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0020 SHEEP MEADOW ROAD
o i � ���� AenRECYC(fpCo2 UPC.12543 No•• 5 HASTINGS,MN I�.u` �' a ^' 1 c III �, 3 p � , �o r^5 �� �IJ' a "'...,1�� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map k o Parcel Application U Health Division Date Issued Conservation Division _ Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis . SSPIT So%Rom.L_ Project Street Address PD SV1.Pe.d Village' Owners VCxm 6v_N r L3,ec( Address ao &P=P I llama ' c�.e�• , 1�. 4m.S � Telephone c>$ -_n S- 1"7-) Permit Request Q,.P.4 1 c zrt- SJnLeny Square feet: 1 st floor: xisti ISM proposed 2nd floor: xistin ►—proposed Total newer Zoning District Flood Plain Groundwater Overlay .Project Valuation's wi(AS Construction Type QkS id�.✓v}i�,;P Lot Size g s des Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family C62 Two Family ❑ Multi-Family (# units) _ Age of Existing Structure Historic House: ❑Yes Rio On Old King's Highway: ' 2 fes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) k1 DA Number of Baths: Full: xistin new Half: exiidY°. new Number of Bedrooms: 3 is ' _new iIE �� Total Room Count (not including baths): e istin fo new First Floor Room Count Heat Type and Fuel: QJGas. ❑ Oil ❑ Electric ❑ Other TOWN OF BARNSTABLE Central Air: ❑Yes 0 No Fireplaces: isfin New Existing wood/coal stove: ❑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 ❑ Commercial ❑Yes Y No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name /2`AGi, "'r- Telephone Number S -I-n �mpn�cr�a er�� Address 14k i j36M&AyJz c AA License # e- S - 00 loco y 3 V 4"Jf)j:d X4A CYL too t Home Improvement Contractor# Worker's Compensation # AW e-400-100 g I Li 3 3_101 bA ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ` AJQ,nD�Ah T Ank/-J _+,-,,n SIGNATURE DATE L (� / i FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. '=£ ADDRESS VILLAGE Y rr OWNER t DATE OF INSPECTION: _ ,--FOUNDATION, . _ FRAME INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL " PLUMBING: ROUGH FINAL ,F GAS: ROUGH z FINAL rFINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Town of Barnstable _ Building s Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept M� Posted Until Final Inspection Has Been Made. it i6SP 1 11 111 Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit Permit No. B-16-1739 Applicant Name: SPRINKLE HOME IMPROVEMENT, INC. Map/Lot: 109-020 Date Issued: 07/01/2016 Current Use: Zoning District: RF Permit Type: Addition/Alteration-Residential Expiration Date: 01/01/2017 Contractor Name: SPRINKLE HOME IMPROVEMENT, INC. Location: 20SHEEP MEADOW ROAD,WEST BARNSTABLE Est. Project Cost: $ 10,085.00 Contractor License: 103757 Owner on Record: KOSMAN,THOMAS E&WEIL, RUTH J Permit Fee: $ 101.43 Address: 20 SHEEP MEADOW RD Fee Paid: $ 101.43 WEST BARNSTABLE, MA 02668 Date: 7/1/2016 Description: replace front door and rebuild front stoop 1.9 Project Review Req : replace front door and rebuild front stoop Building Official This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. 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. 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. i The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) i ra.Insulation 7.Final Inspection before Occupancy i \there 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. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT DT,HE TfQ,, Barnstable Old cgs Highway Flistonk Discs Committee 200 Main Street,Hyannis,iV.A 02601.Tom: 508-362-4787 Fax 508-862-4, 78=! APPLICATTO , CEIRT-T C A TE OF APPROPRIATENESS Application is hereby made,with'four(4)complete sets,for the issuance of a.Cerdficate of Appropriateness'under Section 6'of Chapter 470,Acts and Resolves of Massachusetts,1973,for proposed work as described below and on plans,dralvmp;or photographs accompanying this application for: Cieck nll'categories that apply; L Buildine construction: ❑ New Lr YA��of Eff�lieration 2. Tyne of Buildina: ❑ House ❑ Garagefoarn ❑ Sned ❑ Commercial ❑ Other 3. Exterior Painting,roof ❑ new roof ❑ colorlmateiial:change;of trim,siding,.window, door 4. Sisn :� ❑ New Sign ❑ Existing;Sip. ❑ Repainting Ekisting Sign 5. Structure: ❑ Fence ❑ Tull ❑ Flagpole El.-Retaining wall ❑ Tennis court' ❑ Other- 6- Pool ❑ Swimming ❑ Other man-made pool. ❑ Solar panels ❑ Other Type orPrint Legibly: Date NOTE All applications.m w he:signed byihe camat owner Thomas Kosman Owner(print): R ut-h 4. Weil Telephone#:. 508-362-8014 Addles of Propose&Work:. 2_ 0 Shppn Meadow Roan Village.w_ Rarnetahl A .Map Lot# OZO Mailing Address(if ff nt) Owner's Signatur Description of Proposed Fork: Give particul of work'to be:done: -Replacement of front door and si riP 1 i Zhrc enhancement of trim around door, replacement of existing brick steps -and landing with decking and m .ogany stairs and railings, per plans. Landing expan ed _frnm 6 x 3 to 12 X 4 Agent or Contractor(print)-Sprinkle Home Tm�)royPmPnt Telephone#: Address: Contractor/Agent'signature: For committee use.only,. This Certfcate is hereby APPROVED[DEN1 1M Date Members signatures v ; o poi® F 1 .10 MAR 0 9 2016 Old King's Highway Committee . 1 . Q,•\BoardraitdCauonissioiz�,Old,isgsHighwav\OKIYzApalicadonAO.kHD1L1t7_011 Cen,lppropriate!L=DRAt7doc I CERTIFICATE OF APPROPRIAT]EINESS SPEC SHEET Please submit.z" Coples Foundation.Type: (Max. 12'exposed)(material-brickkement, other) _eon Siding.Type: Clapboard— shingle—.other deck skirting 1 x 4 i4'tatenal: red cedar white cedar. other. �u„�� Color: WHITE I i Chimney Material: Color: Roof`Material: (imake.&style) Color: . Roof htc.33.(s): (7/12 nvnimum) (specify on plans-for new buildings, mayor additions) Window and:door trim material: wood_�, other mAena], specify. } Size:of coinerboards size of..casings(I X 4 min.) color whi s Rakes Ist member 2"d member Depth of:overhang Window:. {rraakel:madel) material color- (Provide vvihdoiv schezfide on Plan fvr_neiv bididings; nutjoriulrlitions) Window grills(please:cliff<ck all that apply: true divided lighis._ exterior:glued grills_. grills.betWeen-glass—removable inferior_ None Therma-Tru 4 panel, 4 lite (Harvey) with 2 3-lite side lights Door style and make: gMgnj:jQ r�r S 23� material rii?@i�}$55 Color: white Garage Door,Style Size of opening Material Color ' Shutter Type)Style/Material Color: Gutter TypefiNfate:rial: Color: Deck-material: wood�_ other,material,.specify. Colnr:natural (with white rails) Mahogany Skylight,type/makOm6dell: material. Color.. Size:. Sign size: Type/Materials: Color: ��+;C . Fen T'}+pe,(Pax 6')-Sty le � D material: Color... Retaining wail: Material IS R Lighting,freestanding ! illuminating sign �0)N Ilia. OTHER INFORMATION: THE ATTACHED CHECK LIST MIDST BE COMPLETED AND SUBIY(.ITTED Please provide samples of paint colors,Manufacturers brochure of windows,floors,garage door,fences,lamp pasts et:. Signed: (plan preparer) Paint Name ,A n M �^ l 10 k=D MAR 09 2016 Q.ABoards mLd ConunissionAOld Kings F.i liway\0KH App1icruicnA0 t1 DRAFT 2011 Cen Appropriateness DXAPT.doc Town of Barnstable Old King's Highway Committee r f � Smooth St ar° C:oll.ect�o Clear and Low-E i FJ1i1* : r LU i C4 l" m c o:'CD LLJ Lu —�IIf•.'4 D II I O 1 !I cj JJ CIDID Lr) cli F 3D G E[ . _. ; O cc, O O w�v i J CD ,. I I' W 5 s a [[r{ D s :ft. ._ COO COO w J - - QOj' :. O .; _ - m C C7 p �-- o `m AS C3 C" a� 1 L7) -- U U f U U L. � D N ('.) "t v.r-x,r D II J J .11 J CD C) L J I 4 ,1. I F— �.. I� O ; 1 O I I coC7 W W , W i CD S co - CD CD 33 o I o 3 I T CD CD CD CD x D I li 9 D w w D om, ,I ®•' J J J J J J J I I J !I . I I (,/) U) cJ)Cn ' M I li � -- --CD CD _, (UO � .I I_I �_ _I O _I c: �7 m ! N 'CC) O) co" (O 00 CD O � O I O (J I APPHOVED RECEIVED M - FEB 032016 AR 09 2016. Town of Barnstable Old Kin g's Highway GROWTH MA.NAGEMENT Committee '::,: . : --�TM Clear and Low-E 'WS'n ati y . +TE!\TT Ia ICD _ '�! I U- . 7iJlj� Cr —�' ► it � �_�� O N _�. � - 20 2:F ca I I .I",�.._...._ L•. o '. o CD ) ► 1 II N ► .; _ � - F. CD CD CD L.L LPL T a O LL I CU `m C.5 D ' O r . O co O �' 3 G i i t I o o I F:� F C — X - - d I C_�_- _ � - CD I o ► 1 i �' II ► a I � II � I � � JCY)— �, o Product Key FXG=Fixed grilles GBG =Whit o F 1 e contoured grilles sealed between lass 0 CD 9 ELD= Exterior lite dividers I J �n J J► CV C1j CV N ®�s/g Cn HARVEY `� �.� I >� �e BUILDING PRODUCTS 31 CD I 4 ;�1,i Y �r rt ti�(f r( ,,�y ♦`,� ���,,"f i 71 J..k..�r.. t '{�N t� � ,���1 { t { � ...�• , ,,�. � r tFIrY cz 1 yt�4%.' tc�Cry-.�} " t. '�.�'1•. 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'' fi i �.�,. a F- : pt� I�r;., i I - t s �.+ �4s' ..•,. .a 7 * ...k �� S'"It�.,.'���ri�.�!"-'!lf'Y i f4 t �, "r �.iw t d 4 Yr�,,,�,a,. v���,y-. .w�• �� it a:. �..1 _ +.«w� �^ C r �i.'� - >t'�t t "Kip-�' � � "°�' � rt� I �a e• �i e 1 3 ,I ,� +..+. t' .w..: 3, ' S + F7• 1 � � t rl I .+f. ..t.-.,ai+fi� I 1. a - a.` `'-Y,7✓'J �, � .y •'"�L�, `' 'Ac �tg,';E �, �j�t IR � t r t {��1: ., � r ! ! 7 'a•!. t�`yI R tplitl�ail; L y RECEIVED�000 FEB 05 ON AP P r-` OV ED co �d9 co to ��4 ySN I�tiN(\C GROWTH MANAGEMENT MAR 0 9 2016 Q 0 cu a Town of Barnstable � � 2 0cu Old Comm tteeway O D �d� Y n � a o E L m 0 N N I I I I 0 I I I LL I I i I g .d eX15t. second floor EXISTING HOUSE H REPLACE EXIST. 3'0" FRONT DOOR m I t AND 1 2"SIDELIGHTS WITH NEW AND INSTALL NEW TRIM v H Lu WOOD RAILING 4- BALUSTERS I '_ BETWEEN 4x4 MOHAGONY POSTS W/CAPS c I I x4 MOHAGONY DECKING ON i Z Q ( I I P.T. DECK FRAME W/ I x DECK SKIRT BD. 0 0 0 06 ex15t. first floor c � 00 - - m W o I( I II TI II( wy C z E ZW EDGE F EXISTING WQO exist. cya e exist. grade I I REMOVE EXISTING BRICK WALKWAY REMOVE EXISTING BRICK LANDING/STEPS I x VERTICAL BOARDS I I O U) _ BRICK LANDING/STEPS REBUILD EXISTING AND STONE RETAINING WALL STONE RETAINING WALL AND STONE RETAINING WALL i i ENCLOSURE UNDER ER DECK i i 2 N W ENCLOSURE UNDER DECK W/ IL BUILD NEW STONE I I W/ I x VERTICAL BOARDS AND L J L J L J U RETAINING WALL L J ACCESS PANELS PER SITE COND5 w ui PROPOSED FRONT PORCH/ PROPOSED FRONT PORCH/ O DECK&STEPS ADDITION DECK&STEPS ADDITION a ~ DATE: 10/22/2015 proposed proposed SCALE:AS NOTED LEFT SIDE ELEVATION FRONT ELEVATION DRAWING#. 1/4" = 1'-011 1/4" = 1'-0" Al - 3 S1 3 0o co co Z o 0 1 2'-G" +/- ex15t. < / EXISTING HOUSE - to remain Q REPLACE EXIST. 3'0" FRONT DOOR // cn n c AND 1 2"SIDELIGHTS WITH / M a) m NEW AND INSTALL NEW TRIM / i / / t!'® 0 N o I / o MAR ® 9 ZU�6 k,9!! L — ' proposed — o_ o of earn "a O — — WOOD DECK/ PORCf+G — — — z < otd c09 v6aeeW y om c U. w �N p F- Y � o, W g _.ate W REMOVE EXISTING W J BRICK LANDING/STEPS AND STONE RETAINING WALL �_ w- WOOD RAILING 4 BALUSTERSM or EXIST. WIDTH H -(� O 13ETWEEN 4x4 MOHAGONY ? & � POSTS W/CAPS X 399 w N EXISTING BRICK WALKWAY W ul s V / a W C EXISTING � �� � STONE RETAINING WALL �o EXISTING BRICK STEP C W O REBUILD EXISTING d G STONE RETAINING WALL w' Q Ul z EXIST. BRICK 7-\ a a C WALKWAY v 4. W RECEIVED a ccH 0 O FEB 03 Mb CL cw proposed GROWTH MANAGEMENTo w FLOOR PLAN a 1/4" = 11-0" DATE: 10/22/2015 SCALE:AS NOTED DRAWING#: A2 3 D � G) rn ONrnxrn rn _X =Z X 7001 r- U1 o00m �, � _ G) x_ m z cn m Z N C 74 rn (n rn 70 � D 0— D G) O rr- Cn O 70 r- =O r Ca / m r III,-III ON IIII 0o O IIII- "v I=1 11= N -I j, (j)Q,O (IIII = ZrnDD UO ZC)ZO prn>� - rnL--c W -16(DjX 2 �90 0<= D -1 U1rn u�� on v �N Ja T N�U1N7np � rn-0 II N N-U-1 rn z6)Z O o0 0 0 O rn 3 0" -i-/- 0 ND0rn0 (1 C00 z DDD� -I A " 00000 Fn f rn 030O=6� D N -orn�� n -o7003 �o03 rn { �C00 O rnrc 0� U) III � O �N — U1NN Z Dr I. Z N��N rn � z� x U1 D � rnZrn {4 NN I�IIII D0001 rn n Z lil—1 ZOO` N Oz DNi �I—II NDzrn O a KCO0Ua O Nrrn -UaCO rn �a 0-0u0 03 �r'n ZUNC U) D 0 J� 0 m 31— 1 0" J �D D� DN �Z N G) • X I\ z d I Z \ W F- Ulm U ,f n I I NI I 71 I\ m I I I I D� G) D I I I I °° O O D:U 0 a I I I I I70 G)Nrnx Ij fl �n i rn =zao Z N i'; _ I I I I I `rn00m rn o Q I I N I I P.T.2x8'S I N O= m D a � �i @16"O.C. I\ N@N � Z � I `NO� Z N . \EXISTING FOUNDATION - to remain ® 0 \ c Z \\ C a Ili O Z �� D PROPOSED FRONT PORCH/ s DECK&STEPS ADDITION T �. Qo 9� n�'o a m���o' �\A r'/1 o Cl) o PROJECT: FOR: mm proposed front entry porch/deck addition at w z o KOSMAN RESIDENCE Thomas KOSMAN 0 N 20 SHEEP MEADOW ROAD, WEST BARNSTABLE, MA 20 Sheep Meadow Road s TITLE: FOUNDATION PLAN / SECTION West Bamstable, MA 02668 r , L '\ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 w www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNHTTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual):SPRINKLE HOME IMPROVEMENT, INC. Address: 199 Barnstable Rd. City/State/Zip: Hyannis, MA 02601 Phone#:508 77571778 Are you an employer?Check the appropriate boa: Type of project(required):. LQ I am a employer with 10 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. gRemodeling any capacity.[No workers'comp.insurance required.] 3.E)I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 4:❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole I IQ Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.: ❑ p 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'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 hive outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors 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: A.I.M.Mutual Policy#or Self--ins.Lic.#:AWC40070049432016A Expiration Date: 1/1/2017 Job Site Address: ;2o&,ePn ffW kbLJ YU City/State%Zip: LA YJyM4J7} ,6i 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 c. 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 cerd nd ns and penalties of perjury that the information provided above is true and correct: Signature: Date: Co Phone#: 508 775-1778 Official use only. Do not write in this area,to be completed by city or town offtciaL 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#: r SPRIN-1 OP ID:DS ACORLLJ' CERTIFICATE OF LIABILITY INSURANCE DATE 10 812 01 Y) 01/08/2o1s 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 pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemen s. PRODUCER CONTACT Bryden&Sullivan Ins Agency PHONE Kelley A.Sullivan FAx 88 Falmouth Road .508-775-6060 ac No,.508-790-1414 Hyannis,MA 02601 E-AAAIL Kelley A.Sullivan ADDRESS: INSURE S AFFORDING COVERAGE NAIC 0 INSURER A:Associated Industries of MA INSURED Sprinkle Home Improvement Inc. INSURERS: 199 Barnstable Rd Hyannis,MA 02601 INSURERC: INSURER D: INSURER E: INSURER F: 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. NSR TYPE OF INSURANCE POLICY NUMBER MMIIDDOI EFF MMEXP LTR IUDC LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTEI57- CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accId.nt ANY ALTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ q 1 $ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident UMBRELLA LJAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECtITIVE Y❑NIA AWC40070049432016A 01/01/2016 01/01/2017 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached I more apace Is required) CERTIFICATE HOLDER CANCELLATION SPRNKHO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sprinkle Home Improvement,Inc ACCORDANCE WITH THE POLICY PROVISIONS. Margo Mack 199 Barnstable Rd. lley A.Sullivan REPRESENTATIVE Kelley A. Hyannis,MA 02601 Kelley ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD n �1 SPRIN-1 OP ID: DS AFRO' CERTIFICATE OF LIABILITY INSURANCE DA07110/201 Y) 07/10/2015 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 terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTANAME:CT Donna M.Souza Bryden&Sullivan Ins Agency 88 Falmouth Road A/C"; E>n:508-775-6060 A/C No): 508-790-1414 Hyannis,MA 02601 ADDRESS: Kelley A.Sullivan A ESS: INSURER(S)AFFORDING COVERAGE NAIC q INSURER A:Associated International Ins INSURED Sprinkle Home Improvement Inc. INSURER B:Western World Rd Hy INSURER Insurance Com an 34754 Hyannisnis,,M MA 0 02601 P INSURER D: INSURER E: INSURER F: 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. LTR TYPE OF INSURANCE POLICY NUMBER ADDLSUBR MM/IDDDY EFF MMIDD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE TOCCUR NPP1403909 07101/2015 07I01/2016 PREMISES Ea occurrence $ 100,00 MED EXP(Any one person) $ 5,00 PERSONAL 8 ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: Emp Ben. $ non AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 C ANY AUTO BDYYVG 07/27/2015 07/27/2016 BODILY INJURY(Per person) $ ALL OWNED M SCHEDULEDBODILY INJURY Per accident $ AUTOS AUTOS ( )X HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 A EXCESSUA13 CLAIMS-MADE CUBW5992215 07/01/2015 07/01/2016 AGGREGATE $ 1,000,00 DED X RETENTION$ 10000 $ WORKERS COMPENSATION PER O - AND EMPLOYERS'LIABILITY y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? El N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Operations performed by the named insured as provided for by the terms and conditions in the policy. CERTIFICATE HOLDER CANCELLATION SPRNKHO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sprinkle Home Improvement, Inc ACCORDANCE WITH THE POLICY PROVISIONS. 199 Barnstable Rd. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE Kelley A.Sullivan ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-006643 Construction Supervisor BRAD K SPRINKLE' 199 BARNSTABLE R M / HYANNISMA 01601� r Expiration: Commissioner 10/08/2017 1(..IN.III../IIIMYI�II!.� �qA/.y/I/Y/AI.NII. Q1�IeeofComamerAtfstra�.Bo�luessdti4�tl0o �E � O»iAE>�dVEME1�1I'CQNTESAC'fiDR 103757 Type: Expt�on: 7pt6� Prhratet?orporallo SPRIN=HOME IMP RQVE,MENT.INC. Bred Sprintde ISOB tVteble Rd �— Hgsmft MA 026M Vadera mtgry Unrestricted-Buildings of any use group which contain less than 35,000 cubic fed("I m3)of endoeod space. Failure to possess a anent edition of the Massachusetts State Building Code is puce for revocation of this license. For OPS UCm5ft informatbn visit: www.Mass.Gov/OPS jet or mobldlims VWW i s ko*m rf ampka"dWL W`d rawi fi♦: wit 4f(',f1M1=W AdWfi air N lrt l&M-sort iHw . iarlara,!rA!!1 K ��s 6 7. All agreements are contingent upon strikes, accidents, or delays beyond Contractor's control. Should a contract be terminated or cancelled after the mandatory rescission period, contractor will recover costs including all time related to this job with a reasonable fee (including profit) for all completed work and materials purchased or ordered. 8. Owner is to carry fire, and other necessary insurance. Contractor's workers are fully covered by Worker's Compensation Insurance. 9. Fencing, carpentry, painting, plumbing, electrical, dry wells, etc., and all other work necessary that is not contained in this contract, shall be the responsibility of the Owner. 10. For roofing, the above pricing is based on a single layer strip unless otherwise specified. Should there be an additional layer or layers of roofing they will be removed and disposed of at an additional cost. Re-leading of the chimney is not IF included in quote unless specified and will be bill additional, if required. 11. For Window installation, contractor is not responsible for removal or reinstallation of window treatments. 12.Contracts not fully executed within thirty days of contract date are subject to pricing adjustment if applicable. ;I RIGHTS TO CANCEL The Owner may cancel this Agreement if it has been signed by the Owner at a place other than the address of the Contractor, which may be his main office or branch thereof, provided that the Owner notifies the Contractor in writing at his main office, or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this Agreement. HOMEOWNER: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES I/we accept this contract in its entirety and Uwe authorize Sprinkle Home Improvement to act on my behalf in all matters relative to the work to be performed on this job (i.e. permits, applications etc.) if necessary. Homeowner Signature Date Contractor Signature bate Thomas Kosman Brad Sprinkle - Regis ration # 103757 ?w A am ' o me caner Si a re a th Weil CAPS COD TOWN OF BARNsras LE INSULATION 2013 MAY -7 AN 8 S6 -CA UE45! SEAMlf53 SVM�EOAM lYSYENOEY [U1TT! OURE45 INSYlAT10N CfIE1N05 1-800-696-6611 �IS� �� Town of Barnstable Regulatory Services Building Division 200 Main St W Hyannis, MA 02601 Date: S/611,3 Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Villa e `AUnntl5 '&5M44 Z® sh �� ��17 Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) (yC ) ( 3) ) ( ) (1() Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls (` ( ) ( ) ( ) ( ) ( ) Sincerely He y E Cas y Jr, President C e Cod I ulation, Inc. t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map -` Parcel Application # DO,t 3 a 5 Health Division Date Issued �- l Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 40 50M AMOW ROAD Village rkW Owner TNOMIS 1WVA*/ RIA* WAIL Address Telephone Permit Request 96fb&C 1 W&U3 &M46bg pdu&h,( tfvn,J AMA A) TU PAY Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation�/g 96 god Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 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 Court o Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing woo coal stove: ❑o�s El No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ ❑ ex new size _ Barn: isting © new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size — Other: e � rn rA Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# �4 Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) -Name_ Je_T Try -Telephone Number 'Address Sy -- License # RAI AAA 425- Home Improvement Contractor# l y 1 -7-23 Email: Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,s wTl hl PI LPUi�, -SIGNAT E • `DATE FOR OFFICIAL USE ONLY I! APPLICATION# DATE ISSUED e MAP/PARCEL NO. t ADDRESS VILLAGE y . OWNER DATE OF INSPECTION: ,xFOUNDA}TIONium, FRAME 'INSULATIONJ cc FIREPLACE 'i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL f GAS: ROUGH FINAL z FINAL BUILDING. DATE CLOSED OUT i ASSOCIATION PLAN'NO. i . F The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA. 02111 www.mass.gov/dia _ Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plambers _ Applicant Information ,, Please Print Legibly Name(Business/Organization/Individual): 46TQ- , L'Jrt)5 Address: St Ji leen ST City/State/Zip: Yh4w ( AA 02--7V ' Phone4:Jot —30''I A Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have-hired the sub-contractors 2.AI am a sole proprietor or partner- listed on the attached sheet 7. ❑.Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' in��nce.t 9. ❑Building addition [No workers'comp.insurance comp. required..] 5. ❑ We are a corporation and its 10.[1 Electrical repairs or additions 3.0. 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.❑Oilier 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 arc doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors 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 up to$1,500.00 and/or one-year imprisonment,as.well as civil penalties'in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un pains and penalties ofpedury that the information provided above is true and correct Si atur Date: Phone Offic 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.PIumbing Inspector 6.Other Contact Person: Phone#: 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 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 homeowner 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 lice to than 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 GTIM of luvestigatians 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASWE Fax#617-727-7749 Revised 4-24-07 www.mass_gov/dia f f� Home Improvement Contract July 10, 2013 Homeowner Information Name: Thomas Kosman & Ruth J. Weil Street Address: 20 Sheep Meadow Road City or Town: W. Barnstable State: Massachusetts Zip: 02668 Daytime Phone: 508-362-8014 Evening phone: Same Contractor Information Company Name: Cape Home Remodel Contractor/Owner Name: Jeffrey Wragg Business Address: 54 Eileen Street City or Town: Yarmouthport State: Massachusetts Zip: 02675 Business Phone: 508-362-1536 Construction Supervisor License No.: CS 75746 Home Improvement Contractor Registration No.: 149773 Contractor agrees to do the following work for the Homeowner: Contractor will provide all necessary labor and materials to perform and complete the following home improvements to the dwelling l o c at e d at 20 Sheep Meadow Road, West Barnstable, MA: 1. Furnish and install (5) Harvey, mulled window units. 2. Furnish and install (1) Harvey 30 degree bay window unit. create new opening, support brackets and roof system included. 3. Furnish and install (12) Harvey single double hung units. 4. All windows listed above will include half screen, lowe/argon, grids 5. Furnish and install (2) Basement hopper replacement units. 6. Remove interior window trim and install new pre-primed trim 7. Remove exterior window trim and install new pre-primed pine trim around all new window units with associated flashings as necessary. 8. Furnish and install 140 feet of pre-primed crown molding. 9. Remove, recycle where applicable, and dispose of all debris generated by Contractor from this repair work. 10.No electrical, plumbing, HV AC, painting, refinishing, flooring, or roofing work. is included in this contract. Contractor agrees to complete the work in strict accordance with all manufacturers' specifications. Contractor guarantees all work for a period of one year from completion of this contract. In the event that any defect in workmanship or damage caused by the Contractor,his subcontractors, employees or agents, is'discovered within one year of the completion,the Contractor, at his own expense, shall forthwith remedy,correct or replace, or cause to be remedied, corrected or replaced, said defect and damage, including, but not limited to, any damage resulting from the defect. Contractor will provide Homeowner with copies of all manufacturers' warranties at time of completion. All workmanship wi 11 be performed in a timely, professional and workmanlike manner, .by qualified tradesmen, during typical working hours. Contractor shall be responsible and shall defend, indemnify and hold the the Homeowner harmless for any property damage or personal injury caused to the - Homeowner or to any third party caused by the Contractor,his contractors, employees and agents in the performance of or as result of the work under this contract. Subcontractors: The Contractor agrees to be solely responsible for completion of the work described in this Contract regardless of the actions of any third party/subcontractor utilized by the Contractor. The Contractor further agrees to be solely responsible for all.payments to all subcontractors for materials and labor under this Contract. Commencement/Completion of Work: Contractor shall order the windows immediately upon notification by the Homeowner that the Homeowner has received a Certificate of Appropriateness from the Old King's Highway(OKH). The work to be performed under this Contract shall commence when shipment of windows'is complete and homeowner and contractor agree on a start date. The work to be performed under this contract shall be substantially completed three weeks after start date. Start date is based on homeowners s i g n i n g the contract and issuing a deposit check, as well as obtaining a certificate of appropriateness from the OKH. Completion date is based on the work described on page one herein. Any changes to the work described or unforeseen weather conditions may postpone this date by the number of days that those events delay the completion date. I ! 1 Total Contract Price and Payment Schedule: The Contractor agrees to perform the work, and furnish the labor and material specified above for the following sum: $19,500.00 /Nineteen Thousand, Five Hundred, and 00/100. Payment terms: $8,000.00 due at contract signing. $5,000.00 due at end of first work week,provided that 1/3 of the work is completed in the first week. Final Balance due promptly upon completion of'all work performed to both parties' satisfaction. Any work order changes will be handled on a cost plus labor basis. Materials cost plus $40 per hour, per man,with the prior written approval of the homeowner. Homeowner. Responsibilities: 1. Old King's Highway Historic Meetings 2. Acquire certificate of appropriateness, all other required permits will be secured by the .. contractor,with the Homeowner to pay all costs and fees attendant thereto 3 �L 1 DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Two identical copies of this contract must be complete and signed. One copy shall be given to the Homeowner. One copy shall be kept by the Contractor. The Homeowner m a y cancel t h i s contract provided that the Homeowner notifies the Contractor in writing at his/her main office or branch office by ordinary mail.posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this Contract. Contract Arbitration: The Homeowner and the Contractor hereby mutually agree in advance that inthe event the Contractor has a dispute concerning this Contract, the Contractor may submit the dispute to a private arbitration firm that has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation of the Commonwealth. The Homeowner shall be required to submit to such arbitration as provided by Massachusetts General Laws c. 142A. I Homeowner's S'gnature acto omen r s ignature Date Date • 2013 AUG 6 010t45 BARNSTABLE TOWN CLERK Barnstable 01.d Kings Highway Historic District Commit.tee. ,. 200 Main Street,Hyannis,MIA 02601,TEL: 508-862-4787 Fax 50.8-862-4784 APPLICATION, CERTMCATE 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 an categories that apply; L Bolding construction: ❑ New ❑ Addition L Alteration 2. Type of B.uildiniz: House ❑ Garagc/barn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting, roof ❑ new roof 1� color/material change,of trim, siding, window, door 4. Sim : ❑ New Sian ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wail. ❑ Tennis court ❑ Other b. Pool ❑ Swimming ❑ Other man-made pool ❑ Solar panels ❑ Other Type or Print Legibly: Date 6/20/13- NOTE AaWhcatious must be signed by the current owner Owner(print): Thomas Kosman/Ruth J. Weil Telephone#: 508-362-8014 Address of Proposed work. 20 Sheep Meadow Road Village W, Barnstable Map Lot# 109.1().2() Mailing Address (if different) Owner's Signature Descri lion of Proposed Work: 'Give particulars of work to be done:Replacement of 4 double windows and 12 si nQle: double hung units with new windows, same dimension, 6 over 6; replacement of 1 double of 17o-me), replacement of existing wood trim with new wood trim nro rnrl a l 1 new windows; Agent or Contractor(print): Cape Home Remodel Telephone#: 508-36 -1 536 Address: 54 Eileen St. , Yarmautbpnrt, MA 02675 ContractorlAgent'signature: For committee use only. This Certificate is hereby AP VED/DF D PV/7Y / D � 10 -u Members signatures. RECEIVED JUN 2 0 2013 IA GROWTI.i. AC70, t APPROVE® .1 JUNt- 10 2013 Old King's Highway Committee i Q:1Boar4L;and CommissiorAOId.Kings HighwaylOKH Appiications\OKS DRAFT 2D11 Cerr ApMpn=ncss DRAFT doc: I CERTIFICATE Off'APPROPRIATENESS SPEC SHEET Please submit S COPks ?"imudation Type: (Mi x. 12"exposed)(Material-brick/cement,other) Siding Type: Clapboard_ shingle_ other- Materal: red cedar white cedar other Color: Caney Material: Color. roof over new-bay--fiberglass shingles RuofYfaterial: (make&style) to match axistipg g,p j:jnjjAe Color.. bl-eek Roof Pitclt(s): (7112 minimum) (specify on plans for nex-buildings, major additions) Window and door trim material: wood X_ other material,specify Size.of cornerboafds size of casings (1 X 4 min.) colon Rakes Ist member 21W member Depth of overhang Harvey Vicon Window: (make/model)classic material ��1 color��to (Provide i,�indor.,schedule on plan far tier buildings, major additions) i Windom,brills (please check all that.apply_: true-divided lights_ exterior glued grills brills between glass removable interior_ None. 6 over 6 to match existing Door style and make: material Color: Garage Door,Style Size of opening Material Color Shutter Type./Style/Matehal: Color: I Gutter Type/Material: Color. Deck material: wood other material,specify Color. . j Skylight,type/make/model/: material Cole Size: Sign size: Type/Materials: ®N Color. _-REM IUD + [� 3 Fence Type(max 6' )Style material: `rL�1Color atostap�e - Retaining wall: Material of 6 hWay pad&rroonee GROWTH MANAGEMENT Lighting,freestanding on building illuminating sign OTHER LNFORMA`I'ION: THE ATTACHED.CHECK LIST MUST BE COMPLETED AND SUBMITTED FPlease provide sampl of p 'nt colors,mannfa rers brochure of windows,doors,garage door;fences,lauap posts etr Signed: (plan preparer) ' 1 a✓` Ptirit Name�tl o M A S l�n 5 M J (Z.o(,3 T g:lBoafds-w&:Comtnissions\old.Kig,i7i3liway\0X-H1 ppUcafions\O%ADRAFT.2011-Cerr.Approprimness.DRAFTdoc Town of Barnstable Geographic Information System June 20,2013 109053 109023 109M #66 109031 #b8 #558 066 1#0 520 109028 �aso22 #4s' �50 t a 132007 109049 # #60 0542 x fn 4 r' 109029 109021 m #3a 109051 gY MEADOW RD #610 SHE 132047 0279 109063 109019 0631 #16 109020 #20 109062 86115 a 109018 ® 132001 �484 #0 109068 109081 109089 g1 #601 #468 109017 108015 #460 #474* 10802�6 �`� 131066 #30' Q �� #430 ``V P 131081 108016 0410 131007001 108014 0390 #454%� 1 5 7 FeM 7 109018 5 108013 131009 #77 #436 0321 DISCLAIMERS:This map Is for planning purposes only.It Is not adequate for legal Map:109 Parcel:020 a boundary determination orregutatory Interpretation. Enlargements beyond a scale of Owner.KOSMAN,THOMAS E&WEIL, Total Assessed Value:$407800 Selected Parcel 1'-700'may rat meat established map accuracy standards. The parcel Ones on this map ..E are only graphic representations of Assessor's tax parcels.They are not true property Co-Owner. Acreage:0.86 acres Abutters boundaries and do not represent accurate relationships to physical features an the map Location:20 SHEEP MEADOW ROAD '�..•. such as balding locations. Buffer ,�+� . Z I { LC i LO / I LOCATlOn� Qt O ?' �'osc� . w -'i RLJ'� ] V � D iRINSS,� CORS_.YA IOX IMAR Sry %7W ,11 i1Y TA9Lc C0UHT' r C; r ' X , C, ./ S rRY G � Oc _ QS F L :• N 6 G _ Y ,1' ✓� ' % •,' . .: ar ceRT / Fr r .YA7- r :; F C S !' . r RECEWED 7-:� / 7- f/� ES ` C O rY F C) �. JUid 2 QQpet GROWTH MANI�uf ,M,E NT I Bay Window Roof- Harvey Building Products Bay Windows Vinyl Page 1 of 1 HARVEY ;x FOR PROFESSIONALS ► . - •- f BUII_DIIVO PRODUCTS Energy Rebates Showroom Locations Customer Service j Contact Us ROO n f PF14Ta GALLER.Saa CEAT�N 7�iE$ASiGS AB'U? 3t�rNEx% Our Products/Windows/Vinyl Windows! Bay Window «home GI ,: �• �� =; Bay Window ry r alussary.,.a^r :'° Qve ew -Features:.Colors&Hardwar Grids&,Sc ins" tD L,o`ns"Performanc � , Custom manufactured to fit virtually any opening -*• Factory assembled for easy installation s _ No exposed joints or caulking on exterior of unit 1H} 1j * Urt �h f "L"style nail fin along jambs t w4 r �f n Head&insulated seat boards available in oak or birch veneer a �� m Cable support system included&required For all bay and bow rn �� windows Multi-point lock on all casements • �F �� •�`�C�°��j�'� All roof systems are fully framed and sheathed in 1/2" " plywood • y Available with optional NEW Harvey Virtually Invisible Enhanced Window Screen(VIEWS) rig 20i3 Harvey'Industries,Inc. Waltham,MA USA All Rights Reserved i, Customer Service!Careers Harvey;Privacy Policy • pp�® ®1 e® 1®2�13 • Stable SoW K eewa� Oxd Commltt RECEIVED JUN 2 0 2013 GROWTH MANAGEMENT http://www.harveybp.com/product.aspx?pid=25&shape=7 6/20/2013 Bay,Window Roof- Harvey Building Products Bay Windows Vinyl Page 1 of 1 F.OR,PaOFESSIO�N`AIS' s s •- ♦� BUILDING PRODUCTS Energy Rebates I Showroom Locations Customer Service Contact Us • i�II-' s Mast�. FR. ��'9h� i 4 sr�13i�0irfl�Cr4�L.E�? � nEE.'�Rl�€'rt'�ki�.Bt�SIL.SM, �CtUTr4-1�'.RV�4"�fr ' u A ' Our Products/Windows/ Vinyl Windows I Bay.Window «home I91 01 Bay Window ITT r r, y ''�" �e s� ; Overview �.gFeatu�r�es�,Col'brs�:�a�r3dwGr�dsj& .Opt. ice• Pet�or_y�ae'�.. sr ' MEN Vinyl bay windows combine traditional style with the + ., 3 €� convenience of maintenance-free vinyl at either 30°or 450 `€ e angles.You choose color,grid options,glazing and roof tD r� style to give your home a distinctive accent.Finished-off Paint warranty with an insulated oak or birch veneer head and seat board, . ' Your window will provide you with.Years of enjoyment. r 's arx They are available using casement or picture windows as well as Tribute,Classic,Slimline and Signature double hung win dows - a �e n� i rrc gid A ' Lena " COMPEM75' Bay Brochure view warranty(PDF) (}20-,3 Harvey industries,Inc. Waltham,MA USA All Rights Reserved Customer Service Careers Harvey Privacy Policy C.Yui. I ID amstab�e bwK98 � eWay . id Comm tt RECEIVED . ON 2 0 2013 GROWTH MANAGEMENT http:7/www harveyb-o.com/-Product.aspx?pid=25&shape=7 6/20/2013 � n rii r� II I r� It 1�11,�1 - - - r7 , mimw■m,� u r f}Y•$■✓ il■ a , `-ban■,R, V.t t r■a ■a w J � b { i ti R o+ r R o a m Y7•i1.• j I �■1 1 R 0.■■A■ (ti' VI ■ ■ w R F AN A ■/y. ■n A■A r ■ ■ ■ cu ■ w� it 1 ,�e s.La`e ■■.r..■A m+ Ir�,�■ J■ ■ �r•r LI UF#_ jae:■...+ rim � eRa .. . ■ ■ ■ ■ �■mmr\le(�?` �l° rD■■■Qr r:rr.Am' I �■■ %• n■■1I m`/1/a 1 ■D■Dr11 lm1 �M r►,■ n ■ ■ ■ k■■Dw � ■ mN/■(rr' �p m+ I �i■.■■•w hr I l /1 ll•Y tft. mmmm((r rr nww■,i .■ra■Re ■I mirlr■. .ht �■ ■ yi■,t„�.19G, .. �,,•,,.: uarr ■■ R :; IaIrU(( r ■■■IN , ■t,Aanme .aD■ or ■I f"7� •-"mow✓,. �� � _. Y` ..- , s ✓�! f �"• -rs . u -- .,_•'.r p rc V.'.rj j 'r. t i I'f jr'C.,�`Y Fml 10 AMA .." _ __y� 1`~ .! r. .r,. ; � ♦t - r ,r �rf 3 1>o/'ra� rtp��y�„y?5 ,Klt t` �IsMd1t �W �. I "•� `y, a a r t ik- ( �,y.'i p ! '! � ��` � •. Sal.. `�\ ,! p y ikr• , r! 1i r • t _ _ f - 4 �- jwWh, Vicon Classic features The Vicon Classic double hung is a premium product, offering ` heavier extrusions, upgraded hardware, and the flexibility of ` three standard colors white almond or bronze and a variety of ( ) tY exterior colors. Vicon windows can be combined with virtually any accessory window to give you the effect you're looking for. • ENERGY STAR®qualified with optional ENERGY STAR glazing package • Available with BetterGrainTM premium woodgrain finish • Premium new construction product offering heavier extrusions and upgraded hardware • Factory calibrated block&tackle sash balances never need adjustment or lubrication �' • Ventilation limit latches that keep top or bottom sash partially open /r;; t • Locking fiberglass half screen { j • Color-matched hardware with Brasstone and optional ' Brushed Nickel ? i �- • Available with optional Harvey Virtually Invisible ` Enhanced Window Screen (VIEWS) C� i I ' pV G ;, AppR � � table I Town of Barns Old C1om ep j =µ I 6 � Tilt-in top and bottom sash for __A1=--M-96�r_ .�,.� ae=-- easy cleaning. ii i hardware glazing additional options Half Screen �-� packages • Low-E • DP 50 Upgrade •Fiberglass Wire • Base • Low-E/Argon • Structural Mullion •Aluminum Wire - • ENERGY STAR • Double Low-E/Argon • Foam Wrap •Virtually Invisible(VIEWS) Low-profile Cam Lock •Obscure •Common Jamb(2-and 3-wide) (standard white) •Tempered •Always Active Limit Latch Full Screen . I , • • Bronze Tint • Fiberglass Wire(standard) •.Aluminum Wire Almond Bronze Brasstone Br.Nickel Oil-Rubbed Bronze •Virtually Invisible(VIEWS) grids Contoured GBG Exterior Grid Package Simulated Grid Configurations (Grids Between Glass) Divided Lites ! 5/811 ( f 1" 5/8" 1�� ; 5/9° •Colonial 1 1 •Prairie I •Custom configurations T= upon request I ( - Color-Matched Color-Matched Color-Matched Color-Matched Interior Applied,GBG, Exterior Applied interior trim/exterior casing extension Harvey interior trim To enhance the beauty of your window, jambs kits provide a precision Harvey also offers maintenance-free • Primed finger joint or clear pine fit and quality workmanship. vinyl exterior casing, The factory-applied • 4-9/16" Kits are available in six - casing with fusion-welded corners • 6-9/16" 2-1/4"Beaded col. popular profiles in either 3"flat with sill nose eliminates the need for exterior caulking • Custom sized up to 7-1/4"wall clear or pre-primed pine, and produces a clean, upscale look, Interior trim and exterior casing available for new AppR v construction styles only.Other trim and casing 1 O 2013 styles available.Ask for details. �UN 3-1/2"Windsor 908 with sill nose cns��te - - 0SYQ c — exterior colors Exterior colors are paint finishes and are available for products with white or almond interior Mrcl, Amazon Green Backwood Black Bronze Buff Burgundy Cashmere Clay Copper a . • a a Cranberry Fire Engine Red Forest Green Grey Harvey Almond Harvey Bronze Ivory Ivy Green Leaf Green Old World Blue Sable Sandalwood Sandstone Silver Metallic Tile Red Universal Brown Wedgewood White `Wicker interior colors BetterGrain finishes Almond Bronze White Pine Red Cedar Dark Oak X! HARVEY Is BUILDING PRODUCTS Interior colors are clear-through vinyl colors.Painted or BetterGrain interiors will not have limit latches. i Thermal Performance Glazing U-Factor R-Value SHGC Visible Light ENERGY STAR Transmittance Compliance Base 0.48 2.08 0.59 0.62 --- ENERGY STAR 0.30 3.33 0.30 0.55 N, NC, SC(S w/grids) Base:This package is always the least expensive version of a particular product.In most cases,it is simply made up of clear glass and there is no glazing on the product. This glazing package does no qualify for ENERGY STAR. ENERGY STAR:This package includes everything that is needed for a product to meet ENERGY STAR requirements.Glazing,gas,glass thickness,etc.will vary by window and usually includes Low-E coating and Argon gas.This glazing package does qualify for ENERGY STAR. For the most up to date structural and thermal performance values,as well as other product specifications,visit harveybp.com. U-factor measures the rate of non-solar heat transfer from one side of the window to the other. About Harvey Building Products Heat transfer implies both heat loss out of a living space during cold weather and non-solar heat gain during hot summer months.The lower the U-factor, Harvey has built a solid reputation as a leading manufacturer and the better the performance. distributor of quality building products. A family-owned and operated R-value measures the resistance of a glazing material business with 50 years' experience, Harvey Building Products is or fenestration assembly is heat flow.A high R-vand known for outstanding craftsmanship and superior service as well as window has a greater resistance to heat flow and a g p p higher insulating value than one with a low R-value. standing behind every product we make. In addition to manufacturing Solar Heat Gain Coefficient(SHGC)measures durable, attractive windows, doors and patio rooms, Harvey distributes a full how well a product blocks heat from the sun.The line of highly respected building products to professional contractors and lower the SHGC,the better a product is at blocking unwanted heat gain. builders throughout the Northeast. Visible Transmittance(VT)measures how much We understand what It takes to be part of your home.TM light comes through a product.The higher the VT, the more light that comes through. G® . Harvey Building Products 1400 Main Street HARVEY Waltham, MA 02451-1623 USA BUILDING ® 800-9HARVEY(800-942-7839) �� PRODUCTS ot1010V 1.0 Information about Harvey Building Products and our 2 YEAR cd�°����` � products and services can be found at harveybp.com. GLASS O *� You Due to printing limitations,finishes and colors shown)n this brochure are for representation only. 12-010 Mas.Sachusctts- Board of BuildinD` e,,UI nt of Puhlir . Rp'ul;Itions and Satoh Construction Supervisor St`�nd: License �rd� License: CS 75746 JEFFREY wRAGG 54 EILEEN S YARMOUTHPOR7' MA 02675 ('nmmisiuner Expiration: 9/20/2013 Tr#: 4202 �+ ✓k -tOanvmovuuea � a�✓G�craaacli/ccaeCla °\ 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: Registration: ;s 1�49773 Type: Office of Consumer Affairs and Business Regulation I Expiration_.=2/7/_-2014:- Individual i 10 Park Plaza-Suite 5170 Boston ,MA 02116 JEFFREY WRAGG €'= � 'r �- r _ . j 1 JEFFREY WRAGG" 1, == Imo.; ` 54 EILEEN STREET`- YARMOUTHPORT,MA`'02675 Undersecretary N, /a' itho esignature I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION otMap a I Parcel, O A 0 " Application # Healtfl Division Date Issued L ci Conservation Division Application Fee Planning Dept. Permit Fee f • = Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address c2 O 5NEE(� fAE7 DOW 'Rb Village Owner K05,MAW .TWOHAS E, WEIL , Row T Address ;0 514EEP MEADOW Pt> Telephone Permit Request 'REMODEL TLUU (1) gA4714 R00145, e INCL - RJR IWO Jr NDawS 1N R2A7WOOMS e 11gs-1444 -JkYL16Nr Square feet: 1 st floor: existing proposed _2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay ' 'Project Valuation / U I c�0 Construction Type Lc10c9 0 FRA+MC Lot Size S i4c- Grandfathered: ❑Yes ❑ No r If yes, attach supporting documentation. Dwelling Type: Single Family: �r Two Family ❑ Multi-Family (# units) Age of Existing Structure 3 KS Historic House: ❑Yes CK No On Old King's Highway: ❑Yes '®I No Basement Type: 9 Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) 3 d O Basement Unfinished Area (sq.ft) (12 Number of Baths: Full: existing new Half: existing new Number of Bedrooms: 3 existing _new N o Total Room Count (not including baths): existing _ new First Floor R or i Counter o Heat Type and Fuel: �§Gas ❑ Oil ❑ Electric ❑ Other ` Central Air: ❑Yes ❑ No Fireplaces: Existing I New Existing wood/coal stove:-❑Ye No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing Cl:.new�E§ize_ M Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes WINo If yes, site plan review# Current Use RE5 0®E NTIQL_ Proposed Use RE5 i M NTl A L. APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name DAV ID W H 17C Telephone Number 5D2 7110 2(�q_2> Address '2 g T REMW—1 57 License# M A NS PI EZD+ MA 4 a o+2 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT-WILL BE TAKEN TO Rc�►3�R ,— et~I lL�s iNc 0P, C Q v 10A lC N 1 SIGNATURE DATE x i TO FOR OFFICIAL USE ONLY APPLICATION# - DATE ISSUED k MAP/PARCEL NO r ADDRESS - VILLAGE OWNER r DATE OF INSPECTION: FOUNDATION, ,;"- -y , R FRAME -INSULATION), FIREPLACE ELECTRICAL: ROUGH ` FINAL PLUMBING: ROUGH FINAL 7 GAS: ROUGH Y= FINAL ' � -EINAL BUILDING`' "'Q'- ram'. ' DATE CLOSED OUT - ASSOCIATION PLAN NO. 1 •r' - Massachusetts-.Deportment of Puhlic Safctc Board of Building_Relgulations and Standard% Construction Supervisor License License: CS 83898 DAVID C WHITE 88 TREMONT ST MANSFIELD, MA 02048 Expiration: 711=2 ('onmiis.iuncr Tr#: 28677 �C nsumer f✓Gfagdi License or registration valid for individul use only .. - Office of Consumer Affairs&B smess Regulation • HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration•..eEMENT Type Office of Consumer Affairs and Business Regulation lO Park Plaza-Suite 5170 r:J Expiration: .6172Q12 Indnndual Boston,MA 02116 D'AWHITE DAVID WHITE 88 TREMONT ST MANSFIELD,NIA 021)48, ' :..;,' Undersecretary Not va id without signature The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . 600 Washington Street Bostoi,MA 0211-1 www.mass gov/dia ' Workers' Compensation Insurnn.ce Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lefty Name P'sinc JOgmL-ation�an: MVID WY lTc ' AddLeSS: �� T •EI"lON 17 57. City/State/Zip: 101ANSFIELb, MA o:)q -2 Phone.# Are you an employer? Check the appropriate box: Tppe of pi oject(require 1.❑ I am a employer with -4. ❑ I am a general contractor and I ct) ' oyees(f=H and/or part-tinie).* have hired the sub=con actors 6 New construction . 2. I am a'sole proprietor or partner- listed an the sheet 7. 5a Remodeling ship and have ao employees . These sub-contractors have 9. ❑Demolition working for me irr any capacity. employees.and have workers' • [No workers' comp.insurance _ comp..m 9, surance.#. Building addition • required.] 5• ❑ We are a corporation and its 10.52 Electrical repass or additions 3.❑ I am a homeowner doing till.work officers have exercised their 11.®Phnnbing repairs or additions myself [No work' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no . employees. [No workozs' 13.❑ Other comp.insurance reginred] •Asy applicant that checks bax#1 Est also fill out fhe sectian below showing theff workers',compensation policy information. t Enmeowners who submit this affidavit indicating they arc doing all work and then hit outside contractas mast submit a now affidavit mdicatiag such. 4'ootraetaws fat check this box must attached as additi=al sheet showing the name of the sub-cantractnrs and state whet=or not those entities have crnployr-- If the sub-oahactm bavo employees,they=ntpnmclt their workers'comp.poBcynmmber. lam an employer that is providing workers'compen information. saSon insurance for my employees. Below is the policy and job site . In rd=company Name: Policy#or Self-ins.Lic.A Expiration Date: lob Site Address: City/Statc/Zip: Atfarh a copy of the workers' compensation pulley declara$on page'(showing the policy number and expiration date). Fwhm'to.secure coverage as required under Section 25A ofMGL c. 152 can lead to the impositian of coal penalties of,a fine up to$1,500.00 and/or one-year uoP=somme� 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 ctat emPri+may be forwarded to the Office of Investigations of the WA for insurance coverage yeahcation. I iio hereby c der e p ' s penalties of perjury that the information provided above is true grid correct TV F S Data: Phone# J og Official use only. Do not write in this area, to be completed by city or.town offwial City.or Town: Permit Ucense# '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#: �IKE Town of Barnstable Regulatory Services ` . : snaivsrna�, aces Thomas F.Geiler,Director i6S9 M1� �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 .5 If Using A.Builder , ;�"�• _ " Es Owner of the �u eri - a hereby authorize Da.u-4 c v h ate RoGec't 1 �e\C�. to act on my behalf, in all matters relative to work authorized by this building permit 20 � ��� Mfc/�®ac.J� c.� .. �A�.c•� s'i�t�.,� (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. . Signature of Owner Signature of Applicant -Print Name Print Name Date Q:F0RMS:0WNERPERMISSI0NP00LS IKE Town of Barnstable Regulatory Services >uuvscnsi,E Thomas F.Geiler,Director trrnss. �p039. � Building Division rFO MI►1� O/ Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 % www.town.barnstable.mai ms Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: ;7 JOB LOCATION: number street village "HOMEOWNER": name home phone# h'"J rk phone# r CURRENT MAILING ADDRESS: city/town stite . . zip code The current exemption for"homeowners"was extended to include o er-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does possess a license,provided that the owner acts as supervisor. DEFINITION OF HO EOWNER Person(s)who owns a parcel of land on which he/she resides r intends to reside,on which there is, or is intended to be, a one or two-family dwelling,attached or detached strut-lures accessory to such use and/or farm structures. A person who constructs more than one home in a two-ye eriod shall not be considered a homeowner.,,Such "homeowner"s}iall-si bnpi't.trb the,.Biii1ding_Officialion a,fornaM- crif&Re to the Buil-dingafficial;that he/she shall be res onsible for all such work performed under the buildt ermit. (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 / 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 hall 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 3 uldVth a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. i 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 caret amend and adopt such a form/certification for use in your community. Q:forms:homeexempt Lt IX C '01 4 ,-H 1' 4. 1_4 _iX Ll 17il 7f 1-j Zo i t ----------- IT PR 1/y 'Town bf Barnstable . Old King's Highway Historic District Committee. HAMM""E`' 200 Main Street, Hyannis, Massachusetts 02601 . (508) 862-4787 Fax (508) 862-4784 CERTIFICATE OF EXEMPTION Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Exemption under Section 6 and 7 of Chapter 470,Acts and Resolves of Massachusetts, 1973,as amended,for proposed work as described below and on plans,drawings,or photographs accompanying this application: Date March 22, 2012 Address of Proposed work, Assessor's Map and lot# 109/020 House# 20 Street Sheep Meadow Road Village: West Barnstable This application is for an exemption of the proposed construction on the grounds that work: Will not be visible from any way or public place ❑ Is within a category declared exempt by the Old Kings Highway Regional Historic District Commission ❑ Other Description of Proposed Work: Replacement of two bathroom windows with Anderson Double=Hung Energy Saver Silver Line windows--same size and location _��_ i-_a. t.....tall ,tien t, 1 skylight on roof wCu Ya,e attache , vrr6 'V2�13 fl above western-most replacement window (see .attached photos) All installations on the South rear of home, as stiown on accompanying photos, , not visible ftem any way or- palblic space .qk,V1 i ghtpropsed as same size as two existing skylights on South side of house, approx.. 14" x 30 Agent or contractor(please print): All Cape Property Management Tel.no. 866-895-5432 Address 64 Christmas Way, S. Yarmouth, MA 02664 Owner(please print): Thomas osm /Ruth J. Weil Tel no. 508-362-8014 Owners mailing address: --- 20 Pen eadow Road West Barnstable, MA 02668 Signed,Owner/Contractor/Age ANC For Committee Use Only This Certificate is hereby Approved/Denied Date: 3 ZL L 4, — Committee Members Signatures: RECEIVED MAR 2 2 2012 GROWT I rNLT .� i TENT Any conditions of approval: ";nn1r-��tjgP. C:IDocuments and SettingsldecolliklLocal SettingslTemporary Internet FilesIOLK110KHExemption Form 07.doc F1 \•aa,:l,r'�, '�y 1 f!. F 1 t 1r 1 6 ,j� w �-• _ •+- St �+� I 111. 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Save Product Summary • - Limited Availability. =_ Contact an Andersen dealer for details. = _ _= r:, • Custom sizing available Request a product o High-PerformanceTm Low-E40 glass provides ' brochure by download or exceptional energy efficiency ,.. by mail • Natural wood interior • Nine factory-finished interior options _ -_ • Eleven exterior color options -- -" -- - ------- -w _ =- • Sixexterior tnmPr profiles Product Index • Composite cladding - - P 9 • 9 Int r I -I e a t it t atch �1 ........_... ' • PG50 standard performance • Nearly-invisible TruScene®insect screen y' optional • Eight foot tall Heights o FSC Chain-of-Custody Certified, Upon Request Base Price:See Dealer What's in the price?A "Size: View more sizes,prices and configure your window OPTIONS AT A GLANCE i i Options&Accessories Sizes&Shapes Performance Combinations Installation&Warranty For Professionals i Printer friendly version Frame Finishes&Colors. Standard Options Interior Wood Species&Finishes Glass Options Grille Patterns I Insect Screens -............-....._ -...-................-..•..-.••...--..-..... Pine Maple Oak Clear Coat Honey Cinnamon Russet j Exterior Trim Profiles ...eti.'vi.ii :.:!:::�:ii:::' Mocha Expresso Primed Painted WhitePainted Birch Exteriors WhRe Canvas Prairie Grass Dove Gray Sandtone Terratone® Red Rock -� ; i _... _..... j Cocoa Dark Bronze Forest Green Black Bean Painting and Sealing Exteriors l i Hardware RECEIVED MAR. 2 2 2012 GROWTH o hq://www.andersenwindows:com/servlet/Satellite/AW/AWProduct/awProductDetail/AW... 3/22/2012 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map act Parcel - ,Application # Health,Divisio n Date Issued Conservation Division ?/l,� Y',%^w!- s divi 2"^ ` =, .Application.Fee Planning.Dept: :'.Permit Feed Date Definitive,Plan Approved by Planning Board Historic _ OKH Preservation/Hyannis V Project Street Address cheu P,PQ VillageP�ST Air'n Sty Owner KOSi'Y)G/'l Address She' ep M!adoQ Aoa,4 Telephone D$ 36.a - J 'o q Permit Request ICA it �(������ a►n�- `f"YL�e .1doa,J S ct►.c�. 61\S+ L+ Square feet: 1 st floor: existing proposed -2nd floor: existing proposed Total new Zoning District, Flood Plain Groundwater Overlay Project Valuation 71 C Construction Type L. Size o Grandfathered: ❑Yes' ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure �Q7'4 Buy lI- Historic House: Ayes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: 0 Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing c _ new (_ Half: existing new a_ Number of Bedrooms: 3 , existing new Total Room Count (not including baths): existing _new_Z First Floor Room Count Heat Type and Fuel: XGas 0 Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing�( New Existing wood/coal stove: ❑Yes No Detached garage: ❑ existing 0 new size—Pool: ❑ existing 0 new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Other: rp 0 F� fl �l n D tUr L5 u u L II ZoningBoard f A U oa d o Appeals Authorization ❑ Appeal # Recorded ❑ OCT 1 9 REC D Commercial ❑Yes No If yes, site plan review# Current Use 'S i ale_ 1�c'(m i I y Aw— Proposed Use mo 4 Le, m�` y OAR— APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) Name SOr�a,�i� �ozaerna A� Telephone Number .S O�s- 7 7,S- f 7? Address 195 II/136(e_ ecxii License # L S (o(o q3 qo vtn 6 MA 0,1L01 Home Improvement Contractor# 103 7577 Worker's Compensation #)C 7Qb 913 130(020 I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO `7'c��mati1rs�c a' to SIGNATURE , DATE ,} FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. r AD,PRESS VILLAGE OWNER ' DATE OF INSPECTION: x FOUNDATION FRAME "INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL - s PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. :. The Commonwealth of Massachusetts Department of Industrial Accidents Qffiee of Investigadons 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please.Print Leeibly Name(Business/Organization/lndividual):S A f,6 Y,.12 �ry1� 'T'v�n fOV�MPlftT Address: 99 S accA City/State/Zip: C4 M a 09 Wj Phone* 7,75 1-773 Are you an employer?Cheek the appropriate box: Type of project(required): 1.t� 1 am a employer with�_ 4. I am a general contractor and I 6. ❑New construction employees(full and/or part'time).* have hired the sub-contractors j 2.❑ I ant a sole proprietor or partner- listed on the attached sheet. 7. IgRemodeling 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.= required.) 5. � We are a corporation and its10.❑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 cheeks box A 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. j tContractors that check this box must.attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. i - I am an employer that Is providing workers'compensation Insurance for my employees: Below is the policy and fob site Information. (� ` Insurance Company Name: �—t SSOG i Q.ir �i��.uST•f l G$ 6� YhA — Policy#or Self-ins.Lic.#:��IM S 9 nn13b1�d i� Expiration Date: Ot Job Site Address: c90 e�t'�1 1'tt� City/State/Zip:+)•Res--,ASL14ek/ylt4 W&6& Attach a copy.of the workers'compensation policy declaration page(showing the policy number and expiration date). Failkre to sc.�uie coverage as required under Section 25A of MGL•c. 152 can lead to the imposition of criminal penalties of a fine up to S r;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 itisuriffice coverage verification. 1 do hereby c th ins and penalties of perjury that the Information provided above is true and correct. Si a Date@ Phon #: Offlcial use only. Do not write In this area,to be completed y city or town offlclaL City or Town: Permlt/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#: oTti Town of Barnstable ° Regulatory Services K�� Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Strect,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, I nm OSI' C(A ,as Owner of the subject property hereby authorize S' rt n IL flyme— -TvY%Droye nq e^+ to act on my behalf, in all matters relative to work authorized by this building permit application for. �o A,",Q (Yle�s�C.J Q� - t�• r/�S�u b12. -(Address of Job) y 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 i `"El°'� Town. of Barnstable BARN STAB * Department of Health,Safety,and Environmental Services 16yg. ,� Conservation Division �ArFn t^p�s 200 Main Street,Hyannis MA 02601 Office: 508-862-4093 FAX: 508-778-2412 Robert W.Gatewood Conservation Administrator MINOR ACTIVITY REGISTRATION Property Owner Telephone number Mailing address ` Project location Map/Parcel# P Project description The following minor activities will be reviewed,under Art.27,by Conservation staff instead of the Conservation Commission,as long as they are constructed at least 60' from a wetland resource area or top of a coastal bank. * Pathways 4' in width * Fencing that does not create a barrier to wildlife movement, 6"above grade * Conversion of lawns to decks,sheds,or patios that are accessory to single family homes,as long as: -'house existed prior to August 7,1996 -alteration within the buffer zone is less then 250 sq.feet. -sedimentation and erosion controls are used during construction * Stonewalls(this does not include stonewalls for retaining wall purposes, grading and/or fill) Signature Date JG Reviewed by Date _GIS Plan Attached(fee charged for plan) Q/WPFi les/Form/MinorAct uinm Town Boundary '• i i 09 0 ....,..._.._. tzbgs6 Parcels FYzoto `` .. .' :•' i i`i �#49 - - �/ /�,_- -- �•-`�.,. ' i C 7234 Address Street Numbers i - r f ' �• ��� _ 109-029/ F7 Buildings -Approximate Locations of % #�15/ ...._....................._................._. t--• New Buildings from Plot Plans ;/ r-'"' / / % /. / _........__........__, - . �-� , Decks/Patios ;. •;.•, •;.,, // : % / r ///,i ....- . 1#34 - - •• - / /of Above Ground Swimming Pools i' /' i 00 In Ground Swimming Pools o Walkways ImprovedO - _.• \ Walkways Unimproved H t,.� P r' /� ,fix -."r, r 4 E r 1 Paths r•' t r' / /!y" FA. E y ( '~k 1'"• °s' \r` Stairways I Paved Roads F^�J Unpaved Roads •,,. / ✓r - �' I i c7 F�?F;. Paved Driveways Unpaved Driveways :,1••r'— �` i ,t 'i1L`-A tit 1 ,..,_. . _-1 -',� 1 ;/ , % i i i r _ r t." c i.._. ,.»,`.t 'L%'�1 s�°.7 ,r'✓�"' """k ,"• }, ice . lTiff, Painted Lines t..'.,,. Paved Parking Lots 1 y r U ,` ✓., 0 Unpaved Parking Lots. CB Bridges Railroad �, ` \ \` ., 'SQ `1t \ •`� �,` 1 �``� ql-y }.;;.-� �, _ Fences \ \`� ��`\ \ `�. 1\ 1 - �: �\ \ ` 'S� y�L�'-'I•' t;._;d �" \,K",�,}�•�132 1"34' t..` ''^\u' : —•— Guardrails —« Retaining Walls ` - Stone Wall s i , `} ` if+.� :r'k! /\ z • r,^^R 109-020\ '; k`+ wi Lr... t i : ^� 3F µi �} . CO Sports Areas \ \ _.J Golf Areas V A �.. i ` ! i �3 «�' t c ( i, Docks/Piers \7 •,� •` t ;+i Boardwalksal J Jetties . Streams 1.::i'. �r i - •4 T '°,...~�, L.:� ..... _.._ .- Drainage Ditches �-^} t.....1 3 i [73 ♦(� Marsh Areas Water Bodies l J' j i �. i i' ' } � „'t7 �r �.� �'• Y` }� Spot Elevations(NAVD88) 109 019' Topo to k Contours(NAVD88) /# 16.% / �._"Woo��r�A•sC 4ito $Ei�AOI✓gtL$� �" � � "�' /• / � / ✓r � � `,'l x-�Catchbasins * n Monuments �j Lamp Posts ® ' F' i j `�,•...,,, ,r Towers � ;f' / h0 r �� /tr Ll �-,✓ � �"` `� c:,:J L.,.� � � `1'� � Manholes Q Utility Pol O Satellite Dish / ar /' ff r \�ti .. }` \ N Fuel Tanks Signs ®® Flagpoles 0 Water Tanks 1 l" / i / t �.\ ,•4�.. _ \y '�` Utility Boxes - / r c. 1 _ ` O Posts t§ • #484 Pilings Town of Barnstable Data Source Disclaimer This map is for planning purposes only. It is 1 inch equals qo feet N Human-made features,hydrography, Parcel lines on this map are only graphic not adequate for legal boundary determination Conservation Division, topography,and vegetation were interpreted representations of Assessor's tax parcels.They or regulatory interpretation.This map does no Feet i http://www.town.bamstable.ma.us from 2008 aerial photographs. Parcel lines are not true property boundaries and do not represent an on-the-ground survey. 0 5 20 20 30 40 V`r )v zoo Main Street,Hyannis,MA 026or were digitized from FY2010 Town of represent accurate relationships to physical Enlargements beyond a scale of t"=too'may (508)862-4093 Barnstable Assessor's tax maps. objects on the map such as building locations. not meet established map accuracy standards. S a Ruth J. Weil & V LAndin ...BARNSTABI:E..................... Thomas..E:...Kosman.......... .. 371y.... `: 3 Belonging to Heed in Book . .... Fagg::,. Land Covet Certificate•No.,... ........ in Book ................ Page..... ...... In ........................, Registry ,,,:of Deeds... Land in Barnstable by Ewald Engineering Company, Inc. October 23,1975 RecordedPlan... ... . .... .............. ....................... ...... Date of Plan ..................................... in ..F3ai,nstable. Registry..oF Deeds,..in plan Book...301........NO. .9........ filed Plan No. ................................ MORTGAGE INSPECTION! PLAN HOMEOWNERS FEDERAL SAVINGS & LOAN ASSOCIAI-101 t _ Loan Me. Thomas E. Kosman 8 Ruth J. Weil I I ' E A'> ID ►r��� ON3A i L 7T 5 54000. 1ti 0 r i �� (�z/•9s� ,Ph o` ME �,C� C�VU o .!lane 211, 1986 ,► SEP - 1010 18896 .Scaler 1"= 4.0. TOWN OF BARNSTABLE HISTORIC PRESERVATION :I I CER1 IFY fI-IAT THIS PLAN WAS PREPARED f )V`�.Fs IN ACCORDANCE WITH THE COMMONWEALTIi '.� `- R CERTIFICATE OF LIABILITY INSURANCE OP ID DS DATE(MMIDOIYYYY) SPRIN-1 Ol 05 10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden S Sullivan Ins Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601 Phone: 508-775-6060 Fax:508-790-1414 INSURERS AFFORDING COVERAGE NAIC# INSURED- INSURER A: Associated industries of HA INSURER B. Spprinkle Home Improvement Inc. INSURER C 1�J9 Barnstable Rd INSURER D Hyannis MA 02601 I --- -- INSURER E. COVERAGES 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 9E ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER OAp�TECMMI D DATE MM/DD/YYYY LIMITS GENERAL UABILITY EACH OCCESURRENCE S ECOMMERCIAL GENERAL LIABILITY i PREMISES(Eaa�ocau+nwr � $ 7 CLAIMS MADE MOCCUR I MEO EXP(Any one person) S t PERSONAL&ADV INJURY ,$ GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: i ( PRODUCTS-COMP/OP AGG S i POLICY O PR - El LOC r JECT ' AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ ANY AUTO I (Ea accident) ALLOWNEOAUTOS I BODILY INJURY I$ (Per person) ! SCHEOULEDAUTOS HIRED AUTOS I BODILY INJURY S NON-OWNED AUTOS — PROPERTY DAMAGE S j (Per accident) GARAGE LIABILITY I AUTO ONLY-EA ACCIDENT $ ANY AUTO I OTHER THAN EA ACC S li AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE RETENTION $ f WORKERS COMPENSATION TORY LIMITS EUi AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNERIEXECUTIV� AWC7004943012010 01/01/10 I 01/01/11 E.L.EACH ACCIDENT s 500000 _ OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $500000 (Mindatory In NH) 1 11 yes,desoribe under i E.L.DISEASE-POLICY LIMIT $500000 SPECIAL PROVISIONAelow OTHER I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION SPRNfwo DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL lO DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Sprinkle Home Improvement, Inc IMPOSE NO OBLIGATION OR UABILITf OF ANY KIND UPON THE INSURER,ITS AGENTS OR Fax 4150E-775-1350 REPRESENTATIVES. Margo Mack AUTHORIZED REPRESENTATIVE 199 Barnstable Rd. Kelley A.Sullivan annis MA 02601 ACORD 25(2009/01) 01988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD f -� �j License or registration valid for individul use only Office o oasuroer arcs sraess e u a oa HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: VRegistration:412 757 Type: Office of Consumer Affairs and Business Regulation Expiration: Private Corporatic! h 10 Park Plaza-Suite 5170 _ Boston,MA 02116 S KLE HOM 1NC. Brad Sprinkle 190 Barnstatilg Rd _�- Hyanriis,`MA 6201 % Uedersi cretary Not valid without sign ure gn 'JunMus'sachusctts- Dcp:u tmcnt of Puhlic $afct� Restricted to: 00 .Board of Building Rcplations,and Standards 00- unrestricted Construction Supervisor License 1G-1 2 Family Homes License: CS 6643 Restricted to: 00 BRAD K SPRINKLE i Failure te.possess a current edition of the 190 LOTHROPS LANl.l ` Massachusetts State Building Code W BARNSTQBLE, MA 02668 is cause for revocation of this license. i Refer to'. WWW.Mass.Gov/DPS 0. —:go- J� Expiration: 10/Sr2011 (' nnnissi,mci Trii: 5478 l i 7 QAr `jWL T f. '10 OCT -6 P -.45 Barnstable Old Kings Highway Historic District Committee ,( �L& , 200 Main Street,Hyannis,MA 02601,TEL: 508-862-4797 Fax 508-862-4784 16s0 APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with four(4)complete sets,for theissuance 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 EAddition ❑"r lteration 2. Type of Building: House ❑ Garagelbarn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting,roof ❑ new roof ❑ color/material change, of trim, siding,window, door 4. Sian : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ tennis court ❑ Other 6. Pool ❑ swimming ❑ Other man-made pool Type or Print Legibly: Date: c'i Q, 1 b Address of proposed work: House# 9 n street: Sheep Meadow Road VillageW. B a r n s t ab 1 eAssessors Map Lot# 109-20 Description of Proposed Work: Give particulars of work.to be done: 1sa X 9?,ciQck with 191 X 21 hu..p 0111- twn set'C of ctairc 7 new 4' x 4'' gliding windows (re lacements) (as approved in earlier submission) ; new 6 x glding patio door as approved in earlier su mission) ; _ q4iiara river-17 1 atti r_P on untlarci r1aG of ciPck ; rP=1 acement of one double hung window Agent or Contractor(print): Sprinkle Home ImprovemeMlephone#: 508-775-1778 Address: Contractor/Ag si ature: NOTE All 4, - atio be signed y the rrent owner Owner(print): elephone#: 50 8-3 6 2-8 014 Owners mailing address: 02668 Owner's signature: l [ committee use only. This Certificate is here y APPROVED/DENIED De -'I I.�Y�l-0 Members signatures SEP -1 1010 00 TOWN OF BARNSTABLE HISTORIC PRESERVATIO c ditions f mmmsn�l Ian A, \01 0iolN.1k Ui6k WkS UICQ.S SAP 2 2 2010 � C � Q ^ owil Ui L Old Kiiig's Highway 1 CA Documents and Settingsldecolli cV ocal SettingslTemporan Internet FilesIOLK110Y-HCert Appropriateness 07.doc Committee Town of Barnstable Old King's Highway Regional Historic District Committee el CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 4 Copies Foundation Type: (Max. 18"exposed)(material-brick/cement,other) Siding Type material: d or: Chimney Material: Color: Roof Material: (make&style) SEp 20 Co or: Trim material Air; N TO iC pREsro D Roof Pitch: (7/12 minimum) NlgfoR Window: (make/model) Ha rvP}, material yj )41 color wh i t P Size(s): Q ' x 4 ' ( ----- --- Door style and make: 61 x_ � '_R" _118 tiA material�;nT1 Color: _W-h itA Garage Door,Style Size Material Color Shutter Type/Material: Color: Gutter Type/Material: Color: Decks: material mahoganySize �/.tx 4 Color: -"with white composite baluster rail s stem white vinyl lattice Skylight,type/make/model/: material o Size: Sign size: f;G Cu"UI c,�Type/Materials: olor: 1,40 oQ�s��,�.� cam, ti�2 Fence Type(max 6' )Style material: SE? Color: t5� ► ToWoof8arn9hWaY Retaining wall: Material: Id WIMP nee Lighting,freestanding on building illuminating sign Please provide samples of paint colors and manufacturers brochure of style of windows,doors,garage door, fences,lamp posts etc ADDITIONAL INFORMATION: proposed deck, windows , and door are on the East side of the home (rear of homw) , facing cranberry bog and not visible from any public .way or neighboring homes Signed: (plan preparerX'17 print name �► 1DGL tel.no<C%�'f� - 9 Xt,3 L cation of application: Street no.20 Street ShPPn MPaclow Road Village w_ Rarnctahl a 2 C:(Documents and SettingsldecolliklLocal SettingslTentporary Internet Filesl=]DKACertAppropriateness 07.doc 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 fivestanding-sign. Fee according to schedule. 5. FOR LIST OF ABUTTERS: PLEASE SEE OKH STAFF SIGNED (plan preparer) Print Date: Z� 3,1 to Tel.Phone no's: NOTE ALL applications MUST BE ACCOMPANIED by the CERTIFICATE OF UNDERSTANDING The Old Kings Highway Historic District Committee IV Y DENY INCOMPLETEAPPLICATI PRN�v P� ATTENDANCEAT MEETINGS: If the applicant or his/her representative is not present during t hearingtbQ application may be either CONTINUED OR DENIED 610R� 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 146'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 PERNUTS, 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 BARNSTABLE OLD KINGS HIGHWAY OFFICE AT 508 862-4787 5 C:IDocuments and SettingsldecolliklLocal SettingslTemporary Internet FileslOL ]DKH Cert Appropriateness 07.doc Ruth J. Weil & ,,.. C 3719 Lind In ....BARNSTAB .E Belonging .•_....... Deed in B k ................ Fage , Barnstable of Deeds LandCourt Certificate No. ... ........... in Book ...... ......... Page...........:. In ........................ Registry ..:..................... i i Land in Barnstable by Ewald Engineering Company. Inc. October: 23,1975 .•• Recorded Plan • .• . .... Date of Plan in ..Barnstable. Registry .oF Deeds, plan ...301........ .99...... ................................. g y .. Book Into. Filed Plan 1 0.' MORTGAGE INSPECTION PLAN HOMEOWNERS FEDERAL SAVINGS & LOAN ASSOCIATIOF - Loan No. Thomas E. Kosman & Ruth J. Weil ' 0 ON 3 . 5 DDCx Iw �0/IZ ,� poi k1l �tZ�c r srA 17L** (Do•3 9 2� sPh i` MEAD �Vrl ROAD � FPr Jr1ne 211,1986 D D 1Q I 118896 SEP -110 .Scale I" TOWN OF BARNSTABLE HISTORIC PRESERVATION t• is - .i'�1,1. - °'�1"j: _. .�'r ;. :.Q•• I CERTIFY THAT THIS PLAN WAS PREPARED '„ , IN ACCORDANCE WITH THE COMMONWEALTH OF MASSACI-IUSEI"TS PROCEDURAL AtJD - ;• d fl '"� TECHNICAL STANDARDS FOR THE PRACTICE r;, •.-•� a OF LAND SURVEYING 250 CMR G.DS AND WITH THE SPECIFICATION SHEET ATTACHED HERE' tC. �11A3 { II ti G � '. ' -�: I � ® •- i .� A � KENNETII •• d� ANDERSON 4 + No. 31298 0 GIST ERA S � Ii I �9L LA1�� li , t �- y' f 1 : ! I ILF !�Ii. t �< i `I : E i ,.I, I ICI - _� - ,,ZZ •. off. �1 77 ti7�s7-7 a In t - t N N _ oLL7�C) Sso� son h : -aOVIV L lsOd Id '4 I . .. AAA s II ' J ©TA � p r ' -41 i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Parcel ApPicaon# Health Division Date Issued a t Conservation Division Application Fee Planning Dept. Permit Fee 3 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis R Project Street Address Village (W. 16:5ilb ti/ Owner 85 Address lAk.e� Telephone �0 b2� 1�b7i0 Permit Request u dw k 'Y -3 -;e- Z -0 6w Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Totallew co Zoning District Flood Plain Groundwater Overlay s Project Valuation 22071 Construction Type ��ai . C" Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 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 bath,): 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: ❑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 A horization ❑ Appeal # Recorded ❑ Commercial ❑Yes ^No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION Lid 6 ��l� y BUILDER OR HOMEOWNER) Name 4664 C� Telephone Number /" 77 q" 17, Address License # ����0 • Kti- fit' �Zb Home Improvement Contractor# /Jr3Jr'6 Worker's Compensation # CU '4Q5Z�✓go/ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT W14ko BE TAKEN TO ow&" SIGNATURE DATE Z tt FOR OFFICIAL USE ONLY I • 1 ; APPLICATION# DATE ISSUED. MAP/PARCEL NO. ' ADDRESS VILLAGE OWNER 9 DATE OF INSPECTION: FOUNDATION FRAME INSULATION t FIREPLACE t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL t FINAL BUILDING s DATE CLOSED OUT ASSOCIATION PLAN NO. r _._... 'L !Nlassachusetts - Department of Public Safet% Board'of-Buil"tlin� RCIVUlations anti Shutdards. i Construction Supervisor License LicenAe, CS 100988 HENRY CASSIDY 8 SHED ROW WE3,T.IEARMOUTH, MA 02673 �y Expiration: 11/11/2013 ('u n un is,i„uc r Tr#: 7620 07— = Office of Consumer Affairs and Business Regulation - - 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2bl4 Tr# 233831 CAPE COD INSULATION, INC HENRY CASSIDY 18 R EA R D O N CIRCLE SO. YARMOUTH, MA 02664 Update Address and return card. Mark reason for change. SCA 1 u 20M-05/1) Address 0 Renewal ❑ Employment �—� Lost Card C /r: armrrcaruto(m.�C/o/Ciljz���c�u��Ct� License or registration valid for individul use only Office o(Consumer Affairs 8, Business Regulation g Y k OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: -registration: 1*53567 Type: Office of Consumer Affairs and Business Regulation xpiration: 12/145/2014 Private Corporation 10 Park Plaza'-Suite 5170 vnsv : :.:: j ::` Boston,MA 02116 CAPE COD INSULATION;;INC: HENRY CASSIDY 18 REARDON CIRCLE.' - �uti�---�EJaa�_ SO.YARMOUTH, MA 02664 Undersecretary Atvawitho t nat re —� The Commonwealth of Nlassacfi Print Form usetts �__� 2 _-- Department of Industrial Accidents Office of'investigations 1 Congress Street, Suite 100 _ Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/.Plumbers A p pliciant Information Please Print Le ,ibl Tattle (13usincsss/organizati011/Ind ividUa�l): el Acldi-css: la - -C'ityhtttle/l,ip: _ AVO)t I�V1� Phone #: r2o� 77�j Iz (_&JL rli-C yvtu an employer? Check the appropriate box: Type of project(required):—- 1. 1 ant a utrtployer with 00 4• ❑ l am a general contractor and I have hired the sub-contractors 6. ❑ New construction rniployi:us (full and/c;r Part-time).* - '.ID I ant a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship,Itld have no employees "These sub-contractors have g• ❑ Demolition working lbr ine: in any capacity. employees and have workers' INo workers' comp. insurance comp. insurance. x 9. ❑ Building addition requi red.1 5. ❑ We are a corporation and its 10.❑ Electrical repairs or addltiolls i.❑ I am a homeowner doing all work officers have exercised their 1 LE] Plumbing repairs or additions rttysclf. INo workers' comp. right of exemption per MGL l2.❑ Roof re a'rs insurance rcyuired.] .t c. 152, §1(4), and we have no 7— /�j J� employees. [No workers' 13• Other l/�ea`ItevIza ho comp. insurance required.] '1uy aplili4;un that chc cks bos fl I nnul also lilt out the section below showing their workers'compensation policy information. I Iomcowucrs who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new allidavit indicating such. 'C•omtr:ictors that check this boy:must attached an additional sheet showing the name of the sub-contractors and state whether Or not those entities have amt,lopccs. Ifthc sub-contractors have employees,they must provide their workers'comp.policy number. I a»t an employer that is providing workers'compensation insurance for my employees. Mow is the policy and job site htf urneution. CkAvhv 1nu -, nutceC:ompanyName: ivl�lL Policy Il or Sell-ins. Lic. #: WCAOO 2� MIDI Expiration Date: .Ioh tii(c Address: 90 �J"S A&ddul City/State/Zip:U) '115arf, 51A6lle-li 14 :mach a copy of the workers' coinpensation 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 up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of STOP WORK ORDEIZ and a tine ui'up tO$2ti0.00 a clay against the violator. Be advised that a copy of this statement may be forwarded to the Office of Invcatigations ofthe l-)lA for insurance coverage verification. /do hereby certify n�ler trite pains fai )enalties of )erjuq that the in%rmation provided above is true and correct. tii�it_uure: - i Date: 3 IN Official use only. Do not write in this area, to be completed by city or town official, 1,1ty 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 h. Other Contact Person: Phone#: Gllefltlt: 4597 'ACORD�_ CINSUL_ [— ---------- CERTIFICATE OF LjABILITY INSU' RANCE jAk*(�l?AhIIIjj,,j)j)j 07102120-121 S WEO A-'i A MATTER OF I NFOTT1'1,1'N_UNLYAN0 CONFEf ------- 001F,", NOT Al' �s NO RtGHTM UPON THE(,F FXTENO OR ALTERTHE COVO:ACE AFFOR1,0rE) U �I'CfIFICATE OF INSURANCE DOES NO1V CON".I I'i w I F.A C -y T I I I P0 L,I C.I F.1�11 CL `1::11'-4fVIA'I*IV1:t-Y U14 NEGA-1-1 rIT,F-I cz,ILXT '*"1�(`1*I T:il:fl I A VIVI�:, ':)it F'"CWLICI�P, AN13 ONTRACTEE I'VVE.LNTHE INliURI:M(�ij,AU I I IQK14LD 11"'Pt II(I'ANT:it II)-0 -L. :00,111.1,oll-a ofillc IJUIIL:Y, ,I Itoloo( III Iluk, .,I u I I I W,I L.Ak ti I u WI I I v I II u 1) 111 ti L:o I 76PTIt= 'S Mai qL1I Y E-MAIL ........... .......... -------- '16333 :"I)%: ... . ......... lu pnylarly IIV,tllIIl:., VAA 0200-1 INJURI:1,W COI III Ilel'CO 1116 U U111 Ce C011111,111V ............... you 117)C ATL'N U M U E R: I'l v I I I,k i f(i "o.lo, ------------- R,E V I S 10 N N 0 IVI 1.1 L..I t. 'UMENT WIIH willuji III,:; b,1AV L�I- h.,�10:1) 01.*4 M, THE INSIURANCt -II(-,jj,,LjCO LIV r(16 POI.ICIC JOG I,) Llsl,ro TOII(L IM(MIED NAMCD At-.10 I r.'.KNI ()r, .Vi'_- 1-()I( I'll,.: POLICY III alut, IR ANY CONTRACTOR 01*1-IE-R I 'dON'. AND t"�,;(1100,10" 01: "UCH MLIOIES I-Imn'S si.ICjjNj,,Aj..q tl,�Vg OESCRI BFD i-n-REIN IS Su0j ;r NEEN RCOLIGfn BY PAID C-L.AIMS, I'd AU. 1111' IV14;I,IP llq9ufAAN(L AODL 6—F CSP826306" 0410-1/2012 04/U,l/2t),j j t�,kcj-j CJC(.'I.l(M-NCIz, 1..0.LIQ'.0..LIU L IAWLI VY ....... IPJH!)D I I AIM"MAUI.- OCC.MZ AIM.--,-im."', ,!__ AL . - - . .I„ ... III il I AI`P 1.1 Qk I p 1,I-I A01.1111,'(W 1:�_ 1-2..O.U.0.u_U(I........... MJ 'l2MMbCKVi1w\ 4101120,12 04N-112 I' BODILY INJUR%'(P.. X UOUILY ............ Itx ....... XONJ453S 12, 1410'010*N 04/0-1/L10V. X "t IIVN t h1l't 0`1 HIA'IAAI:IILI 1'e N 5IM20112 013/301-'Jov x .......... NIA E..L.CAnI I AC.C.101z IT 12 I. Nil) I............... ...... C.L.Di:;CA�C-VOL icv umi r s*1 01111000 VV0 0-1':, 11oll CS�(All-1,ACOAL)lei,Ada................... unnl. Nd(tili011dl hISI-11.0d UIILIIII (4muial UjOility W11011 ro(j(dro(I by wr Itcon lei I,. 1: H01,WL'it CANCELLOWN C'ij)u GQ0 lik6LJILItIojI,IjjC 8HOULD ANY OF THE ABOV15 PCILIC.IEN, Wh Phi k1k THE EXPIUATION DATE THERECIF, NOTICE WILL bt. LIIHLIVI:Wetl IN ACCORDANCE WITH THE KiLICY PROVI:11ON3. 21 (�'.0 lu/u�j 0-1011 .20-10 ACOND C(_)NI:I(MA'j'j0N,All 0910 wklivoti. (it Tht:t ACORV name aod 1000 '(,1 rcjUktufud marks OACORD Nq i-I Y OWNER AUTHORIZATION FORM (Owner's Name) ' owner of the property located at ;b 5L� Ale4kw (Propefty Address) ' MA (Property Address) hereby authorize t) -P ta O/V (Su contra or), an authorized subcontractor for ISE'Engineering, to act on my behalf to obtain a building permit and to.perform work on.my-property. Owner's Signature <k Date oFt„E r Town of Barnstable *Permit-# 4235 Fxpires 6 months from issue date �l Regulatory Services Fee s a • s BAMSTABLE, ' v� 1 . ,0� Thomas F.Geiler,Director . .etED MA'I A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY //,, Not Valid without Red X-Press Imprint Map/parcel Number l VZ0 Property Address � � � '`Pt�E ) t�.)�Sf q.z f [Residential Value of Work' rJ�� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address /t OM Vo`'� Contractor's Name-0 s_- Telephone Number Sc S tt(oC{O Home Improvement Contractor License#(if applicable) WA I S 7 Construction Supervisor's License#(if applicable) qo[Lb`Z [JWorkman's Compensation Insurance -PRESS PLAIT Check one: 110 V 1 7 2009 ❑ I am a sole proprietor ❑ I am the Homeowner TOWN OF BARfVSTAS�[ '1 have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# 1_2) t,S06 0.2 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) [�Re-roof(stripping old shingles) All construction debris will be taken to(245aLL in A S-t�_ El Re-roof(not stripping. Going over existmg layers of rolf) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum.44)#of windows *Where required: lss;Lnce 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 of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is regldired. SIGNATURE: Q:\WHILESTORMS\building permit fonns\EXPRESS.doc Revised 090809 The Commonwealth of Massachusetts Department of Industrial Accidents Offlce of Invesdgadons kvi 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/0 ization/lndividual): Address: zo) City/State/Zip: M� Dcrk(D r2�{ Phone#: —450qs 6c) ,%re y u an employer?Check the appropriate box: Type of project(required): LfeT I am a employer with 1 4. 0 I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' insurance.= 9. ❑Building addition [No workers'comp. insurance comp. required.) 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.❑Other employees.[No workers' comp,insurance required) 'Any applicant that checks box MI must also fin 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 contractor must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. if the subcontractors have employees,they must provide their workers'comp.policy number. I an an employer that is providing workers'compensation Insurance for my employees Below is the policy and f ob site information. Insurance Company Name: L eev-41 Policy ti or Self-ins. Lic.ti: _9 (ma`sExpiration Date: (2-Z% •t021 Job Site Address: 20 &tae P & - City/State/Zip :A I Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 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 S250.00 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 iasuranc coverage verification. 1 do here=fyunderhe pains and pen es of perjuty that the information provided above true a correcL i Si ture Da • Q Phone #: � �j WOW _ Offlcial use only. Do not write in this area,to be completed eta y c4 or town offlcia[ City or Town: Permit/License N 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 Information and Instructions Massachusetts General Laws chapter 152 requires all employnn 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, bye checking the s alonges that with their apply to your situation and, if necessary,supply sub-contractor(s)name(s),address( ) p � ) 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 016clab 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 permitilicense 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 Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 11-22-06 www.mass.gov/dia E0 1 :26 F 1 508 18 1218 001►UNG CHI, INS bO1i001 1/14/2009 9:39 PAGE 0021002 LMG Lib"Mutual Group Libertv., P.O.Box 9090 i MUtUCQ. Dover.NH 0382-1.9090 Ti cic?honc(BQO)653-7.M Fax(03)-245-5330 .::nt;arY 14,M09 . '�•J:�';\1 I�9LL SQI3AItE :LMOUT'PI, MA. 02540- •CerUficate Of VVorkax Compensatirsrk WurAncc. a PERL -RI\E L-ANT- SOU TH YARMOUTK MA 02664 ::;►Number: WC2-31S-338K4-!►2,6 Effective. 12/Z/2008 Evicaaorr: .12/28/2(109 ......SrL a afforded fonder 1X�ockets Compensation Lnw of.tze following sts* S): ••t Sr,1,�P�nriFmr;?rrrn;�C:�v�raar Flrn:�-+• --' rn; .Bp Accident: $100,0C ZaLh A,xidm t i The-workers'compensation .d i;•.1a u b Die<". x E. peli.-_v does nct provide 1 iY Y $I00,Qi)J .:ach Parson CQVMXc for oliy?rnury by Discmw $500,000 Policy Limits UrVI W QIE.LY : °.!his date, the z e-neferer-ced policyholder;s insured by Liberty Muwazl Fire fnmrance Co r 11,c policy listed above. ss:suiance aff tided by the listed Policy is subject to all the-tun,,estlusions and conditions,tnii is not r;d be ar v requicofneay term or condition of as y o_other-docurnarits with respect to which this ficate may be issuer!. Crci r ficate is-issued as I 111 we of infor m.2tion cmly and e-onL--s r_o riLir t upon your the certificate I1tis cergficAte is noz.sn inr,LanCe policy and does not iimend, � le ecoverageosih •':-�i:Y�j,y��ic policy lislcci t:br�Yc. . Policy is=celled before the stated expiratica dstte�Uberr.,-Mutt,2l-;Xiu endeavcs to notify you Of 911THOfi1MW RUP,ESENTATWE: LMERTY hfbW,%L LNNLipANCB GROUP :cti6ale L exeeQad by r.. ER7Y--VUriALAS u4-CS GRoL-L amegaAMMlMUMMeULwadedby!bow cam*ad— 1151lCCC2; Producer of Recor+cE ijLIZTEA1GFT.P.Y SANDPI t.NSWRANCEAGE`CYINC P.EG£I1�E LANE 12ENTERPRISE ROAD :.:i i,-1W YARMOUTI�' MA 02664 HYANNIS, ;WIA 02601 >" . liassacitti;etts- Depaulment'Of Puhlir Salct�. A Boa o Buii;fin!,R�!,ulations and'-Stand.:a tv ice wcense- CS SL 99167 Restricted to:. RF.W'3 *$ - ;. OLIVER KELLY 9 OEREdRINE LANE SOUTH YARIUI6(1THf MA 02664 Expiration;.9(28(2011 . ' i'.nuni>•innt•r . e Von4an ares Boar o ui mg gul a One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 128957 Type: Individual Expiration: 6/14/2011 Tr# 284841 Oliver Kelly Oliver Kelly 9 Peregrine lane S. Yarmouth, MA 02664 Update Address and return card.Mark reason for change. Address C Renewal Employment Lost Card DPS-CA1 0 40M-08108•D13SUFORMCA108212008 Boar o w mg eg aho s an tan ar License or registration valid for individul use only. -- HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: V I~ Registration: 128957 Board of Building Regulations and Standards One Ashburton Place Rm 1301 Expiration: 6/14/2011 Tr# 284841 Boston,Ma_.02108 Type: Individual Oliver Kelly C".� Oliver Kelly 9 Peregrine lane �� .''' .:-" � _•f ��Q�°-•�- ---•— -- -° Not valid without signature South Yarmouth,MA 02664 Administrator �TME l Town of Barnstable Regulatory Services B"R'AS& Thomas F. Geiler,Director 9`b�F�►`0� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-79076230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize O(w e-y— t,�.,��L,l.�{ 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 o If Propedy Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse. side. Q:FORMS:OWNERPERMISSION Town of Barnstable Regulatory Services BAENSrABLE ; Thomas F. Geiler,Director 039. a Building Division �prED MA'1 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 "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/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 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. f Q:\WPFILES\FORMS\homeexempt.DOC Application to b. �gN'jCNe.tEp,h�GS Old King s Highway Regional Historic District Co in the Town of Barnstable for a JUL 1 0 1993 CERTIFICATE-OF APPROPRIATENESS TOWN OFBARNSTAI D ING' dial I WA Application is hereby made, id triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of C apter , 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: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT-LEGIBLY DATE ADDRESS OF PROPOSED WORKX'O �l1�EO/YI i?1t�/ �C D RIViy17-146l6 ASSESSORS MAP NO. �U OWNER/-frill TZhIWAf ASSESSORS LOT NO. HOME ADDRESS. L�FfSYrl�t/�� l/►', NSi�;tSL4 TEL. NO.-YL/12 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). AGENT OR CONTRACTOR 2Z TEL. NO. yZ8 , 95ly 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'thecase of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). Z----9 Signed Owner-Contractor-Agent Space below line for Committee use. Received by H.D.C. Date The r i to is by L t'" y`'t ° Date —� 3 i pMa nrp��eY tUj IPA Approved ❑ IMPO TANT: If Certificate is approved, approval Is subject to the 10 day appeal period provided in the Act. Disapproved ❑ 47- �2 �C/ /�/c-�ft�L /�.Pi�� /G �C�TlcF�cc—�t'.� G✓�3 O�G G �8 �en4lzo �r9�i✓,C/ tiny �� � i3. v 2.G61 coR u� i OLD KING'S HIGHWAY HISTORIC DISTRICT S p e c Sheet Foundation Type rIo�iN�s /, i�irri%J�p x c�po� C c�2�rF r//f SGy Z,Y j7dcii�Ua� i Siding Type -72)� ir�fYrc�! G�?iS i ii�li r/r�ii i9/1 Chimney Type Color -7"e, n7h-7z-,- Roof Material /)tfAZi ,Sih�//_is3 Color Pitdh Windows G 4LJ70 � Ls1/ raj J,,;�_rr A ,N/&L4i1AL- Size Trim Color Doors Color mill Shutters Gutters -fy �> Crf XiS;i�cJG' Deck Garage Doors Color Notes: Fill out completely. including measurements and Y g rnater.ials,/colors to Three copies of this form are required for 34mittal of an applicat along with three copies each of the plot plan. landscape plan and plans.' when applicable. 'Plot plan need not be "Certified" . but should show all structures to scale . N LOT 50 4'LOT LOT LOT I � \ ZbO� W ,� I nh 54,000 l L O T 45 A , RECEIVED BARNSTABLE CONSERVATION COMMISSION ED PAL C T PL ,4'3 /Q MA R 1 1979 C 4 L F .. _� 6Q' ._-.._ A 7- ._._�. .7.9 9 f F E R E N C f ' SN %) WN ON q i' LAN RfGOR /Jf C N rHC B .4fiNSrA8t E CDUNT i _..............__ _.......__......_..,, kf. 6 / Sr RY r.7F c P A G E _.-..9..9.._...__... .y W iY O N Al A C• R y 14 .............. LOCATION SEWAGE PERMIT It0• VILLAGE A eea , /I�e lr{c�w Cat'r/� . L✓ �2�.-r S'�'°��� N S.T A l l E R'S NAME i ADDRESS Trucking V Bulldoz,ing Hyannis, Mass. 775-0828 3 U It DE R OR OWNER DATE PERMIT ISSUED Z T— DATE COMPLIANCE ISSUED. ' I r' Assessor's map and lot number ` �� � �t `/?'................. ...................... Bpi TN E TD` Sewage Permit number r Z BARNSTABLE, i House number ..:................a�...::p............................................. qo rasa po,2639• �F0 MAR a .. TOWN OF" BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....... 5.........`.......................!:!�0.. w• CL-W� . 5 ............. TYPE OF CONSTRUCTION ............L .aO �T 4G.� �:............................................................I................. ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: w �o Location .....��............................................... . ..................................................................................:?.: S . .................................... ProposedUse A. d,� 0................................................................................................................ _ Zoning District IR .......................................Fire District �1,r1, ............................,. .............................................................................. Name of Owner ....J.0 �........ .(�P ...................Address .....!..t..... �` . A��t ' t J .............�.....V.............. ........ ..................... rv.t_ �_.�--•- Name of Builder `( ��r,°,v`• E�o 5 ., -( ..... �4 ,r, ...................Address .. .........................:?�-t... �................... ........ ......... ..... Nameof Architect ....................Q..............`.,?.............................Address .................................................................................... 0 ov�.ve-L Number of Rooms ..................................................................Foundation ...... ...................................................................... Exterior ..................'............:`�:...'�����1Q:5.......................Roofing ...........GS.......`...`..:........:......................................... Floors0 v............ .G:.....?........................................Interior ...........a.........................?........................ Heating ...........:. ii '� ... .......:..:Plumbing d l` t Q- .0 i C- _ . ... `.... ................... ................................. �. .......�-°.��dS\� -. �t..i f.%) ooFireplace ................ ...........................Approximate Cost ..... ..�. .... ...................................... Definitive Plan Approved.by Planning Board -----------_______-----------19_______. Area ' ............. Diagram of Lot and Building with Dimensions Fee . _ � �� j lots SUBJECT TO APPROVAL OF BOARD OF HEALTH ," I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........ �....... ADpleb �� �� &=lOg � - - ,y ~ � 2I064 two to No -----.. Permit for ------.�—...'�-- ` single family dwelling --------------------------' � 20 Sbm Road Location --------���.��.......-------. ' - West Barnstable --------'------------------ Jon frame � ^ .. � Plot � ^ Permit Granted � ` � .Mar-{h Date of Inspection ' Date Completed FZERNIT REFUSED ` ` . ' � .......................... —.------........... lA � � ---.. . ----------------. � ^___.. .. A-�_,________. L~«/ —.--....-----....---.---.—~—~-- . � � . � .................................... .---~.—.---- � / � ~ ___---------..�--- l9 � Approved __.____.________.___________. � ! -----------.---------.—.—...... � " v [ ' As$bssor's map and lot number E X C SYSTEM MUST 131[1' *TNsrc INSTrILED 11 IN 'COMPLIA Sewage Permit number ....... WITH A?,T 1)a 411 STATE TE SANITARY CODE AND AR39T ABLE. • House number. ""e ............. ................................................. . VtATIQNS ,63q.TOWN OF BARNSTA,RLE BUILDING _N_1 -,SPECTOR-- .,, 1 4 CLWA I A- ........... ............. .................... ...... APPLICATION FOR PERMIT TO .........................................................w,*v 0 TYPEOF CONSTRUCTION ............ ........................................................................................ ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: A....... 5 k ee. ......................................................................................................................... Location .....LA ... .... .. .....V--o", _j &O"k Li a4t_ ProposedUse .......... ........................................................................................................................................ ZoningDistrict ........................ .......................................Fire District ............. ............................................................. ..........Name of Owner .......................... ...................Address ..... ...................... Name of Builder ... !<...... .....................Address ... Ste&... .V(j_roJVr ...................................... ..................... ........ Name of Architect ....... .............:.Address ..................................................................................... Number of Rooms ..... ...Foundation P.� .................................................... Exterior .............. .......................Roofing .............. .L......t................................................ ....... 'S-�'Q_a�ro C-k- Floors ........... ..............................Interior .................................................................................... Heating .......... ...........Plumbing ...................... ........................................................... Fireplace ....... .............Li.4).o..... ..... ........... .. .. ..................Approximate Cost ......... ..................................... Definitive Plan Approved by Planning Board -----------—------—----------- Area ...*=-F.. ... '16' Diagram of Lot and Building with Dimensions Fee ..........:':7...T...................... . SUBJECT TO APPROVAL OF BOARD OF HEALTH j MO. (OLJAJC K COPS. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name..........d-CS................. .. ............. ............................. Appleby, Jon fl of1064 two story ............... Permit, for .................................... -e single family dwelling ............................................................. ............ Location ............20...Shee.p.mea.d.o.w..Road. . .... ........ . ...... . . .. .... . ............ West Barnstable ...........................................................;................... Owner .................Jon..Ap.p.l.eby........ .. .... . . ...... :..................... Type of Construction .........................frame................. ................................................................................ Plot ............................. Lot ...........#5A ..................... Permit Granted .............Mar.0i..1...........19 79 Date of Inspection ...... . ... .............19 *Date Completed .... ... ... . ...... ... ..........19 PERMIT REFUSED ......... ......... ...... ............ ... .................... 19 ..... .... .. ........ .. ... ... ............................ .. ...................... Cal:....... .. ............ .......... . ..................... .................. .. a .. . .............................1. ............................................................................... Approved ................................................. 19 ............................................................................... ................ ........................................................... �bb2i1� ` Q G Or xIND a to 10 ku AL 22p ri h rj W m ko d 0 W 2 p 0 to O w OLd 1. ' moo W � O Vi k v p y 2 x 0 � � 2 ! •� URA O h � wOt� Q � O Q �o�TM TOWN OF BARNSTABLE Permit No. `10E4 1 . 1 s�n.0 Building Inspector Cash OCCUPANCY PERMIT Bond "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Jon Appleby Address 19 Murphy Road, Hyannis lot #541 20 Shcepmeadow Road, hest Barnstable Wiring Inspector �� �'� {�-�--'� Inspection date Plumbing Inspector �' / ` .l`�_ Inspection date Gas Inspector Inspection date ✓Engineering Department �✓,/�/ li���/� / Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ' _................. _.... ..._, Building Inspector Assessor's office(1st Floor): Assessors map lot number - bn 109—OV0 1 SEA TIc svgTE Mt t '�� — rv,`t3 INSTALLED IN C Conservation ' Bo. PermHealit number floor): OZ WITIi T� 1 7'TA.Dtt E NVIR . o TOWN REGURA Engineering Department floor): ONMEN?A House number � - � � 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 APPLICATION FOR PERMIT TOO/�ST/1!/GT TYPE OF CONSTRUCTION .t9 3 TO THE INSPECTOR OF BUILDINGS: J The undersigned.hereby:applies for a permit according to the following information: Location ._�D cj/��- 1�/1�79a�Ju� �'� //(/ �i¢�2S✓-Si �!_,� Proposed Use ONG-1-E YftYr�/LfJ Zoning District I I" Fire District U� Name of Owner �1001f -Z S/j,&z Address Name of Builder, �11nt7r Address�151 �✓�a� �7yJT Name of Architect _ Address Number of Rooms Foundation Exterior Roofing ."Floors-- _ _ Interior Heating Plumbing Fireplace Approximate Cost ©00 Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardin a abo construction. 1,4 Name Construction Supervisor's License LV KOSMAN•, THOMAS :=361`14 BUILD ADDITION Permit For � Single Family Dwelling Location 20 Sheepmeadow Road W.- Barnstable Owner. Thomas Kosman Type of Construction Frame j Plot Lot Permit Granted August 23 , 19. 93 Date of Inspection '91yl 19 Date Completed -5 19 Ca • fl COMMONWEALTH PDEPARTMENT OF PUBLIC SAFETY _.._. 1010 COMMONWEALTH AVE • ;- OF BOSTON.MASS.02215 1 1 MASSACHUSETTS ENCLOSE CHECK OR MONEY ORDER • LICENSE FOR REQUIRED FEE, EXPIRATIONDATE 09/=:0/1994 CONSTR. SUPERVISOR MADE PAYABLE TO EFFECTIVE DATE LIC-NO. 5 = ' RESTRICTIONSIt "COMMISSIONER OF PUBLIC SAFETY" {` 00 09/3i /1`,,92 046129 � G (DO NOT SEND CASH). -:0 �� •:��" �v "� GARBED ON THE PERSON OF 1 J THE HOLDER WHEN ENGAG• o�T B PRMT ED IN THIS OCCUPATION COAAMISSIONEN y _.. 2OOM•2.61' d29 I I • I . ✓f2� TOGv�/27Y1�O9'uUeGGI� O�ii��GQ�Cx�(:��ZGGQP�.>�4 HOME IMPROVEMENT �1ON1"RAi_TORS REGISTRATION Board of Building Regulations and Standards One Ashburton Place ' — Room 1301 Boston, Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Registration 100740 Expiration 06/23/94 Type - PRIVATE i=ORPORATION HOME IMPROVEMENT CONTRAC 3 Registration 106740 Capizzi Home Improvement , Inc . Type - PRIVATE CORPORAL Thomas 1--api z z i , Sr . Expiration 66/23/94 1645 Newton Rd. . Cot ui t MA 02635 Capizzi Hose Improvement Thomas Capizzi, Sr. 1645 Newton Rd. AOMINIsiRAWR 'Cotui t MA 02635 CO MM O TH OF KkSSACH USETTS : DE'AIUN ENT OF RgDUSTRLALACCIDENTS _ 600 WASHINGTON STREET Cam::ei; BOSTON, MASSACHU�ETTS 02111 WORIMRS' COUTF—NSATION RgSURANCE AFFIDAVIT 10 0iccn=/Pc. ec) ith a principal place of business/residence at: (City/Statemp) he.::v certify, under the pains and penalties of perjury, that: ; I ar.. an employe:providing the following work::s' compen.-ion cove:.ge for my employes working on this Compary Foii.vNumber J I a= a sole proprietor and havc'no one working for me. I 1 an a sole pro orietor, ge cral centractor or hor eowne: (ci::::one; and have hired the eont.:c,ors list:d i:::: nc have the iollowing worke:s' compensation insur.nc:poiice: amc cf Contractor ane:Company/Policy Number amc 04 Contactor In=.ncc Company/Poliry Numbc: :amc of Contacor 1rs•�—ac: Company/Poliry Numbc: 1 arr. a homeowne:pe:forming all the work mys.- NC 1 r.: Please be aware L::wailc homeowce:s who a-pioy peso::to do a:intensne:,coestrucioc or re;:i.wore o= : ei rot more tea:three units is%-aich the horaeowzc:also resides a.o:tun grounds apouruzaat the:cto are cot gczc.i:v )nsicerc:;o be emplovc.s under the Torkcn'Campersatioc Ae:(GL C 119:,se.:. 1(5)), applic:tioo by a horacowcer for a lic:cs: pee ma miv eviieac:the Ieba1 sure of az employer ucce:t e V-'orkc:s'Ge-xasation Act tt'Js St:t:.:.ea wit be forw::Cc: to:..:De�:.�.......:wduS:::a Accid::I3'Offin a o:inSL:Z^.CC t:C t:a::::1L': to Secure :s rccuircd under SC:Jon 2!i. 152=lead to::.e i...pos:::on of .-s:s=-g fine of up ;o S1500.00 inn D rso nrne:.:of c to one vet cri pez; ::es in teen for.—%of a S:o rk Orc:: .... cn of , 19 Lice:::-'Tc:mi:zor , Memo r ari durs TO: Building Commissioner SUBJ: Modification to Prior Approved Plan � Z,-, o 0 0 FROM: Secretary o the OKH Committee DATE: A 'minor modification has been approved by the OKH Committee to a prior approved plan for the applicant(s) named below. 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