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4650 FALMOUTH ROAD/RTE 28
v / , 1 � �l �I� � i'i'�e..fU GT.�� �� I i I , i� 1 Application num a ...Jq... Fee ................. 1Vl.. ......................... 3 ` 77 Building Inspectors Initials... AUG 1 � 2019 Date Issued.:..-FlAh1............................................ TOWN �- �: 8_ARNS IABLE Map/Parcel......[.10.....CD.j.✓�.a..... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOW S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project. �"� o 2 ":6' C o t! \7 NUMBER STREET VILLAGE Owner's Name: R© � s<<� Phone Number Email Address: Cell Phone Number We— G] Project cost$ l-S ., O O o Check one Residential Commercial OWNER'S AUTHORIZATION .As owner of the above property I hereby authorize Rc e.r r- S cv -c-"C' t to make application fo buildin a 't , accordance with 780 CMR Owner Signature: Date: TYPE OF WORK Siding 19 Windows(no header change)# ❑ Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) l Construction Debris will be going to CONTRACTOR'S INFORMATION' Contractor's name o 0.r r S C:o�T i Home Improvement Contractors Registration(if applicable)# ��S (attach copy) Construction Supervisor's License# C S O G Ck3 S (attach copy) Email of Contractor ILD _o`rr i Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD,OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. r '► APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total ., Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each'tent must be attached.-Provide a site'plan with the location(s) of each tent Fuel source being used LP tank 201bs. or> Yes No ,if yes, a gas permit is required. Natural Gas Yes . No , if yes, a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name:, Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature_ z Date �� All permit applications are subject to a building official's approval prior to issuance. �-� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street. Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 010 e_r T �C,a r� t Address: %4 l A i�l o o s A City/State/Zip: V At`stQuS tn IMS Phone#: Are you an employer?Check the appropriate box: IType of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I _employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.9 I am a sole proprietor or partner- . , '., listed on the attached sheet. 7. remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in an capacity. employees and have workers' g Y9. ❑Building addition [No workers'comp.insurance comp.insurance.: Y required.] 5. ❑'We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submits new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: 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 and penalties of perjury that the information provided above is true and correct Si¢rtature: ",e� Date: Phone#: —SO C6 ``Z — �0I C G Official use only. Do not write in this area,to be completed by ci or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I J �^ 06 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,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhoU 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 commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: 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#6'17-727-7749 www,mass.gov/dia 1i Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstnOtPdi boprvisor CS-069312 E,�pires:06/02/2020 RAPHAEL F SCOTTI i f 33 N WESTGA'TE RD _ ; r HARMCH MA�02645 �� Commissioner � . 1. .%L� �0��2�)2!i/LLUP2 ..f. 7 UlYf/C/TCi�elf mcE ol.col.ou:rsr-ffa 6usiries'S RE9ulatic,: kiOt1AE il"APR6V. k 'TRACTOR FTye lildtuit.t? aSigP•loner EExpiratwri 49..23/2020 t ROBERT SCOTTIna ` DB/A CIASSI( 'l " fBIC-014STRUCTING ROBERT C SCOTT� � 41 APPALOSA W A� a -� MARSTOBNS MILLS,MA 02648 Undersecre+". f i Iowa- Town: of Barnstable r rA � _ = Buildin L e.r.. ?at Tbas,GtrdxSo. hat:itys . sib Er the StreatA riS,vedRPrans>.Must_be.Retained onYJob and,thisCard.Mlast=Fie-�Ce t +. �. - PoSted,'tJntil Final;-ins ection Ha -6 en Made. •z-w:�_ � > r;�< ,.ir:.� �.� �� •• a+- <...:,..:. R.. ._ �+�Uk��r,,, .,,E�rti.�cat�e�ofi.O�cu :a:n _is:rRe uired,�tiatirBu�IsL�n shall�Notbe Occu tedxuntil a';Final.lns ection harbeeh�ifiade�•,... .. .. , . �..,, __..... Permit=.No B-17 3579 Applicant Name: Approvals ,.Date issued. ' 10/16/2017 Current Use : . Structure • .. Per.'mit Typea Building .Sign/ Expiration Date. '' 04/16/2018 . : Foundation: Locatioml 4650 FALMOUTH ROAD/RTE28,COTUIT Map/Lot 610-008-002 Zoning District: RF Sheathing: Owner on Record: MYCOCK,RONALD J Contractor Nam'e:'% Framing: 1 Address: P O BOX 437 Contractor License 2 COTUIT, MA 02635 � Est Project Cost: $0.00 Chimney: Description: Reface existing 20 sq wall sign a Permit Fee: $50.00 -Fee Paid:" $50.00 Insulation: CC Skin Care I R' r Date:' ! 10/16/2017 Final: Project Review Req: i ` riFrv� cJuti�— Plumbing/Gas �x Rough Plumbing: Zoning Enforcement Officer final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after.issuance. Rough Gas: All work authorized by this permit shall conform to the approved appiication'and the¢approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be incompliance withrthe local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location.clearly visible from access street o r road and shall be maintained open for public inspection forthe entire duration ofthe work until the completion of the same. r p —� Electrical J . ;.:The Certificate of Occupancy will not be issued until all applicable signatures by the Bwiduig.and FireCi#icials are.movided on.this permit. Service. Minimum of Five Call Inspections Required for-All Construction Work - R 1.Foundation or Footing s : � ough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy ow Final:L Voltage F' I- Where applicable,separate permits.are required for Electrical,Plumbing;and Mechanical Installations. - - Health ,:Work;shall,notproceeduntil the Inspector has approvedahevariousstages•ofconstruction Final.: r - Per..Sons:c ntrai tin with;unre intered,:cvntractor.-5<do,radt:;have access f the .ua;r nt :fund:; as°set°.fbrth;In MGiR'c:142A;. .., Fire De artment Q.,.,. Q..._ .g. . d y!,. Building plans are to be available on site-° final: All.Permit:Cards are the ro e. of the APPLICANT-ISSUED..RECIPIENT Town of Barnstable T Building Department pFZHE ip� P� o Brian Florence,CBO Building CommissionerCVS.ILE. 200 Main Street, Hyannis,MA 02601 KYII015111�'W- 'WF,gEf WPRiN1E rED MPS ` www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Sign Permit Application Zoning District Permit# Historic District ❑ Location by �� / �IMLJ _ �� I�YI t�' Street address and village . ��/ �' ce Applicant Map & Par I. Telephone Number Email Sign #1 : Sign #2 Wall Wall Freestanding ❑. Freestanding ❑ Electrified* ❑ Electrified* Dimensions Sign #1 c�J CS Dimensions Sign #2 Square feet Square feet Reface Existing Sign New/Replace Sign ❑ Width of Building Face..f�92 ft. X.10 + X .10= *Lighting Type A wiring permit is required if sign is electrified. Signat of Owner/Authorized Agent Mailing address %dam T- T I 01.1.14E r0 Town of Barnstable , ~°* Building Department IARNSfASLE, Brian Florence,CBO � MAs3. �A s639. a�� Building Commissioner rfD MA'S 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 568-862-403 8 - Fax: 508-790-6230 SIGN PERMIT REQUIREMENTS 1. A photograph showing the existing facade, on which has been indicated the proposed sign location. The photograph is to include a portion of adjoining stores or building. For a proposed building or new facade, an architect's elevation.may be submitted in t lieulof a,photograph. 2. A scale drawing of the proposed sign. A scale drawing indicating: 1) The type of proposed sign(wall,hanging; free._standing) .' 2) Dimensions of the proposed sign and any design`s, logos,or lettering 3) A cross-section with dimensions showing edge detail. Minimum scale 1"= 1'.Minimum sheet size, 8.5 x 11". 3. A scale drawing of the bracket. A colored scale graphic indicating dimensions, showing colors,materials and method of affixing it to the sign and to the building. Minimum scale 1'.'= 1'.Minimum sheet size, 8.5 x 11".. 4. A completed Town of Barnstable Sign Application,including scaled diagram showing location of sign on building or location of free-standing sign. Show dimensions. 5. The width of the building face or the leased area. NOTE: the map/parcel number is required on the application.; signs/signrequ&app, revised: 9/22/17 L r p £ t 1 I� iF i r 4. �O \O y _ YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which.you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is' required by law. .. l Avis - DATE: ►9� i Fill in please: , yam APPLICANT'S YOUR NAME/S: 1; Y 1 aW BUSINESS YOUR HOME ADDRESS: (`7 i via.i✓I 5T Cat i'f' ; 4'✓1 OZ& a5' TELEPHONE # Home Telephone Number :�08 5; - /Z 4 3 NAME OF CORPORATION: '. NAME OF NEW BUSINESS J<i-e Iy ti Cov►j,ouAy LAG TYPE OF BUSINESS u C51'qT, 13re -e/rx IS THIS A HOME OCCUPATION? YES NO_ O OU8 - 00 3 O Z s ADDRESS OF BUSINESS SO 41 ��� �I, sv 1" t .. .MAP PARCEL NUMBER l A sessin When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of . Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. , 1. BUILDING COM SSIO ER'S OFFI E This individua ha en in#errn. d o ny per it require ents-that pertain to this type of business. uth riz d Bignat COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: TOWN OF BARNSTABLE MASSACHUSETTS BUSINESS CERTIFICATE BAR.INKfA _`• r, MASS, DATE ISSUED: 09/18/2003 DATE RENEWED: � � U f 1: J ` e BOOK 189 RENEWAL BOOK: RENEWAL PAGE: PAGE 03-263 DATE DISCONTINUED; CERTIFICATE EXPIRES: 09/18/2007 DISCONTINUED BOOK: DISCONTINUED PAGE: In conformity with the provisions of Chapter One Hundred and Ten(110), Section Five(5)of the General Laws, as amended, the undersigned hereby declare(s)that a business is conducted under the title below, located as shown, by the following named person,persons or corporation: KIELY&COMPANY,LLC MAILING ADDRESS: PO BOX 432 COTUIT, MA 02635 A TRUE,COPY ATTEST_ FREDERICK KIDLY 171 MAIN ST COTUI;,MA 02635 CGd Town'CIerk BARNSTABLE"":: Signatu THE ABOVE NAMED PERSON(S)PERSONALLY APPEARED ME AND MADE ATH THAT THE FOREGOING STATEMENT IS TRUE. i TITL Identification Presented: DATE: September 18,2003 PLEASE NOTE: IT IS THE RESPONSIBILITY OF THE APPLICANT TO OBTAIN ANY LICENSES AND PERMITS REQUIRED BY THE BUILDING,HEALTH AND CONSUMER AFFAIRS DEPARTMENTS FOR THE LEGAL OPERATION OF THIS BUSINESS IN THE TOWN. CONDITIONS: OFFICE ONLY—FOLLOW HOME OCCUPATION REGULATIONS In accordance with the provisions of Chapter 337 of the Acts of 1985 and Chapter 110, Section 5 of the Mass General Laws,Business Certificates shall be in effect for four years from the date of issue and shall be renewed each four years thereafter. A statement under oath must be filed with the city clerk upon discontinuing, retiring or withdrawing from such business or partnership. Copies of such certificates shall be available at the address at which such business is conducted and shall be furnished on request during` regular business hours to any person who has purchased goods or services from such business. Violations are subject to a fine of not more than three hundred dollars($300)for each month during which such violation continues. CERTIFICATION CLAUSE I certify under,the penalties of perjury that I,to the best of my knowledge and belief, have filed all state tax returns and paid all state taxes required under law. * Signature of Individual or Corporate (Mandatory) By: Corporate Officer(Mandatory if applicable) � ** or Federal ID Number * This license will not be issued unless this certification clause is signed by the applicant. ; ** Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Mass. G.L. Cha 62C, S.49A. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map V Parcel OF BARNXO�ation #6:;? Health Division �4:,Dtel sued !lr&l Conservation Division Application Lee Planning Dept. �. Permit Fee Date Definitive Plan Approved by Planning Board ' Historic - OKH Preservation / Hyannis Project Street Address �¢` Village_ Co�7 l � b,2("_3s Owner 9pn. MV (Qe k Address Y37 C`of�f� Telephone D '" A.0-7 ) D0 Permit Request .e-- roo-FF old L ct qex- ' Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation J:Z 6 -0 Construction Typer' Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure 30 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 Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new 'size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial 9Yes ❑ No If yes, site plan review # Current Use oA-FG c Proposed Use o,G(c e - - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - - Name H/. l c h c o G)L Telephone Number M- 7 75-7 7 0 Address ' Lt!c LN License #- 0 1`9,?98 arW6&,b(,.e-- Mk. d 2,0(o l' Home Improvement Contractor# Z65:9_0 7 Email coeV-& (owc45f tly{ Worker's Compensation # 2t 10 !Q W ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i` L� SIGNATURE DATES 7 - C. 2 0 ¢ S FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP PARCEL NO. tCF P ADDRESS VILLAGE . i OWNER 4 i DATE OF INSPECTION: " FOUNDATION FRAME t INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL f GAS: ROUGH FINAL FINAL BUILDING " DATE CLOSED OUT AS PLAN NO. y F � f f oFTME rqs�� BAIUMABM MASS. Town of Barnstable QED MA'1 A Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder . r I, 50f mVL00". ,as Owner of the subject property hereby authorize 16 �I tr4`G�p,C,PC. to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date ISO MV CI7C,LL Print Name If Property Owner is applying for"permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WHILESTORMS\building permit forms\EXPRESS.doc Revised 061313 i Trice C'ta2nwo ym-� of�assachuseM Deparonmtgffirdmfti l.Accidents 0, ice of MIesf grrlians 600 Wayhington,reet Boston,MA t1-2111 wn Idia W—ark,-r-s' Campensationlnsui-anc,e affidavit Builder-s/ContractorsMectrkiansTlumbers Applicant Infarmation Please Print Lepibly Na=(B,��ondadividual): Je.Acf ti�G�f1G U GK Addrress: 66 1 1 fp�,� \—N cityrStat&Zip: oa ice? one Are yau an employer?Check the appropriate box: Type of o'ect r ,�/ . rrx s canfracttx and I pT' J ��luired}: L LJ 1 am a employer witlf� 4 _ ❑ I a 6- ❑New cros ra employees{full and/or gai#-#ime}* have hired the sub--contractors. 2.❑ I am a sole proprietor or partner- listed on the attached sheet y- ❑Remodeling ship and have no employees These mb-coat motors have: S_ Demolition. working for me in any capacitir_ employees and have workers' 9_ ❑Building addition [Na Workers' comp:it Meante, comp_msuranc r I 5..❑ re We a a corporation and its 10_0 Electrical repairs cr adr�ions 3.❑ r I officers 1xav exercised fheir I am a hornet wn�er doing all work I l_.Q Plumbing rr�aA'-9 or additions myself, [No workers'comp. right of exmmptionper MGL 12_.0 Roof repairs. - insxxnre required-]1- c-152,§1(4),and we l ss,,t-na employees-[No workers' 13_❑Other comp-insurance required.l *Any wphoat that thus boa-#1 rrmst also fil1 out tfw-section below wing Their tao&ele 0Dn4ensadioa policy infflrMa&39 T Homeowners who submit tfim affitlsvit indicst ag they are doing sit v►oak sad then hire outside coauactars mnsi submit a neww affidavA mdirxtm— ttractms tfist chxY this box must sttadted sa additional sheet show-mg the name of the v*-ors and state whethK xnot tho&amfities have, employees_ Ifthe salr-contmctocs hxse employees,theg must provide tfieir workers'comp policy mmmber I am an employer ihat isprmizbkg workers'corerpeumt on irmirance for my emplvyem ffelatr is the policy a-n.d job site . infor nzat&m Insurance Company Name: Policy#or Self-ins-Lic-;-A` E t o r!o � Expiration Date. 3`J& Z 6160 Job Site Address: L16 7 d ;e iL n hjh A i ! CitY/Staterzip.& 0.3 &,3,T Attach a copy of the workers'compensation policy duration page(showing the policy number and expiration date). Failure 43 secure coverage as requireduuder Sectioa 25A of MGL c, 152 can lead to the imposition of criminal penalties of a fine up to$1,50a.Oa andlor one;-ye-arimprisonment,as well as civil penalties in fe form of a STOP WORK ORDER.and a fine of up.to$250-00 a.day against#lie violator- Be advised that a copy of this statement may be forwarded to die Office of Immstigations of the DIlt for iu=ance caveiage verification. Ida here under tkepiins trnrTpsnaliies ofperjury iJtetfhe irrfor rrrtrtian pral*ided abiwe is.bus and correct ' Sitmature Bate: -7" Cg 2 O Phone#: 5-0-7 Q--7 7 S 7�) - of f---iat use oney. Da not sprite in this area,to be completed by city or town offi'cutl City or Town: PermitlLicense# Issuing Autharity(circle one): 1.Board of Health 2.BnUding Department I Cit flrown(Jerk 4.Electrical Inspector S.Plumbing Inspector } 6.Q4her Contact Person. Phone#r e Information and. tnstfuctxons Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuautto 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 apar raents and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,constriction 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 IocaI licensing agency shaII withhold the issuance or renewal of a license or permit to operate a business or to constract buildings in the commonrrealth for puay applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." MGL cha ter 152 25C 7 states"Neither the Additionally, p , § ( ) `N ether�h commonwealth nor any of its political subdivisions shill enter into any contract for the perio_rmance 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,U necessary,supply sub-contractors)name(s),address(es)and phone nunmber(s)along with their cent l"ficate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(L LP)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 indus's-ial Accidents for confirmation of insurance Coverage. Also be sure to sign and date the affidavit 'I1e afi=+da-vit sbould be returned to the city or town that the application for the permit or license is being requested,not the Deparbaient of Industrial Accidents. Should you have any questions regarding the law or if you are required io obt_i L?a workers' compensation policy,please call the Department at the number listed below. Self-insued companies would 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 e the bottom of the affidavit for you to fill out in the event the Office of Investigations his to contact you regarding the applicant Please be sure to fill in the permit/licease number which will be used as a reference number. In add don,an applicant that must submit multiple permit/license applications in any given year,need only submit one 015a avit 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 maybe provided to the applicant as proof that a valid affidavit is on file for fufure permits or licenses. A new affidavit m st 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: Tho t✓ommonwealffi of Massachusetts Depaftment of Industrial Accidents Office Of JavestigafiG is 600 Washington Street Boston,IAA 02111 Tel,A 617-727- 00 W 406 or 1-ate MAS.S.AFE Revised 4-24-07 Fax 9 617-727-T/-49 www.mass-gov/dia Client#: 291172 TLHITCHCOC1 ACORDr. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/13/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Anne Sanzo HUB International New England Plc°Nlu Ext:508-945-7863 FAX 265 Orleans Road E-MAIL North Chatham,MA 02650 ac,No: 508-945-9136 ADDRESS: anne.sanzo@hubinternational.com 508 945-0446 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Essex Insurance Company INSURED T L Hitchcock Construction INSURER B:Travelers Insurance Co Theodore L Hitchcock INSURER C: 933 Falmouth Road INSURERD: Hyannis,MA 02601 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY 3DU2424 5/05/2014 0510512015 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES ERENTED occu ence $100,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $1,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT JECT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED Per accident)PROPERTY DAMAGE $ HIRED AUTOS AUTOS f $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB • CLAIMS-MADE k' AGGREGATE, $ DED I I RETENTION$ 1 $ B WORKERS COMPENSATION X 2E1016" D312612015 03/26/201 WC YTATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE X E.L.EACH ACCIDENT $1,000 000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1.000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION For Evidence Only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD (Yi7 -a : Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: r;,. r Registration: 165907 Type: Office of Consumer Affairs and Business Regulation Expiration: 4/6/2016 Private Corporatic'l 10 Park Plaza-Suite 5170 Boston,MA 02116� TL HITCHCOCK CONSTRUCTION SERVICE INC. THEODORE HITCHCOCK f`. 55 LISA LANE WEST BARSTABLE,MA 02668 Undersecretary Not valid wi i e 9 ?' '!;8:,S2.h,lo?.. S '--.�8.'i:i!_ � .• .. r .z,� r n �C fd 0 Su;ici nl ::�egala*.ions ai :t tense. CSSL-099828 ` TED L HITCHCOCK 55 LISA LANE' West Barnstable MA 02668 06/01/2016 ,: �t; In stUr c.' .. < • .. - - i Restricted To: t Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS ., t YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office..1 st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall)and get the Business Certificate that is required by law. p DATE: l 3 Fill in please: APPLICANT'S YOUR NAME/S: ,� BUSINESS YOUR HOME ADDRESS: oo .o TELEPHONE # Home Telephone Number26.00 NAME OF CORPORATION �' �t i ;( J�� i1 fi: L&I �, NAME OF NEW;BUSINESS� ��l:`'G✓ � 47 L ss e Cow TYPE BF:BUSINESS C,�6 4 IS THIS;A HOMbbCCUPATi YES O ..-YES:. Gt�� p ADDRESS OF:BUSINESS �biS``�..:::% .:cwr yy{�� MAP/PARCEL;NUMBER ). O-.dU O CYO (Assessing]. ..; When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable..This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO ISSIO R'S OF This individ al h e n irrif a of any per it requirem nts that pertain to this type of business. Auth rued Signatur L o �� COMMENTS: i C I C�� 2. BOARD OF HEALTH This individual hasbee�irl#ofr ed of the permit requirements that pertain to this type of business. Aython ed, Fiic i�yre* COMMENTS: -4/ N l 3 U a �C r Vo i j 3. CONSUMER AFFAIRS LICEN G UTHORITY) This individual has eon i or the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: Parcel Detail Page 1 of 3 Ok H E p """^ a•w. p4 ti's a 1 �i B.rt&lS�'S'CATit� ' MASh, Logged In As: Parcel Detail Wednesday,August 7 2013 Parcel Lookup e Parcel Info Parcel ID r010-008-002 �I Developer 'I Lot Location 4650 FALMOUTH ROAD/RTE 28 Pri Frontage 184 ---- I F- Sec Sec Road SANDALWOOD DRIVE I Frontage 254 I Village JCOTUIT Fire District FCOTUIT �� I Town sewer exists at this address NO I Road Index 0522 Asbuilt Septic Scan: Interactive Map 010008002_1 k x� Owner Info Owner MYCOCK, RONALD J Co-Owner F—— I Streetl PO BOX 437 I Street2 I City COTUIT State MA zip{02635 Country Land Info Acres 1.06 use OFFICE BLD M�DL-94 zoning RF Nghbd 0105 F. . _ �_ Topography I Road Utilities Construction Info _ Building 1 of 1 Year 198�--4 Roof Gable/Hi Ext Wood Shin IeT Built# I St�uct p I Wall gI ." ---- ._ AC Area 5392 J cover Living Roo �Asph/F GIs/Cmp Type;Central styleOffice Bed Bldg I Wallnt Plastered Rooms 00 iAT Int Bath ModelCommercial I Floor lCarpet I Rooms iO Full Heat Total Grade jAverage Type IHot Alr --- Rooms! I C Stories 12 I Heat Gas _ Found I Poured Conc. . Fuel I ation Gross 8907 Area Permit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=270 8/7/2013 Parcel Detail Page 2 of 3 Issue Date Purpose, Permit# Amount Insp Date Comments 2/24/2009 Other 200900716 $0 GAS FURNACE 9/1/1986 Commercial B29940 $44,000 CO OFFICE 8/1/1983 Dwelling B25375 $0 1/15/1986 12:00:00 AM CO OFFICE Visit History Sales History _ Line Sale Date Owner Book/Page Sale Price 1 11/15/1992 MYCOCK,RONALD J 8323/282 $1 2 9/15/1988 MYCOCK, RONALD J&ELLEN L 6450/338 $1 3 9/15/1982 MYCOCK, RONALD J & ELLEN L. 3572/146 $17,000 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2013 $414,800 $77,400 $9,000 $133,100 $634,300 2 2012 $410,400 $78,200 $4,800 $134,200 $627,600 3 2011 $515,200 $0 $4,900 $134,200 $654,300 4 2010 $515,200 $0 $9,500 $134,200 $658,900 5 2009 $515,200 $0 $9,500 $127,200 $651,900 6 2008 $458,200 $0 $18,800 $127,200 $604,200 8 2007 $474,000 $0 $18,800 $127,200 $620,000 9 2006 $466,700 $0 $4,500 $127,200 $598,400 10 2005 $450,900 $0 $0 .$127,200 $578,100 11 2004 $423,000 $0 $0 $127,200 $550,200 12 2003 $264,800 $0 $0 $95,400 $360,200 13 2002 $264,800 $0 $0 $95,400 $360,200 14 2001 $264,800 $0 $0 $95,400 $360,200 15 2000 $293,100 $0 $0 $35,000 $328,100 16 1999 $293,100 $0 $0 $35,000 $328,100 17 1998 $293,100 $0 $0 $35,000 $328,100 18 1997 $241,600 $0 $0 $35,000 $276,600 19 1996 $287,300 $0 $0 $35,000 $322,300 20 1995 $287,300 $0 $0 $35,000 $322,300 21 1994 $287,100 $0 $0 $48,100 $335,200 22 1993 $287,100 $0 $0 $49,100 $336,200 23 1992 $319,000 $0 $0 $53,500 $372,500 24 1991 $411,400 $0 $0 $74,200 $485,600 25 1990 $411,400 $0 $0 $74,200 $485,600 26 1989 $411,400 $0 $0 $74,200 $485,600 27 1988 $398,600 $0 $0 $72,900 $471,500 28 1987 $312,000 $0 $0 $72,900 $384,900 29 1986 $312,000 $0 $0 $72,9001 $384,900 • Photos http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=270 8/7/2013 Parcel Detail Page 3 of 3 A'k a• Ax �w€a..r✓.f r. i vu Y r yb y�yw"p¢�pY 3 � '•w1'+l,'-� Aa��ki, eF c „&"."'�a'p�'k��4 '1 yp."w ak a•, i http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=270 8/7/2013 A t 3 ` TOWN OF BA.RNS'TAJBLE �) i Zoning Bo-c` of Appeals r w �? Ronald J._-_&.._E ��Q�L�..M}�cOCk..__............. Deed duly recorded ill thN4e _....... �... ......� �. Property Owner < � County Re—Islr�• of Deed,: in 1t„nk3.5... ...z... �� � �- ..�l....-...i...._._...., ...__......._........................................,Pa e _ ltr u ititr� a Petitioner District of the band Court t'erlifiealt, No. o rZ = U 0 0 ................ l;onk ..... ..,... ....... Pnl;e ................. C) J 1:.1 1985-88 Appeal1\o. --•-----............................................. ... ., —. FACTS and DECISION Ronald J. & Ellen .L. Mycock.___.—_ filed petition on ..................._.-............. ....... tq Petitioner __— -- . ill Jhr �•i1lni;o requesting a variance-permit for prem ses at 46S.Q..Falmouth.-Read.-•.-.................................. (Street) of Cotuit _._ adjoining premises of __._.-..._ (see attached tirall ................................ -- Locus under consideration: Barnstable Assessor's Map no. Petition :for.Special Permit Application for Variance: �n made under Sec. .•=.... of the ToNvil of lillrnslnlll,• Zoning by-laws and See. _ ._...................... ............... ('httl,irr •10:1.. AI:,KN (fell. l,:rw• to extend a ngr.i.•_- r0:-r-m t�4.._czffice...buildiiiq _. .......... . for the purpose of -- --- - -- - -..--.. Locus is preserltly z<>;:cd ul..__.._........•----�--------_..._- - _..__.-_........._............................... \ollce of till )iear;Ilr was given by mall, postage prepaid, to all persons doetn-41 PiT,-lod '""I new.,spaper published 11) TIM-11 of "y f„lhlishing in az-nstable Patrict „11ich is attached to the record of these proceedings filed with Town Clerk. A• public hearing by the Board of Appeals of the Town of Barnsiahle N a� hold at �Ihe Tm�n 0 fi, t B1It3:ding, Ily annis. Mass., at _-8�15_..---- =-n�ipg. P.M. .-- op"on said .petition under Coning by-1;iws. ' Present at the llc•arinE, were the fol:owim members: Luke P. Lally Ronald Jan_sson_.._.....__._ �tc�t .l31 i.�r- ........--•------- __ _--- C h a i rm a n r IgLctanen.._...............____ __�I 's l��C'�rath_.._....-_----- .- r C � ' w At the conclusion of the hearing, the Board took said petition under advisement. A view of the locus was made by the Board. Appeal No._.__._.....1985.-$�......................_..... Page _._..... of On - ----..._Septeulbex...12,...................................................... 1�65............_, The Board of Appeals found Attorney Michael Ford represented the petitioner who is requesting a Special Permit to extend a non-conforming use or the modification of a previous Social Permit to allow an addition to an existing building at 4650 Falmouth Rd. Cotu:it in an RF zoning district. The property has the benefit of a Special Permit granted by the Bard ( 1_982-82) for the construction and operation of a small office building on a jot consisting of 1.06 acres, formerly located in. a Business Limited C zoning district. Said addition to be 36 x 30 to be attached to the existing structure - approximately 2,160 square feet - to be two stories in height. Parking to ccmply with the new by-law, Section S. Luke Lally made a motion to grant the relief sought by the petitioner with the following restrictions: a vegetated buffer between the building and Sandlewood Drive, and that there be no entrance or exits directly onto Sandlewood Drive - seconded by Ron Jansson. The Board voted unanimously to grant the petitioner the relief requested - the Board also found that the petitioners' use of the property for an office building would neither be detririental to the nieghborhood nor in derogation of the spirit and .intent of the zoning by-laws. `Y Clerk of the Town of Barnstable, Barnstable County, Massachusetts, hereby certify that twenty (20) days have elapsed since the Board of Appeals rendered its decision it the above entitled petition and that 'no appeal of said decision has been filed in the office of the Town Clerk. Si zrecl and Sealed this _. '..: .. .. az;; of ............_....��., 7..................................... 13 :. under the pains and penalties of perjury. Distribution:— Property Owner Town Clerk Board of Appeals - pplieaut Town of Barnstable Persons interested Building Inspector Public Information I3y _... ___ ._._.._._ Brnard of .Appeals Chair _ian c ;_.. 'J" �t S 1,:ap and lot nwnGer .. ........ ........ _ _I( Y ' M MUST 4NE D�/ �c�i F� F ! iV' tYIFJS I �c o Ii�:Snumber .. ............ ` r s ., - ............ �t��/(r�f?I l c�►TITLE `°o A-" 6 House r.urriber ........!•�':5 ...... �.� .................... T(VV .i RFD 8HN R I HIE 6"' T 0 R APPLICATION FOR PERMIT TO �/l ..... � /.. k j... ..1.. ;. .......4.. ...................................................... - JYacOF CONSTRU y it ......... ...`.. (... t.......4. ........................................................I................... ... .............. ..........1 9.fit. . /�-�TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to. th/e following information: l'... ........ �:...!?S �C��,.....•J.cz.7.>c.(�f/ �/JC�G�1Jkl Scr.+�,�u Location eC N P :... Proposed Use I.('4-6 (f�N l� ............... !. ....... ............ ................ . RR ...................Fire District .......��..f.L'.1.�. . Zoning District ..........f:1 K..... /....... Narne of Owner t`��1. .` ..........ti..� .►a.y..n�i3`�... ... Address ..............f..f-!A�! �`.5�... ....... .� � �. .... �� C..�4�....... �1s✓.S�Q. .' .......................Address ....1.:..../.'1c, Name of Builder ... / f Name of Architect _....��. .}.r?:`1J..��., .. y.�S :-:...............Address ....�.. .C(...�S r (.�...'�1:�J...4t�.0 `.L t ... .. ...._.... 1 , Foundation ............... Number of Roams ............�.�............................................... ........ ............................-....... L` . Roofing I�GL ..._.`-C4.? :�.... Exterior ....1-lC� .. Floors ......�.C>d.► ......-..0� . . .... . . . . -Y...........................................Plumbin ......... t1 YF .................Approximate Cast ........��ar.4." 1V—.......... Definitive Plan Approved by Planning Board ------------- ---— __-- • ..Area .......................................... Diagram of Lot and Building with Dimensions ry Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 6� k _ s3 t .f f jay . C1V_ ��icvr "'wXs I hF4e!%y 7aree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above cn'15`:ruction. Name ........ �........ .. . ........... .. p �� � � � Assessor's ma and lot 'number .............. '"......,......... �oF rNe ra . Sewage Permit number �Q o v yEI 7V /G(( O� t BJRNAG& E, i .. _.. y MAea o� House number .........:....:.......................................................... co 1639: . f "TOWN 'OF BARN=STABLE BUILDING INSPECTOR Fr � ,jr, �a� �1 �' �' t!" ... t F, .APPLICATION FOR PERMIT TO ..:.................. ................:............ ....... .............:........................ . TYPE OF CONSTRUCTION ......... .A'er�s;.�:.... . ••�S�t?�� .. :...................... P t Y +� ......................... TO .THE INSPECTOR OF BUILDINGS: " j The undersigned hereby applies for a permit occo�r^ding to the following information: Location ....... I^ r...... ....`...... ....� •� ......�}• ° � ........................A ........ ............t o .t�........................ Y `Proposed Use ...... .!. .... Q ........... .................................... ... . ....................... ........................ Zqning District .. ." ... Fire District .. ... �o-N,a t� J , r,(, c�t� � � -�� rye•-�,� /�t`r � � a y�', j�' Name of Owner --- t !���,..?.. + 1 ., dess �.. �.. � �.. t;, �...................... ... •' ��J 'i4r f;7 P�. ls�FY•;. ���dP/•1� 6�M T6 4 en r)[•� � r Name of Builder .. I.L?. €�i............... .. .. . ....................Address .. ,.:r? ..... Name of Architect . } ,r si r � +a�� ? �...... :......Address, ....... ....................... t� i,�•� �a,t l i !. ......... t . t Number of Rooms ............1A.................................................Foundations ...... .... ,� r $a !9 & [ h ftr'r: ....Roofin . ........ ;.. . 4.................:.........:. Exterior ..�..�. .............................. ... . ..... .......... g ................... Floors a ..:t'=s")t Interior .......... �� e.2 `:... 1 ........................................ Heating ..... ............................................... ............ ...,......Plumbing �'��.�'" Fireplaced� +.................................................................Approximate Cost ........?�2 '........................................ .. .;. �. fmy `\ 1 Definitive Plan Approved by Planning Board ________________________________19________ . Area ....::... f Diagram of, Lot and Building with Dimensions :.>' �';�•�-a- Fee ... SUBJECT TO APPROVAL OF BOARD OF HEALTH a . y� . 41 s �e r elP - I hereby agree to conform to all the,Rule and Regulations of the Town of Barnstable regarding the above construction. ` / Name ' ���,�� ^ ` ` ' ' ` ` ` . ' ' ' � ^ ' .. ' | ' | ' 2537-5 Build Retail S.tore Retail Store Ronald J. Mycock" PERMIT REFUSED 19 \ - ..................... ' ................................................. x«~ ~���� -_'-4 _ ` . ._ ... lg . ------.----.------------- ` --------^^--~--^'—~'^^'--~^- -sq Assessor's offioe�(1st floor):t• • ��`�� OWIN 1,LLRK FTHEtO Assessor's ,map-Iand lot number .....:................ - ax 4 w� �♦ "Board of Health (3rd floor): SEPTIC Sl� 'i'EMlNID Sewage Permit number ............... .�.,^� A..��� p�®�+T INSTALL P 4DLE, Engineering Department (3rd floor): \ o ��b a• " �o S�b /J,e_ . . House number ..:.....:........ `... ......... ............. _ s ENVIRONMENTAL COD APPLICATIONS PROCESSED 8 30 n 9:30•.•A.M" and 1:00-2:00 P.M. only; TOWN REGULATIONS 9 }., TO WIN OF BA¢RNSTABLE BUILDING A.NSPECTUR APPLICATION FOR•'PERMIT TO -*TYPE OF CONSTRUCTION ..... ........... TO THE INSPECTOR,617 BUILDINGS The -undersigned hereby applies for a permit according to the following information: Location ......._..... -, ::............ 1-/Y�� Trig... .'r... ,�lfh.7.. ... )......' !� ......... ............... a F Proposed Use ....... i i4. ....,. ..... ....... ............................ . . ...................................... . .. Zoning District .......A-.� ....Fire District ...... �Tu.�7......... •' ,,..<� .................. :........ .......................................... Name of Owner ....... .. ... Name of Builder. .. r/ Pll� 7`l.( �iit!SZ .IA .`:..Address :leV......YM�elfTLO.�PILt..... Name of Architect ..:.......Address ../..3......CO.Ce.ki7r' ...F4.Aa1!r... X().... QI? Number of Rooms: ...... ..............................•..........f.............Foundation r..QuG .....l. ................. Exterior ....Gt/.aOD..................:... ...................... Roofing ,f ?iY*C�.................. ....... Floors A ��..Es`�...............`............. R............... ..Interior .......She..!�� ........................................ •s J E ` Heating '. ...................... .................................. ......Plumbing ............l.Z....t&,&. .. ......_........:...:... ... Fireplace ..../_?v............................................................... Approximate Cost ........ .. .. .... ... Definitive Plan Approved,by'Planning Board -------_----------------_-------_19__._____ . Area Fee .........:.............. Diagram of Lot, and,Building with. Dimensions•. t ............1� .. .4J.......... 1 . SUBJECT TO APPROVAL OF BOARD OF. HEALTH t f OCCUPANCY PERMITS REQUIRED FOR NEW .DWELLINGS ' I hereby agree to,conform to all the,Rules and Regulations of the Town of Barnstable regarding the above construction. • . Name ...................... /O Co uction Supervisor's License ..................Z.�......... ` D D MYCOCK, RON } No ..29940.... Permit for .....ADDITION. r :� ........ c Commercial/ Office r _� •t .... ................ ........................ .................... ` , i — t �Y ~ + - - ' T• �� Location!` Lot_ #1, 4650 Falmouth Rd. (Rte~ 28) s4 @. .. ..............................y ..... . ....................... ................... �1+ • n . , • , �' t. ` > Owner Ron Mycock.............. fir. l Type of Construction Frame...... ...................... . i jtt7 ♦f ......�` ...... ..~:... +.............................. * I •$ r ' • - • t� _ J 06t . Lot................. ,fj r '` U September 22 Permit sGranted ... ..................'.`. .19 86a Date of Inspection .... ..... ......... ... ....19 Date Completed �..... ...... . ..... `19 N a]� i y^ Y `✓ i4.. l� In jr x Oil h Y - ' A- r' ma and lot number°........................ y 6 *THE To` Assessor's offioe (1st-,floor): _ Assessor's Board of Health (3rd floor): Sewage Permit number ...........�........�.�.... ?..�5�(L.". � i BisasTnnLE• t Engineering Department (3rd floor): } Eta 1 cs lid, %' Jrnes House number 46 S4 �L � ��e3e a`...................................... 0 mo APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00•2:00 P.M. only TOWN OF 'BARNSTABLE u BUILDING INSPECTOR APPLICATION FOR PERMIT TO !�..ff�;�?' '� �......... TYPE OF CONSTRUCTION .........V ran...7_fZf`J 4..............................................................................!........ Ya ....... ...........l9. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ............ .?.. ............... ...... ,> r1Yr.7..<.. ....z.0 %!........... 1�. .......................... Proposed Use ....... .................................................................................................................. .................................................................................................................. Zoning District �.......;�-l.-...�,.: ® ............................................Fire District .......... .....7; .....7................................................... Name of Owner .... ...............Address ..........:,?GW( .... - ................................... Name of Builder .. !f �� �`1.. C.r�F'��..�/1. ....Address .. .....v4? 4/./.... 0 7,.. f......;r9.�......off....�.1...�........................... Name of� Architect is1'C1,!//CJr7�...........Address ... ,a.!i'4{il.........w!..... l4f i Number of Rooms ....../7/....................................................Foundation .. �C12. ��..... �i!t�C����7C.... ............... /i. ..................................... �► ....... ..... �/�f/ ,c T Exterior ...�.�....1 � ................................Roofing �:� , . ..................................................... Floors ....AX. 4 ....................... .-...............................Interior ........ .. /Z. 'Gl ........................................ ............Plumbin ...........//._.... 7!5�....Heating g ........................................ ......................................... Fireplace ....kt ...................................................................!.Approximate Cost ..�/T� ..r ................. ..................... Definitive Plan Approved by Planning Board ________________________________19________ . Area .,4d0v............................ - �94 Diagram of Lot and Building with Dimensions J,� Fee ............�...........f so ..................... l SUBJECT TO APPROVAL OF BOARD OF- HEALTI-. 4 J,: OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... ...................................................... G% '/ 1............:.......... � Z Const,Fuction Supervisor's License ..........O../.....O..... ......... A MYCOCK, RON A-10-8-2 No 29940 Permit for .....Addition............. Commercial./Off ice................................. Location ......Lot„1f 1.....4�5Q..Fa1.mouzh..�oad ......................Cotu t............................................ Owner Ron Mycock........................:.......... ................... Type of Construction .....V.r:aime........................... ............................................................................... Plot ............................ Lot ................................ Permit Granted .......September 22, . .19 86 Date of Inspection ....................................19 Date Completed ......................................19 l � YOU WISH TO OPEN A BUSINESS? F For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this farm at 200 Main St.., Hyannis. Take th.e cc>mpletE d form to the Town Clerk's Office, .1 st. Fl, 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: (O / Fill in please: APPLICANT'S YOUR NAME/S: 1,01)6 BUSINESS YOUR HOME ADDRESS: 16,44 r6- TELEPHONE # Home Telephone Number NAME OF CORPORATIO S THIS AF HOME OCCIUESS TYPE OF BUSINESS PA I ;N7 YES NO ADDRESS O : O26 MAP/PARCEL NUMBER .�%l7 F'BWSINESS --:OO,'R c�U vL [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules arid-reguaat s of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO 0 20Q Main St. - orner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operr�attr�ba in this town. 1. BUILDING COMMISSIONER' FFICE This'individual has bee rmed o a r permit requirements that pertain to this type of business. orized Sign ture** COMMENTS:4_� L v "C 2. BOARD OF HEALTH This individual h en inf it o e p i re u' 4ants that pertain to this type of business. Authorize gnature** COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) .This individual has b inf �f the licensing requirements that pertain to this type of business. r Auth nzpd Signat re** `, COMMENTS: O Irk•. a0 152 �� �"" �'� !b� :` - 1 .� �s •", ,. ... .-ryr`*'v^'•..._..s'e....{q'w?^.^.��►r^..,�:x +fe`'?*"--*r...s•,.�. :•..-r•'"�n^T:T ., ,-;w.,-sans. .•e<+;r.R-tr.,"'s „.. .w,.. .-„,:.; ..-u.... ..;..yam ,..--...; ..... TOWN OF BARNSTABLE Bpi-W 3096 Ordinance or Regulation WARNING NOTICE a Name of Offender/Manager Address of Offender MV/MB Reg.# Village/State/Zip ' Business Name OAPF on 1/0-5- 2�0^ 1 jr Business Address $"(.52Ptr�t �rd Signature .of Enforcing Officer Village/State/Zip �i" el ;"" Location of Offense 5#)vy)E Enforc.in'g;,Dept/Divis ion Offense 20 -61 soa i4 , A e 2. i1G3.aZ. /` f= ..g C; �`.1 . Facts c h This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD.IREG.-PROG. PINK ENFORCING 0' FICER GOLD-ENFORCING DEPT. I .+ JV TOWN OF BARNSTABLF `,,SIGN PERMIT PARCEL ID 010 008 002 GE013ASE ID 251 ADDRESS 4650 FALMOUTH ROAD (ROUTE, PHONE. COTUIT ZIP - LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CT PERMIT TYPE BSIQN TITLEIPTIOIv SIGN PERMITN & ASSOC. INC. ( 17 SQ.FT. ) CONTRACTORS: Department of Health, Safety 1 ARCHITECTS: and Environmental Services .TOTAL -FEES: $25.00 BOND $.00 px CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE + BARNSTABM 1 MAS& OWNER MYCOCK, RONALD J ;� i639• ADDRESS Epl P 0 BOX 437 41LDJNG-DIVI�10N' COTUIT MA ,BY � �-u . - DATE ISSUED 08/20/1997 EXPIRATION DATE 1 j� 1 { c 6703'20'9T25 Mel I PERMIT c� :a fp Y DATE: TOWN OF BARNSTABLE BUILDING DEPARTMENT 367 MAIN STREET i HYANNIS, MA 02601 APPLICATION FOR SIGN PERMIT APPLICANT: UA,JA6A��' ��{fi1�3 /� ASSESSOR'S NO. : oto Ih DOING BUSINESS AS: TELEPHONE:, SIGN LOCATION t Street/Road: �� ZONING DISTRICT: OLD KING'S HIGHWAY DISTRICT? yes no,�� PROPERTY OWNER Name: Address: City: State: zip: 02 >S Tel. No. : ��c�• � �.. SIGN CONTRAC OR Name: A4 Pot-) Address: 7� City: �� )�v(.�lJ�/�C' 1 State: �( Zip: l�I_ ��' Tel. No. : DESCRIPTION DIAGRAM OF LOT SHOWING LOCATION OF BUILDINGS AND EXISTING SIGNS WITH DIMENSIOIIS, LOCATION AND SIZE OF THE NEW SIGN TO BE DRAWN ON THE REVERSE SIDE OF THIS APPLICATION. Is the sign to be electrified? yes no (NOTE: If yes, a Wiring permit is required.) ' r ' I hereby certify that I am the owner or that I have the authority of the owner to make application, that the in�grmation is correct and that the use and construction shall conform .to the provisions of Sect'on 4�3 of the Town of Bar able Zoning ordinances. 7 Date signature �f ner/Authorized Agent Foi' office U- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -. Size (sq. Ft. ) Permit Fee Approved Disap roved 9X/'`j 7 l ip Date Si ature Of Building official MISC4 T � �°�h7 Yd iT Pd�ii �r f+i x,d;i rq 2` 4�m�� .• -_.—!—� �--��� ' ��fi��7�r !.r, tf� find., rj ., 11 bT-..,}a�.� I _ ✓ �l�/ . if", w p� � r5 g� w..•yW+ �rM"3 .5..l ly��.����9v�r,�.a�, ;; I i .._%/`1�`�'� _ W'!r 1f i !I I �•�t y, ) t�. N� i I��h��P4 , ! r • AMIDON 0 COMPANY. IN C I WOODCARVERS%SIGNMAKERS 376 RTE.'130 P.O. BOX 681 1 SANDWICH, MA.'.025.6.3 '(508) 888--0565 PFERMIT tt "il r�i,ti.,y r r ' DATE: i?;• • ...:.:?, 5'� S,r TOWN OF BARNSTABLE BUILDING DEPARTMENT 367 MAIN STREET HYANNIS, MA 02601 APPLICATION ��FOR SIGN PERMIT APPLICANT: Jc �-�(��/� c �'�J �( J�� /AX, ASSESSOR'S NO. : DOING BUSINESS AS: TELEPHONE:_ SIGN LOCATION Street/Road: ZONING DISTRICT: OLD KING'S HIGHWAY DISTRICT? yes no,� PROPERTY OWNER r Name: Address: City: State: 1�11 ") // -^. .r- J'I Jm. zip: �c�C,.7.� Tel. No. . SIGN CONTRAC�jOR f Name: ���u��v� Address: �,/.�,, n AA rl ' City: _c��!/l/( State: yv�11 Zip: 1�� �`.� Tel. No. : i?�, '"��J�J DESCRIPTION DIAGRAM OF LOT SHOWING LOCATION OF BUILDINGS AND EXISTING SIGNS WITH DIMENSIONS, LOCATION AND f SIZE OF THE NEW SIGN TO BE DRAWN ON THE REVERSE SIDE OF THIS APPLICATION. Is the sign to be electrified? yes no (NOTE: If yes, a wiring permit is required.) I hereby certify that I am the owner or that I have the authority of the owner to make :r, application, that the infQrrmation is correct and that the use and construction shall conform to the provisions of Sect'on 4`3 .of the Town of Bar able zoning ordinances. Date Signature V ner/Authorized Agent For office Use _ _ - _ - - ^ - - - _ - _ - Size (Sq. Ft. ) Permit Feed v Approved Disapproved tT 4 p 177. Date sl—g�qidure Of Building official xisca rJ r!� jr ,I , , a n� iI�E��ti• 6��. i N9t'saY�Yd1 N I �yw7: 'rMt T Ft d G.Sr'l °,� r fr YMR!�{�e'r k&+JA,y+��'�(t•�`/t it r r� e Yy,,f�"''�rir'��{('+,�,�, 9Y I �' ����,• + ���'��+ ���a�,l�4�1 '. d�{ � AA , 8:• ua +,: 11Nq, 1 + t AMIDON 0 COMIDANY:.INC:. WOODCARVERS/SIGN MAKERS. I 376 RTE. 130 P.O. BOX 681 SANDWICH, MA.'0256.3 ' 'f508) 888-0565 gc ,_ ; ! �, ► � , , { C' �a ,,fir'o �,� � ( its,, s �� profess- IT'Lam-' aR Em-, gamomer' s and L n� Surveyors AMIDON 0 COMPANY, INC. J WOO DCARVERS/SIGNMAKERS / 376 RTE. 130 P.O. BOX 681 _3(_�� " SANDWICH, MA. 02563 (508) 888-0565 7-1 T Z '\L 11 r` ( ' l 0 0 Profess-nom-l' aR Emgaalears and LL-z` 1 yors AMIDON 0 COMPANY, INC. j WOODCARVERS/SIGN MAKER S / 376 RTE. 130 P.O. BOX 681 SANDWICH, MA. 02563 (508) 888-0565 • � I Y ;z 1 LaLc,i� ��.N • .�.5� e2 i NI i l.gAC-H Ia Lj �>I-' Sf� ?4F, s ' �.Pl Nam! 4-Q lAlIpf, W,/2 ' ©F' kW44rt9', C$Zbs..4� (YA4Z-VI�Of-1 Vi`t°o4hL No ;2z :, �Xls?: -0,AC4- P+T -V.T�oX Tb �KAJ) I, �i LY FLOW(1LXIZT, -r�s n r . I WZ)s?-` A-rloN Cho I5X:IS*r. SLV 6r. t-o cATI ot,1 IMAL, 964 t,.Y it LOW S 75 Q — p►��? x � � Su # ��v7 5,4 ( hcttAL��, ( ( F-A✓PH i cAfE G(.s��flt�(X GAMoc�l 1 At,. 3 P iv i l+ A4�x4ST I, 14 B3. �C-'i'u .. i1t�(x �t L .,3 0 .. �- `t Ai L OTH�r 9- 5I T"V. .I t��MA.T a4 NC.IJ-API Q to I iir-Kll�f" •1 5 , e � �15T C-f'C��-5• �- #"'IT" �fZ.�1/Z.roC.�L7To� J �, yt'T; � X � ' � � ►d � � �Y4"'('��1 'F'�.h.f� `�`34{081 � '1�'t'� SF-�'T, 3�, _P.Xi ' t r Ott.; 1981 1�R. 'oFY ►- � MYGv� - ' Yf'� / a �n r- m + fff�J► �p`J15 1�/�(j_II�I�r ' 5 ALL >•JiEj.,l `tAt.l,. *4, o' I` .t` #+W►,t C I?�l . 1F1 S G_. '.S V-1 t�l o :.7 t'Al� I G S,f •.. "I`l=tom :_ lf�; = l5vp',�-5- 12FAAfsl Ic _ ._ ___ ..._ _.._ .._ _ ► _... I L aF w A r77c 4lAL 9RW-f,1 V, j\ or1. -J IS c( 75,�V- F. � �X I�, �r J � °; +�r�P•t�l c�., wll"fF� Tft�- �� Sia�1 r1' .. r`a- N�.ht G�F � � 1� � � c�3� " �g ' ' Y-1 P.{(y 1 G O'J •`T( f 1. V A:�447' LOCAL AMI CAW-*-+► 40 `t v MAKEPEACE 0101.1