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0991 OAK STREET (CENT./W.BARN)
W O W bl I I � J TOWN OF BARNSTABLE Buildin �tME h�,_ g " 20160025 BARNSTABLE, Issue Date: 01/12/16 Permit y MASS. �ArFG 3�A� Applicant: Permit Number: B 20160122 Proposed Use: SINGLE FAMILY HOME Expiration Date: 07/11/16 Location 991 OAK STREET (CENT./W.BAng District RF Permit Type: RESIDENTIAL INSULATION Map Parcel 216047 Permit Fee$ 35.00 Contractor MCCARTHY,MICHAEL J Village WEST BARNSTABLE App Fee$ 50.00 License Num 58633 Est Construction Cost$ 1,500 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND WEATHERIZATION THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A •CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: WELCH,TERESA M&MICHAEL L : BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 991 OAK ST INSPECTION HAS BEEN MADE. WEST BARNSTABLE,MA 02668 Application Entered by: RM Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY,NO 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 MAYBE 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 FIVE CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.SHEATHING INSPECTION 3,ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 4.;WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 5.PRIOR TO COVERING STRUCTURAL MEMBERS(FRAME INSPECTION). 6.INSULATION. - 7.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). Nam BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health Im i 3 . 3 C �' TOWN OF BARNSTABLE BUilding 201508984 BARNSTABLE, " Issue Date: 01/11/16 Permit MASS. 9� 03 Applicant: Permit Number: B 20160109 Ark p�.i A Proposed Use: SINGLE FAMILY HOME Expiration Date: 07/10/16 Location 129 CONCORD LANE Zoning District RF Permit Type: RESIDENTIAL INSULATION Map Parcel 122120 Permit Fee$ 35.00 Contractor MCCARTHY,MICHAEL J Village MARSTONS MILLS App Fee$ 50.00 License Num 58633 Est Construction Cost$ 1,500, Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND WEATHERIZATION THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: KIRKER,EDWARD J JR&PATRICIA A BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: P O BOX 443 INSPECTION HAS BEEN MADE. OSTERVILLE,MA 02655 G- Application Entered by: RM Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY,NO 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 MAYBE 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 FIVE CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: I.FOUNDATION OR FOOTINGS. 2.SHEATHING INSPECTION 3.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 4.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 5.PRIOR TO COVERING STRUCTURAL MEMBERS(FRAME INSPECTION). 6.INSULATION. 7.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). . � ' o BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS I 1 1 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map . �(0 Parcel 09 Application # 20( 157 U Health Division Date Issued Conservation Division Application Fee U ' Planning Dept. Permit Fee ' Date Definitive Plan Approved by Planning Board AJ Historic - OKH _ Preservation/ Hyannis BUILD Hyannis DEPT JAN Project Street Address 4 2016 ' OINN OF g Village ,,�tl-� c A RNs 7AQI Owner ""fic.rw L✓c�.L� Address Telephone Permit Request '�.-h.li.c�1��••, 1� fcl����,.� al-�,� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family LK" Two Family ❑ Multi-Family (# units) Age of Existing Structure 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 ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: 0 Yes ❑ No Detached garage: ❑ 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 ❑ i Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use —APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address PO Box 52 License # West e a , Cell (509) 280-6964 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY vAPPLICATION # DATE ISSUED - MAP/ PARCEL NO. . ra ADDRESS VILLAGE • 'i �a 4W OWNER- DATE OF INSPECTION: r� FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL k FINAL BUILDING DATE CLOSED OUT �' ASSOCIATION PLAN NO. Town of Barnstable Regulatory Seirvices MASITS ' Riebard V.Soli,Director 1659. Building Division Tom Perry,Buildiug Commissioner 200 Main Street,Hyannis,--MA 02601 wmv.t6wu.barnstab1gm=..us Office: 5.08462-4038 Fax: 508-790-6230 Properly Owner Must Complete-and'sign Ns: Section If Usingg ABuilder--�------�- ��--------�- - - _ . .... r P i' we1 ,:as 0�vnei odf,the..sOjectgxooeny hereby authorize. chVl aA CI CK)to act o ,my.ehalf, in al!matters rdauve to work autho= this building permu application for. (Ad ss•df-04, "`Pool fences'and alarms.are the respbns bility.6 the applicant. Pools are•not:to be, -befoie,-fence 3s:installed and all final :ins ections axe pexfoime. and accepted. w .of.. Applicant Punt. =eG Pint.Name ECIEUVE Date D DEC 1 7- 2015 LUJ Q:F0RMS:0%V.N1E"BRMISS10NP00LS I y Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 • Home Improvement Contractor Registrafor '"° Registration: 169393 Type: Individual Expiration: 6/16/2017 Tr# 264961 MICHAEL MCCARTHY =_ MICHAEL MCCARTHY = =` P.O. BOX 52 WEST DENNIS, MA 02670 = Update Address and return card.Mark reason for change. Address Renewal SCA 1 % 20M•05/11 i� Employment -� Lost Card L' _ .�e�ancr�zovuorull���'2/jlaa:;ac�cweClJ �\ Office of Consumer Affairs.&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: RRegistration: .:'j69393 Type: Office of Consumer Affairs and Business Regulation Expi ration;-.�--hiM2617 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 MICHAEL MCCART.HY.:`:<. MICHAEL MCCARTHY:. ZX 6 RANGLEY LN.SOUTH DENNIS,MA 02660 Undersecretary ` ith t signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 MICHAEL J MCC 'R '- PO BOX 52 W DENNIS MA 0267 " "t Expiration Commissioner 04/10/2016 The Commonwealth oflllassachttsetts :I UW Department of lntlttstrialAccidents I Congress Street,Suite 100 Boston,MA 02114-20I7 i www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTAORITY., Applicant Information Please Print Le ibly Name (Business/Organization/Individual): Mike McCarthy Construction _ PO-Box 52 Address: Wyet ennis, MA 02670 City/State/Zip: Cell 08)#280-6964 TC-169393 Are you an employer?Check the appropriate box: Type of project(required): I.9fam a employer with employees(full and/orparwime).� New construction 2.❑I amasole proprieloror partnership and have no employees working formein 1[7. . O Remodeling any capacity.[No workers'comp.insurance required.] 3.aI am a homeownerdoing allwork myself.[No workers'comp.insurance required.]t . ❑Demolition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors cilher have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions' 50 I am a general contractor and I have hired the sub-contractors listed on the attached sheet ncse sub-contractors have employees and have workers'comp.Insurance.$ 13.❑Roof repairs 6.❑We arc a corporation and its officers have exercised(heir right of exemption per MGL c. 14.LJ/Other �✓c.f 152,§1(4),and we have no employees.[No workers'comp.insurance required.] •Any applicant that checks box 1/l must also fill out the section below showing their workers'compensation policy informalion. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. tConlraclors that check this box must'attached an additional sheet showing the name of the sub-contractors•and state whether or not those entities have employees. If the sub•contraclors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance jar hty employees. Below is the policy and job site information.Insurance Company Name: A_'/ tM /_t4,1 Policy#or Self-ins.Lic.#: V V/L— Ic-r, Expiration Date: )a Job Site Address: City/State/Zip. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL cr 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerhfyunder t a' s enalties ofperjury that the infor»nation provided above is true and correct Signature: Date: Phone M LSbk1 :ik—G f C�t 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 ,�coRo`'� • CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDnYYY) 12/07/2015 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(ies)must be endorsed. if SUBROGATION IS WAIVED,subject to the terns 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 01962-001 NAMEACT Bryden 8 Sullivan Ins Agcy of Dennis Inc Et): (508)398-6060 Ne,: (508)394-2267 PO Box 1497 So Dennis,MA 02660 INSURER(S) F ORD N COVERAGE NAIC INSURER • A.I.M.Mutual Insurance Company 33758 INSURED INSURER B: Michael McCarthy Construction Inc IN R C P O Box 52 INSURER D: West Dennis, MA 02670 INSURER COVERAGES CERTIFICATE NUMBER: 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. ILTR TYPE OF INSURANCE I yp N POLICY NUMBER (APINMA A&SM LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMMISeAGE TO RENTED $ E SIF occurrence) CLAIMS•MADE El OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ .--]POLICY E O OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ c'1s ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOOWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accide $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS MADE AGGREGATE $ DED RETENTION $ $ Mw OR- ��y PR Rp���7pq�pgRTNE Y N E.L.EACH ACCIDENT $ 1,000,000.00 A OFFICERIMEMBER E7(CLUD C� YY NIA VWC-100-6017656-2016A 12/15/2015 12/15/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 (Mandatory In NH) OF NunH) D� MIPT 9PERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) CERTIFICATE HOLDER CANCELLATION Cape Light Compact PO Box 427 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Barnstable,MA 02630 THE EXPIRATION DATE THEREOF; NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION p Parcel ::`Applicatib # Ma ". h _&Vk& 723 Health Division -Date Issued In) �,Applibat& Conservation Division Fee Planning Dept, '.*:*Permit Fe e Date Definitive,Plan Approved by Planning Board Historic - OKH Preservation Hyan his Project Street Address ?9V Village Owner e/-e-_sea- —Address 9 l C, Telephone Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zo,ning District' Flood Plain Groundwater Overlay Project Valuation Construction Type L6t Size Grandfatherod: Ll Yes Q No If yes, attach supporting documentation. Dwelling Type: Single Family Q Two Family Q Multi-Family (# units) Age of Existing Structure Historic House: Q Yes Q No On Old King's Highway: Q Yes L11 No Basement Type: L3 Full Q Crawl Q Walkout Q 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: U Gas LJ Oil Q Electric LJ Other Central Air: Q Yes Q No Fireplaces: Existing New Existing wood/coal stove: L]Yes L3 No Detached garage: Q existing ❑ new size—Pool: Q existing Q new size Barn: L3 existing Q new size Attached garage: Q existing L3 new size —Shed: Ll existing L3 new size Other: I C= C= Zoning Board of Appeals Authorization Ll Appeal # Recorded Ll ' C=3� (/) Commercial 0 Yes Q No If yes,-site plan review# Current Use Proposed Use Jr- 17, APPLICANT INFORMATION rn (BUILDER OR HOMEOWNER) Name L rg TZ Telephone Number S W-7i Address Y /*'JX 0 C T License # C 5 -7aS79 VkYMJ `J 15 vv-,. 4 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE- 9-1-1 16§ FOR OFFICIAL USE ONLY APPLICATION'# � 4 r DATE ISSUED* MAP/PARCEL NO. !1 ADDRESS VILLAGE .Y a OWNER DATE OF INSPECTION- o,Izmc*— !, FOUNDATION 8foD 10 . o R t _ FRAME INSULATION WZrloft— ks�- o y `FIREPLACE L% -ELECTRICAL: ROUGH FINAL L� PLUMBING: ROUGH FINAL ' . j GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT ' ASSOCIATION PLAN,NO. it T Town of Barnstable Regulatory Services '"R'', Thomas F.Geiler,Director � Building Division PrED►,1�� Thomas Perry, CBO,Building Commissioner. 200 Main Street, Hyannis,MA 02601 www.town.bams-t2ble.ma.us 'Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW GtJE L c Map/Parcel: Z l /o - O 7 Owner: T Project Address 94! O#X Builder: The following items were noted on reviewing: w - n� /l(A,Xfrxc�t?1 SI°RGt�b- ov�N��471o/u �Ot,?'S. S� o.�. jioues-- 'Ptw Sy@-izt Ooe7 - Nbe . - (�E;QV-1R."— Z , (o +i> ta� - rby\n. eV1IA . (/EAn e-09 C-- Sale&-rA-F-,eJc AeW,0- AC- 'le t6b er .OF 0-YK- t(0.,p Now,6 C-,q-NNo h C--rn+T6 Reviewed by: -- J Date._ Ll,;-I Zoe Q:Forms:Plnrvw G VDAC TRAVELERS J WORKERS COMPENSATION AND ' EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (7PJUB-0107M26-4-08) NEW-08 INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA NCCI CO CODE: 13579 1. INSURED: PRODUCER: REMODELING ASSOCIATES INC. BRYDEN & SULLIVAN INS AG 2 LYNXHOLM COURT S& FALMOUTH RD HYANNIS MA 02601 HYANNIS MA 02601 Insured is A CORPORATION Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 05-02-08 to 05-02-09 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA m- B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in N item 3.A: The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 0GA 0 n D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE o 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to.be made ANNUALLY. r. DATE OF ISSUE: 05-28-08 MB ST ASSIGN: MA OFFICE: DIRECT ASSIGNMENT 701 PRODUCER: BRYDEN. & SULLIVAN INS AG 232MY 002268 A. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeZibly Name (Business/Orkanization/Individual): ►wN ODE L.1►`1G, A SSoe t^-TV S -r Ai Q. Address: y ti x N O t,►n C%. pa(0 01 . City/State/Zip: I-I yI.�N►S . " f}., Phone.#: S - 7�S 9 Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. 1 am a general contractor and I 6. ❑New construction employees (full and/or part-tim.e).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling . ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' ' Y P h'• # 9. ❑Building addition [No workers' comp.-insurance comp. insurance. required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions . myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. zContractors 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 provi&their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information.Insurance Company Name: ^T kA V E►,L(-5 — Policy#or Self-ins, Lic.M 3-0 a"C)10-7 VIA01 j6- 9-PB Expiration Date: Qj O St Oc� Job Site Address: Jl-S7' QA�-?Cit to/Zip: 1M �1 �p.ic. ST, _ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the 'olator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for ' ance vera e verification. I do here y c under t ins•a d penalties of perjury that the information provided above is true and correct Signature. Date: /t /L _ Phone#: D.Q - 7 5'- 7 7$ 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#: F Information and Ins' &cacti®ns 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 referenc%number-. In addition,an applicant that must submit,multiple permit/license applications-in any given year,need only submit one affidavit indicating content policy information(if necessary)and under"Job Site Address"Lhe applicant should write"all Iocations 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 affdavit is on file for future peirnits or licenses. Anew affidavit musfbe•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 bum leaves etc.)said person is NOT required to complete this affidavit. The.Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 WasEngton Street Boston, MA 02111 Tel: #617-727-490.0 ext 406 or 1-877-MASSAFB Fax# 617-727-7749, Revised 1.1-22-06 www.mass.gov/dia i J ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMIbL D�4AACCH�ED RES DENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: Site Address: 9 pA + S 1 pl•inI Town: tN, t3/g1ZfVSiAgLE Applicant Phone: 08 7 7 Applicant Signature: Date of Application: CN 1 Q8 NEW CONSTRUC ON: choose ONE of the following two options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Slab -Option l: Basement P Fenestration exposed Wall Floor Perimeter U-factor floors R-Value R-Value Wall and AFUE 1]SP.F ST I R R-Value R-Value and Depth National Appliance Energy 3 5 R-3 8 R-19 R-19 R-10 R-10, Conservation Act(NAECA)of 4 ft. 1987 as amended,minimums or greater as applicable Note: This form is not required if you choose either of the two versions of REScheck as.listed below. ❑ Option 2: `�. REScheck Version 4.1.2 or later variant software analysis must-be completed (780 CMR 6107.3.2 REScheck—Web which can be accessed at http://www.energycodes.gov/reschecld n-ADDITIONS.10RIALTERATIONS TO`:EXISTIIVG.BUTLDINGS:`OVF 5.Yings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b -a) SF 100 x I(A - % of glazing (b) Glazing area equal s. _SF b a If lazing is <:40% use.the chart below. If.glaziri is>:40% proceed to "SUIVROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS i MAXIMUM MINIMUM Ceiling and Wall Floor Basement Wall Slab Perimeter ❑ Fenestration Exposed floors R-Value U-factor R-Value R-Value R-value R-Value and Depth 39 R-37 a R-13 R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not compressed over exterior walls, and includingan access o enin s).- LNo' 'er M—An addition or alteration to an existing building/dwelling unit where the total a of said addition exceeds 40% of the combined gross wall and ceiling area of the to fill out Consumer Information Form (found in Appendix 120.P - i . ^ � � . � ///�� �u�� /V /��0� [�nY/n/��ox io Rbr� �ind,�ruos: 1/0 xuxh WYxdZou« � . M&SS8Chl]88ffc Cli8dclinff»r CB0D'J^flDce (780CKYD530/l1-1) Chock Compliance � 11 SCOPE ' ' 11O mph | YV�dSpeed (�o*c gu»�---------------------- ---------------' B ---- � Wind Exposure Category---------------------- --.!-----------------' VV�dExposure Cat. -----Engineering Required For Entire Project -------------C 1.2 APPLICABILITY � � Kumberof Stories(a roof which� axceod�8in12o�pashaUbocono�onadax��) u�r�n �2x�/�s Roof Pitch ------'�.......................................................(Fig 2) --------------.--:51212 Noon Roof Height -.--------� --.(Fig 5m33 . 8uUd�gV��.« -------------------�-'(�g3)---------------- � � 7 _--_-__- --- � ��O L U�Q3 - BuUd�gLong�. --------------------' a/----------------`---^�~~~ ---- - �2L1 Building e Ruho (L8N) -.-.'------------(�Q4)----------------. N i "�-'-��c�Ta|�tt �"2 (Fig . �-�_��8�^ womm� �e�n� up�/.� ---------'�-' --------------' ' � 1.3 FRAMING CONNECTIONS � � . �~ General compliance with framing connections....................(Table 2)....................................... -------- � 2.1 FOUNDATION Foundation Walls mee.ting requirements of0QCMR5404i , Conoabe---------.-------------.'------------------' ConcreteMasonry.............................................:...................... ------...---------_----. 1� � 22ANCHORAGETOFOUNDATON � 5/8 Anchor BuUo'knboddedor5/8 Prop�oturyK4aohan�o/Auchomaoana�omahva.� ooncra� �on � Bolt Spqo�g-ganam/ --------'�----'..�abhy4)---------------' � �� h� 12^ ' Bolt Spacing - ond�untc�p�� ---------' 5)------:-----'__-_- � �o'- . � - ~ � � �T ~~ 8oUEmbodmmt-oono��---'�---------'.(F/Qo)----------------. -� � ---- � � 15^ ' Bo8Embodmmd-masonry------,-------(�A5)--..''/-- -------' �, �3^ 3xy� � P��VVaohac-------___-__________(qg5)_______________. x 3.1 FLOORS ' � Flour-fron-iing member spans checked '�.........`- ..............(per 78UCWR Chapter 55)................................... ��1�� Maximum Opening Dknann�n-..----------(�gO)------,-.--------.`_. Full Height Wall � - Floor Openings less than 2'from Exterior Wall(Fig 0)..................................... � Mgximbm Floor Joist Setbacks Supporting Loadbearing � �d VVa�burShaan«aU-----.(�g.7)-------------.----. `__ Maximum Cantilevered Floor Joists � �d LoadbaahngYVaUo.VrSheenwa�-,---'(�g8)-----------'.-----.`--- F�or Supporting� EndwaUo----'�',-----------U�gA)--------'-------------- - 780C�RCha 55) Floor / Typo '------------------�� p"" ---------`-'� . Floor Sheathing Thk±nanx --------------.�-'�ar78UC�RChap�r55)'�_-----` �� ----- ` -- r� ��b��A dnuUnadinadge/ � �e� | � F�orShaaUhingFq�e ng----------------' ,' _�-� . --�_ 4.1 WALLS � Wall Height � Lood- wuUy . ------------(�Q 10 and Tab�5)--------'. ___� s 1� | ""= " g --'� --' � '- ----'-�--0wsoa------____�______(Fig Table ..--.`_ � �2� .r� 10 and - in� 524,a� VoU Stud StoryOffsets ................................ .......................(Figs 7&8)....... ............... ....................._ ft .5d �' � � / | � � / 4� EXTERIOR-WALLS, Wood Studs LoadbyohngWad�------------------'(Tab� 5)----------�x_--'--_ft-__�. (Tablo5) 2x�__ ft in Gable End Wall Bracing � � Studs (Fig 1O)---��------'`-----___.__. ---- � - �-�'' -� ��V�3 ` �VYSP~�huF�or _-'.--�---------.��F� M)----------------- - --�' ��C\QVV 'Gypsum gth(if VVSPmtuoad M)--------------'�-- --__ end�x4 Ceiling vouoLa�r� 8�oo��OfLc�� U�g11)------__-_________.r_ � � �vmx ' b -��' -- -' ^ � Min. 2 4b�o �� ��4� �mc�g�����orhu� o�_�� br1x�uoUingfu�ngu�ou�� 1Gxpac spacing � m x omox u Double Top Plate / AWC (+aide /o I1%od Consil-Itedo/! in High Wind,,lreas: 110 Inph. I'Virrd Zone 1/Iassachusetts Cheddist f*61- Compliance (780 Ci,-[R5301.2.1.1)' Loadbearing Wall Connections ' Lateral (no.of 16d common nails).................................(Tables 7)..................................................... Non-Loadbearing Wall Connections Lateral (no.of 16d common nails)................................(Table 8)....................................................... Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) Header Spans ...•....................................................(Table 9).................................. ft_in. 5 11' Sill Plate Spans ........................................................(Table 9).................................. ft_in. 5 11' Full Height Studs (no. of studs)....................................(Table 9)..................................... Non-Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) Header Spans.............................................................(Table 9).................................. ft._in. 5 12' Sill Plate Spans.... .......................................................(Table 9).................................. ft_in.5 12" Full Height Studs (no. of studs)....................................(Table 9).......•...•.................................. ..... Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously Minimum Building Dimension, W Nominal Height of Tallest Opening2 ..............................................................................._5 6,8.. SheathingType..............................................(note 4)..................................................... Edge Nail Spacing.........................................(Table 10 or note 4 if less)................,....... in. Field.Nail Spacing...........................................(Table 10).......................... ... Shear Connection (no. of 16d common nails)!(Table 10)....................................................... Percent Full-Height Sheathing...................:...(Table 10)....... ............................................_% 5%Additional Sheathing for Wall with Opening > 6'8"(Design Concepts).................... Maximum Building Dimension, L Nominal Height of Tallest Opening2................................................•.................•......_s 6'8" SheathingType..............................................(note 4)............................................. •.,......, Edge Nail Spacing.........................................(Table 11 or note 4 if less)..................,...,. in. Field Nail Spacing.....................:.................:..(Table 11).................................................. in. Shear Connection (no. of 16d common nails)(Table 11)...............................I....................... - Percent Full-Height Sheathing........................(Table 11)....................................................._% 5%Additional Sheathing for Wall with'Opening > 6'8"(Design Concepts).................:.. Wall Cladding Ratedfor Wind Speed?..............................................:............... ................................................................ 5.1 ROOFS Roof framing member spans checked?........................(For Rafters use AWC Span Tool, see BBRS Website) Roof Overhang ..........:. ..................(Figure 19) ft 5 smaller of 2'or L/3 Truss or Rafter Connections at Loadbearing Walls i Proprietary.Connectors Uplift (Table 12)......:.....................................U= plf Lateral•............................................. Table 12 ......................,................:.....L= plf Shear................................................(Table 12)............................................S= plf Ridge Strap Connections, if collar ties not used per page 21... (Table 13).......................•.......T= plf Gable Rake Outlooker..........................................(Figure 20) ....... ft ft s smaller of 2'or L/2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift....................:..:........................(Table 14)............................................U= lb. Lateral(no. of 16d common nails)...(Table 14)........:•.............................L= . lb. Roof Sheathing Type..................:.................................(per 780 CMR Chapters 58 and 59) ............ Roof Sheathing Thickness.....................................:..... ............................................. in. >_7/16"WSP Roof Sheathing Fastening............................................(Table 2)..................... ............ ..................._. Notes: 1. This checklist shall be met in its entirety, excluding the specific exception noted in 2, to comply with the requirements of 780 CMR.5301;2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Corner Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing 'requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure treated#2-grade.. k + � 1 �°FTHEfO�'� Town of ]Barnstable Regulatory Services BA MASS. ' Thomas F. Geiler,Director .,, Hues. g > 4'Ars16yq. 1% Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.mmis Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 6o �� , as Gamer of the subject property hereby authorizeat&aV-&,Ito act on my behalf, in all:matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. �oF cHe T Town of Barnstable Regulatory Services BARNsrABLE, f Thomas F. Geiler,Director . y MASS. �,,, 1b59• Building Division TFD hW'I A Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 ------------------ HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to- . be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/sheshall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The-arrdersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section'109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeoi'r ers who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section•2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed persoh as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure tha�jhe homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a forrn/certification for use in your community. Q:foi-ms:homeexempt � I f3o��o� �ng�eg- ulatiahs an taan�Ce�cTs�' Construction Supervisor License License: CS 72579 xpira,tionc=l14/2010 Tr# 14112 JONP THAN M 2 LYNXHOLM CTi ` HYANNIS,MA 0200 Comthimioner F . I _ 4 I I 1 � License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 106627 One Ashburton Place Rm 1301 y Expiraton7/ 4/2010 Tr# 0 Boston,Ma.02108 ►"j� .�Se:_In i dual i JONATHAN M T*1EEtT i Jonathan Tyler _ 67 Cranberry LaneA ox 8: — Not valid without si nature W Hyannisport, MA d 67 �°� Administratrh- g • i TOW RIC PRESERVATION HISTO Lij I ��5cz axt n m 2 c E CL ao- D 64&6 I/x N M i g j . i °p- Q 4 t 1 u I I i ET : �.f_yle- I i1 v �w o� 1F— c i w ' off r oaf •;a�� ------ -:------ ---;.- . I i m FI - i I � I , o i I APP ROVED MAR 2 6 Zoos Town of Barnst:t:•., Old King's Highn.:� i Committee J- ICY- = i--- ! C-j ! - AT ±jFj Y. i I APPROVED MAR 2 62008 Town of Barnstable Old Kin g's Highway t Committee 2"X la P-}F'Tzt- 30 i $ L� VUJT fluRRiGiFN� rg5 G DAB S�+�NGL�S �1L-13 �r15. CLfZ�4� ' -P>;yWDUb z X 4" STuDS 3�4't G• I IZ-19 DNS, 2°x8"Tols.T %8°x20" AAIC,4M,. poLTs 20°X�D" -f-ooriNGy 20"X io" 7oa;N A I 6*fiKx 4;a:-rr CtmL. WQ4L I I I x - ® © • � . � oil _wEs-r ouT i.Ti_a�s c � j� + x y p �tt i i�T ea"-Ilt�• Ts.�:ta,'?,��s Tic i7r .Y YTFs.4y .,. 'f Y ;s - r.�va- _- _ - _ -__ _--- _---...... -'----'-- . "l-1:,ii.ra.;-,. :x i i f'.cli63A M. W rlLl BOOK PLAN 32 1 2�`t .I i'Lit t11V 1: Ji1IViE-- - ASSESS(? $F3_A.N 3.(�T �i`XH 3 e 0 L 9- A 6- Vi V N. ce.. s e _ _ /a 5 y ' f e � j Y A'Dd� A�F•`l�.7FD i_c9ti 1 9• "r OAK Sli-REE-f i lanfulry ell i joe aj� 2 7 L� --�• e_•t i 5 �� �-'ice-Ll �-S�s r ! ± g �1 WT6� :_- gR1AL INSU ANCE COMYPAINY,THAT THERE ARE I•IO viSJrc—L.E ENCROACz u o. a �A�,.r.:,����sy`�S :�i i✓ i��i SHOWN AND THAT THIS PLAN WAS PREPARED"UNDER MY IMMEDIATE SUPERVISION. THE LOCATION OF THE DWELLING AS SHOWN HEREON IS IN COMPLIANCE WITH THE LOCAL APPLICABLE ZONING BY-LAWS WITH RESPECT TO HORIZONTAL DIMENSIONAL REQUIRIalffiNTS. - -... pF1HE r ti Barnstable Old Kings Highway Historic District t Committee 200 Main Street, Hyannis,MA 0.2601, TEL: 508-862-4787 Fax 508-862-4784 a, 1639. �EDMA'�& APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or photographs accompanying this application for: Check?Addition �tegories that,apply, 1. Building construction: ❑ New L . LK Alteration r 2. Type of Building: House ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting,roof ❑ new roof ❑ color/material change, of trim, siding,window, door 4. Sim : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ tennis cout ❑ Otle�r-, 6. Pool El swimming El Other man-made pool Type or Print ��Legibly: Date: �''� Address of proposed"w�ork- House# , ' � "=rn Street:�d91[ �l Village /J. 8k), ST Assessors Map Lot# 6 �4-7 Description of Proposed Work: Give particulars of work to be done: 9J-6A�� /-164Iie- -5--Cetot -74y gfflmo&q7r vim: A-M T 1j P Je LD� EX V) Agent or Contractor(print):c S �L Telephone#: -Wlz- �l � 7- Address: _W� e,),e L ><I�ic�_S Lf Contractor/Agent'signature: NOTE All applications must be signedkthe current ow�n�e{{' _ Owner(print): �1�/-/y,EL SL /&/�ESM (�C/� wTelephone#: 73 S' Owners mailing address: Owner's signature: For committee use only. This Certificate is he by APPROVED/ % �n Date Ib-L to Y- Members signatures E� 15 20 08 - pWN OF BARSERVP 10N NX Any n itions of 0 1: �ti0 HIS�pR1CPRE � ' X,�J�� of Alo 1 Q:ICMD-Groups101d Kings HighwaylOKHNew AppIOKH Cert Appropriateness 07.doc Town of Barnstable Old King's Highway Regional Historic District Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 4 copies Foundation Type: (Max. 18"exposed)(material-brick/cement,other)- (;-%A e—Le eln el) Siding Type Q r`-11061 material: d6d�ZL Cl1C�0 Color: Chimney Material: Color: Roof Material: (make&style) )qS00H1g1 / Color: Trim material Alk)� Color: Roof Pitch: (7/12 minimum) ,,n '- l^ n ,l / J Window: (make/model) A,yo s�r1 material l4d)) dl-A fyll) color i Ui) Size(s): CDT Dmxyk,�Z Door style and make: material Color: Garage Door, Style 1-14 Size Material Color Shutter Type/Matenal: Color: Gutter Type/Material: CI��rC� Color: Decks: material �—/�' Size Color: Skylight,type/make/model/: material Color: Size: Sign size: Type/Materials: Color: Fence Type(max 6' ) Style material: Color: Retaining wall: Material: k4a Lighting, freestanding on building illuminating sign Please provide samples of paint colors and manufacturers brochure of style of windows,doors, fences,lamp posts etc ADDITIONAL INFORMATION: 4P o o m„ Signed: (plan preparer) print name s1�o tel.no. Location of application: Street no. Street Village rot ,. PY QAGMD-Groups101d Kings HighwnylOKHiVewApp10KHCen Appropriateness 07.doc AhPR �.��o0u 2 ,1 10,40% °t�aN'gn�ay p1d C`ocnRist>ee i 4. SIGNS Diagram of'sign,showing graphics,size,design and height of post, color and materials. Spec sheet. Site Plan on a GIS map or mortgage survey,OR photographs OR to-scale sketch of building elevation showing location of proposed sign; and any tree to be removed near a freestanding sign. Fee according to schedule. 5. FOR LIST OF ABUTTERS: PLEASE SEE OKH STAFF SIGNED (plan preparer) X C % Print 044Ut lr Date: Tel. Phone no's: 2 75S NOTE ALL applications MUST BE ACCOMPANIED by the CERTIFICATE OF UNDERSTANDING The Old Kings Highway Historic District Committee MAY DENY INCOMPLETE APPLICATIONS ATTENDANCE AT MEETINGS: If the applicant or his/her representative is not present during the hearing is scheduled, the application may be either CONTINUED OR DENIED APPEAL PERIOD APPROVED PLANS PLAN PICK UP There is a fourteen(14)day appeal period for approved plans. This is necessary for each Certificate of Appropriateness and/or Certificate for Demolition issued by the Old King's Highway Committee. Plans approved by the Old King's Highway Regional Historic District Committee may be picked up at Growth Management,Regulatory Division,200 Main Street,Hyannis,after expiration of the 14 day appeal period. If the 10 day falls on a Saturday, your plans will be available the afternoon of the following business day. DENIALS Applications that are denied may be appealed to the Old Kings Highway Regional Historic District Commission within 10 days of the filing of the decision with the Town Clerk. For more information, see the Bulletin of the Old Kings Highway District Commission. BUILDING PERMITS, OTHER AGENCY CONTACTS In most instances,before commencing work, a Building Permit is required. The Building Division will require a certified plot plan for new construction and/or demolition. Commercial work may require Site Plan approval. Demolitions: the applicant should check with the Building Division as to conformance with Zoning requirements. Other Regulatory Agencies at 200 Main St,Hyannis MA 02601: Building Division 508-862-4038 Conservation Division 508-862-4093 Health Division 508-862-4644 QUESTIONS ABOUT YOUR APPLICATION? PLEASE CALL THE BARX§fOtE OLD KINGS HIGHWAY OFFICE AT 508 862-4787 V 0 6ti 91 �Sia�a�i5 QAGMD-Groups101d Kings HighwaylOKH New App10KH Cert Appropriateness 07.doc n'(6\G�Go�� F EB 1 5 2008 TOW OFPR SERVABLE A HISTOR i D Town of Barnstable *Permit 5 Boa as � Expires 6 months from issue dare Regulatory Services Fee 06 . D Thomas F.Geiler,Director )Building Division Tom Perry,CBO, Building Commissioner X-PRESS PERMIT 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us MAY 0 8 2006 Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint r Map/parcel Number a/� 0 4/ O! rfz� ( ()aK S�?AA Pro erty Address —6 l Residential Value of Work t V' Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address fi Oak" rI- Masi Contractor's Name G r Telephone Number Home Improvement Contractor License#(if applicable) / b tl - Construction Supervisor's License#(if applicable) [�Jorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [;,I have Worker's Compensation Insurance Insurance Company Name (Imtefi�d Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) I lI I l Z/Re-roof(stripping old shingles) All construction debris will be taken to 6U A ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owz r must sign Property Owner Letter of Permission. Home Impro ment Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 I Town of Barnstable regulatory Services Ms�s.j'�'8 Thomas F.Geiler,Director i679• ♦0 ATFp, ,�A Building]Division. Tom Perry, Building Commissioner T 200 Main Street, Iiyannis,MA 02601 www.town.b arnstabl e.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder L im-I'r kA-e L .W 2 c ki ,as Owner of the subject property hereby authorize &4 lu �W2 a;J Zoe•l Wq- to act on my behalf,. in all matters relative to work Lorized by this building permit application for. 11 104K -S+. W ESt 6ARJMAbe0 m c, . (Address of Job) N Signature of Owner Date tCkA-eL Lg WEtc Print Name Q TORM&OWNERPERMISSION i 4 4 `q` ✓`zC tJd1)7/I)G4)211J2�CUG �.'�LtlJJILC/LIG.. _— Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 138647 Expiration: 5/1/2007 Type: DBA NEW ENGLAND ROOFING CO. SCOTT PERRY 259OTISST. � MANSFIELD,MA 02048 Administrator I � �`�� � X ��J � d � �� � � oF1 r Town of Barnstable *Permit J� Expires 6 Months from issue date - 1 D EUMSTABLE. : Regulatol'y Sery ces Fee I s Thomas F.Geiler,Director'°tEDiV1A'lA` Building Division 4 Tom Perry, Building Commissioner RES 200 Main Street, Hyannis,MA 02601 LU� 2 ePul�' Office: 508-862-4038 TD 2 2004 Fax: 508-790-6230 _ wN Or8ARNSTA EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint BL� Map/parcel Number 4 7 Lot 2, Property Address trA k 54 w tAt AAa2NSfA LJ4 [Residential Value of Work SOU Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address a, A N d N L C In A-e L W E lc d ( SAm-o g n &6 o w2 Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side [replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property .wner mus sign P operty er Letter of Permission. me Improvement ontra tors Lice a is required. Signature Q:Forms:expmtrg Revise063004 ,o4 IL' -9 f,1i !i: 42 {, W Application to fgTj� egi)Lfta°1 f�JoricMi5strittCom - J bd a In the Town of Barnstable JUN +ri 0 2 2004 '1' CERTIFICATE OF APPROPRIATENESS T /fV0FBARt�_ HISTORic PRESET:. '"En, Application is hereby made,with four complete sets, for the issuance of a Certificate of Appropriateness under cti 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 ❑ Addition Alteration Indicate type of building, ❑ House El Garage ❑ Commercial ❑ Other 2. Exterior Painting: 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Ret nting Existing Sign 4. Structure: El Fence ❑ Wall El Flagpole Other TYPE OR PRINT LEGIBLY: DATE ADDRESS OF PROPOSED WORK 7 I l ��� ASSESSOR'S MAP NO. Z 1 U OWNER � � � �% ASSESSOR'S LOT NO. 0 "1 HOME ADDRESS <S�i�I� TELEPHONE NO. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way. (Attach additional sheet if necessary.) 95i '- � i -Z- D AGENT OR CONTRACTOR �/ � (� ��.- TELEPHONE NO,,�Jfj:j?7J-.-%510 ADDRESS- DESCRIPTION OF PROPOSED WORK, Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. 1%044C67• ��I y :ZV//1/0 Z0 Lv17;z-1 sTi4�/G r ado �v ly ,� .C��/�ebu>s (a� Sl r 0a J1X. Signed Owner-Contractor=Agent For Committee Use Only ,-A' �ll IAED This Certificate is hereby_ AEDate � Approved enie Committee Members' Signatures: a�A� c i Town of Barnstable 'W ' Old King's Highway Historic District Committee SPEC SHEET FOUNDATION 'UN 0 2 2004 HIS GRITOW �PRES RV�B E SIDING TYPE COLOR _ ON CHIMNEY TYPE COLOR ROOF MATERIAL COLOR PITCH ' WINDOWS 1/ 14�� COLOR �D SIZE �XLST�/4" D� /I TRIM COLOR � �-C6��� " i J��G �d" GX 672� DOORS COLORS SHUTTERS - COLORS GUTTERS COLORS DECKS MATERIALS GARAGE DOORS COLORS ' SKYLIGHTS SIZE COLORS SIGNS COLORS FENCE COLOR NOTES: Fill out completely, including measurements and materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape plan and elevation plane, when applicable. SPECSHT ZAssessor's office (1st floor): _ Assessor's map and lot number ...... ../ ...... >.% !�.... °irN¢r°`i Board of Health (3rd floor): fO� 4'---Sewage Permit number .......,.: ................... Z 33A"S ABLE. Engineering Department (3rd floor): raes 9. House number 0 t63I �0 Definitive Plan Approved by Planning Board --------------------------------19-------- . APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN -OF BARNSTABLE BUILDING INSPECTOR b , .:... �� r APPLICATION FOR PERMIT TO ....._.,.....:.............., t TYPE OF CONSTRUCTION ........................�:�a.......G#et �uC�S ...................Y.(/!..l...�............194 ' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......... " I .... ....:... Jet..¢.:� s. �� r.:..!���1.:...<.1.?.� �.......................................................................... .:............. ProposedUse .......... !�� `- !'�......... ............................................................................................................................... Zoning District ...............................:! ................................... ....!...................................Fire District ................� ...... /� y'rL .............. Nome of Owner .....}Pd!.� 1� :! ... �.cr^�-*�:.�.'l/�k�c�:�..Address .........� A.)'��:.....�:�,R.���, Name of Builder ......................................Address Nameof Architect ..................................................................Address `.................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exlerior ..................:.................................................................Roofing ............. .............................................................a..:;. Floors ...................................................................................:..Interior .................................................................................... Heating .....................................................................?.............Plumbing .......................................... +. Fireplace ...................................................................:..............Approximate Cost ..............":, moo,.-......... a Area ....�� .X..:�..�'........:5 .- Diagram of Lot and Building with Dimensions Fee d 00 ................>!r f .l AM OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable reg ra dra ding the above construction. r . 1�Name ..............K�.. ..... iiConstruction Supervisor's License .f ':: .........I....... WELCH, MICHAEL & TEREASA A=216-047 No ..323.44.. Permit for ..1NUALL...F.Q.0.L.. Accessory to dwelling ........... Location ....9.9.1...Oak........Set..r.e...0.t .. ........................ West Barnstable .....................................................................I;:........ Owner ...M.ic.h.ae.1...&...Te.re.a.sa Welch .. .... .. .... .. .. ..... .... .. .. Type of Construction .....F.r.ame........................ .....Frame ....... ............................................................................... Plot ............................ Lot ................................... Permit Granted ..........April: 26, 19 88 ........ ................ Date of Inspection ....................................19 Date Completed ......................................19 '�/40 x 3 °tint Tom,. The Town of Barnstable ti Department of Health Safe �NSrABU. ; Safety and Environmental Services "�• a Building Division oa�A 367 Main Street, Hyannis MA 02601 Office: 508-790-6227 Fax: 508-790-6230 Ralph M.Crossen Building Comrr issioner Home Occupation Registration 3 Dare: Y1,7AR CAL is- L 9 1`I A l Name: m%ck,,f__ the 1ch 0 BA Alvc..yto Phone k: 3G Z 4�o p Address: 99 I O-A k 5-+—,Le #%'t Village:�� Type of Business: p�v b���-r, $-� � Map/Lot: 2 l O '1 rj —\$ INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation\. within single family dwellings, subject to the provisions of Section 4-1.4 of the Zoning ordinance, provided that the activity shall not be discernible from outside the dwelling there shall be no increase in noise or odor;no visual alteration to the premises which would suggest an}t}ning other than a residential use;no increase in traffic above normal residential volunnes; and no increase in air or groundwater pollution. After registration with the Building Inspector, a custonnary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located vvidun that dwelling unit. • Such use occupies no more than 400 square feet of space. • Tlnere are no external alterations to the dwelling which are not customary in residential buildings, and there is no,outside evidence of such use'. • No traffic will be generated in excess of normal residential volumes. • The use does not involve tine production of offensive noise,vibration, smoke, dust or other particular matter, odors, electrical disturbance, heat,glare, humidity or other objectionable effects. • There is no storage or use of toxic or haz:rd.ous materials, o:flarr:.�,at�le or explosive materials, in excess of normal household quantities. • Any need for parking generated by such use shall be nret on die same lot containing tine Customary Home Occupation, and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial velucles related to the Customary Home Occupation,other than one van or one pick-up "ck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business, the street address shall not be included. • No person shall be employed ur the Customary Home Occupation who is not a permanent resident of the dwelling unit. I, the undersigned, have read and agree with the above restrictions for my home occupation I am registering. Applicarnt: `� 9 Date: !'Ylg2elt Homcoc.doc Assessor's office (1st floor): l/ SEFMC SYSTEM �MpUST BE p .. (�.....� ... ..... L0r,CjL ,,..,. =� COMPLi4 a%c Q�piTNEj�`` Assessors ma and lot number. ......11 . :�� c and of Health (3rd floor): d 4,1 Sewage Permit number ........ �5.. . g.,�. ...... �. ......... . . �, NTiNL CODE AND t Basa9TsnLE, Engineering Department (3rd floor): �' ' reed House number .................................................................... TOWN �EGULATIOPlE �p 2639. d`e Definitive Plan Approved by Planning Board ________________________________19-------- . APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only oM TOWN OF BARNSTABLE BUILDING INSPECTOR . f APPLICATION FOR PERMIT TO SN t ev �"� ..�.. TYPE OF CONSTRUCTION ......................../. l.......�/.! ................t.......................,..FPN.tt,� I Std .. ............y... .�. .... ............19 . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........."I...OAK...5.f!.... :Ol... oz(.&.,?.......................................................................... ProposedUse ........... ... '`_ .�. y-...........................:.....:................................/..>........,................................................ Zoning District ......................... ....!..�/..................................Fire District J a Name of Owner ..... 'f' l!102Q k.Address ..........!C, .Y.11. .,....4tA 41:'¢ ............................... Nameof Builder .......................=.......................................Address .................N..................................................................... • Nameof Architect ..........::......................................................Address .................................................................. Number of Rooms ..........................Foundation' Exlerior ....................................................................................Roofing Floors ......................................................................................Interior .......... Heating .................................. ................a...........................Plumbing ................................. ................................................ 10 Fireplace .................................. J...........................,...............Approximate Cost ....................17 1,10r.................................... Area ....R....X. .......... Diagram of Lot and Building with Dimensions Fee ..:...: °00�.r.1 vi 41 �t ' 4` OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to-all the Rules and Regulations of the Town of Barnstab regar ng the bove construction. Name .............. ........ Construction Supervisor's License ............... WELCH, MICHAEL & TEREASA "' 32344 No ................. Permit for ..... N..S'1' D�+...�'OQL Acces,sox.y. ...to...D.We.1.7 ing............. Location ....9.9.1...Odk...S.tr.e.et........................ . .....................W..e.st,..Baxms.table.................. s> . r. . Owner ..... ii c a .] ...&...`.i'.ex:e.as.a...Welch Type of ,Construction .........E-rame..................... ............................................................................... ;, Plot ......:..................... Lot ................................ , J Permit Granted ....Apri1 26, 19 88 Date of Inspection ....................................19 Date Completed ............ ........194 r e i r Application to q3 5►�,pW� 6 p EG.�.S i '� yo ",a► Old Y egg Kin g's Highway Regional Historic District.Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, id triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973; for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building ❑ Addition Q Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: 3. Signs or BillboardA New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: Q Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). / //- TYPE OR PRINT LEGIBLY _ -----� DATE U/ �(—D ADDRESS OF PROPOSED WORK ! u , ASSESSORS MAP NO. 216 OWNER �l� �L-//C�CX. x-C �i " - ASSESSORS LOT NO. HOME ADDRESS / ��/ �k /��' TEL FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). QiL � Oar C�7-L Z�v- ,6?�r"6— c AGENT OR CONTRACTOR /�, �` ��L '� TEL. NO. V� 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). '- .. � - = 7a �7_ IJ � , ;.c�- (ail Owner-Contractor-Agent Space below line for Committee use. C 'Date U The.Certificate is hereby Date �� 9 JUN 181997 — 1 ` Time /;�`•� TO OF BARNSTAB " ' Qt/l& Aa4AQ, Approved ❑ IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period provided in-the Act. Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION SIDING TYPE COLOR CHIMNEY TYPE COLOR ROOF MATERIAL COLOR PITCH WINDOW SIZE (,edrt joiy TRIM COLOR �C / / ~ ' 1-5 DOORS COLOR SHUTTERS COLOR GUTTERS DECK -- - GARAGE DOORS 1pll !M,1 (� ICOLOR. ►i Xr� �� SIGNS COLORS FENCE COLOR NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the plot plan, landscape plan and,elevation plans,, when applicable. Site plan should show all structures on the lot to scale. SPECSHT