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0113 WEST BAY ROAD
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I^+ �. ....r ^ � .r!.�^ .. .. ,..,...�r�n!u.�!cry'T.�r�Aw-��mm» �--•,•wr!�ew.ew..w.+....�"'a9ze ,. ,.�.+�+�'�4. .,.+�A�.....�n.-�.�.rr..r......�,.w.... _ -�--- - ,os=__:,..,_,,'J'r+i,�•,w.�..»..}..d.....�-�.1�.,.`'`. �WE Town of Barnstable �JE`opA? o Planning& Development Department Barnstable Historical Commission NG Q� z •..� 3 sn[txSTAZ.E, + 200 Main Street,Hyannis,Massachusetts 02 160 " g 13¢ `� (508)862-4787 Fax(508)862-4784 1020 roe 'OrFp .lA erin.logan@town.barnstable.ma.us SEQ '$ Commission Members Nancy Clark,Chair Nancy Shoemaker,Vice Chair Marilyn Fifield,Clerk George Jessop,AIA Elizabeth Mumford Cheryl Powell Frances Parks Jack Kay,Alternate N O N OD M DECISION N Summary: Demolition Delay Not Imposed Pursuant to Chapter 112 Historic Prgp„grties, Section 112-3 F Applicant/Property Owner: Lai,Christopher&Shaunna Subject Property: 113 West Bay Road,Osterville Assessor's Map/Parcel: 116/032/000 Hearing Date: August 18,2020 Pursuant to the Barnstable Historical Commission receiving your notice of intent on July 27,2020,a duly advertised and noticed public hearing was held on August 18, 2020 to determine whether the significant structure identified as a single family home on this property is a preferably preserved significant building and whether demolition delay would be imposed for the partial demolition of the structure on the parcel addressed as 113 West Bay Road, Osterville. After review and consideration of public testimony, application and record file, the Commission by a unanimous vote in favor found that in accordance with Chapter 112F the partial demolition of the single family structure is not a preferably preserved significant building. In accordance with Chapter 112-3 F, the Commission determined, by a unanimous vote in favor found that the partial demolition of the single family structure would not be detrimental to the historical,cultural or architectural heritage or resources of the Town. Further the applicant has agreed to revise the plans to reflect matching front and rear gable ends. Final plans are subject to review by Commissioner Jessop before proceeding with building permit sign off. This decision applies only to the demolition described in the notice of intent submitted on July 27,2020. No future demolition shall be permitted without application and approval from the Barnstable Historical Commission. Nancy Shoemake4 Vice Chair Date cc: Brian Florence,Building Commissioner Ann Quirk,Town Clerk Planning&Development Department-Elizabeth Jenkins,Director;Paul Wackrow,Senior Planner; Erin Logan,Administrative Assistant-200 Main Street,Hyannis,MA 02601 gAR:NSTABLE TOWN CLERK Town of Barnstable Planning Et Development Department * . Barnstable Historical Commission 20 JUL 30 P t, 50 BARNSPABM : 200 Main Street, Hyannis, Massachusetts 02601 M"S& (508) 862-4787 Fax (508) 862-4784 s` erin.lopan@town.barnstable.ma.us Commission Members Nancy Clark,Chair Nancy Shoemaker,Vice Chair Marilyn Fifield,Clerk George Jessop,AIA Elizabeth Mumford Cheryl Powell Frances Parks Jack Kay,Alternate July 29, 2020 BUILDING DEPT. AUG 0 6 2020 Re: Notice of Intent to Demolish Structure Et: Relocate 113 West Bay Road, Ostervitle, Map 116, Parcel 032/000;OWN OF BARNSTABLE Cotuit Bay Design c/o Steve Cook 43 Brewster Road Mashpee, MA 02649 Ann Quick, Town Clerk 367 Main Street, Hyannis, MA 02601 Brian Florence, Building Commissioner 200 Main Street, Hyannis, MA 02601 Pursuant to the attached decision, please be advised that the Barnstable Historical Commission will hold a public hearing on the partial demolition of the single family structure on March 17, 2020 at 4:00pm, and will be held by remote participation methods as a result of the COVID-19 state of emergency in the Commonwealth of Massachusetts. This public hearing will be advertised, notices sent to abutters and a notice form will be posted on the building or other visible site on the property. Please contact Erin Logan at 508.862.4787 or erin.top an@town.barnstabte.ma.us for processing information. Sincerely, " Nancy Shoemaker, Vice Chair Ak MMS&rkYdQFMWt P -Etiz Datt f@nkiu� Erin 1-4p%Adxniniaratiee Aistant-ZM fain Sbwt Ry=Ws�Mtn WAI OFIME tp� Town of Barnstable �JEvoPMf qo Planning& Development Department �� P10 Barnstable Historical Commission = * BARNSTS. 93. * 200 Main Street, Hyannis, Massachusetts 02601 9 MA0 s63q. �� (508)862-4787 Fax(508)862-4784 'oy, 0,`` ArFO MA'S° erin.logan@town.barnstable.ma.us OF aAWAS1 Commission Members Nancy Clark,Chair Nancy Shoemaker,Vice Chair Marilyn Fifield,Clerk QJ George Jessop,AIA Elizabeth Mumford Cheryl Powell Frances Parks Jack Kay,Alternate CO T> Z� G)--4 ry rn ao Chapter 112 Historic Properties, Section 112-3 D. n' 'Xr' DETERMINATION of SIGNIFICANT BUILDING 131 West Bay Road, Osterville, Map 116, Parcel 032/000 Pursuant to Intent to Demolish Structure The property located at 131 West Bay Road, Osterville, is associated with the broad architectural and cultural history of this area. In accordance with Chapters 112-2 and 112-3 (D), the Barnstable Historical Commission Chair has determined that this structure is a significant building. This determination applies only to the demolition described in the notice of intent submitted on July 27, 2020. Any future demolition shall require a new determination from the Barnstable Historical Commission. Planning&Development Department-Elizabeth Jenkins,Director Erin Logan,Administrative Assistant-200 Main Street,Hyannis,MA 02601 Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 8/16/17 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 17-2234 Dear Mr. Perr y This affidavit is to certify that all work completed for 113 West Bay Road,Osterville has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey Iluzz ! Or ?p>> c; em4a j v) 7TWO Town of Barnstable tRECE �= 200 Main Street Hyannis MA 02601 508-862-4038 Application for Building Permit PP g Application No: TB-17-2234 Date Recieved: 7/17/2017 Job Location: 113 WEST BAY ROAD,OSTERVILLE . Permit For: Building-Insulation-Residential Contractor's Name: WILLIAM J MCCLUSKEY State Lic. No: CSSL-102776 Address: West Yarmouth, MA 02673 Applicant Phone: (508)398-0398 (Home)Owner's Name: FRANKLIN,SHAN E,DYMEK, Phone: (508)294-2324 TERRENCE M& (Home)Owner's Address: 4 COMMERCIAL STREET, MARBLEHEAD,MA 01945-3130 Work Description: Add A-49,R-44,and R-18 cellulose to the attic.Dense pack the walls with R-13-cellulose.Add 2" ruid insulation to the crawlspace. Air seal the attic plane and basement with expanding foam. =� C . Cn Total Value Of Work To Be Performed: $5,000.00 `-f t m Structure Size: 0.00 0.00 0.00 Width Depth Total Area - I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G:S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the,subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: William McCluskey 7/17/2017 (508)398-0398 Applicant Date Telephone No. Estimated Construction Costs,/Permit Fees Total Project Cost : $5,000.00 Date Paid. Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 7/17/2017 $85.00 X)M-X000t-XXXX- Credit Card . 0299 Total Permit Fee Paid: $85.00 ------...___._.....................__......__._._._..........._................:_._-..................................................................................................... i Engineering Deptl(3rd floor) Map /1G Parcel dv3Z Permit# S House# 11,3 e14K4 Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30)_e j—�t lC5WK5.Fee Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) IMF Definitive Plan Approved by Planning Board 19 $EP MUST BE {NST MPLIANCE TOWN OF BARNSTABLE FENVIRON y AL CODE AND Building Permit Application TOWN REGULA°TiONS Project Street Address t Village I Owner Address Telephone — ed 9 Permit Request ii G G ivCi2e'f'e First Floor ly X square feet Second Floor --------- square feet Construction Type `� (ZA,►L� Estimated Project Cost $ �(', Co Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes I to On Old;KKiin�g's Highway ❑Yes [�io Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other_ -t�ddc ri Pi l wee f`tc�N1 Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing :3? New Total Room Count(not including baths): Existing New First Floor Room/ Count Heat Type and Fuel: El Gas ❑Oil ❑Electric ❑Other CL OSed R Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) ` Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ;dNo If yes, site plan review# Current Use S �a Lam` r, �,, , k*/%Nti Proposed Use �a �— Builder Information Name d ,•�� d e V Telephone Number '�,� Address S License# ^. f Home Improvement Contractor# )01 OI �- Worker's Compensation# \�� W1456.,-01Ar 7 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO MA&ra_c, e me L r-, v1_ SIGNATURE DATE BIJILQING+P,ERtM,I.T DENIED FOR THE LLOWING REASON(S) [S� .� _ 4 u q. FOR OFFICIAL USE ONLY F , r , , 1 f f d r PERMIT NO. �? + ` ATE ISSUED MAP/PARCEL NO. J `'s ADDRESS VILLAGE OWNER r , DATE OF INSPECTION: FOUNDATION. . FRAME INSULATION s FIREPLACE - ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH FINAL GAS: s '[ H s FINAL I ^s FINAL•BUILDING DATE CLOSED OUT* c Lr' L4a� Y ASSOCIATION PLA -, a ,.. wW � i � � r '� / ~ � � u� � _.� = -� _ .� �-~ (.�/ l' � . _ M FO Fi�:}tf��- .e '� _. � _ `: AA � y ,r i �� X�,r rt.p r p,�,.,,o .�ftls�t„�,r .v.,,,.n,�R,;, �..•...q,. �,,. ._ �r ar. .....,yuT .�,^. 5'4'?P9,�YY'+"TC,�Pr'.wvn:�.�.�Yiv.,�, !wA fall n4 .fan i X-if �et r 1 f S �L.�' �"� � r,?7ti,-�;,���:,; �,; • BAY � Ro.A D ; . • ,• . � �' � �:>:`� �° , �j���rs`L i;��.">T kfr x t�•y.�r' '., .F . • � r.+r ' ... t�1 ..1 ,. k'Al,i�.1 ) it ft tir• 1_ , f•' •'' .. - j t r �••1•!'"���tF'''�f�f_t'n�.,.f,{ r'��t,l �, ,� :• ' 11,,,, .i`�•j.. • r h Qy �Lrt t I,rl/ `•0.;ems,, r 1� .f � � � , Hai. r C r Q f t� N4 di�, 7'S11: r7 .,r f 1 ' V�.• f l VI \ J , ►sue`..��fi � ;r f � �. ' �, - V � , . , '• i it �.A��r` •�,rw: r f+ �ti Tit' ;* ! �� ti 1 6 •• i �1,111;'��'j'4...• .,r +� i4r' N/F i 14 14 ;. !� r; ',► I C?UR BHOWNIHEREON WASELOCATED PLAN OF LAND a STRUCTURE + ; AN :ACTUAL FIELD SURVEY ON ON `'ti� �+Rrtaras%�o1977 AND CONFORMS TO THE ZONING )YrLAW OF THE TOWN OF WCST (3AY t. :,i','�'' .� .vsh►.oFstt � MASSACHUSET S, IN o s MASS..-' REGISTERED hAND PURVEYOR at"' OF SCALE t 1°c No fA Its/ 97T ;OAT �,' �' .• o JIIMES �N C- 7o �f' ' ^,�,• hl,{9 �r ' S WISWELL y CAPE COD SURVEY CONSULTANTS. ��I ��t,vl�,r: ..3, •,fj �, 1•. .9�No,i1p29 O A DIVISION OF ROSTON SURVEY CONSULTANT'8,INC• ROUTE 132 SURD HYANNIS)MASS. Gj� It 1 fib J. u.' 1 ,.,�i ,• r ' • ... - F, �I 0i OEPARTRENT Or PUBLIC SAFETY ; -CONSTRUt1ION'SUPERVISOR LICENSE heber�. Expires Restricted to 00 _ . ROBERT A NACLAUGHLIN 21 62EEN TEAL NAY ,1ARNOUTHPORT, NA 02675 MOMS IMPROVEMENT CONTRACTOR \ 1"Istretioe 101014 TrPe - *PRIVATt CORPORATION Explrstlem, 06/24/" - CAPE COD MOVE IMPROVEMENT SK rt A. N"Laughile Ireeouoh Rat Nyjalle NA 02601 iTP'�R`P�?y,:a "r'jK{•y.:.A':�•;��4�,;: ;Ipo't7•i 4'n h;,^•i y:' ;:•., i, 7 seA OrA: olz S. �-S c., r fil .• I �' �` n v) i r CJ �1 b1•'i ,<�of T TC i HEREBY CERTIFY THAT THE pl,�1N OF LAND S1 RUCTURE _ STRUCTURE SHOWN Hf:REON WAS LOCATED BY AN ACTUAL FIELD SI)OVEY ON ON >.� ri�:�7oi977 AND.' CONFORMS TO THE ZONING BY-LAW Of THE TOWN OF -* PAY RD MASSACHU"',ET;TS IN 1 J ' R viLl,f. MASS. -REGISTERED LAND SURVE X) 71 H OF far SCALE I"- '}c� MR A ,3/,I977 7 . DATA JAMES csa C 50 g H. WISWELL CAPE COD SURVEY CONSULTANTS. p No. 11029 O A DIVISION OF BOSTON SURVEY CONSULTANTS,INC. T��yoe ROUTE 132 v � suK� liYANNIS, MASS. I NOTICE NOTICE TO TO EMPLOYEES EMPLOYEES The Commonwealth' of Massachusetts r DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I(we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: ASSOCIATED INDUSTRIES OF MASSACHUSETTS MUTUAL INSURANCE COMPANY NAME OF INSURANCE COMPANY Y 222 Berkeley Street - Suite 1350, P.O. Box 763, Boston, MA 02117-0763 ADDRESS OF INSURANCE COMPANY AWC 7001456-01-96 07/02/96 - 07/02/97 POLICY NUMBER >" a. EFFECTIVE DATES (800) 782-6929 NAME OF INSURANCE AGENT ADDRESS PHONE HOME IMPROVEMENT SPECIALIST OF HYANNIS, MA 02601 EMPLOYER CAPE COD INC ADDRESS 07/25/96 EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT `. The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish �> adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NEAREST AND BEST MEDICAL FACILITY NAME OF HOSPITAL ADDRESS � n TO BE POSTED BY EMPLOYER TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 3 vZ rJ � Permit# 3Q 7 Health Division Date Issued �s Co 3o q Conservation Division Fee !.ZS``•C� Tax Collector Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 1 _ Lo Village U b � iJ! < /t✓ Owner FQ a/y lc A E 1t&,'1 Address Telephone - Permit Request <&Q �S' Aa� -V�o c���� - ,� h . �Y A)a les Square feet: 1 st floor: existing oZ C� proposed 2nd floor:existing proposed Total new 06 Estimated Project Cost D Zoning District Flood Plain Groundwater Overlay 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 ❑No If yes,site plan review# Current Use Proposed Use UILDER INFORMATION Name Telephone Number /f' Address P�6 9 ALicense# (0 && Home Improvement Contractor#/ ' ILI Worker's Compensation# ��fJ 0__ ALL CONSTPhJCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. , ADDRESS - VILLAGE OWNER =.� r } • � - ' .. DATE OF INSPECTION.R..,, ;r FOUNDATION . FRAME INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL , PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. • 7 367 Main Street,Hyannis MA 02601 ' Office;:,508-862�038 Ralph Cressen Fix: 508-790-6230 Building'Corntnissione- 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. Type of Work: � Estimated Cost Address of Work: _ r Owner's Name: Date of Application: ,�Q Z2 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law C]Job Under$1,000 Building not owner-occupied DOwner 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 the Date Con Name Regisnation No. OR Date Owner's-Name q:forms:Atff day s_ __ ni urilNi(/i[Wt lllLtt of ikias acaus'eus " — Department of Industrial Accidents ?� '-_ ON=ol/Ot�estigal/o0s - - ': 600 Washington Street �. Boston,Mass. 02111 / Workers j om ensation Insurance Affidavit / ///ME%! name: I - location: /!� 3 AJ,,0,S7L- �) i _ -�Id ' citV "'�,M'4 _ phone# TL —;�LT" ❑ I am a homeowner performing all work myself. ❑ I am a sole r rietor and have no one worldn in a�ca acity ''///%%%%%%%%%%%% %%%%%%/%%%%%%%%%%%/%%%%%%%%%%%%///%%%%%%%%%%%%%%%%%%%%%%%%%%/%%/%%%%%%%%%%%/O�%%/�%%%�%%%/l//l%///�'0////% ❑ I am an emplo er providing workers' co ensation for employees worktn mp.... .......... my....... .................g on this job. a .V;..a i i:C::r? "om n n m . :.......... d .: ::::::....:::::::. :.....:....�.....:..'...-..%:..:...::.:....i:.;...":.....-.':..:...i:..:...i:..:...-*.:--'....-':.:....::..:....-'.,.-*...i-..:...i..:.:.".-'...,-:.-*.:.i:.:.:-.::.:-..*'X'.-'.-'::..:.:,.":0.:'.................,............. :ililjQ.......-............-.I <d 5:.:g cite s c . �:..�-*.�..&::1-i.�`.�.i]�:X:.:.�:-.�-]:,�.�-�::i�:-��.:ii*"-:i.:,,i,-i:.::i*-;ii,.,.i.i.i-�i..i.�..�.i��.�.i�i.A�i�ii:i��i,.-'m!.i:;�:�i:::::�iil�:ii:::i.i:i�.......�..!..�..........i.%.�.......�..�..."i.�:....,.,�.:*9.........:......,,-.�..:M....:......:.....::*..:.::"1::..,A.:i:::.*�':::..*::,i:.":*,.�'..,i:i...::::.i...��::�i..�:..:..:...:,..i: :::::::: ....... hone#...::;: .:............. :>`:<::> :: :: ''` " `::::: ..:.............:..................::.;:.:;.;:;.;::.: :::.;:.; .,. ......:..:::::::•::::. .::::......... insurance co. .., .::.:. ...::::::::::::.::::::::::::.::.::: ..:::.:::.:.:.:.: .. . ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have . the following workers' compensation polices.: . hl'i;:8t1 names'`>:: -'>? > »'.i> <>»> >:> i >?' :::!3 2':: : >:`: ??>: ;ii i2> >':> ` < ?> >< <>? < <> > [>Si'>:' > > '<» > >s. .. --_P V ..... ............::: .:::..............::::.:.:.:.: ....:,.:... a''"' >: i# �^ S:z:>... Ci':' >'DhOtte# >:>? ;:;: ::: :-: :..........Xiii .................................. ....................................... celc % ............ .. ...:.............:.......:.:.:...... ........:.......:..::.::.:.::. C;:p:;.:;:8 V'n a m e ' :: . .'.<..... _s> t:::: . . ... : `...`:' . ?".:.:.:.:.:.:.:.:....:...:.'• :.: 2'': . ...'...'. .:. .:.::;:.:.. ....:.:.:5.:..... ; .;....,:::: . ...?.'.'........----1-;.:.:.:.:.:.---.%.: n- :•:::::::..:..........:......::.:::::::::::::.::.::..::.:.:.:.:.. address`' c ' �,;'`'``:T`%:i5 .i>Y> : 1. '%'i 3 '"<'.. .?sy:>".' > %! ` ?. > i?<'?i}�'?:'??? '`> :;'::.:' #i s 3?""_?as '.:'' >` `' sit `i s? is i ` ' i2:?S ii ii':: E2 .....: > ' ..... :...................:: '>:... . ........... ............ ...:t)hone# .... ...................... ...::•::::::.::::.:.. z:>:<, z ,:z:>.. n ce co...... ....:...:.:::.:::... t. :.::...:::::...........::.::::::::.:::::::::.:::::..::......................................::. ::::.::;;>:::;:.;;;:.;::.%;:;.>:................::;;:.:;:;.;;.:::.: >;::::.;::>..:::::::::::::::: Failure to secure coverage as requited under Section 25A of MGL 152 can lead to the imposition of ctfminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as dvfi penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that s copy of this statement rosy be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify the p ' penalties of perjury that the information provided above is ftup an l cone Signatures C�. . Date 4//� 9 Print name �h�—.)/ � YUPhone# official use only do not write in this area to be completed by city or town olIIcial . city or town: permit/license 9 . ❑Building Department ❑check if immediate response is requited ❑Licensing Board ❑Selectmen's Office _ p • contact person: phone N; __:_(--]Other Department ormad 9195 PJ� acoRQ. CERTIFICATE OF LIABILITY INSURANCECSR DR DATE(MM/9/9 PAULJ-2 09/2 —B PIzeDLIGra THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Drake,Swan & Crocker Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE , Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Agency, 14 Lot s Hollow Rd. ,PO Box 429 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE Orleans MA 02653-0429 COMPANY David D Rust A Phone fin. 508-255-3212 FaX.NO: ...... ..........---...-----.._.._------------------.-....------------------------- Ir1 LIRfcD COMPANY B Credit General Insurance Co. COMPANY Paul J. Cazeault & Sons, Inc. C _ —__-._--_ --- ---- - COMPANY D COVERAGES 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. POLICY EFFECTIVE POLICY EXPIRATION LIMITS CS; 'I YPL OF INSURAWCE POLICY NUMBER DATE(MMIDD/YY) DATE(MMIDDIYY) L I R GENERAL AGGREGATE $ I GENERAL LIABIU Y -- - PRODUCTS-COMP/OP AGG $ - I COMMERCIAL GENERAL LIABILITY — I I ; PERSONAL&ADV INJURY $ CLAIMS MADE OCCUR —— -'I j EACH OCCURRENCE $ ( ! I OWNER'S&CONTRACTOR'S PROT i --- FIRE DAMAGE(Any one lire) $ MED EXP(Any one person) $ I I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY $ j (Per person) SCHEDULED AUTOS --_ I tIIRED AUTOS BODILY INJURY $ (Per accident) I NON-OWNED AUTOS --'- -'`--- I PROPERTY DAMAGE $ 4 I --' ----- 1 GARAGE LIABILITY AUTO ONLY-EA ACCIDEENTNT $ OTHER THAN-AUTO ONLY: -_�--— ANY AUTO EACH ACCIDENT $ AGGREGATE $ EACH OCCURRENCE $ LXCUSS LIABILITY AGGREGATE $ iUMBRELLA FORM .OTHER THAN UMBRELLA FORM WC STATU,- OTH- WORKI:ItSCUMPENSAi➢ONnNU I Y TORYLIMRS_I_ ER „-.-----.-u.- I EMPLOYERS'LIABILITY I EL EACH ACCIDENT $ 100000 I B ITHEPROPRIETOR/ }{ INCL SWC17005902 08/09/98 08/09/99 EL DISEASE-POLICY LIMIT $ 500000 PARTNERS/EXECUTIVE EL DISEASE-EA EMPLOYEE $ 100000 OFFICERS ARE: EXCL OTHER 1 !DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS ' Roofing. Corporation active 10/l/98. i CANCELLATION CERTIFICATE HOLDER lI pEACOCl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 1 EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL I l 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND WAT,TIVE E COMPANY,ITS AGENTS OR R PRESENTATIVES. AUTHORIZE ER ACC ACORD CORPORATION 1988 Client : 29025 CAZEA CORD. CERTIFICATE OF LIABILITY INSURANCE 06/(07/99 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Mastors & Servant, Ltd. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 5700 Post Road HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P .O. Box 1158 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. East Greenwich, RI 02818 INSURERS AFFORDING COVERAGE INSURED I INSURER A:Transcontlnenetal Inc_ . Co. (CNA_ ) Paul J. Cazeault & Sons Roofing INSURER B: INSURER C: INSURER D: —-----------_---- -------- -- --- -- j INSURER E: COVERAGES THE-POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRI — POLICY EF- CTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DA E MM/DD/Y LIMITS A GENERAL LIABILITY C180024822 04/30/99 04/30/00 E_ACHOCCURRENCE - I$1,_000-, 000 IX [COMMERCIAL GENERAL LIABILITY I FIRE DAMAGE(Any one lire_)$5 0, 0 0 0- __- i J CLAIMSMADEI Xl OCCUR ME D EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1, 0 0 0, 0 0 0 I ' __i I GENERAL AGGREGATE^ $2, 0 0 0,-000 GEN'L AGGREGATE LIMITAPPLIESPER: i (PRODUCTS-COMP/OPAGG s2 , 000 , 000 -- -, - PRO- I l - - — j POLICY(X I I LOC i I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ' ANY AUTO ! (Ea accident) ,$ I I ALL OWNED AUTOS � I � --T_ -_--- ---- - -- i i I BODILY INJURY j SCHEDULED AUTOS (Per person) $ HIREDAUTOS j --- BODILY INJURY $ NON-OWNED AUTOS (Per accident) -— I j-- - -------- PROPERTY DAMAGE (Per accident) $ , GARAGE LIABILITY i AUTO ONLY-EA ACCIDENT $ I ANY AUTO ( i OTHER THAN EA ACC $ -- -- -' AUTO ONLY: AGG i$ E_XICESS LIABILITY_ EACH OCCURRENCE $ OCCUR 1 CLAIMS MADE AGGREGATE $ - $ DEDUCTIBLE $ RETENTION $ is WORKERS COMPENSATION AND IWC STATU- OTH- -_LT_OAY LI.MJS I-ER- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYEE $ IE.L.DISEASE-POLICYLIMI $ OTHER i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS AD DE BY ENDORSEMENT/SPECIAL PROVISIONS i CERTIFICATE HOLDER ( ADDITIONAL INSURED;INSURE RLETTER: CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THEISSUING INSURER WILL EN DEAVORTO MAIL*.3-0-DAYSWRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENT IVE 4 g Y�La4 ACORD25-S(7/97)1 of 2 #S79099/M79097 BAM © ACORD CORPORATION 1988 d < '• � -to ` iy r ` M''•D"'�tt` I•itC•' Y.�.�'•i,rr< ,:< ���r . - S, f,14 a S t�y4FdGr.w,� YM��{•i'�r < tr�7 r+ t, It-e?, }, ,2K{,i�yt�:h Fv ( -' •f t{ -'et' L 3t Ti H Ar •,rrJt 4 i�,l�., �L.,1:I'ztY"C+r rC.'S '`S. sxs��+ix'`cI��.�6'^w- t ,,��aw{�r.`�yz��.,�t�e •R ° �",t'�} mot+ +�i HOME IM.PROVEMEN f CONTRACTORS, REG S%JiA OIV +* s y �>�� �¢ t ^� "• ,.s r t vv,;• rf., 1 7 +i 3..•"'+' c. �•rtI'„^ r: r x3d�`5' >p. //'^'' y l �f }r • :•d r�' i �aAffiha� .,s iY ,✓ )�`�: S%�. �A1c't, +,�r'� E3oard of Eauildin R0•..ulatio.ns L�a>�%c �tn „ S 9 � J)� �,l, ?fi Ty,•,� :ram �' 1"trd • NO •b�,, ++ �� y<t -f :r S,Y' .,.. q+�x _oSton�,Massacchusettsl��;0 x`+�.7 I �, .'�tZC'tl.r� r., .^.✓., t�i 'F^-trr�. Q•4{ +�' s'y r• Ki�J�:+.I) .r �a t "Gk'f :Xjk' ,. .71 ;,"E l^r`t� l rk•". ,4M� 0.t •k.. ..`Y.?Y`'v, .�.�.y�•�E,F..4;,r ...: ..,..,. .. 9 .�;i+� +i YP d6� _ 4°c1.,° �`r• .2�is� _rE � o�.s�y'��'atir. '' t HOME I 9P,RO,VEMENT CONTRACTOR "�� x ' ", � t'? "r.;..�' \>,r +r a.r.•: .ar -�� t a n. r. Xr, ° e 2 u t.t +�. 3 n •r H �. � •Re9:�stryyatbn ;'1.0.37...14;J, . ;^ Expiration °.00900,^I ^y� �I a ?> K r x, I1.�Y fah±Y. .ta.d7' F.,b Yw t'C'' ;f,' i'F dr a j:tl .r. �rj�i.� % d.. .✓M t0O0raKfMO/ML1GO[NaO��✓Y /lde�6`� ° 1YP '•v' Li.P<ARTNERSHIP , ,.:, t.Y,t>�- ,:.,.,,. .�,ja "��.` ��,� �;. ,+�. •. ,i�x1[7f 1' �p •o.•r r ?:_C rr<G v �yat, t. r yd'n-t�\ 4•i�rlSf' LLB' s T NI-y�."�,is.,t 'ti�",oY�. - 3'+ � t. NONE INPROV.ENENTaCONTRACTORt u F. S.. y7`,..+� t x '� ,�t.. , 't •4;Y'7 to c ..tvl s� f.� to s �'n x'I:lrc�C.i 1� 1 t �.�y �.. hl�� �" ��" Re istyyation�103�.i:d1 yJ.k '``"�{i�ri. of avJf. ;''' �• , r` �y,?C•. - s ti t+i' S', .rs; It { ZVa�i .fPAIJI� 'yCAZEAIJLT,, .& SONS ROOF.ING �� frfTrpe- PARTNERSRIP f,g ..,:1 t�s•rr..� , , s•.3ya, � "r "�, I a� ` Via: < 1, t Ql I ��i� •'xd;.x�)ry'�i y t Y: r'+ .s N s 4 '.RY S' h,.:e q'4?ti_ •'ap t+Ez it lon���07/09/OO Paul J c-azeau°lt t h I > r.. P. ,�. F,. v ,,.`tv t`� Y tit.! t " ,1{i •�..�, :c .s:•7Pt'''Y* St.: �.?u.t.dyt�' 4,. ^�'P .'S.o-,�r• ft W.N. ryy Gicidialt`.::Rd`> i P,_ tt�sd'tli +.> •y ti. .t.: .'3..:yF'SP: '!a; - �itbk a°f.':eo a. iXRn" 8+ F°`li., ''�+'1 Z $t;,v-xI'' sI .a•F °'H�i + <'s rW,` 'i r. �i?::+ b: OOFI .f ,. .Orleatii5 f`1A' 02'Ei53<:= . tPAUI � 'wCA1EAULT. `-SONS--ixYr:, �?�G,«+�"�,G"a^,c•�r�r c• ,i:• C �•�:. " :1�;.- :'s c ) yp;.t,:� r�->t .�sa? .Y x.r.,.�..,><sM'. .'nW "e?1,�, `�'•�_,;u,at � �' `C st- °��PauV'A Cazeaul •.+ .,,}. y. _1_S,.'f '•4Y. 1 �. `. .r...` v.- sy%fF's "JGIf !a s .t f'•3 L r t 4 `i i "fJ . S}e`wx: x�5 t� L�. '' t �;' 1 � 3Ss. '1p '8�Vie'.t'l, /eL��+l��'���'q U"K•� •a; X M',k�S'•t ,(.G..� Z 4 iddlalt RdY P`;0.^c80 X 278 v� w ;:4 `.1}T •F,..< rLf`,•�•t• ,r. i ' y '' q e 't �,ny , 'l4Yr .�.:b P.7A•,r t, t n. ` t >M r t t a } r afr�Y + ra € %� '} ti, 2r I ADMINIS lOR' r .t i ti ,,,..�K1.`.rx+ \ •" :.;;�;f n < r u< <ark' �,,x ,ar;:, , 7. .Orleans.,NA402653s,:�,� 4,'rb 3s•�v.�•f y3Yedx YJ} -,�, + �, cc ,J aM1,tr '��`"�. Y�t t�-��kf� �k'1 Y`i r-T{r,°,, ka �uSr "\ ^Y S P 1�v��y+`^�5.�1 , F .e J .h 4t �rk�c:{,,,ear :S• t;.My a Jr '` , d � r ��t.{_.. { e �._I t .._��.� -e � 1 t :., `f -r,s.0 _'2r• ;'k.:»;�:It'�'v.�l. �Q� ——--,.., •J_ e , ,:_.. _—.—_�„'tla�3;'S".�::.-...cu.. r � —. •r`t.��—,—:_:�.:_:! i • x - i?:'.I'r11?I iYiI.PI f Uf I'I1131.J."C: (Ml- h-'�IIHtJR_I'UN CUNI'iIT?UCl'IUPJ `..�Ill'i'f?V:C'iUl? L..fCi'P•1�5f". '•,.;;+ ., Munrfl4l f7r:I'.)i.rE>�;: "10/1 q<) II(f?' J:t'l,r'Ia?Cl 'I•ri, b)t� t w:.:;�.�'S':�: -_ ED •T� 1'f1LJL. .:I CA?FA JI 'I" - .t!i}3(i Mr1a:I,J ;'f• _'>~>,�.:�;,� _- h 'C>O t'oj) I"ot, I'C?r; I.OI: mlt:l Cali?Ilgf2 ?'( i1CIEll"E F:a IIUt..i.'(].(';,:;tj on ' �,,- .�. ;/�te �onv»covu�realbE•�o�./�aaouc�uae��I DEPARTMENT OF PUBLIC SAFETY 9I CONSTRUOTION:SUPERVISOR LICENSE I NuWDai,;:I"-' ' Expires: ' Res tr;ictedpTo::'' 00 V.- ,,.. (- 'zf•I(UL J tA2EART 1585 MAIN ST �• OSTERVILIE, MA 02655 �' t r Erigineering Dept.(3rd floor) Map 6 Parcel D 2 Permit#_ o�C 0 ` House# Vloate Issued Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30) �0*61/ PyVq Conservation'Office(4th floor)(8:30-9:30/1:00-2:00) Planning Dept. (1st floor/School Admin. Bldg.) INSTALL,E0(SEPTIXSqSqTE" ST BE CL Defini ' e Plan Approved by Planning Board 19 ENVIRONME Afi�lD TOWN OF BARNSTABLE TOWN RE � NS Building Permit Application Project Street Address /� /rt��,7_i�AV xC Village 6e; le,2y;/1C Owner_tt2p,94� v i.�e_✓t Address I l 3 1,�• i�va.r ��, z �� Telephone Permit Request 1�'i nP D rn �'x51 n ar vtnrgsov� QJ r �i vsn rl[v w,'Tln ,4 .ai wIP�4 s I l P/a First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ a000°f- Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family (g Two Family ❑ Multi-Family(#units) Age of Existing Structure (D-/00lys Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: QJ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) v*' Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. 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 `J.No Fireplaces: Existing New Existing wood/coal stove ❑Yes JANo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information NameSf�f tC� L���Mhe/ weeI �k�P,A r- Telephone Number _ S$8 l/z) Address PO 2,n?( 96 Ssgw 64#45 License# C S - a;5—QSS 7 c W• d/t'9 C'S/A reR : -*- .27 as ere- 3-/0?o-o Home Improvement Contractor# !Q OB S9 Worker's Compensation#/./wC -Ida 1RY5 DI NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO N 14 SIGNATURE DATE BUILDING PERMIT DEN FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. ` DATE ISSUED MAP/PARCEL NO. ADDRESS, 'VILLAGE � .,.V} OWNER t.� DATE OF INSPECTION: . 1 _ FOUNDATION FRAME ; INSULATION _ FIREPLACE ELECTRICAL: ROUGH FINAL • t PLUMBING w`. 4000Hb - ; FINAL F -t GAS.-- FINAL FINAL ► ' t F FINAL BUILDI • ..� tip �°� �;: � - DATE CLOSEDmC3LJ� ASSOCIATIONA-kw N ' ' The Cunrnlunlrculth of:1 tassuchuscltti Depart�ilcfrt of hiditstrial Accrtlellts • i � ;: -:! = plrceal/ttyestlgatlons •:\ji;« __��;� 690 !f a.vhhrrtutl Street 4 Bastutl.Maw. 02111 1 �• Workers' Compensation insurance Affidavit L11�Plicint inforntatitin Please PRINT'lebtl�ly name aloi4 �IIA 5�. w m v►e✓ Sr�t>ee/� cition 4 P >,< 7 cM SA nc�w 'GVI /��645 S nhr,nr 5//�l I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity �_,__.•,______ _ j I am an emplover providing workers' compensation for m% employees working on this job. coma me n rmt SA�1�c,J }�l,t r yylyl ��A t PP t tdtlrccc 0 zax 9C) eiti 7-44AWe r PV I p9S5 nhnne ti• 91 iYv l Wl v��a�l �'�ts r nnlic,• /�rt�G- ado rR yS-o�-Q� incur race cn _ I am a sole proprietor. ;eneral contractor. or homeowner(circle one) and have hired the contractors listed beio%%, wnc the following workers' compensation polices: cnmrinnv namcc ,-- atitlrccc• cin•- � hone d- in,mrincr rn. �� - _ mice•0 cnm nnv nnint- ;ttltlrc�c� \� rift phone it• incor:rnee c _ •{..^-•�•C'•�_..• _../I•••:\I....S ... .. ..'�. .r....•.I r. •�.•'..�`�r-ram..�i.L....w►V: w.•arL�._ _r..:• Attach additional sheet if neccssarv� __,���,�,�:�.,.... .•.�••:•�-.�. '"'•'"• '"""' Faiiurc to secure coverage as required under section 3A of NIGL 152 can lead to the imposition of cnmtnai penalties of a line up to S1S00.UU am one%•ears'imprisonment as it-ell as civil penalties in the form of a STOP"'ORK ORDER and a free of 5100.00 a day against me. I understand th:. cope of this statentcnt may be funvarded to the Office of Investirntions of the DIA for coverage+•erifrcation. 1 do herehv cerr ft utrdc rile PaIns and penalties ojperjurr that file information provided above is true and correct. 22-22 SianattlrC Oatc �/ Print name i ! FF Phone# APO t l/N •official use unit do not write in this area to be completed by city or town official cin or tmvn: permit/license it rttluilding Department C3ucensing hoard check:if immediate response is required allc2it De s rtmro �: �ticalth Ucpartmcnr .lassachusetts General Laws chapter 152 section '_5 requires all employers to provide workers compensation for their mployees. As quoted from the an cnrplurer is defined as every person in the service of another under any It ontract of hire."express or implied. oral or written. .n graph rer is defined as an individual. partnership. association. corporation or other legal entity. or ally two or morc . ic foreaoirr�_ cna-aged in a joint enterprise. and including the le al representatives of a deceased employer. or the :ceiver or trustee of an individual , partnership. association or other legal entity, employing employees. However the xner of a dwelling house haying not more than three apartments and who resides therein. or the occupant of the Xcllitt;; house of another who employs persons to do maintenance , construction or repair work on such dwelling_ hour on the __rr.unds or building appurtenant thereto shall not because of such employment be deemed to be an employer. 'GL chapter 152 section 25 also states that even• state or local licensing agency sltall �vitlrliuld the issuance or newal of a license or permit to operate a business or to construct buildings in the commmvealth for an• "Plicant who has nett produced acceptable evidence of compliance with ;lie insurance covernge required. 1ditionall:.. neither tine commonwealth nor any of its political subdivisions shall enter into any contract for tine -forninnce of public work until acceptable evidence of compliance with the insurance requirements of this chapter lia _n presented to the contracting authority. plicants , sse fill in the workers' compensation affidavit completely, by checking the box•that applies to your situation and 'plyin_ company names. address and phone numbers as all affidavits may be submitted to the Department of ustrial .-accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The ::avit should be returned to the city or town that the application for the permit or license is being requested. the Department of Industrial Accidents. Should you have any questions regarding the "law' or if you are required y. please call the Department at the number listed below. c;air a workers* cornpetrsatiot; polic v or Towns _se be sure that the affidavit is complete and printed legible. The Department has provided a space at tite bottom of ifdavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pleas sre to full in the permit/license number which will be used as a reference number. The affidavits may be returned to Department by mail or FAX unless other arrangements have been made. Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. se do not hesitate to Live us a =11. Department's address. telephone and fax number. The Commonwealth Of Massachusetts Ir Department of Industrial Accidents _ r Office of Investigations 600 «'ashin;ton Street Boston,Ma 02111 fax #: (617) 727-7749 phone h: (617) 7274900 c.xt. 406, 409 or 375 s d,TMe tom,_ "�►°� The Town of Barnstable 9 WARS- � Department of Health Safety and Environmental Services �°r�; +�`� Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissi For office use only 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. 41 o� Type of Work: 2P wT.,�,j s!5-SW Est. Cost vZ�l� Address of Work: f'l �� ( '�e��+��le Owner's Name I-2AA Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given thaty OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MOROVEMENT 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: Date Contractoi Name Registration No. OR � .. .._ ._1. r,..w.✓.ia.r.ia.c./r..r"+:Q:i:,.:v.n:�.+•..+w�'�,/'i+w/b.ti�t�raG.:..�:�•y_.; � � . • _ + '1.., _'' �. t V'': �jLC -VOO)7/IYLO'�L[IJECUA/L O���LI.LdG'G[(1 � � � S•_ DHPARTNBNT OF PUBLIC SAFETY y`. CONSTRUCTION SUPERVISOR LICENSE Nuabq; -Bxpires: Rest ete'd 'iG ate. -. =' --KBITN A CLIFF 28%EKE RAI DWAY FORESTDALS, NA 0264. •L 7; r +I •t . . .,.i� •. ,\ �, tit\.* �.." . HOME IMPRGVEMENT CONTRACTOR Registration .120859 ' Type - OBA Expiration 03/12/98 SANDWICH CHIMNEY SWEEP KITH A. CLIFF "Z8 EMERALD WAY i ADMINISTRATOR FORESOALE MA 02644 Assessor's map and lot number Sewage Permit number .... ...L. ..:r. �oF7NEto�� TOWN OF BARNSTABLE j_ • BAflH9TADLE, i• Y 9ft BUILDING INSPECTOR 0 PY�• APPLICATION FOR PERMIT TO ...:................................ ........................................................................................... TYPE OF CONSTRUCTION ........ ........(,q rn..e. ..................v............................................................ / 1 a. .......l 9..if TO THE INSPECTOR OF BUILDINGS: I The undersigned hereby applies for a permit according to the following information: Location ...�.�.: .....!. 1�""S A 0--z 'ear . I .................................................................................... I ............1........ Y. ............ . .................. ProposedUse F�m I�r.....0DO. ................................................................................................................................. /i' �.......................................................Fire District ... ..!..� * . Zoning District ........:. ..................................:.............................. r Name of Owner ...F,� I..)A,- I. .owl................Address J: .�..;� � .•....� VWs ........... ... � .. ...... � . . i Name of Builder rA, T,',p +c�!n!meA+ S:n.S'x: ...Address .�a� 1 u 1� c� .... ..........................;r Nameof Architect ...../►Jrlw] r............................................Address .................................................................................... r Number of Rooms Foundation .��.�.!QQnrr t IAw 1 xnAe' v ..............`....... ......... ......................... Exterior .... ............: ... .rsq .� .� �.....'�S /)H 1 n v Roofing ...................... ................:............................... Floors .......... ,.......................................................................Interior .....5AcG'�# a `1 ....., ....................................................................... Heating .....:..:..'........." ........................................Plumbing .0. . rl ........................ .................................................................................. Fireplace ..............N n...?..r-..........................................:'...:.Approximate Cost ....: f�4 ... .......................................... Definitive Plan Approved by Planning Board -----------_______-----------19________. Area �.9 ../�.!.................. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 35 \ CX, 06 0i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �f Name '%/./ .;. 'L'. ..................................... ----~~~" Frank No ..... Permit for —..{lCMqxdP-l............... ' --------,--.----~---~------.. \ ^ Location ... ................................ ---.~.....~..~--------------- � � Ovvne, .....FranX..Wheldon----------- < Type of Construction .......Wacid..Frzmue---... � ' ) ' ----'..----------.----.----- � Plot ............................ 'Lot ................................ / ^ |/ / Permit Granted —.—..�eg.em8er.....9O...lg 77 � } ` . . Date of Inspection ------..................lQ Dote Completed ......................................l9 � � ' � � PERMITAIEFUSED � � 19 � '' --- - ... --- \ —_--.—.��.—'--.-`�-' —.—' ` � . ' � .—.~.~...~~.—.—..~..,...~.--~..---.. . ' ' --------'—^'—`'--'`^'--`—'^----^' / / Approved ---------------- lA � ----.--------------------.. j ^ �| 'r.................................. .........................................� } ~ ' � �\ - c Assessor's map and lot number .1 ,1/�.... ... ` 'a SEPTIC SYSTEM MUST BE � r INSTALLED IN COMPLIANCE Sewage Permit number .......GG�l ... /.�r'... . . ..�'c� WITH ARTICLE II STATE L{ �j R RSANITARY CODE AND TOWN �F THE T + ~ TOWN OF iJ 1 RW"Ag — i BABBSTABLB,4 9° r6 9 �0� _ << RUI�LDING . INSPECTOR: 0 M a• a 3 APPLICATION FOR.'rPERMIT TO ... ..L�"Lr..CX..+.s.�`l .....C9�gq.'� ................................................... TYPE OF CONSTRUCTION ........LA.).Qk!. .........; +M e i.l .................. .� . .... .....19.. ' 70 THE INSPECfC)�`OF-�$'C1iLD1'NC`�: -f � �- -=�.�:���r:=,,-,r.:�. � _ . . •,�-......» The undersigned hereby applies for a permit according to the following information: Location ...1.f.+3....1:. .t....td.'9y.... A!........... s5. ...................................................................... ... ProposedUse .....'E� ' �s ..... .®�. . ............................................................. .. .. ... . ......... ZoningDistrict .... .. ......................................................Fire District ...C. ... ................................................. Name of Owner r... !A .`... �1�.1. .a!�...:............Address o�7 & �f3�T!1.!�!!4-5 .:...W� e W�. . .......... .................................. Name of Builder (�!/.Y.�11. ..F4n1.A P.s?�! J`�T... Jc?c'-rr....Address Ty.a. vu. ... ..!7'/!.9!..!.a?i�. Nameof Architect ......QC)?P..�............................................Address ..................................................................................... Number of Rooms ........I.........................................................Foundation .................... Exterior ....w :�...... ......................................Roofing ..4�..3 .. .. .... 9... ...9... .!............................... Floors . . .?.J?............ .........................................Interior 1�./.e e-.. - Heating �P. : �.m... ...........:........:........::...:...:......:.:......Plumbing :...... 4. .. .:.:................................................. Fireplace ............. s,.......................................................Approximate Cost ..... �..................................... Definitive Plan Approved by Planning Board -----------____---------------19---_-.--. Area fir. ...e�.9.��...� . . �.... Diagram of Lot and Building with Dimensions Fee .. .......................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH t o)6() I t � � 1 . F \ fit Od Kai I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. l Name ........ . .................................................. � Wxeldwm^ Frank No .I24!�Z..... Permit for --. ---- . \ ........................................ ....................................... / ~ ' � Location ..... .�d............................. —.--,---.�stw#.vill�-----------. 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