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HomeMy WebLinkAbout0125 BERKSHIRE TRAIL UPC 12543 No. 53LOR �• :.p - - - MASTINOS MW k . o �,► , , Town of Barnstable *Permit# _0 — Li o l y Building Department Services Ezpires6moVeefromZssae S s Brian Florence, ' CB_ 1=39 Building Commissio6Pp KUF opVAMp '°h�o tit 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us NOV 17 2017 Office: 508-862-4038 - • 508-790-6230 TOWN O� BARNS l r EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not VaUd without Red X-Press Imprint Map/parcel Number S Property Address , Residential Value of Work$ 7 OO©, Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name t f}-tL �(J/�!I(Gf} Telephone Number 6 egr Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ,KI am the Homeowner ❑ I have Worker's Compens t'on Insurance Insurance Company Name 1� Workman's Comp.Policy# Copy of Insurance Compliance Cerilficafte must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side eplacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: Z. ZW fz-57 *Where required: Issuance of this p it does not exempt compliance with other town department regulatac, Historic,ConseQation,etc. ***Note: Prope r ust sign Property Owner Letter of Permission. A co y f t e ome Improvement Contractors License&Construction Supervisors'License is re ed. SIGNATURE: �jv Q:IWPFHM\F0RMS\bui1ding permit forms\E}PRESS.doc 08/16/17 1 Town of Barnstable Building Department Services Brian Florence,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 MAW www.town.barnstable.ma.us 1639. Office: 508-862-403 8 Fax: 50&790-6230 HOMEOWNER LICENSE EXMPTION DATE: ,��/� Please Print 1 IzA ,.. JOB LOCATION: f (,�e l�skire / l number street village "HOhMW? r: name home phone# work phone# CURRENT MARING ADDRESS: J41 � (?OjfT cityAMM 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 gRervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The un i ed` om wn 'certifies that he/she understands the Town of Bamstable Building Department minimum inspection proce he will comply with said procedures and requirements. S' caner 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFII.ES\FORMS\building permit fot=\MTRESS.doc 08/16/17 �WE Town of Barnstable Building Department services A�AXAS& Brian Florence,CBO �`� Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us � 1 Office: 508-862-4038 Fax:.508-790-6230 Property Owner Must Complete and Sign This Section If Usi=A Builder. r . ► as Owner of the subject property hereby, authorize to act on my behA in all matters relative to work authorized by this building permit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date QTORMS:0VMWERMISSIONPOOI.S Rev:08/16W I ?lie Cole nzome a*h of 1Mla"acbme ft JUT w&mewt q f ZtrrlmiWi l Accidents Office of bmesligations ' 600 Washington Street Boston,MA 02111 tvrvtttmassgovfdra Workers' CanrpensatimInsarance Affidavit:BuildersiContractarsMectdi ians(Pkmbers IEcant Infannatian Please Print Nye Address 74 fo✓l 0,� e�tgftartl : 6 phowg--. Are you an employer?Check the appropriate boa: ' Type of project(required): e�ap �. 4_ I am a contractor and I 6. ❑New eanshuction I.❑ I am a to with ❑ t employees(full andfor part-3ime)s Have hired the sub-=tractors 2.❑ I am a sole proprietor orpartuer- listed entire attached sheet, 'f- ❑Remodeling ship and have no employees These sub-contractors have 8.•❑Demolition worsting forme in any capacity. employees and bave wogs' 9_ ❑Building adzlition [No workers'camp.�imsu ante camp.iasurarrrr � -] 5- ❑ We are a corporation and its 10.El Electrical repairs or additions 3.CLI I am homeowner doing all work of wins have exercised their 1L❑Plumbingrepairs or additions mysdf [Na ye.arkers+°dmF- right of exemption per MGL 12_❑Roofrepairs nc incance required-]F c.152,§1(4h and we have no employees_[No wod=s' 131- Other cozp.insurance required-) •Any WKc-&dwtcbedmbaxitmast also fiIl out the swtionberaw shown thekwalerecompensabouparicyini"ass im- Hameawnaswhosubmitthisaffidzvftiadxxtmg they are doingBnwankmAthen him aTmidecmtr+ mmmstsubmitanewaffidarltindicah6.sadi fCaatratY. IEW cbBA this bar r4=stladses=additional sheer sbaming the name of&a s¢b-co�sceo-rs sad state whether at not those entities ham employees.If thesnbtaatxctmshmemtoyees,tbey=rsipmvidethe'u warkeas'camp.policgnimabeL I am an elrrploer 9rat rs provhl&rg workers'compemidimi irrazrrance for wry onrplajwes Below is the palicy arrd job s*e information. Insurance Company Name: PoOfiey A4 or Self-ins-Iic. k Expiration Date: Job Site Address: City/State/2 p: Attach a copy of the workers'compensationpolicy-declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A o€MGL c. 152 can lead to the imposition,of criminal penalties of a fine up to$1,50a DO andfor one-year imprisonment,as w611 as civil peualties.in 1he farm of a STOP WORK ORDEAand a fine of up to$250-00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Irrvesdgations ofthe DIA for msumam coverage verification. y r1'o hereby oetthf3'a t ' s and penalises afpmYhry that the infbnaadws pr ovi W above is true and correct Sitmatnre: Date - phone iF Offrchd um only. Do not eer&r in clefs area,to be completed by city or town o,f c&E City or Tarn• PermibUcense# Issuing Anthority(circle one): L Board of Health 1 Building Department 3.CitfYrown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: h€ormation and Instrueflons Massachusetts General Laws cbaptrz 152 raga es all mmpIoy=to provieie wor3as'compensation for their emzployees. Ptrrsuantto this sty,an EnTL7w is defined as¢_.every person in ffie service of soother under any contract of hart' express or implied.oral or writtEa. An employer is deed as"an ind dnal,pmtam mbip,association,corporation or other legal e n ,or any two or more of the:foregoing engaged in a joint entmptise,andinchhding the legal iepreseotaiives of a deceased employes,or 9ie receiver or trustee of an mdividoaI,per,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occapant of the - dw M g house of another who employs persons to do maint=aca,contraction or repair woik an such dwelling house or on the grounds or building appurtenant thereto shan not bmanse of such employmentbe deemedtD be an employer." MGL chapter 152,§25C(6)also states that'every state or local licensing agency shall withhold Ilire issuance or renewal of a license or permit to operate a business or to construct bufldings in the commonwealth for any. applicantwho has not produced acceptable evidence of compliianm With the 4n m-ance.coverage required." Additionally,MGL chapter 152,§25C(7)status-Neither the commonwealth nor any ofits political subdivisions shall enter into any contract for the pm farmanee ofpublic wo33c until acceptable evidence of compliance with the h=-Bnce. requ r=enfs of this chaps have Been presented in the oO� authoiay_" A ppHcants Please fill out the wozlceas'compensation affidavit complebiy by cb=W g the boxes that apply to your sitnaiion and,if necessary,supply sob-contractors)name(s), address(es)and phone mhmber(s)along with their certffieat-.e(s)of insurance. LmartedLiability Companies(LLC)or LimitedLiabi�ity'ParUmnbips(LLP)withno employees other.thmthe members or partners,are not mquired to rauy workers'compensation ins amm If an LLC or LLP does have empIoyees,a policy is repaired. B e advised that this affidavit may be sabmittcd to the Department of Industrial Accidents for confirmation of mQf7 mnc,p coverage. Also be sure to sign and date the affidavit The affidavit should be-rEtnmed to the city or town that the application for the permit or license is being requesbA not the DePa tneut of h da l Acci oafs- Shouhld.you have any questions regarding the law or ifyou are required to obtain a workers' sh compensation policy,please call the Deparftaeot at the number listed below. Self-imurd,companies should enter their self-insm=ce license number ou the appropriate line. City or Town Officials f Please be sure that the affidavit is complete and prided legibly. The Department has provided a space at the bottom of the affidavit for you to fill out m the event the Office of Investigatio s has to contact you regarding the applicant- Please,be sue to fill in the pe�llieense number wbich wM be used as a refierence number. Iu addi-tion,an applicant that must submit Multiple pennWHcense applications in any given year,need only submit one affidavit indicating cma ent policv-h r ration(if necessary)and under"Job Site Address"the applicant should write"all locations in (CitS'or town)- own)"A copy of the affidavit that has been,officially stamped or madced by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fu ai 'permits or licenses A new affidavit must be filed oiut each year.Where a home owner ar citizen is obtai ling a license or permit not related to any business or commercial veahrc (i-e. a dog license or permit to bum leaves etc.)said person.is NOT requimd to complete this affidavit The Office of Investigations would him to thank you m advance for your cooperation and should you have any questions, please do not hesNte to give us a call. The Dqe rimenfs address,telephone and fax number: 'IaIe C4nweatt of c111n�tbs Degartment cif Iiid Acradent% Offica Of InVe&tigRtio-- t�4 T�ashing�n S'#re� Bosom MA 0�1II T(,-L 4 617 727-4 c=t 4-06 Qr 14M-MA.&S� Fax#617 727 7749 R.evised 4-24--47R .z ��fti� f Town of Barnstable TOR"�Pa �f BAR STALE "E' Regulatory Services , y K � F 41J� 5 Thomas F.Geiler,Director 2 • w LE,MASS. • Building Division A89. 1639. N��`�� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 GIV—ISIfl:A, www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# �� ����- FEE: $ SHED REGISTRATION 200 square feet or less Location of shed(address) Village r Gas 65-8 Property owner's name Telepirone number I2;'1'6 ' �09 6?1s Size of Shed. Map/Parcel# 16) 249 q Si tore Date Hyannis Main Street Waterfront Historic District? / / Old King's Highway Historic District Commission jurisdiction? Ye-5yG. 9w,- ! If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. T.HIS=FORIVI:MUST-BE-ACCOMPANIED.BY A ~�-- -PLOT PLAN ' Q-forms-shedreg i REV:05201 i I tY �N r s z 4* � 4 VJ ` f 5 t'I ryoil 3ti z°. P' I certify that this property is located in Flood Hazard Zone C (out- side the 500 year flood) as identified by the Department of ]lousing and Urban Development (HUD) . Date ��z, is zcc,a CERTI Ft ED PLOT PLAN 01 S �C3-0�ysTja !�9 ct � LOCATION �?•... / _. SCALE . .. ���. . .... DA T E Zoog Reg. �a"Id i v�ey ?�' PLAN REFERENCE .�-3C!!�!� , GoT,`le� . 45. til LAG ` . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . I certify to its title insurance company THE LOCATION OF THE ORIGINAL DWELLING that there are no visible encroachments SHOWN HEREON,EITHER WAS IN COMPLIANCE THE LOCAL APPLICABLE ZONING or easements except as shown and that this NIT EFFECT WHEN CONSTRUCTED (W THBWs plan was prepared under my immediate RESPECT TO HORIZONTAL DIMENSIONAL supervision. REQUIREMENTS ONLY),OR EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER M.O.L. _ _ TITLE VII ,CHAPTER 40A, SECTION ?,UNLESS ��/!! /c�,� /�L�—��A - per- OTHERWISE NOTED OR SHOWN HEREON. TOWN OF BARNSTABLE.BUILDING PERMIT APPLICATION Map Parcel " Application # 1-- Health'Division `Date Issued 6 Conservation Division Application Fee Planning Dept. : Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address Village Gees d le 7 Owner KK&m /a- An Address �s Telephone Permit Request '!Z® ex,-.Vi 4 2:X 22 Square feet: 1st floor: existing — proposed — 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatior#Z�DOO Construction Type ftfleikkl 1' 160 Lot Size Grandfathered: 0 Yes /QPNo If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure 'l Historic House: ❑Yes fVo On Old King's Highway�es ❑ No Basement Type: Full ❑ )dWalkout Crawl ❑Other • Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing Z- new Half: existing new r' 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 L No Fireplaces: Existing — New Existing wood%coal stov% 0 Y s No w� betached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑anew ?ize_ Attached garage: existing ❑ new size _Shed: 0 existing ❑ new size _ Other: o- Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes �No If yes, site plan review # Current Use BLS/ &&OCc. Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number --� Address �Z� lzll� �P1�� License # W. �i.S �� Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 0 O 0 e7 FOR OFFICIAL USE ONLY t APPLICATION# DATE;ISSUED s `,MAPJ PARCEL N0;_ S ;ADDRESS... VILLAGE _ OWNER DATE OF INSPECTION: ss i hFQUNDATIO.N • ENO -p%c:_c 3 aI `3 FRAME ' y .'1NS_ULATI0NA 2 FIREPLACE t "ELECTRICAL: ROUGH FINAL L PLUMBING: ROUGH FINAL 41GAS ,TVAY TROUGH �'7, FINAL DATE CLOS D_QUT ASSOCIATION PLAN NO. I ne Commonwealth of Massachusetts Department of Industrial Accidents - 1`7' Offzce of Xlivestzgatiolzs 600 Washington Street . 1 Boston, MA 02.111 s� W ww.m ass.go v/die Workers' Compensation Insurance Affidavit: Build ers/Contractors/EIectricians/Plumbers Applicant Information Please Print Leffib) r/^ 9 Name (Business/Organization/Individual): y /�%7- `� /y/�AfACR Address: /r► f�'/�-� V2j City/State/Zip:�� � � '� � Phone M. Are you an employer?-Check the appropriate box: Type of project (required): ].❑ I am a employer with 4. ❑ I am a general contractor and I 6 ❑ New construction •. employees(full and/or part time).* have'hired the sub-contractors.. _ 2.❑ I am a sole proprietor.or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• Y1�emolition working for me in any capacity. employees and have workers' 9 ❑ Building addition No workers' comp. insurance comp. insurance. 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.) 3. I am a homeowner doing all work officers have exercised their 1 1.❑ Plumbing repairs or additions Myself [No workers' comp. right of exemption per MGL 12 ❑Roof repairs insurance required.) t c. 152, §1(4), and we have no employees. [No workers' 13•�tber /lQ.�cJ comp. insurance required.] *Any applicant that cheeks box#) must also rill out the section below showing their workers'compensation policy informa.Lion. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside con traeLors must sub mil a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-eonLraetors and state whether or not those entities have cmployccs. If the sub-contractors have cmployccs,they must provide their workers'comp,policy number. I am do employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self-ins, Lic. #: Expiration Date: Job.Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number grid expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against th iolator. Be advised that a copy of this statemeot may be forwarded to the Office of Investigations of the D or in ranee coverage verification. I do hereby certify it r s and penalties ofperjury that the information provided above is true and correct. Si ahure: a e Phone #: . Official use only. Do not write in !Ms area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health Z. Building Department 3, City/Town Cferk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #: information and fn5tructions ; Massachusetts General Laws chapter 152 requires all employers to provide workers' compc•nsalioh for their cTft}7^oYces. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An e�np/Dyer is defined as "an individuaJ, partnership, association, corporalion or other legal Chtily, or any Iwo or more A the foregoing engaged in a join(enterprise, and including the legal representatives of a dcccascd employer, or Ibe receiver or Lrustce of an individual, partnership, association or other legal entity, e therein, ng r the employees. However Lhc owncT of a dwelling house having not more tban Ihrcc aparLmcnis and who resides (herein, or the occupant of the work on such dwe))ing house dwelling house of another who employs persons to do mainlcnancc, constriction or repair or on Lbe grounds or building appuricnaol thcrelo shalJ not because of such empJoymcnl be deemed to be an e.mploycr.' ance or MGL chapter 152, §25C(6)also states that "every state or local licensing agency shall withhold the issu renewal of a license or permit to operate a business or to construct buildings in the commontiveaith for anY applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) stales "Neither the commonwealth nor any ofils political subdivisions shall enter into any contract for theperfonnance ofpublic-work until acceptable evidence ofcompliancc with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please L11 out.the workcrs' compensation affidavil cotnp)etely, by checking the boxes Lhat apply to your situation and, if necessary, supply sub-coniraclor(s) namc(s), address(es)and phone numbers)along with their certificaie(s) of insurance, Limilcd Liability Compabics (LLC)or Limited Liability Partnerships(LLP) with no employees other than the members or partners, arc not req is required. Be advised that tuired to carry works afficrs' compensation insurance. if an LLC or LLP does havc em , e policy this may be submitted to the Department of lndustn'aJ ployees Accidents for confirmation of insurance coverage. Also be sure to sign and date the aff"rd The affidavit should avit. be returned to the city or(own Lhat the application for Lhc permit or license is being requested,not tbeDepartrrient of IndusiriaJ Accidents. Should you have any qucstions regarding the law or if you are required to obtain a workers' Compensation policy,please call the Department al the number lisicd below, Self insttrcd companies should enter their rt self-insurance license number on the appropriate line- City or Town OfTcials Please, be sure that the affidavit is complete andprintcd legibly. The Deparlmcni has provided a space at Lbe bottom of the affidavit for you Lo fit)Out in the event the Office of Investigations bas to contact you rcgard;hg the appli cant. Please be sure to fill in the permiUliccnse number which will be used as a.refcrencc number. Jnad.dition an appl�cUieni FT that muss submit multiple permit/licensc applications in any given year, need only subrnil one atLdavil indica t)ng (city or policy information (if necessary)and under"Job Site Address" the applicanishould write "all locations in town).-A copy of the affidavit that has been officially stamped or r➢arkcd by the city or town ;naY be provided to the applicant as proof that a valid affdavif is on file for future permits or licenses. A new affidavi Inusl be filled pti l each year. Where a home oWner or chimer is obtaining a license Or permit not related to any blis]DLSsor commcrci al yenlurc (i.e. a dog lieenSe of permit to burn leaves etc•) said person is NOT required to complete Ibis a1`ftdavi n �raliDo and should youhayc any qucstions, The Office of lnves(iga(ions would i c o �'kyvo • please do not bcsitate to give us a call. The Depar(inenl's address, telephone and fax number: a Tbe.Cornrnonwt;aU of Massachusetts Department of lndusbr a) Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Te). #J6)7-727-4900 cxi 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4 24 07 www.tnass.gov/d' I I f Barnstable Town o . r� 0 Regul'afo•ry Services H e Thomas F. Geiler,Director Building ]division PTfD Tom Perry, Building Commissioner 200 Maig'Street,_Hyannis, )AA.02601 yrww.to ern.b arnsta b 1 e_ma.us Office: 508-862-4039 Fax: 508-790-6230 EfOn�[EO%WER LICENSE EXEMPTION Plcasc Print DA TE: Ae Of Aelo JOB LOCATION: `/Z� [`}��Z(�SKArG2 / — se number street village "HOMEOWNER name / Q home phone # work phone# CURRENT MArL1NG ADDRESS: Ze city/town slate zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow bOMrOwnerS to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor_ DEFINITION OF BMaO4S'1\'ER PerSoa(s)who owns a parcel of land on which he/she resides or intends to reside, on which th.cre 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 bomc-owncr. Such "homeowner"shall submit to the Building Ofbcial on a form acceptable to the Building Official, that be/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) 71hc undersigned "horoeowncr"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. The undersigned r'ho eo er"certifies that.hdshc understands the Town of Barnstable Building Dcpa.ramciA minimum inspcetio ro dures and requirements and that he/she will comply with said procedures and requirr-MCDt Signatiirc f No co Approval of Building Ot$cial Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Codc Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code stairs that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this secti' .(Section 109.).1 -Licensing of eanstruetion Supervisors);provided that if nc�homeowner engages a poson(s)for hire to do such work, that such Homcowncr shall act as svpa-visor." Many homeowners who use this exemption arc unawzr-c that they arc assuming the responsibilities of a supervisor(see Appendix Q, Ru)cs&Rcgulalions for Licensing Cmsbvc(ion Supervisors,Scction 2.15) This lack of awanriess bNcn results in serious probleras,particularly When the homcOwncr hires unlicensed persorm. In this case,our Board cannot proceed against the unlicensed perron as it would with a)icarsed Supervisor. The honccowncr acting as Superrisor is ultimately responsible. To ensure that the homeowner is fully aware of his/ho'ri-sponsibi)itics, many communit5cs require, as part of the permit application, that the homeowner certify that hrlshc understands the responsibilities of a Supervisor. On the last page or this issue is a form currently used by several towns. You may care I amend and adopt such a fomr/ccr6fic2-tion for use in your corrnrrunity. Q:for rm:homccacmpt sf+Fr � Town of Barnstable Regulatory Services Thomas.F. Geiler,Director D�Epb m Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barostable.ma.us office: 509-862-4039 Fax: 508-79M230 Property Owner Mu..st Complete and Sign.This Section. If Using- A Builder as Owner of the subject.property hereby authorize 1111u1Q,-- to act on my behalf, is all matters relative to wprk authorized by this building permit application for- (Address of Job) r • �T orf 1�� . igna f Owner D to Al Priest Name If Property Owner is applying for permit please complete. the Homeowners License Exemption Form on the reverse side, Q:FORMS:OWNERPERMISS)ON ■■ME■ ■■■ ■■■ ■■■■ ■ ■■■■■■■■ MEMO �■■OMEN no No H MMMmMMMM � .M■ =� ■■■■■■■■■ MENEM ■■OEM MEN■■N■MM■MMMMMMMMMM■■M ME ■■■■�. _■, ■■■■■■■MOO■■■■■■■■■■■■■ mom MEN ��_� ■OEM _ ■M■ ■■■ ■E■ ■EEE loom N ■■■ ■■■ MEN ■NE ■■ ■■■ INN OEM M■■ ONE■NO O■ ON 1 ■■O MEN ■■■ ■■■ 1 i Ill ■■■ ImmillMM■ 1■MM M■■ NINE E ■E NN■ ■■■■IIMMM■I M■■ NONE: IN ON ON M■■ ■■MII■■■■I M■ mom ■■■ 1 �JLNM ENE NOMINEE ONE . 000E ■MENNEE ■■■ mom mom MEN ■M■1 ■EM■M ■MEN 1■ENOMONE■ NN N■■IMEMEM■■■ M■ME ■■■■■MOON ■■ ON MMMMMMMM ■■■ ONEMENN■ MONO sm- L Sm ol OMMEME M■OON■MMEM■■■■■NONO on ■■ONE■■O ■■ NM■, ■MEMEMONEENOMEN■ MENEM MENEM mom INIMMILORMINIMIMME M MA 'PIS MENEM MENEM NONE mommom �q ■■■■■■O■■■NOOO■■■■■■NO MOO■■■DODO MEMEMEM■■OMMMMMMM■MMMM O■EEMENEEN No ■■■■MOO■■■■■■■■NOO■OON■■■ONNOO■■■■ ■■NO�■■■O■MOO■ONO■■�O�OSNEM■■■■O ■MONO■MOOSOOOOOO■■■■OOOIIOON■■■■■ ■M■■MMMMMMMMMMMMMM■O■■NNOME momMENN■NNOMEMEMEMMEM■■■EMMOM■ NMEM 0=1 INMEMMEMMEMIllMEMM■■MMMM■MM■MMM■MO 1 I 1 I o -� �-i i� m a v fl D E 01 I certify that this property is located in Flood Hazard Zone C (out- side the 500 year flood) as identified -by the Department of Housing and Urban Development (HUD) . Date 15- Zoog CERTIFIED PLOT PLAN `No� � LOCATION Wa r C3A/z!ys rA !f9�. SCALE . .�u•Go'. . .... DATE M!!2- z2 200$. IV Reg. L^ag d I uLw ►N PLAN REFERENCE '�'f61sTC� ,A5, S/{o way .e.�r. l,L.l3lC,•. 4Cz . . . . . 1 LAMD PG. 34L I certify to its title insurance company THE LOCATION OF THE ORIGINAL DWELLING that there are no visible encroachments SHOWN HEREON,EITHER WAS IN COMPLIANCE or easements except as shown and that this IN EFFECT WHEN CONSTRUCTED (WITH TH THE LOCAL APPLICABLE ZONIN9 BWS plan was prepared under my immediate RESPECT TO HORIZONTAL DIMENSIONAL supervision. REQUIREMENTS ONLY),OR EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER M.O.L. TITLE VI1,CHAPTER 40A,-SECTION To UNLESS 1//& 7_6,e /cam T, OTHERWISE NOTED OR SHOWN HEREON. '000 1 'v^I' RECEIVE.,.. .. t i 1 JUL 6 7 fJ 'HEr° Barnstable Old Kings Highway Historic Distr�t X j0 &,ST B,F , 200 Main Street, Hyannis, MA 02601;TEL: 508-862-4787 Fax 508-862-4784 10� 9pp 039. `e0 rEDMP�4 APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made, with four(4)complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings, or photographs accompanying this application for: Check all categories that apply; 1. Building construction: ❑ New ❑ Addition Alteration . 2. Type of Building: ❑ House ❑ Garage/barn Shed ❑ Commercial Other o v , 3. Exterior Painting, roof ❑ new roof ❑ color/material change, of trim, siding, window, dim—r 4. Sign : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign r. rn CU 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ tennis court Othe" N 6. Pool ❑ swimming ❑ Other man-made pool � Type or Print Legibly: Date: 01��/L�t/ Address of proposed work: House# 112 n �`---r Street: KS'�K2 jocr`l Village 14),A"05X 2ble Assessors Map Lot# ads Description of Proposed Work: Give particulars of work to be done: /r,e�t2 w btu} .-s A/z 5 `'x zz I a� arm/ dv! za x I�6 Z�� , "WA/ Agent or Contractor(print): �,L�Q/L Tvle.)i n 9, Telephone#: Address: ' GL�`LIr � ✓Q �� Contractor/Agent' signature: NOTE All applications must b"s' ne by the current owner _ Owner(print): Te'lQ/� Telephone#: s F Owners mailing address: Z BfZArsA^ Owner's signature: I f For committee use only. This Certificate is hereby APPROVED/DENIED ® Date �� I Vembers signatures " R®v P P r AP Cit 4 Town°{Ba('+ShwaY .� Qid�09 e Any conditions of approval: �eQ acW,%VX6W5 ova 6aOe t� S� 1, Q:I GMD-Groupsl Old Kings High waylOKH New AppIOKH Cert Appropriateness 07.doc it .• of1t,F ram, Town of Barnstable � �t# , � gyp, Expires 6 monthfrom iss e date Regulatory Services Fee BARNSTABLE, vimMASS. Thomas F. Geiler,Director plfD�rA Building Division �p Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number �7 9 Property Address 124 Aff2gShl"ee .. &/ wea Residential . Value of Work 1$30069 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address y I KAx,G Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ,�, oco eIT ❑Workman's Compensation Insurance Check one: Q C I 2 5 U�o ❑ I am a sole proprietor I am the Homeowner ."OWN of gARNSTAB� ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed) (not stripping. Going over existing layers of roof) Re-side P4006 �, #of doors -O Replacement Windows/doors/sliders. U-Value i 3c7 (maximum .35)# of windows 7 WW t�,0,W.9 `Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,,�onservauon c. ***Note:. Property Ow,er m sign Property Owner Letter of Permission. A copy of Ho a Improvement Contractors License & Construction' Supervisors License is f required SIGNATURE: Q:\WPFILES\FORMS\building erm' s PRESS.doc Revised 072110 t. r the Commonwealth of Massadiusetts Department of Indush al Accidents i Office of Investigations kiri 600 Washiuglort Street Boston,MA 02111 rt»vrumamgov/din Workers' Compensation Insurance Affidavit: Bu lders/Contractors/ElectricianMumbers Applicant Information Please Print Leeibly Name(Busmess/ommizationllndividuat)_ V!K-K-t /l>le'li rc? Address: 125" O',tn'9asA Jke A?/ City/Stat&Zip:V �/ ,�j�P / �1���Phone# ("6 A95 6 15Y5 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6- ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7- ❑Remodeling ship and have no employees These sub-contractors have g- ❑Demolition working for me in any capacity- employees and bave workers' 9. Building addition [No workers'comp.insurance Comp.insuranceI required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3`?I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions 7// __ myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required-]1 c. 152,§1(4),and we have no employees-[No workers' 13.0 Other comp.insurance required_] •Any applicant that checks troy t#1 mast also fill aut the section below showing thee¢workers'compensation policy information T Homeowners who submit this affidac•rt indicating they are doing all waak and then hire outside contractors mast submit a new affidavit indicating such. !Con=tors that check this bat must attached an additional sheet showing the none of the sub-comractors and state whether air not those entities bare employees. If the sub-conttactoes have employees,they must provide their workers'comp.policy number. lam an employer that is providing tvorkeers'courpertsadon insurance for my entplWem Belosv Is diepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.4: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiation date). Failure to secure co-.erage as required under Section 2.5A of MGL c- 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the Y.Oator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DlAf#ins#ance coverage verification. 1 do herieby cePWW y nn 'tl ' s and penalties of perjury that the inforataiion protzded above is trite and correct Si tune: Date: P'71221001-0 Pb—P. Official use only: Do not write in this area,to be completed by city or town q,Q`fciaL City or Town: Permit/License# Issuing Authority(circle one): 11 1.Board of Health 3.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: w Town of Barnstable Regulatory Services BAIMs s SBM M . Thomas F.Geiler,Director 1659. iOlEp 0. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: O9/2 JOB LOCATION: 725 ��RKS�i�/�2 �kbi� &?RnslFazle number / � street village "HOMEOWNER": V JK' ag alelKq 013)62S-6585 name //J� home/phone# work phone# CURRENT MAILING ADDRESS: �5- AeRe s-l? Re 6e Grp % Z&PSIV6116 AL �26d� city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned" meo er"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures an erns and that he/she will comply with said procedures and requirements. Sigma re of o caner 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 ofthis 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 ofawareness 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 caret amend and adopt such a form/certification for use in your community. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 t�rBarnstable . of Town of *Permit# , Expires 6 mouths from issue date ♦ r Regulatory Services Fee + BARNSTABLE, + 9� b 9 `� Thomas F.Geiler,Director �f0 MA'I A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis,MA 02601. 1 -. .. www.town.barnstable.ma.us Umce: 3uo2-403` rax: �U8-/JU=61SU EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Pre s Imprint Map/parcel Number 42� Property Address ',�� �P��KS�Lf lZ2 I2�1n/ Residential Value of Work$,57©0 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address V /�KfO( (ifp Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: X-PRE PERMIT ❑ I am a sole proprietor I am the Homeowner S F P — J 2009 ❑ I have Worker's Compensation Insurance Insurance Company Name TOWN OF BARNSTABL,E Workman's Comp. Policy# 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 r :Replacement Windows/doors/sliders.U-Value 3® (maximum .44) 9 C J t $0 "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.His toric,IConsen on etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of tle—Homejxprovement Contractors License is required. SIGNATURE: C:\Users\decollik\AppDa a\ ocal\M' ros in s\Temporary Internet Files\Content.Outlook\MY7NB41L\EXPRESS.doc Revised 1.00608 i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizationflndividual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the s Lib-con tractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance.# 9. ❑ Building addition [No workers comp. insurance p required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 1 1.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] °Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for any employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year impr' nment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against�th ,iolat . Be advised that a copy of this statement may be forwarded to the Office of Investigations of the.DIA for ' nc coverage verification. I do hereby certify unde p allies of perjury that the information provided above is true and correct. Si nature: i Date: �Q Phone#: `� S �� 0� Official use only. Do not write in this area, to be completed by city or town officiat 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#: c Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver'or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or td construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence.of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractors)name(s), address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit 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 pen-nit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies.should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia Town of Barnstable 1' Regulatory Services aARxstas Thomas F.Geiler,Director Mass. 1e39. ,�� Building Division QED MA't a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: DD JOB LOCATION: /Z kiS ILLY number, street village "HOMEOWNER": V txl o e --6K—?3J_ name home phone It / work phone 4 CURRENT MAILING ADDRESS: S C? city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"ass es responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules regulations. The undersigned' meo r"certifies that he/she understands the Town'of$arnstable Building Department minimum inspe n pr dures and requirements and that he/she will comply with said procedures and requireme Signature He o er Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORM S\homeexempt.DOC �ZHE Town of Barnstable Regulatory Services BAMSrABM Thomas F.Geiler,Director Maas. ;or� � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 �t 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. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form:on the reverse side. Q:FORMS:OWNERPERMIS S ION s ' Of Town of Barnstable *Permit# y �2egulatory Services PEires6nrontksfromissuedate snxxsrnste, Thomas F. Geiler, Director Piz 16S9. a.�� Building Division Tom Perry, CBO, Building Commissioner AU� � � � 200 Main Street, Hyannis, MA 02601 2 rn www,town.bastable.ma.us T cbk 8-86A688 Fax: 5087790-6230 SARNS EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY AeL Not Valid without.Red X-Press Imprint Map/parcel Number Property Address ��s / ,�lGj�/ 112-1 residential Value of Work 4;-�_0 2 ' �Minimum fee of$25.00 for work under $6000.00 Owner's Name& Address V Jt� 1 jt2 e'rlC:-g — 4ZSe�2lGsl� �e �� / Acre Contractor's Name Telephone Number Home Improvement Contractor License# (if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor 21 am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) I le-roof(stripping old shingles) All construction debris will be taken to - ❑ Re-roof(not stripping. Going over existing layers of roof) 0, Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt complian th other town department regulations,i.e. Historic,Conservation,etc. ***Note: Property Owner m t sign Pr e Owner Letter of Permission. A copy of the P Imp r ent Contractors License is required. SIGNATURE: Q:\WPFILES\FORj%4S\ i ding permit forms\EXPRESS.doc Town of )Barnstable mop YHE rti Regulatory Services • r3wxrtsrwt3c.s, . Thomas F.Ceiler,Director Building Division o��Aim g Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 www.town.barnstabl e.ma:us Office: S08-862-4038 Fax: 5.08-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: a"OJBOCION: GGSh1 6� v az number street village V-i v��i` 6' 6B S —6 Sc�S "HOMEOWNER' f GG name / home phone# work phone# CURRENT MAILING ADDRESS: ,/ / Lt - /�,e� city/town state zip code The current.exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"ass responsibility for compliance with the State Building Code and other applicable codes, bylaws, es r gulations, The undersigned"h 'certifies that he/she understands the Town of Barnstable Building Departrnent minimum inspec j ro : d requirements and that he/she will comply with said procedures and require 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 perm foring 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 parson(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption aie unaware that they arc assuming the responsibilities oCa supervisor(sec 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 Hrith a licensed Supervisor. The homeowner aeting.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, nb m ilitics of a Supervisor. On the last page of this issue is a for currently used by that the homeowner certify that he/she understands the respon several towns. You may care t amend and adopt such a fom✓certification for use in your community. °F"(HEr, Town of Barnstable Regulatory Services IARNsrA, MASS. Thomas F. Geiler,Director 6s q.'V�A t `�� rE ); . Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder l as Owner of the subject property hereby authorize l-�i Gls to act on my behalf, in all.matters relative to work authorized by this building permit application for: (Address of job) Sign f wner at 1(,2 I-e-1 Afl P Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. The Comrnortwealth of Massachusetts Department of industrial Accidents Office of investigations 600 Washington Street Boston, MA 02111 ww'w_mass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors[E]ectricians/Plumb erg A a Ucnt Information Please Print I e b Name (Business/organizahonflndividuat): ff I 1 Address: City/State/Zip:W, Phone.#: Are you an employer? Check the appropriate bar: Type of project(required): 1.❑ I am a employer with 4. [] I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sob-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑R-cmrodeling ship and have no employees Thcse sub-contractors have g. Demolition employees and have workers' working far mein any capacity. 9. ❑Building addition [No workers' comp.-M M-aMC comp-e a '�'�'n�'$ 10" Electrical repairs or addition rtquir�] 5. [] We arc a corporation and its � El l p 3. I am a homeowner doing all work officers have exercised their J LEJ Plumbing mpaixs or addition myself [No workers' comp. right o£exemption per MGL 12 ❑Roof repairs incvrance r t c. 152, §1(4), and we have no j employees. [No workers' 13"[] Other comp,insurance required.] An applicant that chccl5 box#1 roust also M out the section below showing their wonicrst'compaisa.tion policy iafMwation- t Homeowners who submit this affidavit in3cating they arc doing all work and than biro outside cmtr-t rs must submit encw affidavit indicating mch- IContxaetors that ehxk this box n mut attached an additional sheet showing the name of the sub-eaotracton and state whether or not those cnti$cs have cmployccs. If the sub coniractrns have auployccs,they must pT vi&thca woTken"comp.policy number. I alit an employer thid is providing workers'compensation insurance for my employees. Below is the policy and job site informadom lmsurencc Company Name: Policy#or Sclf--ins.Lic.#: Expiration Date:. rob Site Address: City/StaS-.c/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and"expiration data; Failure to secure coverage as required under Section 25A of MGL c. 152 can lcaxl to the imposition of crinirial penalties of: fine tip to$1,500.00 and/or one-year impnso fit, as well as civil penalties in the form of a STOP WORK ORDER and a f of up to$250.00 a day against e viola-to e advised float a copy of this statement may be forwarded to tha Office of havcstigations of the MIA fo v c verification. I do hereby certify render a�a' d penalties of perjury that the information provided abo is a and correct 5i c: Date: t� Phone# '7 official use only. Do not write in this area, tb be completed by city or town official City or Town: Permit/License# Iss dng Authority(circle one): L Board of Health 2.Building Department. 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspa6tD 6. Other. Town of .Barnstable Regulatory Services Thomas F.Geiler,Director o,• Building Division s.�xxsTeBr.e. 9 HASS, Tom Perry,Building Commissioner �iOTEp (66. 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Approved: O Bee: Permit#: HOME OCCUPATION REGISTRA ON Date: Name: VIK 4cf 1o1c_z'i6Q Phone —6W -6_�5_e6 n � Address: r-- Name of Business: Type of Business: &l'r de&Lad/Q Al Map/Lot: j U C, 6 1 4501 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 t;the following conditions: m F' The activity is carved on by the permanent resident of a single family residential dwelling_unit,located within that dwelling unit. co Z • Such use occupies no more than 400 square feet of space: o x y • There are no external alterations to the dwelling which are not customary in residential b3. dings, akd therels no outside evidence.of such use. ffi• No trac will be generated in excess of.normal residential volumes. ca NJ• The use does trot involve the production of offensive noise,vibration,smoke,dust or oth r particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects, r There is no-storage or:use of toxic or-hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met.on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment • .There is no commercial vehicles related to the Customary Home Occupation, other than one van or one pick=up-guek-not.to•exceed•one,torticapacity;and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked•on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or.advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit . I,the undersigned,have read and agree with the above restrictions for m ccupation I am register' Applicant• Vi v 4Q.P_ �U -2��cG0 Date: t'2 1.�_VVe YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: i'�/2,�� C' Fill in.please: r APPLICANT'S YOUR NAME/S: K ax, / 711�, _ ;BUSINESS YOUR HOME ADDRESS: Z /G = ; TELEPHONE # Home Telephone Number NAME OF CORPORATION: NAME OF NEW BUSINESS"CU'I�C-LiYcl G01 k6 V�q TYPE OF BUSINESS Cny-, 9-0 OVJ IS THIS A HOME OCCUPATION? -�l' YES ` NO ADDRESS OF BUSINESS " A CiQIVnS! is nk MAP/PARCEL NUMBER (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street),to make sure you have the appropriate permits and licenses required to legally operate.your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been info med of any p ,mit requirements that pertain to this type of business. Authorized tature** COMMENTS 0 t2 i 2. BOARD OF HEALTH This individual h s be informed nit requirements that pertain to this a of business. � q P tyP -' '��STCO�LYWITNALL Authorized Signature** MAZMDMNATERIA REGMTIONS COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual h en info ed of the li nsi egjg&ements that pertain to this type of business. Authorized.Signature* COMMENTS: Assessors oe(1st Floor): �_ SE s 7 Assessor's ma d lot number . � Ol U9 lIV$yqLLE®jN �g M Conservation✓1� ,� ?�( c,, VO waff Tr-rnu � .o `e Board of Health(3rd floor): TOWN , Sewage Permit number ����� T J Engineering Department(3rd floor): �� ULA 39`lea' House number & ; �tr Definitive Plan Approved by Planning Board 7— j _$7 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO R,e• ~ (S-/ / TYPE OF CONSTRUCTION t9 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according Jto the following information: Location / or, Proposed Use Zoning District Fire District u/— dJf ;P ,1 /677 Name of Owner r�pirl L'L�4,dy L Address ,414t o ot 14 if Name of Builder � >�. ( 1 I�� �Lri��J Address '3 e1 '7/92-, �� f 'r /re, T Name of Architect Address Number of Rooms C�� Foundation �Li✓c%G C rtiC Exterior 'JICi Roofing Floors �C)rJ/) Interior Heating �� `7�7— �� Plumbing Fireplace 4-1 Z)L Approximate Cost v`/Zi Area �� a.�Q•� V' Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Constructio Supervisor's License d ;FPO 7 i a VANDYK, BEN 41 -�No 34849 Permit For 1 z Story :.114 Single Family Dwelling Location Lot #16 , 125 Berkshire Trail West Barnstable Owner Ben Vandyk Type of Construction Frame F s Plot- Lot Permit Granted February 24 , 19 92 Date of Inspection l '`� 19 Dat C let 10 , '— 19 AW 3 . w- .. Y1„VV'".rc-�r^".:�•+�F ..��•�Vr`�'�� Y+'+.;y'r7Y y..,/"\'Ir7y1"�? ..r i�. �.u11�°+f Nfl�tl` '�' .r4t��+"t�L�' { _ � � 4 h,7 ',��,,. -,..f tii +-7� t �Y-1�Srr �y,r' .r:r�r' "�, �TA+�'� �4 ��i.f"1t1-�v.� �-':�:::+�ti.,...�, v�y'4•-�.' � T"" Permit No. . TOWN OF BARNSTABLE AI.M9 o' O BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash '6yp. 9�o•�Y'' HYANNIS,MASS.02601 Bond x CERTIFICATE OF USE AND OCCUPANCY Issued to Ben Vandyk - Address Lot #16, 125 Berkshire Trail West Barnstable, Ma USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. .......... '..? �.!...... 19.......g2..... ......... ................... .... . . ............ Building Inspector f TOWN OF BARNSTABLE BUILDING DEPARTMENT TOWN OFFICE BUILDING rua �°b i619 HYANNIS, MASS. 02601 �o lur►^` MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been FF issued for' the building authorized by BuildingPermit $#._ ..C;�,l....�i `�C�...... .........................................................................».._......»»....._.......:»........»..»»»..»».... issuedto ..................._.... y .._.._.................................................................»........... Please release the performance bond. BUILDING PERMIT NO. :.4A ASSESSORS PARCEL NO. /Q CONTINUATION OF ROAD BOND The undersigned owner/contractor hereby agree to maintain their road bond in force until, the. following work items are completed to the satisfaction of the En gineer�:.g Section of the D,epar=ent of Public warts: loam and seed shoulders as soon as weather pe yits: other (e_xmlain) t LOCATION': k0 / 0+"t S"ff (G,,7NZ /CO:;1.,AC±OR) (print name ) [:;G NF7=..: u rl sIZnTION OFBARNSTABLE, MASSACHUSETTS BUILDING PERMIT APPLICANT r-L )A TE 9 PEPmi*r NO, ADDRESS __!L0 J 9 9 0 S P E E I I I C ON T R'S LICE NS F I PERMIT TO STORY o NUMBER OF (TIRE DWELI:NG uI,4i TS 1 PROPOSED LSEj I AT (LOCATION) ZONING (NO.) y 15 T Q E E T 1 015 TR IC T_ BETWEEN AND (CROSS STREET: SUBDIVISION LOT LOT BLOCK SIZE BUILDING IS TO BE n,, r T. LONG BY N HEIGHT AND SHALL CONE Or!M IN C ONST A UC I ION TO TYPE USE BASEMENT WALLS OR FOUNDATION I I'PEI REMARKS: d AREA OR VOLUME ESTIMAT PEP)Aj T r r E 0 COST FEE OWNER ADDRESS EIJH_pIlJG DEPT. By F,P* O­Y,T,H-,E, E­P'A P, T m N 7 Cr OF ANY APPLICABLE Y,N,MUM 01 lHQEF, PLA.,,S MUST BE RETAINED ON jOB AND THIS INSPECTIONS REQU to WHERE nE APPLIC t-BLE SEPARATE o EPM!TS ALL CONSTRUCTION Wor6�� KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ARE REQUIRED FOR I. W-ERE A CERTIFICATE OF OCCUPANCY IS RE. MECHANICAL INSTALLATIONS. OUNOAT;ONS OR ELECTRIC4L. PLUMBING AND 2 PRIOR TO COVER I G $ Q BUILCING SHALL NOT BE OCCUPIED UNTIL k,C v B E P S 1 0 E A D Y Q I.. 1 9 1 N A L I N 5 P E C 0 q r '.-'-L !1;5PEC.TJONI, HAS BEEN MADE, OCCUPANCY. POST THIS.. ..(:ARD SO IT IS VISIBLE FROM STREET RUlt DIN(,INSP;.: INSPI.CTIC"N-,.ppp0v.,t.s 2 2 .444 DEPARIMENT H: NIGINCERI KC, INSPECTION-'.XR�VAt S E su '-ALI OTHER 4ry C-.52 ',HA N!" P:V EPYIT ll!LL �,E'OME 'BULL AND VOID IF CONSTRUCTION H,%'- App.` III;: !s NOT Sl,� MONTHS OF DATE I - ArTED WITHIN THE F!r'- BY IL!.LPHUNL OR VVHI:I i I,. CONSTRU(;Tl(')n -IERMIT ;S ISSUED AS NOTED ABOVE. N0lIFI(,4IjUN LOT 13 LOT 16 �e LOT �a 15 LOT 17 o� 36.p' sz_ C0 0 W N63°49'09 E 129.68 L _ 225 2' yj E R - 3 �7BERK i TRAIL FLOOD ZONE _C FOUNDATION CERTIFICATION RES ZONE.' "RF" TO WN.'BARNSTABLE SCALE.•1 "=50 PL.REF.-462 34 ELEV N/A I CERTIFY THAT THE ABOVE FOUNDATION IS LOCATED ON YANKEE SURREY CONSULTANTS THE GROUND AS SHOWN, AND r �Q�S\A OF Mgsfq`^ q 143 ROUTE 149 P. 0. BOX 265 ITS POSITION DOES _--__ o� PAUL ��,� MARSTONS MILLS, MASS. 02648 CONFORM TO THE ZONING LA W A TEL. 428—0055 w SETBACK REQUIREMENTS OF ��Rir�E N FAX 420-5553 Q � No. 32098 0• B_AR_NSTABLE___ ®'Fs '�EcisTER�°�Q,`` �9 �— �THE -- At tAN JOE PA UL A. M DATE. ?zl NUMBER 50103FND Awr OF 2A10 COMMONWEALTH AVE. (' � r _ MASSACHUSETT$. OSTON,MASS.02215. a. B • ESC r f)( Q H.ECK OR.MONEY ORDER .LIC ENS E•:' EXPIRATION DATE CON.STR. SUPERVISOR x.. �J j" FOR REQUIRED FEE;. '06/30/1993 ff RESTRICTIONS ` ' EFFECTIVEDATE_ LIC-NO. �. o^ y ." MADE PAYABLE T.O :.NONE: .; r• U`6%30/1/991 009.909 ' ';;50;:. CdMMISSIONER OF PUBLIC SAFETY" ... ON P- B R X TON (DO.NOT SEND CASH). -SS 024=44-4269 ? CEDA'R`ST W " BARNST:ABLE MA 02 1 66$;•;.P AS"E .N� "F INC EAEs • PHOTO(BLASTING OPR ONLY) FEE: �' �.'�•" >i`,'• 100.00 ECT3'VE F 1//��.. 1989 HEIGHT: NOT:VALID-UNTIL SIGNED By LICENSEE,AND OFFICIALLY n I�)��r:'• DOB: STAMPED'-OR`-SIGNA'fDRE%OR�tNE;;COMMLSSIONER o •t' I+� _ 1 Y 03/31/1955'.. .1 =a p • �0 .. , �t.�/�• ' TH CUMENT MUST BE. - X �E A Cs L• _ N$ c�Ilp IS CARRIED ON THE PERSON OF %.�c_.. - - • N.c.; �-.j I - " '• R„ E '�4 Yo •i THE HOLDER WHEN ENGAG- A' - SIGNAT.; E OF LICE�,EE)yf I'., SIGN NAME IN FULL-ABO E SIONAT'�1RE LINt •OTNERS-gIGNT THUMB PRW7 EO IN TNI$ OCCUPATION. . •' OA1M6S 200M-2$ 97 814z t.". c1/�,• C91t3Nc i ; r :^� t � � I t Olvl F 0 CD Y'r'G S j"t --------- -- E p e L I- o 1, N �\ 6Or I i! F� ,Id I• Y p- P � /IF A I 7 i r __.._WuDr.K .xesi�eN�e_::-. . ARCHI-TECH A550CIATE5 ' ". r r e 14s, HHRKSYIRE 1XAILS _t+ac_ecucTe �e, He:-"- a r c h I t e c t u r a I d e s i g n 4 I EEN Pt+u lJtuTlou rL41Js�10 1J5 bell tower mall.1600 Fouta 28 (BOB)771.3900 ' u oeetervllle•ms 02632 fax 776.0770 I ' al-'' III-'' nl'� rl-e' III-►I I yl n n e 7� — J � I I •i ,• I I I•II•I ;F - z o ----� �• A I'i. €il;ll jl'.i ,i 1, ., y L_ II i w I I .:k I OIO III —I I - yy � P I�I_sl Y Seth<I��' vie— I - 1 i A ' - \- y - e•ngYYe - .I li I =_ A 'i.a1 nuu_ y- _ 9 R. I , eVAWDYK IZP.41C>r-LIGQ ARCHI-TECH A550CIATE5 1� F. .. .. Lor 1 , BGK'KA•rwa TK IL4 O y W"r f6RYSM—m. architectural deeign 1 g �L i'3 _fL ooK .Pt_aNs� bell towerm"II,1600 rouse 28 (808)771.3900 �J eeneervlile,ma 02632 fax 778.0770 0 I I ❑. FIE is i I�I•I m � I , I: I I I; ° i ! I ' : •�-!I;;,!,i,,�!� i I I I I �' I IIIIII Ii' S!,' Ilj. ,I��il,�!, .II I� IIII1, !: 'i:,!•I;I1�Illi I gum All _ I 'IL,I _ I. ll'�I':' j{I :'I'.iill'�I '�� I:1••''' iI I it IIIII i O C] l I S L Yi__' `! • - - I•I;'j�; !' , ` !. it 'I! �, tl R O1 .1 i 1 —r 1 — 's' '.i,'I ;I Hit I n I I I i:'i;' .I�I';i il. I, �i —a � I. !1' •II!I,. I ' n I � ,'' l1 jl i''���III' •'�i :'ij•� u r d 'i ' I I''' �li �il � , - I II"'I I i � i� ! �` I I it it .. z ;C�il• In,IL .i:' .i II I,if �". lj �I i IIIII! I' lil, �I''I!I il: �,!I:I ,i�l; I•� I .. . - K:ID..... '°, ARCHI-TECH A550CIATE5 . -1 x .L.T- .Vd K4LTL0 W� H64�. l P architectural Cleo lgn P R I �f\ .I .��saerlouc Q JJ A it ball tor'rer mall,1600 louse 26 (908)77(•S90tl % censervllle,ma 02652 fs. 778-0770 t Application to 9�0� JPNr C 0`• `� , ' ♦ ,p�PNS OE.MSS PP�\PH , �. Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF .APPROPRIATENESS Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: Q'New Building ❑ Addition M Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence- ❑ Wall ❑ Flagpole ❑ Other - (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE D 1 i i ADDRESS OF PROPOSED WORK �-o 1--5 ASSESSORS MAP NO. OWNER ASSESSORS LOT NO. 1 I HOME ADDRESS po. SAC (III g6.12 Oz (4e TEL. NO. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). 141 LL-La 13&)z W C--r&g L.E oZ to3 0 bT� Gl2 okl 2261 AGENT OR CONTRACTOR �I NT T -� ASScL, TEL. NO. , — �0 ADDRESSb��� "[� �o GE!-sir —� )�. , �. oZ(o�2 DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). .�a-rs Sign (6ilner-C o tr t Space below line for Committee 4�e. Received by H.D.C. p�ateE C E I u E D The Certificate is hereby !Date . Approved ] . AMPP 8 tb If Certificate is approved, approval is subject to the 10 day appeal period provided is the Act. ❑ 0KHRHDC Disapproved • _.._ � _ - _ � . ..._ Iry 50 70 101) 40 D,C\ %IA I) 911 ' -mod 1d• ��h +mod 9�9FT �M • _ �to0)4Z a1I�?d I d _ q �A a REnr jut0 72011 k'G K OO ' T PRESS o wN OF EAR HISTORIC NSTABL RVAT/oN 12 �fZ vo 1 , e oohs e iy b�cal �00,� y 2,1 Ib R;dc �aov�e _�-4ahgens � �� - - - � � �u` 2►� 2p11 \_ o� u Town of 6 r l hWaY . I old K%n9's N ee . i k committ / 1 I ! � ?-COY ! F 48" 021ou� grtade . . La FLo© k 24 watt x 96r att W*A. �LCD Typ',e al C eae'�►36 ✓Pa{r�l 3/4 s�6t=bfl� ` z-2x8 A N w 44,4