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HomeMy WebLinkAbout0141 LOMBARD AVENUE 1 e UPC 12543 No. HASTINGS. YIN :_._...- �..z•;!f�r.�t"°F�,.'^,.�..:^e+.�:-..�... .x .�;..- .rr�_� i _ „�.. ,.��....--d.:7�W4�r,,..� '"_"�l°!a�Kf";_ _ -�:^�'� -°,�.�^r�'�./e -r��e»'„ �.�fr.+ifF��... -.......+x. _ -_ Town -of Barnstable # Expires 6 fiom issue ' Regulatory Services Fee ZI i BARNSIMM 9cb 1659. �e� Thomas F.Geiler,Director Building Division 9' Tom Perry, CEO, Building Commissioner 200 Main Street,Hyannis,MA 02601 (� www.towmbarnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERART APPLICATION - .RESIDENTTAL ONLY Not VaUd without Red X-Press Imprint Map/parcel Number A S S'OQ .(Q Pro Address � p*-d1 6 • `� `-' per. _i � L b,Prr'� (?'Residential Value of Work S-CAD© Minimum fee of$35A0 for work under$6000.00 .Owner's-Name&Address 7Qvn.-ei( �- E'�RC. i-.H. i°V1 atl-e Contractor's Name 2ca.A-vl (OvAVL/(1_rr4 Telephone Number Home Impiovement Contractor License#(if applicable) ►y-7 3 y 3 . Construction Supervisor's License#(if applicable) Y-PRESS PERMIT VWorkman's Compensation Insurance Check one:. S EP 2 5 2012 ❑ I am a sole proprietor ❑ I am the Homeowner I have worker's'Compensation Insurance ®�(v ®F BARN STABLE J Insurance Company Name 6V/-W Workman's Comp.Policy# 5 C U CS , 3 CV Copy of Insurance Compliance Certificate must accompany each permit. ' Permit Request(check box) [rRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 'G �� VA ❑Re-roof(hurricane nailed)(not stripping. Going over existiag-layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum 35)#of windows ❑ Smoke/Carbon-Monoxide detectors 4 floor plans marked with red S and inspections required. . Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&'Construction Supervisors License is i required. SIGNATURE: n-kwpFTf FC\F(1R11 iC\h„ i; ,P r fi. lz voncec a Gl . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 y s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name(Business/Organization/Individual): �LW,.�y� ('()� /leC�h D ✓� Address: (p i' ,>Ft(,c Zo ✓,a—U City/State/Zip: SF�.>,,. C% +n, iM� Phone.#: M k 300 Are you an employer? Check the appropriate box: Type of project(required):. 1.Rr I am a with employer — - 4. ❑ I am a general contractor and I 6. ❑New construction . employees (full and/or part-tim.e).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the-attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• � . 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work' officers have exercised their l 1.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' .13.[bther (1e&0 f 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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 6L)A-✓e Policy#or Self-ins. Lic.#: Scttj C 3 s' 3u I Expiration Date: 3Ld Ce 1 13 Job Site Address: I y I Lo►v% 6^✓J F}y-e City/State/Zip: 3prir/13 J^(o w1A Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of.a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un the pains-and penalties of perjury that the information provided above is true and correct. Signafore: Date: Z %Z Phone#: 1�`{_X3 _J fS 3 (-0 Official 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 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the ,dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-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 i self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in__(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call.. The Department's address,telephone-and fax number: The Commonweal of Massaehusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-000 ext 406 or. 1-977-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia Full Building Service All types of Siding Asphalt and Rubber Roofs !' Trim Replacement Cedar Roofs Window Replacement y Customer Phone Date m4� ���� �I 7 67�a Address V e City/Town W �rnS � t� Tarp off building and take precautions to protect landscaping. f( Strip entire roof and examine.deck.for rotted sheathing. Plywood replacement cost sheet. Lineal decking replacement cost foot. WL Install CERTAINTEED WINTERGUARD ice and water shield on eaves, valleys,penetrations, and chimney. 0 Install aluminum drip edge. Color: W Cover remainder of roof with CERTAINTEED ROOFER'S SELECT 151b. asphalt felt paper ® Professionally install shingles ac ording to manufacturer's instruct'ons. Shingle type: �e� a Color: CO )0 ra S C C1�. Ventilation: Install exhaust: Type: R,4 e vc„+ S e ven f g r V en - tnsta4l intake. Type: ���s A( ' �J Install vent pipe flashing L�J Chimney - Lift up existing lead flashing, wrap chimney with ice and water shield, insert step flashing ►� do: S Skylights—wrap skylight with CERTAINTEED WINTERGUARD ice and water shield, and reuse existing flashing. Od Clean out gutters. 19 Magnetically sweep job site of nails Clean and remove all job related debris from work area daily. Dispose of debris. (� Provide CertainTeed SureStart Plus extended warranty. L 10 year labor warranty on workmanship �] Additional work beyond this scope is assessed at Per hour, +materials, + 10% Special Instructions o f t� -i'O q /6 b"G i . Cost. Good 4q.1 w, r K — i� ►3 3?c 0 A Better C, 4AC, (� ��0 — iI5 1 y Best A Please select shi le choice C4^ Cf E''l G r `- /'0 Amount $ 71-f G , 0 0 s Down payment $ Payments:are as follows:No money is requested until the project is completed. Special order shingles from our supplier require a 1/3 deposit down with the balance payable upon completion.Please/make checks payable to: Scott Ryan Acceptance ofproposal Customer signature. 'o' 2— v Date of acceptance Se p r�, ;� I , a O 10 DALE TERRACE • SANDWICH, MA. 02563 • TEL/FAX 508-888-8300 FULLY INSURED • MA. BUILDER'S LICENSE #81294 £S08L :#�l ,taunissnutu £LOZI£IL :uol3endx3 ,i £96Z0 HW:'HOIMaN`dS H313�ba 0 6 NVAN 1100S I76ZL8 SO 'asuaoll asua01l JoslnJadnS uol;OnjlsuoO I spjr.pualS pur. sumIrl'aaa fouippn8 jo parog .%,aalrS z)!14nd SU luawiar.d (l -sx3asny�rssr.41 ' i License or registration valid for individul use only 'before the expiration date. ff found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 7 Not valid without signature dW'HOIM(INVS IenPlAIpul £lOZ%6Z(g._.:uol;endx3 :adb1 £b£LbL :uol;ejtsl68a MO-LDVM1N0OIN3W3A0MdW13WOH —_ atoye n2a sam n� slur � uoa 3au3O �1`1 f ,acorroV CERTIFICATE OF LIABILITY INSURANCE Dr,TE(�un1D614/ CER /4/12 TTOS CERWICATE IS ISSUED AS A NIATTER OF INFOfMAT10N ONLY AND COFFERS NO FRRGHTS UPON THE CERTTFiCATE HOLDER T7as C3=RTtFI1;ATE. DOES NOT AFFTFflIAATiVELY OR NEGATR A3Ly AMEND. DCTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW_ KS aginRCAT'E OE INSURANCE DOES NOT CONSTITUTE A CONTRACT BEMEFN TtiE ISSUING Q�ISURER(S1• AUTHORDFTS REPRES!`M1[TATIVE OR-PRODUCE R,AND THE CEWMCATE BOLDER. IMPORTANT- If t cerfficatye bolder is an ADDITIONAL INSURED,the port t mu st ust be endorsed- If SUBROGATION iS WAIVED,subject tO the terms and conditions of the pormy,certain policies nW require an endorsement A statamerd on this cerdfimte does notconier rights to the certificate holder in lieu of such endorsernent(s). PROCUCER GCr(T0.GT Robert F_ Bouch e_ Jr_ Insurance °tom . (5081 564-5560 t Nor t50e) 564-SS31 1352 Route 28A ;+•fo@Bcuchielnsurance.com PO Box 400 _msU ,sjAFFaRD*4CaVEaat ----- --- ►utcs Cataumet, V%. 02534 INSURERA:State Auto (Patrons LYr�Lual� JhSURED INSURER8;G1332a---- ------------- Scott Ryan Construction Ixmae+c-Pit�rim —.--.-_-• 10 Dala Terrace in6li[2EAo ---.- ---------•— -.- .__ Sandwich, t-2L 02563 II6URJ3l E. - .. -----.---------•-- -- -- -- -- INSURER F: COVERAGES CERTIFICATE NUMBER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW KAVE BEEN ISSUED TO THE WSMlI'M NAMED ABOVc-FOR THE POLICY PERIOD INDICATED. K'OTWJTKSTANDNG ANY REOUIREMBff.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESP-cCT TO WHICH TM CERTFICATE MAY BE ISSUED OR MAY PERTAIN. THE WSURAVCE AFFORDED BY THE POLICIES DESMBEED KERESK'S SUB.IECT TO ALL THE TERMS- EXCLUSIONS AND CONOTIONS OFSUCii POU=.LUITS SY.OVMT VAY HAVE BEEN REDUCED BY PAD CLAIM -_---••- INS'FS; ----—'-•eaSU —`-- :AD6l-e'SUBR—- ---.—. POLICY EFF , POLJCY EXP Zl� LTR TYPE OF WSURAq� i JNSR_YJVD_ POUCY tarMER ; mam , p GBaESAt uaJ3am f C'PR000.6509 5/23/12I 5/23/13 �yoeCu»EWCE _ is 1,000,,000 _ � ;DASKq(,ETORFI+TF_D s 50 000 `X=CO�r>10I 0.C1Jv GErIEs�LlJA8t11TY € 1 �P_�LItSEs.�a ats�-?-•---------f '--' CLA%6UA i OCCUR S i ! ;NEO E7P(AM pasaiS s 5,000 r1£ PERSOW.LaIADYINJURY--_8_1.000,,000 �(,�NdtALAGOtEGATE :s 2,000,000 i I i -' ---- ------ - - - -- E i I PRODUCTS-CDr�;oPAGG i t S 2 000 000 :GEN'LAGGREGaTEIrAT APPLIES PER 1 i_ _ .�---c--_. .-_-.. r�6 ! X:POLICY 2 . PRn- ` :LOC S i - -Con. SAIGLELDALT ' C "s A0T0.1ADI3aELwBllm l ;PGCIQOD9544951 i �/5/Il 11/5/i2F(Eaxcdaenl —_---_-•_^' — -.-._ i SWLY1wURYCPetpe-ON I s-- 100.000 ANrAuso _ os�D SCNEDULED X Aus € i _60MY INJURY IPn a[adabA);s _- 300,000 i PROPERLY DFOAGE ;s- -100,000 i H*tEVAUTOS _AUTOS t E ' U98RELLALUIB OCCUR - - { =EJtGItOCCURRENCE :S EXCESSLtAt3 AGGI�GATE ..._._.. is-. CLAWS-M1N DE€ _ •DSD REr&MC.V S $ i MRKERSCOIIPENSAnON i =SC4T353612 ` 3/26/121 3126/13 XBY A7i61IS_..._`ER_�,_.--•-------- •AND E3dPLOYERSLFABIl1iY Y/6} - E1,�aCHACQCENF ._ •_-100,000 `MYPRQPRIIEMP1PARTRE!LE)ECUTmE OTFICPIZMEAMER DICLUX77 lTJ: F E1 DlsEas_EA EtnPtOY 5.--100_0_00_ or-nda-y in Ntf) -„- Jtps dtseDetuber €S=.L =EASE-POULYLWIT F 5 500,ODO ilf:spilPilON OF OPERATIDNS beigm i DE50a"o"CFOPERA'nONS I LOORTMNS t VEMCLES(Attach ACORD tOt_Aa<lificn s Ra dm Sch"we•ir=m space a,eq inea) The vokker's Compensation policy does provide covPTage £or Scott Ryaa_ } CERTIFICATE HOLDER CAN CELLATIO N SHOULD ANY OF THE ABOVE DE SCRIBED POLICES BE CANCELLED BEFORE Town of Sandwich THE EXPIRATION DATE THEREOF, NOME WILL BE DELIVERED IN 16 Jan Sebastian Drive ACCOROANCewrTH THE POLICY PROVISIONS. Sand�rich,- MA 02563 AUMORIZIM REPRESMTATNE Robert E_ Bouchie Jr. 0 1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2011 WW The ACORD name and logo are registered marks of ACORD. Plane; Fax (508) 888-8300 E-Kail: r Engineering Dept.(3rd floor) Map J�Parcel Permit# House# Date Issuedy, a T77 Board of Health(3rd floor)(8:15-9:30/1:00-4:30)9r-/7a!(t309 9 Fees~q O d Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Planning Dept.(1st floor/School Admin.Bldg.) SEF YEC ;,,��a �� Definitive Plan Approved by Planning Board 19 INSTALL LIANCE NVIRON DE AND- TOWN OF BARNSTABLi TOWN R ATOONS Building Permit Application IS Project Street Address Village _1N . '(''n&tn L4 _ Owner- [)bey+ t H(l,1'l,l loll ftC 1--►4D,IPA h Address 141 (amhard Aff _ Telephone �(�g —,�1 —CQP,12 Permit Request 010nlmyu t (Q csy ffen ah I 3 ►mil Mf-*—, IY� , e ag1 — 1 lb-LA OF I:Yj nhner 6ec k�. &; halk Ynt�f- �'lil� �� � �lh�' Ce Y 6l),k 611 f x- � __:KLC- �r� IN I'' >>hi-- -Al m. Sr r� �--- —I First Floor Z 7l square feet Second Floor square feet Construction Type klaAk Estimated Project Cost $ 10,Dt)0 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway aYYes ❑No Basement Type: (ar/Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half. Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None - ❑Shed(size) l ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# - Current Use Proposed Use uilder Information Name tYIU & 5 elephone Number A -411"33&P rI Address �" '" I icense# U 4 (0 a 3 Mas► Kl. 1 I Home Improvement Contractor# (O Worker's Compensation#(I)r— 0001031 —(')D NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT.. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 6 SIGNATURE DATE BUILDING PERMIT DENIED FOR T4 FOLLOWING REASON(S) FOR OFFICIAL USE ONLY — PERMIT NO. DATE ISSUED` MAP/PARCEL NO. DRESS - _VILLAGE NER DATE OF INSPECTION:. "• - . :_ - _ y I + E FOUNDATION ' �• G�30>q7 i y '; y _; _ t { A4 FRAME INSULATION I - } ` { `` i I , • - i FIREPLACE ELECTRICAL: ROUGH s FINAL PLUMBING: ROUGHo . • ^h ' ^'FINAL- GAS:a 1 ROUGH-. I i FINAL FINAL.BUILDING. ..¢.} "' S ► ! _ ac ^1 DATE CLOSED OUT•. y° _ f 1 _+ t { y ' I �. �� _ _{ 1 t ASSOCIATION PLAN NO. _ LN i i o la7 /</o, yt3, 87/ ' o o B9' y � I OrVE /i✓C// = FGTY FEE T m i = H�/lEBY G�.eT/FY T,VAT Thy& ON LOT m XW Z6wl.,v6 e vZ i W,5 OF 7//E 7-20W V v&AS6,l) 01V AW 1CTt/41- /NST,el�ME/VT SlJi�'YEY. /voTE: Lp T NO. 3 /.s /VDT Z-0610B4 //V-9 AZZVb /H-9z9,ed ZONE. SAS-BuicT „ { � ',ZH OF JOHN CyG P.... N/CkZ144J BU/LD/NG Cp, DOYLE,11( ti No.33589 GDMBA�d A✓E, Iy�FGISTER��OQ� A LE /�G5►, SUR`1Ck B I JOHN � DDY�E� PGS 1997 r ' 9� • �.�' Application to Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application Is hereby made, Ili 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 CATEGORIIt THAT APPLY: 1. Exterior Building Construction: ❑ New Building Pt Addition C3 .Alteration Indicate type of bullding: 0 House [] Garage (] Commercial ❑ Other 2, Exterior Painting: 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure., Q Fence D wall ❑ Flagpole Q Other (Please read other side for explanation and requirements). . p TYPE OR PRINT LEGIBLY / Al / L O M 3.4 Q p A d F DATE � ORVS ADDRESS OF PROPOSED WORK ' $ A.;R/ S rA A. 4 ASSESSORS MAP NO. OWNER EnSERT AND MA AY L1^IJ M A�r�A D YF N ASSESSOR'�S LOT NO.UO .lJO HOME ADDRESS T TEL. NO.;���1 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 7LIM12 r& Y i5',kA Y TEL. NOISM� 77 -33ggj ADDR ESS I 1 JU Air DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (sae No. 8,other side). intauding materials to be used, if specifications do not accompany plans. In the case of signs, glve locations of existing signs and proposed locations of new signs. (Attach additional shoot, if necessary). , QoNsT?t v�- r A sc kn'F !i -P-P rcck EXRc T o L r T 1 vs�I�, YJ�t . r � cFISAn SN. lN.6L S /tc.1 To 1-fA7c�� / X N W14171- ALV0IVu , SCkt- EN.S. o L rj, S�g �d •Contractor.Asntoe See below tine for Colnnlittee ue. a _jceived=by` The Cartift t is hereby o � Iwa 9� � � � � _ Ti 51 me� � - �lwo� ev Approved ❑ IMPORTANT: If Certiflcote-la approved, approval Is subject to the 10 day appeal period provided In the Act, ►•1 �T �L.r 6#'�b �1� � 14"1 W1 u-b «b Ir,oj >i d.[� y�1 T t l��.15TA,?,U� oZ(.,LA Town of Barnstable Old King's Hlgbway Hlstorlc District Committee i l�OtJNDATYON �� f/ G M 0P7- T �� Q el S BIDING TypR_U(/N 1,rc CC DA Ft 1•ly /A/a L�COLOcn!'X�0R Y TYPS COLOR Roo]? MATRRTAL /Q P .� Z- T COLORv,�'1A►7"G I�•rC+ _&k arY PITCH �d � TRXX COLOR DoOR9 A L U M/N vII S R F F 1V J�00k COLOR_ ti r 8 RS COLOR aoTTSRs� 1�V�1� TO i+�l/�T c� � X i 5 r i IV6— D S G�f � N hOk Ltl O DOORS COLOR l�a . R i A� e i.; 1 i +' COLORS COLOR � a hg, this Fill out ae�Pletely, laoludLag seasuraeiaaee and ptsriale/withsthesaboopies eao�rof eMe'plattPlan' tam see tequiawd tat submittal a[ so apgliaatioh# 0l0a1 D plans, when apPllaablo. site plan should show All octucturwe an the let landscape Plan and wievaeleo to seals. 892CUT existin house MACON TUBES N double 2x8 box O 23' 8 "1 2 4x6 �osf BOOR PLAN SCREEN PORCH rsM&6AmF*tn 141 lambw Ave wed&mhbkl Ra screen PcA Mt 3/29/97 "by Tun Gray r ;sue 4MM wai I� ISIIN6 YILLEY f — - "TA—Lo 4x4 pot 4x4 s� 1 Q(I MINI IONS b�lON tONNEI I RJR f��NAtION. • a�• txlffillg/oof line P�a0"�,��ItArg ntw whiff for fO m Ire dl while it b nail,! 4�1x6 roof boards " 4 11 .1 ,-. -ant* am&WOO new M full h@Ar 4t8 house 14 eNYy�d hl li'do &M WOO 12' 1 112 Department of Indus&W Accidents 600 Washington Street Boston,Mass 02111 Workers, Compensation Insurance Affidavit name: l ► YY�t�` '1 U ( �(i4�.1 location: 141 11 Uym ` If.W A Aw _ city V V • C YJf nf7?Vk0a �—L pr phone# I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity am an employer providing workers' compensation for my employees working on this job. companymnin . :.. ad ress. situ: '> � hone ..........:.. ..................::::.:..:.:. . 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city: insurance co. :':::,:. >:.::..;:.;::.... : ;<: ;:•::>:<:::>:>:::::z>;>::: :.. till .. . .::.::..:. ...... ..RAY company name: address: : _.,. ::.. :.:. ,:.::•...:;:-..:::;.«::::,;::::>:':::;;;:..:::;:,;.::;;;:•;>.::.....:;:..::.::•:.:: city: ' -nhone#: insurance co. :::...;;noGcy.#: ;..;:;•:::.:;.: :.:.:., M—McL zaaioQaTs1et3f.=IIecasa Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. /do hereby Berri der the pal and penalties o -information provided above is true and correct f ' Signature c/� Date Print name 1 % e] Phone#6bn` to official use only do not write in this area to be completed by city or town official i' (: city or town: permit/license# r1Building Department L; C3Licensing Board ^i l7 check if immediate response is required C3Selcctmen's Orrice i� Health Department contact person: phone#; M01her rCvneG 3Mk PJAi `• f �` ��5 #.Lja. t ri c. ov IM DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE j Number Expires: Resta'etedlTo:, . 1G Z. � TIMOTHY GRAY 15�POBISSET SP 'NASHPEE, MA 02649 THE r, The Town of Barnstable • ar►sivs AJUZ • MAM 9 � Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date ,/"— AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: S GG'ee'L, Est.Cost Ild �Od Address of Work: Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent the owner: Date Contract4f Name Registration No. OR Date Owner's Name TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 155 065 0,01 GEOBASE ID i ADDRESS 141,=LOMBARD AVENUE PHONE (508)362-62951 WEST BARNSTABLE, MA ZIP. 02668- I LOT ' ; LOA BLACK LOT SIZE IDBA DEVELOPMENT DISTRICT IPERMIT 12741 DESCRIPTION SINGLE FAMILY DWELLING (PMT.010311) ' PERMIT TYPE �BC00 TITLE CERTIFICATE OF OCCUPANCY. r i ( CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: BOND .00 THE CONSTRUCTION`COSTS . ~ $.00 756 CERTIFICATE OF OCCUPANCY MASS. OWNER NICKULAS BUILDING COMPANY, UNIT F i639. A�O� ADDRESS 1064 MAIN STREET EDNAR� I WEST BARNSTABLE, MA BUILD 1 G ' S - N' BY � DATE ISSUED 06/25/1997 EXPIRATION DATE TOWN OF BARNSTABLE TEMPOR.ARX CERTIFICATE OF OCCUPANCY ° ! PARCEI; -ID' "' GEOBASE ID ADDRESS _ 11r1 LOMBARD AVENUE pf PHONE (508Y362-6295 WEST BARNSTABLE, MA ' ` , ' ZIP -02668- LOT f LOT` 1 BLOCK TOOT SIZE � DBA DEVELOPMENT DISTRICT / k t IPEERRMMIT TYPE BTC00 DESCRIPTION TEMP. OCCUPANCY PERIMIT a CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services . TOTAL FEES: CIE BOND $_00 CONSTRUCTION COSTS .$.00 756 CERTIFICATE OF OCCUPANCY : HARN31'ABLE, 11 �.MA & OWNER NICKULAS BUILDING COMPANY, UNIT F 1639. ED MA'S ADDRESS 1064 MAIN STREET BUILD�(G DIVISIO WEST BARNSTABLE, MA - BY 1 C✓�iC� DATE ISSUED 01/16/1996 EXPIRATION DATE TOWN: OF BARNSTABLE -BU7ILDING PPkRMIT. PARCEL ID 000 000 02. & GE04ASE �D n 1 ! , ADDRESS L41 LOMBARD AVEAJUE PHONE (508)362-62: _ -EST BARNSTABLE,' M �IP:I 026687-' LOT _ . . �,OT 1 - 3L•UCK� _ y �� I� i�'LOT SIZE — _ • DBA- ,j DEVELOPMENT ( y + DISTRICT PERMIT 10311 ; DESCRIPTION. SINGLE: FAMILY"DWELLING PEPBIT TYPE' BUILD TITLE NEW RES/COMM BLD(DEPMihent Of Health, Safeti E and Environmental Services .I c;ON'tRACTORS; N I t�Kli LAS BUILDING CO. ' .. ARCHITECTS:. — N TOTAL FEES: + .• #t$214.80' - i ;; � ��IE = •` • BOND Cps?ST3UCTION COSTS $120,000.00 - 101 SIN(.1LE FAM. HOME DETACHED ' 1 P IVATE 11 OWNER NICKULAS BUILDING COMPANY-, UNIT F. ADDP.ESS 1064 MAIN STREET — "WEST BARNSTA.BLE, BUILD N DATE ISSUED 09/13/1995 EXPIRATION DATE BY � I THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALL OR SIDEWA OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMIT-LED UNDER THIV BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR . ALLEY GRADES AC Wci, ec nan+•••••- -- - MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS F ANY APPLICABLE SUBDIVISION RESTRICTIONS. APPROVED ��J '-t TOWN OF BARNSTABLE LANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE BUILDING INSPECTOR EPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR DE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- `D UIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. OCC IED UNTIL FINAL INSPECTION HAS BEEN MADE. a. INAL INSPECTION BEFORE OCCUPANCY. rum-m DIMS i BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS kwl�, t - (z ,es - 2 n! v t�. / �� /I/' 2 ,p,t N fj �,.r bwe 3 f 1 HEATIN SPECTION APPROVALS ENGINEERING DEPARTMENT 2w BOARD O�HTH OTHER: 6 J� ; A WORK SHALL NOT INSPECTIONS INDICATED ON THIS THE INSPECTOR HA CARD CAN BE ARRANGED FOR BY VARIOUS STAGES ' TELEPHONE OR WRITTEN NOTIFICA- TION. TION. 508-790-6227 o - - ..:a - •. n.'-tee:. c--sw•, z1 ... f ., Ono , ocv, Assessor's Office(1st floor) Map 4 Lot �d� 5 Pe t# Conservation Office(4th floor) p �3� �� � —D", Date Issu q 13 -q� Board of Health(3rd floor)(8:30-9:30/1:00-2:00) ""�fi e o� Engineering Dept.(3rd floor) House#JP 0-- f ppmc S ST BE Planning Dept.(1st floor/School Admin. Bldg.) INSTALLED 1ANCE Definitive Plan Approved by Planning Board /G 19 .l NV` © M ®8 AND TOW N BARNSTABL uildi ng Permit Application rn oje t Street Addre s illage // i Owner Address Telephone `/ Permit Request �c�. A C'r:7c /r �� f 2/�"-7 Total 1 Story Area(include 1 story garages&decks) V square feet Total 2 Story Area(total of 1st&2nd stories)�7U = 7Z//111: 7 square feet Z Estimated Project Cost $ /Zti C yn C) / Zoning District z/� Flood Plain Water Protection T Lot Size 45�3 OR —7 eo- Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type ,-.&a Commercial Residential Dwelling Type: Single Family C Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished t/ Old King's Highway Number of Baths 101& No.of Bedrooms y Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name %li Z4= . Telephone Number-.?(O Address es License# (90 2z 6� Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO / C- SIGNATURE DATE BUILDING PERMIT DE ED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY r PERMIT NO. 10311 DATE ISSUED Sept. 13, 1995 MAP[PARCEL N 1 5 5' O 015 60 ADDRESS 141 Lombard Avenue VILLAGE West` Barnstable, MA 02668 i F • 1 OWNER Nickulas Bldg. Co. 0 DATE OF INSPECTION: i FOUNDATION �� 1 FRAME �— ,� U INSULATION FIREPLACES ELECTRICAL: ROUGH FINAL PLUMBING. '.,,'.—ROUGH / FINAL GAS: R�,j,I ' FINAL FINAL BUILDING £� 11d :; _y_yrr pa r DATE CLOSED OUT'` ASSOCIATION P"O.,5 /� & Y. ol Ma4jachu-6edJ ..Uc�oa.tnaal v�.�i�efrial.�ad�a� 600 I -Jdf� -Yhwd dames Icdmobet� 02f f f _Commr'ssianer . Workers't'Compeasation Insurance Affidavit whit a principal place of business ate - (Qt�dSraaull� , do hereby certify under the pains and penalties of periwy, that: () I am an employer providing workers' cotttpens2don coverage for my employees w< this Job.I L11-e X-1,1-f , Insurance Company Policy Htnnber () [ am a sole propriesor and ha working for me in any capadtY. I am a sole proprir, co r ftotneov+rner (arrje one) acid have I21I -contractors Usced below o have the foiiowing workers' easation polices: , FJ lZs instaranae oficy Contractor Contractor Insurance Company/Poficy � Contractor Insurance Company/rarcY ' O I am a homeowner performing A the work myseif. 1 undtm ane thu a C=J o:d:is srtamm:will be for+fzrded to d'.e OM=of invadpcons of dw OIA for cam ge verfflazion and that rea::-ed under Section ZSA of MGL 152.can lean to ctte imaoaitias+Of aftMbW RM1Jd= cat>sadnt of a tlae of up to S 1,! ye=, imvriwrinsm as well as civil oanaldes in the fors:cf a STOP WORK ORDER Ltd a floe of S100.00 a d1Y 292i=me Signed this day of , 19 UcenseelPermittee Building Depatmrt M Licensing Board Selectmen alike .7 .. `—� COMMONWEALTH I DEPARTMENT OF PUBLIC SAFETY ONE ASHBORTON PLACE 3 ! :, O �e OF r c;;�sQ�:ratibeit. `✓ MASSACHUSETTS gOSTON,MA 02108 I. LICENSE +s ce!js6 tOr rer0car+�>� EXPIRATION DATE CONSTR. SUPERVISOR :s!lcmWsO- CAUTION I FOR PROTECTION AGAINST 01 / 18/199 6 EFFECTIVE DATE LIC-NO. THEFT, PUT RIGHT THUMB RESTRICTIONS O b/3 0/19 9 3 002265 PRINT IN APPROPRIATE NONE o C BOX ON LICENSE. PLARRY D NICKULAS = BLASTING OPERATORS ° AOX 395 =. m WEST HYANNI SPORT MA 02 MUST INCLUDE PHOTO. 1 PHOTO IBIASTING OPR ONLY) FF•"�F'�'- I, 1 V�J.00 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER ' j SIGN NAME IN FULL ABOVE SIGNATURE LINE THIS DOCUMENT MUST IE SIGNATU OF LICENSEE CARRIEDON THE PERSON)F �w�.--p9 -I-- THE HOLDER WHEN !r'. I/�'.., � COMMISSIONER OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATF N. i I Application to � 995 1 � Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS. Application is hereby made, id triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings.or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: New Building ❑ Addition ❑ Alteration Indicate type of building: ® House 0 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 1-dT 1-91H941lT k�.1.1LA5 ASSESSORS MAP NO. jzs?c') ol" t=0 b e• GoN ANT pb-KT ?V. �5 OWNER KUI-5�k -1 ASSESSORS LOT NO_. L✓ kv HOME ADDRESS °- $off A& V-16, TEL. NO. Z �29� FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners_across any public street or way. (Attach additional sheet if necessary). 3'o44u & 1 rrTZ J9yJu-A^t) G 5t-W-ASW-2S. 14-1 W ILA t>14 s'f. W _ t3erWL-'� t, Wk-, tom. �D.�'l�h � }-1 a K`(�G'�: l�b Lr�M$111�D A�•L�. W f�T. t�1PlIJs'fd�-y, '1'b.L� 4, pt QKIb, EAMEL .e. 1;;2 lrvH B6Kt> dgtrr . i 'I" k3.& l�Tblst 02�10� AGENT OR CONTRACTOR IL� - IUlG TEL. NO. 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). To Gohl`jT�-1 vT ,�, ►1fi11.� L• SNd%'fib Gbht� �TYt.� �1-'tii; 1�11'f 1-� j�D D Qt U'�1. 91 Si ned J r-cuff ctor-Aqent Space below line for Committee use. V� Rec�ly:i�=by Ft�=V L5 n,� �D ,aYl C,�ct. LL55 ��5y5 l ---7 A 01Date � The Certificate is eby c� '^ y-!? '/ Z `t A-' ate �'fime r By)INN OF RARAIgTAA ri r � OLD KIitiG'S 11iGHWAy Approved ❑ IMPORTANT: If Certificate Is approved,approval Is subject to the 10 day a peal pe od provided In the Act. Disapproved 0 OLD KING'S HIGHWAY HISTORIC DISTRICT, E5PEC SHEET FOUNDATION �l Go►.1 ItA . SIDING TYPE l�-l.G_ SWIULS• COLOR CHIMNEY TYPE COLOR 1°« ROOF MATERIAL /aS? 4d LT -5W l k64L;W,— COLOR PITCH WINDOWS SIZE S TRIM COLOR DOORS yA �RF je6-T I COLOR SHUTTERS GUTTERS a.LUMIa�11.(SPoU-"TS. DECK S . GARAGE .DOORS S• COLOR1'(�1 � . Notes : Fill out completely, including measurements and materials/colors to be used. D ® Three copies of this form are required for submittal Dof an application, along with three copies each of the plot plan, landscape plan and elevation plans, when applicable. "Plot plan, need not be "Certified", but should show all structures on the lot to scale. v �o,o0 s s2° sus•. ., 40� 3o E y ��,�y• 190• `8- v �/ 3•,� tA I 0 47 v la7 67/ s i . o ° 89" d ONE IAICN = Fry FEET m o so /od . y tip• z3.�8- . 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