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HomeMy WebLinkAbout0020 CEDAR STREET 5 M E A D No. 53LOR UPC 12543 smead.com Made in USA Iqx7 T �— �oyw T Barnstable Town of Bnstable ..._ -_ . . w _�. .. . _ �.. Building nAHM ,1. 'Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be KeptSAM i v MASS. Posted Until Final Inspection Has Been Made. - P %63p. ermit r° Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. _ i Permit No. B-19-3946 Applicant Name: HOWARD L LADD III Approvals Date Issued: 11/25/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 05/25/2020 Foundation: Residential Map/Lot: 130-014-002 Zoning District: RF Sheathing: Location: 20 CEDAR STREET,WEST BARNSTABLE Contractor Name: HOWARD L LADD III Framing: 1 NJ9 .Ago f./— Owner on Record: STEWART,JOHN& ELLEN Contractor License: CS-060515 2 Address: 20 CEDAR STREET Est. Project Cost: $23,000.00 Chimney : WEST BARNSTABLE, MA 02668 Permit Fee: $ 167.30 j Description: IN BASEMENT-EBBSTEWARTSTUD WALLS SPRAY FOAM Insulation: Fee Paid: S 167.30 INSULATION, BLUBOARD& PLASTER WALLS ADD BATHROOM IN Final: THE BASMENT TO INCLUDE A GYM AND CRAFT ROOM Date: il/25/2019 Project Review Req: R-15 continuous or R-19 cavity in basement walls Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afte�,issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. ' -- — —' Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: ,J� Service: 1.Foundation or Footing ! rr 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: 0 57, -- - -- Ma M41no7 Jo ' L -------- ._.... ""9 O y Xoo •.ld Ixe.0 - N- a�dO'ICj 3oybA 3007 y_J'Y/ 170g ?/OH7N'Vo�J --- 9V1S 'ktoJ„h. ------- ' _ o1V $09 — valCal r e s t 01 ovoi o/xr•r J I i J ----- :57 - ---- �� — MV ld O i v nano (a 8 t'7q - I Zr ----- -------- - ----- p�—�- — — r Luo� NG DEPTo�U� ot�� Lowc. Z 0 �e�a�s BUILDING �#l�te�.�ad NOV 2 5 .2019 :/Cq pano.Iddy TOWN OF BARNSTABLE 'ldaa�•-,Ip18 alq��su.t>�8 [HE�~O Application Number........ ............................................... BAW , . : _., IVG DEpT MASS. $ Permit Fee.......................................Other Fee:....................... 163 � NOV 2 12019 T Total Fee Paid.....................:....................................... ... ...... owN OF BARNSTABLE - r TOWN OF BARNSTABLE Permit Approval by....cm �..............On.C V. 5!. j.q.. BUILDING PERAHT 1110 Parcel.......�.. ..:......Qua--' Map...................................... .. ..... APPLICATION Section 1 — Owner's Information and Project Location - Project Address .e- a r S Village Owners Name_ t L�� �- ��i7 C.��eMae7' Owners Legal Address ), 0 Le-,�ar S t City- (,�J e, a rs +-rx State Zip 60 �9 DL Owners Cell# �� D .� 7-�.��d E-mail Section 2 -Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) [J-171nish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar ❑ Renovation ❑ Pool ❑ Insulation Other-Specify Section 4 - Work Description ue4 w(A I i ' ucr o- 4-' A kv Q/ S / dG i Last updated: 11/15/2018 Application Number.................................................... Section.5—Detail Cost of Proposed Constructio 2-3wo Square Footage of Project Age of Structure Dig Safe Number T # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics E_,, Viring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public . E5 rivate I . Sewage Disposal ❑ Municipal Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: E"t w 5 C ispoE4L I am using a crane ❑ Yes B T�o Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. j Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed { Side Yard Required Proposed-------- I Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No { V Last updated: 11/15/2018 i i Commonwealth of f Division of Profassachusetts Board of guifdin ofessionai Licensure Const�g Regulations and Standards =�u'df�"66l9ivisor CS-060515 200WARD L LA;01) 111 �.��' `� empires; OLD CENIRE ST. ' v" 07/04/2020 MIDDLEBOROa + v CIA 0?;{r Commissioner Office of Consumer Affairs&Business Regulation i HOME IMPROVEMENT CONTRACTOR T �i Individual Reaistratiol�` Expiration .,06/26/2020 HOWARD L LADMttt; AR � `it'r r, 3 i• HOWARD L.LAD In 207 OLD CENTER MIDDLEBORO,MA 02346 Undersecretary gQk The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lep-ibly Name(Business/Organizatimvindividual):��p Address: 101 0 10 C.eN 4er S^f' tn Sat �na c'L'7,4U City/State/Zip: hn a2 Phone#• ' —2 — Are you an employer?Check the appropriate box: Type of project(required): 1.[5 <ram a employer with- �J_ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 111-1 Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#I 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: 2.O G=Ljar' C f City/State/Zip:Gu rS k���c 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 hereby certi under the p ' d penalties of perjury that the information provided above is true and correct. Signstore: 4�jDate: Phone# n Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions 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 operates business or to constrict bmldin.gs in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'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 sire 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"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of IndtasUW Accidents Office of Investigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www;maw.gov/dia f Application Number........................................... Section 9- Construction Supervisor Name 1+6W 0 r- el Telephone Number f0 2! � 7 Address `Z o 7 Of� Germ- Sf City rh lb V__V vb State f N-)o, Zip License Number OCoO t�/ License Type G N 00 4S rr_ piration Date Zo Contractors Email Cvwcioh;d 4e_yeev4i&e�gj-wC _ q(�oil�C��'Cell # f I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and i documentation req ' ed by 780 CMR d the Town of Barnstable.Attach a copy of your license. Signature 4 Date Section 10—Home Improvement Contractor Name 140 wa r L. La Jcj4W Telephone Number,' '-6 01 `Z S-q/ Address Z d1 010 coiv-Jo'S; City M., to S avb State MC, Zip 023,14b Registration Number /'S/7 0 Expiration Date (-2 6—JZU 2 d I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation req 'red by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: t 11 erI -S 7_e Wa V Telephone Number .SO$ 3 7S S_�0 J_ Cell or Work Number Sb 9 3 71 I understand my.responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massach r tts State Building C de. I understand the construction inspection procedures,specific inspections and documentation ed by 780 Crd the Town.of Barnstable. � tureDate Si >� � APPLICANT SIGNATURE Signature ��� � Date/ -/ / . Print Name l 1owo►o-c6 Telephone Number ,ro 8-9�/ E-mail permit to: �bhSf�j� Q�,�`�' G L) I. e i7yy� Last updated: 11/152018 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board (if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation For commercial work,please take your plans directly to the fire department for approval i Section 13 —Owner's Authorization as Owner of the subject property hereby authorize or 2 u�_ to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) ignature of Owner date �Y, Print Name I l �- Last updated: 11/15/2018 Town of Barnstable Building _ 4 ABM : Most This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept , p ^ $ ,P osted Posted Until Final Inspection Has Been Made. Permit 639.6 iWhere a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-3948 Applicant Name: HOWARD L LADD III Approvals Date issued: 11/25/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 05/25/2020 Foundation: Residential Map/Lot: 130-014-002 Zoning District: RF Sheathing: Location: 20 CEDAR STREET,WEST BARNSTABLE Contractor Name: HOWARD L LADD III Framing: 1 Owner on Record: STEWART,JOHN &ELLEN Contractor License: CS-060515 2 Address: 20 CEDAR STREET Est. Project Cost: $8,000.00 Chimney: WEST BARNSTABLE, MA 02668 Permit Fee: $90.80 Insulation: Description: FINISH MASTER BATH WITH TILE, NEW FIXTURES Fee Paid: $90.80 Project Review Req: Date: 11/25/2019 Final: Plumbing/Gas Rough Plumbing: Building Gffieial This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Final Plumbing: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. ; , Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: f Service: 1.Foundation or Footing {� 2.Sheathing Inspection ! Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: ApplicationNumb M er.... ........ �..... ...o......... 0 RARNBrABIX 19 , 0 MASS. 4/01y 101p1b, Permit Fee.......................................Other Fee:....................... 039. ,9,1 —17 Fc 011k, 4/ Fe ?0/,9 Total Fee Paid............................................................... ...... '!R"uo 11 4f TOWN OF BARNST Permit Approval by... . ..................OnA... BUILDING PERMIT MV...............�3Q..........Parcel........ APPLICATION Section 1 — Owner's Information and Project Location Project Address-'?,0 C"r Village Owners Name. 30 k 0 F— je-n Owners Legal Address Zo City W ,Ac,rVI H� State An I zi,3 yL Owners Cell# 3 E-mail Section 2 —Use of Structure Use Group_ ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet 0-,Mugh-,/Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate [] Accessory Structure Fj Change of use El Demo/(entire structure) El Finish Basement El Family/Amnesty D Fire Alarm V1 Rebuild 0 Deck Apartment El Sprinkler System _ ❑ Addition ❑ Retaining wall Solar ElIRenovation El Pool D Insulation Other—Specify, Section 4 - Work Description M 4, 6q� c,,f Last updated: 11/15/2018 Y r Application Number..................................................... Section 5—Detail Cost of Proposed Construction 00 Square Footage of Project Age of Structure . Dig Safe Number # Of Bedrooms Existing Total# Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage '❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ . Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed J Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 i I ®� COmrttonWealth of Division of P Massachusetts Board of Buildin ►ofessional 9•Re Licd Stan Constr 9 rations and Standards i CS-060515 ,.� t?b;S UPS isor M 7 OLD CE u(DD, 111 j' � E�pireS:07/04/2020 DLEBOR&EST J1 A Oy a Commissioner .� , . .Try-�.rznorzuea�g�,/�a�sac�i�elGi Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR I T `Ep.Individual Real t Expiration r:-i,06/26/2020 i HOWARD L LAOU-11P� ` HOWARD L.LA41ti ., 207 OLD CENTER T_.: : �i '"`�.�.G� MIDDLEBORO,MA 02346 Undersecretary The Commonwealth of Massachuselft Department of IndustridAccidents Office of Investigations IF 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LegiblyName(Business/Organization/individual): [kaA,.J Address: 2 o,� City/State/Zip: {'hj A�,16 oa fyv-, e 234hone#: =� 2 A,rre�ouyou an employer?Check the appropriate box: Type of project(required): 1.L9'1'am­a employer with / 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' g ❑Building addition [No workers'comp.insurance comp.insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.[1 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 afi3davit 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-oDntractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. 'n n Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 7 ,o City/Stawzip:w dsaP'Nwd Lt oZ 46?' 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 hereby certify nder thp�naltu ofPerlury that the information provided above is true and correct Si Date: ILV-11 Phone# Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions 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 iri 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 bemuse 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 insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLQ 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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Orfce of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www:maw.gov/dia Application Number........................................... Section 9- Construction Supervisor Name F r CQQ tf-A Telephone Number J�-G rey Address 2oq of e) aj Jer '_S'� City M 1 c���- State Zip,co es y( License Number 660 SAS License Type Expiration Date -L/-20-9E) Contractors Email L'uSdZo*4o / QCr*AJ g;, Cell # �o'fi--7ej2,,T--q( I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date // 2V-/Jr Section 10—Home Improvement Contractor Name � G„� L;��z Telephone Number Address2 o 7 of o cajK- �-Z­ City M i c��,le" State 4`-t—Zip Registration Number ); IM-0 Expiration Date Llj-2 6 2o20 I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date z Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my.responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature e Date/�2�-/T Print Name 14OW a�-.( L Li J J Telephone Number E-mail permit to:,:f v 5 /,r±)� 1,e-01-t Last updated: 11/15/2018 Section 12 -Department Sign-Offs Health Department ❑ Zoning Board (if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation I For commercial work,please take your plans directly to the fire department for approval Section 13 - Owner's Authorization I, lE 1 ev� 3 S�ewa-rt , as Owner of the subject property hereby authorize )4oc,..v4�-A L 11 to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) ignature of Owner date Print Name i Last updated: 11/15/2018 r ' r , c! t Application number.. I...!..� ....... ......... :.. .. 1 0 Fee....................................: . .................. 2 Dept Building Inspectors Initials.... . ..... 1 0/y Date Issued.'. .....osy.:t............ .......................... 0 494STqB�� Map/Parcel..... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: Z o C-���C— f Gu ii OT-t,44a6le-.? NUMBER STREET VILLAGE Owner's Name: IN Phone Number b �'-32('— Or Email Address: Cell Phone Number Project cost$ 7 vU Check one Residential l/ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK t�'Siding ❑ Windows(no header change)# ❑ Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name aw-or`J Lo J Home Improvement Contractors Registration(if applicable)#. �/7s0 (attach copy) Construction Supervisor's License# (j G� ��,�� (attach copy) Email of Contractor �na.►I,�„I�eyec�,�irs�.lioN..g ®�IzB Phone number SL/ ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY-IS IN A tJ►crnDu'n1CrD/rr vnii Mi to nRrd/A/NIcrnR/r dPPRnVA/ RFFnRF d PFRM/r rAm nF tccitFn APPLICATION NUMBER.........................................................,...r *For Tents Only* Date Tent(s)will be erected Removed on number of tents total .Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 201bs. or> Yes No , if yes, a gas permit is required. Natural Gas Yes No ,if yes,a gas permit is required. If food is being served at.your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor mein an capacity. employees and have workers' Y P tY• t 9. ❑Building addition [No workers'comp.insurance comp, insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions ] officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g P myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑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 subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number 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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: j '\a r 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 insurance requirements of this chapter have been presented to the contracting authority" Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confumation 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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington,Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia The Commonwealth of Massachusetts Department of IndustridAccidettis Office of Investigations IF 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ( ( Please Print Lezibly Name(Business/Organizadondndividual): /�dk*r- tG Address: 2.07 City/State/Zip:Ml1 J���a M hoL o�aq Phone#: !?' ?1-2 67"zll Are you an employer?Check the appropriate box: Type of project(required): / 4. I am a general contractor and I P ] ( e9 � � 1.�arn a employer with- /� ❑ g 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers'[No workers'comp.iro rance comp.insurance.: 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t C. 152,§1(4),and we have no employees.[No workers' 13.❑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 mast submit a new affidavit indicating such. tr—ontractors that check this box must attached an additional sbeet 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 is the policy and job site information. Insurance Company Name: L Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: 2FT 11- City/State/Zip:GV 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 hereby certify under the p Manp ties of perjury that the information pravlded above is true and correct Si Date: Phone#: ` Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical 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 insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the 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"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for firture permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877 MASSAM Revised 4-24-07 Fax#617-727-7749 www:maw.gov/dia � _ M SEP ? .; 2019 Barnstable Old Kings Highway Historic District Coll�,>�tge� ��vELOPM�Nr $ 1 200 Main Street,Hyannis,MA 02601,Tel 508.862.4787 Eml erin.loean(a-)to%vn.bamstable.maais APPLICATION CERTIFICATE OF APPROPRIATENESS Application is hereby made,with five(5)colhplete sets,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts,1973,for proposed work as described below and on plans,drawings,or photographs accompanying this application for. Check all categories that apply; 1. Building construction: ❑New ❑ Addition ❑ Alteration 2. Type of Building: ❑ House ❑.Garage/barn ❑ Shed ❑ Commercial ❑ Other 3.-Exterior Painting,roof ❑ new roof 0 color/material change,of trim,siding,window,door 4. Sign_: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: 0 Fence 11 Wall ❑ Flagpole ❑ Retaining wall ❑ Tennis court ❑ Other 6. Pool ❑ 'Swimming - ❑ Other man-made pool ❑ Solar panels ❑ Other Type or Print Legibly: Date �'�✓ NOTE Aft applico*ns must be signed by the current owner C`7 Owner(print): LEA) 1�JD Ht.) —!� KhCf Telephone#: SD$.3 7 S Address of Proposed Work ;� y C C-b,I 09 Sr' Village a�+e J/*f&_Map Lot# /,30•U/Z/-O 6 2- Mailing Address(if different) Owner's Signature G� Description of Proposed ork: Give particulars of work to be done: Agent or Contractor(print): Telephone#: Address: Contiactoi/Agent'signature: For committee use only This Certificate is hereby APPROVED / DENIE Date Members signatures - ' A PPROVE 0 C T 62,119 n19 Conditions of approval Town of Barnstable Old Kings Highwa Committee y Page 1 of 5 I Fo. 'on Type: (Max. 12"exposed)(material-brick/cement,other) S�dmg Type. Clapboard_ shingle V, other Material: red cedar white cedar ✓ other Color. ) phi �e Chimney Material: Color: Roof Material: (make&style) Color: Roof Pitch(s): (7/12 minimum) (speck on plans for new buildings, major additions) Window and door trim material: wood other material,specify Size of cornerboards size of casings(1 X 4 min.) color Rakes Ist member . 2°�member Depth of overhang Window: (make/model) material color (Provide window schedule on plan for new buildings,major additions) Window grills(please check all that apply_: true divided lights_ exterior glued grills_ grills between glass_removable interior None Door style and make: material Color: Garage Door,Style Size of opening Material Color Shutter Type/Stylo'Material: Color: Gutter Type/Material: Color. Deck material: wood other material,specify Color. Skylight,type)make/model/: material Color. Size: Sign size: Type/Materials: Color. Fence Type(max 6')Style material: Color- Retaining wall: Material: ; Lighting,freestanding on building illuminating sign OTHER INFORMATION: Please provide samples of paint colors,manufacturers brochure of windows,doors,garage door,fences,lamp posts etc Signed: (plan preparer) Print Name Page 2 of 5 Legend Parcels N 'Town Boundary i. _ � �, ��, ,�, Railroad Tracks - s Buildings ,-1 Approx.Building X, `� _ Q' .r`� • r f° J Buildings i Parking Lots Paved ,� r 5`.�'••V'i -`ca ✓ ) .". Unpaved v ,� �� '.� • i i Roads Paved Road `` ti..' r•• ,.✓ O r ,\�:ti�}•'; e e t �(t Unpaved Road r''Pr '� < ' ' ®Bridge " y Paved Median y Water Bodies i S \, Map printed on: 10/1/2019 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 026oi 0 333 667 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map $o8-862-4624 reflect current conditions,and may contain such as building locations. Approx.Scale: i inch= 333 feet cartographic errors or omissions. gis@town.barnstable.ma.us s j Legend a + Road Names e �' S 130014002-o" #20 1 Of2 Iva a - $ .� .t •�� fie. �_i.' iK a_ i3 1401 s�� •Mai Map printed on: 10/1/2019 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA o26oi O 42 83 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 508-862_46�4 reflect current conditions,and may contain such as building locations. Approx.Scale: 1 inch= 42 feet cartographic errors or omissions. gis@town.barnstable.ma.us it �i " 4 � 1�.�-.'Ns y.}�•1:-.�'Y•'T.�.'i'�ie 'A�>''��. f� �` •fK 6, t Y - - _�, !�• fi'. •� +r�.4.• ,.�..i.�+�.►. ,ice .S� ��� �' R ��� ����tix ti"�T, • i +'I '� � _--- ---- -_ -� 'mod: 11 ' •-._.i•"s'�q•,�+..ii.%ryW- ; 1: '�W'a{'••htr LY y�/ t ' 3 � it i • • •'•. .• a • ••c .•. 11 1 11 . •• .J A•` TWO i3 Virtually an infinite .universe of colors. Wit!',Maitre lime mr;tl:o right r.f;!or is^' v.NO matte What sh"de yc:!chc•'^s?,yoti,all 3',.4Jays r.Cllnt cr,quality:.t'i;rc thvt have hF IT'-.,c!::.Ulously a1:n!iE,d in our fbct x-, Undc' Solid color chart. Nlaibec color hJtt.A_ ec`:cn cf ncir!y 100 to r.- ire you in your choira. Look:;t our color fl,: to sop tl1r:: 001 MAIBEC ULTRA WW Urrr ., L,OYSTER GRAY 72 IIAY REAL 014 MAIBfiC LAMO$1TE 223 OARGOY[E 253 YELLOW COTTAGE 254 MAIBEC LINEN �--3—tQ0THAMPTON 282 b1A18EC BEACNGRASS 268MAIBEC BF�GE 317 SILVER CLOUD 242 COLONIAL GREEN 245 MAIBEC MULBERRY 3AE TUNDRA 306 GREEN TARTAN 728 CITADEL BLUE 225 SILVER BLUE 344 VINTAGE EWE. 345THUIU09RSKY '737 NAVY BLUE - 275 CEDAR BARK 36e TAWNY OWL 785 COLONIAL ORANGE 339 CANDY APPLE 282 CHOCOLATE TrUeMatch®Custom Color system. N.:,vcn't folm"! "Ist yofre looking for!!'i oul coin chart?ni^,la a:^,!;r Any c-!rjr Give us a'y CU1o(c"^�'p ri!;j OUf ? 3";i VJI!I Gr(:d�:' 3 SO!Id :);n th is S ,tc.',,s it 7=rMct!y,P% (o r 4 9'1 .' r.� (.a,!~'Ci^�$ �"�'-^UaIIY s +r,. p shinC!Ea in`th;;,^,�;,r,`.c;o'or you wart. ,�t wati _. rl:t ,,� hi•,,. .• y:o. '�i; i H2B0. (iv+t tit, loot,of oaittrally wea iored Sinngles St'xinef! .s;. L-1,2C mot. ncZ S LJO Or +..... t'•'3t aorc`.',.IS sun-bh:'-"ra'.,�,a in roa.tdl xni I. �..�».� _...... Semi-transparent colors. The Spice series.. Only trorn Ivlalbec:.Four rich,earthy color.•in stein,r;q;i;irg Ir . T'.^irt,-r':,nce than ii':a!!itJ!1:l'•q T.i.tr..,:rij?^r:?1t_•t9;^, BURNT'GIN.GER CINNAMON NUTMEG BROWN. GOLDEN CURRY In a hurry? Ictlr;5 pla,.ltlr.ts dval abie quickly.WP.,"Pr f,3gtnr dr-F pr•t'on !od-, ;ta in our I7r:T m p)r)tj!`;r.So lid colors and mi '.'.''AI', r.,?rF i'.t+.Soc your rci i!�:fc•r availaNe -.Iors 2r1•l iin•. : f,,,•your THE COLORS SHOWN ON THESE COLOR SAMPLES MAY DIFFER SLIGHTLY ONCE APPUED TO WOOD.TO ENSURE ACCURACY,WE REOUIRE THATYOU ORDER A SAMPLE OF THE DESIRED COLOR PRIOR TO ORDERING YOUR PRODUCTS. i I Cenume Wood siding Mai"bec �r ® A.. ' 0 0 �e t i f 1 I RESOUARED AND REUUTTED.NATURAL(KILN DRIED)OR FACTORY•STAMED. �' • -es:�ur.t.r �wStA4+isvrrn>•s �irwr I _�gra.rryr A118etD60Or I C4;lAFPARENT ��r+.eww.r ( �+.,. lasr},... �.e�e:►.rnteyn.rr�ri �JE WOPNACUIittilEHl1 •trr�r`+r.�..rtfd- own NEW •,"ye�Jrrr�..�r��a:wr.�+r�llr�rz..u. 1 i I i i i 16'1 I i i ( 32' 3/8' STAIN GRADE TNI CKNESS WIDTH LENGTH NOMINAL INSTALLATION Solid stain 2 coals Nantucket' 3/8" 32 161* Sidewall use Kennebunk' Semi-transparent Nantucket'' 3/8° 32°" 16° Sidevrall use Spice series KennebunK'' General Spe.c#08-t(on5 SPEciES:, AVAILABLE cgEdURS curing The pradect W'EUropean teefir ology, • Eastern•.WrTrte Cedar Thyya.gc�rdentafis. � Merbec�sglld stain b9100r chara. shls deer cures the staid fmm the:irtslde $em)transparentSplce series out Fhe shingles are thancoolad d 'M1YitIU rAC:I.URtNG �ackaged l'fitszrntq,Ue system Increase2 tti�. t3nfimrted:cholczdPWldcolour§111d0t d©rablhtynf heprotlDct.- eijnstawo &te7flte ippetlbtades miriRTeze raised gratin taoyr fniel0ateh®symm 9Gtn dnsd:tp iz4o a 169b mqmtife itent'r Eow uDfatde:ocganlc loft Pounds(VQE#} >AC`fUSX-S?AININfi wat8r fiassd<stalns. EACKAC�NF;AfLb COVERAGE. Every Sh(ngte Isfactory coated qrt alf sldesiii Focsxtenbr usgo iy.. 22 saipslbox t6 slifngtes Perstr(pt a controlled environment for maxiiTwtn stain: >rash60zcbve[s:arognd_25sq,�ftaE absPrp��op:aFld[eteiltipa TfiISBisaprOvldes' 5:exppscire. incrWed:proteotg04irbmthe O'maging. �ftectssof�fhesuri;aftattie:efetrienfs. ; tol(owingtFfestainappkatfdh tfib4hingfes. are senYifitougtt a.s3ate of 2ha.art:dner faf ".DU.SEgSiol±SAIAY-V�DVfi 70RILA:DiiYiilb; Genuine fti Wood sjd9 maibe Pre-assembled Strip Installation FASTENING REFERENCE LINE_ Maibec shingles feature a fastening reference line found 6 1/4'from the base of the,shingle.For the 5°required shingle exposure,fasten just below the reference line to respect the installation requirement. See the Maibec Shingles installation guides to know all installation requirements. &tSE Installation System STAPLES NAILS • Stainless steel or aluminum staple with mini num Stainless steel or hoZ.dipped galvanized 7/16"crown, minimum 16 gauge f-ing shank blunt-Zip nail with minimum 7/32"head • Two fasteners per shingle, regardless of its widL-h • Two fasteners per shingle, regardless of its width How to Calculate HOW TO CALCULATE THE AMOUNT OF SIDING NEEDED Example—Area to cover: 1,000 ftz For 5"exposure,add 3%to the area to cover 1,000 ft'x 1.03=1,030 W 1 box=25 ftz 1,030 fiz=41 boxes WARRANTY'-SHINGLES WARRANTY*-SHINGLES SOLID STAIN `SPICE"SERIES < YEARS ,3_., tabour. SOME RESTRICTIONS APPLY.SEE DETAILED WARRANTIES. O REGISTERED TRADEMARK PROPERTY OF MAI SEC INC. TM TRADEMARK PROPERTY OF MAIDEC INC. ®COPYRIGHT-MAIREC INC. MARCH 2019 81016305A.8 i ®r Commonwealth of Division of professio^a�achusetts Board of Building Licensure Constrg Regulations and Standards CS- ut? tSjP.rvisor 060515 r WARD 007 OLD CE ADD' 111, Jr;J' -" pires:07/04/2020 MIDDLESOR A T Co►nntissioner Tip Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR " TY Ondividual lRegisMitiA_ Expiration 5t-f50� 06/26/2020 HOWARD L LADD`_•ttl `" HOWARD L.LAD III 207 OLD CENTER 5' s � ��* '4. MIDDLEBORO,MA 02346 Undersecretary f BUILDING DEPT. pF THE rqf, Town of Barnstable Building Department Services OCT 2 3 2019 snxivsTnarE. : Brian Florence,CBO MASS. $ TOWN OF BARNSTABLE 1639. �0 Building Commissioner ATE A 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF WITHDRAWAL OF LICENSED CONSTRUCTION SUPERVISOR FROM PROJECT I 4 11-> , Construction Supervisor License # C �lfereby certify that I am no longer the Construction Supervisor listed on the application for the project under construction as authorized by building permit # — 2 , issued to (property address) d1r) C (5 LE—on , 2019. I also certify that on VV 201 , I notified the property owner,that the project under construction must cease until a successor licensed Construction Supervisor, is submitted on the records of the Building.Division. LICENSE HOL ER ]SATE q/forms/newcontr reference R-5 780 CMR rev:08/23/17 �+e a I+V1 ­ Application Number..... ..I....1.... ....� -7 , . .:1. D b nsnee. � � . � V� � �V Permit Fee........................................Other Fee:....................... 1639. &JILDIfVG DWee Paid................. Q-'.( — TOWN OF BARNSTABLESEP f 9 2 0"tApproval by-.. ............On.... 3d IVIITT 3 t� Q OWN OF BAR S O PaTcel...........1........ V ........... BUILDING PER APPLICATION Section 1 — Owner's Information and Project Location - Project Address b c 12��A CL SC— Village C�A2&)1TXE l4--' Owners Name �Cl � �` �► �� Owners Legal Addr s o?o was � City U fP, +(�b State Zip Owners Cell# �a i—57 15 - E-mail C^\74 VS. @ V( oL Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑- Commercial Structure under 35,000 cubic feet LK Single/Two Family Dwelling Section 3 —Type of Permit ❑ New Construction 0 Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System F❑ Addition ❑ Retaining wall ❑ . Solar 12 Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 - Work Description c1�L ���� "OL> <quUc. �5'r�- 02 w WD b�S -4 �c %L w: ('QN��C..�y� -- Trv��- N�t,� ice' �t��(..� �PJt_P�� '�r�►2- Pti P&.>5 0 y e-A— QA n-.*CV— J(Z t, Application Number....................................................... Section 5—Detail Cost of Proposed Construction �� ' Square Footage of Project Age of Structure a& Dig Safe Number # Of Bedrooms Existing 2Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics E"iring ❑ Oil Tank Storage ❑ Smoke Detectors [Klumbing f[ Gas ❑ Fire Suppression m Heating System ElMasonry Chimney ❑ Add/relocate bedroom Watery Supply Public ❑ Private Sewage Disposal ❑ Municipal L�1 On Site g P P Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: _ I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No Lam- Section 8—Zoning Information Zoning District i Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard-_ Required Proposed Rear.Yard Required Proposed Side Yard Required Proposed' . Has this property had relief from the Zoning Board in the past? ❑' Yes ❑l No Last undated: 11/15/2018 Office of Consumer Affairs & Business Regulation - Mass.Gov Page 1 of 2 Mass.gov Office of Consumer Affairs and Business Regulation (OCABR HIC Registration Complaints Registration # 187281 Registrant Thomas Hurrie Name Thomas Hurrie Address 418 County Rd City, State Zip West Wareham, MA 02576 Expiration Date 05/01/2021 Complaints Details INo complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search Site Policies Contact Us https:Hservices.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=187281 9/30/2019 Details Page 1'of 1 Licensee Details Demographic Information Full Name: THOMAS HURRIE caner Name: 771 License Address Information City: West Wareham State: MA ipcode: 02576 Country: United States License Information License No: CS-092715 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 5/28/2019 Issue Date: 10/8/2009 Expiration Date: 4/22/2021 License Status: Active Today's Date: 9/30/2019 Secondary License Type: Doing Business As: tatus Change Reason: License Renewal Prerequisite Information No Prerequisite Information No Available Documents https://madpl.mylicense.com/Verification/Details.aspx?result=58624061-3 f5e-422a-9318-... 9/30/2019 g y. e community Development Comprehensive Planning _ PLANNING & DEVELOPMENT omic DEPARTMENT Development Regulatory Review town.barnstable.ma.us/PlanningAndDevelopment { ' 200&367 Main Street•Hyannis,MA 02601 �e�o•e B Ma+ Erin K. Logan ADMINISTRATIVE ASSISTANT Old King's Highway Historic District Committee Barnstable Historic Commission erin.logan@town.barnstable.ma.us 508-862-4787 Town of Barnstable•200 Main Street•Hyannis,MA 02601 L, a o Cedar S f , oyt Town of Barnstable O�OrLopm% Ruining& Development Department :° BAPUNWAUM I Old King's Highway Historic District Committee 5 �` a bo .,'$ 200 Main Street, Hym-mis, MA 02601 'o��~ EOAI{d ryNOF S1P0 4ybNryv.towiiolbarnstal)le.us/plaiining-aii(ideyelopltlent BARN Thank you for submitting your application # the Old King's Highway Historic District Committee. Your application is scheduled to be heard on I ok 1 " at 6:30pm, at the West Barnstable Community Building, located at 2377 Meetinghouse Way (Route 149),in West Barnstable. WHAT TO EXPECT Certificate of Appropriateness and Demolition or Relocation Applications ■ The applicant and abutters will receive a copy of the agenda in the mail, approximately,two weeks prior to the scheduled hearing. ■ We are required to print legal notice in the local newspaper,at least one week prior to the hearing. Legal notice can be found in the Barnstable Patriot. ■ The applicant or authorized representative should attend the hearing prepared to answer questions that apply to the work proposed on the application. ■ The committee reviews applications in the order they appear on the agenda.Should the applicant arrive after the application is called, said application will be moved to the end of the agenda. ■ If the application is approved and an appeal has not been filed,it will be available for pick up, 14 calendar days from the date the decision is clocked with the Town Clerk. 1 o While we strive to have all decisions clocked the da fter the hearing,it is best to check the decision on the Town of Barnstable's website(see below for instructions). ertificate of Exemption &Minor Modifications ■ The applicant is not required to attend the hearing. ■ Provided the application is approved,the signed approval will bF reaqZ for pick-up at the Town of Barnstable's offices located at 200 Main Street,Hyannis, on la- Withdrawal-Should the applicant choose to withdrawal the application,please contact the OKH administrative assistant for directions on how to proceed. Bulletin- To access the Old King's Highway Regional Historic District Bulletin, go to www.townofbarnstable.us go to Boards and Committees, Old Kings Highway Historic District Committee, under the Resources heading you will find the OKH Regional Bulletin. fill certificates issued will expire one year from the date of issue, or upon the expiration date of any building permit issued for the work;whichever expiration date shall be later. The committee may renew any certificate for one additional year,providing the request for such renewal is received at least 30 days prior to the expiration_date Elizabeth Jenkins,Director plaiming&Development Department Erin Logmi,Admin Assistant 508.862.4787 The Commonwealth of Massachusetts Department of IndushWAccidents Office of Investigations 600 Washington Sheet Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organize imvbdividual): k S k\J n-r— Co"J s- &J Address: `U 25? COO City/State/Zip: 4J.A Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.2�I am a sole proprietor or partner- listed on the attached sheet. 7• %Remodeling ship and have no employees These sub-contractors have g• ❑Demolition worlemg for me in any capacity.acin'• employees and have workers' t 9. El Building addition [No workers' comp.insurance comp•insurance• required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required]t C. 152,§1(4),and we have no employees. [No workers' 13.❑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. tContraetors that check this box must attached an additional sbeet showing the name of the subcontractors 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 is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: 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 hereby certi nder the pains d penalties of perjury that the information provided above is true and correct. SignatureC Date: Phone#: Official use only. Do not write in this area,to be completed by city or town ofj'rciaL 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 budding 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 insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation irmirance. 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"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877MASSAFE Revised 4-24-07 Fax#617-727-7749 wwwv maw.gov/dia Application Number........................................... Section 9= Construction Supervisor Name IAS t 4-n_yG_ Telephone Number �_b�-- !9 Address �f�1 V City �1A (�0l�State 1M�P Zip U a-�7 6 r License Number CS- a /License Type U tN ag�IA4Expi.ration Date Contractors Email��c yv�EC_`ti� `� Atx�. Co u� Cell # 4-6 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation req ' ed by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date V ZL-�� I Section 10-Home Improvement Contractor Name- 1 l o, ,,�K �C,�anA Telephone Number ,c'�g'-�3� -[ `4't{ Address t19 C0V(Ll i City LEA/Z�!_ 1�A VU� State (Ak;k Zip Registration Number 12 7,ae Expiration Date `a- I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation req ' ed by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... J Signature Date 1Af Section 11 -Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. F Signature Date APPLICANT SIGNATURE Signature Date F< P- 1 Print Name o 144, s &V4LIV— Tele hone Number p E-mail permit to: b S& '06� Last undated: 11/15/2018 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ _ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13— Owner's Authorization I I, , as Owner of the subject property hereby authorize to act on my,behalf, in all matters relative to work authorized by this building permit application for: 02 O �e �ro-r ��, K/aa �,C�iyr,✓tr�a�� /Gl�. �vZ�� � (Address of job) Sign re of Owner date Gh�i'I"/• r r 11 Print Name i Last updated: 11/15/2018 �W . . Town of Barnstable Building ? aAammABm Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept MAS& Posted Until Final Inspection Has Been Made.s6 Permit 3p. �� mot° Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. -a Permit No. B-19-2719 Applicant Name: Thomas Hurrie Approvals Date Issued: 09/30/2019 Current Use: Structure Permit Type: Building-Addition/Alteration- Residential Expiration Date: 03/30/2020 Foundation: Location: 20 CEDAR STREET,WEST BARNSTABLE Map/Lot: 130-014-002 Zoning District: RF Sheathing: Owner on Record: STEWART,JOHN&ELLEN Contractor Name Thomas Hurrie Framing: 1 Address: 20 CEDAR STREET Contractor License: 187281 2 WEST BARNSTABLE, MA 02668 Est. Proj\ect Cost: $30,000.00 Chimney: Description: Build Shed Dormer to Existing structure, Install (2)windows and Permit Fee: $203.00 � k Insulation: door with cantilleveled 3 x 6 deck. Install.new 16�single garage door. 3 6;8 enterance door. Install (2)windows over garage door. Fee Paid:,Date: 9/ 0/$ 30/2019 Final: 00 I Project Review Req: Plumbing/Gas Rough Plumbing: \Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after"'issuance. All work authorized by this permit shall conform to the approved application and thefapproved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. I Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing �.• 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: M J S J O (� A � r• /^Mt�.o t�+v. Oc�FH Ovt2 >tE a r6cR Ac.J� • y S/k'YC! a.Y.. Y� � u D A •o ` o s O O D � In � m n i L..._— •O L 2 Li e.- „Y, r L 4 J CO' I to 1� a`• o ro q, E W m i rr rnr C) � o cal � dYro ou iC � /d^'UC Lf �` dX/O UUEK /d•U[.. '�-� C_, w LO . V 0 P c � � `8• 6` /0 9- 9�G� 6 /o v SMOKE DETECTORS REVIEWED _ -ace t BARNSTABLE BUILDING DEPT. DATE Nil P 24 Am o� t 7 IR DEPARTMENT DAT BOTH SIGNATURES ARE • Q vIJ 7446 ® YURvvL 0 BCO RL7GM - iPOA/NER � d�6 fo �. .�, L � a ..�/ STnnAGF dvH4f •^v7:4? r0 ® rs o.1 Iva tl YtN Trf C �J r• �491 oo,Me R eeee444 n tJ i� Tw1vv& (j 7w.7VV6 �W PHIL ON �Etovn tuna PL AN• �4«�yy'. I a 9N1111W83d Y03 038111038 3tfV 33t1(11b'N91S 14109 31t10 iN3WA 30 3 I 31da -1d30 Miming l9diSMVO Vb 03MIIA3H SWiOhN DONS vs a) :Al �- /tea 1�1 7 f � . tic f \ w.0 i r BUILDING DEPT. SEP-T 9 2019 TOWN OF BARNSTABLE . a _ va � � Q � p � 4 2 a � a � w v ;1 �i 1 r, a G '1 I -- V �o fil q r . r J ns � r � r is 'i p i i d � b j 1p � r � d G lA 1t1 1 Boise Cascade l Triple 1-3/4" X 14" VERSA-LAM® 2.0 3100 SP PASSED FB01 (Floor Beam) BC CALL®Member Report Dry 11 span I No cant. August 16,2019 11:41:33 Build 7295 Job name: John Stewart File name: Address: 20 Cedar St Description: garage door header City,State,Zip: W. Barnstable,MA Specifier: Customer: ELMorse/Coventry Designer. Code reports: ESR-1040 Company: 2 3 4 1 0 L L 16-06-00 B1 B2 Total Horizontal Product Length=16-06-00 Reaction Summary (Down /Uplift) (Ibs) Bearing Live Dead Snow Wind Roof Live B 1, 3-1/2" 2640/0 2205/0: 248/0 B2,3-1/2" 2640/0 2205/0 247/0 Load Summary Live Dead Snow Wind Roof Tributary Live Tag Description Load Type Ref. Start End Loc. 100% 90% 115% 160% 126% 0 Self-Weight Unf. Lin.(lb/ft) L 00-00-00 16-06-00 Top 21 00-00-00 1 floor Unf.Area(lb/ftZ) L 00-00-00 16-06-00 Top 40 12 08-00-00 2 gable Trapezoidal(lb/ft) L 00-00-00 Top 85 30 n\a 08-03-00 175 30 3 gable Trapezoidal(lb/ft) L 08-03-00 Top 175 30 n\a 16-06-00 85 30 4 door Unf. Lin. (lb/ft) L, 00-00-00 16-06-00 Top 20 n\a Controls Summary Value %Allowable Duration Case Location Pos. Moment 19401 ft-Ibs 44.5% 100% 1 08-03-00 End Shear 4153 Ibs 29.7% 100% 1 01-05-08 Total Load Deflection U516(0.373") 46.5% n\a 1 08-03-00 Live Load Deflection U969(0.199") 37.1% n\a 4 08-03-00 Max Defl. 0.373" 37.3% n\a 1 08-03-00 Span/Depth 13.7 f %Allow %Allow Bearing Supports Dim.(LxV4 Value Support Member Material B1 Wall/Plate 3-1/2"x 5-1/4" 4845 Ibs n\a 35.2% Unspecified B2 Wall/Plate 3-1/2"x 5-1/4" 4845 Ibs i n\a 35.2% Unspecified' Notes Design meets Code minimum(U240)Total load deflection Criteria. Design meets Code minimum(U360)Live load deflection criteria. Design meets arbitrary(1")Maximum Total load deflection criteria. Calculations assume member is fully braced. BC CALC®analysis is based on IBC 2015. Design based on Dry Service Condition. l Page 1 of 2 (tBoiseCascade El� Triple 1-3/4" x 14" VERSA-LAMO 2.0 3100 SP PASSED FB01 (Floor Beam) BC CALC®Member Report Dry 11 span I No cant. August 16,2019 11:41:33 Build 7295 Job name: John Stewart File name: Address: 20 Cedar St Description: garage door header City, State,Zip: W. Barnstable, MA Specifier: Customer: ELMorse/Coventry Designer: Code reports: ESR-1040 Company: Connection Diagram: Full Length of Member b d a • T• • • • • e I. a minimum= 1-1/2" c= 11" b minimum=4" d=24" e minimum= 1" Install screws with screw heads in the loaded ply. Connectors are:SDS 1/4 x 4-1/2 Disclosure Use of the Boise Cascade Software is subject to the terms of the End User License Agreement(EULA). Completeness and accuracy of input must be reviewed and verified by a qualified engineer or other appropriate expert to assure its adequacy,prior to anyone relying on such output as evidence of suitability for a particular application.The output here is based on building code-accepted design properties and analysis methods. Installation of Boise Cascade engineered wood products must be in accordance with current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions,please call(800)232-0788 before installation. BC CALC®,BC FRAMER®,AJS-, ALLJOISTO,BC RIM BOARD-,BCI®, BOISE GLULAM-,BC FloorValue®, VERSA-LAM®,VERSA-RIM PLUS®, Page 2 of 2 't Application number '...............................?.y. ... ..... Fee ....................... ...................... `...... s SEP 7 2019 Building Inspectors Initials............ 101ANI (k 6ARNSTABLE Date Issued.............. 1..7.1. 1.I .............. Map/Parcel........�..�...�... .0-N.......... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION - (Address of Project �� ���0-r- S�• lye ��� NUMBERS SIRUT VILLAGE Owner's Name: '�a�.✓ 9 ��/.�- Stir Plione Number Email Address: �= �� �'�� D� d&Cell-Phone Number--~'.S A '6O4�'•fig/ Lect cost$ Check orie Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: (TYPE OF WORK_-j i mg 0 Windows (no header change)# IDInsulation/Weatherization - Doors(no header change)# Commercial Doors require an inspector's review U Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION - t Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 7S YEARS OLD OR/F THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or> Yes No ,if yes, a gas permit is required.. Natural Gas Yes No ,if yes,a gas permit is required. If food is being served at.your event please obtain a Health Department approval between the hours of 8:00am-9.30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S.�LICENSE-EXEMPTION Homeowner's,Name: Telephone'NumberS �� ��� ' 3ot aJ� �Ce11.or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction' spe 'o procedures,specific inspections and documentation required by 780 CMR and th ow le. Signature �' (-Datev. � 17 17 APPLICANT'S_SIGNATURE Signature All permit applications are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ,( Please Print Legibly kName(Business/Organization/Individual): Address: 62,0 e-e yi- S; - J ' City/State/Zip:._M.&%9�IYiLtS�i�`!�/�a', Phone# Are you an employer?Check the appropriate b x: Type of project(required): 1.❑ I am a employer with S4. I am a general contractor and I 6. ❑New construction Fnployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me"in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#I 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 is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year 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 th DIA for insurance coverage verification. I do hereby ce fy ins and penalties of perjury that the information provided above is true and correct. 4Si ature: 1 Date: g �� TPhone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1 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 witithe insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nlor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the 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"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia j a�71A%�1by /1 o-,,2 oLi S 70''-77X'0q b�l lWC7/ 7 f/JS ! 3a_LS16'C7�J Z "G'/N 1 v7 IISIO N/d 7//7 a^b'71�-?',?/�/ I eases ON r lll.a-moo o I NH001���ao J0 N1 I Nb17d I i 8 i i I , /N/ (:2 SIZ ssx� 1/ s� .�a��y �//Notis s/ /vd 7d s/H1 �1-5l��'vNJJ 9 IVI-Z /X 7 -7/-11 F o 10 i I i l `14 f - IN I ,gz i O { o Q F' TOWN OF BARNSTABLE 'r. CERTIFICATE OF OCCUPANCY I' PARCEL ID 130 014 002 GEOBASE ID L ADDRESS 20 CEDAR STREET PHONE WEST BARNSTABLE ZIP 02668- SOT 2 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT PERMIT 80900 DESCRIPTION NEW RES 3/BED 2/BATH ATTACHED GARAGE 26X28 ' PERMIT TYPE BC00 TITLE _ CERTIFICATE OF: CCUP-ANCY . - .- . CONTRACTORS: Department of ARCHITECTS: Regulatory Services TOTAL FEES: $25.00 BOND $.00 �tHE CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE 0- ' ` MASS. BUIL G I NVIS10 BY DATE ISSUED 12/01/2004 EXPIRATION DATE ` i TOWN OF, BARNSTABLE - ' CERTIFICATE OF OCCUPANCY PARCEL ID 430 014 002 GEOBASE ID ADDRESS 20 CEDAR STREET PHONE WEST BARNSTABLE ZIP 02668- LOT 2 BLOCK LOT SIZE i DBA DEVELOPMENT DISTRICT I, PERMIT 80900 DESCRIPTION NEW RES 3/BED 2/BATH ATTACHED GARAGE 26X28 PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of ARCHITECTS: Regulatory Services I' TOTAL FEES: $25.00 BOND $.00 �tME CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE 0_ +� • BARNSTABLE, I' MASS. 1639. 1� BUILDG ISION BY . I DATE ISSUED 12/01/2004 EXPIRATION DATE II THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED 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 OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- + (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS l BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS I. I, i �+ 2 2 2 (� I I I 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT i I I 2 BOARD OF HEALTH I OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON.THIS I THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. c� I z. l • r 4, k t � 4 e r 1 1�6 1 I p • TOWN OF BARNSTABLE BUILDING PERMIT PARCEL ID 130 014 002 GE08ASE ID ADDRESS 20 CEDAR STREET PHONE WEST- BARNSTABLE ZIP 02668- LOT 2 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT I PERMIT 72905 ,DESCRIPTION SING. FMLY. 3 BDRM W/ATTACH 26X28 GAR.&PORC PERMIT TYPE BUILD TITLE NEW RESIDENTIAL BLDG PMT CONTRACTORS: NICRULAS BUILDING CO. Department of ARCHITECTS: I Regulatory Services TOTAL FEES: $1,319.45 BOND $.00 �ME CONSTRUCTION COSTS $382,080.00 I 101 SINGLE FAM HOME DETACHED 1 PRIVATE „ O_ t * BARNSTABM • MASS. 039. 10rFD�� BUILDING _IVISION BY ��,�/ DATE ISSUED 11/12/2003 EXPIRATION DATE i y _ TOWN OF BARNSTABLE BUILDING .PERMIT ,Cy PARdEL 1b 130 014 002 GEOBASE ID ADDRESS 20 CEDAR STREET PHONE WEST BARNSTABLE ZIP 02668- I LOT 2 � BLOCK LOT SIZE. DBA DEVELOPMENT DISTRICT PERMIT J29-05 (DESCRIPTION SING. FMI,Y. BDRM. 'W/ATTACH 26X2.8 GAR.&PORCj PERMIT' TYPE BUIrjD TITLE NEW RESIDENTIAL BLDC PMT . / . �. CONTRACTORS: NICKULAS BUILDING CO. Department Of ARCHITECTS: 1. Regulatory Services j TOTAL FEES: $1,319.45 `BOND. $.00 - ox CONSTRUCTION COSTS $382,080.00 101 SINGLE FAM HOME DETACHED 1 PRIVATE 0..___. * BARNSTABLE, MAW 039. BUILDING DIVISION BY i DATE ISSUED 11/12/2003 EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT Tn EY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN- CROACHMENT ED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR i ���cJ ERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS / n� NS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. AppROVED D PLANS MUST BE RETAINED ON JOB AND R D KEPT POSTED UNTIL FINAL INSPECTION WHERE APPLICABLE, SEPARATE OF BARNSTABLE MADE.WHERE A CERTIFICATE OF OCCU- PERMITS ARE REQUIRED FOR f v REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- T 0 UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. BUILDING y INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS ® s� / A 0/42 2 of /�La�°a�Z:rw 2 /0/// 1' �`� 3Q/® � 1 TING INSPECTION APPROVALS > ENGINEE I PARTMENT p'IA., ra AS 1111710 r �i O h 214/ B A D OF HEALTH DA- � .9,6ro OTHER: w�glLa�-�4Bf� r'ia2 ,SAT. SITE PLAN REVIEW APPROVAL 4 i !i WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. BUILDING PERMIT r . >. � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# i Health Division ' 1 M7 (��Jam' Date Issued le .yO// 03 Conservation Division 6, 3 Application Fee Tax Collector Permit Fee =('D Q� 7 dgwu�) Treasurer c-- �, �p o .7�:J'1 ter e .,E;"ST.BE •= Planning Dept. ('cC d ;,L,,,� INSTA LED 1. -.Ok iPLlAfi10E ai Date Definitive Plan Approy Planning Board ►'� � EN�/iRptd6�Et'9TAt,CO�EANti ,, Historic-OKH Preservation/Hyannis TOWN REGU 1RT10N3,) — r Project Street Address Z_ Village Owner 4r r"!:!Y C Address A �UK -�G G✓�--r // Telephone G CO l`. �G rs� ✓C� 41 ��— I .�� Permit Request ��f" G.y� Square feet: 1st floor: existing proposed 2nd floor: existing proposed/Z G & Total new yl 6 Zoning District oe Flood Plain Groundwater Overlay N el Project Valuation Construction Type /v ocr-4 Lot Size Grandfathered '�Tes Cl No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes O No On Old King's Highway: Yes ❑No Basement Type: krull ❑Crawl 0 Walkout ❑Other Basement Finished Area(sq.ft.) �/� Basement Unfinished Area s'q.,ft) Number of Baths: Full: existing c� 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: XGas ❑Oil ❑ Electric ❑Other Central Air:�res ❑No Fireplaces: Existing New Existing wood/coal stove: 0 Yes ❑No Detached garage:❑existing ❑new size r Pool:❑existing 0 new size Barn:Cl existing ❑new size Attached garage:❑existing �ew size UX"Z6 Shed:0 existing ❑new size f Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site Ian revie __.Current Use � Proposed Use BUILDER INFORMATION Name �� /�%wL y� Telephone Number 2 �- Address 49 '006>c s-6 License# Z ZC-P Home Improvement Contractor# ' Worker's Compensation# ( ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Z DATE �� v r FOR OFFICIAL USE ONLY } ^ M -PERMIT NO. DATE]SSUED y f r e MAP/PARCEL NO. ADDRESS' r VILLAGE OWNER DATE OF INSPECTION: g,� i FOUNDATION s FRAME Z a za, Q f' INSULATION Ole jzy FIREPLACE ELECTRICAL: ROUGH : FINAL ` PLUMBING: ROUGH ',t ;; i FINAL GAS: ROUGH 4J i, i ; _-~ FINAL • :, k . N ' FINAL BUILDING .-' S t .36 DATECLOSED OUT 'I r < + ASSOCIATION PLAN NO. r - r ^a RESIDENTUL BUILDING PERMIT FEES - APPLICATION FEE i New Buildings,Additions $50.00 SOS GD Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORMHEET NEW LIVING SPACE 3 q /6 square feet x$96/sq.foot= 3 2 7. 93 x.0031= / / Co plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x .0031= plus from below(if applicable) 7 GARAGES(attached&detached) ,{. 3 9 Sf A8o✓e = / )2 8 72 9 square feet x$32/sq.ft.= 36" F Yo x .0031= Sro.RAGe 6-7-A / g� 30�` s"G. 7`t ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch dC x$30.00= ��, 0 0 (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= �, DO (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee / `� IMF Tp The Town of Barnstable O� BAN;q Department of Health Safety and Environmental Services °TEo Mpg' Building Division 367 Main Street,Hyannis,MA 02601 )ffice: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: Map/Parcel: 130 OAX - Oat Project Address: Builder: 41 AR Y The following items were noted on reviewing: ✓ i� T��t? Ge'f z.:va: &M a? JWC v z2,' ✓ W�i� .x'.vsv�9Tiol/ R-13 Nir P�,e wv1'� "YA09 Pei • /�l3� S�•�t � co�w7 ee Reviewed by: Date: q:building:forms xeview 'v e.a .. i .'t t..e ~�J �� .'\�'%," ..iA�p .. ,;}. �� -� "�,�,,:•••',e tA '}'�' ua 1�,` '+,q. r55` + .'y" ';, i+ �. Aft ._.' �.y '�,,4;�,,...� .t:A �, ••�. ��` 1,+ < .t 4 •� t • *, v a I --�- Lr oil -�__ --, LT- -I -ru 1 T I �eL-Ev.A-Tlo,\)• ZCh�E�/v� �•.V SMOKE ETECMRS O.K. BARNSTABLE UIL ING DEPT. f CGDy L'T 4 - L4'. --FJsoNLs ��vnxto�_S�r Lv:Lv'_ 7? 'R- 7Y 1� j - li II C �EE ELI' IV- Hill i I � �1J I i 3 x • © e - x L o i_+ . N _ "` Hoc•ocMl. ISEhM OVER-_,SEE,cun.6ER yh.W` •sltcf 1 H,V, p 9 �r d 07 swat s � D fDer I "iK H � p re u s a — � W J" - � s N 1p x ' �1 4 AA W p � i bt r ,• n N ax/os ueR e/c�a.� Ul 0 0 ,• £ .'D y aX/O OUE.f /d^UC d7l/0 OUEK /J•p C. 6 — 1 d _ orlti WO C I I '°�i i ---•.. - D- P W yE g I r -- o� - H 0 1 Q - E 1 Y � O 1• I D- ~ I v\\ v, y b ]c v C 4 - e c O J ] H 9o'-v"0veu•�� _ •v ���._... _ � � � __ Imo• _ a "1 I iz _t .T .. GA" DiREt-T/J I � — �y�{-� �oqo FOC ., .. —_ � �3-d'r la G+2ry .kG(, I _ ., n MICRU..UnI•:dFAM > _I • - � �• OOEK 0 ;./O� `� LOL, 307*30"x+o"c/a'NL, G.AlL�6 E a z a L.J --- — Y.•Loly. 5�q6 /1NLNO& ADLT / '/,COD£ 5,op.0 -to AM.r...._.Pnoor -- Dooa� raxa ar• ooR _ .ATOP W>ONA) O OW G/LUDE-• 4'F7rN• DktoW ��, � --- 0 6RAD4 G✓ R Q-- -`7_ 4 Y�� 15�Y o •.y•. i o � Ce m 'y Li FFRiF vr�./'y d�FN6iULbe . ! i illilltoo. XI'.2 �t'� m � L lam'• A m.x a . A t �. •�:t c0 SYPPOC � I - O ^ i In Rl 1 �_ L 6L 91)fp^J.✓.bAf 7-6'JTAuOATiD u�7-V'tN/Of X 1 ' J ar T.p: x ra, 4 M p o a rJ 8 m L ° � , e • S� a `y C� K t �Y' 1 A O iP " L J J 171 QUITCLAIM DEED I, JOHN SCANDLEN, of 66 Blanid Road, Osterville, Massachusetts 02655 , in consideration of THREE HUNDRED TEN THOUSAND AND 00/100 DOLLARS ( $310 , 000 . 00 ) paid, hereby grant to LARRY D. NICKULAS, Trustee of CONANT NURSERY TRUST, under declaration of trust dated September 12 , 1997 and recorded herewith at Barnstable County Registry of Deeds, with a mailing address of P.O. Box 507 , West Barnstable, Massachusetts 02668 WITH QUITCLAIM COVENANTS My one-half Tenant in Common interest in the land situate in Barnstable (West) , Barnstable County, Massachusetts, together with any improvements thereon, being described as follows : Being Lots 1 , 2 , 2A and 3 ..as shown on plan of land entitled "Perimeter Plan of Land in West Barnstable, MA. Prepared for W. Nickulas , Scale: 1" = 100 '_,_;dated August 27 , 1997 , J. Doyle Associates" an --dairy~ recorded at— nstable County Registry of Deeds:,a lan Book 535 , Page 36 . All of said parcels are conveye �trbject to and together with any and all easements, rights of way, reservations or restrictions of record insofar as the ."same are now in force and effect. Said premises are conveyed.' subject to the rights of Carolyn .Conley to reside in the little house . next to the landscaping business location for her life, without having to pay rent therefore,, and with the requirement that the Grantees, and their heirs, successors and assigns shall be ,. required to maintain the exterior of the premises , its structural components ' and electric, plumbing and septic systems, all as set forth in the Fred D. Conant Revocable Trust Agreement. ti For grantor's title see deed of Russell C . Peterson, Successor Trustee of the Fred D: Conant Revocable Trust Agreement, said deed dated March 7 , 1997 and recorded at Barnstable County Registry of Deeds at Book 10666 , Page 086 . 71 Fil- j' QUITCLAIM DEED I , WILLIAM NICKULA, of 94 WA12ERFIELD ROAD,. Oste.rville, Massachusetts 026551 FOR NOMINAL consideration of LESS THAN ONE HUNDRED DOLLARS paid, hereby grant to. L,p,RRy D. NICKULAS, Trustee of CONANT NURSERY TRUST, under declaration of trust dated September 12 1997 and relc�otrrdeda herewith at Barnstable P.O. Box 507 ,Registry of Westeeds ,Barnstable, mailing address of Massachusetts 02668 WITH QUITCLAIM COVENANTS My one-half Tenant in Common interesnt n the asaad situate in Barnstable (West) , Barnstable Cou Y, described as together with any improvements thereon, being follows: Lots 1 2 2A. and 3 as shown on plan of land Being MA'- entitled "Perimeter Plan of Land in 100, dated August 27 , .: Prepared for W. Nickulas , Scale: 1" �_..� . 1997 , J. Doyle Associates" and y recorded''at—B.a�nstable u County Registry of Deeds at .Pla Book 535 , Page 36 . C Y - .�.. All of said parcels are conveyed .subject to and together or with _any and all easements , rights of way, reservations record insofar as the same are now in force restrictions of , and effect.. Said pthe remises are conveyed subject to the rights of to Carolyn Conley to reside . in the little life, w thoutxhav having to landscaping business location for h requirement that the pay rent therefore, and with the Grantees ; and their:' heirs , successors and assigns shall be required. to maintain the exterior of the premises, its. structural components and electric, plumbing systems, all as set forth in the Fred D. Conant Revocable Trust Agreement. For grantor's title see . deed of Russell C. Peterson, Conant Revocable Trust Successor Trustee of the Fred 0-• 1997 and recorded at Agreement, said deed dated. March 7 , Page 086 . Barnstable County Registry of Deeds at Book 10666 g, i Affidavit of Substantial Financial Interest 9/�"/��C-�✓�l of on oath I, depose and state as follows: 1. 1 am an applicant for a building permit for the property located at Map , Parcel Cj The address of the property is 2 O 2. 1 have UG % legal or equitable interest in the real property which is the subject of the building permit application which is identified in paragraph 1 above. 3. Within in the last twelve months from today's date, which is Z , the following individuals or entities have had a 1% or greater legal or equitable interest in the real property which is the subject of the building permit application which is identified in paragraph 1 above: Name Address 4. Within the last twelve months, from today's date, which is Alt / , I have had :a 1% or greater legal or equitable interest in the following properties which have been the subject of a building permit application: Map/Parcel Address /3 `,ile LA 5. Within this calendar year, I have submitted building permit applications for property in which I have a 1% or greater legal or equitable interest. 6. Within the last ten days, I have submitted building permit applications for property in which I have a 1% or greater legal or equitable interest. 7. Within this month, I have submitted D building permit applications for property in which I have a 1% legal or equitable interest. 8. Within this month, I have received / building permits for property in which I have a 1% legal or equitable interest. 2 f Signed under the pains and penalties of perjury,Ahis _ day of _, 200_. 2001-0050/affin 1 O/LOTTERY/AFFIDAVIT Application to- il 3.egional piotDric �Di5tritt QCDIT mitteE In the Town of Barnstable. CERTIFICATE OF APPROPRIATENESS pplication is hereby made, with four complete sets, for the ewoak aste f desc ibedtbelow and plans, r Section of Chapter 470, Acts and Resolves of Massachusetts 1973 for proposed rawings, or photographs accompanying this application for, o o :HECK CATEGORIES THAT APPLY: New ElAddition ❑..Alteration Cn W Exterior building construction,: ❑ Garage ❑ Commercial ❑ Other Indicate type of buildingHouse 9 !, Exterior Painting: EK E 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign t. Structure: ❑ Fence ❑ Wall ❑ Flagpole Other c I cn -3 TYPE OR PRINT LEGIBLY: DATE c�� i e �'� ASSESSOR'S MAP NO. ADDRESS OF PROPOSED WORK C� 1 ASSESSOR'S LOT NO. � O Za OWNER -4�` `'✓�..HOME �- ADDRESS �� �" '% 3 ' ~�'{ `� '� TELEPHONE,NO. _ FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way. (Attach additional sheet if necessary.) /i!f f-XR 0 TELEPHONE NO. AGENT OR CONTRACTOR ADDRESS DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of proposed signs.. Signed �'y - �'' Owner-Contractor-Agent For Committee Use Only This Certificate is hereby Date lD• Approve en C ittee Members' Sign ures: „a Tor4n of Barnstable ''�'='' OId King's Highway Historic District Committee SPEC SHEET FOUNDATION SIDING TYPE l--b.:/�� ` "� �-' r�,�j�,.�' COLOR / J CHIMNEY TYPE COLOR C- ROOF MATERIAL /sc,f / COLOR !S PITCH v SIZE WINDOWS �!! ,i %� _COLOR %f✓`l TRIM COLOR i COLORS �•_.l �r � DOORS COLORS SHUTTERS GUT TERS �I' %� � r COLORS // DECKS ” �r /" ° MATERIALS GARAGE DOORS � COLORS SKYLIGHTS �l ) SIZE COLORS COLORS SIGNS /A X COLOR , FENCE NOTES: Fill out completely, including measurements and materials/colarS to be used. Four copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape plan and elevation plans, when applicable. SPECSHT no-ri.sed 11/98 • 6 c CD LI 17 700. V 00 ov. `\ 61)j Y.� C0 ` 1 �.0. 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I do hereby certify wider t suns es o that the information provided above is trues and c rreed Date signature Print name r w / A� J Phan# 2 Z official use only do not write in this area to be completed by city or town official city or town• perndt/licerue# ❑Building Department ❑Licensing Board ❑Selectmen's Office ❑checkif immediate response is required ❑Health Department contact person: phone#; Other U viud 9195 PJEa Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any coact 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, einploying 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 section 25 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,neither the Y commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter,have been presented to the contracting authority. Applicants , Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and -' address and phone numbeis along Rrith'a'certificate•of insurance as all affidavits may be 7 supplying company names, submitted to the Department of Industrial Accidents for confirmatio 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 Accidents. Should•you have any questions regarding the "law"or if you being requested, not the Department of Industrial are required to obtain a workers' compensation policy;please call the Department at the number listed below. City or Towns ' Please b' 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. The affidavits may be retained t� the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. , VNIN The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investloatlons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 i Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individui use i .Jf before the expiration date. If found return to: Reg_stration., only. 100496 ;Ezpirati`on Board of Building Regulations and Standards 5/1,8/2004 One Ashburton Piace Rm 1301 ,_: ' iTYP;e_.=:(ridividual Boston ,Ma. 02108 LARRY NICK ULAS;`. Larry Nickulas _ r 125 LAKEVIEW DR.-`;.` CENTERVILLE,MA 02632 Administratar' - -- __,r. Not valid without signature. s:z;��='-: ✓die -�orvnzo�.zwea�iYa-y�G�aasacduu;eCl6 iV BOARD OF BUILDING REGULATIONS License: CONSTRUCTION'SUPERVISOR s Number 002265 . B i rtfi %1955 Expires: 0,17.1872004 Tr.no: 12771 rt. LARRY D NICKULAS__y= a _ PO BOX 570 `_" / »� W BARNSTABLE,. MA`02668' Administrator ��h { 780 CMR Appendix l Trade-Off Worksheet rEEntorcementAgenc l Permit# Date I � Builder Name I I BuilderAddress d I Checked By I Zone* Building Address -e G ? � 9 f� I �- Phone Number Z vL Date Submitted By L REQUIRED PROP ll Ceilings, Skylights, and Floors Over Outside Air Required Insulation U-Value x Area = UA Description R-Value U-Value x Area UA ceirng D 3 9— L/fib m `7 ,, Uro t OZ,u 3/ Floor Over Outside Air f12 {t2 Skylight tt2 tt2 Ceilings:Total Area Walls, Windows, and Doors Required insulation U-Value x Area = UA Description R-Value• U-Value x Area UA 2 ft2 Wall ' b Ar Window — 33 m Door — ? Sliding Glass Door — 3 tt2 �) m tt2 tt2 Walls:Total Area Floors and Foundations Required U-Value or Area or Insulation Insulation U-Value or Area or UA F-Value x Perimeter = U Description Depth R-Value F-Value x Perimeter = � y 2�S o, I � , Floor Over Unconditioned +� it2 Basement Wall ffR ft ft Unheated Slab in. ft Heated Slab in. ft Total Proposed UA Total Required UA Total Proposed UA must be less than or equal to the Total Reored UA. Statement of Compliance: The proposed building design represented in these documents is consistent with the bui in plans,spcations, and other calculations sub ed with the permit•application. Date Company Name Co Builde'ID er 53 1 :)v 07 03 03: 03p 11IDCapeSDennis 5083984559 p, 1 Jj i at Mid-Cape Home Centers P � P.O. Box 1418 Rte. 134, So. Dennis 02660-1418 • 508-398-6071 - Fax: 508-398-4559 TRUSS JOIST QUOTE STORE# D ACCT.# Na SALESMAN 5KI P CAei_C-ff6 1,3 Address: ... . F.... . ... .................. , Zd Cea6c.-- JOB LOCATION PRODUCT CODE I DESCRIPTION CA QUAN.) LGTH. LIN. FT UNIT PRICE EXTENTION � IML j13� `` XlI"7/ " A, 7, 110 .3 3► Z i ; ?C� I I ; f iI 1 , y 1 i I 7 • f 11 1 1 I I r i I I i i i M I C KO L .4te.t_ t `a S�Q�I '�L L-D (Ja. SUB TOTAL -� r i —;— C"rl�e SALES TAX 1 70 I Z I(�tSTEil1GT.IQNS:::I a}`R.�17 l�� r'L:4( ("A t C 1.10 c t4 4'.! tvt 0,5; �----- �r—— _ TOTAL ~t Price A e to I d s Ave For 30 Days suv ud uo •UJ ' UJp miULapeSUennis p - THE NICKERSON COMPANIES �Rs YiH M:C. : NAME A;zk l LG�K ALA I�IP.tiY.IFOLD ADDRESS SALESMAN ZI_L-J L la' L- � �-uS l Z�1i Crx.t�J-�l A� TEL.--- JOB LOCATION FL �arR�a9r,rn���rraa��i�n�.�lil�r�rs�r�. Id,e / . L p (7L 4o L. f k -ZJ Z. Z i 4 OF 13 LO 17:/.aC« 7 rrs>rt t n jj� l_L uL f ( . Z 1C 2 0 G 2 4 Nov 07 03 03: 03p MIDCapeSDennis 5083984559 p . 3 110 1 ' KIalp -;THE NICKERSON COMPANIES 8rE1 16Y] M.C.H.C.— NAME .Lj2?N MANIFOLD- ADDRESS SALESMAN TEL. JOB LOCATIO ;� IA VF " D L 113 v I 0 G tl G COPY G 0 G p tl tl Effective Date: May 19th, 2003 u G tl Western SuretyCompany tl G LICENSE AND PERMIT BOND o G n n tl G tl KNOW ALL PERSONS BY THESE PRESENTS: Bond No. 14493068 a G n G 0 o Thatwe, Larry Nickulas DBA L.D. Nickulas Companies n G tl G tl G of the Village of west Barnstable , State of Massachusetts as Principal, o and WESTERN SURETY COMPANY, a corporation duly licensed to do surety business in the State of i Massachusetts as Surety, are held and firmly bound unto the Town of Barnstable Building Inspector , State of Massachusetts , as Obligee, in the penal sum of Six Hundred and 00/100 DOLLARS ( $600.00 ) lawful money of the United States, to be paid to the Obligee, for which payment well and truly to be made, we bind ourselves and our legal representatives,firmly by these presents. THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That whereas, the Principal has been licensed Single Family Home at 20 Cedar Street,Lot #2, W. Barnstable, MA 02668 by the Obligee. NOW THEREFORE, if the Principal shall faithfully perform the duties and in all things comply with the laws and ordinances, including all amendments thereto, pertaining to the license or permit applied for, then this obligation to be void, otherwise to remain in full force and effect until May 19th 2004 , unless renewed by Continuation Certificate. This bond may be terminated at any time by the Surety upon sending notice in writing, by First Class U.S. Mail, to the Obligee and to the Principal at the address last known to the Surety, and at the expiration _ a e:+eood � oft` ' � , Aays from the mailing of said notice, this bond shall ipso facto terminate and the Surety sh�ale�h relYj3on.. lieved from any liability for any acts or omissions of the Principal subsequent to said date4 1,1 number of years this bond shall continue in force, the number of claims made against tW& and t' inber of premiums which shall be payable or paid, the Surety's total limit of liability Adill;not be cumula a from year to year or period to period, and in no event shall the Surety's total liability G f� ]1`•cldrs 0,b4l amount set forth above. Any revision of the bond amount shall not be cumulative. n �fd�dd8D9ddA��u�, n p Dated this 16th day of May 2003 tl g G G G tl G n ri g G tl n Principal tl tl -- n n G tl Principal o G n Counters ned (whe e r uired) WEST E N S U R E T COMPANY G n G n G n n G By - By ; Resident Agent Paul T. Bruflat,SpCior Vice President ; G n G Form 532-5-2002 n r G 0 G 7 tl n �c G 1 G I 0 I ACKNOWLEDGMENT OF SURETY ; o STATE OF SOUTH DAKOTA as (Corporate Officer) COUNTY OF MINNEHAHA P I P 1 On this 16th day of May 2003 ,before me,the undersigned officer, personally appeared Paul T. Bruflat who acknowledged himself to be the aforesaid officer of WESTERN SURETY COMPANY, a corporation, and that he as such officer,being authorized so to do, executed the foregoing instrument for the purposes therein contained, by signing the name of the corporation by himself as such W officer. IN WITNESS WHEREOF,I have hereunto set my hand and official seal. G ♦►►\►►►►►►r►►►M►\\►►\►►►4 I + D.KRELL ++ ; i NOTARY PUBLIC Ea� o + SOUTH DAKOTAGM G + + Notary Publi .South Dakota G 4ti►►►►►►~►►►►titer~►r►►►►i I G My Commission Expires November 30,2006 ; G I ACKNOWLEDGMENT OF PRINCIPAL STATE OF ss (Individual or Partners) COUNTY OF On this day of before me personally appeared known to me to be the individual _ described in and who executed the foregoing instrument and acknowledged to me that—he— executed the same. My commission expires Notary Public ACKNOWLEDGMENT OF PRINCIPAL STATE OF (Corporate Officer) ss COUNTY OF On this day of before me personally appeared who acknowledged himself/herself to be the of a corporation,and that he/she as such officer being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing the name of the corporation by himself/herself as such officer. My commission expires Notary Public G I G \\ I G Cd fi G l y 1 fi G H I fi G ' 0 1 O U o G 04 y z ° Q n � o � 0 G Q O G o z P � a) IH 1 n U I-a O n41Cd O ; o a O U1 G=•I Q 'C G I © if :u1-03-01 12:41 Frorr- T-$l7 P.02/02 F-361 °F BAR S CAPE COD COMM .SSiON .O Y` 3225 MAIN STREET v tz r P.O.BOX 226 BARNSTABLE,MA 02630 �7SSacw35�,�^ FAX(8508)362 3836 E-mail:(rontdesk®capowdeomrrission.org Date: July 3,2001 Applicant: Larry Nickulas,Trustee Conant Nursery Trust P.C. Box 507 West Barnstable,MA 02668 RE: Conant Nursery-Trust Subdivision,Phase 1 -ODR97024 Partial Certificate of Compliance _da?_q �_� (Allowing Construction on Lot#2,Cer Street,West Bamstable) I hereby certify that Larry Nickulas,Trustee,Conant Nursery Trust,applicant on the above referenced project,properly complies with the Development of Regional Impact decision dated February 26,1998,and that those conditions attached to the decision.required prior to any development activity on Lot#2,as shown on the approved plan entitled"Division of Land in West Barnstable,MA,prepared for Conant Nusery Trust,"dated January 1,1998,revised February 6,1998,have been met. The applicant has clearly identified the limit of work around specimen trees on Lot 2,and has marked the boundaries of the Phase 1 permanent open space adjacent to Lot 2. The required open space was sold to the town of Barnstable as permanent open space,as recorded in the typed at Book 12777,Page 246. Identification and protection of specimen trees along Meetinghouse Way was addressed by the sale of this land to the town for open space. In regards to the requirements set forth by the decision of the Cape Cod Commission:the Town of Barnstable Building Commissioner is hereby authorized to issue a Building Permit for construction of a single family home on Lot 2. Prior to issuance of a Certificate of Occupancy for Lot 2,the applicant shall receive a Final Certificate of Compliance for Phase I from the Cape Cod Commission. Condition TI (increase sight distance to site driveway)shall be met prior to issuance of a Final Certificate of Compliance for Phase 1. argo L. Fe xecutive Director Date Commonwealth.of Massachusetts Barnstable,ss. S bse bed and sworn before me this 3 day of 2001. 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