HomeMy WebLinkAbout0118 OLD STAGE ROAD sue" R
/�$ O,C D ST?9& S Ro
ETHErp�,, Town of Barnstable
0
Inspectional Services
BAM LL Brian Florence,CBO
9$A i639•,ek. Building Commissioner
TFD Mai 200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
INSPECTION REPORT
Address : 118 OLD STAGE ROAD, CENTERVILLE Case # C-19-664
Inspection Type : 240-63 Signs in Residential Districts Inspector: lauzonj
,Description IDate Unit Status Comment
A. One sign displaying the street 01/06/2020 PASS Sign removed.
,number and identifying the premises
not to exceed two square feet in
area. The street number must be
approved by the Engineering
(Department in conformance with the
Town's regulations governing
numbering of buildings.
Inspection Type : 240-63 Signs in Residential Districts Inspector : lauzonj
...... ....... ...... ..........- ---—
Description Date Unit Status Comment
C. One sign not to exceed two 08/09/2019 FAIL No home occupation. No permit or variance.
square feet in.area shall be
permitted for a professional office or
home occupation for which a special
permit or variance has been granted
by the Board of Appeals.
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
�o �� 3 G&161 :79
Map Parcel Application #
Health-DivisionDate Issued �J
I �
Conservation Division Application Fee
Planning Dept. Permit Fee!
Date Definitive Plan Approved by Planning Board
Historic - OKH Preservation/ Hyannis "
Project Street Address \A o*
Village
Owner 1'1�\Pt��-1 A f~`D n' Address `d 5..�rkn ie O f D
Telephone �� �71 211
(
Permit Request
e � a
q � 12,
`12\CXCAV1
Square feet: 1st floor: existing 1 60 proposed API 2nd floor: existing proposed _Total new
Zoning District Flood Plain Groundwater Overlay �'t ►� T
R Dor Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family lei Two Family ❑ Multi-Family (# units)
Age of Existing Structure 1� ok Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes No
Basement Type: •Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) 6 Basement Unfinished Area(sq.ft) t 0 D
Number of Baths: Full: existing 2- new �05� Half: existing 1 new
Number of Bedrooms: 14 existing _new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: A Gas ❑Oil ❑ Electric ❑ Other
Central Air: ❑Yes X No Fireplaces: Existing-3--Newer Existing wood/coal stove: ❑Yes*No
Detached garage:�existing 0 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 # ft Recorded ❑
Commercial ❑Yes YNo - �yes, site plan review#
ko Proposed Use \� L�7,.
Current Use 1
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
ril
Name �I Telephone Number
Address ie I`��\ l L � License # 1 5-1)
rn
f\1 11 D o , Home Improvement Contractor#
Worker's Compensation # LA 1
ALL CONSTRUCTION DE RIS RE TI G FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE 1 t s 1 1
-i
{
' • ' FOR OFFICIAL USE ONLY
r `APPLICATION#
DATE ISSUED
MAP/PARCEL NO. v
,
ADDRESS r VILLAGE -
OWNER
DATE OF INSPECTION:
.i. FOUNDATIONAQql S
FRAME 8 U l
Re—
INSULATION '. �it
7' FIREPLACE
K ELECTRICAL: ROUGH FINAL
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PLUMBING: ROUGH FINAL
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GAS— f,.= ROUGH FINAL
FINAL BWLDING ' ' ti .h
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DATE CLOSED OUT .
` ASSOCIATION PLAN NO.
INSULATION PLA.CENEENT FOR FROST-PROTECTED FOOTINGS
IN ZE&M BUILDINGS
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Drawn By: MC Date:! 1061 fV Drawing
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
` it 44-i; f
tit 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):
Address:
City/State/Zip: `� Phone #: �� _�� f
Are you an employer?Check the appropriate box: �� Type of project(required):
1.❑ I am a employer with ,. 4. ❑ I am a general contractor and I 6r- ❑New construction
employees (full and/or.part-time)."' have hired the sub-contractors
2.�$ I am a sole proprietor or partner- listed on the'attached sheet. $ ! ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity, workers' comp. insurance. 9. ❑ Building addition
[No workers' comp: insurance 5.. ❑,We are a corporation and its
10.❑ Electrical repairs or additions
required.] � officers have exercised their -
3.❑ I am a homeowner doing-all work right of.exemption.per MGL I I. ] Plumbing repairs or additions
myself. [No workers'lcomp. c. 152, §](4), and we,have no 12.0 Roof repairs
insurance required.] t employees. [No workers'
comp. insurance required.] 13.0 Other y
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit_indicating they are doing all work and then 6e-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 their workers'comp:policy information.
I am an employer that is providing workers'compensation insurance for my employees. -Below is the policy and job site
information:
Insurance Company Name:
Policy #or Self-ins. Lic. #: 4 Expiration Date:
Job Site Address: � City/State/Zip:
Attach a copy of the workers' compensation policy declaration'page(showing the policy number and expiration date). .
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition'of criminalpenaltiesof a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigati n f the DIA for insurance coverage verification.
I do hereVc&ertand r ins and penalties of perjury that the information provided above is true and correct.Si nature Date: ( � )
Phone
Official use only. Do not write in this area,to be completed by city or town offcial.
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 Per
son: Phone#:
.Information and InsOuctions
Massachusetts General Laws chapter 152 requires all employers to provi 'e workers' compensation for their employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employe',is defined as"an individual, partnership, association, rporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the le al representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or of er legal entity,employing employees. However the
owner of a dwelling house having not more than three apartme s and who resides therein, or the occupant of the
dwelling house oftanother who employs persons to do mainte ance, construction or repair work on such dwelling house
or on the grounds o building appurtenant thereto shall not b cause of such employment be deemed to be an employer."
,MGL chapter 152, §25C(6)also states that"every state o local licensing agency shall withhold the issuance or
renewal of a license orb ermit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence f compliance with the insurance coverage required."
Additionally, MGL chapterN1�,52, §25C(7)states"Neithe the commonwealth nor any of its political subdivisions shall
enter into any contract for the�performance of public w rk until acceptable evidence of compliance with the insurance
requirements of this chapter have:been presented to th contracting authority."
Applicants
Please fill out the workers' compensa ion affidavit ompletely, by checking the boxes that apply to your situation and, if
necessary,supply sub-contractors)na�(s),addres (es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies LC)or imited Liability Partnerships(LLP) with no employees other than the
members or partners, are not required to ca%tt
r ers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advise is affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance co Also be sure to sign and date the affidavit. The affidavit should
be returned-to the city or town that the applicatio or the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any ques ion regarding the law or if you are required to obtain a workers'
compensation policy,please call the Departure at th umber listed below. Self-insured companies should enter their
self-insurance license number on the appropria e line.
City or Town Officials
Please be sure that the affidavit is complete d printed legibly. he Department has provided a space at the bottom
of the affidavit for you to fill out in the eve the Office of Investig tions has to contact you regarding the applicant.
Please be sure to-fill in the permit/license n mber which will be used a reference number. In.,addition,an applicant
that must submit multiple permit/license applications-in any given year, eed only submit one affidavit indicating current
policy information(if necessary)and unded"Job Site Address"the applica t should write"all locations in (city or
town)."A copy of the affidavit that has ben officially stamped or marked by e city or town may be provided to the
applicant as proof that a valid affidavit is n file for future permits or licenses. new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license.or permit not related to ny business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to comp e this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and s ould you have any questions,
give us a call.
please do not hesitate to g �
i
The Department's address,telephone and fax number:
Thy Commonwealth of Massachusetts
Department of Industrial Accidents
fOffice of Investigations
'` 600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 5-26-05 www.mass.gov/dia
li
a
t
-
Off ce of Consumer Affairs a'nd usiness Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116.
Home Improvement Qat actor Registration
q'strati6n: 103928
Type: Individual
{` Expiration: 7/1t72012 Tr# 205535
PETER E. KEL'LY
Peter Kelly imFe ,
50 RUSTIC AVE. y�
HYANNIS, MA 02601
�....a � y r Update Address and return card.Mark reason for change.
oPS-CA1 C, 5OM-04/04-GIO1216 - Address Renewal Employment r�Lost Card
✓lie �anvrr�oruUecz��o�,�/�,aoaac�iccaet�a
Office of Consumer Affairs&B si-_ Regulation License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration „103928 Type: Office of Consumer Affairs and Business Regulation
Expiration 7/_10/2012 Individual 10 Park Plaza-Suite 5170
P " R E. KELLY' F oston, A 02116
Peter Kelly
7_s
50 RUSTIC AVE. s=
HYANNIS, MA 02601 _
Undersecretary Not valid without signature
y
'Massachusetts - Department of Public Sufetv
Board of Building Regulations and Standards
Construction Supervisor License
License: CS 15044
Restricted to: 00
PETER E KELLY3 �';
E+; 5^k'
50 RUSTIC LANE rr ma.c r
H.YANNISPORT, MA 02647. aw=
s
Expiration: 8/15/2011
(bnunissiuner Tr#: 21131
OF THE Tp� Town of Barnsta.bie
Regulatory Services
BMWSTABLE
y Mass. �, Thomas F.Geiler,Director
16.19.
o;9. & 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
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, MAC^L\4111 AF-O¢\ l5 , as Owner of the subject property
hereby authorize Yt!5T� 16. \ to act on my behalf,
in all matters relative to work authorized by this building permit application for
(Address of Job) ,632.- - -
o
Sig attire of Owner ate
:MAn�5
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:FORMS:OWNERPERMISS ION
Town of Barnstable
�OFTHE Tp�� ,
Regulatory Servi es
BARNSrABLE, Thomas F. Geiler,Dire for
T MASS. g
Building Divis'on
Tom Perry,Building Co m
issioner
200 Main Street, Hyann' , A 02601
www.town.barns blma.us
Office: 508-862-40,38 Fax: 508-790-6230
HOMEOWNER LIC 'SE EXEMPTION
Please rint
DATE:
JOB LOCATION:
number stre village
"HOMEOWNER':
name ho a phone# work phone#
CURRENT MAILING ADDRESS:
ci town state zip code
The current exemption for"homeowners' was extende to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individu for hire. o does not possess a.license,provided that the owner acts as
supervisor.
DEF ITIO t HOMEOWNER
Person(s)who owns a parcel of land on which he e r sides or intends to reside,on which there is, or is intended to
be, a one or two-family dwelling,attached or detac d tructures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-y r period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on rm acceptable to the Building Official, that he/she shall be
responsible for all such work performed under the bui h in emit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibili for co\heB:
e State Building Code.and other
applicable codes, bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she un�derstanarnstable Building Department
minimum inspection procedures and requirements and that he with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,0�00 cubill be require 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 frdm 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." �t
Many homeowners who use this exemption are unaware thatlthey are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.1k) 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.
Q:fonns:homeexempt
Town of Barnstable *Permit#,_26686e q3
Erpirds-6 months fram issue dat
Regulatory. Services Fee - .
9sextvsrtcBM Thomas F.Geiler,Director
�A i63� s�0� Building Division (
V. Tom Perry,CBO, Building Commissioner
r 'CF QO Main Street,Hyannis,MA 02601
o�j� B2� .town.bamstable.ma.us
Office: 508-862-4038 oi�` �Op�p ®7% Fax: 508-790.-6230
EXP IT APPLICATION - RESIDENTIAL ONLY
T,9 Not Valid without Red X-Press Imprint
Map/parcel Number . 0-7 �`4�.
Property Address 1 1� O ( . TA,
❑Residential Value of Work 2 b d Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address v��
P,A o fv-(� C_e�kj Nem
Contractor's Name�,�� �11 Telephone Numbers D 3(0 . 7 13
Home Improvement Contractor License#(if applicable)
❑Workman's Compensation Insurance
Ch ck one:
I am a sole proprietor
I am the Homeowner
❑ j have_Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over. existing layers of roof)
❑ Re-side I
11k____
Replacement Windows/doors/sliders.U-Value (maximum 35)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License is required.
SIGNATURE:
Q:\WPFILES\FORMS\building permit fcrms\EXPRESS.doe
Revise020108
ti I
+ The Commonwealth of Massachusetts
` .t r 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 Le ibl
Name tBusiness/Organization/Individual):
Address: 01
r `City/State/Zip �r�� Phone.#: AS J'6-7 *? 0C
c -j
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
�,t employees(full and/or part-time).* have hired the sub-contractors
2.ICI I am a sole proprietor or:partner- listed on the attached sheet. 7., ❑Remodeling
// ``ship and have no employees These sub-contractors have g, ❑ Demolition
workingfor me in an capacity. employees and have workers'
Y p �'• 9. ❑Building addition
[No workers'-comp.insurance comp.insurance.
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees. [No workers' 13.❑Other
comp.insurance required.] .
"Any applicant,that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether 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:
Attach a copy,of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage.as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine tip 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
Investi o the DIA for insurance coveraize verification.
I do her y serf; un t e i sand penalties'of perjury that the information provided;i above is T and correct
Simstore: Date:
Phone#:
Official use only. Do not write in this area,to be completed by city or town official
.City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information Ind Instructions
t
Massachusetts General Laws chapter 152 requires all oyers to provide workers' mpensation for their employees.
Pursuant to this statute,an employee is defined as"...eperson in the service of other under any contract of hire,
express or implied,oral or written."
An employeis defined as"an individual,partnership, ciation,corporati or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and inclg the legal repr entatives of a deceased employer,or the
receiver or trustee of an individual,partnership, associ or other leg entity,employing employees. However the
owner of a dwelling house having not more than three ajar tments and ho resides therein,or the occupant of the
dwelling house of another who employs persons to dotenance onstruction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not becaus of such employment be deemed to bean employer."
,1
MGL chapter 152, §25C(6)1also states that"every state i ir to 1 licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business o to onstruct buildings in the commonwealth for any
applicant who has not produced acceptable evidence ompliance with the insurance coverage required."
Additionally,MGL chapter 152,'IS§.25C(7)states"Neither a commonwealth nor any of its political subdivisions shall .
enter into any contract for,the performance of public w ' until acceptable evidence of compliance with the insurance
requirements of this chapter have been resented to th co tracting authority."
Applicants
Please fill out the workers'compensation aY
y,by checking the boxes that apply to your situation and, if
necessary,supply sub-contractors)name(s) {�es)and hone numbers)along with their certificates)of
insurance. Limited Liability Companies(Lrrred Li ility Partnerships(LLP)with no employees other than the
members or partners,are not required to c workers'c mpe anon insurance. If an LLC or LLP does have
employees,a policy is required. Be advise that this affida 't y be submitted to the Department of Industrial
Accidents for confirmation of insurance c verage. Also be s r to sign and date the affidavit. The affidavit should
be returned to the city or town that the a lication for the perim license is being requested,not the Department of
Industrial Accidents. Should you have ny questions regarding th law or if you are required to obtain a workers'
compensation policy,please call the D partment at the number liste elow. Self-insured companies should enter their
self-insurance license number on the ppropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The D\haontap
ent provided a space at the bottom
of the affidavit for you to fill ou in the event the Office of Investigatioo conta t ou regarding the applicant.
Please be sure to fill in the perrnit/license number which will be used aence num In addition,an applicant
that must submit multiple pet!lit/license applications in any given year y submit on. affidavit indicating current
policy information(if necessary)and under"Job Site Address"the apph uld write"all locations in__(city or
town).".A copy of the affidavit that has been officially stamped or mar city or town maybe provided to the
applicant as proof that valid affidavit is on file for future permits or li A ew affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit nd to y business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT req co lete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have anyaqestions,
g ti
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. #617-727-4900 ext 406 or 1-$77-MASSAFE
Fax#617-727-7749
Revised 11-22-06 ='
www.mass.gov/dia
of ' ti Town of Barnstable
o�
Regulatory Services
Um t atar�. Thomas F.Geiler,Director
Arc�1` Building Division
Tom Ferry, Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.b arnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign.This Section
If Using A Builder
S , as Owner of the subject property
he authorize 19;'-f l to act on my behalf,
in all matters relative to work authorized bythis Molding permit application for, .
(Address of Job)
Signature of Owner Date
Print NaLe
Q FOP.M S:OwNF-RPERMIS S ION
-------- ✓�ie i�o�mir?za�uuea� o�.,/�Caoaacrucde�6 ,
Board of Building Regulations and Standards License or registration valid for individul usc.only
HOME IMPROVEMENT CONTRACTOR
before the expiration date..If found return to:
<. � Board of Building Regulations and Standards
Registration .,1,03928 Oite bu n Place Rm 1301
Expiration _7/10/2008 Tr# 125595 Bos on,Z.0 108
} 4 i
Type Individual
PETER E.KELLY 1 =--s i r
Peter Kelly
93 Pheasant Way �"g""�'" " . Not valid without signature
Centerville;MA 02632 Administrator
r
101 L
` of Town of Barnstable *Permit
P 0� �j „(�l� Expires.6 b m bsue date
( Re Fee
• ssrwBze. ' P gato Services
Thomas F.Gellert Director /z,-z-/o
Building Division °
Tom Perry, Building Commissioner
200 Main Street,.Hyannis,MA 02601
Office: 508-862-4038 `���ss PE����
Fax: 508-790-6230 -i�
EXPRESS PERMIT APPLICATION - RESIDENTIAAW V1 � &
Not Valid without Red X-Press Imprint TOWN OF
Map/parcel Number O�) C�
Property Address
( ,Residential Value of Work i°n00b 60 Minimum fee of•$25.00 for work under$6000.00
Owner's Name&Address 0C I 1)'s
lue-
Contractor_s_Named ����.tt �� 'telephone NumlnZC&
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
MNorkmaes Compensation Insurance
Check one:
a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name '► Q ,
Worl man's Comp.Policy# L001< Q c58 0 13 n
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
I.Re-roof(stripping old shingles) All construction debris will be taken to (�,tiz)
❑Re-roof(not stripping. Going over existing layers of roo fl
❑ Re-side
❑ Replacement Windows. U-Value (maximum.44)-
'Where required: Issuance of this permit does not exempt compliance with other tows department regulations.i.e.historic,Conservation,etc.
***Note: jeov
wner sign Property Owner Letter of Permission.
Contractors License is required.
Signature
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296 WINTER STREET
HYANNIS, MA 02601
ERIC ENGELSEN B AIM MUTUAL INSURANCE CO -
85 OLD TOWN ROAD
HYANNIS, MA 02601
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°.JAE?� Town of Barnstable
Regulatory Services
Imo+ = Thomas F.Geiler,Director '
asass,
Building Division.
Torn Perry, Batiing Commissioner
200 Main Street, Hyannis,MA b2601
wwrv.town.b arnstabl e.ma.us
office: 508-862-403 8 Fax: 508-790-6230
Property QwnerMust
Complete and Sign This Scction.
'If Using A Builder
1 e
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.
bD Si-A-6(
(Address of Job)
ignatare of Owner Dat
Print Name
Q:FORMS:OWNERPERMM S10N
The Commonwealth of Massachusetts
Department of Industrial Accidents
. Office.of Investigations
600 Washington Street
Boston,MA 02111
U!Vt
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciaias/Plunnbers
Anulicant Infflrmation Please Print Legibly
Nagle(Businessiorganization/individuaD• k(-7i L•.Se,&1 COIS C:T U-M- o V - -
Address:
City/State/Zip: -Y �t+�C S , fQ Phone#: .SCJS 77c '7a ,�.
Are you an employer?Check the-appropriate box:. -Type of project(required):
1.�am aemployer with • 4. ❑ I am a general contractor and I . 6. ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or parEner-
listed on the attached sheet I ?' -Remodeling
ship and have no employees These sub-contractors have 8. .❑ Demolition
working for mein any capacity. workers' comp.insurance. g, ❑ BmIding addition
o workers' comp.insurance 5. ❑ We area corporation and its
officers have exercised their 10.7 Electrical repairs or.additions
required.] 11.❑ Plumbin repairs or additions
3.❑ I am a homeowner doing all work . right of exemption per MGL g eP
myself.-[No workers' comp. C. 152,§1(4),and we have no 12.0 Roof repairs
insurance-required.]t employees. [No workersl-
• 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 anew affidavit indicating such
$Contractors that check ibis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp:policy arfaruiation.
I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site.
information. '
insurance.Company Name: o Z_, K
Policy#or Self-ins.Lic.#:_ Expiration Date:•
Job Site Address: �j`� 1- � � �'' � L � � —City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failme 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 STOPVORK 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 u the pai nd p Ides of perjury that the information provided above is true and correct.
Si ature: v Date:'. �-
Phone#
Official use only. Do not write in this area,to be completed by city,or town official
City or Town: PermitUcense#
Issuing Authority(circle one):
1.Board of Health Z.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
Infor mation Wad Instructio S.
ter 152 r uires all employers to provide workers'Massachusetts
for their employe
Massachusetts General aws chap erson in the service of an er under any contract of hire,
Pursuant.to this statute, employee is defined as"...every p
".written
• express or implied,oral o • ;• : �' .
ers ,association, rporation ' other legal entity,or any two or more
An employer is defined aS.:. pdivi�n�•,P . .Io er,or the
of the foregoing•engaged in a int enterprise, and including the legal repres fives of a deceased emp y
arts ,association or other legal , employing employees- HoweY.er--
receiver or trustee of an indivi al,partnership,
owner of a dwelling hous a havin not more than to
apartments e�cdow coon Oresides r
dwelling work-on such dwelling house
dwelling house of another who loys pens '
ant thereto.shall not because o uch employment be deemed to be an employer."
or on the grounds or building app
MGL chapter 152,§25C(6)also states at"every state or local ' easing agency shall withhold the issuance or
Tenewal of a license or perms to op to a business or to con. et buildings in the commonwealth for any
applicant who has not produced accep le evidence of cum 1i o�m�ve�altthh noz insurance
ofits political sucoverage bdivisions'shall
pp ter 152, 25C tes `Neither flee c Y
Additionally,MGL chap .. § (�
e f public work acceptable'evidence of compliance with the insurance
enter into any contract for the performanc
1equirements of-this chapter have been prey ted to the con acting authority."
Applicants
Please fill out the workers' compensation affida ' o letely,by checking theboxes vn'th their to your
situation
n and,
if
sub-contractor(s)name(s),address ) and phone numbers) along
supply s employees other than-the
ess P Y no
necessary, P C or L' Liability Partnerships(L•LP)with emp .y
insurance. Limited Liability Companies(LL ) or LLP does have
members or partners; are not required
B advised tha orks affid�t may be submitted to the Depe�sation insurance. If anCartment of Industrial
employees, a policy is required.
Accidents far confirmation of insurance coverauge . oAls�ebe "tee°I licensign se is being requ�estedvnot the Deparfineat of should
be returned to the city or town that the applica f Par .
or
Industrial Accidents. if you are required to obtaia.a wor ers'
Should you have any qu t<o lir e number t below.. S 1f-insured companies should enter their
compensationpolicy,please call the Departm . ,
self-insurance license number on the app ' to line.
City or Town Officials
,., 'Please be sure that the affidavit is complet and printed legibly, The D C0provided you regarding the applicant
of the affidavit for you to fill out in the ev t the Office of Invesbgatlons Y applicant
Please be sure to fill in the peauit/hcense er which will be used as a r erence number. In addition, an
that must submit multiple permit/license� lications in any given year,need my submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address oIk�b the 'ty or town s d write"all locations
be provided to in the or
applicants
tom)."A copy of the•affidavit that has/been officially stamp Y
applicant as proof that-a valid affidavi is-on•file forli future
ease or not related to any es. An mess or stbefaled out-each
commerc a1 venture
year.Where a home owner or citizen obtaining a P
Y ' ed to complete affidavit:
(i.e. a dog license or permit to burn 1 aves etc.)said person is-NOT required .
The Office of Investigations would , e to thank You in advance for your cooperation and sho you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
i
The Commonwealth of Massachusetts .
- Ieparttnent ofIndustrial•Accidents
Office
. 9f Investigations
,. 600-Washiugfol •Street
V
Boston,MA 02.111.
Tel. #617-727-4900 ext 406 or'1-877-MASSAk'E
Fax#617-7274749
Revised 5-2645 www.mass.gov/din
r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 'Z O q Parc I iI Permit# (P
Health Division Date Issue61-0 2 -D?L
Conservation Division Z ,/Z��Z Application Fee
Tax Collector �� /�� 2— Permit Feed
Treasurer �6 2-- L `3
SEPTIC TEM MU T SE
Planning Dept. INSTALLED IN COMPLIANCE
VVITH TITLE 5
Date Definitive Plan Approve y Planning Board ENVM0hM°`ENTAL CODE ANL
Historic-OKH Preservation/Hyannis
Project Street Address k k`6 O u-A�s t;lf r' (—E Q-4)4�®f
Village C-Y\
Owner MPt4 L-\P�, CUE Q n�� Address \\"b O(_ S C•�E �b (J
Telephone
Permit Request Cc so I LC� Q'*1!� D kkE 1�)
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain /' Groundwater Overlay
. -a,,Project Valuation �S 6U v Construction Type P 1 A< Enw ���►
Lot Size 1 "5 9 ft- L Grandfathered: l Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure (`�2- Historic House: ❑Yes A No On Old King's Highway: ❑Yes AeNo
Basement Type: ❑Full I Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 414
Number of Baths: Full: existing 2 new Half:existing new
Number of Bedrooms: existing 5 new
Total Room Count(not including baths):existing `6' new_� First Floor Room Count (�
Heat Type and Fuel: ❑Gas /a,I ❑ Electric ❑Other
Central Air: ❑Yes d No Fireplaces: Existing I New Existing wood/coal stove: ❑Yes VNo
Detached garage]existing ❑new size Pool: ❑existing ❑new size Bar4existing ❑new size
Attached garage:❑existing ❑new size Shed: existing ❑new size 220 Other:
Zoning Board of Appeals Authorization ❑ Appeal# "I Recorded❑
Commercial ❑Yes VNo If yes,site plan review#
Current Use rt!S uQt k 4`
- _ - Proposed Use
BUILDER INFORMATION
I
Name Q_ Telephone Number
Address P _ License# 01 cJ (J
• GL(Q Home Improvement Contractor# 9Z. O
Worker's Compensation# vl
ALL CONSTR7 DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ✓1 61-
,
SIGNATURE DATE I 1-5 I e��
FOR OFFICIAL USE ONLY
Z'
i
~PERMIT NO.
DATE ISSUED '
Jq 4 K..�
� MAP,/PARCEL NO. ( �'� � ` ! -
r
ADDRESS ' — VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION [L(N
FRAME
INSULATION
i
r� S
FIREPLACE
�l
ELECTRICAL: ROUGH := FINAL: `
PLUMBING: ROUGH' -; 6 FINAL)
-affc ,
GAS: ROUGH .... FINAL
r
l ,
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO. .e
°FZHE Town of Barnstable
Regulatory Services
BMWSPAELE, ' Thomas F.Geiler,Director
9 MASS. g
�pTe1659. A`e Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 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.
Type of Work: W 660 �-Q-P— Estimated Cost 1 00
Address of Work: -S N PvC.E ®
Owner's Name:
Date of Application: 2--
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
❑Job Under$1,000
[]Building not owner-occupied
'.Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR
s
5 ate Owner's Name.
Q:forms:homeaffidav
The Commonwealth of Massachusetts
M
Department of Industrial Accidents
Office offnsestigatioos
600 Washington Street
s Boston,Mass. 02111
Workers' Compensation Incur ance Affidavit
Work
Me: maPe C'i✓A �e o J
r)
location ®_� \C,,\` C2 ' 6 `6�0
ci l_��"C� v\\2 1� phone# � �-
I am a homeowner performing all work myself.
❑ I am a sole rietor and have no one worldz in capacity
%% /%/%%%/%/%%/G%/G%%%%%%%%/%%%%%/%% %%/%/%%%/////%%%%%%%%%/%/G%%///G%%%///%%/�%�%%%/%%/�%%%////%///////lam%%%��%/
I am an em 1 er rovitiin workers' compensation for wry employees working on this job.
............
...... .......
DO .name i'`>>:::>::::{> <
.to
n
......:....::.
;>
...........
�
»'"fi Cl:•>
1y
-�•�..1CCC:C6i;`?";'i ::2:i:ai::?%i"i: ';'Zii >;i:>ii '�::`::'i`'i�:`:'a:i`?ii::`::` �� j'i:. cii8i':::;i ii`;: }'a'C
':fftsun %/
❑ I am a sole proprietor, general contractor, or homeowner. (circle one)and have hired the contractors listed below who
have
e followingworkers' co ensation polices:
:cow sn :nam
.:....::........
.... ...................n ....................... ..................:.. ............. ................. :://.:::::;,:::.+::<.�:Y,.ryiii:i::::C4:i:L:;:i :;i:.::::•:!•�:•i?':::•::;:.:-;:•.�::;•:::::.::•il:iY:i:•}:}:-iii:l.-
/!//��
....................................:::•:.......
:.
J:ti}•:...
;�:;:;i:?:i:?;:yy;•}::::;::•i:?{•i'�j{:i}�;�i:+'+.?$%?iiii'?iii$iiiii:i�i:�::^ii:^:4:4::4:•i'fG::•i:v:::::<J:•i:•i
: v Hilie2::i:i:l;:• :: i:i},':�Y::i::ii:i:�:;:;�i�ii'�:;:::>;�i:;:ivC:•. :... ... ... .. .......
address;::>;>::.....:...... ;:>;::....::::::>.>::;>::::.:.:...:_
>b
:`�•icuintsn �.
Failure to secure coverage as required wider Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,4M.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 penalties of pedury that the information provided above is trru and correctsigaat, �%� VWM��(� J D �
ite
Print nameIF �
c � r—Phone —�I
official use only do not write in this area to be completed by city or town official
city or town: permit/license# ❑Building Department
❑Licensing,Board
❑cl ec fi'imnediate response is required (:]Selectmen's Oince
❑Health Department
contact person: phone#; _ ❑Other
Urr;"d 9/95 PJtU
Information and Instruc ' ns
Massachusetts General Laws chapter 152 section 25 requires all employer to provide workers' compensation for their
emplo es..As quoted from the"law", an employee is defined as every p son in the service of another under any contract
of hire, ress'or iiplied, oral or written.
An employe 's defined as an individual,partnership, association, co oration or other legal entity, or any two or more of
the foregoing aged in a joint enterprise, and including the legal r resentatives of a deceased employer, or the receiver or
trustee of an indivi ,partnership, association or other legal en ti , employing employees. However the owner of a
dwelling house ha ' of more than three apartments and who re des therein, or the occupant of the dwelling house of
another who employs pe ons to do maintenance, construction o repair work on such dwelling house or on the grounds or
building appurtenant ther shall not because of such,emplo be deemed to be an employer.
MGL chapter 152 section 25 states that every state or 1 cal licensing agency shall withhold the issuance or renewal
of a license or permit to operate business or to constru buildings in the commonwealth for any applicant who has
not produced acceptable evidence f compliance with insurance coverage required. Additionally,neither the
commonwealth nor any of its political bdivisions shall ter into any contract for the performance of public work until
acceptable evidence of compliance with insurance quirements of this chapter have been presented to the contracting
authority.
Applicants
workers' compensation davit co Cng
ly,by checking the box that applies to your situation and
Please fill in the mP
an names address and ne numbers with a certificate of insurance as all affidavits maybe
supplyingco , P
Y coverage. Also be sure to sign and
submitted to the Department of Accidents for co tson of insurance rag
lication for the ermit or license is
or town that the a P
date the affidavit. The affidavit sho be returned to the c PP
S uld you have an questions regarding the"law"or if you
being requested, not the Department Industrial Accidents y. Y
' co ensation policy,please c e Department at the number listed below.
are required to obtain a workers
City or Towns
Please be sure that the affida is complete and printed legibly. The Department has provided a space at the bottom of the
affidavit for you to fill out in a event the Office of Investigations has to contact youregarding the applicant. Please
be sure to fill in the pernut/li a number which will be used as a reference number\The affidavits may be retmcaed't^
the Department by mail or F unless other arrangements have been made. \
The Office of Investigations ould like to thank you in advance for you cooperation and should you have any questions.
please do not hesitate to us a call.
The Department's address,telephone and fax number: \
The Commonwealth Of Massachusetts
Department of Industrial Accidents
flfflce of Inllesduallons
600 Washington Street
Boston, Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 ext. 406, 409 or 375
`gyp THE 1p�� The T WP �� own of Barnstable
N i
Department of Health Safety and Environmental Services
9.
T BAR�STABLE.MASS. 0p
�EOMp+� Building Division
367 Main Street,Hyannis,MA 02601
Office: 508-862-4038
Fax: 508-790-6230
PLAN REVIEW
Owner: AM:f1w ayl,5 Map/Parcel: AW1,11?
Project Address: Builder:
The following items were noted on reviewing://&/,A/, A)V6 L-'/7-7-/J e— 4B':�k-'-e 171
Reviewed by: -
Date:
L ®a= a' E Rw U-e N Es M^Y STANDARD LEGEND
NOTE:not all symbols will appear on a mop
MAP 209 4=::Z GOLF COURSE FAIRWAY
P2
. 6872
2 .V , EDGE OF DECIDUOUS TREES
9 ""'~^ EDGE OF BRUSH
# t ORCHARD OR NURSERY
v—PY—V EDGE OF CONIFEROUS TREES
Jam \
MAP 209; r — , MARSH AREA
# 42 EDGE Of WATER
DIRT ROAD
MAP 209 -
-_: ;�— DRIVEWAY
7 0 IF— PARKING LOT
�_� PAVED ROAD i
# 128 ' — - - — DRAINAGE DITCH
— — — — - PATH/TRAIL
-`-
_ ----- MAP 209-_-- PARCEL LINE
71
__ O # 12 W no E- MAP#
21 E-- PARCEL NUMBER
/ #tedo F— HOUSE NUMBER
FOOT CONTOUR LINE
MAP 209�
"$ o 10 FOOT CONTOUR LINE
/\ O Elevation based on NGVD29
/ O P 2 j�4.9 SPOT ELEVATION
\ o0o STONE WALL
48 -X—X— FENCE
RETAINING WALL
s�O 76 RAI L ROAD TRACK
09 �. 56 �' \ STONE JETTY
6v MAP 2 / ,� SWIMMING POOL
7 �
# 64 s PORCH/DECK
o BUILDING/STRUCTURE
DOCK/PIER
i+ HYDRANT
e VALVE ® MANHOLE
0 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 N 1 C I N F O R M A T 1 O N S Y S T E M S U N 1 T 0 SIGN ® STORM DRAIN
It PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES:Planimenics(man-made features)were interpreted from 1995 aerial photographs by The James d TOWER
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 o UTILITY POLE
w ° 0 40 80 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. P animetria,topography,and vegetation were mapped to meet National Map Accuracy Standards ELECTRIC BOX
° 1 INCH=80 FEET* enlarged scale. on the map. at o scale of 1"=100'. Parcel lines were digitized from FY2002 Town of Barnstable Assessor's tax maps. 4 LIGHT POLE O
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ROOF-FRAMING PLAN
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TOWN OF BARNS12LI BUILDING PERMIT APPLICATION
Map 2CU ( Parcel 2 Permit# 4TU__�
Health Division 7y-ys 7_1191 r)z Y�7/Zf"--Gt� Date Issued, C�
Conservation Division t17/94� Fee �- -�
Tax Collector
Treasurer ° � ,�muser BE
Planning',De t. hrm'STAL.LED IN��u�'i�IIANC
9 P
Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODS AND
Historic-OKH Preservation/Hyannis TOWN REG►ULAMONS
Project Street Address 1014 s�r6 i66d
Village v� L— 04 . 0_-L(o3
Owner m 4 r! 14 c, 66415 Address Ili 5_996be,6 �j
Telephone 7 -7 Z 1 7-57—
Permit Request Krs- b v)' l s-nn&, 4-ell O JQc-, gcjlldl/c.
A
Square feet: 1 st floor:existing proposed 2H 2nd floor: existing 110 proposed O Total new
Estimated Project Cost ZA 00 0 Zoning District Flood Plain � I� Groundwater Overlay =�
Construction Type W 0 6 0 Rnwf---
Lot Size V �� ( , Grandfathered: �Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family l Two Family ❑ Multi-Family(#units)
Age of Existing Structure \ Historic House: ❑Yes \iI6 No On Old King's Highway: ❑Yes ,VNo
Basement Type: ❑Full ❑Crawl ❑Walkout �Other '%/L4 t ����
Basement Finished Area(sq.ft.) LA 10c Basement Unfinished Area(sq.ft) L1 11D(
Number of Baths: Full: existing 2- new ,4 A Half: existing \ new _
Number of Bedrooms: existing new (AL_T4
Total Room Count(not including baths):existing Cb new A- First Floor Room Count 7
Heat Type and Fuel: AGas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes No Fireplaces: Existing _ New Existing wood/coal stove: ❑Yes No
Detached garage: (existing ❑new size t Pool:❑existing 0 new size LA `1- Barn: existing ❑new size L4 1�
Attached garage:l 1`existing ❑new size Shed:�existing ❑new size Other: Zb0t
Zoning Board of Appeals Authorization ❑ Appeal# ; to Lft Recorded❑
Commercial ❑Yes No If yes,site plan review# l
Current Use Proposed Use �t
BUILDER INFORMATION
Name �— �F Telephone Number o f SD
Ad ress A7-% p'C'` License# O
-1� t � 3 Z Home Improvement Contractor# 1 d 3 !� a
Worker's Compensation#
ALL CO I
TRUCTION BRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO -d ae) Q-4 6i4//1 5?t6`to'
SIGNATURE- &4)
-2/DATE 2"a 0
FOR OFFICIAL USE ONLY
PERMIT NO.
,DATE ISSUED
MAP/PARCEL;
' ADDRESS —' VILLAGE
OWNER'.
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION y
FIREPLACE ol
' ELECTRICAL: ROUGH FINAL,
PLUMBING: ROUGH FINAL "
r `r�
t
+k t
GAS: ROUGH r = 3;, FINAL
FINAL BUILDING' A
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f DATE CLOSED OUT '
ASSOCIATION PLAN NO.
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9 - STANDARD LEGEND
# NOTE:not all symbols will appear on a map
GOLF COURSE FAIRWAY
MAP 209 EDGE OF DECIDUOUS TREES
'. EDGE OF BRUSH
# 42
ORCHARD OR NURSERY
MAP 2O9 v—v-V-T EDGE OF CONIFEROUS TREES
70 MARSH AREA
# 128 - EDGE OF WATER
__= DIRT ROAD
MAP 209 - DRIVEWAY
71 E PARKING LOT
O # 12 PAVED ROAD
— — - DRAINAGE DITCH
M72 — — PATH/TRAIL
# 118 s — ��/ PARCEL LINE
1 V
• 21_ft.from House corner to Lot line.. . MaP„o E MAP#
P 2 # EE� PARCEL NUMBER
18� HOUSE NUMBER
2 FOOT CONTOUR LINE
#'48 — 10 FOOT CONTOUR LINE
7 6 a Elevation based on NGVD29
.9 SPOT ELEVATION
O 56 \ �o STONE WALL
MAP 2
-X—X- FENCE
# 64 RETAINING WALL
RAIL ROAD TRACK
STONE JETTY
SWIMMING POOL
PORCH/DECK
MAP98 O T� 0 BUILDING/STRUCTURE
36 A 08 1 6 \` u T� DOCK/PIER
# 104 # 41 HYDRANT
70 /� e VALVE O MANHOLE
/+ o POST o'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 I N F O R M A T I O N S Y S T E M S U N I T a SIGN ® STORMDRAIN
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 1995 aerial photographs by The lames n TOWER
1"=100'scale map and may NOT meet of property boundaries.They are not hue locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD 0 UTIUTY POLE
w ` 0 40 $0 National Map Accarory Standards at this do not represent actual relationships to physical objects Corporation. Planimehia topography,and vegetation were mapped to meet National Map Accuracy Standards
s ,INCH=80 FEET* enlarged scale. on the map. are scale of 1"=100'. Parcel lines were digitized from 2000 Town of Barnstable Assessor's tax maps. LIGHT POLE O ELECTRIC BOX
\sitemaps\Pub1ic\m209p72.dgn Aug. 09, 2000 08:35:02
a
ASSESSORS REF.: OVERLAY DISTRICT:
I certify that the structures Map 209, Parcel 072 AP — Aquifer Protection District
shown hereon conform to
NOTES: the setback requirements of ZONE: FLOOD ZONE:
the Zoning Bylaws of the I RC RD-1
town of Barnstable. zone c
1.) The structures shown were located on the ground Setbacks: .Sethacks. Community Panel No.
by conventional survey methods on (or between) Front 20' Front 30' #250001 0005 C
07/MAR/11 and 09/MAR/11. Side 10' Side 10' rev. August 19, 1985
Rear 10' Rear 10'
�q OR'b4g�
2.) The property line information shown hereon was dta`
compiled from available 'record information.
RICHAREV
3.) This plan is not for recording and is not to be LNO 34312
0
used for construction layout or deed description
purposes. LC8
Fnd
0
7
Stephen �FGiotrelis
m 14993/207
3.50'
o N N
W
Sg0'5530 to
0
568 64
R60p OSed 1"=10' o
Addition 2.57' - Stockade Fence 14.8'
_ o
m SB/DH t s ,y; lsty w/f
ON o Fnd 25.5' s ty w/f ®Out oathouse
�^� — picket Fence workshop �� e 69,645±SF
----- ------ - _ -
x
i
•� �\ or 1.60±Acres
Stone Drive
-- _ _—
o —— _ \ co
O
Sh l Septic \ � -
8. #118 \ Covers 1 O
c7 2 sty w/f \ 1 h� ��
cu Dwelling
Deck
Porch G)m
�• � - o
w/trellis `<
co LCB
Fnd
I N styW/f
1 . "E
'40 F
N
® Studio N81'48 /
W Thomas R Quinn
Cn C 12446/118
O �
� O F
0 42.9, CB/DH "M warren
520.22 Hazel'
� Fnd
18785/139
n m CB/DH
o O Fnd N/F
Lorraine Patti Anderson
® � � N/F
o ® 10369/305
Fence E Gilchrist
a o picket Fronk
a — 997/184
I,
NIF t
\ Fnd Anthony Rober 0 10 20 30 40 60 80 FEET
11251/154
Sheet # Title: Prepared For: Notes/Revisions:
Plan Showing ProposedAddition CapeS u rvt Scale: 1"=40'Road e See above
at 118 O/d Stage Date. Marcia Deonis
104 g 7 Parker Rand 118 Old Stage Rood �l
BARNSTABLE (Centerville) MASS osterville MA o2s5s 3/15/2011
(508)420-3994 (508)420-3995 fox owg: lCenterville, MA. 02632
copesurv@copecod.net, C768g1