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0202 YARMOUTH ROAD
�o a `/��-�a�� ���.� �_, e OPINE Sign �a TOWN OF BARNSTABLE Permit MASS: 9� 16 9, '0?FO A Permit Number: Application Ref: 201408239 20071050 Issue Date: 11/24/14 Applicant: MACDONALD, DOUGLAS E TR = r Proposed Use:: AUTOMOTIVE SALES & SERVICE` Permit Type: SIGN PERMIT' sA _ Permit.Fee $ } Location 202 YARMOUTH'.ROAD - Map Parcel 328149 - . Town HYANNIS '. g Zoning District SPLT . . k y Contractor PROPERTY OWNER 4 r . Remarks _. ' REFACE EXISTING FREESTND SIGN 15 SQ&& 20 WALL CAR GUYS Al - h.* Owner: .. MACDONALD, DOUGLAS E TR Address: .91 WATERS EDGE MARSTONS MILLS, MA 02648 Issued By t P POST THIS CARD SO THAT IS VISIBLE FROM THE ;REET PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: J/24'/14 'TIME: :40 ------= -------TOTALS-------{Y=---------- f'. PERMIT $ PAID 75.00' AMT TENDERED: 75.00 AMT APPLIED: 75.00 CHANGE: .00 APPLICATION NUMBER: PAYMENT METH: CHECK PAYMENT REF: 1508 VE Town of Barnstable Regulatory Services OWN, OF BARNSTABLE Richard V. Scali,Interim Director } g1639. {� Building Division Tom Perry, Building Commissioner 2 200 Main Street, Hyannis,MA 02601 1 2 J www.town.barnstable.ma.us7 6 a, Office: 508-862-4038 Fax: 508-790-6230 Permit# Building Official approving__________- Application for Sign Permit 1 Applicant: 66 W;N& Assessors No. 32S_sV Doing Business As: _G t/YS ar 6/AY ephone No.- ���'f- Sign Location Street/Road: 6 -- -oIY1=— -------k �----------t--= i Zoning District: Old Kings Highway? Yes/No 'Hyannis Historic District? Yes/No i Property Owvryaks /�j 7� Name:----- - -- /uLdOnf L _ 7' ;q __Telephone:_ Address:--- -/----- - - -------- ,--,- �/ �------ --- - Village:--- -- ------- Sign Contrac 1 Name:----- -�1V0-&1*1d ----------------Telephone: Mailing Address: 1'l��'/! S -S—Wy -&% Description i Please follow the cover directions.You must have an accurate rendition of sign with dimensions and location. Is the sign to be electrified? Y No (Note.Ifyes, a wir.igpermitisrequlred) Width of building face_3 0—ft.x 10=_3cb�}.;` __ 3C) Check one Reface existing signor New__Total Sq. R. of proposed sign (s) Ifyou have additional signs please attach a sheethsting each one with dimensions If refacing an existing sign please provide a picture of the existing sign with dimensions. 4 11 II hereby certify that I am the owner or that I have the a thority of the owner to make this application, that the information is correct and�hat on�ction shall conform to the provisions of §240-59 through§240-89 of the Tble ing Ordinance. J Signature of Owner/Authorized Agen _ _ Datel � R/ 7 i te-171 ed SIGNS/SIGNREQUC7 revised110413 C PROOF CUSTOMER INFO CONTACT INFO DATE M 11/14/2014 VERSION: 1 2 3 4 5 COMPANY: PHONE: CONTACT PERSON: FAX: 1:22:53 PM E-Mailed Called REQUIRED PROOF �Ty ET: STATE: ZIP: EMAIL: DESCRIPTION File Name;The Cer Guys�O2 Ysrmouth_Rd„pole sl®n,fs Folder Name:\\Beckup\e\FLEXI_FILES\T\The Car Guys -- - - - -60 Its F3 $ 3 In r� r CREDIT EXPRESS } : O COPYRIGHT 2014,SIGN*A*RAMA,Inc. THIS RENDERING 19 INTENDED AS A SAMPLE ONLY,COLOR,TEXTURE,MEASUREMENTS,AND ACTUAL APPEARANCE MAY VARY SLIGHTLY FROM COMPLETED WORK AND IS CONSIDERED NORMAL&USUAL, Pleas check layout:(artwork,spelling,dimensions)and fax book with signature.Production 1 HAVE REVIEWED THE ABOVE SPECIFICATIONS&HEREBY FULLY UNDERSTAND THE convict begin until written approval Is recaNad,Addltlenal charges will be applied for any changes - O D CONTENT OF WORK TO BE PERFORMED that era needed after approval Is reechlod,®ION*A*RAMA is not responalblo for any errors In AND APPROVE THIS PROJECT TO BEGIN apelling,layout,or dimensions that have boon approved by the customen This proof Is for listed CUSTOMER APPROVAL SIGNED BY, Items only,Any changes up deletions by the customer not shown or charged herein will be billed 12 Whites Bath•SUlte®,6outh Vermouth,MA 62664 �# oopsratoly,50%DEPOSIT DUE AT TIME OF ORDER(full amount If under 0100),balance due Phone:80g 308 100 E ftc- P ;v Faz 508.508.1760 mdi l�prl son;neI PRINT upafl time of Instolletdan,l HAVE READ AND AGREE TO ALL TERMS. INITIAL vnvw,61 DAMrein®>ayarmouth,ocin j THIS ORIGINAL DESIGN AND ALL INFORMATION CONTAINED THEREIN IS THE PROPERTY OF SIGN`A'RAMA AND ITS USE IN ANYWAY OTHER THAN AS AUTHORIZED IS EXPRESSLY FORBIDDEN.THIS PROPERTY MAY NOT BE REPRODUCED OROUPLICATED WITHOUT WRITTEN PERMISSION OF SIGN"A'RAMA OR THROUGH PURCHASE. DAT- PROOF CUSTOMER INFO ELI CONTACT INFO 11/14/2014 VERSION: 1 2 3 4 5 COMPANY: PHONE: CONTACT PERSON: NO PROOF FAX: 1:20:49 PM E-Mailed Called REQUIRED CTY ET: STATE; ZIP; EMAIL: DES r • File Name;The Cer_Ouya� _02_YarmouthRd_bullding_&_windows,is Folder Name;\\Backup\e\FLEXI_FILES\T\The Car Guys 120 In CREDIT EXPRESS 24 In 508Aw775m2300 " i _ OLD ©COPYRIGHT 2014,SIGN*A*RAMA,Inc. THIS RENDERING IS INTENDED AS A SAMPLE ONLY,COLOR,TEXTURE,MEASUREMENTS,AND ACTUAL APPEARANCE MAY VARY SLIGHTLY FROM COMPLETED WORK AND IS CONSIDERED NORMAL&USUAL, Piao@e ohook layout(onwark,goIlli dimension@)and fax back with signature,Production I HAVE REVIEWED THE ABOVE SPECIFICATIONS&HEREBY FULLY UNDERSTAND THE cannot begin until written approval la roaslvod,Additional charges will be applied for any ohangao p p O CONTENT OF WORK TO BE PERFORMED that are Heeded after approval N r000lvad.SI®N'A"RAMA Is net ecaponaible for any errors In AND APPROVE THIS PROJECT TO BEGIN @palling,layout,or dimonsicns that have been approved by the cu@toman This proof to far listed CUSTOMER APPROVAL SIGNED BY: komo only,Any chongou or deletions by the customer net shown or charged h@raln will be billed 9a Whites Path=Suite398- 106 Fax;SOS-58®-9950 South Yarmouth,MA 03554 -1 oepsrotety,50%DEPOSIT DUE AT TIME OF'DROER(full amount If undor$100),balance duo' Phone;Sob• 95=8 open Wi of InatalleNan,I HAVE READ AND AGREE TO ALL TERMS. INITIAL Email: ampYon,nat PRINT: DATE: � wwWsignerama-eysrmoouEh,00m THIS ORIGINAL DESIGN AND ALL INFORMATION CONTAINED THEREIN IS THE PROPERTY OF SIGN`A"RAMA AND ITS USE IN ANY WAY OTHER THAN AS AUTHORIZED IS EXPRESSLY FORBIDDEN.THIS PROPERTY MAY NOT BE REPRODUCED OR DUPLICATED WITHOUT WRRTEN PERMISSION OF SIGN`A`RAMA OR THROUGH PURCHASE. y • , r 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 the Town (WHICH YOU MUST DO according to M.G.L. = it does`.not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St-, Hyannis.. Take the completed form to the Town Clerk's Office, 15 Ft., 367 Main St:, Hyannis, Mi4-02601(Town Hall) and get the Business Certificate,that is required bylaw. C� DATE Fill in please: APPLICANTS YOUR NAME/CORPORATE NAME_( TC � jpf�Ss C fyJ�j �[�Ye55 BUSINESS TYPE: G/GSS Z "6_0 C11ha S BUSINESS YOUR HOME ADDRESS: 6-b . > c rn� fLi7 i�ir s� svi //� yhL� GZ hY� TELEPHONE # - Home Telephone Number g-o? - 75 7 - NAME OF NEW BUSINESS C U 'S SS ..SS OR EIN: Have you been given approval from the buildin division YE NO G 1 ADDRESS OF BUSINESS (f �C/� MAP/PARCEL NUMBER 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 license in' this town. s required to legally operate your business. 1. BUILDING COMMISSIONE FFICE This individual has i ormed ny permit requirements that`pertain to this type of business. ' ho zed Si nature** COMMENTS: ' 12 BOARD OF HEALTH. This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** ' COMMENTS: 3.1 CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to.this type of business. i Authorized Signature' COMMENTS: i i �y� J I �Itryryt � � gy � 1 •''fll i��l��,l�/ t*i f 'f•'r t,7'J� , - _ + / 'q'�^'�f�gR�� } I � ��am]�9 k���i, f.tom'. •. / lrl II"4 It t I' II S V*a•b W�, t-,1.i DIS t AB ' -[} 25 �«J..M, S ��p/•� �91—�4/4` ' {«•11,;1{� J;.1°J J _ �' ,I} f. . I7'i. , ' \ _ / ^li: .. ^1 }� il`rm (1,y{� J' _.ram �, _ _.-_�;.�- rrm��-c=::�'�` �.� � �''� , ::,••.,J. rf�;;::.rL,,��:r.:..,:-,.rn. , jil 41 .. ,%:. �.,, w � ,. � v \ ,I!.41>r^'��a•J,�Tlnr..,,,..I,. Ai�'�5{^('.'ni' \ ,1 q Ij ® /T ._1'�•• �c - -.. {.�I.11j If41±IL 1 JI 1 Itp C7 ,�` D � 'gip /,lye �•.,�;,'�n,? ^�`C- It Qom' (�, 71 40000�ttR�f81 1 I BNUB 09� If y \' CG &7/fell �cSS , STtf„ 202 yammth Road Hyannis MA 02601 -127 t�t, N =r , 91 1p � � tf j OY /Y 40 • F A� 3o feel qO TR -�j UV fc — } 13 b Auto Smart LLC 202 Yarngmth Road '?'Stir Hyannis MA 02601 -1270 qO IS CLO Sty. R�,�A -r- p /'55 V YOU WISH TO OPEN A BUSINESS? For Your Information) Business certificates (cost$ .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 io operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. i DATE: Sri " SCE I ill in please: APPLICANT'S YOUR NAME/S: �L BUSINESS YOUR HOME AD RESS: / •4 lI o4oe t + U TELEPHONE # Home Telephone Number �b d NAME CORPORATION: 1 C® -NAME OF NEW BUSINESS TYPE-OF BUSINESS a C, -IS THIS A HOME OCCUPATION? _-. YES NO Assessip ADDRESS'OF BUSINESS U vK ' MAP/.PARCEL NUMBER [ g) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main.Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM SSIO ER'S u I4 OF CE This individ h e infer e fan pe i reqnt that pertain to this type of business. Authorized Signat *. COMMENTS: 1 2: BOARD OF HEALTH This individual has be formed of the permit requirements that pertain to this type of business. Aut orized nature** COMMENTS: : {E 3. CONSUMER AFFAIRS ( LENSING AUTHORITY] This individual has _ en in r th.e licensing requirements that pertain to this type of business. Authorized Signature** 11 01 .I _ COMMENTS: v WITH PROOF OF INCOME,RESIDENCE,DOWN PAYMENT, 5 REFERENCES,CHECKING OR SAVINGS ACCOUNT,AND . VALID LICENSE YOU ARE APPROVED h uto smartL.L.C. TEL 508.778-1270 FAX 508-775.5379 ° ' ! www.autosmartllc.biz-• www.capeautocredit.com 202 Yarmouth Road DARRELL G.FIETZ F Hyannis,MA 02601 Manager r' .. r 1 4' r c Y Via, - f. • • e i* • a .i r., t Etl S f r Y i a - i r � y f¢ 4a P s e • At3792 `"� ;fr 04 t' Your Name: i �I t1 rom Auto Smart LLC. 202 Yarmouth Road Hyannis Ma. 02601 To: Town of Barnstable building Commissioner RE: Steven.-Hebden DBA Auto Clinic Im wishirig'to rent`one bay to auto clinic fo6f the exclusive auto repairs to vehicles obtained for resale by my business. No advertizing of any retail repairs will take place. NO storage of.any additional toxic and hazardous materials, or vehicles, other than those previously approved on site. It's also my understanding that mr. steven hebden will be a soul proprietor and will NOT employ any additional employees There will be NO additional signs displayed on the property. a Any questions I be reached'at 508-778-1270 } E. 5 r r e - IM 0 4177 w T A/swt 404;,v ,x 1A6 0Res yr OWN . i yz � M Qo u Oew S� r ? � 411 Date:� /30/ 11 { TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: .A t-,Jo Ok ✓I l o f " BUSINESS LOCATION: YA (MnL,1LINVENTORY MAILING ADDRESS: /� �', I/ 1 wt ✓L1� 12— bg&72TOTAL AMOUNT: TELEPHONE NUMBER: - - PSS 44,,Ati CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: Cr evi ✓� ) LAO �-,e_,ae,--) ✓z INFORMATION/RECOMMENDATIONS: Fire.District: Waste Transportation: /y �,� Last shipment of hazardous waste: Name of Hauler: Destinatiori: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, Storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum 'Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive �R NEW Ll USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) h (Hydraulic fluid (including brake fluid) Refrigerants 'Avl :5 Motor Oils Pesticides $NEW .❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, 'Photochemicals (Developer) lubricants, gear oil a 13415 -?oZ ❑ NEW ❑ USED Degreasers for engines and metal 'Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda ustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes M:S� Fertilizers sphalt&roofing tar PCB's aints, varnishes, stains, dyes ther chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) Any other products with "poison" labels ❑-NEW ❑-USED. (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) liscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes aundry soil &stain removers (including bleach) �; pot removers &cleaning fluids (dry.,cleaners) P�:Other cleaning solvents Bug and tar removers Windshield wash U' , WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS App'f' ant's Signature Staff's Initials YOU WISH TO OPEN A BUSINESS? For Your Information: . Business certificates (cost$30.00 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.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: Fill in lease: APPLICANT'S YOUR NAME/S: 12 p rY '' BUSINESS =YOUR HOME ADDRESS: 2 S'L .L P TELEPHONE # Home Telephone Number / rJ0 y NAME OF CORPORATION: L } NAME OF NEW BUSINESS TYPE F BUSINESS G WS 2 IS THIS A HOME OCCUPATION? YES NO . �2b� ADDRESS OF BUSINESS 0 ✓�1`hPf(f WU� MA /PARCEL NUMBER [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 T01200 Main St. -.(corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and1icenses requited to legally operate'your' business in this town.. 1. BUILDING COMM ER'S OFFICE This individua ha b n ipfor o ny ermityrequirements that pertain to this type of business.,; Auth rized Sig re** . r COMMENTS: (,t)nAX t CadCn Oy © r 9 2: BOARD OF HEALTH t This individual has`been i-n rrngdeofthe permit requirements that pertain`to this type of business. MUST COMPLY WITH ALL j IH'AZARDOUS MATERIALS REGULATIONS Authorized Signature* COMMENTS: ifz�t%e6005 IYA %�iA� S7a � usG= rrvtic`�7y�' If A-iE5 L655 �irAj //� �a/t-l�y�cJS oij ' L, DNSE is ��kuiree� VERICZ C WA-614-i "J6— POL-1 cy i��S�etSSC� akaJ� P�'0'�/I7��I� 7T� 3: CONSUMER AFFAIRS (LICENSING AUTHORITY)This individual °° has en i rrm d of the licensing requirements thatepertain to this type of business. 6nS; ` r� 6"Authq,lfized Aignatup<e j* ` lov. C-�-/C l �.�. COMMENT �L 1r0A GYI ; NUMBER FEE. 4 _ THE COMMONWEALTH OF MASSACHUSETTS $150.00 TOWN OF BARNSTABLE AGENT'S OR SELLER'S LICENSE - CLASS II TO BUY AND SELL SECOND-HAND MOTOR VEHICLES In accordance with-the provisions of,Chapter 146 of the General-Laws with amendments thereto -------------------------------------------------- ------- ----- - ---Auto Smart, LLC DBA: Auto Smart -------- ------ -- - is hereby licensed to buy and-sell secondhand motor vehicles ---------------------------------------------- - ---- -- --- --- 202 Yarmouth Road' Hyannis_ . -- ----- -- -- -- ---- : . on premises described as follows: o ice 2 ba s --------- -------_ff 1 vehicles on remises.. RESTRICTIONS Maximum.of 15 vehicles on premises ____ y ----- - ----------------- ---------------------------------- Issue Date.:. , . July 19, 2010 .. Signed .... .... .... . k - .............................. THIS LICENSE EXPIRES: December 31, 2010 THIS LICENSE MUST BE POSTED.IN A CONS PICUOUS PLACE UPON THE P REMISES. Y �P�OFZHElO TOWN OF BARNSTABLEY Date: * BARNSTABLE,q: Regulatory Services „ L 9 MASS. 0 7 k Thomas F Geiler, Director F t �p 1639. .A�0 J rFDN1°` Licensing Authority � f 200 Main Street , Hyannis,MA 02601 (508).862-4674 AUTO DEALER INFORMATION s No BUSINESS MAY OPERATE WITHOUT A VALID LICENSE ON THE PREMISES Name of applicant/corporation: Home phone#: SOS m3O 0 2 � � r Address ofapplicant/corporation: Rai-p_ Business phone [,�1oleS Business location: ©� ® /7 O/ X141YIYI� f�. D 2'60 1 - .•:. do li tSxW }k-; Business mailing address if different from above: k ; LICENSE TYPE: 4L dri vel-kcle HOURS OF OPERATION: 12 r Sid l y FID Fzll Name of Manager: bAA ge,IL i F1 / 2 email: m T-Au UAV Manager's home address:_ q llu j<U 1. /l Manager's home hone#: � / P Name of property owner: Q G Qc �e ASSESSOR'S MAP/PARCEL#.' MAP ; PARCEL AqSx � ` 4 4 t ; ' •. - .. .. � - - d.� .. �...yy�� Yid. 4a a' 1� Signature of applicant: r DO NOT WRITE BELOW THE LINE- FOR TO USE ONLY k Mir .... ..... ... . ......,. ............... ........... ........... REAL ESTATE TAXES PAID IN FULL r _ Q:\WPFILES\LICENSING\FORMS\To�,N,n Auto Dealer Form.DOC _ q , .1 T Date OWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: ( �G BUSINESS LOCATION: 2 ZLA4 0 k, INVENTORY MAILING ADDRESS: D Z TOTAL AMOUNT: TELEPHONE NUMBER: 12— LeS.S ' CONTACT PERSON: eL EMERGENCY CONTACT TELEPHONE NUMBER: 1Y)Y 8Y6` 60V f� MSDS ON SITE? TYPE OF BUSINESS: G 'S �� USED �De�t-Le2, INFORMATION/RECOMMENDATIONS: � � �Ur�Sr1° Fire District: OI� �Ne� S 1ifc� r012 ! 1� Akl P At-bs OHZY NO Ocr7-1i`,Qe 5P.i21ltL2 5,�. �p� w u,21.c bo r(,e /vT O q tj"i d e Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31,.of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public.Health Division. LIST OF,TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum. �/t Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive NEW ® USED Cesspool cleaners ase Automatic transmission fluid/2 &ctcA Cry Disinfectants Engine and radiator flushes Road salts (Halite) -JAL Hydraulic fluid (including brake fluid) Refrigerants CAL Motor Oils Pesticides ONEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum pr�q ucts: grease, Photochemicals (Developer) lubricants, gear oil A 9a KT" 9- ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes 04 1 SL RoffleS Fertilizers Asphalt& roofing tar 7V 4-e// U P PCB's Paints, vftmfsi•res,stairt , dyes 5 PRAy CA-I1 S Other chlorinated hydrocarbons, LLaccqquer thinners a P1 Krs � (including carbon tetrachloride) NEW ❑ USED Any other products with."poison"-labels - -- - - "- "(including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) - t/ Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or.hazardous (please list): Metal polishes Laundry soil &stain removers (incl uding bleach ) ( 9 ) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents I Bug and tar removers Windshield wash --.-.- WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initia r Pg+jE 1 A p r 3 dr3 „r cv � � � `�••'Y.32, t \ C.. !Y � Y c� 5 i 2�4"tfr i.. 1 S s' �S s � �i��'t to�;ir r � !•�,�t� �`t ti-..a�w1r�r� \y�s t '"#'-}ly i * �s s _ r\ ,. { n , 1 YF 0 { t,;�-l. �SA G rt• �` it c-� r!�# 1 r v f{5� } pk l a d .� °fi - 1 4 l b r _•7 St 41, I� A to ! S• f J 1" YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1" FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) ,� DATE: �� ® �� o. Fill in please: h APPLICANT'S YOUR NAME/S: C ed CJLe AT BUSINESS YOUR HOME ADDRESS: ^' TELEPHONE # Home Tel phone Number • �. „ x fit+' :;"� NAME OF CORPORATION: YY-. .NAME OF.NEW BUSINESS IS THIS A HOME OCCUPATION? YES: p TYPE ' a.41 FL OF BUSINESS ` Auk` ADORESS:.& BUSINESS 00;; C MAP/PARCEL NUMBER C [Assessing) 20 u, YI1 When starting anew business there are several things you must do in,order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you'in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. &.Main Street) to make sure you have the appropriate permits and licenses required to legally.operate your business in this town. 1. BUILDING COMMT!;`§10 R'S OFTAPE This individu I has be n inTo`r ec 0 an emit re uir ments that pertain to this P q p type of business. t uthorized Signature* COMMENTS: � . 2. BOARD OF HEALTH This individual ha n infor d f the rrr+it r uirements that pertain to this e of q p type business. Authorized nature** COMMENTS: 3. CONSUMER.AFFAIRS (LICENSING AUTHORITY This individual had en-infor ne of the lic ui rr�ents that pertain to this type of business•. 3�! se re l �LICC :n✓ Authorized Signature** COMMENTS: `- 17 sir'C. � ��-r F .;r. � E .s` �a '"1` �c`sa �- �� '..`-•e --a�� '. � �,-.y r�� r F = TOWPT OF BABNSTABLE z Permit'No l i$ . i B peCtor sassx a Cash . } OCCUP41NC1( PERMIT 'Bond _ "No bu>Idmg nor structure shall be erected, and no land, building or struetnre shall be t used-for a new, 'different,-_ehanged, or;,enlarged use" without a .;Building Permit therefor': first having been;obtained.from-the Building Inspector No.buiiduig shall_be `occupied nntil;a; 3. r certificate:;of'='oecupancy has been`issiied by the=Building-Inspector; t-= - issued to' DoUgl.as., E. -'MaLDoral.d rAddress: [s�nT� Wiring Inspector_ Inspection date Plumbing IIispector - Inspection date Ins Gas:Inspector pection date n d _s _ Migineeriug Department i {� fC .� Inspection date BUILDING :SHALL-NOT `BE, OCCUPIED-UNTIL SIGNED BY TTHE BUILDINd.SPECTO$`UPON SATISFACTORY COMPLIANCE W1TH TOWN - ' BEQibMEMENTS. F W Bnldmg Inspector v . _ - - fir; Or ' t dsiessor's map and lot numb ® �FTHEtO Sewage Permit number .................1...................................... ETTIC e YSTL1rJ r: INSTALLED NN B rC�. .i�.a. ARNST�LE, S Z House number ................ .. .......................... WITH ARTICLE 9 i S'1�,3 c 9°o Mb e• 0� SANITARY CODE AND TOVJIti TOWN 'OF BARN��T IRILE BUILDING INSPECTOR APPLICATIONFOR PERMIT TO '�................................. ............................ ........ ............................ ................. ... .. .. TYPE OF CONSTRUCTION ................................... .. .. ............... .... . ..... ............ .. .... ....................... .................19.�. TO THE INSPECTOR OF BUILDINGS: Y The undersigned hereby applies for a permit according to the following information: Location ......LAC b°!)Q1!1 l.).......tl...... .: .i.-$..............'"'`.'...C......!...I................................................. J ProposedUse .....��..qu.n ........................................................................................................................................... Zoning District ......................... .......................................Fire District (�� 1 t } Name of Owner .ILA � S....� ...��.... s ..l�0 P Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................................................................Foundation ..................................................... Exterior ...... �'1.i��r ! �. /.�. ►! ...........Roofing .........—yr;Zaa(L.... ... ..................... .......... . .............................................. Floors .............dyt. ....................... c �. .Interior ......... Heating .....��^�L.......... ...G "^"' .....................Plumbing .............1...�� .. ............................................ Fireplace .................` ......................................................Approximate Cost 1.. :Vi. ..... ....�.......... ................. Definitive Plan Approved by Planning Board ---------------_---------------19_______. Area ..... .................... Diagram of Lot and Building with Dimensions Fee f SUBJECT TO APPROVAL OF BOARD OF HEALTH $352.00 Return to: Yarmouth Road Auto. Sales , .41.6 Yarmouth Road � P Hyannis, MA I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... C:,... ................ � MacDonald, Douglas E. . � ^ � 21I86 one story � �qo ---.--. Permit for ------..�-�---. ^ ` ' ' commercial building --------------^~-----~----- � 282 Yarmouth Road Location --.----,-------------.. -- � ---.�----.�������-----.------- Owner ...............Dougl—ao B —Mam Dona ld .—'.--- --- ------- . - \ ' Type ofConstruction ...............frame................ __________________________. . ~ ) � } ' ' #149 Plot --------- Lot ----------'' ' ^ Permit Granted ----'April..IQ........ 79 . . Dote of Inspection ------------lV ` � Date - �� _� f - --7/ ' ' \ � PE RMUT REFUSED ` i | ]q' -----'-----'----------- � .�------------_------------- � ' -------^'~^-----~----------- ` ' . . . ' .,.---.---...�~—..---.--,~—..---.. ' . | � | ` . ..----.—..---..�. -------.----- . ` | . . ..�__-------------. lg ^' ' �\ .....................'................,...,......,........................' ^ � . | � -----------.-------.---.—..—.. ! / TOWN OF BARNSTABLE 2118 6 e Permit No. 0 Building Inspector { »nAIL Cash 7 DAN • -___-_ � d OCCUPANCY PERMIT Bond _ A No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Douglas E. MacDonald Address Wiring Inspector Inspection date Plumbing Inspe Inspection date Gas Inspector r Inspection date ,30 t4_'j'4 Engineering Department L� Inspection date 6 _� -CIA s7 THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE 'OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. Buildin nspector y r FROM TOWN OF BARNSTABLE " BUILDING DEPARTMENT Mr. Francis Lahteine 367 MAIN STREET - Town Clerk HYANNIS, MA 02601 Phone: 775-1120 SUBJECT: FOLD HERE DATE August 19 1981 MESSAGE Work has been completed under Permit #21186 (Douglas E. MacDonald) . Please release Bond. • GNE DATE REPLY SIGNED N87•RMI RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY- • - PRINTED IN U.S.A. TO TOWN OF BARNSTABLE w` BUILDING DEPARTMENT _. Mr. Francis La,htelne•,;- 367 MAIN STREET loWn clerk , < . . , _ HYAN 1, MA 02601 Phone: ??5-1120 SUBJECT: FOLDH ERE DATE August 19, 1981 - M E 5'S,A G E r Work has bee# gomgleted under .Permit #21186 (Douglas E. MacDonald) . Please releas : 4Bond f - , SIGNED s { A J s } r DATE. REPLY .. SIGNED 4 • -"'� ..--. ;�...-.T..s.- N87-RMI 1 RECIPIENT'. RETAIN WHITE COPY,RETURN PINK COPY PRINTED IN U.S-.A. Assessor's,map and lot number .................�a " .......... o�THE To ..... o Sewage Permit number . ...... e. .... .... .... d� � °+► Z 8AHBSTABLE. i House number r MA°a ..................... ..... ................. 00,e,t639, '-0 MPy a TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..../ / /..Z.611�..../..�1.....��"�Ir�. . . . ..................... TYPE OF CONSTRUCTION C yL................................................................................ ..................19Q. / TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Locationt ... ........ !.. ............................................................................................................. ProposedUse .�1,i-.t......101W.//. ................................................................................................... ..75?� ZoningDistrict ................. .............................................Fire District ........... .. .. ............................. Name of Owner �lr1L.!.. 1,�P� .....Address 4d. . e�...fd. ..C✓...././.l. G� . ...: • Li C%� Nameof Builder ....................................................................Address .............�...................................................................... Name of Architect .. r... .�- r5 ...................Address ......... ...................... Numberof Rooms ...........�...................................................Foundation ....` fQZ ........................................................ Exterior ...1� P-4.07 dC'/..5:•S'...........................Roofing ..... �. ..................................................... Floors ?..............................................................Interior .........�G h....... .................................................... Heating Plumbing ........� �. Fireplace ... ... .�.. .. ...... .. ................................... .....A Approximate Cost v�l .................. ................ p pp .... j,. Definitive Plan Approved by' Planning Board --------------------_-----------19________. Area ...&.04......................... Diagram of Lot and Building with Dimensions Fee / SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 ' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS .I 'hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ...... vw..Q Construction Supervisor's License .....:.............................. MACDONALD, EOUaM E. ADDITION ...... or . . ............. .... Commercia ..B d'in ................................. Location ....202 Yarmouth Road ........................................................... Hyannis ....................................................................... Owner Douglas E. MacDonald ................................................................. jype,of, Frame Construction .......................................... ............................................................................. Plot'-.,/......................... Lot ................... ............ e . Pe'rmit Granted .....F'Nu.q 1!6...............19 84 Dat�"o ...............................19 Z f. in�pection ....... I I / I- > -Ddte� Completed ............1915 Assessor's map and: lot ;number ... ...... Q � r ' •. .s Qypf Tp�� THE Sewa ge Permit number' .......................................:......: 33, iTSDLE;y House number. .... .........�,..:�. .. 1............... n6 a 9 1 �O 39• O N Ar' TORN .OF ``RARNSTABLE BU:ILDI.HG 'I�NI E.CTOR APPLICATION FOR.PERMIT 'TO ............................................... �7�-0 2*e TYPE OF CONSTRUCTION ........................ �r .......... .�,zA ! � .................. ............... .................19.��..�' K Vi, , TO THE INSPECTOR OF BUILDINGS: I The undersigned hereby applies for(�a permit aaccording to the following information: ,. Location ......1. .r:.v�n a 1r4 .......�.?..5� ..1. �.a `n. �.�................... ................f........................................................ ProposedUse ......................................................................... ................................................................. ZoningDistrict ....................... . .......................................Fire District ....... ........................................................ Name of Owner Z.`(1 .�.SI.Address ....................... ...:.-',(\I Nameof Builder ....................:...............................................Address .................................................................................... `. Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ............................Foundation -'64a, of . ...................................................... Exterior ......�/1{!►•(�.Y.:fl.L.C:.....- f:...�.r.S............................Roofing ........... lf..?(lX .................................................. .4 Floors ;._•('/h r;hyi::C.-..............................................Interior ���fr, : ................ ....... .. ............:........................................... .Heating ... Z t,p..:......... !� ? ....: f„ .��Y �.......................Plumbing ..... •i....r_ .......................................................... Fireplace .....�.........:- `......................................................Approximate Cost f9 ?() r) )......................:- Definitive Plan Approved b Planning Board ____ i 19_______. Area -� .rlx'f pp Y 9 - ---- - . . .................... Diagram of Lot and Building with Dimensions Fee ` SUBJECT TO APPROVAL OF BOARD OF HEALTH h,35;,00 Return to° ;l Yarmout; i Road Auto Sales 416 Yarmouth Road Hyannis, HA 1 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. nName ,.... -.r ` f��J��(/ra .............. � �--.-I%I_!I _: ,_��-,._.:- _ ....W�, - "-�I- - .- _%�", ,:�.I .i. _ � a " . - 1,--, ,_: ..e x 11.-I j - 0-, I1T I, ,., ..1 . -_- ; 7 � '. . �i.�., o- I ; , �� _. ."..".-� , ."I.-.�. . �I...-...._., - 1 �- . ; I k --, ., ,..�.. .. ,.-.. .... , -I. 1II, .-- i ._ ... .- ..I .- I - ,I ..,� .- I..i.. .I . ...1,.7. � .-�,. .- .. . ,. , �, _ - .- .. .. .- . _ 1.'... , .-I. ,... .-.,... .'- , I.. -,. ! . * ,--1�- �., . ,r.-....�, �- , .!. �-I* 1!, ,�1 � � - � ,, s," , ,; . -? ' 7 , j -� �-,- -�, ? � I, , ,, t ,�,..t, � ,.. ,., _ . 5., I1 � , , - � �,. ," , , '� 0 �F,, , i ", �A :*, , s,• , _ � � g,." 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" ,-,� �.- ,� ",�� - " _ ,i ", - 1 ;$-� , �" .�. � . ,.d. ,,,�.,_ ���,,i . �� _ , " , ,,. , r �. 4.'� ,' I -, 41, V__�- _ - ni , "��� ,�.,, ; � 'I :��,,. , , ,� , �" - , " _ r _ - _, k, w ;�-, �,,� , I .F " , - - � , ��� 11 - I I. , l , 1: - Assessor's 'map;and lot number ..�-)-, ^. �. yD*THE • Sewage' Permit 'number f0"e4w.w4.......... • i ,% Z BARNSTABLE. i House number .......................L........................... .................. NAB . J 90o 163q. 0� -i all a' TOWN ' OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....,/. �.y(�Z P,e-3.... 2�q ....��i .e�!L.���..��rL��,!�...................... TYPE OF CONSTRUCTION !......... C/1................................................................................ �/ .�.................190.,,.1� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location , �J�r�.. . .r 7r?�i! .........t/;L. :................................................................. ProposedUse .Z�/ .t•......XP�...If /r.............. ...............................................................................,......................... ZoningDistrict .................... ....^..........................................Fire District ........... ..... c............... . ........................................ Name of Owner -..��V..-�„7.4;5?.Z .��' /✓�sG l/r✓ .....Address . ...�1/ n,, .f%� ... Name of Builder ........Address ..... Name of Architect 1'I ..................Address ........./ r� �> ! .... .1.!" ......... ........ Numberof Rooms ...........1....................................................Foundation .....��11 C ...........................................I............. Exierior ............. ......................Roofin ..................................................... Floors ... .............................................................Interior ..........�.(� .......�.................................................... Heating .... ?R'.~ ...... ..........................................Plumbing ........, 12 ! ..............................:::.: .. Fireplace ................ ..............................................................Approximate Cost .....�_'a C,0.�>.. <................. Definitive Plan Approved by Planning Board -------------------_-----------19_______. Area .......... D Diagram of Lot and Building with Dimensions Fee .7............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH A b� OCCUPANCY PERMITS REQUIRED', FOR NEW DWELLINGS } x I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable, regarding the above construction. Name .��,;� n.;,.�.�...... ....:............. ......... ............P.�/.':' Construction Supervisoe's License .................................... � D[MM E. A=338-149 N16 AdditionNo .................. Permit for ------------ ' {�000a�zcial Boi ' ------------------.--.-----.. Location ........2�02.�x=uu±h.]ioad------. ^ .....................^+al�is.......................................... . � Owner ....DQU91aa.Z.AvlacDozaJd................. � Type of Construction ....Fxanoa.......................... � � --------------------------. Plot ............................ Lot .---------- ` Permit Granted .. . N.,-----lg 84 _ Dote of | ------------lQ Date Completed ------------.l9 . . ~ ~, - _«r/�x ~ �. to ' / ~ 7 ~ . ' . .. ` ~- ^ ' ' . ^ , ' .. ' � Town of Barnstable Building Department ComplainVInquiry Report n �f l�'(� — Assessor's No.: Date: u ' a Q— 00_ Rec'd by: Complaint Name: k1Q0Zj Location !a� Address: -: o( C� cY'• a x. M/P nn � Originator. Name: Street:— Q, D a a AMAAj,\ Village: State: 14 oz Zip:—OQ 69) Telephone:D/E Complaint Description: �ZL O.QP QX,6-1n.i0 o R Ar, 9_ Inquiry Description: For Office Use Only Inspector's Action/Comments Date: Inspector. Follow-up l Action Additional Info. Attached Copy Distribution: White-Department File yellow-Inspector Pink-Inspector(Retum to OlTce 3fanager) r oil 'm k wo w, its -�1 /F= _!IA.�/ � � �.♦-Ja �I it .mil "- �L� I?i I �►_�.I► `�. r. i .. '�r / i 1 J •a V � � � � ��1ya ie _� . Er�gmeenng Dept. (3rd floor) Map Parcel Permit# House# Date Issued l 'n71p Board of Health(3rd floor)(8:15 -9: %1:00- :30) '7 jjo�9 � Feeg,5—d . Conservation Office(4th floor)(8:30- 9:3 /1:Od 2:00)o 19 BARNSTABIX �fo s9r TOWN OF BARNSTABLE Building Permit Application Pro' reet Address Lrna" Re, Village s S Owner i�O\M 5 -Ma Y"a Address ll p UPQ Telephone �� �(9_�„ Permit Requester First Floor square feet Second Floor square feet Construction Type—Cg=gLn&_JrY�6 a (�- Estimated Project Cost $ 0(5<f) Zoning District Flood Plain Water Protection Lot Size i S Q Cyr 2__ Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure 0�0 Historic House ❑Yes 1R.No On Old King's Highway ❑Yes IR(No Basement Type: ❑Full ❑Crawl ❑Walkout Other 1L%YLz Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing�_ New 0 Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: 90as ❑Oil ❑Electric ❑Other Central Air ❑Yes JU No Fireplaces: Existing New Existing wood/coal stove ❑Yes ANo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board IYes Appeals Authorization ❑ Appeal# Recorded❑Commercial ❑No If yes, site plan review# Current Use A4, Rvg l r Proposed Use Builder Information >� Name &yjwt tgt "felephone Number ,,_4ddress -d. ✓License# C�S d 19(�.7 O ---Home Improvement Contractor# — /Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE . BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) _ r FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. VILLAGE ADDRESS OWNER DATE OF INSPECTION: FOUNDATION FRAME I ILbs INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL GAS: _ ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 0 . 0795811 : 1 ' 1/1 21' A Remove 0 34' M 35' 35' 35' 105' I� jHovJ Loi\ s r 51.40w �O (NSF G -rn-uss cxT �iL -Z o vJNLL , z EK«T 55tS = -71 �:D -7� I G1�s, — 2l•� (tz� ( Zug" G12 FLU 4E� �— ��15 SItSON UJOv� NA�� —WOOD 1,IXALF-2 (M,\-fCN 4P 10 OF Af JAMES E. EGAN 8 STRUCTURAL y l / No 22691 9EGISTOo a�Q �SSIONAI 60RIF-9- UD 5(Al U\P--) 4,zg -&3 �� f11 JIte &mmvnmieaN R DEPARTMENT OF PUBLIC SAFETY 37032 ONE ASHBURTON PLACE, RM 1301 Q_ BOSTON, MA 02108-1618 {�" + CONSTRUCTION SUPERVISOR LICENSE Number: Expires: Restricted To: 00 DANIEL N MACDONALD - Detach bottom, fold sign on 123 WOODCLIFF RD back, and laminate license card. BROOKLINE, MA 02167 Keep top for receipt and change of address notification. t - y. e.� 1 i A 2 y t . y� The Commonwealth of?l iussuch usctts Department of Industrial Accidents 600 ff ashinrtun Street Boston.Alas. 02111 Workers' Compensation Insurance Affidavit c of 1 am a homeowner performi g all work myself.' s I am a sole proprietor and have no one working in any capacity ._.s>..;•..m...�.+..•--w�•.-.�,�....;.�_.�•Aa..-r-.i..+v.4x7�--*s*�e?•-I.+ ~* ..1r';t'�'^""".�.--e.�.,�-r •r• I am an employer providing workers' compensation for my employeeworking on this job. company name- address: cit1•• Phone#• insurance co Policy.# I am a sole proprietor. beneral contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: cominnv name- address: city done#• insurance co policy# :•1i�!c Jam+ .:.s.'..,�.......�„a:•: :.; ,-,^�s��^'.7+--.r company n•tme:address— city: Phone#• insur•tnce co policy# Attach additional sheet if neeessar�' +;.:z:v,>-�l.' �� r:sr e� t..� ,r..•i•„!: —. ,.n 3,.. S'":�i!�'' `1''"' Failure to secure coverage as required under Section 25A of D1GL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 andior one years'imprisonment as well as civil penalties in the form of s STOP R'ORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement ay be forwarded to the Once of investigations of the DIA for coverage verification. I(to hereby cer(' r itder t to p 'is an a at s un•that the information prorided above is true and correct. C� Sienature17 Date Print name L - ' t'` D A-( Phone#, ofricial use only do not write in this area to be completed by city or town official V city or town: permit/license# riBuilding Department ❑Licensing hoard ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; MOther (revised 3;05 PJA) • f 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 emplaree is defined as every person in the service of ,bother under an• contract of hire, express or implied, oral or written. An enrpinrer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more the foregoing engaucd 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 tLe owner of a dwelling house having not more than three apartments and who resides therein, or the occupat of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling ho'Zis or oft 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 even 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 ha- 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. 77 Cin• or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. 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 advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 S O I L LOG s - i •e 4 4„r I ► r 9S c 1000 1000— GAL. oSa . a i GAL PRECAST OR SEPTIC t c. BLOCK TANK SEEPAGE PIT 20 MINIMUM '': 97.� ` i• 1- ' ' FOUNDATION WAS40 STONE A-,,;) 1,.1� ELEVATION SKETCH TEST By L-,!rt...s..� -r'�-✓44 a TOWN INSPECTOR r•-'F�..:� ♦s+�'f�. ''"a'= HACKr+OE OPERATOR TEST MADE ON r''•'` ' / ? . .� Nft.�E�y G.fe.i+tTf�� TN.4YT TNEr G'c•.ei�,+b ��`�= i-�vwG�N;/;:+,�✓ .5.•✓r�ay.y �.E 2� o� vs/.9S �.e�c.�y° .E� /.,. -r;/� �is`1, [� �..�/ .S�IET r r / {f Ms:.•-- ,:AtWESy p G .e•D a.t �.- �, M - 4 4-0 f f Vi t i 5txr^7+ rAV# C ,:_ � e !e Vi t 4 7d/ 4! a y,Y-E 'tt AG.�. S✓�,rr,gC$ u�AT•BK'. � �� ¢„G.�. �D��� WIA-i- JE Cosa;vt/wr s ��y �7' .1+.' Fi`�� ,PAO POO542 C? 'T1s.� �o C us .• ti4 ,wff'.e�,w,e*�'�.cfl-�. �q` 3�'.k' 3 5 ' ,,. lu vifliHs- f}LllacR.r/�,L?'..x: DR;��• �tvh/ � 5 y'� / J sr'o'g 7H/s .r Y� e�M• �r a�� T1 16 -rs atN4 a �, jo: -30 7 /✓ATE f� /,�— t�,�.LOii•�c. .►+*.ws t:,tr.r[.S w.+4� .=n J,�+R+ • e�-../ae.✓ ,�/✓S"734L.��...i'r=. --%4.�'Ti4 �'y'T - G>•,�t+c�.::j .-s.s.,.,r., g'L` /K `.��Y"s-•.�/✓�-�..�.r-. .r7G''o c�.✓.L`. i'7 '. ,+s�,s..�'-r r?,'�•v ��.rss nci cr,"� ✓�?,•C a::) .GO C:.. .:Nt•.,.�.+.1 .+Pd Lf T /"4� Or✓ �+�''`-•rc SCr_.r['.5 �Af d>?� ELEVATION SCHEDULE PROPOSED SITE PLAN s I INV AT FOUNDATION ----'--. SEWAGE SYSTEM DESIGN 2 1 NV INTO SEPTIC TANK = 4 78W t C� FRANK 3. 1 NV. OUT OF SEPTIC TANK 4 1 N V %TO DISTRIBUTION BOX = _� _ ��cltr SCALE = 2®' � c T 975 &e✓�SAE7 7-30 -9r 5 NV' OUT OF DISTRIBUTION BOX CAPE COD SURVEY CONSUL-ANTS 6 INV INTO SEEPAGE PIT = q `T` f 132 ROUTE � p' g°r . 31,co 7_� HYANN'S, MASS Z 80T?GM OF PIT A D1V131ON 1110110N SUNVI1 CONlULTANT/, INC. 8 BOTTOM OF STONE LAYER / A�=y VA Y Irfi 64 -f L oor2 D rZA 1 A-,I t o.k DOOR o(x t o'- o. .-Dooa Ail / -0 -A55 0 "7)/jcl,- �-/Al DA TI 0 -75 C1, L 0 OKI.5 eb y Y,4 y X-A1,-2moli7+, 1 T. Au7-o :.)ALI:- --5 A410. DA rl-. A M' 12NOU7-�4 T20-AD -j C-A �..L:- o AL4- M6167- if At, 5, BIC T'F,*)>4�41-�5 r A?C.-D)-/Yl/x CC) CWK ID 77 I AJ07 -FLDOTL lo" _ � , raoorz � � � , �aBG V� 1 x1 fir'. BLLC�►. - ---.35 -O, `ADD1 T�of \ PLYWOOD "' `F r r II — C� `-�8" 5/�i �_ aoJ ' 3 8 !Iti L- �; - ,M ' ! 7".�"X Tu r� - !!I \ iLL Tn� -� '� ',<1IJC1-/Or1 C 1 /AQ —- I_ Ti- - Ki • 5 cxa -------- -- - - Ci i — --- — - - -A- hIALL 00 17s=1�.1�.' ! r= 1- �PL'r1 .�„Sf- - "Lnnr1 '`1 �`'AlllSi ?IV 4 `. _. 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