HomeMy WebLinkAbout0050 PEARL STREET o ��?� �'�
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PROJECT
NAME:
ADDRESS: D
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PER HT#
PERMIT DATE:
M/P: 3 _R CP, d D�D
LARGE ROLLED YLANS. ARE IN: {
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SLOT A l h
Data entered in MAPS program on:. 1 l
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map —.parcel Application#
Health Division
Conservation Division ; bV Permit# .
Tax Collector Date Issued
Treasurer Application Fe
Planning Dept. ✓ Permit Fee * a3�• ��
r
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address - Ss) 1 54.
Village
Owner ,„ �„ �i� Address �� Su�f�. S .
Telephone � 'uk) $ro2-yr �1 S i 0 dg I e I ren aQ
Permit Request A . t r _ — 5r1
S
e
r r.rko 6 � 11
Square feet: floor:
ee 1st oor. pr
oposed osed 2nd floor:existing r ��,qexisting— p p �h( g proposed S e. Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type
`Lot Size _ `1T ��v� Grandfathered: dYes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family tR( Two Family ❑ Multi-Family(#units)
Age of Existing Structure 75 Historic House: &Yes ❑No On Old King's Highway: ❑Yes Q No
Basement Type: Gull &7 Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) - ®, Basement Unfinished Area(sq.ft)
Number of Baths: Full:existing new Half:existing '—Z ! new
Number of Bedrooms: existing_ new c
Total Room Count(not including baths):existing new First Floor Room C unt
i
Heat Type and Fuel: U4as ❑Oil ❑Electric ❑Other 03
Central Air: ❑Yes Llo Fireplaces: Existing ✓ New Existing wood/coal stove: ❑Yes WKo
Detached garage:❑existing ❑new size Pool:Pool:❑existing ❑new size 0 Barn:❑existing ❑new size
Attached garage:❑existing ❑new size 0 Shed:❑existing ❑new size 6 Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
---Commercial _tom.Yes. ❑_No_If_yes,_site.plan.review#
Current Use Proposed Use
BUILDER INFORMATION
Name dLhaT Telephone Number
Address U License#
WO 0t41, h�. 0.�67a Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE AtJ -- �✓DATE 7hy- y
4
1
FOR OFFICIAL USE ONLY
k '
't
PAMIT NO.
i DATE ISSUED
1
MAP/PARCEL NO.
3 1
j
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
y ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH - FINAL
4
GAS: ROUGH FINAL
FINAL BUILDING
' DATE CLOSED OUT
ASSOCIATION PLAN NO. y
1
3 `
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
a a - 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Nari1e(Business/Organization/Individual); .�
Address: (Vol { � S�-
City/State/Zip: We A- Oc Vs oacir, Phone A: �° Y
Are you an employer? Check the appropriate Type of project(required):.
1.❑ I am a Y emP to er with 4. I am a general contractor and I
6. El New construction..
(employees(full and/or part-time).* have hired the sub-contractors
2. am a'sole proprietor or partner- . listed on the attached sheet. 7. [remodeling
ship and have no employees These sub-contractors have g. Demolition
workingfor me in an capacity. employees and have workers'
Y P h'• 9. ❑Building addition
[No workers'comp.insurance comp.insurance,$
required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their l l.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration elate).
Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cert' nder t pains and penalties of perjury that the information provided above is true and correct.
Si ature: Date:
Phone#:
Official use only. Do not write in this area, to be completed by city or town officiaL .
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and. Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation fortheir employees.
Pursuant to this statute,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
receivezoLtrustee 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, §25C(6)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,MGL chapter 152, §25C(7)states"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 t
requirements of this chapter have been presented'to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary,supply sub-conti•actor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required.„Be advised that this affidavit 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 pernut.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. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
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. In addition, an applicant
that,must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"I:he applicant should write"all locations in (city or
A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like 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 Commonwealth of Massachusetts
Depa tin mt of Industrial.Accidents
Office of Investigat m
600 Washington Street
Boston,MA 02111
Tel. #617-727-4900 ext 406 or 1-877-NiASSAFE
Fax##617-727-7749
Revised 11-22-06
www.mass.gavldia
THE T f s
HyannisMain Street Waterfront rd :., -F.LF
Historic District Commission .
�BARNSTABLE.g` Growth Management ,0' AP
�ATED MA��10 200 Main Street ��
MASS.
Hyannis,Massachusetts 02601
Phone:508-862-4665 / Fax:508-862-4784 Ap
Application toJ9 pq0%
Growth ManagementVED
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: ❑ New sign ❑ Existing sign ❑ Repainting existing sign
4. Structure: ❑ Fence El Wall El Flagpole El Other P D
5. Parking Lot: ❑ New Building' El Addition d Alteration'PA-a4 To 'f 'n P lit
MAR 1 A
(Please see the guidelines for explanation and requirements) p
TOWN OF BAPINb?'ABLE
HISTORIC PRESERVATION
TYPE OR PRINT LEGIBLY DATE `j-ZU-OBI
ASSESSOR'S MAP NO. ASSESSOR'S PARCEL NO. UZU
APPLICANT Jfg �/f I'I �I�I / TEL.NO.
APPLICANT MAILING ADDRESS
ADDRESS OF PROPOSED WORK {� Y12L 1 Tjwrr, 44y4w QZ66 1
PROPERTY OWNER (J�✓nl � �/57 �,G TEL.NO.
OWNER MAILING ADDRESS
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). =k O 3
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t / ' r-
13 7 (� ►'V day)
AGENT OR CONTRACTOR �Z�ZfI�L`I�} -Dj j,(�TEL.NO:
ADDRESS sb7 I� � `� t'f �t�✓Nl S KEG/ OZbD
1/14/00 'Draft Copy-Commission Use Only Pagel F
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).
W AZ fl N !S�), I�I�Tu 12 4A cf, /a7 W H' P(nl .
To u u►N 6- or- sm-t-r 'lam Awo New 'PLAv-ri N&E
Signed Owner-Contractor-Agent
SPACE BELOW LINE FOR COMMISSION USE
LJ
WN OF ,Received by HMSWHDC TORIC PRESEitvw i iulV
Date
Time Lhis Certificate is hereb
By Date
IMPORTANT:If this Certificate is approved,approval is subject to the 20- apkpprovi
the Ordinance.
CONDITIONS OF APPROVAL:
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C3 D
4Ao ' er
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1/14/00 Draft Copy-Commission Use Only Page 2
f
HYANNIS MAIN STREET WATERFRONT.HISTORIC DISTRICT COMMISSION
***SPECIFICATION SHEET***
ADDRESS OF PROPOSED WORKS
FOUNDATION
SIDING TYPE COLOR
CHIMNEY TYPE COLOR
ROOF MATERIAL COLOR
PITCH r
WINDOW COLOR
N f i
9
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fi
TRIM COLOR WN OF bAr"+ -
HISTORIC PRESERVATION
DOORS COLOR
SHUTTERS
GUTTERS
DECK i)l P - M A'"6 pKi /a'i-- Flie- wDem cam) W 141
GARAGE DOORS COLOR
NOTES: Fill out completely,including measurements and materials/colors to be used.
Three copies of this form are required for submittal of an application,along with three copies
each of the plot plan,landscape plan and elevation plans,when applicable.The Plot plan need
not be"Certified",but should show all structures on the lot to scale.
L J
7
1/14/00 Draft Copy-Commission Use Only Page 4
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License: CONSTRUCTION SUP-ERVISOR
Number CS 058633 i
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r tl x Expires 641,1612008
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MCCARTHY
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DEpAK -9..2007 11 :30AM NO. 993 P, l)'age 1 of2
Post-its Fax Note 7671 Dated'q/03- 1poagasii /
From I /, „
CoJD6Dt.. na Co- -7-0
Phone x 631
Phone x50e_%�—.
Asbestos Project Lookup F..*j/10" 7-76 '� Fax# g' ?10
�' -' Ashes o is a naturally occurring fibrous
Search Instructions mineral that is Used in many
Criteria: manufactured building materials.
Regulated Asbestos fibers can pose serious health
g (k Department of Environmental Protection (MassDEP) risks when they become airborne and
Agency: (-' Division of Occupational Safe DOS people inhale them. Construction,
Agency Roles p ( )
renovation and demolition projects that
Region: Southeast_ •• � will disturb asbestos need to comply with
Find Your Region state and federal environmental and
City/Town: BARNSTABLE safety regulations.
Project This site provides information about
Address: asbestos projects in Massachusetts.The
Notifier's projects listed are those that the
Name: Who is a Notifipr? Department of Environmental Protection
(MassDEP) has been notified of and that
Notifier's Role:I CONTRACTOR (CON) are performed by Division of Occupational
Safety(DOS) licensed contractors.
Date Range: 3/30/2007 to Search results are current as of the
dd/mm/yyyy - previous business day.
5/10/2007
Requirements for Wprking Wlth•AsbestQs
Results per 100
Page: eDEP:_File asbestos no ifigations online
'k
'CSerhY Go to Search Results
The search returned 11 result(s). Displaying 100 records per
page.
\!Qfifwr.R-00p fli ition-3 Pt•oaectDq:s iptipb•DefnitiQ
Project Project Notification# City/Town Region Notifier's Notifier's Start End ' Project Qty.
Vame Address Name Role Date Date Description Material
Removed
(Sq. Ft.)
508 99 CAMP BARNSTABLE SE ASBESTOS MAN 4/20/2007 4/20/2007 SHINGLES
NOSTERTZ OPECHEE 760446 REMOVAL CON
RD
:APE COD 27 PARK BARNSTABLE SE LVI 4/27/2007 5/412007 Tms 400.00
10SPITAL STREET 100053949 ENVIRONMENTAL CON
SERVICES INC
4ARRY'S 350 BARNSTABLE SE NORTHEAST 5/2/2007 5/4/2007 Trns,VAT 10.00
iESTAURANT STEVENS 100054046 REMEDIATION CON
BLDG_#1 STREET
64ACYS RT 132,769 - BARNSTABLE SE DEC-TAM 411KO07 5/2/2007 VINYL FLOOR
)EPARTMENT IYANNOUGH 304565 CORPORATION CON TILE,MASTIC
STORE ROAD
AACYS DEPT RT132:769 BARNSTABLE SE DEC-TAM 5/29/2007 1/711960 vinyl fir,mastic
STORE Lyannough 304727 CORPORATION CON
rd
)STERVILLE 99 WEST BARNSTABLE SE ABLE 4/27/2007 4/27/2007 Sir 6.00
LEMENTARY BAY ROAD 100054595 ENVIRONMENTAL CON
SCHOOL AND DEMOLITION
tESIDENCE 50 PEARL BARNSTABLE SE BANNER 5/4/2007 5/8/2007 BIr,Spr,Tms 100.00
ST 100054370 ENVIRONMENTAL CON
SERVICES INC
ZESIDENCE 46 PEARL BARNSTABLE SE BANNER 5/4/2007 5/B/2007 Tms 55.00
ST 100054366 ENVIRONMENTAL CON
ttp://Public.dep.state.ma.us/Asbestos/Asbestos.aspx 4/30/2007
..; Town*of Barnstable
p Regulatory Services
9 '��$ Thomas F':Geiler,Director .
�'p,ED►, ''° Building Division
Tom Perry, Building Commissioner
20Q Main Street, Hyannis,MA 02601
Tice:. 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using.A Builder
as Owner of the subj ect property
hezebp authorize__ I,CkAe-J /—/C .,41,, to act on mp behalf,
in all mattets relative to work authorized by this building pemnit application fox:
(Address of Job)
Signature of Owner Date
Print Name
Q:FORMS,OF�SSIOI4
08/20/2007 15:22 5087786448 HYANNIS FIRE PAGE 01
I ''Y',AIVNYS. FIRE DEPARTMENT
rs, , "95.•HIGH:SCHOOL Flb. EXT. HVANNIS, MA.02601
�i��'Q' �, HARRdLLb S. BRUNE/L�Lgi, CHfEF
• a.°u�,a PIti3 r L31� BUREAU
vu �r�A�Y�n orfiMi[6�ano�
` IUSINESS PHONE:(50&)775.1300 FACSIMILE PHONE:(508)778.6448
LT. IDONgLD H. CIXASI3�JIt., FI•C LT.HRIC F.HUBUM, CkT
it FIRE PREVENTION;OFFICER FIRE PRT'V)<1T® nor4 OFFICM
C.OQE COM, LIANCE FORM
`(HISIR PREVENTION BIJREaAU.HAS�REVI E�UTHE PLANS fTED
r-OR THE PR0P RT'Y`J:Q�ATO AT � .
ALSO KN: W4'Aar:
THE CHART 9ELOW INDICATES. THE STATUS OF OUR REVIEW:
'Yp'• > ;s > bf?G N T(4 ;-' '!'WA RECEIVED REVIEWED COMPLIES
AID
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11-SMQK CONTRf?6%EXHAUST'
1?-SMOF�E GONT?~tOL EQU� ,;'Lt?C�tTJQN
10=LIFE SAFETY Y$ IVf1'l1Fiw
F'IFE'fcXTINCUISN SY��'t=MS
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t,. Wf OIi" � E„ HE 00 UMENTS TO LE AND.CO LIANT FOR THE ISSUANCE OE A BUILDING
.PERMIT., ' $
A��.,• . ?� .{ ..,_t fS •tip', a r,n
WE HAVE COWLETtO.YHE AQdt p NCE'=NESTING FOF1 THE OGZUPANCY PERMIT AND BELIEVE THAT
WITHIN THE SCOPE OF THE BUILDING PERMIT,THE;ABOVE ISSIJE8 AF1E IN COMPLIANCE-
, . ' tt��,��,� q�,.a ,• �,r,,., I
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map - Cc> Parcel 10-2-0 Application # o?64,/.S-J 3 ?ad
Health Division Date Issued
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board (, ,
Historic - OKH _ Preservation/ Hyannis
Project Street Address r�
Village hvik4
Owner 7 ratj&n! of &tn to , Address pcn '
Telephone --no 67Z0 /
Permit Request ),�.��nc�, QepLce. �� `1: R1 v dCkSNi
�c �
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation CPO 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: 0qe isting ❑.;new I size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: - Y3'
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use PgdAA Lr S k e� Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name z Telephone Number 7
Address— _ — -- - —License-#
Home Improvement Contractor#
Email Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE h
FOR OFFICIAL USE ONLY
APPLICATION#
Ir •
'f DATE ISSUED
}
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER :
. DATE OF INSPECTION:
FOUNDATION
FRAME '
s I INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL -
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
S
DATE CLOSED OUT
F` -
ASSOCIATION PLAN NO.
{
THE rof, Town of Barnstable .
Regulatory Services
i • sABxSrABIX,
MASS. Thomas F.Geiler,Director
.
i639� ��
�E1639 Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
Property Ovirner Must
Complete and Sign This Section
If Using A Builder
I, , as Owner of the subject property
hereby autho e uv-� �bc �c to act on my behalf,
in all matters relative to work authorized by this building permit. .,
(Address of Job
**Pool fences and alarms are the responsibility of the applicant. Pools' .
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
Z, 0
Sign e of ner Signature of Appecant
��/7/�.15� T SlJ///��/ � Gt✓I,YL G-��CA�j l 5
Print Name Print Name
D e
Q:FORMS:OWNERPERMISSIONPOOLS 62012 -
The Cornr<trorimmkh of Massachusetts
Deparhumt of liulustrid Accidents
- - Q01ice of lnvestigr ons
600 Waykinggton&reet
Boston,MA 02L11
norms rn=goi-Mia
Workers' Compensat anInsurauceAffidavit:$uildersfContractorsMectricians/Plumbers
Applicant Information Please Print:Legibly
Name(Nosiness/Orpnizationtf uiividm0__
Address:
City/Stat&Zip: Phone
Are you an employer?Check the appropriate box: T . of: ect(required):
4. I arrx a contractor and I � �'°.� '
1."❑ I am a employes with ❑ 6_ ❑New const ructioa
employees Mull and/or part-time)-* havehiredthe sub-contra .
2_❑ I am a sore proprietor or partner-
listed on the attached sheet. 7_ ❑Remodeling
ship and have no employees These -contractors have S. ❑Demolition.
working for me in any capacity employees and have workers' 9_ ❑Building addition
[No:workers'comp.incnranre comp_insurance-1
required] 5-❑ Vile are a corporation and its 10_[]Electrical repairs or additions
1❑ I am a homemxmer doing all work officers have exercised their 11_.❑Plumbing repairs or additions
.
myself. [No�,vorkecs'comp- right of Ftion per MGL 11.0 Roof repairs
innuancerequired.]T C_152,§1(4),and weheno
employees_[No workers' 13_0 other
comp_rnsurance required,j
*Ary appticmt that checks boa 91 mnA also till out the:section below shuvriug they workers''compensation policy infrrmatio-
T Snmeawness crbo submit this afhdsviY inHacstirrg they are doing an wwk s'ud then him onside contractors mnSI suixmit a neA:of davit IDdlra in3 such-
tractors thst check this box must attached as additional sheet showing the name of&e sub-ooufaatbors and state vrhetb e r ornat those mdiies have
employees_ Ifthe mik-contractors have employees,the}must pmuide their work-ess'comp.policy ntmmbes_
I art an employer that is prmidhW workers'compensation irmirance for my empiny€gs Below is thepoUry and job site
irr,jormadi m
Insurance Company-Name:
Policy 4 or Self-ins-T i - ExptratlonDate:
Job Site Address: City/State/Zip: '
Attach a copy of the workers'compensation policy declaration page(showing the police number and expiation date).
Failure to secure caverage as requiredundu Section 25A of MGL c, 152 can lead to the imposition ofcriminal penalties of a
fine up to S1,500.00 and/or one-yearinTrisonment,as well as ciTil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.DO a.day against the violator_ Be advised that a copy of this statement may be forwarded to the Office of
Im esttgations of the DIA for mmirance coverage-vrer fication-
I do hereby c,erht wider tha pal nS aifd enaWas'of that the inejormahka prewided abinre I's and correct
Sit3iattxe: � Bate:
Phone 9:
Q,U} al use only. Da not write in this area,to be completed by city or town ofii'ciaL
City or Town: Permit/License ig
Issuing Authority(tarde,one):
1.Board of Health .2.Building Department 3.Cit fFown Cleric 4.Electrical inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
6
--
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant-to this statute,an mployee 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, §25C(6)also states that"every state or local licensing agency shaII withhold the issuance or
renewal of a license or permit to operate a business or to constr'act buildings in the commonwealth for riy
applicant who has not produced acceptable evidence of compliance with the insurance.coverage required."
Additionally,MGL chapter 152, §25C(7)stateZ,'- Neither the commonwealth nor any of its political affid'ivisions 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 out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s), address(es)and phone nuanber(s)along with their certi-ficate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required- Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurnce coverage. Also be sure to sign and date the 2,$d2vit- '171e affidavit should
be rewmed 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. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
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. In addition, an applicant
that must submit multiple permitllicense applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like 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 Commonwealth of Massachusetts -
Depaztment of Industrial Accidents
office Of lnvestigationa
600 Washingtoa Street r
Boston,MA 02111
Tel.A 617-727-49CO eW 4-06 or 1-9 MASSA -E
Revised 4-24-07
Fax#617-727-7 749
-
www.ma ss-govOa
ti
oFs"E r, ,, Town of Barnstable
ti
Administrative Services
snxxsrns1.E• ; Procurement&Risk Management BLIIUVSTABLE /
y MAss g 230 South Street,Hyannis,MA 02601
Q MMSUBLE•CENTEAV UE•CO UR•HPANYIS
po i639• A1� www.town.barnstable.ma.us �MMws-OSTIR E•v rear <e�
rFD MP't ie��-zaEa
David W.Anthony Tel 508-8624652
Chief Procurement Officer Fax_508-862-4717
David.anthony@town.barnsta6le.ma.us
April 23, 2015
Town of Barnstable
Building Department
200 Main Street
Hyannis Ma, 02601
Ref: Town of Barnstable Workman's Compensation Coverage
The Town of Barnstable commencing on July 2011, chose to enter into a certified Self Insured
Workman's Compensation program. 'Instead of purchasing a policy with an insurance company as
is the traditional method,the Town self funds a trust fund and pays for the lost wages, salaries and
settlements out of this trust fund. For the 2014-2015 fiscal year,the Town remains self-insured.
To manage the claims review and provide technical control of the program we contract with a
certified third party administrator-TD North Insurance/USL
` The coverage of our employees.for injuries suffered while at work is through this program and if
you have any further questions,please contact me directly.
Sincerely;
David W. Anthony i
Chief Procurement Officer
Town of Barnstable
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n___._.__.n__ c_____.n___ �
1.,11111111111.11111 J1111C1 V1\11t •®.
License: CS-052139
f FRANK A ZJBUTI,�'
130 RASPBERRu ly7IA�,• '� 1� IF
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MARSTONS MH S
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-01 _��'in Expiration
06/1812017
Commissioner
r
e,¢RULMABUL
w
Town of Barnstable BARNSTABLE TOWN CLER-
Growth Management Department
Hyannis Main Street Waterfront Historic District Commis�RJL,APR 9 PM1,0
www.town.barnstable.ma.us1h yannismainstreet
j Decision—Certificate of Appropriateness
'Town of:Barnstable, DPW/Structures and Grounds
50 Pearl Street, Hyannis
The Hyannis Main Street Waterfront Historic District Commission,pursuant to the Code of the Town of
Barnstable Chapter 112,Historic Properties,Article III,Hyannis Main Street Waterfront'Historic District,
hereby approves a.Certificate of Appropriateness for the following property:
Property Address: 50 Pearl Street(Pottery Barn in the rear)
Assessor's Map/Parcel: . 326/020
The public hearing on this application was opened on April,I, 2015: After consideration of the testimony given
and materials submitted by the applicant and members of the public,the Commission found.the renovations to ,
the building will appropriately,contribute to the historic character of the Hyannis Main Street Waterfront-
Historic District. The Commission considered the materials, design, color, size, and context.of the proposed
renovations and found it to be appropriate for the protection and preservation of the district. Based on these
findings,the Commission voted to grant the certificate of appropriateness subject to the following conditions:
1. Replacement of all windows to 6/6 double hung, double glazed windows by Shoreline
2. Replace existing white cedar shingles with new white cedar shingles
3. Paint existing trim white to match
' 4. New inner glass doors(to match Guyer Barn doors)
5. Replace onion lamps to match existing
6. Permits from the Building Division are required prior to commencing work., ,.
Present and voting in the affirmative to grant the certificate of appropriateness-were: George Jessop; Paul '
Arnold,David Colombo-and.Taryn Thoman
Opposed:None
`
C�t>
George Jesso Chair Date
p,
Hyannis Main Street Waterfront i c Dist Commission
cc: Keith MacKenzie Betty/Town of Barnstable,Applicant
Tom Perry,Building Commissioner
File
1,Ann Quirk,Clerk of the Town of Barnstable,.Barnstable County,Massachusetts,hereby certify that twenty
(20)days have elapsed since the Hyannis Main Street Waterfront Historic District Commission filed this
decision and that no appeal of the decision has been filed in the office of the Town Clerk.
Signed and sealed this day of.A gl .42)/zJ' under the'pains and penalties of perjury.
Ann Quirk,Town Clerk
OA
• N yi6Vy�
' i 9•PNElweLL,
Town of. Barnsta I%AR 16 PM 11= 25
Hyannis Main Street Waterfront Historic District Commission
AppIication GROWTH NAh GUAE T
Certificate of Appropriateness
Application is hereby made 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:
Assessor's Map No. '3 2 f Parcel No. 6 �,a
Address of Proposed Work -Ne`lZ:t`l V-6-k?— 67F 15T YM4nf t S • /
Applicant Name �61iJ�1 0T_ /kPMrl � -l jfZR. 5 V PF'O ' F J
Applicant Mailing Address 806 T WWY Town/State/Zip N yWr4l S MA 02.6c ] /
Applicant Phone Number 500 7�® 6 ')1 j-
Applicant E-Mail K fi[�f"�• NV<LK1E�P(7_1f C_1J lM To" AAA VS
Property Owner Name�I 61r" 0r— 5A-9-N iL�U6
Owner Mailing Address ?�(� AllIf Town/State/Zip
Owner Phone
Agent or Contractor Name
Agent or Contractor Address Town/State/Zip
Agent or Contractor Phone
Agent or Contractor E-Mail
PROPOSED WORK
Please check all categories that apply:
Building Type: Ev"Commercial ❑ Residential ❑Accessory
❑ Other
Work Proposed:
1. Building Construction: ❑ New Building ❑Addition ❑ Alteration
2. Exterior Alteration: Windows Doors [� Siding ❑ Roof
❑ Other
3. Exterior Painting: Ef
4. Signs: ❑ New sign ❑ Alteration to existing sign
5. Accessory Improvement: Fence ❑ Parking Lot El OutdoorDining
. APB. App QVQDpy
6. Other: AFN
TOWN OF BARNSTABLE
HYANNIS MAIN ST'WAT=r�F
HISTORIC DISTRICT COMMISSI N1 of 3
Hyannis Main Street Waterfront Historic District Commission
BUILDING MATERIAL
SPECIFICATION SHEET
Please complete this sheet only if new building construction or alterations
to an existing building are proposed.
Fill out all sections that are applicable to your project.
Include materials, specifications, dimensions and/or colors to be used,
FOUNDATION
SIDING TYPE l✓ �n �I I L� COLOR L L CAP,
CHIMNEY TYPE COLOR
ROOF MATERIAL COLOR
ROOF PITCH
DOORS INN0161 WN- " 0 VTM Rov%&I N COLOR 6-L�I�FZ
WINDOWS -�f'l�F� �l� 0/� �OV �'""� • COLOR � I T E
SHUTTERS COLOR
TRIM ���1 �5T I COLOR VA-1 IT E
GUTTERS
PATIO/PORCH/DECK
GARAGE DOORS COLOR
OTHER
APPROVED
s
Page 2 of 3
TOWN HYANNIS MAIN ST N TTAl3C E
HISTORIC DISTRICT CONgj;1 i S1ON
Hyannis Main Street Waterfront Historic District Commission
DETAILED DESCRIPTION OF PROPOSED WORK
Provide detailed specifications of the proposal.
Include a detailed description of changes to existing conditions, if applicable.
• Describe proposed materials to be used, desired colors, manufacturer's specifications, etc.
• In the case of signs, give locations of existing signs and proposed locations of new signs.
Attach an additional sheet, if necessary.
E x i*T I l m FcEET6`f 'F,)P<Rq To O PG( R-0-26 TO AtV1W
�� -v0V?>L)C- 6-1 LAZE VO NMV5 T6 9ATC-K c)C115 T1 N-4
��,LP 1���►s�C I T S G � � �I�I r►mac 1 TK
A i 91 DTI rCCc TFU 1M, IN W ! TL To 1AAk TC d W15V N;
a NCW fNNM Gti
m NEW 0910N LAME2 T AAA-1� e2' T([\�fC;
Signed 'f 6w��4ruaa�tCz� r'W
�j Applicant-Agent
Date VJ714-
APPROVED
TOWN OF BARNSTABLE
HYANNIS MAIN ST WATERFRONT
HISTORIC DISTRICT COMMIPA fe!3 of 3
Sign
TOWN OF BARNSTABLE Permit
* BARNSTABLE,
9 MASS.
1639.
1 3 a Permit Number:
Application Ref: 201304446
20070880
Issue Date: 07/05/13
Applicant:
Proposed Use: MUNICIPAL IMPROVED
Permit Type: SIGN PERMIT
Permit Fee $ 50.00
Location 50 PEARL STREET
Map Parcel 326020
Town HYANNIS
Zoning District SF
Contractor PROPERTY OWNER
Remarks
NEW FREESTAND SIND 4 SQ GALLERY ARTRIO
Owner: BARNSTABLE, TOWN OF (MUN)
Address: 367 MAIN ST
HYANNIS, MA 02601
9
Issued By: PC
r_.
POST THIS CARD;SQ THAT IS VISYBLE FROM THE STREET
via c�aa v 1 �o =rvw-i m e
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Town of Barnstable
Regulatory Services
.nRrrsrnaM =
� Thomas F.Geiler,Director 0
1639. � Building Division
Tom Perry, Building Commissioner �o
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Permit#
Building Official approving
Application for Sign Permit
Applicant:— G tdSQYI (S.V_ej4_ _—_Assessors No.__3 Alp— 0 A
Doing Business As: r1 rl o __—Telephone No. O a- a 7
Sign Location S u s Q n <
Street/Road:— SO—��q�� 5 _— qq f 15---- Con ta.ef w '0
j'to yvt i4 '5
Zoning District: Old Kings Highway? Yes/No Hyannis Historic Districts' Ye/No
Property Owner
Name:_'f own—Of2QY�+q � —Telephone:
Address:Tow Ali ��o_'J_ !f Vill a r1 n c�J--
-- age:
Sign Contractor
,Name: Rau d el1 S QiMpay_y _—_Telephone: a S 7d
Mailing Address_�O __$�o }-- S U r'r�/ ►1 _—C��(�
Description
Please follow the cover directions.You must have an accurate rendition of-sign with ' ions ands
location. w
Is the sign to be electrified? Yesl�0)(Note:Ifyes,a wiringpermitis required)
Width of building face &x 10 e 3 G o x.10-
Check one Reface existing sign or New Total Sq.Ft.of proposed sign(s) 1 —
r--
Ifyou have additional signs please attach a sheet,&sting each one with dimensions
If refacing an existing sign please provide a picture of the existing sign with dimensions.
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 Q//
.r
SIGNS/SIGNREQU revised 12110
p6
< 45
Galler rtf1*0 ic
7l
57
wood
OFF tvh��e
�row�
-Tone
Wool ( �SSn
'r Ca,ry e-d Lei+ers
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r�o�,dbfe S► 0���
W -y. DA IRA -E siren
DATE: - hsybte- aeesr� ��d.ee�n
,
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.Town .df Barnstable.'
Hyannis;Main Street;Waterfrolnt:Hlstdnc Districti Commission;
Application
.Certificate 'of Appropriateness for.,Wgnage, Y
Application is.hereby made for the`issuance bf a Certificate of Appropriateness under MGL,Chapter 40C;The Historic Olstncts Ac for
proposed signage as described belowandon drawings orphotdgraphs accompanying this applicaon:
CHECK ALL THAT APPLY'
1.. Business`Sign �.
2 Open/Closed Sign: .,
& -Trade Flag �r
a. Trade Figure or:Symbol::
:5: Lbcation:Hardship Sign
Assessor's Map Na. 02 = Parcel
L
Address of Rroposed,Wbrk 50.' r
Applicant Tel# l?
Applicant Mailing Address I�'ad~� sf` . Town/Stafe/Zap . O O
Applicant E-Mail Address.�., /IS
Property Owner OW,/'t C�ctrn S T' �`jC' Tel#
Owner!Mauing'Address`` k TownlState/ 'ip:
Agentor Contractor . Tel#:
Mailing Address, TownlStatePIR..
Agent E=Mg Address' _
Signature of Appheant'' r�
., _
0 For Location Hardshla'Signs`&freestandirr Ib is to be locatetl on private property:
Check.box V property owner has granted perm§slon to'Iocate Sign or Figure on their property abutting the.tiu'Iding front:
JUN 2 1 2013 Exhih'tt# ` `3
Date.
TOWN'OF BARNSTABLE uuD^
HYANNIS MAIN ST WATERFRONT• HH C
trT^ l+ rile?AICT COMMISSION ,:
Business Sign'I: Sh of Sign s. x
Material(s)of Sign, G
Material of Lettering(if different) rP cV
Will the sign.be Illuminated?
:If yes,what type of light fixture Location of.Fixture
Business Slgn'2: Size of Sign x;
Material(s)of Sign
Material of Lettering(If different) '
Will.the sign be illuminated? Yes t No
If yes,what type of light fixture Location of fixture
OpenlClosed- Size of Open/Closed Sign x
Sign:
Material of.OpenlClosed'Sign
If Neon,indicate:color.(circle one option): Rea/Red&Blue
Color of Open/Closed Sign:
Trade Flag Size of Trade Flag: _ x
. i
Materiai'of Trade Flag:
Trade Figure Dimension of Trade.Figure or Symbol: x x
Or Symbol:
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Town of Barnstable
Growth Management Department
Hyannis Main Street Waterfront Historic District Commission
www.town.barnstable.nta.u4iliann isniainstreet
George A.Jessop,Jr.AIA,Chair Jo Anne Miller Buntich,Director
Acknowledgment of Twenty Day Appeal Period
Required by Section 112-33 of the
Hyannis Main Street Waterfront Historic District Ordinance
1, JCISahr`'�I ("Applicant"), acknowledge that the Certificate granted by
the Hyannis Main Street Waterfront Historic District Commission is subject to a twenty (20)
day appeal period, pursuant to Section 112-33 of the Code of the Town of Barnstable. Within
20 calendar days after the date of issuance of a Certificate, any person(s) aggrieved by the
determination of the Commission.may appeal the decision to the Historic District Appeals
Committee. The Appeals Committee, after an evaluation of all pertinent evidence, may
uphold, overturn, or remand a determination of the Hyannis Main Street Waterfront
Historic District Commission. Decisions of the Historic District Appeals Committee may be
further appealed to Superior Court.
Any subsequent permitting or licensure conducted in reliance of the Certificate granted by
the Commission is contingent on the validity of said Certificate at the conclusion of any
appeal. The Applicant shall be required to fully comply with any decision of the Historic
District Appeals Committee or,upon remand, revised decision of the Hyannis Main Street
Waterfront Historic District Commission.
C� —
r ( -� � i3 f
Signature: Applicant Date
Susan F ( re
Print Name
U TbOL V a �
Address of Proposed Work
200 Main Street,Hyannis,MA 02601 (o)508-8624665(.0 508-8624784
Town of.Barnstable
Growth Management Department ., 2'� J1iNI 26.
Hyannis Main Street Waterfront Historic District Commisslor�
www,town.bamstable.ma,us/h yannismainstreet
Decision —Certificate of Appropriateness
Susan Carey d/b/a Gallery Artrio
Business Sign and Trade Flag
The Hyannis Main Street Waterfront Historic District Commission,pursuant to the Code of the Town of Barnstable
Chapter 1.12,Historic Properties,Article III,Hyannis Main Street Waterfront Historic District,hereby approves a
Certificate of Appropriateness for the following property:
Property Address: 644 Main Street,Hyannis
Assessor's Map/Parcel: 326/020
At the June 19, 2013 hearing, after consideration of the testimony given and materials submitted by the applicant and
members of the public, the Commission found the proposed designs one Business Sign and one Trade Flag will
appropriately contribute to the historic character of the Hyannis Main Street Waterfront Historic District. The Commission
considered the materials, design, color, size, location, and context of the proposed signage and found it to be appropriate
for the protection and preservation of the district. Based on these findings,the Commission voted to grant the certificate of
appropriateness subject to the following conditions:
1. Design of the business sign is approved as shown in the application received and dated May 31,2013
i. Sign shall be wood with carved lettering
I Sign color to be cream/off-white background and two-tone brown lettering
iii. Sign size shall not exceed 45"high x 19"wide
2. One 31x5' nylon trade flag is approved
3. Door shall be painted yellow with street numbers in black and placed above the door
4. The sign shall not be illuminated.
5. Sign permits from the Building Division are required prior to installation of the signs.
Present and voting in the affirmative to grant the certificate of appropriateness were: George Jessop,Paul Arnold, Marina
Atsalis,Joseph Cotelle a d Brenda Mazzeo
Opposed:None
George A.Jessop,jr,Chair Date,
Hyannis Main Street Waterfront storic District Commi ion
cc: Susan Carey,Applicant
Tom Perry,Building Commissioner
File
I,Ann Quirk,Clerk of the Town of Barnstable,Barnstable County,Massachusetts,hereby certify that twenty(20)days
have elapsed since the Hyannis Main Street Waterfront�Historic District Commission filed this decision and that no appeal
of the decision has been filed in the office_of the Town Clerk.
Signed and sealed this day of under the pains and penalties of perjury.
Ann Quirk,Town Clerk
YOU WISH TO OPEN A BUSINESS?
For.Your• Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. .
Take the completed form to the Town Clerk's Officer, 1 st. FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE:_ Fill in please:
APPLICANT'S YOUR NAME S: tA S!k/1 CA►�N�[.{
BUSINESS YOUR HOME ADDRESS:
14 V HY a7irli iSe o oa 6
TELEPHONE # Home Telephone Number ro
f ... i4
t ...
NAME OF CORPORATION...
NAME OF NEW BUSINESS TYPE OF BUSINESS
IS THIS A HOME OCCUPATIONS YES NO
ADDRESS OF:BUSINESS D 1-- OBI Yl MAP/PARCEL NUMBER [Assessing):: ,
3
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING CO ISSIO R'S OFFI
This individu I ha inf d o ny rmi it s that pertain to this type of business.
uth rized Signature*-'Y
COMMENTS:
2. BOARD OF HEALTH
This individual ha be formed of the permit requirements that pertain to this type of business.
l ryl V1
Authorized Signature**
COMMENTS:
3. CONSUMER AFFAIRS(LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE: ��\ 2 z Fill in please:
APPLICANT'S YOUR NAME/S: C.,O- vac 'e--
BUSINESS YOUR HOME ADDRESS: `c3 l2 Uj G VrT,,&� VVI
�r 7-7y -LI67 - u315
t TELEPHONE # Home Telephone Number 7
NAME OF::CORPORATION::
NAME OF NEW BLI$INESS SS 11 L >TYPE-OF:BUSINESS::..
IS:THIS A HOME:OCCUPATION? YES NO / y�
ADDRESS`OF BUSINESS ' � \ 4-ems— MAP/PARCEL NUMBER e1 l0+`OZIJ? (Assessing)
O
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO'200 Main St. - (corner of Yarmouth
Rd. & Main Street) to ma`k�e sure you have the appropriate permits and licenses required to legally.operate your business in this town.
1. BUILDING COMMISSIONER'S OFFIJvE,
This individual hAs,.beeh mformdd 4 any permit, equirements that pertain to this type of business.
Authorized Signaturw�-'
COMMENTS:
2. BOARD OF HEALTH
This individual hat b the permit requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
3. CONSUMER AFFAIRS(LICENSING AUTHORITY)
This individual has a- n inf ed f the licensing requirements that pertain to this type of business.
Aut r'zed S' Aature** S
COMMENTS:
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` , .; �► TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 12 a Parcel C] 2 Q ' j �ican#�•�
Health Division `• Date Issued
lZ
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board P
Historic - OKH _Preservation/ Hyannis
Project Street Address goo to
Village t"I vc
Owners �_ `T •� ��1O�P _ Address 1—fir Sae` "
Telephone
Permit Request ReR.a of pis,g%j; e i�d—F!
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay ;t
"Project At ion D Construction Type •�
Lot Size F7 . 24 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
CD
Dwelling Type: Single Family- ❑ Two Family ❑ Multi-Family (# units) 9
CD
Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kin9�s!Highway5❑Yes, ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other j
x �J
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) !T'3� F
Number of Baths: Full: existing new Half: existing new g
Number of Bedrooms: existing —new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: AGas ❑ 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 0 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 1 9Q 1K C>�> ��P Telephone Number t� A T 7'90 6 3 20
Address License
T'4V a ;h /%A S. Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE Q DATE 24-A* 2O 12-
v=
FOR OFFICIAL USE ONLY
¢APPLICATION#
DATE ISSUED
MAP.,/PARCEL NO.
< r
ADDRESS VILLAGE ,
OWNER
DATE OF INSPECTION:
FOUNDATIOK"7
r FRAME Y
INSULATION ~
FIREPLACE
ELECTRICAL: ROUGH FINAL r
PLUMBING: ROUGH FINAL
F t GAS.'l41i,.z.= ROUGH ir- FINAL
E -
, ;FINAL BUILDING",
a _
i DAT,E CLOSED OUT
ASSOCIATION PLAN NO. -
lit
C Z
The Commonwealth of Massachusetts
Department of Industrial Accidents
P? y ( _ OffCe of Investigations ,
600 Washington Street -
1 Boston, MA 02111.
y�
www.mass. ov/dia.
:s g
Workers Com ensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
P Please print Ee ibl'
Applicant Information - 1
Name (Business/Organization/Individual): mTn W KJ d>� ft-ew �•��«»
1 l � Phone 6 SZ
1l
City/State/Zip: M4' 0
'AXeou an employer? Check the appropriate box: "Type of project(required):
I am a employer with 1200 4• ❑ I am a general contractor and 1 '6, ❑New construction
employees(fill andlorport-time).
* :, have hired the sub=contractors
' Misted on the attached sheet. 7. ❑ Remodeling
2_n I am a sole proprietor-or partner-" These sub-contractors have . =
ship and have no employees SY ❑ Demolition
working for mein any capacity employees and have workers'
'. •9. ❑Building addition
o workers' comp. insurance T comp. insurance.
required.]
;5.:❑ We are a-corporation and its l0.❑ Electrical repairs or additions
.3.❑ I am a homeowner doing all work officers have exercised their* 11.❑'Pltirnbing repairs or additions
myself.'[No workers' comp.. A right'of exemption per MGL-- 12 Roof repairs
t c. 152, §1(4), and we Have no X{
insurance required.] �. 13:❑.Other
employees. [No workers'
.:comp.-insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such,
#contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or notahose.entities have
employees. tf the sub-contractors have employees,they must provide their workers';comp,policy number.
I am an.employer that is providing workers"compensation insurance for my employees:. .Below is the policy and job site'
information a. .
- .• Insurance Company Name: 1 oWNQ F >taA72NS;y48 � �
NIA Expiration Date: N
Policy#or Self ins £Lic.#:n / �1 �j
Job Site Address:^ F4WJ- 67 • City/State/Zip: /�A/� f yh �
Attach a copy of the workers'compensation policy declaration page(showing the,policy number and expiration date).
Failure to secure coverage as required under Section 25A of MOL-c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment as well as civil penalties in the form'of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby c tiner the pa s an p aC rjury th the information provided above is trite and correct.
Si ature: Date:
Phone#
O �cial use only. Do not write'in this area, to be completed by city or Town official
City or Town: Permit/License#
K Issuing'Authority (circle one): r
< T.Board of.Health 2. Building Department 3, City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other` y
-: Ph
Contact Person: $. . one#:..
, 4
,
information and Znstr uctiOns
Massachusetts General Laws chapter 152 requires all employers to provide 4vorkers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
entity,
An employer is defined as "an individual,partnership, association, corporation or other legal or any two r more
t h
the fore in en aged in a.joint enterprise, and including the legal representatives of a deceased employe`However
of gP $,� i
recewer'or trustee of"ffi�hwidual, pug ersNp�ii 7 nation or other legal entity, employing employees. Ho v
R oGvngr Of a cjwell.ing house having not more than three apartments and who resides therein, or the occupant of the
dweil'in�g ho>Sse of another wlidde; ployrss persOns to do r>aintenance'116 �, o�gstn*E,tian1or•repair work on such dwelling house
—pr @n the grqunds or building appurtenant thereto shall 1-Y"M because-of such emp�b ment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that every state or oea l'icensth tage'ncy 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 complia`51"c�;with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any'of its politit al,subdivisions shall
enter into any contract for the pei-fofthance of publicwork until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out.the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
neees'sary,supply sub-contractor(s)name(s), addresses)and phone numbers)along with their cerlificate(s) of
insurance, Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit 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'
please call the Department at the number listed below. Self-insured companies should enter their
compensation policy,
self-insurance license number on the appropriate line.
City r°�Ioivr9;Officials 3'` �•- der';" "t.. t;^ t.t • ►'
t'+ k a ws
t
s q 1t`
Pease be sure that the affidavit is complete and printed I'gigill The Department has provided a space at the bottom
goj�l$e, affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
" Pleasb be sure to fill in the permitllicense number wh3c);will be. sed_a�s��a,{e ere. number. In addition, an applicant
n t
that muss submit multiple permit/licerise applications in any given year, need only submit one affidavit indicating(city or
policy information(if necessary) and under"Job Site Address" the applicant should write"all locations in
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is.on file for future permits or licenses. Anew affidavit must mmercial venture
be
filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or com
(i,e, a dog license or permit to bum leaves etc.) said
d person is NOT required to complete this affidavit,
questions,
Tlae Office of°kVnvestigations would like to thank your in ad'va•nce for yq+ur cooperation and should you have any
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 Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 4-24-07 www.mass.Rov/dia
i
' �IHE � Town of Barnstable
Regulatory Services
BAMSTABM Thomas F.Geiler,Director
16
Building Division _
Tom Perry,Building Commissioner '
200 Main Street,Hyannis,MA 02601,
www.town.barnstable.ma.us
Offi6e"..508-862-4038' '` " Fax:`508-790-6230
Property Owner Must
Complete and Sigh This Section `
If Using A Builder
as'Owner of the subject property
_V1• d�
hereby authorize 6- U77C to act on my behalf,
in all6r4atters relative to work authorized by this building permit application for. ,
(Address of Job)
C�
Signature of Owner �. Date
• x
Print Name-
if,Property Prop e Owner.is applying for permit please complete the,,,.Homeowners License Exemption Form on the reverse`-side.„.
v
QTORMS:OWNERPERMISSION ':
4r
Town of Barnstable t
Regulatory Services
aAMWABLE, ; Thomas F.Geiler,Director
y MAS& $
1679• Building Division
rFD MA'I a
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip node
The current exemption for"homeowners"was extended tome edowner occupied dwelling t�€i
s ofsunits or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
.. , -
superyisor. ' *c, y Al,;� p+�;�`t��'v"+ '
DEFINITrON`OAF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not'be considered a homeowner. Such
"homeowner"shall submit to the,4,pilding Officialyon a fort acceptabje,to the Building Official,that he/she shall be
responsible for all such work'p&ff6r ned ht def�tli bu ldinia D rmit Seetio`ni 109 R l+)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
6 '
The undersigned"homeowner"certifies that he/she understands the Flown of,Barnstable Building Department
minimum inspection'ptocedtit;'ps anciequirements and that he/she will;compl}�'with said procedures and ,
requirements. � -•' i ..
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:\WPFILES\FORMS\homeexempt.DOC
SHE Town of Barnstable Barnstable
Administrative Services W, r.,�
Procurement&Risk Management edea4It►
BARNSTABLE, * 230 South Street,-Hyannis,MA 02601 1111I.F
9� 1M6 9 ` www.town.barnstable.ma.us
RFD MA't A
2007
David W.Anthony * ' Tel 508-8624652
Chief Procurement Officer Fax 508-862-4717
David.anthony@town.barnstable.ma.us 4
August 14, 2012
Town of Barnstable
Building Department
200 Main Street
Hyannis Ma, 02601
Ref: Town of Barnstable Workman's compensation Coverage
The Town of Barnstable commencing on July 2011, chose to enter into a certified Self Insured
Workmans Compensation program. Instead of purchasing a policy with an insurance company as is
the traditional method, the Town self funds a trust fund and pays for the lost wages, salaries and
settlements out of this trust fund.
To manage the claims review and provide technical control of the program we contract with a
certified third party administrator—TD North Insurance.
The coverage of our employees for injuries suffered while at work is through this program and if
you have any further questions, please contract me directly.
Sincerely,
David W. Anthony
Chief Procurement Officer
Town of Barnstable
Details Page 1 of 1
.Licensee Details
Demographic Information
Full Name: FRANK A ZIBUTIS
ender:
owner Name:
License Address Information
Address: 130 RASPBERRY LANE
Address 2:
City: MARSTONS MILLS.
State: MA
ipcode: 02648
Country: United States
License Information
License No: CS-052139 License Type: Construction Supervisor
Profession: Building Licenses Date of Last Renewal:
Issue Date: 6/18/2011 Expiration Date: C�:..._.6/18/2013
License Status: Active Today's Date: 8/17/2012.
Secondary License:
Doing Business As:
Status Change:
Prerequisite Information
No Prerequisite Information.
Discipline 4.
No Discipline Information
Documentum -
` im o S t t�
aria t
Boarild�n;Regulation gd
d of Bu t .
.._ tsor�Ici .se
Corrstxtu�trc Supe�v
License CS 52139
.�
R''tncted-to 00
�gFRANK A'!ZIBUTIS I} r
n J
�_30 RASPBERRY:I�.ATNE4.h - '
MARSTbNS MILLS MA'02648;`= "
.may � E tpicat►a+t 6/1812011�� b
1 r ` 19730, en
C omint vssioner
http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_i'd=1&license_id=240888& 8/17/2012
Town of Barnstable
Regulatory Services
Thomas F. Oeiler,Director D
BARNSTABLE,
MASS. Building DivisionQ.
►bgg. y®
'rFn M Thomas]Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 - Fax: 508-790-6230
Permit
Application for Sign Permit
Applicant: NC04—( Map&Parcel#
Doing Business As: V (IZ(ky &,o7 t I"L Yiyd Telephone No.
Sign Location
Street/Road: 1 'P L :r t- , vNi iVj
Zoning District:�ir-Old]Kings Highway? Yes(1Vo J Hyannis Historic District? (91NO
Property O
Name: 'Telephone: 66 Z-4�eO
Address: ,26-7 M h IJ Sr7f ti Village:
Sign Contractor `' �/ /!
Name: RV P4OU-( � J�(-N e6. Telephone:
Mailing Address: 63 o t'z M kN S7 S lAro o y-(& MA- OZ&6,�
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 No (Note:If yes, a wiring permit is required)
Width of building face, ft.x 10= x.10= Sq.Ft.of proposed sign 10S F
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:
M4-101
Pen-nit Fee:
Sign Permit was approved: Disapproved:
Signature of Building Official: Date:
In order to process application without delays all sections must be completed.
Rev. 9/12/06
PEARL STREET
LANDSCAPE PROJECT
PLANT LIST e,F. ....wM ..w,.,...m..e,...,,.....,n.,
Landscape Improvements Plan
M
Guyer b' """' LANDSCAPE PLANTING NOTES
Bam
sa .•.ra„n,. w' �, „4 .e.we.e•,..,w.e„we�'a'nww..,.e,e•.wrnw�w.aw,.rr..,b.r�
. w eia p�ni.awnei. ba.wmen be.a.e,ma.ae.dnm rube.mr
w� • • nmYn.na mna u�ip�e�memea^pee win.�,ee.ne r.,.werwn mr.msu.me.
Pmv1d4 bp-d a -
grasswhme -
•aeoaduoteahrvb -
A a—,.—al ltvPI -
yy 46 Pearl St
n •
• / _ 3 SV(Fig m betwaun
oxlsgng plants) '
P 15 LS + +
prase wharover -
n••tled eu•tv sMub
a Veo rompval(lypj sc
--
Garage 31
B NF
'140LFo .SHl.
Wnit•Plch•t Fonca(Optronal) a IF
3 LS
a so
26 HO 4 LS
3 SBG 2 5B
50 Pead St ++++
255C a 5
f 15SB 20 P,iva1
22 LS 17 SBG
20 LAN
25 HEH
12
3HE 25 RF
LS
1115
1 HE 16 HEH
-
11 RI
26 HEH
10 RF 121S -
2 Se
3SV
N.w wa•a.a ca�.•tlsg � kennen landscape archite ture,
'9
1
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S"Y Z
�L� J3j
N
qN
t M_p R
a m
SHOW TODAY
3^" X 48" SIGN
6" X 26'' PLAQUE
WE DMMED BY.'
(XISTOMER APPROVED BY:
FILENAME P.0 NUMBER:
mot , Sign
Permit
RMWSTABLE, * TOWN OF BARNSTABLE
MASS
i6
39-.�A Permit Number:
Application Ref: 200705043
20070086
Issue Date: 08/29/07
Applicant: WHITNEY, SAUNIE
Proposed Use: SINGLE FAMILY HOME
Permit Type: SIGN PERMIT
Permit Fee $ 25.00
Location 50 PEARL STREET
Map Parcel 326020 .
Town HYANNIS
Zoning District SF
Contractor PROPERTY OWNER
Remarks
SHIRLEY BLAIR FLYNN CNETER FOR THE ARTS
PO.O TO BE FAXED ON 8/14/07
Owner: WHITNEY, SAUNIE
Address: P O BOX 390
KAPAA, HI 96746-0390
Issued By: )E
POSiT THIS CARD;;SO THAT 1
vISIBLERQM TIDE STREET
r ,
��6U4ff 8oy,�Ai Regulatory servkes
Q, Thomas F. Geiler,D reetor
• YARN37An+a o
Buuilldiag Division
Thomas?Perry,CB®
Building Cm®nrnissaoner
200 Maul Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-79..0-6230
Permit.# aao
/? Application for Sign Permit
Applicant:�D (..T f W jrl� 14 N&Tj� -DOPr Map&]Parcel#_,� p
Doing Business As: d i'1 u ey 12jwH P rLVwN 'Telephone No. z- �lo
Sign Location
Street/Road: �')U �l%��2C. S7'f1 �r �' (�'IVI�(1 ( 1�I)r
Zoning District:�rOld Kings Highway? Yes 1`lo Hyannis Historic District? (91NO
Property OW
Name: () Telephone: U1D7i-`Ro�1
Address--A-1 M k lj 5�7 � 'Village: N I S
Sign Contractor
Name: �(,1/�1U1�`c��' J L.c)- Telephone:�,�f� - e,7-72 f
Mailing Address: 10?i' 6LbM N �7, S•Y�h2a1,4()lrrf�- l�A- �2(0�o�f'
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 No (Note:Ifyes,a wiringpermit is required)
Width of building face ft.x 10= x.10= Sq.Ft.of proposed sign os-
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: O
Permit Fee.-
Sip Permit was approved: Disapproved:
Signanre of Building Official: Date:
In order to process application without delays all sections must be completed.
Rev. 9/12/06
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BARNSTABLE
' '�!...r•.�.tom/
y�,oFV'E l Hyannis Main Street Waterfront TO 1 a:"'!
P
i a
Historic District Commission
""MSTAB
ASSB Growth Management '07 AUG -8 A10 :31
i ,19' `0� 200 Main Street AIfD MA'1 A ,
Hyannis,Massachusetts 02601
Phone:508-862-4665 / Fax:508-862-4784
Application to
Growth Management
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: M New sign ❑ Existing sign ❑ Repainting existing sign
4. Structure: 0 Fence ❑ Wall ❑ Flagpole ❑ Other
5. Parking Lot: ❑ New Building ❑ Addition ❑ Alteration
(Please see the guidelines for explanation and requirements)
TYPE OR PRINT LEGIBLY DATE 7 2-
ASSESSOR'S MAP NO. L ASSESSOR'S PARCEL NO. 0Z0, 01 q
APPLICANT7 ��737' TEL.NO. Q 2 3
APPLICANT MAILING ADDRESS 3&?— 1L g-I&I 6'rytwr,, 1Nftm S 0.4 02-0o'
ADDRESS OF PROPOSED WORtq(o"6 u ?ALL �17t�--7, !N bas w 02,0O i
PROPERTY OWNER BA fJs-(m c- TEL.NO. %) 4000
OWNER MAILING ADDRESS kA'lN Q
C
FULL NAMES AND MAILING ADDRESSES OF ABUTTING OWNERS.Include name of adjacent M
property owners across any public street or way. This information is best obtained at the Town Assessor's CD
Office. (Attach additional sheet if necessary). >
Cn
A/ J7a-r, it i s
��� M44d tfZ i'?sT- j0 R 17 MAN .ftZOET, YN I.l
CD
C7
M
L JUL 0 2 2007
AGENT OR CONTRACTOR���IN (17j� JI A�ytl TEL.NO.
ADDRESS 63 OW MA-16 Sixerr �gn(frj� ILIA_ ol&&`i'
1/14/00 Draft Copy-Commission Use Only Page 1
i
i
I
T'
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).
A*UD CPWL-D -WOUP IS," (_906vlliby v11Tor V h-rc_
VA L1_ _ZC— ( N J1WO ON 7�V' P20 P1S�Zy �LON G—
S�o(1�I� �71?.�,�T. ,�/ �n 17►U�r � ��5 n �I GL� 1��� �WIC 7��
Signed / Owner-Contractor-Agent
SPACE BELOW LINE FOR COMMISSION USE
Received by HMSWHDC
Date
Time This Certificate is
By Date
Signed
IMPORTANT:If this Certificate is approved,approval is subject to the 20-day appeal period provided in 0
the Ordinance. �U
CO 9I�ITIONS OF APPROVAL: '
Zvll ;,SJ4Cl l � S
0
M
�UL 0 2 2007
1/14/00 Draft Copy-Commission Use Only Page 2
HYANNIS MAIN STREET WATERFRONT HISTORIC DISTRICT COMMISSION
***SPECIFICATION SHEET***
ADDRESS OF PROPOSED WORK
FOUNDATION
SIDING TYPE COLOR
CHIMNEY TYPE COLOR
ROOF MATERIAL COLOR
PITCH
WINDOW COLOR
I
TRIM COLOR
DOORS COLOR
SHUTTERS
GUTTERS
DECK
�C7
GARAGE DOORS COLOR O
NOTES: Fill out completely,including measurements and materials/colors to be used. t"E']
Three copies of this form are required for submittal of an application,along with three copies CD
each of the plot plan,landscape plan and elevation plans,when applicable.The Plot plan need
not be"Certified",but should show all structures on the lot to scale. Cl)
O
=Fj
FFj
JUL 0 2 2007
1/14/00 Draft Copy-Commission Use Only Page 4
�L •
���ZaEro� Hyannis Main Street Waterfront
ti 0 Historic District Commission
BARN9TABLE. = Growth Management
y MASS.
i639• 200 Main Street
�ED �e Hyannis,Massachusetts 02601
Phone: 508-862-4665 / Fax: 508-862-4784
Hyannis Main Street Waterfront Historic District Commission
SPECIFICATION SHEET FOR SIGNAGE
'rior to filing your application for a Certificate of Appropriateness, please contact the Building Inspections
,ffice, at 862-4038 to discuss the amount of signage allowed for your building, as well as any other Town
;ign Code regulations which may affect the sign(s) you propose to install.
:ven if you are applying for the same amount of signage as previously existed on your building, the laws
iay.have changed since that sign was installed.
)nce you have applied to the Hyannis Main Street Waterfront Historic District Commission for a Certificate
f Appropriateness for signage, you may apply to the Building Department for a temporary sign permit. The
luilding Department can provide all information regarding the temporary sign permitting process.
'lease fill out all information requested below.
f you are applying for a Certificate of Appropriateness for more than one sign, please fill out ONE
PECIFICATION SHEET FOR EACH SIGN.
BE SURE THAT YOU HAVE INCLUDED WITH YOUR APPLICATION:
• a scale drawing of the proposed sign
• color chips for all colors on your sign
• a photo or scale drawing of the building on which the proposed sign location, as well as any
light fixtures proposed to light the sign,are indicated
• a scale cross-section of the sign,with dimensions,showing edge detail
.• specifications for any light fixtures proposed to light the sign -
• a scale drawing of the sign bracket, indicating dimensions,color,and material
70
ize of Sign _ lAm (OVA-L) X CD
M
[aterial(s) of Sign Ald, M
0
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laterial of Lettering (if different) },/�'INT[ (�iC�l/fVD Y�`� cn
he Sign Will Be (circle one): carved wood painted wood/vinyl lettering
O
other(explain) CD
ocation In Which the Sign Will Hang rT1
'ill there be exterior light fixtures to light the sign? (_�,fl upjb l;["--(V
so, what type of fixture? C�{�7la-nlDA-K,D JUL 0 2 2007
'here will the fixture(s) be located?— LWT) �,�j �
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SHOW TODAY ` `
30" X 48" SIGN
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CUSTOMER °,'z APPROVED BY:
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Data entered in MAPS program on:,. /s
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Remove tree
Parking Lot
PEARL STREET
LANDSCAPE PROJECT
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SIGN DEVELOPMENT TOWN OF BARNSTABLE, MASSACHUSETTS
Landscape Demolition Plan
N O T E S
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BATE N
SOURCES: Base from Town of Barnstable GIs Department SHEET NUMBER
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