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0974 CRAIGVILLE BEACH ROAD
`7 Jr4i 9ville. ° , /� F 4 A�� TI,Vt: a ° ° YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take'the completed form to the Town Clerk's Office, 1'st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: - �� Fill in please: �i;r APPLICANT'S ._ YOUR NAME/S: vAkW t amp MR �`" BUSINESS YOUR.HOME ADDRESS: VAnn r TELEPHONE # Home Telephone Number swig NAME OF CORPORATION: JFAI IVR P.107 Sfv NAME OF NEW BUSINESS O TYPE OF BUSINESS o IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS I AP/PARCEL NUMBER .[Assessing) When starting a new business there are several things you mustdo 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 ISSIO ER'S OFF E This individu I h e n i ed a pe mit requirements that pertain to this type of business. ' Aut orized ignatupol COMMENTS: M ff)i I ,4 � 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: __ .. .._ .�„a- .r. ..., :.,.- a. fir,: �. -;--*r-•w:t� .'ir,.�•.r:.n.�.r}ara,,,;,7-:..�r.d.y„...•„•,,,/' 'T:K-'w,r'T°v-e• .-'r.w...-;',,•5.,,,,•.r-.....� TOWN OF BARNSTABLE BAR-W 9077 FOrdinance or Regulation WARNING NOTICE Name of Offender/Mana g e(r 11CA-e- ' try /"ll�p1' M _ Address of Offender 4 ,� _ -MV/MB Reg.# Village/State/Zip 20L B' u psiness Name ,,�X �QI-7 �P.,, �� �-l- am/pm, on ! -^ (--e -. � _ _ � ram- �� BIsiness Address C,,+ A('4ZVjV 61A(, t Mt n Sing:ature of Enforcing Officer Village/State/Zip Location of Offenseq-1 C—AA14C4' d-1 6ArkL 0�, t Y Enforcing Dept/Division Of f e n s e J14 A �i'� -14 " (41 J� # _ �. . Fact] �, +f1 . #�� () U 1� / ( 3 . _ ✓�"'" "" ot^, 4 - This will serve only as a warning. At this"=:::time no legal action has been taken. It is the goal of Town .agencies to .achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD.%EG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN • OF BARNSTABLE BAR-W H 7 7 Ordinance or Regulation WARNING NOTICE Name of Offender/Manage rn , Address of Offender _3x: MV/MB Reg.# Village/State/Zip Business Name am/ m on ����— 20 Business Address v'k 4d — Si n ture of orcing Officer Village/State/Zip � c_ A� O�,632__ Location' of Offense En orc' g Dept/Division Of fens AXU,1194,0 L 1 APktif - , Facts This will serve only as a warning. At this time no legal action -',has been taken. It is ' the goal of Town agencies to achieve'' voluntary' 'compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are _:ptempts to gain voluntary compliance. Subsequent -violations . will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./RE.G.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. I , License Period: , S"i� =II'• 1-� f i( iti� itsJ ? New Application 1 OwM stable ► Renewal Date: (( ,. ,. -7 — S— LICEN (CATION OTransfer Lot. �r�*��' QAmend The undersigned hereby applies for Lice e to conduct business in the Town of Barnstable in accordance with the Statues of th e .( Commonwealth of Massachusetts and subject to the Ordinances of the License Authorities. r NO BUSINESS MAY OPERATE WITHOUT A VALID LICENSE ON THE PREMISES Name of Applicant/Corporation: a �, tV Business phone# Address of Applicant/Corporation:L32,3- Sb,-t-� ell Phone# 5 J Email Address: ro, t r 2 l_- 00 .C-:D-V%^, Federal ID # 632?SL?o7 last 4 digits only D/B/A: «L V+ dK r Map/Parcel# Business Address:12 7 y , C'r "V, Gqs�.d., Village C(2_4.? Business Mailing Address: 23_�a,'�-f-�•S't-. f-� ;y��� Property Owner Name a-1 •ryc1-.- Name of Manager: Length of Lease Cw� License Type: wL(� -- Manager's Email ---- Hours of Operation: L�i oo R M_ 5 10� M Annual Seasonal Entertainment: YesE] No TV's and• Recorded Music is considered Non-Live Entertainment and rennirec a licence If yes, the Entertainment License Application Form is required. NOTICE:Any misstatement in this application or violation of the applicable town ordinances,bylaws or regulations shall be considered sufficient cause for refusal,suspension,or revocation of any and all licenses. I warrant the truth of the forgoing statement under the penalty of perjury. Signature of applicant: cig 0 le— • For Town use only Tax Collector Town Clerk Grease Tra A p e VES ERMITTED WITHIN THIS ZONE? p p rove NO ❑ R.E.Tax Paid Business Cert Filed Yes❑No❑ Yes 0No❑ Yes[]No Initials DateC l Permit Granted YES NO� �i� p y , clude with application G. Mgmt Approval Police Dept Approval Cons Co'pmy ,App Approved floor Plan on File YES❑ NO Yesn No❑ Yes❑No❑ Yes Occupancy Initials Date Initials Date❑ Initials 4_ _4 r6 Number of Units or Rooms Building Approval Health Approval Fire A Distnct! E Yes No Yes ❑�_, Seating Capacity No❑ Yes[]No �-�•�--.� � Initial Date❑ Initials Date tlnitials�. ._ I ' PROJECT 11 I — NAME: 4JG`'Rcv1 � � v -- ADDRESS: S ��� y,��. :czeJ►-, lF--� PERMIT# C� PERMIT DATE: Mrn: LARGE ROLLED PLANS ARE IN: BOX SLOT Data entered in MAPS program on: BY: q/wpfiles/forms/archive i A AML — — - 6►=` pia'! I m; (3exvc- f /ZL7 JOHN W. KENNEY ATTORNEY AT LAW 12 CENTER PLACE 1550 FALMOUTH ROAD CENTERVILLE, MASSACHUSETTS 02632 (� TELEPHONE 771-9300 /� \ FAX NO. 775-6029 AREA CODE 508 l�./ e-mail:john@jwkesq.com September 7, 2011 o Thomas Perry CD Building Commissioner 10 Town of Barnstable s _. 367 Main Street Hyannis, MA 02601 ' o in Re: Craigville Beach Grille/Beer and Wine License Dear Tom: I am writing to follow upon our recent conversation concerning the decision made,by the.committee whi6h.'interprets the District of:Critical Planning Concern ("DCPC")'regulations'for the Craigville Beach District. The committee gave a negatiVe.response to my inquiry as,fo.'the possibility of adding a beer and wine license to my client's business known as theCraigville Beach Grille. After reviewing the DCPC regulations for the Craigville Beach District it is my opinion that my client should be allowed to proceed to the Licensing Authority to request a Beer and Wine License. I am writing to request that the committee reconsider its decision. The Craigville Beach Grille is a "Small-Scale Food Service" establishment as defined in Section 240-131.3 of the regulations. The business is located �Alithin the Craigville Beach Neighborhood Overlay District as set forth in Section 240- 131.7. Under Section 240-131.7 F.(1)(b) a Small-Scale Food Service Establishment is a permitted use in the Craigville Beach Neighborhood Overlay District. :f F The definition of Small-Scale Food Service Establishment is silent as to the service of any kind of beverage. It does not specifically allow the service of soft drinks or, conversely, prohibit the sale of alcoholic beverages. However, a rational'interpretation of the definition of a Small-Scale Food Service Establishment would include the service of beverages. .The issue,,is whether adding a beer and wine license to a conforming use.constitutes an expansion or alteration of an existing conforming use. If this food service establishment was located in another district and was an allowed use, no further zoning relief would be required to add a Beer and Wine License. Even if you consider the addition of a Beer and Wine License to be an expansion or alteration of a conforming use, Section 240-131.4 (d) of the regulations specifically states "Changes, expansions, or alterations of existing conforming or non conforming uses and structures lawfully existing are permitted subject to the following:". Although this section clearly states that changes, expansions or alterations to conforming uses are permitted, it does not set forth any criteria to which a change, expansion or alteration of a conforming use is subject. Since rn this section of the regulations allows for changes, expansions or alterations of conforming uses and does not set forth criteria that must be met the addition of a beer and wine license to a Small-Scale Food Service establishment should be allowed as a right, subject only to Licensing Board approval. I ask that you review the earlier decision made by the committee interpreting the DCPC regulations based upon the contents of this letter. If you need any information concerning this matter please do not hesitate to contact me directly. Very truly yours; eZohn W. Kenney, sq. 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Ada ,.�.,Y+•a ifi..mot� .?!'�:.w'•t�i.,.• .�. p . -k�� - xr� !"�'k '� -•� -.'1', . �`T� ->g4 4 i! .,•^+.�' � a'+.i, .- a ,ram: - ". •- 4i^r � 3'a"x�}.-r ,�s''fi1'^',:'°' ' w �v xT�y,-.��9'�.Y"' .k+,.` k0.�e ^t3 �r.� .,`�;` S ` - - sa- _.x.. �. .,,,. n�•.�, r!J r =�' „r� a rk� 4 � r a .`tea_, � „xr�.'�r'� � <,,:•:� y�` � c v 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) "c Fill in.Rleace: APPLIGANT'S YOUR NAME: '' BUSINESS ?YOUR HOME AEDRESS: TELEPHONE # Home Telephone Number NAME OF NEW BUSINESS , ►^X TYPE OF BUSINESS: Szs �►+'� �` 15 THIS A HOME OCCUPATION? 0 YES NO.: Have you beenf'glven a ro., is :9 Ic ADDRESS OF BUSINESS �a i MAP/PARCEL NUMBER .Z O O '; When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street],to make sure you have the appropriate permits and licenses required to legally operate"your his town. 1. BUILDING CM NER'S OFFICE r This individ al ha e n.Wo ed� f ny permit requirements that pertain to,this type of business. u horize_d Si tune* COMMENTS: r 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: YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1'FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: O Fill in please: _ l APPLICANT'S YOUR NAME` C ° '�°� �zo BUSINESS YOUR HOME ADDRESS: 3 c�1% fit 11 TELEPHONE # Home Telephone Number el� 42 NAME OF NEW BU51NE$S TYPE OF;BUSINESS ' 'YI�J :IS THIS A HOME OCCUPATION? YI:S NO Have:you been.given appr.:ovaI from the buil lin divis� n YES NO �' ,g �; ; IlsCADDRESS OF BUSINESS: MBER When starting a new busi esThere Vreseveral ings you mutt d or er to a in coCV anVe 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 COMMISSIONER'S OICE This individual ha i med oaay permit requirements that pertain to this type of business. or ed Signature* COMMENTS: 2. BOARD OF HEALTH This individual has beeAired of the it requi em is that pertain to this type of business. A or d ignature* COMMENTS: Al_ fiQ 3. CONSUMER AFFAIRS (LICENSING AUTHO ITY This individual ha gpn i ed oft c �irements that pertain to this type of business. A hori Signature** / COMMENTS: S V r* mot , Sign * TOWN OF BARNSTABLE Permit * BARNSTABLE, 9 MASS p39. �A� Permit Number: Application Ref: 200703354 PP 20070051 Issue Date: 06/01/07 Applicant: NINIVAGGI, ANTHONY & CAROLYN Proposed Use: MIXED USE RESTAURANT &RES Permit Type: SIGN PERMIT Permit Fee $ 25.00 Location 974 CRAIGVILLE BEACH ROAD Map Parcel 226006 ` Town CENTERVILLE Zoning District RC Contractor PROPERTY OWNER Remarks REFACE EXISTING 12 SQ SIGN CRAIGVILLE BEACH GRILL Owner: NINIVAGGI, ANTHONY 8i CAROLYN Address: P O BOX 193 W HYANNISPORT, MA 02672 Issued By: PC POSIT THIS CARD SO_,THAT IS vTSIBLE FROM THE STREET Town of Barnstable °F'"E'ati Regulatory Services Thomas F.Geiler,Director 4 . snxiJST"ate, mass. ' Building Division y $ SATE p 39. p`0 Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit# p�b6363 Application for Sign Permit Applicant: a eJ C—AA, Map &Parcel# � Oar Doing Business As: e. C'Xc,._V ac.." Telephone No. A Sign Location Street/Road: y— Zoning District: Old Kings Highway? Yes/No Hyannis Historic District? Yes/No Property Owner Name: Ao �6; 2N.�/N/ 6 � / Telephone: S� —1b--cqzo. Address: C/` 5A '/'e_e- [j3Lj�C.vtui 9age: �I � �' �0��9 Gi 5`7-1 7 7 7 ( Sign Contractor ° C� a� —b 8 Name: Telephone: Mailing Address: �_ '"• ` -� �`"'""� �(Qt S 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 1 Yes/No (Not ?Pj es, a wiring permit is required) i Width of building face ft.x 20= x.20= Sq.Ft. of proposed sign � I hereby certify that I am the owner or that I have the authority of the owner to make this application,thatap information is correct and that the use and construction shall conform to the provisions of§240-59 throu 240-89co of the Town of Barnstable Zoning Ordinance. o Signature of Owner/Authorized Agent: Date: (7 L/ 2�7-- 07 w3 Permit Fee: Sign Permit was approved: Disapproved: i Signature of Building Official: Date: �. In order to process application without delays all sections must be completed. Q:I WPFILES I SIGNSI SIGNAPP..DOC Rev.9112106 f r� LOCUS BEET S-I-G- N c-o Michael McGowan 121 LOCUST STREET FALMOUTK MA 508-457.1777 508-457-1277 FAX F m P , at- f s � yr Proposed Sign Locations Proposed Sign Area: 36" x 47" 11 .75 s/f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 'Map Q-. Parcel 00 _Permit# I — 111.0; Health Division l/ / /� / ate Issued 5 Conservation Division 7/ 1�Z /�!%n,v� p,4-a� 3 A"licaior� �'�o .��j. o I pR� Tax Collector ✓�/, /�Ds� SEPTPr??r�iut� aUT E� Treasurer IN DAB-C6ti PUANCE --�-•------ ��� C l r MTLE S Planning Dept. E NMETwom; TAL CO AN Date Definitive Plan Approved b Planning Board s PP Y 9 d Historic-OKH Preservation/Hyannis44 Project Street Address �17 �2d Village /2 v 1 f Owner /,v Address _ Telephone 2,21 Permit Request kF10 MI voob Ffli9 yr-1)PV IwAlcA Ve Vic, Square feet: 1 st floor: existing proposed 2nd floor: existing fX proposed Total new r Zoning District Flood Plain Groundwater Overlay Project Valuation ��C� Construction Ty pe ype Lot Size 11W Grandfathered: Yes ❑No If yes, attach supporting documentation. . Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 190 Historic House: ❑Yes S'IVo On Old King's Highway: ❑Yes ❑ No Basement Type: ❑Full Q16rawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing — new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ■Gas ■Oil ■ Electric •Other yy4F, 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 o If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION d� Name I;& 11wallfTelephone Number �7 r S� ti Address License# n:2 (3 Home Improvement Contractor# �(�'*Z4 I z�aoz Worker's Compensation# �.�. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C SIGNATURE DATE -� FOR.OFFICIAL USE ONLY, PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS. VILLAGE OWNER f DATE OF INSPECTION: FOUNDATION ; FRAME ' INSULATION FIREPLACE " ELECTRICAL: ROUGH FINAL .. ga.. t.M PLUMBING: ROU°H _ FINAL GAS: ROUE = o FINAL . . FINAL BUILDING - P° F f 1 DATE-CLOSED OUT_ ` ' J Isz ASSOCIATION PLAN NO. L®CAftTIC3N ® I= RRC3 RERIFY LINES . MAY N®T 13E ACCURATE STANDARD LEGEND NOTE:not all symbols will appear on a map GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES EDGE OF BRUSH ORCHARD OR NURSERY ✓'-T. v'-7 EDGE OF CONIFEROUS TREES 'MARSH AREA I � \ EDGE OF WATER DIRT ROAD ..S DRIVEWAY E--PARKING LOT PAVED ROAD — - - — DRAINAGE DITCH PATH/TRAIL r PARCEL LINE Wpm-< MAP# I 21 < PARCEL NUMBER I j I #1860 — HOUSE NUMBER 1 ' 2 FOOT CONTOUR LINE AP 22 —io— 10 FOOT CONTOUR LINE ' I Elevation based on NGVD29 4.9 SPOT ELEVATION STONE WALL 3; '• •� ' -X—=X— FENCE w r RETAINING WALL # 9 .4r � I / =+ RAIL ROAD TRACK STONE JETTY I roof SWIMMING POOL PORCH/DECK BUILDING/STRUCTURE DOCK/PIER HYDRANT e VALVE O MANHOLE O� POST p"' FLAG POLE T O W N O F B A R N S T A B L E G E O G R A P H I C 1 N F O R M A T V O N S Y S T E M S U N I T .� SIGN ® STORM DRAIN . N PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The pa(a]lines are only graphic rep resentat ons DATA SOURCES: Planimetr cs(man-made features)were interpreted from 1995 aerial photographs by The lames 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD UTILITY POLE a TOWER Q ^� )Q s?Q National Map Ac[uracy Standards at this do not represent actual relationships to physical objects Corporation. Planimetrics,topography,and ve vegetation were mapped to meet National Ma Accuracy Standards * enlarged scale. p p p Ys I pg pp p ry G LIGHT POLE O ELECTRIC BOX i I INCH=20 FEET 9 on the map. at a scale of 1"=100'. Parcel lines were digitized from FY2002 Town of Barnstable Assessor's tax maps. .THE Tp�� The Town of Barnstable t NW p� aAR ASS. 6. Department of Health Safety and Environmental Services 9 MASS. 0a ATF p Mai Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: , C NiNiNpro6 Map/Parcel: 00 Project Address: �VCL CA3 t Wf �C'"\ Builder: The following items were noted on reviewing: Reviewed by: Y Date: � ` 6`Q Z- q:building:forms:review +..r.e.ew,.....,.!w.+......m...-....:.ewr.,.m�...r..a.aw.ur.w......b...,.�.n aoamw� " !/ �w�..+maewm.kern:u+aeew..um+.mw.nw....weremaeavi¢v�waa's)....mwa,nrwm?:mrm:e.. .. vrc'w ..:. rn ir'r rix.a:awlv�T r•v.rew ama,Waco.rnttxYnwiau.me�mawnru's«r,urr�e.ei.rxuAmi.n�ves:n9mWnar�ameawmea. r _ PINay�n d f je jt � qg if : f ¢t a8�y Y _ :..,....��. �"z�•�s�-+r'�r� �'aY�rS�it<�.ma 7iat�.s4..`e -•n'.a.�.a....a..�.�y.:.r.y i Al 1 i 1 { , I j --^. ••-•+,M•u+.'+r. :emer ...v.�.wu.n!•,.w1a..mn+amw•.'w.. rmvdncu w>tor�anatn+ra�ravwenva:R:ttar�,wtrrr-rxaanrsn.wa-.«aws,!.mvwiim,.rmgierarxtcrlwt+,:Ya.�e?weralM�'Mar+a+iwe.oxesnea�dnow,tmm?.newaucmR)+ma.ovNrerma•)gu.a.* QaJ • eeawww.mwara.n l r I I i I r I I s r I r' i a 4 I ' , 1 'r I I r w : 71 zlE I ; •.-'. .-{9...... tr..ix sron-Imr r,nv++::ney?.nivic.•,vnme.�.mxsxa��w..ae+n�.w aw.waaax+�9aevak�aa,.hn�ryuupn'm^n�ii: }�wl�+� .. a�: - 1 Ij ���,..�.....k.�....�...r .,•�+, .a.u... 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D rT,Ma'To4raww�Nt9uiww>W'AS1:� w6:aw...w�ars9reC:wrw S. aroma s:exw+:m.ma aw.ac.I.¢S.m,rtai cvm�w. wrt�;e.�.�ucw.a.w.ea ....srw "w .ora•vr>.=+x.e:>..aasswwa..�.n....�«av �w-�w•..,��.axe..�wnm,..,e�re+n�+e.�.aw.1.w.�......,;� .+!..o-.—....- E . r � i t 1 V14 III �'1 m+�••••^^�+' '••,�••v� .^"k'^� .W..^'!R)9�'�.ALCC.�IYn?F4l'lY%x!�.T.P!�w;F�WS:TrJi:vtR^.'�t TYi^`T-'181'�A'iR.'Y'A1`C.IV xRi.iii.dvA.�lRw4i141.uF<±C!8191i .RIFiuY4W:u,4'Ol FaNYMi>'Flre.K�^vFSFi'Y,tTA"N^^,+Vf,Y.i'fNtMt`_Mbetlw�Pe.iC1✓.wwdw.aw++.r.w.v....:�w. o _ a CRC 1 : V&L 9 3 i�AC�4 ROA 1) • •• —wv..er.w,nvw��rw:mrwo.euw:wrnarr.wn,ewn.rnv�.+N.wm.PLMavtnnANi•..vvm'.tWwnwRtievottvF.u9.renic"!ia'..�OJv✓I:rwtW�IfiAPNe'.:A•LYWPH)t'M'-Lvrv.nafvr�rP+,[aN1'sl tt •. "" •','' •nb4A".bC'Ai�!;v4 Y,.:nr.�ry .:uni G:.r+ryC..!r h'!. L,+f^"".:^N rt... v �ra4LMN w.v!:r.w„�..-,1 ..*r+i,.'...�'�vC'/,n F.T,N N.nJJ ir...of �a aims'_ .. 1..._. w 1,4 tit pr ell , K� ��. ' ' 1��g HOC��►�:�`�F�e?�. 1. ' 1 ' ,,. ...s•:.4"'R'F`Ihs 9A`C)3':1`A:nSio'S':tkOi:G"nn.-::.:f�z..�. _. -_ ..._ qy C 4 i' i L , a - , { a n � . . � ' - 1 LL. s. 'y^�:^!!O':sPP+.:IY:ra+sS.�M+'�:'.x K.c•.1M,5 .,^a.�.P',T�>e.'..}� ,?Prn��'.V a'.:-V`;m... •.""YW ce n..rx`.ra.4-�:rm^w n.rci.s+..... n.+r, .n..'..�++'n,...a^,.,�.rw..x...AAsr P.•-..�W9,wu 'f4,tX.h.h'.f,4.,t.+r..uL+�+ .:a[5�/+4slar srLrL(.e+hL�LFLLr�+.t,r.,M�ew.vrs.m...nnvxasn...� a.. ...:r..ro+ �'••"-• `_ _`�� The Commonwealth of Massachusetts Y�_ n �_-.I ' Department of Industrial Accidents . 3W. ==...- .-= Office of/avest 08MOes . . __= S 600 Washington Street T - �;; Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name: /�y/?1.r 40/i /6/ /3 A d location: � �O �d c�7�s4� �, ,G/�.c/ city /-6/ `�o l?yy!U U j?z /%s� phone# 2'69-6" SO C _---- ❑ I am a homeowner performing all work myself. I am a sole r rietor and have no one worki>i in an ca achy ❑ I am an employer p roviding workers' compensation for my employees working on this job. ciinipanv name::: :><::::>::::>:..% :aildr city ahoae nsur thee t:o... :.... . :.....-I..... .. .. .. oh r;."...:....:M....:Ii:I::.::-.:::.::1X.-....:.:....I.a."....::..X:'..A:...,:-..i.I...."�..":........:...:........:..;...--::I.%t.,.. I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who the following workers' compensation polices: anv.name;mn .::.:.;::.:::.;:..:;.>::.;::.;:::;;:.;:.;:.;:-"...::::: L{il..'QSS:s< `>'X.2": 2 '? ? 3`r i >` <:^2::f:":: ::ass :: ` :>..', j>i<>: !`'r ff f ' yids ' .. ..: ': t : '<! sa :s ' ?: ': -.—.::> .::.:::... ..:.:::.: elm........................ .... :::::. .... :...::.. :::.::...........::::::.::.:.: .:.:..:::.:::..:.. .::::::::::::::...:..::::::::::...::.::::::::.::.:::.. ::.:::::.:..:..::.::.:::::..::.:.:.::..:::.:.:::..:..;:::::::...:::::..:::::.:.:.:..:.. .:.:. _. ............ ... ._.... .._.:. %✓l%li. -<:::<:>: .. .::..:::..:.:...::..:. a dt€ress ...:...:..:::: :::.:::;:... e?> Tiitl3Ari . Failure to aecare coverage as required ender Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to 11,500.00 and/or one years'imprisonment as well as dvII penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that s copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains tes o r.0 'formation provided above is true and correct' Signature Date 5 _ 2 4V _0 Z _ Print name /3,0 Phone# >7 p" —d,pc .S— official use only do not write in this area to be completed by city or town official . city or town: permit/license# ❑Building Department Licensin Board ❑ g ❑checkif immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised 9/95 PJA) l 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 hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased,employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 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 have 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 along with a certificate of insurance 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 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 perniit/license number which will be used as a reference number. The affidavits may be rewifii:d ind the Department bymail 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 Me of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 i � '�" i �1 � t }'�V F4Y 7YGJYL/lYX2G(lP.CI��fL'�a�'.,'�daf�flise�a✓�� ±' BOARD OF BUILDING REGULATi.ONS Lrcense CONSTRUCTION SUPERVISOR, Number cCS 0.73853 #Al - * Expires 02/06/2003 Tr.66:1 73853 4 ?, Restricted To; 00 MARK D BIBBO 150 PILMCO;;POND RD �+; !� MASHPEE MA 02649 administrator'' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map C2 Parcel r)toPermit# �+� 2 � Health Division Date Issued ` `�L Conservation Division Fee ��� O Tax Collector Treasurer ..Qz—. Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address q7tl eA3_A16-L/ tL-L•C agf7 ,�_a Village (�FV7_Ffc_ V/ t"L r Owner l r —/ Address l D a Telephone e0f- F/0 Permit Request Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation�JW Zoning District Flood Plain Groundwater Overlay Construction Type UV 00 8 Lot Size �000 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure SV I ' Historic House: ❑Yes *0 On Old King's Highway: ❑Yes 'A No Basement Type: ❑ Full Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 402 Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing c�` new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other J V/0 Central Air: ❑Yes No Fireplaces: Existi g 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 BUILDER INFORMATION Name 1 n/V V A/ Y R Telephone Number Address License# i Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE —����r — F f FOR OFFICIAL USE ONLY A - 1 � t PERMIT NO. DATE ISSUED ! — MAP/PARCEL NO. k a ' ADDRESS ¢ VILLAGE OWNER — DATE OF INSPECTION: FOUNDATION 1 r :y FRAME ,. t INSULATION FIREPLACE r{r A ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. a . r , 3 1 The Town of Barnstable Regulatory Services Thomas F. Geiler, Director -Building Division Peter F. DiMatteo, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-403 8 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an 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,with certain exceptions, along with other requirements. l Type of Work. Estimated Cost WAV,— Address of Work: //e Al AV, Owner's Name: Date of Application: I hereby certify that; Registration is not required for the following reason(s): Work excluded bylaw Job Under$1,000 OB ding not owner-occupied VOwner pulling own permit Notice is hereby given.that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: ' ` ad V0 Date Contractor Name Registration No. OR r q:for=:Affidav :rev-122001 The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Thomas Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: �0 JOB LOCATION: C / a L ✓l l//e 19 1 A01 number �l street / village�/Cj �// "HOMEOWNER": ( v /" I�l('� byp)) ( hf/O F1'•�`i/ —`e2W3 name home phone.# work phone# CURRENT MAILING ADDRESS: city/tg4vn state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of sic units or less and 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 strictures. 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 Dep nt um inspection procedures and requirements and that he/she will comply with said pro d es a equ- ents. S' ature of Homeo Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction.Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner skull 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. 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As quoted from the "law", an employee is defracd as every person in the service of another under any cart= of hire, e:cpress or implied, oral or written. An employer is defined as an individual- partnership, association, cozporazioa i or other legal eatts•, or any two or more o' the-foregoing engaged in a joim enterprise, and including the legal representatives of a deceased employer, orthe rec.-:ve::: trustee of as individual., partnership, association or other legal entity, employing employers. However the owner of a dwelling house having not more than three apartments and who resides thtre�m, or the occupant of the dwelling house of another who employs persons to do mainfemaet , casanctida or repair wok on such dwelling house or on,the was.cr thereto shall nat because of such employment be deemed to be an employer. building appumma= MGI:chapter 152 section 25 also states that every state or local•licend g ageney.shall withhold the issuance or renewai of a license or permit to operate a business or to coastract buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, commonwealth nor any of it's political sabdivisioas shall eaten'into nay contract£or the performance of public wort until acceptable evidence of compliance with the insurance zegmretccats of thus dmp=have been presented to the cotasa_r*'T'= authority. - /r/m/u/ -Applicants ; ensatioa affidavit completely, thte.barxthat lies to pour sit�and Please fill in the wozicers'camp mop � g � sapplping company names,address and phone numbers along with a c=stificate'of insurance as all affidavits may be submitted to the Departmcat of Industrial Accidens for ca rErrm= a of msamnce coverage• Also be sere l sign and date the affidavit. The affidavit should be.retuned to the city ortowathat the application for the p�or iicerse is big requested,not the DepattrneEz of Industrial Accidents- Shaald yam have any q=tions regarding the"law"or if you lease cin the D arta%m t at the amber listed below. . are required to obtain a workers'compcasatiaa policy,p RVIR City or Towns I I The Departto has provided a space at the bottom of the Please be sure that:the affidavit is caaaplete mad printed eg�.y. � ll�• Pl�se affidavit for you to fill out in the event the office of has to contact you regarding apP be sure to fill inthe pcaaitfiicrose aumbe=which wM be urstei as a rcf==C0 member. The affidavits may be re�ni:a t^ the Departtacnt by marl or FAX unless other have been made- . Office of InycstiQations would Irke to thank you in advance for you cooP�and should you have any questions. please do not hesitate to give us a call. � MR�% The Departrna='s address,telephone and fammamber. The Commonwealth Of Massachusetts Department of Industrial Accidents Me of laves uatloas 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 - phone #: (617) 727-4900 ext. 406, 409 or 375 ' r \ COMMERCIAL PROPERTY MAP NO. LOT NO. FIRE DISTRICT 974 & SUMMARY STREET 1 976_Craigville Beach Road Centerville ;3 LAND :2 s 226 6 C-O � BLDGS. OWNER TOTAL �j!,',) I•.�G LAND -• RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: Lots A-2 & A-3 LC 18162- 0, B DGs. TOTAL . LAND " -- - 6848 -- Z-O--- --- BLDGS. I .el�chowski Antoni J. & Kr st na A. 7-1-77 Ctf. 1072 ($75,7 t (`i ,.. . ,-;- 1, \. TOTAL i (; LAND J g, ,�° BLDGS. TOTAL LAND BLDGS. TOTAL LAND BLDGS. TOTAL LAND BLDGS. TOTAL / LAND 1 INTERIOR INSPECTED: / BLDGS. TOTAL DATE: LAND ACREAGE COMPUTATIONS BLDGS. LAND TYPE # OF ACRES PRICE TOTAL -1;mPA. VALUE TOTAL OUSE LOT LAND EARED FRONT / BLDGS. REAR ,417, TOTAL 'OODS&SPROUT FRONT ` LAND REAR BLDGS. ASTE FRONT TOTAL REAR LAND 0) BLDGS. ` TOTAL LAND BLDGS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ` -� ROUGH TOWN WATER BLDGS. HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND FOUNDATION CEILINGS TILING / BUILUINU COMPUTATION INCRETE WALLS LATH & PLASTER BATH RM. FL. &WAINS. ^ S. MENT BLK. WALLS COMPO. BOARD. �/ TOILET RM. FL. & WAINS. `� S. F. LICK WALLS ACOUSTICAL BATH ROOM FLR. S. F. ONE WALLS TOILET ROOM FLR. S. F. I I?a <,,,•, INTERIOR FINISH S. F. BASEMENT AREAQ LATH & PLASTER MISCELLANEOUS S. F. FULL DRYWALL P " FIREPROOF CONSTR. S. F. EXTERIOR WALLS WALLBOARD MILL CONSTRUCTION S. F. ,LID COM, BRICK UNFIN. INT. FIRE RESISTING IM. BR. ON C. B. STEEL FRAME 15 CE BR. ON COM..BR. PARTITIONS STEEL BEAMS & COLS. �IJ ;N-a a/,Yu v , .CE BR. ON C. B. LATH AND PLASTER TIMBER BEAMS & COLS. Q .CE BR. VEN. DRYWALL / el STEEL TRUSSES 3- 4 MENT OR CINDER BLK BRICK --—- IN. CONCRETE C. BLK. SPRINKLER SYST. IT STONE FACING PASSENGER ELEV. ONE OR T. C. TRIM HEATING FREIGHT ELEV. Y'� UCCO ON STEAM INCINERATOR DING OR SHINGLES ✓ HOT WATER FIREPLACES - Z ARTY WALLS HOT AIR CHIMNEYS ATE GLASS FRONT GAS 12 'z � . . . . . . . . . . . . . . . . . OIL BURNER STEEL FRAME SASH / /0 2 ROOFING COAL STOKER WOOD FRAME SASH REPLACEMENT VALUE 2 y q 9 k/ . IMPOSITION OR T. & G. NO HEATING RENTAL CAPITALIZATION LOCATION :TAL AIR COND.-REFRIG. LAND 2 GOOD FAIR POOR )OD DECK A"_51�� � / AIR COND.-WATER VACANCY _.. LISTER DATE J QL� AQ �OtisYfL�L`f"IOA) .TAL DECK HEATING I /� 1 l � aA �,C$ ✓ WIRING WATER J�9 mac, o E vle i a ka- ' • FLOORS FLEXLUME OR EQUAL �/ ELECTRICITY OCCUPANCY DETAIL & INCOME B IST 2N 3RD PIPE CONDUIT JANITOR INCRETE MANAGEMENT I ATH PLUMBING NE ✓ BATH ROOMS TOTAL FLAT EXPENSES �� - y 4 ^ IRDWOOD TOILET ROOMS f NGLE FL. WATER CLOSET EXTRA GROSS ANNUAL INCOME d _ 1 7 ©L� Y ;PH. TILE LAVATORY EXTRA LESS FLAT EXPENSES .RRAZZO SINK EXTRA BALANCE FOR CAP. "IT •.,7 ,.)4? ^✓'� DOD JOIST URINALS CAP. RATE 'EEL JOIST NO PLUMBING REFLECTED CAP. VALUE 2 �� r AN. CONC. j j•. FIOuJ 6Ar� � OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. CONO. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL. 'f �"R',� `, a''.. FlL I 7I0 Y Y 9 S-" 3a /71 1 2 3. 4 5 r' TO ALL NEW BUSINESS OWNERS 'I Fill in please: APPLICANT'S ®® ® YOUR NAME: C BUSINESS YOUR HOME ADDRESS: . 13i_1�y IL TELEPHONE a 2 �; Telephone Number (Home)�Qg - 1 S - ►�l nit r NAME OF.NEW BUSINESS PE OF BUSINESS IS THIS A HOME OCCUPATION? ADDRESS OF BUSINESS "i When starting a new business there are several thin MAP/PARCEL NUMBER �(O/Od Barnstable. This form is intended to assist you in obtaining the information you must do in order to to b me i n compliance with the rules and regulations of the Town of listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor- Town Hall Y y need. Once you have obtained the,required signatures, I. GO TO BUILDING INSPECTOR'S OFFICE (4TH FLOOR TOWN HALL) ` This individual has peen informed of any permit requirements that pertain to this type of business. Authorized Si nature COMMENTS:. i r 2. GO TO BOARD OF HEALTH (3RD FLOOR TOWN HALL) ' This individual has been informed of the permit requirements that pertain to this type yp of business. Authorized Signature COMMENTS: 3. GO TO CONSUMER AFFAIRS (LICENSING AUTHORITY) - (3RD FLOOR SCHOOL This individual has been informed of the licensing requirements that pertain to this type f business. BUILDING) iness. Authorized Signature • ';;COMMENTS: fEer:obtaining the required signatures you must return to the Town Clerk's Office to 0 :yti:4...•i i... for 4�.years), A business certificate ONLY REGISTERS YOUR NAME in the town w obtain your business certificate (cost $20.00 t„ lssion to operate -you must get that through completion of the processes (which you must do by M.G.L. - it does not give you ��� from the various departments involved. i TOWN OF BARNSTABLE s ` SIGrD1,._PERMIT PARCEL ID 226 006 `" GEOBASE ID 13501 ADDRESS 974 CRAIGVILLE BEACH ROA PHONE CRAIGVILLE ZIP LOT A-2 & A BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO I PERMIT 31640 DESCRIPTION J'S AT THE AEACH. (32 SQ.FT. ) PERMIT TYPE BSTGN TITLE SIGN PERMIT CONTRACTORS: Department of Health, Safety ARCHITECTS: { and Environmental Services TOTAL FEES: ` $50.00 BOND $.00 Ox WE CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE i * BA .STABM1639. + MASS. � ED MAC I B LDI C DIWSI N I B f {f DATE ISSUED 06/18/1998 EXPIRATION DATE x I I 1 I® FRUIT DRINKS. PiR on NINI ■ � ■®■ on ■■� NINE ! In ; \\ S� - .ryt � :�� v a d,• a Ch IN YN V a 1 a, ,_ ,_TROZEN- A FRUIT ' ■ g7z/z/ H ©m ��� ��� , I ■ ITS( ■®� ��� gem - ■■n1 .1101 o �im �1 - a a ,� a ,; , .. a •. � � , » �, a ' ad � � �� ,�„ �.� a, 4 dal -```. a, 3 � � � n .� �, I a r TFiF The Town of Barnstable r = Department De of Health Safe and Environmental Services • .&ABt.�, • P Safety MASS. Building Division b MA'�a 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner gloom Tax Collector 77 _1 Pplication for Sign Permit. Applicant: �J��� _Koma Assessors No. ?ag — Gf]C Doing Business As: S 11P_ k�Gh Tele hone No. '- 7��gP Sign Location g Street/Road: ( / 4 XE:'.4( o 1� Zoning District: Old Kings HighwayP Yetq_Hyannis Historic District? Yeso__. Property Owner /I Name: t Illy TaIy l Telephone: Address: 2q6 � ,<�y L L Village: Ceti bn'y ( (e Sign Contractor Name: �A)c' Telephone: Address: C7YAt_o —Village:__ 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. fs the sign to be electrified? YeILN�o (Note:Ifyes, a wiring permit is 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 Barns Zoning rdin Signature of Owner/Authorized Agent: Date: /7 �, Size: Permit Fee: Sign Permit was approved: `� Disapproved: Signature of Building Offic Date: i�, Sign1.doc T. The Town of Barnstable Department of Health, Safety and Environmental Services ' l Bullding Division 367 Main Sh el,Hyannis MA 02601 Office: 508 790-6227 mph Crosses Fax: 508-775-3344 Building Commissio Sign Permit Requirements 1. A photograph showing the existing facade, on which has been indicated the proposed sign location. The photograph is to include a portion of adjoining stores or buildings. For a proposed building or a new facade; an architect's elevation may be submitted in lieu of a photograph. , 2. A scale drawing of the proposed sign. A scale drawing indicating: 1) The type of proposed sign (wall, hanging, free standing) ' 2), Dimensions of the proposed sign and any designs, logos, or lettering 3) Colors, the drawing may be black and white, but color chips must be attached for colors other than black, pure white, or gold leaf. 4) Materials, what the proposed sign and letters are to be constructed of 5) A cross-section with dimensions showing edge detail. Minimum scale 1"=i' Minimum sheet size, 8.5 x 11". Two Sets. 3. A scale drawing of the bracket. A scale drawing indicating dimensions, color, materials and method of affixing it to the sign and to the building. Minimum scale 1"=1'. Minimum sheet size, 8.5 x 11". Two sets. 4. A completed Town of Barnstable Sign Application, including scaled diagram showing location of sign on building or location of free-standing sign. Show dimensions. r t;J l IN FKo Zc rj D�i Ni�s I.S � oZ (T D 5 '12 / +i U% wn TOWN OF BARNSTABLE BUILDING PERMIT PARCEL ID 226 006 GEOBASE ID 13501 ADDRESS 974 CRAIGVILLE BEACH ROA PHONE CRAIGVILLE. ZIP — LOT A-2 & A BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO PERMIT 69927 DESCRIPTION MOVE SIGN I PERMIT TYPE BSIGN TITLE SIGN PERMIT i CONTRACTORS: PROPERTY OWNER ARCHITECTS: Department of Regulatory Services TOTAL FEES: $25.00 BOND $.00 �tNE CONSTRUCTION COSTS $1,000.00 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE Opp I * EARNSTABLE, ass. � ,I 039. BUIL,.DII�T ISION DATE ISSUED 07/63/2003 EXPIRATION DATE / ✓ n pv j Town of Barnstable oF114E r Regulatory Services y 7QW N' �'F B ARNSTABLE _. Thomas F.Geiler,Director B"MMAM'E' ` Building Division 9�p 039. ��� g 2003 A -3 F1112: ! 2 tEp Mph a Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 a1,I�P Fax: 508-7 0-6230 ED Tax Collector Treasurer Application for Sign Permit Applicant: �r��/f�� Lo u . Assessors No. . c� b D D(D Doing Business As: / �/r �.►/N-c�C /,�rtc/C Telephone No. 6 P — Sign Location �U Street/Road: 9 7 Zoning District: Old Kings Highway? Yes/No Hyannis Historic District? Yes/No Property Owner Name: del l �J �NitOry Telephone: Sob- G -3S/o a Address: _.1U 7, /_���r� Village: ✓T AX r f i Y Et Q ar Sign Contractor Name: Telephone: Address: Village: Description Please draw a diagram of.lot showing location of buildings and existing signs with dimensions,location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Yes/No (Note:If yes, a wiring permit is required) 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: 00 Size: ermit Fee: / Si gn Permit was approved: Disapprov ed:: _ fi Signature of Building Official: Date: Yl /YJ 0-V8, 4.(-4 V1 Signl.doc rev.122801 Ike SNACK -- SHOW = �� E N lip � ' ^~~ ~� � � 17110< 11A>026\��1+00-02+00 ,�08/20/02 V/ llaee Pnoto � \�^ � | // \ 1. TOWN OF BARNSTABLE t_ A4 SIGN PERM I T PARCEL ID 226 006 GEOBASE ID 13501 ADDRESS 974 .CRAIGVILLE BEACH ROA PHONE I CRAIGVILLE ZIP "LOT A-2 & A r` BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT ,CO PERMIT 53696 DESCRIPTION LAMONT VENTURES 12 SQ, FT, 32 SQ FT PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of Health, Safety ARCHITECTS: : and Environmental Services TOTAL FEES: $75.00 BOND $.00 THE LCONSTRUCTION COSTS $.00 j 753 MISC. NOT CODED ELSEWHERE * BA►RN3TABI,E,1639. ' MA83. � I Fo� B LDING 1)1VI.5I N B DATE ISSUED 06/01/2001 EXPIRATION DATE ATMs T Regulatory Services } Thomas F.Geiler,Director 9 �g Building Division 1659. .e Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 ,51,h-00 , Tax Collect - r �Treas Application for Sign Permit Applicant: Assessors No. .. PP • �� 0W �C`��'1����! Telephone No.,_ U�! Z��"/f Q Doing Business As• Sign Location Street/Road: '7-/-/ Zoning Distract: Old King Highway?way? Ye yannis Historic District? Ye . � Property Owner Telephone: C� Named c�'`�/ Tel hone: Village•,`✓�`i 6�� '" l� Address:/ 0 ° 7 Sign Contractor 7:5� ,,� Name: Telephone: � • Address: �� G� � l Village: 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? Ye&IW (Note.If yes, a wiring permit is required). I hereby certify that I am the owner or that I have the authority of the owner to make this application, Section 4-3t the information is correct and that the use and construction shall conform to the provisions of the Town of Barnstable Zoning Ordinance. , Date: S .Signature of Owneuted Agent:/ . ✓ t X ��Permit Fee: -Size: Disapproved: Sign Permit was approved: Date: Signature of Building Offic 1: Signl.doc rev.8/31/98 IAC� �I /G 5.%ndwRoches Ree . Cire' &%m C� r b� �-- i Vt� 3 o '-7 4 TOWN OF BARNSTABLE B NG�PERMIT APPLICATION Map 2 (�, Parcel C , 0 0 � Permit# Y4 63 1 4 Health Division � �w s/ o� Date Issued 2 —/ R Conservation Division / v ,D11 67 �� -OVO(5� �p�� PL'4� Application Fee by Tax Collector— w/SkX NbNrWAl . f� Permit Fee -�•1111®� �a'�iii Treasurer PIP TAL�p I MUST BE COMPLIANCE. Planning Dept.. WITH TITLE 5 &MRONMENTAL COD ` Date Definitive Plan Approved by Planning Board TOWN REGU ANC Y rows Historic-OKH Preservation/Hyannis Project Street Address z� ( i? i a L/i Z e ez- Z' , %"(`rry Village C/F.jJ j,Z n 611e G �,- Owner xy%/ya Y Allw.,g 444Zd C�` Address /02 �%// Telephone 0 Permit Request OZ/0 Square feet: 1 st floor: existing 7do proposed 2nd floor: existing 700 _ proposed Total new Zoning District ram, Flood Plain Groundwater Overlay Project Valuation at '�I WO Construction Type Lot Size Grandfathered: 1 Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure W?.y Historic House: ❑Yes A 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 2 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 BUILDER INFORMATION Name ffr/.4 8 7 Telephone Number 9 rZ C9 " Address 302 l!1191'/ /9A' License# 0 2 3 49S� �Z2 /� e.9ri, hi %f'l Home Improvement Contractor# S5- 02 6 ; 3 Worker's Compensation# �L' .7i 5_,33 112 C2 13 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 0WIV O SIGNATURE DATE t, FOR OFFICIAL USE ONLY � at 4 PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION•_��j�'1y7'y�� O , IAME r FIREPLACE f ELECTRICAL: ROUGH FINAL PLUMBING: ROUnu t¢ FINAL r- GAS: RO FINAL ' FINAL BUILDING Y Of JWto DATE CLOSED'. UTcr re 1, r f e +- ASSOCIATION,PLAN Ndm 0 . t 1 t+l ,The Commonwealth of Massachusetts us-- Department of Industrial AccidentsEli Pff y F 600 Washington Street •.����; Boston,Mass. 02111 Workers' Compensation Insurance Affidavit-General Businesses name: %2/��ffL 15, 0 address: a� X eq ya-, A h/� city state: /!/ -- zip: 6126 phone# 721, "''-6 i fj C•� work site location(full address): —am a sole proprietor and have no one Business Type: ❑Retail❑Restaurant/Bar/Bating Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,Autos etc.) ❑I am an em Toyer with em loyees(full&part time). ❑Other dI am an employer providing workers' compensation for my employees worldng on this job. city: %� ✓�/ .insursnce.cot• -.. olic. # ZC 2 517 %/% I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: couioanv name: address• phone#. insurance co. olic # comuanv name: address . city. phone it insurance eo.:: olicv#. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 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. I do hereby certify under the pains and p ties ofpe ' y iat t formation provided above is true and correct Signature Date Print name AI L� / / Phone# official use only do not write in this area to be completed by city or town offieW cityor town: ermit/license#p ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department , contact person: phone#; ❑Other •w(mveed Sept 2003) *"��# - �:..'`�'saz-..��` ",c'.ter �', .•�a�.:^°' ,y .�..�.. ._ •a � 1 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 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,parnership, 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 Mthhold 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 have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance 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 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. 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 WIN 6(I13V8911980988 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406 RESIDENTIAL BUILDING PERNHT FEES APPLICATION FEE o� New Buildings,Additions $50.00 E1 C) Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE o (� square feet x$96/sq.foot= 04� o x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= 76 � (number) Fireplace/Chimney x$25.00= . (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee � �, � °F Teti Town of Barnstable Regulatory Services 3 PAMSTOM ' Thomas F.Geiler,Director MASS 9 ibJy,� �m prec�R Building Division _ Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508 790-6230 Property Owner Must Complete and Sign This Section If Using A Builder vaj.t ..;.as.,O.wner..of the.subject property- .. .. hereby authorize to act on my.b ehalf,. in all matters relative to work authoiized•by this building.pe=it-application for: ( ddress of Job) r ll ignatur of er to Print Name ...nnn�.tC.f1QTNFRPFRMTCCTl1N f34 prd of dual*4 Re uigtiatrY � hOME1 ` a1/EMNY CONTRA ��r�tFA ems-- 5352 ti X � 04 � --:--tIividual ARK BI K 1�1E 'TAf RY LANk s� XAf'i4t�ii FR .02a73.. : i.' 1yJ► OFaBUiILDIN,�?Kffl �� cerise. CONSTRUCiTION�� jF�ER� ,®= 3. Number: 073$53 Y zp rre02�U6L20�15 Tr.no: 10 4 MWOrete o- ;1 MARK 30'O,S,E-IVIA!RtY LN� W Y MOUl Fi, MA`02673` ,; Administrator i s i F THE p . a'Y The Town of Barnstable BARMSTABLE. Department of Health Safety and Environmental Services MABS a . °'fo► �' Building Division 367 Main Street,Hyannis,MA 02601 ; 508.862-4038 508-790.6230 PLAN PREVIEW Owner: CL Map/Parcel: C) (o Project Address: IL9 IAGCkBuilde' r: The following items were noted on reviewing: L)0 ek VY\ �- -� ► d 2' , 4 rs, Ci V 11 4 7f f Uy t -P to S CG n y U b-2 M 1,%A-r �J �YUVI �(z- ©VQY i � � ©-� V G��r 1 C.b\ .-eve Reviewed by: Date: j6�=� LbCAT10N OF PROPERTY LINES MAY NOT BE ACCURATE STANDARD LEGEND NOTE:not all symbols will appear on a map 1 GOLF COURSE FAIRWAY t EDGE OF DECIDUOUS TREES ^ EDGE OF BRUSH MAP 226 I t_ _ ! ORCHARD OR NURSERY I 006 t — — — V—P�V EDGE OF CONIFEROUS TREES .. \�,— — _ _ _ _ — r -.5 MARSH AREA 974 _ —••-— EDGE OF WATER ` DIRT ROAD e - �Z DRIVEWAY I �PARKING LOT ` PAVED ROAD DRAINAGE DITCH — — — — - PATH/TRAIL PARCEL LINE MAP 326 MAP# 021 -e PARCEL NUMBER #367 t HOUSE NUMBER' 2 FOOT CONTOUR LINE —L�— 10 FOOT CONTOUR LINE Elevation based on NGVD29 X4.9 SPOT ELEVATION coo STONE WALL -X—X— FENCE RETAININGWALL RAIL ROAD TRACK STONE JETTY << „ SWIMMING POOL PORCH/DECK BUILDING/STRUCTURE DOCK/PIER �34 Yc s A HYDRANT e VALVE ® MANHOLE ,,z� €r, 1 i � s + -� r e !_ � •iR'. Y e ..� -t a "is��`` r '�`E Y`� ��Q �ri � �„��., r h o POST [] FLAGPOLE '...:: ., .-::.t .,;� :'.: ._ ,.-.•.:- ._�.•; ,... :si, `� ...a.::at��.5...- -- .. ,. -=;.... ':43. �`S:;F.: -{'rC�{-�S -�fi��'�„ �a�"c'�� p._�� .&!�`!fi���k:�.a,Ysc�r! �y��, T O W N O F B. A R N S T A B L E 6 E 0 6 R A P H 1 G I N F O R M A T 1 O N S Y S 'T E M S U N I T p SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES:Planimetrics(man-made features)were interpreted from 1195 aerial photographs by The James w e I"=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD 0 UTILITY POLE u TOWER 0 .10 20 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards 4 LIGHT POLE O ELECTRIC BOX 1 INCH=20 FEET* enlarged scale. on the map. at a scale of I"=100'. Parcel lines were digitized from FY2004 Town of Barnstable Assessors tax maps g i p: I j f, i Iell � r 1 : •_ i3-, _ } + iwff Mae. 44 x. f. IV F I _ '--- - n- - --- --- 64, i I L� iJ I _ - ._ . .. e FT ,�.— howmne.usa�.,«o»:.-+�++n�w. .vwwanw.ewarm.ro..+,e.:aww�udi.paat�.e.w-shoa.�.,:uc�.v... a.ra.•.�•«•e+v,..s.o�..u�+s.-�•�^..::.:�.....a.+�.:.-....; 4 � ! sc;?c-cn� - sc drrEEiY � 3 k�F + t: x ROLL (ZOOF A 6 2 00 /60G moan �f Cox- p4w PAS' 4 rf r�.(�_.- -- PLY _BLdrL Wow.. FL'�"s ! 2K .0cAl V�l i ��,� • 4Y �'bsks i ' 74W Eacu A 0)07 ` 1 lo E Tu b F5 . Ll F , • � �. - . .KXisT1N6 13�c�-4rnt� � x r. r0 i , But 6 ImIn & Ow K. _ ... .. . - _ gay: !-6 Ott -c6mmonwealth of Massachusetts U + �- Sheet Metal Permit Map r�(�Parcel ` Date: -/ Estimated Job Cost: Plans Submitted: YES NO- Submitted: Plans lAwed 'E�SI WAB LE ° . Business License# - Applicant License# 1 Business Information: ' Property Owner-/Job.Looation.Inforinadon: Name: Name' .�,. Street: �D� � �� WAS Street: Pod 423 City/Town: T MA Cityfl'own CQnTu��e Jl . Telephone: j b Telephone: Photo I:D.required/Copy of Photo.I.D. attached: YES ' x � scar ini�gr :i ,14/ tinrestrieted.license cted to dvvellin 's3-stories or less and commercial up to 10'000 sq. f� /.2-stories or less J-2/M-2-restn g p i Residential: 1-2 family Multi-family Condo/Townhouses Other Commercial: Office ` Retaij/ Industrial Educational tutional s Other Fire Dept Approval _ . Square Footage:'utider 10,000.'sq. ft., / over 10,000 sq.ft. Number of Stories: i Sheet metal work`to be completed: New Work: Renovation: Y '. - i HVAC Metal Watershed Roofing. Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done' r� , i .INSURANCE COVERAGE: 1 have a current liabiiitv.insurance policy or its,equivaientwhich meets-the requirements of M.G.L Ch.112 Yes❑, No)< , - F I • If you have checked ,:indicate the type of coverage:by checking the appropriate box.below: - 1 ' A liability insurance policy E Other type of inderrihity ❑ Bond ❑ I OWNER'S INSURANCE WAIVER.]am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Mass etfs General Laws,and that my:signature onthis-permit application-.waives this requirement: Check One Only Owner Agent ❑ 4 . w I Signature of Owner or er-s Agent i By checking this.box0,thereby-certify that all of the details and Information-1 have submitted(or enter4 regarding this application are true and ` accurate to the best of`myknowledge'and.that aiI sheetmetal work and installations performed under the permit issued forthis application will be In compliance with all pertinent provision of.the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required 1prior to insulation installation:YES No " Prot�Iress.Iuspection Date Cammelit-s Final Inspection Date Comments Type of License: 3y ❑ Master r1'fie ❑Master-Restricted 'ky/Town ❑Joumeyperson. Signature of Licensee 'e[mit.# � . ❑Journeyperson-Restricted Ucense.Numtier. 4 =ee$ Check at www.ntass.20vidol nspector Signature of Permit Approval Gummonncevb*ufmassachms Wurkersa CGmpensaf unInswaance Affidavit B.uif&rsfCantiac#nrs/Electrieian&Mt=hers Ay�t Iaf i cra Please Prmf Name(Busiae�! irrfinnlFn �inaT�_ , Mdre �� -ems _ Ci /st�zp. /� 5 aZ�o one 3 60 �5 Are you=employer?(Mwk the appt opriati*b= T of Froiect ,r 4_ I ona�. c atcactor acid I { �} L❑ I am a employer veitfa_ ❑ �•. 6_ ❑New c=xftu.c:b ri employees(fUll andlorparf-time-* haveiriresltbe sins cos a Eons. s 2 am a sole prvpriefor or partner-, liste-d on the attached sb� 7 ❑Remodeling ship and bade no employees ma's sob-contractors have- g- ❑17emoliiioo : ' • pro-rising forme in any capacitg, r e'mp la des �and have!}workers 9. ElRuildEng addififln . LNawor 'comp: a, ►,� wrap inset—, I re 4 ired_I 5_0 '%Te area corgorafiom a=ff lfs' �]FJ trical r +�+� addition's _❑ I am a homeovuer doing all worm of5r ens Bove exerrssed their 1L❑Plambigg repairs or additions. . o Workers, s °a��rt of e mgfiobger bfGI. 12-0 Roof o f [NO - c-154 §I{4} audwehavan 13-20timr, 0464 _ • .� -bra�or�' � • - • _ comp_Msuranm required. *liay mF thit chectsbos 9l nmst also fill out the sadionhelosv shm a &4r des'mmpe�aiioa F F i� #l�nmevwnr�•sVChnsubmit�iSaffidavifTM�r�wtheyaserlomgslItv�cand�mlrix�oeco4incmrs�s[snb��2a�csa�dac�tm3ir�+*�sarE_ !Cmt®cmrs dat rli lk ibis Goc must stlached ast a3difim r sheet shtrcrmg tfie name of�e soh s and stata orhathe[G[nnS tI sE I emPIoyees_ Iftl a MB_conti dMSh%M EMpI05-6es,they mast provide their-mkee comp_policy numhez - laxr arz errrplt+yes thatisprer��idir tr=briers'c-ortg rurrhan irtsrtrrutce for my employees. Belaty is fhepaHcy curd job x&s Insurance CompanylNme: Policy#or Set€-ins Lim a _ Fxpiratirz�Date: y . r Job Site Addis: CgJStatelTgp= A-t#acJit a:taps+'cif 6e trt-orkers'compensatwn palicy dedzrstion page(sag the policy a€urr<ber n Ercl expiationdate). Failure to sec:are•cavr-rage as requiredunrier Sectibj 25A of MGL c 152 can lead to the imposition of rrimtnal peralties of a fine up in ffte foam of a STOP WORK ORDER-and a fine caf'up tor$250_00 a day against the violator_ Be advised that a copy of this datemmt maybe forwarded to-the Offim of investiptiom of ff e DIA for"=coverage:vacation_ .I da here-by ceipff u paiars and snahqks .p,etlrrry fhatfhe-irzforxratcunpratn dW a' e fS and correct Simzt,um: Date- Phone l�e�D�6 0 001'J OffuzirE use•anty. Do nat turn*in thi.are.4 is be cvuigl-W by City err to afi.Fiat: Citv or Town: Perndbucense Tcs�c'inthriritg{drele one : � , L 3aard_of$ea1th 2.$mZ'fiug Dgparbnent I CaTIFavm ace k 4_EIectrical inspector �.P`liimbin�Firo=rrtor 6.( her ' e . COFitact Per= Phone;##= Y 6 Information ancd Instructions Massachusetts General Laws chapter 152 requires all employees to provide workers'compensation for their employees. Pursuant:to this statute, an en ployee is defined as"---every person in the service of another under any contract of hire, express or implied oral or written- Am employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees- However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states t$2t"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 common wzal' for any applicant who has not produced acceptable evidence of compliance with&e>'nsurance.coverage required" Additionally, MGL chapter f52, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall .� f enter into any contract for the performance of pub work until acceptable evidence of compliance with the ins2rance requirements of this chaptcf have been presented to,the contracting authority:' i Applicants Please fill our 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 mmuber(s)along with their certificates)of f insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)widen employees other than the members or parm.ers,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 Depa-anent of industrial Accidents for confirmation of incnrance Coverage. Also be sure to sign and date the affidavit The affidavit should be retuned to ire city or town that the application for the permit or license is being requested,not the Dep�nenf of Industrial Accidents-`Should you have any questions regarding the law or if you are required to obtaim a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-in sure;;ce license number on the appropriate ae- i. City or Town Officials Please be sure that the affidavit is complete and printed legibly, The Department bas provided a space at the bottom V 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 pemutAicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit(license applinations in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address'the applicant should writs"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 oa file for futurre 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 cammercial venture (i-e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office,of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone and fax number: , nt Coramnrlwmal&of Massachusetts � Departm�ut Qf I&Iustdal•Accid-� Mce of kvesfjgatjGus 600 Washinatoau Stet $astern=MA GG2111 Tel,A 617-727-4M ext 4-06 of 1--&W-MA$SAFE Revised 4-24-07 Fax#617-727-7 49 wv �ass;ga�Idia 35 PLANT , 1 r ' 9674 x, 11/28/2016 209 r. J f �. Y Town ofBarnstable Regulatory Services « Henna ABM • NAM Richard V.Scali,Director 9�- 6 Building Division , Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 - y Property Owner Must Complete and Sign This Section If Using A Builder I, I 1A1Y L, ,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: - L (Address of Job) —T **Pool fences and alarms are the responsibility of the applicant.'Pools are not to be filled or utilized before fence is inst ed and all final inspections are performekand accepted. _-- , - a e f.. ex Signature of Applicant Print Name 1 ' Print Name Date . Q:FORMS:OWNERPERMISSIONPOOLS Town of Barnstable Regulatory Services . of fly. Richard V.Scali,Director Building Division sAMM42M ' Tom Perry,Building Commissioner Mesa 16yg. �� 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 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 resp6nsible'f64 all'such'work perfort&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 I Note: Three-family dwellings containing 35,060 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. " HOMEOWNER'S,EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a-supervisor (see Appendix Q,Rules&Regulations?for Licensing:Construction Supervisors,Section 2•.15) This lack,of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. > To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that,he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 L