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HomeMy WebLinkAbout0000 FOX HILL ROAD t . d+ P, :<: .,.:. v:.. �., ;... .�: •,., .:',=s }, .G . x.,:.v=:. �r.• �s.�..,x-.+'. rrwC., 1, y4rr`�f# xra.✓ a`+r4 a +�JJ" '.�,.. ',r.::...t .r -• ,..•_ .t � � 4 -, n .!^.. rs r e .,., :...°. .-- ..-t>:,:. _ ,:,q..a. ..:1�}[g.., ... y. °.;,^�. ...,...,. � ,• i:., `_:4'•—'' _ - 4.r'. �'.tct; a '],.� r, ;�•' w • +•,•..t�{IFilJt rt ,E . aox c c r , , c _ , r i a , t I w� r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map J Parcel 016 Application # Health Division Date Issued d -� Conservation Division �� -120 �b Application Fee Planning Dept. Permit Fee �' Date Definitive Plan Approved by Planning Board ''� ''� J • r Historic - OKH _ Preservation/ Hyannis Project Street Address 0 EOV 14 JL L /Zb Village Jr Owner L�_A Address PO ei* 9?,?4 Caiu-t KA QU?S Telephone 5-0� '�71 oG51-S— Permit Request Cd bc- /err r Cw1✓er+ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 41�o Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting docum ion. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing ructure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ II ❑ Crawl ❑Walkout ❑ Other "= ? Basement Finished Area: ft.) Basement Unfinished Area (sq;.ft)l •^ Number of Baths: Full: existing new Half: existing ?�' new Number of Bedrooms: existing —new =- a Total Room Count (not including baths): e ' ting new First Floor Room CountF--n Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Ele 'c ❑ Other Ulf Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existi LLD) new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number ? _ 070) Address IK�3 ��lfkl 4 Iv e License # 7>a P6 60 Home Improvement Contractor# 70 4/ Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 17Z-20,91,l v f FOR OFFICIAL USE ONLY r F APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE ' OWNER .l Y r � I DATE OF INSPECTION: FOUNDATION FRAME f. INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL L J - !'� PLUMBING; ROUGH / FINAL , GAS: ROUGH FINAL FINAL BUILDING } DATE,,CLOSED OUTa • ASSOCIATION PLAN NO: f r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information - Please Print Legibly Name (Business/Organization/Individual): � �� C � t�'�2rmSi�iC'.j Cfj2 f✓� c�� Address: 4 City/State/Zip: Chi L'' t/��..� /�,q- ad-*one#: ?2V' CA d(0 Are you an employer?Check the appropriate box: Type of project(required): J.El am a employer with 4. � I am a general contractor and I 2.�mployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction am a sole proprietor or partner- listed on the attached sheet. 7. E]Remodeling shipand have no employees These sub-contractors have 8. n Demolition working for me in any capacity. employees and have workers' insurance.$ 9. Building addition comp.[No workers' comp.insurance P• required.] 5. 0 We are a corporation and its . 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work. officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box,#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy andjob site information Insurance Company Name: Policy#or'Self--ins.Lic.#: Expiration Date: Job Site Address: U' 02 k ��/ mac✓ City/State/Zip:C / e, Attach a co of the workers' compensation policy declaration page(showing' policy number and expiration date). PY P P Y P g ( g P Y P• ) Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP'WORK ORDER and,a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby #jy under the`pains and ienalties of perjury that the information provided above is true and correct Siznal Date: � ��� / Phone#: 7 Y LIS 7 " r4.d o Official use only. Do not write in.this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: tr VE Town°of Barnstable Regulatory Services Thomas F.Geiler,Director s639. ♦0� Building Division Tom Per ' g Buildin Commissioner � 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner.Must Complete and Sign This Section If Using A Builder I, c)C)StTa u A L , as Owner of the subject property hereby authorize V'rVe to act on my behalf, in all matters relative to work authorized by this building permit _Foy L a- t'l L �L (Address of Job) ti **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is.installed and pools are not to be utilized until all final inspections are performed and accepted. S' e of er Signature of Applicant - Print Name Print Name° Date QTORM&OWNERPERMISSIONPOOLS ;_-Massachusetts- Mparttnent.of Public Sxfeth- Board of Building Regulations' and Standards Co nstruction,Supervisor .License License: CS 72866 DAVID A SALIRO 163 TERN LANE CENTERVILLE, MA 02632 } Expiratio 5/6/2013 Commissioner Tr#: 1 35 i Office of Consumer Affairs&Btfsines,s Regulation HOME IMPROVEMENT CONTRACTOR y Registration:, Type: Type: s Expiration 27/2013 Private Corporatioe CA COD CON S-T UGTI$WTSERVICES,INC. DAVIDi SAURO 163TERNLANE ";ram CENTERVILLE, MA 02632 Undersecretary. s '6 o Fo of�-5 S 1-v-6 16'avpry o�) Ccrta. -rW F, ' f'1 .. • +�► . ''.. \ICJ a Iry lk 7. F , ldPad►c 5 d . �Dt.T� a Town Y Barnstable Geographic information System ASMap 190-046 showing Proposed footbridge May 29,2012 170032 190151 � 190145 190032 190067 #81' 4 190150 #25 190 146J�#,91 a 190025 #158 1 148{ 190034 #463 i0 190 1 . 170049 #�16 aC�. #1'�i #617 #40 I-A 190167e Q/ #66,s 190147 /V�/ _ 190035 #511: Z. 4 19005s 190060 `#27 190024 190014 #127 190057 #40 170050 190148 #_20 #71. s :: der #135 O. #65 9'#17 V 190013 = .,i,• 190068 190055 190023 #131 _ - #463 190058 170051 190149 e #34 :-= ;:_ #121145 #15 CA #4`6, 190022 �!' �5 114g) 5. 190036` # � #.124 i 170054 190012 ,� 190059 pt 51 D 0- 190021 OR 190018 #116. CA' ' ? 190054 190135® #0 170053 V.#60 MANpwK #23 • aY 190037 i #113 #130 y #6 L f� ?O 190017 ® s�#114- J {:_: I * #t90134P ' ��✓ ,90018 033 i #146� 190011, . 170023 �A ♦ �p II#43 - a 190038` 1900537 190136 i 5g #9 -- 170015 9� 1900�19 190010 #�10i #1 #107 #100 170055 #� #,�1,,4,� = -- _ 190137 • 190009_ #82 170056 #13 190008 #24 , 190039 _ •:::-- 19004 190138 #29 • #36Z► fit96 >: := s3Jtr #97� #70 ' .190007 a #8 AY • :' r <. 190139 170021 w - 190048 _ #60 170018011 - 170016 #td pEF040� * 190040 � ,:_:_' #87 #174 170020 # pOw ,� #88 190045 1901 0190049 190140 170019 #82 ,. �002 190041 �� #116 #116 9 75 W #50 #92 �.e 190003 #78 _.'�� :.: ['� .190050 190004• V#37 �� y 190141 #67 V w#49 190042 -':; ,�+• "'1 190044002 #161' QQ 190061► 170022 #61 ' . #66 '� a, I #13� VV #66 v #112 190171 0 t90 1 ' (} P 90142 .� 190043 190052 #160 71 189014 � #1_39J> 0} !�7 189051 #43 169089 189011,0 1�1622 ,� 0 g �19004s 1900"001 #6 4.159 #2 i• • 189013 �, #0 #35 = - • 5 ® 18989046 1690W ® 189008 189015 �; :: 189054 #158 i�o5o /�#7 #119 ##221 189012 �Q VVV// #46 :_ 18910 #v 2 #18� • (� 189045 t•d 169013001 �'#27 �� ` •1031010 o • #4 169091 ♦109009 approximate#24t##386 t< ? !✓ {� 189031009 #-7-4� 189047 #133 169013003 #15 :: lk #78 a.�rLa 189049 #17 / r#� 100 ft buffer. :_:. : �`� '189031011 #30� 169013002 189010 $ Q "aUc :",y AN� f #yam e 189048 . #2 e� a #9- -189018 -• ;:, ' - 3, (�N '�/ t8903to12 #.3t p 189031008 169013005 169013004 #18 ••• J _ #so # r g#30 3#26" Vr#12 O r � +- �i 89031013 180031014 o,89d�9 189=007i 16901�3006 169013009 # A :/' 189023 #75 189031015 189031006 , #19 ^ 189022 4#78 #68 #32 169013010 169013011 f ' e ,.% 1#845� ' 189024 4 189031005 1�9013 70 i #t1 #3 f br je.IZZ 1 "` #,701 a19902s #s9 189031004 189031016 70 #60 -#,49 189 003 #22 #25 . DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:190 Parcel:048 boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:COOMBS,CANDACE W Total Assessed Value:$7700 Selected Parcel ED 1'=100'may not most established map accuracy standards. The parcel lines on this map E are on is representations of assessor's taut parcels. they are not true Co-Owns r:%6BARNSTABLE LAND TRUST Acres 6.55 acres Abutters N only 9r� Par property 9e :A to physical , boundaries and do not represent accurate relationships ica features on them P P ys eP P Location,0 FOX HILL ROAD such as building locations. Buffer � Town of Barnstable Geographic Information System July 6,2012 •y� �' � �+ �'� 4 i.. ss *Sea'kt 8 .. 4 ^#1'-A. � j are , f .: u ��,.,,xd � .j d 4we '"' + } ..'• •� ' 1: >„�.. ���s�F�a M„+�° � t �S� y ;l �'�"r,�.t�wr;.�';�y ��, a-Y!�4}",' d, ♦g� Fuller Afill Fond 41 zole<l A-isp uf4� ti. e Y r<' � �; 4 � � •,�'..Y�� x 1� .`'�S�+t�}rTt, -'�,u� �`� � r "�> ..L � T proposed e footbridge IN r' fit- * \ R e .+ .00 �� � ,�'t � �'` ��C� G. � ��. •. _� ,ry ,y.� '� r-, � ?'.. aYYY�... � �'��'��°�1#1��� j� .. ry4 .` N. ' q `L -.• }t.. �T, '' $. � T i[ ,�:'�"�kr •- 4 �.�.ei„sis ��,,i i R � 4 •.� a , ve d. 4i'_.�. ;�f�"`' i ' 41 �" r�{ ,rt. t�p `� A �`"P �tr .� • �R • w � ,�suk. !,w.*.�; ..0 •` `�}t yTY .s 25 Fe �� "�',.:.,R+ ... .��,'..:.; T- 4: f_. {•�... ..:' ,F�y. .• .:� .,.. - -.-�xn'."��aR.,. �'.,�.. ` h '.�.•.. x.l.�+ .y.,.. ''�'. afY �"'rYr DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:190 Parcel:046 a boundary determination or regulatory interpretation. Enlargements beyond a scale of Owher:COOMBS,CANDACE W Total Assessed Value:$7700 Selected Pdfbet - 1=IW may not meet established map accuracy standards. The parcel lines on this map _ are only graphic representations of Assessors tax parcels. They are not true property. Co-Owner.%BARNSTABLE LAND TRUST Acreage:6.56 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Locatlon:0 FOX HILL ROAD such as budding locations. Buffer J Aerial Photos Taken April 19,2008 d Fax a4 0L :: leK lb a ' ;Y Y"i ,�,.� + � ',� �>, Y`"�3�'?a _'�.- h .. ' ''"+c'i rE., ��",iW '� J"y' �_ - ' .. � • } r I �.x y c n • i-� }�.. ,.lr O+ �''R .77. .�A N 411�.. *` �� d'.. �-ir 1.y. _`•'l M�, A°^(�'M� -IV n i u - ♦ �w`�,4~i ,� :a}.• �^t` w �� ,w 1 n ^.xv ,e.�.� ., �P h �5y •• � �, - �r �Vk"s.... ID, y .,., .,.,,,The,Commonwealth. of Massachusetts. William Francis Galvin -.... Page 1 of 3 �M The Commonwealth of Massachusetts �w William Francis Galvin r., . Secretary of the Commonwealth Corporations �. Division ti One Ashburton Place, 17th floor Boston, MA 02108-1512 Telephone: (617) 727-9640_ Q BARNSTABLE LAND TRUST, INC. Summary Screen' , Help with this form The exact name of the Nonprofit Corporation: BARNSTABLE LAND TRUST, INC. s The name was changed from: BARNSTABLE CONSERVATION FOUNDA on 9/3 0%1992 Entity Type: Nonprofit Corporation Identification Number: 222483963 Old Federal Employer Identification Number (Old FEIN): 000109288 , w Date of Organization in Massachusetts; 09/08/1983 ti Current Fiscal Month I Day: / Previous Fiscal Month../ Day: 12 / 31 The.location of its principal office in Massachusetts: No. and Street, P. O. BOX 224 COTUIT, MA 02635 407-NORTH ST. City or Town: : HYANNIS State:.MA Zip: 02601 . Country: USA If the business entity is organized wholly to do business outside Massachusetts, the location of that office: No. and.Street: t City or Town: State: Zip: Country: The name and.address of the Resident Agent: Name: ALEX FRAZEE No. and Street: 380 WHEELER RD., MARSTONS City or Town: ,MILLS State: MA Zip: 02648 Country: USA The officers and all of the.directors of the corporation: http://core.sec.state.ma.us/core/corpsearch/CorpS earchSummary:a... 9/7/2012 i hQ Commonwealth of Massachusetts William r rancis t alvin -... Page L of J Title Individual Name. Address (no.PO Box) Expiration First,Middle, Last, Address, City or Town, State, Zip Of Term Suffix Code PRESIDENT TOM MULLEN 38 COACH LANE upon BARNSTABLE, MA 02630 US election of successors TREASURER JOE HAWLEY 16 BEECHWOOD RD. upon CENTERVILLE,.MA 02632 US election of successors CLERK KEVIN GALVIN P.O.,BOX 700 upon MARSTONS MILLS, MA 02648 US election of successors VICE PRESIDENT ANNE GOULD 150 HUMMOCK LN upon COTUIT, MA 02635 USA election of successors DIRECTOR HID WELCH 344 ANNABCE PT. RD upon. CENTERVILLE, MA 02632 US election of successors DIRECTOR WILLARD MASON 71 MINTON LN upon W. BARNSTABLE, MA 02668 US election of successors DIRECTOR LYNN RICHARDS 84 MARSTONS LANE upon CUMMAQUID, MA 02637 US election of successors DIRECTOR. MARK WIRTANEN 1894 MAIN ST upon W. BARNSTABLE, MA 02668 US election of successors DIRECTOR JIM INGRAM P.O. BOX 177 upon OSTERVILLE, MA 02655 US election of successors DIRECTOR CHRISTOPHER P.O. BOX 312 upon . BABCOCK election of HYANNISPORI", MA 02642 US successors DIRECTOR DONNA LAWSON 46 WOODUCK RD _.upon MARSTON3 MILLS, MA 02648 US election of successors http://corp.sec:state.ma.us/Corp/corpsearch/CorpS earchSummary.a... 9/7/2012 The Commonwealth of Massachusetts William Francis Galvin -:.. Page 3 of 3 DIRECTOR SAM KEAVY 140 PALOMINO DR upon BARNSTABLE, MA 02630 US election of successors � I — Consent — Manufacturer Confidential _ Does Not Require Data Annual Report _ Resident Partnership . Agent - For Profit _ Merger Allowed Select a type of filing from below to view this business entity filings: ALL FILINGS Annual Report Application For Revival I [" Articles of Amendment f. Articles of Consolidation foreign and Domestic__ R" View Filmgs `�� � � ' erg, New`Sea'rch�""�E Comments ©2001 -2012 Commonwealth of Massachusetts a All Rights Reserved Help http://corp.sec.state.ma.us/corp/corpsear6h/Corp S e-archSummary.a... 9/7/2012 ® Sep. 10, 2012 '01 : 37RN1 ;CapeCodConstructionServices.) No, 6659 P. 1 A Q'. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDJYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES.NOT CONSTITUTE A CONTRACT BETWEEN THE ISS REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER UING INSURER(S), AUTHORIZED IMPORTANT_ If the certlflcate holder 1a an gDDITIONAL INSURED, the poll glee) must be endorsed. If SUBROGATION IS WAIVED, 9u4Ject to the terms and conditions of the poMcy,certain pollclee may require an end0reemont A Itatemont on thl ccrtlficato holder In lieu of such endoAoment s. a certificate does not confer rights to the PRODUCER CONTACT Cowan Insurance agency,Inc. NAMFPNoNE Lan Cowan 359 Main Street .978 372.1451 FAX 978 521.4669 M I Ia CD►vanlnsurance.com Haverhill MA 01830 INsuREo - muliEaA, Aeaoclated Employer&Insurance Com an Cape Cod ConstrucI Services Inc, R tR 163 Tern Lane INSUR Centerville MA 02632 COVERAGES CERTIFICATE NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAv9 BEEN ISSUED TO THE INSUR OENAM D ABOVE OR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH REECT TO WHICH.THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,SP EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INBR TYPE OF INSURANCE ADC UB M POL EFF POLICY ExP - OENERAL UASRITY LIMITS COMMERCIAL GENERA IABILITY EACI- CURR CE S DAMAGE TO RENTEO CLAIMS-MAOE E OCCUR' S . MED ono reap RSON ADV IN URY N'L AGGREGATE uM1T APP I a PER: GEN A GAT y POLICY PRp- P ODUCT -COMP! AGG C AUTOMOBILE LIABILITY S COMBINED SINGLE LIMIT ANY AUTO .. ALL OYINEO SCHEDULEb BODILY INJURY(Per person) S AUTOS AUTOS HIRED AUTOS L NON-OWNED BODILY INJURY(Par eecidem) S auT09 - PROPERTY DAMAGE. . a UMSRE"A LM E OCCUR EKCESS LIAB IM9-MA EACH LIAR NCE Re AT .. WORXERB COMPENSATION AND EMPLOYER?LIABILITY Y!NANY PROPRIErORIPARTNERIEXECUT A /Mandalay In NNE ClUDE07 NIA WCC50112920120f2 0812512011 0812512013 L'�" ACCIb Nr s 1 OO OOO a e,dewolbe unapt L.DI 3@•Ea EMPLO 100 000 .. E.L.-DI ASE_POLICY uMl7 500 000 - DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES'-(Attach ACORD 101.Addltlonel Remehe Schedule,tt more zpmce le required) Residential construction mane ement, CERTIFICATE HOLDER - CANCELLATION Town Of Barnstable' SHOULD ANY OF THE ABOVE DESCRIBED POLICItS BE CANCELLED BEFORE 200 Main Street THI; EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 1N ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 P A Fax! 50B 362.9001 a (D19.88-2010"ACOR13 CORPORATION. All rights reserved. ACORD 25(z0101t15) The ACORD name an7logopmarks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map V Parcel fP Application O Health Division Date Issued Conservation Division P,- Application Fe L Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic -.OKH Preservation/Hyannis Project Street Address 0 ���►I � /� Village Ce V)4Z ry - Owner GC a C C. HIV • Coo"&� S Address T d 00)p *3 15 a,14V"16 MG Telephone 50 Y - 73 7 — 7'5,Y Permit Request :,Dd MO1 LS O e)Gt re_M!LW -Gab-0 S/-P 'r tvQos_d e5ok✓1 e. Pomlog V C rY 7 ctffdh Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay `Project Valuation Construction Type WO06( (�)Y wood oV e r 2-x Lot Size 6 , Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑n/47wo Family ❑ Multi-Family ((## units) Age of Existing Structure 2 Historic House: ❑Yes la'No On Old King's Highway: ❑Yes 4 Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) n Ba ment U finished Area (sq.ft) Number of Baths: Full: existing new H If: existing + ? ','rdew p-a Number of Bedrooms: a sting / new �v Total Room Count (not including bath : e istin ew First Floor.Room Comet Heat Type and Fuel: ❑ Gas ❑ I ❑ ctric ther Central Air: ❑Yes ❑ No F' eplaces: Exis ng New Existing wood/coal st�5.-ve: 0 Yes ❑ No Detached garage: ❑ existing ❑ ew size ool: ❑ existing ❑ new size _ Barn: ❑0 existing--❑ n0v 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# h Current Use ,e-4 Proposed Use f!c31n'ge APPLICANT INFORMATION ( HOMEOWNER) Name �dYl�GZ.�� �/lJ - ��v 5 Telephone Number Address 1 D go)< � � License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO m an5w,�� - SIGNATURE -��- �c� ���,,���DATE 1�7 FOR OFFICIAL USE ONLY w If. APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGES OWNER DATE OF INSPECTION: - f FOUNDATION E r FRAME �• r INSULATION 1 r FIREPLACE ELECTRICAL: ROUGH FINAL ; PLUMBING: ROUGH FINAL y , 'f GAS: ROUGH FINAL` ' `' r FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts //11 517 Department of Industrial Accidents V, Office of Investigations. 600 Washington Street Bostot; AL4 02111 www.mass.gov/dia .. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Q Please Print Legibly Name (Business/OrganizationlIndividnaI): C a V1 Gf oxe u c Cc Address: City/State/Zip: Ph �� n — . 7,514"Y e# Are you an employer? Check the appropriate box: 7Type of project(required): . 1.❑ I am a employer with .4• ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. 0 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑R deling ship and have no employees These sub-contractors have g, _ Demolition working for me in any capacity. employees and have workers' �amaehomeowner kers' comp.insurance comp.insurance,$ 9. ❑Building addition ] 5:0 We are a corporation and its 10.0 Electrical repairs or additions 3. doingall work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.[] Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for'my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lic.#: Expiration Date Job Site Address: City/State/Zip: P Attach a copy of the workers' compensation policy declaration page wing the policy number and expiration date}. Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year,imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains annd/penalties of perjury that the information provided above is true and correct. Si ature: !'�'C. Date: Phone#: � D 73 Official use only. Do not.write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department.3. City/Town Clerk 4:Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: ray Town of Barnstable �ofY y�� o Regulatory Services - Thomas F. Geiler,Director MABEL . g Building Division Tom Pe Buildin Perry, g Commissioner 200 Mairi-S ee tr f, H annis MA 02601 www.town.barnstable.ma us Office: 509-962-4038 Fax: x509-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: O Fo x il kOa� / P number x Attie villlllaagaC,- V "HOMEOWNER": CCt l'L�Q C� W•' ( ywLL5 ���' ! 3 < - ! ✓/ U name home phone# work phone# CURRENT MAILING ADDRESS: V city/t v'm state rip code T 6 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. DEFIXM- ON OF HOMEOWNER Persons)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 Department minimum inspection procedures and requirements and that he/sbe.will comply with said procedures and re menu. / .. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to cornplywith the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION .The Code states that ".Any homeowner perfomning work for which a building pernvt is required shall be exempt from the provisions of t)iis secbon_(Seetion 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowncsshall act as svpervisor.,• Many homcowners,who use this exanption are unaware that they arc assuring the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors;Section 2.15) Ibis 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 Supr.Msar. Tho homeowner acting as Supervisor is ultimately responsible. " To ensure that the homeowner is fully aware of his/her irspwmbilitics,many communitics.require.,as part of the permit application, that the bomcovencr certify that btlsbr understands the responsibilitics of a Supervisor. On the last page of this issue is a form cur rtnt]y used by several towns. You may tare tamend and adopt such a form/certifieation for use in your community. Q:forms:homccxcmpt oxT"�faJ,� Town of Barnstable Regulatory Services � sxsrrsrABLE. � .r � Thomas F. Geiler,Director � k For,►, Building n Divisio Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us n barnstable.ma.us Office: 508-862-4038 Fax: 508-79.0-6230 Pro e Owner` (` 1�y Must Complete and Sign This Section ..,. , R <`S 4. .- Ifl.Using A{Builder ��.a 'a: p L 1 a �-• as Owner of the subject.property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date + Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION 09/27/2011 03:14 5087759461 AMERIGAS PAGE 01/01 Roger Maiotini-Makkef Manager Pamela Finkel-Marlret Coor67a(or ArneriGas Propane' Lisa Markley- Manager 193 • • • • Beverley Satkevirh Yourhyannls Hyannis, MA 02601 Kathryn Soto cummerSOMCe Phone: 1 , 686 Wendy Clifford Team! 1 i • •Fax To: Cpi✓I� ��ir�d.� Fnarm /C!� h .S' Fax: !P z 1 o U Pages: i0a4z !LKA Phones 3�7.- 2$'�S" Ij Date: 27 �! Fie: CC: 13 Urgent O For Review ❑Please Comment. O please Reply CJ Please RecyNe VD 7 L►8,, Tdvs�dp-L c '� be cl IALwL S;ie &4t t q S cl r a hove September 23, 2011 TO: Building Dept., Town of Barnstable FROM: Roger Ling, Licensed Electrician RE: 0 Foxhill Road, Map 190, Parcel 46 There is no electrical service at this location. It is a simple wooden shed used to protect the irrigation pump, operated by propane, from the weather. ,t 17 11 10:33a The Compact 508-362-4480 p.1 �., ..l THE COMPACT OF CAPE COD CONSERVATION TRUSTS,INC. �y• 3220 Main Street#2B ;': , • • , P.O. Box 443, Barnstable, MA 02630 - •. ''�~~ Tel. 508-362-2565 Fax. 508-362-4480. Email: compact@cape.com Website: www.compact.cape.com J Date: From: MARK 1- ROBINSON . E xecutive Dir ector To: jed 1 19P Aq%ft - Lm . Re: 0 � C) ops re r ye^ rw wv wa.Q •�iyH. ! • ry a n Rale /4041-. "AA knd +� Clan P/t, r m-f t . 3—pages (incl. cover sheet) �H Oct 17 11 10:34a The Compact 508-362-4480 p.2 !n/lb/ZVIi Zn:Ob 3MIi�yatt AMERIGAS PAGE 01/02 Roger Malofmi-Market Manager ArneriGas Propane Pamela Finkel-Market CoorcSmafDr ,• • Road Lisa Mazkley- Manage✓ Hyannis, MA • 1 Beverley 5atka ch Your li MfS i a Kathryn Soto Customer ServicePhone: 1 i ■ Wendy pi6erd TAamd Fax: • • , ftx. Tat Ma"fer— Orono Fax: / ?, �+ !! r qq`v . (0(1 CQ Dates ( � 1 FIB f�eX Re: CC: ❑Urgent ❑ For Review ❑Please Carom R ❑Please-Reply ❑Please Rile c tv 'C led - E A, ?.O �, , -� �► gym_ och ' d Oct 17 11 10;49a The Compact 508-362-4480 p.2 10/16/2011 20:56 5097759461 AMV<lbAS rHvt l9L/IDY WORK ORDER America's PraPaneCOMMY ATERNAL DATE: l 1 WORK ASSIGNMENT: L r�o��7 Lai LOCATION: Qv/v +y' �4 ESTIMATED TIME. GRID . DATE ASSIGNED: EMPLOYEE NAME: TIME START: TIME STOP: ALL WORK COMPLETED? ❑YES NO F NOT, WHY? COMMENTS: 2� CA" EMPLOYEE`S„SIGNATURE cr.�rr �a. ORIGINAL COPY THE COMPACT OF CAPE COD CONSERVATION TRUSTS,INC. 21 September 2011 Mr. Jeffrey Lauzon Building Inspector Town of Barnstable 200 Main Street Hyannis MA 02601 Dear Mr. Lauzon: Please accept, on behalf of Ms. Candace W. Coombs, the attached permit application to remove a cranberry pump shed from her property at 0 Foxhill Road in Centerville. I am working on behalf of the Barnstable Land Trust, Inc., a non-profit conservation organization that intends to purchase this property from Ms. Coombs later this year. Part of the purchase agreement includes Ms. Coombs' willingness to remove the shed, the only structure on the 6.55-acre cranberry bog property, prior to closing. Her son Craig Coombs of Osterville has agreed to do the work. The shed is perched on the northwest side of Fullers Mill Pond, the manmade impoundment used to irrigate the adjacent bogs. The shed can be reached by pick-up truck over the bog roads around the perimeter of the property. These roads are old and stable. The shed, about 8' x 10' is very simply-constructed. I have been inside. There is a single row of cinder blocks supporting the 2x4 framing and one layer of plywood sheathing. It all can be removed with hand tools. There is a pump in good condition that Mr. Coombs will reuse elsewhere (the family has other bogs in Osterville.) He will also remove the small wire fence surrounding the one propane tank outside the wall of the shed. No hazardous waste of any kind is stored in the shed,per my inspection. Please direct any questions to me and I will either answer them or ask the Coombs to inform you of other details. My contact information is below. Thank you for your attention to this matter. Please send me the permit with a copy to Ms. Coombs. 3220 Main Street,P.O.Box 443,Barnstable MA 02630 Tel(508) 362-2565 Fax(508) 362-4480 email mark@thecompact.net www.thecompact.net Sincerely, M k H. Robinson Executive Director cc: C. Coombs: BLT 2Vl c : a 0 9),al(ol M '9 4.0 d �e�2 J /'� • ..FULLERS MILLPOND BOGS Barnstable MA FY12 Conservation Partnership Grant ' ATTACHMENT #3-d Barnstable Land Trust TOWN OF BARNSTABLE ASSESSOR MAP Town of Barnstable Geographic Information S stem Jame 29,2011 .I m 2k � x Property Locus 6.55 acres z . G Ful/er r[9/ d a1 v�z}i a. t s> h* 0. 19"7 eet A small pump shed (to be removed) sits on the edge of the pond. a , Q rtm enelos�rt