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TOWN OF BARNS///T��(�/A�rBLE BUILDIN ER APPLICATION
Map Zrfa Parcel 2 Z Permit# Y7/S 49
. 'Health Division Date Issued V3 f Od
Conservation Division . Fee C4=>>
Tax Collector fro � 0 a
%A,— sC � ` � I ����T eta
Treasurer a.��-��' INSTALLED IN CO'NIPLIANCE
WITH TITLE 5
Planning Dept. NVIRONMENTAL COCA ANI
Date Definitive Plan Approved by Planning Board ``U " TOWN REM�A��
Historic-OKH Preservation/Hyanni
Project Street Addressr 2GUs �/�itlG
Village
Owner f11tLJD IMDrL— tA10 Address l
YUI
Telephone p
Permit Request f� � 1, �x �(� 1i %�-I'� (� 1
Square feet: 1 st floor: existing (�S roposed 2nd floor:existing proposed Total new
Estimated Project Cost Bonin District Flood Plain Groundwater Overlay
1 9
1
Construction Type � ���
Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation.
Dwelling Type: Single Family O Two Family ❑ Multi-Family(#units)
Age of Existing Structure -7 Historic House: ❑Yes �l0 On Old King's Highway: ❑Yes J�No
Basement Type: Zatull ❑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: Comas 0 Oil ❑Electric 0 Other
Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes Leo
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
BUILDER INFORMATION r
Name �t� G � Telephone Number
Address �\`� U ' License#
Home Improvement Contractor# b� t
Worker's Compensation#
ALL CONSTRUCTION DEB IS RESULTS G FROM THIS PROJECT WILL BETAKEN TO
SIGNATURE DATE _ `�
tq � ,�
FOR OFFICIAL USE ONLY
_ a
PERMIT NO. j
DATE ISSUED
MAP/PARCEL NO.
ADDRESS Y` VILLAGE
OWNER �� •r , f � -
DATE OF INSPECTIO
FOUNDATION -
r FRAME -
4
` INSULATIONS `
FIREPLACE • ' ? _
ELECTRICAL: ROUGH , FINAL
PLUMBING: ROUGH- , ; FINAL
GAS: ROUGH : ~' ~' FINAL
- t
FINAL BUILDING y
DATE CLOSED OUT
ASSOCIATION PLAN NO.
r.
f
STANDARD LEGEND
NOTE:not all symbols will appear on a map
tZt=:Z GOLF COURSE FAIRWAY
X x ..... ..... EDGE OF DECIDUOUS TREES
\ EDGE OF BRUSH
_ ORCHARD OR NURSERY
i L
I �7 EDGE OF CONIFEROUS TREES
MAP -8
, �� �� MARSH AREA
_ 1 /� EDGE OF WATER
DIRT ROAD
174 �
DRIVEWAY
PARKING LOT
/ — — — PAVED ROAD
MAP 268 -�
DRAINAGE DITCH
c� \/ ————— PATH/TRAIL
`1JJP PARCEL LINE
� n
y
Milo
PARC EL
21 NUMBER
O #IN —HOUSE NUMBER
,\
2 FOOT CONTOUR LINE
— 10 FOOT CONTOUR LINE
Elevation based on NGVD29
1- 4.9 SPOT ELEVATION
l� M 268 STONE WALL
-X—X— FENCE
RETAINING WALL
-----------� 4 RAIL ROAD TRACK Ft
STONE JETTY
—� SWIMMING POOL
I I
I I E PORCH/DECK
t CJ BUILDING/STRUCTURE
AP 2 8 -
DOCK/PIER
HYDRANT
e VALVE O MANHOLE
8 MA
O POST O" FLAG POLE
T O W N O F B A R N S T A B L E O E O O R A P H I C I N F O R M A T I O N S Y S T E M S U N I T a SIGN ® STORM DRAIN
w PRINTED SCALE:IN FEET sNOTE:This map is an enlargement of o Ldo.
TE:The parcel lines are only graphic representations DATA SOURCES:Planimetria(man-made features)were interpreted from 1995 aerial photographs by The James ❑ TOWER
- — 1°=1 DO'sale map and may NOT meet perty boundaries.They ore not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD o UTILITY POLE
0 20 40 National Map Acarecy Standards at this represent actual relatignships to physical objects Corporation.Planimetriq topography,and vegetation were mapped to meet Notianol Map Accuracy Standardsp UGHT POLE O EIECfR1C BOX
I INCH=40 FEET* enlarged scale. map. at a sale of 1°=100'.Parcel lines were digitized from 2000 Town of Barnstable Assessors tax maps.
\sitemaps\Public\grouse.dgn Jun. 28, 2000 10:15:06
y The Town of Barnstable
• B�axsresr.E. .
� $ Department of Health Safety and Environmental Services
P
OrEo 5 Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038_ Ralph Crossen
Fax: 508-790-6230 Building Commissions
Permit no.
Date r �
AFFD)AVII
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: � C-' Estimated Cost
Address of Work: I G R E LA4CE
c
Owner's Name: E ki `� ✓�
Date of Application:
i v _
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
[3Job Under S1,000
E3Building not owner-occupied
❑Owner pulling own permit
Notice is hereby given,that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby appl for a permit as the agent of the owner. dJ'
Date Contractor Name Registration No. ,
R
Date Own 's Name
q:forms:Affidav
The Commonwealth of
Massachusetts
----- Industrial
Accidents
Department of
-�"! �ceollosesugebons
600 Washington Street
Mil Boston,Mass OZlll
davit
workers' Com easation Insaranee
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�. f0 S16�.00 anotor
insnran ce'Yos :;;':K 'r �n 2SA of MQ. em lead to the of a-kn2I penalties of a San IIP
that'
Failure to seem's covenonuIn{e vwU as Civa pmaitirs laths loam of ai S'TOP MOBS ORDER and a#ne of SIOUD a day against tam I naderstand
one years'bnpnaomamt as oftbaDlAfor eova'aie teri8ediom
copy of this atataneat may be fntwa:ded to tide OIDoe of Insatti�' '
cc?* othat Pad above is tu and eorred
aiatt fPuiafon�on
1dohcrcby, udr thepan =dple?O
_
Date
t rye i -
ofSdal
oiSdai use only do not white in this am to be eomple"by city Ortowwn ❑BuUing Department
perudt/license# bucensing Board
city or town: ❑Selecmun,s OMre
response is regtti:ed ❑Health Depzn=ent
checkifimme�ti po _ QOther----
phone#'
contact person,
Information and Instructions
5 requires all employers to provide workers' compensation T°:'-"=�
sachusem General Laws chapter 152 section 2 Q eV Person. service of another una.,. and' cry
�4as as
. o quoted from the"law ,an employee is defined �5'
�mplo�es. As
of hire, express or implied,oral or wriam
defined as an individual,partnership, association, corporation or other legal entit�', or, an.,, L or more
�n emploti�er is the le r-sematives of a deceased employer. or the rece.',�- -
the foregoing engaged in a joint enterprise, and including rep
association or other legal entity, �P1Oy�employees. However the owaer of a
austee of an individual, partnership, artme=rts and who resides therein, or the occupant of the dw_11in_house c:
dwelling house haling not more than three ap
Persons to do main cons��°f mpg work an such dwelling house or on the noun
r.
another who employs P I be deemed to-be an employer.
shall not because of such emp °yin
building appurtenant thereto
52 section 25 also states that��3'state or local licensing agency shall withhold the issuance o:
,VGL chapter lin the commonwealth for am applicant wnc -
of a Iicense or permit to operate a ofbusinessc �ce construct
th buildings coverage required. Additionally, n-zth.'r tt�e
not produced acceptable evidence of comp enter urto any contract for the performance of public work ur:-
commonwealth nor any of its political subdivisions shall. of this chapter have been presented to the cotr
acceptable evidence of compliance with the insurance requ
authority.
:kpphcants
ali'maffidavit completely,by checking the box that applies to�rour situation and
Please Min the workers' comp and
numbers along with-a certificate of insurance as all amdavits may be
an names,address Ph°� o be sure to sign
supplying company Accidents far m of insurance coverage. Also ..
submitted to the Department of Indust Or the application for the permit o= ucse �=
date the affidavit The affdavit should be reritraed the ndd you h-may =regarding the "law" or
not the Department of Industrial Ac��• �0
being requested, , . D at the number listed below.
to obtain a workers' comp�°n.Polic''p�call � �
are required
r r ji ///..%//�/,....
City or Towns
The Depart has provided a space at the bottom c.*-=
Please be sure that the affidavit is complete and printed fly a iicaat Please
to fill out lathe event Office of has to contact you regarding th..aPP
affidavit for you er which will be used as a reference number. The affidavits may be r zned t^
be sure to fill in the permrt/hceose numb ®ems have be==ad&
the Department by mall or FAX unless other
The Om
ce of Investigations would like to thank you in advance for you cooperation and should you have and•cp: ons.
to us a call.
please do not hesitate �. ,,,,,,<,,. �.,,,r„��,:,,,,,,.,,,,.
!fir;:%
Opp
The Department's address,telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
amce of Iavestloatloas
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
phone#: (617) 7274900 eat. 4069 409 or 375
.i
• t
BOARD OF BUILDING REGULATIONS `.
S License: CONSTRUCTION SUPERVISOR
Number CS
025853 i
�.. rl
'-�
- Expire OSI23/2001 no: 4079
00
TIMOTHY D STORER
50 REDWOOD LN
Administrator
HYANNIS, MA 02601 I ;t
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