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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
DIQ
r 'I � A �•
Map Pa ce Application
Health Division Date Issued 3 ��
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Street Address JL/,5 p r h2n N 2"yZ AamY t aih to, 1? �
Village
Owner t)Ca L I S l&('L1k.a Address 15(4_, l fifabf
Telephone 50 Z _ 77-5 t L
Permit Request r 0ro Lvi of r-
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation U;0 0 Construction Type ep
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.
o
Number of Baths: Full: existing new Half: existing nev&r=- --r-
Number of Bedrooms: existing _new "D Q
M F
Total Room Count (not including baths): existing new First Floor Roorn Count
a
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other T
Central Air' ❑Yes ❑ No, Fireplaces: Existing New Existing wood/coal stove❑Y� ❑ No
Detached garage: ❑ existing ❑ new size—'Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial E(Yes ❑ No If yes, site plan review#
Current Use V.ri lfad fO Ausl ae_C-6 Proposed Use brij C"dl(u 19-'Styr
_ APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name i e,C� H f &o c D C, Telephone Number S-b 3 _1 Z 5 r '1 763
Address i sci, LN License # ID 99171n
,( 6 Home Improvement Contractor# 7
Eman: ebio
h/ ah-co et 7MWorker's Compensation # U646$�t
ALL CONSTRUCTION D RESULTING FROM THIS PROJECT WILL BE TAKEN TO
OP5/-r/n Rd Oeziots _uko
f
SIGNATURE DATE Z7 I I�
I�
I'
FOR OFFICIAL USE ONLY
r APPLICATION#
! DATE ISSUED _
MAP/PARCEL NO.
ADDRESS VILLAGE
I I -
OWNER
DATE OF INSPECTION:
FOUNDATION,.
FRAME -
INSULATION
FIREPLACE
1
ELECTRICAL: ROUGH f FINAL
t PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING ,
DATE CLOSED OUT
ASSOCIATION PLAN NO.
Office of Invatigations
600 Washington Street
Boston,MA 02111
_ www.mass.go v1d4a
Workers' Compensation Insurance Affidavit:Builders/Contractors/.�lectaicians/Pluimbcrs �
Appficam Information 'Please Print LezffifY
Name($�Sfnrmn,;�xi;n„/FndiyicII4:�C�C L ��(1�:O�l�,
•A.ddrms: 5!E� LV s.C,'. L--,),we, CJ 'dams -Ad
City/State/Zip: Phone.#
Are you an employer? Check the appropriate bow Type of pioject•(regoired):•
1.[�] I am a to with 4. .0 I and a general cofactor and I
8mp * have kred&ie gab-cogs 6. e4T Gon. cLrL rm
employees(full and/or part time).• Q
7. Q Remodeling
2.Q I am a'sole proprietor or partner- listed an$�e'atta ched sheet':
ship and have no employees These sub-Gardraaturs have 8. ❑Dmn ninon
or in Mployees and have workers'
any achy. $. 9. Q Building addition
[NO wnrkt zs' CAmp.insurance.. Gd�.infirtr�nM
] 5. Q•We are a ccjzporaii.on and its 10.E]Electdcal.repaizs or additions
3.❑ I am a homeowner doing aI1•wbrk officers have� red their 11.Q Plmnbio repairs or additions .
rigs df exemption per MGL
myself [so workers camp. 12.Q Roof repass
M=n=required•]t c. 152, §1(4),and we hate no
employees.[No workers' 13.❑ Other
�amP•m=m mquired_]
'Any applicant that checks boa#1 nmst also fin out the section bolow.showing their worla='compensation policy informatiom
Homeowners who submit t$is affidavit indicating they arc doing aD work and then his:outside contracts must submit anew affidavit indiralmg such. -
Co t aetms that check this boa must attached m additional sheet showing the name of the sub-cantractms and state whether or not fhose calf=have
:mployees. If the sub-cemfiactors have employees,they most proyi&their worl='comp.policy number.
"am an employer that is prdYidirng workers'compensation insurance for my employees. Below is the policy and job site
aformm�nrc.• •' . .
a.mance Company Name: Trc,,i _L
olicy#or Self-ins.Lin.#k 'J`�fJ$9�Jr f4` ' l3 ExpirationDaf
ob Site Address:0?qq 6gm61-c,j�(Q /Gl City/St tt/zip:
itnr-h a copy of the workers' compensation policy declar•afion page'(showi the policy n er and expiration date),
ail:=.t o secu=coverage as required under Secticn 25A of MGL c. 152 can lean to the imposition of criminal penalties of a
ere 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
.up to$250.00 a day against the'vioL-Ltr..Be.advised that a copy of this statement may be forwarded to the Office of
vestigations of the DIA for insurance coverage yerEcation-
io-hereby c the pains•and penalties of perjury that the itcformatian provided above is flue and correct
gaat=-
OjT=' l use only. Do not write in this are;to•be completed by city or town afjz-W ,
'City or Town: Permitucense# :'
IMdng-Authority(*cle one):.
X Board ofHeatth Z,BmTtiing Department.3. City/Town Clerk 4.Electricallnspector 5.PlumhMgInspector
6. Other
Contact Person: Phone#: .
i
Rightfax C3-1 3/28/2014 10:05,40 AM PAGE 3/004 Fax ServerAC"R R .
�® CER`�IFICA` E� OF,LIABILI T r II�SUiI�I�� 037282014
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 1NSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the Policy(fes)must be endorsed. If SUBROGATION IS WAIVED,
subject to the terms and conditions of the Policy,certain Policies may requite an endorsement. A statement on this certificate does
not tatter rights to the certificate holder in lieu of such endorsemenl(s).
PRODUCER CONTACT - • ,
HUB 1N7ERNATIONAL NEW ENGLAND NAME:
PHONE.,. .. FAX i
285 ORLEANS ROAD JAC,No EN i
NORTH CHATHAM,MA 02650 EWAIL
INSURER(S)AFFORDWO COVERAGE NAICR
INSURER A:TRAVELERS PROPERTY CASUALTY COOF AMER!
MUM -
THEODORE HITCHCOCK DBA T L HIT wsUREaa:
933 FALMOU'rH ROAD FNSURERC:
HYANNIS,I•AA 02601 INSUHER0;
• INSURER E
11 INSURER F:
7ABOVEFOR
CERTIf(C
ERTIFY THAT THE POLICIES OF INSURANCE LISTED' BELOW HAVE BEEN ISSUED TO THE INSURED NAMED
HE POLICY PERIOD INDICAT>D. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY
R OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE
FFORDED'BY THE POLICIES DESCRIBED HEREIN iS SUBJECT TO ALL THE TERMS,•EXCLUSIONS AND
F SUCH POLICIES.LtMI7S SHOWN MAY HAVE BEEN REDUCED BY f AID CLAIMS.
TYPE OF INSURANCE ADD SURFPOUCY FFF POLICY EXP r L7R INSR VIVO POUCYNUMBElr WlJOD/YYYY A!bVDU1VYYY Wa75
GENERALLIABILiTY
p
COrIttERCIAL GENERAL I,IAR!LR EACH OCCURRENCE
Y . '- �
DAMAGE TO RENTEO
CLAYIS•MADE d OCCUR
MEDEXP(An{rmeP:Ison), y
PE tiSONAL 3 AOV IA,i!/RY g ^
' • GENERALAGGREGATE
[;£Ari.AG(iREGATE WAR APPLIES PER: "
POLICY P E T LOc PRODUCTS•MINCIP AGG
6
AU I ANY AUTOL1A81LIIV - O�!BINEU SIVII1ELIMIT $
ALL OWNED SCHEDULED * - u BODILY INJURY(Per Person) E -
AUTOS AUTOS
NO"I'MNED - BODILY INJURY{Per accAml)
HIRED AUTOS AUTOS I�Oa!+EcNchr AM S -
UMBRF-LIA LIAR OCCUR •R •+ 6 .- -
EACH OCCURREtrCS. , t
EXCESS LIAR CLAIPA&MADE —
r , AGGnMATE
DEO RETENTIONS ..
WORKERS COMPENSA710N 6 M1 r
AND EAipLgYERS'LIABIU7Y ,X TVC STA7U- OTH. f
70nY LLl�17S
ANY PROPRIETORIPARTNERIEXECUT N�Y-�, - - ER
OFFICER�4A(MaEn EXCLUDED? IAII NrA ' E.L.EACHACCIDENT $1,000,Q00 -
IMar47ayinN)q U-1 03.26•2014 03-26•2015
If yas•desaibo undw 2E101644 E1.DISEASE-EA EMPLOYEE $1.000,030
DESCRIPTIOtIOF pERgTKXJSbehrr E.L.DISEASE•POLICY LIMIT $1,000,000
DESCRIP'i1TkTOFOPERAT10N5rLOCAT)ONSfVF111CLES(Attach ACORD 101,Additional ROVIBIMSetodulo,Il more&Mooisrequ0ed).
HITCHCOCK.THEODORE is covered by tho Yrorkors'eompensalion policy.'
ERT Fl AT OLOER AN ELL 0
-TOWN OFBARNSTABLE SHOULD ANY OF''THE ABOVE DESCRIBED POLICIES BE
200 MAIN ST CANCELLED BEFORE''THE. EXPIRATION DATE THEREOF,
HYANNIS,MA 07-fi01 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.'
i
AUTHORIZEDnEPRESENTATIVE -
ACORD 25(2010105) The ACORD frame and logo are registered mearkslof ACOROCORPORATlON.AA rights reserved.
THE Town of Barnstable .
Regulatory Services
t RARINSUR 4 t
asass. Thomas F.Geiler,Director
Eor► Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barustable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, C)cy-�n k 5 '(,ckr\.k kcLS , as Owner of the subject property
hereby authorize �e� ��- C CO C\C- to act on my behalf,
in all matters relative to work authorized by this building permit
9LIZ kcJ196- a ors
(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. S a of Applicant
1
Print Name Print Name
F
D e '
Q:FORM&OWNERPERMISSIONPOOLS 62012
I 7Qn--
,_.. $ -•:'•P,0,i52�:?1!.e;,:_,_S _ .. _ a_'.: �....:_ ., ... .°__. .Y'f�•� ��C`F'ci�iarro�tttmCi�/.�i-[/r ��r'i-:.�ttc�tr�c/(...
- �--•. O1Fcti dPEonsitmer'Affnirs BroSnsipess-Regulation'. .
��—SOME IRAPROVEMENT CONTRACTOR. :.
"=1i egistration 165907' type:
_,cease: CSSL-099828 r „
Expiration: 4/6/2014 Private Corporatic s
r•`:.•`
TED L HITCHCOCK
TL HITCHCOCJCSTRUCTION SERVICE INC i
55 LISA LANE
West Barnstable MA 02668 '
THEODORE HITCHCOCK * Y•;
55 LISA LANE � f
WEST BARSTABLE,MA 02668 `Undersecretary
;fss��r.c 06/01/2014 M1
� 9
• e
Restncted.To:
e •
'License or registration valid for individul use:only
before the expiration date. If found return to: ,
Office-of Consumer Affairs and Business Regulation'
10 Park Plaza-Suite 5170
{
Boston, A_Q216
Failure to possess a current edition of the Massachusetts" - ,r • r
State Building Code is cause for revocation-of-this license. �'•'
For DPS Licensing information visit: www.Mass_Gov/DPS e o ,✓ �'
` jcs{valid"wit out signature; f
n.
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TOWN OF BARNSTABLE
r BUILDING PERMIT
PARCEL ID 328 010 GEOBASE ID 24390
ADDRESS 242 BARNSTABLE ROAD PHONE
HYANN I S ZIP — 1
i
LOT BLOCK LOT SIZE
DBA DEVELOPMENT DISTRICT HY
PERMIT 70377 DESCRIPTION 11 1.6 X 4 LIGHTED SIGN SPARTAN. CLEANERS
PERMIT TYPE BSIGN TITLE S GN PERMIT
BCHITECTSS: PROPERTY OWNER Department of
Regulatory Services
TOTAL FEES: $25.00 _
BOND $.00
CONSTRUCTION COSTS. $1,000.00
753 MISC. NOT CODED ELSEWHERE 1 PRIVATE
* sARMSTABLE,
Mass. i
03 ♦�
FD MA'S A �
BUILDING DIVISION
BY
DATE ISSUED 07/25/2003 EXPIRATION DATE `v im
Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
$" MASS. g' Building Division
Arm 39. Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Tax Collector 0
Treasurer
Application for Sign Permit
Applicant: /) a i N Ci,\,e A A) -Q rL-c Assessors No.--
Doing Business As: /L//,h o .9 A14 2 IJ !CA f Telephone No. � �� 7 7 r t 4
Y
Sign Location
Street/Road: .2- �4.2 8.4 -2— g/ %'`7--.i 6 '/' r
• rJ
Zoning District: Old Kings Highway? Yes/No Hyannis Historic District? Yg s/No
Property Owner 89
Name: /r/.- os -v r Telephone: '7 7 '�r _~f
a � .2 � AA- ti r. Tf- SL Rd `
Address: r Village: `4 r
1 co
Sign Contractor
Name: �0 2 c/ �� q.�/ a Telephone: 7 7 E ;
Address:l o� iy P e r 0 Village: y
Description
Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location and size of
the new sign. This should be drawn on the reverse side of this application.
Is the sign to be electrified? Yes o (Note:If yes, a wiring permit is required) "
I hereby certify that I am the owner or that I have the authority of the owner to make this application,that the "
information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town
of Barnstable Zoning Ordinance.
Signature of Owner/Authorized Agent: Date:
Size: Permit Fee:
Sign Permit was approved: Disapproved:
Signature of Building Official: Date:
Signl-doc
rev.111801
CXiSTWG - stGN
d i
SHIRTS
LAUNDRY
READER L'r wGIU
BOARD 2 LANES Iq
L-E�T6 2 s
5�
® ®®� ®
JORDAN SIGN COMPANY
103 ENTERPRISE ROAD
HYANNIS, MA 02601-2212
LOCAL 508-771-4020
FAX 508-771-6658
FROM JORDRNS I GN FHi; NO. 15087715558 Ju 1. 25 2003 E13:42RM P1
Ma s
JORDAN SiCN COMPANY
103 ENTERPRISE ROAD
HYANNIS, MA 02601.2212
LOCAL. 508-771-4020
FAX 508-771-6658
IM IN
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r �
'72x7 (6
� 1 . 2.5 SQ,Fr.
To-rRL- SIG,Aj plda-m GE Fr
LENGTH O� 4-3vcG7�tNC- �O _ F
_ SHIRTS
�� ''# LAUNDRY �`�:
6
TOWN OF BARNSTABLE
SIGN PERMIT I
Y
PARCEL. ID 328 010 GEOBASE ID 24390
ADDRESS 242 BARNSTABLE ROAD PHONE
HYANNIS ZIP
LOT BLOCK LOT SIZE
DBA DEVELOPMENT DISTRICT NY
PERMIT 45695 DESCRIPTION "SPARTAN CLEANERS" - 24 SQ.
PERMIT TYPE BSIGN TITLE SIGN PERMIT
CONTRACTORS:ARCHITECTS: Department of Health, Safety
��
and Environmental Services
TOTAL FEES: $25.00
BOND .00 THE
CONSTRUCTION COSTS . $.00
Qi► i
753 MISC. NOT CODED ELSEWHERE 1 PRIVATE P?iC# 'E" ;
* BARN3TABLE • I
039.
BUILDI G DIVIS ON
DATE ISSUED 04/26/2000 EXPIRATION DATE f
CF WE Tp
do - The Town of Barnstable
Department of Health, Safety and Environmental Services
Y
MasMs.&�xx ' Budd'' g Division
9�b 1639. `0$ 367 Main Street,Hyannis MA 02601 �!
Office: 508-862-4038 7 ��''° Ralph Crossen
Fax: 508-790-6230 Building Commissioner
�4�n T
Tax Collector
Treasurer
Application for Sign Permit
Applicant: Assessors No. 3
Doing Business As: Zh-eroam Telephone No.
Sign Location
Street/Road:
Zoning District:_Old Kings Highway? Ye yannis Historic District ✓vim
Yes/No �
Property Owner
Name: �'/� ���. '� Telephone:
Address:
Sign Contractor JORDAN SIGN CO.
Name: Telephone: 7
103 RISE ROAD
Address: HYANNIS,MA 02601-2212 Village: AIWWWI.Ow
Description
Please draw a diagram of lot showing location of buildings and existing signs with
dimensions, location and size of the riew sign. This should be drawn on the reverse side of
this application.
Is the sign to be electrified? Ye�(Note:If yes, a wiring permit is required)
I hereby certify that I am the owner or that I have the authority of the owner to make this
application, that the information is correct and that the use and construction shall conform
to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. 4
Signature of Owner/Authorized Agent- Date: - �
e
Size: Permit Fee: ✓
Sign Permit was approved:- Disapproved:
Signature of Building Office .� l Date:
Signl.doc
rev.8/31198