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HomeMy WebLinkAbout0252 COTUIT BAY DRIVE Town of Barnstable Regulatory Services �Tt1E 1p� o Richard V. Scali,Director snx�vsr�sr.E. Building Division 7V1 1MASS. Tom Perry,Building Commissioner 'DTEp Mp1 A 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: Name: `/.e.n a 1 l'S`/ `s s� Phone#: Address: Z S2 �i.� ,r�Ji Village: Name of Business: ��4 -►C �`'��: ) Type of Business: C� S Map/Lot ���Sl 07 v INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no stoiage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pickup truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. , • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit I,the undersigned,have read and with the above restrictions for my home occupation I am registering. p, l z.o►5 Applicant I r""' Date: Homcoc.doc Rev.103113 YOU WISH TO OPEN A BUSINESS? For Your[Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) rixi :lY " �. DATE: Fill in please:" l' Py; w r:lfa w- � ,1 U� 'u APPLICANT'S YOUR NAME/S: �oN�1a G BUSINESS YOUR HOME ADDRESS: j s Z * C.•1%&: A . u Sir M. r r TELEPHONE # Home Telephone Number �— 4571 ,� � ItE :MR NAME OF CORPORATION: SS o��/N �►�S gZ.s�L9Z NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES ✓ NO C. ADDRESS OF BUSINESS 2- --:� \k•.ram m ` 4 MAP/PARCEL NUMBER (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. ,This form is intended to assist you in obtaining the information you-may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO MISSI ER'S OFFICE This individ al h e r infor a of y per it requirements that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION RULES ANUREGULATIONS• FAILURE_ TO Au or' d ig�atu * COMPLY MAY RESULT IN FINES. OM MENT l f a r� 2. BOARD OF EALTH This individual has b informed of th permit requirements that pertain to this type of business. Au ed Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature COMMENTS; TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a I DCOK � J Map Parcel _ Application # I Health Division Date Issued a Conservation Division Application Fee(A C-aci Planning Dept. Permit Fee �Z'06 Date Definitive Plan Approved by Planning Board CJ" Historic - OKH Preservation / Hyannis Project Street Address Village Lr�[U L Owner 12Ltasj Address e_,TL it Dit Telephone Permit Request l�_)—� c; l�!/Xc�. !1< . Zr�l�[,�L 2 K W/TN Square feet: 1 st floor: existing 90proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Zo_OM Construction Type Lot Size . 679 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0- Two Family ❑ Multi-Family (# units) Age of Existing Structure 35-11, Historic House: ❑Yes XNo On Old King's Highway: ❑Yes JD No Basement Type: Y3 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 100, Total Room Count (not including baths): existing new First Floor R` Count 7 -, Heat Type and Fuel: W Gas 0 Oil ❑ Electric ❑ Other Central Air: ❑Yes RNo Fireplaces: Existing New Existing wood/coal stove�l YELsi❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing 0 new size _ Barn: ❑ existing ❑`New s ze_ Attached garage: Wexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name R&&_ E,r— Telephone Number Address )V License # 3 Home Improvement Contractor# IDO7&P, Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE 4 • F o- s FOR,OFFICIAL USE ONLY APPLICATION# h f' DATE ISSUED = MAP/PARCEL NO. -' ADDRESS - VILLAGE f OWNER> t DATE OF INSPECTION: FOUNDATION FRAME r INSULATION FIREPLACE Y" ELECTRICAL: ROUGH ` FINAL' PLUMBING: ROUGH FINAL. - ,y GAS: ROUGH FINAL. �+ FINAL BUILDING G� ' DATE CLOSED.OUT ASSOCIATION PLAN NO. y The Commonwealth usetts of Massach Department of industrial�4ccidRSe Office ofbzvestigatians ents 600 Washington Street Boston MA OZIII Workers' Compensation www mass gov1k a P Insurance Affidavit: Stulders/Contractors/Electricians/plumbers Am Iicant Information Please Print Le I Name (Bu WdOrgmiz /lndividmd): �'1, Address: i 7 -—' City/s te/Zip: (-•b v i Phone #: SD$• (o�.aU S Are you an employer? Check the appropriate box: I.E&I am a employer with_� �4. ❑ I am a general contractor and I TfyPe of project(required): ��Y�(mil and/or part-time).* have hired the sub-contractors 6. ❑New constr=tion 2• I am a sole proprietor or partner- listed on the attached sheet ' ship and have no employees These sub-c Remodeling ontzuictors have ❑Demolition working for me in any capacm'• employees and have workers' 8. [No workers'comp, incLna„ce comp,insurance.# 9. ❑Building addition required-] 5• ❑ We are a corporation and its 10.❑Electrical repay or additions 3.❑ I am a homeowner doing all work off cers have exercised their myself [No workers' c 11.❑Plumbing repairs or additions omP• right of exemption per MGL instance required] t c. 152, §1(4), and we have no 12.0 Roof repairs emP�Y • [No work' 13.❑Other comp• nSurance required.] *Any appfioant that checks box#1 meat also fiD oat the section below showing their worker'compensation policy information t Hameowners who submit this affidavit indiostiog they are �Conhactois that check this box must attacbed as additional sheet aU worn and then hire outside coatractora must submit a new a�davrt indicating such. employees If the sub-contractors ban .ploy d y mast �D g name of the sib-conhaotnr;and state whether or not those entities have provide their worizrs'camp.policy anmber. I am an employer that is providing workers'compensaflon ursrcrance far my e mfO1 °n mPloYees. Below is theP°&cy and job site Insurance Company Name: Policy#or Self-ins,Lic. Expiration Date: Job Site Address:_ Lnti�T -fit City/S Attach a copy of the workers' compensation policy declaration page(showingtate/Zrp.�D�U( tom 3 Failure to secure coverage as requimd under.Section 25A of MGL c. 152 can lead to the�h�number and expiration data:), fine up to$1,500.00 and/or one-year imprisonment, as weIl as civil imposition of criminal penalties of a Of up to $250.00 a day against the violator. Be Penalties in the form of a STOP WORK ORDER and a fine Investigations advised that a copy of this statement may be forwarded to the Office of gations of the DIA for instira ne coverage veafication I do hereby certify under, ofP that the informaii°n Pravided above is true and correct Si Date: Phone# III iol Dfftcial use only. Do not write in this area to be completed by city,or town official City or Town: issuing Authority (circle one): Permrt/Ucense# L Board of Health 2.Building Department 3. 6. Other• City/T'own Clerk 4.Electrical Inspector 5.Plumbing Inspector Contact Person: Phone#: A� CERTIFICATE OF LIABILITY INSURANCE DA TE 9Ao"�Y"' 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). PRODUCER CONTACT NAME: G enn aniTnsumnce A 908 M an Sheet gency PHON c 08 28A194 aC No): 08 28-d068 E-MAIL ADDRESS: O st?"31h,M A 02655 COMER PRODUCER INSURERS AFFORDING COVERAGE NAIC q INSURED INSURER A: SAFETY INS CO PeterD Fieb PO Box 16 INSURER B: C Otui,M A 02635 INSURER C: INSURER D: AM Mutualms.Co. INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INR ADLTR TYPE OF INSURANCE DL SUBR POLICY NUMBER MMO/LDID PCY EFF YYYI MMIPOL DY EXP LIMITS A GENERAL LIABILITY CP00001803 9212010 9212012 EACH OCCURRENCE $ 1,000,000 x COMMERCIAL GENERAL LIABILITY DAMAGE (RENTED PREMISESS Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PROJEc- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ D WORKERS COMPENSATION W C 7023784012010 5A62011 5Q62012 WC OR LIMIT ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory In NH) E.L DISEASE-EA EMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) CERTIFICATE HOLDER CANCELLATION PETER D.FELD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ' AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Town of Barnstable Regulatory • >r+arrsr,�aca, • � ry Services �WASS Thomas F. iler, rector 639. Ge Di . Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Us' A.Builder as Owner of the subject ro _ l P .PAY hereby authorize to act on my behalf, in all matters relative to work authorized by'tbis building permit V( ( �lX �lljpt a-(o3 S (Address of ob) Pool fences and alarms are the responsibility of the applicant. are no to be filled before fence is installed and pools are not to be Pools utilize until ' inspections are performed and accepted. tur of O ignature of Ap cant ' Print Name Print Name Date WORMS:OWNERPBRMISSIONPOOLS �'IKE Town of Barnstable N Regulatory Services MASS , Thomas F.Geiler,Director ' ram 3:9.,��•� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-40 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit.to the,Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildine pemsit (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 mimmnm inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION �� The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware'that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a fomi/certification for use in your community. Q:forms:homeexempt 91te -Co ' Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration =; Registration: 120362 Type: DBA Expiration: 11/30/2013 Tr# 217622 PETER FIELD BUILDING & RESTORATION PETER FIELD P. O. BOX 16 COTUIT, MA 02635 { l� f, Update Address and return card.Mark reason for change. -- Address Renewal Employment Lost Card DPS-CAI is 50M-04f04G101216 � �`° (oarxmcoryuuea ./l4dalkoe.% License or registration valid for individul use onl Office of Consumer Affairs&Business Regulation g y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - Registration: -1.20362 Type: Office of Consumer Affairs and Business Regulation Expiration: 1-1/30/2013 DBA 10 Park Plaza-Suite 5170 ==-_= _= Boston,MA 02116 PETER FIELD BUILDING:&'RES.TORATION PETER FIELD W_ 857 MAIN ST. COTUIT,MA 02635 Undersecretary Not valid with t signatu Massachusetts- Department of Public Safety Board of Building, Re,mlatiuns an11 St:l (I is Construction Supervisor License One-and Two-Family Dwellings License: CS 65638 PETER D FIELD PO BOX 16 COTUIT, MA 02635 Expiration: 7/1512013 ('uumis.i mrr Tr`f: 1300 oq Z � m 0 4 � EXISTING STRUCTURE j N J ' 14--0" +/- N i Z z N ow J `o 4 ¢ W E 3 � 0 � Q HALF P05T5 AT GONNEGTION I n m p TO EXISTING HOUSE. Z 10 Q E i 4 IX4 MAHOG.DECKING. R.G.PO5T5 AND RAILINGS �y s Q K/DECORATIVE GAPS. (SEE DETAIL) lu DNlbdi z O a V V Q V 4 d.4 IIpJ.D,2GI wb , AS NO m DECK PLAN OPTION #1 d'� : '"" R.G.RAILING SYSTEM o NV DECORATIVE GAPS N a, 4 0 1 � J , I 0 « $ HALF POST AT N HOUSE WALL z pW m �. IX4 MAHOG.DECKING ON c 2X815 @ 16"O.G. 115I5TERED" c TO EXISTING 2XV5® Ib" O.G. t Q7 P.T.2XIO'5® Ib" O.G. ATTACH LEDGER TO W E EXISTING HOUSE USING 3 GALVANIZED JOIST ALUMINUM OR PVC I HURRIGAN CLIPS HANGERS AT ALL STAND-OFFS AND 0 i CONNECTIONS TO LAG BOLTS AS REQUIRED 0: o LEDGERS 8 RIM Q E c ATTACH BEAMS TO BOARDS(TYPICAL) POSTS W/GALVANIZED its OR 5TAINLE55 STEEL (2) P.T.2XI2 GIRT CARRIAGE THRU-BOLTS � 8 g (TYPICAL) 13, a e AT P.T.4X4 POSTS Nt/ W AT TACH POSTS RAILING ALUM.STAND-OFFS PER CODE CARRIAGE BOLTS TO RIM BOARD p Q a 5 REQUIRED _ 10" GONG. RETAINING WALL 0 --�-• ON 20 X 12 GONG. FOOTING SYSTEM PER CODE Q m V o S 0TI0N / DETAIL J�w IIII S C A L E : I / 2 = 1 ' - O " db4 Nw.O,wil �.. : A9 NO dam PAN A-3 r v L/ C. Lot ;oo 49 3aIt rp ' - ` r �' ��• �.9C apt,.. . ''" wr� OD 10 341 -3s : OAgy.- v Loy17 =a CERTIFIED PLOT PLAIT:,. � 9.3 C' fu�t '� Sf7�rt°Sou NEW CONSTRUCTION ONLY : - TOP OF FOUNDATION IS FEET IN ABOVE LOW POINT OF ADJACENT ROAD. t J SCALE: 1 40 ' DATE, 11117f7�_ r; DR0'9E PAI- COL lNcjCLIENT t• �Pr I CERTIFY THAT THE�oun SHOWN ON THIS PLAN IS LOC-ATED- E®ISTERED REGISTERED JOB NO. ''3 ON THE GROUND AS INDICATE®�A<l0 CIVIL I LAND CONFORMS TO .THE ZONING .LAWS' . ENGINEER (SURVEYORrVDR-.BYt CAT ' _ _ ' OF BARNST BLE., MASS 33 NO. MAIN ST 712 MAIN ST. CH.BY= SO. YARMOUTH MASS. ' HYANNIS MASS. r . SHEETrLOF� DATE RES. LAND SUFi� ." Town of Barnstable *Permit# Expires 6 months from issue date pfRTAVIulatory Services Fee ����� Thomas F.Geiler,Director - SEP 2 2 2006 Building Division R� AB�CBO, Building Commissioner �ON1N OF BA 200 Main Street,Hyannis,MA 02601 Y www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address LjgA JtqQl esidential Value of Work Minimum fee of$25.00 for'work under$6000.00. Owner's Name&Address Contractor's Name I-h LqFpJ Telephone Number ti E31 HomelImprovement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor the Homeowner have Worker's Compensation Insurance c� Insurance Company Name � I Workman's Comp.Policy# CD Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side eplacement Windows/doors/sliders. U-Value �3 S� (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must si Property Owner Letter of Permission. A co 02 Ho rovement Contractors License is required. t SIGNATURE: Q:Forms:expmtrg Revise061306 Department of Industrial Accidents Office of Investigations ' d 600 Washington Street Boston, AM 02111 `�M y�•J www.mass.gov/dia Workers' Compensation Insurance Affidavit_: Builders/Contractors/Electricians/Plumbers _ applicant Information Please Print Legibly dame (Business/Organization/Individuai): LAD kddress: 02 -ity/State/Zip: n C1 3 La3219 Pone #: re yo employer? Check the-appropriate box:. Type of project(required): I am a employer wit () 4. ❑ I am a general contractor and I h. �— 6. ❑ New construction employees (full and/or part-time).` have hired the sub-contractors I am a sole proprietor or partner- listed on the attached sheet El Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9• ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.) - I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] !y applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: `• )meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. man employer that is providing workers'compensation insurance for my employees. Below is the policy and job site ormation. urance Company Name: (� CD icy#or Self-ins.Lic. #: CP(0� ��� Expiration Date: -41 Site Address: City/State/Zip:���t�j06(� :ach a copy of the workers' compensation policy claration page(showing the policy number and expiration date). lure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 " ip to$250.00 a day against the violator. Be advised that a-copy of this statement maybe forwarded to the Office of -estigations of the DIA for insurance coverage verification. 9 hereby certify under t e p i an pen !ties of perjury that the information provided above is rue and correct ature: Dater me#: You Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town.Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#.: Information and Instructions [assachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. ursuant to this statute; an employee is defined as"...every person in the service of another under any contract of hire, cpress or implied,oral or written." _ n employer is defined as"an individual,partnership, association, corporation or other legal entity,or any two or more f the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the ;ceiver or trustee of an individual,partnership, association or other legal entity,employing employees. However-the wner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the welling house of another who employs persons to do maintenance, construction or repair woik on such dwelling house thereto shall not because of such employment be deemed to be an employer." r on the grounds or building appurtenant .IGL chapter-152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or enewal of a license or permit to operate a business or to construct buildings in the commonwealth for any ,pplicant 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 Inter into any contract for the performance of public work until acceptable evidence of compliance with the insurance equirements of this chapter have been presented to the contracting authority." kPPlicants ?lease fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if iecessary, supply sub-contractor(s)naine(s), address(es)and phone numbers) along with their certificate(s)of nsurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the nembers or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have -,niployees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of [ndustrial 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. Anew affidavit must be filled out each . year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and.fax number: The Commonwealth of Massachusetts . Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston, MA 02111. Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 ;wised 5-26-05 www.mass.gov/dia r �oF ►�,, Town of Barnstable do P Regulatory Services snxx S � Thomas F. Geiler,Director 0 96;. & Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: uLA (Address of Job) �VI 1�1 G r Signature of Owner Dad u Print Name Q:FORM&OWNERPERMISSION /a _ ��ie '[�om�mzarecuea� a�,/�aaoac`ivaek'a q.. Board.of Building Regulations and Standards HOME I"ROVEMENT CONTRACTOR Registrations 126893 AT"pe S f r lement Card THE Home Dep o MCHARD FALLON 3200 COBS GALLERVA-- #20 G�� AtIANTA,.GA 30339 Administrator ' r 07 7. CH r tis l;� j ?WWW mA.h D S J CardVI th Grid3 1-300-746-6686 RES 97 ENERGY PERFORMANCE RATINGS U-Factor(U.SJi-P) Solar Heat Gain Coefficient 0 . 35 0 . 26 ADDITIONAL PERFORMANCE RATINGS visible Transmittance • 0 ..4.3 mvd&-uw*Jft Met Mtew r4V aorta.,to aXOmble NAIC procedraaa W iftmkft while peodast perfar rw a.NFW radegS are ditMUW W a Pond Id of enhau WW eooOWN aril a �ndlle product rtra.CanwR merafiacaaeh UteraLua Ibr atnet product perhrmerKe Udometlati . Ile www.nhc.orq EWAGY SEAR Uuit qualifies for 6nar47 Star Region(s): Nacthecri, Nacth I: Ceneral, South Central, I` 0 Southern. r DP; +25/-25 Ito: Rg�g�>!o�9Y eg-Ras sorder 0:3885118090001 50375 AS i.. i. r • Baud of UOIdiig Rc;ulatiyn.1 rl;d Stands r. HOME IMPROVEMENT CONTRACTOR -Re istratiori: 126893 f Expiratbii_(3l2006 _S_upplement G-Ord THE Home Oepot..At-Ciome:Setvic I (2fCHARD FALL 3200 COBB GALLERIA° 120 �p T �%,,,.'' ° .SS`3 C'° "' `a .tte�'� rK^ ','w.si?f' `�',z� MAR a ■irl '� �'3s, .. $ � ?`i, (f I C Et; 'I. :/► CERTIFICATE NUMBER , a CERT f- Al' OAF NSURA, -E r �Ivacaz~ _EC. <� s..s ATL 000915907-11 PRODUCER a FNO CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MARSH USA,INC. IGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE ATTN:BRENDA BOOKER (404)995-2594 CY.THIS CERTIFICATE DOES NOT AMEND,EXTEND CR ALTER THE COVERAGE MAYA MCCLURE(404)995-3206 OR: RDED BY THE POLICIES DESCRIBED HEREIN. TAMI ROUSE(404)995-3430 FAX(404)760-5663 COMPANIES AFFORDING COVERAGE 3475 PIEDMONT ROAD,SUITE 1200 ...... ._...:......_.... . .... . ATLANTA,GA 30305 COMPANY ' 100492-IPUSA-GWA-03/04 A STEADFAST INSURANCE COMPANY, INSURED COMPANY - - THD AT-HOME SERVICES INC. B ZURICH AMERICAN INSURANCE COMPANY DBA THE HOME DEPOT AT-HOME SERVICES,INC. . HOME DEPOT USA,INC. COMPANY ; 2455 PACES FERRY ROAD NW C NEW HAMPSHIRE INS COMPANY BUILDING C-8 ATLANTA,GA 30339 COMPANY ' �- -- D--AMERICAN-f-1GME-ASSURANCE-COMPANY . .. ...., ...:, * �-. 'i:a v' n;p.a cfar,�..:Sxr 2n?:.�:X �,...«: r S`?'m.'„". '^k t F;:.�sr,.. :.�-Y<..''. t-s .,:d',"s.: *•.,.i.r S �,;.._ Li v het .X , COVERAGES r wx w Tlils.cerftfcatesupersedes and replaces any,grevlouslywissuetl cent(feaie for the,;pollcyppenod:n_otedrbelow _3 a),.,, THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY - PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION - ,LIMITS LTR _ DATE(MMIDDIYY)'1 DATE(MMIDDIYY) A GENERAL LIABILITY IPR 3757 608-01 03/01/06 03/01/07 GENERAL AGGREGATE $ 4,000,000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' PRODUCTS-COMP/OP AGG $ 4,000,000 CLAIMS MADE a OCCUR 'OF SIR:$1,000,000 PER OCC' '" PERSONAL&ADV INJURY $ 4,000,000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 4,000,000 FIRE DAMAGE(Any one fire) $ 1,000,000 MED EXP(Any one person)' $ EXCLUDED B AUTOMOBILE LIABILITY BAP 2938863 03 AOS 03/01/06 03/01/07 COMBINED SINGLE LIMIT -'$ 1,000,000 X ANY AUTO - -- ALL OWNED AUTOS ( BODILY INJURY $' SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNEDAUTOS - (Per accident) X ELF-INSURED AUTO PRBPERTYDAMAGE PHYSICAL DAMAGE $ GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT $ " ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ ' EXCESS LIABILITY - EACH OCCURRENCE $ UMBRELLA FORM _ AGGREGATE $ OTHER THAN UMBRELLA FORM $ G WORKERS COMPENSATION AND 6610998(AZ,ID,MD,VA) 03/01/06 03/01/07 X ORY LIMITS ER EMPLOYERS'LIABILITY C 6610995(AOS) 03/01/06 ' O3/Ol/07 EL EACH ACCIDENT . $ 1,000,000 G THE PROPRIETOR/ X INCL 6611326(OR) 03/01/06 03/01/07 EL DISEASE-POLICY LIMIT $ 1.000,000 PARTNERS/EXECUTIVE E 6610999NY,WI OFFICERS ARE: EXCL ( ) 03/01/06 03/01/07 EL DISEASE-EACH EMPLOYEE $ 1,000,000 OTHER WORKERS `NT E . COMPENSATION CONTINUED 6610997'(FL) 03/01/06 03/01/07 D 16610996(CA) ' 03/01/06 03/01/07 'DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS CERTIFfCATEk�HOLDER " �CANCELlA1,10N ') � " SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, , _ THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30-DAYS WRITTEN NOTICE TO THE 'FOR INSURANCE PURPOSES ONLY CERTIFICATE HOLDER NAMEDHEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR " - LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES,OR THE ISSUER OF THIS CERTIFICATE.. ' MARSH USA INC: BY: Walter Glstra �. M1(3102 « AS 02/27%06 ^c:. 'z�itYRwv�,% i � ,. 3 <a� .,:.'�,s,a WE . �.s'x VALID Dantla Mahot 7743230034 p. 4 HOME IMPROVEMENT CONTRACT y Sold, FLrrrtlished and Installed by: Branch Name: $IflN Date: D6 THD At-Home Services,Inc. d/b/a The Horne:Depot At-Horne Services h, ,> 345A Greenwood Street.Worcester, MA 01607 Branch Number: 'Tst03) Job#: ,?G7�Id`3. Toll Free (800) 657-5182; Fax: 508-756-2859 Federal ID 0 75-Z698460 ME Lie II C 02439 Rf Cont.Lic#16427 CT L.ic i!565522: MA Hnme,Improvement Contractor Reg.#126893 Installation Address: lam[Vi+ V1 Vk_ City State Zip Purchasers: Last 4 Digits.of Dr'ver's Lic.9&Exp.Mo/Yr: York Phone: Horne Phone: '3NN;�- HvU ('4 M-379) 1 (5499}3-57 9 Flo Home Address: QA (If different from Installation Address) City State Zip E-mail Address(to receive updates and promotions from The Home Depot):NIA Protect Information: I/We/You ("Purchaser"), the owners of the pro) located at the above installation address, offer to contract with Home Depot U.S.A., Inc. ("Home De of") m furnish, deliver and arrange. for the installation of all materials as described on the attached Spec Sheet# W 1 5, incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if, upon re-inspection of the job, Ilome Depot determines that it cannot perform its obligations due to a structural problem with the home, pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract. DEPOSIT PAYMENT OPTIONS (Subject lu fund verification an(!or credit approval.) 1. Check,Cashiers Check or US Postal Service Money Order CONTRACT AMOUNT $ (A4ade payable is The Home Depot). *LESS DEPOSIT $ D 2. Credii Car(]`and./Or or her payment options Circle One Below Visa 1astcrCar( Disrovcr American Express BALANCE DUE q p The Home Depot Horne.Improvemeni Loan The I•lorne Depot Credit Card ON COMPLETION S I b D -1 New Account `"I Existing Account (1111.&HDCC ONLY) *Minimum 25%of Contract Amount due upon Available Credit:ti )U y execution of this contract Aeclll:5y % b��=, Y��.7) r_xp.hare: Name as it appears on card: Spv"L� Indicate Payment Method For +By my/our signature:below. I/We agree to allow [-Lome Depot to BALANCE DUE ON COMPLETION: ch e the abn c: rcluen d credit card for the deposit indicated. CC MC ! er s Sign;' ere —Dale -- 1111. or HDCC Authorization Codes Deposit Final Payment # # Purchaser agrees that, immediately upon completion of the work. Pnre:haser will execute a Cnmpledrin C:crtificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable herelutder. Entire Alareement: This agreement and its attachments, including any financing; agreement, contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely felled-in copy of the contract at the time you sign. Keep it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law prohibits home repair contractors from requesting or acceptim;a Completion Certificate signed by the owner prior to tire actual completion of the work to be performed under the-contract. You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There will be a service charge equal to 25%, of the contract amount if the job is cancelled by Purchaser AFTER the third business day. ' BY MY/OUR SIGNATURE BELOW, IIWE AGREE TO BE BOUND BY •l'I-IF TERMS OF THIS CONTRACT. IAVE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPI.F.TED COPIES OF TI-l.F NOTICE OF CANCELLATION. BY MY/OUR SIGNATURE BELOW, UWE UNDERSTAND THAT TI IL{ AGRFEMENT IS SUBJECT TO REVIEW OF Assessor's map and lot number ' ' " "'""""' y�,(��� ��'� — 7� SEPTIC SYSTEM MUST BE - y Sewa a Permit number ...... . . . ...... INSTALLED IN COMPLIANCE g WITH 1`+"1,TI LE If S7._"TE `t ' SANITARY CO E '�D TOWN °`T"ET°�♦ TOWN OF BARNSTLAB BASBSTOALE, • _ G "6 9 BUILUNG INSPECTOR 0 Yar'' APPLICATION FOR PERMIT TO ................ .. ... .K............ .. .............. ................................................. TYPEOF CONSTRUCTION .:........................................ ............. .. .............. ...................................................... • ........... ...................1 %.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: f. Location ............4f1 .. .......... ...... V19I.4 ............... !(1. l l.T................................................. Proposed Use .......kfld14 ......... L ZoningDistrict .....................................Fire District .........................:.................................................... Name of Owner �ry��,,.� it lw T��!....�ef�£GT.y..T.f� T�.Address .�iG.�!.,jr' , I!�sCr..l��pf�.... F ., lew. Name of. Builder /i�ei .? ...t49i ..../r?�'G�..................Address �lz��..C��X / ../..�. .... � 4�s Nameof Architect ...........h'1-.44.Z.........................................Address ..............:..................................................................... Number of Rooms .............•q ........................... ............................................Foundation G'DYE. 4� ................................................... •fir• . Exterior ....Ci. tYJ°13..P,01-.t�•./�5..........................................Roofing ..,yfi ......?!1/!G',l, if............................... Floors %l4C...!'K{.���!/ati.E�G:JE'....--..C1F,/4rlI T.........................Interior .� /i//941..... r ®/!ri7 .. �ylFS.7 /�.............. Heating .. .....'..P/..�................... .......Plumbing Fireplace ....... ."'.1J/Fah'....................................................Approximate Cost ... ...............�.................. Definitive Plan Approved by Planning Board -------------------_-----------,19_______ . Area �.Q.. Q.. ..... Z� Od................. Diagram of Lot and Building with Dimensions Fee .........- m......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 6 /01v� I hereby agree to conform to all the Rules and Regulations of the Town-,of, Barnstable regardin the above construction. ES, ' Name . b...t. �. RIT}:;. ........ . ........ Y "" P R E S r-.r.;1T, ----- ._---- --_--, ----- ' ' 18032 .- � s le family dwelling r . ' -yr---'------______________..P-Co . , ' toi% Bay Drive ' Locatiorp?............................................................. ^,' Cmtmit -----------------.--------.� ' ~ . 0mtw�t~Wemtmn Rmmlty Tromt Owner ------_________ . . .' --.. -.. - frame Type of Construction -------------- '_..--------------------. --- p #93Plot --------.�' Lot ----------' � ' November 24 76 ' � Permit Granted -------------]g � ' . Date of Inspection ------------lg - Date Completed . -----lg ' . °' . ^ . PERMIT REFUSED . . '^ ' -l� ----. _..'-------------_ ------------------.'------.. r ............................. ........................ ' ..--.------.—.~-------.------ ' ' ~ ------------.-.-----..-----,... . , . . Approved ''--------------- lA ----._--^-----........................................ -------��------------.---...- . ` . . ` y � } 11� ; l 4q a T �9 r _0 l N CERTIFIED PLOT PLAN:-- i ! > �c,V93 C" S//OrC9�oo ui NEW CONSTRUCTION ONLY TOP OF FOUNDATION IS FEET IN ABOVE .LOW POINT OF ADJACENT ROAD. SCALES I �a ' DATE, 11)J7l7�` r ' L L2906E ENG/NEERI/VQ COl NV I CERTIFY THAT THE CLIENT p' SHOWN ON THIS PLAN IS LOCATE! , ®19TEKED REGISTERED � JOB NO. �'3 ON THE GROUND AS INDICATE®'Al26r .; CIVIL I LAND CONFORMS 'TO .THE ZONING .LAVI9' ENGINEER SURVEYOR DR.BY:. C AT '. _ OF ®ARNST ®LE., BASS 33 NO. MAIN ST 712 MAIN ST. CH.®Y= `' ?Ape., SO. YARMOUTH, MASS. HYANNIS, MASS. SHEET.I OF,_I DATE RES. LAND SU Assessor's ma and lot number r Vic. �..�.. . .......... 7J �.Epr�� a p _ ✓r ll�i�� SYETE �I �1ALLEi� ; Acop,-,- g.E tt.tt= ►� Sewage Permit number /�! .............................. SA^ITA Y •'- STAIZ R�aI�fLATI ram. APO °Ft"E.T TOWN OF BARNSTABL" "� � � ' i BARNSTADLE, i 0 1639. ,e�0 BUILDING INSPECTOR 0 M APPLICATION FOR PERMIT TO ..�t?/.1.!.XVl. !0.AV...S/iV.Qh F/�Miy/{/.•Dh!,E,�C%N�..... TYPE OF CONSTRUCTION ............................ ....... ' ....5,/.....................19.2 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according ,to the following information: Location ............................�....Gr.. ©S: Of2/il�.... ...! ...�k/dE..................................................................................... Proposed Use ........................................... ............................................... ........... . ..... . .......................................................... r Zoning District ..........................................Fire District r... ....o�`?!j............................................... Name of Owner C07Z//T„p9`! Sflp ! S �it/e . Address p� �.2p� �!y .................... 15, Nameof Builder ............... ....... ........... ... .......Address ........ 7.y................................................ Name of Architect .......... !.'Q!v.. :.. ./FF/Al................Address ........ 2d7ff.................................................. Numberof Rooms ...........7....................................................Foundation ...................J ...Como,........................ �!iy����...:F CgPdpRp FS Exierior S ....................Roofing H�..............................................Interior ....................... �?!! i44. Floors ...................................... ........................................ Heating ........................... ..............................................Plumbing ................... �. Fireplace ..............................�..................................................Approximate Cost .......*� .............................. Definitive Plan Approved by Planning Board ___ 6f_-----------19S___. A Area ........' ........ Q .Fee .................. Diagram of Lot and Building with Dimensions G,[ . ./.... .................... SUBJECT TO APPROVAL OF BOARD OF HEALTH /3/.96' - !!! LOT 105 f m i 35� � ao1 ' � q,0 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction._..._ _. .__ Name ^...,. :...... ...... .....y................................... Cotuit Bay Shores, Inc. 17723 No . ........... Permit for .....one.........s.....to, .......... single family dwelling ............................................................................... C LocationZ�50I otuit Bay Drive ................................................................ Cotuit ............................................................................... Owner ............Cotuit Bay Shcms, Inc. ....................................................... Type of Construction frame ......................................... 7 ................................................................................. #105 Plot ............................ Lot ................................ Permit Granted *................ ..Ju...n..................19e 3 75 Date of Inspection ... .... 479pr Date Completed . ......................... . PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ............. 0 Approved .............................................. 19 . ................ .............................................................. ........................... ............ ..................... ................. l� 1 � ' *�:-.s �' .t : .t ,t,•Yr r ,. ��,`n�' �4€T�,,7`'•ja n�fi 7tir�� rkk .- �'. �t 1 0 : � )5 ty R 3• y \l � •� � .�'� ;fir;:, t� �~ 7 y r �ri"`-C„iC��\F1' � � ,• � .• �`{ •�`� �+��■ Lot 1(/Y W•'v� BO'I r6 ,;;'r1 cv {� r' (� * 4 r r iL g 'r' • j, QM2 6 M4 O� i, ��,,t,/ fjan .,�.: � ;, a' e t �, e, F � u ,14 � \ C6\.�\�� ��10\ \y!� �OC\Ui1C1 \1 \2 \ CO\6C!� .. t r r•,• � �, ��g�g�� + % �t'S�'F ��' "�, al M �V OLD /AD3T 204D ' c o FUI T as Y Di�/�/� �40 ' wide) f'f•t t t y ' r w� 1102 II a;s FC 's '�.�•.. / ced/ify that the foundo ' n is/ noted i L O;T PL AN �Y} as shown on this plan and con�fe e�c`'' Zoning By Lows of the Taf wn of rib` �9 \<�� L 0 I 105 4 y��p _: y�� r fV Y SHORES GRETE /N � r Doti.r�rvory _ y- CQTUI T ; BAR STABL Dote Z /975j,k �f do Sco/e ✓ = i d /975 ' ? / 4 sTe y ARC/A•HANACK• All HARD ENGINEERING CORP. i r ✓oe 4P 74=io a �, h New Bedford, Bornstob B North Pembroke, Mass. f