Loading...
HomeMy WebLinkAbout0070 HIGHLAND STREET 70 �16��A.Ua S'r 6 ACTIVE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map -- �" Parcel r OF BAfS ABLE Permit# L Health DtGsion�" inn , Q Date Issued `L O �- 1 GEC Conservation Division /2 /4Zwl Fee Tax Collector�G0j,=o � V1S Treasurer S L° =ti Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Streef Address 70 14(' m n g S4- Village y 0.vx r i 5 Owner � ��� �'� S 5, ` ` Address 5, � Telephone 50$- n'7 S -o t(fl-:,, Permit Request �--� �- all Square fee 1st floor: existin - proposed 3 2nd floor: existing a proposed Total new 35 Valuation � 4_ oning District Flood Plain Groundwater Overlay Construction Type W Lot Size « � yS3 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes KNo On Old Kings Highway: ❑Yes kNo Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) ��a41 Number of Baths: Full: existing new ' I / Half: existing new Number of Bedrooms: existing new 5 Total Room Count(not including baths): existing J new 2 First Floor Room Count Z Heat Type and Fuel: VGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes * Fireplaces: Existing New Existing wood/coal stove: ❑Yes KNo 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 If yes, site plan review# Current Use -e tic e---• Proposed Use � ✓�..- BUILDER INFORMATION i Name I � e C ' C Telephone Number t Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Z�_ OL �r(�- .ILc.d 4,vlm SIGNATURE �� % - DATE Z rr I .Y FOR OFFICIAL USE ONLY f PERMIT NO: .. .. a 1 DATE ISSUED • ; MAP/PARCEL NO.- ADDRESS VILLAGE OWNER r 'r DATE OF INSPECTION: FOUNDATION �d� FRAME J 4 r $ INSULATION - FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r 7 GAS: ROUGH FINAL ' FINAL BUILDING !bjrlo-i s . DATE CLOSED OUT - ASSOCIATION PLAN NO. , RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 j Alterations/Renovations $25.00 Building Permit Amendment $25.00 . FEE VALUE WORKSHEET NEW LIVING SPACE p square feet x$96/sq.foot= 7, 76'� x.0031= ;q- 7 3= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft.l >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= 3 O (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) w Permit Fee b, 0 ,� projcost FEE VALUE WORKSHEET LIVING SPACE (2000,sq ft or greater) square feet x$115/sq.foot= (less than2000 sq ft) square feet x$96/sq. foot= �� �°�' ®O (affordable housing) square feet x$57/sq.foot= (4013 or low income) 1 w a GARAGE(UNFINISHED),\ square feet x$25/sq.foot= PORCH -,square feet x$20/sq.foot=l 15 A do 0( . ®® DECK `�.�a� square feet x$15/sq.foot= ALTERATIONS/RENOVATIONS ' OF EXISTING SPACE . . . . . .... cost=. . . . . . . . . . . . . . . . `� Total Project Fee-Value 9 ( ,36 ( ' 00 e Office Use Only Permit,-Fee projcost 4 f � f.S, h� a(.,r \i A 'a E 'i:. 7 rkit 1§x k5x n at:'_n:� �^� a� h 7 :� .:r�'y. r a• !:'�. "S°S Ru; ,.'ti t,� . 'aeu?.k ,, :,,a 1 ,,..�' -r. +�. d✓� 5 s-. »✓:,a a,, k.......,. ,,. } .....,. .F,. ..,..c� s e, r'�� , t�§ 1 t d�`u� 7 3. ..:.+x.. qrr s''S w .::.� 7 -4v .�i�" :.;. a'.. -P� ?1r�7 -` R 3�:-!�_ ,��` n� a•x.:.� x .:.a 4S�.:S,t.aw:r�x,.k �7yf^,�� a' t .ry) G, �C; .✓,'... Y f 5 �},:l�� ors., L.-... ns,;£ -W+ )U: ., Y t h ?Y ,r,.ke n l r,:u+,r• r`x) s w s r ta,pp4 t ev ,.. -a._ ! ff. �s g...,�:,1 r n 1,9 !� ,.�" � -.-;� � T �!^.v9 v�"E� �{ r -v„�. x.�'rm-� a �?,_ r � rot l,.!nt'S t.r 2 t- i'Gry �dh�..>r Fr E,::;, s'� s .,x\,.�. `1Pi s*".�i. �i"�- 'e�.1 .•z-� ,jx(^vi:-2�, >a5,,"l.6„.i *'i '�"', s 3r.. � §°oy :,S I TA \ y 7 AP 4 70 60 j MAP 3 17 f1dgnioonservation.dgn Jul.19.2001 16:14:27 The Town of Barnstable Regulatory Services 059. ► Thomas F. Geiler,Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 x Fax: 508-790-6230. . Permit no. Date AFFIDAVIT 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 o f Work: `��� Estimated Cost 0 Z-6 W/ Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied wner pulling own permit Notice is hereby given that: WN PERMIT OR DEANMT W ORK DO NOT OWNERS PULLING THEIR O HAVE . CONTRACTORS FOR APPLICABLE HOME IMPRO ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. R I .v Date Owner's Name f q:forms:Affidav f The Commonwealth of Massachusetts f<� - Department of Industrial Accidents Office of/nsestigadvas 600 Washington Sheet Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: �l location: PYA AJ J( Z- Go f hone# ff I am a home caner performing all work myself. ❑ I am a sole r rietor and have no one workuME' in anv ca achy % /% %%%%%///%%%/%//%/O%%%%%%/%%%%%//O�%/��%%%%/�%%%%%%%%/��%%%%%%%/G%�%/�///, Providing workers' co ensation for mY employees working on this job. ❑ I am an employer p g mP , xx coai an name: address: ow hone.# insurance co. : >; I am a sole proprietor, general contractor or homeowner circle one)and have hired the contractors listed below who the following workers' compensation polices . com an name: X. address .... n ei X. ..::.. oLcv ,.. 7 .: n�I1rAIICe'CQ:" :: so c anv narnei address. ,; >, '`X. : .:. h bn41 e: : ci .. oli ' X. aamranct:.co. >: �/ gaQore to aecnre coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Sue np to S1,500.00 and/or one years'secure coverages well as duff penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties perjury that the information provided above is truo and correct p __ Date I I( Signature SO Print name `���-ems- z C P o e, S Phone# official use only do not write in this area to be completed by city or town official q city or town:-- permit/license# ❑Building Department ❑Licensing Board ❑Selechnen's OtHce ❑check if immediate response is required ❑Health Department phone#; ❑Other contact person• , OrAsed 9195 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of.insurance as all affidavits 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. City or Towns 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 pernut/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 imlesduatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 M CMR Append&1 Table J111b(continued) Prescriptive Packages for One and Two-Family Residential Buildings Hated wild Fossil Fuels MAXIMUM MINIMUM Glazing Glazing Ceiling Wall Floor Basement Slab Heating/Cooling Any'(%) U-value= R-value' R-values R-values Wall Perimeter Equipment Efficiency Package I R value° R valud 5701 to 6500 Hating Degree Days' Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 10 ' 6 85 AFUE T 15% 0.36 38 13 23 N/A N/A Normal U 15% 0.46 38 19 19 1 10 6 Normal V 15-/- 0.44 38 13 25 1 N/A WA 85 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X 19% 0.32 38 13 25 NIA N/A Normal Y 18% 0.42 38 19 25 N/A N/A Normal Z 18% 0.42 38 13 19 10 1 6 90 AFUE AA 18% 0.50 30 19 19 10 6 90 AFUE I. ADDRESS OF PROPERTY: 70 wki A'jo,Ali I�1T�Si �►1�'` 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 29 4 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-i980303a 780 CMR Appendix J Footnotes to Table.15.2.1b: ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. z manufacturer in accordance with =values must be tested and documented b the After January 1 1999 glazing U Y ary , g g the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example, an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. s The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of-any individual basement wall with an average depth less than 50%below grade must me--t the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. " If the building utilizes electric resistance heating use compliance approach 3,4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a NOTES: y a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 The Town of B arnsta a ie „,E�1.E.g Regulatory Services 9�AT t659- Thomas F. Geiler, Director Eo►� Building Division Peter F. Dimatteo, Building-Commissioner 367 Main Street.Hyannis MA 02601 Fax: 508-790-6230 Office: 508-862-4038 HOMEOWNER LICENSE E=&1MON Please Print IZ / I DATE: l�l a �� G,OvI S l�Y� ' A village JOB LOCATION: strta number 57rgy1*1_1 -e��2(� � "HOMEOWNER": home phone# work phone name 70 CURRENT MAILING ADDRESS: M ft— ANhli 5 Siam rip code city/town. The current exemption for"homeowners"was extended include owner-occuvied dwellings of six units or less and to allow homeowners to engage an individual forr hire who does not possess a license,vrovi�d that the owner acts as supervisor. DEFRiPITON OFHOMEOWNER who owns a parcel of land on which helshe resides.or intends to Tom•°A which there is,or is Person(s) accessory to such use andlor intended to be,a one or two-family dwelling.attached or detached eriod shall not be considered r. farm structures. A person who constructs more than one home io fficial on a form acceptable to the a homeowner. Such"homeowner"shall submit to the Building ' 'n�Official,that helshe shall be res onsible for all such work erformed under the building ermit. Building (Section 109.1.1) V Code and The undersigned"homeowner'assumes responsibility for compliance with the State Building other applicable codes,bylaws,rules and regulations. ed"homeowner'certifies that helshe understands the Town of Barnstable Builds Said The undersign cots and that helshe P Department minimum inspection procedures and requirem ,procedures and requirements Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet our larger will be required to comply with the State Building Code Section 127.0 Construction N HOMEOWNER'S�nO or which a building Permit is re gtured shall be exempt from the The Code states that: "Any homeowner pecformiag work fvisors):provided that if the homeowner env aees a provisions of this section(Section 109.1.1-Licensing of constructionsuper. the responsibilities of a supervisor(see person(s)for hire to do such work.that such Homeowner shall act as sut s-assuming S are ection um This lack of awareness often results in Many homeowners who use this exemption are unaware that y Appendix Q.Rules&Regulations for Licensing Construction Sups• In this case.our Board cannot proceed against the weer acting as Supervisor is ultimately responsible. serious problems.particularly when the homeowner hires unlicensed persons, art of the permit unlicensed person as it-would with a licensed Supervisor. The homes responsibilities.many cornmuntues require.as P e of this issue is a To easure that the homeowner is fully aware of kids the rap onsibilities of a supervisor. On the last pcotturtuntcy. application.that the homeowner certify that he/she understands the rap form currently used by several towns. You tray care t amend and adopt such a formkert►fication for.use in y a II .o -:F\nw(y�.�,r.. EY K, ;'-� •s_;' s'� - - -'SEL^'CION� it [og C -KlZU1Ei.1. - sarrEe De+Lc,: .!-d =7b•7- _. G,_o'. / - P. i a DEGK / FAMILY &00rl L4yIN4 RDoe 1 C/4 SMOKE DETECTORS O.K. ��\r.t✓�T BfiRN5TAB BU MING DEPT. v. ------_ D5\'•\ot,,T\ol4 � \ F LJOi� PL�tJ ._ a'�'�s ® r��-TH V"a re• 1;q,,.1,-°,, pixSs_/,wc z"'Z' (� S��oK� of ECT z GROSS 'IO�SE AoD1L�t�N ?'.a L�Px15r)N4 \./A L ,� 70 t11GHCAN.ID S(. 'HYAlTIt�liS, rib - .. 1'S'"\��7"j1 L''(o'.. -\l°'/ LI_b.. ;_`.. Z._Gi. �-V' z'_Ce" g'-O•% -_ ` - ,1 a. I _ I L �N r---------- I s r1 A�L f I I i STA\2 RAI_J' _ I .MAHC.CIo.\.I`/ SIB-L ... II I1t / ® sr\oKe 6E:EC z7� ._ SGAkE••% = l'-D' DnTE• ti ZI ZZCO i Gp-aSs rtc�.v-E Ar->ol i lDw 1-1\C,A NV10 5Z IjYA11�1is P-A I { -.G-XLSt�'it-cot- R00 F SL/a /q l O PA.TE- />.U4 .VAOUSE TO tkkC IAL JvD ST , 'HYAt�111�5, MA M6MFyeat✓_:.?L7UL.�¢aa15s.�._ I .� .. ..i'�c.«e�_Pti.�--ce..iCl�TY�) � .-t5�_4•. ::. .... - 9 I v � �� L0C4R 'stiYC�LE3 'I I _ 2-4 PF 1 L L �Tt.&.DE NiG�,.l ELi�ti'( nteW Pour+ � '' •. - M - 'I _ <..._ SCALE _Y4"=I'=o". C-&O'bS NOOSE ADOI TITIOh{ .._ 7O.HIC,HLANf� ST:. HYkIJi15;fS1►.__.._ - _..—_.____ _- ti�b�l GOr.ISTt;uL"C,oN (n�S�iraq - - . NO2ZH F-LEV/�71or.1 (P�G�) " __j ILA �/�.L�O ,�H���=�i'b•' i7/r'l�' /1�1�=+ C�7,ZC771 ;► czos5 1'1GDSE 4,rz>pr-r10y (� 70 'Co MAYtI.e.V6-, sT` -7 I�IBW Pd2•LN .... - Ex�s"c�NC� �hOM-F � rILW C.btils�.,2.<.Y.T i6� � NE.yJ DF.L\ tiAs"S �LEVATIOI� 5 Cl-\LE VA : I,wa 0/r-1E. AUC. Zl, Zc7ol doss t1aJ-EZE, Aoc:1 1 ION ' -7 0 t1 I H L_&I\-4 D ST,, , f 1`{/�.Nt l lS. , 4 [ ToPOF WAIL - _ — - - - - �- - -...L-J E _ - - - .-CR AM - -- -- x -'' Qn �Q .. .-._ .. .. � •ToP.O� FoVI-.76T;ON ._ � -_ -z _ .. - . I - iE, Z5.., .�_ - G�J�E e.Dni?1o�.1 AVD.Nti7 tS , 6'-d ^� !--�t2'i�SSS�.W 9„�v\I�z� C'. ��•�o.c.. I --3-�-z-�B SEar� z„o rr<.«�,L .. ���'',o-rG"'�.r rtiy,, _ - - Tocor- r uL - - — .. $ L -o f Li-T-1 - _ r— -- LIT F-1 I 6 B^ 3 v Zr3 a�EbN � r 9'il•'T.1\/Prco aS0 o.G.,yS'J+r 5'2S.J l�lSYT( z--,D ge-fZ F - - — — 0 19 (SLOGGCN(1-. El Lj ——I o. crop 030 F::covN1Y.11 N .. ..._ ---., 61IZa DE wSd. ... EX1ST1 w\!� f�e.S6HE1-1T m t -ato. ....._..-. � I - moo•,.\=� \ . - a4L,4��,NCB xi Al i':. IrJcj + I ; fFV- 1 ..6ctu0aZro ti� ' �Uvh�DG 1-6r-�Y ta�u'n w1 ToP/(.a1.14C MO�>V TAD) FK6 HNL-+TEQ' t I mote: ,so\g, �m+�a�zs •s �3= _:_(i-t>o =_FLZA�+t17 3_— — Ae-lo of N� -- z�C Z,.tJ 55t=F1Q Zrto...t°-..tti-O.L.., _,9�z.,.z�1�.v.wo_.zso.. _(Q 16•'_o,C.. . . ---_.. oP6.H-�.EXtsT�.-_. ... .o- •f _ T �e f ._.. Z+Ip lC�•• J C L.v IO .g.l/v' O.C. -..9y7.. 71-� Pzo.?-so Qo �b ....O.C.: - Ioati sco�.i=:(P,Eww) _ Io.:sz. .swYe „ OIG;_: _.-- .. i j - ws:_quo•_._.C qt.a c:-. -- v ,• y. - - to y O (L•hf n u,Eneering"Dept. (3rd floor) Map ,�� 7 y Parcel a'1`7 . Permit# I House# ` 70 Date Issued - 6 —7 6 Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee, a o Conservation Office(4th floor)(8:30-9:30/1:00-2:00) - /^"�� ✓ Planning De' t.(1st floor/School Admin. Bldg.) T►�►p D initi Ian pproved by Planning Board 19 ARN ABLE. MARS ED 59. TOWN OYBARNSTABLE', Building Permit Application Project Street Address 70 Villagey�/✓iy/S Owner }�- /e C ®SS Address xl,� IA-&nw VT Telephone ' — g — 7 a J 9 7 s1 Permit Request First Floor square feet Second Floor square feet =Construction Type ; ! Estimated Project Cost $ �t`p 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 ❑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 No. 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 - Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name C-i<}Z�,,,q-w`� Telephone Number �a�' //77 Address &,P Y 72 License# 0 9 41244d S Home Improvement Contractor# -(a of(1 Worker's Compensation# <;'w C, NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL ONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU DATE � lor BUILDING PERMIT DENIED FOR E FOLLOWING REASON(S) �{r FOR OFFICIAL USE ONLY a i33 PERMIT NO. , DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF.INSPECTION: - > _ i• ' _ # R , i FOUNDATION FRAME F INSULATION -FIREPLACE i r - :. Yi -• �.4 r � � , .. _ ., r ELECTRICAL: } ROUGH _ FINAL PLUMBING: ROUGH L FINAL GAS:: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT- ASSOCIATION PLAN NO. r DATE(MMIDDIYY) 'A, -CORD- CERTIFICATE CIF Lt��1�CT� ��I�U�tAN 5 04 98 >40DUCER THIS CERTIFICATE.IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Drake, Swan Crocker HOLDER:THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 1 4 Lot's Hollow Rd. ,PO Box 429 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Orleans MA 02653-0429 COMPANIES AFFORDING COVERAGE I avid D Rust COMPANY p Assurance Co. of America r,one No. 508-255-3212 Fax No. --- INSURED COMPANY B Credit General Insurance Co. Paul J. Cazeault etal'DBA Paul coMPANY ' J. Cazeault & Sons Roofing C COMPANY D COVERAGES.; a _ 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 HAVEBEEN REDUCED BY PAID CLAIMS. O T7DATEYMMIDD/YY) I EFFECTIVE POLICY EXPIRATION I LIMITS L 1 R. TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) GENERAL AGGREGATE $ 1000000 GENERAL LIABILITY A }( COMMERCIAL GENERAL LIABILITY CFP25552812 05/01/98 05/01/99 PRODUCTS-COMPIOPAGG $ 1000000 CLAIMS MADE OCCUR PERSONAL&ADV INJURY $ SOOOOO OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ SOOO U O FIRE DAMAGE(Any one fire) $ 300000 MED EXP(Any one person) $ 10 0 0 0 !'AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO I ALL OWNED AUTOS $ BODILY INJURY (Per person) SCHEDULED AUTOS BODILY INJURY HIRED AUTOS $ � (Per accident) 4 A NON-OWNED AUTOS - _ PROPERTY DAMAGE $ AUTO ONLY-EA ACCIDENT $ GARAGE LIABILITY -- -- f ANY AUTO OTHER THAN AUTO ONLY i 1 � EACH ACCIDENT $ � ,I .AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ -_ L AGGREGATE s $ I UMBRELLA FORM ! - ! OTHER THAN UMBRELLA FORM $ ! WC STATU O7H WORKERS COMPENSATION AND Ya I TORY LIMITSEn ___ EMPLOYERS'LIABILITY ELL ACCIDENT_ $ lO0000 I 3 THE PROPRIETOR/ INCL SWC17005901 08/09/97 08/09/98 EL DISEASE-POLICY LIMIT $ 500000 PARTNERSIEXECUTIVE EL DISEASE-EA EMPLOYEE $ 100000 !OFFICERS ARE: R3� EXCL OTHER I ISCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS Roofing CERTIFICATE HOLDER.,,, CANCELLATION _ _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL ' 10 DAYS WRITTEN NOTICE 10 THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY I i.• , OF ANY KIND ON T E COMPANY,ITS AGENTS OR PRESENTATIVE& AUTHORIZE EP ATIV t. E ' ACORD 25 S�1195) _ OACORD CORPORA"i ION 1988" t 'H.+ � ,., R ` .: `"T-ct l� ,� .f,t.La '4 4 wy-•tr ...1 .^"'SY l°i¢. ! "i. }T'"i1,Sh'�ir r �yy���'� ir,�/r����QQ! f 'r �l,t - Mr .G r z t f, .• r ! �� D yTy �Jr7 � f A.: A:��r 'c �C r bt t "1 t t � r' ,�'. � a r .RUNE IPR( VMN Yn a4 4 Board Q< r�:�u k t 'Qu A#.I� � I° y ".. kN! 1(-� j t �r ' h� .�1+.4 r :7 �k s� t e _ k',• S, .. �� j{Xt in �j' �'4• h+IrlVsi4.Q ° �,,^ vtiYt9 "'S Y'4 FJJi+..Ytl.!'! 'Y``ti �}Y�< � 1`'ilF:r41� rti !.., n *h S L�.^ 6}r 5 n� ;�aF.! she. .S A } g y ti s"'• 1 i''`O , +l, r 1r Y� 4 <: a.r -!7 is i•. - � M., 1 .Lt � � i�.�ts r } 14+" 'r' - a+� ,:,`.} � l,4+ 1 f• Y �t,t � e l�.• lr *f r r fir' r "' �v'y i! �. i l�:,��+' `[ � ;� 1 .�� ' 0.i,•+ r �, rs s� 6 r `, t'C) ly".�, 1`RPROVEMifT; CQNXfC" QR+`1 •` .r �� rif o Ac }tA``r��" fR � :' ;0f �_�.� ,i•, •a+�f...t_ °">`' r Rg , tat io._n; �,037�4 04 r T I fi �a !� q��• TYP;e A} PARTNA °HOMEa � �7H f OR ENT C0PTRACTOR � ` 3 � !<7�,jr;1 5• � '' 'RQ$1$����iiA� rk.���� ll v. ,a� ,} .,`'fr - `• rx �r, v° v.e;c r }y�, Oat ' �1 �' 4,It t,s C 1 ° t r'q, PFIfL J C� �+11T '$a>�j � '; t4 .> ��w � � s lrs �.l'.y1t t; k ;oaT.ypet PAI0TVERSHIP wry - r• S f �a. .1 F Yt 9 Yvr f��i 1 �v rr� haul J ' Cazeaul k �' z �{ 1`� r tEk itption , 47/09/98., 1 'y�j/.{�.-C e p $}+ � .a� der. '�/'0..rlfi .,ct ..,�. Y ,a P.`i •"t ,y � t t 1�4t y i +iyTri ryf r�r -1P 5��+v'�,1 Ai<_ 1( - a1 ` �.Lr, •! 5§7 �l , - �J - Y r qY l`e a ns MA .p265i3 „ A r , .` 1 ` t, ; 'I,,PAULw. CATEAULT'8 SONS"R001 s �-i � r tia rrx y 11� �`L` �'•.3F.°- +�� l t �.II Kl i� {t k:{° 3r 1C:iPaU1 :-6144t 2 61dlalt` Rd P O Boz ;2r r t ;h 7 e�. .: F' t «^'1 tV.�! (!� �•�' i'4-4;' I' AD r°,•r; 4'q.`l 9 s�`��• � �a � I:' '+� : �Or1e8A,��A 42659 �," � r fir.°, .�6, v�F i 1; Y'•�1 el S s: .N� � _.e,.. ,... - n_�_.. .y., �... gr �t•-t 5 e .y'SY.�' �.� .,-.w�-j..i.C'P.5r%�S.�t: ?...$i.. ..<.r� .. wF� _r..�', E. _.r,�.!—r_. ��— r .i '.� ! E✓d DEPARTMENT OF PUBLIC: SAFEI'Y 136726 ONE ASHBURTON PLACE, RM I: 0:t BOSTON A 02108-•-1.618 CONSTRUCT;ON SUPERVISOR LICENSE Number: Expires: � e 026325 10/20/1999 _mot R:-strJ,cLe-1 To: T 1;7 ; PAUL. t CAZEAULT C 1585 MAIN ST 0STC::tV1LLE, MA O2655 ,\'eep top !-or receipt and change ('}f addn� : notification. OPART qT Of FU@ SAFfT4 q` COS RU \SUR. T � � NSE 04 lie, r * { .0, EVIL qR 92855 i' Ir . r • �`_' The Conn»uaK 4j# ,,,Afassachusetts ? Depnrlmetz kof udaitrtal.4cctd ants ,� � I 011Jceo!/oces�IgaUons 600 fl Street 02111 Workers, Compcnslltton Insurance Affidavit @nnhc��n+ Information• "^•' "Plc se<PRINT I ibj ""_'��'`°""' •"�"'" name location: Cit ` - a'< ?..' nhonc#b. I am a homeowner performing all work myself. ¢`3' ,' ' I am a sole proprietor and have,no one.work.tng 9',,4P &7capacltyl< r ...f�.-.rK.,w,w..q ..r�R...s���r.:-�i �nv4�Rrn• •_. r ; �*- I am an emplover providing*workers compensation,for"tny employees'worki6 on this job " cnnlP1n.•name: ��y�- L� �}Zf�yLT addressOX citL� �/GCS nhonc#: ��0 — ���� insornnee co C?6�/1d/T policy ,• •�s -,,.y..•. �,r 'iA'�v .'w}'r. !.'1'���'I�w..�l�?'%'+we'r+.+w�w.cw�!.rs _r.'+.-�'...'••rr ..�..1....r.....�.... 1 am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company n•tmc• 'tddress• city: phone#: insurance co .... ...: ..•.—•::.- _.. �n. -rxr.Y ;?^r,. ,.vs. '.,'�f': ••rs4� !e�!:•.,�••..u; n.. ,•.`Lp;.,.es}y-�i+•-._.. w - comParn•name: _ address cih: ., phone#• x inenrnnrC eo - 'Y�a'-. ' I o1 IIC}'# Attachaddititioal'shcefittiecessa w� r-�1��.orr,.fnr r to Failure to scenic coverage as required under Section 23A of,A1GL"15*,ttan,lettd�to;`the impositioaofcriminal penalties ofa fine up to$1.500.O0 andiur one years'imprisonment as well as civil penalties.in the form of a STOP�1'ORI:ORDER and s fine of S100.00 a davlagainst me. 1 understand that a cope of this statement may be fon'arded to the Me of Investigation of the DIA for covc;agc verification. 1 do herehr ccrlif c the pains mid pei tics ojperju tag1;0 tie_injornuition pro►ided above is true and correct. Sienature Date ^ CAf � 77Print namc. < `7 S7 !/ hone#i I official use only. do not write in this area to be completed by city or town official • ".. city or town: 'permitAicense# r Building Department ,x ❑pceasing Huard ,• ❑check if imrncdiatc response is required �Scicctrncn's Office - i : •k -. ❑Health Department contact person: phone#. nOther f Irev,w 3195 111A1 - 1, i °F"E r . y The Town of Barnstable MASS• wtxsTastE, • 9e� Department of Health Safety and Environmental Services ArE15-59- " Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT , HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION r 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: rZ/� -- gofOOl'�—'l ti(p Est. Cost .19(1 Address of Work: 26) A/Z(kA 44 t 57nF�7— fit Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building 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 apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name Engineering Dept. (3rd floor) Map 3 Parcel -y Permit# ' House# Date Issued �(��� Board of Health(3rd floor)(8:15 -9:30/1:00- ) Fee Conservation Office(4th floor)(8:30-9:30/1:00=2:00)' g` �t � e. a 19 BARIMABLE, MA35. •• f ��ED MA'�> _ s679• TOWN OYBARNSTABLE _--� Building Permit Application Project Street Address [� f lS I*AA 5YY Village 'A pp N 1yi_S + Owner V t 1 Vh l F &,.0 -p C Address '?.0,. I DaC NO Kjlt sAFe.52±ll V7j—O5-7SI i Telephone ©2 F `?TIS— 14'(� 1/`T // 1 '? 5"'0,9G_5 fYA Ni3 `-Permit Request , fie- 0-0 &).4 0 4J (, k4i 0WS m3 Rep�ca�e_- C a.p�pcnr�s a�J � �'o ?se w� TI CeaQ(Z c(4p6A" ce 0A.. _First Floor S 7d square feet Second Floor square feet Construction Type1'�Qctj Estimated Project Cost $ W,00 k 500.C>0 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure a-S ' Historic House ❑Yes *(No On Old King's Highway ❑Yes X No Basement Type: f4 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) %fW Number of Baths: Full: Existing New Half- Existing New No. of Bedrooms: Existing d� New Total Room Count(not including baths): Existing �J New First Floor Room Count o2 Heat Type and Fuel: 4Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes kNo Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) tl\None J&Shed(size) t U If ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes No If yes, site plan review# Current Use Re 5 i'J j q 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. AU CONSTRUCTI N DEBRIS RESULTING FR ♦M THIS PROJECT WILL BE TAKEN TO 6 SIGNATURE DATE BUILDING�DENIEDO OW EASON(S) dA r FOR OFFICIAL USE ONLY PtRMIT NO. DATE ISSUED MAP/PARCEL NO + + _ t• ' i L; ... . t � - i ' ' i +,• J `` '~.e ) to R � + y - - 1 ' i�3 + ADDRESS VILLAGE' OWNER DATE OFINSPEC`rION:' FOUNDATION err . , -• , ' FRAMEL INSULATION + + FIREPLACE ELECTRICAL: ROUGH ' FINAL PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL r _ + FINAL-BUILDING DATE CLOSED OUT= }} r t 1 4 ^ ASSOCIATION PLAN NO. of 4 + w l l_ F t MICHELLE.M.CROSS - PETER L.CROSS POST OFFICE BOX 190 KILLINGTON,VERMONT 05751-0190 802-775-2196 APRIL 2,1998 MR.THOMAS PERRY,BUILDING INSPECTOR TOWN OF BARNSTABLE HYANNIS,MASSAC�USETTS 02601 DEAR MR.PERRY, ENCLOSED IS MY APPLICATION FOR A BUILDING PERMIT FOR MY HOUSE AT 70 HIGHLAND STREET IN HYANNIS.IT IS OUR DESIRE TO REPLACE THE EXISTING DECK AND TO ADD A 4' BY 9'SECTION TO IT.WE ALSO WANT TO REPLACE THE ASPHALT ROOF SHINGLES WITH NEW ASPHALT SHINGLES OF THE SAME COLOR, REPLACE THE EXISTING WINDOWS WITH ANDERSEN THERMAPANE WINDOWS(U=.3), AND REPLACE THE CEDAR CLAPBOARDS ON THE FRONT OF THE HOUSE WITH NEW CEDAR CLAPBOARDS. I HAVE ENCLOSED A CHECK FOR THE$25 FEE. THIS IS MY FIRST TIME FILLING OUT A BARNSTABLE BUILDING PERMIT-I HOPE I GOT IT RIGHT.I AM GOING TO BE ON THE CAPE FROM APRIL 18-25 AND HOPE TO DO THE DECK PROJECT DURING THAT WEEK. PLEASE LET ME KNOW IF I NEED TO FURNISH YOU WITH MORE INFORMATION.MY HOME PHONE IS AT THE TOP OF THE PAGE AND MY WORK PHONE IS 802-457-2522. I APPRECIATE THE HELP THAT YOU GAVE ME AT YOUR OFFICE AND OVER THE PHONE. I LOOK FORWARD TO GETTING MY PERMIT. THANK YOU. SINCERELY, U PETER L.CROSS RESIDENCE-42 ALPINE DRIVE PICO SKI AREA SHERBURNE, VERMONT «> :-`.fir t . = _ . The�Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crosses Fax: 508-790-6230 Building Commis-: For office use only Permit no. Date AFFIDAVIT, HOME IMPROVEMENT'CONTRACTOR LAW SUPPLEMENT TO PERMIT,APPLICATION i 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: ec k*LEst.Cost Address of Work: :Z® ' Owner's Name l CL�l- a..eQ 4riz— T, Date of Permit Application: I hereby certify that: Registration is not required for the following renson(s): Work excluded by law Job under S1,000. --Bnilding 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 ZWROVEMENTIV WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. The Comtttottltealth of.1fassacka.vetty ;,,li -- Dc'pfrrenutrt of htdustrial.9cculettts OfficeefIffV9 9211527S =\j'•i71_i:;' 600 !i a.vhhz,tun Street Btivott.A1ua v. 02111 Workers' Compensation Insurance Affidavit .Alin)nn-t inftirniatinn• Plcnse I'R(NT ledji�j'_� name• -p'A{Ar, A � p Inc tion• -70 4t'9 �1 S1 tin /AAA All > I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity _ .. - �.�_. alN•r/.wAt�R rw.www.�/. •A•' �.t>�.w��.w.r.w.w.rr.__�. .. .. _�� w.a=....r_ .Iaw�a+r_r•r� (� �/_... _ yam. .� � I am an emplover providing workers' compensation for my employees working on this job. enottt•tm• mime! •tdrlrccc• city nhone�• incur-ince rn nnliet !! I am a soic proprietor, general contractor. or homeowner(circle are) and have hired the contractors listed below who na% the °bllowing workers' compensation polices: comp inv n•ttne, 9(lrlrr•cc• cloy• nhnnc+�• in-mrnnrc rn •t_ _... a �..t-... _— 12 r��.:�— —i T'•T^.w.w'.l•:•.T _�:rR•:'— ___�r.+r�' .._�� cnmmnnc nntnc• — 'tdcirccc• rite• nhnnc i�• incur•tnre rn nnHey itYS •Attach additional sheet if necessary :.'_..:�,..,_.., _.,:•..,•,y.., _.. .. .•,......:. ......r. •...._.,_.,.�........ ,.—,... - �.�r-:- ..� . . r"- - ..��yrlrw.-. —Y�Jr�.�_...�JW- _ .__ _ __ �i'lYf•�.. ....Waver A. Fulurc to secure covcraec as required under section:SA of 111GL 113 can lead to the imposition of criminal penalties of a line up to S1S00.00 andiur uric cars' imprisonment:t. siell as civil penalties in the form of a STOP WORK ORDER and a fine ttfS100.00 a day against me. 1 understand that a copy of this stalctncnt ma% be fursvnrdcd to the Oltcc of Investigations of the D1A for coverage verification. 1 do herchr cerritr tinder the pains an penalties of perjure•ghat the information provided above is tru ail Co ��t° �• Date Print name��{Q2 . L. CZ055 Phone 2`75 2 9L - w ' ofricial use only_ do not write in this area to be completed by tiny or town official city or town: permittlicense 0 rIBuiiding Department Licensing Board L `` C: Check if immediate response is required ❑ Selectmen's Orricc r t. (:]ticalth Department contact person: phone tY; r•K)tlter i Information and Instructions Massachusetts General Laws chapter 15_ section 25 requires all employers to provide workers' compensation for ;. employees. As quoted f Qom the "1a��". an enrplitree is defined as every person in the service of :uiotlicr under ann, contract of hire. express or implied. oral or written. An etyzplurer is defined as an individual. partnership. association. corporation or other legal entity. or any two or ;r. the Foregoing enuaged in a joint enterprise. and including the legal representatives of deceased employer. or the recci\•er or trustee of an individual . partnership. association,or other legal entity, employing employees. Howevcr 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- or on such dweilin�_ out the __rounds or building appurtenant thereto shall not because of such employment be deemed to be an empio:• MGL chapter 152 section 25 also states that even-state or local licensing agency shah withhold the issuance or � a business or to construct buildings in the commonwealth far sn• cti.al of a license or permit to operate icant who has not produced acceptable evidence of compliance with the insurance coverage required. Adc::ionall\•. neither the coin inonwealth nor any of its political subdivisions shall enter into any contract for the perfornt:.,ice of public work until acceptable evidence of compliance with tite insurance requirements of this chapter he= presented to the contracting authority. .4pplicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to;your situation anc supplying_ company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial \ccidcnts forcontinnation of insurance coverage. Also be sure to sign and date ilre affidavit. Tate ".ia\,it should be returned to the city or town that the application for the permit or license is being requested. n ;lie Department of Industrial Accidents. Should you have any questions regarding the "law"or if you are regal-e 0 obtain a «orkers' cornpertsation poiic},. please call the Department at the number listed below. Citv or Tmvils Plecre he sure that the affidavit is complete and printed legibly. The Department has provided a space at tite bottom the v"davit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P'.: be _ _ to fill in tite permit/license number which will be used as a reference number. The affidavits may be returnee to Department by mail or FAX unless other arrangements have been made. The Office of Invemirations would like to thank you in advance for you cooperation and should you have any questic please do not hesitate to __ive us a ca11. Tile Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations n ,. 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone 1: (61 ) '777-4900 exr. 406. 409 or 75 r - 3, 4r a, F ----- ---- --- - ------ - --- -70 -- oil — h�� �y r, Ste'' s I� sq,job�3 - . y ; ` . ;os, .. +�,_ P�lse= .�2c 6�ou,�e �'�" -s��5 a . �+ �f• �o r h,p�15 h4-- L e55 _yX� p¢• •; �(BAN „t/o iZA� i EQecPs5'ke,� V x.36" i ; r . i ; � ; y I J. a c A riot.! k Ya,+N/� A�vS B .ScAJ-X :�So D,47'E Mass. z,4-rt ,t4�i,vG kT Z As 1511j;'o WA4 y $y CEx�Trcy. .7'�1.9T �'ti���•i i I{:{�,�i"��`,r i Tt,�-E �x16 T/1►>!a x�3 U�►' 77 B?7!�/� l.cc..0-771 oN z5 S1✓ 3 ST�4N:1A-uY I , x ; c�ot�v�LL_ sy�o '1 Rc 4ZCa TAYLOaz L RP. k yR�rrMac�lt �c�T �,qSs' ... STATE PROPERTY ADDRESS - - - ( I ZONING IDISTRICT CODE SP•DISTS.I DATE PRINTED I CLASS I PCS I NSH0 AC ' R3-D7 247 - KEY NO. LAND/OTHER FEATURES DESCRIPTION- 7 PC 61 2193110 ADJUSTMENT FACTORS V UNIT ADJ'D.UNIT CROSS, PETER L 8r M I C H E L L E MAP- La�e By/Date Size o soon - S- ACRES/UNITS VALUE Dexripuon CD. FF-De m Acues LOC./YR.SPEC.CLASS ADJ. COND. P PRICE PRICE g L A N D 1 29,300 CARDS IN ACCOUNT — L 17 18LDG.SIT 1 X J --100 ?17 44999_99 97649.99 _30 29303 N9LDG(S)-CAR)-1 1 50.900 01 OF 01` q !!OTHER FEATURE 1 1.900 UST N 1ATNS 1:1 ` U ;, X C= 1)0 5800.00 5800.00 1-90- 5890 9 f1PL 64 ..HIGHLAND ST HYANNIS MARKET 72700-, D FIREPLACE U x C= 1)11 350^.00 35+00.00 1-99 3500 9 NDL LOT 2 1 A SHED S 12 X 16 1977 C= 37 11_15 9.70 192 1900 F #RR 0710 0076 USE APPRAISED VALUE D A 82.100 q. U PARCEL SUMMARY T AND 29300 A S RLDGS 50900 T ( -IMPS 1900 M TOTAL 82100 F E 4 CNST E N - - DEED REFERENCE Tyne DATE Rsc«e.e R I 0 R YEAR VALUE q T Book Page Inst. MO: Yr.D Sal"Price AND 29300 T S J5290/067, 109/86 A 10000 LDGS 52800 U 24171308, 00100 TOTAL 82100 R E BUILDING PERMIT *1/2 ATTIC...... SNumber Date Type Amount ................ LAND :` LAND-ADJ INCOME SE SP-BLDS FEATURES BLD-ADJS UNITS r 29300 1900 9300. Class Const. Total -Base Rare Aoj.Rate Year Built Age 'Norm. Obsv. CND. Loc. %'R.G. Repo.Cost New - Adj.Repo.Value Stories Height Rooms Rms Bath a Flrt. Parlywall Fac. Units Units FA �� Depr. Cono. J1C 000 100 100 81.00 81.00 77 77 14" R7 85 > 72 70756 50900 1.4 4 2 1'.1 : 6.0 Description - Rare - Square Feel Rept Cost MKT.INDEX: 1.90 IMP.BY/DATE:. M L 7/8 8 SCALE: 1109.82 ELEMENTS CODE CONSTRUCTION DETAIL S BAS 100 81.00 , 572 46332 GROSS A2EA 1144 SINGLE FAMILY DWELLING CNST GP-30 T FWD 85 8.50 144 1224 ----12--- STYLr 04 APE COD 0.1 R 914 30 24.30. 57.2 13000 ' FWD . � ! €RTFRWAI_LS-- -foctP967�HrNbLE �r.o U 12 12 EAT/AC C P as- TYE- f1 GAaf A3V----U.-O � . _ T INTER_FIII(fS,H 94 1tYgALt-.----- ----Lr.O INTER_LAr60T f2 VER.7VORMAL TT_0 Lf *----.12---26- ----* -INTER. 02 ANE AS EXTER.--V.O R 814 ! FLOOR STRUfT Q2 D JOIST/BEAT{---Zr.0 A. _ __ _ EFLOOR COVER 04 A2PET ----- -- Zf=O L p 144 Baae. 572 � ! OOF TYPE --- -Oi A9LE=ASPH SH �.0 r Total Areas � Aus_ T BUILDING DIMENSIONS i ! E L E C T R I C A L___ =0 1 V E R A G E_ A 3AS W26 M22 FWD N12 E12 S12 W12 22 BASE 22 FOUNDATION 01 OURED CON C 99.4 .. OAS E26 S22 814, N22 W26 ! ----- -_ ------------ S22 E26 ! NEIGHBORHOOD 614C HYANNIS L , LAND TOTAL MARKET i PARCEL 29300 82100 *---------26---------X AREA 2848 VARIANCE f0 t2782 STANDARD . 25 S TOPOGRAPHY 1 LEVEL *. TOPOGRAPHY * UTILITIES 2 PUS WATER * UTILITIES 4 GAS * UTILITIES 6 SEPTIC ST FEATURE 1` PAVED * ST FEATURE ' *, ST FEATURE * ST. COND. _ * TRAFFIC 1 LIGHT DWELL LOC. 2 MIDDLE * LO.CATION * AMENITIES * AM=_NITIE3 * NUISANCES * 4UISANCES r i AS-BUILT CONDITIONS IN HYANNIS, MASS. Prepared For: Peter L. Cross, et UX. Assessor's Map: MAP: 307 PARCEL: 247 Baxter, Nye & Holmgren, Inc. Community Panel Number: 250001 00.06 D Registered' Professional j F,I.R.M. Map Zone: B Engineers and Land Surveyors Plan Reference: 2471146 —.Lot 2 812 Main Street Deed Reference: 5290/067 Osterville, MA., 02655 Phone — (508) 428=9131 Fax — (508)-428-3750 Owners: Peter L. Cross & Michelle Cross Job Number: 2001-022Aa.Dwc Scale: 1" = 40' Date: May 8, 2001 I S 83'41'03" W 77.36' STAKE SET .SB/DH FND p RFCO 12 T O W N O IF RO A(qN Ako BARN STABLE 4£ S u�. I VO• F. � I 13,453f SQ. FT. oa'o 0.31 t ACRES O W a c� LOT . 1 J ¢ n_ PLAN BOOK 247 PAGE 146 � SB/DH FND ✓ W I < 0 No Qm STAKE SET ��c�.'�� = Q I J ZA.S' W w U1 L SB/FND G CB/DH FND \ P=76.48 A=67 R-193.25' A= 48.64' SURVEY MARKER BRB FND 12�6' SET BRB FND < C; / 0010"0 69 o �\4 A=117.69' R=1 50.73' ��\ oo/o CO \A 80 \G C1O BRB FND � ci N 6�201 I i LINE BEARINGDISTANCE L1 S 14'33'59" E 16.66' SB TO SL BRB FND L2 S 66'55'40" E 15.27' L3 N 66'55'40" W 15.27' L4 S 14'47'37" E 16.94' SB TO CB , CURVE I RADIUS ARC LENGTH DELTA ANGLE C1 193.25, 4.29' 01*16'18" C2 20.00' 31.42' 90'00'00" C3 20.00' 31.42' 90,00*00" I I 1 ' :;• \fit t1F A] �tti I CERTIFY THAT TO THE BEST OF MY..KNOWLEDGE TO STRUCTURES SHOWN HEREON ARE LOCATED IN RELATION a, t:`f •` ,. TO THE MOUNUMENTS SHOWN. i 1 f L G L REGISTERED PROFESSIONAL LAND SURVEYOR DATE