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0390 MAPLE STREET
`3 90 aa-e-� ®� J NO. 152 1/3 ORA ° o 0 0 � i f (f /Z0 \ 1 own of Barnstable °Permit#� Regina fijT Services,loll i639 Thous F.Geiler,Director Building Vivision FDMW° ZvU MaiD:Sfreet,Hyannis,I A 0 604 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 E-XP Ecc_g,ERINUT-APPLICATION _ _�E.STDE NT_T A L ONLY Not Valid without Red X-Press Imprint Yiiaviparcel Number 1 31 /0 5 81 prop; Aur,,; 390 Maple St. West Barbstble ma 02668 �]Residential Value of Work$ 3 0 0 0. 0 0 Minimum.fee of$35.00 for work under$6000.00 Owner'sNante&.Address__ STEPHEN & Joanne Wallace '390 'M&pjd St Contractor's Name Northern Colony Builders LLC Telephone Number Home Tmnrovement Contractor.Licence#fifannlicahlel 234303 FinaiL .danWbCC@comeaSt.net 'Cbiistruetioti Nupervisoes License g(if applicabie) CS 53638 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor S E P 112013 Y 7 e am Vie.kdomeowner ❑ 1 ltave Worker's t=o npe=lion l rana Insurance Company blame Arbella Protection Group TOWN OF BARNSTABLE 'vi'aikumn's'Cotup.Policy 9 WCC-5 0 0-5 01 2 2 8 0-2 01 3 A f`ep of jng!�Iru�ra c mnlinnrn(`arf�f'u�oto.muaf g �n —nnW no� rh rno ai} Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not strip-pine, Going,over existing.layers of roof), Re-side Replacement Arinddows/-dooss/sliders.U-Value _(maximum_35) of=windows #4dam:.7_ ❑ Smoke/Carbon Monoxide detectors 4'floor plans marked with red S and inspections required. Separate Electrical& Eire Permits required. Wheir rv4uirW- iJ'lUam, 6f finis pCmni dots IWt-exer4i compliance with od=iown depaTtuent reguiations,i.e.Historic;Conservation,-etc. AssNot4: _prigpe.ty..(Iwne.r:rmlust.-Sgn.Pr-operty Owner L4lter 2f Permission. A copy oftiie ome Improvement Contractors incense Construction'Supervisom 11cense'is equired. SIGNATURE: C:\Users\decollikWonData \Microsoft\Windows\T oorarv.InternetFiles\ContenLOutlook\8R76BDVA\EXPRESS.doe Revised 061313 i ACORD,.. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 07/30/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Karen Bernier Southeastern Insurance Agency, Inc. ac°No Exc: 508.997.6061 ANC No: 508.990.2731 439 State Rd. E-MAIL ADDRESS: P.O. Box 79398 PRODUCER CUSTOMER ID 0: North Dartmouth, MA 02747 INSURER(S)AFFORDING COVERAGE NAIC9 INSURED INSURERA: Arbella Protection Insurance 41360 Northern Colony Building Co LLC INSURERS: Merchants Insurance Group P.O.Box 278 INSURERC: AEIC W. Barnstable, MA 02668 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2013-2014 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY 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. INSR LTR TYPE OF INSURANCE INSR WVO POLICY NUMBER MM/DD MMIDD LIMITS GENERAL LIABILITY TBI 07/08/2013 07/08/2014 EACH OCCURRENCE $ 1,000,000 ED X COMMERCIAL GENERAL LIABILITY PREM SES Ea oGE TO ccurrrence $ 300,000 CLAIMS-MADE M OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN.L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PET LOC $ AUTOMOBILE LIABILITY MCA7013965 01/05/2013 01/05/2014 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ B X SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION TBI 07/08/2013 07/08/2014 X ORY TALIMITS X T AND EMPLOYERS'LIABILITY YIN C OANY FFICER/MEMBERIPAR UDED ECUTIVE ❑ NIA E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,II'mare space Is required) CERTIFICATE HOLDER CANCELLATION FAX:- 508.790.6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE' WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable Attn: Building-Dept. AUTHORIZED REPRESENTATIVE 200 Main Street Hy nnis, MA 02601 Karen Bernier �<6bH_t/yU /14-1� ©1988- 09 ACOR15 CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD ..Buartl of Buildinw RcguP;itioris untl Srin.tf.u'a ,.. ConstruLtion Supervisor License License: CS 53638 . :.Q)NNIELJ GALL,AG,HER• r PO BOX 471 W BARNSTABLE WA 02668 Expitatlor"""'100/27/2013., i x �" G Imunsuuiu, TfG9' '.` . Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement C for Registration Registration: 167739 Type: �^ r_ Expiration: 10/10/25/2014 Tr# 234303' NORTHERN COLONY BUILDERS w DANIEL GALLAGHER d 1694 FALMOUTH•RD #135 W CENTERVILLE, MA 02632 A �< 9^'oqM Update Address and return card.Mark reason for change. Ej Address Renewal Employment' ❑ Lost Card sCA 1 Co 20M-05/11 CCjj/zs �p r Affairs& �i ess Re Regulation License or registration valid for individul use only Office of Consumer Affairs&Busy ess Regulation g y ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: frelgistration: � 39 Type: Office of Consumer Affairs and.Business Regulation piration: _195620J_ LLC 10 Park Plaza-Suite 5170 — Boston,MA 02116 NORTHERN COLON �a DANIEL GALLAGHE 180 HIGH ST W.BARN,MA 02668 —'" Undersecretary "'Not valff tho t signs re 1 jr • F 5 = ' The Commonwealth of Massachusetts Department of Industrial Accidents _ Office of Investigations 600 Washington Street -- — Boston,MA 02111 M� �:-� w►vw.ritass go'v/dik Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Northern Colony Builders LLC Address: P.O.Box 278 West Barnstable MA 02668 City/State/Zip 02668 Phone#: 508-400-7075 Are you an employer?Check the appropriate box: Type of project(required): 1.Rr I am a employer with 4. I am a general contractor and I empla}.ees(full an�ar Bart-time.). * have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have $. Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp.insurance comp.insurance.: g required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.0 I am-a homeowner doing all xxwk officers have exercised their 11:�Plumbing r airs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other' comp.insurance required.] 'Any applicant that checks box#I 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. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Arbel la Protection Group Policy#or Self-ins.Lic.#: We c—5 0 0—5 01 —2 2 8 0—2 01 3 A Expiration Date: 7/8/14 Job Site Address: 390 Maple St. City/State/Zip: MA 02668 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 irtipri§onment,a§well 4§civil penaltie§in the f6fih of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb certify under Oe pains and penalties of perjury that the information provided above is true and correct Si nature:� Date: 9/1 1 /1 3 Phone#: na n i A l a 1-I aghP r Official use only. Do not write in this area,to be completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• i MAM 'down of Barnstable Jl.Ceryl(CPC :txwuau,:•::'cL't:ucay vx.va;ays Bandwg Divis-ion. Thomas Perry,CBO Building Commissioner www e,!,�hnmga We;ma-es Office: 508-8624038 Fax: 508=790-6230 ' Prn�s�rta (1.:�nPT M���ct C6mplete and'Sig lm If Using A Rudder I, Stephen Wallace , as Ownerofthe subjectproperty' 'hereby authorize Northern Colony Builders LLe to act on my behalf, . h3-:�Inati€z�s•'.relatiYe.t����t�autlx?rized by:�t}is:b�z�dtt�.�e: t��.it apptieaticsrl f€�r: 390 Maple Street W. Barnstable ( ss of Job) r • 1 9/11 /13 4P 0 ram:. S teghP,n Wallace. Print Name UProperty Owner is applying for permit,please aofnplete-the•H®meovvmess License-Exemption Perm w the s:�s�esue ss�:. C:\Uses\decolbk\AnnDataU"A M erosoft\W-indows\Temooruy IntemetFiles\ContentOutlook18R76BDVA\EXPRESS.doc Revised 0613`13 A.I.M. Mutual A.I.M Mutual Insurance Company Massachusetts Employers Insurance Company New Hampshire Employers Insurance Company INSURANCE COMPANIES Associated Employers Insurance Company BILLING STATEMENT This statement represents additional charges and/or credits to your account. Page: 1 of 1 Policy Number: WCC-500-5012280-2013A(1) Northern Colony Building Co LLC Policy Term: 7/8/2013-7/8/2014 PO Box 278 Statement Date: 8/8/2013 W Barnstable, MA 02668 Statement Number: 723090 Due Date: 9/8/2013 Amount Due: $1,038.00 1 fi 'x tie r 7 d z Amount'4 "!t '474l,.i ^� �� s �' °� ;r .Descnptionf s 7/25/2013 Balance as of last statement $1,019.00 7/30/2013 Payment- Check 1580 -$1,000.00 8/8/2013 Installment# 1 of 3 Premium $989.00 Installment# 1 of 3 DIA Assessment $30.00 i i ` Current Bala cr1 e n 7 „$1Y0380 Broker: 4971 - 1 The Fairway Agency Inc Phone: (508)807-0380 If a prior balance appears on your statement,a portion of the Current Balance may be due earlier than the Due Date shown. Premium amounts shown may also be subject to audit. For billing inquiries, please call(800) 876-2765 54 Third Avenue • P.O. Box 4070 • Burlington, MA 01803-0970 • Tel: 781.221.1600 / 800.876.2765 • Fax: 781.272.5847 BRIDGEWATER• BURLINGTON • CONCORD., NH • HOLYOKE • MARLBOROUGH sponsored by Associated Industries of Massachusetts . ........................................................................................................................................................................... Return Payment Stub Insured: Northern Colony Building Co LLC Policy Number: WCC-500-5012280-2013A(1) Policy Term: 7/8/2013-7/8/2014 1 Instructions: Statement Date: 8/8/2013 1. Make checks payable to Associated Employers Insurance Company. Statement Number: 723090 2. Include your Policy Number on the check. Due Date: 9/8/2013 3. Remove stub at perforations and return with payment in enclosed envelope. Amount D ue: $1,038.00 Associated Employers Insurance Company P.O. Box 4131 Pol Premium Policy Id Pol Unit Insured No Woburn, MA 01888-4131 $3,955 1522004 1 5012280 Product: Guaranteed Cost AEIC 02 000723090 001522004 001 00000103800 5 500 DkA-MAIL y SSE kkrCER- j�1) /I /I fij2A l/1 Imn n n q CI�LI/�� To�Si 4�c iC 4rLba;2 Ct-1 arWIA16 SAIL gg ruAiL) A--r/dnl WALL i �F�G�C�iI�SS The rro,wn of Barnstable Department of Health Safet" and Environmental Services Building Division IN N u V 7r t .. 141 Y 1.14 t} ht OF ' .Sf I WILLIAM nCv E ! .••' ;: " CEIZTI'FI�U 'PLC5- ,A Na'19334 a i• MT I8 E P� o- LOGI�YIo� W �' 4 su —�- 46 G6ZLT1 t=V T"Ar TNt_ FUuwv)ml o 5tAowu PL-AQ 1ZeFCREWes %4SZGow 40&%PLV,; WITH TWG �$toE.Lt►-1E �_ �' AWo 5C:1rt3.ACV, Vc4Ut2G&leWTS OP THE -To wU oF' (b Aneu %Th*Le . Aug is wdl- Z04 PAGE GI t LUGAT�O WITI-�lW FI.oOD RAIIJ g,4XTCIZ .�. NYE 1wJG. aA-c� � �l2• � IU ae�tst-c�z�.b s�uo� ��e��xo tzs T�-tcs ac.As-, is LJoT ansEVp v►-, AN osYE�v���c o ��ass. ►i4.;M(JAAEtJT 5L)tzvrY ¢, T:1[. Uc"�SrTS Sldo!.�La APr-PL- GA.I`11"i vj&u aee:,�-� t.l✓1" HCs e�ye:e� 1'v Dear--V-AAI%46 LOT* Lti-di a K/ <4,�,sse*or'sjmap and lot number...1-31.:..rJ'. „ ., .li•f� FTNET SEPTIC SYSTEM MUST P o o� Sewage' Permit number ...... v .r../..A.. .....................:.... I ~�g 7 INSTALLED IIlI COMr LI WITH TITLE 5 Z BAWSTADLE, i House number ..........v` �C ...........................................: ...... t rasa ENVIRONMENTAL M 9�p 1639. 0� MAIM Ar TOWN OF. -,B ALB.N S T-A B . STABLE CONSERVATION g` Y COMMISSIOi'q BUILDING • INS-PECTOR . APPLICATION FOR PERMIT TO ..... --. ... .. ... . .a� ..... .ff r / TYPE OF CONSTRUCTION ......../. rl... ........................................... i...• �� ca. 3..................19.... . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the 'following information: Location ....... .......�??r !' ... 7.......Gl/ tCi� ,el17r5? 3.<. ...............:........................................... ProposedUse ....... .'[....e........................................................................................................ ZoningDistrict ....... .....................................................Fire District ..........................................:................................... Name of Owner j.!!-7r1!l.y..>�..... � 'l�!`t .....Address Nameof Builder• ....................................................................Address .................................................................................... Nameof Architect ......... o/v .....................................Address ............................ ................................................................. Number of Rooms ............. �� h.........................................Foundation ........I-.u./l.......Gr6'I .14� e.f.�:............ Exterior ...........C.1..�.h�.a 1�.:.r�......................................Roofing .................../�-$'�'�1'�.�-�, .:1�..............:................. FloorsCCU?°.....�...................................................Interior ...............<4"g ... 11......................... Heating C............................................Plumbing .................../......................... ....................................... Fireplace .................rll6&.:fie. ................................................Approximate Cost ..................35..1��.a.:........................... Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ...g"lo` .r....:........:... Diagram of Lot and Building with Dimensions 9 g Fee ...��.✓..,r.....:....�...:...,.......... SUBJECT TO APPROVAL OF BOARD OF.HEALTH ' s C1 I� coy,-Cat"- _ 3/1 o/0 2- 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. Name4 4�... .:........................................ WALLACE, JOANNE E. One & 1/2 Story ,N4 ...2.3870. Permit for .................................... .. .......... Single Family Dwelling . ............................................................................... Location ..Lo.t...#.2......3.9.0...Maple. ...S.tr.e.et .......... .. .. .... .. ... West Barnstable - ............................................................................... Owner ..Joanne E. Wallace .............................................................. Type of Construction .......Frame...................... .. .... .. .. ................................................................................ Plot ............................ Lot ................................ March 15, 82 Permit Gran ed ........................................19 Date oVz�bra.-a.P-.R-Z..................19 Date Completed ......../.'�?7:`/***4".�rg'Z...19 A 4 Assessor's map and lot number ......;jl:.:.... ...t..�1s,.. H THE tp�♦ Sewage Permit number ...... ..................... 0 Z BARNSTSDLE, i House number . .3/c®...................................................... 90 rasa p 16}9• 9 01 M a\ TOWN OF . BARNSTABLE BU"IFLDING INSPECTOR APPLICATION FOR PERMIT TO . ... �.. .� � yi q' ,,. .............. .W. .................... TYPE OF CONSTRUCTION ........ / 126t1. '.:-...................................................................................:.......:..... ............. �......... ..........19.... S Rt TO THE INSPECTOR OF' BUILDINGS: \� The undersigned hereby applies for a permit according to the following information: Locution .......e '.T....... .......6'��iF........................................................... ProposedUse .........)40..................................................................................................................................................:.................. ZoningDistrict ......... .. ..........................................:.........Fire District ................................. Name of Owner :..�,0...Via..,.�..R . Address ... ..:....' .�cl..�•,�Y�-Gsrv�,;r.��,1 if r. r Nameof Builder......................................................................Address .................................................................................... Nameof Architect ..........!1C// .....................................Address .:................................................. ............................... Number of Rooms .............. /�(.........................................Foundation .. �.......�'. :............... ............... Exterior /lir.fasa_ix...r�......................................Roofing .......<.........../ �'/��.,•,,r,; ...f.:........... ................. t Floors /,c,t 6 ��.......:. .....Interior .......s:......�1!?r/„Gr✓ ................................:........... Heating :........... ..Plumbing ..................../............................................................ Fireplace .°...............:"A.f................................................Approximate Cost .S- G U I Definitive Plan Approved by Planning Board ---------------____-----------19_______. Area ::?..........�. ...................... Diagram of Lot and Building with Dimensions.. Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH _'` i 1 r O 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 I construction. Name .................................................. ` WALLACE, JOA00E E. &=131-58 \23870 One 6 I/2 Story No .................. Permit for .................................... . , Single Family Dwelling -------------.----,--..----- Location ..Lot-#Z -'].S0- l ..St�zeet `.. . ' ' West Barnstable ------------.-.-.----------- ' .` JoAnne E Wallaoe - Owner -------_�_-___________.. ' ` Type of Ccnstruchon .....I7��anie________ . ` ` --------'-----------^------' ` Plot ............................ Lot ................................ " � ^ March 15 82 ' PermitGranted -------_..�- ........ . ^ Date of Inspection -----------'j9 _ ' ' Date Completed ------------.]V / ` ^�� L /�� n~ � ��/���~ � .� �� � "' � ., x ~ m~~ ` | v ' ' � r . . ' . � ` . ` i ^ - / •a,.-vy,..--r+M'y:;.� ,� �,,y���: !!'s'y r {�,jM^�. '�e'3"'"�' '_P -�+.�r'C"� —�yw�° •�.` _ `;� .Lk r��# <� Assessor's offioe .(1st floor): / OFIMEt� Assessor's map and lot number ... ./.3..� s ... ...o¢�- Q� ♦` Board of Health (3rd floor): Sewage..:Permit dumber .....F2.'..f�...7.................... i BAR39TABLE. : , raea Engineering'.. aFam nt (3rd floor): p oo,,�039• House riUmber ......_............ ...3 7C�..................:.. oMpya` p rlii i;' APPLICATIONS'^�R'OCESSED 8:30-9:30 A.M, and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR .�al� r APPLICATION FOR PERMIT TO ..:................................ . ...C. ................................................................... TYPE OF CONSTRUCTION !U.0 v � / /P�9!�7............................................................. .......................... ................................ ..............6.. .......---...---19 F. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....�.�I..�..... Sfr�.e.f' G(Je J�... . !� �tti,fTY-Yb�e ......:.. .�UT...�..... Proposed Use /!/I!.1 .........�!!1?i/�.l.......��•.w.�./�{,h .............. / Zoning District .............................................Fire District �` �� Name of Owner S��v� LC/G�l�QC c3 y0 �G�C��C .................................Address ......... .................. ...................................................... e.r.............................Address v'ri0 / C.... .........v.fiP.e:Z!... Name of Builder ............... `"� Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms ........... .r.......................................Foundation :v.' .. .v.. ... -.......................... Exterior ............CI.Cc /J,hOQ,:1'W-S'..................................Roofing ...................i�.*f,P.Lc a,�� Floors ....... ./.N...�r...� ..C.°'-!��.�.r.:.... . .........'..:.......,.Interior ..�........ .,.......�.��.�'.fe.�....................................... Heating ............... �c e.... �!!.G..:.......................................Plumbing .................../............�?.......�..'. ................................. Fireplace 4,1�q......................................................Approximate Cost Oo c� Definitive Plan Approved by Planning Board ___---_________________________19________ . Area Diagram of Lot and Building with Dimensions Fee n SUBJECT TO APPROVAL OF BOARD OF HEALTH r/ 2 �f 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 .................................... i WALLACE, STEVE A=131-058 No Permit for ..;&dd...P.qrcb.......... ........S.i.nq.l.e....F a.m.ily...D.we 1.1.i.yKg....... Location ..... 1N4pj.q...S:trqet ....................... .......................Wg.qt..Ba.rns...t.....ab.1e.................. ..... ....... .... Owner ..........S.t.ev.e...Wall.a.ge........................ .. .... .. .. .. .... .. . .. Type of,Construction ......Frame.............................. ............................................................................... Plot ............................ Lot ................................ 19 Permit Granted ........June.....................,...........19 87 Date of Inspection ....................................19 Date Completed ......................................19 Engineering Dept. (3rd floor) Map` Parcel cy - Permit# aj aq;L House# ." "� �d " Date Issued1 Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) �' .+„/07 ���Fee -f1,16 0 0=6 Conservation Office(4th floor)(8:30-- 9:30/1:00-2:00) 1 A-1 I R14 PIa .1 d "..;;''' ������� SEPTIC SYS ST BE D f4w;�1.g � rn3rFg h Ulonn;nn Rnard 19 T ` ► I1IM BAND TOWN OF BARNSTABLE irpwoN ne ONS Building Permit Application Project Street Address AP/(?-, J i r, ' 1 Village UJ i9/1./yJ�I /�,. ��/1J4� 02-6 Zd p Owner S'- �?.u°.N �$7 AI1�GQ d 6-- Address 3`Q r Telephone O j G, _-. .5 Permit Request FO First Floor �,3� square feet Second Floor 9,3 6 square feet Construction Type Woo a R A A4 k--, Estimated Project Cost $ 3�, q Y d Zoning,District Flood Plain N LP Water Protection A/T Lot Size /� 2, A C,2 E J' Grandfathered ❑Yes )qNo Dwelling Type: Single Family J4 -Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes .a No On Old King's Highway Yes ❑No Basement Type: ❑Full ❑Crawl AWalkout ❑Other &A R✓ace e, + /.Au n.dA /ham„ -Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) t Number of Baths: Full: Existing_ New Half; Existing _�_ New No.of Bedrooms: Existing 3 New Total Room Count(not including baths): Existing 15 , New pp First Floor Room Count o2 Heat Type and Fuel: ❑Gas ❑Oil Electric Other (,� G Central Air ❑Yes Cjr.No Fireplaces: Existing New Existing wood/coal stove es ❑No - Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) Attached(size) '70 0 Y7, ❑Barn(size) ❑None Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ER?6--- If yes, site plan review# - Current Use Proposed Use Builder Information Name 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 BUILDING P J ERMI DENIED FOR THE FOLLOWING REASON(S) r� r r FOR OFFICIAL USE ONLY pit 7,G PERMIT NO. ? �f v V Ll [ DATE ISSUED 7 j MAP/PARCEL NO`: a ' ADDRESS a VILLAGE OWNER DATE OF INSPECTION: ` FOUNDATION 1 FRAME INSULATION / Al FIREPLACE ELECTRICAL: ROUG FINAL PLUMBING: ¢ G ,, FINAL GAS: t FINAL,co • FINAL BUILDIN _ J t C)YJ � DATE CLOSED d, ASSOCIATION Pf4 O Application to 1997 002 9 9 « pp 0 +otp�•�y��p Eft Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building j Addition ❑ Alteration L Indicate type of building: ❑ House 0 Garage ❑ Commercial ❑ Other S7Ozedg-e, 2. Exterior Painting: (� 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY ffiek DATE ADDRESS OF PROPOSED WORK ` VN ' ASSESSORS MAP NO. 3 11 OWNER S/ >J R�`^A �-� ASSESSORS LOT NO. d L66 8 HOME ADDRESSIEo : )A BQ r MAelfi A TEL. No. 3 6 2,—E Z '- FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). �► 1/A N,U,'.r .lei- b c /A e <�- ,A (ou Ro X �n U Wr .342�v . ),tm , 4326 a AGENT OR CONTRACTOR 'L E 1�►��-� to TEL. NO. 36 L-5139 ADDRESS I/9 '� A DETAILED.DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8, other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed / locations of new signs. (Attach additional sheet, if necessary). Cc 0 C,R,g j e, F0 um d4A` *d N =-- S j C'1� GI/a60A Ge AA a- 3� 'l -ro -rile WV,'t4e,- - RovF,-A 11s"oh9/f - Roof 10JA; / ;Z '' )C e20 t.f fA044 - AC/ SIgT11 /""X�L Pi'�E, - 4 000,?.r h,?g J q1 T ,,,later - Cp A v q. r e. j90 UN/ 7 /)e 9 ' + Dm, 3 2 x X6 - r �r��5�� f�''l�e,¢,� PAS,,,+.Gb�,�-l/�,�.q /z. o ue, /Z - loll n IDZI e — ,ROOF 1✓0/119 — -1eA` ,-fl Flzze A, �Q Ise Lt �✓ � Signed A 4z- W/0t, —.C460tJ -A?05 U Jr. 8�42N ea/ Owner- ntractor-Agent Space below line for Committee use. fU rt�/',V Received by H.D.C. � n, ` rDate The Certificate is hereby Ti . 1AAD By Approved ❑ IMPORTA If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ i Town of Barnstable ' Old King's Highway Historic District Committee SPEC SHEET FOUNDATION rn 0.C,12'p+P — Uh II CGA�a�� SIDING TYPE_C ,56QAA, 4b COLOR CHIMNEY TYPE N U COLOR ROOF MATERIAL S lifR/-�j COLOR ,YG R P)J PITCH . ,N� /RCAA WINDOW %/t U 1 C', L✓ �� e"/�i�ay SIZE O(l i TRIM COLOR L4 6 0 i/ ��l l C� r�,q� �✓ O � Bj�j/L,y ��NiG� 7'x q DOORS C,;61�Non. 3Z"'5c 80 COLOR . Sao 2 /9J ni �CiyC. . SHUTTERS A) COLOR GUTTERS AIA" �f,/f> 2. CQ kx-, DECK J v � GARAGE DOORS G�OPA�C� 7 'x 9 / COLOR SIGNS . COLORS D Orh%�i nl "'FENCE � COLOR NOTES: Pill out completely,, including measurements and materials/colors to be used. Throe copies of this form are required for •ssbaittal of an application, along with three copies each of the plot plan, landscape plan and elevation plans, when applicable. Site plan should show all structures on the lot to scale. SPBCSFIT . I , MIN, ii! ' i i T Ll C..,9 ii �' � � � •, t�: �I. '� i cam.. AA 1 J Qp OD Lo CD .11714 Ji ' I �j iit i r l: j' .-; is •�+ ���i��; } , 1,I ail 1 I � I • � Z 10 I I J11 .1 jj� I t. I• �. _:l� Q � CO , LO G prp�jj.z . _ D r - O � Al Lill t ; liai: GIi, S W i I I TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION 3 g Number Street address Section of town "HOMEOWNER" '77 0Aj � NAme Home phone Work phone - 1,4go wnw .,i•. PRESENT MAILING ADDRESS Q , BA 7fA bk, /-? , City town State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings 'of six units or less and to allow 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: Persons) 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 acCaptable to the Building Official, that he/she shall be responsible for all such work performed under the buildin 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 Depart m nt minimum i sp tion procedures and requirements and that he/she will compl it sai pro res and requirements. HOMEOWNER'S SIGNATURE 1 APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 12.7. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which alybuilding permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if , Home Owner engages a person(s) for hire to .do such work, that such Home Owne: shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for . licensing Construction Supervisors, Section 2. 15) . This lack of awarene: often results in serious problems, particularly when the Home Owner hires unlicensed persons.. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home " wner-'acti: as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, ma: communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a: supervisor. On the last, page of this issue is a form currently -used by several towns. You may care to amend and adopt such a form/certification for use in your community. 1 .�' ;,• , TOWN OF BARNSTABLE . .� Permit No. — �mn.az Building Inspector Cash _ 7 M;�Y� `� no & OCCUPANCY PERMIT Bond "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Joanne E. Wallace Address lot 1,12 390 Atavle Street West Baxnstabl& `�_ Wiring inspector �'��.. � Inspection date Plumbing Inspector 1'T � �� Y a Inspection date V Gas Inspector /� C - Inspection date . g Engineering Department - Inspection date, � THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUHLE/MENTS. ` Building In p etor I Assessor's offioe .(1st floor): oFTNE Assessor's moo and lot number dt .�.3../ v` S to Board of Health (3rd floor)- Sewage... .... �.r..iG.7..................... .=���C ������ �� e�Q c� P�er,mit: number , ' . ;�:�G �Ba�® ON COMIPUAW` OO ' = BARNszsnLE, Engineefi4'lea"rtmnt (3rd floor): K� WITH TITLE 5 �o YM6 9� O 1639• 9 House riiUmber` :".:. ............................ G�:R OMMENTAL CODE r1, '°'F0UP,. APPLICATIONS'�V &ESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TMAI REGULATI'O'E>>- TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION ' � _� '��..Jv.�.......... ......�....... -.............................................................. :6....-.�....�.� 1.................19. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... ..G....�.... 7!'m e �/��rti.e.. f... �.��.!... [c lZ� 1:?���e^ .r........... � T. . 1. .. .. S� ! ProposedUse ...............1.. '1..�c.I.................... ..!�'/i/el........�!• 41...:............ 9..................................................................... Zoning District .................>'."1.. ..............................................Fire District f.3li /Lwj i ....C__ Name of Owner C;�l�l/P �C/Gf-�a::�.e:..............Address ... ..yv... `r � f�'r'.� :.. . Fc tz�o .......�..................j. ...1 . . Name of Builder ...............02W.'.Y'.............................Address ...J�`rv... �yp .... ..�. �f ,tl Nameof Architect ..................................................................Address .................................................................................... Number of Rooms � ''c-' .......................................Foundation ...............C.[v-7 c i� e ./ C_ .......................... ................................. Exterior ............. 1.l.�,Qt�R�!' -...................................Roofing ....................f� .!.h �. Floors0.7t- ... ::.�-. -�" 2::...................................Interior ................... . e.! ....................................... `. s , 1 Heating ................Cr.<:..C...n.. s!l.jL .......................................Plumbing ...................1.....:.......0.. ........:::..................... Fireplace ......................................................Approximate Cost .......... Ou 0 Definitive Plan Approved by Planning Board ---------------------- -.--.----19-------- . Area ................. ............. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH �7 (� s� 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. f _ Name .. :..............!�b�G�r.fir.�..�--�........................ Construction Supervisor's License ................................:... WALLACE, STEVE No ..-..�0 Permit for Add Porch .. ....... ................................... Sin.......Sr.1 e..Family...DY.e.l.l.i n ..... ...... ..... ............... Location ...390 Maple...S.t.r.e.et.,.................. West Barnstable ............................................................................... Owner ...Steve...W.....al...l.....ac.6..................... .... ... .. .. Type of Construction ....... .. ....... F.r.ame........................ ............................................................................... Plot...............I..,.............. Lot ................................ ........ Permit Granted ...........................June 19 , 19 87..... Date of Inspection ..... Date Corripleted. ............... .....19 I � Application to Old Kings Highway Regional Historic District Committee . in the Town of Barnstable for a CERTIFICATE-OF APPROPRIATENESS Application is hereby.made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building ❑ Addition. ❑ 'Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial -0 Other- 2: Exterior Painting: ❑ 3. Signs or Billboards: ❑_ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence CD-Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR.PRINT LEGIBLY c ,I ,� I , DATE ADDRESS OF PROPOSED•WORK 3 yD MA;bI6 �" l� •AJ ASSESSORS MAP NOR23 -5B 0WNER_� A0JQe 4AJlAut, ASSESSORS LOT NO. HOME ADDRESS TEL.NO.36 s139 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property.owners across any public street or way. (Attach additional sheet if necessary). a 12f,t>-�7 �`� So�v N,4 le-S_& AGENT OR CONTRACTOR �� — TEL. NO. ADDRESS DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs,give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary): �OR.Ok L'id �/�Q �O/�/ SiZe Gvao� F, A -Z;:� .SGR�Pe T /- 2r�� "wo St�1�w vA18r /�ly�voca/ jAl �.fPl+4�l� �LeoF (8/A�k Glr�p 6aA1,TvJr Z-ercao CD MA !?ads q/1��.fiLilt� CSa ester pA�N� s censer As : �,� Signed Owner-Contractor-Agent pJice_below line for£otee use. EAb6ived by H.D.CI—�iLtf,� Date The Certificate is hereby Date Tirr J By. . . . Approved IMPORTANT: If.Certificate Is approved,approval Is subject to the 10 day appeal period provided In the Act. OF-, '. �.,;: � _ . ��:-. t . • r. 'k t `` �. �� . �_. - r' -- r? + . � _ I ,� .. # ,' � - a J w The Commonwealth (if Massachusetts -- •ri. _ —'.i�r Department of Industrial Accidents • � i _:1� ' 011/ceolloy�s�►gat/oas . t;l 'of 61/(/ 1f'ttsliittgton Street �`; '�s�• Bowan,Mass. 02111 Workers' Compensation Insurance.AlTidavit Annfenn nformaiion- name: location• 39® /ox' D/e- S�, city 1/'i &42N.f'jfgbl& ► C).26, 46 nhone#SoL.36Z;-5).3 ❑ 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. cmm�nnV name: address: cih: nhone#: - insurance ce. nniicv# I am a sole proprietor, general contractor, homeowner circle one)and have hired the contractors listed below who have the following reers' compensation olices: any V1.1me: addr • - ��e / �� 1� abone M. u lue,en- [Mli J-0,2Z W:��LZ •• - .. .• ~• ...-'tR•J1;,ra;..•.7�"QC7!�/�'771!Rt'Sr'^,' -•C- _ - _ _ �TJRf - ,S'!�.iri — •- •��r� comnanv name: �(71i1 IJ C 1(�,I f FRA I✓'F. /[° ANR..addret.• L • eih: (4), AA ,1,.)L:LW Mel 0266e phone#:� X�� �� d �L� ;Attach additi6hal'shet t ittie ess_ a� ""_:-•i -�-;�+ ��y :.• »�:•�_•- a..r.,saa+ Failure to secure coverage as required under Section 25A of 51GL 152 can lead to the imposition of erimitui penaldes of a fine up to S1.500A0 and/or one rears'imprisonment as well as civil penalties in the form of a STOP WORK ORDI3t and a One of S100.00 a day agttion me. I understand that a copy of this statement may be forwarded to the oMce of Investigations of the DIA tar.,overage veritieadon. ' I do herebr ccrrifj• icr t/lc pair d pe / of perjury that the inform tion prorided above is true and c orrect Sienature ate Print name c/ ��LJ U �• Phone# off+cial use oniy do not write in this area tc be eompieted by city or town otReial city or town: permit/license# Mudding Department (31.1censing Board ' check if Immediate response is required oSelectmen-s OMce (3I1eallh Department contact person: phone N; MOther �� Information and Instructions n�F� a.,, GoN 'Wo Ar %4i4° /94--e- 6tir�e� - Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for their employees. As quoted from the"law", an empinvee 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 :-gal entity, or any two or more of the fore=oin 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 1.52 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business onto construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter hav, been presented to the contracting authority. op. :��a. .,• r., l:. 4r.ra. •i`•�.. .,-.. �: 11 4'A U��'.-r+: aY;,� �`;=--r+,,�,;•.:i'.�• •ry - .a. . Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying-company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to Sic 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. i.".: `:' ^�R•• o _ :nS:i.•JT.:'Y•':•'.•1�''rf !f.is� d""". ,G�i',!P-li.�, '{�7'��n.., !'•. ' . -.. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. •i•.•..:r.•••.•r�s•:.wSa.:r�vf•s+_ 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 fax#: (617) 727-7749 phone#: (617) 7274900 cat. 406, 409 or 375 ' a OAT OMM CERTIFICATE OF INSURANCE """'I- `11-97 ROOUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS ,-NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT'AMENO, looker—Corcoran Ins Agency Inc EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW '291 State Road COMPANIES AFFORDING COVERAGE Ilymoutb, Ma 02360 LETTERNY A Legion Insurance Company 001 Sue-CODS COMPANY B �UIMO LETTER COMPANY C John Pambuko d/b/a LETTER ;agamore Concrete Forms COMPANY D 9a Village Green LETTER 3ourne, Ma 02532 COLIrANr E LETTER :OVERAGE!! I ;'. . r:. ;;..I {'y,$A'i�H► ' THIS 19 TO CERTIFY THAT TILE 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 OTIIER 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. O POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS KJNQURANDS Type OF INSURANCE R DATE(MM/DD/YY) DATE(MMIODIYY) GENERAL LIABILITY GENERAL AGGREGATE t COMMERCIAL GENERAL LIABILITY :PRODUCTS-COMPIOPS AGGREGATE:1 CLAIMS MADE OCCUR. I PERSONAL S ADVERTISING INJURY`S I ,PWNER'S 4PNTRACTOR'S PROT. EACH OCCURRENCE ' FIRE DAMAGE(Arty on.Are) t MEDICAL EXPENSE(Any one perwQ'S AVTolrosne LIABILITY 'COMBINED ' SINGLE Is ANY AUTO LIMIT ALL OWNF.O AUTOS EOOILY INJURY 1 SCHEDULED AUTOS (Per Palo I NIXED AUTOS BODILY INJURY 1 MON•OWNED AUTOS (p4w.eoromq GARAGE LIABILITY PROPERTY OAMAGII S EACH AGGREGATE EXCESS llAeil►lr OCCURRENCE ' e :1 OTHER TNAN UMBRELLA FORM _._. . ....... STATUTORY A WORKER'S COMPENSATION i 100 (EACH ACCIDENT) A110 ;;rc iG�'�487 2/29,/97 2/28/98 1 500 (DISEASE_PouCYLIMIT) EMPLOYERS'LIABILITY S 100 (DISEASE—MN IMPLOYEEI OTHIR G^SCRWTION OF OPIRATIONS/LOCATIONS/VENICLES/RISTRICTIONS/SPECIAL ITEMS Concrete Forms CERTIFICATE HOLDER CANCELLATION T STEVE WALLACE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 390 MAPLE STREET EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO W' BARNSTABLE, MA 02668 MAIL DAYS WRITTEN NOTICE TO THE CEITIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS I'H REPRESENTATIVES, AUTHORKED REPRESENTATIVE reaeT Qa.»r,tmn BACORO CORPORATION 9. ®. i !t< 113 E.0_A 2— 13 13 IS E __i.tee 0-1-0 j— _L 9°._t f 12. 1 t_I = .40 310 CMR 10.99 Form 5 DEOE File No. SE3-3096 •• CF THE T� (To be provided by DEQE) - :.-. Q Barnstable _ Commonwealth a� '� city.Town of Massachusetts = 3ARX3T Applicant Wallace aua v ��p 1639. �ONAf Order of Conditions Massachusetts Wetlands Protection Act G.L. c. 131, §40 TOWN OF BARNSTABLE ORDINANCES, ARTICLE %XVII From Barnstable Conservation Commission To Steven Wallace cams (Name of Applicant) (Name of property owner) 390 Maple St. W. Barnstable, MA Address Address Map Number 131 Parcel Number 58 This Order is issued and delivered as follows: ❑ by hand delivery to applicant or representative on (date) ® by certified mail. return receipt requested on November 18, 1996 (date) This project is located at 390 Maple St- , W Rarnatahlo The property is recorded at the Registry of Deeds in Barnstable 2982 290 Book Page Certificate(if registered) The Notice of Intent for this project was filed on Oct. 9, 1996 (date) The public hearing was closed on November 12, 1996 (date) Findings The Barnstable Conservation Commi cci on has reviewed the above-referenced Notice of Intent and plans and has held a public hearing on the project. Based on the information available to the Commission at this time. the Commission has determined that the area on which the proposed work is to be done is significant to the following interests in accordance with the Presumptions of Significance set forth in the regulations for each Area Subject to Protection Under the Act(check as appropriate): �/ ❑ E• Public water supply Flood control ❑ Land containing shellfish ❑ Private water supply g� torm damage prevention ❑ Fisheries ❑ Ground water supply Ld Prevention of pollution D"Protection of wildlife habitat Total Fling Fee Submitted S95_no State Share ` $1 5_nn City/Town Share $80 nn (�/�fee in excess of S25) Total Refund Due S CitylTown Portion S State Pardon S ARTICLE 27 only: ('/z total) ('/z total) ❑ Public Trust Rights ❑ Agriculture Q-,Erosion Control ❑ Aquaculture ❑ Recreational ❑ Historic ❑ Aesthetic 10 tom:0 '- 1 -_. 1 F;r Therefore, the Barnstable Conservation Commission hereby finds that the following conditions are necessary, in accordance with the Performance standards set forth in the regulations, to protect these interests checked above. The Commission orders that all work shall be performed in accordance with said conditions and .with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications or other proposals submitted with the Notice of Intent, the conditions shall control. General Conditions: 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modifv this order. 2. This order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state or local statutes, ordinances, by-laws or regulations. 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following apply: a) The work is a maintenance dredging project as provided for in the Act; or b) The time for completion has been extended to a specified date more than three years, but less than five years, from the date of issuance and both that date and the special circumstances warranting the extended time period are set forth in this Order. 5. This order may be extended by the issuing authority for one or more periods of up to three years each upon application to the issuing authority at least 30 days prior to the expiration date of the order. 6. Any fill used in connection with this project shall be clean fill, containing no trash, refuse, rubbish or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles or parts of any of the foregoing. 7. No work shall be undertaken until all administrative appeal periods from this Order have elapsed or, . if such an appeal has been filed, until all proceedings before the Department have been completed. 8. No work shall be undertaken until the Final Order has been recorded in the Registry of Deeds or the Land Court for the _ . - -:i_8L-3— district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final - order shall also be noted in the Registry's Grantor index under the name of the owner of the land upon which the proposed work is to be done. The recording information shall be submitted to the Commission on the form at the end of this order prior to commencement of the work. 9. A sign shall be displayed at the site not less than two square feet or more than three square feet in size bearing the words, "Massachusetts Department of Environmental Protection, File Number SE3-3096 � 10. where the Department of Environmental Protection is requested to make a determination and to issue a superseding order, the Conservation Commission- shall be a-.party to all agency-proceedings and hearings before the Department. 11. Upon completion of the work described herein, the applicant shall forthwith request in writing that a Certificate of Compliance be issued stating that the work has been satisfactorily completed. 12. The work shall conform to the following plans and special conditions. I i 0 SE3-3096---Wallace Approved plan=November 4, 1996 Site plan by John Ellis,RPLS Special Conditions of Approval: 1. General Conditions 1-12 on the preceding page are binding,and demand both your attention and compliance. 2. Within one month of receipt of this Order of Conditions and prior to the commencement of any work approved herein,General Condition number 8(preceding page)shall be complied with. 3. The applicant shall pay for their legal advertisement as invoiced. 4. This permit is valid for 3 years from the date of issuance, unless extended at the request of the applicant. 5. The work limit for the project shall be along the line of the 50' buffer where proximate to the proposed garage. 6. Prior to the start of work,staked haybales backed by trenched-in siltation fencing shall be set along the approved work limit line. Effective sediment controls shall remain until the site is stabilized with vegetation. 7. There shall be no disturbance of the site,including cutting of vegetation,beyond the work limit. This restriction shall continue over time. l UUpon completion of the foundation(s)for the garage,project surveyor/engineer shall provide in writing to the commission verification of the proper siting of the foundation(s),and of the location C �� u: z�►t` and condition of the sediment controls deployed at the site. f ` 9. All areas disturbed during construction shall be revegetated immediately following completion of work at the site. No areas shall be left unvegetated or unmulched for more than 30 days. 10. Drywells or graveled trenches along the drip lines shall be installed to accommodate roof runoff. 11. The driveway shall be constructed of pervious material. 12. It is the responsibility of the applicant, owner and/or successor(s) to ensure that all conditions of this Order are complied with. The project engineer and contractors are to be provided with a copy of this Order and referenced documents before the commencement of construction. The foregoing condition shall not be construed to exempt project contractors from responsibility for any work performed in deviation with provisions of the Order of Conditions or with the detail of the plans of record. 13. The Conservation Commission, its employees,and its agents shall have a right of entry to inspect for compliance with the provisions of this Order of Conditions. 14. At the completion of work,or by the expiration of the present permit,the applicant shall request in writing a Certificate of Compliance for the work herein permitted. Where a project has been completed in accordance with plans stamped by a registered professional engineer, architect, landscape architect or land surveyor, a written statement by such a professional person certifying substantial compliance with the plans and setting forth what deviation, if any, exists with the record plans approved in the Order shall accompany the request for a Certificate of Compliance. Issued By Conservation Commission S' a sl This Order must be signed by a majority of the Conservation Commission. On this day of 18 �b , before me personally appeared , to me known to be the % ing instrument and acknowledged that he/she executed the same person described in and who executed the fore as his/her free act and deed (� MY C CAT!STICIN EXPIRES SEPI 27.,20DQ Notary Public My commission expires The applicant.the owner.any person aggrieved by this Order.any owner of land abutting the land upon which the proposed work is to be done or any ten residents of the city or town in which such land is located are hereby notified of their right to request the Department of Environmental Quality Engineering to issue a Superseding Order, providing the request is made by certified mail or hand delivery to the Department within ten days from the date of issuance of this Order. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and the applicant. . parThe Town of Barnstable " S Detment of Health Safety and Environmental Services °� `e Building Division 367 Main Street,Hyannis MA 02601 Offioe: 508-790-6227 Ralph Crossen Building Commis F= 508 775-33" For office use only Permit no._ Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,aiteratiom renovation,repair,modernization,conversion, improvement,removal, demolition. or construction of an addition to any Pm-misting owner ootazpr ed building containing at least one but not more than four dwdUng units or to sUuc=m which am adjacent to such residence or building be done by rcewemd contractors,with certain a=ptions,along with other requirements. Typeof Work: cP 1 )Caly Est Cost 5 Address of Work: 90 / ��A�l e •J j' �, JUJ �✓J�e. Owner.Name: Date of Permit Application: I hereby certify'lthat: Registration is not required for the following reason(s): Work excluded by law _ _ob under$1,000 Building not ow ncr-0ocupied 7�Owner palling own permit Notice is hereby given that: _ OWNERS PULLING OWN ROVEMENT WORKERMIT OR DO NO�'TEHAACCESS O �T� RS FOR APPLICABLE HONE 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 owmer: Date Contractor name Registration No. OR n o Owners name ••23 . q 1`�,, �� Vic` v� y- � ���� ,� „•. ��. � r 4 , S � a uv �s �A CENTERLINE OF STREAM DIGITIZED } RB FOUND FROM RECORD PLAN t.. nM to w Y' CL c� C' /I , to \- 1 m m LOCATION MAP 5 SANDWICH QUADRANGLE SCALE: 1: 25,000 y s s 0- ASSESSORS MAP 131 PARCEL 58 L 0 T 2 F ZONES: Ilk 46,400 SF UPLAND + ,� ¢� op6 11,500 SF BOG IUIFER PROTECTION OVERLAY DISTRICT y /g 1.33 ACRES f TOTAL �Q ZONING DISTRICT: RF ��,. /�G�F.� ,x 8 8.2 PER RECORD PLAN �9s MINIMUMS P AREA = 43,560 S. F. FRONTAGE = 150 �0�-F .8 WIDTH N/A / POLE 76/2 FRONT SETBACK = 30' 92 / Ln © 0�i } SIDE SETBACK = 15' / / <^ ?o � x REAR SETBACK - 15 / /x'�3.2 yi) 87.6 BUILDING HEIGHT = 30 /� 94 BU / (OR 2.5 STORIES IF LESS) 0 P� / N56y x 9 .1 FLOOD ZONE C FIRM COMMUNITY PANEL / s� / „ w • 94• 86.2 N0. 250001 0011 D / / S � o REVISED: DULY 2, 1992 � ' x 92.9 'o_ q4 96 POLE-2 _ -7 �q i CP. x 91.1 F E���' 1-\N g0 °,0 04. 87.7 �� psE� , NpVSE � pR x 9 0' 487.6 IXFtVC�pN 5 vNpER p 7,9 92 x 8 .3 ��_ STONE - 0 P P �" 84 L 0 T � WALLS. o x 90.1 � s \ 87.3j ��' o. N/F WALLACE _ - -- S „'6 �. « 0 8 .9 85. 11, !9 u' So CONC COVEE,R SCOPE - -x80.9 1-0 >. el A-7 84 84.9 ' �.�' so' N97 ���� `9cSA� 82. x-$0.2807 /f. / �- o �? A-2 ` A-1 \s' 79.6 `�? oo, .3 A—4 WETLAND DELINEATION BY FUGRO EAST, INC. 00- A-3 FLAGGING DATE: JULY 12, 1996 FIELD LOCATION DATE: JULY 19, 1996 SITEE PLAN BRB FOUND AT I i #390 MAPLE STREET ti q� Vb"ES1" I3ARNSTAI3LE, MASS. FOUND OR DISTURBED F F I .p S , STEPHEN WALLACE, ET UX. ; / REVISED: 11-04-1996 SCALE: 1" = 30" JULY 23, 1996 BAXTER & NYE, INC. j 812 MAIN STREET OSTERVILLE, MASS., 02655 (508)--428-9131 i cif kf GRAPHIC SCALE 4 _ IQ. 29874 30 0 15 30 BO 120 I a"121"llwV-0111A 1! ( IN FEET I inch = 30 ft. : 81237 (PPPO1.DW