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Home My WebLink About1834 MAIN ST./RTE 6A(W.BARN.) ��_ NOo 152 1/3 ORa4 ,ad �I c �I 4 4� t )I G C n �� ' rl f U ZS3 oFIKE Town of Barnstable *Permit#o Exp 6 mor t4cjiom issue date . . PERMIT Regulatory Services e a BARNSTABLE, 9cb ,63 5 2015 Richard V.Scali,Director TOArF� UF BARNSTABLE Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 I� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address ) f.3 V kn a lid- 5,r W ' Few►ti r A61 Residential Value of Work$ �/�� c�(! Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address AP,/ A/C,- Contractor's Name UL Z q T ti( _ Telephone Number m- 7 7(— 3 49 Home Improvement Contractor License#(if applicable) Cy I Email: Construction Supervisor's License#(if applicable) 0 -7 1166 0 �rkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ the Homeowner EY I have Worker's Compensation Insurance Insurance Company Name •, vs Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) PRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 1t ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows '#of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner ist sign Property Owner Letter of Permission. A copy the e I rovement Contractors License&Construction Supervisors License is requi SIGNATURE: Q:\WPFILES\FORMS\building permit formsEGESS.doc Revised 040215 Estimate 995 Date Apr 23,2015' Cape & Islands Construction Co. P.o.. Po Box 210 Centerville Ma. 02632 - Terms 508.775.7663 • ' Ship Via i"a f 1 _Ship Date Bill To -Aestem Foster 1834 Main St. W. Barnstable, Ma. 774-487-7776 ID D- • . • • CERTAINTEED Certainteed Shingle Roof 10,800.00 Strip existing shingles from roof. Secure any loose sheathing. Install Hicks brand vented aluminum drip edge where vent able and white drip edge otherwise. Install Wip brand Ice&Water Shield to all eves, rakes,valleys and all protrusions. Install Rhino brand Synthetic Felt Underlayment. Install Certainteed Quick Start starter shingles to all rakes&eves. Install Certainteed LIFETIME Landmark architectural shingles. Storm nail all shingles. (State building code requires 4 nails,we use 6) Re-flash all vent pipes with new boots. Install Rigid Vent II ridge venting. Remove and dispose of all job related waste. leave your property looking like we were never there! Provide all manufactures warranties and LIFETIME warranty on our labor, if it ever fails due to our workmanship we fix it,forever! It's The Best In The Business. Please note our wind warranty is also the best And longest available ANYWHERE! I Total $10,800.00 Signature DATE(MMIDDIYYYY) ACCO CERTIFICATE OF LIABILITY INSURANCE smzol4 THISIS TIFICATE IS ISSUED AS T VELYEOR NEGATRVELY AMENDMATION , EXTEND OR ALTER AND CONFERS NO TIHE COVERAGE AFFORDED GHTS UPON THE ABY THE POLICITE HOLDER. ES CERTIFICATE DOES NOT TEAFFIRMATIVELY OF A AUTHORIZED BELOW. THIS CERTIFICATE INSURANCE AND THE CERTIFI NOT CATE HOLDER. A CONTRACT BETWEEN THE ISSUING INSURER( , REPRESENTATIVE ect to IMPORTANT: If the certificate holder is a certain Dpol cOesAmay require qui INSURED,an endorsement•A statement ondthis certificate dToees not`conferDrights,to the the terms and conditions of the policy, certificate holder in lieu of such endorsement(s). coNrACT PRODUCER FRANK L HORGAN INSURANCE AGENCY IN( PHONE E. FA/C No 44 BARNSTABLE ROAD C PO BOX 250 E-MAIL ADDRESS: NAIC p HYANNIS, MA 02601 INSURERS)AFFORDING COVERAGE 33600 INSURER A: LM Insurance Corporation INSURER B INSURED CAPE & ISLANDS CONSTRUCTION COMPANY IN INSURERC: PO BOX 210 INSURER D: CENTERVILLE MA 02632 INSURERS: INSURER F REVISION NUMBER: PERICOVERAGES CERTIFICATE NUMBER: 20102526 THIS CY IS TO CERTIFY THAT THE POLICIES OF INSUNN TERM OR CONDITION OF ANY CONTRALT-HAVE BEEN O OR OTHER DOCUMENT WITH RESPECT TO WHICHTHOIS INDICATED. NOTWITHSTANDING ANY REQUIREMENT, CERTIFICATE MAY BE ISSUED OR MAY POF SUCH POLICIIES LIMITS SHOWN MAY HAVE POLICY REDUCED BY PAID CLAIMS. D HEREIN IS SUBJECT TO ALL THE TERM EXCLUSIONS AND CONDITIONSPOLICY EFF POLICY EXP LIMITS ADDL SUBR POLICY NUMBER MMIDDIYYYY MMIDDIYYYY INSR TYPE OF INSURANCE EACH OCCURRENCE $ LTR COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES Ea occurrence CLAIMS-MADE MOCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ R - ❑LOC $ POLICY❑P JECOT COMBINED SINGLE LIMIT $ OTHER: Ea accident AUTOMOBILE LIABILITY BODILY INJURY(Per person) $ ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED SCHEDULED PROPERTY DAMAGE $ AUTOS AUTOS Per accident NON-OWNED $ HIRED AUTOS AUTOS EACH OCCURRENCE $ UMBRELLA LIAB OCCUR AGGREGATE $ EXCESS LIAB CLAIMS-MADE $ OTH- DED RETENTION$ WC5-31 S-377540-014 517/2014 517/2015 �/ STATUTE ER A wORKERS COMPENSATION E.L.EACH ACCIDENT 100000 AND EMPLOYERS'LIABILITY Y 1 N $ ANY PROPRIETOR/PARTN a ER/EXECUTIVE N 1 A E.L.DISEASE-EA EMPLOYE $ 1 OOOOO OFFICER/MEMBER EXCLUDED? 500000 (Mandatory in NH) E.L.DISEASE-POLICY LIMIT $ If yes,describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD Jot,Additional Remarks schedule,may be attached if more space Is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers'compensation coverage CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2OO MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 �� f AUTHORIZED REPRESENTATIVE ,( !`' � LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERT NO.: 20102526 Lucy Garfield 5/7/2014 7:38:38 AM (PDT) Page 1 of 1 —` pmmzareiuea�C� 1b4&dacAadeM -Office of Consumer Affairs&Business Regulation ME IMPROVEMENT.CONTRACTOR Type. egistration: 1i6�5936 Private Corporatio _ zpiration: 4�9120�=6= 1 CAPE&ISLAND CONSTR—U=CTGON`CO INC. .: KOURI Va- JOSHUA �� 55 ELM AVE. l HYANNIS,MA 02601 Undersecretary Boa f Sachusetts d Of Build. OePartment constr;;c�:ng Re9ulationsof Public Safety License, n S4per,•,or and Standards JO �s-o� o lards po AXKO `��.r•.rr•�• NO CO Mrtnissio Ezpiratio 02i 201; License or registration valid before the.. for individul use only expiration date. If found return to: Office.of Consumer IO Park Pl Affairs and Business aza-Suite 5170 Regulation d Boston,MA 021-16 e 11 v idw houtsignature i Massachusetts -Department of Public Safety Board of Building Regulations and Standards ^---•-u a.uu�u4lUVnSiI}7erviiOT t a License: CS-074660 � mac. JOSHUA X KOUTtf 6 PO BOX210 CENTERVE X MA 0 Expiration 02/12/2017 Commissioner The Commonrivealth ofMassackuseft Deprarhnent of 1'ndustriad Accidents Office o fnvesti ations — 600 Washingtori,SStreet Boston,MA 02111 wrviu.mas&goe/dira Workers' Compensation Insurance Affidavit: Builders/Conti actorslEiecti cians/Plumber's Applicant Information. Please Print I,eg bly Name(Bustin s an.izatiGwhdividnal): ((Y- �h G Address: City/State/Zip:: Phone# �' J (X Are you an employer?Check pprapriate boa: Type of project(Fequired): - 1.ZPI am a employerwith r4. ❑ I am a.general contractor and I to (full and/or par�ium ).* have hired the sub-cmtcasctors 6. ❑New construction �' a 7_ Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑ g ship and have no employees These sub-contactors have g- ❑Demolition working for ire in any capacity. employees and.have workers' 9. El Budding addition [No worbars'comp.insurance comp $ required-] 5. ❑ We are a corporation and its 10-❑Electrical repairs or additions 3111 am a homeowner doing all work of icen have exercised their I L❑Plumbing repairs or additions myself. [No workers'camp- right of exemption per MGL 12.❑Roof repairs insurancevequired,]I c. 152, §1(4X and we have no employees-[No workers' 13.0 Other comp.-insurance require&] *Any applicanrfat checks box#1muyrt also filloutthe section below showing workers'compensation policy information 1 Homeowners who submit dux.affidavit indicating they are doing all/wank and then hie outside contractors-mast submit a new affidavit indicating such. /Contractors that check this boot must attached an additional sheet showing the mane of the sub-contractors said state whether or not those entities have employees. Ifthesabaamtmctorshave employees,they must.provide their workers'comp.policy number. I alii an employer tliat is providing workers'coiirgm saiioit insurance for my enipli7y ees Below is the policy andiob,sgte informadvit. gmsnance.Company Name: � (— Policy#or Self-ins-Lic.#: i4 -- ExpirationDaate: �� 7 Job Site Address- �N h.(� ti�7 CAW/State/Zip: Attach a copy of the workers'compensation,policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A o€MGL c 152 can lead to the imposition of criminal penalties of a fine up to S 1,500-00 and/or one-year imprisonment,as-well as civil penalties in the fans of a STOP WORK ORDER and a Eme of up to$250.00 a,Clay against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for ts3Rnce coverage verification. I do hemby certify urn r .k 'i a td pe aWes of eiluty that the infor miWom prwided aTiovc` bite and correct Si tare: l Bate: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermiHLicense# Issuing Authority(cirri¢one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: r oFt„E r Town of Barnstable *Permit# S 0 Expires 6 months from issue date Regulatory Services Fee , 4� swxtvsTnst.E. v� " $ Thomas F.Geiler,Director s63q. �0 ACED MA't A Building Division 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 Not Valid without Red X-Press Imprint Map/parcel Number 2-171609, Property Address ma's � '^� s % ky. Residential Value of Work dszr Minimum fee of$35.00 for work under$6000.00 ,AJ � Owner's Name&Address 1Cy,:, ^� �/►NL' �' -S�w Contractor's Name Z>lf'v'e,00 AZvt`� Telephone Number 1,7-6 �Gd Home Improvement Contractor License#(if applicable) / Z G C t?l Construction Supervisor's License#(if applicable) / et d `,* ❑Workman's Compensation Insurance X0P } Check one: ® I am a sole proprietor MAR 17 2014 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name TOWN OF BARNSTABLE Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors [l� Replacement Windows/doors/sliders. U-Value (maximum .35)#of windows *Where required: Issuan f this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pro�rty O er st sign Property Owner Letter of Permission. A op the me Improvement Contractors License& Construction Supervisors License is r qui d. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 072110. The Commonwealth of Massachuseft 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 Lezibly Name(Business/Organization/Individual): T�A-yI AAA`-� Address: c�'R v�.�-� r 4 City/State/Zip: A-iLd /A 0 L L 6,( Phone#: ��v > z- d e-i G o Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.t91 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' Y aP tY• 9. ❑Building addition [No workers' comp. insurance comp.insurance t r ell 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ equir ] officers have exercised their 11. Plumbing repairs or additions I am a homeowner doing all work ❑ g P 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.[1 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. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the CIA for insrrrar;e-coverage verification. I do hereby certify n er the pains an realties of perjury that the information provided above is true and correct Si ature: 1 Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority.(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all'employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any'two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair 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." i MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C( )states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ' Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749. www.mass.gov/dia � 66 o dpccc/w4e6ta. • V,ie��yn�cuea �C?� Office of Consumer Affairs&'Business Regulation OME IMPROVEMENT CONTRACTOR Type: egistration: 176606 Individual Expiration:�?9/9 / ^i ;?p i DAVID L.AMESi'� ! DAVID AMES 8 DEER JUMP HILL RD .- ;= W.BARMSTABLE,MA 02668 Undersecretary Qepartment of Public Safety Massachusetts - Standards Building Regulations and Board of B Cry isor SpeCiall'l Construction SUP CSSL-1 "S License* ,� �.. . Licen DAB LAWS g DEER JITW 0' 68 '. WEST BARNSTI'BL� \ Expiration 05123120" dJ issioner ' o �TME T Town of Barnstable Regulatory Services xx Richard V.5cali,Interim 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 /g Al.- / I /�O S��J�' ,as Owner of the subro l P Perty hereby authorize 9 Lam/. n /—?/17 A S to act on my behalf, in all matters-relative to work authorized by this building petmit. I rP/�l1'�i9 (Address of Job) . . **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. L Signature of Owner - ,1 tote of A hcant _ � PP Print Name Print Name THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) Im A ,GC i DATA DAVID AMES - roofing-aiding-windows-doors finish carpentry DAVID AMES r-r-8-siding-Win.-dam, �hamp�,. January 31,2014 Austin&Diane Foster Route 6A Barnstable, _ %'.roAaivsir. MA 02630 <.v . s Proposal for Exterior Renovations -Window ru &Door Replacements " 1. ,Exte'. �r�,,._,-a �- r m All windows described below to be removed and replaced with Ai.'.. r - double hung windows 2/2 le. The windows o 3' ws will have or exterior applied Z�ls and insect screens. Interior window trim on t. - la ced if necessary eP -with th j stock comparable casingg: will be re laced with - - th P Azec exterior� • using, (2)existing double hung/double mulled window sets on 2n� n• • 2 double hung single window units on 1.floor 1 - ^� C • (2)double hung single window units in stairway. p " CA2. (2)Exterior storm doors w • Retrofit and install custom storm door on side entry suppli e O ; Install new Andersen storm door on front entry.(I fa custom; r ' review additional cost for custom door with homeowner 3. Install new interior grills(white)for Andersen French door. O c . X 4. Coordinate repair to lockset mechanism on existing French door. r ` i of repair exceeds allowance the K � additional cost will be reviewed with Exterior trim to be removed and replaced with Azec in comparable d . 1 �` • 6 comer boards ".: = '.... rj �' • 4 door casings O W n I 30'fascia board(approx.) ui 3`� : `' �. 2 window sills ` -5 - :3 sections of al ;, I uminum gutters and downspouts will be removed and _y` 6. Install drip rap flashing over(1)window installed by homeowner. T ......_._.. ::.:<<:_-W tw�7 Total price the above stated work n' .Y : , � � all materials �:,' � _ labor and debris removal 1 r: n acre ce this -P� moral amade ; Proposal silt is to - a P J'm be as folio - De osit of P $ ,850.00 too :....... order the windows. 2^� - `�•a-:, � - pa ent of$3 000.00 - Ym r due u - 0 a - _ 0 windows and balance of P$3,OOO.00 due ocompletion up n of the- ob.Work rk will c . upon delivery of � - P the ery windows. �. I " 1 ease note: Exterior and'interior amtin staining "`"`": ' ''i P g/ tnm is not included in this j ' _ structural damage found after windows and exterior.trim are removed will be rought to the attention of the homeowner, Repairs to such will be billed over and above the contracted rate on a time and materials basis at$55.00 per hour plus materials Submitted by: Accepted by: David Ames j Diane&Austin Foster f 8 Deer Jump Hill.Road ? West Barnstable MA 0266g 8 Deer Jump Hill-Road -West Barnstable,MA 02668 tel:508-362-0052 (Andersen Andersen Windows - Abbreviated Quote Report Andersen Project Name: DEER JUMP HILL/WREGLY---VAN � � to#: 4 140 Quote D i Version: Quo 0 Print Date: 02/07/2014 Q ate' 02/06/2014 Q 14.0 Dealer: Botello Lumber Company —Customer: i 26 Bowdoin Road Billing Mashpee, MA 02649 Address: 508-477-3132 Phone: Fax: Sales Rep: FOZ Contact: Created By: _ Trade_ID_ Promotion Code: Item Qty Item Size(Operation) Location Unit Price Ext. Price IL0001 1 TW2436 (AA) $ 365.42 $ 365.42 RO Size=2'6 1/8"W x 3' 8 7/8" H Unit Size=2'5 5/8"W x 3'8 7/8" H I Unit, Equal Sash, White/Clear Pine, High Performance Low-E4 Glass, Divided Light with Spacer, Specified Equal Lite, 2W1 H, 3/4", High Definition Chamfer, Chamfer, Ext Grille-White, Int Grille- Pine (Each Sash) Insect Screen, White Zone: Northern U-Factor:0.31, SHGC: 0.28, ENERGY STAR®Qualified: No 0002 2 TW2446 (AA) $ 411.74 $ 823.48 RO Size=2'6 1/8"W x 4'8 7/8" H Unit Size=2' S 5/8"W x 4'8 7/8" H Unit, Equal Sash, White/Clear Pine, High Performance Low-E4 Glass, Divided Light with Spacer, Specified Equal Lite, 2W1 H,.3/4", High Definition Chamfer, Chamfer, Ext Grille-White, Int Grille- Pine(Each Sash) Insect Screen, White Zone: Northern U-Factor:0.31, SHGC:0.28, ENERGY STAR®Qualified: No Quote#: 40140 Print Date: 02/07/2014 Page 1 Of 2 iQ Version: 14.0 .- , Item Qty Item Size(Operation) Location Unit Price Ext. Price 0003 5 TW24310(AA) $ 380.29 $ 1901.45 RO Size=2'6 1/8"W x 4' 0 7/8" H Unit Size=2' 5 5/8"W x 4' 0 7/8" H Unit, Equal Sash, White/Clear Pine, High Performance Low-E4 Glass, Divided Light with Spacer, Specified Equal Lite, 2W1 H, 314", High Definition IE Chamfer, Chamfer, Ext Grille-White, Int Grille- Pine(Each Sash) Insect Screen, White Zone: Northern U-Factor: 0.31, SHGC:0.28, ENERGY STARO Qualified: No Subtotal Is 3,090.35 Total Load Factor Tax(6.250%) Is 193.15 Customer Signature 1.446 Grand Total Is 3,283.50 Dealer Signature **All graphics viewed from the exterior ** Rough opening dimensions are minimums and may need to be increased to allow for use of building wraps or flashings or sill panning or brackets or fasteners or other items. ® Ask to see if all of the products you purchase can be upgraded to be ENERGY STAR@ qualified. This image indicates that the product selected is qualified in the US ENERGY STAR@ climate zone that you have selected. 19 Data is current as of September 2013.This data may change over time due to ongoing product changes or updated test results or requirements. Ratings for all sizes are specified by NFRC for testing and certification.Ratings may vary depending on the use of tempered glass or different grille options or glass for high altitudes etc. Project Comments: Quote#: 40140 Print Date: 02/07/2014 Page 2 Of 2 iQ Version: 14.0 PROJECT NAME: 1N4J�,,Jn O"1 � ADDRESS:F . t , �}} PERMIT# � 54t f PERMIT DATE: M/P: OD ' LARGE ROLLED PLANS ARE IN: - Y j BOX SLOT 'Data entered in MAPS program on: U l a 3 'BY: i f q/wpfiles/forms/archive f Town of Barnstable Regulatory Services o Thomas F.Geiler,Director Building Division a.UaiasrAeie. MASS& �* Tom Perry,Building Commissioner ►�� 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Approve Fee: Permit#: HOME OCCUPATION REGISTRATION o Date:` Name:. ' ///��l/Lc 7 O.S/CZ Phone#:� Address: L,; c 5�y /v/ q /L/ +lfi` . �llag . �.�� . C 7 f�R !7 y, Name of Business: / �' /I `j` a//e�1122\5 06 1 Type of Business: �Q(Y C�—S Map/Lot: O It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation C within single family dwellin subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity !� Y �, ] shall not be discernible from outside the dwelling. there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does anot involve the production of offensive noise,vibration,smoke,dust or other particular matter,' odors,electrical disturbance,heat,glare,humidity or other objectionable effects, o 'There is no-storage-or-use of toxic or hazardou$materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be meEo' n the same lot containing the Customary Home Occupation,,and not within the required front yard. • There is no exterior storage or display of materials or equipment • ,There is no commercial vehicles related to the Customary Home Occupation, other than one van or one pick-up-true;-not-.to:•exceed-one•torr.•capacity,and one trailer not to exceed 20 feet in length and-not to --. excd 4 tires,parked on the same lot containing the Customary Home Occupation. _ • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit . I,the undersigned,have and agree with the above restrictions for my home occupation I am registering. q Applicant:* Date: — G/ YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 15Y FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. y Fill in please: Date: APPLICANT'S NAME: i -o s t- " k YOUR HOME ADDRESS:Fr BUSINESS TELEPHONE # HOME TELELPHONE #: NAME OF CORPORATION: NAME OF NEW BUSINESS 7D V n_ i i��,s_ ge TYPE OF BUSINESS le;i ial IS THIS A HOME OCCUPATION? ✓ YES NO ADDRESS OF BUSINESS Ili�ir/ cSr/ �,Q,y,57`/�� MAP/PARCEL NUMBERa /r/ 069 (Assessing) When starting a new business there are several things you must do to be in compliance with the rules and regulations of the Town of Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in town. 1. BUILDING COM NER'S OFFICE This individua. has enfinf fr�pe-of ny permit requirements that pertain to this type cf � MPLY WITH HOME OCCUPATION Aut orized Signa - e** C MMENTS. ! M COMPLY MAY RESULT IN FINES. C__- kL C✓i,l: 2. BOARD OF HEALTH This individual as en inforr Pd of a ermit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1 Parcel Application # 09p, I C) Health Division Date Issued Y/ 1 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address Village 134r"S!&Q k Owner 40s'_� w 1!:�%��L Address Telephone Sb e 3 62— 1 7 Q Permit Request 7-4ka.e ®y� 04U I� A4a Square feet: 1st floor: existing proposed 2nd floor: existing ✓proposed Total new Zoning District Flood Plain Groundwater Overlay roject Valuation 000 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family. ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure /7° 4' Historic House: Zrl(es ❑ No On Old King's Highway: Wles ❑ No Basement Type: &Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new t Number of Bedrooms: .3 existing _new Total Room Count (not including baths): existing new First Floor Room ,,fount Heat Type and Fuel: ❑ Gas - U'O-`il ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/F5 I stove.-❑Yes ❑ No Detached garage: ❑ existing O new size_Pool: ❑ existing ❑ new size _ Barn: ❑exi ting Q„new:i7 Attached garage: ❑ existing ❑ new size _Shed: ❑existing ❑ new size _ Other: rco- Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use- ' Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name lTil t7 A25/�iL Telephone Number S�0 8 3 6 2-J 7s 3 Address License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 3�"P SIGNATURE _ Cry 4,DM DATE 7 31 0$ J - 1r i t FOR OFFICIAL USE-ONLY APPLICATION# r DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE• - OWNER r Ili DATE OF INSPECTION: ' I FOUNDATION , y FRAME INSULATION s FIREPLACE ELECTRICAL: ROUGH FINAL " PLUMBING: ROUGH FINAL r� r GAS: ROUGH FINAL''-FINAL BUILDING t DATE CLOSED OUT, ASSOCIATION:PLAN NO. The Commonwealth of Massachusetts U9Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors(Electricians/Plumbers A_ licant Information Please Print Legibly Nai]1e.:(BusincsslOrganizaiioa/Individual): �JS'�'►►� � �C� �.�� • Ilk ddress:y� �it}`/Statelzip:; t may Phone.#: SIB 3 G 7•�3 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6 ❑New construction employees (full and/or part-time).* have wed the subcontractors � 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees ncsc sub-contractors have g, ❑Demolition empoye les and bave workers' working for me in any capacity. k 9. ❑Building addition [No workers' camp. comp.insurance. �] 5. ❑ We are a corporation and its 10_0 Electrical repairs or additions . am a homeowner doing all work officers have exercised their 11.0Plumbing repairs or additions Myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs inrnranee required-] c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required-) "Any applimnt that ebmkc box#1 must also fin out the section below showing thou workeM'eon4 cnsnt}on policy infurrnatim t Homeowners who subrmt this off davit indicating tbey arc doing all work and then biro outside contrsc-tom must rubrnit a new al5davit indicating meh. Tcmtraetors that ebcck this box must atiacbcd an additional sbcct showing the name of the sub-contractois and stain wbether ar not those entities have unployeM. If the sub—contractors have ccriployccs,tbey must pnrvidb their workers'comp.policy ntanber. I am an employer that is providing workers' compensation insurance for my employees Belatw is the policy and job site information. Tncnrancc Company Narn Policy#or Self-ins. Lic. #: Expiration Date: Job Site,Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing•the policy number and expiration date). Failure to secure coverage as rr.Tdrd under Section 25A of MGL c:152 can lead to the imposition of c:rimbial 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.DD a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Lavc,stigaTtiODS of the DIA for u'js-L ce coverage verification. I do hereby certify under the pains-and pennaLdes�of perjury that the information provided above rs true and carrecl. �Signattuc �' _7l7 Tate: 7 31 76 _ Phoac k !�—o 3 6 Z .7,F3 Offzcial use only. Do not write in this area, tb be compLeted by city or town cffi.ciaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3, City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: 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, y 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 dcccascd employer, or the receiver or trustee of an individual,painership, association or other Iegal entity, employing employees. However the owner of a dwelling house having not mo th ee re an thr 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 badeemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct bni[dings in the commonwealth for any applicant who has not produc-d.acceptable evidence of compliance with the insurance coverage required." Additionally,MGL ohapter 152, §25C(7) states `Neither the commonwealth nor any of its political subdivisions shall cater into any contract for the performance of public wore unto acceptable cvidcacc of compliance with the inuna.nLe requirements of this chapter have been.presented to the contracting authority.' Applicants please Ell out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply svb-eonfractor(s)name(s), add=s(cs) and phone numbcr(s) along with their certificate(s)of bnirance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no-cmployers other than the nembers or partners, arc not required to carry workers' compensation insurance. If an LLC or LLP does have ;mployecs, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial ALceidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should )e returned to the city or town that the application for the pcmrit or license is bring requested,not the Department of ndustri.al Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' ;omp-nation policy,please call the Department at the number listed below. S-If-insured companies should enter their ;cam innUanr,o license number on the appropriate line. ;ity or Tower Officials 'lease be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom ,f dre affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant -laase be sure to fill in the permiVliccnse number which will be used as a reference number. In addition, an applicant hat must submit multiple prrmitlliccnse applications in any given year, need only submit oup affidavit indicating euaent Dlicy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or A copy of the aff davit that has been officially stamped or marked by the city or town may be provided to the pplicant as proof that a valid affidavit is on file for f lture permits or licenses. A new affidavit,must be filled out each ear.Where a bDme owner or citizen is obta ink a license or permit not related to any business or con-n-nerciat venturc _o, s dog liccnse or permit to bum leaves etc.) said person is NOT required to complete this affidavit. be Office of Investigations would hke to thank you in advanec for your cooperation and should you have any questions, [case do not hesitate to give us a call ie Department's address, telcphoac•and fax number. The C6mmonwe9th of Massachusetts Dq)p ent of Industrial Accidents Office of Investigations 600 Washington Sfima Boston, MA 02111 Ter. # 617-727-490.0 ext 4.06 or 1-V7-MASSAFE Fax# 617-727-7749 :d 11-22-06 www.mass.gov/dia i ENEROY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) A licant Narne: nn Site Address: PP /SUS+Ir , C, 4 S kA-1 (g�°� A+� S� Print Town: Of Applicant Phone: Applicant Signature: �A�- Date of Application: 7/3 Qf _ 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' I MINIMUM Ceiling or Basement Slab ❑ -Option 1: Fenestration exposed Wall Floor Perimeter Wall AFUE I4SPF SFE-RR. U-factor floors. R-Value R-Value R-Value R-Value R-Value and Depth I " National Applimicc Encrgy R-10, Conservation Act(NAECA)of 35 R-38 R-19 R-19 R-10 4 ft 1997 as amended,minimums or fefltcf FlS flpplicablo Note: This form is not required if you choose either of the two versions of RE-Scheck.as.listed below. ❑ Option 2: �. REScheck Version 4.1..2 or later variant software analysis must-be completed (780 CMR-6107.3.2 REScheck—Web which can be accessed at http•//www.energ cy odes.gov/reschecld A:DpXTIO1VS�OXt''A:IITER�:;TIONS�TO':E�ISTING�.BTJSS:,DINGS:::O: {R5:S'E.A.RS OLD* . *Buildings under 5 years old must use option#1 or#2 in New Conshuction sgction above.- Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b- a) . SF 100 x — _ % of glazing b a- (b) Glazing area equals. SF f glazing is'<;4Op%-use.the."chart below. If.,glaziri .:is-5-40'`.% proceed to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MF3.9 MINMUM Ceiling and Slab Perimeter Exposed floors Wall Floor Basement e R-Value R-Value R-Value R-value R-Value and De tli RT37 a R-13 + R-19 R-10 R-10, 4 feet R-30 ceiling insulation maybe used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e. not com reseed over exterior rYalls, and includin an acc ess openings).- SUNROOM—An addition or alteration to an existing building/dwelling unit where-the total ❑ glazing area of said addition exceeds 40% of the combined gross wall an{ ceiling area of the addition, Note:. Owner to fill out Consumer Information Form (found in Appendix 120.P r r • r ' i o Town of ]Barnstable N�oFYrte roily,. .. . Regulatory Services • Thomas F. Geiler,Director IIA.ttN6rAB[. , t"L"� Bui.Idin. ' Division p�"TEU µAi a,�� Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 m-ww.town.b arnstabl e.rna.us flee: 508-862 4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEM ON Please Print Q DATE: 7hil6 t/ JOB LOCATION: number Ir3/ /'/�Iw number street village ,SPe 362-/X3 "HOMEOWNER": I�.S}'f N 7 S/' t work hone# name home phone# p CURRENT MAILING ADDRESS: 93 ST 14)kS �� 6gL4 G 4,— 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. DEFII`IITION OF HOMEOWNER Persons)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 fwo-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form aceeptableto the Building Official, that he/she shall be responsible for all such work performed under the building pemut. (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. l ' b Signa�tvre of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the >tate Building Code Section 127.0 Construction Control. ITOMEOWNER'S EXEMPTION The Code states that "Any homeowner perforing work for which a building permit is required shall be czcmpt from the provisions m -f this section(Section 109.1..1 -Licensing of construction Supervisors);provided that if the homcowncr engages a persons)for hire to dos.uc b Bork,that such Homeowner shall act as supervisor:" Many homeowners who use this exemption sic unaware that they arc assuming the responsibilities of a supe visor(see Appendix Q, _ulcs&Regulations for Licensing Construction supervisors,Section 2AS) This lack of awareness often results in serious problems,particularly ,hcn the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would Writh a licensed upervisor. The homeowner acting as Supavisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, at the homeowner.ccrtify that hc/she tmdcrstands the respormbilitics of a Supervisor. On the last page of this issue is a form currently used by vcni towns. You may care t amend and adopt such a form/ccrtificaLion for use in your community. �oFTMETotti `I'oWn of Barnstable Regulatory Services v huss $ Thomas F. Geiler, Director. 10LA - 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 SigXder If Using A� l bject propertyhereby authorize act on my behalf, in all matters relative to work authorized by building permit application for: (Address of Job) i Signature of Owner Date Print Name s If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. i !�' 1-7 -i%kZ- U t l �oF.Y r *Permits Town of Barnstable I Expires 6 months from issue date Regulatory Services Feet S•�v IARNSTABLE, Thomas F. Geiler, Director v KASS. $ 1639. Building Divis-ion O(}� PIED MPq es ' Tom Perry, CBO, Building Commissioner 200. Main Street, Hyannis, MA 02601 www.town.barnstable.ma.u's Office: 508-862-4038 Fax: 50&790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY -7 Not Valid without Red X-Press Imprint Map/parcel Number � 1—f 0C� Property Address kn [2 Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License# (if applicable) ❑Workman's Compensation Insurance MIT Check one: JUL 3 Y 2008 ❑•.I am a sole proprietor 2'i am the Homeowner TOWN OF BARNSTASLE ❑ I have Worker's Compensation Insurance Insurance Company Name I Workman's Comp. Policy# Copy of Insurance Comptiance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement doors/sliders. U-Value (maximum.44) N0I.SIA 1n *Where required: Issuance of this permit does not exempt compliance with other town departmen r ions-t e_HrStoric,Conservation,etc. 'Note: Property Owner must sign.Property.Owner Letter of Permission. A copy of the Home Improvement Contractors Licen§ee-q rpggired. SIGNATURE: QAWPFILESTORMMuilding permit forms\EXPRSSS.doc di i iThe Commonwealth of Massachusetts 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 A licant Information Please Print Legibly Name (Business/Organi.zahon/Individual): ��5 ,/ C.� ra�- Address: /a Ed- City/State/Zip: Gr� � �, s� Phone.#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. 1 am a general contractor and I 6. ❑New construction employees (bill andlor part-time).* have hired the sbb-contcactors 2.El I am a•sole proprietor or partner- listed on the attached sheet 7. ElRemodeling ship and have no employees Thcsc sub-conbcactors have g, 0 Demolition employees and have workers' worlang for me in any capacity. 9. Q Building addition comp.Msuranm [No workers' co -insurance atp a 5. [� We are corporation and its 10.❑Electrical repairs or additior rtquu�] officers have exercised their 11.0 Minting repairs or additior 3.�I am a homeowner doing all work myself- [No workers' comp. right of exemption per MGL 12 ❑Roof repairs irmnance r t c. 152, §1(4), and we have no • �� employees. [No workers' 13.❑ Other comp,insurance required_] -11 tAny applreant that eh=c x box#I must also fin out the rcatlon below sbowmg their wnrkas'coition policy infom-atim-L t Honunwncre who submit this afF3dxvit indicating they arc doing all work and than hirr outside contractors must submit anew affidavitindicrtarg such Icantraetnrs that check this box uvjA atlachcd an additional sheet s ta showing the name of the subuttach�rs and state whctlicr or not thosd cntitics have employerr,. if the sub-mntracum have rsnploycce,.they must ptvvidC thcQ ica wors'camp.policy number. I am arc employer that is providing workers compensation insurance for my employees. Below is the policy and job site information. Insurance Company Man n Policy#or Sclf-ins.Lic.#: Expiration Date: Job Site Address City/State/zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date; Failure to secure coverage as requircdunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of. 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 t of up to$250.00 a day against the violator. Be advised that a copy of this sta-trmcrit may be forwarded to the Officc of Investigations of the bIA for insurance,covt ra�e verification. I do hereby certify under the pains•and penalties of perjury tfcat the information provided above is true and correct Si c: /J Datc: 7 A - Phone# Official use only. Do not write in this area, to be compItted by city or town offcclaL City or Town: Permit/License# Isst&ag Authority(circle one): I.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Town of Barnstable �0f THE Tp�y o Regulatory Services Thomas F.Geiler,Director • BARNS-MSLE, .MASS-Building MASS- Building Division $ArfD �a Tom Perry,Building Commissioner M 200 Main Street, Hyannis, A 02601 www.town.barnsiable.rna'.us Office: 508-862-4038 Fax: 5.08-790-6230 HOMEOWNER LICENSE EXEMPTION �j Please Print DATE: JOB LOCATION: IK3 /y /'lAvy� 54 number (� street p village "I IOMEOWNER": / (JS 1� 5 i�/'. sP F J� 2— j 7 name CC home phone#' work phone# CURRENT MAILING ADDRESS: 5AL" 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 Persons) 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 buildink permit. (Section 109.1.1) ility for compliance with the State Building Code and other The undersigned"homeowner"assumes responsib 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,l-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 aic 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, bilitics of a Supervisor. On the last page of this issue is a form currently used by that the homeowner certify that he/she understands the responst several towns. You may care t amend and adopt such a form/certification for use in your community. �oFYHEt Town of Barnstable Regulatory Services S" ' S. Thomas F. Geiler,Director 47,E i639' �� .• Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in altmatters relative to work authorized by this building permit application for: (Address of rob) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 002 Application# 620676151 ,53 Health Division / Conservation Division ` Permit# Tax Collector Date Issued Treasurer Application Feel Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board G� � Historic-OKH Preservation/Hyannis 50 7 Project Street Address Village 0"f 3",A).s��Gf_ Owner ysb n �51��— Address �'e3% 7'f'IAi �t— Telephone SD 8 3 6 2 — / 7S,3 Permit Request ALA'Id l"' ,c 4;1E9, - b"mLL. W gc);td /fvti /f.J A, 1r 1 /A 6'.A Pic J L/ Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay �� Type Project Valuation --.t .� � Construction T e 2 x b Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure / 0 0?=SS Historic House: 0-'�es ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other /VON�r_ 1 -z- i Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/copal stove: CI i0 No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:aexisting ❑new size t•.i .,97- Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: i - Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Ca Commercial ❑Yes ❑No If yes, site plan review# co Current Use Proposed Use BUILDER INFORMATION Name. a S Telephone Number :S�r1 J 62- / 7S3 Address 1(?3� M A(A', S¢ License# ,,v.-YL70.QG.s Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOCy �' SIGNATURE C. f DATE FOR OFFICIAL USE ONLY PERMIT NO. ' .DATE ISSUED '&MAP/PARCEL NO. ADDRESS. VILLAGE- OWNER i DATE OF INSPECTION: FOUNDATION FRAME 1 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT .. ASSOCIATION PLAN NO. The Commonwealth-of Massachusetts Department of Industrial Accidents Office of Investigations " " 600 Washington Street Boston, MA 02I11 ,k v www.mass.gov/dia ^ Workers' Compensation Insurance Affidavit: Builders/Cortractors/El6ctricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): . AaS-Yi ej Address: PS 3`1 A t n1 e City/State/Zip: Wfil fi A",Ss All k- Phone:#: 5 ex 3 4 2- Are you an employer? Check the appropriate box: -Type of project(required):, 1.❑ I am a employer with 4. ❑ I am a general contractor and I " N . employees(full and/or.part-time).* have hired the sub-contractors 6. ❑ 'w construction 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7, Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp,insurance comp, insurance.$ " required.] 5• ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.E I am a homeowner doing all work officers have exercised their 11.[1 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 13.❑ Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees: If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Frame: Policy#or Self ins.Lic.#: Expiration Date: Job Site,Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and.correct, Si ature: Date: y Z O Phone#: S D Official use only. Do not write.in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): ..1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instreucti®ns Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a-deceased employer, or the recei=r..or_ttust�.-e-of an individual partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein;or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal.of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant-who has not produced,acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for:the performance of public work until-acceptable evidence of compliance with the in-fiance 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 j 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 fo any business or commercial venture j (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 tc give us a call. The Department's address,telephone-and fax number: Tbe.Commollwean of Massaebuwtts Department of Industfial Accidents Office of Investigations. 600 Washington Street Boston, ILIA€2111 Tel. # 617-727-490.0 ext 406 or 1-977-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gavldia i �7NE �� ivr1'1a vt tsaau��ct�✓aa: REgulatory Services . t RAMV rasa , Thomas F.Geiler,Director 9`�pT fo ;�►`�� Building Division Tom.Perry,Building Commissioner. 200 Main Street, Hyannis,MA 02601 www.town.b arnstabl e.ma.us ice: 508-862-4038 Fax: 508-190-6230 Permit no. Date AFFIDAVIT HOME EATROVEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units.or to structures*hich'are adj acent to such residence or building be done by registered corllractors,wit'n certain excepLLons, clang it c+der requirements. Type of Work: .S#;1:f Estimated Cost 6GU 0, "►® Address of Work-.. D �� /s'►A 1 N� �� LS�" ��✓ T�'� Owner's Name ��5- _ oS �� Date of Application: y Z (� I hereby certify that: Registration is not required for the following reason(s) Work excluded by law •Job Under S 1,000 []Building not owner-occupied [z6wner pulling own permit Notice is hereby given that: OyMRS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENTALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Signature RegistrationNo. 0 at Owner's Signature Q wpfiles.fnrrns:homeafn d xv Rev: 060606 . Tame JS:Z1D(eoatmne� ' pmuiptive Pselcages for 06 and Two-Faauiy Residential Balldlap'Heated with-Pau>ff4els MAXIMUM MINIMUM Glazing G1a . 9 Ceiling Wall Floor Brier= : Slab HeetinglCoolirsg Area'('>a) U•valuo= R-value' ' R-value' R-YalUe' Wall Perimew Equipment Miency, Pnc.' Se R-value' R-value' 5701 to 6500 Heating Degree Days' 12% 0.40 38 13 19 10 6 Normal R I2•/. 0S2 30 19 ' 19 10 6 Normal S 12% 0.30 38 I3 19 10 6 '85-AFUE T 151. 036 38 13 125 N/A N/A. Normal' U 13% 0.46 33 19 19 10 6 .Normal Y 15% 0.44 38 I3 25 NIA N/A 83 AFUE W 15% U2 30 19 19 10 6 85 AFUE X ISve 032 38 13 23 N/A N/A Normal y 19%. 0.42 38 19 23 NIA NIA Normal Z 18% 6.42 38 13 19 !0 6 90 AFUE AA 10% "0 30 19 19 1 10 6 90 AFUE 1. ADDRESS OF PROPERTY: 2, SQUARE FOOTAGE OF ALL EXTERIOR WALLS: S�8 3. SQUARE FOOTAGE OF ALL GLAZING: b 6 4, %GLAZING AREA(#3 DIVIDED BY#2): IZ 5. SELECT PACKAGE(Q—AA-see chart above): *7 NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING EYi ERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES:. NO: q-f0ms-®80303 a �FIKE rq� Town of Barnstable Regulatory Services r r BAMSTABLE, ; Thomas F.Geiler,Director MASS. i639• A.�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: �/Z 1D 7 JOB LOCATION: V y MAIN number LL a street Q village �U"HOMEOWNER": Stuj �aShf->(L 506 362-1? S3 name home phone# work phone# CURRENT MAILING ADDRESS: t� - 1��s1- r�2vJS BLS AA aZ(, eity/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance-with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. C Signature of Homeowner Approval of Building Official . Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a 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 t Application to : ®Yb Riny'ss 3ftbhlap 34gionar Aqi5aorit Mi#tritt Committee In the Town of Barnstable CERTIFICATE OF APPROPRIATENESS Application.is hereby made,with four complete sets, for the issuance of a Certifcate of Appropriateness under Section 6 of Chapter 470;Acts and Resolves'of Massachusetts, 1973, for proposed work as described belowand on plans, drawings,or photographs accompanying this application for. CD CHECK CATEGORIES THAT APPLY: 1. Exterior building construction:' ❑ 'New ❑ Addition (Alteration - Indicate type of building: ❑ House ❑ Garage ❑ Commercial Other44-w n 2. Exterior Painting: r*r 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign . ❑ Repainting Existing Sign Go. 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other TYPE OR PRINT.LEG1-BLY: DATE D ADDRESS OF PROPOSED-WORK ��3`/ /�► 5f- ASSESSOR'S MAP NO. . OWNER- r A�Es' -ems :ASSESSOR'S LOT No. HOME ADDRESS / 8 3 Z ),IV17-IA S4- TELEPHONE NO.STS FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public.street or way. (Attach additional sheet if necessary.) AGENT OR CONTRACTOR TELEPHONE NO. ADDRESS DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. 96 A .S£I/6JrJi •V 01V -fo �2�n�� yr • � � ��. - {i�� o� � �� -�,� �w /�,�jZ Signed• Owner-Contractor-Agent o For Committee Use Only This Certificate is hereby Date 3 p D ' Approv d/Denied 2006 Committee Members' Signatures: Q) AV y �•.l. t� -felt Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION �C.�L .� �'� 9 to CGjL . SIDING TYPE S' /j�1o1,C. COLOR CHIMNEY TYPE /✓0A COLOR ROOF MATERIAL COLOR .-PITCH. WINDOWS COLOR ' SIZE TRIM COLOR DOORS COLORS SHUTTERS COLORS GUTTERS 0-1)4fU5 COLORS vd 41 ^�1:1i_ DECKS MATERIALS GARAGE DOORS t04 ( ag COLORS SKYLIGHTS SIZE COLORS '- l� SIGNS COLORS 2006 HI�ORIC p BARNS TA6LE FENCE COLOR RESERVA)'IpN NOTES: Fill out completely, including measurements and materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies of the Plot Plan, landscape plan and elevation plans, when applicable. SPECSHT Revised 11198 Z,*" e®�v "++� _ •a;�r�.....namArcxr+a,+.�.•w>«r.otsor.+awum.�cu�asix�: �� n..zcww�e�e..o+asavxr�•aar+ ,�'mu..�ss .a. ""' , ' .raa..yew.zesr�.t-rverriaN+e+:•a.•s•...'r•+;•,•:�•.•.xv+_.rm- -nNLAJ.F_k�:iN,2L:.'R2:%dY;::•:i^9,+.h: � r.....:..:.,...:..:....,.:..r.,...r:�...:�..�.r::vn•=.,•.n2aiCu:_a::b+.i::v:..r.�a•�i..'.�� t I' .....».� +ua�-a.n+ww..x.mmm•rrvu». .osa.......w„xe_.�w•a.�+.«... 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I � � � V i t � � I � O I^\ c O s (\J�\ • = t V .• �' n /�~ �i. ./1 n /\. r r - v -�THE T4,y 'Town of Barnstable *Permit it �1�, L:%pirca("'Off 1.7 jroui axrrc dart nAMSTADLZE Regulatory Services M� tree Thomas F.Cciler,Director Building .ng Division Tom Perry,CBO, Building COruuiissioucr (�.J 200 Main St t, y s, MA 02G0I rcc -I .►mu 1 l www.town.barnstablc.ma.us Office: 50&-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - .RESIDENTIAL ONLY Nol Yalid wilkout Red a-Press Imprint. Map/parcel Number 0 Property Address 3 L/ ,�� dlkcsidential Value of Work_. / 000 �T Miuimu["'fee oC$25.UU for work wider$6000.00 Owner's Name&Address (,.S A; n s t'� MA 6� Qe Contractor's Name J ff Tcleplione Numbcr 2 / 7 Home Improvement Contractor License#(if applicable)_ / 0 3 7% 7 Construction Supervisor's License!l(if applicable) C 3 P�fWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor MAR 17 2008 ❑ I am the Homeowner* El I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name_ V �j �0� � �7). JD (� Q r7 �j� M ,� Workman's Comp.Policy It / [ i"1 V l Copy of Insurance Compliance Certificate must be on file. Permit Request(check box ( t Re-roof(stripping old shingles) All construction debris will be taken to r❑Re-roof(not stripping. Going over existing layers of root) ❑ Rc-side ❑ Replacement Windows. U-Value (mitximum.44) 'Where required: Issuance of this permit does not exempt compliancawilh other town department regulations,i.e.Historic,Conscrvation cle. ***Note: Property Owner must sign Property Owner Letter of Permission. , Home lmpro emcn ontractors License is equired. a t i SICNATU Q:Porms:cxpmtrg Revisc071405 "" r of Property .Owner Must Complete & Sign This Form If Using a Roofer / Builder. I (print) vS- /i� dS � as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: Address of Job /8 Signature of Owner_ a: Mailing Address of Owner /YZ Telephone# Date (Please return this form to Cazeault roofing along with your signed contract; It is needed for us to obtain the building permit required by your town, to complete your roofing project, thank you) fax#508-420-4555 i i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass govhfla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatiomgndividual):_PQ� g o o Address: �O 3\ m(a 1 t'1 <Z+" - — City/State/Zip: M R OaffiS Phone#: So y Z8 11 Are you an employer?Check the appropriate box: 1. I am a employer with -2— 4. ❑ I am a general contractor and I Type of project(required): 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 ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance) 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL insurance required.]t c. 152,§1(4),and we have no tZEE OOf repairs employees. [No workers' 13.0 Other comn.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. Insurance Company Name:' ArVf �e Y—c- —T— 0 S Policy#or Self-ins.pLic.#l:/ U d Opp,S 6 (o y Expiration Da=g . 6 Job Site Address: s%-1-1 t.Z-� M 6 Attach a copy ty/State/Zip: (p of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and �naldes of perjury that the information provided above ' true a d correct Si atur Date: C� Phone#: 29,03- —H 2 — 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#- '1� -P Board of Building Regulati ns and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 103714 Type: Private Corporation. Expiration: 7/9/2008 PAUL J. CAZEAULT & SONS, INC.: Paul Cazeault 1031 MAIN ST - OSTERVILLE, MA 02658 Update Address and return card. Mark reason for chan11e. - Address Renewal I Employment ment Lost Card C_1 C_7 i I y 'DPS-CA1 Co '50M-05/06-PC8490/J ,per ✓7/EC V/41ILJltdIUIMQAUL O�✓ UC/tll4C�b hoard of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration_,:103714 Board of Building Regulations and Standards Expiration: 7/9/2008 One Zn, ton Place Rm 1301 Type: .Private Corporation 2108 PAUL J.CAZEAULT&:SONS•;INC`. Paul Cazeault 1031'MAIN ST OSTERVILLE, MA 02658'-. '' Deputy Administrator __.... _. _._....._......._. _.. I Notvali witho ignature �?T/W BE To ui m g g e ul r a ons an to One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Construction Supervisor•License License CS: 26325 Restriction: 00 �"1 "'''" '� " '�• Birthdale: 10/20/1959 !"'J a= _ ':' , =:§• - Expiration: 10/20/2009 Tr# 6311 PAUL J CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 IJ Update Address and return card.Mark reason for change. Address Renewal .Lost Card DPS-CA7 ri 50M-07/07-PCa490 -------- 'p33'�'' � '�h��.� �JltC -C700Y7/I)WOtUfEO.UIL ✓!/LQQrIal.illldCG1.6 oard of Building Regulation§and Standards , _ Construction Supervisor License. License, CS 26325 r f °`• Birthdate ,10/20/1959 Ezpiratlon -1.0720/2009 Tr# 6311 Restriction 00c( PAUL.J CAZEAULT,1 ! 1031 IN ST OSTERVILLE,MA 02655x-`>=' Commissioner r gt J Board of Building Regulati ns and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 103714 Type: Private Corporation Expiration: 7/9/2008 PAUL J. CAZEAULT & SONS', INC. Paul Cazeault 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and return card. lark reason for change. I_...I PS-CAI G 5OM•05/06•PC0480 Address C._I Renewal I j ,ntployntcut Lust Card • o�� Board or Building Regulations and Standards License or registration valid for individul se only HOME IMPROVEMENT CONTRACTOR before the expiration date. If round retu it to: Registration: .103714 Board of Building Regulations and Sta dards tic Ashburton Place tint 1301 lug I . .Expiration: 7/g/2008 B ton, Ma.02108 Type: Private Corporation PAUL J.CAZEAULT'8•SONS,,INC. Paul Cazeault r '' 1031 MAIN ST = C�4,, ,,,` OSTERVILLE,MA 02658 Deputy Administrator Not slid wit ut signature 677-2 Boar 0 ui ing a ulat'ons tan ards One Ashburt Place -.Roo. 1301 Boston assachusetts 02 08 Const tion Supervisor Lic nse License CS: 26325 Restriction: 00 Birthdate: 10/20/1959 'Expiration: 10/20/2009 Tr# 6311 PAUL J CAZEAULT '- 1031 MAIN ST OSTERVILLE, MA 02655 -- ___-.- --__...__- -----•---'.-----....._. Update Address and return card.Mark reason for change. — Address I J Renewal [-�I.Lost Card DPS-CA1 G 50M-07/07-PC8490 �� --'-----•-•-� -- - �' '�'�;� ✓/ee -C�an:mo�ruiea.�� off' /�Uraf¢c�zude�d -;,Board of Building Regulation&and Standards 1'',J h'Construction Supervisor License License: CS 26325 r Birthdate:� 10/20/1959 Ex plratlon; :10/20/2005 Tr# 6311 Restiictlon -00.. r' PAUL,J CAZEAULT::'.:. 1031 MAIN ST OSTERVILLE,MA 02655 Commissioner R3ghtFax H1-2 8/24/2007 1 :21:48 PM PAGE 003/003 Fax Server y ACORD. CERTIFICATE OF INSURANCE DATE(MMIDD\YIq 08-24.07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DOWLING&O'NEIL INS AGC HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 973 IYANNOUGH ROAD 2ND FL ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX 1990 COMPANIES AFFORDING COVERAGE HYANNIS,MA 02601 COMPANY 22LGR A TRAVELERS DIRECT ASSIGNNII•NT INSURED COMPANY B PAUL J CAZEAULT&SONS INC. COMPANY 1031 MAIN STREET C OSTERVILLE.MA 02655 COMPANY D COVERAGE THIS IS TO CERTIFY THAT THE POLICIES Of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE POR THS POLICY PERIOD INOICATEO,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OP ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHCH THIS CERTIFICATE MAY BE IOSUED OR MAY PERTAW,THE INSURANCE APFOADED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS,EXCLUSIONS AND COHOITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REOUCEO N PAID CLAIMS. BY CO POLICYGFF POUCYEXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIVY) DATE(MMIDDIYY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE s COMMERCIAL GENERAL LIABILITY GENERAL A G AGGREGATE MPICIP AGO. S CLAIMS MADE OCCUR. PRODUCPERSONAL 88 ADV.INJURY S OWNER'S&&CONTRACTOR'S PROT, EACH OCCURRENCE S FIRE DAMAGE(Any one fire) S AUTOtAOaILE LIABILITY MED.EXPENSE(Anyone person) S - ANY AUTO COMBINED SINGLE LIMIT s ALL OWNED AUTOS BODILY INJURY(Par Person) g SCHEDULE AUTOS BODILY INJURY PerAcddenl S HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE ) S GARAGE LIABILITY ANY AUTOS AUTO ONLY.EA ACCIDENT S OTHER THAN AUTO ONLY: EACH ACCIDENT S AGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE S OTHER THAN UMBRELLA FORM AGGREGATE: $ WORKER'S COMPENSATION AND A EMPOLYER'SLIABILITY US-0095B64A-07 08-10-07 OB-10-09 STATUTORY LIMITS X THE PROPRIETOR/ EACH ACCIDENT $ 100,000 PARTNERS/EXECUTIVE X 'INCL DISEASE-POLICY LIMIT S 500,000 OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $ 100,000 i OTHER DESCRIPTION OF OPERATIONSLOCATIOIiSIVF-MICLESIRr-STRICTIONSISPGCUIL ITEMS THIS REPLACES ANY PRIORCERTIF'ICAIE ISSUED TO THE CMMRCAIE HOLDER AFFECTING WORKERS COMP COVE-AOF- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUIUG COMPANY WILL ENDEAVOR TOIAML 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BST FAILURE TOMAIL SUCH NOTICE SHALL rMPOSE NO OULIGATION OR LIABIUIY OF ANY H.'ND UPON THE COMPANY,IT$AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Charles 7 Clark I � J , Town of Barnstable *Permit Y� Expires 6 mof om issue date Regulatory Services Fee X-PRESS PERMIT Thomas F.Geiler,Director Building Division SEP 2 8 200t Tom Perry,CBO, Building Commissioner 0 / TOWN OF BARN SE 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us ` Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint [ap/parcel Number roperty Address Ir �jI .¢R� Residential ValueofWork S000. ?0 Minimum fee of$25.00 for work under$6000.00 wner's Name&Address A's f-1 N Itfo 3 4Fi,L_ L3y 22m, tj S�_ vJ 6 Aeo.s Q� ontractor's Name Telephone Number j 3 6 2—/2 rj :ome Improvement Contractor License#(if applicable) :onstruction Supervisor's License#(if applicable) ]Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance isurance Company Name Torkman's Comp.Policy# opy of Insurance Compliance Certificate must be on file. ,rmit Request(check box) [ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) , "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner.Letter of Permission. A copy of the Home Improvement Contractors License is required. [GNATUREi /��is✓l'�v�%g� Forms:expmtrg wise061306 r Application to: JpNEGpp�Q'�Sp Odd Kirig's I=dighway Regional Histic District Committee in the Town of Barnstable for a . CERTIFICATION.OF EXEMPTION Application is hereby made, in triplicate,for the issuance of a certificate of exemption under Section 6 and 7 of Chapter 470, v Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on plans, drawings, or photo- .graphs accompanying this application. TYPE OR PRINT LEGIBLY DATE 9 z,5of0 ADDRESS OF PROPOSED WORK _�B3y ,'JP1� �� ASSESSORS MAP NO. OWNER �V�T`�+� f ASSESSORS LOT NO. HOME ADDRESS �G 3 / �'/��W �� J-4)- TEL. NO. AGENT OR CONTRACTOR S�"'►� ADDRESS Al W, rl',?W3'1LZ¢_Z?/ TEL. NO. Z / 7JU This application is for exemption of proposed exterior construction on the ground that: ��2) 1) It will not be visible from any way or public place. It is within a category declared entitled to exemption by Old King's Highway Regional Historic District Commission. (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work, showing location on lot, and, if an addition is involved, show. ing location of existing building. IPA ,e 12&.7 nc .3� A/&40 11410,00-L-- s /1:1zS !<-s e AA C'oL� z -,� s' A<V SIGNED Space below line for Committee use. . Owner•Contractor-Agent ' F r Rg v� �C The Certificate is hereby D SEP 1 8 2006 V T me TOWN OF BA?NSTABLI: B Hl��D. IRRo��f�r„a. Date � Approved ❑ The categories of work entitled to exern fT are lisied.on Disapproved ❑ the back of this form. 4i Department of Industrial Accidents �/^4 Office.of Investigations ' 600 Washington Street Boston,MA 02111 `,M s�•' www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly `Tame (Business/Organization/Individual): �t/$ w �S Address: SA- ity/State/Zip: Phone#: _5 aB . 36 7_>7 r 3 ►re you an employer? Check the appropriate bog:. Type of project(required): ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).` have hired the sub-contractors El am a sole proprietor or partner- listed on the attached sheet. El Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or.additions required.] officers have exercised their I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.[:1 Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] ,ny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: iomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. zm an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site formation. surance Company Name: )licy#or Self-ins.Lc. #: / Expiration Date: b Site Address: i' City/State/Zip: ttach a co=coverage a worke s' compensation policy declaration page(showing the policy number and expiration date). lilure to se as required under Section 25A of MGL c. 152 cai lead to the imposition of criminal penalties of a ne up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORTS ORDER and a fine 'up to$250.00 a day against the violator. Be advised that a copy of this statement may forwarded to the Office of ivestigations of the DIA for insurance coverage verification. do hereby certify under the pains and penalties of perjury that the information provided above is true and correct: ature: Date: D hone#: SDI 3 f 2 — 7 S3 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#: r � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel va`! Permit# Health Division Date Issued r-- 0 Conservation Division Fee ` YG.r�So Tax Collect t Treasurer_ - Planning Dept Date Definitive Plan Approved by Planning Board ' Historic.-OKH Preservation/Hyannis r Project Street Address 6 3 Y m 4,1� S4— r Village t,-). a4 oeN s+o (3 L: Owner �+�� 5+ ✓L Address / 8S r n1 A ti T-1 Telephone L / 7 SS3 Permit Request )PLA i Ale,iF VA _a, 3) 0 V*14-7 -U Square feet: 1 st floor: existing proposed 54^4 2nd floor: existing proposed .off Total new /L6#W Valuation _ / , 1900 Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfatfiered: Cl Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0"' Two Family O Multi-Family(#units) Age of Existing Structure 2°0 �S Historic House: es O No On Old King's Highway: �s O No Basement Type: @f Full ❑Crawl 2<alkout ❑Other Basement Finished Area(sq.ft.) /�� Basement Unfinished Area(sq.ft) 7°O Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing First Floor Room Count >� Heat Type and Fuel: O Gas mil ❑ Electric O Other Central Air: O Yes 016 Fireplaces: Existing l-k New Existing wood/coal stove: O Yes 2rNo Detached garage:O existing O new size Pool:Cl existing O new size Barn:2`6"xisting O new size Attached garage:O existing ❑new size Shed:O existing O new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded O Commercial O Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Telephone Number Address 3 y c� Sfi License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ?fr</1.J1eIs. Nhcom 10 SIGNATURE I/� ( � 4- � _ DATE / oO ' FOR OFFICIAL USE ONLY . o: PEIMIT NO. DATE ISSUED MAP/PARCEL NO. �{Y f-y ADDRESS VILLAGE OWNER . 1 DATE OF INSPECTION`! FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL , GAS: ROUGH FINAL i FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. The Town of Barnstable 9 � Department of Health Safety. and Environmental Services 59. Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 Building Commissions: Fax: 508-790-6230 Permit no. Date . AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO APPLICATION MGL c. 142A requires that the"reconsn WdOu,alke zdms,renovation'repak,modemizarion,conversion, improvement,removal,demolition,or construction of an addition to naypre-e sag owner-occupied building containing at least one but not more thaw fom dwelling units or to stracttaes which are adjacent to such residence or building be done by registered=M=tors,with certain exceptions,along with other requirements. - Type of Woric:��l-cL � Cost .� �o Address of Work: Owner's Name: � A A)k 4- Date of Application.• y/ 0 I hereby certify that: Registration is not required for the following reasons) Work excluded by law Job Under S1,000 Building not owam-occupied \! �Pulling own pemit Notice is hereby given that: G wrg UNREGISTERED OWNERS PULLING THEM OWN PERMIT OR EALINPROVE MENT WORK DO NOT HAVE CONTRACTORSFOR APPLICA13LE HOME ARBTTRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. ACCESS T SIGNED UNDER PENALTIES OF PERJURY I herebv apply for a permit as the agent of the owner: Connector Name Registration No. Date OR P Date Owner's Name q:fomu:Affidav w FtilElp�� Department of Health Safety and Environmental Services Building Division MRN917ARM ' 367 Main Street,Hyannis MA 02601 MASS. AlEo ram+ Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION G Please Print DATE: 0 ' 7"DU 10B LOCATION: /�&Z / //-a IA( number street village / HOMEOWNER": iAn/f /7�//S//A� �S� 36a-i>5.3 79� -/70? PxS� S�6 9 name r/ ,�/� home phone# work phone# CURRENT MAILING ADDRESS: r�j7 / ' I n/nI 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 struciturs 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 procedur ' d.requirements. Signature of Homeowner Approval of Building Offcial Note: Three-family dwellings containing 35,066 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 perforrning work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they art 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 unlicensA 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 to amend and adopt such a form/certification for use in your community. p:FORMS:EXEMPTIN f `^;,�=�_"�- ``r Ol�crallapes'tf$atfQas 600 Washington Street Bostont Mass. Workers' Com easationInsnrance davit r .knn{i1-..^t iiiL • iv d 3 v� ISM— -' jocacion: .. .... __ •-• hone� "6) 4jr _ . ._. _ ........ I am a homeowner pew I am a sole mvorie'tor=d bm no one vwluddnz in r oyees working on this job. 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Imm ran ce co. of Qi�mal peaaiiies of a Bar to Si4�-OO and/or ceder t3ecttam ZSA of MGL '��tO�°imm attd a tine of 51OO.00 a dad agsiast ms• I�0�d a r aiisu a co recnre coverage us emits lathe fosat of s bTOP VMM ORD� ,nt sears'tmpriaoruuent a mn.dr,II p of rye Dlp fos emerge ' co Dy of L'tit ataumetst ns"be forwarded to the 0M.oflar dw infomta iOB pmvidcd above is Mw and coat% 1 do nereDv certify usda tht paw�d pataltttt ojpa�ury 4 n y jW dtl or town oid" ' offldaluseonly do not writeinthisashtobeeomple b7 - C33,adingDepar=GU : 3 perfuumcesse k Ouceamg Board g city or town: ❑Seleetatm's Office �i,e response is required �$ealth Depar�ent ciucic if inure . _. — �pthet� phone 1f; contact Deraon• YjEO Y Y��:.•�i 1 • . • • • • :1 wau• ..•t• .» .►. •. .• . •. •a •.. •• :1••. • • fell• • •1 A •1 1•J:+• r • •I•�• .l• U • •1 • CHI• • 11 • �••N• • • • r• •• - • ••• •` .Ir .1 lee�•H•. .11 • •' t • ^`I •�+ l• �• w1• •1 •1 •.•«N• .UI • •• • • 1 Il• •• •le •It •1 �•• .1• •1•. •11 1 • • • 1 1• • •• •/ •Il •• J • • / •• • •"• 11 / • • i • • 1 rJ1 Y11 �• 1 i •/ 1 1 e 1 • • a _«• to • vr.••... a .1 � •: 1 1 - , - � 1 • 11 11 1 1 :11 • 1 Y11 ♦ 1 •1 I IA • 1 r 111 I foli-kLA.e11 el ••• 11111 I 1 � 1 1 1 • • • " . 1 • e • 1 { Y. • • 11 •• 1 r• 1111 •11 1 V1/ .11 r ' r1 -ma ../ 111 _• •• 1• •1•K I • / •/• ••.•••1• • �' , ••1 •t• • •1 1•. • • 11• ✓ 1 • •1 ' • e111: YI - I _Illw 1111• .11 ' r•1.1•I• �• irl l• ••'••t•1••IY.1••• •/ • 1 • •'•1/. r. • •.I• •1 •••1••1• -11 .• • Ill •• IIw I/l:l• .• �• 1/• _111w•1•. •1 •1• M•1'.le 1�• 1Y. • •��• •1 ^�••1{_• /• •l ••lee• �M1,0 j1,MIMW�MM//��l ��/��j��jj��GG%G • .,1 • Il '•N��Iw _•feel•�••wY,U •It .•/• • • 1 ••11.1• ' •• el • •IHI• ./• ' l✓-1•• • e1 �.. .11 • e 1 •11 11111• •�.w •IIP' •• Ill �' U• •K IJ el IIwV1•YI/1•+ I .•••• If. l• � . 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Application to Old Kings Highway Regional Historic District Commute O 0 0 , 12 6 in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, id triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts .and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building ❑ Addition 3 Alteration DO Indicate type of building: ® House ❑ Garage ❑ Commercial ❑ Other = Z r 2 Exterior Painting: ❑ I =1 3 Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign o• . 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other C7 (Please read other side for explanation and requirements). YYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK ��y , '/�/�✓ �- ASSESSORS MAP NO. OWNERJ, X&O-11AI A; ASSESSORS LOT NO. �D HOME ADDRESS f�� /�ir� ��` /-y t/r?ff1Lf T f/� TEL NO. 1 f-a FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). / n L i'll i a,&r Lepm A of f A:: 0 /7 i9i.1/ Q��! /lJ. �J,9.41J� :90/ f0 R P I A'[ WIA/AAle.Al f P-L /'rl� rs-/ W :_i9,/.'s1,11 cr / i /M,e..S. /f R9 i pAa /90 7 �i941A i9 e oa 6 AGENT OR CONTRACTOR TEL NO. ADDRESS DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs,give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). T Signed aeA::� Owner-Contractor-Agent Space below line for Committee use. Received by H.D. at he C •ficate is hereby Date TiRV n^ l , . 70VV1`l OF B 1 HW IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period i Town of Barnstable ' Old King's Highway Historic District Committee SPEC SHEET FOUNDATION SIDING .TYPE COLOR CHIMNEY TYPE COLOR ROOF MATERIAL COLOR PITCH Z �C/� . K WINDOWS COLOR 14,q SIZE !Y "Jr • T TRIM COLOR DOORS COLORS SHUTTERS COLORS GUTTERS COLORS DECKS MATERIALS GARAGE DOORS COLORS SKYLIGHTS SIZE COLORS SIGNS COLORS Ili 0Md do, FENCE COLOR NOTES: Fill out completely, including measurements and materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape- plan and elevation plans, when applicable. SPECSHT Revised 11/98 PROPOSED WORK 1834 MAIN STREET WEST BARNSTABLE THE ALTERATION OF A DOUBLE WINDOW ON THE DRIVEWAY SIDE OF HOUSE FROM A 60 INCH BY 72 INCH WINDOW TO A 45 INCH BY 54 INCH WOOD FRAME WINDOW OF THE SAME STYLE, FOR THE PURPOSE OF KITCHEN REMODELING. ALSO, UPGRADING OF TWO OTHER FIRST FLOOR WINDOWS ON RIGHT SIDE AND BACK.OF HOUSE WITH THE SAME SIZE AND STYLE , WOOD FRAME WINDOWS. Q 000 'UEi , T' r 1 I r I -7- , -r 1 1 I , P / \ w � �Jr.r.iil l.i►i� a :34.C.-u►l.u..rfrtf or _ \ J • 1 I tea. •. a. i�, jA Utt 10 Cl f •} -•' _ � l+t'" may.+•' 7 ,ram, ` 4 _ _ _� Assessor's officmap (1st Floor): � ,55D � I SEPTIC SYST�� Assessor's ma and'lot number� . n. INSTALLED I� Conservation ' �-- �� OX772 ? Board of Health(3rd floor): WITH TI Sewage Permit number ENVIRONAICNTA 4T&BLt Engineering Department(3rd floor): 2 TOWN REGU House number �. I J > Definitive Plan Approved by Planning Board 19. APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only. t O� TOWN OF BARNSTABLE Z� BUILDING INSPECTOR APPLICATION FOR PERMIT TO i fI rj f 0b-- TYPE OF CONSTRUCTION lX.109 y/41q.. 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location t"'k� Proposed Use Zoning District o er Fire District J:Vj",3 Name of Owner Ira N- �`i 141 j�ij�;l�� j)I f itfis Q. S1 r�� Address ! Z 9- / Sl (ii/•� J Name of Builder L�W, K, Address 7,!a/%-/)64-/,/A*�� Name of Architect Address Number of Rooms Foundation Exterior tlo c- Roofing Floors Interior �LWlTP Heating Plumbing Fireplace Approximate Cost 47� T i Area r Diagram of Lot and Building with Dimensions Fee C� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding above construction. I 0� Na Construction Supervisor's License T� / ROBIE, MARIA & DIANE FOSTER ,;No 35494 permit For BUILD ADDITION Single Family dwelling Location 1834 Main Street West Barnstable Owner Maria Robie & Diane Foster Type of Construction Frame Plot Lot t' J Permit Grant d. November 3,— 19- 92 Da spec io 19, � Date Completed 9 19 _ T TOWN or BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION 4) -8,ff-s�4�� Number Street Address Section Of Town HOMEOWNER" 361 N& ITaS� 3Ce- 3c?Y9 / boo GY2 7��o Name Home Phone Work Phone PRESENT MAILING ADDRESS /83y 5'1- < City Town State .L . , Zip Code The current exemption for •"homeowners" was extended to include owner- occunied dwellings of six units or less and to allow such homeown engage an individual ,for hire who does not possess a -license, the owner ers,ato 'acts as supervisor. rovided that 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 to six 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 res onsible 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, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and ,requirements HOMEOWNER'S SIGNATURE , C a 'APPROVAL OF BUILDING OFFICIAL Note: Three family . dwellings 35, 000 bi�c feet, or larger, will be .required to comply with State Building Code Section 127 .0, Construction Control. I NISCS HOME OWNER'S EXEMPTION The code states that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section i09 . 1 . 1 -. Licensing of Construction Supervisors) ; provided that if Home Owner engages a person( s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix for Licensing Construction Supervisors, Section' 2 . 155) .Ru This les alackegu oflations j awareness often results in serious problems; particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the unlicensed person as it would with' licensed supervisor. The Home Owner acting. as supervisor is; ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, many communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a ,form/certification for use in your community. ' �� w. *A, y ws ♦1 ,N4 ,os o4 �� * f.o E.16 AC-s 4s 'O r.• 1.800, r S r1ATER8ATE A, d� !AC M' 4 oo - S S ss �2 2 l?AC-S �Y 10 t s0 AC-S !:!0 AC-3 r 11 AC .TA AC YpOGE of PREPARED UNDER THE n NECTION OF THE BARNSTABLE BOARD OF ASSESSORS 434 AVIS AIRMAP INC. :MASSACHUSETT8 CONNECTICUT zy✓SIaC-r-f acr�a��ir anauav � �,s��,=►it.>>�`��, ' �7v�r�rs w �•sve�ri o�ds c7�VE/T �o�Vd�T� -.. Y A2ll.S�`Ji f 4 0 �r 5„ g ,.4.1 I} a4 0 /f• 0 �N w ��1/yd/•�li' a. _ _..._.�.___�� ......f�._:r.,..-:vrsrz_a :sy�=Win•.-. - r .-_ _ __ � P,},�tE•:,F• �.tr: .°�?ct5°�;�w•�.�'3"+.. _ .7113' eR' ?: ;,.I., _ _.�.. _. _ ., .... . .. • ..Kim• I L RF - I •� NEw c ; Rw�� MAVEN i 0 h 0 gyp. r tjk t 0 O A� /\ F.2 N la�'E11 r = lb t V) V•0 QO*O RALSAMRY 132 �'�L�EtiE � � r�/►RpETT //�� 1 PON (p0 SQP�O ( D\l� QO A w000 RD 1 72— t J ONALD RD G °` LAITON °\ - - •` CRAMBERR( r "1� �a CMICADEE I R F 0XEVIE'N &VE• C I C ISO, R D \f PARSE POND\,tea• J J m-a wEQUAQUET 1 X IL W ki In Y 02p0 �� 1 auza �pt \ / ZItt7 //v -aw ♦ LAKE ` Application to (n/ , BP as pE"E,pS��pP`pN� Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness u er Se apter.470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plan , gs or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building Addition Q Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORKYCAI''l W t +�. ST LL=; �3 A I�1.�• �`� ASSESSORS MAP NO. Z i OWNER yv.\ VA 1Z i �t l��13 4 -� 1�( �h1 i✓: �0 -1-617- ASSESSORS LOT NO. HOME ADDRESSf� 't /YI 11it:' ;j G% l3,}IZ IL;, iYllq� 0 �L G TEL. NO. 3 c` FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). AGENT OR CONTRACTOR L'1 t Elk- W1,-)LL I,rJ J rl— TEL. NO.3 17 ADDRESS �C AL1�(=tL171oL��.- DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8, other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). Signed omracto Agent ce belovy line for committee use. I ,Q ertificate ' h y Date 7 TAR! Y 11 e BYTO�/GIV a� NSTABLE Approved ❑ IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ • r �43 t ox - LE rhI . � � .. � � � - ca �s ►` ��Q.jv.ST/4'31.�� f�+a4-a�,6 L�' —3 3 Coto"V _ !i�-adf wa a' .01 -- TOWN OF BARNSTABLE i� LD HIGHWAY �. I OLD KING'S HIGHWAY HISTORIC DISTRICT I SPEC S H E E T FOUNDATION e COLOR SIDING TYPE- CHIMNEY TYPE COLOR ROOF MATERIAL `�'!�!�L "� T�' COLOR PITCH Z � Z W I NOOWS `z I ZE TRI-M COLOR DOORS -� �L� �.-.- COLOR SHUTTERS GUTTERS DECK COLOR GARAGE DOORS e ill ut completely, -- D including measurements and :� o erials/colors to be used. OCT free copies of. this form are required for submittal ?I(99� an application, along with three copies each of TOWN he plot plan, landscape plan and elevation plans , �NGS NgT hen applicable. �� F eqR Hi�HW Plot plan need not be 'Certified , but should show all structures on the lot to scale . 1 � 1 • t 1 • '•' 1 �•: -�s,�� fix. 61 i i•. 7;y}^f: MM�iafi..:sl!!"�"b...'.�Cw. .�r::i_::;::..+..., ,�'. ' eA yam' , H I i ;:w't'rw'�.n `,'`'e t-rh�y .c�r��`+f '"'s/b l' q��F'. ut t r' .�� t �rw•cy",,�, `" 'rem �•r�`•,r,."�- ' " OWN ,r., .{,+6'��r.A.k ' %/d.,fir'��. •.'w`„�,!'rRC,'ti� � `'� � x,-�ya 4i* Y. a.,..�. qa„�i sW's�i h Er1��y*_. t t��im-`�w '. 1 � i �•. :�r A !,.'J..i-.i r.S......T Y,?�+i 'tirC .:'F••AN C! .A�`�Mt� •j�r� /� �.i � < ., ^'4.f K ti+ t G�.) rdj+• aog4Cf� '�.g t '-r � 1Ys• 114iY �� '`� Iti 1'f• � �l �� i,''•M~`arrow+ '�.♦.H. ,r -'i.ice MM I � f �1 °��.��1�, ,.i•Il �' a j� Y.,.*1i��i�Jf' Pw •. • �1 . Assessor's office(1st Floor): w l Assessor's map and lot num O 'Zi Conservation Yv� ow Board of Health(3rd floor): Sewage Permit number { iiiaiar�nt Engineering Department(3rd floor): �o�o 39 House number I BJ y AMC.t ti Sf Lv.--aCufr,,l y, Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABL BUILD ��• ING INSPECTOR 3 APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 1 1?3 M A.3 iv S�'• A2M J' I-t Proposed Use o o ;%- i Zoning District '` F Fire District L j . lzcyt,4',-q k Name of Owner A I 'L Address I T 3 4 Name of Builder o V(J ti t�� Address S d t 1 �''� Name of Architect Address Number of Rooms Foundation Exterior S ``'`� Roofing Floors Interior Heating Plumbing Q Fireplace Approximate Cost f ' Area L Diagram of Lot and Building with Dimensions Fee /G OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS . I hereby agree"to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name I ' ' Construction Supervisor's License ��63 7/ ROBIE, MARIA No 35027 Permit For Build Sun Deck Single Family Dwelling Location 1834 Main Street W. Barnstable , Owner Maria Robie Type ofiConstruction Frame Plot Lot 1 1 � Permit Granted May 51 16 92 Date of Inspection` 19 1 � r g��2 s Date Completed 1s� ,. 1 i t 1 1 ti 1 • 1Application to e rgaP MM'' UU `'y:`S otN"btlNaF�'s n `N Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS 1 Application is hereby made, id triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building ❑ Addition .❑ Alteration Indicate type of building:•_Eg"-House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other .Sun Deck and add Door fran,deck•to house_ (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY �i DATE 4 ADDRESS OF PROPOSED WORK 1834 Main street West Ra=ctnme Ma ASSESSORS MAP No. 217 Maria Robie '` "" ' ASSESSORS LOT NO. C-SC>9- OWNER i HOME ADDRESS 1834 Main St cruet R.;rrmt^hl. M. TEL. NO. 362-3849 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). Keith and Enid May Bunting"1855 Main St West Barnstable, Ma.o2668 Peter J Leveroni 1827 Main St West Barnstahle Ma W66R Lillian V. Leeman Main St West Barnstable Ma. 02668 James A. and Cathy Gill 2 Grove Island Drive #1507 Coconut Grove F1. 33133 Mark S. Wirtanen 1894 Main St West Barnstable Ma 0266R AGENT OR CONTRACTOR Michael Sta�n� D B A UmlIn Fnt i Ar=rcAs _ TEL. NO. 428-1616 5 Old Feilds Rd. South Sandwich Ma. ADDRESS t DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs,give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). + g g Build 12_'b� 16' sun dec n is ete res°sure trey ed�tt er?�P�� 1 Vgo etMo d or where exiet��``��y window Ls. A14 ma erialC °o e ain on r t I chael S yr Lic.# 006371 L Signed caner-Contractor- gent Space below line for Committee use; Received by H.D.C. fr �"' { POFpIfy 1 V r_ The Cert ific ate is hereby p• ✓e•'/ Date i ✓ T d j992 _ i 42 t Approved Certificate is approved,approval issubject to the 10 day peal period Vv provideo�)n-the Act. �. Disapproved ❑ H r � 1 ADDITIONAL INFORMATION FOR MAKING AND FILING AN APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS The four categories for which a Certificate of Appropriateness is required are: (application for demolition or removal is a separate form). t' 1. EXTERIOR BUILDING CONSTRUCTION (new or existing buildings): An application is required for any exterior of a building to be erected or altered including windows, doors, siding, roof, light etc., that will be visible from any public street,,, way or public place. The following scale drawings are required in duplicate with application: plot plan (if addition — showy existing buildings in outline), floor plan and elevations. Also required are snap shots of existing buildings, where additions or ' alterations are to be made. No plot plan is required for addition or alteration which does not touch the ground. 2. EXTERIOR PAINTING: An application is required for any portion of a building, structure or sign to be painted that is visible from a public street, way or public place. Color samples must be attached to these applications. An application is not required when repainting existing colors, changing to white,or using colors approved by the Town Historic District Committee. 3. SIGNS OR BILLBOARDS: An application is required for any sign or billboard to be erected within the District, with the following exceptions: P. Existing signs or billboards on November 27, 1974 shall have until November 27, 1977 to secure an.approved Certificate of Appropriateness. b. Temporary signs for use In connection with any official celebration or parade or any charitable drive as long as they are removed within three days of the event. Certain other temporary,signs that the Committee feels does not detract from the Act may be allowed with the prior permission of the Committee. c. Real Estate signs of not more than 3 square feet in area advertising the sale or rental of the premises on which they are erected or displayed. d. A single sign of not more than 1 square foot in area showing the name, occupation or address of the occupant of the premises on which they are erected or displayed in a residential zone,, 4. STRUCTURE: An application is required to build or alter any structure within the District which is defined by the Act"is a combination of materials other than a building, sign or billboard, but including stone walls,flagpoles,hedges, gates, fences;etc. GENERAL REQUIREMENTS 5. Work on projects requiring approval shall not be started until the Certificate of Appropriateness has been filed with the Town Clerk by the Committee. Approval is subject to the 10 day appeal period provided in the Act. 6. No changes shall be made from the original a roved specifications without advance 9PP P approval of the Commission on an i amended application filed with the Committee. 7. A separate application must be filed with each project requiring a Certificate of Appropriateness. 8. Under heading of "Detailed Description of Proposed Work" give detailed data on such architectural features as: foundation, chimney, siding, roofing, roof pitch, sash and doors, window and door frames, trim, gutters —leaders, roofing and paint color. I ` 9. Unless application is complete and legible and all material required is supplied,application will not be accepted or acted upon. Copies of the Act establishing the Regional Historic District may be obtained at the Town Hall. a l �33V0 .� • • WIN amn IMMENIEdi loom fMENI■■1■■I■MIs d ■� ME ■t■■1■■1 ■I■! ■■ did■d��■I�dld® MI-4pow =moo" PM ■ omoss ■ ��gaua � fl �� III1111N1l, �!�■■® win MIM S kw wim .7 f f+ t OLD KING'S HIGHWAY HISTORIC DISTRICT S P E C S H E E T FOUNDATION SIDING TYPE COLOR CHIMNEY TYPE COLOR. ROOF MATERIAL COLOR PITCH WINDOWS SIZE TRIM COLOR DOORS 2,s° nj i vipw ate rj r doo- COLOR White SHUTTERS r GUTTERS DECK 12' 16' sun deck Pressure Treated Materials GARAGE DOORS COLOR r Notes : `Fill out completely, including measurements and VED materials/colors to be used. Ft Three copies of this form are required for submittal E • of an,app l icat i on, a 1 ong w i,th -three cop,i es each of the p l bt plan, . 1 andscape p 1 an" and..e l evat.i.on plans, tAti�tJIV#, when .app I I cab I e *Plot plan need not be "Certified",* but should show all structures on the. lot to scale. , .. . PRQV ( fh':'i�b`y'la'?x•'�w1 Wig. '>�ur>3IhAu� E S T. 1917 ` � T f Z- �• t` f�; 4 JOHN F. KENNEDY STREET CAMBRIDGE, MASSACHUSETTS 02138 (617)491-7110 n ROUTE 132 CAPE COD MALL, HYANNIS: MASSACHUSETTS 02601 (617)771.5000 I ' I r� P � ; r eo � sr y -ems ti� r' 0 �4 el 1 �~ r o� 3 -- „ _ RECJSiRY OF DEEM � ru,^'J t IA srtgs.✓ RECEIVSD ,tom i9cs OF . GEWO RTHUR Aramit �f ti Qa V `i�. , �f ~L� •1r�,`s-cam f E = fi M„ G 'AYI VAR ,s�.�-,ecr,� �i�.�i� co.�•,t* � '�"Jed'�r c t=�°' �'' ,�,�� ` .-s'ctir.,v f.•�. �soc,•rt��.f.:n;�•�v_;�:` ;y. � , 4, i `;z,.�� :,`� .•c` '��f