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HomeMy WebLinkAbout0718 CEDAR STREET 4 I i 0XI000MIONO. 152 1/3 ORA y 1 0%, . _- _ . .J:a:..w _ ;���;� �I �� �� � � ! �, } . � . . � t �. F Application number. ]os- . 0 Fee .................................................. ........... I QIfifKI !J� 51�BLF Building Inspectors Initials.. .�' NHIu . Date Issued............ �. .I. ............................. f lJ� V Map/Parcel....l.. ....�........................................ TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: '7rg �'�� ;� �- /�c� (�A�,, .�S NUMBER STREET VILLAGE Owner's Name: C'�+ Gc ���, ,�.,AJ Phone Number Email Address: Cell Phone Number Project cost$ � �� Check one 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 © Siding 0 Windows (no header change)# ED Insulation/Weatherization 0Doors (no header change)# Commercial Doors require an inspector's review EKRoof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# 6 a:y g (attach copy) Email of Contractor Phone number yj�:38✓= bl ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTYES 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 8r00am-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 3 All permit applications are subject to a building official's approval prior to issuance. I 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/EIectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): i C-44e 1peel Address: P City/State/Zip: Phone#: .5 0S:38 5 1,0 8n 7 Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I Pployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.011 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' comp.incirrancC.; 9. ❑Building addition [No workers'comp.insurance p j 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.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. .tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state,,ybaber 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.Lire.#: via ` oa � ��v 31 � Expiration Date: 3 Z / / Job Site Address: City/State/Zip: GA.1 l3R r �/ S /1, 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�ce�rtify under the pains and penalties of perjury that the information provided above istrue and correct Signature: Date: / Z�z Phone#: �6 — 3�� 890 ) Official use only. Do not write in this area,to be completed by city or town official City or Town: PeramitMcense# 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#: t 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-yow situation and,if necessary,supply sub-contractors)name(s),addresses)and phone numbers)along with their certificates)of inc,mince. 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 i____......�.7' ..fi.o l..m n,.if--ara romr;rP�4n At'ain a wor1C0T$' Industrial Accidents. Should you have any cuc�uous regarum5—,-law c. u,�..�.�•��- -- 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 firtnne 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 Tndustdal Aecldents flee of Investigatiam 600 Washington Wtret Bosun,MA 02111 Tel.4 617-7274900 ext 406 or 1-M-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass,gav/dla i MID CAPE ROOFING 312 Skunknet Road Centerville, MA 02632 508-385-8801/508-775-3799 Barry Merrill& Paul Merrill Job Site Address Mailing Address Name Name: Street: 715 Ste- Street: City: M4 City: Telephone: J Telephone: We hereby propose to furnish all the materials and all the labor necessary for the completion of: roof replacement of the dwelling at the above address. Mid Cape Roofing proposed to remove and dispose of the existing roof. The roof will be replaced with Certainteed Landmark life time shingles. Aluminum drip edge will -be installed along the gutter line. Ice & water Shield installed on bottom edges to protect ice back-up. 15 pound felt paper will also be applied. The shingles will be installed using 1% inch roofing nails.- .New pipe-vent collars::':will be installed. Ridge vent will be installed along the ridgeline of the roof to provide proper venting of the attic space. Mid Cape Roofing guarantees the workmanship for a period of 10 years. All walls and landscaping will be protected from damage; the property:.will be raked and cleaned of all debris. /- �ro n/T Ost//�1 All material is guaranteed to be as specified and the above work is to be performed in accordance with specifications submitted .for above work and cgmpleted in a substantial workmanlike manner for the sum of: $ —All discounts have been applied. Payment made as follows: Deposit of: $ the day the job is started and remainder to be paid on completion. Any alteration or deviation from the above specifications involving extra costs will become an additional charge over and above the estimate and will be discussed with the homeowner. Respectively Submitted by Mid Cape Roofing NOTE: This proposal may be withdrawn by Mid Cape Roofing if not accepted within 30 days. Acceptance of Proposal The above prices,specifications and conditions are satisfactory and are hereby accepted. Mid Cape Roofing is hereby authorized to perform work as specified with payments made as outlined above. Accepted: lGf l I Division of Professional Licensure.. •4, I, 'I �•'' .Bpard'of-Building Regulations and Standards h , I' ConstrNGfiit�r�IS`iSp�rvisor CS-054428 I 4pires: 05/21/2020 • ,, BARRYY B MERRILL, 312 SKUNNKE'T RD�� CENTERVILLE MA. 62632 S . �r0/S5 Commissioner ;� �e �i�z�no2caea��a�✓/Gr.�d�c�i.�elly �� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE: valid for individual use only Y, Individual before the expiration date. If found return to: Registration Expiration l Office of Consumer Affairs and Business Regulation 0 61:4.88= 12/01/2020 1 1000 Washington Street-Suite 710 BARRY MERRILL� Boston MA 02118 -r— s^/• i BARRY MERRILL), 4/ 312 SKUNKNET ROAD= `"' A y �, ...�� CENTERVILLE,MA Undersecretary I!Not alid without signature ' r �VieIr1 Town of Barnstable Tw ,�{ tier .[r +�..4s Building j.z, •,d. $y F, i.Y`. w).,i. S b�'{�S!<k i .rr'.xi'L. 'T'�% 1!Aci 1F4�. �Ls'G e 2 p t:l' 4"F,, p.✓ tPostsThis.:Card So,T:h:atzit.,isUisible From the,Street ApprovedtPlans Mustbe Retamed�onob and�th'is Card.Musi_te Kept;+,p BAI3NlTfABL Ma..<...,Kitc i�7.,rw' < :'.u{ �.'. ;`} 7€r! ''.S`t:a^ "iFdr{L 6w,�`,y l •:.zz ° `„-9�'.^ 9z^iet S•�. �:,,w,'ayil r�.:�:i!"* 4 tr. ? �"'�` ",.Y'`:ixf"" • MASK. x k L .'� `�y" !"` 'y''ry ,p °s°:rs2 `Y>'tS .t. L`-'R,•,'? «nLzi ,.a x �; E ).' i5., i'{' r"'s, rFe a. Y_Posted lJntilFinal-Inspection HasB.een Made "` `Z ...?_ "w, ,� ,.. , .2:.,•_ i '.:�„, , , „s; , ,,�., , 36jp 1 3� n.', GK 3 'Y »G; s'eq fi •,2 m i �i y k q., u T +ti X: 4w f 4r wr� Permit e, r� " " `c i§.Re i'ire�d l'sach.Bu�ildm shall Not be O u"ied untilka Final�In ctionfhas been=made.m� ° �vl llll� saLuit Where a Gertlficate =hSSr9 i'..,.r q..a,.s,..:.:.. t�. :�� .,%f•.u„w,d'i.:..w,SYt:i3'".is3 p.ary,..:.,§w.>:i.x`w.an, -......3:....�;K.<=:£xua;R ?3�.):i;.....ra..t.rr..:m..;t3x$;:?:i..�.ti.: :c.,�>w.d.:•..r:-,. ;.s.s....:s {�a:.�,ita Jr+�..»r.: Permit No. B-18-2596 Applicant Name: Approvals Date Issued: 10/24/2018 Current Use: Structure Permit Type: Building-Shed-Residential-200 sf and under Expiration Date: 04/24/2019 Foundation: Location: 718 CEDAR STREET,WEST BARNSTABLE Map/Lot: 109-004 Zoning District: RF Sheathing: Owner on Record: SWANSON,CHARLES K& MARGARET M. Contractor Name, Framing: 1 Contractor Licensee -Address: 718 CEDAR ST 2 WEST BARNSTABLE, MA 02668 Est Project Cost: $0.00 Chimney: Description: 8'x12'shed `r Permit Fee: $35.00 Insulation: w; Fee'Paid $35.00 _ Project Review Req: ',p 10/24/2018 Final: cLO— z a= L r = Plumbing/Gas � Y Rough Plumbing: •'t 4yT5 L� S. Building Official k Final Plumbing This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after`issuance. Rough Gas: 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 law's and codes. Final 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. �: a Electrical The Certificate of Occupancy will not be issued until all applicable signatures by tKO Building and Fire Officials are prowtled on this permit• Service: Minimum of Five Call Inspections Required for All Construction Work�r1 Sri 1.Foundation or Footing _ �� s r Rough: 2.Sheathing Inspection 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 a Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT cr Town of Barnstable OFTHE'olyti Building Department Services Brian Florence,CBO s�xHsrnsrs Building Commissioner 200 Main Street, Hyannis,MA 02601 / www.town.barnstable.ma us L Office: 508-862-403 8 Fax: 508-790-6230 �� Z � FEE: 35.0 PERMIT# U 0 SHED REGISTRATION RESIDF.NTLA-L ONLY 200 square feet or Iess Location of shed(address) Village Property owner's name Telephone number g x C ov Size of Shed Map/Parcel# . . � ;11i`lCa�� Signature Date Hyannis Main Street Waterfront Historic District? • Old King's Highway Historic District Commission jurisdiction? You must file with Old King's Highway Conservation Commission(signature is required) l/ Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIEIa BY A PLOT PLAN Q-forms-shedreg REV:08/6/17 I RNJ N V �OTV°� N •6'sr• F M m 4 .`b�'� h Ifqq se•: LOT 2 45247 t S.F. .. oUND,4r/0* OD O. WELL TOWN OF BARNSTABLE ZONING ZONE RF SETBACKS I CERTIFY THAT TO THE BEST OF MY PROFESSIONAL FRONT - 30' KNOWLEDGE. INFORMATION AND BELIEF THE DWELLING SIDE - -15 SHOWN HEREON CONFORMS TO THE HORIZONTAL SETBACKS REAR - I5' OF THE ZONING BY-LAW FOR THE RF DISTRICT. PROPERTY LINES SHOWN HEREON WERE COMPILED FROM AVAILABLE PLANS OF RECORD AND DO NOT REPRESENT AN ACTUAL SURVEY ON THE GROUND. THE DWELLING DEPICTED ON THIS P L O'T PLAN PLAN WAS LOCATED ON THE GROUND > IN BY SURVEY ON NOV. 10. 1997 AND EXISTS AS SHOWN AS OF THE DATE �,��( ' BARNSTABLE. MASS. OF LOCATION. , �3/9 SCALE: I'-40' NOV. • 13. 1997 THIS PLAN IS FOR PLOT PLAN EAGLE SURVEYING A ENGINEERING.INC. PURPOSES ONLY `AND NOT FOR 923 Route CA RECORDING. DEED DESCRIPTIONS YQraouthport. AA. 02675 ------- OR ESTABLISHING PROPERTY LINES.. (508) 382-8182 (508) 482-6888 THIS PLAN IS VOID IF NOT STAMPED AND SIGNED IN RED. 0 20 40 80 PROJECT NO.. 97-288 i N 4•0 N sr- F M m •e?• s. C? o• �b ? se•� L 0 T 2 45247 t S.F. c i Jo N�,�FrF ; Ar�0* 0 r® C5 N ss•? BS- ` TOWN OF BARNSTABLE ZONING ZONE RF SETBACKS I CERTIFY THAT TO THE BEST OF MY PROFESSIONAL FRONT - 30' KNOWLEDGE. INFORMATION AND BELIEF THE DWELLING SIDE - 45• SHOWN HEREON CONFORMS TO THE HORIZONTAL SETBACKS REAR - 15' OF THE ZONING BY-LAW FOR THE RF DISTRICT. PROPERTY LINES SHOWN HEREON WERE COMPILED FROM AVAILABLE PLANS OF RECORD AND DO NOT ;r REPRESENT AN ACTUAL SURVEY ON THE GROUND. FRA' No. �� Q�.; THE DWELLING DEPICTED ON THIS \,�� o PLOT PLAN PLAN.WAS LOCATED ON THE GROUND �e;>. '�fr►51���® IN BY SURVEY ON NOV. /0. 1997 AND BARNSTABLE. MASS. EXISTS A$ SHOWN AS OF THE DATE ✓ �""`�� r^ OF LOCATION. :33SCALE: l'-40• NOV. /J. 1997 THIS PLAN IS FOR PLOT PLAN EAGLE SURVEYING 3 ENGINEERING.INC. PURPOSES ONLY AND NOT FOR 923 Route 6A RECORDING. DEED DESCRIPTIONS Yaasouthport, MA. 0267S OR ESTABLISHING PROPERTY LINES., (508) 362-8132 i (508) 432-5333 THIS PLAN IS VOID IF NOT STAMPED AND SIGNED IN RED. 0 20 40 80 PROJECT NO. 97-288 l TOWN OF BARNSTABLE 4 �_ CERTIFICATE OF OCCUPANCY PARCEL ID 109 004 GEOBASE 14 5304 ( ADDRESS 718 CEDAR STREET PHONE W BARNSTABLE ZIP - ' LOT 2 BLOCK LOT SIZE ' DBA l DEVELOPMENT DISTRICT WB PERMIT 31147 DESCRIPTION SINGLE FAMILY DWELLING (PMT.#26643) PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: Ok THE +. BOND $.00 y i ', CONSTRUCTION COSTS $.00 756 -_CERTIFICATE OF OCCUPANCY,'' BARNSTABLE, *' MASS. 1639. E�.M1C� BUILDI rIS BY DATE ISSUED 05/22/1998 EXPIRATION DATE Tf uo•1 t1�>'. , L 1!, 1 : t� Li ., Ir ?.isll" - Department of Health, Safety 1-1 r:uq;•;, , ,;-r= - - and Environmental Services _ �.Ir} w�. " r. t , `? s [tk,�!.� r t.t� h'. . + r., _. I T �• .•,r.' 'r i� `BARN3fABLE. MASS. 1639. A� ED Mlr►I BUILDING'DIVISION BY L: .3U T+D T i U 'I.�,. H V' _lu " 107. 1), 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 APPROVED PLANS MUST BE RETAINED ON JOB AND FOR ALL CONSTRUCTION WORK: 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. POST THIS CARD SO IT IS VISIBLE FROM STREET--- BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 3 'j�,e�- 1 EATING INSPEC 10 APPROVAL IW;E GIN EKING DEP THE 2 B RD OFH15A H a OTHER: SIT N'REVIEW APPROVAL MM� "J WORK'SHAL'_,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. II � i . i Engineering Dept. (3rd;floor) Map Parcel Permit# A"44 House# 17 Date Issued (O 2 9 —9 board of Health(3r floor)(8:15 -9:30/1:00-4:30) d Jr Conservation Office(4th floor)(8:30-9:30/1:00-2 60) 16 , /b/h trtSTEIM MUST BE Planning Dept. (1st floor/School Admin. Bldg.) IN LJANCE Definitive Plan Approved by Planning Board I ' 3/ 19 . �- @ E AND -� TOWN OF BARNSTABLE ®WN Ns Building Permit Application Project Street Address 11Y Ge.CfC r �-r Village QeST Owner ft&j,(eS S©-w Address FSsex (:)Awy �C.tvMoy .Aol�l Telephone E;6$- 3 6`- OZS 3 Permit Request First Floor 1131 square feet Second Floor square feet Construction Type T m loer e, Estimated Project Cost $ D F4 000 Zoning District / 1� Flood Plain Water Protection Lot Size / / &-cJ?, , Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House Yes ❑No On Old King's Highway Q'Yes ❑No Basement Type: gFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) - Basement Unfinished Area(sq.ft) I3�. Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New �_First Floor Room Count Heat Type and Fuel: )dGas ❑Oil ❑Electric ❑Other Central Air )(Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) 'dAttached(size) `,LQ X /6 ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes QgNo If yes, site plan review# - Current Use Proposed Use Builder Information ' Name 0_71r7M� Telephone Number Address License# Home Improve m ent Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,.AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DA O BUILDING PERMIT DENIWO%Jgl FOLLOWING REASON(S) 6� "� . - Z , FOR OFFICIAL USE ONLY PERMIT NO. l��✓' G �. r DATE ISSUED + MAP/PARCEL NO. ° ADDRESS - 1 - VILLAGE ' n OWNER DATE OF INSPECTION: FOUNDATION VHS FRAME o� ' INSULATION - FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: :'•=ROQGR FINAL GAS: HV,e. FINAL T 1/' V1 _ /r.' } ..... € �—an /FINAL BUILDI'N.G .,;, '• /DATE CLOSED;C)� t; fr ASSOCIATION-A N ISSUE DATE (MM/DD/YY) - ------------CERTI F I C A T E OF INSURANCE - I 10/29/97 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, Mahoney & Wright - Yarmouth EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW OneAtlantic Ave. ------------------------------------------------------------------------ S. Yarmouth, MA 02664 COMPANIES AFFORDING COVERAGE ------------------------------------------------------------------------ (508) 398-6033 COMPANY The Worcester Insurance Company --------------------------------------------------------- LETTER A INSURED COMPANY TRAVELERS INSURANCE COMPANY LETTER B PAUL ANDERSON COMPANY LETTER C P 0 Box 298 COMPANY Yarmouthport, MA 02675 LETTER D COMPANY LETTER E = COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORuED-BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ---------------------------------------------------------------------------------------------------------------------------------- CO POLICY ICY LTRI TYPE OF INSURANCE I POLICY NUMBER I EFFECTEVE IEXPDATEIONI LIMITS ---------------- ------------------------------------------------------+----------------------------------------------------------- GENERAL LIABILITY GENERAL AGGREGATE $ 600,000 A CB 82 29 31 01/01/97 01/01/98 PRODUCTS-COMP/OPS AGGREGATE $ 600 000 CX] COMMERCIAL GENERAL LIABILITY —P—ER—SO—NAL-9 ADVERTISING INJURY C ] CLAIMS MADE CX] OCCUR. EACH OCCURRENCE $ 300,000 C ] OWNER'S & CONTRACTOR'S PROT. FIRE DAMAGE (Any one fire $ 100,000 C ] MEDICAL EXPENSE(Any one person) $ 5,000 ---+--------------------------------+----------------------+---------------------+-------------------------------- --------------- AUTOMOBILE LIABILITY COMBINED SINGLE C ] ANY AUTO LIMIT $ C ] ALL OWNED AUTOS BODILY INJURY C ] SCHEDULED AUTOS (Per person) I$ C ] HIRED AUTOS --------------------------------- -------------- C ] NON-OWNED AUTOS BODILY INJURY C ] GARAGE LIABILITY (Per accident) $ C ] --------------------------------- -------------- ---_---_- PROPERTY DAMAGE I ---=-------------+-------------------------------- ----------------------+---------- - +-------------------------------- EXCESS IC ]OtherlThaFoUmbrella Form I I AGGREGATERENCE 1$ ---+------------------------------------------------------------------ ----------I--------------------------------+--------------- B WORKER'S COMPENSATION UB NB 10100-7-97 10/17/97 10/17/98 1 STATUTORY LIMITS AND EACH ACCIDENT $ 100,000 EMPLOYERS' LIABILITY DISEASE - POLICY LIMIT $ 500,000 DISEASE - EACH EMPLOYEElUU,UUU _--+--------------------------------+--------._---------------+---•-------.+----_-._-..----+------------------------------------------------- OTHER A Bus. Personal Prop. Special CB 82 29 21 01/01/97 01/01/98 $2,000. Bus. Personal Property Replacement Cost $ 250. Ded. ---------------------------------------------------------------------------------------------------------------------------------- DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS = CERTIFICATE HOLDER ______________________________________ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE *Town of Barnstable EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO Town Hall MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Building Deparmtent LEFT, BUT FAILURE TZA H NOTICE SH IMPOSE 0 0 AT N OR Barnstable, MA LIABILITY OF ANY KINCOMPANY, IT GENT 0 RE ESENTAT�VES. - - ----------------- ---------- ----- -- --------- ----- AUTHORIZED REPRESEN 1 . q 64a TOWN OF BARNSTABLE NA } Building Department= Foundation Permit l� . {� Date Odim me S Location EY (�e7 AL P., - rig Insp. of Bldgs.. 0 I as �i 11 TEM to rill i Oman I• li :1 O t n M n�o rr cM g $ g ' • �, jil. �1 i) t � + • '`� � ;,ill ; ; 1 O11 �t i�1111_i 1, !v ' y m 111111tttttt������ i� c� 4 ; 0 o [ C F� =� I V (i `r' 7- `o lri f g 9 o i ppp � Q r o -- IV r --� to G Z .� , � 1 5 ! � `�� I � � � �. i I c i --- I — � ----- 0 l (,vfT i . 5 z T, 8 0 v 5 j i 1 ASPH A LT RooFIN 6 o�e_l 15'FELT PAPER 1 sTLESw 51C4nL?NS.LATED RmF PANE G"X6" OAK COLLAP, -r1 E 11 %i cox PLYWOOD tneArNiM� �\�� SX&" OAK RAFTe—R wITH 5'X7"PWtLiNs yB'QC. 10� ix6" RAFTER 16"O.c. /•1�T�6 PLYWOM SKBFloea o�rn ASPHALT ROOPIMH � •• -- /�i•6YPS.W cE\ur+6 tNlsA 1x S 14 O.C. - •• ' 4ic7"OAK FLOoK Tbisrz zyor- cEDll lt_sjDl� 3 K _AR 910iN6 1T6, O,S.B• Sll i:A TLL.NE. -1 L W NEI.. f R-19 HATT -TAiWATOM X"CDX PLYw000 5u8FLOOR YXIO -Tols ' CON CRCtc YIGYJ P. P.T- SILL FF B�.iLT 1AP UFAM SPr. P.T. SiL.L , C mr RETE WALL, 9 X'WC COMPACTS, FILL. wi-t•11 a0e m 6o ITS - I 1 .I i l .Co LAM COMCRETE WALL_ lo"X99" '�= - CO � FDOTINFj 8'k 16' WITH OAM PRDOFiN6 ON U oisTr 0.km SoIL AND ANC11ON DOLTS Co NCP.$TC FLvo R. �.. GARME SEC_-r1oN CONCRETE F0e-riN6 loxxo" 11 CALL rRAMIN6 S.P,F A (5enE-) ON 4AI0ISTIARBED SOiL_ MAIN M6u-,5L• •SECT ON � . 3 CaPoJ ED YIMB2R FRANIN6?O BZ NATivE ReD OAK, F4.LL DIMeNSIorv, P�Acf Ei\ IGbc. HEAneCL MAIN HOL.SE 1 MxY 1 _ wiru P:N6 TPOM T0.iM • 1i PT DEcxiNn I '� FT X.O s' 16 0C BUILT UP PT BCAln CHLACK Pc.56Y SWANSON � e 1 O' $ONO TL106 O nrvwvED In rnl ar FAPSME15 POnc.14 SEA-TioN-• C RO55 SEcTlonlS i, 1 I Application `to ' 1997 201 Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTI FICATE OF APPROPRIATENE$,S Application Is hereby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: New Building ❑ Addition . ❑ Alteration Indicate type of building: ` k House ffi Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3: Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑. Flagpole ❑ Other (Please read other side'for explanation and requirements). TYPE OR PRINT LEGIBLY DATE r7/ GxsT t3s �t� ADDRESS OF PROPOSED WORK ASSESSORS MAP N0. OWNER 1,46)eS* !3tV O )S0 / ASSESSORS LOT NO. HOME ADDRESS %74 NTEL. NO. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). S��• a �a�h-Pc� S'�i,ez� Chap/ems Sw •uso•c> TEL. N0. AGENT OR CONTRACTOR ADDRESS DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8, other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). �vwber .w.>✓ Cscpe, efe t.1 C � �G;�✓�-- Owner-Contractor-Agent Signed Space below line fo.Committteelfuse. ► , -Received by H.D.C. T e Certificate is hereby G2',/Z Date l 1 1 _ Tim tin lly , `^ �-'S hARFdSTgg� , Approved ' D�NgMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period provided In the Act. Disapproved ❑ G w,v� r-7 yo Te/z r y - . � I Town of Barnstable 'W ' Old King's Highway Historic District Committee SPEC SHEET FOUNDATION ACC OG/-Z-PGt" 00,U Cc)C e /0 x )o `��0��✓l SIDING TYPE C'ft?16,- C/14pk0tx1S CPa�r` COLOR ' Shl�/ems CHIMNEY TYPE /(/��¢- COLOR ROOF MATERIAL 4S ,ohgU/7L S!? COLOR PITCH f(J!l" 49 WINDOW As%jr-Psom 9-y xa-46 _ J- SIZE1202,1% TRIM COLOR 1� stor;C_ 3-a ?cG-S 5i«l DOORS 3-0 X 6-7. Z t.5,ur /-OSJ-COLOR eAJ . 3�f2°I tSX �.f l�g4zS SHUTTERS Ls'?C 3`t COLOR `�� GUTTERS Ifi / A to w►i Hum DECK <Ask G x/G p11-1550i`e- ` e_cc lc[l GARAGE DOORS iw 7 xto Pov►�lerQ L�f COLOR i cJ G�i SIGNS COLORS FENCE N��¢ COLOR 'NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the plot plan, landscape plan and elevation plans, when applicable. Site plan should show-all structures on the lot to scale. SPECSHT DATE': 10/01/97 TIME: 10:57 AM TO: Chuck Swanson @ 15082403646 PAGE: 001-001 ACORD�, CERTIFICATE OF LIABILITY INSURANCE 10/0"1/1997 PRODUCER (508)888-2244 FAX THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bryden Insurance Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 125 Route 6A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Sandwich, MA 02563 COMPANIES AFFORDING COVERAGE COMPANY Commerce Insurance Company Attn: Kathleen Bartlett Ext: A INSURED COMPANY Eastern Casualty Ins Co Catherine Little d/b/a Little Concrete B P 0 Box 1832 Sandwich, MA 02563 COMPANY C COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMIDDIYY) DATE(MMIDDIYY) GENERAL LIABILITY GE14ERAL AGGREGATE S 600,000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/CP AGG S 300,000 A CLAIMSMADE X OCCUR K24387 08/18/1997 08/18/1998 PERS014AL&ADVI14JURY $ 300,000 OWNER'S 8 CONTRACTOR'S PROT EACH OCCURRENCE $ 300,000 FIGt=f�GMGl:F(Cny nna fiml R CQ,(1QQ MED EXP(Any me person) S 5,000 AUTOMOBILE LIABILITY COMBINED S114GLE LIMIT $ A14Y AUTO ALL OW14ED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ A 97MM394963 07/17/1997 07/17/1998 100,000 HIRED AUTOS BODILY INJURY N014-OW14ED AUTOS ; (Per accident $ 300,000 PROPERTY DAMAGE $ 50,000 GARAGE LIABILITY AUTO C14LY-EA ACCIDENT S ANY AUTO OTHER THAN AUTO 014LY: EACH ACCIDENT $ AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THA14 UMBRELLA FORM $ WCSTATU- OTH- WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY B WCGl003602A 06/12/1997 06/12/1998 EL EACH ACCIDENT $ 500,000 THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT S 500,000 PARTNERSIEXECUTIVE OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE S 500,000 OTHER c DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Chuck Swanson BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 718 Cedar Street OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. W Barnstable, MA 02668 AUTHORIZED REPRESENTATIVE David Vajcovec POWER OF ATTORNEY Know All Men by These Presents: (Irrevocable) BOND No. R- 6OA542A499 That this Power of Attorney is not valid or in effect unless attached to the bond which it authorizes executed, but may be detached by the approving officer if desired. That Western Surety Company, a corporation, does hereby make,constitute and appoint the following S j x authorized individuals: AUTHORIZED INDIVIDUALS Y AUTHORIZED INDIVIDUALS �G}3ti:r'_r('Yn �A rY4�kf1�'`f' {'SAY ��y •\ - - tv �,. ✓� r Y U r 13{ ) 1 'h ROY E ,3f1NES III"I d-y�r G .� z}:i ✓�a 4 9'AA-VV1U 1'W K 7�Jf�a �r:i��s- �r�P•.ETER G IKALTHER.��; m r jr y 'f' <h h#A GAR'ET0'A 0A IEi�S 1 OONNAi M) EA RE,.; r,� ��4¢ e E�IV Y;` c'• ���.IA�tEx�+W yQUN0;�,�_ r e' rw ,(S(,1�•tl I +".. fw'rs' gg'� 'M�l1�if.C7��Cy �✓��� �t)f ,fl:j„yjC '!1CkM1`"'J� ,��'� .��si /�}isMi1 //{ ft SY / .� tw ��. I � � emu- �Trh Oi LS n e'er.,�.f�r2w1 F 'a- �txj tr' T� iy ' jl sr�vprIv f�`t 4 �.' �;.c r in the City of ORLEANS State of MASSACHUSETTS with limited authority, its true and lawful Attorney(s) in fact with full power and authority hereby conferred, to sign, execute, acknowledge and deliver for and on its behalf as Surety, one of the following bonds. An ORIGINAL bond required by Statute, Decree of Court or Ordinance for: MAXIMUM PENALTY (A) ADMINISTRATOR REFEREE IN PARTITION EXECUTOR COMMISSIONER TO SELL REAL ESTATE PERSONAL REPRESENTATIVE TRUSTEE OR RECEIVER-In Bankruptcy(Excluding Chapter II) GUARDIAN OF INCOMPETENT CURATOR CONSERVATOR OF INCOMPETENT/CONSERVATEE $ SQQ+QQQ COMMITTEE OF INCOMPETENT SALE OF REAL OR PERSONAL PROPERTY-When this company has qualifying bond or when it is a separate bond for accounting of proceeds of sale only. (B) GUARDIAN OF MINOR OR CONSERVATOR OF MINOR $ 10,000 (C) NOTARY PUBLIC RECEIVER-(In State Court Only) $ 50'QQQ PUBLIC OFFICIAL AND DEPUTIES TRUSTEE-(Testamentary Only) (D) PLAINTIFF'S COURT BOND-Banks,Savings&Loan,and Trust Companies $ 100,000 (Except Restraining Order and Injunction) -All Others,except bonds prohibited by"NOTE"below $ 20,000 (E) COST ON APPEAL (EXCLUDING OPEN PENALTY,STAY.SUPERSEDERS OR GUARANTEE OF A JUDGMENT) $ 2,000 (F) LICENSE AND PERMIT EXCEPT BONDS WHERE THE UNITED STATES OF AMERICA.A FEDERAL AGENCY,OR A STATE IS THE OBLIGEE $ 2S,000 (G) STATE LICENSE AND PERN11T-The following[ THR E El 3 J bonds are authorized where the state of MASSACHUSETTS FMA is the obligee(other state required bonds not authorized). AUCTIONEER ************#********#*************** REAL ESTATE BROKER ***************************** $ 10,000 TRANSIENT VENDOR ##*###**#*************#*#*****# ************************************************* SPECIAL FUEL USERS $ 2,000 (H) ANY BOND OR INDEMNITY provided there is attached to this Power of Attorney, written authority in the form of an endorsement, letter or telegram,signed by the Senior Underwriting Officer, Underwriting Officer, President, Vice President,Assistant Vice President,Secretary,Treasurer or Assistant Secretary of Western Sure ry Company specifically authorizing its execution. For confirmation of the necessary written authority, please contact our Underwriting Department at .L-,,V331-6053 339_0 60 in South Dakota. NOTE:�� 1)EAS!OR,OPEN PENALTY OR STAY BONDS ON APPEAL OR GUARANTEE OF JUDGMENT OR BAIL BONDS OR CONSTRUCTION BID OR CONTRACT OND$fOR DEFENDANTS OR UTILITY DEPOSIT BONDS OR SITE IMPROVEMENT BONDS ARE NOT AUTHORIZED BY THIS POWER OF ATTORNEY, Idi5oction(H). COMPANY further certifies that the following is a true and exact copy of Section 7 of the By-Laws of Western Surety Company, duly efiowit: "Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in he`Company by the President,Secretary,any Assistant Secretary,Treasurer,or any Vice President, or by such other officers as the Board �© ize.The President,any Vice President,Secretary,any Assistant Secretary,or the Treasurer may appoint Attorneys in Fact or Agents who s y ue bonds,policies,or undertakings in the name of the Company.The corporate seal is not necessary for the validity of any bonds,policies, u I'Attorney ar obli ati s of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile." Dated`t ofFe�briiary, 1993. WESTERN S U R E T Y COMPANY AT i ES'Ii,••1%0% +++a+Htttln,•_ Assistant Secretary By ���++STAIL3OFSOUTH DAKOTA ,0 SCOUNTY.,OF'MINNEHAHA } SS President On this'18th day,of Febcuary11993,before me,S.Barnes,the undersigned officer,personally appeared JOE P.KIR A VIETOR who ackno ]edged hemselves to be the President and AssistantSecretarj`respectively,of Western Surety Company,a corporation,and that they,as such officers being authorized to do so,executed the orego' g instrument for the purposes therein c2trttdined,by'siguhig,the name of the corporation by themselves as such officers wn ZIri' ness whereof I hereunto set my hand and official seal. My commission expires n. 1 JA _ Jauary„22%'r c,•? 1999 /:'•. •`hamNotary Public,South Dakota I,the und,iftned pfficer of-Western Surety Company,a stock corporation of the State of South Dakota,do hereby certify that the attached Power of Attorney is in full force and effect and is itreVoebble;Uw d.Cuitliermore,that Section 7 of the By-Laws of the company as set forth in the Power of Attorney,is now in force. ""41111ti'lesilmony whereof,I have hereunto set my hand and the seal of the Western Surety Company this' day of WESTER S U Y COMPANY I 'IMPORTANT:This date must be filled in before it is attached to the bond and it must be the same date as the bond. By IAA PRESIDE T i i tl ` %1Uy ° G y i tl c y c ° c g F Western Surety e n e i , G c e i e i e LICENSE AND PERMIT BOND For County,City,Town or Village Only-Not Valid for Bonds Required by the State.Not Valid for Contract, ° Performance,Maintenance,Subdivision,Agent to Sell Hunting and Fishing Licenses or Utility Guarantee Bond. u G ° , KNOW ALL MEN BY THESE PRESENTS: BOND No. L&P- 6 0 6 4 13 0 3 y ` That we, Charles K. Swanson °G ' of the Town of Barnstable , State of Massachusetts , as Principal, and WESTERN SURETY COMPANY, a Corporation duly licensed to do business in the State of Massachusetts , as Surety, are held and firmly bound unto the Town of Barnstable: , State of Massachusetts , Obligee, in the amount (Valid only when a County,City,Town or Village is named as Obligee) of Nine Hundred & Eight and no--cemts DOLLARS ($ 908.00 )� (NOT VALID FOR MORE THAN$25,000) lawful money of the United States, to be paid to the said Obligee, for which payment well and truly to be made, we bind ourselves and our legal representatives, jointly and severally. THE CONDITION OF THIS OBLIGATION IS SUCH, That whereas, the Principal has been licensed Contractor by the Obligee. NOW THEREFORE, if the Principal shall faithfully perform the duties and comply with the laws and ordinances (including all amendments), pertaining to the license or permit, then this obligation to be void, otheroymain in full force and effect for a period commencing on the 1st day of 1997 , and ending on the 1st day o ' 0 Cmto 1998 , unless renewed by continuation certificate. :A NX,on tRAy'. Urminated at any time by the Surety upon sending notice in writing to the Obligee and to 'wialp cipal, in'c`a�i?e q the Obligee or at such other address as the Surety deems reasonable, and at the expira- 1 ornIgf thirty-, Mays from the mailing of notice or as soon thereafter as permitted by applicable law, vtevers��xte�' is'`bond shall terminate and the Surety shall be relieved from any liability for any subsequent ac$'s, 10 2 the Principal. 1st Day day of October 19 97 CAOZI& � �- Principal Principal Countersigned WE STE R N Y COMPANY G G � • G BY BY Z — Resident Agent President o ACKNOWLEDGMENT OF SU �TY STATE OF SOUTH DAKOTA �ss (Corporate Officer)County of Minnehaha i On this day of , 19 ,before me,the undersigned officer,personally appeared Joe P.Kirby ,who acknowledged himself to be the aforesaid officer of WESTERN e SURETY COMPANY,a corporation,and that he as such officer,being authorized so to do,executed the foregoing rt instrument for the purpose therein contained, by signing the name of the corporation by himself as such officer. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. n S. BARNES ' u ��$ NOTARY PUBLIC s� V NotaryPublic, South Dakota SOUTH DAKOTA �.` G Surety Western Sur y ° . My Commission Expires 1.22-99 �. Y Company P Y G r Form 849—9.92 1-605-336-0850 ' �ir°ri➢ t 4 aaIf::F"T,.,-. �:`xc ,v„ n A'..�. t'. a r il n il v u ACKNOWLEDGMENT OF PRINCIPAL - (Individual or Partners) STATE OF il il C. P P ♦ ss ` P County of o P il On this day of ,'19 ,before me personally appeared ' P e f i il r •} Y c ! u F known'46`�'me•`to be the,,individual_ described in .and who executed the foregoing instrument and r il acknowledged to me that—he_executed the same. + My commission expires r 19 Notary Public ACKNOWLEDGMENT OF PRINCIPAL (Corporate Officer) STATE OF ) }ss County of ) On this` day of , 19 ,before me, personally appeared , who acknowledged himself to be the _ a + of , a corporation, and that he as,such officer being authorized,so. to do, executed the foregoing instrument for the pur- poses therein contained by signing the name of the corporation by himself as such officer. My commission expires 19- Notary.Public v 4•, i- r r JJ r P cd • P P z z z P il � P N U O > , P P • TOWN OF BARNSTABLE • BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION ease print. ,•• - D TE JOB LOCATION Number Street address Section of to HOMEOWNER" Name Home phone Work phone - RESENT MA2LSNG ADDRESS �$e-� Ley 0 6 S� City own State Zip code The current exemption for "homeowners" was extended to include owner-occupiE dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re side, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"' shall submit to the Building Offic on a form acceptable to the Building Official, that he/she shall be resnonsi. for all such work performed under the building permit. (Section 109.1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the S . Building Code a c and other applicable odes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands ..the Town of Barnstable Building Department minimum inspection procedures and requirem' ent-c and that he/she will com w' h s id rocedures and requirements. OMEOWNER' S SIGNATURE PROVAL OF BUILDING OFFICIAL ote: Three family dwellings 35 , 000 cubic feet, or larger, will be required 0 comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109.1. 1 . - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person (s) for hire to do such work, that such Home OwnE shall act as supervisor. " Many Home Owners ,who ' use this exemptiori.'are, unaware that 'they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations , for . licensing Construction* Supervisors, Section 2. 15) . This lack of awarene often results in serious problems ' ,particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home "dwner.' act_ as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, ma: communities require, as part of the permit application, that the Home Owner certify, that -he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. F Tlrc• Cunntrol"reulth of:1lassuc/iusctts _._::_.' s I.` • ;-: Deparltitent of Industrial.4 cculents {��..,.. Office PROWSM211ons 600 lVas/ritr,tott Street -�, Boston. A1ass. 02111 Workers' Compensation Insurance Affidavit . _- --•-� ..--- - • ---- Please PRI1V-T'lei. ,.....—...r.r._.�_..._--..._. ----- --- - �lpplic•tnt intorntation• -bL�2I� � _- _ �namc: C► Go'(eC J4XcV) SO yl - �lt,cation: -1l� Cec�c•✓` S j / city CJ• l�r�c`hsTc.bt� >�,nrt� 73--OZS I am a homeowner performing all work myself. I am a sole proprietor and have no one working_ in any capacity 71 1 am an emplover providing workers* compensation for my employees working on this job. enoman • name: ` address: city: nhnnc#- insurance cn. [] 1 am a soic proprietor. beneral contractor r omeowne (circle one) and have hired the contractors listed below who have the following workers compensation polices: cnmnanv Warne: L -ef(e— �ll dr rest 1 `v it•;: rn ��rjn� nhnnc#• insurance rn. ^✓i,lics # � •I `,� _ _ .�..Y. � ?ram-�:����a iT'-1�.w•5��� �T�.:._ .i�_._... __..__._ ... .._ ...�__....._. r_.__ray___._ r_JY.rr-1.:_ _- - - �_�r�� .Y•__� c n tans• name• 6o"\G'r— addresc: ci nhnnc#• �—47SJ `l insurance co noiic�• Attach additional sheet if neee"-'--- � - + _-+ - — __ ^�--r•• y- —"" .."-. ---' =.- —�..:_:;ti..�:�:,,.;...�_ •�t_-. _�_��-:.—._--.ram.---=�-- - i�Y!'�..I:.�it•.w.ws.o. F::ilurc to secure coverage as required under Section 25A of DIGL 152 can lead to the imposition of criminal penalties 01•2 line up to S1.500.00 andiur une wears' imprisonment as wcll as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a cop).of this statement may be furwarded to the Office of Investigations of the DIA for coverage verification. 1 do herebt•ccrrifi•under the prints and pcnaltics of perjurt•that the information provided above is true and correct. Signature ✓ Date ✓ /10- t- cz -7 Print name C�G�`I-e.S In Sa/\ Phone# 3 7S- 6-7 S ' official [INC unly do not write in this area to be completed by city or town ofrrcial ` city or town: permit/license# rIBuilding Department C3Liccnsing Hoard 1] check if immediate response is required (:3Scleetmen•s Office ►_ E311calth Department contact person: phone#: rnOthcr Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for ,11- employees. As quoted from the "law*. an eiripluree is defined as every person in the service of anuthcr wider any contract of hire, express or implied. oral or written. s An entplurer is defined as an individual. partnership, association, corporation or other legal entity. or any twu or inc. the Foregoing en��aued in a joint enterprise, and including; the le al representatives of a deceased employer. or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However owner offa dwelling house having not more than three apartments and who resides therein. or the occupant of the dwclling house of another who employs persons to do maintenance , construction or repair work on such dwelling_I-rc` or oil the grounds or building appurtenant thereto shall not because of such employment be deemed to be an empiove: MGL chapter 152 section 25 also states that even- state or local licensing agency shall withhold the issuance or rencival of a license or permit to operate a business or to construct buildings'in the�c�titmon�•ealth for an• applicant who has not produced acceptable evidence of compliance with the in coverage required. Additionally• 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 been presented to the contracting authority. Applicants Please fill in the,workcrs' compensation affidavit completely, by checking the box that applies to your situation and supplying_ company names. address and phone numbers as all affidavits 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 tite 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 requirez to obtain a workers* cornpettsation policy• please call the Department at the number listed below. 7,. Citv or "Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom o: the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pie-- be sure to fill in tiie permit/license number which will be used as a reference number. The affidavits may be returned : -;ie.Department by mail or FAX unless other arran`ements have been made. Tile Office of Investigations would like to thank _you in advance for you cooperation and should you have any questior please do not hesitate to _ive us a call. Tile Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 «'ashington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406. 409 or 37.5 GENERAL NO TES : ACCESS COVERS MUST BE WITHIN INVERT ELEVATIONS : DESIGN CR I TER I A :I. THIS PLAN 15 FOR THE DESIGN AND CONSTRUCTION 6. OF FINISH GRADE 9' MIN/MUM. INVERT AT BUILDING: 107. 0 DESIGN FLOW: OF THE SEWAGE DISPOSAL SYSTEM ONLY. l09 o FIRST 2' TO 3' MAX/MIQI COVER INVERT IN SEPTIC TANK: 106.5 1 BEDROOMS AT._I10 G.P.D. PER BE LEVEL MIN 2' OF PEASTONE INVERT OUT SEPTIC TANK: 106. 25 BEDROOM EQUALS 330 G. P. D. 2. ALL CONSTRUCTION METHODS AND MA TER/AL S AND 109.0 MAX MAINTENANCE OF THE SEPTIC SYSTEM SHALL 4' PVC 3/4' - 1 172' D1A. INVERT /N O/ST. BOX: 106. 0 ,lV0 GARBAGE GRINDER SCHEDULE o INVERT OUT D I ST. PDX: 105. 83 ng CONFORM TO MASS. D.E.P. TITLE S AND LOCAL 'o `�• � 06 5 � lOS.S T2• �. -��WASHfD STONE BOARD OF HEALTH REGULATIONS. I07' 0 '� 'AS ! 6.O% 0 3 I03 5 INVERT IN LEACH CHAMBER: 105. 5 SEPTIC TANK REQUIRED: l� a4m 1 J. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER OUTLET 2-300 GAL LEACHING CHAMBERS BOTTOM OF LEACH CHAMBER: 103.5 l0• MIN. D-BOX W/4' STONE AROUND. 12.d*X 25'X 2' 330 G. P. D. X 20OX - 660 GAL . - AREAS SUBJECT To VEHICULAR TRAFFIC OR GREATER 1300 a4L ADJUSTED GROUND WATER: N/A SEPTIC TANK PROVIDED: 1500 GAL . THAN 3' IN DEPTH SHALL BE CAPABLE OF W1 TH- SEPTIC TANK 6' CRUSHED STONE BASE OBSERVED GROUND WA TER: N/A STANDING H-20 WHEEL LOADS. BOTTOM OF TEST HOLE •l : 96. 6 SOIL ABSORPTION SYSTEM REQUIRED: 4. SEPTIC TANK AND DISTRIBUTION BOX TO BE PROFILE : NOT TO SCALE N DESIGN PERC RATE - .MIN/INCH PRECAST REINFORCED CONCRETE AND WATERTIGHT. SOIL TEXTURAL CLASS - I S ALL $EII'ER PIPE SHALL BE SCHEDULE 40 oR EFFLUENT LOADING RATE - 0. 7 GPD/SF APPROVED EQUAL. \ 330 GPD / 0..74 GPD/SF - 446 S.F. 6 BEFORE CONSTRUCTION CALL 'DIG-SAFE-. +11s 9 PROVIDED: 2-500 GAL LEACHING CHAMBERS I-d00-322-4d44 AND THE LOCAL WATER DEPT. \ \ ` FOR LOCATION OF UNDERGROUND UTILITIES. W/4 ' STONE AROUND. A-4Tl S.F. 7. VERTICAL DATUM 15 ASSUMED. FOR BENCH MARKS SET. SEE SITE PLAN. , SPA s o I L TEST PIT DA TA d. NO DETERMINATION HAS BEEN MADE AS TO 1 ` `\ \♦♦ S�teF�i�� �\ �� INDICATES INDICATES COMPLIANCE WITH DEED RESTRICTIONS OR ZONING $' `� �� ' �\ N,N PERCOLATION = OBSERVED REGULATIONS. IT SHALL REMAIN THE CLIENTS \\ ��� \�� ` �� �� TEST = GROUNDWATER RESPONSIBILITY TO OBTAIN ALL PERMITS. SPECIAL i �� ��� � �\ `�/ +116.6 P►7751 1 i � PERMITS. VARIANCES ETC. FOR THIS PROJECT. +los.6 �/ /� o �\ `� � Tp• I TP• 2 TP• 3 GRND EL. 110,6 GRND EL. l 13.9 GRND EL. 107.0 9. IT SHALL REMAIN THE CLIENT'S RESPONSIBILITY // �� /� j ` \ e!• �� G.W.EL. NSA 0.W.EL. NIA 6.W.EL. N/A TO HAVE THE PROPOSED BUILDING FOUNDATION // i� i� j I ,\ ��?� �' \\ O' 110.6 0' 113.9 0' 107.0 DESIGNED TO ACCOUNT FOR THE EXISTING GRADE j ��� �i/ /I \\ �� WOODLOAM WOODLOAM WOOOLOAM AND SOIL COND 1 T I ONS AT THE LOCATION OF THE �' �� % \ �'N SUBSOIL SUBSOIL SUBSO t L PROPOSED BUILDING. �� t� / /� / `9 �� LARGE LARGE LARGE ROCKS ROCKS ROCKS � F - --' +1o7.s I I �►-- -_��,�--?�i*�-,. 54• /06. / 4d' /09.9 4d' IOJ.O 10. ALL DENSE PACKED FINE SAND SHOWN I N TPO I h. - _ - - - I a +I 11 b, _ _ �' ` MED I UM MED-FINE ENCOUNTERED BELOW THE INVERT OF THE LEACHING - : - -- - - - j -� r - - - 1 `� -==�s,.�.,_ SAND SAND FACILITY TO BE REMOVED FOR A DISTANCE OF 5' -__�--,..� � , MEDIUM TO _ l ------ \ ` _ > -- _ _ 96' l02.6 d4--- 06.9 AROUND AND REPLACED WITH SAND I N ACCORDANCE 1 � 1 --- 1�__ \ - �� DENSE PCKED; i FINE FINE SAN WITH TITLE 5. ' t �� �� i ` \ __`� FINE SAND � SAND � WITH SOME 1 ! ^y' -- �• \ 1, !?0' 100.E /20' 103.9 FINES \ I seE\vor 10. \ _--o L T° 2 ( MEDIUM DENSE FINE \\ t\ +1 O6 • �� * r ;\ Fsl rE 45.24Xs S.F. \ // SAND SAND CLAY ~ PERC !S MImix \ \ t1 156' 97.6 156' 100.9 I N, ; DENSE CLAY MEDIUM \ ` / `- SAND \ � -\ ; lsoo aNt �.�______ -I I j --I SAND MIX PROPOSED \\ so' �' /ASEPTIC tAW 2FA5al dmL 1 1 °o'• 1 \\�/� 16d' NO WATER 96.6 16d- NO WATER 99.9 156' NO WATER 94.0 1 r14• aT � % _ •� �`• I rr.2 `� \� +117.4 DA TE: APR 1 L 1 / . 1991 r -1\ N` \� \`� �` TEST BY• EDWARD E. KELLEY `• ` `�\ �ia• \ N `�` h M\ WITNESSED BY: s w TOP of Ci/PLw �� I \ \ �\ ' `� �� o = EL-ft.,r moo, ��__. \ \ ` PERC RATE: 2 MI N/I NCH loo.sJ �` I PII ; \\ ��` �`�.,, IN MED i UM SAND LAYERS S E T / C S Y S T E-M D E• S / CA N �• ** 7 / 6 CE0.4 R S TR EE T ����':-eJ_------ _ WJCE S T SA R NS TA B L E . MA CIORIM - M.76 - 1 ♦���� ��`` �♦ -�� of K �'/ PR ERA R EO FOR FELL® �J A J♦ ``-� ♦� �� ♦ a I-L O �,� ��, +�..: C`I-HA R L EE S S WA /u S o /v r / 2 C / RCU / T RO EAST . WEST YARMOUTH . MA 02e7.3 ♦° _ �?' I tar OF C#MW l oe.72 ' \ 4b� up ID,a,, -D'''s SCALE : / - 3 O J UL Y / 6 E'�4 GL Lam' .S' L!R VE-Y I NG �t LE MC I NE'L�'R I NG . I NC . 92 3 R O zz t Is �4 Mar- m o o t hw o r t . MA 0 2 6?5 f o is 30 60 JOB N0: 96-2_ FIELD:RVB/PDR CALL: SAH/CFW CHECK: CFW DRN# SAH t C� = i .T ,.: .. :. -.. ..r.. .. .s . - ....3. ,A ,._ a.r...•. .....J.. .. .-._ .<. 'G•.. r _y.. h.. ,.a eA . 'a-. 'S tl�i„�.. �-- i4 .. _ -. .. -. ,.. .-. .. .' -sa .- u .:. .. .. • .. .. .. .. .. :.-�. -.. 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