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0191 CARLSON LANE
Oxfore NO.152113 ORA MAW w U" i$t ESSELTE f oF ,gy, Town of Barnstable Permit# Building Department Services Expires i VA. romissuedwe witasTnst�. Brian Florence,CBO VMAS& ►`0� Building Commissione avi ( sgg; , O rFp µpal 200 Main Street,Hyannis,MA 1 25 201 www.town.barnstable.ma.us SEQ \,�1 g6`t Office: 508-862-4038 O�� V��v b�K1�x: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number (� Property Address ❑Residential Value of Work$ 4 36DO Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address<-- d' Contractor's Name r r,,w !,Kra Telephone Number -10�)-77 L 74on n Home Improvement Contractor License#(if applicable) / cc 6 2.- Email: r�►noc�,•,�„ �o,,.. Ldw e .�'� Construction Supervisor's License#(if applicable) o $0 2L O7 t ❑Workman's Compensation Insurance Check one: j ❑ I am a sole proprietor �'r`" 1.✓ ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name 5 t_�\ j�e( ,�►.� Workman's Comp.Policy# LiG (-)1 i 7 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 [],'Replacement Windows/doors/sliders.U-Value . 90 (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is re uired. SIGNATURE: ? QAWPFILES\FORMSIbuilding permit formsTYPRESS.doc 08/16/17 7M } • �" U/LG 1QO 11uI7GdJ'7,LucCt(C�0��'/�(IJJ2C�RUJL' . office of Consumer Affairs&"Business Regulation HOME IMPROVEMENT CONTRACTOR �. ;T,ype: Corporation i I Registration Ex iratio': 1`� _ r=_180182 10/19/2018 Mogan and.Co.'rPpa�y,;°Inch: Francis Mogan'Jri--.- 63 Joyce Ann Rd i •Centeryille,MA"02Ci32?` Undersecretary Massachusetts Department of Public Safet-i y. Board of Building Regulations and Standard License: CS-02607.1 Construction Supervisor FRANCIS E MOGAN 63 JOYCE ANN RD CENTERVILLE MA 0263 ' - 0 �-nn^ r Expiration: i T7ie Commompmkh etp&ysadlnrselfs . Dep=fweat&fIndustrialAccid-=ft Office of MWN igadons ' 600 Was1`afivton,S met Boston,MA 02111 ivwsnv nias.Lgov1dta Workers' CampensationInsurauce AfSdavit BuiIdersiContra brslElec&icians(Plumhers Applicant Information Please Print NazIIe(Bd>Smergaaizatioa/Fmdivirhrai): o�w•1 a�o -� Address CitSrfStatel - O,Uj- 1 VxA- phone-A Are you an employer?C heckthe appropriate box: ' Type of project(required}: 1.❑ I am a employer.wita 4. I am a general contractor and I 6. ❑New comshuction employees(full andfor pad-ime)s have lxiredthe sub-contractors 2.❑ I am a sole proprietor arpartaer- listed on the attached sheet 7. ❑Remodeling strip and have no.employees These sab-contractors have 8. ❑Demolition wod:ing for me is any capacity. employees and bate worms' 9. ❑Building addition, INC sva�,comp-irKIM *+ e comp- .an I - reg3ired] 5. ❑ We are a corporation and its 10❑Electrical repairs or aadilions 3.❑ 1 am a homeowner doing all work officers have exercised their 1L❑Plumbingrepairs or additions. myself[No workers'camp- right of exemption per MGL 12 El Roof repairs insurance required-]Y c.152,§1(4)andwe have no employees-[No wod=' 13.❑Other camp.insurance raequire&] 4Anyapphcax dLatchedubozff1umstd1mfiacutthesectioabeiawdwvdn&&vn¢iceWcompensatiaapa&yiafxmaFimt t El omeawnem who submit dais affidavit hbEcztWZ they axe dining off wad[nail then him outside con=x-=s mast submit a new affidavit indicating suck rcouhactoa that checlr this ban roust eurb as addid—I sheet sbawing the name of&a sr-c�and state whether or not fhnse enddes hose emplares.Iftbe ub-c�* L*�1�haveemplayee%dLey=stpxnvidedreir wotters''cmnp•pGIiLFnumbaL lam an etnpioyer that;is prov r;g workers'congmnsrdion inmrance for my enWFvj sex Below is the palicy and job sfte information. InssuranceCompanyName: Sk ,�I, 5�y� 'Poficy#or Self-ins-Uc.;g. FxpindanDate: Job Site Address. /TI a.f/s CityfStatelzip: Ad#ach a copy of the corkers'compensation policy-declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A.of MGL c� 152 can lead to the imposition of criminal pensIN s of a fine up to$UOQ00 and/or one-yam imprison as well as civil penalties in @re form of a SHOP WORK ORDERand a Eme of up to$250-00 a day against the violatar. Be advised that a copy of this statement may be forwarded to the Office of Investigations ofthe D1A for iusumace coverage yedficataioa_ I do hereby esrttfy otrdgr tits pouts and pen aliies of pedury thatAa info rma6ni proud above is true and correct Sienatace. Date: 9 6-7 Phone 50V ?7(. ay7 V Ofi7cid age oatfy. Do not wrke in this axes,to be completed by city ortown oiciet City or Town• PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3.CStylrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#- aformat-zon and Instrucfions f Massachusetts Goal Laws chap<ra 152 reqaires aII cwpIoyeas to provide workers'compensation for their ermploy=- . Pmsuanttn this sty,an arTlayee is defined as-"_.every Person in the service of another under any contract of hire, express or implied,oral or wrrttca. An,employer is defined as"an mdividnal,partnership,associab om,corporation or other legal=±ty;or any two or more of the Rwegoing engaged is a Joird eot rp6se,and including the legal represeafafives of a deceased employer,or the j receiver or trustee of an individual,partnemhip,association or other legal entity,employing employees- However the owner of a dweIIing house having not more than three apartments and who resides therein,or the octet of the dwmUing house of another who employs persons to do make,construction or repair work on such dwelling house or on the grounds or building appir�thereto shall not bwanse of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also stirs that"every stale or local licensingagency shall withhold ffie issuance or renewal of a license or permit to operate a business or to construe burgdings in the commonwealth for any applicantwho has not produced ed acceptable evidence of cdmpIrance with.the insurance.coverage requked." Additionally,MGT-chapter 152, §25C 7)states"Dleiffi=the ccnnnarrwvM nor imy ofifs political subdivisions shall enter into any contract fur the perfannance ofpnblic workunti acceptable evidence of compliance with the ice. regim emus of this chapter have peen presented to the confraCting auihoity." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your sitnaiion and,if necessary,supply sub-contract or(s)narne(s), address(es)and phone numbers)along with their cent Ecate(s) of insunmce. Limited Liability Companies(LLC)or L=tedLiabi yPar�erships(LLP)wiihno emp ces ocher than the members or partners,are not regret ed to corny workers'compensation insm�ce If an LLC or LLP does have employees,apolicy isrequired. Be advised that this affidavit:maybe submitted to the Department of Industr l Accidents for conformation of msrnance coverage_ Also be sure to sign and date ithe aidavit The affidavit should be-retnmed to the city or town that the application for the permit or license is being requested,not the Deparfineat of Tnrinsfrial Accidents. %ouldyou have any questions regarding the law or ifyou are reqrrred to obtain a workers' compensation policy,please call the Department at the number listed below. Self-ms-taed companies should enter their self insor-ance license number on the appropriate line. City or Town Officials i Please be srae that the affidavit is complete and priated 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 conf c you regarding the applicant Please be sure to fill in the pen�rt/license number which will be used as a reference number. In addition,an applicant that must submit multiple permibUcensse applications in any givea year,need only submit one affidavit indicating c:urr ent policy fi fo=oaation Cif necessary)and under"Job Site Address"the applicant should vmte"al[locations m - (criy or town)."A copy of the affidavit that has been officially stamped or marked by the city or to may be provided to the applicant as proof that a valid affidavit is on file for fbtm: 'pemits or licenses A new affidavit must be filed oi±each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial v� (La. a dog license or permit to bum leaves etc.)said person is NOT regoired to complete this affidavit The Office of Investigations would ifice to thank you in advance for your cocpera dam and should you have any questions. please do not hesitate to give-as a call. The Department's amass,telephone and fax number. The COMMMwedft aMassachmseM ' Depaz rot c&IT;&xstdaI Aocident a offl=of jhVMt gRtiC,= � 11�fA E1�111. . T(,-1-#617-727-4900 eat 406 or 1-M-MASSAFF Fax 617`27 7M Revised 4-2447 WW ma g gpV/dia S Town of Barnstable Building Department Services ` KASL . ' Brian Florence,CBO 1639. 6. 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 as Owner of the subject property hereby authorize ct✓t, �1/lvice..� �—� ���• to act on my behalf 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 f Applicant Print Name Print Name Date QTORMS:OWNERPERMISSIONPOOLS Rev:09/16/17 Town of Barnstable Building Department Services Brian Florence,CBO ' Building Commissioner . 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us 039- Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEhffnON Please Print DATE: JOB LOCATION: number street village "H MEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityhown state rip 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. 4 The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection t5 procedures and requirements and that he/she will comply with said procedures and requirements. r Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page 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:\WPFnM\FORMS\building permit foims\EXPRFSS.doc 08/16/17 '4 R CERTIFICATE OF LIABILITY INSURANCE DATE(°�'"°m'"'"' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER T S17 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Schlegel 6 Schlegel Ins Broker Co JIM HINDMAN 34 Main Street PHONE 508 771-8381 EMAIL FAX No: (508) 771-0663 West Yarmouth, MA 02673 ADOREss: schlegelinsurance@gmail.com —` INSURER(S)AFFORDING COVERAGE I NAIC k INsuRED —'----- --------------.—.—._ INSURERA:PHEONIX MUTUAL RICHARD H GARDNER INSURER B:TRAVELERS — MARA GARDNER INSURER c: - 92 PARK PLACE WAY INSURERD: _ MASHPEE, MA 02649-2725 INSURERE: I — COVERAGES INSURER F: CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLA_IMS. INSR ----- AIIDLSUBR .LTR TYPE OF INSURANCE I POLICY EFF POLICY t7(P I — I IN SR —-- POLICY NUMBER — --—M/Cpry MM/DpYYYY I — - A GENERAL LIABILITY LIMITS CPP0709341 8/20/16 8/20/17 EACH OCCURRENCE I S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS-MADE � PREMIS 4( a^Jrrenc�l Is 50,000 X OCCUR _ LMED E P(Anyone person) I S 5,000 i PERSONALBADVINJURY i S 1,000,000 GEN'LAGGREGATELLINTAPP LIE SPER I GENERAL AGGREGATE IS 2,000 000 PRO- ('� i PRODUCTS-CONIP/OPAGG S 2,000,000 POLICYFIECI ! I LOC AUTOMOBILE LIABILITY 1 S 1 COMBINED SINGLE LIMIT i ANYAUTO la accident) S ALLOWNED BODILY INJURY(Per person) I S AUTOS SCHEDULED AUTOS BODILY INJURY(Per accident) S HIRED AUTOS NON-OWNED AUTOS I PROPERPYDAMAGE 1 S Peraccident ) UMBRELLA UABPOL�cAcimu:S-4MAAADE I I S EXCESS LIAR 1 i EACH OCCURRENCE S I �DED RETENTION S AGGREGATE 11 I S I B WORKERS COMPENSATION I TA S AND EMPLOYERS'LIABILITY YIN N WC-0179798 6/3/17 6/3/18I TnRYSITU- ' OTH-I ANY PROPRIETOR/PARTNERIEXECUTl1/E OFFICERIMEMBER EXCLUDED? Y NIA I I E.L.EACH ACGDENT is lOO OOO (Mandatory In NH) I E.L.DISEASE-EA EMPLOYE S 100,000 If yes describe under DESIRIPTIONOF OPERATIONS below IE.L.DISEASE-POLICY LrMrr.5 500,000 I DESCRIPTION OF OPERATIONS I LOCATIONS/VEMICLES (AVaCh ACORD 101,Additional Re—ft Schedule,if more space is regti red) RICHARD GARDNER HAS ELECTED NOT TO BE COVERED UNDER HIS CURRENT WORKERS COMP POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCR�POLICIS-BE CANCELLED BEFORE THE EXPIRATION DATE THEREOILL BE DEUVERED IN TOWN OF BARNSTABLE ACCOR CE WITH THE POLICY P IN HAND, AUTrI SENTATIVE Am 1 ©1 8 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Town of Barnstable *Permitoy $ Expires 6'non Regulatory Se s r issue date g Services Fee NAM Richard V.Scali,Interim Director Building Divisioni� Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERAHT APPLICATION - RESIDENTIAL ONLY. O Not Valid without Red X-Press Imprint Map/parcel Number Property Address_/ 9 I C(r l Son L tV LrkS f �e^�5tG b� ��• O ZCp(�� ['Residential Value of Work$ &&)0.00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Addressk- i G I Cr,,k So✓1 L t.I cA)es 1• M.A 0ZG c.7 Contractor's Name f�;r�a e%1,e If ��elephone Number rb f ;7 7 $ 30 Home Improvement Contractor License#(if applicable) 153 9416 Email: '7 k e A Construction Supervisor's License#(if applicable) D Pzmft ❑Workman's Compensation Insurance ir Check one: I am a sole proprietor JUL I am the Homeowner �c14 I have Worker's Compensation Insurance T Insurance Company Name SS 0 1 a�vl t tml�1�r S --1 h S t4 i•4"0F1RA RAISTg13LE Workman's Comp.Policy# W CC SD// 6 g Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ t(check box) YRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to s r J_ E X d O ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: TAKEVIN_Muilding Cta;nges\EX]PRESS PERNUMPRESS.doc Revised 061313 i The Contntornvealdn of Massachus&m Deparatternt of Industrial Accidents Office of Invesfigadons vi� 600 Washington Street Boston,MA 02111 tvtnv mass govMa Workers'Compensation Insurance Affidavit: Buildet-JContractom/ElectricianslPlumhers Applicant Information Please Print Leldh Name(Business/Organization/ladiviamq: e p v a-Ite n Address: /i;I 544-2eW0110e0d — Ci l tatel2ip: 26 Phone#: Sd$ 7 7(/ '9 3 3 d 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 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These subcontractors have g_ ❑Demolition working for me in any capacity. employees and have worms' 9. ❑Building addition (No workers'comp.insurance comp.insurance./ ram] 5.❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions right of exemption per MGL myself (No workers'�P- 12.❑Roof regains insurance requited.]T c.152,§1(4),and we have no employees.(No workers' 13.0 Other �� - f"OBE comp.insurance required.] •Any applicant that checks boa#1 must also fill am the section below stowing their wo&ers'comgeantion policy inforumdam T lions who submit this affidam indicting they we doig all wetk and then hire outside contractors must submit a new afiidwit indicating suclL lContractors that check this box must attached an 2dilmong sheet showing the acme of the sub-contractors and state whether at tut those entities hate amployam If the sub-coauacmtt hm employees,they nmst provide theme workers'comp.policy mmnber_ lam an employer that is providing nvrkers'c+ongmnsatioti insurance for my entplo3res BelmV is the policy and job site informadon.Insurance Company Name: A S 5 o C d ry e of F=M,qIo y 0,� l ✓/S u n2 o7 e-P Policy R or Self-ins.Lic.R: 1 N C C < 6 11,4 f-7 Expiration Date: _4LJ/Z r Job Site Address: C C lr� So n L m City/State/Ztp:l.U. LAY MS �U_ D Z Co Co Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to seam coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 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 Iavestigations of the DIA for instvanee coverage%wification. I do hereby certi under d tt ahies of boy that the information pm ded above is true and correct S Date /4 phone 9�a 77� f7 3 3o Offleial rue only. Ito not trrite in this area,to be completed by city or ton.official City or Torn: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityf own Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contract Person: Phone#: try aABNSTABM � 639. Town of Barnstable Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 I Property Owner Must Complete and Sign This Section If Using A Builder I,�e ba o.\j-\ L `G a rL c� ,as Owner of the subject property hereby authorize M ,c ti el A-upaa-l ee 4M AI"Oil"lirto act on my behalf, in all matters relative to work authorized by this building permit application for: ko1, . CGS\Sov" - �—o V\sE-�\'Z>Ce (Address of Job) �l�Z.a;t� e• �JavllZ-e- 7 9 �5� Signature of Owner bate 1�ebr�raln C � Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEVIN Muilding Changes\EXPRESS PERMIMXPRESS.doc Revised 061313 / - Ac CERTIFICAT OF LIABILITY INSURANCE / . . | -'----- �~� ^mC ORiDWO COVERAGE EGAJE"WITS TO ALL T AT S"3-1 LOW ALL IA roWS � | � | --------' � i • CONSTRUCTION Certificate of Completion 00Massachusetts Construction Supervisor License00 INSTITUTE ' Name of Recipient: Michael J Aupperlee 0 CSL Number: CSFA-049205 www.CSI-Institute.net Course: Course # Credits Building Code & Continuing Education CS-2904 2 CEU j Lead Paint - EPA RRP CS-2901 2 CEU Make Safety Your Blueprint for Success CS-2900 3 CEU Energy - The Stretch Code in MA CS-2903 3 CEU Business Practices CS-2902 2 CEU f Total CEU Credit Hours............................................................ 12 CEUs 9/20/2013 Course Coordinator - CSI Institute Training Date P.O. Box 2078 1 Methuen, MA 01844 0 "This educational offering is recognized by the Massachusetts Board of Building Regulations and 'I ELEPHONE Standards as satisfying 12 hours of credit for a Massachusetts Construction Supervisor Licensee." 00 ' Massachusetts Construction Supervisor Continuing Education Provider 0 Coordinator M Approval Number: CSIrCD-0029 lie�poo�u��adormeall�a�C� roJac�fcaelGf. Offc0�; f;ConsumerAffairs&.Buss ess- egulatioii d:icense orbregistration valid for individul Al only before the ez iration date. If found return to: OME IMPROVEMENT CONTRACTOR P... egistration: ,,153.40 Type: Office.of Consumer Affairs and Business Regulation xpiration:,�121-1/2014, -DBA•. 10 Park Plaza-Suite 5170 +BQston,MA 02116 MICFRAI AUPPERLEE RENOVATIONS MICHAEL AUPPERLEE` 16�J SANDALWOOD DR, COTU IT,MA 02635 Underse reta r P. Not valid lWithoutsignaWref Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor 1 & 2 Family License: CSFA-049205 MICHAEL J AUPItI,E` ' rli 169 SANDALWODD D Cotuit MA 02635; I 4 "A 1 —��- Expiration j Commissioner 07/14/2016 I a 109988 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel- Application # 2 0 1 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee :?2S ' Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address 191 Carlson Lane Village West Barnstable Owner Robert Oberly Address same Telephone 508-362-9616 Permit Request air sealing, insulate atticspace Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3208 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family .❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's:Highway:t0 YeF❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other > 1 j Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) -- Number of Baths: Full: existing new Half: existing � nevrr Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use. Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name RISE Engineering ' "'Telephone Number 401-784-3700 Address 1341 Elmwood Avenue License # 100459 Cranston,Rl 02910 Home Improvement Contractor# 120979 ` - Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO k w SIGNATURE= DATE Erik%..Nersthemer for RISE e FOR OFFICIAL USE ONLY e APPLICATION# DATE ISSUED x MAP/PARCEL N0. ADDRESS VILLAGE 5 OWNER_ DATE OF INSPECTION: FOUNDATION r,. FRAME INSULATION s , FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: - ROUGH FINAL FINAL BUILDING ! oK F - DATE CLOSED OUT ASSOCIATION.PLAN NO. 'Y The Commonwealth of Massachusetts 0 tam Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly blame(Business/Or ganizationdndividual): RISE Engineering, a division of Thielsch Engineering Address: '1341 Elmwood Avenue G",/State/Zip: Cranston, RI 02910 Phone#: (401)784-3700 or 1-800-422-5365 Are you an employer? Check the appropriate box: I Type of project(required): 1:N I.am an employer with— 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part tune)." have hired the sub-contractors I 7. ❑Remodeling 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub.-contractors have S. ❑Demolition i working for me in any capacity. employees and have workers' 9. ❑Building addition FNIo workers' comp.:nsurance comp. insurance. $ required] 5.0 We are a corporation and its 10. ❑Electrical.repairs or additions i3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑Plumbing repairs or additions i myself [ITo workers' comp. right of exemption perm MGL insurance required] t c. 152, § 1(4), and we have no 12. ❑Roofrepairs employees. [no workers' 13. i Other Insulate j comp.insurance required.] —-- -- My applicant that checEcs br x tit must also fill out the section below sbowing their workers'compensation policy information. T1forneowners who submit ilria P.ffidavit indicating they are doing all work and then hire outside contractors mast submit a new affidavit indicating such. $Cnntactors that check this i,ox must attach an additional sheet showing the name of the sub-contractors and state wh<ther or Dot those eatities have employees. 'if the sub-contractors leave va lovices,they must provide their workers'coma.nolicy number. _ I am an emplo.Yer;us!7r providbzs workers'compensation insurance far my employees.Below is'the policj�and job site information. +nsura�ce Co:s ir.r >.; rr� lbe-Preston_A>?ency _---- — --- L oiicy#o:Se1i-ins.Lic.-,t: 3 73_0961-00 _ Expiration D��a��t��e: �1,/1/11 Job Site Address: -_ -- Cit,r,tate/7i ''��,H�'!5dou ` ---- p--- .d-,t.ra.ch a copy of the workers' compensation policy declaration page(snowing the policy number and expiration (date). ii aiture to secure coverage as required under Section 25a of NIGL 152 can lead to the imposition of crimir._al 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 WORYC.O DER anal a fuie of :3250.00 a.dav against violator. lie ad-vised that a copy of this statement maybe forwarded to tfie Office oY.;:avesti_gatior.s of the CIA for co-varajie veL .t:cation. a 1 do herby cercipj,imd� vdins t'" enalties ofperjury that the information provided above is true and.correct. Ci'11Ci17/..YE: /fir t�� Date: 'rinill%rime: Erik Plers_r_heimer — Phone LOLL )784-3700 -or 1-88 2?: :L61; O cial use only Do not write in this area to be completed by city or town officdal. - City or Town- — —Permit/license Issui.ng•Autherity(circle one): I.Board of Heath 2. Building.department 3.City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector j6.Othey------ -- Contact person:_ _- —�---- - Phone ACOR® CERTIFICATE OF LIABILITY INSURANCE OPID 47TDATEMIDDM/Y) THIEL- 3/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION the Preston Agency, InC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1350 Division Rd Suite 303' HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 8'10 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, East Greenwich RI 02818-0810 Phone: 401-886-8000 Fax:401-8857-1700 INSURERS AFFORDING COVERAGE jNAIC# INSURED INSURERA: Zurich-American Ins Co. Thielsch Engineering, Inc INSURER B: A,, d... G-, nt.. f Ll.blllty Thie Group Inc. INS North American Capacity Hi Techech Rt�alty Inc, 195 Frances Avenue Cranston RI' 02910 INSURER0: Hartford Insurance Company INSURER E' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTW 11PISTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENTWITH,RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR WY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS,EXCLUSIONS Ar.ID CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MqY HAVE BEEN REDUCED BY PAID CLAIMS. II`75R'fiIIO ' LTR NSR TYPE OF INSURANCE POLICY NUMBER OATS(MMrDD/1^/) DATE IMMID ) LIMITS _ GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERA[LIABILITY 3 7 30 9 6 2-0 0 0 4/01/'10 O 1/01/11 PREMISES(Eu oc urence) T300,000 CLAMS MADE �OCCUR' MEO EXP(Any,ono person) $10,000 PERSONAL A AOV INJURY $ 1,000,000 GENERA:_AGGREGATE $ 2 000,000 GENT AGGREGATE LIMIT APPLES PER: PRODUCTS COMP/OP AGG $2 0 0 0,0 0 0 POLICY X SECT LOC Emp Ben. 1,000,000 AUTOMOBIL E LIABILITY h X ANYAUTO 37309'63-00 04/01/10 O (Ea ccid1/01/11 Ca accid6'SINGLELIMIT eniJ $ 2,000,000 ALL OWNED AUTOS BODILY INJURY j. SCHEOULEO AUTOS IPer person) HIRED AUTOS 80DILY INJURY NCA•rOYANED AUTOS (Per ACldent) P'ROPEPTY DAMAGE ; 1— — ?Per accidonl)GARAGE LIABLE Y' - AUTOONLY-EA ACCIDEi+T $ ANY ALfrG OTHER TKt Pl EA ACC $T . AUTO.CNLY. AGG EXCESS/UMBRELLA LIABILITY f EACH OCCURRENCE . ; 1Q,000,000 B X OCCUR F�CLAIMS MADE EIJ*M 9263637-00 04/01/10 O1/01/11 AGGREGATE $ 10,000,000 I $ _1�DEDUCTIBLE ETFN ION 410,000 WORRIERS CON,PENSATION MG I ' 'E14PLOYERS'•UABlUTY X TORY 1_IMITS EP, A I:1iY�'ROPRIc'roRIPARTNF.R/EY.ECJTIV'c 7309ha-00 04;01/10 O1./.O1/11. E.L.EACH ACCIDENT s1,000,000 OFF!CSV.Y.Ehi0ER EXCLUDED? --'-I E.L.DISEASE EAeMPLOYEE $.1,G00,000 Iryes•descrioounder_J SPECIAL PROVISIONS belaN - -�- _-! E.L.OISEA.5E-PoLicYLIMIT $ 1,000,000 OTHER C Professional Liab DVZ000026.800 04/01/'10 ( '04/01/11 Prof Liab 2,000,000 D ' -:Eric:G/Rented Eck 021-T11INTD5618 04/01/10 04/01/11 1 Equipment 100,000 GESCRIP ITCt:OF OPERATIONS I LOC>TIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/'SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION r -SHOUID ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE.THEREO r,THE ISSUING INSURER WILL 8NOEAVOR TO MAIL 10 DAYS WRITTEN t40TICE TO TFtE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO 00 SO SHALL IMPOSE NO OP.LICA.TION OR LIABILITY OF ANY HIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORISED REPRESS IV' - ACORD 25(Z001/08) �� -- �~ ' kFl ACORD CORPORATION 1988 FGasE Engineering, a division .of Thielsch Engineering, Inc. kell Associates,; a division of Thielech Engineering, Inc. BAL Laboratory; .a division of Thielsch Engineering, Inc. ESS Laboratory, a division of Thielsch Engineering, Inc. ALCO Engineering, a division of Thielsch Engineering, Inc. Water Management Services, a division of Thielsch Engineering, Inc. 4v- 1 _ i 1 - = off ce onnd �- ff�aep:ndZuslpe'.-s 10 Park playa - 25- i#¢ "71.70 r' Boston,Lssach��tsetts ?1. 1..Home Improveontractor Registration '-- :Registration: 120979 Type: Supplement Card z w Expiration: 3/25/2012 t^t THIELSCH ENGINEERING , ERIK NERSTHEIMER > -- 1341 ELMWOOD AVE. CRANSTON, RI 0291:0 - A h� Gy•ti s� Update Address and return card.Mark reason for change. Address Renewal .Ej.Employment ❑ Lost Card PPS-CA1 Co 5OM-04/04-G101216 • ,per ✓/xe �anamzovziueall� ��� ' �\ Office of Consumer Affairs&Bu iness Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration979 Type: 10 Park Plaza-Suite 5170 Expira-`fig` 12 Supplement Card Boston,MA 02116 { THIELSCH ENd' ERIK NERSTH _ z 1341 ELMWOOD _ / CRANSTON;RI 029 Undersecretary Not valid without signature � r rage 1 0I 1 The Official Website of the Executive Office of Public Safety and Security (FOPS) Mass.Gov Home Public Safety ®epartinent of Public Safety Licensee Complaints License Type Construction Supervisor - — License# 100459 Restriction WS,IC Name Erik Nerstheimer City, State,Zip North Scituate, RI, 02857 Expiration Date 3/28/2012 Status Current No complaints found for this Licensee. Back To Search 0-1e. Board of 13i1ildino Regulations and StandarYF's' " License or registration val'd-for individid use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registr.'i n:: 120979 Board of Building Regulations and Standards txpaTali:o:n=.3-j25/2010 I` One Ashburton Place Rm 1301 TYP;e:= uppiemerii Card _ •iP�' 0j1,hla. 021-0.8 1 =LSCH ENGINEER-'-N K NERSTHEIM€R _ 1 ELMW00D.AVE �NSTON, RI 020104'-A - Admin.isti::itor t 0 va] - _— ' N t. -.. l�d without signa;ti;`re Ldb.state.m a.us/dps/licde.tails.asp?tXtS e archL N=( .S FJ onz.'-'- Q _ . -s_y T r Y t A 1y E•�-.� �jS NAT-24531 - 1 p RISE ENGINEERING Federal ID#05-0405629 RI Contractor Registration No 8186 A division of Thielseh Engineering MA Contractor Registration No 120979 CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,R102910 (401)784-3700 FAX(401)784-3710 CONTRACT Page 1 R I S E THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONE DATE Client tl Robert P Oberly (508)362-9516 05/07/2010 109988 SERVICE STREET BILLING STREET 191 Carlson Ln Lane 191 Carlson Ln O SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP West Barnstable,MA 02668 W Barnstable, 8 �vf Y J J ' 1 JOB DESCRIPTION RISE Engineering will provide labor and materials to seal areas of your home against wasteful,excess air leakage. This wo e performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements and other unheated areas(windows are not generally addressed.) This work will be performed at the rate of$66 per man per hour,which includes materials and testing. 24 man hours. $1,584.00 RISE Engineering will provide labor and materials to install a—7"layer of R-23 Class I Cellulose added to 490 square feet of floored attic space. $539.00 RISE Engineering will provide labor and materials to install a I V layer of R-38 Class 1 Cellulose added to 800 square feet of open attic space. $960.00 RISE Engineering will provide labor and materials to install insulation and weatherstripping to 1 attic access hatch(es). $25.00 RISE Engineering will provide labor and materials to install a new,finished plywood,kneewall space access hatch.The hatch will be insulated, weatherstripped and held closed by eye hooks. (Wood surfaces will be unfinished. Prime coat and/or paint is not included.) RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for eligible $1 LO measures,the Cape Light Compact offers 75%incentive,not to exceed$2,000 per calander year. -$2,802.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Hundred Six&00/100 Dollars $406.00 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS. REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. D OT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 4y AUTHO SIGNATURE NOINEERWG C T MER ACCEPTANCE 'OTE:THIS C�N T MAYBE WITHDRAVIN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE — ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATION3 AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK -DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 4 Map Parcel Permit# "O 9- Health Division Date Issued Conservation Division r as Fee 1 °� � Tax Collector • • �j/� `lC j l/� Treasurer �CC.•�� Planning Dept. EXfST1 Date Definitive Plan Approved by Mag�i g Board LIMITED 1'O OF BEDR�MS Historic-OKH 4 ` 6 PFeservaffO/ ya Project Street Address /g/ `.Gl e-IToAl 40y/ F Villag��G� T��,,P,f/S7��Lcrz Owner L- /J ,� Address Telephone Permit Request Alwre /gem lzoleit Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new 'Valuation — Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathbred: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes 8o On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl Cl Walkout ❑Other ..i Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use 3 ' BUILDER INFORMATION Name 41e2 �&c: Telephone Number Address 0�/7 Z�612 c/i0/ D4 License# Home Improvement Contractor# /DO/d/ Worker's Compensation s#r�a)e 699a279F ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 199O e A c s; &u4el<- . :ram - SIGNATURE Cam' DATE / �S -ram-- ` m FOR OFFICIAL USE ONLY PERMIT NO. °a DATE ISSUED MAP/PARCEL NO. - 1 ADDRESS VILLAGE OWNER y , DATE OF INSPECTION: FOUNDATION FRAME s INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH ! FINAL r FINAL BUILDING DATE CLOSED OUT s s ASSOCIATION PLAN NO. R n' 9 ♦V -_ _ Th e Commonwealth of Massachusetts Department.of Industrial Accidents - -- . OfllCC OIIOYCSUA8000S - 600 Washington Street -- Boston,Mass. 02111 Workers' Com ens *on Insarance davit I ` name: G�.C1G�CZi .2�y location city /W., DIIOIIG ❑ I am a homeowner performing all work myself . ❑. 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I is • lA 11 • .11.•_• 1 r e11-111 r • t. •1 Ito • /1 .1 • .11 • •.,Io wolA 1 •_wo 11•% o Ld • tit • 1 •.� • •J:1• •It •• . s It .11 • 11 • • .11 V • • 1 s,•• s_/ .10 till 1 t 1 • e • e .lo e 1 • • e • 1• e..`1I Y.1 • •J •.: I MIME m�j��j�j�jjjo�jjj�jjmjj��jj l mmll�jjjjjjOMMEj�j��j��mmv/j�j��j/�j����j�jj 1 • see..el •• �`•. t I ell .11 • .:►' 11 too •�1 11 11 11 1 1 1 • 1 A MCI If 1 . tll 1 1 1 1 t 1 1 . 1 1 � t l • 1 a 1 1 1 I 1111 - � ' ll ll I ' 1 r tHE Tp�, Town of Barnstable Regulatory Services BA MST"L& v Huss Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I y� .eI , as Owner of the subject property hereby authorize 1�l°Pllx/Si�r� /.[Al`. to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) 9/d � Signature of Owner Date I L� Print Name Q - QTORMS:OWNERPERMISSION ov The Town of Barnstable �0g. Regulatory Services �'prEp,,,oi► Thomas F. Geilert Director Building Division Peter F. DiNlatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 f Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date . AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO P ITERM APPLICATION MGL c. 142A requires that the"reconstruction.alterations,renovation,repair.modernization,conversion, ' improvement.removal.demolition.or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors.with certain exceptions,along with other requirements. Type of Work:-&/&(agzir4 � ���•� Estimated cosc��°oa Address of Work: �9� C A���s �•> e- �'��' Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied i []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THM OWN PERMIT OR DEALING WITH UNREGISTERED. CONTRACTORS FOR APPLICABLE HOME IMPR0. VEM8NT FORK DO NOT HAVE. ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL.c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. . OR Date Owner's Name q:forms:Affidav:rev-070601 ; �� v iw !/Viiv//sts'/7sC!/(%CLG{/L �✓v�Q,OdQ,!.��.(IQP.�,� .. ..._......_._,,.,,.._..., ,..-.,... ,:.`_=..,.-_.....,,,.«.c Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR. =5 before the expiration date. If found'return.to: Reglstration; 100121 - - Board of Buildin Regulations.and Standards g Expiration _6%g/2006. - One Ashburton Place Rm 1301 ,,..:.::.�+.. ,._ .._.._..__.. ,. Boston,Ma. 02108 ` Type:__Private Corporation. OCEANSIDE, INC.: .r::-__ Richard Clark 21 T Thornton Dr Hyannis, MA 02601 . Administrator Not valid.without signaturerj ' 41 n$� •S! • E' it , T TOWN OF BARNSTABLE BUILDING DEPARTMENT 2 rams � rua TOWN OFFICE BUILDING 9 +asq• HYANNIS, MASS. 02601 �0 Y M• rA ' I I i MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit $k......_._. .... . ...» ..._.__ . _... ._................ .. .............................................._................. _ _M issued to ...... .. �......... ...... ....... Please release the performance bond. I C TOWN OF BARNSTABLE Permit No. l� ....... BUILDING DEPARTMENT t "j"` TOWN OFFICE BUILDING Cash � .Ml .65V• \ HYANNIS.MASS.02601 Bond .....X......... CERTIFICATE OF USE AND OCCUPANCY Issued to John & Sandra K.rafton Address Lot #8, 191 Carlson Lane 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. I .. .December.. ... .. .... .. 19...9............ ........................................... Buil Ong Inspector I I TOWN OF BARNSTABLE, MASSACHUSETTS BUILDING PERMIT DATE r � NO.—,..,.� I: 19 PERMIT ' I APPLICANT ADDRESS ao (NO.) (STREET) ICONTR'S LICENSEI NUMBER OF PERMIT TO (�) STORY DWELLING UNITS (TYPE OA�F}}IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) 7 �OI1l l�nf bj'-34 _"_ ZONING DISTRICT (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) I LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: AREA OR PERMIT VOLUME ESTIMATED COST $ FEE (CUBIC/SQUARE FEET) OWNER BUILDING DEPT. ADDRESS BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH).3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. , OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPRr)VAI a MBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS APPROVED Q\6, TOWN OF BARNSTABLE x1-9f3 BUILDING INSPECTOR APPROVED TOWN OF BARNSTABLE BUILDING INSPECTOR �2/1-2, 3 HEATING INSPECTION APPROVALS EN INEERING DEPARTMENT 2 ,.BgOARD OF HEALTH - OTHER ram, n��� SITE PLAN REVIEW APPROVAL i WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. OLD KING'S HIGHWAY HISTORIC DISTRICT Spec S1zee� i i CONCRETE _ Foundation Type Siding Type RED CEDAR CLAPBOARD (FRONT) WHITE CEDAR SHAKES (SIDES h REAR) Chimney Type -MASONARY CENTER CHIMNEY Color RED BRICK . RED CEDAR WOOD SHINGLES NATURAL Roof Material Color 12/12 Pitch 44indows RIVCO WOODEN DBL HUNG 12/12 with gills Size VARIOUS Trim Color SAND . SPORT GRAY Doors RAISED PANEL STFFL COlorSAND SPORT GRAY Shutters NONE ALUMINUM GRAY Gutters PT 'PINE/MAHOGANY Deck ROUGH SAWN WOOD GRAIN SANDSPORT GRAY Garage Doors Color Notes: Fill out completely. Including measurements and materials/colors to b' Three copies of this form are required for su�mittal of an applicatio along with three copies each of the plot plan. landscape plan and plc plans. when applicable. 'Plot plan need not' be "Certified" . but should show all structures oni �' to scale. i i OLD KING'S HIGHWAY HISTORIC DISTRICT S p e c SI-zeat-- CONCRETE _ Foundation Type Siding Type RED CEDAR CLAPBOARD (FRONT) WHITE CEDAR SHAKES (SIDES h REAR) Chimney Type 'NASONARY CENTER CHIMNEY Color RED BRICK RED CEDAR WOOD SHINGLES NATURAL Roof Material Color , 12/12 Pitch Windows RIVCO WOODEN DBL HUNG 12/12 with grills Size VARIOUS Trim Color SAND . SPORT GRAY Doors RAISED PANEL STEFL ColorSAND SPORT GRAY . Shutters NONE ALUMINUM GRAY Gutters PT PINE/MAHOGANY Deck ROUGH SAWN WOOD GRAIN SANDSPORT GRAY Garage Doors Color Notes. Fill out completely Including measurements and materials/colors to b' Three copies of this form are required for su�mittal, of an applicatlo along with three copies each of the plot plan. landscape plan and plans. when applicable. 'plot plan need not be "Certified" . but should show all structures on to scale . v i COMMONWEALTH DEPARTMENT.OF PUBLIC SAFETY OF 1010 COMMONWEALTH AVE. ` Fellcre to porress a current MASSACHUSETTS BOSTON, MA 02215 "essachnsotos State Building Code is canrelorre L.I(_:Ef4':i E of this license rocetlon EXPIRATION DATE ()/';:='t-i/:i.':i'" �_-il\{':;i Fi. ;i_iF-'ERVI _I"i CAUTION RESTRICTIONS EFFECTIVE DATE LIC-NO. FOR PROTECTION,AGAINST THEFT, PUT RIGHT THUMB ii / _ - 10 o PRINT IN APPROPRIATE BOX ON LICENSE. -:;: :' F-:5LASTJNG OP ATC�RS m 1: )fit �1._IL_��EFi E�iI:'�{�F ILL"� Z MUSANbLUD PHOT(3� GAGED IN THISOCCUPATION. COMMISSIONER 'Y 1 c. •�� III 7r Application to Old King's Highway Regional Historic District Committee in the Town of Barnstable for a 3— y CERTIFICATE OF APPROPRIATENESS Application is hereby made, id triplicate, for the issuance of a Certificate of Appropriateness u .Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on 1 drawin s;r_photogra accompanying this application for: JUNL Z 10 CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ® New Building . ❑ Addition ❑ Alteration TOWN OF BARNSTABLE Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Oth 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). . — 6/20/93 TYPE OR PRINT LEGIBLY DATE (( ADDRESS OF PR60SED WORK 191 Carlson LT_1, W. Barn.. Ma, ASSESSORS MAP NO.. '`�" ///1 ' oa•7 OWNER John & Sandra Krafton ASSESSORS LOT NO. HOME ADDRESS 98 Quaker Meetinghouse Rd. E . Sandwich TEL. NO.. (508) 888-4180 .a. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessa ) .� Steven & Andrea Moreton, 50 Cindy Ln: Barn- stable , -Ma. 02630 (2)Countryside *Bldg. Co ; , Inc . 12 Boulder Brook Rd; , E. Sand- w c , - 1760 (4) Robert Edmunds Ent. Ltd. RD2 Rte. 22 , Mt. Kisco , N.Y. ' 10549 (9) Paul &- Wendy Ramsey, P .O. Box 102f-, Sandwicti, tMa. � ,jh. VAWL. W , A;7T4IV ��5/ So 7P ak Ct, hA-ele AGENT OR CONTRACTOR Countryside Building Co . Inc. TEL. NO.(508)g98-08913 / ADDRESS 12 Boulder Brook Rd. , E. Sandwich, Ma. 02537 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 local tonal sheet, if necessary). See Spec sheet and plans attached Cape style home with 2 car garage. Red Cedar roof and clapboard front stained SanOAY'ko'r:t_ Gray , Cedar shingles in rear of home also stained Sards_nor`f Gray T el e over e • R.ivco Windows V (� Signed Sandsport Grayl fEP Owner rtractor-Agent —..•..-.,., Space _�,,,.,,,�nti�-"� �. U Ir Received by H.D.C. Date The Certificate i reby to Time By V Approved � s IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ r THE FOUNDATION SHOWN ON THIS PLAN WAS L OCA TED BY AN INSTRUMENT SURVEY ON AUGUST 9, 1993 AND EXISTS ON THE GROUND AS SHOWN. a� y DATE PROFESSIONAL LANDS YOR LOT B - 435621 S.F. r,11of f;1 V PJo. �24cis THE ENTIRE LOCUS IS SHOWN T6. IN FLOOD ZONE "C" ON FIRM PANEL 250001 0011 D, . DATED JUL Y 2, 1992. Fo N E�. . 1 , ON QD I� O0 Cq L = 150. 0O \ RL SON 1-4NE PZ'16 T PLAN - LOT 8 CARL SON LANE, BARNSTABLE, MA SCALE I ' = 50 ' AUGUST 9, 1993 EAGLE SURVEYING G ENGINEERING, INC. 441 ROUTE 130, SANDWICH, MA PROJECT NUMBER 92-077 �;4) 1 t } §1st �. o r �r 0 C N o -r rn °rn §--1 < O D Z 0 I o00 3 PN y JDATE J/G%V NOV E I`nJL A VD a JOHN + SANDY KRAFTON .5 Now D � LOT #8 BODFISH FARMS W. BARNSTABLE. MA PAWN Jp �1BOX 311 NO DESCRIPTION JB : D II� 'n\I I(5W.8)362-ABLE MA 02668 [L7 (SOW362-9724 REVISIDNSJ9 I , 1 � j A r a EIM a OOO c� 000 Hill WififlWHIIIIIIIIII 70 D 70 rn rn D r 70 � rn 'rn :N �< �d ��_ §rn O rn z r rn < 7 D z O z AA a o a FM ~ D ATE !/D/VLE i JOHN a SANDY KRAFTON �(� (�/�� (��(� (� /�(�� LOT #8 BODFI5H FARMS jA "'NOTED U V�V ll Lill V�l�l�1U�JDD W. BARNSTABLE, MA j5 Dr��o/\I1 I� W. Box T311 A � Ie Ill r��— /\/\\iy=ill lU^\\VIV�I W. BARNSTABLG MA 02668 '� NO (508)362-9724 J! nnn rQ A N 6� b64b»ANto o 9v .?� CSoo ..CCC O ^ n A °b. §n-0 � �aAAb656§(p IKE ill 7Dp �qNc w m O O Arn ♦ D S C u f a 6 ran s r j co D s° r 001 K r 00 1 A b 02 - ----- - -- 03 CZ') 70-q C r 3 j RK �Q n • n ..»,.ND r N O N rn a n 112 • 1 Ll_EC .� � OO 2��.C � �N � 7 O = d�b�dkbk�N� d 770 1 3 Z o a �o�o oC n - s? '• 0 =N .�y boa 3 rn0 O C '. o CCnC to e I 1 o rn R Trn MUNRO z43n ro• �•r r-a• u•-a r-r e-a H�����N�� te•-a _ D 0 OHN SANDY KRAFTON L LOT #8 BODFISH FARMS �f W. BARNSTABLE• MA �`p�"" P.O. BOX 311 BARNST w NO DESCRIPTION ppTE (.08)362-924724 MA 02668 REVISIONS <5 ' 1 h ••c� Gb. a. b. dC 70 rn 70 3 - n G. Y' b. �® Q k G. b. N sr` O 70 D rn ra u•a vo• 0 1 n N n rn O ;O o] 470 D g O z i `s ¢ eo zS © l g I p7 rn O WO �O 1 O i 1 3 Sc•DDiD¢R xresCR eo ea • I c•a I ca I e� DATE ve v JOI1N + SANDY KRAFTON NOW n w n �(\��� (\f1D SCALE Ae NOTED w V G�1U V LOT #8 BODFI5H FARM5 DRAVN m W. BARNSTABLE. MA D�����n WBOX all tKD re �J�J W.V. BARNSTABLE MA 02668 9 NO DESCRIPTION DAT <90362-9724 REVISIONS APPD Je I Y' i I v i 1 A� .. �» ��� ice♦ N D � I I LiJ . � ° I Q I 1 rt1 G I I L J I � I C 'L'rJ I Z I ° G G 1 D O � �• L J y°8 I q il � § I tF a lS z o4� 1 70 C I g c cl N § d R D I I I u O ° a° Z MY �_ u o A �u•o• uit iF c F n L}J F� 'J ii s ec 70N § v r -1 g 0� G g6g A L}J 3Z F n I b' C r I I I LTJ 8' ' RI •--1 A I I 7700 • S 3 �D O Z3 IG x'-0' '':2 x.q e•-.va• r-e yr gg xe•-o• �a � j JOHN + SANDY KRAFTON DATE 5 0 sM[as Nmm NOW \y��/ EN �(( LAND LOT #8 BODF15H FARMS DR•WNJD LI VLF VL/ L��UUUMVVJ����JJ LI V D����ll V P.O. Box 3u W. BARNSTABLE. MA CKD JD V. BARNSTABLE MA 02668 NO DESCRIPTION DATE-- ATE aPP° 1a (S00>362-9724 REVISIONS Engineering De t.' 3rd floor Ma Parcels Permit# g g P ( ) P � ..a 7 House# Fus Date Issued " Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) No CRC Fee '"v Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) t►�rq Definitive Plan Ap r ,by Planning Board 19 BARNSWILE. vl� TOWN OF BARN STABLE Building Permit Application Project StreetAddress /9/ 40 �-tfX.) lArUA- -4 8 Village .141 Owner�� /D arz L- 0,34xxz�z Address Telephone Permit Request &1 / ?> Z RV yagx 'Fr 2 Vp�Zas�c First Floor - square feet Second Floor 1!5wZ square feet Construction Type -7-D ,_c_A,J Estimated Project Cost $ �70,DOO Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family 2/1*- Two Family ❑ Multi-Family(#units) - Age of Existing Structure Historic House ees ❑No On Old King's Highway p'�fes ❑No Basement Type: U"F"ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes If yes, site plan review# - Current Use Proposed Use /_ Builder Information Name O/� C�" ZZ Telephone Number -,�112 Address/G fs— aIW ef 7, 7— License# ljrSf O3 Home Improvement Contractor# /4G 7VO '7— J Worker's Compensation#eB4/U13Z 282 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i SIGNATURE BUI{L�DING PERMIT DENIED FOR E FOLLOWING REASON(S) e ' FOR OFFICIAL USE ONLY PERMIT NO. V - DATE ISSUED evr MAP/PARCEL NO. 7A ADDRESS VILLAGE OWNER - e DATE OF INSPECTION: ; FOUNDATION - FRAME liAA , INSULATION , FIREPLACE , ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL : FINAL BUILDING DATE CLOSED OUT - ASSOCIATION PLAN NO. ; Application 9 9 7 2 2 5 Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a V 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: ❑ New Building ❑ Addition )Alteration Indicate type of building: [House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existin.g sign ❑.Repainting existing sign 4. Structure: Q Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE �� ADDRESS OF PROPOSED WORK /9� �' ���'t-� ,G�✓ ASSESSORS MAP NO. OWNER ,�1 � �/ � �L `l ` '`r ;I`1 , ASSESSORS LOT NO. d� HOME ADDRESS x9% A ,G �l �" ���'> TEL. NO.,. " 9,5 26 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). AGENT OR CONTRACTOR. /�Z� �r� �2e� li� TEL. NO. ADDRESS y�/V�74�i�K�i✓ C�//7"'/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. (tttach additional sheet, if necessary).�/Si�c•�G Sfy�� j�jJs• '/f ',f!'i��r : .�"J � Uds it' ✓ca� 4k� G an�� c44' �ir/TTJ �vc���� ��ti��;�ut OV7— X& vT��y��:c! i?��I?/� �i� ✓c:Sc= C/Hrr> .eT� .Sc���v �i�i�►� �ii�'� � . j�/Slf�Z�/fie` .8�� ac�.%✓���cc/.�- /�c�c�2 •o'- / ��:,1Uacc� �, v� w ! I 'Owner-Contractor-Agent " „Space below line for Committee use. ZIP e71 Received b. H.D C. rP I V ( ; =I bate The tificatetis h eby Date 173-07 Time By Approved i_! IMP QRTYN1 : If rtificat s approved. approval is subject to the 0 day appeal period Application tc I .997 997 225 a+'cHS � BQ� Ov,`EP,.aK' r I Old King's Highway Regional Historic District Committee r in the Town of Barnstable for a CERTI FICATE OF APPROPRIATENESS Application is hereby made, iri triplicate, for the issuance of a Certificate cf 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: ❑ New Building ❑ Addition [R'*`Alteration Indicate type of building: [House ❑ Garage Q Commercial ❑ Other 2. Exterior.Painting: ❑ 3.-Signs or Billboards: ❑ New sign ❑ fxistin.g sign ❑. Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑. Flagpole ❑ O.ther (Please read other side for explanation and requirements).. TYPE OR PRINT LEGIBLY . DATE h2 �_?T ADDRESS OF PROPOSED WORK 191 6 2 d&5eAJ ,Gull ASSESSORS MAP NO.—L�Q— OWNER &Z� Al y `YCO() L �f ASSESSORS LOT NO. 0),2 7 HOME ADDRESS ,/1� L "lYi2G 5y�ti -, A-J //t/ 04egze 21 TEL. NO.,':K-0-'2LS / 4 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). AGENT OR CONTRACTOR ' TEL. N0. ADDRESS 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).!/SING 5�17C G�/iNJS' 7� �A�1 ?L1 : ./� %:�ds�. �i� ✓co� /rl.�ki�'6 an��' y,SL iN� �rJc�i3�[=' ��f/]���E� ��� ;L;.'�c� pT.i�.z�S�;e� ���� c�ie .'-��►'r�� ,�s�-.�-e��v'Ti�eti►'! :?-;.P��°r� . �! I j Signed /Lc / U 5 l - 'Owner-Contractor-Agent 'pace below line for Committee use. Rgceiv d I5. W.D. i� /f/J%JVZ �%J Date bate The Certificate is hereby or TimeAaft :1 wi� By Approved i!! IMPORTANT: If Certificate is approved. approval is subject to the 10 day appeal period provided in the Act. - n . ,� � . - � . _______�G� . . -----:--�`-J� . . . : . . ... . ' . �.. :. � . • Town of Barnstable • • ' Y3 Old King's Highway Historic District Committee SPEC SHEET CHIN NEY TYPE COLOR ROOF MATERIAL COLOR -77 j PITCH 0%34- L°�L ON L�Fi d� i3 vfi/ WINDOWS n;l /Hvucr� y '8'uJiiS'3"i� Doacn oar,-SIZE o"fi/ lylsAU7 TRIM COLOR DOORS 30606 ^,z7T e� � COLOR SHUTTERS COLOR GUTTERS DECK GARAGE DOORS . COLOR SIGN"' COLORS SIGNS ,6c,lRI rif COLORS SIGNS ! ,COLORS FENCE* COLOR NOTES: Pill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the plot plan, landscape plan and elevation plans, when applicable. Plot plan need not be "Certified" except for new homes, but should show all structures on the lot to scale. SPECSHT OF BARN STABLE, MASSACHUSETTS / \ , . TbN0 ASSES MAPS SORS. ""'Oow,., °� � • M-111-ij wqy .. M-111-1,0 M'-111-(el P'1-111-let 'H-III-L4 /.�-111-rcS ea 1S - Se 1, L eg � 9 � .IJJ 1.(.4 UP�/W C Q`.fig CIV .Ptc- filNo 9Z RAI : DRIVE ��? �p f_2 b 1.9f.AC 1OTAL © 40 87AC too- . � IA6AC • 3 ® .84 AC 1 OOAC f� 1-29 ® 0 4 y S84c6 '1 80AG Sgi I-25 h-►►i-b9 © �A4 'may 0 30 cf a I.AC eQ ti �.1� •r AC, . 9 ®'S 1P ` �a°��. ma's O s;c � fit'• ''oo kIAC a* yes -27 8oe 8�a AG 4-10 L��. \ ° ,7OAr- Fi4 .oa SoAG 1-26 Q is y Q \y ,.•�-a�� CAL e14C 'Lln ie ,82'VC V O ,o ISO . G 106 'AWE 4-II I_14 I-7 6 4 e. -IOAt OPEN 6pAG • r-n,•�� to.. 82 e� © P6 © 69AC. E SFbG o oi$ 0� I_e y 3.49A, BIAS ;�? LANE 4.. C'�, goo 36 l.Ob eC 4:2 i 4-7 ... <<a w u :fe9AC ��� ,fie '' Q ^.:• /oo��.. Q ® H.Iyy�6D. ' p9 ' I o Jc A 1' / 0 4-fo 69AC r ^7t --..AAA his a •a ST .,I ro �s .. � M, ! l ��� `p � % , d2�� � - c �, .,l`�� ' G��Q �`� G� ',i 1 L/�Od 1 t � � C� `O I • � n s� n U ' ��� e%� C/ GG < ���v� �� � L , �.^� �� � �i � r- y Y Y ' - 0 .f c j - � �, � '� r Y E _ , I t � I Tr M wl qw gVy t N�� < � i • A4 = e �ti 67'9 - ------------------- L------- - -------------- 00 00 (Y) �(O Lo Q) L —42"x6O"double casement- -3-0/6-8 outswing french door 6'11 : �o -47: J. CO -existing (D 9'x77"bow window --------------------------- -------------- -------------------------- 118,11 9,10 2612 12'8 677 F 92 v�� OCT 2 1997 �,Ay i it it P BENZ off RIB eavaeaa�i a�rynamna®en ------------------------- tl i �: I�Illlla! f�IRI t�l lii iR - i - i f �f�'j F.l ya 2. C -L• 1� ..QZ�f�EL�3�"�^•3 VY,4 t ✓�s 6:3'���c w�ayf�.�� I»��I��p�*r,e111nJJJ9j�^` . 66� sr eirl� i. - = 17. JIRO ir gy r "?,.�,;a.•�'�.-r• � art%.='`I L ! i , n r E vim-•.F �. �, .c � f � SH dN►� � p. • l ( -10 ; `ium; :casn"amc; i ,.maiusann ,t; III �iaaaaaaw a�,aaunnaaucmuan^ ^ caaaaaa, :1�7i� i1�AR{ Ij`� '� !, tM 1GM ''�[lim- 9t >�asa�aa;,aa�___ f�eaaaaaao aaa, uaaaaaaao<ruuanaani Ulm ;GIIu_. 68'9 ---------------------------------- --------------- ao ——— ———————————————— 00 N I N— Cfl I I r- M1 I � I M cO I new O 42"x60'double casement- I new �———�r— —'3-0/6-8 outswing french door existing 4 �-C-0 — —Z--j---- r— ----;+—existinga--77---- r 6' 9'x77"bow window c— ievv 20-8 611 :4'3 -------------- 1 2 18'11 9110 26'2 9'11 2 9 68 9 CON-IRACi ':!" Bu=Lcir�c, F.esi auct� and S n t-ds • i . ire As`c�—ter. Fierce - cc� 134� t etts GZOS i $csta c;, --�--=------------------- ------- 1�-?JV�'t"�i t i COi`t►PAC a QP - - t - icr 100740 F COPFOFt:i ION i = me=E CLTe=-iux r V-�Tc tt - j DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Jiu�ber: Expires: Restricted To: 18 . : ? 1HOMAS .X `CAPI21I JR v::;" 286 PERCIVAL OR _ ^_ G BARNSTABLE, MA 11668 The Commonwealth of Massachusetts Department of Industrial Accidents O//kd of/OYest/pstlsis 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit .Applicant nam•: location: /G SA lii/ WzJ ctv C_o077�i i /�/� 02, G phone I am a homeowner performing all work myself. Q I am a sole proprietor and have no one working in any capacity I am an employer pro%iding workers' compensation for my employees working on this job. company name: address:, Sits•• phone#• insurance co �,L �r� /�/ 1 policy At Q:�rZ4_Ie39 Z 7 S'2,(e, 1 am a sole proprietor. general contractor. or homeowner(circle one) and have hired the contractors listed below who have the follo«in_ %vorkzr compensation polices: Sompany name: address: ciry: phone#• insurance co policy# comganv name: address: city. phone#• insurance co ILLY# VMMddLab_xM Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of erimisal penalties of a tine up to S1,5N.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of S100.00 a day against me. I understand that a copy of this statement maybe forwarded to the Office of investigations of the DIA for coverage veriflc2tiaiL 1 do-hereby certify} under t Dins and pen y1p7les of perjury that the information provided above is true and correct. Signature Date Print name ��->Tfit�l_® �� �ee9 Phone i! official use only do not%rite in this area to be completed by city or town official city or town: _ permit/license# nBuilding Department E3Licensing Board 0 check if immediate response is required 261 ❑Selectmen's Ofliee C3Healtb Department contact person: phone 0; (508) 398-2231 ext. m0ther • (re-sed S.Ot PJA) , G. THE The Town of Barn stable 94, BUS& Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02661' I j Office: 508-790-6227 l Fax: 508-790-6230 Ralph Crosses Building Commissioner For office use only Permit no. Date /1 3'%7 AFFIDAVIT HOME Itii IPROVEMENT 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. rfCe=- 4„ Type of Work: 43, W,5j72aeT ���7ri�/�st2'aO�r Est Cost_ y,4ace0 Address of Work:_/�/ Owner's Name_,���FezG- v-o ci Date of Permit Application: /1 3— 7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under SI,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME 01TROVEMENT 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 ontractor Name �¢ Registration No. OR Date Owner's Name �77M[>o TOWN OF BARNSTABLE 36093 � Permit No. ......:......... BUILDING DEPARTMENT ""'= I TOWN OFFICE BUILDING Cash 7 \Yl .670 '�ro„r► HYANNIS.MASS.02601 a Bond r CERTIFICATE OF USE AND OCCUPANCY Issued to John & Sandra Kraft.on Address Lot #8, 191 Carlson Lance 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. December 23, 93 19................. ..................�........................ Building Inspector F- x Assessor's office(1st Floor): r Assessor's map Ot numbergCSYSd. MUST BE Bpi THE Conservation t�►^� 13� JN4TALLED IN COMPLIANCE Board of Health(3rd floor): WITH TITLE 5 Sewage Permit number - 33 AD ENVIRONMENTAL CODE AND to sas�rantc s � wa Engineering Department-(3rd floor): tOWN REGULATIONS House number - Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1t00-2.00 P. .only, TOWN , OF BARNSTABLE PUILDING INSPECTOR APPLICATION FOR PERMIT TO c�1 /fJ wj 1 d4w oP TYPE OF Franq hA19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for�a_"permit according to the following information: Location I e/A ky) I�LY)P. f�i4il?NS�ad� La>< # Proposed Use S! & Zoning District T , Fire District ('YO Name of Owner Ohn aOd ;5 11in klY44n Address hKre (,a�/ Name of Builder C,01_ I Bu w', . Address 1 L2m&b S'%r plc Name of Architect lm (trill TPS I.t Yt Address sOx Number of Rooms l� Foundation 00[& 6wre � ,I� TPi Exteriorted L xk 611/ ,• Roofing ►, A le-s Floors 3�T r Interior 5kU11 eL- Heating f Or[,E D OC W 64eA- L-Xn (,)i(. Plumbing °2 2 &A41 Fireplace I I 1 Y Approximate Cost At, Area Q X Diagram of Lot and Building with Dimensions Fee s 96 _ 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. r Name P Construction Zupervisor'sLicense •KRAFTON, JOHN & SANDRA No 36$9 3 Permit For 1 Story Single Family Dwelling Location Lot #8, 191 Carlson Lane dn. West Barnstable Owner John & Sandra Krafton Type of Construction Frame Plot Lot Permit Grant d August 12 , 19 93 j Date o spec ions��6" 'Y 19 m 19�a o e y. J ii { s _ , • UM Tl I i 14-HI , f C Fl t i ! I! I i I � IE i r . f L, - If APPROVED BY: i SCALE: l� !J ^(� DRAWN BY; At J _ p DATE: REVISED 7 i y -S HA eG N AlAGty if • & �t NUMBER tr f/ DRAWING i L t • a r , , • + - r \` i i I � , { • 1 i i i �` 'T • t _ 4 - t ! . �Y APPROVED BY: DRAWN BY+ljN1 r d SCALE: J • 41, DATE: �Q . a f 7 REV: ED •. .. ,,�." �fj..d�'d/L.� ,G.,�} ;.Qr•J�. :..._,e` Cam. �•.f,Gl' 4# HTM DRAWING NUMBER .2-t . z