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HomeMy WebLinkAbout0052 MAPLE STREET e No P2® HASTINGS, MN y BUII.DING P�DVTT NO. �_7 Dniw UL.0 ASSESSORS P--�-RCPL NO. CONTINUATION Or ROAD BOND The undersigned' 'ow-ner/contractor hereby to tiaincain the-_ road bond is force unri the foLowtng wor'o itz=s ara coW feted to the satisLaction of the E ngine_r;:.g 'Sec::--:on of the Derar=ent o Public y -r l eshoulders ^C c�. ane se__ �.. scc:: as weather pe—;ts: other (ex`r?iain) 65— t C44 t •� > �Cr. i / !x) -- -- -- (G:�;E_., .,� .rC=R) -- (print --na e J A MOWN OF BARNSTABLE, MASHIM f .Av 32 011.003 `365%8 NO. APPLICANT Mart Dace. G4bUZ0 EETI ICONTR'S LICENSE) PERMIT TO Build CiWN�.lIt?•; i•r `yvl 1 {-- NUMBER OF i (TYPE OF IMPROVEMENT) ,PR OPOSEO USE DWELLINGUNITS AT (LOCATION) lot rr3 52 hIE'St Barnstabie ZONING R (NO.) TI OISTR ICT BETWEEN AND ,. (CROSS STREET) (CROSS.STREET.),,,,_,_„ SUBDIVISION LOT LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY =T. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FD_NOATION (TYPE) REMARKS; Sewage #94-81 30NID AREA OR VOLUME 1312 sq. rt. 80,000 FEE 5 `03.75 ESTIMATED COST S (CUBIC/SQUARE FEET) OWNER Champion Builders, Inc. , Box 58 nuzzaras bay, ZIA ' BUILDING DEPT. )`�, `� � AbORESS BY i /f i THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK C= ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PU?LIC =ROPERTY, NOT SPECIFICALLY PERM17TEA UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AN= LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NO- =ELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL - -APPROVED PLANS MUST BE RETAINED ON JCS AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTIC•. HAS BEEN PERMITS ARE REQUIRED FORELECTRICAL. PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MACE. WHERE A CERTIFICATE OF OCCUP=VCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUiRED,SUCH BUILDING SHALL NOT BE OCC:=iED UNTIL FINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MACE. 3. FINAL INSPECTION BEFORE � OCCUPANCY. POSVTMIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECT) V PLUMBING INSPECT)/ON APPROVALS ELECTRICAL INSPECTION APPROVALS i HEATING INSPECTION APPRO _ I ENGfNEERING 0EEPARTM"ENi OK" I` BOARD OF HEALTH i n /1 SIT=='-AN REVIEW APPROVAL I ='.SH=LL NOT PROCEED UNTIL THE INSPEC• j =E<y.17 "'•LL BECOME NULL AND VOID IF CC^S7RUCTION INSPECTIONS INDICATED ON iH15 CARD CAN BE I =HAC_ _=PROVED THE VARIODUS STAGES OF I "ORK ;S N07 STARTED WITHIN SIX MONTHS CF SATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN ZCNSTRUCiIi,N �_.RMIT ;S ISSUED AS NOTED ABOVE. NOTIFICATION I 1Y ,11 TOWN OF. BARNS•TABLE 8UILDING_'..DEPAF2TME14T E batsar TOWN OFFICE BUILDING .6s¢ �owY HYANNIS, MASS. 02601 MEMO TO: Town Clerk PROM: Building Department DATE: 5/D/ G An Occupancy Permit has been issued for 'the building authorized by Building Permit issued to /1?C Please release the performance bond. I I 1 ., __ ' I j TOWN OF BARNSTABLE Permit No. .J§57.8...... BUILDING DEPARTMENT I ""'f TOWN OFFICE BUILDING Cash .670• HYANNIS.MASS.02601 Bond A............ CERTIFICATE OF USE AND OCCUPANCY Issued to Champion Builders, Inc. Address 52 Maple Street, West Barnstable, MA (Lot #3) USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID. AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY. COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. .. ......... . July. ....... 19.44............ �Buildinle g Inspector i f .Assessor's office(Ist Floor)- kzessoYs'map and lot numb 32 •0 a l , jQ 3 8V3TEeW Pjz'UST BE Qyp{THE Tp`` Conservation(4th Floor): - INSTALLED IN CCMPLIAN w Board of Health(3rd floor): WITH TITLE 5 seararEncc Sewage Permit number ENVIRONMENTAL CODE A A s619. Engineering Department(3rd floor): - �a ,JS i TOWN REGULATIONS House number Definitive Plan-Approved by Planning Board '' 19 f APPLICATIONS PROCESSED 8:30-9:30 A.M.`and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING 'INSPECTOR APPLICATION FOR PERMIT TO , S 1v� r� I � . TYPE OF CONSTRUCTION r • ), 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 5- � r�'P L >T y� Proposed Use Zoning District Fire District ,/� Name of owner�AYyr�'� ���� �-�s �< < Address- Gox ���� �ZZ 6A Name of Builder C9-✓1 Address Z V1 Name of Architect �i L � Address Number of Rooms L Foundation -ea c l Exterior Q s S)2-- 1L Roofing Floors , �f I^' I J� �A� , Interior �nil / Heating Al/ O f I Plumbing Fireplace t' 1 Ll `1 `� Approximate Cost Vbj D OQ Area / yy / Diagram of Lot and Building with Dimensions Fee �l z�9� '2 ofir 3� I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Si ipervisor's License W o z a0 CHAMPION BUILDERS, INC. c r• No . 6 5 7 8 Permit For Two Story A Sinale Family Dwelling _ Location Lot #3 , 52 Maple Street West Barnstable Owners Champion Builders , Inc. d Type of Construction Frame Plot Lot Permit Granted March 31 , 1g, 94 Date of Inspection: Frame Y. �� 19 Insulation " 19 Fireplace 19 pDate.Com leted G0-5- 19 L - "Expect the Best" CHAMPION kiulloer�, 'Developers Contractors B U I L D E R S , I N (508) 888-6648 The Champion Colonial The open downstairs floor pl<ar,- open staircase in the m;ddle and an entry foyer that extends to the second floor combine to give this handsorne 1536 square foot colonial an expansive airy feeling that is both impressive and functiOnal. All three bedrooms ai,e good sized and the extra large master bedroom features a walk in closet. _ . -- - ' - - ---—............. .. = — I 1'irst Floor ------ — ---� Price $ Date Dcck I O'X 12' --- Second 11,10or Brea ;,,Ilk , 1 _ I I � 13�cA;,un; �I ,-� Nrn,k - - - (( I_ .� In' I Closet C7 Kitcl,c12'IX IS'n .__ - J I ir Dining - II �� I �Llstrr Room l I I � I ff' Iic�irwni 12'X 12' I I 12' X i? __ .X 15.4.• Fuycr np e: to above LI:;,)C9 opa, '--"--�__=�=��t=u=_l_=— —k_:_3.:—_-_-�___...--f r•�_._--t�=1.=_::_=:.:mac.. Specializing in Affordable Single Farnlly Homes Office: Mailing Address: 110 State Road (Rie. 3A) • Unit 3A P.O. Box 1558 North Sagamore, Massachusetts 025 2 Bu,Bards Bay. Massachusetts 02532 L_ � +M� jTOWN OF BARNSTABLE Permit No. . 36578 � BUILDING DEPARTMENT I TOWN OFFICE BUILDING Cash 7 Yl env ��.►+� HYANNIS.MASS.02601 Bond X............ CERTIFICATE OF USE AND OCCUPANCY Issued to Champion Builders, Inc, Address 52 Maple Street, West Barnstable, MA (Lot #3) USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY.COMPLIANCE WITH TOWN. REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. .. .... ..... . Ju1Y.1.. ..... , t9.9.............. ...........�/.1��!. .......... ivadigg' Inspector BUIi.v`�PE3.`LIT.fi0.c 7 DA_,:- ASSESSORS PARCEL NO. ( -�tQ3. s CONTINUATION OF ROAD BOND The unaeTsio ed` o�:-ae=/ct t"�acLor hereby agree to maincm—n. ty_ . roarord.... i::.... -..._ . :_...... force unt=l the followi7.g wort itz=s are cold leted to the the Enginee=i:.s Sec_ion of tie Depar rent of. Public lc= and seen shoulders, as scc-+ .. as Z,_x- 7�, _- - ---may--- —--- ��7 -S-r:- -PROVED7777777 4 Li -10-�c 4 O g TI 71 -71 i , C a - 28-0 lv !ll.� A� wa r � r------ WOOD ,r MINE i =Q.=! I HIM i I l oO ' WON, rminl: I � LI t � ! i i 6 kw-oty(40S) • 5s9zo YW 'OltlAJais© • Cl 011171S. .aaa,i5 4{IQ.V4 + • . _ 611N sib+ f i�l� fl �f�+li{►I��l►tlilll{ ' '(rl+ oil ��{t�l `'{I�1► left lt� �f{�f �'I{� � ; �����• � I Jjtflt ►f�Iti}ll��l{I� (t• �� rill {� Ills l }��liiil { {►l►}iu;il}I'tattr� ;I r f 'J►fir � � ' +z..!,{ t �� - _ f� ,. 310 CMR 10.99 Form 5 OEOE File No. SE3-2115 -^--. `oJ T"r>o� (To oe oroyl000 oy OEOE) �` o Barnstable CommOnweallh • w� Oily Town of Massachusetts Jensen N u a Aoohr ant V" Order of Conditions Massachusetts Wetlands Protection Act G.L. c. 131 , §40 TOWN OP BARNSTABLE BY—LAWS, ARTICLE XXVII From Barnstable Conservation. Coruni-lion To Clemmy Jensen Same (Name of Applicant) (Name of property owner) 121 Macaulay Road Address Katonah. N. Y . 1053 Address Same Map Number 132 Lot Num`.Er 21-3 This Order is issued and delivered as foiio,&s: ❑ by hand delivery to applicant or representative on (date) 1U by certified mail, return receipt requested on July OG , 1990 (date) This project is located at Lot 421-3 ( 3) Haple Street, W. Barnstable , MA. The property is recorded at the Registry of Deeds in Barnstable Book_ 6052 Page 121 ;;- Certificate (if registered) --- The Notice of Intent for this project was filed on May 03 , 1990 (date) The public hearing was closed on Tune 05 , 19 9 0 (date) Findings The _Barnstable Conawrv..a..., rnm _ :__ has reviewed the aoove•reterenced Nonce of Intent and plans and has veto a puohc nearing on the Crojecl- Based on the information available 10 the Commission at this time. the Commission has determined that the area on which the proposed work is t0 oe done is significant to the lollcwrng interests in accordance with the Presumptions of Significance set forth in the regulations for each Area Subject to Protection Under the Act(check as appropriate): ❑ Public water supply ❑ Flood control 0 Land containing shellfish ❑ Private water supply ❑ Storm damage prevention 0 Fisheries ® Ground water supply B . Prevention of pollution ❑ Protection of wildlife naoitat Total Filing Fee Suomined $2 5 0 . 0'0 State Snare $112 . 50 City/Town Share •' (V- fee in excess of S25) Total Refuno Due s Ciry/T'�wn Ponron $ ARTICLE 27 Only: total) State ?o total) $ (`h (Yr aq ❑ Public Treat Rights ❑ Agriculture IR Erosion control ❑ Aquaculture ❑ Recreational Effective 11/10/89 ❑ Bietoric ❑ Aesthetic 5.1 herefore, theBarns table Conservation . Co-_'-Lssion, n that necessary, in accordance with the Perlorrnance StanCaras set formof tires egulartions'l to ing conditions are Esls checked above. The oT v; nn protect those inter. orders�,< s; that work be in accordance with said conditions and witr, the Notice of Intent referenced above. Tlo the e telnt that performed t lowing conditions modify or differ from the plans, specifications or other proposals submitted with theNoticle of Intent, the conditions shall control, General Conditions 1. Failure to comply with all conditions stated here!n, and with all related statutes and other reguiatory meas- ures. shall be deemed cause to revoke or modify this Order, 2'. ThiS Order does not grant any property rights or any exclusive privileges: it does not authorize any injury to private property or invasion of pr.va.te rights. 3. This Order does not relieve the perm;t.tee or any other person of thin necessity of complying with all other applicable federal, state or local statutes. ordinances, by-laws or regulations. 4. The work authorized hereunder shall tie completed within three years from the date of this Order unless either of the following apply: (a) the work is a maintenance drecg:ng project as provided for in the Act: or (b) the lime for completion has been extencet to a specified date.more than three years, tut less than five years, from the date of issuance ano that Cate and the special C;rC::mstances warranting the extended time penod are set forth in INS Order. 5. This Order may be extenced by the .sz-u!ng autr.onty for one or more periods of up to three years each upon application to the issuing author;ty at !eas; 30 days prior to the expiration date of the Order. 6. Any fill used in connection with this r� p .,;e,,, sr-ail .,e clean lilt. Conlaining n0 trash. refuse, fubdlSh of de• bris. including but not limited to lumber. bricxs. piaster, wire, lath, paper, carcCcard. pipe. tires. ashes. refrigerators, motor vehrc!es or parts to! any of ;he loregoing. 7. No work snail be undertaken until al: ::,Grrinis;rative appeal periods from this Orcer have elacsed or, if such an appeal has been filed. until :ill Droceec:n;s before the Department have teen completed. 8. No work snail be uncenaken until the�'Flnal Orcer has peen recorced in the Re,:s;ry of Deecs or the Land Court for the distnc: in wnich the lane, is locatec. within the chain of title of the a:!ecied property. In the case of retorted lano, the Final Orcer snail als„ Ve noted ;n the Re;;stry's Grartcr Inoex under the name of the owner of the lane upon which the prCOCSE3 work is to be done. In the case of registered land. the Finai Order snall also be noted on tr;e Lane Cc rt Can:fica!e of Title of the owner of the lano upon which the proposed work is ,,o be done. The recorc.ny :nicrmat:cn shall be suomit;eo is the Co7Mi s s i on on the !orm at the end of this Order Gr',Cr t° CCrnmencement of the worx, 9. A sign snail be displayed at the site no; less than two scuare feet or more than three square feet in size bearing the words. "Massachusetts Department of Environmenta Quality Engineering, File Numoer SE3-2115 10. Where the Department of Environmental Cuai;ty Engineering is requested to maKe a determination and to issue a Superseding Order, the �:drIservalicn Commission shall be a party to all agency proceedings and hearings De!ore the Department.: 11 , Upon ccmpletion of the work desc;cec herein, the applicant si^all :onhwilh recuest in writing that a Certificate of Compliance be issue:; `taiing lira( the work has been satislactortly completed. 12. The wore snail conform to the follov,:ng plans ano special conditions: SPECIAL CONDITIONS -- SE: 115 -- JENSEN T. PLANS: Title: Site and ' wa(:,Ie Alan Dated: May 07, 19,(') .• Signed and stamped by: Arne I• . O jal a, P. E. On file with: Barrlst<tc.. le Conservation Commission Main i'I::1"E:.et:., t"I'J;:tl',r,].s , MA. 02601 "- (508) -•775_•1120, E•':'::t . 1.40 1. . ) Within one month of rec:ei.pt of thi.s T'''] ''::.I"1 e:: commencement ,_]1= General.J� F.. �.:( ... J. 7.C)"1� c{I")r j I.)I"''1 i_a I"' •r t approved number ;; (preceding page) shal3 be complied With .:: 1 ..„ is the responsibility of the applicant, owner anJ/Ur`successor(s) ' to ensure that all conditions of this Order a r e complied t.'d:tC.h . The prf.:!.)(:ct ent'I :I.q;.:,(ar and contractors ors are to be provided d copy of this Order and referenced document, -f'i E:'}'CJ Y"(_' t.t,F_a commencement of 0. ' All work shalliae r')u s e in strict conformance with t.h e plan of record. 4. ) The work liI'I'tit f'C)r"' the house shall be established as indicated on the plan n? r4:r:corCI to the north and shall I he established along t.I"1 i;' ::;4 contour to the South . 5, ) Staked haybales shall be set at the wurk limit prior to t'.h c_' start of work at :" C maintained throughout construction . There shall be no disturbance of this site, including cutting of vegetation beyond the work limit , 7. ) This approval is Health ;.. •• subsurface the .-1 !• I��=. a N i::)I"c,v��.l b•y� t I',r� 1::(c•)�_t r,CI c:;.i:: .. .., shall be installed to <:{C'(':C?11'I(")l.i cl't'.E? roof runoff, : . ) Sod shall not. be ,l .(.a.-I l I - .. '! l grassed .. .. ,....., � I '. .. ... -- - ._ ...> ... landscape_. ...>._. _. ,ci al t I_.l r"`L--_ �� - _.t,f-? project . seeded 't:.f, 1-ir::'<c;(:::lJ.`:ir?`.iT., c,r"t l:a t I 1 e? l l o h' of lawn chemicals kept at a minimum, :I.0. ) A certified plot plan showing the structure shall be supplied .L...., the L.:on:::er•vat't: a.on Department prior to the commencement of work 'the_? site. ���= .I 1 . ) The Conservation Commission, its employees, ca.r' d ltf_ agents sI`i.:'l.l. l. have a right o•F: entry 't:.c; ,...... .. .I.r,�,t�::.i...1. 'r r;r• c-c]rrt t]]. :':::1 r,c:e with t h F' provisions of t i c)n o-F t h c- c�r•i e r rn J.t. 1.3 e I r,-a c 0 11'1 p e d w i t h Issued By Barnstable Conservation Commission Signature(s) _ This Order must be signed by a majority of the Conservation Commission. On this 6th da f July Ig 90 before me personally appeared Mark ;., Ro b i n s o n �— to me known to be the ,person described in and who executed the foregoing instrument and ackri;�wledged that he/she executed the same as his/her free act and deed. October. 28 , 1994 JIN ary b c My commission expires The applicant,the owner,any person aggrieved by this Order.any owner of Ian-`abutting the land upon which the proposed work is to be done or any ten residents of the city or town in which such land In located are hereby notified of their right to request the Department of Environmenua'Quality Engineering to issue a Superseding Order, providing the request is made by certified mail or hand delivery to ti;e Department within ten days from the date of issuance of this Order. A copy • of the request shall at the same time be sent by certified mail or hand delivery to th'Conservation Commission and the applicant. _..., ..........._....................................................._...................... Detach on Dotted Line and Submit to the issuer of this Order Prior to Comr.encement of Work. A To Barnstable Conservation Commission (Issuing Authority) PLEASE BE ADVISED THAT THE ORDER OF CONDITIONS FOR THE PROJECT AT , FILE NUI,sl iER SE3-2115 HAS BEEN,RECORDED AT THE REGISTRY OF ON (DATE) If recorded land, the instrument number which identifies this transaction is If registered land, the document number which identifies this transaction is _. I Signed Applicant I , 1 WIN Ill . I ice Now ' �■�I�iiih '' Application to 1994 0 0 q�4 � d King ighway Regional Historic Jistritomm* r ee in the Town of Barnstable for a • (-,..;-,CERTLFICATE OF APPROPRIATENESS applleatitilrl=;jteraby e, iff triplicate: for the issuance of'a Certificate of Appropriateness under Section 6 of Chapter 470 ; k,�; Aryh:I*ram:., proposed work as described below and on plans, drawings or photographs .'t accompanying this application for: CHECK CATEGORIES THAT APPLY: fz Exterior Butl�dirig Construction: New Euildin " !Z8 e,, 9 ❑ Addition ❑ Alteration ihdtcate;type of building: ® House ❑ Garage 2 g ExtenotPamting.. ❑ g Commercial ❑ Other 3Signs illboajds s❑ New`sign _,F t;;_. y'a; '"4' Structure C� Existing sign * � Repainting existing sign +o •; ❑ Fence.-_' ❑ Wall FI •. ❑ agpole ❑ Other_ ^, (Please'road other side for explanation and r;quirements). T; �7TYPE OR PRINT LEGIBLY . Ff DATE f Lot a Maple Street 132 z ADDRESS PROPOSEDs WORK } 4' ASSESSORS MAP NO. OWNER '=, t .,r',.; Clemmy E . Jens,' n & Donald J . Jensen t ASSESSORS LOT NO. 3 z L21 Macaulay HOMEADDRE S� y Road, Kotonah, New York �; w a TEL. NO. tFl1LI. NAMES=AND ADDRESSES OF ABUTTING OWNERS. 'Include name of adjacent I property owners across an street.or way:, (Attach additional 4heet`i'' ecessar Y Public s w. Ple4ase see attached ^KV � s'X'Sr - t fit•" AGN��ORCO'NTRACTOR Matt ` Dacey/Champion Builder ` Y �' _ _ IncTEL. NO. 888-6648 a ' AOORES P or. iBox 1558 ,; Buzzards Bay,` MA 02532. DE1�'AILED'OESCRIPTION OF PROPOSED WORK:' Give all particulars of v ark to be done (see No. 8, other side), includin �' mat enalstobe used, if specifications do nut accompany plans.,. In the case of signs, give locations of existing signs and proposed�t"':: � locations ojf new°signs; '(Attach additional shee., if necessary):'' � f fyy ' t r Signed ne or ittee use. Owner•Contractor• t kv e i v H J . — � �oy.� � S k "r`)OtL The Certificate ;s hereby , ��.. Date I 9 1s''Ti me TOWN OF BARNSHABLEy, pproved ❑ IMPORTANT: ,f Certificate i' a a - pproved, approve. is subject to the 10 day appeal period prc.vided in the Act. l�D�sal,I>ttw,al ❑ APPROVED - POLICY NUMBER "WOC C4 00 46 34 3 E NSURANCE COMPANY OF NORTH AMERICA Rewrite of; RRIER CODE: 14486 ] New; ® Renewal; ❑ NCCI CA SYM PREVIOUS POLICY N0. WOC C38869991 - WORKERS COMPENSATION AND EMPL'C`YERS INFORMATION PAGE LIABILITY INSURANCE POLICY = Inter/Intrastate Identification No.: am 1. CHAMPION BUILDERS INC he P 0 BOX- 1558 MA 02532 tsured BUZZARDS BAY DIRECT BILLED ❑ Individual ❑Partnership flailing ®Corporation ❑ address L. FEIN # : 043145058 imployer's Identification No.: (�G MASSACHUSETTS )them workplaces not shown above: STATE Ahe —27-93 to 06-27-94 12:01 A.M., standard time at the insured's mailing address. tam 2. Policy period from 06 al) to the Workers Compensation law of the states listed here: tem 3. A.Workers Compensation Insurance: Part One of the policy a MASSACHUSETTS B. Employers Liability Insurance: Part Two of the policy aPPlies to Bodily nouryrk ln eaci.by Accident listed in Item l 003 OOO each accident The limits of our liability under Part Two are: OOO policy limit Bodily Injury by Disease $ 500: • Bodily Injury by Disease $ 100, 000 each employee C. Other States Insurance: Part Three of the policy applies to the slat II STATES DESIGNATED IN- ITEM AK,LA,ME ,MN,NM,NV,ND,OH,RI , TX,.WA ,WI ,WV,WY ,STATES of Rules, Classi Rating Plans. All information Item 4. The premium for this policy will be determined by our Manual fications, Rates and required below is subject to verification and change by audit. Premium Basis Rate Classification:: '— Cod e Estimated Total Per $100 of Estimated Nc Annual Remuneration Remuneration Annual Premium CLERICAL OFFICE EMPLOYEES NOC 8£510 45000. 10. .39 176. LOSS CONSTANT ( $10. IF APPLICABLE ) 186. ESTIMATED STANDARD POLICY �'REMIUM ( I"NCLUDED IN POLICY PREMIUM OF $351 ) 5 MASSACHUSETTS D. I .:a., ASSESSMENT 2 . 60 160. EXPENSE CONSTANT C900 Total Estimated Annual Premium S 35 Minimum Premium S 103 . ( PAGE 1 LAST PA If Indicated here, interim adjust— ments of premium will be made: ❑ semi—Annually ❑ Quarterly ❑ Monthly Deposit Premium S This policy includes these endorsements and schedules: : 2 WC 00601000202 000110 00031 \ 000318 00041 200301 200302 200303 20040 AGENCY NO. 984026 04-2793460 BOS Countersigned t•r J R I ELLY INSAGENCY (Authorised Agent) 43 CHURCH STREET EMBROKE MA 02359 MARKETING OFFICE: N � . RE POOL 93159 DOC 61W C 00 0 CKE•-4266a Ptd. in U.S.A. Copyright 1987 National Council on Compensation Insurance INSURED'S COPY — — -- a?�.,rV i F'.•.'' .'�• .r i y47;: ,' r•:s;56)n .� 'II I' .. s .'C...� 7.•fyyr,,,� s t 5l .{ �y ��K '� � � W y ...q �� ��'"l.+ Y•:�e7 lL lT�.! � � �k'� yY��J �� .ca +� T i;�1��. 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CM. lt J- �?b� t'.�z� �,r� Ck •r� Kh+t'�-s��`r� _h.:J t4�4�r'�Y' ; �.•f.'�.t`�" �-' qe t 5°°s,�],%�k'�—�y��y�a s •,''` y°�� il.��` � p s `��` }, x ,g�C7s e."��"` S..d'Rdv��S,A�,. 4.�^fi"�1.. ,3 >:i•r1d.tM�:��.21t"t'����«�'a74 '`�S•:""� r:.C'�. i.. _,Jan .n v :.a�.5i._ ,l,i t`f3..: �t.4t;.•S�% .u...?:.-,�4�_�+1:1'Y`_�.:�&��9.Ss'e._Y;Ai_.._P.Y'.�� __�9±-1�:_t_ i � a - �:'�� "• _ � fir' ' 'k' � � � i L � 91c p 77 y ->..'} '�� �r.a~f 1. '' t, end r" I<-. !r��k {�� S^ •� �, �a ✓ ,� ' � � • f 3 40 r` . 4 } �, t ukOL di Z t i y 1 .61 - 1 VA � �d i + a` eNo in. ARNSTABLE, MAS Nl�°' ` ��_. 'z : tf PERMIT �e-tq ��3� r ICANT ',ICI!.�• ��:�k:`j' y .�i\Y��,•�, LID, X kF. f3 c�l 1�E ll�+� 020 BEET) (CONTR'S LICENSE) ' ,�t PERMIT TO ;,ui Ld C�We'�.i�."t?' ��;� rl,�"` ' NUMBER OF -7 �, 1 .., ( r<k ,w.3, �3 ..J dWe 1.1 L:1 DWELLING UNITS Z. % (TYPE OF IMPROVEMENT) ',` e: PROPOSED USE) E �y + ApT (LOCATION) _ lot 7i.J 52 1 T ihrtl_iC Barn"L:-,G'L.' - ZONING CT -(NO.) T) BETWEEN AND ' (CROSS STREET) _ (CROSS STREET) y SUBDIVISION LOT LOT BLOCK SIZE BUILDING IS TO BE FT, WIDE BY, FT, LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION * (TYPE) REMARKS: Scwai;e #94-8.1 AREA OR is(J>�)Oi) PERMIT VOLUME ESTIMATED COST FEE (CUBIC/SQUARE FEET) — OWNER l.!itlTtlD:_(r1'e fiuildv-rs, Inc ADDRESS bur, 58 buzzards nay, )A BUILDING DEPT. THIS PERMIT BY ® PERMANENTLY. NVEYS NO RIGHT TO ENCROACHMENTS ON PUBLIC ANY STREET,PROPERTY, NOT ALLEY SPECIFICALLY ERMITTED UNDER LK OR ANY PART TT(HE BOF.UILOiNGECODEM MUST BEAPR PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR I ELECTRICAL, PLUMBING AND . FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE. MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS IRE TO FINAL INSPECTION HAS BEEN MADE, 3. FINAL INSPECTION BEEFORFOREE OCCUPANCY. POS T IS CARD SO IT IS VISISLE FROM STREET BUILDING INSPECTI V PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS AV/- i�­ 3 HEATING INSPECTION APPRO ENGINEERING DEPARTMENT ' S� _c / 4 11D OFFHHEEALTH OTHER J SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL THE INSPEC^�} 'PERMIT.W!LL BECOME NULL AND-VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN 9E TOR HAS APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR dY TELEPHONE OR WRITTEN CONSTRUCTION, PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. YTKF rA•. r iXi tY . 4 APPROVED »- N'OF BARNSTABLE ,:Wire Inspector..- T I �?ol �► N P PRISCILLA AITTANIEMI WETLAND _ N/F ALBERT AITTANIEMI • l O i ' ter•''} ''k' f l CONC. ` FOUND. LOT 2 T.f N/F WILLIAM M. CHASE �o , m o LOT 3 0 43,700 SF 1.0 ACRES 1 �r WAY 0 o ` 70.00' ` i LOT 2 JOB # 93-504 CERTIFIED PL 0 T PLAN !_OCATION MAPLE STREET WEST BARNSTABLE, MA PREPARED FOR: SCALE : 1" = 60' DATE 3-18-94 REFERENCE LOT 3 PB 424 PG 60 MA T TK4Q . LEA CEY I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE � �'� GROUND AS SHOWN HEREON. Cyr / ARN� G :► c cape engineering, inc. CIVIL ENGINEERS LAND SURVEYORS �—Lgl9� ------ RiE. en YARMOUTH, MA. 02675 DATE RE�'gP9(`AND SURVEYOR Application to ��S Q{P,N�sttp N�,S OPt�~pPytH� Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building Addition . ❑ Alteration Indicate type of building: ❑ House §Doldarage ❑ Commercial ❑ Other 2. Exterior Painting: ds;,, ❑ New sign ❑ Existing sign ❑ Repainting existing sign e: 'Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements).. p TYPE OR PRINT LEGIBLY DATI�d 7� /1 ADDRESS OF PROPOSED WORK52 /�'A�C c� 3AiZ►.��h�f e- ASSESSORS MAP NO./`?" OWN EFi/����r'""� M�Keu�A ASSESSORS LOT NO. �Z/ — 3 HOME ADDRESS SZ l�A>c c�S'�- u-). AZ 1,-s-A C e � M� TEL. NO.5� 36 Z `�9�Y FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). AGENT OR CONTRACTOR TEL. NO. ADDRESS DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No. 8, other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). V � D „� UU Signed Owner-Contractor-Agent Space below line for Committee use. Received by . �?y H.D.0 Dav The Certificate 's hereby fQ�/1�av ate 9 eeom le By I� 9 aA Approved ❑ IMPORTANT: If Certificate is,approved, approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION SIDING TYPE COLOR CHIMNEY TYPE COLOR ROOF MATERIAL �� �( �COLOR,'jG4777—: j 4&11d PITCH WINDOW SIZE TRIM COLOR DOORS COLOR ��f��� d� SHUTTERS. 4t o;6 17j54VLOR I GUTTERS DECK GARAGE DOORSQ�?,0L� FOLOR Fj SIGNS F , 7 ,a ��v COLORS FENCE A- COLOR NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the plot plan, landscape plan and elevation plane, when applicable. Site plan should show all structures on the lot to scale. SPECSHT Town of Barnstable *Permit# Expires 6 months rom issue date Regulatory Services Fee ,.PRESS PER17homas F. Geiler,Director Building Division S E P 2 8 2009 . Tom Perry, CBO, Building Commissioner �(1 'TOWN OF BARNSTASLto Main Street,Hyannis,MA 02601 I www.towm.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint (ap/parcel Number nn roperty Address ]Residential Value of Work( C::)OC) (�nMinimum fee of$25.00 for work under$6000.00 )wner's Name&Address } 'ont,actor's.Name �- /}- � Telephone Number fome Improvement Contractor License#(if applicable) c�. \i-k cl 'bnO sor's-License-*-(-kf appiica'bie) y `� -lWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance asurance Company Name Vorkman's Comp.Policy# W L` — —p 'opy of Insurance Compliance Certificate must be on file. ermit Request(check box) %,Re-roof(stripping old shingles) All construction debris will be taken to ,2A S-S-�7,\\& ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of th o Impr ement Contractors License is required. SIGNATURE: i !:Forms:expmtrg .evise061306 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' 600 Washington Street Boston, MA 02111 Q www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: ( �i City/State/Zip: _ t, ,Y „l`!e Phone.#: 13:`S- S- 15't(�C� Are you an employer? Check the appropriate box: Type of project(required): 1.® I am a employer with 4. ❑ I am a general contractor and I � 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors ..2.❑ 1 am a sole proprietor or parer-' listed on the'attached sheet. T. ❑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.x required.] 5. ❑ We are a corporation and its Electrical repairs repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must providt: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: �,. J V Policy#or Self-ins.Lic.M VJ C,k— 3�ls — _!(3 C>\c' Expiration Date: 6 V� '101,[) Job Site Address: ACity/State/Zip: ice, ILA it46 IP Attach a copy of the workers'comp sation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine. of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c under the n es of perjury that the information provided above is true and correct. Si ature: Date: C Phone#: O - — A4 4C. `3 Official use.only. Do not write in this area,to be completed by city or town offu iaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health '2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r 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 of 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 • ii Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and.phone number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided i 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 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 citizen is obtaining a license or permit not related to any business of 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 lice 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 11-22-06 www.mass.g.ov/dia From:Kathy Geddis FaXID:Northwood Insurance Page 2 of 3 Date:9/23/2009 11:37 AM Page:2 of 3 9/4/2C09 11:00:02 AM PST (GMT-8) FROM: insurancevisions.com-TO: 15083932955 Page: 2 of 3 AC<? CERTIFICATE OF LIABILITY INSURANCE r ATE(MM/DDIYYYY) �' / 2009 PRODUCER NORTHWOOD ESHBAUGH INS AGCY INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 540 MAIN STREET SUITE 9 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HYANNIS, MA 02601 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (508)540-1223 INSURERS AFFORDING COVERAGE NAIC# INSURED DEAN F STANLEY BUILDING CONTRACTOR INC INSURERA: LIBERTY MUTUAL 359 CAPT LIJAHS ROAD INSURERB: CENTERVILLE MA 02632 INSURERC: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR TYPE OF INSURANQF POLICY NUMBER DATE 1MMJfDD1YYYYI GENERAL LIABILITY EACH OCCURRENCE $ DA AGE RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ee occurrence $ CLAIMS MADE OCCUR MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Peraccident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY.EA ACCIDENT $ 1 EANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WC1-31 S-374314-019 8/31/2009 8/31l2010 WC STATU- OTH. AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The workers'compensation policy provides coverage only for the state of MA as noted in section 3A of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF BARNSTABLE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 7 DAYS WRITTEN 367 MAIN STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL HYANNIS MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AIITMARI7GR RGO RFCGNTATIVG t OTI. -V/04It/pL092UJCQ.LGIL O�✓I�GQ.QdCLGtl[d2( .�'' Board of Building Regulations and Standards ;I Construction Supervisor License. i . License:CS 35037 Explration;0-,912010 Tr# 12342 r R W W--�r'�(� I 'F�eStflC�tl0�0'r i 4 1 DEAN F STANLEY.' V,Rom' a 359 CAPTAIN LIJAH:RD--- i • � CENTERVILLE,MA 02632 Commissioner � t f fie L/00➢Y�JSlJ02U/E-L a� Standards a 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:l 132149 One Ashburton Place Rm 1301 i Expiration 1--1/28/2010 Tr# 278086 Boston,Ma.02108 ` Widual DEAN F. STANLEY DEAN STANLEY —J10- 359 CAPT.LIJAH RDA=� �°, -tee' Not valid4signa CENTERVILLE,MA 02632 Administrator �= Town*of Barnstable Regulatory Services UAM Thomas F. Geiler,Director fo 59'. Building Division Tom Perry, Building.Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-403 8 Fax: 508-790-6230 I . Property Owner Must Complete and Sign This Section If Using A Builder l C �2 ,as Owner of the subject property hereby authorize �� `Q to act on my behalf, in all matters relative to work authorized by this building permit application for:. (Acldre s of Job) Signat0 er Date Print Name I Q:FORMS:OWNERPERMISSION Town of Barnstable yOp tHE Regulatory Services Tp� Thomas F.Geiler,Director Building Division MRNS ABLE y atwss Tom Perry,Building Commissioner no Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Approved: , Fee: Permit#: 7S HOME OCCUPATION REGISTRATION Date: 2-- Nam e:. 5 \� G Phone#: c-io tJ �)(oz_ 4W 7 Address: SZ M ck_Q St Village: W �V r `u ►/U(, Name of Business: �pe— C& GI� 51 S 0-7 Type of Business: UJ Map/Lot: INTENT: It is the.intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space: • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of.normal residential volumes. - • The use does pot involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. There is no-storage--or.-use of toxic or-hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be me'i.'on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • .There is no commercial vehicles related to the Customary Home Occupation, other than one van or one pickup-tr.uek•nott.o•exceed•one,tort.:capacity,and one trailer not to exceed 20 feet in length and not to _ ... _-- ex=.d 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. . I,the undersigned,have read and agree/with th above restrictions for my home occupation I am registering. Applican /� t Date: YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for.4 years. A Business Certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1st FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and 200 Main Street Offices at the Licensing counter. DATE: -,kl J2j00 Fill in please: >j�� APPLICANT'S YOUR NAME: S}ta.GU M CKP Yyyj "er.IV* BUSINESS YOUR HOME ADDRESS: NA t' ; c`1630140�3 � Q � � � I o � TELEPHONE # Home Telephone Number: NAME OF NEW BUSINESS CIIX COc TYPE OF BUSINESS_ IS THIS A HOME OCCUPATION? YES NO —.T Have you been given approval from the building division? YES) NO �� ADDRESS OF BUSINESS 2, c� �2 VP o _� �'�1V �� MAP/PARCEL NUMBER U When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFIC This individual hasMn ' formed Zany permit requirements that pertain to this type of business. up—Ir— MUST COMPLY g RULES AND REGULATIONS. ITH HOME OCCUPATION uthorized S' natur FAILURE COMMENTS: To I IN ES. 2. BOARD OF HEALTH This individual een i rmed�tthh pq.rrrtit re Auirements that pertain to this type of business. Authorize Signature"* COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature"* COMMENTS: Engineering Dept.(3rd floor) Map Parcel 01 Permit# House# 5a pig Date Issued �— Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) q /���� FA -Pr Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) ���� T0�►�► � ` Definitive Plan Approved by Planning Board 19 BA t6)9# AID TOWN OF BARNSTABLE Building Permit Application Project Street Address P, `-- S-\._ Village 101S Pr rM� TA� pn 1 c Owner be�y A Nr ew \` ��\e..�.�v� Address _ Telephone 3�01.4 — ti 0.co 1-k Permit Request 91.,v �.(`2�2 ZvJ/} y G�y�R C.t -e I� First Floor -- square feet Second Floor Q square feet Construction Type 0 C) .1v-\ Estimated Project Cost $ Zoning District 9 11�_ Flood Plain Water Protection Lot Size,' ��0C) Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's 11 ghway WYes ❑No Basement Type: 5kFull ZLCrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Q Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New (S Half: Existing \ New No. of Bedrooms: Existing 15 New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: `4 Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes (�kNo Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) Sq Attached(size) Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes *No If yes, site plan review# Current Use �JCS Proposed Use UW(f Builder Information Name Telephone Number ���- 3'�(Q Co Address _ License# Home Improvement Contractor# '-1 Worker's Compensation#n NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO t` G U SIGNATURE ZRDATE G't.. at BUILDING PERMIT DENIED FOR THE LL ING REASON(S) 7 r,7, al FOR OFFICIAL USE ONLY h- t a PERMIT NO. � DATE ISSUED MAP/PARCEL NO. Z ADDRESS VILLAGE OWNER 1 DATE,OF INSPECTION: FOUNDATION 3 _l FRAME o INSULATION Q/qUt 4 4,tY 9 FIREPLACE I ELECTRICAL: ROUGH FINAL PLUIv iI NG ROUGH FINAL GAS: µ'af • ,. ROUGH , FINAL FINAL Bql,,' ? NO:. ` DATE CLOSED'•OUT` ASSOCIATION.P;LAN NO. Y �1 The Town of Barnstable anetvsTn U& ' Department of Health Safety and Environmental Services AlEO �A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date r ,I AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT.TO PERMIT APPLICATION MGL,c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work:�)J".0 mliLba(y\ t- y wcost k a,�;_a o Address of Work: Ce\ Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name r +� The Commonwealth of 4fassachusettl ;t;;� Department of Industrial Accidents t /F ' I 011ice of/nyesUgatlons ''' Boston, A1uss. (1211! may.` �`�•. ' Workers' Compensation Insurance Affidavit • Please PRIN'i'le� bly�'"-'�'-' �"'���� ►�p�lican nforntation me• M locition Ce nhone I am a homeowner performing all work myself. CD I am a sole proprietor and have no one working; in an capacity _ r....r5..:....n.....;.+•,.-�.v--'.T.'�'.�^fC!!r�"feP�a?nor.»'�Rs7.75s!�w�c`o'/tfitt??.�_T '. . �' •��' - - - --- `.�'1. ..��..-.�.._ .� L_....a..........::.:1._ __..�-_-..ter..r:.:R1rW.Por.rai —L_-1'.L•-'-:•• - .. .- ..:..._���.MM�� .. .'Mwrylr�••. e C& I am an employer providing workers' compensation for my employees working on this job. om , m• na e• ih'• lic•a O O � — b insnnr�nce o. _ ..,. I am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: com any name: address: cih phone N: incur-incc co polio•a _ - 11'.. ..r�-'f!`..- �T':t..rT�.. .� i-C.�.....�•+1�c�.T�.:•14TT.��ww .fr._. - �� O'Y -t-.Li..�_� com any name: ,address: city. nhone 9- insurance co policy 9 - :Attach addititinal sheet if necessary {.`ry ry _ t.:• nu•�a�� - r —�. •' f +►: liyrii.Lw, �':�Ytrtti•" -�!•Jw:c;.`Zia: V-1ilurc to v secure coerage as rcqui_ rcd under Section 25A of,IN1GL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a da} against me. 1 understand that a copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification. 1 do herehr q rtifi' trdcr t/le p i d pet /ties ojperjun that the information provided above is true and correct. Sienature I( Date "-C � Print name �� Phone �� _ . official use unity do not write in this area to be completed by city or town oRcial city or town: permidliccnse q r-/Building Department [3Liccnsing Hoard check if immediate response is required [:IScicctmcn's Office O11calth Department contact person: phone#: r101hcr (revr.ed 3M5 rnA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' c0mpen,sation for their ploree is defined as every person in the service of another Undc�any emplrn cgs. As quoted f Qom the "law". an c�nr contract of hire, express or implied. oral or written. An etnplurer is dcf►ned as an individual, partnership, association, corporation or other iegal entity, or any two or more c the foregoing enLa�_cd in a joint enterprise, and including the le=al 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 dwclling house of another who employs persons to do maintenance , construction or repair work on such dwelling hous. or oil the grounds or building appurtenant thereto shall not because of such employment be'deemed to be an employer. MGL chapter 152 section '_5 also states that every state or local licensing agency shall vitlihold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for an.' applicant Nvlto has not produced acceptable evidence of compliance with the in coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter lta been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested.' not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation police, please call the Department at the number listed below. ...._.- --..- .-:u,..-. .-... �-.:... ...w.., -s_,--•�.�:.�•.+..+ter.�•� - Ciry or'rowns 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. PleaE be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned tc the Department by mail or FAX unless other arrangements have been made. Tile Office of Investigations would like to thank you in advance for you cooperation and should you have any questions please do not hesitate to give us a call. The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents - Office of Investigations 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 1• .r .a..':•. � •i•��.rl. ��• :?s�Q '.a'r'i1r��t ,{^.' `.5 j' r •�L�,:, '. �.. :r �•.. .y ;j '' l;': iY.,./." ./':'..Is,f' 4�1.• •./y` ..yI':-��e:.,�..il 5!'ai .•l•� •\'!• .,1�. •�1'0'• � f�•� •Q�� '•.'aj•.:.' �,_ 'n�. • i'.t��.. !,:•,r Ij�b�,i:,��a � �4 �' 'ti• � �,VI •. fi:.'•3.�'i i�SY..,�ii.`Z,'�.�' n !'11�Aj ,e. �.'� ��. ��:7. . f•+,.,..'.y'`- .'a(nti:•i.1:r .d:j"i'a.t;rr^.�yr�ia�taah•3:;�.•./,ti3i�•;�:���aya'��iC'S ,I,�.i� .erg le 7���: . i•1' •r e•!r' .i.. ••�3• :�.\• •'i dti. w° -1'' r` - �f. r• ., J.1••pa„.f�'' ..fx` •3, r '�;. �: , c 1 �.y ' ..^i ni' � 4•r1•r;iy Crew .• f.l,i•,4�„�� •AMP � �r�.w p i.. M m �•w � ^a ' no cc 95 'gay`"` •• A N m r CA • i Od w �p rO•,•. 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