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0021 CROSS STREET
� I ���s Ste' �. _� :J -----------95-----------+---33---+ R OPERTV ADDRESS I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I CSTATE LASS PCS I NBHD KEY NO. 0019 CROSS STREET 07 RB 400 07HY. 07/09/95 1041 0 7 .LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS TY UNIT 'ADJ'D.UNIT Lano ey/Date size Dtmenston LOCJYR.SPEC.CLASS ADJ. COND. P PRICE PRICE ACRES/UNITS VALUE oescriprop R OAA N CATHOLIC BISHOP MAP— III co. FF.Detn/Acres E LAND 1 26.900 CARDS IN ACCOUNT — 110 1BLDG.SIT 1 X _54 =1()C 145 34999.9S 50749.9 .53 26900 #3LDG(S)—CARD-1 1 102.400 01 OF 02 a - 11'JLDG(S)—CARD-2 -1 27,200 COST 156500 ,j E6H S 2:0 U %' C= 100 7000.Q 7000.0 , 1.00 7900 3 #PL 21 CROSS ST MARKET 161700 #RR 0392 0140 (INCOME USE AI q'D (APPRAISED VALUE 1 jj I A 156o5CC 1 PARCEL SUMMARY "S i - -.. - - - AND 26900 Tj I LDGS 129600 I TOTAL E S 156500 E I iN CNST N i DEED REFERENCEI Type DATE Rxorew R I O R YEAR VALUE T B—t, Page 'nat' Mo.vr.iD s"I"P,q. A N D 26900 S 7561/021; 1:06/91 150000 LDGS 129600 1 I 1.404/519: :00/a0 (TOTAL 156500 tBUILDING PERMIT t Number Date Type Arm"t 2LAND LAND—ADJ INC ME SE I SP—OLDS FEATURES BLD-ADJS UNITS 7000 Class Cons, Tol Is Base Rate Atll Rate Year Bpilt A Norm. Cobs v. CND Loc -b R G Feel Co,.New Ap Re Value Stbrtes Heignl Rpoea etl Rm B.tn. .Fii. P-l".11 F.c.Units Units A�t� 41� Age ND' Contl. I PI 0 030 100 100 69.95 69.95 32 70 24 74 90 64 1.59984 102400 2.0 8 4 2.0 3.0 �r,pnon Rate Square Feel Repl Cost MKT.INDEX: 1.OD IMP.BY/DATE. ML 5/8$ SCALE: 1100.71 ELEMENTS CODE CONSTRUCTION DETAIL BAS 10Q 69.95 972 67991 GROSS AREA 1974 TWO FAMILY DWELLING CNST GP_00 FOP 35 24.48 324 7932 N * 10--* STYLE 06COLONLAL 0.0 FEP - --- - -- ---- 0.0 b 45.47 306 _13914 *--9---*----16----*-Ff8--20-----* DESIGN AD MT 00 t -------� Ff0 650 65.00 30 1950 ! ! B24 ! EXTER.WALLS OUD SHINGLES 0.0 - --------- ---- ----------- B 4 90 62.96 972 61197 ! ! ± EAT/AC TYPE 1U IL-- W—ZONED 0.0 INTER.FINISH 05PLASTER _ 0.0 ! ! INTER.LAYOUT_ _12 VER./NORMAL----- 0.01 25 EASE 27 IINTER.QUALTY 02 AME AS EXTER. 0.0� ' -- --------- - -- ----- ! i -ARP OI -- F_LOOR_STRUC_T_ Uc D JOIST/BEAM_ _ 0.01 D W 34 ! E LOUR_ COVER_ _04 ET 0.0 Tplal Are as 1... _ 630 Base� 972 � ± ± ! E � RGOf TYPE 03 IP—ASPH_SH_ING__ O.OI A FEP S09 W09BUN34 E09ILDING SS25 .. BAS ! *-----------36-----------X IONS FOUNDATION---101 OUREDECONC 99.9 ti27 E16 Ffb NO3 E10 S03 W10 .. ! ! ! NEIGHBORHOOD 61AC HYANNIS L BAS E20 S27 .. 824 N27 W36 S27 ! 9 9 LAND TOTAL MARKET E36 . . ± FEP ! FOP ! PARCEL 26900 156.500 *--9---*-----------36-----------* AREA 2848 VARIANCE +0 t5394 STANDARD 25 ROPERTY ADDRESS I I ZONING I DISTRICT CODESP-DISTS.I DATE PRINTED I CSTATE LASS I PCS I NBHDPARCEI KEY NO. 0019 CROSS STREET 07 Re 400 07HY 07/09/95 1041 - 00 61AC R308 244 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T UNIT ADJ'D.UNIT Lana By/Dale Sae Dimension LOCJYR.SPEC.CLASS ADJ. COND. P PRICE PRICE ACRES/UNITS VALUE Description ROMAN CATHOLIC BISHOP MAP- CD. FFDe IhlAcres E — BATHS 1s0 U X C= 100 3500.0 3500_0 F— CARDS IN ACCOUNT 1.00 3500 B 02 pp D2 -. 1J2 BSMT S X`. C 100 _. 3.9 3.9 600 2300-B - - COST 156500 F FPLACE U X , C= 100 3100.00 3100.00 1.00 .31JO 3 MARKET 16170C - INCOME A USE -- D APPRAISED VALUE J A 156,500 U _ PARCEL SUMMARY S AND 2690C T LDGS 129600 0-IMPS E OTAL 156500 - E CNST N DEED REFERENCq Type DATE Re-d d R I O R YEAR VALUE T Boot, Page Ins,. MO. Y,p sae°P"" A N D 26900 S LDGS 129600 1 OTAL 15650C - BUILDING PERMIT Number Dale Type Amount LAND LAND-ADJ INC ME SE SP-BLDS FEATURES BLD-ADJS UNITS 4.300 Class Const, Total Base Rale Ad,.Rate r B II Ago Depr. CDnn tl. CND Loc %R.G RePI Cost New AOI Rapt Val,¢ Sloriee Me�ght Rooms Rma,aana a fir. PNywall FaC I Dn�l$ To'," q 0 000 100 100 57.85 57.85 53 70 24 74 90 64 42482 27200 1.0 2 1 1_0 4.0 ciiphon Rate Square Feet Repl.Cost MKT,INDEX: 1'D() IMP.BY/DATE: ML 5/O 8 SCALE: 1/01_00 ELEMENTS CODE CONSTRUCTION DET'/.IL BAS 100 57.85 600 34710 UKUbb AKLA 60U SINGLE FAMILY D-WTUINGCNST GP: ' FFG 30 17.36 200 3472 --------------30------------- ----10---* STYLE J3 ANCH 0_0 FFG ------------------- ! I ! � DESIGN �DJMT 00 _ U.0 --- ! ! tX TER.AALLS �t.100D SHINGLES 0_0 ! ! ! EA'fJAC rtYPE lt'AE=WARM A.IR 0_0 ! ! ! NfiER.FINISH 04 5 RYWALL 0_0 ! ! ! I NTE,1LAYOU7 1-24VER /NORMAll: 0_0 20 BASE 20 20 1 NTER.aUAITY 02 Ai'IE AS EXTER. 0_0 ! ! F COUR S_VW UCT U14D JQISTIBEAM 0.0 D w ! ! ! E F LDOR COVER -07 INYL Fl00RIN6 0_0 E Total Areas A— _ 209 Base a 600 ! ODT-TYP-E -- -Llf ABLE=ASPH SH ---U._() BUILDING DIMENSIONS ! ! E L-EC-T RICAL 01 VERAGE-----------0 0 T BAS w30 N20 E30 FFG E10 S20 w10 ! ! ! FOUNDATTO-N -02 _0NCRETE OLOC-K 9V:9 AN20 . _ BAS S20 . . *--------------30-------------X----10---* -------------- - --- ---------------------- L LAND TOTAL MARKET PARCEL AREA VARIANCE +0 +0 STANDARD RESIDENTIAL PROPERTY MAP NO. LOT NO. FIRE DISTRICT SUMMARY STREET 21 Cross St. Hyomis LAND 308 244 OWNER H BLDGS. G 3S rn TOTAL _ RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: LAND BLDGS. Malchman Nelson M. 8a Suzanne E. 6 17 68 14o4 519 TOTAL LAND 0) BLDGS. TOTAL LAND BLDGS. TOTAL LAND BLDGS. TOTAL LAND BLDGS. TOTAL LAND BLDGS. TOTAL LAND INTERIOR INSPECTED: �� � BLDGS. J ;r TOTAL DATE: 5 LAND ACREAGE COMPUTATIONS rn BLDGS. ND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL HOUSdW LAND CLEARED FRONT BLDGS. REAR TOTAL WOODS&SPROUT FRONT LAND REAR 0) BLDGS. WASTE FRONT TOTAL REAR LAND BLDGS. TOTAL LAND BLDGS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT PEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ROUGH TOWN WATER BLDGS. HIGH GRAVEL-RD. TOTAL LOW DIRT RM LAND ' .SWAMPY NO RD -- __- 0) BLDGS. Cone.Walls Fin.Bsmt.Area Bath Room 0 Base LAND COST ��� BLDG. COST Cone.BIC Walls Bsmt.Rec. Room St. Shower Bath W ✓ esmt. 0130 3 0 PURCH. DATE CCone.Slab. Bsmt.Garage St. Shower Ext. Walls ,'Brick Walls Attic FI.&Stairs ! Toilet Room PURCH. PRICE. �� Stone Walls Fin.Attic Two Fizt.Bath Roof RENT 1/0/0 AAW L T 4- Floors Piers INTERIOR FINISH Lavatory Extra Bsmt. F 1 2 3 Sink % y, 1/4 Plaster Water Clo.Extra Attie 30 EXTERIOR WALLS Knotty Pine Water Only Zp PrT' Double Siding Plywood No Plumbing Bsmt.Fin. 7 0 CEO ?� --Z-- t✓V' Single Siding Plasterboard I Int. Fin. Oro W&,,bhingles TILIN 10 �b Cone.Blk. G F. P Bath FI. Heat Face Brk.On Int.Layout Bath FI.&Wains. Auto Ht.Unit Veneer Int.Cond. Bath FI.&Walls Fireplace Com.Brk.On HEATING Toilet Rm.Fl. Plumbing Solid Com.Brk. Hot Air Toilet Rm.FI.&Wains. _ Steam Toilet Rm.FI.&Walls Tiling Blanket Ins. kHot Water St. Shower Roof Inn. V V Air Cond. Tub Area Total Floor Furn.G S ROOFING COMPUTATIONS Asph.Shingle Pipeless Furn. S.F. Wood Shingle No Heat —7 - S.F. S Asbs.Shingle Oil Burner S.F. Slate Coal Stoker S. F. Tile Gas ROOF TYPE Electric S.F. OUTBUILDINGS Gable Flat S. F. 1 12 3 14 15 16 1 7 18 9 10 1 2 3 41 5 6 7 8 9 10 MEASURED Hip Mansard FIREPLACES S.F. Pier Found. Floor Gambrel Fireplace Stack I Wall Found. 0.H.Door LISTED FLOORS Fireplace Sgle.Sdg. Roll Roofing ' Cone._ LIGHTING l Dble.$dg. Shingle Roof Earth No Elect. 77 DATE Pine Shingle Walls Plumbing W{/ _ Hardwood L• ROOMS Cement Blk. Electric 5^ •7 / Asph.Tile Bsmt. 1st TOTAL Brick Int. Finish ED Single 2nd 3rd FACTORTF REPLACEMENT A-/6 CJ �� ,4b OCCGUPPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep.ACTUAL VAL. DWLG." //T I s rt S77 6 U ' 1 3 so -_ t 2 3 4 5 . 6 7 B 9 1 TOTAL rt }' i RESIDENTIAL PROPERTY "MAP NO. LOT NO. r STREET '21 Cross St. Hyannis FIRE DISTRICT 308 2t�4 SUMMARY� r x % OWNER H 7. LAND 3 /G as BLDGS. a (. _.-... - TOTAL y y y s RECORD OF TRANSFER LAND DATE BK PG I.R.S. REMARKS: BLDGS. Malehman Nelson..M. & Suzanne E. 3A6Aq 716 165 H TOTAL LAND Ja-.s-s o c 6 /!v/ /rf • eLG aj BLDGS. ?. [} TOTAL LAND rE a - 43 S-L) BLDGS. U TOTAL LAND BLDGS. I TOTAL ti�`1 uG1Y1 J Ohr1 �� C 4'µIC LAND SL`I BLDGS. S�W1U1 2I W1r��c,1nMA / TOTAL LAND < BLDGS. TOTAL LAND INTERIOR INSPECTED: BLDGS. 'DATE: TOTAL s l ~� LAND ACREAG O PUTA 1 NS BLDGS. LAND TYPE # OF ACRES PRICE, TOTAL DEPR. VALUE TOTAL HOU T S9 5 GEARED FRONT 4/:{< LAND REAR f a v G 0 G7 00 a, BLDGS. — '� WOODS&SPROUT FRONT ' TOTAL LAND REAR BLDGS. WASTE FRONT TOTAL REAR LAND BLDGS. TOTAL -- LAND BLDGS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH'.-, STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. —FOR. INF. VALUE HILLY TOWN SEWER LAND O ROUGH TOWN WATER BLDGS. HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND SWAMPY - M NO RD. 0) BLDGS: FOUIV L/A 111.1 . LAND COST Cone:Walls Fin. Bsmt.Area Bath Room Base y 7 O BLDG.COST Cone.Bik;Walls Bsmt. Rec. Room St. Shower Bath ' Bsmt. PURCH. DATE Cone.Sbb Bsmt.Garage St. Shower Ext. Walls, !V `BHek.Walls Attie FI. &Stairs Toilet Room PURCH. PRICE. �. .ism VT1.� Roof RENT /„� 77 Stone Walls Fin:Attic Two Fixt.Bath , Floors a 7 Piers, INTERIOR FINISH lavatory Extra _ 9 Band.;V'. 1' L2 3 1 Sink .sA 1/4Plaster Water Clo. Extra Attic r y o EXTERIOR WALLS Knotty Pine Water Only F 340 O 1 or/ Double Siding Plywood No Plumbing Bsmt.Fin. Int.Fin. �O •/ Single Siding Plasterboard �� as 30 o Shingles TILING GEK wc9 H 640 I? � Cone:Blk. G F P Bath FI, Heat 7�O Face Brk.On Int.Layout Bath BathA#&Wains. I L/ Auto Ht.Unit -f 90-0 Veneer Int.Cond. Bath FI. &Walls Fireplace Com.. Brk.On HEATING Toilet Rm.R. yD Sys /o Plumbing Solid Com.Brk. Hot Air Toilet Rm.FI.&Wains. ?4.� • Tiling ' Steam Toilet Rm.FI.&Walls - Blanket Ins., K Hot Water St. Shower Roof Ins. Air Cond. Tub Area Total p , Floor Furri. L/. ROOFING COMPUTATIONS -.Asph.Shingle Pipeless Furn. y 5 S.F. 300 Fl�J Wood Shingle No Heat a `J S.F. h/S� Asbs:Shingle Oil Burner „� 3 y S.F. 8• 6 a`1 3 3 . . . Slate Coal Stoker 0� S.F. 1 O 16'G Tile Gas ROOF TYPE Electric 7 S.F. SO OUTBUILDINGS /`JJ� - F 1 2 3 .4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 MEASURF_.I Gable Flat S Pier Found. Floor Hip �/ Mansard FIREPLACES S.F. Gambrel Fireplace Stack Wall Found. 0. H.Door l. LISTED FLOORS Fireplace Sgle.Sdg. Roll Roofing ) Cone. V LIGHTING Dble.Sdg. Shingle Roof Earth No Elect. DATE Shingle Walls Plumbing Pine Hardwood ROOMS Cement Blk. Electric Asph.Tile Bsmt. 1st TOTAL 3 2 Brick Int.Finish ICED Sirigle 2nd 8 3rd FACTOR 0111 REPLACEMENT OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep• PHYS. VALUE Funet.Dep. ACTUAL VAL. DVVLG. /f7 Ga i A{Z7 S 3s3 a{ 1/7 J D aIR A s-6 1 - 2. 3 4 5 — --- 7 8 9 10 TOTAL R308 244 . P P R A I S A L D A T A� KEY 222217 ROMAN CATHOLIC BISHOP OF LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 26, 900 129, 600 2 A-COST 156, 500 B-MKT 161, 700 BY ' 00/ BY ML 5/88 C-INCOME PCA=1041 PCS=00 SIZE= 1974 JUST-VAL 156, 500 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 61AC -- --MAY NOT BE COMPARABLE-- NEIGHBORHOOD 61AC HYANNIS PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 269001 LAND-MEAN +0% 1565001 74880 IMPROVED-MEAN +730 250 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 10001 LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP]ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] =, _. R308 244 . P E R M I T [PMT] ACTIOR] CARD [000] KEY 222217 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR oCMP NEW/DEMO COMMENT [ ] [R308 244 . � ] LOC] 0019 CROSS STRE CTY] 07 TDS] 400 H KEY] 222217 ----MAILING ADDRESS------- PCA] 1041 PCS] 00 YR] 00 PARENT] 0 ROMAN CATHOLIC BISHOP OF FR MAP] AREA] 61AC JV] MTG] 1003 47 UNDERWOOD ST SP1] SP21 SP31 P 0 BOX 2577 UT11 UT21 . 53 SQ FT] 1974 FALL RIVER MA 02723 AYB] 1932 EYB] 1970 OBS] CONST] 0000 LAND 26900 IMP 129600 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 156500 REA CLASSIFIED #LAND 1 26, 900 ASD LND 26900 ASD IMP 129600 ASD OTH #BLDG (S) -CARD-1 1 102 , 400 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #BLDG(S) -CARD-2 1 27, 200 TAX EXEMPT #PL 21 CROSS ST RESIDENT'L 156500 156500 156500 #RR 0392 0140 OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE106/91 PRICE] 150000 ORB17561/021 AFD] I LAST ACTIVITY] 06/07/96 PCR] Y viiivii;i•i:•:i;;;G:G::•i:•i:•isiii;•;vi::iiii::i:•:ii:Lii:G:;•:i;:}}iit::i:•is•:iiit;;;L:tiiiiiii<i4:•:i;i;;;:•i:Gi:•i:{•};;;•i:;i•:ti•:i;•:ii;•:L:L:i�:v:4:G}}}}}}:{ii•:Lii}:i• .:.................:.:. �:�..................... 79 � '.`..:::.;::::>B ILDIN SERVE ::. ::: Ix- > 44 ' <X�iiitiv .....v.'i::iiiiiiti;•:v:;Si::::: I .............. .. .mot . MANAT:::•: .....::.. . BISHOP { y R;:;< ............. .. <«> SS STREET i.::i•;;:i•.ii•::;•:.t•:.t•:;•::iiii•:;;:ii > ;> .:::..:..:::.::... ....:.:..:............. ... ....... . ........................ SEARCH .,.. iy 7ME Tq1� 0 BARNSTABIZ, = The- Town of Barnstable 'OrfpMpYA,� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M. Crossen Fax: 508-790-6230 Building Commissioner August 29, 1996 Mary Donahue 13 Brewster Road West Yarmouth, MA 02673 SPR-80-96 St. Francis Xavier/ St. Vincent de Paul Society, 19B Cross Street, Hyannis, (308/244). Proposal: Office and food pantry for St. Francis Xavier Church. Dear Ms. Donahue, The above referenced site plan was reviewed at the August 29, 1996 meeting of Site Plan Review Committee and deemed approved with the following conditions: • See Gloria Urenas regarding Sign Permit. • Apply for a Building Permit. Please be informed that a building permit is necessary prior to any construction. Upon completion of all work, the letter of certification required by Section 4-7.8 (7) of the Town of Barnstable Zoning Ordinances must be submitted. Should you have any questions, please feel free to call. Respectfully, Ralph M. Crossen Building Commissioner • r Engineering Dept.(3rd floor) Map Parcel . , rmit# to House D sued / — / q Board of Health,(3rd floor)(8:15 -9:30/1:00-4:30)) on Conservation Office Office (4th floor)(8:30- 9:30/1:00-2:00) lanm Dept. 1st floo chool A n. Bld . OpT11E De ' itiv Ap owed by anning\B04d 19 BARNSTABLE. �O�Eo Mod,` TOWN OF BARNSTABLE Building Permit Application Project reet Address 21 CRM � 0& Village' ' i D ' Owner ' , Address - Telephone Permit Request W AV RPM M. ' First Floor square feet Second Floor ® square feet Construction Typemg�sy��� Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes V No On Old King's Highway ❑Yes No Basement Type: ❑Full A Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ' Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing 'I New No. of Bedrooms: Existing New Total Room Count(not inc ding baths): Existing New First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑'Electric ❑Other Central Air ❑Yes f o Fireplaces:Mstipg 4New Existing wood/coal stove ❑YesC-Ir o' Garage: ❑D ached(size) Other Detached Structures: ❑Pool size Attached(size) /49 X ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of peals Authorization ❑ Appeal# � Recorded❑ Commercial Yes ❑No If ,es site plan review# Y Current Use Proposed Use 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 r SIGNATURE DATE BUILDING PERMIT DEN D FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. a i ADDRESS VILLAGE ER DATE OF INSPECTION: i FOUNDATION FRAME`' ` INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ri • RING: ROUGH +FINAL GAS: .+ ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. R f ' s F TOWN OF BARNSTABLE REPORT SUf W..EMENTAI&Y/CONTINUATIJOREPORT NAME (LAST, FIRST, MIDDLE) DIVISION /DBP7 NOTE DETAILS i OBSERVATIONS-ITEMIZE EVIDENCE, SERIAL !S ETC- s �— <►v y7 5 1 7-e rj v o -r-w w, I— -Bfr S .� SUBMITTED Y PAGE 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel I, 'Application # b Health Division Date Issued Conservation Division Application Planning Dept. .'Permit Fee, Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street'Address,<2 C1^0sIs Sf, Py&ilvniS , MA odGo/ Village Owner Yau10-r Chc2 ' Address Z/ 1174 l Telephone' -775-- 09/8 Permit Request �ifl7d Ue C � `0 5�c� es G��>J�). aid' Cesar �s�i/J�ssi�S /n� Mtt-&151ey' h- tl Q �� G�7af1 Ct a as S»taf�ar� �r��f ev+ G✓ d� k Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ®rod Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) — Y= Number of Baths: Full: existing new Half: existing L new Number of Bedrooms: existing _new "` 11 Total Room Count (not including baths): 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 Sh aU,'1 l �r��`S Telephone Number 77q -353-,570 a Address ^a R e/ License# cS 973 s�� / 2 c7 �r M c1 JJMA as 7-3 Home Improvement Contractor# (0 J J Worker's Compensation # 6:5600 6TM 80\259 10 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1l�ti/GI 4� SIGNATURE " DATE l ^0?0 — l i tr r FOR OFFICIAL USE ONLY APPLICATION# a DATE-ISSUED r94E D E +SS'Afi-e ,MAP/PARCEL NO.,,L.4 l ADDRESS d.} _ VILLAGE OWNER DATE OF INSPECTION: PFOUNDATION,M� t, i FRAME '.'INSULATION?" " s FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ^GAS a ° ROUGH 4- FINAL >INFINAL F F :.t.DATE CLOSED- ASSOCIATION PLAN NO. � r The Commonwealth ofl{7assachusefts Deparfrnent oflrrdustrialAccidents Office of Investigations' . 600 Washington Street, Boston, MA 02111 )vww.mass.gov/din Workers' ComP easationlasurance Affidavit: Builders/Con'tractors/Eiectricians/Plumbers Applicant Information Please Print U2e ffily Name (Business/Organization/Individual)' Address: _ � /Tbl'S Po AG City/State/Zip: U rnv%o v , A d,-2G 7 3 Phone.#: 7 7y ' 3'S-3 7 E7�02 Are you an employer? Check the appropriate box: Type of project(required): I.0 I am a em to er with 4.-[j I ama general conjers' and I'. P. Y 6. ❑New construction employees(full and7orpnrt-time).* have hired the sab- ctors 2. I am a sole proprietor or'partner listed on.the'attachet T. Remodeling ship and have no employees These sub-contractve . g, Q Demolition workin for me in an capacity. employees and havers' ts g y p ty• 9. .0 Building addition , {No workers'•comp. insurance comp. insurance.$ required] 5. We are a corporatio i 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work .officers have_exercieir 11.❑Plumbing repairs or additions Myself. [No workers' comp. right of exemption pL 12.[]Roof repairs insurance required_] t.;.. c. 152, §1(4), and w no employees. [No wor13.❑ Other comp: insurance req ] 'Any applicant•thatehecks box#1 must also fill out the section below showing their wprkers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors liave employees,they must providt their workerr''comp.policy number. ram an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information I Insurance Company Name: kar rA Policy#or Self-ins.Lic. #: 66 S G01089_79:8 M Q S 9 I�0 Expiration Date: Toh Site Address: � � City/Statc/Zip: tyeli flrl l S 0"( . �°7�D•I . 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 tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine. of,up to$250.00 a day against the violator. B e advised that a copy of this statement may be forwarded to the`Office of Investigations of the DIA for insurance coverage verification I do hereby ceritfy under thepains and penalties of perjury that the information pro.vided/above is true and correct Sitznature C E' Date Phone #• 7 7 c _ 33`3 —,$ Officlal use,only. Do not write in this area, to be completed by city or town official .'City or Town: Fern-Lit/License # Issuing Authority(circle one): .1. Board of Health '2.Building Department J. City/Town Clerk 4.Electrical Inspector'S.Plumbing Inspector 6. O they Information and Iusttuctions ; 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 a tityi 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 tiustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house of on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or locaflicensing agency shall with 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�zth the insurz�ce 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),-addiess(es) and.phone numbcr(s) along with their certificates)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 retuned 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 PIcasc be sure that the affidavit is complete'and printed It 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 Plcase be sure to fill in the permit/liccnse number which will be used as a reference number. fn addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessarv) and under"rob Sitc Address" flit applicant should write"all Locations in (city or . town);".A cbpy 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 fo any business or commercial venture (ie, a dog license or permit to bun 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 giye us a call. The Department's address, teiephone-and fax•number: Tho Coromonwealth of Massachusetts Dcpartmwt of Industrial Accidents Office of rrzv�tigat�azrs 00 Washington Street Boston, MA.02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia THEr, Town of Barnstable ` Regulatory Services . � MRN6TABLE, � uAss $ Thomas F. Geiler,Director �ArED IvW'�16`� Building Division Tom Perry, Building Commissionet 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office:. 509-862-4038 Fax: 508-790-6230 -- Property Owner Must Complete and Sign This Section If Using A Builder I, Fa-Ae,(- L 0Cfb l)C , as Owner of the subject property hereby authorize 9Qrr7 S �Da� 4U&hD n Coy tb act on my behalf, m all,matters relative to work authorized by this building permit application for 2i Cass s��f . (Address of rob) - 24�0 W Signature of Owner bate : Print Name If Property Owner is applying for penTi t pleas er.complete the Homeowners License Exemption Form on the reverse side. O•F(TR MS•f1VJTJFR PFR 1„iTCCTlIN Town of Barnstable �p4 SHE 1p�� w� o Regulatory Services y .T a�xtvsTeBM Thomas F. Geiler,Director runs. . � • sbsq. Building Division arED 'r Tom Perry, Building COmrniSSiOner 200 Main.Street,,Hyannis,MA_02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508--790-6230 HOT'>EOV NER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code T r, current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or 16SS 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 Persons)who owns a parcel of land on which be/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 constMcts 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.be/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 scction.(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 arc unaware that they are assuming the responsibilities of a supervisor(sec 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 aw c of his/her responsibilities,many communities requite,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:fornu:homccxcmpt Ati � A 1 i . 3oa�d of Bui mg egulation nd Stan (Construction Supervisor License i License 'CS .97356 : Bgthdate =4/11/1984 " 'W°„�� '� • F I 4/ Tr# 9735 6$,/2011Expirati Restrvction . 00 two - 7. d SHAUN HARRIS s {/ PO. BOX 849 SOUTH DENNIS MAI6 Commissioner. a .a AcoRo® CERTIFICATE OF LIABILITY INSURANCE 7(MMIDDIYYYY) `.•� 1/27/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMA71VELY 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 endorsemengs). PRODUCER CONTACT NAME: Robert E Bouchie Jr. Insurance PHONE 508 564-5560 FAX No: (508) 564-5531 1352 Route 28A AIL ADDRESS: info@ Bouchie Insurance.com PO Box 400 PRODUCER 3212 Cataumet, MA 02534 INSURE S AFFORDING COVERAGE NAIC# INSURED INSURERA:State Auto Patrons Mutual Shaun Harris dba Harris Constr INSURERB:The Hartford 23 Horse Pond Road INSURER C:Pilgrim " West Yarmouth, MA 02673 wsuRERD: INSURER E: - INSURER F: - { COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ INSR' TYPE OF INSURANCE --ADDL SUBR POLICY EFF POLICYXP E - LIMITS LTR POLICY NUMBER MIDDY NMIDDVYYYY GENERAL LIABILITY EACHOCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CTROO11313, 6/19/10 6/19/11 DAM4GETORENTED R I E Ea occurrence) $ 50,000 CLAIMS-MADE a OCCUR ME EXP(Anyone person) $ 5,060 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMITAPPUESPER PRODUCTS-00 MP/OP AGG $ 2,000,000 ;;.A. _. - .. $.. s. X POLICY PRO- LOC JE CT AUTOMOBILE LIABILITY - - COMB INED SI NGL E LIM IT $ - (E a accide nt) C ANY AUTO PGC00001013851 . 10/29/1010/29/11 BODILY INJURY(Per person) $ 100,000 ALL OWNED AUTOS BODILY INJURY(Per accident) $ 300,000 X SCHEDULEDAurosPROPERTY HIREDAUTOS Pena d nAAMAGE $ 100,000 NON-OWNED AUTOS $ $ UMBRELL.ALIAB OCCUR - EACH OCC URRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ .k RETENTION $ $ .4{ B WORKERS COMPENSATION -AND EMPLOYERS'LIABILITY Y/N WC 6S60UB9798M25910 6/24/10 6/24/11 X STATU- OTH- ?�:. ANY PROPRIETOR/PARTNER/EXECUTIVE - - - E.L.EACHACOCENf $ 100 000 OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under '�t DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is requ red) Location: 21 Cross Street, Hyannis, MA 02601 fax: 508-771-5940 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN w St Francis Xavier Church ACCORDANCE WITH THE POLICY PROVISIONS. 347 South Street 6 Hyannis, ma 02601 AUTHORIZED REPRESENTATIVE ^ Robert E Bouchie Jr ©1988-2009 ACORD CORPORATION. All rights reserved. k w, ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD : 1 TOWN OF BARNSTABLE BUILDING PERMIT'APPLICATION, Map J Parcel y = Application # Health Division Date Issued 1 Conservation.Division Application Fee Planning Dept. Permit Fee ' Date Definitive Plan Approved by Planning Board Historic.- OKH Preservation/Hyannis Project Street Address Cross Sb-e,—.E Village ann`IS Owner ✓C;V)l C,C 5 Xa V L,cJL Address SS Telephone $ 775 - 0$I a Permit Request (Lrpc)ye, 0 LCL _-rhstalt A1aeJ-- 55- 50 ah,e, S 15D � a,?- 10 Square feet: 1:st floor: existing proposed 2nd floor: existing proposed Total new . Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Cot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family:.❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): 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 Ll new size _Shed: ❑ existing ❑ new size _Other:' Cs Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial 0 Yes4 ❑ No If yes, site plan review# -► -o rxs Current Use Proposed Use N APPLICANT INFORMATION AA rn (BUILDER OR HOMEOWNER) Name f Ch Cep. Telephone Number 509 775-7-7&3 Address I/-?h.-,tt C License# 9 �� 44ahnis k(A U�//n�- P I Home Improvement Contractor# Worker's Compensation # 9 3 4 M 00 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE r FOR OFFICIAL USE ONLY ,3 APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION a FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING �ht , DATE CLOSED OUT ASSOCIATION PLAN NO. - r r , A. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 s• °W. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organization/Individual): Address: - " City/State/Zip: (".no 15 ka OU01 Phone.#: -,Are,you an employer? Obeck the appropriate box: Type of project(required): 1.U I am a,employer with 4. ❑ I am a general contractor and I employees(full and/or par time).* have hired the sub-contractors 6. ❑New construction ..2.0 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 workingfor me in an`ca aci employees and have workers' y p ty co insurance$ 9. ❑Building addition [N o workers comp. insurance comp. required] 5..❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp.',� right of exemption per MGL 12. 151 Roof repairs insurance required.] t. c. 152, §1(4),and we have no employees. [No workers' . 13.❑Other comp. insurance required.] *Any applicant,that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information.Insurance Company Name: !T&L 1, Iry e,lz6 Policy#or Self-ins.Lic.M 0 34 T M 3V 7 0 Expiration Date: 7�I I d Lt Job Site Address: L- SS ��e E City/State/Zip:k ,t T "(�:n�1 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 penalties of perjury that the information provided above is true and correct Si afore: Date: 9 !� 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 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 o that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each applicant as prof 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 Fax# 617-72777749 Revised 11-22-06 www.mass.gov/dia VIE 'Fawn of Barnstable � o Regulatory Services . . . �B`RN q. Thomas F_Geiler,Director Fn Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstab l e.ma.u s Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. if Using A Builder as Owner of the sub ct ro eri n to P Px . hereby authorize "�. 4uGn Cz C,��. l� S C GtM to act on my behalf, in all matters relative to work authorized by this building permit application for. cam ' .0 n i S (Address of Jo v � � S' o ture' Oumer Da Print Name . If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. r Q:FORMS:O WNERPERMISSION �oFz�try Town of Barnstable o Regulatory Services BARNST,ELF- Thomas F. Geiler,Director 16.19. A,$� Building Division rEo Ma's Tom Perry, Building Commissioner 200 Mairi Street, Hyannis,MA.02601 www.town.barnstable.rna.us Office: 508-862-4038 Fax: 509-790-6230 HONEEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# worlcpbonc# CURRENT MAILING ADDRESS: city/town state rip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of sixnunits or less and to allow hQ�mowners to engage an individual for liire who do I.es not possess a license,provided thtat•the owner acts as_ supervisor. e DEFINITION OF HOMMOWNER Persons)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. s The undersigned"homeowner"certifies that_he/sbe understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/sbe will comply with said procedures and requirements. ? Signature of Homeowner Approval of Building Official t t 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 Supervsors);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 rxcrrrption are unaware that they are assuming the responsibilities of a supervisor(sec 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 pmcced 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 responsnbilitics,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 cart t amend and adopt such a form/ccrtification for use in your community. r Q:fotrns:homcexempt ' '� � taa�ar�g - _ ward of regasbra_ ROME �L � �r bdivldui use only . FS€Bnud return to: One e A of Shmdards " 0 bu�Dn Rm 13e1 T.L.HITCHC0CK$E9WCEMMMM TED Hn-CHCOGK 105 FERNi1OC RD HYANNIS.MA 02668Not ture agm tcfeu..ett+-I lartm...of Pultlir ti; Smart,of Bu ihtintiCorstruCtfl^ .�lIpe_R cs�•o,urLice l,ttiorts:?aF$nJ Restricense. SL 39828 d i Sd✓ta? d nr dVr;ictc t-htl, to: RF,WS TED HITCHCOCI( 55 LISA L q4e WEST BARNSTABLE, MA 02668 "otmi..iun•r Expiration: 6h)2012 Tr#: 99828 .\ 0 Q�0 _ e Ashburton Place-ROOM 1301 Boston AbMchuseM 02108 Home ImProvement Contractor Registration On: IMM7 Type: Private Corporation T.L. H{TCHCQCk(SERVICES INC. Expiration: ti8,{2o10 Tr# 264153 105 FERNDOC RD HYANNIS, MA o2668 507y1.07/A'•PC&ino Update AddreW Brad rethurn cam,�$rk 8�for change. .SewWAdds esy gt 0 ta3+enent L Lost Card f 09/01/2009 14:55 5084204474 PALUMBO INS COTUIT PAGE 01 ' --Ad-bR-D.- CERTIFICATE OF LIABIUTY INSURANCE PROMM THIS CERTIFICATE 13 WSM AS A E9ATT®t al IIttF ATH311 GOL04M 6 ASSOCTAT913 IIQSURANCS ONLY AND CONFERS NO RXWFS UPON THE CERRTIFICATE FINANCIAL SERVICES INC. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 933 FALMOUTH RD. ALTER THE COVERAD$AFFORMW By THE POUCIES BELOW. HYAWIS MA 02602 RLo»®:508--775-6010 rau:508-790-0249 AFFORD=COVERAGE INAICS ST PAUL 'PRAVEL$RS--- ggyx NUMB01 WNS°�R�TC'fS f MNi>ciERC:COVERAGIES TW POUCMS OF It18URAW6 LWW iR OW HAVE BEEN INUZOTO THE W URER aAMEOAGOke FOR THE POUVV PERi001NOICATED-NOTWITWANDINO ANY RECUREMEMr.TOM OR COMMON ON OF ANY CONTRACT OR OTHER OOCUNENT WITH RESPECT TO WMCH THIS CERTIFICATE NAY to ISMSOOR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES OMCF4BR6 MM"tS SUWECTTO AI LTME TER46,F%CLL$fONS JLL�C�tgTtO�OF SUCH POLMS,AO(ifiEGATti UNITS SHOWN WYK*9M REDt/L W W PA OCLAIM iNL' ... _ imol q O Wb11M POl.WYMfRSDER -- DA LIMITS W�Tr I EAOH000URREaCE 7 ... .- _ C OM tEMAAL GENE_b LL M uT 09NSMADE L`� CUR I ( ( ynmo rap.A l"EFlnO1? A PfiE6ADVt AY D TW Tr. P— ` tEMLA�GIUEUMITAPPLIESOO S AGO � .—_.. AUTOti OWE LIAOLM I ` 0 gDtatE 1N11tT AM AM ( ? I AU OWlEDM009 I eaaLrtxntm1) lRr s y SCHEOWMAUTOS tPwt7e/ HIREDAVfO$ rDtflltn ` s! s ttONOVaEDAUfO$ _ i I MAM GARMEL i ALR'OOK1t-MACCOM s AM M90 EA ACC ! A OM Y. AW s EACKOCCmEmas --F=— OOCM MAIMS MADE! At3wIeEATE s DEDUMISLE ¢— — RETEWWM s ihORMFJi3C�IPlMDATH►NAND 1 *#9834M36709 TA LEAD A RNu* oljpm 07/16/09 I 07/16/10 @I.EAdIA=r-NT s 100000 ANY PROPRiETOAvPARrtA,alQxEcufroE aPP ExSERsxtxwmT 6LDt8EiasE-EADurL $100000 r 1aL OPaa+eN` i0as+ t+ EL OISVW-POUCV_umni s 500000 Oran t PEf4TtN OP OPHtATtONS!LOCATE Wi!ttti /EXCLOtN01fS ADOti�®Y ENOOABEfLEgT tAPECgL•RDVMIDIP$ CERTIFICATE HOLDER CANCO.LAIM j,ajtSVID OIODLD ANY OF THE A60W MWAI ED POLIM go CANCILLW Sp"a THE gXpptA"o DATE TMBRHOP.TNl=Ul*0OWN[IteWN.LENDNA"MftMAIL RAVOWMPrEq FOR 8VSD13ZiTIAlt]f POR>'oSE$ f3PLY TDTHECEIf9I 7GXCUM rAMTOTItLWT,DDTFAHAWATO9030WALL MOORL0411109 OR LWWAY W ANY KwD Stet TM NWRER,ha Act w7a oil REPR6.mmTroft � IIHTNOR�D RiRITATLVE ACORD 25(Mal/OA) 0ACORD CORPORATION T988 Town, of Barnstable *Pe►lttitll v���70 1�� - • -� l:vpires 611101111rs jroot is.cee dote C ttwisrasrenU, Regulatory Services 1 eC MASS, AT 1C3�A,00 Thomas F.Geller,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.lown.barnslab lc.ma.us Office: 508=862-4038 F X! 508-790-6230 EXPRESS PERMIT APPLICATION 7RESIDENTIAL ONLY Not Valid will,oul'Ited X-Prrra Imprint. Map/parcel Number Property Address 1 �• S ` S _Lpl �RResidcntial Value of Work -. ll '- - ��J���� Minimum Ccc of$25.00 for work under$GOOU.UO ,, OV Owner's Name&Address >{- 5 ._ 0 Contractor's Name I ; Telephone Numbct• Home Improvement Contractor License It(if applicable)_ >'�i�� Construction Supervisor's License It(if applicable) •�Workman's Compensation Insurance Check one: -PRESS PERMIT , ❑ I am a soft proprictoi ❑ I am the Homeowner . 19�'I have Worker's Compensation Insurance DEC ® 4 2007 Insurance Company Name_ � )QQ rs JOWL OF BARNSTABLE Workman's Comp.Policy itt �(�(� (j� 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 A( w-kt-,. 4 ` ❑ Rc-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ -Rcplacemcnt,Windows. U-Value (maximum.44) •Whcrc rcyuircd: Issuartcc of this permit does not exempt compliance with other town dcparLncnt regulation-,,i.e.Historic,Conservation,cic. ' 'Notes. Properly Owner must sign Property Owner Letter of Permission. ome.lmprov cnl actors License is required, SIGNATURE: Q:Porms:cxpmtrg Revisc071405 i $ - - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www mass govh a . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legiblv Natne(Business/Organization/Individual): Pal) ( -T (-,Q p a 1) I' T l o-�� Address: I©3 ti `m('a I l'1 City/State/Zip: Q S+ a,\m rn A 0affiG Phone M 5p 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 employees(full and/or p art-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.$ 9. ❑Building addition ` required.) 5. F] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.[]Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12Roof repairs insurance required.]t. c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comn.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. t 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: 0 s: (L Cro SS O O Job Site Addres S ' . a G 11.�1 S City/State/Zip: �P�-O 2(p� 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 eertijy er the pains and pe !ties of perjury that t e information provided above is true and orrect St aturet Date Phone#: —y 2 — 1 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 M Property Owner Must Complete & Sign This Form If Using a Roofer / Builder. l(print) h Lo as Own er Ag ent of the subject property hereby authorizes Paul J. Cazeau/t & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: Address of Job car a s S' J Signature of Owner �. Mailing Address of Owner -A l (--,k Telep hone# 7 7f - Q Date d (please return this form to Cazeault roofing along with your signed contract; It is needed for us to obtain the building permit required by your town, to complete your roofing project, thank you)fax#508-420-4555 R O O F I N G 1031 Main Street Osterville, MA 02655 www.cazeault.com 22 Giddiah Hill Road Orleans, MA 02653 Saint Francis Xavier Office Bldg. Attn: Father Tom DATE ESTIMATE No. 21 Cross St. Hyannis,MA 02601 11/26/2007 4018 Phone# Estimated by: 508-776-8657 Mike r Description of work to be perfromed Total Remove existing shingle roof. Re-nail any loose boarding. Install .032 aluminum heavy drip edge. Install WeatherWatch or Stormguard ice&water shield on bottom edge, in valleys, around penetrations. Install Shinglemate underlayment felt. Install GAF brand Timberline architectural style shingles. All shingles to be storm nailed. Vent pipes to receive new flashing. Cut open and install Cobra ridge vent. All roofing related rubbish to be removed from premise. Provide GAF System Plus Warranty(covers both labor&material)see brochure. Timberline Ultra R 0 DATE r J06 NAM _ ` Q r S C PHONE Sn � Ho S RUSSELL PAUL JOB LOCATION ESTIMATE DONE BY(CIRCLE): MIKE PHIL REMARKS , , I I I � I , I I i I , I " I i - I i " I I I i I 1� I , I I I I I ' SOUARESIFLAT SOUARESISHINGLES' Ioum b98-5569 --c,v,,,u: tz)ub) 428-1177 n Orleans: (508► 255-5569 Falmouth: (508) 457-1141 Fax: (508)420-4555 RightFa,X H1-2 Paget oo3 8/24/2007 1 :21 :48 PM PAGE 003/003 Fax Server ACORD. CERTIFICATE OF INSURANCE PRODUCER DATE(MMIDDIYI) 08-24-07 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION DOWLING&O'NSIL INS ACC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 973 TYANNOUG14 ROAD 2ND FL HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO BOX 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, HYANNIS,MA 02601 COMPANIE:s AFFORDING COVERAGE 22LGR COMPANY INSURED A TRA-'ELER.S DIRECT ASSIGNMENT COMPANY PAUL J CA2EAULT&SONS INC. B 1031 MAIN STREET COMPANY OSTERVILLE.MA 02655 C COMPANY D COVERAGE THIS IS TO CERTIFY THAT THE POLICIES Oi"MSURANCE LIST®BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE POR THE POUCy PERIOD INDICATED,NOTWfTH97ANDINO- APF REGUBi y THE POLICIES CONDITION E ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT76 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, BE SHOWN MAY HAVE BEEN THE UCED N PAID CLAIMS. COBy LTR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIPOLICY F POLICY L'XP GENERAL LIABILITY ( YYI DATE(MMIDDIyY) LIMITS COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $ CLAIMS MADE OCCUR, PRODUCTS-COMP/OP AGO. E OWNER'S 88 CONTRACTORS PROT. PERSONAL&&ADV.INJURY g EACH OCCURRENCE 3 FIRE DAMAGE(Any one fire) S AUTOMOBILE LIABILITY MED,EXPENSE(Anyone Pc=n) S ANY AUTO ALL OWNED AUTOS COMBINED SINGLE LIMIT $ SCHEDULE AUTOS BODILY INJURY(For Person) g HIRED AUTOS BODILY INJURY(PcrAccldenQ g NON-OWNED AUTOS PROPERTY DAMAGE g GARAGE LIABILITY ANY AUTOS AUTO ONLY.EA ACCIDENT g OTHER THAN AUTO ONLY- EACH ACCIDENT $ EXCESS LIABILITY AGREGATE $ UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE g $ WORKER'S COMPENSATION AND AGGREGATE A EMPOLYER'S LIABILITY UB-DO95864A-07 08-10-07 08.10-OB THE PROPRIETOR/ STATUTORY LIMITS X PARTNERS/EXECUTIVE X -INCL EACH ACCIDENT $ 100,000 OFFICERS ARE: EXCL DISEASE-POLICY LIMIT S 500,000 OTHER DISEASE-EACH EMPLOYEE S 100,000 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLBSIRFSTRICTIOHSIBPaCUU,ITEMS THIS REPLACES ANY PRiORCHRTMCAn ISSUED TOTBFC3MFICATE HOLDER AMCTING WORKEkSCOMP COVERAGI, CERTIFICATE HOLDER CANCELLATION -----••—._.._.._. __.,___ ....___._ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Be CANCF3.LED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENGEANOR TOM.AIL io DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.WT FAILURE TOMM SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IVND UPON THE COMPANY,ITSAGENTS OR REPRESENTATNES. AUTHORIZED REPRESENTATIVE Charles J Clark _ - Board of Building Regulati ns and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 103714 Type: Private Corporation Expiration: 7/9/2008 PAUL J. CAZEAULT & SONS, INC. -----------_.. - Paul Cazeault 1031 MAIN ST -- - - OSTERVILLE, MA 02658 Update Address and return card. Nla.rk reason for change. C Address -C_I Renewal I j Employment Lost Card DPS-CAI 0 SOM-05/06-PC8490 Z. (Jarrv�novzcup o�✓uaaaac/u�aella Board of Quilling Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:;;103714 Board of Building Regulations and Standards Expiration: 7/9/2008 One rton Place Rm 1301 Type: Private Corporation Bo on,M .02108 PAUL J.CAZEAULT.`&:SONS,;INC'. 'Raul .Cazeault 1031'MAIN ST � J h OSTERVILLE,MA 02658 Deputy Administrator _. Not vali witho i nature �. .. g 1 3 BoaryTomg egulat'ons an tan arils One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Construction Supervisor License 4 / License CS: 26325 '- , i •, Restriction: 00 Birthdaie: 10/20/1959 Expiration: 10/20/2009 Tr# 6311 I r PAUL J CAZEAULT 1031 MAIN ST ---- --- OSTERVILLE, MA 02655 ,x „•' Update Address and return card.Mark reason for change. M• 1 � Address 0 Renewal Lost Card DPS-CAI u 5OM-07107-PC8490 -----•_- -- r`Board of Building Regulation§and Standards <`'? Construction Supervisor License. License: CS 26325 I ' Birthdi to `.1,0/20/1959 Expttad f0/20/2005 Tr# 6311 �• �� Restictton _00 is H PAUL,J CAZEAULT) ,r I 1031 MAIN ST OSTERVILLE.MA 026554 "'=" Cnmmiccinno� Board of Building Regulati ns and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 103714 Type: Private Corporation Expiration: 7/9/2008 PAUL J. CAZEAULT & SONS, INC. Paul Cazeault _..-._....._. 1031 MAIN ST OSTERVILLE, MA 02658 Update Address aid return card.Mark reason for chance. I.'] Address .[ C I Renewal I i Employment Lust ord PS-CA1 0 5OM-05/06-PC8490 07%� Board or Building Regulations and Standards License or regis ation valid or►ndividul use only lugHOME IMPROVEMENT CONTRACTOR before the expiry 'on date.)` found return to: Registration: 103714 Board of Building egulations and Standards Expiration: 7/9/2008 One Ashburton Pla Rut 1301 Type: Private Corporation Boston,Ma.02108 PAUL J.CAZEAULT-- SONS,;INC. ,. Paul Cazeault 1031 MAIN ST ,,,,` OSTERVILLE,MA 02658 Deputy Administrator Not slid without si nature Boar o ui in egulations an to ards x One Ashb on Place - Room 1301 Bosto,, . Massachusetts 02108 Const ction Supervisor License Licens CS: 26325 Restriction 00 Birthdat 10/20/1959 Expiration-1 10/20/2009 Trlt 6311 PAU L J CAZEAULT 1031 MAIN ST ---..--._ .._- OSTERVILLE, MA 02655 -__ _- - -........._.- -- --- - _.. Update Address and return card.Mark reason for change. Address �;_� Renewal [I.Lost Card DPS-CA1 15 50M-07/07-PC8490 --.—__.__....-. ..—. _ '' y. `.,: ✓/ee 'Coamma�r�o�, off'/�7.l�dfrcc�cu4e.� Board of Building Regulation&and Standards Construction Supervisor License :f License: CS 26325 Birthdate 10/20/1959 I .EVIMI:loni 10/20/2009 Tr# 6311 ' .I~ � �� Restntaion 00, r PAUL.J CAZEAULT;:'. 1031 MAIN ST OSTERVILLE,MA 02655 Commissioner TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY/RECTORY OFFICES PARCEL ID 306 244 GEOBASE ID 22221 ADDRESS 21 CROSS STREET PHONE HYANNIS ZIP - LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 53275 DESCRIPTION C/O RECTORY OFFICES ST.FRANCIS X PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY � . CONTRACTORS Department of Health, Safety ARCHITECTS' and Environmental. Services TOTAL FEES: BOND ?HE 1b�_ CONSTRUCTION COSTS $.00 "�• 756 CERTIFICATE OF OCCUPANCY 1. PRIVATE P * BARNSTABM • MAS& 16 .D IiAI� BUIL BY � DATE ISSUED 05/10/2001 EXPIRATION DATE . 6,_ • TVYVAV 0�� �ARIISTABLE.:. , .. . Ia : D PERMIT PARCEL, ID''bOS 444 GEOBASE JD 2222I ADDRESS"` 21 CROSS STREET � Pa ORE f H Y ANNIS � z.I" LOT BLOCK pp,,**1�Y�1 � C�'T 1�1`�E+�.:a.��y���1 y��y i�.L>t! .1J V GLOP�:ENT 1,e+.i.1�.R,S1.L�J.L. R r PERMIT 49601 -DESCRIP°.[ION ADD H-CAS' RAMF/L'IFT' /BATH--OFFICE I Mt LE I PERMIT TYPE BREMODC TITLE COMMERCIAL A"LT/CON' CONTRACTORS:: COX, T ROBERT Department of Health, Safety ARGt `L'ECT and Environmental Services TOTAL FEES: $840 5fJ BOND $.®Q THE CONSTRUCTION COSTS $105,0q0...Qt7 3`77 NONRES./NONHS .P ADD/CONV 1 PRIVATE * 1ARNSPABLE. ; MAS& BUILDING DIVISION BY -_- �, DATE ISSUED 10/2 7/`000 FXPIRATION DATE I THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED` FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS-CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS; HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD. SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL* jINSPECTION APPROVALS* l i �S u IS ,-1 ., Lflwc•-rt� 3-/Y-»e?o�/ 2 � 2 2 3 1 HATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH . OTHER: SITE PLAN REVIEW APPROVAL r WORK SHALL NOT P CEED UNTIL . PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS PPROVEDTHE STRUCTION WORK IS NOT STARTED WITHIN SIX• CARD CAN BE.ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS'ISSUED'AS -TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. `I I � I `I dt- 'y SAINT FRANCIS XAVI ER 9 July 2002 Regulatory Services - Building Division Barnstable Town Offices 200 Main Street Hyannis, MA 02601 a Dear Ms. Thanks so much for your help with'the application process for renewing the sign in�front of our church on South-Street. We,wanted to be sure we were not doing anything that was not allowed. 4Is,,there anyone we would ask about a waiver of the fee on this project? It crossed my mind that perhaps there is such a provision for a non-profit corporation like' St. Francis Xavier. If you could let me know if you discover this I would be most appreciative, for I am sure you'know that every little bit adds up. �F Enclosed you will find a check for the fee. If we later find out it can b waived we will ahi tase do'not Bold up the poess to check thisor us It s more a matter �I for-future times when we might be doing something similar. . Thanks again for your help. ,I look forward to meeting you,- sometime and thanking you in person. Sincerely, (Rev.) Thomas A. Frechette Pastor ZIL St. Francis Xavier Parish 21 Cross Street, Hyannis,MA 02601-4526 Voice508.775.0818 Facsimile508.771.5940 St. Francis Xavier Church South Street,Hyannis Sacred Heart Chapel Summer Street,Yarmouthport St. Francis Xavier Preparatory School Cross Street, Hyannis St. Francis Xavier Cemetery Pine Street,Centerville St. Patrick Cemetery Barnstable Road,Hyannis r i r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Parcel ` Permit# Health Division 7 7-3(s /�!/ Zoa -®�' Date Issued 2 /Zoo© Conservation Division ct A I rD Fee Tax Collector %. , ?if i.TO q�d% e�u'� 4. - SEPTIC SYSTEM MUST BE Treasurer .T / �� � — INSTALLED IN COMPLIANCE F ♦, Planning Dept. f wMi Tm 8 ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis - Project Street Address 21 Cross Street Village Hyannis - Roman Catholic Bishop of Fall River , _ Owner St. Francis'Xavier Address 347 South Street Telephone (508)775-0818 Permit Request 4T c e 4n a�te d 4 /4 A f6 Square feet: 1st floor: existing 1408 proposed 2nd floor: existing 1008 proposed Total new Valuation �� S'. O O D Zoning District Flood Plain Groundwater Overlay Construction Type wood Frame Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. i. Dwelling Type: Single Family ❑ Two Family ❑ Multi Family(#units) Office t Age of Existing Structure Rn vPa, rP�, I) Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) sae Basement Unfinished Area(sq.ft) 945—S g Feet 1 Handicap Number of Baths: Full: existing 121 new INQMr. — Half: existing new Number of Bedrooms: existing NC)Ng new Total Room Count(not including baths): existing 10 new 7 First Floor Room Count 5 Heat Type and Fuel: ❑Gas W Oil ❑ Electric ❑Other Central Air: ❑Yes ®No Fireplaces: Existing NONE 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 Cl Commercial U Yes ❑ No If yes, site plan review# Current Use 0ff1les Proposed Use effi6es BUILDER INFORMATION Name Z Telephone Number Addres _ License# Home Improvement Contractor# CeAlt uille a Tr Worker's Compensation# 026 s�ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO F-1 op- E,'A4 0 SIGNATURE DATE , �9C7 I r r - FOR OFFICIAL USE ONLY <• - PERMIT NO. ' DATE ISSUED s , fin .. � - � ..• A - , t MAP/PARCEL NO. - ADDRESS y, VILLAGE OWNER n DATE OF INSPECTION { • - r F - FOUNDATION FRAME INSULATION , FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH-, FINAL' ` ^.� t.. •a i , GAS: ROUGH- +g FINAL FINAL BUILDING t'3 �� /"Avt - DATE CLOSED OUT ASSOCIATION PLAN NO� dc mF xOct n '•-- , • ' T Town of Barnstable _ Regulatory Services S awRMAZ= suss �, Thomas F.Geiler,Director E163 Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 MEMORANDUM DATE: 113101 TO: File REGARDING: COI Multi-Family Use Re: / Certificate of Inspection is not required for this property--does not consist of 3 or more units within a single structure. Notes: , L; n �i - 0Y-o ) The Commonweautt ofMassacnuse" -� Department of'Industrial Accidents • :��' -���- '=-=�� Olflcr atloyestiga�loos 600 Washington Street Boston;Mass. 02111 Workers' Com ensation insurance Affidavit 'knniic.: fTtTrfaruraum.';, Lname-P40farl— Clocation: hone#city ( �am a homeowner performing all work myse!£am a sole pro rietorandhave no one workingmany ca achyI am an employer providing workers' compensation for.my employees working on this jobcomnanv name: . ..:.... . . .dtv: olicvinsuran ce cn.have the following workers' compensation polices: comnanv namesaddress- ..... :.. .... ......:;.X. :::;:.:: ICY' . ..�... ::y:>r:r:::;::insurnnee co.ae:camnan addrecity- ........insurance co. n of criminal enaltiesofatrue ap to 51�00.00 an or Ftulure to secure coverage as required under Section M of MGL 1S2 canlead tothe impostflo pone years' ure onment as well as civil penalties in theformofa TO of K f D�end a ft of S 1on.00 a day against ma I understand that a copv of this statement may be forwarded to the OfiiceofInvestiga1 do hereoy certij} under she pairs and penalties of pejurythat he information provided above it trr�and correct Date /OSi�tature Phone Print namedoCoincial use onlydo not write in this area to be completed by city or town of8taal ❑Building Department, peentitNcense 0city or town: ❑Licensing Board ❑seiectmen's OMce check if immediate response is required ❑Health Department ❑Other phone►i;ontact person: `�A Information and Instructions \Zassac ns�s G—Acral Laws chapt er f another una 152 section 25 requires all employers to provide workers' compensation `s�uu` em ion ees. :�s quoted from the "law",an employee is defined as every person in the service o of P ✓:;mess or implied, oral or written. .Dioyer s deiuied as an rndrvrdual, Partnership, association, corporation or other legal entity, or any two or more crece : an em d:e iorove e_oin� Raged in a joint enterprise,and including the legal representatives of employees. However the o��of a,� trustee cf n individual, partnership, association or other legal residentityes the in, o �P ` dwelling house}laving not more than three apa���who resides therein, or the occupant of the dwelling House of ce , construction or repair work on such dwelling house or on the grounds another who employs persons to do marntenan to be deemed to-be an employer. n�� building appu thereto shall not because of such employment ance or rene MG,. c hao.er 152 section 25 also states that every state or Ioca1 Iicensing agency shall withhold the issu -r license or permit to operate a business or to construct buildings in the comm�ired�Additionall,th for any -.neither the icant o 0, a P not produced acceptable evidence of compliance with the insurance coverage gfor the erformance of public work unm: P o nscntverith nor any of its political subdivisions shall eater into any have been presented to the comrac=12- —Hacc-al,�:ble ezzd AAce of compliance with the insurance requirements of this chapter author=. a Dpiicnnts ' the box that applies to your sintation and .,ten in tLe workers' compensation affidavit completely, by checking .;....,, of insurance as all affida� is v be �` - any names address and Phone numbers along with a certificate . uDph�ing comp P `� " 4' to the D ailment of Industrial Accidents for confirmation of insurance coverage the erm:*t°r Zi: se is o ;uumrtt.Pd eP ,, should be returned to the citY or town that the application r _ catro F � . ., davit. The affidavit sho .T� ---.L t:�..m`' Should have any questions regarding� `I3;Y ° -ems requested, not the Department of Industrial Accidents• number listed beio,,,. are required to obtain a workers' compensation policy,Please call the D ep artment at the 0 Moor 117, g City or Towns lets and printed legibly. The Department has provided a space at the bottom of ;lease be sure that the affidavit is comp investigations has to contact you regarding the apphcant. Please the you to fill out in event the Office of +.. nil in the fill o itlli ei mrmber which w�be used as a reference number. The affiaavits may be re^�t^ be sure emeaLs have been,made. the Department by mail or FAX unless other an=g - Investigations would like to thank in adva= for.you cooperation and should you have any questionsiL-e ce of :)I :se do not hesitate to give us a call. the Deparuneat's address,telephone and fax number The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Investigations 600 Washington Street 'Boston; Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 i L5 LAND t(I ' � 1 II � I - 1==. 6XIS11N6 Tb}SE RexovEU _ F O BXKSIN 6 TO REMAIN 7 MINN NEW PA2TI110149 :+t I _ �AU.wlupov.A To r/6 � IAI 191 ICI IVl - ' N LB�VIN`rL U4691eYE'/IIHDPNS i I i C I � j TI i I / PARI5H:eeCRVTAR � I T (.�� f 7aeW ocleL VICaR'Z OFFICE Ope:C PASTOR.'S ' • ) a/e/x WwWso Q.r.R j N cny pXlrlf.`IlINDOJJS --._..-• �\ _ ;I; �1 � j I i l••`a�l. I— .Vl'C I--� .. . . gl LWt._ ICE a ,. i,_ ,, ' pAROG1aL vlca<'s /MIL — ....KITCHEN 9LIPFL166a W I-1 �� :.. )� ass1 rq, I•I, i I AITING - �_•� leo�5 c� ° f-(�I� J% (A�. III `/' �! ' ,(f I II_'I 1 �IIII)1 Z I I'I l il •1 I- H . 3 \ It .. I ��I� � I � � I IJkkL 9ce. I VEST RULE � •� II �,.�„ � f �� i waF&c t �NaIRLlPr opgN Por±_R� 2Np FLOOR PLAN — — -- If FLOOZ PLAN WfU ED RENOVATION A�'h:N IZTPA1lON!^c= .' _. _'----_ _......-... .. ',.. xaLe:I/,}..I•.p• F F01z PnASH , EANCIS AVIER FARIS'—' �547 SOUTH 5-. HYANNI5.MA. /- BOARD OF BUILDING REGULATIONS License: CONSTFRUCTION SUPERVISOR Number. CS 013885 Birthdate:.03/12/1955 i Expires: 03/12/2002 Tr.no: 73885 Restricted To: 00 ROGER T COX _ 19 SOUTHEAST LANE CENTERVILLE, MA 02362 'Administrator 1 • ---------- j!• �j � 4 S aFli,NfN.+.1M4`A M.,: \ \\ \ \ �\ �\ �I li �v f ' yry i IL c rto 9.1r oo 1 _ r l' .. _ 1 �,r e' u .. i - i d� i �y r i t e _ N ,4 r I z t ......... .., . ..., . m...._.r , w 1 E A ---------- � k�t��r�aK!�'�",bin i„��i," 4 ,4��•ra„ r,r,wsr,v�p;ht 4:?' 1 oe �A�OCH 14,L I CA? '� V I-- V A) i �IAIZOCIAL VICAt-�'G (D/ 14,\N. "to 9CMAIN C-A r- ?'C-T L L e, 1"rC�4 t�tA -T C 0 N r-r::t,Z- !ICE --A-4 LINO W,,.Jo f—;T7 -ro Lor -----------js CIL 9)00 -71 col x S T5ULe cr >LAN U F-r TFLOOP'. f' N 0Y ZZ rIORHoP, FAfZIGH At;MINI,��T?Allo C lM�, IZENOVA SCALE: rl j S-r- XAVIag ?AfF-jSH DATE: .547 SOUTH ST, DR. BY: ANN I-S - MA , HY cq( rro'slf gJ-) REVISIONS A p lama design CONSULTANTS/CONSTRUC a 625 North Main Street Mansfield, MA. 02048 - Te