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1736 MAIN ST./RTE 6A(W.BARN.)
UPC 12543 o- No. 53LOR 3 u I�IN"� d2 u r3 B c �n y� Al RFvYic -� • Sd�bICE T Lp}µ�SG�( e- bioo sma tis C LLZZ Kti v,,J TH-E 6%rl-,J, of 4uo-,2K 416 uric, Tn 'b0 S+f&-C-IM6 C* kM-t S kt-� l-1 C.L bNE 0.4 2v"-� 01L T INTER-cO-9. occ /.Or 1 T IvGVV-*- F k q 1' ;i � � . . . . . . . _ . , � [ < ( � � r [ [ � 1 . % ( . . L \ . E � ( ( � ( ` [ � � . , ( � � [ � � [ � � � [ � ( � [ � [ \ \ \ TOWN OF.BARNSTABLE BUILDING PERMIT APPLICATION :. MapI9, 7/63 Parcel`.:'- a Applic ti0h #200 9,0 C) A, Health Division Date Issued D9 Conservation Division '.-5-Applicatioh Fee Planning:Dept. Fee Date Definitive Plan Approved by Planning Board Historic OKH Preservation Hyannis Project Street Address Village 0:� �2 Aku TA 2 1 Owner &99k@:7(A- SaArl-E-1 Address r?l L 1h x&A Telephopen:? q) IQ L4 l S k(10 Rermit Rbque8t —,s V e- 5tge- Aeor 4-o ces-r_ khovR- TCVA 6{utvt 4\tA0W A. Lra, aA -AA 0ew Square feet: 1st floor: existing��/O proposed 0 '2nd floor: exist in-gY proposed Total new Z6,ning District —Flood Plain Groundwater Overlay Prqject Valuatior,-#,qo 000 —Construction Type L6t Size Grandfatherbd: 0 Yes Ll No If yes, attach supporting documentation. Dwelling Type: Single Family W Two Family El Multi-Family(# units) Age of Existing Structure $0 Historic House: U(Yes 0 No On Old King's Highway: & es Ll No Basement Type: mull Q Crawl Q Walkout D Other Basement Finished Area (sq.ft.). Basement Unfinished Area (sq.ft) O0 Number of Baths: Full: existing, new 0 Half: existing 0 new 41 Number of Bedrooms: v2 existing 0 new Total Room Count (not including baths): existing new y First Floor Room Count Heat Type and Fuel: Urnas Ll Oil L1 Electric Ll Other Central Air: Q Yes Ltlqo Fireplaces: Existing New Existing wood/coal stove: Ll Yes &rNo Detached garage: L1 existing 0 new size Pool: Q existing L) new size Barn: L11 existing 0 new size Attached ❑garage: Ll existing 0.new size —Shed: U existing W(new siz5XIIOther: Zoning Board of Appeals Authorization LJ Appeal # Recorded L3 CD Xr. Commercial Ll Yes Ll No If yes, site plan review # 0 < Current Use Proposed Use _;__i (—n Ca APPLICANT INFORMATION (BUILDER OR HOMEOWNER) aN rn N I ame S U. n I—k Sk o' v, Telephone Number 544-q3 - 277 (e Address 'f b License # q3_1 0 'R.0)c X Home Improvement Contractor# l b 0 0 3 7 <; .v e(,4j 1 cl,, bft A--b2C3:7 Worker's Compensation # 3rD4_70q5_ ALL CONSTRUCTION DEBRIS R NG F M THIS PROJECT WILL BE TAKEN TO b C, 1AA keAr X SIGNATURE DATE yi 1 I( ; FOR OFFICIAL USE ONLY,"- APPLICATION# DATE ISSUED MAC-/PARCEL NO. A 'r ADDRESS VILLAGE* OWNER DATE OF INSPECTION: F FOUNDATION ' FRAME PJ ` INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL . PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ; ,r FINAL BUILDING DATE CLOSED-OUT ASSOCIATION PLAN NO. E r r Town of Barnstable Regulatory 5eryxces AAftN3TAbL£. `. . Thomas F. Geiler;Director . ..... Building Division Thomas Perry,CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.bams-t2ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: /Rft7,CVTr Map/Parcel: Project Address 1716 X,4frJ Sr, M Builder: S'tc`PVXtjrr- 1�teszrr��?Z'a�/ .The following items were noted on reviewing: /�e u rac DN s G- 60IZe-/0C1 // �,u� CmAG- G d o U00Q -Your S�,c.! 64 Clb l (.csl�� (foj)E 97roe A. V Reviewed by: Date: Q:Forms:Plnrvw 40 po e y,1" 64,i,, AD r 4� : ��0 0 3 7 � J ' S u*vr(/wZestora w-Vv Ca-HV atly P.0. 3op 802, 480 Zaute, 6AY SuWe,,03 E. Sa ,tdw6dv, Mgt 02537 Date: March 6, 2009 To: Barnstable Building Department Regarding: Permit Application Location: 1736 Main Street, W. Barnstable, MA Owner: Roberta Bartlett Applicant: Sunrise Restoration To whom it may concern, Please be advised that the Construction Supervisor for this restoration work herein applied for is Frank Capra. He is an employee of Sunrise Restoration Company. Please contact me should you have any questions or require additional information. Thank you in advance. Sincerely, Bill Feder President (508) 243-7776 1� 0 \ \ V` v : Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Mas a-husetts 02108 Home Improvemeiir�, amtractor Registration Registration: 160037 ij Type: Supplement Card �^ �" I~ Expiration: 6/19/2010 �a SUNRISE RESTORATION COMI?A - F° . FRANK CAPRA 480 RT. 6A P.O. BOX 802 �;� 0¢A.3 E. SANDWICH, MA 02537 _. '�� s�°4v Update Address and return card.Mark reason for change. )PS-CA1 0 50M-0004-G101216 C Address F� Renewal R Employment C Lost Card �le 'C�o�rrnzon�uea/.C! o�../f/�,craaacluaeba Board of Building Regulations and Standards License or registration valid for itidividul use only HOME IM2ROVEMENT CONTRACTOR before.the expiration date. If found return to: Re is ti60037 Board of Building regulations and Standards r > tr -- 1-9/2010 One Ashburton Place Rm 1301 a /-(r Boston,_Ma.02108 Type— pplement Card SUNRISE RESTO [0: MPA .a DANK CAPRA 480 RT.6A P.O.BO` � E.SANDWICH,MA 02537 _ -- Administrator Not valid,without signature 1 � -[004)7/Ilt ywal L Oy✓��(.QJr3r2C/LUd6 .d . Boar Buildin Regulatio s and Stand License or registration valid for individul use only HOME IMP V MENT CO CTO before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 1 One Ashburton Place Rm 1301 Expiration_ /20/2 Trlt 275345 Boston,Ma.02108 T D r i CAPRA HOME IMP VEMENTS FRANK CAP G I 40 COP, LANE` CENTERVILLE,MA 32 dministrator �; of valid without signature Massachusetts- Department of Public Safctl Board of.Buildinh Reggulations mid Stand:a-dx i Construction Supervisor License License: CS 12430 Restricted to:•.00._. I i FRANI(Gi.CAPRA . 40 COPPER.LN i CENTERVILLE, MA 02632 ti i Expiration: 6/16/2010 ('.uumisi nu•r Trr: 26090 i f .1 Town of Barnstable Regulatory Services . • RARNSTABLF. MAS& Thomas F.Geiler,Director 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 authorizeu;nv-10�� ;F�e S�,ro�clz�� to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) AQ&-ab- C'. 3 =o 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:F0RMS:0WNERPERMISS10N Town. of Barnstable o*THE Regulatory Services .RAMST.,SE : Thomas F. Geiler,Director '`s� Building Division rFn�jA Tom,Perry,Building Commissioner 200 Main-Street Hyannis,MA_02601_ vrww.t o w n.b a r n s to b l e.m a.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 siructures 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 ri 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.(Secban I D9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor. Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a.form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt' The Commonwealth of Massachusetts Department of Industrial ccidents Office of Investigations 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/Organization/Individual):_ g - y y�y-L S.( n rozb"o v� Address: -U V /� I • ��x �f vzS � _a�3 _ City/State/Zip: L . S��,�„�� � Phohone.#: �j o 7-77 Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. [ 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. ❑ Remodeling shipand have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' �msurance.t 9. ❑Building addition [No workers co comp.insurance mP• required.] 5. ❑ We are a corporation and its ME] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the 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. -c Insurance Company Name: W1 �V►►%Q.1 C n Policy#or Self-ins. Lic. #: 3 Tk7 o 9_S- Expiration Date: /0 /177 0 Job Site Address: 6 3 CP M All P%S City/State/Zip: (p`Q Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coveraize verification. I do hereby certify and r th pa' sand penalties of perjury that the information provided above is true and correct. XSignature: �' Date: _ X kPhone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i Information and Instructions, Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who`resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapfer'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-contiactor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial .Accidents for.confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write'"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-40,00 ext 406 or 1-877-MASSAFE Fax# 617-727-7744 Revised 11-22-06 www.mass.gov/dia CERTIFICATE OF LIABILITY INSURANCE 03ioiz0o PRODUCER (508)888-2766 , FAX 008)833-0909 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Insurance Agency of Cape Cod Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 480 Rte 6A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P O Box 960 E Sandwich, MA 02537 INSURERS AFFORDING COVERAGE NAIC# INSURED William Feder & Jeffrey So lows INSURERA: Zurich-american DBA: Sunrise Restoration Company INSURERB: P.O. BOX 802 INSURER C: East Sandwich, MA 02537 INSURER0: 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 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DIYL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS NAREGENERALLIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR MED EXP(Any one person) S PERSONAL&AOV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY 114JURY SCHEDULED AUTOS (Per person) $ HIREDAUTOS BODILY INJURY S NON OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: . AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION $ S WORKERS COMPENSATION AND TBI 02/20/2009 02/20/2010 1 we sTATU OTH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 100,000 A ANY OFFICER/MEMBEREXCLUDED?WE NE XECUT E.L.DISEASE-EA EMPLOYEE $ 100,000 MIf yyees,AL PROVISIONS below describe under E.L.DISEASE-POLICY LIMIT $ 500 OOB SPECI OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE O D CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Town Of Barnstable DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Building Department BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 200 Main Street OF ANY FOND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES Hyannis, MA 02601 AUTHORIZED E TATIVE ACORD 2S(2001/08) FAX: (508)790-6230 (DACORD CORPORATION 1988 01/22/2009 21:29 5083624262 LEIF BITTCHER -PAGE 02/03 ACORD. CERTIFICATE OF INSURANCE DAT&(MAAD.MYY) 10-02-08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT5 UPON THE CERTIFICATE BRYDEN 8c SULLIVAN INS AG HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 FALMOUTH RD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE HYANMS,MA M401 COMPANY L12MY A TITAVIiLrmSDTiCTAssiGNmNT INSURED COMPANY B LLB BOTTCH.BR HOME BeR.OVEMINT INC. COMPANY 825 CLDAR STREET C ` WM BARNSTABLF,MA 02.668 COMPANY COVERAGE THIS(R Tp CERTIFY THAT THE POUCIEB OF INSURANCF LISTED BELOW HAVE BEEN ISSUED TO THE INSUR ED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REgn11REMM TERM OR CONOMON OF ANY CONTRACTOR OTHER DOCUMENT WITH REBPECTTO WHM,H THIS CERTIFICATE MAYBE t"UED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESOMSEP HEREIN IS BVBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POUCWB.J UnGTS,WOWN MIAY NAVE SEEN REDUCFD BY PAID CLAIMS. CO POLICY EFT POI ICY EXP m TYPE OF INSURANCE POLICY NUMSER DATE(MMIDDIYY) DATE LUNITS GENERAL UABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL PROOUCTS•COMPIOP AGG. $ CLAIMS MADE OCCUR. PERSONAL 88 ADV,INJURY $ OWNER'S 8A CONTRACTOR'S PROT, EACH OCCURRENCE S FIRE DAMAGE(Ary one ft) $ IVIED.EXPENSE(Arty one pomm) 3 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE Lw S ' ALL OWNED AUTOS BODILY INJURY(Per Person) $ . SCHEDULE AUTOS BO1LYAVJURY(PwAuccideNt) $• I HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT S OTHER THAN AUTO ONLY; EACH ACCIDENT S AGREGATE 3 EXCESS LIA81UTY , UMBRELLA FORM EACH OCCURRENCE . $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UU407MB63.00 07-30-08 07300 STATUTORY LIMITS X TbIE PROPRIETOR/ EAr;HACCIDENI $ 100.000 PARTNERS/EXECUTNE X INCL DISEASE POLICY LIMIT $ 500,000 OFFICERS ARE: EXCL DISEASE.EACH EMPLOYEE S 100.'000 ` l OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVS40LES/RESTRICIIONS/SPECIAL ITEMS 110 REPLACES ANY PRIOR CGTLTIPICAIM ISSUED TO TRL C13Ii=CATE BDLDIM AMECTBNG WORMS COW COVMWjE, 1 z CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE MOVE D6SCRD3M POUCIES 8E CANCCLLED 8EFORR TIFF EXPIRATION DATE THM:QF,THE MUING COMPANY WD,L ENDEAVOR TO MAU.10 GAYS WRITTEN NORCE TOTH6 CERTIFICATE HOLDER NAMED TO THE I.FFT,VJT FAkVRr=TO uRL SUCH NOnCE SHALL IMPOSE NO OBUOATION OR LIABILITY OF ANY IOND UPON 7W COMPANY.ITS AGEmM OR REpRESQNTATIVES, AUTHORIZED REPRESENTATIVE ACORD 25-5(3/93) Charles J Clark c 3/ 19/2009 9 : 54 : 1.0 AM 8988 ® 02/02 ISSUE DATE 0311912009 IRDUCER molTHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND old H Williams Ins Agcy Inc CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE.AFFORDED BY THE 1 Bassett Lane POLICIES BELOW. yannis,MA 02601 COMPANIES AFFORDING COVERAGE sI.IRID Stephen M Childs - 145 Cammett Road COMPANY A A LM..Mutual Insurance Co LETTER arstons Mills,MA,02648 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY TED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT PERIOD INDICA 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.LIMTfS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFFECTIVE POLICY E%PIRATION LIMITS LTR TYPE OF INSURANCE POLICY NUMBER DATE(M MIDDIYY) DATE(MMIDDIVY) GENERAL AGGREGATE I GENERAL LIABILITY PRODUCIS.COMP/OP AGG. =COMMERCIAL GENERAL LIABILITY ( PERSONAL&ADV.INJURY I Q O CLAIMS MADE=OCCUR EACHOCCURRENCE OWNER'S&CONTRACTOR'S PROT. FIRE DAMAGE(Anymm tire) Q MED.EXPENSE(Anyone pmm) AUTOMOBILE LIABILITY COMBINED SINGLE I LIMB ANY AUTO BODILY INJURY ALLOWNEDAUTOS (P.Pe ) SCHEDULED AUTOS HIRED AUTOS \ BODILY INJURY NON•OWHEDAUTOS (Prr wIdd r) GARAGE LIABI LIFY PROPERTY DAMAGE - EXCESS LIABILITY ( EACH OCCURRENCE f UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND AT LIMITS STATE OTHER EMPLOYERS LIABILITY I MA E PROPRIETOR/ EL EACH ACCIDENT 100,000 A ARNERS\EXECUTIVE MCIERSARE: - 7015793012008 12/13/2008 12/13/2009 EL DISEASE—POLICY LD TT 500,000 INCL ®EXCL EL DISEASE—EACH 1 0� EMPLOYEE COMMENTS/DESCRIPTION OF OPERATIONS OR LOCATIONS: TEPHEN M CIULDS IS NOT COVERED BY THE WORKERS'COMPENSATION POLICY. HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE ILL FE DE R INSURANCE OF,THE LSSiJIIdO COMPANY WILL ENDEAVOR TO MAII,lO WRITTEN NOTICE TO THE CERTIFICATE OLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION R UABuM OF ANY RIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. TE.6A L ANDWICH, MA 02563 UTHORIZEDREPRESENTATIVE Fax Server 3/20/2009 8:49 AM PAGE 2/003 Fax Server CI' :U309 MULTiSTA ACORD. CERTIFICATE OF LIABILITY INSURANCE 03120ra°s° PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION $tarkweather 8�Shepley ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 649 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Providence,RI 02901-0549 401 435-3600 INSURERS AFFORDING COVERAGE NAIC 0 [INSURED INSIJRERA- Employers Mutual Ins Mufti-State Restoration,Inc. INSURER B: Beacon Mutual Ins Co 1135 Charles Street INSURER G North Providence,RI 02M INSURER D: INSURER I- 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 BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. POLICY EFFECTIVE P0.ICYEXPIRATION LIMITS LTR TYPE OF IN8URANCE POLICY NUMBER AT A GENERAL LIABLRY 3D66309 01/01/09 01/01/10 EACH OCCURRENCE 51000 000 DA✓1MGETORENTED *0.000 X OOMr&RCIAL GENERAL LIABILRY GLMMSMADE a OOCJR MED EXP(Wry One POM0n) OLIO PERSONAL 8 ADV INJURY S1 OOO= GENERAL AGGREGATE .32.M.OW GENLAGGRETELMITAPUESPOECR PRODUCTS-COMPIOPAGG S 000000 POUCY PRO, L A AUTLI 3Z6M9 01101/09 joiloilio O QED SINGLEUMIT $1,000,000 A ANYAuro 3ES6309 01/01/09 01101M0 X ALL ONNED AUTOS BODILY INJURY S PW Pam-) SCHEDULED ALTOS X HIRED AUTOS BODILY INJURY S X NON-OWNED AUTOS (Per acdde,d) PROPERTY DAMAGE S (Per accide,d) GARAGELIAMITY AUTOCNLY-EAACCIDEKT S ANYAUTO OMER THAN EA ACC S AUTOONLY: AGG S EXCESSIUM7BRELLALIABILITY EACH OCCURRENCE S OCCJR CLAIMS MADE AGGREGATE S S DEDUCTIBLE S RETENTION S - S B wmER8COIMPENBAnONAND 50845 12101/08 12101109 X WcsrATLL OTH. EMIPLOYERT LIABLITY EL EACII ACCIDENT S500 000 ANY PROPRIETCRIPARTNPRIEXEC TIVE OFFICFRIMEMBEREXOLDED7 E.L DISEASE-EAEn $500000 IrYeaE �ovi�d-SIO EL DISEASE-PcucYUMtT S500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESI EXCLU81ON8 ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Except 10 days for non-payment of required premium CERTIFICATE HOLDER CANCELLATION SMOULI)ANY OF THE ABOVE DEOCR18ED POLICIES BE CANCELLED BEFORE THE EXPIRATION Sunrl"Restoration DATE THEREOF.THE MANGMMMRWLL ENDEAVOR TOMIIAL _3M DAY8VMrTEN 450 Route 6A NOTICE TO THE CERTIFICATE MOLDER KAMM TOTHE LEFT,BUT FAILURE TO DO 80 SHALL East Sandwich,MA 02537 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 7pswu,0— Lib. l9Qh AQL'WW ACORD 25(2m1108)1 of 2 #S209976/M209974 MBS 0 ACORD CORPORATION 1988 0 x 92.4 94-3 �B3G 93.6 -- ' to 0 HEARS OF-ER UJNA ;VAK/ / PLAN BOOK 61J ' PAGE 92 9 _0 0 x� . 6 0 g8)^ \ o L 92.6 96.6� 96 8x cp x 94.6 / v 98.4 2 x 94 '0 / o x 9 �7:4` �Z� o x x 9 5 1 95.� 96:4. 8.399 3 �:., r y�N 7:5. 9 ON 195.91 98.0 100.9'- 196.1 � .34.8• a 27.1' \ EXISTING \ 9,• I18 _8 DWEWNG 99.7 C 96.6 x LOT .�RF.�l , �s7.3 \ l ��/ '%/ / . 95. / 14,7484 f .SF. Q3 f AG \ (g8��6//�96.4 A`.� x 96.4 BENCHMARK: x 97_ 1 . J cm b 8�('98)_ 97.8 97.3 EiElG M,=05' x 98.1 (��) % 98.0 Y. 99.4 O2 P,o ':^ 40 SEPT LOCATIONS FROM W!L>�!Lc!-.:.;, N �^ / ��° "AS BUILT" CARD C�7,. !4b.313 0 % TOP OF FOUNDATION IS ELEVATION .. Pam. +� . . x-"98.7 99.'9 (SITE . PLAN DATUM). TO THE BEST OF MY INFORMATION, "PROPOSED ' PLOrF PLAN KNOWLEDGE, MD BELIEF THE WEST BARNSTA,BLE,. 8TR'UCTURE5 .SHOWN ON THIS PLAN 1736 ROUTE 6A HAS BEEN LOCATED ON THE GROUND DATE 10/28108 SCALE 1A = 30' AS INDICATED. JOB 6795-00- CLIENT SOLLOWS " 28 Q SWEETSER ENGINEERING " 23.5 GREAT WESTERN ROAD DATE PROFESSIONAL LAND SURVEYORY PO Box 713 SOUTH DENNIS, MA 02660 off_ 508-398-3922 fax. 5W-398-"3 C: 1 S8 I PROD 1 6795-00 1 dwq 16795-cpp-Proposed.dwq © 2008 SWEETSER ENGZVEERING THETpyy Barnstable Old Kings Highway Historic District Committee . O . ,�AB,� ; 200 Main Street, Hyannis, MA 02601;TEL: 508-862-4787 Fax 508-862-4784 yQ MASS. 0a TE°MAtA APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made; with four(4)complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans,�Rawings,..o[ photographs accompanying this application for: Check all categories that apply; 1. Building construction: ❑ New ❑ Addition ►tom Alteration 2. Type of Building: RIIHouse ❑ Garage/bam ErShed ❑ Commercial ❑ Other 3. Exterior Painting roof ❑ new roof color/material change, of trim, siding, window, der 4. Sign : ❑ 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: ���� — (� Address of proposed work: House# lry i` Street: ��(�at Village Mr 1 .Assessors Map Lot# tq a li�y Description of Proposed Work. Give particulars of work to be done: JLn3J SL ,vrl o u W r�c�o ✓, 4=6_ e- . A�- de c-.K. �j - Agent or Contractor(print): &2 A 1(1Q S`�v g-�� ,, Telephone.#: Address: (o Contractor/Agent' signature: NOTE All applications must be s' ned by the current owner Owner(print): Telephone#E:=L/— Owners mailing address: l�� a�w� � `(�a3 3'7 Owner's signature: r� �} �n For committee use only. This Certificate is h APPR9VED/DENIED Dt5 C L V E Date LOT Members signatures 7 DEC 2 3 20IF 08 - s-/�U TOWN OF BARNSTABLE HISTORIC PRESERVATION Any 1�xm on o o l: AFFROM AS M0D1 PN1 � • , 6�«�s�m ay of _ r Odd�Go�m��ec, 1 ,roups101d Kings HighwaylOKH New ApplOKH Cert Appropriateness 07.doc Town of Barnstable Old King's Highway Regional Historic District Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 4 Copies Foundation Type: (Max. 18"exposed)(material -brick/cement, other) r_Llnn e_.,,J Siding Type Ul-- material: &I fi-J' Color: IUAI-1,nj Chimney Material: Color: Sa,_- 1",L - d`'.� d� Roof Material: (make& style) 09-S �- Trim material /LL color: h, . �`l?t;,vl2. �17 �; (;y� �-c Roof Pitch: (7/12 minimum) sl a. Window: (make/model) n r rgo.i 300 material �,,. J 01color I-L Size(s): Door style and make: (U Po..-. T _ material Color: ` f, t n; Garage Door, Style Size. Material Color Shutter Type/Material: Color: Gutter Type/Material: Color: r Decks: material Size. Color: 'tA Skylight, type/make/model/: material Color.: Size: Sign size: Type/Materials: Color: Fence Type(max 6' ) Style material: Color: Retaining wall: Material: Lighting, freestanding on building illuminating sign Please provide samples of paint colors and manufacturers brochure of style of wimMsWiQ%arage door, fences, lamp posts etc Town of Earn_ .; ADDITIONAL INFORMATION: Old Kincrs ommith; -` Signed: (plan preparer) print name :l�i b• 'd.tZr tel.no.S-u 3, 3-7- -7 Location of application,yAn, , _ Street no. `- Y' Street wage �, ` n r',n. ��h 10 a 2 r'Q:IGMD-Groupsl0id Kings HighwaylOKH New ApplOKH Cerra Appropriateness 07.doe 6 1d . � . �oF'HEro``y Barnstable Old Kings Highway Historic District Committee 200 Main Street, Hyannis, MA 02601;TEL: 508-862-4787 Fax 508-862-4784 �A ib.q. �00 rFDM s APPLICATION, CERTIFICATE OF APPROPRIATEI.ESS Application is hereby made, with four(4)complete sets, for the issuance of a Certificate of Appropriateness unler Sectigyn"Ca Chapter 470,Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings,ors-3 photographs accompanying this application for: Clxeck all categories that apply; wo 1. Building construction: ❑ New ❑ Addition �,� " `� � Alteration �r-- :r rn 2. Type of Building: 0House ❑ Garage/barn 2'Shed ❑ Commercial ❑ der w 3. Exterior Painting roof ❑ new roof 2color/material change, of trim, siding,window, door 4. Sign : ❑ 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: f Date: I . 2 Address of proposed work: House# 3 4a Street: . Village (N.�U_rn 't5 6_.�kAssessors Map Lot# Description of Proposed Work: Give particulars of work to be done: ov-e__ A0 0 0 r2 k" WeJtCL°��J. p c Ae j �' Agent or Contractor(print): SUA n,'-A- Telephone#: EO'R -77-1 Address: Contractor/Agent' signature: - NOTE All applications must be.-S' d by the current owner p Owner(print): 12, Telephone#°-1-7 Owners mailing address: - /7 3 (o /2f( l o'a 37 Owner's signature: Dlb E rC 2 f1 W E For committee use only. This Certificate is hereby APPROVED/DENIED 15 Lam, U' l5 Date Members signatures DEC 2 3 2009MIA uu,ly i TOWN OF BARNSTABLE 1 HIST�;4IQ PRESERVATION Any c iti s of app oval: 1pp9 APPROVED AS MODIFIED—� °�ea,n5�ab�e K�n95 Nrt J ' 1 Q:IGMD-Groups101d Kings HighwaylOKH New ApplOKHCert Appropriateness 07.doc I Town of.Barnstable Old King's Highway Regional Historic District Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 4 copies Foundation Type: (Max. 18"exposed) (material -brick/cement, other) Siding Type 11 U material: 64(i-%— Color: Ak,� Chimney Material: y1`C. k Color: ���_ q. � 4- Roof Material: (make& style Color: � � Trim material ILL Color: _ ',, o ;c--Ct-, -e Roof Pitch: (7/12 minimum) -7 r +` Window: make/model , �, U� o �SrdeUq ( ) n 4� h o � S material �,.. .� cl color -, " Door style and make: iri,(:" Qos.. .. - _ material Color: j Garage Door, Style Size Material Color Shutter Type/Material: Color: Gutter Type/Material: Color: Decks: material I hu�/iu r e� Size _ 1�X Color: ,t/,4L,.r' Skylight, type/make/model/: material Color: Size: Sign size: Type/Materials: Color: Fence Type(max 6' ) Style , material: Retaining wall: Material: Lighting, freestanding on building si WN OF Bd. STA6C Please provide samples of paint colors and manufacturers brochure of 1 Ra age door, fences, lamp posts etc ADDITIONAL INFORMATION: r-. =a r 1- JAIL l 4 2009 wrh Si Drint name f (ad Signed: (plan preparer) + -,tel.no. ��-a Y3� JZ -7 7� Location of a lica"tion _ m Street PP , _ Street�no.mute Q:IGMD-Groupsl0ld Kings HighwaylOKH New ApplOKH Cert Appropriateness 07.doc d' 2 Town of Barnstable BARNSTABLE. M Regulatory Services 9 MASS. Building Division prFD MAC a. 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 a Inspection Correction Notice Type of Inspection / (J Location. 736 /V "/() S-r- Q Permit Number Owner Builder One,notice to remain on job site, one notice on file in Building Department. The following items need correcting: S � 4. !LK-1G&,rJE C.c,IP5 (kUS-� G:.;8 ,p coC-L',g-W. 77 16 r j �O-Vupop g4jif -ZG 7' I b .Soda TU-r3s---. r^'^ d t 1 Please call: 508-862-403&for re-inspection. Inspected by c Date TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. Map G Parcel" � 3� ;Application #�� e0.5 Health Division 5 2�3 Date Issued Conservation Division Application Fee Planning Dept: ,.-Permit Fee ' Date Def niti4 Plan Approved by Planning Board D Historic - OKH Preservation/ Hyannis Project Street Address r G(� �. I Village Owner Q � Ea JA_ Address so_yy%=-e.._ Telephone 7)`7 Permit J quest `o /v/ v b (_ A O f/ : /TIFF !94 '7/3 Square feet: 1 st floor: existing L*Wproposed rnc `2nd floor: existing-70 y proposed Toga I r G, 3 i Sfin, Zoning District. Flood Plain Groundwater Overlay ) 7n . Project Valuation 35 Construction Type s Ln 3>. Lot Size a Grandfathered: ❑Yes ❑ No If yes, attach sup—jR.)rting doccume tation. �� cn Dwelling Type: Single Family I" Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ff'�es ❑ No On Old King's Hig: ay: EKes rd No Basement Type: Cf Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new O Half: existing 0 new Number of Bedrooms: existing 16 new b Total Room Count (not including baths): existing new O First Floor Room Count Heat Type and Fuel: 9'*Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes U o 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 Ur<o If yes, site plan review# Current Use I �-1 Fo.rah Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ���'�'�' ���/� Telephone Number 7 7�i 9 5C �+�L —.T—. Address 4e(J License # Home Improvement Contractor# �I J Worker's Compensation #1�vS ?y!�'' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Z-d� FOR,OFFICIAL USE ONLY x " APPLICATION# DATE ISSUED MAP/PARCEL NO. C o ' ADDRESS VILLAGE OWNER t . DATE OF INSPECTION: '7 FOUNDATION FRAME fifxA 9 ,3 h q ftclk� r INSULATION Ob ZoP( vo o 9 moons FIREPLACE ELECTRICAL: ROUGH FINAL 3 PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING - DATE CLOSED OUT - ASSOCIATION PLAN NO.- f pie Commonwea.Lth of Massachusetts ,Department of Industrial Accidents Office of Invesfigations 600 Washingtort Street Roston, MA 02111 www.mass.gov/dia Workers' Compensation lusurance AfSclavit: Builders/Contractors/E1ectTicians/P.lumbers A- me liumt Information / Please Print Le�zbly Na (Businrss/Ori-im tionadividual): r!-Z--A8 (je /��! �`�/ Address. (� a V City/State/Zip: H A 02431- Phone.#: Are you an employer? Check the appropriate Type of project(required): 1.�I am a employer with 4• am a general contractor and I 6. ❑New construction employees (frill and/or part-timL).* have ed the sub-contractors 2.El am a sole proprietor or partacr- on the attached shad 7. ❑ Remodeling These sub-contractors have g. Demolition ship and have no employees working for me in any capacity. to Yees and have workers' 9. Building addition [No workers' COMP.•incrrranec �� iIIS11I3nce.t 10. Electrical rc sits or additions rbquircd_] 5. [] We are a corporation and its �' P 3.❑ I am a homeownra doing all work officers'have exercised their It. Plumbing repairs or additions Myself [No workers' comp• rigbt 6f exemption per MGL 12 0 oof repairs innuance rcgnircd.] t c:152, §1(4), and we have no 13.vothcr. employees. [No workers' comp.insurance required.] "'!wy applicant that chcckr box#1 must also fill out the rcetion below showing thcu workers'coropersnL on policy informatim t HomeOwncrs who rubrnit this afdavit indicating they arc doing all work and then hire outside contractors must rubrmt a new affidavit indicating each. XCrac unttota that ehecicIbis box rnust itaod an ch additional ehect gho)vmg the name of the sub--onttactors and rtatc whether ornot those rntitirs have carployees. if the sub-contractors have errploycer,they must provide:their workers'comp.policy nUznbcr. I am an employer that is providing workers' compensation insurance for my employees. BeLow is the polity and jab site information. Insurance Company Nam :�A,, Policy#or Sclf--ins. Lic. #: S s /7 ExPii-ation Date: Job Site Addrrss: M A, ,3 _141, 31 City/Statc/Zip: . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to $1,500.00 and/or one-year imprison ut, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.0o 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 t:ovcra- c verification. I do hereby certify un pai.rrcs•and penalli.es of perjury th.al the information provided above is true and correr-t Si atLuc: Date: 2 O Pbonc 29 Off c al use only. Do not write in this area, tb 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/Towu Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their cmployecs; ; pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, cxpress or implied, oral or written." An employer is defined as "an individual, partncrship, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal represcntatives of a deceased employer, or the receiver or trustee of an_individuA partnership, association or other legal entity, employing employees. Sowevcr the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the iwclling house of.anothcr who employs persons to do maintcnanco, construction or repair work on such dwelling house Dr on the grounds or building appurtenant thereto shall not because.of such employment be deemed to be an cmpIoycr." viGL chapter 152, §25C(6) also states that"every state or Iocal licensing agency shall withhold the issuance or -enewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has notproduced-acceptable evidence of compliance with the insurance coverage required." Udditiona ly,MGL ohapter 152, §25C() states 'Neither the commonwealth nor any of its political subdivisions shall alter into any contract for the performance of public work until acccptable cvidcnec of compliznco with the insurance egvirements of this chapter have beenprescnted to the contracting authority.' applicants lease fill out the workers' compensation affidavit completely, by chcckiag the boxes that apply to.your situation and, if eceasaiy, supply,nib-eontractor{s)name(s), addresses) and phone numbers) along with their eerti.fieate(s)of Uurance. Limited Liability Companics*(LLC) or Limited Liability partnerships (LLP)with no employees other than the mmbcn or part�ncrs, are not required to carry workers' compensation assurance. If an LLC or .. does have IIployees, a policy is required. $e advised that this affidavit may be submitted to the Department of Industrial ceidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should returned to the city or town that the application for the pcmait or license is being requested, not the,Department of idustrial Accidents. Should you have any questions regarding the law or if you arc required to obtain a workers' )mpensation policy,please call the Department at the nurgber listed below. Sclf-insurad companies should enter their :If ins ranco license numbet on the appropriate line. ity or Tov �p Officials ease be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom •tbc affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant ease be sure to fill in the perruit/liccnse number which will be used as a reference number. In addition, an applicant it must submit multiple permit/license applications in any given year, need only submit onp affidavit indicating current 4cy informati on(if necessary) and under`Job Site Address" the applicant should write"all locations in_, (city or vn)."A copy of the &$davit that has been officially starnpcd or marked by the city or town may be provided to the plicant as proof that a valid affidavit is on file for fiifurc permits or licenses. A new affidavit.must be filled out each ir.Where a home owner or citizen is obtn'�a license or permit not related to any business or commercial venture 'clog license or permit to hum leaves etc.) said persona is NOT required to complete this affidavit c Office of Investigations would h-kc to thank you in advance for your cooperation and should you have any quegtions, asc do not hcsi:tatc to give us a call Depa.tment's address, tcicphonc•and fax number. Tha Commonwealth of Massachusetts DqD- l east of Indus Hal Accidents Office of Iuvestigatrans 600 Washingtan Street Boston, MA 02111 Tel. # 617-727-49-0.0 cxt 4.06 Gr 1-M-MASSAFB Fax # 617-727-7744 11-22-06 www.mas.3.gov/dia I i ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: ILA � CA AA Site Address:print Town: Applicant Phone: Applicant Signature: Date of Application: NEW CONSTRUCTION: choose ONE of the following two options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM' MINIMUM Ceiling or Basement Slab Option 1: Fenestration exposed Wall Floor Perimeter U-factor floors R-Value R-Value Wall R-Value AFUE )ISPF SIs1R R-Value R-Value and Depth National Applivice Energy R-10, Conservation Act(NAECA)of .35L LR- 8 4 ft.R-19 R-19 R-10 Ino,as amended,minimums . reatcr ns n licable Note: This form is not required if you choose either of the two versions of REScheck as.listed below. ❑ Option 2: �. RE-Scheck Version 4,1.2 or later variant software analysis must be completed i 780 CMR 6107.3.2). �I REScheck--Web which can be accessed at http://www.energycodes.gov/reschecld :ADD)rTIO1VS 0R ALTERATION;S TO`EXIS TING BUILDINGS.:0VER 5'.Y)CARS OLD* *131.1ildings under 5 years old must use.option#1 or#2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b _ a) A') SF 100 x l03: _ /0!�ao = -01 % of glazing (b) Glazing area equals.T3 .SF b If glazing is':5. 40% use.the chart below. If.glazi>i -is>40.O/o proceed to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM I MINIMUM ❑ Ceiling and Slab Perimeter Fenestration Wall Floor Basement Wall U-factor Exposed floors R-Value R-value R-Value R-Value R-Value I and De tli .39 R-37 a R-13 R-19 R-10 R-10, 4 feet R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not compressed over exterior walls, and including any access openings).- e ❑ SUNROOM—An addition or alteration to an existing building/dwlling unit where the total glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note:. Owner to fill out Consumer Information Form (found in Appendix 120.P) �FTHE,, Town of Barnstable Regulatory Services BARxsresLe. 'muss. Thomas F. Geiler,Director 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 6,P9 Ceg A94 to act on my behalf, in all.matters relative to work authorized by this building permit application for: 15, Y— (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on th:e reverse side. Town of Barnstable �oF JHE y�� o Regulatory Services Thomas F. Geiler,Director SAFtNSTABLE, . 9 MASS. 1639. Building Division PrF°µA�p Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 vrww.town.b arnsta bl e.ma.us Office: S08-862-4038 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 rip 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 log.I.I-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. r ' � tssachusctts_ _ � • Board of ��Par'tmc7tt of,p Buildin" Re, ublic Satctj Construction Su ulations and Stantl:tr Licerise: CS Pervisor License ds Restricted 12430 00 FRANK G. _ RA 40 COPPER'L'N'LN CENTERVILLE, MA 02632 t"nnnissi Cr Expirdtio n: 611612010 Tr#: 26090 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for-individul use only 4, before the expiration date. If found return to: Registra`_ -g 1-10321 Board of Building Regulations and Standards • r=_=.� rEx--- ion:-j.M/2008 One Ashburton Place Rm 1301 rIy BAD Boston,Ma.02108 CAPRA HOME IMPROVEMENT �`� s � FRANK CAPRA ,_- / • 40 COPPER LANE � _i `�f CENTERVILLE,MA 02632 � Deputy Administrator Not valid without signature F a joy, K'l .:r�,..:.:"ttri .✓;,iyiK. ^r.+'r,.c:-;.- a.p.' .-� �.. , ,o .i�r+s�' .- ..� ..fir. . oF,ME Town of B a'instable o� ' BARNSTABLE Regulatory Services 6 MIAS.' P�FD ru+" Building.Division 200 Main Street, Hyannis;MA 02601 Office: 508462-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Location �7.3�0 /�QZ/�/ �' 7�. Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. �. The following items need correcting: r. 'U J fir. /Z-gt5 I yv Please call: 508-862-403,9 for re-insp ection. r J G / Inspected by y� G Date /-;-3 fol y r i — L FORM B - BUILDING Assessor's nwnber . -USGS Quad Arca(s) Form Nwnber Massachusetts Historical Commission 19 7-0.3 6 WBA 1 4 A 80 Boylston Street Boston, Massachusetts 02116 v Barnstable Town qGt ° v1 We S t Barnstable - .- r i•5i yf ,, , i� v. t .� , , ..,�ch ; � , 3� �. x, °Place (neighborhood or village) ;. ,,�k c . Y yr'i 7 �s�,' ?��y r r✓ c�r.f� �� YN€�,F��? East l dam. 1 7 3 6 Main Street xlAddress Historic Name Alexsander Michelson House ram' Residential Uses: Present Original Residential z. , 1 9 1 2 c Date of Construction Source Barns table County Registry of Dee ' i 4 1 Style/Form Georgian adaptation Architect/Builder err �: .r._._..". ._"-.. .^,..�.' ..ri :'^�.r"'aM'!`iL",'''k�•`•1-` _r.�ti`^"<'a'Y' Ylt'-tM'3+..�',n - Z Exterior Material: Sketch Map Foundation Low Draw a map of the area indicating properties within Wood shingle it. Nunsber each property for which individual Wa11lI'rim inventory forms have been completed. Label streets Roof Asphalt shingle -= including route numbers, if any. Attach a separate sheet if space zr not sufficient here.,Indicate North. Outbuildings/Secondary Structures Garage - AMUL I� one car , one story O .p IjU fi�)N�lron Major Alterations (with dates) 0. 13 p LANE �• �J 4 I0 5TIZGk-r Condition Good_ d Moved ❑ ' no ❑ 'yes . Date g Acrea e 50 POND . ' Residential artin E. Wir-ta nen' Setting Recorded by Barnstable HIstorical Comm. Organization Date (month/day/year) Dec . 2 2 , 1 9 9 2 Follaw Macrachwca s Histdriral Commirrion Survry Manual ins r ms for c—pkting this form. BUILDING FORM ARCHITECTURAL DESCRIPTION . O see continuation sheet Describe architectural features.' Evaluate the characteristics of this building in terms of other buildings witl�i�t the community. This two story Georgian adap•tation .1ouse has a hip roof with a moderate height and .cross section chimney, through .the .roof peak on the west end.. The roofs- have a moderate pitch . There is an enclosed porch on the south. and west facade of the first floor with some windows having 212 large panes . The house has a low foundat.ion and ..is .located on . the north side of the Old County Roa-d ( Route- 6A ) . MSTORICAL NARRATIVE ❑ see continuation sheet Discuss the history of the,building. Explain its associations with local (or state) history. Include uses of the lntilding, and the roles) the oziwners/occupants played within the community. Alexsander Michelson , the first .owner of the house , was one of the early Finnish immigrants of many that first settled in West Barnstable from . 1895 to 1925 seeking work and improved living conditions . He initiated and was successful in local business ventures and constructed three houses , a . stone garage and a comb.inat'ion house /store . His name was changed from Perka.us to Michelson . Previous Owners : 1959 Robert Churchill. 1956 Francis W. Kl:ay II 1946 Charles E . and Louise - G. "Linnell 1946 . Lois K. Fleming 1929 John E . Lahteine 1929 Victor and Rose J . Lahteine " 1919 Neil -Atwood 1916 Frank Maki . Land and buildings 19,12 Alexsander Michelson from George F. Crocker . Land only. BIBLIOGRAPHY and/or REFERENCES ❑ see continuation sheet Barnstable County Registry of Deeds and Probate . Whel.clen Memorial Library. Finnish history book . The Seven Villages of Barnstable , 1976 , Town of Barnstablepgs . 451 , 452 , 453 . ❑ Recommended for listing in the National Register of Historic Places. If checked,you nsu t attach a completed National Register Criteria StatMuent for7u. C v� °f'HEr°�y Barnstable Old Kings Highway Historic District Committee � o i BARNSfABLE. i 200 Main Street, Hyannis, MA 02601;TEL: 508-862-4787 Fax 508-862-4784 y MAS,4 a �A 1639. `gym rFOMAt'� APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made, with four(4)complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings, or photographs accompanying this application for: Check all categories that apply, 1. Building construction: ❑ New ❑ Addition &'Alteration r 2. Type of Building: ZHouse ❑ Garage/barn ❑ Shed ❑ Commercial ❑gther 3. Exterior Painting roof [;?,new roof ❑ color/material change, of trim, siding, window, door 4. Si • ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Si 01' 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ tennis court❑ Ott 6. Pool ❑ swimming ❑ Other man-made pool ern Type or Print Legibly: Date: Address of proposed work: House#��1p Street:_ U� �"�, Village f/1�,gQ,(ytSTd.r1 U° Assessors Map Lot# �� Wes; Description of Proposed Work: Give particulars of work to be done: 1 R1 e s ja,r e w% +, 5�.,,,,, e e� �� a-�Or IY��er�� r Co►,Q�`'}?�v� SD���� C "Il' '0k^ LCS 2JC�s'�e� AJ�b r I jNOd-- (Ivy G Je_.S : jo0%r c>t.✓� v+^ esri y inn cL►v."� Agent or Contractor(print):_S wr tr,,A / , ,,��-� Co. Telephone#: � _0 g a-!13 7 7 _7 b Address: 6 ,(, (a ' � ;2 "' Contractor/Agent' signature: NOTE All applications must be signed by the current owner Owner(print): go,b�,r`E a 1 lt_u-+ Telephone#: q q q— 1,57 8 (p Owners mailing address: ?3(, xv\ ' �� yI ZY► O x Owner's signature: ` L� 1rS �L �7 lt)a z rn L C- For committee use only. This Certificate is hereby APPROVED/DEN Vy Date ! z-; 0 Members signatures Ne Any ditio appr gl: O\ Col. Q:IGMD-Groups101d Kings HighwaylOKH New ApplOKHCert Approprinteness 07.doc 1 t 3 f � Town of Barnstable Old King's Highway Regional Historic District Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 4 copies Foundation Type: (Max. 18" exposed) (material -brick/cement, other) ce-m f,v. Siding Type Aj material: C-�d1 Color: /y.�l�✓,t,Q r Chimney Material: ���c:IC Color: S�tA f-d r� <1 12e 5 'r Roof Material: (make & style) S �� Color: i 1 4- r rl Trim material !2 1 Y\ Color: 0 r-e Roof Pitch: (7/12 minimum) Window: (make/m6del)1'aSon -)-cw material woo �, color LV!✓11� Size(s): 6-S Door style and make:` &CbUa j J b � material ks Color: G✓haT� Garage Door, Style Size Material Color Shutter Type/Material: Color: Gutter Type/Material: way, Color: IAA:q t Decks: material Size Color: Skylight, type/make/model/: material Color: Size: Sign size: Type/Materials: Color: Fence Type(max 6') Style , material: Color: Retaining wall: Material: Lighting, freestanding on building illuminating sign Please provide samples of paint colors and manufacturers brochure of style of windows, doors, gars e' door00 fences, lamp posts etc O 0 ADDITIONAL INFORMATION: AX � . oel AP a Go Signed: (plan preparer) print name tel.no. Location of application: Street no. Street Village r' 2 Q:IGMD-Groups101d Kings HighwaylOKH New ApplOKH Cert Appropriateness 07.doc Plans shall include the following: _Name of applicant, street location,map and parcel. Name of Builder Designer, or architect; original signature of plan preparer and stamp; plan date, and all revision dates. ALL NEW HOUSE OR COMMERCIAL BUILDING PLANS MUST HAVE AN ORIGINAL SIGNATURE AND STAMP, IF ANY, BY A REGISTERED ARCHITECT, MEMBER OF AIBD, OR A LICENSED MASSACHUSETTS HOME IMPROVEMENT CONTRACTOR,UNLESS THIS REQUIREMENT IS WAIVED BY THE OKH DISTRICT COMMITTEE. A written and drawn scale. Elevations of all (affected) sides of-the building, with dimensions including height from the natural grade adjacent to the building to the top of the ridge; location and elevation of finished grade,roof pitch(s),'. dormer setbacks; trim style, window and door styles. Changes to existing buildings must be clouded on drawings. Landscaping plan, 4 copies drawn on a certified perimeter plan containing the following information: Name of applicant, street address, assessor's map and parcel number. Name, address and telephone number of-the plan preparer; plan date and dates of revisions. The location of existing and proposed buildings and structures, and lot lines. Natural features of site.(e.g.rock outcroppings, streams,wetlands, etc.). Existing buffer areas to remain. Location and species of trees outside of buffer areas greater than 12" caliper to be retained or removed. The location, number, size and name of proposed new trees and plants. _Driveway, parking areas, walkways, and patios indicating materials to be used. Existing stone walls, and proposed walls including retaining walls for slope retention or septic systems. (for removal of stone walls, file Demolition Form). All proposed exterior lighting and signs. Sketch or photos of adjacent properties, (1 copy only) A sketch(s) to scale or photographs of nearby adjacent buildings, where present, along both sides of the street frontage, showing the proposed new house or commercial building in scale and in relationship to the existing buildings. Please discuss with staff if you do not think this is relevant to your application. Photographs of all sides of existing buildings to remain, or being added to (1 set only). Fee according to schedule. Please complete the following: Existing building, foo;Y4 rint: Building 1 6 sq. ft. Building 2 Existing Building, gross floor area, including area of finished basement: Building 1 4 q3 G, sq. ft. Building 2 New building or addition, foot print: Building 1 - sq. ft. Building 2 New Building or addition, gross floor area, including area of finished basement: Building 1 sq. ft. Building 2 4 Q:I GMD-Groupsl0id Kings HighwnylOKH New AppDKH Cert Appropriateness 07.doc rynacrsen winaows ana rauo Loors i New t;onstrucuon wmaows I... nttp://www.andersenwindows.com/servlet/Satelhte/AW/AWProduc... V i Qi � rs My Portfolio Where to Buy Contact Us Search: G For Professionals WrM.001MEsDOOas MAIN IDEAS PRODUCTS LEARN SERVICE ABOUT ANDEf Home > Window > Double-Hung Windows > 200 Series Tilt-Wash Double-Hung Windows 200 Series Tilt-Wash Double-Hung Windows r4r s }^ Where to Buy • Rich natural wood interior Save Product Summary y= '�s r •='., ; .r;,,:,. • Attractive low-maintenance exteriors Request a Catalog • Larger glass area lets in more light F 1 • Low-E or dual-pane insulating glass F, • Pine interiors available with factory-applied white finish Product Index Base Price:$278 What's in the price? 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'e. h r W. a- l i y � d 3t" 4xwp� s�`3 r4 orb i xto ( ' ME D �t':-f 1 4u N Ei dv.F B• • �-t ^se} � i'z•La�t W„� n d r + 3.. v c $ E w i > r F, f r✓ 5 Style:TS210 Heights: 6'8" Widths: 2'6", 2'8", TO"' Finishing Options: Painting Impact Rated Options: Solid Panel Where to Bw . Energy Star Certified 1 of 1 7/3/2008 9:23 AM I-mu uy upor,t-atwog nup:iiwww.merma u.com/1-;aiwoguetaus.aspx-r6tyieNumDer---i-zi3... i . .`•FYI! f F'M Aa 771-1. rr ;r_* ,d J 7 =1 i "'A 1 k J� �, •�ffG.o�Y,�yx�j s Style:TS530SL Heights: 6'8" Widths: 12", 14" Glass Options: Brass Finishing Options: Painting Where to Bw Energy Star Certified 1 of 1 7/3/2008 9:30 AM oF.IKE Town of Barnstable *Permit pExpires 6 m nths from issue date .� Regulatory Services Fee v aARAtsrnl LE, % Thomas F. Geiler,Director 7 MASS. 1639. am Building Division rfd Ma't . Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY . —7 Not Valid without Red a-Press Imprint 1 Map/parcel Number 1 7 / ^ (0 2►� Property Address Lu Residential Value of Work 0,1 Minimum fee of S25.00 for work under$6000.00 Owne'r's Name&Address l736 Contractor's Name (��}f 13 � ���— . -Telephone.Number 1`7 Home Improvement Contractor License# (if applicable) (�Workman's Compensation Insurance Check one: X-PRESS P ER IT ❑ I am a sole proprietor ❑ I am the Homeowner AUG 1 9 2008 I have Worker's Compensation Insurance Insurance Company Name TOWN OF BARNSTABLE Workman's Comp. Policy# (05 (> !� I x V?S' 0 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) Re-side t ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Hisjoric,Conserxation,etc. ***Note: Property Owner must sign.Property Owner Letter of Permission. ! }, A copy of the Home Improvement Contractors License is required. czx <i _ u SIGNATURE• CO r-1 Q:\WPFILES\FORMS\building permit forms EXPRESS.doc Revise020108 i The Commonwealth of Massachusetts 132 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legribly Name(Business/OrganizatiowUciividuan: yQ Ea N I4 1 9. PIZ 1- kddress: y O C,&2 PE tz L N i= City/State/zip: e.#: r7 y— �r 4 - G 3 $�' Phon ��Nfic�✓� I�E Areyu an employer? Check the appropriate bow r7. e of project(required): 1.'jy� I am a e to cr with 4. �I am a general contractor and I mp y ❑New construction employees(full and/or part-time).* �� have hired the sub-contactors 2( •I am a sole proprietor or partner- listed on the attached sheet ❑Remodeling ship and have no employees These sub-contractors have g, 0 Demolition worldng for me in any capacity. errrployees and have workers' 9 Building addition [No workers' comp.- suiamr, comp.insurance. m required.] S. We arc a corporation and its 10-❑Electrical repass or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself- [No workers' comp. right 6f exemption per MGL 12 ®Roof repairs-t insurance regIIiied]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp,insurance required.] *Any applicant that checks box#1 rmust also M out the section below showing thca work='coropanslion policy infmmatiorc t Homcnwnen who submat this aff davit indicating they=doing all work and than him outside contractors must rubmit anew af5davitindica6ig such. tcmtractom tint cbcLk this box nnrst attached an additimul sheet showing the name of the subcontractors and state wbcther ar not those entities have employers. if the subconbwtnrs have amployca,they rmrat prmvidt:their workas'comp.policy nnmbcr. I ant 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.Lie.#: S� 'I a 8 6 x / / Expiraticii Date: lob Site Address: / ZA) City/Statr/Zip: C:�T D r� 0"L Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to sccurc coverage as required under Section 25A of MGL c. 152 can lead twthe imposition of criminal penalties of a Eno tip to$1,500.00 and/Dr one-year imprisonment,as well as civil p enalties in,�e 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 statL emit may be forwarded to the Office of Investigations of the!)IA.for insurance coverage verification. I do hereby cent&under pains d penalties of perjury that the information provided above is true and correct. 1:2 . . .Signature: Date: �✓ 2— 2 d�— Phone#: 52 L Z Offwbd use only. Do not write in this area, tb 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#: � 5 oFZHE, Town of Barnstable Regulatory Services • $"xr' "BIEMAS& R,` Thomas F. Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town!barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder Owner of the subject pro' e , asO ) p p rty hereby authorize �5g/3Zlj- ���!-� /� to act on my behalf, in all.matters relative to work authorized by this building permit application for: 17.36 ! ^iL2 (Address of Job) Signature of Owner Date bob- &- Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable �pP THE r, Regulatory Services t :• Thomas F.Geiler,Director BAttrtsrABLE, v� 1639. � Building Division PJED I��a Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMkOWNIER LICENSE EXEMPTION Please Print t.'t 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 thafthe 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. t - �J r 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 consti-uction 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 hdshe 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 fomJcertification for use in your community. VDAC �— WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE.AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: '(GS59UB'-861 X751 -6-08) RENEWAL OF (6S59UB-861X751 -6-07) INSURER: CONTINENTAL CASUALTY COMPANY NCCI CO CODE: 80381 INSURED: PRODUCER: CAPRA, FRANK G. FLAGSHIP INSURANCE INC DBA CAPRA HOME IMPROVEMENTS 414 COUNTY ST PO BOX 664 NENI. BEDFORD MA 02740 WEST HYANNISPORT MA 02672 Insured is AN INDIVIDUAL Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 03-22-08 to 03-22-09 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA m m B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 1000000 Each Accident Bodily Injury by Disease: $ 1000000 Policy Limit o Bodily Injury by Disease: $ 1000000 Each Employee a® C. OTHER STATES INSURANCE: Part Three of.the policy applies to the states, if any, listed here: a'® COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A Qe� D. This policy includes these endorsements and schedules: SEE LISTING• OF ENDORSEMENTS - EXTENSION OF INFO PAGE' 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 03-24-08 TB 4 ST ASSIGN: MA OFFICE: CNA 04U PRODUCER: FLAGSHIP INSURANCE INC 26GHG 007832 i y� ..��a �.wii�incae!UeCGLLIt- 6f /4'GCL,AIacliaJ2Qd Board of Building Regulations and Standards License or registration valid for individul use oni_v HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: MfiExpiration: 10/20/2008 One Ashburton Place Rm 1301 II 9P S Type: DBA Boston,Ma.02108 CAPRA HOME IMPROVEMENTS FRANK CAPRA 40 COPPER LANE CENTERVILLE,MA 02632 9 ICapeCodTimes.com - West Barnstable garage goes up in flamesbsb I Page 1 of 1 By Karen Jeffrey STAFF WRITER May 29,2008 WEST BARNSTABLE -Firefighters are investigating the cause of a fire that destroyed a garage and damaged the back of a house at 1738 Route 6A this morning. There were no injuries and no one was home at the time of the fire. The blaze was spotted and reported by a passerby who called 911 on a cellphone, said West Barnstable Fire Chief Joseph Maruca. The property is owned by Roberta Bartlett who came rushing back to her home when notified by friends and family that there was a fire. Bartlett was not available for comment. When firefighters arrived, the garage was fully involved in flames and the fire had spread to the adjacent house, a two-story wood-frame, shingled home. Heavy smoke poured from the buildings, smothering the scent of lilacs and lillies-of-the-valley,which border this residential property on the north side of Route 6A. Firefighters from Barnstable and Sandwich responded to the scene while a crew from the Centerville-Osterville- Marstons Mills Fire Department answered other calls coming into West Barnstable. Firefighters used foam and water to control and then extinguish the blaze, which smoked heavily for at least an hour after the fire was extinguished. Further details about the fire were not available this morning. http://www.capecodonline.com/apps/pbes.dll/article?AID=/20080529/NEWS11/80529012 5/29/2008 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108-1904 (617)723-3800 Ma Only(800)392-6108,FAX(800)851-8424 5/30/2008 Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws,Ch.139,Sec.36 BARNSTABLE BUILDING COMMISSIONER 367 MAIN STREET 367 MAIN STREET HYANNIS MA 02601 Re: Insured: ROBERTA C BARTLETT Property Address: 1736 MAIN ST,WEST BARNSTABLE,MA 02668 Policy Number: 0837879 Type Loss: Fire(including Fire caused by Lightning Date of Loss: 05/29/2008 Claim Number: 252191 Claim has been made involving loss,damage or destruction of the above captioned propert,which may either exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139,Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location,policy number,date of loss and claim or file number. MPIUA Claims Division CMA00021 N ��8��:,H8V9 All RM0.1. r - r TIIC' 11111f�1(111)f�Cll 1 U llS.tiaC IIltiC Departllrc•Jrt of ludustrial Accidents Ofl1cPOfh7YZSflgallons :1 J i 60H !f ashilr;;tun Slrcct _ B(1.V1011. , fax-T. 03111 Workers' Compensation Insurance A>fiidavit AiT61icint in format inn Ple'ts-ee PRINT leb�ijjv loc^•inn• rite. nhnn•+t I am a homeowner performing_ all work mvself. 1 am a sole proprietor and have no one working in any capacity �. I am an employer providing workers• compensation for m, employees working on this job. cnmtr rn. n tmt ��L�o�/� R(oFsNG i d d r ry c 6A' /E4V toA/b A+-e— CiIN" -Pembtiot, nhnne d• /O� �7 3C /I, in�rrr^nrr n �P�1 1 rS /A/ nnlic� �'y6 3i 7X l� l7 [ 1 am z sole proprietor. gencral contractor. or homeowner(circle ane) and have hired the contractors listed beiow xho the "oilowin= workers compensation polices: cmmmnm, nnmr- 'ltirlrr••• cir• nhnnc a• in nr-nrr rn nnlict cnmr. n� �nrnr. atidrr— rin nhnnc 0• in-nr^nrr rn - nniic� Attach additional sheet if nectsiary :r - .r:•:..Y - ;�....... ._..- _;.:r...r._..._.• „"'1' _.__._. . .ram.• �.a�e•t•. ....w..:_. F:ururc to s'ecure cuverace as required under tectton=`A of t►1GL 1S3 can lead to the imposition of crtmtnal penalties of a line up to S1.SOU.UU anutur unc cars' imprisonment :ts wC11 :ts civii penalties in the form of a STOP WORK ORDER and a fine ufS100.00 a day against me. 1 understand that copy of this NI:rtcmcnt mat be furnvarded to the Once of 1nvc3ticztions of the DIA fur coverage Verification. 1 rio hercnr ceriir ultrirr the pains and penalties ofpetjurt•that the information prorided above is true/and correct. i=r.acu; Datc 6Z���i97 x Prig: W, c Phone; •�►�i'eiai use uni�• do not��•ritc in this area to be compicteti by gin•artotrn o(rciai .` • t cite nr tnw n: permit/license d r7tluilain:Department ClUcensina Huard it lmen's orrice t.. _ .neck irimmcdintc respunse is required QJeeet f" is Ctllcatth Department phone tt• r,Ulhcr_� cons n;t nerNnn• - r — D Informatioii =A Instructions MassacHusells Getter-:1 Lzws chapter 15'_ section 25 requires all employers to provide workcrs* cnmpc:a:.a;m emnlm ces. .4s quoted born the "ta��'".mt C911plovee is defined as every person in the service o► ::n1)the:une;:r : cor;imc: of hire, etpress or implied. onl or-written. ,3 _.. 'Ji. An emplurer is defined as an individual. partnership. association. corporation or other legal entity. or any two or the rure__oin:_ en:_a_-_•d in a joint enterprise. and including, the I' :1 representatives of a deco ascd employer. or recciN er or tntstee of an individual . partnership. association-or other legal entity, employing, emplovers. Ho«•e'.•c o\\•ncr of a dwelling house having not more than three apartments and who resides therein. or the occupant of nine dwelling house of another%vho employs persons to do maintenance;construction or repair wort: on such dwelI ill _ to shall not because of such employment be deemed to be:gin or on tl:e :_rounds or building appurtenant there VtG;_ :1t::rner !1' section 'S also states that eti•er%• state or local licensing agcrte}'shall Withhuld the issu.nce c. ('fa license or permit to operate a business or to construct buildings in the•communi`ealth for and :c::nt N%•Ito lens not produced acceptable el'idence of compliance with the insurance covernl* required. neither tine commonwenith nor any of its political subdivisions shalI'enter into'any'contrct for:he per:�rill c::cc of`public work until,acdeptable evidence of compliance with the insurance requirements of this c::a:- hce:: oresc:;tcd to the contaac:inc authoriTY- �l)l)ItC�n15 P!case -iil in the workers compensation affidavit completely, by checking the box that applies to your situa::o,, a: suc7ivin_ =otnt;any i:atncs. address and prone numbers as all affidavits may be submitted to the Department of 'etc :serial �cc:de::ts rot• cot:rirmation of insurance cove-2-C. Also be sure to si12 gn and dale the aflidati'tL r1e -should be -c:urt:e� :o tl:e bin or town that tite application for the permit or license is being, *true=te�- 1`1 :iic Decartment of Industriai Accidents. Should you have any questions rer:rding the "law-or if you are o 0b:�in workers* bombe:S :ion policy. plerse c-il the Department at the number listed below. Cite :)r Fwvns P!e_'r_ �,e. 'urc :ha: the aff ica� it is compiem and printed legibly. 17:e Department has provided a space at the bor.;.- the :• �a�it for "•ou to fail out in tite event the Office of Investi`ations has to contact you re`ardin_ the appii='.. be :o till in the pe.-;rtitilic��se number which will be used as a ttference number. The affidavits may be return. -::e D:carme::t by mail or FAX unless other atran:e:nents have been made. The ._Xj5c_- of Investigations would like :o thank you in advance for you coopemtion and should you have any que=:: pi:cse do i:ot Hesitate !o _lye us a call• Z. itte Decar,mient-s address. teieri:one and fax number. The CommomveaIth Of Massachusetts Department of Industrial :accidents -• office st Investigations - 600 Washington Street Boston, -Yi 02111 fax T: (6I7) /Z7-7749 ni:unc =. 6i��, -- -=900 V::. -OE. 4013 or _ - mop 1w , y .{...... {t:.M.{•ff.Ff,.>fiY trr,•r.}};:..:a:::i.::{o:»•n:{.,.u{{}.;}};z�r�:}Ai:Jf:..n.rna: t.}}:fir.trek}giio}'t}};+Ft�9,Sid•14<.'. .safofiG:tid:c� b!r`Rduko�'c}.... .•,.1.,.,v.,-...� .y: <'.. '• ... . '. .. ... • .. ''t. �•� : k ; ....�' � os'rr� •�'DA►7E(MWDDlY1I) i {•r ^%.^A•.•`.�:}}•h'Y^..}7��.,.rrRrr^"woDw"�v:.i'°:v.;..K::t'::.::�. ;:}3.'%d}�3}.t#:%:'d'tt�.ch*:$7>v:f::v;�✓•":S.a.,t'•0,C;;a�°aStut.:•;:i�7.r,t7•rt.w:�{.`.';;el�r ":�c:.•.�tx{ ya .td . . { . ! W:. 10%16/97tiy. C 1.010 x ,s PaooucER,r F, r +vn •; . �; i a': THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ; 2ONLY `AND''CQNFERS*.,'NO `RIGHTS UPON THE CERTIFICATE Court. Street 'Insurance Agency :Inch : c tHOLCER,`THIS CERTIFICATE.DOES-NOT AMEND;'EXTEND OR Court St ,'' r., ;kA. _4 # ; ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. AFFORDING COVERAGE 4 :`. Plymouth 508 747-7670 INSURED A-oe� COMPA'FALCONE ROOFING a Y'`�'� `; a TRAVELERS'.: 4 5 2 RAYMOND AVENUE COMPANY y. E4, 1::,"I ✓r �; / M'� � f.r- Sf �- ; tf� s C! .i y} mot• , J^dK3,'. TA PEMBROKE MA 02359 w , ..... ..ii......:,•.f%r^r?{{•}xccr:t:;:}:.,..,..,.;r:::;:.x}r..:t•}:;ra;:;•.' ••,:•»c;:y¢•{.'iii:%;.'t}<;o:;..:..:':'?o 'u'f:S:'i}Q•%. w�,... ;. ;. .A; ,.. ..�,.}•• :•�.�• fit. rr...:.:{:•::.. v::....,{::. rrr.{.... wl }vr..;virfa. n..vgw: ,;} T`•j. r:..raa„-:i:.t:•r.-�.•.�.:��-.,•'L}}:t`..iii:{lc:cc:{{•x{S}.'-::•:}:}}.'•:r.wrrr.»�r.. k... d;;:r,<r. ,{{• �y..L•{ c�3;�?:•y;;a` .. .. .. : �' '' •X ,$ ':'THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED.TOFTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD _ ,INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY'CONTRAQT•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. `VAw4wfq t•4 ��; '�� `�` ,' r CO TYPE OF INSURANCE J POLN:YNUMBER a;Y �. POLICYEFFECIIYE' POLICYWnRATNNFAV, � MITSL7R a1DATE(MWDIMM,'i Dl (NWDD/nl)', K �•`i .L 1 e A GENERAL Luu31uTY GENERAL AGGREGATE ,)eA s3 0 0 0 0 0 i X COMMERCIAL QENERAL LIABILITY CGL 1616 8 5 K 0 3,/10 7� :(�13/ _0 ;9 S.-PRODUCTS=OOMPlOP ACaO s 3 0 0 0 0 0 CLAIMS MADE CX=R }' PERSONAL'rL ADV NJURY 1 s3 0 0 0 0 0 y' OWNERS&CONTRACTORS PROT r I°Jr I EACH OCCURRENCE �3+"n 000000 °' FIRE DAMAGE(Any one Nre) 6100000 �l`� r •.„�� `LJ.t;y er 1 ) ) MED Ems'(My one person) :5 0 0 0 AUTOMOBILELUUIWTY $. `)� A� d .t AI NY AUTO ( MBI�Nm SINGLE UMR >P +t ALL OWNED AUTOS ..1 Y: fi Wit,' 4x .. t ,BODILY IN ftM �` ! k 6CHEDULEO AUTOS >t s (Pef P—) �, HIRED AUTOS r BODILY INJURY y.K ' NON•OWNEDAUTOS PROPERTY DAMAGE' � II }�? _ GARAGE LIABILITY h �: i � , AUTO ONLY•EA ACCIDENT ti4 4- ANY AUTO i, f t'', /a /g d /r• a y .. ,�.:.i-M ; z l 4 OTHER THAN AUTO ONLY: t } ;�; .. ' . ! _ .�• X � ,_�e 4 A"WeAe�•iACCIDENT : S. AGGREGATE ExCESS LIABILITY EACH OCCURRENCE L 1 y' UMBRELLA FORM s / : /�� /'Y / AGGREGATE e •• OTHER THAN UMBRELLA'FORM Vic• A WORKER6 COMPENSATION AND Y +'- 1 y�� ' a IawE.w . -.. .. TORY LIMITS A EMPLOYERS'UABIUTY 7PUB317X413497 '07/Y2/9T: O7/`T .98 .ELEACHACCIDENT Ewa i100 000.4. THE PROPRIETOR/ pql INCL + ` PARTNERS/EXECUTIVEr r + } f r a' •ri ;'[ EL DISEASE-POLICY LIMIT i5 O O 000 =4„ OFFICERS ARE: XCL 'T }}.:+ :', TEL DISEAgSE.EA EMPLOYEE $10 0 0 0 0 x OTHERw . {. DESCRIPTION OF OPERATIONBILOCATION&NEHICLES/SPECULL ITEMS .. } l. }': •�+�.. � �>k't+ far y =c`p3� _ fir' � ( '�: � s .� •�# J ��' riMig M&M " - � '.:�''r Wit. ��;f�• `"r�,: ''����x - •i:S:4rr.{?]G4:t'.C%•:t Ati4h'�{y.WAY]D•A:tr{r�iN:OCt 4v,49,C:v�•;'.� JC\ v.+rr yi••ry.,.{�;y� yµY� �•,y�y-��--((``'' r:4o„{ryfi;:•r•;:x}y}.:{tfrrlcp•{., rr;; rr{^i'}:�,'':: h:+':t•:E�5 �ir?.�•:'I.5' �l •.,8. •.th is}{ {+::AFL+fk�'..�{�r•''J�Ci C;� �.}{�+•�� r ++. ' ± y '• •. •, v{..: ANY�oF'TIIE•ABOVE-DEfCRIBED POLICIES BErCANCOl®BEFORE THE .. � ,r, tfe.�K:�fj' .!' '746 �►-'7�`?, > i DA EREOF, COi1PANY W ENDEAVOR TO YAIL k r ' ILL gi• ; Jt -yk. ,y1 -+v-�•k ;:1vt+`�SRk,�rt-�,.,bNMkMi,rw's' .� ' +• f '�l ih} 6; ` 3 DA ,�a,��."� p`..N•O.•TICE'TO THE. HOLDER NAMED TO THE LEFT .. ,4 ..,y R 1 t '-�1T S r''�:..V•Gw's'!"'�'� Y,I �•;.1,.,c �.: ..W•l+J�at.iSp A�: •. Roberta Kossow i - i t�( .{a'�+ BUTFAILU TO' LEUCii�` ( NO TiONORLIABILITY`, 176 Main Street <: oR D E.'"COMP OR REPRESENrATNEs. W. Barnstable MA 02630 A� A f •a•. 1................................... ................ .:::::..::.A..r.,rv:::.::::r.::.:.,:.r n..:,.r:.::.::.:::.v.�: r..:.r:.:rn .......: .::::::::::::::.:::::::::::::.::::..:::::.::.:.::::. ... ate. .'��&: i :.1..! ,.;, �!'r7� '':- i2F..r;.riy:l,k;�.it,�A(A'fN)�A'. ';•'S\ ti .y^w./ v. vo 4i,.,�t ^i':i` i f �q\ 1✓t. •'i:; �.��i "'i.' 1�•'�� :1j1.S'1Y�. 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Y;<af .S yt�} J y T.1:�\ .(1��' i!�Fx \t. ,�",1�� ,�i y..,d a• �y' y• y�!},) f t r y.A ., I 9 i S+ J� �).artJ.w r•ls , �. s� s7j':' ��'.��, l•� 1 1 1kA A ;� ,S. �.�. 4 t ,1• 1 t'Y'! ..S 't 4'a � i � , f . 1�� sAt. 3 4/ 1 -.('�Y�eiv •�' O r "�::W��y � ,:.{I '(,h '��vv-�i / ,,S rr •,'� .��, :r a d .r'\ �..1�•, t� .�- fr i�\\ tit .ti Er. ) �}'"� C ,' J�.. t, F' ,•� J—ROVEMEMF cow , �•f � (•s!Y '�h{}'ia '1''� s 1 •�A �` ?I4•. !r�r•�`fk ��,n'7 - �ii�ri • •. •• ' '. ,7� ' �7�'j3�'ij`�+'. k srM ,t a�,w =`y!^ L�'`�t z��,�* ,. i `. .`,• IV-till. red TAlcoke WOW—NA 02359 Y. c t � � .' ' � 't f'i' W�..r.�Te ^�4•, w h,iW JK T'r-a„ in. � rlr:3 ) c !f' .` '1'-C'' .i'.war.. a... :w�.+rF•-'.,,4� end ..7V:. .GYkA� ,a 1 .. ✓ , ,r r aF. r = 't7,',r �! ' 1� rte/,,�f � \ r C • - ,' r ,?h y 'a ? f t }', YI ' i' y� .,) ) tJt1' r x •' . .. •r> t P" .,.,' <j.J�.V yT ✓. y'tf,.,. v'r'r.- .=.,i< /1 -.�,.. J ,o:`,d. OE.;�FNENT QFTPtlBIICrs#(#T T �DNST�N SUPERVISOR 1 �f rl if 0 ill oil' A CONE 4,it2;lt�IIYNOND •:RENBRUKE,`+NA 42359 ,. �'j`;. - , '. • �,: .1 _ ' .� �{. � sy�•, Ala r_ } Y.� -.r, ♦'� � ,;,?� r. .,�E;: ' ' . , r air.•s •• '.t r'• ���� �'7 !;•. �l. qsr, .�: �',, e.',t., �'��.�: rt} i rh r .� 1•. i`,t� ` ,t'', � ) '. � i r �"1,. r' `•%•- f' `f�.:. :-r 5O.'r `r•, w ';✓r',j .,. .,y:: .,}.{.' .t r)e�1i ai•.� �1,t �,�:i l.•i' 1 t .!�'Y.t. ''ti,. •.S, .,' .. `i.,. , "\^. ,,1.:Y .i !f/h"ri .N7 .,�, if �. :t. <�� 1..:7...if.o-s., :�.r)• "s'•54,v,,.. ... � . ':r:" .. 1 '.t.•1 ty ,r\ � ',4�,1'3�,'. ,t At .,r ,,.'rf�' t'• , �\ ;..t'''tr,• i �THE r, 0 The Town-of Barnstab e 9� e$ Department of Health Safety and Environmental Sen'1C� � Building Division 367 Main Stter,Hyannis MA M601 Raiph Crosser. Office: 508-7,90-6227 Building Cam:-- Fax: 508,90-6230 For office use oniv Permit no. Date AFFIDAVIT HOME MWROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION ` „ t air, modernization. MGL c. 142A requires that the reconstruction, afterations, renovation,adn,ti repair, to any pre-existing i3=tJ! n- conversion, improvement, removal, demolition, or construction of an owner occupied building containing at feast one but not more than four d con ra units ,or with to structures which are adjacent to such residence or building be done by registered certain exccptions,along with other requirements Type of Worst: T� r� Est.Cost Address of Worst: .57- Owner's Name �D°ems m5s� Date of Permit Application: 4& 7 I hereby certify that: Registration is not required for the following resson(s): Work excluded by saw Job under 51,000. ` Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PFIIMIT OR DEALING WITH UNREG - CONTRACTORS FOR APPLICABLEPRO GRAM ORARAiV'I'Y FUND UNDER MGS.O 14Z.�� ACCESS TO THE ARBITRATION PR SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner Contractor Name Regiss=tion NO. are 763 G / 73 �o-&A) , sia oo/z — cy) �- ��WO ❑ Owner's name & address ❑ Contractor's name, address &telephone number ❑ Site Plan Review Number ❑ Contractor's signature Plot Plan ❑ Workman's Comp. form. Copy of Insurance Compliance ❑ Construction Super's License OR ❑ Control -Check expiration date -Unrestricted (Not 1 G) ❑ Road Bond(5-2.1 Zoning Ordinances) ❑ Application Fee ❑ Permit Fee ($8.10/$1000 of value) , ❑ Property Owner must sign Property Owner Letter of Perm ❑ Projects requiring the'use of a crane must complete the 1 Commission q-forms/bldgpermits/permitcheckl fists rev. 101106 Engineering Dept. (3rd floor) Map L G ? Parcel ��, Permit# House# / 7 3(,,::) -�U Date Issued Z-Z(, -J !P- Board of Health(3rd floor)(8:15 -9:30/1:00-4:30)k y!Ee, � /Yl Fee Conservation 0ffice14t1� nun. ) SEPT�Coo ST BE INSTLIANCE 19 O/-C/7/ P [(PI F s� r • lei S�•,�P QBLE ENVIRODE AND S T8WN OF B TOWCNS Building Permit Application Project Street Address /-731r igq'/N Village �✓t+'S�- Owner / CbC/r7-A O/lD ISOC w Address 2 59 M-47A/ Telephone S;-D$ • 3-I5' -0$ 3 1 Permit Request ��t/G LlG✓i /X��vy�,►�t _ /ty First Floor LYL0 square feet Second Floors square feet Construction Type sti�@ted Project Cost $ JCS,M-TO Zoning District RF Flood Plain Water Protection Lot Size ( / Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure '1 Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: fXFull Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) D Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing 2 New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: *Gas El Oil ❑Electric ❑Other Central Air ❑Yes 9No Fireplaces: Existing New Existing wood/coal stove ❑Yes ANo Garage: 9 Detached(size) s/M�,Qt eAfZ Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# i Current Use Proposed Use Builder Information Name -mil e1WV4� 1C M-41/C_ Telephone Number [ - 1R 3 ` 31v 1 4 Address �4� �rn.ald 4-L-6-- License# v v� �p�j -r "'a - 644z A.2 3 Home Improvement Contractor# /2 35-7 L- Worker's Compensation# 26 Lf 9 3 `J y NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU DATE f 2�--��7 BUILD P M T EI1I FOLLOW G RE ON(S) FOR OFFICIAL USE ONLY ' PERMIT NO. DATE ISSUED MAP/PARCEL NO. I ADDRESS VILLAGE - OWNER DATE OF INSPECTION: ' FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: v ROUGA FINAL GAS: UG�- FINAL FINAL BUILDING c met o Is I V�t,1 A DATE CLOSED 01 Or go O ASSOCIATION P O. t �aoo?C,o y� 0 � C) q ❑ DE] ■ ❑ ® ® L11 m I Ell I I LLI PROPOSED DOOR W/S/DEL/TE FRONT ELEVATION 4; PROPOSED 12 X 18' DECK ❑ E ❑ PROPOSED S TAIRSEl i is STEP �V IEPROPOSED WINDOW TO REPLACE DOOR LEFT L'LE VA TION PROPOSED ALTERATIONS .; i ATE 24 oa SENT SUNNI3 E ENTERPRISE l 1 s os i 12/2/08 Loc"ON 1736 ROUTE 6A ' SARNSZOM, MASS. DESIGNED BY . SWEETSER ENGINEERING 203 SEIUCKET ROAD F. 0. BOX 711 'spas ras6sao SOUTH DENNIS, MASS 02660 50&JB56991 SCALE 1' 0 4* DRAWN BY cm LE No. 17.8 2008 ©&R. SWEETSER ENGINEERING FILE 06795 d1736 RT 6A_R6.deg. SHEET No. 1 e ❑ Ll LIE10 , r -r f� PROPOSED 12 X 18, DECK PROPOSED STAIRS REAR ELEVATION PROPOSED 12 X 18' DECK 7-11 r flD POST & RAIL LU FF1 A v J i REMO l E EXISTING DOORWA Y RIGHT ELEVATION PROPOSED STAIRS PROPOSED ALTERATIONS `"" "°1738 i o 2a 08 SENT SUNRISE ENTERPRISE l 18 08 12/02/08 LGCA-n0N 1736 ROUTE 6A BARNSTABLE, AASS. DESIGNED BY SWEET= ENGINEERING 20J svzlmEr ROAD P. 0. BOX 713 ^f SOUM DENNIS; MASS 02660 50UJBS6900 =JB16991 SCALE 1 iO c 4 DRAWN BY C LE No. t 738 2008 ©S.R. SWEETSER ENGINEERING FILE#6795 #1736 RT 6AJ26.dwg. SHEET No. 2 I , i 1 N TAIRS ROOF BELOW 2x1O METAL HANGERS EXISTING HOUSE NEW WINDOW TO BA 7H ROOM REPLACE DOOR ,—4„ I o LIVING ROOM ❑� Closet POST r2EX/S77NG L V L i BEAMS ABOViE LAUNDRY F I) BULKHEAD I I Sloped Ceiling Sloped Ceiling it ❑ REMOVE EXIS77NG DOOR � p IBEDROOM KITCHEN d BEDROOM i II MIDDLE ROOM fR0 T RO fff I I ROOF BELOW 3-1/4" OUT OF SQUARE WIDE (Left To Right) I FRONT ROOM SUN ROOM SUN ROOM NEW 3=0 X 6-6- DOOR W/S/DE Ll7F I REMOVE EXIS77NG WINDOW 12'-�" SECOND FLOOR .31' 6`3,, 4 32'164 FIRST FLOOR. EXTERIOR WINDOW & DOOR SCHEDULE: 4 •' DESCRIPTION ROUGH OPEN. UANTITY PROPOSED' ALTERATIONS "o 1�3B i 1 oATE 24 os SENT SUNRISE ENTERPRISE 1 2/2/os LOCAnON ' 1736 ROUTE 6A BARNSTABLE, MASS. DESIGNED By SIPEETSER ENGINEERING • NOTE THAT WINDOWS DESIGN MUST MEET THE NEW CODE WIND LOADS ff 203 SETUCKET ROAD P. O. BOX 713 ° -ma69w SOUTH DENNIS, MASS. 02660 � MARUEAQUEEEL- SCALE 10 a 41 DRAWN BY CRS LE No. 1736 2008 0 S.R. SWEE75ER ENGINEERING FLE #6795#1736 RT 6AJR6.deg. SHEET No. 3 ^ ^ 2X8 FLOOR JOIST 24" o.c. I h SECOND FLOOR -1.75 X 5.5' L It HEADER 4X4 POST _ 1" BALUSTERR S (6'0C) FIRST FLOOR TOP OF FOUNDA 77ON ELEV 99.90 BOTTOM OF SHINGLES d 8"DIA CONC PIER 2X8 FLOOR JOIST 24" o.c.• W124" DIA.18IGF00T- 2X10 DECK JOIST 16" OC METAL JOIST HANGERS CROSS SECTION PROPOSED ALTERATIONS LAN"°1�8 E OATS CUENT SUNRISE ENTERPRISE 1 F24 08 REV. 11 18 08 12/2/08 LOCATION 1736 ROUTE 6A BARNSTABLE, MASS. DESIGNED BY SOVETSER ENGINEERING 203 SE7UCKET ROAD P. O. BOX 713 5mine9av SOUTH DENNIS; MASS 02660 Wa,M6991 SCALE 8 s a 4' DRANK BY C� LE No. 1 Pa 8 2008 0 S.R. SWEETSER ENGMEERING FILE #6795 #1736 RT 6A—R6.dwg. SHEET No. 4 r I i . I i I I 17'-11 " To Frame 2x1O STEPS PROPOSED DECK I I NEW I THICK POURED STAIRS CONCRETE FOUNDATION i I I 2,-8„ 12' : 2x10 EXISTING HOUSE r NEW WINDOW TO BA TH ROOM REPLACE DOOR ,—4„ • ><. I L114NG ROOM 0 POST r2 EXIS77NG L K BEAMS ABOVE LAUNDRY El f i I � BULKHEAD I II Sloped Ceiling REMOVE EXIS77NG DOOR � O I I CIO KITCHEN PROPOSED SHED & DECK PROPOSED S' ED `°179e f - ! DATE CLIENT '11 18 08 SUNRLSE ENTERPRISE. R 12 2 0 8 LOCATION 1736 ROUTE 6A ' ' BARNSTABLE, MASS. i DESIGNED BY SWEET= ENGINEERING 20J SMICKET ROAD P. O. BOX 7f3 SOUM DENNIS, MASS. 0266LI f° - SGR.�S6900 JARJ8S 6991 SCALE 1 n a 4, DRAWN BY Gf�S LE No. 1.36 2008 ®S.R. SWEETSER ENGINEERING FILE #6795 #1736 RT 6AJT6.dwg. SHEET No. 7 1 2X10 RIDGE 1 X6 STRUTS 16"o.c. 2X8 RAFTERS' 16"o.c. 2X8 CEILING JOIST 16"o.c (TYP. 12 8 I 1/2" CDX PLYWOOD (Or Equal) (TYP.) 8'-2X4 STUDS 16"o.c. 8'-2X4. STUDS 16"o.c. (TYP.) 36"X6'-8" EXTERIOR DOOR (TYP.) 18 JF4'—6 TOP OF FOUNDATION 8" DIA POURED CONCRETE FOUNDATION (SEE PLAN VIEW) 18.' CROSS SECTION • 18' . . 8" DIA POURED CONCRETE PIERS W/20" DIA "BIG FOOT" SHED PLAN VIEW a CONCRETE PADS (TYP.) 1 DOUBLE 2X10 PT BOX .. rn 2X10 PT JOIST 16" 0.C. 2X8 PT SILL. PROPOSED SHED No.1736 ' SHED FOUNDATION & FRAME PLAN 11TE 18 os E"T SUNRISE ENTERPRISE REV. . 12208 12/15/08 LOCATION 1736 ROUTE 6A EARNSTABLE, MASS. ' DESIGNED BY SWF'ETSER ENGINEERING 20J SETUCKET ROAD P. 0. BOX 713 °q 69� SOUTH DENNIS, MASS 02660 saa>ase�i SCALE 1• a 4• DRAWN BY CB LE No. 1.7i 6 • 2008 O S.R.'SWEETSER ENGINEERING FILE #6795 #1736 RT 6A—R7 dwg. SHEET No. 6 I x(� GJ11o'1 EXPOSLLPIG 11-3!s� Ell Lil. . . ITT 12" MAX CONCRETE EXPOSURE ! Y Xs SHED FRONT SHED RIGHT SIDE vi A SHED REAR SHED LEFT SIDE PROPOSED SHED r`AN No.1736 ` I i i'�1 s o8 CLIENT SUNRISE ENTERPRISE • REV. 12/15/Oa LOCATION 1736 ROUTE 6.4 BARNSTABLE, MASS." DESICNED BY SWEETSER ENGINEERING 203 SE7ZICKET ROAD P. 0. BOX 713 s e Jes eeao SOUTH DENNIS, MASS-02660 69^91 SCALE 1 c 4• DRAWN BY CRS LE No. 1736 c 2008 O S.R. SWEEISER ENGINEERING FILE i#6795 /1736 RT 6A177.dwq. SHEET No. 5 4 i I n I H6 TIE W/8— 8d G A-L NAILS SIMPSON AC4 M AX. POST CAP SIMPSON 14- 16d NAILS LCB44 POST BASE 1 /2" STEEL . BOLT - ; NUT & WASHERS 1 2 PER BASE 91 CONNECTION DETAILS 2X8 FL OOR JOTS T 24" a c. I I �. ZA SECOND FL OOR 3/$" X 8" Lac & L VL HEADER 4X4 POST & WASHER 32" O.G. 1 BA US TERS (6"OC) r SIMPSON FIRST FLOOR i $" WIDE ALUM FLASHING Wi8 T�8d GAL NAILS TOP OF FOUNDA TION ELEV 99.90 BOTTOM OF SHINGLES { 2-2XIO BEAM SIMPSON AC4 MAX. POST CAP —16d NAILS SIMPSON j L D21044 SIMPSON POST �� 2X10 JOIST 1/2" STEEL BOLT 8 DIA CONC PIER NUT & WASHERS „ Al 2X8 FLOOR JOIST 24 a c. HANGERS 2 PER BASE W124 DIA. B/GFOOT (TOTAL OF 4 PIERS) 'j" R 2XIO DECK JOIST 16" OC r, I CROSS SECTION P _ PLAN No. ROPOSED ALTERATIONS ® DATE CLIENT 10 24 08 SUNRISE ENTERPRISE � REV. n 11 Zl8 08 � 2/2/08 1736 ROUTE 6A LOCATION 5/4/09 BARNSTABLE, MASS. DESIGNED BY SWEETSER ENGINEERING 203 SLE ET ROAD P. 0. BOX 713 off, fox. SOUTH DENNIS,' MASS. 02660 508.385.69C10 508.385.6991 SCALE 1 a _ 4 p DRAWN BY lilia7 ILE No. �36 2008 O S.R. SWEETSER ENGINEERING FILE #6795 #1736 RT 6A_R8.dwq. SHEET No. 4 k l-`s 1 1 X6 W 1 X2 WOOD RAKE WC WOOD SHINGLES . 5" EXPOSURE lilt 11 SIN rn o iICNlilt II::j CQ qg�� 12 MAX CONCRETE EXPOSURE { 1 X4 & 1 X5 CORNER BOARDS L _ J r SHED fR O N T SHED RIGHT SIDE 'j lilt - a " i i I I I I I I 11 9 � tx 5 18 ' 12" MAX CONCRETE EXPOSURE SHED LEFT SIDE SHED REA R PRO P O SED SHED LAN No.173s ! i s 08 CLIENT SUNRISE ENTERPRISE REV. 12/2/08 j { LOCATION 5409 1736 ROUTE 6A BARNSTABLE, MASS. DESIGNED BY SWEETSER ENGINEERING 20J SETUCKET ROAD P. 0. BOX 713 5os.3es.s9oo SOUTH DENNIS, MASS, 02660 fax. 5oB.3B5.6991 SCALE l p 4 DRAWN BY CRaS FILE No. I73E3 2008 0 S.R. SWEETSER ENGINEERING FILE #6795 #1736 RT 6A—R8.dwq. SHEET No. 5 i ---------- ------------- - — -— - - — - - ---- -- - - 3,51 [> 2X8 CEILING JOIST 16 „ o. c 1 /2 CDX PLYWOOD ( TYP . W/SIMPSON PSCL PLYWOOD CLIP ( Or Equal ) ( TYP . ) 2X10 FLOOR JOIST 160. C. 8 - 2X4 STUDS 16 o. c. 1 ( TYP . ) TOP OF FOUNDATION Z 0 1/2" X 12" STEEL ANCHOR BOLT c 1 W/NUT & WASHER PER PIER 8 DIA POURED k� CONCRETE PER F 1 TOTAL 0 0 ( SEE PLAN VIEW) CROSS SECTION 8' - 2X4 STUDS 16 o. c. ( TYP8> DIA POURED 36" X6 8" EXTERIOR DOOR CONCRETE PIERS �g W/24 DIA BIG FOOT � 4 '- 6 „ CONCRETE PADS ( TYP . ) a DOUBLE 2X10 PT BOX 2X10 PT JOIST 16 " 0. C. r `3 —4 _ 6 4 _ 3 yy 4 2X8 PT SILL ; w �8 SHED PLAN VIEW j' PLAN No. PROPOSED SHED 1736 4 SHE'D FOUNDATION FLOOR FRAME DATE CLIENT i 8 os SUNRISE ENTERPRISE � 12 2 Z08 q 5/4/09 LOCATION 1736 ROUTE 6A -41 BARNSTAME MASS. DESIGNED BY SWEETSER ENGINEERING 203 SETUCKET ROAD P. 0. BOX 713 r off SOUTH DENNIS, MASS 02660 fox. 508.J85.6900 508.385.6991 SCALE 1 _ 4 DRAWN BY CRS FNo- 1736 a{ 2008 0 S.R. SWEETSER ENGINEERING FILE #6795 #1736 RT 6A_R8.dw9• SHEET No. 6 r . ro of 5 17 - 11 " To Frame 2x 10 S TEPS �t PROPOSED DECK4, NEW . � x SHED LOCATION % STAIRS I IL CA p 2x 10 METAL HANGERS �2 EXISTING HOUSE NEW WINDOW TO BA TH ROOM REPLA CE DOOR -6 4 » s. LIVING ROOM 0 POST 2 EXIS TING C l/L BEAMS ABOVE LAUNDRY yy l BULKHEAD Sloped Ceiling REMOVE EXISTING DOOR CQ KI TCHEN _ MIDDLE ROOM FRO IT ROOV { i E FRONT ROOM SUN ROOM NEW 3'-0"X 6�_6» DOOR W/SIDE L I TE REMOVE EX/STING WINDOW PROPOSED SHED PLAN No. DATE CLIENT SUNRISE ENTERPRISE 11 18 08 REV. 3 12208 PROPOSED SHED & DECK 5/4�pg LOCATION 1736 ROUTE 6A BARNSTABLE, MASS. DESIGNED By SWEETSER ENGINEERING 20J SETUCKET ROAD P. O. BOX 713 off SOUTH DENNIS, `MASS. 02660 fox. k 508.385.6900 508,385.6991 SCALE 1 _ 4 DRAWN 8Y CRS LE No. 1738 2008 O S.R. SWEETSER ENGINEERING FILE #6795 #1736 RT 6A_R8.dwg. SHEET No. 7 y BA^STAISIE TOWN OF BARNSTABLE BUILDING INSPECTOR Location .. Proposed Use APPLICATION FOR PERMIT TO T TYPE OF CONSTRUCTION TO THE INSPECTOR OF BUILDINGS; The'undersigned hereby applies for a permit according to the following information: Zoning District Fire District ... Name of Owner Name of Builder Address ._rrS.'Str:Trr?r:W;6_ Nome of Architect Address : Number of Rooms ..Foundation .... Exierior Roofing Floors ... Heating Fireplace Difinitive Plan Approved by Planning Board ... Interior ^A(:^AiA^9r:<dA...xjr:^.C^rAi^fL^.,....Plumbing ...^...GrySrrR^. .Approximate Cost i.jissff-1 19 ^Co Diagram of Lot and Building with Dimensions PA-fitfl ^ oJAy'J^^'ouT BfRsiO UV£S XoFT /l/;^ihf jio^sa b a I V "vr / 1 r "^jnxo • J I I V)^//40t7^ xopi A5L LI (//Vt S^S.)/T 5/1'-Y jBAcH Do<3 a iv »?^or wA-j^ Fi^Si 30 / <0 N^^VaifK I £ci?i-£r j'x#^r /•KmeiW ^/V3rL-3^^^-I I hereby agree to conform to all the Rules and Regulations of the Town of Bornstoble regarding the above construction. Name Churchill,Robert S;&Carol 03 No ...??02.Permit for family dwelling Locotiin^B.^..S.-treet West Bamstable Owner Robert S,&Carol Churchill Type of Construction Plot Lot Permit Granted J™.?..8,.19 65 Dote of Inspection 19 | il Dote Completed 19 ji PERMIT REFUSED Approved 19 I ' i.'. V y ir- h '.•7 t i •if . V > •/fc.. Si.- .