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0220 CROCKERS NECK ROAD
i �I REVALIDATED LETTERS OF MAP CHANGE FOR TOWN OF BARNSTABLE,MA Case No: 11-01-0521V Community No.: 250001 July,17,2014 Case No. Date Issued Identifier Map Panel No. Zone 98-01-092A 02/04/1998 SQUAW ISLAND - LOT 49 - 19 ISLAND .25001C0564J X AVENUE 98-01-1020A 12/30/1998 LOT 1, LAND COURT PLAN 25001C0752J X 16194 N - 1623 MAIN STREET 99-01-244A 01/06/1999 PLAN 13687, LOT 5 -215 SEAVIEW 25001 CO776J X AVENUE 00-01-0306A 03/28/2000 648 MAIN STREET 25001 CO544J X 00-01-0998A 08/22/2000 291 BRIDGE STREET 25001CO757J X 02-01-0994A 06/05/2002 1300 CRAIGVILLE BEACH ROAD, 25001CO563J X CENTERVILLE 05-01-0804A 10/06/2005 COTUIT HIGHGROUND,LOT 25001C0752J X 15213 4�220TCROCKERS`NECK ROAD' 07-01-0535A 03/29/2007 CENTERVILLE, LOT 9 -7 36 BROKEN 25001CO564J X DIKE WAY (MA) 11-01-1245A 03/31/20I1 ' LOT B ---265 SEA VIEW AVENUE 25001C0757J X<' 13-01-0725A 02/05/2013 MAP 2591 LOT 12 =- 116 SCUDDERS 25001C0554J X LANE 14-01-1368A 04/10/2014 LOT 18 -- 835 SOUTH MAIN STREET 25001CO563J X Page 2 of 2 Federal Emergency Management Agency Washington, D.C. 20472 ° July 16,2014 Jessica Rapp Grassetti Case No: 11-01-0521 V President, Town Council Community: Town of Barnstable, Town of Barnstable Barnstable County, Massachusetts Town Hall Community No.: 250001 367 Main Street Effective Date: July 17, 2014 Hyannis,Massachusetts 02601 LOMC-VALID Dear Ms. Rapp Grassetti: This letter revalidates the determinations for properties and/or structures in the referenced community as described in the Letters of Map Change (LOMCs) previously issued by the Department of Homeland Security's Federal Emergency Management Agency (FEMA) on the dates listed on the enclosed table. As of the effective date shown above,these LOMCs will revise the effective National Flood Insurance Program (NFIP) map dated July 16,2014 for the referenced community, and will remain in effect until superseded by a revision to the NFIP map panel on which the property is located. The FEMA case number, date issued, property identifier,NFIP map panel number, and current flood insurance zone for the revalidated LOMCs are listed on the enclosed table. Because these LOMCs.will not be printed or distributed to primary map users, such as local insurance agents and mortgage lenders,your community will serve as a repository for this new data. We encourage you to disseminate the information reflected by this letter throughout your community so that interested persons, such as property owners, local insurance agents, and mortgage lenders, may benefit from the information. For information relating to LOMCs not listed on the enclosed table or to obtain copies of previously issued Letters of Map Revision(LOMRs), Letters of Map Revisions Base on Fill (LOMR-Fs) and Letters of Map Amendments (LOMAs), if needed, please contact our FEMA's Map Information eXchange (FMIX),toll free, at 1-877-FEMA-MAP (1-877-336-2627). Sincerely, Luis Rodriguez,P.E., Chief Engineering Management Branch Federal Insurance and Mitigation Administration o Q Enclosure: Revalidated Letters of Map Change for the town of Barnstable, Massach s cc: Community Map Repository N E Thomas Perry, Building Commissioner, Building Division, Town of Barnstable Page 1 of 2 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1 ,r Map`1� Parcel pL� Permit# —1 Health Division )D Date Issued Conservation Division Fee a7`3�z.63 Tax Collector �1 u fW Z Application Fee Treasurera. Planning Dept. Checl a MMTEM M . �¢ BROOMS �� F Date Definitive Plan Approved by Planning Board Rproo ee $y'�"� Historic-OKH Preservation/Hyannis Project Street Address -2-20 S /Jac< Village ca ud % Owner LPL t; ) EJW /.��L �7Caf�G�JdlOi�f'r6�ddress o20�0 C�oc��- S A/L& Telephone J 0 O 089� Permit Request N-2 AMI//OBI 70 EXl<5<'� �w�=�r�/� CQi1,_T 57i1JG OF Ail/ EX N�L=,�> .41111A15 �oaNl�DIAIIIV(_g, Rcy,-1 , 1-19t 1242.11 J!41 ;AIC—k/ L—,V7rZV Di02_5:RLclk4cC )=Xc v7 ecl>a,�wuar - Sv�A .l�eMoc. Sqe feet: 1st floor: existing proposed 2nd floor: existing proposed Total new �, 07-0 Zoning g District Rr^ Flood Plain Groundwater Overlay 40/144 Construction Type"z) FRjqM e Lot Size .44 /4c&4_ Grandfathered: ❑Yes ® No If yes, attach supporting documentation. Dwelling Type: Single Family k-' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ANo On Old Kings.Highway: ❑Yes +VNo Basement Type: ❑Full Xcrawl ❑Walkout ❑Other /B4RT,4e_ Fvie_ U&IP Q, I)AI 134FDR_cO64 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 (o Heat Type and Fuel: XGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove:)<,Yes ❑ No Detached garage existing ❑new size Pool: ❑existing ❑ ❑F%e new size Barn:❑existing w size v 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 -'/N64 Proposed Use 61 MG6, F4M�%��� a BUILDER INFORMATION Name 1��4, L �yG/�'/y Telephone Number J�G�' v ' DcoJ�S� Address 42 ® CKoC&--ERS AV6-ce License# r'r U 1 l�/�' Home Improvement Contractor# 05 Worker's Compensation# /�/� —�d G-fa•�yC� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C6"AfuZcf� GG 0c/ oeSIGNATURE DATE AA�� * v2/v6� l� � � FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER i •- DATE OF INSPECTION: 0 ' - FOUNDATION FRAME (Z4CI y k A-k INSULATION J FIREPLACE F ELECTRICAL: ROUGH -It FINAL {i tt' PLUMBING: ROUGH FINAL � <tr GAS: ROUGH FINAL r FINAL;BUILDING f/�v�` AA Z Y107Rrn i 0 0 Id DATE CLOSED OUT ASSOCIATION PLAN NO. r 780 CMtt Appeedts J Table JS.Zlb(continued) Prescriptive Packages for One and Two-Family Residential Buildings Hated with Fasd Fuel MA%1MUM MINIMUM Glazing Glenn Ceiling Wall Floor Basemeat Slab Heating/Cooling Effi ing g 8 � Wall perimeter Equipmer:t Elfcieney' Area'(°/a) U.value= R-value' R-value R-valuer it_valut° R value - Package ,- 5701 to 6500 Heating Degree Days' _ 6 Normal Q I2°/, 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 85 AFUE 6 S 12% 0.50 38 13 I9 10 25 N/A N Normal T 15%..... _ . ..0.36 _ .. ._..__38 13 19 _.._ Normal- ._..__ .. .-- 11 15% 0.46 38 N/A 85 AFUE 19 V 15% 0.44 38 19 19 10 6 S5 AFUE W 15% 0.52 30 19 10 Normal X 18% 0.32 38 13 25 N/A N/A y 18% 0.42 . 38 19 25, N/A N/A Normal l 13 19 10 6 90 AFUE Z 19% 0.42 38 90 AFUE AA 19% 0.50 30 19 19 10 6 1. ADDRESS OF PROPERTY: ��C ac,<zs Iz Aj 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: . 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): _ NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: ° NO: q-forms-f980303 a 780 CMR Appendix J 4 Footnotes to Table J5.2.1b: I Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area, expressed as a percentage.Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 fl of decorative glass may be excluded from a building design with 300 fl of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. The ceiling.R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be-substituted for-R49 insulation. Ceiling R-values-represent-the sum of cavity ..-.....-. insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example,an R 19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. r 5 The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. `The entire opaque portion•of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. • 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ° If the building utilizes elebtric resistance heating use compliance approach 3;4, or 5.• If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. For Heating Degree Day requirements of the closest city or town see.Table J5.2.1a NOTES: a) Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). f 43 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE , New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Change of Contractor/Builder $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE q square feet x'$96/sq.foot 1� x.0041 �� 4 plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE w square feet x$64/sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq. ft.= x.0041= rt 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 6 >1500 sf-Same as new building permit: _ square feet x$96/sq.foot= _. x-.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) s Deck x$30.00= (number) Fireplace/Chimney x$25.00= b (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool ti. Relocation/Moving $150.00 (plus above if applicable) Permit Fee Projcost Rev:063004 r , r May 15 05 03:27p Nliohael Bosse 5087599095 p.2 3/1,4/06 12 :08 :02 PM 4160 ® 01 /02 ACOM DER-nFICATE OF INSURANCE 03/1/M' oszoBucEm (SM)5$0-2400 FAX (W29-9-4111 THIS CERTIFICATE IS IUUED AS Ac OWTTER OF WFORKATION Murray& PlacDonald Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 46D6 7arles Road ALTER THIS CERTIW-ATE DOES NOTAMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLCIES BELOW. Falmuth, MR 0Z5w Douglas Pbrfiomld INSURERS AFFORDINGCOVERAIGE NAIL# NsaRm K R Bosse -L Esseoc lnsurance Co. _ PO Sax 3315 eaLmg Workers Compensation Bureau Pocasset, KA 02559 INStmamr` 1 0ISi1F7ER Ck- Fietli#.R E: COVERAGES THE POLICIES OF WSURANCE UST'ED BELOW HAVE BEEN ISSUED TO THE iNSURED hAMED ABOVE FOR THE POLICY PERIODINDICATED.NOTWITHSTANDING ANY REOUIREAIEiNT,TERM OR CONEITtON OF ANY CONTRACTOR OTHER DOCUMENT ENr VATH RESPECT TO WHICH THIS CERTIFICATE MAY BE I SSUEDOR LIAY PERTAIN,THE INSURANCE AFFORDED 31 THE POLICIES DESMBEDHEREIN IS SMELT TOALL THE TERMS.EXCLUSIONS AND CONDMONS OF SUCH POLICIES.AGGREGATE UMI'TS SHOWW MAY HAVE BEEN REDUCED BY PAID CLAW4, SEN TYPE OFOMRAkOk POLICYNOSER POLIGYEffECTIYE E11PAtAP10p LUM Gd0ENR1.I7/\WMAPY 3CL6652 07/11/2M4 07/11/2005 F*cm CK=RRENcE S 1,000, X cwL�neRau.LPt@P.1TY ' j DaMAt;tTaaElrelED �' � r� CLAIVS VAM ®O=UR l YEDEJ�Wny mePa�) b j,, A PERSONAL b ADV P"URY b 1 000 -- GENERALAGGREGATe b 1 ow. TAcIrIAOGf�{I4TELM6TAP+PUESPER PROCt1�TS-COMP/DPADO,b 1 OOO X POLICY JECI LOC AUTON ISIMUAMUTY COMBINED BINBLE U?Al } A►YY AUTO (C.-cdwo) f ALLONPIEDAUTOS BOOLYIPtAIRY : - SCW:DuLED AUTOS IPer Plaw) FURED AUTOS BOD2YOLAIRY f NQPIcwa®AUTO$ fI er amooa6 PRGPE m DAMIAee E . acd:161 GWW.E UNI LITV .. AUTO ONLY,•P3aACCIDe mr I ANY AUTO OrHEi UM, EA ACC b AVTOOMr. BAG f I WCESSAILUIRELAUABLITY EAChOCCURR ICE S OCCUR CLAIMS MADE - A6lCaAEGAYE S . DEOU=MLE S IiETLMTION S T $ VPWbcEflS CIDAF6iSA!l01i ABD Tw 10/OB/2w 10/08/mcls ATi! OTT+ ®LOVERs L DL" F.L.EACH A=Mfff § TOO. B C*+PI;;M%N8 R 8KCVLBTIfXBCU•!KE ,^�y�/ 7 F 9/0 OFF]CERA6IBER E]fCLU[IE09 `r �v EL DISEASE-SAE KS 50U HTeA tlBiabe WICer SPECIAL PRASVISIOlB 6dw _ EL OtBEA9E-POi.[CY LA9IT S )l�� OTHER I, OEacRwf Oa OF OtERATme;LDCAf16a I NBCLES!Excudiam FmmD BY 0311DOHlaweM!SpWIRL IPMVB10N$ - CERWICAT9 mama ANY QF THE ABOVE De voices BE CANCBUIEb BEFORE Tw 00VATM DATE THEW",THE PBSMS B6UAMR VnLL 6dWMQR TO MAIL IQ.-1aay2wwnlII MOT/CE TQ THE CBITFrAlSHCWWXAWD TOTHF.LUT, _ MFFAMNRR TO Mites SUCH"7101E SHALT.IYIOSE NO CSUrATION OR LIABILRT ` OFAIIY MO UPON THE MWI6R RSA*EKM ORREPRESEWATWES. AUrKQRIQMD RWAMWTATM cTaudirm w lgmer/ ACORD 25(21WIM) OACORD CORPORATION 1988 9694 1 NAY.22.2005 7:02pm AIM MUTUAL NO.0213 P.2/2 CERTIFICATE Cali' INSURANCE rMVE 'n7CE(Iv1,�itDD/,�) PRODUCER TFaS CERTIF7CATE IS ISSUED AS A MALT Og B`IFORNIAT'ION ONLY xS i 'CONFI AS NO BIGHT'S UPON THE CERTIFICATE HOLDER, THIS CERTIFICA`T`E I\Or�lLOaSt ILSI]IaiLCC Agency Inc DOES NOT AMTM,EXTEND OR ALTER THE COWIlAGE AHORDED BY THE POLICIES BELOW. 194-Worcester Ct Falmouth,MA 02540 COMPANIES AF 'ORDING COVERAGE IN5iJR1iD Lawrence Reich compF Y A A,Y.M. bt"utual Insurance Co P 0 Box 1223 Sandwich,MA 02563 COVERAGES THIS IS TO CERTIFY TRAT THE pOLICIES OF INSURANCE LISTED BELOW MAVE BHENLSSUED TO THE IlYSUREI)NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWUMTANDING ANY REQUIREMENT,Tnikm OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH REBPECCTO WIUCrH TINS CERTIFICATE MAY BE ISSUED OR MAY P]ERTALN,TIlE INSURANCE AFFOUED BY TIM POLtCMS DESCRIBED HERRIN IS"JECT TO ALL THE TPRMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LUSTS SHOWN MAY HAVE BEEN TIEDUCED BY PPJD CLAIMS. Co TYPEOrlN5MA�Ia POLICYENFBCnW POLICYE;7I�M47-, /UI[IT& p, PpLICXNSfit13ER" bATE(MM/DD GEIN AA't'1S()vSM/DDlYY) EiL LtAi1II SMY' I ENERAL AGGREGATE? S COMMERCE&,GENERAL LIAEILrrY ODUCTS COMPIOA AGG. 1 MS MADa�xev ,s�sorSAt a�.trnr.mtivt?Y $. OWNM!3&coNrRAcTOR'SPR07. EACH OCCURRENCE g RE DAMAGE(Any'oqe firs) S °D-E CPENSE(Ary am petsj�,) 3 AUTO M(MME LUSiYY.E1 Y ANY AUTO COMBINED SINGLE S . LIMIT ALL OWNED AUTOS DODILY RfIUAY SCHEMED AUTOS I(�rpmn) S HIRED AUTOS NUN-OWNED ALTIOS BODILY INJURY (Par dctiden�) $ �GARAGS UABILfIY . PMI MY DAMAGE 5 ERGS&LIABILM EACH 0MURRENCE $ Uh1HftELLA FORM EACH $ 7WER THAN UMBRELLA FGRM a RWRIS COMMN'SAT[ON AND YEAS LTAAB'.:TY A HE PHOPftI1sTOR! INCL 7008967022004 07/16/2004 07/16/2005 EL EACH ACCMrT A 100,000 ARTNERS S=urlv2 t EL DISEASC—POLICY LIMIT s _ SbO Dp0 FP[CERSAR6. BXCL I ` EL DISEASE—EACH EMPI•QY R EE 5 100 DDD I ' ;DR 5C[Dp1LONOT0 MATIONSR,0CATIOIti-snTS1[CLBSISPECL&I ItRMS CMTLFICATE ItOL.DER CANCELI ATION SHOVL.D ANY OF THE ABOVE DESCRIED POLICIES BE CAISCELL.ED BEFORE TIC GMRGE SUOIiKP 02MATI04N DATE TIEEREOF. THE Is MG CaklPkW WILL ErmEAVOR To NL4II 10 DAYS wBITTE!%TNO=E TO THE CFRTIFICATFTiOLDER NANMI)TO THE LENT,BUT F-AJIME TO MAIL SUCH NOTICE SHALL IMPOSE No OBLIGATION OR 220 CRA SIEIERPS INTECK ROAD LIABIU.Y OF ANY 14ND UPON M CON2ANy, rrs AOENT'S ()p ` �I'�SENTATIVES, CO �'�� M� O2G3S AUTHORIZED REP> NrAMT r U I May-�18�-o5 03:05P P .of DATECERTIFICATE OF LIABILITY' INSURANCE 5/ 1.8/200 5 '19 2Q05 PHUUUCtH THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATICIN I Mcshea Ta5urance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 349 i HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Main Street Suite##Fi i ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. osterville, Ma. 02655 508-420-9011 INSURERS AFFORDING COVERAGE NAIC# . -- INSURED American Excavating � INSURER A: NationalGrange Mutual Contractors, Inc. IN SURER B: — 27 County Road IINSLIRFR.C: Mashpae, Ma 02649 INSURER D: �— 774-836-5774 INSURER E — _ —� .. El COVERAGES THE POLICIF$OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CO NTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED CR MAY PERTAIN,THE INSURANCE AFFORDED I3Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TkR.M5,EXCLUSIONS AND WNDITIONS OF SUCH POLICIES.AGGREGATE LIMIT,,SHOWfV MAYHA.VEBEEN REDUCEDBYFAIDCLAIMS. INBR 6�'E ... •�— --� POLICY'EFFECTIVE POI.ICYEXPIRATION - "- - --i I INBR D'DI '•'f EC1F'IN3URANCE ?�.']L ICY NUMBER DATE MMIDDIYY` )AtE MMIDONY - - LIMITS GENERAL LIA131LITY EACH OCCURRENCE 5 Q00 X COMMERCIALGENE.RAL LIABILITY I CLAIMS I OCCUR PREMISES(Gd occurenrrr ;5 500,000, ! I DE �I MFDEXP{Any onepereon) $ 10 Q�Q . ... ...— AIIT- .. - I UP86239.8 07/06/04 07/06/05 PERSONAL SADVINJURY iS 1,000 000 •. GENERAL AGGkEGATE $ Q��I I GENTApC,.RF.GATE LIMIT ArrLICS PER. PRODUCTS-COMPIOPAGG�S 2,066 000 dIR T L]LOC POLICY I4 I AUTOMOBILE LIABILITYCOM ANYAUTO t Ira acc jop'SINGLE LtMI'T I5 F- I I iI _ ALLU`NNEDAUTOS ',-'—..............7 I I �B oLrINJURv A I X SCHFDULEDAU)OS I (PtrP ) 100r 000 It x HIRER AUTOS LBB62398 I - DOUILYINJURY NON•D'NNEDAUTOS I ' I IPerecaoenq _ S 300,000 PROPERTY DAMAGE I I (Peracadent) $ 100,000 GARAGE LIABILITY ti I.RUTO ONLV•EA ACCIDENT $ ! ANYAUTO r OTHERTHAN EAACC 13 _.._ •J. AUTOONLY: AGG 5 I, Ta.CESSAIMARELLA LIABILITY —� j j EACH OCCURRENCE $ � l (OCCUR �I CLAIMS MADE ! _ � I AGGREGATE s �I DEDUCTIBLt _$ i I I RETENTION —"- VfOR.EHSCOMPENSATIONAND .�T - W - _ $ EMPI.OY'ERS'LIABILITY /�1 } X I lORYLIMITS I I ER _ ! n 1 ANY PROPRIETOFWAR'IMMEXECUTIVE 1WCB62398 01/20/05 01/20/06 r E.L.EACH ACCIDENT I$ 500 O I i'L III CWFICERJMEMDCR EXCLUDED? - •- •- r I(yes,describe under I E.I. DISEASE•EA EMPLOYE S- 500,00]0 SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT $ 5®O ,Q00 I i I 0E5GRU'TION OF OPERAT IONS I LOCATIONS I VF✓�S EXCLUSIONS AD0FCJ BY ENUORSEMLNT ISPF.C1PL PF;UVISIONS I 1 I f CERTIFICATE HOLDER CANCELLATION . SHOULD ANY OF f HE ABOVE DE5CRIOED POLICIES HE CANCELLED BEFORE TNT=EXPIRATIO I� C30OY � S110pLktD - DATE THFkEC1 n F, THE IS;UIN INGLIRER WILL ENDEAV ( , Ok TO MAIL DAYS W!21TTEN + z NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE I.EFT,BUT FAtLURE TO DC 51)SHALL IMPOSE NO OBLIGATION OR L.IAN1.17Y OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. 5 0 8 m 4 2 0—0 8 9 8 Fax AUTHORILLD REPRkSENTATIVE / ACORD25(2001/08) Q)ACORDCORPORATION 1988 �FZHEToy, Town of Barnstable �O Regulatory Services BAMS''SM ' Thomas F.Geiler,Director Mass. 9`b�E639 �`� 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 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: -T—I -t l Tza L Estimated Cost 1:�_3,owzZ ) Address of Work: Owner's Name: C_7COfz Co ✓' Sv O`C�22 - -T Date of Application: 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. O Date Owner's Name Q:forms:homeaffidav a Page;rl'of 1 Date:October 6,2005 Case No.:05-01-0804A LOMA O�Q%RT Federal Emergency Management Agency �FlAND S�GJ�, � Washington, D.C. 20472 LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT (REMOVAL) COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF BARNSTABLE,BARNSTABLE Lot 152B,Cotuit Highground,as described in the Quitclaim Deed recorded as COMMUNITY COUNTY,MASSACHUSETTS Instrument No.54452,in Book 14081, Pages 165 and 166,in the Office of the Registry of Deeds,Barnstable County, Massachusetts(TM 19,Lot 21) COMM UNITY NO.:250001 NUM BER:2500010021 D AFFECTED NAME TOWN OF BARNSTABLE, MAP PANEL BARNSTABLE COUNTY,MASSACHUSETTS DATE:07/0211992 s' FLOODING SOURCE: LEWIS POND APPROXIMATE LATITUDE&LONGITUDE OF PROPERTY:41.613,-70A47 SOURCE OF LAT&LONGS PRECISION MAPPING STREETS 7.0 DATUM:NAD 83 DETERMINATION OUTCOME 1%ANNUAL LOWEST LOWEST WHAT IS CHANCE ADJACENT LOT LOT BLOCKJ SUBDIVISION STREET REMOVED FLOOD FLOOD GRADE ELEVATION SECTION FROM THE ZONE ELEVATION ELEVATION- (NGVD 29) SFHA (NGVD 29) (NGVD 29) 152B Cotuit Highground "220 Crockers Property Neck Road C 11.0 feet 14.8 feet 11.5 feet Special Flood Hazard Area(SFHA)-The SFHA is an area that would be inundated by the flood having a 1-percent chance of being equaled or exceeded,in any given year(base flood). This document provides the Federal Emergency Management Agency's determination regarding a request for a Letter of Map Amendment for the property described above. Using the information submitted and the effective National Flood Insurance Program (NFIP) map, we have determined that the property(ies)is/are not located in the SFHA, an area inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year (base flood). This document amends the effective NFIP map to remove the subject property from the SFHA located on the effective NFIP map;therefore, the Federal mandatory flood insurance requirement does not apply. However, the lender has the option to continue the flood insurance requirement to protect its financial risk on the loan. A Preferred Risk Policy(PRP)is available for buildings located outside the SFHA. Information about the PRP and how one can apply is enclosed. This determination is based on the flood data presently available. The enclosed documents provide additional information regarding this determination. If you have any questions about this document, please contact the FEMA Map Assistance Center toll free at(877)336-2627(877-FEMA MAP)or by letter addressed to the Federal Emergency Management.Agency,3601 Eisenhower Avenue,Suite 130,Alexandria,VA 22304-6439. Doug Bellomo,P.E.,Chief Hazard Identification Section,Mitigation Division Emergency Preparedness and Response Directorate Version 1.3.3 1056349.1LOMA-SL013050804 TOWN OF BARNSTABLE BUILDING PERM APPLICATION M9p Parcel ji Permit# T� Health Division ®S 1-407/01 q-2 -'Y 7u1 DEC 1 0 2001 Date Issued ��✓® Conservation Division �lllJ/�� Fee7 L' Tax Collector -e� gy 76 °1 Lo � Treasurer C__Al ( SEM SYSTEM MUST BE INSTALLED Br COMPLIANCE Planning Dept. ra ENVIRONMENTAL CODE S ' = Date Definitive Plan Approved by Planning Board T01I REGULATIONS�D ' vAi� - Historic-OKH Preservation/Hyannis �� j�aAA Project Street Address �� (iUG/Z )� ✓C C� J Village CO / U/ Owner Z—�_ &!&7// 14(ddress 5 3 6izC-,q7 1CD _ � �Ulo¢ Telephone Permit Request u)z 2 S 7v2c/ ,;1, C" '= 0.4 �` // if ItJ ' Square feet: 'st floor: existing proposed 2nd floor: existing proposed Total new -S Valuation 9 ezry Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size 7C0 SQL Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Va' Two Family 0 Multi-Family(#units) Age of Existing Structure �O Historic House: ❑Yes )(No On Old King's Highway: ❑Yes ,<No Basement Type: O Full ❑Crawl 10,❑Walkout Other ?4L i�, J- 41a_ :; - Ci(?A�� Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing 3 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 'I New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing �w sizPool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage: ❑existing ❑new size Shed:0 existing O new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes J (No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name �1,J �>✓/�\ Telephone Number 43� � Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE CJ7� K_ s FOR OFFICIAL USE ONLY s PERMI`P NO. DACE ISSUED Y MAP/PARCEL NO. ' .ADDRESS VILLAGE r T ,OWNER, 3 l q i t DATE OF INSPECTION: FOUNDATION FRAME _ /o`o � �-s 1 INSULATION T . ' 1- t FIREPLACE N ELECTRICAL: ROUGH _ FINAL - iv U4 PLUMBING: ROUGH - FINAL GAS: ROUll. rza ., FINAL c. FINAL BUILDING I' Ij cl DATE CLOSED OUT - ' ASSOCIATION PLAN NO. 0 SINE►�,,�. The Town of Barnstable - L� L BA ABLE. Department of Health Safety and Environmental Services R!1ST Y MASS. 0a Building Division pTFD MAC a 367 Main Street,Hyannis, MA 02601 Office: 508-862-4038 , Fax: 508-790-6230 PLAN REVIEW Owner: C U U i1 (J Map/Parcel: O 2' t r , Project Address: 7 2 d CV(D C-6�-(N 1 Builder: N� � C' L'l The following items were noted on reviTg � ��,� 1( eve 4 Reviewed by: r7 Date: �— q:building:forms:review The Commonwealth of Massachusetts 1 =—•/ Department of Industrial Accidents, ,,d -_-�: Office ollasestigatioos 600 Washington Street Boston,Mass. 02111 Workers Co m ensation Insurance Affidavit name: C3C0 CQG SUae , locations citv a-U v I T hone# I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one worlds in a�capacity ❑ I am g em 1 rovidin workers' co ensation for my employees working on this job. :: .. : ,:;: :: an p oyer p. . cam nnv name. ...... :... ..:.:::.::.::.:::. 2ddtess:::.: X. a shone W ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who . have fol lowing win workers compensation polices: the g _.... . ..:..::.,:... _. . .::::. . :......:,:.: ::;::;: ..:..........:...::.. tom any name: ...:::..:....... address.. . . .,.,.. ,: �- ;;:.::e on h M. aim :>.. i nSflCan�eaQ::::�;::r;:::::;ii:;:S:::�:?::::::::<.>:.>:;::.:.>:.::>;;:.>:.»:;o>::<:::.::::.:::.,::.: :::::::;..:........ cumvanv name:: :. ..... city hone# ... _ antvrancc co.. 0 Riilil cv# ; Failure to secure coverage as required under Section 25A of MGL 152 can lead to the i nposttion of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as wen as dvn 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 vtrificztio�. I do hereby certify the pains enalti ofp�J that the information provided'above is tut/and coned Signature Date > /t0OIL (��/ Print name - Phone# — C e only do not write in this area to be completed by city or town oiHtial wn: perndtilicense# ❑Building Department ❑Licensing Board ❑Selectmen's Office if immediate response i,required - ❑Health Department person: phone#; __ ❑�01 (cevued 9195 PJA) 'r 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 ii 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 heaving 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 politicai subdi.sions shall enter into any cow 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 maybe submitted to the Department of.Industrial=Accidents for confirmation of insurance coverage. Also be sure to sign and or town that the application for the permit or license is date the affidavit. The affidavit should be returned to the city aPP "law"or if you being requested,not the Department of Industrial Accidents. Should you have any questions regarding the are required to obtain a workers' compensation policy,please call the Department at the member listed below. E//r// City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottome f the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the app in be sure to fill in the permit/license number which will be used as a refeaence number. The affidavits may be the Department by mail or FAX tmle_ss other arranf;emertts 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 nt of Industrial Accidents Office of imlesduadons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 of Try ram, .�.� The Town of Barnstable • B"BNSTABLL • Services ato�• g Regulatory . �p i6;9. 6 Thomas F. Geiler,Director Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Fax: 508-790-6230 Office: 508-862-4038 Permit no. Date i2i � d � AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires,that the`reconstruction,alterations,renovation,repair,modernisation,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: J V7L E%AcM cs7 � — Estimated Cost 0� Address of Work: O 27 ck Owner's Name p�2�C, �fJOi�D Date of Application: L e /671'1 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 OBuilding not owner-occupied WOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT ORD OLINNWITH WOE DOSTERED NOT HAVE CONTRACTORS FOR APPLICABLE HOME IhP 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. C� OR Date Owner's Name q:forms:Affidav:rev-070601 RESIDENTIAL: SHEDS - POOLS-DECKS-OPEN PORCHES- GAZEBOS DETACHED GARAGES FEE VALUE WORMHEET ACCESSORY STRUCTURES >120 sq.ft.(Sheds,detached garages,gazebos,etc.) >120 sf-500 sf $35.00 $ > sf-750 sf 50.00 $ >750 s 000 sf 75.00 $ .73 >1000 sf- 1500 sf 100.00 $ >1500 sf--USE Nl✓W BUILDING PERMIT APPLICATION - DECKS x$30.00= $ (Number) PORCHES x$30.00= $ (Number) IN GROUND SWIMMING POOL $60.00 $ ABOVE GROUND SWIMMING POOL $25.00 $ RELOCATION/MOVING $150.00 $ (Plus above fee if applicable) PERMIT FEE $ r Q:forms:dkcost eff:082301 i OT The Town of B arnsta a 1e = > i t ' Regulatory Services 059• ,��� Thomas F. Geller,Director TEO"�►� Building Division Commissioner Peter F. DiYlatteo, Building'C 367 Main Street.Hyannis MA 02601 Fax: 508-790-6230 Office: 508-862-:1038 HOMEOWNER LICENSE EON Please Print ccD C,7u, tDATE �� C viltsge � 10B LOCATION: street number �zieG �0 de 9� "HOMEOWNER": home phone 0 work phone name CURRENT MAILING ADDRESS: U(Z� 0 rip code state. city/town. �I own -occupied dwellings of six units or The current exemption for"homeowners"was extended to include to allow homeowners to engage an individual for hire who does not possess a license,orovi' d_ ed less and that the owner acts as supervisor. DEFINMON OFHOMEoWNER who owns a parcel of land on which he/she resides.or intends to reside,on which there is.or is Person(s) accessory to such use and/or intended to be;a one or two-family dwelling.attached or detached sttucns ce s shall not be considered farm structures. A person who constructs snore than one home i�Da��on a form acceptable to the a homeowner. Such"homeowner"shall submit to the Building o Official,that helshe shall be res onsible for all such work erformed under the building etmit. Building (Section 109.1.1) o Code and The undersigned"homeowner'assumes responsibility for compliance with the State Building other applicable codes.bylaws,rules and regulations• ds the Town of Barnstable Building owner'certifies that he/she undersran and that he/she will comply said The undersigned"home Department minimum inspection procedures and requirements procedures and requirements. igoature o omww'ncr Approval of Building Off cis/ • Three-family dwellings containing 35.000 cubic feet or larger will be required to comply Note. Y with the State Building Code Section 127.0 ConstructionoNontrol. HOMEOWNER'S omit is required shall be exempt from the The Code states that: "Any homeowner Perform in8 work for which a building p provisions of this section(Section 109.1.1-Licensing of consantcuon Supervisors).provided that if the homeowner enrages a P the responsibilities of a supervisor(see person(s)for hire to do such work.that such Homeowner shall act as supervisor•assuating Section 2.15) This lack of awarenes coed a, nst�the, Many homeowners who use this exemption are unaware that they an Appendix Q,Rules&Regulations for Licensing Construction Supervisors' • In this case.our Board cannot pro homeowner acting as Supervisor is ultimateiv responsible. serious problems.particularly when the homeowner hires unlicensed p art of the pernut unlicensed person it would with a licensed Supervisor. how responsibilities.rtraay communities require.asap o of this issue is a To ensure that the homeowner is fully aware of his/her P onsibilities of a Supervisor. On the 1 oupcosiunity. application.that the homeowner certify that he/she understands the rap form cucrendy used by several towns. You may rare t amend and adopt such aform/certification for use in y ! 5 s 1 �s l _ w 1 ti � s Pd. �c�4.vc J•-F - i i �1 �ARAGL 19�.2 7(, :SQ, . T. I certify that this property is locateu in Flood hazard Zone All and Zone C as i entif ied by the I epartment Of Housing and Urban revelopment (HiJi ) CE.RTI Ff ED PLOT PLAN Late der, .y,!GS� a LOCATION • , •, 'fit � Ca„-• SCALE . .!. ..3? . .... ®ATE . .. T- PLAN REFERENCE Reg: ..1rd' ur�reyor / / S. !°� .. T y to its title insurance company . certil' ICERT�FYTHAT THE that there are no visible encroachmentsr� I SHOWN ON THIS PLAN !S LOCATED ON THE GRouNfl or easements except as shown and that this As SHOWN HEREON AND ThATIT CONFORMS TOTHE plan was prepared under my iIIy"leC�sate SETBACK AEOU�REMENTs of THE TDWN of ian .WHEN "QN RU ED. saper v is. . nHTE /�f' ; ��,,��� ,Q. ��'-��7✓.fa,✓ _ ���i .� _ __� REG%ST_RED LAND SUR7zY R t /-Q yA F-� v 0� 090.S. Q 781-277 5.,6ea3r®,5war Dk �" I'N SvE,4.D OF X"63p, M Tto Great Road 2�~"I Bedford.M 01730 J e4lemCN7 e ► $1,wPrlcc�F (os®O �aR �Fceti J/.�uit'KV Wo �rwT �/ 8o4D /=f�vNr L✓ar<D o�KS Page 1 of 1 Date:October 6,2005 7Case No.:05-01-0804A LOMA Federal Emergency Management Agency o ` Washington, D.C. 20472• AND Sti LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT (REMOVAL) COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF BARNSTABLE,BARNSTABLE •Lot 152B,Cotuit Highground,as described in the Quitclaim Deed recorded as COMMUNITY COUNTY,MASSACHUSETTS Instrument No.54452,in Book 14081, Pages 165 and 166,in the Office of the Registry of Deeds,Barnstable County,Massachusetts(TM 19,Lot 21) COMMUNITY NO.:250001 NUMBER:2500010021 D AFFECTED NAME.'TOWN OF BARNSTABLE, MAP PANEL BARNSTABLE COUNTY,MASSACHUSETTS. DATE:07/02f1992 FLOODING SOURCE: LEWIS POND APPROXIMATE LATITUDE&LONGITUDE OF PROPERTY:41.613,-70,447 411 SOURCE OF LAT&LONG:PRECISION MAPPING STREETS 7.0 DATUM:NAD 83 '0 f DETERMINATION OUTCOME 1%ANNUAL LOWEST LOWEST BLOCK/ WHAT IS CHANCE 'ADJACENT LOT LOT SUBDIVISION STREET REMOVED FLOOD FLOOD GRADE ELEVATION SECTION FROM THE ZONE ELEVATION ELEVATION (NGVD 29) SFHA (NGVD 29) (NGVD 29) 152E I Cotuit Highground 220 Crockers Property Neck Road rC 11.0 feet 14.8 feet 11.5 feet Special Flood Hazard Area(SFHA)-The SFHA is an area that would be inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year(base flood). This document provides the Federal Emergency Management Agency's determination regarding a request for a Letter of Map Amendment for the property described above. Using the information submitted and the effective National Flood Insurance Program (NFIP) map, we have determined that the property(ies)is/are not located in the SFHA, an area inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year (base flood). This document amends the effective NFIP map to remove the subject property from the SFHA located on the effective NFIP map;therefore, the Federal mandatory flood insurance requirement does not apply. However, the lender has the option to continue the flood insurance requirement to protect its financial risk on the loan. A Preferred_ Risk Policy(PRP)is available for buildings located outside the SFHA. Information about_the PRP and how one can apply is enclosed. This determination is based on the flood data presently available. The enclosed documents provide additional information regarding this determination. If you have any questions about this document, please contact the FEMA Map Assistance Center toll free at'(877)336-2627(877-FEMA MAP)or by letter addressed to the Federal Emergency Management Agency,3601 Eisenhower Avenue,Suite 130,Alexandria,VA 22304-6439. . yy L'il _ Doug Bellomo,P.E.,Chief Hazard Identification Section,Mitigation Division Emergency Preparedness and Response Directorate Version 1.3.3 1056349.1LOMA-SL013050804 AR Federal Emergency Management Agency �l �4 Washington, D.C. 20472 'AND StiG + October'6,2005 MR.GEORGE SUOKKO CASE NO.:05-01-0804A 220 CROCKERS NECK ROAD COMMUNITY: TOWN?OFBARNSTABLE,BARNSTABLE , COTUIT,MA02635- COUNTY,MASSACHUSETTS CONvIlVIUNITY NO.:250001 DEAR MR.SUOKKQ This is in reference to a request that the Federal Emergency'Management Agency (FEMA) determine if the property described in the enclosed document is located within an identified Special Flood Hazard Area, the area that would be inundated by the flood having a I-percent chan_ce.of being equaled or exceeded in any , given year (base flood), on the effective National Flood Insurance Program (NFIP) map. Using the information submitted and the effective NFIP map, our determination is shown on the attached Letter of Map Amendment (LOMA) Determination Document. This determination document provides additional information regarding the effective NFIP map,the legal description of the property'and our determination. Additional documents are enclosed which provide information regarding the subject property and LOMAs. Please see the List of Enclosures below to determine which documents are enclosed. ' Other attachments specific to this request may be included as referenced in the Determination/Comment document. If you have any questions about this letter or any of the enclosures,please contact the FEMA Map Assistance Center toll free at (877) 336-2627 (877-FEMA MAP) or,by letter addressed to the Federal Emergency Management Agency,3601 Eisenhower Avenue, Suite 130,Alexandria,VA 22304-6439. Sincerely? y Doug Bellomo,P.E.,Chief Hazard Identification Section,Mitigation Division Emergency Preparedness and Response Directorate LIST OF ENCLOSURES:, " LOMA DETERIvIINA nON DOCUMENT(REMOVAL) cc: State/Commonwealth NFIP Coordinator - Community Map Repository Region QoO74 5 7aa Town ®f Barnstable r Expires 6 mo l�s frooe issue date Regulatory Services Fee . + BARNSTABLE, • ' - - v MASS. $ Thomas F. Geiler,Director 1639. rf0 MP't Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS ]PERMIT APPLICATION - RESIDENTIAL ONLY y Not Valid-without Red X-Press Imprint Map/parcel Number 01 Property Address ��}}/J�& �r�y Minimum fee of$25.00 for work under$6000.00 Residential Value of Worky Owner's Name&Address Contractor's Name r� :Cy L: S'Lxk--0 Telephone Number D8 4,;Lo'c, " Home Improvement Contractor License#(if applicable) r' Construction Supervisor's License.#(if applicable) Workman's Compensation Insurance P.ER1T ❑ p Check one: NOV 2 ® 2009 I am a sole proprietor I am the Homeowner TOWN OF BARNSTgg I have Worker's Compensation Insurance L� Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. 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 #of doors Replacement Windows/doors/sliders. U-Value_ _(maximum .44)#of windows *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&Construction Supervisors License is re uired. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 090809 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street H Boston, MA 02111 wrvw.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le iP�bly Name-(Business/Organization/Individual): 0,e6 5V6Jx_kCP - Address.: a s `-I`Z 0CI'CEtZ-� Phone X _� re you a -n employer? Check the appropriate box: - Type of project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and I 6 ❑ New construction have hired the sub-contractors employees (full and/or part-time).* ❑ listed on the attached sheet. 7. Remodeling 2. I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, �] Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp..insurance comp.insurance.$ 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions r_equir-ed:] - -I am-a-homeowner-lo ngLLall work officers have exercised their I LD Plumbing repairs or additions mysel-f:[No•workers right of exemption per MGL ❑ comp. 12. Roof repairs c. 152, §1(4),and we have no �insurance-require&]- 13.❑ Other employees. [No workers comp.insurance required.] *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 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 isproviding 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: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains an penaltiesof perju that the information provided above Lis true and correct Si ature: r -DaCe-:� J1/ , 0 Phone�'' 60 I i Official use only. Do not write in this area, to be completed by city or town official. i City or Town: Permit/License# i 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 and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person 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, constniction 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 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,MGL chapter 152, §25C(7)states "Neither the conunonwealth 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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should-you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a.reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia ��HE roh Town of Barnstable Al Regulatory Services IAMSrABLE. ' Thomas F. Geiler,Director Mnss. f 6 9;�A Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bariiLstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Co lete and Sign This Section If Using A Builder I Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by building pe t application for. (Ad ss of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the re ers,e=sLLide. A56 r� r Town of Barnstable OVIK o Regulatory Services =asrtsrnBt Thomas F. Geiler,Director mass. r� 163g ��� Building Division plEo �a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION o Please Print CDAT� V / /� r JOB LOCATION: 2,20 L 1ZoC1C F X ECK C©v.l-U 1 e 1 number street village 6 name a� home phone# work phone# C�-iJRRENTMAIL-ING-ADDRESS: �G� 0 �K0C C= (Z- 5 /Va � 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 responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requireme ts. ignat* of145 owner 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 shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFlLES\FORMS\hometxempt.DOC C;2p- :� Page 1 of 1 Date:October 6,2005 ICase No.:05-01-0804A LOMA VAR Federal Emergency Management Agency Washington, D.C. 20472 ��igND S�GJE ss LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT (REMOVAL) COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF BARNSTABLE,BARNSTABLE Lot 152B,Cotuit Highground,as described in the Quitclaim Deed recorded as COUNTY,MASSACHUSETTS Instrument No.54452,in Book 14081,Pages 165 and 166,in the Office of COMMUNITY the Registry of Deeds,Barnstable County, Massachusetts(TM 19,Lot 21) COMMUNITY NO.:250001 NUMBER:2500010021 D AFFECTED NAME TOWN OF BARNSTABLE, MAP PANEL BARNSTABLE COUNTY,MASSACHUSETTS DATE:07/0211992 FLOODING SOURCE: LENS POND APPROXIMATE LATITUDE Ifs LONGITUDE OF PROPERTY:41.613,-70.447 SOURCE OF LAT&s LONG.PRECISION MAPPING STREETS 7.0 DATUM:NAD 83 DETERMINATION OUTCOME 1%ANNUAL LOWEST LOWEST WHAT IS CHANCE ADJACENT LOT LOT BLOCK/ SUBDIVISION STREET REMOVED FLOOD FLOOD GRADE ELEVATION SECTION FROM THE ZONE ELEVATION ELEVATION (NGVD 29) SFHA (NGVD 29) (NGVD 29) 152B Cotuit Highground 220 Crockers Property Neck Road C 11.0 feet 14.8 feet 11.5 feet Special Flood Hazard Area(SFHA)-The SFHA is an area that would be inundated bytheflood having a 1-percent chance of being equaled or exceeded in any given year(base flood� This document provides the Federal Emergency Management Agency's determination regarding a request for a Letter of Map Amendment for the property described above. Using the information submitted and the effective National Flood Insurance Program (NFIP) map, we have determined that the property(ies)is/are not located in the SFHA, an area inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year. (base flood). This document amends the effective NFIP map to remove the subject property from the SFHA located on the effective NFIP map:therefore, the Federal mandatory flood insurance requirement does not apply. However,the lender has the option to continue the flood insurance requirement to protect its financial risk on the loan. A Preferred Risk Policy(PRP)is available for buildings located outside the SFHA. Information about the PRP and how one can apply is enclosed. This determination is based on the flood data presently available. The enclosed documents provide additional information regarding this determination. If you have any questions about this document, please contact the FEMA Map Assistance Center toll free at(877)336-2627(877-FEMA MAP)or by letter addressed to the Federal Emergency Management Agency,3601 Eisenhower Avenue,Suite 130,Alexandria,VA 22304-6439. Doug Bellomo,P.E.,Chief Hazard Identification Section,Mitigation Division Emergency Preparedness and Response Directorate Version 1.3.3 1056349.1 LOMA-SL013050804 I c;;;2 f` Pagel! of 1 Date:October 6,2005 Case No.:05-01-0804A LOMA tiYaRryA x Federal Emergency Management Agency Washington, D.C. 20472 ND S�GJ ru LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT (REMOVAL) COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF BARNSTABLE,BARNSTABLE Lot 152B,Cotuit Highground,as described in the Quitclaim Deed recorded as COMMUNITY COUNTY,MASSACHUSETTS Instrument No.54452,in Book 14081,Pages 165 and 166,in the Office of the Registry of Deeds, Barnstable County, Massachusetts(TM 19,Lot 21) COMMUNITY NO.:250001 NUMBER:2500010021 D AFFECTED NAME:TOWN OF BARNSTABLE, MAP PANEL BARNSTABLE COUNTY,MASSACHUSETTS DATE:07/02/1992 FLOODING SOURCE: LENS POND APPROAMATE LATITUDE&LONGITUDE OF PROPERTY:41.613,-70.447 SOURCE OF LAT&LONG PRECISION MAPPING STREETS 7.0 DATUM:NAD 83 DETERMINATION OUTCOME 1%ANNUAL LOWEST LOWEST BLOCK/ WHAT IS CHANCE ADJACENT LOT LOT SECTION SUBDIVISION STREET REMOVED FLOOD FLOOD GRADE ELEVATION FROM THE ZONE ELEVATION ELEVATION (NGVD 29) SFHA (NGVD 29) (NGVD 29) 152E Cotuit Highground 220 Crockers Property Neck Road C 11.0 feet 14.8 feet 11.5 feet Special Flood Hazard Area(SFHA)-The SFHA is an area that would be inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year(base flood). This document provides the Federal Emergency Management Agency's determination regarding a request for a Letter of Map Amendment for the property described above. Using the information submitted and the 'effective National Flood Insurance Program (NFIP) map, we have determined that the property(ies)is/are not located in the SFHA, an area inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year (base flood). This document amends the effective NFIP map to remove the subject property from the SFHA located on the effective NFIP map:therefore, the Federal mandatory flood insurance requirement does not apply. However, the lender has the option to continue the flood insurance requirement to protect its financial risk on the loan. A Preferred Risk Policy(PRP)is available for buildings located outside the SFHA. Information about the PRP and how one can apply is enclosed. This determination is based on the flood data presently available. The enclosed documents provide additional information regarding this determination. if you have any questions about this document, please contact the FEMA Map Assistance Center toll free at(877)336-2627(877-FEMA MAP)or by letter addressed to the Federal Emergency Management Agency,3601 Eisenhower Avenue,Suite 130,Alexandria,VA 22304-6439. Doug Bellomo,P.E.,Chief Hazard Identification Section,Mitigation Division Emergency Preparedness and Response Directorate Version 1.3.3 1056349.1 LOMA-SL013050804 LOT 1518 �Q 0 s ti 0 LOT 150A LOT 152E ` o 16 3' LOT 150B W LOT 1538 FOUNDATION o 26.0, o S79 29 20 E r LOT 152A FLOOD ZONE "An & c'FO UNDA TION CERTIFICATION "RF,, RES ZONE.. TO WN.-COTUIT SCALE' I"=30 PL.REF'9414 7 E'LE'V N/A "I CERTIFY THAT THE ABOVE YANKEE SURVEY CONSULTANTS FOUNDATION IS LOCATED ONjsA = P. 0. BOX 285 THE GROUND AS SHOWN, AND POSITION— DOES' —_—__ UNIT 1, 40B INDUSTRY ROAD ITS � ` ^ ; MARSTONS MILLS, MASS. 02648 CONFORM TO THE ZONING LAW ' z TEL: 428—0055 SETBACK REQUIREMENTS OF b u` FAX 420-5553 BA_RNSBLE ' —_ Clt �--- -- ; • $.>. JOB PA UL A. MERITHEW DATE 2�18�?002 IvulVrBl x 52989FND 1 ZZD Cf2oC&c �5 - 1 r / IYN _ MAP IMOU ,x A 1 19 CD : _ D " RESIDENTIAL ADDITIONS OR ALTERATIONS If located: ❑ North of Route 6 - any work visible from outside - needs approval from OKH ❑ In Hyannis - If work visible from outside - Check to see if it's included in the ❑ Hyannis Historic Waterfront District- if so it needs approval from them If ZBA relief(Special Permit or Variance is required for project: ❑Copy of ZBA Decision ❑Documentation proving that decision was recorded at the Registry of Deeds w/in one year of ZBA decision date. r ICATION PACKAGE MUST INCLUDE: Map/parcel number Approval Sign-offs from: Health Conservation (if exterior work) Tax Collector lam' Treasurer Street address Owner's name & address [� Permit request- full description of proposed project) ❑ /Square footage - proposed project Estimated project cost Complete Dwelling information for Assessor's Office ❑ Builder's information Signature Plot plan (shows location & setbacks of house) Plans. ets measuring 11" x 17" fully dimensionlized with foundation, floor plan, cross section, framing schedule & smokes, with a Red S (SB or SH) Home Improvement Contractor's Affidavit Worker's Comp form must include: Insurance company's name &Worker's Comp. policy number ❑ Energy Compliance Form . ❑ Copy of Construction Supervisor's License &Home Improvement Specialist's License OR Homeowner's License Exemption Form. ❑ Application Fee [-Iermit Fee CHIMNEYS ❑ Need Home Improvement License ❑ No plot plan required PIERS & DOCKS ❑Need Construction Super license AND Home Improvement License Owner cannot pull own permit q-forms:permits 1 rev. 1115101 , C�,,_,, .,Vngrngering7tiept. (3rd floor) Map Parcel � rinit# House# r} ZZ- ; Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee L Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) THE Tq;_ Definitive Plan Approved by Planning Board 19 • BARNSTABLE. MARA- TOWN OF BARNSTABLE Building Permit Application Project Street Address ' Cck'gC./G�2� Village - GOT( t Owner Address Telephone , P Permit Request &tV o¢L. /� g®���s - 9 i 1 First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 222F@® Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Z Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. 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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Y Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name - (, ,?�_ I��� c�j Telephone Number Address k ��/,7 License# Home Improvement Contractor# /0,3 7/ Worker's Compensation# e.;�<,/ 7Uo ��Of NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 2 BUILDING PE MIT DENWW 'P E EASON(S) r Oy FOR OFFICIAL USE ONLY PERMIT NO. - r F 4 f DATE ISSUED " MAP/PARCEL NO. 'i ! 1 _ ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL f GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t *� . . °: The Town of Barnstable • a�aivsres�, • 9� & ' Department of Health Safety and Environmental Services ATEDMA'ta' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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: �16: Est.Cost Cin Address of Work: Owner's Name Date of Permit Application: 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: to Contractor Name Registration No. OR Date Owner's Name The Commonwealth of Alassachusetts Dcpnrtmutt of lndustrial.9ccidutts Oficeol/nvesMat/otts 60(I {i ashi►rrton Street -- �� ' Boston, A1u.ys. 02111 `-' Workers' Compensation Insurance Affidavit licant tnfor,/mation: �•l Please PRINT lebt name: Y'%✓�% r7�^� location: �1eyC��s Nr city phone# I am a homeowner performing all work myself. I am a sole proprietor and have no one working* to any capacity :.ts.. ';m"y�{ ^-..xc; 'a'-. _ •='.s*C+J'^Mince+sv<z�a'�v,1cTr.K�a�!�S.'_x '�'�rT.� .�tT"'."'�'�4� "'err•.. e.,r•nr.•r_».«,..r•.,,r.. .::....:.,;.,....y....ti.»Lx ,-.. ._.ur....:r�.xu,F2i."•�.r.:...w�s:.,.,.:y�.r,:._.�'..: .... ::�e..,,u�Er:_.,i' �Pv�e;�r�?•' - - '..c.:�si,:�'i. i...,��........_...._�Y...� [�1-afn an employer providing workers' compensation for my employees working on this•job. company name: ��yL 6i z45yAeyr ®p,6/,4—h address: cite: �/����-�'1�l✓ 147 phone#: 7� �— / /7/— insurance co. �/� ��/� �Y policy# L� 7®'�`7 ' - - -r`:` .. > ,. ,s.. �...,�,.e-,•Cie.._ .v..:� �+.r. -�.+scw 7uw ;,��>i+4'+. rd�,*,4*a4w�""'?n"P'^'. !...M», ., . r�yrwwwrae ....•s t _�,_.,.:i... �.L.�'._• _. ._ ... .f _-A '.. _. ... ..��:4 r. " �M1ib`ri?�urrd" ::s`�:�.:i�_:�• _ ❑ I am a sole proprietor, beneral contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city: phone#: insurance co policy# ....... � - ..- ._.. .n.•i:;;-.;. .r•tr"�'.'- ^'9• 'Y Y T^ SC"''"':tttii'..:.'.^,.'��aa:f��t+.r8 �' tG' x;'`+. �"�'yc .-...« �._.��.^ ..»_....-..�..�......_•____ .. .�)sn:.ar.i..:...: ..::u..J:Jh.aa.:.�y..sue=� �ii►.;37N.,.. � ...-sue-�j <,. ... 'y .a.L:a:;:rs. company name: address- city: phone# insurance co policy# :Attach additional sh it if neceisary^.`; ' =' ir� __.�...._ _...___....-_. s..+�.. a•• it �':.m=� „ai�la t{%Y.sM�7�►c::� .c;,v,. So37GM1 . '_.�°S„_Sr�lftt:l'wtG-,*'!+Srs :r+n. Failure to secure coverage as required under Section 25A of NIGL 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 NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herehr certif1, r the pains at pen es of perjury that the information provided above is true and correct. Signature Date Print nameJLi7ir/� G�Z�l,s4t/C7T� Phone# `��7:2 official use only do not write in this area to be completed by city or town official city or town: permittlicense# riBuilding Department Licensing Board check if immediate response is required ❑Selectmen's Office t [311ealth Department contact person: phone#; MOther ; Revised RI);PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovees to provide workers' conipensati"on for their employees. As quoted from the "law", an e►nplmvee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An etnjyh ver is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing enga�-cd in a joint enterprise, and including the legal representatives of a deceased employer, or tlid-� receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwellin�� house having not more than three apartments and who resides therein, or the occupant of the dwellino house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the ,rounds 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. -.71 M1 . Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. .. ._.. ceay: .r., (rw City or Towns Please be sure that the affidavit is complete and printed legibly. Tile Department leas provided a space at the bottom of P P P 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 ;ive us a call. ►^•yy,:.r.-mn ...,._... ...,....'vr•r.... --.r vrrv.r.ve�q•.�...wiF.:�"ta.r: ,7 ,-..+err^rRe?s+p+;..+�rPn-y...vrMVP:�•:;','Sas5�"'�R"' esn•.`. .;^�w.vmT'e. .'1vaSr^T..•..r,-w�a+e1'tR'+w,+.F•.• • Tile Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 cat. 406, 409 or 375 Alw too r DEPARTMENT Oi,. U LIC SAFETY ONE ASHBUR NPLACE, RM°1301T 3 1995 •BOST0o �02'108 1.618 ',. .,...""i'RUCi'ION SUPERVISOR LICENSE ° '� " n . � ° .� . Expires: Bin 026325 10/20/1997 10l2� -.. `.�d To: 00 4 : . :,�ZEAU T 1, Detach bottom fold sign on _ .Lr,,1�T STD ! back, and laminate license card. a�_i..�E, 1 A 02655 a °__ Keep top for receipt and change of address notification. L ��e L^o��a�naruuea`C`i o�✓l/�ac�zuJeaJ Restricted.To: 00 2 3 4 0 7 `YPNCI. ?I 0"j;HC WHY °_T" S'J°3RV_S0r ICeHN 00 Hone I�:Fires: Eiandate: . 1A - Hasonry only.' 632; ''1201.99' :01201959 1G - 1 & 2�Family'.Ho�es Failure to possess a current edition of the Massachusetts State kiildinq Code is cause for revocation of this 11cease: ,t } 11� r ak'ri��e�. •R44.d.' Ky., HOME. IMPRO1`4 Board r One h 7 BOStOC1 i HOME IMPROVEMENT .. CQI� Few ^# , --------- :� gi�c tration 10371.4 ,t, rYPe — PARTNERSHIP._ "^' t 0 NTRACTOR 14 .. PAUL J . CAZ�AU �� S IV . Paul J . CaZaa: _ 09/98 22 Giddialt cRd,: � _ Orleans M SONS'ROOF „ gault �N 4 F.O. Box va N 'Oz653 COMMONWEALTH OF MASSACHUSETTS Town of Barnstable oFa,E,ow Regulatory'Services Thomas F.Geiler,Director BAx,,,ST,,B Building Division a 1MAM ,m$ Tom Perry,Building Commissioner '°�fn Nv►�t°i 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: _ Fee: � G Permit#: �� HOME OCCUPATION REGISTRATION Date: .l �� �U y Name: I a Z�r2.fh i Phone#: S 0 9 —`( 10—O g ?e Address:_ e.rs village: Cc) Name of Business: wo" UD 0-<�S Type of Business: C Map/Lot: 0 /9 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation - within single-family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not-be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal ' residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to.the Customary Home Occupation,other than one van or one pick-up-truck-not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. . • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: 4-1/ro /0 5< ' Homeoc.doc Rev.5/30/03 TO ALL NEW BUSINESS OWNERS DATE: o`{ f^ P•. �- } Fill in please: YOUR NAME: i'z � APPLICANT'S �'� YOUR HOME ADDRESS:_'I BUSINESS C°, Q� k M-A ��- ao o 5 a8�`f Telephone Number Home q TELEPHONE ,b��s TYPE OF BUSINESS NAME OF NEW BUSINESS Wo�� IS THIS A HOME OCCUPATION? YES NO MAP/PARCEL NUMBER 0 Q-( Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS e �� n " S `� 2� Hance with the rules and regulations of the Town of When starting a new business there are several things,you must do m order to be in comp if you et the business certificate first you MUST go to assist You in obtaining the information you may need. Once you have obtained the required signatures, listed Barnstable.-This form is intended to Y below,you may apply for a business certificate at the Town Clerk's Office jlstfloor-Town He Y and licenses.. the following office to make sure you have all tRd.&Main Streeuiredlt)ts and you will find the following offices: GO TO 200 Main St. - (corner of Yarmouth 1. BUILDING COMMISSIONI OFFICermit requirements that pertain to this type of business. This individual has informe o any p Authorized Signature** 0. COMMENTS: 2. BOARD OF HEALTH This indiv idual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) e of business. This individual has been informed of the licensing requirements that pertain to this type Authorized Signature** COMMENTS: lch you certificate ONLY REGISTERS YOUR NAME in the townUs departments invol ed.do by G L Business certificates [cost$30.00 for 4 years). A business permission to operate•you must get that through completion of the.processes from t e various -it does not give youp G�Rl1FIGAT�ON�Y .�IGIUJFIFSA PRO VAL FORA BUSINESS Town of Barnstable ermit: 771J67 S, INE r ti Regulatory Services ate: ogllf9l Thomas F.Geiler,Director BARNSfABLM4 " Building Division ee:,&. 00 y KAM. 1639.$ �0� Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: E. H; ,Soo k Ko Phone: 508-L/aO -- O 8 1T" Install at: oZ a o CroSa-,-, Ne.c,(22 P-Q Village: Co+u►`t Map/Parcel: p ! `( Date: G/L l O y Stove A. ew Used UL 7 3 7 B. Type: Radiant Circulating C. Manufacturer: Lab. No. � D. Model No.: F 3 <6 pia p Chimney A. New/ xis ' (If existing,please note date of last cleaning) q B. Flue Size C. Are other appliances attached to Flue? IVo D. Pre-fab Type and Mmufacturer E. Masonry: (2nqUnlined Hearth A. Materials: B. Sub Floor Construction: LO o o cQ Installer Name: ���,�,,,,cQ� C�n:rnr�e�, S•�ee Address: Say-.�2w Yc.�, M Phone: Location of Installation: APPROVED BY: 41Z eW G `�S1' Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev122801 r' ♦ - l • '� � i O4 F ORS R' � ������• - �.9 IF ; . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# Cq Health Division Q' 5 9�a �1 Date Issued r' Conservation Division T'' S' 60 Fee Tax Collector , 9� a( U, Treasurer7777 S' T&C SYSTEM MUST BE I STALLED IN CCAfPI.IAiFq_; Planning Dept. WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CC—O q Historic-OKH Preservation/Hyannis Project Street Address 2�o Village Q l Owner &12413t 7�1 �L �✓1��OAddress ?�� l�jc�/t J /M Telephone /(9/ ` 25 , 42 :j 4�790 Permit Request /0 �ecL% 1"4 C�9,�c ScLG�!"� = lc_r•l�`'� J��/ 6 rro ��- � _a f4co-b ZoNF- ?C 910al,l aAl PZfA/) Square feet: 46floor: existing proposed 2nd floor: existing proposed Total new Valuation Q i 0 Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 6--,Two Family ❑ Multi-Family(#units) Age of Existing Structure 7-I Historic House: ❑Yes Q-N-o-- On Old King's Highway: ❑Yes LJ1 o Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other ?Aa_7r1AL EQZ-C. -I—C w�— Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: 0 Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes Lrl'No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing f/new size PCX-a O Pool:❑existing ❑new size Barn: ❑existing ❑new size TLAjf-(fpE 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 f BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation.,# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO .F. 1 SIGNATURE DATE j FOR OFFICIAL USE ONLY III 5 a4• , - PERMIT NO. A DATE ISSUED MAP/PAMR_tL NO. ADDRESS 1 VILLAGE OWNER v ` DATE OF INSPECTION: FOUNDATION FRAME INSULATION i FIREPLACE a ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING , DATE CLOSED OUT ASSOCIATION PLAN.-NO. - { _ i ✓ 1 r The Commonwealth of Massachusetts Department of Industrial Accidents 600 Washington Street Boston,Mass. 02111. Workers' Co m ensation Insurance Affidavit name location city U hone# dam a homeowner performing all work myself. I am a sole etor and have no one worIan in am mpacity providing workers' compensation for mp employees working on this job. Iam an emp P...............................::::.:::::.:...........::..:..,..:.::::::..........::::..:.:.:.....,:::.:.::::::.:::::::.:......:.........:.:.::.::..::::. .....:.:..:::.;: ...:...::.:................. campanv namerr __ - stlace :.:..:.:....::::........:::: :......... ..::.........::.::::... ..........:...::.:::.:..::.. ......::::::.:.::: :::: :.:..:..:....::::.: hone insuranc oil /�. ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have Compensation olices: ....................:.............::.: .....:.>:.,:.:;;;::...;:;.:{.:;:..::•«:<:::<:::;<:%:>::»: :>:>:>: olio workers P ................:.:,:.:.:.::::.::.::..::::::::::.:.::::::::::..::::::::.::.;::.:::::::.:.::::::.:.:.: :::::::.:>::<.::::::::::::.;<.;;:.;:;:.:;.;:.;%::%%:>::»:::;;.;;<:,;;: the following .......:::::::::::::::...:::.::..::::...:.............:..:.:.......::: :.::::._.:::::::::.....:::::.:::::..:.::::::::::::..:.:::::::.::...:.. ;.:::::.::.::: ......;;;:;..,.:..:..............,... ., tom rri nam .........`.... ................:v::::.:...............:::::::::.�:w:.�::.v:.v:::::vii:v::•:i#•:::::•i::viii:':i:•?Y%::�iii::%%%%: :%^::ii;i:v?%%:;:4} :.i ii:;:::{.;.:{{tvi:•...........:...... ............................... .............. . .. ....:......:......:.:::•::-:v:.v w.v:•::Ji::{{:nv:::::::.••:-:::•:::•::.v::...::nv:.::.:.v::.v:.v-.�:.::::.:.:4.{{•:PY•. .................... ........... .. ....... .v::•::::.;:.......:::::::::'ii:::tv::•:::.:i'.v::v"w:•i?i:;:}:: 3v:•:<v.v:.:. .: ::.�.:...::'...t>; :v:;^%::,:;:;,:i:f}.:; :f.:::;}:}'�':'•�v:;:;:_.;:;:;j;.;:;i :};i:;nYi}:r.%j{:isy`%%:i'r:':fi''::;:;:J:ri::�i;�;:':;}i v:�: :.}:i{•:::v:vi:•.v::'•iiiiiii?: ii::`v?:iii'r:{ii?iiiiii::iJi}:%:i?i:':%:'rii::ij.'::;{:iii::%ii:::;:$}ii'r.`•::::'r:!:i$i:v.::::.vi:vhv:.,..:::.:i:4:{•l:%:<}:.:, .. ...... ........ ..........v...:....................... .. hr... .. ........................::•: ::::::.. ..... ... ...:......:w........:•:•:..............v:..,..............•w:........................••r.•F..........h....,.•..,v:•.Ott>.•-.:................+.:::•.�:•.v:. .y:.,• :::...y:.:.:::::,.<::.:>:•:•::::::::•:.:::.v:•:h>.•:..•..•::::•.v::•::..v::.........�...........:•.v:::.v::::::.:..•..:.•t{.::•::::{{•:.}:.:?+:.::o:?;t:•::::::::,:.. Oih :•.....::: ::::......:.:::.:.......:.:. .......:::...:::•::. :. .... . address•. . ?`b h 0 ne :::::::::::..:.......................... ... ............................... .............: itarance ... ...... No oli coverae as required wider Section 2SA of MGL 152 can lead to the Faihne to seeo>R g lmpositlon of eriatinal pmaltln of a Sae np to Si aad/or . one yam,insure cO era as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I mtderstsad that s priCopy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verity ation I do hereby certify under the pairs mid p aloes'of "erjury that the information provided above is trrqu mid cancel Date /�/�7. Z , a Signature Phone# Print named�12 ��N otflcisi use only do not write in this area to be completed by city or town official perndtlllcense# ❑Building Department dty ortown: ❑Licensing Board ❑Selectmen's Office ❑checkif immediate response is required ❑Health Department contact person: phone#; - ❑Other Uumad 9195 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compens �onafor heny ir act employees. As quoted from the "law", an,employee is defined as every person in t he service of another 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 01 more or the foregoing engaged in a joint enterprise, and including the legal representatives oemployees. f to ees Howevsed ler the owner of a trustee of an individual, partnership, association or other legal entity, employing P Y house of dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling another who employs persons to do maintenance, c°mstruction or repair work onbe an w ll�house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to n employer. ter 152 section 25 also states that every state or local licensing agency shall withhold forthe an Lssuance or renews app cant who has MGL chap of a license or permit to operate a business or to construct buildings in the commonweal Ythe not produced acceptable evidence of compliance with the insurance coverage regirdAd °of u�bhIIec w r until P contract for theperformance commonwealth nor any of its political subdivisions shall enter into any of this chapter have been presented to the contracting acceptable evidence of compliance with the insurance nuirements authority. Applicants ' ensation affidavit completely,by checking the box-that applies to,youur situattcn and Please fill in .he workers comp hone fibers�g w �r with a certificate of inance as all affidavits may be supplying company names,address and P e 'Also be sure to sign and submitted to the Department of Industrial Accidents for on of insurance coverage. ty or town that the application for the permit or license is date the affidavit. The affidavit should bdut�Acc� Should you have any questions regarding�"�w"or if you being requested, not the Department o Policy,Please call the Departzneat at the number listed below. are required to obtain a workers' compensation City or Towns e be sure that the affidavit is complete and printed legibly. Thy;Aepi rtmr it has provided a spate at the bottom of the Pleas ons has to contact you regarding the applicant. Please affidavit for you to fill out in the event the Office of l be u gati be returned t^ be sure to fill in the permit/license number which will be used as a reference number. The affidavits may the Department by mail or FAX unless other have bean made• e Office of Investigations would like to thank you in advance for you cooperation and should you have any questions- The please do not hesitate to give us a call. ent's address,telephone and fax member. The D artm The Commonwealth Of Mas sachusetts Department of Industrial Accidents Office of Investlgadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 °F TM@ The Town of Barnstable MUMSfABLL • MASS. �m� Regulatory Services �Eo 59,t. Thomas F. Geiler, Director Building Divisio_ n Peter F. DiMatteo, Building Commissioner 367 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. y Type of Work: f/-I.,. (;A ZA Estimated Cost Address'of Work: n�-�y y CSC U`2Z S A/ cx_ Owner's Name: ( 7E_d C �t''� if Date of Application: i I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 E]Building not owner-occupied, wner 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 G I Date Owner's Name q:forms:Affidav:rev-070601 YATEWED Flea.a-oo page UV 9jw �® �ioai e�Style Bolt Together — — -- #30 Frame PART# DESCRIPTION #1......Top Crept plain ends #2......Sid,Bend 1 tapered end #3......Corner Upright wi%h leg(for front and rear) #4......Upright tube 1 tapered end — #6 nd5. Roll #5......Cro55 Rail 1 tapered end,2 hole5 Cross Rails for the Top �_�__plain ed5.2 holes Install OVER all Middle bends and �\\\ #6......Cro6E: Rail plain ends,2 hole! UNDER Front and Rear bends #7 ....Wind Brace,2 hole5 #5 C;ros5 Rail 1 tapered end. 2 holes fop Cr 5t ! #2 Side Dend 1 tapered end #5 Cross Rail 1 1rapered ena. i I I ;1 #6 Cross Rail holes plain ends,2 holes I eo Rail I t tapperered end. 2 holes - L Cam/ _ _ 44 Upright tube #7 Wind Brace, i i /' 1 tapered end for- #5 Cross Rail " middle bows flattened .✓ 1 T.aper•ed end. rounded end ?_holey �✓ #3 Corner �J Upright for c-.—_ frontanrer d a 1 • ;1'r ,r(;(a.5ii�rjrq? r!fit�Cl hgi(;re exC,t'a.•.:.. I:ia1Se of(i&:nayeCl::r rnitSs!na mWpr;al pleas-.adv: a the delivety pe.'SOn Or the 00, .' yy, A�.y ll. Y1N! Id !• r.�.'I 1 i f.JJ't U r.^- 1 .1✓C. J questions • (`JO rlt 1lf Sara)E UJ-3tC;h put for accumulated Sr:ow.rm the Sides as well a tr(:ton Fi Drr95U'E OOLIId art9CTC TO CClIa()->P„Wet Or IlUavy S:4)W shoul•.f he removed aS SOUr?aV • fhC,dcor of:t e ywag,shouiu be ker;!::iosi:Q£rt all Ames as va?lan!,Mnds could damage the mutenal. Cali CU5$0�l@�9• service Any r;!��mnes or nlodifictrtians to ti..-Se n_,:ti�:n�t�{y :rshuctions will voltl H,e warianty. i • Cam,•✓+?I li t?E::re8C7c'n5ible:r_"any a 'r,ad�:5(iue to virioijs corxiitions resultinj tarn acts of nature 1_800_217.1051 (�1995. 1996, 1997,2000 Cover-It,Inc.All Highis Reserved a COUER InSTALLATion ,, a Page Couer Installation d IMPORTANT. If doors or cover are installed and 6. ..��,� garage is not completed and left unattended:shelter must be tied down securely until completed. Punched (Holes . The turnbuckles Welded in Rope � "� � - should be checked monthly to make sure the cover is tight. 1. Pull cover over garage. The welded in rope and label should be in the front and rear (outside), punched holes on the sides (inside) of the garage. Center cover over the frame on all four sides. 2. Loosen the 4 turnbuckles. Tie the ropes loosely to turnbuckles and check to be sure cover is still centered and has the same amount of overlap on the s . front and back Turnbuckle 3. The place where the heavy rope comes out of the cover should be no closer than 1' off the ground. 4. Pull ropes tighter, using a few knots to secure to turnbuckle. Then twist turnbuckles to tighten rope. Check monthly & tighten. 5. When cover is aligned fasten the cover to the A*lAr frame by using rope . start by inserting one end through the first punched hole in the cover (see detail on left) and then under the bottom cross rail. Continue down the shelter creating a laced effect. When lacing is complete " t tie off at the end and work your way back ' •.., tightening the lacing by pulling the rope down creating a snug fit. When you get to the other end tie off and trim off extra rope. { 6. The turnbuckles should be checked monthly to make sure the cover is tight. r �' Installation is Complete! Enjoy your Cover It All Weather Shelter ®r Grow It Greenhouse. + � Questions Call Customer Service 1-®00-2 17..105 I - - `Ilut ac+�xpr� zeclhy loges ka lust 'OWW , �!� l Ita 18'x.20'x 10'dw'44-ii Q-49 a clean top ,Panel, A__!s ur Attention CustOomersa ��ds. We would greatly appreciate a picture of your Cover-It Shelter covering your car, truck, boat, motorcycle, Snowmobile, greenhouse., plane, R.V., pool, construction Site, etc. and especially something interesting and unique you feel is resourceful and useful that is not on our current brochure. Here are some examples of recent customer photos that we really love and currently use. }' If we use your PHA in our literature or advertising we will first ask your permission and the negative to the photo(s)and then a Neu j�e��"` 0 `vaned lc w 'Jw"r \ pool&,eA utlr. auluinss arsd°Yew it naiclie� µYE ��►Y Y®tJ 5�.®® � Me &.p��, a& M,eu � "sue- ,, a...•. Just take a color photo of your shelter(35mm only) z and send it and negative to r s 1997 Cover-it, Inc., Art Dept. P.O. Box 26037, di, llte oe"OS Oa4 West Haven, CT 06516 udtoeeend ane so �,�yp�/ t cn - Questions Call Customer Serulce 1-800-217-1051 ' Tc wN �� • zZ 7-1 >< ¢� w / '71 N EXIST FLOOp Zo,v� L/N� (/f/ sm �T �6 v O Cx-Cl r I certify that this property is located in Flood Hazard Zone All and Zone C as > _ . identified by the L epartment of Housing and Urban Development (HU[ . CERTI FI ED PLOT PLAN Late • • • • • • y• • • , • • LOCATION f-ji �ii/S7�CG � SCALE . .����3��. .... DATE 007 Reg.`:*. ,and Surveyar� PLAN REFERENCE I certify to its title insurance company that there are no visible encroachments 'I CERTIFY THAT THE or easements except as shown and that this SHOWN ON THIS PLAN IS LOCATED ON THE GROUND lan was prepared under my immediate AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF supervision. �g??'Y �9 � .... . , : .WHEN CONSTRUCTED. DATE GAT Zo / j Z REGISTERED LAND SURVtY R °f THE 1py,- y� The Town of Barnstable Bwar,srear.e. . MASS. g Regulatory Services 1639- A•• Thomas F. Geiler, Director j°rEo ru►'1 Building Division Peter F. DiMatteo, Building.Commissioner 367 Main Street,Hyannis MA 02601 Fax: 508-790-6230 Office: 508-862-4038 HOMEOWNER LICENSE EXEMPTION Please Print DATE: StP r ' /V �ivl% JOB LOCATION: �2,0 v S village _ number ssrx° _ _ 78 "HOMEOWNER": home phone# work phone# name CURRENT MAILING ADDRESS: � 3 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,2.rovi�at 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 shall not h use and/or farm structures. A person who constructs more than one home in a two-year period ered 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 it. (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 pro-pedures an requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic f et or larger will be required to comply with the State Building Code Section 127.0 Construction 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." the responsibilities of a supervisor(see Many homeowners who use this exemption are unaware that they are assuming P 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 .ultimatelyunities quire.spas pnsi lle. f the permit To ensure that the homeowner is fully aware of his/her responsibilities.many application.that the homeowner certify thathe/she am dars�a a the nd responsibilidopt such aties for of ertificavis f' On the las .mtnunity issue is a form currently used by several tow Y Q:FORMS:EXEMPTN .:......................:.DATE ............... SUBJECT ......................................................................... SHEET NO................OF..........:.,. CMKD. BY•.............DATE .......4....... ..................................................................................:........ 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LOT 1528 O \ LOCUS AIM 19-21 x � ,� �, 18,161f S.F N SHELL 0 0.42 ACRE x O' H � F LOT 1518 °� , z. \\ LOCUS' MAP` } ' 18.5 \ PLAN REFS 94=47 x pp ASSESSOR'S-MAP. 19-21 t I X -re �', ZONING,• - "RF" SETBACKS.' x h , ,, ,;�;- DEED.- 1 4 081-1 65 I3 a - '- '- -- - - - P� o ` PROPOSED ADDITION FLOOD ZONE. "C" xl s &.PROPOSED D_vCK � -- - -- zs PANEL NUMBER- 250001-0021-D 29.2 ''rsg.., - - '- -; ;-;- S' OLD DECK TO RE REMO VED cq z DATE r2o o D. 7-2-92 -; ti 'BENCHMARK p - PLOT PLAN OF LAND ABM 19-17 �; ' ' o �/ / c»azy oR 4(N ,env ,ti 'o -se �k I / sw faa.roc eoJ - ` • LOCATED AT- —.�? �9--, /X„� 220 CROCKERS NECK ROAD a. _ . I7.x- d�AsO t o 1 x19 16•3' _ COTUIT, MA -_- � r PREPARED FOR: o';-i'ARAGE o — — =— GEORGE SUOKKO LOT 150A OT =;== L 153E h � y - -, -;-,:-- ., , AIM 19-20 JUNE 7 2005 Xls.z ;';-;-26.o' REV `Sy92.9 2p•E XI9.7 h ,►►►!N �!s��. REV �, ► va�� s� REV }. _ . �� �G�s-t.�F�`•yam � Ise 26' d �c PSTEFHEN YANKEE LAND SURVEYORS � J. s DOYLE & CONSULTANTS c '37 GRAPHIC SCALE -- P.0. Box 265 ® = ? : UNIT 1, 40 INDUSTRY ROAD 20• 0 10• 20' 40• LOT 152A �` .` MARSTONS MILLS, MA 02648 AIM 19-18 �!_9g maps✓ TEL• 508-428-0055 FAX 508-420-5553 1 inch = 20' ft. SHEET I OF 1 JOB ,¢! 53908 SDS f , N ,