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Home My WebLink About0420 MAIN STREET (HYANNIS) (6)�f i ! a� Mcw�\ 5is<e--< -- i PROJECT NAME: 9e ADDRESS: �v 1 PERMIT# 7LI I DATE: 64 M/P:_��)D� LARGE ROLLED PLANS ARE IN: BOX SLOT % I DATE: q/wpfiles/archive f TOWN OF BARNSTABLE SIGN PERMIT PARCEL ID 309 218 GEOBASE ID 22511 � i ADDRESS 420 MAIN STREET (HYANNIS PHONE HYANNIS ZIP - LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 76589 DESCRIPTION 24 SQ WHITE HEN PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of ARCHITECTS: Regulatory Services TOTAL FEES: $25.00 BOND $.00 CONSTRUCTION COSTS $.00 "�•� 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE0 I +► BARNSTABLE, MASS. z6g9. � � MP BUILRA,G�,IVISION BY (( DATE ISSUED 05/13/2004 EXPIRATION DATE �' Town of Barnstable FTHE 1p Regulatory Services ro UN OF r Thomas F. Geiler,Director ARNSTABLE Bnartsrn. e, Building Division 9� 1�� g ZOQ4 SAY —7 �� 9� OS iOlf& MA'S A Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 "t W 508-790-6230 Tax Collector IQ GG Treasurer Application for Sign Permit Applicant: IIJ K I V O�-,o P/10 f'i/I Assessors No. 614 r 0g1 _ r f 2 18 Doing Business As: w I *V V90 h,, Telephone No. —7� �•.27. 4Yt T Sign Location Street/Road: I VI S ► el'— Zoning District: A j Old Kings Highway? Yes/No Hyannis Historic District Yes o Property Owner Name: �(n V I �G Telephone: ��. 7 S. 7 yJ Address: 0KJ 0 0 d Sf7,d U I W Gt Village: N7it4 0VI t y(1261 b T- W 10Vi1 5f✓eG Sign Contracto Name: I��VI �'i al(/� Telephone: 50 t, M- Q (4 02�a I Address: I-"1) (A &JC(JtW 0l-Village: 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? Y s/No (Note:If yes, a wiring permit is required) 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 Section 4-3 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent: �/ te:-7C Size: Permit Fee: Sign Permit was approved: Ic Disapproved: Signature of Building Official: Date: g �� Signl.doc rev.122801 White Hen Pantry - Hyannis Location 4"x2"x2"- 2 gong weatherproof junction box J L 1/4"x 6"x 6" e Hen aluminum plate welded VM'I*t to sq.tube 21 1/2" existing storefront Market & Deli r 97" BUILDING FRONT Custom routed high density foam-Hepplewhite Ivory HC-36 Pointed Toasted Brown BM 2097-10 Custom routed high density foam Painted Peale.Green HC-121 1/2" J1 L %"I'Ote Hen / 24' V Market ' . li 1 3/4' 4 96" BUILDING REAR _ I _ BUILDING JRONT BUILDING } Su"UDES19ka 170 8.580.berty Street 1.ockton,VA 508.580.0096 01 and artmay orknot remains reproduced withoperty ut written permission. p.508.580.0094 f.508.580.0096 and may not be reproduced without written permission. sign and graphic solutions www.signdesignlnc.com a , CO Z' g xr � � f A } CENTER \PEWS . ON1 t t , White Hen Pantry unDESIgNis 420 Main Street, Hyannis 1-800-500-SIGN Existing Views - Front Tel:508.580.0094 Fax:508.580.0096 170 Liberty St.,Brockton,MA 62301 W Ww.si g ndes ign i nc.com: This design is the property of Sign Design,Inc.,and may notpe reproduced In any manner without written permission from Sign 0 l �::I'g r i -- T .�°41. IS,,ULL'I VAN'S Ems 0®NMI _ MO �..tE* R I NEW-S' t, nn vltr;,: G DES19White Hen Pantry --_- � 420 Main .Street, Hyannis - 1-800-500-SIGN . _ _ . _ Existing Views Back Tel:508.580.0094 Fax:508.580.0096 170 Liberty St.,Brockton,MA 02301'. W W W.Sig ndeSl g n I nc.corn This design Is the Property o1 Sign Design,Inc,and may not be reproduced In any marmer without written pennisslon tram Sign 0 E,� L • Hyannis Main Street Waterfront Historic District Commission. MASS 1639. 230 South Street . 94� s .off g��u►�'' Hyannis,Massachusetts 02601 Application to Hyannis Main Street Waterfront-Historic District Commission in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under M. G. L. Chapter 40C, The Historic Districts Act for.proposed work as described below and on plans,drawings or photographs accompanying this application for: PLEASE CHECK ALL CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building ❑ Addition ❑ Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other• 2. Exterior Painting: ❑ - - 3. Signs or Billboards: aNew sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other 5. Parking Lot: []. New Building ❑ Addition ❑ Alteration (Please see the guidelines for explanation and requirements) TYPE OR PRINT LEGIBLY DATE 3 1 Q ASSESSOR'S MAP NO. ASSESSOR'S LOT NO. rL I APPLICANT 11-`, W y N 'FA NT TEL.NO. Z .✓1 b Z. q qqL APPLICANT MAILING ADDRESS 2q p VA-N1)f f2 6� AV F,f N omca> M h f? CK . ADDRESS OF PROPOSED WORK 42-0 .M k 1 N ST If e PROPERTY OWNER M d 1 DL) I DNT TEL.NO. 60A).-JJS. I�iLY) OWNER MAILING ADDRESS _Ft AN.WQOD S T 1f-UJJ& ttA L" TiLUS 1 . &-T W i L-U W s1_K9tT>14'A N N l S FULL NAMES AND MAILING ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. This information is best obtained at the Town Assessor's Office. (Attach additional sheet if necessary). r w42, --Kits& Y AGENT OR CONTRACTOR S 1(,N 1�S l G N TEL.NO. ADDRESS l�I PJIV )T Ittif (J1-QGPTDI\3j kAA 02 Nt I DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done, including detailed data on -such architectural features as: foundation,chimney,siding, roofing, roof pitch, sash and doors,window and door frames,trim, gutters- leaders,roofing and paint color,including materials to be used,if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional,sheet,if necessary). Signed 1 i Owner- ctor Agent o SPACE BELOW LINE FOR CONBUSSION USE Received by HMSWHDC Date DQir, Time This Certificate is hereb By Date Si M PORTANT: If this Certificate is approved,approval is subject to the 20-day a ' pen pr ed in the Ordinance. CONDITIONS F APP AL: k2 b7r i:1 O *hLz� NJ . v Qabc J Me, 6L4 Hyannis Main Street Waterfront s."M ; Historic District Commission v MAss. 230 South Street . i6J9 �� Ec ram'' Hyannis,Massachusetts 02601 Application to Hyannis Main Street Waterfront Historic District Commission in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under M. G. L. Chapter 40C, The Historic Districts Act for.proposed work as described below and on plans,drawings or photographs accompanying this application for: PLEASE CHECK ALL CATEGORIES THAT-APPLY: �. 1. Exterior Building Construction: [INew Building ❑ Addition Alteration x-� `�'❑ _ �- Indicate type of building House .__. _ - Garage,..-._ ❑ Commercial�-_❑ Other. - • - _ :__�_. .. _. , ._. �;, .__ 2. Exterior Painting: ❑ _ _. 3.- Signs or-Billboards: aNew sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other 5. Parkin Lot: ❑ New Building Addition g g ❑ ❑ Alteration rT — (Please see the guidelines for explanation and requirements) } TYPE OR PRINT LEGIBLY DATE 51111 Di. a; ASSESSOR'S MAP NO. ASSESSOR'S LOT NO. I APPLICANT TEL.N0. J b J,-J 0 Z. q qM`r APPLICANT MAILING ADDRESS V6NDf yzP� A-VE, Non-vvCop, MP Q2( 1. " ADDRESS OF PROPOSED WORK 0 M A-1 N 5T of W a.w. PROPERTY OWNER n pu m UNT TEL.N0. OWNER MAILING ADDRESS rt 12NINb0p 5Tf4ttW& A t/TY "Cif US T' . &-- W►t,"W 1;TWT�H1A NN I S FULL NAMES AND MAILING ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. This information is best obtained at the Town Assessor's Office, (Attach additional sheet if necessary). d::n Ll rx ; V% AGENT OR CONTRACTOR 5 J&N N SIGN TEL.NO. D06.ST)O• 0014 V-.)" ADDRESS OT IR-Q�fif , 'PJpwm t,31 A,I A- a%I 6�� ~., �» �. '�� . f SNE h,. Hyannis Main Street Waterfront 's B►RNsz,BM : Historic District Commission- MAUMS v 1639. 230 South Street . Hyannis,Massachusetts 02601 Application to Hyannis Main Street Waterfront-Historic District Commission in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under M. G. L. Chapter 40C, The Historic Districts Act for proposed work as described below and on plans,drawings or photographs accompanying this application for: PLEASE CHECK ALL CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building ❑ Addition ❑ Alteration =" Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other — 2. Exterior Painting: ❑ 3. Signs or Billboards: 6 New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other 5. Parking Lot: ❑ New Building ❑ Addition ❑ Alteration (Please see the guidelines for explanation and requirements) TYPE OR PRINT LEGIBLY DATE ASSESSOR'S MAP NO. 9j O 6A ASSESSOR'S LOT NO. L I P7 APPLICANT_ TEL.NO. 7 b 1.1 b Z. y qq L APPLICANT MAILING ADDRESS 2q 0 VA-N ref�p,�AVE N or_VVaQ J M h ae ADDRESS OF PROPOSED WORK 42t M )a-)N ST 1Zf -j PROPERTY OWNER DI)M VJQT TEL.NO. 50f-)-Ijtq OWNER MAILING ADDRESS rt/LNNcOD 5 T f42_U ', jZ�A liTY TAUS I ��- 1/V I I.LC W �11�t;i:T 1 I•-}�A NN l S FULL NAMES AND MAILING ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. This information is best obtained at the Town Assessor's Office. (Attach additional sheet if necessary). 4D s Y AGENT OR CONTRACTOR (, n S l G d N TEL.N•. eF).5t0- 00 ru T ADDRESS TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY 4 PARCEL ID 309 218 GEOBASE ID 22511 ADDRESS 420 MAIN STREET (HYANNIS PHONE HYANNIS ZIP - LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 76548 DESCRIPTION WHITE HEN PANTRY TENEANT FIT OUT PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of ARCHITECTS: h Regulatory Services TOTAL FEES: BOND $.00 CIE 1 CONSTRUCTION COSTS $, 00 �► 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE "0 Mass. t6g9. 1 FD Mpl A BUILDI IV SIGN BY DATE ISSUED 05/11/2004 EXPIRATION DATE i � —7�c � TOWN OF BARNSTABLE BUILDING PERMIT PARCEL ID 309 218 GEOBASE ID 22511 ADDRESS 420 MAIN STREET (HYANNIS PHONE HYANNIS ZIP — LOT- BLOCK LOT SIZE a DBA DEVELOPMENT DISTRICT NY PERMIT 74471 DESCRIPTION TENANT FIT OUT ( WHITE HEN PANTRY ) PERMIT TYPE BREMODC, TITLE COMMERCIAL ALT/CONV CONTRACTORS: COTE MARK P. Department of ARCHITECTS: Regulatory Services TOTAL FEES: $1,808.$0 BOND $..00 CONSTRUCTION COSTS $288,000.00 437 NONRES./NONHSKP ADD/CONV 1 PRIVATE BA MSTABLE, Mass. —(/.0 BUILD NG DYMISION DATE ISSUED 02/02/2004 EXPIRATION DATE �� TOWN OF BARNSTABLE ', s _ BUILVING PERMIT «� ' PARCEL ID-,309 218 GEOBASE ID 22511 ADDRESS 420 MAIN STREET (-HYANNIS PHONE HYANNIS _ ZIP —< . LOT -' BLOCK LOT SIZE VBADEVELOPMENT DISTRICT HY PERMIT '. 74471 DESCRIPTION TENANT FIT OUT ( WHITE HEN PANTRY } PERMIT TYPE BREMODC.! TITLE COMMERCIAL ALT/CONE i I CONTRACTORS`: COTE MARK P. Depa�.tment,of ` ARCHITECTS-: t - - Regulatory Services ' TOTAL FEES: $1,806.80 BOND $.00 ova CONSTRUCTION COSTS $288,000.00 437 NONRES./NONHSKP ADD/CONS/ 1 PRIVATE *O * BARNSIA39. BLE, * l Ab BUILD ,G D ISION BY r r DATE ISSUED 02/02/2004 EXPIRATION., DATE ,, 9j W THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE.DEPARTMENT OF PUBLIC_WORKSTHE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS ti HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND M FOR (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. CH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELE TRICAL INSPECTION APPROVALS 1 1 1 Ish ////p 13. 1 1 ATING INSPECTION APPROVALS ENGINEERING DEPARTMENT ey 2 OFH H ti . 6 OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. I I I f I I �I � a f 9 �� . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma �`!v / Parcel �/ Permit# 7 U C� 7 Health Divisi �� -b � �(a�� o� ��"� Date Issued A c 0 COY ,n��c� a vas n4�e Fro,.,, -6V4 Conservation Division Application Fee Tax Collector f _ Permit Fee l ? F s Treasurer / Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 6V S7', �-1 Awl 5 Village Owner _04 V10 nu wrvw-7' Address Telephone O - 4/6a Permit Request i IV'I. -7',ENA NvT FI7-eu-r / CffA;c.� ��i�cc�, ► 4CSe k . wieO,C,4L_ S�r�PcY To f1- w�r� Hsu/ �►1. i 'Y j� �•*Q7+��s Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation I �00O 9v Construction Type -VAIr, K Lot Size Grandfathered: 0 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: 2Pull ❑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: YGas ❑Oil ❑Electric ❑Other Central Air: Oes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:0 existing ❑new size Pool: ❑existing ❑new size Barn:0 existing ❑new size Attached garage:0 existing ❑new size Shed:0 existing ❑new size Other: Zoning Board Doff Appeals Authorization El Appeal# _ Recorded El Commercial u Yes ❑ No If yes, site plan review# Current Use 1 L �M£12c1{gL�-r yeotc*,50ti)Proposed Use RE j lt, riA4yi-tE MEV 1 BUILDER INFORMATION Name 6A�Sicc 8wL4&S OF P,& Oyc" Telephone Number Address 13 G ►Qtyev�_ Ro, License# wAfot4a2dJ _ M-A; Home Improvement Contractor# ! d 113 Cl o Worker's Compensation# iw G '1 Q S a '71 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �^ �, DATE 1 a ! Zo Y 1' T } FOR OFFICIAL USE ONLY j f ! PERMIT NO. DATE ISSUED f; 1 ' MAP/PARCEL NO. R - , ADDRESS VILLAGE 1 OWNER DATE OF INSPECTION: FOUNDATIOkN . FRAME h �'�1�/� Y lot t INSULATION I FIREPLACE ELECTRICAL: ROUGH FINAL ra _ PLUMBING: ROUGH FINAL GAS: ROUGH FINAL , FINAL BUILDING /�� ✓ Q h /��/® �/ 'V"�I j DATE CLOSED OUT. ASSOCIATION PLAN NO. t 1 r�1. The Commonwealth of Massachusetts Department of Industrial Accidents 5' 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit-General Businesses i name: Ay S rr 08 13"r '—Ofes I"t° address: r 3 f�i vr� too; city N/ewt&elOKoko i state: /VW zip: U 9-14 fCphone# 1-0? T?�eg work site location(full address): l'/r�� WN,W S T HyAy-WIT ❑ I am a sole proprietor and have no one Business Type: ❑Retail❑Restaurant/Bar/Eating Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,Autos etc.) ❑I am an em to er with em � loyees(full& art time). ❑Other �� %%%/%//��%/%%�%%%/O%/%/O%%/%%%//�%/%%%%% I am an employer providing workers' compensation for my employees working on this job. company name: address: ..:. city: phone#: 1 r� I .insurance co:-... . (A 6 (2d of c. # LAY C, � r5� /� t. I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: camAeny name. address: . . city phone#: insurance co. corn any address city:.. : Phone#t d. insurance so. - olicv# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil 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 un r th pains a d penaltie ofper't Hheznformation provided above is true and c rrect Signature ^ Q`/ �Q / Date i a2� 0 Print name MAP K V • 00—6 Phone# 4C� y M1 official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department check if immediate response is required ❑Licensing Board '. ❑ p q ❑Se)ectmea s Office i ❑Health Department contact person: phone#; ❑Other e (m✓sed Sept 2003) r v 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. Please supply company name, 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 pernit/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 hike 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 WIN of Inllesugadens 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406 COMMERCIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $100.00 Alterations/Renovations $50.00 r/ -6 0 Building Permit Amendment $50.00 FEE VALUE WORKSHEET NEW BUILDINGS square feet x$140.00/sq.foot= x.0061= ALTERATIONS/RENOVATIONS OF EXISTING SPACE � ®square feet X$96/sq.foot o� � f� X.0061 � 7 STORAGE BUILDINGS ONLY square feet X$32.00/sq.foot= X.0061 Commprojcost DFTMero�ti Town of Barnstable Regulatory Services S B WSTASIZ ' Thomas F.Geller,Director KAM tc jq. 1`` Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862 4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder Q I, Lie �c/' (/vw� M... ........:_.., &S Ownex-of the,subject property-. .,......._... .. hereby authorize � 5��.. %�v' chi��5. to act on my.behalf,, in all matters relative to work authotized.bp.this building pe nit-application for: (Address of job) Signature of Owner Date Print Name . � �/xe��'h+��uue� a�...i�%uroa�cfuuada • BOARD OF BUILDING REGULATIONS I' License: C STRUCTION SUPERVISOR j. Number• G \ 052046 Ex ,ire p BMW�� ,_, Tr. no: 10578 Resf�i. Dg ° MARK P COTE 1 136 RIVER RDA { NEW BEDFORD, MA 02�45 IOI OMp�1 I Administrator I � ��TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ✓ Permit# /-�3 �• �fi('Cf.S j�; Health Division 9� y y 1��I��L� S Date Issued ✓ A 6 Conservation Division '1 fl, Application Fee Tax Collector Per CrnIIJST NEC, nERMIT FROM TIM _' -- LNl3INF;t•�'� DIVISfON PRIOR TO Treasurer I '1{�i+ l '"''--_ CONST.:v �{��:i,- . Planning Dept. APPLICANT'.IUST OBTAIN A SZM CONNE" ,PMIT FROM THE Date Definitive Plan Approved by Planning Board ENGI,v,. "SIGN PRIOR TO CONS;, Historic-OKH Preservation/Hyannis Project Street Addr ss `7��:� INS�� S� �`yA Awi S Village Owner o Address Telephone 00-4_1�."06 Permit Request I7 EMnLt 5k1wq_,, Patlk t-r 7-- Gu i hSl iNLI Aa k DeA0 Fo 9- A/yw -r4y,+i1? tel-?-o uT -CID Square feet: 1 st floor: existing 3.00 proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay y. Project Valuation l sbo Construction Type 1.' Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ I Multi-Family(#units) Age of Existing Structure - Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: IYFull ❑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: 8rGas ❑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 8rYes ❑ No If yes,site plan review# Current Use 06 MtY'U-t4ArlA40rzaac Sc �C_�Proposed Use �r'1vAw9 Fir-kP A2. wkrgr Hit+/ 114 BUILDER INFORMATION Name M,4,sin15 X3uiLv3Ek.5 I wc,r Telephone Number q-1�r-&146� Address ►, % kiye e ✓J, License# e— 5 06-2(>y A/64,&0,0 NO, o 47 Y5r' Home Improvement Contractor# loll3 q Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO .,R)V ,DgotP5-71��e CO , SIGNATURE DATE Ib y t t FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED ;4 MAP/PARCEL NO. t - ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME .� INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING w DATE CLOSED OUT� ? , cl o� - w. ASSOCIATION-PLAN?NO F } w The Commonwealth of Massachusetts ) (�ti Department of Industrial Accidents 600 Washington Street 1 Boston,Mass. 02111 Workers' Compensation Insurance Affidavit-General Businesses i name address: [3 k 1 Vt:- RIO city jV6-,v r3L'0,6&R6 state: MA zip'G) !1t J phone# 7 -C b— D 7 6 r work site location(full address): ❑ I am a sole proprietor and have no one Business Type: 0 Retail❑Restaurant/Bar/Eating Establishment working in any capacity. ❑Office❑Sales(including Real Estate,Autos etc.) ❑I am an ern foyer with em loyees(full& art time). ❑Other I am an employer providing workers' compensation for my employees worlang on this job. company name: address: city: phone#: .. insurancer co: Rolle # I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: company name address: city: phone#: insurance co. Rolic` # / . 1 ..., %%/%%%%//////O/i coniyany name: address ciivi....: phone#t insurance co. G. LF S olicv# Fallure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil 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 maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify un r ih sins a penal ' ofperjury that the information provided above is true and correct Signature c Date t!/01 � Print name I"lam 1"C� 1 r 1 O•TE- Phone# g b 6 &..* official use only do not write in this area to be completed by city or town official N. city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (; (revised Sept 2W3) w,'�"'"' gym.=:ter •�'• - -� 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. Please supply company name,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 permit/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 lice 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 BMW of imlesugatl®ns 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext.406 01/07!2004 11:09 5087786448 HYANNIS FIRE PAGE 02 HYANNIS PURE DEPARTMENT '916.HIG H.SCHOOL AD. EXT.HYANNIS,MA.02601 HAROLD 5. BRUNELLE, CHIEF see tnx sari ' Ar►r ♦aa er rcerar rr NEW PREVENTION BUREAU BUSINESS PHONE:(50W)775-1300 FACSIMILE PHONE:(508)778-6448 LT.DONAAD K CILUEfflt-A C H LT.MUC F.HURLER,CFI FIRE P9EW111'I'IO1T OFFICER. FIRE FREVENnON OFFICER BUILDING CODE COWLIANCE FORM THIS'PIRE PREVENTION BUREAU.HAS REVIFEWED THE PLANS DATED FOR THE PROPERTY:L.CZATEp AT m. S ALSO KNOWN A THE CHART BELOW INDICATES THE STATUS OF OUR REVIEW: T Ir'' ':OF.'GItI$"I'Fii1G IDN.I• . ;,.�, t�IUIEN'�';,;.. WA RECEIVED REVIEWED COMPLIES 3-HYD•RAN�,:L ON*/.WATtO S0POLY �. 11VKLER SY5 i., 'u . 4: fir... 5-SPRINKLE i CpNT'f Utr' Il fp� NT r 6.=5TAIVD.FILPG: YS ' 119., 7' 'fip�NQPtp :•V�Oit;'VIv:LO!CA1'il"?I�f ;.:.: .,i-F E'bEP1►R fM tVT C N lLtfft 51V v 9=FI.RE I ROTECTIV '; 1 ..ALINO S r9T: 10-F:P.S;S. &MMONGIATOR-0C— ATION. 11-SMOKE CONTAOL,I EXHAUST 1-2-SMOKE CONTROL EQ0J0.:LG,?C,4TIQN 13-LIFE;SAFETY,S`i'V- M.FEATURES 'I!R=FIRf:EXTINGUISHING'S.YSTE;MS 15-FtE '.CONTROL.EQUIP LQCATION 16-FII�E.P,OTCI'ION ROOMS: 17-FIRE P.bft T N E"Q IR SIONAOE �18-ALARKTIaAIdSMISSIQKi'AAETH[50 �a 19-SE.QUEIUCE QF OPEkATION REPORT _ io--ACGEP�'ANCE^.TE�s71NCa,Gi�iT1RR�A --..__. .._ ks'. WE SeLI :VE: H5 bOCUMENT O MP ETE AND.COMPLIANT FOR THE ISSUAfVCE OF A BUILDING PERMIT.'. '7. . WE HAVE COMf�LETEp THE ACCEPTANCE TES OR THE OCCUPANCY PERMIT AND BELIEVE THAT WITHIN THE SCO12E='OF THE BUILDING PERMIT,THE ABOVE ISSUES ARE IN COMPLIANCE.