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0795 WEST MAIN STREET
✓9s'lu��t'1'U�� ^'� � _ (.� i I I � I \1 t Town of Barnstable_ m to Post�This Card So That it is Visible From the Street Approved Plan Must be Reta' ed onJob and this Card Must be Kept �� Sign Permit Posted Until Finallnspection'Has Beenf�Made m Where a Certiffcate;of Occupancyis Required.such Building shall Not be'Occupied until a Final Inspection has been-made Permit#: B-20-474 Applicant Name: Sean Parker Approvals Date Issued:, 03/10/2020 Current Use: Structure Permit Type: Building-Sign r . Expiration Date: 09/10/2020 Foundation: .Location: 795 WEST MAIN STREET, HYANNIS Map/Lot: 249-036-002 Zoning District: HB Sheathing: Owner on Record: SMITH, ELIZABETH JANE Contractor Name;` Framing: 1 Address: 105 EAST GATE ROAD. Contractor License: " 2 BREWSTER, MA 02631 = -•. Est. Project Cost: $3,000.00 Chimney: Description: Put business sign(including an 8'x 2'weatherproof PermitF e: $50.00 bulletin board ' i Insulation: for changeable copy) on front face of building. Fee Paid: $50.00 Project Review Req: Date.-.f 3/10/2020 Final: Plumbing/Gas Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is`commenced within six months after issuance. Final Plumbing: All work authorized by this permit shall conform to the approved application and theapproved construction documents for which-this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Rough Gas: 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 work until the completion of the same. ggl-! Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the Building-and Fire-Officials are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Service: . 2.Sheathing Inspection - Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lin_mg is installed 4.Wiring&Plum bing.1nspections 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 contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site - , Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: i Vanguard Skills 795 West Main Street Hyannis, MA 02631 ' sean@vanguardskills.com -508-367-7503 F0.5'x1.0.'=0.5ftZ � T 9 Ed f- 4.5'x.66'=3ft' Changeable COPY F 8.0'x 2.0'= 16 ft2 Upcoming Events .Total= 1.9.5 ftz EXTREME.WeatherPlusTM .Extra Large Outdoor Bulletin Board X 2, https://www.outdoordisPlaycases.com/ StoreModules/P rod uctDetai Is.aspx?p=Weather- _ 'A ` Plus-Extra-Large-Premium-Outdoor-Enclosed Bulletin-Boards-Wall-Display-Cases#price _Jk r� .III. i Ili t �. Town of Barnstable Building °�+,` "�`k:,: � dry ar .e�.' r �.�� a arA PostThis Card So That rt�s Uis�ble Frgmthe Street Approved Plans Must be Retained on Jqb and this Card Must be Kept M" $Posted Until£Final Inspection Has Been44 :, � ° Where a Cert�ficateBofaOeeupancys Required,such Building shall Nofibe Occup�ed�unt�l a Final�lnspection has been made�� � Permit al Permit No. B-19=2275 Applicant Name: GREGORY M BOOKACH Approvals Date Issued: 08/06/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Commercial Expiration Date: 02/06/2020 Foundation: Location: 795 WEST MAIN STREET,HYANNIS Map/Lot 249 036 002 Zoning District: HB Sheathing: Owner on Record: CHARKOW ASSOCIATES LLC � Coritractor:Name GREGORY M BOOKACH Framing: 1 Contractor'Ucense C5=000682 Address: 105 EAST GATE ROAD 2 � . BREWSTER, MA 02631 -Est ProjectCost: $.15,000.00 Chimney: Description: Expand Bathroom for AdA accessibility. MoveSmk 'Expand;(2) Rerrnif,Fee: . $236.50 Interior doorways,making pne of the two doorways,a pocket door Insulation: f .n Fee Paid:, $236.50 for ADA Accessibility. Replace exterior slider witht,36"urged door. Request to start demo ASAP Final: r "Date E 8/6/2019 y3'� Project Review Req: Tenant Name? � � � � � � � �' ---- �i � Plumbing/Gas wl Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work ad 'PU'dby this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents-for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws acid codes. This permit shall be displayed in a location clearly visible from access street UUroad a d shall be maintained open for opb..lic inspection for the entire duration of the Final Gas: work until the completion of the same. ' - Electrical The Certificate of Occupancy will not be issued until all applicable signatures bythe Bwlding and!,Fire Officials are vi•proded on A.is; Minimum of Five Call Inspections Required for All Construction Work:; Service: 1.Foundation or Footing { Rough: 2.Sheathing Inspection 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) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final- Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Application Number... ..../1. .� * MASS., � � D '�l �� Permit Fee... �.�.�...� v .Other Fee: q.,,. 30iMNG total Fee Paid.............: ..... .. O TOWN OF BARNSTABii 15 2019 Permit Approval by.... ..... ..........oa..... :.. ........ BUILDING PERN OF BARNS BCE Map.... ..(�t..........'.............Parcel... .6�..6.�.� ,�....... APPLICATION Section 1 -Owner's Information•and Project Location Project Address_ �Se3� M�.;,, ��Ce c ( Village Owners Name 1='c Z��L� c�n c, �^••` Owners Legal Address U.S _ njy .�o City E e, State M Zip �F- Owners Cell # J 0 R � 0 15 0 E-mail e_c, Section 2 —Use of Structure Use Group M , ( Commercial Structure over 35,000 cubic feet � `L &"" `L"\ Lid ommercial Structure under 35,000 0 cubic feet Al o o�t"„be- Single/Two Family Dwelling Section 3— Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Acces`sory Structure ❑ Change of use ❑ Demo/(entire structure)' ❑ Finish Basement ❑ Family/Amnesty. ❑ .Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System . ❑ Addition ❑ Retaining wall ❑ Solar Renovation ❑ Pool ❑ Insulation i Other—Specify Section 4 - Work Description n r g Q r s JC- ..S'` f o. Q L`V c,1C 0 {' _' C L CA • Last undated: 11/15/2018 Application Number.................................................... Section 5—Detail Cost of Proposed ConstructioSquare Footage%'i rP ro`tj,e'cct 4 41_ti� A geof Structure , 1 ` Dig Safe Number dA # Of Bedrooms Existing Total#Of Bedrooms (proposed) /1/,C�N�,n G,P, 110 MPH Wind Zone Compliance Method ❑ ,MA Checklist,0 WFCM Checklist ❑ Design Section 6—Project Specifics iring 4 ❑ Oil Tank StorageY - ❑ Smoke Detectors Plumbing ❑ Gas ❑ Fire Suppression d❑ ❑Heating System Masonry Chimney ,. . Add/relocate bedroom Water Supply ublic 0 Private Sewage Disposal Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: o t I am using a crane ❑ Yes tom'No p ty c �� S g Section 7—Flood Zone Flood Zone Designation X IvI iA, Within or adjacent to a wetland,coastal bank? Yes ❑ No M/ Section 8—Zoning Information Zoning District WIG Proposed Use c Lot Area Sq. Ft. 0 .1 6 L r(_ J Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed } r� Side Yard` Required Proposed fi ` Has this property had relief from the Zoning Board in the past. ❑ Yes No K i Last updated: 11/15/2018 Application Number............................................ Section 9- Construction Supervisor Name c� ®ky>m� Telephone Number Address J70 L nCity S` C" State M.A Zip 67-631 License Number License Type .VS Expiration Date 0 24 Contractors Email OkYd 1V&V 6C1 IQ R,1 O© ebp M Cell # 771f, 21 Z-®'75'? I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation req ' ed by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature </i. Date l l - 4� Section 10—,Home Improvement Contractor Name k e o kAcC v Telephone Number �14 —2 (77,5 T Address) ity �F7��N�1-�r State A.a Zip 0�3) p ` Registration Number ( (�- ' Expiration Date I Z "�� '' 201 Q I I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentatio equired by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature , Date 4 NJ Section 11 -Home Owners License Exemption Home Owners Name: V,-e S m i7K Telephone Number �- ��6-�� �-� Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780. CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date 1 o l l APPLICANT SIGNATURE Signature Date Mot' , d Print Name se-C',n ����t Telephone Number 50�r 3 6 7 1S 02 E-mail permit to: Ska \/a y U S�-k `�s , con Last updated: 11/15/2018 Section 12—Department Sign-Offs i Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13— Owner's Authorization it k',9_v, ��y.Z_ S d' , as Owner of the subject property hereby authorize t)c_r-I4p,— to act on my behalf, in all matters relative to work authorized by this building permit application for: (Ad ess of job) ;2J t � ! Signs a of Owner date Print Name Last updated. 11/15/2018 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person k 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 budding 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 shA withhold the issuance or renewal of a license or permit to operate a business or to constrict 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." u 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 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-kom:d 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"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 Departinerifs address,telephone and fax number: The Commonwealth of Mas "usetts Department of Industrial Accidents,- Office of linvestigaflow 600 Washington Street - Boston,MA 02111 - Tel.#617-7.27-4900 ext 406 or 1-877-MA,SSAM Fax#617-727-7749 Revised 4-24-07 wwr;maw.gov/dia gQk The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invest1gadons IF . 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):' E, - Address: 170 e-i l Tci2A ° City/State/Zip: r M Phone#: 7 2117 ' Are you an employer?Check the app opriate box: a project(required): with 4. 0 I am a general contractor and I 6. of p �ect(r� 1.❑ I am a employer ❑New construction �.,, employees(full and/or part-time).* have hired the sub-contractors 2.C'� I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sees and have have S. ❑Demolition working for me in any capacity. employees and have workers' 9. Buildingaddition [No workers'comp.it rrance comp.instnance•t ❑ required.] 5. We are a corporation and its 10.❑Electrical repass or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.[1 Plumbing repairs or additions mysel£[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.Lie.#: 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 f the DIA for insurance coverage verification. I do hereby c ' under the pains and penalties of perjury that the information provided above h true and correct Si m Date: 0[ iQ Phone#: 0 Offixial 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#: BUILDING DEPT. JUL 15 2019 TOWN OF BARNSTABLE 44" Between Toilet CL and Sink CL LI � ry�®��� Toilet 19" From Pedestal Sink 15 From u I�J�"J'J I _ t 1 Center to Left Wall g Center to Right Wall ... _ �� _,� F roposeb"Etiy�Door� i o From Wheelchair Ramp Proposed Breakout Room 9" �••Y E. I 4^ E Bathroom N _Width 11 5 F t � s Width 6'6" ;N Length 9'1" M Length 7'5" Proposed First Floor (Commercial) Proposed 36" Door - 795 West Main St., Hyannis E Event Space _ Breakout Room II ' Width 15'6" Width.11:6" „ Proposed 42 Hallway The entire first floor is office Length 28 5 _-A'Length 8'5" a space to be used for a learning ' -. center, after proposed renovation w to make all services wheelchair - Proposed 32+" Pocket Door accessible. I - "Conference Room �r Width 15'4„ , Length 9'10" ° ~ L . Barnstable Bldg. Dept. Approved by: Permit #:i -tea DEP Jul -.15 2019 TOwN OF BgRNST Existingy r E � 1 28" Existing Slider Entry From Wheelchair Ramp Existing Existing t • Closet Breakout Room Bathroom Width 11'5" Width 3'1" � ' L L Length 9'1 Length 7'5" 0 ` O0 g Existing First Floor (Commercial) 28" Door Breakout Room II i 79S West Main St., Hyannis Event Space ;�- - s Width 15'6" 'Width.11'6" i g w 'Length 8'S" a The entire first floor is office i Length 28'S" "' space to be used for a learning 28" Door ! center, after proposed .._ renovation to make all services wheelchair accessible. a , Conference Room Width 15'4" Length 9'1WI x L .:- >. O .. - �..,! ......, y .r.:..., ..�,_. •a.., :..:w... ... �. \a `eye �b `� . 1P,w.. +aa. � �: .:� �f \'�. ..i, .. ? ,. \ \ 46 Aw a a \ JVU ik ' \ a ''� .ate �.•�:� •�� \� �,� .,•. -; ..:. .. � ��.� J0S, r' v r . it w \ \ :AV, P� - ., \ �v "AVAyy�A,�\\• y\m.w\�Aov �y �,,. �� ®t \ \ QqI A w -*4 AL t nvai L ` � [ � ;� _ Me: � ��mo {-ii u n o: at +ce a � u� €t u� n+ ss Regulation, v Park Fl. f a� \. i! nCItUre . > Town of BarnstableBuilding' `. iPost:This CardASo Thatis Visible From;the Street ApprovedPlans Must beRetamed on Jo,b and this CardMust be Kept 9 MAAS& Posted-U Cel Final lii`section Has Been Made � + `� � rt Permit ';,nti ' nrKxA Where a rtificate of Occupancy IRequ,ired,` ch tBuildrng shall,Not be Oc pied unla Final Inspection has beena Permit No. B-19-2580 Applicant Name: GREGORY M.BOOKACH Approvals Date Issued: 08/12/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 02/12/2020 Foundation: Commercial Map/Lot: 249-036 002 Zoning District: :HB Sheathing: Location: 795 WEST MAIN STREET, HYANNIS Contr`actor'Name': GREGORY M BOOKACH Framing: 1 Owner on Record: CHARKOW ASSOCIATES LLC Contractor"License CS-000682 2 Address: 105 EAST GATE ROAD - Est Project Cost: $4,000AO Chimney: BREWSTE'R,MA 02631 Pe'rmi Fee: $ 160.00 Description: Remove Load Bearing Wall Replace with 46 LVL Posts(2f and a Insulation: Fee Paid = $160.00 beam.consisting of(2)1.75x11.875 LVLs with a O 5x11 Steel Plate, Final: as per engineered plans. ; Date 8/12/2019 r r' ?; f Plumbing/Gas Project Review Req: . Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after:issuance. All work authorized by this permit shall conform to the approved application,and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance 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. Electrical The Certificate of-occupancy will not be issued until all applicable signatures by."the'Building?and Fire Officials are'.provided on this permit. Minimum of Five Call Inspections Required for All Construction Work:",, . 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) Low.Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "P sons co acting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department Final: —�, All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT IKE Application Number."... .... .......... ............ BARNSTABLF, MASS. Permit Fee.......:........... ..........Other.Fee,....................... 1639. G DEPT Total Fee Paid..... DI/V AUG2010 .......................... ...... 'r.,40t_, 1 .. 13,a pN On 00"� ....... TOWN OF BNYMST ABLY-, Permit'Approval 6y.............................STA BUILDING PERAff BLE map..Q2 ...Pamel......00.1 ............................ APPLICATION Section 1 — Owner's Infoimition and Project Location Project Address �_ Village k Owners Name. Owners Legal Address 6,k el c,)r\- city. lc� r 3�_ State zip 6 '3 Owners Cell # 0 Y( E-mail Section 2 — Use of Structure- Use Group_A. Commercial Structure over 35,000 cubic feet V(Commercial Structure under 35,060 cubic feet Id Single/.Two Family Dwelling - Section 3 —Type of Permit ❑ New Construction E] Move/Relocate ❑ Accessory-Structure E:] Change of use El Demo/(entire structure) El Finish Basement El Family/Amnesty Fire Alarm Rebuild El Deck Apartment Sprinkler System ❑ Addition ❑ Retaining wall FJ: Solar Renovation El Pool ❑ Insulation Other—Spec Section 4 - Work Description V"f-rA IC-- \QC_N r I 'A C_0\ C L\)L IR o.3 rj_ A S n c r P Ar 11/1 cnni 4 `i Application Number.................................................... Section 5—Detail Cost of Proposed Construction , U 0 Square Footage of Project s-a� Age of Structure EA Dig Safe Number # Of Bedrooms Existing Total# Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ,❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply Public ❑ Private Sewage Disposal Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highw Debris Disposal Facility: V Cea-,<< �r, I am using a crane ❑ Yes No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard . Required Proposed u � Rear Yard Required Proposed { Side Yard. Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No J Last updated: 11/15/2018 �IHF Town .of Barnstable Building Department Services " &"X"14AS&ME Brian Florence, CBO 1639. �� Building Commissioner Fa Mt++ 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 I I Property Owner Must Complete and Sign This Section If Using A Builder I, E I 1 Z cwo'effi-` J c 7e S,`"`6V `\ , as Owner of the subject property hereby authorize &(ef., O4 4 Lx^ &-c^ ke�kclr to act on my behalf, a-, in all matters relative to work authorized by this building permit application for: (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. Si nature of Owner Signature of Applicant Print Name Print Name U 1`D1NG�EP�. Date �u AUG�•9 �p19 �F g0'NSjNb�E Q:FORMS:O WNERPERMISSIONPOOLS Rev:08/16/17 WOW v VI R V _ ti�ssfo -a- lAce nWe 'fat"on nda .ds a I vd' "7 Ir �� r, ANO S. MR, T ........ " go Al" 0 1202 5108 02 1Q� 01 M IN M A, 7N -A SN Nil R, IM RI, im N.RPR R T;z jdrin, viws,,�onl rdtf6ai villd f dh` lduall v p the:exp ir ma to: rner Of "Aft,i'r, �§U ness Regulation N id Perk"AW butte SI 7 \\\K 152111, 'p, so n MA. A, re %,\sW 6iiW ...:•..:.L..w._' � "^" „,a_m'.KK,sa. v, Y,,., �:w. L:.,naw� ,mra�,,.w�y r'�r'Z� µ.,M�'�i// ��';.�'s% f7�� s.`.;:.+:... ..a�'.. ,i✓.':/�'kkK1.� G.M'.. ^.u'ranu s aY IF G:. 2.1��..�,.x( aRrw�W'.: � - fi...s4.j# _ .,•rvw r,w'r + ,,. ii :.. -...,.-wma-».»4-. �::.;,�}.. �yµ „ x r.,.�� M i ,,, �,,,y»,.« 9- .'s„`°.`p""` ,..d ,...;.,.,. „F..,,•,.,,,:..rry .va.<. ,.. r ,„r. ,j.,.w.,..,...�v $w.«d m ''"`. " QM• NVV .. ji ol ..r �� -" '. nr.: • 3 4�E .Y e • wr v,.+o µ-. '.• _ K r.rrY+--n • � .�{ 7 a. _ r n�r� ,.sa Y, � '? JANKA w l! rry Y gg a _ y,v r w w, D0T114 G�l3S •' , LJ r ` x10 , sae w x AA f "�"�, s4,-,"�,. JAWO, t P 1 , _ �Pg�E • j o CO Existing o m • q......�.. .w.�.. .,...,.. .,.., :use. ,..w. ... .. ..� 28' Existing Slider Entry Provide(2). 4"x6" $" • - rp From Wheelchair Ramp . ��`p® ®��� LVL Posts-- - Existing UU Closet Breakout Room I ` , Width 11'5" Existing First Floor (Commercial) a o 1 Length 9'1" � 795 West Main St., Hyannis 14' I o ` r ....w. .... .w The entire first floor is office 28 Door space to be used for a learning y ' o Breakout Room If center, after proposed secretaries u` VidthAVV' Window ..r renovation to make all services \28" Do r- is 'Length 8'S'' wheelchair accessible. j �28,,.Door I, Proposed Removal of 15'6" w � > Load-Bearing Wall to be 15'6" Existing Load-Bearing �� Conference Room " Replaced with (2) 1.75"x 14 g .w 11.875" LVLs with 0.5"x11" _ Wall to be � Width 15'4"w Steel Plate as per Engineered Removed w' Length 9'10" Plans. f _. .......... ...........�,..e,...o ,,....-w�y5[ a a � Barnstable Bldg.Dept. ,pO,zA- r XppcoVed by' permit#:_. Application Number............................................ Section 9- Construction Supervisor Name (,Ce 0 ; &Al , Telephone Number -7 o 7 S Address \70 ck 4-Q,, City c. State Zip License Number 0 0 0 b 9 �. License Type Expiration Date Contractors Email o oCK V� 2 Low Cell # -]M a`7S I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 7 0 C and the Town of Barnstable.Attach a copy of your license. Signature Date kl c� l l P\ Section 10—Home Improvement Contractor Name e Telephone Number °7 7 �( a. I a• �-7 5 Address V'�0 �reen�, ����. City c,ws�ro' State _Zip f - Registration Number. y S Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 MR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Nam. L �iCLti •Date LC L' Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT IGNATURE Signature Z/ Date r1 Print Name Sc c"'-A 90'rkr,r Telephone Number S 0,F 2 6 `7 75 6� E-mail permit to: Sc ( Vc-' V k c + 1\S' 0 vn r Last undated: 11/15/2018 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ r For commercial work,please take your plans directly to the fire department for approval • s Section 13— Owner's Authorization I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of j ob) Signature of Owner date I I Print Name CIIA 1, t, (N i Last updated:11/15/2018 CO " 11 R A.L rc:� c a t"N PESTtONr PLAN: P Pr ,E.. t.. ~�, .y a � '� ,aYsA ,* iy'+ :,tiv t�+� `YnY" •"aW fide. 5 v u: c ,yj*, x�a �� '. may."5�,t� ppk rtff� ,><" v�• U,0, w." 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"'^a 1F ^e -; a ;.:a:.. ..r, ...a»` =,a. .•.a .,:-:y .^: ^,za:„°'" .,, wv.` � arr.' ..', 'r iA4� aaa .Y;s? <azs+w a ^a,*0? aaar m.,a:,sr Y eta", 7 pll cgi7 E�tZGi 12S I�GiI?G', YYItY t m , � as D a. ag L®fib P1AIlE N(p25001CQ564) FLy"m i D ZOtIE; X .= e m 95s. V 3 �H l'AN`Nl' S w o y _ t2y crty;fit"this p1rr ,wspreAredfgrtaya� p � so2he � � " 'R � �, � z:F�.•: e area f fl t e` g bpt�SCYL1 f10 �W tit Y2S QG Al i td.'P'7o ZdY1taC' N "� O ate aTalzdt �tb �' Ql �m�4� Kn s 'is-,w2raX Q�2a t n�ctcl �or arecoYc!! g pCu2rY aVd2sVetsk AoCY 7f0dY igck�YGyi e? Y,�a-hISHSID13 ,._ e>i�z pYepar n eecl` descripttQv�� l ert rcA tatty �f l?u�Iding tocAt�ov�s, property tine ; ,Date.'-3 ahe'2't 2019 I ns ns, fences or lot chi t tguYcttrot neat kte accoY�pitshecl� o�r1y by an acwrate"; `itleref 19��5-3 1 Yt�Y2VfSLf/VG1�Nl�t[CII�IG�'YeCttffE�tlfdYlYlLifbt{?G1iIW{1Gt1SSYldWYI'S1(eYeOVI^ '` FILE NO;19 11�1 t{ "} l •]flLdt ? SUR+ Y .IQtSF®R�YMGIRTCAGFUk ,POSES•C� 1LY �N . 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Pl�tiatiU* .4 C , kspplatt rVl2Ut u lob .4' F Y - ' z,nk� , '. a ', , Ea ,k3, ,q A.�. e�0 A�.@ l ^f �.. 4 4. , � o >.:rv,' s ,x,"✓" ".a2�g6i"�Yy^ ;. .,z ` aEzP ik ;y'a � o ? p,,,��� e � " fie. ^ btiVt(� � "�� �(t ' ,.?i t� L, wz a ", �th4 msphalr pASs�f�ic �izm m .. ��a nay r ry���� tfvccvottci"tMe�ct pos's't:bfe Lisj? 4' ti Ogsph��f.- ak,4 `A—1 %: „ �° c �'."�' �4�' �. �' al ��.'akdt t'�4r;z A�..7 �uti "✓.ro"hktik i 9r t 1 i ep'+�„x� FLOOD PANF�NO ZSCa�?tCO564 J .FLOOD ZONE X a ,hereby certify thcit this ptar -was prepared far Atty Ma thew p J1t2simmons-, e, a sl'rosrhr�heec; oe� tttrTicts ,lal} M food hazard�r ea ,or , with an effectrve date of P6 f4 acid the tlo atroh of the br yldiho sloes conforvn to FQ aP a � l2x�hIn e zt th t� e�of c s ruct7onw it' respe�Ito hor�z©ntal � �4'v��s �x � �� ahafsetback regcr�r. eh or, rsexentp one �tolatr'oh enfor=.m ntac�ion " vtdeC �h �r4 Sect z;`Chis pldn was not made for recording purposes or fors Sq. ] =t5 -�" p>reh�rrng de e�t�p��ort����1�el�cat��on �bulldtngloccrt�ois��a�o�ae�y Irh�y , J�v�e�t irnetsu�ns, fences or lot cohfigurat<on may be accorhpf�shed only by Oh accurate rtle r 1�SiS 321 - strrehesuruey; p7eltertdierehtttfor�atro han whr�+s s'lown reQn FILE l0 lJ=t�CI °. 'T"t-fIS�1*K3�t'A t�3S..1h1L)ARY�11t��E>'ltiNQ�t�1;OR Iv1�RTG,a.�E"FURF'OSES©t�LY ,. �_ N IGOBph}�Y; IN ; 7_t o �� az, ��ea�FAX�at az�-aa � nnA�t�co,�HiALSURVEYOGM v https:Hdrive.google.com/drive/u/0/folders/15KfrM30SD8fKsx1XIajA4UaPk2bHU9Ft 1/1 �Py�FTNETOk o TOWN OF BARNSTABLE B�gT L Office of the Building Inspector Mne6. 'Op 1639. ` aMA�" Date .......August. . . ....17..,''...1987 ............... ..... ... ...... Fee .......$.2.5. 0 0 Permit No. .....87-82 ................ PERMIT TO ERECT SIGN IS HEREBY GRANTED TO. .............James V. Kowalski, M.D. . ............................................................................................................................................... D/B/A wine 7S west Main Street LOCATION ........................................ ................................................................................................ .... Hyannis, Mass. 0'?6 J/ ............................................................................................... ........................................................................................................... ANY VIOLATION OF THE SIGN LAW WILL CAUSE IMMEDIATE REVOCATION OF THIS PERMIT --.....,�� Buiidmg Inspector f *' c,, 0 ♦. �� °; TOWN OF • DARNSTAD•LE ' n 6UILDING . DEPARTMENT "T } TOWN OFFICE BUILDING •ut ' HYANNIS, MASS. 02601 APPLICATIDN FOR SIGN PERMIT DATE August t9p7 Application is hereby made for a sign permit in accordance with the description and for the purposes hereinafter set forth. This application is made subject to. all Rules and Regulations of the Town of Barnstable , now in force or that'm;y hereafter be enacted affecting or regulating thereto and which are hereby agreed to by the undersigned applicant and which shall be deemed a condition entering into the exercise of this permit.' INSTRUCTIONS • 1. This application must be filled out.completely. 2 A drawing, in duplicate, showing the shape and dimensions of the sign, lettering on same, height, method of securing to building, or if freestanding, method of erection. Drawing must show sizes of structural supports, and size and depth of foundation. Y ,z SIGN LOCATION wr,er- Tames Kowalski , Me 1). Street•- Rd. We st Main• Stree t :)ning District- ' Fire .District -..._.. _ OWNER OF PROPERTY \Jame James. V. Kowalski, Me D. address West Main. Street ? ,;ty Hyannis St MA Zip 02601 Tel No.( ) ;IGN CONTRACTOR Arcs Code Jame Hy-Line Sign Company address 541 Main Street ;;ty Hyanni s St MA 02601 Zip Tel No.( 771 -2220 ype of Construction -Wood Area code Free-standing -Free Standing or Attached DESCRIPTION DIAGRAM OF LOT SHOWING LOCATION' OF BUILDINGS AND EXISTING '{ SIGNS WITH DIMENSIONS LOCATION 'AND SIZE OF THE NEW SIGN TO BE DRAWN ON THE REVERSE SIDE OF THIS APPLICATION. Is there any electrical wiring required for this sign ? Yes No X If "Yes. who is the electrical contractor 7 ea �� FOR OFFICE USE ONLY xmiT Fee , gEATE DATE DEPT. ROUTEROVED REJECTED INITIALS I + PLANNING ' all permit to: & ZONING #f ELECTRICAL INSPECTOR BUILDING' /7 INSPECTION j 1 hereby certify that I am the owner or that I have the authority of the owner to make application, that the informatio.- ,en is correct and that the use and construction shall conform to all the Rules and Regulations of the Tgwn of Borns:: ,ich are imposed on the property. ,y yr i tvo1g; `7 0 , -� 5 l •t � Y h { .`1 t_ �,5dt � a S � � t ' -..• �'ry' it QOtOber .��� - {, *.. t I, t 't y 1 • ',,fix $ " t r � b e = ,f 1 975-111- Nir..`,• 'CBignani ) <R 1 y tl ; L r• f V Y Mr. Benjamin Grae si w i 795 west Main Street'. -, � -. �Hyennis�' N�aesachusetts 02601 . •.' •. °`- ''. �3 Garage "; .'.• Y f 'C t .Bear".Sires � •° 'f ' I have dieouaeed 'the matter of your garage with Town �.counsel. - He is oP the" opinion" that; due to the deoision rendered in your appeal number 1973-18t in which your;houee �' � � t ' was determined to be a non-conforming .uses your house is_a - non-oonforraing use y � Y , Therefore theBuil� dingy Inspector will not be:abl®' to a, issue a, permit construotion of a garange without Por spocia.. permit. for ,that purpose from.the Board of Appeals. Our, next hearing 'date will,be the 21 st •of Nove�ber•'_ � ., L � _ { r~„ �` r Ia order to have your appeal heard on that'.date,: your appeal inuet be filed,on or.before Novembe ' r 2� �973.�e ,y 5 Very Y �I v`�'�t� -yM'+y� P s ` p oos Mr. Josaph"DaLu� = d `' � htf ( F � ,st uiS'ding Tnepeotar Y� �.tt{Y ra� M 5'j r y t. ;rr _ r '+.µ S a t a;• } ; •r' k erya i •} r 'r a t Y f Y 5 r r L f ! Y v _ t t{k 1 1 Y ... .. ... ,. . ..,..-_ : .. ..r.r.t JL �:.C`..,. 1�,:v!•.n F.�. .. .i r..$ wet.�� .'..s,i� hra.,... s. •� 'r, .,i.£v o.. ..li.. „ •f h }.5. ,l .'t!-. .� TOWN OF BARNSTABLE SIGN PERMIT PARCEL ID 249 036 0.Q2 GEOBASE ID 15757 ADDRESS `, 795 WEST MAIN STREET PHONE Hyannis ZIP - LOT 1-2-3 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 19034 DESCRIPTION JAMES V. fOWALSKI, M.D. ( 10 SQ.FT) I PERMIT TYPE BSIGN TITLE SIGN PERM T CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $25.00 BOND $.00 Ox " CONSTRUCTION COSTS $.00 753 MISC_ NOT CODED ELSEWHERE * ■ARNSTABLE, # MARS. OWNER KOWALSKI, JAMES V & J i639. A� ADDRESS 795 WEST MAIN ST IMI�►� HYANN I S MA BY ILD IOl� DATE ISSUED 11/04/1996 EXPIRATION DAT / The Town of Barnstable a Department of Health Safety and Environmental Services s A�� Building Division . g Q•3 ,q( �.+ 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Application for Sign Permit Applicant: r)RIVE-5 I_ d:V`✓/9 4, 5 e/ Assessors No. 00 ,9- Doing Business As: .-M/VlES- i/. A<6 elephone No. Sign Location Street/Road: `795 7— M d//t/ 7— Zoning District: /��� Old Kings Highway? YesAtEo Property%Owner Name: J.19"d7.5 V. S Telephone: Address: Village: Sign Contractor Name: CL 115S � .S C '/6/V 5 Telephone: `7-7/— Z Z Zb Address: 2 7y /�/2�7/ �7- Village: /VG9ti2i� C 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/ (Note:Ifyes, a wmmg pelmitm required) I hereby certify that I am the owner or that I have the authority of the owner to make this application, that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent: _ Date: 9 Size: �� 2 Si, Permit Fee: _ZO� ' Sign Permit was approved: ✓ Disapproved: Signature of Building Offici Date: 795 JAMES Vo KOWALSM9 MoDo MSEASES OF THE SKON �LAGtC 13r1GK620Ud�� I , i F4 � 7 • ,. _:, .x. �'%� � J � � - Z - 3 ' � 2�� � r .� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r ' Map ' Parcel (036—W2 �� 4 Permit# 1179?c f INI Health Division ' 00 Lo IN'SSTALLEn IN CC"'�yUI N Date Issued Y /e ®© Conservation Division Ufa �`r,zJL �,� ,,� Fee Tax Collector Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis �� Z r, Project Street Address '7 c?S W CS'[' r�-'I At N " -�- Village Owner =�M r_s K caw 4LS t, 1 Address ,,P}M 1= 3 . Telephone Permit Request 1RS t'k q os T R:0T t-,F_-12 ADS S tL� 9-ILt'1.NCV-_ stAF-f�� t H 1pl 9 6, j4S tom.F Qu i rzyL o Square feet: 1st floor:existing t2c4d" proposed b 2nd floor:existing AZCV _ proposed O Total new O Estimated Project Cost SooO Zoning District �A 6 Flood Plain W A Groundwater Overlay Construction Type PAR Y Lot Size I.q AG Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family 0"' Multi-Family(#units) Age of Existing Structure 1&0 Historic House: ❑Yes 21To On Old King's Highway: ❑Yes C-Ldo`o Basement Type: ®'Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) t z co Number of Baths: Full:existing r� new O Half: existing new O Number of Bedrooms: existing new e�) Total Room Count(not including baths):existing "7 new c�:> First Floor Room Count Heat Type and Fuel: 2,5as O Oil ❑ Electric ❑Other Central Air: W�Ygs O No Fireplaces: Existing eo New U Existing wood/coal stove: O Yes CHFfdt- Detached garage:❑existing ❑new size Pool:O existing ❑new size -Barn:O existing ❑new size Attached garage:❑existing O new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial Ues O No If yes,site plan review# Current Use Proposed Use s AM m BUILDER INFORMATION Name kRwseS it IYI1N9_N ! . m7NL Telephone Number So S • 4 2 B .G t 06 ` Address E5�x 31 O License# CS n f(,179 ©F 2Yc IJe MA Home Improvement Contractor# 1 o©t 3:1 b2[ Worker's Compensation# WG`S 9 8003 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN T S L? M PrC.or� S A x rrPN R 4 R2r_'F N- SIGNATURE DATE _ Q ao f i FOR OFFICIAL USE ONLY f .: IL PERMIT NO. r t DATE ISSUED { Y t MAP/PARCEL NO. �'�' .` � f# •» /f. # .- .-, ADDRESS - QA<"-•. VILLAGE � OWNER . � t � _� � . •p <.. ' �- t {{. �e DATE,OF INSPECTION FOUNDATION - FRAME .� ., _� � _ ;_ '-{ •. � _ INSULATION, N4 FIREPLACE ELECTRICAL: ROUGH FINAL .iT. PLUMBING: ROUGH FINAL 1 GAS: _ ROUGH FINAL t r ' FINAL BUILDING t DATE CLOSED OUT ASSOCIATION PLAN NO. f , 's' ' �F THE Th, do The Town of Barnstable netu+!MnucE, r ° Department of Health Safety and Environmental Services �p i63q• � reo 39. Building Division 367 Main Street,Hyannis MA 02601 ' Office: 508-790-6227 Ralph Crossen: Fax: 508-790-6230 Building Commissioner For office Ilse only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 1,12A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of -in addition to any pre-existing owner occupied building containing; at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, Nvith certain exceptions, :110►19 with other requirements. Type of Work: go-7- 12 a Pt4\Q, Est. Cost 's-000. Address of Work: ? 9S BEST 'M A►N STR SET" — HYANNIS Owner's Name TAMES K01e�l1�;-C1 Date of Permit Application: g • q 00 I hereby certify tlint: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING TIIEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER IY1GL c. 1,12A SIGNED UNDER PENALTIES OF PERJURY E I hereby apply for a permit as the agent of the owner: - _ Q, Q • bo �oGC rZ5 - l"1�A 1�Tl C `� T I�IC� 10 O l 39 Date Contractor Name Registration No. OR an e Owner's Name -- —� Ilse Cornntontvealth of Massachtisetis. j Deparintent of Industrial Accidents _- Office of/nvesUgadons 600 Washington Street 1 Boston Mass. 02111 Workers' Compensation Insurance Affidavit name: location: city phone# I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity dam an employer providing workers' compensation for my employees working on this job. company name: address.-: x 31 O city; �Ste-r :1, ��k! OZG.C� 12hone th S-O B AZ 8 610k insurantesco r-- WST"i;GZ N G 14!=%o►*`tT�e policy# \UG 9 577 9 O n Z 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who ha.. the following workers'compensation polices: company name- address: situ: Phone#.. tnsurancs eo_ policy# company name ` a�dres9:� - w city: Phone# insurance co. Policy# Failure to secure coverage as required under Section 25A of N1CL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 andiu, one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. !do hereby certify and r the par s and p a/ties of perjury that the information provided above is true and correct. Signature ROG — N pate $ •9 • 00 Print na me_EOO e. k] � COO Phone# CO 9 2a• 610A Ccontact ly do not write in this area to be completed by city or town official permidlicensett " Building Department (� r _�Liccnsing Board f.. mediate response is require) oSeleetmen's Office { 0I1ealth Department n phone M. flOthcr (—iscd 1P95 MA) Now Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of!tire, express or implied, oral or written. An employer is defined as.an individual, partnership, association, corporation or other legal entity, or ady two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter hav been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns II _ 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. Pleas be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of,.Investigations would like to thank you in advancefor you cooperation and should you have any questions .o flia , please do not hesitate to give us a call. µ �. ,.. ,tip '�,•, r .., �, , IN- The Dapartme.�it's aid;ass, t�f�nllc and !`Ix aus .. :t. T[.c I Ctt:lt'{"1'::1: C, !"idU- if'_ r1r�::... dffIice Of hivestigatialls 600 Washington Street Boston, Ma. 02111 > f:<,_,'N' 7l: ((17) 72.7-7749 �/LC �/dpL))L49LLlJEQGC/L 4�✓v(QdJQC� . BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 016174 B i rthdate: 05/07/1939 Expires:05/07/2002 Tr.no: 26118 Restricted To: 00 CHARLES D ROGERS 300 BAXTER NECK RD �': �✓' ��eocTnfJC IWI 1 C MA WFAR 0�iminicfraMr ✓fie V�anv�r�onc�e�z�� a�����a�c�e� . Board of Building Regulations and Standards One Ashburton Place Room 1301 !7 a r-,r;'I!ii I rn ra r r„ ri I^ll'!- r�.,i..l t Y- ., t .r R 1". F..'r cil 1 t r a r Ion 4 E i:•r":+! i0"? Tv n o P - i. a t^,• r` ,,_rt- :l ie i�orn�no�uavall�o�./llaalae�eu.;e, T NONE IMPROI)EMENT CONTRACTOR Registration: 100134 nnCFPS MARNEY , Ih1(3 , Expiration 6/9/02 Charles Rogers Type Private Corporatie r' .(D u0X 310 Osterville MA 02655 ROGERS & MARNEY, INC. Charles Rogers G� A7 � ' t�� 445 WEST BARNSTABLE ROAO ADMINISTRATOR Osterville 9 C MA O�SS. Town of Barnstable Approved i,#';" Regulatory Services Fee ';'7 &--0 Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Officer 508-862-4038 Fax: 508-790-6230 Home Occupation Registration Dater (71— Name: ► 11 - `��ds Phone Address:Dg5�k)•Mdm Village: Name of Business: A�;T c-,oY--4a '-�—t"� S Type of Business2 CltvA17 s CQ MPX C�q ' 4C Y°Yn0de 1iMap/Lot: 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. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. , . • No traffic will be generated in excess of normal residential volumes. • 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. • There is no storage or use of toxic or hazardous materials, or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • 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,hav ..read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: 6 oZ Homeoc.doc TO ALL NEW BUSINESS OWNERS DATE: . , Fill in please: APPLICANT'S ". .` `t. YOUR NAME: ®� h)y- BUSINESS XOUR HOME ADDRESS: (50) '95 6 1 all TELEPHONE Tele hone Number Home NAME OF NEW BUSINESS TYPE OF BUSINESS Ce IS THIS A HOME OCCUPATION? YES _NO Have you been given approval from the building division? YES= NO ADDRESS OF BUSINESS ��� 1�YIOI I V1 MAP/PARCEL NUMBER y 9 D36 D 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. Once you have obtained the required signatures, listed below, you may apply fora business certificate at the Town Clerk's Office (Ist floor - Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street).and you will find the following offices: 1. BUILDING COMMISSIONER'S OFFICE This individual s been i f rmed of any permit requirements that pertain to this type of business. Authorized Signa . COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. 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: Business certificateP (cost $20.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate - you must get that through completion of the processes from the various departments involved. **SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. Assessor's map and dot riumber� .......................:'' THE P�pF tp�♦ Sewage Permit number .! c-&*... .1'< +�!� ,. N � Z BAB & E, i Housenumber .............:............... ........... `.:. .......... •...,....... • 9�0 MAG039 Aj�p MAC a' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION F uc-,6 `��` lC� ... ............................. OR PERMIT TO ......... ............ . ... .. .................. 7 TYPE OF CQNSTRUCTION �'" � t= ................................. . , .............................. , ..... .................. TO THE INSPECTOR OF BUILDINGS: - } The undersigned hereby applies for a permit according to t e following information: Location ........... 63 .................................................. .............. ....l......................................... ^� . .. .................... ProposedUse ............. ..................... . ........................................ ..............................,...................................... Zoning District ... ....M ..................Fire District ............ ............. ..................................... ► .. tF Name of Owner -..P3 .....`- .!`....L7E...�. `....� Ad rd ess ... .:... 1-1. ?....... ... 4 Nameof Builder ..........`�-�, .................. .................Address .......................................... Name of Architect ........ .......e�(-A4..Address �L�. ..��............................... Number of Rooms .......... .�..>... ...................... ............'...`....Foundation pcoox ....Cb...�.e ........................... n .... Exterior .' fC .... . . .:4� .t`1.. ...................Roofing ...... �r. ................................................................ Floors 1�.... A ....................................Interior ..3:�6 '-fOC- ......................................... Heating ..............................�,;......... ...............- ` ...................Plumbing b ................ .�......................... Fireplace .........."O!V 4re.. ............................................Approximate Cost ....4.,1,,,,,, Cr��.:...�............................... .. .. Definitive Plan Ppproved by Planning Board --------------------------------19________ . Area < a �� 1 J .......................................... Diagram of Lot and Building with .Dimensions a Fee ��21 o U ...... ....................i................ SUBJECT TO APPROVAL OF BOARD OF: HEALTH EChecki %, . , ' Pondside Realty trust .� P. 0. Bx 717 e � • Centerville r� _ � I as I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...... ^� 4?.....1....:.0 ? ...... T 1 A=Pt of 249--36 PINE GROVE REALTY TRUST No Permit for .,Build.................... Commercial Building .................................................................... .. Lots 1, 2, 3, 795 West Main St. Location ................................................................ Hyannis ............................................................................... Owner Pine Grove Realty Trust Type of Construction ........Frame ................................ ............................................ ............t................... Plot ............................ Lot ................................ Permit Granted ..,. A.taguat...2.5.,..........19 81 Date of Inspection. ....................................19 Date Completed ......................................19 -PERMIT REFUSED ` ................................................................ 19 ..............................:................................................. �. ............................................................................... .............................................................. ............. Approved ................................................. 19 ............................................................................... ............................................................................... y ` ; TOWN' OF BARNST'ALLE permit No VAUSTAM .Building Fnspector >' 0a� � Cash t ) OCCUPANCY i :PEiZM,FT Bond. -_ Issued to Pine Grbve R.ea y1 `I'rust Address Wiring Inspector ''a ;ram-%-�- " Y Inspection date Plumbing Ins'pec`or �- -t;_—, �. f Inspection date, `rGas Inspector. ° t �`Z2.%! o Inspection:date Engineering Dep in neent 4 ram! Inspection date ,Board of Health Inspection date« i ,r THIS PERMIT WILL NOT BE VALID, AND. THE BUILDING SHALL NOT BE OCCUPIED,�UNTIL. .. _ SIGNED—BY THE, BUILDING' INSPECTORi.UPON;:•SATISFACTORY COMPLIANCE. :WITH:-TOWN', REQUIREMENTS AND IN, ACCORDANCE WITH.-SECTION 119:0.,OF,THE MASSACHUSETTS'STATE r BUILDING CODE. ............................................... .... ._ .... Biuldina• Inspector THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA )13o%�j s map and lot number .....,... .A 0 ra � !.. J ge, Permit number ' Q co . . SEPTIC SYSTEM 51 4 ..;7.�'rkl.�� .... ............ �JMMpps�0 IN CU��:`, ousenumber ._.......................... ......�.� ....... yTTIE .�� r i'B9BBSTADLE. i ''c M639 TOWN OF BARNST*BLE' BUILDING INSPECT Il- k- r-;APPLICATION FOR PERMI TO .... .. .. ............................................................. y.. TYPE OF CONSTRUCTION �`''dC.-IC ' ...... ............................................ w ........ ��..............19.. .� �. TO THE INSPECTOR OF BUILDINGS: p 1 ' The undersigned hereby applies for a permit according to t e following rmation: 9 - 2 V�� �' A 1.!�...... .. ................ ��.!��..5...........:... Lpcation .../� .......)........................................................... ProposedUse ......�.�t.C:.�..��.............................................................. ................. ................................................. ZoningDistrict ...Q..�ao ..................... .. ....................Fire District ....... .. ......................................................... ... .... (AD Name of Owner ,.1..10.1... �1��...... T�Tress .. yL .......... .:... !. ?....... ?......:..... . Nameof Builder ..........Z M.��............. .. .................Address .................................................................................... Name of Architect .............:?.�? ` ` ...- ?!`�.. ...CG� ...Address Q Number of Rooms .............C.�................................................Foundation .. ..QC ... .....�.�:........................... n Exterior ....�. K- .`'..?...................Roofing ...... ... P............................................................... Floors .... Interior .. Q�C ............:........................... / seating .............................`�;. ....... �.�-. ..1.................:Plumbi;ng ....`-� `!` .................... �. . .................. f � C 1 Fireplace ..........Ott®JV ............ ................................Approximate Cost ....... .. ..Z� ......................................... Definitive Plan Approved by Planning Board ________________________________19________ . Area (..�.t�v.. . ....................... (Cneck� Diagram of Lot and Building with Dimensions Fee .........................k .0) . ............ • SUBJECT TO APPROVAL OF BOARD OF HEALTH 11 Pondside Realty 'rust P. 0. Bx 717 Centerville I hereby agree fo conform to all the Rules and Regulations.of the Town of Barnstable rrding the above \��j construction. � . s& -�4 UC6 Name ..... '. ...., I, FEALTY TRUST s 05 permit for ' Build Commerci l . ............................ Building �'``p .......... location Lots 1, 2, 3., 795�i.�ain St. ' Hyannis +4, ............................... ........... ., ................. z Owner ... ...............................................................ne .Grove Realty Trust - - -- F fi Type of Construction ...•.tame.. AN , ......... ::...... ........ #y Plot 1G ' �.� i �'✓ T - '> Lot r x Permit Granted August 25, f19 81 f Date.of Inspection ........................ �. ...r19 Date Completed ................ .... .. ... 9 ' PERMIT REFUSED . ............... .V .. 19 .. .......... . .._ ................. i� .................. ..... . .. .....................� . ............ _� r o ..... ........................................................... ... .............................................. ........ u Approved y� ..`....................................... 19 ................................................ ............... . ................... ........................................................ H aF « , -t � .j " ��oD � SF' ( K.• t�Of filCHARD � A®r No;24048.. ' I •"� �� ��� '.. � _. _ mac. c.ALC �� Z7•AT� �-(� '83 , G T4AT THE OFFtcff Pt..n.� RE>='Elz ►.Ic> 3v�c..b 1 h>4 1 S LoGA.TrE -oW-- -'f"A a , Is for 'L � Q .W A-tIcT1i-� IN 7 }E pc.A� fivi� WE9T' FNE KzA� Ft.oo:D " Pc. 1 +.1/ -DlkTt� FPS 1 o,19g1 -- - . -- - _ B,4-AT CtZ u,(E "wo SueVGYotZS UN AN OSTEfL�/\L�.Fs o MASS. TN1� VLAN "IS UoT BQ►SE'o . UJSTevME1JT SuiZV�`f TI�� UF�S�TS Siaoe=l.a /LPPI.I GA.tiIT' P D24L R-A� IQ e�QyoFI INI E TOWN. OF BARNSTABLE ]BARISTABL V NAB& 039. a N BUILDING . INSPECTOR (yn-S 4,3-- ��(3,j APPLICATION FOR PERMIT TO ........ ..........4....................................................................................... TYPE OF. CONSTRUCTION .......................................... ./. ............... -97, ................................................ 2- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit` ermit according to the following information: Location ... v'l 'Yv. ....................................................................... ........... .................................... - vti ProposedUse ......................................................................Y.... .............. ....................................................... Zoning District ......R..e).......................................................Fire District ......... ..................................... ..... .... ..... ....... .... .... . .... Name of Owner .............................................:% ... . ................... .........Address'7 9 Vk Nameof Builder ......................... ..........................Address .................................. ......... ... ........... Nameof Architect ..................................................................Address ............................... ...................................................... ► .......... Number of Rooms 2#.................................................Foundation .. .. ........... .... ..... ............................. Exierior ....\;.1-.1 Ii-te........ ...Roofing ....... -.A......................................... ......... Floors ......io..7?01/.......0................................ 0").Q ...........Interior . IN v.................................................................................... 9 ... .......................................Plumbing Hedtin ........................ ........................................................... Fireplace .............K 9 ....Approximate Cost ........ 4- ................................... Definitive Plan Approved by Planning Board --------------------/11 -------19--------- Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH > uo > > -C M N"s�j > Z -< 0 > G) > rri ---I M W 00 Ar M rn 0 :< rn ;0 Z q) 0 -Tq 0 0 > V5 -'D C- C,) 0<; - --i > M ;0 ri > z -C > 0 -1-- M. 03 (f) > > o G) r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............................. Gfraos1 * -�^^u�"`�' ' , lAnRR add tm.No ..�����- Permit for ---.---- � �� � ) ..--.�.� ���...�.� � ���----..-----.- . , Location ..........7g5..West ..�aio..St. _____.. . . _.__.____.Hyannis_____________ / GrassiOwner ---..��.���.��.------------ '- Type of Construction --. �r�»»e l ---------- ---.----_..-.---.-----------.. � ` � � Plot ............................ Lot ................................ ! ^ / Permit G,onna6 ............July-Jz.�.......... 9 73 . Date of Date Completed ^ - � | ~ . . PERMIT REFUSED /.--------.--.-.--------.. lA \ -------------------------.- ' -------'-'-'-----^~'~^^—'~~---'' . .,---.~-.---.-....,.-~.--..~-':--... ' .. ,-.-..-----.-.----.-...-.-.--... � ^ ^ ^ ' Approved .................................................. yJ -------.------.-...--------...-' . / �- \ / � / ~ -------`------------^^~'~-^^' ' | I = TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �,( Map I?arcef � 4=, Application # Health Division f Date Issued Conservation'Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic'- OKH Preservation/Hyannis Project Street Address Z ��// 1J Village �: Owner� �f7 ��f'/(� S'� ? Address Telephone Permit Request Sr�1 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay 9roject Valuation 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 Courj, - Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Otherj ; Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wool oal stave: ❑ ;es ❑ No A. Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: D xisting ] new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Ln m 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 ��� Telephone Number r, Address /, �11S1,C��«� /�� License#6,3 ��- 1 &/Z 1''�2,� Home Improvement Contractor# C/� 9 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE (. DATE J 7- ° A t 5 3 FOR OFFICIAL USE ONLY APPLICATION# ` DATE ISSUED MAP/PARCEL NO. i ' ADDRESS i VILLAGE -OWNER I i DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH 'FINAL PLUMBING: ROUGH FINAL , GAS: ROUGH FINAL ; _ t FINAL BUILDING DATE CLOSED OUT ASSOCIATION"PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents _ Office of Investigations - + d 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): SM9/J1 45z �z_� Address: City/S ate/Zip: / Phone.#: Are ou an employer? Check the appropriate bog: .Type of project(required)... 4. I am a general contractor and I 1; I am a employer with J 6. []New construction . employees (full and/ozport-time),* � have hired the sub-contractors 2. I am a'sole io rietor or partner- listed on the''attached sheet. 7. �/Remodeling ❑ P p These sub-contractors have Demolition 8. Dem ship and have no employees ❑ . vorkin for me in an capacity. employees and have workers' g 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 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.❑ 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 ornot those entities have employees. If the sub-contractors have employees,they must providt,their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is-the policy and jab site information. Insurance Company Name: d'� � ,11y1cS' Policy#or Self-ins.Lic,#:_ F�%�9, Expiration Date: ,r lob Site Address: 79 /�� �J� > City/State/Zip: ,_�i�1 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 maybe forwarded to the Office of Investizations of the DIA for insurance coverage verification I do hereby certify under the pains•and penalties of perjury that the in provided above is true and correct. Si mature: Date: _ Phone#: G 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): A.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5•Plumbing Inspector 6. Other Contact Person: Phone#: s ® -200- 03:241C FROM: 15k35�ri� f41 TCl: 1J4�n79�thL���J 1 16 I ACORt? CERTIFICATE OF LIABILITY INSURANCE OPID XG OATE(MNV7DrYYW} DAVIb-2 07/21/06 S DD 1cER —ZHIS CERTIFICATE IS I4SUEO AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Warthwood In®. Agenvy, Inc, HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 805 Went Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannin DM 02601 Phone: 508-771-1632 Fax:508-393-2955— INSURERS AFFORDING COVERAGE N_AIC# , INSURED INSURER A: Travelers YnsurEn_Ce Co, INSURER 8; Trov�lar• ia�uruw� Cagpany David COX, Inc INSURER Co- P. 0. SOX 401 INSURER D: B Xa=wuth MA 02664 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED LOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY FERIOD INDICATED.NOTWITHSTANDING ANY MUIREMENT,TERM OR CONDIT N OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W WCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.To INSUFjM14CE AFFOR ED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDIITIONS OF SUCH POLICIES,AGGRESATE LOWS SHOWN AY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR -<T'PE 10INSURANC POLICY NUMBER RAIOR DATE MMiDO(YY DATE MMIEXP D ltaHT9 GENEPALLIAGIVN EACH OCCURRENCE S 1000044 I A Ogj!1MERC-GEN6RAL LAITY 680-1481H796 03/1AAo's 03/14/09 PREMISES E6occur nca s 50000 '`CLAIMSA4ADE "QGCUR MED EXP(Any one peracn) s 5000 reinee� a PERSONAL&ADV INJURY $1000000 75 GENERAL AGGREGATE S 2000000 I i GEWL r(GGREGC�PRC IT APPLI S PI5R: PRODUCTS-COMPIOP AGO S 2 000000 POLICY - r LOC CSL 2000000 AUTOMOBILE LIABILITY Jj COUSINEO SINGLE LIMIT ANY AUTO I (�eccIdenl) d ALL OWNED ALTOS BODILY INJURY $ SCHEDULED AUTOS (Par poison) HIRED AUTOS BOOILY INJURY NON-OWNEDAUTOS { (PeraccldwI) $ !f PROPERTYDAMASE g (Par acoldont) OARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO EA ACC S OTHER THAN AUTO ONLY: AGG g EXCESSIUMBRELL.A LIABILITY EACH OCCURRENCE Is OCCUR CLAIMS MADE AGGREGATE _ 8 DEDUCTIBLE I g RETENTION $ g WORKERS COMPENSATION AND EMPLOYERS'LIABILITY TORY LIMITS ERA E B 6RUS91OX742207 07/15/07 07/15/08 E.L.EACH ACCIDENT S 100000 ANY PROPRIETORIPARTNERIEXECUTIVE OFFICEWMEMBEREXXCLUDED? 6MM91OX742206 07/15/08 07/15/09 E.L.OISEASH-EAEMPLOYEE 1100000 If dmmbo under SPECIAL PROWIONS below E.L.DISEASE-POLICY LIMIT 1500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS AODED BY ENDORSEMENT I SPECIAL PROVISIONS I 4 1 CERTIFICATE HOLDER CANCELLATION TOWNSAB SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAN02LLED BEFORE THE EXPIRATION GATE THEREOF,THE MUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN TOWN OF SAMSTABLE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 60 SHALL Building Dept. IMPOSE NO OBLIOATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AOENTS OR 367 MAIN STRELV EYAMIS MA 02601 REPRESENTATIVES. - AUTNO D RE9 ACORD 26(2001108) ®ACORD CORPORATION 1988 �Op1HET Town of Barnstable Regulatory Services &UMSTABM Thomas F. Geiler,Director TEo,r,,,c4. 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 Owner Must Complete and Sign This Section If Using A Builder ��Qfl�il6 5- /Z Z as Owner of the subject property hereby authorize_ ,7A&Z02 &ak to act on my behalf, in all.matters relative to work authorized by this building permit application for: (Address of Job) Si• ature of Owner Da e Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable �ofTHE A Regulatory Services `� O"• Thomas F.Geiler,Director BARNSTA.BLZ, MASS Building Division PT�D 'Na 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 code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and 4 to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF 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 Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 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 1o9.1.1-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. THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA »: f r 5.4 lit}etrC .r,yir e yt, xry��` e»PRE S Cyr* j-. 0p1HE Tph �' Town of.Barnstab'le Permit# k d Eyxtes 6 moi r ur ss'ue dale _ �fl.lJ Regulatory Services :. r Fee ` _r M� f VVi + B�BNSTABLE. * �io�-t`"� /n� ( 'Thomas.F Geiler,Di ectot ` rfD MAt 1`111 Buil ling'•DiviS10n. :Tom'Perry;CBO, 'Bu►lding' ,ouimissiouej r „� t � 200 Main Street;Hyanms;NA,02601 ,wwwaown.Uarnstable:nia.tis' 4038 5790=6230Ofice: 508-862- ` 'EXPRESS PERMIT APPLICATION •- R ESIDI;NTIA L ONL y w -Not Valid;without Red k-Press Irnprinf Map/parcel Number. Q41?j0 3C /CXJ� d ' Property Address 7 i 5 5, [Residential Value Of Work ` 'b l;VD -m r7 Minimum fee of$25.'00 for work under$6,000.00 Owner's Name&Address 71Jt S- 41 Contractor's Name 12-06 Telephone Number r : Home Improvement Contractor License f#(if applicable). %e� ;6'R Construction Supervisor's License#(if applicable) ' G-S ✓Ci.R r KWorkman's.Compensation Tnsiirance Check one: s ❑ `1.am a sole hroprietoi j ❑ [am the Homeowner fl; PERMIT PAYMENT RECEIPT I have Worker's Compensation insurance u TOWN OF BARNSTABLE lnsaranceCompanyNamc ,/�2D`ZTHt,l.flcf0, s�Jsve��n�C, sQ�� -cy 1' BUILDING DEPARTMENT i 200 MAIN STREET' l HYANNIS, MA 02601 Workman's Comp..Policy �.`��3 Copy of Insurance Compliance,Cet ttttc`ate must accotnpatiy each pernut "j DgTE; 56/29�10 x" 10:37 --------- Permit Request(check box)' ! -_ __ _-- --- -- TOTALS" El Re-roof(strip* mg old shingles) All consh ticton debt is will be taken to ' PERMIT t PAIR s . .40.80 ❑ Re-roof(not stripping. Going Duet. . existmg l�iycrs of roof) a AMT -TNOERED; 40.00 AMMT PPLIED: r tt `- Re-side " #of doo gpPLICATION NUMBER. 201003231 ASH 3231 ( Replacement'Windows/doors/sliders U Value . � � i PAYMENT (maxmnm�:44)#of wm PAYMENT *Where.requi ed: lssuance of this permit does not exempt comphance wrth other town dep trunent rc ul rooms i e hlIil ***Note Propeity Owner must'srgm Ptopet ty Owner Letter of Petxmisstonk Y x; A copy of tlie., tome pt;ovementContractors License&Constructron.Siipervisoi s'License is . t i quire( , s ' SIGNATURE- •J - C.'.:\Users\decollik\AppData\Local\M7soft\I ndows\Tenii)orary Internet Files\Content.Outlook\4STGU5QO\EXPRESS.doc Revised 090809.. •` pp THE 1p� HP ti� # IY * BARNSTABLE,' MA 9. Town of Barnstable AlFD MAC� Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property '' J p P n' hereby authorize /001e-fZ 5 �8 to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) ature of Owner Date t � 4 Print Name .If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\4STGU5QO\EXPRESS.doc Revised 090809 _ The Commonwealth of Massachusetts - 3117 Department of Industrial Accidents 07ceolluestlgalleas _ = 600 Washington Street F� f Boston,Mass- 02111 Workers Compensation Insurance Affidavit :yam.--ter n • i rt u tti erfotminQ all work myself. p I am a homeowner � Y I am a sole proprietor and have no one working in any caoaciry— __.y . .- I am an employer providing workers' compensation for my employees working on this job. nv : •ROGERS & MARNEY INC. 1 re P.O. BOX 310 .• s• (508) 428-6106 ' 02655 OSTERVILLE, MA t ENV i a n the contractors listed below who have 1 am a sole proprietor, general contractor,or homeowner(circle one) and have hired the following workers eonpensation po ices: SEE ATTACHED SHEETS n ` li v s in r _ w _ s m •t m' r h n i v : • -.:�-T--- :. '" to 51300.00 and/or LAttich additionifalteet if ne_cssa�'_ �^"""'-"'" WORK ORDER and a Gne of S100.00 a day against me. t undentand that a F:rilurc to secure eorerage as required under section 35 s of s1GL 15I can teal to the imposition of er:r'sinal penalties o a the up one years'imprisonment as well as civil penalties in the form of a STOP O copy.of this statement mad be for„rrded to the Office of lrt•'cstigations of the Dl.a for carcn;c s'erifieatzon. 1 dry hereby cer:ify uncle he p irs rs penalties of ptrfurs that the lrtjormaior provided above is trte and correct. -- ROGERS & N -t — S''-'1J" (508) 428-6106 �• oRcial use only do no: %rice in this area to be completed b! cin or town o(Ticia nguildin;Depart:ncnt ( permit'liee+se= Gt-icensin;Board F cin or to-n: �-jjdcctmen's O(fc: t required (-1Heslth Oepartmtnt 1 C cncct it immediat: response s req r-Othcr�- t phone r: contact person: r4{xFl } '66V01/2010 14:57 5083932273 NORTHWOOD INSURANCE PAGE 02 OR OP ID se FDATOK- 0, CERTIFICATE 4F LIABILITY INSURANCE 6>/!0l��/i�o��l�l� � �YS, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS '" ? ';k CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY TH E POLICI.E9, di' I BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(8),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. + ?�I ghrttlf the calfficale r Is an ADDITIONAL INSURED.the po os mutt be endorsed. su ect to the terms and conditions of the poky,certain policies may regW0 an endorsement. A statement on this cortfflcate does not confer ruts to tha celtMeate holder In Aeu of such en(torsement(s). �t(�QIu PRODUCER 4�Ic�ti„, z ►iAM Ilk��r af)1� - Northwood Ins. Agency, Inc. IAIC.No.Ext): S40 Main Street Suite 9 ADDRESS: Hyannis MA 02601 cUsroMERDi ROGER-1 ehone:508-?71-1632 Fax:508-393-2955 _ tNeuRER(D)AFFORDING coyE(tAc NAIL/ IHSIURED INSURERa oenar&L Casualty Ltumit4me Co. 24414 Rogers s Marney, Inc. MOURER5: AMERICAN INTERNATIONAL Gary Souza P.O. Box 310 INSURER C: osterville Mh 02:655 MURERD: INSURER E: .. # INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TW$IS TO CERTIFY THAT THE POLICIES OF INS;JRANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERt00 INDICATED. NOTWITHSTMpING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCIUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS 9UBJECT TO ALL THE TERMS, EACLLISIONS ANO CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF ENDURANCE INSR POUCYNUMBM (MINDOAYYN) (MMIDDAYYYY) LMRB 06NERAL LIASIL Y eACH OCCURRENCE $1,000,000 A X COAMAERCMLGENIMALLIABILITY CCI 0395621 03/20/10 03/20/11 PREMISSEEStE xe ncel $100,000 CLA)MS-MADE I X I OCCUR MEo EXA(Arry one persal) $5,000 PERSONAL 6 ADV INJURY $X,000,00 0 GENERAL AGGREGATE s2,000,000 GEM,AGGREGATE LIMIT APPLIES PER. PRODUCTS•COMP/OP ACC, t2,000,000 POLICY JECT LOC 6 ALITOI ILF LIABILITY COMBINED SINGLE LIMIT tEa accloeal $1,000,000 A ANY AUTO CBA 0395621 03/20/10 03/20/11 BODILY IN,AJRY fPer person) i ALL OWNED AUTOS . gppgv INJURY(Per accident) $ X SCHEOMED AUT05 - _ PROPERTYMAGE X HIRED AUTOS (Per X NONOWMED AUTOS t 6 A VNBRELLALIAB XI OCCUR CCU 0395621 03/20/10 03/20/1Z EACHOCCLNMENCE t10,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE r DEDUCTIBLE 6 X RETENTION s 10,000 t 01/01/10 01/01/11 TORY EMITS ER A. AND EMPLOY6t@'UABILRY _ ANY PROPRIETOPIPARTNEP)WCLMVE Y J-1 4 N A A _ - E.L.EACH ACCIDENT $500,0 00 OFFI(ERMEMBER EXCLUDECO (Mandatory In NMI E.L.DISEASE-EA EMPLOYEE 1500,000 IT e,desa�be DESCRIPTION OF OPERATION$below E.L.OISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATION@!LOCAMOND A VE41CLE13 (Attach ACORD 10N.Additional Remarks Schadula,R more apace It required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICtEe Be CANCELLED BEFORE ^ BARNSTi THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WrTN THE POLICY PROVISIONS. s Town of Barnstable AUTHORIZEDREPRESENTATNE 367 Main Street Hyannis MA 02601 a. 61099-2009 ACO O CORPORATION. AN r(phta,raearved. ACORO xs(2008109) Tna^CORD nema end l000 ra re.otstored merko of AOORD Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Reqistration: 164688 Type: Private Corporation Expiration: 10/30/2011 Trtt 290070' ROGERS AND MARNEY, INC. GARY SOUZA P.O. BOX 310 ------- ------------ — OSTERVILLE, MA 02655 Update Address and return card.Mark reason for change. I .. t Address Renewal =j Employment Lost Card DPS-CAI 0 50M-04104-G101216 - - Office of Consumer Affairs& Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ' Office of Consumer Affairs and Business Regulation Registration: 164688 10 Park Plaza Suite 5170 Expiration: 10/30/2011 Trtt 290070 Boston,MA 02116 Type: Private Corporation ROGERS AND MARNEY, INC. GARY SOUZA 445 WEST BARNSTABLE RD. 4 —— �— OSTERVILLE, MA 02655 Undersecretary Not voidvoidd it out signature f assachusetts- Department of Public Siifeh Board of Buiidin Rcr� ulations and Standard:~ Construction Su 'g . License: cs hervis 4029gg or License Restricted to; .00 GARY SOUZq P.O. BOX 211. COTUIT, MA-02635 l mnri..ioner Expiration: 8/16✓2012 T ra: 102999 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 necessar% si�;n<3turc 5 on this fond at. 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 15t FL, 36; Main St., Hyannis, MA 0 601 (Town Hall) and get the, Business Certificare that is required by law. b DATE: 01 y I")-v LI Fill in please: t k APPLICANT'S YOUR NAME/S: --t 0 cloN Co v G s BUSINESS YOUR HOME ADDRESS: 'k TELEPHONE # Home Telephone Number _o C7 Y 4 M� .NAME OF CORPORATION: ES l " C ' ti 5 C A 91 1VQ7 QTE N L N C C NAME OF NEW BUSINESS: TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS: 5 �G S M i� .�, - \A\ A w n>> SMAP/PARCEL NUMBER_- <J ') L� `��� [Assessing) 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. ,- — MUST COMPLY WITH HOME OCCUPATION 1. BUILDING COM ISSION 'S OFFI RULES AND REGULATIONS. FAILURE TO This individu ha b infcfrm d f -fiy9,rmi re uirements that pertain to this type of busines OMPI_Y MAY RESULT IN FINES. Au orized 'gna r j OMMENT / ` 1 l 2. BOARD OF EALTH This individual has,b en inf r d the ermit re irements that pertain to this type of business. Authorize ignature** MUST oOMPLYWITH ALL COMMENTS. J I ^TE�'x! �r�rrni i l sr . 3. CONSUMER AFFAIRS(L)JPENSING AUTHORITY) This individual has een inf r ed o he licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: /a j 4 Town of Earnstaibk Regulatory Sakes ' Richard V. Scali,Interim Director RAURM Building Division NAM 1 `e� Tom Perry,Building Commissioner Eo ° 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: ]Fee: Permit#: HOMIE OCCUPATION ION REGISTRATION Date: 04 /2 7 /.10 Name:-S MC( ul S L P Ai�SCp P1 AJ 0- Phone#: M A 1 ki TV-U IV Cc- Address: 7 1-r�. ''qJ Z S T m (41 A/ 5•I Village: t' Name of Business:Z S Tr(..J Q 5 � Type of Business: L P N b s C o P N67- Map/Lot: l4 H N 11/1 S 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. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: u The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. I o Such use occupies no more than 400 square feet of space. o There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. o No traffic will be generated in excess of normal residential volumes. o 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. c There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of . normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. o There is no exterior storage or display of materials or equipment. o There are no commercial vehicles related to the Customary Home Occupation, other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. o If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. o No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,*reaeeth the above restrictions for my home occupation I am registering.Applicant: Date:Homeoc.doc Rev.103 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map- Parcel y 3G d C � t Applicatibtr# 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 7 9 5 L-0- Village /yY����S _ Or caner___A>2- _Ss,m4vs /Cv.4_j .#c_sAci Address _ `�� 7'/`�,� y Telephone Permit Request s rs 4-4- ,X-- yE /ZN ocac,.e s Square feet: 1 st floor: existing proposed 2nd floor: existing + proposed Total new Zoning District Flood Plain Groundwater Overlay __4 :. a Project Valuation /Oct Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) 7 ° Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: YesL':❑ No w Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other co 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: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name e�L �oJ7�A Tele hone Number s''D - 5'Z 43- G�aG Ad resdresd �-y �e� 3�� License#� GS io 2959 Home Improvement Contractor# 1/6 VC 88 Worker's Compensation # Cc/ 037 5-6 Z/ ALL CONSTRUCTION DEBRIS RESULTING FRO THIS PROJECT WILL BE TAKEN TO r9h.sPA�3c2 /.'2¢.ig ►� Jl�vo`1 SIGNATURE 1D TA E 1 FOR OFFICIAL USE ONLY APPLICATION# -� DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: _ -FOUNDATION a FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL N, PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING t DATE CLOSED OUT _ ASSOCIATION PLAN NO. �_N The Commonwealth of Massachusetts t i Department of Industrial Accidents, t r Office of Investigations 600 Washington Street ! Boston,MA 02111 `�•a ��' www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name (Business/Organization/lndividual): /,?06 e-z T Z - 2-a —7 Address: /'7 O.. /'a0x 3 is city/state/zip: ySi •zv•cc� ' �� Phone #:*. ,5'0$- `123-6r06 Are you an employer?Check the appropriate box. Type of project(required): I. 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. t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp, insurance 5. ❑ We are a corporation and its ;� required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 I.[] Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required] t. employees. [No workers' comp.insurance required.] 13.❑ Other •Airy 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. #Contractors that check this box must attacbed an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: /l/oAt`iy to Q 0-0 A)Sev2 aae,tL Policy#or Self-ins.Lic.#: G[. t 03 9 SG 2 / Expiration Date:_ O 9,zzo�/Z Job Site Address: ¢5 W. m . 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 certi der the p and p a of p rjury that the information provided above is true and correct Si afore: Date: Z7 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: OP ID: KG DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 03125N 1 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(% 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 endorsements CONTACT PRODUCER 508471-1 632 NAME: Northwood Ins. enC ,Inc. 508-393-2955 PHONE FAA No 540 Main Street Suite 9 A/C No E:t Hyannis,MA 02601 ADDRESS: PRODUCER ROGER-1 ' CUSTOMER10 fi INSURER(S)AFFORDING COVERAGE NAIC i INSURED Rogers&Mamey,Inc. INSURER A:General Casualty Insurance Co. 24414 P.O.Box 310 INSURER a:AMERICAN INTERNATIONAL Osterville,MA 02655 INSURERC: INSURER D: INSURER E: 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICYEX LIMITS LTR /Y INSR TYPE OF INSURANCE POLICY NUMBER MMIDDYYY MMAO/YYYY GENERAL LIABILITY EACH OCCURRENCE Rh NCE $ 1,000,000 A X COMMERCIAL GENERALLIABIUTy CCI0395621 _ 03120111 03/20/12 PREMISES Eaoccurren� $ 10,000 CLAIM&MADE OCCUR MEDEXP(Anyoneperson) $ S,DD PERSONAL 6 ADV IN,URY $ 1,000.000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY Pk0 f M lOCT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANYALITO BODIL Y INJURY(Per person) f ALL OWNEDAVTOS BODILY INJJRY(Per acadenl) $ SCHEDI!LEDAUT(-S PROPERTY DAMAGE $ (Per accident) HIREDAUTOS .. f NC•N-OWNED AUTOS _ $ UMBRELLA LIAR OCCUR t - EACH OCCURRENCE f ExCESSUAB CLAIMS-MADE _ - AGGREGATE $ DEDUCTIBLE RETENTIGN 3 - WORKERS COMPENSATION , T OCR IMITF WC STATU- X E 0 _ R AND EMPLOYERS'LIABILITY 01l01I11 01101/12 E L EACH ACCIDENT $ 500,000 B ANY PROPRIETORIPARTNERIEXECUTIVE Y❑ N I C006518443 OFFiCERMEMBER EXCLUDED, E L DISEASE-EA EMPLOYEE $ 500,00 (Mandatory In NH) oyes.descnbe unoer Pi DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101.Additional Remark Schsduls,If more spats is required) CERTIFICATE HOLDER - CANCELLATION DARN3T1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ton Of Barnstable AUTHORIZED REPRESENTATIVE 'I 367 Min street Npnai S Wh 02601 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD f P`�FSHE r�� BARNSPABLE. .. MASS. 1639• Town of Barnstable �0 ArEp�yO. Regulatory Services Thomas F.Ceiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 1 ' Property Owner Must Complete and Sign This Section If Using A Builder I V 1 as Owner of the subject propemr herebv authorize /�pC,r-ZS �'�'2r1�=`� , '�'`�8 to act on my behalf, in all matters relative to work authorized by this building hermit application for:' 7Y5 �c titer« S (Address of Job) vt 7/Z o/// iature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C':\Users\decollik`AppData\Local\Microsoft\Windows\T'emporaiy Internet Files\Cuntcnt.outlook\4S'I'CiU500\I{XFRL:SS.duc Revised 090809 Massachusetts- Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License License: CS 102999 R Restricted.to 00 GARY SQUZA P.O BOX'211� COTUIT, MX'02635 --G-- -y- J� Expiration: 8/16/2012 t (' nunisvionc°r Tr#: 162M t , 4 . _ •T�`.. i y y� fi S ? � •. •i f ' ' o - .. 1{- t .,'. � ; - _ • . ,° Y Y .. Y y _ ` •�+. '. i .1::* � s y, ry. Y+- •! �` � r �' f'7 �a`t � °,k .�{, "�j_��' ' �{,� , �, �- ...ti ! 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