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1850 MAIN ST./RTE 6A(W.BARN.)
� o 7YlG'Q!C Jan CO UPC 12543 Q' No..�.5® HASTINGS,MN 0 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map pp J Parcel Application lication We 1 C� Health Division Date Issued Conservation Division Application Fee ` Planning Dept. Permit Fee422 Date Definitive Plan Approved by Planning Board Historic - GKH Preservation / Hyannis Project Street Address - l a mcu Yl : 'LL VillageP � do� Owner C ev'P� Qr-� Address Telephone — .3 6)---333(o �n,4 406W •Permit Request — ;i5dah_daj 1A)ML � '1���GSS �a 106 V-X ,eyl �i_ c�rT� hL�-� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �'�� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full 0 Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new N - Number of Bedrooms: existing _new Total Ron Count (not including baths): existing new First Floor pub m Court go t Heat Type'and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other 71= C ;v Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood coal stow: ❑ s ❑ No m Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ xisting ❑ new size_ "' rn Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use - _ -APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �J�� EN&4 Telephone Number Address (a3 3 License # W~d /CW45— A, Gfd/�l„ Home Improvement Contractor# J`��d�cs Worker's Compensation # G)(V0439,q�� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATUR DATE f _ '; ry FOR OFFICIAL USE ONLY v APPLICATION# DATE ISSUED MAP/PARCEL NO. i z Y ADDRESS VILLAGE OWNER F DATE OF INSPECTION: ,, -FOUNDATION FRAME INSULATION- FIREPLACE ELECTRICAL: ROUGH FINAL 't2 PLUMBING: ROUGH FINAL y GAS: ROUGH FINAL �$ FINAL BUILDING 3. i DATE CLOSED OUT F; ASSOCIATION PLAN NO. r 01/06/2014 04:26 9787778415 PAGE 01 ACOO d CERTIFICATE OF LIABILITY INSURANCE 1/6/2014 CWF i'{}R!,, n E 04 T►:E CERTIFICATE#OLD'eR�TNI$ ..e -._ CERTIffG#TE DDEy NvF ,fir. „"..:_.Y u't i,� ^ „ z+'z BELOW. THIS CEiiiiFlC!►7E OF :f15LtJCRAW--£ 9M NOT ccW3tnU E A COIt7t'-hCT Sr?Sr�r'r Taw. Yc.= _ +yn REPRt"BENTATME OR PRODUCER,AND THE CERTIFICATR MOLDER. , t W tf bUBROGAtION IS AMEO,suDjed to mPORT:-IT: Ly Vit --r 3 i 'wP'M=1 P-9v?SGNAi WSL't?E[.L' :s1il�{;.CsS trttA4 �rtdo�sYO•y"s d tl ,' ow oa?tmcats haidu to rigs 0:tra=%s Marc:e:R+ CON PRODUCER "Cry INgR � NC (978)777-9415 %I 774-2463 123 Sylvan St ADDRE Nluae Danvers, b9k 01923 WSWC'r --T INSURER A:COmmerea Ins. CO. 3.t ins. Cp. INSURED Building Por=a&m+arc Cott-act_ng, �ltlantiC Chart@r INSURER C P.O. Box 633 INBURER0: `Tones Truro, MIL 02 666 INSURER E-. WSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY tNAt THE POLICIES OF INSURANCE LI&T$D BELOYt hRVE$ciN 3LviJEO TO Tric �ISISRE AE4'?'�3;.90VE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAMO:NG ANY REQUIRE?AfNT,TE�+`.I'A OR CONDITION OF ANY CONTRACT OR OTFIfiK DOCUMENT W(TH RJECT T TO t:'THE THIS CERTIFICATE MAY EXCLUSIONS AND CBE ISSUEDMONS OR OF U MAY P PERTAIN. LITHE MITS INSURANCE OWN M1AY�NAOVE BEEN REDUCED BY PAID CLAIMS RDED BY THE POLICIES DESCRIBED HEREIN i3 SUBJECT TO ALL THE TERMS. FAM JAPIX pOUCY NUNIBER 0 IYYrY ll1MRS TYPE OF INBURANCS INea EACH OCCURRENCE i 1 000 000 GENERAL UASILnY ! SO OOO 'E COMMERCIAL GENERAL LIABuTY PREMISES Ee omurenee CLA1Ms MADE OCCUR MED SIP IA.Otto DGM • 1 O0O B 3DE9441 11/19/1311/19/14 pFRBDNALIADVINJURY i 1,000,000 R; GENERAL AGGREGATE s 2,000,000 PRODUCTS-COMPIOPMM S OOO 000 GEN I,AGGREGATE LjM T APPLIES PER: _ POLICY PRO we 1,000,000 AUTOMOBILE LIABILITY — Ea�denl BODILY INJURY(Pw person) f ANYAUTO LQ3983 BODILY INJURY(Per aoclow l) $ p� A�il`OWNED x �D-0WNED DSULED 2/2/13 2/2/14 er NDN P eodWr� S HIRED AUTOS AMOS fl is x UMBRELLA UAB OCCUR EACH OCCUMENCE i 2,000,000 CUDW3904112 5/i/13 5/1/14 �� s 2,000,000 D MWESB LIAR CLAIMS-MADE s OED RETENTION WORKERS COMPENSATION M AND EMPLOYERS'LIABILITY YIN 11/23/13 11/23/14 El EACMACCIDENT S 500,000 AFF ERIMEVA �'�T�° � ® MIA WCV00939900 C ocficevNeuaHe Erculoea► E.L.DISEASE-EA EMI'LOYE1: 500,000 t"";dolorory"„ E.L.DISEASE-POLICYLIMR a 500,000 p$BCRIPTION OF OPERATIONS odow AuM DESCRiPT10N OF OPERATIONS I LOCATIONS I VEHICLES(AtiBf.T1 ACORD IOI.Ad=wwl Roffmft Sd+m+1e H mon eP2w Ie r9q CERTIFICATE MOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Barnstable, Na THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE H THE POLICY PROVISIONS. AUTHORIZED ENTATME L - tzw_ —1;1�1?1j;Z'6��' a 19M2010 ACORD CORPORATION. All rights roeenred. ACORD25(2010105) The ACORD name and Ingo are m9latwed marks of ACORD The Camnionwealih of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 wmp mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eiectri-cians/Plambers AvyUcant Information / Please Print Le ' I ess Name(Busin /t?rganirafion/individuai): <I Address: City/State/Zip: —f ru y RA, Phone Are an employer?Check the a proprlate box: Type of project(required): 1.L16 I am a employer with . ❑ I am a general contractor and I employees(frail and/or part-tim ),# have hired the sub-contractors 6. Now construction e proprietor or partner- listed on the attached sheet;i 7• Remodeling 2.❑ I am a sol ship and have no employees - These sub-contractors have 8. ❑Demolition working for mein any capacity. workers'comp.insurance. g, ❑Building addition - [No workers'comp.insurance S. ❑ We area corporation and its 10.❑Electrical repairs or additions 4; required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions myself.[No workers'comp. a 152,§1(4),*and we have no 12.❑Roofrepairs insurance required.]t employees.[No workers' comp.insurance required.] *Any applicant that checks box 01 must also 0 out the section below showing their workers'compensation policy h6mmdon: t Hommmers vdro submit this affidavit Meeting they are doing all work and then Me outside contractors mast submit a now WMdavit indicating suety_ ttontraetors that check this box must attached an additional sheet showing the name of the sab•wuheotors and their workers'camp.policy rnSomradon. lam an employer that isprovkUng workers'compensation Insurancefor ray employees ,Below IS tlrepolicy and job site Information. Insurance Company Name:_1� 17/G Policy 0 or Self-ins.Lie.#: W�yd�Cf�� q�L Expiration Date: v o2DI / Job Site Address:I& M(J�l V eCT City/State/Lip: s //I Attach a copy,of the workers'compensation policy declaration page(showing the policy number and expiration date). Faslure to secure coverage as required under Seodon 2SA ofMGL c.152 can lead to the imposition of oriminal penalties-of a fine up to$1,500.00 and/or one-year Imprisonment;as%yell 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 wider the pales and penaltles ofperjury that the fnformadon provided above true and correct Si P one Offlklal use onry. Do not write In this area,to be completed by city or town of}IclaC City or Town: Pt rmltUcense# Issuing Authority(circle one): 1.Board of Health 2,Building Department 3.Cityll'own Clerk 4.Electrical Inspector S.Plumbing Inspector 6,Other Contact Person: Phone#t Y. OWNER AUTHORIZATION FORM 1 1, t � � �✓t%121-�A-�.� (Owner's Name) owner of the property located at MR-lAJ 67, \rJaT T S-t-A-GLG- 0Va (Property Address) (Property Address) t hereby authorize D ) Id j no) man C.-e (Subcontractor) L an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my.property. Owner' ature Sig G Zo l3 Date r Massachusetts-D.epartment-of Public Safety Board of Building Regulations and Standards Construction Supeh-isor T` License:CS-078815 JOSH EMON_D PO BOX 633 ro f' Tru MA OZ66iG�- Expiration Commissioner 03125/2015 O"'�"p' License or registration valid for individul use only er Affairs&Baseness Office of Costum Regulation @; NIEN CONTRACTOR before the expiration date- If found return to: E IMPROVEMEE,, T ,. eg Type:" i Office of Consumer Affairs and Business Regulatio istrati 10 Park p1m-Suite 5170 LLC iration:=lL3f22dlr_ Boston,MA 02116 BUILDING PERFO roeCO1 i CT1NG.LLC_ JOSH EDMOND Y 8 KINNIKINNICK RD TRURO,MA 02666 ``—' Undarseeretar9 of valid without signature" i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map / Parcel 0 /0 Application# Zo O v3 Health Division Date Issued Conservation Division Application Fee Tax Collector - ' Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board W" Historic-OKH Preservation/Hyannis Project Street Address M ,+) A/ ZT. Village LC- Owner (244167 EyE71Hh-r1 r Address-hPO , Atts7-214 UAI it SgOO, I&QX /Z Telephone 3 Q P - 46 7- 90S- 60 GA-'L COA4 7 4-eT : X47W KI yA/ ��A,Q.//A�v 1 O q70/ Permit Request �u - K;;S�Y�; . �n � �/G�n/CH l�Oo✓L TO Seote r4-0� n N kTrv,-r ew i,,/.iI Lc� l we, bg ©wO u0,Ar SeP����e IPA�,ti►�; Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 9L Cf 60 Construction Type r Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 2 Two Family ❑ Multi-Family(#units) =; Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: O Yes-n❑No AQ Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other - , 7-1 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 Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes I&No If yes, site planryeiew# Current Use -Ci vl P P-Mwi :' w_4 6' Proposed Use 51 BUILDER INFORMATION `Namen p 30 1llvomeTelephone Number a oc Address .0_ `Z� `-( License# C �- R e. 2 Home Improvement Contractor# 1 �.�n,•,; �1 C20-k Worker's Compensation# Wc_ 014 L �C4 D ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO E P A PPV0Vt'� Dev, efir, �raccr(r ca f i 5e 0� "h T e S i o SIGNATURE DATE -2 6 ` 10 FOR OFFICIAL USE ONLY Y APPLICATION# DATE ISSUED MAP/PARCEL NO. '9{ ADDRESS Pa VILLAGE ' OWNER ,f r DATE OF INSPECTION: FOUNDATION - _= FRAME / C&I INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL • FINAL BUILDING �0 O DATE CLSED OUT �z , ASSOCIATION PLAN NO. ' i r The Commonwealth of Massachusetts Department of Industrial Accidents VJOffice of Investigations 600 Washington Street Boston,MA 02111' wlvw.mass.gov/dia ' Workers' Compensation Insurance Affiddvit: Builders/Contractors/Electricians/Plumbers A_uulicant Information Please Print Le>?ibly Name(Business/Organization/Individual): Address:_ City/State/Zip: /7 lrA_14/S Od-& d f Phone.#: 5o do 7 Z S`- 21Ir Are you an employer? Check the appropriateMI ;Type of project(required):, 1. I am a employer with 4. general contractor and I 6 New construction . employees(full and/or part-time).* • have hired the sub-contractors listed on the'attached sheet. 7. [�]'11'emodeling 2.❑ I am a'sole proprietor or partner- These sub-contractors have ship and have no employes These ❑Demolition employe and have workers' working for me in any capacity. $, 9. ❑Building addition [No workers' comp.insurance comp, insurance. required.] 5. We are a corporation and its 10.❑Electtical repairs or additions '3.❑ I am a homeowner doing ill-work . officers have exercised their 11.❑Plumbing repairs or additions ' myself.[No workers'comp right of exemption per MGL 12.❑Roof repairs insurance.required.]t c. 152, §1(4),and we have no j employees. [No workers' 13.❑ Other comp,insurance required.] *Any applicant @rat 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 isproviding workers'compensation insurance far my employees. Below is.thepolicy and job site' information. Insurance Company Name: Policy#or Self-ins.Lie.# 611 Expiration Date: C1—/S 2-0/(� Job Site Address: City/State/Zip: M, 13AQ1.97_/,6,L� 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 maybe forwarded to the Office of Investigations of the DIA for' e covers a verification. I do hereby rtify der the ,ains'1A penalties of perjury th the information provided above is true and correct Si afore: l Q 4 7 Date• — Phone## t7 d Ofj7cial use only. Do not write in this area, to be completed by.city or town offciaL City or Town: ' Termit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contkct Person: Phone#: q �' �lassuchusetts- Department fit'Public Sat'ch • Br►ar'd nf'Building Regulations and St:utdards Construction Supervisor License License: CS 69152 Restricted to: 00 JOHN M FALACCI PO BOX 1224 HYANNIS, MA 02601 Expiration: 1 211 1/201 0 ('nnmis�imer Tr#: 7462 ✓fie L�oo�vnzoozcoe� ����z ---• --- — - — _ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only — before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: 148770 10 Park Plaza-Suite 5170 Expiration:-- :10/25/2011 Tr# 288061 Boston,MA 02116 Type: ` Private Corporation HOME IMPROVEMENT SPECIALIST OF CAPE COD JOHN FALACCI. 25 IYANNOUGH ROAD HYANNIS,MA 02061 Undersecretary Not valid without signature • V ACORD�, CERTIFICATE OF LIABILITY INSURANCE DA9/22D2009) 09/22/2009 PRODUCER (781)447-5531 FAX (781)447-7230 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Mason & Mason Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 458 South Ave. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Whitman, MA 02382 Gwen Vosburgh INSURERS AFFORDING COVERAGE NAIC# INSURED Home Improvement Specialists of Cape Cod Inc INSURERA: National Grange Mutual 14788 PO Box 1224 INSURER B: Travelers Property Casualty Co 38130 Hyannis, MA 02601 INSURERC: Star Insurance 000204 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD1 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY MP049363 09/02/2009 09/02/2010 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 500 000 CLAIMS MADE FX-1 OCCUR MED EXP(Any one person) $ 10,000 A PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY F1 PRO JECT LOC AUTOMOBILE LIABILITY BA2638N65609SEL 04/24/2009 04/24/2010 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ B X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC0428640 09/15/2009 09/15/2010 WCTORY LIMIT- I OTHS FIR - EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1OO,OLIO OFFICER/MEMBER EXCLUDED? OFFICERS ARE INCLUDED E.L.DISEASE-EA EMPLOYE $ 100,000 It yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS esidential remodeler CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of Barnstable BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 200 Main St. OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE David H Mason ACORD 25(2001/08) ©ACORD CORPORATION 1988 F i ��of1He, �o 'own of Barnstable. �. Regulatory Services � .uxrtsreB�. • r Thomas F. Geller,Director �ATfn �A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 wnv.town.barhstable.ma.us Office: 508-862--403 8 Fax: 508=790-6230 Property Owner Must Complete and Sign This Section If Using A Builder C r cz; wer 64XI , as Owner of the subject property hereby authorize I. to act on my behalf, in all matters relative to.work authorized by this building permit application for: . (Address off ob) y Signature of Owner Date C rc� Print Name j Q:Folz.Ms:owxFMERMISSlox Tf l . .5 t- :13 Barnstable Old Kings Highway Historic District Committee 200 Main Street Hyannis,MA 02601;TEI: 508-862-4787 Fax 508-862-4784 sr�e Y 6i W. APPLICATION, CERTIFICATE' OF APPROPRIATENESS Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or photographs accompanying this application for: Check all categories that apply; 1. Building construction: ❑ New ❑ Addition AAlteration 2. Type of Building: ❑ House ❑ Garage/bain ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting,roof ❑ new roof ❑ color/material change, of trim,siding,window, door 4. Sign : ❑' New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ tennis court- Other 6. Pool ❑ swiriiming ❑ Other man-made pool Type or Print Legibly: Date: r f P, !UM Address of proposed work: House# Street: ' Wil,,; & irT" Village [J• ;�AP t'-"1.1-.A�)"'�Assessors Map Lot# 010 Description of Proposed Work: Give particulars of work to be done: 77 ( CK "C i CIS 7002 4 1)Zt:..l_�,S l-o,` t-• S'Tt�lA CC tiSL�. "RC-FLAGc yI.; S)c— bF !c-1J _2\jC((-t j,�l J \jlnt ItitA'1 C�I)I,Vt /\Jo-j C)ly1-)&� - i )Vtc((5 A" -' > • c��.51 I'�•-��� 1J���I�d��� I in.-(3'�'1�t"✓ ��(.r�j L- Agent or Contractor(print); Telephone#: Address: Contractor/Agent' signature: NOTE A11 applicad°ns must be signed b. the current owner oil -y 3 d'TG (493 AvsT>?iA Owner(print): MA I C, i - VER\4 A T Telephone#: 5 3 l0 ' �fJJ ►\aA, hlAv1 v ��l U"`t Owners mailing address: U N IT S S DO I 'Ba 1 2 Po A C DIM1 > -a t4e Owner's-signature: For co mil a use only. This Certificate Is hereby P)RO'VED DENIED \ Date Members signatures APR 0 2 2 R 10 TOvVM.nr!3A'INSTABLE Any_con fap al: that 9hwaY Km9 etn ee 1 Q:I GUD_Groupsl old Kings High waylOKH New AppiOKH Cert Appropriateness 07.doc Town of Barnstable Old King's Highway Regional Historic District Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 4 Copies Foundation Type: (Max_ 18"exposed)(material-brick/cement,other) Siding Type material: Color: Chimney Material: Color: Roof Material: (make&style) Color: Trim material P71ff - p 1 N E ` , COIOT: LJ 4 i TE Roof Pitch: (7/12 minimump�),A, Window: (make/model) 3 0,+L, material color i T� Size(s):_ 54-,A;E AS c R1(G1 tvA L Door style and make: f:"1A�3 r!P O6? material Color: W lA i Garage Door,Style Size Material Color Shutter Type/Material: Color: Gutter Type/Material: Color: Decks: material 1 A��,E TR I� Size 2 i 1� i Color:r' �' q S':�-uc 1.1 Skylight,tyWrnake/model/: material Color: Size: Sign size: Type/Materials: Color: Fence Type(max 6')Style . material: Color: Retaining wall: Material: Lighting,freestanding on building illuminating sign Please provide samples of paint colors and manufacturers brochure of-style of windows,doors,garag6 door, fences,lamp posts etc ADDMONAL RVFORMATION: j 1 �`W___.—`'= c I�I?! APPROVED IU i�� l iI AP 0 sue? P 010 I -rr� ' o STiS (. eid Town : - 'S-aHm4 hlrawbaley;rl ,a4 , 4f"' t-,�._._! Committee Signed: (plan preparer) print name tel.no. Location of application: . Street no. f SSa Street tt ST Village W,- 75A-a tJ (3Le- Z OGMD-Croups101d Kings Highwayi0KH New AppIOKHCed Appropriateness 07.doe I - ��i �xt� s�•u/. I rya/ FIT/0 Doi i ExS. (,cJ 1 Tel- ._. F �I PKoPa�Ep r7ECK 0 AJ ; APPROVE® '� ��- ,•�� - '' APR 2 7 2010(l�� U/Oo jj — WH17E Pr9/,)%-Q Town of Barnstable - Old King s Highway Committee it ; �{-~-.r` `_'_'•mil. I 1r Eu: f r - ��; •�-r-----,� � I Neu./ I ± l/U/ll(� I �r. ua`v ✓� v � � I�� 77 \TT-v i \� �Li - vo APR 0 2Ir 2 -; TOV?N OF BARNSTABLE - NiSTO �sC `'�ESERV,4-PION "#�+^ � ��•fie. �`�'• Tom'` F"�►'��� $'� � J�++r, '� ��a,1 ,�c3r e11 'S qua • F �: +Ay 4' �..Pa y �kU � �blv" �e�1.. , s •i• ��' t a,.�g�°�'-rs;�Jl,��'�t•a���, '��.1�'��l ,. t ,,.••,. 'ffs � �� -re•� - X+'r % �'• t sl3y -t.L�kstd 'ka,•• ' r dl.Ltt1` u'-+F-t M�1'� 1ti;' `�P'>!✓x�a•' �e.t.R t a 3.f s,•.3 N 'J ,. ` / •`l s �t:se+(Si soma, ��kfi,1& :Y ss 1t`N•J o1� 4Kt:.lsv4 i '�"�`��� LP . J i�� �? lze,.,1�T�wiU✓t+Af`6E, a.. a's��'- J4,. skit jt � t Yr e1 i" ti ,� �1 ;�+"'3S1!`� (s Y'a.1d t as , i t!'14.t i�•taf�la' I �,� •�i"r. �, 19j 6Li +5f6pk •s, 5 Sy 17. ffil All 1 I��, Igr� 6 iFul '� Q �9st�y,Iy!'. kltyl�. 1-.�. a � es y Z_.Api;�" ?• �hCyt-� ..�'+ iI 3y �'� �� 3 � �..ci�1 t^�� � tlu;' t- '� ,1' `�� •.w • � III •` ,`4T 2 �, S � + wN ryry n it INS I Nut y . lip ! J -' f f f ��} �i � 1.' r �� �i 'S. '� �' -64 r.� 4iq a a• u j �..i p. A{Jf) ?M�e4 �`i�}�� i� ,(1 e.µ `�,' ro 'u si.- , � :�• � n•4. e. i0afa'} f y4 -G�As'.. �t 4 n 'X'Sk�g'6�K�. µ. fr.3t`•q�' { �'i �F ;i' i ��a�♦ q' � r � �^._ .� 1 '• ' r;�.'- '4; �t,� ��t�it'5,�,.�Jig.13'e�.Lays F',i. 2..fw c- K��a��aAC., ), n J .3' �.J• �'' i ;,j:'!ci � ..✓�l.F �rf.�,.�2F�Ji�i4 � � s ,.�y�J �J.. � A "!!'i �'tZh Hii&�p,:,V'A�3�4 •`i ta_�}a t �f�/ ~ h a I MW. ' aka a,. S WWI: low x �' � ��1f:�9�sE! �`�,�'�rji1� ltif'� - +s"$ifiz�tti!'44'a'� ,"'•"� _� 4:�":' 4 e`� h r �<. . �� I ,t "rn,''tT.e>y f C Qr^,v" 4 � t'�`{ �,,,. •e.+Y<' \a,r,�.. �n.+ io., O Sri } �7Fco MN APPROVED I i . , APR 2 7 201 i Town of Barnstable did King's Highway Committee s V\ > �� � i zi iOf Ez- N 1. i i • i I i 7 { I f APPROVED n t 1 APR 2 7 2010 i Town of Barnstable � - -J"�ICYKin9'siii9frway_.__...._._._.._.._..___.___..____._...• l j. ' Committee I r T 'Nate ° Pond �o�e� ��y EXISTING CESSPOOL o " Ot-'� .�90• PERMIS510N SHALL BE OBTAINED ° FROM ABUTTER TO PUMP, "L S —LOCUS WTH SAND AND ABANDONED OR DISCONNECT AND ABANDON y- 61 9ao Benchmark Set y y •/vo TOP CONC. BOUND �c s EL.=100.43 (Assumed). 10 �e /iL LOCUS MAP co ce/dh �t NOT TO SCALE •p0 O 101 00STING CONTOUR .10o.48 EXISTING SPOT GRADE PROPOSEDSEPTIC TANK ♦o♦� x / / 0 s --9HW--0VERHEAD WIRES \\ / ��• O♦$� e\ W—PROPOSED WATER UNE GARAGE ;02 0 o2>>s� 'm ® POITAeLE WELL TEST Prr o,a ♦o�c �� F '00 EX. SAS J 1y p�p p ♦Oy 1 •`Cy��X.�� v0 o. c' ♦� ♦oa' ,N1 VENT o ♦ 21 /J2 ♦oast oa EXIST. WELL 62•' HOUSE(/lEtSo) e (to be abandon 8)dh ♦O T.O.F.-1 74t I-KO Q�E I _ -- --'� 0 00 6Uj ♦O! A Og3 h ♦ ♦Oag _ ♦ 3 r 10 \0 N(mil 00 Cq I EX S PTIC TANK CO L f \..�a 00 ♦O♦"6 Q r I HODS 0,3 c19 GARAGE 6 E —� "183 J C1, }♦o. � — b� I Cb EX. SA S ��O 11 o I EX. WELL , N m WELL n 9g split raft fence 1 y`, N o �\ q1 $ �. p o• t EXIST. o qb� b22 o BAR'�rj/ SEP11C TANK l 96� 5y 4b HOUSE J1866 C�'J96 9b32 0 n x m• rn o 0 32,022fS.F. p3 a1 `i a Map 217 +gb by1 s'aw Parcel 010 01 9y5 1 p2 EX. WELL / fil9(' e 9 N 4j 34,SO' �'JO - G ��O f S cJ� ♦00' cotchbaHOUSE si #1837 sAJ �8 PROPOSED SEPTIC SYSTEM UPGRADE PLAN EX. SAS -- 1850 MAIN STREET RTE 6A , WEST BARNSTABLE, MA Prepared for. Virginia Johnson, 113 Linden Street,,Hyannis, VA 02601 nwalFa nr ocr non _ t- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel'*. ��(.� '..Application # Cab �dU��� Health Division �y Date Issued �O Conservation Division r :_.Application Fee - Planning Dept. Permit Fee- Date Definitive Plan Approved by Planning Board i r Historic - OKH Preservation /Hyannis p Project Street Address ��� Village LJ Owner (��atP..� CJv -[� � Address 4 � Telephone 30— 333L, Permit Request .Do I >om Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new -24 b Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes X No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes�No On Old King's Highway:�kes ❑ No Basement Type: ❑ Full ❑ Crawl XWalkout ❑ 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 3 new First Floor Room Count-, Heat Type and Fuel: ElGas ^Oil ❑ Electric ❑ Other Central Air: ❑Yes No Fireplaces: Existing i New Existing wood/coal stove: ❑Yes XNo Detached garage:Pkexisting ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing _❑ newi size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: © t� Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes XN 0 If yes, site plan review# .Current Use - Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name CvAi& D Cymt 'k Telephone Number 362, 33" Address 1 � �M �� License# Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO TES L (-i1M SIGNATURE �� DATE 2Z3L- /0 dj FOR OFFICIAL USE ONLY I % APPLICATION# z � I5 DATE ISSUED F MAP%PARCEL NO.. ' ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION`,�0,VAS ok 9 �o lQrytS(_ 0 FRAMEl7Cf✓lc ✓ r; INSULATION: I � FIREPLACE . ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL f GASi � ROUGH " =' FINAL b� fINAL BUILDING ,:. /. °` OA 19 Ito F ;.j. DAT_.E CLOSED OUT . ASSOCIATION PLAN NO \WF-4 N Wete ' Pond ,�o�eN EXISTING CESSPOOL 1 $O' PERMISSION SHALL BE OBTAINED n FROM ABUTTER TO PUMP, FILL S 8. W7H SAND AND ABANDONED OR LOCUS 0 C C. i 9A DISCONNECT AND ABANDON H Ro � 03 90 �9 0$. Q`j` Benchmark Set tip1 t,�e TOP CONC. BOUND 196, EL.=100.43 (Assumed) J ce do J/�P LOCUOSSCALE MAP NOT T/ �" 101 EXISTING CONTOUR y 00 ° �b .100.9e EXISTING SPOT GRADE PROPOSED SEPTIC TANK �°�� x /. $g S —8H19�—OVERHEAD WIRES �3• O\;A \ —W PROPOSED WATER UNE GARAGE "-,� ;02 0 o2�\s`A je POITABLE WELL TEST PR 10 2• EX. SAS �. o`y VENT /12 o � �• x �qe ao � g �o°s sf• EX/S71 G " i1 EXIST. WELL ,•HOUSE (to be abandon B)dh \o "TO., 74t r ��oPohF� o 0fO `°1 3 PFr k .10 EX. S P77C TANK 6° '1 a +oIh �� �r .Q$00. lay `•. 0. Nub GARAGE. HODS I �l ,0 6 fy183 (0 t w °° m EX. SAS EX. WELL c�.1in "O. to P ED £ po `O WELL o split fall fen Le i11 r �2 p q1. $ w o, �•' EXIST. o 060 +0622 +t BAR �SEP7IC TANK •` of 9b• Gj5 t._..- _ ..,.. o f �6 HOUSE 5\ #1e6e•.i - ' t p4 k m a' 'm o_• 3 .` 32,022&S.F. a Map 217 +0e. - s ewo Parcel 010 5� CO. /�/A 188.20, C)y5- .0 02 EX WELL 4f4l* S / 1 W 3 �O `r enr catchb as/ \ HOUSE 64 CO. PROPOSED SEPTIC SYSTEM UPGRADE PLAN EX. SAS 1850 MAIN STREET RTE 6A , WEST BARNSTABLE, MA Prepared for. Virginia Johnson, 113 Linden Street, Hyannis, MA 02601 OWNER OF RECORD Engineering by. SLUE DRAWN J011 No. LEEMAN, LILUAN V., ESTATE 0 1.=30' P.T.M. 194-09 c/o JOHNSON, VIRGINIA Engineering Works,Inc. 113 LINDEN STREET 12 West Croefield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. HYANNIS. MA 02601 (508) 477-5313 9/25/09 P.T.M. 1 Of 2 ,per The Commonwealth of7dassachusett� Department of htdustria[Accidents Office of Investiga ions 600 Washington S'lreel BOX tog., MAki OZX11 wrvw.mass.gov/dfa Workers"Compex�sationTnsuranceAffdavit: Builders/Contractors/EIectncianstTlumbers Please Print Le 'bI A ' Iicant Information Namr, pusinosdorkwiUtionlln"dud): 1�/+ • Address: l� City/State/Zip: Are you an employer? Check the approprlate box: Type of prof ect(required): I.El I am it employer with _ 4• ❑ lam a general contractor and I 6 ❑New coushuctioa employees (full and/or part tiuoe).* have hired the sUb-contnctars 7, �odc� listed on the attached sheet ❑ 2.❑ I am a'sole proprietor orparinrx Thcoo sub-contractors brava g, []Dcmoli60n ship and have no employees cmployccs and have workers' 9 f5'A��g addition working for mein any capacity. imp.insuranco.# f [No worlccrs'•comp;insurance S. [] We are a corporation and its 10.0•Electrical repairs or additio: . • rtclu ccQ off c6rs have excrciscd thoir I1_Q Plumbing repairs or addido: 3.IR :1 am a homeowner doing all work ri t df excmPon ti er MGL mysel.t:[No workers' con3p. l5 p 12.❑Roof repairs inru ncO rcgwcd-� I c. 15Z, §1(4), and we have no 13.[]O thcr . ' Cmpleyoeg. [go workers' comp.insurance rcEw ell •l�ry applican[that chccSs box f11 must also fit out tho roction bcloty showing thc'u workaa'compenaatlon policy lnfonradon. t ljom pplica C who cuccait Oxhi;sttidastt indicating icy art doing all work and tern hire outsidt contractors must submit anew zffi& t'ndiaiing cute kt:ontrdetnrs 6Ij cheek o&box rre:zt adiacd sn additson2l sheet zhowing the name of the subconh—twl and rwo wbcther or not$rose cntidcs hive employers. itihc rub-contr aotorr havo cnployocz,they mud provides ibcir workers'comP.Polley number. 'cvmpensativn insurance for my employees BeLow is tfle policy andjob site I am an employer that 1s provIdLtgworkers informallon. Insurance,Companyg=o: . Policy#or Sclf-ins.Lie.#: Expiration Date,: Citylstatclzip: Joe Site Address: Attach a copy of the workers' compeusatioli policy deClw-aHon page(showing the policy cumber andExPira{ion date). Failure.to secure covcrago u r&Vu red,under Section 25A of MGL c. 152 can lead totho imposition of criminal penalties of a fito dp to 31,500,00 zndlor ono•ycal impriso=cnt, as Well as civil penalties in the form of a STOP WORK ORD$R and a to of up to S250.00 a day against thq violator. Be advised that a copy of this statement may bo forwarded to the Office of Invcsti ations of the bIA for insurance covers c verification. 1''do hereby c under the a enaltics ofperjury that fhc informafivn provided Above is true and correct IT ate — Ajt- � Q7. Si a c. Ci t:;b f 2 333� Offut use only. Do not wrifeltizUr areu, tb be cor4kiad by city or town officlat City or Town: Permlt/Licenre# Irsuing Autbority(circle one): 1.Board of Health 2.Building Department 3. City/ToWn Clerk 4.Electrical Inspector 5. plumbiog Inspector 6. Other tttt: Town of Barnstable oF ,gy, . "o Regulatory Services BARNSMIrx Thomas F.t;eiler,Director KAM Building Division rEn 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 I� t �y Please Print , DATE: (/f jV�1+j� �A JOB LOCATION: 1 ew /'wr/ �� number ���y��l street ® ry Q / village "HOMEOWNER": `/1A i Ga D, Fy G 11A!a � CAP?--333G � name AA home phone q work phone N CURRENT MAILING ADDRESS: tM/1/O SK city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minim inspection proc toes and r irements and that he/she will comply with said procedures and req ' ejnen� Signature of omeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that. "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness o13en results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed personas 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/catification for use in your community. Q:\WPFILES\FORM S\homeexempt.DOC j r v w r ► r r r r r ► r ► r r r r r ► r ► r f i s I w r W ► r r r ► r ► r 0 r v r ► ► ► r r r r _ 1UUMUNK&I mom 1111i1111110111110 Itiasf�� lei ►I���� sm. 11IINIII mom slum MOM w ■ w . . � � • ■ ■ w w � w ■ � t ■ w w � w ; r ■ ■ . . � � � w ■ w w w w � ■ r a w t w � w ■ ■ w 'I '�`�`��►�►•�1���`��'1I�I�I��-�"��'U►�l��� "��1IrI�1��-���r��I�/����'�U►�I� , t r • x. • sit C-Z pm'a all -PH kft -LI 4w 4.0 ..A v pr AM I,j jog jg1ko f1wail - `��'4"'_- _ -.i'4�'r �' _s.•i..., r,.:� :.' ?S�Mkr;y+�*t•. � ,..� �'I��. y �•'.� �' ,.a.tif}.4 ti%"�` —Pi- I Ort S1tE rp Barnstable Old drags Highway Historic District Comndttee- 0 ? 200 Main Street, Hyannis,MA 02601;TEL: 508-862-4787 Fax 508-862-4784 Y !dA-4S c i• sb3 p• � APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or photographs accompanying this application for: C teck all categories that apply; t 1. Building construction: ❑ New ❑ Addition KAlteration. 2. Type ofBuildin>;: ❑ House ❑ Garage/bara ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting,roof ❑ new roof ❑ color/material change, of trim,siding, window, door 4- Sign : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign S. Structure: ❑ Fence El Wall ❑ Flagpole ❑ Retaining wall ❑ tennis court- �' Other 6. Pool ❑ swimming p ❑ Other man-made pool Type or Print Legibly: Date: 1 J {.ups L�l _ Address of proposed work: House# � Street: , bhtj SiT Village ��. !�APQ4-ST &` Assessors Map Lot# 01 Description of Proposed Work: Give particulars of work to be done: %1 i) 1 1Crc Pc.C;� ; i� cat Do��(z 'i�2����s �-oz L..''S'T-E�"'-1/-t CL (�cSL�. I�LQL,AC� ��C►Si►,tiu �;;r-�n��.rs C;\rJ �rT�+��2 Sint C">f� /vZ'--1 l.�Ar�l�� 'Di Agent or Contractor(print); Telephone#: Address: Contractor/Agent' signature: NOTE All applicat;otrs must be signed b. the current owner Owner(print): :{6 1 (r D- 1 F*R yA A2-1 Telephone#: 5ti � .3 V —3 08-5 *}A V_1A h Vc—,r\1 o-,`t Owners mailing address: UN IT 5 30U '80X, 1 Z FA , AE D9701 b V4-4w o t p I r Owner's signature: For co mitfpe use only. This Certificate.is hereby PRO VED DENIED Date D Members signatures APR 0 2 2 L) J V Imo• —"'�� �- p\e T01"J'.1(?i ;-,;�: l'v5�la {E l Any con f ap al: - t Bar 9 Way 6% Old K�n9 ee rV • - 1 Q:1CMD-Groups101d Kings Xgh wa)lOKH New AppIOKH Cert Appropriaremss 07.doc Town of Barnstable Old King's Highway Regional Historic Distrigt Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 4 copies FoundationType: (Max. 18"exposed)(material-brick/cement,other) Siding Type material: Color: Chimney Material: Color: Roof Material: (make &style) Color: Trim material ter' p 1 N le Color: LJt4l'i-F- Roof Pitch: (7/12 minimum) Window: (make/model)Nj�H 3 v Lf Lt material color �b TE Size(s): € A S p ft1 G I tvk t_ Door style and make: 1" CN&A FIAX,)(o L F material Color. W Fi i1t Garage Door,Style Size Material Color Shutter Type/Material: Color- Gutter Type/Material: Color: FF Decks: material 1 RESS'Y'E TRE)i'ED Size 1r l Color:N hWM L' Svc r�i N Skylight,type/make/modeU: material Color: Size: Sign size: Type/Materials: Color: Fence Type(max 6')Style . material: Color: Retaining wall: Material: Lighting, freestanding on building illuminating sign Please provide samples of paint colors and manufacturer_s brochure of-style of windows,doors,garage door, fences,lamp posts etc r`"�t�.�, i ADDMONAL RVFORMATION: ;I � �= �_;±:r`+I ;; P P m O E ilI i AP `0 -� p 010 T!,c's. table S+ hway L: +s, ;.,'+`�._ Committee _ - . Signed: (plan-preparer) print name tel.no. Location of application: Street no. ($SD Street ! " '` Village (,.l,- P. S j q( 12 Z Q.ICMD-CrourpsiOld Kings HighwayIOKHHew App1OKHCed Appropria[eners 07.doe 04 _ . 379� _ 70 3�� i llGC7 uElV P11 10 pvlel EKS. W. --...-- I e--- _ { p `�ZT �.�..L • 1 1 Ni > G-0 Jz P�oPo SE p f7ECK SECT off/ PPROVED APR 2 C WOOD — WHITE Vlllk)%ED � l Town of Barnstable Old King's Highway Committee { � vEG(J�iS j/rJ j i ��... 4 AEG I I �xcoc We`D GPvEc i L �G it V E � ►� 7,19 O I APR 0 2 ZOOT01-Mil XL L / J OMINI OF BA' NISTABLE PRESUIVWD' IN ",, gee✓b _ A� •.1 i /r �^" �•' u/,dl� is��k � '''E'.�4 1 �•�Y `r• -a' r'... �+�v1��Y .H�IS'.!,P[ �+Y•ted�s`"'I�^�ie�' �r� :y,,y ���>°� t3 ; —C;r;.�d�L•yJ,��.`y "'�+4y 't+l .tS• .�j '� 'W, tiro ! y � i r.. �� �� 4 y'._¢H@Igz�l..lE4w'�v.��c.:��w+.i1:n.ai��?�w6�4, - d'A � i%:yR,�••�' Aj ._`� }. � �,!'+ �$113;� '�b:'a15,ljr ,.7,k ii>u t Jd r "`e v •1'• �'0••f!. .r 6�•l�•i�cL`driy, 1 1 {j_U rl 1 u���+.tc�y�U'�e.. 1 '. :��4`�t r. f?ry�r,�Va9w �'tefir,3Fr .:y' 4tr�l�cl�l - 'ta 1 - 7°�� • !q' a.•. �1>i=� r 1 to 1t °k.dcl � - .•}� !i ' ���.� �efs,.a�,igg ae� Jd � ••.li tl,t '"'.+�+w i •. f ����R . , /��' j:: •�; n t tr3•gi � i�f4Y Y i.fd�,,,;.7 c �a.. Y. dlt,rc�: a'a I •►,•o�� �• � 1 �+ • I/� 's�GMktiZ, s'�a'� � "1'"1`` 3s � �prc'Lcabnl��I L' ��,.i.,�a Y � ! �r �,r � /• � ' Lj�.. y.'� /. �y[)x 1 ,. ''W^��Y�IS�'y��l'll�t�IF� � '�,� .."�r tl`�! Z� Sa Tc .���' � �� f� stt. � � nj y !.Y . lra�j ,., a;'a' j y. ?Y �• .�' _rr1Kai i 3• r � t P i >`a •�i M,� ��• 'I�f}�M, `tea,' � `�,.'� . ;,. ��� '• � � � . � fit �" ,��! ,1° W WN'-' •�� � r '. ' � .1<3fay�r� �f i �. � �•°Fh.• �"i t .. �f. ° � T .�� w.0 � tL `s,{ .•� ._` .� � 3 �:,.: it{i 6.,,y c�'�"ul�kd� t".'� p, �..-i��: � 1 � w��: +.1':.. r 1rJ. �• s(`�;C�ai�;(.�, �u .9a�-'�,�1 �n �,: ." �a.�'t_ i•�-- ' � :L6d ,12 �. �4a� �%"�'if4l'6H ��W'. �'p<:• � t.' :i -t��t® j Tc U ��' t,! � .r��'k!^; • ' r. .�.h f :1a �.�{, d��'1���3�+ 7� �iF ?y t 3 •t •he �'"�'�f�a• �`I. !i,a n �r��)�Y wb'.fJ • - l :�(� ee.'.c>rf� � 7.4"�+c"�,L� C' ,i,_1 z + �,1�� �- iy�-r .,i6••tt 1 7: p t� tim3� ,y. IN� AM' 4�ois,ci� j At� r �' ! -Y.�.. T A •,. LrS ..:�. .;f... Y �'`,rr. ) t yS'Y +Irn + V1\y,,, _ P •irv �..{Q� •`4r- \�+ - _ 1 l.... _ •7 ` :` ..`-2. - \ Hai N, APPROVED APR 2 7 81 Town of Barnstable 'Old King's Highway Committee 1V ail e7— + v ........... > Aj 7714 --- ...... .... J -71, n/ ikz �1 11�� J � �• CNi Zs QY IJ I ! / � � � i v •' i � � i , OV- ra— ! \ ! \ ! 1 , I APR 27 2010 U� '--- — Town of Barnstable J °O Committee i Pond EXISTING CESSPOOL o wple Of 9a PERMIS5aON SHALL BE OBTAINED e j. ';�,/1I. FROM ABUTTER TO PUMP, FILL S 3 WITH SAND AND ABANDONED OR --LOCUS �'�o J• 02`. o DISCONNECT AND ABANDON e 9a�3 6A . � 1 Benchmark Set � LOCUS MAP NOT TO SCALE `i 101 EXISTING CONTOUR °0 0 ` r+00.98 EXISTING SPOT GRADE SEPTIC TANK \O\6a .h', --OHW—OVERHEAD WIRES - / 7 °\ \ —W—PROPOSED WATER LINE GARAGE ` ;Dz o ok �sue POTTA WELL ,�% p gyp• o. ® TEST PTT LEGM EX. SAS A \k' VENT 00 0.1 Zf /8 \PA`1 �0 r y1 -o `�vf m� / EXIST., WELL°a 62•.. HOUSESn 7WO (to be abandoned) \° T.O.F.=10EL74tCB�dh LO y9 yf / ° h \0°• _oaan \Oaf !/CI.K N'r :EjS C"-�C r' EX. S PTIC TANK 3 bO amf r ab�° 4- c �—� jvp 1r1 v HODS o>, 9 GARAGE 63�W Ao I /. orb• �p10 ,I,Z o ' EX SAS EX. WELL 9B 7 $ split roil fence 9 V1 o L m EXIST 9b BAR�r'/ SEPTIC TANK 65 Oat\ I HOUSE #1866 Ufib• �9b�'1 2 \_:�% \ m � 32,0221-S.F. boa_• , a Map 217 a �. ey, s'ew Parcel O 10 y`o `�C'y5c 9�02 EX. N/ELL �A� e 9 N 41 34,2D ( °� �iYY S c o 0p (,T cotchbasi HOUSE \ � 6+ � 0,9•� i\ 11837 A PROPOSED SEPTIC SYSTEM UPGRADE PLAN EX, SAS —,~---- 1850 MAIN STREET RTE 6A , WEST BARNSTABLE, MA Prepared for. Viminin .w— s,i i:..tee., c,--. --- ... -- Town of Barnstable *Permit# Pv 1. Expires 6 moutlisfronr issue date Regulatory Services Fee + snxtasrnsr.s, 9�a b 9 � � Thomas F. Geiler,Director TED MA't Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X--Press Imprint • Map/parcel Number - Property Address y rl R—Ny (.0 vim' esidential Value of Work` t/p(��L� Minimum fee of$25.00 for work under$6000.00 I Owner's Name&Address ( w 1�zz Q. 946 Contractor's Name �, �� . �� c� Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) Qj-7 S2g ❑Workman's Compensation Insurance X-PRESS PERMIT Check one: 2 ® 2009 I am a sole proprietor NOV ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurancotiompany Name Workman's,Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request eck 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 #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum :44)#of windows .*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. f the Home Improvement Contractors License&Construction Supervisors License is req it SIGNATURE: QAWPFILESTORMS\building pennit fors\EXPRESS.doc Revised 090809 The Commonwealth of Massachusetts Department of Industrial Accidents J, f,r Office of Investigations 600 Washington Street n/�t Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print L1e' i0bly Name (Business/Organization/Individual): CQn �—E� �T� "rr, _ �11��iC1� Address: City/State/Zip: \cLIA Phone #: 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 e loyees(full and/or part-time). have hired the sub-contractors 6. ❑New construction 2. am a sole proprietor or partner- listed on the attached sheet. T ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capadity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.t 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 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] 'Any applicant that checks box 111 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. iContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information.. Insurance Company Name: Policy# or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against.the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby ce ' under it s and penalties ofperjury that the information provided above is trice and correct. Si nature: Date: 1 Phone ti: 3G;) ` (lS� 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 S. Plumbing Inspector 6. Other Contact Person: Phone#: • Tv 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 Linder 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 forego ing.engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the conunonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a.reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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 1-8.77-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www,mass.gov/dia r (dsv. 16. 200411:49AM No. 6544 P. 1 'down of Barnstable Regulatory Services _ u u maa A G&W.Director 'tea Duff&hg DQvisfon Tom Perry,mftg Conuabstmw 200Mft Skagit,Hy=b.MA M601 • +wvvar.�wn.�arn+tabiesna.as Offiicc: 508-862-4038 Fax: 508 790"6234 Property Owner Must Complete and Sign This Section if I7sing&Dug4er . rVMI4A17,a-OwM of the Mmm pwpem hanby authoi= m act on mybabalf, in an==Is irh&c to wo*mhotized bythis bwIdiziq pe=VP n for. (40 s of job) S�nature o Dare NA 1 p Nun if Pr Dg,rtv Ojwneris applying for permit please complete the Homeownets License Exemption Form on the reverse side. - r :Nlassachusctts - I)CIrurtUncnt of Public `afch I Board of Building Regulations and standards Construction Supervisor License License: CS 75281 Restricted to: 00 TODD J CANTARA 10 ECHO RD W YARMOUTH,'MA 02673 Expiration: 3/12/2011 ( nnui.�i acr Tr#: 12753 i ✓�te 'r�om�reo�z� a���a�i[t6e� . . . Board of Bulldfng Regulations and standards License er'registration valid for individul use opl.v HOME IMPROVEMENT CONTRACTOR before theexpfration date. If found ret(Arn to:- Rogistratfon: 159211 Board of Building Regulations and Standards One Ashburton.Place Rm 1301 Expiration:.4/10/2010 Tr1F 266397 Boston,Ma.02108 Type: Partnership ECHO CUSTOM CARPENTRY .r TODD CANTARA:.; 10 ECHO RD. ---_. W.YARMOUTH,MA 02673 Administrator Not valid without signature 1 i i cF THE A Town of Barnstable *Permit# Expires 6 months-from issue date • HARNSfABLE, = Regulatory Services Fee • Thomas F.Geiler,Director i63g.. ♦0 A'E°MA�a Building Division X.PR,�S,�e Tom Perry, Building Commissioner �7 200 Main Street, Hyannis,MA 02601 SEP � All Office: 508-862-4038 TOWNOFr - 2 zOOZ (i Fax: 508-790-6230 EXPRESS PERNIIT APPLICATION - RESIDENTIAL ONLYAR�STge Not Valid without Red X Press Imprint Map/parcel Number 7 0 l O Property Address Residential Value of Work 900 Owner's Name&Address s 1J t/ Contractor's Name ��-'J�; �� Telephone/ '�(- �— Number��W Home Improvement Contractor License#(if applicable) zQ 7 �S Construction Supervisor's License#(if applicable) o d ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ the Homeowner �r( I have Worker's Compensation Insurance .Insurance Company Name L� G'(t^ l%'/v Workman's Comp.Policy# !/" C �� J y S I Permit Request(check box) 41 Ov�/ ❑ Re-roof(stripping old shingles) All construction debris will be taken to G� E(Re-roof(not stripping. Going over / existing layers of r000 ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with oiher town department regulations,i.e.Historic,Conservation,etc. Signature Q:Forms:exprntrg Revisedl21901