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0059 LOCUST AVENUE
UPC 12543 a NO.. 5 os��ST.CONSJ�� HASTINGS, MN �"jxet�r , .^F .9 � �.fA•~'��"„., y-•.y,..-- "F.���"i.."�"3*.S`�,�j�i`r�>.5"�"`dt^sr�.:+�jt'. gri- f . q �ocvs-r Avg, rv3 M tq 7—o 2 8 i i { a .r 5 ys � it ;i y fi i �.: � � Y I t Town of Barnstable Building Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept te». ems$ Posted Until Final Inspection Has Been Made. Permit nu• Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-20-1690 Applicant Name: Bethany Bausemer Approvals Date Issued: 07/29/2020 Current Use: Structure Permit Type: Building-Tent Expiration Date: 01/29/2021 Foundation: Location: 59 LOCUST AVENUE,WEST BARNSTABLE Map/Lot: 197-028 Zoning District: RF Sheathing: Owner on Record: RILEY,WILLIAM A&JUDITH A Contractor Name: Framing: 1 Address: 1469 MARY DUNN ROAD Contractor License: 2 BARNSTABLE, MA 02630 Est. Project Cost: . $625.00 Chimney: Description: Tent 30'x 30' Frame for a small wedding August 9th 2020 provided Permit Fee: $25.00 b American Tent and Table Inc. Insulation: y � � Fee Paid:! .. S 25.00 1 am renting this property from 8/8 to 8/15.The event is held on Final: ► t Date: 7/29/2020 Sunday 8/9.The tent will be set up Saturday 8/8 in the afternoon and taken down Monday 8/10. Plumbing/Gas The tent will not have sides. �,.�✓�wt Rough Plumbing: Project Review Req: Building Official � Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within•six months afterissuance. All work authorized by this permit shall conform to the approved application and thelapproved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 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. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: r TOVIN GI BARt61tiR►,_E Bill and JudyRiley.ile. 2009 i Af? -g PM f 2; 4 7 P.O. Box 212 Barnstable, MA 02630 (508) 362-5456 March 5, 2009 LIUiSIOW. Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 ATTN: THOMAS PERRY, DIRECTOR ROBERT McKECHNIE, BUILDING INSPECTOR RE: (5_9_LOCU§t-AVE WEST=BARNSTABLE Dear Tom and Bob, This letter is to clarify our'intention of converting the walk-out space downstairs of our property at 59 Locust Ave into a one bedroom apartment for our daughter, Bon- in-law and future granddaughter. We purchased the property last September and plan to move into the main house upon the sale of our primary residence on Mary Dunn Road in Barnstable. Attached is a letter of intent from Bob.Norton of Kinlin-Grover Real Estate who is actively pursuing buyers on our behalf. Presently we are in the process of obtaining permits to build our retirement home on our adjoining property located at 73 Locust Ave. Before and during the building process our primary residence will be 59 Locust Ave. Upon completion of our home at 73 Locust Ave, we hope our daughter and her family will be able to purchase 59 Locust Ave and pass the ground level apartment on to one of her younger brothers to help them establish a home on the Cape. It is not our intention to rent this space - only to help our kids get their feet on the ground. Thank you for your consideration in this matter. 3'! i M Sincerely, kt,( qv-CT- VZ r 03/05/2009 17:53 FAX 508 362 9001 RINLIN GROVER BARN Q 001/001 -1I N LI NGMAC GRbVERwRealatate March 5,2009 Tom Perry Building Inspector 376 Main Street Hyannis,MA 02601 RE: 1469 Mary Dunn Road Dear Mr. Perry, This letter is to confirm that WiUiam and Judith Riley of 1469 Mary Dunn Road have listed their residence with my office. I anticipate it going into the MLS Service at the end of March. If you have any questions please do not hesitate to call. Sincerely, Robert J.Norton RJN/ksp Cc: William and Judith Riley 1 �, z C) C -0 Kinlin Grover GMAC Real Estate 3221 Main Street • P.O. Box 156 • Barnstable, MA 02630 Office 508.362.2120 / 508.362.5505 • Fax 508.362.9001 •Web www.kinlingrover.com a . f Bill and Judy Riley. P.O. Box 212 Barnstable, MA 02630 (508) <362=54-5� .......................... March 5, 2009 Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 ATTN: THOMAS PERRY, DIRECTOR ROBERT McKECHNIE, BUILDING INSPECTOR RE: 59 LOCUST AVE, WEST BARNSTABLE Dear Tom and Bob, This letter is to clarify our intention of converting the walk-out space downstairs of our property at 59 Locust Ave into a one bedroom apartment for our daughter, son- in-law and future granddaughter. We purchased the property last September and plan to move into the main house upon the sale of our primary residence on. Mary Dunn Road in Barnstable. Attached is a letter of intent from Bob Norton of Kinlin-Grover Real Estate who is actively pursuing buyers on our behalf. Presently we are in the process of obtaining permits to build-our-r_etirem.ent_hom_e, on_our_a-djoin-ing-pr_o:p:ert-y=located-at 73--Locust_-ve.3 B fore�and=dur-in`g--the-b`ui:ding, process-our=pr_imar_y r-esidence-will-be 5.9-L-ocust Ave.., Upon completion of our home at 73 Locust Ave, we hope our daughter and her-family will be able to purchase 59 Locust Ave and pass the ground level apartment on to one of her younger brothers to help them establish a home on the Cape. It is not our intention to rent this space - only to help our kids get their feet on the ground. Thank you for your consideration in this matter. Sincerely, 4: • ,� f 17:53 FAX 508 362 9001 KINLIN GROVER BARN 2 001/001 3 . N LINGmAc OVEN..�Estat yi'x.i i~ March 5, 2009 Tom Perry '.' BuiIding Inspector 376 Main Street Hyannis, MA 02601 RE: 1469 Mary Dunn Road Dear Mr. Perry, This letter is to confirm that William and Judith Riley of 1469 Mary Dunn Road have listed their residence with my office. I anticipate it going into the MLS Service at the end of March. If you have any questions please do not hesitate to call. Sincerely, Robert J. Norton RJN/ksp Cc: William and Judith Riley . ..•. 1 I Kinlin Grover GMAC Real Estate 3221 Main Street • R.O. Box 156 • Barnstable, MA 02630 Office 508.362.2120 / 508.362.5505 • Fax 508.362.9001 •Web www.kinlingrover.com k P 3/10/09 Judy Riley called, will complete bldg per app. They plan to move to 59 Locust when house on Mary Dunn sells. They need the money from the sale to build at 73 Locust. They want pregnant daughter to be able to move into the apt at 59 Locust. Told her Tom will review application when it is submitted. Suggested she move to 59 Locust now, but she likes Mary Dunn better. Suggested she remove kitchen and have daughter live in 59 Locust, but she wants the kitchen. Bob discovered the kitchen. 06/26/2009 19: 36 Michele Cudilo, PE N0.859 01 :AN uF BARNS FABLE 2099 JUN 26 ' APB 8: 36 MICHELE CUDILO, P.E. Consulting Structural Engineer bl is m- ' Centerville, Massachusetts 02632-1979•(509)771-7601 • Fax(509)771-7163 mcudilo@comcast.net June 26,2009 Town of Barnstable Building Department 200 Main St. Hyannis, MA 02601 Attention: Mr.Thomas Percy/Bob Maceclmie VIA FAX: 508-790-6230 Building Commissioner/Inspector RE: Proposed Residence Modlflcations 59 Locust Ave.,W. Barnstable,MA Dear Mr. Pent', Please be advised that the as-built entrance portico at the above captioned project is accommodated for uplift loads, as required in the 7`'edition Massachusetts State Building Code. As such,the uplift mechanism at the posts, Simpson CS16 with 10-12d to each the beam and post, is adequate. Should you have any question on the above,please call. Sin rely, ichele Cudilo,P.E, . /2008-170 cc: B. Reilly of MICHELEG� CUDILO No.34774 y STRUCTURAL gFQI$'1 fcR�'� g t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map `.`.1!2� Parcel." Applicatidh'#_; .O� leb63 ' Issue' d .2 Health Division bri -1511 bate Conservation Divisi6n App�licatiohl Fee Planning,Dept' „'..Permit Fee Date Definitive:Plan Approved by Planning Board Historic =OKH Preservation Hyannis 09 Project Street Address GO,. L_Ccus± PaJ(-_nkA(- Village W es�-_ \e?>C_A rn -alo)I- YY)0. 0(J25 Owner V-\J Jday-y� Address�J�(;Ce (a yi,4 Ypt Ain je:j_ p�rl Telephone S�-_2,LC22_,_C__�- C_,To Permit Request LJ-PAAY ccn�in;+- oy-nk-) . i\:i�pk: oipos d e �. Tbtal new Square feet: 1 st floor: existing proposed 2nd floor: existing pr :Zoning District Res�cfnnfi eel: Flood Plain Groundwater Overlay . iij Project Valuation M0,000 Construction Type \jj Qca' Lot Size Z- /A-C�yr-_5 Grandfathere'd: U Yes' dNo If yes, attach supporting documentation. Dwelling Type: Single Family Two Family U Multi-Family(# units) Age of Existing Structure Historic House: LJ Yes Wono On Old King's Highway: 5(Yes L] No Basement Type: L3 Full U Crawl Ll Walkout U Other Basement Finished Area (sq.ft.) im Basement Unfinished Area (sq.ft) A Number of Baths: Full: existing fir. new A- Half: existing A— new r-1k Number of Bedrooms: existing —new CD Total Room Count (not including baths): existing 7 new tAA- First Floor KOOMICount Heat Type and Fuel: U Gas (dOil U Electric U Other Central Air: U Yes VN o Fireplaces: Existing-`New Existing wood/E^o!al stov(f-. Ll Yes N(No c� Detached garage: U existing U new size—Pool: &(existing U new size Barn: L1 existing U-Thew�_�,size Attached garage: Ll existing U new size —Shed: N(existing Ll new size Other: Zoning Board of Appeals Authorization L3 Appeal # Recorded U Commercial U Yes U No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER)- _ Name (j(2Y-0 (-')I Ili Telephone Number t cQ_-Sq SID J Address JqL�l M00_4 D(_t,hki 861, License#_C_ COLA f MCA , Home Improvement Contractor# 0 2(0 LOB Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 70\/Q)n ,IZ DATE 1?J 11 2,jf�(:2 R SIGNATURE FOR OFFICIAL USE ONLY 1. APPLICATION# r DATE ISSUED €' MAP/PARCEL NO.. f ' ADDRESS VILLAGE OWNER DATE OF INSPECTION: m� FOUNDATION v FRAME RJR ��0�09 �ae ?oac5 - SIR Ts r, LUG �ki�kri�f46641 OK INSULATION AIA)T G� E FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL f GAS: ROUGH FINAL E FINAL BUILDING i r DATE CLOSED OUT 3 ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): I r r ' Vl 'Address:- ?) L_<)r A is+ i9nxfn► Ae— �C-ity/State/Zip�107) 'gam► r,1 J-o.bl t° Phone.#: 4;De- 3(D2-�-{ S D Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction .2:0 I am a sole proprietor of partner- listed on the attached sheet. T. Q Remodeling ship and have no employees These sub-contractors have g. 'Q Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'-comp. insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 03.�I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] "Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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: Policy#or Self-iris.Lic.M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the'imposition of criminal penalties of a fine tip 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 coveragMerification. I do hereby certify under the ink and pe ties perjury that the information provided above is true and correct. Si `attire: Date: Z . D _ Phone k — — Offu:ial use.only. 'Do not write in this area,tb be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 1.Building Department 3.City/Town Clerk 4.Electrical.Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I i 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 tiustee 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." i Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and.phone number(s)along with their certificate(s)of insurance. Limited Liability Companies.(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is.being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit(license number which will be used as a reference number. In addition,an applicant that must submit multiple permit(license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in _(city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid.affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance'for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations, 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia HE Town of Barnstable t Regulatory Services Thomas F.Geiler,Director Muss �Pr16 9, Building Division Tom Perry,Building Commissioner 200 Mairi:Street, Hyannis,MA 02601,_ ......_...._.. _ ..._._......._... ......_..._.. . ..... _.... _. .... www.town.barnstable-ma.us Office: 508-962-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 1 ZI l22 j7,Cr_-)9 JOB LOCATION: q � C,l.{ ,lPY1t 1P number street village "HOMEOWNER•':W 1 l I i C-A1'Yl !3 JCA A L4 C)?>S ,1D? -t-t name ,(� home phone# work phone# CURRENT MAILING ADDRESS: 2. 0_ �=.Q) 2�1.Z Ka AA2ta- MCA cityhown state rip code The current exemption for"homeowners"was extended to include owner-occupied dwellinEs of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on,t form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building Permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned `homeow>3efi�ce�s that.he/sbe understands the Town of Barnstable Building Department minim-.inspection pr ee/d/lures requirements and that he/she will comply with said procedures and requir S'ignaiirm of Homeo er Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION .The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exerription are unaware that they arc assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problerns,particularly when the homeowner hires unlicensed persons. in this case,our Board cannot proceed against the unlicensed person as it would with a licensed j Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homoexempt ofrgti Town of Barnstable Regulatory Services A8, Thomas F.Geiler,Director nb;a'�� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject.property hereby.authorize to act on my behalf, in all matters relative to work authorized by this binding permit application for. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERM LSS10N J - �.,;'a C$.SET ��'�,/ 4•� 40' • i ,..... ,,.d 1.52''7 AGrz�s . . .,• �O.BCdL�- AGrL�s VRA�.Ia oir P7 m N ss r NIt 4 sQ4 4 A --Q's { S moles _ ! C Q uM a� O I � C I � - _ = 91 I 3 `'• k yl , i -J o �p}iHE Tp�y Barn•stable Old Kings Highway Historic District Committee O URNffUBI$ ; 200 Main Street, Hyannis, MA 02601;TEL: 508-862-4787 Fax 508-862-4784 v pt,,ce a rE°MA�s APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made, with four(4)complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings,or photographs accompanying this application for: Check all categories tha7al y; ' 1. Building construction: ❑ New ❑ AdditionAlteration 2. Type of Building: LI House ❑ Garage/barn ❑ Shed ❑ Commercial Q-�)ther 3. Exterior Painting, roof ❑ new roof ❑ color/material change, of trim, siding, window3 oor a 4. Sign : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing ' - 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ tennis court ❑ 6 her 6. Pool ❑ swimming ❑ Other man-made pool 110 rr Type or Print Legibly: Date: 3/1917,009 Address of proposed work: House# S Street: / <<!�/Sf- /FP�1ur Village WJ3 fr)S'hXkCAssessorsMapLot# Description of Proposed Work: Give particulars of work to be done: P rewI nc4.S l(A PjI/6)j),10 Cj 0� ► S a.,t n\/ v Y � Agent or Contractor(print): VV (itM ei 1 C L4 Telephone#: Address:- (ro Qi (p 6 Contractor/Agent' signature: ' NOTE All applications must be signed by the curre owner Owner(print): ry) Telephone#: Sue—-3 LQ Z- S LA S(_O Owners mailing address: P.O. 21 Yn i -�j Owner's signature: For commit ee a only. This Certificate is here PPR. /DENIED Date Members signatures pECE0ME MAR 2 5 2009 TOWN OF BARNSTABLE Any conditions of approval: HISTORIC PRESERVATION j �t,P� 5�ae�al t _a�\�g���� 1 QAGMD-Groups101d Kings Highway10KH1VewAppI0KHCer1 Appropriateness 07.doc Town of Barnstable Old Kings Highway Regional Historic Distrigt Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 4 Copies Foundation Type: (Max. 18"exposed) (material -brick/cement, other) Siding Type material: W I1 j (10✓ Color: Chimney Material: t\jI A- Color: Roof Material: (make & style) A j-Ghl fiP }- ,1 qj (9 S1p�cl 1 t Color: 11�/e(.�► k--e.d tnl DOc� Trim material R, Color: Roof Pitch: (7/12 minimum) (j Window: (make/model)RV>dP,ys 1 1/z kie_hu material yklOOd color yV Kihe_ Size(s): Door style and make: 12, 1 itf- material V\) Color: _n Qt LArQ/ Garage Door, Style N ` P Size Material M Color tq Shutter Type/Material: W CCd 1 LA-yym bP r Color: Gutter Type/Material: PrI!.AW)'t►-1 l._rY1 Color: s Decks: material m(jhno�o►r,vl Size ( p Colo i 00 Skylight, type/make/mode 1�_material �` 1 � Color: lle: ova,\sr,�ay ° s 9e Sign size: Q� Type/Matenals: Q� �} oG° Fence Type (max 6' ) Style . (� A material: N Color: I A Retaining wall: Material: l� Lighting, freestanding 1 f A on building illuminating sign Please provide samples of paint colors and manufacturers brochure of style of windows, o s,gaTag (bO fences, lamp posts etc `L�. ADDITIONAL INFORMATION: S�v Signed: (p]anpreparer) j print name\pf jlli(cVyl p`ioef,i� tel.no. ��-31n2��.��� Locatio application: Street no. �� � Street O , Village 2 Q:IGMD-Groups101d Kings High wnylOKHNew AppIOKHCert Appropriateness 07.doc si i l� e I ir�Fl - ' , lip I,— \'II Fp Vp i 1-r ;I i�i I i I €i i ,i •�i i I �:. f:3 � - I ! i _ I LI ' i< !iii !i i ll1----���--j--•II I� ;�'!., �! ' i� i. FTi I:." li if if j'i"I - l. -, 71 ---� i rif --- i ! Iii •' �; !i �—! i I� �-� I ILJ; ijl > o � p c a m a � ✓ E m S m o ° m z < c 00 . 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P �p 6.19. `Oro rEa � APPLICATION, CERTIFICATE OF APPROPRIATENESS. Application is hereby made, with four(4)complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans,drawings, or photographs accompanying this application for: Checkk all categories that apply; 1. Building construction: El New VAddition ❑ Alteration 2. Type of Building: U House ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Paintin.Q, roof ❑ new roof ❑ color/material change, of trim, siding, window, door 4. Sign : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ tennis court ❑ Other 6. Pool ❑ swimming ❑ Other man-made pool Type or Print Legibly: Date: Address of proposed work: House# Street: Ln t;l ii c,+ 'AA ),,:D Villager 20rn d-CAt J CAssessors Map Lot# Description of Proposed Work: Give particulars of work to be done: D Agent or Contractor(print): Telephone#: Address: —] ( �- Contractor/Agent'signature: // NOTE All applications must be signed by the current o er Owner(print): Telephone#: Owners mailing address: (� L1, 26A Y Y\ ( CO3 Owner's signature: For co tee use only. This Certificate is he by APPROVED/DENIED D E C (� U nU„ E ate $ Members signatures l► L� _ f NO V 0 6 2008 HISOTORIOC BARPRESNSTAB pN Any conditions of approval: . DEC arnstable Old King's 19 1 Q:IGMD-Groups101d Kings High way10KHNew AppIOKHCert Appropriateness 07.doc Committee I Town of Barnstable Old King's Highway Regional Historic District Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 4 Copies Foundation Type: (Max. 18"exposed) (material -brick/cement, other) Sao C Siding Type ,S , � material: WV t« C-(fjfA- O K Color: r n+tA rrz Chimney Material:_ �+ Color: (� r' Roof Material: (make& style) Ay-c-b',}-CG-ti i rx Gi 5 jQ -\Q I'I' Color: �r �Gt-}-h era�� wpL-,G Trim material p Color: W Roof Pitch: (7/12 minimum) h Window: (make/model) material ;,N 00d color (/J11 i I-L Size(s): Door style and make: 12- 1 i _ material�,,, I 00d Color: _nrA 4-L rc I Garage Door, Style till Size Material — Color N 1 _ Shutter Type/Material: ' N OOGI ILA. Color: n)h', Gutter Type/Material: A-►i,t�-�,,,nvi rY1 __ Color: Decks: material Size Color: a(,L-4-L Ar—a Skylight, type/make/model/: N P! material _Color: _Size: Sign size: tJ Type/Materials: t4 A- Color: Fence Type(max 6' ) Style A- material: Color: Retaining wall: Material: {mil Lighting, freestanding N`N on building illuminating sign tj At II Please provide samples of paint colors and mXPPRCYVtD of style of windo d ara a door, P P P y g fences, lamp posts etc /� ADDITIONAL INFORMATION: �S' G DE Town o arns Tp 8 „ommittee p BAoZ- -� print name ESFR�gBO Signed: (plan preparer) - 4 tel.no. - -{SIL Lo n of application: Street no. q Street Gt-t S+ in I tr Village JL/ ry-),<t-rA1.,1 . 2 , Q:IGMD-Groups101d Kings HighwaylOKH New AppIOKH Cert Appropriateness 07.doc • J `� ( 'YE>Vti..__ - ,7 tJ•;, •."V ii�� t�1 .. .. -� �'-1•iY4i-5 ' n R` �3 i�7..4^�rf 'E.'� i.• .L. t t r '^i f i 49 ;)q f, / �0 AV ,� 4.. J;��icF,. ,/ �.. � i. P� r t,�4,,y� - 'S 1(5��'k r• �.f11 . l t r.� v�„W♦ F � rl'Lsr, I� Fv'_t � t�tF�:Z,t 1r� 7� c � . ;+... .r r o.. r 7r" it�.i. i •. ai f� :.. • _ ._. .. _. ... .. ti .>.< 3� r�'a x�"rt t :tife`3'iXy�rt, �, r` � r x ,Y�t .t J+r K � 1y. rV. ' ►i1 NOV 6 Z008 ri'V''-!OF 3ARNSTABLE �19 S G : •' HISTGRIC PRESEf�VAIION 0• e rr /tl UF t3td j� .. :BLE NEVI RA14 _ 2069MAY 9 DI�VISION�� IMPORTANT" ANY,CONSTRUCTION THAT INCREASES LIVING .SOAC- PEy1 ND 1'200 SQ. FT. PER • ::S?hLLATIQN OF BEVEL MAY REpUIRE ?F-- ADDITIOAIA� SMOKE lJETEC?C- A SEPARATE PERMIT IS REQUIRED Grp a?ION OF SMOKE DETECTORS ' - Cor SA77SFY pile ' E1115Tic:G— NIMNFY EN1GlAl D�WPOW� AKb MRA T:DktAW—. - ----- - ------ - -- --- Jr to I 1 _ I �, � .. I � - -�!—�J'-�)-f`• -•e7-�r_'�_�£_..�.. - _ ---_._`_-=_----= h:..II.�' -i:._�-ii__-L}--ii_�� i �-I+i (-- )i (.._i --- - -- - . __ �.,_w_.u-.iL� __—.__...__..--_._ __ ! h, t:-f� t ��..I _I (- _ —`,��� I''r�i'r��.''= _f��.jr-� ,L"7 i- t --j(! I• li ( Il. 'i C. mE,P V_ D PAY d. P w ITS t3D�( . \✓ £ S'' t t�'�a '}' f G' N l t:•1! QJ 0`i 1 Fs\ o m';6'T.4f:.+'7 • ' ) N�.w 'C3RY w INoow CPRE p AJ�� EAST L "e fill LIE ' SCALE:1/4sl i 1 / APPROVED BY: P I . 1 DRAWN BV � DATE: - REVISED , rr DRAWING NUMBER +III 1 t i ' i a } I 1 91 TO l i wil jl i t' 1 m . _ F a Gt G m T Vi a m a z z a � D s -rj z - 1 V I I l n • i - t 1 t ; t.• , � I 4I � 'I•,i�.fir=?�'' � `t:, l r' g c?7 1 . m y i I I a og 0.0 i f ; o G Id T! , i . m t • i + v f v a i e ..a.- 4. m = .. I O � m s n , • 2 SA � „ JJ PT, ZX 10 __..._ _.._. 1>t01TON 6 r_--_ -- f DeTAILS SCALE: K < <I APPROVED BY: DRAWN BY DATE: REVISED DRAWING NUMBER S o2 1 �O` i Y) /----'-'---- — s - ......_..:__....._. ......._.............._. ._.. j - (,r/x� �oK �.`�XIL3/' �1 5nnx LP, -Io — -' -- -_ --— • N f�� ............... �1 G XG sm s e/�al YP C-til�uc.-(�vt� �T�IL: QF M;aS MICHELE yG� CUDILO ° 14o.34774 c STRUCTURAL �o .beTAILs. gEGfSTEP��� SCALE: — 1 II APPROVE0BY: -RAW-BY BATE: REVISE- . °'i.,•&;PM1��yFa.`f:�yo�l t 5q JIDGu S-' fop-: ye-04 ORAWINO NUMBER Tat c C-00A z N. 1 { r •u1u I • � I ! 'i�� I III �� I , I I �►,T I ��� i/ ° 'TI- - --I i Y' 11 ! LL I i Ti !I z Tr Li t � - a o �1 r �, zJ m a APPROVED 5 DEC 10 2008 � Town of Barnstable Old Co!grs Highway D Committee 4( 'vov T 6' y�s��iyoF eoo8 q�,gTo� - - \ - i_. ............ . -+}- F'.... _............__._..-.__ _ _--... _-___._...__......_._.-._..._... .._ - ,..-_..._._. _ _..__- ...-__._.._.._..._............. . i .._ '-- - ----._._._. _ .. ........................ ... - - _.__.._11 - =-I, :L ice _._... _.. 1i,u, ---------- . .✓ �.1 . gyp/ Q - ... � .:I I — -_ - �/ ij 5c1 LCCUSr AVE, WEST -&\P-1,1STAI,LE ' SCALE: 1/41' _ 11 APPROVED BY: DRAWN BY IN/1 DATE: I(_(� -.O REVISED VVV���WWY---TTT ' - DRAWING NUMBER s • I ! i ( I 1 1LL-ice _ 1 mi I 1 COMMO b M� .o 0 c cn � 51 _ Nt v KP In z o zISS l \�(av i I !Il -� �---� • III I �I` I ! \ �, - Ij - �M Ll I ,1111 : GI fl :I i iij. j li I III I I, �' - rl _ • O O\ 111 I! 'I �l�� III I �----� , I I FtI I m r ___ 1 p r v �' 1' III II III 111 jl o PI i t .N mm m m z m cc' z < 70 m a � 1 '` ' ll \ is i I •� �I � �_I I; i '��i I I i /,... ' iI!I iL TA I �I1 I' E N oonaF,�o,, �A • Q mLoa I 1^ �iICU x �e I C� Inc L\ kA N N _ q ��• Q h ^No v o a °n X k (� ' tnE M z N ' s� Qb i r t , u!n Li.I,I Inns' � I I V��U _Ill LJ I � . • I i! ;I ;, I-��r: ,.I I-•---ter . I Ili i I T r _4 , ri � I I � � � � � ' I '•� 1 LII I � At. I ijl i II •I � {.�� _ 1 III rh a I a 1 � I II III T I • m 001 i m a o G1 2 • Z m n . m a 1 v 17 H meWrap o VraP'wy��!�f� d f a��7/'9 J I� Y .'G 1 Y Lill rP j ILI L.L �I Gods r � • / �,c�d i t { F. Y } r.v t 7/0 b d J w4 7 i �fws t N t a 'rd �O O�/� of N t i f r. � 1 'i . .. . .;.::!._ Bill and Judy Riley. P.O. Box 212 1 w Barnstable, MA 02630 (508) 362-5456 _.............._....._...._.....__._.. March 5, 2009 Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 ATTN: THOMAS PERRY, DIRECTOR ROBERT McKECHNIE, BUILDING INSPECTOR RE: 59 LOCUST AVE, WEST BARN STABLE Dear Tom and Bob, This letter is to clarify our intention of converting the walk-out space downstairs of our property at 59 Locust Ave into a one bedroom apartment for our daughter, son- in-law and future granddaughter. We purchased the property last September and plan to move into the.main house upon the sale of our primary residence on Mary Dunn Road in Barnstable. Attached is a letter of intent from Bob.Norton of Kinlin-Grover Real Estate who is actively pursuing buyers on our behalf. Presently we are in the process of obtaining permits to build our retirement home on our adjoining property located at 73 Locust Ave. Before and during the building process our primary residence will be 59 Locust Ave. Upon completion of our home at 73 Locust Ave, we hope our daughter and her family will be able to purchase 59 Locust Ave and pass the ground level apartment on to one of her younger brothers to help them establish a home on the Cape. It is not our intention to rent this space - only to help our kids get their feet on the ground. Thank you for your consideration in this matter. Sincerely, L.. �iccF�`�le i 03/05/2009 17:53 FAX 508 362 9001 KINLIN GROVER BARN 2 001/001 xxi-NLINGmAc G Rov IE R Estate March S, 2009 Tom Perry Building Inspector 376 Main Street Hyannis, MA 02601 RE: 1469 Mary Dunn Road Dear Mr. Perry, This letter is to confirm that William and Judith Riley of 1469 Mary Dunn Road have listed their residence with my office. I anticipate it going into the MLS Service at the end of March. If you have any questions please do not hesitate to call. Sincerely, Robert J.Morton RJN/ksp Cc: William and Judith Riley Kinlin Grover GMAC Real Estate 3221 Main Street • P.O. Box 156 • Barnstable, MA 02630 Office 508.362,2120 / 508.362.5505 • Fax 508.362.9001 •Web www.kinlingrover.com ;1 jll I: �iii�• � I �II I 'I�j! •I I! i i 0 IOTI] t i sirJ .j r ��•J 1 (•I A yea � .,L .k •{ -+f�rr r a G}p yam. � � `� w� r�'•"'r d' �s.• C f •I www it n f r A s�•.r.....�a .:�...y " '.uU 'rax,y.,���FFF� 9�r ' . ':iv �:�" eu°'a _ c,. s,...i ...Fj�i. •i.J ,sf .� ^'� 'i frillill", is)•>��,'Ky� +.+''t4,✓�.u•x" _ "�j.9•'' Yf l iT„ cI'?�a+'Y ..r-.+• >•, ��q t; i r --�, ><i !`��S:st��t{{33'' 1711ts2009 d� *M S'sf - ,,,�,'.�j i 12/1812008 �s i•O � M�:Y '" l �`-.' •ni t,�'•1`•'G.�w'; :. P.. 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HomeWraP�lrt HomeWrap, r, Tyve Vrap HomeWrap — i 07 New 0#09AA>-6:S :.Parcel Detail Page 1 of 4 r .w L i S,' � �� p !t•311 ., Logged In As: Parcel Detail Friday, )anu Parcel Lookup Parcellnfo Parcel ID 197-028 J I Developeer NO Location 59 LOCUST AVENUE I Pri Frontage 230 Sec Road I Sec Frontage village WEST BARNSTABLE I Fire District'W BARNSTABLE Sewer Acct _ I Road Index 0906 Asbuilt Septic Scan: Interactive , � C 197028 1 Map � :: - Owner Info owner HAGBERG, CLIFFORD & JANICE L I Co-Owner %RILEY, WILLIAM A& JUDITH A streets 1469 MARY DUNN ROAD v� I Street2 -� - City BARNSTABLE - Y I State MA zip 02630 Country US - Land Info Acres 2.00 I+ use'Single Fam MDL-01- ( J zoning RF I Nghbd 0108 Topography 'Level I Road Paved utilities Gas,Well,Septic I Location . - Construction Info Building 1 of 1 Year:1955 ) Roof Gable/Hip �.I Ext,Wood Shingle Built Struct Wall 'I Effect 2018 ( Roof As AC 'None Area Covers ph/F GIs/Cm p I Type I Be style:Ranch I wa i Drywall ^� I Rooms '3 Bedrooms Model Residential I Floor !I Rooms 2 Full + 1 H I Grade Average I Heat Hot Air I Total:7 Rooms Type Rooms http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=14244 1/9/2009 Parcel Detail Page 2 of 4 Stories 1 Story I Huel i� ation -� Found-[Conc. Block Fuel t Permit History _ --------_-_-- Issue Date Purpose I Permit# Amount I Insp Date I Comments Visit History_ Date Who Purpose 12/18/2008 12:00:00 AM Nancy Finch Sale Review 5/9/2000 12:00:00 AM Paul Talbot Meas/Listed-Interior Access - Sales History Line Sale Date Owner Book/Page Sale P 1 1/7/2000 HAGBERG, CLIFFORD & JANICE L 12771/085 2 1/7/2000 HOWLAND, KENNETH B & SHARRON K 12771/083 3 12/11/1998 HOWLAND, KENNETH B & SHARRON K TRS 11908/039 4 11/15/1984 HOWLAND, KENNETH B & SHARRON K 4305/103 5 9/15/1982 PECK, COTTER 3549/160 6 9/22/2008 RILEY, WILLIAM A& JUDITH A 23168/210 - Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parc( 1 2009 $141,400 $9,100 $8,100 $265,700 2 2008 $164,700 $9,100 $8,100 $296,700 4 2007 $163,500 $9,100 $8,100 $296,700 5 2006 $148,200 $9,100 $8,400 $215,100 6 2005 $133,100 $8,700 $8,600 $195,500 7 2004 $108,100 $8,700 $8,700 $195,500 8 2003 $98,900 $8,700 $9,000 $100,000 9 2002 $98,900 $8,700 $9,000 $100,000 10 2001 $98,900 $8,700 $9,000 $100,000 11 2000 $78,100 $5,400 $2,900 $78,000 12 1999 $78,100 $5,400 $2,900 $78,000 13 1998 $78,100 $6,200 $2,900 $78,000 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=14244 1/9/2009 ••, III .1 .1 •..� :11 •• A 11 '.1 '.1 •... 1 1 1 1 •• • 1 1 '.1 •.1 •.•. 1 1 1 ••1 • 1 1 •.1 '.1 •. 1 1 1 •:• • 1 1 '.1 '.1 •. 111 •:: '.. 11 •.1 '.1 111 •: '.. 11 '.1 '.1 111 '\ � �:tiy �'� i ���_ j �� n • '.iLL�Rx16 `r ..12J782008.. _ - 17/18/2008 . ,- . �- mil'•' 17, JI f f hh I r �fi,812008 J 1211a�008 it h .�'����:..� �, �..' e. . :<Ae Y w �,'�ar ...�. '•.... to 3*+rt L 3�tir� •��,.--' mot+ t„ �' � � �"`�� 'y''�`.+~.o..�...».+ii� .t 1 L ....'�rt�""JJ��1�. + �`7 r a. � ��"_� 0'•� I �• +„+r.��w'�"•iiw++•��Y. �w,J„•,wane+..tw t& � ,'It Y -�%��' � � � "'"" . rt�•,� ...�y���`Wra��iwwc�.�����`u� I 1.. ,,,s,rs ' �� / � I 121182008y S- 12/l&2009 .:•'F° -F�. f'q w T rAIrP+ Ii� +�Md��y�aC1 i n3 rf Sm .. `p`s >• ! w1f'�titi ,+� ice, '" } ;�,� �n�Yd �� Y b��` .�� C � .•i � ,.. �LL1... 4 ;.. _�➢�i l.E. � �'� �j�,�i r`jy'j���,�o tK5 �j��;}'�� � __-.c�,..-,.._.._____�� ' t ��y�yyC .t6�'�.�`' .�y 1 . � ���� �� �pl ��+ ter. �-_� 3. �l.�•"14�¢. a'�a. •_.. .t3r �+ ,. - '^/}�� �.;rr<.1+• 1'r �q ,,yr .L .�e'�����s '�4 y -. j� �, r='� �r'��'��` an .�.• 1, 1� i �l' Mi#1 a!E• n.. j r r' , S `' w� lit 1/Pa '12/1&2008 i b ,�. 9' � � �,L M/� •f wr �'Fi'I� TLC„ I rw 1 J 1 ail + �� M•+._Iw•�._ �..�^.ti.�n M.._ � 12M 2008 Oct,1He, Town of ]Barnstable # 'b Expires 6 moadhs from issue date Regulatory Services Fee BARNSTABLE, Thomas F. Geiler,Director 9 MASS. �A i639• ♦0 Building Division lfD MA't p Toni Perry, CBO, Building Commissioner ,1 200 Main Street, Hyannis, MA 02601 www.town.bamstable.ma.us 01"lice: 508-862-4038 Fax: 508-790-6230 EXPRESS.PERMIT APPLICATION - RESIDENTIAL ONLY Not Vali.d.mithout Red X-Press lmprin-t cei !�4ap;parcel Number_I� n 12 Property Address v Residential Value of Work Minimum fee of$25.00 for work under $6000.00 Owner's Name & Address t I l Qr 1/1 l�_ -- Contractor's Name_ ►'Y D—rcL Telephone Number Home Improvement Contractor License#(if applicable) __._^ _ Construction Supervisor's License#(if applicable) " ❑Workmen's Compensation Insurance PERMIT Check one: -,'PRES ❑ I am a sole proprietor •I am the Homeowner OC� — 7 2008 ❑ I have Worker's Compensation Insurance Insurance Company Name -TO\NN ®F BARNSTABLF Workman's Comp. Policy tl Copy of Insurance Compliance Certificate must be on file, Permit Request (check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Rc-roof(not stripping. Going over existing layers of roof) �. Re-side R Replacement Windows/doors/sliders. U-Value_ �� (maximum,.44) "Whcrc required: Issuance o this permit does not exempt compliance with other town department regulations,i.e.Historic,Conserve iSfl;`etc--- —,_.... ***Note: Property Owner must sign Pro erty Owner Letter of Permission. A copy of the Home I-mproinent Contractors License is required. 5C o t,ji L-- v�di tlG SIGNATURE. Q \VPI'It-I S\I'ORMS\building permit forms\EXP ' S.doc Revised 100608 The Comtnorcwealth of Massachusetts Department of Industrial Accidents Office of In vestig'atlons 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectrician.s/Plumbers Applicant Information Please Print Legibly Dame ()3usiness/0rganLE6on/Inciividuan: \. Address: � Pho City/�tatelZip: ne.#: F21 an employer? Cbeck the appropriate bar: Type of project(required): 4_ [] I am a general contractor and I m a employer with 6. ❑Ncw constructionployees (full.and/or part-time). have hired the shh-contractorslisted on the atjachcd sl=t 7. ❑R-emcdeling m a sole proprietor or partner- Tbese sub-contractors havep andhavem croployecs 8. ❑Demolition rking far mz in any capacity employees and have workers' 9 0Building addit ion O warkGIS' GQLIIp.rrt�etrrnre comp.insuxanmt. [] VTe arc a corporation anal its 10.❑Electrical repairs or adtliti-quired] officers have exercised tbcir 11.❑Plumbing repairs or adr3iti m a homeowner doing all workyself [No workers' compright 6f exemption per MGL 12 ❑Roof repairs srtrance i t c. 152, §1(4), and we have no �1 employees. [No workers' 13. Othcr ramp.mmirancc required.] `Any applicant drat ehecls box#1 ruust also fill out the section below sbowing their wm-i,='czngcn=Ecn Policy information_ t Homeowoa-s who submit this affidavit in6ciling dray arc doing all workand than hire outside contractors must submit anew affidavit indieatmg such tc ntraetom d atebmV this box umst attacbcd as additional chat sbowing the name of the sub-amhmdum and strtc whetha or not thost CUd6CG have urployecs. If the sub contractars have employers,they must provi&them wort as'comp.Policy number. I am an eraplayer the Is providing workers' cotnperrsat on insurance for my empfoyees B'efcty is the policy and job silt ircform.atiort. lnsut rancc.CompanyNamz Policy#or Self--ins.Lic.#: Expiration Date: lob Site Address: City/StatdZip: Attach a copy of theworkers' compensation poliy declaration page(showing the policy number and erpi_ration der Failure to secure coverage as required under Section 25A of MGL c. 152 can Icad to the imposition of c imifial penalties c fins vT to $1,500.00 and/or onz-year imps sonmzat,as well as civr7 penalties in the farm of a STOP WORK ORDER and of up to-$250.00 a day aga:mst the violator. Be advised that a.c opy-of this sta-tcmzrit maybe forwarded to the Office of Investi tions of the DIA for' c cov Mgr,verification. Ida hereby cerii der th ¢ penaldea of perj�c rhid the informo ion provided above is true and correct Si c: /✓� Date: v Phone# O fzcial use only. Do not write in this area, tb be comp:tted by city or town a City or Town: Permit/License# Tss>:dagAuthority(circle one): 1.Board of Health 2.Building Department 3. City/ToPvn Clerk 4.Elecb-ical Inspector S.Plumbing Inspector 6. Other r :ro . . 1 Town of Barnstable �pQ THE)'j Regulatory Services swaxsrwaLt:. Thomas F.Geiler,.Director .. MAs& 16J9. ,�� Building Division PIED I'��IN Building Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 vt'ww.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOhItOWNTER LICENSE EXEMPTION Please Print FA ION: �� 1 L (_mot_/t �� Tl VL��I.� a�; n- f number street village NER : Li ���' 1 P.t/13�(02 6� �Z name home phone# work phone# AILING ADDRESS: P• CL�o ?i 2 0ZC032 anal Pa city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside_, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the buildin)Z permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department r„iminum inspection pro tYuYes n requirements and that he/she will comply with said procedures and requir Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing M,000 cubic feet or larger will be,required to comply with the State_Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of constivction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor.,. Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for.Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, than the homeowner 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 t amend and adopt such a form/certification for use in your community. °FTHE, � Town of Barnstable Regulatory Services KASv sexx S. Thomas F. Geiler,Director i659. _. rE16 9. & Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta ble.ma.hs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder r , as Owner of the subject property hereby authorize to act on my behalf, in all.matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. i Town of Barnstable IKE Regulatory Services Thomas F.Geiler,Director • Building Division •nx�vszasia. MASS Tom Perry,Building Commissioner q i6; . �E A 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Pee: Permit#: D a L.( HOME OCCUPATION REGISTRATION Date: ��/9/,V I/ Name: &1/r_'FOQ b f Phone#: Jam? —?6 Z Address:_ S1�7) LQCUST p�-VLs Village: Name of Business: T7,t 25/4-D 17L If CC, Type of Business: G,W /YyG770,t/S Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and a e with the above restrictions for my home occupation I am registering. Applicant: Date: 'v 5/ Homeoc.doc Rev.5 /03 TO ALL N W BUSINESS. OWNERS DATE: Ulm gOla Fill in please:APPLICANT'S YOUR NAME:BUSINESS YOUR HOME ADDRESS: 5-9 LOc�S�U&-79a-7S i i /�/. /�A�N s T G�� A! / D ZG6j-- TELEPHONE Telephone Number Home - - 7 NAME OF NEW BUSINESS � GT /a2� l��•pcG�. CDC TYPE OF BUSINESS 6-71 ��cT/oNS IS THIS A HOME OCCUPATION? YES. N. Have you been given approval from the building division? YES= NO 0 ADDRESS OF BUSINESS L oc uST. o MiAPIPARCEL.NUMBER 02- When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in.obtaining the information you may need. Once you have obtained the required signatures, listed below, you may:apply fora:business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. -(corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSION 'S OFFICE This individual has-been infor a of any permit requirements that pertain to this type of business. orized Signature- COMMENTS: ./ 2. BOARIY OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: s Business certificates (cost $30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME In the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments Involved. **SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. f1\!11NCI IMFR\I nklrA Fnrmc\nwwhomfrm.rinr•. i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1W _7 Parcel _ Permit# Health Division �� Date Issued k Conservation Division Application Fee Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address �� 1-DcU57- Ate Village 0, Owner C'L/C'o/z f-_> - i- JM& 2-:�7-- Address 5'7 ,— Telephone 5-0 Permit Request 21- 7—e-4/7-5 FDeE PJeDD)/L�'— Gi /o-.Z— rn > a z Lt 6 o �- Ln m Square feet: 1st 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 Cam' Two Family O Multi-Family(#units) Age of Existing Structure D Historic House: O Yes Q-116— On Old King's Highway: ❑Yes Q-Ift Basement Type: III ❑Crawl O Walkout D Other Basement Finished Area(sq.ft.) &00 Basement Unfinished Area(sq.ft) 900 Number of Baths: Full: existing Z new Half:existing new Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: O Gas I II ❑Electric O Other Central Air: ❑Yes O'No Fireplaces: Existing New Existing wood/coal stove: 0 Yes 3'11 Detached garage:O existing Q new size Pool:existing ❑new size Barn:O existing ❑new size Attached garage:®e isting ❑new size Shed:O existing ❑new size Other: °Zoning Board of Appeals Authorization O Appeal# Recorded❑ Commercial O Yes Illo If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name 2AWR Y TZ7 Telephone Number Syf' 7 y�—/7 Z Address rYAecPAI License# /yI -`�it� �1 2-7ZF Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATEz- FOR OFFICIAL USE ONLY n PERMIT NO. DATE`ISSUED MAP/PARCEL NO. ADDRESS- r VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION ` FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE=CLOSED OUT,'_ ASSOCIATION PLAN-NO. Plug 26 02 12: 1 p Sperry Tents and Sails (5081 748-3997 p. l IF, 0 11 Marconi e f Marion,MA 02738 ' I Sperry Tents Phone:(508) 48-1792 Fax(508)7 3997 1 To: Carrie Hagberg From: Nikld Sperry Fax: (508)790-7914 Date: 26!' August 02 Phone: Pages: 4 Re: Permit for Tent CC: ❑ Urgent ❑ For Review ❑Please Comnumt ❑Please Reply 0 Please Recycle Carrie, As discussed,please find to follow the informatiion you need to get the permit for your event in Barnstaple. The Town Hall (Building Department - Nancy) will need to see a copy of our insurance certificate and'certificates of flame resistance for each tent that you hire. The person I spoke to at the Town Hall last week told me that it was taking around 3 weeks to issue a permit, but just ensure they a fully aware of the date of your event and they may rush it through for yowl If you have any questions or need arty furt irdonnation,please do not hesitate to contact me. Kind regards, I 1 I Aug 2G 02 12: 14p Sperry Tents and Sails (5081 748-3997 p. 2 08./22/2002 12:01PM THE HART ORD PAGE 2 OF 2 Yt rl 1rE 1MC HAR'i FORD ACORD C 'I'IFICA -E OF LIABILITY INSURANCE. August 22,2002 Prodrer 'nUS CERITFI(:N[E IS lti'SUFD AS A MATTER OF 7.10705 INFORMATION ONLY AND CONFUtS NO RICIrM UPON PayUrs Irtcrronrnt TIDF.LEKIIFIC CIE HOI-DER.TIUS CLWM(i\I'F: '11.R afi)d DOFS NO'r AMEND,IDC17ND ORAL-WRTHE COVERACE 108 FanrotsVrn Av ( AFYORDFD BY1I3F:POIJCfES BELOW. Parstimoq Cl" 06032.19 13 fatstased ._.. -__ --•-- hotness AIT-dog Covrragc SPERRY TENT Imma A Twin Cry Im Go IL MARCONI Images,B: MASU NJ,MA 02738 {,oma C: Faa:508-748-3997 lmwa D: Imwa E: IIIE PO(lctlS OF W SURAN(J+LISTI])RU.OW IIAVL B7FI.1 SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PBRI WUICA77'-n.NOTWCII LST-ANUITIG ANY RF.OUIRDA(PNI', OR CONDIf1C)?I OF ANY CONTRACT OR OTHER DUCUMFM' { RESPEC]"PO WHICH THIS CER'1'LFICACI:MAYBE LSSIIFD MAY I'EKI:A1N,7HE INSURANCE AFFORDED BY THE POUCIEiS DESCRU3fi1)KE F3( IN IS SUW12CTTCI Au.7'HFi'1'Dims,ExC USIONs ANC CONDITIONS OF suai POLICIES.AGGRE(iA-m LINKS - SHOWN MAY HAVE BEEN REDUCED BY PAID Cl Als,,& Geoenl UabDIIy .-.-__....Irn we r. [iattias . Corrrmacial CicJrral I.iabiliq' 13-h Ocewteac: S Oaitm Mad.: Fist Damage(avy one litc.): $ Cann: Mrd FaWonc(am om Paso.): $ Policy Nnnbcc Pasuml R Adv Lability. b Policy Elfnii-Datc' (Tetrul AWcptr.: $0.00 Policy Evim Date: Pts•dncb-Cortp/Up AWp $0.00 Gcrrlal App2ee,-Omit Applies 1'u: Policy: Ptojw: ff>C: Aminnoobilr Uabillay _Lnstatr. Limits Any ado: Catb Sio4c Limit(es accidcat): S NI Owred Abdo: Bodily lajmy(Pa person): S S lydolcd Aulos: Bodilyw �j Y(Pa Aecidest): $ Hitrd Autw: PlcSesty Dtssuv:(Pa Ara:ided): $ Non Owrrd Nnos: Policy N.M-: Policy Etfecsi-..Date: Pol icy ExsAi.lion Dv,: Cartgr IJet�pry hrsttae r. IJmhs Any Auto- ANo Only-PA.A06dcrs: Policy Nun l.ir C111a lltan AWo Only: Puliry Efoomti,c Datt: EA Accidat: b Po _Cq.u.lion Uatr.:j.101 y Ira uac r. UnaOs (kcm...... P.ah(kxusumr.: S Claims Made: •�J7.galr: S Dcdu-.libl, Rctrnion: S Policy Ntorbct: Policy Fffislivc Date: -Policy Cspii.ti..Dalc:__.•--._ Worker's Comperoaliun Iatwrcr.Ajby .enxr$Jspc1A lindols SoFiopinycrs CialtDltr WC:Staumy lintib: X O U'a: Policy Nwrtrt: 76WG KN6973U.f--Each Accidcd: SLOO.ODO.00 Policy P.ffective Date: 21-MAY-02. E.L Disease-EA Earployee: $100,000.00 -1'ol�L!xQiuliaanDale: 21-MAY_03E.L.Disease-PolicyLimil: b500,00D.00 Dtsc ripion nl opt" Nrtticictf-m1mioro add ps-bl.m: 108:WSTALLAT7QN OF SILT:WEST IsARNSTABI P, un•,fS:SFYTF:MBER La.7A Crrtitkarc Iluldrr CerrctDalion Should arry of 0e about of s ibed policio be caatcekd before llr. C--\RRIL IIAGDLiRG r�su.lion dale IhrJ.W,We usuiatq unwct will ensk-os to rmil l0 slays 69 1 OCUST AVU W. wsi'ten/mice o the-olificale lu)dea mn:d m th IcU,but failwe to sb WEST BARNSTABLE,MA R sn"full ffVmc m obligal'urn no liability of anyldrd upon Or.imtun,its agt•Jt m tstpl,mcnati— Rrtcrrnccflru1 ..0079.2A Y02 -•-- ---- -AUIHORDP.DREPP SBNIAl1VE: , I � Aug 26 02 12: 14p 1 Sperry Tents and Sails (5081 748-3997 p. 3 ( q�� 4 ''•t •.19;.��.��.�'l.l"l"� :+t' 'i•. .7i: %�� d t �'�,r pp�� C�JD � REGISTEFil 7 1 ® �y APPLICA ' Date of Manufacture NUMBIC11,C �1t.1 I l-1 l3r» 2 1.5 ric'�n, ivi:t�.� 02738 d2 ' ZO d2 _ — -... . .._ .._..._._ ....._. ... . ..._ This iy t at the materials dr,crihed have heen flame-retardant treated or are inherentm able and wereNAME: _ TCITYCertificareb made that: ) The articles.described on this Certificatr heen treated with a flame-retardant approved chemical and that thtE application of sairj r,t,r n,ic:Al was done in conformance with California Fire Marshall Code, a ual to or exc`•�..rig: Nir.^A. 7n't • CPAI 84 N}=pA-7U(. Gp/+[ee Method of application: .C.00� rcU Type, color and weight of ca vas/vinyl: Description of Item certified: Flame Retar ant Process f_;sed Will Not Be Removed By Washing A d Is Effectivfr F-or The Life Of The Fabric Name of Applicator Flame _._... i I l I i Aug 26 02 12: 14p Sperry Tents and Sails 15081 748-3997 p. 4 �u�r�.arai_�i.m�!ynas;eta lti..� - - '. .... • -.�._-o,R?�--�-... zi AMW ate ry fz _ . REGISTERED I- S `y ::•.:;:.-?'r -':.:;', APPLICATION.; < R R ��AlT ,S { Datelof Manufacture• " NUMBER - 1 1 Ma�coni Ln Box 215 Y �. 0273 Marion Mass g . 14F.:� , - ::`:: ;.. ^,;fir)..,_•.,., '..`_ ;; h-:-.'•This is-to certify that he materials described have been flame-retardant treated or:.are;':: inherently noninfiamma �.. Y. le) and were .supplied 'to: • -- _ NAME: 'CITY- 'TnfkRC�ti]' -- - STATE Mom- 021 3 R `':'Certification is hereby mace that: •- The articles.described on this Certif gate ha a bee' treated with a flame-retardant approved ::chemical and that the application of said Chibmical as done in.confQ.rmance wit, California -Fire Marshall Code, equal.to or-exceeds NF 701 CPAI 84 �o Method of application: GofkTE�D — =: Type, color and weight of canvas vinyl: -7 Zoo St Descrlptfon of Item certified: 1JGT 1 FF: � ame Retardant Processse(d ill Not Be Removed B Washin And Is Eff For The Life Of Th 9 ctive F I e Fabric Pame of Applicator of Flame Resistant Fi ish Signed: , I I I i I l The Commonwealth of Massachusetts -Department of Industrial Accidents Office ofloyestigat/ons 600 Washington Street Boston,Mass. 02111 Workers' Com,J ensation Insurance Affidavit ame• 5 C41/P,�2,L7� ;//9Gi��2G� cation: '/I ' � (,O� �% /.�' .�-f�� --2 7 W ' ' hone# -5Vr ] I am a homeowner performing all work myself. ] lam a sole rietor and have no one woildn m' ca aci ] I am an employer providing workers' compensation for my employees working on this job. i.t•,• ::•:{•Y:Y:ii:...:{.:i?:i::: >:}:4:{{J:!•:>.-i:�: i�;i}{:;y'{v:^':!v:4??:•i?:iii?:>.:;{is i�>:?{{4:??J:i?{v:v:-?:•:?:i:j ....... ?.... r..:::::.... •::1:•:i•?i::•F�:?•?:':::?:•??:4:•:>:�i:rii:?v.:.:�'..:?:•:'rv-•:•:?? :•:?:•:>:i?:::'•;{Ji`?'-•?? ?•??>:•>i•:'{:.•??:•?::::{.?•::.i.........i-: ... ........................................:::::::::?::::::: : ::C<:::::::s:::::::.::�::::::::::::::.�:.t.:::::...:>i::.�:•:.:::>r:.:t::.??:::::.t:..•::::::::::.�:..:..::::..�::::.:: :::.:....::::: _ �mpsnY n -- .�:::::•:..:::..:.�. ............ .::::•:::•:.�:............... ..:...............................:...... .,•r::::::.,;::...:i::•;:;•i:ri:�:•.:;•i;:•i>i:i:-iii:>:>";�::>::::":::::..... ••:::::::::-r.•:i i ii:::;::Y:::::`•ii::::{:;;:..?>:•:;:.�::.;:.i:•:!-:::a::%<:�iii<i?::::?;�:; •;:::;:;::;;::�::>>:?:iiiii:'•: �{.::;ii:;:;::;:i;???•>.....:•i:{;•:;?•:{;:�{`•iy:�iii-i::::::�t:i>::r:.;;�;.,i::?;:••,,i;•.:-.;....,.........�•:::.? »oh n SsTarf . ] I am a sole proprietor; general contractor, r homeowner ' cle one)and have hired the contractors listed below who the following workers' compensationJolices: :........:...... .......::::.,..s:-;:.i:.i;::.i>:.:;.::{.:{.:�:{.:;.;;:.iii:;.ii:i.is;:ii<.>:�:.:?{.i';.?:;.:;.i:;;.isi.:.?:;;.i:.i?i:?.i:.ii:;.ii:.i;ii:.i:-:�i:.;i:;.i:.i::.ii:i:<;.:�i:-i:.i:?.;>:;->:{:::.:?. on6say narie<<' v " :.?:�:;-;iii:.::.i::.�.:.::::::::.:::!::.:: :::::::::::.:� .... : ::::....; :.:::::... -- :�:+#:r :'i��,•''�i:$:� i::l::y<:;:::'{;:}:;`;:::�' ':�:$:v? $:�:�:� ::i:'rr. %'::ii`::isr't+.�i:�S:�:#;a:�>:�i:::<%::�:%�i::�':.�:=:;::j_:::;:>:{•::$:�i::'t:;>5::�Si5�'':'�: :�::iii::i'<�i<:;?�v::??::>::�i:.ii>':•:•:: : ..............:•:.,:??.......n.........r.:t :,.........r... ..,.r...t .......;.....p........r.......... ..:..:.;tr.........,.:.:•:-:::..........n,:?:-i:•>•..:Jii::•y .. ,.............. ..t........... ...r. ....r..:........:n. ... ... ...........v..:rv:n:v:.vi>}niii::::v:•::.:i:{r-.•..v:::J?;v?v-.x::�::::•.: .:n?i•v::: t .:.:•?:•"r 4:{•>i .. ,-n4::::n•rwL>^:••::a{{{•?:4 •::.v:::v.v:w:n••:r.v, v. .r. ??r!4i'y;:.??:v{::;.{: ..: :... 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B'�..::.i:•::?•?i:.;.:;:.:;•:;i•?i:.::•::{•:??:•:;• ;•::-i>x;:�;<?<.;:;>.•ii;•:;•i:•ii:`{?•:�:•:i-:•i:?:i:::ii`::;i;:;::�;.;�.: tP. Z:::5>>::;i:;.: <>:-iis-i:;<:;-ii:..................................�:C' 4>iii:?•::{•:�>ii::v:??v::::..............nn.:..:.v:r::nvv.i:ii?:•??ii'.;"v::.......r::.v:::--:v::.::'{-:?i??;{r:3:tv>ii:':•�?.;i:?::ji�?i??'.v:::.......:.v:::::.v::::::?,•r.,.. ................r.. ...............nt::....::::::::.........n.:::^?:•f{v:::tvn??•:.v..:........•. ..':v:w::::Y:.v.{•iti>?{:4:v,};::::,w.r•+.""-... ,:....r.................::::. J.............-......J................:.......-..r.....n.....n....•v:•.:nx.r.v.v:n:.:.n:........r:::::, r•... :w:::::.vf. r....... ......-..... ..............v:......:•x•....A.......r...r..... r........:.•:v.,................-.............t..............r.v:^::::n{'"...... .....r.:..........•.::::n?•:::::••- .. ...t ......... f�;�r..?:•>:?, r. .....r. ..........n..... -...rv:::••n:••v:•.v::::::::nv,y-..r;-:••:::...:.. :..... .................r...v-.vv:n,•:>:•?::{r:::•w:w:::::::::::::.vtt..r:.v:wnv::::.. ..........;.:.....::•:............:irv;O::S:•:r.v:::::tv:.v:::•.v.•;{....r........v.v t•.v:r-nvv•.r.....,..-_r..xr..................r.. .... ..t..............:..t• ........tn:. ............. ..t................{.................t....r... .. ................r-r.........r.•>.L'r:•ii:•i:•>?ii:?i:::.v:::::::.+..n nn��ppwce Q� Y 1'on �j dime to secure coverage as requited imder•Section 2SA of MGL 152 can lead to the itnpoattlon of criminal penaldes of a fine up to 51,500.00 and/or m years'imprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day agairet me..I understand that a ►py of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification do hereby certify under the pains penalties of perjury that the information provided above is ow mid correct ��ature Dte, 'tint name Gil az Phone# 5 D,? 2-- 2et 3 - .official use only do not write in this area to be completed by city or town official city or town: peradt/liceroe# OButlding Depar mend ❑Licensing Board ❑checkif immediate response is regtured ❑Selectmen's Office _ (:]Health Department contact person: phone#; ❑Other INS I (mvAW 9195 PJA) Information and Instructions ssachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for-their )lovees. As quoted from the "law; an employee is defined as every person in the service of another under any coraract Lire, express or implied, oral or written. employer is defined as an individual, partnership, association,.corporation or other legal entity, or any two or more of foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or ,tee of an individual,partnership, association or other legal entity, employing.employees. However the owner of a ;lling house having not more than three apartments.and who resides therein; or the occupant of the dwelling house.of ;ther who employs persons to do maintenance, construction or repair work on such dwelling house or on the.grounds or lding appurtenant thereto shall not because of such employment be deemed to bean employer. iL chapter 152 section 25 also states that every state or local licensing agency shall withhold the:issuance or renewal i license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has :produced acceptable evidence of compliance with the insurance coverage required. Additionally,.neither the nmonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until ;eptable.evidence of compliance with the insi rance requirements of this chapter have been presented to the contracting hority. iplicants ;ase fill in the workers'. compensation'affidavit completely,by checking the box that applies.to your situation and ?plying.compa.y.names, address and phone numbers along-with a.certificate of ins rmce'as all affidavits may be matted to the Department-of Industrial Accidents for confirmation of insurance coverage: Also be sure to sign and. to the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is ng requested, not the Department of Industrial Accidents. Should you have any questions.regarding the"law"or if you required.to obtain a workers'.coinpensatioa policy,.please call the Department at the number listed below. ty or.Towns :ase be-sure that the affidavit is*complete and printed legibly. The Department.has provided a space at the bottom of the j idavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please sure to.fill in the perniit/liceose number which will be used as a reference number. The affidavits.may be returned io Department by mail or FAX Vnldss-other arr: emeats have'be=.made:` Le Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. 2se do not hesitate to give us a call. %%%%%%%/O%/%////%%/%//////%%%/%%��%%��%%%///�/%%� %%%%///////////// ie Department's address,telephone a4d fax number: . The Commonwealth Of Massachusetts Department of Industrial Accidents Me of I nvestlgatlons 600 Washington Street Boston,Ma. 02111_ fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409..or.. 375' Town of Barnstable Assessors Division Page 1 of 3 :;� ..m...• q � t. s G Your Location : Home : Town Departments : Administrative Services : Assessors Division : More About ' «Back-Forward>> T Friday, Januar, Search Website Assessors Division- More'About Town Departments •AII Departments Data is based on Fiscal Year 2002 Assessor's database and is provided for infc *Town Council purposes only. *Town Manager *Administrative Services 59 LOCUST AVENUE V :Regulatory Services Map/ Parcel/Parcel Extension: Mailing Address: •Community Services 197/028/ HAGBERG, CLIFFORD &JANICE L •Public Works Owner of Record: •Police Department I HAGBERG, CLIFFORD &JANICE L 59 LOCUST AVE . Property Location: W BARNSTABLE, MA 02668 11 Town Information � 59 LOCUST AVENUE Parcel ID: 197028 •AII Information •Agendas. *Annual Report •Employment FAA's Fiscal Year 2002 Assessed Values •Forms and Applications Appraised Value Assessed Value *Hearing Schedules Building Value: $98,900 $98,900 •News/Press Links , *Operating Budget Extra Features: $8,700 $8,700 •Ordinances Outbuildings: $9,000 $9,000 •Property Assessments *Regulations Land Valuer $ 100,000 $ 100,000 *Town Charter Totals: $216,600 $ 216,600 Town Calendar •Town Maps 0 Town Newsletter M. Receive Town Updates By E-mail.' Sales History Click Here To Join Owner: Sale Date: Book/Page: Sale Contact Town Hall HOWLAND, KENNETH B &SHARRON K 11/15/1984 4305/ 103 $7101 Town Hall PECK, COTTER 9/15/1982 3549/ 160 $0 367•Main Street HOWLAND, KENNETH B &SHARRON K 12/11/1998 11908/039 $ 1 Hyannis, MA 02601 HAGBERG, CLIFFORD &JANICE L 1/7/2000 12771/085 $281 r Phone 508-862-4000 E-mail Contact Town Hall ' Land and Building Description Land Building Lot Size (Acres): Year Built: ' 2 1955 . L. http://www.town.bamstable.ma.us/comeonin/Departments/Administrative Services/Financel:.. 1/4/2002 *•"J i Town of Barnstable Assessors Division Page 2 of 3 Zone: Living Area: RF 1684 Appraised Value: Replacement Cost: $ 100,000 $ 125,181 Assessed Value: Depreciation: $ 100,000 21 Building Value: $ 98,900 Construction Details Style: Interior Walls: Ranch Drywall Model: Residential Interior Floors: Grade: Hardwood Average Grade Stories: Heat Fuel: 1 Story Oil Exterior Walls Heat Type: Wood Shingle Hot Air Roof Structure: AC Type: Gable/Hip. None Roof Cover: Bedrooms: Asph/F GIs/Cmp 3 Bedrooms Bathrooms: 2 Bathrooms Total Rooms: 7 Rooms Outbuildings & Extra Features Code Description Units/SQ FT Appraised Value Assessed Va FPL1 Fireplace 1 $2,400 $2,400 SPL2 Pool Vinyl 512 $9,000 $ 9,000. BGAR Bsmt Garage 2 $6,300 $6,300 Building Sketch http://www.town.bamstable.ma.us/comeonin/Departments/Administrative_Services/Financel... 1/4/2002 'Town of Barnstable Assessors Division Page 3 of 3 3 Back Home Departments Town Information Contact Town Hall Website Developed and Maintained internally by the Town of Barnstable Information Systems Department Town Hall-367 Main Street- Hyannis,MA-02601 -508-862-4000 DISCLAIMER: Although we strive to provide accurate information,we are only human. Please consult directly with the appropriate department if there is a question of accuracy. Copyright 20010 Town of Barnstable. All Rights Reserved. http://www.town.bamstable.ma.us/comeonin/Departments/Administrative_Services/Finance].:. 1/4/2002