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Home My WebLink About1040 MAIN ST./RTE 6A(W.BARN.) 75 Oxfo cr NO. 1521/3 ORA MAW 14U" ESSELTE ITYY ----------------------- -�L 1 � ,s ��$ 1 Jx Assessor's map and lot..number ... .. l.� z: ti Ci Se. SEPTIC SYSTEM MUST BE wage Permit number ........... y t14!tC .......... . INSTALLED IN COMPLIANCE -{ -+ WITH ARTICLE II STATE `7"ET 4 TOWN OF BARNS AND TOWN �t BARNSTODLE; S "6 0 m U kL011,G - INSPECTOR a' ti �+' APPLICATIONFOR PERMIT O .......................................C......................................:.......................................... gy t TYPE OF CONSTRUCTION G<-�:�� .................�-� ...................................................... w .........fL... ...�........................197 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......1Q d.... l,. 0.07 .........axa.........J...4.F4? E"� ..... .Z:F ........................... i ProposedUse ..... 4` .... ............ .......J..S..(... . ..�—.r.�........ ........................ Zoning District ......<✓....... ..-.)E.3..................................Fire District V✓f5.7.......... ..................�...................................... Name of Owner ..�P' _.�rE�". .. ...�...'....I.. ..Address ......� ..%).ME ................................................... Name of Builder ..1A)1C.. .f�(Y�..' .r.......M.li1.�r.A�... .Address �4�� .t ......� ....�Q7,dt///S- r Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................................................................Foundation ........I Exterior .........T.1.1h'?e......... i �.1JC'a ..............Roofing �. ............... ....Ash.... `��..................................................... Floors .............................................Interior .................................................. .v. Heating ..................................................................................Plumbing ....................8 ............................................. Fireplace ..................................................................................Approximate Cost .......).C1.C?® Definitive Plan Approved by Planning Board -----------_______-----------19________. Area ....... .................... Diagram of Lot and Building with Dimensions Fee .... : ��....... . . .. ... ................... SUBJECT TO APPROVAL OF BOARD OF HEALTH `X36 so 110 IG hl I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. i 1 Taylor, Allan C. No ...... Perm' for -- « ------ «� . � '---------^-----^-------'--^' Location ....1.U.40..Ua..6..A................................. ~� - � W. Barnstable --.-----------.—.----------- - ^ ` � Owner --Alluu...C°.. ......^--__-- ' | Wood Frame Type of Construction -------------- ~ -----.-----.---------------. ~ - 88 I78~ L 8 - ` Plot ............................ Lot ................................ ' ' | Permit Granted -----.. I —l9 77 Date of Inspection --l9 x ` ^ � Dote Completed ��v. --lQ ' ^ . ` PERMIT REFUSED .--...—~—..--..—....----.. lV ..------...,..,—.--._---~------- ' ~^ .._,...—.^~..—^----.--...—,—~.~—.—. . - - ` -- | . ---.-----.-.----_---.—~---.—.. .—.~..,~—.—.--......—......—.----.. -~ Approva6.-----------.----. 19 - ' ' --------------'^'—^`^`—'^^—^--- - � ^� ` --------'--^^-------^—'^^^^'^^^'' � _ Assessors map and lot'.number ..►...1.. ..� .. ,.,!.,(J ... .... i Q��; �C�vi - //- / - 77 tv � S Sewage Permit number h1P A440b _v r .. ...... . ........�.... ....,.............. TOWN Off' BARNSTABLE c ypf TH E T�� t �O Y Z BASB4T/IDLE, i y n 1- s Nam �� RUILD.ING ' INSPECTOR �p i639. `00 , 0 MAY a`• �y �U _ a 5 I APPLICATION-FOR PERMIT :TO .. .... .'..................Al.............................................................................................. G F , TYPE OF CONSTRUCTION �?� '� ....................... ..:................. .....,.............................. .............................................. /l I /......................192 TO THE INSPECTOR OF BUILDINGS: - - The undersigned hereby applies for a permit according to the following information: Location ......�.n4h....��r-,.�,�T. G,.....................t .,. Proposed Use .....i1 �``-- ....��C �.......... �C_.1 "�. I U..'7 CT t.� 2•� p...... ........................................................ •Zoning District � ..................................Fire DistrictNF7 R e /5 .......... ...... .........�....8....�...�.................. Name of Owner .�....� -��. .:... ...:. AyC.PK..`�,,,....Address ......C..�. ..................................................... f t !7 , MA.h�...�,I/?.Address �7�G /�� .....GI Name of Builder .�.�,�..� ;..fi!XM...'.......................... ...................:..:................ � �,._...,,........ l� rr Nameof Architect ..................................................................Address .............................................................../..................... l Number of Rooms ...................... ..........................................Foundation ........�}� !�C Exterior" t!4 ?`�.................� 1 1��Cr�---................Roofing ................'' Q ........ r1 S' .c.�1 T..................................................... Floors \` ....................................... Interior — Qt 7 .................................................. Heating .......................Plumbing �� L ...................................................................... Fireplace ..................................................................................Approximate. Cost (��7C .................................................................... Definitive Plan Approved by Planning Board -----------_-_____-----------19-------- . Area ..... .................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ...c. — Name....... ......................... ............... ............... .. Allan C. Taylor No .1.9.7.14..... Permit for .... ..................... ............................................................................... 1040 Rt A Location ....I A ................... ........................................ W. Barnstable ........................................ ........................................ Owner .........AlIan--C�... aylor.. ./............ od Frame Type of Construction ..... . . ................................ ............................................ .......................... Plot ......................... Lot M..1.7.8-.L...8........... 6 ay'0 od Lot M Permit Granted ...... .... .. A.........19 77 Date of Inspection .... ....... .... ................19 Date Completed ........ ......................19 PERMIT'R FUSED ............................. ...............FUSED ............... 19 CL, ....................... ...... .t .......... ... ..�r.............................. . ............................................I.................................. . ............................................ ..A............................ Approved ................................ .............. 19 ............................... .................... ............................................................................... THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) Im ^AC C DATA IApplication to ep0�ON5 PEt,O55EP�``5 . / OPE�HEPS H� Old King's Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building R) Addition ❑ Alteration _ Indicate type"of building: ❑ House ❑ Garage ❑ Commercial ❑ Other j �_"• - ,`J 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 I ADDRESS OF PROPOSED WORK - . '' % ASSESSORS MAP NO. G. OWNER _ y-4' ASSESSORS LOT NO. HOME ADDRESS TEL. NO. - o �- FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). AGENT OR CONTRACTOR TEL. NO. ADDRESS n- s` � !• DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8, other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). _, •< �" . � � Signed Owner-Contractor-A ent - - ' .19 Space below line for Committee use. Received by H.D.C. x l ? Date The Certificate is hereby Date 6A CA, Time ZR414 By Approved [ IMPORTANT: If Certificate is approved, approval is subject to the 20 day appeal period provided in the Act. Disapproved ❑ 4' ADDITIONAL INFORMATION FOR MAKING AND FILING AN APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS The four categories for which a Certificate of Appropriateness is required are: (application for demolition or removal is a separate form). 1. EXTERIOR BUILDING CONSTRUCTION (new or existing buildings): An application is required for any exterior of a building to be erected or altered including windows, doors, siding, roof, light etc., that will be visible from any public street, . way or public place. The following scale drawings are required in duplicate with application: plot plan (if addition — show existing buildings in outline), floor plan and elevations: Also required are snap' shots of existing buildings; where additions or alterations are to be made. No plot plan is required for addition or alteration which does not touch the ground. 2. EXTERIOR PAINTING: An application is required for any portion of a building, structure or sign to be painted that is visible from a public street, way or public place. Color samples must be attached to these applications. An application is not required when repainting existing colors, changing to white, or using colors approved by the Town Historic District Committee. 3. SIGNS OR BILLBOARDS: An application is required for any sign or billboard to be erected within the District, with the following exceptions: a. Existing signs or billboards on November 27, 1974 shall have until November 27, 1977 to secure an approved Certificate of Appropriateness. b. Temporary signs for use in connection with any official celebration or parade or any charitable drive as long as they are removed within three days of the event. Certain other temporary signs that the Committee feels does not detract from the Act may be allowed with the prior permission of the Committee. c. Real Estate signs of not more than 3 square feet in area advertising the sale or rental of the premises on which they are erected or displayed. d. A single sign of not more than 1 square foot in area showing the name, occupation or address of the occupant of,the premises on which they are erected or'displayed in a residential zone. 4. STRUCTURE: An application is required to build or alter any structure within the District which is defined by the Act as a combination of materials other than a building, sign or billboard, but including stone walls, flagpoles, hedges, gates, fences, etc. GENERAL REQUIREMENTS 5. Work on projects requiring approval shall not be started until the Certificate of Appropriateness has been filed with the Town Clerk by the Committee. Approval is subject to the 20 day appeal period provided in the Act. 6. No changes shall be made from the original approved specifications without advance approval of the Commission on an amended application filed with the Committee. 7. A separate application must be filed with each project requiring a Certificate of Appropriateness. 8. Under heading of "Detailed Description of Proposed Work" give detailed data on such architectural features as: foundation, chimney, siding, roofing, roof pitch, sash and doors, window and door frames, trim, gutters—leaders, roofing and paint color. 9. Unless application is complete and legible and all material required is supplied, application will not be accepted or acted upon. Copies of the Act establishing the Regional Historic District may be obtained at the Town Hall. C ` - i .r ''"' '��° ✓" _ 1. � 4 �. � _. � ( t r: - 'wnuS•k.+r�:o,..r.r._�•n�.>.�.nnn,�....rrs..n. .:.. '..��.r,.-, a.,......,... ... .. a '�•�f�� \ t J - .� TOWN OF BARNSTABLE BAR_W 4673 Ordinance or Regulation WARNING NOTICE Name •of; Offender/Manager Address of Offender MV/MB Reg.# Village/State/Zip Business Name 1 R i M %-t(� lao-(-� A3 j am/=. on '7 ©& 20 A:) Business Address /0 Signature .of Enforcing Officer 'Village/State/Zip to 13►9-�: Location of Offense Si4' g ICJ GL fG 1 Enforcing Dept/Division Offense °� L/C7"�,� ' Facts (),4F RJ - L/4Cn i This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town. Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. ------------------ Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION SIDING TYPE CHIMNEY TYPE COLOR ROOF MATERIAL COLOR PITCH WINDOWS SIZE TRIM COLOR DOORS COLORS SHUTTERS COLORS GUTTERS COLORS DECKS MATERIALS I24�DOORS COLORS SIGNS COLORS FENCE COLOR 4 NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this form 'are required for submittal of an application, along with three copies of the plot plan, landscape plan and elevation plans, when applicable. �7�sj i4: R"I 40 ri{.. '� F=,,cep + t p tkw 9_ .d•� �h. {cu .:� �:.�+:'� �aFs`�,,�i:t ��;' 'r � �C?ii�ii��N��kF��; �a tE i �' f� • �s.`�. OF,J J -M ilia r American e , . � : } FuriniShin lfts Accessories . , • .�• .s• `etY. firca, 1'}' 30, Portsmouth Spice Jonquil Georgian Yellow Barrett Quince O � � O OF Clementine Goldenrod York Bisque � Beetroot Shaker Red India Trade Curry Lyman Camellia Madder Codman Claret Pumpkin Farmhouse Ochre Woodstock Rose �Yt Covered Bridge Stagecoach Andover Cream y English Bartlett Tailor's Buff Alden Till Richardson Brick Pale Organza Gable Green Blonde Lace l F 1 Flowering Chestnut Redrock Canyon Emma Knightley Straw Danish Pine Mountain Laurel i i Roseland Cogswell Cedar Lady Banksia Asian Jute Canyon Gold Rundlet Peach Colors shown are available in interior and exterior finishes. L o 3A TOWN OF BARNSTABLE BUILDING PERMIT PARCEL ID 178 008 GEOBASE I'D 10463 aa�� ADDRESS 1040 MAIN STREET/RTE 6A ( PHONE W BARNSTABLE ZIP - LOT A BLOCK LOT SIZE DBA . DEVELOPMENT DISTRICT WB PERMIT 73298 DESCRIPTION REMOVE & REPLACE RED CEDAR ROOF SHINGLES PERMIT TYPE BROOF TITLE BUILDING PERMIT .ROOFING CONTRACTORS: PROPERTY OWNER Department of ARCHITECTS: 'Regulatory Services TOTAL FEES: $100.00 BOND $.00 OFF CONSTRUCTION COSTS $4,000.00 750 ROOFING AND SIDING 1 PRIVATE 0 * ELAMSTAIRE, • ass. z RFD MA'S A P BUILDING DIVISIO BY �✓� /�� DATE ISSUED 12/01/2003 EXPIRATION DATE � r .w TOWN OF BARNSTA19LE T• BUILDING PERMIT . '� - PARCEL .ZD�178 008 GEOBASE ID' ' 10463 ADDRES6 1040 MAIN STREET/RTE 6A ( _ PHONE 1 - W BARNSTABLE ZIP - LOT A BLOCK LOT SIZE DBA DEVELOPMENT / " � DISTRICT WB PERMIT 73298 DESCRIPTION REMOVE & REPLACE RED CEDAR ROOF SHINGLES PERMIT TYPE BROOF. TITLE BUILDING PERMIT ROOFING CONTRACTORS- PROPERTY OWNER Department of ARCHITECTS: Regulatory Services TOTAL FEES: $100.00 BOND $.00 CONSTRUCTION COSTS $4,000.00 750 ROOFING AND SIDING 1. PRIVATE 1 * 0 * BAMSPABLE, • w Mass. -BUILDING DIVISION. BY DATE ISSUED 12/01/2003 EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY'ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4:FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS I BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS I 1 1 1 I I I I ` I I 2 2 2 I I I I I I 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT I I 2 BOARD OF HEALTH I I I OTHER: SITE PLAN REVIEW APPROVAL I I I, I I 1 WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. -77 BUILDING PERMIT f y r r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �w { 3 Map ! 7 Parcel © o g Permit# , Health Division S' 3 25 3 SD Date Issued 1400' Conservation Division a : �^�� Application Fee Tax Collector Permit Fee Treasurer SEPTIC SYSTEM MUST BE Planning Dept. ANSAUED IN COMPLIANCE Dat Hist H a ini ' Plan Approved y Planning Board "TV'ENVIRONMENTAL;TITLE 6 E A€D 0�_ Preservation/Hy nnis� T®wN REGULA ION4 Project Street Address I o K b ,/lit r,4 ,'Ac S -�- 2-�- 6✓4 Village LU ? ZiA A o Owner b v t4I �. Address Telephone Permit Request S-� ,/� ". 4 lV 6 WdRk, QjAeg Zjj I0'D nly Avo&_&1w7_— Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation - Construction Type Lot Size Grandfathered: O Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes O No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new i Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas O Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:Cl existing O new size Attached garage:❑existing O new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded O Commercial ❑Yes O No If yes, site plan review# Current Use Proposed Use 11 /,J BUILDER INFORMATION Name / c L f4i ,� «1c Telephone Number �— 3 Address S 0 S �.4 iV License# rAl—/0,4 (.,U 4 S —� � � � ✓�'(� Home Improvement Contractor# dl Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Z If SIGNATUR DATE 1� FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED " MAP/PARCEL;NO. ADDRESS- VILLAGE > OWNER DATE OF INSPECTION: - ti FOUNDATION FRAME i INSULATION v FIREPLACE k , ELECTRICAL: ROUGH FINAL f v PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT, ASSOCIATION PLAN NO. :a The Commonwealth of Massachusetts Department of Industrial Accidents - Office oflayestf9ations • 600 Washington Street 'Boston,Mass. 02111 " Workers' Compensation Insurance Affidavit / name: t'' location JIK 6IL hone# ci all work myself. �] I am a homeowner performing ❑ I am a sole rietor and have no one warlQn in ca achy job. //%/ // %///%%/%/%%/%%%%%%%%%////%%////%/%/%%%/%% %G/�////////%///i%�/%g%///S///4%////fig�n%this'%//%%%//%%//////////�///�//%%%�%///l////%%/%%/%%/ orkers m(�ensationfor tk>a:v{.:,i:v :t : :Y�rr{ " t ,°•n 'µ?"`;�4rt.. rov"din R' T...n^+ tr!iv{4:•+: :4, :{•4:.•v n t R, } 4 Fi 4:.i}>: em 1 er g {<:.},..: )}...^ f;+ .Y.4::vvfY':•'•2 yj; ' q+ F,Z;+,i). n c!.. 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Iuadetstaad that a one years,imprisonment su s as penalties in the form of a STOP WORK ORDER and copy ea of tlds statement may be n ea to the Office of Investigations of tht DIA for coverage vermcvAon. I do hereby fy t e airs and penalties°fPed wY that the inforipr0sided ab°ve is trw and correct Date 'L Signs ( Phone# Print name do not in this area to be completed by city or town official official use only C]BaAlng Depattneat persrdtlllcense# Licensing Boat �. city or town: oselectmenIs Office a chtckitirrsated&je response is required ❑Sealth Departzaent "' ❑Other phone#; contact person• S (m++'�9f93 Y7A1 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the `law", an employee is defined as every person in the service of another under any cgntract of hire, express or implied, oral or written. s artnershi association corporation"or other legal entity,-or auy,two or more of An employer is defined as an individual, V p, , . , the foregoing engaged in a joint enterprise, and including the4legal representatives of_a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing'eriiployees. ljiowever 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 thereto shall not because of such employment be deemed to be an employer. building appurtenant MGL chapter 152 section 25 also states that every state or local licensing agency shall withhbld'the issuance or'renewal of a Iiceiise or permitto op�erate,a Ihusiness or to construci.buildings in the corninonwealtlffor-aiiyGapplicant who has not produced acceptable evidence-of compliance with06j'nsurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perfb'. ce of public work until with the insurance regairemerrts of this-chapter have been Presented to the cod=ting acceptable evidence of compliance authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that appl es toy all�� maybe nd supplying company names,'address and phone numbers along with a certificate of insurance es 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 the Department of Industrial Accidents. Should Y9u have any questions regarding the"law"or if you being requested, not are required to obtaiii a workers' campensatioa policy,please call the Department at the number listed below. ON City or Towns 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 mutllicense number which will be used as a reference number. The affidavits maybe returnIn ed be sure to fill in the pe the Department by mail or FAX unless other arrangements have been made. The Office of-Investigations would like to thank you in advance for you cooperation and•should you have any questions. ,.please do not hesitate to giyeus a call. `N The Department,s address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents MCC at tnvesugauans 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 D�,�HE Tok, Town of Barnstable Regulatory Services Thomas,F.Geiler,Director MASS TED tia� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 office: 508-862-403 8 Fax. 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property._ hereby authorize �PAtida C t 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 acne - QTOWS:OWNEUERIvILSSION r application to: JPNE�O`E 0o�art OpE� �po 1, Old King s Highway Regi6fiaf.Historic District Committee in the Town of Barnstable for a CERTIFICATION.OF EXEMPTION Application is hereby made, in triplicate,for the issuance of a certificate of exemption under Section 6 and 7 of Chapter 470, Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on plans, drawings,or photo- graphs accompanying this application. 5 TYPE OR PRINT LEGIBLY DATE //At, ADDRESS OF PROPOSED WORK ,111 �> ►�A�� U/ V'�4-�SSESSORS MAP NO. OWNER �9 ��+� 10,_n_ ��+ ASSESSORS LOT NO.�� c HOME ADDRESS 0 1-4 0 -a TEL. NO. AGENT OR CONTRACTOR ADDRESS �^� g L / TEL. NO. This application is for exemption of proposed exterior construction on the ground that: ®� (1) It will not be visible from any way or public place. ❑ (2) It is within a category declared entitled to exemption by Old King's Highway Regional Historic District Commission: (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work, showing location on lot,and, if an addition Is involved,show, ing location of existing building. SIGNED wner.Gon actor•Agent Space below line for Committee use. . Received by H.D.C. The Certificate is hereby Date ,�1 � Time By Date Approved ❑ The categories of work entitled to exemption are listed on i" Disapproved ❑ the back of this form.. TOWN OF BARNSTABLE BASW Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender " 10 #0 XMI* l y-JfQC e MV/MB Reg.# Village/State/Zip W RA )"PY./ Business Name D R M T i ye 9A QA am/pm, on .4 20_'� Business Address ^M)'Al $7k' to Signature of Enforcing Officer Village/State/Zip W b17" 572,4/?t' r /t01 Location of Offense d `, ''/�� is,yi ?t �; f i' �°''"/' ,�•= Enforcing Dept/Division Offense o, rep fJ iY/A/VWP A " f6,4d- /1' / Facts Cl i tk 0,PPI` Ulk T7G-,✓ W2►74 ",4//. G' This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. �±hr °f r Town of Barnstable Regulatory 'Services BARNSUBi E' .Thomas F.Geiler,DirectorKAM A $ , 039.► Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 y Fax: 508-790-6230 Date . � o Address 4. y . , To Whom It May Concern: `� y - Our attention has been alerted to.&� fact that you are flying illegal contrary to - the Town:of Barnstable's Zoning Ordinances.The Town has a sign c isOWO-Yegarding flags. Section-4-3.3,.Prohibited Sign I)'Any sign,all or any portion of which is set in motion by-movement,'- :.:including pennants,banners or fl s,except-official flags of nations or administrative.or political subdivisions thereof." °'o 'Please=ntact meat 508-8624033 when these flags:have been removed so;that:I°can-inspect.the site:Thank. you for your anticipated cooperation. Sincerely, Building Inspector Application to 1998 244 CA, f � ` y r Old Kings.Hghway Regional Historic District Committee in the'.Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application Is Jv*eby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts. 1.973, 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.80d'ing ❑ Addition ❑ Alteration Indicate type of building: ❑ House !❑ Garage ❑ Commercial ❑ Other 2 Exterior Painting: [ 3. Signs or Billboards: ( ] New sign.. ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall :0 Flagpole ❑ Other (Please-readother side for explanation and requirements). TYPE OR PRINT LEGIBLY' DATE ' ADDRESS OF PROPOSED WORK ��jL(tQ/3—iJL �'/1.S7Ab��_ ASSESSORS MAP NO. OWNER • h LJ/1(t �OhIcSti ASSESSORS LOT NO. HOME ADDRESS 13 TEL. NO. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional she'it if heeksiary). (ataar,_ j�soy �r .�►� 3� Arf6i L Nh61, Ch iMOCIA C, 1049 2i w9 N oVin6-er. :�OA S> uS(kt IClnlQIS ILY (a f9 AGENT OR CONTRACTOR 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). Folr4 �� rd f %�i%1? 00 i 11.ak er p — 19 CAD G� )Sjz-C S -wf tjrU i t� 1 q ® � �'t►�i i.►�,1 Ii� Signed � Q � U Owner-Contractor-Agent -space, e r mitres uqe. - R ei ._ Df. ! . .. at, a Certifi a is Hereby Date Y f� � ime qiOF & Approved ❑ IMPORTANT: If Certificate Is approved,approval Is subject to the 10 day appeal period i -�--_Tz�_�__�___-- ___ _� --, ��' ' V � � � � .. � ,- - _._- R r , r � 7 . � � 1996 047 Application to -old'Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building ❑ Addition ❑ Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial Other C1Ctn al/1, S��_ 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 2"CQ2,! l c�-1 C1(D ADDRESS OF PROPOSED WORK r1�� \C�-1 C�LU IN. I�YIA V1CcIIf 9 _ASSESSORS MAP NO. OWNER MI«'�Y —le II)e,I �r JQ 4llfij�k:b ASSESSORS LOT NO. HOME ADDRESS TEL. NO. 2 — FULL NAMES AND ADDRESSES OFABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet:if necessary). I2itIntl-A Lam, k ;5 55 ?Ctcl-J Lc 6y I LrInn yiaen , �C�h r, l U u G Mcu�► J c.,-m ,-, D mA) M rz AGENT OR CONTRACTOR 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). O PU�- 0,.,_?i oe_ W-Lk IMC 0 QA&,v-, ShJ6 U(J " FSX 12. LJ�'vv�� kct� 0 �Se, vJMite, �c�ink c��D� on Rase ' .u�v� cacots cad NauklorlS O C\ (dO0Se-AO'4 �O �r� �-e d i odic¢ t on C l�k v�. A ISo JWQ_'mac- i�c,iCL £,�,c3N �z UJL9 �. rP.rnov-e d�, cue d cep ta_� Lo i tv, a Lc'n fir- - 6n4- on Av� fU,�c D igned - - O r-Contractor-Agent Space below line for Committee use. Received by H.D.C. DRe 2 P 9 W 12 Thi Certifica reby e •r„«, TirrffljftIjIA"A,AIC, [By-__ _-p v L_-Approved '--❑ IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period provided in the Act. DisannrnvPd n Town of Barnstable 1W, Old IGng's Highway Historic District Committee SPEC SHEET FOUNDATION SIDING TYPE. COLOR ,t kM�CA CHIMNEY TYPE COLOR ROOF MATERIAL S1 COLOR PITCH �V Pxn I �C In WINDOW Q SIZE TRIM COLOR ,CA' 0 DOORS COLOR nr �Q �d)Zk 0 SHUTTERS GUTTERS DECK GARAGE DOORS �� COLOR N NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the plot plan, landscape plan and elevation plans, when applicable. Plot plan need not be "Certified", but should show all structures on the lot to scale. SPECSHT WHOLT IMP sasphaCt ' Shin�1CS b^ Y ✓�z.10 I Y TR�.s y"rd' 70P PLATC D D D Lz y• Pu'CLIP �"Y 9A*'TcNS � y� POST yx COX PLy16001i je/ooi 10rst+ dal-�boX . 41yDTF : ALL 9 %-ftJ Boords -("It ciimCr151o�Q� "P) 1 N l /1, l (,, . g ' ( 'Z 1 iJ 9-rl� i � 1 e f Y TOWN OF BARNSTABLE SIGN PERMIT PARCEL ID- 178; 008 GEOBASE ID 10463 ADDRESS 1040 MAIN STREET/RTE 6A ( PHONE W BARNSTABLE ZIP - LOT A BLOCK LOT SIZE DBA YYDEVELOPMENT DISTRICT WB I PERMIT 35243 DESCRIPTION PRIMITIVE BARN (8 SQ.FT. ) PERMIT TYRE, BSIG4 TITLE SIGN PERMIT CONTRACTORS:-- Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES{ $25.00 TME 1 BOND $.00 7•� CONSTRUCTION COSTS. $.00 753 MISC. NOT CODED, ELSEWHERE : BARNSrABL MASS. 039. B ILD NG DIV�I� O DATE ISSUED 2, 08/1998 EXPIRATION .DATE i ---- -- _-_ - ------------------- ------- ---- ----- ---- - ----- - - --- - --- r X�°� ° The Town of Barnstable � a BARNszABM = Department of Health, Safety and Environmental Services � MAS& �� Building Division iOtFo M. 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner �reasurer � Application for Sign Permit Applicant: f ' 6lS Assessors No. � /v�Op `0 Doing Business As:�/'i m: �� rlr/1 Telephone No(-5-1&�- Sign Location �/� Street/Road: Y4- Zoning District: 80 Old Kings Highway? De /No Hyannis Historic District? o Property Owner Name: John Lrnk �(�"t S'G� Telephone(g/d) Address: ��d RT- 6 kq Village: 6N• l'Y)S�/6 Sign Contractor Name: �li1f �/ �/ Telephone: 1 -=� ? Address: j j&j( (4 l/��Y/�( ��2,Lj4dX Village: Descnption t Please draw a diagram of lot showing location of buildings and existing signs with dimensions, location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Ye o (Note.Ifyes, a wiringpermitisrequired) I hereby certify that I am the owner or that I have the authority of the owner to make this application, that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent: Date: r .Size: Permit Fee: as 07) Sign Permit was approved: Disapproved: Signature of Building O i ial: Date: Signl.doc rev.8/31/98 OU T ` WO Ip ��tf�Y �p Sid i4! •_!l .� T •1 f'L` - � �t iC :7 ��• ..fir `+' °+ wo 5, 46 Pjg-UG ��02/�C BUG C�Sro�c cam%dv��r /fit G�i�G i E r' ��E r The Town of Barnstable Department of Health, Safety and Environmental Services . _ Building Division NAM 1"9- �,0� 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax 508-790-6230 Building Comm ssio:: Occupation Re ' Home Occup gss=don Date: ° N Name: Phone #: �/ � .r �/®Y,4 1 Address: _Village: /,d_ &imi'TC Ah Type of Business. 1 is-41 Map/Lot: IIVTE . It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dweilings,.subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shad 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 msidentW vohumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permined 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 shah 400 square feet of space. • 'There are no external alterations to the dwelling which-we not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residenuai volumes. • The use does not involve the production of oilensive noise.%ibration,smoke.dust or other particular matter.odors,electrical disturbance,heat.hare.lmmidiLy 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 tie shall be met on the same lot containing the Customary Home Occupation,and not within the required front rard. • 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 took not to exmed one ton capacity,and one nailer 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 car.ulvertiscd 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 undersigued,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: Homecc.doc 1 -76o 3ioo J 9� e le� C I©CO I �3/� Office 1st oor) Map Parcel Permit# _ - .00) Date Issued Fee o2s v--Z) owea/ Engineering Dept.(3rd flood House# �a P BARN8rAB12. MABG 19 ses9. .� I � En►Ad. TOWN OF BARNSTABLE ; Building Permit Application Project Street Address Q Village Owner I r Address Telephone \50 F — ` 2- "'19 3 02 Permit RequestCJ - f First Floor square feet Second Floor square feet Estimated Project Cost $ k5,y(ry a-v i Zoning District A�F Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use C Construction Type / Commercial Residential ✓ Dwelling Type: Single Family t� Two Family Multi-Family Age of Existing Structure —'— Basement Type: Finished Historic House Unfinished ,,--Old King's Highway Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces O Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name Telephone Number — 760 Address License# ome 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 SIGNATURE DATE o7 — BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) , I 02/12/96 17:33 NEWPRO CORP. j 1 509 790 6230 NO.425 901 FAX COVER SHEEN' ff r1r sV a oo• a'I s a err a� EWPR 09 INC* 26 Cedar Street Woburn, Nlassachusetts 01801 (617) 933-4100 l<AAV (617) 933-9624 TO: COMPANY: FAX NO.: / FROM: l COMPANY: 1PMONE.NO.: FAX NO.: NO. PANES: 'INCL.COVER PAGE NOTES: i M - p Ln Oj _ V O 7_ 1 �♦ ;� ��a r�mnrf-:reCacc.�ti1. _./i[.:,ie/lS 234Q8 j irn TiR Lf f) Q. ui z �r M L` ti ill RI O2112196 17:34 NEW'RO FOR?. 1 5O3 790 6230 NO.425 902 Ti "" lt0lfk ttiPROVEMENT cW 'ACTOR !,p! FeylStrat.lon 100020 (1� Type PRIME CORPORATION �,'•'� EXplration Oo108/9b NeN;�co, tnc. Nicholas A. Cogllan: ��,�.6V,.kedara5tr:etr' nprn,;,sst �rrosi Toby n 0 Old0l i r TRANSMISSION VERIFICATION REPORT Y • TIME: 02/12/1996 17: 21 NAME: BARNSTABLE BLDG DIV FAX 1-508-790=6230. TEL 1-508-790-6227 DATE,TIME 02/12 17: 20 FAX IV NAME 918006336219 DURATION 00: 01:03 RESULT Oh MODE STANDARD ECM / 15 Parcel -t# Conservation Office(4th floor)(8:30- 9:30/1:00- 2:00) Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) q5^ 9 Fee cf2) Engineering Dept.(3r4'floor) House# Q IKE BARNMBLE. MAB& 19 TOWN OF BARNSTABLE Building Permit Application / Project Street Address /0 y d Village L ¢-S+ t� o.,sue 5 4 o_\, p a Owner b 111,,.& 1� _1111 41z-� ' Address V 0 Telephone 0 g - 3 L-z - 19 3 -2- � Permit Request First Floor / Cj square feet Second Floor square feet . Estimated Project Cost $ /y Q 0 Zoning District Flood Plain Water Protection Lot Size / . C A--L,� Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms 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 Telephone Number 5_0 316 Z g 3 21 Address �c) 0 x L License# YA A D-"_6(o F< Home Improvement Contractor# C Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 7 2 r BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) ` FOR OFFICIAL USE ONLY , P MIT NO. ) I ISSUED P/PARCEL NO. RESS VILLAGE OWNER t DATE OF INSPECTION: FOUNDATION FRAME' , INSULATION ' FIREPLACE . ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING • I r DATE CLOSED OUT ASSOCIATION PLAN NO. w - • - '- The Commonwealth of Massachmettl Department of Industrial Accidents •. � ii ��!� Ol//ceollao�stlgalloos 600 11•ashin im Street Boston.A1ius 02111 Workers' Compensation Insurance AlMda,it name: L�� Aiol-��; Inal ion: Dt10 Qw— l� phone# L *a homeowner performing all work myself am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. comnanv name: address, phone#• insttr once s•n policy# 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: comnanv mmp• address: mod•• phone#! ine��rnnrn�n Bolin,# t�•• • "•.- N':,T.�-.. - .. rc�t•7:r.�;•.•.i�*'n+i'�':�!Rt,�+fr^'� •r�.S'�l�r �►?'^S!:"_ .AT3�S!�-�'"r7S_ comnanv name• address: city: #: - incur-••-e co nolic,# - 'Atinch'additianal'aheet if oeetssaryr Failure to secure coverage as required under Section 25A of NIGL 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. I understand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verifieatioo. I do herehr certifj-under the pains and enalua of perjuq•that the information pros ded above is true and comet / Sienature ate �/G�1� Print name Phone it official use onh• do not write in this area to be completed by city or town ofilcial city or town: permit/license tY rnliuilding Department Ot.icensing Board ' check if immediate response is required QSeleetmea's Office C311altb Department COMM person, flOther (m,sed3.'95 P)A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the .scrvicc of another under any contract of hire, express or implied, oral or%vritten. An empinrer is defined as an individual, partnership,association.corporation or other :-,-gal entity, or any two or more of the fore, ' engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the ip, association or other legal entity, employing employees. However the receiver or trustee of an individual , partnersh owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of tite 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 1.52 section 25 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 commonvealtli for any applicant who leas not produced acceptable evidence of compliance with the insurance coverage required. Additionally.neither the commonwealth nor any of its political subdivisions shall enter into any contract for-the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter hav, been presented to the contracting authority. ;.�ww�- •!��T!�••r.^�.r„�' :�:•a, s i':. �,n.. 1 i!:: .ay;•, : . y-: per^�«aY:�t!¢7c•" �•.•�i�J •�.' .. . t .« _ .p,'sT:.• �.. •Zk=.•r: '.\4; •��z:. . :.";_. ri=;�i`�'. -.a�....f�^;a+.'.iK"4•�t.+: fir.::--.c'�.._. ••. Applicants Please fill in the workers' compensation affidavit completely, by checking the boa that applies to your situation and supplying-company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to 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. ��• r....•...... .,ar�r.•.. .,e...,•r ....'.�.5. .S3f�tdwT rt'Li ��'F�+s[y• :J •�: ... .. . .. Y City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. k you in advance for you cooperation and should you have any questions, The Office of investigations would like to than 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 w,:4 600 Washington Street — Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 The Town of Barnstable 5 Department of Health Safety and Environmental Services 1659-Ma Building Division 367 Main Strut,Hyannis MA 02601 Ralph Crosser Office: 508-790-6227 Building Commis; Fax 508 775-33" For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,altemtions,renovation,repair,modernization,conversion, improvement,.removal, demolition, or construction of an addition to any prc-aas>ing owner oomVied building containing at least one but not more than four dwelling units or to sWxtures which arz adjacent to such residence or building be done by registered moors,with certain exceptions, along with other requirements. Type of Work: Est.Cost Address of Work: Date of Permit Application: '7" — — 9)6 I hereby certify that: R.egisuation is not required for the following rcmn(s): Work excluded by law Job under S1,000 Budding not owner-Oocupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERNQT OR DEALING WfIIFt1NREGISI�COMRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PEP-MY I hereby apply for a permit as the agent of the owner. Date Contractor name Registration No. OR ' n,,e 'Owner's name w+ Y • r 129 Parcel e�rmit# '7 CS Conservation Office(4th floor)(8:30-9:30/1:00-2:0 Q to Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:45 `-� oZ�. °7) Engineering Dept. (3rd floor) House# SEPTIC ST B� BNSTALLLI�'ICE D19 E�d1/�RON TOWN OF BARNSTABLE TOWN REGULATIOMS ffeee"tAddress Building Permit Application Id-21l , � 1,�J Village Owner VC) A-,-t I. P Address �� - q3P- Telephone v Permit Request \ First Floor square feet Second Floor square feet Estimated Project Cost $ s07) J Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type 61 o o cJ Commercial / Residential Dwelling Type: Single Family !/ Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway -A4T:QQmoo.-&Q_ZI- 1q'14 S:� ol�tr�. 4A ,Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor �— Heat Type and Fuel 0t \LV�t)qk<:[- Central Air Fireplaces Z Garage: Detached Other Detached Structures: Pool Attached Barn�1 ,� f\ None Sheds Other Builder Information Name Telephone Number 362 "z € 7/ I Address 1 C 4i-v.tic S� License# 60 z/O 9 f GJ n4 h ws S� l-14 S S _ Home Improvement Contractor# /O a, /y Worker's Compensation# 3 0 2 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PER IT DEN D FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY , 1 PERMIT NO. r DATE ISSUED ' MAP/PARCEL NO. ADDRESS VILLAGE OLER DATE OF INSPECTION: FOUNDATION �. FRAME - INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING.: f ROUGHi FINAL GAS: 'tI"R�-UGH, M FINAL FINAL BUILDING+Z ..• 5 i . J DATE CLOSED Ot r 1 Ir Pili® p. ' ASSOCIATION PLAIVMNO.V The Commonwealth of!lfassachusetts Department of Industrial Accidents Y l N o ficcof/lvestfgat/ons f; 600 Washin;;ton Street Boston.Mass. 02111 �- Workers' Compensation Insurance Affidavit w_ Ple PRINT le lbl ' R A.np]rcant tnfoJrmafion/-•/ ase -' � J�RCN V•S�1.^-so.^' A C�lc4 s� M, e S l' �'t�-h�-t� L / V� s S phoned c- 'Z� -7/ 0 1 am a homeowner performing all wort:myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. o Se l C r.. /a Ye e( addr se• city nhnne#• incurince co policy# 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: m any n. address: city: phone#• cu nolicv# -. -�� - _ - vF„s-. -sros-er�•�-•-1+R-��SFy�r-•�F--�v. e.�+w-r�x+L�3�"1"'�Cr,.r r.+�^_�i►,�.e.^"�r,._., .�.'^-Pia rim any name-___ city nhone#• rnce co policy# ' cur• --- .Attach addi_tionai'sheeil iieeessa �+�: .•w�^ ;�+:_ "!e:"`: :•'•' :' :"� - �'""`"'' Failure to secure coverage as required under Section 25A of MCL 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 5100.00 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. 1 do herebt•certify under the sins and penalties ojperjun•that the information provided above is true and correct Si_nature Date r '..^"�� l� /--q 'L� � 2 -2� Z1 Print name Phone# 0 r of 1621 use only do not write in this area to be completed by city or town official city or town: permit/Iicense tl r'tlruilding Department Licensing hoard check if immediate response is required OSelettmea's Office Health Department contact person: phone#: nOther fremed 3,95 P1A) The Town of Barnstable �,$ Department of Health Safety and Environmental Services � Building Division 367 Main Street,Hyannis MA 02601 Office: 508 790-,6227. Ralph Fauc 508 775-3344 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,.ramo%-4 demolition, or construction of an addition to any pre-cdsting owner occupied building containing at least one but not more than four dwelling units or to strucaues which are adjacent to such residence or building be done by registered contractors,with=twin aceeptions, along with other requirements. Type of Work: �' Sv-mc.� �' vC� �` Est Cost ssb O �� Address of Work: ,/v Yo mow,. 13,,0 -A-' �4 O%-ner.Name: v V �a ai a ri Date of Permit Application: 141�e 4 /2 CF 9 a I hereby certify that: Registration is not required for the following reason(s): Work emduded by law Job under SI,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH DNIiEGISi'l CONTRACTORS FOR APPLICABLE HOME I PROVENffi'NT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. I42A SIGNED UNDER PENALTIES OF PERJURY : I hereby apply for a permit as the agent of the owner. J, 4 NS o^ O 2 Date Con r Registration No. OR ' owner's name 4r: !aly.�'' -�»•��,�.�5 rr,.. .:r-"t�: r.pie_' .•L. �(ti�i,.: y< 3'yFst ..aatz,. T19±. 1. 3� ¢�tltw th•...•p ,TJ'.,# L.•• ksa7,KJ': ;:y trt -"9j 4',;;,,,i•`' 7-• 1. ',`.5(('�l' RT{. •F�ri+S ,t �, 1d ,: 1-t. . .rw. �''a " '4.t�tf'i *YY t Az;;s<°-13. #^:;;; ti ,,,n� b,• L' - t'Y,: Y$....(3Y, u:x.c'k'"s a f �. ,� .. Y. R.,rat , 3c x, �?,L [d A fit,• I [�'CL�'' •F'` .Af y �4gi r' ,.�• _Q". go '""i: � •. +_'��w •f' ,[LY�EYw�''-..+:!�.'.T'.. 6o. - s'. FIOME ¢IMPROVEMENT ,C0NTRACTOR5 7REGIST,RATION t I " xBoar`Id 'ofBui'1c1`ing f2egulatonsandg5:tandar�ds s�,i .z :. aan:` J.iEa• �sr, sk;rK�aS`i'F' K -..A.r�..' ', .s.."`j'�.r:r;�•�; rrr•, _ rt. .,�. _ p UOne "Ashbur.tan Place y !Roo.m 1301 ? '7c$w4 ,rez�fT,;;rr ... Bb 4 f ra ,t r t Eh'�-,'4'''i z? _ X -3' '�ti' - - .. { d zL7 l Al n " +oT "t1'� 1 .`r ✓., 3 g � '.. ��f��r�,. j��•55kp.Al ¢a, z; •.s{IQ=� ,g� ,,, �� - r��, U <� .,.- +,,r'. . 7. - ^ — :1 Fr L ^` _ ' Cwy YT'. €,-j)M q- x�' ,�sHOME:rIMPROVEMENT:-CONTRACTOR �� ..w;Syw'�'3.., 4Y.f & J��$ ' '1�+ •fit. °' fd ,SN,f' ,K. y _ P� yi Y�,iLF8;4.'(i'�°+€xa,,.3 ` " xPir':atlon, 06/30/96 � Regstration 1021'49 �fi ,r. r k�a e .� t t^r r ks �sayri �{r ? ' �_r�L^4a TYP.e.,' �INV--,L IA!.. rs �Fi? .� ,: . `:i_e $ a ! k� r2t � } R :r �i� { � .:qs :� .. i .' � - <I ONE.,IMPROVENENT CONTRACTOR" �� ': 1gi �j..}r-a�`'�' �!o .,�, �.<e�;�*�a.��a+d �' �"'".�.G• k' ,,, . �s<�� ' � �� •. �.� �... � .'� : F✓.ry,;�,T-fit r'I � ��p��jl�rS`�� ^' .,. -'�r� f � 1 � idN �.'.{ ti✓1'§ii Y a.r. 5- a�,j. {•Y fK�Si.Y z:i %4?n�' 2z# '�+Lkk.r'S:f!Z 4#. .� 'a?, v�'S1 1. •� r3x r . w z - �� .. TYPeINDIVIDUAt :,: r 4 mom? �� car r a �; a� t s:. r• EzPiration. JOhnson �g 0T160 Churc.hr5t ��'��`.= � w� . � ',. ��'�'° � �"• d t 1's+• -4r --Cl. .'S4ti u 5 Yx +. s f �'t �R rw -s,:�; s:, 'a5 •�'.�eT i. �'' +, r 'r>-r• 'Lcr. •1,.. "ems, .a"f�' r I.�, i•�yr`.. �d Ai''R'- W,c•�•,. ��r.i .y .d r, a.,). xr.John Johnson..�y � r 'gh•�� Y-. 02668 ' 0 nnjJ., Johnson. Fj r� �..,F• s Cn-4.,a �„Zt':,••�. e' ?Y� " 'F TPLj',z'' L'-::..: G �11 Ip` p -�•yy �M.�ror.'^'Y .a�".^N•v�9ki '^!'+.% :"SY,._.- .'�i...K�. }. x < 3 s l N roR s:PO Boz -RD 160 Church �. +-e. `'"ADMl ISM t , ,��• -i, d..;C x. . s•'� .� tiyS:.,s vl �,i y�� .+as '��C ,,a+,4 ns. .'�`� t+•i �'�� wawa,r a,� a.,f.."`. •.J ,y q+ '�j71, x�•�� ;�k�""'�� ,��P:� �;�,r� ��y F,��; �. , ,`,'�`�:°T =� �,,. � ��..• }' `��`� �:' �• � -yN..•Barnstable,MA•02668_,;4; w 1 s .�� i� •�..,��s"t �.��; } ri�% '%t��n,�y+�R'f...��.n �•,.;�t��'�� .+.• �<��.: Pe)4k f'��-�a't�e� �ya�!•., d'"�"''c'41'`""�' ��"a.''�_.,: Iptw�iveaC �mrzt .. COMMONEALTH i` . DEPARTMENT OF PUBLIC SAFETY W s ot susstori:;ovatlon •'. OF ;:ONE ASHBORTON-PLACE ... ": oftA1a11QAl�se. MASSACHUSETTS . ,q"�i BOSTON,MA 02108 • i/`'�sir•' _ '. . - EXPIRATION DATE CAUTION FOR RESTRICTIONS EFFECTIVE DATE. LIC-:NO.: PROTECTION AGAINSTTHEFT, PUT RIGHT THUMB t�(ir_, (.)r, PRINT IN APPROPRIATE BOX ON LICENSE. •_i JOl-iNSON g BLAS:qpq 4RERATORS y: _T'. j MUST°IIyC E PHOTO. m' y�yytt f� PHOTO LASTING OPR ONLY) "FEE: �� A..1 i'�i v I F�L?f_M . ' NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY I HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER, it 11!+tirvtspoess. c �tNIaIIQAAte. THIS DOCUMENT MUST e: Ar _ SIGNATURE OF LICENSEE ! p:SIGN NAME IN FULL ABOVE SIGNATURE LINE CARRIEDONTHEPERSONG - - _ - `• THE HOLDER WHEN Ef - _ J OTHERS-RIGHTTHUMB PRINT GAGEDINTHISOCCUPATIO TONER ' Application to ��/�j/ `/��A/ /�/��T /Jl� 7 SP P„r�M 1 V V V O V 1 • 8P OE�,p5�,P EpN 0P �Pv.tvvD�' Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building ❑ Addition 22 Alteration Indicate type of building: C& House ❑ Garage 9 ❑ 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 FP f) _ 9 (0 ADDRESS OF PROPOSED WORK (0 -204r6kAW ASSESSORS MAP NO. / 7� ej , OWNER r)r ASSESSORS LOT NO. HOME ADDRESS TEL. NO. 3(DQ FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). .I AGENT OR CONTRACTOR -ah✓L ksan A TEL. NO. � ADDRESS -U L.Rrl �—rj AYE 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). C.ka'r�� 2x- r\� Q C'"b6.s ,L --p 10TVA% O.-r-, re poor- O LCI cv\ L Ve aW m- S( -Ak-s MO - A� Ppflo� P Signed 14R�o n Space below line for Comm er-Contractor-Agent Committee use. IjLCG --Received=by=H: ,,oDate 'i The C i to is eby Date ln'r) . . Approved ❑ IMPORTaT. If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ CF Town of Barnstable ;pe Old King's Highway Historic District Committee ' SPEC SHEET FOUNDATION SIDING TYPE fP.p 1 D iJ�n� _ �.►ci4 S tJ COLOR CHIMNEY TYPE COLOR ROOF MATERIAL COLOR PITCH WINDOW SIZE TRIM COLOR DOORS COLOR SHUTTERS GUTTERS i DECK GARAGE DOORS COLOR NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, � d ® 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. SPECSHT S --- -- -- -- -- -- r � r e w Q NO • h U O 1 . N o poi _ •� as M O Fy Wor e v r n � o r C t Nv t ti o� • s o 0 � a �`ryobH' 8 L f e2 ��• i 10 © v v r J •rt� 2d .� a, s v g � 01& • � l :vd or � 9 1 • ssessor's'Office 1st floor Map LZ q Lot 0 Permit z + G - ��Sc Conservation Office 4th floor Z Date Issued e r 0 -Reard of Health 3rd floor qt3 � y�';7 />�ineering_Dept. (3rd floor) House# �`S�IJ �� '�' °A� Planning Dept. (1st floor/School Admin. Bldg.): 'SEPTIC S� BE Definitive Plan Approved-by PlanningBoard 19 INSTALLED I NCE V (Applications rocessed 8 - . a.m.& 1:00-2:00 .m. E�# vmoigwi�i CODE AND TOWN IEGULATIONS TOWN OF BARNSTABLE ' Building Permit Application Proiect Street Address . go Ma.t�., �` r� Village W 9 K i_,r-p�. !,�e Fire District W . 13a f,Owner Address' Address NA Telephone 3 2 '4 2 2" t a14* i Permit Re guest: InA lc 2 LAo--- Zoning District Flood Plain Water Protection Lot Size / 4_- C_ Grandfathered Zoning Board of Appeals Authorization t Recorded Current Use 42----.`-1 Proposed Use Construction Type L .0 o Eaistinz Information Dwelling Tune: Single Family Two family / Multi-family Age of structure 75 Basement tie S z'2 e Historic House � Finished Old Kin@�ghway 4u4 eti,a---- 4 A0 k_ l ry Unfinished Number of Baths No.of Bedrooms 3 Total Room Count(not including baths) S First Floor Heat Type and Fuel i Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None z Sheds Other Builder Information Name So Telephone numberGZ Address /(,y License# O O S Y o 1 �"• �. �- a-S 7`c, Le Home Improvement Contractor# ``/v 2- Worker's Compensation #/z 4 S 3/fir 3 y c) 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 Proiect Cost 6 a Fee -5-0• 0z_j SIGNATURE DATE 2(_ Lac 4 1— BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T FOR OFFICE USE ONLY \f ADDRESS 1040 Main Street VILLAGE West Barnstable, MA OWNER David & Abigail Jewell Donati DATE OF INSPECTION: - FOUNDATION FRAME .. INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING: 1 DATE CLOSED our:' ..-, vo ASSOCIATE PLAN NO¢ ► C/r � t COMMONWEALTH Z DEPARTMENT OF PUBLIC SAFETY �.. `' Codo+q latOfr OF .ONE ASHBORT6N PLACE � dtAislloa!•so• MASSACHUSETTS BOSTON,MA 02108 CAUTION EXPIRATION DATE 'I;, :- " _ . -. ._ - _ _ + RESTRICTIONS EFFECTIVE DATE uC-NO. FOR PROTECTION AGAINST ` II THEFT, PUT RIGHT THUMB " PRINT IN APPROPRIATE BOX ON LICENSE.' ;: _ BLA fy�RQTORS ImMUSt'ftl PHOTO. PHOTO(BLASTING OPR ON FEE: I .• a_s%•:r:,;_. ''��;Et`_`_ .'^,i'; i_'_.._ ... _. I NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIAUY Q 19g3 HEIGHT: I STAMPED•OR•SIGNATURE OF THE COMMISSIONER JUL 9, / 77 iI!�+II/O M"'022 a t tMtaStataBal/ L this IlQaaia. THIS DOCUMENT MUST e CARRIEDON THE PERSON G i SIGNATURE OF LICENSEE f SIGN NAME IN FULL ABOVE SIGNATURE LINE THE HOLDER WHEN EMI OTHERS•RIGHT THUMB PRINT GAGEOIN THIS OCCUPATI I` � IONEF , V� lrJ(7';77�jj�i2;47Ztl1l�e2�L n✓`� I / I r I _ I HOME IMPROVEMENT CONTRACTORS REGISTRATION Board of Building Regulations and Standards' One Ashburton Place - Room 1301 Boston % Massachusetts 02108 I ' HOME IMPROVEMENT CONTRACTOR - -- --• . ..... . ......___.._ __ __ Registration 102149 Expiration 06/30/96 Type - INDIVIDUAL I HOME IMPROVEMENT CONTRACTOR John Johnson I Registration 102149 John J . Johnson IQ Type - INDIVIDUAL PO Box 118 I Expiration 06/30/96 160 Church St W . Barnstable MA 02668 I John Johnson E/L.-,,--7f j;ohn J. Johnson ADMINISTRATOR PO Box 118 160 Church St W. Barnstable MA 02668 , - - : The Town of Barnstable • snsxerA13M • '� peg Department of Health Safety and Environmental Services Building.Division. 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner For office use only , I 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: `� "' ` Est Cost �o Address of Work: l0 Y O ,'� S 4" 4i. Owner Name: /�v J. T.' Date of Permit Application: /� 2S I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under S 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 of the owner: Date Contractor name Registration No. OR Date Owner's name 11%02'94 17:02 $61772.77122 DEPT IND ACCID 0001 C� l l tL -:- 1 OI32JY1onwe.cz i/L O Wa1.J ZCit.u6ettJ ..U�artmen�o��ndu�triaL.�1 cci . 600 Wwknfton Shn l James J.Campbell &ton, V."Aduauai 02f f 1 Commissioner Workers' Compensation Insurance Affidavit (poensec�pamQtee) .. with a principal place of business at: cc�cris�zlat do hereby certify under the pains and penalties of perjury, that: O I am an employer providing workers' compensation coverage for my employees working on this job. Insurance Company Policy Number I am a sole proprietor and have no one working for me in any capacity. () I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number () I am a homeowner performing all the work myself. I understand chat a copy of dhis s=tement will be forv.zrded to d:e Office of Investigations of cite DiA for coverage verification and that failure to secure =�e-age as recii.-ed under Section 25A of MGL 152 can lead to the imposition of criminal penalties consistine of a fine of up to S 1,500.00 and/or cr. Years' imprisor:nent as well as civil penalties in the for.of a STOP WORK ORDER and a fine of S 100.00 a day against me. Signed this day of /4 Zs 19 iri Licensee/Permittee Building Department Licensing Board Selectmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 TOWN OF BARI`'STABLE BUILDING PERMIT ;l — 9•N�S,P PMpS e s��Pt OENH��EP,M PNS Old Kings Highway Regional Historic District Committee in the Town of Barnstable fora 1995 066 CERTIFICATE OF APPROPRIATENESS Application is hereby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: n 'a"- 2�-Adefifi Yn OR Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial Other 10 'E" UG`nt 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 104 ZbL Co All) ,ZrQ2 CjS1nWLL ASSESSORS MAP-NO. � D OWNER 3)066, lt'1 ►�i AhiQC�;I J eAiJi? I-�rx,"k ASSESSORS LOT NO.�-�� HOME ADDRESS. TEL. NO. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). ZiL & A Nm 1 l- �0 ZZ V to A i n Ylt1 C C lip ca 1� ��l Ste• 10y�'1 ��2 . �n A , '1 TEL. NO. 5DB 3dP2 Ct, 25�� AGENT OR CONTRACTOR Nb iUCL'I l�C U c C1 f�f�.Ll ADDRESS �C)I4D ,Z-kP- A lily QJZ_. � DETAILED DESCRIPTION OF PROPOSEDVORK: 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). Un2 VJ� ��a }- SV-A A. �,. se � ?Bev ED _ Signed Owner-Contractor-Agent Space below line for Committee use. Received by 'Date-- y'� he Certif' to is hereby /?�v�' Date k Ii F� R s. �• �^�` h d 1 ,1 TAP _ I LB . 1� TG�yVro Ur 0Ah1V01)A0L- �i OLD KINNG'S HiGHVVAY = approval is subject to the 10 Approved ❑ IMPORTANT: If Certificate is approved, day appeal 1 Y PP Period provided in the Act. Disapproved ❑ i Town of Barnstable Old Ring's Highway Historic District Commission SPEC SHEET ' 1 FOUNDATION SIDING TYPE �� „ �c1 \ra��,r�r� COLOR CHIMNEY TYPE COLOR ROOF MATERIAL_ (��' nc \P COLOR (Zg C2�ra r ' PITCH WINDOW boje(- b 5 e ��eM< -, ,J:��.�, SIZE Cn z3 �' TRIM COLOR C r a e DOORS ZN . COLOR SHUTTERS Q GUTTERS DECK GARAGE DOORS �' �a COLOR NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each Of the plot plan, landscape plan and elevation plans, when applicable. Plot plan need not be D "Certified",but should show all structures on the lot to ® o scale. W - SPECSHT r � ��h �� , 2,e,� ��._..., su��'� '� �, c _ �.. �, l CF TN[Tp • The Town of Barnstable 4 : '""f7"" Inspection Department 367 Main Street, Hyannis, MA 02601 508-790-6227 Joseph D. DaLuz Building Commissioner November 3, 1993 Mr. & Mrs. James Kittredge P. 0. Box 267 1040 Main Street West Barnstable, MA 02668 RE: A=178 008 1040 Main Street, West Barnstable Dear Mr. and Mrs. Kittredge: This letter will verify our meeting in my office with Art Traczyk from the Planning office re the zoning of your property. The primary use of this property is retail and the assembling of fixtures is accessory to that use. The zoning district is VB-B and retail use is permitted. The decision rendered at our meeting was that a Variance and/or Special Permit was not required and the hearing before the Board of Appeals was not necessary. Good Luck 111 Peace eph D. D Luz Building Commissioner JDD/gr cc: Zoning Board of Appeals I 02 Department oflndastiial Accidents Office.of Investigations, 600 Washington Street Boston,MA 02111 •J www mas&govldia Workers' Compensation Insurance Affidavit: Bui3ders/Contractors/Electricians/Plumlbers Applicant Information Please Print Lejfbly Name (Business/Organization/Individual)' Address: P-0 City/State/Zip: 14 Phone#: 2-eed�'s� 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 ' 6 El New construction loyees (full'and/or part-time).* • have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet $ ? Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workin for mein any'capacity. workers' comp. insurance. g i g ty IN-Budding addition [No workers' comp. insurance 5. ❑ We,are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or.additions 3. "� am a homeowner doing all wo right of exemption per MGL 1'1.❑ Plumbing repairs or additions myself. [No workers' comp c. 152,§1(4), and we have no 12.0 Roof repairs insurancereq*ed.]t 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 anew affidavit indicating such ' ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. - Insurance.Company Name: Policy#or Self-ins. Lic.#: 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 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: D ate:. Phone#: Official use only. Do not write in this area,to be completed by city.or town offices 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. Pursuarkt 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." ;. - i , association,corporation or other legal entity,or any two or more An employer is defined as;: indivi¢ a1,:par�ersluP 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. How�er.t4e owner of a dwelling house having not more than three apartments and construction s therein,or,the occupant of the or repair wo Ybn such dwelling house dwelling house of another who employs persons to do maintenance, thereto shall not because of such employmentbe deemed to be an employer." or on the grounds or building appurtenant 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 thetommonwealth for any ot produced acceptable evidence-of compliance with the insurance coverage required." applicant who has n ter 152, states"Neither the commonwealth nor any cif its-political subdivisions shall Additionally,MGL chap .. §25C(� 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 sab-contractors)name(s), address(es)and phone numbers) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(L•LP)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 ons regarding the law or if you are required to obtain a workers' Industrial Accidents. Should you have any questi compensationpolicy)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 bom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant in the permitlhcense number which will be used as a reference number. In addition, an applicant Please be sure to fill that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Site Address"*the applicant should write"all locations in (city or policy information(if necessary)and under"Job tom)"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�liceases..A new affidavit.must be filled out each en is obtaining a license or permit not related to any business or commercial venture year.Where a home owner or citiz (i.e. a dog license or permit to bur leaves etc.)said person is NOT required to complete this affidavit. The office of Investigations would life to thank you in advance for your cooperation and should you have any questions, please do not hesitate tb give us a call. The Department's address,telephone and.fax number: The Commonwealth of Massachusetts . Department of Industrial Accidents 1 Office 9f Investigations 600-WashingfonStreet . Boston,MA 02111. :`Tel.#617-727-4900 ext 406 or•1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 wwwmass.gov/dia TOWN OF BARNSTABLE BA,R_W Ordinance or Regulation `WARNING NOTICE Name of Offender/Manager � Address of Offender MV/MB Reg.# Village/State Zips Businesses ame ' IJA/4 /71 P'- AO.1eA/ //"?o a�mA m- on /0/X1 20 /v Business Address 10 ` n Awt? I,v Signature-.of Enforcing Officer Village/State/Zip VF.4 ' don,VsTA-A3LG'' Location of Offense Enforcing Dept/Division Offense Z y(' ' N! s� e- /� Facts A00le Al -1.4 A, This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. 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