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HomeMy WebLinkAbout0130 BERKSHIRE TRAIL z UPC 12543 No. 53LOR HAST.NrC UN --..__- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. }/CryJ -_ Map Parcel_ J ' Application Health Division Date Issued 01� Conservation Division p� Application Fee Tax Collector Permit Fee '70.0d Treasurer Planning Dept. y Date Definitive Plan Approved by Planning Board O Historic-OKH Preservation/Hyannis Project Street Address / 3o kx'4>2r- ��RI Village GAY ST �i��t�37S�r �Ip �_ r1CT Owner -- 67Ae-1 �. �'�st��RM .S(t54A) Q/4ddress kk Telephone :ta R- (?y/ — nD P K I rllOd ma 017% Permit Request Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay - Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family C./ Two Family ❑ Multi-Family(#units) Age of Existing Structu�r �1 S' YA5 Historic House: ❑Yes RrNo On Old King's Highway: Q Yes ❑No Basement Type: VFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)) °� Number of Baths: Full:existing new Half:existing V new Number of Bedrooms: existing _ new Total Room Count(not including baths):existing new First Floor Room Lunt N 0 0 Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Q P r Central Air: ❑Yes o Fireplaces: Existing _ 0 New Existing wood/goal stove:cW Yesz o �' dZ Detached garage: xis'ng ❑new size Pool:❑existing ❑new size Barn:❑o- isting 0 new size Attached garage:�xistin ❑new size Shed:❑existing ❑new size g g g g s e Other: © Cq Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION' / "Name �o �a Telephone Number °� ��/ ' � 6 rco-JL (� �� `gddreO .-/ Cr-b,2 S7 2rZ T' �CT"niSJ� License# )46P k iN7 dnJ,M- a) Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO IGNATURE AD TE 10 -D 1 FOR:OFFICIAL USE ONLY .. APPLICATION.# DATE ISSUED MAP/PARCEL NO. < ADDRESS. VILLAGE y OWNER DATE OF INSPECTION: FOUNDATION Ole— to FRAME minis ha,c/-o d o��Fi�ir� 0 6 3 3 �t� �i •Jr INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL l GAS: ROUGH FINAL A' FINAL BUILDING alit 2l'hadr! DATE CLOSED OUT ' ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers"Compensation Insuranceffi.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organization/Individual): . ' 60jq 1 Address: r� ' . City/State/Zip: Poflow-1-0AIA. M,4 0/Wrhone.4: 50 7CI51 Are you an employer? Check the appropriate bog: '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 sub-contractors 6. El New construction . 2.El 'I am a ole pioprietor 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 have workers' [No workers' comp.insurance comp. insurance. #• 9. �Building addition required.] 5. We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their '3.�.I am a homeowner doing all work � 11.❑Plumbing repairs or additions myself: [No workers' comp. right of exemption per MGL 12.F]Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' . .13.El 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. $Contractors that check this box must attached an additional'sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below isthe policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M 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 imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do reby certify u der the ains•and penalties of j !th the information provided above is true and correct Simture: Date: .O _ Official-use only. Do not write in this area,tb be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two.or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee-of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold`the issuance or renewal of a license or permit to•operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,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 insrance 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-contiactor(s)name(s),address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. "The affidavit should be returned to the city or town that the application for the-permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate-line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"a1l-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 fo any business or commercial venture (i.e. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this.affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:: The Commonwealth of Mawaeh=tts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 4.06 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov(dia °F'MEZ, Town-of Barnstable yP °^ Regulatory Services ' MAM Thomas F.Geiler,Director 9 MASS. $ f . Bulldincr Division Tom Perry,Building Commissioner 200 Main Street, Hyaffiis,MA 02601 Office: 509-862-4038 Fax; 508-790-6230 Permit no. Date • AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization, conversion, -improvement,removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. . 60 Type of Work: *J �K' Estimated Cost �,500 Address of Work: Owner's Name: MAY * bu$fln/ 600 Date of Application: .10 0/ I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law ❑Job Under$1,000 Building not owner-occupied' 2S,Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES.OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Date Owner's Name Q:fomu:homeafdav _attachment to j �� ` s`'` ' "P i,.r�,��;,,,v=. the house it . .. .._r....._..��� ..... ..-�.1 ! '/'! _UC•�:I:Il�;n.l jliiSi Garr Graham 508-951-1268(homeowner) - -�p---��� -.�• New Deck i 130 Berkshire Trail,West Barnstable i Lsia ix,lc -All framing is pressure treated lumbar Decking is composite material Joist spacing=16 inches on center Riling if requited(deck should end up 18-24 inches high) Baluster spacing=3-/" Riling Height=36" 12"Sonar tubes,48"deep Beams=2-xIO" support posts for beams are 4"x 4"pressure treated 1 ,. uro- ' B sro- ro 23' OFIME'r Town of Barnstable Regulatory Services BAgp9FABLE, : Thomas F.Geiler,Director y MASS. i639' 61 Building Division RFD MA't 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: B 1t6log JOB LOCATION: 134 Cle k. 41i;ZF 2, 6)07 84,e/✓ITfl3(t number B street village ,,/� "HOMEOWNER":(;./t y 91 A)j ktgA f S_dY>•-�I S�- 1��� (M o(�)(�� name home phone# work phone# CURRENT MAILING ADDRESS: �� Ce�R Q �T,Q % Ckte '/@,,A./ N6Pk/,y74 Ad /,A .A city/town state zip code The current exemption for"homeowmers"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requir ments. ure f omeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a fomi/certification for use in your community. Q:forms:homeexempt I Application to ®Yb Ring'.0 3bigbWap Regional 3�ifstoric Miotrict Committee s�.7 L', --— - C In the Town of Barnstable � r -a lq!I; �► I JUL CERTIFICATE OF APPROPRIATENESS J Application is hereby made, with four complete sets, for the issuance of a Certificate of ApproateneS under:Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on-ans, drawings, or photographs accompanying this application for: o �► CHECK CATEGORIES THAT APPLY: G 1. Exterior building construction: ❑ New ❑ Addition ❑ Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign /C 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole 90ther t C TYPE OR PRINT LEGIBLY: DATE % u&I y as - 7 ADDRESS OF PROPOSED WORK /31 ',` � ��� A 1 C. ASSESSOR'S MAP NO. OWNER G�i4-Ky 6re'4Hol'-k .74 i,-�W F 6�4NR^'t ASSESSOR'S LOT Nco1 HOME ADDRESS 5 C"44 6"X77 Mf4TELEPHONENO. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way. (Attach additional sheet if necessary.) AGENT OR CONTRACTOR TELEPHONE NO. ADDRESS DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. 1 Signed A�OywnAgr-tontractor-Agent For Committee Use Only CD This Certificate is hereby Date Approved enied Committee Members' Signa es: 1 BERKSHIRE . TRAIL ( , R=275.00' L=118.35' 31.6.5- ti AS LOT 29 �2 _ '` W rn w LOT 20 LOT 19 g 47787 +/- SF LOT 28 (1.10 +/- AC) LOT 26 i # 92-094 CERTIFIED PL 0T PLAN LOCATION : BERKSHIRE TRAIL W. BARN_ MA SCALE : 1 " = 60 , DATE : 11102192 PREPARED FOR: REFERENCE : L-19 PB. 462 PG. 34 NICKULAS HOMES I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. I Oil 0! S141f ARNE down cape* en l�. H. engineering inc. OJALA '1� CIVIL ENGINEERS fl 1c 6 lANO SURVEYORS R E .: - :: YARMOUTH. MASS. `E. .: ::.. DATE _ g ss SURVEYOR Assessor's office(1st Floor): Assessor's map and lot numberA D THE Conservation - 4 9 �T'IC, YSTEM MUST BE , Board of Health(3rd floor: ALLED 1PI %0%0"1 LiAYdC@ °• 1< DAS)IT�DLE . Sewage Permit number ,. YD � �c ��./E�5 C /�s�p� , ( ) ��Y����fr�AL CODE AND ��O r0 9. EngineeringDepartment 3rd floor: �.�D House number °SS ' t Ito Via� TOM REGU�T@DNS Definitive Plan Approved by Planning Board 1 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF L BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereb applies for a permit according to the following information: Location Proposed Use Zoning District F Fire District Name of Owner---4 / Address Jv Name of Builder 11Iz 4 � �e v Address /00 k S-C� Name of Architect Address Number of Rooms Foundation Exterior Z—J,/ C_ Roofing Floors < JIV Interior Heating �L� Plumbing Fireplace t Approximate Cost �SrlCl V ` T Area Diagram of Lot and Building with Dimensions Fee X —4&) Son � i Z 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 �Q Construction Supervisor's License Z �J/ D. NICKULAS 4 S. 1� No 35512 Permit For 1 z Story Single Family Dwelling Location Lot #19 , 130 Berkshire Trail West Barnstable Owner D• Niekulas Type of Construction Frame Plot tot t Permit Granted November 16, 19` 92 i Dateof Inspect�ro'p 19 l v1Zs Date' o eteD-� /9-, /-9-71 19 :a Cj r - r � ..'' - � ..-.. «� .- ..-.. ..- _.•., r 'tip.,,..-. - . _. - }4 � .- � ...�. n _ ., r TOWN OF BARNSTABLENo. ... .35512 Permit . ........... BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash .Y• HYANNIS,MASS.02601 Bond ......X........ CERTIFICATE OF USE AND OCCUPANCY Issued to D. Nickulas Address Lot #19, 130 Berkshire Trail West Barnstable 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. - i December 231 92 . . 19...... ... ... .. .. ... . .. ..... . . .. ........... .................. ................... Building Inspector °�..° °•`w TOWN OF BARNSTABLE BUILDING DEPARTMENT rua a�1°T 0 TOWN OFFICE BUILDING 1639'r. HYANNIS, MASS. 02601 �o cur MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by Building Permit $k....... J ��__� _. _ .... ._....._ _...... �...... ..� issued to ......4:.J/,/, �-�!N ....................__.................................._................_................ _. i Please release the performance bond. GWN OF BARNSTABLE, MASSACHUSETTS B U•I L D i A=10 -05-007 a Noveraber 16 DATE , 9'Z I PERMIT CIO' APPLICANT Jet �fickulas Bldg• ADDRESS 95� Barns Lab e 1 ,.; (NO.) (STREET) a (CONTR S LICENSE) PERMIT TO Build Dwelling (a) STORY Single Family Dwe'llin UMBER OF. SED USE) ? y; , (TYPE OF IMPROVEMENT) NO. WELLING'UNIiP ' (PROPO - ''AT (LOCATION) Lot #19, 130 Berkshire Trail, W. -Barnstable . :.ZONJUG`•. ISTREET) ,. (NO.) DISTRICT_ r' BET-WEEM- AND ` ICROSS STREET) ' (CROSS STREET), SUBDIVISION' LOT %•. LOT BLOCK- SIZE (.. :BUILDING•IS TO BE FT. WIDE BY FT. LONG BY FT, IN HEIGHT AND SHALL'CONFORM'IN CONSTRUCT)) TO-TYPE'. USE GROUP BASEMENT WALLS OR FOUNDATION REMARKS: Sewag$af 25404 (TYPE) • r r S Bona owME 1268 :'sq. ttr. r S5,000.00 Fee.MIT $ 1'01 50 r (tyBIE/SOpaRE FEET) ;',.• ESTIMATED COST DWNER Nickula$ BOX 5 0,7, W. Barnstable BUILDING DE PT. BY "{`r � �.'dt .R >4 ,. a[ ,i;y; --. •1'�.•...e wM ii c, 'j t �,�ti 1 t Yi UBLIR WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE rTHE APfPLICANT FjROM HE CON DIT IOr OF qNY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL •APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORKi CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICALELECTRICAL�INSTALBIATIONS.O 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERSIREADY LO LATH1. j 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS CARD SO IT" IS VISIBLE FROM STREET' BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS Aaid 2 2 /SAS d/116i.v(i o� ��2 pZ • z� � I HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT R OF 1 z- OTHER SITE P REV APPROVAL (vu�jz- OR SHALL NOT PROCEED UNTIL THE INSPEC• PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION TOR HAS APPROVED THE VARIODUS STAGES OF WORK 15 NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED EP THIS CARD CAN 8i CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR WRI7TEr NOTIFICATION. BERKSHIRE TRAIL \ V I N R=275.00' L=118.35' .31.65'; N 7Z OU�; / ,•i LOT 29 y v i Co LOT 20 LOT 19 f dl h 47787 t/- SF LOT 28 (1.10 +/- AC) 151.10' , LOT 26 \ # 92-094 CERTIFIED PLOT PLAN LOCATION : BERKSHIRE TRA IL W. BARN_ MA PREPARED FOR. SCALE : I " = 60 ' DATE : 11/02/92 REFERENCE L-19 PB. 462 PG. 34 NICKULAS HOMES I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. ARNE H. T down cape engineering inc. �A �6 LA CIVIL ENGINEERS ^ �' LAND SURVEYORS iRE 6A - YARMOUTH, MASS. DATE R SURVEYOR t Application to t e Old Kos Highway Regional Historic bistrict Committee J Q in the Town of Barristable 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: Ef"New Build' ❑ Addition ❑ Alteration Indicate type of building: ❑ House LJ 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 ADDRESS OF PROPOSED WORK L'OT 1 ) gKS1-1 1R� ^(f�-IL- ASSESSORS MAP NO. 1 Q� W- Pa6.�L157613c..-E� Mo OWNER jA ILKL<L-b.S ASSESSORSLOTNO. IS^� t HOME ADDRESS ram. U 13�bx 5-67 W. BdCUIHILE Lam. 27- TEL. NO. 2-(oZ- LIZ 72� FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). �Ie—y-U�ZI f�6. u sT�.�t bz� 10 C) PLL) 44 d—f bo).! F. 0, 1,0,4 1 {6 aJ 0 CA t_i?T A4c"L.L-( ���� 1�� 1 MaIN w. gb �u . oz�S o +� p�(s1 G� Fl"s f? CTOp SLJ)L.b UGr Go. B�1`TE�>;te�t` sue• TE NO.-(L- -1= GoZ�3Z A E T O CONTRA -7 ADDRESS CP • .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). • t Signe / a, Owner-Contr r- gent Space below line for Committee use. Received by H.D.C. 44. Date The Certificate is hereby °' V Date RECEIVE ® Time MAR q 9 1992 4�o By ao I«� fApprovedc�s Y IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period A °1ROVE ovided in the Act. Disapproved ❑ 4WHRNDQ r Fora "A-1" i OLD KING'S HIGHWAY HISTORIC DISTRICT Spec Sheet Foundation Type �1, Go}1L• ' �1 ' �bj1 �0�11�� Siding Type Chimney Type L-A�4 Color, kluVT I',( -/.� Roof Material Color Pitch �l 1► Windows Size Trim Color 1 \� Doors Color L-u�• Shutters Gutters r� Deck G- FL--&-L-4 Garage Doors Color 'g L-\-A il. R Coits .. ill out completely, including measurements and materials/colors to be used. Three copies. of this form are required for. submittal of an application, �IU► �. `I 19~along with three copies each of the plot plan, landscape plan and elevation plans, when applicable. S H1� � aD K` ` t plan need not be "Certified" but should show all structures on' the lot to sc e. . ._. . . �t APF'f20.V IED be Lu 92, g Lu _ vi W cr o 8 , LA I J I/ , I I I N ZZ 1 Yt C }; �ty.—� I u i � I II I • I If➢... �� �� �' c �1��1 Is v ti I uvS a—t_...I I �- I.' I 131-o I I 131_0ll i �•". I I IL_._.__ I - �^ R.., --__e- s` i II� ii 1 III " I Q_ \ rl, , ' \ 1 1 1 I I 1,�� (`l `y..` 1y1 �'•�:H' ,• �I �`�_ '�� I•�q� � �:�:J ...A i - .I _.-._-..c.- yy ffi 'S'"N"_S i; i I AKCH I.-TECH ASSOCIATES' if LJ- architectural c� e5igri � - wulduf,nol•1 >�:..: �Er_T!ohls p (508) 771.3900 o gum— center lace, unit 4, 1650 route 28 Centerville, ma . 02632 fax 775-1945 E Ij II I , I 11 It , Pl lj 1 I I 1 1!II I �I I �I I I III IIII!I !�I !,Mill �� li I I•I,,II,.I�I)I II •I • , i I .I I I I I I I I I I! i { ! 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