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HomeMy WebLinkAbout0295 HIGH STREET 0 �IIII n J�gECYC(fpcp 2m UPC 12543 No o�ppSi•CONSJS�� HASTINGS, MN . ` Town of BarnstableBU11CI1 Post This Card So That it is Visible From the Street-Approved Plans Must be Retained'on Job and this Card Must be Kept v Post 6 �� ( ed Until Final InspectionMas Been Made. Ma+R Where al Certificate of Occupancy is Required,such Building shall Not'be Occupied until a'Final'Inspection has been made. Permit Permit No. B-18-1275 Applicant Name: Lesley Garrigus Approvals Date Issued: 04/27/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 10/27/2018 Foundation: Location: 295 HIGH STREET,WEST BARNSTABLE Map/Lot: 111-072 Zoning District: RF Sheathing: Owner on Record: GARRIGUS,STEVEN N&LESLEY E TRS r Contractor Name:'``,k Framing: 1 Address: 295 HIGH STREET Contractor License `�� 2 WEST BARNSTABLE,MA 02668 "- "'_-` Est. Project Cost: $10,000.00 E� ; � Chimney: Description: replace all windows ! 'R Perrriit Fee: $51.00 I Insulation: Fee Paid:! $51.00 Project Review Req: ) t Date: 4/27/2018 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. 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-laws 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. t Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: y 1.Foundation or Footing _ _ ' �T ..�= 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 S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable ,RECEIPT 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit '�I Application No: TB-18-1275 Date Recieved: 4/25/2018 Job Location: 295 HIGH STREET,WEST BARNSTABLE Permit For: Building-Siding/Windows/Roof/Doors �/� I( n < G� ,� l... J Contractor's Name: State Lic. No: Address: Applicant Phone: (508) 744-7930 (Home)Owner's Name: GARRIGUS,STEVEN N& LESLEY E Phone: (508)744-7930 TRS (Home)Owner's Address: 295 HIGH STREET, WEST BARNSTABLE,MA 02668 Work Description: replace all windows Total Value Of Work To Be Performed: $10,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Lesley Garrigus 4/25/2018 (508)744-7430 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $10,000.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $51.00 4/25/2018 $51.00 XXXX-XXXX-XXXX- Credit Card 7465 Total Permit Fee Paid: $51.00 �r THIS-IS NOT A VERMIT . ,, Town of Barnstable _ Building _ _ ..M .. SAMSTABM : Post This Card So That it is Visible From the Street Approved Plans Must be Retained on Job and this Card Must be Kept I 6� Posted Until Final Inspection Has Been Made. Permit +• Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit Permit No. B-17-3570 Applicant Name: CAPE COD INSULATION, INC Approvals Date Issued: 10/27/2017 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 04/27/2018 Foundation: Location: 295 HIGH STREET,WEST BARNSTABLE Map/Lot: 111-072 Zoning District: RF Sheathing: Owner on Record: GARRIGUS,STEVEN N&LESLEY E Contractor Name: CAPE COD INSULATION, INC Framing: 1 Address: GARRIGUS FAMILY REALTY TRUST Contractor License: 153567 2 WEST BARNSTABLE, MA 02668 Est. Project Cost: $3,600.00 Chimney: Description: weatherization Permit Fee: $85.00 Insulation: Project Review Req: Fee Paid: $85.00 Date: 10/27/2017 final: Plumbing/Gas Rough Plumbing: -- Building Official Final Plumbing: i 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-laws 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. -- - Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior,to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health 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. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT • j e� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map . Parcel-, Application Health Division Date Issued a o A z JQOIje-IZ, Conservation Division Application Fee Planning Dept. r Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH — Preservation/Hyannis Project Street Address ,? 9�' /z//9A d Village 641, �2/ids Owner L°s le/. o�i6Ia4l.� Address ✓ ice Telephone r 7,X-54-7 f 1 D Permit Request =kris r� �� 7 46i'4 020- ���✓ / ��/��`e y .., : C34 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed, Total nevv Zoning District: Flood Plain Groundwater Overlay (n - Project Valuation Construction Type /I00w4,9 011 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting doyumer tation. ao Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) m Age of Existing Structure Historic House: ❑Yes ONo On Old King's Highway: ❑Yes EfNo 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 # /7, Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# ' Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name .1QL,1 , 99.4,4J)A ,5 A eP Telephone Number / .2, / !L Address License #____ Home.Improvement Contractor# Email el. my Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �Lf��7 r FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ' ADDRESS VILLAGE " OWNER DATE OF INSPECTION: z FOUNDATION FRAME INSULATION r FIREPLACE w ELECTRICAL: ROUGH -FINAL PLUMBING. ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Eficc �g �Rit�art!`V'.Scali,:mirttiC.tor• - 1GS9�atilt 't'u��Perry,.Builting Eomnussorier' Z()0`Miiit`�ti!e�YC;I+Tjn�'iars'.ltilA:.�f€)� _ •;��iv;Edir'u:tiarnsta�ifcn�;u.5� Qf ce; SQ 62-I038 .0-62 p' ' ope w er,M...: s::' a r _�S :,as:'Qwnerog t act pxot: lxerb.zutl�asize Ca e.Cod Insulation 'it a ,ma.Uers.re.).auve.10 wo&.auto oozed by'di s.bu a ing:peiniiti:apgl ca io :'for. — ( iresshaol). .�..'I?Qat yeses axis alarirs;ar :te rspa. s . aye z�ot: .f3lc�tir iiec bf�r .fc� e.�s.:ii�t8 `a bzie "aIliial' isp ctio s r p: Sned::aFz ccep e _. 6 rr 171e. �IAluVam. i Dat'e Q;bUZth�IS:01',Z.'F.�ZPY,:�1rFJSSI47NPUUI:S - The Commonwealth of Massachusetts Department of Industrial Accidents 1 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia %Yorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TIM PERMITTMG AUTHORITY. Applicant Information Please Print Ledbly Name(Business/Organization/Individual): A P` C(JD i a,,[[t 1,mil I� Address: City/State/Zip: rJ- 04 O*AIPhone#: Are you an employer?Check the appropriate box: Type of project(required): 1.®I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself.(No workers'comp.insurance required.] 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet.'These sub-contractors have employees and have workers'comp.insurance? 13.❑ROOf repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.®Other A)4t' eJ112A77 J" 152,§1(4),and we have no employees.[No workers'comp.insurance required.) •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. :Homeowners who submit this affidavit indicating they are doing all work and then hive outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A-i LQ.,-ta e C 14A A fe Q- Policy#or Self-ins.Lic.M /,f'(1 E 190 q3 i 1 O,A Expiration Date: O&30 4d�k Job Site Address: J�' City/State/Zip: X1W Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify ui er the pains nd penalties of perjury that the information provided above is true and correct Simature: i� Date: J i Phone#: S� �7244Z Official use only. Do not write in this area,to be completed by city or town offtciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ®f Massachusetts Department of Public.. Safet Board of Building Regulations and Standarrds License: CS-100988 Construction Supervisor HENRY E CASSID-Y,\ ' 8 SHED ROW WEST YARMOU-H ijj 2'^ i ^ 151 1.\ . Commissioner Expiration: 11/11/2017 I i s Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Mas!fhgiusetts 02116 Home ImprovemedfiGontractor Registration Type: Corporation Cape Cod Insulation, Inc R T ,{ i r Registration: 153567 18 Reardon Circle w `�� Expiration: 12/14/2018 So. Yarmouth, MA 02664 - �v` Lehr .�SAP scA 1 4.) 20M•05/11 Update Address and return card. Mark reason for change. — - -Addis C�//ae c0oo�vnaooacueccll�o�-� /�cadac�icoeCld Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only Ttype,; Corporation before the expiration date. If foun urn to; =Registration Ex r ion Office of Consumer Affairs and sl ss Regulation 1E 67 12/14/2018 10 Park Plaza- e 5170 Boston,MA 11 Cape Cod Insulatlo ry Cassidy''� Hen � xa 18 Reardon Circle So.Yarmouth,FOX"'.Q266 " -' Undersecretary t al' hout si atu AC�, CAPECOD-27 KDqYI CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/30/2017 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 have ADDITIONAL INSURED provisions or 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 endorsements. PRODUCER �RAJCT Rogers&Gray Insurance Agency,Inc. PHONE 434 Rte 134 A/c No Exc: ac No: 877 816.2156 South Dennis,MA 02660 .mall ro ers ra .com fflURER(Sl AFFORDING COVERAGE NAIC q INSURER :Peerless Insurance Company 24198 -ININSURED SURE B:Safety Insurance Company 39454 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER D:Atlantic Charter Insurance Company 44326 South Yarmouth,MA 02664 NSURERE: INSURER F: 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. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. ILTR NSR ADDLSU TYPE OF INSURANCE ER POLICY EFF POLICY EXP WVn POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE aX OCCUR CBP8263063 04/01/2017 04/01/2018 DAMAGE TO RENTED 100,000 MED EXP(Any one arson 5,000 PERSONAL 8 ADV INJURY 1,000,000 GEN'LAGGRE ATE LIMITAPP ES PER: GENERAL AGGREGATE E 1,000,000 X POLICY LOC P ODUCTS-COMP/OPAGG 2,000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 ANY AUTO 6232707 COM 02 04/01/2017 04/01/2018 AUTOS ONLYVAUTOS BODILY INJURY Per arson II BOORDILY INJURY Per eccidenlX AUS ONLY �eccR�nt AMAGEC' UMBRELLA LIA EACH OCCURRENCE2,000,000 X EXCESSLIABADE EXCI0006636002 04/01/2017 0410112018 2,000,000 Y, DED RETENTION$ GREG TE D WORKERS COMPENSATION X PER OTH• AND EMPLOYERS'LIABILITY ANY PRRROPRIIETgOERR/PARTNER/EXECUTIVE Y/ RIOWCE00431902 06/30/2017 06/30/2018 1,000,000 �1Fand tory In NH)EXCLUDE09 �N NIA E.L.EAC ACCIDENT If as,describe under E. .DISEASE-EA EMPLOYEE 1,000,000 DES RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Addlllonal Remarks Schedule,may be attached If more space Is required) Workers Compensation Includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE jJQLDER C C I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Thlelsch Engineering Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 196 Frances Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Cranston,RI 02910 AUTHORIZED REPRESENTATIVE ACORD 26(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD Assessor'sffice(1st Floor): Assessor'6..fnap and lot number �_ _ _G'-------a� � moo*,rNE>o` / Conservation(4th Floor): Board of Health(3rd floor): Sewage Permit number sARIy�m, Engineering Department(3rd floor):,, o630'���� House number o Mar Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN , OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO , TYPE OF CONSTRUCTION /D 19 TO THE INSPECTOR OF BUILDINGS: The undersigned,hereby applies for a permit according to the following information: Location Proposed Use Zoning District_~ _ L L Fire District_Vat ad y,—J& - Name of Owner Address Name of Builder Address Name of Architect Address f e Number of Rooms Foundation .0a Exterior Roofing Floors Interior � 4 r Heating ,� � Plumbing Fireplace „�f Approximate Cost D 0 C) �5 Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam/ `9 Construction Stipervisor's License 0 '7 �/ fiAI-TTANIEMh, RAYMOND J. No, 36161 Permit For A DI/Oil__ STORAGE BLDG. �h � ' Accessory. .to Dwe. .i.n Location- :Lot #2 , : 2.95 Hia west Rarngtahl P Owner Raymond -J._ -Aittaniemi ,Type of Construction- ' Frame 'y `• ' Plot Lot 'a` P�mitGranted September 13 19 93 Date,of Inspection, Frame 19 insulation 19 Fireplace 19 r Date Completed / 19 r " � h i t r r I f . Application to 9 3-718 • �'Nd'"tN b,J�N 1 ePPN`'�PfNN•4�EP,N•G'• Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a Q [� 0 D 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 M. "Addition ❑ Alteration Indicate type.of building: ❑ House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK 2 6?9 J'101V 12 f-rA tJ Il� �_ ASSESSORS MAP NO. la —D72— OWNER ��T 4 /'1� ± 611 h M I ASSESSORS LOT NO. Z 9"L HOME ADDRESS 5/ � S %/� �.52 AR TEL. NO. 6 2, FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). AGENT OR CONTRACTOR � �� �-� TEL. NO. d D Ud7� 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). Signed 12 ' Owner-Contractor-Agent Space below line for Committee use: p te- The Certificate is hereby AM TOWN QQ I HI HWAY Approved IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ '•F. `r7c SFr r..r� INFORMATION FOR MAKING AND FILING AN APPLICATION ° ADpIVI QjNAL ' (3 FOR A CERTIFICATE OF APPROPRIATENESS ro riateness is required are: v a Certificate of Appropriateness (application for demolition or removal is a four.,ategor4aes for`which P separate form). An application is required for any exterior of a windows, doors, siding, roof, light etc., that will be visible from any public street, 1. EXTERIOR BUILDING CONSTRUCTION (new or existing buildings): application: plot plan (if addition — show building to be erected or altered includingwith way or public place. The following scale drawings are required in duplicate p shots of existing buildings, where additions or existing buildings in outline), floor plan and elevations. Also required are snap alterations ar e to be made. No plot plan is required for addition or alteration which does not touch the ground. d that is application is required for any portion of a building, structure or sign to be painted tications. An application is not 2. EXTERIOR PAINTING: An app .the Town Historic District Committee. visible from a public street, way or public place. Color samples must be attached to theseth ap required when repainting existing colors, changing to white, or usingcolors approved to be erected within the District, with the 3. SIGNS OR BILLBOARDS: An application is required for any sign or billboard following exceptions: roved Certificate a. Existing signs or billboards on November 27. 1974 shall have until November 27, 1977 to secure an approved of Appropriateness. official celebration or parade or any charitable drive as long as they are b. Temporary.signs for use in connection with any si ns that the Committee feels does not detract from removed within three days of the event. Certain other temporary g the Act may be allowed with the prior permission of the Committee. c. Real Estate signs of not more than 3 square feet in area advertising the sale or rental of the.premises on which they are he erected or displayed. ore than 1 s d. A single sign of not mquare foot in area showing the name, occupation or address of the occupant o t premises on which they are erected or displayed in a residential zone. within the District which is defined by the Act as a 4. STRUCTURE: An application is required to build or alter any structure gates, fences, etc. comb ination of materials other than a building, sign or billboard, but including stone walls, flagpoles,hedges, GENERAL REQUIREMENTS shall not be started until the Certificate of Appropriateness has been filed with the Town 5. Work on projects requiring approvalappeal pen Clerk provided in the Act. Clerk by the Committee. Approval is subject to the 10 day P 6. No changes shall be made from the original approved specifications without advance approval of the Commission on an amended application filed with the Committee. ro riateness. 7. A separate application must be filed with each project requiring a Certificate of App P tailed Description of Proposed Work" give detailed data on such architectural features as: foundation, 8. Under heading of "De utters —leaders, roofing and paint color. chimney, siding, roofing, roof pitch, sash and doors, window and door frames, trim, g 9. Unless application is compl ete and legible and all material required is supplied, application will not be accepted or acted upon: Copies of the Act establishing the Regional Historic District may be obtained at the Town Hall. Nv F ..tip R: COMMO TH OF MA.SSACHUSETTS =i�R DEPARTMFNT OF INDUST UAL ACCIDF.NtS 600 WASHINGTON STREET BOSTON, MASSACHUSEITS 02111 fames J Camooev C,n-mssione, WORKERS' COMPENSATION INSURANCE AFFIDAVIT 1, (licensee/permittcc) with a principal place of business/residence at: (City/State/Zip) do hereby certify, under the pains and penalties of perjur),, that: [ J I am an employer providing the following workers' compensation coverage for my employees working on this job. Insurance Company Policy Number [ J 1 am a sole proprietor and have no one working for me. i� [ J 1 am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed bclow who have the following workers' compensation insurance policies: Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number OV am a homeowner performing all the work myself. NOTE: Plcasc be 2warc that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not generally considered to be employers under the Workers' Compensation Aa (GL C. 152,sect. 1(5)), application by a homeowner for a license or permit may evidence the legal sutus of an employer undcr the Workers' Compensation Act 1 understand that a copy of this statement will be forwarded to the Department of Industrial Accidents' oft-ice of Insurance for.eoverage venfieation and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of_reiminal penalties consisting of a fine of up to S1500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine ofS100.00 a day against me. Signed this day of 4i; 19 (IL \ f Licens /Permirtc Licensor/Permittor �L a a• J t. OLD KING'S HIGHWAY uS'TORIC DISTRICT Spec Sheet Foundation Type Siding Type _ Chimney Type = 9-- Color Roof Material Color Pitch low W indoWs Size _/20 Trim Color Doors A�� .)./' ���-P o Color � Shutters Getters ,ZAA�-,9-c�--�/ Deck Garage Doors Color Notes: Fill out completely. tneluding measurements and materials/colors tc Three copies of this form are required for sutmittal of an applica! along with three copies each of the plot plan. landscape plan Ind plans. when applicabla. 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