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!�D C law�s}�ell C I� p 7zAt i May. 23. 2016 10: 29AM No. 2272 1P. 1/1 y (^ 0 e Town of Barnstable tPermitA � � �/yI � �✓ �� �, >�yb•e9 6�tanrhsham lssne date Regulatory Services Fee $ AANNsramrs, > Richard'V.Scala,Wrector Building DivUlon r µpr Toth Perry,CPO,.Eniidbt$Commissioner A , 200 Main Street,]�yanzda, ,��02601 wwvv,town,bamatable' '" �/f/ 10, Office: 508-862-4038 °� 2�,a Fax:S. 8-790-6230 MOMS PX MMT APPUCAMN - RESIDE ONLY Map/parcel Number ,w NoVaUd>Utrhor�rAedX-1'ras�sZi��,pri►�t l Property Address () C V �f Rasideatial Valuo of Wolk$ g_ _ ,(� 1vlt7nimum fee of$35.0o for work undeu S6000.00 r Owner's Name Amress.__ �� i[` rvrn f� _ CA— Contractor's 14, 6 -?on q'elephone W=b�� �� I Homo Improvement Corkaotor L1come#(if applicable) -0 ( Email; e Construction Supervisor°a License#(if applicable) �'` �u 0 �� �` CD c4 'Worlaaaa's Co>��atlonl:osurance � Checbc one: co) I am a aole proprietor V Y t'ho Iiomeov/= IV6 Worker's Compensatrio�n-laeurauce m Insurance Company Name Worim � � ar;'9 camp,Policy# Copy of basuroxce Compliance,Certificate meat accompany each permit, permit Re eat(chock box) i [deoof(hw'ricane nelled)(sdtipping old shingles) All oonstiuction debris Will,betaken to ❑ e--roof(hurricane nailed)(not atdpping. Going over existing layers of root K ke-aide ❑ ReplacementWindows/doors/sliders,VValue (maximum,32)It ofwindowe #of doors: ❑ SmoWCarbon Monoxide detectors 4 iloolr plans harked with red S and inspections required. Separbte glectrtcal&Fire Permits required. *Where requhed: laaauce of this petmit does not exempt compliance with oQeer rowo depmuwnt regalations,Le.Mmrlc,Cowavulon,eta *''Note: PsoporW Qwucr,mnat sign Property Owner Letter of Permission, A copy of the Home Tmprovement Contractors License&Coustxuction Supek-Asolrs License is red. SYGNATUftEt. - C-%Yjsas\Deco11WAppba oaPMaosofAW1ndowsl°Tcmporaryln ctPDc4lContort,oadookl2PI01DHK\MORESS.doe Revised 040215 f oFTHe ram, Town of Barnstable *Permit# R-lbiols P� Expires 6 months fronj issue date Regulatory Services Fee * BARNSfABLE, + 9cb b q; `0$ Richard V.Scali,Director •e�FD Mp`l A Building Divisio 1 Tom Perry,CBO,Building Commissioner �+` „ ' 200 Main Street,Hyannis,MA 02601 #1 � �„( www.town.barnstable.mlt� q/ YI o Rey Office: 508-862-4038 U aC ?416 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDEN, MR , ONLY Not Valid without Red X-Press Imprint �/C Map/parcel Number � I � <(: Property Address l"� C I Dne I Op—yt AJ Residential Value of Work$ f q(P)5, 005 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address UD I I I I C&ry'Y • Y`-e S CQ�f Contractor's Name Telephone Numbe - l Home Improvement Contractor License#(if applicable) ( 4 Email: C?rh(:Q_tQ C)a7 p` +: CYY) Construction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance Insurance Company Name )jl,(nn9t) jCA- Workman's Comp. Policy# Vl cs---�Sl S ��P�Q�U -- ya Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) 9-1�e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ e-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doe Revised 040215 The Commonwealth of Massachusetts ^i- J r Department of IndustrialAccidents I Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information p Please Print Legibly Name'(Business/Organization/Individual): T U L ` _ GA71�_+ U t!T' J T O�Q_� Address: A-I'A i/v S %l'�-L L:F 'J Ciry/State/Zip: 6 S' V 1 l-t MA 0265 Phone #: —L-128 _ I-�-i Are you an employer?Check the appropriate box: Type of project(required): 1.❑1 am a employer with employees(full and/or part-time).* 7. New construction 2. r am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑ Demolition 3.❑f am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Building addition 4.❑[am a homeowner and will be hiring contractors to conduct all work on my property. [will ensure that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance. ther�L� 6.❑We are a corporation and its officers have exercised their right of exemption per r�fGL c. lO 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#l 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: �M /��� ��L' �� C-y p io Policy#or Self:ins. Lic.#: VV C — 3) E G 662 61 GZ �/'`1_�y� xptration Date: v Job Site Address:J 1(�1./V t ' ��� 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: "IS'15 — r Phone#: Official use only, Do not write]in this area, to be completed by city or town officiaL City or Town: Cufz I Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 8/11/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER.THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER DOWLING & O'NEIL INSURANCE AGENCY INC NAME: 973 IYANNOUGH RD PHONE FAX PO BOX 1990 A/c A/C No: HYANNIS, MA 02601 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIL# INSURER A: LM Insurance Corporation 33600 INSURED INSURER B: PAUL J CAZEAULT& SONS INC 1031 MAIN ST INSURER c: OSTERVILLE MA 02655 , INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 25918664 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICYNUMBER MM/DD MMIDD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO CLAIMS-MADE E1 OCCUR PREMISES Ea occurrence)nce $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECTPRO-- LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WC5-31S-386670-025 8/10/2015 8/10/2016 V 1 PERSTATUTE OERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N E.L.EACH ACCIDENT $ 1000000 D?OFFICER/MEMBER EXCLUDEN NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1000000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION L CAZEAULT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PAU PAU MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 031 MAIN LLE MA 02655 ACCORDANCE WITH THE POLICY PROVISIONS. OSTAUTHORIZED REPRESENTATIVE LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 25918664 1 1-386670 1 15-16 WC I shankar.gada1e@Mertymutua1.com 1 8/11/2015 4:45:09 AM (PDT) I Page 1 of 1 r i,Zt,2 Office of Consumer Affairs and Business Regulation 1 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 103714 Type: Supplement Card Expiration: 7/9/2016 PAUL J. CAZEAULT & SONS, INC:. _-_ RUSSELL CAZEAULT ---- ''- 1031 MAIN ST - OSTERVILLE, MA 02658 Update Address and return card.Mark reason for change. sCA 1 ¢: 20M-05/11 El Address 0 Renewal Ej Employment Lost Card �r>>• �rJa��ra�rarr-ruP.al�o�G�I�ari:lur✓.t�,ellJ Offlce•of Consumer Affairs&Business Regulation License or registration valid for individul use only P IMPROVEMENT CONTRACTOR before the ex iration date. If found return to: OME T _ / Office of Consumer Affairs and Business Regulation ` 'i7 Registration:;;1.037.14: Type, 10 Part(Plaza-Suite5170 ;rat ;. 9 P ......7/9I20.16;;• Supplement'ward Boston,MA 02116 ion:' PAUL J.CAZEAULr.&'SONS;MCi RUSSELL CAZEAbLT•-• :r..., 1031 MAIN ST OSTERVILLE,MA 02658 Undersecretary Not valid witho nature )W ^/lassachusetts -Department of. Public Safety Board of Building Regulations and Standards Construction supervisor License: CS-108157 RUSSELL CAZEAULT, 2071 MAIN STREET -- --_ Brewster MA 02601 t' Comm;ssio;,er 11i2312018 V; Property Owner Must Complete & Sign This Form If Using a Roofer / Builder. (p�fnl) r14 / ?iSCoT)-�Z4,-;5 75a Dr- 0 Z A- 6"7— , as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: Address of Job Signature of Owner Mailing Address of Owner /90 Cam, s�F�� � Telephone # ':5D8 +z8 7G 8 5 Date s h//C- C i 1 Please return this form to Paul J. Cazeault Roofing along with your signed contract. It is needed for us to obtain the building permit required by your town to complete your roofing project fax#508-420-4555 office@cazeault.com I B { t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map o 4S Parcel 4 'Application /690,&00 Health Division Date Issued Conservation Division Application F Planning Dept. Permit Fee `ZZ Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis ' Project Street Address I 6 C t &4-n C o y 2 n , Village ( C U i Owner Address ? 17 e-er4 T , i cjdjf 10 Telephone Permit Request 3 Ix 6 0 (�)_CJ Oh Shore s -z 4oy S—aS i0iPI Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 42 K Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units)1 Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kin g-'s-Highway>>❑Yin ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other w w Basement Finished Area(sq.ft.) Basement Unfinished Area (sq. ) L - x Number of Baths: Full: existing new Half: existing new ®' Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ .Appeal # Recorded ❑ NA Commercial ❑Yes @ No If yes, site plan review # IVA Current Use 2�S 1 lil% �_l r_( Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name . Y_ c..S i^G(� �y�'�i�S Telephone Number ���' r4 T- 3 5-11 Address / s W l l/ti�S i C!Y - �/ - License # 671 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM/THIS PROJECT WILL BE TAKEN TO l _1Go 1 el �or�Y/1 e SIGNATURE 1 l - /l� _ DATE a A) OF - FOR OFFICIAL USE ONLY L APPLICATION# PLATE ISSUED MAP/PARCEL NO. } V f • ADDRESS VILLAGE ' OWNER- + DATE OF INSPECTION: r FOUNDATION FRAME INSULATION r FIREPLACE _ - ELECTRICAL: ROUGH FINAL i• =-.PLUMBING: ROUGH FINAL GAS: ROUGH a FINAL FINAL BUILDING DATE CLOSED OUT. ASSOCIATION PLAN NO.--- . _.. • - _. ter ' The Commonwealth of Massachusetts Department of Industrial Accidents = 1 _ Office of Investigations 600 Washington Street -�� Boston, MA 02111 'R7 _ . www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization individ7al)Y:11 �� U a Vc( Address: l� �IVe-r:5 City/State/Zip: Phone 3 St Are y an employer? Check the appropriate box: Type of project(required): 1. I am a employer with G 4, ❑ 1 am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its ME] Electrical repairs or additit 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additit myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c: 152, §1(4);and we have no employees. [No workers' 13.❑ Other comp. insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 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.#:-A 1A_)C1�� S � 3� r y Expiration Date: Job Site Address: l qo l�M, )�e�l �V, City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a 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. 1 do hereby certify under thepains and penalties ofperjury that the info rmation provided above is true and correct. Signature: Date: Phone# 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 S. Plumbing Inspector 6. Other Phone#: Contact Person: �Y C' 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 Linder any contract of hire, express or implied, oral or written." An employer is defined as"an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance;construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed_to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." .. Additionally;MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es)and phone number(s) along.with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a-policy is required. Be advised that this affidavit 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 Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required.to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ' Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 'Revised 4-24-07 www.mass.gov/dia r t i; u I is f i� 119assachusctts - Dcparthncnt of Public Safch Board of Building Rclgulations and St:uid:u'ds Construction Supervisor License it License: CS 34967 Restricted to: 00 .I JONATHAN A BURTIS 15 RIVERSIDE RD MASHPEE, MA 02649 I Expiration: 8/30/2011 !• ('nnmissiiOt Tr#: 20384 �i . y I i P r � I� i i i �i j y i I I. ! i f .r Restricted to: 00 00- Unrestricted 1G-1 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS ) 1 ,t1 B'. dN.. s Building�'•u:.,�, �'NAl ae iui of this ir;.YGib1•tc: �"sJaJ.lEli�ass„�4�,ov!IU$i`� � r Town of Barn-stable Regulatory Services ` a�xrrsrA9LZ Thomas F_ Geiler,Director Fo Building bivlisiou Toro Perry, Building Commissioner 200 Main Strcct, Hyannis,MA 02601 ivww.town_b arnstable.ma.us Office: 508-862-4038 Fax: 508-79( Property O,wrierMust Complete and .Sign This Section If Us in;7 A Builder 0+} , as Owner of the subject.property hereby authorize to act oa nay 6eb, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is-applying foir permit please complete the Homeowners License Exemption Form on'the reverse Tow)a of Barnstable of T rye Regulatory Services STAB Thomas F. Geiler, Director aARNLy- '`'`S-11 Building Division Tom Petty, Building Commissioner 200 Maid•Streetz Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 FTOTfEOI%NER LICFNSE EXEMPTION Please Print DATE: JOB LOCATION: i number street • village — ---"HOM$OWNER": name home phone# work_pbone# CURRENT MAILING ADDRESS: city/towo 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 hue who does not possess a license,provided that the owner acts as_ supervisor. DEFINITION OF EOMEDIV ER 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 BmIding 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 regalations. The undersigned"homeowner"certifies that_hc/sbc understands the Town of Barnstable Building DcpartrAent ts and that be/sbc will comply with said proceduxcs and m;r,;mtun inspection procedures and requiremen rcquircmcn ts. Signatisre 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. HOMEOVVXER'S EXEMPTION The Code states that "Any homeowner performing work for which a building perrrdt is required shall be exempt from the provisions of this seetion,(Scetion 109.1.1 -Licensing of construction Supervisors);provided that if the homcovmer engages a pason(s)for hire to do such work, that such Homeowner shall act as supervisor." Many hofncownes who use this cxcmption arc unaware that they are assuTning the responribilitics of n supervisor(see Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.1� m This lack of awarcncss bften results in serious problems,particularly rs when The homeowner hires unlicensed peons. In this ease,our Board cannot proceed against the unlicensed parson,as it would with a licensed Supervisar. The homeowner acting as Supervisor is ultima Wyresponsiblc. To ensure that the homeowner is fully aware of his/her-respannbilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilibcs of a Supervisor. On the last page of this issue is a•form currently used by SCVCMI towns. 'You-may care t amend and adopt such a forrn/ecrtifi m eation for use in your community. , r , A-�PRO CERTIFICAT'E OF LIABILITY INS ( URANCE I� B OP ID .AH DATE(MM/DD/YYYy) II II ITTL-2THISCETA A FORMA0T5IO/N2 8/09FTE AMATTEROFINReid-Hofmann Insurance Agenc ONLYANDCONFERSNO RI 128 Rt 6A PO Box 1839 HOLDER MA .THIS CE HTS UPON THE CERTIFICATE RTIFICATE S NO EXTEND OR Sandwich 02S63 y ALTER DOE T AMEND,THE COVERAGE AFF RDED BY THE POLICIES BELOW. Phone: 508-444-8841 jl INSURED Fax:508-5188-5148 INSURERS AFFORDING COVE GE NAIC# IN u SURER A: ACE USA Little Riveper Boat YardlI INSURERS. 15nR versidelRd. I INSURER c Mashpee MA 02649 INSURER D: COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 191I''LED TO THE INSURED ANY REQUIREMENT•TERM OR CONDITION OF ANY POLICICAOR OTHER DOCUMENT NAMED li RESpECTTO WIiIGi0THIS YCERTIOF-D INDICATED ATE nE I.'I UEDIO DING MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIESiiIOR OTHER RD HEREIN IS SUBJECT TO POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REL}ID ED BY PAID CLAIMS.NS D ALL 11'IE'PERMS.EXCLUSIONS AND COCOMUI IUNS UI'SUCH LTR NSR TYPE OF INSURANCE j jl POLICY NUMBER CPEFFEC OLTCp"ExPIRATIO Ip GENERAL LIABILITY it DATE(MM/DD/YY) DATE(MM/DD/YY) A I X COMMERCIAL GENERAL LIABILITY D36 j�07200 EACH IOCCURRENCE 05/08/0g $ 1000000 i CLAIMS MADE OCCUR OS/O8/10 PREMISES(Eaoccurence) $ 50000 A X Dock Construction N01 25790 MEDEXP(Ar,yonepersor!) $ 5000 05/08/09 05/08/10 PERSONAL aADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: $ 1000000 ' ": ., ( p• I, GENERAL AGGREGATE $ 2 0 0 D 0 0 0 POLICY PRO" IiPRODUCTS-COMP/OP AGG JECT LOC I1 $ 1000000 AUTOMOBILE LIABILITY �-- ANY AUTO I1COMBINED SINGLE LIMIT ALL OWNED AUTOS j(Ea arridarl) $ SCHEDULED AUTOS I E I 160bil%Y INJURY HIRED AUTOS li j(Per parson) $ NON-OWNED Auros h .. _-•- (BODILY INJURY (Per accident) $ GARAGE LIABILITY PR PERTY DAMAGE I(P r ar6clanl) ' $= r I '. ANY AI.fiO (AUTO ONLY-EA ACCIDEM-, pJ EXCESS/UMBRELLA LIABILITY C• OTFIER THApI $ �Ai-fl O ONLY: AGG OCCUR ❑CLAIMS MADE jiEACli OCCURRENCE AGGREGAIE. $ DEDUCTIjBLE RETENTION $ WORKERS COMP $ ION AND I� ENSAT - �— EMPLOYERS'LIABILITY �I $ ANY PROPRIETOR/PARTNER/ CUTIV I _ OFFICER/MEMBER EXCLUDED E —TORY LIMI TS ER If yes•describe uncle, I I E.L.EACH ACCIDENT $ SPECIAL PROVISIONS below E.L.DISEASE- OTHER Ij EA EMPLOYEE $ Marina Oper. Liabi E.L.DISEASE-POLICY LIMIT $ _ i Y08293454 05/08/09 05 08 'I'1+ / /10 'CRI I Prot&Inde 1000000 / $iDNS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS mina / OF OPERATIONS 1 LOCATIONS 1 VEHICLES EXCLU / Boat Yard i ii marina/boa yard i! IFICATE HOLDER l CANCELLATION j con- u TOWNMA2 SHOULD ANY OF THE ABOVE DESCRIB D POLICIES BE CANCELLED BEFORE THE EXPIRATION f-V) � DATE THEREOF,THE ISSUING I Ij NSURE WILL ENDEAVOR TO MAIL 10 `� NOTICE TO THE CERTIFICATE HOLDER JAMED TO THE LEFT,BUT FAILURE TO DO SO WRITTEN HALL Cla 111 Sh e L t d a,/` REPRESENT!f IMPOSE Ea ATIVES.OBLIGATION OR LIABILITY QF ANY KIND UPON THE INSURER,ITS AGENTS OR V AUTHORIZED R NTATI E RD 25(2001/08) IICORD CORPORATION 1988 I - - .. t , a . Board oMB IT n Regula ons and Standar s One Ashburton Place - Room 1301 " Boston. Massachusetts 02108 , Home Improvemerif:�.Cbntractor"Registration Registration: 102423 ft- Type: Individual Expiration: 7/1/2010 Tr# 271459 JONATHAN A. BURTIS Jonathan Burtis 15 Riverside Road r Mashpee, MA 02649 ub_ A, W Update Address and return card. Mark reason for change. 'PS-CA1 0 5oM-07i07-PCa4so - E] Address [:] Renewal E] Employment Lost Card 92. T0o0�7mtoOLUSPQG/L a�i/((pgQpr`yu� — -- 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: Registratiown 102423 Board of Building Regulations and Standards Expiration_ J1/2010 Tr# 271459 One Ashburton Place Rm 1301 (zap' L �1 Boston,Ma.02108 J IType: I �i�idual �I`� JONATHAN A.BURTIS'F Jonathan Burtis 15 Riverside Road >:::`•� '/., ! �� � /` //L — ��----"" M Mashpee,MA 02649 -- Administrator Not valid without signature The Commonwealth of Massachusetts William Francis Galvin - Public Browse and Search Page 1 of 2 K The Commonwealth of Massachusetts ~� i: s�r'� William Francis Galvin Secretary of the Commonwealth, Corporations Division One Ashburton Place, 17th floor Boston,MA 02108-1512 Telephone: (617) 727-9640 LITTLE RIVER BOAT YARD, INC. Summary Screen Help with this form Re.quest:a.Certificate . The exact name of the Domestic Profit Corporation: LITTLE RIVER BOAT YARD, INC. Entity Type: Domestic Profit Corporation Identification Number: 042717230 Old Federal Employer Identification Number(Old FEIN): 000149429 Date of Organization in Massachusetts: 08/02/1979 Current Fiscal Month/Day: 04/30 Previous Fiscal Month I Day: 10/31 The location of its principal office: No.and Street: 15 RIVERSIDE ROAD City or Town: MASHPEE State: MA Zip: 02649 Country: USA If the business entity is organized wholly to do business outside Massachusetts,the location of that office: No.and Street: City or Town: State: Zip: Country: Name and address of the Registered Agent: Name: JONATHAN BURTIS No. and Street: 15 RIVERSIDE RD. City or Town: MASHPEE State: MA Zip: 02649 Country: USA The officers and all of the directors of the corporation: Title Individual Name Address(no PO Box) First,Middle,-Last,Suffix-- - - - Address,City or Town,State,Zip Code PRESIDENT JONATHAN-BURTIS"- - "" " " -—- - - -- f 70 RIVERSIDE RD. MASHPEE,MA 02649 USA TREASURER LORRAINE BURTIS 70 RIVERSIDE RD., MASHPEE,MA USA SECRETARY LORRAINE BURTIS 70 RIVERSIDE RD. MASHPEE,MA 02649 USA DIRECTOR SAME AS ABOVE SAME SAME,MA 00000 USA DIRECTOR MARK C.BURTIS 53 NEHOIDEN RD. MASHPEE,MA 02649 USA business entity stock is publicly traded: _ The total number of shares and par value, if any,of each class of stock which the business entity is authorized to http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 2/12/2010 I I'IH1Y-16^-6UU7 14:so rnvl_, re,IZA0 1110. rn> VVU YV OYl f .VVG CERTIFICATE OF LIABILITY 1NSURA•NCE----oPID--LF DATE(MMI°D/YYYY) u )LITTRII 03 13 09 PRODUCER THIS CERTIFICATE IS ISSUEDjAS'A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Paul. Peters Agency, Inc. HOLDER_THIS CERTIFICATE DOES NOT AMEND,EXTEND-OR P O Box 669 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Falmouth MA 02541-0669 u.I.)i.' Phone: 508-548-2500 INSURERS AFFORDING COVERAGE, j,r; NAIC# INSURED — -- INSURER A: +.L: ..L u ;.,,, ✓;.. >,, C .•r,. I .F INSURERB.C: — Little River Boatyard, Inc INSURER � • 15 Riverside Rd. --- Ma!;hpee MA 02649 INSURER D: t INSURERE: I'•t,G "'-y , COVERAGES I.1, ACU THE POUCIEi7 OF INSURANCE LISPED BELOW HAVE.REEN ISSUCD TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA FO.NO'I WI IHS(ANDING ) � ANY HEOUIREMENT,TEAM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY RF 1$$I)FD OR t MAY PFRTAIN,THE IN$1)RANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AI,1,THF.TERM;,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.ACGREOXIE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IID POLICY NUMBER CTfV JPOLICY EXPIRATION "" --� -- LTR NSRD TYPE OF INSURANCE DATE MM/DD/YYYY II DATE MM/DD/YYYY LIMITS GENERAL LIABILITY GACI I OCCIIFRGNCG „ $ 'I)AMAGE-I 6-HEN I ED CUMMFKGIAI RFNGRAL LIABILITY / '7'l,l ) �.) /? ) } ;� '�i'REMI.ES(La orclu(nce) _ $ :U_Oc CLAIMS MAUL I I OCCUR 1 j MFh HXP(Any onn porann) •'$' ;j j (}r';} r (PERSONAL ADV INJURY I. i I I t,1'1 D GENERAL AGGREGATE $ GEN'L AGGkE(,A fr I IMI i APPLIES PER: PRODUCT:-COMP/OP AL(; $ POI-ICY ---' IF LOC a - -- AUTOMOBILELIABILITY • _-CL'L G""' '•? '° COMBINED SING LC LIMIT $ ANY AUTO (Cn nGCidenl) -- ALL OWNED At ; _ DODILY INJURY $ $CHFDULFD AUTOS (Pei yetsutl) HIRFO AUTO; _...,.DODILY INJURY NON-OWNED AUTOS r;ANCl'+LAI;t 114 (Per ar:cidcnt) ... r1(Ui r t IY.. r•i I`I&IJ)i6 r.`ttS l — �' I'RUI tRTY DAM.AC,E IING 1.4 it I ,IP";accld5nll/ )� I y ❑ ;,..a GARAGE LIABILITY r r. F'r 1 r If- A I E I.p,- AUTO ONLY-EA ACCIDENT- S I,t�, , ANY AUTO ` - fi ,r,r .. r,l ,-.I' .J,•EA ACC F• t n to r 'OTI-ICR THAN i'AUTOONLY: r ACC T. EXCESS,I UMBRELLA LIABILITY �tEACH OCCURRENCE OCCUR I CLAIMS MADE AGGREGATE :I DEDUCTIBLE I••,I'q 1 ' r , 1' IRI I $ — RETENTION S $ WORKERS COMPENSATION AND EMPLOYER^'LIABILITY y/N TEACH IT:. fA ANY PROPRIETOR/rARTNER/tXEL;LIIIW WC295-36-34 02/27/09 02/27/10 ,;E.L. CCIDENT ' $500000 OrrICER/MEMBER EXCLUDED? k ' (Mandatory In NMI ! 4E.L.DISEA:JE-EAEMPLOYEE $500000 It Yes,Describe undor ... — :wECIAL rROV1510NS onlow C.L.DISCASC-POLICY LIMIT S 500000 OTHER G G 2 DESCRIPTION OF OPERATION3I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Boatyard/Marina t 3 n ii CERTIFICATE HOLDER CANCELLATION $MOULD ANY OP THE ABOVE DfiSCRIBED POLICIES 9E CANCELLED BEFORE THE EXPIRATION L MASHTOI DATE THEREOF,THE I$$UING INSURER WILL ENDEAVOR TO MAIL 10_ DAYS WRITTEN y �f �: NOTICE TO THE CERTIFICATE HOLDE R NAMED TO nIE LEFT,BUT FAILURE TO DO SO SHALL -6 LLUVA CJ7' IMPOSE NO OBLIGATION OR LIABILITY/F A144/KIND UPOjV THE IN"U R,ITS AGENTS OR REPRESENTATIVES �.;•� AUTHORIZED REPRESENTATIVE Y i ACORD 25(2009/01) ;. O 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo aro rogistered marks of ACORD • I The Only Complete Seawall Solution Page 1 of 2 �11 - r , PAGE 0EAWALLS DOCKS HUNG&TM',8ERS t1wo AN EXPERT PORTAL ShoreGuard Seawalls: Products HOME EXAMPLES ARTICLES The ShoreGuard Seawall SystemTm Products for ShoreGuard seawalls and bulkheads have been developed and refined for years with the most advanced marine construction engineering in the industry. CMI uses a unique combination Elite Seawalls Sheet Piling Wales Capping Tie Rods of performance and aesthetics for product development to give our customers the most value of anyone in the industry. Engineers,contractors and developers specify jobs with our products to ensure long term seawall performance and looks. € Each component for a seawall has been designed for maximum performance in its category. Not only do ShoreGuard t ' seawalls offer the largest range in styles and colors,CMI also offers product specifications and any information you could possibly need to assist in your decision making on the properly performing products as well. Designing a seawall completely with ShoreGuard components ensures the best seawall in the business. Anatomy of a ShoreGuard Seawall Seawall Capping: Sleek and streamlined for beauty and unmatched longevity Sheet Piling: 30 different interlocking sheets in sizes and materials ranging from light-weight residential to heavy industrial http://cmiwaterfront.com/Seawalls/products.php 3/2/2010 The Only Complete Seawall Solution Page 2 of 2 3 E Seawall Wales: t TimberGuard: Strong and durable a 1 }`r , I v fi Polymer encapsulated for added,long marine piling and timber lasting structural is the ideal combination strength i of protection and looks Seawall Tie Rods: Remove the weakest link in a '� ♦ seawall by reducing corrosion. z t Home Seawalls Docks Piling&Timber Company Info Contact Engineering Portal Privacy Policy Terms of Use Legal Policy SiteMap ©2008 Crane Materials International.All Rights Reserved. I http://cmiwaterfront.com/Seawalls/products.php 3/2/2010 i Seawall Sheet Piling Offers the Best Solution On The Market Page 1 of 2 S REG • .L: HOME SHOREGUARD, •' TIMBERGUARD 0, COMPANYCONTACT40 PAGE SEAWALLS DOCKS PILING&TIMBERS INFO AN EXPERT PORTAL ShoreGuard Seawalls: Sheet Piling • PRODUCTS AMPCES ARTICLES Find out why 9 out marine installations are constructed cted with ShoreGuard sheet piling. The primary component of your seawall is Elite Seawalls Sheet Piling Wales Capping Tie Rods sheet piling. Our patented ShoreGuard sheet piling system is completely interlocking, providing unmatched strength, durability and erosion protection.We offer - _. .- 30 different sheet piling products,all made from advanced plastics,composites,or ��•`' _ alloys to provide the perfect, most cost effective fit for your project. ShoreGuard provides the most options and best availability for sheet piling in the industry. 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Contact CMI.for more information on all of our sheet piling products To view technical details, specifications,and AutoCad files for ShoreGuard sheet piling, You have all sorts of options in sheet piling. please visit our Engineering Site.. http://cmiwaterfront.com/Seawalls/sheets.php 3/2/2010 Seawall Sheet Piling Offers the Best Solution On The Market Page 2 of 2 Vinyl Sheet Piling Slate Grey Clay Brown Aluminum iN Sheet l UltracompositeTM Piling �l FRP Sheet Piling I Home I Seawalls Docks I Piling 8 Timber I Company Info I Contact Engineering Portal I Privacy Policy I Terms of Use Legal Policy Sitelvap ©2008 Crane Materials International.All Rights Reserved. http://cmiwaterfront.conVSeawalls/sheets.php 3/2/2010 ShoreGuard°Sheet Piling SG-225 Specification Crane Materials International www.cmiengineer.com (866) 867-3762 SG-225 Drawn: JAB Date: 06/18/09 + Allowable Moment (M) 1,920 ft-lb/ft 8.54 kN-m/m Section Modulus (Z) - 7.2 in3/ft - -387 cm3/m T � Moment of Inertia (I) 18 in'/ft 2,458 cm'/m i Impact Strength 11,000 in-Ibs/in2� 1,925 N-mm/mm2 Thickness (t) � M_ --0.225 in ! � ~ - 5.7 mm Section Depth 5.0 in 127 mm �t I Section Width 18 in _ v 457 mm - Material Weatherable Rigid Vinyl Standard Colors Grey, Clay Profile/Patented Features Box Profile, I-Beam Lock Standard Packaging i 15 sheets/bundle 5.0" ,225" 18" - Physical pro`>erties are defined by ASTM testing standards,The Aluminum Association Design Manual,and/or standard engineering practice.The values shown are nominal and may vary.The information PPound in this document is believed to be true and accurate.No warranties of any kind are made as to the suitability o any CMI product for particular applications or the results obtained there from.ShofeGuard.C-Loc.TimberGuard.GeoGuard,Dura Dock.Shore-All.and Gator Gates are registered trademarks of Crane Materials International.ArmorWare.Ultra Composite,Gatorpocks,GatorBridgge and CMI Waterfront Solutions are trademarks of Crane Materials International.United States and International Patent.numbers 5.145.287:6.000.883; 6,033,155:6.053.666:D420.154:6.575.667;7.059.807:7,056.066;7.025,539:7,393,482:Other patents pending.0 2009 Crane Materials International.All Rights Reserved. 11' Crane Materials International 4501 - 75 Parkway, - 1 Atlanta, GA 30339Phone :•• :• • 11 1 • • Fax 770-933-8363 Massachusetts Department of Environmental Protection . Bureau of-Resource Protection -Waterways Regulation Program . X231797 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Water-Dependent, Nonwater-Dependent,Amendment . G. Mun.icipal Zoning Certificate William Prescott Name of Applicant 190 Clamshell Cove Road Shoestring Bay Cotuit Project street address Waterway City/Town Description of use or change in use: To replace the existing vertical log wall with a C-lock vinyl wall. To be completed by municipal clerk or appropriate municipal official: "I hereby certify that the project described above and more fully detailed in the applicant's waterways license application and plans is not in violation of local zoning ordinances and bylaws." Printed Name of Municipal Official Date Building Inspector Barnstable i of Municipal Official Title Cityrrown I CH91App.doc-Rev.6/06 Page 6 of 13 � t Massachusetts Department of Environmental Protection Bureau of Resource Protection -Waterways Regulation Program X231797 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Water-Dependent,Nonwater-Dependent,Amendment ImportanWhen filling out A. Application Information (Check one forms on the computer,use NOTE: For Chapter 91 Simplified License application form and information see the Self Licensing only the tab key Package.for BRP WW06. to move your cursor-do not Name(Complete Application Sections) Check One Fee Application# use the return key. WATER-DEPENDENT- BSI General A-H �---�� ( ) ❑ Residential with <4 units $175.00 BRP WW01a ❑ Other $270.00 BRP WW01 b �—� ❑ Extended Term $2730.00 BRP WW01c Forassistance -----------._.._.._.._..----------------.._.._..----------------.._.._..-----------.-.._..-------------.._..----.._..-----------.-.._..----------------------- in completing this Amendment(A-H) ® Residential with <4 units $85.00 BRP WW03a application,please see the "Instructions. ❑ Other $105.00 BRP WW03b NONWATER-DEPENDENT- Full (A-H) ❑ Residential with <4 units $545.00 BRP WW15a ❑ Other $1635.00 BRP WW15b ❑ Extended Term $2730.00 BRP WW15c Partial (A-H) ❑ Residential with <4 units $545.00 BRP WW14a ❑ Other $1635.00 BRP WW14b ❑ Extended Term $2730.00 BRP WW14c Municipal Harbor Plan (A-H) ❑ Residential with <4 units $545.00 BRP WW16a ❑ Other $1635.00 BRP WW16b ❑ Extended Term $2730.00 BRP WW16c Joint MEPA/EIR(A-H) ❑ Residential with <4 units $545.00 BRP WW17a ❑ Other $1635.00 BRP WW17b ❑ Extended Term $2730.00 BRP WW17c Amendment(A-H) ❑ Residential with <4 units $435.00 BRP WW03c ❑ Other $815.00 BRP WW03d ❑ Extended Term $1090.00 BRP WW03e CH91App.doc-Rev.6/06 Page 1 of 13 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Waterways Regulation Program X231797 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Water-Dependent, Nonwater-Dependent,Amendment B. Applicant Information Proposed Project/Use Information 1. Applicant: William Prescott Name E-mail Address P O'Box 359 Mailing Address Note:Please refer Medfield MA 02052-0359 to the"Instructions" City/Town State Zip Code Telephone Number Fax Number 2. Authorized Agent(if any): Charlene Antrim ciengineedng@aol.com Cape& Islands Engineering E-mail Address 800'Falmouth Road,-Suite 301C Mailing Address Mashpee MA 02649 City/Town State Zip Code -5084777272 5084779072 Telephone Number Fax Number C. Proposed Project/Use Information 1. Property Information (all information must be provided): Same Owner Name(if different from applicant) Map 5 parcel 50 Tax Assessor's Map and Parcel Numbers Latitude Longitude 190 Clamshell Cove Road 'Cotuit MA 02635 Street Address and City/Town State Zip Code 2. Registered Land ® Yes ® No 3. Name of the water body where the project site is located: Shoestring Bay 4. Description of the water body in which the project site is located (check all that apply): Type Nature Designation ❑ Nontidal river/stream ® Natural ❑Area of Critical Environmental Concern ® Flowed tidelands ❑ Enlarged/dammed ❑ Designated Port Area ___. _ ❑ Filled tidelands ❑ Uncertain ❑ Ocean Sanctuary - ❑ Great Pond ® Uncertain ❑ Uncertain CH91App.doc•Rev.6/06 Page 2 of 13 i ;- Massachusetts Department of Environmental Protection Bureau of Resource Protection -Waterways Regulation Program X231797 Transmittal No. Chapter 91 Waterways License Application -310 CMR 9.00 Water-Dependent,Nonwater-Dependent,Amendment C. Proposed Project/Use Information (cont.) Select use(s)from Project Type Table 5. Proposed Use/Activity description on pg.2 of the "Instructions' Amend lic 10203 by replacing the existing vertical log wall with a C-lock vinyl wall. 6. What is the estimated total cost of proposed work(including materials& labor)? $20.000 7. List the name&complete mailing address of each abutter(attach additional sheets, if necessary). An abutter is defined as the owner of land that shares a common boundary with the project site, as well as the owner of land that lies within 50' across a waterbody from the project. Antis, Gerald A& Carol S 176 Clamshell Cove Road, Cotuit, MA 02635 Name Address Mikus, Patricia L 26 Glenbrook Lane, Arlington, MA 02174 c/o Tsihlis, James Tr Address Name Address D. Project Plans 1. I have attached plans for my project in accordance with the instructions contained in (check one): ® Appendix A(License plan) ❑ Appendix B (Permit plan) 2. Other State and Local Approvals/Certifications ❑401 Water Quality Certificate Date of Issuance ®Wetlands 3-4855 ° File Number El,Jurisdictional Determination JD- File Number ❑ MEPA File Number ❑ EOEA Secretary Certificate Date - ❑ 21 E Waste Site Cleanup RTN Number i CH91App.doc-Rev.6/06 Page 3 of 13 I Massachusetts Department of Environmental Protection Bureau of Resource Protection -Waterways Regulation Program X231797 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Water-Dependent, Nonwater-Dependent,Amendment E. Certification All applicants, property owners and authorized agents must sign this page. All future application correspondence may be signed by the authorized agent alone. "I hereby make application for a permit or license to authorize the activities I have described herein. Upon my signature, I agree to allow the duly authorized representatives of the Massachusetts Department of Environmental Protection and the Massachusetts Coastal Zone Management Program to enter upon the premises of the project site at reasonable times for the purpose of inspection." I hereby certify that the information submitted in this application is true and accurate to the best of my knowledge." Applicant's signature Date Prope rty Owner's signature(if different than applicant) Date ' ? uj 1/29/10 Agent's signature(if appli tile) Date P .. CH91App.doc•Rev.6/06 Page 4 of 13 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Waterways Regulation Program X231797 41 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Water-Dependent, Nonwater-Dependent,Amendment F. Waterways Dredging Addendum 1. Provide a description of the dredging project ❑ MainIenance Dredging (include last dredge date & permit no.) ❑ Improvement Dredging Purpose of Dredging 2. What is the volume(cubic yards) of material to be dredged? 3. What method will be used fo dredge? ❑ Hydraulic 0 Mechanical ❑ Other 4. Describe disposal method and pro\e\disposal location (include separate disposal site location map) V 5. Provide copy of grain size analysis. If grain size is compatible for beach nourishment purposes, the Department recommends that the dredged material be used as beach nourishment for public beaches. Note: In the event beach nourishment is proposed for private property, pursuant to 310 CMR 9.40(4)(a)1, public access easements below the existing high water mark shall be secured by applicant and submitted to"the Department. CH91App.doc•Rev.6/06 Page 5 of 13 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Waterways Regulation Program X231797 t Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Water-Dependent,Nonwater-Dependent,Amendment H. Municipal Planning Board Notification Notice to William Prescott Applicant: Name of Applicant Section H should 190 Clamshell Cove Road Shoestring Bay Cotuit be completed and Project street address Waterway City/Town submitted along with the original Description of use or change in use: application material. To replace the existing vertical log wall with a C-lock vinyl wall. To be completed by municipal clerk or appropriate municipal official: "I hereby certify that the project described above and more fully detailed in the applicant's waterways license application and plans have been submitted by the applicant to the municipal planning board." Printed Name of Municipal Official Date Town Clerk Cotuit Signature of Municipal Official. Title Cityrrown Note:Any comments, including but not limited to written comments, by the general public, applicant, municipality, and/or an interested party submitted after the close of the public comment period pertaining to this Application shall not be considered, and shall not constitute a basis for standing in any further appeal pursuant to 310 CMR 9.13(4)and/or 310 CMR 9.17. CH91App.doc•Rev.6/06 Page 7 of 13 Massachusetts Department of Environmental Protection 97 Bureau of Resource Protection -Waterways Regulation Program x231m Transmittal al No. Chapter 91 Waterways License Application -31.0 CMR s.00 Water-Dependent, Nonwater-Dependent,Amendment Appendix A: License Plan Checklist General View ❑ PE or RLS, as deemed appropriate by the Department, stamped and signed, in ink, each sheet within 8 1/2 inch by 11 inch border ❑ Format and dimensions conform to"Sample Plan" (attached) ❑ Minimum letter size is 1/8 of an inch if freehand lettering, 1/10 of an inch if letter guides are used ❑ Sheet number with total number in set on each sheet ❑ Title sheet contains the following in lower left: Plans accompanying Petition of(Applicant's name, structures and/or fill or change in use, waterway and municipality] ❑ North arrow ❑ Scale is suitable to clearly show proposed structures and enough of shoreline, existing structures and roadways to define its exact location ❑ Scale is stated &shown by graphic bar scale on each sheet ❑ Initial plans may be printed on bond; final plans due before License issuance must be on 3mil Mylar. Structures and Fill ❑ All Structures and Fill shown in full BLACK lines, clearly labeling which portions are existing, which are Proposed and indicating Existing Waterways Licenses ❑ Cross Section Views show MHW*and MLW*and structure finish elevations ❑ Dredge or Fill, actual cubic yardage must be stated and typical cross sections shown ❑ All Structures and Fill shown in full BLACK lines, clearly labeling which portions are existing, which are Proposed and indicating Existing Waterways Licenses ❑ Cross Section Views show MHW*and MLW*and structure finish elevations ❑ Dredge or Fill, actual cubic yardage must be stated and typical cross sections shown 0 ❑ Actual dimensions of structures(s) and or fill and the distance which they extend beyond MHW* or OHW* ❑ Change in Use of any structures on site must be stated *See 310 CMR 9.02, Waterways Regulations definitions of High Water Mark, Historic High Water Mark, Historic Low Water Mark, and Low Water Mark. Note: DEP may, at its discretion, accept appropriately scaled preliminary plans in lieu of the plans described above. In general, DEP will accept preliminary plans only for non-water dependent projects and projects covered by MEPA to address site design components such as visual access, landscaping &site coverage. Anyone wishing to submit preliminary plans must obtain prior approval of the DEP Waterways Program before submitting them with their application. CH91App.doc-Rev.6106 Page 8 of 13 i Massachusetts Department of Environmental Protection Bureau of Resource Protection -Waterways Regulation Program X231797 i Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Water-Dependent, Nonwater-Dependent,Amendment Appendix A: License Plan Checklist (cont.) Boundaries ❑ Property lines, full black lines, , along with abutters' names and addresses ❑ Mean High Water(MHW)*or Ordinary High Water(OHW)*, full black line ❑ Mean Low Water(MLW)*, black dotted line, (.............) ❑ Historic MHW*or OHW*(----) ❑ Historic MLW*(..._... _.._) ❑ State Harbor Lines, black dot-dash line (—. —. —. —)with indication of Chapter&Act establishing them (Ch. , Acts of) ❑ Reference datum is National Geodetic Vertical Datum (NGVD)or(NAVD). ❑ Floodplain Boundaries according to most recent FEMA maps ❑ Proposed & Existing Easements described in metes& bounds Water-Dependent Structures ❑ Distance from adjacent piers, ramps or floats (minimum distance of 25' from property line, where feasible) ❑ Distance from nearest opposite shoreline ❑ Distance from outside edge of any Navigable Channel ❑ Access stairs at MHW for lateral public passage, or 5 feet of clearance under structure at MHW. Non Water-Dependent Structures ❑ Depict extent of"Water-dependent Use Zone". v See Waterways Regulations at 310 CMR 9.51-9.53 for additional standards for non water-dependent use projects. Note: Final Mylar project site plans will be required upon notice from the Department, prior to issuance of the Chapter 91 Waterways License. CH91App.doc•Rev.6/06 Page 9 of 13 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Waterways Regulation Program X231797 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Water-Dependent, Nonwater-Dependent,Amendment Appendix A: License Plan Checklist Cont. c Registry Statement CID 3112 inche 5 inches Lo cu s Map First Sheet 0 my zm CID 1 „ �21 inches--lillp- CD CD Sample Plan 81/2 inche P.E. or RIS v Stamp -3 3/4 inch e Plan Accompanying Petition of... DEP Stamp First Sheet Only 3/4 " Border CHMpp.doc-Rev.6/06 Page 10 of 13 i Massachusetts Department of Environmental Protection Bureau of Resource Protection -Waterways Regulation Program X231797 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Water-Dependent,Nonwater-Dependent,Amendment Appendix B: Dredging Permit Plan Checklist For projects applying for dredging permits only, enclose drawings with the General Waterways Application that include the following information: General View ❑ Submit one original of all drawings. Submit the fewest number of sheets necessary to adequately illustrate the project on 8-1/2 inch X 11 inch paper. ❑ A 1-inch margin should be left at the top edge of each drawing for purposes of reproduction and binding. A 1/2 inch margin is required in the three other edges. ❑ A complete title block on each drawing submitted should identify the project and contain: the name of the waterway; name of the applicant; number of the sheet and total number of sheets in the set; and the date the drawing was prepared. ❑ Use only dot shading, hatching, and dashed or dotted line to show or indicate particular features of the site on the drawings. ❑ If deemed appropriate by the Department, certification by the Registered Professional Engineer or Land Surveyor is included. Plan View ❑ North Arrow ❑ Locus Map ❑ Standard engineering scale. ❑ Distances from channel lines and structures if appropriate. ❑ Mean high water and mean low water shorelines (see definitions of"High Water Mark"and "Low Water Mark"at 310 CMR 9.02, C. 91 Regulations). ❑ Dimensions of area proposed to be dredged or excavated. ❑ Notation or indication of disposal site. ❑ Volume of proposed dredging or excavation. P ❑ Ordinary high water, proposed drawdown level, and natural (historic) high water(for projects lowering waters of Great Ponds). Section Views ❑ Existing bottom and bank profiles. ❑ Vertical and/or horizontal scales. ❑ Proposed and existing depths relative to an indicated datum. ❑ Elevation and details of control structure(for projects lowering waters of Great Ponds). CH91App.doc-Rev.6/06 Page 11 of 13 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Waterways Regulation Program X231797 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Water-Dependent, Nonwater-Dependent,Amendment Appendix C: Application Completeness Checklist Please answer all questions in the General Waterways Application form. If a question does not apply to your project write"not applicable"(n/a) in that block. Please print or type all information provided on the form. Use black ink(blue ink or pencil are not easily reproducible, therefore, neither will be accepted). If additional space is needed, attach extra 8-1/2"x 11"sheets of paper. ❑ Proper Public Purpose: For nonwater-dependent projects, a statement must be included that explains how the project serves a proper public purpose that provides greater benefit than detriment to public rights in tidelands or great ponds and the manner in which the project meets the applicable standards. If the project is a nonwater-dependent project located in the coastal zone, the statement should explain how the project complies with the standard governing consistency of the policies of the Massachusetts Coastal Zone Management Program, according to 310 CMR 9.54. If the project is located in an area covered by a Municipal Harbor Plan, the statement should describe how the project conforms to any applicable provisions of such plan pursuant to 310 CMR 9.34(2). ❑ Plans: Prepared in accordance with the applicable instructions contained in Appendix A-B of this application. For initial filing, meet the requirements of 310 CMR 9.11(2)(b)(3). ❑ Applicant Certification:All applications must be signed by"the landowner if other than the applicant. In lieu of the landowner's signature, the applicant may provide other evidence of legal authority to submit an application for the project site."If the project is entirely on land owned by the Commonwealth(e.g. most areas below the current low water mark in tidelands and below the historic high water mark of Great Ponds), you may simply state this in lieu of the"landowner's signature". ❑ Municipal Zoning Certification: If required, applicants must submit a completed and signed Section E of this application by the municipal clerk or appropriate municipal official or, for the initial filing, an explanation of why the form is not included with the initial application. If the project is a public service project subject to zoning but will not require any municipal approvals, submit a certification to that effect pursuant to 310 CMR 9.34(1). ❑ Municipal Planning Board Notification: Applicants must submit a copy of this application to the municipal planning board for the municipality where the project is located. Submittal of the complete application to DEP must include Section H signed by the municipal clerk, or appropriate municipal official for the town where the work is to be performed, except in the case of a proposed bridge, dam, or similar structure across a river, cove, or inlet, in which case it must be certified by every municipality into which the tidewater of said river, cove, or inlet extends. ❑ Final Order of Conditions:A copy of one of the following three documents is required with the filing of a General Waterways Application: (1)the Final Order of Conditions (with accompanying plan) under the Wetlands Protection Act; (2)a final Determination of Applicability under that Act stating that an Order of Conditions is not required for the project; or(3)the Notice of Intent for the initial filing (if the project does not trigger review under MEPA. ❑ Massachusetts Environmental Protection Act(MEPA): MGL 30, subsections 61-61A and 301 CMR 11.00, submit as appropriate: a copy of the Environmental Notification Form (ENF)and a Certificate of the Secretary of Environmental Affairs thereon, or a copy of the final Environmental Impact Report(EIR)and Certificate of the Secretary stating that it adequately and properly complies with MEPA; and any subsequent Notice of Project change and any determination issued thereon in accordance with MEPA. For the initial filing, only a copy of the ENF and the Certificate of the Secretary thereon must be submitted. Note: If the project is subject to MEPA,the Chapter 91 Public Notice must also be submitted to MEPA for publication in the"Environmental Monitor". MEPA filing deadlines are the 15"'and 30'"of each month. CH91App.doc•Rev.6/06 Page 12 of 13 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Waterways Regulation Program X231797 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Water-Dependent,Nonwater-Dependent,Amendment Appendix C: Application Completeness Checklist (cont.) ❑ Water Quality Certificate: if applicable, pursuant to 310 CMR 9.33, is included. ❑ Other Approvals: as applicable pursuant to 310 CMR 9.33 or, for the initial filing, a list of such approvals which must be obtained. Projects involving dredging: ❑ The term "dredging" means the removal of materials including, but not limited to, rocks, bottom sediments, debris, sand, refuse, plant or animal matter, in any excavating, clearing, deepening, widening or lengthening, either permanently or temporarily, of any flowed tidelands, rivers, streams, ponds or other waters of the Commonwealth. Dredging includes improvement dredging, maintenance dredging, excavating and backfilling or other dredging and subsequent refilling. Included is a completed and signed copy of Part F of the application. Filing your Completed General Waterways Application: ❑ For all Water-Dependent applications—submit a completed General Waterways Application and all required documentation with a photocopy of both payment check and DEP's Transmittal Form for Permit Application &Payment to the appropriate DEP regional office (please refer to Pg. 10 of the"Instructions"for the addresses of DEP Regional Offices). ❑ For all Non Water-Dependent applications—submit a completed General Waterways Application and all required documentation with a photocopy of both payment check and DEP's Transmittal Form for Permit Application &Payment to DEP's Boston office. Department of Environmental Protection Waterways Regulation Program One Winter Street Boston, MA 02108 ❑ Application Fee Payment for ALL Waterways Applications: Send the appropriate Application fee*(please refer to Page 1 of the"Application"), in the form of a check or money order, along with DEP's Transmittal Form for Permit Application &Payment. Department of Environmental Protection P.O. Box 4062 Boston, MA 02211 0 *Under extreme circumstances, DEP grants extended time periods for payment of license and permit application fees. If you qualify, check the box entitles"Hardship Request' on the Transmittal Form for Permit Application &Payment. See 310 CMR 4.04(3)(c)to identify procedures for making a hardship request. Send hardship request and supporting documentation to the above address. NOTE: You may be subject to a double application fee if your application for Chapter 91 authorization results from an enforcement action by the Department or another agency of the Commonwealth or its subdivisions, or if your application seeks authorization for an existing unauthorized structure or use. CH91App.doc•Rev.6/06 Page 13 of 13 L r TOWN OF.BARNSTABLE BUILDING PERMIT APPLICATION Map a75_ Parcel D Permit# Health Division CX0 ©3 Date Issued Conservation Division X D_j 5 7 77 �( �C_CI 7g Fee g� Y� �` o Pia s�3/4/: 61 Tax Collector Treasurer ��BTE'MMUSTou INSTALLED IN COMP t Planning Dept. VWTH ���� ENVIRONMENTmAL�8 ' Date Definitive Plan Approved by Planning Board COOED Historic-OKH Preservation/Hyannis TOWN wn OW,2, Project Street Address Village Owner /�����J '� Address Telephone o Permit Request �� rn Square feet: 1st floor: existing proposed 2nd floor: existing proposed Totaf new m r Valuatiori Zoning District Flood Plain Ground ivater Overlay rn Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑Ne If yes,site plan review# Current Use Proposed Use U� _ BUILDER INFORMATION Name V� ���� Telephone Number 6�G Address © f —qq� 6�2 License# 64z::� L12 10_q•� j�Z �,�:� Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY PERMI7`NO. DATE ISSUED "MAP/PARCEL NO:'' ADDRESS !� _� VILLAGE OWNER', DATE OF INSPECTION: -FOUNDATION- FRAME ! j INSULATION ��i�."• � (''i # - - - .. FIREPLACE ELECTRICAL: ROUGH .FINAL PLUMBING: ROUGH FFINAL f , .-' GAS: ROUGH ; FINAL r f r^ FINAL BUILDING O.91 ' f tT1 •r y .-�/ ,1- cs 1 DATE CLOSED OUT to ASSOCIATION PLAN NO. i'y I — ✓CT, e i�omvnzonur a�✓�aaaac�iuoelld 'Board of Building Regulations and Standards HOME IMRROVEMENT CONTRACTOR Regist ti'on. 123494 -xpira ions.26/2007 ype=Prate Corporation Gillmore Marine tr iit ;Inc. George Gillmore N 37 Bowdoin Rd Mashpee,MA 02649 i . Administrator ft� � 1 (`�Ze TOomi�noauueci� �✓L� az'��� iBOArRD:OF BUILDING=REGULATIONS' �y, License C NSTRUCTION SUPERVf,SOR NumberxS 068433 Tr rioi 25522•- s: Res I�ted "r FO BOX 940 GOTUIT,,MA 02ti35 I Commissloner Apr 25 05 .09: OOa AW Banister Co 15083599151 p. l ^p►' eb eU05 Q:57RM GILLMORE MRRIME. 508-477-7740 p. 1 Town of Barnstable Regulatory Services ThomasF.Ge0er,Director ' epe building Division Tom Perry, Bugding Commissloner 200 Main Street, Hyaaais;MA 02601 www.town.barnatable.ma,us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A BuUder I, ��t�_`•/a h� �;s.S �'rT ,as Owner of the subject property hereby authorize. ���, 2 f'1'II �/}�� to act on my be ha , in all natters relative to work authorized by this building permit applicator for: O • (,Address of Job) Signature of Owner Date Print Name Q;ronnis:owrr�ralaanssrox . i The Commonwealth of Massachusetts :--- -�(7Department of Industrial Accidents — �IcB efld�s' 600 JVashin;ton Street vt ` Boston,Mass. 02111 Workers' Compensation Insurance Affidavit-General Businesses • address: C) J/ state: zi : o ci ty work site location full address ❑ I am a sole proprietor and have no one Business Type: Li Retail❑RestaurantBar/Bating Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,Autos etc.) ❑I am an e/�m Toyer wi th eIn 1 es(full& art time). El Other / r� // RR 'M ERR am an employer providing.Workers' compensation for'my employees workin on this job. cis '•,�' ;tm any.nime: 7. ' hone#•',' —G �� ]�y/���� `;,'••. �� . `//r•- "7 ',i L:'' 011c. .# •.7 4!LJ..,C/•... .. -+i .9nslii-ance.eb:•:' : /'` // / %/'..'/e / /////.11� /////////// / / : .�• // / /////u. I am a sole proprietor and haye hired the independent contractors listed below who have the following workers' compensation polices: cam any _ hone city:. ' � `'••�� •,� :;;r.g::, .. 9nsiirence co. 1 .. ♦1'. _ -,1,.. ..,n'•4 .f'aY' .. address hone -.i•_ - X,cRIP 31 Fallure to secure coverage u required under Section 25A of MGL 152 can'lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or. one years'secImpure coverage es s re u ctd penalties Section the form of a STOP WORK ORDER and a fine of s100.00 a day against me. I understand.that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby Geri' nder s a nalties of perjury that the inform ation provided above is tru nd corr. Date Signature Phone# Print name � � - , ofr'icia]we only do not write In this area to be completed by city or town official permR111cense# ❑Building Department city or town: ❑Licensing Board ❑Selectmen's Office ❑check if immediate response is required ❑$ealth Department contact person: phone#; ❑Other t (revised Sepe 20M) 1 - Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 tan ndrndual,P��s P� association,corporatim'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 section 25 also states that every state or local licensing agencyrshall withhold the issuance dr renewal of a license or permit to operate a business or to construct buildings in the zommonwealth.for'ariy applicant wfio�has not produced acceptable evidence of compliance with the insurance coverage require& Additionally,neither.the commonwealth nor any of its political-subdivisions shall enter into any contract for.the performance of public'wdk until r acceptable evidence of compliance with the insurance requirements of this chapter have been presentedto the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation Please . supply company name, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. .Also be sure to sign and date the affidavit. The affidavit shouldbe 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 listedbelow. City or Towns Please be sure.that the affidavit is complete and printed legibly. The Department bas 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 pernrit/license number which will be used as a reference number.. The affidavits.may be returned to ,. the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would hike to thank ybu in.advance for you 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 otn"of Imsugatlons 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext.406 i oFIKKE ti Town of Barnstable b Regulatory Services • BaaxsTMtS, II Thomas F.Geller,Director rinse. 9�A 1b.19. p�� Building Division QED MP'� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ` / `. IZAN Type of Work: Estimated Cost Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 []Building not owner-occupied El owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby app for a permit as the agent of the own r: *at Contractor Name Registration No. OR Date Owner's Name Q:fomis:homeaffidav f ' I • i .J11VL'J 11\ll\V 11l11 -L' ••1 �J A / r• ,+ • - { .Bk 19689 Pg 30 #21696 villooD �. �vw ' 8'x 12' i FLOAT q Zrr l 9 j o .... -2, h i Y x IT RAMP 1p LOCUS ^ I PROPOSED • ! CG4'UCf QUADRANGLE O _1 OS 4-x 34',IqEIt ANTIS,GERALD A.&CAROL S. EL_W_&L-- spy �p•G 'O� 176 2 CLAMSHELL COVE RD J~ 0,0.. •�-�........ $ OOP 0 P`3 1 OTU1T,MA 02635 ,�• " �j r ti til � SALT.�SH , l �Ptiy ����', I EL 2.8 VERTI Lam' B ^Z 'y99 � I EXISTING Y W1DE STAIRWAYS i ,B A &LANDINGS � TOP OF EXISTING 4" 12 VERT.LOG WALL• M EL.4.1 -EL.5.4 OWNER/APPLICANT: KEIM,ROBERT L.&CHRISTINE ,/ 1'90 CLAMSHELL COVE RD COTUIT,MA 02635 „►f:t^`:`-r�`%?;:<;; i� q C5q �y MIKUS, RICIA L. CIO TSiHLIS, MES TR %'I,;.'1A 26 GLENBROO ARLINGTON,MA 0 74 . . . . . . . . . . . . . • . O 20 10 0 = 20 40 ELEVATIONS kk.B BASED ON N'E' W• 9� SHEET 1 Of 3. SCALE: 1"=201• SLY 10.2001 LICENSE PLAN NO. 1 o PLAN ACCOMPANYING PETITION OF . ved by DepM n I p,n �ROBERT KEIM - of Massachusetts � � ; � ►� TO CONSTRUCT&MAINTAIN " A WOODEN PIER,RAMP&FLOAT 1N SHOESTRING BAY,BARNSTABLE,MA CAPE.&ISLANDS ENGMECRING MASHPEE,MA Bk 19689 Pg 31 #21696 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . ... . . . . . . . . . . . . :. . . . . . . . I ' c . . .. . . . . 1"x 10" SKIRT 5/4 DECKING ' 1"SPACING 2'x 6" JOIST$ Q 2'-0" ? 1 12"x 20' iyiu�ry� STYROFOAM 514 DECKING I!2" GALV. 2"•x 4" SKID # } -_... .•::' - ! BOLTS (J l'• FLOAT SECTION I..77" <:.•'':'•'• °" SCALE: 3/8"=V-0" C 3"x6" 4'-0" HANDRAIL Y-0" 2"x 4" RAIL EL.I I.Ir _v HANDRAIL SPIKE DECK Q I _ z'x4^ TO STRINGERS A I� � I I • I 4 x 4,. I )BRACES I' POSTS I j I" SPACING J 5/4 RECK. DECK EL.8.8' I r- N 3/8" GALV. 5/4 DECKLAG BOLTS ♦♦ ♦ 3-4"x10"s x 2"x 6" 3".x 8" 2"x 6" SPLIT CAP CROSSBRACE RAMP SECTION 3/4"GALV. BOLTS SCALE:3/8"_']'-0' CROSSBRACE ALW EL.3.3' MLW EL.2.8' 12" 0 I' 2' T 4' 5' , 10"D{AM. PILES SCALE IN FEET — I I MLW EL.0.0 LICENSE • . . . . . . . . . . , . ELw .-os SE PLAN NO. I ozoi. ' APp�red b �a�, Aatedjon . ..41......... -. Date "•,'�: � :,� • PROPOSED BENT SECTION' SCALE: 3/8"=1'-0" ROBERT KEIM 'CAPE&ISLANDS ENGINEERING SHEET 3 OF-3 JUL. 10,2001 MASHPEE, MA ELEVATION. ARE BASED ON MLW t131SIJ_ ab3W�NH or -LS3-L.Lv`AdO0 3nu, S033p 3O 1SIJ3a b �cl 57' a 15, 30' 4, m" 2 BENTS Q 15'-0" O.C. } 8' x IT LG. FLOAT RAIL EL.11.8 Q r-z rn 3'x IV gp�IlY p y - DECK E 8 ; z cn G' 3-4"x 10"STRINGERS AHw EL-LY ML W EL:0,0 I Li j i EXISTING ; VERTICAL LOGS 0 0 o Jou &SANDBAGS 10" PILES _ a 25 LONG n 10" FENDER PILES ' 35' LONG (2) SECTION A :A, SCALE: 1"=10' ' 6 'PROFILE. OF PROPOSED PIER RAMP & FLOAT -9cn EXISTING ;n1 N ti •����-� �•r�. � STAIRWAY � RAIL EL.U.8 - • DECK EL.81 2-3"x 10" STRINGERS td �F�YTVI�I��Y`� a 1 -2"x 10" STRINGER }� ) D ' LICENSE PLAN NO. ► p2ca 0 p to Approved by Department p[�p1o160d0a o We: MAR-2 2QQ 10" PILES ro 25' LONG r J SECTION B = ; SCALE: V'=10' w N F•� / 0) TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. Map Parcel CD-6-0 Permit# 930 Health Division '7� 2 7 � Date Issued Conservation Division l , Fee �© Tax Collector Treasurer �ZZ�ZOc� IEv.TgL�E®1� WITH TIl'��5 Planning Dept. ENVIRO (�F� N�ENTgLC®®Date Definitive Plan Approved by Planning Board �' WN REGTAL C OZ Aft ONS Historic-OKH Preservation/Hyannis Project Street Address t qO e LAW Village t Owner ss Telephone zc� ^ a� 33 M Permit Request _5t,_9_ � Square feet: 1 st floor: ex' ting proposed 2nd floor: existing proposed Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: 0 Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family Two Family O Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes �kNo On Old King's Highway: Cl Yes ANo Basement Type: 0 Full ❑Crawl ,&Walkout O Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 110 Number of Baths: Full: existing a new Half: existing 3 new Number of Bedrooms: existing new <f9 Total Room Count(not including baths): existing 6 new First Floor Room Count Heat Type and Fuel: ❑Gas XOil Electric O Other Central Air: ❑Yes �No Fireplaces: Existing )- New Existing wood/coal stove: 0 Yes 4No Detached garage:0 existing ❑new size Pool:0 existing ❑new size Barn:0 existing ❑new size Attached garage:Aexisting ❑new size Shed:0 existing 4new size IYXlb Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial 0 Yes k No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i I00 SIGNATURE DATE a� FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS i _ VILLAGE OWNER ` • DATE OF INSPECTION: T FOUNDATION f FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH - FINAL GAS: ROUGH = :3 FINAL FINAL BUILDING r cw DATE CLOSED OUT ASSOCIATION PLAN NO. ti. C *IHE?, Town of Barnstable o� Department of Health,Safety,and Environmental Services RAM STAB14 t"AS& 1639• Conservation Division `��' A�Fo►��A 367 Main Street,Hyannis MA 02601 Office: 508-862-4093 Robert W.Gatewood FAX: 508-790-6230 Conservation Administrator MINOR ACTIVITY REGISTRATION K-e-t-rY---, a F� 3 Property Owner Telephone number C) 0'� S Mailing address lC�x I (C' ©C 6- y SCE Project location Map/Parcel# Project description The following minor activities will reviewed,under Art.27,by Conservation staff instead of the Conservation Commission,as long as they are constructed at least 60' from a wetland resource area or top of a coastal bank. * Pathways 4' in width * Fencing that does not create a barrier to wildlife movement,6"above grade * Conversion of lawns to decks,sheds,patios that are accessory to single family homes,as long as: -house existed prior to August 7, 1996 -alteration within the buffer zone is less then 250 sq.feet. -sedimentation and erosion controls are used during construction * Stonewalls(this does not include stonewalls for retaining wall purposes,grading and/or fill) dad'v&i�- '5Az)t�-6 nature Date Z� Reviewed by Date ZPlan Attached(fee charged for plan) minoract.doc | | ■ » � . I pig » §ems or e ■] � ■ . f , aJ� . C7*% a , _� \k) } ■ Rmi - §®�� - co 9 o ®a$i z i$= I \_ks � • � , ' ' ' ' . � &■�§ . . . � / . . co' � � o / • §aft ` f W§Z ■ ' ice§ atIT • ! � . I �� r- IL j & 2 o x . ) 2 § 2 B . , � 7 , , • | i� ƒ� � \ a ■ o e § 2 k § § Q CD % { 7 B ■ ■ E § \ $ \ / § § ¢ k �. /k / f § 2 / ) ■ a 9 2rm § _ 2rrl � I i MBA�`I —._ goo-•SEAR MEA+� � •NIb I4 ' Ft�ooD All ILL • WA��� Fl- rcuNon nu 't TOIoFcpCi%.A J. uupee L>rar 6-S, '6r?ANG - �', C FA HC-p c i AV---IF r:s E7 Lo-r S-7 j-VF PA ul- J. F + I � SViSED vS.C86.S. /VbuvMC►.+T M,L b 9C, E L' 38 217 EL 0M•S.L, C 4=U-43 \ -1bPgC'g CLA M S 14 E L_L f�o�E L—Fj::f--icf Towti aF �r��►r�"i tC o0bc--L SE- 3- �A�Ep Aur��=T 9 ' 1981- �``T%.AOFjW CERTIFIED PLOT PLAN pcp8 n Lc:5f S8 CL A&A—J—L L c2:3�.i c L.D NEW CONSTRUCTION ONLY $ 20740 ' TOP OF FOUNDATION IS �'�° FEET F°�sre�`�oQ IN ABOVE LOW POINT OF ADJACENT �.�. l� ��.o.�d+ . J ���+ ROAD. SCALE, I 4-0' DATE a/124/82 `ELDREDGE ENGINFCR!!VG CD. lN M�r�>= 1 CERTIFY THAT THE Fc�tiDh-nol.l CLIENT Fts-&eVA SHOWN ON THIS PLAN IS LOCATED EGISTERED REGISTERED JOB No. PJLIIR ON THE GROUND AS PiDICATED AND CIVIL LAND � CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR,BY$' J e•E• OF BARNSTA LE , " A33�Eoycf:P1TA' C H,8 Y` P.Fi>✓. _ 712 MAIN .S T R E.E T. H YA N R I S MASS,. SHEET L OF I �?'E G. LAND YOR ► DATE � MAY - 2 2 - 0 0 M O N 1 3 = 5 4 P - 0 1 ,' •��A:r{R�.�:�-_�..n�"t�f WF,���'.4���gs/,y+hf'ti' -1'4:i 'E.%.:'_ � ir..�c.�� 1°'' The DUTCH BARN .,, IElhh+ IM'fna; wll utg11tlM11 MP11epV[Glh IM.u',1fN1H A solution to many storage & space needs, its standard features are: • One double door • Two 18x22 jalousie windows The MINI BARN An .economical all-purpose storage unit. Its standard features include: • One double door • One .1IBM jalousie window �.4.0 ti p x lG . ....... The ' AaFRAME A delightful way to provide storage space and to enhance your property. Standard features include: One double door • Two 18x72 jalousie windows with shutters.' lkl 4 1 M ;Y — 2 2 — 0 0 M O N 1 3 S S A" The QUAKER y ik, J t � l x i Versatile and charming, the Quaker's standard features are: ` • One double door • Two 18x22 jolousie windows with shutters` The LMINI 611 WA c Nostalgia and function are combined in this barn_ it's features are: • One. double door • One 60x15 jalousie window F i _ Pressure Treated Skids I B'Wide Onnis i j rA-h 1 6i. .. 10'Wi,1p Hnrnz Io Ink..-Ct 33 17 Wrdr.Bums n, x 10' and 10' x 10' buildings All buildings are fully OSSer�� ri bl( and delivered to feoture only one window with shutters. your Niepored site <97� The Commonwealth of Massachusetts S t— .'tm�_,! —.. - -Department of Industrial Accidents .� iHE- V. _ . :: _ _ OlfJce oll�estigatioos 1 T� r _,✓_ y 600 Washington Sheet Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit yn location � t 0— -e m Yvn SV.,e L � city T hone# 2_b—�3 3 I am a homeowner performing all work myselL lamas I *etor and have no one woll:kinz In anv cmiciw rkers' ensation for my employees working on this job. ...: :.. :.:.: ::.. ::::........ ovldm wo comp .....':. ..: I am an e ::::::..::::.. ❑...... . : ......::: 1. am :;:.;;:.:.:.;:.;::.:;:.:•::.:.:::..:....:.... ....... ...... COMM is{:<::;:;:;:i:..........iii:>:!:i::i'ri:<::�ii i{i•i:?:•:+::•i:•:ii:::......:•:::::i:•i:•:i::{.:.:�::::::::... ... nice ;(n X. e cI .....................:...............:..................:.....::..::...::..::,:: insurance :: :: conU=Wr, homeowner circle one)and have hired the contractors listed below who ❑ I am a sole proprietor,general have workers on Po .:<.;:.;:.; ::.;:.>;:<.;:.>;:.:;:>:::»::>:::;:>:<::: thefollowln ... .......:.:::::.::::..,.::.:::;.::::::._::.�:::.�:::::::::::::::::.:::::::::::::.;:...:.:::::._::.:_:.::::.�::::::::::::::::::.::.�::::.:::.;:.; .:::::::: :.;::.::.::::.:::.::::::::::::.:..:;;:.;:::<... v Cfl n ......:... ::::.::.:........:.....::::::::::::::....::•.::.,•:::•:::.:.............:•.............. e <aarM. :::::.::::::.:::.......:.::::.:.:............... .............. .:.......... . hone. ........ ................: :...........:•::::..........::•::•...........4:w:..........•:-.v{.n;..{::;..:...::n�ir•i v.:....n:;Nl,.::...... ..�w:•iN......:..:v�:::•:::::•::::. O�itY ':::•::::::.;...:•::::•:::::::::::.;_::::::::::::::•:::::.�.�::::•:: ..................:...::•...........x:::::•v:yr•:r-:•Jiiv,}:.vJ::n4{.,{nn%;YI.•:{.,r.,..{.;i.::{?•:�:•i:i:::::._::v:••,:::::•.v:::w:x.::- '/ //j//// :::i'i:::::is#:�::::j;:;;'?:::�:::�: �i:`::2::�i::y:2:ii:::i%:::;;::::i::{ ... ;:rain a d dr elf:: `ea e K .::.:.:::.:..:..............:..:.:::......:..::::::.............:::...............:............... ; ;;:.;<:::»:<:»>; :::;::N:>::»::s::>:>::::<<::«:<::«:::<=:::<>:. :>:.>:<::: of insuranceeo::::::...::.:.;;::.:.::::.::::............... . req�red wider on 25A of MGI.14 can lead to the of ertMhW penalties of a Sae ap to s1,500.00 ands or Failure to secure coverage as one years'imptisomnent as well as civil penalties in the form of a STOP WORK ORDER and a Ste of S100.00 a day against me. I a copy of this statement may be forwarded to the OIDce of Investigations of the DIA for coverage verincatLom I do hereby certi the p and p ofpeJurY that the information provided above is ow.and correct e ;. . l signature Print name ofncw we only do not write in this area to be completed by city or town official permdtNceme# ❑Building Department city or town: ❑Licensing Board once V required ❑Selectmen's Oihlce ❑check if immediateresP Q _ 01leaithDepartment - contact person: phone#; ❑Other Uevued 9195 P1A) Information and Instructions „ Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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, pa rtnership, 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 tm dwelling house having not more than three aparents and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , consotuction 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 section 25 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,neither the commonwealth nor any of its political subdivisions shall eater into any contract for the performance of public work until acceptable evidence of compliance with the insurance requires of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone nurnbers.along with a certificate of insurance as all affidavits may be ents for confirmation of insurance coverage. Also be sure to sign and submitted to the Department of Industrial Accid 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. VF City or Towns 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/liemse number which will be usedas areference number. The affidavits maybe returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 0mce of imlesugauans 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 °0HE Tp The Town of Barnstable. MUMMM • MASS Department of Health Safety and Environmental Services 059.� Building Division g 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 Building Commissioner Fax: 508-790-6230 s, Permit no. Date AFFIDAVIT r HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other , requirements. Type of Work: Estimated Cost . Address of Work: C) CLPMA OZAU iT 02(03 Owner's Name Date of Application: 2ZI� I hereby certify that: Registration is not required for the following,reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑B 'lding not owner-occupied i wner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DER HAVE cE. 142A. ACCESS TO THE ARBITRATION PROGRAM OR SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. OR L17 Date Owner's Name q:forms:Affidav The Town. of Barnstable CF 1HE T F �`''o Department of Health Safety and Environmental Services Building Division •43" ' 367 Main Street,Hyannis MA 02601 wAS&►ss. 9 i63n. ,0� �pTED MA'I a Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: b 0_4A J OL� TOP" Q&y 1 number street village "HOMEOWNER" T� �`f-a h a0 a333 name t /1 home phone# work phone# CURRENT MAILING ADDRESS: / CL.�vI P1L city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said pro dures and re uire ents. Signature of Homeowner Approval of Building Official . Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,.Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map `� (/� Parcel 95W Permit# 7 �-- Health Division Date Issued l0 Conservation Division I OJI_/d / JLC_ Fee Tax Collector. SEPTIC SYSTEM Treasure I �60 IN STALLED IN C06'��LIANCL ' WITH TITLE 5 Planning Dept. ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planting Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address 90 c�Q 07 Village L/ Owner /eO�D('� ��/h'I Address Telephone Ta 0 a 3�J 3 Permit Requester ��G/y G% �G�. e_ i C41 fox P� Square fe : 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation o' ,BDO t Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfatliered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing ` new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use _�j BUILDER INFORMATION Named " ` Telephone Number 7-oftf Address r. License# O5� T'577 607�1�, /4�4 , 0.2.6e 3�� Home Improvement Contractor# 1OF6 Worker's Compensation#n/ we — ola A�JO ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO aY24 .L"Z4__ SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED " MAP/PARCEL NO. 4-7 ADDRESS VILLAGE OWNER DATE OF INSPECTION:; ' 1 " FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL } GAS: ROUGH FINAL .� FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. .' ;. , of�►�roil, SALZ „STAB The Town of Barnstable "a 9. �0 Regulatory Services 'Eo►+�►+°i Thomas F. Geiler, Director t Building Division ` Ralph Crossen, Building Commissioner ' 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Faxf 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,.demolition,or construction of an addition to any pre-existing owner-occupied building containing at least'one.but not-more-thaa.four_dwelling units or to structures which are adjacent to such residence.or.building be-done by registered„contractors,with certain exceptions,along with other requirements. Type of Work: Al"Zet. �C%�if�— - •- -- YP CC ��// Estimated Cost a� Ovd- � Address of Work: Z7b �-!�� 1,xW C. egcle I1W- �Q ?� Owner's Name: Date of Application: - I hereby certify that: -- -- _ Registration is not required for the following reason(s): ❑Work excluded by law OJob Under$1,000 - -------E]Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR.OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE.HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permitas t o agent o wner: � Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav The Commonwealth of Massachusetts Department of Industrial Accidents °-�_",= �-��� Office of/a�esugatioos �`� - 600 Washington Street \ � + Boston,Mass. 02111 Workers' Co Gmpee//nsation In davit ;�}7Di:G:IIE'iTt{��CIIr�A/IItL� � ////// name: location 2 G ctty L f // ��� phone# �1'0 —v C I am a homeowner performing all work myself I am a sole provn* tor'and have no one worlds is any acity �/�i%%%l%%%% //// ///////%/O�///////i'/i.�/////%%%%/%%%�O/�%//O��%/%:.�,.,.... FieoeI am an emplover providing workers' compensation for my employees working on this job. N. comnnm name .. '''• IIF+ ::::{-:..: iii{!i t,',:f.Y:vti 4.,>:.v:;:{?•i:::'::.{{:-i:.:ti::ti'; .:....'.':'. ...-;.}:isyi.,'ii ::}:;i:}ii:.•.!;:::::�;:.;:::iiit.',vi::j}...:�:�:;r::. . address ' T. ....:.: ...:... - ...:...J:.. ... ..... .... 'shone.#:....::: . city :.::::.::.::::.::.:::: : insar^ncc co. zl 0 • iwi/mi/i//i/Gi //G%////'l/////////%% O/%////G%///////%i/ // // /%/ ///%////%//////////////////////////%/�::�::::• I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have7. ' --._ �- company name: •:........ ..:.:.. .... ... ::.:. ....::.:..............:..h:nv::::.::::•::::i:v: i:4'^i:+}i":::.::::..:•v:vvm, .. ........... .... .. .... .:......... ..........::J;:X•::::-•:•:xLw w:;:x::•:•�::�:::`:{•:{{{•i'••ii:i:::{}.4{i:iiii;i:i i::i;i:iii:;:i;;iii . ....:::.::.... . .:..... one:#.;>:>.:.c:;.:>:<:'�>:;;:':':<.: > :<'.><>:;:: '.< >:::::.»r«:.::><;: ...:::.;... city: :;ev ilisurnnce c o. .:................:::.... :::.:..... ..::::::•..........:::•:::::•.................. ... comnanv name- address' ....:..:::::::.,::-.... citT: :.::.::::::::..::::,:::::one.:: :.. :..;.;.. :»::::•;:.;;::.::::::<'::::::>.::> insurance co. Failure to secure coverage as required under Section ZSA of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one yearn'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a flue of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the once of Investigations of theDIA for coverage verincatlon. 1 do herenv certify un paw ies ojperjury the the injorrnation provided above is trues and eorrreea Date fD /�G 4 Sienature � -. Print name /ic e ;;a tErn Phone 111cizi use only do not write in this area to be completed by city or town official permit/license N ❑Building Department City or town: ❑Licensing Board ❑selectmen's Office check if immediate response is required Qliealth Department contact person: phone f!; ❑Other_ r,:` ,rss • 4 - a Information and Instructions General Laws ter 152 section 25 requires all employers to provide workers' compensation for their Massachusetts G �P to ee is defined as every person is the service of another under any cow-- employees. As quoted from the'law", �P .y of hire, express or implied, oral or written. association, corporation or other legal entity, or any two or more c: An employer is defined as an individual,partnership, s of a deceased,employer, or the rec.�ve- ,the foregoing engaged in a joint enterprise, and including the legal repiese association or other legal entity, emploYmB employees. However the owner of a trustee of an uidividuat,partnership, or ttie oc ant of the dwelling house of dwelling house hawing not more than three apartments and who resides therein, �P _ to persons to do maintenaaen, constructim or repair work on such dwelling house or on the grounds c another who employs p be deemed to be an employer. building appurtenant thereto shall not because of such employment -. . . 152 section 25 also states that every state or,local licensing,ageney�shall withhold the issuance or renev MGL chapter in the commonwealth for any applicant who h. of a license or permit to operate a business or to construct buildings , not produced acceptable evidence of compliance with the insurance coverag re re1df.°Additionally,e of blin k um P _ . of its olitical subdivisions shall enter into any contract P rmanc commonwealth nor a� P of this'chapter havebeen presented to the contr' acceptable'evidence of compliance with the insurance authority: . i/. ; - Qiihi WON- / Applicants , ensatim affidavit cm*cWy,by checiang the box that applies to your situation and a Please fill in the workers' comp hone numbers along with a certificate of insurance as ail affidavits maybe 4 supplying company names,address P of en coverage. Also be sure to sib and . submitted to the Department of._.Industtial Accidents - application for the permit or Lc=s is ' date the affidavit. The affidavit should be returned to the city or town that aPP g •mow or if y Accidents, Shetild Yon have m y questions the c being requested,not the Departtaemt o�Industrial artinicatat the zuunber.Iisted below. required to obtain a workers' ccunpensatian Policy.Please call due Dep are - - -_ . . . ;� r� iii,/ City or Towns -y^ legibly.- The Department has provided a space at the bottom of Please be sure that the affidavit is_camplete and printed the applicant. Please to fiIl out in the eveet the Office of has to contact you regarding _-- to - affidavit for you i miniber. The affidavits may be returned _.. �..a ti_-. =- ., .. a�&which wdl be used as a reference -µ be sere to fill ia`the pemnrtllic®s have been made. the Department by mail or FAX unless other The Office of Investigations would like to thank you ia'advatrce for You c°°peration and should you have any questons• please do not hesi=to give us a ca.L , .,.4 NONE The Department's address,telephone and fax number. `. - , ._, • . . The Commonwealth Of Massachusetts Department of Industrial Accidents 018ce of IWesduadons 600 Washington street - Boston;Ma. 02111 . far* (617) 727-7749 phone#: (617) 7274900 ext. 4069 409 or 375 � I M�q►.1 loo-.TEAR- tnEAt�-- ______� _ All to. _- _--- --- �/ AArr--ro,o -FL`t0'0 p.0 7 .— ',O M...,W. t �✓ : ToP EL \ \ T0,01'oPi3nV0L - l �F i•• .h 1-7( '�� .- 1 -/Aim :43, o�� :,a `� J�� t. .� .'Tfr ��(]r-_oi.-�J.PiS� � C1� r . � ( �f •�aT�� f�px �� ��'1 f 3O ram" '�Gt- S- � ) �V- A• � vuDra 62,-r II ,crW{r, � J V La-r 5`7 i; 4� L- T S8 �VF PAUL J. f•A1i.IKvS L; � Iwo 1Jo iE: VAilci t5�r°FaED /y1p►1uJ�LCt.+T M'L6 SC EL' 38?-1'7 C.g. A K'480-ao A=(�•Q 3. M_tCP .N 1 cr') f�p-CE CzFei-�c� TbWW aF �►� .L� - p�L of CcY.►C�-i7oi.�� - 3- 86-T , ►7A-veD A�.�t,�T 919 8 -- ��1``"v�r CERTIFIED PLOT PLAN -v t� Lc3r 56 CiAaAt:-;LJELL_m.:'a �D o : CGSTU IT NEW CONSTRUCTION ONLY$ IN TOP OF FOUNDATION IS ' - FEET ABOVE LOW POINT OF ADJACENT 4hn svR �3A.9klS t-A t la—44 MASS. ROAD. SCALE, I"= 4c:>' DATE, 6/124/84- LOREDGE ENG! F_c i iG co.w MAiKI= I CERTIFY THAT THE F'c�NDhT14tJ CLIENT MTS SHOWN ON THIS PLAN IS LOCATED EGISTERED RGOISTERED JOB uO. _ ON THE GROUND AS IUDICATED AND CIVIL LAND ,.Q� CONFORMS TO THE ZONING LAWS ENGINEER ( SURVEYOR DR.BY'-_ __. OF 8 11B1 Ae2R NSTA_ L��4�)-A-e-- HYANRIS, -' ASS -* E-Kc_---- AS � � 712 MAIN •S,TRE.ET CHUY MASS, SHEET 1 OF f DATE �EO. LAND SURVEYOR e z N oNg 'NOD F.41� p�r.W ,�d zz W. Kip,� ��•c v M 1 x., t Kip, L4 9' ecL DGTI.I r rt Z 0 o F-XIgT11Jc� Hodsc m • _pLG�R PLAN � rJEa-, Jaw yr� - . N i • F- x id , ai7e wJJx I o. . i e �1.pe �i. e a' -'RlT T ao � w gnw '.�r�L• 0 ,13�� �� _ 72 I W i e1.9e I Z z PTA .1v Kt•t/zxia x _� � � g I >:°c. . .wu a BXigTiNc� roJrlGaTioN � _z.,�c. . d►.1 I rOUNDATION F'I.AN � I vein. 4 ' `� N z ry� Inl•9' -- Zgl•3e �I,�n �� � �ryry O NoeIV FAI�.��Wfib. ux1O. .z W 4 Ep Irl I 0 I VA I �e WG{J17 19EGIL � � � . a Q exl �Tlr�c, House. P IMR FLAN o" O wy yeeaL ; 2 tLId aITe »RIJw. 10. . 1, a �L�e Col. 0 J I I i ' I• ♦ IT.;/L�10 \ .L < PL- OL Z To cc� I I I I I I i 0 ID �) � � � \ T 2/L%10 i J u LI'�e GI.O= UI•o° °> \' 1 l e e f,I Z s v• —� � to i _ i —__i ___i � �ICJ � 0 � �� FT•zj/2>tlo�. � � 4L �/ pl.ge Z Z J II. T� R'{.r7L%la 9 r:RIgT114c�, PodrJnAT1oN ! I A MUN12AT10 ft^N INS -1'•0' o ~ . - � �� TDO7I7/!)LOIZU/BCLGUL d�'!/Gd�JQ�ltCl. Board of Building Regmations and Standards HOME IMPROVEMENT CONTRACTOR. Registration: 109606 Expiration: 09/21/2002 Typo: PRIVATE CORPORATIOt A I ENTERPRISES:NC. PETER POMETTi 140 RIVER RD _- COTUIT,MA 02635 Administrator BOARD OF BUILDING REGULATION! License: CONSTRUCTION SUPERVISOR j Number. CS 050457 Birthdate: 04/19/1949 Expires:04/19/2002 Tr.no: 2134E Restricted To: .00 PETER M POMETTI PO BOX 2056 ""�'. ` COTUIT, MA 02635 Administrator TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION• trap cOQ Parcel D 5 Permit# 12 _ Health Division Date Issued_ Conservation yBiv Fee ',2 .oG Tax Collect Treasure Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address j`)e A MS tt ( �'� �� Jq_6 Village _ Q Owner 1Q©� P.,�'i �! � Address 1 e (g,-,J (r Telephone 2 $ 31p Permit Request moo r V,- 'r Square feet: 1st floor: exing proposed 2nd floor:existing proposed Total new Estimated Project Cost '1�00 Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No •If yes, attach supporting documentation. Dwelling Type: Single Family I/Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new* size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑;No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name L CA-Z&es e t 1 G, Telephone Number �° tla $ Address 0 6 0 X, 7 S-2 License# 0 34 IN C��� - /' DaG 3 Home Improvement Contractor# 1 a o 5 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO G a ac c SIGNATURE DATE _ /'" y Z6 oe? - FOR OFFICIAL USE ONLY F PERMIT NO. DATE ISSUED ' MAP/PARCEL NO ADDRESS VILLAGE OWNER ' DATE OF INSPE QN: ) ' FOUNDATION FRAME f INSULATION FIREPLACE ` ELECTRICAL: ROUGH FINAL t - PLUMBING: ROUGH FINAL GAS: = ROUGH FINAL , r FINAL BUILDING DATE CLOSED OUT. ASSOCIATION PLAN NO. of me r, The Town of Barnstable • eAaxsrAUL - 9� HAM �' Department of Health Safety and Environmental Services ` �e5g6 �0 ATEOr � Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGLI c. 142A requires that the "reconstruction, alterations; renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with _ certain exceptions,along with other requirements. Type of Work: Est.Cost Address of Work: �D C (,4/"J� Owner's Name Date of Permit Application: 20 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Ag4 -20 /1915 -7-�L Date Contractor Name Registration No. OR Date Owner's Name `� The Commonwealth of Massachusetts ' Department of Industrial Accidents - # ee of/fiveSMAR ANS 600 Washington Street . Boston,Mass. 02111 Workers' Compensation Insurance davit name: ---*S-, C S JrR' '`r location )4PI D e- I,4 n,J 4 (l co� .ciG T� i f /"t�4J' hone# 2/Z O ❑ I a homeowner performing all work myself, . am a sole rietor and have no one worki>i in achy %❑ I am an employer providing workers' compensation for my employees working on this job. .. ........ ::::::::;::: comQ ny :'`fore is::::::::;::::::::::::i':;: : tnsura /% ❑ 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have . . .. the following workers' compensation polices: conaariv:n :>:.;:::.::::. .......................... .;,............. ......:................... address..::::::`,,::.:.:>:::::.::,:.::::::::.:::::.::::. . ;:;.;:.:.;:.:;.;;::.:::.;::.;;: :::::::::::::. ............................::.::::.:::::::::........ .. ............ . ........................................................... .... .: >N :<s :::...:..:::.::::::::::::::::::....,::.:::.:::.:.::.:.:::::::::::: :.:;.;•::..::::::..;:.:::.;;.::::::::::•:::::.:.;:;; _``'3. ....... :....:.::....:......:............................................... :::................:..:......::..:::.::...:::::::......:.:... :.::::.:....:.::::::::.:.:.:.:.... .:.:,..... :: ::::: ;.:... :;<.;:............................................ ......................................... :.::. ................................. :.:: Xx: ['... 0:.;:.;:.:::.::.;....:;•;:::<:;:;;:;::::::>::::;:;:::;:;;:<•:;:::;2:::::::::::::: ::;::;:YS::::;:;:;::::;::;:;::::::;;:.;::;::::::.;.:::.;:.;.;;•:;;:;;:;::;;:::i:>.::::;:::>.:;;::5:::::: b�lclt::#:;::: ;:':::::;..:;:-:-..:::>::t:>.....:....:::::::::::;:<:?:: ::::?:::::'::;>:::.:�::::.�.�:::::::.�::::::::::: lnsnranc t ::::.:::.:::::::::::::::::::::::::::.................... ...... .............::.....%.....:::::::::::::::::::::::.::::................... /l/%//////%%. :.::.:.:::......:::::::::..:......................................::::::"."",::::::.."'" ...:::::.:.:::::.::.....................................:. %... :c $ny:tmame::<::«<:<>:<:<:::::::::>::::'......:::>:::::<:::><>:::<'.:::.':.:::':':'........ .:. :::..,.:• :...:................ ........ ......amQ ............ ..........:::::.::.:::.::::.:::. .........:...-. ......•...:•::::.. , - adiU ..,..:.,. ..........4........ ..0: . ... ..: .4 ... - ...%.:.%.... ........�. ...,........ .4.. . ...%....:4 ................. .......... . :::: ::::::::::.:.:::::::::::::.:.:::::.::.::::::.:::::::::::::.:::.:::::*-,,:::.::..:::.....::::::::::::::::::.::,.:::::.................. ........................................................................................................................................::.:::::::.::::. :::...:::.......... ::. .;:. city:::;:::`:::?::<:::;:`::::::?:<:;;:; ;::::;:`.;::>:::<:>::::':`'>:: ; ':>:><::>:<'....:::>......:::> :: ; :::::::»::>::::?::»:`:<::»><:b : <>':<:: • ::.::.:.:............................................................%..................:...................... ............... ................. .................... ................................................................................................ ........... .............. .. ......................................................................................................,:.:::::...::•................... ...................................... ........... ,......... . ..;:.::.:•;:.-:-1:..;:::::..:.>;:::.:::.::.::::.::::::.::::.:.:.;;:::.;:.;:;.:;.;:::.::.:;::;.::.:;.:;.:.:.:;.;:.::.;:;:•.-I.,-,:..•:::.::::.:._.:. O1-tY.�.::::.;.;:.;:.:;:.;:.;:.;:.:;.:;::::::-..:::::::._::..:::.:.::.,.:::. ........................ insnrsnct.co. _ . . ......... _. :: _ ......,...:... .:: Fatiure to secure coverage as requited under Section 25A of MGL 152 can had to the imposition of criminal penalties of a Hue up to$1,S00.00 and/or one years'imprisomnent as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify under the airs and enalties of that the information provided above is truo and coned Si tune Date .� �o _ Print name 19/',t J Zry&,+ ''T-- Phone# �; ,p �I? t� Fd usenly do not write in this area to be completed by city or town official permit/license# ❑Building Department ❑Licensing Board 1 mamediate response is required ❑Selechnen's Office ❑Health Department n: phone ❑Other uev. 9/95 PLV 0 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted front the"law",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 section 25 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,neither the commonwealth nor any of its political subdivisions shall enter into any conract 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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Departncmt at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided as space at the bottom of 6 affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sire to fill in the Oink license number which will be used as a reference number. The affidavits may be wtai-mRie the Department kiy maid or FAX unless other arrangements have been made _ The office of Investigations would lice to thank you in advance for you 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 offloo of IN88110 008 600 Washington street • Boston,Ma 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 r+ HOW IMPROVEMENT CONTRA ,OR Registration 120689 DBA �- - •_Type _ �ExPiiation 'OV21/00 CAZEAULT CO ` JAMES L. CAZEAULT � o QdBOX 752/..193 CLAMSHELL COV....:: AOMiwsTRAroa OTUIT NA 02635`• The Town of Barnstable. MWMABM . ble MASS. � Department of Health Safety and Environmental Services ram' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner December 8, 1994 Ms Priscilla H.Heald C/O Goodhue 16 Windsor Street Methuen,MA 01844 Re: 190 Clamshell Cove Road;Cotuit,MA A=005.050 Dear Ms Heald: The above referenced property is being advertised as having a lower level apartment. Please be informed that this office has no record of a building permit being issued for this use. Therefore,the apartment will have to be removed as the use is a violation of the Town of Barnstable Zoning Ordinances. Please contact this office regarding this matter. Sincerely, Ralph M. Crossen Building Commissioner RMC/km CAPE COD EDITION fY3.�6 ON � WATERFRONT "Get Your Feet Wet" VOL. 1 - NO. 1 NOVEMBER 1994 -eferred Views of Cape Cod Ins d6 tr- A�sover all the Possbit-es the Cape can Differ ` lap` e Creating a life style -- ' some R�nuiG consider. - 1 �.:. total ibhs 3 A:water 4ew home with y�pur- own winery In the back y ..StorY on Page 6 ; W' Stay in contact with:< the Beauty of Cape Codas waterfrola year round..:'See how on- Page 7. Cotuit Coves Waterfront carpeting, legged ceiling, separate dressing area, and a private bath with double This spectacular waterfront post & beam fireplace, balcony, and slider to the waterside porcelain vanity and heat lamp. Completing home sits on the shores of beautiful deck. The dining room also has a slider to the main living quarters are two second floor Popponesset Bay. Situated on .60 acre, it the deck and windows that beautifully frame bedrooms and a bath. o comes complete %ith a large deck which the ever-changing bay views. provides the perfect setting for enjoying the A finished apartment in the lower level magnificent waterviews. With country pine cabinets and pleasant includes a fireplaced living room with double breakfast island, the kitchen adjoins an sliders to a waterside patio, pleasant kitchen efficient mudroom. P The interior of this special home was and one bedroom. designed with comfort and elegance in mind. The fast floor master suite takes advantage The expansive formal living room features of the home's waterfront location, with Offered by Kinlin Grover Properties, cathedral ceiling, gleaming wide oak floor, windows on two walls and a slider to the windows on two sides, floor-to-ceiling brick deck. This comfortable suite has wall-to-wall 4 Wianno Avenue,Osterville;420-1130. R005 050. LOC 0190 CLAM SHELL COVE ROA CTY 01 TDS 200 CT KEY 670 ----MAILING ADDRESS------- PCA 1011 . PCs 00 YR 00 'PARENT - -6 HEALD, PRISCILLA H MAP AREA 01WB JV 342613 MTG 0000 %GOODHUE SPI SP2 SP3 16 WINDSOR ST UT UT2 .60 SQ FT 3650 METHUEN MA 01844 AY9 1983 EYB 1983 OBS CONST 0000 LAND 104100 IMP 217200- OTHER ---=LEGAL DESCRIPTION---- TRUE MKT 321300 REA CLASSIFIED #LAND 1 104, 100 ASD LND 104100 ASD IMP . - 217200 ASD OTH #BLDG(S)-CARD-1 1 217,200 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE-- #PL 190 CLAMSHELL COVE. RD TAX EXEMPT #DL LOT 58 RESI DENT'L 321300, 321300- 321300 #RR 0317 0134 OPEN SPACE COMMERCIAL I NDUSTR I AL EXEMPTIONS SALE 03/91 PRICE I ORB 7469/128 AFD I A LAST ACTIVITY 11/15/91 PCR Y �e n �1 �; /9D �naDia��aue � (�A�/� . %. = G"�S QSD � ����a i z �. �.� � � � TOWN OF BARNSTABLE Permit No. 2432. 1 Building Inspector 'AR"T� Cash 7 ■t6)9 �arFr�� OCCUPANCY PERMIT Bond Issued to Pr -ilia Healo Address 14q ('i_amshell Cove Road . Cotuit Wiring Inspector Inspection date Plumbing Inspector '%' �/ /� (1 ( Inspection date Gas Inspector dl+ Inspection date Engineering Department /�{ Inspection date Board of Health �„ �,� r, Inspection date /!2 - ,? THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ....................................................... 19.........._ .................................................................................................................. Building Inspector I • • F'r--�Pahl I✓SS E77F (MEAL) MBA W � a-Ilb I4 i �' FOOD ' WATE N W�` OA"V- tA Zoe► F ��� —� �7V M.H.W, i� •�` I T F> of �� titi of BA h/K' i �� �_ __ _._ —�. __ � � / G.ra.c .O• . TO-ToP cF eA iK Pam= tse J. P uuoee Ae-rur ,c,-wpr =, 6-F-, 'GRAND - FATHC-p CLAUSa Lo 5-7 I.-VF PA u L J. FA I W KV S 298 I / 16a ram± ram± 2�, l-loS.F + rLEVA�IaJS EASeD ou AACQUMCWT kA16 SC,EL1 38.'L17 / EL O ' M•S.L. C.g.FND. ��4S0oo A°U43 -raPcB T.g.M Q D EL° CL,I�M S�4 E L L CC-D\/ (40 .N►D� _ t OTF-: -tom TOW W OF oP�C aF Cc�u CrnoNS sE- 3- 881 , . 1) AuLusT iq 82. �t�aF��s CERTIFIED PLOT PLAN G I N LC5T S8 CLAMSt-IELL Qom./E Q D _ 8 H NEW CONSTRUCTION ONLY $ lYg1 C��iT iM► p TOP OF FOUNDATION 13=� FEET FoIaTEa�o� IN ABOVE LOW POINT OF ADJACENT 4�osuR`+ SAJI 1SIA81624MASS,* ROAD. SCALES 1 " DATE , 6/24/82 ZLDl4'EDGE ENGIN996190 CQ.INC�, MAiKe 1 CERTIFY THAT THE F�uwbA--n0W CLIENT SHOWN ON THIS PLAN IS LOCATED CIVIL LAND J09 �' EOISTERED REGISTERED A1I 119 ON THE GROUND AS INDICATED AND AND � ENGINEER SURVEYOR DR.BYs. .1 eE CONFORMS TO THE ZONING LAWS — OF BARN S TA kL E , JAI A S S.-Y, EXcEPr-AS 712 M A 1 N •s T R E ET H YA N R 1 S, MASS., SHEET!„OF 1 DATE 0. LAND SURVEYOR 1 w g 29874 0 MHcy Fcoop za.�� - N mot M.N.W. `T �y .33 -/, Yz uNDIe-(2 AD-) ESr 451 KI/F PAIL J • M i I,1 Ku5 Fi✓2 McIhj()MCwT Ail/L8 SC L l..` '58.11-7 EL O._= M.S.L. (p HYd do y L4o• \�� CIS �B ESE OF 3> S7.0 `r8� � 7'RVEM LN L S (�,Fl� NZ L -min O UG -�- -�_ mop of - Pole F nrr.��s f,o • LEGEND EXISTING SPOT ELEVATION 0,10 ltl N M.,SO D PLOT CLAN #ZXISTING CONTOUR --- 0 ----- o? ALBE �G FINISHED SPOT ELEVATION 90 r LOT 5F3 CLAMSN CovE QD t�DrLurT' FINISHED COWTOUR 0 �; ; M�RSE y P No.10951�O�Q IN APPR®1�Ed� l BOARD OF HEALTH � A9�,cFSSONALEL=vl�C'�� ����•��•��•!+�_J�� e' . DATE AGENT SCALES /" =1�- �+0• DATE� �4 Ju+ z'����-� ` DREDGE EAIQ/NEEJ�'ING C� lOV CLIENTrI,,,x p�� i CERTIFY THAT THE PROPOSED ESt ,LLW3. REGISTERED JOB NO, 1� BUILDING SHOWN ON THIS PLAN CIVIC. i LAND CONFORMS TO THE ZONING LAWS P DR•B'•M: J DD OF BARNSTA I.E MASS. ExC�pr -'? WAIN STREET cri. IIv o�>?�_!�!'? SNEETL OF DATE REG. LAND SURV9Y0It j As It ma and lot number .. �... . . . > .. ypF THE v os, OJT �vQ^ o Sewage Permit number .................................... ' SEPTIC , - SYSTEM MUST • ' STALLED 1N 'BaaaSTAI1LE, House number 4/.9..'.P........................................ 114 CO'MPLIAla roo "6 9 � ......................... WITH TITLE 5 �a 3 d`e TOWN OF BARAT coop ,. �l� c"IJECT TO AP. BUILDING INSPECT O R': T com MISS OERVAYI^,I APPLICATION FOR PERMIT TO ................ �-�fNT� O& ........ kgA-. '�'I ..........Q�' TYPE OF CONSTRUCTION ............I'..:1!�............................................................................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: information: Location ....... ` �...... '� Sfi�� i�J C�.4I ... j S- ..................................................�t. .. .......... ..................... Proposed Use 1 E.`f''fZ�'Q n'i ..... ..(�r�Sl D "��.- ................... ... .................. .................................................................................................................. Zoning District ................. ice.rr ......................... .. . . .//.....Fire District ......... Name of Owner •'Q ��.I I'L 3 (`(. PS t `fj'"J' .................�......... ........................�.................Address .....................................................p.............................. Name of Builder- . ,�!� 1 fi?e� ���O � � W . �d!�) A� Address ............................ zvvv- ...... ""1 � f. K7I t'.........................t. ...........................0 i Name of Architect Address ................. ....... �r Number of Rooms .................1.0..........................................Foundation ....... ....W"......W..9 .....5-. I\r(?......... Exierior .0.i.i 's..... .'..... ..............Roofing V C 1 � .....PI13A�3 ........................ .`.............'................. .. Floors �+ + ,'� Q D..............................................Interior �� f , -->> �. ..... ..&TT b....Heating �...... ..Plumbing ..... .... . ......... ................................... .................... Fireplace ....... . .... .. .....�;C( .... 3'.'' .................Approximate Cost ... .....(�� (.............. ............... [� 929 9�� ........... Definitive Plan Approved by Planning Board __ ?�-r -___________19___ _ . Area /.............. ........................ Diagram of Lot and Building with Dimensions (SSh AThNCIA �O P6071 PwN) Fee ........ ' StJBJECT TO APPROVAL OF BOARD OF HEALTH /ham 7/, a i i 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. Q� j Q Name . .. .C.,1.V�Cd ...... .... .1 "1`. ............... Heald, Priscilla No Permit for ......two„Stor r Y.. .......9� 1e..�;..Mil dwe�.l:t y... . 1 tag....................... Location ............ .QlaMbell..GQve..,RQaql.. .............................�A.1^tl]Z.................................... Owner ................Priscilla..HwId................. • Type of Construction ..........frame..................... .......................................................... ................. Plot ............................ Lot ...............#58.......... w. Permit Granted AVgu 19 82 Date of Inspection Date Completed ........?..... Assessor's map and lot number ./ - ='.. ......6 v r %TH E TD` c. Sewage Permit number ? Z BAR39TLZLE i House number ................... .......�`.P....................................... rasa °o s639• \� �'o war a• TOWN OF BARNSTABLE BUILDING INSPECTOR � Vim' kU APPLICATION FOR PERMIT TO ............... ................................................... ...... ...........:....::;............:............. TYPEOF CONSTRUCTION ............. � : ' .........................................................................................................::: ............. .. ....A......................19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following � information: Location .......... .�.. . .. ..??........... `� ��.� ......(D—M— ....( f.:.............:!-(V1 1 JM�.. . ..:............... Proposed Use ................................1 .................. : ....................................... . . .......:.............................................................................. Zoning District .................. ...................................... .Fire District ........ /l..f............................................ Name of Owner ............h . ........ i ,`.. �. .Address ................................................� ... � ` .. ��. Name of Builder" .I� .F :.... d. t.......................................�tAddress .... . .?. ....... `a.... ............................... �! !�v1 3M1T' �.{. Jf..........................f�...........................t. Name of Architect ..............:..................I. .................Address ................ ...... 4 S' ¢ Number of Rooms ................. ...........................................Foundation G i .....1tJ f C� Pf Exierior ........ ..... .....::r Roofing L � .....� °.1�1 ....................................................... ............. .................................................... Floors ! DOS P )D..............................................Interior ...1... U �V 1 �3 V 1 ... j ....... J Heating .. ..y...f. ' ...................Plumbing.... ........ . ....... ......... .. . .�. ..................... ........................................................ z Fireplace :............�?......�:�....... .................Approximate Cost .................I�..�.....`......................r............ ............. . 0 Definitive Plan Approved by Planning Board ___ -� __ I 25: - ---- 19 - Area �...� ...................... Diagram of Lot and Building with Dimensions r;S�4 A tA( A �O PUOj PkJAN) Fee ...�`. �. �..................... SUBJECT TO APPROVAL OF BOARD OF HEALTH o 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. t Name .. :.a. r?. ! . .: .... �r......(.°. ..b?: .�. ,,Heald, Priscilla A5-50 24321 Permit for .... ............ ...........s in..k l..e....family.dwelling................... Location ......1.90..C.l.amshell...Cove.. ..... . .... .. . ............... ........ ......... cotuit ............................................................................... Owner .......Priscilla. . . ..Hea.ld............................. . . ...... ....... .... Type of Construction .......frame..... ................................................................................ Plot ............................ Lot .........#5$................. Permit Granted ......Augu.s.t..26..............19 82 ..... . .. .... Date of Inspection .....................................119 Date Completed ..... ................................119 0/0 1111X3 I� 499 DELETE 505-531 I SKETCH VECTOR 1.7/00 500 V VACANT D DWELLING O OTHER , , L�fJi /j/o p A-ADDITION R-RIGHT C-COMMENCE.(PEN DOWN) L-LEFT NOTES: All ADDITIONS MUST Y HEIGHT i �(r',►/ ;;j�/;O BE STARTED FROM SAME 505 I0 I v ✓ w UUP X•XANGLES 20� 25 30 BEGINNING SOUTHWEST POINT. •- - y 37700 0-DOWN H•HALT)PEN UP) EXTERIOR WALLS i 1+ I506 �jRAME 4 BLOCK 7 STONE 701 _ 2 BRICK 5 STUCCO 8 ASBESTOS 1 I 702 -- 3 MAS &FR. 6 ALUM/VINYL 9 CONC I 703 -I-- -'-- -'-- -'-- -'-- -1-- -'-- -'-- -'-- -'-- STYLE 507 1 RAISED RANCW7'GWPE C00 ) GARRISON II —'—— -- 2 SPLIT-LEVEL 5 COLONIAL OLD 8 CONTEMP'Y 705 —I—— —r_— —I— — —r—— —+—— —+— — —:-- —+—— — 3 RANCH C 90LONIAL NEW 9 OTHER 706 AGE { , �D^d 707 —'—— —'—— —'—— —'—— —I— — —'—— —'—— —'—— —'— — —'— — 508 pp :REMODELED 19 708 —1—— —I-- —'— — --'-- —I-- —'-- —'— — —1-- —'—— —'— — ERECTED I�Q3 ___ 14 ��` � '. 1 709 - LIVING ACCOMMODATIONS 1/i TOTAL BED o 3 FAMILY O f. t 710 -'-- -'-- -'- - -1-- -'-- -t-- -'-- -'-- -'-- -'-- 509 ROOMS Q& ROOMS- - ROOMS- Jar t± -- -1-- -'-- -'- - -'-- /Q 711 -�-- —1—'- - -'-- --'-- -'--- FUII HALF ACDN'L TOTAL r I BATHS BATHS FIXT 1 FIXT L •• 1 $ 'i '' .. 712 --- -'-- -'-- -'-- -'-- -+-- -+-- -'-- -+- - - - Q KITCHEN 1370 BATHROOMAvAOD ' ,, '� ? ' ADDITIONS ' 510 r 511 t / T J / , Z - AOON CODE LWR iST 2NO 3R0 AREA AOON CODE LWR 1ST 2ND 3RO AREA YES YES cl, ' 512 1 7BASEMENT3 Z� �, 5`3 /�1` �N� �� 601 AT - - -- _ -- -t---- 605 A5 -- -- - - -- -1--- CRAWL PART i /1 T' , 602 A2 - - -- -- -- -I.--- 606 A6 I ?2"TING 3 .` l ti I 603 A3 - - -- --- - - -' 60'7 A7 - - -'- - NONE bmrc CENTRAL AIR CON - •�-t- - !. �� 604 A4 - -- —I--- 608 AB HEATING FUEL.IE 513 1 2 3 4 5 6 l • r ! REMODELING&MODERNIZATION DWELLING.COMPUTATIONS i NONE GAS ELECTRIC COAL SOLAR r EXTERIOR BATHROOM I 2 ff"TING SYSTEM TY aE 5 i b 1.2STORYJG INTERIOR PLUMBING G NONE WA R ELECTRIC HOT WATER STEAM - ADDITIONS ELECTRIC -IL v?SF ATTIC (,/�) KITCHEN HEATING BASE PRICE 514 noxf u"2 Pt3nn WtAprR tuutir+)wx )99 DELETE 801-810 OTHER BUILDING&YARD IMPROVEMENTS BASEMENT INTERIOR CONDITION RELATIVE TOEXT. TYPE CODE DUAN YEAR SIZE G CONO RATE BASE VALUE MA MOD CODES TRUE VALUE HEATING « 515 1 3 8[Il[R SAM POORER 801 PLUMBING # PHYSICAL CONDITION - �y 802 ATTIC + 516 1 2 4 5 6 7 --- -- - - --'-'--- - - -- FX CD FR PR VP UN 803 - ADDITIONS +� Z -- -- - - ---'--- - OTHER FEATURES +300 a OTHER FEATURES 804 SUBTOTAL b'y33O 520 1BRICK TRIM --I—I- - - — 805 --- -- - - ------ — — -- ---- 521 2STONE TRIM —I—I — --- ---' - - ------ — — -- --- - x GRADE FACTOR% t/_.3�j — 806 522 3RECROOM -=I-I- -- - --- --- - - ------ - - -- -- -- . x F,6 D FACTOR% 523 4 IN BSMT lIV AREA 1-I-- 801 __ __ __ __ ___ __ _ _ -r--- _ _ =BASE VALUE 524 5 WET FP: STACKS J OPENINGS z — S25 6 METALFPSTACKS — _ 810 MISCELLANEOUS IMPROVEMENTS —— —— x MARKET _ ADJUSTMENT 526 7 WOOD BURNER(CENTRAL) — GROSS BUILDING SUMMARY TOTAL VALUE =TRUE VALUE 527 8 BASEMENT GARAGE NO.CARS� — MARKET ADJUSTMENT 5I8 9 UNFIN AREA(-) --% - ID USE CONSTRUCTION GRADE ERECT REMOD CDU 511E RAIF BASE VALUE FHYS F/L CMPSI TRUE VALUE 529 10 HEATING AREA I-) I I I 530 GROUND FLOOR AREA GRADE I I I 531 FACTOR ;A A e c 0 t "� 800 I SEE DE1gILED LARD — TOTAL GROSS VALUE --I---+--_ 532 COST 6 DESIGN FACTOR __ ----- 2 St -------- ------- 533 .(;DU ; V CO AV FR PR VP UN= DATA COLLECTED BY DATE 2-7 83 961 -�A I A� ,Aw l ot�(fAlue- - Bonin�a �1 eu 7Fe.rtwn 1 I c I , r NUMBER SUFF. STREET NAME MAP PARCEL CARD NO. TOWN CLASS ROUTING NO.1 Fi03d 110 010 / 109 101 113 o o za R Record of Ownership & Mailing Address: Memorandum �I�f�i� 5 e-A Ua 75--80v/'' '3L _T- - a 1 tee bs,r eS - "Ie - a� F 15 O 901 902 35 Thrcc onC�s �1 d _ Twa a-1tder �/8�}-�u�e� a� 903 1�1 (and kCL . . u�c� 5e ,-:-1� 904 Zh`I F�ao� Last t r1 YY1 r Of d t e S'e G f-t ova l-.0.n d It r I r �8660 +�. x25 FRdNil- 04T14rOe.AL Cb_1cam& 50%131110q0 cui ,L�c183= SSZ40 - Neat- c W d SIB i J �rA z. - i a 3/800 ACRES ST.CLASS CO. LIVING UNITS FIRE DIST ZONING- MULTI NC - NEIGHBORHOOD 102 o1 103 0 0 / 108 -- `104 f� J[ ] 1 05 y 299 DELETE 300.330 LAND DATA,&COMPUTATIONS I SALES DATA 300 0 NONE ACTUAL EFFECTIVE EFFECTIVE ACTUAL UNIT PRICE DEPTH EFFECTIVE INFLUENCE FACTOR LAND VALUE MO YR TYPE AMOUNT SOURCE VALID 0 N FRONTAGE FRONTAGE DEPTH ---- FACTOR UNIT PRICE '301 LOT L -- -•.. - - - - - - -I - - - �. -- 200 1 REGULAR LOT c —— 201 2 MINUS LOT — _ If - 3 APARTMENT SITE L _ - -•- -.- - --- --I- --- -._- L J_-- 0 202 301 (WATERFRONT L - r �--° - - - -I--- --- - - - -•- --- --- - I- _-- -_L TYPE CODES VALIDITY CODES 310 10.FT. r 1 Land 0 Valid Sete 1 PRIMARY SITE S _- -i-_- -i - SO.FT. -- -�-- INFLUENCE FACTORS -- L --o° 2 Land 6 Building 1 I.-t-d Addn'I Parcel, 2 SECONDARY SITE - - L -- 3 Building 2 Nor Do-Markel 3 UNDEVELOPED I S i---1-- - SO.FT. -�._-- 1 UNIMPROVED 1 RESIDUAL -..._......,,.'-... SOURCE CODES 3 Related Alm s01. f 1 R-UrW Individu•4 or Corp. ]Ij 5 WATERFRONT 2 EXCESSIVE FRONT--- o,I 1 Buyer 5 Liouidation/Foreelowre S -i - --1- -- SO.FT. -- -•-- -- ° 315 ACREAGE - 3TOPOGRAPHY F 2 Saner B Fi Ind did E,rmdContract A _ _ ___-•- - JLCRES — --i--- -- L --i 3 Agee 7 1nNudar-Sea vPe.t Prop. 1 PRIMARY SITE 4 SHAPE OR SIZE 1 Other or Other-Sr Mwno 2 SECONDARY SITE A -•---ACRES .- --i--- 5 ECONOMIC -- � 106 ENTRANCE CODES INFO CODES 3 UNDEVELOPED MISIMPROVEMENT ( 1 4 MARSHLAND A -- ---•---ACRES _-.i--- 6 RESTRICTIONS- -- - --°° 0 ENTRANCE B SIGNATURE GAINED S CURRENT UNOCCUPIED 1 OWNER 5 WATERFRONT NONCONFORMING /'1 EyTRANCE GAINED 6 EST.FOR MISC.REASONS A - -•- _- -ACRES _- --,--- 7 CORNER/ALLEY 1+I -- - �� 9 DESIGNATED ( 2 NOT APPLICABLE.UNIMP PARCEL (SEE MEMO) 2 TENANT A -- -_-•---ACRES _.i--- g VIEW(+1 -- L -- 3 ENTRANCE A INFO REFUSED 7 OCCUPANT NOT AT HOME FOREST LAND( L 320 OPEN SPACE A -_-•- - -ACRE$ _ __ 1 l -I--- 4 ENTRANCE REFUSED,INFO AT DOOR 3 OTHER 325 0 TOTAL i4 _ -i---•---ACRES SUMMARY OF VALUES SIGNATURE BY OWNER OR AGENT BELOW INDICATES DATA ON THIS FORM WAS GROSS IRREGULAR LOT C• TOTAL VALUE LAND COLLECTED IN YOUR PRESENCE,IT DOES NOT MEAN THAT YOU HAVE VERIFIED 1 -- --I---'--- 770 2 SITE VALUE THE INFORMATION HEREON. 3 RESIDUAL TOTAL VALUE BUILDINGS 1 SITE B MINUS R.O.W. TOTAL VALUE LAND 3 BLOGS. .400 PROPERTY FACTORS DWELLING SET BACK MEMORANDUM l TOPOGRAPHY UTILITIES STREET OR ROAD MORE THAN 1 NBRHO.AVG. INSPECTION WITNESSED BY: LEVEL 1 ALL PUBLIC I PAYED I SAME AS 2 _ NBRHD.AVG. LESS THAN PROCESSING DATA ABOVE STREET 2 PUBLIC WATER 2 �' SEMI IMPROVED 2 NBRHD.AVG. 3 U BELOW STREET 3 PUBLIC SEWER 3 UNPAVED 3 NONE 4 DEL ADD CHG F/O No DAY YR I 2 3 4 ROLLING 4 GAS 4 PROPOSED 4 FRONTING TRAFFIC BUILDING PERMIT RECORD 1 2 ] 1 STEEP S WELL 5 CURB A GUTTER 5 LIGHT 1 DATE NUMBER PRICE PURPOSE 1 2 3 4 - LOW 6 SEPTIC 6 SIDEWALK 6 MEDIUM 2 1 2 3 4 - 1 SWAMPY 7 NONE 7 ALLEY 7 HEAVY 3 1 2 3 4 I MARSHY B NONE 187 NONE 4 ✓ / O /0 O o "R / BARNSTABLE,MASSACHUSETTS L 1 J "I CERTIFY THAT THIS PLAN CONFORMS TO THE RULES AND REGULATIONS OF THE REGISTERS OF DEEDS." ;DATE: JAN �20 10 CAPE& ISLANDS ENGINEERING 800 FALMOUTH ROAD, SUITE 301C MASHPEE, MA 02649 SHOESTRING BAY -2 8'x 12' � /�'o FLOAT �' -2— _ /• ti ` 3' x 18' RAMP LOCUS 9XMTING \ �� COTUIT QUADRANGLE -1 4' x 34'.P-IEk P ANTIS,GERALD A. & CAROL S. SP"P �p'G1� ,�(,p4 �� 12 176 CLAMSHELL COVE RD p p W,,,,�• P OTUIT, MA 02635 • MLA L�y ��` -'�O� O 1 SALT MARSH —�') Fti MxW EL.2.3 AL LO EL.2.8 y�j EXISTING T WIDE STAIRWAYS 0 & LANDINGS EXIS.TING.VERT. 12 LOG WALL TO BE REPLACED WITH C-LOCK VINYL OWNER/APPLICANT: WILLIAM PRESCOTT 190 CLAMSHELL COVE RD COTUIT, MA 02635 %VA OFDAVID A4q�9 yBJ, �� CyG LE N CKS • MIKUS, P RICIA L. 2808 C/O TSIHLIS, MES TR s SISTER 26 GLENBROO N. LLA Laraos° ARLINGTON, MA 0 74 . . . . . 20 Io 0 20 40 ELEVATIONS ARE BASED ON MLW SCALE: 1" =20' SHEET l OF 2 JAN.10,2010 PLAN TO AMEND LICENSE NO.10203 WILLIAM PRESCOTT TO REPLACE A VERTICAL LOG WALL WITH C-LOCK VINYL IN SHOESTRING BAY,BARNSTABLE, MA CAPE&ISLANDS ENGINEERING MASHPEE,MA "I CERTIFY THAT THIS PLAN CONFORMS TO THE RULES AND REGULATIONS OF THE REGISTERS OF DEEDS." DATE: JAN.10,2 CAPE &ISLANDS ENGINEERING 800 FALMOUTH ROAD, SUITE 301C MASHPEE, MA 02649 a --------------------------------------------------------------------------------------------------------------------------------------- ' PROPOSED WALL SECTION VINYL C-LOCK 3"X 6"WHALER HORIZONTAL PILE \�\ NOTE:NO HEAVY MACHINERY SHALL (DEADMAN) �� ��.. BE ALLOWED IN WORK AREA TIE ROD 36" MHW EL.2.3 SAND/LOAM MIXTURE EL.1.7-EL.3.0 - PLACED BY HAND ONLY =III=1 I=III 10' H OF,ya�_ cy GJ, DAVID '. CHAR g N • OBS • • AI LAN05�� 12" 0 1' 2' 3' 4' S' SCALE IN FEET • WILLIAM PRESCOTT CAPE & ISLANDS ENGINEERING SHEET 2 OF 2 JAN.10,2010 MASHPEE, MA ELEVATIONS ARE BASED ON MLW "I CERTIFY THAT THIS PLAN CONFORMS TO THE RULES AND REGULATIONS OF THE REGISTERS OF DEEDS." DATE: JAN , 2010 • s-- ------ - ----- CAPE & ISLANDS ENGINEERING 800 FALMOUTH ROAD, SUITE 301 C MASHPEE, MA 02649 SHOESTRING BAY -2 FLOOD 8'x 12' FLOAT / �/ moo Y x 18' RAMP LOCUS EXISTING � � \ � �� �' COTUIT QUADRANGLE 4'x 34',I'-fE�t ,�P ANTIS, GERALD A. & CAROL S. 12 176 CLAMSHELL COVE RD OTUIT, MA 02635 SALT MARSH LOG MKW EL.2.3 EL,2.8 EXISTING Y WIDE STAIRWAYS & LANDINGS EXISTING VERT. 12 LOG WALL TO BE REPLACED WITH C-LOCK VINYL OWNER/APPLICANT: WILLIAM PRESCOTT 190 CLAMSHELL COVE RD y COTUIT, MA 02635 %19 Of Mgs��cy c'�S�S�•� o� DAVID . " • 0� LES N CKI , MIKUS, P RICIA L. 2808 C/O TSIHI S, MES TR opci�ANUS��v�OQ 26 GLENBROO N. ARLINGTON, MA 0 74 . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . 20 . . . to . . . 2 40 ELEVATIONS ARE BASED ON MLW SCALE: 1" =20' SHEET I OF 2 JAN.10,2010 PLAN TO AMEND LICENSE NO.10203 WILLIAM PRESCOTT TO REPLACE A VERTICAL LOG WALL WITH C-LOCK VINYL IN SHOESTRING BAY, BARNSTABLE, MA CAPE&ISLANDS ENGINEERING MASHPEE,MA "I CERTIFY THAT THIS PLAN CONFORMS TO THE RULES AND REGULATIONS OF THE REGISTERS OF DEEDS.' DATE: JAN.1012 CAPE & ISLANDS ENGINEERING 800 FALMOUTH ROAD, SUITE 301C MASHPEE, MA 02649 e ------------------------------------------------------------------------------------------------------------ r PROPOSED WALL SECTION e VINYL C-LOCK f D Avov _ 3„X 6"WHALER HORIZONTAL PILE �\/\ NOTE:NO HEAVY MACHINERY SHALL AN] BE ALLOWED IN WORK AREA TIE ROD 36" MHW EL.2.3 EL.1.7-EL.3.0 SAND/LOAM MIXTURE PLACED BY HAND ONLY =III q I=III- 10' %IH Of Mgs�9c DAVIp CHAR S • 085 • AI LANDS�� 12 0 V 2 3 4 5 SCALE IN FEET WILLIAM PRESCOTT CAPE & ISLANDS ENGINEERING SHEET 2 OF 2 JAN.10,2010 MASHPEE, MA ELEVATIONS ARE BASED ON MLW /19^C.\Qjrf\S\^el I CLc>'4iL.\"h MYCOCK,KILROY,GREEN &MCLAUGHLIN,P.C. ATTORNEYS AT LAW 171 MAIN STREET Bernard T.Kilroy HYANNIS,MASSACHUSETTS 0260I of counsel Alan A.Green Area Code 617 Edwin S.Mycock Charles S.McLaughlin,Jr.77I-5070 Michael D.Ford Address all Mail Anita J-McCarthy Hyannis,Mass.0260I Refer to File" June 15,1982 Joseph DaLuz,Building Inspector Town of Barnstable Town Hall Hyannis,MA 02601 Re:Lot 58,Clamshell Cove Road Cotuit Coves Subdivision Dear Mr.DaLuz: I am writing to you with respect to the above mentioned lot and,more specifically,whether said lot is buildable for single family dwelling purposes under the provisions of the Town of Barnstable Zoning By-Law. My examination of the record title of this premises reveals that this lot has been in record ownership separate from adjoining land since April 13,1973.As you are aware, acre zoning became effective in this area of Cotuit in August of 1973 and therefore it is my opinion that this lot has unlimited life for single family dwelling purposes under the grandfather clause of the Barnstable Zoning By-Law,Section G, Subsection E. Very truly yours. Michael D.Ford MDF/vj June 15,1982 Attorney Michael Ford 171 Main Street Ityannis,MA 02601 RE:Xx)t #58,Clamshell Cove Road,Cotuit Dear Attorney Ford: I have reviewed lot #58 as shewn on a plan of land entitled "Plan of COTUIT CXNES -SectiOTi 3 -owned hy Allan &Edith Crawford" by Newell B.Snow dated June 1,1968. Your rcaeardi shows the property containing 26,170 square feet consistent with zoning prior to August 23, 1973 at "sMch time die zoning was changed to Residence F with a lot size requirement of 43,560 square feet.As you have shown,this lot is not contiguous and is therefore protected hy Section G,paragraph E of our zoning by-law. Subject to the approval of the Board of Health and possibly the approval of the Conservation Conmission this lot is buildable. Peace, JDD/gr Joseph D.DaLuz Building Conmissioner