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HomeMy WebLinkAbout0023 PERCIVAL DRIVE Oxford® NO. 152113 ORA MADE w use►. ESSEM U .. /w,�,.rwti _..�t'�!u..rw�,h_TTr�.1��- _�'- tst- ram„ — _.____—_____:af......._ '�r's'`_+.lwr+..r�w.. Barnstable p e^"� L" •. e Town of Ba Building _ Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept A ,�' Posted Until Final Inspection Has Been Made. Permit Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. 1 P Permit No. B-19-3041 Applicant Name: Jonathan Whipple Ap provals Date Issued: 09/16/2019 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 03/16/2020 Foundation: Location: 23 PERCIVAL DRIVE,WEST BARNSTABLE Map/Lot: 111-056 Zoning District: RF Sheathing: Owner on Record: VIOLA,JEAN Contractor Name: JONATHAN N WHIPPLE Framing: 1 Address: 23 PERCIVAL DRIVE Contractor License: CS=078683 2 WEST BARNSTABLE, MA 02668 Est. Project Cost: $2,268.00 Chimney: Description: Insulate attic,install home air sealing,ventilation chutes and Permit Fee: $85.00 weatherize attic access pull down stair. Insulation: Fee Paid:. $85.00 Project Review Req: Date: 9/16/2019 Final: �dts.Tcrn Plumbing/Gas 4 Rough Plumbing: ffIcIal This permit shall be deemed abandoned and invalid unless the work authorized by this permit is'commenced-within ed"within six months afie!issuan . Final Plumbing: All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the Building-and-Fire-Officals are provi')ded on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Service: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue,lining is installed Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final: Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: I c t r ` t„E Town of'Barnstable *Permit# Expires onthsfrom issue date BARNS?ABI� ERMIT Regulatory Services Fe 1KA6 s.& Thomas F.Geiler,Director 2013 Building Division Tom Perry,CBO, Building Commissioner ,Q OWN OF BARNA�TAKS 200 Main Street,Hyannis,MA 02601 I www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number 0 Not Valid without Red X-Press Imprint Property Address IZ& 'P." r�t�— (�!"• �iL� ��� ov [Residential Value of Work$ 3�� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Addressc—"-7,0, Contractor's Name Lb(Z t}','y{ph Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) CS . 0:7 ff 1 5- 1 ❑Workman's Compensation Insiiiance Che one: I am a sole proprietor ❑ I am'the Homeowner,' ❑ Lhave Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) QrRe-roof(hurricane nailed (stri ping old shingles) All construction debris will be taken to �gUU5 S A ?6_AUUA(_ t\;C-� Sh�rci�C) `10 V Mjq& grc_h;+eL+,r-kL ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter o rmission. A copy of the Home Improvement Contractors ce e o struction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 060513 Email. r� The Commonwealth ofMassachruseas Departrnei'nt of Indksb iat Accidents - Offike of Imestigations 600 Washington Street Boston,MA 021II n Kwanass govldia Workers' Campensatian Insurance Affidavit: Builders/Contractor$!Electricians/Plumbers Applicant Information Please Print Leeibly xa t13 am/lndivi�ai): hit.)4oQh&Y\ M �D& Ad&m. : `�C 'fix LI CitylstatrlZip: S �Vbr, Phow lk- _�o?J Are you an employer?Check the appropriate bo= Type of 4. atn a contract d I �or an project�r���� I_[I I am a employer with ❑ I 6- ❑New contraction loyees(W and/or part-time).* have hired the sub-contractors 2_ I am a sole praptietor orpartner- listed on the attached sheet 2- ❑Remodeling i ship and have no employees These contractors have 8. ❑Demolition working for me in any capacity- employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp-in�i required'-] 5. ❑ We are a corporation and its 10-.❑Electrical repairs or additions _. 3.❑ I am a homeowner doing all work officers ha-.T exercised thek 11.0 Plumbing repairs or additions; myself-[No workers'comp- right.of exemption per MGL 12-.2015,0o f insurance T c.152,§1(4),andweImmno �a mod) �3��13.[�Other employees.[No workers' T p comp-insurance required.-] *Any appti�at that checks boa#1 mmst also fill out the:section below showing their worirers7 compensation poaT infutmatkm fi Homeoarners who sabmit this a�indicating they are doing all umt and Bien hoe outside contractors louse submit a new affidsmi indicating sucb_ tContractors that check this ban mast attached za additional sheet sht wh g the name of the sub-coutisctors and state whether ornot those eatities have employees. If the sttb-cmtmctors have employees,Hrey most provide their workers'comp.policy number I am an employer that is providing workers'compemudion invirance for ary employees Belaw is the paUcy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: FxpirationDate: Job Site Address: CitylStatelZip: 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 head to the imposition of criminal penalties of a fine up to S 1,500.00 andlor one-year imprisonment,as well as civil penalties in the farm 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 fiorwwded too the Office of Investigations of the DIA for insurance coverage verification- I do hereby a fy ender thapains and penalties ofperjury that the information prosi&d``above is and correct Si tune: - Date: VZ d 1 Pone#- 50 8 BVY EU- O,, Iciai use only. Do not write in this area,to be completed by city or town official City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 mnnber(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to 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 GommoLawealth of Massachusetts - Department of Industrial Accidents Office'Of kvestigations 600 Washington Street Boston,MA 02111 Tol.#617-727-4900 ext406 or 1-877 MASSAFE Revised 4-24-07 Fax#617-727-7749 www.massgov/dia f . . [HEti . Town of Barnstable Regulatory Services Thomas F.Geiler,Director iOrEp,,,p,(p Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, property as Owner of the subject --�.--z NI (I P P rt9hereby authorize ; . '&K �' \�E7t��� to act on my behalf, in all matters relative to work authorized by this building permit • • `,i'. - as..f -... .. d.,� /.i.x'�.'' _. _ .;+�. •.. _ O^/.) _ _ ._,�•1.�7 _ .. (Address of Job) Pool•fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepte ignature of Owner Signature of Applicant ��/_el`- Print Name Print Name A-tom • Date Q:FORMS:OWNERPERMISSIONPOOLS 6r2012 Town of Barnstable Regulatory Services MUM> i►sr.E Thomas F.Geiler,Director 'DTEI L619. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWIN'W': 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/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"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 'i s 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 persou(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners 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 person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the 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 form/certification for use in your community. C:\Users\decolluk\AppDatEi\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXI'RESS.doc Revised 053012 i • 1 ' __� 7 _ .l ; k' Office of Consum er Affairs and Business Regulation - s 0 Paik.Plaza.<'=Suite 5170 g- t3ostorl, setts•02116 e-.i1-7nprovemenl �y: acto>"Registration Registration: 172930 Type: Individual. CHRISTt>PHER DESTEFANO � J ) Expiration: 8/14/2014 Tr# 230325 CHRI-STOPHER DESTEFANO � - P.O. BO:"( 497 SANDWrCH, MA 02562 l"I date'Address and return card.Mark_•eason for sCA 1 ;W 2OM-65n chap i _ '� Address change. Renewal Q Employr•,;ent Q Lost.Cardj Office of Consumer A fairs&Business etiolcaeL�a LicensDr registration valid[or individul use only.. ! ME IMPROVEMENT CONTRACTOR 'be expiration date. If found return to: egistration: '�:72g30 .1 Type: Office if Consumer Affairs and Business Regulation xpiration: :8/t4/261.4, Individual 10 ParkPlaza-Suite 5170 r `�&g—�—=� Boston;MA 02116 l CHRISTOPHER DESFEEAN -``�i.� CHRISTOPHER DEST-EFANO: - : 68A ROUTE 6A ' = SANDWICH,MA 02562 �'"g-=``'' — 6 } Undersecretary Not valid without signature 1 i l � Massachusetts - Department.af Public Safety,. ' Board of 6Bbilding Reg ulations';aiid'Standards' Construction Supenixor License: CS-079151 . CMUSTOPHER PO BOX 497 Sandwich MA 025§3 Expiration CortltnisSioneY 09/7/2Ol4 -< TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. r. Map Parcel 4p� OL56 - Application # o0� 3�(� Health Division Date Issued Conservation.Division Application Fe _ ( � Planning Dept. � Permit Fee Date Definitive Plan Approved by Planning Board Historic.- OKH Preservation/Hyannis Project Street Address Village . X? 1109 PjZl�h Jam' Owner A1ak,!Q,-z7—-` /��/� h✓ &1'7�Address v,*2 Telephone Permit Request /��� ems-✓ i v oFX ill; c1� E�j�. t o Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation l C00 0 Construction Type Lot Size (t • SC3 �i S` Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family W-� Two Family ❑ Multi-Family y(� ❑ h (# units) � Age of Existing Structure '1 � ❑ -� • Historic House: Yes �;r o On Old King's Highway: Yes Oho Basement Type: ❑ Full ❑Crawl &'Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing_ CA new Half: existing o2 new Number of Bedrooms: existing _new - Total Room Count (not iA�FsLll c baths): existing new First Floor Room Counter Heat Type and Fuel: Oil ❑ Electric ❑Other <_ — :n > Central Air: W Y6s ❑ No Fireplaces: Existing New Existing wood al stove.; ❑l.es ❑ No :X Ci Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ex sting 4nevrpj size_ Attached garage: • xisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: `" rM Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name f A:;)-.z� 19 Telephone Number Address � �z<i� ��`v�C. CD License# �• �-�-� /7? Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ,c_. l�l���/-� OL- DATE ion iS �'- 3 } �l FOR OFFICIAL USE ONLY -APPLICATION# ' DATE ISSUED j MAP/PARCEL NO. 3 ADDRESS VILLAGE OWNER DATE OF INSPECTION: T FOUNDATION e/e_- FRAME - T INSULATION _ FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ..GAS: ROUGH ' G FINAL FINAL BUILDING 4 DATE CLOSED OUT ; ASSOCIATION.PLAN NO. }, ' 'r . i THEr Town of Barnstable Regulatory Services ' � RARTl3TAbL.£. •. . MCC Thomas F. Geiler,Director i63g Building Division ' Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 WWW town.baniA2ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: �eL 5 ff Map/Parcel: Project Address Z 3 i0C-XC i y4L RJR• Builder: `.± oar-OW The following items were noted on reviewing: l� SoNa /c1,��S 'N61,4r L U N Gtl! 7-y-f 10./l7 c 12E�E Reviewed by: Date: //,O,9 Q:Forms:Plnrvw The Commonwealth ofAfassachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contrac'tors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organization/Individual): Address: nZ v? �( �i v� Y' City/State/Zip: a2 - Phone.#: Are you an employer? Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-.time).* have hired the sub-contractors 6. ❑New construction .2.❑ 1 am a We proprietor or partner-' listed on the attached sheet. T. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp. insurance comp. insurance.t re ed] 5. ❑ We are a corporation and its '10.0 Electrical repairs or additions 3. " 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, §l(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'comperisation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine 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 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:�a ereby certify nder t and penalties of perjury at the information provided above is true and correct. Sifore: Date: Phone#: Offu:ial use.only. Do not write in this area,to be completed by city or town offeciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation'for their.employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C( )states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and.phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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 Massachusett§ Department of Industrial Accidents Office of Investigations, 600 Washington Street Boston,MA 02111 TO. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia i Town of Barnstable , ' do Regulatory Services •AENSfABL& ; Thomas F.Geiler,Director �b p.0� Building Division iO�Ec►,�+ Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038' Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION C, Please Print DATE: Z JOB LOCATION: number street` village „HOMEOWNER": ® ,t /�� ��1! Xs/� L_,0hZ n e 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/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"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 requt ment s. Signatu of om wner 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 homeowners 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 person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the 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 form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC Town of Barnstable Regulatory Services IMAM 1 e' Thomas F.Geiler,Director 6. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date, Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION f 1 `C4 I f-j c-C BARP�STABLE �pF1HETp�O Barnstable Old Kings Highway Historic DislPkY Cd&fnittee &kRNsr„gLF- ; 200 Main Street, Hyannis,MA 02601;TEL: 508-862-4787 Fax 508-862-4784 UAW. a 1639. ED MAt APPLICATION, CERTIFICATE OF APPROPKI:AMMI 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 all categories that apply; 1. Building construction: ❑ New El Addition 6zteration 2. Type of Building: ouse ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting, roof ❑ new roof ❑ color/material change, of trim, siding, window, door 4. Sign : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign �� 5. Structure: El Fence El Wall El Flagpole El Retaining wall ElE tennis court Other 6. Pool ❑ swimming ❑ Other man-made pool Type or Print Legibly: Date: Address of proposed work: House# Street: '. i-2CYK e., ✓i9-L 0,6c'-d e Village 'A'�(019ssors Map Lot# Description of Proposed Work: Give particulars of work to bedone: ,9 -Y ` / T?' �-X X / `Ti�fFn� 1g,� X /d� CS��Ejf Agent or Contractor(print): zza xr Telephone/#: Address: S�-�it �" v�L ✓; v L_ �ZJ�r--�.� Contractor/Agent'signature: �— NOTE All applications must be signed by the current owner Owner(print): z D,<I&AI Telephone#: \,5 Owners mailing address: ir 7 i'y7V T Owner's signature: r/A- kFor committee use only. This Certificate is hereby APPROVED/DENIED �c (� (Z O �p Date Members signatures L� lh l5 V FEB 0 3 2009 �- O TOWN OF BARNSTABLE 0 •' HISTORIC PRESERVATION Any conditions of approval: ,,.�` 0 d o 1 Q:I GMD-Groupsl0/d Kings HighwaylOKH New 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) Siding Type material: Color: Chimney Material: Color: Roof Material: (make&style) Color: Trim material Color: Roof Pitch: (7/12 minimum) Window: (make/model) material color Size(s): Door style and make: material Color: Garage Door, Style Size Material Color Shutter Type/Material: Color: Gutter Type/Material: Color: Decks: aterial Size Color: c Skylight, type/make/model/: material Color: Size: Sign size: Type/Materials: Color: ov Fence Type(max 6' ) Style . material: Color: p Retaining wall: Material: FEB , of 6a,Lighting, freestanding on building illuminatinigtag's rl lo ri relay Corn Please provide samples of paint colors and manufacturers brochure of style of windows,do d r fences,lamp posts etc I V ADDITIONAL INFORMATION: la 2 Z ABA TORNtQr OfSER Signed: (plan preparer) print name tel.no. Location of application: Street no. Street Village 2 Q:IGMD-Groups101d Kings HighwaylOKH New AppIOKH Cert Appropriateness 07.doc 4/ cv G.ex'—' ��e o r / AV C52 X 40 et L / �: //, Z_TT RP ly i a� e c9 X / a /*o j 8 i tS \Nl eat 0 c' \fie . ��t� K�2>�l L � <C.-1. Et��•�S o ,��;- �,t,,_.__� � ��Pf , � �: �-�-� j � ,•cam;� = I� FFR '0 z 2.009 HISTORIC PRESERVATION • u,�..�:�n dam• .. LOT 10 rtt ss:<st±'Sf. (oar= AC.) I uide I I ! 72 74 to At Pc c f 1 I I 1 I i t 1 1 �• 1 t I. .I 1 1 i. t I. I. 1 � -,. . LOT 9 F I I , 74 f 1 I 1 \ 1 1 1 t ► , s. too r >e is \ \ N �\:• 1 ! /.__.a DjGE 1 PRDPDSSD . ��ftjyt8c 1R \ I CT1L7T �- t. ` ELI. /ipa f BA! ' C:.CS:SR D FIX PEgcN�'y EXISTING CONTOUR: PROPOSED CONTOUR:' — --. . MANSa s y%IS7ING SPOT ELEVATION: ZSS PROPOSED SPOT ELS7dTI0 v.. v� EST 80LE: cauaRa 'r��•�.ara BOOXD t • 'J . D E.CE VE F EB '0 "1009 TOWN OF BARNSTABLE HISTORIC PRESERVATION i • ;.I I i ONt 40 LA)i fi h � W Co x(p FOS+ t W S I� c N CVJ �DiC.0 o 0 NSW SAv�►'r�tTObti' dr acctcT�I�� C®py �. arc to �r i n E pI G Hie getfs ri LC 3 c, 5 L4 KU ,f r'�d i} K AA :. Kam.. totA �d rAnolo `l A4 - - _ �-.. -.-��...r•�_. ., h1- ....�;;•+.. -- 'n - 3!'y:., r:�"! �+.• 1 'Y r-ate rL':;i..+rw-:'+n'.r•.%+:n.a..��a �-:.r^..•,.,-..t-r.: -'fiey`I"Y':,„ J-,`t;•^*� TOWN OF BARNSTABLE Permit No. .........37®30 ....... ` BUILDING DEPARTMENT TOWN OFFICE 6UILDING Cash 7 Ml '�ouY► HYANNIS.MASS.02601 Bond ...x........... CERTIFICATE OF USE AND OCCUPANCY Issued 1 0 Horsefoot Boddlings of Cape Cod Address23 Percival Drive, West Barnstable USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID. AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. December 28. , 19—P............. Building Inspector ; Asses or's effice(1st Floor): Assessor's map and lot numb r �vrP. SE�'7M Ty t '` Ty j E �F C�THE TO Conservation(4th FlooTALL :�.rrt`a�a-� a� Board of'Health(3rd flo fuse Tww� UlfiNP i'sue: C���.., 5 Sewage Permit numbs z t.� : DAUSUBLE NVII�Dd O.2 _c.,,L CODE AND N"& Engineering Department(3rd floor)- °�''39'b���' House number TOWN REdUL"� �NS or�r 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 BARN T' BLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO �IS �� t TYPE OF•CONSTRUCTION { V ' 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accordingto the following information: Location ar io p uyw ���ud f,- , w&igr � Proposed Use- Zoning District Fire District3i15' L�G Name of Owner !'IQr�S O�'�l0!-D/NG�s 0� � at) Address �`�� ll/�j�.664 SE MA 4Z67a Name of Builder !3 /� � rt � Address � 1�6�!/V�P&V15 0 41670�� Name of Architect Address ,p,, "1 4271S Number of Rooms Foundation -� ' ®�� ��� � ,! kflT-1 s106(A 10- T Exterior �1#W �,AI-? 6405 MOO L Roofing �Q �r��^ Floors � �� `� ���� Interior 2!( Q (RAl Svc: Heatingi'�ff: 4 &AS - WIA)-WP) -PkUM13'd4 Plumbing Fireplace PwSS i(r r`��� Approximate Cost# i2-0 Area Diagram of Lot and Building with Dimensions Fee SSE �fE D P�-�9I� 0A�0 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstab reg rding the above construction. Name l Construction Si ipervisor's License D 328� HORSEFOOT HOLDINGS OF CAPE COD 23" PERCIVAI; DRIVE, WEST BARNSTABLE .� L�D�I'j 1 b 41No 3�3 0 Permit For 2 story y S. F. D. Location Owner Type of Construction Plot Lot Permit Granted Sept. 15, 19 94 Date of Inspection: . Frame /OzA 19 Insulation 19 F. Fireplace 19 Date-Completem a i 1 i LOT 9 90, LOT 10 LOT 6 3 5,434 1 AS.F. O B3 x . 17 C�q ^' ° 0t n O V +I b O h IT 239.'72' �R=172. 12' A=5. 00' OPEN SPACE JOB # 94-039-10 CERTIFIED PLOT PLAN PREPARED FOR LOCATION : ASES MAP 111 PAR 56 PERCIVAL DRIVE WEST BARNSTABLE REEF REALTY SCALE : 1" = 60' REFERENCE : LOT 10 PLAN BOOK 413 PAGE 99 OFNSS I HEREBY CERTIFY THAT THE STRUCTURE �� JOHN 9cti .SHOWN ON TIffS PLAN IS LOCATED ON THE o Z. �m GROUND AS SHOWN HEREON. DEMAREST,JR. ^� o No.36859 Z; su DEMAREST - MUELLAN ENGINEERING 24 SCHOOL STREET P. 0. BOX 463 SEPT. 13, 1994 WEST DENNIS, MA 02670 (508) 398-7710 DATE OF SIONAL LAND 4VEYOR N ASSESSORS MAP: fit PARCEL 69 4- TEST HOLE LOGS NOTES: �> CURRENT ZONING: RF ENCINEER: DOYLE ENGINEERING 1.VERTICAL DATUM: ASSUMED FROM QUAD/NCVD+/-I 0� ice BUILDING SETBACKS: WITNESS: THOMAS MCKEAN P.MUNICAPAL WATER IS NOT AVAILABLE. ' v S.SCHEDULE 40-4"PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. bi4,b F:So S: 15,_R:,s DATE: 9-80-86 4.ALL PRECAST UNITS TO CONFORM WITH AASHTO H-fO&X-20 ��47• PERCOLATION RATE., <2 MIN/IN LOADING SPECIFICATIONS. O \' FLOOD ZONE: C y�2Q TN-1 BSD TH-2 S.PIPE PITCH PER FOOT. 6.FIRST 2 OF PIPEIPE O OUT OF D-BOX TO BE LAND LEVEL LOWS TOP A,SUBSOIL 7.THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE E'_r BID USE OF A GARBAGE DISPOSAL. _ B.ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE CLEAN LOCATION MAP STATE OF MASS.ENVIRONMENTAL CODE(TITLE FIVE)AND LOCAL SAND HEALTH REGULATIONS. LOT f0 80 eP WITH 9.CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR 0443}S.F. ` TO CONSTRUCTION. ! \ , 10.PROPOSED SEPTIC SYSTEM AND WELL LOCATIONS ARE IN ACCORDANCE WITH MASTER PLAN ON FILE WITH THE BARNSTABLE HEALTH DEPT. BE I 0 I BO I I ,R2 , � eI ,V� Y 76 78 1 , 1 I 1 1 / / NO GROUND 6RlA AM£pONrRED EKED 72 74 I ', 96 SEPTIC SYSTEM DESIGN 1 I 1 , / 98 I 1 \ LOT 9 FLOW ESTIMATE: I 1 I 1 II 1 1 1 5 \ / // 2-BEDROOMS AT>gL-GAL/DAY/BEDROOM=330 CAL/DAY SEPTIC TANK: 6W DECE 74 I I I \ \ \ \ \ l / 100 .440 CAL/DAY-1S DAYS=495 CAL / 3 BEDROOM pt USE 7000 GALLON SEPTIC TANK PROPOSED DWELLING` I \ 1 I RR5 \ 5 , 1 I LEACHING AREA: rl.-9aD CAR / I \ \ \ \ 1 I I 1 , 76 ?B \ \ \ \ \ 1 I , 1 1 USE ONE LEACH PIT(6'x 69 WITH 2'OF STONE 1B 20 (10'EFFECTIVE DIAMETER x 6'DEEP) 102 PROPOSED DWELLING SIDE AREA- 10 x PI x 6-188 S£ (25)= 470 CAL/DAY BOTTOM AREA 5 x 5 x PI=78 SF (1,0)=78 CAL/DAY TOTAL CAPACITY-JUL CAL/DAY 1 ) \DS ® PROPOSED SEPTIC SYSTEM SECTION 2 PEASTONE B3. , ` B /. i. ; / sDa ` , UTILITY OF 3/4"-1 1/r 88 _ - /' / gRBPpR�05 \0rR I I CLUSTER 98D WASHED STONE - U/ yg � .9RD \ O�v6\ \ ..102 TOP OF FOUNDATION 9a- - - ,/00 92_ -98 Jg_ 87.39 98 - s- _ - - -- p�0 e3.7 87B4 1000 GAL ELEV. D-BOX B7.f6 0 r00.- - - -_-_-g6 I 6 ELEV. SEPTIC TANX ELEV. 102- _ \ R�6\\ E006 Oi Yp ELEV. TEE SIZES: ELEV. ELEV. 2' 10' -Tr-ELEV._ ` 00 7 INLET:6"UP.10'DOWN ONE LEACH PIT(6'. 6')WITH U ILIrY ° / I�(E OUTLET:6"UP,19"DOWN 2'OF STONE(10,EFF.DIAM.x 6'DEEP) c STER DR (H-20) 05.6 PERC1VALb� SITE AND SEWAGE PLAN X ECTRIC MANHOLE LOCATION.• EXISTING CONTOUR ———— PROPOSED CONTOUR: .... ........ LOT 10 PERCIVAL DRIVE EXISTING SPOT ELEVATION: 255 B CHMARE WEST BARNSTABLE. MA PROPOSED SPOT ELEVATION:25 AT Kc BOELAV UND TEST HOLE: PREPARED FOR, UTILITY POLE:-0- FENCE LINE: DM REEF REALTY HYDRANT:-' DEMAREST-MCLELLAN ENGINEERING SCALE. r=30' DATE: 5-20-94 24 SCHOOL STREET P.O.BOX 463 DM ------ WEST DENNIS.MASSACHUSETTS 02670 THOMAS MCLELLAN,P.E. JOHN Z.DEMAREST JR,PlS. REFERENCE: PLAN BOOK 413 PACE 99 < < ` dr'�"s�r►`,,aa`" Application to r\ \ Old Kings Highway Regional Historic District Comlitlee in the Town 994 0 7 of Barnstable for a 7 CERTIFICATE OF APPROPRIATENESS Application is hereby made, id triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ® New Building ❑ Addition (] -.Alteration Indicate type of building: ® House Garage ❑ Commercial ❑ Other 2 Exterior Painting: R 3. Signs or Billboards: ❑ New sign Q 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 M A UT '�� ADDRESS OF PROPOSED WORK Lo 'VL V��_219"IlF, ASSESSORS MAP NO. ZZI OWNER 4 ASSESSORS LOT NO. HOME ADDRESS Q Q.'_Rx)�� �c��C� •/LJ ,) 19M, TEL NO. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). S�P, &i t Bch& d L /s7" AGENT OR CONTRACTOR-9P_et' P.JQ.0 Jk Aid TEL. NO. _�9y� •���� ADDRESS 2 A i31),k JA14 �II, �//P_/Il/�/i�(' �� 4 24 24 DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of f 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 addiiional sheetr'if necessary). mw&./ lZ bo=o xZ�_r o r5,,✓/� U , r� 55 ,: . . w Roo a1 a ., .. ,.._... . Signed Owner-Con tractor•A t Soace below line for Committee use. R"ecew.ed' y H`D'C . LI IJ 91 a The Cer L4 ca Is hereby Date Trmc -/�Y�7 BvT�tn/�1�p rte�nl�-rnral,E D KING' HWAY Approved `; IMPORTANT , If Certificate is approved, approval is subject to the 10 day appeal period provided In the Act I ADDITIONAL INFORMATION FOR MAKING AND FILING AN APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS The four categories for which a Certificate of Appropriateness is required are: (application for demolition or removal is a separate form). 1. EXTERIOR BUILDING CONSTRUCTION (new or existing buildings): An application is required for any exterior of a. building to be erected or altered including windows, doors, siding, roof, light etc., that will be visible from any public street, way or public place. The following scale drawings are required in duplicate with application: plot plan (if addition — show existing buildings in outline). floor plan and elevations. Also required are snap shots of existing buildings, where additions or alterations are to be made. No plot plan is required for addition or.alteration which does not touch the ground. 2. EXTERIOR PAINTING: An application is required for any portion of a building, structure or sign to be painted that i! v1sihie from a public street, way or public place. Color samples must be attached to.these applications. An application is no- renuired when repainting existing colors, changing to white,or using colors approved by the Town Historic District Committee 3. SIGNS OR BILLBOARDS: An application is required for any sign or billboard to be erected within the District, with th following exceptions: a. Existing signs or billboards on November 27. 1974 shall have until November 27. 1977 to secure an approved Certificat of Appropriateness. b. Temporary signs for use in connection with any official celebration or parade or any charitable drive as long as they at removed within three days of the event. Certain other temporary signs that the Committee feels does not detract fror the Act may be allowed with the prior permission of the Committee. c. Real Estate signs of not more than 3 square feet in area advertising the sale or rental of the premises on which they a erected or displayed. d. A single sign of not more than 1 square foot in area showing the name, occupation or address of the occupant of t' premises on which they are erected or displayed in a residential zone. 4.-STRUCTURE: An application is required to build or alter any structure within the District which is defined by the Act as combination of materials other than a building, sign or billboard, but including stone walls, flagpoles,hedges, gates, fences, et -- -'-GENERAL REQUIREMENTS f . .=_5. Work on projects requiring approval shall not be started until the Certificate of Appropriateness has been filed with the To% . : .max-• -;!Clerk y j I. . 1. .,: r -, .r..a;� •� .. �_ .,-,..., ._ .., -- - -- '. ab the Committee. Approval is�sub'ect to'the.10 day appeal period provided in the Act. - • 6. No changes'shall be made from the original 'approved specifications without advance'approval of the Commission on amended application filed with the Committee. 7. A separate application must be filed with each project requiring a Certificate of Appropriateness. F i _ t 8. Under heading of "Detailed Description of Proposed Work" give detailed data on such architectural features as: foundati, `"� '"chimrie . . V. siding, roofing, roof pitch, sash and+doors, window and door frames, trim, gutters —leaders, roofing and paint co: 9. Unless application is complete and legible and all material required is supplied, application will not be accepted or acted up I _- Copies of the Act establishing the Regton;t Historic District maybe obtained at the Town Hall. u John M. Kelly 410 High Street W. Barnstable, Ma. 02668 James Leo Boyle 5 Village Drive E. Sandwich, Ma. 02537 Joseph & Carol Henderson 159 Starlight Drive Marstons Mills, Ma. 02668 Anthony S. & Helen Baudanza Box 683 44 Percival Drive W. Barnstable, Ma. 02668 David L. & Joan Lamachia P.O. Box 230 W. Barnstable, Ma. 02668 Steven & Pamela Shakin 18 Old County Way E. Sandwich, Ma. 02537 Weeks Crossing Comm. Assoc. P. O. Box 560 Mashpee, Ma. 02649 . :n OLD K I NG'S HIGHWAY HISTORIC 0 I.STR LC7 SPEC SHEET FOUNDATION aLaa—el- Qrr-t!�-CE pA e- Cd G0�: AN1VAMOaS 6ie62i✓ SIDING TYPE_ C LUL>C ES, COLOR CHIMNEY TYPE ;' COLOR ROOF MATERIAL , COLOR PITCH WINDOWS R3VCO l�aug�� SIZE TRIM COLOR W N(l DOORS C t_b F�t COLOR_ 0646/ DOA SHUTTERS GUTTERS DECK2i..2�- � GARAGE DOORS COLOR fiAnA Q Notes : Fill out completely.: including measurements and materials/colors to be used.. Three copies of this form are required for sutmittoi of an application. along with. three copies each of the plot plan., l.ands.came plan and elevation plans . Q when app'l i cab i e. *Plot plan need not be "Certified" . but shouln sncw y all structures on the lot to scale . i w 1 9�•, g9. 0�'0 1 N- - 11 gGo I1746. 90 ca Os 95. En CO CQ o. � V CO_ co CQ cx� GO Cl- 1-91 co Pub? V V M •. - - Pl>a1..o:MaTFICb ' �LIAF.I/NDE1L.LETTT . • .p�vtsev.�1�9194.. �ptivp�rraar_-._.. �Ya or, L2V - 1 �i -srL.A uC.wr.Fgcar vc = G - N�cp our1..7FM PM`+ - �E �as�a:_.v.fclas �1 i'oxZT4A*-VR. .__Nit:F{EPaN1�HLLLA L1.G.G. . �.- tu..y. — •.ram'.'-�'� — .:9+t-1'..t1yIT..9�... _-.:r n --�l4tFT.�1-h'�O�IOM ' i�y��J II 11 Il • �uv--_�rsnrt:rwi� _..4.�ePs_Tn"ce"Af�V ll a>< • _IE�c(�;oy'�!EL�-va-Tlot�ts.-----..._ #k-1 4 ?LAVA o F'Iovl QAK.uMotc_-Lerti- • - �visrv::G123199 - LOr.lo�1CfivA�... 14'•0(10'-0 r.T.00.VY- 4�5" 1��toil 3!8�•4" 12�0�4" �� -.'Hoc y 1TcNeN I v. -N lip h -�ruLrcv cl�,• Rwr'ui..:.:._..... e'z'�'Isv.a� «r. .. 10 AM. H. (Dj 3° 2� IZ`x13 19"r13 I 1 uv I% _. iio�o tnze MK %>.q �r og 9 o�y-8 3 �g�xg' 244),2AAZ 44 1�1LL. ?4°XZ4qLG!'.. 1L8'Z . . .L " • y '1 . VF1Jf S0 2"Y 5'! 11 '31.Ox TIT 5i2v2"%Ci�94tu w 83n15- ox(a�l.i ' 1 :41; — F1Rsr.R.FI-A-i.. im-5rt Mos•F.up.py- - 4" -�---•a.-- � rxi �a �wllwm�r PMww n'•DL i aR oF4 - pt,�rra.o r'to�Peu 4AA.vl+Vt7--LET r -j¢•^,yev 4,1z3144 _1-0f 10 PCCGVI4L G�c , [r><to'R1oyb . -2t1d rt+P R<•FT� s^xD"R�•pteres G14.OL, lya'-VMS e- e2•ac. I'•D"F44 .-FAM. RK _ �F.4. 'o C-2"x1"P-•rtvs 151$'.Sc'P'P` e— LJ �1°6Noe wx 1l1- O M.2 ©IKte r / r 14 B ly"O•C. � JJI. .N�.oRn Be1.ou p ri/ gA G�1 �i1-LII Y I!o III C r'/ .� W� o'F4 n.sw.-aa4 r/ -s21'WO wv.4,oe�e M2o t� �'►�.^sugGw^aC k ru,MteS 9R.CA. vcoPP�ev Port• ------------- vAr•+P-P�F �_t� rimm r •i•Cor1c. ISaeu 4cf• A'loNe.4.a.F�. — - 3o'K!dx b'colt- FW. ]NS✓t�sriora' crloN: _ —IV°x9".ne(ev rrr,.. . •$r'GT1aN- 42.. AfkE7E= IE72 5P . R=Z�o U=.os 4i4iLAScerIFSIY GAVE - 25Z4 uoAl,aR� a v.<e s.f u yA,rL.Afz,)-= 40 s.F. .V,40 FI-44,.VIV-A4MA-2DS.P., U=-25.: NET 41ALL. AREA'2198..S.F P'IZ U40D ZI16 .00 �30G(sw7 r ZoG2s ... 2524 of woos Its— nn: vww.w.u..rr^ S�� PLe nl o' HOPI riE v 44-r-uNoi,-[--Lie er �ensee �Izsl94 t.or w P�uvn.L C VF F6 t°sM F G^Ys i Fm- �- ��--�.ppof g4�(CEP"WHzersrmu�ray vc.7 8r R-ii 44 " P� R tR R-Lo IWin-�-SS 9ctPS 41ca�c. FL.. V"Mal O� Z�� i:fZFi Ticrl — .p1 n. TV - L .9-,•rug LVM.�-!/��D G� G� !i% A G!-(I G� G� Q r t 1 r �TGM Fes'.: I vKuv� 2L� � b 734, Fom. �11�Rf9P M C,oN4 rr4.ZL . L —�. �NIM ICE`fWIN� WCC 'L�K311' ' MR iPUwMO IW[11 COMMONWEALTH OF MASSACHUSETTS IrT'. ..A OF INDUS TRIAL.ACCIDENTS 600 WASH M-TON ST'RM _S CahDt � Q$TO. SGit1S- N. • - J�1 . .. - WO R$,' COMI'F3!ISATIQN VS J►R NCE AF IDAVI'I' Everett. W. Boy,.-Jr'. (license/pertn.itiee) _ . with.a principal plac_c of bus'incss/residerrceat: 2 e O. Box - West ri zit- Massachus ts- 02_`20 (Otylstocaip) do hereby certify, under the,pains and penalties of perjury, that: RJ 1 am an employer providing the following workers' compensation coverage for my ernployees working on this job. Aetna WC# 006-C-23219584CAA. Insurance.Company Policy Number ( J I am a sole proprietor and have no one working for•me. ( J I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation insurance policies: Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance.Company/Policy Number Name of Contractor Insurance Company/Policy Number 0 1 am a homeowner performing all the work myself. NOTE Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more than three units in which the homeowner also resides or on the grounds apputtsnant thereto are not generally considered to be employers under the Workers'Compentation Act(GL C 152,sect. 1(5)),application by a homeowner for a license or permit may evidence the legal tutus of an employer under the Workers Compensation Act 1 understand,that a copy of this statement will be forwarded to the Department of Industrial Accidents'Office of Insurance for coverage verification and that failure to secure coverage as required under Section 25A of MGL 152 can kad to the imposition of criminal penalties consisting of a fine of up to$1500.00 and/or imprisonment of up to one year and,civil penalties in the form of a Stop Work Order and a fine of-$ Y )00 00 a day against me. nc g Si this day of ALLusa , 19 A 0 l J Lic sec/Permittec Licensor/Permittor ...- - - :.'. COMMONWEALTH DEPARTMENT OF PUBLIC SAFE TY �'. ; �''•�pc•r;c•-a a ccrr®nt t ' ONE OF uc Foricvoci(!on MASSACHUSETTS BOSTON,ppA 02108- cy i::j l:ayrco. L I C E K-S E CAUTION DCPIRATIONDATE CONSTR. SUPERVISOR FOR PROTECTION AGAINST C 3/1 1/1 9 9 6 EFFECTIVE DATE LIC-NO. THEFT,PUT RIGHT THUMB R-STRICTIONS PRINT IN APPROPRIATE NONE o `.�6/30/1993 ... 032804 5 BOX ON LICENSE.JR f ° 13 0 X i ft b BLASTING OPERATORS SS i _033-42-4928 W TENNIS MA 02670 Z MUST INCLUDE PHOTO. Z m J . PHOTO OHASTWO OPR ONLY) FEE' PAID . . NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY - HEIGHT: s PED-OR-SIGNATURE OF THE COMMISSIONER DOB: JUG 9 1993 54 03/11 /19 SIGN NAME W FULL ABOVE SIGNATURE LINE Y:r,•••:•.j;' dlil I l:'`• „• THIS DOCUMENT MUST BE TURE OF LICENSEE b�j"'-� )..:' n GARRIEDONTHEPERSONOF THE HOLDER WHEN EN- ����� ♦ I I GAGED W THISOCCUPATION. ISSIONER .. TOW N'OFIriARt4S1ABLE, MASSALHUSETf Ap111 056 �9 PERMIT ta'b� Everett W. Bo /ReefDKealr- �L --•,__. L)�,r+.�i�o +'r�+t-- to-- : . ... . APPLICANT Y _ ADDRESS - _-. ICONTR'S LICENSE) BR OF PERM!T TC Build dwelling ( 2 ) STORY Single family dweilit=lg DWELLIING UNITS 1 (TYPE OF IMPROVEMENT) N0. (PROPOSED USE) lot i�1- 23 Percival Drive, West Barnst�. ie ZONING Re AT (LOCATION) DISTRICT (NO.) (STREET) BETWEEN' AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT - BLOCK SIZE Y BUILDING IS TO BE FT. WIDE BY FT, LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION I TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION I (TYPE) Sewage #94-433 _ REMARKS: BOND ` 120,000 PERMIT $ 135.25 .AREA OR I 2,176 sq. ft. ESTIMATED COST FEE VOLUME $ (CUBIC/SQUARE FEET) Horsefoot Holdings Of Cape Cod /1 OWNER BUILD) P _ BOX West Dennis, BY ADDRESS THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE 1 PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAIN: FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONOITIO OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AN3 I. FOUNDATIONS OR FOOTINGS- MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLA71ONb. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS vf� • /v/G•9Y 2 2 HEATING INSPECTION APP OV S E INEERING DEPARTMENT OF HEALTH .. SITE EVIEW APPROVAL O1 n NOT PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE nA" DROVED THE PROCEED UNTIL STAGES OF WORK 15 NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CC.4T�U �N. PERMIT i�;�Et l•C,"ASNCTE� -co - ---- TIFlC�1TIOk f