HomeMy WebLinkAbout0078 CHANNEL POINT ROAD �IYANNIS
f�
1
oFY�Tp,, Town
of Barnstable *Permit#� "
Expires 6 months front issue dale
Regulatory Services Fee
BARNSUBLE,
r
i6& 1a$ Thomas F. Geiler, Director
�AlFo �r, Building Division
Tom Perry, CBO, Build ing.Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number ,,,� � 7 / -
Property Address C Hi A/1? a'�Y��S
Residential Value of Work ~O� Minimum fee of$25.00 for work under$6000.00
Owner's Name& Address y3 a,
(dc® Y
Contractor's Name ��✓ C��s �l 1 Tele phone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
AWorkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
E D �QQu
❑ I am the Homeowner TOWN o� A�N�TA�
Q I have Worker's Compensation Insurance
LE
Insurance Company Name
Workman's Comp. Policy# y L l 3 3LY) ,Z1 02
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box) / )�
❑ Re-roof(stripping old shingles) All construction debris will be taken to (�✓` f �i ` '���"�ti
❑ Re-roof(not stripping. Going over existing layers of roof)
O'Be-side
❑ Replacement Windows. 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.
Home Im vement Contractors License & Construct Supervisors License is required,
SIGNATURE: r ^
Q:\W PFIL;ES\FORMS\Express\EXPRESS PERMIT.DOC
Revise060409
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
j' 600 Washington Street
_ Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): f'C�ft.•�tf� � j ffA4.%,V7
Address: /%� �1�1� 7 _
City/State/Zip: Ce0'1'1vj1(r AC_ Phone #: s 6 K- 775
Are you an employer?Check the appropriate box: Type of project(required):
1.-6I 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.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees . These sub-contractors have 8. 0 Demolition
workingfor me in an capacity. employees and have workers'
Y9. ❑ Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other�/�r f�f�
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.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
C IjY.. /' r� r
Insurance Company Name: r '�/ QL.
Policy#or Self-ins. Lic.#: W 1 3�� 3 Y Expiration Date: lC�
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify and r the pains and penalties of perjury that the information provided above is tr a and correct.
Signature: Date: A>
Phone#:
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
r ..a
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership, association,corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships (LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 4-24-07 Fax # 617-727-7749
www.mass.gov/dia
• a ti ��
THE rod, Town of Barnstable
ti
Regulatory Services
$"R'' eI E MAS& $' Thomas F. Geiler,Director
E16396 Building Division
Tom 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 and Sign This Section
If Using A Builder
I, R0,10 1 eL �h ��g�;� , as Owner of the subject property
hereby authorize 8,142. cte'F C4-'�eh' to act on my behalf,
in all matters relative to work authorized by this building permit application for.
n g,c 6��� �
(Address of Job)
Signature of Owner Date
a"CAJ
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:FORMS:OWNERPERMISS ION
Town of Barnstable
"o Regulatory Services
vslnst>r Thomas F.Geiler,Director
MAss.
039• �� Building Division
Tfo �A Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such-
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they 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\homeexempt.DOC
09/11/2007 09:03 5082401860 KERRY INS PAGE 01/02
LMG 9/11/2009 8:56; 13 AM PAGE 2/002 Fax SOrvAr
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:Liberty Mutual Group
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P.O. F1ox 9090
DoverA NH 03821-9090
Teleplione. (800) 653-7893
Fax: W3) 334-B162
E-Maill: IMS@LibertyMutu.al..com
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septem6er_ 09, 2009
ESN CREILL CONSTRUCTION CO INC.
1.95 PI0. STREET
CENTER MA 02.632--
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RE. No-fi'ice of Reinstatement of Insurance
Dear. P61.icyholder:
we herd�by re5ci.nd our non-payment of premium cancellation notice
ef.fectEi_ve September
16, 20b9 sent -to you, on the policy numbered:
WC1-31b-34242.1-029
Any subsequent cancellation, issued may result in the loss of payment
plan, pfr.ivi I.eges.
Subsequent cancel.l.ati,on may require payment of current policy balance,
if a.ny4 in its
enti_r_eity to avoid cancellation.
Sincerely,
i
David (Reeder
. er�,i sincj Accountant
.r.nvolLinta.ry Ila.r,ket Se.rvi.ceci - Financial
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CC: I�,RRY INSURANCE AGENCY. INC
PREM11UM FINANCING SPECIALISTS INC
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09/11/2007 09:03 5082401860 KERRY INS PAGE 02/02
'fn: KERRY ZNsOBAIiCF,AGENFY INC: sto FromDeb Aerachemant
4-2.A-09 7121am p. 2 of 4
DATE(MM0701YYTT1
CERTIFICATE OF LIABILITY INSURANCE
PRDOUCER ERRY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
K INS RANGE AGENCY INC
ERRY IN RANGE
RTE 6 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
AS NOLDF3R, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
NORTH EASTHAM,MA 02651 ALTER THE COVERAGE AFFORDED BY THE POLCCI S BELOW.
(BOB)255-6006 INSURERS AFFORDING COVERAGE NAIC 0
IN11URE0 CRESWELII,CONSTRUCTION CO INC INSURER A: edy..pd�IwRL 5wm
195 PINE StrREET INBURER_t
CENTER VI,.LE MA 02632 INSURERC:
[MauRFR O:
INSUM E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED A90VE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONOITION OF ANY CONTRACT OR OTMIER 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 T11E TERMS.EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES,AGGREOATC LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIcv APE E POLI P]lPl R ON
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AUTNDRIZED REPRE89NTATIVE
Jeff Eldridge ' �� A
ACORp 25(2009I0 fAf) w 1988.2009 ACORD CORPORATION. All rights mozorved.
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Nlassachusetts- Department of Public Safeh
Board of Building; Regulations and Standards
Construction Supervisor License
License: CS 76536
Restricted to: 00
STEPHEN W CRESWELL }
195 PINE STREET P.-
CENTERVILLE, MA 02632
Expiration: 8/27/2011
Commissioner Tr#: 2900
k Board-of Budding Regulations and Standards
HOME IMOVEMENT CONTRACTOR k�
Registration; 160627
f I Ex trabon 8> 2010 '._ Tr# 272337
VA
altiidual
az STEPHEN W...C�,ESWELU r
STEPHEN.,CRESWEL
F 195`PINE ST t�
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Massachusetts Department of Environmental Protection w073189
Bureau of Resource Protection - Waterways Regulation Program Transmittal No.
Chapter 91 Waterways License Application -310 CMR 9.00
Simplified,Water-Dependent, Nonwater-Dependent,Amendment
G. Municipal Zoning Certificate
R& B Anderson Realty Trust -
Name of Applicant
78 Xhannel Point Rd Hyannis Inner Harbor Barnstable
Project street address Waterway Cityrrown
Description of use or change in use:
Maintance dredging to provide the applicant with access to navigable waters.
To be completed by municipal clerk or appropriate municipal official:
"I hereby certify that the project described above and more fully detailed in the applicant's waterways
license application and plans is not in violation of local zoning ordinances and bylaws."
Printed N e of Municip Official
fgnature of Municipal Official Title City/Town
Page 6 of 17
CHgl App.doo
Rev.01/31/02
Massachusetts Department of Environmental Protection W073189
Bureau of Resource Protection -Waterways Regulation Program Transmittal No.
Chapter 91 Waterways License Application -310 CMR 9.00
Simplified,Water-Dependent, Nonwater-Dependent,Amendment
B. Applicant Information Proposed Project/Use Information
1. Applicant;
toOa1_dlA �ersar��Rl8�k3
R E-mail Address
Mailing Address P
Note:Please refer Y MA ��!�.�'
to the"Instructions" City/Town
CitylTown State Zip Code
Telephone Number Fax Number
2. Authorized Agent(if any):
aobe�tA;Bfl71a1; .
Name E-mail Address
Mailing Address
11.N, O 97.E 5T
City/Town State Zip Code
508 295 2128 0WEM
Telephone Number Fax Number
C. Proposed Project/Use Information
1. Property Information (all information must be provided):
Owner Name(if different from applicant)
MM �rI7t
Tax Assessors Map and Parcel Numbers Latitude Longitude
WN
Street Address and Gty/Town State Zip Code
2. Registered Land ❑Yes ® No
3. Name of the water body where the project site is located:
F VejeB;!P¢f N 73PSFAw�.Y"°'+ J ."�erralS>
4. : Description of the water body in which the project site is located (check all that apply):
Type Nature gesicination
[;I Nontidal river/stream ® Natural ❑Area of Critical Environmental Concern
® Flowed tidelands ❑ Enlarged/dammed ❑ Designated Port Area
[] Filled tidelands ❑ Uncertain ❑ ocean sanctuary
❑ Great Pond ❑ Uncertain
❑ Uncertain
Page 2 of 17
CHg1 App.doc
Rev.01/31/02
Massachusetts Department of Environmental Protection W073189
Bureau of Resource Protection -Waterways Regulation Program Transmittal No.
Chapter 91 Waterways,License Application -310 CMR 9.00
Simplified,Water-Dependent, Nonwater-Dependent,Amendment
C. Proposed Project/Use Information (cunt.)
Select use(s)from
Project Type Table 5. Proposed Use/Activity description
on pg.2 ofth
"Instructions" It is proposed to maintain dredge 870 cu. yds. Dredging will be by the mechancial method loaded on barges.The material
will be off loaded at Hud Baxters bulkhead, Pleasant St. Hyannis.Trucked approx.400'to Baxter Boat House parking area
where it will be dumped into a filter cloth lined jersey barrier dewatering area. Once dewatered, material will be trucked to
S&J Exco,200 Great Western Rd. So. Dennis.
6. Is the project a pre-1984 existing structure AND less than 600 square feet?
❑ Yes ❑ No
7. Is the project a post-1984 existing or new structure, less than 300 square feet AND water dependent?
❑ Yes ❑ No
8. What is the estimated total cost of proposed work(including materials& labor)?
$26,000
9. List the name& complete mailing address of each abutter(attach additional sheets, if necessary).An
abutter is defined as the owner of land that shares a common boundary with the project site, as well
as the owner of land that lies within 50'across a waterbody from the project.
Michael Wyman 66 Channel Pointb Rd Hyannis, MA 02601
Name Address
Dorothy Murray 15 Packard RD. Milford, MA 01757
Name Address
Name Address
D. Project Plans
1. 1 have attached plans for my project in accordance with the instructions contained in {check one):
❑ Appendix A (License plan) ❑ Appendix B (Simplified License plan)❑ Appendix C(Permit plan)
2. Other State and Local Approvals/Certifications
[0 401 Water Quality Certificate pending
Date of Issuance
(�Wetlands SE3-4399
File Number
❑ Jurisdictional Determination JD-
File Number
❑ MEPA
File Number
❑ EOEA Secretary Certificate
Date
❑21E Waste Site Cleanup
RTN Number
WglApp.doc Page 3 of 17
Rev.01/31/02
Massachusetts Department of Environmental Protection W073189
Bureau of Resource Protection -Waterways Regulation Program Transmittal No.
Chapter 91 Waterways License Application .310 CMR 9.00
Simplified,Water-Dependent, Nonwater-Dependent,Amendment
E. Certification
All applicants, property owners and authorized agents must sign this page.All future application
correspondence may be signed by the authorized agent alone.
"I hereby make application for a permit or license to authorize the activities I have described herein. Upon
my signature, I agree to allow the duly authorized representatives of the Massachusetts Department of
Environmental Protection and the Massachusetts Coastal Zone Management Program to enter upon the
premises of the project site at reasonable times for the purpose of inspection."
"I hereby certify that the information submitted in this application is true and accurate to the best of my
knowledge."
Applicant's signature Date
Property Owner's signature(if different than applicant) Date
- ' -z 7 /05
Agent's signature(if applicable) Date �
APPLICANTS FILING A SIMPLIFIED APPLICATION STOP HERE
Massachusetts Department of Environmental Protection W073189
Bureau of Resource Protection -Waterways Regulation Program Transmittal No.
Chapter 91 Waterways License Application -310 CMR 9.00
Simplified,Water-Dependent, Nonwater-Dependent,Amendment
F. Waterways Dredging Addendum
1. Provide a description of the dredging project
® Maintenance Dredging (include last dredge date& permit no.) ❑ Improvement Dredging
Provide the applicant with access to navigable waters. _
Purpose of Dredging
2. What is the volume (cubic yards) of material to be dredged?
870
3. What method will be used to dredge?
❑ Hydraulic ® Mechanical ❑ Other
4. Describe disposal method and provide disposal location(include separate disposal site location map)
Dredged material will be dewatered at the Baxter House Parking lot. Once dewatered material will be
trucked to S &J Exco, 200 Great Western Rd.So. Dennis
5. Provide copy of grain size analysis. If grain size is compatible for beach nourishment purposes,the
Department recommends that the dredged material be used as beach nourishment for public
beaches. Note: In the event beach nourishment is proposed for private property, pursuant to 310
CMR 9.40(4)(a)1, public access easements below the existing high water mark shall be secured by
applicant and submitted to the Department.
S A M F;L-tf t G
CHW App.doc Page S of 17
Rev.0151102
NO TES.' L oCUs N
ELEVATIONS ARE SHOWN IN FEET AND TENTHS
BASED ON THE PLANE OF MEAN LOW WATER. MINUS
FIGURES INDICATE DEPTHS BELOW THAT SAME PLANE
ulr
-A -y
�AR9f, �p,.p•A
2083
H�ANNI�S' INNER o HA ,Bp,R USGS 1: 25000
HYANNIS QUAD.
KEY MAP
9 � �� HaT i OtK N -•(y , (a
DREDGE LIMIT AS SHOWN \PiER
N'*PW LICENSE PLAN # 506
�� ' DUNE 22, 1966
®� Or N, 9+ '� �'� i�A EXISTI
DREDGE 0 0 6
RO i. / --6.0 . ' o+
rnp 1?o v • FLOOD ZONE
c
bi BRAMAN.J i -2 q A9 EL.Nt 1 0
#a5a-5o14n / a
.m �� �� / '�* o ' o ♦ h MAP. 326, PARCEL 75
•y �Fo P�o`��o`i EXIS /NG�P/ER♦6\ , • l,�h � DOROTHY MURRAY
N
� o suRyE� .� & LOA s ,0� ? / 15 PACKARD ROAD
MILFORD, MA. 01757
��� p• /��'� 3 BENCH MARK
EXISTING FLOATS � %� �'• 7�" E �� CONCRETE Bp,U/VQ
i� • ELEY. 14.46 M L.W.
•
FLOOD ZON
MAP 326
PLC k PARCEL 74 ce/FND
o �
EXISTING PIER DO I
3/07 SB/FND �0,MAP ,
E QQ
73
MICHAEL 6OT P.LWYM N ��'� PLAN
66 CHANNEL POINT RD.HYANNIS, MA. 02607 �,\P�0 26 50 100,
MAINTENANCE DREDGING IN mmmi
Hyl4x IS IN1VE.R -f-14QR.8Q.R SCALE: 1" = 50'
HYANNIS, BARNSTABLE COUNTY, MA. i7eVOE10 -7/1+/10-7
APPLICATION BY RRA� " SUI?VZTNG & ASSOCIATES, LLC
R & B APPLICATION
REALTY TRUST LAND SURVEYORS AND CIVIL ENGINEERS
NO MEMBER 1, 2005 SHEET 1 OF 2 258 MAIN STREET, BUZZARDS BAY, MA 02532
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R & B ANDERSON REALTY TRUST NOVEMBER 1, 2005 SHEET 2 OF 2
P,�t T ti Massachusetts Department of EnvironmdgYffiTPr6fe—ati'orr
o� Bureau.�of Resource Protection - Wetlands DEP File Number:
s�B = WPA Form 5 Order of Conditions SE3-4399
�A 1�'
TFp ,fa Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
And Chapter 237 of.the Code of the Town of Barnstable
A. General Information
Important:
When filling From:
out forms on Barnstable
the computer, Conservation Commission
use only the
tab key to This issuance if for(check one):
move your
cursor- do ® Order of Conditions
not use the
return key. ❑ Amended Order of Conditions
� To: Applicant: Property Owner(if different from applicant):
Ronald F. Anderson, Trustee
Name Name
78 Channel Point Road
Mailing Address Mailing Address
Hyannis MA 02601
City/Town State Zip Code City/Town
State Zip Code
1. Project Location:
78 Channel Point Road, Hyannis
Street Address City/Town
326 74
Assessors Map/Plat Number Parcel/Lot Number
2. Property recorded at the Registry of Deeds for:
Barnstable 8416
County 152
Book Page
Certificate(if registered land)
3. Dates:
April 15, 2005 May 24, 2005 " " AUG - 3 2005
Date Notice of intent Filed Date Public Hearing Closed Date of Issuance
4. Final Approved Plans and Other Documents (attach additional plan references as needed):
Site Plan
Title August 26, 2002
Date
Title
Date
Title
Date
5. Final Plans and Documents Signed and Stamped by:
Robert Braman PLS
Name
6. Total Fee:
$1545.00
(from Appendix B:Wetland Fee Transmittal Form)
Wpafon S.doc•rev.8/2/os
Page 1 of 7
oFr Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
STAB WPA Form 5 - order of Conditions SE3-4399
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
And Chapter 237 of the Code of the Town of Barnstable
B. Findings
Findings pursuant to the Massachusetts Wetlands Protection Act:
Following the review of the above-referenced Notice of Intent and based on the information provided in
this application and presented at the public hearing, this Commission finds that the areas in which work is
proposed is significant to the following interests of the Wetlands Protection Act. Check all that apply:
❑ Public Water Supply ® Land Containing Shellfish ® Prevention of Pollution
❑ Private Water Supply ® Fisheries ® Protection of Wildlife Habitat
❑ Groundwater Supply ® Storm Damage Prevention ® Flood Control
Furthermore,this Commission hereby finds the project, as proposed, is: (check one of the following boxes)
Approved subject to:
® the following conditions which are necessary, in accordance with the performance standards set forth
in the wetlands regulations, to protect those interests checked above.This Commission orders that all
work shall be performed in accordance with the Notice of Intent referenced above, the following
General Conditions, and any other special conditions attached to this Order. To the extent that the
following conditions modify or differ from the plans,specifications, or other proposals submitted with
the Notice of Intent,these conditions shall control.
Denied because:
❑ the proposed work cannot be conditioned to meet the performance standards set forth In the wetland
regulations to protect those interests checked above. Therefore, work on this project may not go
forward unless and until a new Notice of Intent is submitted which provides measures which are
adequate to protect these interests, and a final Order of Conditions is issued.
❑ the information submitted by the applicant is not sufficient to describe the site, the work, or the effect
of the work on the interests identified in the Wetlands Protection Act.Therefore, work on this project
may not go forward unless and until a revisedNotice of Intent is submitted which provides sufficient
information and includes measures which are adequate to protect the Act's interests, and a final
Order of Conditions is issued. A description of the specific information which is lacking and why it is
necessary is attached to this Order as per 310 CMR 10.05(6)(c).
General Conditions (only applicable to approved projects)
1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory
measures, shall be deemed cause to revoke or modify this Order.
2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any
injury to private property or invasion of private rights.
3. This Order does not relieve the permittee or any other person of the necessity of complying with all
other applicable federal, state, or local statutes, ordinances, bylaws, or regulations.
wpaform5.doc•rev.8/2/05
Page 2 of 7
,T"FT massacnusetts Uepartment of Environmental Protection
, � Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 — Order of Conditions sE3-4399
i639. Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
And Chapter 237 of the Code of the Town of Barnstable
B. Findings (cont.)
4. The work authorized hereunder shall be completed within three years from the date of this Order
unless either of the following apply:
.a. the work is a maintenance dredging project as provided for in the Act; or
b. the time for completion has been extended to a specified date more than three years, but less
than five years,from the date of issuance. If this Order is intended to be valid for more than three
years, the extension date and the special circumstances warranting the extended time period are
set forth as a special condition in this Order.
5. This Order may be extended by the issuing authority for one or more periods of up to three years each
upon application to the issuing authority at least 30 days prior to the expiration date of the Order.
6. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse,
rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard,
pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing.
7. This Order is not final until all administrative appeal periods from this Order have elapsed, or if such
an appeal has been taken, until all proceedings before the Department have been completed.
8. No work shall be undertaken until the Order has become final and then has been recorded in the
Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title
of the affected property. In the case of recorded land, the Final Order shall also be noted in the
Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to
be done. In the case of the registered land,the Final Order shall also be noted on the Land Court
Certificate of Title of the owner of the land upon which the proposed work is done.The recording
information shall be submitted to this Conservation Commission on the form at the end of this Order,
which form must be stamped by the Registry of Deeds, prior to the commencement of work.
9. A sign shall be displayed at the site not less then two square feet or more than three square feet in
size bearing the words,
"Massachusetts Department of Environmental Protection"for, "MA DEP'j
"File Number SE3-4399 "
10. Where the Department of Environmental Protection is requested to issue a Superseding Order, the
Conservation Commission shall be a party to all agency proceedings and hearings before DEP.
11. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of
Compliance (WPA Form 8A)to the Conservation Commission.
e12. The work shall conform to the plans and special conditions referenced in this order.
13. Any change to the plans identified in Condition #12 above shall require the applicant to inquire of the
Conservation Commission in writing whether the change is significant enough to require the filing of a
new Notice of Intent.
14. The Agent or members rs of the Conservation Commission and the Department of Environmental
Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours
to evaluate compliance with the conditions stated in this Order, and may require the submittal of any
data deemed necessary by the Conservation Commission or Department for that evaluation.
Wpalorm5.doc•rev.8/2/05
Page 3 of 7
1>�r Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands °�P File Number.
UMSTABLA
WPA Form 5 - Order of Conditions sE3-4399
�p i439' Massachusetts Wetlands Protection Act M.G.L. c. 131 §40 Provided by°EP
rEo�y�
And Chapter 237 of the Code of the Town of Barnstable
B. Findings (cont.)
15. This Order of Conditions shall apply to any successor in_interest or successor in control of the
property subject to this Order and to any contractor or other person performing work conditioned by
this Order.
16. Prior to the start of work,.and if the project Involves work adjacent to a Bordering Vegetated Wetland,
the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden
stakes or flagging. Once in place, the wetland boundary markers shall be maintained until a
Certificate of Compliance has been issued by the Conservation Commission.
17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully
stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or
water body.. During construction, the applicant or his/her designee shall inspect the erosion controls
on a daily basis and shall remove accumulated sediments as needed.The applicant shall immediately
control any erosion problems that occur at the site and shall also immediately notify the Conservation
Commission, which reserves the right to require additional erosion and/or damage prevention controls
it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of
work line has been approved by this Order.
see attached
Findings as to municipal bylaw or ordinance
Furthermore,the Barnstable hereby finds (check one that applies):
Conservation Commission
[) that the proposed work cannot be conditioned to meet the standards set forth in a municipal
ordinance or bylaw specifically:
Municipal Ordinance or Bylaw Citation •
Therefore, work on this project may not go forward unless and until a revised Notice of Intent is
submitted which provides measures which are adequate to meet these standards, and a final Order of
Conditions is issued.
® 'that the following additional conditions are necessary to comply with a municipal ordinance or bylaw,
specifically:
Chapter 2V of the Code of the Town of Barnstable `5
Municipal Or
dinance Hance or B la
Y
w
Citation
The Commission orders that all work shall be performed in accordance with the said additional
,Conditions and with the Notice of Intent referenced above.To the extent that the following conditions
modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent,
the conditions'shall control
Wpaform5.doc•rev.8/2J05
Page 4 of
SE3-4399 Anderson
Approved Plan=August 22, 2002 Site Plan by Robert Braman,PLS
Special Conditions of Approval
I. Preface �.
Caution: Failure to comply with all Conditions of this Order of Conditions can have serious consequences.
The consequence may include issuance of a stop work order,fines,requirement to remove unpermitted
structures,requirement to re-landscape to original condition,inability to obtain a certificate of compliance,
and more.
The General Conditions of this Order begin on page 2 and continue on pages 3 and 4. The Special
Conditions are contained on pages 4.1,4.2 and 4.3 if necessary.All conditions require your compliance.
II. Prior to the start of work,the following conditions shall be satisfied:
1. Within one month of receipt of this Order of Conditions and prior to the commencement of any work
approved herein,General Condition number 8(recording requirement)on page 3 shall be complied with.
2. It is the responsibility of the applicant,the owner and/or successor(s) and the project contractors to ensure
that all conditions of this Order are complied with. The applicant shall provide copies of the Order of
Conditions and approved plans(and any approved revisions thereof)to project contractors prior to the start
of work. Barnstable Conservation Commission Forms A and B shall be completed and returned to the
Commission prior to the start of work
3. General Condition 9 on page 3 (sign requirement)shall be complied with.
4. The Conservation Commission shall receive written notice 1 week in advance of the start of work.
5. The Natural Resources Dept. shall be notified at least 21 working days prior to the start of work at the site,
to inspect the areas for shellfish. If deemed necessary by the Shellfish Constable,shellfish shall be removed
from the work area to a suitable site and/or replanted at the locus following construction. The foregoing
measures for shellfish protection shall ensue at the expense of the applicant.
6. A protocol for the temporary stockpiling and dewatering of the dredge spoil shall be submitted for
conservation agent approval. No work shall ensue without the agent's sign-off should temporary
stockpiling and dewatering involve Town property(the Lewis Bay ramp parcel),then prior approval of the
Harbormaster shall also be obtained
Pace 4.1
TII. The following additional conditions shall govern the project once work begins.
7. General conditions No. 12 and No. 13 (changes in plan)on page 3 shall be complied with.
8. The Conservation Commission,its employees,and its agents shall have a right of entry to inspect for
compliance with the provisions of this Order of Conditions.
9. This permit is valid for 3 years from the date of issuance, unless extended by the Commission at the request
of the applicant.Caution: a future Amended Order does not change the expiration date.
10. Herbicide,pesticide and fertilizer use is discouraged on lawns within Conservation Commission
jurisdiction. If fertilizer is used,only slow-release low-nitrogen fertilizer(with 30-50%water insoluble
nitrogen or `W.I.N') shall be applied. Over-fertilizing shall be avoided(not-to-exceed limit= 1 pound of
nitrogen per 1,000 sq. ft. of lawn per application).Ensure that no fertilizer is spread on hard surfaces like
driveways and sidewalks.
11. A post-dredging bathymetric survey shall be performed by the project engineer and results submitted to the
Conservation Commission for compliance review purposes.
12. Dredging shall occur only November through February.
13. Dredge spoils shall be appropriately dewatered and deposited in conformance with DEP Water Pollution
Control protocol. Spoils shall not be deposited within Conservation Commission jurisdiction without prior
board authorization. The applicant shall consult in advance with the Conservation Dept.regarding the
method of dewatering.
14. Work shall not impede boat traffic.
15. Dredged material shall not be deposited within Conservation Commission jurisdiction without their prior
approval.
16. Work on the pier shall ensue mid-tide rising to mid-tide falling or as otherwise necessary to provide a
minimum 12"clearance for the work barge above the substrate.
IV. After all work is completed, the following condition shall be promptly met:
17. At the completion of work,or by the expiration of this Order,the applicant shall request in writing a
Certificate of Compliance for the work herein permitted. Barnstable Conservation Commission Form C
shall be completed and returned with the request for a Certificate of Compliance Where a project has been
completed in accordance with plans stamped by a registered professional engineer,architect,landscape
architect or land surveyor, a written statement by such a professional person certifying substantial
Page 4.2
compliance with the plans and setting forth what deviation,if any,exists with the record plans approved in
the Order shall accompany the request for a Certificate of Compliance.At the time of the request for a
Certificate of Com liance an updated se uence of color hoto a hs of the undisturbed buffer zone shall
be also submitted.
Page 4.3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number
RARNMB SE3-4399
WPA Form 5 — Order of Conditions
ass.1639. ��� Massachusetts Wetlands Protection Act M.G.L. c. 131 §40 Provided by DEP
iOlF��.f A
And Chapter 237 of the Code of the Town of Barnstable
B. Findings (cont.)
Additional conditions relating to municipal ordinance or bylaw:
This Order is valid for three years, unless otherwise specified as a special condition pursuant to P General
Conditions #4,from the date of issuance.
p a
Date
This
Order mus
t be signed by a majority of the Conservation Commission. The Order must be mailed by
certified mail (return receipt requested) or hand delivered to the applicant. A copy also must be mailed or
hand delivered at the same time to the appropriate Department of Environmental Protection Regional
Office (see Appendix A)and the property owner(if different from applicant).
Sign t es:
2
On Of
Day Month and ear
before me personally appeared
Cie
to me known to be the person described in and who executed the foregoing instrument
acknowledged that he/she executed the same as his/her free act and Rr"deed. ,'�`+� '��O,v� �+�'0
Notary Public ,
My commission Expires s f'
This Order is issued to the applicant as follows:
by hand delivery on [� by certified mail, return rec>yi �.�s
AUG 3 ZOQS
Date
Date
Wpaform5.doc•rev.a/2/05
Page 5 of 7
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
ABLA WPA Form 5 - Order of Conditions SE3-4399
1639.3 �
Jf Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
And Chapter 237 of the Code of the Town of Barnstable
C. Appeals
The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land subject
to this Order, or any ten residents of the city or town in which such land is located, are hereby notified of
their right to request the appropriate DEP Regional Office to issue a Superseding Order of Conditions.
The request must be made by certified mail or hand delivery to the Department, with the appropriate filing
fee and a completed Appendix E: Request of Departmental Action Fee Transmittal Form, as provided in
310 CMR 10.03(7) within ten business 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 the Conservation Commission and to
the applicant, if he/she is not the appellant.
The request shall state clearly and concisely the objections to the Order which is being appealed and how
the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands
Protection Act, (M.G.L. c. 131, §40)and is inconsistent with the wetlands regulations (310 CMR 10.00).
To the extent that the Order is based on a municipal ordinance or bylaw, and not on the Massachusetts
Wetlands Protection Act or regulations,the Department has no appellate jurisdiction.
D. Recording Information
This Order of Conditions must be recorded in the Registry of Deeds or the Land Court for the district in
which the land is located, within the chain of title of the affected property. In the case of recorded land, the
Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land
subject to the Order. In the case of registered land,this Order shall also be noted on the Land Court
Certificate of Title of the owner of the land subject to the Order of Conditions.The recording information
on Page 7 of Form 5 shall be submitted to the Conservation Commission listed below.
Barnstable
Conservation Commission
Wpaform5.doc-rev.8/2/05 BARNSTABLE REGISTRY OF DEEDS
Page 6 017
Assessor's Office Ist floor Map Lot Permit#
Conservation,Office 4th floor Date Issued
Board.of Health Ord floor
Fn ig necring Dept. Ord floor) House#
Planning Dept. (1st floor/School Admin.Bldg.): i i
NAM
Definitive Plan Approved by Planning Board 19 039.
(Applications processed 8:30-9:30 a.m.& 1:00-2:00 p.m.)
t
TOWN OF BARNSTABLE
Building Permit Application
Proiect Street Address r U C�1 n net?6i-rli—
Village \S Fire District
(hvncr ( ► !'1 �(� Address'
Tcic hone —
Permit Request: V —
Zoning District Flood Plain Water Protection
Lot Size Grandfathered
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use
Construction Type
Existing Information
Dwelling Tyne: Single Family Two family Multi-family
Age of structure Basement type
Historic House Finished
Old Kings Highway Unfinished
Number of Baths No. of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel Central Air Fireplaces
Garage: Detached Other Detached Structures: Pool
Attached Barn
None Sheds
Other
Builder Information
Name lO L L 41�1_YY1 V,1 l 6 of��j , Telephone number ��—��t— `1�U�f
Address c ��P G LI lXa' 'Y1 ��l1 Pi�J�i(", License# o J b 5lp� ( l L 0 fit'^
CLnn I., m-o '02LQ01 Home Im rovement Contractor#
Worker's Compeusation # o f f+-'6D1r° (2rno l Eby-
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
Project Cost J,
Fee
SIGNATURE DATE I
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
BPERM T
FOR OFFICE USE ONLY
ADDP%ss 78 Channel Point Road VILLAGE
r
OWNER Ronald Anderson
DATErOF INSPECTION:
t
FOUNDATION t
•FRAME...-/,S
INSULATION a
FIREPLACE I
• r . r
ELECTRICAL: ROUGH FINAL -
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
-
�36�s -{
FINAL BUILDING:
U'DATE CLOSED OUT: 00
,
ASSOCIATE PLAN NO. {{
i
,
1
� � ✓/t8 TOO�l14JtOI�O���d�udeU4 �
F HOME IMPROVEMENT CONTRACTOR
Registration 104361 DEPARTMENT OF PUBLIC SAFETY
Type - INDIVIDUAL
Expiration 07/13/96 license: CONSTRUCTION SUPERVISOR
Number Expires
i� 2 Breakwater Shores Dr.
�'*yannis MA 02601
d WIIIIAN R TOURIES
ADMINISTRATOR
..�..,�,� 2 BREAKWATER SHORES OR
v commes"" HYANNIS, MA 12601
I
E
REST ONS: 16
License or registration valid for individual
t se .only before pi date. If found
a retur o e As urtoLlace m 1301
w.s.
6
i
i
l E(
l-
��THE T��✓
C O
The Town of l3arnstafile
on� -
I)C lat'tfi10TII i I I I}':il�li �:31�'i�� :i(Itl I:fl�lI II IIICItt:�l
Building DivIS1011
367 Main Street,Hyannis MA 02601
Office: 508 790-6227 Ralph Cros9en
Fax: 508 775-3344 Building Commissioner
For office use only
Permit no.
Date
AFFMAVIT
HOME IMPROVEMENTCONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c.142A requires that the-reconstruction,alterations,renotation,repair,modernization,eonversion,
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,alth certain exceptions,along with other
requirements.
T3W of'Alork: \ e Est.Cost
Address of Work: n "r>e
Owner Name:
Date of Permit Application:
I hereby certifv that:
Registration is not required for the following reason(s):
Work tNcluded by law
Job under SI,OW
Building not owner-occupied
Omer pulling own permit
Notice is hereby given that:
OWNTERS PULLING THEIR OWN PER!,,OT OR DEALING NWM UNREGISTERED CO—RACTORS
FOR APPLICABLE HO,`vIE IMPRO%TVE-`' ' WORK DO NOT HAVE ACCESS TO THE
ARBITRATION PROGRAM OR GUARAN FUND UNDER 1,1GL c. 142A
SIGNED UNDER PENALTIES OF PERTURY �-� t `S1 , vc�wl_lt -S0__PE�
I hercby apple for pc as ^ent of r:
D e Registration No.
I
OR
Date ChA-ner's name
f
V J 600 WI.jknyl,,n Shwt
James J.Campbell 12o3lon, MamacLialb 02111
Commissioner
Workers' Compensation Insurance Affidavit
(tkenscelpermiccce)
with a principal place of business at:
(cicy/sa Zip)
do hereby certify under the pains and penalties of perjury, that:
() I am an employer providing workers' compensation coverage for my employees working on
this job.
Insurance Company Policy Number
1 am a sole proprietor and have no one working for me in any capacity.
() I am a sole proprietor, general contractor or homeowner (circle one) and have hired the
contractors listed below who have the following workers' compensation policies:
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
C
Contractor Insurance Company/Policy Number
() 1 am a homeowner performing all the work myself.
I underst nd iha:a copy of this statement will be forwarded to the Office of Investigations of the DIA for coverage verification and that failure to secure
coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to s 1,500.00 and/or one
years'imprisonment as well as civil penalties in,the form of a STOP WORK ORDER and a fine of s 100.00 a day against me.
fi
q q
S" n this day of �(� 19
kL- ensee ' er mite Building Department
Licensing Board
Selectmens Office
Health Department
TO VERIFY COVERAGE IN ORMATION CALL: 6 7-727-4900 X403, 404, 405, 409, 375
- '� ....
Assessor's map and lot number 55 . ...2�D........... ...
SewagePermit number ..........................................................
yofTNEro�� TOWN OF BAR,NSTABLE
i 33ARNSTABLE, i
I
ftH Av ,� BUILDING INSPECTOR
10
APPLICATION FOR PERMIT TO .••�1w��a .. �' t S. .. ..... ......��� .�....
TYPE OF CONSTRUCTION ............................................. h .......................................:....................
....Z�r...............19.
TO THE INSPECTOR.OF BUILDINGS:
The undersigned hereb applies for a permit according to
the followi information:
Location .:............74F �w.�l. r. . .T. r ...................
........ ..... ......... ................ ....
Proposed Use .................. ��SC��I � v ...............................
..... . .....
Zoning District ....6.................................Fire. District ................l. .... ��................ .
Name of Owner .... ............. .... ess ........
7C.. ................Name of Builder ....................................................................Address ....................................................................................
Nameof Architect .............•!"!n.........................................Address ...................................................................................
Numberof Rooms ...............—............................................Foundation ..............................................................................
Exterior .................................. .`..........................................Roofing ...................... ........................................................
Floors .........................................Interior
Heating ..................................................................................Plumbing ..................................................................................
Fireplace ..................................................................................Approximate Cost ....................................................................
Definitive Plan Approved by Planning Board -------------------_-----------19________, Area ..... .. ......... ...............
Diagram of Lot and Building with Dimensions Fee
E-
.............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Na re a ....
Anderson, Alton F. . . P t
16665 . permit for demol3s
garage
Location 78 Channel Point Road y
...............................................................
..........................Hyannis................................... , k
Alton F. Anderson ,
Owner ,
Type of Construction ...........................frame............... c �
................................................................................ p
Plot ............................ Lot ................................ 1
qqa i
i
Permit Granted ... .....Qatober..16........1.2— 73
Date of Inspection ... . '... ..a.. 19
Date Completed 3
l!
PERMIT REFUSED
................................................................ 19
ff +
............................................................................... k
I
............ ...............................................................
............................................................................... 1
� I
Approved 19
........................................................ ..................
.................... .........................................................
r'
Assessor's map and lot number M4P,,#,12.6,,,,,,Lo.t,,#74 "� � d�""G ��/C✓�/?�
SEPTIC SYSTEM MUST BE
,� j � G �l V ITH A2 IN COMPLIANCE
Sewage Permit number :-. ...... .�'���f"..•... .... n ICLE II
- "IT'ARY STATE
QyOF?NE tp�t TOWN OF B A R l��`�`17 co�L� TOWN
MAWSTIBLE, i
BUILDING INSPECTOR
'APPLICATION FOR PERMIT TO const,ruct,,, dd.........................,,Q i,S �,�g, b �, ,�, g,............
TYPEOF CONSTRUCTION .WQ.Q.d...traMe........................................................................................................
................. ..........19...�.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ...78.. Channe l PointRQ ...
. „ ... ..... .,. .. . 5........................................... ...................................
ProposedUse .Q!e,...F.a111Uy....DXCJ,1.7.xlg. ......................................................................................................................
Zoning District Fire District Hyannis H
........................................................................ ....... . ..................................................................
Anderson
Name of Owner AI QCI...kr...bc...Eve ..?x1...M.................Address .1$...P1eas.ant, St , a H anni,S , Mass
Name of Builder EZY ll... .....................Address P....O......ROX... ...........
Nameof Architect .NQ11.......................................................Address ....................................................................................
Number of Rooms ....Two......................................................Foundation .Paur.ed...CoTAG.xe.t.e....................................
Exterior ..WQw.d...Shingles..............................................Roofing ..Asphalt
Floors ....P!Y..WQQd..W/..Wall....to....Wall...ira-rpelInterior ..Sheel...r0.G.k.......................................................
Heating FQr.G.ed..W4=..Air...h. ..Gas......................Plumbing.1...full...bath,,:&...1...hall...ba.th..............
Fireplace NQrLe.......................................................................Approximate Cost ..,$.2�.,. .Q�...Q.Q...................................
// .Tf
Definitive Plan Approved by Planning Board ________________________________19________. Area ........../..........5�?..............
Diagram of Lot and Building with Dimensions Fee 'c ........./
i SUBJECT TO APPROVAL OF BOARD OF HEALTH
47'o ,.
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Farw,erS 1por`h
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I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name . .. ........ .... .............................
k
Anderson, Alton F. & Evelyn M.
a
16655 add to..
No .:............... Permit for ...................... .... ........
single family dwelling - T
...............................................................................
Location
78 Channel Point Road
Hyannis......................................... _
Owner Alton F. & Evelyn M. Anderson .4
Type of Construction frame
..
............................................................... ................
1 ,
f t
Plot ............................ Lot ................................ j,
m
!
Permit Granted ..... October 15 73........ . . .......o.....:..�. �.1�.
Date of Inspection .. .. ... . ..��....... ........ .�� >
Date Completed ....7 ..........19
PERMIT REFUSED
................................................................ 19
I
............................................................................... $ i,
............................................................................... r
...............................................................................
...............................................................................
R ,
Approved r'
............................................................................... J
..................... .........................................................