartment unit confo"rn shilly= to:all"applicable building,fire,and hea,th`codes ani�this decision:; 8. The appli(ant has beerr,nformed thatupon certification ofthis Comprehensive Permit by the Town.Clerk a . Regulatory Agreement`and De"claratio'n of Restrictive Covenants; restricting the accessory apartment un t in pOpetufty as an'affo,5b.1 renaal un t shall be executed Thereafter bothahe Comprehenswe .Permit and the; Agreement shall be recorded atthe"Registry of':Ueeds as binding covenants on the>property: The documents Iim'it the:aparr"me.nt to that:of an affordable unit rented to:a person or fain iy whose incometi"s 80%or less of` 'e Area:Median income(AMlj:of the`'Barnstable Metropoli.tanStat stical,Area.(N SAj and cap the monthly: _ re;ntal incorne'(including utilities]to not exceed 30°l0 of,the monthly household ircome:of"a household earning 8Q%of=the median income,adJ"usted by household size In;the event t:atutilities,<are,separately'm6tere&the: ; :utility allowance;established by the Town of Barnstable shall be deducted:from rent levef`so calculated; 2 f T.wn,oi'Barnstable Zoning,Board of Appeals Decisign&Notice Comprehensive Permit No.2017-00.5 O'Donne.il. -9 Ac ;ording to the,:Massa'cFiusetts=Depai�t�nentof Housing and Com► iunity Developrrient,Subsidized Housing Inventory,ahe Town of`B:arnstabfe has' 'O' ofIts year round'housing stock=qualified as:affordable hausing units: The town has not reached the 109'o statutory minimum affordable housing required in MikChapter 4QB or met any.ofthe: tat0, Minima provided forin 760.CMR:56.0�(3);. 10 The Town'of BarnStable's Comp'rehenslVe Plan;encoyrages the adaptrve use of existing housing stockto create affordable unitsand the,dispersal of these runits throughout Barnstable. This applicatlon and the'location of the unit conform tathatobjectve,- Based iipon tlie�findrgs,the'Hearing Offic,'gr ruled that the applies#ion of Stephen and Traci O'Donnell is, consistent with local needs because-at adeq.gotel'y=prpmotes the,objective of.providing affordable housing for the; Town of Barnstablewrlthout jeopardizing the health and safety of the occupants provided certain.i:orad,itionsare; imposed Decision&Conditioni The Hearing:OMer ruled to granttomprehensive`PermittNo .20.17-005 to-St a'nd Traci'0"Donnell for 304 High Street,W'est Barnsta' 00 allow the;creation'of a,one bedroom afford"able apartment u;mt within the; existing dwell'i`ng I.1 in Chapter 9,,Article ll af'ithe Code of the Town of Jeandln conformity to the foltowirfg conditions and restrictions; 1 Occupancy of the affordable unit shaill rat exceed two(2)per""sons, 2 The number of`bedrooms in the:-Accessory Affordable Apartment shaft be limited to one(1j.; 3 Fa:mliy me;mbersof the applicants/owners,s.hall noY at any time°occupy�.theaccessory:unit; 4. All leases shall have a minimuir term-of one year andhave provisions that require the tenant to:provide any: 'and all information necessarytq verlfy'eligibiltywlth the Accessory:Affordable Apartment Program including; income informatlorl of the tenahtrent and utility;payments: 5. All parkingfor h accesoaatmand hepclpai wllingshbeonst Ovgostetry er n re parking is expressly prq.Pbited : 6 Accessoryaodgipg.orrenting of;rooms is prohibited fbr the durationof this:Comprehensive Permit.. 7, The applicants half; otter certi`ficatioh.of this Comprehens ve Permit.by the'Tawn.Clerk"i a. execute a Regulatory Agreement.and peclaration of'Restrictive Covenants,as approved by the'Town Attorneys gffice,and b ; make apialicaton fora building permit with fhe Builtling Division for the='accessary apartment °1Nork iequi"red to briln'the unit mto compla'tdWith,oresent d-.'de standards shall be completed prior tq'issuance of a Certificate of Occupancy for the accessory apartment 8 It'i the explicit intent that the; pplicant secure.an occupancy permit and the unit be occupied by qualified teriant(s)'as restricted by this comprehensive perrriit,within one year of the ce"rtifcatjon of the pertimit. 'The Building Commissioner"and/or:monitoring agent ma.yetend this timefor good cause. 9 To Meet. rd J�Jlty requirements,the rent eharge..d(J. clud'ing..utiliities)shall not exceed 30R�o of 804�of t he. rr etlian income for the i3arns#able MSA,adjusted.fdr'familysize,"ascalculated aril published annually;Eay tiie Town of 9arnstable In the event that utihties;are$separately rheterecl the utility al owance estab fished w the town of garnstab e,shali be deducted from rent level so calculated. 10.The applicant shall engage in open and<fair marketing`of the unit and provide docurnentation,.of'the activity to #ha Housi"ng Coardmato;r/MontoringAgent; T ;Town of Barnstable Zoning egard of Appeals Decision&Notlee-Conlprehen"sine Permit No.2Q17,005 4 0 Donnell' 11. Information re artling the Income levehof any prospective tenant si"all first be submitted to.an.'approved by the Housing,Coordinator/Monitoring #getit before any iease;is signed;: 12::Annualiy :the applicant shall work with-the Housing Coordinator/Mon oring Agent°to provide necessary rnformatio'n and dpcumentotioo of tenant income;eligibility and5cor formanw with the Accessary Aff-b-c!' ie; ApartmentPrograml. `13 Whenever a vacancy occurs, notice sha l be given to the Housing Coordinator/Monrtonng;Agent4before; reengagin;the teriants 0-11, h process preciously cited. 14 An`nual Income,to determine program elrgrbility,willbe caleulate'd p'er 24:GFR Part 5:: 15 The Housing Coo:r,,dmator of the.Growth Management Department shall be thg monitoring agent;for the accessory apartment.Annual monitoring dial inclu.die verification of tenancy,affordability,,and compliance; with Comprehensive Pe,:rmit The.homeowner'shall.be,resppnsible.for the fee for F ausrng Quality S_antla ..s' (HCIS)in.. coons 16 Ewery twelve months-the applicant shall review-the income eligibility of the tenant,of theAccessory Affgrdable>A "' tment unit; No late.r'than a year from the date of issuance pf this Gompreher►sive PerFn t,the applicar�t'shaU file wltijahe Housing Coordinator/Monitoring Agent an annual;affidayit� oting the.rent; charged,,and income ofahe unittenant>along with a'll requfred supporting documentation: Ttie.property owners and/or to°Want shall provide,any additLona.l information deemed necessary` o vefify the,information= proylded;in the affidavitand annual monitoring,documents 17 Upon any.r.e from the Housing.Coordinator/Monitoring Agent that,the terms,'and conditions of.this:-perrri t: are not be"ing upheld,the Hearing Ofticer of th:epnir►g Board of Appeals;rriay holdµa hearang'to revokethi"s permit or Cause enforcement action t,betaken far,compliance;: 18, Thts Decision,the Regulatory Agreement and Declaration of Restrictive-Covenants andAl other=necessary: docurrients shailte recorded atthe 13arristab a County:Registry..of Deedsprio"r.to application far'a building permit::. 19 Should-ownership of the subject property transfer,the perm t holder identified here,innshall.notify the Nousipg Co'ordinator/Monitorir�gAgent:and provide,w Ith1hrKe0, ays.of the date of transfer the name and current contact information for the new owner pf th, bject property: M.Th'rs Corn.prehenslve Permit shall be,,exercised as conditioned herein'or itshall.exp re.. Ordered Comprehensive Permit No.2017 �Q5 is gr'antetl with conditdons to Stephen and Traci 0 Donnell for, property addressed!lb High''gt,West Barnstable, MA.This permit,is not transferable withou#prior permission of the Hearing Officer.The zoning relief issuedinthi°s C:gmprehensive Permit is:that of a variance 10-Section,240=11(Af' ,24 13`(A}P--bpal permltte:d usesa.n the R'F Zoning;Districts to permit.a one bed ''accessory affordable . apartment dint within the principal dwelling: : A written copy of this decision wil be forwarded.to the.Zoning Board of Appeals as required'bythe Town of Barnstable Administrative Code Chapter 24;1,Section 1j'. If after fourteen(f14)"days:fr"orn that transmittal wild; proyrded that the members--o the,Zoning Board of 4peaIs take nq-action to reverse the decision,this decision shall b'e'frled:wlth the Town Clerk's Office. It shall then.become final o'niy,af#eflO.days has.ekpieed and certified by,the Tpyun Clerk that no appeal was flied=on the decision; Appeals of fhis decision,if any,shall be made to the Barnstable Supet:ior Court>pursuant to M'Gl.Chapter 40A: Section'17,within twenty(20)days`aafter't a date of the,filing o:f-this decision In the office of'the Town Clerk The applicant has;the right to appeal this decision as o4tlined`in MGL Chapter 408 $ection22 4 I Town:df Barnstable Zoning Board of A,ppe.al"s Decsion ol siue PemitNo:200 OQonnelfh Bnan"Florence; HearingOffier Date.Signed I Ann:Quirk,Clerk of the Town of`Sarnstable, 9arnstable County;Massachusetts,hereby certify that!twenty:(20) days have elapsed"since the Zonirtg Board of Appeals filed;this decision and that no appeal of:the decision h'as beenli'led in°the.offlce ofthe.:Town Clerk;: da of2U f f); Signed and,tea1ed this y unWer.th'e painsand:"penaitles of perjury:; .. d 3 r Ann Quirk;Town Clerkke r W tq�s x: t r r 1 ARNSfA LE, R'EGIS`TR QF DEEDS aobn F. Meatle,Register ' S 011 9.1 .6 REGULA,TORX AGR$ElV1ENT AND DECLARATION OF"RESTRIM."COVENANTS, 'PHIS REGU7.ATORY AGREEMENT And DECLt1Rt1`TIQN C?F RESTRICTIVE G(7VENANTS,is made day of_ uQ./ 20 ,by,:and between Stephen,and firact O'ITonnell of 304'High Street,West Barnstable;7VIA a d its successors:and assigns (hereinafter the"Owner'),and the TOWN Q`F BARNS TABLE(tl e"Ivluhictpal ty"),a pa oot subdivision Qf the Commonwealth, ,WHEREAS the Owner has,been granted a Comprehens veT, rn*=der Massachusetts General La�v Chapfer; 40B`and local regulattons`by the Zoning Board of Appeals to pertrut the creation of an accessoory apartment in:; an owt�et occupied"dWellin.9N,ich will be rented°to a Low or Ivigderate Income'Person/Family(hereinafter "DesignattedAffordable Jntt'�,.And, NOW THEREFQRE,to mutual con5ideraaon of the agreements and covenants contained".herein,:an"d oilier good and ualuable;eonsideYatxon,`the receipt andsufficietcy of which is:hereby ackno�yledged the porkies ageee assfollow : ; ,w: I . .. . ...:PROJECT SCORE AND'DESiNi A;, TFe terms,.of this Agreement and Covenant regulate the:property located at 304 High'Street,'West $arnstalle, as further described r a deed,recorded herewith as Barnstable County Registry of Dees , .Book'6043 Pige-'158 and:Shown on-Piati'B,00k 274;.I'age 42,, B Tl%e Piolect located at 304 High Street,West Barnstablea MA wili`consist of one accessory apartment: unIOVOtch:vviU be rented to an eUgible low or rr}oslerate ncome'J'dtvldual or faintly(tl'c"Designated;Affordable- `Ut ,!or�the r`Unitl. G ton o acorwtemofcmpnsiThe Owner agree P rehve pemtt ci Appeal No: ` club 'd'Ci na appablcsmte federal,an2 d s e ipal.law and, v regalattons. aid p;i rW Is re,cortled herewith as I3atnstable County Registry of Deeds Boole Page--�� , D.: The Owner agrees to occupy the pruicipaI dwelling utut.located on.the property:as"their,principal is idence,,15 accordance wdz the:terrns of the comps ehensiveerinit 1 E II THE 01'(I�TER'S`COYENANT'S AND'RESPC)NSIBII.ITIPS• t1:.. "THE OW ,FR.HEn REI R.E EFINTS,COVENANTS AND"WARRANTS?iS FOI,LOWi 1 InreceiV wthe comprehensive pernvt to cteate:the Designated Affordable unit,the;Owner a reed that the,Designated Affordable Unit shall be set asidexin peipettuty:for the publlcpurpose;of providing safe,and decenk housing to"persons earning at or below$.Q°lo=of the area methan;income o .Bart stable:M tropalitan Statisttcal.Area:(lvfSA),and that the`Designated tlffardalle Unit shall be deemed to be;itnpressed"witl;a public trust.: Th;e Designated Afforda-blc Unit shall be rentedi perpetu"ity to a"household.wath a maximum income of 80%of the AAe'I Median Income(AMA of,Barn that rent(including uWtttes) shall`:'not exceed an amount that is affordable,.to a household whose inearne is.8Q%of he median incptne of BarnstablerMS'A Ir the:event that uhliues are separately metered;a sutilityaallowanee established by the>Barnstable Housing Authouty shall be.declu,Gted from,tlle rent.leeI: j 3.. The Designated:Affordable Unit;:wili,be:xetained as"a permanent,year:xound;rental dwellingunit with at i least atone-year lease + i 41 The Owner has,the full legal rgght,power and audiorty to;execute;and deliver this Agreement; 5: Tle execur}on and pexforrr}ance of this Agreerient by th"e Owner will nat violate or,as apllcaliie�has not:violated any provision. of law;rule oX;,iegulat on,or any older of any court or other:agency or governmen al body,<ana>wal not:.violate or,as appl cable,has n..otviola'ted any pi ovis'ion cif any indenture,agreement;mortgagez 1 mortgage note,pr other it atxiiment to which the owner is a patty or by whioh:t Qr""the Qwrier'is bound,will not xesult;iri the creation or imposition of attypxahibited encumbrance.oF.any nature. 6 The Owner,at the:time of execution and,delivery of this Agreement,has good,clear`ii atketable titleto the pxemtses: �7:. There is no acttpri,sw.t ar°proGeeling at law or in equity or by or bcforc,aiiy:governmental instrumcntality.orothcr-agency.ncitiv pending;or, to the,knowledge of the SJwner;threatened against or affecting tt,or any of its propertt s or rtghtsa which;if Adversely detertntnerl;would materially uxipatr its.i-Alt to carryon: business substantially as now conducted(and as tiow contetz;plated"by this Agreetxient)or would tnatertally adversely affect i"ts,financial condition; �. CQM.PLIANC j The 0wnex hereby agrees that any and ail requirements of thelaws ofthe Commonwealth of nt""totvassachut tcib nrderorthepoion .oths,Agre nim tuterstictions an d,t e ' covenants rint�iiigvtth the land shall,be deemed to be sattsfied n...full and,that;atty requirements of privileges;of ;estate are lso deeined,fo'be.satisf ed:in full.: LiIvIITt1'l:'iON(3I�PR��I�'S- 1. Tl e owner agrees:to:lirri t lus/her profiC y renting the Designated Affordable.Unit,in perpetuity to a -household with a Maximum income of"80%"or less of the Area Median Income(AM1)of Barnstable Metropolitan Statistical Area(IvISA)aiid.[hat rent(tnclud ng utilitles)shall note Geed AA amount that,is affordable to a.hauseholdwhose'incorne":is'80°!o of the-median incomeof Rarnstable;lVISA. In the event that: utilities.are:separately metered,a utility allowance estiblished by the Barnstable Housing Authority shall l'e deducted."from.thezent 2. The Owner shall::annually dcliver?to the Municipality Arid to tle Monitoxing.Agent,.as:designated by.(lie Town;Manxger;proof fihat the Designated"Affordable Unit is rented,th..e tenant's t?corne ficatian,a copyof the.lease agreement and th' rent-harged'for the unit or"units, Sucli information shall also be forwarded to the: Monttaring:,Agerttwrthin 0 da,P,of the occupation of the dwelling unit or utdts by a,nevv tenant, The C wnet, shall noti jI!the Monttaring Agent,as designated lay.the I'own:.lVZi;tiager,lvithin thirty'(30),days of the date that a tenant has'vacated the Designated Affordable Unit Imo; Iv UNIOIPALITY°CQYENANIS�ANT REgPUN IBtI;ITIES 1 . ,through the"monitoritig agentdesignated by�the Town Managex'agrees to The MCINICIPA ITXF pexform the duties;.of veritytng Chat the Designated Affordable Unit is being te.:nted in perpetuty.to"a household' Nvith:a maximum income of$Q%or..less of the Area.Median Income(AMI).of Barnstable 1V1$21,and that rent, (including utilities),shall not exceed an amount that is affordable to a household whose income is 80%_of the inecltan incgme,'of,Barristable MSA In the even. t;'that utilities are separately teetered;a utility allowance esti blished,by the:l3arnstable IIQ%istrtg Authority shall be deducted:fxo x the relit: IV':; RLCORDINGOF AGREEMENT.: 1 JU n e.cecuttQn,the QWNER shag irmme`dia"tely cause this Agreement glad any amendments hereto to be recorde with the"legistry of.Decds for Barnstable County ar,tf the'Project.con41 is to whole"4r in part,,of registered land, file dus Agreement and 1y amendments. hereto'with the"Registry District cif the Barnstable L'and Court(colleetively�hexeinafter the",Registry of IDeeds'. ,and the dwne"r.,sl all pay all fees and charges' incurred in connection',therewith. Upon zecording or filing,as applicable,the:Qwnex;;shall,txrmediately'txan"stint; to the Municipality evidence of such recording or filing'including the date and;instrument,book and page or ` registxatio#:numbet"of the greernent,,: ' Y: .�. G"OUERN`ING:.OF AGItLEM�NTc: This Agreement shall be governed by the laws of the Common'iealth of Massachusetts Any amendment§to this Agreement must be:tri wrtd ng and executed;Uy alIof the ypattes hereto The invalidity of any:elause,parr or provision 0 this Agreement shall not:affect the validity of tl e,remgi"Ting portions I ereoE YT I�jCOT�CE Allnoticcs:to"be:given.pursuantto this:Agreetncnt shall;be i"n waiting and..sliall be:dcemed.gven whei delivered"by hand.:or°vuhet rnaited;by certifiecl:or registered . postage pxepa,;le turn receipt requested,to cL pasties h4oto at,the addresses sUT....th.belo1v;of to<such,other place,as a party nay"froth time to acne'designate, by.,avrittenriotice:: III:�, HkJTiD FiAI�MLESS;; The Otvn'er hereby agrees;to indGmnifywandhhold;harmless the;IYlunic pality and/or its;delegate from any_ and all actions of inactrons by the;Owner,;its agents,servants or employees Which sWt rn claims made agairisG Mur}icipallty and/or its delegate,, nclucin but not Ltxuted tc�awards,lut3gmenes;outTo =poclet expenses and; attarnep.fees necessitated-by such aehoas.: yIII ENTIRE:UNDERSTAAIDING A; This',Agreementshall=constituteehe emte,understanding;betwcen.fhe pares and any<amendments or changes hereto must be iri Writing;,executed b1.y tlie,pardes,and-,appended to this documents' B. This Agreement and all of the Eeoveiiants,agrees Lento and restrictions'contained herein shall be deemed: to ?be for the public Purppse of providing safe:affordable housing,a4 .shall.h deemed to'be, ,and by these presents are,granted by the Owner to run in perpetuity"iwfavor of and.be held by the:Municipality as any other permanettt restriction held by a governmhxital body as that term is used in MGL Ch 1$h,Sedeti n 26 which shall iun with the land;, escrtbed in a "d.,eed xeeQrded letewitli as Barnstable Cqunry Registry of"Deeds Brook 26043 Page 158 and shall be b ncLng upon the Owner and all sumessoxs u tale, 'This Agreement is made for ahe benefit of the Municipality and the Nluriiapalty shall be deemed to lie the izplder of the xestrictton;;creat€d by. taus Agi eerrient The Ivluncipallty has determined that the acquiring afsuch R restriction is in>the pulilic interest:; 'Th.c.:Mun cipalft y,Aall not be sub ra tonthe do ense,.,of'lack o£privityof estate The cov enants and;restrictions' contained in this'Agreement shall'be.deemed`to affect: the litle to the property,described`in"a deed recorded herewith;as`Barris"table County Regiatty ofDeeda Baok 26043 Page 158, TX,, T) RM ?E ACREEMENTs The to Ag un O.this reement shall be p er petu al,provided,however,that the Owner of a Designated Af€ordable Unit"or Units may yol lnta>•l y:;cancel the granted Cotnpreliei stve Por"t"and the°terms and;, restrict ions'imposed herein Such cancellation shall only;take effect after 1) expiration of the:-:lease terms a entered into between the whet a'nd enant occupying said unit and 2);norificatton by the Owner of said dwelling tQ:tlie,Zaning Board of Appeals of his/her desire t1 cancel the Comprehensive permit upori,a date certain andthe recording of.sad:notice ah"the"BaJnstable:County Registry,of;Deeds or.;Barnstable County: Registry of the,Land Court as the:-'case maybe,thus rendering°said Cornprehensi�e:Permit void. Upon the: caricellauon o'f the::compreliensive permit;the property which is the subject matter of;this restrictive covenant shall revert to the use perrnitted,under zoning and the(restrictive covenant,shall be rendered void. X SUCGESSO�S ANIa ASSIGNS;; Ai; The Parties to this Agreement intend,declare,;and covenant.or, behalf.'of themselves and any successors art isassigns then rights at i duties as defined in this lteg►ilatory tlgreeinent and'the aStachcd;compicl ensive r z . ...... ...... .. Ii The Owner intends,declares,aizd:covenants qn behalf.of itk-f and its successors atrzd assigna(i) that tbi, Ag eemi4fttldr"the covenants,,:agreementsPand,restrtciions,,c tained,hereinshall bearzd are covenants running j witl the land,encumbering the I?rojectfor the-term of this.Agreertient,and axe;bindin 'up'on the Owner's successors in htie,(u�are riot metely personal coveiia4p,, f the Owner,and(ili);shall l nd:the Owner, Es successors and assigns and,inure to tlie;benefit of the Ivluntctpatity and its successors.aAd assigns for tt e,term of the Agreement. XIS OEFAUl.'1'i If any default,violation or Breach by theOwner of this Agreement is riot cured"to the;sattsfacton of the; Ivloiutotng;A}�eitt;aytthi#i thty(3.Q)days after critics to the owner thereof,then the IVlonitorir�g Agent rnay.serici' tiot%ficaltot::to,the Ivlunlcrauty that the Qwner is:iti yiglatipn of;:the terms and:;;conditotts hereof:. Thee Ivfuriicipality may exercise any remedy mailable to it. Tl1'e°Owner will pay all costs-arid expenses,inc luding.iegal fees,Incurred by tl c Monitoring Agent th'enfoftl ig thi A—11 en ent and:the C+Wtier hereby Agrees that the: , Muitcapaltty an�l,the Monitoring Agenttivill haven lien on the;Project to secure payme'tat of such costs:and expenses The MQnitormgAgentrnay Aerfect such alien on the.`Project byrecordzng,a:certificate setting forth- tlie amount°af the eosts:and.expense due and.owing iu ti a Registry of Deeds or the Registry of the DtstucrJLa d Court for I3arnstable£Coutty A'purchaser of theiProje,"ct or any'iort}on,thercof,tivill lie:halile,for tlie,paymenc of any unpaid costs an expenses thak were'the subject of<a,perfected lien prior;to,the purchaser's;acquistion of the: Project or;p:ortton-?thereof; XII MORT'AGEE CONSENT The Qwner`represet�ts and warrants that it has obtained the consent of;all existing mortgsgees,p the Protect to the'execut an a>}d;cecordtng of this Agi ee nent sr d to the terms iinclFcondidon$hereo£rand that all-such; mortgagees-have.exGcutedconsent to this Agreement IN WITNESS WHEREOF,we hereunto set our hands'and seals this. day of OWNTER. Slyt,}0.iUi.0 COM1vMONWRAI,DV SSACIIUSETTS ,County of Barnstable,ss' Or this_ day:of. 20 e£ore me,the undersigned notary`pubhc personally appeared ,the Owners),proved to me through satisfactory eyidence of.identifsation,whicliRwere to be=the persons} whose naine(s)is-signed an the preceding o .attached docurrientand acknowledged to lie^4that he%she signed.t voluntarily foi the:stated purposes: Notarg`Public' Printed: , My Commission Expires;. j i 4 i f OWNER 'y.w COMMQN WEALTH;Ole Mt1SSACHUS�TTS t z � g.;o�a `� .I.w�t' Country ofB"arristable, Oil Oii thFs [ day f $Q before me,;the t}r�dexstgrted,notatyy"public;perspnally appeared the Owner(s),proved to tne-through satisfacioy evtdencenof idea fcation,which were ,to be the persori(s) whose natne(s) s signed,on the precedtng;oi attached document;and aclnowled;ed to be that he/she signed yolui,taitly+fvr the,;gtate�i�,urpose ' Notary:PubU Pxinted ; My Commission"Expires ..- ��p2a Flotary i►uWia catrwaMwWth a t .....Fwatsrnt C4m(nlaWon Etip�t: MY,. Au TOWN;QF BARNSTt1BLE BY: ' WN AGER I' CW4M Wl:ACTH OP 1vIt1SSACHUSmETTS Cotnty of:Bax stalile,,ss3 On"tht� da of— 2Qbe fore mc,the utderstgned nptary public,pexstinally appeared:: : �L,:the Town Managex fo the Town of Barnstable,proved to me through satisfactory evidence gf:ideripficarion,;,which:were :t .Y ^;to"be the person,whose name,ts signed on the`pxeced ng Qt attached:doctirxient and ackn, vled ed to be that'he/she stgne i tt voluntarily for.the stated , 1 NAt1Xy:P-- Z fiGetr�a r Printed -° � czussion Ex fires SHIRLEE NVj AY OAKLEti'' ► "� , 'Nc�ry Public , ���.t�, �'Y .� �li�����w � «y 1 "C.pMMONWEAtTH OF MASSACHUSEIT$ ��%`� �it �� �\�/� Nty.Comnda3lon-Expher_ ,� h��tlt;tttttt► �ARNSTABL REGISTRY, FOODS •� M��a,f» o2z 9 � . 3�- John F. Mea'dtv Register �� ,per U/ze�oaiiinaoracuecrll�o���iQvao�crr�e�. • \ Office of Consumer Affairs&.Business Regulation HOME IMPROVEMENT CONTRACTOR - - Registration::.; -'1.79647 Type: V - Expiration =& 512018 Individual STEPHEN J.O'DONN;EL�,,,,��,�\«= STEPHEN O'DONNELL. L._ y 304 HIGH ST WEST BARNSTABLE MA 02668 Undersecretary la' Massachusetts Department of Public Safety ug Board of Building Regulations and Standards i License: CS-078737 Construction Supervisor STEPHEN J ODONNELL 304 HIGH STREET �* H WEST BARNSTABLE IVIA 02668 Expiration: %Commissioner 02/08/2019 License or registration valid for•individual use only before the expiration date: If found return to: Office of Consumer Affairs anA Business Regulation 10 Park Plaza-Suite 5170 i Boston,MA 02116 Not valid without signature Construction Supervisor Restricted to: Unrestricted-Buildings of any-use group which contain h' less than 35,000 cubic feet(991 cubic meters)of enclosed space. - L - i I ' i Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. - DPS Licensing information visit: WWW.MASS.GOV/DPS 5/24/2017 08 : 07 AM PDT TO: 15087756688 FROM:6174885501 Page: 3 ,acoRo® fYYI CERTIFICATE OF LIABILITY INSURANCE DA�4r 0117 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER 00391 .001 NA ;CT H....O.__1.J_6-.............._...... ...._............_.._.....-...........,....__.............. ._ .................................... ..... ..... ....... . Horgan Insurance Agency,Inc. ;�IUC_.No..Lacy: (508)775-5830......... .... ....... . ............. ..... PO Box 250 Hyannis,MA 02601 .(..�... ..................... ................................................ ........_....._......... _......_........................._..............__...... :......................_..._... INSU.R.Ei3CB)..AFF.�31111iN4i_fX?VE(UAQ.E........... ............ ........_..s'..............NAIG..if............. ...... ........... .. ... ........... . ......... .......... .. ...... .... _.Adantic Charter Insurance Company VDAC 44326 INSURER A.; INSUREDINSIJAEii...4............ ...__.............._..................-... ........... ....._.................... Graham,LLC liLilRE9.Gs._.................. ... ........__ . ............................ ............................ ...........-......_.....:................ .._._.... 358 West Main Street Hyannis,MA02601 INSURER.D: ........... _..... .. ......... ........... MS.4.REE_E:........... ....,................,.. ........................... ......................................,.. . COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .................... ................... ..... .......................... .................... ................... ..... .... .... INSq ...,.....�..L..1.C..�.f.E..F..F...._.;...p_�...�....q..�..(p....................._................ .. LTR_........_.._. TYPE OFINSURANCE INSR�WVD ......_... ................_._ POi1CYNUMBER (MM/DDmrv),z.r!imA!4Dn!rr)..! LIMITS .._..._.., - .. GENERAL LIABILITY 'EACH OCCURRENCE $ -- - .................... ................p . AMAGE 1'O RENY`ED COMMEACIAI GENERAL UA131UTY $ !...- ........... ..... _. ...... CLAIMS-MADE OCCUR MED EXP(Any one person) $ _... :.._._...: _.................-..........._.._..._.... ............. ._... ....__...... ..__...._....... PERSONAL&ADV INJURY "S _..._............ ....................................._.._...... :_............._............--_............... -- _... y GENERAL AGGREGATE $ ................. ............ taENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AG '$ 1'Ro _........_.._.. ._. .._ POLICY__a. ._-JECT....._.._.._L�._............._.....f ....__...._......... .._....... ...._.... __.... .... ._. .... _. AUTOMOBILE LIABILITY CbMBINED§INGLE LIMIT $ :.(Eaaxident)......... .......... .,... ................. ...... ... i ANY AUTO ;BODILY INJURY(Per person) $ ALL OWNED SCHEDULED --•. BODILY INJURY(Per accident) $ __.__:AUTOS :NON ALffO NON-OWNED I PROPERTY DAMAGE __..._.................._.. _. I HIRED AUTOS i AUTOS (Per.accident)................ .......:$ .............. ... ..:._.-.-..i._--_..........__.. ....__..._�_...._.._......__._... ..._. ......... ................._._..__..._.......... ..._..... _............. .............._._._........ ..................___ ........._..._._........._..._... _...._.........__...._........___-._ ....i.... ; $ UMBRELLA LIAR :OCCUR EACH OCCURRENCE S ............. ... .... ......._...... EXCESS LIAB j CLAIMS MADE i AGGREGATE i$ .............. . .....: . ... _.................. ......,......... . .... ........ DED RETENTION$ $ ... _._..............:..__._.P..._....._.__ ...._.........._....._..........._.... .... _..._................_.._.........__............................ _....._. ._........ _...._ . _ ._................_.........._ .__..>' i tRli�s ....... + .._....._ _....._._.. ...._..............__.... _........... ....... ................... pN y Y!N E.L.EACH ACCIDENT $ 500 OOQOO A � IpROPp�ETpq�p�Tp/EXEcuTIVE:............. WCV01059004 1/29/2017 1/29/2018 ,............................. . .............,.............. ........,.............. CERMEMBER E)CCIUDEp? Y €:':N/A' (Mandatory in I" E.L.DISEASE-EA EMPLOYEE$ 500�OOQ00 PolicyCoverage State: Ma __..............................._........................................L................... _ .................... ��tt tt11��ssc�e��rr,,�� _ D�ICRIPTIO MPERATIONShelow E.L.DISEASE-POLICY LIMIT ;$ 500,000.00 _........_._._.....-. ... .......__..._.._...........__.................... ......_.__,.__......_,... _.._.:........_.._..................._......................................_..........._...........,...._._..................._..............__.._..............-._.._...._..............._..__._........._ ..._ ......._............_..._...._............. ..... Gary C Graham is covered by the workers compensation policy AND Laura A Graham Is not:covered by the workers compensation policy. i ................ _. ....._..... ........... .... .......... OFSCRIPTION OF O PERATIONS 1 LO S!VEHI CLES(Attach ACORD 101,Additional Remarks Schedule,if more specs is required) CERTIFICATE HOLDER CANCELLATION Traci&Steve O'Donnell SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 304 High Street BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY W Barnstable,MA 02668 WILL ENDEAVOR TO MAIL NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE •C iI�/'��"r ©1988.2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER COPY The Camuroirwealth o,f-Vassad iusetts Departurerzt v,fludushialAccideu& -- Office v�'Ix gatit�rrs 600 Washington Street _ Boston,CIA 02 U1 tv>vtu mas-mg We lmrs' CumpensafrmInsn-ance Affidavit-BEdlders/Cian#ractursMechicianslPlumbers APpUcaufWw=iiGu Please•Prin E,e�L-b�V Na=(Bncin��'elY7r��Za�]� IIt�FVL�D3y 5 �� U�1,iiC.!f Address: 3 6Li �itgf tatel �i(/, &(► ,5 A `l r phano Are YOU an employer?Checktheappropriatebo= ' T of project r I_❑ I am a employer with 4. I am a general contractor and I Type e J (required): P * Isave lliredthe sub-contactors 6. ❑New constmctian employees(full and/or part time). 2.❑ I am a sole propsietor orpartuer- Tisted on the attached sheet. 7 ❑Remodeling ship and have no employees 'These sub-contractors have g.,❑Demolifioa waJdng firm in any capacity. employs and have wodmre 9. ❑B.uildiag addition [No*odors' camp.;raa=Me comp.mcrtrance.1 l� Ele#dcal of additions required] 5- ❑ We are a corpmafion and its 0 feP 3.❑ F arm a homeorumer doing all wcnk officers have exercised their Ito Plumbingrepairs or additions Mymif No W&ken•O=P- tight of exemption per MGL I ❑Roofrepairs imsuranrerequired,.]t c.152,§l(4)6 and we haven employees.[Nowod=s' 13.❑Other cow insurance required.] 'Any W iczutCut eheftboar in must also illautthe section belowshaHMA flmk orkere eompeUMfioupa&cyinffi=dML I Snn�who submit dos sffidnir i-urtiug tBr-y arm doing ill waair and then hie outside contmcmrsamst submit anew affidalat in dieatino smelt TCou=ctorsffizt Awk this boar mast waach aaadditiansl sheet shnicmgthemmneof the snb-�a snd stda whether or not ihose eoMieshax�e employees.Tfthesnb-caatmdaashaveempIcyeas;theymmstpmvidetheir xorkers'ramp.policy mnabez lain art etxp r that is prauidit tuarJiers'tort rtsrrtiari insriratrca jot nt}*cmpFay�ees $elory is the po8cy�turd jab site injormadon. �• -- ___ —_.__A . Iagrance Company.Nama: "Policy 4-or Self--ins.Lic.--01L Expi aDafe: Job Sate Address_ CO/State zip: Attach a copy of the workers'compeusationpolicy-declaration page(showing the policy uutaber and expiration dame). Failure to secure coverage as requires under Section 25A o€MGL c I572 can.lead to the imposil of criminal petralties of a fine up to$U00 40 and/or one-yearimpriso-1 as w611 as civil penalties is the form of a STOP WORK ORDERand a fine of up to$250-00 a dap against the violator. Be adtased that a copy of this statement,may,be forwarded to the Office of ' Investigations of the DIA for insurances coverage yicion. -1do hMTby certi ,nudrer thgpahw and paigUes afpajury tFu&1 Ee ificzbrma#iarrpt m• d abma is trans and correct �iasaafnrP' 6^� Date: �^1 Phone lk TOJ- Y57- 7,V3 9 0,0Wid us-e mil. Do not write in tfds area,to be cvInpretled by tarp artown ofciat � City or Town: Perm tUcense f1 Issuing AnBor€fy(tat de one): L Board of II•eaItli 1 Building Depar(mt nt 3.#ity]£owa Clem 4.Electrical Inspector S.Plumbing Inspectur 6.Other Contact Person: Phone#: = armation aAd instructions Masmc usefts Cyrbm-al Laws chapter 152 reggaes all emglog=m prOvidc workers'compensation for their employees. pursuant-tr ibis stafatc,an wq7Tayre is defined as.":c7My person m..$f a service of another vnda a¢y contract of limey express Or;�plied,oral Ord." An Toyer is deemed as`pan in�iaA p=tnersfiip,asso6fion,carporatton or other legal entity,Or any two or more of the foregoing engaged in a joint MtMEMP,and mclndmg the legal aeprese afrves of a deceased employer,or 1.e receiver or trustee of an M&Vld A pMt=shnp,associaiiOn or Other Iegal entity,employing employees. However the owner of a dwelling Manse having not more than.three apartmentsand who resides thezein,or the occ�of the- dweIIiug house Of.anofer who employs persons to do ma>�ce,wnstraction or repair wow on such dweIImg house or on the grounds or building app therein shallnotbecanse of such employment:be deemedto bean employer." MGL cchaptnr 152,§25C(6)also stains that¢every s afe or local licensing agency shall withhold$ire issuance or renewal of a Hcen e,or permit to operate a business or�to construct buildings in the commonwealth for any applicantwho has not produced acceptable evidence ofcompllancewith the hw rance_coverageregnired. Additionally,MCsL chapter 152,§25CM stains aNeither the comnumwm1lh nor;�ay ofits political subdivisions shall enter mto any contract for the pmEm=3ancd ofpnblic wotic unnl acceptable evidence of compliancewith fie msarancc._ re, �Cnfs of this chapter have Been presented to the contracting M ioay_" y Appri� Please fill Oil the worker'compensation affidavit completely,by d=S:i .g the boxes that apply to your situation and,if necessary,supply sob-coirtractar(s)name(s), addresses)and phone it mbeir(s)along with their cerEda-cate(s)of insurance. LfiitedLiabdity spa i (LLQ or Limited Liability'Parinerhrps CLEF)wrthno e loyees other than th.e ens or aria are not to cagy wOrkers'compensation insurance. If an LLC or LLP does have �.c=b r � r�1 employees,apolicyisrued BeadYised that this a.ffiday¢maybe suhmi�dto the;Departmentof Industrial Accidents for confirmation of ii n ce coverage. Also be sure to sign and date the afffdavit- The affidavit should bretameed to the city or town that the application for the permit or license is being rm est not the Dep ��i of e the Lew or if you am to obtain a wo Lchrstrial A cci Pni� Shonldyou hate any questtans regarding yo required compensation policy,please call the Dep mtnent at the mmber listed below: Self-fimn-ed campanies should enter their self-is¢ra ce license number on the approprLdn line. City Or Town Officials t _ Please bo sure that the affidavit is comp Iete andpninfed legibly. The Deparhnenl has provided a space at a ottom of the affidavit for you to fill out in the event the Office oflnvmdgations has in co ct Yon regarding the applicant P lease be sure tD till in the pennit/Iicense number which wM be used as a reference number. la addition,an applicant fat must submit multiple pm mWHceuse applizations in any given year,need only submit one affidavit iM&catmg coilert y or Policy•mfozanation.(ifnecessaiy)and under"lob Site Q-idrese the applica�shouldwrife-&U locations in - - » ed or maxlced the city or town may be provided to the ' been officially by e-affidavitl3�athas ally sfamp town). A copy of th . . applicant as proofthat a valid affidavit is on file for future permits or licenses Anew affidavit must be filled ovf each _ _ vie usiness or commercial a home owner Or citizen is obtaining a license or permit not re7atEd is?any b Yam-�� . (i.e.a dog license or permit to bum leaves etc.)said person is NOT rued to complete this affidavit the Office of Investigations would like to thank you in advance for your cooperation and should Yon have any please do nothesitafe to give us a call The.Depar r m fS address,telephone and fax number: ' CGMDjOUWWjth of Massach Bnctoa,MA Cdl11 Tf,-L 4 617- -4 cit 4-06 Qr I477 MASSAFR Fax#617` 27'749 . xevised¢24-07 - gp4dhL Town of Barnstable Regulatory Services ��� roiryk Richard Y.Sca%Director �* Building Division E E rIURNSTs R Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town_barnstable.ma_us Office: 508-862-403 8 Fax: 508-790-623 0 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCA1lON- 3 oy X•9 `� W'���sa� l� number village "HON�EOGINFR": S s., �7G// 2y-7/V 9-8t/a f) name home phone# work phone# CURRE11T MArLI NG ADDRESS: `� `� /yiG city/fown state up code The current exemption for"homeowners"was extended to include owner-occppied 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 reguIations. _ The undersigned"homeowner'certifies that he/she understands the Town ofBamstable Building Department minimum inspection procedures and /frequirements and that he/she will comply with said procedures and requirements. SignatLrm of H wncr 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 2.1S) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. Tn 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 Iast 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.XWPFMFST0RMMbu9ding permit fDT=WTRFSS.doe Revised 061313 SHE rgiy Town of Barnstable Regulatory Services KAM$; Richard V.Scab,Director pQ� s63q. �$ 'tea.19.1 Building Division Tom Perry;Building'Commissioner - _..__...._..---....... . .._...._ ..._ _...---. ..._.. 200 Main Street,Hyannis,MA 02601 www.townbarnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This S ction If Using ABuild f4. as Owner of the subject property hereby authorize to act on my behalf, is all matters relative ttowork autho \byis building permit application for.o Lt , � cv, 6m? &/ dress of Jodi) "'Pool fences and are the respons ility of the applicant. Pools are not to be fille or utilized before fend is installed and all finbl inspections are erfonned and accepted. Sign of Owner S' of Applic t Punt Name Print Name Y Date Q:F0RMS:0WNE"ERMISSI0NIF00LS Andersen. Andersen Windows - P9. Vy - Project Name: O'Donnell >o.,...... Quote#: 6046 Print Date: 11/22/2017 Quote Date: 11/22/2017 iQ Version: 17.1 ✓�'��'�'� Dealer: Shepley Customer: Graham LLC 216 Thornton Drive Billing Hyannis, Ma. 02601 Address: " 508-862-6200 Phone: Fax: Sales Rep: Pete Balboni Contact: Created By: MH Trade ID: Promotion Code: Item Qty Item Size(Operation) Location Unit Price Ext. Price 0001 1 TW20210 Sash Only $ 270.64 $ 270.64 RO Size= NIA Unit Size=2' 1 5/8"W x 3' 0 7/8" H 400 Series Tilt-Wash Basic, White/Pre-finished White, (Top Sash) High Performance Low-E4 Tempered, No Grille Grommet Tilt-Wash Basic, White/Pre-finished White, (Bottom Sash) High Performance Low-E4 Tempered, No Grille Grommet Viewed from Exterior Subtotal Is 270.6 Total Load Factor Tax(6.250%) Is 16.9 Customer Signature Grand Total Is 287.5 Dealer Signature **All graphics viewed from the exterior ** Rough opening dimensions are minimums and may need to be increased to allow for use of building wraps or flashings or sill panning or brackets or fasteners or other items. o Iwo h Z •9 b�FrE4,J.a".. Quote#: 6046 Print Date: - 11122/2017 Page- _1 0f - 2 iQ.Version: -=17.1 d(0c) °FS> rti Town of Barnstable Permit# Expires 6 months from issue da Regulatory Services Fee �— + RARNSTABLE, " v$ %639. .,0� Thomas F. Geiler,Director ATFD MA'1�` Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-b230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY `` Not Valid without Red X-Press Imprint Map/parcel Number Property Address 3Y4 `e, l u -s'TZl_F'J t•e. Zeidential Value of Work t�S-6 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Telephone Number Contractor's Name s��--3L1 -a�7i Home Improvement Contractor License#(if applicable) q Construction Supervisor's License# (if applicable) 00,5 MAY - 3 2010 ❑Workman's Compensation Insurance Check one: 'OWN OF BARNSTABLE X I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name ► "44 l�ir� ra 1,--, ra' `: CQ5,VC1, Y 7 Workman's Comp.Policy# I K 0 Z D l Copy of Ins-urance 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) R/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 ; re uired. SIGNATURE: j f The Commonwealth of Massachusetts f o artment De Industrial Accidents T� P 1 Office of Investigations 'j 600 Washington Street Boston, MA 02111 Q fvww.rnass.gov/dia Workers' Compensation Insurance Affidavit: ]Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organi2ation/Individual): (JJ �'^� 6 h-.Scams Address: 6 C 4. City/State/Zip: ram. iY.b 4 r-14 PS Phone #: S 6 3c- T -X�- Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. E I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hued the sub-contractors 2.[� I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling shipand have no employees These sub-contractors have g, Demolition P working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp.insurance.$ required.] 5. [] We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I I El Plumbing repairs or additions right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I 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 e. 152 can lead to the imposition of criminal penalties of a fine Lip 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 pins and penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#: - .2,�-7 t 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 n . ato Phnnp# 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,Iv1GL 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 IrLC or fLl'sloes 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 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 4-24-07 wwtiv.mass.gov/die IKETp� Town of Barnstable yY 'L�n Regulatory Services sa iE MAS& " Thomas F. Geiler,Director r Mass. � o ,�d`� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 wwtiv.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, , as Owner of the subject property hereby authorize to.act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) - IWO L�-7 D Signature of Owner Date ' Print Name kyl(' S�&Ss If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the.reverse side. Q:FORIvIS:O WNERPERMISSION F Town of Barnstable P�O�THE Tp�� o Regulatory Services t3axrtsTasr e Thomas F. Geiler,Director Mass. 1639. , Building Division ATfD '�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: cityhown 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 buildinl?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 requ& ments.n 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 pari 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:\WPFlLES\FORMS\homeexempt.DOC NI ttis a huSetts > eh trtnicnt of Public Saf to r jk� Board otBiiildin�r ,, .. , �;`Re�gtation.s .ind.Standards :Construction Supervisor License License:, Cs,. 5409 Restricted to 00 . i r ; is t a r ;'+, ,,'• t �;�' JOHN J JOHNSON PO BOX 11$ .- } W BARNSTABLE;'MA 02668 P i Expiration: 6/21/2010 ('rmmissirnci Tr#: 28049 �/ie_1°000r�mo�ru�reca�C�i o�,-,/f�Qaefzuaet7a - , Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registrat o�n:v 102149 Board of Building Regulations and Standards �ExPir.atlors _6/�30/2010 TriA 268765 One Ashburton Place Rm 1301 p..__.... f?j `1 Boston,Ma.02108 �r�YP h�d4 adual- . . JOHN JOHNSON John Johnson PO Box 118 160 Chu ch St / _ `h W: Barnstable, MA 026ti8- "` Administrator Not v id without signature �FTHE A Town of Barnstable *Permit# / 2 Expires 6 months from issue date srAS Regulatory Services Fee v� %6 9. �m�' Thomas F.Geiler,Director AlED1"0'`� Building Division Tom Perry, Building Commissioner E�S PERMIT �� 200 Main Street, Hyannis,MA 02601 X Office: 508-862-4038 Fax: 508-790-6230 S E P 1 9 2003 EXPRESS PERMIT APPLICATION - RESIDE �'�IRNSTABLE I ffll V Not Valid without Red&Press Imprint Map/parcel Number t 1 ) 7 Property AddressCr Residential Value of Work IY ) Owner's Name&Address rZ.�� /� us :3® Contractor's Name IQ�e c ,!y l Telephone Number_ �' `/0� I Home Improvement Contractor License#(if applicable) %/ a S Construction Supervisor's License#(if applicable) / - MWorkman's Compensation Insurance J�r�9�'� �/'�f l+'7��Check one: one:El too c /_ � I am a sole proprietor /'� ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name /��e/Z/ a 2 Workman's Comp.Policy# s/ 9 / 9 1 Permit Request(check box) on'Re-roof(stripping old shingles) All construction debris will be taken to yct4 I'lil ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side �� l ❑ Replacement 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: Prope y ust s' rope Owner Letter of Permission. Home !:pr7ovve icense is required. Signature �_, Q:Fomm:expmtrg Revise053003 b `tPM STRAUSSiENV CONSULTING 5083628574 P. 03 Fraser Construction Roofing & Siding Specialists Payable immediately upon completion NO MONEY DOWN - NO Payment at the start or part way thru Payments accepted are: CASH -CHECK-MASTERCARD -VlsA-AMERICAN EXPRESS Possible Extra -Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$40.00 per hour,plus materials, plus 206/6 overhead mark-up on total extras. FRASER CONSTRUCTION Warranties the shingles and labor for 10 years. FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 yieara CERTAINTEED Warranties the shingles and labor 100%for the first Q years, and then on a pro rated basis for 30 years total if the shingles become defective. a ERTAINTEED Warranties the shingles to be ALGAE resistant for a full 10 years. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate, All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION: Curries Workman's Compensation an- Public Liability insurance on the above work. DATE OF ACCEPTANCE: 1 j 2063 RtUBMITUD BY: S rr�p Homeowner Friier onatruetj9A Application to. E goN°'NSP pros.- .. bp'pN`'.1PNN SEP,�� Old Kings Highway Regional�Iisric District Committee in the Town of Barnstable for a CERTIFICATION.OF EXEMPTION Application is hereby made, in triplicate,for the issuance of a certificate of exemption under Section-6 and 7 of Chapter 470, Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on plans,drawings,or photo- graphs accompanying this application. . TYPE OR PRINT LEGIBLY DATE " ADDRESS OF PROPOSED WORK/ tTic ��7` ASSESSORS MAP NO. r OWNER !A C) ASSESSORS LOT N0, ��- HOME ADDRESS TEL. N0. AGENT OR CONTRACTOR GLwI ADDRESS —7� ��✓���d�^ �6 d�Zt.�/l TEL. N0, This application is for exemption of proposed exterior construction on the ground that: ❑ (1) It will not be visible from any way or public place. ❑ (2) It is within a category declared entitled to exemption by Old King's Highway Regional Historic District Commission. (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work, showing location on lot,and, if an addition is involved,show• ing location of existing building. 7c% SIGNED Space below line for Committee use. . Owner-Contracto Received y H.D.C. The Certificate is hereby Datepq/613 Time By Date Approved ❑ The categories of work entitled to exemption are listed on Disannrnvprl 7 ♦L- V__J. _r -_ r 9,4e Board of Building Reg ' One Ashburton R °- Boston. Mass n � Home ImprovemeritX ' FRASER CONSTRUCTION Co ; �. DEAN FRASER ;=A -i-- 71 TARRAGON CIR r- COTUIT, MA 02635 Board of Building Regulations and Standards Licen, HOME IMPROVEMENT CONTRACTOR before Board Registrartion 112536 One A Exp cat p 3�23f2005 Bostoc ;DEA FRASEWCONSTRUPTION co; DEAN FRASER 71 TARRAGON COTUIT,MA 02635 Administrator fiY � J � � � i '1 X�������R 3 5 t j �.•• _ ,a.� it .�•(a �.u, 5 •r.�:[r 314a"r.n.L 1� V:; Applecation to �i t �.t� � t04 .�ir^�Yr � x".T ��..'4•tz-°`X'� r: � �i'a t - l r � f ` x ' ° � 4 " s x ti >gli Regional Historic, Istria Committee S f!n the Town of Barnstable fora a - }{ 6 3tq i t J x BA4i2S1ABlk y. CERTIFICATE OF APPROPRIATENESS` d Application is hereby made m triplicate, for.::the issuance of a Certificate of,Appropriateness under Section 6 of Chapter 40, < f` h «} Acts and S Resali►es of fMassachuSetts,"T973, for¢proposed work as described below and on plans, drawings or 'photographs r.L }L ,accompanying"t?ns appl�Caiion fbr: „ CHECK CATEGORIES THAT Exterror Bt��l iAR 2 � g Cx�n&tr�cttorj New Building D. Addition Q 'Alteration " ` ulndicate t' �Ftif�.-rY c 1-10Use IR a�.. ❑.<Othef Y YsPe„ sRQ td4f'fiarage �] Commercial E;Xterl�lrxrP, i,1tA e t' ✓�';. �',...'ti++gt "�,3'=' ''g,/'`.;'w•jy�g'A.\!+a fc � �.ti'cp r r x _ _ t s .. , 3 Signsoi Bill#wactis lews�gn ❑46istmg.signRepain'tm9 , 9 9 exrstin sign r. 4 Structure: Fence t [❑ Wall ❑Flagpole' Other f { t (Pleaseread other side for explanation and requirements). ^� ,' TYRE OR PA# T LEG11131Y h Ir f DATE IY7:l� <. ADDAESSOFfP'AOPOSf=t7'.WOFt�K CJES �AtNS0 : ASSESSORS MAP NO. - t `t OWNER D��;.' VA ?r� ASSESSORS LOT N0. 1 �l,�t� tHOMEADbRES5 = `ti ���(ir JIJ �`'� ' UPl`� Q. tS�S' �: i xd r= TEL:NO . s f. FULL NAl18ES AN ADDRESSES OF ABUTTING OWNERS_ Include name.'rof adjacent<property ownets':acros`s'`any public �¢ streetor�way (Attach additional'sheet if necessary) 9 r r IP 6 AV � � -;� :"`JAR t z�."d t �'�'� �t�t,s r,-`J ,i�" :',f fi•.� , . , ;WTH -- `S,. F zr-+.•i';-..aut- -, ^� t: 't - f;4 A UN A); "C()i�ITtRtACr{�f~i� �rf �� ..I. � Mom_T�t_��iQ� � � �`- vi } a }..,. a Ss�i Y"�y s ' > tu4 ,C-.{ F ` X f,- n6 + t fi4 r M d DETAILED DESCRIPTION OF,,PROPOSED WORIQ •Give allr'particulars of,work to{be done_(see No B other`side) including materials to be used, if. .... ications do not accom an,y;plans In the case of.signs;give locations of;ezist rig signs arSd proposed' s locations of neyv signs (Attach additional sheet if;ri cessary). ` �� 999y r }+7, C5)'u:,,A. .i"�t'Pt :a'"✓' L3,�` it :�9x� tt k.. s x t ,c' �$oo„_ ,. .i k a 3T tart Signed' Ap ' Owner-contractor Agent ' Space!,x,!' Is a#or Committee �T Received by'H D C DateCertificate is hereby Da e �.. ". Time . Q: r H17. y" ��ll rry ° Approved IMPORTANT If Certi icate_is appr vdd,:approval is subject fo the TO day`aWeal period '># a - p' provid in,,the Act. , p�sagpCgved �] i { K lart� & �4sociates Architects y 92 Mendo Street, Upton,,Mass. 01568 _ 617-529-6611 1� OKH HIST.DIST. f x BARNSTABLET 111 !~ nv � y�r3®,L .� •L.L .,*7I1 I / • \�t7 � _ f F �} J.75 1,14 IJ 6 AP a nhfA'bY � f i , V f wi 0. WVIST L0 f 36 - 4 p s{ s w 7 � e ./��''''�) .'I 1M1 �J /. ♦.-� ^ R r '' ✓ rh;} 3� Y( 4x's ..-�,t? `i"dy ! ice. t �0�• r: . 'L tL� j;'F`t` 41 IV 41 h �`izyt FAA i a r } ti -��'' 7 :y 4 - N S 'vn✓ t ,� F{�'f6 jyY:1'ox, v .7'r! ly I., 4t �, i4 C„�ttiti e.-� 1 a �'' h:. < #e,.-.S t F d :J j 4 tv` �,F S �i 1 t �t •e. ,fie Fr ,r.. „ Y - -. F S 3 t a f t d r 'ts- Jl je? � A g Y - c f ) . P y,i •,.•,� 4,{is,�`lys>•,�'.yf„t.arx'r5ti.?"e' a :.�' #,.",. ... _ .. ... .. AN E _ St r ! + t ` , �' _ICING'S HIGHW Y REGIONAL HISTORIC DISTRICT BARNSTABLE ISTORIC DISTRICT COMMITTEE ! 1� t.,y3 2 A k b y "`4 : R MAIN'x;STREET.,, HYANNIS, MA 0260.1 x' E . FORM: "A-I" y„41 SPEC SHEET �.. t Y b FOUNDATION TYpE•; C. 0 ti) G'y� T IC. C�C #; SIDING F TYPE: } _� �� — �.^�� �lJG L L./�l TO C F b 3 9t1 r.f F mrr CHIMNEY TYPE , COLOR N rr is Vf ROOF MATERIAL; G f S 11 + _ CQLQBt: 1_. .T � �'� - { : P ITCH �ti-7-7-77777 . J SIZ E: L /VTS I : � /�IU yy x ,C ' TRIM 'COLOR• E N t DOORS U J� COLOR: GUTTERS:: DECK-.' ` £: P3` j "�,�':�1 �� ..T' ��TEC)Cy 07 GARAGE DObR •s r �. +' _I� OOi,OI :" ti , s= aTWO COPIE77 S. OF THIS FORM IS , REQUIRED FILL OUT COMPLETELY REGARDING" MATERIALS, .MEASUREMENTS AND COLORS. �iAwo 1 4 r �» , LANDSCAPE PLANS PLOT]PLANS-ELEVATION PLANS. � 4 �'�.34 T~�„. � ass .�•�tia,;r�yr�( .es �` i,:,F ` i i r . _ 1 + d ,� wrt e�{a'' � e ; �k*n s��ac f J "d2"fi r•,z �G =S' Y�3d'a,'i'dtu., m - �.+- :. t - t., v Assessor's map and lot number ..... ........ CF THE 6 C Sewage Permit number ........ ................... SEPTIC SYSTEM MUST o 11AWSTAILE, INSTALLED IN COMPL NAM House number ...................................................... IA 1639�' WITH TITLE 5 101 M Ak"I ENVI V' .'ODE AND T11 TOWN OF BARN PRXBt,1�4 IONS BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...... ..$.Zgq.a j ...rlL .......... TYPE OF CONSTRUCTION ............W.00.v...... AJI,.. -n....................................................................... ..V nn ........9.7.............19.9s -TO THE INSPECTOR-OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location q . 108 ............................................ . ... ..... . ... ....... ..........!W�5T....0..R.am. Le..... Proposed Use .....5j.fj.G.11..F........... CG. ......9.f [A. ........................................................ ZoningDistrict ........9.....E..................................................Fire District .............................................................................. Name of Owner PDAK........AIJAA r(.,Q...............Address .9.Z.... ......;-s..T....UFRG.!�...P(5�g Nameof Builder ....... ............................ ...........................Address ............................ ................... ................ ............. Nameof Architect ...((........................... .............................Address .......G�...................(. .................. ................. ............ Number of Rooms ............(P_.................................................Foundation .....4......cvvc Exterior ..... ....... ...............Roofing Aq—&P.011........ ............ Floors .......(,.0..on.,n....... ........ rz::�.....................Interior .... ...0M.K.-D........................ .......... .....................Heating. Prl .....f m_vk. YO. 9"'. RIL. P I'u m b i n g , Fireplace ....... .........................................................Approximate Cost .... I ................C)...................... Definitive Plan Approved by Planning Board --------------------------------19__�------ Area ........15/.1 /? Diagram of Lot and Building with Dimensions Fee ............. ............ SUBJECT TO APPROVAL OF BOARD OF HEALTH 0ASI-1 Z-129NO I/M, AM771,41 377 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ......IL Name ..... .. ... . ...... Construction Supervisor's License .................................... €; MARTIN, DOAK� � s. *.,.No ...2U55... Permit for ....O A9•.A orY•............ ........SZJJg7. ..kaiUl�y...Du1�.11nS.................. G Location ......30.4...H7gk1..Stx.��t......................... - .. ..................... le......................... , r - Owner ........D.Qak..Mart!n................................. Type.of Construction .......Era=......................... ....f............................................... .................. e Plot ......................... 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A7 GENT%[3tY�NST/ldlf5.. dB0 Qf _ fN67.h!.: T4'S 7- F;T tDATA -P ;42Z 2 MAQ� -5-- 7 - BS' No ►V i 7Ei2 F NCcJ</ivTC.eQQ 9w- f o4nd ztiD.s 4iwwr1 OYG LOCQ, P.� O!2 g/tAylt?� QA 4`tOWYI� LP/ COiL. 7', Rs12 i T lei D 100•S _ . [74- 27-7 rt Ton 977 s F/.vF F/1V " �; �a 9 4.7 . awe e- . s : : :_,.. � v�1 ��A ._ yN ✓. F f i t ��,�K;ECC,EY 130/VEy Z30N�1 t1Q Z��QQ..;.,O aA J0 $9�5'0 iQ TOWN OF BARNSTABI�fi ,' ••+ `. BUILDING DEPARTEENT- COMPLAINT/INQUIRY WfPORT Date �` �/ - �-� Rec'd — Assessor�s Last Name P' t Name ORIGINATOR Street-" Villa e - • State Zi Tele hone: Home Work Descri ion- _ 'COMPLAINT (v Td _INQUIRY Requestor's Signature COMPLAINT Street Address LOCATION �. A= OFFICE USE Ofi_LT INSPECTORS Date % P ACTION/ �-S Ins ector C0yZffiNTS �� ::C_i0 . lew ADDI i iO::�;L y_ 1isFo. 71 TT 7-.cI D � �5a �,l �UO�a•�,� �� COPY DIS:?IEUTIO.:_ ZO -G 7G� P� FILE Y ELLO:: - I1:Sp£CTOR 2.F, - Il;SPECTOR r (R--TUR2, TO OFFICE Y.GR. KZ�f] 5; 7, PaI4 .. & ! . � _� ��� � . . � �� . _ ��%1 . 2 � a��w- . \�\ . � y�-»:& - - f���f,,,z}` `�= �� � ���7��\. 2 ��_ � .�6 6 6�z;y-- y � ^ �zZ � .���#f;J: ��,�- � • �\�2 � . - �.�� �<� «� a � .» � ��%�d? - . g��!:�/� \�����{< � � * �\� �'% '�,�a�-'%�Z� � �.�:���7����'® � . ����:�� ® » - � � . � . ��: �/ `9 0 b 6 0 SMOKE DETECTOR REVIEW80 6*DAT BARNSTABLE BUILDING DEPT. 4z FIRE DEPARTMENT BOTH SIGNATURES ARE REQUIRED FOR PERMITTING d e tt4 r 70 = � Fill ®ri. Q:. !` • rLol 01, ! � F M f3 �b � FS31 1 -� c ! i ai, t „ Deb ropose� eve rect o bane v � Ei Rini i 44 ITT L orr4 1 " s �€ P9 s � 8 l --------------------------------- F Tt �` Fw D _ DO ©o i 1 , . - ' I Pre 5e ) • i i f 1 i 00o j I d. j cL ' _ L J4Nr .C3 I ben _ li 1 T SMOKE DETECTORS R� IEWED E 8 ;GDEPT ATE FIRE DEPARTM DATE BOTH SIGNATURES ARc' RED FOR PERMITTIN {3 � 1 , � 1 9 vi ° El o ti a 0 — i 00 _ a s _....fieELI o o ? i ,I rAj 3 ' Q eta 1 Flo Q Prese^ '. y f f t s F � s i RI Nr L J4 a o, �t Pro sanf