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HomeMy WebLinkAbout0015 HEZEKIAHS WAY ® ��� NO. 152 1/3 ORA _Y �MCCARTHY RUCTION CO: ` . 11 "61 and Commercial Builder I 77ON SPECIALIST 4 MCCARTHYC 11 W. October 21, 2014 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main Stret Hyannis, MA 02601 RE: Insulation Permits E5 Dear Mr. Perry, This affidavit is to certify that all work completed for permit application#201405387 at 15 HEZEKIAH'S WAY has been inspected by a certified Building Performance Institute(BPI) inspector.All work performed meets or exceed Federal and State requirements Sincerely, Michael McCarthy McCarthy Construction �MCCARTHY. R� .I zc RUCTION CO. T i sid Mal and Commercial Builder s J I` WEA�T2IZATION SPECIALIS ,t�X. t tea_ •• .e-'.+..�,,.,'• G AR YC 1 B' October 21, 2014 Town of Barnstable Thomas Perry CBO o Building Commissioner a �. 200 Main Stret 1) Hyannis, MA 02601 �1 ME ZM RE: Insulation Permits --� Dear Mr. Perry, This affidavit is to certify that all work completed for permit application#201405796 at 15 HEZEKIAH'S WAY has been inspected by a certified Building Performance Institute(BPI) inspector.All work performed meets or exceed Federal and State requirements Sincerely, Michael McCarthy McCarthy Construction O� TOWN OF BARNSTABLE �1KE Building 201405796 * MkMSTABLE, + Issue Date: 09/11/14 Permit 9 MASS �Ar16 �A�� Applicant: MCCARTHY,MICHAEL J Permit Number: B 20142406 Proposed Use: SINGLE FAMILY HOME Expiration Date: 03/11/15 Location 15 HEZEKIAH'S WAY Zoning District RF Permit Type: RESIDENTIAL INSULATION Map Parcel 109001001 Permit Fee$ 35.00 Contractor MCCARTHY,MICHAEL J Village WEST BARNSTABLE App Fee$ 50.00 License Num 58633 Est Construction Cost$ 1,500 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND WEATHERAIZATION/INSULATION THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: MCMAHON,WILLIAM B&KAREN L BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 15 HEZEKIAHS WAY INSPECTION HAS BEEN MADE. WEST BARNSTABLE,MA 02668 Application Entered by: RM Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY,NO 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 MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FIVE CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.SHEATHING INSPECTION 3.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 4.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 5.PRIOR TO COVERING STRUCTURAL MEMBERS(FRAME INSPECTION). 6.INSULATION. 7.FINAL INSPECTION BEFORE OCCUPANCY. 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. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). POST THIS CARD SO THAT i BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION TOWN 0F RARi�ai:'��t Map Parcel6001-41 SEP -2 kfl 10: C6_ Application # 01 `405�1 Co Health Division Date Issued 1 � ' Conservation Division. Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 5 ae-a �t�o%; \,✓.., Village N.42, ,rn. Owner P, Address S` -- Telephone 77c1 -3 C Permit Request tc /-I.„ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size - Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. / Dwelling Type: Single Family LK Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current-Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Mike McCarthy Construction Telephone Number PO Box 52 Address west Dennis, MA 02670 License # e280-6964 CSL.-58633 HIC-169393 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 'SIGNATURE DATE S/lllc/ 1 In FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED 4r MAP/PARCEL NO. ADDRESS VILLAGE ' zr ;r. OWNER =`3 _ DATE OF INSPECTION: � r y� 4? - 'FRAME S, INSULATION. . FIREPLACE .... ....... . ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: Cs-058633 MICHAEL J MCCAR 1. PO BOX 52 W DENNIS MA 6267�. I - Expiration Commissioner 04/10/2016 �x (252 e eaN 0 Q*1�jaC1M(4,ef M. Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 Type: Individual Expiration: 6/16/2015 Tr# 238121 MICHAEL MCCARTHY MICHAEL MCCARTHY P.O. BOX 52 WEST ENNIS, MA 02670 Update Address and return card.Mark reason for change. SCA 1 Co20M 11 Address Renewal ❑ Employment Lost Card • t� a ' F; A� �® CERTIFICATE OF LIABILITY DATE(MM/DD/YYYY) BILITY INSURANCE o7/10no14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 01962-001 RRUJACT Bryden&Sullivan Ins Agcy of Dennis IncPO Box 9 /UC.No.Ext: (508)398-6060 .No.: (508)394-2267 So Dennis,MA 02660 igghss: 1 BIER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: A.I.M.Mutual Insurance Company 26158 _ Michael McCarthy Construction Inc R B P O Box 52 INSURERC, West Dennis,MA 02670 INSURER D, IN$URERE• COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N07WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 'AI-IICH 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. IrjR TYPE OF INSURANCE �yp� � POLICY NUMBER R MSr LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR EEIEMISES Ee MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ p POLICY F-UECT F-LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO accident) - $ ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE $ d UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS MADE AGGREGATE $ DE RETENTION $ q�'N�4yfi�R�I�;P�iRo�9psR�/Cq►R'T�IN4Ef� X T �Ii�T14s °�' A OFFICER/MEMBER EXCLUDEp7 ECUTNE YN N/A VyyC-100-6017656-2014A 7/17/2014 7/17/2015 E.L.EACH ACCIDENT $ 500,000.00 (Mandatory In NH) Yfl d Cn �d8f E.L.DISEASE-EA EMPLOYEE $ 500,000.00 6ESsCR fl OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more apace Is required) Workers Compensation Coverage applies to MA employees only. CERTIFICATE HOLDER CANCELLATION Thielsch Engineering 195 Francis Avenue Cranston,RI 02910 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cranston, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 251988-2010(2010/05) The ACORD name and logo are registered markOs of ACORD ACORD CORPORATION.All rights reserved. I i The Commonwealth of Massachusetts Department oflndustrialAccldents Oice of Investigations 600 Washington Street Boston,MA 02111 kvivip.mass gov/dla Workers' Compensation Insurance Affidavit: Builders/Contractors/E,lectriciamNlumbers Applicant Information Please Print Le ' I Mike c arthy onstruction Name(Business/Organization/Individual): PO Bog 52 Address: West Dennis, NIA 02670 City/State/Zip: CSLpA§§P HIC-169393 Are)u an employer?Citeck the appropriate box: Type of project(required): 1. I am a employer with 1_ 4. ❑ lama general contractor and I 6. ❑New construction employees(Rill and/or part-time).* have hired the sub-contractors 2.❑ I am a sole propridtor or partner- listed on the attached sheet:= 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers'comp.Insurance. 9. ❑Building addition (No workers'comp.insurance 5. ❑ We arc a corporation and its req�d,) officers have exercised their l0.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MOL I L[]Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),'and we have no 12.❑R °°f repairs insurance required.]t. employees.[No workers' 13.Q'Other comp.insurance required.] *Any applicant that checks box A must also fill out the section below showing their workers'compensallon policy Wbrutadon. t Homeowners v&o submit this affidavit Indicating they are doing all work and then him outside contractors must submit a new affidavit Indicating such. tContractors that check this box must attached on additional sheet showing the name of the sub•ccahactors and amir workers'eomp.policy 16nnation. I am an employer that Is providing workers'compensatlon Insurmice for my employees. Below Is the policy and job sile Information, {� Insurance Company Name: •n / 1�1�-� Policy#or Self-ins.Mr.#: VW(_ lac-(�,d 1 16V_" -a I`IA BxpIIation Date: Job Site Address: I �� J: c le-1A �, lam.y City/State/Zlp: 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 ofMGL c.152 can lead to the imposition ofcriminal penalties of it fire 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 caHt&I;M" enallles of perjury that the ir{/orntation provided above i s true cord correct. SI ture: ts: Phone M Offlcial use on y. Do not write In this area,to be completed by city or town off k1at } City or Town: Permit/I.tcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3,City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector j 6.Other Contact Person: Phone 9: •77c-i-30• r „ f OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at l A/e 7- y , (Property Address) (Property Address) hereby authorize A Subcontractor) an authorized subcontractor for RISE Engineering,to on my behalf to obtain a building permit and to perform work on my property. Owner's Signature Date e TOWN OF BARNSTABLE BUILDINGIPERMIT APPLICATION 6o f CO ( Yd � � ' RNSTR8LE Map . Parcel Application #0 0 C(105'0 Health Division AUG ! S AM its D! Date Issued y, Conservation Division Application Fee Planning Dept. ""g Ir w,� Permit Fee DIUsSd�;.; Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address )'�i Ne Z��t f cl-.•, 1�._, Village `/✓ter 'rv�, Owner Address 5, Telephone Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family O// Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name A4ike Y Construction _ Telephone Number Address PO Box 52 License# Dennis, Cell (508) 280-6964 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Y1v11 SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# ,a DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER - DATE OF INSPECTION: xFO.UNDATI.ON suAa s--c FRAME,- .;INSULATIONS.�.- FIREPLACE 4 r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r' GAS: ROUGH FINAL r s' FINAL BUILDING DATE CLOSED OUT j' s ASSOCIATION PLAN NO. Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 MICHAEL J MCC.AR PO BOX 52 W DENNIs MA #267; ( 1 „ ", ` Expiration Commissioner 04/10/2016 Office of Consumer Affairs and Business Regulation _- 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 Type: Individual Expiration: 6/16/2015 Tr# 238121 MICHAEL MCCARTHY MICHAEL MCCARTHY P.O. BOX 52 WEST DENNIS, MA 02670 Update Address and return card.Mark reason for change. SCA 1 20M-OS/11' Address ❑ Renewal Employment Lost Card . Ci CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/10/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 01962-001 hgaJACT Bryden&Sullivan Ins Agcy of Dennis Inc PO Box 9 AIC.No,Et; (508)398-6060 lac.No.: (508)394-2267 So Dennis,MA 02660 �Sss: INIURER(S)AFFORDING COVERAGE N IC 0 INSURED -INSURER • A.I.M.Mutual Insurance Company 26158 _ Michael McCarthy Construction Inc INSURER B• P O Box 52 N E C West Dennis,MA 02670 INS`RE D: N E COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO—iWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DCCUMENT WITH RESPECT TO 'AL7•IICH 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. TYPE OF INSURANCE il�ypr� ` d� POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ I n CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: 0LICY E7ECT RO-' OC PRODUCTS-COMP/OP AGG $ ,� AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO Ea a 'den •$ �� BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED AUTOS PROPERTYDAMAGE accident) $ UMBRELLA LIAR OCCUR $ EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ Mn D ERM�PpL�O�YEERp8��pLIgARBTINUETRY� X TORY LI I S OER A OFFICER/MEMJER EXCLUDED ECUTNE N (Mandatory I NH) Y N/A VWC-100-6017656-2014A 7/17/2014 7/17/2015 E.L.EACH ACCIDENT $ 500,000.00 I( fl days O uYer E.L.DISEASE-EA EMPLOYEE $ 500,000.00 D SCCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Addltlonal Remarks Schedule,N more apace la required) Workers Compensation Coverage applies to MA employees only. CERTIFICATE HOLDER CANCELLATION Thielsch Engineering 195 Cranston,Francis Avenue Cranston,RI 02910 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ACORD CORPORATION.All rights reserved. i (7-7 64-o61a t OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at A/e 7— (Property Address) (Property Address) f hereby authorize Y Subcontractor) an authorized subcontractor for RISE Engineering, to ion my behalf to obtain a building permit and to perform work on my property. `''I'cfA�I.P�►'� �`mac . Owner's Signature Date I The Commormr of Uassachuseff-�i .Uepm,ftu,mt ofhsdraftwrl Acczdentg - - ( ice o��n�esi�gr�tiQns 600 Washsrrgtom %-eat Boston,MA 02I11, wnw.7nas&ga P/dia Wormers' Compensat€onTnmm-aceA fcda-it:$uFilders/Conba:ctors/E-IectriciansTlumbers Applicant InfarmatiOII Please Priaf Legibly Mike c 'a _ `+y on truc" Name(Busiup s oi-gsnuxtionllndividnaZ)_ PO Box 52 West Dennis, NIA 02670 Address: Cell (508)2841-6964 fl y f _ CSL-58W,,4HIC-169393 Are yam an employer?Check the appropriate box= I'Tpeof ect(r 4-_ aara. cLtnf t racorand'I I�'o1 �e�- . am a employer witbL ❑ I 6- ❑New ccrosfiu m. employees(fult andlor part-time)* have hirea the br&ctors. 7_❑ I am a sole proprietor orpattner- listed on the attached sheet 7. ❑Remodeliag ship and have no employees These sub-eoutrartors have g- ❑Demolifiza In and have workers' working forme in any cagactt5r- �P �� 9_ ❑Building add.iton Wo•Rrorkets' Comp_insurmce comp. cnranrt-- 10�Electrical repairs or adduioas �nir m ed.� 5_.❑ te We a a corpora6cnaadits 3.❑ 1 am a homemxue<doing all work offices have exercised Oieir II.Q PIumbing.repair3 or additions. myself [No workm'comp- right.of e mmpiionper MGL 12-0 hoof repairs a�rtTanr_e regmIed_] c- �Z, §1(4),and we have do employees-[No workers' 1 _I�U.ther Comp.in-mance req--red-j *Any anpti mat that checks box Rl must also fM out the:section below sbnwiiv ibex worlse*s'comne...nsa ioa pDaT infntmztzon_ J Homeowners who submit this sf E&vft ir--'Rrgdag they are domg sII rrao,saw,then hire outside contactors mast scabmit a a�w a ad�ri ine`o�__ g sorT' =C ntoicmrs ihst check this box mratt sttsch8d ea additions]sheet showbag the mama of 15e P3V-=Ar3Cbxs=d state whether ornut thane Mies bre employees_ If th_e gab-coutoictors have empIosces,the}•nest geoids their workers'comp.policy number- lam an employer ihatis ptmidbtg it,orl e-rs'co.mpensafw.n irm4rarcca for ml,e-mpiayees Belotr it the policy'ardl:ob azls iteformalian_ ,�^ Insurance Companyl'Iarne: I / t✓ '� PORIZY 4 or Self ins Lio_ V 1/`l L— I W -(a u!��� G���;T/� Expiration Date: 17 /S— JobSite t ddiess: ��r_ffCZt���l� CitYISt WZtp: Attach a copy of the workers'compensation policy dedarstiotn page(showing the pow-number and expiration date). Failure fro secare ca-verage as required under Seetiou 25A o€MGL c. M cau lead to the imposition of criminal pecalfies of a fine up to S 1,500.00 aruilor one-year imprison as well as civil peualhEs in the foram.of a STOP WORK ORDIR and a fine of up.to S250.00 a.day against the violator- Be advised that a copy of this statement:maybe forwarded to the Office of Inre*ptions of the D4 for insarmcf coverage vetifieation- I eIri.herebp eerti poi an shier of perdury thatthe irrfornzc ti¢n prat ided above is hwzo-ti&correct Signature: }date: Phone#: ©fficiat use only. Da trot write in this area,to be completed by dlty or town offitciaL City or Town: PerwitUcense 9 Issuing Aathoritg(drele one)- 1.Board of Health .Budding Department I CitFlTawa Clerk 4.Electrical Inspector S.Pltambing Iusp-tdo r .6.Other Contact Person: Phone tr_ 6 I I -75 o'f 00 Divi 'TO THE BE Sr OF �� /IVFOR.MAT/OAJ . f,-NOW4LE-0GE- AS 5U/L7" ' PLOT PLrA /U ANO 45EI-IE P THE DATE ,Z Z�Q7. SCi4LE: I�'S S"01.VA/ OM 7-H/S PLAAJ HAS ppEPARELD FOR: 8 E.EAJ LOCA-rED O/V 7-NE- AS DICATEL:> DgAJ A. SPErPKMAIV C OAJSTR UCTIORJ LAND Su2VeYING i ra-LE r 7" 45IUGRG. DIVISION DAT /5 SP qK WFTY, No.HARWICH, MA. 02645 i2EG. LAND 5 RVEYD� TEGE. Soe •f-3 -5565 Lk) o C-- AAZkj� -40 pip e- W./, Pi-)'CA7 114 0 Ai 05(,�7 IV tv IV Cb N P, 12 0 \10 NAL( MAW-<: 'CAToi f5>1 E4-CV, 17Z_ (c:, TOWN OF BARNSTABLE ` CERTIFICATE OF OCCUPANCY PARCEL IUD 109j001 00V" GEOBASE ID 43536 ADDRESS 15 HEZEKIAW S WAY PHONE (508)775-2991 x• ;; � -ZIP _ LOT .14 BLOCK LOT SIZE" DBA r DEVELOPMENT DISTRICT WB PERMIT 26714 DESCRIPTION SINGLE FAMILY DWELLING (PMT.023790 PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY j CONTRACTORS: Department of Health, Safety ARCHITECTS: an d Environmental Services TOTAL FEES: BOND $.00 Ox CONSTRUCTION COSTS $.00 j 756 CERTIFICATE OF—OCCUPANCY + BARNSTABM # MASS. 039. i BULL Y •,�-IV�ISIO � I s DATE ISSUED 10/31/1997 EXPIRATION DATE 3 ?-. TOWN Oki.BARNStABLE mTIFICATE Or .00CUPANCY. PARCEL ID 109 AHB FLAY.001 00V GEOBASE ID, 4�525 i ADDRESS, 15 IEZEKI - PUONE -(5.08)775-2991 r ZIP - LOT. 14 ; ' BLOCK LOT SIZE . �t _ ABA DEVELOPMENT DISTRICT WB PERMIT 26714 DESCRIPTION SINGLE FAMILY DWELLING (PMT.423790 � PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of.Health, Safety , ARCHITECTS:-. and Environmental Services '. TOTAL FEES- BOND $z_00 Ox� CONSTRUCTION COSTS $3..00 I 1 I 756 CERTIFICATE. OF.OCCUPANCY : snwvsrABi.>E, .+ MAM �► 16,3 6� i BUIL 'bT � 1IL60VISI B DATE ISSUED 1,0/31/199T EXPIRATION DATE i 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 OF THIS 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- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS I BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS bt,v� x, 2 2fr 't 2 3 ?1 HEAT G INSPECTION APPROVALS ENGINEERING DEPARTMENT 'b`, i "ii;% `' ' �-_ 15i 2 /� 3 BOARD FHE H - SITE PLAN REVIEW APPROVAL 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 �' ' � � ;I ��� � - .� b .� 1 I � y I T r Lumbermens Mutual Casualty Company na�nU b iz erican Motorists Insurance Company COMM s American Manufacturers Mutual Insurance Company Home Office: Long Grove,IL 60049 POWER OF ATTORNEY Know All Men By These Presents: That the Lumbermens Mutual Casualty Company,the American Motorists Insurance Company, and the American Manufacturers Mutual Insurance Company,corporations organized and existing under the laws of the State of Ilinois, having their principal office in Long Grove, Illinois,(hereinafter collectively referred to as the"Company")do hereby appoint Royanne Sorensen and Ronald Weimar of Centerville, Massachusetts(EACH)•"•""•"""`""•'•'••` their true and lawful agent(s)and attorneys)-in-fact,to make,execute,seal,and deliver during the period beginning with the date of issuance of this power and ending on the date specified below,unless sooner revoked for and on its behalf as surety,and as their act and deed: Any and all bonds and undertakings provided the amount of no one bond or undertaking exceeds TWO HUNDRED FIFTY THOUSAND DOLLARS($250,000.00)•••.w.wwwwwwwwwwwwwwwwwwwwwwww»:rww»wwwwwwwwwwrwrww EXCEPTION: NO AUTHORITY is granted to make, execute,seal and deliver any bond or undertaking which guarantees the payment or collection of any promissory note,check,draft or letter of credit. This authority does not permit the same obligation to be split into two or more bonds in order to bring each such bond,within the dollar limit of authority as set forth herein. This appointment may be revoked at any time by the Company. The execution of such bonds and undertakings in pursuance of these presents shall be as binding upon the said Company as fully and amply to all intents and purposes,as if the same had been duly executed and acknowledged by their regularly elected officers at their principal office in Long Grove, Illinois. THIS APPOINTMENT SHALL CEASE AND TERMINATE WITHOUT NOTICE AS OF December 31, 1997 This Power of Attorney is executed by authority of resolutions adopted by the Executive Committees of the Boards of Directors of the Company on February 23, 1988 at Chicago, Illinois,true and accurate copies of which are hereinafter set forth and are hereby certified to by the undersigned Secretary as being in full force and effect: "VOTED, That the Chairman of the.Board, the President, or any Vice President, or their appointees designated in writing and filed with the Secretary,or the Secretary shall have the power and authority to appoint agents and attomeys-in-fact,and to authorize them to execute on behalf of the Company,and attach the seal of the Company thereto,bonds and undertakings, recognizances, contracts of indemnity and other writings,obligatory in the nature thereof,and any such officers of the Company may appoint agents.for acceptance of process." This Power of Attorney is signed,sealed and certified by facsimile under and by authority of the following resolution adopted by the Executive Committee of the Boards of Directors of the Company at a meeting duly called and held on the 23rd day of February, 1988: "VOTED,That the signature of the Chairman of the Board,the President,any Vice President,or their appointees designated in writing and filed with the Secretary,and the signature of the Secretary,the seal of the Company,and certifications by the Secretary,may be affixed by facsimile on any power of attorney or bond executed pursuant to resolution adopted by the Executive Committee of the Board of Directors on February 23, 1988 and any such power so executed,sealed and certified with respect to any bond or undertaking to which it is attached,shall continue to be valid and binding upon the Company." In Testimony Whereof,the Company has caused this instrument to be signed and their corporate seals to be affixed by their authorized officers, this August 22, 1996. Attested and Certified: Lumbermens Mutual.Casualty Company American Motorists Insurance Company American Manufacturers Mutual Insurance Company �vAw■I C.wo G AM■t.ry u IC I/ g Iwo— Ire cou"Anal 3 Robert P.Harries,Secretary. by J.S.Kemper,III,Exec.Vice President I STATE OF ILLINOIS SS COUNTY OF LAKE I, Irene Klewer,a Notary Public,do hereby certify that J.S.Kemper, III and Robert P.Harries personally known to me to be the same persons whose names are respectively as Exec.Vice President and Secretary of the Lumbermens Mutual Casualty Company,the American Motorists Insurance Company,and.the American Manufacturers Mutual Insurance Company,Corporations organized and existing under the laws of the State of Illinois,subscribed.to the foregoing instrument, appeared before''me this day in person and severally acknowledged that they being thereunto duly authorized signed, sealed with the corporate seals and delivered the said instrument as the free and voluntary act of said corporations and as their own free and voluntary acts for the uses and purposes therein set forth. 4 "OFFICIAL SEAL ► Irene Viewer ► 4 Notery'Public,Statweeof Ulinola b. My commission expires 1-28-98 Irene Klewer,Notary Public CERTIFICATION I,J.K.Conway,Corporate Secretary of the Lumbermens Mutual Casualty Company,the-American Motorists Insurance Company, and the American Manufacturers Mutual Insurance Company,do hereby certify that the attached Power of Attorney dated August 22, 1996 on behalf of the person(s)as listed above is a true and correct copy and that the same has been in full force and effect since the date thereof and is in full force and effect on the date of this certificate;and I do further certify that the said J.S.Kemper, III and Robert P.Harries,who executed the Power of Attorney as Executive Vice President and Secretary respectively were on the date of the execution of the attached Power of Attorney the duly elected Executive Vice President and Secretary of the Lumbermens Mutual Casualty Company, the American Motorists Insurance Company,and the American Manufacturers Mutual Insurance Company: IN TESTIMONY WHEREOF,I have hereunto subscribed my name and affixed the corporate seal of the Lumbermens Mutual Casualty Company, the American Motorists Insurance Company,and the American Manufacturers Mutual Insurance Company on this 19 ru 4�0 SOL 441. �p GOIkR1ID � s ��iwrae g [.nlp �j3Y � .,7QAt\ao� ^•YY J.K.Conway,Corporate Secretary This Power of Attorney limits the acts of those named therein to the bonds and undertakings specifically named therein and they have no authority to bind the Company except in the manner and to the extent herein stated. FK 0362 6-96 Power of Attorney-Term Printed in U.S.A OJ 600 V" S���t,.,,✓,CCIDEN7� `;,�;�:1�G7 S3 ..73•'*�CS_ �.,1�JCr :�QS�Qr��. ��lLSSA CH USE775 'WOR3CEI COM7'-ENSATION rNSURANGEIIDIVIT O 1 GCti fCCI 1 R«} -wich a princip21 plIc-c of busincsslresidcnasc do hcrcby ccrri6-, under zhc pins and pernlcics ofperjur). fir: [ j 1 =man cmplovcr prodding chc followinsworkcrs'tomcns job /O '" yjtJ parioncovcn�formycrnployccs..-orl:jn .S (� on =hi< 17 Insurance Company .� Policy Numbcr [ ) 1 em a sole propricior_nd h:ivc noon,workjng for MC_ v [ 12 j m 2..01c proprietor,gene.-]conmaor or homcownU (cir do one):nd h:v `�c nc, followMO worl:c.'wm c hued zhc concmczor+1i reel o pcnrzdon iruur ncc poljdr bolo.{- h=^x of Con7--Gor . 1 n..`t:.;n cc Comte ylpol icr hc:r,;bcs ? 'zmc ofContrz or nsu-ncc Co:ap:ny(Policy Nembcr h=rnc ofCon;r aor - 1 n:uJ2ncc Ccmpzny(Poljc7 Number homco.,-ncrperror-;ing_116cwor'r,my c]f }�OTC- I'l<`:e be a�<<•tea.- ,k c 1:<e«•V•<r:not �or< < -Lr«ccit ic�;c t o t.cct to Go _ L<Ixt,cc.- �� cctcuccaoc{ccc«+uci.cccrtci:cr� c��oca _ •�<r<G to b<cr_pl<ycr, `1<r Lx C7 /• cr 2]a4 rcr:Gcl or oc t<< Kc+cla z "�tt or F<rrl�t r-: clYri Cor` a- � £ VX14C�(t-7CtRO t cc OC t LCL.0 rz J�• J'c= - Act(Cl—C ]S2,•<c 1(S)) zppl:cat:cc by=borxo�-ocr for I Iic<or< )'<"iGcc« l.c 1I r;:r:,<l�«-lorcr ccl<r L�<'Clor�<ri .. c, ,::: :::rent: `r. . - G t••_t (plc: ca icr� c �c:,r J l<c�<nc'O�«cf1-,�:_ cc for.<L�cr�c <c':r:Cc^ (_ r < IC:CCCr<<=`•rZ<L r<Cc�rCG�r:G<f�!Cj oG:TJ/. 7 <; rr r•,< r<,` ^<c. v�.cc J 5C•C•.C•C�:C4r tr-r,; c.^ C-J�_<_:.:J<:C cc c`-<c• -t 00.00_ < ct c. t•� tc cnc G_y L'I L4c(crm Cr:<rcY>rJcrf OrGcr =^C Sl�ncd this I cozy of_ 9 Liccn_CCJPcrr,-tizzcc L'ccn:o r/Pcrr�;trot I: J 94709 DEPARTMENT OF PUBLIC SAFETY 94709 ONE ASHBURTON PLACE, RM 1301 BOSTON, MA- 02108-1618 CONSTRUCTION SUPERVISOR LICENSE _ Number: Expires: �ie Restricted To: 1G - /! D6PARTNENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE t^� - I1 j Nuayer Expires: JOSEPH C VAUGHNKeejRestricCedTo ;1G 43 TROTTERS LN of t; _ q 1�4ARSTONS MILLS, MA 02648 \r F d 3 � `' ` +M'�►d�1"�''l 3OS�PH C VAUGHN `yo\ %YROTTERS 11i NARSTGNS belt.;, H9 O263B I 71w -Cow uArlm I ; 'HOME -IMPROVEMENT -CONTRACTORS,-REGISTRATION j Board of BuildingRegulations and. Standards I One Ashburton Place — Room -1.301 I A' Boston, Massachusetts .02108 I HOME 'IMPROVEMENT `,CONTRACTOR' Registration 100513 'Expiration106/19/98 = I . Type •- DBA i -/. I .. HOME IMPROVEMENT CONTRACTOR Registration *100513 VAUGHN• HOMEBUILCiERS. i Type - OBA Joseph C . Vaughn I Expiration 06/19/.98 43 Trotters ' .Lane I Marston. Mills MA 02648 � �� .; -VAUGHN HOMEBUILDERS I� Joseph C. Vaughn rotters tLane JJI ADMINISTRATOR ,Marston Mills MA 02648 TOWN OF BARNSTABLE t BUILDING; PERMIT ,j PARCEL ID 109 001 001 GEOBASE I D PHONE 50t3 '775 AL��DP.T_:SS - 15 HEZEI;;_AH'Sr[�rAY ZIP O'?G68- WEST BARNSTABLE, MA F�LOCR LOT SIZE LB^ 1�} DEVELOPMENT DISTRICT 23730 DESCRIPTION SINGLE FAMILY DWELLING SEW.PMT.#9'' ERMI TYPE E'JIL-) TITLE NEWRESIDENTIAL BLDG PMT C.ONT: AC'.rU0R5: VAUGHN, JOSEPH Department of Health, Safety ��RC'�I?' .P'CTS: and Environmental Services `..OTAL FEES: ; 32i-; .50 THE %..- ND _00 u NSTRUCTION COS";� $1.05,O(";:i_Ot). 101 S'.iZ�JGLi' RM HOSE DETACHED 1 PRIVATE P t ' * BARNSTABLE. ; OWNER iC MAHON , WTLLIAM KAREV ADDRESS 1.'-:) IYANOUGH ROAD ED�A HYY N N I S, MA I' I IO BY ISSUED 06/.L. 1a97 E:'P:L^�A7'ION DATE 9 i ' f.i les� 9 - 17 - 9-7 /eG's -7 _ a3 - 97 I.'. ...w�,�-.,....-• ...-`,.--..,-..... _ ...I "'"'�'-„v---'-`-v._ , -v.l+r.....-,.n.r,��- .w_ ... ,.-. .n...t: r.�.:•:7.+u--i.+.Nrk^.-4•,•r3✓:�- - �.` .. N • oF1HE r The Town of Barnstable BAaM� Department of Health Safety and Environmental Services 039. �fo Building Division 367 Main Street,Hyannis,MA 02601 3, Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection k n .. 7 Location �j � -�r- Permit Number Owner Builder Kt)(Q t NJ One notice to remain on jobsite, one notice on file in Building Department. The foolllowing items need correctingn \\t r C�QOV L tiv> LOnrL V) �t . y nc Please call: 508-790-6227 for re-inspection. Inspected by Date i Engineering Dept.Ord floor) Map Parcel 06/ 06 / Permit# House# '/s0L-_Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) �'� —3©2(�M�ee q ,�a� V,;r* ®Conservation Office.(4th floor)(8:30-9:30/1:00-2:00) _ �- INSTALLED IN COMPLIANCE Olanning Dept.(1st floor/School Admin. Bldg.) WIT Ewa E�' Et��°JIR+�NT, of � -DE AND Definitive Plan Approved /by Planning [�Board `91 9 1 ?"S" fit. ; BARNSTABLE. MASS. Sp' TOWN OF BARNSTABLE �g`�� �'E°""� Building Permit Application Project Street Address 15 eZe�_I'A,E4 LD 7 14 Village VV . LtfVh5fiQ-ble- Owner 1/1/! ( Ct VV l 4'. j /UGMQ h90 J Address,_16 qw n 0 i S Telephone 29) 77 J- a9c1 1 � Permit Request fi00 +,15 L jJ_0 A jf&JCf7 la W j o �oc h ef� gG-120G2-. W/ U n F'N 6H-E70 OOD M b First Floor X oq(o square feet Second Floor ko% d'Z} square feet Construction Type N 07W i Estimated Project Cost $ 105 4 000 Zoning District Flood Plain Water Protection Lot Size 1 • I A'La,5� Grandfathered ❑Yes ❑No Dwelling Type: Single Family Y*' Two Family ❑ Multi-Family(#units) Age of Existing Structure NOW Historic House ❑Yes 2'go On Old King's Highway &1i's ❑No Basement Type: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 5& X 26 Number of Baths: Full: Existing New 2. Half: Existing New No. of Bedrooms: Existing New 3 I. Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: &has ❑Oil ❑Electric ❑Other Central Air ❑Yes 3,90 Fireplaces: Existing New Existing wood/coal stove ❑Yes pN Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) CiAttached(size) c9 ❑Barn(size) ❑None ❑Shed(size) " ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes [ fo If yes, site plan review# - Current Use Proposed Use Builder Information Name yft&714 n1 t+0"Ct)w/w) tk I W Telephone Number (606) Address License# 0146 2 3 6 M A-a5 RD N5 M!1 1 S , Ir ) 14 Home Improvement Contractor# 10 O 5 ! 3 07-&ll!5 Worker's Compensation# W-C-1 02 7 Q 7 a-- 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 LO, JYL, VA. DATE BUILDING PdIr- D R'THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER" • r - DATE OF INSPECTION: FOUNDATION FRAME CF r z INSULATION FIREPLACE i,3'q J ' ELECTRICAL: ROUGH FINAL PLUMBING: - ROUGiI c FINAL . GAS: ROUGH--` FINAUBUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. ' ` a 1 The Town of Barnstable B,RM �•g Department of Health Safety and Environmental Services ��fON1P��`0 Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 P Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection Location S ► t�1• Permit Number Owner JL jl U4 A Builder I LI,l --4 a One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: - 1 .. Please call: 508-790-6227 for re-inspection. Inspectedgy,h� ,,:1 /ka I-S, Date L, Application to � .. � � � 7 Old Kings Highway Regional Historic District Committee 10.2 in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: [ New Building ❑ Addition ❑ Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: L10 3. Signs or Billboards: 0 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 -,fin Oil ADDRESS OF PROPOSED WORK 6 14e, ze kla V) 5 I.JN ASSESSORS MAP N0. q .Z OWNER KN6(166 n 5i 11 01.IYIaho n ASSESSORS LOT NO. HOME ADDRESS 15_lyun�C4 "14 TEE. N0. '5CF--77v-'a-qf/ uhll i6i OZ(oo.1 FULL NAMES AND A DRESSES Or- ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). 1. NO 2tit A U NC� �)_.( 1- - i/;7-r I.j:'LI ice, AGENT OR CONTRACTOR WOLIN !-IOI�LEI�I,ULi t2�, ���C TEL. NO. 0L ADDRESS 43 1^rc -1-1�-t�s._!�n>� 1'1�'itS , s ]� c(,l 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.act aczompan,y plans. In the case of.;gns, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). NUM E trF zt_ BIDSSignedJ� Owner-Contractor-Agent gpac Committee use. o e iv H ate 1 }(j a Certificate is ereby D e �. POL�, A Iiime o�ff�,� � M P QLD KIN TOWN OF BARNSTABLI= `t�L�WA/I 'I l Approved ❑ IMPORTAN If Certif(cate:vi?approved,approval is subject to the 10 day appeal period provided in the Act. rlic�nnrnvor� r1 f r 1 Town of Barnstable Old King's Highway Historic District.Committee SPEC SHEET rI' ' FOUNDATION ItU `R'�Ui Go�C.✓c �.SOU.PS I� ( 14*0TT')2-A)& VO lain SIDING TYPE fl 1 �' CQ�Cc'�S ill ~ `Oj�OLOR Y l ' CHIMNEY TYPE clC� COLOR YP ROOF MATERIAL QLI COLOR PITCH I wlNDow SIZE 2�4-,` TRIM COLOR . W 1 r-,dkoury-, Cv--e__0—rr1 c( - DOORS � Lt✓ I _1,V-)S c�t.�C, 'e.G` COLOR air 1'1 2G� 44-41 .I SHUTTERS COLOR T�-V F'l� ti ;'�r(fIc- GUTTERS o—I U-1'y-) DECK PV�'S S w✓ C, -t�y 40 GARAGE DOORS ��eP COLOR SIGNS I�I ' COLORS 1 � FENCE COLOR rkrm 1I 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 If 1 r. '�' gc'tulaNHtY . lf.Ar)M641l1C1.....- F/SSE'ICi.4E:: PAm e•wfc4 TuAHso#A I A.14 145a.ca.-- .f, COwC AfVO4 1 LEFT ELEV/<T%ON RIC,UT E.UWATION _ - Ar«�Sm4G1L9 I F s-ass•ew1 evi i n ustom o esigns All Rght, , i Q I copynry„Tr H19R ��...✓J-••,,-1 K.f}LISP%C-ta OG'sx wuYn - .J —_-. ... .._... •� W1U..CtrxH — ... -4MWDCpW,CAP.. ' Q CT i I, _—..-.-- Za.tl1 ctnrlt r.•pqo^nns -\ V . .......... .. FR.AttT ELEV/�T10N .. �1 T� 9 J u h • Vren...... plan, •nd ..,.ul/ by DGD Art to,Inc use of fnf.r 1.110-frs only Any o,ner u,e„,1 r.t rfy Pr on.O.ff — ♦usuw'ci ----- - LaeluCt SwucuS )u2M.c/m!a RALA \wlT! CLDAR S4WLLLSUlf . .. O I 1 M it orb T REAR ELEy&T(Ohl._.._--_•-- r•nan I � I j 1 1 n• Rnr- ' G i 3 U� a i srxe wrt � •tea:- �_.. c b► t e aN.eas�estna__._ I 508.428.6191 vac's ' o eviin I @ustom 1 o; v ----- -t-- ---r T —�.. r�.r.�.U-•,��.>>LL o; a esigns 1 V! hi( s � oPy^9 O/e9e AN Rght, Rete/ve0 R cou•Act V 2s.2�nl'�YR.CD4R.,Re/,fOl J 3'i'O co` elLLin(ALLY cm. 1 tv a ' v I � - 1 2A 0 140 I 1 SL �p1�OKTION PUIN --- -_ _ Wo __ . q P/llimtna/y Qlahl andIayOutt by DCD.ate 101 the use O1 the,/(u$'Omels Only Any Other,ule if ft/lltly PtOhi011e � Q � O • \ ;r �. x, B°BROOM•'. I t UNCINISHE{7 z TL 8 " I ' 2t h Oi _ O I I 62n200 r4, °• --'- BEf�RDOh( r pi _ _ 1 ---- (4. I O' N IY 6ELDt4n.FLDOP- PLAN S.g' I•tp t.io' 1 . .. , . . .tile. 2ao wt^Ecs --• --. -- 'Y- 7.I041OIL 2•10 4itTLes Y4.-MS 7_0 OWiEX%u TLRS - "i►�Ywoon'_ tC.4i e _ 2.G aq.J%Tc 608.448.6191 K 1.5 RMrr.0 S' t 'Z-t.LL.;A6TL- . 'rl'SwGCeFt're•re' R o a o eviln '_---_•.P 101.1a:i.w'RdCI. N'w t2 @Ustom KYT'dt Ct�.lt. }p . UNFt�I ILNEA r.r o esigns S4"l I R't"IO[T. afa•T.l:RK\N�o x.�oppaTa i. P.J000\bTG. copyright p 1996 -... .. An R.ghtt -- I Re\erred • 1.1 DTUoo.a�4j 4 � i-\o r.aslt• - . i f' "a•.wett¢ottc.{:'. I.D 6TT./•erl.r� •. ._.. He"cc.fo WtLnioc¢. m i f- r a au•t4f.Mt.\won r N ' w+tQ1RGCT) i SECTION-.(i.Pj __:.: d Prel.m.nary plans and layouts ey OCO.ar,for the we of their CUft OMert Only.Any Other me.f 111,Ctty P I I I \ ,,,—_a.a.anrnorwns o.+Twuc ,ar.l.0 wlwcus "cm"�` --�.aTn�rwv LIKIL Slur GIi STA TIA w�Uma1E cwuE _ _- IFAn n.nsuluG Lrn,.rtl ou _ 1.6 VA.C" IEM•vyu's Cp&IM)ou 0313Ca01V4}M1f)'V ft:RETUIt4 _. _ I.a SOIrR W/NaR 1,3(IS'CM) EYnS:rabCC'G DlWuf) ' yn mmrr;ow 1•f. I .. 'I 2n4 rT•SII�w/$aAlia me•q waoa eo1.T'r I 4 \V�!:��'J rA?�'ti.io'� I SGFF rt nETnIL Cwr.1 el ,ALL/ ^TERTAgLE C,�.-:1 0) t t4.12 f]EC.K- c' 1. �1 \ KITCu E N pREA14 F/-ST ! i I — .• _.._� - i i 508.448.6191 —W IO.4S 6%.r•t/- ry E� -,-(}l�l t.l.•w MIC�- I =t =� � D evlin @ustom Nc { GA2A4E A. o esl ns C. Nil-'.CIO 5ucETCDCK All Rphl {� 1996 - n�3 t G. O 2a All t n � — � Rexrree I I 41 I -0 'i. 4R[/tTRooM � nIN11JG ��. I;u 0 = 1 m .iDYER'(Pith. • � in• t C pi FJRSL.FLfSXt.PLAN CH:1•oT' 1_ t o' R'e' G'° ca - �''... - V�o• I 40 ! Yb' ra y prom only• 4e' 1 ' Pr erlmmary plans and Iayoult by OCD arr ror the utE of 1nrlr Eutlomen Any olnrr use n tl nEll Dne i '�, bauC'W IMNtY N: R•rxlL v6�iT. I \ — G�rn�. FACSL RAKE." nacre e-wrw rcal+ss7.A , •>°.,•aw noc� �^rail.aoatl - _ 6Y1441'L�._. COr+G/.ra)Y I LEFT Ut-1/t'T oN Rtr UT EI-FvtiT1ON ban -- i .NAa suwctcs I 506-428.6191 I _ I o eviin \ I T.a @ustom •�I -ldvcaowc u es igns ... . - q topy:gnl T to" All tyntl 1{nUn — rZ,t*h4aw'1 a.2a CAP.._. rau ti:cuRca7.._ ll Elul, un ccnnt cuvgancnf J .. .._ . FR,OIff ELEV/�TON ' � /SI 9 ' Vl-m—•y plans and layoull by DC 0 a•f to• In, ule of ine.• CullOmell only Any Otnt•ull.,fl•.Ctly proh.b.le - •togx vcuT� . . uewAu swucw ' tbx4 UlstLc..n.u.a) ' I I �urJctnzol:.e.�n w-� - \vurtL CLPAREl 311WC�ES .. W � I 'ittSCFaty- _— i r i• REAR EIEVA,T 10-N _ xo-s Ta- S-I c•o et. ..—'•�_ +4-0' ie-han I i i O � ' o i aaur wrt 508.448.6191 �I IV T •� N v eviln J 14 a c. I j @ustom� l'•4' l'4 1'.4' � ..� I • I o esigns a I r^ T I-F1G.rw0.C.1—W...)NL r 01 31 ry r j r X5 F.e cl],JW. >f .p I COpyn Qht 0 19% All Rghts Z --_.'_~ « 41 L.10 r I Retelveo E' Co.+.•Act c1w I r I o¢� It: I r4 CO• c1LL1.1 l,LL-C0. P` Y L_ m - : lad 3 w 1 NI Z I to 0 —_--_ u o v o 140 •� ----------- — —...- - . ... -------- — zz I -FDppnnt101J PLAt4 4 zk ' 1r 1—nary plan, An. layoun Dy DC D ate tot the u,e 01 l"'I customer+only Any other, u+e rt,t nc uy Prohr D.te c.o o-i• •xa I Zv ��.r• : a a• o O c• � r �JIJ C I NIS HEI7 x` z'• " r —1 Its 0 xt h D 'm I I — BEn200Pro, BEf-)RDOM . r I f o; B 4__ T L' Tom_• - - SE[DKD.FLD0P- PLAN ,g.g l.lo l.,o' l.,o .,•.,o S,s' 1"o e'x[ --'--------- '•r rw.�oo•� ----'—' -- 4uo aie4L — z.lo atyTEts Y4.—.NS- —_ 7_8 O0"IlLm RAFTElts tcutt rt 2.6 CL4.JSR •---f- "'-- - 608.428.6191 K 1•S Ra/•Fr,u 4.: 'i.i.FASTS-,.' . '2'S4.CTROGK' L a eviin a Q z @ust0m ._.-..---- e•EOI.+aJ..4.•raa[l- UNFI4ILNEFS wur rx[ ti� to r:r a esigns „a•,.,"woo 2..Q JOWM I. xMO JOtb,i, eopyri9hl01996 Al a.gnts 6RAoo,wel 'i'Su lt140c K. 1.a 6f ,14�.. 46"c c.c.10 co autaT¢ocsr. . r e .�''• 314•T aG.pwwoofi r ' zlo- I $'1 { SECTION d,.h.b.11 preliminary plans and layouts oy DCD.are for the we or their customers only Any olner use n st r,c u p ttr " �_a.c.+.\t131a.Ans o°+Tv1.ut Ay..rrx w1YGLLs oa EmunL. ----NI[TAL tYYv[t3G[ r ` _ f-SWrGLL STw/_TfR IL CLOl0. C—rt:.! _ --- IEAn CUSMtNG C�NJf)OY yC•tLY\Y _ --/aB it"C" tfM MSu'r,LPAI Mt)CV ON CaAw FSi Y`:RETLACN ....---._ 1a0 SOvt rt w/N.rt 1,3 C1s•unl -- E4°S:AtnCt'6 K=W Un#ACLT1r OW W. RIIlG ._ 1�8 CK°G117 Sle'q Auoron p0.TTj I \V NY\'J GAF C'Si.Co I 5(.iFT CT nET/`IL(1•t,1 0'1 - 4tii ATEIL1ilgL-E.G`a',r o) Ta_Ix nE.cac.. 1•o 210 b —___ ...._...�._. .. FP- _,_ -1 r 6 I KITC4LW p2LA1CGA5T •- � SGSCk b.lE i I 4crEn {IMhR 508.428.6191 _ i f(}1 °..N.•rw µ1Cro _ � _ 6 evlin • Custom — i N I C S Gna�4E w xrm rL_4. esigns O <r'K �•Zua.Eoyc&AS—1 C 'l C r."c alv F\i v, j Eopyrrghl 9 1996 tea-T.C,GO%tiLICOLIC All Rght wn�3 f aG. w-n: - 0, s .I� 4RE/tT WOOM tn Ily � D 91 FJRS7.FlSpR'.PLI�)Qr1,oT' °o' ao' uo 4.0 1 4'o. . 40. I I hS vrellmrnaty plans and Idyouls by DC D art'101 the ule OI Ihtrr Cuslomtts only Any Olhfr u%e is t1,.Clly plohr Drlt • . is ; .. Q o � 3 � rd -s e Luc-) 14- Cleczv , o CL'ryY' ro 515 a co-v- side 1 =-- J J JWes-- , o4 4-0 wcLl...k- v,ck., S j ,d PAY . Sca e cam,d Pd e c+ LcLcf co-P r�j CID le t L 1 ryl 1 O fop Of foun� ,d ,r' Mill r,. Gonc. covers r 4" •y' ,•Gasfiron or 2 ' layer 0f SCh. ,40 PVC- pipe wlmin. `7"^'in• waSheoJ tl' s-T'~; mot% �c �,_iv+_4;T1-- P'�`Gh !/4nPer 3G rnaX. '� P f ✓ ^2 � ecz sfor�e 4 SCAT 20 pVc pipe l a G /'7ir7. pitch /�8"Per ft. c/e-,ZL SQ.no/ q"rntn. Jow lin a ___ �, —� 3G• aX. -+ I i .� o ' �' ---- preca t /owai usor �..,a s...�. _ tiC �i, Cr? `F 12Z,2S_ .° . lt✓ � /I��l •'` � N.•,, . '• 1—° i•l °,, ems •. , C� C � C7 0 ° ° :° D • o inv. el. ,61, crusheah IZ.1 ,g5 %n V. ?l. 't qQ.J. '�T O•,•> a •-e • . e - .e • , . ; ° o • ,• • °Ie °..° °in V. e/. Septic fault �� . l �- . / '. - � . ° .o r. . e .• . � 3/4 //z i.�ashec/• Si one t ,Stone>'b�se;•-•° rlisf. / r t tv bo�C inv. el. 0 �X �2� i / 57 1 60�orn test hole. elev. l N '�- \ SEL�/AG SYSTE- M P� cF/LE- All 4. tiv NUMe�Ie of BEodeoon�ds . L T- E- S7- H O L L o G C.r L. .;r-�XL.�DISPOSAL UN/T . TEST OATS : , , t TOTE-� L ESTIMgTEl.� FLO[N 4A//TAIESSED BY: �' / D�q x �. C o L AT/ o TE : Z M/N. /dVG H / J ice'"' GAL./82.� Y _ B ) : PE�2 N iEA L err .� d�'r./� 4� �,. 1s- r -��� .•!�� f �. 17 )P- E SEPTIC T CAPAC/7 7 : HOLE l t �j= ,�?C T C.'A L S E P T l:� T i4 lu'A-' S/Z E . �`-' �-'�``-- GAL L. _� �.` J) / I �i�_ � /\, - t J L �, Cf /ltlG ,2Et? .�C4'/ � !'?E1VTS ' �•Sv ' 1 ( i , `rv" � S lt/A L `_ Zx �"vUtl< n "�•7`f = jam'``` L. + B©TTOM TOT�9L LEfiCH/NG Gf�PACc��: 3w I 1 Nj E S EA-3-V E L E A C H /lu G C A P)9 C 1 Tr Lowest Y �'� Lenoti..� IJ -- - - I � ►.i(�� N1FtjrZ tii'k-rC 0 �- GA L. I-L a (� Lam. " vrt•� ALL W0R1<MANSHIP AND MATER/ALS I?5 ►c)Y��/� IIZ,�: maw SHALL C0NFOd2M TO O. E.P. TITLE 5 yvti�ptu4u i� Ih}•� AA/D THE TOl,UAJ OF PRULES ANC) ieEGULPT/OAJS POR Z SUBSU�2FACE O/SPOSAL 0) r'� SANITAIeY SEWAGE, fU�7 1aD•SS 5b {10,5 2) COMPLlANG F- WITH ZONIAJ(S F2 E G ULA7'/O/l/S Nv tc-Aj r�i� -- ND w�TA'. �. SHALL 6E DETE,2M/NE D BY BU/LD/IVG F. IIVSPE CTO� / COM/vJ/SS ICAJE- 2. 3) EXIST/IVG AND F/NFL G12ADES S LL /eC-MA /AJ E SSE/VT/ ALL Y THE SAME. L ,97-E- ,qPPdeo VC- o : B D. OF HE A L T H .) AGENT � - S TE- PLAAJ o� P2 0Pos � D G 0�1 ST)aUCT/0AJ EF E i�? E IQ E !'% Ff ice', r�'- .�`�.. / ,c�" T� S 75 A& IPA C- SCA L E ��� !'�%L} � Oq TE /q ,ACLU L E GE,V C) ',,u, ,!w ��`�/%'e..../ -+ ✓i' �'�1/ ` f ^r ram' (f, •f Jr aA i ;� GEC �T' fyP e')c�Sf'/r,q spot a/eV_ Q•0 9► �' '' -�,��./,� �CJr --f';'`i!�, f --^, 4 e�Kistirn9 Gon four - — — — — — � / _ fyp. prop. fin. spot a/ev_ = o. o , r>, / `�- !-- j�-t 1.. � r� �.. prop. fin. contour - o o— "' a .-4 /`,4 /` ' c� 1__OC AT/oN , MAP rest hole location _IG1, 7 � �