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0022 LEWIS BAY ROAD
�.. W TOWN OF BARNSTABLE (3) . 9.8sq'SIGNS ON LIS BAY-GLEASON-PARK CCHEALTHCARE PARCEL ID 327 212 G90BASE ID 24314 ADDRESS 22 LEWIS BAY ROAD PHONE HYANNIS ZIP - LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT TYPE BSIGN DESCRIPTION !I)N9p8ERMSQ� SIGNS ON 3 STREETS CONTRACTORS: PROPERTY OWNER Department of ARCHITECTS: Regulatory Services r � TOTAL FEES: $75.00 BOND $.00 p4r CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE I O.I.R_._ » BARNSTABLE, • MASS. 39. •`�Al BUILDING D , ISI N t BY DATE ISSUED 10/18/2005 EXPIRATION DATE k - Town of Barnstable Regulatory Services ' Thomas F.Geller,Director Building Division ►° Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 4 Fax: 508-790-6230 QQ Permit# e 7G U_ n Application for Sign Permit Applicant: G• T3 AJ 1A W! I Assessors No.=— `T' Doing Business As: U31 aJ 'D 1S 16 AJ Telephone No._SOC `� 00 r= Sip Location Street/Road: CP. fRo t S 0 4 ' 94 l S Zoning District: Old Kings Highway? Yes/No Hyannis Historic District?. Yes/No Property Owner Name: C 0 6,0\0 LiZ CA-L Telephone: A • . Address: 2 7 ?4 Q�Y- ST village: 44 Y A n.9 fJ t S Sign Contractor Name: '0��OC E10 S 16 lU 10 G•L-G Telephone: 50� •5 3 Soo U Mailing Address: q I N DOSTMIA l— I'/ LI C kok0 tM ED 43 A-q . VUl Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Yee -(Note:If yes, a wiring permit is required) Width of building face 2,Z ft.x 10=• x,10 I hereby certify that I am the owner or that I have the authority of the owner to make this application, that the information is correct and that the use and construction shall conform to the provisions of§240-59 through§240-89 of the Town of Barnstable Zoning Ordinance. r Signature of Owner/Authorized Agent: � /�. -- Date: �L r ,r Size: Z r 1 r Permit Fec:_____ Sign Permit was approved: Disapproved: Signature of Building Official: _ Date: g IWPF"S1SIGNSiSIGNAPP.DOC 11 ,CC�I h S �1•S >/ 5l�a Town of Barnstable . Regulatory Services Thomas F.Geiler,Director MAK Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 `A www.town.barnstable.ma.us { Office: 508-862-4038 Fax,,,,,,50&790=6230 Permit# W E p tom, Application for Sign Permit `' Applicant:_ �Z E�V C .lb l-13 01 A Assessors No. Doing Business As: ??A-C-f) U31 4) b 0S l k IU Telephone Now$;3$s• T©G (o Sign Locatio Street/Road S k) ��' (,JIS r h� Zoning District: Old Kings Highway? Y o Hyannis Historic District? Yes/No ° llJ Property Owner Name: C E C-00 4 6- �s G Telephoner Address: Sign Contractor Name: &OVAL)CODD S 16A)(J& 1-4-•C • _—Telephone: S'097, 4 Mailing Address:r I A) D 0 S��L PA P-r- Q64-'Q VA 00 tok_•_y. 14, ,/4- 6 ®5 t) Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location and size of the new sign. This should be drawn on,,the reverse side of this application. Is the sign to be electrified? Ye( yy� {Nate IJ);es, a wiring permit is required) Width mf building face 7 _—ft.x 10= a.10 I hereby certify that I am the owner or that I have the authority of the owner to make this application,that the information is correct and that the use and construction shall conform to the provisions of§240-59 through§240-89 `of the Town of Barnstable Zoning Ordinance.'n.�/j,,,� e D'��I Signatuee of Owner/Authorized Agent:(�C�iJM , 1� m��(� ,._ Date: l hol!c� 1 t Size: �2 Permit Fee: Sign Permit was approved: _-_ _ _ - Disapproved: Signature of Building Official: Date ¢:1 OTMESI SIGNSUIGNAPP.DOC Town of Barnstable Regulatory Services Thomas F.Geller,Director MAMBuilding Division ►`� Tom ferry, Building Commissioner "-n 200 Main Street, Hyannis,MA 02601 -> www.town.barnstable.ma.us Office: 508-862-4038 Fax' S08-790-6380 Permit Application for Sign Permit Applicant:_=Z L- G{ 1�A i-1)0/ #j Assessors No. Doing Business As: L b(L)f k) 16 Telephone-No, 0�' • 3�5 . �� Sign Location StreevRoad: �' L S i�CL� S 1�� s 3q.� Zoning District: Old Kings Highway? es/No Hyannis Historic District? YYeslNo Property Owner Name: C— n Er- CO'i) ll� �C. Q Cf 'Telephone: Address: '7 � ��L �2MEZ-5-T Village: Sign Contractor - Name: f A 0 C 00 S 16101 /Q L C TTelephone: gy?'' °i!a:20 O Mailing Address: Lf 1 N 00 Sic! L �' k (�De�.-p 1tiL��'� `� 1� A- a '20T `� Description, Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Yes (Note:If yes, a wiring permit is required) Width of building face—' 1*ft.s 10 s a.10 I hereby certify that I am the owner or that I have the authority of the owner to make this application,that the information is correct and that the use and construction shall conform to the provisions of§240-59 through§240-89 Of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent:. Date: bo Size• �J 2 6 Permit Fee:. Sign Permit was approved: Disapproved: Signature of Building Official: Date:- e 1 S t �xs�St/� S ► h :1WPFXESISIGN=1GNAPP.DO Q C �,v i� Project Cape Cod Hospital Primary Care Internists 22 Lewis Bay Road Hyannis,MA Sign D-1,Building Identification r, Exterior double sided painted 3,_3„ aluminum post and panel sign w.7 2 -6 Header 1/2"reveal 4„ 2,� 4„ Size 2'-6"w x 10"h Paint Matthews Paint Co.acrylic eq polyurethane,eggshell finish(TYP) 31/2" Color Background 10" 1„ Match B.Moore 2066-10 Blue ? 1/2" Text&logo eQ„ White Vinyl 4 1/2" _ s Font Minion large&small caps xJ _ Panel One 3 Size 2'-6"wx2'-5"h 4 7/8" Ground Match ICI 1331 Balustrade Blue 5'-10" U Text Color-white 2'5" 3 Material-vinyl 2° ` Font-Frutiger 55 Roman caps&lc r M k 3 1/2" o "r x r! Panel to be fastened from front to facilitate changes.Fasteners to be painted to match gr ound, " r Panel Two Size 2'-6"w x 5"h eq. Ground Match ICI 1331 Balustrade Blue 5" 2" Text Color-white eq" Material-vinyl Font-Frutiger 55 Roman caps&lc Posts Color Match ICI 2004 Egret Install Aluminum base plate and J-bolts mounted to concrete footing. Baldwin Design 86 Earthbound Cartway Brewster Massachusetts 02631 t 508.385.5006 f 508.385.5886 e baldwin@gis.net Drawing Scale:3/4"= 1'-0" .....:.::::::.:.. • k ;l' ,:de✓s° "'�` Y^` � 4 � y�';, tm`a\ � .�S'3 BSc r ' � �µ 'moo.`i•'S� ��� ' t E a' ; t:. t �::. ^.:•:^sec ,::. :,:':::,,;,..e;:�. ......:.::. ::. . . ..»:f::. ...... .'.is .;t;i;:n;y%tH:,t.:::t;:; 9:.ia>3ov�::..♦ ..^ .» e. f.. is.::n..:.'s::: ..:. :.:::vTi,::::t::0.::.:.:. i { E. ���.fi .::Wit.:its%•.w................ ... �`6 {�ftiobv fi+ n i 3 U ,1 i.. Primary Care Internists Gleason Street existing sign ' • �D .2� t � #'y a� <.13u � -{�' x#su' ....... ...... ._..... ...:..... ...f_............:::.::.:.�.:::......�................. ......._..,. .....:. ..�r.':�:' ��:Ssr'��a�n»sass's�# � I w :. � k All 1 i. .. ... >Att: Ml NO Hill RENOWN Primary Care Internists ,. Lewis Bay Road existing sign ' ••. s Y •I Y ;j P> - s^ r K .. . ............ a , Primary Care Internists Park Street existing sign _ • �. � Ills 2 if6# ii .........................::::::::::..........................................:::.:...:::::................................ .... ..........................................:.:::::::::::::.;;;::.;.�;:;;;:.r;ew.. ..:. ...::::.»:::fir:::...... :............... ...::.::.::A:r::i;' e::.:' `' .;i„;;i:: F." ♦ ...?s.......� ....l.;i:;1. , ... ...:::... Bloom Primary Care Internists Gleason Street facade 3 xk Assessors map and lot number .................................. :. .� bpi THE t0� Sewage Permit number ...... ..(.,������ G�• •�•G�2r'j't�l"tl SEPTIC SYST �� INSTALLED I House number NCO s stE .......................:................................................ ITH TITLE i639' e� E W RON NTAL CO °MAX a` I TOWN OF ' F 'B A R NS T A DI EGULATIONS �D • r BUILDING INSPECTOR ' APPLICATION FOR PERMIT TO ......firM.. .b.1.5... ................................... :...........................:................ TYPE OF. CONSTRUCTION .........Uvao.I'!........F h..(... ./gyp 1�................................................................ ....................... ........a:..........19.$�0 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according �to/�the following information:/ Location ..:. .... :. r:. .f..13..... .....1..\..hl 1./.. AWIX............................................. Proposed Use ....D.0.C,,...r0.AAW....... !... .. .{ ................................. .............................................. Zoning District ....AA....io.................................................Fire District .... . Name of Owner 0 V"l ... .4M.....ROS N 64 .l.Address C.1: ' `. A Ll..i... .................... Name of Builder 40t... .'... Address Name of Architect .................MOM.4.............................Address Number of Rooms ................kal...........................................Foundation ...� 40.c .c- ., .. A0, .V.. ...�®/ice nn Q .... `` c Exterior .... �$.�. ..... . . . . . : ........Roofing ....�!� PHIt.4.t ......................................... Floors ......oef.!1.:... ..!t.C. el .. .. ..............Interior .........b.A.`,/...WA.41 ........................................ Heating aT...W. .roy ........8Y..... ..�V .Plumbing ........ &A.ras.......................................... Fireplace .........US...........................................................Approximate Cost ........tZ.0..�l. Definitive Plan Approved by Planning Board ----------------------- ----19--------. Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH s I hereby agree to conform to all the Rules and .Regulations of the Town of Barnstable regarding the above construction. fir. NameY ... ...... ........... ...... ... ... ,. ROSENBLATT, MALCOLM No 22-4-9L1.... Permit for ..REMODEL............... LAW OFFICES ............................................................................. Location ..2...2.. ..L.e...... w...i.s.. Bav ...............Roa:d ......................... .................UY4XITUA............................................ Owner ... .qk j.q.Q. ...R.0.s.e.nb1.qt.t............... .. .. . .. ....... .... .. Type of Construction ,EXAMMe........ ................... .................................................................... ............ Plot ............................ Lot ............ ................... Permit 'Granted ..'.S.e.p.tembar...5........19 80 Date of Inspection ....................................19 Date Completed ........... ........................19 PERMIT REFUSED ................................................................. 19 '*—****— .......................... C- .;............................................... .......... .. .................................................... ............ . .. .. ......................... ...................... Approved ........ ......................... ..... 19 .................................................. ............................................................................... _ Y + Assessor's map and lot number .............................. ..,..:..,. THE Sewage Permit number .:..�....:..!..!/ � Q ~ Z HA"STADLE, i House number .... 9� UU& r k V po,039 00 TOWN OF BARN,STABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ,, � t .. ..- ............................................................................ TYPE OF CONSTRUCTION .........1A.10.0.. ........F A P1 ^................................................................ .....''.............r........59..........19h'a TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for aptermit according to the following information: Location .... ..... a-.E.W I c�......./ + Y....... .. �:�t....... hj �s° ....... ...................................... e Proposed Use L �. '�' �'" �� � ..........................................................I......................... V.Zoning District .....14 ..... .................................................Fire District .... ,• , ii i< cz Name of Owner ll i..�n�Pke ...../'Cle• &;L► U .Address ...... � 4` �.. .. ::. .... � .................. Name of Builder •'•.... .......1r"d"t 1.... .� Address / `�. i # � ' M1 .. .......... Nameof Architect ................. ............................Address .................................................................................... Number of Rooms Foundation ... . --. x,..G /'✓l�,"„ ...................................... .............. ......... � + Exlerior .... "". .: ... .a".; ....». ..�. Roofing .... �Y`'�'?�1� � Floors ..... +i` ,n �................Interior N�Y, 4)::...................................... .. Heating !��.: ..�....!.�f ......, Ott........�?..... .... ....Plumbing ........`..4. . ':. ........................................... Fireplace ....... .-��":............................................................Approximate Cost .......r2it..O... ........................................ Definitive Plan Approved by Planning,,Board ________________________________19_______. Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH a I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. f .d . Names ;'. ,+! !{.... ...!..... 4 P.A_ .�°.. ROSENBLATT, MALCOLM A=327-212 No .224.91... Permit for ..R.EMDEL................ Sa X ..................Law...W k.Z C u................................ r Location .....2...Lemis;..Bay....Rtacad................ Hyannis. .............................................................................. k Owner .....MaIC.o.J.�m..Ro.san>bIz t:t............. . . Type of Construct n ..Frame......................... Plot ................ ...........Lof;` ...................... ...... Permit Grant'd .......S.eptember...5.;:.19 80 Date of Ins ection ........ .........................19 P , Date Compl"eted ........ ....................... ....19 PERMIT REFUSED ............. ..............I................... ...... 19 / ............ . ............................................................... ............ .......................... .......... ........... .............:.... .• ........................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... o l 8v Assessor's.map and lot number .... F 7H E TO ... ' SEPTIC SYSTEM M UST -"Sewage Permit number wNTALLE�'IN COMP iA _ STABLE. * House number ....... .. TITLEo "6 a ♦� 5 0 �`. ........ ENVIRONMENTAL ENTAL CODE 'r a` MA TOWN OF BARNS TTHTE ATI(Ii � : BUILDING hNSFECTO APPLICATION FOR PERMIT TO ..... .4-'MA...A. H................................................................. TYPE OF CONSTRUCTION .....:..vY. ®..&..` � 1. ............................................................................... ......,•1 v,,Y.....4?..................19. TO THE INSPECTOR OF BUILDINGS: �- The undersigned hereby applies for a permit j�accordingto the following information: �..,1. :L Location .�/...i�.......................................%... ........ .............................. ' ....... ... .......... ...........;...................... , ProposedUse)) .......L.. .:........ I,.l Ci.�i�................C. ...r... ....................................................... Zoning District � ..Fire District / (..y.hAl"ll ..................... Name of Owner .1 r-5....0! ;�.. �'L. ..../^G TAddress . . .... ud :...!�? 1....f..y1k/.'. ............ ,Name of Builder' .J.0St..........A9.4cAA.0................Address ................. Name of Architect ....Address } 3+ Number of Rooms ............................... ............................Foundation ...................... .. ..�:.................... ..... ...... '.. r , Exterior ............. .. ./. !... -.' .....................::............Roofing ....... � :.. ...... Floors ..........................VJ 41 yL .............Interior ......... .�.1 Heating ........... f..�.......a.2.4........................I.................Plumbing .../T �fG d.��.,r.{/......�1./..'.1...n................. ' . 4 Fireplace ..................... .....................................................Approximate Cost .............1�/l........ Definitive Plan Approved by Planning Board _________________:___-________19_______. Area ...... � ...5:. ...' 80 Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF- BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam ...... ........... " ,�.,, e ............ ....... ..... • 1,7 ! l,EVVIS BAY REALTY TRUST � 24194 ADDTO ' No ................. Permit for ----------- ' ,,Professional Office .................. ° Loco/ion -22..,Levvi.o_Bay..Road_____^ ' . Hyannis .----.—=------------------- C^wne, �evvia Bay Realty ��zuot ----------------------. ' Frame Type of Construction .......................................... -----^`c---------r---------'' . . � P|c^ ............................... Lot ................................. July G, 82 Permit Gronlo6 ----��--------lV . ' ' . Date ofInspection .................lP . . . ` Date Completedo| --. -----.]9���- . � ' � u`~� -- . ` ' .. � - ' . . K N Assessor's map and lot number ...... of the Sewage Permit number .................. da PAUSTAMLE, Housenumber ......r......) ..................................... ......... .. 1639- aMAY TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....A LT)5 A...9 7-A4 . ..................... ......A........................................................................... TYPE OF CONSTRUCTION ........W Ir.................................................................................... �-Ir 6�4L � /0 ................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: is Location .1 ................. ............ . .... ............ ..... .... ........................................................................................................ ProposedUse ....... .......... .......................................... ...............I........................................................ ZoningDistrict ........................................................................Fire District ........H....Y-AA/Vg. ............................................ Name of Owner P—4-4.TY.... k rAciclress ............... ....... . ... ............ Name of Builder' .4q,�........... ................Address ..... ..... .................. Nameof Architect ..................................................................Address ..................................................................................... Numberof Rooms ..................................................................Foundation .............................. .......................................... Exlerior ............ ....................................Roofing .......4SAW ................................................. Floors 4.,4 ........................ Interior ......... ......W11./..................................................... .. Heating ...........k.A/.........: .....L............................................Plumbing ... ................. Fireplace .....................7777.....................................................Approximate Cost ............ ........A................................... Definitive Plan Approved by Planning Board -------------------------------19--------- Area Diagram of Lot and Building with Dimensions Fee ........... ................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam ........................................................ 7— c� LEWIS BAY REALTY TRUST A=327-212 'No ..2.41 A ..ADD TO � . Permit for .................................. .......Pr.of asalona.1...affi-ce...................... Location ..22...Leiais...Bay. ..RQad................. ,pyanmis ................. ..............................i............................. Owner ...............Lewis ewi s.JB.ay Re,alty Trust .... .... Frame Construction Type of i n .............i.............`................ .............................. Plot ....I.............t...... Lot ............................... July;l 161 82 Permit Granted .......... ....................19 Date of Inspection .............. 19 Date Completed! ............... ......................19 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3 a—7 Parcel Permit#/ Health Division Date Issued ro Conservation Division Fee Tax Collector Treasurer 1 Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village N�rt`�►+ 1 S' Owner 1 �e C Address -Z G F 4-;s 9,4; 5 0, Telephone 'Permit Request .ST��'� —1— 11�, fiz a 3 7 27 A . Square feet: 1st floor:existing proposed 2nd floor: existing proposed Total new Estimated Project Cost 156 a Zoning District Flood Plain Groundwater Overlay 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) 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 ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use �Cell 6,p Proposed Use BUILDER INFORMATION Name --�57 L CA Z€41 u Telephone Number S-0 8 Address License# to 3 6 :1 D J Home Improvement Contractor# 6 g g Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO L/!-1 R PA C, SIGNATURE DATE _ . FOR OFFICIAL USE ONLY - PERMITrNO. DATE ISSUED MAP/PARCEL NO. ADDRESS . VILLAGE OWNER . . DATE OF INSPECTION FOUNDATION ' FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ` r . PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL FINAL BUILDING + DATE CLOSED OUT ASSOCIATION PLAN NO. Ira- - --- ° The Town of Barnstable 9M ' Department of Health Safety and Environmental Services Building Division ` b 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building'Commissione. Permit no. Date 4 1 191 5 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. 2y ca Type of Work: S 1'-` -67,ss Estimated Cost 6a a Address of Work: q �"�1' Y3 `�► �� Owner's Name: C A4Ze Date of Application: c i j I hereby certify that: Registration is not; for the following reason(s): ork excluded by law C]Job Under S1,000 Building not owner-occupied [30wner 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 q:forms:Affidav - '- The Commonwealth of Massachusetts Department of Industrial Accidents Mg .�:_� Office allnyesti8aua�s 600 Washington Street V4`b •�,+/ Boston,Mass. 02111 _ -, . ,= Workers' Com ensation Insurance Affidavit name: L 212 v 1 location- 120� city 1�c� c�-,N-^ �° yohone# 02 0 2 d ❑ I a homeowner performing all work myself. a sole proprietor and have no one workin in any capacity w ❑ I am an employer providing workers compensation for my employees working on this job. comnnnv name: address: city __ ... , .. phone#: •� _�, ,, w. .... � _ insurance co. noiicv# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and.have hired the contractors listed below who have the follo«•ing workers: compensation polices: comnnnv name: addrrts' city phone - :...:..insarance co. rrUN iNi�aG�/r//////rir,;r/�i. cliff//%//afi...... ll �L�lrii L�/ii/Goa/,r�/////////GGG//,v//////'ll(///,l/,( '!� /.(///,C(//// OE � %%%/; comnnnv name: address: cih- Phone#. insurance co. alley# Faaure to secure coverage as required under Section 25A of MCL 152 can lead to the imposition of criminal penalties of a ane up to S13'00.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fte of S100.00 a day against me. I tmderstand that a copy of this statement may be forwarded to the Mee of Investigations of the DIA for coverage verification I do hereby certify under th suss and pen ' of perjury that the information provided above is truo and caned Sismatue Date c'3 Print name e-1 C 2 `r( Phone otticial use only do not write in this area to be completed by city or town otndal city or town: permitilicense 0 QBuilding Department -CDLicensing Board ❑ check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone do ❑Other�� tmnam 9,95 PIA) 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 co=- 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 c: the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the rec-v.: 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 an such dwelling house or`ou the grounds c: 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 renew , 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 l�1 acceptable evidence of compliance with the insurance requirements of this chapter have bees 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 canfinaatioa of insurance coverage. Also be sure to sign 4nd ,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=Ly 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 peimitMccnse number which will be used as a reference member. The affidavits may be retaned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would h1c to thank you in advance for you cooperation and should you have any questions- please do not hesitate to give us a call. �� The Deparmzeat's address,telephone and fax member. The Commonwealth'Of Massachusetts. Department of Industrial Accidents Office of luestloadons 600 Washington Street Boston; Ma. 02111 fax#: (617) 727-7749 phone#:'(617) 7274900 ext. 406, 409 or 375 I M. `' pEppRTMENT Of PUBIIC SAfET1 CONSTRUG�ION SUPERVISOR CS. -0436701 05/20/2000 ,. 00 t ReslriNTed To 4 . j Cp�AUIT 193EAgSNEII COVE •: C01UIT, NA 02635 r s RECEfVED F "OM DOLLARS ' Account Torsi Ambuntpaja Balance Due' ��� EFFICIENCY®'LINE AN AIY DPRODIiGT s •' „g..:F� .e Py�F7NEr TOWN OF BARNSTABLE i HARNSTABLE, i Office of the Building Inspector 9�O M6 S. `��9 GAp�°r' August 13, 1986 Date ................................................ $25.00 Fee ............. ........... ............ Permit No. ..246 ............ PERMIT TO ERECT SIGN IS HEREBY ' i GRANTEDTO ........................... ay.......... ......................................................................................... . ... D/B/A ...................Medical Center LOCATION ....................22...Lewis Bay..Road.............................................................................................................. Hyannis, Massachusetts .............................................................................................................................................................................................................. ANY VIOLATION OF THE SIGN LAW WILL CAUSE IMMEDIATE , REVOCATION OF THIS PERMIT " �? �� Building Inspector .Y: TOWN OF' BARNSTABLE L BUILDING DEPARTMENT teuarr } TOWN OFFICE 13UILDING aua 'L a7P `F HYANNIS, MASS. 02601 7t 1 r�Y• APPLICATION FOR SIGN PERMIT DATE Application is hereby made for a sign permit in accordance with the description and for the purposes hereinafter set forth. This application is made subject to. all Rules and Regulations of the Town of Barnstable .now in force or that may hereafter.be enacted affecting or regulating thereto and which are hereby agreed to by the undersigned applicant and which shall be deemed a condition entering into the exercise of this permit. INSTRUCTIONS 1. This application must be filled out completely. 2 A drawing, in duplicate, showing the shape and dimensions of the sign, lettering on same, height, method of securing to building, or if freestanding, method of erection. Drawing must show sizes of structural supports, and size and depth of foundation. SIGN LOCATION �! CL K LE�t� 7�r4 02 _Owner T Street.- Rd. Zoning District P12-0 Fire District yqnnl s OWNER OF PROPERTY Name m Address City SL Zip Tel No.( )Area Code SIGN CONTRACTOR - - - Name PL__N 6Aj Co. Address 6 *3 O L 0 y1.j +q l NJ City ate , �fttMO VTI' St W ' Zip CP Tel No.( (P/1) - zitd ®®� Area Code Stan �ding or Attached /�Type of Construction Free 1) DESCRIPTION DIAGRAM OF LOT SHOWING LOCATION OF BUILDINGS AND EXISTING SIGNS WITH DIMENSIONS LOCATION AND SIZE OF THE NEW SIGN TO BE DRAWN ON THE REVERSE SIDE OF THIS APPLICATION. Is there any electrical wiring required for this sign? Yes No If "Yes." who Ts the electrical contractor ?. FOR OFFICE USE ONLY Area d / DATE DATE DATE Permit Fee �� DEPT. ROUTE RECEIVED APPROVED REJECTED INITIALS PLANNING Mail permit to: & ZONING ELECTRICAL INSPECTOR BUILDING INSPECTION LIZ4 hereby certify that I am the owner or that I have the authority of the owner to make application, that the informatio- given is correct and that the use and construction shall conform to all the Rules and Regulations of the Town of BarnsTat:l which are imposed on the property. Phone Signature of ton owner/authorized agent Assessor's map and lot number ......................................... %THE 6 q ----4 r- ,,-c,- , F(j �- 7-0 Sewage Permit number ........................................................ BARNSTABLE. House number ..... ........................ ............................... 7p0 MAO& t639. TOWN OF BARNSTABLE BUILDING I''HSPECTOR - APPLICATION FOR PERMIT TO O.'ap"I....... ...................................... TYPE OF CONSTRUCTION ...k 9124...... A',............................................................................... ......�.1.1.............19S� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...... ........ ......R. .................................................................................. ......................... ProposedUse ....... ........................................................................................................................................... Zoning District ........... .............................................Fire District .........)Y ....V.421.5.................................... Name of Owner MALCPLA?.....)......XA�� EVAMEldress ........X.- .V/9.tt.)/V.1.. .........4. ........................ Name of Builder 716A,AACAddress ....... ... ........................... Nameof Architect ................�Vb.....................................Address .................................................................................... Number of Rooms ............. .............................................Foundation ....pu! ...................... Exterior .... .......................Roofing ........... S......... Floors .......!;. A&...PA7................................................Interior ........... 4........ ....... .R.. .............. Heating .......... .................................Plumbing .............. ................................................. Fireplace ............... .....................................Approximate Cost .......... .................................... Definitive Plan Approved by Planning Board -----------—------—-----------19--------- Area ....... ......................... d Building with Dimensions Diagram of Lot an Fee ......... ...... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... ... .?A'A ............ ConOrl ction Supervisor's License ...... ROSENBLATT, MALCOLM L. A=327-212 25535 REMODEL & ADD to No ................. Permit for .................................... Commercial Bldg. /Offices ............................................................................... Location .....2.2...Lews Bay...Rgad.............. H annis Owner .........Malcolm L. Rosenblat�. Type of Construction ......Frame...................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ...Sept. 14, 19 83 Date of Inspection ....................................19 Date Completed .......................................19 r 3 Assessor's map and lot number Tau. 0,*'fw E 3- .�ew'/ge Permit number .......................................................... t BARNSTABLE. House number ....................... M.4.z.........................I...... NAG& 039. TOWN . OF BARNSTABLE BUILDING INSPECTOR . OA iL hio 0 ....................................... APPLICATION FOR PERMIT TO ... .... .. .r - TYPE OF CONSTRUCTION .... ......��. K ............. ............................................................... Iai..r...... ............. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit. according to the following information: Location ...... .......APY ........................................................................................................... ProposedUse ........0.....r...r1....C...E....3.....................................e.................................................................................................... Zoning District ..... .............................................Fire Fire District .........HYA.lvv.l..�.................................... Name of Owner .Q.4,141.....J.......X.0.:S,6,VAL*hTr-ss ......... ......... 1"A........................ Name of Builder A2.,4,.(,:h.A0.......If....O.A...4...9.T...,..60.%../XAc1dress ...... .111.11&�az.&4...../1.1. Name of Architect ............ .............Address Number of Rooms .............. .'..............:..............................Foundation .... j 0........ ...................... Exterior .... .......................Roofing ............ ........11V4.V.. .Floors ......................................................................................Interior .................. ... &1.a.t� ............ Heating , ....... .......................:..............Plumbing ............:.Alo.A.I.E ................................................. Fireplace /f/,O..Iv...fv.............................. ...........Approximate Cost ............/... ................................... Definitive Plan Approved by Planning Board ----------------------------- Area .......................................... j!;1) 00 Diagram of Lot and Building with Dimensions Fee ..........011. ... ....................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .............. ...0.0.4.�.4.Contt fction Supervisor's License 6.@ ..... ROSENBLATT, MALCOLM L. ' 25535 No ................ Permit for .��!�ODEL & ADD. ........................... COMMERCIAL BLDG. / OFFICES ..................................................... ........................... Location ...2.2....Lew.is....Bav...RoA6................... . ....... .... ...— ..... .... Hyannis .......................:........................................... Malcolm L. Rosenb�latt Owner`.................................................................... 'Type of Construction .......Frame ' ..........f......................... ................................ .......................................... Plot ............................ Lot ................................ Sept. 14, 19 83 Permit Grante ............... Date of J/e tion .........3....................... P ...19 Date Completed .........................................T9 i ; {�� ek f 1 Assessor's office(1 stj Floor): Assessor's map and lot number La 7" ,210? �Pyo�YN¢>0 o Board of Health(3rd floor): �/� � 9 �, Sewage Permit number. / • _ Z 11A.MTSLLL. i Engineering Department'(3rdfloor): r �,$ moo*_-rns`$ ,House number ° i639- \®� Definitive Plan Approved by Planning Board 19 o,rz+A, APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO JFSU U ) TYPE OF CONSTRUCTION *^ �� 19 1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information:k Location Proposed Use Zoning District 1l Fire District Name of Owner f-'e Co. <�i �IC-,3 Address -Z> Name of Builder Address_ Q Q t-�`��'►Y��(ham Name of Architect Address i Number of Rooms ' Foundation Exterior (131�'S �UK&C Roofing Floors Interior J r)e" I Heating � ) _ Plumbing Fireplace ! A( )O A-) e. Approximate Cost Lot) Area � Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Co st u p n r ction Supervisor's License C & I HEALTH SERVICES -J, f A=327-212 3d?-aio No 33190 Permit For Bld. Entrance & Elevator Addn. Medical Building Location 2 Lewis Bay Road Hyannis Owner C & I Health Services Type of Construction Frame Plot Lot Permit Granted September 7, 19 8 Date of Inspection 19 Date Completed 19 0 t Assessor's office(1st Floor): 'Assessor's map and lot number nnUST CONNECT TO TOWN SEWER Bpi THE>o� Board of Health(3rd floor): env ♦� Sewage Permit number 2i Bsaa9TABLL Engineering Department(3rd floor): r�� �° rasa ^House number, dc 1639' Definitive Plan Approved by Planning Board APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE _ BUILDING INSPECTOR APPLICATION FOR PERMIT TO Fj(.)I LD 65 -� -C6: `' ca -e TYPE OF CONSTRUCTION i ICJ 19 I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information:i , Location Proposed Use -- 1 Zoning District 12CD Fire District Name of Ownec- Lg: Address Name of Builder Addresses Name of Architect Address Number of Rooms Foundation C <Z; Exterior r t ��"6 Roofing Floors Interior . 4 Heating � ( �CTc Plumbing Fireplace >V 0 aJ Approximate Cost 6co tC Area '! Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 4 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Na Construction Supervisor's License C & I HEALTH SERVICES ;. No 33190 , Permit For BLD Entrance & Elevdtor Addn: Medical Buildina Location AS2 Lewis Bay Road - Hyannis 'i -7 owner C & I Health Servi cP-q - Type of Construction Frame Plot Lot Permit Granted September 7, 19 89 ' Date of Inspection 19 Da`'t>3 Completed �! 9 S® 19 n • �s 3 1 ° elt a /, ee i Q0 00 W �■ b�LiLL-IrL � L4 Ir � , to Rog M91 Aw ZIP t--------------------------_-----------------------------------..__________--1 vi FRONT ELEVATION W p N S � H ' J N m 1 _ �z tn Li Jlr✓`, Z Li '-1�1i 'I u ell q -.E /f IMP L�3iltk 'J L---------_--� __________________________ u . RIGHT SIDE ELEVATION �/ r��r^^ ,1^j �� 'r ii s �� ,.�.�,t.i"�'� �^+rf �t ➢ 3.i'�a5 7 " �� , II k VVK y l:."'I�I��.�.J.:RN'L:l,_... ❑ wu... a s mar. o — � -- jcIm Wa �_`1 CD ---- L.. ..".fir _i C Z tn Z k unurr roams / II U m a:1 W_ 4 ;Z ...�A •� .. ® T"A � I U N 2 i rb vry rD El ® - r - an 0 SECOND FLOOR PLAN FIRST FLOOR PLAN FRONT ELEVATION -pj� ,r•"r ':I a'u•u . •rH•q.•M_— - $IUE ELEVATION r 3 •r••••' Ye'i ("C1 t-' _ -'_ — --- ©3y,���,«wH, « •rw"»i::.i•'"..'�a�w w.r,•,«W 1 ��- wu u•r - mom^/,Tea - -•• • ^wi••�i•'H«. o ri'r••�'t. w . h REAR ELEVATION t./'IGKS •r•uHu.• �...u.H... 7 .ti..o r. •y A .r'W.y ■ SEC IUN • W1 c= y.y�.0 y ^ .«,..... :�.r'uw•....•v�,�u,«•. ` ------i--i-�� N_-1 U ro:•::s'�YLi^i:•=wy}I«... I, �, N '�qi POD fol RKCEPTION DESK •'•'`••'^•••• t j __ _ iii,,v .......pear..orr„a., _ - --"• Ll: 7Y„fn•r O ,[ i W a I 1 Rua row 4 ' I •,.0.c pi•A/r Tw _ ned r ' __ � _ �� Q. ' I •u o.e Bole nle. 4 R1SS.,...o •• U N S �.�•I.s,rw r. j ALL., r t6w9 �'e1 z0 p 1 „en a olir §F� jscar t5;9t�iia:y,... �' I Ld -- - -- - _- eo'/Tal ma IIw^:. •r•oa , '. ..! !` m.•✓<,P'C. (+E:;ti 1 SECTION THRU ELEVATOR -- n � ---�— FOU __ATV0IJ Ptr►N iv f. t •. 1 �e, 4�' �T. '� q' •S ppnnt .yi. 11 `T .Ilia„ /. � y,)�� ,.��, 4 r� Il��� l aA r� �.,�'•d�'��J�� 1�1!•.T�. I -al,/f•T.h�.�i%r�i7: ��.�f;Y� ... f1 rTP1 ,11�.5 ,a I 'Lf 1 T 1 i •�• r r �[ ��?(f. r y� � '� ,; -'�--.h;,vdINUM r.17i�'N:c,w+ !�ti�. ..}, # 4 :� 4 .��.� .:'�[. Y. •t 7",M1.9. N*e.'42's". +fF �I'i' FIRE CERTIFICATE OF INSPECTION In accordance with the requirements of General Laws, Chapter 111, Section 51, this Fire Certificate of Inspection issued by the head of the local Fire Department certifying compliance with local ordinances is a prerequisiteefor .,an :original or renewal license. PRIMARY CARE INTERNISTS NAME OF . CLINIC 22 -LEWIS BAY ROAD, HYANNI:S, MA. 0.26.01 ADDRESS OF CLINIC was inspected on IL -by L� ��aw• DA .,NAME OF INSPECTOR I HEREBY CERTIFY THAT THIS INSTITUTION COMPLIES WITH THE LOCAL ORDINANCES. ' YES NO If answer is "NO", - indicate violations and recommendations. Violations: Recommendations: ISSUED .Signature Head of Local Fire ` . Dept. INSTRUCTIONS: FIRE OEPT.TO RETURN TWO COMPLETED COPIES TO CLINIC CLINIC TO RETURN ONE COPY TO: Division 'of Health Care-Quality , 80� Boylston Street 11th Floor Boston, MA 02116 FIRE. 1 'yvy ice*` ai ,. ,# .' ,:: r s, �.. :. :, : r♦, 'A•' r oy..r.'fti � as �rr ADDITION ONLY TOWN O A ABLE.0 33190 Permit N BUILDING DEPARTMENT I """ I ;TOWN OFFICE BUILDING 'Cash. WL 7 bsY" HYANNIS,MASS:02601 .Bond u CERTIFICATE OF USE AND OCCUPANCY t° r Issued to C' & I Health 'Siprvices,- Address 2 Lewis Bay Road- Hyannis, Mass: USE GROUP FIRE GRADING ' OCCUPANCY'LOAD ' = - •* ., THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT,BE:OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE' BUILDING CODE. y Janna.ry 18,.... 19...90......... '"�'''.e'"`'' ..: , Building Inspector S + i �S�M1'1.^rr�..—wy.,--,�r`"w''1j7,�.,..r•. ,.,,.,,.:..,df�5w,,„ ,�„�'^"�+.14-+1..,�i,.»•.ayµ.-v�..•�+..;sFF"'r"w."+"ro'•.�^'4{y-.i�:f�'�' ADDITION ONLY TOWN OF BARNSTABLE 33190 o`7O Permit No. . • BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash .Nl ''tOjuV'' HYANNIS,MASS.02601 Bond M" CERTIFICATE OF USE AND OCCUPANCY Issued to C & I Health Services Address 2 Lewis Bay Road Hyannis, Mass. rUSEGROUP y` FIRE GRADING, OCCURANCY.LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND,IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. x Janaary 18, 19 90 J Building Inspector 'ThF.Tommonlue-alth of fflassar4uspfis TOWN OF BARNSTABLE In accordance with the Massachusetts State Building Code, Section 120.0, this CERTIFICATE OF USE AND OCCUPANCY is issued to LEWIS BAY MENTAL HEALTH ASSOCIATION 3 Terfif that I have inspected the building known as Mental Health Clinic located at 22 Lewis Bay Road in the village of Hyannis s County of Barnstable Commonwealth of Massachusetts. The building is hereby certified to be in compliance with the Basic Code and for the purpose stated below. 4 USE GROUP B FIRE GRADING 2 hours OCCUPANCY LOAD 25 . I October 14, 1982 I i Date Certificate Issued F. 1 Building Ojfcinl j The building official shall be notified of any changes in the above information. I I i I SEP-10-96 TUE 13:36 DOWN CAPE ENGINEERING 508 362 9880 P.02 z N N/F BARBARA DRAKOS q O' N/F EMSTING C.C.HOSPITAL TC �ASSIN e IN h � PROPOSED' ADDITION 2 W SIM CONCRETE WOvoPp BUILDING RETAINING WALLS �0 goo �Qi N/F 148aj, GOSS MED. BUILDING, INC. EASEM€NT JOB # 96-310 CERTIFIED. PL O T PLAN LOCATION : 22 LEIS BAY MAD HYANNIS, MA SCALE : 1" 30' DATE : SEPTEMBER 10, 1996 PREPARED FOR: REFERENCE DEED BOOR` 6616 PACB SB DEED BOOK 9219 PUB 8 f CAFE COD I HEREBY CERTIFY THAT THE STRUCTURE HOSPITAL jOSPl r T SHOWN ON THIS PLAN IS LOCATED ON THE jL GROUND AS SHOWN HEREON. 0 TAL Off�=' own Cape &��8. In& iA10a� � M*St yoroc^ M 02675 DATE LAND SURVEYOR SO U ZA, TRUE JOB NO. 1 `� ` I^�{� SHEET NO. DATE l W/. �DD. AND PARTNERS, INC. JOB CONSULTING ENGINEERS 'CLIENT BY y l - ------- .. �� - _ O��q� JEROME A .YURKOSKI - -- - o STRUCTUR o No-36852 y v - - � T - - --- jr \ Nk L coti1G; jFo.LSN D - - - ---- ... Ab- :N 4 Co _ +� � u } " Cc " t ' r .,.. ' \� �\ � q1 if , ��. ' " � '1 • -Vy ' soro N -...... .. _ .. _. Cv 1Co"o/G , NSW l2� Wkbe C0gC, SOUZA, TRUE JOB NO. r O ` \ SHEET NO. AND PARTNERS, INC. JOB �-- -� A �Q DATE 77 - 9 CONSULTING ENGINEERS CLIENT c. BY - - tx..A s`r .... - 'Lx WOOD t—:z)c lST 1 tip Ge _ V I DrR 2 x � s'�'►�DS . �c µ IEW �3>- 2x12g 141FW4 2x 42 _ d+� f 1�" o�c- log . .�Cv"O.,G, l.,tl 4W I (z>- 2xas OF 4M V-�,t -�P�aN 9 C� JEROME A. Gy YURKOSKI a o STRUCTURAL. I ca No.36852 CO O� IS Ea F SON � 4 JEROME A.�yG '�' YURKOSKI �' _ UMN 2X l,2 o S No 36852 ��'.� © -�Y+t . N 49�4v-f n � T I Z z D t 5 I m ,T, LF cn Z � m Z �-� ..Sp�ST �•}� �3'-7.?c 12� �pv lD'E C3) • � � rn Fn llh- 1 o 2r 0. O .1 SOUZA, TRUE JOB NO. SHEET NO. 4 Cl AND PARTNERS, INC. JOB � '� DATE �- CONSULTING ENGINEERS CLIENT nor By ?� YURKM S A. �N c ST U36 2 to AL � .. _G oN.c��1�_ ��J��►11- �� �_. _ W,�llol.'�" 1N l�'�c � ei'l c e— c.&4 pc. 11-L 4, �-o►�b1�V�l-S_l D1t�►�Ns1.at�S _ �5�� tic, S�z� �r�9 -7oi-l>L L..p M4'-) ct- -r o �-Ssrr. 4014 (1a- T W 1 T-�k CoK c h. I -S�LL" 16S �R.�SSuCz -�,�'�D 'Sols'�l�.�N �'���' � No. �. �Iz15,►�� -� S �Q ►_o, t..). �. o, S'�G' ,Al.. 1.-1�N1.�'�Z -�s/�LL� �I� SpR�t�G�- `p wa , �/No, 2 C.AP..AbE dam. Tile Cunrnrun%,ca1111 of 4fassacbusetty Department of Industrial Accidents ad _ � _- OIIlceal/ayes'tl9atlons IVt�. ��; +' 61111 «iisbitri ttM Street Bu�7on.111ir�•s. O?lll �-' Workers' Compensation Insurance Affidavit A Please 1'RiNT 6ly pttllCatli In10t=T1iatii�n'~ s location- "home-0- I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity � _ a•� M I am an emplover providing workers' compensation for my employees working on this job. comn�m n•tme Richard White Sons Inc - address 70 Rowe St city: Auburndale, MA 02166-1530 phone#• 617-332-9500 - insti nnceco Liberty Mutual nolicv# WAl-1l0-i.��ny.-1 - I am a sole proprietor, general contractor, or homeownex(circle one) and have hired the contractors listed below who ha the following workers' compensation polices: m anv nn c• address: �n phone#- i"cur-ince co ••_..--.•R.�-ti nolicv#..,.,.,,r.,.-.�,�„ ..,.�-=„---r--•�•^� ^g-;.::_. �• ter:.r. _. �n -r!n-....,�,r.. �•r-e•e.c. -� - -- com anv nimc• address: city: phone#• � nolicv# incvr•tnce co -•----•- Attach addi_tionaisheet iftiecessa :+ Frs�.:�...+s!'esf,Ri{r�•. v .+ 2..-=..�r..-•._... - — -- - — ,.�...� � .> >:r�wa.:.�.. Failure to secure cnvera0c as required wader Section 35A of 11tGL 1S3 can lead to the imposition of criminal penalties of a fine up to 51.500.00 andiur one •ears'imprisonment as well as civil Penalties in the forth of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement mac be forwarded to the OMcc of Investigations of the DIA for coverage verification 1 do herebt•cc •under the pains and penal' olperjun•dial,th e information provided above is true and correct. m Sianatu Date 9/11/96 Print n e Joseph A Tnhp3 Spni nr Vice Proei rl—l- pl10nC# 617-332-9500 onicial use onto do not write in this area to be completed b�city ortoan oRciai city or towwn• permit/license 0 r'IBuilding Department • C3Liccnsing Board (3Seiectmen's Office (3 check if immediate response is required C)fieatth Department phone N.- contact person: ,F Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for the emplo%ces;:k As quoted from the "law", an enrplo.vee is defined as every person in the service of another under any contract orfaire, express or implied, oral or written. . An ctnph rer is defined as an individual, partnership, association. corporation or other legal entity, or any two or nor tite fore�_oin-, crignued in a joint enterprise, and including the le-al representatives of deceased employer. or the receiver or tntstee of an individual , partnership, association or other legal entity, employing employees. However th owner of a dweliin�_ house having not more than three apartments and who resides therein. or the occupant of the dwcllikc house of another who employs persons to do maintenance , construction or repair work on such dwellin�� lie or on the;,_rounds or building appurtenant thereto shall not because of such employment be deemed to be an employe MGL chapter 152 section 25 also states that ever} state or local licensing agency small withhold the issuance or renewal of:a license or permit to operate a business or to construct buildings in the commonwealth for am• :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 anv contract for the performance of public work.until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. 77, 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 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 vdtt have any questions regarding the "law"or if you are require-- to obtain a workers' compensation policy, please call the Department at the number listed below. Cin• or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom o the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pie: be sure to fill in the permit/license number which will be used as a reference number. The affidavits mavrbe returned 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 question please do not hesitate to aiye us a call. - The Department's address. telephone and fax number. "I The Commonwealth Of Massachusetts Tµ$ Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma 02111 fax #: (617) 727-7749 f nhnne (f 1 7) 727-4t900 ext. 406. 409 or 375 1 a �J2� �jpry/�//�ZOiILUJE'pGG/2 ����iGCLOO�tll6P.� DEPARTKENT OF PUBLIC SAFETY CONSTRUCTION.SUPERVISOR LICENSE Au�her, Expires: Resticted. To� ":00 J0$EFH A TOPPA r;1475 HIGHLAND STIRO BOX 5997 HOLLISTON, KA 01746 I Engineering Dept. (3rd floor) Map ti Parcel j Permit# 7 3 ' House# Date Issued Board of Health(3rd floor (8:15 -9:30/1:00-4:30) 1" Q- /�~ f'� Fee Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept. (l:st floor/School Admin.Bldg.) THE initi Plan Approved by Planning Board 19 ' BARNSTABLE, ` MASS TOWN OF BARNSTABLE ASEWER CONNECTION PERMIT FROM THE Building Permit Application ENGINEERING DIVISION PRIOR TO ro'ec treet Address 22 Lewis Bay Road-Primary Care CONSTRUCTION Village Hynnni s" Owner Cai)e CodHospital Address 27 park St. ,- Lymfii G, MA Telephone 508-771-1800, Ext. 2104 Permit Request To install area way retaining wall and roof to help prevent flooding of the i9� `First Floor squa feet Se udZor square feet Construction Type 90 ss Estimated Project Cost $ J 1000 . o 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 Primary Care Proposed Use primary (arP Builder Information Name Richard White Sons, Inc. Telephone Number 617-332-9500 Address 70 Rowe St. License# 00853A Auburndale, MA 02166-1530 Home Improvement Contractor# Joseph A. Toppa, Sr. Vice President Worker's Compensation# WA1-110-432074-144 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 Wellesley landfill SIGNATUR DATE 9/G/Q C BUILDING MIT DENIED FOR THE ULOWING REASON(S) FOR OFFICIAL USE ONLY 'PERMIT NO. DATE ISSUED 1 MAP/PARCEL NO. f ADDRESS VILLAGE'`. pOWNER DATE OF INSPECTION: FOUNDATION f. FRAME ► �e INSULATION f r FIREPLACE ELECTRICAL: ROUGH FINAL r� PLUMBING: ROUGH FINAL f r, O:S O GAS: ROUGH,_,s C s FINAL «' FINAL BUILDING I ft-_.,6 DATE CLOSED OUT r ' ASSOCIATION PLAN NO. �Yt�� w � i I ' I r I j �t ,l . j i — a a I � 1 a i i 1 I i ! • — ..--'-" ___._�C__'—...�._�I.—.__�_�."'�. �...-:.-.4---_.._""y.....�_.�•-4__-- '• �--.��}�._�—..___yam �.._ r _..._...—- - _ i • 1 4t LA ew I rya 7 `V 77" .- a� I I- -3y _ 1_f1.5i�� w � i I ' I r I j �t ,l . j i — a a I � 1 a i i 1 I i !