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S///� _ /J J�0.ECYCtfpcp UPC 12543 4� No�53LOR p9_.«,5�" HASTINGS, MN YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS NAME in town (which you must do by M.G.L.- it does not give you permission.to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business qe ificate that is required by law. ;x.� .� :.,• Fill in please: Date: 1 161 I APPLICANT'S NAME: yN I-1 /,4 1�t2 YOUR HOME ADDRESS: 10 r ter. A- r BUSINESS TELEPHONE # Sam ?=.6� S 6 HOME TELELPHONE #: S0 RG NAME OF CORPORATION: 1041 o'(L e- leskl h lA('h �004 e ' CSC 5n NAME OF NEW BUSINESS _TYPE OF BUSINESS G-r ,r,k IS THIS A HOME OCCUPATION. ✓ YES NO ADDRESS OF BUSINESS - h e-- MAP/PARCEL NUMBER 161 (Assessing) f( c� (=21 When starting a new business there are several things you must do to be in compliance with the rules and regulations of the Town of Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in town. 1. BUILDING COQ�as NER'S OF CE MUST COMPLY WITH HOME OCCUPATION This individen infQr ed o an per it requirements that pertain to this type of busily S AND REGULATIONS. FAILURE TO 00� SAY RESULT IN FINES. z Signature COMMENT 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature" COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature" COMMENTS: Town of Barnstable Regulatory*Services o Thomas F.Geiler,Director Building Division Mxiasreei.$. v atwss Tom Perry,Building Commissioner �'°rEo .t►��� no Main Street, Hyannis,MA 02601 Office: 508-862-4038 F 508-790-6230 Approved: Fee: - Permit#: HOME OCCUPATION REGISTRATION Date: I 1'09, -- Name:. C\ ` t J`r}41A 1-t A a Phone#: �� ` S'( 11 C_ ) !� t✓ villa e S 7_ �k-a✓Lt�S l f} �� Address: g : �/�) Name of Business: 16L I h I.(AkC ly AA(4 e- � P�1�y) Type of Business: G rti,n n I r e-S I C4 r) Map/Lot: 1 b l - �� .� EVIT.I`T: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space; • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does nbt involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no•storage-or:use of toxic orhazardou$materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met.on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation, other than one van or one pick-mp-traek not-.to.•exceed•one torn<capicity,-and one hailer not to exceed 20 feet in length and-not to _ ... .--. exefs.d 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit . I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant G' Date: ( I I09 Town of Barnstable a F t Regulatory Services F BARNSTABLE c Thomas F.Geiler,Director Building Division 20�9 CEP -5 PM 3: 03 sueivsreet,e. buss g Tom Perry,Building Commissioner 1639. ♦0 6 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Approved: Pee: . Permit#: OG0O HOME OCCUPATION REGISTRATION .Date:. Name C--71A/lSy.0 7�G1i2� Phone# Address: `Name of Business: / 7,169 DE as TE Type of Business: �7 ,)av Map/Lot.- ` L� INTENT: It is the intent of this section to allow the residents of the Town.of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use: No traffic will be generated in excess of.normal residential volumes. • The use does riot involve the production of offensive noise,vibration,smoke,dust or other particular matter,' odors,electrical disturbance,heat,glare,humidity or other objectionable effects, . There is no-storage-oruse of toxic or-hazardous materials,or flammable or explosive materials,in excess of — normal household quantities. • Any need for parking generated by such use shall be met,on the same lot containing the Customary.Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment • .There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pickAip-tauek•notw.exceed•one•torr_capacity,and one trailer not to exceed 20 feet in length and not to _ .. exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation: • . If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling.unit I,the undersigned,have read and agr th ove restrictions form a occupation I am registering. Applicant Date: V� YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates (cost $30.00 for 4 years.) A Business Certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.I.- it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 15t FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. �- � .- Fill in please: Date: x. : LI-II.M.mn APPLICANT'S NAME: -77; 42< �-• f'�,,e -� t z� YOUR HOME ADDRESS: /a ea 4 APA �,�� � 6,Jgr-gI 4915',e,--YS7-4M6 ,.+i1,4 0 24,6'A— BUSINESS TELEPHONE # HOME TELELPHONE#: NAME OF CORPORATION: ' NAME OF NEW BUSINESS T,�n oc✓T TYPE OF BUSINESS; AIAE IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS e) MAP/PARCEL NUMBER Z (Assessing) When starting a new business there are several things you must do to be in compliance with the rules and regulations of the Town of Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to lega y operate your business in town. 1. BUILDING CO TONER'S OFFICE This individ alpeen Kf r of a y permit requirements that pertain to this type of business. M N Authorized Si ure** AN REGULATIONS. FAILURE TO COMMENTS: l-\ C 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: i v v a C7 a s m 1 O x N 07 a a v x 3 3 m I rl a C o c o m 3 3 r 3 I m m z r z 3 m m 1-e c� a � F-1 I •• •• z a v 1--I - m m m 3 - I coN � a - E co - I O� 3 m o m r m a z m c� � 1 1 OD A N a x o r -r cr m oco cn =M (= N N N 1 T� O CJ•1 CT1 [l'1 1• ? 1 CO 0 0 0 O O O O O O 1 I I 1 1 1 1 1 Town of Barnstable oFtME t�,, Regulatory Services o Thomas F.Geiler,Director r + Building Division ~ sARNSTABI.E, � _ v� s `0$ Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 - www.town.barnstable.ma.us f©'�F t u: P� 3 Office: 508-862-4038 08-790-6230 Approved. d Fee: Permit#: f a HOME OCCUPATION REGISTRATION Date: Name: /e. Phone Address: /j�) Village: Name of Business: Type of Business: Map/Lot. Q ZI INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to.the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read a the a s for my home occupation I am registering. Applicant: Date: Homeoc.doc Rev.5/30/03 YOU WISH TO OPEN A BUSINESS? . For Your Information: Business certificates (cost$30:00 for 4 years).' A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1'FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) • �� ` � :� � DATE: ;.. Fill inplease: a= APPLICANT'S YOUR NAME: �>'12GZS BUSINESS, -YOUR HOME ADDRESS: fl1 w,4ys TELEPHONE # Home Telephone Number .5 _ j z • tfc7 3 .........:. .: NAME OF NEW BUSINESS Tlxe L',P� L'oo�T L'. s�r / , ors, TYPE OF BUSINESS IS THIS A HOME OCCUPATION YES NO ....:.......... .... ............. ............. ......_. .... Have. ou been.: iven:a roval.frorn,the b.uildm ;;divisions YES..... NO y 9 PP 9. ADORESS OF BUSINESS s a MAP/PARCEL NUMBS :- O - WE w wA aim . rr 0Aews7,43ZF' 97,9 ozGGj_, � When starting a new business there are severd I things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St..- (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required.to legally operate your business in this town. . 1. BUILDING COM IONER'S OFF I E This individ I b en a any permit requirement that pertain to this type of business. oriz d nature6�4 ** _ OMMENTS: ! 2. BOARD OF HEALTH This individual has be_prj,informed of the mit r uirements that pertain to this type of business. Authorized Sig ure** ' d0PAME TS: cJ S' 4`h�—e• GZ- G �-r-� Cb 0=<eeZZ2 n -2412 GA� o. £.f I s 3. CONSUMER AFFAIRS [LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS:_ 4 V 9 P N .,. J. I Town of Barnstable �F THE Regulatory Services o Thomas F.Geiler,Director Building Division BAMRrnai.e, M^S& $ Tom Perry,Building Commissioner 1639. 10 AlF p Mp,�a 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: °, Permit#: �-f�'9�r7 HOME OCCUPATION REGISTRATION Date: y Name: Phone#: Address: Village: A klz Name of Business: mm--�� Type of Business: - Map[Lot: 110 0a INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings, subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within•that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials, in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity, and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I;the undersigned,have rea an agree the above restrictions for my home occupation I am re iste fig. Applicant: Date / Q Homeoc.doc R TO ALL NEW B INESS OWNERS DATE: Fill in please: YOUR NAME: --,��-�� APPLICANT'S BUSINESS YOUR H ME ADDRESS f 3 •�z2_ � 93 Telephone Number Home ELEPHONE TYPE OF BUSINESS �<°4 NAME OF NEW BUSINESS 10 - IS THIS A HOME OCCUPATION? YES NO Have you been given approval from the building division? YES NO MAP/PARCEL NUMBER ADDRESS OF BUSINESSclula When starting a new business Cher are several things nyloutheSnfo�mation in eyou may need.r to be in lOnce you have obtained the required signatures,o listed Barnstable. This form is intended to assist you in obtaining below,you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall]. You MUST go to the following office to make sure.-You have all the required permits and licenses.. GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMIS ER'S OF E This individual has rmed of permit requirements that pertain to this type of business. ut rized Sig ture** COMMENTS: 2. BOARD H A TH This individual ha an informe of e p r it requ' ment t t pertain to this type of business. u orized Signature* COMMENTS: ' 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This -individual has b n inform of the licensing requirements that pertain to this type of business. Aut orized Sign ture** COMMENTS: Bu siness certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS R NAME from the various departments involved.n (which you must do by M.G.L. -it does not give you permission to operate-you must get that through completion of processes **SIGNIFIES A PPRO VA L FOR A BUSINESS CERTIFICATE ONL Y. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# Health Division G�� ' "� �'#- 3A11-H3TAcBLE Date Issued �'-2�P " O S� Conservation Division t J e ® L,-5 ;�11,^ Fee d S 0N< C SYSTEM Tax Collector 7 0 5� .�A �..„ .. --umnw TO "val OF BED __.__� CV Treasurer � ---- — - flflrfSION " Planning Dept. Checked in By Date Definitive Plan A proved b Planni g((B��oard Approved By Historic-OKH �attbn/Hyannis Project Street Address /® Village Owner ,elf Address 144� Telephone So �- 5 3 Permit Request Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation � Zoning District Flood Plain Groundwater Overlay 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 Cl Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing aL new Half: existing new Number of Bedrooms: existing 2 new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑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 ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number 5 8 36 a-/Kef 7 Address License# OS73gc)- �2ea ��' Home Improvement Contractor# /09751 Worker's Compensation# Wd aOO/W!o /opS ALL CONSTRUCTION DEBRIS RESULTING FR THIS PROJECT WILL BE TAKEN TO SIGNATURE C•or- �/ DATE -71Y15 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ♦ 1 L . ADDRESS I � VILLAGE OWNER DATE OF INSPECTION: in :3 r FOUNDATION gay �j FRAME INSULATION ; ov ^ 'E FIREPLACE ELECTRICAL: %OVGH FINAL >- ��rwrt PLUMBING: ROU%H FINAL, GAS: ROH FINAL tV ' FINAL BUILDING t r DATE CLOSED OUT z ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ',M .•�� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: �' Y, City/State/Zip: �}KcS7 o�.lS ��S �iq OXV/Phone#: t of 36 tle7 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 T. 2<emodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet I ship and have no employees These sub-contractors have 8. ElDemolition i ' comp. insurance.working for me in any capacity. workers 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.El I am a homeowner doing all work rightexemption per MGL 11.❑ Plumbing repairs or additions of mP myself. [No workers' comp. C. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 1.3.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers�comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. /� ? Insurance Company Name: �/t'I f e4�`1��y (=IOSu/t� �/ y,US Policy#or Self-ins.Lic. #: ,J0 O/W!a l S Expiration Date: / y ®S Job Site Address: QdJ€ 1A) _RAJ 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 rtify nd r the p in and penalties of perjury that the information providedaa is t ue and correct:Si afore: Dater S Phone#• �D� '56. 7 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions' Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership, association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair workon.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 certificates)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 fixture 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia °FtMElp Town of Barnstable Regulatory Services Thomas F.Geiler,Director Maas. 0 `0� 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 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adj acent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: D L)e-��,�1 Estimated Cost 2;, R oag Address of Work: yrr�� Owner's Name: /D�'1 4 r�h`/ FL)t e y Date of Application: I hereby certify that: Registration is not required for the following reason(s):, ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALT S OF PERJURY I hereby apply for a permit as the ag f the o er: -7/0-1�/0!5 -7 Date Contractor Nake Registration No. OR Date Owner's Name Q:forms:hameaffidav Town of Barnstable Regulatory Services ' a" VIAn a Thomas F:Geiler,Director 1639. �pIEDMA'��,0� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, m all matters relative to work authorized by this building permit application for. (Address of Job) 6 OS of erZ 15ate 4Pame Q:FORMS:OWNERPERMISSION I ✓die Vr anrn�zanureu,�l�t �✓�/ i�.t6e� BOARD OF BUILDING REGULATIONS License CONSTRUCTION SUPERVISOR �' Nurnbec..CS' 057382 Birthdii M7 V,1960 ",y' Expi[es, 07/27/2005 Tr.no: 2453 i Restrictedi,;00} JOHN D BOURQUE 80`6 ROCKER RD «�, W.BARNSTABLE, MA '02.668 Administrator' r— �/e �iooxn�zo.uueall�i. a�,/l�aaaae/auaetCa —_ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR _ Registration: 109751 Expiration:..9/24/2006 Type.: Partnership BOURQUE&COLE;CUSTOM.HOMES&REM. JOHN BOURQUE 80 CROCKER RD. GG�� WEST BARNSTABLE, MA 02668 Administrator Application:to. BOY'PN'+PP`Mt,•`a5'1`EP�G� .. ..�'j'.:.^�.,. .!' ' o ar' Old King's Highway Reiiional•Hist01'1C District Committee in the Town of Barnstable for a CERTIFICATION.OF EXEMPTION Application is hereby made, in triplicate,for the issuance of a certificate of exemption under Section 6 and 7 of Chapter 470, Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on plans, drawings,or photo- graphs accompanying this application.' i TYPE OR PRINT LEGIBLY DATE 7 -2 5 ADDRESS OF PROPOSED WORK 244S2b4 ASSESSORS MAP NO. /d OWNER /hBMAS >� ( �U�y �J�E ASSESSORS LOT NO. HOME ADDRESS �� � TEL. NO. �� ��� -V.,!5r4C AGENT OR CONTRACTOR ADDRESS �•T� �BX �DDS �4ST0/1/� HAS TEL. NO. K•�6v70Z This application is for exemption of proposed exterior construction on the ground that: ❑ . (1) It will not be visible from any way or public place. ❑ (2) It is within a category declared entitled to exemption by Old King's Highway Regional Historic District Commission. (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work, showing location on lot, and, if an addition Is involved, show, ing location of existing building. Wf Zc,r-e- SIGNED Ow •Contr for-Agent Space below line for Committee use. Received by H.D.C. The Certificate is hereby Date Time By Date Approved ❑ The categories of work entitled to exemption are listed on Disapproved ❑ the back of this form. Assessor's map and lot umb r THE Sewbge Permit number ..../.. 1........:................... ......� - Z BAUSTADLE, i House number ......... ......... -!?......................................... 9 roes 039. TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ' \�G�!"' ' He "� �-....hda................................................................ TYPE OF CONSTRUCTION ......... (i111 ►:'�................................................................................................................ ..............!.�.?. ....19 TO THE INSPECTOR OF BUILDINGS: The undersigned/ hereby applies nfor-a 1permit 1according lt�o/the Lfollowing informations:Q Location ........�.v.......� ...... .��X�`'..1 !/!!! `?`- .:......::". 7...... G�{J`C1C-r............................................. ProposedUse .............��7.� ., /1✓� .................................................................................... (n�Q� f q1vv) ZoningDistrict ..........................................................:.............Fire District .................................:............................................ Name fof Owner. !�.... ...... ��...4�.!..............Address I.U....I?,]............ ..I..�!...��..�.rVl. ..L.... Name of Builder !\�..... ... .! ........................Address .�.!%..rQ�/!!1' .�< L .�. , M.!1.......... Name of Architect .........Address I.......................................................Foundation ..t, . Number of Rooms C ................................................... ........... Exterior ...... .. ,A.. I....S.Ut�I�^P�� Roofing ........ ........d.�.� �!`....................................... c �P.... ...... ..JV. .............Interior .......�..�1.C12� Floors Y .....................:....................:.. :................................................................ Heating ..Plumbing ... ....Y!�9.�!.!�-.. `��...............................Approximate. Cost .........1............v.! FifepFare ................................. Definitive Plan Approved by Planning Board_________ -------------------1 9 Area ` ........... Diagram of Lot and Building with Dimensions Fee ?S SUBJECT TO APPROVAL OF BOARD OF HEALTH ---- - - � Z 0 a� ��s • -_ OCCUPANCY PERMITS REQUIRED FOR NEW.DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable'regarding the above - construction. . Name .11 ... .. � ..1............................. Construction Supervisor's License .................................... s -HEH3ERT, ROGER & LINDA ,,/A=110-021--000 No .... Permit for ....Du?-.],d..BaM.......... ............41=eSSC)JW..tci..Dwe11g...................... Location ....10-Wayside.-T-ane........................... ...................weat.Ba�alS-tahl,e............................ Owner ...Roger.. 1.1nda. Herbext. ................ . Type of Construction ........Frc-11M....................... ....................................................................... Plot ............. .............. Lot ................................ Permit Granted ....June....18 r ..........19 84 -Date of Inspection ....................................19 Date Completed ......................................19 Assessors map and lot number_...�` ., n O Sewage Permit number .........7.......� �........................... / Z EAR39TADLE, House number ...... .. !.- ............................................... r MA66 �p t639- 9� E YI1Y TOWN OF BARNSTABLE BUILDING INSPECTOR y /� r APPLICATION FOR PERMIT TO � Ur �� / ��� z(v DW�..r�._(' .............................. TYPE OF CONSTRUCTION � �� t�- ....:............................................................................................................................... ................................................ 1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the, following information: ,r) i/V4 �Si �E L_A/�1 E Location -...........................::.............................:................ .... ... ............ / .......... Proposed Use ....C.................................. .........- .,fa r,r Arm i r......!........ cLcPr�./1....y......................................................................................... .... ...... Zor,�ng District .... ......................L ... ........................................... District .................................... ....................................... Name of Owner .. .....,:.r......-....r...;..... ..........Address ............................. .. Name of Builder .'?.aCh.$!...c!.........F.r....}..IIC ...............Address .................................................................................. Name of Architect k'6 R:�J '� C ............... C1 t �k k' Address �V p `W `�O 7 � Rlr-CL ��,��R k,44i-- Number of Rooms Foundation Cu Exierior } e;o b. C R f~.......i� �[� .45 D t 1L` ....�.. Roofing ......... ..........-.-....................................................... q4eR Floorst�!�(:......... F-...:... ..CP:...................................................Interior .................�.............................................:................. 1 � Heating �..f..� ..........Plumbing �� V r C i ........�............... ............................................................... r 5-0-0 � Fireplace J...0 4► ►� t! I'V3 C�C1...1;..........Approximate Cost ...... ��„5.�...................................... Definitive Plan Approved by Planning Board -----------____---------------19________. Area a O O O .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH • r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name.... ............................ Hebert; Roger &,,D inda 20631 a t story No ................. Permit for .................. single family dwelling ............................................................................... 10 Wayside Lane Location ................................................................ ' Webt Barnstable ............................................................................... Roger & Linda Hebert Owner ................................. ................................ frame Type of Construction /... ................................. .................................. <......................................... Plot #98 ......................�. . Lot ...... ...................... Permit Granted ... ... ....19 78 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED .......... ......... . ...................... 19 .. ...... .... ........... . /pproved ..... .... ............................. . ..... ... ... 19 ..........................I........... .. !. ........ ........ ............. ...... Assessor's map, and lot u�,�r .......... ............. . . ... D/! . ��' �y . .. . . .... � Q�o�THE Tory Sev�/6ge Permit number ...... ` " r . o •JJ Z. BAHBSTABLE, i House number ... I ........ 1�................................. a 9 YAS 0 Op t639. 0 �Fo YAK a�0 TOWN OF BARNSTABLE BUILDING .IN.SPECTOR Ine APPLICATION FOR PERMIT TO ..."....1\D ...' .. ..�. .... .. �.1.. ................................................... TYPEOF CONSTRUCTION ........ -. .:..............................:...........:............................................................ ..............!..1,1.. TO THE INSPECTOR OF BUILDINGS: The undersigned herebytt applies fora permit �according to1 the following information: Location ........`..V.n......�N.. . ... .� ...�� �y,,•`'�-'.........:` . .... .� � ........... ProposedUse ............ ..................................................................................................................................... Fire District W 04-t 3aA/MZoning District ................................................... .......................... .................................. Name of Owner (1 .. ... .1-. ... lr `.......:......Address ...l!1/.��'W� Name of Builder ..Address Name of Architect ................i— ...Address ............................................... ...................................................:................................ Numberof Rooms .........).......................................................Foundation .. ...... .................................................. Exierior ......C,&bA.... .�1A/y`P ...............................,.......Roofing ........a4f.W. . .......................................... Floors ..........................................................Interior'. ......PAJ Heating ............ ...................................Plumbing ................................................................:................ y Efel ceL�,%vA................................. "..............................Approximate. Cost .........0.0 � (L...... .......................... Definitive Plan Approved by Planning Board ------------------------------ ---. Area .....:. ................ Diagram of Lot and Building with Dimensions Fee ?S SUBJECT TO APPROVAL OF BOARD OF HEALTH V I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. .......................... I Construction Supervisor's License ..................................... HEBERT, ROGER & LINDA No ...4 2 ... Permit for ...BUILD BARN.......... Accessory to DwelliaV..................... .................................................... Location .!Q..WaY§ide..Lane.............................. West Barnstable ............................................................................... Owner .......TodeK & Linda Hexbert .......................................... Type of Construction ......F...r.......arre .......................... ............................................................................... Plot ............................ Lot ................................. Permit Granted Jude...1.8.......................19 84 .. . .... . . . Date of Inspection ....................................19 Date Completed ................... .. .............19 TOWN OF BARNSTABLE Permit No. _20631 1 sin Building Inspector Cash mum - �'° OCCUPANCY PERMIT Bond _ R _ 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 Roger & Linda Hebert Address Box 62 Osterville lot #98 10 Wayside Lane, West Barnstable Wiring Inspector //� Inspection date Plumbing Inspec r Inspection date Gras Inspector l 1 Inspection date VIngineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. • .........r... Ella s ild g Inpector Y Speed Letter, TOWN OF BARNSTABLE To Mr. Francis Lahteine From MASSACHUSETTS Town Clerk Subject _ -No.9S10F0LD MESSAGE Work has been completed under Permit #20631 (Rot3er & Linda Hebert) . Please release Bond Date 3 26 82 Signed REPLY -No.S FOLO -No.10 FOLD Date Signed Wilson Jones Company GRAYLINE FORM"-OW 3-PAST RECIPIENT—RETAIN WHITE COPY, RETURN PINK COPY 01976•PRWED IN U.SA ,SpeeC 'Letter®, �wN 61F ARC ABA. ` Mr. `Francis Lahte ne f,'ASSA.CAU aE From To r~ /' L Town Clerk j• ' • Subject —No.9&10 FOLD 1- MESSAGE lldrk has been.completed,under Permit #20631 (Roijer . & Linda Hebert) . K Please release Bond.. y Date 3/26/82 Signed " t ;fit � J. It(( REPLY N0.9FOL.D f , —No.10 FOLD ' ` Date Signed . Wilson Jones Company 7f' RECIPIENT—RETAIN WHITE COPY, RETURN PINK COPY., GFAvuN_C)1978. FORM NU. 3-PA" '' TURN OVER FOR USE WITH WINDOW ENVELOPE. p 1 WS•PRIMED W V.S� ' r FILL IN NAME AND ADDRESS HERE FOR RETURN IN WINDOW ENVELOPE —FOLD —FOLD I • �e i I I 1 3 TOWN OF_ BARNSTABLE 20b31 Permit No. .�: Yaas�Pn Building Inspector Cash OCCUPANCY PERMIT Bond _ Y 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 Roger'& Linda Hebert,' Address Box E2 Os terville lot #98 10 Wayside Lane, West Barnstaule Wiring Inspector �'— ' Inspection date Plumbing hrspector"(—�G,,;�"-,' � ���4 Inspection date 'l Gras Inspector t,l�) nn + Inspection date 7 n 7G) yEngineering Department �.�/l,Cl�� Inspection date THIS PERMIT WILL NOT BE VALID,vAND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. .... ..»�_ln 19 5T'2 /�� /n�a% f Ad/..., / Building Inspector f Assessor's map and lot number .. ....l..t/................:...... ' d , " �pf Tp� THE 7� r ..._ Sewage Permit number ._..... ......" .......................... 25EW- C V-sTu MUST B/.. / t �NSTALLED�IN COMPI_IAN BASH9TSDLE, House number ...... ../. ...................... IWITH AryTiCLE II s$TAT.E: ro rya `SANITARY tODE AND 'TOW, .°'�o 39- TOWN - OF BA:RNST TR X BUILDING" INSPECTOR APPLICATION FOR PERMIT TO ..CO.- 'S.. � 2 l c..... . . ..... .�ty....... ► l1.. '.. S1`,t R LLE TYPEOF CONSTRUCTION ........:III. ...............(................................................................................................... LL .7.................19. ITO THE INSPECTOR OF BUILDINGS: 7'.==6utR-The u dersigned hereby applies for a permit according to the following information: 9 35 W �r n /� fLocation ...� ......U!'.1 . . �.� . .... .0 9.�V a &P. !. .........*4. ....... ProposedUse � .� ........ .(. . /.........,NP.,e1.f?�'..: ...............................................................................::..... L ( W- B Zoning District R.�.�i����............................................Fire District .....�.........*A..A:� ogk.P ......................... Name of Owner� ..... !. Zje7 .........Address .®::F�N�..(p ....L1 !11.4............... r t . Name of Builder i l 7�....t�CIMIp,�I ..('..............Address .................................................................................... Name of Architect ..: ..�? .!�. ....................Address ..... !!. ���tJ......1YA .;>,.0..................................... Number of Rooms ..... ..........................................................Foundation .. .©u d-...... � .................. Exterior ...... .........................Roofing .......As .ph 4 .................................................. Floors !!bok.:t�J te ..................................................Interior ...sk.ez ....�®.�.......................................... Heating _ Plumbing r ! i _ �t . ................................................................ ...............� C....... .............................................. Fireplace ...........1.... .....51 ,.........Approximate Cost .. ...................................... 4 Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area o2.a-0.0 .. .................. Diagram.of. Lot and Building with Dimensions Fee .. A0 SUBJECT TO APPROVAL OF BOARD OF HEALTH 39Xaq dqq ' 536 9� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. .... ............ ~ Hebert, Boger & Linda ' U0 ' ' 20631 two etnrvkmw° -----'' Permit for — ---- —' single family dwelling � ----.--------------..�------ lO Wayside Lane ^' ' Location ------------__-------. _ _ West Barnstable ----.---------------------- . � � Boger & Linda Hebert Owner ......................... ' _ �r��a Type of Construction ----- ---- ----- . : . ' -----^--------------------'' ^ ---------. Lot Plot ___ - Permit Granted —. -.—' g 78 Date of Inspection '�A ^7Q ... u,----lA � . �~~ V ` � ~ � � . . PERMIT REFUSED � l�r -----`-------------_' —. .............. ' —'p�- 4 ----' / . --.. —. ......................... .--_— --.. �� -----. Approved ................................................ 19 . _ -------------.----_...---..—. . ---------------------.—.—.'..^ . . e� (�X M1� N o ti Ii00004 1191 O �cj � „Z V Wtillay ) � o ff CA o oo ' 3 A 1 M 'a 2FFq S113s� 3. fi w fA o a , - ' fit'.'. 'O G .. � .:S. v► -� '` � � .. r - .°-"�` y r 0 S say 04 n (n c J • ;+ - - r ��.-�„ �: � .� � � ,� � fill tk + N 47 Al /l d l V r •�_ "''�^,. ._ (M1/ "iY".V"vr --+"" � . tom-•,"--• yier�i'.+'."'-.. : ,,,.ti l 1 ri o6 v� ' JQ 01 ]] ul, f7 ` 1.3 . R it qa CL L� � � '� "rf @ + � ���_• � ;•� ,. :,`1 � it �� 1� .J AJ •t �1: ;T' '"U. f��`r'.�= N t dl 161 rr A • i p _ E. - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION _g. Map v _Parcel e9z Permit# D D 1 Health Division 5laml Date Issued &Conservation Division 14 " 8e MID /00 F,40" yoa7%0 D Application Fee Tax Collector Permit Fee j�- Treasurer SEPTIC SYSTEM MUST GE Planning Dept. IILSTALL.ED IN COMPLIANCE WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE ANC Historic-OKH Preservation/Hyannis TC)WN REGULA1IONS Project Street Address 10 WA-Y s I i�,e LAN e Village &r2,N S-rfrt3L( MA_ 0 a-loG� Owner-1- 4a MNs T- FL.,, Address _S A-14 t Telephone Og s 6 -A --4 S b 3 0N9'-rrZ_uCr1 O N O Permit Request MA-►, -b t�c�< a V � S I �� C tJ ��. N CRA,N L+-1E W 1 of -b6 u c tLO CS __P>00 r_'Z- oN S I b� F ©r f'� YI 1 Ly Square feet: 1st floor: existing proposed N A 2nd floor: existing V64 proposed _ K}A- Total new _ Zoning District Flood Plain Q O Groundwater Overlay Project Valuation (- M Construction Type Lot Size Slo , (9 2 SF Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family a Two Family ❑ Multi-Family(#units) Age of Existing Structure 0? r?-s Historic House: ❑Yes O'k On Old King's Highway: O'�es ❑No Basement Type: O Full ❑Crawl ❑Walkout ldther PA-tz-VI A-L— Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) (3 59 Number of Baths: Full: existing new Half: existing A!�)_ new Number of Bedrooms: existing 3 new AO' Total Room Count(not including baths): existing f{ new First Floor Room Count Heat Type and Fuel: a as ❑Oil 0 Electric ❑Other Central Air: O Yes ®TIo Fireplaces: Existing �_ New Existing wood/coal stove: �s ❑No Detached garage:Dexisting ❑new size_ Pool:O existing ❑new size_Barn:5existing ❑new sizeawsp Attached garage:❑existing ❑new size �in' Shed:❑existing ❑new size la'Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded O Commercial ❑Yes .-&<o If yes,site plan review# Current Use J Jom Proposed Use f+6,M t' BUILDER INFORMATION Name M NST►2 c•tC 1 ON Telephone Number qf"( +� Address ` O Yt Ny 1 N rrS I NE :R nAT--) License# es 7 S Home Improvement Contractor# Worker's Compensation# 70 106 0 ) ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO N S^T E -_ A S-F f t I 0 SIGNATU DATE S 1 4-6 a3 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL:NO. ADDRESS" VILLAGE OWNER u , DATE OF INSPECTION: .S FOUNDATION ` f. FRAME INSULATION e FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH I FINAL GAS: ROUGH S 1� t-j FINAL FINAL,BUILDING - ci DATE CLOSED OUT ;a cap 0 " & ' a �. ASSOCIATION PLAN NO '` The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 5 f .�� I b JOB LOCATION: n ( .9-) r t>e L,A-N C— -7+9 LG number street village �a I it l ' t� s `HOMEOWNER": II ( t2 L.�/ 3 f name home hone# S�5rk p ones# CURRENT MA=G ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more.than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner I 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. i i �0f1HE� � Town of Barnstable NAP Regulatory Services eaarrsMU, ' Thomas F.Geiler,Director aUss. 9`bplEo 9,yA � Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. 45� f'✓l � E C-I� Type.of Work: {�E P t C C W ( � `Dp W k `I»� Estimated Cost �� Address of Work: W ' ` I S C�J , (�f�`� (�1STj� t3 L- U� a-4,6 Owner's Name: f-f G Ms <j- Date of Application: S I 3 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 OBuilding not owner-occupied Ddwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date• Contractor Name Registration No. OR 5� ac� 63 Date Owner's Name . f _ The Commonwealth of Massachusetts Department of Industrial Accidents Office 0//nresti9ations 600 Washington Street Boston,Mass. 02111 Workers' Compensation.Insurance Affidavit location: � S � L' city �� t�� t2�\S't /+ L( /1/1R 0��� phone# q [] I am a homeowner performing all work myself. [] I am a sole proprietor and have no one working in any capacity [] I am an employer providing workers' compensation for my employees working on this job _ gam+ WNr21 vs 4 r- ',� ,�yt' '"f.:,Y r`" '' M> _,�P v r ice`'•'t'"s'ri'xt�' k •as "+ -it,4 Xr.. : xt'�tixc �'�4} ;I}`.�.k'�,. t5+ a'�f� � y'�`o ws'rr-�r7 _ r '.',t;.,a,§�C�i.a S.f{ �Ldr. s. x rfi v •'' y1_iyK i o'm an �raa:me�-4.,.±� ���.st��>'{t�,t..�.r .�.-�1 z_:� l., sZ._ r t- a �t �r a hjs �t'k •'�r•�r. r fit•... 'i ; :nv::a.1 qa y ,.-.y ya!•,r- r;X...,,.... 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J+,�'' � '�F� �.n*,2,5�".'i b s.` -��. +•-- •f'�;;' r Xy-s •ice,{ .S -. x E -r 3 sY` r 1as'h^'+itu°Txjts$ �'urr`ch-ri y'.''�' o'Gv�' 4�k' ..a`s r w 'Sv 1{. •,'tea• p...g�T iM E?47�- tr_ F^� i'tt-'r ='+a -a�- ^s..kfl �.,�,.izc •tt'.,c, i a e 'tir+,s.'t hrtptf r sr "�. . a.. . sj 6 �hr x x S v r A R. — i.. _.n _. .._.....'�.�.. �0�1- ;•`{.`.`,.r%.t,*,Jk.?s9..5.w>:3`-Awe,...•_:.-.a ._ ...:...e�'.t .. .:rL�'�; I am a sole proprietor,general contractor or homeowner(c- cle one) and have hired the contractors listed below who have the following workers' compensation polices: _ gy yx pry. , .• 'ari;' +s ,.n.y._,.'t"iv,.�na.�.3yh;i 7�V; '�t r 4�� r r � g�,�, r Y r " r w s � '+'C'...x i..l wr t •i F dad. y��o°{s [ i i v f'i'xa•s !-. m E t � -i Lf'��•-G't�. her� £�'` y E,,7. i c a x, rr'{. Fyr d 1 y,• '.'T 6 F•..,r-�YPt � •� c011ip'a �aame a s . 4 {-.�yy�`, t,rn. �h .,yi X v-.F���: 't� ���•L�'�P�'•,. �`'�tv��,�','�r � s'Yi. 'fi .+.,� ir��US�i£t s,�.� sa nl.+�,'�,L.,A `i'��e a.'3x?gM "" s4ic 7$dtlrEsN f.'r T. 1sa. u. ti�vitF3-� }is`'t•- J � � � ¢ U1 e+.i �'i� � n-U CI a 1§tt k ..>u�i'•: JAL .n r } r ✓w.i+i.'2t Yfz d"�t�s''�ti' �" ra;t r�kF7f��,�*�i�.�yka}'k{.4''!` ."�'.:�yY"�`„'"�S+t..0.�r.V '��"�.k�3-;;s x{r'rSj;ta`S• l.sU��.��hu�,a3,°7i�r'y�6aF{:7+r St4 M��,�i� e�3+�•,,b {Wt ca• �7r„.;K'1� Y� . .� � 1 '�_.rt�.`'�'`'; -t t -•— aL ti a at �;titi`a' S r�'9 '� kl.�, x�t`iF��y - a ' �Z.r :a'z�'�r��a��"'rh;�a J�'yFtkf'•'''t sK`��w_� y wi>�°�.j�,Y�.- "`� .��IC iF `�` 1, ����.. u c <-�,.,: � �"t�±; lour•'ance_eti �- b ._ .:..;.,` '_u ct• ¢; it.,. I t r,i5� yr s,t+"':`,.ml`Yry�' �.,�• r x v F,,ti c h ry'ry,t il�i•'�i}"t "°�'atn".i ,Eya.;:.;}kv,� '� -.pst 'S��`ZL;,9 R;j V.ifp.X.'/�'�i'`y X�� �v..,Eys�a{-� tv�'sr "'� �4'� 1 5. -',. 7v- Y r y tik t '{ - •t, t�•a 1 (?r ���s�' ++•&' b � i' �,.5.. _. 4uy�+x°'��G'�s�,j �,t{.'�SLLak"Si.a� �,yaxli i�r�`,s,i Jr^r",'a "• . Lxi, i" 'y�� rf t"i�'s..���t u•6ii S t•�9f �f l J'�ry-A ,,f�".b"".��,oaf'°t §:i. .ice: , Fcom.LIaLn r� x3 q„ 4_.,. MR. .."AS2'.-�k •-� i ss kT'".tr•. + S�j *r+3c }{r iL re 4 h k°'S1 ti' ',Gi •e: 't ?r'• r S �`i'4ttr ,dkx1: s a�+`t-h..F.tti `r 4"+, .n M'r � saii 5 M+'y, e,�,• a-'" ,s Sp'lRt' .,: k Y�.t.S:.:sL _p, q', �i,C� ,'�'* 20152 vMq'••„r ,P;' ,,n. P�r� it,.- ii, .rs�.•'l�,.r�1= ir.ri44-• 7 t�,1' k„G-„�'4•a.5 sa. �w ° `'.+"ti �C`� _�.' ' 9��. � �,i�9Wf�i'�cF'•r >.�t*.t ,�^fir%"P"s s'. . $ddf�S9 _' f ly # 1Y •k rr- 'ty4 C!• p �..y r;:j tir +y'•'e.¢' ?' ;y'+'G+ 74�,r n1 �4�.+�{"�'7}'+,�, a'y?`ik t �ytas�N' i rg k•5i,}?>', *gt2'ir� �.V,,t ... mf+.'a j.,r"t1-{'ygYk' .a�. 5 sad=t ^,, Y 1�yrRrx4 f i=�^ ! i;iik ,ar,tft3 t re�jt"• i SUN' rY.��u3 ali'ti5 'MV c'.iy.. v F" •FYt".t"r+s. �.CI.'.:-•.u'+Ly� .•yo}•vr gay Yip b"�s _ A'Y..iS•_1 1. x r..:E�,.';a z +.T Fx+,,`�: a" d-^t sxMa. J f d Y• r snv iv �-z'-'''». r tom.. a 's 1r i�rvit'3r'iT'�'aE'j i tur✓,fi i ;aSl; r i f.4. Y'�.•yF!',,�M„`ys«5j..-•ry �]�'3`t F '�G:�`.. a 'ET w9-. +-�`c+s f -M1hi 1•.ri. i'S"t-�ye:k`1'3: .+is :rid i (s i.� iri f A+a��it.i ti.ti' i yy'f...f'r� " V..tz.fi.t Y r5 •1:?'" �.'7�,:a ea,1,, R,�-r ts.� 9m• .asr .,, 3'k'...53 s.tti:L 7�� iTt(x..'� Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal pena]ties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification. I do hereby certify under thepains andpenalties ofperjury that the information provided above is true nd correct Signature Date c3 O - �� Phone# Lsos ��'� 4S LS Print name all oRcial use only do not write in this area to be completed by city or town official city or town: permitflicense# F—Building Department ❑Licensing Board []check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; r 10ther (revised 9/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the-"law", 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 of 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 r 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 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out.in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill'in the permit/license number which will be used as'a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. _ . . The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 MAR-06-2003 13:56 HSBC BANK USA P.02 V a X 'Cis 'r 'gin i s-0 Ct cat i s j 4.0 K = � 53 -- RESIDENTIAL: SHEDS - POOLS -DECKS-OPEN PORCHES- GAZEBOS FEE VALUE WORKSHEET ACCESSORY STRUCTURES >120 sq.ft.(Sheds,gazebos,etc:) >120 sf-500 sf $35.00 $ >500 sf-750 sf 50.00 $ >750 sf- 1000 sf 75.00 $ >1000 sf- 1500 sf 100.00 $ >1500 sf—USE NEW BUILDING PERMIT APPLICATION DECKS x$30.00 (Number) PORCHES x$30.00= $ (Number) IN GROUND SWIMMING POOL $60.00 $ ABOVE GROUND SWIMMING POOL $25.00 $ RELOCATION/MOVING $150.00 $ (Plus above fee if applicable) PERMIT FEE $ Q:forms:dkcost eff:082301 i Home Depot Store 2680 39 LONG POND ROAD r PLYMOUTH.MA 02380 DATE: 3 ON 02 CUSTOMER: FUREY,CYNDIE SALES ASSOCIATE:. 10 WAYSIDE LANE P.O.0. WESTBARNSTABLE.K442688 (50 "W45M Thank you for shopping The Home Depot! We value your business! ITEM TOTAL FRAME SIZE LOCATION PCEDSCRI�PnOONN UAl1T PRICE CITY PRICE Windows and 1 Pallo Doors RO S¢e=&0"W x 6 8"H Unit Size= 400 �,FMfH Double de Units S 1 T 1!4"W x 6'7 1!2°H Unit Code tern Sww FWH6W8 P smtr: tnr eauab r Part 260118 LR Extern Color: Terratone Interior Color: Clew Pine CASs Tiypee High Performance Tempered Glass Interior GaiUe:Grlle,inbuW.Removable.CdonW,Tfir, 0Q���le-��-Nab W In�Or/Prefmished Exterior,Roffon Gri9e Cottsfina�lon:Removable Irn*Aor Grille Insect Screens-Gliding Insect Screen.Terratone Double Screen Track: 5114•.Terratone -. Hardware Color:Estate Style-Brut Brass Threshold: Oak Sit Support Yes FWH6068,Unit Terrakww/Claw Pine.PALR HWWing,High $ 1.275.60 PedOrmance Tempered Glass 286511E FWH3168.Gr91e,Intarlor,Removable.Colonial,3W5H, S 102.60 77/e Maple-.Term— gal InW aNPi &ushed Exterior.Roman FWH6068,Gliding Insect Screen,Terratone 26 $ 160.80 FWH6068,Track,Double Screen,5 IW,Terratone $ 102.24 28S7904 Hardware Pack.AdIve/Passive,E Style-Bright Brass $ 262.20 2577544 FWH60,Threshold.S IV.Oak,1207030 5 15.78 PD80,Support Sill,Aluminum(Neutral Gray)1997057 $ 11.52 $ 1,930.74 $ 1,930.74 i 1 i I ITEM PRODUCT CODE TOTAL. FRAME SIZE LOCATION DE8CR9rTiON UNIT PRICE CITY PRICE f_.. Wiridaft artd ! Pa6o DWM RO Size=Z 7'W x V 8'H Unit Size 400 Series.FW14 Single Lkft j 2'6118'W x 6'71/2'H Unit Ca&%n Size: FWH2765 pan www.. s trees eq�rs r' Exterior Color Tenatone Interior Color: Gear Pare lass Type: Hip Perkwmance Tempered Glass Interior Ce:Grille.Interior,RemmmWe,Colonial.7/8', I f Maple-Natural InteriorlPreflnlstted Exterior,Roman Ogee,Terratone I Gri a Construction:Removable Interior Gn11e Threshold;.Oak Si!Support Yes i I ! ! ! FWH2768.Unit,TenatonalClear Pine,S Handd g.Hig1► S 533.40 Perliormance Tempered Glass 2665006 ! FWH2768,Grille.Interior,Removable.Colonial,3W5H, S 51.30 7/8,Maple-Natural Interiar/Preflnlshed Exterior,Roman Ogee.Terratone 2666102 i FliZ7,tiveshcid,2'7•,Oak,1207010. s 8.46 1Ai PD30,Suupport,Sig.Aluminum(Neutral Gray)199M5 a 6.66 s 559.82 $ 5W.82 QUOTE : PRETAX TOTAL $ 2,530.56 Estimated Lead Time 5d . Se e 33e 3 i ITEM PRODUCT CODE FRAME SIZE i LOCATION QEBCWPTtON ILIM PRICE QTY TfiRI E CornPa-..': tMlllwork 1. +y RO Size=105 314"W x 82"H Unit Size=1051/4"W x 81 1/2�H Product Category. Entry Doors !Manufacturer Cade. SM Manubdurer. Southern Millwork Company sue: rAr equal r Product Type: Pfe+kM Doors Pnxdud Lure: Fiberglass Product Style: Traditional Fiberglass Product Unfinished Wood Grain Product Caffouation: Double Door Unit w/Two SideUtes Unit Swing: Inswing Door Style: FG-21 Sidelite She, 105SL Sldelife Width: 14" Nominal Width: 38" Nominal HeWt Frame W 105/1 4' Frarru3 Height 81 1/Y Rough Operft Width: 105 31,r Rough Height Or � 48/16 j Extensl n.lamb FirtL L tkdentstred 0*Gran LSL The Active Door. RW Acliv a Door Sores Dame Bore Passing=Bores No Bore lack Prep Bacluset 2 3W D+e�adbo8 Prep Diameter 2118" Sid Type Alurni nen MM F7'wish AdAstable%W Oak Cap J Hirtsr, mrsh: Brass Matching BrkarwukL- Ypeasra�Bridcmould Shipped Separate: Yes FRENCH DR /SIO SU1THRN MLA-PATIO 6 Harift Set Not Inclined The sidefites must be field mulled and will be shipped unattadnai. Bores are measured from the top of the slab to the center of the hare. i i Traditional Fiberglass M21 Unfinished Wood Grain door $ 1,455.00 with 4 911 Uanished Oak Grain LSL jamb and Two S 1,455.00 S 1,455.00 QUOTE M PRETAX TOTAL $ 1,455.00 Estimated Lead Time Y'..'s�4.'roa7d7:.e�;Sir-:i8'.t-.ti-!.;+,,•,4.....,•�y� w. _ _ ... _.�=..;,,--..:y.�e..:•.av-.f.i--:.ro;.-., -..-v• _. •-- ^., .-,. .- •-.-+.-...... .. i °ZIKErt° The Town of Barnstable BARNSTABLE. = Department of Health Safety and Environmental Services Y MASS. 0 1639. �0 MFya Building Division 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: kOM15 r'UhCc� Ti--- Map/Parcel: C�a Project Address: �Q wc,�A:5,'de- Lcne. Builder: K rv) 65n5irycfion The following items were noted on reviewing: 4, frost.. '��i�ec kcJ �c�v'1ck Kano{ tf-- 6ecr, _ 5vNc. +vbe-5 611M C,cc'-�! b►-fl (w ere nccce---41 (� aX7 loot \oast% io ecK have c, rr-4A1'rrnarn A Reviewed by: Date: V q:buildinglorms:review -06-2803 13:55 FfSBC BANG USA P.el Application to QRvx Ring,# Ap fil nar Megional Wsuvic Aaiadtt COW? f�eeBARhSTA6 In the Town of Barnstable N 3 MAR -6 PM 3: CERTIFICATE OF APPROPRIATENESS Application is hereby made,with four conp►ebe sets,for the issuance of a Cerfficats of Appropei teri; edion 5 of Chapter 470, Acts and ResoMee of Mossaachusa ts, 1273, for proposed work as described.am iss, drawings,or photographs acoompanying this application for: -� CHiECK CATEGORUES THAT APPLY1 1. Exterior building eonstnrclfon: ❑ New Addition ration indicate type of buuiirding: ❑ House ❑ Garage fl Commerdal other __ c3 2. ExLErfor ftarmg: ❑ — G;) 3. Signs or Billboards.'' ❑ New Sign ❑ Existing Sign 0 Re ndng Existing Sign w � 4. StructUrm ❑ Fenae Q wag ClFlagpole TO Other TWE OR PRINT L AGIISLYa DATE %�i�Y1�►� 6_ ..?.DOS ADDRESS OF PROPOSED WORK /d"A—r9/A74 44 4✓ ASS ESBOR'S MAP NO. OWNEm ASSESSOR'S LOT No. HOME ADDRESS d ln/ftf-/DE ddle A/ R9rw r- y TELEPHONE NO. .Me-U;j PULL NAMES AND AOORESSES OF ABUTTING OWNEM, Including those of ad;aoent property owners across any Public street or way. (Attach additional sheet If necessary.) r d Q 9. AGENT OR CONTRACTOR .J�I�Cpwr TFS,EPHONE NO. ADDRESS t ia✓P /A � DESCRIPTION OF PROPOSED WORK Give particubirs of work to be done, inctuftq materials to be used_ Please include locations of/proposed signs. dry �I /�'W �� `�� 4/S�'aJf��/� � �Gt�urrA L�IA/�Da✓s f f•�eSOI ('<1� 4��7�� Signed For Cormmltfto Use Only This Cerdficsts is herK p ' pprawe ed m{tt+ee Members Signatures: MAR-06-2003 13:56 HSBC BANK USA P.03 Plot Plan 4f Land in WEST MWTAM. HA. Prepared For MAYT FEDEPAL CREDIT 111I0H CHICUD T17LE INWAUcE GWAMY. INC. September 11. 1995-Scale;-I- - so' Thompson Surveying A Engineering, Inc. 525 Mill Street Marion. MA. q L( 4« OwG• yrr.i. v r, lts- Z� I certify to Navy Federal Credit: Union. Chicago Title Insurance Co"Apy. Inc. and Paull a Seguin the f0ilprin9: This Plan nos Rot made from a tape and instrument swrvey.These certifications are made -to . file client ourveyed and are for W� purposes P purps only. Under 00 circunst&nces are the distances shown to be used to establish ros rty lines or for construction purposes_ is plan is not to be used for recording or deed dascriptians_- The existsn� dwelling shown on the plan does not fall within a special flood hazard son As 4@lihuated:on the F.I.R.M. COffi Rity #25Q0@1,. Panel 2lIC.-dated; Tba existinp dwelling shoes on: the.::.Aog4st 19.. Rpli Ice c. applicable zoniR b lam Pl.an:.is iq rampliance Mi.th. local requirements. a x`' With respect to horFir07+x :x xtiwn5iamtla, cOrt-IPnoperif being are visible egcroactgent&.or.easeadnts. g s hwrt oa Assessors Plat P110; Lot 021_ Aas.,uo • c tw>, Q'I . Ito a..a� a • gnTc�`p� ^� . TOTAL P.03 /x I