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HomeMy WebLinkAbout0060 OLANDER DRIVE oC VC co c1c r vL TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # 00 5 C1 Health Division Date Issued Conservation Division Application Feet/ Planning Dept. Permit Fee _�,�,5' Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Q (Gt:0 jell Qom' Village a In Owner Ta m e.5 L F Address _5&M r Telephone 5r 7 Permit Request _ill 5'V k4lDfl 9 11 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size - / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family �1Y Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl 44alkout ❑ Other Basement Finished Areas ft. Basement Unfinished Areas ff w, Number of Baths: Full: existing new Half: existing ti J neW'l r Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count .7e --a Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �� ii Telephone Number S� �ra 1'3� 3 n Address / Ca ny) M011,E License #- / d :3 2 G 2 6,�eiA2 S LP-1- //I I A V 1l I Home Improvement Contractor# Email (All Cap eptcrgN I ' V e r Cl��l Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Lad,6e SIGNATURE DATE i - FOR OFFICIAL USE ONLY APPLICATION# t DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE t OWNER to t DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 27ie ComrRorrivealtli of- assadjusetts Departisreazt of radusbial Accidents t� 1�3,f,,�rce of Investigations lTnifgafians. ., { 600 Washijigtou Street itmit T11aw.gtrf'Illia Workers' Compensation Insurance Affidavit Bmldei-s/Contractors/EIectri;cians/Plumbers Applicaut Iuf6nnation Please Print f,eal Name,(Busk ewffi'ganizatioafladi iduai Address: AS'5 opt af6 J T l CitylStatel _ 8/ 1� I" o 3 / Phones 3 Are yqa an employer?Check appropriate bat: Type of project(required): 1.EVI am a employer with 4 ❑I am a general contractor and I employees(full anaor part-time)* have hired the sub-contractors 6- ❑New construction 2.❑ I am a sole prqprieto r orpartner- Fisted on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition wot3dng farsne in any capacity employees andhave xvod zs' 9. ❑Buililing addition. [No wodmrs'comp.insurance comp-Msuranrr required.] 5. ❑ We are a coiporation and its 14❑Electrical repairs,or additions 3.❑ I am a homeaumer doing all urork officers have,ei cised their 11.❑Plumbing repairs or additions myself-[No-workers'comp- right of exemption per MGL 121-1 Roofrepairs insurance require&]1 c.152,gI(4},andwe have no employees.[No workers' 13.❑Other comp-insurance required-] 4Aayapp@isattdstcbecJmboxP1ym alsafllouI the sectionberowslmssingileawuaerecampensad Upnriepinfannsaan. 1 gameawners who submit this af5davu i-U-t ilg they are doing all wc*and then hire outside contractors—st submit anew affidavit mdxating saclL fCaunacturs t5at check this box mast attached an.sdditinusl sheet shotrng the na@.e of the sub-cantrxctJo-u snd state whether.ar nat tbase endures have emplayees.Ifthezuh-cmtmctombaceemplUee%theymmsrpmridetheir workem'-comp.policynumber. I ant an employer that is prEniding workers'conrpensattan insurance for my*empkjwes, Below is thepoiicy and job sate inforrma om Insurance Company Name: f I" C� 1 Q,�-�►/ — Pohcy or Self-ius.Lie.4,. C V o I a-' o w 6 Q ��cpigattonDate: Job Site Address: , 0 01 am 12✓' -Pt- ' CitylStatel?.ng:—' V 4.nn V✓ p/.//t'e4A a Attach 2 copy of the workers'compensation policy dedaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL r 1572 can lead to the imposition of criminal penalties of a fine up to$1,540 t70 andJiir aae-{ear imprisozrmeat,as well as civil penalfies.ime ftsznz of a STOP WORK ORDER and a Erne of up to$250-Oa a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations afthe DIA for insurance coverage verifrca,#ion. Ida Itt=reby certify Ratder thapairis d imnaWks vfgetfitry that the utfarmafior}protirled abmwig barb and correct Sionature. c Date:: Phone;97- Ofi%dal um only. Do►tot write in this area,to be wmpleted by city ortonrn o,o`rsiat City or Town.: PermitUcense 4 Issuing Author*(drde one): L Board of Health 2.Budding Department 3.Cky1rtwn Clerk 4.Electrical Inspector S.Phunbing Inspector 6.Other Contact Person: Phone#: formation and Instructions Ma�caclr=etts Geheaal Laws chapter 152 rejm=all employers to provide workers'compensation for they employees. pro this sue,an employee is defined as."-.every person in the service of another under any contract of hire, e2press or implied,oral or wrif :m" An ernpkyer is defined as"aa individual,partaersbip,association,corporation or other legal entity,or any two or more of the foregoing=gaged m a Joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trastm of an mdividnaal,partnership,association or other legal entity,employing employees. However the owner of a.dwelling house having not more th�m three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do mainfeaance,construction or repair work.on such dwelling house or on the grounds or building appz enant thereto shall not because of sncla employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a licer, a 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.coveara.ge required." Additionally.MGL chapter 152, §25C(7)states"Neither the comet anwealth nor any of ifs political subdivisions shall enter mio any contract for the performance ofpumblic work unit acceptable evidence of compliance with the in�T' ^�._ requirements of this chapter have been presented to the contracting a rthozrity-" Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone nr mber(s) along with their certificate(s)of ir=ance. Limited Liability Companies.(LLC)or Limited Liability PazimeEships(LLP)with no employees other than the members or partners,arenot regtm-ed t4 carry woikms'compensation msormm If an L LC or L.LP does have employees,apolicy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for conformation of in saran ce coverage. Also he sure to sign and date-he affidavit The affidavit should be retrmmed to the city or town that the application for the pearnit or license is being requested,not the Depar6n6n1 of Tn iustri al A ccidezzts. Should you have any questions regarding the lave or if you are regma-ed to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-h sari ce license number an the appropriate line. City or Town OfFicials r � _ Please be sane that the affidavit is complete and priated.legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in time event the Office oflnvestigations has to contact you regarding the applicant Please be sine to fill in the pezmit/liceme,number which will be used as a reference number. In.addition,am.applicant that must submit multiple peunit/Ecensa applications in any given Year,.need only submit one affidavit mdirafmg current policy in$zrnation Cif necessary)and under"Job Site Ad�ess"the applicant should wee"all locations in (city or town)--A copy of the affidavit that has berm officially stamped or marked by the city or town may b e provided to the - applicaut as proof that a valid affidavit is on file for future permits or licenses Anew affidavitnust be filled out each wner or citizen is obtaining a license or permit not related to any business or commercial venture year.Where a home o (Le. a dog license or permit to bum leaves etr-.)said person is NOT raFdmd to complete this affidavit The Office of Invesligaiions would at to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. -The COMMMWWlffiE of Massachn3etts- Depaiimmtc&ladusbidAmidents Off ce of lvestigati= �Q4� �an Siz�t Bow MA Ed],11 Fax#617-727'749 Revised4-24-07 - vIdia InO qUM Plien;o d7'1 1(rC 7rr>ren92cnPlYlC�n�C��1%�ryd1[Y.r�[cJe(tJ I• > r � Office of Consumer Affairs&Business Regulation v : OME IMPROVEMENT CONTRACTOR egistration 186888 Type: Y �• Expiration DBA r 9I-IZO r ALL CAPE ENERGY nor;e�`n�a OLIs a;!n �L1I`uo;sog g ssau►sn S-eze I g�pue•s to !d�Iaed OI , :o;ujn aa•puno3,3I ale lF J3tunsuoa.Io as►-T.IO 1 SHAYNE DEWITT I f►uo asn!npinipu!.►0 P uoi;ea!dxa aq;a ro3aq 161 COMMONS WAY? 3 P!!eA u0 !1e31si2a.r.ro asuaarT BREWSTER,11AA 02361- �— rsecret Unde ry a l e • r G Restricted To: CSSL-IC-Insulation Contractor M/£Z/ZO -. Jauolsslu woD b vol;vjidx3 �3iar TOZO VIAiJa;s,eaig 413M sn0mm03 191 I.A. .ZbB£0OSS3 :asua3l� Failure to possess a current edition of the Massachusetts wlr.11adS.ios►:uadng uo!lanjlsuoj State Building Code is cause for revocation of this license. splepuelS pue suoi;eln6aa 6ul131 ng to pjaog For DPS Licensing information visit: www.Mass.Gov/DPS A;ales o(Ignd TO.;uawpedaO- sTjasny3essew r,- HOME OWNER WEATHERIZATION WORK PERMIT: PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. . . hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property located at: aw The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather stripping; air sealing; attic& basement insulation; exterior wall insulation;ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to Housing Assistance Corporation the property with such equipment and materials as may be necessary to perform weatherization. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. have read the provisions of this agreement and give my consent. Home Owner(signature) Home Owner email: Date: Agent:(signature) Date: Weatherization Contractors: Adam T Inc Cape Save All Cape Energy Frontier Energy Solutions Alternative Weatherization Lohr Home Improvement Building Science Construction Resolution Energy Cape Cod Insulation Tupper Construction ;0/16M/2015 06:22 TO: 15087901414 FROM:6174886501 Page: 2 AC40RR0 CERTIFICATE OF LIABILITY INSURANCE 1E`161201YYY"' 10/16/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 00109-003 NpAHpMNEE:'CT Bryden&Sullivan Insurance of Dennis (NC.No,Ea): (508)398-6060 �IUC.No.; PO Box 1497 � ss: South Dennis,MA 02660 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Atlantic Charter Insurance Company VDAC 44326 INSURED INSURER B: All Cape Energy,Inc. INSURER C: PO BOX 1492 INSURER D: Brewster,MA 02631 INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER ( �r (� � LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITYDAMAGE TO RENTED PREMISES(Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP(Arty one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENt AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO-- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION$ $ MOMMATIM X .TWIWI S. OR. A . 6l� Igp��1�(& S1&�(ECUTNE"N" NIA WCV01250400 9/3/2015 9/3/2016 E.L.EACH ACCIDENT $ 500,000.00 ( in NH) Policy Coverage State:NIA E.L.DISEASE-EA EMPLOYEE $ 500,000.00 U&I &OF OPERATIONS bebw E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS LOCATIONS IVEHICLES(Attach ACORD 101,Additional Remarks Schedule,0 more space is required) CERTIFICATE HOLDER CANCELLATION Housing Assistance Corp.,Energy Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 460 West Main Street BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY Hyannis,MA 02601 WILL ENDEAVOR TO MAIL NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ` AUTHORIZED REPRESENTATIVE 0198"014 ACORD CORPORATION.All fights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER COPY - °FT„E l � Town of arnstabl.e Regulatory Services * sAxrrszws . ' Thomas F.Geiler,Director ' ' 1` BuildingDivision lFD rnA'� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 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 of Work: 4 Estimated Cost �. Address of Work: (o' Owner's Name: Date of Application: 4Z —7 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 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION MWE `7 0 Parcel Permit# Health Division I `� `� �! e 3 S i~e_ Date Issued _/° Conservation Division rf 0 Application Fee Tax Collector Permit Fee :.J �Jv Treasurer SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Planning Dept. MTN TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address Q 001_191VDZ0-i2 Village ��✓��is Owner Address /6 C f1r4z21r� �z S S Telephone f ® � ��Si �5�/ /Z6OI Permit Request 16 x/9 ,0�C'4 Square feet: 1 st floor:existing ,S SV proposed 2nd floor:existing 12a proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation"20aa Construction Type iVooO .9�f4c, Lot Size 157e'-f-E Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 0, Two Family ❑ Multi-Family(#units) Age of Existing Structure o .s Historic House: ❑Yes ELNo On Old King's Highway: ❑Yes ❑No Basement Type: Q_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 2- new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: k Gas ®Oil ❑Electric ❑Other Central Air: M Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name__ Telephone Number 728 Address License# - 7 3 9 S.3 Ly %r��2rn�c��'`. ✓= i � Home Improvement Contractor# 13 5 1'SZ Worker's Compensation# ALL CO STRUCTI Rr U NG FROM THIS PROJECT WILL BETAKEN TO SIG TURE DATE _ FOR OFFICIAL USE ONLY ,PERMIT NO. DATE ISSUED r , MAP/PARCEL NO. ADDRESS , ?,. ,. , /� VILLAGE r- ,.)1Li OWNER ~I } . DATE OF INSPECTION: FOUNDATION S c��� 0 3 FRAME r INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH;-# FINAL t+ .. GAS: ROUGH,.fi i c FINAL FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts ' Department of Industrial Accidents � -� — Olflce ofln�estigatlaos t 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name �/9/1 U �/�/'✓'a location: O �0 •� 'z city �T ,� e9 6.) phone# ❑ I am a homeowner performing all work myself. 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Failure to secure coverage as required wider Section 25A of GL 152 can lead to the imposition of arizttinal penalties o[a Sae up to S1,500.00 and/or ne yam,imprisomnentt as well as civil penalties in the form of a STOP WORK ORDER and a Sae of S100.00 a day against ma. I13n 'End Othat a opy of this statement maybe forwarded to the Office of Investigation of the DIA for coverage veriScation. 1 do hereby certify under the p ' and pen% o 'itry that the information provided above is true and correct Date �'�✓Q Signature �- Print name �' .�•� ���3�� d Mae I Cf1dal do not write in this area to be completed by city or town offidal permit/Ucense# ❑Building Department cityClUcensing Board nse i'required ❑selectmws Office ediate respo ❑HealthDepartment phone#; _ Other Um"d 9195 PJA) Information and Instructions Massachusetts General Laws chapter 152 section ee sed�fine d� every person employers to Pin the servicerovide eo£another�under any contract ation for their employees. As quoted from the `law", an emp y � 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 - i f 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 maybe . PP P r submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign an C;_ 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 `haw'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 ret®srd 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 Inyesugation: 600 Washington Street Boston,Ma. 02111 - fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 Town of Barnstable Regulatory Services 9 MASS. Thomas F.Geiler,Director 1639. n 3 or p 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 I, �C7 19 10 , as Owner of the subject property hereby authorize Z j 4 1 Zj i,,-3 f to act on my behalf, in all matters relative to work authorized by this building permit application for(address of job) Jr Signa e of bAer Date ell C41i Print Name I Q:FORMS:OWNERPERMISSION f Y • fie BOAR,1.D Oizu.rJea�/i ac`TiuLOeNC2� MMAS r License: CONSTRUCTION SUPERVISOR Nlumber!t$ 073853 birt;W e-4_2f067,954 E4IO 2�Q6[26f 5 Tr.no: 10264 fie+arr I�M MARK D BIBBO ' 3Q ROSEMARY LNs � j W YARMOUTH, -?- Adm!nistratior K Board of$u�lc��s�ALegu9attons and HOME IP, kQVEMEO QONTRACTC 2 ' Fie alstratiarrt-:�-4,35852 S� tt� -�5 04 „I 1N ividual ,RK BI90 `doIV ;1 . t(jAAK SlBf3EFT LAA j RO E;#Viv�k' �iE�. r`� 'x ,$1r Y�lE2tii�l hd Ma:02673 Ad *na3s�traYds 1='n"r-tF-: c)p- nq to nj IR Yk ru cz I= Thr cghhcht is SWA oil vWx of Wmavow awl cnav, 2 Ij edFj v elm us cpHay Ondio p"aim blin. ROBOT! OF PIT: -------------------------------------------------- Q0 LP T -------------------- ---------------------------- 301 ON. ---------------------------------------------------------------------------- it: E� ------------- ra'Urnme Mid Q1,Avyin kind to thajayd nwao, �",cv-a the pfl!c/ pe:i'A Q At 13 t 1 t h s Lc.i u ie c o i C,I T a c r il a 1 d Li,?a i'! i OvMkate my be ynd 1�mj putm, on imm"s allv M by He py(Ws dHsvbq New i Hold to m 1 to Mu, n':hSaW, A 0"Wani P ilk Q04" Q�l 144t 611 4"s &lp pavej bj p C Vinoi. ----------------------7---------------------------I----------------------------------------------- --------------------------------- pyhy SOMOS; 19faMe call axplatimi city tkusand� ---------------------------------------------------- 1 350102431 1 SO& 1 SANOT Kam! aggrepte: 2,01., !F'61.;;c1 _-i,14' PHSn" 2001 A 19 .ad: Man Scasn"ce: ----------- FjW0 LIMP7 a0 QT ------------------------------ W, ci. Q,n J� ENWIRS' ONLITT Anamink WON ----------------------- -----------------------------------------------------------------------------------7------------ ------------------------ -------------7--------------------------------------------------------------------------------------------- ---------------- -------------------- -------------- ---------------------------- --------------------------- ---------- -------- ------------ CEPTIFICATE HOLDER CANCELLATION , 20., qf tie Asia 93ziledgWi6a; be pyaHj before W-i �hveoh the imams mm W— Mayor to Ili II 11 TGUN Cf RPTITAL.-E 'he C?ftificaze hiold?r to -,',he faTvi; to 01 I"tAe Q ipqe no W2dy-o", 17 ANN ST 1Q of aq kid UPI Do compay) is apmS Of ""HeEmHe", RANKHA 00".11 -------------------------------------------------------------------------------- ----------------------------------------------- ------------------------------------------------------------------------------- t:20 L-oCACTI®tea of PMOPERw ILoNEs AA.w N®t 0E ^CCUR^-TE STANDARD LEGEND NOTE:not all symbols will appear on a map r tk=zQ GOLF COURSE FAIRWAY. - r. w� EDGE OF DECIDUOUS TREES r fl. i r 1 Y IU 270 � � - r s _- EDGE OF BRUSH t i ORCHARD OR NURSERY r r - /� O r r V-V�� EDGE OF CONIFEROUS TREES L_I(_ Map 2 70 r r MARSH AREA 65 r r 1 EDGE OF WATER DIRT ROAD 215 DRIVEWAY r rr I PARKING LOT • � PAVED ROAD ( — — DRAINAGE DITCH ------ i r PATH/TRAIL PARCEL LINE 7 -------i r r r. MAvno-a—MAP# Q / I / r 21 PARCEL NUMBER i i nA a 0 �O #1e60 0 HOUSE NUMBER i M i q X - 1 FOOT CONTOUR LINE 4 - - 10 FOOT CONTOUR LINE Elevation based on NGVD29 55 60• ,4.9 SPOT ELEVATION 2-0=5 o0o STONE WALL -X—X- FENCE 7 RETAINING WALL L J—� a - / O, + 1 RAIL ROAD TRACK STONE JETTY SWIMMING POOL # 1 / 5 PORCH/DECK 27 7/0 ] ❑ BUILDING/STRUCTURE - DOCK/PIER HYDRANT 4 a 27 e VALVE ® MANHOLE o POST 0FP FLAG POLE T O W N O F EI A R N S T A B L E 0 E O O R A P N I C I N F O R M A T `1 O N S Y S T E M S U N 1 T 0 SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES:Planimehics(man-made features)were interpreted from 1995 aerial photographs by The James u TOWER 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD UTWTY POLE 0 20 40 National Mop Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Plonimettics,topography,and vegetation were mapped to meet National Map Accuracy Standards 1 INCH=40 FEET* enlarged scale. on the map. at o scale of 1"=100'. Parcel lines were digit¢ed from FY2003 Town of Barnstable Assessors tax maps. LIGHT POLE O ELECTRIC BOX a, �' � ` .- 1 l� ` , . �y _ .. !I 4 � i . _ \�, '� � .. .. -- "V ._ �: M� � ;0� _ � .. �,, _, � - �? \ 7 �' '© 1 ,. � �' � � � � � , r , � � r _ � 1 � ♦ 1 � i �^ 5 � - � (. � J U5r h,rS c1 � tic 1Q CciVC12Xre '1 VZ3rJ �g� s� s , e el