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HomeMy WebLinkAbout0430 SCUDDER AVENUE i i � ,, i Town' f Barnstable 41 Building Department Services,` -� ,` ►, Brian Florence,CBO ' Building Commissioner * auexszns 200 Main Street,Hyannis,MA 02601 MAs& t639. A�� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATIO Date: 12/11/2019 Name: CHARLES H.DOWNEY,JR. Phone#: 1 (508)272-3500 Address: PO BOX 866,430 SCUDDER AVENUE Village: HYANNISPORT Name of Business: WEATHERMARK DIVERS DIVING SERVICES,IN-WATER BOAT MAINTENANCE, c Type of Business: CREW SERVICES,BOAT DELIVERY Map/Lot: )Y �6 f INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the' activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. g4fter registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the O Cr— Cfollowing conditions: M � • The activity is carried on by the permanent resident of a single family residential dwelling unit,located Dn within that dwelling unit. Z O • Such use occupies no more than 400 square feet of space. C • There are no external alterations to the dwelling which are not customary in residential buildings,and < rn there is no outside evidence of such use. M O • No traffic will be generated in excess of normal residential volumes. U) C— ` • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular, matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. p Y. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess N� of normal household quantities. • rn • Any need for parking generated by such use shall be met on the same lot containing the Customary Home ' MA O Occupation,and not within the required front yard. r— • There is no exterior storage or display of materials or equipment. : C • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one rn pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to ® --A exceed 4 tires,parked on the same lot containing the Customary Home Occupation. O • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. « I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: �!/! Date: 06 Homeoc.doc Rev.06/20/16 1 12f iZ ZGig �� ��C Sr4W sty AMA-95 , h 6 V--,o(V r t Town of Barnstable Building Department Brian Florence, CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Pre-application for Business Certificate Date 12/11/2019 Map ), 0 Parcel 00 4 Applicant Information Applicants Name CHARLES H.DOWNEY,JR. PO BOX 866,430 SCUDDER AVENUE Applicants Address HYANNISPORT.MA 02467 Email Address charlie.downey.wmd%mail.com Telephone Number 1 (508)415-3309 Listed ® Unlisted ❑ Business Information New Business? _ Yes eN6 Business is a registered corporation? ____ ___________ _____: Yes If yes Name of Corporation Does business operate under the registered corporate name? Yes No Is the business a sole proprietorship or home occupation. (oes � _________ - No If yes then a Home Occupation Registration is required—See Building Division Staff - Name of Business WEATHERMARK DIVERS Business Address PO BOX 866,430 SCUDDER AVENUE,HYANNISPORT,MA 02467 Type of Business DIVING SERVICES,IN-WATER BOAT MAINTENAN BOAT DELIVERY Build* Commissioner Ofi UsM - Co ditions �/ � Building Commission G& �" Date—a(,:) � J Clerk Office Use Only Town of Barnstable Post:This.Cacd So That rt;Cs Visible From-the•Street�ApproYed Plans:Mwstabe Reta�ned,on;Job and,this Card Must-be Kept S ehl r $ Posted Until Final"Inspection Has:=Been Made .'� n. ; � • WhereaCertificate of Occupancy,�s Required;;auch Building-shall Not beQQccupled,unt�l:a F►nallnspect'on has been made , ,. egistlCatl® Registration Number: B-19-3690 Applicant Name: Approvals Date Issued: 11/04/2019 Current Use: Structure Permit Type: Building-Shed-Residential-200 sf and under - Expiration Date: 05/04/2020 Foundation: Location: 430 SCUDDER AVENUE, HYANNIS Map/Lot: 288-009 Zoning District: RF-1 Sheathing: Owner on Record: DOWNEY,CHARLES H &LISA Contractor Name:- Framing: 1 Address: 284 MASSAPOAG AVENUE .Contractor Licenser 2 NORTH EASTON, MA 02356-2694 Est Project Cost: $0.00 Chimney: xx Description: Shed 11x18 Permit Fee: $0.00 Fee Paid Insulation: $0.00 Project Review Req: SHED REGISTRATION- LESS THAN 200 SQUARE FEET, ,� bate 11/4/2019 Final: : 1 Plumbing/Gas h , k Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorzed by this permit is commenced withmssiz$months after;,issuance. All work authorized by this permit shall conform to the approved appl cation andL he;:approved construction documents for-which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and struuctureggs shall be in with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or,road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. q . y Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire®fficials are provided on this permit.. Minimum of Five Call Inspections Required for All Construction Work: ��� 3 Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final' 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contra ng with unregistered contractors do not have access to the guaranty fund" (asset forth in MGL c.142A). Final: R' Fire Department 'sue Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: To of Barnstable o r BuRding Department Services Brian Florence,CBO Building Commissioner Um 1 tia� 200 Main.Street, Hyannis,MA 02601 www.town.barnstable.ma us Office: 509-862-403 8 Fax: 508-790-6230 PERWT# �I �J : $35.00 SHEA REGISTRATION RESIDENTIAL ONLY 200 square feet or less • _. � urn 430 Scudder Avenue Hyannisport �n o Location of shed(address) village 1 "^ Charles H. Downey,,Jr. 1-508-272-3500 Property owner's name Telephone number 11' x18' Size of Shed Map/Parcel# 11/01/2019 Signature (yj Date Hyannis Main Street Waterfront Historic District? . Old Ring's Highway Historic District Commission Jurisdiction? You must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 9:00-9:30&3:304:30 PLEASE NOTE: IF YOU ARE wnuiN THE JORLSDIcnoli OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE TBE APPROPRIATE COMMISSION FOR DETAILS, THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REv:06117 b 2I�4y'► C C;y�ll✓��2,�au10'�`� • (,uma�@ �,-,��►,j. Caws . 4c T• +� r � . r r' • „ cla 00 CY a ... • �. _ off :.... .'{ 60 co- GO n .f c I r • am �? OD01) rGo a t Cp r c*v _ti as CD ass -"•-+.' I _ Go CV CD C"i C" -- ch �? P t 1} - tz IL N I FLooD 4�t.,8 15.300 5� � � o �r Jam+/F L A t t2Z 1 • 40'Y04 -E QT t FBI -r;-{AT T}Ac FcL!u D A-"o.�t - i= StL1aLtt::tE A"O 5=•s-GA=-V C of t ELa Ait��,t z"3 of � �.s M i4? 'LDS 9 �� srrt fit.c A-1-J D t 5 1.ocF1-T"c� w r-s-,u J--%, Ar).jo e-- a-a-�6= QM �IS c Co o a t ooD o-7.02- �( Aa-� a _9 cs _o -,n4- �,' • LccATi ct....t : t-•-ty A t_..c.,.,��. Po 2-r Z-h s PLh t-r t� sac t (�t�M-O cm," Ras LA.., IaST2u MCt.1r �Q.tc-� RuD 'mac i L-A" For. (_cQu A L. L A i P-Q ��5E-i''S 5 t�CW/..i ��cV La t�tar $�� t�l�'f';=•-L> F�a,r�-�r 28� 1 9 S8 �fl 'r'o De-T�t.s tuS L.car L.t...t��.: " • • • 2.�.c�-i-=fZ� ram,o ���--ro J�ut1Fc i)G�V t�cs�r}a►� Qft TE r cd.'Lrs. C ? Q,.ttt_t A4ggs �.tcRr t`7 QctJ Zt t�=MA=Lxr Assessor's office(1st Floor): /0 ; �� �' �• p� iAssessdf's hap and lot num G�$$ d�rA„ ^tl d ��Y MUS-�'BE PyD*THE `Conservatio ARCM n(4th Floor): ��--v 7��c\qy' , �IT ��®�- Board of Health(3rd floor): ����® ' l Sewage Permit nu mbar �'Jr. �� (,` � sea»r�ntt TOWN R o639. Engineering Department(3rd floor): • , ` J �"`�`" House number �!3O Definitive Plan•Approved by Planning Board 19 y1? 9 T APPLICATIONS PROCESSED,8:30 9:30 A.M.and 1:00-2:00 P.M.only TOWN . OE BARNSTABLE BUILDING INSPECTOR e ' 1 APPLICATION:FOR PERMIT TO f 0V\S'-�r y L C"C' TYPE OF'CONSTRUCTION Vyo 19 4 TO THE INSPECTOR OF BUILDINGS: �[ �99.2-73 The undersigned hereby applies for a permit according to the following information: LocationProposed Use Use Zoning District C Fire District X Name of Owner "O h 0.`C 2, h'4 Address Name of Builder \,Y1—V-. S \�-vYo\N Address ��`�^'�S �•� 7 ti� V-1,31Ak-X�o - Name of Architect -c O` S `'� Address Number of Rooms 3 a�• a �"'\� �� Dti. Y"k Foundation � 1��Ct� Co.�Cct�k�c o� Exterior�'J�� C -Z-,c o-,RI.t 4(�,�1 c \•C i��Roofing Floors wc- (( © w o�-(( Interior uJ`U Oa.1 \0.5 Heating v Plumbing Fireplace �1 'e S C �--�� �,\(�C-V, Approximate Cost J ✓� d i Area Diagram of Lot and Building with Dimensions Fee � !�°d OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the.Town of Barnstable regarding the'above construction. Name �--V�- v---� Construction Supervisor's License 0 0a(2) ZIGMONT, RONALD Na 36684 Permit For BUILD DWELLING Single family dwelling Location 430 Scudder Avenue Hyannis Owner Ronald Zigmont Type of Construction Plot Lot Permit Granted May 6 19 9 4— Date of Inspection: Frame 19 Insulation 19 Fir.eprace 19 Date Completed �" 19 TOWN OF BARNSTABLE 36684 Permit No. ......:......... BUILDING DEPARTMENT t """ I TOWN OFFICE BUILDING Cash wa � 6y9 HYANNIS.MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Ronald Zigmont Address 430 Scudder Avenue, Hyannis USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIEDIUNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. Au.9ust..5 . . ... l9 9.4............ .... s ue;............... Building Inspector 4 . :. t TOWN OF BARNSTABLE? MASSACHUSETTS BUILDING . PERMIT7 6 94 DATE PERMIT NO NQ 3 6 6 8 Denni s iJj APPL.4fANT 'Dr. j_(7— ADDRESS ,6T (N 0.) (STREET! (CONTR'S LICENSEi lIu-ild dwt�llib-L�� r ': I - . -1',, 6 11-i,-_ PERMIT TO —6-Al-L NUMBER OF (TYPE OF IMPROVEMENT) STORY (PROPOSED LISE) -DWELLING UNITS AT (LOCATION) 430 Scudder AVezue, Hyanais-pori: ZONING P y (No.) (STREET) DISTRICT- - BETWEEN AND (CROSS STREET) (CROSS STREET) SUBDIVISION LOT L OT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP —BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: Sewage #94-146 APPEAL,-#1992-73 B0,1 D AREA OR 1-080 sq. ft. 59,000 PE 54.00 VOLUME ESTIMATED COST FEERMIT (CUBIC/SQUARE FEET) OWNER RO ri n alo LIg .0 ADDRESS Scudder Ave-nue, -hcyanniqport, MA BUILDING DEPT. BY '2;; 41 0 V, P'E_RlpfTT_D_UE I N I-L L A E T Rr-A-P-P I C T F ANY APPLICABLE SUBDIVISION RESTRICTIONS. ,F 5W THE CCONDITIONS MINIMUM OF THREE CALL -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE p LE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK' CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. ., PRIOR TO COVERING STRUCTURAL�QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE I OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION 6PPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS S-) v 2 2 2 14 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 ARD OF HEALT _?l'A:3NfulI / - I OTHER SITE PLAN REVIEW APPROVAL f Z" WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIOUUS STAGES OF WORK 15 NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. GH MNEY IA- INC1LE�i �- CLAt' AR'D�i 130NT :1-r-VATIQN �G15.LrE - woWoov O i �iHINC� LE-4i ,.._Trt L Ef Slp�- LL.EV/1 T I ON HAYfl.-OWEi AfAc+I 14"966K 12IN IN VH c N 12W)c 10 c. 12 10 0 x 16 — � N V _ � LI NTH. 800r1 �E�ROOr1 G x 1 9%,X I D - p — 9 x-7 O•r•'Drz. N I -O 45 O sca.L- 116 MAY#rLOWVR T•NCH f 04-05-1994 06.23PM FROM DELANEY REAL ESTATE TO 3980684 P.1i2 , Town of Barnstable Zoning Board of ,appeals RMAS&r� + 230 Swth Scncc,Hyannis.Massxhuscas 02601 1639. (508)790-6290 Fax(508)790-6454 J'tFa Town of Barnstable zoning Board of Appeals Natioe sxtension of Bulk variance Appeal No. 1992-73 `� Samm:s six (6) Month extension Granted .C3 7a Appeal No. 1992-73 r, r ngpsicant: Peri wentworth Property Locations. 426 B^nddes: Z:.-Ause, Gyannis- Pyre' -AIUI y Assessors Map/parcel: 288/009 •'^ f'^ BaCkgratsnd z on December 10, 1992, the applicant through his attorney iiichael Ford waj�graated a variance from the Barnstable Zoning ordinance, section 3-1.3(5), Bulk Regulations, to permit the existence of a lot which does not conform to the Minimum Lot Size and Minimum Frontage Requirement. That Notice and Decision was filed with the Town clerk on December 21, 1992 and certified on January 11, 1993. Prior to the expiration of that variance, the applicant, through Attorney Peter L. O'Xeaffa requested an extension of the variancei in him Recembar 09, 1993 letter to the Zoning Board of Appeals. Procedural Sumsnargt At the January 05, 2994 Public Bearing of the Zoning Board of Appeal, the letters requesting the extension of the variance was road and the matter taken up. The Board reviewed the file and noted that the request had hean made prior to the expiration of the Variance and that good cause was noted in the request letter. conclusions A motion was duly Made and seconded that a. six (6) month extension- of the Variance be granted beginning January 10, 1994. The vote was as follows: Ayes Gail tightingale, Dexter Bliss, Emett F. Glynn, Elizabeth Nilson and Nay: gone order: A six (6) month extension of the variance granted in Appeal too. 1993-73 has been given beqjWding. January 20, 1993. Richard L. Boy, Chairman Town of Barnstable Zoning Board of Appeals s TOTAL P.02 04-05-1994 06:22PM 1 508 778 0209 P.02 1 GH I MNEY �7+IINC,LE11711 '� -- lit _ b - — - --- - — - -ILLUM CLAP60AW-7 FONT 1: --r-VA ION i� W o cw , •bEG K � - ,-I L F-El -e5d PF. ELEy ION MAYfLowF--f3 IFANC+1 TH Ej- 12ININ kiTC-415 N 902900 12�'X 10f• 12` o ID`�x 10 L - - i N LiKiN1RH. 800r-� �EaRool t - _ I G �x l 2'✓ 9�'x l O Zi - Wox t os� _ _ i 9x-7 o.r -or2. 91 MAYfLOt- R .NCH sown of aaras;t , ����� Zoning HoaL•d .`�A Bulk variance pecision sad ti 21 rQ1 3 Appeal go. 1992 eumtaary Granted with condition+ Appeal No. 1992-73 Applicant: Pori Wentworth Address: 310 Plum St. West Barnstable, M& rxaperty LOaations 426 scudder Avsnua, Hyasseis Fort XK, (rear lot) Property owner: Barbara sheer S� k' 34P•A3, pA64S lt9 Assessor's Map/Parcel: 288/009 tonings #w-ls Residential F-1 District overlay zoning District opt Groundwater overlay District Applicant's Request: variwme to section 3-1.3(5) Bulk Regulations, Minimum Lot site and Minimum Frontage Requirements Activity RsgUosts Tc dove'lop the lot as a single family dwelling. Procedural rrovisionst section 5-3.2 (3) variances& Backgrounds This decision concerns the petition subMitted by Pori Wentworth, who had appealed to the Boning Board of Appeals for a variance to the Balk Regulations, section 3-1.3(5) hulk Regulations, Minimum Lot size and Minimum Frontage Requirement to allow for Assessor's Hap/Pareal No. 288/009 to be considered separate for the purpose of zoning and development. According to the Assessors Records the lot is 0.35 acres and is assessed an Accessory Land with improvements. The lot in improved with a minor shed and is considered accessory to front lot R010. Procedural Sammary: The application was filed in the office of the Town clerk and at the Zoning Board of Appeals office on November 09, 1992. A public heating, duly noticed under M.G.L. chapter 40-A, was opened on December 10, 1092, at which time the hearing was held and then closed and a decision rendered_ The petition was hearts by Hoard Members; calil Nightingale, Ron Jlknsson, Dexter alien, Elizabeth Nilsson and chairman, Richard soy. Attorney Michael Ford represented the petitioner before the Board. He submitted to the Board a Memorandum dated becentLar 10, 1992 in support of the s Any person aggrieved by this decision may appeal to the Barnstable Superior Court, as described in Section 17 of Chapter 40A of the General Laws of the Commonwealth of Massachusetts by bringiag:.an action within-twenty days after the decision has been filed in the office of the Town Clerk. l Chairman z, / yrJ L Clerk of the Town of Barnstable,. Barnstable County, Massachusetts, hereby certify that twenty (20) days have elapsed since the Board of Appeals rendered its decision in the above entitled petition and that no appeal of said decision has been filed in the office of the Town Clerk. Signed and Sealed this -1/ day of _ g.u. 19 V7) under the pains and penalties of perjury. Diatri,bution: � /J Property .Own_ er Town Clerk Town Clerk Applicant Persons Interested Building Inspector & Public Information Board of Appeals es beeision and eotice Appeal No. 1992- 3 appeal for a Variance. Be siplained the history of the lots and that they were purchased under aeparate deeds by Mary S_ Cochran, mother of the petitioner Barbara Ghea. Ms. she& came into possession of the lots in 1982 from bar mother. Attorney Ford summarized the requirements of chapter 40A and the facts related to the lot that justify the granting of relief sought. He cited the pan handle and the financial hardship imposed on the applicant without the benefit of this buildable lot. as discussed the neighboring lots and the continuity this would have with the surrounding lots in size and in character. A proposed plan for development of the lot was prepared. The plan titled: "certified plot plan" and dated 10-14-92 shows a building footprint measuring 50 x .30 feet and a 24 foot square garage structure attached to the home by a breezeway The Board presented questions related to the property and specifically to the extent Of proposed building upon the lot and the frontage on to the roadway. The public bras asked to speak and Joseph Gardner expressed his support for the appeal. no one spoke in opposition. Find of Facts based upon the evidence presented and the testimony given at the meeting of December 10, 1992, the Zoning Board of Appeals unanimously finds as follows: I. The petitioners mother purchased the properties in 1977 an two separate Iota but due to changes in zoning they were merged for the purpose of zoning.. 2. The lots are the elsea of those generally found in the surrounding neighborhood 3. The lvt is unique in that it is one of the few loco left within this neighborheod 4. Granting the relief sought. is consistent with the spirit and intent of the Zoning ordinance and would not be detrimental to the neighborhood affected. Conclusion.: Accordingly rased upon. the findings of fact, a motion was duly made and seconded that, Appeal Mv, 71992-73 'be granted subject to the condition that any structure built on the lot shall be in accordance with and no greater than that footprint represented in the plans submitted. The vote was as followsa 3 08 � .��i``i`a� Aye: Gail Nightingale, Nan Jsneson, Dexter alias, Elizabeth Nilsson and. Chairman. Richard Baby Decision and Notice Appeal xo. L992-73 mays gone orders APpeal No 1992-73 ban granted a Variaacs from Balk Regulations, liiaimum Lot Area and minimum Lot Frontage Requirements for bath Assessors Nsp/pasres, no 288/009 and No 288/010. APPsale of this decision, if any, *hall be made Pursuant to K" chapter 40A, section 17, and shall be filed within twenty (20) days after the date of the filing of this decision in the office of the Town Clerk. This variance mnst be Coca rded for both lots at the register of Dears and the Petitioner has oni year in which to exercise the variance. r i 7,7 TOWN OF BARNSTABLE, MASSACHUSE17S B U I L O 1 IV PERMIT DATE is .i:i � �. ., _'I 19 PERMIT NO • APPLICANT . . - _._. ADDRESS �M-..,,.. �.! I`7c• U (J�'�)i!_u (NO.) (STREET) ICONTR'S LICENSE) JI3w.�.<i. !S3:Ic�� _-1,J c .. ,-,.;r;t` s ' I ;.- NUMBER OF PERMIT TO - (_I STORY `' '�`" �"' �'f ""r% DWELLING UNITS - (TYPE OF IMPROVEMENT) 70. (PROPOSED USE) AT (LOCATION) 430 Scudder AVPnue t ;iy;- aais'-porL ZONING j--_ (N0.) (STREET) DISTRICT— BETWEEN AND (CROSS STREET) (CROSS STREETI LOT SUBDIVISION - —LOT—BLOCK—SIZE i BUILDING IS TO BE FT, WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION i f TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: 5C'Wci� ; i(9�f-11{�i A2PEA!, #19921-73 j AREA OR -68 Z s is t. - 59.0(,0 PERMIT i� I VOLUME �' ESTIMATED COST $ FEE S 54•0U (CUBIC/SQUARE FEET) OWNER iOCF11C ice:: i:� SqCiCCi: AZe'f i1c4, BUILDING DE T. ADDRESS �C BY i t F' WIIxKs—TN't1'S��ANL"E—UF—rTTT'PlFRAITT—D-O'ETFU I "E"CE-A'"5t THE AP P L I C AI TT—Vg O M' T1 C O N O i T IONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I.FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBFINAL INSPECT SSE TI TO LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. _ POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION 6PPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS j 'I� `� ? 2 z T".1-A? Pik. z �G L4 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT W Nv� "A y -�}) ARD OF HEALT O �r .��C91'� vlvw�-(nCYWI U OTHER SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT ''-!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS'INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. PERMIT iS ISSUED AS NOTED ABOVE. NOTIFICATION. F M A c D a Ar La ��`' ►�o.Sit� c!b ' N � 11? � 27'* �u1 LC�IN�. SITE W I-}►i�� r 15. 3ac, i PLr1 C4i • 0 \i 0 M N/F LA AZ 7$ 2 cE 0--r-s F--e THAT THE F,=W b AT►oo J SHCw r.J tlM-4-a A GOM P 1 THE S I O O L►"E A►c4 0 z E"i i3 A, .►G 2 G ou Qe an r^3 o F -rr4E; -rcw u •SSff M A-P /1 B6 P^tc..M-L. C1 �fj r�SrY�C�1 E A• J D t S L ocPri•t-S-O w i rv-n u FLoo D 2o..j is S ('� A N f3 G E F I Q M CE� F L=-r F' PAt.4EL ►S0 25000► 000 a A � 7-z! . 05 02 •9 4 _ -.,��`tti`,. ._�.t�_,, '_,.�` L�ATI r LE : i " = Q= Dt�T� o� • 02.9 4 -if YlS PLA-t-+ 15 NdT ('FRS 0 ewe.a Ai.d I�,s r2 u r✓►t_i..r r �v Q.�>=--r A)-4 0 T- P L A F Lc�La A, L , L A I &•� oP�E�`S Sr�wr_, �t-1ovLD �.rar i�E iJA-'T'�-A F�2�•A-f!�•s �Ls� 19 ,cam USE- -rr D r�'r'>=•�I ti E Lc�r L�+..+��.�.• I Fou+a.,rss�tsca� Lacra'r+d.., DA i a4,2�,.atL ��T �IL MASS t. C0LM0NwF_A'.L5 O F •sAC G00 v.-*ASii \ -:; G�Q;\ - �a•*.cs_ i3OSTON, M_A_5ShCIjUS37- -SO�d33 -Wa COMP TLSA37ON I.NSURANC£AFTMAIC U'- (Iicetsscc! - - "t irIa s princilut plsocofbuiincs/residcnast: - • � oS'r uZw d�'b'`l�� . do hcrcb ccrz? ,y.,<GrylSuc�llip) y fj:under chc painsand pcnZlCsa vfgxryury.dma j D sm 2n cmplovcrproviaing ncc .. follow;nsv'o�;;n ompjob_ nsiron covr formy cmPlOYccs wqrldnZ o,, tj1i� Incur=ncc Company Policy Numbu 3 3 =m= sole propriaorznd h2%'c no one working for me j� I �m s sole proprietor.Zcnc=l conmaor or homcovmcr(cirdc onc)=.nd L-vc hired the conrr=czors K�o h=�c the followinbworkcs cnmperratioA i.nsursncz poliacr_ It•-red bclow -=xafCo Z:rc:cr • Ir_st:.^_ncc Co p�aylr'o?ic�?1czr..bcr - N =mc ofC 0n:r=aor 7n5urncc Cc>np:nyPolicy Nembcr IZZ i t:.cofCor.„,_Gor j Incur=n ccCompmylPo?icynimbcr D I =m= hor. cc.;-ncrpCr,'o �oacrn y:cl�c 4 Cl t .�c�<e«�•<r.�.%a«D�c�"Xrcecr is 1e C`a�tic - ACi jj,,< L< rx<~'<C ZJ .0 Ct1tZ<t CC OC LS< RVGL i <e.,r:1e«L p CiUCttttS<retoseeOotF<otr�j. to be erFle7ett`Lcr Lie bet'<ci Ge��•r:t,,a cif. �GL C 152.«c I`7 .�pI•GLKL� t t aC�<rr�it r-•:y<ri 1<t<c L(�<Ii J:T.t<<� <r�cKr CCl<f V< of�ch �C�pCCt�'.`C).a` pC"t't--JCC f.00 O laCG01< -tr.t C. Jaf c•tu•c,C<CZc t:C'QT«c��ac:Lrtc fCr.GG�cr�< <cra:Ca^c!- r Z<�ucc.r<ZvrlcrSc'.•cr._S/.cf+�G�)�.c_.J<:Ztc t - - o - <c.vYcc�]SC•L.C{_.L�c::=:r� ftc c c!S 7 GG.OG: e:y per. cc is tic!cr-c!:�cc bcrl Orlct—.1= Signc2 this "T-�4v% L.iccn_cclPcrr.�ir;cc � ._ �' Lccnsor�Pcrr.-iirto;. { I . KH -11 1-� 13V 1-?.n. 11­11*C, !L�, 7..'- .17 - 1E l.a." ------------------------------------------------------------------------------------------------------------------------------------ PRODUCER 1 THIS CERTIFICATE T 9 ISSUED AS A MATTED OF INFORMATION ONLY AND CONFERS 1 NO RIt'_.HT 1111FOY THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, i The Insurance Exchange 1 EXTEND FIR AUER THE COVERAGE LwvnuDED BY THE POLICIES BELOW 24 School Sfreet ------------------------------------------------------------------------- Pzo. pov 561 COMPAN IES ES AFFORDING COVERAGE West Dennis. MA 0267-14 -------------------------------------------------------------------------1 1 JR: 394-8S'00 COMPANY A C0101lia IPSUMCE COMDany 1 LETTER --------------------------------------------------------I COMPANY B CIGNA INSURE T ER E E D LP E IT Dennis Theo Construction Co. COMPANY C 1 47 Helmsman Drive 1 LETTER Y1tfiloth , M 275 8iluport , A06 ------------------------------------------------------------------------- COMPANY D I LETTER ------------------------------------------------------------------------- i 1 COMPANY E LETTER ETIER COVERAGES ------------------------------- POLICIES ICY THIS IS 7' CERTIFY THAT DLI IES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD � ­ 10 IqDTCAT.FD. ROTPIT HSTARDING ANY REQUIREMENT TERM OR CQHDIT I I jQ� BY ffjj#�T JTJ JEjUl?rT -- ­F4-p ISSUED 0 Q HE INSURANCE AFFO E y U U .5 E. THE"TE9 SI TL'Ti"AT - PERTAIN, T6 Ad It'LL. 1 ia I CERTIFICATE MAY BE R MA CE THYF� DR HHE I EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. ------------------------------------- ---------------------------- -------------- --------------- ---------T----------------------- CO it I POLICY I POLICY I LIABILITY LIMITS IN 1A01WS U. 1 10!LTRI TYPE OF INSURANCE i POLICY NUMBER !EFFECTIVE DATEIEXPIRATIOH DATE! !EACH OCCIIRR.I. AGGREGATE I I--------------------------------- --------------------------- -------------- --------------- --------1------------ - I ---------- G T GENERAL LIABILITY !BODILY I Vw FORM CCL 14 07 56 021101/94 021101/915 !INJURY I$ i .4 1 Ivi rOMPP-ENT?H CT rX-i /GP ------------ ----------- I L i UNDERGROUND EXP LOSTOP r !PROPERTY! I COLLAPSE !DAMRGE 15 -Xi PRU !jCTC.:,HAZARD i ODU z..,COMP. OPERATIONS -------- ------------ --------- r "ONTRPI711"AL IBT & PD INDEPENDENT I hTRACTORS I i CO,0 1C MBINEDI$ 100000113 1$ 10000601 ry'l BROAD FORM PROPERTY DAMAGE 1 ----------- --------------------- I I PERSONAL INIIJURY PERSONAL INJURY :_5 i --------------------------------- --------------------------- -------------- ------- ------- --------------- -------------- ---- 1 AUTOMOBILE LIABILITY I 'BOD IF-'.I i l(PERSON)l$ I I ANY AUTO --------i------------ WFED AUTO (P-TV. PASS! BO 1 ALL 1 S I ID INj.: I r b"TOO.' i L ALL OWNED "01HER. THAN} i 1ACCIDEMTj$ (P ------------ RIV. PASSI It I HIRED AUTOS 00FERTY! L I NON-OWNED AUTOIS i !DAMAGE !$ I CAR. AGE LIABILITY 1--------i------------ IlBI & PD I !COMBINED:$ --------------------------------- ---------------------------1 --------------- -------------- -------- ------------ ----------- i EXCI?SS LTABILITU UMBRELLA FORM lBI & PD 1 j T MB I lCOMBINED!$IFIANURELLA --------------------------------- --------------------------- - 1 ------------- --------------- ------I--------------------------- i ST T IATU ORY `IOF T-101 BE ISSUED 1 02/041144 A 2 110 41 0 5 1--------------------------------- WORKERS' COMPLKSE AND 1$ i0-0000 (EACH ACCIDENT) EMPLOYERS' LIABILITY 500000 (DISEASE-PUHICY)i i 1001000 (DISEASE-EA EMP): --------------------------------- --------------------------- -------------- --------------- --------------------------------- 1 i OTHER ---------------------------------------------------------------------------------------------------------------------------------- DESCRIPTTGN OF CT 3P4ZRATIOFc,,/Li3CATIONSI/',,EtulICLES,IcOPE IAL ITEMS BUILDING CONTRACTOR CERT T FIC.,jT HOT-DER CANCELLATION SHOULD, ANY OF THE APOITE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX- 1 HE; I ATTGH DATE T. I I HERITAGE REALTY & DEVELOPERS it PIR 1. IE THEREOF THE ISSUING COMPANY WILL ENDEAVOR Tp llla 1 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED 10 RE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR I 1 '­BIL ITV OF ANY KIND U M THE COMPANY, ITS AGENTS OR REPRESENTATIVES. L Q - - ---------------- ---------------------------------------------- HORIZED REP RESENT TIV ------------------------------------------ ------------- amill -- --- --- - ---- ---------------------------------------- iS + wLL s, _ �+'rs' { .rr T jv ` °`�.$g•'}7 4• y 7. f ,r fpll&toteprrs*saawrot a_ = COMMONWEALTH DEPARTMEN PUBLIC SAFETY _ sose"esn•8bh Bowl" OF ONE ASHBORTON PLACE CodNsaereHerrevpepp 3AASSACHUSETTS BOSTON,.MI�021�8 talstleNfe. CAUTION 9 EXPi�?ATIO�' DATE I E s T EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST E 33 'THEFT, PUT RIGHT THUMB S RESTRICTIONS 3285- PRINT IN APPROPRIATE 1 :. BOX ON LICENSE. I BLASTING OPERATORS - MUST INCLUDE PHOTO. _ I. PHOTO(BLASTING OPR ONLY) FEE: , NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY ` HEIGHT: ?. STAMPED=OR-SIGNATURE OF THE COMMISSIONER , I ^ - .�: �o � i 3 GINI'NAftlAll LL"A TORE .F f ' - °• -;x CCARRIIEEDONTHE PERSONO .. SIGNATURE OF LICEN6EE THE HOLDER WHEN EN=: �J � aii �e• O i[:RS RICH, iHumll PRINT GAGEDIN THISOCCUPATION. ONER I . .v. w�'YA'�f`W i'M�� � '.'f+� 9� $'1%� - �. � . ..1. •� ., `."yam., '� i Assessor's map and lot number ....X�?&y........... Sewage Permit number .......................................................... C CF TM E TOWN OF RA.R.NSTA.RLE i BAHBSTAELE, i M69 �•� BURDING INSPECTOR Om APPLICATIONFOR PERMIT TO ............................................................................................................................. TYPEOF CONSTRUCTION .......,r(LLP:e.-, .......................................................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for QaJ permit according to the following information: Location ....... ....... ............ .... .................................................................................................................................... Proposed Use ...... . � . . ..�� 4................ ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner !.�ddress .... .. .. Name of Builder .. .Address ... ..... .!�'/. ... Nameof Architect ..:...............................................................Address .........................................................., Number of Rooms ........................../.......................................Foundation �. .) ....... .......................... Exterior ...............tkl` ..................................................Roofing ...... .................. ..... .......................... Floors ............. ...................................................Interior ................ Z ................................................ r. Heating l..'.. .....................................Plumbing ...................... ........................................................... Fireplace '�/ ..............................Approximate Cost .....nz?��................... . .. . ................... .. ..... ....... Definitive Plan Approved by Planning Board ________________________________19________. Area s` ......... ................................ Diagram of Lot and Building with Dimensions Fee R.g � SUBJECT TO APPROVAL OF BOARD OF HEALT�kS`.E._i 2'--I`� :�i EM MUST BE EO IN COMPLIANCE V�:`ITii ARTICLE II STATE SANITARY CODE AND. TO REGULATIONS. ; f -Sou-o- Cs I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... ....�Ul�®:!!./.��!�.............................. Hawthorn, Margaret l No 16207 Permit for ..... tool shed ...... 5 ....................................................... E Scudder Ave. Location ............... Hyannisport ............................................................................... Owner Margaret Hawthorn ................................... ......................... Type of Construction frame ................................................................................ Plot 1 ............................ Lot ................................ Permit Granted ....19 73 Date of Inspection ............19 ` 22 Date Completed ........ ........ ....�..7......19 ��►ww w k, PERMIT REFUSED ................................................................ 19 ............................................................................... ............................................................................... a ............................................................................... 1 Approved ................................................ 19 ' ............................................................................... ............................................................................... 4 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map O� Parcel Application D / Health Division Date Issued 9�J-13 Q� Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address �'�DD MIC Village YZg�VA t o4eZ gY 4zo, Owner P4 VIV� t�Rf'I' Address Telephone Permit Request Xi>72 Ae /I �f i 7�1/� ` ex- a®1 �® a Square feet: 1 st floor: existing proposed -,K2nd floor: existing `i proposed -- Total new -� Zoning District Flood Plain Groundwater Overlay Project Valuation , ® OConstruction Type Lot Size /�K �• Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure �b °��5 Historic House: ❑Yes U'No On Old King's Highway: ❑Yes ❑ No Basement Type: VFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) l ®010 Basement Unfinished Area (sq.ft) 1 (0 Number of Baths: Full: existing new _11�9- Half: existing new Number of Bedrooms: existing _new Q "5 Total Room Count (not including�Otli s): existing new First Floo Dom Court Heat Type and Fuel: ❑ Gas I ❑ Electric ❑ OtherYp Central Air: ❑Yes P"No Fireplaces: Existing New Existing wo d/coal stye: Yeso Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: existin ❑ nig-0 size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes Lill, O If yes, site plan review # Current Use lqgon,lW Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �/ IiCJ®D� Telephone Number �l3 ' 2-0 Address /94, .:V_1V400E�- 61*11 CIPA License # 6 ��22 Home Improvement Contractor# Email:4� 0 / ,�'Du,� Q (en ea%�i j orker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE /' FOR OFFICIAL USE ONLY rr APPLICATION# DATEISSUED MAP/PARCELNO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: r.FO.UNDATION;� FRAME -,INSULATION.;, FIREPLACE ELECTRICAL:,,.., ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING-= r DATE CLOSED OUT ASSOCIATION PLAN NO. r The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of InvesUgations ' 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Bwlders/Contractors/Electricians/Plnmbers Applicant Information Please Print Legibly Name(Business/Organization/Individual) AJ-66 Address: l 9b �e lnoiW 61y r4aw5- City/State/Zip: 64Vma//d/Lr-- d'1sh��,,"� Phone#: 6E)E-'� V ��'�.� ` 6 Are you an employer?Check the appropriate box: Type of project(required): 1.El am a employer with 4. I am a general contractor and I 6 New construction m loyees(full and/or part-time).* have hired the sub-contractors am p I a a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g Demolition , working for me in any capacity. employees and have workers' -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 11.❑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.❑Otter 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 hue outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attacbed 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 date). 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification.. I do hereby ce fy under the pains and penalties of perjury that the information provided above is true and correct Si ate Date: 1 Phone#: el-3`J ol m i9 icial 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 for their ernployebs. 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 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 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 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-contractor(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 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 pennitllicense 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 bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would Ike 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 Department of Industrial Accidents Qfliee of lovestigatlons 600 Washington Street Boston,MA 02111 Tol,#617-727-4900 ext 406 or 1-977 MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass-govfdia Town of Barnstable. } Regulatory Services sVIAM Thomas F Geiiler,Director Building Division Tom Perry,Building Commissioner 200 Main Sty Hyaxmis,MA 02601 www.town.barms AIe mans , Office: 508-862-4038 < Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as�Ownet,of the subject ptopeity hereby authorize_ �611�A,1224 to act on my behalf, in all matters relative to work aaithorized 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. Signature of Owner Signature of Applicant } Print Name Print Name Date Q:r-oxMs:o � rs 6rznu • . s Massachusetts -Department of Public Safety Board of Building Regulations-and,Standards 1 Cunstru�CiurtS}�ncniwrl:�c.�,Fam�1; License: C$FA-062622 DANIEL C W06D 196 SCUDDEI2 Box '. CENTERVIPLE lYfA '0263 Expiration Commissioner 03/28/2014 or�vnzaa2eaea��� Offic of Consumef Affairs c�c$us�nessC< �a� jeCGt i x y Re�iyhon i License or reg�strafron valid"for mdvidul use at�ly j M.E IMPROVEMENT COfi(TRACTOR, Fit or a the Qxpirafion dafe If found,..ret�lrn#'o gistration £ 1527�3 k o I ® xpiration 9/28/2014 B Type' Office of Consumer Affa�rs:.and business Regulation l DA 10:Park Plaza-Suite 5170 J GROUP r Bo§ton,DIA 02116 DANIEL WOOD 196-SCUDDER BAY CIRCLE 7 ,N CENTERVILLE,MA 02632``` -- Undersecretary ' j Not valid without signature bo ZE z r i o � � . s i 2/ o Ul ca. J • Q ov U T op O S 1 p 1. 'r