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1049 MAIN ST./RTE 6A(W.BARN.)
y i 1 . 10% aV" � - J �� � � � Y i!� G 09 �� �� 2 V\ . /® y� Met, SY- Commonwealth of Massachusetts Executive Office of Energy & Environmental Affairs Department of Environmental Protection Southeast Regional Office•20 Riverside Drive, Lakeville MA 02347 .508-946-2700 DEVAL L PATRICK MAEVE VALLELY BARTLETT Governor Secretary DAVID W.CASH Commissioner September 26,2014 Dr. John Doriss RE: BARNSTABLE—Public Water Supply Great Marsh Chiropractic Great Marsh Health Service P.O. Box 122 PWS ID#: 4020022 West Barnstable, MA 02668 Sanitary Survey Dear Dr. Doriss: Please find attached the following information: Sanitary Survey Report for a survey performed at Great Marsh Health Service, Barnstable MA on July 10, 2014. Please note that the signature on this cover letter indicates formal issuance of the attached document. If you have any questions regarding this document, please contact Isabel Collins at 508-946-2726 or Isabel.Collinsna,state.ma.us Sincerely, Richard J. Rondeau,Chief Drinking Water Program p Bureau of Resource Protection RAC ecc: Barnstable Board of Health Barnstable Building Inspector Barnstable Planning Board YADWP Archive\SERO\Bamstable-4020022-Sanitary Surveys-2014-09-26 P:\ic\ss\ss20l4\P:\is\ss\ss2014\Branstable-4020022 rt, This information is available in alternate format Call Michelle Waters-Ekanem,Diversity Director,at 617-292-5751.TDD#1-866-539-7622 or 1-617-574-6868 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper Great Marsh Health Services Bamstable 4020022 July 10.,2014 I Public Water System Sanitary Survey CITY: BARNSTABLE PWSID: 4020022 PWS NAME: GREAT MARSH HEALTH SERVICES Survey Date: July 10, 2014 Report Date: September 26, 2014 Surveyor: Isabel Collins Affiliation: DEP Person Interviewed: Dr. John Doriss Title: Certified Operator/ Owner Person Interviewed: Title: Person Interviewed: Title: PUBLIC WATER SUPPLIERS: Attached is a Sanitary Survey Report for the above referenced sanitary survey site visit. At the end of the report is a Water System Compliance Plan which consists of the following (checked items only): ❑ Table A - Summary of violations and Notice of Noncompliance (if violations were observed during the survey) ® Table B —Summary of deficiencies and required corrective actions ® Table C—Recommendations ® Water supplier response and certification. Within 30 days of receipt of this inspection report, .you must complete and submit the response form if your system has TABLE A—Violations and/or TABLE B-Deficiencies. Attach a copy of each completed table listing the date that. the corrective action was or will be taken by your system and all other applicable documentation. (310 CMR 22.04(12)) . 1 Great Marsh Health Services: Bamstable 4020022 July 10,2014 SYSTEM DESCRIPTION: The health center is a transient non-community water system. It is served by a 2-inch diameter driven, well installed to a depth of approximately 70-80 feet, which is pumped via.a Goulds 1 horse power centrifugal (jet) pump,' located in a basement area of the building. The jet pump then feeds to two hydropneumatic "well mate' storage tanks for ; pressure control. There is no treatment and the system is metered. ADMINISTRATION: General System Information Is this correct? Yes ® No ❑ .. �>�ma's .i""".-�p.�x�,�«'- � as.� � �i'sfi'- �„Cp a'�'Fs.:""r'q�•°i'""�-f'��: �,--'"A'4,d�n 3��"�1�,.. "�'� ,.r � i - ,.. 7"sk z�a '�2 w� ^,� ram..:= ASeason- Season+ Po ulatlono ulatlon '� � p �#Distnbutlon- PWSID¢' . � ' i . t Classy Serv�ed�(S�ummer)�n y�(Wmter�)�� Connectlons����Systems�. 4020022 NC 101 1231 25 25 1 1 Facility Address: Is this correct? Yes ® No ❑� NameAddr s uTowrililz ZipEMal Phone# Fax# Comm nts GREAT 1049 WEST 026680000'greatrriarsh@verizon.net (508) (508) MARSH RTE 6A BARNSTABLE 362- 362- HEALTH 4533 5151 SERVICES Mailing Address: Is this correct? Yes ® No ❑ - f= �PWS MarFin'gress �`� e3 .Xi �1���'�ti�rt�.�.� ...v-....'�: aiY.''k'' -; S. ERA .,� 1 c' .x: u y '3 yf^' 3n �c .` 'iz- `{ - '`" `°"" wL ,u 3 Y F x. ` .' '1 Syr , ,: *.. `u �'t r �y�" � Name Ma� ng'A dres �x dress j y Town St�a-�te �i `. ..2s�.:.,,.»..;.Sn.. __.-n_r-`!- ...i'��, ',_• .�`>.sx..''.s �ti'A.i: ':+r-m .i�,"' .�..?r� 'g x.' GREAT MARSH HEALTH P.O. BOX 122 1049 MAIN WEST MA 026680000 SERVICES ' STREET BARNSTABLE Contact Information Is this correct? Yes ®. No ❑ k � yWork or aPrima`;<:. PWStD# Ftrst MILast.� dress4 Town " State rZi ;� k" ry r`t£ 'e"z+- auzac-"tn #-'C. S' � ��': . 1 . ,. a . eE Phone# Phone#)Contacts - .-,' '=..�! �_k'.� a �. ,s.-.w �€:r.xc,...�•axix��-:x..r..�s a: X73::i:°2,��'' ..a.{f_� ���:�: � ���e �..�..�„-.� ��_�sa. s�.,a,.:.+Inc.�'x+.oa.�._ 4020022:JOHN`C !DORISS 61 POWERS DR CENTERVILLE'MA 02632 5083624533' Y Comments: None. Certified Operator Information Is this correct? Yes ® No ❑ RR Pr�mar ear tor�lnf� � ��� M. PUVSID#" Fir MILatcldress �x,Addres (g2++), Town State Zlp NO k Pho e#Home 4020022''JOHN C DORISS 61 POWERS DRI ICENTERVILLEIMA :02632 5083624533 ` 2 Great Marsh Health Services Bamstable 4020022 July 10,2014 - PWrS D#F st MILa�st osit n Li enseGracl LIc se#' Pima O;p e�rato 4020022 DEREKIS RITCHIE DW OPERATOR;3D/IT 7852/7395 4020022 JOHN 'C DORISS DW OPERATOR 1T 01 20779 Y _ _..... _...... ..................... __ . -..__.._� temDistnbutonClass s P�WSID�# Distr,,ibution�Class PopulationServed _ 4020022'VSS 251 Does the PWS have a certified operator? (Verify that primary operator listed Yes ® No ❑ in WQTS is correct PWS operator) Are operator grades appropriate for system size and/or treatment type? Yes Z No ❑ . Does the system have the correct staffing levels for the system size and,grade? Yes ® No ❑ Is certified operator or a backup operator available for emergencies? Yes ® No ❑ Comments: None. OPERATION AND MAINTENANCE: Is there an adequate spare parts inventory? Yes ® No ❑ Is there an O & M Manual? Yes ❑ No Is there a preventative maintenance program? Yes ® No ❑ Are operational records collected appropriately? Yes ® No ❑ Are records properly maintained and available for review? Yes ® No.❑ Frequency of master meter readings? Daily ❑ Monthly ® Other ❑ Frequency of distribution meter readings N/A How frequently are meters calibrated? Not done Y The Department recommends that source meters be calibrated on an annual basis. Are emergency telephone numbers posted? Yes ® No ❑ Is all critical infrastructure locked? Yes ® No ❑ Does the PWS have available an emergency response plan prepared in accordance with the provisions of 310 CMR 22.04(13)?- Yes ® No ❑" Who-performs emergency repairs? (Systems without"dedicated staff) Contractor Comments: Contractor has spare parts. _ 3 Great Marsh Health Services Bamstable 4020022 July 10,2014 TREATMENT - GENERAL: Treatment listed Unapproved treatment No Treatment ® above is correct ❑ installed ❑ • Unapproved treatment is subject to MassDEP permit requirements If a sediment filter is being utilized how often is the filter replaced? N/A For sources without permanent disinfection: Is an emergency chemical injection'port available? Yes ® No ❑ N/A ❑ Are there any unprotected bypasses in the treatment process that could result in contamination of finished water? Yes ❑ No ❑ N/A N Is information from the manufacturer available for reference? Yes ❑ No ❑ N/A N Is chemical storage, containment, and safety equipment adequate? Yes ❑ No ❑ N/A Is equipment properly maintained? Yes ❑ No ❑ N/A N Are alarms tested and adequate? Yes ❑ No ❑ N/A N Are chemical treatment forms submitted monthly as required? Yes ❑ No ❑ N/A N Are they completed properly? Yes ❑ No ❑ N/A N Is operator familiar with the treatment system and its operation? Yes ❑ No ❑ N/A N Is the treatment system providing 4-Log inactivation treatment? Yes ❑ No N Has the system experienced a loss of membrane integrity? Yes ❑ No ❑ N/A N Comments: 4-log inactivation treatment not required at this time. SAMPLING: RzTf. -,__ , ps :' Total Coliform Freqy��� 4� Kc+-..J uenc+ F> u ahn 4s. IVo�of Bacteria Samples fl r `" Freueric No ofBacteriaSam' `les°� Frei uen PWSID# �2b, q <YY �' .a.; p. 4i q c1/ 4020022 1'QUARTER 1 QUARTER Does the system have an approved Total Coliform Sampling Plan? Yes N No ❑ Have changes been made to the system (population, configuration, storage tanks, etc.) such that the coliforin sample plan does not comply with 310 CMR 22.05? Yes ❑ No N Is the system taking the correct number of bacteria samples? Yes ® No ❑ Is-the system using appropriate coliform sample sites? Yes N No ❑ Is the Isystem using_appropriate source sample sites? Yes N No ❑ Are raw water sample taps available for all sources?: Yes N- No ❑ Comments: Raw water can be sampled form storage tank drain. 4 Great Marsh Health Services Barnstable 4020022 - July 10,2014 STORAGE: Maintenance and Condition ` , StoNagm T -k yp�e�. s� TantMatenal , a Capactyr. r Last k a ,Laste-d. �SIntrutecgtnutryam akpi, CPWSIe 9e [ 4020022 TANK#1 and#2 HYDROPMEUMATIC STEEL/FIBERGLASS 29.5 EACH;N/A N/A j GOOD • MassDEP recommends storage tanks be inspected and cleaned every 5 years. Protection and Safety . ,-��-,- s. .. gya,®•�->,�. c rzt c^'�`r�'-� r �' _.!u r - a�...� 35 k` tw �..r.: d -:.0 S� 2b -•�s;a• a u ri. . sv" x apt , � , l (gh Low � xI rty . Covered �..- � Ventedl �PIN$ID �STORAGE�TAIWNAMEEIi �®v,�er�flow ,- �and� �;: .�••_�,�.:: '�w ;�:,.�� y�, �s� � Repair ,Flooding4(>�5Qft)° Fenced;? i 4020022 TANK#1 and#2 N/A Y N/A Y N/A Y Y -- -- The'storage tanks have nearby injection ports,to allow emergency disinfection. Yes ® No ❑ The storage tanks are adequately protected against vandalism. Yes Z No ❑ P)Are there any holes.or failures in the tank roof or structure? Yes.❑ No Z (2)Have any tanks been identified as subject to flooding or run-off? Yes ❑ No Z (3)Are.all the tanks protected from unauthorized entry? Yes Z No ❑ (4)IS proper screening in place on all overflow pipes and vents? N/A ® Yes ❑ No Comments: - w The storage tanks/system could be chlorinated via modification of a pressure gauge fitting located after the jet pump. PUMPING STATIONS: Pum ingStations �� ;.�.-r*-Y,:o,s,�tau� �a•1._.�,.,...,...,.,�.t..:,n,._.._._:.�;,�K ?•• . .. < •ta gPum r• tat z;y. i .�,:tJ ..Si�`"'g• ' ' � x y !�...= .,t'.�-"at`RVA *mac 3a P`4'�#ofr Wa er °�"'Emerg Motor ," )CmnlXF PWSID.,�,+xStn`= Q_t- cation E Function ru GPM P a � "Motor „Ype VAILXABIL(TY�TYPE CODE 20 F zr Pumps � TYpe i ower{? ;HP1s� s, .Named Ms s'. z-s_:...9. ''�:FY...'� .,.,+ �k+ "".W'`�• tT �".+x� {�':i, � yv xM�F` '-: 4020022 WELL 1 BASEMENT R 2'N 1 HORIZONTAL ACTIVE 1 CENTRIFUGAL y PUMP ' >.` - ❑ Are alFpump..stations recorded in WQTS? Yes ® No Is there flooding or standing water in the pump house? Yes ❑• No M Does the air/water relief valve discharge have an air.gap?N/A Yes ❑ No ❑ Are there any open floor drains:in the facility? Yes ❑ 'No Are pump stations'adequately maintained? Yes ® No ❑ - Comments.• • „ None. 5 f - r - Great Marsh Health Services Barnstable 4020022 July 10,2014 DISTRIBUTION/TRANSMISSION Has the system submitted a distribution map to MassDEP Yes ❑ No Are valve locations known or identified? Yes ❑ No How many distribution systems are there? 1 Is adequate pressure being maintained? (20-60 psi) Yes ® No ❑ The distribution system has 0 dead ends which are flushed N/A List distribution system weaknesses or problems None Date of last leak detection survey: Weekly Percent of system surveyed?: 100% Are distribution valves exercised regularly? Yes ❑ Frequency? No Is there a hydrant maintenance program? N/A ® Yes ❑ No ❑ Is there an adequate flushing program? N/A ® Yes ❑ No ❑ • The Department recommends that the distribution system be flushed twice a year. Comments: PWS has no hydrants CROSS-CONNECTIONS / BACKFLOW PREVENTION: F Cross Con ec It Ott' tatus ' , � PWSID# Does System Hare A'pprovedCross,Connecton Plan?Was X-Cprim, urveyConducted?, I4020022 Y Y NTNC & TNC only: Was a cross-connection survey conducted by a Massachusetts Yes ® No ❑ N/A ❑ Certified Cross-connection Surveyor? Surveyor Name: Derek Ritchie Surveyor Certification#: 31740 Date of last system-wide survey 2/10/10 Did the cross-connection survey reveal any unprotected cross- Yes ❑ No ® N/A ❑ connection(s)?If yes, have all cross-connections been eliminated or properly protected? Yes ❑ No ❑ Have testable backflow prevention devices, if present, been Yes ® No ❑ N/A ❑ tested in accordance with the frequency stated in 310 CMR 22.22(14)(d)? Are there Hose Bib vacuum breakers on all threaded faucets? Yes ® No ❑ N/A ❑ Comments: None. 6 Great Marsh Health Services Barnstable 4020022 July-10,2014 SOURCES: r r az ource T e andConsum = � > "st Ma c Montt ly �A�g Daitji Maz Dad FWS�i #SOU' °J /aPUGh T �oFr �oPCIrChE r �Yam'��r bra •4 rt. a �y H e �D mand Ground, Ground SURFA'GE Surf ca a EAR+ Demand D mand 4020022 1'; 100 0 0 020.13 0.003 0.00007945 0 Groundwater Sources:, Well Construction Information Is this correct? Yes ® No ❑ 7" "`.sx Gro nu `dWaterSources x.}lG w. .s".. :'.£.:.ais 'z+.k3'3-3�p�.y* `» ,}a....- T ...:_.s SoucID SourseName ? Location ' Availability#WeII T'.e De th Pump Setting Comments _YP� . P . _., 4020022 01GWELL 1 1049 MAIN STREET(ROUTE 6A)ACTIVE DRIVEN 1 85 r Well Inspection ,` 'kv • �� �, � ' � i�q �-�� �Inlell ns ectionCheckFist�� Source tD1=� earrlpstalled CasmgFtCi@#tk(ft)`In P1ts(�Y1N)?t INeU House?�Vent73ereened?Seasonal? Condition?3 402002201G': UNKNOWNN N JUNKNOWN IN JUNKNOWN . Are all wells in use approved and recorded in WQTS? Yes Z No ❑ Are all of the wells listed on the sampling schedule?. Yes ® No. ❑ Are manifolded wells reflected accurately on the schedule?' Yes' ❑ No ❑ N/A *.Is the wellhead damaged in a manner that would make the source susceptible.to contamination. Yes ❑ No ❑ See • *Are there unprotected openings in the well cap or casing? Yes ❑ No ❑ comment *Is the wellhead, cap, and/or vent subject to flooding? Yes ❑ No ❑ below Are all wells> 1.00 ft from the nearest surface water? (NC systems) Yes ® No ❑ Is the quantity of water supply adequate? Yes ® No ❑ Do any sources run dry? Yes ® No ❑ . If yes, during which periods and how is it handled? Comments: Well is-buried,;unable to perform well inspection. Wellhead is subject to flooding, see table B-Deficiencies. Great Marsh-Health Services Barnstable 4020022 July 10,2014 Source Protection: SWAP Database Information t � TNCtSjSZonellnfo� � �� g°•. dii' d.s4.Ca�t..•.�rX.it".. '"z .?.,. Sa*�C�Z-e.a.:3n .a.et.- mow., ,.;.,a,?m;G .�7!;+.•�R�`F. .'i' 4R3.c .. :f_.x.. .,r.�.,, --fin i ' ""..: .tx v ..w.::rra ... ,s+'i t me ,.w .,:rea,-S.- 3++.xrw; .:.,oft Sour•.i a fDApprovedVolume� Zorterl t Mf�PAZo�nel Determina tion � I,s�Zonel( Pollu�Uons owrrce mZone � (.ft) (ft) ' Method �O,wned? z N�'W -"1 4020022- 1,000 100 DEAFAULT N ROADWAYS,PARKIN 01G AREA Is there excessive use of fertilizers or chemicals in Zone I? Yes ❑ No Are there any known or potential, sources of pollution observed in the Zone I or IVWPA (other than those listed above)? Yes ❑ No Is there an awareness of threats and an attempt to minimize them? Yes ® No ❑ Is-protection area posted? Yes ❑ No Are source water protection measures adequate? Yes ® No ❑ Comments: None. OTHER ISSUES OBSERVED: � None Statement of Zone I Compliance ❑Your system is currently in compliance with Zone I requirements for the following.well(s): Please be advised that any modifications to the Zone 1.or activities within are subject to DEP approval. ®Please note that you lack ownership or control of the required 1( QO ft) Zone I protective radius around the following well(s): 4020022-01G If you plan to modify or expand this source or to replace any wells, you must notify DEP (in accordance with 310 CMR 22.21(3)(b), 310 CMR 22.04(1) and 22.21(10)(a)). At the time of such notification of a proposed modification or expansion, DEP may require you to comply with the Zone I requirement ®You are hereby notified that the following well(s): 4020022-OIG are in non-conformance with the MassDEP's requirement (310 CMR 22.21(1)(b)(5)) that Zone I activities be limited to those directly related to the provision of public water or will have no significant adverse impact on water quality (as specified in Policy 94-03A). To the extent possible, efforts should be made to reduce or eliminate the impacts of non-conforming uses within the Zone I. Pursuant to 310 CMR 22.04(1) and 22.21(a), you must notify the DEP if you plan to modify or expand your source or to replace any wells. At the time of such notification of a proposed modification, expansion, or replacement, DEP may require you to comply with the Zone I requirement that all Zone I activities be limited to those directly. related to water supply or will have no significant impact on water quality. Non-Conforming activities documented within the Zone I: ROADWAYS,PARKING AREA PRIOR OUTSTANDING ACTIONS NONE 8 I Great Marsh Health Services Barnstable 4020022 July 10,2014 SUMMARY OF FINDINGS Table A—Violations:None Please note that this document is also a Notice of Noncompliance(NON)pursuant to M.G.L. c.21A,§16 and 310 C.M.R. 5.00. Within 30 days of receipt of the NON and inspection report,you must fill-in the corrected date(s)and submit this form to MassDEP and the attached SANITARY SURVEY COMPLIANCE PLAN RESPONSE FORM, including all applicable attachments.If the time required to complete the correction is greater than 3 months,submit quarterly progress reports and provide an anticipated completion date. GWR AcUon Due Date _ T/F/M Citation TABLE A-CORRECTIVE ACTION Significant Complete by.: Deficiency* Date :PWS 1. 2. 3. Table B—Deficiencies MassDEP has made note of several items that do not reflect good water system practice and, if left unresolved,could lead to problems that are more serious. Some of these items may be potential violations,and are summarized below. Due to the item's severity or importance MassDEP has included a required course of action with a compliance date. GWR.. Action Due.: Date T/Fft Citation TABLE B-CORRECTIVE:ACTION Significant Complete by Date Deficiency*' 1. T 310CMR22.26 Wellhead subject to flooding. Expose wellhead and construct pit Y 11/30/2014 or extend well 18"above grade. 2. 3. Table C -Recommendations MassDEP has made note of items with a recommended course of action, summarized in Table C. It is strongly encouraged to follow the recommended actions in order to improve ability to provide a safe supply of drinking water. Failure to do so could eventually lead to violations of the regulations. VFW TABLE C-RECOMMENDATIONS 1. T It is recommended to calibrate your meter annually. 2. 3. *Groundwater Rule Significant Deficiencies: The EPA, as part of the Groundwater Rule, required states to identify specific Significant Deficiencies that are related to the potential for fecal contamination of the water system. Significant deficiencies, when identified at a PWS that is subject to the Groundwater Rule, are regulated under the treatment technique requirements of the GWR. A PWS has 120 days to correct any significant deficiencies after notification from the state of their existence. If the deficiencies cannot be corrected within 90 days, then the PWS must enter into a MassDEP-approved correction action plan, with intermediate timelines for compliance. Failure to have an approved corrective action plan in place within 120 days or to comply with the timelines contained within the corrective action plan, constitutes a treatment technique violation, as detailed in 310 CMR 22.26(4). If a system fails to correct any identified significant deficiencies, then the PWS will be required to provide an alternate source of water, eliminate the source of contamination, or provide treatment that reliably achieves at least 4-log inactivation of viruses. �- 9 Great Marsh Health Services Barnstable 4020022 July 10,2014 SANITARY SURVEY COMPLIANCE PLAN RESPONSE FORM for TABLE A & B Within 30 days of receipt of this inspection report, you must complete and submit this response form if your system has TABLE A—Violations and/or TABLE B-Deficiencies. Attach a copy of the completed tables listing the date that the corrective action was or will be taken by your system and all other applicable documentation. (310 CMR 22.04(12)) Please note that violations listed in TABLE A of the Compliance Plan are also a Notice of Noncompliance (NON) pursuant to M.G.L. c.21A, §16 and 310 C.M.R. 5.00 and may require the submission of quarterly written progress reports on the identified violations. The following corrective actions listed in the Sanitary Survey Compliance Plan(s)TABLE A and/or B has been taken by the public water system.(Please check all that apply). ❑ My system has taken ALL of the corrective actions listed within the timeframes specified in the Sanitary Survey Compliance Plan(s). • For each item, I have listed the completion date of the corrective action within each table. • I have attached copies of supporting documentation as required. ❑ My system has taken SOME BUT NOT ALL of the corrective actions listed within the timeframes specified in the Sanitary Survey Compliance Plan(s). My system HAS NOT complied with ALL of the requirements set forth in the Sanitary Survey Compliance Plan(s). • For each item, I have listed the actual or anticipated completion date of the corrective action within each table. • I have attached copies of supporting documentation as required. • I have attached a revised corrective action schedule establishing timelines for my system to address outstanding items and I will submit a written progress report each quarter(every 3 months)until all items have been addressed, at which time written documentation of completion shall be submitted to the Department. I understand that my system may be subject to further enforcement action. ❑ My system is UNABLE to comply with some or all of the corrective actions"within the timeframes specified in the Sanitary Survey Compliance Plan(s). I understand that my system may be subject to further enforcement action. • .An explanation is attached. I hereby acknowledge receipt of the inspection findings and compliance plan table(s)of the sanitary survey conducted by the Department of Environmental Protection's Drinking Water Program. I certify that under penalty of law I am the person authorized to fill out this form and the information contained herein is true, accurate and complete to the best of my knowledge and belief. Water Commissioner,Owner, Owner Representative or Other Responsible Party: Signature: Date: Print Name: Title: Return this form,a copy of each Compliance Plan Table and all attachments to: DEP-BRP Drinking Water Program,20 Riverside Drive,Lakeville,MA 02347 Attn: Isabel Collins 10 'fKE Sign ��, ; TOWN OF BARNSTABLE Permit MASS. 1 s Permit Number: Application Ref: 201301720 20070844 Issue Date: 03/20/13 Applicant: Proposed Use: MIXED USE OFFICE &RES Permit Type: SIGN PERMIT Permit Fee $ 50.00 Location 1049 MAIN ST./RTE 6A(W.BARN.) Map Parcel 178030 Town WEST BARNSTA13LE Zoning District WBVB Contractor PROPERTY OWNER Remarks REFACE SNIPE ON EXIST FREESTND SIGN-M. MASSAAD, LMT BLK ON WHITE SNIPE- GREAT MARSH HEALTH SERVICES LADDER SIGN Owner: DORISS, JOHN C Address: 61 POWERS DR CENTERVILLE, MA 02632 Issued By: ............ ARD: T T.I :. IBLE..FR M THE > ::> >.> > :`` >: ' SOS. S..C. _ ...S0. �3A. ... _.. . S. . _.. ........:.. ::.::::::..:..::... .::.:::.::..::.:.:::.:. .. ........ i e PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 03/20/13 TIME: 14:12 t -----------------TOTALS--;=-------------- PERMIT $ PAID -50.00 AMT TENDERED: 50.00 AMT APPLIED: 50.00 CHANGE: .00 APPLICATION NUMBER: PAYMENT METH: CASH PAYMENT REF: -- cl' ' oFTM¢t Town. of Barnstable' . . Regulatory Services 9� $ Thomas F.Geiler,Director ►`� Building Division -' Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.tOmbatnstable.maxs O-ffice: 508-862-4038 Fax: 508-790-6230 Permit# Building Official approving Application for Sign Permit Applicant �(�C�i�Q� Ca,_s-5 Assessors No. Doing Business As: Telephone No. Sign Location Street/Road: 1(9 4=9 n S`�- 1 A 4f �vte��� Q• e—, Zoni¢rg District� Old Sings Hrgh ''ewayP /No Hyannis Historic DistdctP Yes%1 w �� , Name: 410A,I n r Telephone: 011 a Address• 10 SJ S U.. Mage: (A 412)c"r n S �-�—" c`n b , Sign Contractor i� �y W en Name: u q S, Telephone: 214 -2 12-3(S" Mailing Address: -2j..�,n�`G i✓1 Sc !ll� SB ot,Q4 yG)M t /`? 2- (5 �f Description . .Please follow the cover directions.You must have an accurate rendition of sign with dimensions location. Is the sign to be electrifiedP. Yes/No (Note:lfyes,a wuirrgpermitis ret�zirerlJ �� width of budding face •44-5- $x 10- ' � C) x.10- Check one Reface existing sign or New Total Sq.Ft of proposed sign(s) Ifyou have additional signs please aaacb a sheethis g each one with dimensions If refacing an existing sign please provide a pichne of the existing sign with dimensions.. 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 cons ction shall conform.to the provisions of §240-59 through§240-89 of the Town of Bainstabl Ordinance. j S4mtn a of Owner/Aidprized Agent: Date 3 �/ is UL CD MARgfAT 0 UQ 0 HEALTH SERVICES o JOHN C. DORISS, D.C. •� J.TRIMBLE—Re g. Dietitian M. MASSAAD, LMT KAREN SEXTON, D.C. MUSIC THERAPY MT.ac rA MI . P.N 1049 r. 01 CD CD CD rr W hn N ~ O 0 1 T 4 i i�EALfH StrVfCES A ., tnprm.nc. G cC AA p O C�Ctgq UQ CD G y CD M n O 0— CD t� W n CD CD •J N II N n ' CD R° C CDCD II N CD N `+ O ', O YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: Fill in lease: �:. APPLICANT'S YOUR NAME/S: t--t;� CSC,( �_. rL SSA ° r BUSINESS YOUR HOME ADDRESS: 2 - 0,,. TELEPHONE # Home Telephone Number - 2/ 9 NAME OF CORPORATION: NAME OF NEW BUSINESS r( i61c, 'S k TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES —emu ADDRESS OF BUSINESS T JL + MAP/PARCEL NUMBER 1 -7 0 " M (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this /town. 1. BUILDING CO�*O FF E V � _Jv ��This individ in�r a any er it requirements hat pertain to this type of business. [�zed-Sign ture* OMMENTS: 2. BOARD OF HEALT d 6 V(j This individual has ee for _ ed of the permit requirements that pertain to this type of business. a 0M Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: ". � -^ .. •. _.N'a�.p(i.r.."r-p...,,�},. �-r..,,.�,.mn .nr .-.�-'1'?,..."+�S�wa *k`h``r+!.�+r�'+.'S`:.r"'^'�'^x S1f",r�.-�....L,P�f"d?�`'"''"^'^....-::;ir � Assessor's office(1st Floor): Q 0 Assessor's map and lot number I I ✓0 y SINE tp` Board of Health(3rd floor): ' ew �r- ♦w Sewage Permit number — /� - O . . 9 .- -�! Engineering Department(3rd floor): / t 'Da�s9rsnt,� I � WAS s House number �a •e)o• .Definitive Plan Approved by Planning Board r 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN . OF BARNSTABLE BUI101..NG INSPECTOR GY Amm APPLICATION FOR PERMIT TO ' TYPE OF CONSTRUCTION v�f�l� CG~ C�'Fs�/c �DU/S�,D.CI�/GiV d` C0�1/C'/jLr� A!.v 9 19 TO THE INSPECTOR OF BUILDINGS: J � �DUTE �A SOT The undersigned hereby applies for a permit according to the following information: ''I Location Zo;;e �1y/F �� l!//i�/7i�CdV✓-f `iV e Proposed Use ��. Zoning District Fire District �� • S� --�s,�-- rn Name.of Owner �� J�y�/ L !/ate/SS Address �X ply Name of Builder �G� ���� ��/� Address IleIL�Iiy/> U1U �G���Oa7i� M i k _ Name of Architect Address Number of Rooms /n �� Foundation Exterior Roofing Floors Interior Heating Plumbing •3,rr r ,• Fireplace Approximate,'Cost Area�/) ►�It�l e�. Diagram of Lot and Building with Dimensions 1 Fee U C Qk 1 �9126 - h LL OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 1•,hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License DORISS, JOHN C. DR. A=178-030 No 34060 Permit For Relocate Garage Storage Building Location Lot " 2, 10 4 9 -13 8 Route 6A West Barnstable Owner Dr. John C. Doriss Type of Construction Frame Plot Lot Permit Granted Novdmber 14, 19 90 Date of Inspection 19 Date Completed 19 �7 PERMIT COMPLETED INS //IDS � € f TOWN OF I ,Aeosre-ZLa A55E55OR5 MAR" 118 LOT�4jO 'ZONING: f 5ET6ACKS: FRONT: ;50'51 DES F 15 R EAR ft I r2. Hi4rHHkT pyeeHgAo EI.F.4 �n�>✓ of p�.Y'r�_ ` � � _ _ - � I l i � Z8 I ' /� I �-�'• EyCls'T /� � •j •� / /'.� ! / a.��/ \ �'' :I'.•''1 •�.ZQ''.r.'••LLB i•'•�'�J�� 7 'SST 0 T. Icooc.l `� 1 Iphtlol� ..•� -� � I �•J• y� gF L._._ aD00..kRl 5�} ;v —• � •�to��►�aiu G eta�.. ._. �/ �. � , 41 . I � MEND.: LOCUS f5AZ6TP A: comrouL . . : (PROP,)--o---¢- REF f�EmcE : ONGt.BAUNP . :� C8 Pf?EPAR I .s ca LE : ,1 =,q o� DATE .I.d�I' ;�.:yi�.�;o�. r ..a•'=�.'I� �i":lv: ''.v'q' i`. •�..r.r :�. `i�'�:�"��-�N'i`!•. ,:� '•19� V;�,�. %c�. :'r..•:t�;;yl;:�,� '•..�..� '� .�'+. ''.��•..^I'. :.i�:�l"l,•'`! ,7;•..r.;.�'�•: . •iY,.l A .... ,.. .. 1..,� .. •.a�. .�. a�•:.a..:..i .�" •/..:\,r,':}�.• %�r•:'- Application to �M cAvg `s t Old King's Highway Regional Historic District Committee in the Town of Barnstable for a C; RT.I.F:I,CATE-;OF:AFF..R.OPRIATENESS 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 viio�k'iii'desc ii'&d below and on plans, drawings or photographs accompanying this application for: E CHECK CATEGORIES THAT APPLY-. ., 1. Exterior Building Construction:•'❑ New Building. ❑`,Addition '. ❑ Alteration Indicate type of building: ❑ Othe eloeatin y g: ❑ House ® .Garage; ❑ Commercial. g 2. Exterior Painting: " 3. Signs or Billboards: •' •g ❑ New sign ❑`Existing sign ,�] Repainting existing sign I' 4. Structure: Fence `❑ ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). . TYPE OR PRINT LEGIBLY :: .. , ... •.l• _. _�� .. r.,i;.,:. . . . . ..DATE ADDRESS OF PROPOSED WORK T049"I�ia1n St': W: Barnstable ASSESSORS MAP NO.. 178 !.: . Y OWNER .Tnhn ..r _ ..,..:;;; :'��., - i.:!•;:.:I,. , :. � :r. :::: ,:,•, � '• .:. . :,. .. •... . i�nri �� ASSESSORS LOT NO. 30 . HOME ADDRESS -1=685 -Main`:St'-:•:-'WQ: ;BArnsitictblb'�'' . TEL:NO: 362-4580' Z--FULL NAM-ES'A'ND 'ADDR'E•SSE'S:UF' A`BUTTING'OWgtff.S!"fnclude'nJme'tifia�l'acerit' 'ro '`tt `bwners across ari 1 p pe y y public street or way. '(Attach additional='sheeKif hei essa�y).'i'•'''''�`::"i'�''i ''` `-= :rr;:' : ;. :; i: ;; •:�;,, •„ James Kittredge P.O: Box ass .'02668' ' Robert: J. :Olander• :,102:5- 4Mai:n-.�iStj-=-Barnstable,:i:Mass:° "02630.� John ;H. :Irwin -,C,/,.Or zrw.in, &;;Ir.wi,n �60 ;Adams •St.. .Milto ,.;-.;M;ca;::.s;;s::;. ,02187n •.:�:��:� tl.;i;is .:`Y' �. ,: 1)=,u;.;.':.:: :• ....; !1.: �i'�:ii ii'.1i i+.,i� :y;,; Walter Ungerman P.0. 329 Centerville,: , 14ass . .02632.. :, r :,a 1 1e AGENT ORar ONT ACTORwneyl P, R. .2.2, ..'... , r., .tab. :!: t. ss; .0.2,7EL:.NO: Robert P et, tengill • ADDRESS - New—F -la'..�i i�V�� arr Ma S r DETAILED DESCRIPTION`•OF-PR-OPOSED`WORK-. 76'4ll ' A 6oalp6 B other side), including materials to be used, if specifications do not accbmparly'plans'li'ri:the'case'df si4'n',"give'166ati66s-of ezistfrig"Signs and proposed locations of new signs. (Attach additional sheet, if necessary). -� �Reset �. 2?C••.,CIS:;. :-g ;:!'.i: •:::::i- ;;::•i:,;:,:i:•,,c;: :�•;•, ,,:;::r� ' r:;_:i-:-, ,.rly r:t�i'• :•:;:.�•. .::1 1��;'.il;; ,,,,.,. . stin garage on new location ,no. .,,..f,arfzom.,preY.ious :location -Prepare slab on which garage will ultimately rest l - 'Turn garage 90% .,so. that. gara,ge ,door ,.faces ,west,.,.,toward White Cap Lane ins •ea td'Irof' north toward' Paint, garage existing,.colors,. •white and black, and ra repair the 'structure.' Y Signed . - Owner-co ractor•Agent Space below line for Committee use.. Received by..H_D.C-: Date The Certificate is hereby _�/`/ �6 U'7 � Date Time Approved ❑ —'" IMPORTANT: If Certificate is approved, approval Is subject to the 10 day appeal period provided in the Act. Disapproved 177 � 1 Assessor's office n st Floor): �78-030 f �i7 G C, _ .., Assessor's map and lot number es o �. o`Tw(>o Board of Health(3rd floor): IX3 , ACE o a Sewage.Permit number -�O - �i✓� 6'I f 0 Engineering Department(3r ): E�'VIRONDOE J _ A � t ssaa9rantt J rua House number TGWN REC—w:�:AS oo,Fprtiv b��eg' Definitive Plan Approved by,Planning Board 19 . APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only •0 TOWN OF BARNSTABLE • � fZb 4 BUILDING INSPECTOR 't APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION (��/�^� 6011CIlS1/` 19 �o TO THE INSPECTOR OF BUILDINGS: '��' ( � �A The undersigned hereby applies for a permit according to the following information: (� Location 10 � �� r'(//�/�fr �� Z°ti YIY R"5; f S',;w'l/_= Proposed Use - Zoning District Fire District 5 l� Name of Owner Address Name of Builder Address z/V Name of Architect Address Number of Rooms /�� . �/ ��� Foundation C6*r 71� Exterior Roofing Floors Interior Heating Plumbing Fireplace Approximate Cost0 OCJ Area Diagram of Lot and Building with Dimensions Fee ------------------ v' 26' 76� • ,? yf 01 . Z\ OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name -� Construction Supervisor's License - `� DORISS, JOHN C. DR. r No 34060 Permit For Relocate Garage t Storage Building Location Lot #2 , 1049 -138 Route 6A , West Barnstable ' Owner Dr. , John C. Doriss Type of Construction Frame Plot Lot • 1 Permit Granted November 14 , 19 90 Date of Inspection 19 Date=f om0U§ted 19 -- �.� ! As`sessor's offioe (1st' floor): l Assessor's map and lot number ..........� � .. TN¢To board of Health (3rd floor): ( I Sewa a Permit number _� _ ing 1I Ffouseefnumbepartment Ord floor).........................................:...ba_� �n q Mon�tS. o py•a�e�' L APPLICATIONS PROCESSED :8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR { APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION .R.C!?..o.. . w ���✓ .... :................................................. . .................................. ..................... ..............19... TO THE INSPECTOR OF BUILDINGS! The undersigned hereby applies for apermit according to the following / information: Location ��y 9 1ed;°h ST;..........6')eS J L�R art ST`Ab�e..,:..M4SS:..:................................................ ................................. ...................... Proposed Use ..._ OcAors O¢41Cf .......................................................................................................................... .\. ................................... !/ �' oesf C?ei. 'SA Zoning District .W<A�.. C��^.C!? 1 Qb�c ,mae a�s.�ess „Fire District .............. �G........J ........... . .. ................................................................. Name of Owner ...`...! -...5OAI" ..... .�/,SS.........Address /6�S'... �l;n.....5 ......WrS ....L3A ns7 4/-, C n J ...................... .., ............ ....... P/e�f r��l-�-R� �4�.., �r Name of Builder ....7"!.om.a.s......%3 !+��a�!��1.........................Address r --Mass, .................................................................................... Name of Architect 7?40;�...�! !t% ................................Address ..�.�.....De,ca ..............................................ml . G/ptices cr /�jass ip .............. Number of Rooms ........ ............................................Foundation ..6,•14reC� - FkbaSC�+,e�7G Exterior ..........�-./a.P..' a!`G ................................................Roofing ....../7sotig�f...s ,:?.4.��......................................... v Floors .....W.o Interior ..... ...Ce �ce� f r,i�cq� Heating .....rases<.•........�..........................Plumbing ......... ...... .......................................................... Fireplace .......... ?.+. ..... .......................................................Approximate Cost .... �` `1� ../.rO"`� ................................................... • �Definitive Plan Approved by Planning Board ________________________________19________ . Area ...... / 1 �... ............ Diagram of Lot and Building with Dimensions Fee IS �_s ...........'........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH ILI asp g OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town, of Barnstable regarding the above. construction. ' Name ....:.....................................................•..... Construction Supervisor's license ...YI,IC . DORISS, J6HN".C." A=178-30 No Permit for ......ggM0NL.....&-AWITION .............Doctors...Office.............................. Location ........ .... ............... West Barns��4.b .......................................... j.q.......................... .,Owner ...C.....pqrj.ss............................ Type of Construction ........F.ram!e........................ 17 ............................................................................... Plot ............................ Lot ................................ Permit it Granted ...... ............19 86 Date of, Inspection ....................................19 Date Completed ......................................19 L 1ST /585 106t FOA 0 rnr I CC4S //v BM 7, "� Wee ,, ARCEL N. KEY q I CARD N PERMIT N 'REM. ADDN. YR. INSPECTION DATE LISTER TYPE OF IMPROVEMENT ' / OF / . PROPERTY LOCATION: GREAT MARS,Y CHIROPRAC7/C, /AJC, PHOTO: /Oy% MAID ST. 1r6A. wssr %ARNSrA&Li; YES NO — ; _ — E ; i i i i i i ? «...I.....:....:....: I I.....i........:....:....v. 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F I i�F' 1 : - , _ i 11 } 1 E i ! i :.....:... 1 ; , —} « p . . . . : : : : . ._............_............... . . . r . t - ..._:.....:.... ......_..._. { . . a { is � . 1 i i i _d.._ ..................... ....t....: -.....i.... ... G......... r • , ...;.._i...... r . . i 1. _ _ .-.....1.......... ....._..................... ,_.• •..... • ......... _.... •. -,-♦- } r r_-r"«._•i -t • • • r ...l_...... .. - a . — %r i � - /�. . Assessor's offioe -(1st floor): � oFTNEtc Assessor's map and lot number ...... � d... Board of Health`(3rd floor): l r n' - Sewage Permit number .... .t.1.1.. .l�..�S. ,^� ..Rs�.. ..... � 1 : BAsayTsnLe. ; Engineering Department (3rd floor): W �—�� �o rnea L�` �� Mon 7. O 1639• \00� Housenumber ........................................................................ ''tEo YAY a. APPLICATIONS PROCESSED 8:30=9:30 A.M. and 1:00.2:00 P.M. only, SEPTIC SYSTEM 'US ROSTALLED IN COMPLIANCE TOWN OF B.ARNSTA�BXTI'��� � AL C�< , P. BUILDING 'INSPECTOR APPLICATION:FOR PERMIT TO .....................................................:....................................................................... TYPE OF CONSTRUCTION ..... (n.�?.q.lw............"/.......i�!z .............................................................. /•. ...........7. .............19... j TO THE INSPECTOR OF BUILDINGS: r The undersigned hereby applies for a permit according to the following information: p /...............e h s 6/e ILf,4 ss. Location ../ ch �V` l✓..f �4�..........G? ProposedUse JE�G�OrS Once :............................................................................ .......................................... Zoning District W�s� air a6.L... ..................... ...Fire District ....: es garvtS�a ................................... Name of Owner ..........................!?...........................................Address ................... ...!9.......... . SOS VAryS0�Q6�� /u!4 . ...... ... . ....... _ ,ram Plurra4o4 Plz v ��.� Name of Builder ....7"�lP. .s.....Bec�na7/C.......................Address ..:.......9� M`gss, Name of Architect Re6.-C ...`..W. .tif ...............................Address /.y.....Deca�ur GIOtiCes , ` Number of Rooms IQ - Foundation .. Bkrep� Fa�� basEi�►c .. ............................................ ..........GIAr. a�................................... /3s.. �?1...��. /<..................................... Exterior .............Roofing .......... �°4a Floors WBvd...................................................................Interior ....,TAeeuZr`od� f uooc� ............ ................................. ......................................... Heating ,b.as6oaraC ha7� -..�DY�.. -..........Plumbing ................... .......................................................... Fireplace .......... 8!'�............................................................Approximate Cost as ©9 0 Definitive Plan Approved by Planning Board ________________________________19-------- . Area ......��c �..... . ............. Diagram of Lot and -Building with Dimensions Fee � �d` D"S ...... ...................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH S' r Iq OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding th abo construction. Name ....................C,........................................... y Construction Supervisor's License ...(57 L/ DORISS, JOHN C. 298114� REMODEL /ADDITION No ................. Permit for•.................................... Doctors Office .......................................................................... Location .......1.049...Main...S.t.re.e.t........................ ...... ........ . . .... . . West Barnstable ............................................................................... Owner ........John C. Doriss.................................. Type of-Construction ..Frame............................. ................................................ .......... Plot .................... Lot ................................ Permit Granled .... pgMs 2.1.................19 86 Date of ins-pection .........x...........................19 .2, Date COmR16ted ....... 19 UNITED STATES POSTAL SERVICE M First-Class Mail O�' ���+r .; o age& ee P it.Np:G=,1Ax-.a'f, 's • Print your name, aadres�, �r�d Code,i�.;this b."0':: Town of Barnstable Building Division 367 Main St. Hyannis;MA 02601 m SENDER: 90 ■Completeitems 1 and/or 2 for additional services. I also wish to receive the ■Complete items 3,4a,and 4b. following services(for an o ■Print your name and address on the reverse of this form so that we can return this extra fee): 0 card to you. ■Attach permit.this form to the front of the mailpiece,or on the back if space does not 1, ❑ Addressee's Address ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N ■The Return Receipt will show to whom the article was delivered and the date ., c delivered. Consult postmaster for fee. EL v 3.Article Addressed to: 4a.Article Number -acz3 2- E 4b.Service Type ❑ Registered ❑ Certified °C / A.. ❑ Express Mail ❑ Insured c W ❑ Return Receipt for Merchandise ❑ COD 7.Date of Delivery w a 00- p 5.Received By: (Print Name) 8.`Addressee's Address(Only if requested c W and fee is paid) M g 6.Sign re:(Ad ressee or Age ) ~ a°, y m PS Form 3811, December 1994 102595-97-MI79 Domestic Return Receipt i YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO BY M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 151 FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. 1 C=L-7C.at b '' - DATE: Fill in please: . a y �N APPLICANT'S YOUR NAME: Di 0)4a AJ 1 CO BUSINESS YOUR HOME ADDRESS: 20X 5/Z — ZEj7S1'1'I /�✓ S/ 73/4 TELEPHONE # Home Telephone Number: —1y16 _ Z15 D —lab iFf NAME OF NEW BUSINESS—.fN -- Z 4/l.m 6,yV Nos,c //1E214 E>� TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO C Have you been given approval from the building division? YES NO 2 /1 ADDRESS OF BUSINESS 16�J /�'�i97/y S; $y�-E C (� , 15/�l.�/S!yl�Bcc N/�,(MAP/PARCEL NUMBER �� Oil V When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S O ICE This individual has been i ed of any p it requirements that pertain to this type of business. AutFtonzed Signature** COMMENTS: 2. BOARD OF HEALTH This individual ha be r��nformed of tlye,permi re uits that pertain to this type of business. Authorized Signatures" COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual hasftinfor•p; 6of the lice si r uire rats that pertain to this type of business. Authorized Signature** COMMENTS: I � � ,CCU ism � z C �'�'' Assessor's map and lot number ....�./.lZ..`./........ ort IN COMPLIAkE Sewage Permit number r .. p,,,,. : 4sIi A � I STATE r` >� SANITARY 0(1iDE AND TOWN Qo*THETp�. TOWN' OF BA.R N , .� �� 89113STABLIL • O9a�e�0 DUI=LDIMG INSPECTOR APPLICATION FOR PERMIT TO ......:. � -�a... - �.c�......... .X.... .............. . t TYPE OF CONSTRUCTION ................. . . ....................................................................................... ........... . ..... ...........192{•- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .................................. ProposedUse ..................w..e' C�..........................................................................................................I......................... ZoningDistrict ................V.5..—B..................................Fire District .................:................................................... Name of Owner .... 2....!/N.��Cry� !v .....Address ......../ �1�..6 �;e..li!fL /.... � !V. 1.:!t' �!?' Nameof Builder .............r 19"Ir, ..................................Address .................................................................................... Nameof Architect ..............5�4! rn.................................Address .................................................................................... Number of. Rooms ....Foundation �Li¢P .............................................................. ............. ................................................................ Exterior ....... L�'/ . k / .. N.(� 1 ..........Roofing ....,.I ........ Floors ..............................Interior .................................................................................... Heating ©/�........... `0, .....Plumbing w ,M .....:............... ................... . ......................... ............ ..................................................................... Fireplace ................./vajetoo.o. ..............................................Approximate Cost .........Z?itsr............................................ Definitive Plan Approved by Planning Board ------------____—-----------19_______. Area .........67 ...................... Diagram of Lot and Building with Dimensions Fee /�:......... .............. ................... i SUBJECT TO APPROVAL OF BOARD OF HEALTH I � 1 I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........ .. ..... .......... Peter Ungerland 4 No .1.71374. .. Permit for Addit.1-on... -maa�* Location ....Rtp... ..A.: .............. r-........................................................................... ... Owner ....FR.ter..UnaPF:Ian. � f f. . Type of Construction Dmamea.................. tPlot ...........77............ Lot ................................ .i 4 0 Permit Granted ..Oct..... 15...... 19 74 I Date of Inspection .. ..1?.. Date Completed .C�2 ........... 9 PERMIT REFUSED ; ............................................................... 19 f t . ................................................... ........................ . ... ........................................................................ .'. ............................................................................. Approved ................................................ 19 .................................................................. ................ . . X �i Y�,4� ,�. :�'rif a..� J17� �,._��u��-=�.%.f. �,,,"�:`_ gr .r � -�..J��s•N.,��w n0. r."1.,,..,,..,s,�y,=N., -� ;.�._. ::.- -� Assessor's map and lot number ..../,7.0'072 ..... O JR� Sewage Permit number )?,Pg/..;�,y� ............. �oFtMETo�` TOWN OF BARNSTABLE Q Z BARNSTA13L Y BUILDING INSPECTOR Op�O PY� . • APPLICATION FOR PERMIT TO ............! ..... .........P` ..............' T �.' TYPE- OF CONSTRUCTION ................... ...�.:.!d�!1.,..f..,............................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned,,hereby applies for a permit according to the following information: Location .......................................... Proposed Use ��. ... ../..... ....... p" Q ZoningDistrict ................:�../.. 7.......! �..................................Fire District .............................................................................. Name of Owner .....,! ... ....!..........�...../ -...... .....Address �"1`' Nameof Builder ..............J-141-405...................................Address .................................................................................... Nameof Architect ..............e ,.4 .................................Address .................................................................................... Number of Rooms ............. � ...............................................Foundation ............: .................................................. r / Exterior .......� ..el .. �.A ¢.....�.....C� .../,fJ ./. ..........Roofing .........7� ....................................................... Floors , ..................................................................Interior .................................................................................... .. ...� /y .../1....il. �- k/ Heating ! Plumbing ............ ...�N.��........................................................ Fireplace ...................4" ..............................................Approximate. Cost ......... . ............................................ Definitive Plan Approved by Planning Board ________________________________19-------- . Area .........4 .0..................... .f Diagram of Lot and Building with Dimensions Fee �S' SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of.the Town of Barnstable regarding the above > construction. c� n Name .... ......... Peter Ungerland .................. ... .........& ../e......... PERMIT REFUSED ~--------~-----'~~---'—'----' � Approved .............................................. lg � --------------------------' � , ----------------------^—^^—' RovrE I 2 32.6 5 ' Q° I !- - , ot ti 70 �. oll L j �e2 IV O 4DOi r/on/ ! y 7, 1 r� S7X SST, A Sex � s 1 40,c4 r/OA/, 4� • . � y .SC/�L E � tr. ��� T4 •EXIST/,�/� ?iv,�di;i� • . 3 TOWN OF BARNSTABLE ' t SIGN PERMIT PARCEL ID 178 030 GEOBASE- Ib' •.'10485 ; ADDRESS 1049 MAIN STREET/RTE 6A- ( PHONE W BARNSTABLE ZIP - LOT 6 BLOCK LOT SIZE IDBA DEVELOPMENT DISTRICT WB 'PERMIT 53784 DESCRIPTION KLH PUBLISHING 4 SQ FT PERMIT TYPE BSIGN TITLE SIGN PERMIT 1 CONTRACTORS.- ARCHITECTS: Department-of Health, Safety and Environmental Services ;TOTAL FEES: $10.00 BOND $.00 THE ' CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE * • * BARNSTABLE, MASS. 1639. A� ED MI'I► B ILDIN DIVI ION DATE ISSUED 06/07/2001 ' EXPIRATION DATE �► Thomas F.Gede ,Director z Building Division �&0 3► Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601 Fax: 508 190-623C Office: 508-862-4038 Tax Collector " `" TreasurerpL Application for Sign Permit 7 Applicant: I�A�?L- 14 Assessors No. • k Telephone No. -7�� I� S . Doing Business As: L Sign Location �jg RN cS774�BC.t. MA Streef/Road: 10 N r' . Hyannis Historic District? Yes Zoning District: Old Kings Highway? y o o� Property Owner I S S Telephone: Name• C. Address: rnf}i w ST• Village: l�� . Sign Contractor, ? Telephone: Name: Village: Address: Description and existing��with dunensions,location Please draw a diagram of lot showing location of buildings reverse side of this application. and size of the new sign. This should be drawn on the r (Mote.-I fYes, a wirinSpermit is required Is the sign to be electrified. Yes/No (N of the owner to make this application, tha I hereby certify that I am the owner or that I have the authn ityshall conform to the provisions of Section 4- ` the information is correct and that ons the use and ctructs e4 of the Town of Barnstable Zoning Ordinance. Date: 40 l Signature of Owner/Authorized Age t: P. � ermit ;5. Size: Disapproved: Sign Permit was approved: / t� Date: Signature of Building 0 cial: signl.doc re►•.8131/98 r'• = TOWN OF• BARNSTABLE SIGN PERMIT PARCEL -ID 178 030 GEOBASE ID 10485')� ADDRESS 1049 MAIN STREET/RTE 6A ( PHONE W BARNSTABLE ZIP - LOT 6 BLOCK 1.OT SIZE DBA DEVELOPMENT- DISTRICT WB % .I ! PERMIT • y31140 DESCRIPTION GREAT MARSH, INC. jPERMIT TYPE BSIGN TITLE SIGN PERMIT 9 CONTRACTORS: Department of Health, Safety ' ARCHITECTS: and Environmental Services I i TOTAL FEES: $25.00 I BOND $.00 SHE CONSTRUCTION COSTS $-.00 ,� . y�•�,� i 753 MISC. NOT CODED ELSEWHERE * BARNSTABLE, MASS. �► 1639. I • FO MA'S BUILDI G DVIS O Y DATE ISSUED 05/22/1998 EXPIRATION DATE TOWN OF BARNSTABLE � �~ SIGN PERMIT PARCEL ID 178 030 GEOBASE ID 10486- ADDRESS 1049 MAIN STREET/RTE 6A ( PHONE W BA.RNSTABLE Z I P LOT 6 BLOCK LOT. SIZE r llBA DEVELOPMENT DISTRICT WB PERMIT 31140 DESCRIPTION GREAT HARSH, INC- PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of Health,Safety i ARCHITECTS: and Environmental Services TONAL FEES: $25.0© tNE I CONSTRUCTION COSTS $.00 t$ 753 MI SC,. •NOT CODED ELSEWERE : BARN3fABLE, MASS. III 039. UILDING'DIVISIO II BY DATE ISSUED 05/22/1998 EX.PxRATION 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 OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED I FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- 3.INSULATION, OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET I BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS •I 1 1 1 I i I 2 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVEDTHE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHSFT ATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- NOTEDABOVE. i it BUILDING PERMIT 1�lo.36 = (508)790-6227 r� q FAX(508)790-6230 Town of Barnstable , �,y.. "O' GLORIA M. uRENAS ealth, Safety and Environmental Services "fx fi TOWN OF BARNSTABLE BUILDING Biding Division ' DING SERVICES 367 Main Street,Hyannis MA 02601 d TOWN HALL 3 .q 367 MAIN STREET Ralph Crossen HYANNIS,MA 02601 ZONING ENFORCEMENT OFFICER / 5 Building Commissioner � "' `= ' Application for Sign Permit ,, J a/ C 1�orrss ��o / 8, LoI`30 . ' Applicant: n h - Assessors No. �re ov rs rp �°� - `�S . Doing Business As: � �A � �. Telephone No. -3 3p 0 -?p Sign Location StreeVkoad• ��y� q�� S7< G�eSI� /�jo+�r►s7���'Lc �l��l Zoning District: �� Old Kings Highway? e o `~ Property Owner ` Name: PTO h ti L . d7 o r;s s Telephone: ,3 6 2 Address: -31-1 -Village: Yar_r71 o 14-Z ,ov r-� t Sign Contractor Name: ��n o IAn Telephone: `S6'57 r 133 -Z97 7 Address: .60 x '1/ Village: �"0225����e G ZC9 Description 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? Yes49 (Note:ffyes, a wmmgperrmitisrequired) v 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 Tow;arnstab Wing Or ce. Signature of Owner/Authorized Ag Date: ly Size: Permit Fee: Sign Permit was.approved: Disapproved: Signature of Building Offici / Date: r � , 6�9 , �Mtr SX/ 74-Mon .:pe-CA VQ . C.C.N, j j Ift Colon►its - 7�/oh a� ,N, i - i I tv�,�TH .d yt71 sI7 'r riv 7/M J M lya/od . ...., v c �.is ,.•�.ea r� D!'rr/ r�..y ti ,as rf1 r1,lo.or s- We .•• c rl I/ "All.t I � 0 0• • o 1 �I or•ors -a .00 .os is n' °. t o. I \ o I w (rt�wirl •rr �i ODJ V � � � o �-• s►•w 1 y O � M.00,0�♦/C L R/V 6,7 d 6"0 - I .� I /s/N•r 00'Ol r IA .00.00 ./Q C� ,. \` \� • • Jj uyff �, b R. IO• A � o • 0 MI t , O ^ i p; b p b `i a w iA ' r• sr�, oD•i/a �►1 ,9, .!/' N✓N/Mi'�ds 'N 1J/Nd.�9 I NMOP . is A�L If _ t5d� i ./�,/ f ��tiui iti J` � .� L� +� f -a{i � � i� • � _ .�. .`v�� � f � �� � � .� r,� _ �� �-_ -- r� � � � I � n `" i ti .�. ,��c Y . � . s " P€•'aruid ZDTID 13502E s= Town of Barnstable -Planning Department Old King's Highway Historic District Committee s7a tO MK MEMORANDUM TO: Building Commissioner. FROM: Gwendolyn Brown, OKH Secretary DATE : � SUBJ: Modification to Prior Approved Plan A minor modification has been approved by the OKH Committee to a prior approved plan for the applicant (s) named below. The modification is briefly summarized and I have attached backup material for your records . Applicant (s). o�, �S Address of proposed Work 78i aree,,L 6)30 Meeting Date Approved by OKH Minor Modification cL,', v 1 c--1 C�o,. r hia , a r� 115 Chairman MEMOBc NOTICE OF JUDGMENT :IVIL DOCKET# SUMMARY PROCESS 9725SII 1288 PLAINTIFF VS DEFENDANT .John C. Doriss ' Cindy Haun Plaintiff's Attorney/Prose Trial Court of Massachusetts If not rep- Florence Bacas, Box 202, Barnstable, Ma. District Court Department resented by Attorney,use First Barnstable Division Plaintiff's Barnstable, Mass. 02630 address ADDRESS j PLAINTIFF'ADDRESS If not rep- Defendant's Attorney/Prose - resented by 1039A Main St., W. Barnstable, Ma. 02668 Attorney,use Defendant's DEFENDANT'S ADDRESS address ADDRESS Property Apt.# Address 1039A Xain St:, W. Barnstable, Ma. 1 TO THE ABOVE NAMED PARTIES The box marked below shows the action of the Court on the Summary Process action brought against you. On 12/18/97 ❑ by default Xr&'after hearing ❑ by agreement. i& The Court found judgment in favor of the plaintiff. 00K Possession Execution not to issue until 12/30/ 1997 09K For Rent due in the sum of $ 910.00 1= For costs due in the sum of 176.00 ❑ For use and occupation in the sum of ❑ For damages (waste) in the sum of * ® Other condition nt due for 9/15, 10/15, 11/15, and 12/15 (1/2 Month). Court finds no creditable evidence to support the Counterclaim and finds for the ** ❑ The Court found judgment in favor of the defendant.(This means that the defendant does not have to vacate the premises. ❑ The Court dismissed the claim. ❑ Other: ** Plaintiff—Defendant in Counterclaim, John C. Doriss on the Counterclaim. Plaintiff 12/19/97 JOSEPH J. REARDON Defendant DATE Judge O Signed agreement on file. NOTICE TO THE DEFENDANT If the Court has found against you,and has ordered possession,you are required (unless otherwise'ordered by the Court) to vacate.the premises by the date stated. If you should fail to do so,you may be forcibly evicted. All payments of Rent,Cost or Damages,are to be made directly to the plaintiff or to his attorney unless otherwise ordered by the Court. The defendant may,within ten (10)days after-the date of this judgment , appeal the Court's decision to the Superior Court Department ATENcON: ESTE ES UN AVISO OFICIAL DE LA CORTE.SI USTED NO SAGE LEER INGLtS,OBTENGA UNA TRADUCCION. FD= PARCEL# : .R178 030 . 01 01 1049 ROUTE 6-A 05 VBB 500 05WB 11/06/92 0311 00 C014 R178 030. 104853 DORISS, JOHN C $ ELIZABETH MAP-. / #LAND 1 28,800 30 3SITE i X 1 =100 100 71999.99 71999.99 .60 43200 #LAND 3 50,200 01 - .01 10 1BLDG.SIT 1 X 1 =100 100 71999.99 71999.99 .40 28800 #BLDG(S)-CARD-1 1 161.900 COST 353800 31 3RESIDUAL 1 X .09 =100 489 16000.00 78240.00 .09 7000 #BLDG(S)-CARD-1 3 108,000 MARKET 206200 #OTHER FEATURE 1 4.900 INCOME 284200 FIX FIXTURE U X B= 100 1227.80 1227.80 14.00 17200 B #PL 1039 MAIN- ST USE - NO BSMT S X B= 100 5.40 6.80 2038 13900-8 #DL LOT 6 APPRAISED VALUE RG1 DETGAR S 15 X 20 1975 C= 84 19.30 16.21 300 4900 F #RR 1387 0246 1827 0176 A 353,800 #SR WHITE CAP LANE PARCEL SUMMARY LAND 79000 BLDGS 269900 A TRUE COPY ATTEST: O-IMPS 4900 TOTAL 353800 ,� N CNST Goo ° ✓ o� PRIOR YEAR VALUE AND 79000 DIPECTOR OF ASSESSING 6177/279JTI03/88 A 1 BLDGS 274800 2698/233 00/00 TOTAL 353800 *NEW ADDITION30Z . .... LAND LAND-ADJ INCOME USE SP-BEDS FEATURES FOR FY1989 BLD-ADDS UNITS •ADDN COMP..Fr90 79000 4900 3300 834060 11/90 AC 3500 •60/40.......... 18 19 *RELOCATE GAR 408 000 120 120 56.30 67.56 30 80 11 90 100 90 385500 347000 1.4 6 14.0 N/S 1/91 ........ 1 .00 / 1/00.43 BAS 100 67.56 4107 277469 GROSS AREA 5529 OFFICE BUILDING CNST GP:00 18B 152 102.69 730 74964 •------33-----• N STYLE 35COMMERCIAL 0.0 18S 142 95.94 208 19956 15 ; DESIGN ADJMT 04DESIGN ADJUST 20.0 UFN 30 20.27 484 9811 ; 23 EXTER.WALLS 01WOOD FRAME 0.0 •-• HEAT/AC TYPE 090IL-HOT WATER 0.0 7 •----24----•-6-• INTER.FINISH 04DRYWALL 0.0 •-• •--13-• 7 10 ; INTER.LAYOUT 12AVER./NORMAL 0.0 •g-. • INTER.QUALTY 02SAME AS EXTER. 0.0 21 FLOOR STRUCT 02WD JOIST/BEAM 0.0 W BASE EFLOOR COVER 04CARPET 0,r 5045 ; ; ROOF TYPE 01GABLE-ASPH SH 0.0 43 •-13-• ELECTRICAL 01AVERAGE 0.0 BAS W27 N17 W28 S06 W01 S02 W10 ; ; FOUNDATION 00 99.9 NO2 BAS W06 S12 W29 N43 E04 N07 ; •-----28----• W04 N15 BAS E33 S23 E13 S02 E08 •-•-10-• ; 22 COMMERCIAL AREA C014 N07 E24 S10 BAS E04 N07 E06 S21 12 17 ; LAND TOTAL MARKET E13 S22 . . ; ; ; PARCEL 79000 353800 •-----29-----• ♦----27----X AREA VARIANCE .0 .0 m STANDARD 50 d S TOPOGRAPHY 1 LEVEL • TOPOGRAPHY • UTILITIES 2 PUB WATER • UTILITIES 4 GAS • UTILITIES 6 SEPTIC ST FEATURE 1 PAVED • ST FEATURE • ST FEATURE • ST. COND. • TRAFFIC 5 DWELL X NUISANCES f LOCATION • AMENITIES • AMENITIES • NUISANCES i f TO ALL NEW R INESS OWNERS DATE: Fill in please: a . .a �•S �X,U. APPLICANT'S , a YOUR NAME: m�64_- e T— /fiC_C_ <<«� _ BUSINESS f YOUR HOM§ADDRESS: Cam( TELEPHONE u Telephone Number Home ,50 SI•..3 CD Z - S_G ... ,,; ,: I::: _,:.,.r ., r., ..,r .. .r r r•a !/� ,�.,, ,ra,:i''i!La;';:i}u a.,,i r„A.L 4..,..r: i ,I i' ! iNA .EW.�,.._r... . .,.. SS .r EMU.... ....: ......:.... �.{� ., :.:a:,. ....m....!.... ... r.._. /1 r ... .. i.4iir!L. ..! . yy �... !: li�t.n„�v'.i •'a' Vi j�`..: ,......u, .._,v Ir .,! L:I,,, .r,•v.._.. a...l ..,. .. v.... ..... la. .1.,ar. .... ..J ,.r ... , 1 .L � ... ..: .,. 1 : ,.. ., :... : _ ..,:, n ...... :: , 1 :,.�.,...I,,,...n,I ..f ..I.::I.I:.. .L rl4lvl.. .r,!•,:,.,I.. ii!r ..... _. _. .. ... .. .. ... .. .y .. .. _..r. ., Q....._............ ,I. r.r.... . the.... /'� , ....._r_:.........�..�Y: ,.,. � ...,. ....,�, 1 :._:.... ...., r,...:. _ _,... ..._..._ ...... .. ..... ,......_............. .. a. ......,. . ....u......_.. ......_.. ...., ..L. .:.... ..... .. .: t ,.-rl;..,t;6':!ifi::ai'1:5,:::!.e!i�!:.x'•a'.,...... ... .,. .. ... ... .. .._..... ,.._......_....,. �., _� ......, ._. ...._,.r,.,.._.....:._._....__ When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St.— (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIO R'S OFFICE This individual ha en inf r ed of any permit requirements that pertain to this type of business. t rized Signatur COMMENTS: 14,A r IP9J 2. BOARD16F HEAFeinform4d This individual has b �thermit ments that pertain to this type of business. Au t zed Signature" COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature" COMMENTS: Business certificates (cost $30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. "SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map / Parcel 0-3 Application# DLO /ry Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. Permit Fee L Date Definitive Plan Approved by Planning Board © PC Historic-OKH Preservation/Hyannis ll Project Street Address ` -Y 1,�Gl/P7 Village k`cs7`' 43arhf Al Owner Toll .e �)n �lSS Address Telephone &o-0) 1YIS- SS 9-3 Permit Request �di0��Q /'7 AA A /T 11 fC ccme� J Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 00-0 Construction Type rc-4t r l /91,aA � Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure / D — /9649' Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas x0il ❑Electric ❑Other Central Air: ❑Yes �No Fireplaces: Existing 8/9n P New Existing wood/coal stove: ❑Yes XNo Detached garage:X existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial Yes ❑No If yes,site plan review# Current Use 3,12w/ Proposed Use BUILDER INFORMATION �r' P/4 Name eedxr w045 Telephone Number g r^1 7 Address PC 6 o k y 7 7 License# 5- Q� 1NI ��D y Home Improvement Contractor# Iq I.0 • I g5pq 6 M q Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO t�l�S� •ex ✓esS �-4► Sol 77 S• 000 }�SIGNATURE DATE 27 10e, �> FOR OFFICIAL USE ONLY y; i PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: r , FOUNDATION i FRAME INSULATION FIREPLACE s ELECTRICAL: ROUGH FINAL F• PLUMBING: ROUGH FINAL GAS: ROUGH FINAL; N FINAL BUILDING — - ,t DATE CLOSED OUT ASSOCIATION PLAN NO:- 1 ne t,ommonweacrn of lvlusaacnu��us Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 •`� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plu'abers Applicant Information J w Please Print Legibly Name (Business/organizationadividual): C t,�, s �r Le S 17, A , C e— oLA wOY S Address: City/State/Zip: M 02 C,G^ hone#: U Ca 4 b i I -7 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a with 4. ❑ I am a general contractor and I employer 6. ❑ New construction gmployees (full and/or part-time).* have hired the sub-contractors 2.E�I am a sole proprietor or partner- listed on the attached sheet $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.[t�`Other Ze — (ZaoC comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the 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. n Insurance Company Name: Policy#or Self-ins..Lic. #: Expiration Date: Job Site Address: I oil°� (2+ A City/State/Zip: W' k90-1yv0S, 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. 1 do hereby ce • er the pains and p alties of perjury that the information provided above is true and correct Signature: Date: 7 / -7 A S Phone#: 6 11—7�� Official use only. Do not write in this area,to be completed by city or town official. I City or Town: Permit/License# Issuing Authority (circle one): 1_Board of health 2-Building Department 3.City/Town Clerk a.Electricai inspector 5.Plumbing Inspector 6. Other i Contact Person: Phone#: Information and Instructions '. t 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-contractors)name(s),address(es) and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom. of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that.a valid affidavit is on file for future permits or licenses. Anew 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. 1617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mzss.gov/cha ` Town of Barnstable �ot,NE,oy� , Regulatory Services = Thomas F.Gener,Director �j°�FD►u►��10 , Building Division.• Tora Perry, Binding Commissioner 200 Main street, $yannis,MA b2601 ww mtown.b arnstable.mams )ffice: 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 authorizes�1/'/1i`�res oz�Q� �.J / S to act on my behalf, in all matters relative to work authorized bythis binding permit application for, 614 (Address of Job) e of Owner Date I OW4 Print N=e Q:F0RMS:0WNERPERM1SSI0N Application to.. Old Kirig's Highway Regionaff4' tocic District Committee in the Town of Barnstable for a CERTIFICATION.OF EXEMPTION YApplication 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. . TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK /®y ( �'nS.V 4)r learh ASSESSORS MAP NO. Z �� OWNER v 0�h C. D D rys S ASSESSORS LOT NO. HOME ADDRESS 6 l {'_D>n/Crs t`. �r t/rli� "/TE.L. NO.C`5��1 yQr�� AGENT OR CONTRACTOR (?4-06 - ""WAS ADDRESS � ® 9� la?7 �O, �Zn�Js TEL. NOCZov �y�^ ��ff 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, shove- ing location of existing building. To 4ear. .c4 q- r-eplg4e s�n�les )h d� �rezL.,ew;t mrq° Z�q sl rt b�.rla0ri Goh, lem4,4 • V � p v �zz , 7�Ps C . -J4r`.,s'-� e yolqC kJ?, d�rs II W e + isi�ltva� �' 1n�a0a'jc c S'er%es C SIGNED Space below line for Committee use. . Owner•Contracter-Agent j R ,� Certificate is hereby a Tt 0 B T��OW OF BARNSTAB Approved ❑ :' —. The categories of worlAntitled to exemption are listed on Disapproved ❑ the back of this form. V RightFax Norcross 7/31/2006 9:29 PAGE 003/003 Fax Server ....... .... ...... . ........... DATE I M M,\bb\ A4154RD. .......... ............ .......... ............ ............ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORM! PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ROGERS & GRAY INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 434 ROUTE 134 ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. P 0 BOX 1601 COMPANIES AFFORDING COVERAGE SOUTH DENNIS MA 02660 COMPANY 26F ff A MRTFORD UNDERWRITERS INSURANCE C=ANY INSURED COMPANY YERKES, CHRISTOPHER N. DBA B CEDARWORKS COMPANY P.O. BOX 1277 C SOUTH DENNIS MA 02660 COMPANY D .......... .......... ............ .......... .......... .......... .......... x THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD •INDICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. • Co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LT R DATE(MMI DATE(MMI GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE=OCCUR. $ PERSONAL&ADV.INJURY OWNERS&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one tire) $ MED.EXPENSE(Arty one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMB ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per Accident) PROPERTY DAMAGE $ IGARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ H AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND STATUTORY LIMITS A (UB-3774B94-2-05) 10-15-05 10-15-06 EMPLOYER'S LIABILITY EACH ACCIDENT $ THE PROPRIETOR/ P INCL DISEASE—POLICY LIMIT PARTNERS/EXECUTIVE $ OFFICERS ARE: X EXCL DISEASE—EACH EMPLOYEE Is 100,000 OTHER MCRIPTION OF OPE RATIO NSILOCATIONINEHICLES/RESTRIC'nONS/SPECIAL ITEMS I THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. NMI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE GREAT MARSH CHIROPRACTIC LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 1049 MAIN LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. WEST BARNSTABLE MA 02668 AUTHORIZED REPRESENTATIVE ............ ............ .......... ............ ............ .......... ............ . ....... ....... . ............ .......... Iwo........ A 11""I 'll I Z 203 496 4%2 us Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent Stree Number /o Post OffiDze,State,&ZIP Code '20 . Postage $ _ Certified Fee Special Delivery Fee Restricted Delivery Fee Ln Return Receipt Showing to Whom&Date Delivered n Return Receipt Showing to Wham, Q Date,&Addressee's Address oTOTAL Postage&Fees $ M Postmark or Date 0 LL 07 a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). ai 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) return address of the article,date,detach,and retain the receipt,and mail the article. u) 3. If you want a return receipt,write the certified mail number and your name and address °) 0) on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. GGo 5. Enter fees for the services requested in the appropriate spaces on the front of this M receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. o LL 6. Save this receipt and present it if you make an inquiry, 102595-97-8-0145 a I i lJ� 1 , Y �; '' �I 'V IME T ■AFexsTABLF, Mass. The Town of Barnstable 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 December 4, 1997 Mr.John Doriss 1049 Main Street West Barnstable,MA 02668 RE: 1039 Main Street,West Barnstable,MA Map/Parcel-178/030 Dear Property Owner: A review of our records,including the permitting history of 1039 Main Street,West Barnstable,MA,as well as the Zoning Board of Appeals records indicates that the use of that address as anything other than a single family home is illegal. You are hereby ordered to discontinue the use of the above referenced property as it is now being used and restore it to a single family home. You.are to accomplish this work and notify this office to inspect within 14 days of your receipt of this letter. A building permit must be applied for to redesign the layout to accommodate the conversion. You must do this before you make any changes. You have the right to appeal this decision. If you so choose,we will be more than happy to help you. If we do not hear from you within the 14 days,we will be forced to seek criminal action against you. Very truly yours, Gloria M. Urenas Zoning Enforcement Officer GMU:lb CERTIFIED MAIL Z-203 495 452 Q960712B 718 Pal RUG 27 '97 14:53 qmT MARSH CHIROPRACT'YC 1049 )WK 6TREBT WEST BAUSTABLE, 'MA 02668 Job= C. Doriss, D.C. 508 362-4533 Town. of Barnstable Buildinc Services Attn. Gloria M. i John C. Doriss owner of 1039 Main Street FROM: VAX NO. (508) 362-5151- Three .( 3) No. of Pages to Follow; ?dote the enclosed letter to ui COMKEWTB: 8/27/97 DATE: - 367 Main Street, HyannisMA 02601 7t,ornu a Mexo++,Ra,cHo DV dor of Public Health yAX. sos-790.b1ss�08.7g0.6704 July 23, 1997 PAX: John Doriss 34 Amy Lane 02675 Yarmouthport,MA SANITAR NOTi WE TO ABATE VIOLATIONS OF 10SESs r�itlHUMAN jl 13 TATIONY CODE lI MINIMUM STANDARDS Or rIz N AND TIIE T WN OI?BARIYSTAI3LE 1t NTAL OIt,D1NAN EAR"I1CLL 51 ��i'` you located at [039 Rt. 6A, W. Barnstable, was inspected on July The property owned by y Cade a because o a 22, 1997 by Edward Barry, Health In i 105 CMn 10 A State Barnstable, tart' complaint. The following violations Minimum Standards of Fitness for human Habitation were observed: Broken glass panes at half window. The floor of the back bathroom was 4I0_500' p�3 + not secure to the floor joists. e The tem erature of the hot water was only 90 degrees farhenheit. al0,190; T p d a1� q 41U.r The heating unit in the dishwasher was malfunctioning. ! w a poste which provided the owner's 41_Q.481: There was no 20 square inch sign p name, address and telephone number. You are directed to correct the above listed violations within seven (7) days of receipt of this notice. same these violations may request a hearing if written petition rdcc�StTegeived 1 Howeverd,by the Board of You days after the date ornat Health within seven (7) y r a hearing, Please advised t, mu st be corrected regardless r any rega finueste of not more than $500 be Each separate day's to comply with an order could restalt In a In failure to comply with an order shall constitute a separate violation. HE B ARD 01 HEALTH h� �J s-r'ys-s , Z PER ORD R 0 ��z ��,��eT ft'e�'' !�v �.� T McKean Director of Public Health �rnO Flo 09: 5tscoy Gendron P90110 Neelth Qlvisien Town of 8a riftle R0.M04 Hpellgl%MMMUM M01 • John C. Dojeiss 34 Any lane rt i Yarmouthport, Mass . 02675 July 26,1997 Dear Cindy i�aun: This letter is intended to serve as your i official l noticedio of mY inentintention to quit our residence agreement , regarding T.,..ra ,nnrrc+.ahl e. Mass . in acco! tdance Wi th terms at 1039 A Mainz:�'Lret�L of our rental agreement made on February 15 , 1996 , follows the september completion date, we have operated on a month to month basis . The situation has now arisen that I will need to retake the space for another use. you can -refer to paragraph #2 of the lease that is enclosed . The end of the month to month lease agreement would then fall on August 15 , 1997 . Considering hthe nature of Cape Cott you may take until september 1 , 1997 to vacHte twill be prepared to give, a favorable reference regarding you as a is aival of the tenant . The reason notmfoatfailureterinion ofatoemakerementrentarrpayments. end of the term. It is Sincerely, 1 also wish to receive the •ccmputo Item and/or z for addWonw senArAs. following services(for an •Complete nemo 9,4a,and 4b. extra too): •P*4 yoyurr�namo alb wwma on the moons of cyie form so Inert we can return this rCard to 4 terra to the front of the mellpiooe,cr on the back If W806 dose not S•O Addressee's Address a •PWI*L R odpt RoqueettMe on the maUpleee below the edge numbs{ 2•❑ Rtsstricted Delivery •She rietta"Reootpt W show to whom dto aAlde was deumw and fhe dau consult posumter for f99. 3 Article Addressed to: 4a ARlcle tdu�er tjr 11 a��, .� Y � 4b.Service Type //'��!!!/�.1 �,�/ p RegWred eCertifed91 tLZ �'I"'r' e— p Express Mali insured �Q-3 Q r_4� �j 0 Rehm Receipt for Me se Q coo 7 �'7� 7.Date of Dell ede y:(PrMf e tgsaee sae Onty requeated and fee Is paldf (Ati ressoa or Abe PS Form 3 11, December DoFe-9 is Return Receipt. i .y • ww_ 1 � JOF � t � t J t TOWN OF BARNSTABLE BUILDING DEPARTMENT COMPLAINT/INQUIRY REPORT Date Rec'd By Assessor's No. Last Name First Name ORIGINATOR Street Village State Zip Telephone: Home vf! -9L3D Work Description: _ COMPLAINT INQUIRY Requestor's Signature _ y. COMPLAINT Street Address LOCATION A= OFFICE USE ONLY INSPECTOR'S Date / Inspector ACTION/ _ ./ COMMENTS �Q/��/CS i97 Gam ✓ 106yc �14�� y�;��a/���✓7`1�'�iy C'�/��GG��7/ib'd/�a7%!'� . FOLLOW-UP 2l �i✓�if/>S 7ad�/7/7�J,U 7d rt���/ri'.�i�iY ' ACTION ADDITIONAL INFO. ATTACHED COPY DISTRIBUTION: WHITE - DEPARTMENT FILE YELLOW - INSPECTOR PINK - INSPECTOR (RETURN TO OFFICE MGR.) MISCl STATE PA L PROPERTY ADDRESS I I ZONING I DISTRICT CODE SP- DISTS.I DATE PRINTED I CLASS I PCS I NBHD ,1049 ROUTE 6—A 05 VBB 500 D:5WS 07 9 9" LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS TY UNIT -ADJ'D. UNIT Land By/Date Size Dimension LOC./YR.SPEC.CLASS ADJ. COND. P PRICE PRICE ACRES/UNITS VALUE Description D Ct R.I S S♦ J Co. FF-De Ih/Acres E ..#S L D G(S)—CARD—1 L 30 3SITE 1 : X 1 =10 100 58999.9 58999.99T .60 35400 #19LDG (S)—CARD-1 A '1 0 1 BLOG.SIT . 1 X ` 1 =10C 100 58999.95 58999.99 .40 2.3600 #LAND N 31 3RESIDUAL : 1 � X , AS =10C 489 . 11800.00 57702.0 .09 5200 #LAND _ D #PL 1039 MAIN ST FIX FIXTURE U X '. 8= 100 1227.8 1227.80 . - 14.00 17200 S #DL LOT -6 A — . NO SS MT S X t 8= 100 5.4C 6.80 2038 13900-8 #!RR '1 387 0246 D RG1 � DETGAR , S '15 X 20 197. • C= 80 . 19.3 . 15.4 . _ 300 4600 F . ##SR WHITE CAP LA D i ' A U T S A T M I E E N DEED REFERENCE Type DATE A T Book Page host MO. Yr T S I 6177/279JTI03/88 U 2698/233: bO/00 I I R E BUILDING PER S LAUD LAND—ADJ ' iNCOp?E SE SP—BEDS FEATURES SLD—ADJS U NIT S Number Date T 87000 4600 3300 B34060 11/90 A Const. Total Vear Built Norm. Obsv. Class Units Units Base Rate Adj.Rate A t Age De- Con'. CND Loc 4ti R.G Repl Cost New Adt Repl Value Stories Height Rooms Rms Bath 40B 000 120 120 65.80 78.96 30 80. 14 87 8.0 67 449991 301500 1 .4 6 Description Rate Square Feet Repl.Cost MKT. INDEX: 1.00 IMP.BY/DATE: / SCALE: 1/00.4.3 ELEMENTS CODE CONS S SAS 100 78.96 4107 324289 G RE OFFICE BUILDING CNST NP:00 T 188 . 15.2 120.02 730 87615 *------33-----* N STYLE - - _35COMMERC R 18S . 142 112.12 208 23,321 9 15 ! " DESIG 1 ADJ IT 04DESIGN U UFN 30 23.69 484 ' 11466 ! " 23 E)('TR®MALLS 03 r1fl0U fR —* ! HEAT./AC TYPE 09 :IL—RIOT *----247---*-6—* . IN'�ER.PIIViSH 04 RYQALL T *—* *--13—* 7 10 ! " IN'TER_LAYUUT 12 A V R .I W U ! *8—* * ! ` INTER kl:fV-, -_02 AME AS + ------- R 21 FLOOR STRUCT 02 D JOIS F . A D W ! SASE ! E LOOK tbWA-- 04 ARP ET L E Total Areas Au: = Base = .5045 + ! X a_{'�F IY_P --- -07 'A8C_E_—A BUILDING DIMENSIONS 4.3 1 3—.* _L E C T R.i C A L J 1 V E R A G E T SAS W27 N17 • W28 S06 W01 S0:2 W10 F 0UAi6AT104 u0 ------ NO2 SAS W06 S12 W29 N43 E04 ' N07 28— -- W04 .N15 SAS E33 S23 E13 S02 E08 ! " *-*-10—* ! 22 -----OORTMH]:AL -AAt -CD1 L N07 .E24 . S10 SAS E04 N07 E06 S21 ! 12 1 .7 ! LAND E13 S22 ! F ! ! PARCEL ' 8700 *-----29-----* *----27----X AREA VARIANCE +1 STANDARD ATION NL�MBE -' KEY NO: 1 n48153 WC 8 ELIZABETH MAP- 8 0.r 9 0 0 CARDS IN ACCOUNT 1 2'1.3 0 0 01. ;. OF 01 _ 34a800 COST 393100 521r' 200 , ARKET : INCOME 289200 " USE 827 0176 APPRAISED VALUE E C 2890- 200 .. PARCEL- SUMMARY ' AND 87000 LDGS 301500 —IMPS 4600. TOTAL 393100 CNST' Recorded R.IOR YEAR`' VALUE D Sales Price AND 8 7 0 0 0 A ' 1 3LDGS 202200 .- OTAL 289200 IT NEW ADD.ITION30% A",eo"' FOR FY1989. ..- .. ADDN ' COMP. ' FY90 C 3500 6 0/4 0. ::..-.== afi:. Pa„y.aIIF.c. WRELOCATE GAR 14.0 RUCTION DETAIL IAL ADJt7S7 20.0 Al E------- D,0 bfA7ER --- Os0 0.0 ORMAL ---- 0.0 EXTERs 0.0 V t-A-K--- 0.d . SPH Sii--- 0.0 0.0 09 ---------- TOTAL - MARKET MARKET 393100 +0 50 • a 1*� �� • • •ff t • • • }: ' • .1. .11. .: svajkL IS •Iwo 1 -7 • 25-2) ! • . . .. ILA r i �� • A /- / CAI tLA r AL I ON �- • / � I "Ai ow LAU �.� I u �� may♦ NA Man- INTOVE Ingo ripp iA ! i •Ir•I' • •1. :1. �J � loll I o _ �� • _ c ' A.& �. -, IMAM- MINA • :22Y?Y:•:•;•:as^"2,`Y x:'zi;,w:;:x?^;x?a"?x??m.'x„`::Yiz?xYruxix?ixzzx?zzk?2?Y{xzc;;w}„+czraiix?x;2?„?a;?xhzx;:;c2Yi;;yw2z;sz2:???x:;xi?^^??:zY;?zxk;, „zrz„'^;:`;zkzzzxr::?x?:`a:Y;z;."�::ru,w tt`Y;k?;?`: xz,axz.w-nMwa:w::.nw:,•::: n,,:,,r,,,vn:.naaya:..,.:n:: .,...tu.a,:n.nz`.^,::za: ,.,•,,:nwww,xu,2>.za,wzx ? a^•z••xi 2xzzxr ?K,?xk :z µ? 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I 7 7 / `7 i �AA3 i Health Complaints 23-Jul-97 Time: 10:55:00 AM Date: 7/21/97 Complaint Number: 917 Referred To: EDWARD BARRY Taken By: Fred Stepanis Complaint Type: CHAPTER II HOUSING Article X Detail: UNSANITARY.CONDITIONS Business Name: next to Great Marsh Chiropractic Number: 1049 Street: Route 6A Village: WEST BARNSTABLE Assessors Map_Parcel: Complainant's Name: Steve Haun Address: Telephone Number: (508) 563=9303 Complaint Description: Steve's daughter and her family living in this apartment. No hot water. Oil burner with exposed wiring in hallway. Actions Taken/Results: Investigation Date: Investigation Time: C- 1 Map Parcel Permit#• Date Issued Fee Engineering Dept.(3rd floor) House# �� [yxy! IKE BARNSTABLE, a MARS. 19 *6 o WN OF BARNSTABLE /0 Building Permit Application ' P of reer�Address _ • Villa , �t f'i►SD�c� Owner r 4 n r D'o/-Isy Address 4,)e Telephone Permit Request y g r r- o e a� o � 44 'a Ge rove 1e Al �LD�✓M i ftt a 4V 44o /refs J�V^l rcca1-Js Ar411194-o' 645�1.11ly _c� First Floor square feet Second Floor square feet Estimated Project Cost $ � Zoning District Flood Plain Water Protection Lot Size Grandfathered ? 'Zoning Board of Appeals Authorization Recorded 'Current Use 6?z S ty Proposed Use 'Construction Type bAgf w �:, Commercial Residential Dwelling Type: Single Family J C.f Two Family Multi-Family Age of Existing Structure akjVL lea o Basement Type: Finished Hi oric House g Unfinished ti GA/,u Cam Cc' - Ol I 'ng's H a�G "h Number of Baths / ��L No. of Bedrooms Total Room Count(not including baths) First Floor 3 Heat Type and Fuel PI 4al)-44r- - AV Central Air " O- Fireplaces - Garage: Detached y'ef Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name �Ce. � Telephone Number. Address License# 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 SIGNATURE DATE BUILDIN P IT DENIED FOR THE FOLLOWING REASON(S) s FOR OFFICIAL USE ONLY PE_ M NO D SU M / R LNO. ADDR S f ; VILLAGE { OWNE t DATE F I SPECTION: ' FOUN AT N , G FRAME ' INSULATION;' - i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING J t DATE CLOSED OUT ' ASSOCIATION PLAN NO. • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE Z 'l5✓ �(� JOB LOCATION / 9Ch f �e�� dqr,,fA4d �S�i .,�• .y ). Number, Street address Section of town "HOMEOWNER" Q-p`j h o r1 sf C S P Name y Home phone Work phone - PRESENT MAILING ADDRESS Ci. y town State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(s)• who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period .shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form acGeptAble to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109. 1.1) The undersigned "homeowner" assumes responsibility for compliance with the Stat Building Code -and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minim inspection procedures and requirements and that he/she will comply with s procedures and re re en s. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING 6FF ZIAL Note: Three. family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. The Commonwealth of Afassachusetty _=f:::: Department of Industrial Accidents :s office oflavestl9at/Ons 600 fl ashinaton Street •: +' Bunton,Alas. 02111 Workers' Compensation Insurance Affidavit """"' Please PR11VTle�rbly ' - �l location: /03 ,'17 s / cif ��s/I-/— AA r-rt f' A�aff nhonc#! C��� G Z — KS33 1 am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this job. comps nnme• CJ`/ �ci�7L /"1Qrs� hl�roeno U/1-� . . address Sit) � n " � �Or�I/'"ti�G� I'll DL6Ghonc#• insarince co AJpre-:!S ITC I-- -r policy# AC 3S— 1 a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the f owing workers' compensatio olices: com •t n n\MC policy -1.�`�u.�s+... ., -•- Mrn• c.-rc•os-��"'-�rnte•«fr..*s�:s�p"' ''xatirs+ag�II�'.91R'�ii[%"'°':1'�547�='3�;:r�"�"'r�ry.,'w��*a•'!�''..'_^':'�s c6moanv e• ddress• city phone#* insur•tnce co policy 4 :Attach additional'sheet ittieeessaty��::,i��.: :.'1^s o":. t'tr t sfrrr{r.-.�.:.;:T.y��•�� : .:e.rF:.�i w ._:rY. ! —` '•�'-�.r "� .'.�V�� 1--•--- � 2..a►.,w.�r.o. Failure to secure coverage as required under Section 25A of 51GL 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 NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a Copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verification I do llereht certij• nder die us an/d penalties a uq• h t the information provided above is true and c`orrecL l� Date �/ 2.0/lam Si-nature ` -z-- Print n c Joh B.r, r-r Phone# 6 1- 0 icial use only do not write in this area to be completed by city or town official city or ton: permit/license# nBuilding Department Licensing Board check if immediate response is required Selectmen's Office 011calth Department contact person• phone#t;. nUther •r Imised V95 PJA) �� � � ���--� r� �,�,.eh� .� _� . �, --- J r The Town of Barnstable . g Department of Health Safety and Environmental Services 16-3 Building Division 367 Main Street,Hyannis MA 02601 Ralph Office: 508-790-6227 Building Commissions F= 508 775-3344 For office use only Permit no. Date AFFIDAVIT HOME MOROVEMENT 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-adsting owner o=ipicd 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,tors,with certain e:ooeptions, along with other requirements Type of Work:a►f- Est. Cost Address of Work: l g Rig `�i� �i✓ /y� OR•ner.Name: vl 3 r tt J Date of Permit Application: 2 9 I hereby certify that: Registration is not required for the following rzason(s): _Work excluded by law ob trader S1.000 Building not owner-occupied I/ Owner pulling own permit Notice is hereby given that: CONTRACTORS W ONERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED FOR APPLICABLE HOME IMPROVEM[EN i• 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. cJ6�� Z, d/,tl tJ OR ' C_ Hate Owner's name; The Town .of Barnstable A�o �a Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner May 11, 1998 Dr.John Doriss Great Marsh Inc. 34 Amy Lane Yarmouthport, MA 02675 Re: SPR-087-97 Great Marsh Inc., 1049 Main Street (Route 6A)W. Barnstable (178/030) Proposal: Establish a professional office for therapeutic massage. Dear Mr. Kelly, The above referenced proposal was reviewed at the Site Plan Review Meeting of May 7, 1998 and approved under Section 4-7.4 (2) of the Barnstable Zoning Ordinance with the following conditions: • Applicant must install 3" - 12" address numbers after Engineering Department makes address determination. • Site inspection with Fire Chief to note any fire hazards. • Applicant must seek OKH approval for shed. • Office use only. This proposal allowed in the district and an intensification of use. On site parking is adequate. The concerns of the Health Department regarding the septic system were resolved. The concerns of the fire department were addressed with the conditions set forth. Please be informed that a building permit is necessary prior to any construction. Upon completion of all work, the letter of certification required by Section 4-7.8 (7) of the Town of Barnstable Zoning Ordinances must be submitted. Also, all signage must be discussed with Gloria Urenas of this Division. Should you have any questions, please feel free to call. Respectfully, Ralph�Crossen� Building Commissioner i f� \a 1 o Commonwealth of Massachusetts Executive Office of Energy &Environmental Affairs Department of Environmental Protection Southeast Regional Office•20 Riverside Drive, Lakeville MA 02347.508-946-2700 Charles D.Baker Matthew A.Beaton Governor Secretary Karyn E.Polito Martin Suuberg Lieutenant Governor Commissioner April 7,2016 Mr.John Doriss RE:BARNSTABLE-BWSC 1049 Main Street Release Tracking Number:4-0025935 Barnstable,MA 03560 Commercial Property 1049 Main Street NOTICE OF RESPONSIBILITY URGENT LEGAL MATTER:PROMPT ACTION NECESSARY Dear Mr.Doriss: On December 31, 2015 at 4:05 PM the Department of Environmental Protection ("MassDEP") received verbal notification of a release and/or threat of release of oil and/or hazardous material at the above referenced property which requires one or more response actions. During site assessment activities related to a #2 Fuel Oil release, C11-C22 Aromatic Hydrocarbons were detected at a concentration of 166 µg/L in an on-site drinking water well. This represents a condition of Substantial Release Migration. The Massachusetts Oil and Hazardous Material Release Prevention and Response Act, M.G.L. c.21E, and the Massachusetts Contingency Plan (the "MCP"), 310 CMR 40.0000, require the performance of response actions to prevent harm to health, safety, public welfare and the environment which may result from this release and/or threat of release and govern the conduct of such actions. The purpose of this notice is to inform you of your legal responsibilities under State law for assessing and/or remediating the release at this property. For purposes of this Notice of Responsibility, the terms and phrases used herein shall have the meaning ascribed to such terms and phrases by the MCP unless the context clearly indicates otherwise. MassDEP has reason to believe that the release and/or threat of release which has been reported Is or may be a disposal site as defined by the M.C.P. MassDEP also has reason to believe that you(as used y in this letter, "you" refers to John Doriss) are a Potentially Responsible Party(a "PRP")with liability under M.G.L.c.21E§5,for response action costs. This liability is"strict", meaning that it is not based on fault,but Solely on your status as owner, operator, generator, transporter, disposer or other person specified in M.G.L. c.21E §5. This liability is also "joint and several", meaning that you may be liable for all response action costs incurred at a disposal site regardless of the existence of any other liable parties. This Information Is available in alternate format.Call Michelle Waters-Ekanem,Diversity Director,at 617-292-5751.TTY#MassRelay Service 1-800-439-2370 MassDEP Website:www.mass.govldep Printed on Recycled Paper h Release Tracking Number 4-0025935 Page 2 of 3 MassDEP encourages parties with liabilities under M.G.L. c.21E to take prompt and appropriate actions In response to releases and threats of release of oil and/or hazardous materials. By taking prompt action, you may significantly lower your assessment and cleanup costs and/or avoid liability for costs incurred by MassDEP in taking such actions. You may also avoid the imposition of, the amount of or reduce certain annual compliance assurance fees payable under 310 CMR 4.00. Please refer to M.G.L. c.21E for a complete description of potential liability. For your convenience, a summary of liability under M.G.L.c.21E is attached to this notice. You should be aware that you may have claims against third parties for damages,including claims for contribution or reimbursement for the costs of cleanup. Such claims do not exist indefinitely but are governed by laws which establish the time allowed for bringing litigation. MassDEP encourages you to take any action necessary to protect any such claims you may have against third parties. At the time of verbal notification to MassDEP,the following response actions were approved as an Immediate Response Action(IRA): • Continued assessment. • Excavation and disposal of up to 10 cubic yards of contaminated soil. • All Remediation Waste must be properly stored/handled and disposed of within 120 days from the date of generation per 310 CMR 40.0030. • Provide temporary water supplies. ACTIONS REQUIRED Additional submittals are necessary with regard to this notification including, but not limited to, the filing of a written IRA Plan, IRA Completion Statement and/or a Permanent or Temporary Solution Statement. The MCP requires that a fee of $2,470.00 be submitted to MassDEP when a Permanent Solution Statement is filed greater than 120 days from the date of initial notification. Specific approval is required from MassDEP for the implementation of all Immediate Response Actions(IRAs)pursuant to 310 CMR 40.0420. Release Abatement Measures may not be conducted until a RAM Plan is submitted pursuant to 310 CMR 40,0443. Assessment activities, the construction of a fence and/or the posting of signs are actions that are exempt from this approval requirement. In addition to verbal notification,310 CMR 40.0333 requires that a completed Release Notification Form (BWSC-103, attached) be submitted to MassDEP within sixty (60) calendar days of December 31, 2015. You must employ or engage a Licensed Site Professional ("LSP") to manage, supervise or actually perform the necessary response actions at this site. You may obtain a list of the names and addresses of these licensed professionals from the Board of Registration of Hazardous Waste Site Cleanup Professionals by calling (617) 556-1091 or visiting http://www.state.ma.us/Iso. MassDEP has Brian Snow of OHI Engineering listed as the LSP of Record. i i Release Tracking Number 4-0025935 Page 3 of 3 Unless otherwise provided by MassDEP, potentially responsible parties ("PRP's") have one year from the initial date of notification to MassDEP of a release or threat of a release, pursuant to 310 CMR 40.0300, or from the date MassDEP issues a Notice of Responsibility,whichever occurs earlier,to file with MassDEP one of the following submittals: (1)a completed Tier Classification Submittal; (2)a Permanent or Temporary Solution Statement or, if applicable, (3) a Downgradient Property Status. The deadline for either of the first two submittals for this disposal site is December 31,2016. This site shall not be deemed to have had all the necessary and required response actions taken unless and until all substantial hazards presented by the release and/or threat of release have been eliminated and a level of No Significant Risk exists or has been achieved in compliance with M.G.L. c.21E and the MCP. If you have any questions relative to this Notice, please contact Andrew L.Jones at the letterhead address or at (508) 946-2785. All future communications regarding this release must reference the following Release Tracking Number:4-0025935. Sincerely, Dan Crafton,Chief Emergency Response/Release Notification Section Bureau of Waste Site Cleanup C/AU/Ig Enclosures: Release Notification Form; BWSC-103 and Instructions Summary of Liability under M.G.L.c.21E ec: Board of Health Board of Selectmen Fire Department • `+`d,. .,i„a t t ',��?l rR,,.tt• i..,;' ',34�,i '�. 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SANOTARY CODE AND TOWN P�MIKE ro�I TOWN OF BAR19rnLE i i BARNSTODLE. i "6 BUILDING INSPECTOR 'Fa MAI a' APPLICATION FOR PERMIT TO ........ lr�Lr��. .....:. `1. .`^d ................................. . .................. TYPE OF CONSTRUCTION ...............1, .... J/ ...............................................:..:.................... ....... ..................19. ' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .: r ��G f.... i9/z lJ 57`��J zE ......... ................................... J... .... .. ............... ProposedUse ............... 7/1 .............................................................................................................................................. !t, U Zoning _District ....,.:E!/..L ..�f/... xxs .�' . ....� N�G4 . `. ..............Fire Distract ............1� Nameof Owner .............................................. .............Address ..................................... ......... Name of Builder ...l�tlIzel. l .:N... 6 21.y1 ! .........Address 1 � ! .. 1 ..�...............�T......... i9 Name of Architect .................r!.t//E .....................................Address ......................../.J1..4. .................... ........................ Number of Rooms ........... .................................................Foundation ................aow, .................................. Exterior ......... /1�T�' �El�f�/Z /l�✓��3......Roofing /�.!!97�...................... 5 / C Floors Cr.�/��� ,ei U�Z...............Interior ...................... L�O�� ....................... 7 :��/........................:... Heating .............../..V.QN ................................................c .Plumbing ....................... A�J .......................................... Fireplace ................./.!iv^�F.................................................Approximate Cost .............CJ./���..................................... -----_19_____--. Area 1 Definitive Plan Approved by Planning Board ---------------________ ........��.�.....�..�.�...:.. Diagram of Lot and Building with Dimensions Fee .................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the. Rules and Regulations of the Town of Barnstable regarding the above construction. Name . .. ... . .............. .. .................... i ' Ungerland, Peter *,'a .....16994. Permit for barn ................................... Location ............Route 6A .................................................... ...........................West...Barns.tabl.e................... Owner .............Peter..RiA0;!ja.nd................... Type of Construction ................f.rAmp............... .. ............................................................................. ji'Plot ............................. Lot ................................ r:1 Permit Granted ..............AP..........1.....3...........19 74* bate of Inspection ...... ........19 Date Completed ...............19 PERMIT REFUSED ................................................................ 19 ............ ... ............................................................. ............................................................. .........................I.......................................... ............. ............................................................................... Approved .............................................. 19 ................ .............................................................. .................. ......... .................................................. Io I I 3Z' TOWN OF QSrt-5LC A5SE550R5 MAP" 118 LOT#50 3 9 op OF p .� I 20,Mira. :. . GAS'rat�� _.ZONING : FOUND 10'MIN• ���-4 N ►JEhi 5ETBACKS: FRONT_ �o'SroEs= IS REAP, SEPTIC TANK t�}5T. IaOX. LEACHINU FACILI?Y PHim&ROUNOGOVEQ - --- - GA,� 9 a E I W iDEWdLK ZQ I -1000G�.�. 3.G5 33•IS' � �' .� / ED/AF._ V '-,`--- --:/'"I J•p— IL L.IONEAGE S2aTSEC eo;ir- w •�I TEST HOLE L065 DESIGN FOR'3,6&4 fv� 7:2- 1 10 ofr-rIGF I 7D,iQl TEST eY� •�' PERC.RaTE MIN.//N.. � 0 DATE : $ 8` FLOWRAcTE 75 GAL./DAY(PEf? SF �8.4aB Gtll� I _ J F� . II.B' XI bT CT. �_- W/TNE55: -- 0. 5•EPTIC TANK 289.8 (1.5 ) h34. REQ'D.SEPTIC TANK loco FiL 3h.�8f LEACHING FACILITY `� L $ I Iro1�GI"'. s14EWA►LL 12�fG Z.5)=�� •,oGlo c�` J IP`T"� ci5r; '.b.u��:'i �— 60TToM ;ems �S•5 G/o V I . �' _ gF �— TOTAL 20q..115F. Wv� 1214 USE 001LEACHINC, L,6&O Il.5.).- u I coos NOTES I / I `` ���,e -�oITIoU� ► 1 1. DATUI1(M5L)t TAKEN FROM f4'fj& glr-;- —QUADRANGLE MAP I / 2. MUNICIPAL WATER 15 46T AVAILABLE .3. DE516N LOADIN6 FOR ALL PRECAST UIJ/T5:AA5140-14-044 �\ M . 4b \� 4. PIPE ✓01NT5-SH LAL BE p'IADE WATER T16HT::`�--- ,4 I :5.-C-ONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH I I µOF_,��. COMM.OF MA.55.STATE ENvIRONMENTAL CODE TITLE Y I ?* '-6. THIS PLAN FOR.PROPOSED /,FORK ONLY.AND sNoucO Nor RICHARD CyGv, 6E USED FoR:PROPERTYi C•N: STAKING. o 7• (7TTLIZE `.E1(1Sr'C1Vb.�fELL. ;: FAIRBANK H •-- --_. _ y No.2o204 -B-�X/STING-�,EP��G:=SYsr�M Ta SE•MGE . LAND_7NS EL D=�D�JED'jAITQ .Q15T, OT!_T. - T_5...(•PeOV/DIA1, CV d?ADE oaf 'ISTFfiNG`��`� . )� �1�-.E-.-��1-L? :�F..FTAG E�PL•AN---�---:"_:---'--- I. �.. o%wr�.ca�e.engi�eerir�q . zEGENo.: _'.._ _ . :. cocas-:-`t ATE G° w�tlrEZ .r LA f;AZ�Tc�8L,� \ --'CONrou2s CIV1,!_ ENGINEERS ) -.R E. a 2!0`�.. EFEREN _ ZD .- --- — — -- SAND SuR EYDRg •,:•-. --C6_ _.. ... _ .G' _P FPARED-R: . T _ _CO ■ 2� main St.Yarmouth Ma - — T. _ E bovPd�,� �ie4/t �.1 �f -DATE ES f SC .$ �� (o JOB NO. 'ems-32<t ,���: ,e,.. _� �An,f l i . APPROVED.: ,•.i• _QAifE:' . .. • .. !. .. .F a '..a 1 � , .!� , ....'. s e aY. •q.. ,K` r. t. . . . " .[S{ n. 1 w J >:. ti ,.Y-sf .'n" ;+ws�;• ,a.. 'x, g Y •f. 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