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HomeMy WebLinkAbout0100 STATICE LANE /oo i i l A 1 0 y i I 1 I Town of;Barnstable *Permit# Expires 6 months from issue date Regulatory Services. Fee z • saRxsrnatE, • , MASS. Thomas F.Geiler,Director X-PRESS PER MIT i639. ♦� -r. Building Division Tom Perry;CBO, Building Commissioner �UN 2 7 2��2 200 Main Street,Hyannis,MA 02601' - wwwaown.barnstable.ma us + - OWN OF BARNSTABLE. Office: 508-862-4038 Fax:'508-790-6230 EXPRESS PERMIT APPLICATION '--. °RESIDENTIAL ONLY Not Valid without Red X Press Imprint Map/parcel Number Q Property Address I V b $-}'µ t rE�'1dZl�✓ ['17f Residential Value of Work 2•Sd0 'ou Minimum.fee of+$35.00^for work under.$6006.00:, Owner's Name&Address PA-1 I Contractor's Name m�!�/Bf/��LiV�'�6YE Telephone Number �d�y�/- Hom Impprovemen�C�t�rac License#(if applicable) 1' Cza-1 � Construction Supervisor's License#ry(if applicable) e- c 06 k ql3 EWorkman's Compensation Insurance Check.one: ❑ I am a sole proprietor am the Homeowner,q have Worker's Compensation Insurance .Insurance Company—Name VJ ®J 0 '"7y °2 J• AMIN F, ASJoCr��ed ef) �NJU Nf� Workman's Comp.�i'n, P, .y Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) A ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over, existing layers of roof) R side �'�eal �. #of doors Replacement Windows/doors/sliders.U-Value U� '�a' (maximum.35)#.of windows_ d�°///a�le` `Where required: Issuance of this permit does not exempt compliance with other town department regulations_:i.e.Historic,Co ervation,etc. ***Note Property Owner must sign Property Owner Letter of Permission. x A copy of the Home Improvement Contractors License&Construction Supervisors License-is required. or= r SIGNATURE: ; C:\Users\decollik\AppData\Local\4icrosoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 Jk r- - �e �PQ�aiauseal��o�G%ULa.1Juc�ic�.teCf4 ' ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistrafion 100740 Type. " Office of Consumer Affairs and Business.Regulation Expiration 6/23/2014 10 Park Plaza-Suite 5170. Supplement Card _ Boston,MA 02116 CAPIZZI HOME IMPROVEMENT INC; ROBERT ELLSWORTH 1645 Newton Rd. Cotuit,MA 02635 Undersecretary,- Not valid without signature - a Y Massachusetts-Department of Public Safety Board of Building Regulations;and Standards Construction Supervisor ^ r License:CS-061438- t SETTS d� RrXH ROBERT T E Y O g; 69 PALMERAD . ' MASWEE 1WA OZ64 r- . Expiration Commissioner 10/15/2013 Al n - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): (f A f J 9 Zf, I'm f7 � MIA/1- 1HG Address: ('6 City/State/Zip: /mil ✓r.�� Phone#: Are y an employer?Check the appropriate box: Type of project(required)' 1. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6, ❑New construction 2.❑ I am 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 a ��aU dlf✓ � employees:[No workers' 13. Other comp.insurance required.] *Any applicant that checks box#I 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. lContractors 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.#: 0 Q ! 3 ;L Expiration Date: /0 0 (/'t4 �u ' Job Site Address: `C P. City/State/Zip: a m#1 e/ ,(III OZde . 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$1,500.06 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 certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: 599� T 4� 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 I Building Department 1 City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Client#:47298 CAPIHOM ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 6/08/208/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED;the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER: - - CONTACT Karen Walther NAME: Rogers&Gray Ins.-So.Dennis PHONE FAX AIC No Ext: A/C No): 877-816-2156 434 Route 134 E-MAIL ADDRESS: . " South Dennis,MA 02660-1601 INSURER(S)AFFORDING COVERAGE NAIC p 508 398-7980 INSURER A:National Grange Insurance Co. INSURED INSURER B:Associated Employers Insurance Capizzi Home Improvement,Inc. INSURER C Capizzi Enterprises,Inc. 1645 Newtown Road INSURER D INSURER E: Cotuit,MA 02635 - INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR - POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD MM/DD A GENERAL LIABILITY MPB1075H 6/08/2012 06/08/2013 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES ERENTED cc nce $500 OOO CLAIMS-MADE a OCCUR MED EXP(Anyone person) $10 000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO LOC $ MBI JECT A AUTOMOBILE LIABILITY M1 M28044 6/08/2012 06/08/201 (CEO,aco den'SINGLE LIMIT 500,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X" SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X Drive Oth Car $ A X UMBRELLA LIAB OCCUR CUB1076H 6/08/2012 06/08/2013 EACH OCCURRENCE $5.000 000 - EXCESS LIAB HCLAIMS-MADE - AGGREGATE $5 OOO OOO DED I X RETENTION$10000 $ B WORKERS COMPENSATION WCC5010547012011 12/25/2019 12/25/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1 OOO OOO OFFICER/MEMBER EXCLUDED? � N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEEI$1 00O 000 - I' If yes,descr be under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers Comp Information Included Officers or Proprietors CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©198 -2010 ACORD CORPORATION.All rights reserved-' ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD . #S82889/M82857 TLH Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT /SOWN THE PROPERTY LOCATED AT oJk� e- �. IN MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACC RDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CO E. SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: Town of Barnstable *Permit Expires 6 rrrarriii, fran irsur date. HA _ Regulatory Services Fee 6 -4 0-Y1 39, Ae� Thomas F.Geiler,Director Building Divisi6n X.PRESS _Tom Perry,CBO, Building Commissioner . PERMIT 200 Main Str.www.tow eet, Hyannis,'MA 02601 'I' n.barnstable.ma.us Office: 508-g,J8-443 200$ Fax: 508-790-6230 TpwN OF 3'APPLICATION RESEDENTIAL ONLY Not Valid without Red X-Press.imprint Map/parcel Number 9016 .far/ c c Property Address JGt� �� � f'c Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address 77iG /�`y�j A-/D S �G 7 Contractor's Name 7 �� ��� S ��l?a� Telephone Number S-4�T-5��,S7 2-1--7-6"3 Home Improvement Contractor License#(if applicablel_gg2����y S-61`7 Construction Supervisor's License#(if applicable) l. _12, _JS ❑Workman's Compensation Insurance Check one: F ❑ I am a sole proprietor ❑ lam the Homeowner have Worker's Compensation Insurance^ Insurance Company Name ����,7`_ � Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on tile. Permit Request(check box) e-roof(stripping old shingles) All construction debris.will be taken to a ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑.Replacement Windows. U-Value (maximum .44) "Where required: Issuance of iermit not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: roperty O n r must sign Property Owner Letter of Permission. Home pr ement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Ree1se071405 NAM Town_ of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division . Tom Perry,CB0 Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstableana.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must , Complete and'Sign This Section If Using A Builder ll ,as Owner of the subject property hereby,authorize-771 C.-•�d���. [/j�s�. �l� to act on my behalf, in all matters relative to work authorized by this building pemut application for. - a � - L (Address of Job) lt/?OL� Si tore of Own' Date Print Name Q.-Fonw:expmtrg Reviw071405 t , . y II 1.• The Commonwealth of Massachusetts Department oflndustrial Accidents Office oflnvestxgadons 600 Washington Street Boston,MA 02111 www.rnassgov/dia Workers'Compensation Lnsnrance.A6fida.vit;,Bnilders/Contractors/Electricians/Plumbers Applicant Information Please Print]Le 'bI Name(Business/OrganizationnndMdual):. Address: /o City/State/Zip• f yc,�.��'f I U Z6�L Phone A 9- --71-.-P Are you an employer?Check the approprlate box: 4. I am a F project(required):. I am a employer with�_ ❑ general contractor and Iew construction employees(full and/orpart,time).'� have hired the sub-contractors 2.❑ I am a'sole proprietor or pautfncr- listed on the attached sheet emodeling ship and have no employees These sub-contractors have ODemolition working forme in any capacity, employees and have workers' Building addition [No workers'comp,insurance comp.insurance. required.] 5.❑ We are a corporation and its ectrical repairs or additions 3.❑ I am a homeowner doing till work of have exercised their umbing repairs or additions rnyself [No workers'comp. right of exemption per MGL ofrepa� insurance aequired.]t c.152, §10),and we have no employees.[No workers` her comp.insuraocerequired.J , *Any applicant W cheaka box#1 must also fill out tha section belowshowing their workers'ccmdpensation policy udformatioa. f Homeowners who subedit this affidavit indicating They are doing an work and then hire outside contractors must subnrit a new affidavit indicating such. tContractors Qlatcheck this box must attached en additional sheet showing the name ofthe sub-cootractora and state whether or not those entities have employees. if the sub-cmdhaetors Rave employees,they mast pravidb their workers'comp•policy number. I=an employerthat is providing workers'compensation insurance formy employees Bdow is.thepolicy and fob site information. Insurance Company Name• Policy#or Self-ins.Lic.#: Expiration Date:_,6 Job Site Address: 574 -e 4neO City/State/Zip: 44 ^11 f' JI�/� e0evl 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 lip to$1,50050.00.00 and/or one-year imprisommmen4 as well as civil penalties in the form of a STOP WORK ORDER and a fine ofup to$250.00 a •violator Be advised that a copy of this statement may be forwarded to the Office of �esti f the b uuance covers a verification Ido her cen*�r r epains-and penalties ofperjury that the information provided above is true and c/orrec4 Sitmatusr • Date: 7 Official use onlX Do not write in this area;Yb be completed by city or town of ciaL City or Town: PermitlLicense# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector S.PIumbin,Inspector 6, Other r , Jlee '„a�noou o�`./ afir�se� License or registration valid for individul use only Board of Buading Regulations and Standards before the expiration date. N found return to: HOW llAPROVIRMBIT CON'[' OTOR (Board of Bonding Regulations and Standards [ae®tatratton:. ism" One Ashburton Place Rm 1301 Bastan,16��.QZ1Q8 E aatian; •21812010 1� �3153 IWw Private Corporation T.l„HrrCHCOCK'SM1VICE&-J dC. TED HITCHCOCK 105 FERNDOC RD Not with t signature HYANNlS,tdtA 02668 Adodnistratur Ifs - doarorffli in a ladns an ar s g -- One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement. Contractor Registration Registration: 158587 Type: Private Corporation Expiration: 2/8/2010 Tr# 264153 T.L. HITCHCOCK SERVICES INC. TED HITCHCOCK 105 FERNDOC RD HYANNIS, MA 02668 Update Address and return card.Mark reason for change. 50ws-0710;•Pcaaao Address ❑ Renewal Ej Employment ❑ Lost Card 04/14/2008 15:15 508-790-0249 GOLDMAN & ASSOC. PAGE 0Y/e:d _ — Davl<ILtIalDelww► AaQR� CERTIFICATE OF LIABILITY INSURANCE twzcsw I -R!L 01- PRoouceTL TM CERTIFICATE WP ISSUM AS s MATMOFINFORMATION GOLD io ASSOCIATES YA4stl"MC E 0MY AHD COMRS NO RiSM %R)W TH6 Ci WFiCATE FMANCTAL SRRVIC BS JNC. HOLDER.THIS CERTIFICATE DOB MDT AMEitID.M END OR 93S FALmom L RD. ALTBR TIC COVERAGE AFFORDE0 EY THE POLICIES BELOW. WFAMIS Nh 02601 — Phone:508m775-6010 raz:500-790-0249 INSURERS AFFORDri6GtX}VERAGE _ RAICO INSUM -- INSUREta: ESSEX INSIIRANCP CO I � PIL6a.m �-m CO. SEitVI�Hg� COGS 6:ON$ ZO�T c GPIMTO $BATS lgst3pANC8 CO 105 FSItND00O26Q1 IN9UpERD HTA11NES I3A — R[SURER e THE POLICIES OF INSURANCE LISTED BELOW MANE BEEN RSUEO TO THE INSUREDNAItEO A8t)VE FOR TiBz POLICY PERIDD INDICATED,NOT ATiiSTAND�tG ANY REQUIREMENT.TERN an CONDITION OF ANY C'ONiRACT OR OTHER DOCUMENT WiTH RESPECT TO WHICH THIS CERTIFICATE MAY HE E 4WD OR MAY PERTAIN,TK=URAMAr-F0FM5YW P=r&OSCRIBEDHOM IS KIBIFCTTOALLTHETWA%VICIMMM 000 T N&OFMCH POUCHMAGGMGATELVMW=Ui%VR/iUEBEEN 6YPAM.MAM I — LTR HSR TYP8671N CE POLICY NUMER DA'Te DATE i.AIlYB O63MLLiAGUM EACH CCJRRENM 21000000 A X X c L GEX8AAL tmmu Y *3CB2332 07/28/07 07/28/08 PRSR1_ $5DOQQ CIAiLIS mas ®OCCUR OWE P¢tVen Pame9 S 5000 PERSC 7At SADV MUURY 21000000 Gem-wiaeRwATE 3 00000Q 8MLAGORE ATELMITAPPLBE3PM SDI ST:-MmwAw 22000000 POLICY PRo. -- JECT tOC _ AUTOIFDRILELIA24M OAT-EDOME41w S 8 ANYAUTO Pa=0006224230 12/20/07 12/20/08 ALL OwNEO AUTOS BODE• DNiuRr 4250000 SCHEOULED AUTOB IPor p° HIREDAUTO$ BDOB'WAMV 4•500000 X NON-0VMDAUT08 IP-- ftqq PROM fft DAMADE i 250000 raic duq GARAGE LIABILITY AUTO i-IR-EAACCMM 9 ANY AUTO OTHEF TWA EAACC S AM AE B mm MIAIIASUM EACifa Cd1RREtiCE & OCCUR CLAIMSMAOE AGGPB,AtE S _ S DEDUcram S RETENTION b g VRIFIRENS COMPBb9 IMAND tt'Y t�A11TS ER C �� 2246868 03/28/08 03/28/09 Ee.o*u4cm Tr S 500000 OyFeeFtCFRttVtEIiBEREXCtUDED7 EL�1={wF-sAe�'t sS00000 8PE'u'aL�B PRO ev�6SioNStelaw ELOI:sve.E-POUCYUMTT s 5 0 0 0 0 0 OTHER DE90RiP"TiDNf�OPERA7tOlSSYtOOPlT�1&IVEIHCLF3tEIZQ.IJ3EDN8 BY ISPECiALFR81iBtOA� M CI3MFXCAM HOLDER IS LIS= AS ADDITIMAAL INSURED ATn& AC CQRDWG :0 THE POLICY PROVISIONS CERTIFICATE HOLDER C=ELLATION SHORIDANYOPIM ARM DESCRIM POI-WS8EGMCZU=8VM TMEXPIRAIMN vAT6>R TitEiSSiIftTGBISURBRY�.I. NcE►+r6RtTOTaAs 30 DAYawwrwmw NOTME T07NE CIEWf SATE HOLOER NAM TO THE LEFT.BUT FAXURP TO DO SO SHALL WOSENVOWJWION OR LIABILITY OF Alf•KRIB UPON THE(MURE31,TIB AGENTS OR A F4WRESWATM A -------'--... AC ORD 25(2n0 " O AC ORD C is / . °. The Town, of Barnstable 9 MAM Department of Health Safety and Environmental Services 161 9,.�► Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner SHED REGISTRATION Location of shed(address) ViVage Property owner's name Telephone number 21731,0 Size of Shed Map/Parcel# Signature to ci Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction?. J Conservation Commission(signature required) I q /0 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAMS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg Opt-'r� oa �o 0 V I h 7 l 4) � oN G x Sr 0 J CER i�l Fl EU �'LO f PLAN LOCATION SCALE . . .=3b. .. DATE PLAN REFERENCE _�..1 �•rf is . . . . .. . . . . . . - r"! ' �10. :�1"0 1 CERTIFY THAT THE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE' SETBACK REQUIREMENTS, OF`THE TOWN OF F'!T �!�'T �h:�.4--:. WHEN CONSTRUCTED. REGISTERED LAND St nVVOR ; ' ,f' �pF 1HE 1p��� Town of Barnstable, Massachusetts - °•^ -Department of Planning and Development '"R'`' "B`E' " Office of The Planning Board y Mnss. `b se79. 'DrF®Mpl 367 Main Street,Hyannis,Massachusetts 02601 (508)775-1120 ext. 190 June 20, 1989 Aune Cahoon, Town Clerk Town of Barnstable Town I-la 1 1 367 Main Street Hyannis, MA 02601 Re: DEFINITIVE SUBDIVISION 4701 - SPECIAL PERMIT MODIFICATION Open Space Subdivision 41701 ; "Bayberry Place" ; Subdivision Plan of Land in (Centerville) Barnstable, Mass . Prepared For Bayberry Place Realty Trust, Jacques N. Morin, Trustee; Plan dated 12/20/08; Low & Weller Engineers ; Assessor's Map 273 , Parcel 86, 90, 91 , & 110-4 . At a duly posted meeting of the Barnstable Planning Board held June 19, 1989, it was voted to APPROVE the request to MODIFY the SPECIAL PERMIT, pursuant to Section 3- 1 .6 of the Zoning Bylaw of the Town of Barnstable, to allow the reduction in sideyard setbacks from FifteF�n ( 15) to eight (8) feet for all lots, with the EXCEPTION of lotS i , 3 , 11 , and 12 , in subdivision #701 , "Bayberry Place" . Respectfully, . N •Jos ph E. Bartell , Chairman r"I nstable Planning Board s :JEB s vktj ,. r i Assessor's office(1st Floor): ©» Assessor's map and lot number a7 — /� — /f� FJ�' , �r Board of Health(3rd floor): 's *� Sewage Permit number 106U61 .S't/eZ+r Z 9TADLL i Engineering Department(3rd floor): ■Ass House dumber to}9, \e� Definitive Plan Approved by Planning Board v -- 4a 19 h ��rev d• APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARN"STA LE BUILDING INSPECTOR - w APPLICATION FOR PERMIT TO CR a5 l-RA Is / zed ; TYPE OF CONSTRUCTION r 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 14vq-AAjis P` Proposed Use Y17 ^ Zoning District All Fire District Name of Owne inAddressI� q� ��/�D� All? Name of Builder Addresobj �L(rati/ i Name of Architect v►r / G Address � 1 Number of Rooms '/.-� Foundation Exterior Roofing —40Agf 'klFloors 417alllAtZ Interiors I ) ` J Heating W ,,(L, Plumbing Fireplace — Approximate Cost /OSi 00V Area o Diagram of Lot and Building with Dimensions Fee. �o OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstabljegrding the above construction. Name Construction Supervisor's License a No #8398 Permit For New Home Single Family Dwelling Location 100 Statice Lane , Hyannis, MA 02601 Owner Roger & Barbara Boyce ` Type of Construction Plot 273• Lot 109.010 i A Permit Granted July 06, 1995 19 Date of Inspection 19 Date Completed ® 6 19 brad . r i t T 'k: � C.V MM V 1V'W_t''•H t ,l l�._V�'_ivit �at��.i i�.��x �.��. , E��' i7EI`AIr MF.h'T OF LNDUSTR A.3ACCIDENls 600 WASHINGTON STFtE>T ^ BOS M.TOM, ASSACHUSETTS 02111 fames.; Canooel: Gom►n:ssione: WORKERS' COMPENSATION INSURANCE AFFIDAVIT IJ 0 ts (licenseeipertui ec), with a principal place of business/residence at: �s c�z(g, % iG •Pl do hereby terrify, under the pains and penalties of perjury,thin (J I am an employer providing the following workers' compensation coverage for my employees working on this job. Insurance Company Policy Number ( J 1 am a sole proprietor and have.no one working for me. ( 1 am a sole proprietor.g cncraJ contractor or homeowner(circle one)a.nd have hired the contractors listed beJo` who have the following workers' compensation insurance policies: N Tly—sltll-L c 3 cu Lf,-/a Name of Contractor Ins cc Company/Policy Numb" , Name of Cont o Insurance Company/Policy Number i 4 Name of Contraaor Insurance Company/Policy Number 0 1 am a homco timing all the work myself �cuc be awue that wbile homcowecrs who employ persons to dv maia e eonstrucpog or repair tcaaae, wo on a rd dwcliinv�roorc thsc t rcc units is which the horaeownct siso residas or on the srouads appurtenant.tbctcto arc scocralll• consiccrcd to be cmu ovcrs under the Worltcn'Compcasation Act(CL C 1.52.sect. 1(5)),applieatsoe by a botoeowoer for a license or permit may evieeacc the legal status of an employer under the Worlcrs'Compensation Aet ;. l.unticn.:.nd th::;co.;*of t.a st:tc;acm will be forwa:ccd to the.rlcoa.:mcat oflndus:rijhccidcnts'Office of lnsurar�cc for coverage vcr':,c:::oa:.rc: ::i....:c to secu:c cove—,..ec qs reauirc-ender Section?; 'oi.MGL!5-=lead to the imposition of erir:.inal penal ccasi:.:-c of:lint:o:us go 15 Q0.00�.cfor imprison::c:.t of u� to one yc: :ad cw pcn:idu,in the loan of a Stop Drop. Order usd S 140.00 a car a{:infine s:m a of .Sic cd t i day Lic Per. t •csorlPrrri: rc. w+ h f COMMONWEALTH OF DEPARTMENT OF PUBLIC SAFETY MASSACHUSETTS I ONE ASHBORTON PLACE lop BOSTON,MA 02108 i L JL ai i'd. 3vr�3`. c �aPe.v e-ccat9en EXPIRATION DATE LICENSE �r ePri�to cret ,� CONSTR. SUPERVISOR CAUTION 06/17/?995 ! RESTRICTIONS EFFECTIVE DATE - FOR LICNO. PROTECTION AGAINST NONE PJS/30/1993 THEFT, PUT RIGHT THUMB ° PRINT IN APPROPRIATE X VIARK A WENZ EL ;" BOX ON LICENSE. 4 �IHiDAH WAY Z CENTERVILLE MA C12632 z BLASTING OPERATORS PHOTO(BLASTING OP R ONL m m h FEE: MUST INCLUDE PHOTO. .03 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY HEIGHT: i STAMPED-OR-SIGNATURE OF THE COMMISSIONER THIS DOCUMENT MUST BE! � yT ,�-� CARRIEDONTHEPERSONOF T �; `-,? THE HOLDER WHEN EN-_ SiGNATUR F U NSEE a SIGN NAMETN FULL ABOVE SIGNATURE}LINE OTHERS•RIGHT THUMB PRINT GAGED IN THIS OCCUPATION jj ER R - . I O l.� i Al 1-4- 50 S�FK-'C 0 3 l /py' v BULL p�N� S �G CERTIFIED PLOT PLAN LOCATION L 9 B C . ... . . . SCALE . . ��:3�? .... DATE / iG.// PLAN REFERENCE .p�`�!vG'.. 207 �, ,�,_s ,S✓-�?k�.v o�v /��,!��% � .-mil. oa�s y PG c��. : . . . . . . . . . . .. . . . . . . . . . . . .. . � EDYyAR K 'EGG °C1 'orf,1Sii`�`.1� I CERTIFY THAT THE L L SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF e .7?9.4'?.4;, . . . ,WHEN CONSTRUCTED. DATE !!'lr�r.� �/a�1�✓��� REGISTEREDD L LAN�D7 SURV R • a `OptME TOE The Town of Barnstable O� BARNSTABLE. ' Department of Health Safety and Environmental Services MASS 1659 ''�EDran+a`0 Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 ph Crossen \ Fax: 508-790-6230 Building Commissioner Inspection Correctio otic Type of Inspection 2 � Location Pe it Nu ber g 1 Owner �� Buil r One notice to remain on jobsite, one notice on file in Building artment. - The following items need correcting: RIGUI-- "FO "DEL r4kt �L5 2-''/'� e' l Please call: 508-790-6227 for reeinspection. S Inspected by �)-. S� �� Date - g . = TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 273 109 010 GEOBASE ID ` 37559 ADDRESS 100 STATICE,LANE PHONE Hyannis ZIP - LOT 19 BLOCK 'LOT SIZE `_ DBA DEVELOPMENT DIST�ICT HY PERMIT 11285 DESCRIPTION. SINGLE FAMILY' DWELLING PERMIT TYPE BCOO TITLE CERTIFICATE OF OCUdpa*gfifient of Health, Safety CONTRACTORS: and Environmental Services ARCHITECTS:. TOTAL FEES: ��NE BOND $.00 {. � CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE ' * BAMSTABLF, ; MASS. OWNER MORIN, JACQUES N TRS ibg9. �♦� ADDRESS BAYBERRY PLACE REALTY TRUST ED MIS 44 STEVENS ST HYANN I S, MA _BUILD Nh DIVISION DATE ISSUED 10/30/1995 EXPIRATION DATE BY �� ,� DIVISION APPROVALS FOR CERTIFICATE OF OCCUPANCY TO BE SIGNED BY EACH DIVISION HEAD UPON COMPLETION BUILDING: t DATE: COMMENTS:l 14 I PLUMBING` f ''� M DATE: COMMENTS,` -� r, i. ELECTRICAL: DATE: COMMENTS: GAS: DATE: COMMENTS: CONSERVATION: DATE: COMMENTS: OKH: DATE: COMMENTS: HISTORIC: DATE: COMMENTS: FIRE DEPT.: DATE: COMMENTS: OTHER: DATE: COMMENTS: s TURN THIS IN TO THE BUILDING COMMISSIONER AFTER ALL SIGN-OFFS ARE COMPLETED.A CERTIFICATE OF OCCUPANCY WILL BE ISSUED AT THAT TIME. '' (00 S--ATccG L-Ac4e ; 14YAN1+Is L_ L0T I9 Department of Health, Safety r_ and Environmental Services + BARNSTABM McRia► ?7wt� MASS` 031 9. BUILDING DIVISION BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED APPROVED PLANS MUST BE RETAINED ON JOB AND FOR ALL CONSTRUCTION WORK: WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2.PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. • 0 9 M I A BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS Vt la'OV"f 3 1 HEATING INSPECTION APPROVALS ENG EERING DEPARTMENT 2 1.67 OARD OF HEALTH OTHER: r u / SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. 508-790-6227 --- - t y f�v$Si ,Mr :� .�' �'=^ ' �� ..� i �� � rr� �� . y � ,.� �, � �� 1� I b � i i I � � ,�,_�..e'er ��ay�, >�� i.� 3•' �1 � :.� �"��' .K , rp � Y# t�'�'✓,t- !L'H�erC+KL: = � i ..,-. 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"£'"-:�.� n '..*.�, y,t-. �ty;F ...-�..���� _``�^� f.� ' .w.'3a,�.��t�� "r� ....t' � a} 'Yt�,'Ze''�•'�� - ''�.�?' " .��'1..' 13-0' 2-8" '.1d 10-9 1 Do BEDROOM•1 o serf. QQ DINING - "4 1T.%IL' . C-D L 2=11 4 e'° 1° O --' — one ---- 5• O O ❑ LIVI NG RM. °o - 20 x 14 b ❑. t OW :o C BEDROOM-2 - . ' •Q I fall.l �1%n.l 5'Su>I N6 R . aP 5 DOOR 'SCHEDULE 0 O I ,ax-EN i I closer 1 T sere. •t - '-SLIDER i10.CG t-R'x L-!' 2-10 G-10)1'I. a� S P-L"xL-G Y"•B %L COvIRID ia�•`j O 2-4 xL-L" 2• x 'i _ PD0.CM` MAST.BEDROOM S LLs WINDOW SCHEDULE 1 14 x.lt PICTUR! N '% - Y I-L'a 4'•T �'SRTL 1 f . WEf-PIN[ ! 1 2•L% - " D WCS.PINE CSNT,243 9'•$- 3'-Sh' 1 VELVX SKYLIGHTS • -ax2 31 iS6" 4 1 - 'THE CRANBROOK scflal/=1 tt- awawloer: oa•vm e•: wrE 1991 - aensEo oa.•neo Nul.ela APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS LOCATION L.OT � f ST7"/ L' !� NO. VILLAGE DATE APPLICANT 7-504PyG'3 /U• 1Y02/h/ FEE ADDRESS /yg55 TELEPHONE NO. (Non-refundable) ENGINEER z5. TELEPIONE NO. 3GZ-ZZ ,6 DATE SCHEDULED (Applicant' s signature) ASSESSOR'S MAP 6z LOT NO: SOIL LOG SUB-DIVISION NAME Biry�G-"72,0� p4o�& DATE—' /D/,�./ � ,9 TIME EXPANSION AREA: YES NO �'D►�✓�921� C%� /��� ENGINEER TOWN WATER PRIVATE WELL S ,- .,,4 � .J'�"�t/Lt�1 BOARD OF HEALTH ��fr/ fjfj2�0 EXCAVATOR SKETCI3: (Street name, etc. ;dimensions of lot, exact: location of test holes .and percolation tests, locate wetlands in proximity to test holes ) NOTES : 00 /10 ��. ' 0 wpo / 1> � /N ' S •. 119 �SC 4-:~ PERCOLATION RATE: _Tf/f'/ll . Brit, y02N TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: 3 3 4 .s' 4 U 6 7. 7 . 8 9 r. �:.. l:a;... ►1 10 f r' -a � 10 . 1 11 .12, 12 13 13 14 •14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE :. COACHING FIELD t�­LEACHING PITS LEACHING TRENCHES !i UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ,ASSIGNED ON PERC TEST APPLICATION �ORIGINAL: .;..COMPLETED IN ENTIRETY Y P . r , AND �2ETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT }� i° k'.i w 4 Ate^ ? I��� ... i~ �:� t,„..,� d (lied GR E I�� cl �� �IAe ..-w n'�.u• ld .V _ l PP e� o„ 4G1-0„ 4'-10�� I ZN3 I iN SNUB ` 10 4'LAV. BEDROOM- 1 cr 010 cp sKYL. Qp DIN 1 NG .� 40 t2X t2' 10, I la IL LIA- �o l » cr- O - — `I :DESK. . ! _ o a - � N coo ser ♦ CL.pSET � WNEN 4'arxn4o a 4'8IFoLc V G p ❑ LIVI NC RM. ►� p -w o .� .BE4ROOM-2 . 7'X 9 DOOR 1.OPT, I -_6 PT. t I -- C LQ5 ETi _.SKYL. i SKYL.. `n 5 Slfp(NG .. I 0k1 OOF —41 WALK-rn ` ./ DOO R SCHEDULE I cl~osET 5TY L E DF.SCRIPILON - • a •_ x _19? CA, _SKYL.. I BEDROOM -- -, 4 FIRE C. 2=8"XG-8" 2- 10Vx(06 -IOAF 1 G ` OVERRD r _apT.^ �-'J I� MAST. . �, i � QX 6 =G" 2 • X�•.9yw PORCH 14 X 12 4'1.nV WINDOW N DO W SCHEDULE �----- _ f - oer:_ 1 PICTURE UNIT uX - " ' I SKYL.._ WES-PINg ZAZ± WES-PINE ?it(*-- Z-4.x 3 — D WES-PINE CSMT.ZW3 V-SA 41A 3'-5W, Z VELUX SKYLIGHTS f --#Z 31 ,X S6 „ 4 31 „ 9 "-_ 45% x 47 '1. , „ . 01* „3., .`,. > , D ' 71 — — i / N • " THE CRANBROOK ,, SCALE:1/ = 1 ft APPROVED BY: DRAWN BY: DATE: 1991 REVISED DRAWING NUMBER ti n 0 0 A _ _