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2482 MEETINGHOUSE WAY/RTE 149
o? i UPC 12543 Io. 53LOR ' HASTINGS,Nit l Town of Barnstable • as" r� w Building e t Post Ttiis:Card So That it is Vis1ble'From'the Street `A roved`Plans Must be Retained on Joli'and this:CadJMusf be Ke t °' "� t. 4�sa* pp 5 s�,ie ' P �z Permit Posted Until Final lns ection Has'Been�Ma ., tR . < Where a Certificate of.,Occupancy�s Required;such Building shall Nof;be Occup1ed until a:Finalanspection has been,made , Permit No. B-17-964 Applicant Name: MICHAEL MCCARTHY Approvals Date Issued: 04/10/2017 Current Use: Structure Permit Type: Building Insulation-Residential Expiration Date: 10/10/2017 Foundation: Location: 2482 MEETINGHOUSE WAY/RTE 149,WEST. Map/Lot: 155-026 Zoning District: WBVBD Sheathing: b Y.c -T A a n - 77" Owner on Record: PACHECO,DOUGLAS Aa; to °$ , t Contractor,Name: MICHAEL MCCARTHY Framing: 1 Address: PO BOX 472 � � �� "Contractor Licenser 169393 2 PAO WEST BARNSTABLE, MA 02668 r Est Project Cost: $0.00 Chimney: s ., rs' Description: Weatherizations "P.ermit Fee: $85.00 Insulation: ,a x�. L Project Review Req: Weatherization AFee Paid: $85.00 f ' = Final: � �^ �• _ Date: 4/10/2017 rc e v Plumbing/Gas -` Rough Plumbing: a "`` . s ° �"EI'Idin Official _ g Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months-after issuance. a� t :- . Rough Gas: All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. . - ..,.-«---•-� Electrical The Certificate of Occupancy will not be issued until all applicable signatures by,the Building and Fire Officials'are provided on this'permit. Service: Minimum of Five Call Inspections Required for All Construction Work: x '• `- . r' 1.Foundation or Footing Rough: 2.Sheathing Inspection w 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 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage 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 Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 4lassachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-058633 Construction Supervisor MICHAEL J MCCARTHY ". �. _ P.O.BOX 52 WEST DENNIS MA 02670 _ r1 Expiration: Commissioner 0 4/1 012 0 1 8 67 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massackhusetts 02116 Home Improvement Contfactor Registration . .. Registration: 169393 Type: Individual Expiration: 6/16/2017 Tr# 264961 MICHAEL MCCARTHY MICHAEL MCCARTHY P.O. BOX 52 -..... _._... - - ------ WEST DENNIS, MA 02670 Update Address and return card.Mark reason for change. 1 SCA 1 20M-OS/1 7 Address D Renewal �i Employment Lost Card ••= /<Lx If:[9LYO/YP/%(lCCL(��[�^��ZGJJGC�IkiClf 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:.-'169393 Type: Office of Consumer Affairs and Business Regulation �''` 10 Park Plaza-Suite 5170 Expiration: ;6%1'M.- Individual Boston,MA 02116 MICHAEL MCCARTHY MICHAEL MCCARTHY __�-- 6 RANGLEY LN. SOUTH DENNIS, MA 02660 Undersecretary ` • Y Not id with)tsignture The CorHfi nweaM of Masswiin a Depoftent of 1ndus&&144ccider* I Congress S 4 Spite 100 Dos%MA 02114.2017 IFwwamample/dia Workers'Compensation Insurance Affidavit:Bui Conbwtors/Elech idamMiumbers. TO BE FILED WITH THE PERiV=MG AUTHORtflf. on Please Print Name Musbmworpaization/Iwividual): Address: Q G. tsar 5,z City/tStall MP: 1 c>.)- On-.., o1(7t-Phone#: 52t Aro yos an Reek the priate bow, Type of I�i�(regui�: 1,E(14am a emr�loyar with employcos(tidl and/or pert-sane),• 7. ❑1Vtav consttuctitm 2.[3 I am a role propriamror parermmp aw trove no employees waddng for ma in g, 13 Rensodeling array .cwdty.INo workers' cow insurance quirad.] ,' 301 am a ham otrner defog all work mysol£No wodams'comp,barance required.]t 9. ❑Demolition 4.[31 am a homeowner and will be hiring contractors to conduct all work on my property. twill 10 Building addition amaze tort Ali contraarars other have workers'compensation ie9urance or are sole 11.o Blectrical mpairs or additions ampnetc;with no employees' 12.r]Plumbing repairs or additions 3.3 I am a gaoerai contractor and I have hired the listud on the attached sheet. M Roof to rs 'Theis sub-aowaaton have employees and have woritsrs'comp.lmusesoO � � 6.[j We am acorporation and its officers have wrdsed thef d&of esemption per HOL G 14.[]Other 152.6 KQ,and we have no employees.(No wodcrre comp.imansce required.] *Any appliccot that cbWm boa#1 must also fill out the section belaw showing their workers'compereation trolley ida oration. Homp mem who submit this dMvit iodicetiag they are MM all wodc and than hire outside contractors mast mbaut anew affidavit indicating such. t a ttdcmma dmet check Ws box must amebed an additional sheet showing the name of the sub-cwrtraatoms and state whether or notdnn.eatitim have empbyea ifthesub s haveemployees,they mmist p wAdo thcfr mockers'comp.po&y mzmber. l am anemployer&w isp vving wodters'comp on k swuncefor my employees. Bdowistheponcy andjob site htl6� . Insurance Company Name: 14., c•.9 1'�Yc 1.,y. R Pa-co oe Selz=ins.Lie.#-. J 5 G7%I 7'S'7 V Expiration Date. )e , - t Job Site Address: CitylStatdzip: Attaeb a copy of themor leers'compensation-policy declaration page(showing the pofici number ad expiration date). Fatal=to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year bVdsonmm%as well as eitn')penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this stateant may be tbrwarded to the Office of Investigations of the DIA for iffimmm coverage verification. I do hereby ender Ades ofpwjary t9id Me h ormaden pwvlded dare k titre and c�orrea 0 Zt S' Date: .- t rs k> f c.-t: OfflW are onfye Do not w lee In this area,to be completed by dly or dolor twaL City or Town: Permit/License# IMIng"thor k(circle one): L Bosrd of"Health Z.Building Department 3.CitytTown Clerk 4.Electrical inspector S.Plumbing Inspector ti:Other Contact Person: Phone#: c• MCCART9 OP ID:KS CERTIFICATE OF LIABILITY INSURANCE D TEPN 1212o/201 Y1r) 2/22o1s 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(les) 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 the certificate holder In lieu of such endorsements. PRODUCER NAOM'fEr ACT Dennis Office Bryden&Sullivan Ins Agency PHONE Fax of Dennis Inc. .508-398-6060 ac No):508-394-2267 485 Route 134,PO Box 1497 E-MAIL So.Dennis,MA 02660 ADDRESS: Dennis Office INSURERS AFFORDING COVERAGE NAIC 0 INSURER A:National Liability&Fire Ins INSURED Michael McCarthy INSURERS: Construction Inc PO BOX 52 INSURER C West Dennis,MA 02670 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. INSR TYPE ADD SUB POLICY EFF POLICYEXP LIMBS LTR POLICYNUMBER MMIDD MMIDD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE:TO RFNTE15 CLANS-MADE 1-1 OCCURPREMISES(Ea occurrence) $ MED EXP(Anyone person) $ PERSONAL&ACV INJURY $ GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITYCOM EaaccidentBWED SINGLE LIMITLIABILITY $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) b HIRED AUTOS NON-OWNED PROPERTY D GE $ AUTOS (Per accident) $ UMBRELLALLAB HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DIED I I RETENTION$ $ WORKERS COMPENSATION X ST TUTS ER AND EMPLOYERS'LIABUM A ANYPROPRIETOR/PARTNEJEJECUTIVE YIN V9WC747574 12/15/2016 12/15/2017 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? Y❑ N I A (Myaensdatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00 DESCRcribe under IPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Michael McCarthy has Opted to Exclude himself for Workers Compensation benefits. CERTIFICATE HOLDER CANCELLATION CAPELIG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXP9tATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. Box 427 AUTHORIZEDREPRESENTATIVE Barnstable,MA 02630 1�fi""""t! U` � " " _ r z) ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD -� Jb - z� e � T � Town of Barnstable Regulatory SerAces BAR�STABt$ � Buss 8+ kkhard V.Seat,Directns �FO�AO�Q ffid1ding Division Torn Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable_ma.us Office: 508-862-4038 Fax: 508-790.-6230 Property Owner Must Complete ax d Signs This Section. If Usin .A_Builder Chz er o_:as m f ..�. ..-., . die.SuhJect property hereby aurhoave to Set on niybehA in.aU matters relatim to work authorized by this boding permit application for: _ 0 - Ass=of ,d Pool fences and alarms are the responsibilit),of the applicant. Pnols are not.to be.filied or utiLed'before fence iS installed and: all fi.nJa inspections are-performed and accepted. Si'�dtuiekf Owner Signature of.A.ppikant " Print Name - Pnnc Name Date Q:FOntS:0WNI..EgFER1.t75S ION PWLS � - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel TOWN OF BARNSTABLE Application # Health Division �ni? } _ D�� 1�: �,� Date Issued d Y io i7 lP/K L•-'t f Conservation Division Application Fee �5 ,00 Planning Dept. Permit Fee 9 " ` 11t�v1 N Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address `ff�� „� ���. c l.✓�„ Village � �� ��l•.�k't,,. Owner ®�� P�`�c�� Address S'�"'v� C Telephone 5M —7)3—CCi 3 i Permit Request `T Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: 0 Yes ❑ No On Old King's Highway: ❑Yes 0 No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil 0 Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded 0 Commercial ❑Yes 0 No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Mike McCarthy Construction Address PO Box 52 License# West Dennis, MA 02670 Cell (508) 280-6964 Home Improvement Contractor# CSL-58633 HIC-169393 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION #. DATE ISSUED r MAP/ PARCEL NO. ADDRESS _ VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME s INSULATION FIREPLACE k ELECTRICAL: ROUGH FINAL 1' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL W FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. I ►�� .1MCCARTHY ='1CQ§FRUCTION CO. ' , idtial and Commercial Builder f ,i TGY.EA7�4IZATION SPECIALIST K 10 MCCARTH� October 21, 2014 Town of Barnstable Thomas Perry CBO d Building Commissioner ~-1 200 Main Stret % Hyannis, MA 02601 . N) 0 RE: Insulation Permits Dear Mr. Perry, c5 � rrs This affidavit is to certify that all work completed for permit application#0 at 24822 MEEYINGHOUSE WAY/RTE 149 has been inspected by a certified Building Performance Institute(BPI) inspector.All work performed meets or exceed Federal and State requirements Sincerely, Michael McCarthy McCarthy Construction - I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map v-, Parcel Application Health Division Date Issued l O Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �v Historic - OKH _ Preservation / Hyannis Project Street Address oZ A Village Owner 2 Address Telephone / /� Permit Request 1 6S rcl UJQr/k c-z),t , Ie Square feet:.1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation - Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing n:& Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room C,ounP Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No_ Fireplaces: Existing New Existing wood/�oal stove:) ❑Yes ❑ No co Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name - pai/65 aj" Telephone Number Address License # Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE lJ l t" FOR OFFICIAL USE ONLY /APPLICATION# DATE ISSUED MAP/PARCEL N0: ' ADDRESS VILLAGE r OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION :3 FIREPLACE '.: ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL -� GAS:. ROUGH FINAL FINAL BUILDING. DAT&CLOSED OUT AS4.SOCIATION PLAN NO`= r Hw Cor woyrnenh t of Massachusetts Deparhnent of lirdusti-hd Accidents office vfAMWsagations 600 Washington Street $ostorj,M,4 02- I wmv.rrrasmgorrfdia Warlcers' Compensation Insurauce Affidavit:Builders/CantractursMecfricians/Plumbers Applican t Infarmation Please Print ,'b . Name(Easiness Ownha ionlf ffnidaq_ al-141Z� 9L�� �dtlress: City/StatrJZip- Phone g7 Are yan an employer?Checktlte appropriate box: T of of ect (r _.— _ 4. ❑ I are a general contractor and I-- - }� PT' ] �-e'ri��= l._❑ I am a employer with 6_ ❑New conshxtiou employees(full anc%r part-tithe)* have hired the sub�contracfors. 2.❑ lam a sole proprietor or partner- listed on the attached sheet 7. ❑Rem odeling ship and have no employees These mb-oontractors have g_ ❑Demolitioa w for mein an c ci employees and have workers' ork�ng Y � t5 9_ ❑Building addition [No'w-orkers' comp:ina�tranre comp_mcnranc t 5_❑ We are a corpotaticnand its lf?_❑Electrical repairs or additions 3_ am a htsmeau her doing all wow officers have exercised their 11-0 Plumbing repairs or additions myself [No worker s'cxmip- right-15 of 1(4 pa d per MGL 12-❑Roof repairs ssuuance required]l c_152,§1(4},and we baste no employees-[No workers' 13-❑Other, comp-insurance required.] *may apphcmt that checks boa 41 rmst also fM out the section bekwshnvdng ffi&wnxkers'mmpensadonpoHU infacmadiaai #Snmeowness vrho submit this affidavif�* '�QTMn g tt„ey aSe fining alI Rorfc and(hen hag oaztside coulxactnrs rnDSt submit a nets affidavit indices ins sacb— t0ouucsctors that chrrk this box mint sttaclred an additional sheet dwwbg the name of fire sub-rn sand state whether ocnot those uatities have employees- If the sob-contma'ars bn%-empIoyees,they mast provide their workers,comp.policy number. lam an employer that isptmdding it orkers'conTensahbn inrrirvutca for my e.mpinyees: Belau is thepoticy and job file information_ Insurance Company-Name: Policy 9 or Self-ins-Uc- Expiration Date: Job Site Address: CityrStatelZtp: Attach at copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secare coverage as reg6redunder Section 25A o€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 to$250_t}0 a.day against the violator_ Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA far insurance coverage verffication_ I do hereby rc the s a penatlies ofperjtuy thatthe information protided aba'e iss pw-a and correct Date l') IIV Phone#: ©aZ al use only. Da not write in this area,to be completed by citJ or town official City or Town.- PernzitUcense# Fcsuing Authority(circle one): 1.Board of IleaIth 2.Binding Department I City T'own Clerk 4.EIedrical Inspector S.Plumbing Impector 6.Other 11 Contact Person: Phone 9: 6 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 shalt withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth,`.or 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 employees, a policy is required_ Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confrznation of insurance coverage. Also be sure to sign and date the affidavit. 1'lre afa-davrit 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. Sell 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 pennit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Depart moat of Industrial Accidents Office of kvestigatio-us 6-00 Wac_hingut-aa Street Boston,MA 02111 Tel.it 617-727-4900 w4Q6 or I-877-MASSAFE Revised 4-24-07 Fax# 617-727-7 749 7iww.aass govldia I Town of Barnstable Regulatory Services P�oFIKE Tgcyti Richard V.Scali,Director Building Division * STD Tom Perry,Building Commissioner ALAS. 9� 1639- ��� 200 Main Street, Hyannis,MA 02601 ArEOy a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: (d ` Please Print _ �J' `,�, JOB LOCATION: b �/S L 1_34 /A rl er street village ••HOMEOWNER": �� name hoe phone#m v�4. 41c, work phone# CURRENT MAILING ADDRESS: a� city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The dersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection prod es and r uir e is at he/she will comply with said procedures and requirements. Sign re of eowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities, many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 i w swxNsr"r.E. 9$ '� ,0� Town of Barnstable ATFo�y a Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Ow er Must Complete and S' n This Section If Usin A Builder I, , as Owner of the subject property hereby authorize z to act on my behalf, in all matters relative to work autho ed by this building permit application for: (Address of Job) Signature of Owne Date Print Name If Property wner is applying for permit,please complete the Homeowners License Exemption Form on the reverse si e. Q:\WPFILES\FORMS\building permit forms EXPRESS.doc Revised 061313 ��: :� -�-� .�: �w �, _- . ;� { - - � ; _ �_ - _ .� � _ ,,.. _ _ i t j , - - '�� - i a _ � _ — `,� . I f � _ i � Y ., _ _ _ ,.,_._ r r.. � ,_ �� - - � - '-�,. �'�_ . ........ ........ WON �� �. 4: ,� � ._�;ti �� I — � , ,r= �. _ �♦ e�; _ ,;,�:,. .:, 'i:�; �.�; �, ���:� .. -- g_., _ �:� _r „ -� � - �. �. �. .— v _ �4� a ... �, } � r; Parcel Detail Page 1 of 6 ig IHt a eJle P A CL Z tZ z"4" mod. . } �.; Logged In As: Parcel Detail Monday,June 9 2014 Parcel Lookup Parcel Info Parcel ID 155-026 I Developer Lot Location 2482 MEETINGHOUSE WAY/RTE 149 I Pri Frontage 210 Sec Road I Sec Frontage village WEST BARNSTABLE I Fire District W BARNSTABLE Town sewer exists at this address No I Road Index 1013 Asbuilt Septic Scan: Interactive �� t 155026_1 Map Owner Info owner PACHECO, DOUGLAS A I Co-Owner Streets PO BOX 472 I Street2 City WEST BARNSTABLE I State MA zip 02668 Country Land Info Acres 0.86 I use Single Fam MDL-01 I Zoning WBVBD I Nghbd 0105 Topography Level I Road Paved Utilities Gas,Well,Septic I Location Construction Info Building 1 of 2 Year Roof Ext UAWFOSI1.017J Built 1850 Struct Gable/Hip I Wall Wood Shingle I BMTj763j Roof AC 14 is Living Area 2418 I Cover Asph/F GIs/Cmp I Type s None I 1�T°16 BOAS. t6 Style Conventional Int I wall Plastered I Rooms 4 Bedrooms I is is Model Residential I Int Pine/Soft Wood I Bath 2 Full+ 1 H Floor Rooms ©As . �As Heat Total 1r' 4 Grade Average I Type Hot Air I Rooms 8 Rooms I ��_ TIP is Stories 2.2 Heat I Fuel oil I Found- Brick Wallsation I Gross 3934 Area Building 2 of 2 Year 1920 I Roof Gable/Hip I Ext Wood Shingle Built Struct Wall http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=10386 6/9/2014 f Parcel Detail Page 2 of 6 Living 1801 I Roof A Type sph/F GIs/Cmp I AC Area Cover None I AT 920j nt Be Style Store I wall Drywall I Rooms 01 I Model Commercial I Floor Int Pine/Soft Wood I Rooms Bath 0 Full 5 Grade Below Average I Total Type None I Rooms stories 1.3 I Heat None I Found- Stone Walls I Fuel ation :F Gross 2886 I Area Permit History Issue Date Purpose Permit# Amount Insp Date Comments 11/14/2013 Insulation 201308292 $1,500 6/30/2014 INSULATE 12:00:00 AM 4/1/2014 RENO-GUT KIT CONVERT TO 7/5/2013 Remodel 201303660 $10,000 12:00:00 AM BTH 1ST FLR-REROOF HSE,BARN,SHOP 4/1/1993 Addition B35797 $3,400 1/15/1994 WB ALTER. 12:00:00 AM 6/1/1989 Demolish B33007 $0 1/15/1990 WB PORTIO 12:00:00 AM - Visit History Date Who Purpose 4/15/2014 12:00:00 AM Mike White Bldg Permit Completed 1/31/2008 12:00:00 AM Paul Talbot Cyclical Inspection 6/8/2007 12:00:00 AM Jeannette Kirwan In Office Review 6/7/2007 12:00:00 AM Sheila Fowler In Office Review 5/4/2007 12:00:00 AM Kathy Perry In Office Review 1/7/2004 12:00:00 AM Andrew Machado Meas/Listed-Interior Access 3/16/2000 12:00:00 AM Paul Talbot Meas/Listed-Interior Access - Sales History Line Sale Date Owner Book/Page Sale Price 1 5/13/2013 PACHECO, DOUGLAS A 27370/224 $210,000 2 4/7/2009 MOORE, SALLIE L 19700/098 $0 3 8/15/1960 MOORE, SALLIE L& KAURANEN, EDITH E 1088/172 $0 - Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2014 $210,500 $23,200 $2,900 $122,300 $358,900 2 2013 $228,200 $23,200 $3,300 $122,300 $377,000 3 2012 $221,800 $22,400 $3,100 $122,300 $369,600 4 2011 $272,300 $0 $2,900 $122,300 $397,500 5 2010 $271,800 $0 $3,400 $122,300 $397,500 6 2009 $277,100 $0 $2,700 $160,100 $439,900 7 2008 $250,900 $0 $8,400 $166,900 $426,200 http://issgl2/intranet/propdata/PareelDetail.aspx?ID=10386 6/9/2014 Parcel Detail Page 3 of 6 9 2007 $250,500 $0 $8,400 $166,900 $425,800 10 2006 $223,100 $0 $8,400 $181,300 $412,800 11 2005 $229,200 $0 $8,400 $164,900 $402,500 12 2004 $244,400 $0 $8,400 $281,600 $534,400 13 2003 $207,200 $0 $8,400 $55,800 $271,400 14 2002 $207,200 $0 $8,400 $55,800 $271,400 15 2001 $207,200 $0 $8,400 $55,800 $271,400 16 2000 $142,400 $0 $2,100 $38,200 $182,700 17 1999 $142,400 $0 $2,100 $38,200 $182,700 18 1998 $142,400 $0 $2,100 $38,200 $182,700 19 1997 $125,500 $0 $0 $27,800 $156,900 20 1996 $125,500 $0 $0 $27,800 $156,900 21 1995 $125,500 $0 $0 $27,800 $156,900 22 1994 $134,900 $0 $0 $50,200 $187,900 23 1993 $134,900 $0 $0 $50,200 $187,900 24 1992 $153,200 $0 $0 $55,700 $212,100 25 1991 $159,300 $0 $0 $80,100 $243,900 26 1990 $159,300 $0 $0 $80,100 $245,900 27 1989 $159,300 $0 $0 $80,100 $245,900 28 1988 $123,700 $0 $0 $51,800 $181,600 29 1987 $123,700 $0 $0 $51,800 $181,600 30 1 1986 1 $135,700 $0 $0 $51,8001 $193,600 Photos � r In ® 1 k f ,1 Y'• S. / F http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=l 0386 6/9/2014 •� � q M} A F_ S �1 €:Ais F r Vi I. 13U ix T. 4 30I�FL xc v: q OF 1S CA ! 1 r x, 121361203' z per.. w". ,. ovsinooe Y V } lit, ',110 4 t a' M KKKK5i45'iii ' O8/051'2Q13 i g i0 =b, ;Z..-M 4 �• ,f it • t �r 0!!3fl2008 - 03/1012009 ilk 1� t# s k - `� ' ,' � .+fib � _`. .k'..°•, ,�y.,.,Y. +7 i 4 a 1 Parcel Detail Page 6 of 6 ilk xv all � l �R i x� rti . o http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=103 86 6/9/2014 i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel v T Application Health Division Date Issued J Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village �-1c��- .,,�b Owner —N Address 5. Telephone tea) 733 ( 3 Permit Request _ 7 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation /S G` Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full e'Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area Number of Baths: Full: existing new Half: existing ew cs' Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room CountUn e" Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other rn Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing Cl new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Mike McCarthy.Construction Telephone Number j West-Qolmg9,�V A A'()70 Address License # CSL=58633 HIC-,1693`93 Home Improvement Contractor# oWorker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE 1.01;113 s FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. 'Z ADDRESS VILLAGE OWNER < m f. o DATE OF INSPECTION: Hv3 j6FOUNDAT.ION+u �t t� y�rrt+isarat��neu,« g t . FRAME .. .. .� INSULATION.;,_s: FIREPLACE ELECTRICAL: ROUGH FINAL tl 1 PLUMBING: ROUGH FINAL 5 GAS: ROUGH FINAL FINAL BUILDING? DATE CLOSED OUT _ t` ASSOCIATION"PLAN NO. ?lie Conlmonnealth of Massac tusetts f Department of Indruirial accidents office of Investigations 600 Washington Street Boston,MA 02111 wnnv.irrass.govvldia dersJCo acfnrs Iectr ebrs Wokers' Compensafinn Insurance Affdavit:Bn 'Please PrintTP. ''caul Ynfoamattion e a y - o - Name aL6ines�slOtganiz hm%a&%d=I) 52 West Dennis,,MA.02670 Address: CSL-58 e3 #RIC-169393 City/State/Zip- Type of project(requhvd): Are you an employer?Check the sppropriate boa: general tractor and I �. ❑ I am a g (_ ❑New construction 1.❑ I am a employer with have hired the sub-contractors ogees(full and/or part-time).* 7- ❑Remodeling listed on the attached sheet 2. am a sole proprietor or partner These sob-contractors have 8. ❑Demolition ship and have no employees employees and have wodaffs' 9_ ❑Building addition working for me in any capacntY. comp.insmaac-I 10_❑Elechical repairs or additions [Na Workers'come.insurance . 5. ❑ �je are a corporation and its airs or ad"Ms required-] officers have exercised their 11_.❑Plumbing reP 3.❑ I am a homeowner doing all work right.of exemption per MGL 12_❑goof repairs myself[No workers'c mP. c_152,§1(4),and we have no 13.1 insurance required.]I employees.[No w°rke�-] comp-insurance re4 •Arty app]vcant that checks box�l mmsi also fill out the sectioabelow sl o g tbetr workers'compensation policy information. <mch- arE doing vn wmk Rnd then hire outside contractors mast submit a mesa affidasit iadicaas i Homeowners who submit this off davit i&�g�Y m�of ibe sub-canuutOrs�stare whether m not tbose en"ias have tContractors thst chga this boot must attached an additional sheet showing number. th ,must provide their workers'comp.policy employees. If the suh-�coatsactors Lase emp l ogees, F3` � I am art ettiployer ilratis providing vt�orkers'conzpertsation insurance f or itt1 r envPw ees. BeIotr is illspa�j and'ob site information. Insurance Company Name: Fxpiratian Date: Policy;,�or Self-ins-.Lic.#: n 11 city/StatelZip: �5 �. S h Job Site Address: r-%-- u-ation date). cl Attach a copy of the workers'compensation policy dearation page(showing.the pobcy nnraber atom ezp Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition Of csinvinal penalties of a soffit,as well as civil penalties in the frnm of a STOP WORH ORDER and a fine fine up to S 1,500.00 and/or one-year imgri be fnrwarded to the Office of of up to$250.00 a day against the violator. Be advised that a copy of this statement may -- Investigations of the DIA for insurance coverage verfration ----- _- .. - trbtrue is hue an corre I do ftereby c ttd ....he is andpenaUies ofperjury Mat the inforstatim,pr Date. Il �17 Si tune: Phone#: Oficial use ottt3% Do itot write in t)tis area,to big earnpleted by city or tmm o,�jicifiL permit/lAcense# City or Town. Issuing Authority{circle one): ector S.Plumbing Inspector 1.Board of�tdth 2.BRnr"ding DePaT1z°ent 3.CitFfFown Clerk 4.Electrical Insp 6.Other p}tane#- 6 Contact Person- (�/e$2LW) gZ09UuealG�o1QAcadccc/uae6& License or registration valid for individul use only Office of Consumer Affairs&Business Regulation . OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 169393 Type: Office of Consumer Affairs and Business Regulation xpiration::_,6/16%201.5a Individual 10 Park Plaza-Suite 5170 - _ Boston,MA 02116 MICHAEL MCCARTHY- -==3!" MICHAEL MCCARTHY} '-.=.-r 6 RANGLEY LN. SOUTH DENNIS, MA 02660= " - Undersecretary Not valid without signature �} Massachusetts -Department of Public Safety , Board of B 'wilding Regulations and Standards Construction Supervisor License: CS-058633 ` MICHAEL J McCARTHY i I PO BOX 52 W DENNIS 1flA 02670 Commissioner Expiration 04/10/2014 ' a , I 1733- Pacheco, 14....Pdf(19.4 KB) OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at ( roperty Address) (Property Address) hereby authorize. AJ C C.,V G Q (Subcontractor) an authorized subcontractor for RISE Engineering,to on my behalf to obtain a building permit and to perform work on my property. Owner's'Signore Date f D CECC 0MC SEP - 6 2013 IL TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Parcel ®c� — A —lication # P PP Health Division Date Issued s•.. Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH ✓ Preservation / Hyannis Project Street Address a nas Ovut�ft Village Y`1� Owner Address Telephone Permit Request OJ 9v- t9 vJ� tge',f: Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation IQ Construction Type v w C Lot Size Grandfathered: ❑Yes ❑ No If yes, attach Ir pporting d�curntation. Dwelling Type: Single Family ® Two Family ❑ Multi-Family (# units) Q w Age of Existing Structure p g g � Historic House: �Yes ❑ No On Old King's ighway Ye�s,� No. Basement Type: ❑ Full —f'Crawl ❑Walkout ❑ Other co Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) °- Number of Baths: Full: existing to 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: P Gas )I Oil ❑ Electric ❑ Other Central Air: ❑ Yes 0 No Fireplaces: Existing Q New Existing wood/coal stove: V1 Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: 01 existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) ��s 3 a � Name Telephone Number !� Address License # we Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 5 XY11 z FOR OFFICIAL USE ONLY i APPLICATION# DATE ISSUED MAP/PARCEL NO. i t -,ADDRESS ` t VILLAGE y. OWNER 4. DATE OF INSPECTION: ��:FOUNDATION _ • C FRAME ,QFiQ ew Og INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL f PLUMBING: ROUGH FINAL GAS: ROUGH i FINAL � r r ` FINAL BUILDING ?F/ 0�3 / DATE CLOSED OUT ASSOCIATION PLAN NO.,"`- I = The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations i 600 Washington.street Boston,MA. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Blinders/Contractors/Electricians/Plumbers A licant Information Please Print Legibly Name (Business/OrganiiadondndMdual): Address: city/state/zip: 19 one#: �� Are you an employer? Check the appropriate boa 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.❑ 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. .10. Electrical airs or additions required] 5. ❑ We are a corporation and its ❑ repairs 3. I am a homeowner doing all work officers have exercised their l 1.❑ Plumbing repairs or additions myself. No workers' comp, right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no : . employees. [No workers' 13.❑ Other . comp.insurance required.] *Any applicant that checks box#1•.must also fiIl 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. xConhmctors 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 run an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: .Policy#or Self ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Faalure 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 violatot. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the Da for insurance coverage verification. I do hereby_ u filer p and penalties of perjury that the informadon provided above is true and correct .Si azure: Date: Phone#: Official use only. Do not write in this area to be completed by city or town official City or Town: PermittlLicense# 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: w- Phone-#: Information and .Instructions - Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pummt'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 th three apartments and who resides therein,or the occupant of the an dwelling house of another who employs persons to do maintenance, construction or repair work oa 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`shail withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any I ce of compliance with the insurance.coverage required." applicant who has not produced acceptable eviden 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 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 enterthai.r self-insurance license number on the appropriate he. 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 BE 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 relaxed 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 sfbuld you have any questions; please do not hesitate to give us a call : The Department's address,telephone and faX number: The Commanwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street Baston, MA 021-11 Tel, #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 .evised 4-24-07 www.mass.gov/dia Town of Barnstable �THPT� Regulatory Services F ReR7tCrARrR Thomas F. Geiler,Director 59. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us a Office: 508-862-4038 Fax:•508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 4h / JOB LOCATION: Q -- z aa�rz�,L2�,e . U, Z&7 her strut village "HOMBOwNER": G — l ✓ �/�� 3 �(o/ 3 N name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The ctreat exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFIIQITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such - "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building'Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department m;n;rrnrm inspection procedures and requirements and that he/she will comply with said procedures and re men Signatu 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 perfam¢ng'work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,gnat 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 hisRner responsibilities,marry communities require,as part of the pemut 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.amrnd and adopt such a forin/certification.for use in your community. Q:foms:homeexerript Town of Barnstable 7 Regulatory Services r SABNSZ'ABLS, � nines. Thomas F. Geiler,Director 10� Building Division '°lED MIC(k Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.towiLbarnstable-ma.us Office: 508-862-4038 Fax 508-790-6230 Property Owner Must' Complete and-Sign'This,Section, If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date QFORMS:07NERPERMESIONPOOL4 62012 I 14' �+ Kitchen A N 21' � to 26. in 26' a� Bedroom in Bath fOtchen Dining Bedroom Bath Bedroom N N Family N Q C_ in in a�' J o—+ 19' s�—a 9' r� O —47 Living Foyer Enclosed Porch Bedroom V � C!9 3' 13' 28' 00 M � rn TOTAL Sketch by a m mxk,hx. Area Calculations Summary Living Area Calculatlori Defalis First Floor 1379 Sq ft 14 x 24 = 336 0.5 x 0.5 x 2 = 0.5 0.5x2x0.5 = 0.5 6 x 2 = 12 28.5 x 23 = 655.5 19 x 15.5 = 294.5 5 x 16 = 80 Second Floor 1197.5 Sq ft 20.5 x 19 = 389.5 28 x 28.5 = 798 j 2 x 5 = 10 Total Living Area(Rounded): 2577 Sq ft 14' N Ktchen A N pre p LY 21' c r0e `n c 26' vi 26' a Bedroom in Bath 0 Dining N Bedroom Bath N Bedroom N Family N 90 m in in 19' 19, Living Foyer Endosed Parch Bedroom ~ 3' 13, 28, 6' 0 o O < w `E f C r- O M. 1 -Tt W � 00 t= =AMeIch a'"m mode."x Area Calculations Summar y Living Area Calculation Details First Floor 1379 Sq ft 14 x 24 = 336 0.5x0.5x2 = 0.5 0.5x2x0.5 = 0.5 6x2 = 12 28.5 x 23 =655.5 19 x 15,5 = 294.5 5 x 16 = 80 Second Floor 1197.5 Sq ft 20.5 x 19 = 389.5 28 x 28.5 = 798 2 x 5 = 10 Total Living Area(Rounded): 2S77 Sq ft Barnstable Old Kings.Highway Historic District Committee 1 200 Main Street,Hyannis,MA 02601,TEL: 508-862-4787 Fax 508-862-4784 KAM z 9. 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: ❑ New ❑ Addition Rg Alteration 2. Type of Building: House 56 Garage/barn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting roof ❑ new roof 10 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 /3 1 1 NOTE AH appGcafions must be signed by the cumew owner Owner(print): =�. � ti�fji�s�i�i l Telephone#: 1 Address of Proposed Work r7�JS� Village Y'V1 Map Lot# �� Q Mailing Address(if different) 9,-! Owner's Signature Description of Proposed Work Give particulars of work to be done:;;-�►J 1 � i i y� ' ? � , r-4-i lJ. JJ]] , fd, �.,� �A d tt � ✓ r iiw Ue%d �Gi.j�`i � � J � T � 5✓� faddl/ L ti� yr�/tl V101AQ 4- 1�1> C� ,.�.,`- , ;► ��� o 4'e- r; `mot s,1"-r �&r,, F is Agent or Contractor(print): .cam . .�, >,� Telephone#: Address: Contractor/Agent'signature: For committee use only. This Certificate is hereby APPROVED/DENIED Date 5C Members signatures RECEIVED JUN 0A Z013 GROWTH MANAGEMENT V� �O i 1�N sra�`e I N`g,���,ay Ii o� Q.IBoarols and Commissions101d Kings HighwaylOKHAppliaationslOKH2011 CxMji o doc 1 I r CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 5 copies Foundation Type: (Max. 12"exposed)(material=brick/,cement,other) 4,Siding Type: Clapboard 41/ shingle V other , I Material: red cedar j- white cedar other Color. ✓- .vrd Chimney Material: Cv'? Color. !A of yyj- Roof Material: (make&style) 5 AalT rm!'s� ' � Color. Roof Pitch(s): (7/12 minimum) 14 U L-f (specify on plans for new buildings, major additions) a Window and door trim material: wood V// other material,specify Size of cornerboards size of casings(1 X 4 min.) color W�i1 1 � Rakes Ist member I 0'—� Vd member t Depth of overhang 1 J" Window: (make/model) material color (Provide window schedule on plan for new g(P p f buildings, major additions) Window grills(please check all that apply_: tine divided lights_ exterior glued grills_ grills between glass_removable interior None V4 ,Door style and make: E�s/'(g ge,��,F( . material �dgO 4 , � � Color: ,aw�� ; Garage Door,Style Size of opening Material Color Shutter Type/Style/Material: Color. z�-;�--=`'_, � ! Gutter Type/Material: ijGtk l ewv" '� � Color. W Deck material: wood other material,specify Color. FT Skylight,type/makelmodel/: l Color. Size: r. Sign size: �q?pe v RECEIVEDr 6 i0M13 4 � Color. /V Fence Type(max 6')Style �yN �' material: JUN UCoI( 0f Ba` h wM Retaining wall: Material: GROWTH MANAGEMENT Lighting,freestanding on building i�illuminating sign OTHER INFORMATION. I ply D�,'ray - tv s`�'r'ja-v� j t ,95 u 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) 3 dr�s1 �z _ �.:<�-- Print NameDoa"-�0�� 2 9.Woar*and Commissions1Old Kmgs HighwaylOKff 4plia nions1OKH2O11 Cen*propnateness.doc r 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. Fee according to schedule. 6. SOLAR PANELS Drawing of location of panels on house showing roof and panel dimensions. RECEIVED Site plan showing location of building on property. (Assessors map may be submitted) Height of solar panel above the roof. -JUN 0 4 2013 Color of panels Finish(matt or glossy) GROWTH MANAGEMENT 7. FOR LIST OF ABUTTERS: PLEASE SEE OKH STAFF SIGNED plan preparer) A&y41 � ,y=� Print f Date: Tel.Phone no's: � t� 0 NOTE & 17 -2 A The 01d Kings Highway Historic District Committee MAY DENYINCOMPLETE APPLICATIONS Jl1N 2 6 2013 Town of Barnstable A7TENDANCE AT MEE77NGS: If the applicant or his/her representative is not present during the hearing aypplication may be either CONTINUED OR DEMED 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 14`h day falls on a Saturday,your 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 PERMITS,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 508-862-4038 Conservation Division 508-862-4093 Health Division 508-862-4644 QUESTIONS ABOUT YOUR APPLICATION? PLEASE CALL THE BARNSTABLE OLD KINGS HIGHWAY OFFICE AT 508 8624787 S I Town of Barnstable Geographic Information System June 6,2013 156035002 179038 16so04 15s023+ ♦ 156068` .#6s f PSG 1012 At #84z #12 #866 156024001 036 170 68 179011 156031 #826* if 886• 089 1111, 166065 179012 156033 156030 #21 179001002 #50 #837 179018 #66 15 118157 1 4* 15802 1#9600 #978 #52 #867 #902 166007 156036 179004 #897 #918, 042 156034 156028 156026 179003 179014 179013 066 0881 #970 #28 #41 #66 156028002 � , 1790010 I ON D 035 0 179015 .#1050 2 #29 • 179002 166064 #1000 #0 178022 156027 165034 "0 1022 ` #905 00 `156024 s 178008 178010 165023 •#976• #1040 #1074 so . . 9001 15503> � q 1780 #28 #106w4 1 155026 1802450 � � 098 R2506 166033 #1 •17801 166021 . 18 #9999 *026 #996 A 155022 165043 #2482 178028 �4i 1780301 178012 156048A00 0246574691 r #27 � :10`9 #1094 166016♦ #48 156060 #162 s�3 #4 #2449 A- 155017 P1 178027 178 # 6 155016 #2455 `� 155027 WA45 0 1003001 #68 155037 5� #2472 • 178006 178004 55 002 #1071 #1085 178004003 #85 024 155038 O�0J 602#2,46 17802s • 01095 4 0 24391 1P 44 178003 155020 � 165044 , 01121 156003 5 0 #2429� ��� #2444 0 ' . 1p 15 0 18ADI 178004001 • #0 176004 155019 76 @9,p 155029 245�4 #1165 � 165040 #24�01 •0 02377 � 155030 02416 15500200A a 166045 165031 177001 02321 #2400 0 2412 #0 165002 165046002 155046003 1W 0 ss 023 �70 #23 165048001 DISCLAIMERS:This map is for planning purposes only. It Is not adequate for legal Map:155 Parcel:026 Selected Parcel boundary determtnatlon or regulatory Interpretation. Enlargements beyond a scale of Owner.MOORE,SALLIE L Total Assessed Value:$377000 V-100'may not meet established map accuracy standards.The parcel lines on this map Co-Owner.9/oPACHECO,DOUGLAS A Aereage:0.86 sues Abutters E are only graphic representations of Assessor's tax parcels.They are not true property •:''� boundaries and do not represent sowro Buffer le relationships to physical features on the map Locadon:2482 MEETINGHOUSE WAY/RTE such as building locations. 149 r ty.�g h �{ 1 a i „ >_ t _ id Qik r F y Air0� !yam � + _ •-. � r - k41 T \; f _ 1 7 . 4+ P a� „ _ i T it �i ems, .� ........... .�—_ ._.,.,. a � y x, � � per a ,.� �""'*�a r .�.�. a,....�• _.. _. _,.�.-_.... _- _...--,__ .._...,_ —... `'R ,ems ca• w_a s .Y y . a � 0 m L A V a r ... _ rr x A"t + 1..1. �� r •ems.. y *� 04 M, _ \MCCARTHY :- - ! TOVIN OF BARNSTABLE �, ' RUCTION CO. l sitl i al and Commercial Builder 7014 VIAR 31 FM 1: 4 4 till A 'EAT�[tIZt1TION SPECIALIST � # QUAL T Id3BU[tc f'V - � DIVISIOfV q �cf rt S � y March 15, 2014 w 3, 1 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main Street Hyannis, MA 02601 RE: Insulation Permits Dear Mr. Perry, This affidavit is to certify that all work completed for permit application#201308292; Status A; Parcel 155026 at 2482 Meeting House Way,W. Barnstable, MA; Permit Type RADD and issued on 12:00:00 AM has been inspected by a certified Building Performance Institute(BPI) inspector.All work performed meets or exceed Federal and State requirements Sincerely, , Michael McCarthy McCarthy Construction I t J 'JP YE�H 1�E t� Application to , `00 Na p0 MBV 0 000�S�PP�PN� Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE FOR DEMOLITION OR REMOVAL Application is hereby made, in triplicate, for the issuance of a Permit for Demolition or Removal of a building or a structure or part thereof, 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. TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK a_JVFV?J44e A!j A&VJ& � Di. 0opurvAlt SSORS MAP NO.!' r . _OWNER SALCr AS Z. e4��D,P l'_/, z ����N,-,l ASSESSORS LOT NO. HOME ADDRESS e21fuf�t1��s� +f�IC�ez �.(J, BlrrNr�61} TEL. NO.Sa�,3-31o0 NAMES AND ADDRESSES OF ABUTTI.NG OWNERS: Include names of adjacent property owners across any public street Pr way. (Attach additional sheet, if necessary). 1 T/ �'( vs��2,; fc�Sff Z�9� � �y✓sPll�czv C.t� D�.1oLG6IE s 11s 7''aa' s, /Llao.eE, F_�f � J, �� ,e�.Ir��ter- %1/.9�rrv�,��:. r9 o z ssy /5`9/� �,Oi�il/ 7,�/�/OL/ Tca� ST. r�'�.%yl�lt.�t�r �%�/.r'�• C�o�/3 � AGENT OR CONTRACTOR Q O g Qr_/7-TEL. NO. ADDRESS, 70�1,fG! DESCRIPTION OF PROPOSED WORK: If buildingis to be removed, give new location. Snap shots showing all"views of buil ing must acicgmpF�aVy application. (Attac ._��1•ditional s eet, if cessary . Note: If approval is granted for relocation, a separate Certificate of Appropriateness is required for new location if within the Old King's Highway Regional Historic District. SIGNED Space below line for Committee use. Owner-Contr ctor-Agent ---, Received by H.D.C. The Certific .4•'is hereby R&r'o /to/ Date l Date �5,„ ld Timed—� By j Approved IMPORTANT: If Certificate is approved, approval is subject to the 20 day appeal period provided in the Act. Disapproved ❑ 4---A—Ssessor's office(1st Floor): Assessor's map and lot number " � �O�THE Board of Health(3rd floor): 0, Sewage Permit number ¢ i BAHd57dBtL J Engineering Department(3rd floor): �o rued House number. 1 � ° t639- Definitive Plan Approved by Planning and 19 ��ray APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN . OF. BARNSTABLE • BU I LD [K INSPECTOR APPLICATION FOR PERMIT TO ', TYPE OF CONSTRUCTION 19 0 /. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit/according to the following information: A Location ��/,�2 "l �� y�iO�/SP ZU�u� /�(/ CY1'J Proposed Use Zoning District /I Fire District Name of Owner -q 60 �"e �IT1� Address 61 /U• �e Name of Builder GL0 �U//✓6-X�� � Address/6, �o A � D �o� 17�j Name of Architect Address, Number of Rooms Foundation Exterior Roofing Floors Interior Heating Plumbing Fireplace Approximate Cost Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable re ding the abo construction. Name Construction Supervisor's License 00 q 5'/0 MOORE, SALLIE L. & EDITH KAURANEN No 33007 permit For Demolish Portion r Of Barn Location 2482 Meetinghouse Way 'West Barnstable i Sallie L. Moore & Edith Kauranen ? Owner - Type of Construction Frame Plot Lot , j. Permit Granted June 23, 19 89 Date of Inspection 19 { Date Completed 19 { r i f ' b 1 S r Z---A—ssessor's office(1st Floor): Assessor's map and lot numberTHE To`` Board of Health(3rd floor): Sewage Permit number t esa39Tsnta, J Engineering Department;(3rd floor): rnss House number `: �:�° t6}9 Definitive Plan Approved by Planning Board 19 (moo rar a• APPLICATIONS PROCESSED 8:30-9:30 A.M.-and 1:00-2:00 P.M.only 1'1 TOWN OF BARNSTABLE _ BUILDIH_G ASPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION 19 T i TO THE INSPECTOR OF BUILDINGS: t The undersigned hereby applies for a permit according to the following information: Location U k2 �`/ ��9 G�D /ASP LUcu., .(/ . �C�r�hS�Q h It V ` i .. •Proposed Use - �" v_ .' ZoningDistrict �T Fire District ��i ' • Name of Ownerjq///e Al' J16o Y r %rP171-1 A USA Address �:?L/ Name of Builder �U C// ,�1�//1/+6/U� Address/6, !�h °K 7572P - e Name of Architect Address Number of Rooms 4 Foundation Exterior Roofing Floors a, Interior Heating Plumbing Fireplace Approximate Cost Area i Diagram of Lot and Building with Dimensions Fee 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 Supervisor's License .� C/o MOORE, SALLIE L. & EDITH KAUR,'�NEN - A=155-026 No 33607 Permit For Demolish Portion Of Barn Location 2482 MeetingbouG -Wav West Barnstable Barnstable Owner Sallie L. Moore & Frj; t r Kauranen Type of Construction Frame Plot Lot Permit Granted June 23 , 19 89, Date of Inspection 19 Date Completed 19 c - AO)® c Application to 93 O PNEGH�t tH �NO'NStP P�5 H SP�pN gEPE�DPP fPNpM Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, iri 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 ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE •3^a` �3 ADDRESS OF PROPOSED WORK-2-Y / E�T/�G i/S� ASSESSORS MAP NO. /s 3 OWNER LL E �� C /� i ��� ASSESSORS LOT NO. HOME ADDRESS.2yqz NO. `3&2- �'37-SZ FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). _ ✓c�.sclJr� ��`/3 .�ZS���' �✓%�r11L ;�'i�sF<Ur�l Gt✓, �i�.t"rysr��Sc:�' d1�68 �✓l.V�, .Z/V'G `/r K��C,oGi. /l�ifJG�1 T G�+ate GJ 777TJ iJ'!� O 2 2.03" ,l3�:•tJs7 6u�1l �e../�7 a� Cc�-m� ,C� ��-7 /f1he o z 6 o .,7L AGENT OR CONTRACTOR Z-Z 4"VI 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). vJjaS�2�� g-6c-��5_ ,.�t,�rTF -,—uiD vdd/�S �.✓�/�' i I I s M<2,�F-PC—D Signed Owner-Contractor-Agent AEe 11,n,06rV.F.,1use. P — ceived by H.D.C. D i ti , Date The Certificateis hereby GOV )22- TO NSTg8t1 F Approve IMPORTANT: If Certificate is approved,approval is subje �ct to`the 10 day appeal period provided in the Act. (�` ' \ A� r\ \nc�cx�S � Q�Disapproved ❑ ��.\(�Qj Con pe�c,c-� 73 1 035 OLD KING'S HIGHWAY HISTORIC DISTRICT S p e c S he e t Foundation- Type Siding Type Chimney Type _ _ Color Roof Material Color Pitch Windows ��r! �- C�7G � �y,%"/ Size Trim Color Doors '�lit/D ��i�n? •�yCJiE'--�' Color Shutters Gutters Deck Garage Doors Color ill out completely. including measurements and materials/colors to be pr0 ree copies of this form are required for su�mittal of an application, long with three copies each of the plot plan. landscape plan and elev: Tans . when applicable. plot plan need not be "Certified" , but should show all structures on r! to scale . `?3 �35 PLOT PLAN FOR LOT N Indicate location of garage or accessory building Additions with dashed lines --------------- Sewerage disposal (cesspool) ED Well ifN I I I (Lot....................ft. rear) Abutter's .�• Abuttor's N I Name ame I I Lot# Lot Rear Yard .......�.`.Z.......ft. I I a If this is a If this is a i d corner lot, cue'lot, V write in write in w name of name of other met. HOUSE Sideyard other street. Sideyard — ft. 24 ft. I Set Back a ....... .......... ft. . . I I 4 (Lot....................ft.. frontage) \ / / ------ ---------------------------------------------------- / (Name of meet) 7_7 W/ � ormatioa � Supplied by V D0D Mark North Point ll 0 D d Q" w U LC <1 0 U') Ln z w c� z ID-1 Q o a v } 03 03 E \0 \o C5 w _ >- v0 <E z Z 10 � o Liw � Q w w w w w 0 w (n Q r/I D 0 o 0 0 E- N �zZ 0 zF- N y {n0 0 0Z w Q = l m L?_ N 3w0 w W w N O w 0 <L p 1 Li 0 -j Q 0 w 0 0 t- 0� -1 !- Z Ofzm Zzm — ••}- <I -I O H <t O H <L C) Q w (n Z Q O 0E- E- = t- �-- E -j zZ: w Zw (n }- wW mZ r O wZ wz C) ^ <EH (n • u) C3 wry mE0I ZZ i- QH C) t- H H Q CL <L H O (n Z Z Of wNm wmm ^I- Z Z ZHm -I CO (n Gr w 0 Of r- Q m 0 Z Q " 0 �t 30 '<1 \0 >- 00- Q (1) N3 r7N3 zm m1�"3 = t-) WC) S� �L� E MoneE. _.---- __ -- - - Gl7 ►T�-� KFl U 2 A tit' Ni MEEZ ►l'r MO ,sE --3750 1� 1 I aD I , I �Pti. • ` l� 9 I i grA - WN. sob� - o . .-'' s;•r. - air-��'� CaPIZZI Home Improvement Inc. 1645 Newtown Road ' Cotuit, MA 02635 Tel.428-9518 1 1.800.262-5060 T�Etirl`31�rr Assessor's office(1st Floor): ���� //��y, *,: SEPTIC SYSTEM MUST ' Assessor's map and lot number INSTALLED IN C® PLI Conservation '� �v-1�,� Z�IA �9-. .::' ,� WITH TITLE 5 Board of Health(3rd floor � � ENVIRONMENTAL CID Sewage Permit number �2 Z l_;Z=--'- ® �a� Iryfi_, �� ��k� se iTUL ; Engineering Department(3rd floor): '`�` ~°o o639. \�d� House number ��MCI Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION / 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 0�? �� Proposed Use 'TG� Zoning District Fire District L-> • hS �o�.,�-e Name of Ownerz-�/4E A/d0/1E E�nN /`[,441,Q�,d�,�! Address o2i eel P� /5/f Al Name of Builder Address (Z771 Name of Architect Address Number of Rooms Foundation Exterior Roofing Floors Interior Heating Plumbing Fireplace Approximate Cost .3"fep-0 Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the abov nstruction. Name Construction Supervisor's License a VGl,q j MOORE SALLIE, & EDITH KAURANEN No 35797 permit For ENCLOSE FRONT PORCH Single- Family Dwelling Location 2482 Route 149 West Barnstable Owner Sallie Moore & Edith Kauranen Type of Construction Frame Plot Lot F Permit Granted April 20 , 19 93 Date of'Inspection 19 Date Completed s 19 Ai