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HomeMy WebLinkAbout1895 MAIN ST./RTE 6A(W.BARN.) m 'Slll�lm OxfordNO. 152 1/3 C7FtA 0 0 0 o b F7 I 1 7 •5 y -1 1 e di rI aS- _.ate I N . y � is ,or tye- , 1. Town of Barnstable Building P,osfT:his Card%n That+it is.Visible Fr..om the Street-Approved Plans Musi be Retained on Job andnthis.Card Must be Kepi PostedtUntil Final In"spection Has.6een Made.' Permit ° .MxtR � W;herea Ceitifcate.of Occupancy�is_Required;,sucFi Building�shall N'ot be.Occupied�until a Final Inspection hastbeen made. ; Permit No.� 1347 1676 .Applicant Name:` ;PETER J APPLETON Approvals Date'Jssued:'. 06/19/2017 Current.Use: Structure Permit Type: Building-Addition/Alteration-Residential • Expiration.Date: 12/19/2017 foundation: Location: 1895 MAIN ST./RTE-6A(W.BARN.),WEST Ma Lot: 216-025 Zoning'District: RF Sheathing: � z 3 a Owner on Record: DAVIDSON,PAUL C&DEBRA M',,, tContractorName APPLETON CONSTRUCTION Framing: ] Address: 1895'MAIN STREET, ., :, Contractor Ucense: 103218 2 WEST'BARNSTABLE,MA 02668 "� st Project Lost: $2,500.00 Chimney: Description: 4x6x2deep bump out for a Gas Fireplace Perm e:' $85.00 Insulation: Project Review Req: 4x6x2deep bump,out for a GasFireplace s Fee Paid: $85:00 " din 6/19/2017 final: /! P Plumb Date. z, i 9-11- r_,__ ugh mbing: Ro R Buildin Official g final.Plumbing: This permit shall be deemed abandoned and invalid unless the work authorizedibyithis permit is commenced within ix.month�s after issuance. r' �n �� � Rough Gas: All work authorized by this permit shall conform to the approved applicationrand�the approved,construction document0dr which this permit has been granted. ' �swi All construction,alterations and changes of use of-any building and structures shall=be m compliance with thedocal zornngsby laws.and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or roadland shall be maintaine6open for publitlinspection for the entire duration of the work until the completion of the same. 4. - Electrical _ The Certificate of Occupancy will not be issued until all applicable sign atures°liy the eud g andretOfficials a�rpro3dedron thispermit. _ Service:. Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing a Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level'before firest flue lining is installed final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection , S.-Prior to Covering Structural Members(Frame Inspection) Low Voltage.Rough:.,. 6.,Insulation 7.Final Inspection before Occupancy Voltage Fi nal:. final: , Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health . Work shall not proceed until the Inspector has approved the various stages of construction.. final: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A), Fire.,Department Building plans are to be available on site Final:.. All Perrnit.Cards are the property of the APPLICANT-ISSUED`RECIP.IENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION MaPC2 Parcel U Applicatio �z Health Division Date Issued 6 i9 �7 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board el, Historic - OKH _ Preservation/ Hyannis 7, $,i��/G�� I Project Street Address �2,: S / Village /� ' d Owner `�� 4 �JAV: � Address Telephone 27 7 Permit Request 1'5 10 All y S Square feet: 1st pgoxisting proposed 2nd floor: existing proposed Total new Zoning District �If1� Flood Plain Groundwater Overlay Project Valuatio �6"Cl,L`" Construction Type k UQ F✓ Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Struuctture� Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: M_Fal ❑ 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: was �❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes 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 ❑ JUN 05 2011 Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use, TOWN OF BAP'NSTAL3LC —�- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) C� / Name r, ", �Pek/ Telephone Number Address ' License,,# c��s ` w - � � •���"�'43 Home Improvement Contractor# i r � / Email �`� V �T.�,(1� �Z-R,i C �"� C� Worker's Compensation #' Iri I�T{.11 �1'�l'A4 F�y�'�f 11` G,� • , 'ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN'TO SIGNATURE DATE • t to FOR OFFICIAL USE ONLY APPLICATION # _ t 3 DATE ISSUED I MAP/ PARCEL NO. ADDRESS VILLAGE OWNER i 4 ' DATE OF INSPECTION: FOUNDATION k FRAME INSULATION - - '} FIREPLACE _ ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL GAS: ROUGH FINAL y '. FINAL BUILDING DATE CLOSED OUT. + ASSOCIATION PLAN NO. 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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-famuly dwelling,attached or detached structures accessory to such use and/or farm strncta es. 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 fora acceptable to the Building Official,that he/she shall be responsible for all such work perfomned 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,roles 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. Signehu-0 of Homeowner Approval of Building Official Note: Tbree-family dwellings containing 35,000 cubic feet or larger will be required to comply wi$i the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXElMMON The Code states that: "Any homeowner performing work for which a building permit is required . shall be exempt from the-provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. Yon may care to amend and adopt such a form/certification for use in your community. Carswell,James,3179 Main Street,Unit D,Barnstable,Map 299 Parcel 025-OOD. Remove and replace windows ***Certificate of AppropriatenessApproved as Submitted*** Davidson,Debra, 1895 Main Street,West Barnstable,Map 216 Parcel 025 Add bump out to accommodate gas fireplace ***Certificate of Appropriateness Approved with the condition that flame resistant materials may, be used pending approval by the Building Department*** Date:May 11,2017 i t { Town of Barnstable Old King's Highway Historic District Committee DECISION Wednesday, May 10, 2017 2017 MAY 11 Pm30 6:30pm BARNSTABLE TOIAN CLERK The Barnstable Committee of the Old King's Highway Historic District Committee,acting in accordance with the Old King's Highway Regional Historic District Act,Chapter 470,Acts of 1973 as amended,has held a hearing and made determinations on the following applications: I APPLICATIONS Lewis,Jon&Eliza,111 Harvey Avenue,Barnstable,Map 319 Parcel 012 Remove existing 12' X 12' Shed ***Certificate of AppropriatenessApproved as Submitted*** Lewis,Jon&Eliza, Ill Harvey Avenue,Barnstable,Map 319 Parcel 012 Construct 18' X 20' outbuilding ***Certificate of Appropriateness Approved as Submitted*** Eger,Bryan,57 Angela Way,West Barnstable,Map 133 Parcel 072 Build addition to the east side of the home. i ***Certificate of Appropriateness Approved as Submitted*** Desrocher,Timothy,354 Old Jail Lane,Barnstable,Map 277 Parcel 018 Build 20' X 16' Pool Cabana ***Certificate of Appropriateness Approved as Submitted"* Peterson,Richard,45 Collie Lane,Barnstable,Map 335 Parcel 078-003 Replace Windows ***Certificate of Appropriateness Approved subject to using window grills six over six*** Connolly,Brian&Nicole, 169 Salten Point Road,Barnstable,Map 301 Parcel 003 Build new single family home ***Certificate of Appropriateness Approved as Submitted*** Cotto,Michael&Kim,435 Old Jail Lane,Barnstable,Map 277 Parcel 002 Build new single family home ***Certificate of Appropriateness Approved as Submitted*** I APR1 � ;t; ;' Barnstable Old Kings Highway Historic District Committee _ s 200 Main Street,Hyannis,MA 02601,TEL: 508-862-4787 F@MWWAMAG . XAS& °"gyp APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with five.(5)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: 21�ew ❑ Addition ®-7vlrration 2. Type of Building: ❑ House ❑ Garage/barn ❑ Shed ❑ Commercial P"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 ❑ Swimming ❑ Other man-made pool ❑ Solar panels ❑ Other Type or Print Legibly: Date NOTE Aft aNficadons—n=be signed by the current owner Owner(print): �)0 2 Ct_. ►Ja\1 I c�s n r\1 Telephone#: sa$-`]�l u Address of Proposed Work /�� YVI t'�+S _ Village lt'_Map Lot# Mailing Address(if different Owner's Signature � � Description of Proposed Work: Give particulars of work to be done: e u fk P O u°T 0(-Y-74 4 �-) �► ' 6-41 CV�blly ' ��-� +� 1�� ��� l�=•o� � �E�+ t✓1,�. ,f.�_ .v�,w-fcl� �1-�,� f,�tild-- � cv��-- Agent or Contractor(print): f ✓ I—Irok, Telephone it: <_0 F_ 31 Address: 3 7 ^� i��F�'��, Ve !M 14. C)V L-7 Contactor/Agent'signature: For commi ee use only. This Certificate is kereyPPRO D/ D Date 4100 Members signatures . O ' °®V E® AP MAY t02017 r Town of Sargst ble Old Nay Committee 1 Q:IBoards and Commisstans101d Kings HighwaylOKHApplicationslOKF12011 Cert Appropriateaess-doc CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please.submit 5 Copies Foundation Type:(Max. 12"exposed)(material-brick/cement,other) v ,vbvg- i WOK 3 Siding Type: Clapboard_ shingle 1--`other Material: red cedar white cedar [/tether Color. Chimney Material: .69 A5 -U-01w Roof Material: (make&style) f Vr L f e tf-j C L4C, Color. ; ,Y�-�tF�J��,�•crtr h Roof Pitch(s): (7/12 minimum) 2--- (specify on plans for new buildings,major additions) Window and door trim material: wood k;c cn other material,specify Size of cornerboards /X-5— size of casings(1 X 4 min.) color U.— Rakes Ist member IX b 2°d member Y 7 Depth of overhang c �� Window: (make/model) material color RFr►� (Provide window schedule on plan for new buildings, major additions) Window grills(please check all that apply_: .APR 18 2017 true divided lights_ exterior glued grills_ grills between glass_removdQ$6 None ����A1vAG�� Door style and make: material Color- Garage Door,Style Size of opening Material Color Shutter Type/Style/Material: Color. Gutter Type/Material: Color. Deck material: wood other material,specify Color. Skylight,type/make/model/: material Color. Size: Sign size: Type/Materials: Color. Fence Type(max 6')Style material: Color. Retaining wall: Material: Lighting,freestanding on building illuminating sign OTHER INFORMATION: THE ATTACHED CHECK LIST MUST BE COMPLETED AND SUBMrITED Please provide samples of p ' lors,m nufacturers brochure of windows,doo garage door,fences,lamp posts etc Signed: (plan preparer) �' Print Name `� ����✓ 2 Q:lBoardc and CommwwwlO&Kmgs HtghmV10KHApphcations10K112011 Cert Appropnateness doc Town of Barnstable Old Kings Highway Local Historic District Committee CHECMST- CERTIFICATE OF APPROPRIATENESS Please check the applicable categories,This check last must be completed and submitted with your application. 1. ALTERATIONS(new paint color,changes to siding,roof shingles,windows or door etc.) i Application for Certificate of Appropriateness,5 copies. Spec Sheet,4 copies;brochures and color samples. Plans of building elevations/photographs 5 copies,ONLY IF there is a change to the location and size of window(s),or door(s). Fee according to schedule. 2. MWOR ADDITIONS e.g.decks,shed(over 120 sq.feet) Application for Certificate of Appropriateness,5 copies. Spec Sheet,5 copies;brochures and color samples. Site Plan,5 copies,ONLY if there is a change to the building footprint. A site plan drawn on a mortgage survey plan or GIS map may be used for minor additions,UNLESS the porch,deck, pool,or shed etc.is close to lot lines,zoning setback lines,or other buildings,in which case a certified site plan must be submitted,see requirements as applicable,see 4.Site Plan,below. Photographs of all building elevation affected by any proposed alterations. Plans: 5 copies plus 1 at reduced scale to fit 8.5 x 11 or 11 x 17 paper Company brochure of manufacturer's shed OR to-scale sketch of affected structure or building elevations. 3. STRUCTURES,NEW/ALTERED(fences,new stonewalls or changes to,retaining walls,pools etc) Application for Certificate of Appropriateness Spec Sheet,brochures or diagram. R Site plan,see Instructions 2.Site Plan,above. '(;F � Photographs of any existing structure that will be affected by change. Fee according to schedule. 8 201 j 4. NEW HOUSE,ADDITION OR A COMMERCIAL BUILDING GRO MA Application for Certificate of Appropriateness(5 copies). Gj`� ' Spec Sheet,5 copies,brochures and samples of colors. Site Plan,5 copies,at an appropriate scale. 5 copies of site plans at a reduced scale to fit 8.5"x 11 or 11 x 17 paper. Site Plans shall contain the following: _Name of applicant,street location,map and parcel. _Name of architect,engineer or surveyor,original stamp and signature;date of plan and revision dates. _North arrow,written and drawn scale. _Changes to existing grades shown with one-foot contours. _Proposed and existing footprint of the building and/or structures,and distance to lot lines. _Proposed driveway location. _Proposed limits of clearing for building(s),accessory structure(s),driveway and septic system. _Retaining walls or accessory structures(e.g.pool,tennis court,cabanas,barn,garage etc.) Building Elevations: 5 copies of plans at a scale of/o"= 1 foot;a written and drawn scale. 5 copies of plans at a reduced scale to fit 8.5"x 11 or 11•x 17 paper. 3 Q.-Wwrds and CommissionAOld K&w HighwaylOKHAppikationslOKH2011 Cert Appropriatemm.doc Plans shall include the following: Name of applicant,street location,map and parcel. Name of Builder Designer,or architect;original signature of plan preparer and stamp;plan date,and all revision dates. ALL NEW HOUSE OR COMMERCIAL BUILDING PLANS MUST HAVE AN ORIGINAL SIGNATURE AND STAMP,IF ANY,BY A REGISTERED ARCHITECT,MEMBER OF AIBD,OR A LICENSED MASSACHUSETTS HOME IMPROVEMENT CONTRACTOR;UNLESS THIS REQUIREMENT IS WAIVED BY THE OKH DISTRICT COMMITTEE. A written and bar drawn scale. Elevations of all(affected)sides of the building with dimensions including height from the natural grade adjacent to the building to the top of the ridge,•location and elevation of finished grade roof pitch s)dormer setbacks;trim style,window and door styles. Changes to existing building§must be clouded on drawings _Window schedule on plans. Landscaping plan,5 copies drawn on a certified perimeter plan containing the following information: _Name of applicant,street address,assessor's map and parcel number. REC,EMD _Name,address and telephone number of the plan preparer,plan date and dates of revisions. _The location of existing and proposed buildings and structures,and lot lines. AM 18 Natural features of site(e.g.rock outcroppings,streams,wetlands,etc.). u);0�1'T'H _Existing buffer areas to remain. AIANAGEAVI Location and species of trees outside of buffer areas greater than 12"caliper to be retained or removed. _The location,number,size and name of proposed new trees and plants. Driveway,parking areas,walkways,and patios indicating materials to be used. _Existing stone walls,and proposed walls including retaining walls for slope retention or septic systems. (for removal of stone walls,file Demolition Form). _All proposed exterior lighting and signs. Sketch or photos of adjacent properties,(1 copy only) A sketch(s)to scale or photographs of nearby adjacent buildings,where present,along both sides of the street frontage,showing the proposed new house or commercial building in scale and in relationship to the existing buildings. Please discuss with staff if you do not think this is relevant to your application. Photographs of all sides of existing buildings to remain,or being added to. Fees according to schedule. Please complete the following: Existing building,foot print: Building 1 sq.ft. Building 2 Existing Building,gross floor area,including area of finished basement: Building 1 sq.ft. Building 2 New building or addition,foot print: Building 1 sq.ft. Building 2 New Building or addition,gross floor area,including area of finished basement: Building 1 sq.ft. Building 2 4 Q.IBoards and Commi Wowl0ld Kings HighwaylOKHApplicattontlOKH 2O11 Cert Appropriateness doc 5. SIGNS Diagram of sign,showing graphics,size,design and height of post,color and materials. Spec sheet. Site Plan on a GIS map or mortgage survey,OR photographs OR to-scale sketch of building elevation showing location of proposed sign;and any tree to be removed near a freestanding sign. REC, D Fee according to schedule. 6. SOLAR PANELS APR 7 8 2017 Drawing of location of panels on house showing roof and panel dimensions. C Q WrI,I� MA Site plan showing location of building on property. (Assessors map may be submitted) NA(x�j�,�? Height of solar panel above the roof. Color of panels Finish(matt or glossy) 7. FOR LIST OF ABUTTERS: PLEASE SEE OKH STAFF SIGNED (plan preparer) Print Date: Tel.Phone no's: NOTE The Old Kings Highway Historic District Committee AMY DENY INCOMPLETE APPLICATIONS ATTENDANCE AT MEETINGS.• If the applicant or his/her representative is not present during the hearing is scheduleg the application may be either CONTINUED OR DENIED APPEAL PERIOD APPROVED PLANS PLAN PICK UP There is a ten(10)day appeal period,plus a 4 day waiting period for approved plans from the date the decision is filed with Town Clerk. This is necessary for each Certificate of Appropriateness and/or Certificate for Demolition issued by the Old King's Highway Committee. Plans approved by the Old King's Highway Historic District Committee may be picked up at Growth Management,Regulatory Division,200 Main Street,Hyannis,after expiration of the 14 day"wait"period. If the 10 day falls on a Saturday, our plans will be available the afternoon of the following business day. DENIALS Applications that are denied may be appealed to the Old Kings Highway Regional Historic District Commission within 10 days of the filing of the decision with the Town Clerk. For more information,see the Bulletin of the Old Kings Highway District Commission. BUILDING PERM[TS,OTHER AGENCY CONTACTS In most instances,before commencing work,a Building Permit is required. The Building Division will require a certified plot plan for new construction and/or demolition. Commercial work may require Site Plan approval. Demolitions: the applicant should check with the Building Division as to conformance with Zoning requirements. Other Regulatory Agencies at 200 Main St,Hyannis MA 02601: Building Division 508-8624038 Conservation Division 508-8624093 Health Division 508-8624W QUESTIONS ABOUT YOUR APPLICATION? PLEASE CALL THE BARNSTABLE OLD IGNGS HIGHWAY OFFICE AT 508 8624787. 5 Q.Woards and Commissions101d Kings Higlnv4y101GfAppliaationsl0KH2011 Cert Approprialeness.doc G y u � r �. s 4 Q... 4 2 cl y t O f.0 Q. Q7 'Jl . / 1 0 p„ S IN i �e rpoa�viicoazcuea�o��aaacc�uae(,�.e Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: ,;`-032-18 Type: Office of Consumer Affairs and Business Regulation Expi ration:,;-::7/6/-2018.. DBA 10 Park Plaza-Suite 5170 Boston,MA 021 APPLETON CONSTRUCT;IQN > `" Peter Appleton 37 Baird Way N. J Centerville, MA 02632 Undersecretary ( Not valid withqXsijfhature • _ � w� _. � .rr-�-ems.--._... ._i-+._ 9.. T___ �� ~ Massachusetts Department of Public Safety . Board of Building Regulations and Standards. `' License: CS-005414 . Construction Supervisor `; PETER J APPLETON s, 37 BAIRD WAY CENTERVILLE MA 626A4 CA yes: ^^� Expi ratio n ,':^ Comlmissioner 06/08/2018�*" u " c�//ze c(�omvr�zoouuea.�o��/laaa�cc�ume%i2t . Office of Consumer Affairs&Business Regulation License or registration valid for individul use only _ OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: :.::`'03218 Type: Office of Consumer Affairs and Business Regulation .Registration: DBA 10 Park Plaza-Suite 5170 Boston,MA 021 APPLETON CONSTRUCTION == ;:- _. ._ Peter Appleton 37 Baird Way Centerville, MA 02632 Undersecretary Not valid witho s' nature Construction Supervisor Restricted to: . use group which contain Unrestrieted-Buildings of any less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current'edition of the Massachusetts se. State Building Code is cause for revocaASSf this GOVIDPS DPS Licensing information visit:WWW. I'" a 73 6`' 1 s p BUILDING DEPI JUN052017 TOWN OF BNRNST�^,B� i �� j� . ` v ���� � � ��, v � � � � —� � + - �. `''j _ �,J e� -� - � _ � � . .. � T �- G � � _ � � r .� �. �� j I i " i5/30/2017 15:03 5087751135 CHAGNON INSURANCE PAGE 01/01 REP CERTIFICATE OF LIABILITY INSURANCE ��( '5�;17 0 S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTA71VE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT, If the certificate holder is an ADDITIONAL.INSURED,the pollcy[es) must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to.tho certificate holder In lieu of such endorsement( . Go PROMJCER NA Ray Travers Chagnon Insurance Agency, Inc. P 508 771-1660 FAIL (509) 775-1135 PO Box 355 SS: ra travers@ciaimsurance.net 411 Route 28 INSURE b AFFORDING COVERAGE NAIL 0 West Yarmouth, MPS 02673 INSURER A:Commerce Insurance Company INSUR3) INSURERB:Aasociated Employers Ines Co. Peter Appleton dba App INsuRERc:Associated Emp Ins Co. AEIC Appleton Construction , R D: 37 Baird Way INSURER e' Centerville, MN 02632 I F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURAWE 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 CERTITICATE MAY BE ISSUED OR MAY PERTAIN,THL INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L R TYPEOFBOURANCE POUCYNURSER PM EFP ID UMTS A GENERALLIAMITY BGGBgi, 3116/17 3/16/18 EACHOCCURRENCE $ 1,000,000 DANAGETORFRM $ SO 000 COMMERCIAL GENERAL LIABILITY CLAW MADE ❑X OCCUR NEO OP(Any ore arson 8 5,000 PPRSONALS ADV INJURY 8 00 000 GENERAL AGGREGATE S OO OOO GEN'LAGGRE GATE LIMITAPPLESPER PRODUCTS-oo nOPAGG S 2,000,000 POLICY jT& LOC CO M iLELPAFr rUTMOLAIUTY AO BODILY INJURY(Per IwHan) S ANYAU70 ALTO WNED �� oo UIED BODILY INJURY(Per aiduno 6 NON-OWNED PR�OaP�DAMAGE 6 HIRED AUTOS AUTOS 6 UeSORELLALUIB OCCUR EACH OCCURRENCE S EXCESS LRAB CLAIMS-MADE AGGREGATEDED S 6 N C VWRKERS COMPENSATION WCC50050131142017A 3/24/17 3/24/18 we srATU- oTH- AND EMPLOYERS'LIAPILITI Y I N ANY PROPRIEfORIPARTNEWEXECUTNE NIA NACCIDENT 6 500 000 OOya��;UH,EXCLUDED? � EL, EMPLOYE s 5001,000 . DES6RIP_r1ONOFOPERAT10NSbalow S.L.DISEASE-POLICY LIMIT 6 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I V E)OCLES(Ahem ACOT D 101,Addtional RIlrffift Sd*dlde,If More SPRCe Io lutiLi d) Carpentry, Excluding roofing CERTIFICATE HOLDER CANCELLATION SMOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N Barnstable Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA 02601 _ AUTHOR6'J=DRePRLSF]JTATNE Kimberly E Cha on 01988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD dame and logo are registered marks of AGORD Phone: Fax: (508) 790-6230 E-Mail: TKE r Town. Of Barnsta I *Permit Kytra 6 month Lfrom issue date Regulatory Services Fee RibhardV-Scali, Director jiujid ing Division foin Perry Coo,puil(ling Commissioner 200 Main 8-treettlydrinis,MA 02601 ww%y.town.biiiiistable.ina.us X11111PRES89PElIn Office: 508-862AO38 MIT Et,XPRESSPERATIT APPLICATION - RESIDE NTLAI ONLY Mot Valid Willow Red X-tress lity;ritil OCT 2 9 2014 mpp/purcel Number Pruperty Aedres, TOWN OF BARNSLABLE 900 ca Minimum fee 6.fS35.00 for Work under S6000.06 ,Q Wtic of Work S S I Owner's Name&-,A?Jdress 'AaLt -- U/U Number 6 Contractor's Dame Teldpljone 7Y 9' I- _L,�LL, ConsIructiowStipervisor's License 41(ifapplicable) ,E]Workinan's Compensation Insurance 01,5k one: (071 am a sole proptieior D I alm the 140meowney 0.1 have.wo!,ker's Compensi6on.1murance I'Vorkman's Comp.Policy Copy or.Insurmia Compliance CertiftcaW-trillst accompany each.I iermi.t., Peril it Request(check.box) Re-roof(burricarle nailed)(stripping old-11hingles) Alllconsti=Tiori debris,xvill.-be takeivto []-Re-ro6--,7.(hurricaj%e nailed)*(not.stripping. Going over.misting layers ofroof) P -side lteplaceivent Windowsldoorslslj'de-i-S.'(j Value _.._______(maximum.35)#of windows 19A, de-^5-E-1-3 /'J C/IW IC tt of doors: 1:'Sm0k-c/C8rbou.N46tibm.&Aelectors 4 floor plans marked Nvi.ih red,S:ati&juspections required. SeparafeElActricRI.&Fire Permits required. 1XVIiercmquired'. issumicc oraiis permit does not oxImpi comp)jalice with other imyn c1cpartai6irit-tegulatioll.%i.e.Historic,Consmati4n,etc. **tNote: Property;Ownermust sign Property Owber Letter ofTerm 6-sion. A copy of the Home Improvement t ContractorsR Construction Supervisors License is requilFed. S 1,G,NI A r b R FI: QAW1111LESTOR. Slbuildil),*permit fbT-nsT.XPKF-qS.etdc Revised 061.313 Vol, Office of Consumer Affairs and Business Regulation 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 168999 Type: Individual Expiration: 5/4/2015 Tr# 240027 MICHAEL HUNTER MICHAEL HUNTER _ = = -+ 35 SHELTERED HOLLOW LN YARMOUTHPORT, MA'02675 y �' "= Update Address and return card.Mark reason for change. scA 1 Co 20M-05n1 ' ❑ Address ❑ Renewal ❑ Employment Ej Lost Card Office of Consumer Affairs.&Business Regulation .License or registration valid for individul use only 0ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:, egistration:. .;j68999 Type: Office of Consumer Affairs and Business Regulation Expiration:`5f462015t_, Individual 0 Park Plaza-Suite 5170 Boston,MA 02116- MICHAEL MICHAEL HUNTER ;yr �,�-,fir-==-- 35 SHELTERED HOLLOW:LTf :;'�. YARMOUTHPORT, MA 02675 Undersecretary Not valid without signature Restricted-To: CSSL-WS_Windows and Siding jVlassachuse�ts'=Department of'Public:Safefy3 1 Board of B,ufldin F�egulations and Standards Failure to possess a Cgastruction Su ei-iso"r S eci ? current edition of the Massachusetts ' p ,p���aicy - �.�,� State Building Code is cause for revocation of this license. For DPS Licensing information visit... ww.Mass.Gov/DPS MICHAEL P HiJN_3 ER - �" . 35 SHELTEREDO YARMOUTHPORT 10Z67 Expiration Commissioner 08/09/2015 0 Barnstable Old Kings Highway Historic District Committee 200 Main Street.Hyannis,MA 02601,TEL: 508-862-4787 Fax 508-862-4784 q 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; 20 i4 S1_: ` 11 pm l:3 1. Building construction: ❑ New ❑ Addition BRQ,t►_ iB!c ;'_liiti+N�,�l=RK Alteration 4: 2. Type of Building: P9 House ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting, roof ❑ new roof ❑ color/material change, of trim, siding, window, door 4. Sim: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ Tennis court ❑ Other 6. Pool ❑ Swimming ❑ Other man-made pool ❑ Solar panels ❑ Other Type or Print Legibly: Date o2G NOTE AM app&cadons must be signed by the card owner Owner(print): _ m I +,--,I, p} �I a VV I Asp _ Telephone#: 609 - ZYY 73 q 7 Address of Proposed Work: /9a VillagekL-lalg /A Map Lot#o,1&`0A---'� Mailing Address(if different) Owner's Signature Description of Proposed Work: Give particulars of work to be done: UI Agent or Contractor(print): M 1 L Hwi lef- Telephone#: t910-1,79,-I q 7 Address: Contractor/Agent' signature: _ For committee use only. This Certificate is hereby APPROVED/DENIED Date �a Members signatures JJI 1014 �AGE�E� APPROVE® AUG 2 7 2014 I own of Barnstable Old King's Highway Committee 1 Q-\Boardc and Commission.A01d Kings Hghsvay\0KH Appliratiors\OKII DRAFT 2011 Cert Appropriateness DRAFT& CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit J Copies Foundation Type: (Max. 12"exposed)(material-brick/cement, other) Siding Type: Clapboard__ shingle — other Material: red cedar white cedar other Color: Chimney Material: Color: Roof Material: (make&style) Color: Roof Pitch(s): (7/12 minimum) (sper't�V on plans for ne►v buildings, major additions) Window and door trim material: wood__..(other material, specify Size;of cornerboards size of casings (l X 4 min.) color _ Rakes 1st member 2'd member Depth of overhang Window: (make/model)" q6b material 'Wooj color (Provide window schedule on plan for new buildings, nuijor additions) Window grills(please check all that apply_: true divided lights____ exterior glued grills— grills between glass /removable interior_ None Door style and make: material Color: Garage Door,Style Size of opening Material Color VLU Shutter Type/Style/Material: Color: R® Gutter Type/Material: Color: AUG 2 7 2014 Town of Barnstable Deck material: wood other material, specify Color: Old King's Highway Skylight, type/make/model/: material Color: Size: Sign size: Type/Materials: Color: RE+CEMD Fence Type (max 6' )Style material: Color: AUG O 5 2014 Retaining wall: Material: GROWTH MANAGEMENT Lighting, freestanding on building illuminating sign OTHER INFORMATION: THE ATTACHED CHECK LIST MUST BE COMPLETED AND SUBMITTED Please provide samples of paint colors,manufacturers brochure of windows,doors,garage door,fences,lamp posts etc Signed: (plan preparer) Print Name Plr, I JC1V((tS 2 Q:Vloards evil ConvidssioYmNOld Kings Highway10K11 Applieations10Kf1 DRAFT 201l Cert Appropriateness DRAFT.doc Town of Barnstable Geographic Information System August 5,2014 217009 217002 217001 01834 217036 217060002 #1809 #1825 655 943 217010 01860 217011 217014 �VA 41 #186 6, 217013 019701k 023 � 216033 i�, � 217012 ® 01960 01894 #1837 -lpsq 216021 11 4 #18 216035 216051 216031 #1934 #33 01856 211912 ® #1912 6034 216039001 216052 #1955 #45 n ® 216030 m 216022 01871 y 01849 216032 216041 #1851 01945 216063 216025 #57 #1895 a 216042 216040® 216029 C #2440 #1951 ® 01919 1 � = 218�020 216023 216024 n 2 Alt• #,_6� # g�o -I Ap RIDGE RD N 2160 7 216047 0968 #991 216 1 #37 216064 216071 216062 •® 06 # #22 020 ® ® 236005W00 AC2 #224016063 � 216028 � #.1� #952 5 216065 216060 ^ 2#246 oP+ 0951 216046 0141 `i216� DDDO,Q 216027 #2423 #9 #10 DISCLAIMERS:This map is for planning purposes only. It Is not adequate for legal Map:216 Parcel:025 Selected Parcel o N boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner.DAVIDSON.PAUL C 8 DEBRA M Total Assessed Value:$459600 1'=10D'may not meet established map accuracy standards. The parcel lines on this map - E are ordy graphic representations of Assessors tart parcels. They are not true property Co-Owner: Acreage:1.14 acres Abutters ` boundaries and do not represent accurate relationships to physical features on the map Location:1895 MAIN ST./RTE 6A(W.BARN.) such as building locations. Butter ti s 7/�r 1t t �4 tf' �' .�i`-h f�� •' -.r.�, fir.. • r '., yi.,�,,r� t n�1y� ,a. `. 47, �:f yr �s��+���yty�� tl' `r�y. .f` ( /• � iy/�. ,i �• � ' j.�.Y1 1 _i i y. '1• - :lk'P i ..• �E:` W r�i� * j•�•. f Z�t�j=+ �i Y,. 'fit;-=� �a• 4 ate r ',t �Si�-� ,,•;;�.1 .,'�`�'�:� 11 +Ifs•x� , , • , ' �"'� !",` 'a•'� t�� '• �, 'g 1; "!•�� ,� � - ;�F r }'•�� pp• �+�r '� uvi���!+ ��'i'1 r ��'�'� , ,•.�:i �1yL1i tj r + � l• r '�1 ,`!�`� �� •� '�' - r �y� .�+� �'� "�1c�' _`•'� ,S!• }'Y .-ir•AFT};•er.� OW; _ t O f^ t� \.`. •` t �. •', ..J•.� �'- �.¢_t %'jam •�Si ks�iV�`�•t♦ !C't�rr+�.;!e'�'.._ '" t� f r\�•. 1 ht �'�.•�'� t .�ky��f:7s,f�•�,r�`•r1'„i�'."1,�¢ i• `iir1 .r •t' �� t �'-s ;,$• f..A,'c �s'�. s jf �S1r'�.�:�1t/�t�Y/��fr"<p��l- /�'. �►t. � � ,�• 7` r t 'f`• � C .'Via. '. :�,/ [�':`'Alz ."��f+.�' •� XY 10 �. i � '�• m dt •+tea • ( � � � � _ I � � it Window Covering With Cande Light Ideas With 18 Smart And Nice Decora...over For Your Craving Home Accessories Ideas Gallery:hpMirror.Com 7/30/14,1:26 PM ( r t� 1( « 1 1 V 1 V _ Tweet 0; :1 0 Line <_..._.3 " Design Inspiration o residentialmedia.tableaux.com RECEIVED AUG 0 5 2014 HST Drapery Side Panels GROWTH MANAGEMENT i Window Covering With Cande Light Ideas With 18 Smart And Nice Decorating Ideas Windows Cover for Your Craving Home APPROVED AUG 2 7 2014 18 Smart And Nice Decorating Ideas Windows Cover For Your Town of Barnstable Craving Home : Window Covering With Cande Light Ideas Old King's Highway Committee With 18 Smart And Nice Decorating Ideas Windows Cover For Your Craving Home The image entitled Window Covering With Cande Light Ideas With 18 SmartAnd Nice Decorating Ideas Windows Cover For Your Craving Home above, is marked with http://hpmirror.com/18-smart-and-nice-decorating-ideas-windows-cover-for-your-craving-home/dscf4245/ Page 2 of 6 Town of Barnstable fdegul.atory',Servi.ces WOOrd;5eitli,Director tiuildi ng:Di visi.o n Thmnas°Perry,.C130 Build og Commissioner 200 Main Street, }lymmis,;MA.0260.1 w ww.town.ba ras table.rua.us Office: 508-862-4038 Fax 508-7J0 6234 Property Owner Must Complete aid Si.r ''1"us Settion IfUsi:nt-,A Buildct L-DeL41 1<LC13 ant as Owner:of the.spbject property; hereby anc o ze__� 'd� i�7"t,►r f2___ to act on my beliz ir: :i.11 matrcts zelative to:work autlaomi ed bey tl is bud6l per-rat L:application for: (;Address of job) D4 Signature of.Owner ]date Print Name Tf.Prol)crty owner is applying-for permit;Flease:60shp Cite the'Hanieownerc C iecesc kzcmgcioti.Forut on ih.c reverse side. QAWPHLESWORMS1buadiag permit forr..stsmakwarbaadctacto5,doc Revised 050412 HUNTE-1 OP ID: PS CERTIFICATE OF LIABILITY INSURANCE 7,TO/28/2014 E(MM/ Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER CONTACT Edward J.McGrath Insurance NAME: E.J. McGrath Insurance Agency P.O.Box 1003 A/C FAX,E:t:508-385-2454 (NC No): 508-385-5991 Dennis,MA 02638 E-MAIL E.J.McGrath Insurance Agency ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA:Safety Insurance Company INSURED Mike Hunter INSURERB: Window Remodelers Inc INSURERC: 35 Sheltered Hollow Ln Yarmouthport, MA 02675 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IOLICY EXP LTR TYPE OF INSURANCE ADDL WVD UB POLICY NUMBER MM DIYYYY LICY EFF MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE a OCCUR BMA0015181 10/15/2014 10115/2015 PREM PREMISES Ea occurrence $ 100,000 Business Owners MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ PROPERTY 51000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION BARNT01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE E.J. McGrath Insurance Agency ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD i The 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/Conti-actors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: 3,-'- TE-rc E:F-) �a C.C 41 Y14�1-7 cJ i k 0 2 r City/State/Zip: /amyl wi-4 ��- /fly 026 7u-Thone#: �-S_08 - 776- Are you an employer?Check the appropriate bog: 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.H 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.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.2�Other W 'J V LO comp:insurance required.] qz e' *Any applicant that checks box 41 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 thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: ��9.5� 2T `� W G3�nNs%��(� City/State/Zip: w. ��nNsr�gc� 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. Signature: 222 , s 9V-t i x_ Date: Phone#: 1�-0 6' 7 7C ^ -3(� l 3 Official use only. Do not write in this area,to be completed by city or town official City or Town: Pera►itlLicense 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#: . o Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because,of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have is required. Be advised that this affidavit may be submitted to the Department of Industrial employees,a policy 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 I (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the . applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial.venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. . The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 wwwmass.gov/dia TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION..., Map- Parcel".` # -0 - 73 Health Division Date Issued Conservation Division -Application -30 Planning Dept. PerrYiit Fee Date Definitive'Plan Approved by Planning Board Historic OKH Preservation Hyannis Project Street Address V_6_ Mel I Al ST it/i571 F E- , MA Village I rJu� TA 113L& PAU.t, D1 ' A V 1,0�0/o Owner ' Address &1�7 A+12AJ�r-T4,9Z:C 114A Telephone 1P-1.-7 Permit Rbquest OL16 /0 iV, M) "A L� 3 I2/,4)6 IWAP LL IAI—Jd X6-M 3 )C61-fdAe' JVDA) ;LO,<d 3�,4 12' t�'l /L L .,9100 M' rtU d 11411-57k; 2:34 7#A 1ALL QAJ /E' 6LOOk 600 60 [A)A�kk I(AN16L C �S / /0 SG,4t sc-_.f* 9 S bare feet: 1 st floor: existinU - proposed :2nd floor: existing proposed Total new a Zoning District' Flood Plain Grouhdwater Overlay Project Valuation Spa Construction Type R&X0 D66: Lot Size ! /, 3 PCILC-S Grandfathered: U Yes LJ No If yes, attach su Irting dfRumehiation. U.�Dwelling Type: Single Family Or"' Two Family Ll Multi-Family (# units) C) > .1 Age of Existing Structure Historic House: U Yes 21k On Old King's;A ghway es-, Q No Basement Type: &<ull El Crawl Q Walkout Q Other Basement Finished Area (sq.ft.)' Basement Unfinished Area (sq.ft)l 1-3 IYO M15,Q,,_66- Number of Baths: Full: existing 71- new Half: existing —new Number of Bedrooms: 4 existing —new cc Total Room Count (not including baths): existing / 0 new First Floor Room Count Heat Type and Fuel: Ell Gas U210il Ll Electric Q Other Central Air: El Yes ®'No Fireplaces: Existing / -New Existing wood/coal stove: Ll Yes aeo Detached garage: existing L] new size—Pool: 0 existing Q new size Barn: LJ existing U new size Attached garage: Ell existing LJ new size —Shed: 0 existing U new size Other: Zoning Board of Appeals Authorization U Appeal # Recorded Q Commercial Q Yes BT�o If yes, site plan review # Current Use PELOCAfTlPr-L Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 91611111 L. 134fleAc &.NS71WCT/c"J Telephone Number Address _...,3(a MT 91 . License# &S 0 9-?l 9; ?1JM0vM1. 1q.4- P93 ( o Home Improvement Contractor# CLAIPJ60 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Soll"E b4A1.6F/tk- �0 SIGNATURE DATE /0� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. y ADDRESS VILLAGE OWNER . DATE OF INSPECTION: FOUNDATION FRAME 3�(� oy/2� �lS r Olc 3 1� D9 4ci— INSULATION ,8 r /7 0 "' Xi FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL p GAS: ROUGH FINAL f FINAL BUILDING OfL , 0�. DATE CLOSED OUT, ASSOCIATION PLAN-NO. i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' d 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly . Name(Business/Organization/Individual): /�'1�� �Ll A)ST, 14k�\-17d Address: City/State/Zip: PLgM6 UT H ni 023(00 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 employees(full and/or part-titn.e).* have hired the sub-contractors 6. ❑New construction .2J9 I am a sole proprietor or'partner-' listed on the'attached sheet. T. R. emodeling ship and have no employees These sub-contractors have g• '0 Demolition workingfor.mein an capacity. employees and have workers' Y P tY• 9. ❑Building addition [No workers' comp.•insurance comp.insurance.$ required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LF]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 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: A�.�. 11�CA�7d � 11� �R �I� JL 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 tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day.against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certiijy under thepains andpenalties ofperjury that the information provided above is true and correct Signature: // �(i� )tom— Date: Phone#: 7 0 2-�C 5-0 -5% 'A go Official use only. Do not write in this area, to be completed by city or town offcclal City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 1.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: I Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-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 pernrit/license number which will be used as a reference number. In addition,an applicant that must submit multiple pem:dt/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicart 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 maybe 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 ritizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: .The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations. 600 Washington'Street Boston, MA 02111 Te1. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-72777749 . Revised 11-22-06 www.mass.gov/dia Ii l _ --s= -- - - � ✓�ze��rmzo�ztae . >; Board.ot Building Regulations and Standards i HOME IMPROVEMENT.CONTRACTOR. Regist Lj 159016 Ezpication 3/26/2010 Tr# 265657 BA I<I _ TI- N MICHAEL BURKE G�STRUCO (zV MICHAEL BURK , r"- 36 MT.PLEASANT ST#4= PLYMOUTH,ma 02360 Administrator -i 37 BOARD OF BUILDING REGULATIONS"�. License CONSTRUCTION SUPERVISOR . NUmbeCS. 0931821 , �.. i r i,jxpires..12L_22L2Q09' Tr. no: 93182 I Restricteii: • MICHAEL S Sntg— BURKE� B- ;' { 5 DWIGHT AVE;NIJf f PLYMOUTH, MA 02360� % y r Commissioner � JJ ti ' 1 License or registration valid for individul use only before the expiration date. If.found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02108 ,V Not valid without signature r/2le CO NnSurRU�C�z Oo�N RSGPh s ILDIN BOARDOF BGURISOR I TIT License: I 093182 t Number CS 12G22 009 Tr:no: 93182 i t �E piles Restnc a MICHAEL S R // I WIGHT sioner AV 5 D MAUO 3601�`�';"`,, iPLYMOUTH, Comrriis r- ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY,DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: lyM#g. 6 j,1W (16j�JSllk VCT16A) Site Address: S`/5 M&A) print Town: o 64i2MS?1F,;szur Applicant Phone: _i5-6 Z S 0._ 5i Applicant Signature: Awy� Date of Application: Z/zo f y NEW CONSTRUCTION: choose ONE of.the following two-options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE-AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Slab Option 1: Basement P Fenestration exposed Wall Floor Perimeter U-factor floors R-Value R-Value Wall R-Value AFUE HSPF SEER R-Value R-Value and Depth National Appliance Energy .35 R-3 8 R-19 R=19 R-10 R-10, Conservation Act(NAECA)of 4 ft. 1987 as amended,minimums or eater as applicable Note: This form is not required if you choose either of the two versions of REScheck 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.energycodes.gov/rescheck/ A.DDITIONS--OR ALTERATIONS.TO EXISTING BUII.,DIIVGS..OVER 5 YEARS.OLD* *Buildings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the %o of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b_a) SF 100 x — _ % of glazing (b) Glazing area equals SF b a If glazing is.<40%.use the chart below. If glazing is> 40.% roceed to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM Ly Fenestration .Ceiling and .Wall Floor Basement Wall Slab Perimeter U-factor Exposed floors R-Value R-value R-Value R-Value R-Value and Depth .39. R-37 a R-13 R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not compressed over exterior walls, and including any access openings). 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 and ceiling area of the addition. Note: Owner to fill out Consumer Information Form (found in Appendix 120.P oFTM�To,,ti Town of Barnstable - Regulatory Services. • swswsr"L& wAas. �, Thomas F.Geiler,Director En,19. ' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, P'q y G 1),9 v r 1JS o r , as Owner of the subject.property herebyauthorize 1V/C4 ,9-f-1 'Bur k-,—v C,U s TruC--T 10 ,ter to act on mybehalf, in all matters relative to work authorized by this building permit application for. T y S /4A/A1 S-F (Address of Job) T hyk Signature of Owner Date ��AuL C /4v 0 J Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:FORM S:O WNERPERM 1SS 10N �oF Town of Barnstable SHE r, Regulatory Services ? BARNST"M : Thomas F.Geiler,Director as�ss . Building Division TfD � Tom Perry,Building Commissioner 200-Maiii.Street, _Hy_annis,MA 02601,. vt'ww.to wn.b arnstabl e.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellintrs 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 HOMXOWNER 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.be/she understands the Town of Barnstable Building Department. minimum inspection procedures and requirements and that he/she will comply with said procedures and re ents. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION .The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they am 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 n sponsibilities,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:forrrr_s:homeexempt Davidson common bath wall detail 2" X 4" 16 o.c. Floor 1 with 1 floor above Davidson bath remodel --- - - 1895 Main Street West Barnstable, MA 2"X 8"header 2"X 6"header Laund closet New 3011 ry door 5-11 1/4" 2'7" i I m 9'-11 1/4" Michael Burke Construction 36 Mt. Pleasant St. #4 Plymouth, MA 02360 Tel. (508) 250-5928 Master bath pocket door wall detail 2" X 4" 16" o.c. Floor 1 with 1 floor above - Davidson bath remodel 1895 Main Street West Barnstable, MA I 2"X 8"header I y 28" pocket door 4'-8" 0 co co io II i Michael rke Construction Burke i 36 Mt. Ple asant St. #4 Plymouth, MA 02360 I ' - - -- -- -- Tel. (508) 250-5928 E Master Bedroom 1 st floor New 28"pocket door New wall location c 'o Non load bearing 0 Remove existing wall Non load bearing 101-0.1 Remove existing door,close wall o Deb Davidson Master Bath plan 1895 Main Street CO West Barnstable, MA - Hall ® New framing Framing 2" X 4" 16" o.c. Michael Burke Construction 36 Mt. Pleasant Street Plymouth, MA 02360 Tel. (508) 250-5928 Existing window Existing half bath Deb Davidson floor 1 common bath 1895 Main Street West Barnstable, MA Door to be removed New framing 9 13-5 r Non load bearing wall 0 to be removed r Existing non load 9 wall to be Wall framing 2„ X 4„ 16 o.c. New washer/ "' bearin • removed dryer closet r i - Kitchen V-9 5/16" 9'-11 1/8" N Existing closet h 1 New 30 door Hallway Michael Burke Construction 36 Mt. Pleasant St. #4 Plymouth, MA'02360 _ - - - Tel. (508) 250-5928 `OPINE TO Town of Barnstable BARNSTABLE. Regulatory Services MASS. 1639. � Building Division prFD MAC a " 200 Main Street,Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 Inspection Correction Notice Lo C' 770XI/ ; Type of Inspection / 0C1? 4ro t; e Oti Permit Number zaa'::?'5o�6 ?3 Owner 1 PS Builder One notice to remain on job site, one notice on file in Building Department. The follo ing items need correcting: S k o j re 7oOWZC--� w / IMF RA -76 R0 IA-) VeltY, dices 2 cac-o Gay° - nD � 1/ �C(S-r(QG x511 rU I z 6r- f-,w-aen(aTG- Please call: 508-862-40•�8 for re-inspection. Inspected by Date 3 N /01 A i �oFt ►o�, Town of Barnstable We Expires 6 months from issue date .\\ BMINSMBLE, . Regulatory Services Fee y MASS. 0a 1639. .0 Thomas F.Geiler,Director �PrED MA'1 A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PER UT APPLICATION = RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number _ Property Address t'"� Residential Value of Work Od Owner's Name&Address C-�-r a cA'4 1 s o r y. 10 c_ Yrnr v'h o v't•1n Y'Y"\ 0 Contractor's Name ��'�'�'` � �,;�n apr O.i�w�r� Telephone Numbers-0(16 Home Improvement Contractor License#(if applicable) G S S LA O 1 1 Cd 5 Construction Supervisor's License#(if applicable) �� �]Workman's Compensation Insurance PRESS PERMIT Check one: ❑ I am a sole proprietor NOV 0 5 2�Q$ ❑ I am the Homeowner —�© I have Worker's Compensation Insurance J® N OF BARNSTA5LE Insurance Company Name 'T v Workman's Comp.Policy# Permit Request(check box) r' I} Ln ❑ Re-roof(stripping old shingles) All construction debris will be taken to 1 a ❑Re-roof(not stripping. Going over existing layers of roof) cu Cv �� •0 Re-side Replacement Windows. U-Value (maximum.44) ❑ Other(spef(ei�f CAY _ ry 1Ze MAIN.` 0US' �T �. c�z t�" s�Off' t� *Where required: issuance of this pertfiit does not exempt coinphance wiih'otheiWtown depaitm nt iegalah i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Signature Q:Forms:expmtrg Revised121901 ,per The Commonwealth of Massachusetts �\ Department of Industrial Accidents ~ Office of Investigations a 600 Washington Street �< Boston,MA 02111' ww'mmass.gov/dia Workers}Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information .Please Print Legibly Name(Business/Organization/ludividual): %L k-c'f SD t InrA. •Address: y,_ Cn M, a i4-• L -Me. City/State/Zip: ©r r 0.r M A Phone.#: S O's --)AO j 0 LS Are.you an employer? Check the appropriate box: .Type of project(required):. 1.❑ I am a employer with I 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. ❑New construction . •employees(full and/or part-time). Remodeling 2.❑ I am a'sole proprietor or partner- listed on the*. sheet �• ❑ g ship and have no employees These sub-contractors have g• Demolition employees and have workers' working for me in any capacity. 9. El Building addition [No workers' comp.insurance comp. insurance.# 5 ❑ We are a corporation and its 10.❑Electrical rep airs or additions . required.] ' 3.❑ I am a homeowner doing all work . officers have exercised their l l.❑Plumbing repairs or additions ' myself.y o workers comp. right of exemption per MGL 12.❑Roof repairs insurance.required.]t c. 152, §1(4), and we have no 13.0 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. f Homeowoers.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot 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: y M V 4.VA Zy%S u-A-�ct Co Policy#or Self-ins.Lic.#: WC-1• 3��J�3bO �l� � Expiration Date: 3' 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 tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK:ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe 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. Signature: Date: n l 3. _ Phone# SO Official use only. Do not write in this area, to be completed by.city or town offcciaL 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#: 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 hiie, express or implied,oral or written." An employer is defined as "an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter..152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for:the performance of public-work until acceptable evidenee.of comI l anee 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 numbers) 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 fuhue 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 io any business.or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number;. The CwnmanwWth of Musachusetts Departnnemt of lndnstria1 Accidents Office of Investigations 600 Washington Street B¢stena-MA 02111 Tel. #617-727 4500 ext 406 err 1-877-MASSAFE Fax#G17-727-7749 Revised 11-22-06 www.maess.gov/dia r J . N]wssachusetts- Department of Public SafetA Board of Buildin�� Regulations and Standards Construction Supervisor Specialty License License: CS SL 101185 " Restricted to: RF,WS,DM MARK NICKERSON y 321 RED TOP ROAD BREWSTER, MA 02631 Expiration: 10/26/2011 ('unmii:•i ncr Trr: 101185 0 ✓!ie V�o�ttmzo�zrae�o�./Lt!caaeaclauaella Board of Building Regulations and Standards License or registration valid for individul use only =- HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - `" Board of Building Regulations and Standards Registration:, 133851 One Ashburton Place Rm 1301 Ezpiratio_n=8/17/2009 Tr# 259484 Boston,Ma.02108 Type:-Private Corporation NICKERSON HOME--IMPROVEMENT MARK NICKERSON = 12 COMMERE DRIVE ,a.eQ-�.•� ORLEANS,MA 02653 Administrator Not valid without signature i I • r� Liberty Liberty R7utual Group j P.O.B ox 9090 11 utuil. Dover,MI 03821-9090 Telephone(800)653-7893 Fax(603)-245-5330 March 10,2008 TOWN OF BARNSTABL.E ATTN:BLDG DEPT 200 MAINT STREET HYANNIS, MA 02601- RE: Certificate of Workers Compensation Insurance Insured: MCAS LLC DBA NICKERSON HOME IMPROVEMENT PO BOX 2476 ORLF--ANS, MA 02653 Policy Number: WC2-31S-360989-018 Effective 3 1 2008 / / Eapiration� 3/1 /2009 Coverage afforded under Workers Compensation Law of the following state(s): MA ,/' Employers_Liability(j imit�). Sole Proprietor/Parrner Coverage Election Bodily Injury By Accident $100,000 Each Accident Bodily Injury by Disease:_ $ I00,000 Each Person Bodily Injury by Disease: $500,000 Policy Limits As of this.date,the above-referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy listed above. The insurance afforded by the listed policy is subject to all the terms,eadusions and conditions,and is not altered by any requirement,term or condition of any or other documents with respect to which this certificate may be issued. jiis.certificate is issued as-a matter Of in&oihiati6n only and confers no right upon you,the certificate holder_ .This certificate is not an insurance policy and does not amend, extend,or alter the coverage afforded by the policy listed above. If this policy is cancelled before the stated expiration date,Liberty Mutual will endeavor to notify you of such cancellation. AUTHORIZED REPRESENTATIVE ` UBERTY MUTUAL.INSURANCE GROUP This CertiBCate is executed by LIBERTY D4U71JAL WSURgNCE GROUP as respects such insurance as is afforded by those companies. cc: Insured: Producer of Record MCAS LLC ROGERS&GRAB'INS AGCY INC DBA NICKERSON HOME IMPROVEMENT P.O BOX 3700 PO BOX 2476 ORLEANS, MA 02653' PLYMOUTH, MA 02361 3/10/2008 _ -- Oct 30 08 08:52a Davidson 8638589022 p. 1 Town of Barnstable Regulatory Services ere T6onmsF.Geller,Director Buiddingr,Division Tom Perry, Balding Commoner 200 Main Suem Hyannis,MA 02601 Office: 50W62-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder C ' UI ' J S o A .as Owner of the sub1 ect xo P�9 huebyauthorize o w � m pvovv^a - co act on my behalf, in all matters sela&e to work authorized by this bulging permit application for. (Address of Job} signature of Owner Date p UL C ��}y•Z>soAJ 0 Print Name Y , Q.MItMS:OvrNEMRh=WN Z'd toK-99ZIM uGM)P!N VBN e8Z$0-80 0E PO i Op THE rp�Y Town of ]Barnstable Permit# Ecpires 6 niauhs frogs issue dal r a Regulatory Services Fee 3 BARNSTABLE, b 9. � Thomas F. Geiler, Director a ArF0 MAC Building Division Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.bamstable.ma.us Off ice: 508-862--4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Nol Valid without Red X-Press/nrprint Map/parcel Number Property Address_ i /J Residential Value of Work0�1 Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address PM L) 1 f, ;qy,tS p � Contractor's Name_--_- M,9 {r\L A'f C Telephone Number �n� I Ionic Improvement Contractor License#(if applicable)— a��W) Construction Supervisor's License#(if applicable) �orkman's Compensation Insurance mPSS PERMIT Check one: OCT 1 4 2008 ❑ I am a sole proprietor. ❑ I am the Homeowner D-"[ have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name VIA Workman's Comp. Policy# D d j Uc -0), + a66 Copy of Insurance Compliance Certificate must.be on file. Permit Request (check box) ; a 7 Re roof(stripping old shingles) All construction debris will be taken to (�(3�C �'1� C., GO L,rt ❑ Re-roof(not stripping. Going over existing layers of roof) �> X Re-side nL ✓' ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) *Where required: Issuance of this pennit does not exempt compliance with other town department regulations,i.e. Histori ,"'Conservation,etc. 'Note: Property Owner must sig Property Owner Letter of Permission. jAcopy of th Iome I prov me Contractors License is required. SIGNATURE: Q'.WPPILES\FORMS\bui[ding permit fonns\EXPRESS.doe Revised 100608 L The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations • d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers" Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ly. Name(Business/Organizationadividual): Address: City/State/Zip: CG�� Phone.#: Are.you an employer? Check the appropriate box: :Type of project(required):. 1,tJ I am a-employer with�'� 4• ❑ I am a general contractor and I • * , have hired the sub-contractors 6• ❑New construction . employees(full and/or part-time). Remodeling 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet Elg ship and have no employees . These sub-contractors have g. Demolition working for mein any capacity, employees and have workers' 9 �Building addition [No workers' comp.insurance comp.insurance.$ 5. [] We are a corporation and its 10.❑$lectrical repairs or additions required.] ' 3.❑ a homeowner doing all work . officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12,[ oof 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. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot 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.thepolicy and job site information. Insurance Company Naive: !`T\ vYt��v•� — Policy#or Self-ins.Lic.#: Expiration Date: lob Site Address: 1%6 I b rt n�� �rL� 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 tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK,ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of —Investigations of the WA for insurang.'COVARe vQrific on. I do hereby certify and r the pal and p alti of jury that the information provided above is true and correct. Date: Si afore: a � - Phone Official use only. Do not write in this area, to be completed by.city or'town offrciaG City or Town: Permit/License ff 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#: J6'.LIA KUI AAA"ILIA It9 ILA 8.0.A9.0.8- ABAutLA csna e+dr.v as w+ . 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 hiie, express or implied,oral or written." An employer is defined as "an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a-deceased employer, or the receiver or trustee-of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter..152, §25C(7)states `Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public-work until acceptable evidence of compliance withthe 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-conti•actor(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 nuigber listed below. Self-insured companies should enter their self-insurance license number on the appropriate-line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all-locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Depaztnent's address,telephone-and fax number:. o Comxnonwf,- lth of Massnhusotts Df,-partmont of lmdvsWal Aeaidemts Q-fce o mve .tigat ns 600 Wash ngto i Street Boston,.MA 0.2111 TO. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia Ar NOTICE -NOTICE TO TO - EMPLOYEES EMPLOYEES The Commonwealth • of. Massachusetts DEPARTMENT OFINDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22-& 30, this will give you notice that I(we)have provided for payment to our injured employees under the above mentioned chapter by insuring with: ASSOCIATED INDUSTRIES OF MASSACHUSETTS MUTUAL INSURANCE COMPANY NAME OF INSURANCE COMPANY 54 THIRD AVENUE, P.O. BOX 4070, BURLINGTON, MA 01803-0970 ADDRESS OF-INSURANCE COMPANY AWC 7016215012008 01/10/2008 - 01/10/2009 POLICY NUMBER EFFECTIVE DATES P O Box 494 Leonard Insurance Agency Inc Osterville, MA 62655 (508)428-6921 NAME OF INSURANCE AGENT _ ADDRESS PHONE Mark Herbst 35 Peep Toad Road Centerville, MA 02632 EMPLOYER ADDRESS 01/04/2008 EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above,named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. .A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. CThe reasonable cost of the services provided by the treating physician will be paid by the insurer,if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention,employees are hereby notified that the insurer has arranged for such attention at the NEAREST.AND BEST MEDICAL FACILITY NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER Cons truction uction Su pervisor License � t + License: CS 48546 f i I `�, t Expira /27/2010 Tr#. 14362 qr.Restnction_�0 - �� MARK D HERBSNP 35 Pe.ET TOAD RD CENTERVILLE,MA 02632�� r Commissioner ��xe �aminzo�•uuea�/z a��/�voac/ucaelta I� --— _. .__ ._ �\ Board 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� 126480 Board of Building Regulations and Standards Ex ifat on`gjg/2010 Tr# 267766 One Ashburton Place Rm 1301 -�!7' Boston Ma.02108 t� —Individual MARK MARK HERBST MARK HERBST r J �, 1 e 35 PEEP TOAD RD: CENTERVILLE, MA 02632 Administrator Not valid without signature MARK HERBST . . 35 PEEP TOAD_ ROAD . CENTERVILLE MA 02632 508-420-6216 CELL PHONE 774-238-2938 www. MarkHerbst.com PROPOSAL SUBMITTED TO: WORK PERFORMED AT: Deb Davidson 1895 Rte. 6A SAME W.Barnstable AM 508-394-3265813-326-1757 We herby propose to furnish the materials and perform the labor necessary for the completion of the following; New Roof House&garage Remove 1 layer of existing red cedar roorng Install 8"drip edge ` Install ice&water shield at edge, in valley areas, and chimney area Install 151b.felt paper Install Certainteed Woodscape 30yr.Architectural shingle to match Color= Weatherwood Replace anZplumbing boots Cut ridge&install cobra vent Storm nail all shingles All debris cleaned daily Price includes material, labor&dump fees All material is guaranteed to be as specified.The above work will be performed in accorandance with the specifications submitted and completed in a substantial workman-like manner for the sum of; Nine-Thousand Eight-Hundred dollars($9,800:00)with payments as follows; %@ start with balance due in full upon completion *Any alterations)from above proposal involving extra costs will be added under a separate written agreement and become an a tra charge. RESPECTF LY UB D: 10-02-2008 Mark Herbst ACCEPTANCE OF PROPOSAL The above price,specifications and conditions are satisfactory. We herby accept this proposal. You are authorized to do he work d payments will be as specified above. Signature *This proposal may be withdrawn by said company if not accepted within 30 days Assessor's map and lot 'number . .. .... low �a 'TA6 EO IN C'?'"'PLIANCE Sewage Permit 'number ........ ...... G,a.1 N AR-V':` E I ;T TE .... N.CODE AND TOE %TMETo�o. TORN OF BARNSTXHtt = i 898BSTSBLE, i "6 ,,� BUILDING INSPECTOR O YPY IL• APPLICATION N.f1j! G lv�'�.....�....�.!':r :C f J. £AL„�g? FOR PERMIT TO 7. w L .... ..... f,I . TYPE OF CONSTRUCTION W�d D ' FY�t-�Gll!t lit vY Cy................ .. .. ................................................ .............. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: /• /� L' Location .WL'S. .. .. UYi�G1l0. ...P../%: i�J 7G... !"".(./,1.�-...#,w o.....(.�..n/ �07 .7...)...................... ProposedUse .........�.ft:1PsL S..�.V ..... .?!rt�... /3• f........................................................................................................... Zoning District .................'.....................................................Fire District ....t�................................................................... 4 Name of Owner ../.! l.l.`:?........94 f /!� .......................Address .wets 1�.©AC F b fo .9 1*z.PIC� I�./ .... ....................... .................. / 0 Name of Builder ���'�a.......�.4t �` ........Address if / ..�.. ..�............. Name of Architect Bev.! yla........AA7.`X!.��11.....................Address .................... .............................................................. Number of Rooms /O Foundation .. � ���t.7. ............................................... ....................................................... Exierior ......F!..1. .L...............................Roofing ... .................. Y..,1e ....................................... Floors Gv�o�..�.7T...- Y �r Y4. ....Interior K' C/uC -->f.,✓OCJ �..... .......................... ............................................................... Heatin .. ep 7P Plumbing ' . Gi�✓� ��� � g :................ ,. g /� j... ..... ........... .......... Fireplace ....q.o.qZ................................................................Approximate Cost .......... .................................................. Definitive Plan Approved by Planning Board -----------______-----------19_______. Area ................................ Diagram of Lot and Building with Dimensions SQL A ?� /kv Fee .......... :.............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I ,rA — I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ' � 1 Name .......... ... ..... ........................... Phillips, Philip ' � No —l.73%5_ Permit __dv��ll.lng.�&..antique � shop ( l #l97�~6) ' ��----. --.. ' � ' / .��~l_ - . �~ /�� Location —. .................................................... ` -- / Weat Barzzatm6le - � .-------------------------.. ' ` Philip Phillips ' Owner, ------- ' . r ' � � ....------------ . ` Type of Construction ---�rame---------__ . ' _--,---------------------.. - ' ^ ` ' Plot ---------. Lot ................................. , > - - ; . Permit Granted —' 'l9/__.lg 74Date Completed Jeh&.c PERMIT REFUSED ' . ^ . ^ 19 - . ----' ' ~ ----. . ' , ` ---.. � . � --~—. ^ ^ � 19 ' ' ---------------^---^---' ~ ' ~ ' ........................................................... ~� � - | _ = FEE TOWN OF + BARNSTABLE, MASS. -19 o�• THIS IS TO CERTIFY THAT PERMIT IS HEREBY GRANTED TO ' Rio .Milip T'�1illigz rlutd v� v ......... ......... ......... ....... ...... ......... O (ADDRESS) � � (PROPERTY OWNER) TO ...... ............ __ v._ _.._..__......._._ _ (il�r4•fy (BUILD) (ALTER') 41, ama ......._.............................................................................................. _.................._.._._ ............................. .................................................... (TYPE OF BUILDING) (APPROXIMATE SIZE) •. fn ...« op LOCATION .............._._......._..........................._.._........_.._..._......._........._.._.. _................_........................................._..:..... ..... _...gum . _.. (STREET AND NUM BERI (VILLAOEI NAME OF BUILDER OR CONTRACTOR gob p APPROXIMATE COST __._._.._..._AA `D _' _......_.............._..._.._..._....._ _....___.____._....._..___...... _._..._. o mas 1 HEREBY AGREE TO C,NFORM TO ALL THE RULES AND REGULATIONS OF THE TOWN OF BARNSTABLE, REGARD] . G THE ABOVE CONSTRUCTION. oal op In N (O-NER) (CONTRACTOR) y 0 o+3a - ✓ _ BUILDING INSPECTOR Subject to Approval of Board of Health. • . _ ,. .� � � i v �1 Assessor's map and lot number ............. :.�.!..!n ``i �. u Sewage Permit number ..........,.�............................................ � r T"ET°�y� TOWN OF BARNSTABLE Z BARNSTABLE, i "6 M 9. a BUILDING INSPECTOR aY �NI"elc /Id," e 14,eo 9,d� e I/ �� (ApfA1 197�� APPLICATION FOR PERMIT TO .....'V ................................................................................................................... TYPE OF CONSTRUCTION .VUUD F✓��,►G G T:.e/. .... ....L�.. ...............19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: IwY' 1� ��U 619 � Or Location !.(°5. .�N..�:.UIV...7..... r?!= �'�7� ........7...........�................................................................................ .......................... Proposed Use .....Ok)6 LL 1!!rt}......�.^,0 S,q K f.......................................................................................................... Zoning District . r �P �? /2�/f �- ................�.....................................................Fire District ........... ................................................................. Name of Owner .. �.1.'1.? �'/t 1 T I we�4 070k e L� Jo .................................Address .................................................................................... . / , Nameof Builder LT,/•i•, f I I ��.11.S.....................Address..................................... .................................................................................... Name of Architect : ..... . �l �'�... Address .................................................................................... If 10.............................................Foundation ..S-.o^..C.t''e f Number of Rooms ................. (.............................................................. U�Ogo 44!q......v v�4 ...Roofing ///Ouo J // /iYG�F�i Exterior, .....,,.........:...... Floors ..!,v!!�1. ..-.�.�'....--...... X../... :Interior .C!JP.r'..�...�aC/� - LC/OU .............................' ....................... Heating r1en-l) �-�0 7 «d� 7Pld Plumbing ('r1 ? G.-,, Yri� � �"........... .............................................................................. .......... ... Fireplace 1?Qid/ .Approximate. Cost ..................................:............................ ..... Definitive Plan Approved by Planning Board ________________________________19________ , Area �+........... 'Z v Diagram of Lot and Building with Dimensions SCf oq -7 Fee ............... ............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH [4, Y • 5774 ` 614 a 1 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. i' Name .:. e..�.......... 'O - ........ ............ ' Phillips, Philip � � . ~ � No — .... Permit for ......8�ell.1og..&......... ' antiq ( l ' -----'^ 'r—'' —' | [r\ ! Location ------------------^ `—' West Barnstable --------------------------.. ` ` C�vne, -- Pb1 ll1po ��b1l1p.� . _______. � / � Type of Construction ------rama-------- ----..---------------------' � Mc� ---------. �� ---________ � . ` ^ , ! Permit Granted ..... ' � --.� � ..lP 74 Date of Inspection ------------l9 * ' Dote Completed ...................................... ' . PERMIT REFUSED ' -----_—.------------- 19 --------------------------. ' � - --~--'--------------------- ' .—.-------.-----------------. ---------------------'---^—' ` ' ^ � Approved ................................................. lA ^ ------------------ ------'' �- � � ^ ----------------------'---- ^