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0007 CHERRY STREET
ti 'r chi s r TOWN OF B. RNSTARRE CAPECOD INSULATION ? d er. 9 FM11* FW@--),]I- N...-ASS SEA MEE53 SPPAT FOAM 9USpENl1E0 6AM OUtTEFi INSYIANON CNEIN03 c> 3` �"'�_a 1-800-696-6611 01, 1q-I Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 P Date: S Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute. (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village 1/1/l6L rk Mc AA k- 7 C-,err a,tAA I'� Insulation Installed. Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls ( ) ( ) ( ) ) ( ) Sincerely He y E Cas y Jr,,President t. Cae Cod I ulation, Inc. , 3 1- r TOWN OF BARNS TABLE BUILDING PERMIT APPLICATION A O/ate j/�j w f ._ TOPIf AflRN!R Ak Map Parcel Application # 9 A" 1 S AM 9� �7 Date Issued Health Division Conservation Division Application F c Planning Dept. DIV�h%l Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address '�� _ Village Owner , ✓G Address Telephone (52' Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Ood ,�' r a Construction Type 1,V- Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family J Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes (dNo On Old King's Highway: ❑Yes Flo 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 batl ,): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ 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 ❑ Commercial_ ❑Yes ❑ No _ ,If,yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name � l' ��� i1� Telephone Number �(���V/ /44 Address /t i�. �� / License # Home Improvement Contractor# Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE L r � FOR OFFICIAL USE ONLY APPLICATION# 1 DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE #` OWNER DATE OF INSPECTION: FOUNDATION 'f FRAME s INSULATION— FIREPLACE ELECTRICAL:- ROUGH FINAL ' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r >a �'Irr�s:nclur,ctts - Uc , u'fnuut of Public .tiafC1% I ' t3oartl ul litril"tlin�� Ro;;ulatrnns :urn `+t;,nilartls construction Supervisor License "..0 S� 100988 "��'d 4• 5tap�a I HENRY CASSIDY tl 8 SHED ROW WESjT '4ARMOUTH, MA 02673 .._ems_ Expiration: 11/11/2013 l „Iwni..i,lu r Tr#: 7620 �G'[:CY.,1JW°`1.(,l-:lE' 1• Office of Consumes Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: '153567 Tvpe: Private Corporation Expiration: 12/15/Zbl4 Tr# 233831 CAPE COD INSULATION, INC - HENRY CASSIDY __._.-_..... .__-_. 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 __..__._.._...__.__. ......... ._ Update Address and rehu'u card, Mark reason for change. Andress CI Renewal l_� I?rnployn,eut L L,osr Curd 'r�� \(j'rac uir�//r(�t'rr(/}Z C�(::'('(17J:1Rr,➢�l Cf,1K��J .... - i, uriirr ut Consuwa AltLirs J Ltusuress 12cgulatio❑ License or registration valid for individul use only ` rOME IMPROVEMENT CONTRACTOR before(lie expiration date. If found return to: egistration: 153567 Type: Office of Consumer Affairs and Business Regulation w� ;Expiration: '12115/2014 Private Corporation 10 Park Plaza-Suite 5170 Boston,NIA 02116 .0Y,C01)1fT,ULATI0N.',INC IB lit::"rRDON CIRCLE: Y\WAOUl t I MA 02664. ------ _ — -- -- ----.___.._._.____..__-_.....-- _ t.lndersecrewry of van witho t oat rc ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: / City/State/Zi Zi �- Z�)Tr/.,G '-Phone #: Are you an em oyer7 Check the appropriate box: Type of project(required): 1.❑ I am a employer w#h 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' [No workers' comp. insurance comp. insurance.t 9• ❑ Building addition required.] 5 We are a corporation and its 10.❑ Electrical repairs or additions I 3.❑ I am a homeowner doingall work officers have exercised their . 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required]t c. 152, §1(4),and we have no 3a.❑ I am a homeowner acting as a employees. [No workers' 13•2�Other Z&-[J�i�%i general contractor(refer to#4) comp.insurance required.] ;Any applicant that checks box#1 must also fill out the section below showing their workers'compensatiod�olicy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractom that chuck 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 1 mnp oYeCs,they must provide their workers'comp.policy number_ � I an 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.#: 12,eq Expiration Date: Job Site Address: /� lt.��'J�' ,Sr'" ;j � City/State/Zip:�JY,,5� e D / Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and enalties of pedury that the information provided above is true and correct Date: cz Phone#: r�� �7 %2 F use only. Do not write in this area, to be completed by city or town official own: Permit/License# uthority(circle one): of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector Person: Phone#• ;V CAPECOD-27 MYOUNG DATE(MMIDDIYYW) CERTIFICATE OF LIABILITY INSURANCE 7/8/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PliooucER License#PC-514062 CONTNAME ACT Margaret Young Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 IAIC.No xt: A/C No): South Dennis,MA 02660 ADDARESS:myoung@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:PEERLESS INSURANCE COMPANY INSURED INSURERB:COMMERCE INSURANCE COMPANY Cape Cod Insulation,Inc. INSURER C:Evanston Insurance Company 18 Reardon Circle INSURER D:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth,MA 02664 INSURER E r 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 • A POLICY EFF POLICY EXP LTR TypEOF INSURANCE I SR WVD POLICY CY NUMBER MM/DD MM/DD/YYYY ' LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CBP8263063 4/1/2013 4/1/2014 PREMISES Ea occurrence $ 100,000 CLAIMS-MADE �X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO LOC $ JECT AUTOMOBILE LIABILITY COMEaBINED SINGLE LIMITdent $ 1+000+000 acd B ANY AUTO 13MMBCKVMK 4/1/2013 4/1/2014 BODILY INJURY(Per person) $ALL OWNED X SCHEDULEDAUT AUTOS BODILY INJURY(Per accident) $ X H REOD AUTOS X NON-0WNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000io00 C EXCESS LIAR CLAIMS-MADE XONJ453512 4/1/2013 4/1/2014 AGGREGATE $ .1,000,000 OED X I RETENTION$ 10,000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER IDANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCA00526904 6/30/2013 6/30/2014 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Workers Compensation includes Officers or Proprietors. Addtional Insured status is provided under the General Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIVE - - ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD d OWNER AUTHORIZATION FORM 1, MC.Irk �� (Owner's Name) owner of the property located at 7 , (Property Address) 1VV -i h hi 26 G , (Property Address) f hereby authorize rod Tf1s Ja , (Subcontracto ) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owners SiFEW— Date t o Town -of Barnstable * oF � Permrt# O Ewes 6 months am issue date Regulatory Services Fee 9� iG ��� Thomas F. Geiler,Director -PRESS PERMIT Building Division OCT -3 2012 Tom Perry, CBO, Building Commissioner � . 200 Main Street,Hyannis,MA 02601 www.townb arnstab e 1 pus TOWN OF BARNSTABLE 0ffice: 508-862-403 8 Fax: 508-790-6230 EXPRESS PEE IT APPLICATION RESIDENTIAL ONLY Not Va&d without Red X-Press Lnprint Map/par6el Number ' J l - -}— m Property.Address G1 C (eeJ t Residential Value of Workµ > S imam fee of$35.00 for work under$6000.00 Owner's'Name&Address t)w V_ RY10 c ,,G k Gkj.1C( f Q�� c v. A.�5 60 � . Contractor's Name 0elephone Number (� - Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor Q I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name ' Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. ' Permit Request(check.box) - ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing-layers ofroof) ❑ Re-side #of doors . Replacement Windows/doors/sliders.U-Value ,c _3 /mmdmum..35 #of windows ( ) ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. . Separate Electrical&Fire Permits required. *where required: Issuance of this permit does not exempt compliance with other,town department regulations,i.e.Historic,Conservation,etc. ***Note: Prop Owner must sign Property Owner Letter of Permission. A cop o the Home Improvement Contractors License&Construction Supervisors License is i P required. SIGNATURE: Q:\WFRM\F'0RMS1b ding permit fo RESS.doc I - C 41*1 ? ( The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations + d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): K o"r V m C Address: C CS CQJ2,j+ . City/State/Zip: �'� Qv 0),z60JPhone.#: 509 b 9 0`6 V� Are you an employer. Check the appropriate box: Type of project(required):_ 4. I am a general contractor and I 1.❑ I am a employer with ❑ 6. ❑New construction . employees (full and/or part-time).* have hired the stab-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 g. Demolition d have workers'an working for me in any capacity. employees9. ❑Building addition [No workers' comp.insurance comp.insurance.$ quired.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions S4. am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13 Other ® S 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. 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). 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 Investi ations of tlw DU for insurance coverage verification. I do hereby certify nder the pains an enalties ofperjury that the information provided above is true and correct signattue: Date: o ` 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#: 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 bean 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 Moth the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if . necessary, supply sub-contractor(s)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/Ecense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/hcense 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 CornmQnwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TO. 617-727-4900 ext 406 or 1-$77-MASSA.FE Revised 11-22-06 Fax#617-727-7749 www.rnassgov/dia I °FtHE ram, Town of Barnstable ti Q. Regulatory Services 9BARNSTABLE,� Thomas F.Geiler,Director 16.39-I" Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8. Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder W l nC I/i C V, , as Owner of the p ro subject e J p nY hereby authorize V" °� V"�e(i�� "� to act on my behalf, in all matters relative to work authorized by this building permit: C C S c (A<4ess of job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to befe e or utilized before fence 's insta dandallfinal inspe ons ormed and accepte . Sign e of Oyer S tune plicant Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS 62012 �IHE r Town of Barnstable �~ Regulatory Services Bnxtvsrast s Thomas F.Geiler,Director Mass. 16S9' Building Division . lEn Mai" Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508.862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: '0 3 r 1�- JOB LOCATION: number streeu village "HOMEOWNER"M (Ar y MC'(,�)rnZ oy, 5 8-81 S'-6994 5�v , name home phone# work phone# CURRENT MAILING ADDRESS: G"\/- (Q / �J 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 pemut (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other. applica e codes,bylaws,rules and regulations. The undersi d"home er certifies that he/she understands the Town of Barnstable Building Department Fm.inspe on proc es and requirements and that he/she will comply with said procedures and A ents. ignat 1 o Home er 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 k 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:forms:homeexempt a APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 1 Name A/u/V Telephone Number V* Address � 2I�� ��� License# 1414 / Home Improvement Contractor# 5. Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE / �✓ TOWN OF BARNSTABLE_BUILDING PERMIT APPLICATION .• • J l_' Map Parcel Application #Coe D� Health Division Date Issued Conservation Division Application Fe Planning,Dept. =Permit Fee c� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address CY `ST�Zcy 7 Village ` 4NN leb Owner �N (. Address ( Telephone 0 G 7 / Permit Request ��0 Fjkm raO%o7 E)NOMV06 Square feet: 1 st floor: existing 10 proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay "'J: Project Valuation Construction Type /e"►0,0,6Z. p Lot Size r l 4024f 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 XNo Basement Type: gFull ❑ Crawl ❑nWalkout ❑ Other Basement Finished Area(sq.ft.)• 1���- Basement Unfinished Area (sq.ft) V14 Number of Baths: Full: existing d new _( Half: existing new _ Number of Bedrooms: !Yexisting enew Total Room Count (not including baths): existing new First Floor Room Count o Heat Type and Fuel: ❑Gas XOiI ❑ Electric ❑ Other Central Air: ❑Yes X No Fireplaces: Existing i—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 ❑ Commercial ❑Yes XNo XNo If yes, site plan review# Current Use Qf6KC O Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) (r�Name J"6 � Telephone Number �0� /�� ll>t) dry. Address J IL Pfi/�w 0 L✓ License # Z v �F J Lft?,tfo V 6 f, Home.Improvement Contractor# / U Worker's Compensation # w a 7"01?(5(0Y7_ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO V,� SIGNATURE DATE ���L/ FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: { FOUNDATION F P ' FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 'd} DATE CLOSED OUT ASSOCIATION PLAN NO. , a .i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorslEIectri Bans/Plumbers A- licant Information Please Print Le I Namr, (Businrss/Organization/Individual): ON Address: Ci /StateJZip: �fi���v7`� -. Phone.#: �Y - F_. you an employer? Check the approprta z: Type of project(required): am a employer with 4. . lam a general contractor and I 6. ❑Ncw construction r mployccs (full analor part-time).* have hired the sub-contractorslisted on the attached shact7. ❑Remodeling I am a sole proprietor or partner- These sub contractors have ship and have no employees 8. �]Demolition employees and have workers' working.for mr,in any capacity. 1 9. ❑Building addition [No workers' con)P.•1M 11r cC C°�'Insuuance. LO_ Electrical rc airs or additions rPmrirC ] S. ❑ We arc a corporation:and its ❑ p 3. I am a homeowner doing all work officers have cxezci-sed their 11.❑Plumbing repairs or additions mtyscl�[No workers' comp. right of exemption per MGI. 12.❑RDof repairs inerrranCe requnrd j t P. 152, §1(4), and we hay.c no 13.0 Other employees. [No workers' soap.insurance required_] *Any applicant that chcckc box#1 must also full out the=fion below showing their workers'coon policy infvrrmticm- t Homeowner;who cubmdt this affidavit indicating thcy arc doing a]l work and then 1&c outside contractors must submit a new afdavit indicat ng such. Tcontzactou that cbccic this box must attached an additional ehcct showing the name of the sub-contrctora a and state whether or not thosd en i cS have employees. 1f the sub—_onb-adore have=nploycu,thry mutt pnrvi db their workers'comp.pDbcy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the polity and jab site information. lnsurancr,Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: �7 S/< City/State/Zip:__//?/gi` L;) Af��t���j Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to•securc coverage as requiitd under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 5nc nip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a friar, of up to$250.00 a day against the violator. Be advised that a copy-of this statrmerit may be forwarded to the Office of Invcsti atians of the DIA for inanrancr,coverer c verification. I der Izereby certify under the pains and penaldPs of pe -- hat the information provided above is true and correct Si afore: /. Date: /�/v Phone Offuial use only. Do not write in aLs'area, tb be completed by city cr town afficiaC 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 Phone Contact Person: #: 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 ipdividual, 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 anindividual,partnership, association or other legal entity; employing employers. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the swelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house mr on the grounds or building appurtenant thereto shall not because of sucl;employmcnt be deemed to be an employer." v4GL chapter 152, §25C(6) also states that"every state or IocaI licensing agency shall withhold the issuance or -enewal 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 surance coverage required_'; in vdditionally,MGL ohapter 152, §25C(7) states`Neither the commonwealth nor any of its political subdivisions shall rater into any contract for the performance of-public work until acceptable evidence of compliance with the zn` ce egvircmenfs of this cbaptcr have been presented to the contracting authority." LpPlicants lease fill out the workers' compensation affidavit completely, by checking the boxes that apply to.your situation and, if ccessary,supply stab-contractors)name(s), address(cs) and phone numbers) along with their certificate(s)of tsurancc. Limitrui Liability Companies*(LLC) or Limited Liability Partnerships (LLP)with no employccs other than the icmbcrs or partners., arc not required to carry workers' compensation insurance. If an LLC or LLP does have t nployets, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial ccidcats for confirmation of insurance mvcragc. Also be sure to sign and date the affidavit The affidavit should returned to the city or town that the application for the permit or license is bring requested, not the Department of idustrW Accidents. Should you have any questions regarding the law or if you arc required to obtain a workers' ,mpensation policy,please call the Department at the nurraber listed below. Sclf-insured companies should enter their :if insuranro license number on the appropriate lint. ity or Tower Officials ease be sure that tiro affidavit is complete and printed legibly. The Department has provided a Sparc at the bottom 'the affidavit for you to fill out in the event the Office of Investigations has to contact.you regarding the applicant case be sure to fill in the permitliccnse number which will be used as a reference number. In addition, an applicant it must submit multiple pemmitlliccnse applications in any given year,need only submit our,affidavit indicating eurrcnt lacy information(ifneressary) and under"Job Site Address" the applicant should write"all locations in (city or Nn)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the plicanf as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled but�,each ir.Whcrc a bomc owner or ci6,-cn is obtaining a license or permit not related to any business or cor nercial venture ;. a dog license or permit to born leaves etc.) said person is NOT required to complete this affidavit e Office of lnvcstigations would h1C to thank you in advance for your cooperation and should you have any questions, ase do not hcsitatt to give us a call Department's address, telephone-and fax number. The Commonwoalth of Massachusetts Dg)artment of Industrial Accidents Office of IuVestigatierns 6.00 Washington street Boston, MA 02111 Tel. # 617-727-49-00 ext 4.06 ar 1-V7-MASSAFB Fax# 617-727-774g 11-22-06 www.mass.gov/dia Cape Regency A Radius Health Care Center %G Gv Lib i►^ ,y (e47` Y C oh�� �,' WGe-e C6i4�� ROOMY s4C rll��. Zte ( 4!.Aa�' Y � Ate. el) e- - 44 y 12le v 120 South Main Street, Centerville, MA 02632 508-778-1835 Fax:508-771-7411 _ I he Uommonwealth of Massacnuserzs Department of lndustritrl,4ceidents Office of Investigations 600 Washineon Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information -�- Please Print Leffibl� Name (Bus iness/Organizahon/Individual): �)7��C"�Y� Cn Address: U L Clt /StatelZip: U M� pQZ(v6LJ Phone.#: S Ar you an employer? Chec the appropriate box: Type of pro]ect(required): 1. I am a employer with 4. ❑ I am a general contractor and I . employees(frill and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.ElI am a•sole proprietor or partner- meted on the attached sheet 7. ❑Remodeling ship and have no employee,; These sub-contractors have 8. ❑D cmolition working for me im any capacity, employees and have workers' [No workcrs' comp, inx�tranGe comp.inairrancr.• t 9. ❑Building addition rtquired] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homoownrr do' ail work officers have exercised their � I.❑Plumbing repairs or additions Myself-.[No workers' comp. right of exemption per MGL 12 ❑Roof repairs insurance rcquirn:L] t c. 152, §1(4), and we havt no employees. [No workers' 13.❑ Other comp.insurance required] *Amy applimnt than checks box#1 Murt also fill out the erection below showing their workers'compensation policy infmTmiion. t Homeowoca who rubnrit dhis affidavit indicating they are doing all work and than hire outride cantrsetots must rubrmt a new affidavit indicating such. tCrmtractan that cbcalc thu box must adathrd an additional sbcct showing the name of the rub-�tracturs and rtalo wbetha arnot,thosC rntitirs haver msnploy=. If the sub-mnb=torz have canp)oycce,they must provide tbcir woTk='comp.pobcy number. lam an employer thal is providing Ivorkers'compensation insurance for my employees. Belaw is the policy and jab site information. Insurance Company Name: QC r)R Policy#or Srlf-ins. Lic. #: �� 1`��1, Expiration Datc:-1 i n9 Job Site Addrms: .1 C�Q �-r�sl City/Statc/Zip: `ZbkDcj Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to scctze coverage as required under ScctiDn 25A of MGL c. 152 can lcad to the imposition of criminal penalties of a fine uip 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 statcmerit may be forwarded to the Office of ImVestiZations of the bIA for in.rnrance coverazc verification. I do hereby ce yy under paias-and penalties of perjury that the information provided above is true and correct: Date: Phone — Offzcw use only. Do not write In this area, to be corrrpleled by cii� or town offtciaL City or Town: Permit/Licease# Issuing Authority (circle one): I. Board of Health 2.Building Department 3. City/Towu Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE"UMMIr" 08/14/2009 PRODUCER (781)447-SS31 FAX (781)447-7230 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Mason & Mason Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 458 South Ave. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Whitman, MA 02382 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Kimberly Wood INSURERS AFFORDING COVERAGE NA)C 9 INSuRED C&C Remodeling, Inc. INSURERA: Western World 000071 21L Fruean Ave. INSURER& Star Insurance 000204 Yarmouth, MA IBC: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR IM TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY NPPI177771 06/16/2008 06/16/2009 EACH OCCURRENCE $ 1,000, X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S SO, CLAIMS MADE �OCCUR MED EXP(Any one person) S S A PERSONAL&AM INJURY $ 11000100( GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE APPLIES PER: PRODUCTS-COMP/OP AGG $ 1 000 low PoucyJECT LOC AUTOMOBILE LIABSJTY COMBINED SINGLE LIMIT ANY AUTO (Ea a0derd) S ALL OWNED AUTOS eooar e1.wRY S SCHEDULED AUTOS (Per parser) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Par aoGdeM) PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC E AUTO ONLY: AGG S EXCESSIUMBRELLALUUMM EACH OCCURRENCE $ OCCUR Q CLAIMS MADE AGGREGATE S S DEDUCTIBLE S RETENTION S S WORICERS COMPENSATION AND WCO428S68 06/16/2008 06/16/2009 wcSTATU I JO& EMPLOYERS'LIABILITY B ANY PROPRIETOMPARTNIMM)MCUMVE E.L.EACH ACCIDENT $ 100, OFFICEwMEMBER EXCLUDED? OFFICERS INCLUDED E.L.DISEASE-EA EMPLO S 100 I�s,desPORO IO E.L.DISEASE-POLICY UST $ 500 00 SPECUU PROv18I er below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EMRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town•of Barnstable BUT FAILURE TqNA&SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY ...200 Main Street OF ANY arm u ON E AURE&ITS AGENTS OR REPRESENTATIVES, Hyannis, MA 02601 AUTHORIZED REk ACORD 25(2001/08) OACORD CORPORATION 1988 Town of Barnstable ,. N�of THE r��.,• Re _ .. gulatory Services Thomas F. Geiler,Director awt:xsrwatr;, "ASS. Building Division p�'p jE0► �"��� Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 ,R wAown.barnstable.ma.us Tice: 508-862-4038 Fax: 508-790-6230 H011TEOwNER LICENSE EX EMPT7ON Please Print DA TE: I✓ / 0 i JOB LOCATION: villa e street g nu /`mber HOMEOWNER": A00 �/ 50 )11)) (/`D 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. D);FTNTTION OF$OMEONTr'NER , 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- or detached structures . be, a one or two-family dwelling, attached uctures accessory to such use m and/or far structures. A person who constructs more than one home in a fivo-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. r e undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department ,,;min, pection procedures and r quirements and that he/she will comply with said procedures and •equ' eme :ignaturc of Homeowner .pproyal of Building official Note: •Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the tate 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 'this section(Section 109.1..1-.Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to dosuch ark,that such Homeowner shall act as supervisor." Many homeowners who use this exemption an:unaware that they are assuming the responsibilities of a supervisor(sec Appendix Q, Iles&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly icn the homeowner hirrs unlicensed persons. in this case,our Board cannot proceed against the unlicensed person as it would Huth a licensed pervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully awars of his/her responsibilities,many communities require,as part of the permit application, t 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 cral towns. You may care t amend and adopt such a fom✓certification for use in your community. • 1 �oFmeT ToWn of Barnstable 0 Regulatory Services BA"ySrAB Thomas F. Geiler, Director. uasq Building.Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstsble-ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section if Using A Builder r. A10 0 , as Owner of the subjectp property ' hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. • a l° . Town of Barnstable *Permit Expires 6 months f Me date +* sas Services Fee xsrAs�, + eiler,Director Lftilding Division LJ Tom Perry,CBO, Building Commissioner yannis,MA 02601 OK 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 vlap/parcel Number,3 o) ,31 'roperty Address QV\,e_''C V\ ®U Residential Value of Work 00 C4.4-- Minimum fee of$25.00 for work under$6000.00 )wner's Name&Address 1NYV LA 7C :ontractor's Name 7� Cb n9 d`Yi�rJ Telephone Number J�9g-2�0- c` ` Some Improvement Contractor License#(if applicable) J '7 L� construction Supervisor's License#(if applicable) - Workman's Compensation Insurance Check one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance nsurance Company Name Workman's Comp.Policy# �opy of Insurance Compliance Certificate must be on file. 'ermit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-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 Immprrovement tracto s License is required. SIGNATURE: �/' ' �:Forms:expmtrg tevise071405 r j f - J StapJ k f befor registration IVjl �oacJ pVE a the expiration for indrv�dul x E Tard ef& daW If found uac are.► NOM Est � � p�! Cac Ashy �Iding Tfegulations.an r``4ru to. Ete t t [3oston, jr6f place R;i 7301. d Standards_ Gem o�t�d r°,� ''d V thou t.si"nature. L The Commonwealth of Massachusetts Department of Industrial Accidents st. Office of Investigations �`' 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): Address: 3_ 1P4(5;,s Lo-) City/State/Zip:CC vt1` lyty At d:>,63k Phone #: ; 5?)S_,2_9�O -j-9f Y:7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the'sub-contractors 2.W I am a sole proprietor or partner- listed on the attached sheet. t �• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I I.El Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.�ff Roof repairs insurance required.] t employees. [No workers' 13.[1 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below.is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: 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). 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 certif under the pains.qV pena ies ofperjury that the information provided above is true and correct, Si afore:it: 7 1? Date: I a Phone • �� g' �g _ g Official use only. Do not write in this area,to be completed by city or town official Yz 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#: �t \� y •1 ��tNE Tp� l saxxsreau� : Town of Barnstable Regulatory Services fOe Thomas F.Geiler,Director Building Division Tom Perry,CBO 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 as Owner of the subject property hereby authorize a- Co Ai`C& to act on my behalf, in all matters relative to work authorized by this building permit application for: n CANC-C-4—Y s1, u JCchnJs PCB (Address of Job) Signature of Owner Date Ann .0x Print Name Q:For ms:expmtrg Revise071405 aAWl.Nt� FG2 " Nf•l crux _ SI�E�r 1 i 1� -- 2xrsT.r�G W✓'God \ j 7-1 t I1 I i I J , r 3 ' ►a � l tai I I. I 1 3d' r ' i�G O�Z Rn11J Gpx SUEET dF - a S Ll N -12 t6� 2 ''7 24�3 C I i �Z r 2FrsT.r�G kjrN floes 1 , P/ 3 40 -i I We,ALMON G. COX and ANGIE F. COX, husband and wife, both of Barnstable ( Hyannis), Barnstable County, Massachus•.etts, beingxxmarried, for consideration paid, rant to ALMON G. COX and ANGIE F. COX, husband and wife, and ANN.E. G. COX, being unmarried, all of Barnstable (Hyannis), Barnstable'County, Massachusetts, as joint tenants and not as tenants in common 16 with q1t{ttjgiln tnuettsttis X9'eCpbltdCSdC (Description and encumbrances,if any) The land with the buildings thereon, situated in Hyannis, Town of Barnstable and County of Barnstable, Massachusetts and shown on a _- certain plan hereinafter referred to. Said land is bounded and described as follows; Beginning at. a. stake in the SOUTHERLY side of Cherry Street THENCE running SOUTHEASTERLY by said Cherry Street, fifty ,.(50) feet, to Locust Street;. THENCE running SOUTHWESTERLY by Locust Street, one hundred (100) feet to a stake at land now or formerly of Lila L. Canet; THENCE running NORTHWESTERLY by-:other land now or formerly of Lila L. Canet, fifth (50) feet to a stake. THENCE running NORTHEASTERLY by other land now or formerly of Lila L. Canet, one hundred (100) feet to Cherry Street- and point of beginning; Meaning.and intending, hereby to convey a certain lot of land fifty feet in width and one hundred feet in depth at the extreme SOUTHEASTERLY part of said Cherry Street. Said lot of land being a part; of. the premises shown as "Reserved . Parcel"' .on a plan entitled, "Ridgewood,"' Hyannis, Massachusetts, belonging to Ernest S. Bradford, George B. Lewis, Thomas Otis, .Lindsey N. Oliver, 1g24..-Said premieessare conveyed .subject to,_any_ and all restrictions of'record. ` For our title, see deed of Mary C. Carlson to us dated, March 30, 1946 and recorded in the Barnstable County Registry of deeds, in Book,.643,page 452. MUM NIWX releacssexxc�lffixg�ast8�a�per�ilCs�t�¢ tam;a�Ggccotmx4rxas�xmat�ol�eaiaata�tstCtnepe9n. diaca,;�Kxolssasa� Wi2nes.s..0.Rx....hands and seals this......s.ixth...................day of........pr.0.....................15?1.... ................................................................................. ,�(... ... •....................... ................................................................................ ,Xr.;kf!1'.1- ...... .° ........................ ................................................................................ ................................................................................ iIIllr �tamtnnttulrxlti; of fbsssrituutis BARNSTABLE ss. APRIL `6 1961 Then personally appeared the above named ALMON G. COX and acknowledged the foregoing instrument to be his free act and deed,before me . . . . .. ... ..... Notary Public—J otaa yPublic—J My commission expires %'/GR/��1 �.3 19 (' Individual Joint Tenants—Tenants in Common—Tenants by the Entirety.) I Outs*Norm n# Quifriaim Dub �. ALMON G. COX ET UX BjSTA$LE -' REGISTRY OF DEEDS TO c ' -ALMON G. COX et ux: and. . APR 12,1961, ANN E.. G. COX' F` —.RECORDED_...__ Z. x 'o c a E o Barnstable ss AFril 12t 1 61 a C C c / ... ... 9. v v r minutes..: .m o'clock and !ff a. o m 15 c y _+ Received and.entered with...: I,. ................ . :Barnstable we E ^+ e y - o ..... County ...............„ ... .,....................................r Deedsaw < J 0 Page... , .................... Bok.. : .......z a CIO =}`'•.' .' Attest. I [. � A .. I oH v Register... p V C v ,� _ FROM THE OFFICE'OF . o Ellis & Staff . O _ 330 Main,Street' Hyannis,..;Mass. 4 HOBBS IN WARREN. INO. - - PUBLISHERS STANDARD LEGAL FORMS • !� BOSTON - MASS. I Form 881 '7 �? - (:5t Assessor's office(1st Floor): O o*Y"E Assessor's map and lot number Board of Health(3rd floor): Sewage Permit number /� -7-)IIUST CONNECT TO TOWN SEW=` �' o ��� _ Z BABd9'fdDLL i Engineering Department(3rd floor): iGJ� rues House number °° '639' ®� Definitive Plan Approved by Planning Board 19 �o Mpv d APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING . INSPECTOR p APPLICATION FOR PERMIT TOE,, l� Sc: a/ RC7¢> f SCREEr/ IQO{tf„4-1 t S, sy TYPE OF CONSTRUCTION j F&�b r-kA n.z 6/94 19 :99 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby'applies for a permit according to the following information: Location :5t Proposed Use Zoning District M. T-b Fire District al��Ay S Name of Owner!) 63/ Address 7 C4,wril J7` Name of Builder Address 2,5- zBAP�A✓H,LL R-L . Name of Architect Address d-6a-me_ Number of Rooms g2-ma Foundation rs"s,.r...CA , 7'�u4a. Exterior s I n<l Roofing A's Floors / r1 Interior Heating_, ° Plumbing Fireplace 62hz Approximate Cos (�,s-m oz, Area Diagram of Lot and Building with Dimensions Fee �y 3 o C /,00 J 5 1 , t,exr� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLIN13,15 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. , e S' Name Construction Supervisor's License � - COX, ANN No 33094 Permit For Replace, Expend & Enclose Porch/ Single Family- Dwelling-Location 7 Cherry Street Hyannis- Owner Ann Cox Type of Construction Frame ! �` r Plot Lot { f Permit Granted July 24, 19 89 R, Date of Inspection 19 Y Date Completedd� ,L_19 t .h M _ t A f J 11/02/94 17:02 '$6177277122 DEPT IND ACCID .0001 (' Catni WnujP,a&L J Ma-jjaclytt�eltj 2aparfinenl o�J ndu�Eria6,�Jcci nf� 600 gqV/�/V��rra�tiq&.Shwef James J.Campbell Aston, /i'/aejackwadd 02 f f f Commissioner Workers' Compensation Insurance Affidavit C'—wr--— with a principal place of business at: Cher r--t 5-ts et I b 4 an l kA yo2-(tz i /st"i4p) 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 () I am a sole proprietor and have no one working for me in any capatity. I am a sole proprietor, general contrauor or omeowner 'circle one) and have hired the contractors listed below who have the following workers' compensation policies: Eve I OcL (�ons v��-fary Wcusraa�__ ins. 5Is De►�oq�3y� Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number () I am a homeowner performing all the work myself. i understand that 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 151 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 enalties in the form of P WORK ORDER nd a fine of S t00.00 a day against me_. Signed this Q day of S 19 .nset:Permitrige V Building Department Licensing Board Selectmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 TOWN OF BARNSTABLE BUILDING PERMIT # 3 75— O,3 4-1 K.+, •x .s`a�4 j�ser :ry �` . 'Y ��i . '+?xi5L4 $4�kwN, t t y�&-'eta [,: 3o7 Mam Suc.:,}7\12wi,N I�''iA 02601 O1hoc: 508-79"227 Far 508 775 3344 MdPh Crassea For office use only Ba(figg«Ommissioner Permit no_ Date AFRIDAN IT HOM-EWPROVEM WrOONTRACMRL&W . SUPPIENINTTO PERMITAPP1JC&-nO3V MGL c.I42A requires that the'Scoosstnxtion,altaatioas;Iraa«tioq Tcpak impmvrtnc it, veraocal,demolition_or oor action of - 'an addnt<oa to any prr`pust owner building containing at least one but not morn than four daclling units or to structures which erne adraceat �- to such irsideam or building be done by rr&cr=d contractors,with certain exceptions.along with other Type of"Mori::_ ()Lt � k-rdse S�cG� (un atC u,Est.Cost r if' 00 Addressof Work: °�, (�yr c cy cps, 1 d�h15 Owner Dame:_ N n6\ Date of Pcrrnit Application: I hcricbyc-rtifvthat: Registration is not required for the follotAin€rerson(s): Work excluded b`V iza- Job under S1400 Building not ov.-ncr-occupied t/ O-ncr pulling own perirtit hoti<X is hcrcbv gi\cn th2t: O«';•* '�PULLT�G Tr'�IR O�:T 1^Er�.Si�O�D�ALT':G l:'lTr?U:.'REGISTERED CO�'7RACIORS FOR APPLICABLE HOB P.�:O�i`• ti i .�:'OFi; DO I OT HAVE ACCESS 7O Trit ��81 TF��TIO FFCOG f;Or Cllf c�?.-T� fl1D( .-DER 1?GL c. 1<2A SIG-'QED UNDER PEI;ALTIES OF PER1i1Fl- 2Y�,k-for e Dace �f71:.cC:Crr�r�:c P.csistration 3�0- OR Deic -ncr's name TOWN OF BARNSTABLE .. BUILDI?dG IJF.?_-- �'.^ Please print. -- DATE JOB LOCATION r7 ✓herrect dnr�� Number treet address :.:Section of c . . "HOMEOWNER" Anil 4+ Name Home phone Work ,phone x1 PRESENT. MAILING ADDRESS C.Vi r Cit y town ' State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual 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 re- side, on which there is, or is intended to be, a one tO six 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-yearperiod 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 St at Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department 5�Dimum inspection procedures and requirements and that he/she will comply wi s id procedures and requirements. HOMEOWNER'S SIGNATURE APPROV.-W OF BUILDING OFFICIAL Note: Three fa;-lily d cllires 35, 000 cubic feet, or larger, will be reeuired to cOm-Ply with State Euildinc Coce Section 127 . 0, Construction Control. c ccce `c g work for which a �.- builc.� erir S - _c 'P"`rsions of this section (Section 109 . 1 . 1 - Licensing of Ccnstruction Supervisors) ; provided that if Home Owner engages a person (s) for hire to do such work, that .such ' O shall act as supervisor. Ho . wner Many Home Owners who use this exemption are unaware that they are assUming the responsibilities of a supervisor (see Appendix--Q,- Rules -and Regulations for licensing Construction Supervisors, Section 2.15) . ' problems, This lack of awarenes often results in serious _. P , particularly when the..Home.Owner hi unlicensed persons. In this case our Board cannot proceed against..the res inlicensed person as it would with licensed Supervisor. The. Home"bwiier=actin as supervisor is ultimately responsible. . To ensure that the Home Owner is fully aware of Mhis/her. re sponsibilities,. man communities require, as part of the permit application, that the.16me -owner 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 to amend and adopt such a form/certification for use in your community. t THE LOFT POST & BEAM GARDEN SHED EVELAND CONSTRUCTION 209 Iyanough Road Hyannis, MA 02601 (508) 778-5667 FRAME - ALL LUMBER TO BE FULL DIMENSIONAL PINE 2 X 6 FLOOR JOISTS, RAFTERS, COLLAR TIES @ 24". O.C. 4 X 4 CORNER POSTS 2 X 4 STUDS AND PURLINS 1X VARIOUS WIDTH' DECK, ROOF BOARDS & SIDING ALL VERTICAL SIDING TO HAVE 112" X 2" BATTONS @ SEAMS OTHER SPECS SOLID CONCRETE BLOCK FOOTINGS (POURED WHERE REQUIRED) ALUMINUM- GABLE VENTS ALUMINUM PLINTH POST FEET ASPHALT ROOF SHINGLES, UNLESS OTHERWISE SPECIFIED 1 X 8 RAKE BOARDS; 1 X 6 FACIA; 6" TEE HINGES; LOCKING HASP ALL HEIGHT DIMENSIONS APPROXIMATE i i la i I • i r scssor's OfGce�lst floor Ma .� 9 �C I3 I ,�. Permit# . ,j `X ConservaU�n Office 4th floor Date Issued �✓ Board of Health 3rd floor 41. ` C�11t1T En ineerin Dept. Ord floor House# SEWER M PlanningIN THE Dept. 1st floor/School Admin.Bldg.): p$To NAM .. Definitive Plan Approved by Planning Boarr 19 1 (Applications processed 8:30-9:30 a.m.& 1:00-2:00 p.m.) �] TOWN OF BARNSTABL Building Permit Application Project Street Address 5VT'e e� Village Fire District C m ner Address Telephone Permit Request: �u� Idip4 I�e�m�f �U �F e-�&by- c-& O C I `E Zoning District Flood Plain Water Protection' Lot Size Grandfathered Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type EaistinQ Information Dwelling Type: Single Family Two family Multi-family Age of structure c'Sot 4 e A r s Basement type Fu l Historic House W✓ Finished Old King's Highway 1fA Unfinished Number of Baths 01 No of Bedrooms 63 Total Room Count(not including baths) o o(lS skn cr�� First Floor \3 plus J-Qn iurc, — � Heat Type.and Fuel D i r Central Air a.j& Fireplaces dA Garage: Detached Other Detached Structures: Pool All& Attached Barn /✓fiq None ✓ Sheds A//4 Other N�/} Builder Information Name Telephone number Address License# Home Improvement Contractor# Worker's Compensation # 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 O U Q Fee SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T FOR OFFICE USE ONLY 3/16/95 309. 131 ADDYSS 7 Cherry Street VU-LAGE Hyannis Ann E. G. Cox OWNER DATE OF INSPECTION: FOUNDATION � F .FRAME t ••INSULATION i FIREPLACE 111111 ELECTRICAL: ROUGH FINAL 1 �J PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' - J FINAL BUILDfI W ell% Y DATE CLOS � pz ASSOCIATE P" • 10. J `Y APPLICATION FOR PEf yIiT Tp,(,�t•AISTALL AND REQUEST FOR EL- �`IICf SERVICE 7 �� Wiring 2 8 Inspector -61 of. fires g Permit # COM/Electric# 1_ ��� Town of K I&5t 15 ,&.-Massachusetts Building Permit # /i� ( Date ►7—2 V 1 Customer: iA to on (Street #) Lot �m the_village of utility pole number or underground mber y Customer's billing address I � ' Temporary New installafidn Change of service '�' Starting date Job description / P lA , ✓ .2-. d d of ., 1ZAt I C C= �w Pd' l� Ply 5-- G F— elc>64 jels i .t q lvl cr CIn, `.42 G(JeC�✓1 Service entrance voltage Amperage Phase Wire size(etr..er al.) Conductor per phase f Number of meters / . Water heater Off peak: YesNo Estimated load: Electric heat kw,lights kw, Range dryer Motors, H.P.&Phase . Ready for first inspection— 911Z1914 Ready for final . inspection Electrical Contras or e4�L; �.qq, 31 1A- Telephone #YAR Q270 Address w+ _ Additional Remarks. - Cr W!2 e Do Not Write Below This Line ELECTRICAL WIRING INSPECTION CERTIFICATE >. INSPECTOR OF WIRES r ; INSPECTIONS `DATE FEE CHARGE' c - Temporary Service E Roughing in _ mot,_ a<Service and Meter ' Off Peak Meter 1 J I Final Approval �. i Disapproved' �oV `r ` 4 `For the following reasons CERTIFICATE OF INSPECTION. Date To the COMMONWEALTH ELECTRIC COMPANY.The installation described above has been completed and has this-day b nilispected and approval granted for connection to your service va Inspector of Wir s WIRING INSPECTOR TO BE NOTIFIED WHEN-WORK IS READY FOR INSPECTION Permit Good For One Year From Date Of Issue CA 46 i INSPECTOR'S NOTICE Assessor's office(1 st Floor): 0 po`TN E To Assessor's map and lot number / Board of Health(3rd floor): Sewage Permit number L -���" � -7 • Engineering Department(3rd floor): J Z HA ktAA&LLL . �' S, � rAsrt House number Definitive Plan Approved by Planning Board 19 �p MP a 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 ,f r t,,,� Ste.-V 6k 6 AJ PUS N TYPE OF CONSTRUCTION �o J/fit 19 I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: `Location � ,,, , 12 4 Proposed Use Zoning District R b Fire District 4 All)15 Name of Owner nn �l�' Address 7 C errs 54 G Name of Builder AA-4 AL4 - .ram.... Address 2,75- 14,1- R . U Name of Architect � Addressee_. Number of Rooms _� o Foundation ��_ »� fir' 7474 4P P P P Exterior ' �� �� �� Roofing 5/D j 11 Floors ��� * - Interior Heating A--7+ n Plumbing hd Fireplace /t: Approximate Cos14 �37, Area Y Diagram of Lot and Building with Dimensions Fee (� c loan+ 1 ` i t5- F� t OCCUPANCY PERMITS REQUIRED FOR NEW DWECONG°S I hereby g 9 a ree to conform to all the Rules and Regulations of the ToZ-�;arnstable regarding the above construction. 69 Name 1 , Construction Supervisor's License COX, ANN A=309-131 No33094 Permit For m & Enclose Single Fa ing Location 7 CherryStreet Hyannis Owner Ann Cox Type of Construction Frame Plot Lot I Permit Granted July 24 , 19 89 Date of Inspection 19 Date Completed 19 w N ChIERR,r STREco ET b S 830.22'45 E' 4 35.00• o �� •p 0 13't #7 W 0 O 'o o II •p• 3 � M b b O 4952 + S.F.Ln 0 50.00. 3 TOWN OF BARNSTABLE ZONING BY-LAW DATED SEPT, 14. 1989 ZONE RB SETBACKS FRONT - 20' I CERTIFY THAT TO THE BEST OF MY PROFESSIONAL SIDE - l0' KNOWLEDGE. INFORMATION AND BELIEF THE DWELLING REAR - 10' SHOWN HEREON CONFORMS TO THE HORIZONTAL SETBACKS OF THE ZONING BY-LAW UNDER CHAP.40A SEC.7 OF THE PROPERTY LINES SHOWN HEREON MASSACHUSETTS GENERAL LAWS. WERE COMP/LED FROM AVAILABLE PLANS OF RECORD AND DO NOT REPRESENT AN ACTUAL SURVEY ON THE GROUND. ��a�AH of C. �y THE DWELLING DEPICTED ON THIS ® FRANK WHITING N : PLAN WAS LOCATED ON THE GROUND 9 N0.29889 BY SURVEY ON FEB. 17. 1995 AND pv tctR`�® J�i� PLOT PLAN EXISTS AS SHOWN AS OF THE DATE �y�1 U IN OF LOCATION. �,r 7 BARNSTABLE. MASS. THIS PLAN /S FOR PLOT PLAN ��Zn ��s� SCALE: 1'-20' FEB. 17. 1995 PURPOSES ONLY AND NOT FOR RECORDING. DEED DESCRIPTIONS EAGLE SURVEYING A ENGINEERING.INC. OR ESTABLISHING PROPERTY LINES. 10 Seaaea.*d Lane 8yannls, ma. 02601 (508) 778-4422 0 0 /0 20 40 PROJECT NO. 95-215 r j 2'-416L I i i i i i B. �r A O m —► a �� � m -4 b o e: z eo e; r: c n E - . I I I I N I7�01 f T I T I D Az� O 3AX N 3 Q W 0 r* 0 0 0 fi rt 3 0 X C O a (O p d 3 X 3 c n r p Q (00 � mQ0 � -, 0 N 0 6 z 0 fl 0 0 v IT 0 X X Q (D 0 to lb Q cc- d` �W 0 � E � (o 0 QO C Q N 3 a (Qp E (o d " 0 obi S� lQ � tt O w * 0 djr 0 msz W 3 CC th CID CP E 0y 6 0 21-0" th 3 w v 33 11 In, W -0 N (D cD 0 E ,. lC 3 0 X CP S 0 C rp 0 Proposed Handicap Ramp for: C&C Remodeling Inc. SCALE: 1/4" 1" SECTION APPROVED: PAG£•: Ann Cox 21L Frusan Way A LETTER DRAWN BY: Jason Cox REVISED: l Cherry Street South Yarmouth, MA 01601 � PAGE I of I Hyannis, MA 02601 PHONE:508-813-0886 FAX:508-160-1111 y.. www.bulldingce ecod.com DATE S/3/2008 NUMBER � (� w N c��RRY SrR01 EEr �, h m S B3'22'45•E, 3S.00• o a� •p 0 13't #7 W ^ o . o o o Il ,p• 3 = h 4� p Ln O 0 50. 00. ` N 83•22'45 w TOWN OF BARNSTABLE ZONING BY-LAW DATED SEPT. 14. 1989 ZONE RB ' SETBACKS FRONT_ - 20' I CERTIFY THAT TO THE BEST OF MY PROFESSIONAL SIDE - 10' KNOWLEDGE. INFORMATION AND BELIEF THE DWELLING REAR - lo' SHOWN HEREON CONFORMS TO THE HORIZONTAL SETBACKS e OF THE ZONING SY-LAW UNDER CHAP.40A SEC.7 OF THE PROPERTY LINES SHOWN HEREON MASSACHUSETTS GENERAL LAWS, WERE COMPILED FROM AVAILABLE PLANS OF RECORD AND DO NOT REPRESENT AN ACTUAL SURVEY ON THE GROUND, THE DWELLING DEPICTED ON THIS PLAN WAS LOCATED ON THE GROUND BY SURVEY ON FEB. 17. 1995 AND PLOT PLAN EXISTS AS SHOWN AS OF THE DATE IN OF LOCATION. BARNS,ABLE. MASS, THIS PLAN IS FOR PLOT PLAN �L �1`>� SCALE: I'-20' FEB. 17. 1995 PURPOSES ONLY AND NOT FOR "RECORDING. DEED DESCRIPTIONS EAGLE SURVEYING A ENGINENBING.INC. OR ESTABLISHING PROPERTY LINES. 10 Seaboard Lane 8pAnt9, Xa. OZ601 (608) 778-442Z 0 IO 20 40